text:
/*
  PDD layer implementation for peripheral type DMAMUX
  (C) 2013 Freescale, Inc. All rights reserved.

  This file is static and it is generated from API-Factory
*/

#if !defined(DMAMUX_PDD_H_)
#define DMAMUX_PDD_H_

/* ----------------------------------------------------------------------------
   -- Test if supported MCU is active
   ---------------------------------------------------------------------------- */

#if !defined(MCU_ACTIVE)
  // No MCU is active
  #error DMAMUX PDD library: No derivative is active. Place proper #include with PDD memory map before including PDD library.
#elif \
      !defined(MCU_MK10D10) /* DMAMUX */ && \
      !defined(MCU_MK10D5) /* DMAMUX */ && \
      !defined(MCU_MK10D7) /* DMAMUX */ && \
      !defined(MCU_MK10F12) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MK10DZ10) /* DMAMUX */ && \
      !defined(MCU_MK11DA5) /* DMAMUX */ && \
      !defined(MCU_MK11DA5WS) /* DMAMUX */ && \
      !defined(MCU_MK11D5) /* DMAMUX */ && \
      !defined(MCU_MK11D5WS) /* DMAMUX */ && \
      !defined(MCU_MK12D5) /* DMAMUX */ && \
      !defined(MCU_MK20D10) /* DMAMUX */ && \
      !defined(MCU_MK20D5) /* DMAMUX */ && \
      !defined(MCU_MK20D7) /* DMAMUX */ && \
      !defined(MCU_MK20F12) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MK20DZ10) /* DMAMUX */ && \
      !defined(MCU_MK21DA5) /* DMAMUX */ && \
      !defined(MCU_MK21DA5WS) /* DMAMUX */ && \
      !defined(MCU_MK21D5) /* DMAMUX */ && \
      !defined(MCU_MK21D5WS) /* DMAMUX */ && \
      !defined(MCU_MK21FA12) /* DMAMUX */ && \
      !defined(MCU_MK21FA12WS) /* DMAMUX */ && \
      !defined(MCU_MK21F12) /* DMAMUX */ && \
      !defined(MCU_MK21F12WS) /* DMAMUX */ && \
      !defined(MCU_MK22D5) /* DMAMUX */ && \
      !defined(MCU_MK22F12810) /* DMAMUX */ && \
      !defined(MCU_MK22F12) /* DMAMUX */ && \
      !defined(MCU_MK22F25612) /* DMAMUX */ && \
      !defined(MCU_MK22F51212) /* DMAMUX */ && \
      !defined(MCU_MK24F12) /* DMAMUX */ && \
      !defined(MCU_MK30D10) /* DMAMUX */ && \
      !defined(MCU_MK30D7) /* DMAMUX */ && \
      !defined(MCU_MK30DZ10) /* DMAMUX */ && \
      !defined(MCU_MK40D10) /* DMAMUX */ && \
      !defined(MCU_MK40D7) /* DMAMUX */ && \
      !defined(MCU_MK40DZ10) /* DMAMUX */ && \
      !defined(MCU_MK40X256VMD100) /* DMAMUX */ && \
      !defined(MCU_MK50D10) /* DMAMUX */ && \
      !defined(MCU_MK50D7) /* DMAMUX */ && \
      !defined(MCU_MK50DZ10) /* DMAMUX */ && \
      !defined(MCU_MK51D10) /* DMAMUX */ && \
      !defined(MCU_MK51D7) /* DMAMUX */ && \
      !defined(MCU_MK51DZ10) /* DMAMUX */ && \
      !defined(MCU_MK52D10) /* DMAMUX */ && \
      !defined(MCU_MK52DZ10) /* DMAMUX */ && \
      !defined(MCU_MK53D10) /* DMAMUX */ && \
      !defined(MCU_MK53DZ10) /* DMAMUX */ && \
      !defined(MCU_MK60D10) /* DMAMUX */ && \
      !defined(MCU_MK60F12) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MK60F15) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MK60DZ10) /* DMAMUX */ && \
      !defined(MCU_MK60N512VMD100) /* DMAMUX */ && \
      !defined(MCU_MK61F12) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MK61F15) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MK61F12WS) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MK61F15WS) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MK63F12) /* DMAMUX */ && \
      !defined(MCU_MK63F12WS) /* DMAMUX */ && \
      !defined(MCU_MK64F12) /* DMAMUX */ && \
      !defined(MCU_MK70F12) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MK70F15) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MK70F12WS) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MK70F15WS) /* DMAMUX0, DMAMUX1 */ && \
      !defined(MCU_MKL04Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKL05Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKL14Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKL15Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKL16Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKL24Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKL25Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKL26Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKL34Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKL36Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKL46Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKV10Z7) /* DMAMUX */ && \
      !defined(MCU_MKV31F12810) /* DMAMUX */ && \
      !defined(MCU_MKV31F25612) /* DMAMUX */ && \
      !defined(MCU_MKV31F51212) /* DMAMUX */ && \
      !defined(MCU_MKW01Z4) /* DMAMUX0 */ && \
      !defined(MCU_MKW21D5) /* DMAMUX */ && \
      !defined(MCU_MKW21D5WS) /* DMAMUX */ && \
      !defined(MCU_MKW22D5) /* DMAMUX */ && \
      !defined(MCU_MKW22D5WS) /* DMAMUX */ && \
      !defined(MCU_MKW24D5) /* DMAMUX */ && \
      !defined(MCU_MKW24D5WS) /* DMAMUX */
  // Unsupported MCU is active
  #error DMAMUX PDD library: Unsupported derivative is active.
#endif

#include "PDD_Types.h"

/* ----------------------------------------------------------------------------
   -- Method symbol definitions
   ---------------------------------------------------------------------------- */

/* Channel request source constants. */
#define DMAMUX_PDD_CHANNEL_SOURCE_0  0U          /**< Channel request source 0. */
#define DMAMUX_PDD_CHANNEL_SOURCE_1  0x1U        /**< Channel request source 1. */
#define DMAMUX_PDD_CHANNEL_SOURCE_2  0x2U        /**< Channel request source 2. */
#define DMAMUX_PDD_CHANNEL_SOURCE_3  0x3U        /**< Channel request source 3. */
#define DMAMUX_PDD_CHANNEL_SOURCE_4  0x4U        /**< Channel request source 4. */
#define DMAMUX_PDD_CHANNEL_SOURCE_5  0x5U        /**< Channel request source 5. */
#define DMAMUX_PDD_CHANNEL_SOURCE_6  0x6U        /**< Channel request source 6. */
#define DMAMUX_PDD_CHANNEL_SOURCE_7  0x7U        /**< Channel request source 7. */
#define DMAMUX_PDD_CHANNEL_SOURCE_8  0x8U        /**< Channel request source 8. */
#define DMAMUX_PDD_CHANNEL_SOURCE_9  0x9U        /**< Channel request source 9. */
#define DMAMUX_PDD_CHANNEL_SOURCE_10 0xAU        /**< Channel request source 10. */
#define DMAMUX_PDD_CHANNEL_SOURCE_11 0xBU        /**< Channel request source 11. */
#define DMAMUX_PDD_CHANNEL_SOURCE_12 0xCU        /**< Channel request source 12. */
#define DMAMUX_PDD_CHANNEL_SOURCE_13 0xDU        /**< Channel request source 13. */
#define DMAMUX_PDD_CHANNEL_SOURCE_14 0xEU        /**< Channel request source 14. */
#define DMAMUX_PDD_CHANNEL_SOURCE_15 0xFU        /**< Channel request source 15. */
#define DMAMUX_PDD_CHANNEL_SOURCE_16 0x10U       /**< Channel request source 16. */
#define DMAMUX_PDD_CHANNEL_SOURCE_17 0x11U       /**< Channel request source 17. */
#define DMAMUX_PDD_CHANNEL_SOURCE_18 0x12U       /**< Channel request source 18. */
#define DMAMUX_PDD_CHANNEL_SOURCE_19 0x13U       /**< Channel request source 19. */
#define DMAMUX_PDD_CHANNEL_SOURCE_20 0x14U       /**< Channel request source 20. */
#define DMAMUX_PDD_CHANNEL_SOURCE_21 0x15U       /**< Channel request source 21. */
#define DMAMUX_PDD_CHANNEL_SOURCE_22 0x16U       /**< Channel request source 22. */
#define DMAMUX_PDD_CHANNEL_SOURCE_23 0x17U       /**< Channel request source 23. */
#define DMAMUX_PDD_CHANNEL_SOURCE_24 0x18U       /**< Channel request source 24. */
#define DMAMUX_PDD_CHANNEL_SOURCE_25 0x19U       /**< Channel request source 25. */
#define DMAMUX_PDD_CHANNEL_SOURCE_26 0x1AU       /**< Channel request source 26. */
#define DMAMUX_PDD_CHANNEL_SOURCE_27 0x1BU       /**< Channel request source 27. */
#define DMAMUX_PDD_CHANNEL_SOURCE_28 0x1CU       /**< Channel request source 28. */
#define DMAMUX_PDD_CHANNEL_SOURCE_29 0x1DU       /**< Channel request source 29. */
#define DMAMUX_PDD_CHANNEL_SOURCE_30 0x1EU       /**< Channel request source 30. */
#define DMAMUX_PDD_CHANNEL_SOURCE_31 0x1FU       /**< Channel request source 31. */
#define DMAMUX_PDD_CHANNEL_SOURCE_32 0x20U       /**< Channel request source 32. */
#define DMAMUX_PDD_CHANNEL_SOURCE_33 0x21U       /**< Channel request source 33. */
#define DMAMUX_PDD_CHANNEL_SOURCE_34 0x22U       /**< Channel request source 34. */
#define DMAMUX_PDD_CHANNEL_SOURCE_35 0x23U       /**< Channel request source 35. */
#define DMAMUX_PDD_CHANNEL_SOURCE_36 0x24U       /**< Channel request source 36. */
#define DMAMUX_PDD_CHANNEL_SOURCE_37 0x25U       /**< Channel request source 37. */
#define DMAMUX_PDD_CHANNEL_SOURCE_38 0x26U       /**< Channel request source 38. */
#define DMAMUX_PDD_CHANNEL_SOURCE_39 0x27U       /**< Channel request source 39. */
#define DMAMUX_PDD_CHANNEL_SOURCE_40 0x28U       /**< Channel request source 40. */
#define DMAMUX_PDD_CHANNEL_SOURCE_41 0x29U       /**< Channel request source 41. */
#define DMAMUX_PDD_CHANNEL_SOURCE_42 0x2AU       /**< Channel request source 42. */
#define DMAMUX_PDD_CHANNEL_SOURCE_43 0x2BU       /**< Channel request source 43. */
#define DMAMUX_PDD_CHANNEL_SOURCE_44 0x2CU       /**< Channel request source 44. */
#define DMAMUX_PDD_CHANNEL_SOURCE_45 0x2DU       /**< Channel request source 45. */
#define DMAMUX_PDD_CHANNEL_SOURCE_46 0x2EU       /**< Channel request source 46. */
#define DMAMUX_PDD_CHANNEL_SOURCE_47 0x2FU       /**< Channel request source 47. */
#define DMAMUX_PDD_CHANNEL_SOURCE_48 0x30U       /**< Channel request source 48. */
#define DMAMUX_PDD_CHANNEL_SOURCE_49 0x31U       /**< Channel request source 49. */
#define DMAMUX_PDD_CHANNEL_SOURCE_50 0x32U       /**< Channel request source 50. */
#define DMAMUX_PDD_CHANNEL_SOURCE_51 0x33U       /**< Channel request source 51. */
#define DMAMUX_PDD_CHANNEL_SOURCE_52 0x34U       /**< Channel request source 52. */
#define DMAMUX_PDD_CHANNEL_SOURCE_53 0x35U       /**< Channel request source 53. */
#define DMAMUX_PDD_CHANNEL_SOURCE_54 0x36U       /**< Channel request source 54. */
#define DMAMUX_PDD_CHANNEL_SOURCE_55 0x37U       /**< Channel request source 55. */
#define DMAMUX_PDD_CHANNEL_SOURCE_56 0x38U       /**< Channel request source 56. */
#define DMAMUX_PDD_CHANNEL_SOURCE_57 0x39U       /**< Channel request source 57. */
#define DMAMUX_PDD_CHANNEL_SOURCE_58 0x3AU       /**< Channel request source 58. */
#define DMAMUX_PDD_CHANNEL_SOURCE_59 0x3BU       /**< Channel request source 59. */
#define DMAMUX_PDD_CHANNEL_SOURCE_60 0x3CU       /**< Channel request source 60. */
#define DMAMUX_PDD_CHANNEL_SOURCE_61 0x3DU       /**< Channel request source 61. */
#define DMAMUX_PDD_CHANNEL_SOURCE_62 0x3EU       /**< Channel request source 62. */
#define DMAMUX_PDD_CHANNEL_SOURCE_63 0x3FU       /**< Channel request source 63. */

