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Stroke Research and Treatment
Volume 2013, Article ID 767212, 6 pages
Acute Stroke Imaging: Recent Updates
1Department of Radiology, University of Massachusetts Medical School, Worcestor, MA 01655, USA
2Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
Received 24 April 2013; Accepted 17 June 2013
Academic Editor: Padma Srivastava
Copyright © 2013 Prachi Dubey 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.
Acute ischemic stroke imaging is one of the leading causes of death and disability worldwide. Neuroimaging plays a crucial role in early diagnosis and yields essential information regarding tissue integrity, a factor that remains a key therapeutic determinant. Given the widespread public health implications of stroke and central role of neuroimaging in overall management, acute stroke imaging remains a heavily debated, extensively researched, and rapidly evolving subject. There has been recent debate in the scientific community due to divided opinions on the use of CT perfusion and access-related limitations of MRI. In this paper we review and summarize recent updates relevant to acute stroke imaging and propose an imaging paradigm based on the recently available evidence.
1. Introduction
Acute ischemic stroke is one of the leading causes of mortality and morbidity worldwide. Statistics from the American Heart Association estimate an average of 1 stroke every 40 seconds in the United States amounting to approximately 795,000 people experiencing new or recurrent strokes, per year [1]. In view of the widespread public health impact of stroke and its profound impact on patients, stroke research has remained in the forefront. A recent systematic review article reported no significant difference between reperfusion strategies based on the current literature, emphasizing need for future randomized clinical trials to determine the efficacy of alternative reperfusion strategies [2]. As noted by Gonzales R in a recent commentary, the failure to recognize relative efficacy of treatment strategies can be partially attributed to lack of appropriate patient selection due to ineffective, inconsistent, and contradictory neuroimaging approach. This was one of the potential causes that lead to the halting of the Interventional Management of Stroke III Trial [3].
There is a critical need for reproducible and sensitive imaging biomarkers that allow accurate assessment of efficacy of rapidly evolving thrombolytic treatments. This underscores the primary need for standardization of imaging techniques across institutions so data from multicenter trials can be collectively analyzed. The glaring lack such consensus amongst imaging techniques was highlighted in a recent systematic review which found wide variability in the employed thresholds for CT and MR perfusion imaging and significant inconsistency in definitions of tissue states; factors which add to the widespread variability in perfusion-based assessment [4].
Despite the inherent challenges and past failures, stroke imaging is rapidly evolving with enormous ongoing research and global public health impact. In this paper we sought to review recent cumulative evidence including evolving expert opinions and recommendation to assess the adequacy of current state of clinical practices in acute stroke imaging. Based on our assessment we propose an optimal imaging paradigm for patients presenting with suspected acute ischemic stroke.
2. Identification of Target Clinical Goals in the Acute Care Setting
The initial step in approaching the imaging paradigm is to summarize the targeted clinical goals for patients with suspected acute ischemic stroke in the acute care setting. The fundamental objective of treatment is to enable rapid reperfusion for maximal tissue salvation. There is substantial evidence to suggest efficacy of intravenous thrombolytic therapy in the first 4.5 hours from onset of symptoms as well as increased risk of hemorrhagic complications and lower efficacy outside the therapeutic window. The European Cooperative Acute Stroke Study (ECASS) investigators demonstrated the efficacy of treatment instituted within the first 4.5 hours [5]. This was confirmed on a systematic review with pooled data from 11 randomized controlled trials evaluating intravenous thrombolysis (IVT) and 3 randomized controlled trials evaluating intra-arterial thrombolysis (IAT). This review concluded efficacy of IVT within 4.5 hours of onset of symptoms, beyond which the risk of treatment outweighed the benefit. The clinical utility of expanding the treatment window to 6 hours with IAT treatment is currently investigational [6].
Based on the above considerations the following goals must be achieved to allow early initiation of treatment. The choice of imaging approach and interpretation protocol should be designed with the intent of addressing the primary clinical goals such as to allow safe and prompt initiation of thrombolytic strategies.
2.1. Goal 1
Exclusion of Primary Intracranial Hemorrhage, Assessing for Alternate Etiologies for Symptoms and Treatment Contraindications. Once the patient presents to the ER with neurological symptoms possibly corresponding to a suspected acute stroke, the initial goal is a "rule out" approach. This is particularly critical in those patients with early presentation, as they are most likely to benefit from rapid institution of reperfusion therapy.
Initial evaluation focuses on exclusion of primary intracerebral hemorrhage (PICH), intracranial metastasis, tumor with herniation, or other alternate etiologies explaining the clinical picture.
2.2. Goal 2
Infarct Characterization: Identifying of Core, Quantification of Core Volume, Imaging of Penumbra and Pial Collateral Vessels. This has been thoroughly reviewed and concisely presented as the "core, clot, collateral" approach and is currently the mainstay of acute stroke neuroimaging [7].
2.3. Nonenhanced Head CT
Theoretically Goals 1 and 2 can be assessed on NECT/CTA combination, which is the most ideal single-step imaging solution. Guidelines published by American Heart Association and American Stroke Association Stroke Council in 2007 mandate universal and immediate availability of nonenhanced head CT (NECT) within 30 minutes of initial presentation to the ER [8].
There is no controversy regarding the utility of NECT with regards to accomplishing Goal 1. In particular it is widely accepted that NECT can reliably exclude intracranial hemorrhage, which is critical for therapeutic decision making.
In terms of infarct characterization to address Goal 2, NECT-based scoring system designed by the Alberta Stroke Program, commonly referred to as the ASPECTS scoring system, (Alberta Stroke Program Early CT Score) provides an effective tool for quantifying early ischemic changes in the MCA territory (Figure 1). This methodology has provided useful prognostic information with regards to response to reperfusion. Patients with high ASPECTS scores (8–10) corresponding to low infarct volume on initial imaging demonstrated the best clinical outcomes [9]. However, as noted by Demchuck et al. the greatest limitation of ASPECTS application is the inability to accurately visualize the early ischemic changes on NECT in the real world setting, [7]. This is more problematic in the setting of preexisting white matter changes. An interobserver reliability study demonstrated a 77% concordance for total ASPECTS score with lower agreement for scores based on a cut-off (>7 and ≤7) and also lower agreement for cortical and internal capsule regions [10]. Overall, there is substantial cumulative evidence indicating ASPECTS NECT scoring as a very objective, semi-quantitative, prognostic tool and we recommend utilization of online resources to aid ASPECTS utilization in early acute stroke imaging; see http://www.aspectsinstroke.com/ [11].
2.4. MRI with Diffusion-Weighted Imaging
There is conclusive evidence regarding the sensitivity of MRI with diffusion-weighted sequences for the detection of infarct core including those cases in which the infarct core remains occult on standard T2-weighted imaging [12]. Evidence-based guidelines proposed by the Therapeutics and Technology Assessment subcommittee of the American Academy of Neurology, endorses the role of DWI in accurate diagnosis of acute ischemic stroke particularly in the first 12 hours as being superior to NECT and also suggest, that baseline DWI infarct volume has predictive ability towards final infarct volume and overall clinical outcomes [13].
Recent considerations for the same were reviewed by R. Gonzalez indicating a significant role of MRI with diffusion-weighted sequences in identifying infarct core and allowing assessment of core volume, which is a useful predictor of treatment efficacy [14]. In the past, pretreatment infarct core volume has been demonstrated to be a highly specific predictor for malignant middle cerebral artery infarction at a threshold core volume of greater than 82 mL. [15]. The MR Stroke study group investigators found a 5.8 fold increased risk of symptomatic intracerebral hemorrhage in patients with large-volume infarct cores (>100 mL) compared to small (<10 mL) and moderate (10–100 mL) ones [16]. A core volume threshold of approximately 70 mL has been suggested as having dichotomous prognostic implications with patients with higher core volumes having unfavorable outcomes regardless of treatment [17, 18].
A recent study demonstrated that posttreatment final infarct volume (FIV) also has significant influence on clinical outcome in patients undergoing IAT [19]. This study showed high specificity for poor outcome with FIV of >90 cm3. Therefore with regards to established management goals, MR with diffusion-weighted imaging provides the most accurate information related to Goal 2 principles of core identification and core volume quantification. However, diffusion-weighted imaging alone has limited utility for detection of penumbra for which MR perfusion estimates are more reliable and it provides little information about vascular substrates, including assessment of occluded vessel and degree of pial collateralization.
Additionally, there are accessibility issues due to individual contraindications to MR and limited availability of MRI leading to underutilization of MRI in emergent setting. A recent study evaluated the adherence to AAN guidelines of preferring MR over CT in the initial 12 hours of presentation and revealed that the target was met in less than 1/3 of patients in their study [20].
2.5. Mismatch Imaging: CT Perfusion and MR Perfusion
Perfusion imaging either CT or MR is most relevant in terms of ability to delineate the ischemic penumbra. The clinical utility of penumbra imaging has long remained an issue of debate. The hypothesis of penumbra identification is that identification of "at-risk" tissue may allow widening of the treatment window beyond 4.5 hours and allow detection of patients who will either benefit from treatment or those in whom treatment is not likely to cause improved outcome.
It is notable that the recent study by the MR Rescue investigators found no role of penumbra imaging in selecting patients likely to benefit from endovascular therapy within 8 hours from onset of symptoms. There was evidence of good functional outcome in patients with favorable penumbral pattern in the late time window regardless of recanalization. Interestingly, this study raises the possibility that patients who have a favorable penumbral pattern may be inherently more resilient to the effects of vascular occlusion and therefore harbor a favorable outcome regardless of treatment, thus explaining lack of differential effect of therapy when stratified on the basis of penumbral pattern [21].
Nevertheless there remains an interest in imaging penumbra due to its potential role as a prognostic biomarker. Previously, CT perfusion performed soon after the initial NECT has been supported as being a safe and efficacious strategy for imaging tissue at risk [22]. On the other hand a recent study demonstrated low sensitivity of MTT maps in predicting acute infarct detectable on DWI sequence. CBV also did not correlate with the DWI abnormalities. This study advocates against utilization of CTP in acute NVS [23].
