Atacama petroglyphs. Close-up of moonlit sacred prehistoric rock carvings (petroglyphs) on a rock-face in the Rainbow Valley (Valle Arcoiris), Atacama Desert, Chile, at night. These carvings show two juvenile llamas (foreground) and adult llamas on the rocks above. Shown here are a llama and several shaman in cross legged meditation position. In the sky the Southern Cross constellation and the Milky Way can be seen at centre, with Jupiter at right. Photographed in in Yerbas Buenas, Chile.


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#FridayPiday
FridayPiday: Alexander Simone (Arizona State, 2016)
Since he was a child, Alexander Simone (Arizona State, 2016) knew he wanted to be an inventor. He founded Pronto Concepts, a company of inventors and designers on a mission to make small changes to routines that improve lives in a big way. His company gave way to a brand new, patented product called ProntoBev, a device that can chill any bottle of wine in 30 seconds or less and was recently featured on the hit ABC show, Shark Tank. "When Shark Tank calls, you answer," said Brother Simone.
He recalled trying to enjoy a bottle of warm wine with a girl. "In the moment, I tried to find a solution to the problem. I grabbed a pasta strainer, filled it with ice, sprinkled a generous amount of salt and poured the wine through it. It was instantly cold! But unfortunately, watered down, salty and absolutely disgusting!" After making a few unsuccessful prototypes, he tabled the idea. After picking up the idea again in 2015, he was able to build a tiny prototype that proved his theory that a device could chill a bottle of wine in 30 seconds.
As a final project for his Marketing for Entrepreneurship course, he and a group of students built his product around a company and presented an early version of the concept. "Building prototypes was definitely the hardest part. It was challenging and frustrating waterproofing each different design iteration." Brother Simone went through 13 prototypes before coming up with the final design.
Shortly after, he set out to receive funding and launched an Indiegogo Campaign. With an initial goal of $25,000, he surprised even himself by raising more than $60,000 from backers. "It was an incredible experience receiving support from friends and family as well as brothers of AEPi I had never met before." Brother Simone had every intention to apply to be on Shark Tank next year when he was more established, but was surprised when ABC called him to be featured on the show. "It came at an inconvenient time because I was in the middle of trying to push my campaign, but ended up being the best thing for me."
With only a short time to prepare for his pitch to the sharks, Brother Simone quickly got to work. "I had no time for nerves and no margin for error. I was surprised that the tank felt comfortable to speak in and can't explain the feeling of being in that setting. I just focused on the viewers at home and making a deal."
Watching each shark drop out one by one was devastating and he knew his only offer from Kevin O'Leary would hurt the company more than help it. With nowhere else to turn, he was close to walking away with nothing. Then, out of nowhere, Mark Cuban countered with a deal that Brother Simone couldn't resist. "Mark was our guy. I have groundbreaking technology that is ten times better than our competitors and he's the one looking into the future and making these types of investments. It seemed like a risk at the time to mess up the one deal I had from Kevin, but it easily paid off."
Now his only goal is to raise another $100,000. "My offer from Mark is contingent on raising [another $100,000]. There's a lot of chaos with getting production ready for spring 2018. Once the dust settles though, I'm excited to start putting my effort into another project. I've had to make a lot of hard decisions on my own, but having Mark Cuban on my side to introduce me to the right people and help me with those decisions is the best part."
"I learned more about running a business from AEPi than I did from studying Entrepreneurship in school. AEPi has helped me and made me understand what an amazing network Jewish culture can be. I feel that AEPi is the most connected fraternity because of this aspect."
Brother Simone is offering a special 19.13% discount to brothers who place an order and use the code ESPONDA. To learn more about the product or investing, visit Pronto Concepts' website: ProntoConcepts.com
ASU, fridaypiday
« Commit to Being Your Brothers' Keeper
FridayPiday: Max Silver (Guelph, 2018) »

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: postgres makes db dump without password if i write on console at home (new machine, random IP):
/usr/bin/pg_dump --host xxxxxx --port xxxxxx --username "yyyy"
--no-password  --format plain --create --clean --section pre-data --section data --section post-data --inserts --column-inserts --verbose --file "/POSTGRES/backup_2016-09-08" "bbbbb"

serwer dumps database without asking for password! how do i block it?
my pg_hba.conf
# Database administrative login by Unix domain socket
local   all             postgres                                peer

# TYPE  DATABASE        USER            ADDRESS                 METHOD

# "local" is for Unix domain socket connections only
local   all             all                                     peer
host    all             all             127.0.0.1/32            md5
host    all             all             ::1/128                 md5
host    aaaa              all             0/0                     md5
host    bbbb      all             0/0                     md5

A: ops, how stupid I am...
i have used 1 time pgadmin and logged to my  external postgress server
it made in my home directory .pgpass file
if i delete it - pg_dump doesn't work without password
my error!

redpajama_set_name: RedPajamaStackExchange


RATIONALE: Studying samples of blood and bone marrow from patients with cancer may help doctors identify biomarkers related to cancer.
PURPOSE: This research study is looking at blood and bone marrow samples in patients with chronic myelogenous leukemia enrolled on a CALGB clinical trial.
Monitor molecular response rates of patients receiving treatment for chronic myelogenous leukemia by quantitative reverse transcription polymerase chain reaction (RT-PCR) and quantitative Southern blot monitoring of blood samples.
Compare quantitative RT-PCR and quantitative Southern blot results with marrow cytogenetics at the time of complete molecular response in these patients.
Monitor the frequency of residual disease in patients who achieve a complete blood Southern blot and marrow cytogenetic response (eradication of BCR/ABL by Southern blot and absence of the Philadelphia chromosome by cytogenetics).
OUTLINE: Peripheral blood samples and bone marrow aspirates are collected at baseline and at 3, 6, and 9 months after starting therapy. If patient continues to receive protocol treatment after 9 months, additional peripheral blood samples are collected every 6 months and bone marrow aspirates are taken annually. In the event of disease progression (blast crisis), an additional peripheral blood sample and bone marrow aspirate are collected.
Samples are examined by quantitative Southern blot analysis with probes to BCR, quantitative reverse transcriptase-polymerase chain reaction analysis for BCR/ABL fusion transcripts, and cytogenetic analysis.
PROJECTED ACCRUAL: A total of 60 patients will be accrued for this study within 1.5 years.


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Karcher 1.520-149.0 HD18/13CED 1300 PSI 1.8 GPM Electric Pressure Washer. WHATEVER THE CLEANING TASK, WE HAVE THE SOLUTION. All Kärcher compact models have a number of outstanding features in common: rugged 3-piston axial pumps for long service life; patented anti-twist system (AVS) for easy and safe operation; and Kärchers automatic pressure-controlled shutdown for low energy consumption and extended service life. Models are ETL safety certified to CSA and UL standards. We warrantee and represent that the goods are as described in the above listing. We specifically disclaim any implied warranties of title, merchantability, fitness for a particular purpose and non-infringement.
The item "Karcher 1.520-149.0 HD18/13CED 1300 PSI 1.8 GPM Electric Pressure Washer" is in sale since Friday, July 28, 2017. This item is in the category "Home & Garden\Yard, Garden & Outdoor Living\Outdoor Power Equipment\Pressure Washers". The seller is "sharpprices" and is located in Netcong, New Jersey. This item can be shipped to United States.


