(Peters) Professor of Anesthesiology and Intensive Care Therapy; and Chairman.
Received from the Abteilung fur Anasthesiologie und Intensivmedizin, Klinikum der Universitat-GH Essen, Essen, Germany. Submitted for publication May 6, 1996. Accepted for publication September 20, 1996.
Address reprint requests to Dr. Giebler: Abteilung fur Anasthesiologie und Intensivmedizin, Klinikum der Universitat-GH Essen, 45122 Essen, Germany.
Therefore this study in more than 4,000 patients was performed to provide a better assessment of the incidence of complications associated with thoracic epidural catheterization in patients having abdominal or abdominothoracic surgery and receiving thoracic epidural analgesia.
The study was performed in accordance with the Helsinki Declaration. After approval of the local ethics committee, written informed consent for thoracic epidural catheterization was obtained from all patients or their next of kin. Initially 4,707 patients were considered. After exclusion of patients (see below) from the study, a total of 4,185 patients undergoing thoracic epidural anesthesia were studied. A total of 2,059 patients undergoing thoracic epidural anesthesia were studied prospectively from September 1988 to December 1994. In addition, in 2,126 patients receiving thoracic epidural anesthesia between January 1983 and August 1988, the incidence of neurologic complications was investigated retrospectively from patient hospital records. Catheter insertion techniques, perioperative analgesic management, and neurologic surveillance protocol were identical in both groups.
All patients were scheduled for elective upper abdominal or abdominothoracic surgery; that is, intestinal and colorectal (20%), hepatobiliary (21%), esophageal (7%), pancreatic (8%), or vascular surgery (11%). Before operation, full medical histories were taken with emphasis on detecting bleeding disorders and anatomic or neurologic abnormalities. A clinical examination was performed and followed by measurement of clotting parameters.
Intravenous heparin (> 20,000 IU/day) or subcutaneous low-dose heparin (5,000–7,500 IU three times a day) was discontinued 6 h before epidural catheter placement or removal. After operation, subcutaneous heparin (5,000–7,500 IU three times a day) was continued in all patients.
Excluded from the study were 157 patients because epidural analgesia had not been administered due to either more than one abnormal preoperative clotting parameter; that is, prothrombin time < 70%(Thromborel; Behring, Marburg, Germany; normal reference value, 70–130% or 9–11.5 s), activated partial thromboplastin time > 55 s (Pathromtin; Behring; normal reference value, 25–55 s), platelet count < 150,000 micro liter sup -1 (Coulter Counter, model STKR; Coulter Electronics GmbH, Krefeld, Germany; normal reference value, 140,000–440,000 micro liter sup -1), or clinical signs of potential bleeding disorders suggested by bruising, petechiae, or ecchymosis.
In two patients of the group studied prospectively platelet counts were less than 50,000 micro liter sup -1, in five patients activated partial thromboplastin times were prolonged (> 55 s), and in 52 patients abnormal prothrombin times (< 70%, > 16 s) were found before operation. Despite these single abnormal values, epidural anesthesia was administered in these 59 patients. In 48 patients of the retrospectively studied group, epidural catheterization was performed despite one abnormal clotting parameter.
After most patients with coagulation problems were excluded, thoracic epidural anesthesia was recommended for 4,550 patients. However, 365 of these patients did not consent to thoracic epidural catheter insertion and thus were excluded from further study. Therefore the final study population included 4,185 patients (set as 100%).
The patients' ages ranged from 16 to 90 years (56 +/- 14.2 years; mean +/- SD) in the prospective and from 17 to 94 years (54.4 +/- 15.7 years) in the retrospective group. In the prospective group, 936 patients were women and 1,123 were men. In the retrospective group, 978 were women and 1,148 were men.
After surgery, 1,283 (62.3%) of the prospectively and 1,314 (61.8%) of the retrospectively studied patients were transferred to an intensive care unit (ICU), whereas the remaining patients were treated on the surgical ward. The epidural catheters were left in place after operation for approximately 4 days (prospective group: 4.2 +/- 1.9 days; range, 1–53 days; retrospective group: 3.9 +/- 2.1 days; range, 1–55 days).
Patients were premedicated with 1–2 mg flunitrazepam given orally 2 h before surgery. After cannulation of a peripheral vein and infusion of 500 ml Ringer's solution, a thoracic epidural catheter (Portex 18-G Tuohy needle, closed-end catheter with three lateral eyes; outer catheter diameter, 0.9 mm; Hythe, Kent, UK) was inserted under local infiltration anesthesia (1% mepivacaine) with the patient in the sitting position. In a few patients requiring prolonged analgesia because of chronic pain, the catheter was tunneled subcutaneously.
Epidural catheters were placed at a vertebral level considered appropriate for the scheduled operation, taking into account each patients' specific anatomy. Therefore, epidural puncture was performed near the vertex of the vertebral column's kyphosis and at the convexity of a scoliosis. Epidural puncture was always performed via the paramedian approach at T8/9 and above and via the median approach further caudally. The epidural space was identified by the loss-of-resistance technique using a 10-ml glass syringe filled with saline. After insertion to 5 cm, subarachnoidal or subdural catheter placement was tested by injection of 3 ml 0.5% bupivacaine or 1% etidocaine without epinephrine. To minimize unrecognized intravascular catheter placement, the catheter was gently aspirated with the bacterial filter removed. Additional doses of 3–5 ml 0.25%-0.5% bupivacaine or 1% etidocaine were given during operation if considered appropriate. All epidural catheterizations were performed by either one of six staff anesthesiologists or by first- to third-year residents under direct supervision. Thoracic epidural catheterization was omitted when attempts to insert the catheter were unsuccessful at two vertebral levels. Epidural catheter placement was always followed by general anesthesia consisting of etomidate, oxygen/nitrous oxide, isoflurane (0.5–1%) or enflurane (0.6–1.5%), and fentanyl and muscle relaxation (alcuronium or vecuronium), as required.
Patients were transferred to an ICU if indicated by preexisting risk factors or by the nature and course of the specific surgery performed. All other patients were monitored in the recovery room for at least 2 hours by pulse oximetry, electrocardiograph, and noninvasive blood pressure measurement until the responsible anesthesiologist decided they were ready for transfer to the general ward. On the surgical ward, arterial blood pressure, heart rate, and respiratory rate were measured by the nursing staff every 15 min for 4 h, hourly thereafter for the first day, and every 2–4 h during the ensuing days. Patients transferred from the ICU to the surgical ward were observed according to the same protocol.
After operation, 0.15–0.3 mg buprenorphine in 5–10 ml 0.9% saline was administered epidurally every 4 to 6 h, and in patients transferred to the ICU it was supplemented by a continuous epidural infusion of bupivacaine (0.125%-0.375%, 3–5 ml/h), if required. In contrast, while also receiving epidural buprenorphine, patients transferred to the general ward received bupivacaine (0.125%-0.375%, 4–8 ml) by bolus injection every 4 to 6 h, if required. All patients were instructed to report immediately any new back pain, radiating symptoms, or muscular weakness. Uncomplicated epidural analgesia was assumed when fewer than six dermatomes showed sensory block, motor function was unaffected, an no other symptoms were present. The epidural catheter was always aspirated before any epidural drug was administered to minimize the risk of unintentional subdural or subarachnoidal application. Dislodgment of the epidural catheter was assumed if no sensory blockade could be observed after a test dose of 0.25% bupivacaine that under normal conditions would yield a sensory blockade of at least four dermatomes.
Any difficulties or unusual events during epidural puncture and catheterization as well as the following data were collected: unsuccessful catheter placement (impossible to insert a catheter at two vertebral levels), vertebral interspace punctured (count of spinal processes of vertebrae starting with C 7), surgical procedure performed, postoperative transfer (peripheral ward/ICU), and day of removal of the epidural catheter. Furthermore, any postoperative neurologic complications were recorded. Dural perforation was defined as cerebral spinal fluid return through either the catheter or needle. Peripheral nerve lesions were assumed if disturbed function was observed in areas strictly distal to a lesion with, depending on a given nerve's composition, motor, sensory and vegetative (e.g., sweat secretion) deficits. In contrast, spinal root damage was assumed with radiation of pain and diminished sensitivity corresponding to a dermatome. Generally, unlike peripheral nerve lesions, the hypalgetic area is greater than the hypesthetic area in case of root damage. To verify spinal root damage, therefore, hypalgetic or analgetic areas corresponding to a specific root must be demonstrated. Accordingly, pain during puncture or catheter insertion was qualified as "radicular" if it occurred segmentally; that is, it corresponded to a dermatome of an irritated spinal root.
Postoperative neurologic surveillance consisted of determination of patient sensitivity to pinprick within all dermatomes potentially affected by epidural anesthesia and of motor function, particularly mobility of arms and legs, every 6–8 h by a staff anesthesiologist. Any abnormal findings were recorded. Electromyography was not routinely performed to test for motor blockade in the thoracic region. Reports of intense back pain associated with sensory or motor deficits were considered signs of an expanding mass in the spinal canal. Neurologic sequelae were assessed by an independent physician on the first and second postoperative day as well as after removal of the epidural catheter by examining the patients' sensory and motor function as previously described. In case of any positive neurologic finding, a full neurologic examination was performed by a consultant neurologist. If damage to a spinal root close to the catheter insertion site was suspected, electromyography was also performed. In patients with postoperative radicular-type pain at a level adjacent to the catheter insertion site, the epidural catheter was either withdrawn for 1–2 cm or removed. Cessation of pain after catheter removal or withdrawal was assumed to indicate catheter-related irritation of a spinal nerve root.
Respiratory-depressant side effects were defined as clouding of consciousness or a decrease in the respiratory rate below 8 min sup -1. Blood gas measurements were not routinely performed except during supervision in an ICU.
Data were expressed as mean +/- SD unless indicated otherwise. The following a priori null hypothesis was tested: The incidence of defined complications between prospectively and retrospectively studied patients does not differ between upper-(T3/4–6/7), mid-(T7/8–8/9), and lower-level (T9/10–11/12) catheter insertion. Incidences of defined complications were compared using the chi-squared test for an increasing or decreasing trend in the proportions over the columns. If a significant trend emerged, we compared the levels. Thus three chi-squared post hoc tests had to be performed. Statistical significance was assumed when the alpha error (P) was less than 0.05/3; that is, P less or equal to 0.016.
The upper thoracic region was chosen for catheterization in almost 66%, the mid-thoracic region in approximately 28%, and the lower thoracic region in 7% of all cases in both the prospectively and retrospectively studied patients. The overall incidence of neurologic complications after thoracic epidural catheterization was 3.1%(n = 128). Although significantly more complications were observed in the prospectively studied group (3.6%) compared with the retrospectively studied group (2.5%), this difference could be entirely attributed to a significantly greater incidence of primary dural perforations in the former group. There were no significant differences between groups in the incidences of other neurologic complications and no patient had more than one complication.
In all but 14 (0.7%) prospectively studied patients, epidural catheter placement was associated with efficient postoperative epidural analgesia. Table 1. shows neurologic complications and their incidence as related to the epidural puncture site and the calculated maximum risk of complications using the upper bounds of the 95% confidence interval.
Unsuccessful catheter placement (1.1%; n = 45) and primary dural perforation (0.72%; n = 30) were the most frequent complications, followed by radicular-type pain during epidural puncture or catheter insertion (0.48%; n = 20) and peripheral nerve lesions (0.57; n = 24). Postoperative radicular-type pain was observed in nine additional patients (0.22%). In all these 29 patients, radicular pain always stopped shortly after needle or catheter withdrawal, respectively. None of these problems required further treatment or led to sequelae.
In 14 (0.33%) of 24 (0.57%) patients suffering from a peripheral nerve lesion, a peroneal nerve palsy was found. All of these 14 patients (nine prospectively studied and five retrospectively studied patients) had been operated on while in the lithotomy position (Quenu's procedure), which probably explained this type of nerve damage. The other 10 patients (0.24%) with peripheral nerve lesions-five in each study group-showed transient irregular dysesthesias, transient loss of sensory function, or transient motor weakness in the perineal region or lower extremities, respectively. These complaints persisted for a median of 4 days (range, 1–20 days). However, the consultant neurologist found no evidence of damage to spinal roots adjacent to the catheter insertion site in these cases.
There were no signs or reports of postspinal headache or subarachnoid or subdural catheter migration. No symptoms or signs suggesting epidural hematoma or meningeal inflammation were recognized. In fact, no complications were observed even in the subgroup of patients receiving epidural analgesia despite impaired coagulation.
Of note, there is a significant trend of an increasing incidence of unintentional dural perforation with epidural puncture toward lower thoracic interspaces in both the prospectively (P =.0001) and retrospectively (P < 0.0001) studied patients, and in the total study population (P < 0.0001). The incidence of dural perforation doubled for mid-thoracic, and increased seven times for lower-thoracic epidural analgesia when compared with high-thoracic epidural analgesia at the T3–7 level.
Thus no persistent neurologic deficits related to thoracic epidural catheterization were observed in this study of 4,185 patients. The predicted maximum risk of permanent neurologic complications, using the upper bound of the 95% confidence interval, was calculated as 0.07%.
