text:
In this area you will be able to:
- Propose, vote on, and discuss research ideas
- View current studies
- View published research
Show More
Here, you can submit a research idea to the community, cast your votes, and discuss research ideas proposed by other members. Please make your research question as specific as possible. Other members will vote on your research idea, and we will prioritize research ideas with the most votes.
You are allowed to vote for your own proposed research idea if you want. However, you can only vote for a total of five research ideas. If you have already cast your five votes and an idea you like even more is proposed, you can change your votes at any time to reflect your current preferences.
The research team will review all submitted ideas and provide a response to you and to the community. If your idea leads to an IBD Partners Study, you will have the opportunity to serve as a patient collaborator on the research team for that study.
We encourage you to prioritize the ideas that are most important to you, even if the research team determines that your idea is not a good fit for IBD Partners. We will share ideas labeled "Not a Good Fit" with researchers outside of our network when appropriate. We want to make sure all of your votes count!
Thanks for your participation in this important platform to help the IBD research community understand what research questions are important to patients. We are passionate about finding answers to your questions!
Published Studies
Collecting Biospecimens from an internet-based cohort study of inflammatory bowel disease (CCFA Partners): A feasibility study
CCFA Partners has been successful for survey-based research for many years. The purpose of this study was to determine whether or not it would be feasible to use the CCFA Partners Internet-based platform to collect biologic or biospecimen data such as saliva, blood and stool samples. We found that nearly 40% of participants contributed saliva and about 25% contributed blood samples. The majority of participants who contributed saliva or blood also sent a stool sample. All samples provided sufficient quantity and quality of material for genetic testing. Saliva and blood samples were genotyped for common mutations ("single nucleotide polymorphisms") known to be associated with inflammatory bowel disease. Stool samples were analyzed for bacterial content, which may be related to inflammatory bowel disease. Overall, this study supports that it is feasible to collect biospecimens using an Internet-based platform and will be successful on a larger scale to be used for many different types of research.
Full Scientific Manuscript
biospecimen; biobank; biobanking; specimen; biospecimen handling; healthcare; genetic testing
|Research Methods
Keep or Destroy? Attitudes of Patients With Inflammatory Bowel Diseases on Biospecimen Handling at Biobank Closure
A biobank is a collection of samples from patients (including spit, stool or blood). Biobanks are important for understanding risk factors for developing disease or for severity of disease. The purpose of this study was to understand how patients with inflammatory bowel diseases (IBD) feel about the continued use of their samples after the biobank has closed. A total of 26 CCFA Partners members participated in a phone interview about the risks and benefits of their samples being used for research, and the results of these conversations were used to create a survey. The survey included three primary themes: 1) degree to which samples remain an individual's property after donation; 2) samples are a good that can be sold; and 3) the belief that results from sample analysis could lead to discrimination. About 1,000 CCFA Partners participants completed the survey online. Most participants expressed the desire to know what would happen to their samples and genetic information if the biobank closed. Most were comfortable with the samples and genetic information being destroyed. Most were also comfortable donating their samples and genetic information to IBD research. Most participants were not comfortable with selling their samples and genetic information after the biobank closes. We learned that it is important for researchers to create a plan for samples if the biobank closes and to communicate this plan to the participant at the beginning of the study.
Full Scientific Abstract
biospecimen; biobank; biobanking; specimen; biospecimen handling; consent; informed consent; genetic testing
|Research Methods
Perceptions of Patients with Inflammatory Bowel Diseases on Biobanking in the CCFA Partners Cohort
A biobank is a collection of samples from patients (including spit, stool or blood). Biobanks are very important for understanding risk factors for developing disease or for severity of disease. We wanted to understand more about why patients with inflammatory bowel disease (IBD) would or would not participate in a biobank. We first did a series of interviews over the phone with patients who were participating in the CCFA Partners study. This helped us to understand the important concerns about biobanks and develop a survey for use in CCFA Partners. We then sent a survey to over 800 people with IBD in CCFA Partners. We did a total of 26 phone interviews. Patients doing the interviews told us that they had concerns about how samples would be collected/stored; who would be allowed access; whether these samples would be used for other things (not only research); and whether this would affect whether they could get life insurance. Most people were not that worried about using the blood for genetic studies. People thought that that biobanks were important for research, that they might lead to a cure; that by donating they would be helping others or family members with IBD; and hoped that they might personally benefit, although most understood that they likely would not. These themes aided in the development of a survey instrument to assess perceptions of biobanking. A total of 476 people initially finished the survey. Almost 40% said that they would 'definitely yes' donate samples, 56.0% would 'probably yes' donate, 5.1% 'probably no' and 0.7% 'definitely no'. There were no factors that made someone more likely to donate (reported donation rates were not different for Crohn's disease (CD) versus ulcerative colitis (UC), remission versus active disease, or education level. People were most willing to donate spit, followed by blood and lastly stool. Knowing these important thoughts on sample donation/biobanks will help researchers to develop consents for IBD biobanks and design educational materials on biobanks for IBD A biobank is a collection of biological samples, such as saliva, blood, and stool, from individuals with a common condition such as inflammatory bowel disease (IBD). Biobanks are important for understanding risk factors for developing disease or for severity of disease. We wanted to learn more about IBD patients' understanding of and willingness to participate in a biobank. We first did 26 phone interviews with patient volunteers participating in the CCFA Partners study. Those interviews helped us better understand concerns related to biobanks. Patients doing the interviews told us that they had concerns about how samples would be collected/stored, who would be allowed access, whether these samples would be used for anything other than research, and whether participation in a biobank would affect life insurance eligibility. Most patients were not that worried about using blood for genetic studies. Participants thought biobanks were important for research, that they might lead to a cure, that by donating they would be helping others or family members with IBD, and hoped that they might personally benefit. These results from the phone interviews were used to develop an online survey instrument to assess perceptions of biobanking. In a larger sample, a total of 1,007 people with IBD completed the online survey. Almost 40% said they would 'definitely' donate samples, 56.4% would 'probably' donate, 3.6% 'probably not', and 0.6% 'definitely not'. There were no differences in willingness to donate specimens based on disease type (Crohn's vs. ulcerative colitis) or on disease activity (in remission vs. currently active disease). People were most willing to donate saliva specimens, followed by blood and lastly stool samples. Knowing these important attitudes and beliefs about sample donations and biobanks will help researchers develop consents and educational materials related to biobanks that will encourage wider involvement.
Full Published Manuscript
biobanking; sample collection; sample storage, confidentiality; HIPAA; community; population
|Research Methods, Study Updates


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Actually, after listening to Silly God Disco once or twice more, I really like the jazzy feel and power of the bass in the song. It feels like the way I want to play Niccolo: Bombastic, dramatic, powerful. I think I may end up dumping his english accent, too. It was getting annoying to my own ears. I'll need to shop around for an appropriate replacement.niko2pico wrote:"Libera Me" gives me chills.
yeah seven nation army is definitely yours
Seven Nation Army is still his official theme song, though.