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Waste and Biomass Valorization
Seed-Assisted, OSDA-Free, Solvent-Free Synthesis of ZSM-5 Zeolite from Iron Ore Tailings
Peng Zhang
Suqin Li
Penghui Guo
Changquan Zhang
Comprehensive utilization of iron ore tailings (IOT) not only solves environmental problems but also creates huge economic benefits. Our approach is focused on reutilization of IOT by converting it to ZSM-5 zeolite. The solvent and organic structure-directing agents (OSDA) used in the hydrothermal synthesis of ZSM-5 zeolite are major obstacles to achieve the sustainable synthesis routes. Therefore, the development of environmentally friendly ZSM-5 zeolite synthesis method is strongly desired. Here, ZSM-5 zeolite is synthesized successfully from IOT via a seed-assisted, solvent-free method without using the organic template or solvent. In addition, the influences of Na2CO3·10H2O/SiO2 molar ratio, amount of seeds, and crystallization process of ZSM-5 are systematically investigated. The raw materials and as-synthesized products are characterized by XRD, XRF, SEM, 27Al MAS NMR, and BET analysis; and the ZSM-5 zeolite synthesized by seed-assisted, OSDA-free, solvent-free method has the same mesoporous and microporous structure as the seed crystal. The synthetic route proposed in this work provides a novel green alternative for the synthesis of ZSM-5 from IOT.
Graphic Abstract
Figure schematic illustration of the seed-assisted, OSDA-free, solvent-free synthesis of ZSM-5
ZSM-5 zeolites Iron ore tailings (IOT) Solvent-free method Organic structure, seed-assisted, directing agents (OSDA)-free
This work is supported by National Science Foundation of China (Project 51874039), National Science and Technology Major Project (2017ZX07402001), and National Key R&D Program of China (2017YFC0210301). The authors would like to thank Yonghong Tang from shiyanjia lab for the support of 27Al MAS NMR analysis (www.shiyanjia.com).
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1.School of Metallurgical and Ecological EngineeringUniversity of Science and Technology BeijingBeijingChina
Zhang, P., Li, S., Guo, P. et al. Waste Biomass Valor (2019). https://doi.org/10.1007/s12649-019-00752-4
Accepted 06 July 2019


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garciniacam - 16-Light Light Tower for Remote and Rugged Operations
You will discover quite a few places where operations carry on throughout the evening or in low visibility conditions. Though permanent lighting solutions for enclosed spaces is usually a feasible solution, the exact same is just not the case with open spaces. A case in point could be a parking lot or a building website. These places could be efficiently illuminated employing a light tower.
Components of a light tower
You'll find three key components in a lighting aylesbury tower: a trailer, the mast, as well as the light assembly. The adjustable-height mast and light assembly are installed on the trailer. The trailer is very important for two primary reasons:
It can be installed using a modest tank to carry various gallons of diesel, petrol, or gasoline. The fuel acts as a back-up energy supply in remote places. Having mentioned that, there are lots of urban areas exactly where towers are powered employing the aforementioned fuel sources.
The trailer lends enhanced mobility to the complete light tower assembly. It can be fitted having a license quantity for operations exactly where the trailer needs to use public roads for movement.
Special remote place lighting solutions
The lighting requires in urban locations are vastly diverse from those at remote areas. As an example, powerful winds and rough roads are not commonly skilled at urban internet sites. Similarly, homeland safety applications vary in execution from mining operations in a mountainous region. In relation to carrying out operations in remote locations-where even standard road access may well be lacking-a stronger, more sturdy selection of towers is needed.
You will find specific suppliers within the marketplace that have sensed this requirement and have supplied much better alternatives towards the conventionally utilised towers. So, if you have to have illumination options in rugged regions like North Canada, you'd require a very sturdy selection of towers for lighting.
The new-age remote lighting light tower range options the following:
The use of a higher variety of lights. Although frequent towers possess a light assembly of just 4, six or eight high-power bulbs, the new towers offer you at the least 16 high-power bulbs. You can count on these 1,500-watt metal halide lamps to create no less than 2.five million lumens.
The trailer and mast are fabricated within a manner that enables them to offer an extended service life even when the going gets truly tough.
If it isn't achievable to position the light tower at the spot of action, the high-powered towers might be effortlessly placed even 300 feet away. They could nevertheless deliver enough light to produce your operation doable.
This, and lots of other enhanced functions can be knowledgeable inside the new-age light tower range that is definitely at present available in the marketplace. These towers is usually used within a myriad of applications which include homeland security, building, mining, public events, parking lot safety, disaster web pages, refineries, airports, and much more.


