text: Home Web Security Web Security One of the ways that malicious software can access your network is through websites. There are several solutions that can help prevent your employees access risky websites, such as content filtering, link scanning and by using professional anti-virus software. Education is also important. Below are a few of the dangers to watch out for: What Are Phishing Websites? Phishing sites are spoofed websites pretending to be major players in order to gain information from you. Paypal and HMRC as well as banks are the major ones faked. Often they come as a link in a phishing email or they may be created by a common mistype of the web address or URL. What Are Blacklisted Sites? There are hundreds of blacklisted databases and web addresses can get on these lists for a whole host of reasons. They are normally identified as 'abusive hosts' which often means they have been sending out spam emails from their domain. Legitimate websites can get on these lists but our advice is to avoid accessing them until they are taken off the list. How Do We Ensure We Access the Web Securely? Our advice is to work with a security focused IT company that will support you to deploy a cyber security solution which is both secure and flexible. This is to ensure you don't lose the user experience or frustrate your employees and reduce productivity while protecting your business and your critical data. Our Favourite Free Tools for Cyber Security are: We always advise working with a professional IT business but if you did want to have a look at some free cyber security tools, these are our favourites: MX ToolBox MalwareBytes Sophos Free Anti-Virus We Offer a Full Cyber Security Audit If you are interested in our web security solutions, please call our Leamington office on 01926 452 462. Emerald Case Studies Our latest Case Studies and what our customers are saying... Published on 24 January 2017 Helping You Win Business-Changing Contracts We first met GCS in 2013 when they had a problem with their printer one weekend. Based in the same serviced office building as us back then, we happened to both be working on a Saturday when Tom asked for help. We've been best friends ever since! Working with themas their technology partner... Read more Read Further Case Studies Infrastructure & Communications Technology Roadmaps IT Network Cabling IT Hardware Disaster Recovery Your IT Project Team Emerald IT Testimonials "We started working with Emerald following a security breach which cost the business a substantial amount of money. As a small business we didn't believe we needed big business IT security but the service Emerald provides is very cost-effective for small companies and keeps us safe." TREVOR DAVISON - ALLWOOD INTERIORS LTD Read Further Testimonials


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Location of Cry Baby Bridge:
There is some dispute about the actual location of Cry Baby Bridge. This may be due to the fact that the "bridge" is actually a "culvert", at least according to some descriptions. According to some locals, the bridge is located near the Nature Preserve on Cap Ranch Road. Traveling past the Nature Preserve 1 to 2 ½ miles there is purportedly a very small bridge (the culvert). However, several online reports assert that there is no bridge-like structure in this area. If the culvert is there, it isn't easy for non-locals to identify.
Another source says to take CR2100 off of FM779 north of Mineola to find the bridge. According to this report, the original bridge has been replaced by a concrete structure that has been repeatedly vandalized. It is covered with graffiti and located along a road with trees on both sides.
Interesting Facts about Cry Baby Bridge in Mineola, Texas:
According to sources that claim that the bridge/culvert is in the vicinity of the Nature Preserve, there is an old cemetery located nearby.
The story of the bridge makes reference to the American Indians in the area. According to local lore, an Indian chief learned of a planned attach on his people by white men in the area and he separated the men from the women and children. The white men learned about the split and brutally killed the Indian chief, his warriors, and all the women and children at the trees near the bridge. Some people claim that there are trees that have branches and leaves that resemble an Indian chief's face and headdress.
Ghosts at Cry Baby Bridge:
Cry Baby Bridge visitors report that if you turn your engine off on the bridge and then roll down the windows, the cries of the Indians who were purportedly massacred in the area.
Other Texas Cry Baby Bridges:
Port Neches TX Cry Baby Bridge
StrangeUSA.com (1901-2112). Cry Baby Bridge. Retrieved February 14, 2013 from http://www.strangeusa.com/Viewlocation.aspx?id=9814#sthash.Gxi6Ezis.dpbs
Rhodes, C. (2012). Local Legends: Cry Baby Bridge. Retrieved February 14, 2013 from http://catierhodes.com/2012/02/10/local-legends-crybaby-bridge/
The Shadowlord (1998). Shadowlands Haunted Places Index: Texas. Retrieved February 14, 2013 from http://theshadowlands.net/places/texas1.htm
Wikipedia (2012). Mineola, Texas. Retrieved February 16, 2013 from http://en.wikipedia.org/wiki/Mineola,_Texas
Mineola TX Texas United States
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subset: commoncrawl


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S: Broughton Reunion 2010
BC: The End
FC: Oklahoma City, OK March 2010 | The Broughton Family Reunion
1: "Unless the LORD builds the house, They labor in vain who build it..." | The house of which the psalmist sings is not merely physical - it is family. His biblical world view tells us that family is a divine edifice, impossible to assemble with mere human effort. Among the chiefest of God's blessings, he "builds the house" through bonds of love that expand as he carefully chooses and adds every new member stone by stone, through adoption, birth, and marriage. People are sinners, so "the house" possesses many defects, but in amazing ways. God brings together unique individuals, disparate in many ways, so that he can teach them to confess and to forgive, to laugh and to lament, to love and to pray, and above all to glorify and enjoy him. Ultimately, God uses family, imperfect and sinful as it is here on earth, to draw us into that glorious heavenly family of whom he is Father. Those of us pictured in these pages have been blessed by God's gracious building of a particular earthly family that we hope foreshadows the joys of that heavenly one. In God's providence, he answered prayers to bring our family together for a few days of early springtime in Oklahoma to appreciate his goodness and to enjoy one another. It is hoped that the pictures scattered through these pages will recall happy memories of our time together and help us to keep one another in our thoughts and prayers. May God be pleased to continue building his eternal family through our earthly one!
2: East coast Broughton clan goes west | are you going to check that?
3: Hi, Sugar! | Oklahoma!
4: Get your kicks...
5: there's just somethin' women like about a pickup man
6: Between the gates of time
10: Oklahoma City Zoo
11: Will hangin' with C'Hollis
12: Ally & Cam catch some wildlife | Ransom goes on safari
13: Oh, give me a home... | Oklahoma dirt is red due to the presence of iron oxide!
14: the train!!!
15: What's your favorite part of the zoo, Will? "The truck." | Red Sox nation!
18: The FAmily Reunion March 6-7, 2010 | Abel Broughton
20: Mauricio & Abby Cremer | Dan, Jana, Hollis, & Kanon Gridley
21: Alyssa Dager & Joshua Broughton | Adam, Kristen, William, & Trevor Broughton | Aaron, Qiana, Cameron, & Ransom Broughton
22: "Behold children are a hertiage from the Lord." - -Psalm 127:3
23: Clara with Sandy and her family: Lindsey & Charlie Durham, with daughters Kennedy, Landrie, & Gentery, Meagan & Patrick Wells
25: Hmph. Yay! Huh? Why?
26: A family is pieced together with hope and faith. A family is quilted and bound with love and grace.
27: William & Susan Broughton with Sons and families
28: Sam & Jenny Broughton with daughters and families
29: Family
30: Smile, Ladies!
31: What's up, Cuz?
32: But the mercy of the Lord is from everlasting to everlasting On those who fear Him, And His righteousness to children's children. -Psalm 103:1
33: Clema Broughton


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Meeting the needs of every reader in your classroom just got easier.
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Three fiction titles all connect to a common theme–selected for three different reading levels, A–C. Every reader can participate and have an opportunity for success.
Thematic Teacher Guide
Each Thematic Teacher Guide includes multiple activities and strategies that focus on elements common to all three titles (e.g., theme, characters, historical period). The Thematic Teacher Guide provides varied, multidisciplinary activities to use before, during, and after reading. It also includes opportunities for collaborative learning and leveled assessment.
Student Packet/Answer Key*
The individual Student Packets for each title in the kit are filled with prereading, during reading, and post-reading activities to address important reading and literature skills. The Student Packets emphasize active, meaningful learning. A separate Answer Key is provided for each of the three Student Packet variations.
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Individual Reader Response Journals provide multiple opportunities for students to make personal connections and record thoughtful responses to what they read. These journals encourage the important reading-writing connection. Prompts relate to individual titles and to the overarching theme.
*Refills and extra copies are available for Student Packets and Reader Response Journals. Please call 800.688.3224 to order.
**Please note: These are suggested reading levels only. The final decision about the appropriateness of any title rests with the teacher, who is most familiar with the abilities, needs, and interests of his or her students.
© 1999-2018 ECS Learning Systems. All Rights Reserved.