Reliance on postprocessing, restricted brain coverage, and vendor related-differences in processing algorithm are primary limitations which have not yet been completely addressed and remain as mitigating factors in enabling wider utility of CTP. Additionally the inherent low contrast to noise ratio increases susceptibility to artifacts and lowers overall sensitivity. These considerations were reviewed by R. Gonzales and for the same reasons the clinical utility of CTP was felt to be doubtful in the current state of practice [3].
On a contrary note, a recent expert commentary by M. Lev acknowledges the aforementioned CTP limitations but continues to endorse this method due to its relative cost efficacy, rapid availability, and potential for quantitative assessment relative to MRI [24]. A recent study demonstrated that CTP-based penumbra volume was an independent predictor of clinical outcome in 90 days along with recanalization status. This study also demonstrated that the CT perfusion based penumbra volume could not be accurately assessed by clinical parameters, NECT or CTA [25]. CTP rCBF maps with appropriate threshold levels are felt to represent an accurate estimate of the infarct core [26, 27].
MR perfusion parameters are equally sensitive in depicting tissue at risk although expense, lack of universal applicability and access issues in the ER setting remain limiting factors. Recently the applicability of MR Perfusion was reviewed by M. Fisher, highlighting its utility in delineating tissue at risk of infarction and thus holding promise in expansion of the therapeutic window. A key aspect underscored in this review relates to the identification of "benign oligemia," which refers to hypo perfused tissue which will not proceed to infarction regardless of treatment. The MR perfusion parameter with delay of >5 to 6 seconds compared to normally perfused tissue was considered to be a useful indicator of impending infarction in the absence of reperfusion [28]. Using pooled data from the DEFUSE (diffusion and perfusion imaging evaluation for understanding stroke evolution) and EPITHET (echoplanar imaging thrombolytic evaluation trial) studies, Mlynash et al. found that based on and diffusion-determined mismatch, patients with a mismatch who have large core volumes (size of DWI lesion) or large perfusion defect (large-volume, severe delay) had unfavorable outcomes despite reperfusion. This study suggested a > 8 secs with a volume of approximately 100 mL as an adequate threshold for identification of patients with malignant profile of infarction who would be poor candidates for reperfusion therapy [29].
2.6. CT Angiography
CT angiography continues to be the superior method for characterization of vascular anatomy. Figure 2 in addition to allowing for assessment of the site of vascular occlusion, it also allows assessment of the presence of calcifications and atherosclerotic disease, which can influence recanalization techniques. It is also the most effective non-invasive means of assessment of leptomeningeal collaterals, which not only determines rate of core expansion but also influences possibility of hemorrhagic transformation [30]. A study by Bang et al. demonstrated higher risk of hemorrhagic transformation in patients with poor collateral status [31]. Another study demonstrated discriminatory ability of a poor collateral score in detecting a malignant profile (larger DWI lesion volume at baseline, higher median NIHSS and functional dependency at 3 months after stroke) [32].
A recent study showed that CTA evidence of occlusion of distal internal carotid, proximal middle cerebral, or basilar arteries as a predictor of poor outcome and added incremental predictive value to NIHSS. This suggests the utility of CTA in early phase treatment decision making [33].
A potential confounding factor is acquisition protocol-dependent overestimation of infarct core volume using CTA source images for detecting of early ischemic changes [34]. The source images acquired by slow CT acquisition demonstrated greater infarct volume correlation with MR diffusion core estimates compared to the multislice CT scanner. This overestimation has critical clinical implications given it may prevent institution of reperfusion treatments in patients who could have potentially benefited from reperfusion therapy [34].
Overall, CTA has a definite prognostic role in acute phase of stroke imaging. In particular, with relevance to our defined Goal 2, acute-phase CTA can enable assessment of site of occlusion, integrity of vessels in terms of atherosclerotic disease, and degree of collateral flow, all of which influence management decision making (Figure 2). It must, however, be kept in mind that CTA entails exposure to radiation and iodinated contrast, which are potential pitfalls of utilization.
2.7. Proposed Imaging Paradigm
Despite significant advances in our understanding of physiologic surrogates of imaging observations and the respective technical confounds, there are still considerable debate and lack of consensus particularly with relevance to penumbra imaging and role of perfusion imaging as it relates to core characterization and penumbra estimation.
If we take a minimalist approach, the expert opinion seems to converge most definitively on two standard queries prior to therapeutic decision making (1) is there primary intracranial hemorrhage? and (2) what is the volume of the infarct core? These two components combined with clinical neurological assessment seem to be most directly related to clinical outcome in postperfusion recovery phase and will help stratify patients appropriately for treatment decision-making.
The limitation of the minimalistic approach is that although it raises specificity, by helping us identify those that will have a favorable outcome after-reperfusion, it also at the same time lowers sensitivity, thereby potentially excluding patients who may have benefitted from more aggressive reperfusion therapy.
One of the ways to achieve efficient imaging selection for treatment triage is development of a unimodal imaging protocol. Simplistically stating, a one-stop, all-inclusive imaging protocol can accurately and reproducibly classify patients who will either (a) benefit from treatment or (b) have no impact or negative impact of treatment. NECT is the most obvious choice for Goal 1-related aspects of management. However, beyond that it would be ideal if the CT imaging and interpretation protocols can be optimized in such a way that Goal 2 can be consistently and reliably achieved in acute-phase urgent care setting on the same CT scanner without having to transfer the patient. We believe that in many cases this is feasible, particularly when the ASPECTS score is carefully interpreted, providing infarct core volume information. To assist in the latter, we encourage the use of online resource described by Modi et al. [11] (http://www.aspectsinstroke.com/) to optimize utilization of NECT. This can be followed by CTA/CTP to assess the remaining aspects of Goal 2 with relevance to site of occlusion, collateral flow assessment, and penumbra imaging, all of which have been established as either predictors of treatment efficacy or overall clinical prognosis in poststroke recovery phase. This approach minimizes scanner time and utilizes the most widely available technologies only. Based on the considerations presented in the Gonzalez and M. Lev commentaries, we agree that NECT with ASPECTS assessment along with CTA can provide sufficient information for adequate triage of patients who will benefit from treatment. The remainder of the imaging including penumbra imaging with CTP can be performed while the treatment implementation has begun minimizing the "door-to-needle" time [3, 24].
However, we acknowledge coexistent evidence that indicates limitation of NECT in core characterization due to multitude of factors including inherently low sensitivity to early ischemic changes. It is agreed upon that core volume is a key determinant of treatment efficacy, for which MR with DWI is the imaging gold standard. In an ideal world with no cost, availability or individual applicability issues, an all inclusive MR protocol for acute stroke imaging would be more preferred from the viewpoint of obtaining accurate and consistent tissue specific information with minimum susceptibility to postprocessing variability.
As stated above we emphasize that if MRI is not available and decision for endovascular therapy has to been taken based on the initial NECT, then immediate CTA (to assess vessel occlusion and collateral status) and CTP (infarct core assessment on rCBF map) should be considered (Figure 2). This approach would require less than 10 minutes and can be performed while the intravenous thrombolytic agent is being initiated [3, 24].
The utility of mismatch imaging is undoubtedly promising; however, the recent body of evidence does not provide compelling arguments to necessitate a paradigm shift particularly in routine clinical settings outside of major academic institutions. This is especially true in light of the results from the recent penumbra-based trial of imaging selection by the MR Rescue investigators demonstrating no utility of penumbra imaging in detecting patients who would benefit from endovascular therapy of acute ischemic stroke [21].
At this time with proven efficacy of IVT within the first 4.5 hours, it is notable that the frequency of thrombolytic therapy in patients with acute ischemic stroke remains remarkably low. A large multicenter study found only 3% utilization of thrombolysis for all acute ischemic stroke patients and only 10% for those who presented within the first 3 hours [35]. This is largely related to complexity of imaging protocols and a general lack of consensus amongst the experts regarding imaging appropriateness leading to inability to select the appropriate patients who would benefit from treatment in a timely fashion. In light of these compelling statistics, we strongly encourage a minimalist imaging approach, which can be reliably and consistently reproduced regardless of variability in institutional capabilities. NECT with ASPECT emphasis with simultaneous CTA/CTP and prompt MR with diffusion remain the most rigorously optimized imaging tools.
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text:
Hello guys,
Sorry for not posting these few days, have been busy and lazy lately.
I also haven't updated a while about my life and perhaps it would be right dumping
that crap in this
post cuz i dont have much to post lately, also because of bad lightning otherwise i would've posted more looks here..
Well where do i start?..
Lemme see, I have quit school for a while. Not forever ofcourse,
but i will be starting a new course next year. In the mean time (when i get accepted for a new job) i will be starting working for a while till my new school starts. It all sounds pretty easy when i'm telling it like this. But it really isn't.. I did find a job though. And i already applied and had my conversation with the manager last week. (The 1st three pictures were my look that day) Now i'm hoping to get a positive phone call tomorrow if i will be accepted or not. I know that the manager said that i dont have to worry much, but i'm still hoping ofcourse.. even though i have high chances to get accepted because i'm free for the whole week lols. Well maybe not the weekends, because i also want my free time.
If i get accepted i have to sacrifice myself to get up every morning at 4:30am, because they start at 6 in the morning.. xD Pretty early? hell yeah i've never woken up this early lols. But the good part is that i'm usually done working at 2 or 3pm in the afternoon, so i can still make appointments or just sleeeep till dinner lols. It also seemed like a nice job, because you have to serve food and make milkshakes in a very small place at the trainstation. And another good thing is, if i get accepted, i get to work with a friend of mine who also works there. Would be awesome if we could be collegues haha. But yeah i'm still hoping for now and crossing my fingers that i will be accepted, because i really need this job.
Wooh. This was a lot of bullcrap of whats going on now lols.
Sorry to bore you guys, i just wanted to get this off my chest haha.
Aniways here are the few looks that i had last week.
Sooo this was my boring post for today, more will be coming soon~
Hope you all have a nice day
And oh join my give away!
It ends the 24th of november! Be fast lol.