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Global Pro-AV Industry Will Reach $325 Billion in 2024, According to New Forecasts from AVIXA
FAIRFAX, VA – June 25, 2019 – The global professional audiovisual industry will grow to more than $325 billion in 2024, from $247 billion in 2019, according to updated forecasts in the new 2019 AV Industry Outlook and Trends Analysis (IOTA) Global Summary produced by AVIXA™, the Audiovisual and Integrated Experience Association. Overall, the demand for pro-AV products and services is driven by rising GDP across much of the globe because the pro-AV industry provides solutions to nearly all facets of the economy.
"Those who have followed AVIXA's previous forecasts will note the new estimates represent an upward revision," said Sean Wargo, Senior Director of Market Intelligence, AVIXA. "The hike in the revised forecasts reflects strong economies and demand for new products and services. The growth in pro-AV revenue is actually outpacing expectations for global GDP growth."
For the first time, the new IOTA report includes additional data from distributors and integrators to track the amount of markup over the manufacturer price that is applied by the pro-AV channel. In 2019, markups are projected to represent an additional $22 billion in revenues globally, before accounting for services revenue.
"The story of pro AV is ultimately one of the value-add offered by the distributor and providers in the creation of exceptional experiences from the raw materials of AV products," said Wargo. "This story isn't complete without accounting for this value through the markups applied by the channel, as they source and optimize hardware and services together. AVIXA now more accurately accounts for this in its channel revenue estimates."
Until the latest report, the Americas had consistently represented the largest pro-AV revenue-producing region. The new forecast shows the Asia-Pacific region overtaking the Americas in 2019. The Americas represent $89 billion in revenue for 2019, compared with $90.6 billion for APAC. The gap swells to more than $15 billion by 2024. APAC's growth is spurred in part by the region's demand for security, surveillance, and life safety solutions, which in turn fuels growth in the streaming media, storage, and distribution (SMSD) product segment. SMSD is forecast to expand at a compound annual growth rate (CAGR) of 10.5 percent in the Asia-Pacific region from 2019 through 2024.
The pro-AV market in the Americas is projected to continue its growth, although at a slower pace than APAC. With a CAGR of 4.7 percent, the Americas will reach $112 billion in revenue in 2024. The corporate segment will be a major driver of pro-AV market growth for the region, with revenue rising at a CAGR of 4.2 percent from 2019 through 2024. The shift to private, public, and hybrid cloud deployments over purely on-premises solutions is driving much of the growth. The research also shows growth in markets for environmental systems and performance and entertainment solutions.
Meanwhile, Europe, the Middle East, and Africa (EMEA) will experience moderate growth of 4.5 percent CAGR through 2024, despite near-term economic challenges. The region will capture the largest percentage of revenue for audio equipment among the three regions and is expected to overtake the Americas in this segment with $6.7 billion in 2024. Revenue from video displays, particularly direct-view LED, will see considerable growth in EMEA. This product segment is forecasted to grow at 8.4 percent in the region over the next five years. The region's highest pro-AV revenue source is the corporate market. Although the revenue from the corporate market in EMEA is smaller than the amount captured by other regions, this $18 billion market is a crucial part of EMEA pro AV.
The IOTA report was produced by AVIXA in conjunction with IHS Markit, a noted insights and intelligence firm. The research methodology includes manufacturer inputs, both in the form of qualitative and quantitative guidance on the size and growth within various product categories. Interviews and further data collection among distributors, integrators, and end users helps determine the segmentation of products into solutions and markets. The research methodology also helps verify the flow of product, any commensurate markups applied by suppliers, and value-added services sold. The combined methodological approach makes IOTA the most comprehensive and representative report on the total pro-AV channel on the market today.
To learn more about the IOTA report, visit www.avixa.org/IOTA.
About AVIXA
AVIXA™ is the Audiovisual and Integrated Experience Association, producer of InfoComm trade shows around the world, co-owner of Integrated Systems Europe, and the international trade association representing the audiovisual industry. Established in 1939, AVIXA has more than 11,400 enterprise and individual members, including manufacturers, systems integrators, dealers and distributors, consultants, programmers, live events companies, technology managers, content producers, and multimedia professionals from more than 80 countries. AVIXA members create integrated AV experiences that deliver outcomes for end users. AVIXA is a hub for professional collaboration, information, and community, and is the leading resource for AV standards, certification, training, market intelligence, and thought leadership. Visit avixa.org.
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https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODQ5NTE2LW92ZXJ2aWV3
Drugs & Diseases > Otolaryngology and Facial Plastic Surgery
Neck, Cervical Metastases, Detection
Author: Benoit J Gosselin, MD, FRCSC; Chief Editor: Arlen D Meyers, MD, MBA more...
Sections Neck, Cervical Metastases, Detection
Anatomy of the Cervical Lymphatics
Classification of Cervical Node Groups
Mechanisms of Lymph Node Metastasis
Evaluation of the Neck for Cervical Metastases: Physical Examination
Detection of Cervical Metastasis: Radiological Investigations
Cervical metastasis by a tumor is firm statement of its aggressive malignant nature. Nothing is more controversial than the management of cervical metastatic disease. This is not surprising considering the lack of knowledge of carcinogenesis, pathophysiology of metastases, and implications of tumor spread. Fortunately, great strides have been made in the understanding of the intricate processes related to metastatic disease. Proper understanding of anatomy and the detection of cervical metastatic disease is crucial to this process. Forthcoming techniques will also facilitate the detection of primary and metastatic disease.
For excellent patient education resources, visit eMedicineHealth's Cancer Center. Also, see eMedicineHealth's patient education article Cancer of the Mouth and Throat.
Photograph showing an aspirate being placed on a glass slide. After the 20-mL disposable syringe with an attached 21-gauge needle is placed under the skin surface and the mass is aspirated, a small drop of aspirated fluid is placed on a glass slide.
The lymphatic system has 3 components: the capillaries, vessels, and nodes.
Larger than arteriovenous capillaries, lymphatic capillaries are thin-walled, with a single layer of endothelial cells. Lymphatic capillaries are found in all tissues; however, they are more abundant in the upper respiratory and GI tracts. Pooled capillaries drain lymphatic fluid into lymphatic vessels, which have 3 layers.
As in the capillaries, the vessels have a single layer of endothelial cells surrounded by an inner, longitudinal elastic layer. This first muscle layer is surrounded by a circular smooth muscle layer, which, in turn, is enveloped by an outer connective tissue layer. Lymphatic vessels contain many more valves than the venous system, with the lymph circulation entirely dependent on compression by surrounding muscles. Lymphatic vessels drain into lymph nodes.
These nodules of tissue are of variable size. Typically, as many as 75 nodes are located on each side of the neck. Nodes contain a subcapsular sinus below a prominent capsule, into which lymphatic fluid drains. This capsule is often the first site of metastatic growth. The fluid permeates the substance of the node (composed of a cortex and a medulla) and exits through the hilum to enter more lymphatic vessels. These nodes are located between the superficial cervical and prevertebral fascia and, thus, are very amenable to surgical removal. The lymphatic fluid eventually enters the venous system at the junction of the internal jugular and subclavian veins. Many nodal descriptions exist today; Rouvière's is the classic model. The following describes the main cervical node groups:
The occipital nodes are in the superficial group, which includes 3-5 nodes. This group of nodes is localized between the sternocleidomastoid (SCM) and trapezius muscles, at the apex of the posterior triangle. These nodes are superficial to the splenius capitis.
The deep posterior cervical group includes 1-3 nodes. This group of nodes is located deep to the splenius capitis and follows the course of the occipital artery. These nodes drain the scalp, the posterior portion of the neck, and it's the deep muscular layers of the neck.
The postauricular nodes vary in number from 2 to 4; they are located in the fibrous portion of the superior attachment of the SCM muscle to the mastoid process. Postauricular nodes drain the posterior parietal scalp and the skin of the mastoid region.
The parotid nodes can be divided into intraglandular and extraglandular groups. The extraglandular parotid nodes are located outside but adjacent to the parotid gland, where they drain the frontolateral scalp and face, the anterior aspects of the auricle, the external auditory canal, and the buccal mucosa. Embryologically, the lymphatic system develops before the parotid gland, which surrounds the intraglandular nodes as it develops. This explains why the parotid gland contains lymphoid tissue. The intraglandular nodes drain the same regions as the extraglandular nodes, to which they interconnect and then drain into the upper jugular group of lymph nodes. As many as 20 parotid nodes may be found.
The submandibular nodes are divided into 5 groups: preglandular, postglandular, prevascular, postvascular, and intracapsular. The preglandular and prevascular groups are located anterior to the submandibular gland and facial artery, respectively. The postglandular and postvascular groups are posterior to these structures. Differing from the parotid gland in embryological development, there is no true intraglandular node; however, occasionally, a node has been identified inside the capsule of the gland. The submandibular nodes drain the ipsilateral upper and lower lip, cheek, nose, nasal mucosa, medical canthus, anterior gingiva, anterior tonsillar pillar, soft palate, anterior two thirds of the tongue, and submandibular gland. The efferent vessels drain into the internal jugular nodes.
For the submental nodes, 2-8 nodes are located in the soft tissues of the submental triangle between the platysma and mylohyoid muscles. These nodes drain the mentum, the middle portion of the lower lip, the anterior gingiva, and the anterior third of the tongue. The efferent vessels drain into both the ipsilateral and contralateral submandibular nodes or into the internal jugular group.
The sublingual nodes are located along the collecting trunk of the tongue and sublingual gland and drain the anterior floor of the mouth and ventral surface of the tongue. These nodes subsequently drain into the submandibular or jugular group of nodes.
The retropharyngeal nodes are divided into a medial and lateral group, located between the pharynx and the prevertebral fascia. The lateral group, located at the level of the atlas near the internal carotid artery, consists of 1-3 nodes, which may extend to the skull base. The medial group extends inferiorly to the postcricoid level. This group drains the posterior region of the nasal cavity, sphenoid and ethmoid sinuses, hard and soft palates, nasopharynx, and posterior pharynx down to the postcricoid area. Management of these nodes must be considered if any malignancy arises from the mentioned drainage areas.
The anterior cervical nodes are divided into the anterior jugular chain and the juxtavisceral chain of nodes. The anterior jugular chain nodes follow the anterior jugular vein, located superficial to the strap muscles. These nodes drain the skin and muscles of the anterior portion of the neck, and the efferent vessels empty into the lower internal jugular nodes.
The juxtavisceral nodes are separated into the prelaryngeal, prethyroid, pretracheal, and paratracheal nodes. Prelaryngeal nodes are located from the thyrohyoid membrane to the cricothyroid membrane and drain the larynx and the thyroid lobes. A single delphian node is often found overlying the thyroid cartilage.
The pretracheal group consists of nodes between the isthmus of the thyroid gland down to the level of the innominate vein. Varying from 2-12 in number, these nodes drain the region of the thyroid gland and the trachea and receive afferent flow from the prelaryngeal group. The pretracheal efferents empty in the internal jugular group and the anterior superior mediastinal nodes.
The paratracheal nodes lie near the recurrent laryngeal nerve and drain the thyroid lobes, parathyroid glands, subglottic larynx, trachea, and upper esophagus. The efferent vessels travel to the lower jugular group or directly toward the junction of the internal jugular vein and the subclavian vein. The anterior nodes drain bilaterally because the midline of the neck has no division. Treatment must be planned accordingly when a tumor is located in subjacent draining areas.