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Here's my YouTube introduction to the project.
The first project was a potato pickle, using up spare sweet and sour syrup from my bread-and-butter project. It will be hard to get through the whole bag without spoiling some, so I thought it smart to preserve a few right off the bat. The potatoes came out crisp and chewy, just as we hope to get from a good pickle.
This being 2.0 Cooking, the next step was to stage the pickles, take a pic, run it through a few filters, and post to instagram. Tag the pic with a few keywords.
Posting on Instagram allows me to link also on Twitter and Facebook. No "likes" for the pickles, but one comment.
While we're at it, let's post the recipe up on a sharing site.
Now that I have a web based recipe, let's have a little more fun. How many calories a serving? Cruise over to My Fitness Pal and import the recipe.
Saved and logged, I find out that a single serving of pickles is thirty calories, 5 carbs. Information. Power. But not popular...yet.
So off I go, for two months I prepare, pic, and post potatoes in every way I can imagine. It took longer than twenty days, and I didn't make it to twenty recipes, but I got through the whole twenty pound bag, feeding the two of us at home and a few extras. (The potato roses came out especially nice and I made them a couple times for socials.)
I was helped along with some great cutting tools. Pictured here are a regular shredder, knife, peeler, and in the upper left corner, my beloved ceramic Mandoline. Here the lowly potato shows of it's great versatility. The wide variety of meals and presentations practically guaranteed we didn't die of boredom.
Savoury potato pancakes with a side of cottage cheese. Always hearty, always satisfying.
Wedgie fries made in my Actifry. Just a tablespoon of oil and we have crispy wedges nearly as perfect as what we get in the restaurant.
My Mandoline again. It makes quick work of the potatoes.
Sliced thin, they make a killer scalloped potato. I added bacon bits for colour, and to make this a meal.
Mashed potatoes of course. I added a little cream cheese as I had it on hand.
This is a Saturday afternoon affair; home-made perogies. I've decorated these with my caramelised onions. I think I used this recipe. The attraction here is not in the fancy ingredients but in the time invested to make them. These garnered the greatest number of likes; 8.
Potato soup. A meal like this is practically free, a concept that is quickly being lost on this generation. I took leftover roasted potatoes, peeled them, added a little chicken stock, and took the immersion blender to them. I added a little extra roast chicken and caramelised onion. This is the only way I'll eat soup; thick and savoury. I garnished with a little rosemary from my windowsill. All the food is left over from the roast dinner the night before.
This made far more soup than I could use up.
Julienned. I firmed up the potatoes by salting them, pouring on a little vinegar so they wouldn't brown, and patting them dry. Combined with the other vegetables, I end up with a generous stir fry.
Here is the finished stir fry, with baked tofu. This meal provided leftovers for many lunches.
My potato roses. I used my trusty Mandoline again, then treated the slices as rose petals. I stuffed these, delicately, in to mini muffin tins. The middle petals were a single slice folded in quarters. I poured a little egg and milk in to the cups, and baked.
The potato rose recipe: http://www.grouprecipes.com/143130/potato-rose.html
Crustless quiche, using up some of the extra vegetables from the stir fry.
Twice-baked potatoes with extra-fine shredded cheese. The extra-fine shredding can reduce calories without sacrificing taste.
And, what twenty day potato challenge can go by without including potato salad? I take it as a personal challenge to make a potato salad as good as what we get in generous tubs in the store. It's not that much work, really, and it is so good.
Every good project ends with a Lessons Learned session, so here we go:
- The potato pickles were prepared October 1st, and the twice-baked potatoes on December 5, when the bag was finally finished - 66 days.
- Total number of unique recipes; thirteen.
- If you see a black cat today, don't let it cross your path. If you saw a meteor this week, chalk it up so "science".
- Twenty pounds of potatoes feeds two people for far longer than twenty days. We were eating lots of other things along the way, of course.
- I should not have worried about the bag going bad before I finished.
- Producing a quality YouTube video is Really Hard and a whole other skill-set I have barely mastered. The video is pretty but the sound is horrible. Practice will make perfect.
- I'd give a whole afternoon just to video editing. I suspect this is the WORK component of You-Tubing and I have a whole new level of respect for home-grown videographers out there.
- Staging, photographing, filtering, and posting really doesn't take that long. This is another example of practice perfection. I've been staging Pancake Sunday for over eighteen months already.


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Vision Hopper II Wading Boots
Vision Hopper Felt Sole Wading Boot
Designed for maximum comfort and support the Hopper II wading boots will remind you more of hiking boots than traditional wading boots.
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Vision Hopper Gummi Wading Boots
The boot opens up wide so it is very easy to put on and the nylon lace loops hold the laces while you tighten them up. High design with neoprene cushioning maximizes the comfort and support.
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Anna Kendrick's black dress is a retro throwback with its feminine '50s-inspired silhouette. [#image: /photos/5582c75b941a95530d04e9cc]||||||Photo courtesy of Starworks Group.
**WHO: **Anna Kendrick
**WORE: **Black Sportmax pleated v-neck dress
**WHERE: **Vanity Fair Women in Film Dinner, June 15
Anna's lu look is a toast to taste with its flattering silhouette and on-trend pleat detail. The mid-length skirt flatters, while her belted waist highlights her feminine figure. And, of course, the black color choice--accessorized with equally chic black accessories--is a classic.
Like Anna's look? Let us know in the comments below!**


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Join our Wishmakers on Campus® program, a fundraising program designed for college students interested in contributing their time and energy to help support the granting of wishes to children with life-threatening medical conditions.
The fundraising possibilities are endless for individuals and student groups – anything from a 5K walk/run, to a bachelor/bachelorette auction or silent auction. By participating in Wishmakers on Campus, you can help bring a ray of hope for children diagnosed with life-threatening medical conditions.
Download a Wishmakers on Campus packet and get started today!
For more information or questions, please contact Jessica Quijada at 800.304.9474.
Seattle University students collected cash and travel items to make the SU MPAC project a success and to help support travel wishes.
Students of the WSU Sports Management program held the Water Balloons Olympics to support Make-A-Wish!
The Chi Omega sorority at WSU hosted a cook off to benefit Make-A-Wish.
Fill out and submit the Wishmakers on Campus® packet and get started.
Eastern Washington
November 05, 2019
Western Washington
August 02, 2019
May 14, 2019
March 01, 2020
Work directly with wish children to grant their wishes. We are especially in need of volunteers in Anchorage, Longview, Olympia, Spokane, Tacoma, Tri-Cities, Wenatchee and Yakima.
Read wonderful wish stories and learn more about local activities and accomplishments happening right here in Alaska and Washington.


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Our mission is to provide the finest rugs in the world at the lowest prices while treating our customers to the best service possible. When you visit Landry & Arcari, we take the time to learn about your needs and then to share our design expertise and product knowledge so you can make your choices with confidence.
The Boston store has a gallery-like setting with high ceilings and an open floor plan. Rugs are draped on the walls from supports which are raised and lowered at the push of a button by the same mechanism used for garage door openers. This is a very helpful device since we specialize in over-sized rugs and have carpets up to 18 x 27 feet and on occasion, even larger. However, customers can easily look through our sample rack of 6 x 9 feet rugs on their own. Our Boston location also carries our full line of broadloom carpeting and area rugs.


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Spotlight On Outstanding Teachers, Brian Kennedy
Quick Key Mobile™ turns your mobile device into a scanner and eliminates hand-grading of formative assessments, even for teachers working in paper-based classrooms without a computer or an internet connection. Analytics and data exports are fast and easy, so you can focus on your students.
|From the Quick Key Mobile Team and Family
Author: Walter. Ready to give Quick Key a try? Click here to sign up instantly!


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Engineering Expertise
At Silverstone the recruitment and retention of highly skilled and competent staff is key to everything that we do.
The continued professional development of our staff is crucial in maintaining a dynamic workforce, in a quickly developing market.
This is achieved through regular and monitored training programs, tailored to individual competencies, the obtaining of external qualifications, where appropriate, and continued coaching and support within the teams.
This ensures that we have the right people, suitably qualified, and experienced, performing tasks to the highest standard, supported by the wealth of knowledge and experience of the whole team.


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PRIMADERM S.L. · C/Coneixement, 3, 08850 Gavà, Barcelona (B64959133). made by 4funkies


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'Tis the season! It truly is the best times of the year and one way to celebrate it is to make COOKIES. Holiday cookies are totally in...it's like the thing to do. Everyone is baking away making their favorites...gingerbread, peanut butter kisses, chocolate, peppermint, or these simple Christmas cookies with frosting and sprinkles! My mom makes these cookies every year so I asked her for the recipe and made them myself. My mom was raised in Sibley Iowa, a small farming town in the … [Read more...]
Chewy Chocolate Cookies with Hershey's Hugs
And so it begins. Holiday Baking! It's my favorite time of the year...to bake! I absolutely hate snow and cold weather but I love the holiday season when it comes to the sweet treats. Oh, and I love the music, don't you? There's nothing quite better than chocolate in the winter. I don't know what it is, but it's comforting and for some reason tastes better in below freezing weather. I found these Hershey's Hugs at Target and couldn't pass up their cuteness and figured they would … [Read more...]