subset: commoncrawl


text:
"Night of the Living Dead" (George A. Romero, 1968) Johnny and Barbara (Russell Streiner and Judith O'Dea) are two dutiful kids who schlep all the way up to a high hill-top cemetery outside of Pittsburgh to put a rememberance on their father's grave. It's a big deal to Barbara, but not to Johnny (who hasn't been to church lately) and, according to his grandfather, is "goink to Hale!" It's the Summer Solstice, 8 pm at night but still light out, and there's a thunderstorm a-brewing.
Boy, howdy!
There's not a soul around at the cemetery, but that doesn't mean there's no activity. There's that tall unsteady guy in the dark suit over there (S. William Hinzman), looking a little pale. In fact, it looks like he hasn't had a bite in days! But Johnny, still the same disrespectful cut-up he was when he and Barb were kids, can't help making fun: "They're coming to GET you, Barbara..." he dramatically intones, not realizing that he may be right for once in his miserable life. Before he knows it, that tall pale guy is attacking Barbara, and when Johnny steps in, the thing attacks him, trying to bite his neck. Before long, Johnny is taking a dirt-nap with a tombstone for a pillow, and "Gary Shambling" is chasing Barbara out of the bone-yard.
Then, it's all down-hill from there.
Within ten minutes she's trapped in a farm-house surrounded by flesh-eating zombies trying to get in—good thing they seem unable to open doors! And it's a good thing that Ben (Duane Jones) has happened to run out of gas nearby. The reason? Barbara is probably the last human being alive you want to be trapped with during a zombie attack (that is described by a newscaster as "wholesale murder"—life being cheap, I guess) Hysterical and useless, she seems incapable of doing anything except the exact-opposite of what should be done in a crisis, and is at her best when she's numb with shock.* Ben, on the other hand, is smart, competent, logical and efficient, well aware that this is no "Sunday School Picnic," and a fast study, figuring out that perforating zombie brain-pans with anything from bullets to tire-irons is the only way to stop them.
Ben may be the greatest hero in all of horror films; that he is African-American, the only black face in a crowd of white—and whiter—is just one of the sign-posts that "Night of the Living Dead" may be doing something more than target practice. Director George Romero protests up and down that Jones was hired because he was the best audition (and, indeed, he gives the best performance of the non-grunting, teeth-gnashing roles), but the fact that his Ben is so unquestionably in charge and handling the situation, despite his dithering neighbors in the buffet—and nothing is made of it—speaks volumes for a film made in 1968.
But you can read all sorts of social messages into "Night of the Living Dead," if that's what it takes to keep peeking at it through your fingers. It could be a treatise on race relations, sure. It could be a cautionary tale, as most of the victims are killed due to the actions of someone they loved. It could be a political statement of using unity against an implacable foe (like soulless communists), whether attacking from within or without. It could be a warning against the Tyranny of Science (radiation is the cause of it all, but that's as useful as being in a control group). Or it could be a protest against neighbors who drop by at odd hours to chew the fat. Maybe it's promoting vegetarianism. Whatever the reason, "Night of the Living Dead" sinks its teeth into more dynamic issues than "Is it better to be upstairs, or in the basement?" (Answer: Outside with "The Gun-Club").
Inspired by Herke Hervey's low-budget "Carnival of the Souls," Romero, who also made industrial films—and filmed shorts for "Mr. Roger's Neighborhood"—drew style-points from Richard Matheson's "I Am Legend," (and it's first screen adapation "The Last Man on Earth"), but amped up the dynamics with quickly cut hand-held shots and frequent close-ups of angry antagonists squaring off in low-light conditions. Romero also made a more grisly movie than folks were used to, although the gore was decidedly low-tech: for blood the crew poured Bosco over the victims (probably just made them more delectable for the zombies!).
"Night of the Living Dead" is a boiler-maker of a movie, determined to keep activities at a feverish pitch, and has none of the care of yesterday's "Carnival of the Souls." But, the sheer adrenaline that courses through the film makes it a dynamic film-going experience—upsetting, nihilistic, and cynical. In the public domain, it was made part of the National Film Registry in 1999. It has spawned more remakes and sequels (with more on the way) than just about any movie ever made.
You can watch "Night of the Living Dead"...for free...here.
Have a Safe and Sane Hallowe'en. Remember, no candy for zombies!
* That being the case, the first thing Ben should have told her was: "Barbara! Stay inside the house and whatever you do, don't go out there with those zombies!" It's a "win" either way!


text:
Money Supply, Monetary Policy and Inflation.
The Federal Reserve regulates the economic conditions in USA by controlling the amount of circulating money in the financial market through devising a practically feasible Monetary Policy.
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text:
(From Genesis 4:1-15)
- The story is written in the all-knowing, first voice narrative form. Never in the story does the voice of God say that Cain's offering was unaccepted. I think the Narrator reveals Cain's perception that Abel and his offering were "regarded" by God, but for Cain and his offering; God "had no regard." The response of Cain to this perceived disparity of value between himself and his brother was anger. The suggestion is that Abel was accepted and blessed, while Cain was not.
Questions: How do we know when someone is "blessed" by God? How do we perceive that to look? If a brother is "blessed" and "regarded" by God, does that mean that we are not? Do we tend to believe we are NOT blessed if our life doesn't fit the same pattern of our brother?
Question: Who are the narrators in our lives that prescribe values to life and to God which may not be true and generative for us?
- Cain believes God has chosen Abel and his offering over his own. Cain's response is anger, but his anger is directed towards Abel, while his argument is with God… Arguing with God is a good thing, as the story of Job points out. Jacob also wrestled with God, begging to be blessed and received a lifelong limp as a result. When we argue with God, we interact emotionally with God and our perceptions of God, reality, and our selves are changed. This is the process of redemption. Anger, when acted upon with violence, is displaced, because we treat the Creation with disrespect in retaliation for the disrespect we feel from our own perceptions of an unfair and unstable god.
- Cain manifests the human disease process in all its fury:
- Distrust of God
- Devalued Self- "I'm not enough…" (4:5 & 7)
- Jesus has been called the "second Adam." (Romans 5:12-21) He could also rightly be called the "second Abel." Jesus became the shock absorb-er of human anger and violence. Jesus' resurrection absorbs the violence,and turns death into a means of creating new life.
- As to the consequences for Cain due to his actions, the story repeats the Edenic theme of leaving a garden and plunging into wilderness, where the earth wars against our best efforts of self-sufficiency.
- In contrast to the narrative assumption of the intentions of God regarding both brothers, the voice of God in verse 15 promises protection even for the murderer Cain, and earlier states that God hears, and is moved by the shedding of innocent blood. God can be on both sides of a dysfunctional act, all-the-while working to bring resurrection from the ashes.


