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By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/stroke/DS00150
A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. Within minutes, brain cells begin to die.
A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications.
The good news is that strokes can be treated and prevented, and many fewer Americans die of stroke now than even 15 years ago. Better control of major stroke risk factors — high blood pressure, smoking and high cholesterol — may be responsible for the decline.
Watch for these signs and symptoms if you think you or someone else may be having a stroke. Note when your signs and symptoms begin, because the length of time they have been present may guide your treatment decisions.
- Trouble with walking. You may stumble or experience sudden dizziness, loss of balance or loss of coordination.
- Trouble with speaking and understanding. You may experience confusion. You may slur your words or have difficulty understanding speech.
- Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg, especially on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Similarly, one side of your mouth may droop when you try to smile.
- Trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.
- Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you're having a stroke.
When to see a doctor
Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Call 911 or your local emergency number right away. Every minute counts. Don't wait to see if symptoms go away. The longer a stroke goes untreated, the greater the potential for brain damage and disability. To maximize the effectiveness of evaluation and treatment, you'll need to be treated at a hospital within three hours after your first symptoms appeared. If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance.
Ischemic stroke |
A stroke occurs when the blood supply to your brain is interrupted or reduced. This deprives your brain of oxygen and nutrients, which can cause your brain cells to die. A stroke may be caused by a blocked artery (ischemic stroke) or a leaking or burst blood vessel (hemorrhagic stroke). Some people may experience a temporary disruption of blood flow through their brain (transient ischemic attack).
Ischemic stroke
About 85 percent of strokes are ischemic strokes. Ischemic strokes occur when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). The most common ischemic strokes include:
- Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot often may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions.
- Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms away from your brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus.
Hemorrhagic stroke
Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms). A less common cause of hemorrhage is the rupture of an arteriovenous malformation (AVM) — an abnormal tangle of thin-walled blood vessels, present at birth. The types of hemorrhagic stroke include:
- Intracerebral hemorrhage. In an intracerebral hemorrhage, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging brain cells. Brain cells beyond the leak are deprived of blood and damaged. High blood pressure, trauma, vascular malformations, use of blood-thinning medications and other conditions may cause intracerebral hemorrhage.
- Subarachnoid hemorrhage. In a subarachnoid hemorrhage, an artery on or near the surface of your brain bursts and spills into the space between the surface of your brain and your skull. This bleeding is often signaled by a sudden, severe headache. A subarachnoid hemorrhage is commonly caused by the rupture of an aneurysm, a small sack-shaped or berry-shaped outpouching on an artery in the brain. After the hemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow to parts of your brain.
Transient ischemic attack (TIA)
A transient ischemic attack (TIA) — also called a ministroke — is a brief episode of symptoms similar to those you'd have in a stroke. A transient ischemic attack is caused by a temporary decrease in blood supply to part of your brain. TIAs often last less than five minutes.
Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your brain. A TIA doesn't leave lasting symptoms because the blockage is temporary.
Seek emergency care even if your symptoms seem to clear up. If you've had a TIA, it means there's likely a partially blocked or narrowed artery leading to your brain, putting you at a greater risk of a full-blown stroke that could cause permanent damage later. It's not possible to tell if you're having a stroke or a TIA based only on your symptoms. Up to half of people whose symptoms appear to go away actually have had a stroke causing brain damage.
Risk factors
Many factors can increase your risk of a stroke. A number of these factors can also increase your chances of having a heart attack. Stroke risk factors include:
Potentially treatable risk factors
- High blood pressure — risk of stroke begins to increase at blood pressure readings higher than 120/80 millimeters of mercury (mm Hg). Your doctor will help you decide on a target blood pressure based on your age, whether you have diabetes and other factors.
- Cigarette smoking or exposure to secondhand smoke.
- High cholesterol — a total cholesterol level above 200 milligrams per deciliter (mg/dL), or 5.2 millimoles per liter (mmol/L).
- Diabetes.
- Being overweight or obese.
- Physical inactivity.
- Obstructive sleep apnea (a sleep disorder in which the oxygen level intermittently drops during the night).
- Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm.
- Use of some birth control pills or hormone therapies that include estrogen.
- Heavy or binge drinking.
- Use of illicit drugs such as cocaine and methamphetamines.
Other risk factors
- Personal or family history of stroke, heart attack or TIA.
- Being age 55 or older.
- Race — African-Americans have higher risk of stroke than people of other races.
- Gender — Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they are more likely to die of strokes than men.
A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain suffers a lack of blood flow and which part was affected. Complications may include:
- Paralysis or loss of muscle movement. Sometimes a lack of blood flow to the brain can cause you to become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm. This can cause difficulty with several daily activities, including walking, eating and dressing. With physical therapy, you may see improvement in muscle movement or paralysis.
- Difficulty talking or swallowing. A stroke may cause you to have less control over the way the muscles in your mouth and throat move, making it difficult for you to talk, swallow or eat. For example, some people may experience slurred speech (dysarthria), due to incoordination of muscles in your mouth. You also may have difficulty with language (aphasia), including speaking or understanding speech, reading or writing. Therapy with a speech and language pathologist may help you improve your skills.
- Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts. These complications may improve with rehabilitation therapies.
- Emotional problems. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression.
- Pain. Some people who have had strokes may have pain, numbness or other strange sensations in parts of their bodies affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm. Some people may be sensitive to temperature changes, especially extreme cold. This is called central stroke pain or central pain syndrome (CPS). This complication generally develops several weeks after a stroke, and it may improve over time. But because the pain is caused by a problem in your brain, instead of a physical injury, few medications may treat CPS.
- Changes in behavior and self-care. People who have had strokes may become more withdrawn and less social or more impulsive. They may lose the ability to care for themselves and may need a caretaker to help them with their grooming needs and daily chores.
As with any brain injury, the success of treating these complications will vary from person to person.
Preparing for your appointment
A stroke in progress is usually diagnosed in a hospital emergency room. If you're having a stroke, your care will focus on minimizing brain damage and helping you recover and avoid another stroke in the future. If you haven't yet had a stroke but you're worried about your future risk, you can discuss your concerns with your doctor at your next scheduled appointment.
What to expect from your doctor
In the emergency room, you may see an emergency medicine specialist or a doctor trained in brain conditions (neurologist), as well as nurses and medical technicians. Your emergency team's first priority will be to stabilize your symptoms and overall medical condition. Then you'll be evaluated to determine if you're having a stroke, and to find out the cause of your stroke, to determine the most appropriate treatment for your condition.
If you're seeking your doctor's advice during a scheduled appointment, your doctor will evaluate your risk factors for stroke and heart disease. Your discussion will focus on avoiding risk factors for stroke, such as not smoking or using illicit drugs. Your doctor also will discuss lifestyle strategies or medications to control high blood pressure, cholesterol and other stroke risk factors. In some cases, your doctor may recommend certain tests and procedures to better understand your risk of stroke or to treat underlying conditions that may increase your risk of stroke.
Tests and diagnosis
To determine the most appropriate treatment for your stroke, your emergency team needs to evaluate the type of stroke you're having and the areas of your brain affected by the stroke. They also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Your doctor may use several tests to determine your risk of stroke, including:
- Physical examination. Your doctor will ask you or a family member what symptoms you've been having, when they started and what you were doing when they began. Your doctor then will evaluate whether these symptoms are still present. Your doctor will want to know what medications you take and whether you have experienced any head injuries. You'll be asked about your personal and family history of heart disease, TIA or stroke. Your doctor will check your blood pressure and use a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis. Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes.
- Blood tests. You may have several blood tests, which give your care team important information such as how fast your blood clots, whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or whether you may have an infection. Your blood's clotting time and levels of sugar and key chemicals must be managed as part of your stroke care. Infections also must be treated.
- Computerized tomography (CT) scan. Brain imaging plays a key role in determining if you're having a stroke and what type of stroke you may be experiencing. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show a brain hemorrhage, tumors, strokes and other conditions. Doctors may inject a dye into your blood vessels to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography).
- Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Sometimes your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography).
- Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.
- Cerebral angiogram. In this test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.
- Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke. You sometimes may have a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached in your throat and down into your esophagus — the tube that connects the back of your mouth to your stomach. Because your esophagus is directly behind your heart, a transesophageal echocardiogram can create clear, detailed ultrasound images of your heart and any blood clots.
Treatments and drugs
Emergency treatment for stroke depends on whether you're having an ischemic stroke blocking an artery — the most common kind — or a hemorrhagic stroke involving bleeding into the brain.
Ischemic stroke
To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.
Emergency treatment with medications. Therapy with clot-busting drugs (thrombolytics) must start within 4.5 hours if they are given into the vein — and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce the complications from your stroke. You may be given:
Aspirin. Aspirin, an anti-thrombotic drug, is an immediate treatment after an ischemic stroke to reduce the likelihood of having another stroke. Aspirin prevents blood clots from forming. In the emergency room, you may be given a dose of aspirin. The dose may vary, but if you already take a daily aspirin for its blood-thinning effect, you may want to make a note of that on an emergency medical card so doctors will know if you've already taken some aspirin.
Other blood-thinning drugs, such as heparin, also may be given, but this drug isn't proven to be beneficial in the emergency setting so it's used infrequently. Clopidogrel (Plavix), warfarin (Coumadin), or aspirin in combination with extended release dipyridamole (Aggrenox) may also be used, but these aren't usually used in the emergency room setting.
