The Death of a Parent; Then & Now. The first-hand experience of losing both parents and how to move on from it.
Since I started writing my blog, it has been with the key purpose of gaining knowledge through life experiences; expanding my mental (and sometimes physical) capabilities by exploring the unknown and embracing them wholly. Little did I know that my most enlightening challenge would also be the ultimate testament of my character; the death of a 2nd parent, my Mother.
Death's embrace is not selective; on the contrary, its heavy cloak sweeps over the young, the old and the unsuspecting… a kiss we are never prepared for and one we are rarely able to break away from. And so I find myself in the shadow of its latest victim, one I was not prepared for it to steal away so abruptly. We are naive to believe we are EVER prepared for it. Only weeks before the night of Death's visit, I had already been reflecting on mortality and it seemed as though I had left the door ajar.
Death was a familiar friend, taking my Father barely a week before my sixteenth birthday, which would inevitably leave an imprint on my future decisions and paths that although would pain me greatly would also provide me with valuable insight traditionally known later in years. By comparing experiences, I have found myself become my own psychological study in understanding the grieving process so I hope this provides some comfort to those bereaved as well as educate curious souls.
My purpose is not to sadden the reader or encourage pity, I abhor the very notion. It is simply to provide another insight into a subject matter that many of us fear to tread, perhaps to preserve some element of innocence (or ignorance) within ourselves. From personal experience (something never to be scoffed at. It is an abomination when people talk about anything solely as a spectator, never having lived it themselves and casually casting judgement as eloquently as a bourgeois politician) I cannot agree with withholding any truths, even on the basis of politeness in some cases. Life is NOT difficult; it is merely what we each make of the hurdles we are presented with crossing. Some can overcome, some cannot, but with encouraged understanding some can 'attempt' to rise to the challenge and if I can at least bolster your spirit into trying, my writing has completed its objective.
The death of my Father has always been a precise memory for me; I had been out with friends for an unimportant daytime distraction and on arrival at home found a note on the door from a neighbour, mentioning my father had had a 'funny turn'. From marching over to the nearby hospital to going through endless double doors until my Mother's wailing indicated I had reached the correct area, I was ushered into a room to find a man lying on a bed as though sleeping, whose face was riddled with the onset of rigour mortis from the heart attack that had ultimately killed him. Confusion and mild squeamishness hit me and I left hastily, only with thoughts to gain the comfort of my friends whilst my Mother was being comforted by her own. This was when I truly began to understand the meaning of friendship and gaining comfort from those around you; one half of my family had died yet no consolation comes from teenagers.
The following 2 weeks before the funeral was a blur of black outfits and tear stained faces, mixed with the occasional interaction of ignorant teenagers, one of which was myself. Having never experienced death before (aside from seeing my mother sobbing uncontrollably after receiving the call about my grandfather's death. She was even more upset that she could not make the trip to the Philippines for the funeral), the impact Dad's departure had on our lives was immense and imbalanced everything. Mother was devastated of course, and went through phases of high criticism of my outward display of emotion to occasional 'Let's end it all' suggestions whilst driving the car. She had lost her ally, her lover and the man who completed her picture of a perfect family. It was just her and I now.
The lead up to the funeral itself was saturated with prayer and Church attendance. Even with a deeply Catholic upbringing, I was not prepared for the mourning period and 9 days of a Novena. This rosary based ritual was paid daily to a shrine for my Father, with a large gathering of my Mother's Filipino clan who although mainly there to alleviate my Mother's loneliness with their strong personalities and Tagalog tongues, were considered brash and alienating to my unfamiliar eyes and ears. My only contribution to the funeral arrangements was delivering the eulogy and playing my Father's favourite Operatic piece La Traviata on the piano. I remember my disdain at the filming of the funeral, a sad morning captured for posterity that I did not care to remember but remained an unhealthy keepsake for my mother.
Choosing the plot in a cemetery to bury my father and attending a dance festival within the same week are clearly contrasting events and to this day I am not sure how I managed to partake in either however to the unsuspecting souls around me, I was riddled with pain and anxiety which I always tried to suppress. My Mother did not understand me, her cultural as well as religious background was heavy with judgement and my way of grieving was chastised; I was 'cold' and uncaring because I did not cry on cue. I would simply hang my head and try to be resilient to the judging eyes around me, but what else could I do? Looking back on my former self I simply had no outlet for my grief. Friends did not know what to say or words to console, I had no other family in the country to turn to aside from my mother who was beset with such intense grief that it was easier to remain stoic to be able to function on a daily basis.
But based on her reactions, I made the decision that when the adult age of 18 arrived, I would move out and rent my own place. I had to do this. At the time it was considered selfish and inconsiderate to leave my Mother to live alone, however I felt it was the only thing I COULD do to reclaim some sense of myself and to focus on the task at hand; to LIVE life.
My home had become a museum to my Father, even down to his toiletries on the top bathroom shelf. The air was unhealthy and my Mother's sadness infiltrated every room. Work was her distraction, her escape from this unchanging environment so perhaps that spurred me on further to make distractions, by my own choice, for myself. Had I stayed, I felt I would have suffocated from the perpetual presence of Dad, not in physical form but in all else, so I left as soon as I could. I had always craved family companions through childhood, but unlike my English peers, this family time always came at the price of a plane ticket, and only at intermittent times throughout the year. So being alone was not unusual for me, on the contrary, I quite enjoyed the freedom to just be with my thoughts, with no expectation from others.
My own self prescribed methods for healing and self-improvement took time but through many more unplanned life experiences, I got to a place mentally that was positive, looking to pursue everything with gusto, to learn more about life on a more spiritual level, all of which educated me in how to remain in the land of the living. With this precious education, I was then to be seized in the grip of another death that has been my ultimate test in coping with my own sense of being alone.
For the past 17 years, I have watched my Mother vary in temperament. Age softened her to a degree however I was always very aware of the constant sadness she retained since my Father's passing.
The weekend I visited her due to a distressing conversation on the phone, when I had become acutely aware that her 'chest infection' was more serious than initially thought, I had no idea would be our last reunion. Over 48 hours in a hospital, I took time to stay by her side and tidy up her home, the eternal museum still thick with the air of grief. Medical professionals varied their reports of her hospital stay to a few days to then weeks, always with an element of possible rehabilitation which held a glimmer of hope for me. But that Sunday evening, I was finally provided with a concrete answer that she would not survive the pneumonia that had viciously taken over her body. To be told that your Mother will die struck me with some relief for her release from the mortal prison that consumed her, followed by unbelievable shock that we would never spend dinners or days out ever again. A friend had come down to the hospital to be with me in the final hours, amidst the gaggle of my Mother's friends that perhaps knew sooner than I did that the end was near. The emotional trauma clouded my mind and the need to be outside was overwhelming so we went to a communal space where I could gather my thoughts. I sobbed exhaustedly, letting the news echo in my head hoping that every tear would ease the sharp pain of my heart breaking.
I had also had to be the messenger to my family; my cousins, Aunts and friends were continuously updated throughout this time so I had to repeat this tragedy and the reasons why she died over and over again. I had only the welcome arms of my friends to hold me and remind me that she was in a better place, with my Father, all of which I knew was what she wanted since the day he died. Although relatively composed, I had to ensure I did not buckle as I now had a huge task to complete, an event planning situation that I begrudgingly had to deal with; the funeral of my Mother.
The impact of a close parent's departure from this life is like that of an atomic bomb, with the dust clouds swirling around at such velocity, enrobing you with an almost suffocating list of things to do (your own grief being at the bottom of the list); the house had to be cleared of over thirty years of memories; banks, utilities, workplaces… all have to be notified of the death and no action can take place until the death is certified and this piece of paper with confirmation of a person no longer alive is presented. The body had to be moved from hospital to funeral home, papers need signing and a requiem mass had to be planned with all direction stemming solely from me. The responsibilities are enormous and whilst the desire to curl up in bed and weep for hours is on an almost desperate level, you cannot succumb as work has to be done and within a limited time frame (2 weeks from death). Activities such as eating, sleeping and talking are merely details that need to be carried out to maintain the strength to put a foot forward, albeit unwantedly. Sunglasses were a permanent presence on my face, not only due to sensitivity from the light of day but to lessen enquiries into my well-being, something unavoidable when seeing the intense pain in my eyes. Slowly but surely though, progress is made, the death is recorded and the questions reduce.
The arrival of a few family members helped with the emotional trauma as blood relatives can partake in nostalgia, liberating fond stories from memory to assist the mourning period. However it does not relinquish responsibilities, so I continued day by day being immersed in paperwork, receiving visitors paying condolence (always in shock as they had 'just' seen or spoken to Mum the week before) and various people reminding me of something I had to do next. Two aspects of all these affairs though were highly cathartic, both involving writing. This was a vocation I had finally embraced in adulthood; how to release the internal narrative in written form to articulate what I could not always say through spoken word. I penned a poem which my friend, the darling Emilia was able to make into a song, with her own celestial voice intertwined with the equally darling Alice (a proper recording of the song will be posted on my blog at a later date). The eulogy was written a few days after which would provide pretext before the song could be performed.
The day of the funeral instills a surreal, dream-like sensation of existence. This was my 2nd funeral in two days though, in the confines of the same church. The previous day I had witnessed the family and friends of Santos Rabasto go through the same motions, the man my mother had been friends with for 30 years and had sadly died the week before her. These 2 friends were unexpectedly intertwined even in death, even as far as being positioned in adjoining rooms at the funeral parlour. His funeral was Part 1 of the Final Act and all the planning and hard work was coming to fruition. So many people from this enormous Catholic community in a sleepy Surrey town had worked together, purely to ensure my Mother had a glorious memorial in the church she so loved, with the congregation she always helped unconditionally, from offering a lift to visiting its sick. The outpour of stories I heard about my Mother were inspiring, my Aunt even proposed she was a present day Mother Teresa and after years of dedicating her life to others, she would now be allowed to rest. Reading the eulogy on the same spot where I had delivered one previously, all those years ago, I was somewhat shaken but nonetheless determined to remind everyone of the message that through recognising my Mother's life, we must never lose sight of living our own, to live a GOOD life.
The end was in sight with the impending burial, allowing family and close friends to stand around the hole in the ground that the pall-bearers bear such commendable respect to. This time it was different though as it was another coffin being added to an already well inhabited grave. There was no sense of isolation or inconceivable patterns of thought; I was standing there feeling so close to both my parents and extremely wistful that they were now bound together within the earth's soil.
There is much to be said about all the details when dealing with a death and if I happen to know you, I encourage you to enquire as it is impossible to record everything down without pondering the writing of a book (and I dare say this will happen in future). Until that point, I can honestly say that life from my Father's and up until the day of my Mother's departure taught me everything I know and for all those experiences, even the more painful ones, I would not alter a thing. I feel an even greater desire to pursue life and unfold its possibilities, my dear Mama serving as a reminder that our mortal coil can be thwarted when we least expect it.
An army of caring hearts had contributed and ultimately kept my strength from failing; the hospital staff with their relentless desire to keep trying, the friends and family who swooped around to guide and whisper words of consolation when needed and the church community who unconditionally kept giving, through word and action, even to an irregular visitor like myself. I am in dumbfounded awe at the wondrous demonstration of humanity that I have had the privilege of being at the centre of these past few weeks, such fine examples are incomparable and serve only as reminders that there is good in each and every one of us (we just have to drag it out to air once in a while).
At the wake I had the misfortune of being on the reciprocal end of some hurtful (perhaps spouted from concern rather than judgement) comments that I am now 'alone' and that it's 'just me' now, however I have actually never felt more UN-alone since the night Mum died. Through the staggering support from friends and family that I have had, from afar via social networks to even a dear friend taking a flight from Hamburg to be by my side and hold my hand when I needed it, I feel even more connected to this temporary home we call Earth. As is the case with all speculative experiences, I cannot truly comment on what the future holds, whether I will shed tears at unpredictable moments or if my pensive silences will linger longer than usual. All I know is that I am now watched over by not just one but two loving parents and the comfort that brings with venturing further forward is unquestionable.