In a 51-yr-old man who underwent Hartmann's procedure, postoperative respiratory depression was observed on the surgical ward. Twenty minutes after having received 0.3 mg buprenorphine epidurally, he was drowsy with a respiratory rate of 4 min sup -1, a PaO2of 59 mmHg, and a PaCO2of 60 mmHg. After tracheal intubation and mechanical ventilation for 4 h he recovered without further complications.
This study is a survey of more than 4,000 thoracic epidural catheterizations performed for postoperative pain relief at a single university teaching hospital where thoracic epidural catheterization is frequently performed. The population includes all patients scheduled for elective upper abdominal or thoracoabdominal surgery and eligible for thoracic epidural or general anesthesia during an 11-y period. The data suggest that thoracic epidural catheterization can be performed with a low incidence of neurologic complications.
This study focused on neurologic complications, the incidence of which remains controversial and may increase the risk:benefit ratio of thoracic epidural anesthesia. In contrast, unsuccessful catheter function ("failure of analgesia") was not assessed in the retrospectively studied patient group, and catheter entry into an epidural vein was only assumed if blood returned from the catheter, either spontaneously or with aspiration of the catheter, and was not relied on using epinephrine with the test dose. Furthermore, because general anesthesia was always induced shortly after thoracic epidural catheterization, primary failure of epidural block despite seemingly acceptable catheter placement cannot be distinguished from secondary catheter dislodgment. However, epidural catheter placement in the prospective group was followed by efficient postoperative epidural analgesia in all but 14 patients (99.3%). Therefore, failed block despite seemingly acceptable catheter placement, which is a complication after all, occurred with an overall incidence of only 0.7%. This incidence is less than the numbers previously reported  and supports the assumption that a concerted effort had been made to place the epidural catheters.
As might be expected, a greater overall incidence of complications was noted in the population studied prospectively when compared with patients studied retrospectively. However, this difference between groups was entirely attributable to primary perforation of the dura but was not significant for any other neurologic complication. Data recording may not have been as complete in the retrospective group, presumably inducing a minor bias toward better outcome. However, because the protocol of the prospective part of the study was adapted from the routinely performed neurologic postoperative surveillance protocol during the last decade, the routine neurologic examination protocol in the retrospectively studied epidural catheter placement group did not really differ from that of the prospectively studied group. In addition, even in the retrospective group, all patients with suspected or claimed possible neurologic damage, transient or permanent, had been recorded by name for medicolegal reasons. This argues for and is supported by data that the incidence of neurologic complications is similar in both groups and does not appear to have changed in the 12 y of study in our hospital.
Accidental dural puncture is the most common complication of lumbar and lower thoracic epidural catheterization. [18–20] Its incidence may depend on the experience and skill of the anesthesiologist and, in most university training programs, dural perforation is noted in approximately 3–5% of cases, with an incidence of probably less than 1% in private practice.  The incidence observed in our retrospectively studied population (0.42%) for thoracic epidural anesthesia is in the same lower range and is similar to results reported by others (incidence = 0.61%).  However, these latter data are based exclusively on patient records assessed retrospectively.
Despite a greater incidence of dural perforation (1.02%) found in our patients studied prospectively, our data confirm a low incidence of dural perforation with thoracic epidural catheterization. The incidence of dural perforation is even lower than reported previously (1.2%) in 1,071 patients.  Of greater interest, our data now indicate in a large prospectively studied population that the incidence of dural perforation after epidural puncture and catheterization is similar to or even smaller than that reported in the lumbar region, and in our large population, it was not associated with neurologic complications or other sequelae.
The incidence of dural perforation increased as a more caudal puncture site was chosen; that is, in lower thoracic segments regardless whether prospectively or retrospectively studied patients were considered. This is consistent with a retrospective study  reporting significantly more unintentional dural perforations in the lower thoracic (0.85%) and lumbar regions (1.16%) than in more cranial vertebral regions (0.20–0.29%). The lower incidence in the upper thoracic region may be due to the fact that with the paramedian approach the epidural space is approached in a more tangential fashion than with the midline approach often used for lower thoracic or lumbar puncture, possibly resulting in a greater margin of safety. Thus our prospective data contradict the view  that dural perforation occurs more often with thoracic epidural catheterization because of its suspected greater technical difficulty.
Headache subsequent to lumbar dural puncture develops with an incidence as high as 70% when a large-gauge needle is used. Routine epidural administration of opioids may be one explanation for the notable absence of postdural puncture headache in the patients in our study, regardless of whether they were studied prospectively or retrospectively. Another explanation for the low incidence of postdural puncture headache could be the decreased cerebral spinal fluid pressure in the thoracic regions compared with lumbar regions secondary to gravity in the sitting position, but this is speculative. Of note, despite 30 documented dural perforations in the thoracic region (i.e., very close to the spinal cord), no serious neurologic complications or persistent sequelae were observed.
In our study, neurologic complications such as radicular pain during puncture or postoperative radicular-type pain always subsided shortly after needle or catheter withdrawal. None of these problems required further treatment or led to sequelae, confirming the generally low overall incidence of neural lesions with thoracic epidural catheterization. In fact, of 24 cases with peripheral nerve lesions, 14 were diagnosed as peroneal nerve palsy, which were related to the surgical procedure and positioning rather than to epidural puncture. The other 10 patients had transient peripheral nerve lesions in the peroneal region or lower extremities, respectively. Because these lesions did not correspond to dermatomes innervated by thoracic spinal roots, no sensory or motor deficits, therefore, could be attributed to thoracic epidural catheterization. However, although we studied more than 4,000 patients, our large population size may still be considered too small to properly assess the incidence of severe and permanent neurologic complications of thoracic epidural anesthesia such as paraplegia. Furthermore, because our data have been collected from a single center where thoracic epidural catheterization is performed frequently, the relative incidence of complications after this procedure in the hands of clinicians who perform these procedures less regularly may be different than the observed incidence.
The risk of epidural hematoma formation after epidural catheterization appears to be increased in patients with coagulation disorders and those treated with anticoagulants. [14,27,28] However, administration of anticoagulants may still not be an absolute contraindication for epidural anesthesia, because lumbar epidural anesthesia has been performed without major complications in patients receiving heparin, warfarin, or antiplatelet drugs. [29–31] Furthermore, the incidence of bleeding and intravascular epidural cannulation was reported to be significantly greater with lumbar (1.31%) than with thoracic (0.34–0.48%) epidural anesthesia, similar to the results reported for unintentional dural puncture.  We adopted rather liberal limits with regard to values of coagulation variables in those patients considered candidates for epidural catheterization. [16,32] In those patients in whom catheterization was performed despite a definitely abnormal single coagulation parameter, epidural catheterization was always atraumatic and no complications occurred in this subgroup. However, the incidence of epidural hematoma-induced paraplegia associated with thoracic epidural anesthesia remains unknown. No apparent catheter-related epidural hematoma was observed in another study,  and a recent meta-analysis estimated the risk for a major spinal hematoma after epidural anesthesia to be approximately 0.0007%.  Accordingly, upper- and mid-thoracic epidural anesthesia may in fact carry a smaller risk for epidural hematoma than does lumbar epidural anesthesia, although intuitively the reverse situation is usually considered.
The incidence of respiratory depression after an intravenous or epidural morphine regimen for analgesia is approximately 0.9%. [33,34] An incidence of 0.07% was observed and a maximum risk of 0.20% calculated after thoracic and lumbar epidural administration of morphine.  A greater incidence of respiratory depression (0.6–1.2%) has been reported for epidural fentanyl  and during continuous epidural infusion of 6–100 micro gram/h fentanyl when combined with 0.1% bupivacaine.  In our study, buprenorphine was used for postoperative epidural analgesia. Due to its lipophilicity, its distribution along the spinal column is presumably limited to neighboring segments of the puncture site, in contrast to hydrophilic morphine.  This may explain why we observed only a single case of respiratory depression in our population.
In summary, thoracic epidural catheterization does not appear to be associated with more complications or more serious complications than reported in the literature for lumbar epidural catheterization. In fact, no permanent nerve injuries related to thoracic epidural catheterization were observed in our study, which included more than 4,000 patients having abdominal or abdominothoracic surgery, and the predicted maximum risk for permanent neurologic complications, using the upper bounds of the 95% confidence interval, is 0.07%.
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Badner NH: Epidural agents for postoperative analgesia, Current concepts in acute pain control. Anesthesiology Clinics of North America. Edited by Sandler AN, Benumof JL. Philadelphia, WB Saunders, 1992, pp 321-37.
Rosenberg PH, Heino A, Scheinin B: Comparison of intramuscular analgesia, intracostal block, epidural morphine and on-demand-i.v.-fentanyl in the control of pain after upper abdominal surgery. Acta Anaesthesiol Scand 1984; 28:603-7.
Blomberg S, Emanuelsson H, Kvist H, Lamm C, Ponten J, Waagstein F, Ricksen S-E: Effect of thoracic epidural analgesia on coronary arteries and arterioles in patients with coronary artery disease. Anesthesiology 1990; 73:611-18.
Hasenbos M, Van Egmond J, Gielen M, Crul JF: Postoperative analgesia by high thoracic epidural versus intramuscular nicomorphine after thoracotomy, part III. Acta Anaesthesiol Scand 1987; 31:608-15.
Bredtmann RD, Herden HN, Teichmann W, Moecke HP, Kniesel B, Baetgen R, Tecklenburg A: Epidural analgesia in colonic surgery: Results of a randomized prospective study. Br J Surg 1990; 77:638-42.
Liu SS, Carpenter RL, Mackey DC, Thirlby RC, Rupp SM, Shine TM, Feinglass NG, Metzger PP, Fulmer JT, Smith SL: Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 1995; 83:757-65.
Yeager MP, Glass DD, Neff RK, Brinck-Johnson T: Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology 1987; 66:729-36.
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Christopherson R, Beattie C, Frank SM, Norris EJ, Meinert CL, Gottlieb SO, Yates H, Rock P, Parker SD, Perler BA, Williams GM, the Perioperative Ischemia Randomized Anesthesia Trial Study Group: Perioperative morbidity in patients randomized to epidural or general anesthesia for lower-extremity vascular surgery. Anesthesiology 1993; 79:422-34.
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Home Open Access News Cancer Research News New campaign for breast cancer launched
Cancer Research News
New campaign for breast cancer launched
Latest figures from Public Health England revealed that one in 3 women diagnosed with breast cancer in England are over 70.
It was also revealed that this age group also accounts for more than half of all breast cancer deaths annually.
The figures come as Public Health England launch a new national campaign called 'Be Clear on Cancer'.
The campaign is aimed at reminding older women 'don't assume you're past it', and to visit their doctor if they spot any changes in their breasts.
Around 13,500 women aged 70 and over are diagnosed with breast cancer in England each year, and surprisingly two thirds (67%) wrongly think women of all ages are equally likely to get breast cancer.
Dr Yvonne Doyle, Regional Director at Public Health England, said: "Research shows that women over 70 have low awareness of the cancer symptoms, other than a lump. They're also more likely to delay presenting to their GP with breast cancer, which could ultimately affect their chance of survival.
"One in 3 women who get the cancer are over 70, so don't assume you're past it or dismiss any symptoms as a sign of ageing."
Lack of awareness of symptoms other than a lump, such as changes in the shape or size of the breast, is believed to be one of the reasons for this, which the campaign aims to change.
Laura Evans
Cancer vaccine trials encourage personalised immunotherapies
How integrative oncology is transforming cancer care
Exploring the human epidermal growth factor receptor 2 (HER2)
Innovative approaches to cancer treatments oncological engineering
AI for mammography performance and quality enhancement
The two main types of skin cancer
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What links a call centre in Bangalore, the 2010 Chilean mining accident and the New England Patriots? The answer? All are examples of successful organisational cultures, where individuals bond together to form a motivated, cohesive and cooperative team. In The Culture Code, Daniel Coyle employs the latest psychological research to investigate how successful cultures are created and what we can learn from them. Drawing on examples from business, sports, the arts and family life, he reveals how high-performing cultures ignite motivation and encourage cooperation by tapping into a common language of subconscious signals to which we're built to respond. As in the case of the Chilean mining accident, a culture built on trust and cooperation can be the difference between disaster and salvation. In business, the effects are scarcely less drastic - according to a recent Harvard study, a strong, aligned culture can increase revenues by 516 per cent and net income by 756 per cent. The Culture Code reveals for the first time the building blocks and shared language of successful cultures, and shows how we can all follow the same basic principles to improve our work and our lives.
De som köpt den här boken har ofta också köpt The Culture Map av Erin Meyer (häftad).