The lateral cervical nodes are divided into superficial and deep groups. The superficial group follows the external jugular vein and drains into either the internal jugular or transverse cervical nodes of the deep group.
The deep group forms a triangle bordered by the internal jugular nodes, the spinal accessory nodes, and the transverse cervical nodes. The transverse cervical nodes, forming the base of the triangle, follow the transverse cervical vessels and may contain as many as 12 nodes. These nodes receive drainage from the spinal accessory group and from collecting trunks of the skin of the neck and upper chest. The spinal accessory chain follows the nerve of the same name and may account for as many as 20 nodes. This chain receives lymph from the occipital, postauricular, and suprascapular nodes and from the posterior aspect of the scalp, nape of the neck, lateral aspect of the neck, and the shoulder.
The internal jugular chain consists of a large system covering the anterior and lateral aspects of the internal jugular vein, extending broadly from the digastric muscle superiorly to the subclavian vein inferiorly. As many as 30 of these nodes may exist, and they have been arbitrarily divided into upper, middle, and lower groups. The efferents of these nodes eventually pass into the venous system via the thoracic duct on the left and multiple lymphatic channels on the right. These nodes drain all the other groups mentioned. Direct efferents may be present from the nasal fossa, pharynx, tonsils, external and middle ear, eustachian tube, tongue, palate, laryngopharynx, major salivary glands, thyroid, and parathyroid glands.
Although fairly consistent, these drainage patterns are subject to alteration with malignant involvement or after radiotherapy. In such cases, rerouting is possible, with metastases arising in unusual sites. Metastases have also been shown to skip first-echelon nodes and manifest in the lower internal jugular group.
Spread patterns of cancer from various primary sites in the head and neck to the cervical nodes have been documented in retrospective analyses of large groups of patients undergoing neck dissections. Since the first descriptions of nodal groups, various classification systems have been described.
To address surgical management of early-stage neck metastases via neck dissection, various authors have proposed a number of classification schemes. This lack of uniformity and standardization results in redundancy, misinterpretation, and confusion among clinicians. The most widely accepted terminology was originally described by a group of head and neck surgeons at Memorial Sloan-Kettering Hospital. This classification uses neck levels or zones and divides each side of the neck into 6 separate regions. This system is still used today.
Level I is bordered by the body of the mandible, anterior belly of the contralateral digastric muscle, and anterior and posterior bellies of the ipsilateral digastric muscle. Two nodal subgroups are found. The submental group (Ia) is found in the submental triangle (anterior belly of the digastric muscles and the hyoid bone), and the submandibular group (Ib) is found within the submandibular triangle (anterior and posterior bellies of the digastric muscle and the body of the mandible).
The nodes found in level II are located around the upper third of the internal jugular vein, extending from the level of the carotid bifurcation inferiorly to the skull base superiorly. The lateral boundary is formed by the posterior border of the SCM muscle; the medial boundary is formed by the stylohyoid muscle. Two subzones are also described; nodes located anterior to the spinal accessory nerve are part of level IIa, and those nodes posterior to the nerve are located in level IIb.
The middle jugular lymph node group defines level III. Nodes are limited by the carotid bifurcation superiorly and the cricothyroid membrane inferiorly. The lateral border is formed by the posterior border of the SCM muscle; the medial margin is formed by the lateral border of the sternohyoid muscle.
Level lV contains the lower jugular group and extends superiorly from the omohyoid muscle to the clavicle inferiorly. The lateral border is formed by the posterior border of the SCM muscle; the medial margin is formed by the lateral border of the sternohyoid muscle.
The lymph nodes found in level V are contained in the posterior neck triangle, bordered anteriorly by the posterior border of the SCM muscle, posteriorly by the anterior border of the trapezius, and inferiorly by the clavicle. Level V includes the spinal accessory, transverse cervical, and supraclavicular nodal groups.
Level VI lymph nodes are located in the anterior compartment. These nodes surround the middle visceral structures of the neck from the level of the hyoid superiorly to the suprasternal notch inferiorly.
A complete understanding of these anatomic relationships allows various practitioners to exchange information in an unbiased fashion and is critical in the decision-making processes involved in management of nodal metastases.
The current hypotheses on the development of malignancies relate to alterations in the normal mechanisms of cellular proliferation and differentiation and a failure of cell death (apoptosis). This loss of growth control is the result of genetic mutations, including the activation of proto-oncogenes and/or inactivation of tumor suppressor genes. The resulting phenotypic changes provide cancer cells a growth advantage, including loss of response to normal growth controls, defects in response signals for programmed cell death, resistance to cytotoxicity, and defects in terminal differentiation.
Proposed by Fidler, the concept of tumor heterogeneity suggests that tumors are composed of heterogeneous subpopulations of cells differing in immunogenicity, invasiveness, cellular growth kinetics, sensitivity to cytotoxic drugs, and ability to metastasize. The local tumor environment may favor the development of more aggressive clones in the formation of metastases. Although the size of individual clones with metastasizing potential in a given tumor is significant, only a very small percentage of circulating cells lead to the development of metastatic colonies.
The events surrounding the initiation of local tumor invasion by epithelial tumors include a loss of cellular adhesion to surrounding tumor cells and basement membrane, invasion by malignant cells of the subjacent connective tissues by the production of cellular enzymes and growth mediators, cellular attachment to extracellular membrane molecules, neovascularization, and entry or exit from the circulation through the attachment to endothelial cell ligands. A repeat of these events occurs at metastatic sites.
In the case of head and neck squamous cell carcinomas, malignant cells may progress from carcinoma in situ, to microinvasive carcinoma, to a deeply invasive tumor with lymphatic metastases. Interestingly, a head and neck squamous cell carcinoma has the ability to manifest at both extremes of histopathological development in the same anatomic location. The critical step in the transition from carcinoma in situ to microinvasive and invasive carcinoma is the destruction of the basement membrane. This destruction is accomplished by the production of specific proteolytic molecules by tumor cells, including matrix metalloproteinases, collagenases, and plasminogen activators.
Angiogenesis is the growth of new capillaries by sprouting from established vessels. In normal tissues, self-limiting angiogenesis is part of reproduction and organogenesis in addition to wound repair and healing. Conversely, pathological angiogenesis is not autoregulated, but results from alterations in growth-control mechanisms of disease processes (eg, malignant transformation). Various tumor-derived factors (eg, prostaglandin E2, platelet-derived growth factor, transforming growth factor-beta, transforming growth factor-alpha, beta-fibroblast growth factor) are still being investigated for their propensity to facilitate endothelial cell proliferation.
Recent research looking specifically at the production of cytokines regulating immune, inflammatory, and angiogenetic responses in patients with laryngeal squamous cell cancer has revealed higher serum concentrations of the cytokines interleukin-6, interleukin-8, and vascular endothelial growth factor. These agents may be important in proinflammatory and proangiogenetic responses of tumor cells.
The ability of a tumor to stimulate an angiogenic response should directly determine the capability of a tumor to metastasize and ultimately kill the host. A clear correlation between tumor angiogenesis and nodal metastasis has been demonstrated in early and invasive breast carcinoma, ovarian and endometrial carcinoma, non–small-cell carcinomas, prostatic carcinoma, adenocarcinoma of the colon, and squamous cell carcinoma of the esophagus.
The literature notes conflicting reports regarding microvessel density and nodal metastasis in head and neck squamous cell carcinomas. Tumor sites of varying origins with different vascularization patterns at their primary sites may behave differently. Malignancies of the head and neck, especially head and neck squamous cell carcinomas, are the result of a series of genetic misadventures of squamous epithelial cells leading to malignant transformation. Variable genetic susceptibility, prolonged tobacco and alcohol exposure, viruses, and immune suppression all can facilitate these genetic derangements.
Tumors invade local connective tissues by the production of proteinases and the expression of surface markers that facilitate attachment to extracellular matrix components. Tumor growth and size being limited by available nutrients from the surrounding milieu, recruitment of host capillaries leads to the formation of an intratumoral blood supply. Capillary and lymphatic invasion by tumor cells allow malignant cell dissemination and the establishment of histologically identical tumors at distant sites.
Most recently, the expression of vascular endothelial factor-D in a mouse tumor model was found to lead to the lymphatic spread of tumor cells, tumor angiogenesis, and tumor growth. Further research in this area will likely provide more details in the multiple steps involved in the lymphatic spread of squamous cell cancer.
The dissemination of tumor cells beyond the primary site unfortunately remains the most significant factor in prognosis and needs further study.
Evaluating neck metastases based on physical examination findings has been the classic method for patients with new tumors in the head and neck. The single most important factor in determining prognosis is whether nodal metastasis is present. Survival rates decrease by 50% when nodal metastases are present. Furthermore, the presence of cervical adenopathy has been correlated with an increase in the rate of distant metastasis.
During the clinical evaluation, careful palpation of the neck, with specific attention to location, size, firmness, and mobility of each node, is noted. Attention is particularly directed to nodes that appear fixed to underlying neurovascular structures, visceral organs, or nodes that demonstrate skin infiltration. The description of each node becomes an important part of the medical record, which can be used to assess the response to treatment or the progression of the disease.
Unfortunately, clinical palpation of the neck demonstrates a large variation of findings among various examiners. Although both inexpensive to perform and repeat, palpation findings are generally accepted as inaccurate. Both the sensitivity and specificity are in the range of 60-70%, depending on the tumor studied. Because of the known low sensitivity and specificity of palpation, a neck side without palpable metastases is still at risk of harboring occult metastasis, with the risk determined by the characteristics of the primary tumor. The incidence of false-negative (occult) nodes based on physical examination findings varies in the literature from 16-60%. Before the introduction of diagnostic imaging, particularly CT scan, clinical palpation was shown to be inadequate for detecting cervical metastasis. Soko et al reported that only 28% of occult cervical metastases were found by clinical palpation. Martis reported a 38% prevalence of occult metastasis based on clinical examination findings.
Debate persists over the relative merits of imaging in the evaluation of the neck for metastatic disease. [1] Studies that correlate radiologic and histopathologic findings show that early microscopic metastases can be present in nodes smaller than 10 mm that demonstrate no stigmata of neoplasia (ie, central necrosis, extracapsular spread). Evidence of early metastatic disease in clinically occult nodes is minimal and may evade the efforts of the pathologist and radiologist.
Ultrasound is reported superior to clinical palpation for detecting lymph nodes and metastases. The advantages of ultrasound over other imaging modalities are price, low patient burden, and possibilities for follow-up.
Sonographs of metastatic lymph node disease characteristically find enlargement with a spherical shape. Commonly, nodes are hypoechoic, with a loss of hilar definition. In cases of extranodal spread with infiltrative growth, the borders are poorly defined. Common findings of metastases from squamous cell carcinoma are extranodal spread and central necrosis together with liquid areas in the lymph nodes. Lymph node metastases from malignant melanoma and papillary thyroid carcinoma have a nonechoic appearance that mimics a cystic lesion. Sonography may also be useful for assessing invasion of the carotid artery and jugular vein.