- Intravenous injection of tissue plasminogen activator (TPA). Some people who are having an ischemic stroke can benefit from an injection of a recombinant tissue plasminogen activator (TPA), also called alteplase, usually given through a vein in the arm. This potent clot-busting drug needs to be given within 4.5 hours after stroke symptoms begin if it's given into the vein. This drug restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if TPA is the most appropriate treatment for you.
Emergency procedures. Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible.
- Medications delivered directly to the brain. Doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain, and then release TPA directly into the area where the stroke is occurring. The time window for this treatment is somewhat longer than for intravenous TPA but still limited.
- Mechanical clot removal. Doctors may use a catheter to maneuver a tiny device into your brain to physically grab and remove the clot.
Other procedures. To decrease your risk of having another stroke or TIA, your doctor may recommend a procedure to open up an artery that's moderately to severely narrowed by plaque. Doctors sometimes recommend these procedures to prevent a stroke. Options may include:
- Carotid endarterectomy. In a carotid endarterectomy, a surgeon removes fatty deposits (plaques) from your carotid arteries that run along each side of your neck to your brain. In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery, and removes fatty deposits (plaques) that block the carotid artery. Your surgeon then repairs the artery with stitches or a patch made with a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke. However, a carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
- Angioplasty and stents. In an angioplasty, a surgeon inserts a catheter with a mesh tube (stent) and balloon on the tip into an artery in your groin and guides it to the blocked carotid artery in your neck. Your surgeon inflates the balloon in the narrowed artery and inserts a mesh tube (stent) into the opening to keep your artery from becoming narrowed after the procedure.
Hemorrhagic stroke
Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain. Surgery also may be used to help reduce future risk.
Emergency measures. If you take warfarin (Coumadin) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract their effects. You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure or prevent seizures. People having a hemorrhagic stroke can't be given clot-busters such as aspirin and TPA, because these drugs may worsen bleeding.
Once the bleeding in your brain stops, treatment usually involves bed rest and supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, surgery may be used in certain cases to remove the blood and relieve pressure on the brain.
Surgical blood vessel repair. Surgery may be used to repair certain blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if you're at high risk of a spontaneous aneurysm or arteriovenous malformation (AVM) rupture:
- Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.
- Coiling (endovascular embolization). In this procedure, a surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Your surgeon then guides tiny detachable coils into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot.
- Surgical AVM removal. Surgeons may remove a smaller AVM if it's located in an accessible area of your brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM if it's too large or if it's located deep within your brain.
Stroke recovery and rehabilitation
Following emergency treatment, stroke care focuses on helping you regain your strength, recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged. If your stroke affected the right side of your brain, your movement and sensation on the left side of your body may be affected. If your stroke damaged the brain tissue on the left side of your brain, your movement and sensation on the right side of your body may be affected. Brain damage to the left side of your brain may cause speech and language disorders. In addition, if you've had a stroke, you may have problems with breathing, swallowing, balancing and vision.
Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and your degree of disability from your stroke. Your doctor will take into consideration your lifestyle, interests and priorities, and availability of family members or other caregivers.
Your rehabilitation program may begin before you leave the hospital. It may continue in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home.
Every person's stroke recovery is different. Depending on your condition, your treatment team may include:
- Doctor trained in brain conditions (neurologist)
- Rehabilitation doctor (physiatrist)
- Nurse
- Dietitian
- Physical therapist
- Occupational therapist
- Recreational therapist
- Speech therapist
- Social worker
- Case manager
- Psychologist or psychiatrist
- Chaplain
Coping and support
A stroke is a life-changing event that can affect your emotional well-being as much as your physical function. You may experience feelings of helplessness, frustration, depression and apathy. You may also have mood changes and a diminished sex drive.
Maintaining your self-esteem, connections to others and interest in the world are essential parts of your recovery. Several strategies may help both you and your caregivers, including:
- Don't be hard on yourself. Accept that physical and emotional recovery will involve tough work, and it will take time. Aim for a "new normal," and celebrate your progress. Allow time for rest.
- Get out of the house even if it's hard. Try not to be discouraged or self-conscious if you move slowly and need a cane, walker or wheelchair to get around. Getting out is good for you.
- Join a support group. Meeting with others who are coping with a stroke lets you get out and share experiences, exchange information, and forge new friendships.
- Let friends and family know what you need. People may want to help, but they may not know how to help. Let them know that you would like them to bring over a meal and stay to eat with you and talk, or to go out to lunch with you, or attend social events or church activities.
- Know that you are not alone. Nearly 800,000 Americans have a stroke every year. Approximately every 40 seconds someone has a stroke in the United States.
Communication challenges
One of the most frustrating effects of stroke is that it can affect your speech and language. Here are some tips to help both stroke survivors and caregivers cope with communication challenges:
- Practice will help. Try to have a conversation at least once a day. It will help you learn what works best for you, feel connected and rebuild your confidence.
- Relax and take your time. Talking may be easiest and most enjoyable in a relaxing situation when you have plenty of time. Some stroke survivors find that after dinner is a good time.
- Say it your way. When you're recovering from a stroke, you may need to use fewer words, rely on gestures or rely on your tone of voice to communicate.
- Use props and communication aids. You may find it helpful to use cue cards showing frequently used words, pictures of close friends and family members, or daily activities, such as a favorite television show or the bathroom.
Knowing your stroke risk factors, following your doctor's recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If you've had a stroke or a TIA, these measures may help you avoid having another stroke. Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:
- Controlling high blood pressure (hypertension). One of the most important things you can do to reduce your stroke risk is to keep your blood pressure under control. If you've had a stroke, lowering your blood pressure can help prevent a subsequent transient ischemic attack or stroke. Exercising, managing stress, maintaining a healthy weight, and limiting the amount of sodium and alcohol you eat and drink are all ways to keep high blood pressure in check. Adding more potassium to your diet also may help. In addition to recommending lifestyle changes, your doctor may prescribe medications to treat high blood pressure.
- Lowering the amount of cholesterol and saturated fat in your diet. Eating less cholesterol and fat, especially saturated fat and trans fats, may reduce the plaque in your arteries. If you can't control your cholesterol through dietary changes alone, your doctor may prescribe a cholesterol-lowering medication.
- Quitting tobacco use. Smoking raises the risk of stroke for both the smoker and nonsmokers exposed to secondhand smoke. Quitting tobacco use reduces your risk of stroke.
- Controlling diabetes. You can manage diabetes with diet, exercise, weight control and medication.
- Maintaining a healthy weight. Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease and diabetes. Weight loss of as little as 10 pounds may lower your blood pressure and improve your cholesterol levels.
- Eating a diet rich in fruits and vegetables. A diet containing five or more daily servings of fruits or vegetables may reduce your risk of stroke.
- Exercising regularly. Aerobic exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your level of high-density lipoprotein (HDL, or "good") cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.
- Drinking alcohol in moderation, if at all. Alcohol can be both a risk factor and a preventive measure for stroke. Heavy alcohol consumption increases your risk of high blood pressure, ischemic strokes and hemorrhagic strokes. However, drinking small to moderate amounts of alcohol may help prevent ischemic stroke and decrease your blood's clotting tendency.
- Treat obstructive sleep apnea, if present. Your doctor may recommend an overnight oxygen assessment to screen for obstructive sleep apnea (OSA). If OSA is detected, it may be treated by giving you oxygen at night or having you wear a small device in your mouth.
- Avoiding illicit drugs. Certain street drugs, such as cocaine and methamphetamines, are established risk factors for a TIA or a stroke. Cocaine reduces blood flow and can cause narrowing of arteries.
Preventive medications
If you've had an ischemic stroke or TIA, your doctor may recommend medications to help reduce your risk of having another stroke. These include:
Anti-platelet drugs. Platelets are cells in your blood that initiate clots. Anti-platelet drugs make these cells less sticky and less likely to clot. The most frequently used anti-platelet medication is aspirin. Your doctor can help you determine the right dose of aspirin for you.
Your doctor may also consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce the risk of blood clotting. If aspirin doesn't prevent your TIA or stroke, or if you can't take aspirin, your doctor may instead prescribe an anti-platelet drug such as clopidogrel (Plavix).
Anticoagulants. These drugs, which include heparin and warfarin (Coumadin), reduce blood clotting. Heparin is fast acting and may be used over a short period of time in the hospital. Slower acting warfarin may be used over a longer term.
Warfarin is a powerful blood-thinning drug, so you'll need to take it exactly as directed and watch for side effects. Your doctor may prescribe these drugs if you have certain blood-clotting disorders, certain arterial abnormalities, an abnormal heart rhythm or other heart problems. Other newer blood thinners may be used if your TIA or stroke was caused by an abnormal heart rhythm.
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Presented to:
James Goldberg
Prodigal Son
"For I am come to set a man at variance against his father. . . and a man's foes shall be of they of his own household. He that loveth father and mother more then me, shall not be worthy of me." In Matthew chapter 10, Christ says this, our loving savior says this difficult and terrible thing, lays out bluntly in somber prophecy, a possible grim consequence of conversion. We would rather not believe him. We would rather believe that conversion and familial bonds strengthen each other, that love transcends and smoothes over even the most deeply seated differences. James Goldberg's play Prodigal Son unerringly and compassionately shows just how rocky the path to conversion can be for even the most loving families. A single father, utterly devoted to his son, a brilliant and thoughtful and damaged man. A son, committed to honoring a father completely worthy his respect, but also committed, fully and completely, to a new revelation. Goldberg's play takes these two superbly drawn characters, and sets them at odds with a compassion and intelligence that earns and rewards every moment of an audience's rapt attention. The play never once vilifies the agnostic father, and never takes the easy way out, suggesting his eventual conversion and testimony. The play shows us two proud, smart men, who will never agree and who will never stop loving each other. A hopeless situation, perhaps, but the play is full of hope as well, and the possibility of redemption and transcendence. For this extraordinary dramatic achievement, the Association for Mormon Letters is proud to honor James Goldberg's Prodigal Son.