/* Channel enabled bit mask */
#define DMAMUX_PDD_CHANNEL_ENABLED DMAMUX_CHCFG_ENBL_MASK /**< Channel enabled bit mask */

/* Trigger enabled bit mask */
#define DMAMUX_PDD_TRIGGER_ENABLED DMAMUX_CHCFG_TRIG_MASK /**< Trigger enabled bit mask */

/* ----------------------------------------------------------------------------
   -- WriteChannelConfigurationReg
   ---------------------------------------------------------------------------- */

/**
 * @brief Writes to DMA MUX channel configuration register.
 * @param PeripheralBase Pointer to a peripheral registers structure (peripheral
 *        base address). You can use the constant defined in the registers
 *        definition header file (<peripheral>_BASE_PTR) or the constant defined in
 *        the peripheral initialization component header file
 *        (<component_name>_DEVICE).
 * @param Channel DMA channel number. This parameter is of index type.
 * @param Value DMA MUX channel configuration register value. This parameter is
 *        a 8-bit value.
 * @return Returns a value of void type.
 * @remarks The macro accesses the following registers: CHCFG[Channel].
 * @par Example:
 *      @code
 *      DMAMUX_PDD_WriteChannelConfigurationReg(<peripheral>_BASE_PTR,
 *      periphID, 1);
 *      @endcode
 */
#define DMAMUX_PDD_WriteChannelConfigurationReg(PeripheralBase, Channel, Value) ( \
    DMAMUX_CHCFG_REG(PeripheralBase,(Channel)) = \
     (uint8_t)(Value) \
  )

/* ----------------------------------------------------------------------------
   -- ReadChannelConfigurationReg
   ---------------------------------------------------------------------------- */

/**
 * @brief Returns DMA MUX channel configuration register.
 * @param PeripheralBase Pointer to a peripheral registers structure (peripheral
 *        base address). You can use the constant defined in the registers
 *        definition header file (<peripheral>_BASE_PTR) or the constant defined in
 *        the peripheral initialization component header file
 *        (<component_name>_DEVICE).
 * @param Channel DMA channel number. This parameter is of index type.
 * @return Returns a 8-bit value.
 * @remarks The macro accesses the following registers: CHCFG[Channel].
 * @par Example:
 *      @code
 *      uint8_t result =
 *      DMAMUX_PDD_ReadChannelConfigurationReg(<peripheral>_BASE_PTR, periphID);
 *      @endcode
 */
#define DMAMUX_PDD_ReadChannelConfigurationReg(PeripheralBase, Channel) ( \
    DMAMUX_CHCFG_REG(PeripheralBase,(Channel)) \
  )

/* ----------------------------------------------------------------------------
   -- EnableChannel
   ---------------------------------------------------------------------------- */

/**
 * @brief Enables or disables DMA MUX channel.
 * @param PeripheralBase Pointer to a peripheral registers structure (peripheral
 *        base address). You can use the constant defined in the registers
 *        definition header file (<peripheral>_BASE_PTR) or the constant defined in
 *        the peripheral initialization component header file
 *        (<component_name>_DEVICE).
 * @param Channel DMA channel number. This parameter is of index type.
 * @param State Parameter specifying if DMA MUX channel will be enabled or
 *        disabled. This parameter is of "Global enumeration used for specifying
 *        general enable/disable states (PDD_DISABLE and PDD_ENABLE defined in
 *        PDD_Types.h)" type.
 * @return Returns a value of void type.
 * @remarks The macro accesses the following registers: CHCFG[Channel].
 * @par Example:
 *      @code
 *      DMAMUX_PDD_EnableChannel(<peripheral>_BASE_PTR, periphID, PDD_DISABLE);
 *      @endcode
 */
#define DMAMUX_PDD_EnableChannel(PeripheralBase, Channel, State) ( \
    DMAMUX_CHCFG_REG(PeripheralBase,(Channel)) = \
     (uint8_t)(( \
      (uint8_t)(( \
       DMAMUX_CHCFG_REG(PeripheralBase,(Channel))) & ( \
       (uint8_t)(~(uint8_t)DMAMUX_CHCFG_ENBL_MASK)))) | ( \
      (uint8_t)((uint8_t)(State) << DMAMUX_CHCFG_ENBL_SHIFT))) \
  )

/* ----------------------------------------------------------------------------
   -- GetChannelEnabled
   ---------------------------------------------------------------------------- */

/**
 * @brief Returns DMA MUX channel state.
 * @param PeripheralBase Pointer to a peripheral registers structure (peripheral
 *        base address). You can use the constant defined in the registers
 *        definition header file (<peripheral>_BASE_PTR) or the constant defined in
 *        the peripheral initialization component header file
 *        (<component_name>_DEVICE).
 * @param Channel DMA channel number. This parameter is of index type.
 * @return Returns a 8-bit value.
 * @remarks The macro accesses the following registers: CHCFG[Channel].
 * @par Example:
 *      @code
 *      uint8_t result = DMAMUX_PDD_GetChannelEnabled(<peripheral>_BASE_PTR,
 *      periphID);
 *      @endcode
 */
#define DMAMUX_PDD_GetChannelEnabled(PeripheralBase, Channel) ( \
    (uint8_t)(DMAMUX_CHCFG_REG(PeripheralBase,(Channel)) & DMAMUX_CHCFG_ENBL_MASK) \
  )

/* ----------------------------------------------------------------------------
   -- EnableTrigger
   ---------------------------------------------------------------------------- */

/**
 * @brief Enables or disables DMA MUX channel triggering.
 * @param PeripheralBase Pointer to a peripheral registers structure (peripheral
 *        base address). You can use the constant defined in the registers
 *        definition header file (<peripheral>_BASE_PTR) or the constant defined in
 *        the peripheral initialization component header file
 *        (<component_name>_DEVICE).
 * @param Channel DMA channel number. This parameter is of index type.
 * @param State Parameter specifying if DMA MUX channel triggering will be
 *        enabled or disabled. This parameter is of "Global enumeration used for
 *        specifying general enable/disable states (PDD_DISABLE and PDD_ENABLE defined
 *        in PDD_Types.h)" type.
 * @return Returns a value of void type.
 * @remarks The macro accesses the following registers: CHCFG[Channel].
 * @par Example:
 *      @code
 *      DMAMUX_PDD_EnableTrigger(<peripheral>_BASE_PTR, periphID, PDD_DISABLE);
 *      @endcode
 */
#define DMAMUX_PDD_EnableTrigger(PeripheralBase, Channel, State) ( \
    DMAMUX_CHCFG_REG(PeripheralBase,(Channel)) = \
     (uint8_t)(( \
      (uint8_t)(( \
       DMAMUX_CHCFG_REG(PeripheralBase,(Channel))) & ( \
       (uint8_t)(~(uint8_t)DMAMUX_CHCFG_TRIG_MASK)))) | ( \
      (uint8_t)((uint8_t)(State) << DMAMUX_CHCFG_TRIG_SHIFT))) \
  )

/* ----------------------------------------------------------------------------
   -- GetTriggerEnabled
   ---------------------------------------------------------------------------- */

/**
 * @brief Returns DMA MUX channel triggering state.
 * @param PeripheralBase Pointer to a peripheral registers structure (peripheral
 *        base address). You can use the constant defined in the registers
 *        definition header file (<peripheral>_BASE_PTR) or the constant defined in
 *        the peripheral initialization component header file
 *        (<component_name>_DEVICE).
 * @param Channel DMA channel number. This parameter is of index type.
 * @return Returns a 8-bit value.
 * @remarks The macro accesses the following registers: CHCFG[Channel].
 * @par Example:
 *      @code
 *      uint8_t result = DMAMUX_PDD_GetTriggerEnabled(<peripheral>_BASE_PTR,
 *      periphID);
 *      @endcode
 */
#define DMAMUX_PDD_GetTriggerEnabled(PeripheralBase, Channel) ( \
    (uint8_t)(DMAMUX_CHCFG_REG(PeripheralBase,(Channel)) & DMAMUX_CHCFG_TRIG_MASK) \
  )

