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But beyond that, experts aren't convinced that the keto diet has any other scientifically-proven health benefits. In fact, it may have some distinct downsides. If you follow the keto diet incorrectly, for example (like by eating lots of saturated fats, versus healthy unsaturated fats), you're at risk of raising your cholesterol levels. “The best strategy to keep your heart healthy is to get as much fat as possible from unsaturated sources such as olive, avocado and canola oils, nuts, seeds, avocados, and olives," says Ansel.
Lots of apps and websites offer keto diet challenges—basically, a blueprint for the keto diet with a fixed starting and ending point (they typically last for a week to a month, though some may be longer). Speaking of apps, plenty of keto-centric ones are right at your fingertips (a.k.a., your smartphone), like the KetoDiet app, which can help you calculate your macros and track your keto diet effectively.
I would like to know what led you to the conclusion to recommend eating in the morning and fasting in the evening instead of the other way around. You do not link any studies here that show TRF in the morning is better than TRF in the evening. You do state “Nighttime eating is well associated with a higher risk of obesity, as well as diabetes.” but I would hazard a guess that alot people that snack into the evening have many other factors at play that could effect their risk of obesity and diabetes and are possibly not fasting at all. I have been doing TRF from 12-8pm every day for almost a year and have seen vast improvements in my health, not least of which is a loss of 70 lbs, so it seems odd to read items 3 and 4 on your 4 ways to use this information for better health. If you have evidence that supports the idea that TRF in the evening is bad then I would like to see it and perhaps change my dieting habbits.
IF makes intuitive sense. The food we eat is broken down by enzymes in our gut and eventually ends up as molecules in our bloodstream. Carbohydrates, particularly sugars and refined grains (think white flours and rice), are quickly broken down into sugar, which our cells use for energy. If our cells don’t use it all, we store it in our fat cells as, well, fat. But sugar can only enter our cells with insulin, a hormone made in the pancreas. Insulin brings sugar into the fat cells and keeps it there.
Those issues can be part of what's known as the “keto flu,” Warren says. Other side effects of the keto diet, all of which are tied to carb withdrawal, can include lightheadedness, nausea, mental fog, cramps, and headaches, in addition to tiredness. Luckily, the keto flu doesn't usually last more than a week—which is coincidentally about when people start to see the number on the scale go down, says Warren.
Disclaimer: In this weight-loss guide, we recommend a low-carb diet, as it appears to be more effective than other diets. While a low-carb diet has many proven benefits, it’s still controversial. The main potential danger regards medications, especially for diabetes, where doses may need to be adapted. Discuss any changes in medication and relevant lifestyle changes with your doctor. Full disclaimer


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As baby boomers approach their retirement years, and a significant number of workers enter middle-age, an increasing amount of age discrimination cases have been cropping up in California and nationwide. In a recent case against the San Francisco police department, the Ninth Circuit has ruled that a class of over-40 police officers are able to proceed with their age discrimination case after they were denied promotions. The case was reinstated under California’s Fair Employment and Housing Act and could bring justice to the officers who were wrongfully and illegally denied promotions.
According to Bloomberg, the lower court wrongfully rejected the proposed class for failure to raise a common question of law or fact. The Ninth Circuit determined that the officers in fact met requisite standards for class certification. Our Orange County age discrimination and employment law attorneys are committed to protecting the rights of workers throughout California. In addition to fighting for the rights of individual workers, we are dedicated to raising awareness to prevent future discrimination.
Plaintiffs for the attorneys stated that they believe the decision was the right one for the class and could have wider implications beyond the Ninth Circuit. The decision has the effect of reducing the burden of proving the merits of a case at the class certification stage. Critics of the decision allege that making class certification easier will mean that litigation will last longer, pose more risks, and be more costly to defendant employers.
According to the court opinion, the U.S. District court went beyond its scope when it faulted the proposed class’s statistical showing of disparate impact during the 2005 hiring policy for promotion. The trial court had challenged this evidence and ruled that it didn’t include any other analysis that could account for alternative explanations for the disparity in hiring. When applying a Supreme Court precedent, the court held that the officers only had to identify one common question of law or fact, not that they would prevail on the question.
In this case, the police officers were over the age of 40 and had taken an exam in 1998 that would place them on a list for eligible promotion to assistant inspector. These officers were not promoted when the department announced a new policy that was intended to be more flexible, but ultimately dismissed exam results and promotions were not given to individuals from the prior list. The officers sued alleging a disparate impact on older employees under the FEHA and the Age Discrimination in Employment Act.
Class certification in employment lawsuits allow plaintiffs to bring one case when they share a common question of law or fact. Under the Federal Rules of Civil Procedure, the Supreme Court that the officers did meet their own burden by pointing to the San Francisco Police Department’s hiring process. According to the plaintiffs, the police department eliminated the results of a 1998 exam that the officers passed which they expected to help them achieve promotions to assistant inspector. The Supreme Court found that based on this single discriminatory action that had a statistical backing, the police officers met their burden of showing a common question of law or fact.
Employment lawsuits can be filed with assistance from the Nassiri Law Group, practicing in Los Angeles, Riverside, and Orange County. Call 949.375.4734.
More Blog Entries:
California Employment Law: New new Donor Protection Act, December 7, 2013 Orange County Employment Lawyer Blog
California Worker Wins Wrongful Termination Lawsuit, January 1, 2014, Los Angeles Employment Lawyer Blog

domain: news


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The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
Wiley Online Library requires cookies for authentication and use of other site features; therefore, cookies must be enabled to browse the site.
Several readily available rating scales are brief, useful, and easy to incorporate into clinical practice.
The Office of the National Coordinator for Health Information Technology.
Support for objective assessment of disease derives from the collaborative care model.

domain: health


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Building good will/transforming ill will
Ill will, negativity, aggression, even hate...these things seem like unavoidable consequences of modern life. These emotions self-perpetuate; "hate breeds hate." Transforming negative will into positive will not only makes you happier; it empowers you to promote positive change in the world around you. Building good will doesn't make you a pushover or a sissy. Instead, it gives you the strength to change your life and others' lives.
Through a collection of techniques and gentle reminders, you can change ill will into good will.
- Avoid situations that promote anger and negativity. This could be as easy as making sure you get enough sleep and aren’t running on an empty stomach or as complex as cutting a toxic, negative person out of your life (at least for a time).
- Don’t argue. Take slow, deep breaths and walk away from a heated situation. Yelling and screaming rarely resolve conflict.
- Keep an eye on your “trigger.” Figure out what provokes you to get your claws out and examine it mindfully. You will usually find that the trigger is as much you as anything. Don’t allow yourself to justify overreaction.
- Practice understanding. Contemporary society has disconnected us, so that we all feel like the most important person in the room, leading everyone to step on one another’s feet and to feel extremely insulted by said stepping. Despite this, most people are generally good intentioned and do not seek to insult or harm us. Remember this, and find the good in the situation.
- Cultivate the good in you. Feed your compassion and lovingkindness and nourish your calm. These resources will only grow as you do so.
- Be generous. Instead of feeling affronted when others seem to take from you, give freely. This may mean walking away from situations where somebody seems to have taken minor advantage of you. Remember, small things aren’t worth big anger.
- Self-examine. Investigate minor bouts of ill will in your life, their causes and ramifications. Under this microscope, they often look smaller than they had appeared in the heat of the moment.
- Remember that your own anger and negativity hurts you more than anyone else. It is an affliction to be overcome.
- Allow your anger and negativity to pass through you. Fighting it will amplify it. Examine it and let it go.
- Life is (sometimes) suffering. Accept that pain and misfortune are part of living on this planet.
- Be realistic. It’s true: “You can’t always get what you want.” Don’t get frustrated chasing false hopes.
- The world is not perfect nor can it be perfected. Let go of your personal perception of the ideal world and replace it with the reminder that we are good-enough human beings in a good-enough world.
- Give your ego a break. When “I” am wounded, “I” get upset. Remember that there’s a whole world greater than you. You are important, but you are not more important than anyone else.
- Meditate, pray, and use whatever techniques cultivate good will in your life.
- Meet ill will with good will. Hate cannot dispel hate. Recall all the beautiful souls who prove this lesson–Martin Luther King, Jr., Gandhi, the Dalai Lama. We have much to learn from them.
- Cultivate positive emotion. Allow yourself to be happy, content, and calm. A positive state of mind promotes good will outside the mind.
- Communicate. Speak up for yourself and for others, while remembering that even your biggest opponent has his or her own truth. Consider the thoughts of others, and talk about problems instead of arguing about them.
- Have faith in karma. It’s not your job to punish others. Those who deserve punishment tend to find it.
- Don’t try to change people with anger. Cultivating ill will toward someone will almost never be the path to their eventual renewal. Especially don’t cultivate anger toward those to whom you can’t express it. It’s an exercise in futility that only leaves you feeling helpless.
- Practice forgiveness. Forgiving others, even for grievous wrongs, is the most important step in your path to healing.
Most of the world's religions offer teachings on changing ill will into good will. Whether it's the Christian "treat others as you would like to be treated" (wouldn't we all like to be forgiven for our transgressions and talked to with respect, understanding, and compassion?) or the Buddhist urging away from extreme emotions, the idea that anger is best when it can be turned into lovingkindness is a universal.
In order to reduce the amount of ill will we unknowingly send into the world, we must begin by Realizing Intention. Examining our intentions for hateful undertones can help free us from the vicious cycle of ill will.

