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Schematic of optical coherence tomographic (OCT) imaging system and oral cavity/oropharynx target. The OCT system parameters are as follows: λ = 1310 nm and full width half maximum = 80 nm; lateral resolution = 15 μm; axial resolution = 10 μm; frame rate: 1 to 2 Hz. A/D means analog to digital conversion; DSP indicates digital signal processing; and RSOD, Rapid Scanning Optical Delayline.
View of optical coherence tomographic handheld probe.
Optical coherence tomographic (OCT) probe tip depicting gradient refractive index (GRIN) lens and prism mounted at the end of the optic fiber.
Optical coherence tomographic image of healthy buccal mucosa. BM indicates basement membrane; LP, lamina propria; SS, stratified squamous epithelium; and vertical bar, 500 μm.
Optical coherence tomographic image of the mucosal side of the lower lip. BM indicates basement membrane; LP, lamina propria; SD, seromucinous duct (tangential slice); SG, seromucinous glands; SS, stratified squamous epithelium; and vertical bar, 500 μm.
Optical coherence tomographic image of the dorsum of the tongue. BM indicates basement membrane; FP, filiform papillae; KL, keratin layer; LP, lamina propria; SS, stratified squamous epithelium; and vertical bar, 500 μm.
Optical coherence tomographic image along the floor of the mouth revealing extensive glandular duct (GD) system. BM indicates basement membrane; LP, lamina propria; SS, stratified squamous epithelium; and vertical bar, 500 μm.
Optical coherence tomographic image along the undersurface of a healthy tongue. BM indicates basement membrane; GD, glandular duct; LP, lamina propria; SS, stratified squamous epithelium; and vertical bar, 500 μm.
Optical coherence tomographic image of healthy floor of mouth with blood vessel imaging. BM indicates basement membrane; BV, blood vessel; LP, lamina propria; SS, stratified squamous epithelium; and vertical bar, 500 μm.
Multimodal analysis of a vallecular cyst using optical coherence tomography (A); endoscopic view (B), and correlative histologic features (C). BM indicates basement membrane; FH, follicular hyperplasia; SS, stratified squamous epithelium; V, vessels; and vertical bar, 500 μm.
Imaging of region involving leukoplakia using optical coherence tomography (A); endoscopic view (B), and correlative histologic features (C). BM indicates basement membrane; LP, lamina propria; SS, stratified squamous epithelium; V, vessels; and vertical bar, 500 μm.
Invasive squamous cell carcinoma of maxilla illustrated using optical coherence tomography (A) and correlative histologic features (B). Note absence of basement membrane and tissue microstructures. Vertical bar indicates 500 μm.
Multimodal analysis revealing transition zone of cancer and adjacent tissue along anterior mandible margin using optical coherence tomography (A); endoscopic view (B), and correlative histologic features (C). CA indicates cancer (squamous cell carcinoma); LP, lamina propria; SS, stratified squamous epithelium; and vertical bar, 500 μm.
Imaging of cancer transition zones and adjacent tissues along alveolar border using optical coherence tomography (A); endoscopic view (B), and correlative histologic features (C). BM indicates basement membrane; CA, cancer (squamous cell carcinoma); LP, lamina propria; SS, stratified squamous epithelium; and vertical bar, 500 μm.
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Ridgway JM, Armstrong WB, Guo S, et al. In Vivo Optical Coherence Tomography of the Human Oral Cavity and Oropharynx. Arch Otolaryngol Head Neck Surg. 2006;132(10):1074–1081. doi:10.1001/archotol.132.10.1074
Optical coherence tomography (OCT) is an evolving imaging modality that combines interferometry with low-coherence light to produce high-resolution tissue imaging. Cross-sectional in vivo images were obtained using an OCT device consisting of a Michelson interferometer, 1.3-μm broadband light source, and a handheld fiberoptic imaging probe. Image pixel resolution approached 10 μm. The mucosa of the oral cavity and oropharynx were examined in 41 patients during operative endoscopy. Optical coherence tomographic imaging was combined with endoscopic photography for gross and histologic image correlation. Optical coherence tomographic images of the oral cavity and oropharynx provided microanatomical information on the epithelium, basement membrane (BM), and supporting lamina propria (LP) of the mucosa. Normal microstructures identified in these tissues included an overlying keratin layer, papillae, ducts, glands, and blood vessels. Regions of pathologic features studied included mature scar, granulation tissue, mucous cysts, leukoplakia, and invasive cancer. Optical coherence tomographic imaging showed distinct zones of normal, altered, and ablated tissue microstructures for each pathologic process studied. Abnormal findings were directly compared with regions of normal tissue or conventional histopathologic features when tissue for analysis was available. This study provides a composite series of in vivo OCT images of the oral cavity and oropharynx in a variety of normal regions and pathologic states as well as outline future applications of OCT technology.
The National Cancer Institute estimates that newly diagnosed cancers of the oral cavity and pharynx affected 28 260 Americans and accounted for almost 7300 deaths in 2004.1 Within the United States these malignant neoplasms constitute almost 3% of all cancers in men and 2% of all cancers in women.2 Unfortunately, advances in surgery, radiotherapy, and chemotherapy have offered limited progress in terms of overall patient survival as regional failure and distant tumor recurrences continue to account for the disconcerting mortality rates over the last 2 decades.3,4 The single greatest determinant of long-term patient survival remains early lesion detection and effective treatment. Presently, noninvasive imaging methods are unable to characterize the tissue microstructures in the epithelium and subepithelial layers. A reliable means to noninvasively image living tissues at high resolution could add substantially to the diagnosis, treatment, and monitoring of benign and malignant diseases within the upper aerodigestive tract.
Optical coherence tomography (OCT) is an emerging noninvasive, noncontact technology capable of high-resolution imaging of the mucosal epithelium and lamina propria (LP). Optical coherence tomography combines light from a low coherence light source with a Michelson interferometer to produce cross-sectional images of tissue structures. Conceptually, OCT is analogous to B-mode ultrasonography but uses broadband near-infrared light, rather than sound energy, to produce images with a resolution approaching that of light microscopy (10-15 μm).5,6 Optical coherence tomography images differences in the tissue optical properties, which includes the effects of both optical absorption and scattering. Tomographic systems are used in ophthalmology and dermatology, but in vivo study of OCT in the human oral cavity and oropharynx has been limited.7,8
In this study, we used a multipurpose OCT system for imaging the oral cavity and oropharynx during surgical endoscopy and in the clinical outpatient setting with the primary objectives of characterizing tissue microstructures and evaluating the efficacy of OCT to image the surface and submucosal tissues.
Optical coherence tomographic imaging was performed on patients undergoing oral examination in the outpatient clinic and during surgical endoscopy at the University of California Irvine Medical Center under protocol approved by the Human Subjects Institutional Review Board at the University of California Irvine, Orange. While the patient was under general anesthesia, OCT imaging was performed with a handheld probe positioned manually or with endoscopic guidance. Digital photographs of imaged areas were obtained and, when clinically indicated, correlative biopsy specimens were obtained.
The components of our fiber-based OCT system are schematically illustrated in Figure 1. Near-infrared light from a broadband light source (central wavelength λ = 1310 nm, FWHM [full width at half maximum] Δλ = 80 nm, AFC BT 1310; JDS Uniphase, San Jose, Calif) enters a 2 × 2 fiber coupler. In the reference arm, a rapid scanning optical delay line attains A-scan at 500 Hz without phase modulation. A phase modulator generates 500-kHz phase modulation for heterodyne detection. Signals backscattered from the sample arm are obtained by phase-resolved processing with the interference fringes. The lateral and axial resolution of the system is approximately 10 μm per pixel. The horizontal image window was set laterally from 2 to 10 mm in length while detailed images of tissue microstructure were recorded up to a depth of 1.6 mm, depending on the turbidity of the media.
To image the oral cavity and oropharynx in vivo, a custom flexible OCT probe was designed to accommodate specific anatomical structures (Figure 2). The probe consists of a 900-μm, single-mode, 1310-nm OCT imaging fiber distally mounted with a gradient refractive index lens and a 0.7-mm right-angle prism (Figure 3). The gradient refractive index lens is 1.00 mm in diameter, has a 0.23 pitch, and works as a focuser. Mounting of the prism and gradient refractive index lens is performed with an optics grade, low-viscosity, wicking UV glue. Scanning is achieved by linearly translating the fiber optic along the long axis using a motorized stage (model 663.4pr; PI Line, Tustin, Calif). The fiber optic and optical elements are enclosed by a transparent plastic tube (1.95-mm inner diameter, 0.21-mm thickness, fluorinated ethylene propylene material), which is mechanically supported and protected by a secondary outer stainless steel cylinder. To help orient the user, colored markings were made along the sides of the optic fiber and opposite light exit along the fiber tip.
The probe design was optimized during clinical evaluation to decrease bulk, improve acquisition speed, and optimize image quality. The current design was used for more than 95% of cases reported in this study. Image acquisition was monitored in real time on a 17-in LCD (liquid crystal display) monitor placed alongside the endoscopy video monitor. The entire OCT system is contained in a mobile endoscopy tower.
Images from multiple sites in the oral cavity and oropharynx were obtained. Acquired images were then sorted into the following 4 categories: normal healthy tissues, benign pathologic features (nonmalignant and precancerous lesions), invasive cancer, and transition zones at the borders of benign and malignant lesions. A breakdown of the images obtained at each anatomical site is tabulated in Table 1 and Table 2.
In cases in which biopsy specimens were obtained, histopathologic features were compared with OCT images to assess epithelial thickness, basement membrane (BM) integrity, and characterization of tissue microstructures within the LP. The OCT images were then used to construct a database of normative in vivo tissue microanatomy and pathology.
Forty-one adult subjects ranging in age from 24 to 89 years participated in an OCT study of the oral cavity and oropharynx. Optical coherence tomographic images were collected from multiple sites during operative endoscopy in 34 subjects and in the outpatient clinic in an additional 7 subjects. When clinically indicated, histologic biopsy specimens were obtained and compared with OCT images and lesion photographs. In cases in which no biopsy was indicated, comparison of OCT images was made using standard histologic criteria.9-13 The distribution of images obtained is displayed in Table 1. Images were collected, and categorized, first separating normal anatomical structures from pathologic lesions. Images from clinically evident pathologic lesions were subdivided into benign processes, premalignant lesions, and malignant lesions. Attention was also given to images demonstrating transitions from pathologic tissue changes and normal histopathology. Multiple benign and malignant pathologic lesions were identified, and are tabulated in Table 2.
