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Grandparent Membership
From: $45.00
Product Description
Two Adults Named on Card and Their Grandchildren under the age of 18
Four Guest Passes Per Year
If you are purchasing online – Please specify in the comments section of checkout the exact two adult names to appear on the card. Thank You – Please note the price for duplicate or replacement cards is $5
Memberships take from 2-14 days to process, if you will require your membership sooner, please purchase an emergency membership card.
The CREHST Museum is a member of the ASTC Passport Program – Details and restrictions about the Passport Program can be found on the ASTC Website (ASTC Passport Link)
For questions call 509 943 9000
Additional Information
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Start learning with our library of video tutorials taught by experts. Get started
Learn how to use your Nikon D800 digital SLR—and improve your photography in the process—with this guide to the camera's features, controls, and exposure options.
Photographer and teacher Ben Long shows how to use Capture NX2—the Nikon nondestructive photo-editing software—to review, enhance, and print photos.
Details the features, controls, and options in the Nikon D5100.
Photographer and author Ben Long details the features, controls, and options in Nikon's popular D7000.
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subset: commoncrawl


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Personal Injury, Family Law, Disability and Criminal Defense Attorneys For Asheville
With DeVere Lentz & Associates, you will find a law firm that is dedicated to providing you with personalized, dedicated legal help. Out team of attorneys will go out of their way to fight for your legal rights. We are a third generation law firm that was established in 1924 in Ashville, N.C.
Each client is treated with dignity and compassion, and our difference is the personal touch we give every client. Our office will return all calls in a timely manner.
We are a general practice but concentrate in the following practice areas:
- Criminal defense
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Make an appointment for a consultation with us today. Our number is 828-484-1741. Let us help you fight for your rights.


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Summary: A 37-year-old woman had an episode of paroxysmal atrial tachycardia. She was sent for cardiac imaging to evaluate for cardiac ischemia and possible subsequent cardiac ablation. The patient received a Cardiolite (technetium Tc99m sestamibi) exam that was negative for ischemia, but showed an area of increased activity in the left breast. The patient denied any breast symptomatology or family history of breast or ovarian cancer. A clinical breast exam by her primary care physician was normal, but she was referred for breast evaluation with mammography, which revealed an abnormal cluster of calcifications in the left breast. Subsequent breast ultrasound, ultrasound directed biopsy, and eventual magnetic resonance imaging (MRI) of both breasts were performed.
Multifocal infiltrating ductal carcinoma and high-grade ductal carcinoma in situ (DCIS)
Transaxial FLAIR MR images show raw data images from the initial imaging, a Cardiolite (technetium Tc99m sestamibi) exam,demonstrated a subtle region of abnormally increased activity in the left breast (Figure 1).
Diagnostic mammogram, including MLO and CC views (Figure 2), showed dense breast tissue. Within the subareolar aspect of the left breast was a faintly visualized spiculated mass with associated pleomorphic calcifications. Diagnostic breast ultrasound imaging performed on the same date showed an 8 × 9 mm hypoechoic shadowing mass in the subareolar aspect of the left breast (Figure 3). This lesion was subsequently biopsied under ultrasound guidance and revealed intermediate grade ductal carcinoma in situ (DCIS) and an associated area of infiltrating carcinoma.
A subsequent MRI of the bilateral breasts was then performed and demonstrated two areas of concern. The first area of concern was the pathologically proven infiltrating ductal carcinoma site, located in the subareolar region of the left breast. This spiculated mass measured 1.9 cm × 2.0 cm on contrast-enhanced images and had a component of reactive and/or inflammatory changes related to recent needle biopsy. The dynamic enhancement curve was of a washout type, consistent with known malignancy (Figure 4). A second spiculated mass was seen in the inferiomedial left breast, away from the first lesion and the previous biopsy site. The appearance and enhancement curve suggested a second area of neoplasia (Figure 5).
A second ultrasound-directed biopsy of the lesion found by MRI in the inferiomedial left breast also showed infiltrating ductal carcinoma. Subsequent bilateral modified radical mastectomies were performed. A 1.9 cm × 2.1 cm subareolar and a 1.0 cm × 1.2 cm inferiomedial left breast cancer were confirmed status post mastectomy. Three of 7 lymph nodes were positive for malignancy with infiltrating ductal cancer.
Scintimammography is the use of radiopharmaceuticals in the detection or characterization of breast pathology. Sestamibi is one of the radiopharmaceuticals currently used for scintimammography. A high level of both sensitivity (69% to 100%) and specificity (71% to 94%) have been reported in the detection of breast pathology with sestamibi scanning.2,4-6
The role of scintimammography is not fully defined. Studies have shown there is some usefulness of this technique as an adjunct to mammography and ultrasound when these methods are not definitive.4 Using scintimammography can potentially reduce the number of breast biopsies in these equivocal cases. If a patient has a positive scintimammogram in the region of an abnormality found on other imaging, breast biopsy is indicated. On the other hand, if no activity is found in the region of concern on the scintimammogram, biopsy may be deferred and interval follow up performed.3,4
Due to multiple factors, sestamibi uptake in scintimammography can vary from minimal to intense. The factors known to affect uptake include size, location, and cell type of breast pathology.3 Lesions that are <10 mm or those lesions of certain histological type, such as lobular carcinoma, have decreased sensitivity of scintimammography with sestamibi.3,5,6 For this reason, sestamibi scintimammography is not considered a good screening tool.3
A well-defined role for Tc99m sestamibi is present in cardiac imaging. Utilization of radionuclide myocardial perfusion imaging(MPI) has increased rapidly over the last few years.1 A study performed by Levin, et al., showed a 19.1% increase in the use of MPI from 1996 to 1998.1 Notably, subgroups of physicians, such as those in private cardiology offices, increased the use of MPI much more rapidly during this time frame.1
In this environment of increased MPI imaging, the likelihood of scanning asymptomatic breast disease increases. Even without optimizing the nuclear scan to evaluate breast pathology, this case reminds physicians interpreting MPI with sestamibi to be vigilant in evaluating not only the intended cardiac structures but also the surrounding soft tissues, including the breast.
The role of scintimammography is currently limited to an adjuvant role in cases of equivocal mammography and breast ultrasound imaging. A growing number of patients undergoing MPI provide an opportunity to identify asymptomatic breast disease. This case highlights the need for reviewing the raw data images carefully for incidental findings, such as significantly increased breast activity, which may be the first indication of disease.


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Workboots are taking a cue from the athletic market this season, attracting young consumers with bright color pops. From citrus shades to cool blues, this new palette is adding punch to the category for spring.
Sign in using your Facebook or Twitter account, or simply type your comment below as a guest by entering your email and name. Your email address will not be shared.Ads by Google


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Laos Tours
- Luang Prabang
- Vientiane
The French summarized the temperaments of their three Indochinese states with the pronouncement that "the Vietnamese plant the rice, the Cambodians watch it grow, and the Laotians listen to it grow." If this doesn't already make you want to visit Laos (properly Lao), then you should choose somewhere else. Lao is a land of Buddhist traditions, where saffron-robed teens peek curiously out from wats (temples) and no one is in a hurry. And while being the world's most heavily bombed country hardly seems a ringing endorsement, World Heritage Luang Prabang's temples and mixed heritage soothe the soul, and Vientianne, the world's smallest capital, moves at the same serene pace as the Mekong river floating by its shores.
Indochina Encompassed (ATIE)
From the vibrant cityscape of Bangkok to Halong Bay's magnificent limestone karsts, this trip encompasses the highlights of Indochina. Marvel at the wonders of Angkor Wat, sail the Mekong and savour noodles in Chiang Mai. Shop for souvenirs in Ho Chi Minh City and join the locals sipping coffee at a lakeside cafe in Hanoi. With hotels, transport and a number of included activities arranged by our CEOs, this adventure offers up the perfect combination of must-see highlights and free time.
Highlights: Float down the mighty Mekong River, explore the bustling streets of Hanoi, sail a junk through Halong Bay, shop in Hoi An, experience magnificent Angkor Wat.
- Travel Style:
- Classic
- Trip Type:
- Small Group
- Service Level:
- Standard
- Physical Grading:
- 2
Thailand and Laos Adventure (ATBH)
From the energy of Bangkok to the calm of Laos, this trip is a study in contrasts. Visit temples in Chiang Mai then spend the evening exploring the night market. Sail the Mekong into the heart and soul of Laos. An experienced CEO will make sure you get the most of your tour, but will leave plenty of time for you to do your own thing. We utilize many forms of transport—both public and private—to keep travel time short, maximizing time spent exploring the history and culture of this unforgettable region.
Highlights: Explore Bangkok's canals, discover Buddhist temples, float down the mighty Mekong, get wet in the spray of waterfalls
- Travel Style:
- Classic
- Trip Type:
- Small Group
- Service Level:
- Standard
- Physical Grading:
- 2
Trip | Length | Style | Service Level | Starting Price |
Indochina Encompassed (ATIE) | 29 days | Classic | Standard |
Thailand and Laos Adventure (ATBH) | 14 days | Classic | Standard |