domain: psychology


The mayors of Hiroshima and Nagasaki commended the Japanese government’s support for two U.N. statements against the use of nuclear weapons. Being the two cities that suffered the devastating effect of atomic bombing during World War II, both are hoping that the use of nuclear weapons in the world will soon come to an end.
Japan, for the first time, endorsed two anti-nuclear weapon statements by the United Nations. The first was made by New Zealand, stating, “It is in the interest of the very survival of humanity that nuclear weapons are never used again, under any circumstances.” The other statement was made by Australia, which basically has the same principle as the one made by New Zealand.
According to Hiroshima Mayor Kazumi Matsui, the government’s move is an indication of having the same intent like Hiroshima’s for a world without the threat of nuclear weapons. As for Nagasaki Mayor Tomihisa Taue, having Japan agreeing to the U.N. statements is a step for a nuclear-free world. Both mayors also challenged the government of Japan to step up and initiate leadership in guiding other countries to also commend the U.N. statements against nuclear weapons.
Despite having experienced the loss brought by atomic bombings within three days time back in the Second World War, Japan has not previously endorsed U.N. statements that discourage the development and use of nuclear weapons. Otherwise, Japan would be contradicting its policy of reliance on its ally, the United States. However, the pacifist government was able to agree with Australia and New Zealand’s statements, as both are technically not legally binding.
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Water Boy - Paul Robeson - Spirituals (Vinyl, LP, Album), Disco - Crossfade (5) - Crossfade (CD, Album, Album), Sono Come Tu Mi Vuoi - Mina (3) - Speciale Mina (Cassette), Bröllopssång - Eldkvarn - Kärlekens Väg - En Mässa (CD, Album), Cha Ching, Courante - Fritz Reiner / The Pittsburgh Symphony Orchestra / Strauss* - Le Bourgeois Gentilhomme (V, Lost In The Silver Box - Hardfloor - TB Resuscitation (Cassette), South Side Of The Sky - Yes - Fragile (CD, Album), Steel Reserve - Initial Point - Gates of Ivory (File, MP3, Album), Whats Going On - Squiggy - Live WFMU (CD, Album), Forever Dead - Torture Killer - Swarm! (CD, Album), Black Fire - Sabbat - Sabbatical Siamesevilucifer#2 (Vinyl), Dear - Fun People - Anesthesia (CD, Album), The Analyst - Arpanet - Wireless Internet (CD, Album), Benjamin Boyce - Where Is Your Love (CD)
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NezuruDefleshed - Abrah Kadavrah: Ma Belle Scalpelle music CD album at CD Universe, Additional Tracks, enjoy top rated service and worldwide shipping.
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ArashimuroDefleshed discography and songs: Music profile for Defleshed, formed Genres: Thrash Metal, Death Metal. Albums include Under the Blade, Fast Forward, and Royal Straight Flesh.
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MulkisAbrah Kadavrah is a death metal music album recording by DEFLESHED released in on CD, LP/Vinyl and/or cassette. This page includes DEFLESHED Abrah Kadavrah's: cover picture, songs / tracks list, members/musicians and line-up, different releases details, buy online: ebay and amazon, ratings and detailled reviews by some experts, collaborators and members.
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GorAbrah Kadavrah () Defleshed discography (all) Abrah Kadavrah () Obsculum Obscenum () > Body Art Defleshed. Type: Demo Release date: Catalog ID: N/A Label: Independent Format: Cassette Reviews: None yet Songs; Lineup; Reviews; Additional notes; Single-sided: 1. Necromantic Barbeque.
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FaegalGet all the lyrics to songs on Abrah Kadavrah and join the Genius community of music scholars to learn the meaning behind the latitelsimpratattrerpwhistmarpvolraga.coinfog: Body Art.
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ZulumuroI killed a police-wife with a rusty knife / Then cut through sinews and bloodways / Must I continue? / It's a shame this art is forgotten / I'm collecting all that is rotten / IMissing: Abrah Kadavrah.
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FejarAbrah Kadavrah I wanna reach out and stab ya 6. Gone With The Fæces [music & lyrics c by DEFLESHED ] As your ugly face penetrates my heart I drop my moral thoughts, turn killing to an art I don't care about sex, or to spread the oat I just need the sound when I cut your throat And to feel your life running down my face.
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TaujindAdd new page. Stroll Around. Popular Pages Random Page.
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domain: artistic