The following tomographic series represents a survey of tissue imaging in which epithelium, BM, LP, and other regional microstructures were clearly identified in normal tissues using OCT (group 1). Each OCT image represents a specific region of interest with common and unique characteristics. Figure 4 is a classic OCT image of normal buccal mucosa with clear identification of the stratified squamous epithelium (SS) along the mucosal surface, the underlying LP, and the transition between these tissues along BM boundary. The darker appearance of the epithelium is directly related to its lower optical density and scattering properties, which, in turn, results in lower signal intensity. By contrast, the LP is a more optically dense tissue and appears brighter in comparison caused by a higher signal intensity. Taking note of these optical differences, OCT permits identification of seromucinous glands along the mucosal surface of the lower lip (Figure 5), filiform papillae along the dorsum of the tongue (Figure 6), and the elaborate glandular duct system within the floor of the mouth (Figure 7). Signal propagation or absorption allowed for further characterization of tissue microstructures. Duct and lymphatic systems are characterized by regions of low signal intensity (black regions), which likely represent clear fluid that does not scatter or absorb light. As a result, signal intensity is relatively undiminished after passing through these structures and is readily observed beyond their distal walls (Figure 8). In contrast, blood vessels produce an “optical shadow” with the absorption of light by hemoglobin and the result of the image loss beyond the point of the proximal vessel lumen (Figure 9). The normal tissue OCT studies (group 1) provides a set of reference images for comparative analysis with diseased tissues (groups 2-4).
In group 2, tissue microstructure was different in comparison with native tissues depending on the pathophysiology. For example, in Figure 10, OCT images of a mucus-filled vallecular cyst show 2 thin tissue layers and a region of hyperplastic epithelium enveloping a large region of low signal intensity (presumably turbid mucus); correlative endoscopic and histologic images are provided for comparison. In other accounts, signal intensity and uniformity of regional epithelium was markedly different compared with group 1. As seen in Figure 11, OCT imaging of leukoplakia revealed increased optical density of the epithelium, superficial signal “flash points” with secondary shadow formation, and a varying epithelial thickness (Figure 11). These findings represented acanthosis, hyperkeratosis, mild dysplasia, and chronic inflammation in correlative histologic analysis.
In invasive malignant neoplasms (group 3), marked changes in the appearance of the OCT images were identified. Ablation of the tissue architecture and elimination of the BM were seen in all cases of histologically proven malignancy. Figure 12 clearly demonstrates the characteristic loss of layering and BM integrity. Elimination of the BM in addition to the destruction of normative tissue microstructures produced images with poorly identifiable landmarks, boundaries, or microanatomical structures.
During the study, careful attention was made to image the clinical margins of both benign and malignant lesions (group 4). Disruption of tissue architecture was observed as pathologic tissues encroached into healthy regions. In Figure 13, the transition from normal epithelium and BM to invasive tumor is clearly demonstrated. Furthermore, tangential orientation of OCT imaging along the boundary of a lesion revealed multiple points of BM invasion offset by islands of intact microarchitecture (Figure 14).
The histologic images shown in Figures 10, 11, 12, 13, and 14 illustrate the submucosal microanatomy for each of the related OCT Images. These histologic cross sections correlate with the OCT cross-sectional images, confirming the findings noted above.
The in vivo characterization of mucosal and submucosal tissues is of exceptional value in the treatment, diagnosis, and monitoring of both benign and malignant diseases within the upper aerodigestive tract. The tissues of the oral cavity and oropharynx are readily accessible with epithelial changes observed long before BM transgression in premalignant conditions. Unfortunately, considerable challenges exist in distinguishing premalignant lesions from early tumor development on physical inspection and with current noninvasive modalities. Characterization of pathologic lesions is limited by the inability to look into the tissues. Visual imaging provides information about the surface of the lesion but very limited information about the BM and subsurface structures.
Within the oral cavity and oropharynx healthy epithelium varies from 75 to 550 μm in thickness while the underlying the LP may extend up to 2000 μm.12,13 To reliably characterize mucosal pathologic processes an imaging modality must have a functional resolution approaching 10 μm.14 In comparison, the effective resolutions of magnetic resonance imaging (0.5-1 mm), computed tomography (0.5-1 mm), positron emission tomography (1-5 mm), and ultrasonography (100-500 μm) are at least an order of magnitude larger than required to observe pathologic changes in the boundary between the epithelium and the LP.15-17 Other modalities, such as contact endoscopy, use in vivo staining with methylene blue, acetic acid, or indigo carmine to produce a resolution of 10 to 71 μm with the capability of observation up to 100 μm below the tissue surface.18 Only the most superficial layers of the epithelium can be visualized due to intrinsic optical limitations, and the images are obtained in an en face plane, an orientation that clinicians trained in reading cross-sectional histology are unaccustomed to. Furthermore, many disease processes of the oral mucosa result in immense epithelium thickening, thereby precluding any possibility of BM evaluation using existing technology.14,19 As a result of these limitations, tissue biopsy remains the diagnostic procedure of choice.
Optical coherence tomographic imaging can produce detailed cross-sectional images of the subsurface microstructure at an axial resolution of approximately 9 μm and a lateral resolution of 10 μm using safe low-power near infrared light in vivo and in real time. Optical coherence tomography has been used in ophthalmology,20-22 but its use in the head and neck has been limited, as imaging requires the patient to remain motionless and endoscopy is often needed to visualize the region of interest. Because of the combined requirement for the patients to remain motionless and the need for general anesthesia in most head and neck endoscopy, most studies to date have focused on the ex vivo imaging of analogous animal tissues.7,8,23-25 Ex vivo tissue has considerably different optical properties than in vivo due to the loss of blood, oxidation of hemoglobin, and tissue desiccation. In the head and neck, only a few limited in vivo imaging studies have been published that have focused on patients with cancer. Sergeev et al26 and Bouma and Tearney27 have reported the use of OCT in the aerodigestive tract. These findings were limited by the challenges in the depth of imaging, resolution, and speed of image acquisition inherent in OCT imaging. By using a different light source and a faster and more robust piezoelectric translation stage, we have been able to improve resolution from 15 to 20 μm to 10 μm, increase maximum image depth by almost 50%, vary the horizontal image width from 2 mm to up to 10 mm, and increase the frame capture rate from 1.5 to 2 seconds for a 2-mm scan to 1 second for a 6-mm scan. The improved resolution and depth of imaging allows more rapid and precise characterization of the tissue structures, which we have used to perform extensive in vivo imaging of normal, benign, and malignant tissues in the oral cavity and oropharynx.
This study confirms the feasibility of using OCT to identify differences in mucosal and submucosal tissue structures of the oral cavity and oropharynx. Epithelium, LP, and BM boundaries were clearly identified in all normal tissues imaged. Each tissue microstructure, including papillae, glands, ducts, and blood vessels, revealed unique optical characteristics that allowed for image correlation with known histologic features. Optical coherence tomographic imaging of pathologic conditions such as leukoplakia revealed benign changes in epithelial density and tissue thickness without alteration in the BM. In contrast, OCT images of early cancer revealed ablation of normal tissue microanatomy in addition to BM compromise. Further imaging of lesion borders revealed transition zones between cancerous and noncancerous tissues. Optical coherence tomographic images of these clinically suspicious lesions were correlated with histologic specimens and intraoperative digital photographs. Of particular note were the considerable histologic distortions created by tissue biopsy as well as fixation of specimens when compared with OCT images of the same region. The in vivo OCT imaging of living tissues may represent a truer biologic picture than any image produced by other high-resolution modalities.
The ability to perform in vivo tissue imaging with a noninvasive, high-resolution modality could significantly alter the detection and management of early stage disease. With the capability to perform a tomographic study, one could easily monitor disease, document progression, and target tissue biopsy specimens to regions of greater histologic yield. Additionally, OCT is an evolving imaging modality where both improvements in source coherence bandwidth and electromechanical design will lead to higher-resolution images and faster frame rates.
The application of this high-resolution imaging modality provides valuable information on the physiology of benign mucosal disorders and on the development, transformation, and progression of cancer. Our ongoing OCT investigations are focused on new applications in children, microsurgery, and office-based instruments, in addition to continuing to expand our adult clinical series.
Correspondence: Brian J.-F. Wong, MD, PhD, or Zhongping Chen, PhD, Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Rd, East Irvine, CA 92617 (email@example.com or firstname.lastname@example.org).
Submitted for Publication: May 3, 2005; final revision received March 12, 2006; accepted April 22, 2006.
Author Contributions: Drs Ridgway, Jackson, Crumley, and Wong had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Ridgway, Jackson, Guo, Armstrong, Crumley, Chen, and Wong. Acquisition of data: Ridgway, Guo, Mahmood, Su, Armstrong, Shibuya, Crumley, Chen, and Wong. Analysis and interpretation of data: Ridgway, Armstrong, Crumley, Gu, and Wong. Drafting of the manuscript: Ridgway, Su, Armstrong, and Wong. Critical revision of the manuscript for important intellectual content: Ridgway, Jackson, Guo, Mahmood, Armstrong, Shibuya, Crumley, Gu, Chen, and Wong. Statistical analysis: Ridgway. Obtained funding: Wong. Administrative, technical, and material support: Ridgway, Jackson, Guo, Mahmood, Su, Armstrong, Shibuya, Gu, and Wong. Study supervision: Armstrong, Crumley, Chen, and Wong.
Financial Disclosure: None reported.
Funding/Support: This study was supported by grants DC 006026, CA 91717, EB 00293, RR 01192, and M01-RR00827-28 from the National Institutes of Health, grant 32456 from the Flight Attendant Medical Research Institute, grant 12RT-0113 from the State of California Tobacco Related Disease Research Program, and grant F49620-00-1-0371 from the Air Force Office of Scientific Research, and the Arnold and Mabel Beckman Foundation.
Previous Presentation: This study was presented in part at the annual meeting of the American Head and Neck Society; May 15, 2005; Boca Raton, Fla.
Acknowledgment: We thank master machinist Rudolph Limberg and Steve Knisley for assistance with construction of the instrument and Aya Yamamoto, RN, and Clevan Barclay, ST, for their help and patience in the operating room.