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Live Scorecard England vs India 10th T20 Match World Cup 2012
India will play against England in the 10th T20 match at R. Premadasa Stadium, Colombo. The match will be played between IND vs ENG on Sep 23, 2012. The match will start at around 19:30 local time. The match between England vs India is going to be interesting, keep your eyes open on Colombo match.
Anonymous user


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Wednesday, September 13, 2006
Forgiveness II
Have you ever had to ask for mechilah? As in, really ask for it, not just to cover your bases in case there was some minor incident in December that you've both long forgotten anyway? It can be so hard, in so many ways. First of all, in a disagreement, there are usually two sides, and both feel they are in the right. In order to get to the level where one side can forgive the other, someone has to go first--swallow their own hurt, their pride, and humbly come to the other party and say, "I'm sorry, I did you wrong, and I know I hurt you. Please forgive me." Second, even if one side is willing and able to do that, sometimes the other side is still hurting too much to let that pain go, and if they're being honest, they won't just tell the other party that s/he is forgiven when it is not so. Then, the first party has two choices--accept that forgiveness has not been granted, and forget about it; or accept that forgiveness has not been granted, and try again later.
Recently, I had the experience of having to ask for mechilah from someone who was once a good friend. We'd lost contact since the disagreement, and I always felt the loss, so I asked her for mechilah finally many months ago when we chanced to meet. I was struck when I received the first "No" of my life; it stuck in my mind that I had perhaps received the most honest answer I ever had. So I tried again recently, since it is the season...and I got what I called for, b"H. It was the most liberating feeling, to know I had this girl's forgiveness. A huge weight was lifted from me. And it was hard--make no mistake. But it was completely, totally worth it.
15 comments:
- flör said...
to and adult, whom i finally asked 10 years later..and my cheeks still burned with embarrassment (kids do really stupid things..) - 7:21 PM, September 13, 2006
- flör said...
- 7:21 PM, September 13, 2006
- Lvnsm27 said...
I can imagine. Glad you finally got it
- 7:44 PM, September 13, 2006
- socialworker/frustrated mom said...
Yup I did and it is worth it.
- 9:39 PM, September 13, 2006
- Scraps said...
flor--wow...that must have taken a lot of guts. Props to ya.
lvnsm27--me too!
sw/fm--glad you agree. :) - 12:55 AM, September 14, 2006
- Irina Tsukerman said...
Yep, quite recently, and it was mutual... however, I didn't feel there was any problem on either side. Unless someone does something REALLY low to me, I don't usually hold grudges. And what *I* did, wasn't very nice... but it's just general human flow type of thing, nothing dramatic... but it sure felt good to have it over with!
- 9:52 PM, September 14, 2006
- kasamba said...
Wow- you've got to admire her honesty and your persistance to right things!
You go girl!!! - 7:37 PM, September 16, 2006
- Scraps said...
irina--I'm not sure it's always a matter of a grudge, but sometimes you have to have a little time to forget before you can forgive. But yeah, it feels great to have it over with.
kasamba--I do admire her honesty, which was why it stuck with me that I still needed her forgiveness. And I wasn't telling to story to toot my own horn, but thanks anyway. :) - 9:42 PM, September 16, 2006
- socialworker/frustrated mom said...
Sure and have a sweet new year may all your wishes comes true for the good.
- 3:30 PM, September 18, 2006
- flör said...
AMEN to that..sweet year in the blogosphere
- 8:02 AM, September 19, 2006
- Scraps said...
sw/fm and flor--thanks, right back at both of you!
- 9:39 AM, September 19, 2006
- Human Bean said...
Kol Hakavod to you!
- 7:45 PM, September 19, 2006
- Scraps said...
- 11:10 AM, September 20, 2006
- wandering said...
ah yeah I have been there before. I also noticed though, that people are much more inclined to forgive you after you have made the first move. It kind ofmelts their heart a little when they see that you acknowledge adn regret what you did...
- 10:24 PM, September 24, 2006
- Scraps said...
I'm sure that definitely played a part in getting my friend's forgiveness...and not only that I made the first move, but that I came back to try again.
- 4:57 PM, September 25, 2006


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Regal Riverdale Cinema 3
2011 Cunningham Boulevard,
2 people favorited this theater
Opened as a single screen independent of 800 seats in July 1965, sold to Martin Theatres and remodeled into one of the first "twins" in 1969. Reopened in that format on May 1, 1970… not by "splitting", but by adding a completely new addition (with 500 seats) onto the original facility. One of the very first multi-screen complexes.
Sold to Neighborhood Theatres around the late-1980's which split the smaller twin, creating a triple. Downgraded to a dollar house in its later years. Closed in 1997. It still stands, in use as a church.
Recent comments (view all 14 comments)
Blog post of pics from May 2007:
Evidently the theater went thru a minor facelift after 2003.
The recent opening of the Riverdale Theatre was announced in Boxoffice of August 9, 1965. A single-screen house of 610 seats, it was designed by architect Drew Eberson for the regional circuit Gordon Enterprises, operated by brothers Julian, Jerome, and Leonard Gordon.
I was involved in adding "DOLBY" CP-50 sound upgrades in the early 80's, also adding projection and sound eguipment for new additions when theatre was purchased by Neiborhood Theatres.
This theater was operated by Carmike Cinemas from 1985 until it was sold to Neighborhood Theatres (1987?). Carmike closed the Beechmont Twin in Newport News about the same time they sold the Riverdale Twin to Neighborhood. Carmike chose to concentrate their business in Tidewater Virginia at Williamsburg.
Operated as a single screen, double screen and finally triple screen from 1965 to 1997
I just posted a photo of the Grand Opening ad dated July 1, 1965
Just posted a photo of the ad announcing the addition of the third theater – June 14, 1991
Just posted a photo of an ad announcing the opening of the twin.
Just login to your account and subscribe to this theater