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This Diwali I gave a miss to my traditional shopping spree and tried something out of my comfort zone… It turned out to be a really comfortable experience as I did not have to bother about waiting in the ques outside trial rooms or billing counters. Getting spoilt for choice is a happy option actually. So I decided to save my time but look my best by shopping smart and getting it delivered to my doorstep.
Though I am a self-confessed shopaholic, I am not really a fan of online shopping. There are a few things from my checklist that make me feel apprehensive about the so called 'best deals' on various websites.
For instant – How will the fit be?
Will the colour look the same as the one on the portal?
How quickly will it get delivered?
What if I want to return it or get a refund?
And the list goes on…
For a change, I wanted to try out shopping online when I saw my friend wearing an outfit that she bought from Westside online on the omni channel TataCLIQ.com recently.
After scouting through the portal, I selected this outfit from Bombay Paisley by Westside as my Diwali attire. It has that interesting Indo-western, boho-chic look that I really wanted to add to my festive wardrobe.
Here's why you too should try:
♡ It got delivered to my address within 3 days of my order placement.
♡ The best part of purchasing from Westside online is that you can also pick up the merchandise from the nearest store.
♡ The look and fit of the outfit was what I had expected it to be.
♡ I love the fact that I can wear it for this festival of lights by simply dressing it up with accessories like a golden belt and a tiara.
☆☆☆ Here's hoping that you too have a wow experience shopping for Westside products on TataCLIQ.com.
Wish you all a VERY HAPPY DIWALI !!!
–Sayanti Banerjee
YouTube channel
TheWoWDetector (https://www.youtube.com/channel/UC41qQrF7PQJlfg7RsaLPsGw?sub_confirmation=1)
📷 instagram: Sayanti_banerjee
🐥twitter: @mesayanti
Snapchat: thewowdetector


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Diabetes mellitus secondary to treatment with immune checkpoint inhibitors
Cancer immunotherapy has been one of the highlights in the advancement of cancer care. Certain immune checkpoint inhibitors bind to PD-1 on T cells and mediate an antitumour immune response. Given that immune checkpoint inhibitors are becoming part of standard care, a new class of adverse events—immune-related adverse events—has emerged. Among them is endocrine toxicity, most commonly targeting the thyroid, pituitary, or adrenal glands. New-onset diabetes mellitus has been reported in fewer than 1% of patients. We present a patient with type 1 diabetes mellitus secondary to immunotherapy, together with an overview of the associated literature. Patients who develop type 1 diabetes mellitus experience a rapid course, and diabetic ketoacidosis is commonly the presenting symptom. Insulin is currently the treatment of choice; oral antidiabetics or corticosteroids do not assist in management. Several predictive factors are under investigation, but physician awareness and prompt management are key to a positive outcome.
DOI: http://dx.doi.org/10.3747/co.26.4151
Copyright © 2019 Multimed Inc.
ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)