subset: commoncrawl


text: O Jeff Neumann on Gawker Fighting dirty Road Rage Diapers Pennsylvania Shit Babies 8/10/10 5:19am 8/10/10 5:19am Edit5,669g165LEShare to KinjajFacebookiTwitterkTumblrK New Mom Road Rage: The Dirty Diaper Windshield SmearSA road rage incident flared up Saturday as two cars were leaving the Fayette County Fair in Pennsylvania, prompting one driver to grab her kid's dirty diaper and smear it across the back window of her adversary's car. Classy! [AP] LDiscuss


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Kids Bedding
Girls Bedding
Boys Bedding
Kids Sheet Sets
Crib Bedding
Girls Crib Bedding
Boys Crib Bedding
Crib Sheets
Baby Blankets & Swaddling Blankets
Kids Pillow Shams
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Children's Decorative Pillows
Kids Bed Skirts
Kids Throw Blankets
Crib Bedding Accessories
Cradle and Bassinet Bedding
Moses Baskets
Toddler Bedding
Canopy Bedding
Kids Window Treatments
Fabric Shop
Mattresses & Foundations
Kids Bedding Designers
Girls Pillow Shams
Boys Pillow Shams
Girls Decorative Pillows
Boys Decorative Pillows
Girls Cradle & Bassinet Bedding
Boys Cradle & Bassinet Bedding
Baby Toile Pink Toddler Bedding by Doodlefish Traditional and elegant this soft baby pink toile with cream accents is gorgeous! Add the toddler coverlet and pillow to your existing crib skirt and sheet and go from nursery to "big kid" room without changing your room decor. This toddler bedding set includes a reversible coverlet and pillow sham with insert. Sheets, blanket, bed skirt, pillows and window valances are available separately. Pink Baby Toile Bedding is custom made especially for you upon order. Doodlefish offers drapery panels as rod-pocket or rod-pocket with a 3" header in 84" and 96" lengths. Drapery panels measure 50" wide and are available in any Doodlefish fabric (please indicate your fabric choice below). Coordinating valances are available in two standard widths, a perfect fit for today's most common window sizes. Single width valances are 42" wide with an 18" drop and fit windows 30" to 40" wide. Double width valances are 80" wide with an 18" drop and fit windows 70" to 80" wide. Custom widths are also available upon request. Please remember to measure from the outside moulding to the other outside moulding of your window. All window treatments are fully lined with traditional white backing.
Category: Bedding, Toddler Bedding
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text: In the beautiful town of Bristol, you will find a grand place. It was originally the summer residence of the prominent Colt family and has been transformed to a park which offers picnic sites, walking trail, beach, tennis courts, skateboard park, swings and hosts soccer games. One can park their vehicle and stroll a waterfront path which has beautiful views... More


