Fostering News: Why do we let greedy financiers profit from the pain of foster children?
The three girls were born to others elsewhere, yet she calls them her daughters. She is all the family they have here. She helps with their homework and cuddles them through the inevitable tears. Their home is now her Liverpool terrace, its books jostling with African art. Maria is their foster mum. Over 10 years, she has cared for kids so troubled it hurts to hear the bare details. They come to her after being sexually abused at home, and then groomed by strangers. Teenagers are so unsettled they can't even use the toilet – instead they urinate behind the sofa and leave turds in shoeboxes. Ten-year-olds speak only with fists – which they sometimes use on her.
Maria's life can be counted in police callouts, urgent summonses to see headteachers, and sleepless nights. It's 24-hour work that takes every scrap of physical and emotional effort: two children were so troublesome that for four years she never got a full night's sleep. That means she's paid less than the minimum wage of £7.50 an hour. But it's never about the cash. These children come to her with no hope, no smiles, no joy, "and then you see them blossom into who they really are – and that's cracking, that's what makes it worthwhile".
I visited Maria and her girls just a few days ago, as Carillion hit the news. Her world, with both tea and love on tap, could not seem further from PFI hospitals and HS2 tunnels. Yet over the past few years, unknown to the public, foster care has become thoroughly Carillion-ised. Just like the collapsed construction firm, it is now a big business that is utterly parasitic on the state and reliant on dubious financial engineering.
I understand why politicians and pundits now predict the end of the costly private-sector infiltration of public services. But to see what is happening in foster care is to realise a grim truth: the debt-ridden, return-greedy business model that has ruined Britain has wormed its way into the most private areas of our lives. It has penetrated even the intimacy of child-rearing.
Central to the new business of fostering is austerity. Because of spending cuts, the sector is booming, taking more money from councils – and thus making the cuts to come far bigger. The household benefits cap, the two-child limit for poor families, the precarious low-paying jobs market: all are helping to tear families apart – and pushing more children into care. In England, 72,000 children are in care, a total that has risen every year for nine years.
For most of us, such figures bring despondency. Among financiers, however, they represent opportunity. In 2013, the Financial Times reported that private-equity barons were sniffing around this "growth market". Analysts called fostering "a classic private equity play".
Sure enough, the barons have upended the industry. Once there were hundreds of private fostering outfits, typically small and set up by former social workers, but now finance firms have hoovered up many of them. The result is an expensive oligopoly.
Take Maria's home city of Liverpool, where almost 900 children live with foster parents. Private agencies take care of just under a third of those – at a cost of over two-thirds, £10.5m, of the council's £15m fostering budget. A city hit so hard by austerity that it teeters on the verge of bankruptcy now spends so much on private foster care it has had to cut back even more on vital services.
Nor is Liverpool alone. In a 2016 report, the government adviser Martin Narey found that private foster agencies were "charging almost 92% more" than local authorities.
The National Association of Fostering Providers (NAFP), which represents all the major chains, among others, can see "very little evidence that compares the cost of like-for-like placements of children in foster care". Yet Liverpool council provided me with just such a comparison. It has recently recruited a carer from a for-profit agency, who looks after two girls and a boy, aged seven and under. For that, the agency had charged the council £1,956.40 a week. Now she's in-house, the fee has fallen to £758.34. No wonder Liverpool's cabinet member for children's services, Barry Kushner, is recruiting more carers for the council.
There is a difference between paying for foster care, which is labour-intensive, and profiteering off the backs of children. The big money certainly doesn't reach the carers. Before joining the council as a foster mother, Maria worked for a private agency – on the same pay.
One reason for agencies to charge more is that they take on older children with more complex needs. The NAFP argues: "Local authorities tend to place less complex children with their own in-house foster carers." Yet Kushner reports a senior manager at a giant private agency telling him: "We want older children. We want complex needs." This is a business model based on monetising vulnerability.
These are children who have been through more concentrated trauma than most adults ever have to face. They should be all that counts. Instead, they are cogs in giant financial machinery. Take the biggest firm of all, the National Fostering Agency. In the past six years it has been passed between three private equity shops. It's currently under Stirling Square Capital Partners – which also owns businesses making "premium trousers", running holiday parks and deploying armed guards.
The National Fostering Agency is held by a division called SSCP Spring Topco. Going by its last published accounts, it has been loaded up with vast expenses and debt, so much so that it paid no corporation tax in the 18 months to March 2016. Further down is a note that discloses that the foster care business is carrying a loan for £62.5m from yet another division of Stirling Square Capital, this one based in Luxembourg. The annual interest on that loan is 14% and it runs for 10 years. Neither the National Fostering Agency nor Stirling Square Capital wished to respond to my list of questions, but this looks like a way to funnel millions spent by British taxpayers on disadvantaged children out of the country to a tax haven. As the Guardian reports, such chicanery is common among the financiers who now run foster care.
Foster care agencies run for profit by private equity investors are pushing up the cost of placing vulnerable children with families, local authorities have warned.
Concern about independent foster agencies (IFAs) came as a Guardian investigation revealed that one of the largest firms in the sector channelled money to Luxembourg via a complex loan arrangement. Analysis of the accounts of several private equity-owned IFAs, which charge councils to match children with foster carers, also reveals multimillion-pound dividends paid to investors and six-figure salaries for directors.
The details emerged ahead of the government's national fostering stocktake, which is due to report on the sector. Ahead of the report, councillors and foster care veterans voiced concern at the effect of IFAs on council budgets. IFAs typically pay carers higher fees than local authorities and sometimes offer "golden handshakes" worth up to £3,000 to poach them from rival agencies.
David Simmonds, a Conservative councillor who is vice-chair of the Local Government Association (LGA), said that if cash constrained local authorities could pay carers more to retain them they would end up spending less overall.
Carers are in short supply, but councils are legally obliged to find a foster home for vulnerable children, meaning they are often forced to turn to IFAs if they don't have in-house carers. Fees paid to IFAs per foster child are almost 92% higher than those paid directly to carers registered with the council, according to a 2016 report by government adviser Sir Martin Narey, with the average fee per week rising to £759 for IFAs, from £396 for council-registered carers.
Narey said the gulf was "very large", even if there were some reasons other than profit to explain it – such as IFA-registered carers taking on more challenging cases. According to Coventry city council, its IFA placements cost £40,000 on average per year compared with £30,000 for council-registered placements.
The number of children living with foster carers registered to IFAs rose 5% to 17,410 from 2012 to 2016, according to government figures, compared with a 1% rise in children with carers registered directly to the council, to 34,395.
Liverpool councillor Barry Kushner said the cost of paying inflated fees to IFAs had cost the council an extra £6m in one year. He said the council has begun trying to lure foster families back in-house by offering incentives such as reduced council tax, training and free leisure centre passes.
A spate of mergers and acquisitions among foster care firms, typified by last year's £400m tie-up between the National Fostering Agency and rival Acorn, has fuelled concern about IFAs.
Andy Elvin, chief executive of fostering and adoption charity TACT, warned that consolidation would reduce competition.
The merger between Acorn and NFA created a vast fostering company owned by private equity group Stirling Square Capital Partners (SSCP).
Analysis by the Guardian of accounts filed at Companies House reveals that the firm uses a corporate structure that transfers money to a parent company in Luxembourg. SSCP owns the firms via subsidiary SSCP Spring Topco, which had annual revenues of £104m but lost £21m after hefty interest payments on loans. This included an interest payment on a £62.5m loan from the Luxembourg parent company. Interest payments have the effect of reducing a company's taxable profit.
The accounts also show that SSCP Spring Topco's highest-paid director took home £319,345 for the year. The Guardian has contacted Stirling Square for comment about whether the loan structure generates a tax benefit.
Two other companies in the sector, Orange Grove Fostercare and Partnerships in Children's Services (PICS), are owned by private equity group Sovereign Capital. Labyrinthine accounts for the Orange Grove group show that a parent company, Boston Holdo B, paid investors a dividend of £1.7m last year and took investor loans of £5.4m, paying an interest rate of 14%.
Sister company PICS paid £2.2m interest on borrowings including £14m of loans from investors, some of whom were company directors. The highest paid director took home £200,000, including pension contributions.
Sovereign said the high-interest loans were "normal practice" and that it paid all "applicable" tax.
Elvin said: "Any money leaving the system is not being spent directly on vulnerable children. Therefore all dividends, bonuses etc are being paid directly from taxpayers' money allocated to be spent on children in care.
In late 2016, The Children's Family Trust (CFT) applied for a sum of money from the National Lottery to fund a project titled 'Ace in the Pack'. The hope for this project was to develop our current Children's Guides for our Looked after Children, making the information that needs to be accessible to them more user-friendly and interactive. With the support of Paul and Max from 'C&T', we anxiously awaited the outcome of this application and began thinking about how this money could help us develop our current packs.
We are absolutely thrilled to announce that we were successful in our application and thanks to the National Lottery, we have been able to completely re-vamp our guides for looked after children and bring them into the 21st century!
Each playing card is representative of a different piece of information, message or topic. Given the generosity of the National Lottery, we wanted to make sure that our cards are looking progressively towards the future and therefore, in an age where technology is paramount, we decided to incorporate the use of QR codes to elaborate on the snippets of information displayed on each card. We understand that not everyone will have access or be able to use a smart phone or tablet to scan the QR codes, therefore they are just additional information for our children and young people, expanding on the information already provided on the playing cards.
The information detailed on our cards was created in consultation with a group of young people in our care, as well as a team of staff with differing experiences of fostering and skills. By combining these groups of people, we were able to ensure that our cards not only met the requirements of the children's guide for our organization, but also took into consideration the kinds of information that our looked after young people felt would be beneficial to other children in our care. As children are at the heart of CFT, we wanted to involve them in this project and we were thrilled to have the participation of some of our children and young people who feature on the cards as they talk about their experiences and give advice from their time in care. We would like to thank Callum (age 16) and Adam (age 15) for all their hard work and input on this project, they really demonstrated their creative ability and passion towards a project, especially when working with Paul and Max to be filmed and helping to edit some of the content!
Previously our children's guides were issued dependent on a child's age, however going forward, we wanted to recognize that there is no 'one size fits all' when it comes to children and young people, and therefore wanted to equip the children in our care with additional information or 'extras' we feel would be useful for them, appropriate to their level of understanding.
In addition to our new interactive cards, each child or young person will now receive a non-branded welcome bag which containing a pack of the our playing cards, a wallet containing information for important contacts, a notepad and a weekly planner with dry wipe pen. In addition to this, our children and young people will also be issued with leaflets appropriate for them. These additional extras, along with the 'Ace in the Pack' playing cards, will make up our brand new children's guide which will be issued to all our children and young people in early 2018.
Once again we would really like to thank everyone involved in this project including Paul & Max at C&T, Callum and Adam and the staff closely involved in this project, Jayne Figgett, Shelley Candlin, Emma Higgs and Connie Ingles.
We hope you are all as excited about the new guides as we are and we hope that our children will enjoy using them as they play their way through important information!