text:
Italians are a very superstitious people. This is particularly evident on the first day of every year. Everything that happens or that you do, could be potentially reflecting on the type of year you are going to live. The first phone call you receive... The first person you see on the street... And of course, the first meal you have. The traditional dish in Italy on January 1st is a pig leg called Zampone (=big leg) or Cotechino (which is basically the same thing without the pig foot at the end of it). For how awful they may sound, they are actually delicious since what you are really eating is a cooked, juicy, soft salami. Here is a photo I found on the internet.
I usually bring one with me from Italy as they are vacuum packaged. Unfortunately, this past Fall I did not go there and therefore this is the first time in years that I have to do without. Instead I made a small pork roast cooked slowly on a stove top in milk. As you can see from the photo I just posted, the Zampone is served with mush potatoes (optional) and lentils (mandatory!). Lentils represent money. The more lentils you eat on New Year's Day, the more money you will make during the year. If I am correct, such tradition derives from the biblical account of Esau selling his birthright to his younger twin brother Jacob for a bowl of porridge (and the folklorist version is that the bowl of porridge was indeed a serving of lentils). Of course, I made plenty and ate as many as I could possible handle. Here is my recipe for lentils (great as a side dish or as a soup):
- a package of dry lentils (1lb)
- one small carrot, one small onion, two celery sticks
- 2 cloves of garlic (minced)
- 4 TBSPs extra-virgin olive oil
- 4 slices of bacon
- 2 bouillon cubes (I prefer the vegetable based flavor from the Knorr brand that you can find in the ethnic section of the grocery store)
- 1/2 TBSP of Paprika
- Pinch of black pepper
- Pinch of black pepper
- 1 small can of tomato paste
- water
In a food processor mince finely carrot, celery and onion (soffritto). Sautee in a large saucepan or pot with olive oil and garlic. Cut bacon in small pieces and cook it with the vegetables for a couple of minutes. Rinse the lentils in cold water, drain and pour in the pot. Add black pepper, cubes, paprika and cover with water. Add tomato paste. Stir occasionally and cook covered on low heat for approximately one hour. Check from time to time stirring regularly and adding more water if necessary (it depends on how "soupy" you would like the end product to be. I don't like mine watery). The lentils are ready when they are soft. Have a prosperous 2010!!


text:
Phil started his apprenticeship in 1969 working for Franklin Electric Power Board and in 1982 went into business for himself.
Today his business Kinetic Electrical Franklin employs 6 people. After over 30 years of business, he is still supplying service to many of his original clients.
Click here to discuss your next project with Phil
Phone: 09 238 9591
Fax: 09 238 0772
Email: email@example.com
Postal Address:
1/80 Adams Drive
Pukekohe 2120
New Zealand


text:
(Un)expected – Lingering Questions Which Will Never Be Answered
(Un)expected is a photo project about the coping process of surviving relatives of suicides in West Flanders (Belgium). The book contains five stories about how these people cope with their loss in different ways: the sadness, the grieving process, but also the attempts at finding a new way to live.
In 2008, my mother stepped out of life and quite recently a friend did the same. West Flanders, the region where I grew up, has a relatively high percentage of suicides: one and a half times the European average and twice as many as in the Netherlands. Every month 20 people commit suicide in West Flanders.
My mother's death was the most traumatizing death for me, especially as it is a suicide. The death of my friend was ultimately the trigger that led me to make a project on this theme. For the survivors, the suicide will always present lingering questions which will never be answered.
Excerpt from the chapter 'Mother and Father'
"For the first few months after her death, my father was angry, because my mother had abandoned him. He lived completely on autopilot, going through the motions of running the household exactly the way they had once agreed to do the chores. He took care of the garden dogmatically, almost as if she were still there checking up on him. Over and over, he told me that she was the best off of all of us, and that there was nothing but loneliness left for him."
I personally had many reasons to start this project. On one hand, it was a way of mourning and coping with the loss. On the other hand, the project served to rationalize, to give a place to the loss of my mother, to contextualize her suicide among those of my friends and neighbours in West Flanders.
One of the first things I was confronted with during my research on suicide was that I have a 17 times higher chance to die the same way as my mother, this is because one of my parents had stepped out of life. Naturally these are only statistics, but these numbers are confronting. Rationalization was, therefore, an important element to avoid the self-fulfilling prophecy aspect.
A key moment was when I started talking to fellow survivor relatives. There were many similarities that I discovered, numerous experiences and sentiments that we shared. Most of them had not anticipated or seen warning signs that the person would step out of life; however, at same time, there was nearly always fear and tension for years prior to the death that often stemmed from psychological problems.The relatives are all coping in different manners and trying to finding different ways of moving on. But, I was surprised that some relatives felt a sort of relief after the death. Everybody felt guilty about this feeling but the relief seemed to be quite a normal sentiment for some, especially if the person who died had a long history of needing psychiatric help. Of course, you have the same deep feelings of mourning but it feels strange that you can feel relief after losing someone you love. For survivors, the fact that they lost their loved one to suicide remains a shock, compounded by feelings of impotence and the questions that will remain unanswered for eternity.
My mother also had psychological problems for many years but I didn't think she would commit suicide. Everyone denied the problem until you think it's the most normal thing in the world and you don't think about it, until it is finally too late.
I moved from West Flanders when I was eighteen years old, and I've always had a love-hate relationship with this region. When I returned after a long time to the area for this project, it took a few weeks to get in contact with the survivors and even more time to earn their trust. It was an advantage that I was also a survivor and could conduct empathetic in-depth interviews with the relatives. Everyone felt freely, expressed their feelings but overall, all survivors felt that it was important to tell the story of their loved one. I gave them also the guarantee that they could stop the collaboration at any point during the process, which gave extra confidence so they could be very open. It remains a region where people do not just talk openly about such issues and feelings, it was not for everyone and only a handful of people have contacted me.
I began by taking black and white images of the streets because it was the lowest threshold for me to photograph, this allowed me to start and experiment. In the Netherlands, this is just the opposite – you get a warm feeling when you drive through villages and can look freely inside the living rooms. In Flanders, people like to lock up. The lowered rolling shutters are quite normal in Flanders. Often rolling shutters are still down during the winter days because most people work outdoors. When they are leaving in the morning it is still dark.
A lot is kept secret when it comes to suicide. The taboo is persistent in West Flanders. In Flanders, social norms dictate that you should not discuss your problems, you should focus on your work. If you work hard, problems will disappear. With this project, I especially wanted to break the taboo and most importantly, draw attention to the usually invisible survivor relatives. I experienced the same difficult loss as they have, so I could understand the relatives. Survivor relatives stories make it recognizable again for the people who lost someone – it instills a sense of oneness. It enables the survivors to see that they are not the only one who has made it through this pain and it can soften a bit of the pain. That's why group talk sessions can also be very important. When working with the survivors on this project, I learned that you have to keep trying to communicate with that person and be direct in your questioning – what's wrong and how do you feel. You don't have time to hesitate, because the negative emotional spiral where they go into can go faster than you think, and you can easily loose contact. The longer you wait the more difficult it becomes.
For professionals in psychological healthcare, I wanted to help them visualize these survivors. Despite how good they are in their profession, they can never fully understand what the relatives feel, unless they, too, have felt that loss. Through this book, the stories and the pain becomes more visible. Through my interactions with the survivors, I developed a greater understanding the complexities and the array of emotions that the survivors are struggling with. One of the survivors lost her son at the age of 17. She talked a lot about her son and about when he was young. She showed me a lot of pictures where he was near the age of my own son. It became so close and personal that I hesitated to continue for a moment. It was very difficult for me, it all became too close.
Excerpt from the chapter 'Kris and Ward'
"So sad for him, for me, so difficult to experience. Forever. The rest of life. Still going on. Even so. Trying to be grateful. The emptiness, the loss, the absence, the expectation that it ends in death. End. But not my end. But still something that ends in me. Writing is good, is necessary, being allowed to feel sad. Trying to live. I'm trying. Really, that's all I can do."
Photography is a means and not an end in itself for me. I feel particularly attracted to difficult and challenging issues that do not get as much media attention-very human themes that we can all learn from. Photography is a way to get to people to learn about the complexities of life. By interacting with people, gaining deeper insights into their struggles, I attempt to understand what went wrong and why. And even if I am unable to find those answers, my work has led me to continuously question life. After a project, I often feel richer as a person and I look at the world differently. The themes of my individual projects often depart from a larger theme, then I start digging deeper until I see something intimate and deeply human.
I start with larger and broader issues and I try to find out as much as possible about the suicide, mourning, etc. Then I start reading about it, then watch movies. I also want to see the work of other people who work on the same theme. This can be very inspiring, but can also give you the feeling that you would make it completely different. All those sources of inspiration stimulate me.
Excerpt from the chapter 'Anja, Walter, Hannah, Mira, Wout, Ward'
"Sometimes it almost gets to be too much for Walter. At those moments, he is afraid that his children will consider suicide a realistic option if life gets too hard…Walter wants to maintain her presence in the family. He feels that everything should be able to be discussed openly and he wants to be part of his children's lives in a sensitive, supportive way. They frequently talk about Anja at the dinner table. It's hard sometimes, but they're come so far together already."
I'm a late bloomer, but the fact that I wanted to do something in the creative sector was very apparent. I have no theoretical and philosophical background. I've always been a doer. I'm a graphic designer and worked in the advertising industry for 7 years. That experience has shaped and deformed me. I have completely followed my own way, step by step. I personally see it as liberation and am therefore going to broach topics that would not exist in the commercial world. This does not mean that I have discarded my luggage – you are and will remain forever a child of your time (and education) and it is reflected in every decision you've made in your life. I try to distill the good elements. Wrong choices do not truly exist in my opinion – each individual experience (no matter whether the experience is good or bad) contributes to your uniqueness as a person and as a professional.
In the beginning, I did a lot of commercial work and have slowly made the decision to create more personal work. As a late bloomer, to me, it seemed unthinkable to make personal work after my graduation. First, money and especially securing my future in the beginning, was very important and there was still a little too much pressure from home. My parents were very simple people with a simple idea of earning a living.
I try to live as simply as possible, this gives me the mental tranquility that allows me to be concerned with my personal work. Mental peace is a prerequisite for me to do a good job. As an introvert, I seek my energy from my inner world which allows me to focus on the work at hand – unencumbered by the impulses of society around me. Since the birth of my son, I work much more efficiently. Just after the birth, I was disorientated but I have since found the extra stability.
When starting a new project, you often have beginner's luck when a project starts but soon you feel that things could still be better, then the doubt slowly begins to fester. The doubt can really gnaw but ultimately that doubt will let me dig deeper into the subject. The doubt keeps me sharp and ensures that I will take new steps.
Film, music and architecture have always been very important to me. But at a certain point when I'm deep in a project, I try to isolate myself almost completely on external impulses, these are moments when I see little exhibitions, no music listening during work, so I can up to keep the focus. I almost exclusively use social media to carry out my work.
I really look at everything – the smallest details of how everything has taken shape in the editing and finishing, and of course, how the soul of the whole is brought forward. That's why I find photobooks so fascinating because it tells a lot about the photographers and designers' choices.
I must be honest that photography fascinates me when it's about something factual, I'm a documentary photographer, the abundance of aesthetic that has crept into photography in recent years is really disturbing to me sometimes. Everything should be beautiful. With (Un)expected I sometimes took less aesthetic choices because the content comes first. What's great about a strong photo book is it isn't a standard sum of parts. Aesthetic images don't necessary ensure a good photo book. The content, edit, the text and graphic design can make the work be a very intense experience, if every choice is well made.
Buy Peter's book '(un)expected' here.