/* ----------------------------------------------------------------------------
   -- SetChannelSource
   ---------------------------------------------------------------------------- */

/**
 * @brief Sets DMA channels source.
 * @param PeripheralBase Pointer to a peripheral registers structure (peripheral
 *        base address). You can use the constant defined in the registers
 *        definition header file (<peripheral>_BASE_PTR) or the constant defined in
 *        the peripheral initialization component header file
 *        (<component_name>_DEVICE).
 * @param Channel DMA channel number. This parameter is of index type.
 * @param ChannelSource DMA channel source number. This parameter is a 6-bit
 *        value.
 * @return Returns a value of void type.
 * @remarks The macro accesses the following registers: CHCFG[Channel].
 * @par Example:
 *      @code
 *      DMAMUX_PDD_SetChannelSource(<peripheral>_BASE_PTR, periphID, 1);
 *      @endcode
 */
#define DMAMUX_PDD_SetChannelSource(PeripheralBase, Channel, ChannelSource) ( \
    DMAMUX_CHCFG_REG(PeripheralBase,(Channel)) = \
     (uint8_t)(( \
      (uint8_t)(( \
       DMAMUX_CHCFG_REG(PeripheralBase,(Channel))) & ( \
       (uint8_t)(~(uint8_t)DMAMUX_CHCFG_SOURCE_MASK)))) | ( \
      (uint8_t)(ChannelSource))) \
  )

/* ----------------------------------------------------------------------------
   -- GetChannelSource
   ---------------------------------------------------------------------------- */

/**
 * @brief Returns mask of enabled DMA channels requests.
 * @param PeripheralBase Pointer to a peripheral registers structure (peripheral
 *        base address). You can use the constant defined in the registers
 *        definition header file (<peripheral>_BASE_PTR) or the constant defined in
 *        the peripheral initialization component header file
 *        (<component_name>_DEVICE).
 * @param Channel DMA channel number. This parameter is of index type.
 * @return Returns a 6-bit value. The value is cast to "uint8_t".
 * @remarks The macro accesses the following registers: CHCFG[Channel].
 * @par Example:
 *      @code
 *      uint8_t result = DMAMUX_PDD_GetChannelSource(<peripheral>_BASE_PTR,
 *      periphID);
 *      @endcode
 */
#define DMAMUX_PDD_GetChannelSource(PeripheralBase, Channel) ( \
    (uint8_t)(DMAMUX_CHCFG_REG(PeripheralBase,(Channel)) & DMAMUX_CHCFG_SOURCE_MASK) \
  )
#endif  /* #if defined(DMAMUX_PDD_H_) */

/* DMAMUX_PDD.h, eof. */

redpajama_set_name: RedPajamaGithub


text:
The 2021 Penrith Panthers season is the 55th season in the club's history. Coached by Ivan Cleary and co-captained by Nathan Cleary and Isaah Yeo, the Panthers are competing in the National Rugby League's 2021 Telstra Premiership. After the Panthers round 2 victory against the Canterbury-Bankstown Bulldogs the Panthers become the first team in NRL history to win the opening two rounds holding the opposition to nil as well as the first team to hold the opposition to nil in three regular season games in a row. Due to COVID-19 restrictions, Bluebet stadium was reduced to a capacity of 14,077 in rounds 1 and 3; after this in round 5 further lifting of restrictions meant that a crowd of 20,890 would be allowed into the stadium. This large crowd, however, was short-lived as Panthers misunderstood the new COVID restrictions, meaning tickets for the hills were oversold. From round 7 onwards the new capacity would be 16,110 until restrictions eased further. After round 12 was completed, the NSW and Queensland state of origin sides were announced for game one, where a record 7 Panthers were selected to represent their state. As a consequence, in round 13 Penrith would have to play without 7 of their stars and 3 debutants for the club. After 27 straight regular season wins and 12 straight to start the season, the win streak was broken, losing 26–6 against rivals the Wests Tigers. Penrith finished second overall at the end of the regular season and went on to play South Sydney in the first week of the finals series. They would go on to lose 10 - 16 but after wins against the Parramatta Eels (8 - 6) and Melbourne Storm (6 - 10) they would set up a rematch against the Rabbitohs. In the grand final Penrith were the eventual Premiers winning 14 - 12, their third title and first since 2003.

Squad

Player transfers
A † denotes that the transfer occurred during the 2021 season.

Fixtures

Pre-season

Regular season

TBA = To be announced
 Round 10 attendance refers to the total attendance on day 3 of magic round
 Round 16 was played without crowds due to the June outbreak and lockdown in NSW
 Round 20 and 21 was played without crowds due to lockdown in QLD

Finals

Bracket

Ladder

Other teams
In addition to competing in the National Rugby League, the Panthers are also fielding semi-professional teams in the 2021 Jersey Flegg Cup (for players aged under 21) and the New South Wales Rugby League's The Knock-On Effect NSW Cup (NSW Cup).

Representative honours

Domestic

References

Penrith Panthers seasons
Penrith Panthers season

redpajama_set_name: RedPajamaWikipedia


text:
Wedding party etiquette Snacks that ruin diets Dorm room decor See her best looks
'SNL': Chris Pine knows the burden of being handsome
Bill Keveney
Hey, it's not that easy being good looking.
Saturday Night Live host Chris Pine didn't exactly say that, but he demonstrated as much on Saturday's show.
In the opening monologue, Pine, who stars in the upcoming Wonder Woman (in theaters June 2), lamented how he's always being confused with a bunch of other dashing movie stars named Chris.
"I have a movie coming out this weekend. It's called Guardians of the Galaxy," he said to audience applause. "See! You see! I knew that was going to happen. That's Chris Pratt."
SNL's Leslie Jones came out to clarify identities, only to confuse Pine, who plays Captain Kirk in the Star Trek films, with Chris Evans ("You're Captain America!") and then Chris Hemsworth ("Thank you, Thor!")
Kate McKinnon then explained the similarities: "You're all named Chris and you're all scruffy and squinty and jacked, but in a sweet way."
Pine brought out a poster of the four men before breaking into "I'm Chris Pine" to the tune of Uptown Girl: "I'm not that Chris/I look just like him, but I'm not that Chris/not Pratt or Hemsworth, I'm a different guy/not Evans, either. Look, I'm my own cool vibe."
In a later sketch, a tall, handsome corporate employee named Michael (Pine) gets hauled in front of the company president and a human resources officer. He thinks he's in trouble, until the two very conservatively dressed women explained the real problem: They both have the hots for him.
"You're the one that has been driving us both crazy," explains the president (Aidy Bryant), doing a gender reversal on the usual pattern of sexual harassment.
"With your flirty hallway looks," the HR person (Vanessa Bayer) chimes in.
The president continues: "And the hunky way that your body is."
The pair tells Michael he has to pick one of them, before breaking into a duet of of The Boy Is Mine and slinking as seductively as they can, considering their office attire, on a conference table. Michael eventually gives in, picking the HR executive over the more powerful president. It must be love.

redpajama_set_name: RedPajamaCommonCrawl


text:
"It is the object of administrative study to discover, first, what government can properly and successfully do, and, secondly, how it can do these proper things with the utmost possible efficiency and at the least possible cost either of money or of energy," Woodrow Wilson (1887).
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Parivartan Sandesh Foundation is a charity organization registered under Section – 60 vide registration number 1843/4/3693/96-112 in Delhi (India) and FCRA registration number-231661665. Organization is working for the betterment and development of deprived and marginalized population through promoting various programs in India to ensure right to education, access to health services, empowering adolescents through vocational skills to have better livelihood chances & spreading awareness of social issues.
We believe that every child should have the right to explore his talents and chase his dreams, and he can only do so if provided with a platform and environment for growth and development.
Provide financial assistance to poor children for treatment of Congenital Heart Defects, supporting poor girls for monthly basis treatment of early puberty disorder. Provide free Primary Health Care Services with medicines at slums of Delhi through Mobile Dispensary Unit.
Adolescent girls and women groups are formed within the community, and our PSF centres conduct courses for Tailoring Skills, Communication Skills. Provide scholarship to deserving candidates to get career oriented courses from affiliated institutes.
For many years PSF has been developing and designing campaigns that focus on bringing awareness to important health issues , environmental issues, social issues, safety issues and personal hygiene. These campaigns will help children to be more conscious and appreciative of the environment and the world they live in. We have created campaigns for schools and open markets.


