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Home News One Month After Rowan's Mental Health Rally-Where are We?
One Month After Rowan's Mental Health Rally-Where are We?
Alex Rossen
On Monday, Nov. 8, a rally was held outside of Savitz Hall, advocating for more mental health services. -Photo via Multimedia Editor / Nick Feldman
Roughly one month ago, Rowan's mental health services became the center of the university discourse. At the Student Government Association's (SGA) senate meeting on Nov. 8., student voices were heard throughout the evening advocating for change. Earlier that day, students demonstrated for the exact same cause outside of Savitz Hall.
Since then, a group of student leaders from organizations such as the Rowan Progressives, Her Campus Rowan, the student senate and more, have been regularly meeting with administrative officials to discuss what they want to see on behalf of the student body.
After a month of deliberation, negotiating, advocacy and many meetings, student and faculty representatives are ready to report on what progress has been made to improve Rowan's mental health resources and address student concerns.
Students and administrators alike agreed that there remains a long process ahead before the desired progress can be achieved. Accordingly, Nia Wade, a sophomore psychology major, felt that it was too early to say if meaningful progress was being made.
"The action we need to take would take time… but we shouldn't be [moving] at a slow pace," Student Body Senator-at-Large Raymond Wos, Jr. said.
Despite this, and despite the numerous logistical challenges, there remains a commitment towards doing what can be done.
"It's all part of continuously improving, to be honest… but part of it is listening, so we're doing that," Wellness Center Director Scott Woodside said. "I think it's unrealistic to say [we] can meet every student's needs, but we're sure as heck trying."
Even so, student outlooks on the future for mental health services remain largely grounded in a sense of cautious optimism.
"Compared to previous years, Rowan is making meaningful progress to improve mental health resources," Sean Rovins, a pre-health studies post-Baccalaureate student, said. "We won't know until the spring semester if they commit to their plans, but I am hopeful. We'll keep fighting for the resources we need until we get them."
"I believe we are in the very early stages of making meaningful progress, but it'd be difficult to say that what we've gotten so far is at that level yet," Ryan Clare, a fifth-year music composition major, said. "The dialogue we've been able to have with those in [the administration] is a good sign and I'm hopeful it'll result in the change that students have been asking for."
University Senate President Bill Freind explained some ways in which Rowan's faculty and staff plan on implementing new strategies for addressing mental health at Rowan.
"One of the things that faculty will be doing, many of us have gone through QPR (Question, Persuade, Refer) training so that we can recognize students that are in crisis. We're looking into incorporating, on our syllabi, lists of different mental health resources," Freind said.
Freind is also the co-chair of the university's well-being committee, which seeks to utilize initiatives like Rowan Thrive to spread awareness about well-being on campus.
"The message that we really need to get out is that mental health is not just about counseling and psychiatry," Freind said. "Mental health is also about mental health in all of its facets: exercise, sleep, mindfulness. And we're pushing this through the Rowan Thrive initiative, but we need to be doing a better job of that… and that's something I've asked the student representatives for help with."
For Wellness Center Director Scott Woodside, the idea of increasing access regarding the Wellness Center's resources is at the heart of what, to him, needs to be done.
"We're talking about doubling counselors and space," Woodside said, "but it's really [about increasing] access, and that's gotta continue to improve. Especially if we keep adding students."
During this process towards change, student leaders made the call to their peers to continue to persevere and keep advocating for the change that they want to see.
"Be ready to continue fighting for better conditions on campus," Clare said. "We're the ones paying for this university to operate and we need to make our voices heard when it's not living up to its promises."
For comments/questions about this story tweet @TheWhitOnline or email thewhitnews23@gmail.com.
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Master of Orion II: Battle at Antares 1996 MicroProse Software, Inc., MicroProse Ltd.
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The Best of Microprose Strategy 1998 MicroProse Software, Inc.
Star Trek: Generations 1997 MicroProse Software, Inc., MicroProse Ltd.
Knights of the Sky 2016 Night Dive Studios, LLC, Retroism
Transport Tycoon Deluxe 1996 MicroProse Software, Inc.
Dark Earth 1997 MicroProse Software, Inc., MicroProse Ltd.
Teamchef 1996 MicroProse Ltd.
Worms United 2012 Team17 Software Limited
Spirit of Speed 1937 1999 MicroProse Ltd.
Motocross Stunt Racer 2002 Dig-Concepts.com, LLC
Urban Assault 1998 Microsoft Corporation
Minesweeper 1995 Microsoft Corporation
Microsoft Golf 3.0 1996 Microsoft Corporation
Microsoft Casino 2000 Microsoft Corporation
Microsoft Combat Flight Simulator: WWII Europe Series 1998 Microsoft Corporation
Age of Empires II: The Conquerors 2000 Microsoft Corporation
Links Extreme 1999 Microsoft Corporation
Microsoft Baseball 2001 2000 Microsoft Corporation
Close Combat: A Bridge Too Far 1997 Microsoft Corporation
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redpajama_set_name: RedPajamaCommonCrawl


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Q: Mouse stuck in different select mode pycharm I know that when one presses the scroll button down one can access many lines at once and selcet them partly but now evenmy normal mouse selects like that, with multiple cursors:

I have no idea how to escape. pls help :')

A: Right click on the background, and unselect "Column Selection Mode":

Or use the shortcut keys to toggle the mode:
Alt + Shift + Insert

redpajama_set_name: RedPajamaStackExchange


I can't even imagine how fabulous this is going to be.
I watched this three times in a British Airways flight in October, then saw it in the theater twice.
So good! I hadn't realized that it would include clips of their early work. It was wonderful to see that.


Proposed 16990-17000 Sunset Project | PROTECT PALISADES BLUFFS!
To view the relevant Coastal Act Regional Interpretive Guidelines, please click here.
Second, third, fourth and fifth stories of rear of building do not have required 10 foot setback from first floor as required by Q Overlay.
To view the plans for 17000 Sunset, please click here.
Please click here to view detailed analysis of geology and hydrology issues.
Site was old arroyo that was filled to build Sunset and current site pad (see photo).
44,500 cu. yds. of fill and dirt must be excavated and hauled away.
Malibu Village is at risk since it is directly below site and sits on fill placed over an ancient landslide.
Site is natural drainage channel for Marquez Knolls neighborhood – Storm water drainage has NOT been studied.
Hydrology and its effect on geology has not been studied to the depth of proposed construction or during a period of heavy rain.
Please click here to view an independent geology report critical of project.
Please click here to view another independent geology report.
Site is on dangerous stretch of Sunset and location of many serious accidents.
Cars and motorcycles routinely exceed posted speeds on this stretch of Sunset.
Driveway does not align with light at Marquez even though this alignment would reduce the risk of accidents caused by dangerous left turns in and out of the project's driveway.
Inadequate representation of the project for the community – context renderings were promised, but not produced.
Excavation and hauling of massive amounts of undocumented fill will affect surrounding neighborhoods – haul route not yet determined.
Rare Torrey Pine trees will be removed.
Presence of hydrogen sulfide gas not adequately studied.
Construction worker parking will burden Marquez neighborhood for years.
EIR required as matter of law.