Because lymph nodes of borderline size cannot be reliably diagnosed using ultrasound alone, ultrasound-guided fine-needle aspiration and cytologic examination of the nodes in question can be easily performed. The result of the aspirate examination depends on the skill of the ultrasonographer and the quality of the specimen (ie, harboring an adequate number of representative cells). Using this technique, most studies report that a sensitivity of up to 70% can be obtained for the N0 neck.
Photograph showing the smear technique for plating a sample aspirate. After a small drop of fluid is placed on a glass slide, a second slide is used to smear the aspirate evenly over the surface of the slide. The slide is then prepared for cytologic evaluation.
Since its debut in the 1970s, CT scans have been an invaluable tool in all fields of medicine, including the evaluation of head and neck cancer. Since the advent of high-resolution systems and specific contrast media, fine-cut CT scanning has allowed the detection of pathological cervical nodes of smaller size that may be missed by clinical examination. CT scanning is now used routinely for the preoperative evaluation of the neck because, presumably, it helps decrease the incidence of occult cervical lymphadenopathy. [2]
Introduced in 1998, multiple-spiral CT scanning promises further improvement of temporal and spatial resolution (in the longitudinal axis). This technique permits rapid scanning of large volumes of tissue during quiet breathing. The volumetric helical data permit optical multiplanar and 3-dimensional reconstructions. Improvement of the assessment of tumor spread and lymph node metastases in arbitrary oblique planes is another advantage of the spiral technique.
Criteria for the identification of questionable nodes are also evolving as technology advances. Central necrosis remains the most specific finding suggestive of nodal involvement, but its absence does not exclude metastasis. Unfortunately, metastasis is usually quite rare or not visible in small lymph nodes, where detection would be crucial. Because of the higher imaging resolution, various studies have reduced the traditional values of 10-15 mm for a node to be suggestive. Many authors have proposed a minimal axial diameter of 11 mm for the submandibular triangle and 10 mm for the rest of the neck. Other criteria include the presence of groups of 3 or more borderline nodes and the loss of tissue planes.
An imaging-based classification has also been proposed by Som et al, [3] and due to its specificity, has also been endorsed by clinicians managing head and neck cancer. The boundaries of the nodal levels were easily discerned by radiologists and yielded consistent nodal classifications.
For an evaluation of the diagnostic abilities of Ga-SPECT, see Kotani et al. [4]
The value of MRI is its excellent soft tissue resolution. MRI has surpassed CT scanning as the preferred study in the evaluation of cancer at primary sites such as the base of the tongue and the salivary glands. The sensitivity of MRI exceeds that of clinical palpation in detecting occult cervical lymphadenopathy. Size, the presence of multiple nodes, and necrosis are criteria shared by CT scanning and MRI imaging protocols. [5, 6]
Many reports indicate that CT scanning still has an edge over MRI for detecting cervical nodal involvement. Advances in MRI technology (eg, fast spin-echo imaging, fat suppression) have not yet surpassed the capacity of CT scanning to identify lymph nodes and to define nodal architecture. Central necrosis, as evaluated by unenhanced T1- and T2-weighted images, has been shown to provide an overall accuracy rate of 86-87% compared with CT scanning, which has an accuracy rate of 91-96%. [7] The use of newer contrast media, especially supramagnetic contrast media agents, hopefully will improve the sensitivity of MRI.
Positron emission tomography imaging
This new imaging modality has been increasingly studied in the staging of head and neck cancer. [8, 9] The technique relies on the uptake of 2-fluoro-2-deoxy-D-glucose (FDG) in metabolically-active lesions. The study may also be fused to a corresponding CT scan to facilitate the localization of the lesion of concern.
In comparing their usefulness in the detection of cervical metastasis, PET/CT fusion images have been found to be superior and more accurate for the detection of cervical metastasis, compared with PET alone or with conventional imaging modalities. In addition, PET can contribute to the detection of residual or early recurrent tumors, leading to the institution of earlier salvage therapy. [2]
A study by Tan et al indicated that FDG-PET/CT scanning is more sensitive than contrast-enhanced multislice helical CT (MSCT) imaging in detecting paraesophageal lymph node metastases in patients with esophageal cancer. The study involved 115 patients with esophageal cancer, in whom a total of 946 lymph node groups were resected; metastases were confirmed histopathologically in 221 of these groups. Although no significant differences were found between FDG-PET/CT scanning and enhanced 64-slice helical CT imaging with regard to specificity and accuracy in detecting lymph node metastases, the sensitivity of FDG-PET/CT scanning was 74.7%, compared with 64.7% for enhanced MSCT scanning. The sensitivity difference was even greater for paraesophageal lymph node metastases, being 72% and 57.7%, respectively. [10]
The investigators' findings also indicated, however, that enhanced MSCT imaging can effectively distinguish false-negative lymph node metastases visualized on FDG-PET/CT scans. Tan and colleagues concluded that combining FDG-PET/CT scanning with MSCT imaging should increase accuracy in staging lymph node metastases in esophageal cancer. [10]
A study by Jung et al suggested that in papillary thyroid carcinoma, a primary tumor with a high avidity for FDG and a high maximum standardized uptake value (SUVmax) is predictive for cervical lymph node metastasis. The study included 193 patients with papillary thyroid carcinoma who underwent FDG-PET/CT scanning prior to treatment, with the FDG-avid tumors being larger than the nonavid tumors (0.93 cm vs 0.59 cm, respectively) and the incidence of cervical lymph node metastasis being greater in the avid tumors than in the nonavid ones (49.2% vs 33.3%, respectively). Moreover, among the avid tumors, the SUVmax was higher in the ones that metastasized than in those that did not. [11]
None of the currently available imaging techniques can help depict small tumor deposits inside lymph nodes. Characteristics of metastatic lymph nodes that can be depicted are the size and presence of noncontrast-enhancing parts inside metastatic lymph nodes caused by tumor necrosis, tumor keratinization, or cystic areas inside the tumor. Only rarely does tumoral tissue enhance more than reactive lymph node tissue; in these rare cases, the tumor can be visualized within a reactive lymph node.
Patients who need an evaluation for a possible nodal malignancy require a comprehensive multidisciplinary evaluation of all potential sites of drainage to that node to identify its primary source. This includes a thorough evaluation of potential primary sites using endoscopic techniques. When appropriate, include laryngoscopy, esophagoscopy, bronchoscopy, and examination of the nasopharynx. If no primary source is identified, taking blind mucosal biopsy samples of the most likely head and neck subsites is essential. [12]
PET/CT techniques have a promising role; however, greater clinical experience is needed prior to making this modality the standard for the detection of metastasis in head and neck cancer.
Complete documentation of nodal characteristics by clinical examination and palpation guide the examiner in using adjunctive radiological tools to exclude occult nodal metastasis.
Yoon DY, Hwang HS, Chang SK, Rho YS, Ahn HY, Kim JH, et al. CT, MR, US,18F-FDG PET/CT, and their combined use for the assessment of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Eur Radiol. 2009 Mar. 19(3):634-42. [Medline].
Kurien G, Hu J, Harris J, Seikaly H. Cost-effectiveness of positron emission tomography/computed tomography in the management of advanced head and neck cancer. J Otolaryngol Head Neck Surg. 2011 Dec. 40(6):468-72. [Medline].
Som PM, Curtin HD, Mancuso AA. An imaging-based classification for the cervical nodes designed as an adjunct to recent clinically based nodal classifications. Arch Otolaryngol Head Neck Surg. 1999 Apr. 125(4):388-96. [Medline].
Kotani J, Kawabe J, Higashiyama S, Kawamura E, Oe A, Hayashi T, et al. Evaluation of diagnostic abilities of Ga-SPECT for head and neck lesions. Ann Nucl Med. 2008 May. 22(4):297-300. [Medline].
van den Brekel MW. Lymph node metastases: CT and MRI. Eur J Radiol. 2000 Mar. 33(3):230-8. [Medline].
de Bondt BJ, Stokroos R, Casselman JW, van Engelshoven JM, Beets-Tan RG, Kessels FG. Clinical impact of short tau inversion recovery MRI on staging and management in patients with cervical lymph node metastases of head and neck squamous cell carcinomas. Head Neck. 2009 Jul. 31(7):928-37. [Medline].
Verhappen MH, Pouwels PJ, Ljumanovic R, van der Putten L, Knol DL, De Bree R, et al. Diffusion-Weighted MR Imaging in Head and Neck Cancer: Comparison between Half-Fourier Acquired Single-Shot Turbo Spin-Echo and EPI Techniques. AJNR Am J Neuroradiol. 2012 Feb 9. [Medline].
Chen ZW, Zhu LJ, Hou QY, Wang QP, Jiang S, Feng H. [Clinical application of positron-emission tomography for the identification of cervical nodal metastases of head and neck cancer compared with CT or MRI and clinical palpation]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2008 Dec. 43(12):705-8. [Medline].
Liao CT, Fan KH, Lin CY, Wang HM, Huang SF, Chen IH, et al. Impact of a second FDG PET scan before adjuvant therapy for the early detection of residual/relapsing tumours in high-risk patients with oral cavity cancer and pathological extracapsular spread. Eur J Nucl Med Mol Imaging. 2012 Mar 21. [Medline].
Tan R, Yao SZ, Huang ZQ, et al. Combination of FDG PET/CT and Contrast-Enhanced MSCT in Detecting Lymph Node Metastasis of Esophageal Cancer. Asian Pac J Cancer Prev. 2014. 15(18):7719-24. [Medline].
Jung JH, Kim CY, Son SH, et al. Preoperative Prediction of Cervical Lymph Node Metastasis Using Primary Tumor SUVmax on 18F-FDG PET/CT in Patients with Papillary Thyroid Carcinoma. PLoS One. 2015. 10 (12):e0144152. [Medline]. [Full Text].
Stoeckli SJ, Alkureishi LW, Ross GL. Sentinel node biopsy for early oral and oropharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol. 2009 Jun. 266(6):787-93. [Medline].
Chen Z, Malhotra PS, Thomas GR, et al. Expression of proinflammatory and proangiogenic cytokines in patients with head and neck cancer. Clin Cancer Res. 1999 Jun. 5(6):1369-79. [Medline].
Curtin HD, Ishwaran H, Mancuso AA, et al. Comparison of CT and MR imaging in staging of neck metastases. Radiology. 1998 Apr. 207(1):123-30. [Medline].
Hao SP, Ng SH. Magnetic resonance imaging versus clinical palpation in evaluating cervical metastasis from head and neck cancer. Otolaryngol Head Neck Surg. 2000 Sep. 123(3):324-7. [Medline].
Kresnik E, Mikosch P, Gallowitsch HJ. Evaluation of head and neck cancer with 18F-FDG PET: a comparison with conventional methods. Eur J Nucl Med. 2001 Jul. 28(7):816-21. [Medline].
Merritt RM, Williams MF, James TH, Porubsky ES. Detection of cervical metastasis. A meta-analysis comparing computed tomography with physical examination. Arch Otolaryngol Head Neck Surg. 1997 Feb. 123(2):149-52. [Medline].
Safa AA, Tran LM, Rege S, et al. The role of positron emission tomography in occult primary head and neck cancers. Cancer J Sci Am. 1999 Jul-Aug. 5(4):214-8. [Medline].
Schechter NR, Gillenwater AM, Byers RM. Can positron emission tomography improve the quality of care for head-and-neck cancer patients?. Int J Radiat Oncol Biol Phys. 2001 Sep 1. 51(1):4-9. [Medline].
Southwick, HW, Slaughter, DP, Trevino, ET. Elective neck dissection for intraoral cancer. Arch Surg. 1960. 80:905-9.
Stacker SA, Caesar C, Baldwin ME, et al. VEGF-D promotes the metastatic spread of tumor cells via the lymphatics. Nat Med. 2001 Feb. 7(2):186-91. [Medline].
Benoit J Gosselin, MD, FRCSC Associate Professor of Surgery, Dartmouth Medical School; Director, Comprehensive Head and Neck Oncology Program, Norris Cotton Cancer Center; Staff Otolaryngologist, Division of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center
Benoit J Gosselin, MD, FRCSC is a member of the following medical societies: American Head and Neck Society, American Academy of Facial Plastic and Reconstructive Surgery, North American Skull Base Society, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Rhinologic Society, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, College of Physicians and Surgeons of Ontario, New Hampshire Medical Society, Ontario Medical Association
Nader Sadeghi, MD, FRCSC Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, McGill University Faculty of Medicine; Chief Otolaryngologist, MUHC; Director, McGill Head and Neck Cancer Program, Royal Victoria Hospital, Canada
Nader Sadeghi, MD, FRCSC is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Thyroid Association, Royal College of Physicians and Surgeons of Canada
Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;The Physicians Edge;Sync-n-Scale;mCharts<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; .
William M Lydiatt, MD, FACS Head and Neck Surgical Oncologist, Methodist Estabrook Cancer Center; Chair-Elect, Department of Surgery, Nebraska Methodist Hospital; Clinical Professor, Department of Surgery, Creighton University School of Medicine; Lecturer, Department of Biology, University of Nebraska-Omaha
William M Lydiatt, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society
encoded search term (Neck%2C Cervical Metastases%2C Detection) and Neck, Cervical Metastases, Detection