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President Biden watches inauguration fireworks from the Truman Balcony with Jill and his family after he stood at Abraham Lincoln's feet and urged Americans to 'meet the moment' and 'unify'
We don't care who's President: Antifa smashes windows at Portland's Democratic Party headquarters, burn American flags in Denver and vandalize stores in Seattle just hours into Biden's administration
Head of US bishops' conference warns Biden's pro-abortion policies 'will advance moral evils and threaten human life and dignity'
Biden warns staff he'll 'fire them on the spot' if they disrespect or talk down to others as part of pledge to 'restore decency' in the White House
Biden STOPS deportations of certain undocumented immigrants for 100 days in blitz of executive orders reversing Trump's policies
Biden's predecessors Obama, Bush and Clinton unite to call for a 'return for normalcy and a 'more perfect union' during inauguration without Trump - the first President to snub ceremony in 152 years
Republicans say they will 'vigorously work against Biden's agenda' when it's harmful', but welcome his call to 'stop the shouting' and' lower the temperature'
'We'll bring truth back to the briefing room': Biden's new White House press secretary Jen Psaki promises 'transparency' in her podium debut - without mentioning her predecessor
The color's purple: Kamala, Michelle and Hillary all wear bipartisan purple to inauguration to underline unity
PIERS MORGAN: Put your toys back in the stroller and admit defeat, Mr President – or your increasingly sad and pathetic sore loser antics really will make you Diaper Don
By Piers Morgan for MailOnline
The worst shot I've ever played in golf came on an excruciatingly public stage.
It happened two years ago at the world-famous Carnoustie course in Scotland as I was competing in the prestigious televised Alfred Dunhill Links Championship where, uniquely, amateurs get to play with professionals in a tour event.
'And now, on the first tee, journalist and broadcaster Piers Morgan,' declared the announcer, prompting a splattering of applause from the 500-strong crowd.
It was 9am, it was cold, wet and windy, and I was suffering from both the ravages of four consecutive days of hard golf and a rather fierce hangover.
I took out my driver, strode forward with all the confidence of an ageing three-legged gazelle into a lion compound, and smashed my first shot of the day low and hard straight into a small stone bridge 40 yards in front of me.
The ball ricocheted off the bridge at a sharp left right angle and flew at high speed towards the newly renovated clubhouse, narrowly missing a window of the restaurant where many top golf stars were having breakfast.
It then rebounded back off the wall over the spectators, causing many to shriek and dive for cover, and ended up close to where I was still standing as I turned the air quietly blue with horrified profanity.
Trump's mood on Thanksgiving Day won't have been improved by the reaction to a photo of him sitting at a very small desk during his White House presser, which led to the Twitter hashtag #DiaperDon trending all night
On Thanksgiving day, footage emerged of President Trump playing a round of Thanksgiving Day golf and hitting a tee shot into a lake at the Trump National Golf Club in Sterling, Virginia. 'Oh s**t' he exclaimed after playing the shot, closely followed by the words: 'I hate this f***ing hole.' Others around him chuckled, but Trump remained stony-faced. He was absolutely furious
Trump spent the rest of the day spewing out his fury on Twitter and at a fiery press conference at the White House, the first he's conducted since the Election. At a press conference when a reporter asked Trump if he would concede, he responded with venomous anger: 'Don't talk to me that way, you're just a lightweight, don't talk to me that way, I'm the President of the United States, don't ever talk to the President that way.''
'Mr Morgan,' observed my wizened-faced old caddy, 'I've been working at Carnoustie for 42 years, and I've never seen anyone do that!'
I was mortified - and should have walked off the course there and then and gone home.
It was very clear that I was mentally and physically done, and I had no chance of winning anything.
Instead, I battled on for five of the most embarrassing hours of my life, shanking, air-shotting, slicing and five-putting my way to ignominious sporting humiliation that rendered me a laughing-stock amongst the knowledgeable Scottish golf fans who amassed in ever larger numbers to have a giggle at my self-implosion.
The levels of my inner rage and indignation also rose in ever larger numbers, but I tried not to show it.
I thought of this when I watched footage of President Trump playing a round of Thanksgiving Day golf yesterday and hitting a tee shot into a lake at the Trump National Golf Club in Sterling, Virginia.
'Oh s**t' he exclaimed after playing the shot, closely followed by the words: 'I hate this f***ing hole.'
Others around him chuckled, but Trump remained stony-faced.
He was absolutely furious.
And he spent the rest of the day, supposedly a time for Americans to come together and show each other kindness and generosity, spewing out his fury on Twitter and at a fiery press conference at the White House, the first he's conducted since the Election.
After Trump repeatedly said the result was rigged, Reuters correspondent Jeff Mason asked him the following very simple question: 'Sir, just to be clear if the Electoral College votes for Joe Biden, will you concede?
It was a perfectly reasonable thing to ask, and Mason asked it in a perfectly respectful manner.
'Well, if they do,' Trump replied, 'they've made a mistake, because this election was a fraud… so no, I can't say that at all.'
When Mason understandably then tried to ask his original question again, Trump responded with venomous anger: 'Don't talk to me that way, you're just a lightweight, don't talk to me that way, I'm the President of the United States, don't ever talk to the President that way.'
Of course, this is the same President of the United States who spends his entire time abusing the media as 'Fake News' and hurling very personal insults at any journalists like Mason who dare to hold him to account.
Day by day, hour by hour, his presidency and power is being diminished. And the longer he goes on squealing about a 'rigged and fraudulent' election, and the more he throws his toys out of the stroller about the election being 'stolen' from him, the smaller and more ridiculous he becomes. Trump is pictured on the golf course in Virginia yesterday
The more Biden does this, the worse Trump behaves, probably, I suspect, because he can feel the vestiges of power being sucked out of him and he hates it as much as he hates hitting his golf ball into a lake. Yesterday was a nadir for the President. For him to spend Thanksgiving carrying on like a spiteful deluded lunatic was even by his standards a ridiculous and unedifying spectacle
Trump's rage spilled over to social media where he took aim at anyone and everyone from Fox News and Twitter – both of whom have done so much to empower Trump - to Congresswoman Alexandria Ocasio-Cortez, and NFL stars who took the knee in solidarity.
'No thanks!' he sniped at photos of two quarterbacks, Texans' Deshaun Watson and the Lions' Matthew Stafford, kneeling on their respective sidelines during the national anthem just before kickoff at Ford Field in Detroit.
His mood won't have been improved by the reaction to a photo of him sitting at a very small desk during his White House presser, which led to the Twitter hashtag #DiaperDon trending all night.
But in a way, the desk's dimensions were the perfect illustration of what's happening to Donald Trump.
Day by day, hour by hour, his presidency and power is being diminished.
And the longer he goes on squealing about a 'rigged and fraudulent' election, and the more he throws his toys out of the stroller about the election being 'stolen' from him, the smaller and more ridiculous he becomes.
The truth is that Trump lost the election fairly and squarely.
There's been zero evidence of any mass fraud of the kind he keeps claiming, and indeed, independent officials have declared this the safest and best-run election of modern times.
So, Trump's refusal to accept defeat is just the rumblings and grumblings of a shockingly bad loser, and it is beginning to present a very real danger to American democracy which depends entirely on election results being honored.
As someone who likes him personally and sees many qualities in him that his enemies refuse to admit exist, it's increasingly sad and pathetic to watch.
I beseeched him a few days after the election to concede when it was obvious Trump had lost.
If he'd done so graciously, albeit through gritted teeth, I think he'd have made a lot of people feel better towards him.
But instead, he's behaved like a spoiled toddler who's had his rattle taken away and intends shrieking and shouting until he gets it back.
Smart parents know the best way to treat such a little brat is to ignore them, and that's increasingly what Joe Biden is doing as he calmly gets on with the process of appointing his own administration and preparing for government.
The more Biden does this, the worse Trump behaves, probably, I suspect, because he can feel the vestiges of power being sucked out of him and he hates it as much as he hates hitting his golf ball into a lake.
Yesterday was a nadir for the President.
PIERS MORGAN: Butt out of Brexit, Mr Biden - you're not even... PIERS MORGAN: How can hypocrite Harry complain about how the...
The cold hard reality is that come January 20, whether Trump wants to concede or not, and regardless of whether he turns up at the Inauguration, he will no longer be leader of the world and Joe Biden will become President of the United States
For him to spend Thanksgiving carrying on like a spiteful deluded lunatic was even by his standards a ridiculous and unedifying spectacle.
He's now turned into me at Carnoustie two years ago – flailing and swinging away in a desperate attempt to change the narrative, only the more he lashes out, the worst it gets, and the louder people laugh at him.
The cold hard reality is that come January 20, whether Trump wants to concede or not, and regardless of whether he turns up at the Inauguration, he will no longer be leader of the world and Joe Biden will become President of the United States.
If Trump's still inside the White House at that point, then Secret Service agents will be forced to carry him out kicking and screaming like a big baby and he really will be Diaper Don.
I hope that doesn't happen, though there will be many praying it does so they can gleefully stamp on the presidential grave of the man they love to hate.
For the love of God, Mr President, grow up and concede.
PIERS MORGAN: Put your toys back in the stroller and admit defeat, Mr President


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Home / Jobseekers / Employment Rights
In part two of our review of 2020, we cover the turbulent period from July to December.
Back to work toolkit
The six months from July were turbulent, with many Government announcements on Covid, including extensions of the Self Employment Income Protection and furlough schemes and national and local lockdowns.
In July, Age UK called on the Government to introduce a furlough-type system for vulnerable older workers who may not feel able to return safely to the workplace in August. And a new survey from Phoenix Group showed 7.4m carers feel their jobs are at risk if their caring responsibilities increase as a result of the coronavirus. Meanwhile, analysis by Rest Less showed the over 65s have seen the biggest percentage drop in the average number of hours worked than any other age group since the coronavirus pandemic.
As 18% of over 50's say Covid could affect their retirement plans, campaigners warned that the Government's focus on youth unemployment ignores the threat to older workers from unemployment and early retirement. Meanwhile, it was confirmed that IR35 legislation for the private sector will come into effect next year and the Office for National Statistics showed the pensions gap between men and women is widening.
In August, as figures show the over 50s make up nearly half of all self employed people, there was a warning about long-term unemployment for over 50s.
A report from the Resolution Foundation highlighted those who are missing out due to the pension auto-enrolment scheme and calls for greater regulation of those areas of the economy most affected. Meanwhile, the International Longevity Centre UK [ILC] launched a new international programme of work to identify the challenges and innovations to respond to an ageing workforce and TUC Wales launched a toolkit on older workers which aims to help union representatives tackle age discrimination at work and encourage more age-friendly workplaces. The Government also announced the extension of its Access to Work scheme meaning people working from home or in the workplace with a disability will be eligible for extra help, including support for special equipment, travel costs and mental health.
A study showed Black, Asian and Minority Ethnic people aged 50-70 are more likely to be in the poorest fifth of the population in England compared with White people and Black people are living on an average of £100 less a week compared to White people. And a report showed how a lack of social care services was adversely affecting working carers.
In September, a report from the Institute for Fiscal Studies showed one in eight older workers have changed their retirement plans as a result of the Covid-19 pandemic, with 8% planning to retire later and 5% planning to retire earlier.
The Government announced a package of measures designed to boost retraining in the wake of Covid-19 as new figures from the DWP showed an increase in economic inactivity among older workers which is not explained by caring responsibilities or sickness. And as a study showed older workers were less positive about lockdown working, another revealed a big rise in mental health issues for the self employed.
In October, as the Chancellor Rishi Sunak announced changes to the Job Support Scheme and Self Employment Income Support Scheme from November in order to help those affected by Covid-19, IPSE hit out at "grossly unfair" support scheme for the unemployed. As the state pension age rose to 66, International Longevity Centre UK said G20 governments should commit to an Ageing Society New Deal and invest more in preventative health, supporting older workers and reducing avoidable barriers to spending.
Another report from the International Longevity Centre revealed that people aged 65 and over spend more time volunteering and caring than any other age group, with the average contribution across Europe amounting to 124 hours per person per year. Meanwhile, an IPSOS Mori poll showed the majority of employers don't acknowledge the impact of the menopause at work and a report showed older people are less likely to take up employer financial advice.
In November, as unemployment rises by a third among older workers since pandemic, it was reported that Covid is leading many to consider leaving self employment.
Amid calls for more support to boost financial literacy and advice, a report warned that Generation X faces a pensions disaster. Meanwhile, the Government announced plans to extend the suspension of the Minimum Income Floor [MIF] for Universal Credit which, campaigners believe, could have prevented many self employed people from getting benefits over the next months. A report showed that the gender pension gap is closing, but said women still save a lot less than men.
In December, analysis by Rest Less found women face an increasing gender pay gap as they get older due to various factors, including reduced hours or career breaks for caring responsibilities. Another report by Rest Less showed the number of redundancies amongst people aged in their 60s has nearly tripled in the last quarter.
* Read part one of our review here.
Published: 31st December 2020
What can you do if you have severe menopause symptoms at work?
Coping with the menopause at work is a really important topic affecting many people;...read more
Pensions resolutions for 2021
Each new year brings a clean slate: a chance to set about achieving our goals and...read more
workingwise.co.uk review of 2020 part one


