This is an extensive lesson plan (on the left). Teachers should select only the parts they wish to use or have time to teach in one term or half a term.
Burning of Benin contains extracts from the diary of Captain Bacon written in 1897 during the Benin Punitive Expedition.
Burning of Benin activities provide a range of stimulating activities to use with this.
The reading comprehension booklet contains Year 6 SATs style questions involving retrieving and recording information, summarising main ideas, drawing inference, explaining and justifying with evidence from the text.
Solutions to questions can be found in the answers booklet.
1) KWL chart. Use this frame for initial assessment of individual student's knowledge of the topic. Use it as an ongoing record of student's learning during study of the topic. It can also be used as evidence of student's learning on the topic.
2) Mind map frame. Brain storm areas of study with the class and record these on this chart. You can add more areas if needed.
4) Sources of historical evidence.
This file can be used as a class or group information reading text on sources of historical evidence. Sources can be discussed and rated for reliability.
What is this photograph about?
What can you see happening in this photograph?
Who is this person in this photograph?
Together as a class/ group, compose a sentence on a photograph e.g. This tourist is travelling on a London bus to Oxford Circus in Central London. Discuss use of capital letters in the sentence.
Further activities ideas can be found in the download file below this one.
6) Travel back in time to the 15th century, you have been asked by His Majesty The Oba to produce advertisement posters that will be sent to Europe to encourage traders to come and trade with the kingdom. You have been given the frames to work with. You can change the images on the frame and/ or add to them. Your poster must increase trade to the kingdom.Good luck.
7) News report. Write a news report about a visitor interested in trading with the kingdom.
8) Compare and contrast Oba of Benin with Egyptian Pharaoh.
10) Story map and writing frames. Students can use the frames below to illustrate and retell the creation story above. The frames can also be used to retell other stories relating to the topic.
11) Plaque frames. Students could use the frames below to produce their own plaques for different occasions in the kingdom of Benin e.g. to depict a foreign visitor in audience with His Majesty or a chief coming back from war or on a victory parade. The frames could also be used for students' own experiences e.g. receiving an ward at school assembly or a mayor's visit to the local area. Students will need to plan what event they wish to show and the characters to include, draw a sketch first before depicting the final scene on the plaque frame. This activity supports Art and Design NC requirements at Key Stages 2 and 3.
12) Chief Blacksmith commission. His Majesty requires a record of the annual Igue Festival. He has asked the palace chief blacksmith to produce this. The blacksmith will need to attend the festival for the nine days, he will need to note down events that are interesting and relate to His Majesty's specifications and requirements. He can use a combination of writing and drawing to record events as they happen. At the end of the nine days, he must decide on which aspects of important royal events to include and in addition to the king, who else to include in his plaque composition.
Task: students in role as the chief blacksmith use the diary below to record selected events as they happen to help them produce the royal plaque. Page 1 is for writing and page 2 for drawings.
Students can use ideas from YouTube videos on Igue Festival or use their own ideas.
Tip: the plaque must glorify the king.
'Women do not go to war except Idia the mother of Esigie.' A Benin saying.
Few women in world history have successfully led an army to defend their country's sovereignty. Idia is one of them. She led the kingdom's army in numerous wars, taking decisive actions to defeat the enemy. She possessed both knowledge of war tactics and application of medicine to heal the wounded. This pamphlet presents some of her achievements.
One can be printed and photocopied as an A5 booklet for individual students.
The other can be used as a whole text for whole class work or as the teacher desires.
LO: To compose sentences (simple and compound sentences).
To select vocabulary for effect (select words with same or similar meaning).
To use appropriate punctuation in sentences (capital letters, full stops, comma).
Use these activities to showcase your students' creativity in art and writing.
Art: Tweeter and Facebook friends. Students can draw faces of characters on the plaques in the photo gallery section as friends.
Writing: Tweeter and Facebook feeds. Students can summarise their knowledge of incidences and events in Benin history through their posts and friends reply as below.
Queen Idia: Setting off for Udo this pm, any ideas on where to camp for the night?
Friends: Iyase (prime minister): We can keep going until sunset and camp at any suitable space.
Head of Army: Ekpon is about 50 miles form Benin, perhaps we can stop there to plan the next part of the journey.
Queen Idia: What does everyone else think?
1) Produce an illustrated booklet on 'The King's Mother' (Iyoba).
1a) Write a seven word biography on Queen Mother Idia. Example: Passionate about the King and Benin kingdom.
1c) Summarise Queen Mother idia in two words. Example: Awesome warrior.
1d) Write adjectives around Queen Mother Idia brass head to describe her personality.
1e) Colour in the map of Nigeria showing Queen Mother Idia war areas including countries on its borders and the Atlantic Ocean. Which colours will you use for land, forest and the sea?
Additional LO: To write a personality profile of a person or character.
2) Imagine you are one of the Benin soldiers sent on the Udo mission. Send daily tweets on the royal army progress. What are you happy about? What surprises you? What is not going to well. remember you have to use 140 characters to do so.
What conversation do you engage in?
What images will you as the Queen mother or soldier upload to keep your friends informed.
You can use the blank tweeter and facebook pages below.
Remember that people's tweets and their facebook conversations show their personality and what they are really like. Your entries should reveal what your character is really like. So choose an incident or event from the pamphlet which will help you show this.
Download the booklet below for students to complete after reading the short stories. The activities will help improve their reading comprehension and writing skills.
This book contains reading comprehension questions and activities to accompany the Diary of An Edo Princess. The activities are suitable for students in key Stage 2 (7 - 11 year old).
The comprehension questions cover literal level (Thinking back - Why is the princess keeping a diary?); interpretive level (Thinking about it - Find a reason why the princess thinks so.) and applied level (Thinking it through - Describe how the people preserve their history.).
The activities are designed to help develop students research and writing skills. These fun cross-curricular activities will engage all abilities of students. Download book and worksheets below.
16) Watch the video below and summarise the key points in an information text or booklet.
This book contains historical information to support teaching of this unit.
It is an edited and updated version of the first edition published in 2013. It contains more students activities and additional information. The photographs in the book are available to download for whole class teaching from this website in the Teachers section here.
This book can be purchased from the Amazon links above.


Ez Tracks offers free cover tracks of today's popular music. When the visitor firsts registers they are allowed 1000 free downloads after accepting or declining partner offers. Ez Tracks is paid for by advertisers and a royalty is paid to the original artists for allowing Countdown to make a cover of their song. Ez Tracks is the home site of Countdown, the worlds largest cover band. Ez Tracks offers over 50,000 songs sung by Countdown. Ez Tracks offers various genres of music to download. The featured genres are 80's, Christian, Country, Hip Hop, Kids, Pop, R&B, and Rock. Other genres including Alternative, Audio Bible, Ballroom Dance, Bluegrass, Broadway Shows, Christian, Christmas, Classic Rock, Comedy, Dance, Folk, Oldies, Karaoke, Latin, Love, Nature, New Age, Rap, Remixes, Rock, School Songs, Soul, Sound Effects, TV Theme Songs, Wedding, World Music, and even instrumental can be found by clicking on the More Genres tab located next to the featured genres. The user also has a counter conveniently located on every page to let the user know how many downloads he or she has left. EZ Tracks not only offers music downloads, but ringtone downloads, music codes to embed music, and music videos as well.


text:
Olivia Newton-John rescheduled for Sept. 30
Original show June 10 was postponed as Newton-John undergoes cancer treatment
Olivia Newton-John rescheduled for Sept. 30 Original show June 10 was postponed as Newton-John undergoes cancer treatment Check out this story on timesrecordnews.com: http://wtrne.ws/2rzMY1D
Times Record News Published 11:53 a.m. CT June 2, 2017 | Updated 3:54 p.m. CT June 2, 2017
Olivia Newton-John(Photo: Contributed photo)
Spectra Venue Management has announced that the postponed Olivia Newton-John show, originally scheduled for June 10, has been rescheduled for 8 p.m. Sept. 30 at Memorial Auditorium.
Tickets purchased for the June 10 show will be honored at the new show date.
Ticket-holders who cannot attend the show Sept. 30 can contact the Kay Yeager Coliseum Box Office at (940) 716-5555 for refund information.
Newton-John postponed her summertime U.S. and Canada concert dates earlier this week. She announced she has cancer and will be undergoing treatment.
"We are very excited that we were able to reschedule this show and fans will see a true legend in concert. Obviously, we will continue to keep Olivia Newton-John in our thoughts as she undergoes treatment but we are confident she will battle this with the grace and courage she exudes," said Brian Hoffman, MPEC general manager.
Ticket prices: $49.75, $59.75, $89.75 (plus applicable fees).
Tickets can be purchased online at www.wfmpec.com, by phone at (940) 716-5555 or in person at the Kay Yeager Coliseum Box Office.
Also coming up at Memorial Auditorium are shows by iconic rock band Kansas in September and Mannheim Steamroller in December.
Read or Share this story: http://wtrne.ws/2rzMY1D

redpajama_set_name: RedPajamaCommonCrawl


1stMix offers the best quality ready-mixed concrete solutions for your foundations. Using specialist mini mix vehicles, we will provide you with a highly cost-effective means of placing small volumes of ready-mixed concrete. Ideal for home building, extension and renovation work, or where site access is difficult.
This is a versatile, economical and durable mix designed specifically for use in foundations and groundworks.
How much ready-mixed concrete do I need?
If you are unsure how much concrete you require for your project, use our ready-mixed concrete calculator on the right of this page. Simply enter the dimensions of the area(s) you need for your foundations. If you have a more complex shape, divide it into rectangles and calculate the volume individually. Then send us your requirements using the Quick Quote Enquiry Form by following this link.


text:
package pl.com.softproject.utils.commons.dictionary.dao;

import com.csvreader.CsvReader;
import java.nio.charset.Charset;
import org.junit.Test;
import pl.com.softproject.commons_administrative_division.AdministrativeDivision;
import pl.com.softproject.commons_administrative_division.Community;
import pl.com.softproject.commons_administrative_division.CommunityType;
import pl.com.softproject.commons_administrative_division.District;
import pl.com.softproject.commons_administrative_division.Province;
import pl.com.softproject.utils.commons.dictionary.XMLAdministrativeDivisionSerializer;