Dear Bob: Replacing an inefficient air conditioner (AC) with a more efficient model could significantly reduce your electric bill. A new AC unit is 20 to 40 percent more efficient than one from the 1990s—and ENERGY STAR-certified systems are even more efficient. Replacing an aging system now, before summer starts, could help you avoid delays or price premiums.
How much money you save by replacing your current AC unit depends on how often your AC runs and your electric rate. If we have a hot summer and you keep your home's temperature in the low 70s, your cost of cooling will be substantial and so will the potential savings from replacing your old air conditioner with an efficient new one.
The best way to determine possible savings is to have an in-home assessment conducted by a qualified heating, ventilating, and air conditioning (HVAC) professional or a certified energy auditor. Electric co-ops are often interested in reducing peak summer loads and sometimes offer information, rebates, or a list of qualified professionals. It's a plus if the contractor has North American Technician Excellence (NATE) certification. Contractors should be knowledgeable about energy efficient systems and have good references.
In order to size the system, the contractor will need to look at the efficiency of the home by checking insulation levels. If you add insulation where it's most needed, you may be able to install a smaller AC unit, and you should enjoy greater comfort and lower cooling costs. The HVAC contractor you hire should also assess your ductwork, which is often poorly designed, leaky, or inadequately insulated.
Replacing an aging air conditioner is a great way to improve comfort, cut energy costs, and reduce peak energy demand. Your co-op may be able to help, and you can learn a lot from the information resources available at www.collaborativeefficiency.com and on the ENERGY STAR and energy.gov websites.