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/*
 * To change this template, choose Tools | Templates
 * and open the template in the editor.
 */
package Moose.commands;

/**
 *
 * @author Team1065
 */
public class StopAndWait extends CommandBase {

    public StopAndWait(double time) {
        // Use requires() here to declare subsystem dependencies
        requires(drive);
        this.setTimeout(time);
    }

    // Called just before this Command runs the first time
    protected void initialize() {
    }

    // Called repeatedly when this Command is scheduled to run
    protected void execute() {
        drive.tankDrive(0, 0);
    }

    // Make this return true when this Command no longer needs to run execute()
    protected boolean isFinished() {
        return this.isTimedOut();
    }

    // Called once after isFinished returns true
    protected void end() {
    }

    // Called when another command which requires one or more of the same
    // subsystems is scheduled to run
    protected void interrupted() {
    }
}


Martin, Harper and Layton are flying on the Executive Airbus to a gathering in British Columbia when Martin turns to Harper and says, chuckling, "You know, I could throw a $1000 bill out the window right now and make someone very happy."
Harper shrugs and replies, "Well, I could throw ten $100 bills out the window and make ten people happy."
Not to be outdone, Layton says, "Well I could throw a hundred $10 bills out the window and make a hundred people happy."
The pilot rolls his eyes and says to his co-pilot, "Such arrogant asses back there. Hell, I could throw all three of them out the window and make 32 million people happy."


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Home	Board index Sophian.org The Order of St. Haniel: The Way of the Sacred Artist
Musical Instruments as Magical Weapons
#1 Postby Phillip » Thu May 15, 2014 8:43 am
1 Samuel 16:23 "Whenever the spirit from God came on Saul, David would take up his lyre and play. Then relief would come to Saul; he would feel better, and the evil spirit would leave him."
I am only a beginner in playing two string instruments, but learning to play them has been a wonderful experience, and I am entranced by string instruments and by learning to play music in general. There are many energetic experiences that music seems to convey, especially when playing. The experience in meditation of a kind of "energy bubble" around oneself an in the environment, especially when chanting out loud seems much the same as when playing a song.
Recently, I came home after there was a shooting in my community. Police were all over, and the neighbors where excited and shouting to one another and there was a general ruckus around. I didn't want to engage, or know too much about what happened after finding out that people were responding to such a klippotic event.
Rather than meditate, I opted to play some songs I knew fairly well, some soothing songs, and to open my windows and sliding glass door. I wanted to respond energetically to the situation, but meditation felt too focused on my own energy, and I wanted to work with energy more overtly within the environment and as directly as possible, but chanting divine names would simply be weird, and get the wrong energy in response, and sitting on by balcony over-looking the drama unfolding in meditation didn't feel overt and direct enough.
So I played. In a very short time, I noticed that the drama mongers simply cleared out. The police waited at their posts for the CSI to arrive and seemed more calm and settled. As a Templar, I couldn't help but notice the potency of the instruments as magical weapons. Their power and ability to so directly and forcefully push an energy movement onto an environment is striking, and the general social acceptability of stringed instruments allowed for the energy movements to enter seamlessly into consciousness without much resistance. Imagine if I were as good with my instrument as others are!
I also experimented later with different songs at different times of day. Some songs appear to have energetic links to different times of day. One song in particular taught me this, as when played at night, with the windows open (something about outdoors cultivates the full energetic effect), there was an energetic experience that was quite profound and potent. The night itself seemed to shimmer after playing a couple rounds of the song. When played in the afternoon or morning, it is a pleasant song, but nothing like when played past a certain time of night.
So as I learn to play, I am fascinated with the work with instruments as a work with magical weapons, as David appears to have been using his harp with Saul, and as a vehicle of prophecy as the prophets of old appear to being using the harp and musical instruments.
How might other mystics who are musicians chime in about their mystical work with music? How have your mystical explorations been influenced by your musical studies?
Re: Musical Instruments as Magical Weapons
#2 Postby Tau Malachi » Thu May 15, 2014 11:04 am
Greetings and blessings in the Holy Light of the Messiah!
I cannot speak as a musician, per se, though as a boy I did play the guitar, and at times, I did play at sacred events of Tau Elijah's circle, and likewise voice, song and chant, has played a significant role in prayer, meditation and ceremony for me over the years, and I can play a "mean" rattle when the Living Presence moves and inspires it, and I often enjoy chant with a rattle in prayer.
First, I cannot help but consider the simplicity of primordial meditation with sound-vibration, merging the mind with sound, becoming the sound-vibration, resting the mind in the silence within and behind, its own intrinsic nature. In the midst of a creative expression of sound, whether voice or other musical instrument, I find a distinct experience of repose and movement in this, a deep and profound peace, or satisfaction, coupled with immense joy, or bliss – true enjoyment. In some way, in the midst of such movements, the I-thought, or sense of self, vanishes, and there is only the song or music flowing from the universe, or from the Spirit of God, and there are profound experiences of nearness to God, and at times unification with the universal and God – it is a powerful way of cleaving, devekut.
The affects upon others in the environment can also be profound, not just from the sound, though, but from the influxes of spiritual powers that moves through it, and the Living Presence manifesting as it. Through devotional song and music the soul is elevated, consciousness expands, and we merge with spiritual powers, and sound-vibration and energy radiate into the environment, that space, and may have a powerful influence on others, uplifting them with us.
Concerning David and Saul, consider this. Saul, apparently, often suffered from severe depression and anxiety, and as we know, the Holy Shekinah cannot rest upon a depressed person. Thus, Saul would call upon the boy, David, who was a musician and mystic – one who would be anointed as a prophet, and eventually as king; David would come with an elevated soul, the Shekinah resting upon him, and cleaving to the Shekinah and Yahweh, David would play, dispelling the depression, elevating Saul, and the Holy Shekinah would return to Saul. As we know, we join ourselves with spiritual forces corresponding with our thoughts and emotions, and the words and actions that flow from them, whether divine, archonic or demonic forces. In the midst of negativity, so we become joined with negative spiritual forces, archonic and demonic. Song and music that is devotional, or positive and uplifting, has an incredible power to help shift thought and emotion, in effect invoking divine spiritual forces and banishing archonic and demonic forces as it transforms our mind and heart, our thoughts and emotion, shifting them to what is good and true. As has I've explained, though, when with song and music there is cleaving to God, or to the Sefirot and Yahweh, along with the sound itself there is an energetic transmission and influence, and therefore the song and music can have an even more powerful affect on those who listen and hear it.
Here we may remember a very common term for groups or orders of angels, "choirs," and we may remember what is said of the worship of the angels in heaven before the Throne of Glory, that they worship in the exterior and interior presence (Shekinah) with song, chant, music and dance, giving praise and thanks to the Holy One, rejoicing in the presence of the One God. If the angels worship in heaven in this way, then what shall we do? If we worship as the angels in heaven worship, with song, chant, music and dance, then surely something of the blessings of heaven will be in our worship, and heaven will be moved by our worship, and the angels of God will join in our worship, praying with us, giving praise and thanks with us, and rejoicing with us in the Holy Shekinah, the presence of the Most High (Elyon).
There is something heavenly in devotional, or positive and uplifting song, music and dance, and in some way, when taken up by it, our soul reaches into the heavens and the heavens reach out to us, pouring out blessings and inspirations upon us. This becomes very obvious in our experience when the Spirit moves, takes us up, and we experience periods of an inspired, creative flow in voice, music and dance; there is a very distinct Divine Presence and Power in it, as though it "comes from above" or from "deep within the soul."
Once upon a time I could sing like the angels, but now it is more like a squawking crow; but nevertheless, it is all about conscious intention and cleaving, and the energy within and behind, so that even squawking can be taken up by the Spirit of God, the Living Presence, and be divine. Praise God!
When there is a conscious intention and cleaving, song, music and dance become divine – a great power for good.
There is something to be said of musical instruments as prayer weapons. First, of course, if this is our intention we will consecrate them with that intention, and invoke the blessing of God upon the instrument, offering it to the service of the kingdom of heaven and God. Then, taking it up and using it in this way, so it will become the vehicle of all of the spiritual forces channeled and communicated through it, and over some time it may hold much power, residual energy of the many spiritual powers that have been directed and moved through it in worship, in prayer, meditation and ceremony; hence, it can become a very powerful prayer weapon that, if it were passed to someone for them to use, might communicate inspiration and power, just as with other prayer weapons that are well seasoned through many spiritual works.
As an example, I have a rattle that I've used in prayer and ceremony since the early eighties – it is an enduring rattle that has outlasted every other, and it has been part of many great convocations and such. I've been told that when given to other initiates to play in ceremony that spiritual power passes to them and it has lasting affects, all as the Spirit of God gifts to them when they use it. This can be true of any musical instrument that becomes seasoned as a prayer weapon with time and experience. In a manner of speaking, the angel and spirit of sacred objects grows and increases over time.
These were some thoughts I was inclined to share, given your observation and contemplation dear brother.
#3 Postby Phillip » Thu May 15, 2014 1:23 pm
Shalom and Thank you!
I didn't mean to exclude with my invitation specifically to musicians. I'm only a beginner on mandolin and guitar, myself. I wondered in my invitation how many accomplished musicians have had mystical experiences in the practice of their art, and don't imagine that their experiences are mystical because they didn't happen through formal "meditation" practices.
A friend of mine who is an accomplished musician has said about his musical practice that, "magical coincidences and psychic events seem to happen more when I practice regularly." How interesting! It appears that for this person, practicing his instrument is a meditation practice. This has been my experience as well, but I practiced meditation for some time before practicing a musical instrument, and I wonder how common these experiences are for people practicing a musical instrument. So the keys you give about linking the technology of spiritual practice to the art of musical practice are invaluable, thank you!
I also would not limit my invitation to traditional music or musical instruments. The rattle is, indeed, an interesting instrument, and I had some very interesting experiences at the last ceremony playing Elder Gideon's rattle. Since these experiences are accessible to a beginner on mandolin and guitar such as myself, they must be accessible in any play of sound. I am also skeptical about quality of sound necessarily determining quality of energy. I also squawk like a crow when I sing, and always have… I don't have the excuse of a traumatic event! But in the play of transmitting energy do such things matter? It appears not! Perhaps more refined vehicles of sound can transmit more refined subtleties of energy, when linking a refined spiritual awareness to a refined musicality, a work I can aspire to, and was also curious about.
You answered a question I had within and behind this also, the notion of sound itself as a kind of vehicle, and patterns themselves seem to be a container for diverse qualities of energy. Certainly, just as there are containers more suited to certain liquids, there are certainly songs/sounds/chants/rhythms more suited to certain energies, but yet I wondered how diverse the quality of energy invested can be in each vessel. I am hearing that linking intention, prayer and a good heart to be key to the quality/nature of the energy invested.
#4 Postby Tau Malachi » Sun May 18, 2014 8:40 am
When we pray and meditate, and worship, and we take up chant, song and music, our conscious intention and faith is everything, and the play of kavvanah and devekut through sound-vibration. This opens us to the Holy Shekinah and Holy Spirit, and moves light-power or energy with, in and through us and the sound-vibration generated, and it may be that the Shekinah transforms and uplifts the sounds, and brings special beauty and power into them. As we know, at times in sacred ceremony voice or music can be taken up by the Spirit of God and something can happen that we did not expect, something more than we can ordinarily produce according to our natural ability or talents.
There is, of course, a difference between individual prayer, meditation and worship through chant, song and music and leading prayer, meditation and worship in assembly with chant, song and music. If and when we are seeking to communicate light-power or energy to others, and seeking to help inspire and uplift others, greater quality and beauty of the sound offering, much like the visual environment, can be very beneficial, naturally so. The more people are able to open their hearts and minds to the sound, the chant, song or music, and enjoy it and merge with it, the more receptive they may become to the light-power of energy communicated through it. Thus, there is a place and role for quality and beauty with voice and other musical instruments when we are working with others; hence, when we are interacting with karmic vision and physical senses in this world. In our own prayers, meditations and worship this does not matter so much, but in assembly, when we are seeking to inspire and uplift others, it does. So there are times when our abilities and talents, and the extent to which we have cultivated them, take on a greater significance.
This is why musicians tend to practice with voice and instruments, cultivating their abilities and talents, their skills, and becoming well acquainted with their capacity, so that when playing with and for others, their offering might inspire and uplift, and bring some enjoyment to others.
Unless we happen to be a very talented professional musician, though, our aim and way with chant, song and music is very different, for performing for others is not our central focus, but rather our main focus is one of faith and devotion, and sound, music, as a vehicle of kavvanah and devekut, and an offering to God.
In terms of gifted worship, the issue isn't really how we sound with our voice or instrument, or how we look with our gestures and dance, its all about the play of faith and devotion, the expression of devekut-cleaving, and the experience of higher vital and mental states of consciousness, and self-transcendence, that may come during gifted worship when we open to the Spirit, cultivate joy and uplift ourselves in the Spirit, and let the Spirit of God take us up as we cleave to God.
I believe we have had some delightful experiential examples of this during gifted worship in circle, such as recently during the Feast of the Holy Bride when the Spirit was moving in assembly in a powerful way, generating much joy among us.
These were a few thoughts I was inclined to add.
May we take joy in the Queen of Shabbat this day, and savor her good company!
#5 Postby Anna » Fri Jun 06, 2014 7:26 am
Blessings in the Gift of Messiah!
Dear Brothers, what a delightful contemplation. I have felt eager to join in but life has kept me busy and so I have been blessed with more time for contemplation and experience of this wonderful gift of musical prayer and worship.
The Feast of the Holy Bride filled me with awe at the beauty and wonder of gifted worship. The weave of melody and chant, rising and falling, shifting in its tonalities and textures, uplifted me in the moment but also continues to inspire creative worship in my prayer life. I find myself naturally singing many prayers and playing as a child in the mother's lap with a broad palette of range and textures of song and chant, and also with instruments.
I, too, am finding that the power in worship with instruments and voice lies in the intention and in cleaving to God. In this way, while I might set out with an idea of what instruments I might work with in worship, I may find that, in the moment, there is inspiration not to pick any of them up but simply chant or sing, or both. Or, I may find myself going from native flute to rattle to silence.
As a multi-instrumentalist I have many colors and textures available to me but even with one or two instruments, there are many possibilities for shifting sounds according to inspiration in prayer. As you pointed out in another thread, Brother Phillip, scales and modes offer further vehicles for expression in worship. We can see this in sacred musical traditions around the world with such a variety of scales and modes and harmonies that are very different from our western musical aesthetic.
It is amazing what can happen in worship, for though I might have practiced and gained certain skills, it is not at all unusual to experience a surpassing of technical skills in movements of worship. I recall one particular movement with native flute where a long continuous melody poured out of the instrument without being interrupted by having to take a breath.
Another delightful discovery for me is the incredible capacity for improvisation that is often gifted in musical worship, in such variety and depth of expression. Praise God! I am so grateful for these blessings being poured out and pray that many beings are uplifted through our worship in Spirit and in Truth!
Return to "The Order of St. Haniel: The Way of the Sacred Artist"