The Foster Care Co-operative (FCC) will be working with Shaping Our Lives and the University of Worcester on some groundbreaking research - looking at what barriers potentially stop disabled people from becoming foster carers, and how these barriers could be overcome.
Gail Granger, one of FCC's social workers based in the Midlands, is lending her experience to the project in order to provide an 'industry perspective' and an 'employer's voice'. This will support Dr Peter Unwin, Principal Lecturer in Social Work at the University of Worcester, and the research he has initiated.
The research, entitled 'Mutual Benefits: the potential of disabled people as foster carers', will be funded by a grant from the DRILL programme (Disability Research on Independent Living and Learning) – which is a £5 million research programme funded by the National Lottery.
It is very important that the fostering task should be as inclusive as possible. Not only does this enable more people to become carers, but it also provides diverse carer-to-child matching options when looking to provide children with a home. In theory, the better the match, the more stable the placement should be.
Other than some very wide criteria and a full assessment and checking process, the main requirement for becoming a foster carer is to be able to care for children in your home. If this criteria can be met, there shouldn't be any reason why a person can't become a carer – no matter what disability they may have.
FCC are very much looking forward to the results of this research, along with how any barriers to disabled people becoming foster carers can be overcome. They are also extremely proud of Gail for lending her expertise to this ground-breaking piece of research.
You can read more about the research here.
Thousands of new foster carers are required each year in order to care for vulnerable children. If you are thinking about becoming a foster carer or you have some questions about fostering eligibility, you can call FCC on 0800 0856 538 or message them here.
We welcome Nadhim Zahawi to his new role as Parliamentary Under Secretary of State at the Department for Education. We note with some concern that this is an unpaid position, and truly hope this is not a reflection of the priority placed on the role by this Government. Indeed, it is vital that his appointment marks the start of an increased profile for children's social care as well as a new period of stability within the Department for Education, especially given the importance of 2018 for fostering. We will be seeking a meeting with Mr Zahawi at the earliest opportunity.
We look forward to the release of the national fostering stocktake report as soon as possible – it is essential that publication is not delayed as a result of the ministerial change. We would urge the Minister to fulfil the Government's commitment to consult widely with the fostering sector – including foster carers and especially fostered children and young people - on the report's recommendations before making any decisions on the direction forward.
The Minister will also have a vital role in driving forward the much-needed improvements to fostering that result from the stocktake consultation. While 2017 saw a significant focus on fostering, with the Education Committee's inquiry and the stocktake, it was a year of conversation, introspection and discussion rather than action, momentum and change. This is the year when change must happen within fostering, and we need the Minister to lead the way - thousands of fostered children and young people, as well as the families that care for them, are depending upon him to deliver.
"The figures highlight the rising demand on children's services which have insufficient resources. We are working closely with local authorities on preventative strategies that support families to reduce the likelihood of children being taken into care.
However, without enough secure, stable and caring foster families, children in care risk being moved around; placed somewhere that's not right for them or separated from siblings because there is a need for 7,180 more foster families in the UK.
We need more loving carers to foster children especially those who are older, disabled, are from ethnic minorities, and siblings, as they often struggle to find families.
Fostering can be a life changing, life enriching experience for carers and children. Barnardo's views its relationship with foster carers as a partnership offering continued support, training and advice for as long as it is needed."
Staff development is an integral part of working at St Christopher's. At various points in your career you have the opportunity to apply for funding to complete training in a relevant area.
Sam, manager of a 16+ service, asked for support to complete a counselling and psychotherapy certificate.
"Since October 2017, I've been studying for a Certificate in Counselling and Psychotherapy at the Tavistock and Portman NHS Foundation Trust, a specialist mental health trust based in North London. I have been attending a seminar and lecture every Tuesday morning, reading set texts and completing observations from my placement.
"The lectures and seminars give me an opportunity to develop my understanding of psychodynamic psychotherapy and psychoanalysis, and this further underpins the theoretical background on how I work.
"For my placement I was fortunate enough to be able to use the St Christopher's football team, which I am involved with two nights per week. Writing my observations of the sessions has helped me keep an objective eye while participating in them and reflecting more deeply on the psychological factors at play. This is further aided by the work group discussions that I participate in at the course.
"The course is giving me a greater understanding of the development of the young people I work with, but it is just as applicable to the staff I work with. It's helped me understand how development that occurs in infancy, childhood and adolescence is no less relevant to adults and I've become more aware of my own emotional states and subsequent responses.
Want to work for a charity that invests in your development? Take a look at St Christopher's vacancies today.
Children and young people from Team Fostering recently spent time with care home residents at Broadacres Care Home, Rotherham, as part of a scheme to bring young and elderly together. It was arranged as part of our Volunteer Programme, which helps young people develop a range of skills and experience to enhance future employment prospects.
The young people spent several hours with the residents over the festive period, playing board games and pass the parcel. The group of children and residents read poems and books together, performed songs and took part in a festive quiz.
Julie Eveleigh, Interim Manager at the home, said: "Team Fostering approached us to bring the children in to entertain our residents.
"They put on a buffet and kept the residents company with games, music and dancing.
The children and young people who took part in the scheme worked incredibly hard and have taken a lot from the experience. Broadacres have invited the young people back for future events and activities, and this was a fantastic scheme which really brightened up the festive season for both parties.
Foster carers provide an invaluable service for thousands of young people. Yet as the Education Committee found in our fostering inquiry, the reality is that the foster care system in England is under significant pressure. Some of the most vulnerable young people in our society are being failed by a care system which doesn't meet their needs. In our report, we have been very clear that efforts need to be redoubled to ensure that as a country that we value foster children, foster carers, and foster care.
For too many children and young people, their experience of care is that of something which is done to them, not with them. As we would expect, there are laws and guidelines intended to encourage placement stability and the involvement of young people in decision-making about their care. But the sad fact is that this isn't always applied in practice. One young person we heard from said they had been through eight placements in four years, another spoke about having 'moved six times in less than no time', while another had lived in thirteen different foster placements and two children's homes in five years. This frequency of placement can only be damaging to children's wellbeing, their development and their future prospects. More needs to be done by government to ensure young people and children don't face the prospect of a dizzying number of foster care placements.
In our report, we also made clear that young people should be placed with their siblings whenever it is possible and appropriate to do so. There must be greater efforts by social workers and others to facilitate regular and meaningful contact when it is not. Indeed, there must be greater involvement and better information for foster children on their placements, and a consistency of practice to ensure all young people are able to benefit from an appropriate and positive experience of foster care.
Foster carers have a really important role in society and often provide fantastic care in difficult circumstances. But foster carers are underappreciated, undermined, and undervalued. We believe the Department for Education should step up and show they truly value foster carers by establishing a national college, which would work towards improving working conditions for carers, provide a resource for training and support, and give them a national voice and representation. It is only right that these hugely committed carers are given the support they need to help improve the lives of the young people in their care. A national recruitment and awareness campaign initiated by the Department for Education could also help to improve capacity in the system.
Too often foster carers also have to trudge through bureaucratic treacle. Too many carers are not adequately supported, neither financially nor professionally, in the vital work that they do. The government needs to ensure all foster carers are paid at least the national minimum allowance. Ministers must also look to make sure this allowance matches rises in living costs and allow carers to meet the needs of those they are caring for.
The government's move to extend the extra 15 hours a week childcare entitlement to children in foster care is to be welcomed. This followed strong representations from the Education Select Committee and it is much appreciated that Justine Greening and Robert Goodwill acted on this issue. We hope that DfE ministers will seriously consider the recommendations of our fostering report and ensure that children and young people can then receive the help they need to enable them to climb the ladder of opportunity and thrive in their lives ahead.
We asked one of our foster children to list things she would like from her 'forever family', when the time came to move on. The first item at the top of her list was her own horse. She loved riding, so it came as no surprise to us. We didn't want to spoil her dream, but at this point we had no idea how, or if, we might be able to help make her dream come true.
Saying goodbye is one of the biggest challenges faced by foster carers, as well as for the children and young people in their care. We have fostered for more than eight years, and it does not get any easier.
We are short-term foster carers, so when each placement begins there is a presumption that it is a temporary arrangement until a permanent home can be found. 'Short-term' may not be quite what you expect. Experience has taught us to expect a placement to last for about one year, but often it takes longer. Our most recent placement, which ended in late November, lasted for almost two years.
The children become part of our family. That's not just my wife and I, and our two daughters. It also includes grandparents, aunts and uncles, and cousins. And these days there's a grandson too, and another on the way. When the children leave us, they say goodbye to the whole clan. It is tough for everyone, and their absence is keenly felt.
With that in mind, we do all that we can to prepare our foster children for the next stage. We try to include them as far as possible, to make sure that the outcome is not only in their best interest but enables them to fulfil their aspirations. Most, but certainly not all, say they want to stay with us until they become adults. The promise we make to them is that their forever home will be even better than ours, or we will not let them go. We really mean it. It is a big promise and I know it makes social workers fret, for foster carers are not meant to make that sort of commitment. But if we are not ambitious for 'our' children, and prepared to fight on their behalf, what is it that we are trying to achieve?
Hence the list, which becomes a starting point for conversations about their future, whether they are returning to their birth family home, being cared for by a close relative, staying in long-term foster or residential care or being adopted. It may change over time, as their horizons expand. But it remains as a constant reminder to those responsible for their futures, including us, that we should aspire for the very best.
In a sense, the first steps towards the moment when we must say goodbye are taken when the children arrive, and everything we do is rooted in the need to help them thrive in the big wide world beyond our doorstep. Some children have profound needs; some must simply rediscover their self-belief to be ready for take-off. Whether it is reading or practicing maths, learning carpentry or playing football, flying a kite or playing cards, these are all life skills that most children and young people take for granted. One of our young people was surprised to learn that both our daughters drove their own cars. Since that day, one of her ambitions is to pass her driving test, get a job and buy a car. I have no doubt that she will do just that.
I'd be lying if I said it did not break my heart each time a child leaves our home. But I hope that when the time comes we have helped them acquire the skills and the wisdom to help them on their journey. That is what fostering is really all about. And I also hope we have kept our promise that their new home will be even better than ours.
And, by the way, our former foster daughter has recently ticked off that item at the top of her list, and is now the proud owner of her own horse, called T-Bone. Just so you know, dreams do come true.