domain: biology


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We’re looking for photos of the new street in all its glorious shapes and forms. We want streetscapes, street life and street trees; locals in locomotion and visitors experiencing the magic, robots and aliens too. Anything you feel makes this street unique, marvelous and awesome, in addition to plain old charming. Post your images on Flickr and tag them “roncy”.
Oh, and dear photographers please mark your calendars: don’t miss the action on July 23, 2011 starting on the High Park Library lawn at 10 a.m.

domain: artistic


Local Leaders Want Businesses To Help With Earthquake Relief“I think that Chicagoans have a big heart. If you can donate only one dollar, it’s a dollar more than we had.”
Former Bow Truss Coffee Workers Sue Company For Wage TheftMore than a dozen former employees of the Bow Truss Coffee Roasters chain have sued the company’s founder, accusing him of failing to pay them after their paychecks repeatedly bounced.
Emanuel, Aldermen Leery Of Trump's Threat To "Send In The Feds" To Fight CrimePresident Donald Trump did not specify what he meant when he threatened to “send in the feds” if Chicago doesn’t get violent crime under control, but city leaders and clergy said the last thing the city needs is National Guard troops on every street corner.
Aldermen Hold Off On Plan To Overhaul TIF RulesA City Council committee has delayed an effort to tighten the rules for the city’s often-criticized tax increment financing system.
Emanuel Allies: Garcia Budget Plan As Real As 'Leprechauns And Unicorns'At a City Hall press conference, City Clerk Susana Mendoza and three aldermen who back the mayor rolled out a couple of hand trucks of budget books and audits they claim mayoral challenger Jesus "Chuy" Garcia could use to craft his budget plans.
Aldermen Furious At McCarthy's Lack Of Data On Police StaffingAt City Council budget hearings on Thursday, some aldermen were angered that Police Supt. Garry McCarthy could not immediately tell them exactly how many officers are currently on the force.
Alderman Takes Matters Into His Own Hands To Fill PotholesCBS 2’s Derrick Blakley the city's so slow to fill the potholes, 22nd Ward Alderman Rick Munoz is taking matters, and a shovel, into his own hands.
2 Investigator Dave Savini Comes To Aid Of Neighborhood CBS 2 Investigator Dave Savini was in the 22nd Ward recently, working on a story and doing what he does best: chasing bad guys and making them nervous.
Aldermen Form Caucus To Push For Reform AgendaSeveral members of the Chicago City Council said Tuesday they’ll be speaking out and pushing hard to reform City Hall, which could put them at odds with Mayor Rahm Emanuel and some of their colleagues.
Aldermen Block Mayor's Ethics Reforms, For NowMayor Rahm Emanuel suggested he was not all that concerned that aldermen had balked at his proposed ethics reforms for the City Council.
Aldermen Calling For Controversial O'Hare Janitorial Contract To Be Re-BidSome Chicago aldermen said Tuesday that the city’s janitorial contract at O’Hare International Airport should be rebid, over concerns about the layoffs the contract would mean for union janitors, as well as the company’s ties to mob figures.
City Council 'Progressive Caucus' To Host 3 Public Hearings On BudgetMembers of the Chicago City Council’s self-described “progressive caucus” said the mayor’s office isn’t giving residents enough of a chance to discuss the city budget, so they’ll hold more budget hearings of their own.


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Lake Como has been a popular destination for centuries because of its beauty and mild climate. Located in northern Italy, the area around Lake Como begins to take on the crisp air of the Alps, becoming slightly cooler and drier than the country’s southern peninsula. The entire area has hosted some of the world’s greatest writers, composers, performers, painters, actors, and diplomats while continuing to astound its visitors with breathtaking scenery and priceless monuments. In fact, a mere one-week stay is enough to take the visitor through several centuries of history.
The vibrant and bustling city of Como, found in the southernmost tip of the lake’s left arm, offers its visitors many museums, churches, fine cuisine and numerous recreational activities. On the list of every itinerary to this city should be its imposing cathedral, the Duomo, which started construction in 1396 and underwent many changes until it was finally completed in 1740. While the primary style of the building is Romanesque, such touches as the rose window and the other decorative accents show the influences of later styles as well.
Visitors interested in science should also pay a visit to the Tempio Voltiano in Como. This museum honors the work of Alessandro Volta, whose research helped further the development of the electric battery. Much of the actual equipment that Volta used in his experiments is still in the museum. After having traversed through the interactive exhibits, the gift shop can be a good place to stop and buy some unique souvenirs.
The Teatro Sociale is one of the most venerable locations in northern Italy. It is here that locals and tourists alike can get together to hear their favorite modern performers or simply enjoy a classical play. The seats are made of plush velvet and showcase the utmost care that has been taken to keep the theater in perfect condition. Also, the intimate size of the venue ensures that there are truly no bad seats in the house!
From Como, one can travel by ferry, bus or car to explore other popular towns such as Bellagio, Menaggio and Varenna. These quaint villages are wonderful getaway locations where one can truly relax, whether it be through inspiring walks, tasting local dishes such as polenta or by taking part in thrilling water sport activities. The slow ferry can also make a stop at Isola Comacina, the lake’s only island. It hosts numerous archeological sites such as the famed Gothic spire at the Romanesque basilica of St. Mary Magdalene.
Some of the oldest buildings in this area of the lake include the 11th century castle Castello di Vezio, just up the mountain from Varenna. It only takes about half an hour to hike up the mountain using a cobblestone path but rewards its visitors with breathtaking views in all directions. Another very interesting destination is the 12th century church of Santa Maria del Tiglio, found even further north in the town of Gravedona, featuring well-preserved frescoes and an impressive, wooden crucifix.
A few more ideas for exploring Lake Como off the beaten track…
There are numerous hiking opportunities all around Lake Como offering spectacular, majestic views of the mountains that surround the lake. For those who prefer to take a cable car to reach some of these viewpoints, there is one cable car that leaves from Argegno leading up to Pigra, and another that leaves from Como, leading up to the small village of Brunate. Coming down, you can either return on the cable car or take a hike back down the hill, enjoying the views along the way.
The Museum Moto Guzzi, in Mandello del Lario, commemorates the manufacturing of one of the oldest brands of motorcycles in Italy. Make sure you stop by between 3:00 and 4:00 PM, as that is when you are allowed to tour the old factory. There is no guide, but as you walk by the old bikes, you can read the plaque by each one to learn more about them. There is a small gift shop, and it is a convenient walk from the town’s train station.
Most architecture aficionados visit Italy for its diverse array of World Heritage Sites. However, the Ex Caso del Fascio, designed by architect Guiseppe Terragni for the Italian dictator Benito Mussolini may offer an interesting alternative. It still stands next to the city’s historical center and combines all of the major architectural movements that were at work in the 1930s, engaging its viewers with an interplay of many different architectural elements and geometric designs.
Not everyone comes to Italy to play golf, but the Menaggio & Cadenabbia Golf Club in Menaggio is quite interesting as it follows the British “links” style of course design. Indeed, the “19th hole” takes one back to the way that golfers played in the 1920s and 1930s. The views of the surrounding area are truly spectacular while one engages in a game.
For further details and other interesting activities around the lake, browse our Como Guide site.
Originally posted 2017-03-05 20:33:02. Republished by Blog Post Promoter

