text:
Robert Raschke
Steven Curry
Silke Remke
Ester Little
Richard Gerkin
Richard Manch
Alan Leibowitz
Banner Good Samaritan Regional Medical Center, Phoenix, AZ
Reference as: Raschke R, Curry S, Remke S, Little E, Gerkin R, Manch R, Leibowitz A. Arterial ammonia levels in the management of fulminant liver failure. Southwest J Pulm Crit Care 2011;2:85-92. (Click here for PDF version)
Previous studies have suggested that an arterial ammonia level greater than 150 mmol/L is highly sensitive for predicting subsequent development of cerebral edema in patients with fulminant liver failure. We performed a prospective cohort study to confirm this relationship. We enrolled 22 consecutive patients who presented to our transplant hepatology service with grade 3-4 encephalopathy associated with fulminant liver failure. All patients underwent placement of an intraparenchymal ICP monitor, and every 12 hourly arterial ammonia levels. The prevalence of intracranial hypertension (IHTN) in our population was 95% (21/22 patients), with 82 discrete episodes recorded. The sensitivity of arterial ammonia levels to predict the onset of IHTN was 62% (95% CI: 40.8 to 79.3) at a cut point of 150 mmol/L. Arterial ammonia levels preceding the first intracranial hypertension event were less than 150 mmol/L in 8 of 21 patients (39%). Fifty nine of 82 episodes of IHTN (73%) occurred when arterial ammonia levels were less than 150 mmol/L. We conclude that the arterial ammonia level is not useful in making decisions regarding management related to cerebral edema in patients with fulminant liver failure. In fact, since almost all our study patients with grade III or IV encephalopathy secondary to fulminant liver failure went on to develop intracranial hypertension, our study supports the contention that all such patients might benefit from ICP monitoring regardless of arterial ammonia levels.
Cerebral edema is the most common cause of death in fulminant liver failure (FLF) (1,2), occurring in 80% of patients with advanced encephalopathy (3). Cerebral edema causes brain injury by compromising cerebral perfusion pressure and/or by causing cerebral herniation. Intracranial hypertension (IHTN) is the most reliable sign of cerebral edema, and is defined as an intracranial pressure (ICP) greater than 20 mmHg (4-6). Many authors have recommended ICP monitoring in FLF to guide management of cerebral edema (7,8) although this procedure entails significant hemorrhagic risk (9,10).
The pathogenesis of cerebral edema in FLF is likely multifactorial, but substantial evidence supports a causal role for hyperammonemia. Elevated ammonia levels alter neurotransmitter synthesis, and interfere with mitochondrial function causing oxidative stress and neuronal apoptosis (4,5,6,11-16). Increased delivery of ammonia to astrocytes provides substrate for the accumulation of intracellular glutamine (17-18). The resulting osmotic effect causes astrocyte swelling and cerebral edema (6,7,19). Clinical studies have repeatedly shown that arterial ammonia levels around 150 mmol/L have a statistically significant association with the development of IHTN and cerebral edema in humans (8,20-22).
Clemmensen and colleagues (8) measured arterial ammonia levels at the onset of grade III encephalopathy in 44 patients with FLF. Fourteen of those patients subsequently developed cerebral herniation. The patients who developed cerebral herniation had significantly higher mean arterial ammonia levels (230 vs. 118 μmol/L P<0.001), and all had ammonia levels > 146 μmol/L. At this cut point, arterial ammonia had a sensitivity of 100%, a specificity of 73% and a PPV of 64% for the subsequent development of cerebral herniation (8).
The results of this study raised the possibility that arterial ammonia levels could be used to select FLF patients likely to benefit from ICP monitoring. If arterial ammonia levels above 146 μmol/L were highly sensitive for predicting the development of IHTN, patients with arterial ammonia levels below this threshold would not likely benefit from ICP monitoring, therefore the significant hemorrhagic risk of monitor placement could be avoided (20,23).
The primary aim of our study was to confirm this premise by reassessing the sensitivity of the arterial ammonia concentration for predicting the onset of intracranial hypertension (IHTN). We chose IHTN as our dependent variable since cerebral herniation is uncommonly seen in patients managed with our neuroprotective treatment protocol (24), and because intracranial hypertension can cause brain injury by compromising cerebral perfusion in the absence of herniation. The secondary aim of our study was to determine whether following serial arterial ammonia levels are valuable in predicting the timing of recurrent IHTN episodes before and after liver transplantation.
A prospective case series was approved by the Institutional Review Board at Banner Good Samaritan Regional Medical Center, a 650 bed community teaching hospital in Phoenix Arizona. The Transplant Hepatology service identified consecutive patients admitted with FLF, as defined by standard criteria (20) between May 2004 and September 2006. All patients underwent serial neurological examinations by an intensivist, and those who developed grade 3-4 encephalopathy were evaluated for study participation. Eligible patients' families were asked to provide informed consent.
Serial arterial ammonia levels were obtained in study patients. An arterial catheter was placed and 5 cc of arterial blood was drawn into a sodium heparin-containing tube every 12 hours. These samples were transported to the chemistry laboratory on ice within 30 minutes. Quantitative plasma ammonia concentrations were performed using an enzymatic kinetic assay (Roche Diagnostics, Mannheim Germany). This assay has a reportable range of 5.87-587 mmol/L and a coefficient of variability of 2%.
An intraparenchymal ICP monitor (Codman MicroSensor® - Codman/Johnson & Johnson Professional, Inc., Randolph, MA) was placed in the non-dominant frontal lobe under local anesthesia by a neurosurgeon. The ICP was monitored continuously thereafter. Hemostatic therapy and ICP management used in the study have been previously described (24). ICP monitors were removed post-transplantation when the patient could tolerate lowering of their head to zero degrees without precipitating IHTN. In patients who did not undergo transplantation, ICP monitors were removed upon clinical recovery or death.
Our main independent variable was the arterial plasma ammonia level. Our main dependent variable was intracranial hypertension, defined as an ICP > 20 mmHg for > 20 mins. We performed 3 separate sets of analyses to examine the relationship between arterial ammonia levels and IHTN: 1) we analyzed the arterial ammonia level that most closely preceded the onset of the first episode of IHTN in each patient; 2) we analyzed all arterial ammonia levels in relation to all episodes of IHTN; and 3) we analyzed all arterial ammonia levels in relation to all episodes of IHTN occurring post liver transplantation. The second and third analyses involved data values that were not independent of each other, therefore standard statistical techniques were not appropriate and time series analysis was performed. Statistical analyses were performed using SPSS 13.0 (SPSS Inc. Chicago IL.) Operating characteristics of arterial ammonia levels were calculated at a cut point of 150 mmol/L.
Twenty two patients were entered – their clinical characteristics at study entry are listed in Table 1.
Table 1: Patient Characteristics:
Mean age:
32.7 years (S.D. 10.3 yrs, range 15-56)
17/22 (77%) female
acetaminophen toxicity (12 patients)
hepatitis A (3)
hepatitis B (1)
anticonvulsant hypersensitivity syndrome (1)
sulfa hypersensitivity syndrome (1)
Wilson's disease (1)
Cryptogenic (3)
Encephalopathy grade:
8 patients (36%) Grade III
14 patients (64%) Grade IV
Our 22 patients cumulatively underwent 3252 hours of ICP monitoring. Mean monitor duration was 147.8 +/- 143.3 hours. Monitors were left after liver transplantation in nine patients for 85.6 +/- 60.6 hours.
The prevalence of IHTN in our population was 95% (21/22 patients). Eighty-two discrete episodes of intracranial hypertension occurred. 62 occurred prior to, 4 during, and 16 after liver transplantation. The peak ICP during IHTN events was 33 +/- 13 mmHg (mean +/- S.D.) and the median duration was 60 minutes.
Relationship between arterial ammonia levels and the first episode of IHTN: The mean arterial ammonia level preceding the first intracranial hypertension event in each patient was 185 +/- 67 mmol/L (range: 96 – 337 mmol/L). The sensitivity of arterial ammonia levels to predict the onset of IHTN was 62% (95% CI: 40.8 to 79.3) at a cut point of 150 mmol/L. Arterial ammonia levels preceding the first intracranial hypertension event were less than 150 mmol/L in 8 of 21 patients (39%). We could not accurately calculate specificity or area under the receiver operator curve (AUROC) since only one patient did not develop IHTN.
Relationship between arterial ammonia levels and all episodes of IHTN: The mean arterial ammonia levels just prior to each of the individual 82 episodes of IHTN were 122 +/- 80 mmol/L (range: 15 – 270 mmol/L). Fifty nine of 82 episodes of IHTN (73%) occurred when arterial ammonia levels were less than 150 mmol/L.
Relationship between arterial ammonia levels and all episodes of IHTN occurring post liver transplantation: Nine patients underwent liver transplantation. Seventy-nine ammonia levels were obtained post-liver transplantation in these patients. Four transplant recipients experienced 16 post-operative IHTN events. The mean arterial ammonia just prior to each of these events was 70 +/- 48 mmol/L (range: 15 – 161 mmol/L). The sensitivity of the arterial ammonia level preceding each IHTN event was 13% and the specificity was 100% at a cut point of 150 mmol/L. Arterial ammonia levels were statistically lower in post-transplant IHTN episodes than in pre-transplant episodes (P<0.001).
Our study showed that almost all patients with grade III or IV encephalopathy secondary to fulminant liver failure will develop intracranial hypertension – this supports the possible benefit of intracranial pressure monitoring in all such patients regardless of arterial ammonia levels. Although the high prevalence of IHTN in our study population prevented us from calculating the specificity of arterial ammonia levels, sensitivity is the key characteristic of this test in terms of our research question. Our study shows that arterial ammonia levels > 150 mmol/L are not sensitive for subsequent development of IHTN, and therefore should not be used to identify a subset of patients unlikely to benefit from ICP monitoring.