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ISRN Orthopedics
Volume 2013, Article ID 842852, 11 pages
SPECT versus Planar Scintigraphy as a Clinical Aid in Evaluation of the Elderly with Knee Pain
1Department of Hand Surgery, Kaplan Medical Center, Hebrew University, P.O. Box 100, Rehovot, Israel
2Department of Orthopedic Surgery, Kaplan Medical Center, Hebrew University, P.O. Box 100, Rehovot, Israel
3Division of Orthopedics, Tel Aviv Sourasky Medical Center, 10 Weizmann Street, 64239 Tel Aviv, Israel
4Imaging Division, Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 10 Weizmann Street, 64239 Tel Aviv, Israel
5Department of Orthopedics "A", Assaf Harofeh Medical Center, 70300 Zerifin, Israel
Received 30 July 2012; Accepted 17 October 2012
Academic Editors: H. Serhan and H. Yuan
Copyright © 2013 Amir Oron et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Chronic knee pain is a common complaint among the elderly and appears in 30%–40% of the population over the age of 65. This study was performed in order to evaluate correlation between clinical presentation of chronic knee pain and the imaging findings of SPECT and planar bone scintigraphy. Methods. We prospectively recruited 116 patients over the age of 50 who had neither knee surgery nor trauma. Patients were divided into symptomatic and asymptomatic groups. All patients were examined by an experienced orthopedic surgeon; on the same day imaging was performed. Statistical analysis was performed to correlate physical examination findings with planar scintigraphy and SPECT findings and blood pool images. Results. In symptomatic patients, planar scintigraphy correlated significantly () with the presence of excessive joint fluid, synovial condensation, and decrease in range of motion as measured in extension and flexion and patellar grinding test. SPECT findings correlated with all of the above tests as well as with medial and patellofemoral joint tenderness. Conclusions. We believe a finding of tenderness at the medial articular crease or of the patellofemoral compartment of the knee should be considered an indication for the use of SPECT scintigraphy rather than planar scintigraphy.
1. Introduction
Bone scans have become a key tool in assessing musculoskeletal pathology [1, 2]. Use of Single Photon Emission Computerized Tomography (SPECT) is becoming more common over the years as well [3]. Use of SPECT allows a three-dimensional assessment of the isotope dispersed in the subjects body, as compared with a two-dimensional assessment with planar "regular" scintigraphy. Bone scintigraphy is divided into three consecutive phases. The Perfusion phase, assessed at 30 to 60 seconds following injection, the Blood-Pool phase assessed at 2 to 5 minutes following injection, and the late phase at 2 to 5 hours following injection [4]. The use of Polyphosphate compounds with the isotope and mainly Tc-MDP allows differentiating between pathologies within soft tissues surrounding the bone and those within the bone in the perfusion phase and that found in the late phase which is attributed to the chemical reaction of the polyphosphate compounds and the hydroxyappetite crystals within bone [5]. Planar scintigraphy of complex or large structures within the skeletal system does not relay an accurate three-dimensional anatomic image, while use of SPECT mapping allows for spatial localization of the pathology in the mapped organ [3].
The differential diagnosis of knee pain in the elderly population is wide [6]. The most common etiologies are osteoarthritis, osteonecrosis, and degenerative tears of the menisci [6]. Knee pain may be referred from the hip or lumbar spine, and vascular malformations of the lower limbs have been attributed to knee pain as well [7]. Use of diagnostic aids allows for improved anatomical localization of pathology in the knee [6].
Osteoarthritis is the most common joint disease and afflicts the knees of 30% to 40% of those over 65 years of age suffering from it. Local degenerative changes in weight bearing joints appear from the second decade of life. By the age of 40, degenerative processes within weight bearing joints may be detected in up to 90% of the population, although these are generally asymptomatic [8]. In 1994, the World Health Organization and the American Academy of Orthopedic Surgeons defined osteoarthritis as "the result of both mechanical and biologic events that destabilize the normal coupling of degradation and synthesis of articular cartilage and subchondral bone" [9]. The subchondral bone has an important role in the development of chondral pathology. In 1986, Radin and Rose suggested that the cartilage within the joint is susceptible to shearing forces at points of decline or rise in subchondral bone density and cartilage fibrilation appears at these sights. Recurrent microtrauma, even in a healthy joint, brings about reorganization of the subchondral bone and thus transitional areas of changing subchondral bone density [10].
An important tool in assessment of knee osteoarthritis is planar scintigraphy performed following instillation of marked Technitium [11]. In these patients an enhanced uptake in subarticular bone during the late phase may precede the roentgenogrphic changes by many years and relays the changes in local vascularity and the osteoblastic actitivity which mark the initial stages of osteoarthritis [11].
A good correlation was found between pathological roentgenograms and bone scintigraphy in osteoarthritic patients and these changes may be predicted by scintigraphic findings [12–14]. A diffuse uptake was correlated with pain and osteophyte formation, whereas localized uptake was correlated to subchondral bone sclerosis. A negative planar bone scintigraphy was found to be a good prognostic sign [15].
2-to-5 minutes following instillation of the isotope containing fluid to the circulation the blood pooling phase of the scan is elicited [4]. Assessment at this stage elicits inflammatory changes within the skeleton and soft tissues surrounding it [14, 16], due to concentrations of the isotope containing fluid in areas of hyperemia and neovascularization [17]. During periods rendered as "active osteoarthritis", synovitis may be seen as an exaggerated pooling during the blood pool phase, which is positively correlated to osteoarthritic knee pain [15]. Collier and Johnson found SPECT to be superior to planar scintigraphy in patellofemoral osteoarthritis when concomitant involvement of one of the other knee compartments was evident as well, which was attributable to its ability to distinguish between the compartments which overlie each other in the planar view [12, 18, 19]. Both SPECT and planar scintigraphy were found inadequate in assessing the lateral compartment, although SPECT was superior to planar scintigraphy to some extent. As far as the medial compartment is concerned no advantage in the use of SPECT over planar scintigraphy was found in assessing osteoarthritis, although a pathological reading in the SPECT mapping may point to early subchondral changes in articular cartilage [18].
Aseptic necrosis of the medial femoral condyle is the corner stone of diagnosing osteonecrosis. The typical presenting symptom is pain along the medial articular aspect which is greater than that usually accompanying osteoarthritis [6]. Osteonecrosis typically afflicts the older population with predominance in women and may progress to osteoarthritic changes secondary to the disease. In the early stages of the disease, increased uptake is recorded in the initial blood flow phase and the late phase. The image of localized uptake in the medial femoral condyle in the SPECT mapping usually appears before that in planar scintigraphy [15, 18].
Meniscal pathology may cause knee pain as well, mainly in the medial compartment. The patient will describe a "locking" or "giving way" sensation of the knee. At times, excess joint fluids and localized tenderness over the articular crease may be appreciated as well [6]. In the younger patient population meniscal tears are usually traumatic in origin whereas in the elderly they are attributed to degenerative processes within the joint [6]. A number of clinical tests may be elicited in the knee with meniscal pathology with localized tenderness over the articular crease, and positive Mcmurry and Appley tests being the most widely accepted [20]. Fowler and Lubliner found the Mcmurry sign to be specific in meniscal tear associated with a limitation in knee extension [21], whereas others found limitations in the use of this test [20]. As to the Appley test, the literature attributes a low predictive value to this test in predicting meniscal pathology [20]. Localized tenderness over the articular crease is of high sensitivity and specificity in lateral meniscal tears whereas in medial meniscal tears these values are considerably lower. It should be pointed out that these findings are mainly from a relatively young patient population with a traumatic meniscal injury pattern, which may very well affect the clinical presentation in such cases [20]. Meniscal tears appear in SPECT mappings as localized uptake in a semicircular form in the vicinity of the suspected tibial plateau [3, 22, 23]. It has been found that degenerative "chronic" tears may mimic localized active osteoarthritis as well [18, 22].
Knee pain is a common complaint among the elderly. The orthopedist is often faced with the question which is the best diagnostic modality suitable for affirming his clinical diagnosis. Often, the roentgenographic appearance does not add to the confirmation of the suspected diagnosis since changes are late in most clinical pictures that is, osteoarthritic changes, avascular necrosis, and meniscal tears. In his effort to afford an objective finding to the elderly patients' knee pain, a growing number of diagnostic tests are performed, planar scintigraphy and SPECT becoming ever so popular. This study was performed in an effort to correlate findings in physical assessment of the knee with those in planar and SPECT scintigraphy, in an effort to better delineate the clinical value of each of these studies in the elderly with knee pain.
2. Patients and Materials
116 patients were prospectively enrolled in this study. The patient population included 68 patients who complained of chronic knee pain and a control patient group which included 48 patients asymptomatic as to knee pain. Patient recruitment was performed at both Sourasky Medical Center in Tel-Aviv and at Assaf Harofeh Medical Center in Zerifin, Israel. All scans were performed at the Sourasky Medical Center Nuclear Medicine Department. The study was authorized by the local Helsinki committee. Following patient informed consent to enroll in the study, each patient was independently interviewed and physically examined. Inclusion criteria for enrollment in the study included: age over 50 years, patient willingness to undergo both planar and SPECT scintigraphy of both knees, agreement to undergo physical examination, fill in questionnaires and pain response scales, and patient health was considered "good" by the examining physician—that is, patient was mobile without use of assistance or devices and was able to take part in the study. Patients were excluded from the study if trauma involving the knees occurred in the previous two months, if pregnant or suspected to be so, patients with a known allergy to Technetium or its derivatives, and patients with history of Gout, Rheumatoid Arthritis, Psoriatic arthritis, or other known inflammatory disease. The patient incurred a fracture to one of his knees in the past or a surgical procedure involving either of his knees in the last six months. Patient participation in another clinical trial during participation within this trial was an exclusion criterion as well.
Every participant filled out two questionnaires pertaining to knee pain. These were a Visual Analogue Pain Scale (VAS) and the Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC). These are well accepted in the evaluation of knee pain [24]. Through interpretation of the patient responses to the questionnaires they were divided into a study (patient rendered symptomatic as to chronic knee pain) and control group.
All patients were evaluated by an experienced senior orthopedic surgeon (NH). The evaluation included the following measures; observation: angulation of the joint (varus versus valgus), the degree of freedom in rotation of the joint, and periarticular edema. Palpation: synovial fluid bulging, medial, lateral, patellofemoral, and popliteal sensitivity. Range of motion was assessed in flexion and extension. Stability of the joint and specific physical signs assessed included the Mcmurry test, Appley test, Compression & Traction test, Bounce home test, Anterior and Posterior drawer signs, and Medio-Lateral stability. Patellofemoral grinding test and angle were assessed as well.
All patients underwent planar and SPECT scintigraphy according to the following protocol. Following intravenous instillation of 25 mCi of Technetium MDP-99m, a dynamic assessment of five seconds per scan per minute was performed, and then a blood pool assessment was performed with collection of 500 K counts in an anterior view of the lower limbs. The planar scintigraphy was performed utilizing an anterior view with accumulation of 700 K counts. SPECT was performed up to a 180 degree angle with step angle of 3 degrees. Matrix was set as and a zoom of 1.28 at a speed of eighteen seconds per step. Reconstruction was performed utilizing the Filtered Back Projection method with a 3.10 Mz filter, so a transaxial, saggittal, and coronal as well as a three-dimensional reconstruction was formed. Scintigraphies were assessed in order to relay local concentrations and there intensity with respect to knee anatomy.
Both physical and radiological assessments were performed without the physicians performing them aware to which study group the patient belongs.
Statistical analysis was performed using the SAS statistical analysis system (SAS Institute Inc., Cary, North Carolina, USA). Analysis was performed on ninety-six knees (48 patients) in the control asymptomatic group of patients and on one hundred and thirty two knees in the symptomatic trial group (68 patients). Chi-square probability values were calculated utilizing the Frequency Procedure or in some cases the ANOVA procedure. For continuous variables such as range of motion , and probability values were calculated utilizing the GLM Procedure or ANOVA analysis.
3. Results
Within the scope of this study we prospectively assessed 116 patients. Forty-eight patients were assigned to the control group and sixty-eight were assigned to the study-symptomatic group. The average patient age of those assigned to the study group was 64.735 years with a standard deviation of 10.316 and that of the control group was 66.354 with a standard deviation of 10.771. The study-symptomatic group of patients was comprised of 42 women (62%) and 26 men (38%) while the control-asymptomatic group was comprised of 17 women (35%) and 31 men (65%). The gender differences between the groups were statistically significant ()—percentage of women within the study group was 62% compared to a mere 35% in the control group.
Patients enrolled in the study were divided into a study "symptomatic" group as to knee pain and a control "asymptomatic" group based on their responses on the VAS and WOMAC questionnaires. The average VAS response in the study group was 77.15 with a standard deviation of 42.7 and that of the control group was 1.23 with a standard deviation of 3.4 which was found to be statistically significant (). The average WOMAC response in the study group was 745.26 with a standard deviation of 634.9 and that of the control group was 13.96 with a standard deviation of 29.7 which was found to be statistically significant () as well.