/**
 *
 * @author Adrian Lapierre <adrian@softproject.com.pl>
 */
public class AdministrativeDivisionDAOCsvImpl {

    @Test
    public void loadAll() throws Exception {

        AdministrativeDivision result = new AdministrativeDivision();

        CsvReader gminiy = new CsvReader("D:/realizacje/SoftProject/UKE/materiały/gminy-utf.csv", ';', Charset.forName("UTF-8"));

        gminiy.readHeaders();

        String currentWoj = "";
        String currentPowiat = "";

        Province province = null;
        District district = null;

        while (gminiy.readRecord()) {

            if (!currentWoj.equals(gminiy.get("Wojewodztwo"))) {
                currentWoj = gminiy.get("Wojewodztwo");
                province = new Province();
                province.setName(currentWoj);
                result.getProvince().add(province);
            }

            if (!currentPowiat.equals(gminiy.get("Powiat"))) {
                currentPowiat = gminiy.get("Powiat");
                district = new District();
                district.setName(cleanPowiat(currentPowiat));
                province.getDistrict().add(district);
            }

            Community community = new Community();
            community.setName(gminiy.get("Gmina"));
            community.setTeryc(gminiy.get("Nr_GUS"));
            community.setType(cleanTypGminy(gminiy.get("TypGminy")));

            district.getCommunity().add(community);

            //System.out.println(currentWoj + " " + currentPowiat + " " + gminiy.get(1));

        }

        gminiy.close();

        XMLAdministrativeDivisionSerializer serializer = new XMLAdministrativeDivisionSerializer();
        //System.out.println(serializer.toString(result));
        serializer.toFile(result, "d:/gminy.xml");

    }

    protected String cleanPowiat(String powiat) {
        return powiat.replace("Powiat ", "");
    }

    protected CommunityType cleanTypGminy(String typ) {
        String cleaned = typ.replace("gmina ", "");
        if(cleaned.equals("powiat grodzki")) cleaned = "powiat-grodzki";
        return CommunityType.fromValue(cleaned);
    }

}

redpajama_set_name: RedPajamaGithub


text:
Match line-ups
League: CSA Men
Home Facility: NA Coach: Lewis,Mark
Asst. Coach: Cromwell,David
Web Address: No Link Submitted.
Team Number: 21728 (for use when searching)
Matches Played/ Scheduled
Match date/
Opposing Team
Confirmed 11/30/18 5:00pm Naval Academy Midd Lost 4-5 -
Confirmed 12/01/18 3:00pm Tufts University MIdd Won 8-1 -
Confirmed 12/08/18 3:00pm Wesleyan University WES Won 9-0 -
Confirmed 12/09/18 12:00pm George Washington University TRIN Lost 2-7 -
Confirmed 01/05/19 2:00pm Williams College Midd Won 5-4 -
Confirmed 01/11/19 3:00pm Amherst College AMH Won 7-2 -
Confirmed 01/12/19 12:30pm Bowdoin College Midd Won 9-0 -
Confirmed 01/12/19 6:00pm Colby College Midd Won 9-0 -
Confirmed 01/13/19 11:00am Bates College Midd Won 8-1 -
Confirmed 01/17/19 5:30pm Hamilton College Midd Won 9-0 -
Confirmed 01/19/19 12:30pm Brown University Harv Won 5-4 -
Confirmed 01/25/19 6:00pm Dickinson College Dickn Won 7-2 -
Confirmed 01/26/19 3:00pm Virginia, University of F&M Lost 4-5 -
Confirmed 01/27/19 11:00am Franklin and Marshall College F&M Lost 4-5 -
Confirmed 02/02/19 12:15pm Tufts University midd Won 9-0 -
Confirmed 02/02/19 4:45pm Williams College midd Lost 4-5 -
Confirmed 02/03/19 12:00pm Bates College midd Won 5-4 -
Confirmed 02/09/19 4:00pm MIT Midd Won 5-4 -
Confirmed 02/15/19 10:00AM Bowdoin College YAL2 Won 9-0 -
Confirmed 02/16/19 8:30AM Brown University YAL1 Lost 3-6 -
Confirmed 02/17/19 11:00AM Williams College CPCT5 Won 5-4 -
Legend: Conflict: Scheduling conflicts, Adjust: penalties, extra points etc.,Round: Playoff,Districts,Sectionals
Expired Membership Click here to renew your membership.
Membership will expire during season
Win/Loss
Ref. Exam
Ellen, Jacob New York M 5.53 2 12/02/2019 14 / 6 - 06/25/18 - pass
Cembalest, Will Brooklyn M 5.46 3 09/30/2020 5 / 6 - 06/25/18 - pass
Kagan, Jacob A. Chapel Hill M 5.49 4 02/28/2020 11 / 6 - 06/25/18 - pass
Bermingham, Nicholas O. Denver M 5.41 5 02/28/2020 13 / 8 - 06/25/18 - pass
Best, Theodore S. Brooklyn M 5.56 6 10/01/2020 18 / 3 - 09/11/18 - pass
Epley, John C Greenwich M 5.49 7 02/29/2020 18 / 3 - 06/25/18 - pass
Hinton, Wiatt F. Baltimore M 5.22 8 01/05/2020 9 / 8 - 06/25/18 - pass
Merrill, Alexander O. Locust Valley M 5.24 9 03/01/2021 13 / 2 - 06/25/18 - pass
Wolpow, Thomas S Wellesley M 5.16 10 02/28/2020 13 / 4 - 06/25/18 - pass
Giles, Alex 4.09 - 02/28/2020 2 / 2 - 10/31/18 -
Keller, Pk Rye M 5.19 - 03/01/2021 0 / 0 - 05/28/19 - pass
McInerney, Finlay M 4.71 - 02/28/2020 4 / 3 - 06/25/18 -
Moll, Nate Birmingham M 5.20 - 09/17/2019 11 / 3 - 09/11/18 - pass
Total Players: 13 Average singles rating: 5.22 (number ratings only)
Legend: P: Playoffs matches, D: District matches


Abstract: Multiclass semantic image segmentation is widely used in a variety of computer vision tasks, such as object segmentation and complex scene understanding. As it decomposes an image into semantically relevant regions, it can be applied in segmentation of face images. In this paper, an algorithm based on multiclass semantic segmentation of faces is proposed using conditional random fields. In the proposed model, each node corresponds to a superpixel, while the neighboring superpixels are connected to nodes through edges. Unlike previous approaches, which rely on three or four classes, the label set is extended here to six classes, i.e. hair, eyes, nose, mouth, skin, and background. The proposed framework is evaluated on standard face databases FASSEG, FIGARO, and LFW. Experimental results reveal that the performance of the proposed model is comparable with state-of-the-art techniques on these standard databases.


text:
Black Man Questioned by White Police Officers For Having Too Many Credit Cards
Cedric 'BIG CED' Thornton August 27, 2020 August 27, 2020 46842
(Image: Screenshot)
The level of racism Black people have to endure is mind-boggling at times! According to The Daily Mail, a Black man in Texas, who didn't commit a crime nor was accused of one, was being questioned by white police officers based on the number of credit cards he happened to have in his wallet earlier this month.
On Aug. 12, at a gas station in the Fort Worth suburb of Burleson, Texas, 39-year-old Brian Friar had been seen withdrawing cash from an ATM when three white police officers came up to him and insisted that he show them his identification. Friar decided he should record the interaction, especially as a Black man in today's climate.
Friar, who works as a forklift operator, told The Daily Mail: "I was at the ATM machine at the store, minding my own business, looking through my cards to see which one I would use.
"The next thing I know a policeman came up to me saying that I have a lot of credit cards.
"Then two other officers pop up. I started filming because I was frightened. He had a gun on him, and the other ones had guns too."
In the video, an officer says, "Prove to me the rest of those cards are yours. You have 10 in there." The officers also questioned why he was in the area, "How did you end up in Burleson?"
The Daily Mail obtained a statement from Chief Cordell from the Burleson Police Department.
He stated: "Our three officers had stopped in the QT to take a break and I am told were approached by a male (witness) who told them the gentleman was at an ATM machine attempting to get money while using multiple cards and that the transaction kept being denied.
"He said the man was acting suspicious. The officers approached the man, activated their body worn cameras and explained why they were contacting him.
"Officers observed multiple receipts and cards as described by the witness. Officers asked him if he minded sharing identification to match the name on the cards and he eventually provided identification and cards."
Cedric 'BIG CED' Thornton
Cedric 'BIG CED' Thornton, is the co-founder, and owner of TheIndustryCosign.com.


A typical installation requires three lights in the cockpit: One for the pilot, one for the co-pilot, and one for the third crew member. This reading light includes an ON/OFF switch and dimming control. It provides sufficient movement capability to be orientated upon request. This light uses LED technology and consists of a nickel-plated, brass main body for intensive use in the cockpit or cabin.
Smooth beam for comfort reading.