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You may also like
Algarve 4-Pc Sofa Set by Zuo Modern
The Algarve 4 Piece Sofa Set brings all of the style and comfort of home outdoors. Its square shape and cutouts give this Set a contemporary feel that keeps consistent with the style of your modern home. The Algarve Sofa's Cushions are both comfortable and water resistant, making this modern sofa ideal for relaxing outdoors. The Algarve Coffee Table with its aluminum frame makes this modern coffee table sturdy, and its UV protected synthetic weave gives it lasting style.
This Set includes 1 Sofa, 2 Armchairs and 1 Coffee Table.
- Aluminum Frame
- Tempered Glass Top
- Water Resistant Cushions
- UV Protected Synthetic Weave
- Suitable for Residential and Commercial
- Side Table is Not Included
- Ships Via Freight
- Sofa Size - 55" W x 30" D x 29" H
- Armchair Size - 31.5" W x 30" D x 29" H
- Seat Height - 18.5" H
- Coffee Table Size - 47.2" W x 17.7" D x 19.3" H
- Modern,
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Posted: Nov 22, 2012 7:52 PM by Associated Press
SOUTH LAKE TAHOE, Calif. (AP) - The former owner of a South Lake Tahoe medical marijuana dispensary has been indicted on drug charges.
A federal grand jury on Wednesday indicted Gino DiMatteo on charges of conspiracy to manufacture at least 1,000 marijuana plants, possession with intent to distribute marijuana and manufacturing at least 100 marijuana plants.
The Tahoe Daily Tribune reports (http://bit.ly/10moSlJ ) that court documents allege DeMatteo committed the crimes after being convicted of felony conspiracy to distribute marijuana in New York in 2002.
His attorney, Robert Woelfel, didn't immediately return a call for comment.
The 43-year-old DeMatteo remained in custody at the Sacramento, Calif., jail.
DeMatteo's City of Angels II collective closed this summer after his landlord sought his ouster and city officials would not allow him to move his operation.
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Library-Museum Partnerships: Oh, the places you'll go!
Libraries and museums share common missions—to engage communities in lifelong learning, cultural enrichment, civic conversations, information resources, and gathering as neighbors. Sharing so many goals makes libraries and museums excellent partners that together can more fully support and engage their communities. Join in this interactive CSL in Session to explore and discuss the many possibilities of how museums and libraries can collaborate—and why they should. From programs for kids to digitization projects, share your ideas and learn new ones from fellow attendees from both libraries and museums in this lively online forum, and come out with a list of first steps to take in creating or strengthening a partnership with a library or museum in your community.
Library-Museum Partnerships: Oh, the places you'll go!
Libraries and museums share common missions—to engage communities in lifelong learning, cultural enrichment, civic conversations, information resources, and gathering as neighbors. Sharing so many goals makes libraries and museums excellent partners that together can more fully support and engage their communities. Join in this interactive CSL in Session to explore and discuss the many possibilities of how museums and libraries can collaborate—and why they should. From programs for kids to digitization projects, share your ideas and learn new ones from fellow attendees from both libraries and museums in this lively online forum, and come out with a list of first steps to take in creating or strengthening a partnership with a library or museum in your community.
Building Social Capital to Enhance Collaboration
Typically when people think about social capital, it is associations, networks and relationships that result in a gain. I believe that organizations tend to build partners with those who are similar (bonding social capital) instead of bridging, another form of social capital with those who are different. In this workshop, participants will learn more about social capital and how to leverage networks that can increase program partners and potential funders.
- The definition of social capital and the differences between bridging and bonding
- Networks that can increase program partners and potential funders
Localize, Mobilize, and Spotlight Your Library Services and Outreach
A practical webinar looking at a variety of ways libraries can increase their impact and reach in their communities using mobile technology, social networking, and integration with the consumer services users already use.
Libraries play a critical role in their communities that goes beyond their collections, focusing on events, outreach and library as place. In an increasingly digital and mobile world, libraries need new ways to reach out and engage. Now with the new OCLC Library Spotlight program (www.worldcat.org/spotlight), you can set up a dynamic mobile view of your library and dramatically extend its visibility into many popular web services—in just 10 minutes. Learn about this free service, available to all, that will make it easier for your library to be found on the web and through highly trafficked services like Yelp. Hear how one library focused its messaging and engagement through coordinated efforts at a local level to maximize their web presence and reach.
Libraries, Children and Families: new research and policy recommendations on role of libraries in early reading
A webinar discussing recent Pew research and an IMLS policy report focused on the role and impact of libraries on the lives of early reading development.
The importance of early childhood education was underscored by President Obama in his most recent State of the Union address: "Study after study shows that the sooner a child begins learning, the better he or she does down the road." Join us to hear Susan Hildreth, director of the Institute of Museum and Library Services, present on a recent report, Growing Young Minds, developed with the Campaign for Grade-level Reading, that highlights the role of libraries in early learning. The report also offers a plan of action for policy makers to build on current research and include libraries in early learning strategies. Attendees will learn about best practices for enhancing reading programs and how to participate in your community's efforts to address literacy concerns. In addition, Lee Rainie, director of the Pew Research Center's Internet & American Life Project, will describe the Project's newly released report about the special role that libraries play in the life of families with children. Attendees will learn what matters to parents about their library experiences with their children, and how library programs and outreach can address those needs.
Events for (Almost) Everyone
Events can be an excellent way to connect with patrons, volunteers, your partnering organizations, and your surrounding neighborhood. They build good will, educate about your services, and add to your list of annual successes. This presentation will share the rudiments of low- or no-cost events for which the idea and spirit behind them are as important as the successful execution.
Community Led Library Service Development
- Do you want to find a way to provide public library services needed and wanted by diverse community sectors—without adding projects or increasing budget?
- Do you believe the library can play and important role in community members' civic engagement?
- How do you determine what staff should be doing in order to offer the best library services for your community?
Community-led service development has a long history in British public libraries and a nearly decade-long track record in Canada. Instead of adding projects or tasks to library staff in an effort to promote library services, the community-led approach establishes the library staff as trained listeners and brokers of awareness to provide service development for both marginalized and comfortable community sectors.
The community-led approach helps the library to identify which traditional library roles are now redundant, and thus of little worth to the community, allowing both professional library staff and support staff to concentrate on those services that are meaningful to the public. Community-led service development allows both the community and its library staff to grow, become engaged in the civic sphere they share and find the best venues for individuals to pursue their aspirations for their primary needs of health and welfare, as well as life-long learning and the support of personal values.
At the end of this one-hour webinar, participants will:
- Be able to identify the key aspects of community-led service development that differentiate it from traditional outreach and/or customer service approaches.
- Be prepared to identify and research model community-led public library service providers that match your library's size and staffing levels.
- Be able to determine whether community-led library service development can improve your local library's potential as a civic service agency.
- Understand and be able to communicate to public library stakeholders the major issues associated with the community-led service development approach – including training, tax support, and mission realization.
Support Patron Learning in Small Spaces with Small Budgets
This webinar will showcase how small and rural libraries can provide effective training to patrons even with limited staff, resources, or space.
In small communities, libraries can often be the only provider of free public access to technology and the internet. And as more people turn to their library to learn technology skills, even the tiniest of libraries are faced with the challenge of providing training to patrons with limited staff, resources, and space. Learn from small and rural libraries who are making training a reality for their patrons, using volunteers, leveraging partnerships and integrating learning into everyday interactions. Whether the technology training you do (or want to do) is one-to-one, on-the-fly or a more formal program, this session will include tips and suggestions for improving the effectiveness of the training you provide. This webinar is hosted in collaboration with TechSoup for Libraries and the Association for Rural and Small Libraries.
Telling the Right Story for Your Online Campaign
Pink Slime. The Boy Scouts of America. Trayvon Martin. Each of these news stories started with an online petition that led to real, tangible impact. Each represents the power that people and organizations have today to engage and motivate hundreds and thousands of supporters to take action. The internet, social networks and mobile technology provide an unprecedented opportunity to increase the efficiency and impact of the time proven model of collective action, but you still need a story. Learn lessons from Change.org about how to not only tell a good story, but how to tell the right story.
- Key elements of online campaigns that tell an engaging story for your cause, campaign or organization
- How to tell the right story to align with your campaign strategies and meet your objectives
- Overview of tactics to motivate supporters and create the biggest impact with your story, such as online petitions, social media, email, SMS, etc.
Crowdfunding: Not just for first-world problems
Sometimes it seems like crowdfunding is just for new digital devices, iPhone covers and games. But crowdfunding can be used a powerful tool for social change! Whether you're an established non-profit or a social start-up crowdfunding can help you activate and expand your supporter base and maximise your fundraising to make a difference.
This webinar will introduce you to both the theory and practice of crowd funding, dispelling misconceptions, exploring case-studies and giving attendees the knowledge they need to utilize this new fundraising form in the pursuit of their social mission.
- A clear understanding of how crowdfunding works.
- An overview of the main platforms and how to choose the one that's right for you.
- What motivates people to give to crowdfunding campaigns, and what holds them back.
- Knowledge of what makes for good crowdfunding rewards and the role video plays.
- How long a crowdfunding campaign should be and how much can you raise.


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In Persuit of Perfection - Japanese Whisky @ Camp Whiskey
Time: 8- 9:30pm
Location: Williamsburg
Fee: $40 (cash or charge)
Please RSVP to firstname.lastname@example.com
Camp Whiskey is a project committed to bringing together our whiskey community with the best that New York City in the summer has to offer. It is hosted by Jeff Galli (Char No. 4), Jonathan Wingo (The Whiskey Shop) and Gary He (bon vivant).
The whiskeys that we choose are the whiskeys that we love to drink, have been dying to try, and are most excited to share with you. Many expressions are unavailable in the US and will be sourced from Scotland, Ireland, Japan and beyond. Each week's program will center on a different style of whiskey.
Most of all, Camp Whiskey will create an informal atmosphere in some spectacular Brooklyn locations to taste, learn, and just relax.
About the Camp Counselors
Jeff Galli has been behind the bar at Char No. 4 (Brooklyn) since it opened in 2008. In that time, he's had the opportunity to learn from whiskey greats such as Dave Broom, Dr. Bill Lumsden, and Fred Noe. In the distilling world, he's worked with Nicole Austin at King's County Distillery, testing new recipes, and consulting on blend and barrel readiness as well as Nick Cowles, making apple brandy on a food fired still in Vermont. Last year Jeff was a judge at the New York Independent Spirits Competition. But perhaps he's best known for the bottle of OGD114 that accompanies him, like a calling card, to important social events.
Jonathan Wingo runs The Whiskey Shop, a boutique liquor store focusing in American craft whiskeys, in Williamsburg, Brooklyn. After a fortuitous run of press write-ups for the shop, he was lucky enough to be chosen as a member of Forbes 30 Under 30 to watch in the Food and Beverage category. He conducts whiskey classes and private tastings. In his free time, he flirts with his favorite American craft distillers, and distills a bit.