Planar and SPECT scintigraphy results were assessed according to the localization and intensity of the mapping in the respective compartments of the knee. The lateral compartment was divided into areas rendered as the Lateral Femoral Condyle and Lateral Tibial Plateau. The medial compartment was divided into areas rendered as the Medial Femoral Condyle and Medial Tibial Plateau. The patellofemoral compartment was divided into areas rendered Patellomedial and Patellolateral, whilst in the SPECT scans an area rendered Retropatellar was assigned. When the Blood Pooling phase was assessed, the scans were evaluated according to their uptake patterns rather than according to the different knee compartments.
The following tables contain data relevant to correlations between the different mapping methods and findings during the patients' physical examination.
Incorporated in these tables are abbreviations which represent the following.
BLPAT: the uptake pattern in the Blood Pool phase. BLPOW: the relative amount of uptake in the Blood Pool phase. LatFmPs: the uptake pattern at the Lateral Femoral Condyle. LatFmPw: the power of local uptake at the Lateral Femoral Condyle. LatTiPs: the uptake pattern at the Lateral Tibial Plateau. LatTiPw: the power of uptake at the Lateral Tibial Plateau. PtMedPs: the uptake pattern at the Medial Patellar aspect. PtMedPw: the power of uptake at the Medial Patellar Aspect. PtLatPs: the uptake pattern at the Lateral Patellar aspect. PtLatPw: the power of uptake at the Lateral Patellar Aspect. RetPtPs: the uptake pattern at the Retro-Patellar aspect. RetPtPw: the power of uptake at the Retro-Patellar aspect. Alignment: knee alignment (Varus or Valgus). Rotation: limitation in knee rotation. Fluid: a finding of excessive fluid in the knee joint. Synovia: synovial fluid inflamation. MEDJO: Medial joint crease tenderness. LATJO: Lateral joint crease tenderness. PATJO: Patellar joint tenderness. POPFOS: Tenderness to palpation of the Popliteal Fossa. BAKER: tenderness to palpation of Baker's cyst. PES: tenderness at the Pes Anserinus area. BHT: Bounce home test. EXT: Extension range of the knee. FLEX: Flexion range of the knee. Mcmurry: Mcmurry meniscal test. Appley: Appley test for meniscal pathology. COMPRES: Compression & Traction test. ANTDRW: Anterior Drawer test. POSTDRW: Posterior Drawer test. MEDSTA: medial stability. LATSTA: lateral stability. PATGRIN: Patellar Grinding test. QANGLE: angle value.
The values in bold are those with statistically significant Chi-square probability values. In order to prevent skewing of the radiological findings' interpretation it was decided that a correlation rendered relevant to statistical analysis would be between positive findings on physical examination and in both localization and amount of uptake in the examined scan.
A correlation between physical assessment findings and the results during the blood pool phase was found only in the study group. Such a correlation was found for physical findings such as excessive joint fluid, synovial inflammation, patellofemoral tenderness, and a restricted range of motion in both flexion and extension. It should be noted that in the control group probability values were not calculated for the joint Rotation examination, Bounce home test, Mcmurry and Appley meniscal tests, the Compression & Traction test, the Posterior Drawer test, and Lateral stability tests. This was due to the fact that no positive tests were found within the control group of patients. Due to the same reason, Chi-square probability for the joint Rotation test and Posterior Drawer sign were not calculated in the study group.
The following tables present Chi-square probability for physical assessment findings correlated with findings on both planar scintigraphy and SPECT, within the different knee compartments and study populations.
In Tables 2, 3, 4, 5, 6, and 7 the bolded values are Chi-square probability values of statistical significance (). Here too, in order to prevent skewing of the radiological findings' interpretation it was decided that a correlation rendered relevant to statistical analysis would be between positive findings on physical examination and in both localization and amount of uptake in the examined scan.
In the study-symptomatic patient group we found physical findings of excessive joint fluid, synovial thickening, limited joint range of motion, and positive patellar grinding tests to be associated with pathological findings in both planar scintigraphy and SPECT. When compared with Table 1, it is notable that all these physical findings but a positive patellar grinding test were correlated with excessive uptake during the blood pool phase. It should be noted that when the symptomatic patients were evaluated using SPECT a significant correlation was found between excessive tenderness at the medial joint crease and patellofemoral compartment on physical examination with positive findings on the SPECT examination. Such a correlation was not found when assessing the planar scintigraphy findings.
A number of additional differences were found between the assessments of patients using the SPECT compared with planar scintigraphy. While planar scintigraphy findings showed a correlation between findings of excessive joint fluid and synovial proliferation with excessive uptake on planar scintigraphy at both the Medial Femoral Condyle and the Medial Tibial Plateau, these findings correlated with excessive uptake only at the Medial Tibial Plateau when SPECT was used. It was also found that a restricted range of knee flexion correlated well with a finding of excessive uptake at the Medial Femoral Condyle on planar scintigraphy whereas SPECT correlated this finding with excessive retropatellar uptake. Limited extension of the knee correlated with excessive uptake at the lateral and medial femoral condyles and the Medial Tibial Plateau in both planar scintigraphy and SPECT.
A positive patellar grinding test correlated with excessive uptake at the Medial Tibial Plateau on planar scintigraphy and at both the Medial Tibial Plateau and the Lateral Femoral Condyle when evaluated using SPECT.
A number of physical findings did not correlate with either excessive uptake on planar scintigraphy or in the use of SPECT. These findings were knee alignment, angle, lateral joint crease tenderness, tenderness over Baker's cyst, or in the vicinity of the Pes Anserinus, meniscal tests and tests for knee joint instability. It should be noted that for knee joint rotation and posterior drawer sign Chi-square probability values were not calculated, due to the absence of participants with pathological findings.
In the control-asymptomatic patient group a number of physical findings correlated with planar scintigraphy. These included excessive medial joint crease tenderness with excessive uptake at the lateral femoral condyle, patellofemoral tenderness and excessive uptake at the Lateral Femoral Condyle and tenderness at the vicinity of the Pes Anserinus, and uptake at the Medial Tibial Plateau.
When evaluated by SPECT, a correlation was found between tenderness to palpation of the lateral joint crease or at the patellofemoral compartment with excessive uptake at the Lateral Femoral Condyle was noted. A positive Appley test correlated with excessive uptake at the Medial Femoral Condyle.
4. Discussion
Previously published studies stated that SPECT scintigraphy is superior to planar scintigraphy when osteoarthritis of the patellofemoral compartment is present concomitantly with osteoarthritis in the medial or lateral compartments of the knee [1, 16, 17]. It was also stated in previous studies that SPECT has no advantage over that of planar scintigraphy in assessing the medial compartment of the knee [16]. Our findings show an advantage of use of SPECT over planar scintigraphy in delineation of pathology in both the medial and lateral compartments of the knee.
We did not find a correlation between localized lateral compartment sensitivity in neither planar nor SPECT scintigraphy. These findings do align with those of a previous study by Yang et al. which found both methods to be of poor clinical value in evaluation of the lateral compartment of the knee [16].
When reviewing the results the physical findings of intraarticular fluid, synovial proliferation, limitations in range of motion, and the positive patellar grinding test were found to correlate positively with both planar and SPECT scintigraphy as well as a pathological reading during the blood pool phase. Previous studies have found pathological readings during the blood pool phase to be correlated with an inflammatory condition in the localized area of the skeletal system. Thus, objective findings in scintigraphy which were correlated with the above physical findings further corroborate our assumption that within the symptomatic patient population the knee pain stems from osteoarthritic changes. This may be further strengthened when reemphasizing that patients enrolled in the study did not suffer from trauma or undergo surgical intervention prior to enrollment in the study.
SPECT was superior to planar scintigraphy in correlating localized medial articular crease and patellofemoral tenserness with uptake in the medial tibial plateau. Further advantages incurred through use of the SPECT mapping were probably due to its ability to better define anatomic areas and delineate localized uptake. For example, synovial proliferation with a finding of excess intra-articular fluid were found to correlate positively to excess uptake at both the Medial Femoral and Tibial Condyles on planar scintigraphy whereas SPECT findings were limited to the tibia alone. A similar scenario, but of greater clinical impact was found when correlating limited flexion of the knee with planar scintigraphy findings which resulted in excessive uptake in the vicinity of the Medial Femoral Condyle while SPECT correlated with excessive uptake at the patellofemoral joint that is, where pathological findings would be expected in patients suffering from osteoarthritic changes and a flexion contracture.
Of interest is the fact that in the control group, which contained patients rendered asymptomatic as to knee pain, a positive correlation was found between tenderness at the lateral articular crease and patellofemoral compartment with excessive uptake in the lateral femoral condyle (Tables 8 and 9). This may be explained by changes in subchondral bone which may appear prior to articular chondral damage and thus does not eliminate knee pain in these patients. A positive Appley test correlated positively with excessive uptake in the medial femoral condyle in SPECT scintigraphy, as well. We could not find an acceptable explanation to this finding, whilst moreover other meniscal tests such as the Bounce home and Mcmurry tests failed to show any significant correlation whatsoever.
It is of note that a positive correlation was found in planar scintigraphy between localized tenderness at the patellofemoral junction and excess uptake at the lateral femoral condyle which may be explained by localized overlapping and inferior capability of planar scintigraphy to differentiate uptake emanating from the patellofemoral compartment from that of a true lateral articular joint nature.
This study was aimed at comparing planar and SPECT scintigraphy while correlating them to physical assessment findings in patients suffering from chronic knee pain and those asymptomatic as to knee pain. One of the difficulties encountered within the scope of this study was the absence of a clinically proven entity for knee pain in the symptomatic patient group. This could be coped with by performing a concomitant assessment of patients by knee arthroscopy which was not done within the scope of this study. Our working diagnosis in most, if not all, symptomatic patients assessed within the scope of this study, was that they suffer from osteoarthritis of the knee as indicated by their complaints and physical assessment. It should be noted that the symptomatic and asymptomatic patient populations differed significantly () as to gender and were not of equal size, facts which may very well bring about a statistical sway in the study results.
Our findings suggest SPECT scintigraphy to be superior to planar scintigraphy when correlated to physical assessment findings in elderly patients suffering from chronic knee pain. When tenderness localized to the medial articular crease or the patellofemoral compartment was found during physical assessment these findings correlated positively with SPECT scintigraphy, whereas planar scintigraphy findings lacked any correlation. In an age when unicondylar knee arthroplasty is readily available as a treatment for unicompartmental osteoarthritis of the medial or lateral compartments of the knee [25, 26], an advantage exists in the ability to delineate sequestered compartmental involvement in the human knee. We believe a finding of tenderness at the medial articular crease or of the patellofemoral compartment of the knee should be considered an indication for the use of SPECT scintigraphy rather than planar scintigraphy as a diagnostic aid in assessing the elderly with chronic knee pain.
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text: Share: Comments Print December 17, 2009 at 12:17 PM Storm assistant coach Nancy Darsch sticks with team Posted by Jayda Evans In a collective effort to help teams function economically, WNBA owners agreed to limit coaching staffs to two. In Seattle, that prompted head coach Brian Agler to designate Nancy Darsch (pictured right) as his sole assistant for 2010. Former assistant Shelley Patterson will not return. This summer will be Darsch's third with the team, joining the Storm after head coaching stints in New York (1997-1998) and Washington (1999-2000) and an assistant coaching role with Minnesota from 2003-05. She was the head coach at Boston College before being hired by Agler for the 2008 Storm season. "I'm thrilled to return to the Storm staff and appreciate the continued support of Brian, Karen [Bryant, the CEO] and our owners, Force 10 Hoops," Darsch said in a released statement. "I have enjoyed my experiences with the organization the past two seasons and look forward to continuing my role with the Storm." With the staff settled and the dispersal draft completed, Agler and Darsch will turn their focus to scouting. But the Storm roster, limited to 11 players, is mostly set with eight players under contract or reserved by the Storm. The only unrestricted free agents are posts Lauren Jackson and Ashley Robinson. Jackson, a 6-foot-5 power forward, gave a verbal commitment prior to leaving to Australia to rehabilitate a lower back injury while Robinson constantly says she only wants to play in Seattle. If she does not play overseas this offseason, Bryant is looking at her to help with marketing promos, already completing a commercial for the team. Yet Robinson, a 6-foot-4 center, will most likely still have to earn a contract at training camp, which opens in April. She's averaged 1.4 points, 2.3 rebounds and 11.6 minutes in six WNBA seasons. The Storm's major void — unless posts Janell Burse and Suzy Batkovic-Brown don't return — is at guard. Veteran PG Shannon Johnson retired. Newly acquired G Chelsea Newton, the 10th pick in the dispersal draft of Sacramento players, is a possibility as a replacement. Free agency was supposed to begin Tuesday, but was pushed back January. Now "core" designations and qualifying offers must be sent between Jan. 1 and Jan. 14. Negotiations can begin Jan. 15. Offer sheets and contracts can be signed beginning Feb. 1. Comments