text:
A Conversation with Andy Jassy, Amazon Web Services
Greg Becker
Photo: Silicon Valley Bank CEO Greg Becker with Andy Jassy, head of Amazon Web Services
As part of our ongoing series of conversations with influencers in the innovation ecosystem around the world, I had the pleasure of sitting down with Andy Jassy, head of Amazon Web Services, for an event with 75 of our clients in Seattle this week.
The stories of how businesses really got started are always fascinating to me, so I was listening closely when Andy recalled sharing the original six-page business plan and vision document for AWS with Jeff Bezos and the board. He started by sharing the approach Amazon takes when considering a new business opportunity, which was of keen interest to our audience of founders and business leaders.
They ask four questions:
If it's successful can it be really big?
Is it [the target market] being well served today?
Do we have a differentiated approach to that space?
Do we have any competency in that space?
If the answers to all four questions are positive, then, Andy explained, Amazon would pursue the opportunity even if it is very different from what they are doing today. Amazon likes to invent, to pioneer, and to make bold bets. We've seen this penchant for innovation over and over at Amazon.Since it is a question I have been fielding a lot these days, I was quite interested in Andy's take on current valuations in the technology space, particularly recent speculation regarding the value of Amazon Web Services. He said, "Valuations are temporal, you really build a lasting meaningful company over time and you have to be successful over a long period of time. It's a marathon." I couldn't agree more.
Thanks to all the incredible business leaders and innovation companies I get to meet around the world, I continue to be inspired by their vision to improve business, health, communication and especially as they are disrupting industries that are overdue for a new way of thinking. I'd personally like to thank Andy Jassy and all of our Seattle clients who participated in this event for the interesting conversation and inspirational ideas.
Tips on surviving an economic downturn from a serial founder
Greg has been a champion of the innovation economy since he joined SVB in 1993 as a banker to fast-growing technology companies. Today, he is the president and CEO of the world's only financial institution dedicated to the innovation sector around the globe. Greg has led the expansion of the company, now the nation's 14th largest bank in the US, to include four primary businesses serving the innovation sector: global commercial banking, venture capital and credit investing, private banking and wealth management, and investment banking.
Under Greg's leadership, SVB has achieved considerable growth. SVB joined the S&P 500 in 2018 and has been named one of the best banks in America, one of the fastest growing public companies in the US, and one of the best places to work. SVB has been included in the Bloomberg Gender-Equality Index for the last four years and is consistently among the Top Corporate Philanthropists in its headquarters' region. Working with employees, clients, and partners, Greg has also prioritized investments and initiatives to increase diversity and inclusion at SVB and across the innovation ecosystem, foster economic development and support community well-being.
Prior to taking on the SVB President and CEO role in 2011, Greg held a variety of leadership positions, including co-founding SVB Capital, which manages some of the world's top-rated venture fund-of-funds and direct investment funds.
Greg is a Class A Director for the Federal Reserve Bank of San Francisco, and since 2016 has been a member of TechNet's executive council, which he chaired from 2020-2022. He is also a member of the executive board of the Silicon Valley Leadership Group, which he chaired from 2014-2017, and serves on the One Mind at Work Guiding Council. Greg earned a bachelor's degree in business from Indiana University.


text:
Government Sues Fifth Third, Citing Fake Accounts
Jill Jaracz
Remember a few years back when the Consumer Financial Protection Bureau (CFPB) went after Wells Fargo for opening accounts in customers' names without their knowledge? The CFPB says it's found another case of this behavior, this time at Fifth Third Bank.
The CFPB has filed a lawsuit against the bank, alleging that for several years from at least 2010 through at least 2016, the bank's cross-selling strategy and high level for sales goals unwittingly encouraged its employees to open new accounts for existing customers without proper authorization. The strategy was designed to "increase the number of products and services it provided to existing customers; used an incentive-compensation program to reward selling new products; and conditioned employee-performance ratings and, in some instances, continued employment on meeting ambitious sales goals," said the CFPB in a statement.
The allegations state that not only did Fifth Third employees open unauthorized deposit accounts and credit card accounts, they also transferred funds from consumers' existing accounts to the new unauthorized accounts. Furthermore, the bank employees transferred money from customers' actual accounts to these newly-opened accounts. They also opened lines of credit for customers without their approval.
While the CFPB acknowledged in its filing that it's fine for companies to set sales goals and have performance incentives, the government agency says that such programs need to be monitored so that employees aren't feeling the pressure to do unlawful activities in order to meet their goals.
The CFPB claims that the bank didn't properly monitor its program or stop these practices, although it was aware of the alleged behavior of its employees. Because of this, the agency says the bank violated the Consumer Financial Protection Act of 2010, the Truth in Lending Act and the Truth in Savings Act.
In response, Fifth Third is ready to fight back. "Fifth Third Bank respects and values the important role that the CFPB plays in protecting consumers but believes that the civil suit filed today is unnecessary and unwarranted. The Bank will defend itself vigorously and is confident in the outcome," said Susan Zaunbrecher, chief legal officer of Fifth Third Bank, in a statement.
Zaunbrecher said that the banks' pay structure doesn't reward employees for opening unauthorized accounts, and that the bank has controls in place to prevent and detect such behavior.
Fifth Third says that the CFPB investigated for three years, looking at nearly a half billion pieces of data. From this, the CFPB found less than 1,100 accounts that fit this profile, which was .01 percent of new accounts opened during this time span, and involved less than $30,000 in erroneous charges. Fifth Third claims it had already discovered this activity and took steps to waive or reimburse customers for these charges. "While even a single unauthorized account is one too many, we took appropriate and decisive action to address each situation," said Zaunbrecher. "The Bank is confident that it has treated its customers fairly."
Additionally, California-based shareholder rights law firm Johnson Fistel, LLP, is investigating the CFPB filing for a potential class action lawsuit for Fifth Third potentially violating federal securities laws.
This news comes on the heels of Fifth Third uncovering an internal fraud incident involving a "small number" of former employees, who had been stealing and sharing the personal information of customers with a fraud ring since 2018.
The bank is still investigating the situation but has confirmed that it's found about 100 customers who have experienced fraud. The bank says it will reimburse those who have had direct financial losses because of the fraud, and it's also giving one year of an identity monitoring service to anyone who may have been affected by the actions.