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Utah Valley University
Policies and Procedures
Title | Sick Leave Pool | Number | 355 |
Section | Human Resources | Approval Date | Feb 11,1999 |
Subsection | Compensation and Benefits | Effective Date | Feb 11,1999 |
I. Policy
- The institution will establish on an as needed basis a reserve or pool of sick leave days to be used by full-time salaried employees. Contributions to the pool will be voluntary only. Draws from the pool will be permitted only in serious/catastrophic cases.
An employee may not use any combination of his/her own sick leave and the sick leave pool longer than five months without applying for Long Term Disability and Social Security Disability.
II. Procedures
- This pool is to be generated for a specific inpidual employee at the time of need, strictly on a volunteer basis.
- An employee desiring to contribute to this pool must:
- Turn in a short term leave slip.
- In the comments section, explain that the sick leave is to go into a specific employee's pool.
- Such contributions will be accumulated on a leave record entitled "sick leave pool" to be maintained in Human Resources.
- The leave slips will be treated as regular leave slips as far as deductions from employees' records are concerned.
- Leave will be used on a first in, first used, basis. All unused leave will be credited back to the appropriate employee.
- An employee desiring to draw on the established pool must turn in leave slips as he or she normally would, including the signature of the immediate supervisor, and an indication in the comment section that the leave is requested from an established pool.
- The request will be granted subject to:
- The employee having exhausted his or her own available sick leave,
- Availability of days in the pool, and
- An administrative determination by the Department Head in consultation with the Director, Human Resources that the case is serious/catastrophic.
- All regular procedures must be followed in connection with donating slips and withdrawal slips.


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Inventors have struggled for years to create displays that can conjure vivid three-dimensional images that users can manipulate and interact with. Chemists could exploit such marvels to design new drug molecules. Oil and gas explorers could see exactly where to aim their drills. Surgeons could pass probes or radiation beams through the collated slices of diagnostic data produced by magnetic resonance imaging (MRI) and computed tomography (CT) machines to test procedures before performing an operation. But shortcomings such as a flickering image, a narrow angle of view or the need to wear special glasses have bedeviled the devices.
Two companies have recently mixed their own technology with off-the-shelf components, including the Digital Light Processor (DLP) chip from Texas Instruments, to create interactive systems called 3-D volumetric displays that overcome these limitations. The two firms' products are just now transitioning from the laboratory to commercial models.
This article was originally published with the title Seeing Triple.
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The Federal Government will Become America's Model Employer for the 21st Century.
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Visit this federal site to search for our regulatory notices, proposed and final rules.
You may elect Option B insurance in an amount equal to one, two, three, four or five times your annual basic pay (after rounding up to the next even $1,000).
The cost of Option B insurance depends on your age. When you have a birthday that moves you to another age group, you will begin paying the premiums for the new age group in the first pay period that starts after your birthday. The premiums increase depending on your age group, as shown in the following table:


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11-06-2012, 09:20 AM | #1 (permalink) |
Join Date: Jan 2012
Posts: 82
FS: 2012 Rome 390 Boss L/XL White Bindings
I have my like new 2012 Rome 390 Boss bindings for sale. I only rode these bindings once this year, and you can tell. They are 9.5/10 cosmetically, aside from the below picture of a paint chip on the back heelcup of the right foot binding. Looking to get $115 for them. Comes with original box and all included accessories (canting pads, mouting hardware, stomp-pad, leash, etc). Selling because I bought Flow NX2-AT's because I wanted to try rear-entry this season and the wife wont let me keep both, lol!
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11-07-2012, 08:40 PM | #5 (permalink) |
Join Date: Jan 2012
Posts: 82
I only got one day on it due to the horrible "snow" here on the east coast, but it gave me a chance to get the Magnetraction benefit. Edge hold was great and board was super fast. I loved it, but take it with a grain of salt. Only 1 day on it, but what I've seen I like a lot.
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text: The National Aquarium, with its breathtaking views of the Baltimore Inner Harbor and five levels of award-winning exhibits, provides a magical and memorable backdrop for your special occasion. Whether outside or in, spacious locations are available for as few as five guests or as many as 3,000, making the Aquarium the ideal place for weddings, corporate events, meetings, team-building outings, fundraising galas, holiday parties—whatever you are celebrating! Unique options, like a private film screening in the 4D Immersion Theater or a dive presentation, provide an experience your guests won't soon forget. Our professional staff is ready to assist you in planning your event. A Greener Way to Celebrate When you hold your special event at the National Aquarium, a portion of your fee supports conservation education programs. Hosting a green event has never been so elegant—or so easy! From compostable serving ware to sustainable menu selections, events at the National Aquarium are eco-friendly from start to finish. Back to the Top


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PyX — Python graphics package
PyX is a Python package for the creation of PostScript and PDF files. It combines an abstraction of the PostScript drawing model with a TeX/LaTeX interface. Complex tasks like 2d and 3d plots in publication-ready quality are built out of these primitives.
- PostScript and PDF output for device independent, freely scalable figures
- seamless TeX/LaTeX integration
- full access to PostScript features like paths, linestyles, fill patterns, transformations, clipping, bitmap inclusion, etc.
- advanced geometric operations on paths like intersections, transformations, splitting, smoothing, etc.
- sophisticated graph generation: modular design, pluggable axes, axes partitioning based on rational number arithmetics, flexible graph styles, etc.
Status and Availability
PyX is in steady development. Planned features are listed on the roadmap. The current release, PyX 0.12.1, is available at the download section of the SourceForge project page.
- 2012-10-26: PyX 0.12.1 released
- This release fixes drawing bugs in the gradient style for the recently introduced key graph.
- 2012-10-17: PyX 0.12 released
- This release adds a density graph style to create density plots. The color scale is shown by a separate key graph. The key graph feature has been integrated in existing styles where appropriate, like the 3d surface style. A rather large set of other additions and bug fixes all over the place completes this release.
For a full record of all news consult the news page.
Authors and License
PyX is written by Jörg Lehmann, Michael Schindler, and André Wobst. PyX is free software licensed under the GNU GPL Version 2 or (at your option) any later version. Other licensing schemes might be available upon request. Refer to the license page for further information.
The authors kindly acknowledge financial support from the German Speaking TeX User Group DANTE e.V.