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By David Klein
Pope Benedict XVI, who advanced Catholic-Jewish relations, dies at 95
(JTA) - Jewish groups are among those marking the death of Benedict XVI, the Catholic pontiff who died Saturday at 95, a decade after shocking the world by becoming the first pope since the Middle Ages to resign.
"It is with great sadness that I learned today that Pope Emeritus Benedict XVI has passed away," Ronald Lauder, president of the World Jewish Congress, said in a statement issued Saturday. "He was a towering figure of the Roman Catholic Church, both as pope and before that as the cardinal who gave the Catholic-Jewish relationship solid theological underpinning and enhanced underst...
Obituary - ELLIOTT JORDAN LAYISH
Obituary - DON KIRSCHENBLATT
Obituary - STANLEY BECKER
Obituary - RACHEL WOLF
Obituary - BARBARA JOAN WOLPE


In 1993 singer Al Rumjen and guitarist Devil Hands moved to London to form a band, they got robbed on their very first night as they couldn't be arsed to unload the removal van. This would set the tone for the freak show that followed.
After recruiting a bassist and drummer from an ad in melody maker, King Prawn's infectious blend of Ska, Hip Hop & Punk Rock wowed crowds from the Arctic Circle to Sicily and one or two other places in between, earning them a reputation as one of the most entertaining live acts coming out of London. The rock press loved their sense of unpredictability and their growing fanbase adored their ability to simultaneously implode and explode on stage.
The band released their first two albums on Words of Warning Records, 'First Offence' produced by Skunk Anansie guitarist Ace & 'Fried in London' co-produced by Harvey Birrell (Therapy?). An invitation from Madness to play Madstock in Finsbury Park followed as did nominations for 'Best New British Band' at the 1998 Kerrang! Awards and again in the 'Spirit of Independence' category in 2000.
The band signed to Spitfire Records (Eagle Rock Entertainment) for the release of their 3rd album, 'Surrender To The Blender'. The release was accompanied by extensive European touring, supports with Therapy?, Desmond Decker, Prince Buster, Ska-P, a billing at Dour Festival and an hilarious prime-time Italian TV performance on Roxy Bar shared with the relentlessly naff Atomic Kitten.
In 2002 the band released their fourth album 'Got the Thirst' on Golf Records, with Skunk Anansie's Ace returning to the production seat. The album featured their best known single 'The Dominant View', assisted by regular airing on the newly launched P-Rock cable TV channel. Promotional work for this LP saw a debut tour in Japan, a BBC R1 Maida Vale session & billings at Reading & Leeds Festival. The band saw the year out with a final sell out show at London's Forum before bowing out for a much deserved decade long sabbatical.
The decision to split in 2003 at the height of their popularity left a lasting legacy as a seminal band in the late 90's Ska-Punk scene. Singer Al Rumjen moved to Italy and enjoyed a 5-year stint as vocalist for Asian Dub Foundation, touring the world and recording two albums with the band.
In 2013, The Prawn once again hopped eagerly aboard the joyous charabanc for more musical escapades. The newly reformed King Prawn, with Zac Chang replacing irreplaceable bassist Babar Luck, expanded to a 7-piece with brass section and keyboards.
During that Summer King Prawn returned to play Reading & Leeds festival, Rebellion festival, headline shows at Slam Dunk, Boomtown Fair, Bearded Theory and several festivals in Belgium.
To coincide with the release of a new single, the band played an 11-date club tour culminating with a highly charged show at London's Koko. King Prawn remain a force to be reckoned with, one whose appeal is timeless and cross-generational.
King Prawn have recently completed recording their self-produced 5th studio album – taking a painstaking four years to finalise but to be frank, it's a stone cold corker.


'BC35' is so called because it's a celebration of the 35th anniversary of Martin Bisi's legendary studio in Brooklyn's Gowanus, where he's recorded the likes of Sonic Youth; The Dresden Dolls; John Zorn; Helmet; White Zombie; Swans, et al. And the form this celebration took was to record some improvisations and composed pieces, all live, over a weekend in January 2016 at BC Studio, with current/former members of Sonic Youth; Swans; White Hills; Foetus; Cop Shoot Cop; Live Skull; Pop 1280; Violent Femmes; The Dresden Dolls; Alice Donut; Lubricated Goat... to name just some. And Bisi contributed guitar to a small number of the tracks.
Diversity would be the expectation here... and that's true across some of the material but, on the whole, the core seems to be based around instrumental and experimental psychedelia where many of the pieces are delightfully fucked up. If this were a film, it'd be where the low budget exploitation kitsch of HG Lewis meets the darkly surreal and unsettling undercurrent of David Lynch. It somehow succeeds in being simultaneously absorbing and unnerving through its contrasting layers of both allure and menace on pieces like 'Nowhere Near the Rainbow', 'Denton's Dive' and 'Synesthesia!'.
There are some vocals to be heard on a small number of tracks, such as the wonderfully titled 'Details of the Madness' and 'Humash Wealth Management, Inc.', whereby the latter has a voice over that sounds like Sleaford Mods' frontman impersonating a Dalek, in what comes across as a mildly aggravated rant. And the polemical agitation rears its head once again on 'Soft Glitter Cosmos Needs a Pig War'. Both tracks are by Tidal Channel and are, by far, the weakest on the album... terrible, in my opinion. But if what sounds like a Sleaford Mods + Dalek collaboration floats your boat, then hunt down the two tracks immediately! The album's best vocal performance appears on 'Take This Ride', courtesy of Ajda the Turkish Queen.
The impromptu immediacy of the whole project shines through on many of the pieces. It's quite remarkable, really, just what's been achieved here in what was largely a weekend of experimental, musical spontaneity. It's an apt celebration of both Bisi's influence and what's been described as the uniqueness and "idiosyncrasies" of his studio.
5) Humash Wealth Management, Inc.
"...delightfully fucked up. If this were a film, it'd be where the low budget exploitation kitsch of HG Lewis meets the darkly surreal and unsettling undercurrent of David Lynch."