domain: geography


text:
Tiger nut seller, Ohemaa dies together with her child few minutes after delivery at Winneba Hospital.
Ohemaa has been selling tiger nuts on the streets of McCarthy hill, a suburb of Accra after she divorced her first husband with whom she had four children. The hardworking woman re-married but still had to struggle to help her husband in taking care of the family even when she was heavily pregnant.
She disclosed the difficulties and struggles she goes through on the street as she was in her ninth month of pregnancy. “I extremely get exhausted while running up and down in the traffic. I don’t find it easy at all. Even the horns of motorbikes and cars make me panic a lot”.
Her condition, she said makes people laugh at her but she is not discouraged by their attitude. “I take the tiger nuts on credit and if I stop selling them, the tiger nut will get spoilt and I will be in debt”. She said.
After Crime Check Foundation aired Ohemaa’s story, it touched the hearts of many including Shalom Prayer group in France and Madam Gifty and her mum, Grace in the United States, who gave her an amount of Five hundred Ghana cedis each. CCF through its other donors also gave her two bags of rice, two bottles of oil and three tins of tomato paste.
In addition, a donor of CCF, Grandma in the U.S gave her food items such as brown rice, tomato paste, spaghetti and clothes among others for her upkeep.
Few weeks after Grandma’s donation, Ohemaa has been reported dead few minutes after delivery. “I was told after delivery, she experienced excessive bleeding which led to her death. The child also died together with her at the Winneba hospital”, says Ohemaa’s mother, Akosua Ampofowaa.
The 70 year old woman said she has been aggrieved ever since she heard the news. “I was with Ohemaa some few weeks ago. I decided to leave her place for a while and revisit after her delivery. I even spoke to her not long ago to assist me in buying my drugs. She was so much of help to me whiles alive.” She said.
The aggrieved mother thanked the donors of the Foundation for their immense support towards her daughter and encouraged them to do same for other people in need.

domain: sociology


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Dental implants don’t need crowns, clasps, or suction to stay in place. Instead, we insert them into the jawbone like natural tooth roots. In today’s blog, we’re going to look at this process in depth, and explain the benefits of addressing tooth loss with implant dentistry. Find out when you should contact your Newhall, CA, about replacing missing teeth!
Planning Your Treatment
First, we’re going to use advanced Cone Beam 3D scanning technology to carefully create detailed images of your teeth, roots, jawbone, and oral structures. Using these materials, we can help choose the best area to place your new implants. After all, since these act as new tooth roots, they need to be able to absorbs daily bite forces and provide a dependable chewing surface. Once we plan the placement process, we move on to adding your new tooth roots.
Guiding the Process and Osseointegration
Each dental implant is made from titanium, a biocompatible material that bonds with the jawbone tissue. We insert them into jawbone itself, using advanced technology to guide the process and ensure we place them in the optimal area of your jawbone. Then osseointegration will take place, which bond them with the jawbone and ensures they have the potential to last for decades, possibly even a lifetime.
Restoring Your New Teeth
After we insert your new roots, we will focus on the visible portion of your new tooth or teeth. For an individual one, we attach an abutment that holds a dental crown in place. We custom-make the crown to ensure it blends with your smile seamlessly, and the materials will be able to absorb daily bite forces. If you have lost several teeth, then the next step may involve creating a bridge or a denture, that we attach to the new dental implants. These prosthetics will never need to be removed for cleaning or soaking, and they can last for several years with proper care and attention. If you have any questions about treating tooth loss or about creating our custom and lifelike dental implants, then contact our team today. We know how vital a full smile is for our appearance and overall health, and our team is ready to help you through each step of the process!
Do You Have Missing Teeth?
Restoring your lost teeth improves the function and stability of your smile. Whether you have lost one tooth, or most of them, we can secure lifelike and long-lasting replacement options. To learn more about addressing tooth loss with a lifelike implant option, then please schedule a consultation by calling Newhall Dental Arts in Newhall, CA, today at (661) 259-7760. Don’t let tooth loss lead to problems for your quality of life!

domain: medical


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Find the perfect RV rental in Paintsville Lake Campground, KY. Simple, easy, and fully insured.
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An hour's drive east of Lexington along the West Virginia-Kentucky state line lies one of Kentucky’s best state-run campgrounds. This isolated, rustic area in eastern Kentucky is nestled snugly into the foothills of the sprawling Appalachians, an ancient chain of mountains with mesmerizing views and stunning natural beauty.
The campground itself is rather small, offering just over 40 sites in the forest groves in the rolling hills. Most of these spots allow for camping in tents, but when you rent an RV near Paintsville Lake Campground, you can stay on the lakefront in a cozy, spacious, private campsite, equipped with electric and water hookups. Hot showers and clean restrooms are within walking distance of each site, so you won't need to walk too far to access them. When you're ready for a trek, you can enjoy hiking on one of the many nature trails meandering through the area.
In addition to hiking, guests can swim, kayak, canoe, go fishing, or read a nice book on the shores of Paintsville Lake. Playgrounds, concert performance spaces, a full-service marina, boat ramps, volleyball courts, and a myriad of other fun features await when you're camping at Paintsville Lake Campground.
Kentucky is a wonderland of natural beauty, sought out by outdoor enthusiasts from all over the country for its magnificent mountains, sprawling forests, lakeside recreation spots, and epic caves. Guests who rent an RV near Paintsville Lake Campground can enjoy one of Kentucky’s best state parks without even leaving their campground, as it's part of the larger Paintsville Lake State Park. All the neat amenities like the park’s hiking trails, picnic pavilions, and lakeshore swimming areas will be more than enough to keep you occupied while you stay at the RV campground, and you won’t even need to drive anywhere to enjoy it.
Grayson Lake State Park and Jenny Lake State Resort Park have more of the same, and when it comes to exploring by the lake, you won’t find much better. Grayson Lake State Park in tiny Grayson, Kentucky, has a whole bunch of activities to take part in, like golfing, boating, water skiing, fishing, swimming, and more. Jenny Lake State Resort Park has wilderness lodges, beautiful campgrounds, and a wide-open lake good for just about any water-based activity you can think of.
Nearby Daniel Boone National Forest is the largest wilderness area in all of Kentucky, not too far from your campsite at Paintsville Lake State Park. There are hundreds of places to camp, 600 miles of hiking trails, and several National Natural Landmarks to be seen while driving through this legendary forest.
Over by the city of Bowling Green, you can see the state’s only national park if you don’t mind a small road trip through the Bluegrass State. Mammoth Cave National Park is home to the largest and longest known cave system in the world, so gear up and get ready to explore some subterranean caverns with their own ecosystems and rare bat species. Four hundred miles of passageways in this underground labyrinth mystify and impress all who visit the incredible natural landmark, so don't miss out on it when you pick up your campervan rental near Paintsville, Kentucky.
Paintsville is a small rural community in eastern Kentucky and has a fair number of things to do considering its small size, with small-town diners, little taverns, tiny country shops, and some historical sites. The Stafford House is a small piece of local history, found in the heart of the city. This charming, elegant home was built in 1843, making it the oldest standing building in Paintsville.
Another fun historic site celebrates the life of Loretta Lynn, the so-called “Queen of Country Music.” This legendary performer was born and raised in Paintsville, and her childhood home, the Loretta Lynn Cabin in Butcher’s Hollow, delights country music fans and historic site lovers alike. Visitors to this divine part of Appalachia can really get a feel for the mountain culture and unique heritage of the region when they head to the Loretta Lynn Cabin and learn about the early life of the country superstar.
The U.S. 23 Country Music Highway Museum further celebrates the tradition of Appalachian music, and when you book an RV in Johnson County, you should make this incredible place part of your itinerary. Full of memorabilia, old antique instruments used by country legends, and a bunch of black and white photographs paint a detailed picture of the music scene throughout the known history of Appalachia, making it a valued piece of history and heritage worth checking out when you do some Paintsville camping.

domain: travel


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Un essai écrit par le journaliste culturel togolais Tony Feda sur la reconnaissance du génocide des Hereros commis par les troupes allemandes au début du XXe siècle et sur les survivances du colonialisme qui affectent aujourd’hui encore la vie et la politique en Afrique.
An essay from Togolese journalist Tony Feda about the recognition of the genocide of the Herero’s committed by German troops and how traces of colonialism are still affecting contemporary life and politics in Africa.
»In my view, doing cultural journalism is tantamount to making big politics.« An article about the cultural journalist Komi Antoine Feda's everyday encounters with culture politics in Togo.
»I'm the son of Syria and the son of war and the son of refuge.« The Syrian writer Assaf Al Assaf in an interview with Palestinian journalist Rasha Hilwi.
Three self-introductions of the cultural journalists who have been invited for a five-month fellowship – Yania Suárez Calleyro, Komi Antoine Feda, and Rasha Hilwi
To stay on the fast moving Wild West of the emerging VR industry and to live in Eastern Europe are two things that don’t get along very well, says Andrius Lekavicius.
For journalists, developers/coders, designers, artists, and all other creatives and professionals who work on digital projects. The deadline is June 30, 2016.
In her multimedia longform »Ackerbunt,« journalist E. Weydt tells the impressive story of two sisters in the Andes growing potatoes 3,500 meters above sea level.
The web project »Mapping Frictions« by Australian journalist Kavita Bedford aims to tell stories from the vibrant multicultural local community of Western Sydney.
Elisabeth Weydt, fellow for digital journalism, gives an insight into where her passion for stories started and new ways to tell them through digital journalism.
»I passionately believe in a ›born digital‹ approach to content.« An interview with Andrius Lekavičius, fellow for digital journalism.
For the multimedia report by NRD, WDR, and Süddeutsche Zeitung on the world bank, Elisabeth Weydt did investigative research for ten months in an international team of 50 journalists.