Our study did not confirm the clinical utility of arterial ammonia levels in predicting neurological injury in patients with FLF, as suggested by Clemmensen et al (8). This could be because the clinical event of interest in the two studies differed – Clemmensen focused on cerebral herniation, and we measured IHTN directly. Cerebral herniation occurred in 14 of Clemmensens' 44 patients, but it was not observed in our patients. Our study utilized a management protocol specifically designed to prevent cerebral herniation (24). It is unknown how many of our patients with IHTN would have gone on to herniate if IHTN had not been detected and aggressively treated.
Several other studies have examined the predictive value of arterial ammonia levels for cerebral edema and IHTN in patients with acute liver failure. Bernal and colleagues studied 165 patients with acute liver failure and grade 3-4 encephalopathy and found that arterial ammonia on admission was higher in those who later developed IHTN (121 vs 109 mmol/L p<0.05 (20). However, the sensitivity of an ammonia cut-point of 150 mmol/L was only 40%, and the positive predictive value (probability that a patient with ammonia > 150 mmol/L would develop IHTN) was only 16%.
Bhatia and colleagues studied 80 patients with ALF, 58 of whom had grade 3-4 encephalopathy (21). They calculated an optimal cut-point for arterial ammonia for predicting mortality was 124 mmol/L by ROC analysis. Patients with ammonia levels above this cutpoint had a higher frequency of cerebral edema (47% vs. 22% P=0.02). Sensitivity and positive predictive values can be calculated from data presented in their paper, and are 71% and 48% respectively.
Our results confirm those of Bernal and Bhatia in that all 3 studies showed that the operating characteristics of the arterial ammonia test are insufficient for triaging ALF patients in regards to invasive ICP monitoring. But our study has several important differences. IHTN or cerebral edema was detected in only 29% of Bernal's patients and 35% of Bhatia's. Both studies relied heavily on physical examination to diagnose these outcomes despite evidence that it lacks the sensitivity to do so (1,3,25-27). Our study utilized the gold standard (ICP monitoring) in all our patients. We found a much higher prevalence of IHTN – 95% in patients with grade 3-4 encephalopathy. This high prevalence explains the higher positive predictive value in our study, and suggests that previous studies may have suffered from significant underdetection of IHTN and cerebral edema.
Our study is also unique in that we performed repeated measures of arterial ammonia. This was important in terms of our hypothesis that patients' risk for IHTN might change over time in response to treatments such as lactulose, continuous renal replacement therapy, and liver transplantation. Unfortunately, we found that repeated measures of arterial ammonia were no more clinically useful than the single levels used in previous studies.
Our study has several important limitations. Our limited sample size produced wide confidence intervals about our estimation of sensitivity. Our study only included patients with advanced encephalopathy - it's possible that arterial ammonia levels might demonstrate improved prognostic significance earlier in the course of FLF. We did not attempt to analyze the effect of cumulative ammonia exposure over time.
Our findings, and those of previous investigators, suggest that other factors besides peak ammonia levels are important in the pathogenesis of FLF-induced cerebral edema. Two other proposed causative factors are pathological alterations in cerebral blood flow (28-32) and systemic inflammatory response (30,33-34). The interplay of all three factors may be critical to the pathogenesis of cerebral edema in FLF and this might explain why simple measurement of serum ammonia is not sufficient to predict IHTN.
Further work is needed to elucidate the pathogenesis of IHTN in FLF and identify variables that predict which patients will develop this life-threatening complication. Until then, we suggest that all patients with grade 3 or 4 encephalopathy secondary to FLF are at high risk. Our study shows that arterial ammonia levels in these patients cannot be relied upon to accurately triage patients in regards to their risk for IHTN. Thus, it is not helpful in determining which patients might benefit from ICP monitoring, nor determining when ICP monitoring can safely be discontinued.
An arterial ammonia level of 150 mmol/L is poorly sensitive for determining which patients with ALF will develop IHTN and should not be used to determine which patients are likely to benefit from ICP monitoring. The prevalence of IHTN in FLF patients with grade 3-4 encephalopathy is so high that no other predictive test is likely to be of added value. Although arterial ammonia levels are correlated with episodes of IHTN, most individual IHTN episodes occur when arterial ammonia levels are < 150 mmol/L. After successful transplantation IHTN events can continue to occur even as ammonia levels enter the normal range.
1. Lee WM. Management of acute liver failure. Semin Liver Dis 1996; 16:369-378.
2. Ellis AJ, Wendon J. Circulatory, respiratory, cerebral and renal derangement in acute liver failure: pathophysiology and management. Semin Liver Dis 1996; 16: 379-389.
3. Gill R., Sterling R, Acute Liver Failure. Journal of Clinical Gastroenterology 2001; 33 (3.:191-198.
4.Blei AT, Brain edema and portal-systemic encephalopathy. Liver Transplantation. 2000;6(Suppl 1.:S14-S20.
5. Kato M, Hughes RD, Keays RT, Williams R. Electron microscopic study of brain capillaries in cerebral edema from fulminant hepatic failure. Hepatology. 1992;15:1060-66.
6. Blei AT, Olafsson S, Therrien G, Butterworth RF. Ammonia-induced brain edema and intracranial hypertension in rats after portacaval anastomosis. Hepatology. 1994;19:1437-44.
7. Takahashi H, Koehler RC, Brusilow SW, Traystman RJ. Inhibition of brain glutamine accumulation prevetns cerebral edema in hyperammonemic rats. Am J Physiol. 1991;261:H825-H829.
8. Clemmessen JO, Larsen FS, Kondrup J, Hansen BA, Ott P. Cerebral herniation in patient with acute liver failure is correlated with arterial ammonia concentration. Hepatology 1999;29:648-653.
9. Lee WM. Acute liver failure. N England J Med 1993; 329: 1862.
10. Blei AT, Olafsson S, Webster S, Levy R. Complications of intracranial pressure monitoring in fulminant hepatic failure. Lancet. 1993;341: 157-8.
11. Vaquero J, Chung C, Blei AT. Brain edema in acute liver failure. A window to the pathogenesis of hepatic encephalopathy. Annals of Hepatology. 2003;2:12-22.
12. Tofteng F, Jorgensen L, Hansen BA, Ott P, Koadrap J, Larsen FS. Cerebral microdialysis in patients with fulminant hepatic failure. Hepatology. 2002;36:1333-40.
13. Kosenko E, Felipo V, Montolia C, Grisolia S, Kaminsky Y. Effectos of acute hyperammonemia in vivo on oxidative metabolism in nonsynaptic rat brain mitochondria. Metabolic Brain Diseases. 1996;12:69-82.
14. Norenberg MD. Oxidative and nitrosative stress in ammonia neurotoxicity. Hepatology. 2003;37:245-8.
15. Vaquero J, Chung C, Cahill ME, Blei AT. Pathogenesis of hepatic encephalopathy in acute liver failure. Seminars in liver disease. 2003;23:259-69.
16. Widmer R, Kaiser B, Engels M, Jung T, Grune T. Hyperammonemia causes protein oxidation and enhanced proteasomal activity in response to mitochondria-mediated oxidative stress in rat primary astrocytes. Arch Biochem Biophys. 2007;464:1-11.
17. Swain M, Butterworth RF, Blei AT. Ammonia and related amino acids in the pathogenesis of brain edema in acute ischemic liver failure in rats. Hepatology. 1992;15:449-53.
18. Cordoba J, Gottstein J, Blei AT. Glutamine, myo-inositol, and organic osmolytes after portocaval anastomosis in the rat: Implications for ammonia-induced brain edema. Hepatology. 1996;24:919-23.
19. Tofteng F, Hauerberg J, Hansen BA, Pedersen CB, Jorgensin L, Larsen FS. Persistant arterial hyperammonemia increases the concentration of glutamine and alanine in the brain and correlates with intracranial pressure in patients with fulminant hepatic failure. J Cereb Bood Flow Metab. 2006;26:21-7..
20. Bernal W, Hall C, Karvellas CJ, Auzinger G, Sizer E, Wendon J. Arterial ammonia and clinical risk factors for encephalopathy and intracranial hypertension in acute liver failure. Hepatology. 2007;46:1844-52.
21. Bhatia V, Singh R, Acharya SK. Predictive value of arterial ammonia for complications and outcome in acute liver failure. Gut. 2006;55:98-104.
22. Kundra A, Jain A, Banga A, Bajaj G, Kar P. Evaluation of plasma ammonia levels in patients with acute liver failure and chronic liver disease and its correlation with the severity of hepatic encephalopathy and clinical features of raised intracranial tension. Clin Biochem. 2005;38:696-9.
23. Bass NM. Monitoring and treatment of intracranial hypertension. Liver Transplantation 2000; 6(4. Supp1:S21-S26
23. Davern TJ. Predicting prognosis in acute liver failure: Ammonia and the risk of cerebral edema. Hepatology. 2007;46:1679-81.
24. Raschke RA, Curry SC, Rempe S, Gerkin R, Little E, Manch R, Wong M, Ramos A, Leibowitz AI. Results of a Protocol for the Management of Patients with Fulminant Liver Failure. Critical Care Medicine. 2008;36:2244-8.
25. Hoofnagle JH, Carithers RL, Shapiro C, Ascher N. Fulminant hepatic failure: Summary of a workshop. Hepatology. 1995;21:240-52.
26. Canalese J, Gimson AES, Davis C, Mellon PJ, Davis M, Williams R. Controlled trial of dexamethasone and mannitol for the cerebral oedema of fulminant hepatic failure. Gut 1982;23:625-9.
27. Brajtbord D, Parks RI, Ramsay MA, Paulsen AW, Valek TR, Swygert TH, Klintmalm GB. Management of acute elevation of intracranial pressure during hepatic transplantation. Anesthesiology. 1989;70:139-141.
28. Wendon JA, Harrison PM, Keays R, Williams R. Cerebral blood flow and metabolism in fulminant liver failure. Hepatology. 1994;19:1407-13.
29. Sari A, Yamashita S, Ohosita S, Ogasahara H, Yamada K, Yonei A, Yokota K. Cerebrovascular reactivity to CO2 in patients with hepatic or septic encephalopathy. Resuscitation. 1990;19:125-34
30. Jalan r, Olde Damink SWM, Hayes PC, Deutz NEP, Lee A. Pathogenesis of intracranial hypertension in acute liver failure: Inflammation, ammonia and cerebral blood flow. Journal of Hepatology. 2004;41:613-20.
31. Kramer D, Aggarwal M, Darby J, Obrist W, Rosenbloom A, Murray G, Linden P, et al. Management options in fulminant hepatic failure. Transplant Proc. 1991;23:1895-8.
32. Jalan R, Olde Damink SWM, Deutz NEP, Hayes PC, Lee A. Restoration of cerebral blood flow autoregulation and reactivity to carbon dioxide in acute liver failure by moderate hypothermia. Hepatology. 2001;34:50-4.
33. Rolando N, Wade J, Davalos M, Wendon J, Philpott-Howard J, Williams R. The systemic inflammatory response syndrome in acute liver failure. Hepatology. 2000;32:734-9
34. Vaquero J, Polson J, Chung C, Helenowski I, Schiodt FV, Reisch J, Lee W, Blei AT, and the U.S. Acute Liver Failure Study Group. Infection and the progression of hepatic encephalopathy in acute liver failure. Gastroenterology.2003;125:755-64.