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Guidelines for Patients: The benefits of good nutrition when you are infected with HIV
When our bodies do not get enough food, or the right foods, we become weak and cannot develop or function properly. Healthy and balanced nutrition means eating the right type of food in the right quantities. People with HIV have higher than normal energy needs (see Box 1). So a healthy diet is especially important if you are infected with HIV. Food cannot cure HIV infection, or treat the virus, but it can certainly improve fitness and quality of life. Eating enough and a balance of different foods helps to:
Maintain your body weight and muscles,
Maintain and improve the performance of your immune system.
Box 1. Nutrient requirements for people living with HIV1, 2
Why is it difficult for people with HIV to eat enough food?
There are several reasons:
People living with HIV or AIDS have a weakened immune system and so are more likely to catch infections. Infections reduce appetite but, when you are ill, you need more nutrients to fight the infection,
Some medicines change the taste of food and reduce appetite,
Symptoms such as mouth sores, nausea and vomiting make it difficult to eat.
Symptoms such as diarrhoea reduce the absorption of food,
Depression, worry and tiredness reduce appetite and willingness to prepare food and eat regularly,
HIV infection may lead to increased poverty and decreased access to food.
If you eat less than you need, you are likely to:
Feel cold, especially your hands and feet,
Get dry skin and hair, body rashes and itching,
Feel tired and weak,
Lose your appetite.
Why is it important for people with HIV to prevent malnutrition?
If you eat less than you need or do not eat the right foods you risk malnutrition which:
- Reduces physical strength,
- Affects absorption of food,
- Delays wound healing,
- Weakens the immune system. Repeated infections may lead to malnutrition.
People with HIV who are malnourished are sick more often and can develop AIDS and die earlier than people with HIV who are well nourished. It is very difficult to reverse malnutrition so people with HIV/AIDS need to prevent malnutrition.
Eat plenty of fruits and vegetables (Marlou Bijlsma)
How can you prevent malnutrition?
To prevent malnutrition you should:
- Understand the importance of eating well,
- Eat a healthy and balanced diet,
- Practice good hygiene to prevent food born infections,
- Maintain a healthy weight. Get weighed regularly and increase food intake if you are losing weight,
- Treat opportunistic infections early,
- Adjust your food intake to deal with HIV related complications – see below.
- Use herbs and spices to improve digestion and stimulate appetite.
Dietary guidelines to prevent or treat the complications of HIV infection3, 4.
This section suggests how to adjust your diet so you can cope better with the complications of HIV and opportunistic infectionsb. Infections increase nutrient needs but often reduce appetite. When you have an infection it is a challenge to eat enough to prevent malnutrition.
How to eat enough when appetite is poor
- Eat foods that you normally enjoy.
- Ask somebody else to prepare food. The smell of cooking may make you feel hungry.
- Take light exercise, such as walking or doing household chores, before a meal.
- Eat with family or friends. If you stay in bed, ask them to join you.
- Eat smaller meals, but more often. Eat whenever appetite is good.
- Eat healthy snacks between meals, like nuts, fruits.
- Sit up straight when eating, this removes pressure on the stomach.
- Drink a lot of fluids, but not during or just before meals, as this will fill your stomach.
- Use spices that you like to improve taste and smell.
- Avoid fizzy drinks, beer, cabbage and beans. These make gas and can make you feel bloated.
- Avoid junk foods. These may satisfy your appetite, but do not provide the nutrients you need.
Changes in taste
Some medicines cause a change in the taste of food, making it less appetising.
How to deal with taste changes
- Sour fruits like orange and pineapple usually taste nice.
- Use spices to improve the taste of food. Find ones that taste nice.
- If possible take medicines after meals.
Infections can cause a sore mouth and loss of appetite. It is important to maintain food intake even when eating is difficult. Mouth sores will not heal if a person is malnourished.
How to deal with mouth sores
- Eat soft, mashed foods such as porridge, home made soup, soft fruits such as avocado, banana, papaya or boiled vegetables such as carrot, pumpkin and squash.
- Add nutrient rich liquids like milk to food to increase nutrient content and soften the food. Add groundnut or sim sim paste to boiled vegetables.
- Eat food and drink fluids at room temperature.
- Rinse your mouth with garlic tea or cinnamon tea
- Chew on small pieces of unripe mango or papaya to relieve pain.
If it is painful to brush your teeth, rinse with bicarbonate of soda and water.
- Very spicy and salty foods.
- Acidic and sour foods such as lemons, vinegar or pineapple.
- Very cold drinks or very hot foods and drinks.
- Foods that require a lot of chewing or foods that are sticky like bread with groundnut paste.
If you have oral thrush avoid sugar or sweetened foods. Drinking thyme or garlic tea may help. Increase the energy content of your diet with fat-rich foods.
When the body does not get, or cannot absorb, enough nutrients it uses stored reserves and weight is lost.
Many people with HIV lose weight unintentionally especially during infections. So it is important to treat infections early and to eat more afterwards to regain weight.
When regaining weight you must do exercises to build your muscles. If you eat more without exercising you may grow fat but will not increase your muscles.
How to gain weight
- Eat more at each meal including more staple foods such as sorghum, maize, bread and millet.
- Eat more legumes especially fat-rich ones like groundnuts and oilseeds like sim sim.
- Eat meat, fish and eggs if you can afford them
- Eat more often - eat healthy snacks between meals such as fruits, seeds, nuts, and avocados.
- Add honey or sugar to tea and porridge.
Certain foods can cause digestive problems such as bloating or constipation that may be prevented by changing your diet. Some medicines, especially antibiotics, cause digestive problems because they decrease the ‘good’ gut bacteria that assist digestion.
How to avoid or reduce digestive problems
- Chew your food well before swallowing
- Add papaya to meat dishes.
- Take a short walk after meals.
- Eat fermented foods such as soured porridges or milks, and fermented maize/sorghum drinks especially when on antibiotic treatment.
- If foods like onions, beans and cabbage make you feel bloated, avoid them for a week. Re-introduce them, a little at the time, when you can tolerate them.
- Eat more wholemeal cereals and fruits if you have constipation.
You have diarrhoea if you pass watery stools three or more times a day. Consult a health worker if the diarrhoea continues for more than three days, you develop fever or blood appears in the stool.
How to deal with diarrhoea
- Drink plenty of water or other fluids - at least 8 cups per day, to replace lost fluids. For example, drink soups, diluted fresh fruit juice or oral rehydration solution (ORS),
- Eat soft, mashed, moist foods, such as porridge, stews, boiled vegetables (e.g. squash, pumpkin), and fruits (e.g. banana, mango, papaya).
- Eat refined foods, such as white rice, refined maize meal, or white bread
- If fat causes problems, reduce fat intake by using less cooking oil and cutting visible fat from meat. Boil instead of frying food. As soon as the diarrhoea improves, slowly add more fat to your meals to increase your energy intake.
Do not eat foods that make diarrhoea worse; these may be spicy foods and unripe or acidic vegetables and fruits.
Nausea and vomiting
Infection, certain foods, stress, lack of water and some medicines can cause nausea. If vomiting occurs the body looses water rapidly and can dehydrate quickly.
How to deal with nausea
- Sit straight up when eating; try not to lie down until an hour after eating. A short walk after eating can help.
- Drink plenty of fluids, after meals.
- Ask someone else to prepare your food. The smell of cooking food may stimulate nausea.
- The smell of oranges or lemons may relieve nausea. Squeeze the peel or drink lemon juice in hot water or herbal tea.
- Eat dry and salty foods such as toast and crackers.
- Avoid fatty and sweet foods.
How to deal with vomiting
- To prevent dehydration take small frequent drinks.
- After vomiting, slowly drink half a glass of water, diluted soup or diluted fruit juice every 15 minutes, or take Oral Rehydration Solution. Re-start solid foods when you stop vomiting.
Rashes and itchy skin may be related to a poor diet and malnutrition. A compress made with papaya or tomato may bring relief.
Many people with HIV are also infected with tuberculosis (TB). People with TB often lose weight. They need a healthy diet to improve their health, regain weight and replenish nutrient stores. TB patients who eat well have fewer side effects from the TB drugs and recover faster. Adjusting the diet can relieve some of the side effects of TB and TB drugs.
How to deal with the side effects of TB and TB medicines
- To avoid vomiting eat a proper meal and wait half an hour before you take the TB drugs.
- If you have diarrhoea or need to gain weight, follow the recommendations in the above sections.
- Antibiotics in the TB treatment destroy both the harmful TB bacteria and the ‘good’ bacteria that help digestion and so can cause diarrhoea. To restore the ‘good’ bacteria eat fermented foods, like sour porridge, sour milk and opaque beer. Take 1 cup with every meal.
- One of the TB drugs (Isoniazid) can cause numbness or a
burning feeling of the skin, especially under the feet. The combination of
Isoniazid and alcohol makes it worse. To avoid this:
- Eat food rich in vitamin B6 such as whole wheat bread, beans, lentils, peas, potatoes, bananas, avocados and when available, meat, fish and liver.
- If possible take a daily 10mg vitamin B6 tablet.
- If you have an irritable cough and it is difficult to sleep, cut up an onion and keep it beside your bed. Onions stimulate secretions that keep the airways moist, and so soothe them.
- WHO. Nutrient requirements of people living with HIV/AIDS. Report of a technical consultation May 2003. www.who.int
- Kenya Government, Ministry of Health. Kenyan National Guidelines on Nutrition and HIV and AIDS. Kenya Ministry of Health, UNICEF, FANTA and KEMRI. 2006. www.fantaproject.org
- FAO/WHO. Living well with HIV/AIDS, a manual on nutritional care and support for people living with HIV/AIDS. FAO/WHO, Rome, 2002.
- WHO. Nutritional counselling, care and support for HIV infected women: guidelines on HIV related care, treatment and support for HIV infected women and their children in resource constrained settings. WHO, Geneva, 2004.
a For more information contact MarlouBijlsma at yahoo.co.uk
b Adjust these guidelines to your patient’s resources and food habits.

domain: food


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- This event has passed.
Middlebury New Filmmakers Festival – British Invasion
August 24, 2023 @ 7:15 pm$17
The British Invasion comes to the tent at Swift House Inn!
MNFF9 brings three outstanding British narrative films to the tent at Swift House Inn:
Scrapper, Thursday, August 24, 7:15pm
– Georgie is a dreamy 12-year-old girl who lives alone in her London flat, filling it with magic after the death of her mother. Out of nowhere, her estranged father Jason arrives and forces her to confront reality.
A Kind Of Kidnapping, Friday, August 25, 7:15pm
– MNFF9 AWARD WINNER: Best Narrative Feature
– A young, broke couple kidnap a sleazy politician who decides he can spin the story to his own advantage.
After Love, Saturday, August 26, 7:15pm
– Mary Hussain, who converted to Islam when she married and is now in her early 60s, lives quietly in Dover with her husband Ahmed. Following his unexpected death, she discovers that Ahmed had a secret life just twenty-one miles away, across the Channel in Calais.
A generational comedy, an uproarious romp and a beautiful exploration of self-identity – each part of a wonderful trio of films from terrific British filmmakers. Enjoy The British Invasion!
Advanced tickets can be purchased here.