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Deshka Foster
Postdoctoral Medical Fellow, Plastic and Reconstructive Surgery
Ph.D. Student in Cancer Biology, admitted Summer 2017
Resident in Surgery - General Surgery
Best Basic/Translational Oral Presentation, Holman Research Day, Stanford University Department of Surgery (2019)
Excellence in Research Award, Surgical Oncology, American College of Surgeons (ACS) Clinical Congress (2019)
Advanced Residency Training at Stanford (ARTS) Program, Stanford University School of Medicine (2017 - present)
NIH Loan Repayment Program (LRP), National Institutes of Health (2017 - present)
Resident Research Award, American College of Surgeons (ACS) (2017 - 2019)
Fall Courses Travel Award, Association of Academic Surgery (AAS) (2017)
The Donald R. Cooper, M.D. Award for Excellence in Surgery, Drexel University College of Medicine (2015)
Women's Health Scholar, Drexel University College of Medicine (2015)
Fulbright Research Scholarship, U.S. Department of State (2010)
Stanford Advisors
Michael Longaker, Doctoral Dissertation Advisor (AC)
Michael Longaker, Postdoctoral Research Mentor
dsfoster@stanford.edu
University - Student Department:&nbspSchool of Medicine - IDP's - Cancer Biology Position: Graduate
University - Scholar Department:&nbspSurgery Position: Medical Fellow
Current Clinical Interests
Lab Affiliations
Michael Longaker, Longaker Laboratory (7/1/2017)
Endogenous Breast Cancer Shows Clonal Proliferation of Cancer Associated Fibroblasts at Primary Tumor and Metastatic Sites Foster, D. S., Chinta, M., Nguyen, A. T., Salhotra, A., Ransom, R., Jones, R., Titan, A. L., Mascharak, S., Norton, J. A., Longaker, M. T. ELSEVIER SCIENCE INC. 2019: S262
Role of the Skeletal Stem Cell in Achilles Tendon to Bone Interface Healing Titan, A. L., Jones, R., Salhotra, A., Robertson, K. S., Foster, D., Menon, S., Murphy, M., Lucero, G. V., Chan, C. K., Longaker, M. T. ELSEVIER SCIENCE INC. 2019: S228–S229
Effect of Mechanical Loading on Clonality of Injured Flexor Tendons after Repair Titan, A. L., Foster, D., Jones, R., Salhotra, A., Nguyen, A. T., Longaker, M. T. ELSEVIER SCIENCE INC. 2019: S221
Fibroblast Proliferation in Wound Healing Is Clonal and Focal Adhesion Kinase-Dependent Chinta, M., Foster, D., Nguyen, A. T., Salhotra, A., Ransom, R. C., Jones, R., Titan, A. L., Marshall, C., Mascharak, S., Longaker, M. T. ELSEVIER SCIENCE INC. 2019: S223
Regenerative Skin Healing Through Targeted Modulation of Engrailed1-Negative Fibroblasts Mascharak, S., desJardins-Park, H. E., Moore, A. L., Borrelli, M. R., Chinta, M., Foster, D., Lorenz, H., Longaker, M. T. ELSEVIER SCIENCE INC. 2019: S228
Cancer-Associated Fibroblasts Persist but Show Decreased Fibroblast Activation Protein Expression after Neoadjuvant Chemotherapy in Human Pancreatic Ductal Adenocarcinoma Foster, D. S., Nguyen, A. T., Chinta, M., Titan, A. L., Salhotra, A., Jones, R., Mascharak, S., Norton, J., Longaker, M. T. ELSEVIER SCIENCE INC. 2019: S257–S258
Tumors Co-Opt Fibroblast Wound Healing Capacity Foster, D. S., Mascharak, S., Nguyen, A. T., Chinta, M., Salhotra, A., Titan, A. L., Jones, R., da Silva, O., Norton, J. A., Longaker, M. T. ELSEVIER SCIENCE INC. 2019: S231–S232
Wounds Inhibit Tumor Growth In Vivo. Annals of surgery Hu, M. S., Maan, Z. N., Leavitt, T., Hong, W. X., Rennert, R. C., Marshall, C. D., Borrelli, M. R., Zhu, T. N., Esquivel, M., Zimmermann, A., McArdle, A., Chung, M. T., Foster, D. S., Jones, R. E., Gurtner, G. C., Giaccia, A. J., Lorenz, H. P., Weissman, I. L., Longaker, M. T. 2019
OBJECTIVE: The aim of this study was to determine the interaction of full thickness excisional wounds and tumors in vivo.SUMMARY OF BACKGROUND DATA: Tumors have been described as wounds that do not heal due to similarities in stromal composition. On the basis of observations of slowed tumor growth after ulceration, we hypothesized that full thickness excisional wounds would inhibit tumor progression in vivo.METHODS: To determine the interaction of tumors and wounds, we developed a tumor xenograft/allograft (human head and neck squamous cell carcinoma SAS/mouse breast carcinoma 4T1) wound mouse model. We examined tumor growth with varying temporospatial placement of tumors and wounds or ischemic flap. In addition, we developed a tumor/wound parabiosis model to understand the ability of tumors and wounds to recruit circulating progenitor cells.RESULTS: Tumor growth inhibition by full thickness excisional wounds was dose-dependent, maintained by sequential wounding, and relative to distance. This effect was recapitulated by placement of an ischemic flap directly adjacent to a xenograft tumor. Using a parabiosis model, we demonstrated that a healing wound was able to recruit significantly more circulating progenitor cells than a growing tumor. Tumor inhibition by wound was unaffected by presence of an immune response in an immunocompetent model using a mammary carcinoma. Utilizing functional proteomics, we identified 100 proteins differentially expressed in tumors and wounds.CONCLUSION: Full thickness excisional wounds have the ability to inhibit tumor growth in vivo. Further research may provide an exact mechanism for this remarkable finding and new advances in wound healing and tumor biology.
Management of Ileal Neuroendocrine Tumors with Liver Metastases. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract Fisher, A. T., Titan, A. L., Foster, D. S., Worth, P. J., Poultsides, G. A., Visser, B. C., Dua, M. M., Norton, J. A. 2019
Assessment of treating metastatic ileal neuroendocrine tumors (NETs) with complete resection of primary tumor, nodal and liver metastases, plus administration of long-acting somatostatin analogues (SSAs).A prospective database was queried for patients with ileal or pancreatic NETs with pathology-confirmed liver metastases and tumor somatostatin receptors. Patients did not have MEN-1 and had no previous treatment. The impacts of SSA treatment on the primary outcome of survival and secondary outcome of progression-free survival were assessed with Kaplan-Meier analysis. Log rank test was used to compare overall and progression-free survival among groups.Seventeen ileal NET patients and 36 pancreatic NET patients who underwent surgical resection between 2001 and 2018, who had pathology-confirmed liver metastases and confirmed tumor somatostatin receptors, did not have MEN-1, and had no previous treatment were identified. Median follow-up for patients with ileal NETs was 80 months (range 0-197 months) and 32 months (range 1-182 months) for pancreatic NETs. Five-year survival was 93% and 72% for ileal and pancreatic NET, respectively. Progression-free 5-year survival was 70% and 36% for ileal and pancreatic NET, respectively. Overall 5-year survival for pNETs was greater in those patients treated with SSA (79%) compared to those who underwent surgery alone (34%, p < 0.01). The average ECOG score was low for surviving patients with ileal (0.15) and pancreatic NET (0.73) indicating a good quality of life.Resection of primary lymph node and liver metastatic ileal or pancreatic NETs followed with continued SSAs is associated with an excellent progression-free and overall survival and minimal side effects.
Skeletal Stem Cell-Schwann Cell Circuitry in Mandibular Repair. Cell reports Jones, R. E., Salhotra, A., Robertson, K. S., Ransom, R. C., Foster, D. S., Shah, H. N., Quarto, N., Wan, D. C., Longaker, M. T. 2019; 28 (11): 2757–66.e5
Regenerative paradigms exhibit nerve dependency, including regeneration of the mouse digit tip and salamander limb. Denervation impairs regeneration and produces morphological aberrancy in these contexts, but the direct effect of innervation on the stem and progenitor cells enacting these processes is unknown. We devised a model to examine nerve dependency of the mouse skeletal stem cell (mSSC), the progenitor responsible for skeletal development and repair. We show that after inferior alveolar denervation, mandibular bone repair is compromised because of functional defects in mSSCs. We present mSSC reliance on paracrine factors secreted by Schwann cells as the underlying mechanism, with partial rescue of the denervated phenotype by Schwann cell transplantation and by Schwann-derived growth factors. This work sheds light on the nerve dependency of mSSCs and has implications for clinical treatment of mandibular defects.
View details for DOI 10.1016/j.celrep.2019.08.021
Flexor Tendon: Development, Healing, Adhesion Formation, and Contributing Growth Factors. Plastic and reconstructive surgery Titan, A. L., Foster, D. S., Chang, J., Longaker, M. T. 2019; 144 (4): 639e–647e
Management of flexor tendon injuries of the hand remains a major clinical problem. Even with intricate repair, adhesion formation remains a common complication. Significant progress has been made to better understand the mechanisms of healing and adhesion formation. However, there has been slow progress in the clinical prevention and reversal of flexor tendon adhesions. The goal of this article is to discuss recent literature relating to tendon development, tendon healing, and adhesion formation to identify areas in need of further research. Additional research is needed to understand and compare the molecular, cellular, and genetic mechanisms involved in flexor tendon morphogenesis, postoperative healing, and mechanical loading. Such knowledge is critical to determine how to improve repair outcomes and identify new therapeutic strategies to promote tissue regeneration and prevent adhesion formation.
View details for DOI 10.1097/PRS.0000000000006048
A Clearing Technique to Enhance Endogenous Fluorophores in Skin and Soft Tissue. Scientific reports Foster, D. S., Nguyen, A. T., Chinta, M., Salhotra, A., Jones, R. E., Mascharak, S., Titan, A. L., Ransom, R. C., da Silva, O. L., Foley, E., Briger, E., Longaker, M. T. 2019; 9 (1): 15791