make xen tools, if it fail see bellow.
./configure --enable-xen --target-list=i386-softmmu --extra-cflags="-I$path_to_xen_source/tools/include -I$path_to_xen_source/tools/libxc -I$path_to_xen_source/tools/xenstore" --extra-ldflags="-L$path_to_xen_source/tools/libxc -L$path_to_xen_source/tools/xenstore"
Troubleshooting compilation errors: If you get an error from configure like "ERROR: User requested feature xen ERROR: configure was not able to find it" then see this: http://xen.1045712.n5.nabble.com/Upstream-Qemu-With-Xen-configuration-problem-td4561779.html , ie. you need to point the paths for "configure" to xen source directory, not to xen dist directory.
Add "device_model = path/to/new/qemu" in your VM configuration files.
Replace /usr/lib/xen/bin/qemu-dm by the qemu present in i386-softmmu/qemu of the build of QEMU.
with the last xen-unstable, device_model_version = 'qemu-xen' is needed in the guest configuration file.
Now xl will always try run qemu upstream with seabios, so build xen with seabios.
As of commit ee2bc468cbc7 in that tree no patches to SeaBIOS are required.
Build Xen, at least make tools to update the "xen-bios"
tips: make -C tools/firmware clean before make tools to take into account the new SEABIOS_DIR parameter.