On November 7, @shrmnextchat chatted with the SHRM Government Affairs Team about 2018 Midterm Election Results and Implications for the Workplace.
Last night's midterm elections resulted in a tilt of power for the 116th Congress with democrats clinching the majority in the House of Representative and republicans expanding their majority in the Senate.
On February 7, @shrmnextchat chatted with members of the SHRM Government Affairs team and Council for Global Immigration on 2018 HR Advocacy and Public Policy Priorities.
On September 13, @shrmnextchat chatted with special guests Jonathan Segal (@Jonathan_HR_Law), Paula Harvey, SHRM-SCP (@Paula4Harvey), and Cecilia Clark (@ciciHR2Serve) on Crisis Planning and Recovery for HR.
As hurricanes Harvey and Irma made landfall in the U.S. over the past two weeks, no one could have imagined the historical nature of their effects. Even the best prepared contingency plans were put to the test.
What is HR's role in crisis planning and recovery?
Don't have one? Good. You can skip today's post.
#Nextchat RECAP: What's Next for Paid Leave?
On January 25, @shrmnextchat chatted with SHRM Senior Vice President of Knowledge Development Alex Alonso (@SHRMKnwldgeSVP) and SHRM Vice President of Research Shonna Waters (@Shonna_Waters) about What's Next for Paid Leave.
#Nextchat: What's Next for Paid Leave?