text:
PulmonologyResource Center
Photoclinic
Sarcoidosis Presenting as Symptomatic Hypercalcemia in an Octogenarian
Sharon Jamie, MD, MHSA, Carl V. Tyler Jr, MD, MS, and Joseph G. Parambil, MD
Volume 19 - Number 4 - April 2011
Jamie S, Tyler Jr CV, Parambil JG. Sarcoidosis presenting as symptomatic hypercalcemia in an octogenarian. Clin Geriatr. 2011;51(4).
Sarcoidosis is a systemic granulomatous disease of unknown etiology that generally presents in young adults and is rarely diagnosed in the elderly population. In this article, we describe a newly diagnosed case of sarcoidosis in an 88-year-old woman presenting with fatigue, profound weakness, anorexia, severe hypercalcemia, and generalized lymphadenopathy. Axillary and mesenteric lymph node biopsies demonstrated nonnecrotizing granulomas consistent with the diagnosis of sarcoidosis. Because manifestations of sarcoidosis in the elderly tend to be atypical, we reviewed the published literature on the clinical presentation, barriers to definitive diagnosis, and complexities associated with treatment of this multisystem disease.
An 88-year-old woman presented to the emergency department with a 10-day history of progressively worsening generalized weakness, fatigue, nausea, and anorexia. Five days previously, she had visited her family physician with the chief symptom of constipation, which was attributed to chronic opiate therapy prescribed for chronic low-back pain due to lumbar spondylosis. Her constipation was treated with polyethylene glycol once daily as needed. At the time of that outpatient examination, the patient's mental status was intact, but weakness and emerging confusion prompted her family to take her to the emergency department for further evaluation.
The patient's medical history was significant for essential hypertension, heart failure, atrial fibrillation, previously mentioned chronic low-back pain due to lumbar spondylosis with lumbar canal stenosis, and celiac disease. She had never smoked cigarettes. Five years earlier, while undergoing an evaluation for unexplained weight loss, a computed tomography (CT) scan of the abdomen showed mesenteric lymphadenopathy. CT-guided biopsy revealed nonnecrotizing granulomas, which the consultant hematologist attributed to celiac disease. At the time of the patient's current admission, her medications included amlodipine 5 mg once daily, oxycodone 10 mg 3 times daily, atenolol 50 mg twice daily, furosemide 20 mg once daily, digoxin 125 mcg once daily, warfarin adjusted based on international normalized ratio levels, trazodone 50 mg nightly, and vitamin D3 2000 IU once daily.
The physical examination revealed a confused and disoriented elderly woman with dry mucous membranes, reduced skin turgor, and a blood pressure of 180/85 mm Hg. An examination of the patient's heart, lungs, and abdomen was unremarkable. There was palpable left posterior cervical, bilateral axillary, and left inguinal lymphadenopathy. She demonstrated grade 3/5 weakness in all upper and lower extremity muscle groups, with associated mild hypotonia and normal tendon reflexes.
Pertinent abnormal laboratory findings on initial assessment included severe hypercalcemia, with a serum calcium of 15.8 mg/dL (normal: 8.2-10.2 mg/dL) and ionized calcium of 7.68 mg/dL (normal: 4.60-5.08 mg/dL); and prerenal azotemia, with a blood urea nitrogen of 58 mg/dL (normal: 8-23 mg/dL), creatinine of 1.8 mg/dL (normal: 0.6-1.2 mg/dL), and urine sodium of 11 mEq/L (normal: >20 mEq/L). Subsequent laboratory testing revealed a reduced serum parathyroid hormone (PTH) level of 2.5 pg/mL (normal: 10-65 pg/mL), undetectable PTH-related peptide level, normal 25-hydroxyvitamin D level of 36 ng/mL (normal: 14-60 ng/mL), and elevated 1,25-dihydroxyvitamin D3 level of 106 pg/mL (normal: 25-45 pg/mL).
The hypercalcemia responded quickly to infusions of intravenous (IV) normal saline, IV zoledronic acid, and subcutaneous calcitonin. Her vitamin D3 was discontinued. Within 48 hours, the patient's blood pressure and serum chemistries, including serum calcium, normalized, and she became lucid and returned to her baseline state of mental functioning. Initially, the clinically suspected diagnosis was an occult underlying malignancy, most likely lymphoma, based on her known celiac disease and the presence of generalized lymphadenopathy. CT scans of the patient's lungs revealed bilateral, upper-lobe predominant, bronchovascular nodules with associated bilateral hilar and paratracheal adenopathies (Figure 1). CT imaging of the patient's abdomen and pelvis showed lymphadenopathy throughout the retroperitoneum and celiac regions, with prominent mesenteric lymph nodes (Figure 2). Excisional biopsies of the left axillary and mesenteric lymph nodes revealed nonnecrotizing granulomas in both specimens, consistent with granulomatous lymphadenitis (Figures 3A and 3B).
The initial in-hospital pulmonary consultant doubted that the patient had sarcoidosis even though it was on his differential diagnosis, and the patient was discharged. However, a second pulmonologist consulted after the patient's discharge from the hospital determined that she indeed met the criteria for sarcoidosis; this assessment was based on the constellation of clinical, radiographic, and pathologic findings. The second pulmonologist initiated oral prednisone 0.5 mg/kg twice daily and hydroxychloroquine 200 mg twice daily. At the 6-month follow-up visit, the patient reported improved energy levels and mood, with markedly less back pain. Her serum calcium levels have remained normal.
NEXT: Discussion
Sarcoidosis is an inflammatory granulomatous disease of unknown cause, with pulmonary involvement seen in more than 90% of patients with the disease.1,2 Extrapulmonary manifestations most commonly affect the extrathoracic lymph nodes, eyes, skin, and joints.1,3 Subcutaneous sarcoidosis is found in up to 12% of cutaneous disease as an early initial presentation of sarcoidosis.4 According to the American Thoracic Society, the European Respiratory Society, and the World Association of Sarcoidosis and Other Granulomatous Disorders, the diagnosis of sarcoidosis is established when clinical and radiologic findings are supported by the histologic evidence of nonnecrotizing granulomas, and when other conditions that can produce similar pathology are excluded.2
Although the etiology of sarcoidosis is still unknown, two parallel avenues of genetic and environmental investigation support the hypothesis that sarcoidosis development depends on an appropriate environmental exposure in a genetically susceptible host.5 Findings of a study published in 2007 revealed that immune characteristics of celiac disease may be associated with an increased risk of developing sarcoidosis.6 Sarcoidosis shows a predilection for persons who are younger than 40 years of age, and typically peaks between the second and third decades of life.2,7 There has been a second peak incidence reported in Scandinavian countries and in Japan in women over age 50 years.2,8 Although many patients with sarcoidosis live with the disease through their later years, few are newly diagnosed after the age of 65 years. This was shown in a retrospective series by Stadnyk et al,9 who reviewed new cases of biopsy-proven sarcoidosis over a 35-year period and found that only 7.8% occurred in elderly patients.
Making the diagnosis of sarcoidosis in the elderly (≥70 years) is often difficult and lengthy because clinical presentations are usually atypical in this population.10,11 In a retrospective case series examining sarcoidosis diagnosed in persons over 70 years of age, Chevalet and colleagues11 noted that an alteration of general health with asthenia, anorexia, or weight loss was the most frequent clinical presentation of the disease, even though intrathoracic organs were most commonly involved. Additionally, because elderly patients also present with characteristic symptoms of pulmonary and multisystem disease, sarcoidosis should also be considered in the differential diagnosis of these disorders.12 Not surprisingly, there was a long interval for most of the cases described by Chevalet et al11 (mean, 31.2 months) before essential evidence was established for a diagnosis of the disease.
Chest radiographs also display atypical patterns in elderly patients including mediastinal adenopathy alone or in combination with unilateral hilar adenopathy, solitary or multiple pulmonary masses, and atelectasis—features that are distinct from the salient characteristics, such as bilateral hilar adenopathy, described in younger patients.13,14 A rise in serum angiotensin-converting enzyme (ACE) levels is not an efficient diagnostic tool in elderly patients because of the increased frequency of renal insufficiency and diabetes mellitus in this population, which tend to increase ACE levels.2,15 In addition, elevated ACE levels are not specific for sarcoidosis because mild elevations can be seen in many intra- and extrathoracic diseases.16
In addition to an elevated serum ACE level, several other nonspecific laboratory abnormalities have been noted in patients with sarcoidosis, including hypergammaglobulinemia, cutaneous anergy suggestive of impaired lymphocyte responses to recall antigens, and peripheral lymphopenia.1,2,17 Hypercalcemia occurs in approximately 5% of patients with sarcoidosis, although hypercalciuria is 3 times more frequent.3,18,19 These abnormalities of calcium metabolism are due to the dysregulated production of 1,25-dihydroxyvitamin D3 by activated lymphocytes and macrophages within granulomas, and gamma-interferon produced by these cells is thought to play a major role in the aberrant synthesis of this vitamin.3,17 A case report published in 2007 found that hypercalcemia can occur in persons with granulomatous disorders such as sarcoidosis in the setting of unusually normal (ie, not elevated) levels of 1,25-dihydroxyvitamin D, with dehydration, increased uptake of oral calcium, or decreased calcium excretion, especially in those with mild renal insufficiency, being contributing factors.20 In normal subjects, there has been no increase in 1,25-dihydroxyvitamin D2 levels claimed after oral administration of 25-hydroxyvitamin D at high doses; however, there has been a substrate-product relationship reported in older persons and in persons with sarcoidosis, renal failure, and primary hyperparathyroidism, among others.21 Elevation in plasma PTH and vitamin D3 by primary hyperparathyroidism and sarcoidosis, respectively, has an additive effect on the regulation of serum calcium level.22 Undetected persistent hypercalcemia and hypercalciuria can cause nephrocalcinosis, predispose affected patients to symptomatic renal stone disease, and may even progress toward renal failure.2,23,24
Because the histologic evidence of nonnecrotizing granulomas is usually necessary to make the diagnosis of sarcoidosis, biopsies directed at morphologic or clinical abnormalities usually provide the highest yield.11,17 Bronchoscopy with transbronchial biopsies should be considered only when there is radiographic evidence of intrathoracic involvement, as routine biopsies of the lungs in the elderly are less definitive.11 However, bronchoalveolar lavage with flow cytometric evaluation of the effluent may be considered even when there is no intrathoracic involvement on chest radiographs.11,25 It is not uncommon for the elderly patient with sarcoidosis to undergo 2 or more biopsy procedures,10 as seen in the case patient discussed in this article. This is because sarcoidosis is indeed rare in these patients, and before it is established, a local sarcoid-like reaction that occurs with malignancies should be excluded.9,26 It is important to appreciate that such sarcoid-like reactions within the draining lymph nodes can occur in approximately 4% of carcinomas, nearly 14% of cases of Hodgkin's disease, and approximately 7% of cases of non-Hodgkin lymphomas, and must be distinguished from multisystem sarcoidosis.26,27 Histopathologically, the granulomas in these sarcoid-like reactions are usually not uniform, showing areas of marked proliferations of epithelioid or giant cells; they may contain fibrinoid exudates or display areas of necrosis, but some of them can demonstrate features typical of sarcoidosis.27
Once established, the disease course of sarcoidosis in the elderly is generally similar to that of younger subjects.11,28 It is not always easy to control; however, results have generally been satisfactory with the use of oral corticosteroid therapy.10,11 Although most patients stabilize or improve with treatment, relapses occur more frequently in the elderly.29Treatment complications in the elderly have been difficult to ascertain, but based on available evidence, seem to be mainly infectious in nature.11 Although oral corticosteroid therapy is associated with disease control in more than 80% of elderly patients, their use must be balanced with the significant toxicities associated with these agents.11 In addition to infections, side effects of oral corticosteroids relevant to the elderly include ocular cataracts, accelerated atherosclerosis with ischemic cardiovascular and cerebrovascular consequences, gastritis with ulcer formation, hypertension, osteoporosis, and diabetes mellitus.30,31 Several cytotoxic steroid-sparing agents have been used to treat sarcoidosis.32 While these agents clearly are of value in selected patients, no studies have clearly delineated when these drugs should be used or specifically defined their safety and efficacy in certain cohorts of patients.1,17 Therefore, monitoring for symptoms of drug toxicity is essential, and prevention of modifiable risk factors should be addressed in elderly patients taking long-term oral corticosteroid therapy.10
This case of sarcoidosis in an octogenarian illustrates the difficulty of diagnosing rarer conditions with nonspecific presentations that affect multiple organ systems. While sarcoidosis is typically diagnosed in young adults, it can indeed manifest in older patients. Identification of this disorder is important because available treatments lead to improvement or stabilization of the disease in more than 80% of elderly persons.
The authors report no relevant financial relationships.
We gratefully acknowledge Paul Stagno, MD, PhD, Department of Pathology, Fairview Hospital, Cleveland, OH, for providing the microscopic pathology images, and Craig Irish, MD, Department of Radiology, Fairview Hospital, for providing the radiographic images.
Dr. Jamie was a Resident Physician in Family Medicine, Fairview Hospital/Cleveland Clinic Family Medicine Residency at the time of this submission; she is now a Fellow, Case Western Reserve University, Cleveland, OH; Dr. Tyler is Coordinator of Geriatric Education and Research, Fairview Hospital/Cleveland Clinic Family Medicine Residency, and Associate Professor, Department of Family Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, OH; and Dr. Parambil is Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
Wu JJ, Schiff KR. Sarcoidosis. Am Fam Physician. 2004;70(2):312-322.
Hunninghake GW, Costabel U, Ando M, et al. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee. February 1999. Am J Respir Crit Care Med. 1999;160(2):736-755.
Holmes J, Lazarus A. Sarcoidosis: extrathoracic manifestations. Dis Mon. 2009;55(11):675-692.
Shigemitsu H, Yarbrough C, Prakash S, Sharma O. A 65-year-old woman with subcutaneous nodule and hilar adenopathy. Chest. 2008;134(5):1080-1083.
Culver DA, Newman LS, Kavuru MS. Gene-environment interactions in sarcoidosis: challenge and opportunity. Clin Dermatol. 2007;25(3):267-275.
Ludvigsson JF, Wahlstron J, Grunewald J, Ekbom A, Montgomery SM. Coeliac disease and risk of sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2007;24(2):121-126.
Gordis L. Sarcoidosis. In: Epidemiology of Chronic Lung Diseases in Children. Baltimore, MD: The Johns Hopkins University Press; 1973:53-78.
Alsbirk PH. Epidemiologic studies on sarcoidosis in Denmark based on a nationwide central register. A preliminary report. Acta Med Scand. 1964;176(suppl 425):106-109.
Stadnyk AN, Rubinstein I, Grossman RF, et al. Clinical features of sarcoidosis in elderly patients. Sarcoidosis. 1988;5(2):121-123.
Margolis ML, Israel HL. Sarcoidosis in older patients—clinical characteristics and course. Geriatrics. 1983;38(1):121-123, 128.
Chevalet P, Clément R, Rodat O, Moreau A, Brisseau JM, Clarke JP. Sarcoidosis diagnosed in elderly subjects: retrospective study of 30 cases. Chest. 2004;126(5):1423-1430.
Alhamad EH, Alanezi MO, Idrees MM, et al. Clinical characteristics and computed tomography findings in Arab patients diagnosed with pulmonary sarcoidosis. Ann Saudi Med. 2009;29(6):454-459.
Conant EF, Glickstein MF, Mahar P, Miller WT. Pulmonary sarcoidosis in the older patient: conventional radiographic features. Radiology. 1988;169(2):315-319.
Nunes H, Brillet PY, Valeyre D, Brauner MW, Wells AU. Imaging in sarcoidosis. Semin Respir Crit Care Med. 2007;28(1):102-120.
Lieberman J, Sastre A. Serum angiotensin-converting enzyme: elevations in diabetes mellitus. Ann Intern Med. 1980;93(6):825-826.
Allen RK. A review of angiotensin converting enzyme in health and disease. Sarcoidosis. 1991;8(2):95-100.
Belfer MH, Stevens RW. Sarcoidosis: a primary care review. Am Fam Physician. 1998;58(9):2041-2050, 2055-2056.
Rizzato G. Clinical impact of bone and calcium metabolism changes in sarcoidosis. Thorax. 1998;53(5):425-429.
Goldstein RA, Israel HL, Becker KL, Moore CF. The infrequency of hypercalcemia in sarcoidosis. Am J Med. 1971;51(1):21-30.
Falk S, Kratzsch J, Paschke R, Koch CA. Hypercalcemia as a result of sarcoidosis with normal serum concentrations of vitamin D. Med Sci Monit. 2007;13(11):133-136.
Bevilacqua M, Dominguez LJ, Gandolini G, et al. Vitamin D substrate-product relationship in idiopathic hypercalciuria. J Steroid Biochem Mol Biol. 2009;113(1-2):3-8.
Yoshida T, Iwasaki Y, Kagawa T, et al. Coexisting primary hyperparathyroidism and sarcoidosis in a patient with severe hypercalcemia. Endocr J. 2008;55(2):391-395.
Asakura K. Renal involvement in sarcoidosis. Intern Med. 2002;41(12):1088-1089.
Rizzato G, Colombo P. Nephrolithiasis as a presenting feature of chronic sarcoidosis: a prospective study. Sarcoidosis Vasc Diffuse Lung Dis. 1996;13(2):167-172.
Chapman JT, Mehta AC. Bronchoscopy in sarcoidosis: diagnostic and therapeutic interventions. Curr Opin Pulm Med. 2003;9(5):402-407.
de Hemricourt E, De Boeck K, Hilte F, et al. Sarcoidosis and sarcoid-like reaction following Hodgkin's disease. Mol Imaging Biol. 2003;5(1):15-19.
Brincker H. Sarcoid reactions in malignant tumors. Cancer Treat Rev. 1986;13(3):147-156.
Lenner R, Schilero GJ, Padilla ML, Teirstein AS. Sarcoidosis presenting in patients older than 50 years. Sarcoidosis Vasc Diffuse Lung Dis. 2002;19(2):143-147.
Hunninghake GW, Gilbert S, Pueringer R, et al. Outcome of the treatment for sarcoidosis. Am J Respir Crit Care Med. 1994;149(4 pt 1):893-898.
Curtis JR, Westfall AO, Allison, J et al. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006;55(3):420-426.
Boumpas DT, Chrousos GP, Wilder RL, Cupps TR, Balow JE. Glucocorticoid therapy for immune-mediated diseases: basic and clinical correlates. Ann Intern Med. 1993;119(2):1198-1208.
Lynch JP 3rd, McCune WJ. Immunosuppressive and cytotoxic pharmacotherapy for pulmonary disorders. Am J Respir Crit Care Med. 1997;155(2):395-420.