subset: commoncrawl


text:
The main purpose of this section is to regulate the production, sale, distribution, transportation, or offering for sale of pesticides in Oklahoma. This includes registration, offering in an unadulterated form and sale or use consistent with its labeling. This is accomplished by requiring that all pesticides marketed in Oklahoma be registered, performing marketplace inspections, producer establishment inspections, restricted use pesticide dealer audits, label inspections, and sampling.
Oklahoma is utilizing the Kelly computerized system of pesticide product registrations. Information on which pesticides (and manufacturers) are registered in Oklahoma can be accessed online through Kelly Registered Pesticides.
The common saying has it that "the devil is in the details," the Agricultural Retailers Association (ARA) provides a well thought out plan. This site has information on the conceptual trio of "deter, detect, and delay;" that is, "deter an unwanted event from happening; detect potential criminal or terrorist activity as early as possible; and, failing all else, delay violators as long as possible until proper authorities arrive." The first step is to identify critical assets, then work to establish layers of protection. It lists numerous important steps and useful, pragmatic actions. Many are "soft," non-aggressive procedures such as keeping close tabs on inventory, and establishing contact with local representative of law enforcement and emergency response units.
Section 24(c) Products
- Avid 0.15EC Miticide/Insecticide For Nematode Control on Golf Course Greens Only
- Chateau Herbicide SW to be used in row middles of transplanted peppers
- Dual Magnum for Control of Annual Sedge and Yellow Nutsedge in Sweet Potatoes
- F5688 11% ME Insecticide Termiticide used in new and post-construction sub-slab termite treatment
Section 18 Products
Section 3 Label
- BASF Headline AMP Return & Replace
- Diazinon Cancellations
- Expired/Non-Renewed Pesticide Products
- Herbicide Application
- Mosquito Control to Prevent the Spread of West Nile Virus
- MSMA Cancellation
- Oklahoma Combined Pesticide Law&Rules
- Pesticide Complaint Statement
- Pesticide Establishment List
- Pesticide Procedures
- Online First-Time Pesticide Product Registration
- Online Renewal Pesticide Product Registration
- Paper-based Pesticide Product Registration
- Online First-Time Producer/Device Establishment Application
- Online Producer/Device Establishment Renewal
- Printable Producer/Device Establishment Permit Application
- Online First-Time Restricted Use Pesticide Dealer License Application
- Online Renewal Restricted Use Pesticide Dealer License Application
- Printable Restricted Use Pesticide Dealer Permit Application Form
- Restricted Pesticides List
- Restricted Use Pesticide Dealer List A-F
- Restricted Use Pesticide Dealer List G-M
- Restricted Use Pesticide Dealer List N-S
- Restricted Use Pesticide Dealer List T-Z
- Termiticide Residue Level Minimums
- Unwanted Pesticide Disposal Program
- Worker Protection Standard
- CFATS Help Desk: Critical Infrastructure: Chemical Security | CFATS FAQ


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Suitable for all your coin gimmicks is this, the perfect pocket-sized purse to carry them along. Size doesn't matter - half dollars, dollar sized, or otherwise, they all fit inside.
This coin purse is the non-clasp type, with the locking mechanism built into the inside of the brass frame.
Made of leather.
Do you own this product? Write a review.


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Ah, the '80s. The decade where this film geek truly came of age (I may not be young), my teenage film geek self delightedly overwhelmed with the coming of home video rental, pay cable and some seriously lax mall cinema security, all leading to a decade of truly gluttonous movie bingeing on that decade's cinematic buffet. (And literal bingeing on oversized theater snacks.)
An eye-opening era where, for good or ill, much of my movie mania was born, much of my movie taste determined.
Luckily, time has provided a little perspective. (For example, I sadly now no longer think that John Cusack is the greatest actor who ever lived.) With such hindsight in mind, I now present to you Dennis' '80s Awards:
Best Gratuitous Nude Scene In a Teen Comedy: "Sixteen Candles" (1984) – Back before the PG-13 rating arrived to put parents on their guard, a PG was usually seen as safe kid stuff that mom and dad could let the kids go see unsupervised. Suckers!
Nostalgic (and absent-minded) parents today who decide to share this childhood favorite with their children are no doubt abashed when Molly Ringwald's Samantha starts off by spying enviously on her more popular (and decidedly more womanly) romantic rival (Haviland Morris) in the showers. Nearly full-frontal nudity, accompanied by a comical "boing!" sound effect in a 1984 PG movie? John Hughes, a generation of teenage boys salute you. Honorable mention: "Airplane!"
Most Egregious '80s Cinematic Hate Crime: "Hardly Working" (1980) – This was a tough one, as the '80s were a period of enthusiastic onscreen insensitivity. Every character actor with a passable Russian accent and every Asian extra who could pass for Vietnamese got shot, pummeled or blown up multiple times by your Stallones, Norrises or Schwarzenneggers looking for simplistic geopolitical problem-solving.
Runner-up goes to poor Gedde Watanabe for his portrayal of cartoonish exercise in racial self-hatred as Long Duk Dong in "Sixteen Candles," but at least Watanabe was actually Asian. Nope, the statue (which I envision as a bronze likeness of Judge Reinhold for some reason) goes to venerable schtick-master Jerry Lewis who broke out, in 1980(?!), a caricatured Japanese hibachi chef complete with nonsensical jabbering, squinty eyes and huge buck teeth, and made even an 11-year-old suburban white boy think, "ummm" Picture "The Office"'s Michael Scott doing his Ping character, but with less sensitivity.
Most '80s "80s Hair": "Pretty in Pink" (1986) – This one almost broke me. There's just so much out there (and so much of it). Obviously, Richard Dean Anderson's MacGyver hockey mullet was the epitome of all '80s hair crimes, but he was a TV guy. So, after much deliberation, I have to go with Andrew McCarthy's perma-coif in this teen staple as nice-guy rich boy Blaine.
Sure, he had stiff competition even in his own film, with the somehow middle-aged high school villain James Spader's blonde evil-guy pouffe and the sticky new wave pompadour atop Jon Cryer's Duckie. But there's something so quintessentially '80s about Blaine's impeccably manicured, desperately casual salon cut that just epitomizes '80s guys who spent more time on their hair than their sisters did. (When McCarthy was forced to wear a bad wig for the re-shot finale, it looked like his hair had simply achieved sentience and was trying to escape.)
Most Representative '80s Oscar Travesty: "Driving Miss Daisy" (1989) – Look, I like this movie. Morgan Freeman and Jessica Tandy are great, and it's a quaintly moving little fable of tolerance. But winning Best Picture over Spike Lee's un-nominated masterpiece "Do the Right Thing" was just deliberately insulting (or tragically, terrifyingly out of touch – take your pick, Academy members!)
Lee's exhilarating, brilliantly constructed howl of rage at the state of race relations in America was the best film of 1989, and exactly the sort of movie wake-up call the Oscar voters slept through by instead handing the statue to the filmic equivalent of a nice, soothing cup of cinematic tea.
Biggest Comedy Action '80s Blockbuster (In a Smarter, Parallel Dimension): "Big Trouble in Little China" (1986) – This John Carpenter-directed action flick is many things: A peerless vehicle for Kurt Russell's signature brand of goofball leading-man charm, an affectionate throwback to old-time adventure serials and, at its root, a slyly hilarious deconstruction of the sort of mindless action heroics clogging every '80s multiplex.
Russell's macho trucker-turned-reluctant-evil fighter Jack Burton is the very soul of jingoistic American overconfidence – stampeding into battle against ancient, unfathomable evil with nothing but his trusty knife, a belly full of cheap American beer and a catchphrase for every occasion. Honorable mention: Fred Ward in "Remo Williams: The Adventure Begins."
Greatest '80s Villain, Teen Movie Edition: William Zabka as Johnny Lawrence, leader of the Cobra Kai dojo in "The Karate Kid" (1984) – Why are we even discussing this?
Greatest '80s Villain, Adult Edition: Alan Rickman as Hans Gruber in "Die Hard" (1988) – Seriously, I'm trying to be clever, but there's just no question on this one either, right?
Acceptable '80s Performance By a Teen Heartthrob Named Corey: Corey Haim: "Lucas" (1986). Corey Feldman: N/A.
Least Likely '80s Action Hero: Billy Crystal in "Running Scared" (1986). That didn't work …
Most Egregious Onscreen '80s Sexual Assault Played for Laughs: "Revenge of the Nerds" (1984): Having sex with the jock quarterback's girlfriend while disguised so she thinks you're him? More like "Revenge of the Date Rapists." Honorable mention: Paul Gleason and a gorilla in "Trading Places."
Most Homophobic '80s Eddie Murphy Character: There was no one funnier than Eddie in the '80s, and few more thoughtlessly gay bash-y. He's sort of apologized since, but for impressionable teen males, Eddie did some serious damage.
His "hilarious gay guy" disguise in "Beverly Hills Cop" was one thing, but literally half of his concert film "Eddie Murphy: Delirious" (1983), buoyed along by Murphy's electric charisma and undeniable comic chops, caused a lot of ignorant high school guys to parrot his lines – no doubt unknowingly hurting a lot of their friends' feelings. That's why I don't feel sorry when he stars in "Norbit."
And finally The Most 80s Thing That Has Ever Existed: "Top Gun" (1986) – Jingoism. Xenophobia. Literally faceless evil Russkies. Military fetishization. Karaoke. Hilariously unintentional homoeroticism. Ritualized bro-handshakes. Kelly McGillis trying not to be taller than love interest Tom Cruise. Shirtless beach volleyball action. And Kenny Loggins, warning us that we were, indeed, all entering the black hole that was the '80s Danger Zone.
Dennis Perkins is a Portland freelance writer.
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text:
Maternal Blood Test Might Spot Birth Defects More Safely
WEDNESDAY, Nov. 9 (HealthDay News) -- In what a team of scientists says is a first, the researchers appear to have successfully screened for a rare form of fetal abnormality by means of a completely noninvasive blood test.
By performing a DNA analysis on a blood sample from a prospective mother, the team was able to accurately identify a specific chromosomal irregularity called "fetal microdeletion syndrome" in the unborn child, reported investigators at the Magee-Womens Research Institute (MWRI) at the University of Pittsburgh Medical Center.
In so doing, the researchers indicated it may one day be possible to avoid the use of much more invasive -- and thereby riskier -- standard diagnostic techniques, such as amniocentesis.
"If a fetal anomaly is suspected, mothers are usually offered an invasive screening procedure," said David Peters, head of the MWRI team and an associate professor in the department of obstetrics, gynecology and reproductive sciences.
"But there is a pretty significant, if small, level of risk to the health of the fetus associated with those tests. So there's been a strong push to try and reduce that risk," he noted.
"So I think the most compelling point," said Peters, "is that we have been able to illustrate a proof of concept. We have shown that you can identify these sorts of abnormalities without having to collect a physical sample from the baby or the placenta."
Peters and his colleagues discussed their findings in a letter published in the Nov. 10 issue of the New England Journal of Medicine.
Although this may be the first such test for this particular type of defect, maternal blood tests are also being developed for other fetal anomalies such as Down syndrome, as reported by HealthDay earlier this year. That study, conducted by Greek researchers, was published in the March 6 online edition of Nature Medicine.
According to the March of Dimes, roughly one in every 150 American babies is born with a structural or numerical chromosomal abnormality.
Such abnormalities can develop during egg or sperm cell growth, both before and after conception. Oftentimes they give rise to severe mental or physical defects, including Down syndrome and spina bifida.
Typically, chromosomal abnormalities are first identified during pregnancy by invasive diagnostic procedures.
Chorionic villus sampling is one option, involving the extraction of cellular material found in tiny finger-shaped growths located in the placenta. The procedure requires a catheter or long needle, and is usually conducted in the latter part of the first trimester.
The other option is amniocentesis, involving the extraction of a small amount of amniotic fluid surrounding the fetus for subsequent DNA analysis. The procedure is usually performed during the second trimester, and entails the use of a local anesthetic and the insertion of a needle through the mother's abdominal wall, uterus and amniotic sac.
But these invasive methods involve some risk, as fetal limb damage, fetal respiratory distress and even miscarriage can occur as a result.
To explore the potential of a less-invasive screening tool, the MWRI team focused on a couple who had already previously had a child born with physical and developmental abnormalities. In that case, the culprit was the absence (or "deletion") of specific chromosomal DNA, a condition that the child had inherited from his father.
At 21 weeks into her current pregnancy, the mother underwent traditional amniocentesis, which confirmed that her unborn child also suffered from the same rare fetal microdeletion syndrome.
In turn, at 35 weeks into the pregnancy the team drew a maternal blood sample and conducted a series of high-tech genetic sequencing tests. This time, no fetal tissue or blood was extracted.
The result: The non-invasive blood test successfully arrived at the same diagnosis as the invasive amniocentesis.
Peters acknowledged that the 35-week mark is late for prenatal screenings, but added that the time frame was appropriate for a comparative analysis of a new screening approach that is still in its infancy.
"I'm not a clinician, but I think it's fair to say that at this point we're a long way away from having something that would practically be able to replace amniocentesis," he cautioned.
Dr. De-Kun Li, a reproductive and perinatal epidemiologist in the division of research at Kaiser Permanente Northern California, in Oakland, said that while the risk associated with invasive screening is very low, an equally accurate risk-free blood test would be ideal.
"I believe the risk of spontaneous abortion or miscarriage due to an amniocentesis is 0.5 percent," he noted. "And the rate has been going down, because we are now much more technologically savvy. But of course a blood test would be noninvasive, cheaper and less risky. The question is, will the accuracy be the same? If so, then of course we'll go with the blood test. No questions asked. But that's a big 'if.'"
More information
For more on birth defects and chromosomal abnormalities, visit the March of Dimes.