text:
OH THE HORROR!Posted: March 10, 2017 Filed under: Charles "Icarus" Johnson, Gus802, Humor, Little Green Footballs, Totalitarian Progressives | Tags: #rumpswab, Charles Johnson, LGF, Little Green Footballs, Trump Derangement Syndrome, twitter 87 Comments
From the Lions, Tigers & Bears Department:
The Trump Administration Is Full Of Vampires, Zombies, Evil Scientists, Nazis & Assholes
Propublica? Yeah, sure. No reporting bias there.
If that is true, it means that Gusano and Johnson missed the filing deadlines to apply for the positions of Ingeniero Sanitario de la Embajada de Argentina and Internet Fair Practices Enforcement Monitor and Nazi Detector Czar in a timely manner.
OMG! DEATH PANELS! Not all of Johnson's TwitterRats buy into his hysterical bloviating bullcrap:
Charles, how many times can you pants yourself on the internet before you realize that you're the joke of the butt?

subset: commoncrawl


text:
Ahnalin loves "The Purple Elephant!
I do too!
The "Purple Elephant" is a darling
chapter book that was written by my friend
Donna Gielow McFarland.
Ahnalin loves to read and
has been enjoying Donna's stories.
So Donna sent Ahnalin
a copy of "The Purple Elephant"
to review.
So here is Ahnalin's review:
I think that the book Purple Elephant is a
very funny book,
because it is about going on
adventuring and having fun.
My favorite parts were when the
purple elephant sits on a stack
of hay and the prince is under the hay
and my other favorite is when
they introduced Dianna the dragon.
So there you have it.
Ahnalin loves the Purple Elephant!
Ahnalin is 8 and loves
reading fantasy stories
with adventure.
The Purple Elephant fits perfectly
into her taste in reading.
The story is exciting
and funny and
the characters really
draw the reader into the story.
at Amazon.com
Donna, thank you
so much for this book.
We can' wait to read
more about Prince Carmel
and his adventures!


text:
Important: The hinge to hold the geode box is glued on, and CAN get lose if twisted or over time. I have tried to drill and screw the hinge, but only resulted in damaging the geode. Another reason for not making the hinge permanently attached to the geode is because the geode will last Centuries , but the hinge won't. The value is based on the geode box, not the hinge. Therefore I don't guarantee the hinge won't come off. If this concerns you, please do not order this item.
This listing is for 1 Natural Brazilian agate geode with beautiful crystal formation. The surface of the geode is polished too to reveal the beautiful nature patterns of the agate.
The sizes of the rings in the picture are US 4 and 8. Jewelries are just for demonstration purpose and not for sale.
The measurement of geode approx. : 2.44" x 1.85"x1.4"/62mm x 47mm x 36mm
Weight of the geode :3.65oz/104g
You will get the exact item in the pictures. Pictures are part of the description.
Placement tips:
- Use as a wedding/engagement ring box. Place your valuable jewelry in it to cleanse and charge for best wealth enchanting, protecting and healing purposes. You can also write down your important goals or wishes and place it in it (close the top )
- To enhance educational luck, place it at where the Flying Star 4 (the star of academic luck and achievement) is located or the Southeast of the student's bedroom
- To enhance wealth luck, place it at where the Auspicious Flying Star 8 is located or the Northeast of the Fengshui Bagua
- On your work or study desk
* Feng Shui Properties of Agate Geode: Agate is one of the seven treasures of Buddhism. It can enhance the positive energy and ward of the negative Qi. It serves as a powerful Feng Shui enhancer and protector. In health, it also has a peaceful healing energy toward one's mind and body.
***Return, Refund and cancellation : If you are dissatisfied with your order for any reason, I do accept return and refund, but the shipping cost are not refundable. If you mistakenly placed an order and would like to cancel, please request cancellation within 2 hours of purchase, anytime after that, a 10% cancellation fee may be deducted from the total refund***
International customers please read the following terms before ordering::
- International customers should contact your Customs agency for information about any import duty, or any other restrictions that may apply. Buyers are responsible for any import taxes that may apply. Sellers aren't responsible for delays due to customs nor accepting returns because buyer's failure to clear the customs in buyer's home country.
- There may be translation errors regarding the weight of the items if the language of your country is other than English (example: Pound/ lb/LBs often translated as KG ). Please double check with me before ordering to confirm the weight of the product.
- Post office doesn't offer any guaranteed delivery time with international mail due to various reasons such as customs etc. In general, I mail out all orders placed before 6pm ( Central TX time) the following business day and once it is posted, an email notice with a link to track your package will be sent to you. All orders will be shipped with tracking numbers. However once the package is posted, I can not control the delivery time nor delays by customs or post office. Hence international shipments are made at the buyer's risk. We do not compensate for any shipment that is late, damaged, or misdirected /lost. Please contact me before ordering if you would like add insurance to your package for priority and express international packages. First class international mail cannot be insured nor compensated by Post office if it is damaged or lost. .
- Lastly, by law the actual value of the item has to be indicated on the customs form for all orders when posting (even it is a gift order)
1-2 business days
I'll do my best to meet these shipping estimates, but can't guarantee them. Actual delivery time will depend on the shipping method you choose.
Buyers are responsible for any customs and import taxes that may apply. I'm not responsible for delays due to customs.
Just contact me within: 3 days of delivery
Ship items back to me within: 7 days of delivery
Request a cancellation within: 2 hours of purchase
But please contact me if you have any problems with your order.
Because of the nature of these items, unless they arrive damaged or defective, I can't accept returns for:
Buyers are responsible for return shipping costs. If the item is not returned in its original condition, the buyer is responsible for any loss in value.
All products from my shop are ethically sourced and processed. I value minimum impact on our environment and recycle, repurpose as much as I can. We have a 9000 gallons of rainwater collection system for our garden,orchard, chickens...and my rock workshop. Also since I am extremely allergic and tend to have bad reactions to most chemicals, I only use natural and organic products for cutting, polishing and cleansing our rocks and minerals.
If you are dissatisfied with your order for any reason, I do accept return and refund, but the shipping cost are not refundable. If you mistakely placed an order and would like to cancel, please request a cancellation within 2 hours of purchase, anytime after that, a 10% cancellation fee may be deducted from the total refund***
I guarantee all of the geodes offered in my shop are natural and not man made or treated.


text:
"Hey, why don't I just have Chip Davis give you a call?"
Me, trying to be nonchalant: "Sure, that'd work. Thanks!" >click.<
Me, at work at my desk, suddenly deepcore boring through memory to being 16, maybe 17, sitting in my then-girlfriend's family room.Her dad's in the music business, so they have a ridiculously awesome stereo system - which means basically that it's the first CD player I've ever seen.
"Sit here," she says, putting me in a spot on the floor a few yards in front of and directly between the speaker towers. "Close your eyes."
I do.
I hear her padding across the thick carpet, then the buzzWHIRRwhine of the CD tray sliding open and shut.
I don't hear a speaker hiss - this is a CD after all - but I hear the anticipatory hum of speakers awaiting sound.
And then there's a laserstarlightcomputerkeyboard pattern dancing in one side of my head, all the way down behind my eardrum, and I've got this tense chill goosebump kind of thing because I've never heard anything like this. Before I realize it, this music is mirrored in my other ear, the melody suddenly with depth and texture and the sound's converging inside my skull, and then comes this big pulsing bass and I'm HOOKED.
This is my first listen to "Toccata" by Mannheim Steamroller.
You may laugh now. I'll wait. Done? Okay, now, remember: This was a time well before Steamroller became became a cheesy Christmas music empire, and there was something inherently geeky and computeriffic about this synth-powered stuff. Seriously. And I was sucked into the whole concept-album-layers-story thing, too, so this notion of songs as chapters and pieces of a bigger picture
was a new and cool thing to me.
Within days, I'd gone to the mall and bought "Fresh Aire III" and those times when I was lucky enough to get the keys to our Cheverolet Eurosport, which boasted a cassette deck, I would blast "Toccata" with the windows down. I bought more tapes, and again, lest you doubt the appeal to a writer and nerd, consider (as Bill Nye would say) the following:
- Fresh Aires I through IV are themed seasonal cycles.
- Fresh Aire V is based on Johannes Kepler's "Somnium" (The Dream), a 17th-century piece of science fiction, and includes liner notes and excerpts from the astronomer's writings about moon-creatures and their civilization.
- Fresh Aire VI goes to Greek mythology for inspiration, so I went reading about Orpheus and Sirens and the River Styx.
- Fresh Aire VII, not surprisingly, is about the number 7 and includes, no kidding, a piece in which Chip corresponded specific musical notes to colors based on light frequencies related to sound frequencies. If that's not geeky, I don't know what is. Also, there's a song based on the seven stars of the Big Dipper.
So now, 20-plus years after hearing "Toccata," I'm at work my waiting for Mannheim Steamroller founder and composer Chip Davis to call.
When he does, we talk for a few minutes about growing up in Ohio, and the northwest corner of the state - I think I'll send him a copy of "Crossing Decembers" - and then we covered the territory that was the purpose of the call in the first place.
As we were wrapping up, I had to tell him: "When I was about 16, I was dating this girl, and she put on "Toccata," and it blew me away," and about how for a long time, Steamroller was kind of my secret joy, musically speaking.
A couple nights back, I popped Fresh Aire III into the CD-ROM drive while I was writing. A lot of stuff's gone by since that first listen, but I still got the goosebumps.


text:
Many Vue.js app components will probably have some sort of parent-child relationship. In this part of the series I aim to talk about common patterns as well as anti-patterns that you should avoid.
If you follow the basic structure you should be safe for the future.
The goal is to understand how to write reusable components that are independent from the parent.
This is the second article of a series of Vue.js communication articles.
- Vue.js communication: single components
- Vue.js communication: parent-child components (you are here)
- Vue.js communication: any component (using vuex)


text:
Hi loves ♥ I have a review for you on a new skin detoxifying clay mask. Masks are so popular right now, I am so happy I was chosen to review the Valentia Skin Detoxifying Clay Mask. This is my second product from this brand and I am impressed. This mask is made out of kaolin clay which is suppose to remove dirt and oil while deeply cleansing and exfoliating the skin, revealing softer smoother skin.
The Ingredients:
Kaolin Clay– Known for detoxifying, the clay minerals draw out the impurities, improve skin tone and tighten pores for smoother firmer skin
Plant Stem Cells– Decreases the level of pro-aging toxins working to soothe skin, reduce redness and improve evenness.
Spirulina– Botanical stimulant full of vitamins and minerals that hydrates the skins surface and contributes to tissue regeneration of the skin.
CoQ10– Creates cell production to lessen the appearance of wrinkles by reducing free radical damage and stimulating healthy collagen production.
Hibiscus & Cranberry Fibers– Anti-aging properties to firm and reinforce skin to prevent creation of new wrinkles.
Astaxanthin– An antioxidant that repairs collagen production and combats free radical damage, restores skin to elastic, bright and wrinkle free tones and textures.
I love how all the ingredients are written on the package so you know what your putting on your face.
Application & Review
I applied this mask with my fingers and massage it into my face, I waited 15 minutes per instructions and then with warm water took a face cloth and wiped the mask off , I noticed dead skin and dirt coming off my face onto my face cloth. I was very surprised to see some of the blackheads on my nose were removed also! My skin felt so refreshed and cleaned after this mask. I love how you were able to see the results right away.
Honestly, this brand should be receiving more hype, their skin care products are amazing. Their products are manufactured in the USA and they are cruelty free, I can't say better things about this brand. I use their Valentia Rose Serum everyday. It's my new holy grail! If you missed that review, check it out Valentia Royal Rose Hydrating Serum Review !
*Valentia is giving my readers a coupon code of 35% off till the end of the month so if you wanted to try this mask or any of their other skin care products you can.
For more information:
*Disclaimer* I received this product to review, all opinions are honest and my own. I am not being paid to feature this product or provide a coupon code.
I hope you enjoyed this post. Don't forget to subscribe for more beauty posts ♥