Dr. Bert-Jan van den Born, Academic Medical Center, Department of Vascular Medicine, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Interventions targeting renal artery stenoses have been shown to lower blood pressure and preserve renal function. In recent studies, the efficacy of catheter-based percutaneous transluminal renal angioplasty with stent placement has been called into question. In the identification of functional coronary lesions, hyperemic measurements have earned a place in daily practice for clinical decision making, allowing discrimination between solitary coronary lesions and diffuse microvascular disease. Next to differences in clinical characteristics, the selection of renal arteries suitable for intervention is currently on the basis of anatomic grading of the stenosis by angiography rather than functional assessment under hyperemia. It is conceivable that, like the coronary circulation, functional measurements may better predict therapeutic efficacy of percutaneous transluminal renal angioplasty with stent placement. In this systematic review, the authors evaluate the available clinical evidence on the optimal hyperemic agents to induce intrarenal hyperemia, their association with anatomic grading, and their predictive value for treatment effects. In addition, the potential value of combined pressure and flow measurements to discriminate macrovascular from microvascular disease is discussed.
Renal artery stenosis is associated with increased risk for kidney failure and is an independent predictor of mortality (1,2). Balloon angioplasty with or without stent placement has been used as a treatment modality for renovascular hypertension and preservation of kidney function in patients with renal artery stenosis. However, recent large randomized studies such as the ASTRAL (Angioplasty and Stent for Renal Artery Lesions) and CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) trials failed to show a beneficial effect of percutaneous transluminal renal angioplasty with stent placement (PTRAS) over medical therapy alone regarding blood pressure reduction, prevention of renal function deterioration, or cardiovascular outcome (3,4). This was confirmed in a recent meta-analysis of randomized clinical trials comparing revascularization and medical therapy for renal artery stenosis demonstrating that angioplasty with or without stenting was not superior to medical therapy across a wide range of clinical endpoints (5). Despite the lack of superiority of PTRAS in recent trials, a considerable range of smaller clinical studies have demonstrated that PTRAS was successful in improving blood pressure control and renal function (6–16). ASTRAL and CORAL enrolled large numbers of patients with moderate to severe chronic kidney disease.
These patients may have entered the trials too late for potential benefit of PTRAS. In addition, although ASTRAL and CORAL were performed in populations with large proportions of subjects with controlled hypertension, previous studies have shown benefits of PTRAS in patients with (recent histories of) uncontrolled hypertension, therapy resistant hypertension, recurrent flash pulmonary edema, or refractory heart failure (17–19). Next to differences in clinical characteristics, the selection of renal arteries suitable for intervention is currently on the basis of anatomic grading of the stenosis by angiography rather than functional assessment under hyperemia, whereas measurement of pressure gradients alone (without hyperemia) does not appear to have additional diagnostic value (20).
In the coronary circulation, anatomic abnormalities do not coincide with functional significance (21,22). Assessment of functional characteristics of the stenosis by sensor-equipped guidewires to measure pressure and/or flow under hyperemic conditions has significantly improved clinical outcomes (23–25), whereas coronary interventions based on anatomic criteria were not superior compared with optimal medical therapy alone (26). In addition, the combination of coronary pressure–derived myocardial fractional flow reserve (FFRmyo) and coronary flow reserve (CFR) have been demonstrated to provide additional value for identifying clinically relevant flow impairment (27,28). Here, measurement of FFRmyo and CFR is synergistic, with FFRmyo providing information on the functional severity of a focal coronary artery stenosis, whereas CFR provides information on the functional properties of both focal and diffuse coronary artery disease and microvascular function. This information allows discrimination between solitary coronary lesions and diffuse or microvascular disease, thereby further improving the selection of patients who may benefit from mechanical revascularization (29). Translating these principles to renovascular disease might contribute to more optimal patient selection for renal intervention.
To assess the contribution of functional measurements in selecting patients with renal artery stenosis, we performed a systematic review on the feasibility, reproducibility, and clinical applicability of renovascular hemodynamic hyperemic measurements in patients with and without renal artery stenosis.
We systematically retrieved reports on intrarenal hemodynamic measurements in patients with renal artery stenosis (Online Appendix). We selected studies that explored the diagnostic value of intrarenal hemodynamic responses with pressure and/or flow wires. We collected information on reproducibility, maximal hyperemic response, dose-effect responses for hyperemic agents, cutoff values, and associations of measurements with treatment outcomes. We included studies obtaining hyperemic physiological measures, including mean hyperemic gradient (MHG), hyperemic systolic gradient (HSG), renal flow reserve (RFR), and/or renal fractional flow reserve (rFFR) in patients with and without renal artery stenosis.
We defined MHG as the mean pressure gradient under hyperemic conditions (MHG = Pa − Pd during 1 cardiac cycle), HSG as the maximal systolic pressure gradient over a stenosis under hyperemic conditions (HSG = Pa − Pd during the systolic phase), RFR (sometimes referred to as renal flow velocity reserve because flow velocity rather than flow is measured) as the ratio of intrarenal flow velocity or average peak flow velocity (APV) at hyperemia to intrarenal APV during baseline conditions (RFR = APVhyperemia/APVbaseline), and rFFR as the ratio of distal (i.e., renal) pressure to proximal (i.e., aortic) pressure during hyperemic conditions (rFFR = Pd/Pa), where Pd is the pressure distal to the lesion and Pa is the pressure proximal to the lesion. An example of intrarenal measurements under baseline and hyperemic conditions explaining MHG, HSG, RFR, and rFFR is shown in Figure 1.
(Left) Combined measurements at baseline circumstances. (Right) Combined measurements under hyperemia. (Top) Electrocardiographic (ECG) recording. (Middle) Proximal/aortic (red) and distal/poststenotic (blue) pressures. (Bottom) Flow velocity signal. The mean hyperemic gradient (MHG) and hyperemic systolic gradient (HSG) are calculated by subtracting the distal pressure from the proximal/aortic pressure during 1 cardiac cycle and the systolic phase, respectively. Renal fractional flow reserve (rFFR) is calculated by dividing the proximal by the distal pressure. Renal flow reserve (RFR) is calculated by dividing the hyperemic averaged peak flow velocity by baseline averaged peak flow velocity. HSG, rFFR, and RFR are calculated across the mean of a 5-beat period (shaded areas). PTRAS = percutaneous transluminal renal angioplasty with stent placement.
For this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, and PubMed were searched (until June 2015) for clinical studies performing intrarenal hyperemic measurements expressed as MHG, HSG, RFR, or rFFR. The electronic search strategy was verified by a clinical librarian who was trained in systematic review searches. Two reviewers (P.M.v.B. and T.P.H.) first evaluated the reports based on titles and abstracts. Case reports, guidelines, editorials, and reviews were excluded, as well as abstracts with combinations of title and abstract that indicated that there was no possibility that the abstract could fit the requirements of this review.
Disagreement in study selection was resolved through final discussion with a third author (B.J.v.d.B.). We recorded number of subjects and investigated arteries, clinical conditions, number of antihypertensive medications, baseline kidney function, blood pressure and stenosis severity, types and doses of hyperemic agents, types of measurements (pressure and/or flow), and observed mean MHG, HSG, RFR, and rFFR. When possible, we calculated sensitivity, specificity, and positive and negative predictive values from the retrieved studies that examined the diagnostic accuracy of renal hyperemic indexes for functional outcomes.
A total of 565 records were found after searching MEDLINE and Embase, and after removal of 265 duplicates, 300 records were screened for eligibility, resulting in 15 studies with relevant information on the diagnostic value of renal hyperemia (Figure 2) (30–44). Because 3 selected studies had overlapping study cohorts (40–42) and study cohorts were heterogeneous, no qualitative synthesis of study data could be performed.
An overview of the selected studies is included in Table 1. A total of 451 subjects (range 11 to 62 per study) and 479 arteries (range 11 to 62 per study) were included. Characteristics of study participants varied and included subjects with possible renovascular hypertension (n = 11), patients with established renal artery stenosis (n = 2), patients with suspected renal artery stenosis (n = 1), and normotensive patients who underwent cardiac catheterization (n = 1).
Grading of the severity of renal artery stenosis was reported in 11 studies and ranged from 51% to 78%. The number of antihypertensive drugs in treated patients varied from 2.2 to 4.0 and was not reported in 3 studies. Kidney function was reported in 12 studies. Studies that reported blood pressure used different methods, varying from single office blood pressure assessments to 24-h ambulatory blood pressure measurements. In all studies, renal artery stenosis severity was assessed by angiography with and without orthogonal views. In studies including subjects with renovascular hypertension, values for mean MHG, HSG, rFFR, and RFR ranged from 10 to 27 mm Hg, 28 to 63 mm Hg, 0.75 to 0.89, and 1.1 to 2.0, respectively. No studies used combined assessments of both intra-arterial (IA) pressure and flow velocity.