text:
So imagine that you are a female ladybird. Because you are already four days old you feel it is really about time that you get a hold of yourself and cease to live your life in an aimless fashion. You feel that it is time to get pregnant. While wandering about on your green plant reflecting on where your life has gone you suddenly look up and see an attractive male about 2 cm ahead (which is about how far a ladybird can see). You feel really flattered when this handsome stud mounts you, but then, when he is just about to insert his thing you instinctively start to run around, kicking forcefully backwards to get him off. This stud won't give up that easily though so in spite of the rather uncomfortable ride he hangs on. You therefore switch to a different strategy. Almost to your own amazement you throw yourself of the green plant and falls towards the ground. You make your handsome stud lands first thus making him absorb the long fall. For a second the male lets go of you and you try to escape, but luckily for the male he retains his consciousness before you have been able to run more than 2 cm away in which case he would not have been able to find you.
The stud mounts again and this time you don't fight. Instead you think to yourself, this guy can copulate right after falling down an equivalent of ten floors, now that is a trait I want my ladybird offspring to have. So the romance begins, and since you are ladybirds, and since ladybirds are fond of copulating you go on for a long time. (Here is a video of two ladybirds getting it on to the tunes of Donald Crawford's "You Know I Know".)
If both the male and the female have not mated recently they will keep going for about 275 minutes, or 4.5 hours. However, if both have had sex recently and thus feel a bit tired or drowsy or satisfied, then they will limit they will stop after only 176 minutes or 3 hours.
Following not so much cuddling you depart, exhausted but happy… However, for a ladybird sex is not just joy. Because ladybirds are really really promiscuous animals they are also very often the victims of sexually transmitted diseases, in fact the ladybird has more STDs than any other insect. According to one estimate that I found, up to 90% of some populations of ladybirds can be affected, so you better use the condom (or become a ladybird nun).
Most of what you have read here is my recollection of a lecture that was given to me by Professor Mike Majerus at Cambridge University, UK. In 2004 I attended a science summer school at Fitzwillam college and there I had the great privilege of taking a course called "sex and aggression in insects" taught by this extraordinarily entertaining ladybird world authority (I would vote for him to take over after David Attenborough if he ever quits). Though I have not read his books he has written several, so if you are interested in ladybirds and evolution I am sure that the following books are probably really good references.
Melanism: Evolution in Action: In this book majerus decribes the evolutionary forces that has given rise to melanism, or skin color. I'll bet that many of the examples are on the somewhat rare black ladybirds which he talked alot about during his course.
Guide to Ladybirds of the British Isles: As the title suggests this is a short (8 pages) guide to ladybirds.