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Whenever I mentioned I was going to Hiroshima, EVERYONE would ask, "Are you going to Miyajima too? You MUST go!" The more I looked into it, the more I realized they were right. Miyajima is considered one of the top 3 most beautiful places in Japan.
- Sunday 9:30am Leave hotel for Miyajima after breakfast
- Hiroshima Stn to Miyajimaguchi (400 yen/person) 25 min by JR Train
- Miyajima Port (170 yen/person) 10 min by Ferry
- Sightsee & Lunch
- Last Ferry from Miyajima is 22:14 we left at 18:00
Once upon a time, when Cliff and I were still dating, we used to have fun on trips. Somewhere along the trip of our lives, traveling with Cliff has just about become unbearable to me. He never walks with us, he always acts like he's on some business trip by himself, he complains constantly and he is picky as to where and what he eats. I go into "vacation mode" and ergo his otherwise "normal" behaviour becomes even more intolerable to me because I feel like our time together as a family is so precious. So, the net result is I turn into one snarky bitch which in turn turns Cliff into even more of a party and poor Chase has to witness his parents acting like imbeciles. So on Sunday morning, before we even had breakfast, I declared I would be on my best behaviour.
At Hiroshima Station, get to the JR side (remember you need to use the underground tunnel through the station). Purchase tickets (400 yen/person) to use the train to get to Miyajimaguchi (literally means the mouth of Miyaguchi). From the Miyaguchi Station, walk straight out and follow the herd to the port. There are plenty of signs and it is a short straight shot (you may have to walk underground to avoid traffic).
Amazing landscapes, autumn colors, floating shrine, oysters, rice paddles and wild deer are just a few of the many things you can look forward to in Miyajima:
I was immediately charmed by this little island which in and of itself is a community/town. I don't know why I was so surprised. I just thought it would be like another seasonal fair but it's a real town with residents. You can rent bikes to get around, but we opted to walk. The tide was still high enough at that point, so we were able to take a boat ride to the floating torii:
Even though the guide was talking completely in Japanese, we had a great time just watching everyone in these hats and who could be in a bad mood in a boat on a lovely day?
Miyajima Ropeway:
FYI: Getting anywhere on Myajima feels like a hike. The great news is it's absolutely beautiful. There are trails and bridges and ponds and wildlife all around you. I was excited to take the ropeway which is actually a gondola (think ski lift/gondola) up to the highest peak on the island. It takes you to the shrine of a famous monk who supposedly showed the good people of Miyajima "The Way". When we got to the top, it was around lunchtime, but there is only 1 cafe and you can only order a couple of dishes from a vending machine. We didn't want to waste our appetites on that mess, so we ended up placating Chase and ourselves with a few popsicles until we could get back to the main area and get some "real" food. Despite the long-ass-practically-vertical climb to the top, we did have a good photo-op:
Once we returned to the village, I couldn't wait to get my bag of chestnuts and rice-cake-on-a-stick! They also had a bunch of other options:
Chase and I would have been completely happy eating some more street food, but Cliff won't do it. So I had to stop so we could go and eat in a restaurant. Still good food. Miyajima is surrounded by oysters, so that's also something you need to try. The oysters are meaty & delicious!
With our bellies full, Chase somehow found a gaming area where you could either shoot targets or toss rings for cheap prizes. He LOVES these opportunities. I made Cliff be his audience while I shopped for rice paddles:
My shopping was interrupted by a small crowd oohing & ahhhing outside my shop. I looked outside only to find my son and husband in the middle of this crowd, guns poised and a pile of cheap toys in front of them. I felt like "The Mom" as I stood akimbo and interrupted this carnival party with, "What is going on here?!?"
Evidently, Cliff realized early on that the displays were rigged and he schemed with Chase to shoot siultaneously at 1 target to take it down. They would wait for the game manager to turn around so she couldn't see what they were doing. Seeing the pure glee mixed with crazy in their eyes and the fact that they were actually bonding and having fun enabled me to just shake my head and walk back to my paddles smiling. Good for them, I thought.
Chase would not be outdone by our cartoon antics on the mountain so when he had his opportunity, he took it:
By the time we got ready to head back on the ferry it was about 6:00pm. Despite spending all day on the island, as we walked back I realized we hadn't even seen half of the island. There was a whole other section we forgot about at the dockside! It was an amazing day for our family. Everyone behaved. All the way back to the hotel, Chase kept going back and forth between Cliff and me hugging us and telling us, "Thank you" and what a great time he had. Even though we were tired physically, I feel like our souls were rejuvenated.
Until next time…
October 24th We go to Korea!


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Talavera Cocina Mexicana
Online Reservations
Yummy margaritas and great hot spicy salsas. Will definitely be back!
The food was good, we had the fish ceviche very fresh. My friends had a dish with mole that was quite good. I had the filet, it was interesting but next time I will stick to the more traditional dishes. Nice place for a celebration. They also have a restaurant in the grove Jaguar that is quite good.
This past visit, I treated two friends to dinner and we had a great time. My friends had never been there before and they loved it. I will definitely return and continue to bring new customers, because I have never been disappointed. Their food is so heavenly, it's indescribable, though that doesn't stop you from trying to articulate the complexities to the moles and various other dishes. I look forward to the next time that I get to go.
The waiter took time to explain some of the items on the menu and also made recommendations. Service was attentive and timely, and the food was excellent. I will return.
The overall experience was excellent with a party of 10. However at the end of the meal, I requested a lemonade to go (which was fantastic) and the waiter felt the need to tell me that I would be charged for it which was a bit offensive. The service from Marvin Vasquez/Assistant Manager was awesome and ultimately I would recommend this restaurant and attend again.
A mix of traditional and newer dishes that are to die for! Basically fantastic food with fantastic drinks.
My wife took me to Talavera on Friday evening for an early Father's Day celebration, and we both agreed she made a wise choice. We had the $29 Coral Gables Restaurant Week pris fixe menu with appetizer, entrée, and dessert, all of which were very good. She decided her margarita was the best she has ever had. Service was efficient and friendly without being obtrusive, and a number of employees not directly involved in serving us smiled and spoke pleasantly at various times. We were not halfway through the meal when we both said that this is definitely a place we will come again.
Great place to get real Mexican food. Wonderful home style cooking with excellent service.
I went with a group of girls and we had a great time. The mariachis were very good.
The food was great and the service exceptional. My husband had the tacos which were delish. I tried the Miami Spice which was the tenderloin. The guacamole was one of the best I have had. A must go!
Everything about our visit was great, including the food, ambiance and friendly server. However, the hostess was not only rude but had us wait over 25 minutes despite the fact that we had reserved through Open Table. This was a terrible beginning to an otherwise enjoyable dinner.
Finally found a good Mexican restaurant in the Miami area. Miami has great Caribbean, Central American and South American restaurants, but not high quality Mexican restaurants. Talavera has a great menu selection and offers genuine Mexican dishes. Although the hostess was not very personable, our waitress was very friendly and attentive. She really took care of our table. We started with a couple of great tasting tequila shots - which were enormous, by the way. The Ceviche was really a fine ceviche. We proceeded with various main dishes: huachinango, carnitas, arranchera... What a treat. We ended our culinary experience with a guava cheesecake: delicious!
When I arrived at Talavera the hostess was very helpful. She told me there were no tables left, therefore I'd have to sit outside, but I mentioned I had made a reservation online and she quickly found me one last table inside. The food was delicious. I had the shrimp ceviche and the Talavera steak. The steak was flavorful and perfectly cooked! Good experience. I'd definitely go back again!
Food was truly great. Margaritas were strong and good
Had a wonderful dinner,. Food delicious. One our our favorites.
Being myself raised by Mexicans I know what real Mexican food is, and Talavera really has it! They accomplish great Mexican food.
Talavera Cocina Mexicana in Coral Gables,FL is exquisite.They impressed me in every aspect of their operation (beautiful decor,immaculate appearance,wonderful ambiance,large portions,authentically-spiced Mexican fare,and a professional bar/wait staff).I rate them at 5-stars.My server,Erixon,did an awesome job.I chose the RED SANGRIA as my beverage.It proved to be so perfectly balanced that I ordered a second glass.My appetizer,GUACAMOLE,was the best I've ever had.My entree,CHILE RELLENO(roasted poblano pepper stuffed w/Oaxaca cheese,served w/grilled zucchini and white rice)was scrumptious,and such a large portion!Dessert,CREPAS DE CAJETA(crepes topped w/Mexican style caramel and topped w/walnuts) was decadently rich. BRAVO Talavera, BRAVO !
First time we go and we can tell you the margaritas and huaraches were awesome! The enfrijoladas were ok....chicken on the dry side. Que fundido....to dye for! I can tell you, we will go back again.
This place has some great dishes that are different than your standard Mexican restaurant fare, and they are all delicious. The Mexican chocolate Poblano Mole dishes are delicious. Guacamole is homemade and very tasty. I make a point of eating here whenever I visit Miami.
Authentic Mexican Cuisine in Coral Gables!You can immediately tell the difference between Tex-Mex dishes and the dishes offered at Talavera.The ingredients they use are wonderfully fresh,and the herbs and spices they use are vividly tantalizing.This was my 2nd time dining at Tavalera (once for lunch, and this time for dinner),but I'm sure I'll be back again.The portions are so large that I had to take some of my meal home with me, and the food was so delicious that I wished that I could've sampled every item on the menu.The restaurant's decor is very unique."Talavera" is a style of pottery,and you will see huge urns and vases in the Talavera style which create an artistic atmosphere.My server,Vanesa V.,was awesome. I love Talavera! BRAVO!!
I have a number of business related lunches and dinners and need a restaurant which can provide a memorable feel...not only for the meeting content but also to make the client feel special. This is a super venue to meet those criteria...the service is wonderful, the menu varied with items that you can't get at other restaurants....I highly recommend the Talavera!!
I came to Talaveras to enjoy some drinks with friends, decided to go earlier and try the food. I was very intrigued by the menu. Food was fantastic! Great sauces. Loved the spice. Drinks were great, tried some margaritas. I'm huge on service, thought it was very good. But could have some improvement. Our waiter was very knowledgable on the menu.
Everything was fabulous, from the food to the service. You cannot go wrong....2 Thumbs up!!
Was highly recommended to us by friends...and were not disappointed! Food was very tasteful and attractively presented. The waiter was very on top of our needs. Highly recommend it and looking forward to visiting again -- can't wait!
Not a fan of usual, gooey with cheese Mexican fare, but this was exceptional!
Talavera has done it correctly. We tasted the tlacoyos azules, the tortilla soup, the cochinita pibil, the crepas de cajeta, and the margaritas de tamarindo. First of all, this is the only place in Miami you'll find a tamarind margarita. Go. Now. All of the food was amazing - with the exception of the tlacoyos. The tlacoyo itself was nice, but there was a sauce on top remnant of ketchup that toned it down a little too much, in my book. The broth in the soup was so warming - the small portion is plenty to leave you warm and cozy inside before your main entree. Cochinita was great - love those pickled onions!!
The chefs are excellent. They have just the right blend for their sauces. The brunch items are delicious. The bus man made the experience better by watching for needs like water, tea, chips, and sauce. He is a great asset. The waiter was better on a previous visit.
This is my husband and my favorite Mexican restaurant in Miami. Location in Coral Gables is just off Miracle Mile (not so much of a miracle any longer). Food always good….margaritas. We normally get the queso flameado, shrimp cervice and the chicken with mole sauce. Absolutly wonderful. While the latino influence is obviously everywhere in Miami, it's hard to find good Mexican food. Try this place…you won't be disappointed. Service can run a little slow at times but nothing ofensive.
Amazing food...I will definitely be back. I love the ceviche. Everything we ordered was delicious. The margaritas are really good as well. We also had an amazing chocolate cake dessert with a kick.