text:
No we're not talking normal. What is normal? Who knows? Normal is boring right? We're talking about being regular, as in, daily 'movements,' a good working 'system,' 'dropping the kids off at the pool, doo-doo'…yes people, we are talking poop. So let's get a little giggle in…and now talk some shop. What are some constipation causes and how to 'go' on the reg?
In fact, when we work with clients one on one, we'd say the far too many people fall into this group. Why does it matter? Well aside from feeling totally uncomfortable, 'bloated,' heavy and just icky, it can actually result in some toxins (which is what poop really is: waste) getting reabsorbed back into your system. We know, that's a horrible visual, but it's more or less what happens on a micro level. We need to eliminate waste in order to detoxify – everything from hormones to environmental toxins. Constipation, if unattended to long term, can lead to hormonal imbalances, skin problems, mood issues – even affecting your day to day personal and work life. People with IBS miss work 3 times more than those without IBS!
IBS and constipation are huge issues – a myriad of things could be at play including bacteria, parasites, deficiencies and more, but the very first place to look, and often a huge problem solver, is to look at the foods you're eating. Pulling out common food sensitivities is a huge part of the puzzle. Most common sensitivities include gluten, dairy, soy and sugar. But what about adding in foods? It's absolutely just as important. Check out a handful of suggestions for foods, nutrients and tips to help you relieve that 'backed up' feeling.
- Drink plenty of water – at least 8 cups a day.
- Upon waking drink warm water with a squeeze of lemon – this can be the magic elixir for a slow moving system.
- Foods to focus on include:
- fermented foods [sauerkraut, miso, kombucha, yogurt (non-dairy if needed), etc] – this populate good flora for optimal bacterial balance
- ground flax seed & chia seeds – packed with fiber and healthy fats to keep things moving.
- gluten-free rolled oats* – soluble fiber helps add substance to keep #2 smooth sailing.
- whole grains like brown rice and quinoa* – see above.
- beets! very helpful for regularity + detoxifying!
- plenty, and then some: dark leafy greens – kale can act like an inner scrub brush!
- dried figs and/or prunes – packed with fiber for regularity
- raw apple cider vinegar – supports breakdown in the stomach so food doesn't go undigested
- healthy fats like coconut oil, ghee and olive oil – fats are crucial for slow moving systems!
- bone broth (+ see exciting giveaway below!) – one of the most restorative gut foods there is, supports optimal gut lining!
*some people with IBS symptoms have found they do best when they remove grains, but everyone is different! see how your body reacts with and without
- Get plenty of magnesium! This is absolutely key. You can get it most concentrated from food in pumpkin seeds, sesame seeds, dark leafy greens, whole grains and legumes. You may want to even consider supplementing with additional magnesium – we love Natural Calm.
- Exercise…more if you can! Yoga is very helpful with constipation
Those are just a handful of things to start doing – but remember, when it comes to constipation, food is the FIRST place to look. We clean up the diet big time at Prescribe Nutrition. We don't mess around and ditch the problem foods and add in the good foods – many people experience massive digestive relief. Jump in our next program and commit to 20 days to see a better operating digestive system by signing up for Prescribe 20. It's actually a fun [not horrible] gentle detox and you will experience some major shifts for the better.
What's more? It's time for a gut friendly giveaway. Kettle & Fire is going to hook-you-up with a chicken and beef bone broth for you and your favorite cooking buddy. Head to our Instagram and follow the directions for your chance to win. The benefits of bone broth are endless so you won't want to miss this one!


text:
This one is for all of our readers near the City of Brotherly Love. Get ready to put your cameras to good use next month so everyone's perspective of the region can be available.
Take a picture on Greater Philly Photo Day, October 9th, and send it to us on our website. It will be included in the huge gallery exhibition, online exhibition, and the Philly Photo Day book – PLUS 3 photos will be chosen for display on Septa regional rail posters across the Delaware Valley!One photo will be chosen to wrap an entire car – maybe yours!?To embrace every viewpoint, PPAC will offer free photo workshops so everyone's perspective is included. With your help, PPAC will send hundreds of cameras and 20 teaching artists to schools, homeless shelters, retirement homes, and community centers in all 11 counties!


text: October 29, 2014 at 8:03 AM Astoria bridge restoration work to take until 2021 Posted by The Associated Press ASTORIA, Ore. — It's taking a little longer than planned for the first phase of a project to paint and repair the Columbia River bridge at Astoria. The Daily Astorian reports work began in 2009 on painting and replacing some steel parts. Workers have found some rivets that were less than half of their original size… More Comments | More in General news | Topics: Astoria, bridge, repairs


text:
Danniel Schoonebeek
Danniel Schoonebeek's first book of poems, American Barricade , was published by YesYes Books in 2014. His work has appeared or is forthcoming in The New Yorker, Poetry, Tin House, Iowa Review, Fence, BOMB, The Brooklyn Rail, jubilat , and elsewhere. The recipient of awards and honors from Millay Colony, Poets House, Oregon State University, the Juniper Institute, and the Akademie Schloss Solitude, he hosts the Hatchet Job reading series and edits the PEN Poetry Series. In 2015, Poor Claudia will release his second book, a travelogue called C'est la guerre . http://dannielschoonebeek.tumblr.com/


text:
One #HOT fashion photographer I discovered today - Julia Kennedy, she graduated from Manchester Met. in 2000 and has made quite a name for herself in London, working for clients including Hudson, The Independent and Harpers Bazaar.
Beautiful work - capturing the topic in such a soft and delicate manner, yet looking so dam hot at the same time! Each piece makes me want to see more - from front covers to fashion shoots she has a timeless way of pulling in the viewer. She will no doubt be seen around the fashion scene with this incredible work!
A very clean, simple & user friendly site - see it here.
Images courtesy of Julia Kennedy.


text:
Software Defined Wide Area Network Market: Overview
Wide area network (WAN) covers large geographical area compared to Local Area Network (LAN). Public network such as a telephone system is used by WAN for connectivity. Software defined WAN (SDWAN) opens options to enterprises in order to configure their network. Hardware devices working in the network are managed and controlled with the help of SDWAN. SDWAN makes it possible to implement flow related complex algorithms to the hardware components of a network. It offers enormous potential for organizations having multiple locations and significant network traffic.
Automation technologies are used for routing and rerouting data traffic, reducing the complexity involved in the procedure. Increasing adoption of cloud technology has resulted in large data repositories. Cloud technology requires high bandwidth in wide area network. SDWAN helps in improving the bandwidth as per the requirements of cloud technology.
Software Defined Wide Area Network Market: Trends and Growth Propellers
Enterprises worldwide strive to improve the operational efficiency. SDWAN helps enterprises in achieving high operational efficiency with high-speed internet connectivity and network coverage. Enterprise mobility is one of the major drivers of SDWAN market, it is increasingly being adopted as the number of mobile workers are increasing globally. It helps in providing secured access to enterprise data, growth in terms of flexibility and scalability, business continuity.
Also, employees can maintain a healthy work-life balance with the help of enterprise mobility. It has increased the usage of many devices such as smartphones, tablets and notebooks to access business applications driving the SDWAN market. Bring your own device (BYOD) policies adopted by enterprises are also increasing the demand for SDWAN. Traditional networks with complex architecture can be easily upgraded into simplified networks with the help of SDWAN. However, with implementation of SDWAN, enterprises must invest in new software solutions, hardware equipment and design and integration increasing the overall cost. However, Implementation will help in reducing the costs in the long run. Security concerns could restrain the growth of SDWAN market as the new set of rules and technologies used for managing networks are not tried and tested.
Software Defined Wide Area Network Market: Segmentation
SDWAN market is segmented on the basis of component, deployment type, service type and end-use adoption, On the basis of component, the market is segmented into virtual appliance, physical appliance and hybrid. In terms of deployment, SDWAN market is segmented into on-premise and cloud deployment. Based on service type, the market for SDWAN is segmented into managed services and professional services. In terms of end-use adoption the market is segmented into banking, financial services, and insurance (BFSI), manufacturing, healthcare, IT and telecom, oil and gas and others.
On the basis of geography, the global SDWAN market is segmented into Europe, Asia Pacific, North America, Latin America, and the Middle East and Africa. Additionally, Currently, North America is projected to exhibit significant growth as compared to other key regional segments; this will be the result of the increasing bandwidth requirements and need for highly efficient networking architecture.
Software Defined Wide Area Network Market: Top Players
The global SDWAN market is intrinsically considerably competitive and features a number of large several international and domestic key players. Major players in the software defined wide area network market include Cisco Systems, Inc., Aryaka Networks, Inc., Talari Networks, Inc., CloudGenix Inc., InfoVista S.A.S., Pertino, Inc., VeloCloud, Inc., Glue Networks, Inc., Mushroom Networks Inc. and FatPipe Networks Inc.
The research report presents a comprehensive assessment of the market and contains thoughtful insights, facts, historical data, and statistically supported and industry-validated market data. It also contains projections using a suitable set of assumptions and methodologies. The research report provides analysis and information according to categories such as market segments, geographies, types and applications.
The report covers exhaustive analysis on:
- Market Segments
- Market Dynamics
- Market Size
- Supply & Demand
- Current Trends/Issues/Challenges
- Competition & Companies involved
- Value Chain
Regional analysis includes:
- North America
- Latin America
- Asia Pacific
- Japan
- Western Europe
- Eastern Europe
- Middle East & Africa
The report is a compilation of first-hand information, qualitative and quantitative assessment by industry analysts, inputs from industry experts, and industry participants across the value chain. The report provides an in-depth analysis of parent market trends, macroeconomic indicators and governing factors, along with market attractiveness within the segments. The report also maps the qualitative impact of various market factors on market segments and various geographies.
Report highlights:
- Detailed overview of parent market
- Changing market dynamics in the industry
- In-depth market segmentation
- Historical, current and projected market size in terms of volume and value
- Recent industry trends and developments
- Competitive landscape
- Strategies of key players and products offered
- Potential and niche segments, geographical regions exhibiting promising growth
- A neutral perspective on market performance
- Must-have information for market players to sustain and enhance their market footprint
The report offers a comprehensive evaluation of the market. It does so via in-depth qualitative insights, historical data, and verifiable projections about market size. The projections featured in the report have been derived using proven research methodologies and assumptions. By doing so, the research report serves as a repository of analysis and information for every facet of the market, including but not limited to: Regional markets, technology, types, and applications.
The study is a source of reliable data on:
- Market segments and sub-segments
- Market trends and dynamics
- Supply and demand
- Market size
- Current trends/opportunities/challenges
- Competitive landscape
- Technological breakthroughs
- Value chain and stakeholder analysis
The regional analysis covers:
- North America (U.S. and Canada)
- Latin America (Mexico, Brazil, Peru, Chile, and others)
- Western Europe (Germany, U.K., France, Spain, Italy, Nordic countries, Belgium, Netherlands, Luxembourg)
- Eastern Europe (Poland, Russia)
- Asia Pacific (China, India, Japan, ASEAN, Australia and New Zealand)
- Middle East and Africa (GCC, Southern Africa, North Africa)
The report has been compiled through extensive primary research (through interviews, surveys, and observations of seasoned analysts) and secondary research (which entails reputable paid sources, trade journals, and industry body databases). The report also features a complete qualitative and quantitative assessment by analyzing data gathered from industry analysts and market participants across key points in the industry's value chain.
A separate analysis of prevailing trends in the parent market, macro- and micro-economic indicators, and regulations and mandates is included under the purview of the study. By doing so, the report projects the attractiveness of each major segment over the forecast period.
Highlights of the report:
- A complete backdrop analysis, which includes an assessment of the parent market
- Important changes in market dynamics
- Market segmentation up to the second or third level
- Historical, current, and projected size of the market from the standpoint of both value and volume
- Reporting and evaluation of recent industry developments
- Market shares and strategies of key players
- Emerging niche segments and regional markets
- An objective assessment of the trajectory of the market
- Recommendations to companies for strengthening their foothold in the market
Note: Although care has been taken to maintain the highest levels of accuracy in TMR's reports, recent market/vendor-specific changes may take time to reflect in the analysis.
Software Defined Wide Area Network Market