text:
SALISBURY, Md. – The Salisbury University football team has been playing throughout this season with a teammate on their mind who has not been able to suit up in 2013. A.J. Slye is in Virginia, battling leukemia, and while he battles the disease head on, his teammates have been working this week to do what they can to help eliminate it, as well.
On Monday night, the team organized a Leukemia Walk, looking to rally support from the campus and surrounding Salisbury community for the fight.
This week, Salisbury football players have been selling T-shirts bearing an orange ribbon (the color of leukemia awareness) and the words "I support AJ Slye". The shirts are on sale from 11 a.m. until 1 p.m. in front of Maggs Physical Activities Center and in front of the Commons Dining Hall. Sales will continue on Friday, October 18 and T-shirts will also be on sale at Saturday's game against St. John Fisher College, at Sea Gull Stadium.
All money raised by the team this week will be donated to the Leukemia and Lymphoma Society (LLS). The LLS will also have a table at Saturday's game, which is scheduled to begin at noon, providing information regarding the disease and the fight against it.
Slye, a linebacker, is from Stafford, Va., and was a freshman on the team in 2012.


text:
PLAY, and play some more!
There's going to be a list down here. Don't fear. It is there to help you find more excuses to play at work, in relationships, with your kids, as a scientist. It is there because I am very serious about play, but people miss the point when they see me play with everything around me. They think I'm not serious. I am. Seriousness is something else. Seriousness is a mask of 'what will others think, when I behave other than what I think is expected here?' Seriousness is a prison and here's the liberation.
If lists or reading aren't your thing then here is a link to a podcast, with an interview with me on Play. Why play is one of the most powerful forces on earth. :)
We must all play more! I have to retell this bit again and again. And the resistance is huge. Which is crazy. Play is not serious, according to many. What!? Play is serious as hell! The opposite of play is apathy, depression and compliance to a zombie society. We must, should, and I hope, would love to play more! Play is messy, chaotic, and lacks clear direction (unlike games). When I play I feel alive, present, can relate to kids of all ages. I can do all kinds of things, discover new things and failing most of the time is part of the fun and learning.
I once 'fought' with seven toddlers for half an hour. They kept screaming for more. Their parents around the fight smiled. They didn't join or didn't know how to. Or, I must admit, took their rest. The kids were very much in control. If I was too scary they would almost cry and ask me to be less scary. If I started running from them, they would ask me, to be the 'monster' again. I could only see how smart and honest these kids steered the 'fight', when I played with them. Yet, playing like this gets two reactions: compliments of those who long to do it too. And others who will not take you serious, for playing with kids is not being serious. Or is it?
So what is play good for*?
Basically play is how nature invented learning. All mammals learn through play. Playing is integral learning with your whole system(!) involved. When a young tiger hunts his mothers tail, it learns to move, be agile, be present in the moment and it learns the borders of it's mothers patience. When children play tag, the simplest game ever, they learn so much at the same time: hunting and being hunted, (dealing with) winning and losing, motoric skills, fairness within the group, collaboration, how to improve the game when it gets boring, social patterns, leading and following, creativity, presence of mind, being present in the body and probably more. Compare that to sitting still behind a table and making sums. The only reason we teach like that is to drill compliance and being able to measure progress one level at the time. "B- for your sums, Johnny, you need to concentrate better." Even though Johnny had perfect concentration in the tag game an hour before, when he was so concentrated he always knew how to turn aside into an unexpected direction in the last moment. And he helped frame a new rule (you can't be tagged, when you hold someone else), because he was aware how the smallest children needed an extra way to escape.
"Without any form of play, civilization is impossible." Johan Huizinga.
Biological Benefits of Play.
Physical play develops the body. Motoric skills are developed, so are muscles and flexibility. And, with a lot of falling down, dealing with pain.
Play helps build neurological networks. The science around this is developing fast, but it mostly supports what I keep on saying: Play is how nature invented learning.
Play helps with boosting a lot of healthy endorphins and hormones, helps your brain to deal much better with anxiety, and get more flexible too. (see links at bottom)
Play boost the biological aspects of power, leadership and partnering. Hormones make you play towards the other sex. It's only when that play is disturbed (often through social anxieties) we get deviant patterns, ranging from shyness and shame to violent domination in order to get gratification. See next bit.
Social Benefits of Play
Playful people are more attractive to the other sex. Yes! Playful people feel safer and healthier to the other sex, especially for women. All the movies about creeps show it too. Creeps never play, or know how to play fight. There's always a stiffness, something controlled and not genuine. Because when you play, you can't control your image. So fakes fear to play.
Social relationships, collaborations, friendships are enhanced through play. No wonder men and women go play to bond, though they call it sport, game, share.
Play builds capacity to be free. It creates social flexibility. Play is the escape out of fight, flight or freeze modus. Because if you can play with something, you're free in it. I can play fight with toddlers, play improv on stage, invent stories around the fire, deal with groups of bankers, refugees and hippies. Those that diminish playful expression of self are oppressors. Ask more what their interests or fears are.
Play builds culture and social patterns. Whenever there's a party, where people add with playful contributions, from dressed up wagons to small acts on street corners, it adds to feeling community. Play also helps those patterns to evolve to new times and new games. Escape rooms, video games, sports, etc all derive from people playing with possibility and sharing their findings.
Play builds social, spacial and contextual awareness. Playing in your and with your environment means you develop relationships with your culture. You discover boundaries and you'll discover ways to get things done within your context. Through play you mostly do this subconsciously. But in certain cultures the elders are revered. So if they freeze up, you've made a mistake. In others you find that asking with Bambi eyes gets you an extra cookie.
Play boosts the capacity to allow yourself to make mistakes and learn! When you play and fail, making mistakes means little to no harm is done. It's a mood of exploration and people feel that. You tried and discovered. You didn't die. The play mood makes you much freer of fear for social embarrassments. The play mood allows to show behavior outside our box. Men, secure in their maleness, can make some effeminate moves without fear of being thought of as gay. Homophobic guys, filled with fear of being seen as one, can't. Thus playful people can cross borders in a safe way, while those filled with fear crab each other back to conformity. You choose.
Mind and Soul
Play is full system learning. It's a totally integral synthesis of conscious, subconscious and biological developments. No, we don't need to understand everything. My full system can comprehend stuff, my brain cannot. Blocking that capability, because of the need of proof or control is like cutting off an arm that makes things we don't understand. Don't handicap yourself or others like that. Open up.
Play boost adaptability. Playful people see possibility everywhere. Resilience in darker times needs that skill. Start Ups need everyone to stay open to help fill gaps, while it develops routines. It is an essential quality for fast changing times. Thus companies full of routines need to play to break routines, when the world around them changes. Then why does education still put so much emphasis on acting according to procedure, model and method? Man is not a machine! And should not trained to be.
Play boost collective intelligence. Yes. People playing together, or having a playful attitude are way more open to find, share, accept new possibilities and solutions. Since play is fully integral it also means their whole systems bring in information for the whole. This is as simple as a boring teacher noticing his class gets restless and he doesn't demand attention, but rather brings in more excitement.
Play boosts critical and creative thinking. When Sir Ken Robinson claims schools kill creativity, here's one of the main ways they do it: they curb playing. And because playing means seeing many other options, it also boosts critical thinking. Why do we do it that way, when this and this and this and this is possible too?
Play boosts the heart mind connection. The wah? Science has only barely begun to discover the relationship between thinking with the brain and the heart. Yet spiritual people know this from experience. Heartmind is when you make decisions with a sense of wisdom, sensing the whole your connection with an issue. A glow from the breast may point you to head in a certain direction. it's up to the conscious thinking to define how. My believe and experience is, that play boosts my capacity to act, talk and play with my heartmind connection.
Play helps to channel. Now we go into more scary land for some. But many experiences in my life, make me believe this is how it works. In improv theatre one principle says: choose to know. As a actor in training I work with that. I once played a methadone addict (without ever having been close to one) and something happened. The group I was working with were stunned. I had behaved exactly like one of their heavy cases. Play may connect you to the Collective Consciousness or the Akasha Chronicles. Perhaps in more ordinary words, playing opens up to an intelligent common sense of how things work.
Play boost aliveness and inspiration. Indeed. Working in a 9–5 cubicle is killing. Playing with the situation (and day dreaming) the escape within the situation. Playful people seem more alive. They are fun to be with. They have adventures everywhere and spawn many new ideas. People that don't play and especially those that curb play feel dead and anxiety driven. If you don't want to end up dead, before dying, do play! And when you play a lot, you get ideas how to escape the cubicle (if you're still in one) and get paid for much more fun work.
Play is being!
Yes, all of the above happens at the same time when you play. You play when you do art, dance, play hide and seek, roleplay, build lego castles (of own design!), invent games, chasing each other through the forest, play fight with friends and loved ones, cuddle without wanting, make love with laughter, mess around with stuff, experiment with whatever, etc. See how painfully much of school(work) is missing this experience. And I wonder how purpose driven games (for education) may lack play as well.
Bonus: Innovation and Play
Much more inventions happened because people messed around, than educators in science care to tell you. Hey, they teach method. But breaking the rules, trying it different, looking closer at the possibility within failures often led to astonishing results. Check, for instance, how Viagra or Post It notes were discovered. After such findings often scientists will put it in the traditional scientific frame needed to get published. Thus hiding the messiness that helped boost discovery.
Hey, even the universe plays. The weirdest animals walk this planet. Nature tries things out. Diversity means nature stores options. Monogamous people keep communities alive in times of STD's. Cheaters prevent communities from inbreeding. It's our own believes that want us to choose sides. Nature loves them both. The whole complex interacting play of everything in nature, has been build up over millennia. Our comprehension of how it works is still very very shallow. Thus don't believe those who claim which interventions will boost business in a safe way. Or prevent natural disasters with geo engineering (which will lead to the biggest disasters of this century). The safest way of life is learning to play with how it works. It's us playing to the rules of the bigger pattern and accepting those principles that make us part of the whole. It's seeking to control the game, that leads to disease, in individuals, in organizations and in human society. Seeking to dominate is a deadly game.
Play as part of, because in the end: you are part of the whole. And when you play, you'll find that whole is within you.
If you want to start a play revolution, than read onwards here: playvolution now
- ) Once again I write this from the top of my head, but I know science is quickly adding proof to most statements I make. It even improved my belief in play with many new insights, some of which I roughly mention. Go find the science in books like Play, how it shapes the brain, opens the imagination and Invigorates the soul, The Power of Play or this unrelated article also called the Power of Play, which talks about biological and relational advantages of having a playful state.
- For people seeking more ways to play, or get playing: there's this wonderful free book by Play Expert Bernie deKoven: A Playful Path.
- A nice addition is this short Youtube video on Play from BigThink.
- And what if you don't play enough? You'll never grow up! Even worse Play deprivation is an indicator for mass murder. Indeed.
- Warm heartened TEdx talk by Andre Stern who never went to school!
- I also used a lot of different (quotes in) pictures people posted on the internet to share. I may have mistakenly added one from someone not having that intention. Then I'll remove it, when you ask.