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Wage and Hour Division (WHD)
Press Releases
U.S. Department of Labor |
ASTORIA, S.D. -- Asmussen Bin Builders LLC has agreed to pay $110,262 in back wages to 34 employees following an investigation by the U.S. Department of Labor's Wage and Hour Division that found violations of the Fair Labor Standards Act's overtime and record-keeping provisions. Asmussen Bin Builders, owned and operated by Richard and Paul Asmussen, is an Astoria-based commercial construction company that builds large grain bins for agricultural cooperatives throughout the country.
"The Labor Department is committed to ensuring that all workers receive the wages they rightfully earn," said Chad Frasier, district director of the Wage and Hour Division in Denver. "Employers are legally obligated to comply with the law and ensure that their workers are fairly and properly compensated for every hour worked."
An investigation conducted by the division's Denver District Office revealed that the company improperly classified several employees as exempt from the FLSA, thereby denying them overtime compensation. Investigators found that employees were required to work long hours – performing an average of 55 hours of work per week while completing construction projects – and were paid "straight time" wages, rather than time and one-half their regular rates of pay for hours exceeding 40 per week, as required under the FLSA. Additionally, the employer violated the act by failing to display a required FLSA poster at its work site and to maintain accurate records of employees' work hours and wages.
The FLSA requires that covered employees be paid at least the federal minimum wage of $7.25 for all hours worked, plus time and one-half their regular rates of pay, including commissions, bonuses and incentive pay, for hours worked beyond 40 per week. Employers also are required to maintain accurate time and payroll records.
For more information on improper classification of workers as exempt, please visit the Fair Pay website at http://www.dol.gov/whd/regs/compliance/fairpay/main.htm.
For more information about the FLSA and other federal wage laws enforced by the Wage and Hour Division, call the division's toll-free helpline at 866-4US-WAGE (487-9243) or its Denver office at 720-264-3282. Information also is available on the Internet at http://www.dol.gov/whd.
U.S. Department of Labor releases are accessible on the Internet at www.dol.gov. The information in this news release will be made available in alternate format (large print, Braille, audio tape or disc) from the COAST office upon request. Please specify which news release when placing your request at (202) 693-7828 or TTY (202) 693-7755. The Labor Department is committed to providing America's employers and employees with easy access to understandable information on how to comply with its laws and regulations. For more information, please visit www.dol.gov/compliance.


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November 10, 2012
Chris Lee and Jesse Johnson VandySports.com
Vanderbilt moved to 6-4 on the season and 4-3 in the SEC with a thrilling 27-26 comeback victory at Ole Miss on Saturday. VandySports.com breaks down all the notable moments and performers from the game. ...More... To continue reading this article you must be a member. Sign Up Now for a FREE Trial
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MattP wrote:Some real beauties in there Frank.
I have 3 of these, but what I think is the only male I have, is just beginning to develop the spotted pattern that yours have.
Have you spawned these as I've not read any information about that anywhere!
wrasse wrote:Very nice looking fish Frank. The male with the big spot pattern is a cracker!
What temperature are you keeping these in?
MattP wrote:Hi Frank,
Thanks for the spawning info which suggests they are very atypical compared to the usual cory methods. I think I'll make do with trying to source some more adults, as with most corys they look so much better and settled in a larger shoal like yours.
Cheers Matt
MatsP wrote:Edit: And I'm pretty sure Pier Aquatics had some a while back. Not sure how much they were - if my memory serves, they weren't crazy expensive, but not "I'll have a dozen, as they are nearly giving them away" either...
minkweir wrote:Lovely fish!
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SOURCE AIRS Foundation
Alliance in Reconstructive Surgery Spotlights Real-Life Stories, Education -- and Celebrity Supporters -- at Chateau Marmont
HOLLYWOOD, Calif., Oct. 16, 2013 /PRNewswire/ -- Hollywood's Chateau Marmont played host Monday evening, October 14 to the launch event for the AIRS Foundation, the 501(c)(3) that is raising awareness - and funds - for women who have had mastectomies and want reconstructive surgery, but cannot afford it, according to AIRS Co-Founder Morgan Hare.
(Photo: http://photos.prnewswire.com/prnh/20131016/NY98889 )
The by-invitation-only event launching AIRS- which stands for "Alliance in Reconstructive Surgery" and for which New Beauty magazine served as a media sponsor - spotlighted, Hare said, "real-life stories of hope and healing." She noted that AIRS provides funding for breast reconstruction, as well as education for physicians and the medical communities, mastectomy patients, caregivers, and advocacy groups. "While every woman who has had a mastectomy might not feel a need for reconstructive surgery," Hare said, "AIRS now makes it possible for a breast cancer survivor who wants reconstruction to have it, regardless of her financial plight."
The advocacy organization was co-founded in 2012 by Hare and by Janet Denlinger of Dallas-based Hylaco, LLC, as well as by internationally renowned plastic and reconstruction surgeon Dr. Rod Rohrich, who, with Hare, attended and co-hosted the October 14 event.
"Restorative breast surgery is vital to comprehensive physical and emotional healing for breast cancer survivors," Rohrich said. "Yet most women who would choose reconstructive surgery simply are not able to because of the high cost. AIRS fills this need. AIRS is dedicated to supporting and funding a woman's right to restoration, education, health, and wholeness."
Hylaco Chief Scientific Officer Janet Denlinger agreed that every woman, independent of her circumstances, should be offered the entire range of reconstruction options at the time of her mastectomy so she is able to make an educated decision about what is right for her.
"At the AIRS launch event we came together to celebrate not only the technical advances in our field," she said, "but also the real women, their real stories, relationships, and recoveries, all of which are nurtured by the ability to make women whole again after mastectomy."
"As a surgeon for both reconstructive and cosmetic surgery, it was wonderfully inspirational to be able to join with Morgan and Janet to launch AIRS," Rohrich added. "We wanted to create a nonprofit that makes its mark not only with education for patients and their caregivers, but for the healthcare community. Our goal is to deliver enhanced treatment and outcomes."
Hare pointed out that while federal and state laws may call for insurers to cover the cost of reconstructive surgery, that government safety net is, she said, "full of holes."
She added: "Many women don't have insurance, or have high co-pays, or are without the means to make an educated decision on reconstructive surgery. We want to provide education as well as financial support for these women. As leaders in a national movement for health and healing, we want to ensure that every woman who needs and wants reconstruction gets it."
Alliance in Reconstructive Surgery Foundation (AIRS) is a 501(c)(3) nonprofit organization dedicated to helping survivors of mastectomy around the world restore normalcy to their lives by providing access to reconstructive breast surgery. Founded in 2012, AIRS provides physician training, opportunity, and funding to make that possible. AIRS' mission is to help women who cannot afford this procedure. Restorative breast surgery is a vital part of total physical and emotional healing for many breast cancer survivors. Yet seven in 10 of those who want reconstructive surgery do not have adequate insurance or financial resources to pay for it.
Educating women about post-mastectomy options is of particular importance, especially when a large percentage of women diagnosed with breast cancer are unsure- or unaware - of their reconstruction options. Most breast cancer patients who have had a complete or partial mastectomy (removal of all or some of the breast tissue and nipple) are candidates for reconstructive surgery. AIRS works in partnership with doctors worldwide, providing the resources to make reconstruction a reality for cancer survivors. To this end AIRS also provides physician education and training, globally, while supporting advances in healthcare research.
Please visit us at: www.airsfoundation.com.
Facebook: www.facebook.com/AIRSAllianceReconstructiveSurgery
Twitter: @AIRSFoundation
©2012 PR Newswire. All Rights Reserved.