text: Sometimes you just want to have some fun out on the open road. You want to feel the power of your vehicle at your fingertips. You want it to handle like it's connected to you in an almost symbiotic relationship. You want to feel like you could conquer the most demanding racetrack in the world. So why not get behind the wheel of a car that was created for exactly that? The Mercedes-Benz AMG GT spent most of its development time in what's known as the "Green Hell" section of the Nurburging racetrack. That means it's ready to take you on the ride of your life. The Mercedes-Benz AMG GT features a front-mid-engine concept with a transaxle, V8 Biturbo engine, thoroughly modified suspension, new aerodynamic design and an intelligent lightweight construction to create a driving experience unlike any other. This is one ride that will truly take your breath away.


text:
Hyssington Methodist Chapel
Hyssington Methodist Chapel is one of the chapels forming the Shropshire and Marches Methodist Circuit, (within the Wolverhampton & Shrewsbury District).
For more information, please follow the links to the various websites.
Venue Details
- Address:
- Hyssington Methodist Chapel
Church Stoke
- Hyssington Methodist Chapel
- Postcode:
- View SY15 6EG on a map | Get directions to SY15 6EG
Contact Details
Additional Information
- Notes:
The Shropshire and Marches Methodist Circuit was formed from the amalgamation of eight smaller circuits, two from the Birmingham District (Cwm and Kingstone and Leominster, Presteigne and Kington) and six from the Wolverhampton and Shrewsbury District (Wem and Prees Green; Oswestry, Ellesmere and Chirk; Llanymynech; Shrewsbury; The Marches, and Shropshire South).
- Page last reviewed:
- 21/08/2018
Related Links
Shropshire and Marches Methodist Circuit - Information about the Shropshire and Marches Methodist Circuit.
Twitter - Follow Shropshire Methodists on Twitter.
Wolverhampton and Shrewsbury District of the Methodist Church - Information about the Wolverhampton and Shrewsbury District of the Methodist Circuit.
The Methodist Church in Britain - Information about the Methodist Church in Britain.


text:
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Discrete Browser's Insta-Hide allows you to instantly hide the browser if, for example, someone...
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14-November-2003Shareware(Free To Try)
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text:
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Habitat Restoration at Easkoot Creek - Hosted by the National Park Service and One Tam
Join One Tam at Easkoot Creek at Stinson Beach, where we are removing invasive Cape Ivy to allow native plants and animals to thrive! Easkoot Creek is a small stream flowing from Mt. Tam into Bolinas Lagoon. Work involves removing weeds by hand and with tools, spreading mulch, and/ or planting. Please bring closed-toed shoes, long pants, sun protection, and a water bottle. Tools, gloves, snacks and water will be provided. Volunteers ages 10 and up are welcome. Read our Youth Policy Guidelines (PDF) for youth under the age of 15. If this is your first time volunteering please come 10 minutes early to fill out paperwork, or bring the completed form.