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Diffusion Magnetic Resonance Histograms as a Surrogate Marker and Predictor of Disease Progression in CADASIL
A Two-Year Follow-Up Study
Background and Purpose— Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a cerebral small vessel disease caused by mutations in the NOTCH3 gene. MRI is sensitive in detecting preclinical involvement and changes over time. However, little is known about correlations between MRI metrics and clinical measures on a longitudinal scale. In this study, we assessed the role of quantitative MRI (T2-lesion volume and diffusion tensor imaging [DTI]–derived metrics) in monitoring and predicting disease progression.
Methods— Sixty-two CADASIL subjects were followed prospectively over a period of 26.3±1.2 months. Dual-echo scans, DTI scans, and clinical scales were obtained at baseline and at follow-up. T2-lesion volumes were determined quantitatively, and histograms of mean diffusivity (MD) were produced.
Results— At follow-up, T2-lesion volumes and MD histogram metrics had changed significantly (all P<0.01). Lesion volumes and average MD correlated with clinical scores at baseline. Changes of average MD correlated with changes of the Rankin score, the National Institutes of Health Stroke Scale score, and the structured interview for the diagnosis of Alzheimer dementia and multiinfarct dementia score (all P<0.01). On multivariate analysis, average MD and systolic blood pressure at baseline were predictors of changes of average MD during follow-up. Moreover, average MD was the main predictor of clinical progression. Sample size estimates showed that the number of individuals required to detect a treatment effect in an interventional trial may be reduced when using MD histograms as an end point.
Conclusions— This study establishes correlations between changes of DTI histogram metrics and clinical measures over time. DTI histograms may be used as an adjunct outcome measure in future therapeutic trials. Moreover, DTI histogram metrics predict disease progression in CADASIL.
Cerebral small vessel disease (SVD) is a major cause of disability and dementia in elderly people.1 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a monogenic variant of SVD caused by NOTCH3 mutations. Recurrent strokes and progressive cognitive decline are the main clinical manifestations.2–4 In view of the poor prognosis4 and the lack of an efficient treatment, there is demand for explorative trials. Yet, sample size calculations have shown that the number of patients needed to demonstrate a significant treatment effect is large when using clinical end points.5
Conventional MRI is sensitive in detecting preclinical involvement and has been recognized as an important diagnostic tool in CADASIL.6,7 Moreover, the volume of T2-visible lesions was found to correlate with clinical scales in cross-sectional studies.8 However, without longitudinal data, the role of the T2-lesion volume in monitoring or predicting disease progression remains unknown.
Diffusion tensor imaging (DTI) detects ultrastructural tissue damage even in areas that appear normal on a conventional MRI.9,10 Quantitative measures of a large proportion of the brain can be obtained by means of histograms of the mean diffusivity (MD). In a recent pilot study in 14 CADASIL subjects, average values of MD histograms were more sensitive than clinical scales in detecting changes over time.11 Moreover, increases in average MD were most pronounced in the small number of patients who showed increases in disability during follow-up. However, the study was not sufficiently powered to formally address correlations between DTI and clinical measures on a longitudinal scale.
Correlations with clinical measures over time are one of the preconditions for establishing surrogacy of a biological marker in therapeutic trials.12 Establishing MRI as a surrogate marker for clinical progression would be of great interest, because MRI end points might reduce the number of patients needed to demonstrate a treatment effect. Surrogate markers might additionally be suited to identify risk factors for disease progression and, thus, possible targets for therapy.
The aim of this study was as follows: (1) to assess the role of quantitative MRI in monitoring disease progression; (2) to investigate correlations with clinical measures both cross-sectionally and on a longitudinal scale; (3) to provide sample size calculations for MRI end points; and (4) to identify prognostic markers and possible risk factors for disease progression. To address these issues, we prospectively followed a large cohort of CADASIL patients by quantitative MRI and standardized clinical scales.
Study participants were recruited as part of a larger study.5 In the present study, we included all of the individuals (29 men, 35 women, age 44.9±9.9 years) with proven CADASIL in whom DTI had been performed. None of the participants had had a stroke within the 3 months preceding inclusion into the study. We also studied 7 healthy controls (age 42.4+9.1 years).
All of the subjects were examined twice by a trained neurologist, at baseline and at the end of the follow-up period. At both time points, patients were assessed using the following scales: the modified Rankin scale, the Barthel index, the National Institutes of Health Stroke Scale, the Mattis dementia rating scale, and the structured interview for the diagnosis of Alzheimer dementia and multi-infarct dementia (SIDAM).5 Hypertension was defined by a systolic BP >140 mm Hg, a diastolic BP >90 mm Hg, or use of hypertensive medication together with past diagnosis of hypertension. Laboratory investigations at baseline included plasma homocysteine and fibrinogen.5
All of the imaging studies were done on the same 1.5-T system with a standard birdcage headcoil. The following sequences were obtained at both time points: T1-weighted axial, coronal, and sagital scouts, which were used to prescribe a precise imaging plane; a dual-echo (DE) turbo spin-echo (24 axial slices, thickness 5 mm, no gap, repetition time=3300 ms, echo time=16/98ms; field of view=188×250, and Matrix 192×256); a T1-weighted spin-echo (repetition time=768 ms, echo time=14 ms; rectangular field of view=188×250, and Matrix=192×256); and a pulsed-gradient spin-echo single shot echo-planar pulse sequence (interecho spacing=0.8 and echo time=123 ms), with diffusion gradients applied in 8 noncollinear directions chosen to cover 3D space uniformly (duration, 25 ms; maximum amplitude, 21 mTm−1; and 2 b-values, 0 and 1044 s/mm−2).13,14 Fat saturation was performed using a train of 4 binomial radiofrequency pulses.
Axial DE slices and T1-weighted slices were positioned to run parallel to a line that joins the most inferoanterior and inferoposterior parts of the corpus callosum.15 Diffusion-weighted images (10 axial slices, 5-mm section thickness, 128×128 matrix, and field of vision 240×240) were acquired with the same orientation as the DE images with the middle slices matched onto the middle slices of the DE images. This brain portion was chosen because it is a common location for the CADASIL lesion.6,7,16 For follow-up scans, the anatomical planes were repositioned according to published guidelines.15
Image Analysis and Postprocessing
For lesion volumetry we applied a previously established and evaluated 2-step procedure on all of the baseline and follow-up images.17 First, regions of abnormal hyperintense signal were identified and marked by 2 experienced readers on hardcopies of T2 and proton density (PD) images. Next, a local threshold based segmentation technique was applied on the lesions on the digital PD-weighted images by trained radiological technicians using the marked PD lesions as a working template. This provided an absolute total lesion volume for all of the baseline and follow-up scans.
Lesion volumes were calculated for both the full set of 24 slices (whole brain) and the 10 central slices corresponding to the diffusion-weighted images. The diffusion tensor was estimated from the diffusion images, and maps of MD were produced as published elsewhere.18,19 MD maps were cleaned from extracerebral tissue using a semiautomated threshold procedure followed by manual refinement where necessary. The inner table of the skull was defined as a peripheral edge of the volume-of-interest, that is, peripheral cerebrospinal fluid (CSF) spaces were included. A cutoff threshold of MD >1.9×10−3 mm2/s was applied using SPM99 software to suppress the influence of macroscopical CSF. Repeated image review had shown that no false exclusion of nonlacunar lesions occurred at this conservative threshold. Histograms with 4000 bins (width, 0.001×10−3 mm2/s) were produced from all of the remaining voxels. To allow interindividual histogram comparison, bin counts were normalized by division through the total number of all voxels different from zero.
Statistical inferences regarding changes of clinical scores and MRI measures were based on Wilcoxon tests for dependent samples. Correlations between clinical and MRI measures were calculated using the Spearman rank correlation coefficient (SRCC) and the partial correlation coefficient where appropriate. Bivariate exploration of determinants of clinical deterioration and changes of average MD were based on the SRCC and the corresponding tests. Independent variables were selected on the basis of epidemiological data suggesting a role for age, systolic blood pressure, and homocysteine levels in SVD. We additionally included the time between baseline and follow-up, gender, T2-lesion volume (whole brain), and average MD at baseline based on previous data suggesting a possible role of these factors in determining disease progression in CADASIL.3–5,11,20
Multivariate analysis of outcomes was done using linear regression (average MD, Rankin, and SIDAM) or logistic regression (stroke occurrence) with forward selection. Regressors with a P<0.05 were included in the respective models. Statistical analyses were done with SPSS version 12.0.1 for Windows (SPSS Inc). Sample sizes were calculated as described previously.5
Sixty-two CADASIL subjects (27 men and 35 women, aged 44.4±9.6 years) completed the protocol and were thus included into the analysis. All but 2 of them had developed symptoms. The mean interval between baseline and follow-up was 26.3±1.2 months (range, 23.6 to 30.9 months).
Clinical and Neuroimaging Characteristics
The mean clinical scores and MRI characteristics obtained at baseline and at follow-up are shown in Table 1. At follow-up, all of the clinical scales had deteriorated when compared with baseline. Twelve individuals had developed new strokes. The volume of T2/PD-weighted lesions had significantly increased (Table 1; Figure 1A). Also, average values and peak locations of MD histograms had significantly increased, and peak heights had significantly decreased (Table 1; Figure 1B). In controls, no significant changes of any MRI characteristics were found.
To assess how consistently imaging and clinical measures deteriorated over time, we computed the proportion of CADASIL subjects in whom the measures in Table 1 worsened. Worsening was defined as a deterioration of clinical scales, an increase in T2-lesion volumes, an increase in average values and peak locations of MD histograms, and a decrease in peak heights of MD histograms. As shown in Table 1, the proportion of worseners was generally higher with imaging than with clinical measures.
Correlations Between Neuroimaging Characteristics and Clinical Scales
The volume of T2-visible lesions, average MD, and peak heights of MD histograms significantly correlated with clinical scores (Table 2). In contrast, peak locations showed no significant correlation with clinical scores.
To explore the role of MRI as a possible surrogate marker for disease progression, we assessed the relationship between MRI characteristics and clinical scores on a longitudinal scale (Table 3). Changes of average MD correlated with changes of the Rankin score (Figure 2A), National Institutes of Health Stroke Scale score, and SIDAM score (Figure 2B; all P<0.01) with a nonsignificant trend for the Barthel (P=0.07) and Mattis dementia rating scale score (P=0.11). In contrast, there was no significant correlation between changes of T2-lesion volume and changes of any of the clinical scales.
To identify factors that would predict progression of MRI measures, we looked at changes of either T2-lesion volume or average MD as the dependent variable and the following independent baseline variables: age, gender, systolic blood pressure, homocysteine level, T2-lesion volume, and average MD.
In bivariate correlations, average MD (SRCC=0.51; P< 0.001), age (SRCC=0.50; P<0.001), T2-lesion volume (SRCC=0.37; P=0.003), and systolic blood pressure (SRCC=0.35; P=0.006) were found to predict changes in average MD during follow-up. In contrast, there was no significant correlation between any of the independent variables and changes of T2-lesion volume during follow-up. On multivariate analysis, the average MD at baseline (P<0.001) and systolic blood pressure at baseline (P=0.006) were the only predictors of changes in average MD during follow-up explaining about one-third of the variance (R2=0.34).