CSSC Wärtsilä Engine (Shanghai) Co. Ltd (CWEC) – a joint venture (JV) between Wärtsilä and CSSC – has announced that it has commenced the construction of its new 20 000 m2 factory in Lingang, Shanghai, China. It will be the first factory in China capable of locally manufacturing large bore medium speed diesel and dual-fuel engines. Its local nature will also provide both CSSC Group and other Chinese yards with greater access to Wärtsilä's range of engines, as well as improved delivery times and pricing.
In particular, CWEC will target offshore and LNG markets, which are both currently experiencing significant growth in China. Additionally, it will target the large container vessel industry.
Wärtsilä 26, Wärtsilä 32, Wärtsilä 34DF, and Wärtsilä 46F engines will all be produced at the new factory, and are expected to be ready for delivery by 2016. The factory is capable of producing 180 engines per year.
Following the ground breaking ceremony, CWEC and the Hudong Zhonghua and Shanghai Waigaoqia (SWS) shipyards signed strategic cooperation agreements, which will be crucial in the promotion of efficient ship design and solutions development. In addition to this, a letter of intent was signed with the SWS for the delivery of Wärtsilä Auxpac 32 generating sets for three large container ships, which are being built in the yard, in 2017.


Welcome to Shedd Aquarium's Early Science Learning professional development digital badging program! Educators who take part in this program will explore topics surrounding inquiry-based early science learning within an online community of educators while gaining valuable classroom connections.
The goal of this program is to offer a flexible, interactive professional development program for early science learning educators that brings together a community of educators.
learn about inquiry as a student-centered science experience.
discover tips for maximizing the classroom environment to encourage science exploration.
gain strategies to empower young learners in the inquiry classroom.
uncover tips for creating a student-centered classroom.
learn about inquiry skills, their meaning and how to implement them in your classroom.
As an educator, you will complete a series of missions which are mini-lessons and activities surrounding inquiry-based learning, inquiry skills and early science learning topics. After a brief introduction, you will dive into the inquiry process by trying out techniques and lessons in your classroom. Finally, you will learn how to sustain inquiry and inform others about the great work you do in your classroom. All teachers who complete the program will receive 20 CPDUs, digital badges to share on social networks and a signed letter to present to their administrators.
What is digital badging and how does it work?
Digital badging is unlike any type of professional development you've participated in before! To complete missions, you may be asked to take pictures, watch videos, interact with other educators and discover new resources. One of the best features of digital badging is that it's completely at your own pace. You will be able to complete all missions from the comfort of your home and classroom, with consistent support from Shedd Aquarium staff members. You will have the ability to ask questions and receive assistance throughout all aspects of the program.
If you need technical or logistical support, please contact us.
PNC Grow Up Great is a comprehensive bilingual program designed to help prepare children – especially underserved children – from birth to age 5 for success in school and life. Through Grow Up Great, PNC provides the leadership, advocacy, funding, resources and volunteers to help parents, caregivers and communities in their efforts to increase the potential for young children to succeed.
To get started on your badging journey, click on "Badges" at the top of the page. Badges should be completed in the order in which they are presented.
Registration for this program is closed. If you are a current participant, please log-in under 'Returning Users'.


When an adult suffers a traumatic injury, our Trauma Center is ready to respond 24 hours a day. The Trauma Center combines the latest technology with exceptional staff to provide the highest level of care to trauma patients in the region.
It is the only adult Level I Trauma Center in eastern Wisconsin. Severely injured patients from as far away as Pierce, Rusk and Oneida counties in Wisconsin are brought to the Trauma Center for life-saving care.
Trauma is any serious injury caused by an external force, such as a motor vehicle crash, falls, violence, sports- or recreational-related injuries and job-related injuries.
What Does "Level I" Mean?
A trauma center is not the same as a hospital emergency department; emergency services are only part of a comprehensive trauma program. A Level I facility must have the capability of providing total care for every aspect of injury, from injury prevention to rehabilitation.
Learn how to prevent injury with our full range of programs and resources!
Have prompt availability of specialists in trauma surgery, orthopaedic surgery, neurosurgery, surgical critical care, rehabilitation medicine and emergency medicine to adequately respond to and care for the various forms of trauma. In addition, specialists in anesthesiology, radiology, plastic surgery, oral and maxillofacial surgery and internal medicine also need to be readily available.
Have an operating room dedicated solely to trauma patients.
Provide injury prevention programs in the community.
Provide professional education for physicians, nurses, emergency medical services personnel and physician liaisons.
Conduct resident training in general surgery, orthopaedic surgery and neurosurgery.
Conduct research — a commitment to research is primarily what separates Level I trauma centers from Level II trauma centers. At Froedtert & the Medical College of Wisconsin, a strong relationship between Medical College of Wisconsin researchers and care providers keeps the Trauma Center on the leading edge of the latest advances in trauma care.
Level I trauma centers in most states, including Wisconsin, are designated by the American College of Surgeons (ACS) for three-year periods. Lower levels of trauma care are provided by trauma centers that have Level II, Level III and Level IV designations.
Our Trauma Center offers "Stop the Bleed" information and training. Stop the Bleed training can help you save a life if you're a bystander to trauma. The goal is teach you how to stop uncontrolled bleeding with basic hemorrhage control techniques, such as pressure, packing or a tourniquet.
In 2016, 3,238 severely injured patients were seen in the Trauma Center. The Froedtert & MCW health network is proud to support this vital community resource to improve the health of the populations we serve.
Falls remain the greatest cause of traumatic injury among patients at the trauma center, accounting for 37 percent of cases — closely followed by motor vehicle crashes (23 percent) in 2016.
Most patients (64 percent) in 2016 arrived at the Trauma Center via advanced life support transport (paramedic).
Flight For Life, staffed with flight nurses and flight paramedics or physicians for rapid transport of patients to the Trauma Center from an injury scene or transfer from another hospital.
The Trauma Center is a member of regional and state organizations dedicated to coordinating trauma care and preventing injuries, including the South East Regional Trauma Advisory Council (SERTAC). In addition, Medical College of Wisconsin faculty members hold positions on the state Trauma Advisory Committee, the state EMS Physician Advisory Committee for the Wisconsin Department of Health Services, and serve as the current State Trauma System Medical Director.