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Show All Results...
- Tracks
- Artists
- Albums
Captain Prabhakaran (1991)
Captain Prabhakaran (1991)
Captain Prabhakaran (1991)
- Music Director
- Ilaiyaraaja
- Actors
- Mansoor Ali Khan, Ramya Krishnan, Rubini, Sarath Kumar, Vijayakanth
- Producer
- Rowther Films
- Director
- Selvamani RK
About this album
The film has been directed by RK Selvamani and has in the cast Sarath Kumar, Vijayakanth, Ramya Krishnan and Rubini. Ilayaraja brings edgy and upfront songs for the film.
Aattama Ther Ottama
Paasamulla Pandiyaru


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Welcome to our Audio Visual Installation Company
We are a professional audio visual installation company that installs commercial sound systems, LED stage lighting, projectors, projection screens, digital signage & public address systems into commercial properties & businesses. As an audio visual installer we can provide you with a complete audio & visual installation service from start to finish on all projects no matter how large or small it is.
From a sound system installation to a projector or commercial TV screen install, we cover all aspects of an AV installation project into restaurants, bars, boardrooms, halls, call centres & hotels, basically anywhere that has an audio visual installation requirement.


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I was born at a very early age. As the years passed, I became older and older. My dream was to become a professional basketball player. That didn't work out, but most other things have. I have a very cool job, I live in a beautiful place and I get to write every day. God … Continue reading About
REORIENTED A novel about faith, scripture and sexual identity Inspired by real events, REORIENTED tells the story of D.J. Martinez, a gay Christian student who tries to start a support group for LGBT people at his conservative Bible college. Through dialogue and discord, conflict and friendship, REORIENTED explores the modern-day intersection between evangelical Christianity and … Continue reading Books
Over the years, I've had the opportunity to tell many cool and powerful stories. Here are a few that have stuck with me. Faith and culture If Coaches Coached Their Teams the Way We Do Church | May 2, 2014 (Venn Magazine) What is Easter Supposed to Look Like? | April 15, 2014 (Venn Magazine) … Continue reading Writing
Movie review: 'Deadpool' is dead-on
Stop me if you've heard this one: So the slate of upcoming films for 2016 walks into a bar, and the bartender says, "Hey, I don't have enough seats for 600 superhero movies!" OK, that wasn't a great joke, but my point is: There are an awful lot of superhero movies being released this year. … Continue reading Movie review: 'Deadpool' is dead-on
Still clueless at Christmas
Back by popular demand (which means I liked it, and a couple of other people did, too) is the "Clueless Consumer," my annual stroll through some of the weirdest and, in some cases, most terrifying items that are topping the wish lists of the young and old this year. If, as your kids, grandkids or … Continue reading Still clueless at Christmas
Someone else who gets 'Reoriented'
If there's one thing I've learned through my experience in the Christian publishing world, it's that evangelicals tend to get all kinds of suspicious when you tell them that you've written a book about Christianity and homosexuality. They want to know what your "angle" is, and if it's the "right" one (i.e., the one they … Continue reading Someone else who gets 'Reoriented'
Clueless at Christmas
I've always enjoyed Conan O'Brien's "Clueless Gamer" video game reviews. The following is a column I wrote for the local paper inspired by O'Brien's bit, but in the context of Christmas shopping. The links to each item are included, for the most part, not to promote the products, but to prove to you that they … Continue reading Clueless at Christmas
The curious case of sink drips 'n' plungin'
What images does the phrase "home ownership" bring to mind? If you are an aspiring homeowner, it is probably something like this: A grinning husband with perfect teeth strides toward the "For Sale" sign in his new front yard and self-assuredly affixes across it a bold, red "SOLD" sticker. Later, in the enclosed back yard, … Continue reading The curious case of sink drips 'n' plungin'
From the vault: I just want to talk for a while
To raise awareness about the launch of a very cool new nonprofit called Evangelicals for Marriage Equality, I'm reblogging an earlier post titled "I just want to talk for a while." The group is advocating a particular position — namely, that civil marriage is a secular institution and hence, not something evangelicals need to be … Continue reading From the vault: I just want to talk for a while
Reoriented making an impact in 'the real Portland'
One of my favorite teachers I've ever had was my high school biology teacher, whom I will always call Mr. Lord no matter how old I get. Thanks to the magic of the Internet, we've stayed in touch over the years, and he's always been a great supporter of mine, for which I'm very grateful. … Continue reading Reoriented making an impact in 'the real Portland'