text:
The Attachment Point: Slackchat #1
With a little inspiration from 538 and frequent Insurance Nerds contributor, Rob Galbraith, we're trying something new! We love the interactivity of our podcasts, but as busy insurance professionals, we were finding it hard to find time to connect. Starting today, you can expect a recurring series of posts titled The Attachment Point to appear on or around Thursday … Read more


text:
ENCOURAGING farmers not to farm is no way to reinvigorate agriculture – and Alan Sugar's sidekick Nick Hewer should know better.
Mr Hewer is the front man for a new TV series that will see him appear as a troubleshooter helping farmers find new ways of making money.
Called The Farm Fixer, the BBC Two programme will see the Apprentice star help farmers develop new products, create brands and find customers.
"I wanted to use everything I had learnt, over the past 40 years of business, to help them come through this difficult time," he says.
So far so good. After all, what could be better than highlighting the harsh realities of farm life to a viewing public largely disconnected from the countryside?
But wait a minute: just how will Mr Hewer go about "fixing" farms?
According to the BBC, his business ideas so far include harvesting seaweed, brewing beer, producing flavoured pet water and entertaining cruise ship groups.
So nothing much to do with actual farming, then.
This is more like encouraging Alan Sugar to make money from selling computers by telling him to give up and sell something else instead.
Suggesting that the challenges faced by farmers can be solved by parachuting in a celebrity merely trivialises agriculture – and misleads the public.
Doubtless supporters will commend this new programme as a light-hearted way of introducing agriculture to a non-farming public.
But whatever next?
How about The Euro Fixer – Nick Hewer fixes the Eurocrisis for people who aren't really interested in economics?
I'll bet now that this new show will be simplistic and patronising rather than even a semi-serious attempt to solve the challenges faced by farmers.
And I look forward to watching it only in the hope of being proved wrong.


text:
2007 - 2009
Tenured Associate Professor, Department of Biology, University of North Carolina at Charlotte (Charlotte, NC)
2007 - 2009
Associate Professor, Department of Biology, University of North Carolinaat Charlotte (Charlotte, NC)
1999 - 2002
Assistant Professor, Department of Surgery, University of Rochester (Rochester, NY)
1997 - 1999
Instructor, Department of Surgery, Georgetown University Medical Center (Washington DC)
1995 - 1997
Post-doctoral fellow, Department of Surgery, Georgetown University Medical Center (Washington DC)
Post-doctoral fellow, Department of Surgery, Johns Hopkins Medical Center (Baltimore, MD)
PhD:1995, Department of Medicine, University of Sheffield (Sheffield, UK)
BSc (Dual Hons): 1991, Physiology and Pharmacology, University of Sheffield (Sheffield, UK)
Dr. McKillop's laboratory studies normal liver physiology and pathophysiology of those liver diseases that lead to hepatocellular carcinoma (HCC) development. To achieve these goals, the laboratory makes extensive use of cell biology techniques to better understand the aberrations in signal transduction pathways that occur in HCC that drive tumor development and progression. These studies address fundamental characteristics of cancer cells in the liver: the increased rate of cell growth following transformation, the inability of transformed cells to perform the physiological functions of the normal cell type and the (relative) resistance of cells to be deleted following transformation. Incorporated into these studies, Dr. McKillop's laboratory also has a particular interest in the effects of alcohol as a possible accelerant during the development and/or progression of HCC. From a translational aspect, Dr. McKillop works particularly closely with clinicians in the Divisions of HPB Surgery, Transplant Surgery and Hepatology to study human HCC development and progression. These studies involve the collection and analysis of patient data and outcomes to improve treatment strategies and translational studies to develop and improve surgical approaches to manage HCC.
Simo KA, Niemeyer DJ, Hanna EM, Swet JH, Thompson KJ, Sindram D, Iannitti DA, Eheim AL, Zuckerman V, Mckillop IH. Altered lysophosphatidic acid receptor expression during hepatic regeneration. HPB. 2014;16(6); 534-542. PMID: 24750398
Swet JH, Pacheco HJ, Iannitti DA, El-Ghannam A, McKillop IH. A silica-calcium-phosphate nanocomposite drug delivery system for treatment of hepatocelullar carcinoma: In vivo study. J Biomed Mater Res B Appl Biomater. 2014;102(1); 190-202. PMID: 23913418
Niemeyer DJ, Simo KA, Iannitti DA, Mckillop IH. Ablation therapy for hepatocellular carcinoma: Past, present, and future perspectives. Hepatic Oncology. 2014;1(1); 67-79. Doi:10.2217/hep.13.8
Simo KA, Mckillop IH, McMillan MT, Ahrens WA, Walters AL, Thompson KJ, Kuwada TS, Martinie JB, Iannitti DA, Gersin KS, Sindram D. Does a calculated "NAFLD fibrosis score" reliably negate the need for liver biopsy in patients undergoing bariatric surgery? Obes Surg. 2014;24(1); 15-21. PMID: 23934335
Simo KA, Tsirline VB, Sindram D, McMillan MT, Thompson KJ, Swan RZ, McKillop IH, Martinie JB, Iannitti DA. Microwave ablation using 915 MHz and 2.45 GHz Systems. What are the differences? HPB. 2013;15(12); 991-6. PMID: 23490330
Thompson KJ, Swan RZ, Walling TL, Iannitti DA, Mckillop IH, Sindram D. Obesity, but not ethanol, promotes tumor incidence and progression in a mouse model of hepatocellular carcinoma in vivo. Surg Endosc. 2013;27(8); 2782-91. PMID: 23468327
Curry JM, Thompson KJ, Rao SG, Besmer DM, Murphy AM, Grdzelishvili VZ, Ahrens WA, McKillop IH, Sindram D, Iannitti DA, Martinie JB, and Mukherjee P. The use of a novel MUC1 antibody to identify cancer stem cells and circulating MUC1 in mice and patients with pancreatic cancer. J Surg Oncol. 2013;107(7); 713-22. PMCD: PMC3880940
Sokolov E, Eheim AL, Ahrens WA, Walling TL, Swet JH, McMillan MT, Simo KA, Thompson KJ, Sindram D, McKillop IH. Lysophosphatidic acid receptor expression and function in human hepatocellular carcinoma. J Surg Res. 2013;180(1); 104-13. PMID: 23182454
Thompson KJ, Swan RZ, Iannitti DA, McKillop IH, Sindram D. Diet-induced obesity and ethanol impair progression of hepatocellular carcinoma in a murine mesenteric vein injection model. Surg Endosc. 2013;27(1);246-55. PMID: 22806512
Brandon-Warner E, Schrum LW, Schmidt CM, McKillop IH. Rodent models of alcoholic liver disease: Of mice and men. Alcohol. 2012;46(8);715-25. PMCID: PMC3496818
Simo KA, McKillop IH, Ahrens WA, Martinie JB, Iannitti DA, Sindram D. Invasive Biliary Mucinous Cystic Neoplasm: A Review. HPB. 2012;14(11);725-40. PMCID: PMC3482668
Brandon-Warner E, Eheim AL, Foureau DM, Walling TL, Schrum LW, McKillop IH. Silibinin (Milk Thistle) potentiates ethanol-dependent hepatocellular carcinoma progression in male mice. Cancer Lett. 2012;326 (1); 88-95. PMCID: PMC3449310
Lakner AM, Steuerwald N, Walling, T, Ghosh, S, Li T, McKillop IH, Russo M, Bonkovsky HL, Schrum LW. Inhibitory effects of microRNA 19b in hepatic stellate cell-mediated fibrogenesis. Hepatology. 2012;56(1): 300-10. PMCID: PMC3342471
Brandon-Warner E, Walling T, Schrum LW, McKillop IH. Chronic ethanol feeding accelerates hepatocellular carcinoma progression in a sex-dependent manner in a mouse model of hepatocarcinogesis. Alcoholism Clin Exp Res. 2012;36(4):641-53. PMCID: PMC3288433
Vedantham K, Swet JH, McKillop IH, El Ghannam A. Evaluation of a bioresorbable, controlled release drug delivery system for the treatment of hepatocellular carcinoma. J Biomed Mater Res A. 2011;100A(2): 432-440. PMID: 22105845
Grant Title: Next generation IRE technology for treating HCC
Funding Agency: Development Grant - Carolinas Healthcare Foundation
Role: Principal Investigator
Years: 2014
Grant Title: Development of bioceramic scaffolds for use in hepatocellular carcinoma chemotherapy
Funding Agency: North Carolina Biotechnology Center – Multi-Center Grant [NCBC-MCG]
Role: Principal Investigator
Years: 2011-2013
Grant Title: Characterization of Leucocyte Infiltrates in Liver Biopsies of Subjects with Drug-Induced Liver Injury (DILI)
Funding Agency: NIH Ancillary studies funds allocated to the DCC of DILIN grant
Role: Co-Investigator
Years: 2011 – 2012
Grant Title: Role of obesity and alcohol in hepatocellular carcinoma development and progression
Funding Agency: Society of American Gastrointestinal and Endoscopic Surgery (SAGES)
Years: 2011-2012
Role: Co-Investigator
Grant Title: Effect of Alcohol on Hepatocellular Carcinoma Progression
Funding Agency: National Institute Alcohol Abuse and Alcoholism/ NIH R21 Grant (R21 AA016858-01)
Role: Principal Investigator
Years: 2008–2010
Grant Title: Acquisition of a Laser Capture Microscope system to enhance biotechnology research in the Charlotte region
Funding Agency: Institutional Development Grant Proposal, North Carolina Biotechnology Center (NCBC)
Role: Co-Investigator
Year: 2009
Grant Title: Regulation of Benign and Malignant Hepatocyte Growth
Funding Agency: National Cancer Institute/ NIH R01 Grant (1RO1CA90895)
Role: Principal Investigator
Years: 2002–2006