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Green Party Watch
News on the Green Party of the United States
Roseanne Barr wins California's Peace and Freedom Party nomination: Cindy Sheehan is VP nominee
Posted on August 4, 2012 by Green Party Watch News Network
In a post at their website, the Peace and Freedom Party announces their nomination of Roseanne Barr for President, and Cindy Sheehan's nomination for Vice President.
Roseanne Barr for President
Updated August 4, 2012 by the Website Workers Council
On August 4, the Peace and Freedom Party nominated Roseanne Barr for President and Cindy Sheehan for Vice President.
Barr had sought the Green Party nomination. Numerous articles about Barr's campaign can be found in Green Party Watch's archives
Socialist Party Presidential nominee Stewart Alexander was seeking the California based Peace and Freedom Party nomination as well as Barr.
Check back soon for more details.
The following was sent in reply to an inquiry sent to the Peace and Freedom Party via their website:
Here is a brief report on how the voting went this afternoon at the Peace and Freedom Party California State Convention in Los Angeles:
Wow! What a session! We went through the whole process, with nominations and seconds and speeches and so on – and at the very end of her 15 minute speech, the last one before the voting began, Peta Lindsay announced that the PSL was withdrawing her name from consideration, because her nomination would likely leave a blank on the California ballot (as she is not yet 35, the constitutional minimum age), and the Peace and Freedom Party needs names on the ballot. Then she paused, while peoples jaws dropped and there were gasps all over the hall – and announced that they would be voting for Roseanne Barr and Cindy Sheehan, who would be good representatives of the party and fighters for socialism!
The rules had been changed to allow three ballots before eliminating the lowest vote-getter, rather than one ballot. Of course, a majority (of all present and able to vote) for one candidate would end the voting at that point.
First ballot: Barr 29, Stewart Alexander 12, Stephen Durham 18, 4 abstentions. (32 votes required for a majority, we thought. After the vote, there was a count-off to determine exactly how many delegates were present and able to vote. There were in fact 64, meaning that the required majority was 33.)
(The several people who had told me they intended to vote for Rocky Anderson before he withdrew, voted in the first round instead either for Roseanne Barr or Stewart Alexander.)
Second ballot: Barr 37, Alexander 6, Durham 16, 5 abstentions. Barr was declared nominated.
Several people who had voted for Alexander or Durham recognized that Barr was going to be nominated, and switched their votes even though no one had yet been formally dropped, ending the process before it could become too wearing.
While both Cindy Sheehan and Christina Lopez were nominated from the floor for VP, Lopez declined (because she is Durhams's running mate nationally), and Cindy was nominated for Vice President with all in favor except 13 abstentions (mainly from FSP). So it's official – Roseanne Barr and Cindy Sheehan are the Peace and Freedom Party ticket.
Lots more happened today, and there will be plenty of important decisions tomorrow, but I know people wanted this news. -Kevin
It should be noted that Rocky Anderson had withdrawn from consideration three days before the convention, saying he did not have the needed support to win the nomination.
Others who sought the Peace and Freedom Party's Presidential and Vice Presidential nominations included former Salt Lake City Mayor Rocky Anderson of the Justice Party, Stephen Durham of the Freedom Socialist Party, and Peta Lindsay of the Party for Socialism and Liberation.
Presidential Campaign Cindy Sheehan, Peta Lindsay, Rocky Anderson, Roseanne Barr, Stewart Alexander
Green Party Watch News Network
A network of Green activists reporting on Green Party candidates, chapters, committees and issues using Green Party Watch, social networks, radio and TV to carry news of the Green Party before the American people
Stein and Honkala Arrested During Occupy Event in Philadelphia
Green Party candidate Ursula Rozum rips Ann Marie Buerkle, Dan Maffei
Rosseanne orginally said she was just doing this to draw attention to the green party ,then she said she was doing it to broaden the green partys base. after getting such a good vote at green party convention i can only say that she is either an egotist or a quitter or a bit of both. movements are not made by celebritys they are made by you and i. two green left candidates running for president for the third time in a row i call that a more serious display of vote splitting than running against the democrats.
Richard Kuszmar
Zhon
She is obviously not a quitter, james, you silly dolt.
She is obviously not a quitter, james.
james?
the above comment was mine it was not meant to be anonymous i have commented on this website before
Gregg Jocoy
You're good James. :-) Thanks for your comment.
Here is the conversation about this story at Ballot Access News
Here is coverage at Independent Political Report.
Third Party Politics covers the Peace and Freedom Party here
Paul Whitcomb
Sounds like James is right about the vote-splitting. Although I have complete confidence in Cindy Sheehan, and like what I know about Roseanne Barr, I would like to know why not to vote for Jill Stein. Has Barr written an article delineating this?
I will say that the Green Party seems to suffer from a perennial lack of drive, enthusiasm, exposure. I am not sure they have the personnel nor the apparatus to aggressively prosecute a national campaign.
Roseanne, tell us why we should vote for you over Jill Stein and then hang some serious fire on the campaign trail, ok? You and Cindy have the ability to get this country inspired. Don't sit on your hands.
I've got of respect for Roseanne for her willingness to go there with powerful rhetoric on broad policy issues, but when she was probed about specifics on some of the for a I got to watch, she was more fuzzy about the nuts and bolts of her plans than I would've liked. For my money, Dr. Jill's Green New Deal is the best face the green party can put forward in 2012. But I wish Roseanne much success with the P and F party. I think she has a lot voice left to project for progressive causes.
arcadia11
it was not enough, i guess, for america to be the laughing stock of the world. we are now the laughing stock of ourselves.
good luck to us all.
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EBC has a variety of adult Community Groups that meet throughout the week. We gather in homes and on campus to enjoy fellowship and study together. There's a group to fit just about every schedule!
Interested in joining a group? Contact Neil Uy for details and locations.