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I want to tell you a story about a patient who shocked me.
When I was first starting out as a psychoanalyst, I rented a small consulting room in Hampstead, on a wide leafy street called Fitzjohns Avenue. It was near a number of well-known psychoanalytic clinics and a few minutes' walk from the Freud Museum. At the south end of Fitzjohns Avenue, there is a large bronze statue of Freud.
My consulting room was quiet and spare. There was a desk just large enough for writing up notes and preparing my monthly bills, but no bookshelves or files – the room wasn't for reading or research. As in most consulting rooms, the couch wasn't a couch, but a firm single bed with a dark fitted cover. At the head of the bed was a goose-down cushion, and on top of that a white linen napkin that I changed between patients. The psychoanalyst who rented the room to me had hung one piece of African folk art on the walls many years before. She still used the room in the mornings, and I used it in the afternoons. For that reason it was impersonal, ascetic even.
I was working part-time at the Portman Clinic, a forensic outpatient service. In general, patients referred to the Portman had broken the law; some had committed violent or sexual crimes. I saw patients of all ages and I wrote quite a few court reports. At the same time, I was building up my private practice. My plan was to reserve my mornings for clinic work; in the afternoons I hoped to see private patients who had less extreme or pressing problems.
As it turned out, my first private patients were fairly demanding, too. Looking back, I see many reasons these first cases were difficult – partly, there was my own inexperience. I think it takes time – it took me time – to realise just how very different people are from each other. And it probably didn't help that I'd received a number of referrals from senior psychiatrists and psychoanalysts trying to help me get started. Doctors often refer patients to junior analysts that they don't want to see themselves or can't place anywhere else. And so I was struggling with:
Miss A, a 20-year-old undergraduate. Although the psychoanalyst who'd assessed her described Miss A as "suffering uncontrollable bouts of crying, depression and pervasive feelings of inadequacy", she came across as a cheerful young woman who insisted that she did not need treatment. In time, however, I learnt that she was bulimic and regularly, compulsively, cut herself. Because she had only attended her sessions sporadically, two other therapists had given up seeing her.
Professor B, a 40-year-old research scientist; married with two children. He'd recently been accused of plagiarising a rival's work. The vice chancellor had referred the matter to the Disciplinary Committee. If he was found guilty – and Professor B told me it was likely that he would be – he might be given the chance to resign discreetly. His physician had put him on antidepressants and asked me to see him for psychoanalysis. Professor B vacillated wildly between states of triumph – mocking colleagues on the Disciplinary Committee, for example – and dejection.
Mrs C, who owned and operated a small restaurant with her husband; she was a mother of three. She wanted help because she felt anxious and suffered panic attacks. In our first meeting she said that she "found it difficult to relate honestly", but it was only after several months of therapy that she told me that she was having an affair with her children's nanny, a woman who had been working for the family for the past seven years since shortly after the birth of her first child. Now – contrary to an agreement with her husband – Mrs C was secretly trying to get pregnant because she could not bear the thought of losing her nanny.
Another of my earliest patients was a young man named Peter. He was undergoing treatment at a large psychiatric hospital nearby. Three months before we met, Peter hid in the cupboard of a local church, where he tried to kill himself by taking an overdose of various drugs and then slitting his wrists. He also stabbed himself in the neck, chest and arms with a small knife. He was discovered by a cleaner. Although she was frightened, the cleaner held him as they waited for the ambulance. "Who did this?" she asked him. "Tell me, who did this to you?"
The consultant psychiatrist at the hospital asked me if I'd see Peter five times a week for psychoanalysis. She felt that daily therapy, together with a weekly meeting with her, was Peter's best chance for recovery, for returning home to his fiancée and to his work.
Peter was 27 and worked as a structural engineer. Before he was hospitalised, he and his fiancée had bought a one-bedroom flat outside London. He had been having difficulties at work, and was anxious about money – but none of this seemed to explain his violent attack on himself. Part of my job, then, was to work with Peter to identify the causes of his suicide attempt – if we couldn't understand the forces that had pushed him to attack himself, there was every reason to think it would happen again.
Peter was tall and lanky, but carried himself as some depressed people do, shoulders hunched forward, head down. His manner was depressed too – he spoke haltingly, with little eye contact. Once positioned on the couch, he hardly ever moved.
Peter attended all of his sessions, and was almost never late. After several months, he left hospital and was able to return to his life. But increasingly, in our sessions, I felt him disappear to a place I couldn't find, let alone understand. "You've been silent a long time – can you tell me what you've been thinking about?" I asked in one session.
"A holiday in Devon – when I was a child," he replied.
There was a long pause. Could he tell me more? He replied that he wasn't thinking about anything in particular, he was just thinking about being alone.
I had the thought that he wanted to be away from me, on holiday from analysis, and told him so. "Could be," he replied.
It was as if Peter was trying to protect himself from my intrusiveness, as if he was complying with the conventions of analysis – being on time and answering my questions, for example – but in such a way as to prevent any meaningful connection developing between us. He seemed to have little faith in our talking.
But I did learn that Peter had a history of making friends and then turning on them. In his professional life, too, he'd quietly go about his work, then suddenly get into a row with his boss and quit. This had happened several times. I tried to use this information to show Peter that he seemed to have two psychological positions open to him – acquiescence or blowing everything up. He seemed to agree, but I never felt this idea was meaningful to him. And soon this pattern was enacted in the analysis. Peter went from going along with me to mocking me. After one particularly tumultuous week, Peter stopped coming to his sessions. I wrote to him, proposing that he talk to me about his decision to end his treatment, but I received no reply.
I contacted the psychiatrist, who told me that Peter had stopped seeing her, too.
Two months later, a letter arrived from Peter's fiancée, informing me that Peter had taken his own life. She explained that, during the month leading up to his death, Peter had grown increasingly disturbed and withdrawn. The family had held a funeral at West London Crematorium the week before. She wrote that she was grateful for my attempts to help him. I sent a letter of condolence to her, and then informed Peter's psychiatrist.
I'd known that Peter was a high-risk patient. When I took him on, I'd enlisted the help of a supervisor, an experienced psychoanalyst who'd written a book on suicide. He had repeatedly pointed out to me the many ways in which Peter seemed to idealise death. Now, I went to see him again, anxious that there was something I'd missed. My supervisor tried to reassure me. "Who knows?" he said. "Being in analysis with you might have kept him from suicide for the past year." Still, Peter's death disturbed me greatly. Of course, I knew that we all have the capacity to act in self-destructive ways; nevertheless I had a kind of faith that the desire to live was more powerful. Now, instead, I felt its fragility. Peter's suicide made me feel that the battle between the forces of life and death was far more evenly pitched.
Six months later, I received a message on my answering machine. I heard the unmistakable sounds of a public telephone – the pips, the coins falling – and then Peter's voice: "It's me. I'm not dead. I was wondering if I could come and talk to you. I'm at my old number."
The instant I heard Peter's voice, I felt faint, confused. For a moment I persuaded myself that the answering machine was malfunctioning, that I was listening to a very old message from Peter that had never been erased. And then I laughed – out of anger, out of relief. And because I was stunned.
That evening, when I wrote to the consultant psychiatrist to tell her that Peter wasn't dead, I did what many people do when they're angry – I made a joke. "Unless there are payphones in hell," I wrote, "Peter is still alive. He left a message on my answering machine earlier today, asking for an appointment."
Peter came to see me the following week. In a matter-of-fact way, he told me that he, not his fiancée, had written to inform me of his death. He'd also intercepted my condolence note. "It was touching," he said.
"Oh that is interesting," my supervisor said. "It's surprising this doesn't happen more often. When you think of all those adolescents who say 'you'll be sorry when I kill myself' – you'd think more of them would fake it." We decided that I should only take Peter on again if I felt he was really prepared to make a serious commitment.
After several meetings, Peter and I agreed to resume his sessions. Ultimately, his disappearance and return proved helpful, because it clarified something that we had never understood: his need to shock others.
In the sessions that followed it slowly became clear that Peter enjoyed thinking about the distress he caused when he suddenly quit work or ended a friendship. He'd blown up the analysis twice – first when he quit and then, a second time, when he faked his suicide. In the first phase of his analysis, I hadn't realised just how attached Peter was to violently upsetting others. But why?
Peter's parents had divorced when he was two, and his mother had remarried soon after. During this second phase of his analysis, Peter sought out his biological father and spoke frankly with his mother. He discovered that his mother had been having an affair with the man who became his stepfather, and that his father and mother both drank heavily. He also discovered that the first two years of his life were very different from the story he'd been told. His mother and father both admitted that they couldn't cope and had been violent with him when he was a baby.
Peter told me that his dad didn't remember much, just that it was a terrible, unhappy time, an unhappy marriage. "My mother cried, she kept saying that she was sorry," Peter said. "She was only 20 when I was born and no one was there to help her. She said that sometimes she felt she was just going crazy."
Her confession gave Peter some relief. For as long as he could remember, he had felt afraid. He told me that it helped to know that he was frightened of something. For a small child, violence is an overwhelming, uncontrollable and terrifying experience – and its emotional effects can endure for a lifetime. The trauma becomes internalised, it's what takes hold of us in the absence of another's empathy. So why did Peter turn on those close to him?
Peter's behaviour made it clear that he couldn't allow himself to feel weak. Dependence for him was dangerous. Peter's story might be summed up as, "I'm the attacker who traumatises, never the baby who is hurt." But Peter also felt bound to turn on himself. When Peter assaulted himself in the church, he enacted this same story. As he told me, "I thought – you pathetic little cry-baby. I can do this to you and you can't stop me."
I believe that all of us try to make sense of our lives by telling our stories, but Peter was possessed by a story that he couldn't tell. Not having the words, he expressed himself by other means. Over time I learnt that Peter's behaviour was the language he used to speak to me. Peter told his story by making me feel what it was like to be him, of the anger, confusion and shock that he must've felt as a child.
The author Karen Blixen said, "All sorrows can be borne if you put them into a story or tell a story about them." But what if a person can't tell a story about his sorrows? What if his story tells him?
Experience has taught me that our childhoods leave in us stories like this – stories we never found a way to voice, because no one around us helped us to find the words. When we cannot find a way of telling our story, our story tells us – we dream these stories, we develop symptoms, or we find ourselves acting in ways we don't understand.
Two years after Peter left his message on my answering machine, we agreed to stop his psychoanalysis. I thought there was more work to do, but he felt that it was time.
All of this happened many years ago. Since then, Peter hasn't asked to meet again, but I did run into him recently, at the cinema. We recognised each other across the lobby. Peter said something to the woman he was standing with, and they walked over. He extended his hand and then he introduced me to his wife.
* This is an extract from Stephen Grosz's The Examined Life: How We Lose and Find Ourselves (Chatto, £14.99)