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Nikola Széchy (Seč) (mađ. Széchy Miklós) (?, o. 1320. - ?, 1387.), ugarski velikaš te ban cijele Slavonije (totius Sclauoniae banus) (1344. – 1349.), hrvatski ban (1359. – 1366. i 1374. – 1380.) i slavonski ban (1366. – 1368. i 1372. – 1373.).

Bio je jedan od najznačajnijih pristaša kralja Ludovika I. Anžuvinca (1342. – 1382.) koji mu je dodijelio niz službi na teritoriju Hrvatske i Dalmacije te Slavonije. Nakon što je kralj Ludovik I. 1343. godine potvrdio privilegije nižem slavonskom plemstvu i slobodnjacima, poslao ga je tamo sa zadatkom da, kao "ban cijele Slavonije" provede kraljevu odluku. Kao "ban Hrvatske i Dalmacije" aktivno je sudjelovao u političkim i vojnim zbivanjima u Dalmaciji, gdje je izmirio plemstvo i pučanstvo grada Trogira, nakon bune pučana tijekom 1357. – 1358. godine.

U ratu između Ludovika I. i Mlečana, sudjelovao je 1378. godine, zajedno s flotom iz Genove, u pomorsko-kopnenoj bitki i pobjedi nad Mlečanima kraj Trogira.

Bilješke

Vanjske poveznice

 Széchy, Nikola - Hrvatska enciklopedija

Mađarsko plemstvo
Hrvatski banovi
Ugarski palatini

redpajama_set_name: RedPajamaWikipedia


Mark Mazzetti is the Washington investigations editor, a job he assumed after covering national security from The Times's Washington bureau for 10 years.
In 2009 he shared a Pulitzer Prize for reporting on the intensifying violence in Pakistan and Afghanistan and Washington's response. The previous year, he was a Pulitzer finalist for revelations about the C.I.A.'s detention and interrogation program. He is the author of "The Way of the Knife," a New York Times best-selling account of the secret wars waged by the C.I.A. and Pentagon since the Sept. 11 attacks. He is a two-time recipient of the George Polk Award.


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Roy Rochlin/Getty Images Entertainment/Getty Images
The Meaning Of Kim Kardashian's Fourth Baby's Name Is Perfectly On-Brand For The Wests
By Kelli Boyle
Baby Kimye number four is here! Proud parents Kim Kardashian and Kanye West announced the arrival of their fourth child, a boy, on May 10. The announcement unfortunately didn't include the baby's name, but just a short week later on May 17, fans finally know his name: Psalm West! Hey, cutie! Just like his siblings North, Saint, and Chi before him, little baby Psalm has a unique, one-syllable name. And the meaning of Kim Kardashian's fourth baby's name is so sweet.
According to babynames.com, "the name Psalm is of Hebrew origin and means 'Song.'"
It's perfectly on-brand with everything the Wests stand for these days. A ton of fans suspected the name would be something religious, and adding in a musical element? The name Psalm checks all the boxes.
Clearly Kardashian and West knew what they were doing when they named this little one. The name fits right in with the names of his older siblings, as it's something not a lot people name their kids, and it has that Kardashian weird-yet-still-kind-of-glam flare.
The baby's name announcement hit Instagram on May 17. Kardashian posted an adorable conversation from West, simply captioned with her new son's name: "Psalm West."
Welcome to the world, little buddy!
Kardashian, outside of a couple of mentions, has been very mums the word about the arrival of her fourth child. She confirmed in a January interview with Andy Cohen on Watch What Happens LIVE that she and West were expecting their second son in the spring.
"It's a boy, I think it's been out there," she told Cohen, adding how she thinks the secret got out, "I got drunk at our Christmas Eve party and told some people. I can't remember who I told because I never get drunk."
Then, in the Season 16 premiere of Keeping Up With The Kardashians, Kardashian and West revealed the baby news to the family in the very first scene. Later in the episode, in a conversation with Kylie Jenner, Kardashian said that it was someone else in the family who spilled the beans: North West!
"North has been going around saying she finally has a baby brother so Saint won't bother her anymore," Kardashian told Kylie Jenner in the clip. "She's the one who's been selling us out this whole time."
Oh, North. You say the darnedest things.
In her 73 Questions interview with Vogue (which also featured Kanye West and their children), Kardashian talked about the upcoming arrival of Psalm and why North, Saint, and Chi were excited for his birth.
"So who's most excited for baby number four?" the interviewer asked Kardashian, who then turned to Saint West and asked the same question.
"Who's most excited for baby brother? You?" Kardashian said to her son. "I think North is too 'cause Saint will have someone to play with instead of her. And Saint wants to name him Sainty Two, right?" Glad that's not the name they chose.
Kardashian also confirmed in this interview that the baby was not going to have a direction-themed name like big sister North West.
"That is all for North," Kardashian said. "Actually, Anna [Wintour] had some influence in naming North because once she heard that rumor, she asked me and said that name was genius, so that was helpful to me." Pretty upset we're not getting the South West baby the internet has dreamed of, not gonna lie.
Anyways, congrats on your new little bundle of joy, Kimye!


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ICYMI for Tuesday 31st October 2017
'I'm super-grateful': Alan Doyle releases new book and solo album
Alan Doyle has been performing for years and has built a dedicated fanbase, not only for his work as a musician but as an actor and author as well. (CBC)
RIP: Canada's 'Pet,' Juliette (Cavazzi)
Juliette Augustina Cavazzi (née Sysak), CM, singer, entertainer, and television host made her CBC Saturday night music variety program Juliette (1956–66) one of Canada's most popular television shows. Over her career, she was honoured as Member of the Order of Canada, the BC Entertainment Hall of Fame and Canada's Walk of Fame. (FYI Music)
Question: What Do Bob Dylan and Leonard Cohen Have in Common? Answer: Suzanne Sheridan
Yes, both men are songwriters; yes, they are both musical icons of the latter half of the 20th century; yes, both are standard-bearers for human rights; yes, they both had multiple life-partners. But what they solidly have in common is singer/performer Suzanne Sheridan. Few women have attempted to conquer the oeuvre of even one of these men much less both in the time frame of less than a month. But no one has ever accused Suzanne Sheridan of being timid in her approach to music. (Hamilton Hub)
Stompin' Tom Connors receiving star on Canada's Walk of Fame
The New Brunswick born and P.E.I. raised music icon is hailed as Canada's unofficial poet laureate, after writing more than 300 songs about the country — most notably, The Hockey Song, Bud the Spud and Big Joe Mufferaw. (CBC)
By GarfieldUK| 2017-10-31T04:57:27-07:00	October 31st, 2017|Categories: News|17 Comments
Russ Gordon (@CDNz1) October 31, 2017 at 05:22
Good mourning!
Benoit from Ottawa October 31, 2017 at 05:43
Good Hallow's Eve ('s Day, I guess).
Not here today. Off to the fambly cottage to see how things are, after all this rain (many effects in our area). With any luck, there'll be power…
GarfieldUK October 31, 2017 at 05:46
Amusing, David Frum's being interviewed on CBC R1, and his computer is on, and pinging occasionally (for instance as a FB notice). Modern times. Ah, I think he's muted it now.
janet athanasiou (@janada59) October 31, 2017 at 06:26
Happy Halloween! Anyone dressing up?
Not I. I'm doing my best (hah!) not to be here, going to the cottage.
I am dressed as a tired nerd
@Garf – you too?
it's my go to outfit
I did think of being a sexy nerd but that sounded like too much work
I usually go as a nerdy nerd, but thought the tired factor would mix it up a little 🙂
funhug October 31, 2017 at 09:42
Did Funhug scare everyone away?
krib October 31, 2017 at 11:26
I may go to my vampire costume to hand out candy, because it's easy. we'll see. we don't get that many kids
Did the pirate for the swing dance this past weekend. Dancing with an eye patch on is tough.
Sooo, I'm a huge procrastinator, and haven't purchased our Halloween candy yet. I keep seeing these maps that will show what the popular candy in each state, so I clicked on a couple of them. According to two different maps I need to stock up on either York Peppermint Patties or Snickers on the way home.
The only time I have come in contact with a Peppermint Patty is watching Snoopy cartoons
garf: https://www.bendicks.co.uk/our-delicious-range/bitters.html
You may need a mortgage though.
they look interesting but way out of my price range