text:
Chanoyu (Teeweg)
Aktuell (Facebook)
Chanoyu (The Way of Tea)
茶の湯
In Japanese culture the Way of Tea takes pride of place, for it assembles many of the traditional arts, crafts and disciplines: from architecture and garden design to ceramics, metal, lacquer and wood crafts all the way to the arts of brush writing, painting, food preparation and flower arrangement.
The Way of Tea has brought forth its own aesthetic which has in turn deeply influenced Japanese culture. It is often referred to by the terms wabi 侘び and sabi 寂 and characterized by a preference for asymmetry and imperfection, for simplicity and quietness, for earthiness and the unassuming, for the patina and dignity of the naturally aged. It shows profound respect for how things are in and of themselves and aspires to accentuate their innate qualities.
The preparation of tea itself can be regarded as a performative gesamtkunstwerk that as a whole points to something beyond the sum of its individual parts. The tea utensils, the calligraphy scroll, the flowers and the details of the ritual are carefully selected and prepared in accordance to the time of day, the season and the particular occasion. In the course of the tea gathering host and guest harmoniously collaborate to give meaning and life to its predetermined choreography.
Chawan (Tea Bowl)
In their choice of ceramics the early tea masters soon decided to temper the perfection of imported Chinese porcelain with the much rougher Korean and Japanese stoneware and Raku vessels. They particularly valued their organic distortions and simple iron and ash (deposition) glazes.
In the preparation of tea attention naturally focuses on the tea bowl (chawan 茶碗). The best tea bowls are regarded and revered like living people with an unmistakably unique individuality and a personal history. They are often given a name that refers to a seasonal mood, a poem, a historical event or a text from the Zen canon.
With all of its irregularities and asymmetries a truly excellent tea bowl still accomplishes the feat of emanating a beautifully poised serenity and unpretentious wholeness. Its seeming simplicity does not result from the ineptitude of its maker but represents the "beginner's mind" so highly valued in Zen: the state of naïve, spontaneous and imperturbable lack of intention that is achieved by true masters only.
A Zen saying that echoes the Daoist approach of Laozi and Changzi states: The usefulness of a tea bowl is a result of its emptiness.
Chashitsu (Tea Room)
The tea room Bōki 忘機 at the Asian Art Museum Berlin was built by Japanese specialists and integrated into the exhibition rooms of the Japanese art collection in 2000. It measures ten tatami mats (tatami mats of about 180 x 90 cm are a traditional Japanese unit for the size of rooms). The adjacent preparation room (mizuya 水屋) serves for washing and preparing the utensils used in the tea gatherings, another room allows for the storage of larger utensils. A sunken hearth for the water kettle is used in the winter season for heating water. The alcove (tokonoma 床の間) is decorated with items from the holdings of the museum. They are exchanged on a regular basis, always according to the respective season
The conscious being-in-the-present carries with it that great attention is paid to the individual seasons: in the selection of the calligraphy scroll and the tea utensils, in the arrangement of the tea flowers, in the shape and color of the sweets offered, and in the particular details of the procedure. In studying tea, too, we only ever practice forms that are in accordance with the current season.
© 2023 Chado Urasenke Teeweg-Verein Berlin. All rights reserved. Contact: mail@teeweg-berlin.de.