Fluorescent proteins are used extensively in transgenic animal models to label and study specific cell and tissue types. Expression of these proteins can be imaged and analyzed using fluorescent and confocal microscopy. Conventional confocal microscopes cannot penetrate through tissue more than 4-6 μm thick. Tissue clearing procedures overcome this challenge by rendering thick specimens into translucent tissue. However, most tissue clearing techniques do not satisfactorily preserve expression of endogenous fluorophores. Using simple adjustments to the BABB (Benzoic Acid Benzyl Benzoate) clearing methodology, preservation of fluorophore expression can be maintained. Modified BABB tissue clearing is a reliable technique to clear skin and soft tissue specimens for the study of dermal biology, wound healing and fibrotic pathologies.
View details for DOI 10.1038/s41598-019-50359-x
Wound healing and fibrosis: current stem cell therapies. Transfusion Jones, R. E., Foster, D. S., Hu, M. S., Longaker, M. T. 2019; 59 (S1): 884–92
Scarring is a result of the wound healing response and causes tissue dysfunction after injury. This process is readily evident in the skin, but also occurs internally across organ systems in the form of fibrosis. Stem cells are crucial to the innate tissue healing response and, as such, present a possible modality to therapeutically promote regenerative healing while minimizing scaring. In this review, the cellular basis of scaring and fibrosis is examined. Current stem cell therapies under exploration for skin wound healing and internal organ fibrosis are discussed. While most therapeutic approaches rely on the direct application of progenitor-type cells to injured tissue to promote healing, novel strategies to manipulate the scarring response are also presented. As our understanding of developmental and stem cell biology continues to increase, therapies to encourage regeneration of healthy functional tissue after damage secondary to injury or disease will continue to expand.
Doxycycline Reduces Scar Thickness and Improves Collagen Architecture. Annals of surgery Moore, A. L., desJardins-Park, H. E., Duoto, B. A., Mascharak, S., Murphy, M. P., Irizarry, D. M., Foster, D. S., Jones, R. E., Barnes, L. A., Marshall, C. D., Ransom, R. C., Wernig, G., Longaker, M. T. 2018
OBJECTIVE: To investigate the effects of local doxycycline administration on skin scarring.BACKGROUND: Skin scarring represents a major source of morbidity for surgical patients. Doxycycline, a tetracycline antibiotic with off-target effects on the extracellular matrix, has demonstrated antifibrotic effects in multiple organs. However, doxycycline's potential effects on skin scarring have not been explored in vivo.METHODS: Female C57BL/6J mice underwent dorsal wounding following an established splinted excisional skin wounding model. Doxycycline was administered by local injection into the wound base following injury. Wounds were harvested upon complete wound closure (postoperative day 15) for histological examination and biomechanical testing of scar tissue.RESULTS: A one-time dose of 3.90 mM doxycycline (2 mg/mL) within 12 hours of injury was found to significantly reduce scar thickness by 24.8% (P < 0.0001) without compromising tensile strength. The same effect could not be achieved by oral dosing. In doxycycline-treated scar matrices, collagen I content was significantly reduced (P = 0.0317) and fibers were favorably arranged with significantly increased fiber randomness (P = 0.0115). Common culprits of altered wound healing mechanics, including angiogenesis and inflammation, were not impacted by doxycycline treatment. However, engrailed1 profibrotic fibroblasts, responsible for scar extracellular matrix deposition, were significantly reduced with doxycycline treatment (P = 0.0005).CONCLUSIONS: Due to the substantial improvement in skin scarring and well-established clinical safety profile, locally administered doxycycline represents a promising vulnerary agent. As such, we favor rapid translation to human patients as an antiscarring therapy.
Author Correction: Genetic dissection of clonal lineage relationships with hydroxytamoxifen liposomes. Nature communications Ransom, R. C., Foster, D. S., Salhotra, A., Jones, R. E., Marshall, C. D., Leavitt, T., Murphy, M. P., Moore, A. L., Blackshear, C. P., Brett, E. A., Wan, D. C., Longaker, M. T. 2018; 9 (1): 4411
In the original version of this Article, the authors inadvertently omitted Elizabeth A. Brett, who contributed to the generation of the histology figures, from the author list.This has now been corrected in both the PDF and HTML versions of the Article.
Acta2, Tnc, and Col24a1 Expression Are Associated with Abdominal Adhesion Formation Marshall, C. D., Foster, D. S., Ransom, R. C., Manjunath, A., Gulati, G., Hu, M. S., Moore, A. L., Barnes, L. A., Longaker, M. T. ELSEVIER SCIENCE INC. 2018: E128
View details for DOI 10.1016/j.jamcollsurg.2018.08.347
Nerve-Dependent Mandibular Regeneration by Skeletal Stem Cells in Fracture Repair Jones, R., Ransom, R. C., Salhotra, A., Foster, D. S., Wan, D. C., Longaker, M. T. ELSEVIER SCIENCE INC. 2018: S197
Reduced Scar Thickness Achieved by Topical Doxycycline Is Mediated by Specific Skin Fibroblast Populations and Not Immune Cell Infiltrate Moore, A. L., Murphy, M. P., Irizarry, D. M., Des Jardins-Park, H. E., Duoto, B. A., Mascharak, S., Foster, D. S., Jones, R., Wernig, G., Longaker, M. T. ELSEVIER SCIENCE INC. 2018: S210–S211
Clonal Analysis of Local Fibroblasts in Wound Healing and Tumor Stroma Foster, D. S., Ransom, R. C., Nguyen, A. T., Salhotra, A., Jones, R. E., Hu, M. S., Norton, J. A., Longaker, M. T. ELSEVIER SCIENCE INC. 2018: S236
Gastrinomas: Medical or Surgical Treatment. Endocrinology and metabolism clinics of North America Norton, J. A., Foster, D. S., Ito, T., Jensen, R. T. 2018; 47 (3): 577–601
This article reviews the role of surgical and medical management in patients with Zollinger-Ellison syndrome (ZES) due to a gastrin-secreting neuroendocrine tumor (gastrinoma). It concentrates on the status at present but also briefly reviews the changes over time in treatment approaches. Generally, surgical and medical therapy are complementary today; however, in some cases, such as patients with ZES and multiple endocrine neoplasia type 1, the treatment approach remains controversial.
Management of Liver Neuroendocrine Tumors in 2018. JAMA oncology Foster, D. S., Jensen, R., Norton, J. A. 2018
Fibroblasts and wound healing: an update. Regenerative medicine des Jardins-Park, H. E., Foster, D. S., Longaker, M. T. 2018
Genetic dissection of clonal lineage relationships with hydroxytamoxifen liposomes. Nature communications Ransom, R. C., Foster, D. S., Salhotra, A., Jones, R. E., Marshall, C. D., Leavitt, T., Murphy, M. P., Moore, A. L., Blackshear, C. P., Wan, D. C., Longaker, M. T. 2018; 9 (1): 2971
Targeted genetic dissection of tissues to identify precise cell populations has vast biological and therapeutic applications. Here we develop an approach, through thepackaging and delivery of 4-hydroxytamoxifen liposomes (LiTMX), that enables localized induction of CreERT2 recombinase in mice. Our method permits precise, in vivo, tissue-specific clonal analysis with both spatial and temporal control. This technology is effective using mice with both specific and ubiquitous Cre drivers in a variety of tissue types, under conditions of homeostasis and post-injury repair, and is highly efficient for lineage tracing and genetic analysis. This methodology is directly and immediately applicable to the developmental biology, stem cell biology and regenerative medicine, and cancer biology fields.
Incidence and Prognosis of Primary Gastrinomas in the Hepatobiliary Tract JAMA SURGERY Norton, J. A., Foster, D. S., Blumgart, L. H., Poultsides, G. A., Visser, B. C., Fraker, D. L., Alexander, H., Jensen, R. T. 2018; 153 (3): e175083
Axillary reverse mapping with indocyanine green or isosulfan blue demonstrate similar crossover rates to radiotracer identified sentinel nodes JOURNAL OF SURGICAL ONCOLOGY Foster, D., Choy, N., Porter, C., Ahmed, S., Wapnir, I. 2018; 117 (3): 336–40
Sentinel lymph node (SLN) resection is imperative for breast cancer staging. Axillary reverse mapping (ARM) can preserve arm draining nodes and lymphatics during surgery. ARM is generally performed with isosulfan blue (ISB), restricting its use for concurrent SLN biopsy. Indocyanine green (ICG) could serve as an alternative to ISB for ARM procedures.SLN mapping and biopsy was performed via periareolar injection of 99 technetium-sulfur colloid (99m TcSc, TSC). ISB and ICG were injected in the upper arm. Blue-stained lymphatics or nodes were visualized in the axilla; ICG was identified using the SPY Elite® system.Twenty-three patients underwent SLN biopsy with or without axillary node dissection and ARM procedures. Twenty of these patients had at least one hot node; 12 patients had SLNs that were only hot, 6 hot/blue/fluorescent, and 2 hot/fluorescent. Overall, crossover of ARM agents with SLNs occurred in 8 cases. Inspection of the axillary cavity after SLN biopsy revealed fluorescent lymphatics and nodes remaining in 14 and 7 patients, respectively. Blue lymphatics and blue nodes were detected in fewer cases.Nearly one-third of patients showed crossover between breast and arm draining nodes, which provides insight as to why some patients develop lymphedema symptoms after SLN biopsy. ICG and ISB identify similar numbers of SLNs. As such ICG could substitute for ISB in ARM procedures.
Endoscopic Excision of Benign Facial Masses in Children: A Review of Outcomes. Journal of laparoendoscopic & advanced surgical techniques. Part A Foster, D., Sinclair, T. J., Taylor, J. S., Dutta, S., Lorenz, H. P., Bruzoni, M. 2018