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AAA Michigan says gas prices jump 32 cents in past week; statewide average $3.70 a gallon
Published On: Feb 04 2013 09:24:18 AM EST
AAA Michigan says gasoline prices have jumped 32 cents during the past week to a statewide average of about $3.70 per gallon.
The auto club says Monday the average is about 16 cents per gallon more than last year at this time.
Of the cities it surveys, AAA Michigan says the cheapest price for self-serve unleaded fuel is in the Marquette area, where it's about $3.59 a gallon. The highest average is in the Grand Rapids area at about $3.73.
Dearborn-based AAA Michigan surveys 2,800 Michigan gas stations daily.
Related stories:
- Slight tick upward in U.S. gas prices
- How to save money on tech in 2013
- How to eat healthy while traveling
- Construction jobs: Not quite a comeback yet
- Oil prices jump 10% in a month
- America, the Saudi Arabia of tomorrow
Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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Posted: Jan 31, 2013 3:34 PM by The Associated Press
SACRAMENTO, Calif. (AP) - The governing board of California's stem cell funding agency has voted to overhaul how it distributes scientific grants after critics raised concerns that too many board members represented schools that have won funding.
The final proposal is expected to be decided by a vote on March 13, and if accepted would bar California Institute for Regenerative Medicine board members associated with grant-eligible institutions from voting on where the money goes.
The San Francisco Chronicle reports that 13 of the 29 board members are associated with schools that receive grants, which have raised concerns over conflicts of interest.
The vote follows a report by the Institute of Medicine that found the agency should restructure its system for distributing grants.
Offensive or inappropriate comments are subject to removal. To report a comment, please e-mail us at email@example.com, and include the name of the story and information on the comment.
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Why States Should Ban Adolescent Driving (cont'd)
posted by Vivian Hamilton
My previous post argues for raising the driving age, ideally to 18. Thank you to those who commented. You raise many good points, so I continue the conversation here. (And I must especially thank Prof. Cunningham for reading my article, and for his kind words.)
Treating Teens as Presumptively Delinquent? One comment suggests that raising the driving age treats young people as "presumptive law breakers." I resist that characterization. Raising the driving age recognizes adolescent incapacity in this context and aims to protect adolescents, and those with whom they share the roadways, from the too-often tragic consequences of that incapacity. Such policy reform is consistent with the state's obligations to its young people. I briefly discuss those general obligations, then return to the driving context specifically.
The State's Obligations to Adolescents, Generally. The state should safeguard both the welfare interests and autonomy interests of the young. (I elaborate on this state obligation elsewhere, drawing on the work of my colleague James Dwyer and others.) Welfare interests pertain to young people's well-being, irrespective of any affirmative choice they make. Autonomy interests refer to their interests in making self-determining choices and having the freedom to exercise the liberties of which they are capable. Compelling evidence suggests that driving is a liberty that adolescents do not have the capacity to exercise competently. The state thus fails to guard adolescents' welfare interests — and protect them from their deficiencies — by extending them this liberty despite their incapacity.
Policymaking affecting adolescents in general poses a major challenge for lawmakers. Young people attain different capacities at different stages in their development, and development correlates predictably (though not perfectly) with age. Identifying and extending to adolescents liberties in contexts in which they have attained competence can be a challenge. Further complicating the state's task is that, even where adolescents may have achieved the ability to perform competently, certain real-world contexts predictably confound their capacities and impede their performance. Thus by mid-adolescence, individuals have reached adult-like information-processing and logical reasoning abilities. But the quality of their decision making suffers in situations that require adolescents to quickly assess and react to risk, to reason while highly stressed or in the heat of passion, to make decisions in unfamiliar circumstances, or to act in the presence/under the pressure of peers. The neurobiological processes that support decision making under these conditions do not fully mature until late adolescence or early adulthood.
Prof. Cunningham's analogy to rules that allow minors to disclaim contracts is a good example of a policy choice that may be at odds with what we now know about adolescent decision-making capacity. (I discuss adolescent contractual capacity briefly in another article (at pp. 1851-57, which argues against adolescent marriage.) By mid-adolescence, individuals have the cognitive capacity to understand the rights, duties, and responsibilities of a contract, and in light of that understanding, are able to make a voluntary choice to enter it or not. Absent the same factors that would invalidate a contract entered by an adult (duress, etc.), there is a strong argument that the adolescent should be held to his or her bargain. But contract policy might also permit minors to disclaim contracts entered in the sorts of contexts likely to compromise their decision making (e.g., the typically pressured context of buying a used car?).
Back to adolescent driving:
How Serious a Public Health Threat? One commenter (SgtDad) notes that traffic fatalities have declined in recent decades, making adolescent driving an "ever smaller problem," with policy changes in turn having an "ever smaller effect." To what extent does adolescent driving remain a true public health problem? An estimated 48 thousand 16- to 19-year-olds will die in car crashes
February 27, 2013 at 10:10 pm Tags: adolescent health, adolescents, cognitive development, teen drivers Posted in: Psychology and Behavior, Uncategorized Print This Post 3 Comments
Why States Should Ban Adolescent Driving
posted by Vivian Hamilton
Car crashes kill more teens each year than any other cause; and of the crashes in which they are involved, teens are overwhelmingly at fault. Decades of law-reform efforts have led to mandatory seatbelt laws, an increased legal drinking age, and graduated-licensing systems. Yet traffic fatalities still account for nearly 40% of all deaths of 16- to 19-year-olds. Driving, then, is arguably the greatest public health threat facing U.S. teens. (The next three leading causes of teen death — homicides, suicides, and cancer-related illness — trail only distantly.) While existing measures have had some positive effects, they insufficiently safeguard both young drivers and the public at large from young drivers' immaturity and inexperience. A report of a National Academies interdisciplinary workshop, for example, concluded that "the sheer magnitude of the injuries and fatalities that continue to result from teen crashes shows that current prevention efforts are inadequate."
Most of us know that teens crash at rates far higher than those of older drivers. Fewer may be aware that the younger the teen driver, the higher the risk — by far the highest crash rates are those of 16-year-olds (250% higher than those of 18-year-olds), followed by those of 17-year-olds (50% higher than those of 18-year-olds). Driving inexperience and developmental immaturity are the primary factors that contribute to adolescent crash risk. Driving inexperience, however, is not the primary cause of the higher crash risk of younger teens. At younger ages (15 to 17), driving inexperience is secondary to developmental immaturity; not until later ages do different levels of driving experience account for more of the differences in crash rates. Thus the crash risk for 15-year-old beginners is much higher than that for 17-year-old beginners, but the crash risk for 18-year-old beginners is only slightly higher than that for 20-year-old beginners. At each month of driving experience, young drivers crash at rates higher than those of older drivers with equal driving experience.
By ages 15 or 16, adolescents indeed have the cognitive ability required to learn traffic rules and basic driving skills. But the self-regulatory capacities and psychosocial maturity essential to competent and safe driving remain immature in adolescence (the developmental stage between childhood and adulthood, generally spanning ages 12 to 17), as observed in research of adolescent behavior generally and driving behavior specifically, and supported by research of the adolescent brain. When decision-making contexts involve stressors that require the exercise of psychosocial maturity/regulatory competence — requiring, for example, that a decision be made in an unfamiliar situation (such as the new perceptual situations involved in driving); under time pressure (such as the nearly-instantaneous reactions often required when reacting to driving hazards); in in the presence/under the influence of peers (including the direct or perceived influence of peer passengers); or in an emotionally-charged situation — adolescent decision making suffers. These characteristics all confound the execution of whatever nascent driving competence adolescents do possess.
February 24, 2013 at 9:59 am Tags: adolescent health, adolescents, cognitive development, teen drivers Posted in: Psychology and Behavior, Uncategorized Print This Post 12 Comments


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Gifts for Dad for Adults - Food Gift Baskets
Gift Buzz
Specialty fruit baskets from Harry and David, Gourmet Gift Baskets and other top merchants are a classic and much-loved gift each Christmas. Look forward to the sweetest pears, golden apples and much more of unsurpassed quality and selection.... Read More »
Does he have everything? Or does he not want anything? Dad's have always been tough when it comes to finding a great gift. One way to go is to find a gift you know he doesn't have. Here are 7 unique finds he's never seen before. Read More »
My father-in-law is about to turn 60, and my own dad is already 65. I can tell you from firsthand experience that men this age are seriously hard to shop for. Dads don't really want stuff. They want some stuff, true, but it's expensive stuff... Read More »
With dad's big day occurring on the doorstep of summer, hooking dad up with a great Father's Day gift that will help him enjoy the great outdoors is a super idea. If you have a dad who loves to spend the summer months enjoying all that Mother... Read More »
Hand-pickedChristmas Gifts
Did you know that we hand-pick all gift ideas for adults in the food gift baskets category? Every product featured on Gifts.com has been reviewed in detail by our team for its high quality, popularity and much more. View great Christmas ideas for adults from the best stores online and further refine your food gift baskets results by price, Gift Guru top picks and more to find the perfect gift.


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Pretty Slick
James Fox Filmmaker James Fox grows frustrated by the lack of plain talk and BP's inability to plug a gushing well after its Deep Water Horizon rig exploded and sank in the Gulf of Mexico. During the summer of 2010, Fox travels across all four Gulf states documenting the largest man-made environmental disaster in U. S. history. He flies over ground zero with Marine Biologist Dr. Carl Safina who warns him that BP is sinking the oil with the chemical dispersant Corexit, sweeping it under the rug. He investigates this further and conducts his own independent water tests to determine toxicity levels. The results show that public safety takes a backseat to a tourist-based economy and the symbiosis between big oil and government becomes clear. |
When making a fiscal sponsorship donation with a credit card, 3% is deducted from the donation amount to cover the merchant account processing fees. This deduction is waived when donating with a check. Checks can be made out to "San Francisco Film Society" and mailed to: San Francisco Film Society ATTN: Finance Dept. 39 Mesa St. Suite 110 San Francisco, CA 94129 Please indicate "FSP 1347" in the memo of the check. |


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Advances in video conferencing technology have made it possible to communicate with people all over the world. With the introduction of HD Video and better than CD quality audio, teaching and performing music over the Internet is now a reality. The purpose of the symposium is to identify and develop strategies to establish synchronous distance learning as a viable means of teaching music to anyone in the world.
The symposium will be a virtual conference with four primary sites--Manhattan School of Music (New York), Peabody Institute (Baltimore), Royal College of Music (London), and Yong Siew Toh Conservatory (Singapore)-- and up to twelve additional real-time interactive partner sites through a bridge provided by Internet2. The conference will be webcast in real-time. In addition, selected papers and multimedia presentations will be featured on the symposium website.
Thomas Hampson, renowned baritone and educator will present the keynote address.
Attending the Conference:
We have openings for 15 interactive sites to connect to the conference through the Internet2 bridge. Interactive sites will be able to see each presentation and ask questions during the Q & A sessions. Requirements include a video conferencing system supporting H.323 transmission.
If interested please
. Interactive sites will be selected on a first-come, first-serve basis.
The conference will be streamed live at
2011 . All rights reserved . Yong Siew Toh Conservatory of Music