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Publication Date: Jul 13, 2010
368 pp
List Price US $14.95
List Price US $14.95
Winner of the 2011 Arthur Ellis Award for Best First Crime Novel
In Middle East lore the Debba is a mythical Arab hyena that can turn into a man who lures Jewish children away from their families to teach them the language of the beasts. To the Arabs he is a heroic national symbol; to the Jews he is a terrorist. To David Starkman, "The Debba" is a controversial play, written by his father the war hero, and performed only once, in Haifa in 1946, causing a massive riot. By 1977, David is living in Canada, having renounced his Israeli citizenship and withdrawn from his family, haunted by persistent nightmares about his catastrophic turn as a military assassin for Israel. Upon learning of his father's gruesome murder, he returns to his homeland for what he hopes will be the final time. Back in Israel, David discovers that his father's will demands he stage the play within forty-five days of his death, and though he is reluctant to comply, the authorities' evident relief at his refusal convinces him he must persevere. With his father's legacy on the line, David is forced to reimmerse himself in a life he thought he'd escaped for good. The heart-stopping climax shows that nothing in Israel is as it appears, and not only are the sins of the fathers revisited upon the sons, but so are their virtues—and the latter are more terrible still.
Disguised as a breathtaking thriller, Avner Mandelman's novel reveals Israel's double soul, its inherent paradoxes, and its taste for both art and violence. The riddle of the Debba—the myth, the play, and the novel—is nothing less than the tangled riddle of Israel itself.
Excerpt from The Debba
It was in Toronto in 1977, seven years after I had last seen him, that I learned of my father's murder. When the phone rang I half expected to hear Aunt Rina's
voice, inviting me to the Passover seder. Instead I heard the line crackle and a
faint voice said, "Starkman? David Starkman?"
In an instant I knew. "Ken?" I croaked in Hebrew—yes.
"This is Ya'akov Gelber. I am an attorney in Tel Aviv—"
"My father," I said.
"I am afraid so."
Perspiration broke out on my chin as Mr. Gelber said without preliminaries that my father had died. "You of course have my most profound sympathies," he said in Hebrew, "but there are some…urgent matters to discuss, else I would not call you on the holiday."
It was only April but the Toronto weather was freakishly hot and my cheap one-room apartment on Spadina Avenue was baking in the heat. My sole white shirt, which I had put on for an evening out with Jenny, was soaking with sweat, as Jenny kept massaging my neck, the back of my head, the veins at my temples. I again had a migraine after last night's black dreams. It often hit me when evening fell, and so we rarely went out. I had hoped tonight would be better, but it wasn't. I dabbed at my face with a dish towel and tried to concentrate on Mr. Gelber's voice, which was explaining in my ear how someone had broken into my father's shoe store the previous night while he was taking inventory, and following the robbery (an unsuccessful attempt, really, since nothing of value was taken), my father was stabbed in the heart with one of his own knives—the one used for cutting soles. "It was probably an Arab robber," Mr. Gelber said, his voice neutral, "because the body was also mutilated."
"In this fast-paced thriller, the philosophical wrestling matches the action blow for blow."—Hadassah Magazine
"Sharp, biting prose distinguishes this first novel from Israeli author Mandelman… The author deftly blends a murder mystery with a nuanced examination of the intransigent Israeli-Arab conflict." —Publishers Weekly, starred review
"An absorbing and captivating novel that bridges the uncomfortable political gap between the Palestinian and Israeli sides." —Kirkus Reviews
"A first-rate debut novel that tackles current issues in the Arab-Israeli conflict while revealing the paradoxes of Israeli life for those who embrace the arts yet must deal with violence on a daily basis." —Booklist, starred review
"…a literary thriller that powerfully confronts uncomfortable paradoxes around the founding of Israel. The issues it raises are as near as the headlines, and the novel seems likely to be as controversial as the play that forms its centerpiece."—Library Journal
1. How powerful are David's black dreams? Trace the various moments throughout the novel where they become more or less powerful. Do you think he can ever be completely rid of them?
2. What was Isser's motivation for writing "The Debba"? Why do you think he insisted David produce the play so soon after his death–especially when he himself witnessed the conflict it could bring?
3. Discuss David's attraction to Ruthy versus his attraction to Jenny. What about each woman captivates or distracts him? What do you think brings David and Ruthy back together? What does each woman see in David?
4. Discuss Isser's friendships with both Paltiel and Abdullah. How did the relationships evolve from his military days to his death? Do you see any similarities in David and Ehud's relationship?
5. Why is David considered such a threat, so dangerous they send assassins after him? Are they afraid of him or the play? Where does David find the determination to overcome the obstacles he encounters?
6. Discuss family loyalty in The Debba. Does it differ between the Jewish and Arab families we meet?
7. The Debba is steeped in mystery—of both the past and the present. From the myth of the Debba to the circumstances surrounding Isser's death, discuss the power these secrets have over the characters.
8. Where, and among whom, does David feel most at ease? Does he fit in anywhere? Will he ever be able to escape his past?
9. Has this fictional account influenced your knowledge or feelings about Israel's history or current situation?
10. What is Abdullah's ultimate motive for helping David stage the play?
11. How does the revelation of David's true father influence David's feelings about where he fits in the Israeli community? Did your opinion of David's character change when you learned the truth? Were you surprised?
12. What was your opinion of Isser's play, "The Debba"? Discuss the play's supporters and protesters and the intensity of their opinions.
13. Of all the characters seeking vengeance in The Debba, do any of them attain it?


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Sony has revealed that Assassin's Creed Revelations will be playable in 3D on the PS3.
The news comes courtesy of the PlayStation Blog, which features a QA detailing a few of the new features coming to Revelations.
The blog mentions a revised control scheme which pushes Eagle Vision to L3, freeing up triangle for secondary weapons.
It seems Altair's appearances will mainly be in Masyaf key retrieval, which will task him with parkouring his way around dungeon-like environments similar to the Romulus Lairs in Brotherhood.
The assassin recruitment mechanic from Brotherhood will also make a welcome return, but in Revelations, once a recruit reaches the rank of Master Assassin he or she can be ordered to protect an Assassin Den.
A new Animus user-interface and a 'Den Defence' mission type that plays like a tower defence mode are also mentioned in the blog post.
Along with the fleeting mention of 3D support the blog touches on a 'Google Maps-style satellite view' which can be used while bouncing around Constantinople.
Assassin's Creed Revelations on PS3 will also include the original Assassin's Creed.


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The Model 032 ELS Competition Belt is made for use with the Safariland® Equipment Locking System (ELS) forks and plates. It features two rows of pre-cut holes running the full length of the belt. ELS 35 Receiver Plates can then be attached in various locations or angles on the belt. Hook-lined to attach to Model 030 underbelt (sold separately).
NOTE: This item will be shipped from the manufacturer.
Additional Information


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CW3E Surface Meteorology and Soil Observations
In support of Forecast Informed Reservoir Operations (FIRO), CW3E has partnered with USACE, NOAA, Sonoma Water, and local landowners to add six meteorological stations to the Lake Mendocino watershed in the upper Russian River watershed in northern California. These stations measure temperature, relative humidity, pressure, precipitation, and soil moisture and temperature at six levels. Data are collected every two minutes. The plots here represent raw data from the stations and have not undergone any quality control. Plots are updated once per day. Please direct any questions and requests for past and/or QC'd data to firstname.lastname@example.com.
Plot description: Surface meteorological and soil data observed at the location highlighted in the map. Top panel shows temperature (°F; blue line) and relative humidity (percentage; red line), second panel shows surface pressure (hPa), third panel shows hourly precipitation (inches; blue bars) and accumulated precipitation during the period shown (inches; red line), fourth panel shows the soil moisture (fraction) at various depths (color denoted by legend on right), and the bottom panel shows the soil temperature (°F) at the same depths as soil moisture.
Plot description: Accumulated precipitation (mm on left axis, inches on right axis) measured at the above the locations during the 2019 water year (1 October 2018 – present).


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Everyone of us is born into the world with one or many angels guiding and aiding us in our on a regular basis life. You want money to pay rent/mortgage, purchase meals, get around city, take courses, etc. We are usually not striving to make money for money's sake however to allow a significant and pleasurable life-style. No by no means received something but…..still putting it our there to my money angels to return through.
Untuk Anda yang baru pertama kali berwisata ke Kota Bandung Jawa Barat, dan kebetulan hanya membawa uang asing atau greenback saja, sedangkan belum tahu dimana saja lokasi alamat dan peta map Money changer di Kota Bandung, maka dibawah ini adalah peta petunjuk lokasi semua Money Changer yang ada di Kota Bandung.
Please, make me consider God's commandments and be affected person And additionally i want money to solve my worries. I discuss in regards to the specifics of creating extra money in your profession in my weblog and e-e book, akin to finding niche markets, negotiating, and subcontracting to consulting companies.
Money Angel I am in need of money to repay past due bills and money to remodel house and purchase a brand new automobile I want 10, 000.00. 697, 712, 1217,1991, 2468. You should summons your money angel, acknowledge that they are there, and then, start asking in your wants and needs. Call upon your money angel and get the abundance of wealth you so need, they're right here to assist you. It is their for you if you'd like it to be. their is a never ending money stream that never gets dry or runs out. Example 1: Money angel please assist me in coming up with or attracting the rest of my lease.
You want money to pay rent/mortgage, purchase meals, get round city, take courses, and so on. We are usually not striving to make money for money's sake but to allow a significant and pleasant way of life. No by no means bought something but…..nonetheless placing it our there to my money angels to return thru.…