Benign masses of the eyebrow and forehead are common in pediatric patients and can result in facial asymmetry, discomfort, or super-infection. Excision is classically conducted via an incision directly over the mass, which can produce sub-optimal cosmesis. Recently, an endoscopic approach using pediatric brow-lift equipment has been adopted. We reviewed our center's experience with endoscopic removal of benign facial lesions and compared these cases with an equivalent series of open cases.A retrospective chart review was conducted to identify pediatric cases of endoscopic and open removal of benign eyebrow or forehead lesions at our institution from 2009 to 2016. Clinical and cosmetic outcomes were reviewed.A total of 40 endoscopic and 25 open cases of excision of benign facial lesions in children were identified. For the patients who underwent endoscopic excision, the majority (85%) presented with a cyst located at the eyebrow. Histologic examination revealed 36 dermoid cysts (90%), 2 epidermal cysts, and 2 pilomatrixomas. Of the 36 cases with post-operative follow-up, 32 patients (89%) had an uncomplicated recovery with good cosmesis. Two patients had an eyebrow droop that resolved without intervention. One patient had localized numbness overlying the site, but no motor deficits. One patient presented with a recurrent dermoid cyst that required open resection. For the patients who underwent open excision, the majority (52%) had dermoid cysts located at the eyebrow. Of the 22 cases with follow-up, 20 of the patients had an uncomplicated recovery (90%). Comparing the rate of complications, there was no statistically significant difference between the two groups (P = 1.0).Endoscopic excision of benign forehead and eyebrow lesions in pediatric patients is feasible and yields excellent cosmetic results. When compared with open excision, complication rates are similar between both approaches and a facial scar can be avoided with an endoscopic approach.
The evolving relationship of wound healing and tumor stroma. JCI insight Foster, D. S., Jones, R. E., Ransom, R. C., Longaker, M. T., Norton, J. A. 2018; 3 (18)
The stroma in solid tumors contains a variety of cellular phenotypes and signaling pathways associated with wound healing, leading to the concept that a tumor behaves as a wound that does not heal. Similarities between tumors and healing wounds include fibroblast recruitment and activation, extracellular matrix (ECM) component deposition, infiltration of immune cells, neovascularization, and cellular lineage plasticity. However, unlike a wound that heals, the edges of a tumor are constantly expanding. Cell migration occurs both inward and outward as the tumor proliferates and invades adjacent tissues, often disregarding organ boundaries. The focus of our review is cancer associated fibroblast (CAF) cellular heterogeneity and plasticity and the acellular matrix components that accompany these cells. We explore how similarities and differences between healing wounds and tumor stroma continue to evolve as research progresses, shedding light on possible therapeutic targets that can result in innovative stromal-based treatments for cancer.
Wound Healing and Fibrosis: Current Stem Cell Therapies Transfusion Jones, R., Foster, D. S., Hu, M., Longaker, M. T. 2018
View details for DOI 10.1111/trf.14836
Management of Chronic Wounds-2018. JAMA Jones, R. E., Foster, D. S., Longaker, M. T. 2018; 320 (14): 1481–82
Surgical Site Infections after Inguinal Hernia Repairs Performed in Low and Middle Human Development Index Countries: A Systematic Review. Surgical infections Cai, L. Z., Foster, D., Kethman, W. C., Weiser, T. G., Forrester, J. D. 2017
Inguinal hernias are a common disorder in low- and middle-human development index countries (LMHDICs). Poor access to surgical care and lack of patient awareness often lead to delayed presentations of incarcerated or strangulated hernias and their associated morbidities. There is a scarcity of data on the baseline incidence of surgical site infections (SSIs) after hernia repair procedures in LMHDICs.We performed a systematic review of the literature describing the incidence and management of SSIs after inguinal hernia repair in LMHDICs. We conducted qualitative and quantitative analyses of manuscripts describing patients undergoing hernia repair to establish a baseline SSI rate for this procedure in these settings.Three hundred twenty-three abstracts were identified after applying search criteria, and 31 were suitable for the quantitative analysis. The overall pooled SSI rate was 4.1 infections/100 open hernia repairs (95% confidence interval [CI] 3.0-5.3 infections/100 open repairs), which is consistent with infection rates from high-human development index countries. A separate subgroup analysis of laparoscopic hernia repairs found a weighted pooled SSI rate of 0.4 infections/100 laparoscopic repairs (95% CI 0-2.4 infections/100 laparoscopic repairs).As surgical access continues to expand in LMHDIC settings, it is imperative to monitor surgical outcomes and ensure that care is provided safely. Establishing a baseline SSI rate for inguinal hernia repairs offers a useful benchmark for future studies and surgical programs in these countries.
Surgical Site Infections after Appendectomy Performed in Low and Middle Human Development-Index Countries: A Systematic Review. Surgical infections Foster, D., Kethman, W., Cai, L. Z., Weiser, T. G., Forrester, J. D. 2017
Acute appendicitis is a common surgical emergency worldwide. Early intervention is associated with better outcomes. In low and middle Human Development-Index Countries (LMHDICs), late presentation and poor access to healthcare facilities can contribute to greater illness severity and higher complication rates, such as post-operative surgical site infections (SSIs). The current rate of SSIs post-appendectomy in low- and middle-index settings has yet to be described.We performed a systemic review of the literature describing the incidence and management of SSIs after appendectomy in LMHDICs. We conducted qualitative and quantitative analysis of the data in manuscripts describing patients undergoing appendectomy to establish a baseline SSI rate for this procedure in these settings.Four hundred twenty-three abstracts were initially identified. Of these, 35 studies met the criteria for qualitative and quantitative analysis. The overall weighted, pooled SSI rated were 17.9 infections/100 open appendectomies (95% confidence interval [CI] 10.4-25.3 infections/100 open appendectomies) and 8.8 infections/100 laparoscopic appendectomies (95% CI 4.5-13.2 infections/100 laparoscopic appendectomies). The SSI rates were higher in complicated appendicitis and when pre-operative antibiotic use was not specified.Observed SSI rates after appendectomy in LMHDICs are dramatically higher than rates in high Human Development-Index Countries. This is particularly true in cases of open appendectomy, which remains the most common surgical approach in LMHDICs. These findings highlight the need for SSI prevention in LMHDICs, including prompt access to medical and surgical care, routine pre-operative antibiotic use, and implementation of bundled care packages and checklists.
Regression of experimental NIS-expressing breast cancer brain metastases in response to radioiodide/gemcitabine dual therapy ONCOTARGET Renier, C., Do, J., Reyna-Neyra, A., Foster, D., De, A., Vogel, H., Jeffrey, S. S., Tse, V., Carrasco, N., Wapnir, I. 2016; 7 (34): 54811-54824
Treating breast cancer brain metastases (BCBMs) is challenging. Na+/I- symporter (NIS) expression in BCBMs would permit their selective targeting with radioiodide (131I-). We show impressive enhancement of tumor response by combining131I- with gemcitabine (GEM), a cytotoxic radiosensitizer. Nude mice mammary fat-pad (MFP) tumors and BCBMs were generated with braintropic MDA-MB-231Br cells transduced with bicistronically-linked NIS and firefly luciferase cDNAs. Response was monitored in vivo via bioluminescent imaging and NIS tumor expression.131I-/GEM therapy inhibited MFP tumor growth more effectively than either agent alone. BCBMs were treated with: high or low-dose GEM (58 or 14.5 mg/Kg×4); 131I- (1mCi or 2×0.5 mCi 7 days apart); and 131I-/GEM therapy. By post-injection day (PID) 25, 82-86% of controls and 78-83% of 131I--treated BCBM grew, whereas 17% low-dose and 36% high-dose GEM regressed. The latter tumors were smaller than the controls with comparable NIS expression (~20% of cells). High and low-dose 131I-/ GEM combinations caused 89% and 57% tumor regression, respectively. High-dose GEM/131I- delayed tumor growth: tumors increased 5-fold in size by PID45 (controls by PID18). Although fewer than 25% of cells expressed NIS, GEM/131I- caused dramatic tumor regression in NIS-transduced BCBMs. This effect was synergistic, and supports the hypothesis that GEM radiosensitizes cells to 131I-.
Palliative Surgery for Advanced Cancer: Identifying Evidence-Based Criteria for Patient Selection: Case Report and Review of Literature JOURNAL OF PALLIATIVE MEDICINE Foster, D., Shaikh, M. F., Gleeson, E., Babcock, B. D., Ringold, D., Bowne, W. B. 2016; 19 (1): 22-29