To identify factors that would predict clinical worsening, we looked at the following dependent variables: changes of the Rankin score, changes of the SIDAM score, and newly occurring strokes. On multivariate analysis, the average MD at baseline was the only significant predictor for changes of the Rankin score (0.04 points per 0.01×10−3 mm2/s of average MD; P=0.002), changes of the SIDAM score (0.28 points per 0.01×10−3 mm2/s of average MD; P=0.012), and newly occurring strokes (odds ratio, 1.34 per 0.01×10−3 mm2/s of average MD; P=0.001).
Sample Size Estimates
To explore the possible role of MRI for future interventional trials, we performed sample size calculations using longitudinal data from the current study. Table 4 indicates the number of subjects needed for inclusion assuming a trial duration of 2 years, a power of 80%, and a type I error probability of 0.05.
The current prospective study, which was conducted in a large cohort of CADASIL subjects, establishes significant correlations between magnetic resonance diffusion histogram metrics and clinical measures on a longitudinal scale. Sample size estimates showed that the number of patients needed to demonstrate a treatment effect in an interventional trial is lower with neuroimaging than with clinical end points. Moreover, our data suggest a role for MD histograms in predicting disease progression.
The results obtained at baseline extend previous studies8,10,11 by demonstrating that both the volume of T2-visible lesion and average values of MD histograms correlate with multiple clinical measures including disability, activities of daily living, neurological outcome, and cognition.
Whereas the volume of T2-lesions was correlated with clinical scales at baseline, there was no correlation on a longitudinal scale, that is, between changes of T2-lesion volumes and changes of clinical scales. One explanation for a failure to observe such a correlation, aside from noise in the data itself, rests with possible interference of brain atrophy. Conceivably, brain atrophy, which was not investigated in the current study, might counteract lesion growth, and, in fact, there were several individuals in which a decrease of T2-lesion volumes between baseline and follow-up was observed (data not shown). An alternative explanation would be a ceiling effect in patients who have extensive white matter lesions. Finally, the volume of T2-visible lesions may be clinically less important than the severity of tissue damage within T2-lesions and within brain tissue appearing normal on T2 images.
DTI provides quantitative information on the degree of tissue damage within areas that are hyperintense on T2 images, and the MD within such lesions was shown to correlate with clinical measures in earlier cross-sectional studies.21–23 Moreover, DTI is sensitive in detecting tissue changes within brain tissue appearing normal on conventional MRIs, and, again, such changes were found to be clinically relevant.10,21,23 Thus, compared with lesion volumes, MD histograms might be expected to provide a more comprehensive view of the extent of tissue damage within the brain.
In support of this, we found significant correlations between changes of average MD and changes of clinical scales over time. Again, correlations were found for multiple clinical aspects, including disability, neurological outcome, and cognition. These findings emphasize the importance of MD histogram metrics and show that increases in MD reflect a clinically important aspect of the pathology. Of note, the measures in Table 1 all changed in the expected direction over time. However, decline was much more consistently seen with imaging than with clinical measures, suggesting that MRI is superior in detecting changes over time.
Our findings have important implications. Because of their sensitivity in detecting changes and the observed correlations with clinical scales, diffusion histograms seem suited as an adjunct outcome measure in future interventional trials. Additional criteria must be met to establish MRI as a surrogate end point in a therapeutic trial,12 and those criteria can only be determined in an actual trial. Yet, our sample size estimates suggest that MD histograms will reduce the number of patients needed to demonstrate a treatment effect.
Interestingly, sample sizes were even lower for T2-lesion volumes of the whole brain than for MD histograms. However, the lack of correlation with clinical scales over time suggests that T2-lesion volumes are less suited as a surrogate marker for clinical disease progression in CADASIL. Of note, a 40% treatment effect on T2-lesion volume may be less relevant than an equivalent effect for mean MD in terms of physical or cognitive disability.
MD data can be obtained with relatively simple protocols, which are available on most imaging units, and image postprocessing can be largely automized. Also, MD histogram-derived metrics have been shown to be reproducible.19 The relatively low imaging-reimaging variability underlines the potential of DTI-derived metrics for longitudinal studies.
In our previous study on clinical end points,5 age was the main risk factor for clinical progression during follow-up. In the current study, which included MRI, age was no longer in the model, whereas average MD was the most important predictor of both increases in MD and clinical progression during follow-up. In fact, a prognostic influence of average MD on disease progression was found for various clinical end points including disability, cognition, and newly occurring strokes. It is not clear why patients with higher average MD at baseline showed greater rates of progression during follow-up, but it might be that CADASIL follows an accelerated course.
We also identified systolic blood pressure as a risk factor for increases in MD during follow-up. This finding agrees with epidemiological data showing that systolic blood pressure is a main risk factor for cerebral white matter lesions. It additionally demonstrates that the phenotype in CADASIL may be modified by conventional risk factors. Finally, and most importantly, our data suggest that CADASIL subjects might benefit from antihypertensive treatment, although the optimal blood pressure levels in these patients are still unknown. Additional studies are needed to resolve this issue. Hypertensive patients who have high values of average MD on brain MRI are at an elevated risk for clinical progression and may, thus, need closer follow-up with rigid blood pressure control.
Of note, the volume of T2-visible lesions at baseline was not a predictor of progression during follow-up. This finding contrasts population-based studies that found progression of T2-lesions mainly in individuals with higher baseline grades of white matter hyperintensities.24 However, these studies are difficult to compare because of different methods in lesion quantification and statistical analysis.
Our study also has possible limitations, which need to be considered. Brain coverage for the DTI measurements was incomplete. However, we consider it unlikely that this limitation affects our main findings, for the following reasons: (1) imaging-reimaging studies with a similar protocol have shown that the reproducibility of this method is high,19 a finding that is also supported by the lack of changes in our control individuals; (2) the area of interest covered a large and representative portion of the brain, which is the major site of pathology in CADASIL; and (3) any inaccuracy attributable to incomplete coverage would likely jeopardize rather than enhance the observed correlations with clinical scales. Another possible limitation is the use of relatively crude measures of cognitive functioning instead of dedicated neuropsychological test batteries, such as the Vascular-Alzheimer Disease Assessment Scale-Cognitive Subscale. Thus, the relationship with specific aspects of cognition, such as executive function,23 remain unexplored. Additional studies are required to address these and other issues, such as the role of brain atrophy and the volume of T1-lesions.
In the current study, we used a fixed threshold for suppression of macroscopic CSF from the MD maps. Using this threshold, most of the signal from lacunar infarcts and sulcal CSF was removed. Thresholding additionally influences the impact of partial volume effects and, thus, brain atrophy on average MD. These issues need to be considered in future studies. Importantly, however, varying the threshold between 1.7×10−3 mm2/s and 1.9×10−3 mm2/s had no significant effect on longitudinal changes of MD (data not shown).
To our knowledge, this is the first study to formally address correlations between longitudinal changes of quantitative MRI metrics and changes of clinical scales in patients with subcortical ischemic lesions.20 Our findings cannot be generalized to the large group of patients with sporadic SVD. Yet, there are many similarities between CADASIL and sporadic SVD. We, therefore, speculate that DTI histograms might also be suited to monitor the progression of white matter lesions secondary to sporadic SVD.
This study was supported by grants from the Deutsche Forschungsgemeinschaft to M.D. (Di722/3-1).
↵*Dr Holtmannspötter and Dr Peters contributed equally to this work.
- Received March 22, 2005.
- Revision received July 1, 2005.
- Accepted September 5, 2005.
Opherk C, Peters N, Herzog J, Luedtke R, Dichgans M. Long-term prognosis and causes of death in CADASIL: a retrospective study in 411 CADASIL patients. Brain. 2004; 127: 2533–2539.
Peters N, Herzog J, Opherk C, Dichgans M. A two-year clinical follow-up study in 80 CADASIL subjects: Progression patterns and implications for clinical trials. Stroke. 2004; 35: 1603–1608.
O’Sullivan M, Jarosz JM, Martin RJ, Deasy N, Powell JF, Markus HS. MRI hyperintensities of the temporal lobe and external capsule in patients with CADASIL. Neurology. 2001; 56: 628–634.
Dichgans M, Filippi M, Bruning R, Iannucci G, Berchtenbreiter C, Minicucci L, Uttner I, Crispin A, Ludwig H, Gasser T, Yousry TA. Quantitative MRI in CADASIL: correlation with disability and cognitive performance. Neurology. 1999; 52: 1361–1367.
Le Bihan D, Mangin JF, Poupon C, Clark CA, Pappata S, Molko N, Chabriat H. Diffusion tensor imaging: concepts and applications. J Magn ResonImaging. 2001; 13: 534–546.
Dichgans M, Putz B, Boos D, Auer DP. Role of subvoxel free fluid on diffusion parameters in brain tissue with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and its correlation with physical disability: histogram analysis of standard and fluid-attenuated MR diffusion. AJNR Am J Neuroradiol. 2003; 24: 1083–1089.
Molko N, Pappata S, Mangin JF, Poupon F, LeBihan D, Bousser MG, Chabriat H. Monitoring disease progression in CADASIL with diffusion magnetic resonance imaging: a study with whole brain histogram analysis. Stroke. 2002; 33: 2902–2908.
Bito Y, Hirata S, Yamamoto E. Optimal gradient factors for ADC measurements. Proc Intl Soc Magn Reson Med. 1995; 2: 913.
Miller DH, Barkhof F, Berry I, Kappos L, Scotti G, Thompson AJ. Magnetic resonance imaging in monitoring the treatment of multiple sclerosis: concerted action guidelines. J Neurol Neurosurg Psychiatry. 1991; 54: 683–688.
Chabriat H, Levy C, Taillia H, Iba-Zizen MT, Vahedi K, Joutel A, Tournier-Lasserve E, Bousser MG. Patterns of MRI lesions in CADASIL. Neurology. 1998; 51: 452–457.
Cercignani M, Inglese M, Pagani E, Comi G, Filippi M. Mean diffusivity and fractional anisotropy histograms of patients with multiple sclerosis. AJNR Am J Neuroradiol. 2001; 22: 952–958.
Cercignani M, Bammer R, Sormani MP, Fazekas F, Filippi M. Inter-sequence and inter-imaging unit variability of diffusion tensor MR imaging histogram-derived metrics of the brain in healthy volunteers. AJNR Am J Neuroradiol. 2003; 24: 638–643.
Schmidt R, Scheltens P, Erkinjuntti T, Pantoni L, Markus HS, Wallin A, Barkhof F, Fazekas F. White matter lesion progression: a surrogate endpoint for trials in cerebral small-vessel disease. Neurology. 2004; 63: 139–144.
Chabriat H, Pappata S, Poupon C, Clark CA, Vahedi K, Poupon F, Mangin JF, Pachot-Clouard M, Jobert A, Le Bihan D, Bousser MG. Clinical severity in CADASIL related to ultrastructural damage in white matter: in vivo study with diffusion tensor MRI. Stroke. 1999; 30: 2637–2643.
Molko N, Pappata S, Mangin JF, Poupon C, Vahedi K, Jobert A, LeBihan D, Bousser MG, Chabriat H. Diffusion tensor imaging study of subcortical gray matter in cadasil. Stroke. 2001; 32: 2049–2054.
O’Sullivan M, Singhal S, Charlton R, Markus HS. Diffusion tensor imaging of thalamus correlates with cognition in CADASIL without dementia. Neurology. 2004; 62: 702–707.