text:
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Thank you for visiting our website! Below you will be able to find the answer to Neighbor of Sudan crossword clue which was last seen on Universal Crossword, August 27 2017. Our site contains over 2.8 million crossword clues in which you can find whatever clue you are looking for. Since you landed on this page then you would like to know the answer to Neighbor of Sudan. Without losing anymore time here is the answer for the above mentioned crossword clue:
We found 2 possible solutions in our database matching the query Neighbor of Sudan
|Universal August 27 2017
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|Thing made at an auction
|Black band of mourning (var.)
|Pushed to the limit
|Coarse wheat variety
|It's purchased by the bagful
|Funny bit of wordplay
|It may go through the floe
|Atomic no. 55
|The two of them
|Cookie you may twist apart
|Display one's grief
|Con artist's cohort
|Western state, briefly
|Any volcano blowing its top
|Questionable at best
|Bunny tail
|Fading dial-up device
|Type of end or admiral
|A.D.'s A
|Store, as cargo
|Risky thing to build or write on
|Neighbor of Sudan
|Sea of Antarctica
|Hardly uniform
|Prescription division
|Person in charge at work
|Small, insignificant amount
|Like a hedgehog or porcupine
|Seals' partner
|Accept as one's own
|Republic in the Caribbean
|Stuff in a bag on the mound
|A human joint
|Tales of great exploits or heroism
|Colors or shades
|Quisling's place
|Redhead of classic TV
|Accepting customers
|Cones center?
|Fist bump
|Quartet x 2
|___ and Span (cleanser brand)
|Cupid's weapon
|Picture holder
|Barbecue, for one
|Rock that's an asset
|Fading document deliverers
|Short-sleeved shirt
|Pointless Olympic sword?
|Chess piece
|Put through one's paces again, in the army
|Sandwich complement
|Fading photo producers
|Back of the neck
|Away from the office
|Didn't stay
|Banned insecticide
|Bingo relative
|Smooth, as a path for
|Deer mom
|Blue feeling
|Three fading things
|Big name in canals
|Cloth near the kitchen sink
|Suffix with "bass" or 54-Down
|Great rating
|G8 member
|Fading drive occupiers
|Architectural wing
|Church doctrine
|Fifth note of a common scale
|Certain British submachine gun
|Common evergreens
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text:
SouthBendTribune Home
Indiana Toll Road
Metro Briefs
February 22, 2006
Two listed in serious condition after crash
Two South Bend men were seriously injured in a crash Tuesday afternoon when the car in which they were traveling veered off Dragoon Trail east of Russell Avenue and hit a utility pole. Local residents experienced no power outages, but a mile of roadway was closed between west of Marian High School and Russell from about 1:30 to 5 p.m., said Capt. Tim Spencer of the Mishawaka Police Department. The passenger, Timothy Lang, 32, and the driver, Gerald Varga, 33, were taken to Memorial Hospital in serious condition. Spencer said the vehicle was traveling too fast and went off the road when taking a curve. The Fatal Alcohol Crash Team, which investigates fatal and serious injury crashes, is leading the investigation.
Toll Road veto by mayor stands
Members of the Mishawaka Common Council failed Tuesday to override Mayor Jeff Rea's veto of their resolution opposing leasing of the Indiana Toll Road. They needed two-thirds of the council, or all six Democrats, to override the veto. And with John Gleissner, D-at large, gone on vacation they didn't have it. Jason Mazurkiewicz, R-2nd, who was on vacation when the first vote was taken, voted with his fellow Republicans to sustain the veto. The resolution opposing leasing of the Toll Road was adopted Feb. 6.
Police chase juvenile after home burglary
A resident of the 100 block of East Seventh Street told police he found two males inside his house early Friday and fired two gunshots before they fled. The 32-year-old resident called police at 10:38 a.m. while holding one of the suspects at gunpoint. The suspect, a juvenile, managed to escape but was chased down by police and arrested on Seventh Street. The other juvenile remains at large, according to police reports. Police said the suspects gained entry into the house by forcing the rear door open.
Ministry to ex-inmates focus of presentation
The public is invited to learn Thursday about a ministry that helps inmates to reenter society and about the Indiana Department of Correction's new faith and character-based dormitories. The event will be 6 to 8 p.m. in the auditorium of the St. Joseph County Public Library, 304 S. Main St. It is sponsored by the South Bend-based Companions on the Journey, a prisoner reentry ministry. A screening of the video "To Serve This Present Age: Reentering through Faith" is planned, plus a presentation about the new dorms. The video was made by the Reentry National Media Outreach Campaign, a Georgia group, whose Web site is www.reentrymediaoutreach.org. For more information, call Rob Sambosky at (574) 289-9130 or Jeff Williams at (574) 386-3483.
Child molester gets 40-year sentence
A man convicted of two counts of child molesting has been sentenced to 40 years in prison. John Bliley, 61, was convicted after a jury trial last month of the two Class A felonies. Superior Court Judge John M. Marnocha imposed the sentence. He was charged with engaging in sexual conduct in the summer of 2002 with a 13-year-old boy. The boy was befriended by Bliley when both acted in a summer musical play production. Bliley and his lawyer plan to file an appeal.
Indiana Toll Road
Former officer, police in 4-hour standoff
January 20, 2012
She'll take her treats over a trophy Jail death ruled...
October 3, 2006
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text:
Extramural Proposal Development Fund
Deadline to submit application for Spring and Fall 2016 is April 13, 2015.
One of the primary goals of the UH Hilo Research Council is to foster research and scholarly activities, particularly those that result in extramural grant applications. To support extramural grant writing activity by permanent faculty, the Research Council will supply funding to hire lecturers for faculty working on extramural grant proposals for Spring or Fall of 2016.
To be eligible, you must be a permanent faculty or staff member and be able to secure support from your department/school chair, College of Arts and Sciences division chair, and dean/director for your participation.
View the UH Hilo Research Council Extramural Proposal Development Award instructions. There is a three-page application form that must be completed and sent to your department chair, division chair (if applicable), and dean/director for their recommendation and approval. This form must be filled out using Adobe Acrobat or the free Adobe Reader. Do not open this form with any other application. Incorrectly formatted forms will not be accepted. It is up to the applicant to see that Department Chairs and Deans fill out this form correctly.
The applicant must also give a title for the proposed grant along with a short summary of the grant topic. This summary is only a paragraph long, but must be a well written, concise description of your grant topic. The proposal will be evaluated on the basis of this paragraph, your past grant activity, and the support of your department/college. The council strongly encourages untenured faculty that may have little or no experience to apply along with more experienced faculty. The council is very supportive of helping develop early career faculty. In addition, the council also encourages those that have previously obtained extramural funding as well as faculty who have been without support and are looking to re-establish grant funding.
The Research Council will provide funds to reimburse the department/college for hiring a lecturer to replace a three-credit-hour course for one semester. In return, the applicant is obligated to submit a grant proposal for extramural funding during the year following the end of the course release. Applicants who have submitted Seed Money Grant proposals or have been awarded a Seed Money Grant in the past are encouraged to apply for funding to assist in turning their Seed Money Grant proposal into an extramural grant application. The Research Council will also consider applications for funding to improve a previously submitted extramural grant proposal that showed promise but was not funded upon the initial application (many grant applicants are unsuccessful on their first try, but are successful upon subsequent submissions).
If you have any questions, contact Ken Hon, chair of the UH Hilo Research Council.


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Rashaan Salaam accomplished the improbable, rising from playing 8-man football at La Jolla Country Day to becoming the fourth San Diegan to win the Heisman Trophy in 1994.
It was Salaam's greatest achievement, earned barely two months beyond his 20th birthday, and one that he candidly admitted in the ensuing years he couldn't match.
Likable, outgoing and engaging, Salaam walked through much of his life with a smile, but the facade may have hid something darker.
On Monday night at a neighborhood park in Boulder, Colo., where Salaam played college football for the University of Colorado, the 42-year-old was found dead. In an interview with USA Today, Salaam's...