The European Food Safety Authority (EFSA) has recently published a guidance document for assessing potential risks arising from applications of nanoscience and nanotechnologies in the food and feed chain. The EFSA guidance, prepared in response to a request from the European Commission, is the first of its kind and provides practical guidance on the physico-chemical characterisation requirements of engineered nanomaterials used e.g. as food additives, enzymes, flavourings, food contact materials, novel foods, feed additives and pesticides and; testing approaches to identify and characterise hazards arising from the nanoproperties.
To assist with the practical use of the guidance, six scenarios are presented which outline different toxicity testing approaches. For each scenario, the guidance indicates the type of testing required.
EFSA conducted a public consultation on its preparatory work, acknowledging the importance of developing risk assessment methodologies in this field to support innovation whilst ensuring the safety of food and feed. In total 256 comments were received from 36 organisations spanning from academia, NGOs, industry to Member State and international authorities. All of these contributions were considered and incorporated into the guidance document where appropriate.
Risk assessment of engineered nanomaterials is under fast development and consequently, in keeping with EFSA's commitment to review its guidance for risk assessment on an ongoing basis, this work will be revised as appropriate.


text:
French teenager in Trump's jail for jogging
United States President Donald Trump's war on immigrants does not only cause much injustice at the United States-Mexican border. Also at the United States-Canadian border.
From Heavy.com in the USA:
Cedella Roman: 5 Fast Facts You Need to Know
By Paul Farrell
Cedella Roman is the French teenager [who] was held by U.S. authorities for two weeks after she accidentally jogged across the U.S.-Canadian border. In an interview with the CBC, Roman, 19, said that she was jogging along the beach on May 21 in White Rock, British Columbia, when she was forced off the beach due to the tide. After going on to a dirt path and stopping to take a photo of the coastline, Roman says, "An officer stopped me and started telling me I had crossed the border illegally. I told him I had not done it on purpose, and that I didn't understand what was happening."
Roman is a citizen of France and was in British Columbia to visit her mother in the town of North Delta. Roman told CBC that she didn't have any documents with her during her jog. She said, "I said to myself, well I may have crossed the border — but they'll probably only give me a fine or they'll tell me to go back to Canada or they'll give me a warning."
1. Roman Was Held in the Tacoma Northwest Detention Center, Over 120 Miles From Where She Was Arrested
Roman told CBC in her interview that she was taken to the Tacoma Northwest Detention Center, some 120 miles from where she was first taken into custody. Roman said, "They put me in the caged vehicles and brought me into their facility. They asked me to remove all my personal belongings with my jewellery, they searched me everywhere. Then I understood it was getting very serious, and I started to cry a bit."
The Tacoma Northwest Detention Center is a privately run immigration prison that is run on behalf of the Department of Homeland Security.
2. Despite Roman's Mother's Attempts to Get Her Daughter Back, the Teenager Spent 2 Weeks in Tacoma
Roman's mother Christine Ferne told CBC that she immediately went to Tacoma as soon as she learned her daughter had been arrested. Ferne brought her daughter's passport and Canadian student visa documents. Ferne said that officials in Tacoma told her that she must go to Immigration Canada to ensure that Roman was permitted to be brought back to Canada. Ferne told the network, "It was just unfair that there was nothing, no sign at the border. It's like a trap … anybody can be caught at the border like this." The CBC report says that Roman was released on June 6 and Roman's family don't know if she will ever be able to return to the United States.
3. Roman Says on Her Facebook Page that She Is From a French Town that Is Right on the France-Italy Border
According to her Facebook page, Roman says she lives in Vancouver, British Columbia. On that profile, Roman says she is originally from the town of Briancon, France, in the south-eastern part of the country, north of Nice and close to the Italian border.
The story on Roman's ordeal published in the Bellingham Herald, a newspaper based on the U.S. side of the border in Washington state, begins with the words, "The moral of the story is when you go out for a run, walk or hike, know where you are – exactly where you are."
4. U.S. Officials Say Roman's Treatment Was Done 'Accordingly'
In a statement quoted in the CBC story, a U.S. Customs spokesperson said that Roman was "processed accordingly." The teen's treatment was in keeping with the policy of detaining and processing people who are deemed to have crossed the border at non-entry points. The spokesperson is quoted as saying, "This applies regardless of whether or not the individual claims to have inadvertently crossed the border."
5. The Canadian-U.S. Border 'Isn't Marked in the Traditional Way'
This 2018 video is called Why the U.S.Canada Border Is The Most Bizarre Border in the World…
According to the Province, the Canadian-U.S. border "isn't marked in the traditional way." Areas of the border include "no-touch zones", an 18 foot area that separates the two countries.
I myself have been in United States territory once: the ferry from Vancouver island to Vancouver city in Canada goes for a few minutes through United States territorial waters. Trump was not president yet. So there was no United States navy stopping us. I saw only killer whales. If the trade war between Trump and the Canadian government will escalate further, will United States warships then attack that ferry and arrest all the passengers and crew?
What do you tell your kids about borders? Crossing into Canada a few days ago, I warned my 9-yr-old, Saira (not her real name), not to giggle. Crossing was a breeze. Coming back, I said, would take longer…
— Jeff Sharlet (@JeffSharlet) July 29, 2018
Canada's ruling elite is whipping up anti-refugee xenophobia with the twin aims of turning politics sharply to the right and diverting attention away from its agenda of austerity and war. While the Conservatives are leading the way with appeals to far-right and outright racist forces, Justin Trudeau's federal Liberal government is presiding over the deportation of desperate asylum-seekers and working closely with the Trump administration to strengthen security at the Canada-US border: here.
This entry was posted in Human rights and tagged Canada by petrel41. Bookmark the permalink.
18 thoughts on "French teenager in Trump's jail for jogging"
OIKOS™-Redaktion on June 23, 2018 at 5:25 pm said:
Thats really crazy. It seems in future we all need our own security guide for living in freedom. ;-( Michael
petrel41 on June 23, 2018 at 6:50 pm said:
Yes, a 'crime' to cross a border … where no one can see it is a border.
And if the mother would not have reacted so quickly, then her daughter would have been for yet longer in a private prison (uneducated guards, lots of ill treatment and sexual abuse).
Really, and it sounds like Canada isnt a democratic state. ;-(
In this case, it is the United States border patrol, not the Canadian government.
Yes i know, but i never heared before about so big differences between Canada and the USA.
Pingback: Donald Trump's anti-human rights nightmare update | Dear Kitty. Some blog
petrel41 on June 27, 2018 at 11:18 am said:
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petrel41 on August 13, 2018 at 8:43 am said:
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redpajama_set_name: RedPajamaCommonCrawl


One of the reasons to be pleased about this upcoming plant, according to you, is "the plant will provide new and guaranteed demand for natural gas". How do you know that? Having potential buyers does not mean that more product in the marketplace creates more demand. Based on supply-demand principles, this plant will obviously create new supply. I tend to think that more supply does not lead to more demand, especially in the oil and gas industries. I presume that Royal Dutch Shell hopes for more natural gas demand? Where will demand come from? What new residential, industrial, and commercial customers will they find and when do they expect to see revenue from it?
Hasn't Valero already done this?
I HAVE EXPERIENCE WORKING IN A SIMILAR SETUP IN THE U.S. AND MEXICO.
The new NEXUS pipeline being built to the north east will help with demand from this plant!!!