domain: medical


text:
CLANDEBOYE LODGE HOTEL WEDDING PHOTOGRAPHER
As a wedding photographer in Northern Ireland, I have the privilege of capturing weddings in some of the most amazing venues throughout the country. Recently, I photographed Rachel and Daniel's wedding at the Clandeboye Lodge Hotel on a sunny winter's day leading up to Christmas. The lighting was incredibly beautiful, especially for a winter's day.
The day started with photographing Rachel getting ready on-site. It was a relaxed morning, and everyone was excited for the day ahead. Rachel prepared for the day with her two daughters, a memory that they will undoubtedly cherish for the rest of their lives.
The ceremony was held in The Blackwood Suite, and it was breathtaking. The arched timber beams, gothic windows, and enchanting ambiance created a truly magical atmosphere. The couple exchanged their vows in front of their family and friends, and the ceremony was wonderfully delivered by Stewart Holden, a humanist celebrant who gained fame as a contestant on Mastermind.
As the day drew to a close, we were treated to a stunning sunset that provided the perfect backdrop for portraits of the couple. The lighting was absolutely gorgeous, and we took full advantage of the opportunity to capture some incredible shots in the stunning and immaculate gardens at Clandeboye Lodge.
The couple's first dance was made extra special with a surprise performance by famous country music singer Nathan Carter, which undoubtedly delighted them. The dance floor was lively and further enhanced with smoke machines and sparklers, creating a fantastic atmosphere. We thoroughly enjoyed documenting Rachel and Daniel's unforgettable wedding at the always-impressive Clandeboye Lodge Hotel, where the staff's professionalism is consistently admirable. This venue is truly outstanding and never fails to impress.


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Published on Friday, November 30, 2012 by The Nation Fracking Our Food Supply http://www.thenation.com/article/171504/fracking-our-food-supply
[Excerpted] Ambient air testing by a certified environmental consultant detected elevated levels of benzene, methane, chloroform, butane, propane, toluene and xylene—compounds associated with drilling and fracking, and also with cancers, birth defects and organ damage. Her well tested high for sulfates, chromium, chloride and strontium; her blood tested positive for acetone, plus the heavy metals arsenic (linked with skin lesions, cancers and cardiovascular disease) and germanium (linked with muscle weakness and skin rashes). Both she and her husband, who works in oilfield services, have recently lost crowns and fillings from their teeth; tooth loss is associated with radiation poisoning and high selenium levels, also found in the Schilkes’ water.
...Earlier this year, Michelle Bamberger, an Ithaca veterinarian, and Robert Oswald, a professor of molecular medicine at Cornell’s College of Veterinary Medicine, published the first (and, so far, only) peer-reviewed report to suggest a link between fracking and illness in food animals. The authors compiled case studies of twenty-four farmers in six shale-gas states whose livestock experienced neurological, reproductive and acute gastrointestinal problems. Exposed either accidentally or incidentally to fracking chemicals in the water or air, scores of animals have died. The death toll is insignificant when measured against the nation’s livestock population (some 97 million beef cattle go to market each year), but environmental advocates believe these animals constitute an early warning.
Exposed animals “are making their way into the food system, and it’s very worrisome to us,” Bamberger says. “They live in areas that have tested positive for air, water and soil contamination. Some of these chemicals could appear in milk and meat products made from these animals.”
...In addition to the cases documented by Bamberger, hair testing of sick cattle that grazed around well pads in New Mexico found petroleum residues in fifty-four of fifty-six animals. In North Dakota, wind-borne fly ash, which is used to solidify the waste from drilling holes and contains heavy metals, settled over a farm....
....Fracking a single well requires up to 7 million gallons of water, plus an additional 400,000 gallons of additives, including lubricants, biocides, scale and rust inhibitors, solvents, foaming and defoaming agents, emulsifiers and de-emulsifiers, stabilizers and breakers. About 70 percent of the liquid that goes down a borehole eventually comes up—now further tainted with such deep-earth compounds as sodium, chloride, bromide, arsenic, barium, uranium, radium and radon. (These substances occur naturally, but many of them can cause illness if ingested or inhaled over time.) This super-salty “produced” water, or brine, can be stored on-site for reuse.
Depending on state regulations, it can also be held in plastic-lined pits until it evaporates, is injected back into the earth, or gets hauled to municipal wastewater treatment plants, which aren’t designed to neutralize or sequester fracking chemicals (in other words, they’re discharged with effluent into nearby streams).
At almost every stage of developing and operating an oil or gas well, chemicals and compounds can be introduced into the environment. Radioactive material above background levels has been detected in air, soil and water at or near gas-drilling sites. Volatile organic compounds—including benzene, toluene, ethylene and xylene—waft from flares, engines, compressors, pipelines, flanges, open tanks, spills and ponds. (The good news: VOCs don’t accumulate in animals or plants. The bad news: inhalation exposure is linked to cancer and organ damage.)
Underground, petrochemicals can migrate along fissures through abandoned or orphaned wells or leaky well casings (the oil and gas industry estimates that 60 percent of wells will leak over a thirty-year period). Brine can spill from holding ponds or pipelines. It can be spread, legally in some places, on roadways to control dust and melt ice. Truck drivers have also been known to illegally dump this liquid in creeks or fields, where animals can drink it or lick it from their fur.
Majia here: We can see what happens when an injection dome collapses by looking at the headlines at Enenews concerning the collapsed one in LA
Officials: ‘Large chunks’ were knocked off salt dome when cavern collapsed — Giant sinkhole now getting deeper
Also see my post on injection domes
Sep 25, 2012
Injection Wells and Salt Dome Collapse. Majia here: Currently Enenews has been following the collapse of a salt dome that had served as a storage place for waste in Assumption Parish. The emergence of a massive sink ...

domain: biology


text:
Director Kevin Tenney loves Halloween, and it’s never made more clearly than during the “Night of the Demons.” The 1988 horror film is still a fun and hilarious horror comedy that doesn’t just embrace its horror tropes, but celebrates Halloween as a whole. From the pumpkin in the opening shot to the book end sub-plots involving a crabby old man preparing for trick or treaters, “Night of the Demons” is a perfect film for a Halloween party, and just a downright fantastic summary of why the eighties were such an unabashed festival of novelties for the horror genre.
The low budget gladly never shines through what is a horror film centered on limited scenery and set pieces. But director Tenney is able to wisely use those settings to stage some truly excellent moments of comedy and horror, all of which are tough to forget. There’s the opening shot of Linnea Quigley leaning over a candy rack as Amilia Kinkade lurks in the background shoplifting, and the final scene that will arouse laughter and some eye rolls. “Night of the Demons” is just so much fun for folks that can appreciate the punk rock horror sub-genre that director Tenney evokes with immense enthusiasm. Judy is a virginal young girl whose boyfriend is pressuring her to sleep with him, and figures out if she wants to lose her virginity as she ventures out for Halloween night.
Her friend and local Goth Angela is throwing a private party with her friends at the abandoned haunted Hull House. Within the creaky halls and dusty rooms, Angela and friends accidentally invoke a demonic entity that begins possessing the party goers one by one, and the vicious demons are making a play for virginal Judy for sinister plans. Director Tenney’s horror comedy is very small scale, but still filled immense dread and tension. Tenney is capable of building some very respectable mounting horror, with the unleashing of the demon, and the slow destruction of the party goers, and then unleashes them in a harrowing manner.
Much of the house feels like a character in and of itself, allowing for a lot of terror and grue to ensue, including eye gauging, neck breaking, and impalings. Tenney is able to make even the most simplistic effect look incredibly creepy, while turning the demonic make up in to memorable characters with their own unique elements. Angela is particularly a terrifying villain whose menacing of Judy and fellow survivor Rodger becomes eerie, especially when she’s constantly featured hovering through the dark halls, anxious for blood shed. “Night of the Demons” is such a raucous and very novel horror film that hasn’t aged a bit. If anything the eighties decor only lends a whole other layer of entertainment value to the havoc that ensues.
It’s a worthy horror film given a worthy treatment by Scream Factory. Among the features in the Scream Factory release is “You’re Invited: The Making of Night of the Demons” is a great extensive look at Kevin Tenney’s horror classic and its legacy. At over an hour in length, Tenney and co. discuss the creation of the film and how it began life titled “The Halloween Party,” and eventually became “Night of the Demons” after Mustapha Akkad threatened to sue the low budget production. There are interviews from the entire cast, including Linnea Quigley, and they offer some fun anecdotes about filming in the creepy abandoned house, and how much of the story changed to fit the budget restraints.
There’s even explanation of the inconsistencies in the story and how Judy’s Alice in Wonderland costume factored in to it. It’s a fun segment for fans. There’s a twenty two minute interview with the gorgeous Amilia Kinkade, who played the enigmatic Goth Angela, a character that eventually became the primary villain for the “Night of the Demons” trilogy. Kinkade is still very attractive and garners a unique personality that makes her fun to listen to during the interview. She seems to embrace her role as Angela, and explains her history in dancing, music videos, and her experiences with celebrities like Ray Charles.
It’s a fun interview and Kinkade’s a bit of a bubbly persona that you can laugh with. There’s the four minute “Allison Barron’s Demon Memories,” a four minute recollection of Barron’s days shooting “Night of the Demons” as character Helen. There’s also the theatrical trailer, the trailer for the home video release, TV Spots, Radio Spots, a Promo Reel, a Behind the Scenes Gallery, A Special Effects and Make Up Photo Gallery, Another Photo Gallery, and a gallery featuring Posters and Storyboards for the film.