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text:
The Role of MRI in the Diagnosis of Multiple Sclerosis
By Matilde Inglese, MD, PhD
Multiple sclerosis (MS) is the most commoninflammatory demyelinating disease of theCNS and the most frequent cause of nontraumaticneurological disability in young andmiddle-aged adults.1 Women are twice as likelyto be affected as men, and onset typicallyoccurs between the ages of 20 and 40 years.
Variability and diversity characterize MS. Deficits in sensory, motor, cerebellar, brain stem, and autonomic functions are the most common clinical manifestations. Most patients (85%) experience a relapsing-remitting course characterized by the episodic onset of symptoms followed by residual deficits or by a full recovery within a few weeks, especially in the early stages of the disease.2
Approximately 15% of patients with relapsing-remitting MS (RRMS) will remain clinically stable or nearly stable for 2 or more decades (benign MS). However, within 25 years, RRMS in most untreated patients will evolve into secondary progressive MS, characterized by a chronic and steady increase of physical symptoms and disability.
Approximately 10% to 15% of patients with MS experience a primary progressive course. Primary progressive MS (PPMS) differs from RRMS in that it affects both men and women equally, occurs in older persons, exhibits lower levels of inflammatory markers and myelopathological features, and is unresponsive to immunomodulatory agents.3 Progressive relapsing MS is uncommon and is progressive from the onset with clear, acute relapses with or without recovery, and with periods between relapses characterized by continuing progression.4
MS is a clinical diagnosis, dependent on a detailed history; careful neurological examination; and supportive paraclinical investigations, including MRI, analysis of both cerebrospinal fluid (CSF) and evoked potentials, and blood tests to exclude confounding diagnoses. The classic MS diagnostic criteria are evidence of lesions in the CNS disseminated in space and time (ie, more than 1 clinical episode involving more than 1 area of the CNS [brain, spinal cord, and optic nerves]).
The use of MRI, since its introduction by Young and colleagues,5 has had a major impact on allowing early and more precise diagnosis of the disease. In patients with clinically definite MS, brain MRI reveals multifocal cerebral white matter lesions in more than 95% of patients and focal spinal cord lesions in 75% to 85% of them. Cerebral white matter lesions that are indistinguishable from those seen in definite MS are observed in about two thirds of patients who have a single episode of suspected demyelination or clinically isolated syndrome (CIS).6 Because the presence of such lesions increases the likelihood of developing clinically definite MS, it is not surprising that standard MRI features suggesting dissemination of pathologic lesions in space and time were incorporated into the diagnostic criteria for MS by the International Panel on the Diagnosis of Multiple Sclerosis in 2001.7
THE ROLE OF MRI
The previous diagnostic criteria for MS, authored by Poser8 in 1987, were established for use in clinical trials of MS and included clinically definite MS, laboratory supported (ie, evoked potentials and CSF analysis, including IgG index and oligoclonal bands) definite MS, probable MS (either clinically or laboratory supported), and possible MS. Because MRI was relatively new at the time these criteria were presented, the technology was included as a paraclinical element but was not further defined.
According to the new McDonald criteria, the diagnosis of MS requires objective evidence of lesions disseminated in space and time.
MRI findings may contribute to the determination of dissemination in time or space.
Other supportive investigations include evaluation of CSF and the visual evoked potential (VEP).
Diagnostic categories include possible MS, MS, or not MS.
For dissemination in space, 3 of the following 4 features are required, based on criteria established by Barkhof and colleagues6 and Tintore and colleagues9:
At least 1 gadolinium-enhancing lesion or 9 T2-weighted hyperintense lesions.
At least 1 infratentorial lesion.
At least 1 juxtacortical lesion.
At least 3 periventricular lesions.
A spinal cord lesion can substitute for any of the above brain lesions. If immunoglobulin abnormalities are detected in the CSF, then the MRI criteria are relaxed to require that only 2 T2-weighted lesions typical of MS be present.
For dissemination in time, a new gadolinium-enhancing lesion appearing 3 or more months after the initial clinical event indicates a new CNS inflammatory event (the duration of gadolinium enhancement in MS is usually less than 6 weeks). If no gadolinium- enhancing lesions are detected but a new T2-weighted lesion is, then MRI should be repeated after another 3 months to detect the presence of a new T2-weighted lesion or a gadolinium-enhancing lesion.
Application of these criteria in several natural history and treatment trial cohorts indicated that they were more robust in facilitating an earlier diagnosis of MS than could be achieved through other diagnostic methods.10-12 The criteria also proved robust in predicting the likelihood of conversion to clinically definite MS in patients with a CIS in whom MRI ultimately showed evidence of dissemination in space and time.10-12 Specificity was high, in particular when dissemination in time was present; dissemination in space per se was less specific.
The requirement that a gadolinium-enhancing lesion be present 3 months after the initial event to fulfill dissemination in time had poor sensitivity. This was ameliorated by requiring that either a new gadolinium-enhancing or T2-weighted lesion be present instead.13
In the light of subsequent studies, and in view of criticism from the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (AAN), the 2001 criteria were revised by a reconvened International Panel in 2005 (Tables 1, 2, and 3).14 The AAN subcommittee had recommended that the presence of 1 to 3 lesions was sufficient evidence for an MS diagnosis.15
Table 1 - Revised MRI criteria for the diagnosis of MS in space and time
Dissemination in space
Dissemination in time
Three of the following:
Either:
NOTE: A spinal cord lesion can be considered equivalent to a brain infratentorial lesion. An enhancing spinal cord lesion is considered to be equivalent to an enhancing brain lesion, and spinal cord lesions can be included with brain lesions to reach the required number of T2-weighted lesions.
MS, multiple sclerosis.
Table 2 - Revised MRI criteria for the diagnosis of primary progressive MS in space and time
One year of disease progression (retrospectively or prospectively determined) Plus 2 of the following:
Detection of a gadolinium-enhancing lesion at least 3 months after the onset of the initial clinical event at a site not corresponding with the initial event
MS, multiple sclerosis; CSF, cerebrospinal fluid.
The criteria published in 2001 and in 2005 draw on the criteria established by Barkhof and colleagues6 and Tintore and colleagues.9 The criteria differ in what extent a spinal cord lesion can assist in fulfillment of dissemination in space. In the 2001 McDonald criteria, only 1 cord lesion could substitute for a brain lesion, whereas in the 2005 criteria, any number of cord lesions can substitute for brain lesions and a cord lesion is also assigned the same status as an infratentorial lesion.
Although the MRI features of MS in children are similar to those of adult-onset MS, children tend to have fewer lesions. Lesions also have a lower propensity to enhance with gadolinium in children. A Canadian study of 20 children in whom MS was diagnosed demonstrated that although all children had 1 or more T2-weighted lesions, only 53% met McDonald criteria for lesion dissemination in space at the time of their initial demyelinating event.16 This finding suggests that MRI criteria specific to pediatric-onset MS needs to be developed.
MRI AND PPMS
Patients with PPMS are clinically distinguished by the absence of the key hallmarks of MS: relapses and remissions. This, together with a predilection for the spinal cord, resulting in a slowly progressive paraparesis, tends to characterize this subtype of MS.
PPMS has a relatively later age at onset and a lesser female preponderance than other MS subtypes. On MRI, patients present with fewer lesions, which have a lower formation rate and lower level of gadolinium enhancement than lesions seen in other MS subtypes.
In addition, affected patients show more spinal cord involvement, possibly with a greater incidence of diffuse change in the cord.3 The clinical and MRI characteristics of PPMS make diagnosis difficult, especially with the fulfillment of the criteria of dissemination in time.
The original McDonald criteria for PPMS were based on the work of Thompson and colleagues,17 which was established for rigorous research purposes rather than for the clinical setting. Briefly, 3 levels of certainty were defined:
1.Definite MS. Clinical progression for at least 1 year and positive CSF and MRI findings or equivocal MRI findings and a delayed VEP.
2.Probable MS. Either clinical progression for at least 1 year and positive CSF and equivocal MRI findings or a delayed VEP or else clin- ical progression for at least 1 year and positive or equivocal MRI findings and a delayed VEP.
3.Possible MS. Patients with clinical progression for at least 1 year and equivocal MRI evidence or delayed VEP.
In the revised McDonald criteria, the presence of CSF oligoclonal bands is no longer required.14 In their place, the presence of at least 2 spinal cord lesions and either 9 brain lesions or 4 to 8 brain lesions plus abnormal VEPs are required (Tables 2 and 3).
Although a positive CSF finding increases the comfort level for a diagnosis of PPMS, such CSF findings are not specific and may be commonly detected in patients with progressive myelopathies attributable to other causes, particularly those associated with infection (eg, human T-cell lymphotrophic virus type 1). It should be noted that although the dissemination in space criteria can be met by brain or spinal cord MRI alone, in most cases, both should be obtained. Even in the presence of abnormal findings on brain MRI scans, spinal cord imaging is helpful in ruling out alternative diagnoses, such as spinal stenosis or low-grade tumors in patients with a progressive spinal cord syndrome.
It has increasingly been recognized that in both the brain and spinal cord, a diffusely abnormal signal intensity can be present in the white matter. In a recently published study, Lycklama à Nijeholt and colleagues18 described diffuse abnormalities in addition to focal lesions in 43% of patients with progressive MS. However, in 14% of patients, only diffuse abnormalities in the spinal cord were found, correlating with a PPMS diagnosis.
Although the revised MRI criteria recognize that diffuse cord changes occur in MS, cord changes are not considered to be sufficiently reliable to be incorporated into the diagnostic criteria. At this time, therefore, there are no specific alternative recommendations for imaging patients with a diagnosis of PPMS.
MRI AND NMO
Neuromyelitis optica (NMO) is an inflammatory demyelinating disease with severe synchronous or sequential clinical optic nerve and spinal cord involvement that typically spares the brain and that, unlike MS, tends to leave severe residual injury early with each attack. A serum autoantibody marker of NMO (NMO IgG) that distinguishes NMO from MS recently has been identified.19
Recent revised diagnostic criteria for NMO20 incorporate both MRI and laboratory data in a multiparametric model that yields a 90% specificity for the differential diagnosis of MS. In contrast to MS, most patients with NMO will have a normal brain MRI scan or only few nonspecific T2 hyperintensities early in the disease course. In a recent study of 60 patients who had NMO, 36 (60%) had MRI evidence of brain abnormalities. In addition, brain abnormalities developed in 15 of 30 patients who had a normal initial brain MRI scan.21
Spinal cord involvement in NMO, as seen on an MRI scan, typically differs from that seen in MS. The vertical extent of T2-weighted visible lesions (usually 3 or more segments) is typically increased. On axial sections, lesions commonly involve much of the cross-section. Unlike in MS, extensive "syrinx-like" longitudinal swelling and T1 hypointensity are typical in the acute and chronic stages, respectively.
MRI PROTOCOL FOR THE CNS
A standardized clinical protocol for MRI in MS or suspected MS has been recommended by an international group of neurologists and radiologists convened by the Consortium of MS Centers (CMSC).22 The recommended field strength is 1 tesla or greater. MRI sequences recommended for lesion identification (Table 4) include:
Axial proton-density and T2-weighted (PD/T2W) spin echo and fluid attenuated inversion recovery (FLAIR).
Sagittal FLAIR sequence covering the corpus callosum.
Precontrast axial T1-weighted sequence.
Postcontrast axial T1-weighted sequence. For each sequence, contiguous 3-mm-thick slices with no gap are recommended.
Table 4 - Protocols for brain and spinal cord MRI in suspected MS
Brain protocol sequence