An overview of the pharmacological and hemodynamic properties of the agents used to induce renal hyperemia is provided in Table 2. Of the 15 studies, 12 used papaverine (30 to 40 mg IA) (40,41,43,30,32,33,35–39,44) 4 studies used dopamine (5 to 50 μg/kg IA) (35,39,42,44), 3 studies used isosorbide dinitrate (1 mg IA) (30,32,35), 1 study used acetylcholine (100 and 1,000 μg IA) (34), 1 study used fenoldopam (0.05 to 1 μg/kg/min intravenous) (35), and 1 study used nitroglycerin (0.3 mg IA) (31). In 2 studies, isosorbide dinitrate was used to dilate the proximal renal arteries in combination with papaverine for dilation of the renal microcirculation (30,32). In a study by Manoharan et al. (35), flow velocity was continuously recorded after the administration of a large variety of hyperemic agents at different doses. The agents and doses were tested within the same subjects in nonrandomized order. For the longer acting agents, the investigators waited at least 5 min between different vasodilators. In terms of RFR, intrarenal bolus injections of 30 and 50 μg/kg dopamine (RFR 1.88 and 1.97), fenoldopam 0.8 μg/kg (RFR 1.82), and fenoldopam 0.3 and 1.0 μg/kg/min IA infusion (RFR 1.91 and 1.88) resulted in the largest hyperemic response. No significant difference was observed between 30 and 50 μg/kg dopamine IA and between fenoldopam 0.3 and 1.0 μg/kg/min as a continuous IA infusion resulted in a similar response, suggesting that plateau phases were reached. When dopamine was administered in a similar dose intravenously, a significant increase in renal blood flow velocity was driven mainly by an increase in systemic blood pressure, suggesting that intrarenal administration is needed to induce a renal specific hyperemic response. Continuous intrarenal infusion of fenoldopam in a dose of 1.0 μg/kg/min resulted in a similar hyperemic response compared with dopamine, with a mean RFR of 1.91. In 2 other studies by Mangiacapra et al. (39) and Protasiewicz et al. (44), the effect of intrarenal dopamine on rFFR was evaluated in patients with renovascular hypertension. Intrarenal administration of dopamine 50 μg/kg IA was compared with papaverine 30 mg IA and papaverine 40 mg IA, respectively. Mangiacapra et al. (39) described an identical hemodynamic response with a significant decrease in rFFR compared with baseline values for both dopamine 50 μg/kg IA (0.80 ± 0.14) and papaverine 30 mg IA (0.80 ± 0.14). Protasiewicz et al. (44) found that dopamine 50 μg/kg IA resulted in the most pronounced hyperemic response, with a mean rFFR of 0.77 ± 0.16. The mean rFFR for papaverine was not reported.
Orthogonal renal angiography is considered the clinical standard for grading the anatomic severity of renal artery stenosis. Three studies assessed the relationship between angiographic grading of the stenosis and intrarenal physiological measurements. Subramanian et al. (33) could not find an association between quantitative angiographic grading of renal artery stenosis and functional characteristics in 13 patients with renovascular hypertension (mean renal artery stenosis severity 74.9 ± 11.5%) expressed as HSG (r = 0.22; p = 0.44) and rFFR (r = −0.18; p = 0.54) following papaverine IA (mean dose 26.9 mg; range 8 to 40 mg). Similar findings were reported by Jones et al. (34), who could not find an association between angiographic grading and HSG (r = 0.32; p = 0.12) in patients with hypertension and a mean renal artery stenosis of 55 ± 17%, using acetylcholine 100 μg IA for induction of hyperemia. Finally, Leesar et al. (38) documented a moderate but statistically significant linear correlation between rFFR and minimal luminal diameter on angiography (r = 0.66; p < 0.0001) using papaverine 30 mg IA, whereas Kadziela et al. (40) demonstrated that a cutoff value of 0.8 had the best predictive value for the identification of patients with renal artery stenosis, defined as luminal narrowing >70% by angiography. Patients with rFFR >0.8 had stenosis severity of 77 ± 9% compared with 54 ± 15% in patients with rFFR ≤0.80 (sensitivity and specificity 78%).
Two studies aimed to identify most optimal cutoff values for hyperemic measurements on the basis of blood pressure improvement (Table 3). In a cohort of 62 patients with hypertension and mean renal artery stenosis of 61 ± 10%, Leesar et al. (38) aimed to determine cutoff values for HSG, MHG, and rFFR by classifying subjects dichotomously into groups according to the presence of hypertension improvement, defined as an office blood pressure <140/90 mm Hg or a reduction in office diastolic blood pressure of ≥15 mm Hg at 12 months following PTRAS. HSG ≥21 mm Hg was an independent predictor of blood pressure improvement after PTRAS (odds ratio: 1.32; 95% confidence interval [CI]: 1.05 to 1.65; p = 0.013). In predicting hypertension improvement, HSG was minimally superior to MHG and rFFR: the area under the curve for HSG was 0.87 (95% CI: 0.72 to 0.96) with 82% sensitivity and 84% specificity compared with 0.85 (95% CI: 0.76 to 0.94) with 80% sensitivity and 76% specificity for MHG and 0.81 (95% CI: 0.70 to 0.91) with 73% sensitivity and 88% specificity for rFFR. Mangiacapra et al. (39) conducted a similar study with a cohort of 53 subjects and a mean stenosis severity of 58 ± 16%, defining responders as subjects with any systolic blood pressure decrease at 3-month follow-up. Both papaverine and dopamine-induced MHG, HSG, and rFFR were predictive in identifying responders, with areas under the curve ranging from 0.69 to 0.77 but variable sensitivity (56% to 86%) and specificity (50% to 86%). A third, smaller study by Protasiewicz et al. (42) including 37 subjects with mean stenosis of 60 ± 12% found that a (nonhyperemic) mean baseline gradient of >22 mm Hg was highly specific in predicting whether 24-h ambulatory blood pressure would decrease at 3-month follow-up and superior to MHG and rFFR. For RFR, no studies were performed to evaluate its optimal cutoff value for the identification of functionally significant renal artery stenosis. All the studies used a decrease in blood pressure as an outcome. No studies aimed to identify cutoff values for functional measurements based on post-procedural kidney function development.
Three studies prospectively examined responders and nonresponders to PTRAS based on intrarenal physiological measurements and predetermined cutoff values (Table 3). Two studies, totaling 52 patients, prospectively assessed the effect of PTRAS on blood pressure and the use of antihypertensive treatment (41,37). In the first study, by Mitchell et al. (37), rFFR was measured with IA papaverine in 17 patients with therapy-resistant hypertension undergoing PTRAS with unilateral renal artery stenosis (mean angiographic stenosis severity 77.7 ± 6%). The primary outcome parameter was an improvement in office blood pressure, defined as ≤140/90 mm Hg or an absolute decrease in diastolic blood pressure by 15 mm Hg without an increase in blood pressure–lowering medication. During follow-up (mean 10 ± 2 months), 6 of 7 patients (86%) with abnormal rFFR (<0.80) had improved blood pressure response at 90 days compared with 3 of 10 (30%) in the normal rFFR group (p = 0.04), whereas 2 patients (29%) with abnormal rFFR were taking more antihypertensive drugs at follow-up, compared with 8 (80%) in the group with normal rFFR. In addition, the magnitude of blood pressure improvement was greater in the group with abnormal rFFR, whereas HSG did not discriminate between PTRAS responders and nonresponders. In the second study, blood pressure responses were evaluated 6 months after PTRAS in 35 patients with renovascular hypertension (mean stenosis severity 73%; interquartile range: 66% to 80%) (41). Blood pressure was measured using ambulatory recordings. There were no differences between patients with normal or abnormal rFFR at 6-month follow-up with a mean blood pressure reduction of 2.0/0.5 mm Hg (interquartile range: −7.0 to 5.5 mm Hg/−7.5 to 5 mm Hg) in patients with rFFR ≥0.8 and 2/1 mm Hg (interquartile range: −6 to 13 mm Hg/−5 to 3 mm Hg) in patients with rFFR <0.8. Kadziela et al. (43) investigated the association between rFFR before PTRAS and improvement of renal function in 34 patients with hypertension with an average stenosis severity of 74% (range 67% to 80%). The rFFR threshold used in this study was 0.8. The investigators focused on renal parameters, including estimated glomerular filtration rate, albuminuria, and cystatin C serum concentrations, but found no relationship between rFFR and changes in kidney function after PTRAS at 6-month follow-up.
We retrieved 15 studies totaling 451 patients with useful data on intrarenal functional measurements, renal angiography, and clinical outcomes. These studies constituted a relatively small and heterogeneous group of patients with large variations in hemodynamic agents and readout parameters. Despite these limitations, reported studies have provided useful information regarding the added value of intrarenal pressure and flow measurements for clinical decision making in patients with renal artery stenosis.
Following the studies of Beregi et al. (30) and Mounier-Vehier et al. (32) using papaverine 40 mg IA as hyperemic agents, Manoharan et al. (35) found that both dopamine (50 μg/kg) and fenoldopam (0.8 μg/kg) bolus injections, and fenoldopam 0.8 to 1.0 μg/kg/min IA as a continuous infusion, resulted in a more potent decrease in renovascular resistance and thus higher RFR compared with papaverine, whereas there was no significant difference between dopamine and fenoldopam. In terms of rFFR, Mangiacapra et al. (39) found similar values for papaverine 30 mg IA and dopamine 50 μg/kg IA as bolus injections. These data suggest that both dopamine (IA bolus) and fenoldopam (IA as infusion or as bolus injection) are equivalent in their ability to induce renal hyperemia. Fenoldopam is a slightly more potent agonist against peripheral dopamine-1 receptors but does not act as an agonist against peripheral dopamine-2 receptors or alpha- and beta-adrenergic receptors, in contrast to dopamine, which is less selective for these receptors (45). Given the similar effectiveness of fenoldopam and dopamine, both could be considered for the induction of renal hyperemia. Because dopamine is more widely available and costs are significantly lower compared with fenoldopam, dopamine 30 to 50 μg/kg IA may be the preferred agent for functional assessment of renal artery stenosis.