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Scientists are still uncovering all of the merits of whole grains. Basically, the point is that whole-grain foods retain the bran and germ as well as the endosperm or flour portion of the original grain. That makes them better sources of:
and other nutrients that are lost when the grain is refined for white rice or white flour. Even though some vitamins and minerals are added back to refined grains after they go through the milling process, they still aren't as good as the original.
The benefits of eating more whole grains are becoming clearer as scientists continue to examine the evidence. In fact, researchers analyzed several studies totaling 149,000 participants on the relation between whole grains and cardiovascular disease for the journal Nutrition, Metabolism and Cardiovascular Diseases. The findings, available online in April 2007, showed a consistent association between eating at least 2.5 servings of whole grains a day and good heart health. The health benefits, researchers found, include a lower incidence of insulin resistance and type 2 diabetes, atherosclerosis, high blood pressure and inflammation.
In addition, the American Institute of Cancer Research suggests that diets rich in whole grains can reduce the incidence of certain types of cancer. Not only do whole grains contain fiber, vitamins, minerals and natural phytochemicals (plant compounds not designated as "nutrients" that can protect cells from damage that could lead to cancer), but eating more whole grains, fruits, vegetables and beans could reduce the amount of red meat and processed meat in our diet - foods linked to increased cancer risk.
To incorporate more whole-grain foods in your diet, choose:
For more ideas, see the Web site of the Whole Grains Council at http://www.wholegrainscouncil.org/.
This article originally appeared in Chow Line (3/23/08), a service of Ohio State University Extension and the Ohio Agricultural Research and Development Center and was adapted for use on NetWellness with permission, 2010.
Last Reviewed: Mar 30, 2010
Anne Smith, PhD, RD, MS Professor Emeritus of Human Nutrition College of Education and Human Ecology The Ohio State University |


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Login with Facebook
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Love it, congrats on the print!
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Ever get called by the same telemarketer's machine over and over? ever wish you could make them call about something you care about? well watch him take over the telemarketers machine and make it send out messages about the cure for cancer.
Want to know more about the cure for cancer?
Please read these posts:
FAQ's about Phoenix Tears Therapy for the Beginner
Rick Simpson on Visual Inspection and Quality of Oils: Debunked
Phoenix Tears Healing a Diabetic Ulcer (8 months of treatment)
Duke the Cancer fighting Dog
REBLOG: Do you still need proof that marijuana cures cancer?
Related articles
- Spain Study Confirms Hemp Oil Cures Cancer without Side Effects (pakalertpress.com)
- … and another cancer cure! (biosil.wordpress.com)
- Marijuana Cures Cancer? Author Martin Lee Comes To SoCal To Talk About It (blogs.laweekly.com)
- Two-Time Testicular Cancer Survivor Lives Each Day to Make a Difference and Believes That Together We Can Cure Everyone Affected by Cancer. (prweb.com)


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Reading some of the positive reviews of this hotel, I begin to wonder if I stayed at the same place. I wanted to like it as it seemed to have a certain amount of charm from the outside but reality proved otherwise. To start with, it's not in a very good location being a mile or so from the main... More
- Also Known As:
- Rama Luang Prabang
- Official Description (provided by the hotel):
- Rama hotel's aim is to provide comfort and high standards at economical rates. It is centrally located within walking distance from many famous bars and restaurants, ancient temples, the famous night market, Nam khan and the beautiful Phousi Mountain, making it the perfect choice for travelers looking to revitalize their bodies. Rooms feature the latest modern amenities including satellite TV, high speed Wi-Fi, hot shower and a fridge. You'll feel right at home at Rama Hotel. ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Booking.com, HostelBookers and Agoda so you can book your Rama reservations with confidence. We help millions of travellers each month to find the perfect hotel for both holiday and business trips, always with the best discounts and special offers.


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Mac Duggal 76207M Prom Dress
Show off those curves in Mac Duggal 76207M! This shimmering and sexy dress is a classic fit that has been brought up to date for prom this year! The stunning embellishments draw attention to your neckline and waist, ensuring that you look flawless in this prom dress. Make sure you are the center of attention at your prom and steal the crown in Mac Duggal 76207M prom dress! We love and so will you!
- Mint - Peach


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Active Directory, AS/400, Business Intelligence, CIO, Cisco, Database, DataCenter, DB2, Desktops, Development, Exchange, Exchange 2003, Exchange 2007, Hardware, iSeries, Linux, Lotus Domino, Lotus Notes, Management, Marketing Technology, Microsoft Access, Microsoft Excel, Microsoft Windows, Mobile, Networking, Oracle, OS, Outlook, Outlook 2003, Outlook 2007, Routers, RPG, RPGLE, SAP, Security, Servers, SQL, SQL Server, SQL Server 2005, Storage, Tech support, Virtualization, Visual Basic, VoIP, VPN, Windows 7, Windows Server, Windows Server 2003, Windows Server 2008, Windows XP ...VIEW ALL TAGS
I have written a report that is Landscape, and legal size paper. (14 x 8.5) If the user goes into the print options and changes them to landscape, and then specifies legal size paper, it prints fine. How can I set it up so that these are the default, and the user does not have to specify each...
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AS/400 menu that could be user specific
Is there any way in which I can create a menu where the options can be user specific. Say in total there are 99 option present in the menu but I want the system to display particular 10 options to a particular user based on some criteria. Can this be handled though a menu in AS/400. And Can this be...
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Seperate menu for user profile in AS/400
How to create seperate menu for user profile in AS/400?
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Does Siebel 7.7 work on Windows Vista (64-bit)? * Where can I find Siebel 8.0 software? * Why does Siebel needs ODBC? Thank you so much for your time.
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What is the most simple way to understand subnetting?
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Given an IP address range, select the correct subnet mask for the scenario. IP address: 22.214.171.124/24 You need to create 6 networks with a minimum of 28 hosts per network. What is the correct subnet mask and the 3rd subnet range?
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View Crystal Reports in Internet Explorer
Please help me...when I open my Crystal Report on Internet Explorer, Crystal Report format view as a text but when I open in firefox, browser report views are correct.
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When I deploy my ASP.NET website on Windows 7 with Oracle 11g database in back end. I am using SAP Crystal Report version 13.0.2000.0 It gives error as: Unsupported Operation. A document processed by the JRC engine cannot be opened in the C++ stack.Description: An unhandled exception occurred...
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Business Law Today, Standard Edition
Author:Miller, Roger LeRoy, Jentz, Gaylord A.
1 Customer Product Review
Edition: 9
Pub Date: 2010
Publisher: South-Western College/West
Summary: Miller, Roger LeRoy is the author of Business Law Today, Standard Edition, published 2010 under ISBN 9780324786521 and 0324786522. Three hundred fifty seven Business Law Today, Standard Edition textbooks are available for sale on ValoreBooks.com, one hundred sixteen used from the cheapest price of $13.19, or buy new starting at $155.81.
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The most useful thing I learned from this book was the basic terminology of the world of Business Law. It helped me to understanding the basics about the law and how it affects the business world. GREAT book!
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The primary subject of this book was Business Law. It was VERY effective in covering that subject. I have never taken a business law class before, nor have I studied the law, let alone business law, ever before, and this book was great at teaching me all the essential basics of business law.
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Pub Date: 2010
Publisher: South-Western College/West
Edition: 9th
Pub Date: 2010
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Abu Dhabi 'leisure tourism in demand'Abu Dhabi's leisure tourism offering is now taking hold amongst European travel majors with the emirate's pavilion at ITB Berlin – the continent's leading travel trade fair – receiving a record number of enquiries f More… |
Dubai Tourism wins big at ITB BerlinDubai's Department of Tourism and Commerce Marketing (DTCM) won three major awards at the recently concluded International Tourism Bourse (ITB), a global travel and tourism show, in Berlin. DTCM won, for the third consecutiv More… |
Abu Dhabi wins double honours at ITBAbu Dhabi marked its record-breaking appearance at the ongoing ITB Berlin travel trade fair by scooping double honours in the Cologne Business School show awards. Abu Dhabi Tourism & Culture Authority (TCA Abu Dhabi), which mo More… |
DNA to unveil bespoke treatment at Berlin eventAbu Dhabi-based DNA Health Corporation has announced it will introduce its bespoke 'DNA 4 Life' treatment and hospitality packages to key international trade partners at ITB Berlin this month. "We have already re More… |
Bahrain pavilion at ITB Berlin draws crowdsBahrain's pavilion at the prestigious business travel exhibition, ITB Berlin, attracted a large number of visitors, who showed interest in the kingdom's historical and modern landmarks and attractions. As part of the Ministry of Cultur More… |
Oman Air showcases at ITB BerlinOman Air, the national airline of Oman, showcased its multi-award-winning products and services at the recently concluded ITB Berlin, an international travel show. Oman Air's chief executive officer Wayne Pearce greeted guests from the tra More… |
Bahrain tourism to take part in Berlin expoBahrain will showcase its tourism sector at the world's leading travel trade show, ITB Berlin, set to open tomorrow (March 7). A delegation from the Ministry of Cultutre's tourism sector led by assistant underse More… |
Oman Air showcases at Berlin showOman Air, the national carrier of sultanate of Oman, is showcasing its premium products at ITB Berlin 2011, ITB Berlin, one of the world's biggest travel trade fairs. "The German people are keen travellers and Oman Air is already a well-kn More… |
Emirates Palace occupancy up 30pc in FebEmirates Palace, the leading Abu Dhabi landmark hotel, has reported occupancy in February rising to 82 per cent compared to 52 per cent on the same month last year. The hotel is currently participating at ITB Berlin, one of the world's big More… |
German firms eye Abu Dhabi tourismMore than 20 sharing partners at Abu Dhabi's pavilion at ITB Berlin, the ongoing leading travel trade show, are drawing a stream of trade enquiries from German speaking markets. ITB Berlin opened yesterday (March 9) and will conclude on Ma More… |


text:
Product Description
The Outward Hound Booster Seat attaches in seconds to the back seat of most automobiles giving small dogs the ability to ride safely while looking out the window. For dogs up to 10 lbs
Care Instructions:
Wash on delicate setting with like colors. Line dry
Made in China