American alternative rock band, formed in Bellingham, Washington in 1997.The band is composed of Ben Gibbard (vocals, guitar, piano), Nick Harmer (bass), Dave Depper (guitar, keyboards, vocals), Zac Rae (keyboards, guitar), and Jason McGerr (drums). In 2014, founding guitaristand producer Chris Walla announced that he would be departing from the band after recording their eighth studio album, Kintsugi.The band was originally a solo project by Ben Gibbard, when he released the demo album You Can Play These Songs with Chords to positive reception. This led to a record deal with Barsuk Records.Gibbard decided to expand the project into a complete band, releasing their debut album Something About Airplanes in 1998, and their second album, We Have the Facts and We're Voting Yes, in 2000; both records were positively received in the indie community. Their third album, 2001's The Photo Album, gave the band their first charting single.


text:
"It's a simple thing, but that's important," Lee said. "If you're coming from the sideline, you have to scream a player's name."
And this is where Lee believes the breakdown occurred. KU defensive coordinator Clint Bowen has had success this year using different personnel packages to give confusing looks to opposing quarterbacks.
That takes good communication, though. In this instance, something as simple as a player coming into the game without telling someone else to run off resulted in the use of an important timeout.
"Last week there were some things," KU coach David Beaty said, "that we have to clean up as a staff."
And this all is part of a recurring problem for Beaty in Year 4 of his KU tenure: The Jayhawks, for many different reasons, continue to burn timeouts at an alarming rate.
On Saturday, KU used five, with none of them coming as a clock-stopping measure.
"I can assure you we have a plan to get that fixed," Beaty said. "That won't happen again."
Though KU had been mostly clean in this area the last two weeks, it struggled in the season opener as well; fourth-down indecision and offensive confusion contributed to the team taking five other non-clock-stopping timeouts.
Saturday's issues, according to Beaty, were different.
He said twice — including the time KU had 12 men on the field in the fourth quarter and also another play two minutes earlier — KU had trouble when trying to sub in fresh defensive linemen.
"There's no excuse," Beaty said. "You've got to get that taken care of, and we just didn't handle it."
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KU linebacker Joe Dineen also said, while specifically catering to Baylor's offense, Bowen had put in some new defensive packages last week.
"It sounds fundamental, but just substituting and how you substitute is really important. Obviously, we wasted some timeouts doing it," Dineen said. "That's something we can't have."
KU stopped play for other reasons as well.
In the first half, Beaty called timeout before a Gabriel Rui 48-yard field-goal attempt on a fourth-and-22. After the break, KU still attempted the kick, with Rui missing.
Beaty also used a timeout late in the first half when Baylor showed blitz on a third-and-8, which left KU's offensive players scrambling to adjust.
Finally, late in the third quarter, Beaty halted the game while hoping that the replay official would take a look at a potential targeting penalty on Baylor after KU came up short on a fourth-and-9 pass. The play was not reviewed.
"We wanted them to get a look at it because we were down three scores at that point, and we really needed to extend that drive," Beaty said. "That was a big, big deal for us, so we felt like that was well used there. Unfortunately it didn't go our way."
The final two timeouts of the half, for Beaty, weren't as acceptable. Though timeout usage might not be KU's most pressing problem, it certainly is one that is difficult to miss, even among the most casual of fans.
It's something Beaty vows will improve in future weeks.
"That's a combination of all of us that are involved in that, players included," Beaty said. "There's a shared responsibility there, and we've got to get it managed better."
Jesse Newell
Jesse Newell covers University of Kansas athletics for The Star.
Kansas coach David Beaty Jerry Larson AP
Behind the Scenes with Kansas Football (Official Trailer)
Kansas coach Les Miles on his grass-eating history
KU's Bill Self honored as 2019 Kansan of the Year at banquet in Washington, D.C.
By Gary Bedore
KU basketball coach Bill Self was honored as 2019 Kansan of the Year at a banquet of the Kansas Society of Washington, D.C., on Wednesday night.
MORE UNIVERSITY OF KANSAS
KU offers basketball scholarships to Nos. 16- and 20-ranked players in Class of 2021
Dajuan Harris, latest player to commit to KU, has bond with Jayhawk Christian Braun
Les Miles explains the origins of his grass-eating habit; it started in the 1960s
KU will sell beer, wine at home football games starting this fall
KU offers scholarship to another MOKAN Elite player: Kennedy Chandler of Tennessee
Former KU fan favorite Julian Wright returns to Sprint Center on Saturday


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The UK Could Be the First Country to Intentionally Give People Coronavirus to Test Vaccines
Ed Cara
A Union Jack flag flutters in front of Big Ben in London, England.
Photo: Jack Taylor (Getty Images)
The UK is considering a controversial approach to testing potential vaccines for the coronavirus that causes covid-19: intentionally exposing volunteers to the virus, in a strategy known as challenge trials.
Last week, the Financial Times reported that the UK government will allow human challenge vaccine trials to begin by January 2021. In these trials, volunteers would be given an experimental vaccine and then later exposed to the coronavirus in a controlled setting. These trials, advocates say, will speed up the development of covid-19 vaccines, though other experts have worried about the potential health risks to volunteers.
At this point, however, the status of these trials still appears to be in flux. A spokesperson for the UK's Department for Business, Enterprise and Industrial Strategy said in a statement to Gizmodo: "We are working with partners to understand how we might collaborate on the potential development of a COVID-19 vaccine through human challenge studies."
Last Thursday, the pharmaceutical company Open Orphan, which the Financial Times reported will be involved in running these trials, said that it was in "advanced negotiation" with the UK government and other partners to begin these trials but that there "can be no certainty that these discussions will lead to a new contract until final negotiations are concluded."
A representative for another reported partner, the Imperial College London, declined to comment on the report specifically, telling Gizmodo via email that "Imperial continues to engage in a wide range of exploratory discussions relating to COVID-19 research, with a variety of partners."
According to the Financial Times, the challenge trials would be held at a facility used for quarantine in East London. Further details about how many people are expected to volunteer or how many vaccines will be tested still appear uncertain, though pharmaceutical companies such as Sanofi and AstraZeneca have said that they will not be involved.
Challenge trials aren't a new thing in medicine. Ideally, they help fast-track research into infectious diseases like covid-19. Rather than wait potentially months or more for people given an experimental vaccine to become naturally exposed to the target germ, for instance, you can just study how they respond right from the get-go. Not only could this speed up human trials, but it could provide crucial insight into the natural history of a disease, both in how it sickens someone and in how the body fights back, since doctors would be there to monitor the person from the very beginning of their infection.
But though challenge trials have been used in the past to test some of the first vaccines and drugs ever developed, the design of those trials would be considered unethical and dangerous by today's standards. In modern times, they have been used to study diseases like the flu, tuberculosis, and dengue, including to test out potential vaccines.
The problem is that it can be hard to develop challenge trials that don't place people at too much risk. Challenge trials tend to work with well-known diseases that are treatable with existing medications or have strains milder than the more common variety in the wild. But neither option is really feasible for covid-19, which is approaching 1 million recorded fatalities worldwide (steroid drugs may help save the most severe cases, but their benefits are modest).
In lieu of this, advocates for a covid-19 challenge trial—most prominently led by the organization 1DaySooner—have proposed only using young, healthy adult volunteers, arguing that they face the least amount of risk from the viral illness. While it's true that younger people are much less likely to die from covid-19, critics have noted that we don't really have a firm grasp on the potential long-term complications of even a seemingly mild covid-19 case.
Another consideration is that challenge vaccine trials are usually used for diseases that are tricky to track in real time or may not be common in a natural setting. In countries like the U.S., however, covid-19 is still very prevalent, so it probably won't be hard for people to become exposed to it. In the UK, daily new reported cases were very low during the summer, but the pandemic looks to be making a comeback both there and throughout Europe in recent weeks. By January, though, who knows what things will look like.
In any case, all vaccine trials—challenge or not—will be vetted for approval by the UK's regulatory authorities. It's likely that challenge trials will be especially scrutinized for safety concerns, both locally and by others such as the World Health Organization. For what it's worth, there seem to be no shortage of potential volunteers. According to the Financial Times, at least 2,000 people in the UK have pledged to volunteer for a challenge trial through 1DaySooner.
ScienceHealth


The Courtyard by Marriott offers either self parking or valet parking for $12/day, with in-and-out access to the the Sophia Street Parking Garage (600 Sophia St, Fredericksburg 22401). Get your parking pass at the front desk.
Self-parkers who do not need in-and-out access can save $4/day by going directly to the garage.
Please observe signs when parking temporarily on the street or in downtown lots. Decal rules and time limits are strictly enforced by the city.
Saturday parking has been reserved in the Monroe North and Monroe South lots off Sunken Road. Please park only where you see the ECACECS signs, as cars may be ticketed or towed elsewhere. Monroe is #39 on this campus map.


text:
Blauwe Gerrit, Blaauw Garrit of Blauwbroek is een fictief wezen dat vooral in sagen uit de Veluwe een rol speelt. Het wordt wel gezien als een aapachtig (maar onzichtbaar) plaagwezen.