Criteria for selecting patients with advanced cancer for palliative surgery (PS) remains poorly defined. Decision making for PS requires realistic treatment goals with well-defined criteria. Here we discuss a 71-year-old Jehovah's Witness with advanced stage renal cell carcinoma (RCC) who presented with profound anemia due to intractable bleeding from gastric metastasis. After repeated attempts with endoscopic and angiographic management, she underwent surgical palliation. Through this case, we developed 10-item evidence-based criteria for selecting patients for PS.The study objective was to provide a review of pertinent literature for PS and identify evidence-based criteria for patient selection. These criteria were relevant for selecting this patient with metastatic RCC and may prove beneficial for selecting advanced cancer patients for PS.A MEDLINE search revealed 175 publications relevant to PS. Among these, 17 articles defining patient selection criteria (PSC) were reviewed. A frequency-based analysis of each criterion was performed. Another search returned 30 cases of RCC gastric metastases from 25 published reports. Outcome analysis was determined by the Kaplan-Meier actuarial method.Ten criteria were identified: symptom control, prognosis, preoperative performance status, quality of life (QoL), tumor burden amenable to palliation, procedure-related morbidity and mortality, feasibility of nonsurgical therapies, anticipated hospitalization, requirement for additional palliation, and cost. This patient met all inclusion criteria and underwent a successful gastrectomy. Median survival for patients with RCC gastric metastasis was 20 months.This report illustrates an example of implementation of evidence-based criteria for selecting advanced cancer patients for PS. Validation of these criteria is warranted.
View details for DOI 10.1089/jpm.2015.0146
Pancreatic mucinous cystic neoplasm in a transgender patient WORLD JOURNAL OF SURGICAL ONCOLOGY Foster, D., Shaikh, M. F., Gleeson, E., Babcock, B. D., Lin, J., Ownbey, R. T., Hysell, M. E., Ringold, D., Bowne, W. B. 2015; 13
Cystic pancreatic lesions are increasingly more frequent detected clinical entities. Mucinous cystic neoplasm (MCN) is a hormone-related pancreatic tumor (HRTP) with a strong predominance in young and middle-aged females.Here, we present the case of a 31-year-old surgically transgendered female-to-male patient with a history of alcoholic pancreatitis, on chronic testosterone therapy. He was found to have a pancreatic MCN and underwent distal pancreatectomy and splenectomy.To our knowledge, this is the first reported case of a transgender patient with a history of hormone replacement therapy (HRT) and pancreatic MCN. We consider possible mechanisms for the pathogenesis to explain this patient's neoplasm.
Richter-type Spigelian hernia: A case report and review of the literature. International journal of surgery case reports Foster, D., Nagarajan, S., Panait, L. 2015; 6C: 160-162
Abdominal wall hernias through the arcuate line termed Spigelian hernias are uncommon. These hernias presenting as a Richter-type, with strangulation of part of the circumference of the bowel wall is very rare.We report a 27-year-old male patient who presented with a Richter-type Spigelian hernia.A MEDLINE literature search of this rare entity yielded six publications presenting Richter-type Spigelian hernias. All of these articles and accompanying references were thoroughly reviewed. There was no gender or anatomical side predominance among the patients. All except our patient presented here were elderly. Pain was the most common symptom and was present in all patients. All patients underwent surgical repair and none reported recurrence of their hernia afterwards.Richter-type Spigelian hernia is rare and has been reported infrequently in the existing literature. Clinical diagnosis is challenging and CT scan is the diagnostic study of choice. Surgical repair is the definitive treatment and involves primary or mesh repair of the defect as appropriate. Necrotic bowel should be resected and we recommend biologic mesh repair in these cases if the defect is large.
View details for DOI 10.1016/j.ijscr.2014.10.088
Evaluation of three rapid diagnostic tests for the detection of human infections with Plasmodium knowlesi MALARIA JOURNAL Foster, D., Cox-Singh, J., Mohamad, D. S., Krishna, S., Chin, P. P., Singh, B. 2014; 13
Plasmodium knowlesi, a malaria parasite of Southeast Asian macaques, infects humans and can cause fatal malaria. It is difficult to diagnose by microscopy because of morphological similarity to Plasmodium malariae. Nested PCR assay is the most accurate method to distinguish P. knowlesi from other Plasmodium species but is not cost effective in resource-poor settings. Rapid diagnostic tests (RDTs) are recommended for settings where malaria is prevalent. In this study, the effectiveness of three RDTs in detecting P. knowlesi from fresh and frozen patient blood samples was evaluated.Forty malaria patients (28 P. knowlesi, ten P. vivax and two P. falciparum) diagnosed by microscopy were recruited in Sarawak, Malaysian Borneo during a 16-month period. Patient blood samples were used to determine parasitaemia by microscopy, confirm the Plasmodium species present by PCR and evaluate three RDTs: OptiMAL-IT, BinaxNOW® Malaria and Paramax-3. The RDTs were also evaluated using frozen blood samples from 41 knowlesi malaria patients.OptiMAL-IT was the most sensitive RDT, with a sensitivity of 71% (20/28; 95% CI = 54-88%) for fresh and 73% (30/41; 95% CI = 59-87%) for frozen knowlesi samples. However, it yielded predominantly falciparum-positive results due to cross-reactivity of the P. falciparum test reagent with P. knowlesi. BinaxNOW® Malaria correctly detected non-P. falciparum malaria in P. knowlesi samples but was the least sensitive, detecting only 29% (8/28; 95% CI = 12-46%) of fresh and 24% (10/41; 95% CI = 11-37%) of frozen samples. The Paramax-3 RDT tested positive for P. vivax with PCR-confirmed P. knowlesi samples with sensitivities of 40% (10/25; 95% CI = 21-59%) with fresh and 32% (13/41; 95% CI = 17-46%) with frozen samples. All RDTs correctly identified P. falciparum- and P. vivax-positive controls with parasitaemias above 2,000 parasites/μl blood.The RDTs detected Plasmodium in P. knowlesi-infected blood samples with poor sensitivity and specificity. Patients with P. knowlesi could be misdiagnosed as P. falciparum with OptiMAL-IT, P. vivax with Paramax-3 and more correctly as non-P. vivax/non-P. falciparum with BinaxNOW® Malaria. There is a need for a sensitive and specific RDT for malaria diagnosis in settings where P. knowlesi infections predominate.
View details for DOI 10.1186/1475-2875-13-60
Ex vivo Evans blue assessment of the blood brain barrier in three breast cancer brain metastasis models. Breast cancer research and treatment Do, J., Foster, D., Renier, C., Vogel, H., Rosenblum, S., Doyle, T. C., Tse, V., Wapnir, I. 2014; 144 (1): 93-101
The limited entry of anticancer drugs into the central nervous system represents a special therapeutic challenge for patients with brain metastases and is primarily due to the blood brain barrier (BBB). Albumin-bound Evans blue (EB) dye is too large to cross the BBB but can grossly stain tissue blue when the BBB is disrupted. The course of tumor development and the integrity of the BBB were studied in three preclinical breast cancer brain metastasis (BCBM) models. A luciferase-transduced braintropic clone of MDA-231 cell line was used. Nude mice were subjected to stereotactic intracerebral inoculation, mammary fat pad-derived tumor fragment implantation, or carotid artery injections. EB was injected 30 min prior to euthanasia at various timepoints for each of the BCBM model animals. Serial bioluminescent imaging demonstrated exponential tumor growth in all models. Carotid BCBM appeared as diffuse multifocal cell clusters. EB aided the localization of metastases ex vivo. Tumor implants stained blue at 7 days whereas gross staining was not evident until day 14 in the stereotactic model and day 28 for the carotid model. EB assessment of the integrity of the BBB provides useful information relevant to drug testing in preclinical BCBM models.
Two treatments, one disease: childhood malaria management in Tanga, Tanzania MALARIA JOURNAL Foster, D., Vilendrer, S. 2009; 8
In the Tanga District of coastal Tanzania, malaria is one of the primary causes of mortality for children under the age of five. While some children are treated with malaria medications in biomedical facilities, as the World Health Organization recommends, others receive home-care or treatment from traditional healers. Recognition of malaria is difficult because symptoms can range from fever with uncomplicated malaria to convulsions with severe malaria. This study explores why caregivers in the Tanga District of Tanzania pursue particular courses of action to deal with malaria in their children.Qualitative data were collected through interviews with three samples: female caregivers of children under five (N = 61), medical practitioners (N = 28), and traditional healers (N = 18) in urban, peri-urban, and rural areas. The female caregiver sample is intentionally stratified to reflect the greater population of the Tanga District in level of education, marital status, gender of household head, religion, and tribal group affiliation. Qualitative data were counted, coded and analysed using NVivo7 software.Results indicate that a variety of factors influence treatment choice, including socio-cultural beliefs about malaria symptoms, associations with spiritual affliction requiring traditional healing, knowledge of malaria, and fear of certain anti-malaria treatment procedures. Most notably, some caregivers identified convulsions as a spiritual condition, unrelated to malaria. While nearly all caregivers reported attending biomedical facilities to treat children with fever (N = 60/61), many caregivers stated that convulsions are best treated by traditional healers (N = 26/61). Qualitative interviews with medical practitioners and traditional healers confirmed this belief.Results offer insight into current trends in malaria management and have implications in healthcare policy, educational campaigns, and the importance of integrating traditional and biomedical approaches.