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I urge all of you to go to cube.ign.com and look at their GameCube Launch: Ready Your Budget under the news section. It tells you how much you have to pay if you click on all the things you want. I clicked on a bunch of stuff and it said $500.
I clicked everything and it said $1200.90. Now I son't think that I will spend that much, in fact I know i wont spend that much. I think I will only buy the system and a game, since a might not have the cash to get anything else.
I think I'll do the same thing buy the system a single game, but theres a memory card needed to save game data that I also want, so hopefully I wouldn't have to spend too much. Theres so many things I want to buy, but it just cost so much money!!! Hopefully the other GC stuff besides the game and the system will stay at the $20-$30 range unlike PS2's stuff.
Yes, It's going to suck if we have to pay $40 for a memorie card and $70 for a Controller.
I forgot to mention this but tell how much you guys got and it kinda sucks that there are some things that are not on there to choose.
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The Day of Dialogue provides a forum for honest dialogue in order to explore the complexities of human experience, promote understanding, and create community through the practice of civil discourse.
November 5th, 2014
The University of Montana's 9th Annual Day of Dialogue will be on Wednesday, November 5th 2014. The Day of Dialogue is a campus-wide series of events focused on topics of diversity. Students, faculty, staff, alumni, and community members discuss, present, perform, and exhibit art throughout the day.
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For more information or to request disability related accommodations for the day please contact 406.243.5622 or firstname.lastname@example.com.


text:
Surge in heroin linked to painkillers in NY
Posted at: 02/19/2013 2:36 AM
By: Associated Press | WHEC.com
Drug treatment counselors and police are seeing a surge in heroin addiction in Buffalo and across the state, much of it because of people switching from prescription painkillers like oxycontin and hydrocodone.
The Buffalo News reports that the Erie County crime lab was asked to test about 500 samples of heroin in 2010. Last year, the number had nearly tripled. Police said people they arrest typically started on pills prescribed by doctors, then started buying them on the street. Eventually they turn to heroin because it's cheaper.
The state attorney general's office is attacking the problem by targeting heroin traffickers with the state's "drug kingpin" laws. The office is also going after doctors who write illegal prescriptions.
State lawmakers have also passed a measure to block addicts from stocking up on painkillers.
Have a story you want our news team to investigate? Call us at 585-232-1010, click here to send us an e-mail or leave us a Facebook post or tweet.
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Hey all, I'm Zap, amateur cartoonist and experienced webcomicker. Thought I'd share some of my work. I've traditionally worked in pen and ink, as I'm colorblind, but I've recently begun to work digitally on the iPad. And hey...this is a Pokemon forum, right? Thanks for looking! More will follow!
GOD THESE ARE ALL WONDERFUL Seriously, the expressions of all your characters in the comics are freaking amazing. You are very talented with pen and ink, man, it's all awesome. Welcome to the Studio and hope you're here to stay!
Hello, and welcome to Smogon! Your art here is pretty impressive, and the expressions on each character are wonderful. That ghost's expression in the last panel was especially amazing, haha. Your pokemon art is also great, and I love how you've incorporated objects into the artwork for the pokemon to interact with. Join #smeargle on synIRC.net, for talking to the other notorious artists on Smogon :D Do you take requests? Also why does the robot say he doesn't have any emotions when he looks sad aaaaaaaaaaaaaaaaaaaaa
Hello! Like others said, your expressions for the characters are really top notch and the lineart is very clean as well. As for the colored ones, you have executed the shading nicely and the color choices are vibrant. As for the robot comics/secret base one, were they done digitally or did you use ink? And may I ask what colors you are blind too? Anyways, hope to see more!
The first ones are all pen and ink. The Secret Base bit is from my webcomic, Pixel. http://pixel.thecomicseries.com/ I've been doing that one in various incarnations off and on for over ten years, now, and this is the most recent reboot. As for colors, I have an extremely difficult time with reds and greens, blues and greens, and yellows and white. The flame on Charmander's tail on the lightbulb Pickachu is holding? The highlights were more or less crapshoots, as I can barely make out the difference in shading. My color work will likely be posterized like that all the time, as subtle blending pretty much escapes me. I focused on developing line quality and inking, which led to works like these. (Apologies for the photo quality, as this was simply too big to scan.)
Wow, these are awesome! I love the humour in the comics! BTW, how did you do the robot apocalypse comic? Was that inked or digital?
hello, welcome to smogon. i don't really have any particular comments right now, but these are all excellent pieces. i was going to comment on the charmander piece and how some established light sources should be affecting the colors around those areas, but i actually understand now since distinguishing greens may be difficult for you. :o what i pretty much just wanted to say was that i appreciate how you're jumping in on community stuff like the smeargle card project and mac. looking forward to seeing more.
All of your art great, and I don't know what it is about that Dialga but I really love its style and expression! Luvdisc'd
The comics are entertaining and funny. I love the pictures here. The colors fit so perfectly; almost like a copy of the pokemon's actual drawing. Great work. :)
Been awhile. Here's the pieces from last month's Smog, plus some other work. And this is something I've been working on lately.
You are really good with pokemon face expressions! You really know how to give a pokemon character. I really liked the Snorlax and Ditto pictures! Also, your comic strips are very cool. My favorite is the robot apocalypse strips. Keep up the good work! (Luvdisc'd! <3)
Took a real swing at digital painting, and came up with this. Plus, I've gotten back to work on my webcomic, Pixel. I've gone digital on that, too.


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DeGournay Wallpapers
Decals and other wall accents are all well and good for someone who wants to accessorize the rooms in their home, but for others, there is nothing better than the all-over design offered by wallpaper. DeGournay Wallpapers are all hand-painted, offering a level of both personalization and sophistication that is unmatched by other papers. In addition to the high-quality work, the designs are highly original, and while plainer, repeating patterns are available, DeGournay really shines through their scenescapes.