text:
Questions and Comments About Homeschooling
AN A to Z ARTICLE
An upset educator wrote me today. Her questions may be some you also have, so I thought I'd put them up online.
"Am I Really Qualified to Teach My Own Children?" Some Thoughts on This Common and Provocative Question
Would that homeschooling parents had a dollar for each time that they asked themselves or have been asked by others why they think they are qualified to teach their own. By Richard J. Prystowsky.
Canadian Homeschool Resource FAQ
Questions about homeschooling from a Canadian point of view. Answers lots of legal questions for Canadians.
Catholic Homeschooling FAQs
There are many times, of course, when those who are investigating homeschooling as a viable alternative for their children, want to know "Just what is Catholic Homeschooling?" and "Why should I homeschool?" From Our Lady of the Rosary School.
A Conversation with John Holt (1980)
What is your philosophy of learning?
Basically that the human animal is a learning animal; we like to learn; we need to learn; we are good at it; we don't need to be shown how or made to do it. made to do it. What kills the processes are the people interfering with it or trying to regulate it or control it.
Homeschooling FAQ
Some answers to common questions people have about homeschooling. From Homeschooling Research & Scholarship.
Homeschooling, A Piece of Cake
Homeschooling parents, especially those just getting started, frequently ask a very simple and seemingly innocent question. Just what is the best way to homeschool?
Homeschooling SAQ (Seldom Asked Questions)
If I homeschool, will I have to wear Birkenstocks? If I homeschool, will I have to raise goats and chickens? Will I have to bake my own bread and sew all of our own clothes? by Rebecca Prewett.
How to Homeschool FAQs
It would be a rare parent (or teacher!) who could teach every subject. Most parents are facilitators, helping the child to find the resources necessary for learning. There are many creative ways to tackle unfamiliar or difficult subjects. From CHN.
Miles O'Neal's Homeschool FAQs
Texas homeschooler reassures new homeschoolers about socialization and other concerns.
Nabrit Family Adventure FAQ
This early, fact gathering phase placed us in the roles of PacMom and PacDad foraging our way into a homeschooling information subculture and consuming bits and pieces of knowledge along the way.
They Don't Have to Go
A certain number of parents and kids have come to feel that contact with inspiring and enlightening people can be achieved without kids having to put up with all the rest of it; that school is, in short, unnecessary. By Diana Sandberg.
What New Homeschoolers Want To Know
While some answers specific to Oregonians, much of the advice is general. Provided by OHEN.


text:
Food Network's Cupcake Wars winner and vegan-evangelist Doron Petersan will sign copies of her new cookbook, Sticky Fingers' Sweets: 100 Super-Secret Vegan Recipes tonight at 7:30 p.m. at the Tattered Cover, 2526 East Colfax Avenue. Petersan will also be slinging vegan treats, alongside local vegan vendors. Watch for an interview with Petersan on Cafe Society later today; in the meantime, find more information on Tattered Cover's website.
For information on dozens of culinary events around town, visit our online Food & Drink listings -- and if you have information for a culinary event you'd like included in our online calendar, send it to email@example.com.
If you like this story, consider signing up for our email newsletters.
You have successfully signed up for your selected newsletter(s) - please keep an eye on your mailbox, we're movin' in!


text:
While these listed meet ups may be counted toward a participant's 100 Mile Club goal, it is ultimately the decision of each coach or school to honor miles from this calendar at their site. At most events, a credit slip will be given to take back to your school for mile-credit. For listed community races/walks/etc, a race bib, results listing, and/or medal should suffice for credit.
All posts are independent local meet ups hosted by outside volunteers, and are open to 100 Mile Club participants and families. Please check periodically for time/date changes and cancellations, or contact the volunteer listed as "organizer" for any questions.
If you are interested in listing your meet up on our site calendar, click below.
Please Note: Meet Ups must be submitted at least 5 days prior to the event date to be approved and appear on our calendar. Please click here to view our Calendar Policy and Disclaimer.
Events for February 3, 2018
Day Navigation
10:00 am
Hidden Valley Nature Center Hike
Join us for a hike at the Nature Center. Park in the dirt after hours lot located at 11401 Arlington Ave Riverside Ca 92505. Follow the Coyote Trail to the Nature Center. There is a paved trail that is stroller friendly so bring out the whole family. We will meet by the main parking lot[…]Find out more »


text:
Quixtar is the online outlet for distributors to sell Amway products, and one of the largest ecommerce sites on the web. (Don't ask to buy soap - I don't sell it.)
Mike was part of a team of consultants that Amway brought in right before they launched the first Quixtar site in 1999. They picked their brains on how to improve this new service. The team consisted of the team leader, Dr. Quentin Schultze, and Jeffrey Veen (of Wired fame), Molly Steenson, and Peter Merholz.
Say what?
"Mike will save you time and money, direct you wisely, and teach your whole organization about using the internet wisely. Few people have tackled online communication more earnestly, with greater courage, and with a willingness to learn even in the face of truly unconventional wisdom. Many consultants merely borrow your watch to tell you what time it is. Mike shows you a better watch. Ask him what time it is in your organization."
- Dr. Quentin Schultze, Professor of Communication, Calvin College


text:
Intel Xeon E-2100 Processor for Entry-Level Workstations Unveiled
HIGHLIGHTS Intel Xeon E-2100 is the successor to Intel Xeon E3 processor The new processor offers higher max turbo frequency, faster DRAM speeds Chip has been crafted for the demands of creative professionals: Intel Intel on Thursday launched new Xeon E-2100 6-core processor for entry-level workstations. Intel Xeon E-2100 processor is the successor to Intel Xeon E3 processor. Original… Read More »


text:
Sei sicuro?
This action might not be possible to undo. Are you sure you want to continue?
(Easy Piano Songbook). 9 selections arranged for easy piano from Disney's big 2016 release featuring songs from Lin-Manuel Miranda. Songs include: How Far I'll Go * I Am Moana (Song of the Ancestors) * An Innocent Warrior * Know Who You Are * Logo Te Pate * Shiny * We Know the Way * Where You Are * You're Welcome. This souvenir folio also includes beautiful full-color scenes from the film.


text: "Roberto C. Sanchez" <firstname.lastname@example.com> writes: > Matthias Julius wrote: >> "Roberto C. Sanchez" <firstname.lastname@example.com> writes: >>> >>>Then that's what you would do with private education. >> >> >> I thought you were suggesting home schooling. >> > Either private education or homeschool. Either way, it's not like the > penalty levied on people now becuase they pay taxes for public > education, whether they use it (or ever would) or not. You can not homeschool when you need to go to work. You feel it as a penalty. I think it is a necessity. People pay taxes (indirectly) based on their income. People who contribute less than they would have to pay for tuition benefit from the public school system. This is the whole point. Of course, this assumes public schools provide the education they are meant to. > >> >>>Yes. Please see my previous comments about the Postal Service as an >>>example of how this *could* work. I still maintain that all private is >>>the way to go, but there are other ways it could work. As long as the >>>proposed method doesn't involve forcible redistribution of wealth, I am >>>all for it. >> >> >> I'm afraid it would not work without it. Do you want to base the >> education of children who's parents can not afford to pay for the >> education of their kids on voluntary redistribution of wealth, on >> charity? Or how do you think it should be paid for? >> > > I think it is the responsibility of the parent. Just like feeding and > clothing a child. What happens when a parent does not feed or cloth a > child? The child is removed from the home for neglect and placed into > foster care. I don't see why it should be any different for school. Yes, it is the responsibility of the parents to care for their children. But, how about those who are unable to? Those who are unwilling to should get their children removed. Matthias


text:
Snow romantic!
"Our place" is Morton Arboretum. We go there every season several times a year for picnics, hikes, taking in the fall colors, playing in the snow, etc. I was really hoping that he would propose here, our special place. So when we decided the day before to go to the Arboretum for our annual "play in the snow day" (goodness knows we have plenty of it here this year!) I was very hopeful this would be the day! We were also planning to try snow shoeing.
Eric arrived at my house to pick me up with a dozen (minus one) beautiful red roses, and we headed off. We had lunch, then rented our snowshoes and headed out. After about twenty minutes and a few falls we decided we needed a break. We drove around the east side of the Arboretum and stopped at the lake we always picnic at during the summer- crabapple lake. We got out and walked around a bit finding our picnic tree and remembering all our good times there. Then we drove around to the West side to find our other favorite spot; Marmo lake (where we had taken our Christmas picture last year, and where we stop to visit almost every trip to the Arboretum). We took the wrong path to the lake, and once we realized it Eric said "well, do you want to try to find it or go home?" It was at this point I decided today wasn't the day. He wouldn't risk me saying "no" as cold and wet as I was from several spills in the snow. I said "no I want to go find it." Once we arrived at the lake, we put on our snow shoes again and set off. We stopped at our tree and took pictures, but then kept on walking. I was sure this was just a snow day now, but we were having fun so we kept walking around the lake. We got to a bench to take a break, and I said "remember last year we drew hearts in the snow?" and I drew "I love u" in the snow on the bench. He said "my turn" and turned his back to me to make his picture. I took a picture of him, and then turned around to look at the lake. When I turned back he had drawn a heart, and placed a small blue box in the center. I gasped when I realized what it was, and as I turned to grab it I crossed my snowshoes, and almost fell face first into the bench. I stopped myself, and he picked me up as we both started laughing. I opened the box and in it were rose petals (from the sacrificial 12th rose), and a letter. In the letter he expressed all the things he knew he would forget to say in the moment, at the end of the letter it said "Now I must ask you the question that my heart already knows the answer to." He said, " I have another box for you. Do you want it?" I screamed "YES!", and he took the other box out of his coat pocket, got down on one knee and said "Katie, Will you marry me?" I said "Absolutely I will!", clapped my hands, jumped up and down and squealed! It was the perfect proposal for us, and exactly what I was hoping for!