Blauwe Gerrit springt volgens de verhalen mensen op verlaten plekken op de schouders en maakt zichzelf steeds zwaarder. Als men de bewoonde wereld bereikt, is men uitgeput. Wandelaars die in een karrenspoor lopen, duwt hij aan de kant (vooral waar twee wegen of paden elkaar kruisen). Hij danst als een blauw licht door de struiken. Zijn ogen gloeien als schoteltjes. Tussen de huizen van mensen heeft hij weinig macht.

De plaaggeest doet zelden iemand kwaad, maar grijpt wel in als onrecht dreigt.

Verhalen
De jonker van Bussloo kwam op een winteravond in de buurt van Voorst met een lege weitas. Hij ziet Hanna, de zeventienjarige dochter van een arme weduwe en grijpt haar. Hij neemt haar mee op zijn paard, maar het meisje gilt en zegt Blauwe Gerrit te zien. De jonker gelooft niet in dit soort verhalen, maar zijn paard staat schuimbekkend stil en wil niet meer voor- of achteruit. Als een visioen toont het wezen zich; de jonker en het meisje zien het spook met ogen als vurige bollen, gehuld in een wapperend lichtgevend blauw kleed. De jonker steekt met zijn wapen, maar er is slechts lucht. De jonker ontsnapt te voet, maar Blauwe Gerrit laat het paard met rust en springt op de rug van de man. De jonker stuurt Hanna op het paard naar de pastoor van Gietel, hij heeft een toverboek. Maar Hanna rijdt naar haar moeder en beiden danken God. Ze vergeten de pastoor te waarschuwen en de jonker wordt pas bij daglicht van de zware last verlost. Hij komt met angstzweet in Bussloo terug en lijkt dertig jaar ouder geworden in deze nacht. Hanna brengt het paard terug en krijgt twee handen vol goud van de jonker. Ze is verlost van de armoede.

Een molenaar nam een grote schep uit de meelzak, veel meer dan hem toekwam. De schop werd zo zwaar als lood en kon niet meer uit de zak gehaald worden. De molenaar hoorde gegrinnik en het leek alsof er iets wegging, daarna kon hij de schop weer bewegen.

Blauwe Gerrit springt op zwaarbeladen wagens, vooral bij voerlieden die te veel gedronken hebben. De kar is niet meer vooruit te krijgen.

Achtergrond
Het verhaal werd voor het eerst uit de volksmond opgetekend rond 1900.
Er zijn vele versies van hetzelfde verhaal uit Gelderland bekend.
Blauwe Gerrit is de naam die op de Veluwe gegeven wordt aan een alf (natuurgeest uit de Noordse- en Germaanse mythologie, zie ook kabouter en elf).
In de Middeleeuwen werden alven beschreven als duivelse wezens die in het onderaardse dodenrijk of de onderwereld huisden.
Blauwe Gerrit heeft overeenkomsten met andere kwelgeesten, zoals de Ossaert, Flodder, Lange Wapper en Kludde.
Zie ook Glüende Gerrit, spookt in Woeste Hoeve.
Ook in de Kempen is een soortgelijke verschijning, de Gloeiige.

Zie ook
 Volksverhalen van Nederland

Nederlandse folklore
Sage
Veluwe
Volksverhaal
Wezen uit folklore
Spook

redpajama_set_name: RedPajamaWikipedia


These are the rules of the sea.
If you're on a boat you must wave to anyone who waves at you from another boat, you must wave to anyone who waves at you from land, and you must initiate waving to as many other boats as possible.
The only way you can avoid these rules is if you're a dog, or a pirate, or both.
You must also wave to anyone floating in the water on a tube and vice-versa.
And don't be so quick to exempt Fido; I've seen people (drunk, perhaps, but still) wave their dogs' paws as they passed. True story.
I've never seen them do it with a pirate-dog, though, so I guess that exception still applies.
I have definitely seen waving dogs as well. Very awesome.
As an avid boater, this is one of my favourite awesome things to date. Boating people are friendly people and darn if we won't wave and everything and everyone we pass.
I always meet the nicest people when I take a boat out on the lake.
It's almost impossible to be in a bad mood when you're out on a boat (unless you get motion sickness … that tends to put a damper on the day). My family used to go boating all the time, too, and I agree — everyone's very friendly and happy. Makes me miss our boat!
I was thinking the same thing Becky. On dirt roads esp. We wave at any and all we pass on the road going to home…and we know only a few of them!
My favorite awesome thing so far!! Its so true…everyone waves, even when speeding 35mph past each other! I have had a boat all my life and without fail, this waving ritual happens at least 10 times per outing; it makes me smile.
This is a great one. Such an awesome feeling!
Waving anything and to anyone is seriously AWESOME!
:) Aw i like this one! Specially cause yesterday i went to the beach and we waved to the boats!!
That dog is a bonus! 2 awesome things today, 1) waving (which I frankly do pretty much everywhere I go…), and 2) THAT DOG! Thanks for putting one up on labor day, I didn't dare get my hopes up but I was so happy when I saw the post today!
I rode the ferry from Delaware to New Jersey this past summer and made good of this rule. There were many boats on the water that day, all who were extremely willing participants in this awesome exchange.
Same thing applies if you ride a motorcycle.
Laura is correct in remarking that anyone actually in the water should also be waved to. However, if that person is in some difficulty and is waving back vigorously it's advisable to stop waving and get some help!
I did this in Paris! All the drunk French people were very happy to wave at me and my tourist friends on our cruise of la Seine! haha.
Yay Jeeps! I used to drive a Jeep, and was big into the "Jeep wave". There seemed to be a hiearchy of sorts.. it was always cooler to wave if you had the top down on your jeep, when another driver still had their top up.. but it was EVEN COOLER if you had taken the doors off your jeep (a common practice in the summer time), and you could do your "jeep wave" out the side of the car where the door was supposed to be.
Admittedly, this was before I met my wife and she taught me the important rule of "safety first". Now doors remain on our vehicles at all times.
I also practice this rule of the sea while traveling on a Greyhound…"Hello, I wish I driving in your car"!
I enjoy waving to the crew hanging around on deck on the ships going up and down the Welland Canal.
I enjoy going up and down the Welland Canal! I love going through locks in a small boat and chatting with the people around you.
I think this is the same with hiking. I think 5 different folks waved enthusiastically to me on my hike. Maybe they thought I was somebody famous.
One of your awesome things should be having your own site and winning a Webby award!!
Haha, that dog seriously just made my day! So funny!!
I would argue that if 2 pirate dogs are on separate boats, that they are obligated to wave to one another. That would then be awesome.
I was about to say – that Pirate dog sure looks like he just farted..
And it smells just ARRRRGGGGGHHHH-ful..
We wave to each other on dirt roads out here, but it's mostly because we need to be certain that someone will stop and help you when you break down miles and miles from anything.
i loveee this. my favorite is when cruise ships leave port before the other cruise ship, and everyone on both boats are waving good bye to each other.
I completely agree with "Boat Waving" and also with "Country Road" waving! Here in Texas, once you pull off the asphalt, you must wave to everyone, whether you know then or not! If you don't have one already, you need to save a spot for "country road waving".
This is absolutely true !!!
Actually I don't see bass fisherman waving to boaters.
Its awesome feeling but i like to wave to children only specially bcoz when there parents r busy in driving they get boared and u also get an awesome response.
It makes ur day as well as that child's day……..
try it in road traffic etc.
That's what I say the wave means.
If only we could bring these good habits that we practice on the water to the roads (other than our bikers)! The same peeps that do a happy wave on the water should do a friendly nod on the road once in a while, right?!!