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Walk In The Rain - Walk in the rain,What better way,To enjoy a shower,When it's rainin',Your raincoat on,Breathin' the air,Enjoying the sound,It's oh so great,The feel,Invigorating.
2 Responses
May 18, 2012
I Love Dressing Up, Diving Into The Water, And Singing! - https://vimeo.com/50911663
If "Walkin' In A Winter Wonderland" sings to the beauty of falling in love int eh winter snow at Christmastime, then why not sing that lovely melody to the words of dressing up in fine clothes...
1 Response
Dec 20, 2012
I Find Walking In The Rain Therapeutic - I broke up with my boyfriend not that long ago. It wasn´t working, but I still loved him. I was sitting in my apartment that night when the sky opened up. I love the sound of rain, but that night, I didn´t want to just listen. I wanted...
2 Responses
Jul 15
A Walk In The Rain - I haven't walked in the rain in a long time and I miss it. I used to go out when it rained and walk. I really enjoyed it for the mood and playfulness of it. I hope to walk in the rain again. A dance might be nice too...with a kiss. Rain is sexy and clean and...
4 Responses
Nov 14, 2012
One Life's Priceless Moments -
you rarely have to worry about running into anybody. the world feels like it belongs to you. the smells and sounds of the rain washing away the dust of your life. distant thunder and/or lightening. i love it all. if you want to cry, it doesn't...
May 5, 2010
It's Raining ^^ - It's raing now...the rain make feel upset...i missing a person who nerver thinks about me. Sometime, i think everthing is not fair to me. I loved her so much but she never love me. I gave up...i can't forget :(
Sep 4, 2011
Heavy Rain! - Every time it rains heavy there is a spot where it turns into a waterfall off corner the roof. Shortly after work A storm was approaching It was kinda hot so I decided to cool off when the fast moving storm passed by. Did not even change out of my work clothing...
Jul 8
Wet Walks - Its amazing!(when i'm feeling like it ofcourse)
sometimes i even fold the umbrella & put it back in my bag,just because...
I love getting all wet & drippy.
I love the feeling of water running over my body.
I love going crazy with the puddles!
Its calming and exciting...
1 Response
Jan 4, 2011
Walking In The Rain. - I'm finding it hard to not to go for walks in the rain. Every time it starts raining and I'm not at work I'm out the door.A few days ago it started raining the heaviest I have seen it all summer. So I quickly put on shoes and ran out the door. It was so...
4 Responses
Aug 16, 2012
A Short Walk - The other day was finally off from work and it had been raining all week so was hoping for sure I'd be able to enjoy the rain today. Well my friend calls me up asking if I go with him to run a erran being the good friend I am I said yea he came for me and it...
Sep 12
The Best Date Ever - we decided to go for a walk on the ATV trails near where we lived we got about 3 miles out and it started to pour, not the warm gentle rain you see in the movies, i mean a true cold spring rain that feels like needles when it hits your skin. we sat under...
1 Response
Mar 21, 2012
Walk, Run, Whatever - no matter what pace i'm going at, there is nothing like a little rain (or a lot) to perk me up. it feels great!
2 Responses
Jun 24, 2008
Thorpe Park - i went to thorpe park with my mates yesterday and it was raining hard (secret smile) when we arrived it was raining really hard to we ran to the thorpe park megastore and we all bought ponchos. i was already wearing a umbro rain jacket and over trousers, that under...
Jun 29, 2012
I'm Not Crazy - I love to run around in the rain. It is fun. I love being like a kid again. It is something you will never grow out of.
4 Responses
Mar 14, 2008
This Walk.. The Will - Walking alone in these streets..
not sure where i' going but, i'll know when I get there.
Then, all the sudden... here comes the rain
coming down hard from the sky
falling to my face, making my eyes fill with tears...
Of remembered days like this.. when he...
Oct 1, 2011
The Sky Is Crying - I live in Scotland, so we get rain a lot. I like the rain, it's great to just run around in the rain, and feel like a 4 yr old again.
I like the rain because, it's peaceful and it's sad aswel because it's like the sky is crying, that's what I was always told...
1 Response
Sep 22, 2011
Beautiful Rain - I loved walking in the rain it was the most beautiful thing that I have every seeing the sound of it could put me to sleep and when I get back up I would just feel so happy!!! It makes me feel at one with my self I would feel more happyer whenit rain's but now it...
2 Responses
Nov 14, 2011
Reminds Me of Childhood - I think I like it because it was always something you weren't supposed to do. My mom would always tell me to come in because there was lightning or something to that effect, but storms never scared me. I loved to go splash in the water that...
Apr 24, 2008
Stress Release - I love to go out when i'm stressed or mad and walk in the little ark near my house, or sometimes I even just wander. I loved where I used to live because it rained a LOT and it was warm rain. kinda like a shower. i love to lay down somewhere and watch it...
4 Responses
Nov 29, 2007
Ocean Rain. - I went to the ocean today and had a walk on the shore, observed some shells and admired the rocks when the salty breeze of the ocean air started to mix with the scent of fresh rain and not long after, it started to slowly fall. I had an umbrella with me, as the sky...
1 Response
Feb 17, 2012
It's Liberating -
It's totally liberating. Especially if you just don't care about getting totally soaked.
Actually when I was a kid and it rained, I would go into my backyard and swing on our playset and then I'd come back inside totally sopping wet. Yeah, my parents totally...
2 Responses
May 29, 2010
Soaked Through - I often find myself wandering to and from various events, lectures, work. Most of all, I enjoy walking in the rain. Not just a bit of rain, but when it pours down like there is no tomorrow. It's almost exhilarating, getting absolutely soaked through. It makes me...
1 Response
Oct 25, 2011
Relaxing - It's this amazingly calm feeling that just rushes over you in the form of raindrops. To me it's like it's reflecting how you feel even when your not too sure yourself. Washing away the stress, the madness, and the hassle of everyday life. Just being careless and...
1 Response
Nov 27, 2007
Dancing In The Rain :) - i used to walk everywhere and when i did i often got caught in the rain i used to love 2 take the long way home so i could stay out in the rain. the feeling of that new fresh water falling from the sky onto my skin its so refreshing i can breath a little...
1 Response
Aug 12, 2012
Walking In the Rain - When I lived in Florida it rained every afternoon every summer. When I was a child, it was just rain. When I got older, it was almost like a cleansing. If I was alone when I was in the rain, I just invisioned all the badness in my life washing away. If I was...
May 18, 2008
I Like To Walk In The Rain - Walking in the rain is nice and refreshing sure you can get soaked some but so what? I like walking in the rain.
1 Response
Jan 17, 2012
First Love - First Love
I ne'er was struck before that hour With love so sudden and so sweet, Her face it bloomed like a sweet flower And stole my heart away complete. My face turned pale as deadly pale. My legs refused to walk away, And when she looked, what could I ail? My...
Aug 14, 2012
Summer Rain Storm After Work -
Years ago, I lived in the southeast. Summers were hot, humid, and at times, very wet due to heavy rain and/or thunderstorms which could dump an inch of water in just a few minutes. I worked in the banking industry at the time. ...
8 Responses
Mar 31, 2010
Walking the Dog - it's ok, before any animal cruelty people start bashing me for taking my dog out in the rain - she loves it too. she tries to catch the drops as they bounce off the pavement.
just last week, on a beautiful sunny day, we went to our local forest preserve...
3 Responses
Jul 1, 2008
Frets Be Hurtin - Alright so on this past Wednesday it was pouring like crazy. I decided to go jogging in a wife beater and some underpants, cuz you know I'm ******* crazy. I went to our local park that was flooded due to the 6inches of rain that made puddles up to three feet...
Oct 4
Middle Of The Night... - It's been raining buckets lately where I live, and I am so in love with it. A few nights ago, it was pouring down so hard it was impossible for me to sleep, so instead of trying to catch a few elusive winks, I went out onto my back patio, in all my...
3 Responses
Jul 25, 2011
Not Today.. - I waken up by the sound of rain hitting against my windows. At first it sounded like hail, but when I peaked out the window, I discovered it was rain. Instantly I knew today was going to be a bad one. Don't get me wrong, I adore rain, but whenever it did rain, my...
1 Response
Oct 22, 2012
Rain - I like when it rains I wish it would rain everyday I also like the fog,
2 Responses
Oct 6
Stellar Rain - It was one of those warm spring nights... It happened to be pretty late that evening. He was walking me home after a great but eventful night... I lived just down the street. It had been an overwhelming two weeks but we were both feeling the same.He had been an old...
1 Response
Nov 22, 2011
It's Refeshing... - I like a gentle shower to walk in where you dry as fast as you get wet. I don't really like torrential downpours where you're wet in 2 seconds and you look like a cat that fell in the bathtub. Just a nice stroll in the rain, trying not to step on all the worms...
6 Responses
May 26, 2009
My Puppy Use To Love The Rain - One thing always mezmarized me growing up here in the Rocky Mountains and that was the rainstorms. I would sit for hours and watch the thunder and lightning and just getting out in the rain. I just recently lost my little buddy after 14 years and...
1 Response
Jul 23, 2012
Soaked In The Woods - My wife and I were walking back along a trail in the Great Smoky Mountains National Park when we could see a wall of rain moving through the woods. We saw no reason to hurry since we were still at least a mile from our car. We were soaked almost...
3 Responses
Dec 15, 2009
Rain And Emotions - Small drops of silver lines are drawn in the black velvet paper - that's how rain was pouring today, the light from the street lamps made the silver lines visible. Rain is such a wonderful companion, it can celebrate your joy, when your happy and it can cry...
1 Response
Jun 28, 2012
Not Bothered - I can't ever be bothered to run, just take it you wimps!! The rain won't melt you!! Anyway, I love to walk in the rain and feel the rain pounding down on me, so long as I avoid the places you can get splashed by the cars, then it's enjoyable.
1 Response
Nov 28, 2007
Water - The rain splattered against the window, easy at first, but growing steadily fiercer. It came in gusts sometimes, blasts of it smashing hard against the window before returning to a steady pattering against the glass. It rolled down to the pane where it continued to roll...
2 Responses
Oct 1, 2012
Liberation - Walking in the rain is simply one of the most surreal, liberating experiences one can have. Oftentimes, people avoid being in the rain for trivial reasons of not wanting to get sick or be cold. But let's face it: if you're cold, you can put on a jacket and drink some...
1 Response
Feb 6
It's Been A Long Time... -
...but out in warm summer rain, barefoot, splashing in puddles in the yard.
Nothing else like it...
1 Response
Mar 31, 2010
Washed In The Rain! - It had been raining in since the past few days. However today looked absolutely nice and sunny. It was a nice day, so i decided to go out shopping with my grand mother. I blew dry my hair, put on some eye makeup, painted a peach pout, wore a frilly skirt...
2 Responses
Jul 18, 2011
An Amazing Walk - Went for a walk today just to clear my head. It was really hot outside and then suddenly little drops of rain started falling. I didn't even think about turning back. It felt so good to feel the cold rain on my skin, I just couldn't stop smiling. I returned home...
1 Response
Jun 8, 2012
Love By Eyes - A Person who talked with me by his eyes....He offered me by his eyes......but I did'nt want to fall in love....but suddenly i fall in love & started to talk with him by eyes.....Our love was going by this way......we never talked by mouth....And He never...
Sep 30, 2011
Wolf's Rain After Paradise Part 3 - again, the shortened version.
Toboe walked out of the sweet shop, and started to scoff down sweets as fast as he could. These luxuries were rare, and he needed to eat. It was raining, but he didnt seem to mind. The gobstopper was melting in...
Nov 23
Walking Without An Umbrella In The Pouring Rain - I tend to shield myself with an umbrella or hood. But then there comes a day where I just want to take the full impact of the rain.
One might speculate that I feel like a complete idiot leaving shelter and stepping out into the...
Nov 27
I absolutely love the rain. I grew up in India, where it rains so much that we have a separate season for it. We would run outside every time it rained and dance and make paper boats in the puddles. I live in California now where it rarely rains and its killing me.
2 Responses
Dec 1
I Love Rain But - it's currently raining out, it's been raining all day. I love the smell, the feel, everything. although, I hate being alone on days like this.
1 Response
Nov 21
Evening Rain - At home, all is quiet, listening to the rain. All is good on nights like this.
2 Responses
Nov 27
I love walking along the beach, hand in hand with the one you love, the sun setting behind the waves, water lapping your feet and the crisp smell of the salt water in the air, even better if the beach is deserted, not a care in the world, safe in each others arms.
1 Response
Dec 5
I love when it rains...I love the smell of the rain,like the world is being cleansed of it's dirty sins.like everything is becoming fresh and renewed.like a tshirt fresh out the wash and about to be air dried.like for a minute everything that was once tainted can change...I love...
Dec 4
Drip Drop Drip... - Whenever the rain falls I stand up and gaze out the window. The sky is always a bright gray. I watch as it pours over the trees, hugs the grass, and cover the streets. It almost makes me want to cry.
I remember when I was 14. I lived in northern Arkansas. It...
Nov 19
It's raining. The winds blowing. I'm home alone and laying in the dark. These are the moments that I'll always remember. <3 feels like rain. <3 I love when the rain hits the roof and makes a trinkle sound :)
6 days ago
I love it when it rains in hawaii! Since it's so freckin hot here! When starts to rain it a treat from Mother Nature! Currently laying in bed cuddling with my blanket
2 Responses
Dec 2
The rain is where I feel most at peace with myself. If I could I would stand in the rain close my eyes and take it all in. I love how it feels against my face. It almost helping my forget what I was feeling.
Dec 4
It doesn't rain much in Texas, but I love it. Grey overcast days are my favorite.
2 Responses
3 days ago