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14 May 2021
Rice is coming under attack from those who say we should reduce our dependence on it or even—shock, horror—remove it from our diet completely. But is rice actually ‘bad’ for us?
In the colonial 19th century, the Malayan people were tasked with clearing land for rice farming. Regional neighbours Siam, Indochina and Burma had already established themselves as rice exporters, and Malaya was quick to follow. The cultivation of rice in Malaya was to compete with other colonial powers like the Dutch. This in turn caused a drop in prices for rice, and countries around the region had a surplus of food. Rice was then used as a commodity for trade and sustenance for Indian and Chinese migrants in Malaya.
Today, it’s common knowledge that rice is a carbohydrate-rich food that provides energy and contains moderate amounts of micronutrients. And although rice is a well-loved, substantial source of energy, a growing global trend has started to demonise the humble grain. This denigration of our starchy staple had been popularised largely by the Western media, claiming that rice is lacking in nutrients and is full of sugar. In 2017, The Independent UK published an article titled ‘Why you should stop eating white rice, according to a physician’, just one example of the fear-mongering that surrounds white rice.
This ‘fear’ stems from the idea that all bleached white products such as flour and rice are ‘bad for you’ because they contain no significant amount of fibre or other key micronutrients that are needed daily. It’s also widely feared that rice can cause Type 2 diabetes, because of its high sugar content.
As Malaysians grow to be more health-conscious, our rice-loving palates beg the question: Is rice really ‘good’ or ‘bad’ for you?
We put the question to Leonard Yap, a dietitian at LiveSmart Malaysia. He told us that rice as the main source of carbohydrate and energy can also be a good source of vitamins and minerals. Vitamin B complexes such as thiamin (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6) and folate (B9) are all found in rice in moderate amounts. These water-soluble vitamins are vital for energy production and are important cofactors for many enzymatic reactions found in the body.
As for minerals, magnesium, which regulates muscle health and nerve function, is found in rice in moderate amounts. Rice also contains a moderately low amount of iron, an important mineral for the formation of red blood cells. Lastly, a substantial amount of manganese is found in rice – this functions in many enzymatic reactions and is needed for protein, cholesterol and carbohydrate metabolism.
Rice can come in many forms but the two kinds we most commonly eat in Malaysia are long and short-grained white rice, like basmati or fragrant jasmine rice. White rice itself, milled rice that has had its husk, bran and germ removed, owes its popularity to the food scarcity caused by World War II. The milling process lengthened rice’s shelf life, making it a valuable and shelf-stable commodity. These days, new rice products that differ in their variety and colour of grain are increasingly common. Are these new varieties and their multitudes of colours any more nutritious compared to white rice?
Well, yes. According to Leonard, “Wholegrain rice such as black heirloom rice compared to white rice is definitely superior in nutrients. It contains more of the existing vitamins and minerals but also provides more fibre and some varieties may contain anthocyanins which are antioxidants that can be found in red, purple and black wholegrain rice.”
What about the nutritional differences between whole-grain varieties? The difference there is less stark—only minor differences may be seen in terms of nutrient density. Interestingly, whole-grain rice has a higher calorie count compared to white rice—the upside of consuming brown rice is its low glycemic index. Glycemic index (GI) is the measure of how much a specific food increases your blood sugar levels. The higher the GI, the higher or faster your blood sugar levels will increase. High GI foods are quickly digested in the body while low GI foods may take longer to digest due to fibre content. In this case, a low GI is much better to control blood sugar while keeping you satiated for longer.
Rice as culturally sustaining
So what do Malaysian home cooks think? Judith Loh, a semi-retired childhood educator, said that rice has deep roots to Chinese culture and in Chinese households. For instance, when a child is unwell, they show signs of rejecting rice. And when their appetite for rice returns, it may indicate recovery.
Mary Easaw, a retired dietitian from the National Heart Institute and currently working as a senior lecturer in International Medical University, said: “In Indian culture, when it is asked if you have eaten, we’re referring to rice.” For both Judith and Mary, rice is a part of every meal, the varying factor only whether the rice is steamed, fried or made into porridge.
Neither of them would mind paying a few extra ringgit for a pack of wholegrain rice such as brown rice. Judith said: “Brown rice is not very commonly eaten in Chinese families but since I’m older, I look into the benefits of rice and its effects on me.”
Hajar Haslina, a retired secondary school teacher, keeps approximately seven types of rice in her pantry, all varying in texture and size and some that are specific for dishes such as nasi dagang. To her, various types of rice is a necessity in her home and is always factored into her monthly expenditure.
For these women, the value of rice stems from it being a staple starch as well as the nourishment and potential benefits it provides. “There is no need to cut down on rice,” says Mary, “only the need to educate people on how to eat it and understand its benefits.” Hajar added, “We don’t need to revolutionise food that nature has provided, we only need to revolutionise the way we consume it.”
We come back to the question of whether rice is really bad for you. The answer is no, it provides energy, sustenance and most importantly it’s a beloved staple to the everyday Malaysian. What can be bad for you is the uncontrolled consumption of rice, just like any good thing that’s taken to an extreme. It is our duty to understand and educate ourselves on how to manage our portion so we can enjoy eating longer.
Tunku Muhammad Tunku Farahat is a student of Dietetics with Nutrition at International Medical University with an interest in fermentation. He is also an abstract artist and writer.
Tapioca, past and present
A highly specific jollof rice
Kadazandusun cuisine and its future

domain: agronomy


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Magnificent waterways, world-class national parks, fine food and wine and an extensive number of trails make this easily accessible region (just 75 km south of Perth) a perfect getaway for a day or longer break.
The Peel region encompasses the townshops of Boddington, Mandurah, Dwellingup, Pinjarra, Serpentine-Jarrahdale and Waroona - with the region offering an abundance of forests, parks, rivers and other natural attractions.
The Mandurah foreshore and its meandering network of waterways make it a perfect haven for those who enjoy the water and what better way to experience these waterways than with a paddle. Alternatively, art lovers can enjoy the Federation Heritage Art Walk which will take you on an enlightening journey through Mandurah and Peel and feast on food and wine offerings along the way.
Inland you'll uncover the newly bustling adventure capital and evergreen forest township of Dwellingup - with bushwalking/hiking, mountain biking, 4WD and kayak trail options through jarrah forests and along the beautiful Murray river - with its winter rapids and slower moving segments. The region is also home to sections of the Bibbulmun Track and a Tree Adventure ropes experience that's great for kids.
Each town offers an array unique characteristics and attractions - including historic Pinjarra, resting on the banks of the tranquil Murray River, one of the oldest established towns in Western Australia. The area is also becoming increasingly celebrated as the horse capital of Western Australia, with its bridle trails.
Serpentine National Park features dense forests which also harbour a wealth of walking tracks. Serpentine Falls is a favourite picnic destination, with its cool, emerald-coloured waters - the falls are the perfect place to hike and enjoy a lazy afternoon.
The old milling town of Jarrahdale is a historic town where you can enjoy lunch at the local pub, enjoy delicious afternoon tea at one of the cafes or visit the stunning Millbrook Winery.
- Bike: Murray Valley Mountain Bike Trails
- Walk/Hike: Heritage Walk Trail - Pinjarra, Lane Pool Reserve - Dwellingup, Kitty's Gorge - Serpentine, Mt Cooke
- Paddle: Peel Region Canoe Trails
- Food & Wine: Peel Region Craft Beer and Wine Trail
- Art: Mandurah City Art Trail / Mandurah Marina Art Trail
Accessible Trail Options:


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Last week’s UK eShop line-up was a case of quantity over quality, with 23 games released before the week was out. This week’s 16 strong assortment of digital releases looks far steadier in terms of quality, despite big name titles being thin on the ground.
The first Scribblenauts Showdown (Â£34.99) reviews are starting to emerge as we type. Sadly, scores so far are mixed, which isn’t particularly helpful for those on the fence. Video Chums enjoyed the sandbox mode but found some mini-games too simplistic, finally opting for a respectable 7.6. Game Crate meanwhile deemed it mediocre, handing out a lukewarm 5.5. â€œIt has fewer puzzles, worse controls and less replay value than any other Scribblenauts title,â€ they said.
Fear Effect Sedna (Â£15.99) hasn’t had the sturdiest of launches either, with scores as low as 3/10. Read more on that here.
NORTH (Â£2.69) and One Eyed Kutkh (Â£4.49) are two other brand new releases. NORTH has been likened to an interactive art piece; an abstract walking simulator, if you will. Scores are predictably mixed, but it’s certainly cheap enough for anybody curious to take a punt. One Eyed Kutkh meanwhile is an interactive child’s storybook, of sorts, aimed at a slightly younger demographic. â€œThe gameplay remains simplistic throughout, making this a very accessible and easy to understand experience.â€ said the Xbox Tavern (no reviews of the Switch version are available currently).
Then we have Flinthook (Â£10.99), the very well-received grappling-hook based platformer, praised for its art direction and music. It’s a little bit brutal and old-school – or brutally old-school – but that’s ok. Scores for the PS4 version were a mixture of 7s and 8s.
Bleed 2 also hit the PS4 a few months ago, being a short but sweet twin-stick arcade shooter. It’s certainly worth a look. The same goes for EARTHLOCK (Â£22.49), a traditional RPG inspired by classics from the PS2 era.
The Switch also gets a belated conversion of Kona (Â£17.99), a first-person survival mystery set in snowy 1970’s Canada. If you missed it on PS4, here’s a second chance.
I, Zombie (Â£4.49) is something of a blast from the past, first hitting Steam in 2015 where it gained a reputation for being an inexpensive little time-waster.
The Metro’s review of 2D shooter roguelike Steredenn: Binary Stars (Â£11.99) went live today, gaining their recommendation (8/10). The Switch version includes an offline co-op mode, which â€“ to quote â€“ â€œmeans that no-one need miss out on one of the most original and fun 2D shooters we’ve played in years.â€
Here’s a rundown of more new releases due on Switch this week:
ACA NEO GEO REAL BOUT FATAL FURY – Â£6.29
â€œREAL BOUT FATAL FURYâ€ is a fighting game released by SNK in 1995. Using the previous system as a base, isolating the Sweep Button, the inclusion of Combination Attacks, and other elements such as ring outs make for an even speedier and tempo-based play style. Sixteen fighters battle it out to see who is the strongest.
30-in-1 Game Collection: Volume 1 – Â£13.49
Defend your village against Vikings, climb to the top of the tower and overcome obstacles, play a round of hockey, switch colors and pass safely through gates, or play the classics such as snake, memory or cup game!
Bit Dungeon Plus – Â£8.09
You and your beloved friend were captured by demons… You wake up what seems like hours, maybe even days later trapped in a prison cell, and your friend is missing. You find a sword in your cell and vow revenge against the beasts who took your friend – the quest to find your friend one and destroy the demons begins!
The Men of Yoshiwara: Ohgiya – Â£13.49
“The Men of Yoshiwara: Ohgiya” is a popular romance game in Japan aimed at a female audience. Step into the pleasure district of Yoshiwara with the roles of male and female reversed and enjoy a heart-rending love story.
TurtlePop: Journey to Freedom – Â£17.99
Master new gameplay with multi-character control and turtle-linking, environment manipulation, item deployment and match 3 mechanics that make challenges even more fresh, intense and fun! They are aided by â€˜The Genie’, who is an airborne support turtle that you can use to manipulate the game world and enhance the abilities of the turtles!
World Conqueror X – Â£8.99
Across dozens of battles and multiple modes, you manage a diverse range of troops and military units in turn-based conflict, utilising advanced strategies such as air defences, while always being mindful of battlefield environments and cities.
Midnight Deluxe – Â£4.99
Use your controller or touch screen controls to launch Midnight into the night sky, but watch out! The world of Midnight is a dangerous one thanks to the likes of spikes, circular saws and plenty of other dangerous objects.
Cycle of Eternity: Space Anomaly – Â£4.49
The story is twisted around three graduates of the space fleet, who fell into a time trap. Trying to get home they get into an even bigger mess. Fight with enemies, improve your ships, go through the story and try to free your heroes from the space trap! Classic turn-based RPG with the unusual story in the space.
Pre-orders for Bombslinger (Â£10.79) and Outlast 2 (Â£26.99) are also live on Switch, with Bombslinger being a roguelike-take on Bomberman. Ponchos at dawn!
Next week: Kirby Star Allies, Sparkle 3 Genesis, Aero Fighters 3, Enchanting Mahjong Match, and Gem Smashers.

domain: hobby


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In Dramatic Dialogue, Atlas and Aron develop the metaphors of drama and theatre to introduce a new way of thinking about therapeutic action and therapeutic traction. This model invites the patient’s many self-states and the numerous versions of the therapist’s self onto the analytic stage to dream a mutual dream and live together the past and the future, as they appear in the present moment. The book brings together the relational emphasis on multiple self-states and enactment with the Bionian conceptions of reverie and dreaming-up the patient.
The term Dramatic Dialogue originated in Ferenczi’s clinical innovations and refers to the patient and therapist dramatizing and dreaming-up the full range of their multiple selves. Along with Atlas and Aron, readers will become immersed in a Dramatic Dialogue, which the authors elaborate and enact, using the contemporary language of multiple self-states, waking dreaming, dissociation, generative enactment, and the prospective function.
The book provides a rich description of contemporary clinical practice, illustrated with numerous clinical tales and detailed examination of clinical moments. Inspired by Bion’s concept of "becoming-at-one" and "at-one-ment," the authors call for a return of the soul or spirit to psychoanalysis and the generative use of the analyst’s subjectivity, including a passionate use of mind, body and soul in the pursuit of psychoanalytic truth. Dramatic Dialogue will be of great interest to all psychoanalysts and psychotherapists.
'In this brilliant book, Atlas and Aron have done nothing less than shift the ground under our feet. In one fell swoop, the commodious metaphor of "dramatic dialogue," adopted from Ferenczi and then turned to wider use, makes it possible for the authors to see and describe commonalities among clinical and intellectual contributions that have often been considered incommensurable. In illuminating a whole new approach to the problem of psychoanalytic pluralism, and in a lucid, clinically rich text that covers an enormous range of ideas, Atlas and Aron are opening 'a door to the psychoanalysis of the future.'
-Donnel Stern, Ph.D., Training and Supervising Analyst, William Alanson White Institute, Clinical Consultant and Faculty, NYU Postdoctoral Program in Psychotherapy and Psychoanalysis.
Table of Contents
Chapter 1: Generative Enactments
Chapter 2: The Prospective Function
Chapter 3: Dramatic Dialogues
Chapter 4: Therapeutic Action and Therapeutic Traction
Chapter 5: The Truth of the Session
Chapter 6: Theatrical Engagement
Chapter 7: At-one-ment, Mutual Vulnerability, and Co-Suffering
Chapter 8: The Prequel
About the Authors
Galit Atlas, Ph.D. is on the faculty of the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis, and at the Four-Year Adult and National Training Programs at NIP. She is the author of The Enigma of Desire: Sex, Longing and Belonging in Psychoanalysis (Routledge, 2015). Her New York Times article "A tale of Two Twins" was the winner of 2016 Gradiva award.
Lewis Aron, Ph.D. is the director, New York University Postdoctoral Program in Psychotherapy & Psychoanalysis. Author and editor of numerous articles & books on psychotherapy & psychoanalysis, including A Meeting of Minds, and co-editor of the Relational Perspectives Book Series. He is well known for his study and reading groups around the world.

domain: library


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When you date someone, how do you think you're supposed to act?
Like yourself...if you start acting like someone else, it's going to be difficult to carry on the facade should the relationship work out, and then the person won't know who they are actually with.
Not 4 me!!! 4 my friend. I'm not dating anyone! Check my status on my page. Im single baby!
just act like yourself. thats why the person is dating you in the first place duhh lol
yourself. why act different? id rather them fall for ME instead of something im not.

domain: psychology


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This past summer I was “yardsaling,” which is one of my favorite things to do. I happened to find this fabric set, all cut out, at a very reasonable price. Can you see how much it cost me?? Yes, it was only 50 cents. Fifty cents!! All of the pieces were there, even the directions. Someone had cut it out, and then never finished the project.
Now I think I may have seen an old used version of this set before. The set was beyond saving, and so I had to pass it by. But this fabric was brand new! All I had to do was wash the fabric to freshen it up. Well, that and sew it all together and stuff it….
There was even a backdrop to complete the scene. I looked around online, and all I found was an uncut fabric panel of this same pattern, for $37. I estimate this panel to be around 30 years old. (Do any of my readers know?)
And so I began to work on this nativity scene. I laid out everything and read the directions several times. Everything had already been ironed and were as flat as could be. So much of the work had already been done for me! I sewed the fronts to the backs.
Each piece was clearly marked where to leave the seam opening, for stuffing and for turning the pieces right side out.
The backdrop has a back to it with “Away in a Manger” printed on it.
The only things not included (besides thread and stuffing) were the recommended flannel pieces to pad the backdrop. I used some flannel that I already had, and some batting. The only thing I needed to purchase was some iron on interfacing for the manger.
My Sewing Machine Cabinet
Here is my ancient sewing machine that someone gave me years ago. It was in a different cabinet then. I found this beautiful cabinet at an auction. No one else wanted it, so I got it for only….. $2! Can you believe it?! My husband was nice enough to adjust it a bit for me, so that my machine will fit and rotate down to close it all up.
Here is a close up of my Japanese made machine. A sewing machine repairman once told me that it was built like a tank! Most of it is made of metal. Only the buttons and dials are plastic.
My sewing machine cabinet doubles as an island in the kitchen when it is not in use. I have since moved it against the back wall, opposite the sink. So I guess now it is doubling as a buffet instead! I keep the recycle bin under it.
Enough about the machine– let’s get back to the project.
Here are the Three Kings front and back sewn together. I trimmed the circle for the bottom before sewing it on. The whole project was taking more time than I had thought it would. I had not counted on the third bottom piece– but that is what enables these pieces to stand up even though they are stuffed like a pillow.
So here at B4 and Afters I do strive to be complete in showing you how I did something, and that takes extra time. For example, I was going to show you this same shot of the shepherds, but guess what? Shepherds was spelled wrong on the bottom piece and I thought that would not be good, so I had to retake the picture using the kings instead.
Let me go ahead and mention here– do you have any idea how stopping to take pictures slows down a project?! Any time you see a step by step description like this let me assure you– the writer has taken great care to show you everything. I must take more than enough pictures to be sure that I have enough of each step– because if I do not– there is no going back to undo the project if I forgot something!
Here are the sheep sewn together.
I do most of my sewing without pinning things together, but pinning was a necessity in this case. I carefully pinned the bottom piece to the two top pieces, lining up the side seams and the places to be left open for turning and stuffing.
Here they are all sewn and ready to be stuffed!
Here is the back of the sheep:
The directions said to insert either cardboard or plastic canvas ovals in the bottoms of the people and animals. I decided to use plastic canvas in case they got wet accidentally, since cardboard could distort its shape.
I cut out these shapes, but because of the seam later had to trim them even smaller.
Here are the individual characters all sewn. But before stuffing them, I washed them and ironed them again. I wanted to sew them before I washed them, so that washing them would not damage the cut edges and make them fray too close to the seam. I was a little afraid to wash them, knowing the fabric was old. But they came out of the wash just fine, and did not fade or anything.
Here are the manger pieces on the interfacing. I washed these before ironing on the interfacing and sewing it all together.
- Ruffled Piano Bench Cover
- Removable Kitchen Chair Slipcovers
- Recliner Slipcovers
- Storage Chest Slipcover
I put the plastic canvas into the backdrop. This bottom seam would be hand sewn closed.
The last thing I had to do was stuff the main characters and hand sew all of their openings closed.
Here’s what I did step by step:
- sew fronts to backs
- sew bottom pieces to the matching top front/back
- sew the backdrop with padding together
- wash and iron everything
- insert the plastic canvas into all the pieces except the manger
- iron the interfacing onto the manger, sew, and assemble the manger
- hand sew the corners of the manger sides together
- stuff the people and animals
- hand sew all the openings closed
Finally it was alllll done! I LOVE IT! I didn’t think that I needed any more Christmas decorations. When I saw this set for 50 cents though, I just knew I could make room for it somewhere.
I crocheted the red, gold, and white dresser scarf as a teenager, more than twenty years ago. Here are the backs of everybody:
I hope that you have enjoyed seeing how I made this stuffed Christmas Nativity Scene!
The Star of Christmas: Jesus!