Available data on the association between anatomic severity of the stenosis and hemodynamic parameters show variable results, with most studies showing a poor correlation between angiographic grading of renal artery stenosis and hemodynamic parameters. Because angiographic renal artery stenosis severity has limited predictive value in clinical outcomes after PTRAS (3,4), identification of optimal thresholds for physiological parameters may only be based on studies evaluating clinical outcomes in relation to physiological data.
For MHG, Mangiacapra et al. (39) found that a cutoff value ≥20 mm Hg had the highest predictive value for blood pressure improvement after PTRAS. Mangiacapra et al. (39) and Leesar et al. (38) found similar optimal cutoff values of ≥21 and >22 mm Hg for HSG to predict blood pressure improvement. This appears to be in line with earlier studies identifying that release of renin into the renal vein occurs only when translesional pressure gradients exceed 10 to 20 mm Hg (46,47). In the studies by Leesar et al. (38) and Mangiacapra et al. (39), receiver-operating characteristic analyses of the optimal cutoff values found HSG, MHG, and rFFR to be consistently discriminative with high areas under the curve. However, the derived optimal cutoff values differed substantially between the 2 studies, whereas mean baseline stenosis severity, serum creatinine, and number of antihypertensive drugs were similar. Together with the finding that mean baseline gradient, a nonhyperemic measure, was superior in its correlation with blood pressure decrease compared with MHG and rFFR in the study by Protasiewicz et al. (42), the additional value of hyperemic parameters can be questioned. A possible explanation for the discrepancy, however, may be the large proportion of patients with diabetes (40% of included subjects) in that study. Diabetes is known for its structural and functional microcirculatory abnormalities, both in the coronary and in the renal microcirculation (25,48), which may lead to suboptimal improvement of renal perfusion compared with subjects without diabetes. This hypothesis is supported by a much lower renal hyperemic response in the study of Protasiewicz et al. (44) compared to the use of the same hyperemic agents in equivalent dosages. In the 4 studies documenting RFR, mean RFR varied between 1.1 and 2.0. The renal vasodilator properties are therefore modest compared with the myocardium, where mean CFR in healthy subjects is 3.0 to 3.5 (49,50). The difference between normal and abnormal RFRs is therefore relatively small, which may result in a lower discriminatory power compared with the myocardium, where CFR is considered a robust risk stratification tool for clinical outcomes.
Two prospective studies that evaluated hyperemic indexes found contradictory results for rFFR (41,37). Both studies adhered to a cutoff value of 0.8, similar to the cutoff value that is used to identify culprit lesions in the coronary circulation. Mitchell et al. (37) showed that measurement of rFFR before PTRAS was associated with a significant blood pressure response after PTRAS, but Kadziela et al. could not relate rFFR to blood pressure changes (41) or changes in kidney function (43). Both studies used papaverine as a hyperemic agent, whereas Manoharan et al. (35) showed that papaverine results in an increase in APV that is about one-half as large compared with the increase that can be observed following dopamine. It is therefore conceivable that the failure to achieve maximal hyperemia may have influenced the outcome of these studies.
FFR depends on the magnitude of maximal arterial flow during (pharmacological) hyperemia, where larger magnitudes of hyperemic flow drive higher pressure gradients and lower FFR values and vice versa. As such, a lower vasodilator reserve of the renal vascular bed means that for a given stenosis, the difference between resting and hyperemic pressure gradients is generally smaller than in the coronary circulation. This suggests that rFFR has a lower dynamic range than in the coronary circulation and that differences between normal and abnormal rFFR values are smaller, which potentially limits its discriminative value and may explain why the predictive value of resting gradients is almost equivalent to that of dopamine-induced gradients. Moreover, whereas the coronary autoregulation is designed to maintain blood flow irrespective of a wide range of perfusion pressures, renal autoregulation aims to keep the filtration pressure constant at the expense of renal blood flow (51). Although the physiological behavior of stenoses is the same in coronary and renal arteries, it is important to realize that physiological behavior of the systems themselves is different, and hence physiological tests may have different clinical value.
This overview of currently available evidence shows that there are multiple challenges for invasive functional testing in renal artery stenosis. As such, many lessons can be learned from invasive testing in coronary intervention, some of which may yield important possibilities for the setting of renal artery stenosis and PTRAS. Next to a demand for further investigating clinical indications that are not yet well defined in randomized studies, hyperemic measurements may be of additional value in situations in which there is doubt of interventional benefit, such as subjects with similar features as those included in the ASTRAL and CORAL trials.
In renal artery stenosis, assessment of rFFR and RFR has only been performed separately. In coronary physiology, it is now recognized that the combined assessment of CFR and FFRmyo provides diagnostically and prognostically important information over either of these indexes alone (29,52). Johnson et al. (27) documented that the values of FFRmyo and CFR for a given stenosis and vascular territory are defined by the relative contributions of focal, diffuse macrovascular and microvascular disease. Thus, combined measurements of CFR and FFRmyo reflect clinically relevant basic coronary physiology and allow identification of the prominent origin of perfusion impairment. It is conceivable that the synergistic properties of CFR and FFRmyo also apply for RFR and rFFR, and the combination of RFR and rFFR may allow more appropriate assessment of renal vascular function (Central Illustration). This theory is strengthened by the findings by Protasiewicz et al. (42), which showed lower hyperemic responses in a cohort with a large proportion of patients with diabetes. However, the relationship between these 2 measures in the renal vasculature is not yet established, and further study is required to identify whether combined assessment of rFFR and RFR may help identify certain subsets of patients who may benefit from PTRAS.
PTRAS = percutaneous transluminal renal angioplasty with stent placement; rFFR = renal fractional flow reserve; RFR = renal flow reserve.
Besides evaluating rFFR and RFR, the combined assessment of coronary pressure and flow allows discrimination of the resistance to blood flow induced by the stenosis and renal microvasculature, as depicted in the Central Illustration. Such indexes of stenosis and microvascular resistance are upcoming in coronary intervention and have been shown to provide relevant diagnostic and prognostic information. For assessment of renal artery stenosis, such measurements may be able to identify relevant flow obstruction induced by a stenosis, which may be treated by PTRAS, or from pathology in the microvasculature, in which case PTRAS may not be beneficial. The aforementioned physiological approach has not been tested in renal artery stenosis but may reflect a promising avenue for further research.
The studies included in this review show that evidence for outcome improvement using intrarenal functional assessment of renal artery stenosis severity is still insufficient. This may be at least partly related to the heterogeneity in methodology and subjects' characteristics.
The presence of distinct differences between myocardial and renal physiology implies that successful physiological indexes in coronary interventions may not be fully transferable to the setting of renal artery stenosis. Hence, determining treatment strategy for renal artery stenosis on the basis of intrarenal physiological measurements faces multiple challenges.
Nonetheless, the studies indicate that dopamine and fenoldopam, infused intrarenally, are the hyperemic agents of choice. In post hoc analyses, MHG, HSG, and rFFR seem to be able to discriminate responders from nonresponders. However, studies that aimed to validate cutoff values for MHG, HSG, and rFFR showed variable results, whereas for RFR data are scarce. This may be explained by differences in microcirculatory characteristics that may be clarified by using combined pressure and flow measurements. Future studies on intrarenal functional measurements should aim for further improvement in techniques that may serve as a benchmark for prospective clinical studies that evaluate the value of PTRAS. With such effort, functional testing may help evolve the treatment of renal artery stenosis, similar to the evolution of elective percutaneous coronary intervention, by improving patient selection and clinical outcomes of PTRAS.
The authors are greatly indebted to clinical librarian Mrs. C.E. Limpens for her valuable contributions and comments relating to the search methodology.
For details on search strategies, please see the online version of this article.
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Here is my first try at a puzzle. Find the missing number.
6 1 6 5 3 2 9 7 9 7 8 6 ?
almost half of the numbers should be discarded!
Take the right half of the triangle numbers, you are left with a sequence as follows: 72 69 76 76 79 32 69 86 69 82 89 79 78 6? when you group them into pairs.
translating ASCII codes to symbols, you get the phrase HELLO EVERYON?. The question mark should obviously be an E, which translates to ASCII code 69, meaning the question mark ought to be a 9.
Not the answer you're looking for? Browse other questions tagged pattern number-sequence .
What is a VP Number™?