text:
In several episodes in Locodol you see Nagarekawa Station which is based on Nagareyama Station in real life.
Image from Episode 12 - 19m42s
The station building.
Image from Episode 1 - 03m05s
Closer look at the building.
Image from Episode 9 - 11m31s
Ticket office.
Image from Episode 9 - 06m56s
They had this cardboard cutout at the station.
Image from OVA 1 - 18m40s
Station platform.
Closer look at the train in the background of the last picture.
The train had this Locodol emblem on it.
Image from Episode 1 - 01m36s
Chairs on the train platform. No pillows in real life though.
Image from OVA 1 - 19m02s
Train arriving. Notice the bridge over the tracks in the picture.
Image from Episode 4 - 15m08s
This bridge is also seen in the show.
Image from Episode 9 - 06m16s
View of the station from the bridge.
Here's another Locodol decorated train I saw at the station.
Closeup of the emblem.
Location map:
This location was visited on 2015/10/02.
Special thanks to the ones who went here before:


text:
The Minibus and Room Booking can be accessed by logging into the system using your club, society or community project username and password.
All bookings made using the system are considered provisional until approved by an administrator, which is one of the four Senior Executive Officers.
Not sure which rooms you can use? Confused about rules? Don't know who to contact or when to book? HERE is the SGSU Room Booking Policy!
(NB: Book AHR 1 for one half of the AHR with mirrors, AHR 2 for one half of the AHR without mirrors, and both AHR 1 and AHR 2 for the entire room).
Please note that only single bookings can be made using the system, and that bookings can only be made up to 28 days in advance. For blanket block bookings required in a particular term, or for bookings beyond 28 days, it is required that the bookings are made during Council.
For UNIVERSITY rooms please see the spreadsheets below showing avaliablity and then email email@example.com to request the booking.
October-December 2018 Show Season 1 (Updated 19/09/2018)
January-April 2019 Show Season 2 (Updated 17/01/19)
If you have any questions about this document or room booking, please email: email@example.com
Clubs, Societies or community projects wanting to book a minibus will also have to additionally come into the SU to fill out a minibus booking form and get it authorised by a Senior Officer of the Students' Union (President, Vice-Presidents or General Secretary).
Please email email@example.com if you have any specific questions regarding room bookings or login details.
SGSU Minibus Drivers:
Please note you will have to log-in in order to view this page.
To book the social learning space, aka the space outside the library, please follow the instructions in this document.
The library, to whom the social learning space belongs, allow us to use their space for SU events. It is primarily a space for learning, so please follow the conditions of use.
Please email Annabel Strachan (Vice President of Education and Welfare) if you have any specific queries.


text:
Category: Side Note
When the Bully Becomes the Prey (Must See TV!!!) Fixed
In this word and in this modern time when we have our first black president, crossover music that knows no color or genre and long past intergrated education where all races share knowledge together from pre-school to grad school that there is still bullying going on in our educational institutes. A bully is only a weak minded person that is not happy with themselves so they want to make those around them miserable as well. Well for young Jaide, she went from the bully to the preyy as she got her face lumped up, hair pulled and forced to quit her day job and actually pick up a book. Check out this feather weight bought and leave me some comments on your views of bullying. Enjoy! I definitely did!
Panasonic In Dash DVD/MP3/ 7 inch Flip out Touch Screen
Here is the 7 inch touch screen panasonic in dash dvd/tv/cd/mp3 player. Comes with Original box, antennas, remote and manuals. I am currently asking $300 for it! Let me know! You can email the owner Teko at email@example.com
Stroops In From The Netherlands….
Shout out to Ro of Burn Rubber. As you all may know, Ro is working on a mixtape. Hiis producer resides in the Netherlands. After his producer saw our video named "Stroop Love" he offered to send Ro some hand made Stroops straight from the village in the Netherlands…. And guess who Ro offered to break bread with??? Yeah, Thanks Friend. Check out the pic and if you need to further understand how good Stroops are watch my original video "Stroop Love".
Chuck Norris Vs. Bruce Lee
Shout out to Alex Washington. She calls me the Chuck Norris of blogging so I want to post the epic fight of Chuck Norris versus Bruce Lee. We all know Bruce won, but Chuck was getting in his ass at first. The only difference between this fight scene and me in real life is I Will Not Lose!
Freshman Never Sleep!
If you don't know aobut them, get familiar! Freshman Clothing is definitely a clothing line on the move. But the title is exactly what it is. They never sleep. The video posted is from the co owner of Freshman Clothing, Eric Lowry, rounding up some skateboarders to go out a skate at a secret location. You may also know Eric Lowry for his custom sneakers that he makes. Check out the video………
What A Start To A Week….
I know a lot of you are use to me blogging everyday all day, but I could not blog for anything yesterday. I had to post my dude Pat Piff, which you should all listen too!. Buother than that I could not sit in front of the computer for nothing. My job is on some "Micro Management" shit right now and it is funny. No matter how hard I work they find something wrong. Hopefully today will be a better day and I can post what is new on the day….
Just bare with your boy….. And one more thing, MAKE SURE YOU ARE AT THE BLOCK PARTY!


text:
This page will direct you to useful information about baggage, including check in and hand baggage, baggage restrictions, and extra baggage if your allowance isn't enough.
It's often quickest to use the website, but if you need to talk to someone we're here to help.
You'll find the answer to most questions here. But if you have a specific flight or booking related query, drop us a line.
If you haven't found what you were looking for, choose the subject and we'll get back to you as soon as possible.
If you like to keep it short and sweet (and all in 280 characters or less) you can also get in touch with us on Twitter


text:
- Description
Soul Horn 9
These horns are available from Soul Doll.
White resin only.
This part is not kept in stock here in the UK at the moment, unless stated above, but another order being placed on the date shown on the home page to re-stock the site, if you want to purchase it you can buy through this site and when payment is received I will add it to this next order and you will receive it once production is complete
Thanks for looking
- Reviews


text: In her first US publication, Canadian Lawson draws on Chinese motifs for a gentle tale with the cadence and flavor of folklore. Hard-working Xiao Sheng barely makes a living gathering grass until, during a drought, he finds a miraculously renewed green patch. Hoping to ease his labors, he transplants it to his own dooryard; in so doing, he finds a magical pearl that makes any supply--rice, gold--self-renewing. The boy and his mother are generous with their new wealth; still, two greedy neighbors try to seize it. Xiao Sheng swallows the pearl to protect it; after making him prodigiously thirsty, it transforms him into a magnificent dragon, source of rains that restore the region to prosperity. Morin, as he did for Mollel's much-praised The Orphan Boy (1990), provides stunning illustrations, using closely related hues (mostly of brown, gold, and orange) in luminous oils where thickly applied details cast shadows on a thinly veiled canvas that imparts a subtle texture to the art. A well-told tale, effectively celebrating the benevolent Chinese dragon and set in splendid format. (Picture book. 4-10)