text:
require 'bio-polygenetics'
require 'rails'

module BioPolygenetics
  class Engine < Rails::Engine

    # Config defaults
# DEPRECATED
    config.widget_factory_name = "default factory name"
    config.mount_at = '/'

    # # Load rake tasks
    # rake_tasks do
    #   load File.join(File.dirname(__FILE__), 'rails/railties/tasks.rake')
    # end

    # Check the gem config
    initializer "check config" do |app|
      # make sure mount_at ends with trailing slash
      config.mount_at += '/'  unless config.mount_at.last == '/'
    end

    initializer "static assets" do |app|
      app.middleware.use ::ActionDispatch::Static, "#{root}/public"
    end

    # consider the possibility to keep the modules in the lib directory, which is more compatible
    # with a normal gem/package
    paths["app/models"]           << "lib"
  end
end

# #In your Rails application into
# # config/initializers
# # create a file called bio-polygenetics.rb
# # you can change the mount point of you engine, using option
# # --with_engine=namespace like http://YourDomain:port/YourMountPoint
# # Otherwise, if you want your RailsEngine to be called at root level, leave everything as it now, without that file.
# module BioPolygenetics
#    class Engine < Rails::Engine
#      engine_name = '/Genetics'
#    end
# end

redpajama_set_name: RedPajamaGithub


Riverside Research radio frequency systems experts develop and transition proven, secure-by-design (SbD) electromagnetics (EM) transceiver technology. We define SbD as a suite of EM, digital, and packaging technologies that detect, prevent, and monitor intrusions to enhance trust in the information being received. SbD can be conceived as a type of program protection plan where the entire system-of-systems, including the physical layer, is considered critical to mitigating the potential of side-channel attacks.


We have been getting a lot of custom requests for White Diamonds shaped in bigger sizes. The Hope Diamond gives you the paddling and wave-cruising abilities of a funboard with the outstanding performance levels of a White Diamond. The Hope Diamond is available in lengths from 6'6" to 7'6" and is sized 4-to-6 inches shorter than your funboard.
This model helps replace a long board or fun board. Gets you out in the lineup on something stable and fun.
Gives the rider tons of paddle and float for a good time.


Pulmonary function tests. Spirometry is the most common lung function test. During this test, you'll be asked to blow into a large tube connected to a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs. Spirometry can detect COPD even before you have symptoms of the disease. It can also be used to track the progression of disease and to monitor how well treatment is working.
Chest X-ray. A chest X-ray can show emphysema — one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure.
Sputum examination. Analysis of the cells in your sputum can help identify the cause of your lung problems and help rule out some lung cancers.
Computerized tomography (CT) scan. A CT scan is an X-ray technique that produces more-detailed images of your internal organs than those produced by conventional X-rays. A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD.