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This Shrimp And Bacon Mac And Cheese Recipe combines the rich flavors of shrimp, bacon, and cheesy macaroni for a deliciously satisfying meal. This comfort food classic is made with creamy cheddar cheese sauce, succulent sautéed shrimp, and crispy bacon bits, creating a mouthwatering combination of savory and indulgent flavors.
The buttery breadcrumbs sprinkled on top add a delightful crunch, while the parsley garnish adds a pop of freshness. Whether you’re looking to impress guests at a dinner party or simply craving a hearty homemade meal, this recipe is sure to hit the spot.
Get ready to indulge in a bowl of deliciousness with this irresistible Shrimp And Bacon Mac And Cheese Recipe.
A Decadent Twist On The Classic Comfort Foodhtml
Indulge in a rich and delicious mac and cheese experience. This recipe takes the classic comfort food to new heights with the addition of succulent shrimp and crispy bacon. The combination of these savory ingredients creates a truly mouthwatering dish that will leave your taste buds begging for more.
Start by cooking the bacon until it’s nice and crispy. Set it aside and sauté the shrimp in the bacon fat for a few minutes until they’re cooked through and beautifully pink. In the meantime, prepare the mac and cheese sauce, using a blend of cheddar, mozzarella, and Parmesan for maximum flavor.
Once the sauce is smooth and creamy, fold in the cooked shrimp and crumbled bacon. The result is a cheesy, gooey, and oh-so-satisfying mac and cheese dish that is sure to impress your family and friends. Serve it as a main course or as a side dish at your next gathering.
Ingredients You’ll Need
Gather all the necessary ingredients for this mouthwatering dish. Explore the variety of flavors that will make this recipe special.
- Shrimp: Fresh or frozen, deveined and peeled.
- Bacon: Crispy and chopped.
- Macaroni: Elbow or any pasta of your choice.
- Cheese: Cheddar, Gouda, or a combination, grated.
- Flour: All-purpose.
- Milk: Whole or 2%.
- Butter: Unsalted is preferred.
- Garlic: Minced.
- Onion: Finely diced.
- Nutmeg: Freshly grated.
- Salt and Pepper: To taste.
- Breadcrumbs: Panko or regular.
- Parsley: Fresh, chopped for garnish.
With these ingredients on hand, you are ready to create a creamy, cheesy, and indulgent shrimp and bacon mac and cheese that will delight your taste buds.
Step-by-step Instructions For Making Shrimp And Bacon Mac And CheeseHTML Content Begins
Step-by-Step Instructions for Making Shrimp and Bacon Mac and Cheese
Follow these simple instructions for a scrumptious homemade meal. Learn the secrets to achieving a perfectly balanced dish.
Start by cooking the pasta according to the package instructions. While the pasta is boiling, fry the bacon in a large skillet until crispy. Remove the bacon from the skillet and set aside, leaving the bacon grease in the pan.
In the same skillet with the bacon grease, add the shrimp and cook until pink and opaque. Remove the shrimp from the skillet and set aside with the cooked bacon.
Next, melt butter in a saucepan over medium heat. Gradually whisk in flour until smooth. Slowly pour in milk, whisking constantly until the sauce thickens. Stir in the shredded cheese until melted and creamy.
Drain the cooked pasta and return it to the pot. Pour in the cheese sauce and stir until well coated. Add the cooked shrimp and crumbled bacon, stirring gently to incorporate. Serve hot and enjoy!HTML Content Ends
Choosing The Right Shrimp And Bacon
This Shrimp and Bacon Mac and Cheese recipe is truly a crowd-pleaser. To ensure the dish turns out perfectly, it’s important to choose the right shrimp and bacon. When it comes to the shrimp, finding the best variety is essential. While fresh or frozen shrimp both work well, opt for shrimp that is peeled and deveined for ease. Large or jumbo shrimp will provide a meatier texture, adding a satisfying bite to the dish.
Now, let’s talk about the bacon. Exploring the different options to find your favorite is always exciting. Traditional smoked bacon offers a rich and smoky flavor, while maple bacon adds a touch of sweetness. Alternatively, consider trying a savory blend such as peppered bacon for an extra kick. Whichever bacon variety you choose, be sure to cook it until crispy to add a delightful crunch to your mac and cheese.
With the right shrimp and bacon selection, you’ll be on your way to creating a mouthwatering Shrimp and Bacon Mac and Cheese that will impress your family and friends. So, head to your nearest grocery store to grab the ingredients needed for this delectable recipe!
Preparing The Cheese Sauce
Creating a velvety and flavorful cheese sauce is an essential step in making the perfect shrimp and bacon mac and cheese. To achieve a luscious texture, start by melting butter in a saucepan over medium heat. Add flour to form a roux, cooking it until it turns golden brown. This will help thicken the sauce. Next, gradually whisk in milk, making sure to whisk constantly to prevent any lumps from forming. Once the milk is fully incorporated, start adding your chosen cheeses. Combining different cheese varieties will enhance the overall taste and texture of the dish. Sharp cheddar, Gouda, and Gruyere are great options, but you can experiment with other types as well. Continue stirring the sauce until the cheese has completely melted and the sauce is smooth and creamy. Season with salt, pepper, and any additional desired spices. This step is crucial to enhance the flavors of the dish. Finally, remove the sauce from heat and you’re ready to pour it over your cooked macaroni, shrimp, and bacon for a deliciously indulgent mac and cheese.
Cooking The Shrimp And Bacon
To master the art of cooking shrimp and bacon to perfection, it’s essential to explore different cooking methods that enhance the flavors. Here are some tips to help you create a delicious shrimp and bacon mac and cheese dish:
1. Pan-frying: Heat a skillet over medium heat and cook the bacon until crisp. Remove the bacon and drain on paper towels. In the same skillet, cook the shrimp until pink and opaque. Remove and set aside.
2. Grilling: Preheat the grill to medium-high heat. Wrap the shrimp in bacon and secure with toothpicks. Grill for a few minutes on each side until the bacon is crispy and the shrimp is cooked through.
3. Baking: Wrap each shrimp with a piece of bacon and place on a baking sheet. Bake in a preheated oven at 400°F for about 10-12 minutes until the bacon is crispy and the shrimp is cooked.
4. Sauteing: In a skillet, cook the bacon until crisp. Remove the bacon and reserve the grease. Saute the shrimp in the bacon grease until cooked through.
By experimenting with these cooking methods, you can elevate the flavors of the shrimp and bacon in your mac and cheese recipe. Enjoy the combination of smoky bacon and succulent shrimp in every bite!
Boiling The Macaroni And Combining The Ingredients
Boiling the macaroni to perfection is crucial for a delicious shrimp and bacon mac and cheese dish. Start by bringing a pot of water to a rolling boil and add salt to enhance the flavor. Cook the macaroni according to the package instructions, making sure to not overcook it. Al dente macaroni works best for this recipe as it holds its shape when combined with the other ingredients.
Once the macaroni is cooked, it’s time to combine it with the shrimp, bacon, and cheese sauce. In a separate pan, cook the bacon until crispy, then remove it and set it aside to cool. In the same pan, cook the shrimp until they turn pink and opaque. Remove the shrimp from the pan and set them aside.
Now, it’s time to prepare the cheese sauce. Melt butter in a saucepan over medium heat and stir in flour until well-combined. Gradually add milk, stirring constantly to avoid lumps. Continue cooking and stirring until the sauce thickens. Add grated cheese, salt, and pepper, stirring until the cheese melts completely. This creamy cheese sauce is the perfect complement to the macaroni, shrimp, and bacon.
Finally, combine the cooked macaroni, shrimp, and bacon together in a large baking dish. Pour the cheese sauce over the mixture and stir gently to ensure all ingredients are evenly coated. Bake the mac and cheese in a preheated oven until golden and bubbly. Serve hot and indulge in the comforting flavors of shrimp, bacon, and cheesy macaroni.
Baking And Serving The Dish
Understanding the importance of baking the mac and cheese is essential to achieving the perfect finish. Baking allows the flavors to meld together, creating a delectable and indulgent dish that will satisfy even the most discerning palates. The heat from the oven creates a golden crust on top, adding a delightful crunch to each bite. To bake the mac and cheese to perfection, preheat your oven to the specified temperature and place the dish in the center rack. Keep a close eye on it, making sure not to overbake and dry out the pasta. Once done, remove from the oven and let it cool for a few minutes before serving.
When it comes to presentation, there are various ways to serve this mouthwatering dish. You can opt for a family-style presentation and serve it straight from the baking dish, allowing everyone to help themselves. For a more elegant touch, transfer the mac and cheese to individual serving plates or ramekins. Garnish with fresh herbs or a sprinkle of grated cheese for an extra pop of flavor. No matter how you choose to serve it, this shrimp and bacon mac and cheese recipe is guaranteed to be a crowd-pleaser.
Customizing Your Shrimp And Bacon Mac And Cheese
Customizing Your Shrimp and Bacon Mac and Cheese
Experimenting with additional ingredients and flavors is a great way to make your shrimp and bacon mac and cheese recipe your own. Consider adding fresh herbs like parsley, thyme, or basil for a burst of aromatic flavor. For a spicy kick, try adding some red pepper flakes or hot sauce. Vegetables like diced tomatoes, roasted red peppers, or spinach can also be a delicious and nutritious addition.
When it comes to toppings and garnishes, the possibilities are endless. To enhance the presentation of your dish, consider sprinkling some toasted breadcrumbs or crispy bacon bits on top. A dollop of sour cream or a sprinkle of grated Parmesan cheese can add a creamy and savory touch.
Remember, the beauty of cooking is that you can customize recipes to suit your taste preferences. So don’t be afraid to get creative and make this shrimp and bacon mac and cheese your own!
Tips And Tricks For Success
Tips and Tricks for Success
Explore expert tips for making the best shrimp and bacon mac and cheese. Troubleshoot common issues and find solutions for a flawless result.
1. Use high-quality ingredients: Opt for fresh shrimp, quality bacon, and a variety of flavorful cheeses, such as sharp cheddar and Gruyere.
2. Cook the pasta just right: Ensure al dente pasta by following the package instructions and refreshing it with cold water after draining.
3. Enhance the flavors: Sauté the shrimp and bacon separately before combining them with the cheese sauce to maximize their taste.
4. Experiment with seasonings: Add a pinch of cayenne pepper, paprika, or garlic powder to elevate the flavor profile of your mac and cheese.
5. Don’t overbake: Keep an eye on your dish to avoid drying out the cheese sauce. Bake until bubbly and golden brown, and then remove from the oven.
6. Garnish with care: Consider garnishing your mac and cheese with fresh herbs like parsley or a sprinkle of crispy bacon for added texture.
Frequently Asked Questions Of Shrimp And Bacon Mac And Cheese Recipe
What Does Putting An Egg In Mac And Cheese Do?
Adding an egg to mac and cheese helps create a creamy and rich texture. The egg binds the ingredients together and adds a nice consistency to the dish. It also contributes to the flavor and gives the mac and cheese a slightly custard-like taste.
Is Milk Or Water Better For Mac And Cheese?
Milk is better for mac and cheese as it adds creaminess and enhances the flavor. Water lacks the richness and may result in a bland taste.
How To Make Shaq Mac And Cheese?
To make Shaq mac and cheese, follow these steps: Boil macaroni until cooked. In a separate pot, melt butter and stir in flour to create a roux. Gradually add milk and stir until thickened. Mix in shredded cheese until melted.
Combine with cooked macaroni and enjoy!
What Not To Do When Making Mac And Cheese?
To make mac and cheese, avoid these mistakes: using too much or too little cheese, overcooking the pasta, not seasoning the cheese sauce properly, using low-quality cheese, and skimping on the butter and milk for the sauce.
Indulge in the heavenly combination of shrimp, bacon, and creamy mac and cheese with this delectable recipe. The rich flavors and contrasting textures create a mouthwatering treat that will leave you craving for more. Whether you’re preparing a quick weeknight dinner or hosting a special gathering, this dish is sure to impress.
So why wait? Give it a try and embark on a flavorsome journey today.