The cultivation of vine in Santorini has a very long tradition and the wines of the island are among the most famous wines produced in the Mediterranean Sea. The volcanic soil of Santorini is giving to the grapes distinctive tastes and aromas which you will enjoy by opening and tasting bottles of wines such as the sweet Vinsanto and other wines made by the varieties of Athiri, Aidani, Assyrtiko, Maurotragano and more. White and red, the wines of Santorini will captivate your gastronomic palette as you are enjoying the island's landscape from the privacy of your Windmill Villa.
The vineyards of Santorini are scattered around the island and you will find more than 10 wineries offering wine tastings. Ask the people of Windmill Villas to arrange a wine tour to the wineries of the island so that you can try all the different types of Santorini wines along with local appetizers. You can visit one or more wineries on the island through an organized tour or let's create together a must-visit wineries plan. Close to the Windmill Villas, your will find one of the most famous wineries on the island, the Domain Sigalas, where you can enjoy local wines of high quality.


Today's guest on The Successful Pitch is none other than Kevin Harrington, one of the original judges on Shark Tank. If anybody knows what it takes to have a good pitch, it's Kevin Harrington. He's literally heard over 50,000 pitches in the many years he's been doing this, from listening to pitches for infomercials to listening to pitches on Shark Tank. He has a really great key here which is that, "Consistency is the ultimate motivational tool." He said, "When you're out there, you need to show the investors how they're going to get their money back." He gives an example of exactly the kind of pitch he would like to hear in order to get him to say yes. He said, "You need to test before you invest." He gives us great insights into what a magical transformation is that he is looking for when he hears a pitch. Enjoy the episode.


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Home Bali A Capital Idea: Bali Promotes Denpasar Heritage Tours
A Capital Idea: Bali Promotes Denpasar Heritage Tours
Bali,
Efforts by the Denpasar Tourism Office to launch "Heritage City Tour" are being pegged to attract foreign tourists to spend time exploring Bali's capital city.
Describing the target market for Denpasar Heritage Tours, the head of the Denpasar Tourism Office, Wayan Gunawan, told the State News Agency Antara he expects cruise ship passengers berthing at nearby Benoa would take the opportunity to view the historical sites offered by the tour.
The tourism official estimates 1,300 tourists from Australia and the U.S.A. are carried on a single cruise ship visiting Bali with at least 240 from that total likely to sign up for the planned "Heritage City Tour."
The proposed tour would include visits to the Bali Museum and the Jagatnatha Palace.
Gunawan said there are 9 tourist objects to be found in Bali's capital with the most popularly visited are the Badung market, the Kumbasari market, Bali museum and the Jagatnatha Palace.
Gunawan is trying to bring some of the economic benefits of Bali tourism to the Island's capital, an area often overlooked by tourism visitors.
Denpasar City Tour with Bali Discovery
© Bali Discovery Tours. Articles may be quoted and reproduced if attributed to http://www.balidiscovery.com.
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Tracking down the hidden Portuguese pearl in north Jakarta
Built in the mid-18th century, Gereja Tugu is the second-oldest church in Jakarta and currently preserved as a historic monument. (ANTARA...
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Diamonds By Lauren Guide on How to Choose a Diamond Necklace, Out in California, the traffic was far too severe about the freeways in Los Angeles. So they stood a nifty idea, they would create diamond Lanes, in support of drivers that have 2 or more people inside their car would be permitted to drive inside them. The theory was that folks would start carpooling so they really might use the express lane understanding that would please take a great number of cars off the road, increasing traffic flow. Unfortunately, it failed, and the unintended consequences was make things even tougher on commuters and those while using the highways.
Because tanzanite is trichroic, (shows 3 different hues from different axis of observation) this is a marvel to think about whenever you turn the ring round and round within your hand. From one direction it look more blue and from another it looks more purple. This quality helps make the backdrop of a white metal the right background against which to see this phenomena. Against 14 karat yellow gold or 18 karat gold this effect is often a little muted especially when tanzanite is mounted in a pendant and it is limited to one position of observation.
Company management: A company must have good stewardship in the officers. David Wright are at the helm of Diamond Rewards. He is very transparent in the past and provides association in the industry. He provides full contact details and invites one to visit when in his country. He listens and acts when necessary. He has set a goal to remain a viable chance for all involved for years to come. David realizes that when getting a multi-country environment many governmental standards should be in place. He is addressing this to stay all safe. This is Diamond Rewards!
Some could point out that it can be in poor taste to offer the love of your life a synthetic diamond ring and this has been believable a hundred years ago when there were nothing else but a typical gold ring for many who can't spend the money for luxuries of gems. But in today's society, genuine gems have turned into more of a commodity than the usual prolonged treasure. It was the monumental reputation of the diamond that led lovers to want this remembrance of jewellery for all time.


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Q: socket.io server on android I am trying to implement a socket.io server on Android.
For some reason, all the tutorial/snippets (for instance this, or that) I find when searching for "Android Socket.io (server)" are: node server, Android socket.io client. Ie., I wasn't able to identify a single case where you have the socket.io server on the Android.
Is it possible at all to have a socket.io server running on an Android device? If yes, how?

redpajama_set_name: RedPajamaStackExchange


What services do you offer at The Shakespeare Hospice?
Our Day Hospice offers a range of physical, psychological and spiritual care as well as information and support. Patients and carers attend for appointments or for the whole day, returning to the comfort of their own home after each visit. For patients who are too ill to travel, our Hospice at Home team deliver care and support in the patient's own home. The aim of this service is to enable those who wish to die at home to do so in comfort and with dignity.
Family Support Services are available to all patients, carers and their family members. This service includes counselling and bereavement support. Our Young People's Services include support for bereaved children or those facing a loss, support for young carers and Day Hospice care for young people aged 16-24 with a life limiting illness.
Our services are available to patients, carers and family members affected by a life limiting illness. We support patients from the moment of diagnosis and no referral is required from a GP or hospital.
Patients and carers can be referred through their GP, hospital, District Nurse or other health professional. They can also self refer – visit our referral page or contact the Hospice on 01789 266852 for more information.
When is the Hospice open?
The Hospice is open 9.00am – 5pm Monday – Friday.
How long can I come to the Hospice for?
Patients and carers can access the Hospice services for as long as they need. The team assess people on an individual basis and develop a supportive care plan according to their needs, which is reviewed every 12 weeks.
Who might I see at the Hospice?
In the Day Hospice there is a team of Nurses and Healthcare Assistants along with an Occupational Therapist and Physiotherapist. There are also Complementary Therapists and Diversional Therapists. Through our Family Support Service you may see our Macmillan Social Worker, Counsellors or Chaplain.
Our Hospice at Home team includes trained Nurses and Healthcare Assistants, along with Complementary Therapists who also offer services in patients' homes. All our services are supported by volunteers in a wide variety of roles.
Are there any beds in the Hospice?
No. When the Hospice was originally being developed our community told us they would prefer to remain in their own homes with family and friends around them, and access the services through a Day Hospice. The Hospice at Home team was later formed to give patients' access to end of life care in their own homes.
"From the Hospice I have got practical help from the physios in the form of extra exercises when I had my mastectomy – help with aids for my home because of the mobility problems when the bone cancer appeared i.e. providing two zimmer frames, one for upstairs and one for downstairs because if you only have one it is always in the wrong place."
"I started my weekly visits to the Hospice at the same time as my chemo sessions started and what a revelation. The "Hospice family" came riding in on their chargers and encouraged me to talk, relax, join hands on diversional therapy sessions and be a receiver of the wonderful alternative therapies which have helped address aches and pains as well as dealing with my inner calm."
"I cannot describe what the Hospice gives me – it's like being in a loveable bubble, all the services I receive are also on offer to my family and carers who have taken up the support, they have reaped as much benefit as I have.
The whole approach to us is a holistic one and it's up to individuals to take as little or as much as they want."