Reads in a data file. There are more options available in addition to the above. Please refer to the Script Reference Manual/Command Reference/OpenGroup for further information.
/text If specified, data file is assumed to be in text format. Otherwise the file is input as a SIMetrix binary data file as saved by the SaveGroup command. See Data Import and Export for details of text format.
/overwrite Forces existing group of the same name to be overwritten. If not specified, the group being read in will be renamed if a group of the same name already exists.
filename Name of file to be input.
where 'n' is chosen to make the name unique.
/temp If specified, the option setting will be temporary and will be restored to its original value when control returns to the command line. (i.e when all scripts have completed).
option_name can be any of the names listed in Options. For options of type Boolean, use form1. For others, use form 2.
Displays the value of an expression. This command can be used to export data from the simulator in ASCII form. See Data Import and Export for more details.
/file filename If specified, outputs result to filename. The values are output in a format compatible with OpenGroup /text. (See OpenGroup).
/append filename As /file except that file is appended if it already exists.
/noindex If the vector has no reference, the index value for each element is output if this switch is not specified.
/noHeader If specified, the header providing vector names etc. will be inhibited.
/plain If specified, no index (as /noindex), and no header (as /noHeader) will be output. In addition, string values will be output without enclosed single quotation marks.
/force File specified by /file will be unconditionally overwritten if it exists.
/clipboard Outputs data to system clipboard.
/names names Semi-colon delimited string providing names to be used as headings for tabulated data. If not specified, the vector names are used instead.
/width width Page width in columns for tabulated data. If not specified no limit will be set.
/lock If specified with /file, a lock file will be created while the write operation is being performed. The file will have the extension.lck. This can be used to synchronise data transfers with other applications. The file will be locked for write operations.
expression Expression to be displayed. If expression is an array, all values will be displayed.
To enter multiple expressions, separate each with a comma.
The display of arrays with a very large number of elements (>500) can take a long time. For large arrays it is recommended that the /file switch is used to output the results to a file. The file can then be examined with a text editor or spreadsheet program.
The results will be tabulated if all vectors are compatible that is have the same x-values. If the any vectors listed are not compatible, each vector's data will be listed separately.
The precision of numeric values can be controlled using the "Precision" option setting. Use the command Set precision = value. This sets the precision in terms of the column width.
Deletes specified option. See Options for a full explanation.
/temp If specified, the option setting will be deleted temporarily and will be restored to its original value when control returns to the command line. (i.e when all scripts have completed).
option_name Name of option. This would usually be defined with a value using Set. See Options for a complete list.
Note that most Option values are internal. This means that they always have a value. If such an option is Unset, it will be restored to its default value and not deleted. See Options for more details.
If Unset is called for an option that has not been Set and which is not internal and error will be displayed.


Occasionally, when working in the administration screens for Users or Projects, the Save buttons are missing or not visible.
This can happen when working in the Chrome browser under Windows.
What has actually happened is that the window has opened partially off the screen.
This can happen due to corrupt cache files or extensions that tamper with the window position. The behavior is often not seen in a different profile or under Incognito mode.


Students in Central Wyoming College's Associate of Applied Science in Photography program are presented with a student-oriented program which allows them to grow in their chosen field. Students are given the opportunity to learn the technical aspects of photography as they pursue their degree. Graduates are afforded career options ranging from portraits to photojournalism, and the training provided by the university includes instruction in the planning and implementation of setting up a studio. Students are instructed in both digital and traditional photographic techniques, including a variety of camera formats. The program encourages students to develop their own photographic style, and express that style throughout the program as they hone the skills necessary to pursue a career in the photographic arts. By learning the methods in a variety of areas related to photography, students at the Central Wyoming College will develop a portfolio which showcases their unique perspective on photography.
Northwest College in Powell, Wyoming provides students with an opportunity to pursue a two year Associate's Degree in Applied Science with a focus on the photographic arts. Students will be presented with a curriculum which allows them to learn the technical aspects of photography, including darkroom and digital techniques. Students at Northwest College will learn to express themselves creatively, and graduates will have opportunities to continue this expression of skill across the nation. Graduates will be provided the skills necessary to secure positions in commercial photography, including portraits, photojournalism, and aerial photography. With the skills acquired at Northwest College, photography students will enter into an exciting field with multiple career opportunities where they will be able to express themselves by using the skills learned in the program of study offered by the university.


text:
Outbreaks don't justify breaking up Denver's homeless camps, expert says
Denver officials cited outbreaks of Hepatitis and Shigella when they resumed homeless sweeps last month, but a national expert and a local advocate say the numbers of positive tests health officials have disclosed to The Denver Post don't justify the actions.
The city also cited a fatal shooting downtown as a factor in clearing out a nearby encampment of people experiencing homelessness, even though police still can't say whether the shooting was connected at all to the gathering that was cleared out just a week later.
Still, Denver Public Health Director Bob McDonald stands behind the actions and said the overall conditions at encampments support his decision to break them up.
City officials cleared out another encampment Tuesday as protesters shouted profanities at police and city officials. Another sweep is scheduled for Wednesday.
There is a Hepatitis A outbreak in Colorado — and in Denver — but it's not new, nor is it on the rise.
The outbreak began in September 2018 and peaked almost exactly a year later, according to data collected by the Colorado Department of Public Health and Environment. Since then, the number of cases reported has declined, averaging less than a single reported case statewide each week of 2020.
Denver has seen a total of more than 100 cases of Hepatitis A since the outbreak began but only three new cases since June, said Tammy Vigil, spokesperson for the city's Department of Public Health And Environment.
McDonald couldn't say whether those three cases were contracted by people experiencing homelessness.
A total of 20 cases of Shigella have been reported in Denver since May, Vigil said. Five of those cases were reportedly connected to separate encampments, but it's unclear whether the rest were connected to encampments.
At least four cases of Trench Fever have also been reported in Denver, but that's not something city officials track specifically, Vigil said.
While those relatively small case numbers can qualify as outbreaks, they don't qualify as emergencies, said Dr. Jim O'Connell, president of the Boston Healthcare for the Homeless program and assistant professor at Harvard Medical School.
And breaking up encampments during the ongoing coronavirus pandemic only exposes people further to a deadlier virus, he said. The U.S. Centers for Disease Control and Prevention has recommended against breaking up encampments during the pandemic because the coronavirus is likelier to spread when people are closer together, as in shelters.
"It sounds alarming to say 'We've got to clear these out because of the outbreaks,'" O'Connell said. "It might be pushing the public health issue a bit further than there are facts for."
Plus, breaking up the encampments does nothing to quell the outbreaks, O'Connell said.
Cathay Alderman, of Denver's Colorado Coalition for the Homeless, agreed.
"If you're going to tell us that there is a Hepatitis outbreak then go in and treat it like a Hepatitis outbreak," Alderman said. "Don't treat it like a camping ban enforcement."
But McDonald said those outbreaks and reports of violence only constitute part of his decision. Other considerations include rodent infestations, the locations of the encampments, the accumulation of food and human waste, and criminal elements like narcotics and prostitution, he has said.
Certainly, the encampments pose a complicated problem that has challenged Denver officials for years.
In recent weeks, the sweeps have become so contentious that Denver police have started to tape off encampments while staff goes to work. Protesters toed that line Tuesday at the corner of 22nd and Stout streets, shouting profanities at officers standing guard and asking them to leave the encampments alone.
Another sweep is scheduled Wednesday for the encampments along Park Avenue and 22nd Street from Stout Street to California Street, city officials say.