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Latest News Headlines
Commercial Credit News
|‘Clear evidence’ that changes to Debt Relief Orders are working|
|Friday, 29 January 2016|
Insolvency Service statistics released today show there were 20,404 individual insolvencies in England and Wales in Q4 2015, up 3.6 percent on the previous quarter but down 10.5 percent on the same quarter in 2014.
The quarter-on-quarter rise has been driven to an increase in the use of Debt Relief Orders (DROs), a form of insolvency designed for people with low incomes, few assets and relatively small debts, after changes to eligibility criteria took effect in October. DROs are now available to people with up to £20,000 debt (previously £15,000) and £1,000 in assets (previously £300).
There were 6,501 DROs in Q4, up 15.5 percent on the previous quarter. A quarter of these (1,629) were for individuals with debts higher than the previous limit of £15,000.
Joanna Elson OBE, chief executive of the Money Advice Trust, the charity that runs National Debtline, said: “These figures are clear evidence that recent changes to the eligibility criteria for Debt Relief Orders are working, and this is good news for people in financial difficulty. With this important option now available to more people who are struggling with problem debt, the changes are helping us to help more people back on the path to financial health.
“We hope that these changes will come to be seen as a good first step towards the wider review of debt solutions that we have long been calling for. We have to ensure that a viable debt solution is made available to every single person struggling to repay what they owe, and that no-one is allowed to fall through the cracks of a system that has evolved organically over several decades.
“Anyone who is struggling to cope with debt should seek free advice from a charity-run service like National Debtline as soon as possible.”
Forums International Ltd
Attendance at your first meeting is free of charge, and please quote reference 'CCR2016' to receive the special 10% discount off of your first annual subscription.
Find out more here.
The latest edition of CCR Magazine, the leading editorial publication in the UK credit industry, is out.
CCR is the premier magazine for consumer and credit professionals. It provides an independent voice to the industry, breaking major news stories and running in-depth features.
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Temporarily Out Of Stock
Don't get too bummed. This item is on the way and will be available for purchase as soon as it rolls into the warehouse.
Can't wait? Consider one of the other Men's Road Jerseys we have in stock.View Similar Products
Celebrating 100 years of the Giro, Santini's Monza-Milano Jersey is filled with passion for this now century-old cornerstone of the summer race season. Santini also refers to the Monza-Milano Jersey as the "Invincible Wave", borrowing the phrase from an original newspaper headline announcing the creation of the Giro. Though the jersey honors the entire race, it specifically pays homage to the final stage. If you spend your spare time seeking out pirated live feeds and reloading your browser for time gap updates, this is the jersey you should be training in this summer.
As your mind drifts to images of serpentine roads winding through the jagged Dolomites, the Monza-Milano's effective combination of stretchy, breathable fabrics will keep you cool and dry whether you're riding a charity Fondo or training on your regular loops. Form-fitting, raw-cut sleeve endings preserve race-ready style, and accents like the Giro 100-year anniversary logo and a graphic of Milan's famed cathedral fill this limited edition piece with both function and memorable style.
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- Q & A
Amazing Jersey (Add 1 size up!)
- Familiarity: I've used it several times
- Fit: Runs small
- Size Bought: Large
- Height: 5'7"
- Weight: 143lbs
I love the fabric and the design. It's very comfortable and the clean cut on the sleeves looks pretty nice!
It runs a bit small so I would recommend to order 1 size up than usual.

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CHEF Nico Simeone’s third Glasgow restaurant is now open.
Public House by Nico joins award-winning sister restaurants Six by Nico and 111 by Nico, bringing modern British gastropub cuisine to Glasgow’s West End.
Occupying a prime position at 333 Great Western Road in Glasgow, Public House by Nico offers a broad selection of seasonal small plates underpinned by larger dishes to be enjoyed on their own or shared.
The menu also offers a weekend breakfast and brunch and a Sunday Roast offering.
Dishes on the menu include; Beer Batter Fish of the Day, Tartare Sauce, Mushy Peas; Flat Iron, Chimmicurri, Smoked Tomato Compote, Flat Cap mushroom; Chestnut Gnocchi, Sprout Tops, Smoked Pancetta, Sage; Cauliflower Soup, Gribiche, Tempura Cauliflower and Curried Monkfish, Mussel, Bok Choi & Lime.
The restaurant, which has a 60- seat capacity and a small dedicated bar area, offers a slice of cosy countryside in the heart of Glasgow where guests will also find real local ales, fruity wines and fine single malt scotch.
Nico Simeone said: “It’s been on my radar to open a modern gastropub restaurant for some time. The goal of the restaurant is to make the dining experience fun with the sense of playfulness the Scottish are known for.
“The boutique pub is making a comeback and we wanted to introduce the trend to Glasgow.
“Public House is charmingly old-fashioned and a place that guests can enjoy exception food and wines. It’s local with a menu specifically designed to be value for money.”
The new neighbourhood restaurant is open six days a week, Tuesday – Sunday.