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text:
MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C82B81.485B7CF0" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C82B81.485B7CF0 Content-Location: file:///C:/A3894633/Rhytidectomy-071003.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"
TITLE: The Aging Face and Complications of Rhytidectomy<=
SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology
DATE: October 3, 2007
FACULTY PHYSICIAN: Francis B. Quinn, Jr., MD
SERIES EDITORS: Francis B. Quinn, Jr., MD
material was prepared by resident physicians in partial fulfillment of
educational requirements established for the Postgraduate Training Program =
the UTMB Department of Otolaryngology/Head and Neck Surgery and was not
intended for clinical use in its present form. It was prepared for the purp=
of stimulating group discussion in a conference setting. No warranties, eit=
express or implied, are made with respect to its accuracy, completeness, or
timeliness. The material does not necessarily reflect the current or past
opinions of members of the UTMB faculty and should not be used for purposes=
diagnosis or treatment without consulting appropriate literature sources and
informed professional opinion."
Aging is a normal and ubiquitous process of life= . The effects of aging on the face m= ay carry the persona of being unattractive, undesirable, and helpless. Within a society which values yout= h and a youthful appearance, many desire to restore a younger form to disconnect = from the connotations associated with aging.&nb= sp; For these reasons, facial cosmetic surgery and facial rejuvenation procedures have become popularized. With an aging population, procedures that aim to restore a youthful appearance will increase in demand. The purpose of this review is to understand the process of aging upon the face and the complications associated with rhytidectomy.
Aging Face
Facial anatomy is composed of three essential
elements. The skin serves as a
protective barrier and varies by pigmentation, texture, elasticity, thickne=
and hair distribution. The
underlying soft tissue and fascia contains the musculature and neurovascular
supply. The bony and cartilag=
skeletal elements provide the basic shape of the face. In aging, elasticity of skin becom=
weakened and its texture and pigmentation changes due to inherent and
environmental effects. Over t=
the distribution of collagen loses its organized pattern. Additionally, there is resorption =
remodeling of the underlying skeletal elements of the face with aging which
replace the softer curves in youth.
Age is the most significant factor determining facial structures.
From a histologic perspective, the epidermis and subcutaneous fat thins and redistributes during the aging process which contribute to rhytid formation. Additionally, there is effacement of dermal-epidermal junction which leads to a flattened rete ridge pattern.&n= bsp; Elastosis is the progressive loss of organization of elastic fibers = and collagen and is another finding during aging. Finally, there is weakening of the underlying facial mimetic muscles which may result in the sagging appearanc= e of skin folds.
The appearance of aging upon the face begins from
youth and there are distinct changes that may be identified as one ages.
Aging of the nose may be exhibited by thinning a= nd weakening of the nasal skin, bone, muscle, fibrous tissue and cartilage with visible underlying nasal skeleton and tip ptosis. There may be separation of the upp= er and lower lateral cartilages resulting from splaying of the fibrous attachments= at the scroll. Narrowing of the = nasal valve from weakened cartilage is not uncommon. Midfacial aging results in l= oss of orbicularis oculi muscle tone and descent of malar soft tissue. This results in an illusion of exc= ess fat in the lower eyelid. Additionally, the nasolabial crease deepens.
The lower third of the face also has prominent age-related changes. There is= chin ptosis, resorption of mandibular height, thinning of subcutaneous fat with excess skin resulting in jowl formation.&n= bsp; There is platysmal banding, and loss of the youthful cervicomental angle, and submental fullness. Laxity of the platysma accounts for the formation of paramedian vert= ical bands in the neck, and ptosis of the platysma leads to enhancement of jowli= ng.
The Superficial Musculoaponeurotic System is a fibromuscular fascial extension of the platysmal muscle that arises superio= rly from the fascia over the zygomatic arch and is continuous in the inferior c= heek with the platysma. It was des= cribed in 1976 by Mitz and Pyronie in a landmark paper. The branches of the facial nerve l= ie deep to the SMAS. The functio= n of the SMAS is to transmit the activity of the facial mimetic muscles to the facial skin. Posteriorly, the= SMAS fuses with the fascia overlying the sternocleidomastoid muscle, but it is a distinct layer superficial to the parotid fascia. Anterosuperiorly, the SMAS invests= the facial mimetic muscles of the mid-face (i.e., orbicularis oculi, zygomatic major/minor, levator labii superioris).&nb= sp; Anteriorly, the SMAS invests the superficial portions of the orbicul= aris oris and gives off fibrous septae that insert into the dermis along the melolabial crease and upper lip.
Facial Nerve
The anatomy of the extracranial facial nerve (FN= ) is important when considering surgery upon the face. The facial nerve is protected by t= he parotid after it exits the stylomastoid foramen. Its lower divisions are deep to the masseter fascia and there is a potential space between the SMAS and masseter fascia in the inferior cheek. This is an important factor when considering deep/composite rhytidectory techniq= ues. The temporal branch is the most superficial division of the FN. It crosses the junction of the anterior 1/3rd and posterior 2/3rd of the zygomatic arch. Above = the arch, it travels in the temporoparietal fascia to innervate the frontalis a= nd orbicularis oculi muscles. The marginal division descends from the inferior parotid to 1-2cm below the mandibular body and returns above the inferior border of the mandible anter= ior to the facial artery.
Complication of Rhytidectomy: Hematoma
Although there are multiple approaches to rhytid= ectomy that are beyond the scope of this Grand Rounds, the surgeon must understand= the complications which may result from this operation. Hematoma formation is the most com= mon complication and has an incidence from 1-15%. Its consequences may be partial sk= in flap loss, infection, pigmentary changes, persistent facial edema, prolonged convalescence, and scarring. = Major expanding hematomas occur within 24 hours of the operation and early signs = may include sudden sharp pain followed by swelling and ecchymosis. There may be hardening or tightnes= s of the skin, trismus, anxiety and dyspnea.&nb= sp; Late signs include swelling and discoloration of the lips and buccal mucosa. 1.9%-3.6% of large hematomas require an operative intervention. Prevention and early recognition a= re keys to the management of hematomas. A compression dressing may provide = the pressure needed to prevent the development of a hematoma. Aspiration and evacuation of hemat= omas when they are detected is essential to prevent the sequelae of this complication. Persistent ecch= ymosis and prolonged edema usually resolves after treatment of the hematoma without compromise to aesthetic result.
Complication of Rhytidectomy: Hematoma
Risk factors to the development of hematomas fol= lowing rhytidectomy have been studied. The detection and management of preoperative and postoperative hypertension has been found be an effective measure to prevent hematomas. In a study by Berner et al. in 197= 6, preoperative and postoperative BP within the first 2 hours of operation were found to be similar, but reactive hypertension was found in the subsequent 3 hours and medications were less effective in this period, and pain and anxi= ety had an affect on BP. Striath = et al. in 1977 found a 9.2% hematoma rate in 500 rhytidectomies when systolic BP preoperatively was greater than 150 mm Hg.= Recently, Grover et al. in 2001 conducted a multivariate analysis of 1078 rhytidectomies and found a strong association of hematoma formation wh= en preoperative SBP was greater than 150 mm Hg.
Several retrospective studies have found a great= er incidence of hematomas in males. Baker et al. in 1977 found a major hematoma rate of 8.7% in males an= d an overall rate of 3.26% in 137 men who underwent rhytidectomy. Lawson et al. in 1993 found a hema= toma rate of 9.6% in 115 males. Gr= over et al. in 2001 found a 12.9% incidence in males and 3.6% in females. This finding may be related to inc= reased blood supply to bearded skin and greater sebaceous glands in males.