1-6, "My Name is Betty" collection. Recorded 3/5/07 on an old hand-held Tape Recorder. The quality is absolutely wretched, but totally awesome!
7-13, "The Hour of Power" collection. Recorded 2007 on a Tascam 4 track, on a one hour tape. Improved quality!
14-25, "The Dragon Rodent" collection. Also recorded 2007 on a Tascam 4 track, featuring the lost track: "To Save the Children we had to Kill Them." aka "Janet Reno."


text:
Fiction at Literati: Halle Butler
Thursday, March 14, 2019 - 7:00pm
Literati is thrilled to welcome novelist Halle Butler who will be reading and discussing her latest book The New Me. Halle will be joined in conversation with Aisha Sabatini Sloan.
About The New Me:
Im still trying to make the dream possible: still might finish my cleaning project, still might sign up for that yoga class, still might, still might. I step into the shower and almost faint, an image of taking the day by the throat and bashing its head against the wall floating in my mind.
Thirty-year-old Millie just can't pull it together. Misanthropic and morose, she spends her days killing time at a thankless temp job until she can return home to her empty apartment, where she oscillates wildly between self-recrimination and mild delusion, fixating on all the little ways she might change her life. Then she watches TV until she drops off to sleep, and the cycle begins again. When the possibility of a full-time job offer arises, it seems to bring the better life she's envisioning - one that involves nicer clothes, fresh produce, maybe even financial independence - within reach. But with it also comes the paralyzing realization, lurking just beneath the surface, of just how hollow that vision has become. Darkly hilarious and devastating, The New Me is a dizzying descent into the mind of a young woman trapped in the funhouse of American consumer culture.
"The New Me is a bouncy, profane, highly addictive novel about work, female friendship, and other alienations. Halle Butler's insane talent shimmers on every page of this deadpan misanthrope's ode. A must-read!"
--Claire Vaye Watkins, author of Gold Fame Citrus and Battleborn
"Halle Butler has a way of looking at our twenty-first-century neoliberalist condition that simultaneously exposes its brutality and renders that same brutality absurd, hilarious, fizzy with humor. She's an incisive, curmudgeonly bard of the uniquely precarious times we live in, and it is crucial that you read her immediately."
--Alexandra Kleeman, author of You Too Can Have a Body Like Mine
Halle Butler is the author of Jillian. She has been named a National Book Award Foundation "5 Under 35" honoree and a Granta Best Young American Novelist.
Aisha Sabatini Sloan grew up in an apartment building five miles from the ocean. She has studied visual art, cultural studies and creative writing. Her first book, The Fluency of Light, was published by University of Iowa Press in 2013 and her most recent books is DREAMING OF RAMADI IN DETROIT (1913 Press, 2017).
The New Me (Paperback)
By Halle Butler
Published: Penguin Books - March 5th, 2019