On a Support Plan? We can help!
With the release of version 5.08 build 318, Remote VirtualBoss installation has been greatly simplified!
Please jump to this section to see a revised Installation Guide.
In order to run Remote VirtualBoss, you'll need to install a copy of PC VirtualBoss to your computer.
If you have not already done so, download VirtualBoss to your computer and follow the installation instructions.
It's important to note that Remote VirtualBoss is only available in versions 4.0 and up. If you're using an earlier Version, a free update is available!
Remote VirtualBoss requires the use of a web server software in order to run on your computer. The web server software will allow you run a website on your computer.
The choice is up to you, though we find Apache easier to use and recommend it. Click a choice below for setup instructions.
Windows has a built in Web Server software called Internet Information Services (commonly referred to as IIS). As a Windows user, IIS may already be installed by default on your computer. Although, it is not uncommon for this service to not be turned on or installed by default with your computer.
To see if IIS is installed, go to the Control Panel of your computer and click on Administrative tools.
If you see Internet Information Services there, it's already installed and you're ready for Step #3.
If you do not see it here, you'll need to install it. You can typically do this by clicking Start, and choosing Computer. From here, click on Uninstall or Change Program.
Then click on Turn Windows Features on or off.
In our opinion, Apache is a bit easier to manage than IIS. If you don't have IIS installed, you may consider Apache as your web server of choice. You will need to download a special version of Apache to work with Remote VirtualBoss. Click here to download Apache web server from our website.
for All Users, on Port 80, as a service -- Recommended.
only for the Current User, on Port 8080, when started Manually.
After this step, Apache should finish configuring itself and open a web page showing you the "Localhost", or default website on your computer. Now we're ready for Step #3. Please see our Apache Troubleshooting section for common issues and ways to resolve them.
Now that we have VirtualBoss and a Web Server Software installed, it's time to install Remote VirtualBoss. To begin the installation of Remote VirtualBoss, go to Options → Remote VirtualBoss.
With version 5.08 build 318 and higher, Remote VirtualBoss is automatically installed along with VirtualBoss. We've also included Apache 2.2 already pre-configured to work with Remote VirtualBoss so there is no need to download and configure additional software! Once you have VirtualBoss installed, you will already have Remote VirtualBoss installed as well. In order to use Remote VirtualBoss, you will still need to configure your router.
By this step, you should be able to view your Remote VirtualBoss website by going to your Localhost. You may notice that your website is running, but it is only available to users on your local network. But we want to make this website available to users from anywhere. To do this, you'll need a few things.
Find your router on this page by looking up its name and model #. Follow the "default port-forwarding guide" for your router to set up a simple port forward to you computer.
After you've set up your port forward rule, you can test to see if it's working with this easy to use Port Checking Tool.
Now that your website is set up and your router configured, you'll want to start accessing your website remotely. Your website works like any other website on the internet. The only difference is that you are in control of it! Your computer is running the website so it's important to remember that if your computer is turned off, the website is not available.
You may also want to consider using a DNS update client to make it easier to remember your website address.
There are many free services that you can use. No-IP is one we recommend.
If you get stuck and are on a Support Plan with us, we can help!


Earlier this week, we highlighted some of our favorite Australian young adult authors and books and many that we are excited to try in the future. While researching that post, I realized how very vast the choices were and how much we had left to explore. While I've included over 100 different Aussie YA books in this Wall of Books, there are hundreds more left out. If I've left out your favorite, leave it in the comments and I'll add it in. I'd like to thank Kat from Cuddlebuggery for helping me add in some of the data. I'd also love to recommend some other Australian blogs and reviewers that regularly feature Aussie fiction: Vegan YA Nerds, Belle's Bookshelf, Maree's Musings, Inkcrush, Trinity, Reynje, and Emily. I am almost certainly missing some very important people but it is late and my mind is mush. I know several people found some fun books in our Wall of Short YA Books so I hope some of you find one or two new Australian YA books to read from this post. I was/am surprised how many of them are available through Amazon US (and especially for Kindle!) There are a few which are not available on Amazon so I linked to Fishpond in those cases, though just a few seem to be sadly out of print.
That looks like an amazing amount of work to put together! But such nice eye candy.
It does take forever but it's worth it. Also, it is mindless so I just did the lion's share of it while I watched Dexter, Homeland, and a really crap Sarah Jessica Parker movie (I Don't Know How She Does It) I think that movie is supposed to be inspiring for mothers but all it made me want to do is never ever have children.
I need to make a tick list. I have read most of them, I think.
You've read "most of them"?! Holy heck, then you are some sort of Wonder Woman. There are some pretty obscure ones hiding in there.
Whoops.... "heard of" most of them.
One of you delightful ladies *needs* to read Creepy & Maud - I'd love to hear what you make of it. I've not reviewed it yet, but it's pretty unique..
That one looked specifically interesting to me, Rey! I saw that it is available for Kindle and that you and one other reviewer I trust really loved it and that pretty much clinched it for me.
Crikey! ;) Great work, Flann. The Kobo store has been my latest go to resource for Aussie ebooks. They have a ton of UQP titles. BN.com has a few too, like Brown Skin Blue and Loving Richard Feynman.
We'll brainstorm Aussie book suppliers when I see you next. There are definitely a few I need to buy very soon, hard copy and ecopy.
I love all three of those and I'm jealous that you're experiencing them for the first time.
Wow, there are so many I've read, and so many I've never even heard of! One thing is sure, I'll be coming back to check out this list very often! It's a good way to make sure I read at least one Aussie title every month. There are plenty to choose from.
Even as the maker, there are so, so many that I've yet to read. It's exciting to see how much there is out there.
I have printed off the list so Miss 10 and I can see which ones we have already read/want to read.
Glad to help you find a few new books!
Ah! I had no clue. Will fix that now. I have to admit, there aren't tons of sources for of compiled information on this subject so I checked blogs, some Australian websites, and lots of people's Goodreads shelves. I'm kind of offended on her behalf as well that several people (including me!) have her books shelved as Australian when she is from New Zealand. Yikes. I'm duly embarrassed and apologize for the mistake.
Awesome wall! There's quite a few on here I need to read!
"The Power of One" is one of my favorite books. In order to read the sequels, I had to get them through inter-library loan. Perhaps it is not considered YA?
Do you mean Bryce Courtenay's Power of One? That is meant to be amazing, I agree, but he isn't Australian. I think he's South African?
i had a peek earlier but only just now catching up on commenting.
's such an awesome resource.
some of my all time fave books are on here. forinstance, i crazily LOVE raincheck on timbuktu. also, will by maria boyd is awesome. i've read it three times, although i dont know anyone else who has read it.
i also liked the blue water high book, felt a bit like dance academy but for surfer nuts (instead of dancer nuts). how did you even find out about that book?
Also, Girl Next Door - I got this out of the library in Brissy and it's been burnt on my brain ever since - fantastic read.
You have just dramatically increased my TBR pile... all I can say to this is, THANK YOU! I even have a GR shelf dedicated strictly to Aussie authors. It's small now at 16 (including all of Melina Marchetta's books), but I have a feeling it will steadily continue to grow.
Wow--thanks for putting such a comprehensive list together! Really appreciate it. Not only is it helping me put together a "down under" library display, I'll be adding some to my TBR list!


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A socio-cognitive account of meaning
As the theoretical background for this analysis, we adopt a socio-cognitive, usage-based perspective on meaning, according to which meaning essentially resides in the intersubjective process of meaning coordination among interlocutors (Langacker 2001; Verhagen 2008; Brone 2010: 399; Langlotz 2011). In doing so, we move beyond the traditional cognitive linguistic, subject-centered account of meaning, in which aspects of mutual and joint interaction as described by, among others, Clark 1996 remain somewhat underfranchised.
Our account of intersubjectivity does not concern the interactive process of explicit meaning negotiation as it occurs among interlocutors and in which different opinions about a commonly focused topic are discussed. Instead, we define it as our cognitive ability to take other people's perspective and to model the mental states of our interlocutors. This view is very much in line with the theory of mind (Whiten 1991; Givon 2005), which revolves around our ability to identify and differentiate the mental from the physical world and, more specifically, the ability to conceptualize thoughts, ideas, emotions, attitudes, beliefs etc. in other people's mind (Brone 2010, 91-92). During interaction, both at the stage of interpretation and production, interlocutors imagine what they assume to be in the minds of their conversational partners and align their construal with it. Accordingly, conversation can be characterized as a process that requires constant alignment and negotiation among intersubjective viewpoints.
Linguistic expressions are cues for making inferences, and understanding thus not primarily
consists in decoding the precise content of the expression, but in making inferences that
lead to adequate next (cognitive, conversational, behavioral) moves. (Verhagen 2005, 22)
With regard to the impact of these perspectival aspects of intersubjective meaning coordination on everyday language use, Clark (1996) identifies the notion of layered meaning as a key concept of his theory of language use as a joint activity. He points out that in many so called staged communicative acts (1996, 368) like sarcasm, irony, lying, teasing and many others, participants do not necessarily act and communicate in line with the expectations and norms of that specific situation. Clark links this observation to the crucial insight that the experience of common ground does not have the status of an independent or inherent value in communication. Instead, "when [we] act on the basis of our common ground, we are in fact acting on our individual beliefs or assumptions about what is in our common ground" (96). Indeed, interlocutors may always exploit common ground for humorous, ironic or other communicative purposes (Veale et al. 2006). Clark describes the meaning in staged communicative acts in terms of different meaning layers, where the primary or basic layer corresponds to the concrete situation of the communication between speaker(s) and hearer(s) (the ground as Langacker calls it).[1] On top of this primary layer, interlocutors may decide to create another, secondary layer of meaning, which can only operate relative to and hence dependent on the primary layer of interpretation.
In their analysis of adversarial humor, Veale et al. (2006), Brone (2008; 2010) and Brone and Oben (2013) identify prominent patterns of layered meaning, through which interlocutors achieve a trump over their opponents by pretending and then elaborating a misunderstanding, in which (parts of) the expressions used by a previous interlocutor are recycled and successfully turned against their original users, as illustrated in (1).
(1) (our translation) Spectator shouting at Dutch politician H. Wiegel:
Son of a bitch!
H. Wiegel: How nice of you to introduce yourself; my name is Hans Wiegel.
In this brief dialogue, the second interlocutor creates a secondary layer of interpretation, involving a pretended misunderstanding, in which he activates an unanticipated alternative meaning, allowing him to achieve both verbal and social superiority over his opponent. On the basis of mutually assumed common ground, both speakers 'know' that the first speaker intended his utterance to be understood as an insult. Also on the basis of common ground, both speakers must conclude that the meaning construal in the reply of the second speaker will generally be regarded as superior compared to the initial insult by the first speaker.
[1] With this distinction, Clark relates his model to the work of Russian linguist Mikhail Bakhtin,but also to Relevance theory, several discourse models and more cognitively oriented paradigms;for an overview, see Brone (2012).