The Bucket List Bookshop's top 100 list is based on a whole load of sources, including international and national prizes, sales, reader ratings and expert lists. Here are all the sources behind the Bucket List.
The Bucket List and its sources are updated every January, so if you've got feedback, ideas or additions, we'd love to hear from you!
The Nobel Prize in Literature goes "to the person who shall have produced in the field of literature the most outstanding work in an ideal direction…" (excerpt from the will of Alfred Nobel).
The Nobel Committee – of three to five people – examine nominations and cut down the long list of about 200 names to 15, which they present to the Swedish Academy. This is condensed to five names, and the Academy reads their work over the summer. In October, they choose the winner.
The Nobel Prize in Literature has been awarded 110 times to 114 Nobel Laureates since 1901. The nomination files are sealed for 50 years; the Bucket List takes into account the winners and known nominees since 1901.
"… the Man Booker has become influential beyond the wildest dreams of its founding fathers." – Ion Trewin, Literary Director of the Booker Prize Foundation from 2006 to 2015.
The Man Booker Prize, for "the best novel in the opinion of the judges," has been running since 1969. It aims to "promote the finest in fiction" by awarding the best novel written in English and published in the UK every year. The judging panel – which has included writers and poets, critics, academics, actors and even politicians – represents the "common man," helping build trust in the audience.
The winner of The Man Booker Prize receives £50,000, and shortlisted authors receive a cheque for £2,500 and a designer bound copy of their book.
The Bucket List takes into account the authors of the winning and shortlisted books since 1969.
The author of the winning book and the translator split the £50,000 prize; each shortlisted author and translator split a prize of £1,000.
The Bucket List takes into account the authors of the winning and shortlisted books since 2005.
The Pulitzer Prize for Fiction is awarded "for distinguished fiction published in book form during the year by an American author, preferably dealing with American life." One of many prizes also spanning journalism, music and photography, it has been awarded annually since 1948.
Every year, about 1,000 books are sent to five letters juries for judging in several categories, including fiction. The winner is awarded $15,000.
The Bucket List takes into account the winners and nominees since 1948.
The Neustadt International Prize for Literature is "the first international literary award of its scope to originate in the United States and is one of the very few international prizes for which poets, novelists, and playwrights are equally eligible." It was founded in 1969 as the Books Abroad International Prize for Literature.
The prize is highly international; after only three years, 34 jurors from 25 countries had chosen finalists writing in 13 different languages. To date, only four countries (Canada, Colombia, India, and Poland) have been represented more than once.
The winner receives $50,000, a replica of an eagle feather cast in silver and a certificate.
The Bucket List takes into account the winners and nominees since 1969.
The Costa Book Awards has five categories, recognizing "some of the most enjoyable books of the year, written by authors based in the UK and Ireland." The categories are novel, first novel, children's book, poetry and biography.
The Costa Awards prize is considered more "populist" than the Man Booker Prize. The winning books are selected from shortlists by five distinct panels of judges.
Publishers nominate books for the prize before the end of June every year, paying a £5,000 fee if the book is shortlisted. The winner of each category receives £5,000, and an overall winner receives £25,000.
The Bucket List takes into account the winners in the novel category since 1971.
The America Award is a lifetime achievement award for international writers, considered to give alternatives to the Nobel Prize. It was first presented in 1994.
The rotating jury of between six and eight includes American poets, prose writers, playwrights and literary critics.
The prize is sponsored by the Contemporary Arts Educational Project, Inc., in loving memory of Anna Fahrni, and by the publisher Green Integer. There is no prize money awarded.
The Bucket List takes into account the winners since 1994.
In the autumn, the Society of Authors invites UK publishers to nominate books. The following June, a panel of five women choose the "best, eligible full-length novel in English." The key criteria are accessibility, originality and excellence in writing by women.
The Bucket List takes into account the winners and nominees since 1996.
The National Book Award goes to books written by an American citizen and published by an American publisher. Established in 1950, it is administered by the non-profit National Book Foundation.
The Foundation selects 20 judges every year – five for each of the four award categories (Fiction, Nonfiction, Poetry, and Young People's Literature). Until 2013, judges were well-respected writers, but others have since been included, such as critics, librarians and booksellers. Each panel reads the books submitted over the summer – sometimes numbering in the hundreds – and the winner is not revealed until the final awards ceremony.
The night before the reveal, each finalist receives a prize of $1,000, a medal and a citation from the panel at a private Medal Ceremony. The four winners are announced at the National Book Awards Ceremony and Benefit Dinner, where they each receive $10,000 and a bronze sculpture.
The Bucket List takes into account the winners and finalists of the fiction award since 1950.
An international jury of prominent figures from literary science and history meets once a year and each member votes in private. Candidates must be living, but can be any age or nationality, and at least one of their works must be available in Czech.
The criteria for winning the prize are "the quality and exclusivity of the artwork, its humanistic character and contribution to cultural, national, language and religious tolerance, its existential, timeless character, its generally human validity and its ability to hand over a testimony about our times." The winner receives $10,000, a diploma and a miniaturised model of the Franz Kafka Monument in Prague.
The Bucket List takes into account the winners of the prize since 2001.
The Common Wealth Awards of Distinguished Service were created to "reward and encourage the best of human performance worldwide." Influential American business executive and philanthropist Ralph Hayes instructed the awards to be made in his will, to recognise outstanding achievements in the dramatic arts, literature, science, invention, mass communications, public service, government and sociology.
The awards have been presented by PNC Bank since 1979. Each winner – almost 200 so far – receives a $75,000 prize, which is presented at an invitation-only dinner. In total, $6 million has been awarded, funded by the Common Wealth Trust.
The Bucket List takes into account the winners of the literature award since 1979.
What are the world's best-selling books? Some helpful people have pulled together a lot of data from "reliable, independent sources" to make a list on Wikipedia. The page "provides lists of best-selling individual books and book series to date and in any language," not including comics or textbooks.
The Bucket List takes into account the authors of the best-selling individual books listed.
It's difficult, if not impossible, to know exactly how many books an author has sold, but Wikipedia's diligent contributors have pulled together approximate numbers from reliable sources, to produce "a list of best-selling fiction authors to date, in any language." The list only features authors with sales of 100 million or more, and it doesn't include authors of comics.
The Bucket List takes into account the authors listed.
There's a bit more accuracy in Nielsen Book Scan UK sales, although they are limited to the UK. Based on its own UK sales data, Nielsen compiled a list of the top 100 best-selling books of all time.
The Bucket List takes into account the authors of the books listed.
Amazon sells more than a million e-books every day, not to mention the real books being shipped out globally by the minute. As the world's biggest online bookshop, it's a good place to get an idea of what's selling. Amazon's "Most popular authors" list shows whose books are selling the most copies.
An ongoing online poll has produced a list of the "Top 100 authors of all time voted by regular people." The Best 100 Authors list is made up of reader votes.
The list is generated and adjusted by reader votes; at the time of writing, 16.9k voters have cast 161.7k votes on the list.
The Book Depository, one of the world's leading online bookstores with more than 18 million titles, produced a list of the best books ever written, which was quickly criticised by readers. The editors took notice of the readers' own choices: "we believe in listening to our customers… so here's your list of the top books of all time, as selected by you." The result is the Best Books Ever list.
Every year we ask the Bucket List Bookshop community to share their favourite books.
The list is not ranked, but the editors revealed that Don Quixote received fifty percent more votes than any other book.
In the book Novels and Novelists, A Guide to the World of Fiction (1980), Martin Seymour-Smith and his co-contributors chose 55 works of fiction representing the best ever written. The works eceived full marks on four criteria: readability, characterization, plot and literary merit.
Author Ronald Schwartz asked 115 major writers about their favourite books, and published their responses in For the Love of Books.
The Ideal Library was composed by 100 prominent cultural figures (mostly writers); the final list includes works that received two or more votes.
J. Peder Zane's The Top 10 lists the top ten books chosen by each of 125 writers, boiled down to the top 100 overall.
In the project The Book That Changed My Life, National Book Award-winning authors selected 100 life-changing books.
Amazon's back, with the editors' pick of 100 books to read in a lifetime.
The Telegraph's literary critics chose what they considered the best novels ever written, published in a countdown in 100 Greatest novels of all time.
Two years after his last list, writer and editor Robert McCrum put together his list of the 100 greatest novels written in English, in The 100 best novels written in English: the full list.
Librarians know a thing or two about what makes a good book. In The 100 Favorite Novels of Librarians, they select the 100 best books (with a few recommendations that didn't make the cut).


text:
Edie Windsor To Focus Efforts...
Defense of Marriage Act (DOMA) plaintiff Edie Windsor dropped by HuffPost Live this week, speaking at length about her history-making legal victory as well as her plans for the future. See the VIDEO HERE. In the wake of U.S.
Federal Judge Strike's...
With Federal Court Ruling, Wisconsin's Marriage Ban Becomes the Latest to Fall [caption id="attachment_1823" align="aligncenter" width="534"] Plaintiffs in a federal lawsuit challenging Wisconsin's ban on gay marriage appear during a press conference at the Madison Concourse
Texas GOP Platform Draft Endo...
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Floor Plan Details
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Whitepalm Luxury Apartment Homes
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Ski or snowshoe to the top of Flattop Mountain. This day is an adventure with lots of learning about winter travel in Rocky Mountain National Park.
We'll get above tree line following a winter trail eventually venturing onto some lower angled snow slopes just below the top.