In July 2012, supported by EASST and by local donations, Mike Pitney of Ashford Fire Station led a group of eight fire fighters from Kent Fire and Rescue Service to Ukraine to officially donate much-needed fire suits and equipment to the town of Korosten in Zhytomyr oblast, near Chernobyl. In addition to the provision of equipment, the Kent fire fighters provided training to the Ukrainian fire fighters in techniques for rescuing road crash victims.
On Friday 6th July, an official ceremony of donation of the two fully equipped fire engines and fire suits was held at the Kyiv Fire Station Number 25 of the Ministry of Emergencies in Ukraine.
"Fire fighters in Ukraine have to cope with equipment dating from Soviet times, including shabby fire gear offering little protection from flames. Our donation will definitely save lives and prevent serious injuries," said Mike Pitney of Ashford Fire Station. The Kent Fire and Rescue Service in the UK ran charity activities in the UK to raise money to travel to Ukraine to deliver the vehicles. The donation was facilitated by EASST who worked closely with their Ukrainian partner the Road Safety Support Foundation and the UK Embassy in Ukraine to ensure smooth delivery of the equipment.
Via the provision of its road traffic collision training, this initiative is contributing to the UN Decade of Action on Road Safety 2011-20 which seeks to save 5 million lives during its span. Post-crash care is one of the 'Five Pillars' of the Decade, along with safer roads, safer vehicles, safer road users and effective road safety management. Kent Fire and Rescue Service is addressing an area often overlooked, but absolutely vital to casualty reduction.