Spinal cord protocol sequence
MS, multiple sclerosis; FLAIR, fluid attenuated inversion recovery; FSE, fast spin echo; PD/T2, proton density/T2-weighted; 3D T1, 3-dimensional T1-weighted.
PD/T2W images. MS plaques, which appear as areas of focal hyperintensity on PD/T2W images (Figure 1A), can be found throughout the brain, with a predilection for periventricular white matter, the corpus callosum, U-fibers, the brain stem, and optic nerves. At the initial stage, the lesions are typically thin and linear (Dawson fingers) and are probably associated with inflammatory changes around the long axis of the medullary vein. The focal demyelinating lesions located along the lateral borders of the corpus callosum are best depicted by sagittal FLAIR imaging. These lesions together with abnormalities in the corpus callosum, U-fibers, and optic nerves may allow for the differentiation of MS from cerebrovascular disease.
Figure 1. Axial T2-weighted (A) and axial post-contrast T1-weighted (B) imagesfrom a patient with multiple sclerosis. The T2-weighted image showsseveral typical hyperintense lesions in the periventricular white matter. Onthe post-contrast T1-weighted image, 1 of these T2-weighted visible lesionsenhances after the injection of gadolinium-chelate, indicating an active inflammatorylesion with leakage of the blood-brain barrier.
Although MS predominantly affects white matter, lesions occur in gray matter and are better detected on FLAIR imaging than conventional MRI. Their small size, less severe inflammation, and partial volume artifacts in CSF and adjacent white matter make gray matter lesions difficult to detect on conventional MRI.
Up to 90% of clinically definite MS cases show T2-weighted lesions on brain MRI scans. Preexisting T2-weighted lesions can reactivate with re-enhancement, enlargement, or both. Eventually, after many reactivations, single lesions will fuse with those that are adjacent, forming confluent lesions. A net accumulation of new and enlarging lesions increase the total T2 volume by 5% to 10% per year, with a large variability among patients. Despite their exquisite sensitivity, however, T2-weighted visible lesions lack pathological specificity.
T1-weighted images. Approximately a third of T2-weighted visible lesions will appear hypointense (ie, black holes) on corresponding T1-weighted images. Although acute MS lesions also may appear hypointense on T1 images, this is a result of transient edema. They do not have the same pathology or significance as true chronic T1 black holes. A T1 hypointensity may last months after an acute event and may evolve into an isointense lesion, in which the edema is resolved and repair is suggested, or else may persist as a chronic, permanent hypointensity or true black hole.
Chronic black holes are focal areas of relatively severe tissue injury, including axonal injury, matrix destruction, and myelin loss. These lesions cannot be determined with complete certainty on a single MRI scan because, by definition, they should be persistent for at least 6 months. In routine clinical practice, however, T1 black holes are assumed to be any lesions that are hypointense but non-enhancing on post-gadolinium-enhanced T1-weighted scans. Such hypointensities are unlikely to be acute on a contrast-enhanced scan, the exception being if the patient has received high-dose corticosteroids (which suppress gadolinium enhancement by resolving the leaky blood-brain barrier) within hours to weeks of MRI.
Because of greater pathological specificity for severe axonal loss, black holes have a stronger correlation with clinical disability. In addition, T1-weighted images allow for the assessment of atrophy. Brain and spinal cord atrophy in MS are more severe in patients with secondary progressive disease. Although atrophy is measured using automated computer software, volume loss also is evaluated qualitatively and may be described by using an ordinal scale (mild-moderate-severe) based on global assessment of ventricle size and sulcal width.23
Gadolinium-enhanced T1-weighted images. Gadolinium-enhanced T1-weighted imaging is extremely useful for identifying new lesion activity (Figure 1B). Enhancing lesions are a surrogate marker for focal disruption of the blood-brain barrier associated with macroscopic inflammation, an early stage in focal MS lesions. New enhancing lesions usually last 4 weeks (range 1 to 16 weeks).24 In addition, confounding diagnoses such as leptomeningeal disease, meningioma, other mass lesions, and vascular malformation may be less well visualized or even missed without contrast-enhanced MRI scans.
Finally, the identification of enhancing lesions is an important component of the revised McDonald criteria, providing evidence for disease dissemination in space and time. Conventional doses of gadolinium-chelate (0.1 mmol/kg) are recommended with a minimum delay of 5 minutes following injection. The enhancement pattern can change with the evolution of inflammation. It is more often solid and homogeneous with acute lesions and may appear ring-like in larger and older lesions. Although enhanced MRI is considered optional for the follow-up of MS,23 it should be strongly encouraged.
MRI protocol for spinal cord. The CMSC MRI Working Group recommends using the following sequences for MRI of the cervical and thoracic spinal cord:
Pre- and post-contrast sagittal T1-weighted scan.
Sagittal fast spin echo PD/T2W scan.
Axial PD/T2W scan as well as post-contrast T1W scan of suspicious lesions.
Slice thickness should be 3 mm or less without a gap between slices. If spinal MRI immediately follows contrast brain MRI (the gadolinium-chelate dose of which should be 0.1 mmol/kg), no additional gadolinium is required and the pre-contrast sagittal T1-weighted images are not included (Table 4).
For patients with symptoms involving the spinal cord, both brain and spinal cord MRI scans are recommended to exclude MS mimics such as vascular malformations and neoplasms, especially if the symptoms have not resolved.
Spinal MRI may be very useful when findings on the brain MRI scan are normal. It is recommended for patients with suspected MS when the brain MRI results are equivocal. The importance of spinal MRI has been emphasized in the revised McDonald criteria where spinal cord lesions can be included with brain lesions to fulfill the criteria of dissemination in space and time. In contrast to brain lesions, spinal cord T2-weighted visible lesions do not develop with normal aging or chronic hypertension and diabetes. Spinal cord lesions can be found in 50% to 90% of patients with clinically definite MS.
The most common site of presentation is the cervical cord. Typical MS lesions do not extend beyond 2 vertebral segments, tend to involve the posterior and lateral regions, and occupy less than half the area of the cord on axial images.
Although the diagnosis of MS relies on the demonstration of disease dissemination in space and time, the exclusion of other neurological disorders is also essential. The International Panel emphasized that even if the clinical evidence and paraclinical studies are strongly indicative of MS, there must be "no better explanation" than MS for a secure diagnosis to be made.7 However, the limited specificity of T2-weighted visible lesions may increase the likelihood of an MS diagnosis in patients affected by other disorders (Table 5).
Because the current diagnostic criteria have not explored the ability of MRI to detect features not suggestive of MS, a workshop of the European Magnetic Resonance Network in MS (MAGNIMS) was held "to define a series of MRI red flags in the setting of clinically suspected MS."25 Such red flags, derived from evidence-based findings and educated guesses, are summarized in Table 5 in a way that more closely conforms to everyday clinical practice. Recognition of such features in the workup of patients in whom MS is suspected may reduce the likelihood of a false-positive diagnosis.
The MS experts participating in the MAGNIMS workshop agreed that if a patient meets International Panel criteria and there are no MRI red flags, a diagnosis of MS is certain. No additional tests are needed beyond routine examinations.25
If the patient meets the International Panel criteria and there is at least 1 MRI red flag, diagnosis of MS can only be made after appropriate additional test results are negative. In the case of equivocal findings, repeated imaging and laboratory tests might be needed and a wait-and-see approach should be taken before starting treatment with immunomodulatory agents.
Hypoxic-ischemic lesions. The most common MS mimics radiologically are hypoxic-ischemic cerebral small-vessel disorders. They usually are asymptomatic but can present with migraine, transient ischemic attacks, stroke, or subcortical arteriosclerotic encephalopathy. In contrast to the periventricular distribution of MS lesions, hypoxic-ischemic lesions can be dominated by arterial anatomy. Lesions can be cortical infarcts, border zone, or watershed lesions; lacunes; or multifocal basal ganglia lesions.
In addition, infratentorial lesions are specific for MS, but also occur in small-vessel disorders. Although these lesions are typically located at the surface of the pons, at the base of the fourth ventricle, and in the intra-axial tri-geminal tract in MS, they are usually centrally located in the pons in subcortical arteriosclerotic encephalopathy.
Acute disseminated encephalomyelitis (ADEM). ADEM, another common MS mimic, is a monophasic immune-mediated demyelinating disease that usually occurs in response to an infection or vaccination. In the acute phase, multifocal and commonly symmetrically distributed white matter lesions tend to uniformly enhance on MRI. Dawson fingers, corpus callosum, and periventricular white matter lesions are relatively absent compared with such signs in MS. Rather, lesions are typically located in the basal ganglia and thalamus.
Follow-up MRI can be very useful in the differential diagnosis because lesions in ADEM tend to resolve or remain unchanged with no new lesions being formed, whereas the appearance of new lesions is common in MS, although cases of recurrent ADEM have been reported.26
Immune-mediated diseases. In systemic immune-mediated diseases, such as systemic lupus erythematosus and Behçet disease, MRI abnormalities may be indistinguishable from those of MS. However, the predominance of lesions located at the cortical or subcortical junction, as well as the concomitant finding of brain infarcts, calcification, or hemorrhages, should always raise the suspicion of neuropsychiatric, systemic immune-mediated diseases; small-vessel vasculitides; or antiphospholipid antibody syndrome. In these disorders, enhancing lesions and T1 black holes are much less common than in MS. Also, spinal cord lesions are rare and can completely disappear after corticosteroid or immunosuppressive treatment.27,28
In patients with Behçet disease and CNS involvement, brain stem and basal ganglia lesions can be extensive and may be associated with swelling and enhancement in the acute phase and shrink at follow-up, leading to regional atrophy, which is less common in MS.28
Progressive multifocal leukoencephalopathy (PML). PML needs particular mention because of recent reports regarding its development in patients taking the humanized monoclonal antibody natalizumab (Tysabri) and interferon beta 1a (Avonex).29,30 PML, which is caused by infection of oligodendrocytes by the JC virus, usually occurs in immunocompromised patients.
MRI scans show multifocal and asymmetric lesions in the cerebral white matter that typically start in a juxtacortical location and progressively enlarge within weeks. These lesions never develop in the optic nerves, very rarely develop in the spinal cord, and rarely display mass effect.31 Most cases show no gadolinium enhancement.30 Although no imaging feature is pathognomonic of MS or PML, in the future, MRI findings could be used to help distinguish these 2 pathologies.
HIGH-MAGNETIC FIELD MRI
With the introduction of 3 tesla (3T) MRI systems into clinical practice, several questions arise, including the comparability of 3T versus lower-than-3T imaging data. Studies comparing 1.5T with high-field MRI up to 4T revealed an increased sensitivity (up to 45%) in the detection of white matter abnormalities in patients with MS at higher magnetic fields.32 A more recent study33 has shown that high-field MRI (ie, 3T) has a substantial influence on the classification of patients with CIS according to imaging criteria. In this prospective intra-individual comparative study, 40 patients with CIS were studied consecutively with a 1.5T and 3T MRI system. Eleven patients (~ 28%) fulfilled more MRI criteria at 3T. This will have consequences for prognosis and clinical trials.
The past few years have seen increasing improvements in imaging for the diagnosis and management of MS. MRI criteria have been incorporated into formal clinical diagnostic criteria for MS, and the incidence of misdiagnosis is becoming less frequent. However, because the presence of multiple lesions on MRI is not specific for MS, particular caution should be exerted, especially in the presence of MRI red flags or features "not suggestive" of MS.
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