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All prices are in All prices are in USD
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Crucifix 7752 - 1 3/4", Center 8852 - 7/8". These two pieces are designed to match. Order beads and a parts unit with this set and you will have all the parts needed to make one rosary.


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Don't water down Connecticut's clean energy
While both of us have served as leaders in our respective communities here in Connecticut for decades, we met for the first time in March 2012 to begin a conversation about how to move beyond the false choice of "jobs versus the environment." And while we certainly do not agree on everything, we have found common ground in our shared concern about the moral imperative to heal the planet while protecting the livelihoods of workers here in our own communities.
Connecticut needs to implement policies that move us from a fossil-fuel-centered economy to one focused on clean and renewable resources like wind, solar, fuel cells and other renewable technologies, building a sustainable economy with good-paying jobs here at home while reducing the threat of climate disruption here and around the world.
One of the current policies that the state uses to help with this transition is the Renewable Portfolio Standard ("RPS"), a requirement that electricity sellers must purchase certain quantities of electricity from renewable sources. Connecticut's RPS, in combination with similar policies in other New England states, is already driving major investment across the region. These investments create good-paying jobs that we are confident will last far into the future.


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John Ahern Jr., 69, Was High School Counselor
John J. (Jack) Ahern Jr., 69, of Yarmouthport died on Monday, May 13, at his home of pancreatic cancer. He was the husband of Susan Everett Ahern of Yarmouthport.
He was born and grew up in Woburn. He was graduated from St. John's Preparatory School. He attended Catholic University in Washington, D.C., and Boston College, where he completed his bachelor's degree in philosophy. He went on to Boston University and earned a master's degree in counseling.
Mr. Ahern was the first guidance counselor on the Vineyard, serving as director of guidance for the then-new Martha's Vineyard Regional High School. He embraced the treasures offered by the Island, from enjoying its tranquil beauty to playing timpani with the Vineyard Sinfonietta.
After leaving the Island, Mr. Ahern worked as a test consultant for Harcourt Brace Jovanovich. He then relocated to Cape Cod, where he owned several businesses and was, most recently, the genial proprietor of the gift shop at the Red Jacket Beach Motel.
He was an avid yard-sale follower and, until his illness, was a guiding force for the Cape Cod Post-Polio support group.
In addition to his wife, he is survived by a daughter, Elinor Marie Ahern of Rancho Palos Verdes, Calif.; two sons, Thomas Joseph Ahern of Boston and West Falmouth and John Joseph Ahern 3rd of Martha's Vineyard; a stepdaughter, Heather Sandahl of Walpole; a stepson, Robert MacIvor of Olmsted Township, Ohio; a sister, Ann Marie Hampton of South Dennis and Whitehall, N.Y.; a brother, David G. Ahern of South Dennis; eight grandchildren, and many nieces, nephews, great-nieces and great-nephews.
A service of remembrance will be held at 11 a.m. on Saturday, May 18, at the Doane, Beal & Ames Funeral Home, 729 Route 134, South Dennis, preceded by a visiting hour from 10 to 11 a.m. at the funeral home. Interment will be private.
In lieu of flowers, contributions in his memory may be made to Bumpy's Path, part of an outdoor education classroom for schoolchildren, c/o Castleton State College, Development Office, Castleton, VT 05735 or Hospice and Palliative Care of Cape Cod, 270 Communication Way, Hyannis, MA 02601 or a charity of one's choice. It was Jack's wish that in his memory, you go out of your way to do something nice for someone else today.


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As the nation slowly recovers from the severe 2007-2009 recession, a battle rages between lawmakers who want the government to aggressively tackle deficits with spending cuts and those who caution the economy is still too frail to stand on its own feet.
The debate will be in the forefront when Congress returns on Monday from a nine-day recess, now facing a Friday deadline for roughly $85 billion in automatic, deficit-reduction spending cuts.
President Barack Obama and congressional Democrats suggest too much austerity now could threaten the recovery and damage the nation's social safety net. They support some spending cuts but also want higher revenues from closing tax loopholes.
Republicans, who control the House, insist on tackling deficits with spending cuts alone.
Neither side is optimistic a deal can be forged in the few remaining days. Obama's Thursday phone calls to Congress' top two Republicans — House Speaker John Boehner and Senate Minority Leader Mitch McConnell — produced no breakthrough.
The potential shock to the economy comes at a time of sharply rising gasoline prices and a slowdown in consumer spending probably caused by the Jan. 1 increase in Social Security payroll taxes affecting nearly all workers.
Nationwide, the average price of gas was $3.78 a gallon Thursday, according to the AAA, an increase of 47 cents a gallon in just the past month. Also, Wal-Mart, the nation's leading retailer, reported it expects sales to be flat for the February-April period compared with a year ago — suggesting a slowdown in spending among low- to middle-income consumers.
Meanwhile, the White House continued its daily recital of horror stories from the looming spending cuts.
National parks, military programs and the jobs of FBI agents, firefighters, federal prosecutors and government researchers are all on the chopping block.
On Friday, Transportation Secretary Ray LaHood sounded the alarm, telling a White House briefing air traffic controllers would be among the first furloughed.
He predicted major flight delays and cancellations over "the next 30 days." A Republican, LaHood urged his former GOP House colleagues to help.
"This is not rocket science," he said.
Follow Tom Raum on Twitter: http://www.twitter.com/tomraum