redpajama_set_name: RedPajamaCommonCrawl


text:
De kandidatenlijst voor de Tweede Kamerverkiezingen 1994 van de Libertarische Partij was als volgt:

De lijst
Toine Manders - 1.789 stemmen
H.M. Spil - 302
S.N. van Glabbeek - 77
A.N. Struijk - 81
Henry Sturman - 72
A. Breuning - 90
A.A. in 't Veld - 50
J.F.B. Wigger - 44
L.P.M. Nelen - 49
E.K. van Glabbeek - 29
B.A. van Doorn - 171

Libertarische Partij

redpajama_set_name: RedPajamaWikipedia


The Backyard is an inspiring and creative place for your next event.
Reservations accepted for private events hosted outdoors in the Backyard and on the Rooftop Deck.
Contact Keri at kfarmelo@backyardonblake.com to check availability and make your booking.
Our RiNo community organizations and non-profit organizations are welcome to reserve these spaces free of charge.
The following Backyard businesses accept reservations for indoor events as well: The Preservery | River North Workshop | Judith & Joe.


text:
The "mit beschränkter Haftung (mbH)" suffix (German: [ˈɛmbeːˌhaː], "with limited liability") is sometimes added to the name of a firm that already ends in "-gesellschaft" ("company"), e.g., "Mustermann Dental-Handelsgesellschaft mit beschränkter Haftung" ("dental trading company with limited liability"), which would be abbreviated as "Mustermann Dental-Handelsgesellschaft mbH".
These reports must be filed every two years for both nonprofit and for-profit businesses. The filings are due during the anniversary month of your business's formation or the anniversary month in which you were granted authority to do business in the state. As a courtesy, the Secretary of State will send a reminder notice the month your report is due.
Maine	words or abbreviations of words that describe the nature of the entity, including "professional association", "corporation", "company", "incorporated", "chartered", "limited", "limited partnership", "limited liability company", "professional limited liability company", "limited liability partnership", "registered limited liability partnership", "service corporation" or "professional corporation"; beginning July 1, 2007, may also include "limited liability limited partnership"	for business corporations: Title 13-C § 401 Maine Revised Statutes; for non-profit corporations: Title 13-B § 301-A Maine Revised Statutes
Public Sector Undertaking (PSU) – Alternatively known as Public Sector Enterprise (PSE). It may be public limited company listed on stock exchanges with major ownership by a state government or a central government of India or it may be unlisted entity with major ownership by a state government or a central government of India. Some of these entities are formed as business entities through special legislation, where these entities are governed by the statutes of these legislation and may or may not be governed by company laws like a typical business entity.
On the other hand, if you are not responsible for its tax, then you should declare the equipment in Part III of the Business Property Statement (Equipment belonging to others). Where equipment is declared in Part III of the Business Property Statement, the Assessor will also send a Notice to File to the person reported as the equipment's actual owner.


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Watch Sports video Passion Of Shahid Afridi online. Free collection of interesting videos and funny video clips. Find Sports videos similar to this one, enjoy with your friends by sharing on Facebook, WhatsApp, SMS, MMS, Instagram, Twitter etc. Best HD quality available.


The church in Tidenham Parish is vibrant and full of life with regular worship services and prayer meetings as well as social events. There is something for everyone to draw us closer together and to draw us closer to God.
Meets most weeks at 10:30 am on Tuesday mornings. Venue may vary. Contact Judith Wells for information on 01291 624678.
A chance to talk life and faith with coffee and cake. Will meet at Toast (formerly Pritchards at the Live and Let Live) each Wednesday 10:15 – 12:00, except when there is a Healing Eucharist at St Luke's. Contact Steven Shaw 07934 436935.


Marriott wanted to soften the blow by the end of this card and this is a great way for the card to go out. Cheers to Marriott and Chase for doing this with some grace. And stay tuned for some more news tomorrow for Chase cardholders!
Wyndham Hotels announced they are buying La Quinta Hotels. The U.S. based chain has a very small presence in Canada with only 2 hotels but does have almost 900 hotels in the U.S. and Latin America. Of note for most Canadian is the La Quinta Returns program will be absorbed into Wyndham Rewards which means you 'll be able to use the latter to redeem for stays at La Quinta Hotels once the sale is approved and the programs are integrated.
Receive 100 bonus AIR MILES Reward miles when you spend $50 or more at Rexall today or tomorrow!
Or go shop at Shoppers Drug Mart tomorrow to earn 20X Shoppers Optimum Points when you spend $50 or more. Remember right now is the time you want to rack up as many Shoppers Optimum Points as come February 1st your points will convert to the new PC Optimum program and the more points you have the more value you'll get for them. Read more about that here.


October 2013 – what will you do now?
Having finally finished this (with some hints from a friend), I am now fully equipped to write my impressions of this game.
This game is one in the series of Emily Short's games based on fairy tales (the others including Bronze and Glass). In this game, you are Rapunzel, or some version of her, and you are attempting to get out of your tower. There is a in-game device key to progressing in the plot, which is broadly hinted at using textual clues. Once you figure that out, the puzzles should all be fairly straightforward; I took about twenty minutes on Indigo. There is really little I can say without spoiling it. What I can say, however, is read everything carefully, including and especially the introduction.
You are Timothy Hunter and you have just died. But there seems to have been some kind of mix-up, for you are given three second chances. Three chances to act differently at three moral dilemmas in your otherwise ordinary life. What will you do with these chances?
This game is heavily story-driven, as each stage serves to advance the plot and to flesh out the kind of person the PC is. It also promises three mutually exclusive paths, which greatly increases the subtlety of the game. In this playthrough I only managed to find one of the paths.
I found the scenarios posed to be thought-provoking and they made me pause in genuine consideration. These same scenarios also gave the game much of its poignancy.
One major grouse that I had was that the 'wise words' of the guardian-figures in the game tended towards a moralistic, preaching tone, which makes Tapestry less than elegant. It sometimes helps to underscore the theme of redemption, but the overall effect did not always serve that purpose, which is a shame. There was a lot of extra 'special effects' as well, which I thought were not strictly necessary.
Nevertheless, this game is overall well-written and will tug at your heart-strings.