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Quick Links
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Hilary Blecker worked for a decade conducting workplace health and safety trainings for day labor centers, unions, and grassroots organizations--creating spaces for workers to identify hazards and strategize about how to advance their rights and dignity. She is a founding partner of The Blue Door Group, a consulting group that teaches, designs, and facilitates interactive processes for learning and capacity-building. She also co-founded the Philadelphia Trainers' Collaborative, which brings together educators, organizers, and trainers to share skills and techniques for creating more effective participatory education. Hillary received her B.A. from the Johns Hopkins University and her M.P.H. in Community Practice from the University of Washington, as well as completing a Graduate Certificate in Diversity Leadership at Temple University. She is passionate about harnessing the power of conflict and dialogue to build relationships between and among people of diverse class, race, and gender identities.
Yvonne Boudreau is a Medical Officer in the Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Western States Division. She also holds a position as Assistant Clinical Professor, University of Colorado School of Medicine, Department of Family Medicine. Her work involves national and international surveillance and evaluation of a wide variety of occupational health issues, providing recommendations and policies to address these issues, and outreach to and collaboration with state and local health departments, academic institutions, and other federal agencies to help build occupational safety and health capacity throughout the US.
Angela Dartt is a Senior Industrial Hygienist wit Golder Associates and an External Advisory Board Member for the NIOSH-funded MAP ERC. Angela has been practicing as an EHS professional for over 10 years, and currently provides consulting services to clients in manufacturing, mining, and oil and gas in North America and internationally. She is an active member of the American Industrial Hygiene Association (AIHA) and has served as an officer of the AIHA Ergonomics Committee since 2012. Angela graduated with a Doctor of Philosophy from Colorado State University in 2010 and is a Certified Industrial Hygienist through the ABIH, as well as being a proud alumni of the MAP ERC.
Arthur Frank is a Professor of Public Health and Professor of Medicine at Drexel University in Philadelphia. Dr. Frank has worked as an occupational physician with special interest in occupational lung disease, especially those caused by asbestos, and work in the area of Agricultural Safety and Health. He has served as an advisor to many government agencies in the US and has done extensive work around the world including China, India, Mongolia, and elsewhere.
Herb is the Area Director for OSHA's Denver Area Office. He has held numerous positions from Field Industrial Hygienist to Area Director at OSHA for the past 38 years. The Denver Area Office is responsible for enforcement of the OSH Act and providing compliance assistance to employers in Colorado. The Area Office is also responsible for federal enforcement in Wyoming and Utah. He is a graduate of Colorado State University and is a Certified Safety Professional and Certified Industrial Hygienist.
Dr. Leslie B. Hammer is a Professor of Psychology in the Department of Psychology at Portland State University and a Senior Scientist in the Oregon Institute of Occupational Health Sciences at Oregon Health & Science University. Dr. Hammer is the Director of the Center for Work-Family Stress, Safety, and Health, funded by grants from the National Institute for Child Health and Human Development and the National Institute for Occupational Safety and Health (NIOSH). This center is one of six centers that make up the national Work, Family, and Health Network that recently completed a cluster randomized trial of workplace policies and programs that impact worker health. Dr. Hammer is also the Director of the Occupational Health Psychology graduate training program at Portland State University that is funded through a training program grant from NIOSH. She is the Associate Director of the NIOSH-funded Oregon Healthy Workforce Center (OHWC), one of four centers of excellence in Total Worker Health. Most recently, Dr. Hammer was awarded a grant from the Department of Defense to study ways to increase supervisor support and enhance employment retention for veterans reintegrating into the workforce, testing the effectiveness of a supervisor training workplace intervention.
Ed Hendrikson is a consultant for the United Nations program on HIV/AIDS, UNAIDS. He researches HIV-related disease in displaced populations in Africa and Central America. Ed is bilingual in English and Spanish, and he is proud to work for and serve migrant farmworkers in rural Colorado, people who have contributed greatly to the success of Colorado and deserve health care for themselves and their families. He also works on additional research projects with University of Colorado Health Sciences Center and the University of Texas in Austin. He is currently serving on the board of the Colorado School of Public Health, and he was recently awarded the White House Award for "Champions of Change."
Dr. Robert E. "Robin" Herron is a Professor Emeritus with Colorado State University. He has established ergonomics programs at four major universities, including Baylor College of Medicine (Houston), University of Illinois (Champaign-Urbana), and the Colorado State University (Fort Collins). His background includes many years working on medical and engineering college faculties and providing direction for numerous government and private research grants and graduate student dissertations (Ph.D and M.S.). He served as a Principal Investigator for NASA for ten years measuring anthropometric/physiological changes in all of the astronauts from the Apollo 16 through the Skylab Missions. His administrative experiences includes deanships at the University of Illinois and Colorado State University over a seven year period. He has also been a consultant to a wide range of Fortune 500 companies: HP, GM, Exxon, Roche, Coors Ceramics, Pfizer, Ciba-Geigy, Rubbermaid, Southwest Airlines, Shell Oil, Union Pacific Railroad, Teledyne Waterpik, and Visa, among others. His international work includes research, meeting organization, and presentations in the UK, France, Germany, Switzerland, Finland, Italy.
Dennis is Director of Environmental Health and Safety (EHS) and Systems Safety Engineering (SSE) for Ball Aerospace & Technologies Corp. His responsibilities include regulatory compliance, occupational safety, permitting, emergency response, SSE, EHS management systems and program development, sustainability, and external relations. With over 23 years of experience in the field, he has worked in both industry and consulting, helping companies solve complex EHS and regulatory problems. He has previously been Director of EHS for Newalta Corporation, Northear Regional EHS Team Leader for BASF Corporation, and has extensive experience working for Environmental Resources Management (ERM) for various industry clients. Dennis has been active in numerous EHS professional organizations including the Aerospace Industries Association, Air & Waste Management Association, National Association for Environmental Professionals, National Association for EHS Management, Colorado Environmental Management Society, and the Rocky Mountain EHS Peer Group. He has been a guest speaker at numerous professional and charitable events, speaking on topics including technical EHS issues, managing organizational change, EHS culture, strategic planning, and charitable giving.
Dr. Hurrell is an Adjunct Professor of Psychology at St. Mary's University in Halifax, Nova Scotia and an affiliate of the Canadian National Center for Occupational Health and Safety. He holds Bachelor's and Doctor of Philosophy Degrees in psychology from Miami University and a Master's in clinical psychology from Xavier University. He is the past Editor (and cofounder) of the Journal of Occupational Health Psychology published by the American Psychological Association. Prior to his current appointments, he was employed for over thirty-four years, as a researcher and administrator, by the US Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health (NIOSH). Dr. Hurrell has authored over 100 scientific publications and 8 books and served on the advisory boards of several major US occupational health and safety research programs.
Jan Johnson is a Certified Health Physicist with over fifty years of experience in radiation health physics, including radiation worker training, environmental and occupational radiation protection, and radiation risk assessment. Dr. Johnson was a member of the faculty at Colorado State University, initially as a Research Associate, eventually managing the CSU Environmental Health Program. Since 1995 she has worked as a consultant in radiation protection. She was a member of the Environmental Protection Agency Science Advisory Board Radiation Advisory Committee until 2013. She is a Fellow of the Health Physics Society and received the Society's Founders Award in 2013.
Deborah is a graduate of the University of Colorado Health Science Center's School of Nursing. She has worked in Occupational Health for more than 17 years. She worked as an Occupational Nurse Manager at Rocky Flats and as the Occupational Health Coordinator at NREL. Deborah was a Nurse Case Manager with Pinnacol Assurance, and she is currently the NREL Health Management Nurse. Deb's background prior to Occupational Health was in emergency medicine and geriatrics.
As Pinnacol's director of safety services, Jim McMillen oversees a team of 27 health and safety professionals whose main goal is to help Pinnacol's policyholders create a safety of culture within their workplaces. McMillen joined Pinnacol Assurance as a loss prevention representative in 1997. Serving as director of loss prevention services from 1999 through 2004, he gained high-level experience in loss prevention, industrial hygiene, risk management, and claims management. McMillen also served as a business director, prior to assuming his current position. Before becoming a member of the Pinnacol team, McMillen worked for the Wausau Insurance Co. and Coors Brewing Company. McMillen holds a Certified Industrial Hygienist (CIH) designation, and is a member of the American Industrial Hygiene Association as well as the University of Colorado Risk Management Insurance Program Advisory Council. He is also a member of the Mountain and Plains Educational Research Center Advisory Board and a former Division of Workers' Compensation Premium Cost Containment Board member. McMillen received a bachelor's degree in chemical engineering from Georgia Tech and a master's degree in public health from Emory University.
Karen Mulloy received her medical education at the West Virginia School of Osteopathic Medicine. She completed a combined residency program in Family Medicine with a Master of Science in Community Health at Marshall University School of Medicine, as well as a residency in Occupational and Environmental Medicine at the University of Kentucky School of Medicine. Dr. Mulloy has a long-term interest in the health effects of mining. As Chief in the Division of Occupational and Environmental Health at the Marshall University School of Medicine, she was responsible for clinical evaluation and medical monitoring of coal miners. At the University of New Mexico she worked with the Miners Colfax Medical Center on their medical screening program for miners throughout the state of New Mexico, including the Navajo Reservation. She was the lead investigator of a HRSA grant to medically evaluate former uranium miners and millers. She also established a clinic at the A-C-L Indian Health Service Hospital that served former miners and millers from the Acoma and Laguna Pueblos and was funded by the Laguna Pueblo to expand medical services for the former uranium industry workers. Among her research interests are health effects in atomic weapons workers and the establishment of occupational illness, toxic exposure, and injury surveillance as part of environmental health surveillance programs throughout the western states. She has been a co-investigator at the Mountains & Plains ERC and was the Director of Continuing Education from 2007-2011 and the Director of the Occupational Medicine Residency Program from 2011-2012.
John Schumpert attended the University of California, San Diego School of Medicine, and completed an Occupational Medicine residency at the Midwest Center for Occupational Health and Safety at the University of Minnesota. Dr. Schumpert held staff physician positions at the 3M corporate headquarters and the Idaho National Laboratory, and was Occupational Health Medical Director at Benefits Healthcare in Great Falls, Montana. He founded his practice, Resources for Environmental and Occupational Health (REOH), in 2001. He serves as a Faculty Affiliate for the University of Montana Center for Environmental Health Sciences and as Medical Director of the State of Montana Department of Labor and Industry.
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Oxley and Aronson present a work based on their new PBS show, Peg + Cat.
It's a good thing that Peg and Cat are problem-solvers. Their picnic has been laid, and everyone has a piece of pie just the right size for them—but there are three picnickers and four pieces of pie. While Peg melts down about the lonely piece of pie, Cat goes to the coop and gets a chick, solving the problem. But by leaving the coop unlatched, he has created a bigger problem—100 times larger, to be exact. When collecting the adorable chicks by hand only garners 10, the duo latch onto the MacGuffin of using "wheely things" to lure the chicks back, because "[c]hickens really love going for a ride." While the story is not all that strong, the pictures are a riot, math subtly woven into both the text and layout—the clouds are infinity signs, and the page numbers are all +1 math problems. There are places where the text comes up to the level of the artwork, particularly the spreads that depict the chicks running amok, the text describing their actions so readers can search the chicken-crowded scenes to find them. Standouts include "chickens doing the chicken dance" and "chickens bending over and wiggling their bottoms in the air."
Cute, but one can't help but wish for a separation of screen and text. (Picture book. 4-8)


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The Blue Room
- Steve Cramer
- 17 January 2008
Citizens' Theatre, Glasgow, Tue 22 Jan–Sat 26 Jan
Mention David Hare's adaptation of Arthur Schnitzler's La Ronde to even the most occasional of theatregoers, and there'll be instant recollections of its notorious nude scenes, originally featuring Nicole Kidman, and Telegraph critic Charles Spencer's description of the play as 'theatrical Viagra'. It would be foolish to claim that the piece doesn't have an element of voyeurism to it, yet there are more subtle observations to be made within this fly-on-the-wall glimpse of many human sexualities than obvious jollies of insight into the bedroom habits of its characters.
Taking in an array of a dozen characters, from prostitutes to students to cab drivers and on to an errant politician and his wife, the piece looks at relationships, sexuality and power, and goes a long way to sorting emotional sheep from goats. If there's an element of power and trust in any relationship, and folk are liable to be hurt, there are differences between those who hurt people in order to empower themselves, and those who do so out of simple emotional incompetence.
Joe Gallagher, producer for this piece from Replico, feels that these differences also manifest themselves through different kinds of people employing disparate strategies in their relationships. 'The most interesting element of this play is the sexual politics and the deliberate tactics and layers you see in these characters. The idea of the status of the characters in society and their secret passions as well as the different levels of deceit employed by people is continually fascinating,' he says.