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Blue Ridge Helicopters specializes in flight instruction, flight training, inspection, and maintenance for Robinson R22 and Robinson R44 Helicopters.
Blue Ridge Helicopters has several three passenger aircraft and two one passenger aircraft. Our helicopters are maintained to the highest standard by our Robinson Helicopter Certified mechanics to ensure the safety of our customers.
Call us for more information and scheduling. Office: 770-963-0590
Data is submitted by registered FlightAware members on 2013-Nov-10 22:05.You must register or login to edit FBO information.
Jet A and 100LL airport fuel prices for all FBOs at KLZU


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Note: We don't believe in get rich programs - only in hard work, adding value and serving others. Our programs are intended to help you share your message with a wider audience and to make a difference in the world while growing your business. We don't make any guarantees about your own results because we don't know you and, besides, your results in life are up to you. Agreed? We just want to help by giving you great content, direction and strategies to move you forward faster. Anyway, all of our terms, policies and disclaimers for all of our programs and events can be accessed via the link below. Thanks for stopping by. Until next time, live fully, love openly, and make a difference today.
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Siliconera - DmC Devil May Cry was released in Japan last week and sold 110,429 copies on the PlayStation 3. The Xbox 360 version of the game wasn't featured in the top-20 sales ranking, but sales tracker, Media Create, report that it sold approximately 6,000 copies.
I think it is the other way around, the hardcore are giving this a pass, my 10 year old nephew is bragging to me he finished the game 3 times already, and he only barely finished just 2 games before that.
It's an ok game. Just not the DMC game I wanted to play. If they continue with this version of Dante I probably won't play Devil May Cry ever again.
It's a reason why they have classic Dante on Project X Zone....


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Revolving Door: 'Time,' RTV 6, TheAtlantic.com, and More
Here are this week's media highlights from Mediabistro's Revolving Door Newsletter:
Jessica Winter has been named arts editor at TIME. She had been senior editor at O: The Oprah Magazine. (release)
Kevin Finch has been named news director at RTV 6 in Indianapolis. He had been a documentary writer and producer at Calamari Productions. (release)
Spencer Kornhaber has been named associate editor at TheAtlantic.com. He had been editor at AOL's Patch.com. (FishbowlDC)
Matthew Polevoy has been named social media producer at CBS News. He had been in audience development at CNNMoney.com. (TVNewser)
Nicole Price Fasig has been named Web editor at Good Housekeeping. She had been editor at J Walter Thompson. (mb)
Click here to receive mediabistro.com's Revolving Door Newsletter via email.


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You just missed an important client meeting. Those notes from the conference? They're covered in spilled coffee. And you haven't changed the month on your calendar since … 2009. Throw all of those dead trees away, pull out your iPad and download these apps. Once you're finished, you'll feel a glorious feeling wash over you. It's called being organized, and you might want to get used to it.
Looking for more cool apps? Check out the rest of this series:
3 Apps To Help You Stay Informed
4 Apps For Impressive Presentations
3 Apps For Determining Financial Needs
4 Apps for Life Insurance Agents
$5.99 for the iPad
After downloading Noteshelf, you may never have to buy a paper notebook again. This app for the iPad allows you to take notes with your finger or stylus in 17 different shades of ink. Users can choose among several background templates, ranging from simple-ruled to day-planner to music notes. Highlight key points in your notes with more than 450 icons, or imbed — and write on — your own photos. Once you're done, you can share and print your notes easily, exactly as you see them on your iPad.
$4.99 for Apple devices
Forget that to-do list hanging on your refrigerator door or pasted via sticky note to your desk. The Todo app is meant to manage all of that for you. Users can set up multiple reminder alerts, create projects and checklists, set due dates on the calendar and share everything via email.
Air Display
$9.99 for iPads; $4.99 for Android devices
Is your computer screen more cluttered than a hoarder's one-bedroom apartment? You could likely benefit from Air Display, which wirelessly connects your tablet to your desktop or laptop, instantly providing a second — or third — monitor for your computer. Use the extra space to keep an eye on your Facebook and Twitter feeds, your personal calendar or calculator tools. The app also allows users to provide a mirror image of slideshow presentations. Hand the tablet over to your client, and they can follow along while you click through the show on your computer screen.
$4.99 for Apple devices
If you need help managing the multitude of documents, PDFs, emails and other files you're required to keep track of these days, you'll want the GoodReader app. With GoodReader, users can create folders; move, copy and rename files; and even email files as well as send them to other apps. There's text search to help you find info within files, a 50-times zoom capability for when you need a closer look, and a PDF hyperlink feature that allows you to jump back and forth within a document. One of the app's best features is it annotation capability. Readers can mark up documents using text boxes, pop-up comments, freehand drawing, lines, arrows, rectangles … even cloudy shapes.
Free for Apple, Android and BlackBerry devices
Do you blog using WordPress? With the service's app for phones and tablets, your audience won't have to miss a minute of your insights if you're traveling, away from your desk or otherwise engaged. The app allows advisors to manage their WordPress blog or site from their mobile device, including creating and editing posts and pages, adding images and videos, and moderating comments. Analytics are also available, so you can keep track of which posts were popular and which ones weren't.
$9.99 for iPad app, free mobile app for Apple and Android; LeadForce subscription required
The LeadForce app gives agents access to all their leads, wherever they are, and it includes maps to contacts with GPS. The app also tracks and updates the sales cycle as it progresses. Managers have access to the LeadForce system, so they can tally the number of leads each agent receives and reassign leads as needed. LeadForce also offers a reporting system that tracks leads and creates analysis charts and graphs.