Usually, I write a new post when I'm inspired, motivated, or seek to encourage others. Today is not one of those days, my friends. Instead, I'm sharing from the deepest place in my heart and soul to work through my own challenges. Raw, real emotions of struggling. Baring the hidden fears, doubts, and disappointments that crash through my ordinary life on earth.
A year ago, I was unaware of what was going on behind the scenes. All I was certain of was that I encountered one trial after another. A dry season. Everything became an uphill battle. It required much time, endurance, and patience. Let's not forget the fervent prayers crying out for provision, favor, and strength.
There are pros and cons to being oblivious to the spiritual realm. To not being able to connect the dots. When you think that everything bad happening to you or your family is simply coincidental. That bad things do happen to good people so you brush it off as accidental or a temporary setback.
But the truth is that nothing happens by mere accident. I don't believe in coincidences. What I have come to learn this year is that God does permit His children to experience seasons in the wilderness. It's a dry place where no matter how diligent you are to accomplish something, no matter how big your dreams are, and no matter how talented you may be, the end result is that your efforts become unproductive.
You hit one road block after another. It's like walking through a maze. You find yourself in this vicious cycle spinning your wheels, but going nowhere. Welcome to the wilderness!
The wilderness journey of faith is when you will wander the farthest, reach rock bottom, and continue a downhill slide where everything near and dear to you is stripped away. This parched season will most definitely pull you so far outside your comfort zone that you start questioning your own faith.
Can you withstand the fiery furnace of affliction? When your normal cozy life evaporates before your eyes, will you trust God in the dark?
As for myself, I desperately want to have unwavering faith. To be unshakable. That no matter what unfathomable opposition comes my way, I'm steadfast with a heart after God. Yet the truth is that I'm growing weary in the wilderness.
It's one thing to have faith when life is running smoothly. It's another thing when the enemy's arrows are flying every which way. When you get knocked off your feet, but you can't get back up. When a sense of oppression has a strong hold on you.
On March 8, 2016, I received the bad news that my mom was diagnosed with stage 3 brain cancer. How does anyone prepare for this? How do you remain strong when your heart is shattered into a million pieces? How do you hold it altogether when you've come undone? As the weeks have turned into months, it's been beyond scary watching the cancer take my mom's brain hostage. Her memory, moods, cognitive function, and ability to process information is greatly challenged. She feels as if she's losing her mind. She used to be so feisty, strong, and independent, but suddenly our roles as parent and child are reversing. It breaks my heart to watch my precious mom who is my best friend suffer like this. There are moments when I am strong, but today doesn't happen to be one of them. So the tears stream down my face and all I can do is beg God for mercy.
Major financial setbacks. Need I say more?
In June, 2016, I sincerely believed God was opening new doors of opportunity for me to use my gifts, strengths, and talent. Following three months of a lengthy interviewing process, it appears that the opened doors have once again been closed. Extremely disappointing!
Losses. Grief. Despair. Loneliness. Obstacles. Hard lessons. Releasing control. Surrendering your will. This all sums up the wilderness journey.
While I may not fully understand why I'm experiencing this wilderness faith, I do know from the Bible that it's a time when the Lord will produce fresh fruit. Despite all of the weariness, loneliness, and battles, God will use this parched season for something good. He has me diving in deeper to thirst for Him. I want to know Him more. I want to see His face. Spiritually, He is growing me and changing me like never before.
In the midst of wandering, waiting, and growing weary in the wilderness, God meets me smack center where He shows me His glory. As I soak into His goodness, I anticipate that He will complete what He began in me. There will be victory and rejoicing! God will make a way to remove each obstacle in His perfect time and for His divine purpose. Lastly, my wilderness experience is not in vain. It will be used to encourage others, give them hope, and help them persevere during their own wilderness journey.


Sleek and sophisticated, Götzburg is a brand that exudes class. As its tagline states, this is clothing for the gentleman, not the player. With high-quality materials and timeless design, you're bound to find your next go-to underwear in this collection.
Götzburg underwear speaks for itself - and it speaks volumes. Clean lines and a muted colour palette are mainstays of the brand's aesthetic, helping to ensure every piece matches seamlessly with the rest of your clothing. In shades of black, white, grey and navy - with the occasional stripe thrown in for good measure - this range of underwear by Götzburg is just what your drawers have been missing. Wear it underneath your everyday jeans and T-shirts or pair it with all manner of formal wear. The precise stitching and super soft materials make sure Götzburg's boxer shorts sit perfectly underneath straight-cut trousers, while the vests and tanks are ideal partners for your men's linen shirts.
Relax in style with Götzburg. Whether you want to sleep soundly in comfortable pyjamas, or are looking for your next pair of lazy Sunday slacks, this collection has just what you need. It sticks to the same basic tones as the underwear, as well as introducing splashes of bolder hues, meaning chilling at home has never been so cool. The brand was founded in 1889 and its line reflects this with an elegant, grown-up vibe. Years of experience mean Götzburg's designers know how to craft a fine garment, from loose trousers to slim-fit tank tops, so you'll look like you've stepped off the catwalk when you've actually just rolled out of bed.


The House of the Serpent is a charming, rambling old house on a rather expansive property that provides good bed and breakfast, but it's not your usual B&B. Where else would you find a New Year's Celebration in the middle of the year presided over by a veiled Gorgon? Will she be pleased with the troupe's performance or will someone be turned to stone?
I think I will make the Gorgon and her wretched mirror walk the plank. Is this some kind of joke? An aging, buxom Buccaneer with an eye patch and a bird of ill repute. I thought the mirror only spoke the truth! Really! Someone will pay for this!
:-) I am rather taken with this one myself Monika. I had just so much fun drawing it. I wonder what my inner bird has to say? For now, I suspect it is best we do not tempt fate by having her talk.
No, Albert was a victim of gossip perpetrated by Big Mike of Big Mike's Horse and Donkey Exchange. Lies, all lies.
Funny how as we get older in the mirror our inner selves stay the same age. Heh!! Methinks I am but 21 but the mirror doesn;t lie.
This is awesome...you're a full on Buccaneer!
she was a Buccaneer and unlike many of her male counter parts she lived to old age!
Shi Xainggu (better known as Cheng I Sao, Ching Yih Saou, or Zheng Yi Sao) — 1801-1810, South China Sea, commanded either five or six squadrons consisting of 800 large junks, about 1,000 smaller vessels, and between 70,000 and 80,000 men and women.
Shi Xainggu Anita Marie. Very awesome!
The Soul Food Hermitage Store is the place where travellers, who plan to travel lightly, can stop to buy some supplies. The Messenger and Tote bags are perfect for carrying your journal, scissors, glue and pens. Buy one and you will be ready to write anywhere, be it at the local coffee shop or while waiting for an appointment.
The Crest Hermitage is a Nature Store stocking a wide variety of magnificent nature cards, prints, magnets and other merchandise. It features the work of Monika Roleff.


Welcome to my website and to my practice. I am a licensed clinical psychologist offering therapy, coaching and consulting services. My office is located in Palos Verdes Estates in the South Bay of Los Angeles County. My clients come from Palos Verdes Peninsula, Manhattan Beach, Hermosa Beach, Redondo Beach and all parts of Los Angeles and Orange County. I love my work and I am passionate about empowering people to overcome obstacles, get healing, gain awareness and understanding and create lives they love. I believe any one can live a more meaningful and joyful life. Sometimes people just need a caring person to come alongside to guide them in the process.
provides therapy, coaching and consulting for adults, couples and teens.
Personal growth, relationship tools, mental health tips and exclusive offers.
Complimentary membership for a limited time.