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- 1971 prediction
- The l971 book Man in the Telesphere l08pp predicted an "electronic web". Two chapters are devoted to the "electronic web" will effect global governance.
- Global Nation Organization
- Calls for a one world democratic government that will treat all people as equals.

domain: politics


text:
Ever since the libertarian movement began attracting conservatives, the movement has grown by leaps and bounds. Not surprisingly, some of these conservatives have come with baggage consisting of conservative positions that some of them have simply been unable to let go of. Rather than simply accept the fact that their conservative views are contrary to those of the movement which they have decided to join, some of these conservative libertarians have instead tried to get the libertarian movement to abandon its libertarian principles and embrace conservative positions instead.
There is no better example of this phenomenon than the issue of immigration. Conservatives share the same view on immigration that liberals (i.e., progressives or leftists) have: that the federal government should centrally manage and control the peaceful movements of people across borders that separate nations.
Interestingly enough, most liberals and conservatives believe that governments should not have the authority to manage and control the movements of people across state and county borders. It is only people’s movements across international borders, they say, that the federal government should manage and control.
The libertarian position turns on what is called the non-aggression principle. It holds that people are free to engage in any peaceful act without governmental interference. Obviously the act of crossing a border, in and of itself, does not entail a violent act or one that violates the rights of others. For example, the countless Marylanders who cross the border into Virginia every day aren’t violating anyone’s rights simply by crossing the border. If they commit murder, assault, rape, or other violent crime when they get into Virginia, they are violating people’s rights. But they are not violating anyone’s rights simply by crossing the border into Virginia.
Conservatives and liberals often say that libertarians oppose borders. That is patently false, at least for libertarians who favor limited government. As a limited-government libertarian, I favor borders. I believe in them. I just want people to be free to cross them back and forth, including, by the way, the retention of their original citizenship if that is what they wish to do.
Thus, open borders — or the free movements of people across borders — has long been the libertarian position because it embodies the libertarian non-aggression principle as well as the exercise of such fundamental rights as freedom of association, economic liberty, liberty of contract, private ownership of property, and the pursuit of happiness.
Yet, conservatives who come into the libertarian movement with immigration baggage spend a lot of their time not just promoting the conservative (and liberal) position on immigration but also trying to persuade libertarians to make that position the official libertarian position. What that would mean, of course, is that libertarians would be abandoning the core principle of libertarianism, the non-aggression principle.
But embracing the liberal-conservative position on immigration would actually mean more than that. It would also turn the libertarian movement into one of death, suffering, and an immigration police state. At the risk of belaboring the obvious, there are few things that would be more destructive for the libertarian movement than to become known as the movement of death, suffering, and a police state.
Whenever you see an article or a speech advocating immigration controls by a conservative libertarian, you will notice one glaring feature, without exception: the absence of any mention of the death, suffering, and the police state that inevitably accompany a system of immigration controls. There is a good reason for that silence: the conservative libertarians do not want libertarians to know that the system they are advocating for the libertarian movement comes with death, suffering, and a police state.
Consider the immigration police state that immigration controls have brought to the United States, primarily in the American Southwest but also, more recently, in other parts of the United States as well.
- Fixed highway checkpoints. These are located on domestic highways. Federal agents stop domestic travelers who have never crossed into Mexico. They ask them questions. If people refuse to answer their questions, the agents will break their car window, drag them out of their car, and beat them up. People are subject to a complete search, including being ordered to completely disrobe to enable federal agents to search their body cavities. Their vehicles can also be completely searched. If illegal drugs or contraband are found, the person will be charged, prosecuted, convicted, and punished. That’s what a police state is all about.
- Warrantless trespasses onto farms and ranches within 100 miles of any U.S. border. No search warrants. No probable cause. No reasonable suspicion. Just trespass. If a farmer or rancher puts a lock on his gate and forgets to give a key to the Border Patrol, they simply shoot off the lock and enter the property. If they find “undocumented immigrants” working on the farm, they seize and arrest them, even if that means the loss of the farmer’s crops. That’s what a police state is all about.
- Roving Border Patrol checkpoints. This is where Border Patrol agents arbitrarily stop any vehicle they want, based on a “reasonable suspicion” that the vehicle might be carrying illegal aliens. As a practical matter, that means that they are authorized to stop anyone they want, and they do. When I was living in my hometown of Laredo, Texas, I was subjected to one of these roving Border Patrol checkpoints for no reason whatsoever. That’s what a police state is all about.
- Violent government raids on private businesses, ones in which the business owner has decided to use his own money to enter into mutually beneficial labor relations with citizens of foreign countries. That’s what a police state is all about.
- Forcible governmental separation of children from their parents, with the aim of inflicting massive mental and psychological suffering in both parents and children. That’s what a police state is all about.
- Forcible deportations of people who are engaged in purely peaceful acts, such as exercising the fundamental God-given rights of pursuing happiness and entering into mutually beneficial economic relations with others. That’s what a police state is all about.
- The construction of a Berlin Fence and the proposed construction of a Berlin wall along the U.S.-Mexico border, along with the use of political stealing through eminent domain in order to take people’s property from them in order to construct the Berlin fence or wall. That’s what a police state is all about.
- Border Patrol agents boarding Greyhound buses in cities and towns within 100 miles of any U.S. border, which they are now doing all over the United States. They are targeting Hispanics and anyone else who doesn’t look like a genuine American and demanding to see their papers. If the bus traveler is unable to prove that he is an American citizen, he is forcibly removed from the bus and taken into custody. That’s what a police state is all about.
- Complete searches of body and vehicle at international crossing points, including body cavities after the person is required to completely disrobe in front of federal agents. People are also now being required to turn over their cell phones and passwords to enable federal agents to do a complete search of their cell phone. That’s what a police state is all about.
There is also the massive death toll that accompanies a system of immigration controls. The countless immigrants who die of thirst or exposure on lonely deserts or from suffication in the back of 18-wheelers. Under a system of open borders, those deaths would never happen because people would be free to cross back and forth peacefully and harmoniously. Such deaths are an inherent part of a system of immigration controls.
I would be remiss if I failed to remind people of the infamous “voyage of the damned,” in which the presidential regime of Franklin Roosevelt, an icon for both conservatives and liberals, used immigration controls to prevent a shipload of German Jews in the 1930s from disembarking at Miami. We have the “quota” system, Roosevelt maintained, meaning that the federal immigration planners had set a “quota” for German immigrants and the “quota” had already been filled. For that matter, it’s worth mentioning that Roosevelt used the immigration “quota” system to prevent millions of German Jews from immigrating to the United States in the 1930s, when Hitler was willing to let Jews leave Germany, long before he ended up killing them in the Holocaust.
Like I say, the conservative libertarians who attempt to persuade us libertarians to abandon our libertarian principles and embrace the conservative-liberal position on immigration never — repeat never — mention the death, suffering, and a police state that are inherent aspects of the immigration-control system they advocate. Why, they rarely even criticize, much less condemn, any of these police-state measures or the death and suffering that their system produces. They want libertarians to focus only on the lightning and never on the thunder that inevitably accompanies their lightning.
Given libertarians’ devotion to freedom, peace, prosperity, and harmony, the consequences of the conservative-liberal system of immigration controls should always be on the mind of every libertarian. That last thing we need is for libertarianism to become the movement of death, suffering, and a police state. Let’s leave that to conservatives and liberals.