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NCIS Spoilers
CBS is bringing its shows back in the next few weeks. How did they end? How will they return? We have all the latest details direct from the network!
Posted in: Young Sheldon
NCIS Season 14 Casting Scoop: Who's Tess?
We have our first piece of NCIS Season 14 casting news. Get an idea here of what kind of new agent is set to come on board.
NCIS Boss Teases a New Gibbs, A Test for Bishop, A Decision for Tony
NCIS Season 13 is nearly upon us. So who better to turn to for a preview than showrunner Gary Glasberg himself?
NCIS Season Premiere Pics: Can They Save Gibbs?
The NCIS Season 13 Episode 1 premiere may be over a month away, but we have the first photos of Gibbs and the team from "Stop the Bleeding." Take a look now!
CBS Premiere Spoilers: Guest Stars! Serial Killers! Russian Satellites!
CBS has unveiled the official descriptions for 15 fall season premiere episodes. Ready for a look at what's ahead?
Posted in: Scorpion
NCIS Season Finale Photos: Finding Neverland
What will go down on the NCIS season finale? How will the gang recover from last week's death? Check out official CBS photos here!
NCIS Photo Gallery: Ready for a Baby Shower?
A baby shower at NCIS? Check out these photos from NCIS Season 12 Episode 13 and get an idea of what's to come on TV's highest-rated series.
NCIS Photo Gallery: Reviewing Gibbs Rules
McGee takes another look at Gibbs' Rule on NCIS Season 12 Episode 10. Check out photos from the next all-new episode of the drama now.
NCIS Showrunner Teases Powerful Story Ahead, Abby's New Romance & More
NCIS showrunenr Gary Glasberg prepares fans for a powerful episode in this exclusive interview with TV Fanatic. Get an idea now of what's on tap.
NCIS Photo Gallery: Hit and Run
Check out these photos from NCIS Season 12 Episode 8, "Semper Fortis." which is scheduled to air on Tuesday, November 18th on CBS.
NCIS Photo Preview: Really Stretching It
What can fans expect from NCIS Season 12 Episode 6? These photos should help shed some light on events to come.
NCIS Boss Previews Danger Ahead on Season 12
NCIS Season 12 is almost upon us. Gather up some scoop and some spoilers in this exclusive interview.
NCIS spoilers may not seem like something in high demand given the procedural nature of the show, but when it comes to guest stars are on the way in and what they might mean to the team, and potential character departures and new storylines, this intel can be as hotly-sought after and much-debated as anything.


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Music Videos The Best Christina Aguilera Music Videos
661 votes 167 voters 18k views 11 items
Christina Aguilera official music videos as found on MTV, VH1 and YouTube. All Christina Aguilera music videos are listed from most popular to least. The Christina Aguilera songs featured in these music videos span albums from the artist's entire career, and include Christina Aguilera's most popular and most viewed videos, along with sexy or controversial music videos.
Some of these videos are some of the greatest in the pop star's history. Songs like "What A Girl Wants," "Hurt" and "Dirty" are some of Christina Aguilera's best music videos.This is an effort to collect the best music videos by Christina Aguilera for fans and newcomers alike.
Christina Aguilera - Hurt
71 25Is this the best?
Christina Aguilera - Dirty
57 16Is this the best?


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Website in CSS
Budjetti $100-300 USD
Hi Bidders
We are looking for a CSS expert to turn a graphic design concept into a fast loading w3c complaint website reality.
The website is to consist of 2 pages.
Please only bid if you are experienced in creating fluid CSS websites, which use an indestructible navigation and box approach. We will only respond to bidders who quote in their private message the numbers ten and four, so that we know that this is not just a standard response.
Bidders MUST BE good communicators, and be able to provide feedback on a daily basis. Bidders MUST be able to keep to deadlines. Excellent service is VERY important.
Please also provide samples of your work in your private message.
Thank you for your bids.


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2013 Aston Martin V8 Vantage - 2012 Geneva Auto Show
Although Aston Martin's limited-production V12 Zagato has garnered the lion's share of publicity lately, Geneva heralds the arrival of major changes to the core models in the automaker's lineup. Reflecting changes originally introduced on the slightly sportier Vantage S, the 2013 Aston Martin V8 Vantage Coupe and Roadster gain more aggressive styling cues along with improvements to the steering and brake systems plus the availability of an even more capable automatic transmission.
Cosmetic revamps include Vantage S-inspired reworks of both fascias that bring a lower bumper, deeper aerodynamic splitter and larger air intakes up front with a more aggressive rear diffuser. Tying the bolder nose and tail treatments are more deeply sculpted side sills.
To enhance vehicle dynamics, both V8 Vantage models feature a quicker-ratio (15:1 vs 17:1) power steering system culled from the Vantage S and wider tires, changes Aston Martin claims will both quicken responsiveness and raise levels of cornering grip. The redesign also nets larger front brake discs with six-piston calipers to enhance stopping power and pedal feel and adds a new Hill Start Assist feature.
While the 420-horsepower/4.7-liter V8 and standard six-speed manual transmission carry over unchanged, the 2013 remake brooms the existing optional six-speed Sportshift automatic in favor of the seven-speed Sportshift II that previously was only available on the Vantage S. The extra cog, plus a narrower ratio spread, revised final-drive and improved shift quality are expected to give both the Vantage V8 Coupe and Roadster a slight bump in acceleration and a sportier driving experience.
No word yet on exactly when we can expect the 2013 Aston Martin V8 Vantage Coupe and Roadster to arrive here in the U.S. Pricing for the cars also has not yet been released.


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The Front Office single on Mijji seems to be a combination of two different recording groups. The A-side "Girl" is polished, Motown-type soul, written by Steve Cook and arranged by Val Garay (who would go on to engineer and produce many high-profile acts in the 1970s and '80s) and Mark Holly.
The instrumental flip side is something else altogether. "Wow" is first-rate psychedelia done by a band who knows what they're doing and don't hold back. The song writing credit goes to Gilbert Day, who is also credited as producer with G. Zacharisen (possibly George Zacharisen). Satori Music, BMI published both songs, released on Mijji M3007 in 1968.
Beyond those names, the identity of the musicians on "Wow" is a mystery. This was the last release on Mijji, which had a handful of other singles. Sound 70 had two singles on Mijji:
Mijji M-3002 – Sound 70 – "There Is No Reason" / "Seven Day Fool"
Mijji M-3004 – Sound 70 – "One Too Many Mournings" / "Chicago Blues"
Day-Gardner-Brown produced both singles, and other than song writing and publishing credits for the cover songs, "Seven Day Fool" and "One Too Many Mournings" (sic), there are no other names on the labels. Sound 70 played live around San Mateo, Belmont and San Carlos, California, adjacent towns on the peninsula between San Francisco and San Jose. Sound 70 seems to have come out of the Bundles, whose songs "Mark My Words" and "Watch Me Girl" went unreleased at the time but now appear on the Big Beat CD Dance With Me: The Autumn Teen Sound.
Judging by "There Is No Reason" and the heavy drums on "One Too Many Mournings", Sound 70 had the ability to cut a track like "Wow", but that's only speculation.
The only other single on Mijji that I can find is by the Venus Flytrap:
Mijji M-3005 – Venus Flytrap – "The Note" / "Have You Ever" (both by Donald Danielli – Daniel Sanchez, prod. by Gilbert Day, published by Guard Music, BMI)
The original release came on Jaguar Records J-103, owned by Barry Wineroth. It was a hit in the Santa Barbara area, but the Redwood City band also had a following in the South Bay, which may be why Mijji repressed it. Both songs copyrighted in April and July, 1968, orig. publisher Wren Music BMI, then Guard Music BMI, part of Golden State Recorders.
At the time of the single, the Venus Flytrap were Nancy Morgan, lead singer; Peter Sessions on lead guitar; Dan Sanchez rhythm guitar; Ken Czapkay on bass; and Debbie Binetti. Bard Dupont of the Outfit replaced Ken Czapkay when he was drafted, and Michele Sevryn replaced Nancy Morgan shortly before the band split.
If anyone has more info or photos of the band, please contact me.
Sources include: "The Continuing Adventures of Bard Dupont, Introducing the Outfit" by Alec Palao, originally published in Cream Puff War No. 2, February 1993, page 87-96.