text:
MOSTLY TRUE: Odds of fatal terror attack in U.S. by a refugee? 3.6 billion to 1
President Donald Trump's executive order on immigration halts the admission of all refugees into the United States for four months as the federal government develops stronger vetting systems.
It places an indefinite ban on Syrian refugees.
Trump has cited national security concerns as the reason for his order, and during his campaign he called Syrian refugees "a great Trojan horse" that could lead to future terrorist attacks.
In addition to the refugee halt, his order also suspends immigration for citizens of seven majority Muslim countries for 90 days. They are: Iraq, Syria, Iran, Sudan, Libya, Somalia and Yemen.
Critics of Trump's action say the notion that refugees represent a terrorist threat is false. They say the chance of being killed in a terror attack by a refugee is beyond remote.
"The chances of being struck by lightning TWICE is 1 in 9 million. The chances of being killed by a refugee committing a terrorist act is 1 in 3.6 billion," California Democratic Congressman Ted Lieu said on Jan. 27, 2017 in a press release. "These facts lead me to conclude that Trump's action is not based on national security, it is based on bigotry. Lady Liberty is crying."
We decided to fact-check Lieu's claim that the "chances of being killed by a refugee committing a terrorist act is 1 in 3.6 billion." We interpreted his statement to apply to terrorist attacks on U.S. soil.
Before we start, here's some background on refugees:
The U.S. Code defines a refugee as any person outside of the U.S. that is of special humanitarian concern to the U.S. and "has a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion," according to the Pew Research Center.
America accepted large waves of refugees from Vietnam and Cambodia in the 1970s, followed by high numbers from the former Soviet Union in the 1990s. More recently, refugees from Somalia, Burma, Bhutan and Syria have been granted refugee status and resettled in the United States.
Refugees are the most heavily vetted of any people who enter the United States, facing an 18- to 24-month processing period, according to the Migration Policy Institute.
Our research
A spokesman for Lieu cited a September 2016 study by the Cato Institute called Terrorism and Immigration: A Risk Analysis, as evidence for the claim.
Cato is a Washington D.C.-based think tank that advocates for limited government, free markets and greater immigration admissions.
Its study does, indeed, conclude that "the chance of an American being murdered in a terrorist attack caused by a refugee is 1 in 3.64 billion per year."
Here's what the study reported:
"Of the 3,252,493 refugees admitted from 1975 to the end of 2015, 20 were terrorists, which amounted to 0.00062 percent of the total. In other words, one terrorist entered as a refugee for every 162,625 refugees who were not terrorists. Refugees were not very successful at killing Americans in terrorist attacks. Of the 20, only three were successful in their attacks, killing a total of three people."
To arrive at the "1 in 3.64 billion per year" statistic, Alex Nowrasteh, the Cato study's author, told us he added up the nation's population for each year between 1975 and 2015, and then divided the total by the three deaths. Lieu omitted the "per year," portion in his claim, though we did not view this as an egregious oversight.
In his study, Nowrasteh notes that a trio of Cuban refugees carried out the three fatal attacks in the 1970s.
Not a single refugee, Syrian or otherwise, has been implicated in a terrorist attack since the Refugee Act of 1980 set up systematic procedures for accepting refugees into the United States, the report adds.
The study draws on data from a Global Terrorism Database maintained at the University of Maryland, College Park.
Origin of past terror attacks
Trump's executive action affects many categories of immigrants from students to employers to refugees.
Refugees, however, have not been the primary perpetrators of any of the country's major terror attacks that killed Americans in recent decades.
A Somali refugee injured nine people in a knife and car attack in November 2016 on the Ohio State University campus before he was shot dead. None of the victims died.
Many of the major terror attacks that have killed Americans were carried out by U.S.-born citizens or permanent legal residents from countries not included in the ban.
Here's a look at the origin of those responsible for major attacks in recent years:
9/11 terror attacks
Of the 19 people who hijacked planes on Sept. 11, 2001, all entered the United States legally on a temporary visa, most on tourist visas. They were not refugees and they were not from any of the seven countries in Trump's executive order.
San Bernardino attacks
Syed Rizwan Farook and Tashfeen Malik shot and killed 14 people and injured 22 others in December 2015 in San Bernardino. Farook was an American citizen born in Chicago. Malik was born and raised in Pakistan. She arrived in the United States on a fiancée visa and later became a permanent resident.
Boston Marathon bombings
Tamerlan and Dzhokhar Tsarnaev, who carried out the Boston Marathon bombings in 2013, were born in Kyrgyzstan to parents from war-torn Chechnya. Three people were killed and at least 264 were injured in the attack. The Tsarnaev family arrived in the United States in 2002 and was granted political asylum.
Asylum is typically granted to people already in the United States who have fled persecution in their home country. Refugees are generally people outside their home country, and have applied for resettlement.
Omar Mateen, the Orlando nightclub shooter was a U.S. citizen and son of Afghan immigrants. He shot and killed 49 people and wounded 53 others inside a gay nightclub in June 2016.
Experts weigh in
We asked experts on refugees and terrorism to evaluate the Cato study, and the claim at the center of this fact check.
"Having gone through the methodology they used, the figure of one in 3.6 billion is absolutely correct. It is a well-done analysis based on available data," said UC Irvine Professor Ruben Rumbaut, a leading expert on refugee resettlement in the United States.
Joel Day, a visiting research scholar at the University of San Diego and expert on terrorism, said the Cato study draws from reliable sources, including the Global Terrorism Database, considered the best of its kind.
Day said he agreed with the study's methodology, adding "I think their data is absolutely right."
Another expert, Mark Krikorian, executive director of the Center for Immigration Studies, a think tank that favors stricter immigration policies, said the "one in 3.6 billion" statistic from the Cato study includes too many qualifiers. Notably, he said, it excludes terrorist attacks by refugees that did not kill anyone and those "we'll never know about" foiled by law enforcement.
"It's not that it's wrong," Krikorian said of the Cato study, but its author "is doing everything he can to shrink the problem."
Kathleen Newland, a senior fellow and co-founder of the Migration Policy Institute, said she believes the Cato study is credible.
Her own work, she said, has shown there's "vanishingly small probability," that an American would be murdered by a refugee in a terrorist attack.
Newland said her only disagreement with the study is its designation of the three Cuban refugees as terrorists. In her evaluation, she said, the crimes they committed don't strictly amount to terrorism.
In opinion polls, Americans have expressed worry over accepting a large number of Syrian refugees.
Newland said people tend to lump refugees in with all categories of immigrants, without considering the data showing how infrequently refugees are involved with terror attacks.
"I think people just don't make the distinction between categories of people," she said.
Our ruling
California Democratic Congressman Ted Lieu recently said the "chances of being killed by a refugee committing a terrorist act is 1 in 3.6 billion."
Lieu's claim is backed by a September 2016 study by the Cato Institute.
It's important to clarify, however, that its study examined terrorist attacks on U.S. soil, something Lieu does not explicitly state.
Also, the Cato study says the odds of an attack are one in 3.6 billion "per year." Without these words, Lieu's claim could be viewed as slightly understating the odds, but we did not view his omission as egregious.
Several experts on terrorism and refugees examined the Cato study and told us its methodology and conclusions were credible. One said the study had too many qualifiers, but did not dispute its data.
A high-profile terror attack involving a Somali refugee took place in November 2016, after the period examined by the study. Nine people were injured in that attack, but there were no fatalities.
This is a notable piece of information, but does not take away from the accuracy of the congressman's claim regarding the "chances of being killed by a refugee" or the study he cited as its source.
Lieu's statement is accurate, though it needs a couple clarifications or additional information.
We rate it Mostly True.
MOSTLY TRUE – The statement is accurate but needs clarification or additional information.


text:
Another weekend passed, another year under belt. Actually the weekend started with company pre-Christmas party, which was a blast. At least compared to the last years fiasco. Sang a lot, drank somewhat more modestly due the first and overall I was rescued back home in a decent condition.
Woke up on Saturday at around noon. Logged in later 'only to check the AH', but instead that resulted not only checking the spiffy 170g more on Pupunen, but also checking in with Copra.
And boy Hudson is right. I logged in, checked my gear and tried to empty my bags from unnecessary quest stuff, but because I put the LFG tool on, I was asked to join the Blood Furnace in about a minute after that. The 'group' was two DK's, who were adamant that we could handle the instance by the three of us.
It became clear after the first wipe, that a) two tanks will not make it and b) Copra's mana efficiency with feral gear was insufficient. Also I learned that it helps a lot to change to the tree form if you are going to heal... After a few mobs we got a feral druid into the group, who quit the group because the DK's didn't want to reset the instance (we had just started!), the group split. The feral, however, invited me to another team, which was with three DK's. We cleared the site in one, swift, solid flow. And even though this was the first time I healed as druid, I was thanked for great heals and especially great for a first timer. Thank you, pleasure to serve! With the drops from this I got my MP5 up to 40 and overall mana almost to 5k. Not bad, considering my gear was still almost feral.
After that I just got rid of the excess loot when I was invited for the Hellfire Ramparts. Jeeves! I didn't even have LFG on!
I must say that I laughed out when I saw the group. Four DK's and me. You gotta be kidding me. They said they had tried on their own, in fact they were in the first mini-boss already, but had wiped because they had no healing abilities. Right, and onwards. No problems in the first, Watchkeeper Golgomar, nothing in the second, Omor the Unscarred (two parts of the quest done), but the darn Vazruden was the tough part. Nazan, whom he sends to 'protect' him, was easy, but the dragon Vazruden rides was the death of Copra. The DK's pulled the Dragon into such a place (the bridge to the platform), that it was impossible to avoid the dragon's breath. As Copra started to take damage, he was dead. Wipe one.
Second try resulted almost the same, but it was closer. And it was my fault that it went bonkers, like it always is. After which the group called it quits.
Copra earned an upgrade to his mana, mana regen and MP5 at the cost of armour and agility. I just have to learn to avoid damage better and see next time that I'm not at the bridge but on the platform to avoid the darn dragon.
What was the most interesting thing about this was that... I really, REALLY liked it! Healing seems to be for me, even though I'm at a loss of what to use and when and obviously I'm using too much time clearing curses and poisons. But all in good time, these were my first runs as a healing druid and healing with HoT's is pretty different than the way of the Priest. It's more proactive healing than reactive healing.
Sunday came, got Spore: Galactic Edition for my birthday present. And I was left alone with the dogs (kids can take care of themselves already) and the game. What's amazing with the current games for PC is that when you first install them from DVD, it takes at least a half an hour. Then it patches itself, loading of the patch taking at least another half an hour and the patching another! When it finally was ready, I had leafed through the Art of Spore, the game manual (which I never read) and played some pinball. Yea, what wouldn't you resort to when waiting for a game to install.
The start went smoothly, it remembered my details after removing the Creature editor. I just loved the start, the meteor and all, but the little bugger bugged me. The cell-stage is the most frustrating so far, really. But I have to run something else than herbivore next time...
The biggest surprise came from the stage when the creatures emerged from the water. Biggest because the game is full of sense of wonder, joy of finding and understanding and exploration. The surprise was to find creatures from my friends (JoBildo being one, cheers!) and my former creations from the demo Creature Editor, which I thought were lost! I think that when I start the game anew, I will play the creature stage a bit more, because of the exploration, the social minigame and the sheer scope of the continent.
Now I rushed through it by doing the things the game suggested, and found myself in the Tribal stage sooner than I expected.
Being the social, diplomatic and peacefull in nature, my creatures were/are herbivores, social and diplomatic. So the tribal stage was a pretty straight forward after I realised that I need enough of the instruments to conduct the diplomatics properly. Got an achievement for finishing that stage under an hour, which amazed my son who had played the game by his friend. And never got that fast.
I finished the game in the Civilisation stage, after conquering one continent by converting the cities to my super-religious dogmas. The other continent is having a civil war: two cities are fighting each other, so it would be like stealing a candy from a kid to finish them off.
All in all, I played about six hours of Spore, enjoying every moment. I think it delivers everything that it promised, at least so far I have been thrilled, amazed, surprised and laughed playing it.
I can't wait to play more. And that is a good sign.


text:
College of Arts and Letters Donor Scholarships
Every year the College of Arts & Letters awards donor scholarships to both new and continuing students.
Application deadlines for the 2018-2019 academic year for all students are as follows:
New UT Students, College Credit Plus, Post-Secondary, or Toledo Early College High School: December 1, 2017
Continuing, New Transfer, and Graduate UT Students: March 14, 2018
Access the application by clicking on the following link:
College of Arts & Letters Scholarship Application
Additional Scholarship Opportunities
Department of Art Scholarships
- Scholarships are awarded annually to both entering freshman and continuing students. To apply for these scholarships, please visit the Department of Art site for details and deadlines.
Department of Music Scholarships
- Scholarships for music majors are available to qualified students. Non-majors may receive scholarship assistance by playing in selected ensembles and studying privately. To apply for these scholarships, prospective students must complete an audition. Please visit the Department of Music site for details and deadlines.
Dean's Essay Award for the College of Arts & Letters
- Scholarships are awarded each year to undergraduate students in recognition of excellence in writing and creative expression. Please review the announcement for more information.
- Essays must be submitted with a faculty nomination form.
Office of Student Financial Aid/Scholarship Services
- Students may be eligible for other University of Toledo donor awards not specific to enrollment in the College of Arts & Letters. Scholarship applications, including the Office of Student Financial Aid General Scholarship Application, can be accessed using the UT Scholarship Search. A complete listing of all opportunities and requirements for UT and outside scholarships is available on the Financial Aid website.


text:
Celebrate the Holiday, Burn it for Good Fortune
The innovative Light n' Go Yule Log is an engineered all natural wood log, which can be lit with one match, and enjoyed for 1.5 hours. Dressed with a handle and seasonal decoration, it is a fun holiday gift, easy to burn for an instant warm atmosphere. This holiday log can be enjoyed in all winter in a fireplace or during the summer in a firepit.
According to ancient tradition, burning the Yule Log during winter solstice will bring good fortune in the coming year. According to Eco Forest, burning the Yule Log anytime will make a quick and easy fire adding cozy enjoyment to any setting.
The Eco Forest line of firewood products is 100% natural, innovative, and attractive. Each product is designed to be "best…Read more
The Showstopper, and it's Portable The Bonfire Log is new, unique, and the most extraordinary innovation in firewood of our…Read more
5Seasons is a division of Essay Group, focused on the design and distribution of seasonal garden programs. With the help…Read more