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me...at McDonald's? gurl, don't you worry, I would never come bother you while you're at work! I know how bad you gotta pay back your ex-label for all those flops.PosziMC2 wrote:The front door of MCDonalds. I see now. Greet Ashanti there! <3phoenix98 wrote:parking lots? gurl, I never even visit those...the limo always drops me off at the front door, the lesser driver parks it wherever he wants.PosziMC2 wrote:Or simply because you're unknown #oops
And how is your parking lot tour going? Are you on the level of Ciara yet?
I dont need photoshop. This is all natural beauty here
besides, when I'm craving fast food, I kick it at Burger King with Mary J.


text: Listening To Music In 2012 – Use Cloud Music Cloud music services promise to give us unprecedented access to music. With user-friendly interfaces, cloud music services allow users to access music across a wide variety of devices, including computers, MP3 players, smartphones, set-top boxes and video games consoles. The greatest advantage for users is that they can create an enormous music library and enjoy it anywhere in the world. Other advantages of using a cloud-based music service are: Access data from anywhere – as I mentioned before, this is most prominent advantage for users. User love to have their


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The Muslim cleric accused of framing a young Christian girl in a blasphemy case in Pakistan was granted bail Thursday, his lawyer told CNN.
Two bomb blasts in different parts of southwest Pakistan killed 12 people and injured 25 Thursday, officials told CNN.
A suspected U.S. drone strike killed 16 people and wounded six others Thursday in one of Pakistan's semi-autonomous tribal regions, two officials said.
France's first lady is filing a defamation complaint against the authors of a biography published Thursday which claims she had an affair with a former French minister while seeing President Francois Hollande.
Roger Federer overcame a scare against Swiss friend Stanislas Wawrinka before finally securing a victory which ensures he will spend a record-breaking 300th week as world number one. The 31-year-old recaptured top spot after a 17th grand slam success at Wimbledon in July and by reaching the last eight of the Shanghai Masters, he has reached another landmark in his illustrious career.
Monisha Kaltenborn has continued her rise within Formula One after becoming the sport's first female team principal.
European Ryder Cup teammates Lee Westwood and Justin Rose will play off for the World Golf Finals title after both Britons won their last-four ties on Thursday.
A North Dakota freshman walked in front of his class, made an apology and then shot himself with a handgun Thursday morning, Richland County authorities said.
The shooting of an unarmed and naked Alabama university student killed in a late-night confrontation with a campus police officer appears to be unjustified, the lawyer for the young man's family said Thursday.
A fire tore through a home in northeast Baltimore early Thursday morning, pushing a person to jump from a second-story window and leaving four children and a grandmother dead.
Attorneys argued again Thursday about whether accused Fort Hood shooter Maj. Nidal Hasan can be forcibly shaved so that his stalled court-martial can proceed.
A lack of oxygen due to underdeveloped lungs caused the death of a newborn giant panda at the Smithsonian's National Zoo in Washington, officials said Thursday.


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Army Navy Store » Military T-Shirts & Tank Tops » US Army T-Shirts
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US Army t-shirts are the same great military t-shirts that we already sell but in a US Army theme. You will find 101st Airborne division t-shirts, Army physical training t-shirts, US infantry t-shirts, and US Army cavalry t-shirts just to name a few in our US Army t-shirts category. A US Army t-shirts doesn't only identify ones patriotism but they are also very fashionable and can be worn as everyday clothing, work out clothing, costume, and much more. US Army T-Shirts are also known as US tee shirt, United States t-shirts, 101st airborne t shirts, army division 101 attire, air force corps infantry clothes, etc. US Army T-Shirts are commonly misspelled as usa amry tshirts, etc.
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1 Meetup Group matches "Vajrayana Buddhism" near Tacoma, WA
Dharmakaya is an organization dedicated to teaching the skills of mental and spiritual awareness that are at the heart of Buddhist practice. The methods are those taught by Buddha over 2500 years ago and passed through the centuries in an unbroken lineage of Indian and Tibetan masters. The Trungram Tradition is drawn from the methods of three of the most important Tibetan masters, the great yogi Milarepa and his two students, Gampopa and Rechungpa. It is a unique meditation lineage of the Kagyu …
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#12 Brock Jessup
LCSC: Redshirted the 2011 season.
JUNIOR COLLEGE: Graduated in 2010 from Treasure Valley Community College…during sophomore season pitched two complete game shutouts, recorded a 2.00 ERA and helped his team to NWAACCS regional championship.
HIGH SCHOOL: A shooting guard in basketball and pitcher, first baseman and outfielder in baseball for Skyview and Columbia High Schools…earned All-Academic award in both sports…pitcher of the year and helped team to state championship in 2007.
PERSONAL: Born Jan. 12, 1990 in Nampa, Idaho to Driggs and Patty Jessup…has three sisters Corrie, Chelsey and Calley…cousin Danyele Jessup is a junior at LCSC…father Driggs played basketball at Multnomah…majoring in Kinesiology and Secondary Education…hobbies include hunting and fishing.
© 2012 Lewis-Clark State College Lewis-Clark State College, 500 8th Avenue, Lewiston, ID 83501 | College Website Athletics website maintained by: Sports Information Office | Disclaimer | Technology Use Guidelines | Admin


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text: Hey guys, Rin D here. To be honest I haven't explored this site at all. I just went to a search engine and was like " i wonder if there's a site besides fanfiction.com that I can go to roleplay..." sooo with the combination of being hungry and wanting to share my ideas with other people..here I am.


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Recap of Thanksgiving & #GivingTuesday Many ministries within the Church of God in Chri
This Day in History: Rememberi...
On December 1, 1955, Rosa Parks refused to give up her seat to a white person when the white sectio
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Long Beach's Porch Party Music Scene
By Sarah Bennett
Five Sad Toasts to the 21st Amendment
By Sean J. O'Connell
Six Nerdy Groups With Annoying Fans
By Drew Ailes
Andrew Youssef: Appreciation of a Life Well Lived
By Nate Jackson
Andrew Youssef Passes Away :-(
By Gustavo Arellano
Top Five OC Metal Shows in December
By Alex Distefano
Ask Willie D: I Have a Stalker. Help!
By Willie D
True Story: Is There a Therapist Onboard?
By Jack Grisham
Suicidal Tendencies Are Still Cyco!
By Ryan Ritchie
Gwen Stefani Fan Art From Every Style Era
By Jena Ardell
Thanks for the set list. Going to Friday night's show.
What time did Coldplay start playing?
Coldplay started at 9:00