text:
Live: Crash on A637 between Flockton and Midgley, plus Huddersfield breaking news, weather, M62 traffic and travel for Friday November 16
Latest updates on news, traffic, travel and weather in and around town
Susie BeeverBreaking News Reporter
Breaking News Blog header
Welcome to ExaminerLive's breaking news service.
Stay with us throughout the day to be the first to know everything that's happening across Huddersfield and the rest of West Yorkshire.
We'll also be bringing you updates on crime, health, sport, politics, education and more live from the ExaminerLive team.
And remember to check back before you travel as during peak times we'll provide you with all of the latest traffic updates on the M62 and roads around the region.
You can also download our app to get news on the go and push notifications for the latest breaking stories here .
If there's something you've noticed and want us to check out then please feel free to get in touch - you can call us on 01484 437712, email editorial@examiner.co.uk or tweet @Examiner. You can also find us on social media here .
Armed police in Birkby 11:23
Two jailed for drugs crimes in Huddersfield 09:47
M62 update
Traffic is still slow on the M62 eastbound near Wakefield following the earlier accident near junction 29, Lofthouse.
All lanes have been re-opened.
Traffic was held to move the vehicles. Lane three (of three) was closed to allow Highways officials to assist with the scene.
M62 accident
Two cars have been involved in an accident on the M62 eastbound between Lofthouse (junction 29) and Rothwell (junction 30).
One lane is closed.
Lane three (of three) is closed to allow the Highways officers to assist with the scene.
Congestion between Flockton and West Bretton
Drivers are being warned of congestion on the A637 at Midgley, between Flockton and West Bretton, following a crash involving a car and a truck.
West Yorkshire Police were called to the Stocksmoor Road/Bar Lane area at 3.37pm today. The car involved is a Toyota Auris.
No-one is believed to be hurt but the incident is causing congestion.
The crash is thought to have happened on or near to a bend.
The road is a busy route for those heading to and from the M1.
PC speaks out after thug jailed for finger bite attack
A police officer who had his finger bitten in a shocking attack caught on camera has said he is "still living with what happened".
See what he had to say here.
Daniel Brearley is seen about to bite the police officer's finger
West Yorkshire Police ranked eighth best employer in UK for being 'inclusive'
WYP have been announced as one of the country's top ten employers.
The Force were revealed as having made the shortlist, coming in at number 8 on the Inclusive Top 50's best employers. WYP shared the news today, saying they were "incredibly proud". The shortlist ranks companies based on representation of employees of different genders, race, sexuality and disabilities.
11:23 KEY EVENT
Armed police in Birkby
We have reports of armed police in Birkby last night.
Residents say officers were called to Tanfield Road late yesterday evening at around 9.30pm. ExaminerLive has contacted West Yorkshire Police and we'll let you know as soon as we have more information on this.
Armed police called to Tanfield Road, Birkby
Police seize imported Range Rover that wasn't taxed
West Yorkshire Police's road policing unit tweeted about this earlier this morning after the car was seized in the town centre.
Fire fighters collecting for Children in Need in the town centre
Try and spare a few pennies if you're in town today!
Two jailed for drugs crimes in Huddersfield
Two drug dealers have been jailed for more than ten years after they took advantage of a vulnerable homeowner turning her house into a drugs den.
Brandon Diskin, 21, and 23-year-old Saul Britton, both from the town, were jailed this week after being convicted for possession of Class A drugs with intending to supply.
It's after the duo took over a house on Sunbury Grove in Dalton and turning it into a drugs den. Police said the pair targeted the house which was owned by a vulnerable woman, and used it to cut and sell drugs.
Diskin and Britton were jailed at Leeds Crown Court on Wednesday for four-and-a-half years, and six years, respectively.
Brandon Diskin (L) and Saul Britton, who targeted a vulnerable homeowner turning her Dalton home into a drugs den (Image: West Yorkshire Police)
Here's what's going on on the roads this morning. You can also keep up to date with your train times from Huddersfield Station here.
Slow as per at Cooper Bridge coming from all three directions
Brighouse Road is slow in Queensbury between Bradford and Halifax this morning
Gelderd Road is queuing all the way into Leeds
No problems to report at the moment on the M62 - looking all clear!
07:34 Susie Beever
Happy Friday to you. We'll start this off with our leading story today - an exclusive, in-depth report into how chances were missed nine years ago into bringing men who groomed girls in Huddersfield to justice.
The CEO of a group working with the victims and their families told ExaminerLive how social services and police let victims down, and that the system is 'not fit for purpose'. Read it all here.
The 20 members of the Huddersfield grooming gang convicted of horrendous offences against young, vulnerable girls


Who makes the best fiberglass entry doors?
Water leaks from window frame during heavy rain. Can't figure out the cause. What kind of professional do I need?
How much would it cost to install a new exterior front door and a new full view storm door.
I would like to have washer and electric dryer moved from the basement to master bath on second floor.
Bought a house with a sunroom that I am told was constructed using a kit. The roof is leaking can it be replaced?
How to fix? Water coming in around windows & from above? What roofing or other issue is this?
how is the quality of mercury advantage windows?