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Fincen Spying Plan Invites Privacy Workarounds
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The fragile Bitcoin economy will change drastically as companies scramble to obtain the proper licensing in response to guidance from the Financial Crimes Enforcement Network (FinCEN), which categorizes administrators and exchangers of virtual currencies as money services businesses.March 19
If U.S. know-your-customer rules required banks to identify and scrutinize foreign recipients in addition to the senders of money, other countries would likely return the favor.February 26
The bulwarks of financial privacy may, by default, become unsanctioned, underground networks like Bitcoin and startups run by youngsters brazen, or naive, enough to test the legal and regulatory limits.February 12
The dangers to financial privacy are monumental. Consider an Obama administration plan to give spy agencies unfettered access to data on American citizens and others who bank in the U.S.
Suspicious Activity Reports, filed by financial institutions that operate in the U.S., are the primary documents that the Financial Crimes Enforcement Network intends to share. The reports cover all personal cash transactions exceeding $10,000, suspected incidents of money laundering, loan fraud, computer hacking and counterfeiting.
The Treasury Department proposal, revealed by Reuters last week, aims to consolidate financial data banks, criminal records and military intelligence. This initiative will put intelligence agencies, such as the Central Intelligence Agency and the National Security Agency, on the same footing as the Federal Bureau of Investigation, which currently does not have to make case-by-case informational requests to Fincen.
Also under the new proposal, Fincen's database would be linked to the Joint Worldwide Intelligence Communications System, which U.S. defense and law enforcement agencies use to share classified information.
Money was never meant to be a method of supranational identity tracking. Its use in that way could signal some level of law enforcement desperation. When all other enforcement tactics fail, surveil the finances.
More than 25,000 financial firms, including banks, securities dealers, casinos, and money transfer agencies, routinely file "suspicious activity reports" to Fincen, according to the Reuters article. Banks and other firms tend to over-report some financial details of ordinary citizens since the requirements for filing are so strict they don't want to be accused of failing to disclose activity that later proves questionable.
Increasing encroachment against financial privacy like this Fincen move "raises concerns as to whether people could find their information in a file as a potential terrorist suspect without having the appropriate predicate for that and find themselves potentially falsely accused," Sharon Bradford Franklin, senior counsel for the Rule of Law Program at the Constitution Project, told Reuters.
One protection from becoming scooped up in a fishing expedition and being falsely accused is the use of virtual or alternative currencies. But this week, Fincen issued guidance on virtual currencies and regulatory responsibilities.
Clarifying circumstances where the "money transmitter" definition applies under the law, Fincen classified de-centralized virtual currency as a convertible virtual currency that has no central repository and no single administrator, and that persons may obtain by their own computing or manufacturing effort. Although bitcoin was not singled out by name, the guidance appears directed at cryptocurrencies that operate in a peer-to-peer, distributed fashion such as Bitcoin.
The primary impact of the likely tighter compliance will be felt by the bitcoin-to-fiat exchanges operating in the U.S. and this will lead to jurisdictional competition, as seen in online casino gambling where the more entrepreneurial jurisdictions rose to dominance by embracing the technology early and not overregulating.
Almost serendipitously, discussions about adding privacy extensions to the Bitcoin cryptographic money protocol have been increasing lately.
Bitcoin is nonpolitical money and it falls outside the scope of reporting financial institutions. Since bitcoin does not provide user and transactional privacy by default, multiple bitcoin wallets and Tor, a client software and volunteer server network that enables online anonymity, can enhance privacy without modification to the core Bitcoin code. Nonetheless, code-modifying proposals for augmenting Bitcoin privacy have been introduced. One idea calls for automatic mixing techniques, which would periodically give all users the opportunity to shuffle coins among one another, making the money harder to trace without implicating individuals. Another concept is "coin control," a method for users to select which of their wallet's multiple addresses to use as the "from address" (currently picked somewhat randomly by the client software).
Various proposals for improving bitcoin privacy include "Patching The Bitcoin Client" (2011), "Automatic Coin Mixing" (2012), "Coin Control" (2012), and "Yet Another Coin Control Release" (2013).
Also, a recent cryptographic bitcoin privacy extension submitted by researchers from The Johns Hopkins University was accepted for presentation to the IEEE Symposium on Security & Privacy in Oakland, Calif. The paper Zerocoin: Anonymous Distributed E-Cash from Bitcoin will be introduced on day two of the May conference.
Having received a preliminary copy of the academic paper, I interviewed Hopkins research professor Matthew Green about some of the details of Zerocoin.
Operating as a decentralized layer of anonymous cash on top of the existing Bitcoin network, "Zerocoin creates an 'escrow pool' of bitcoins, which users can contribute to and then later redeem from," Green explained. Users receive different coins than they put in (though the same amount) and there is no entity that can trace your transactions or steal your money. "Unlike previous e-cash schemes, this whole process requires no trusted party. As long as all the nodes in the network support the Zerocoin protocol, the system works in a fully distributed fashion," added Green.
Zerocoin developers are working on improved efficiency because implementation is impractical today given the space constraints of the "blocks" that make up the Bitcoin public ledger. "For one thing, the transactions are very large (40kb to spend a coin)," Green said. "While this isn't the end of the world – and bandwidth is always increasing – supporting these would put quite a strain on the block chain."
When I asked Green about the possibility of a "back door" for law enforcement that had been floated recently, he clarified, "The back door isn't part of Zerocoin. There's absolutely no need for it, and building one in would take significant additional effort. In fact, we only mentioned it as a brief note in the conclusion of our paper, mostly to motivate future research work."
If someone did try to build a back door for any reason, the open source Zerocoin would quickly become Zero-adoption.
Jon Matonis is an e-money researcher and crypto economist focused on expanding the circulation of nonpolitical digital currencies. His career has included senior posts at Sumitomo Bank, Visa, VeriSign, and Hushmail. Currently, he serves on the board of the Bitcoin Foundation. Follow him on Twitter @jonmatonis.