text:
| Uttar Pradesh (UP)
| G.L. Bajaj Institute of Management and Research (GLBIMR)
G.L. Bajaj Institute of Management and Research (GLBIMR), Greater Noida - FAQs
Greater Noida (Uttar Pradesh (UP))
Greater Noida > G.L. Bajaj Institute of Management and Research (GLBIMR)
Frequently Asked Questions About G.L. Bajaj Institute of Management and Research (GLBIMR)
Is G.L. Bajaj Institute of Management and Research Greater Noida if Affiliated for Recongnized
G.L. Bajaj Institute of Management and Research GLBIMR Greater Noida is Affiliated to (AICTE) & Recognized by (NAAC)
When was G.L. Bajaj Institute of Management and Research Greater Noida Established
G.L. Bajaj Institute of Management and Research was Established in Year 2007
Where is G.L. Bajaj Institute of Management and Research Located
Greater Noida, Uttar Pradesh (UP)
Institute of Technology and Science - ITS, Ghaziabad
Affilated By : AICTE, UGC, AIU, NBA
Jaipuria School of Business - JSB, Ghaziabad
Institute of Management Studies - IMS, Ghaziabad
Affilated By : AICTE, AIU, NBA
IILM Academy of Higher Learning - IILM, Lucknow
Affilated By : AICTE, MHRD
G.L. Bajaj Institute of Management and Research - GLBIMR, Greater Noida
G.L. Bajaj Institute of Technology and Management - GLBITM, Greater Noida
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text:
The Note (2008)
The Note stream online free with English Subtitles
Genre: Comedy, Short
Director: Jon Greenhalgh
Actors: Ida Sovová, Jan Santroch, Ondrej Moravec, Vaclav Spanos
The Note Photos
Cyberflic
A detective duo hunts a criminal organization, which is using an unknown liquid explosive material.
Abel is a therapist who regularly meets with a handful of clients struggling to deal with the physical and emotional problems of being overweight. Enrique is an actor best known…
The fun-loving, easy-going, 60- to 75-year-old Senior Softball team "Kids At Heart" suddenly decide to go for their secret dream — win the World Series (BEFORE IT'S TOO LATE!) Renaming…
Comedian, writer and politically incorrect HBO talk-show host Bill Maher takes time off from his regular hosting duties to perform a hilariously scathing stand-up set in this comedy special. Taped…
A visit to the doctor confirms that the worst has happened: Terry is crushing on her new neighbor Brett. With help from her best friend and not-so-secret admirer, Duncanty, Terry…
Sing a Song of Six Pants
The stooges are tailors, and are heavily in debt to the Skin & Flint finance company. When the boys read about the big reward for a fugitive robber, they think…
What do you do when the party of the year kicks you to the curb? Simple… create your own! When Sean (Franz Drameh, Attack the Block) and his friends are…
Captain Spaulding, the noted explorer, returns from Africa and attends a gala party held by Mrs. Rittenhouse. A painting displayed at that party is stolen, and the Marxes help recover…
Van Wilder 2: The Rise of Taj
Having graduated in the US as Van Wilder disciple, now self-confident Taj Mahal. arrives as 'don' (teaching assistant) history at England's super-prestigious Cambridge. He falls victim to the haughty, aristocratic…
Country-Western Wildcats! Marsha Jordan – the first real star of Sexploitation – is Sweet Georgia, the sex-crazed nympho wife of rancher Big T. Unfortunately, because Big T is an ugly,…
Juke box – Urli d'amore
The owner of a record company demands that only married people can work for him.


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At your arrival in Paris, your personal concierge. will come to your hotel or apartment.
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They apologize for the 'sins of Christians,' leave the deity of Christ open for discussion.
An attempt by leaders of the National Association of Evangelicals (NAE) to win friends and influence Muslims is alienating another group — evangelical Christians.
Others are just beginning to hear of it. In November, NAE President Leith Anderson and NAE Vice President Richard Cizik signed onto a Christian response to an invitation to dialogue from 138 Muslim leaders around the world.
Their response — initiated by Yale Divinity School and endorsed by other liberal Christian leaders — apologized for the sins of Christians during the Crusades and for "excesses" of the global war on terror, without mentioning Muslim atrocities. It appeared to leave the fundamentals of Christianity — especially the deity of Christ — open for discussion.
The very name of the Muslim communiqué — A Common Word between Us and You — is from a verse in the Quran that condemns "people of the Scripture" (Christians) for alleged polytheism (the doctrine of the Trinity).
Mohler said the agreement "sends the wrong signal" and contains basic theological problems, especially in "marginalizing" Jesus Christ. He also condemned the apology for the Crusades.
Neither Anderson nor Cizik could be reached for comment. On the NAE Web site, Anderson asserts he signed the letter as a private individual, although he is identified as NAE president. He also seems to acknowledge problems with the statement.
Bauer said he already was dismayed by the NAE's recent controversial excursions into questionable areas such as global warming.
The National Council of Churches has embraced liberal causes and is affiliated with ultra-liberal groups, such as MoveOn.org and People For the American Way.
Sookhdeo called for Christian leaders who signed the letter to withdraw their names, saying the confession of guilt puts Christian communities in Muslim areas of the world at risk.
"I find it difficult to understand how senior evangelical leaders in the West can join hands with other Christians who actually are betraying the Christian faith (and) their Christian brothers and sisters in the Muslim world," he said.
Read the Yale document and the list of signers. You also can read the original Muslim statement.


Don't let A/V problems make you loose your mind. Leave it to the AV Guys to determine the culprit in your setup and get it working better than ever. Networking, Satellite, Cable, Music, Surround Sound, and so much more, we can figure it out.


The Jeep Cherokee blazes its own trail. When the Cherokee was redesigned as a 2014 model, it was both praised and criticized as different, daring, even. It signaled a break from tradition. Especially when viewed from the front, the Cherokee was unlike any other member of the Jeep family.
Not much has changed for the 2017 Jeep Cherokee, apart from newly standard high-intensity discharge headlights on all but the Sport model. Two new option groups (Heavy Duty Protection and Trailer Tow Prep) are available for the top-end Overland edition, which was launched during the 2016 model year.
Jeep calls the Cherokee a midsize, but we see it as more of a compact crossover SUV, along the lines of a Ford Escape or Honda CR-V.
The Cherokee nameplate is an old one, last used in 2001. The current models are fully modern, emphasizing capabilities in a variety of conditions. If equipped with four-wheel drive, the current version boasts a startling level of off-road expertise, especially the trail-rated Trailhawk model, continuing Jeep's reputation for conquering wilderness trails.
Five trim levels are offered: Sport, Latitude, Limited, Overland, and Trailhawk. Offered only with four-wheel drive, the latter is the Trail Rated version of the Cherokee. Trio special editions also are available: Altitude, High Altitude, and 75th Anniversary.
Two engines are available. The standard four-cylinder, making 184 horsepower, is smooth and quiet. Strong, too, provided that it's not overloaded with people and cargo. Generating 271 horsepower and 239 pound-feet of torque, the optional 3.2-liter V6 has plenty of torque and performs without fuss.
All V6 models get Stop/Start. With a towing package, a V6 model can tow up to 4,500 pounds. A 9-speed automatic transmission blends with both engines.
In addition to abundant ground clearance, the Cherokee offers a choice of three optional traction assistants, providing either all-wheel or four-wheel drive. Active Drive I is the basic setup, for four-cylinder models. Active Drive II adds a dual-range transfer case. Active Drive Lock, with a locking rear differential, is standard on the Trailhawk. Additional skid plates and red tow hooks go on the Trailhawk, which has unique front/rear fascias and is raised by an inch.
All 4WD Cherokees include Selec-Terrain, with distinct modes for Sport, Snow, Sand/Mud, and Rock. Low-range four-cylinder models boast a startling crawl ratio, of 56:1.
Crash-test scores disappoint. The National Highway Traffic Safety Administration gave Cherokee four stars overall and for individual tests, except for side-impact, where it earned five stars.
A rearview camera is standard, except for the Sport model. Active-safety features are available on upper trim levels, including lane-departure and frontal-collision warnings, blind-sport monitoring, adaptive cruise control, and parking sensors.


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Japan to consider new COVID-19 emergency declaration
Yasutoshi Nishimura (third from left), the minister in charge of the central government's coronavirus response, is joined by the governors of Tokyo, Saitama and Chiba prefectures at a news conference on Saturday. | KYODO
Kyodo, AFP-Jiji, staff report, REUTERS
The governors of Tokyo and three prefectures neighboring the capital on Saturday urged the central government to declare a state of emergency following a resurgence of COVID-19 cases.
The governors of Saitama, Chiba and Kanagawa prefectures joined Tokyo in making the request.
Economy minister Yasutoshi Nishimura told reporters at a briefing after meeting the governors that the government would need to hear from experts before deciding on whether to make an emergency declaration.
Tokyo Gov. Yuriko Koike said the high number of cases in the four prefectures has put an increasing burden on the health care system, even amid calls on citizens and businesses to take measures to prevent the spread of infections. Koike said it has become critical that more steps be taken to curb the movement of people, leading to the request for the emergency declaration.
"We have shared a recognition that the four prefectures are in a grave situation now, which possibly needs a state of emergency declaration," Nishimura, the minister in charge of the government's coronavirus response, said after a three-hour meeting with the four governors.
While the central government discusses its next steps, Nishimura said he asked the governors to implement their own stronger measures "immediately."
Nishimura, who earlier this week said a state of emergency could be necessary if cases continued to rise, said he had asked governors to request that businesses further shorten their hours, that residents avoid nonessential outings after 8 p.m. and that companies make use of remote work. He also said the government would beef up financial support for establishments that comply with such requests.
There was no immediate word on whether the governors would seek school closures. Japan was one of the first countries in the world to shutter schools, with then-Prime Minister Shinzo Abe calling for closures in February.
Japan has avoided the harsh lockdowns seen in other nations, with no legal mechanism to enforce closure requests and calls for people to stay home.
The government hopes to pass legislation allowing penalties for noncompliance in the next Diet session this month.
Prime Minister Yoshihide Suga, who took office this fall after Abe resigned, has been criticized for his government's response to the new wave of infections, and in particular its support of a controversial program promoting domestic travel.
The Go To Travel campaign has been suspended over the New Year's holiday period — when many Japanese travel to visit family — and government officials have urged people to stay home to help suppress the new wave.
The government has been reluctant to impose a new state of emergency, for fear of the economic impact.
The rise in COVID-19 cases is compounding a seasonal increase in hospitalizations, said Fumie Sakamoto, infection control manager at St. Luke's International Hospital in Tokyo.
"The Japanese government has not done a great deal to control the infection," Sakamoto said. "I would expect the (infection) numbers will get bigger in the coming days, and the emergency declaration should have come earlier, probably during December or November."
The new spike in infections also comes little more than six months before Tokyo is set to host the virus-delayed Olympic Games.
Tokyo 2020 was postponed last spring as the scale of the pandemic became clear, but despite optimism from officials and organizers, most of the Japanese public is opposed to holding the Games this summer, favoring a further delay or outright cancellation.
The developments on Saturday came as Tokyo reported 814 new COVID-19 cases, two days after the capital saw a record 1,337 infections. Among the daily total Saturday, 118 cases involved people age 65 or older while the number of severely ill patients, based on city's standards, came to 94, up eight from the previous day.
On Thursday, Tokyo logged a record 1,337 new infections, exceeding the 1,000 mark for the first time since the pandemic began. A nationwide record was also set Thursday, with 4,520 new cases.
Japan's stance against emergency appears to shift as virus cases soar
Coronavirus looms over Japan's new year festivities
Tokyo, Yoshihide Suga, health, Yuriko Koike, state of emergency, covid-19, covid-19 in Japan