domain: law


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The Manor Royal BID provides a range of services to help protect Manor Royal businesses and reduce crime. None of these services are a replacement for measures individual businesses ought to take to protect themselves and their staff.
Businesses ought to see these services provided by the Manor Royal BID as an enhancement to their own security arrangements, in addition to those provided by the police, to make Manor Royal as safe as possible and a “harder target” for criminal and anti-social behaviour. Success in reducing crime depends on everyone playing their part.
The following organisations work together for a safer Manor Royal:
Sussex Police - Crawley & Gatwick Business Watch - Blue Light Security - Manor Royal BID
Businesses in Manor Royal can access the following services to help protect their property and people, made possible and freely available by the Manor Royal BID.
Membership of Manor Royal Business Watch (DISC)
This includes access to the accredited password protected DISC security system providing instant messaging, alerts, and access to secure information about criminal activity. DISC also provides access to o enders “mug shot” gallery, easy to use online reporting and weekly updates and news. Find out more here
Manor Royal Business Rangers (provided via the Blue Light Group)
Funded by the BID, the Business Rangers are a dedicated presence providing regular security patrols, reassurance, assistance and advice. The Rangers act as the “eyes and ears” of Manor Royal to identify, prevent and resolve issues. They regularly liaise with the police and the dedicated Manor Royal Maintenance Team, escalating issues to the proper authority when they have to. Find out more here
In addition, the Manor Royal BID also provides...
• Area-wide CCTV and ANPR security cameras
• Free security radios for vulnerable retailers
• Support from a dedicated Business Crime Manager
• Free business watch window stickers and police officer vinyls
• Affiliation with Crawley & Gatwick Business Watch
• Free site premises security patrol signs
• Free site security review (via the Blue Light Group)
• Access through the BID to the local policing and Council teams
To speak to any of the Manor Royal BID team about security across the Business District - click here


by Brian A. Wilkins
ORIGINAL LINK: http://blog.operation-nation.com/2011/10/18/occupy-phoenix-police-showing-silent-solidarity.aspx
As Occupy Phoenix enters Day #5, protesters had to make adjustments as to location of the occupation. Occupy Phoenix commenced this past Friday, with a march through downtown Phoenix that included stops at Bank of America, JP Morgan Chase Bank, and NBC 12.
Then Saturday came. Occupiers began the day at Cesar Chavez Plaza, which houses several Phoenix city and Maricopa County offices. The crowd was forced by police to move to Margaret T. Hance Park, just north of downtown, because police said the plaza closed at 6pm. Police then said the … Read Entire Article


Daytona Beach, FL – Update: The Volusia County Sheriff’s Office says the issue has been resolved and all 911 cellular service has been restored.
Earlier Reporting: This morning, lightning strikes in parts of Daytona have disconnected 911 service for some cell phone users.
The affected area is around Tiger Bay Road in Daytona Beach. The Volusia County Sheriff’s Office (VCSO) Communication Center has confirmed that some AT&T customers cannot call 911 from their cell phones, and that other cell phone carriers may be affected as well.
Both the VSCO Communication Center and AT&T are working together to restore service to those affected. Those who are affected are asked to use a landline to call 911. The VCSO will being updating progress and will let the public know when the issue is fixed.
Copyright Southern Stone Communications 2017.


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Hi all! We’re back with week 8 of Bookmark Your Thoughts‘s Goodreads de-clutter challenge, Down the TBR Hole!
- Go to your Goodreads to-read shelf
- Order on ascending date added.
- Take the first 5 (or 10 if you’re feeling adventurous) books.
- Read the synopses of the books.
- Decide: keep it or should it go?
- Keep track of where you left off so you can pick up there next week
Book 1: Someday, Someday, Maybe
The Blurb: Someday, Someday, Maybe is a story about hopes and dreams, being young in a city, and wanting something deeply, madly, desperately. It’s about finding love, finding yourself, and perhaps most difficult of all in New York City, finding an acting job.
The Verdict: Oof…dismiss. I added this because I love Lauren Graham, but I think I’ve just aged out of my interest in this.
Book 2: A Certain Age
The Blurb: Full of the glamour, wit and delicious twists that are the hallmarks of Beatriz Williams’ fiction and alternating between Sophie’s spirited voice and Theresa’s vibrant timbre, A Certain Age is a beguiling reinterpretation of Richard Strauss’s comic opera Der Rosenkavalier, set against the sweeping decadence of Gatsby’s New York.
The Verdict: Keep. Still interested!
Book 3: As You Like It
The Blurb: Readers and audiences have long greeted As You Like It with delight. Its characters are brilliant conversationalists, including the princesses Rosalind and Celia and their Fool, Touchstone. Soon after Rosalind and Orlando meet and fall in love, the princesses and Touchstone go into exile in the Forest of Arden, where they find new conversational partners. Duke Frederick, younger brother to Duke Senior, has overthrown his brother and forced him to live homeless in the forest with his courtiers, including the cynical Jaques. Orlando, whose older brother Oliver plotted his death, has fled there, too.
The Verdict: Always keep Shakespeare.
Book 4: We Are Pirates
The Blurb: We Are Pirates is a novel about our desperate searches for happiness and freedom, about our wild journeys beyond the boundaries of our ordinary lives. Also, it’s about a teenage girl who pulls together a ragtag crew to commit mayhem in the San Francisco Bay, while her hapless father tries to get her home.
The Verdict: Dismiss. I’d forgotten about this and I didn’t really miss it.
Book 5: How to Be A Grown-Up
The Blurb: In How to be a Grown-Up, Buchanan dispenses all the emotional and practical advice you need to negotiate a difficult decade. Covering everything from how to become more successful and confident at work, how to feel pride in yourself without needing validation from others, how to turn rivals into mentors, and how to *really* enjoy spending time on your own, this is a warm, kind, funny voice in the dark saying “Honestly don’t worry, you’re doing your best and you’re amazing!”
The Verdict: Dismiss. Not reading too much self-help.
Book 6: The Year of Magical Thinking
The Blurb: ‘An act of consummate literary bravery, a writer known for her clarity allowing us to watch her mind as it becomes clouded with grief.’ From one of America’s iconic writers, a stunning book of electric honesty and passion. Joan Didion explores an intensely personal yet universal experience: a portrait of a marriage–and a life, in good times and bad–that will speak to anyone who has ever loved a husband or wife or child.
The Verdict: Dismiss. I just don’t think I’ll reach for it.
Book 7: The Atlas of Forgotten Places
The Blurb: After a long career as an aid worker, Sabine Hardt has retreated to her native Germany for a quieter life. But when her American niece Lily disappears while volunteering in Uganda, Sabine must return to places and memories she once thought buried in order to find her. In Uganda, Rose Akulu—haunted by a troubled past with the Lord’s Resistance Army—becomes distressed when her lover Ocen vanishes without a trace. Side by side, Sabine and Rose must unravel the tangled threads that tie Lily and Ocen’s lives together—ultimately discovering that the truth of their loved ones’ disappearance is inescapably entwined to the secrets the two women carry.
The Verdict: Keep.
Book 8: Billy Budd and Other Stories
The Blurb: Stung by the critical reception and lack of commercial success of his previous two works, Moby-Dick and Pierre, Herman Melville became obsessed with the difficulties of communicating his vision to readers. His sense of isolation lies at the heart of these later works. “Billy Budd, Sailor,” a classic confrontation between good and evil, is the story of an innocent young man unable to defend himself against a wrongful accusation. The other selections here–“Bartleby,” “The Encantadas,” “Benito Cereno,” and “The Piazza”–also illuminate, in varying guises, the way fictions are created and shared with a wider society.
The Verdict: DIS. MISS. Reading Moby Dick was the most frustrating and irritating experience, so I think I’ve had all the Melville I need for one lifetime, thank you.
Book 9: The Secret Garden
The Blurb: The plot centers round Mary Lennox, a young English girl who returns to England from India, having suffered the immense trauma by losing both her parents in a cholera epidemic. However, her memories of her parents are not pleasant, as they were a selfish, neglectful and pleasure-seeking couple. Mary is given to the care of her uncle Archibald Craven, whom she has never met. She travels to his home, Misselthwaite Manor located in the gloomy Yorkshire, a vast change from the sunny and warm climate she was used to. When she arrives, she is a rude, stubborn and given to stormy temper tantrums. However, her nature undergoes a gradual transformation when she learns of the tragedies that have befallen her strict and disciplinarian uncle whom she earlier feared and despised. Once when he’s away from home, Mary discovers a charming walled garden which is always kept locked. The mystery deepens when she hears sounds of sobbing from somewhere within her uncle’s vast mansion. The kindly servants ignore her queries or pretend they haven’t heard, spiking Mary’s curiosity.
The Verdict: Keep!! A classic that I can’t believe I still haven’t read! Bonus points for the Secret Garden musical having absolutely stunning music.
Book 10: Gli Amori Difficili
The Blurb: Se queste sono, per la più parte, storie di come una coppia non s’incontra, nel loro non incontrarsi l’autore sembra far consistere non solo una ragione di disperazione ma pure un elemento fondamentale – se non addirittura l’esistenza stessa – del rapporto amoroso.
These are, for the most part, stories of how a couple doesn’t meet, and in their not meeting the author seems to VERB not only a reason for despair, but also a fundamental element– if not the existence itself– of a loving relationship.
The Verdict: Conservare. Keep!
This week’s tally: 5 stay, 5 go
Removed so far: 37
Five more next week!

domain: library


text:
Bow Tie - Nuts About Pups
‘Nuts About Pups' Bow Tie
An original aDoraBle Pooch Co design ‘Nuts About Pups’. Peanut butter lovers, this one is for you! A super fun and unique design for that ultimate treat that's hard to beat. Perfect for both boys and girls!
Our bow tie assures to give your pooch that extra touch on those special days or just because! A fab combo with matching collar!
- Elastic to ensure snug fit to collar
- Super Soft Polyester mix
- Matching Collar available
Feelin' extra stylish?
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Spot clean with soap and water. Lay flat to dry.

domain: design