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Administration of Rapidly Generated Multivirus-specific Cytotoxic T-Lymphocytes (VIRAGE)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
|ClinicalTrials.gov Identifier: NCT01070797
Recruitment Status : Completed
First Posted : February 18, 2010
Last Update Posted : September 4, 2014
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Patient's on this protocol have a type of blood cell cancer, other blood disease or a genetic disease and have received a stem cell transplant. The donor of the stem cells was either a brother or sister, another relative, or a closely matched unrelated donor. The patient is being asked to participate in this study which tests if blood cells from the donor that have been grown in a special way, can prevent or be an effective treatment for early infection by three viruses - Epstein Barr virus (EBV), cytomegalovirus (CMV) and adenovirus.
Adenovirus is a virus that usually causes symptoms of a common cold, but can cause serious life-threatening infections in patients who have weak immune systems. It can affect the lungs and cause very serious pneumonia, and can also damage the gut, liver, pancreas and eyes.CMV can also cause serious infections in patients with weak or suppressed immune systems. It usually affects the lungs, causing a very serious pneumonia, but it can also affect the gut, the liver and the eyes. Approximately 2/3 of normal people harbor this virus in their body. In healthy people CMV rarely causes any problems because the immune system can keep it under control, but after a transplant, the risk of developing CMV disease is much higher because the immune system is so weak. EBV is the virus that causes glandular fever. It is also a life long infection like CMV that is normally controlled by the immune system. When immunity is weak, the virus can become active and cause fevers, enlarged lymph nodes and sometimes a type of cancer called lymphoma.
Investigators want to see if a kind of white blood cell called T lymphocytes (T cells)can be used to prevent and treat adenovirus, CMV and EBV in the early stages of reactivation or infection. T cells have been grown from the patient's stem cell donor in the laboratory in a way that will train them to recognize the virus and control it when they are given after a transplant. This treatment with specially trained T cells (also called CTLs) has had activity against these viruses in previous studies and in this study investigators want to see if they still have activity when they are made in a simpler and faster way. These donor-derived multivirus-specific special cell lines are an investigational product not approved by the Food and Drug Administration.
The purpose of this study is to evaluate whether donor-derived multivirus-specific special cell lines are safe and can control three viruses: EBV, CMV and adenovirus.
|Condition or disease
|Adenovirus Infection Epstein-Barr Virus Infections Cytomegalovirus Infections Stem Cell Transplant
|Biological: Multi-virus Specific T cells
|Phase 1
Blood has been previously taken from the patient and the donor to make the cells.
To make the special cell line, special blood cells called dendritic cells (DCs)were made first from the donor blood. Then, a specially produced gene called a plasmid that carries the adenovirus, CMV, and EBV genes was introduced into the dendritic cells. Dendritic cells with these new genes are then mixed with T cells to stimulate them. This stimulation trains the donor T cells to kill cells that are infected with CMV, EBV, and adenovirus. Once a sufficient numbers of T cells were made, they were tested to make sure they killed the patient's cells infected with these viruses, but not the patient's normal cells, and were frozen.
If the donor has never been infected with CMV, the CTLs made for the patient may not have activity against a CMV infection. If these donor CTLs show no activity against CMV infection, the cells will not be given.
The patient may receive Benadryl (diphenhydramine) and Tylenol (acetaminophen). Then, the donor's special cells will be thawed and injected into the patient's intravenous line. After the patient receives the cells, the levels of these three viruses in the patient's blood will be monitored. Investigators will also take blood to see how long the T cells given to the patient are lasting in the patient's body.
If the special cell infusion has helped the infection or if the patient has had a treatment (for example with steroid drugs) that might have destroyed the T cells that were given to them, then the patient is allowed to receive up to 2 more doses of the cells.
The patient will continue to be followed by his/her transplant doctors after the injection. The patient will either be seen in the clinic or contacted by a research nurse to follow up for this study every week for 6 weeks then at 8 weeks, and 3, 6, and 12 months. The patient may have other visits for standard care.
The patient will also have regular blood tests done to follow counts and the viral infection. To learn more about the way the T cells are working in the patient's body, up to an extra 30-40 ml (6-8 teaspoons) of blood will be taken before the infusion and then at 1, 2, 4, 6, and 8 weeks and 3 months. Blood should come from the central intravenous line, and should not require extra needle sticks. Total time participation for this study will be 1 year.
|Study Type :
|Interventional (Clinical Trial)
|Actual Enrollment :
|10 participants
|Intervention Model:
|Single Group Assignment
|None (Open Label)
|Primary Purpose:
|Official Title:
|Administration of Rapidly Generated Multivirus-specific Cytotoxic T-Lymphocytes for the Prophylaxis and Treatment of EBV, CMV, and Adenovirus Infection Post Allogeneic Stem Cell Transplant (VIRAGE)
|Study Start Date :
|January 2011
|Actual Primary Completion Date :
|May 2013
|Actual Study Completion Date :
|April 2014
Experimental: Group A
Group A is for CMV seropositive donors.
Biological: Multi-virus Specific T cells
Subjects will receive Multivirus specific T cells on one of the following dose levels:
Level One: 5 x 10^6 rCTLs/m2
Level Two: 1 x 10^7 rCTLs/m2
Level Three: 2 x 10^7 rCTLs/m2
Level Four: 5 x 10^7 rCTLs/m2
If a patient has a partial response (as defined by a 50% fall in viral load) or receives medication (such as steroids) which may affect the persistence or function of the infused CTL they are eligible to receive up to 2 additional doses at the same initial dose. The minimum time between additional doses is 28 days.
Experimental: Group B
Group B is for CMV seronegative donors.
Biological: Multi-virus Specific T cells
Subjects will receive Multivirus specific T cells on one of the following dose levels:
Level One: 5 x 10^6 rCTLs/m2
Level Two: 1 x 10^7 rCTLs/m2
Level Three: 2 x 10^7 rCTLs/m2
Level Four: 5 x 10^7 rCTLs/m2
If a patient has a partial response (as defined by a 50% fall in viral load) or receives medication (such as steroids) which may affect the persistence or function of the infused CTL they are eligible to receive up to 2 additional doses at the same initial dose. The minimum time between additional doses is 28 days.
- Assessment of dose limiting toxicity in subjects receiving rapidly-generated donor-derived multivirus-specific CTLs [ Time Frame: 42 days ]Safety and toxicity outcomes including DLTs, GvHD, clinical signs of viral infections, secondary graft failure and laboratory measurements will be summarized using descriptive statistics for each dose level (frequency table, means, standard deviations, medians and ranges).
- Determine the effect of rCTL infusion on viral load [ Time Frame: 1 year ]Primary endpoint for the phase II portion of the study is antiviral efficacy, and is whether the institution of additional antiviral therapy post rCTL is needed.
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
|Ages Eligible for Study:
|Child, Adult, Older Adult
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Patients will be eligible following any type of allogeneic transplant to receive CTLs as prophylaxis or for early reactivations as defined below.
- Prior myeloablative or non-myeloablative allogeneic hematopoietic stem cell transplant using either bone marrow or peripheral blood stem cells.
- Prophylaxis for patients at risk of CMV, adenovirus or EBV infection (for Phase 2 portion only). In the phase 1 portion patients must meet criteria in 3 below.
Early treatment of reactivation or infection which is defined for each virus as below:
- CMV: CMV antigenemia is monitored at least weekly post transplant. Early reactivation is defined at CMV antigenemia with less than 10 leucocytes positive. If any patient develops CMV antigenemia (with greater than 10 leukocytes positive) or clinical evidence of CMV infection (defined as the demonstration of CMV by biopsy specimen from visceral sites (by culture or histology) either pre or after CTL infusions, standard treatment with Ganciclovir, and/or Foscarnet and Immunoglobulins will be initiated. Patients may receive CTLs for antigenemia or elevated PCR without visceral infection.
- Adenovirus: Adenovirus infection will be defined as the presence of adenoviral positivity as detected by PCR or culture from ONE site such as stool or blood or urine or nasopharynx. Adenovirus disease will be defined as the presence of adenoviral positivity as detected by culture from more than two sites such as stool or blood or urine or nasopharynx. In patients who meet the criteria for disease Cidofovir may be added unless the subject could not tolerate this agent due to nephrotoxicity. Patients may receive CTLs for elevated PCR in blood or stool.
- EBV EBV-LPD is defined according to recent guidelines as proven EBV-LPD defined by biopsy or probable EBV-LPD defined as an elevated EBV DNA level associated with clinical symptoms (adenopathy or fever or masses on imaging) but without biopsy confirmation. Patients with EBV DNA reactivation only defined as EBV DNA levels > 1000 copies/ug may also receive CTLs on study. Patients with proven or probable EBV-LPD should also receive Rituxan
- Early treatment may be given to eligible patients with a single or multiple infections. Patients with multiple infections with one reactivation and one controlled infection are eligible to enroll.
- Patient with a CMV seronegative donor may only receive CTLs for a CMV reactivation in the dose escalation phase if the line has activity against CMV.
- Clinical status at enrollment to allow tapering of steroids to less than 0.5 mg/kg/day prednisone.
- Karnofsky/Lansky score of 50 or greater
- ANC greater than 500/µL.
- Bilirubin 2x upper limit normal or less
- AST 3 x normal or less
- Serum creatinine 2 x upper limit normal or less
- HgB >8.0
- Pulse oximetry of > 90% on room air
- Available multi-virus-specific cytotoxic T lymphocytes
- Negative pregnancy test in female patients if applicable (childbearing potential who have received a reduced intensity conditioning regimen).
- Written informed consent and/or signed assent line from patient, parent or guardian.
DONOR ELIGIBILITY: The donor for the CTL product will be the same donor who donated the allogeneic product for the patient's transplant. These donors for allogeneic (i.e. HLA matched or mismatched related or unrelated) stem cell transplants will have fulfilled eligibility for and consented to stem cell donation as per the stem cell transplant program's standard operating procedures.
Exclusion Criteria for initial CTL and for subsequent infusions:
- Patients receiving ATG, or Campath or other immunosuppressive T cell monoclonal antibodies within 28 days of screening for enrollment.
Patients with other uncontrolled infections. For bacterial infections, patients must be receiving definitive therapy and have no signs of progressing infection for 72 hours prior to enrollment. For fungal infections patients must be receiving definitive systemic anti-fungal therapy and have no signs of progressing infection for 1 week prior to enrollment.
Progressing infection is defined as hemodynamic instability attributable to sepsis or new symptoms, worsening physical signs or radiographic findings attributable to infection. Persisting fever without other signs or symptoms will not be interpreted as progressing infection.
- Patients who have received donor lymphocyte infusion (DLI) within 28 days.
- Patients with active acute GVHD grades II-IV.
- Active and uncontrolled relapse of malignancy.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01070797
|United States, Texas
|Houston Methodist Hospital
|Houston, Texas, United States, 77030
|Texas Children's Hospital
|Houston, Texas, United States, 77030
|Principal Investigator:
|Helen E Heslop, MD
|Baylor College of Medicine
|Responsible Party:
|Helen Heslop, Professor of Pediatrics-Hem-Onc Cell & Gene, Baylor College of Medicine
|ClinicalTrials.gov Identifier:
|Other Study ID Numbers:
VIRAGE ( Other Identifier: Baylor College of Medicine )
|First Posted:
|February 18, 2010 Key Record Dates
|Last Update Posted:
|September 4, 2014
|Last Verified:
|September 2014
Epstein-Barr virus
cytotoxic T Lymphocytes
Adenovirus Infection
viral infection
hematopoietic stem cell transplantation
Communicable Diseases
Adenoviridae Infections
Cytomegalovirus Infections
Epstein-Barr Virus Infections
Virus Diseases
DNA Virus Infections
Herpesviridae Infections
Tumor Virus Infections