Having just taken my own journey into the city via subway, I arrived a huddled mass on a rainy day on Times Square Plaza, ready to have my first Portal experience under the tutelage of Lee and Shared_Studios Founder and Creative Director Amar Bakshi. I was ushered out of the inclement weather and into the cozy, well-lit quiet of the Portal, where Bakshi set to work connecting me with some excellent souls in Berlin.
I was prepared for a pretty standard videoconference connection, but what I got was something infinitely more hygge. I was totally at home in the immersive, full-body viewing setup, feeling like I was chatting and making eye contact easily with my conversation partners, who were seated on a sofa in Berlin.
But that was just the start of this fireside chat. When Lee returned to the room, he did what people do in Portals. He just jumped right into the good stuff. Why are the Portals important? Because the one that was set upon the pavement behind Nova High School in Milwaukee for 18 months produced a lasting impact on the local community and those around the globe who interacted with Lee's energetically creative Portal sessions.
Lee's particular neighborhood in Milwaukee was selected for Portals through a connection made by a documentarian working on the film, "Milwaukee 53206," which explores life in the ZIP code with the highest incarceration rate of black men in America. The Portal was originally placed there to open the door for discussions on criminal justice, but it quickly became the center of healing community engagement. And, also, a little thing called fun.
The first big new idea to come to the Portal came from the students at Nova High School. Their curiosity about the burnished gold shipping container prompted daily visits, and then the community innovation began. It started with a talent show that gave local kids the chance to share their skills on a global stage. Then there were music performances with remote instrumentalists, a Portal Rap series, spoken word, and yoga classes. Entrepreneurial youths started sharing their fashion and business projects with those they connected with on the world stage, gaining support and a window into other ways of life.
Lee also built powerful new connections and established community programs through the Portal, supporting the Milwaukee Fatherhood Initiative and even arranging to have rival gang members use the neutral spaces to negotiate peace.
Along the way, Lee built long-distance friendships with other Portal curators as they connected their spaces for these projects. Most particularly, he collaborated on several perspective-changing programs with Kristen Erickson, an educator in a community that is the polar opposite to the 53206 — at the Greenwich Academy in Connecticut. Erickson is a big part of the Portals project, and serves as the Head of Educational Programming for Shared_Studios.
The Portals project's original mission to connect strangers through casual conversations about everyday life has evolved into a multidimensional offering of educational and entertainment programming. But ultimately, it's still just about making regular people feel welcome to chat about anything they'd like.
Learn more about the AV integration in the Portals project in this case study.


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Causes of High MPV Blood
High Levels of B12 & Side Effects
What Are the Causes of High MCV Count?
Treatment of Thalassemia With Herbs
What Does Vitamin B12 Do for You?
What does fact checked mean?
At Healthfully, we strive to deliver objective content that is accurate and up-to-date. Our team periodically reviews articles in order to ensure content quality. The sources cited below consist of evidence from peer-reviewed journals, prominent medical organizations, academic associations, and government data.
The information contained on this site is for informational purposes only, and should not be used as a substitute for the advice of a professional health care provider. Please check with the appropriate physician regarding health questions and concerns. Although we strive to deliver accurate and up-to-date information, no guarantee to that effect is made.
What Is the Major Difference Between Thalassemia & Sickle Cell Anemia?
Written by Amber Williams
Thalassemia and sickle cell are genetic disorders. Thalassemia is the result of an imbalance in the two globin chains that produce the hemoglobin molecule. In sickle cell, a mutation of the genes causes an abnormal hemoglobin to be produced, which causes the cells to form a crescent shape (sickle). In either case, the production of hemoglobin is disrupted and cannot do its work of delivering oxygen to the body.
In sickle cell, the red blood cells stick together when deoxygenated and form polymers that make the cell membrane rigid and unable to flow through capillaries as needed.
Symptoms of sickle cell do not often appear until at least 4 months of age and can include the following: painful "crises" that last for long periods, fatigue, jaundice and difficulty breathing. Severe cases of thalassemia can cause death at birth. General symptoms of thalassemia include bone deformities, enlarged liver or spleen and stunted growth.
Blood transfusions are usually necessary for both sickle cell anemai and thalassemia. The major difference in treatment between the two is that sickle cell may also require dialysis, kidney transplant, surgery for eye problems or abnormal erections and gallbladder removal. Antibiotics are necessary due to the incidences of infection.
Sickle cell can cause organ failure if not properly treated. Sickle cell patients are also susceptible to infections that can be fatal if not immediately addressed. Thalassemia can lead to death by heart failure if not treated.
Thalassemia is more likely to be present in those of Greek or Italian descent, whereas sickle cell is more often found in people of African or Asian ancestry.
Treatments for Low TSH Levels
What Does Low TSH Level Mean?
Kenalog Injection Vs. Cortisone Injection
What Are the Symptoms of Protein or Iron Deficiency?
What Is the Difference Between B-12 & Methyl B-12?
Information Center for Sickle Cell and Thalessemic Disorders
NIH: National Institutes of Health
National Heart, Lung, and Blood Institute. Sickle cell disease.
Gong L, Parikh S, Rosenthal PJ, Greenhouse B. Biochemical and immunological mechanisms by which sickle cell trait protects against malaria. Malar J. 2013;12:317. doi:10.1186/1475-2875-12-317
Amber Williams has been writing professionally for over 10 years. She currently writes primarily in the parenting and health categories. In addition to freelancing, Amber worked as an editor for a peer-reviewed research journal for 7 years. She graduated from Bennett College with a degree in English and Education.


A successful intranet is one where everyone in the organization participates in creating and maintaining the published content. In the past it was common for a hospitals' Information Technology department to be solely responsible for publishing updates to the content of the intranet site. The process was slow and cumbersome typically with departments identifying the necessary changes, developing change orders that are then forwarded to the IT department where a dedicated person would receive the change orders and eventually (at their convenience) update the intranet site. This process was loaded with problems. The changes would often be lost in translation where IT would make updates which the departments did not expect or were not exactly what the department needed which would require a cycle of change requests and updates by IT before the content was updated correctly. Often the IT department would sit on the change request so the content was not being updated in a timely fashion. Frequently departments would altogether give up on requests they deemed not important enough because of the tedious nature of the process.
Today's modern and successful intranets have done away with the middle man and encourage the departments and in essence all employees to maintain the content of the intranet in real-time. This concept often strikes fear for many who believe that the intranet will become a wild west of random content, out of control designs, colors and images as well as inappropriate or unapproved messages or information. These fears are mostly unfounded if a proper plan is established.
A portal governance committee should be created with members consisting of representatives that are particularly heavy users of the intranet such as the Human Resources, Marketing/Public Relations and Laboratory departments. This governance group should be tasked first and foremost with developing a set of guidelines on how the hospital's intranet should be maintained. The governance committee is responsible for determining a template of what a typical department's intranet page(s) should look like in terms of what common content should appear and where/ how it should look.
The governance committee's other main responsibility is making decisions about the site's appearance, navigation and any questions that come up after the intranet is up and running. With the proper plan in place it is quite rare for extensive policing to have to be done. In the rare instance where some content is not up to the organization's standards the offending users are simply asked to make the proper adjustments as most intranet systems maintain audit trails and logging to identify who last updated certain content.
The advantages of delegating content publishing throughout the organization simply cannot be overlooked.
The content is always fresh and up to date which encourages everyone to use the intranet as the go-to resource for all information dissemination.
When everyone embraces the intranet because the content is fresh; the intranet encourages a paperless environment thereby decreasing costs and streamlining internal processes.
Hospitals cannot continue to have a "Webmaster" handle publishing content on the hospital's intranet. At the very least the webmaster's role should be much more different than what it was in the early 2000's. Key employees should be able to edit and publish content on the intranet at will and as necessary. Webmasters should not be responsible for publishing content but instead should handle delegation of editing capabilities as well as monitoring of any general site wide feedback or comment forms as well as aid in assisting the super users with any questions or issues they may have publishing their data.
at many hospitals. If your organization has not embraced the concept it is time to speak up!


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Harry Styles breaks barriers in controversial Vogue cover
The pop star turned fashion icon overnight by wearing traditionally feminine clothes for the popular magazine
Via Vogue Magazine
Photo taken from Vogue, photography by Tyler Mitchell.
Sophie Shram, Arts & Culture Writer
On November 13, 2020, the internet was broken once again, this time by former One Direction member, Harry Styles who not only became the first male solo artist to appear alone on the cover of Vogue Magazine, but also the first man in 127 years to appear wearing a dress. The singer-songwriter wore a stunning baby blue, frothy, lace trimmed gown paired with a black double breasted-tuxedo jacket.
Styles has always been known for having an immaculate style and taste in clothing. His fans continuously praise him for wearing gender non-conforming clothing, or typically "feminine" outfits. His attempts to break the stereotypes set around clothing is one of the many reasons his fans adore him. In an interview with Vogue discussing his fashion he stated, "When you take away 'There's clothes for men and there's clothes for women,' once you remove any barriers, obviously you open up the arena in which you can play." He also added that for clothing, "It's like anything—anytime you're putting barriers up in your own life, you're just limiting yourself. There's so much joy to be had in playing with clothes. I've never really thought too much about what it means—it just becomes this extended part of creating something."
While Styles' fans adored his expression of male femininity on "the world's most influential fashion magazine" as described by the New York Times, many disagreed with his choice. Critics claimed that Styles' appearing in a dress is an attack on masculinity. On November 28, 2020, conservative commentator, Candace Owens, mocked Styles by tweeting, "There is no society that can survive without strong men….Bring back manly men." Fans were quick to respond and clap back with examples of iconic singers such as David Bowie, Iggy Pop, and Kurt Kobain crossdressing to prove that femininity does make anyone less of a man. Even "Lord of the Rings" star Elijah Woods stated that "Masculinity alone does not make a man, in fact it's got nothing to do with it."
Styles reaffirmed the contemporary idea that manliness is based on cultural trends of the time, and has nothing to do with actual manhood. Additionally, many took the opportunity to point out the internalized toxic masculinity in critiques of Styles, and to open the eyes of critics and show them the harm it can cause to young males' or anyone's ideas of themselves. People pointed out that freedom of expression, especially through clothing, is essential for growing adolescents to be able to figure themselves out.
Despite the backlash and controversy, Styles' support prevailed when Vogue's December issue needed to be waitlisted due to its abundant demand. A source from Condé Nast, a global media company, stated, "We sold 40,000 subscriptions since launch a little over a week ago, and have already ordered a second print run."
Though some show contempt for the singer's decision to don a dress, the support and admiration is clear with the sales of the magazine, and the quick actions taken defend the singer on social media. Harry Styles' decision to appear in the gorgeous gown was an effective step taken to help normalize male femininity, and to show that clothes have no limits or gender. Despite the controversy, Styles holds firm on his stance to break the gender barriers surrounding clothing and continues to awe and inspire fans to do the same and wear what makes them feel confident.
Sophie Shram, Arts & Culture Editor
Senior Sophie Shram is an editor of the Arts & Culture section for The Holly Spirit. She is involved in the Botany Club, as well as the French National...