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Junior doctor in legal dispute over whistleblowing claims
A junior doctor claims his career has been derailed after being involved in a legal dispute over protection for whistleblowers.
Chris Day, 31, says he has been in 'limbo' for nearly two years after waiting for the outcome of a tribunal which could be a landmark ruling.
Dr Chris Day was working overnight in January 2014 when two locum doctors failed to turn up. He had to cover other wards and A&E and reported his concerns to managers.
Since his one-year placement at Queen Elizabeth hospital in Woolwich, South-East London, ended he has failed to find permanent work.
He is now awaiting an employment tribunal ruling after bringing a claim for unfair dismissal and whistleblowing detriment against Health Education England (HEE) and Lewisham Greenwich NHS Trusts.
"I have had my career wrecked," he said.
His claim was helped by £22,000 raised via the Crowdjustice website. A second hearing has just taken place and judgment is expected at any time as to whether to allow the case to proceed.
At the first hearing last August, Mr Recorder Jan Luba QC said there was a need to clarify for all junior doctors whether HEE, which took responsibility for trainee doctors from the London Deanery, was technically an "employer" and owed them employment rights.
Dr Day told the London Evening Standard: "What my litigation has uncovered is that these quite powerful functions are not governed by any kind of employment legislation.
"They've tried to prevent a whistleblowing court case happening by trying to say junior doctors don't have whistleblowing protection."
Lewisham and Greenwich NHS Trust denied failing whistleblowers. It said: "We investigated Dr Day's concerns in detail. We have robust procedures to support staff who raise concerns and we encourage our staff to speak out when concerns arise.
"We identified the need to increase medical staffing numbers for the intensive care unit at Queen Elizabeth hospital. The unit is now fully compliant with quality standards."
HEE said it would not comment during an active legal case.
The married father-of-two told News Shopper: "One night I made a call then it snowballed out of control. In this case it's simply my phoning a manager in middle of a night shift and giving them information on this case which they probably didn't want to hear.
"What's happened is I have been knocked off a career path to consultant doctor. I work as a locum doctor in A&E now doing ad hoc shifts when they're short of staff."