The use of aspirin or other non-steroidal anti-inflammatory is also associated to the development of hematomas. Grover et al. found a higher hemat= oma rate in individuals that used ASA/NSAID within 2 weeks of rhytidectomy. Other agents that may increase ris= k for hematoma formation include Vitamin E, Ginkgo, ginger, ginseng, and garlic.<= /p>
The deep-plane technique was studied by Kamer et= al. in 2000. In 451 rhytidectomie= s, there was an incidence of 2.2% of major hematomas and 6.65% incidence of mi= nor hematomas. These all occurred= in the subcutaneous plane.
The use of general anesthetic was studied by Ree= s et al. in 1994 in 1236 rhytidectomies. This study concluded that general anesthetic is not a risk factor for the formation of hematomas as there was a 1.1% rate of hematomas in the gen= eral anesthetic group and 0.9% in the conscious sedation group. The use of a suction drain prevent= s the formation of seromas, but has minimal impact on the formation of hematomas according to a study by Perkins et al.&nbs= p; The use of fibrin glue has also been studied by several studies. These studies by Marchac et al., G= rover et al., and Fezza et al. do not provide evidence that fibrin glue prevents = the formation of hematomas.
Complication of Rhytidectomy: Nerve Dysfunction
There is risk of injury to sensory and motor ner= ves from rhytidectomy. The most c= ommon nerve injury is to the great auricular nerve with an incidence of 1-7%. When transected, it should be repa= ired with 10-0 nylon perineural sutures. Injury to the lesser occipital nerve may also be encountered. For this reason, dissection poster= iorly should remain in a subcutaneous plane.
Facial nerve deficits from paresis to complete paralysis have an incidence of 0.3%-2.6%.&= nbsp; In a study by Baker of 7000 rhytidectomies, there was a 0.7% inciden= ce of paralysis with 0.1% of permanent paralysis. The marginal mandibular division w= as found to be most commonly affected followed by the temporal branch. Neuropraxia, heat injury, needle i= njury, and inadvertent transaction are the main causes of FN injury.
The region from the mandibular angle to the faci= al artery is where injury may occur during dissection, and it is more commonly injured when dissection is performed to correct platysmal laxity. Presence of platysmal atrophy or hypoplasia may increase the risk of potential injury, as well as in revision rhytidectomy procedures. The temporal branch of the FN is at risk when a forehead or brow procedure is combined with rhytidectomy. F= or this reason, forehead procedures should remain subgaleal at the level of the superficial layer of the deep temporal fascia to avoid injury. The buccal division of the FN is a= t risk of injury from subperiosteal dissection for midface-lift. During this procedure, the dissect= ion from periosteum along the inferior border of the zygoma requires transition over the masseter tendon near the buccal branch. A sub-SMAS dissection over the che= ek also places the buccal branch at higher risk than a more superficial dissection.
Complication of Rhytidectomy: Skin Flap Necrosis
Compromise to the vascular supply to the skin and ischemia from vascular congestion may result in necrosis of the elevated sk= in flap. This may result from an unrecognized and untreated hematoma. The use of tobacco has been associated with a 12 time greater risk of skin flap necrosis. For this reason, smokers should be counseled for smoking cessation for several weeks prior to and after the procedure. Other causes of skin flap necrosis include an underlying vasculitis, injury to the subdermal vascular plexus and excessive tension at the closure. The incidence of ski= n flap necrosis is 1.1%-3%. The most common region of skin flap necrosis is in the postauricular region where the flap is the thinnest and closure is under tension with the most distal arte= rial supply. Conservative manageme= nt for partial-thickness skin flap necrosis is appropriate with local wound care.<= span style=3D'mso-spacerun:yes'> This usually heals with little or = no visible scarring or with hypopigmented scar.
Complication of Rhytidectomy: Scars
Scarring from rhytidectomy usually occurs in the postauricular region. This ma= y also occur in regions where the skin closure is under the greatest tension. Scars are usually evident at 12 we= eks postoperatively and serial local steroid injections may diminish their appearance. The use of approp= riate incisions in regions to camouflage the surgery also minimize the appearance= of scarring.
Complication of Rhytidectomy: Hair Loss
Alopecia may occur along poorly placed incisions= or in regions where the skin flap elevation is too superficial. Hair loss has an incidence of up to 8.4%, and 1%-3% require surgical revision.= This most commonly occurs the temporal region of the hair-bearing scalp. Heat injury due to cau= tery and excess tension also contribute to hair loss from rhytidectomy. This complication may be prevented= with carefully planned incisions respecting the hair follicles and minimizing the use of cautery with appropriate closure technique.
Minoxidil is an agent used for alopecia and has = been studied as a preventative medication following rhytidectomy. Eremia et al. conducted a restrosp= ective review of 60 rhytidectomies in 2002 and found that there was no incidence of permanent alopecia and temporary alopecia was found in 1.7% of cases.
Complication of Rhytidectomy: Pixie Ear Deformity
Excessive skin excision at the earlobe or excess= ive tension across the skin incision may result in the pixie ear deformity. This form of deformity may also oc= cur from inappropriate closure technique following parotid surgery. This may be avoided by incising th= e flap prior to the SMAS dissection or placement of suspension sutures.
Complication of Rhytidectomy: Infection
Postoperative infection following rhytidectomy is relatively uncommon with incidence of about 1%. Leroy et al. reviewed 6166 rhytidectomies and found an incidence of 0.18% of postoperative infections = that required hospitalization. The infections usually occurred within the first postoperative week and the most common organisms cultured were Staphylococcus and Streptococcus. These infections improved with intravenous antibiotics and incision and drainage. Of note, the majority of these infections had been prescribed postoperative antibiotics empirically.
Complication of Rhytidectomy: Parotid Injury
Parotid injury from rhytidectomy procedures is r= are with appropriate dissection. = It is more common in sub-SMAS dissection techniques and may delar healing with possible formation of a salivary pseudocyst. This may be prevented by cauteriza= tion of exposed ductules if noted during the dissection. Serial aspirations and compression= dressings with use of anti-sialogogues or Botox injections may be used when appropria= te.
Complication of Rhytidectomy: Pigmentary Changes
Individuals with darker complexions (Fitzpatrick= types IV-VI) have a higher risk of hyperpigmentation postoperatively. This may persist for months, but gradually fades. For this rea= son, appropriate preoperative counseling is important along with avoidance of sun exposure and use of sun block and cosmetics. Telangectasias may develop in prone individuals in areas of dissection.
Complication of Rhytidectomy: Depression
An important postoperative complication that mus= t be considered in individuals with either a pre-existing mood disorder or chang= e in mood postoperatively is depression. Short term situational depression occurs in 30% of women following rhytidectomy. Onset of depres= sion occurs within the first postoperative month and is related to the individual's unnatural appearance.&n= bsp; Management of depression includes reassurance and possibly a short course of an antidepressant. Consultation with a psychiatrist may be required for some patients.<= /p>
Complication of Rhytidectomy: Deep Vein Thrombosis and Pulmonary Embolism
DVT and PE account for up to 5% of postoperative morbidities. Reinisch et al. conducted a review of 9937 rhytidectomies and found a 0.49% incidence of thromboembolic complications (0.35% DVT and 0.14% PE). 83.7% of all patients had general anesthesia. A decreased incid= ence was found in patients in whom sequential compression devices were used.
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