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Chris Watts Talks 'Relationship with God' & 'Amazing Grace' After Murdering Pregnant Wife, 2 Daughters
By Alex Olsen
It has been several months since 33-year-old Chris Watts was placed behind bars in the Weld County, Colorado area. The unfaithful husband and soon-to-be father of three tragically murdered his pregnant wife Shanann, 34, and their two precious daughters Bella, 4, and Celeste, 3 last year.
Before the murders took place, Watts had an affair which Shanann found out about. She reportedly threatened to take the kids away from him, which is likely the motive for his unforgivable outburst.
After eventually confessing to the crimes and pleading guilty to the charges, Watts was sentenced to life in prison. The judge on his case even referred to it as "the most inhumane and vicious crime" he had ever handled during his career.
In a new interview that was conducted from the prison, Watts detailed the gruesome murder. As previously reported, the dad allegedly killed his wife first. His oldest daughter sadly walked in on him wrapping her mom's body in a sheet, in which he told her that her mother was "sick."
Then, he took his two girls on a 45-minute drive to his worksite to dump the body. Watts revealed that he then smothered his youngest daughter with her favorite blanket — a tragic sight for her older sister to witness. Little Bella pleaded for her father not to do "what he did to Cece" to do her, but he did.
Despite these horrific events, Watts claims that he "found God" in prison, reported NBC News. During the interview, he said he asked God for forgiveness and is regretful of murdering his family.
"I never knew I could have a relationship with God like I do now," Watts stated. "It's like the amazing grace with all of this, but I just wish nobody had to pay any kind of price for this...I know there is a purpose for everybody, I just hope I can find mine."
His comments led to a mass public outrage. Much of the public was not pleased with his "hypocritical" remarks.
Please continue to pray for those mourning Shanann, Bella, and Celeste. In breaking news, a plane crash tragically claimed the lives of 12 people.
Next: Plane Crash Tragically Claims the Lives of 12 People, Prayers NeededMar 09, 2019
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Over ten years ago the London based Street Artist Stik started painting Stik figures in the Streets of London. Stik is the most hyped Street Artist in the whole world at the moment. So we have been really happy to get the chance being on the run with him during his stay in Berlin.
Usually the focus should stay on the Artworks and not on the artist. But after hanging around with Stik in Berlin, hearing his stories and having a good time with him, there are some things which should be written about the Artist himself. Stik was homeless, for over ten years. A lot of this time he was living in squats and St. Mungos Hostels who are supporting homeless people. So he knows the other side of our society and how hard and ugly the Street life can be if you are an outsider, a forgotten one.
A very good example to point out his personality is this story: A really bad company (Stik would have NEVER worked with them) used his artworks for adverts without his permission. A lawyer was taking legal actions for Stik and the company had to pay 10.000 pounds. But Stick didn't want to take that money and donated it directly to the St. Mungos hostels.Stiks past has and will ever have a big influence on his behaviour, not just by donating and working on charity projects but to go out and make the city more beautiful where he used to live: On the Streets.
The idea of Street Art is that it is accessible for free, free to everybody, it is about making our world a little more beautiful. It is about changing the world in an positive way and it is about communication with in the society. Stick is breaking up the natural borders between the different spoken languages. He found the key of telling story's in a new kind of international, for all understandable, universal language: Pure emotions. Stiks works are an perfect example that six lines and two dots can say more than a thousand words.


Samsung has noticed that due to the working of any 3rd party application, the display automatically starts even after closing flip cover or while charging or when the screen is closed.
If you are facing the same problem then we advise checking your device in "Safe Mode" or after uninstalling it.
Always on Display when Turn off Flip cover on the Samsung Galaxy Screen. Because of the unsupported app installed on your mobile. Just remove the third-party apps and enter into safe mode it's working or not. Delete third-party app on Android is easy After that follow the below steps to put your Galaxy S10/Galaxy S10 Plus into safe mode.
Step 1: Firstly turn off your device.
Step 2: After your device is turned off completely, then again start your device.
Step 3: And when the device is starting the name of the device will be appeared on the screen, As the name of the device appears Press Volume Down Key by doing this your phone will start in Safe Mode.
Step 4: If your device has successfully entered in safe mode, then text Safe Mode will be displayed at the bottom left corner.
So this is the steps you need to follow for checking your phone in safe mode.
And if the device supports Bixby Key and this situation occurs in Safe Mode. Then check your Bixby key.
For checking Bixby Keypress it several times and check the working of device properly.
This situation can also occur if you use 3rd party fast wireless charger. Therefore Samsung recommends using Samsung fast wireless charger for the Samsung device. Write a feedback up us, is this troubleshooting tips helped you or not? also, share more suggestions that missed in this article. that helps to others for why Display Is On After Closing Flip Cover On Galaxy S10/ Galaxy S10 Plus.


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Green Dragon Kratom Smoothie
Is it spring? Is it summer? It's hard to tell. But, it's always the right time for smoothies, especially when there's Green Dragon involved! Especially once warmer weather makes its way here, it's always nice to have a cool treat in hand.
Since I'm not a huge fan of cooking breakfast, a great way that I have found to get some nutrition up in me real quick, as well as getting my morning kratom dose is to fire up the juicer and make a good old fashioned summer smoothie!
This smoothie calls for both spirulina and chlorella which have massive nutrition benefits!
SPIRULINA BENEFITS
According to Healthline, "Spirulina is an organism that grows in both fresh and salt water It is a type of cyanobacteria, which is a family of single-celled microbes that are often referred to as blue-green algae. Just like plants, cyanobacteria can produce energy from sunlight via a process called photosynthesis. Spirulina was consumed by the ancient Aztecs but became popular again when NASA proposed that it could be grown in space for use by astronauts."
A standard daily dose of spirulina is 1–3 grams, but doses of up to 10 grams per day have been used effectively. This tiny algae is packed with nutrients. A single tablespoon (7 grams) of dried spirulina powder contains:
Protein: 4 gramsVitamin B1 (thiamine): 11% of the RDAVitamin B2 (riboflavin): 15% of the RDAVitamin B3 (niacin): 4% of the RDACopper: 21% of the RDAIron: 11% of the RDA
It also contains decent amounts of magnesium, potassium and manganese and small amounts of almost every other nutrient that you need. In addition, the same amount holds only 20 calories and 1.7 grams of digestible carbs." (Source: Healthline)
CHLORELLA BENEFITS
"There are over 30 different species, but two types — Chlorella vulgaris and Chlorella pyrenoidosa — are most commonly used in research. Because chlorella has a hard cell wall that humans cannot digest, you must take it as a supplement to reap its benefits. Chlorella's impressive nutritional profile has led some to call it a "super food." While its exact nutrient content depends on growing conditions, the species used and how supplements are processed, it's clear it packs several beneficial nutrients," according to Healthline. They include:
Protein: Chlorella is 50–60% protein. What's more, it's a complete protein source, meaning it contains all nine essential amino acids.
Vitamin B12: Some chlorella varieties may also contain vitamin B12, but more studies are needed.
Iron and vitamin C: Chlorella can be a good source of iron. Depending on the supplement, it may provide anywhere from 6–40% of your daily need. It's also an excellent source of vitamin C, which helps you absorb iron.
Other antioxidants: These tiny green cells provide a wide range of antioxidants
Other vitamins and minerals: Chlorella provides small amounts of magnesium, zinc, copper, potassium, calcium, folic acid and other B vitamins
Omega-3s: As with other algae, chlorella contains some omega-3s. Just 3 grams of chlorella delivers 100 mg of omega-3s.
Fiber: In large quantities, chlorella can be a good source of fiber. However, most supplements don't provide even 1 gram of fiber per dose.
THE GREEN DRAGON KRATOM SMOOTHIE
Ingredients 1 tsp spirulina1 tsp chlorella1-2 tsp of Beaufort Kratom Green Dragon powder1 cup coconut or almond milk1 frozen banana, chopped1/2 of a ripe avocado, chopped1 tbsp shredded coconut
InstructionsAdd all your ingredients to a blender or juicer and puree until smooth and enjoy!