Good evening Widgetheads. This week brought us a ton of interesting things to talk about, what with CES in Vegas and all. We talk about the newly available Dell 30″ LCD (or as we like to call it, ecstasy). Plus, Dell also brings us the new XPC with one helluva SLI setup. 2 gigs of video ram? Yes please! We also dabble on John Carmack's comments on the next-gen systems, and question for how much longer is id going to be the leader in pushing games to the next level. All this, plus your mail, on this weeks episode of The Widget.


Oxford Brookes UCU members began the two-day strike with a strong picket in front of JHB, as well as two further pickets at Wheatley and Harcourt. We were once again required to remain off university premises by university management (and reminded of this by security officers), but we nonetheless managed to speak to a number of staff and students, who – while often uninformed, particularly in the case of students – were overwhelmingly supportive of the strike. We will be picketing tomorrow as well, so do join us on the picket line!
Some members on the picket line at Wheatley.


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Home / Local News / Fearing for life
Fearing for life - by Barbados Today December 6, 2012
by Latoya Burnham
A survivor of domestic abuse, who was also shot four times after she left her abuser, says she is more vigilant now since his release from prison this week.
Cynthia [not her real name], had an audience, including members of the Church of God, The Garden, St. James on the edge of their seats last night as she once again recounted her ordeal that began more than a decade ago and ended up with one of her sons witnessing her near murder.
In the forum, hosted by the Business and Professional Women's group, Cynthia stood and told her story of being a survivor, in the most basic sense of the word.
Asked by a member of the audience how she felt about her attacker being released, Cynthia smiled wryly and confessed it was the one question that came up every time she told people about her story — about how she would deal with his eventual release.
Now it has happened, she said: "He is out on Monday that just gone. He is in society. There is nothing more I can do other than be protective of me and my surroundings. There is nothing in place for me to do other than protect my life and limbs to the best of my ability."
And to say that still does not come easily for her, is an understatement. In fact, she confessed to Barbados TODAY that before this point she had allowed her face to be used as she told her story, but this time around, she gently requested that her image be protected now that he is on the street.
The reason is there is still an element of fear for her own life, after it was almost taken from her.
Cynthia's story began back in 1999 when she met a man she thought was whom she had been looking for. Renting with her four children then, she told of how the man, who owned his own home, suggested she move in with her children to help save her money.
She said she worked in a gaming establishment at the time and trouble began to brew when one of her regular customers hugged her while in Bridgetown in the presence of her boyfriend.
"He was like who dis man is? Where you know he from, that kind of thing. Me, my mout' always big, so I said you know where I work and when I meet he I was working, so I don't see de point. Anyway, I figure that was over and done wid and I ain't debating it any further, but later on he would have found out information about the guy and warned him not to talk to he woman because I belong to he."
He began to check up behind her, calling her regularly to find out where she was. If she was going by a friend he would call the friend to find out when she got there.
Because of his seeming obsession with her and continuous calls to her job, she got fired and then was home, dependent on him.
After this point she said the verbal abuse started and she would always answer back. Then the verbal turned physical, and again she would fight back, or try to. The physical also escalated to the use of weapons, she said, and anything he found he would use to hit her.
"I used to defend myself. I would not take it sitting down. But one day we had this really big flare up and I said, you have to realise you have a problem because my fear was that my three sons would think this is the way you treat a woman and I wasn't accustomed to that kind of living.
"I said you have to get help or I'm through the door. So he did, went … to one session," she finished sarcastically, as there was some mumbles of laughter in the audience.
She said then began the period of "walking on eggshells". When she decided to start going about looking for a job, she knew something was brewing in the house, she just did not know what. So she warned her children not to come home from school, but to go to their father for the weekend, as they sometimes did.
She began to make plans to leave, but it seemed some force had different plans for her. Each plan she devised that would see her easing out and never coming back was somehow waylaid by her watchful boyfriend who seemed to have a sixth sense that something was up.
So on Friday night he questioned why the boys were not home. She told him they were spending the weekend with their father. So that night he kept her close, legs draped over her as they slept. On Saturday he did not allow her to leave the house, followed her everywhere, even to the bathroom, and that night again slept with his body draped over hers.
On Sunday, the same thing happened, but then her best friend stopped by to check on her and she revealed what was happening. He started to chase her friend off his property, so she threatened to go get the police. From then he moved into action, she said, shutting down the house and forcing her into a back bedroom and stifling her sounds with a pillow over her face. She fought and was able to scream to signal the police who forced their way in.
She was able to escape, but did not press charges because as she said, she just wanted to move on with her life.
"When we ask women why they don't leave? The fear of the unknown."
But then he began to follow her and threaten that he would kill her, she said, and anyone in the way would follow suit.
She finally filed charges, but he refused to return to court to answer them. When he was finally arrested, he was remanded for a short period but then granted bail.
Cynthia told how she had to pull her children from school for a period and seek a restraining order, but even when her children returned to school she did not feel safe, and would collect them each day at the end of school.
One fateful evening however, all her precautions went out the window. After repeated calls by an unknown persons to the house where she was staying asking about her movements and her children, she rushed to pick up her two youngest children, but barely missed the bus. She flagged down an "unofficial taxi" and told the man she would pay for the seats if she had to, but she needed to get to her children urgently.
The man agreed to take her, so she collected one of her sons and the driver said he would take her directly to her house when she got the other, but he needed gas. So he pulled into a service station, with her and her 10-year-old in the vehicle and proceeded to go in.
"After he drove into the station, who should I see approaching but the same guy. I was in the front, so I get to roll up the window but not lock the doors, so he pulled open the door telling me he want to talk to me…
"I told him you say you gine kill me so whatever you gine do do here. So a struggle ensued and I fell in front of him and I remember seeing him go into his pants waist and pull out this thing that turned out to be a gun. I got the first gunshot in the middle of my head," she said, as the audience gasped.
"The second one went through here," she pointed to her left temple, "and lodged somewhere in my nose. The last two I got as I was trying to get into the store section of the gas station. My concern was that my youngest son was in the back. He was really small so he crawled under the seat and stayed there. My concern was getting my second one."
She spent more than a week in hospital under protective guards because she said she later found out her attacker had dressed as a guard and tried to get in to her.
She had to undergo a number of surgeries, one in an attempt to save her eye which was damaged, but it was too far gone she said and doctors could do no more.
Even after she was released, she said he continued to call her friends to try to get to her and even had persons come to the house to her. It was so much, she confessed that she attempted suicide. It was back in hospital the second time that a nurse told her about the crisis centre for abused women.
Her attacker tried to commit suicide, but was saved and eventually charged and later sentenced to 12 years for serious bodily harm, with the three years he had served on remand taken into consideration.
It was not over however for her and her children. They had to go through counselling and her 10-year-old who had witnessed the entire incident became withdrawn and angry. Through counselling where he was able to draw what he felt, she said he eventually was able to handle his feelings.
A member of the audience asked if she did not know before the situation escalated what was happening, about the signs.
Cynthia admitted some signs presented themselves shortly after she had moved into his home, but she confessed that most women don't really know what those signs mean or what to do about them and she was no different. "I did not know what was red flags. I only knew what that was after I got counselling. The normal woman does not know what a red flag is. If you ask what is a red flag in a relationship no one can tell unless you get education about it and know what to look for." [email protected]
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RubberDucks 1-2, Baysox 0-0: Pitchers stay hot in doubleheader sweep
By Brad Bournival ABJ/Ohio.com correspondent
Apr 20, 2019 at 6:37 PM Apr 20, 2019 at 7:01 PM
The start was greatly exaggerated, especially the way the RubberDucks are playing of late.
Some may have fretted when the Ducks lost their first six games this season, but no one in the clubhouse worried.
They started Saturday's doubleheader by winning 1-0 in walk-off fashion over the Bowie Baysox and completed the sweep with a 2-0 win that took the customary seven innings at Akron's Canal Park.
The RubberDucks (7-9) have won seven of their past 10 and are riding a four-game winning streak.
"We knew what we were capable of doing," Ducks manager Rouglas Odor said. "It was early in the season. I knew they were going to come out of it. Most of the games we lost, we were doing a lot of good things, but that's the way the game goes. We didn't make a play here. We didn't make a pitch there or take a good at-bat. That's part of the game, but now we're playing how we're capable of."
The one constant during the win streak has been starting pitching. One great outing has begat another for the red-hot RubberDucks.
Zach Plesac didn't disappoint in Game 1.
Plesac, a right-hander, didn't pick up the win, but he pitched five shutout innings. He allowed four hits and two walks and struck out five.
It was the third solid outing for Plesac, who is 1-0 with a 1.02 ERA through 17 2/3 innings.
He has pitched 13 2/3 consecutive scoreless innings.
"This is a great group," Plesac said. "We all push each other. It doesn't feel like there's any pressure on us. In between starts, it's getting the job done to be ready to go every fifth day. That's what everyone on our staff is ready to do to carry on the momentum moving forward."
The Ducks won Game 1 in dramatic fashion when Ka'ai Tom singled to center with one out in the bottom of the eighth to score Daniel Johnson.
Game 2 was much of the same with Tanner Tully picking up the win.
A left-hander, Tully gave up four hits in six innings. He walked one and struck out six.
In that one, the Ducks picked up all the support they needed when Li-Jen Chu homered to right in the second inning. The RubberDucks forced home an insurance run in the sixth when Wilson Garcia walked with the bases loaded.
"It's always nice to have an early cushion," Tully said. "It gives you a little breathing room, especially when our hitters start swinging the bat and scoring some runs for us."
That's become the norm for the Ducks during the winning streak.
It started Wednesday when Jake Paulson gave up two hits in seven innings. He gave up two runs, both earned, and walked three in a 5-3 win over the Trenton Thunder.
It continued Thursday when Matt Solter gave up one earned run on four hits and struck out 10 in five innings in a 7-4 win over the Baysox.
In the past four games, starters are sporting a collective 1.17 ERA.
"Everybody keeps going out there and setting the bar higher and higher," Tully said. "You go out there and try to match it or do a little bit better. With the defense we have behind us, we're going to go out there and throw games like that all the time."
After a day off for Easter, the Ducks return to Canal Park to begin a three-game series against the Binghamton Rumble Ponies. Ducks left-hander Sam Hentges (0-2, 7.82) and Rumble Ponies left-hander Anthony Kay (0-1, 2.77) are the scheduled starters.