Architecture defined by humanity, progress, and trust.
Lammey + Giorgio was built on a foundation of trust with their clients. To move to the next level, they needed an identity that leveraged not only that trust, but their progressive side as well.
Create an identity that didn't alienate their then current clients, but allowed the firm to attract new talent and find more diverse projects.
In interviews with clients and the team, my research partner and I were able to gain insights into the firm. In a collaborative workshop with Lammey + Giorgio, we addressed those insights and planned for the visual design phase.
The Lammey + Giorgio brand is a visual chameleon, flexible enough to appear minimal and honest in one context and dynamic and progressive in another.


text:
BUILD Grant 2021
BUILD Grant Update April 2021
BUILD Grant Update –April 23, 2021
The City of Billings was awarded a BUILD grant in September of 2020. To keep the City Council updated on activities and milestones, this update will be provided monthly. Information will be provided by the Public Works Engineering Division, Planning Division and City Administration.
The draft agreement template was received by the City on March 26. Staff has started reviewing the agreement template. Note: The agreement cannot be submitted until the construction documents are ready. This means the City will need to complete the right-of-way purchase, environmental documents and final construction documents before the agreement is sent to Federal Highways (FHWA) for its review. Staff anticipates that the draft agreement could be sent this fall (more on the right-of-way and environmental process below). It is anticipated that the FHWA review and signing could take up to 6-months. This tentatively puts an executed agreement to April 2022. Once the city receives the executed agreement, the project can be bid. These tentative dates do not take in account the potential for some back and forth between the city and FHWA on the final agreement.
There are two active Engineering items on the IBL. We anticipate receiving the six appraisals for right-of-way procurement from Mr. Repac this week, after he worked through the various federal requirements. Additionally, we have been in contact with an environmental professional that has completed the NEPA environmental process for other recent TIGER and BUILD grants as required for federal funding. At this time, based on several discussions with the professional services firm, we anticipate the fee being less than $50,000 such that the work can be contracted direct. We anticipate completing the environmental scoping and contracting this week, and look to have the environmental (NEPA) work completed within about 6 months from contracting. The 6 months includes consultant work to prepare the field review and reports, submittals by the consultant to various agencies, and review by agencies for approval.
Planning continues to work on setting up the numerous progress reports that will be required FHWA to administer the grant.
Working with the city's FHWA representative, we are developing a date for a public announcement and press release as official kick off of the project. Staff will be coordinating between FHWA, Congressional delegation, and Mayor/Council for the event timing.
Next steps: Continue initial review of the agreement, continue right-of-way procurement and environmental work. Staff will continue with regular meetings and correspondence with our FHWA representative. Schedule public announcement and press event.
BUILD Grant Update February 2021
BUILD Grant Update May 2021
BUILD Grant Update June 2021
BUILD Grant Update July 2021
BUILD Grant Update October 2021
BUILD Grant Update January 2022
Grant Submission


Realty ONE Group's 10,000 nationwide agents now have access to 200 branded items, including collateral, apparel, premiums items and signage through an online store created and managed by BFC.
The single sign-on portal replaced a variety of sites and internal processes, allowing for increased efficiency and brand management, with the option for easy updates and editing, along with agent personalization. To learn more about Realty ONE Group, click on realtyonegroup.com.


I would not be surprised to hear "Lori I have been trying forever and no matter what I do I can't seem to get it, find it, or get rid of it.
It is a very common complaint and this is my suggestion for you.
Stop trying and start loving.
For example. if you have been trying to lose weight See if you can notice the part of you that has been trying. The part of you that feels she or he is not good enough unless she or he loses the weight. By moving into loving yourself and those parts that don't feel good enough you will naturally and effortlessly start to lose weight.
Would you like to learn more about loving yourself and how it can change your life? Join me in an upcoming class, where you will learn and experience how to start cultivating your own approval and self love. Click the link below to find out more.


text:
Deposit return scheme for Scotland: summary
Published: 1 Aug 2018
Environment and Forestry Directorate
Business, industry and innovation, Environment and climate change, Money and tax
Summary of the Deposit Return Scheme for Scotland consultation paper.
Where you will be able to get the deposit back? (Questions 14 to 16)
What is a Deposit Return Scheme?
Why are we introducing a Deposit Return System in Scotland?
What are the options for a Scottish deposit return scheme?
What materials will be collected? (Questions 1 to 6)
What types of products will have a deposit on them? (Questions 7 to 13)
How the scheme is communicated so everyone understands it? (Question 22)
How much the deposit should be? (Questions 25 and 26)
How to create additional benefits from the scheme? (Questions 30 and 31)
How the scheme will be paid for? (Questions 17 to 21)
How to prevent fraud in the system? (Questions 23 and 24)
What infrastructure to put in place, and the logistics involved? (Questions 27 to 29)
Who owns the system (Questions 32 and 33)
How the system is regulated (Questions 35 to 39)
Examples of Deposit Return Schemes (Questions 40 to 48)
Example 1 – Take back to designated drop-off points
Example 2 - Take back to dedicated drop-off points and some shops (with cartons and cups)
Example 3 – Take back to any place of purchase
Example 4 - Take back to any place of purchase (with cartons and cups)
The return location, where people can return their containers and reclaim their deposit, is key to the success of a system. The two basic models (take back to a place of purchase and take back to a dedicated point) are at the heart of the four examples discussed later.
There are broadly three options for return location:
1. Take back to a place that sells drinks. This is where you would be able to take your drinks containers back to any shop that sells drinks in disposable containers. In return for providing this service, retailers would receive a handling fee, a sum of money paid for each container they take back. This option offers the widest coverage of return sites, making the system as accessible as possible for everyone and ensuring that as many items as possible are returned. The main consideration in relation to this option is the requirement it places on retailers in terms of storage and staff time for handling of containers. For sites that would require a RVM, the cost, location and maintenance of this would need to be considered.
2. Return to designated drop-off points. This is where items are returned to a central collection point, rather than there being lots of smaller ones in shops and public places. This would most often be a RVM, or a bank of them, in a centralised location. It could be located at a local waste disposal site. This option would minimise the impact on retailers, as their role in it would be to ensure the deposit is charged but they would not be required to take back items. As there would be fewer return points, it would likely mean the system would be less accessible, particularly in sparsely populated areas or for those who cannot take returnable containers any great distance.
3. A mixture of take back to a place of purchase and take back to a dedicated point. In this option, larger retailers in particular would be required to accept returns, probably through hosting automated RVMs. There would also be other return sites, perhaps in shopping centres or other civic amenities, operated by the system administrator. Smaller retailers would be expected to accept returns if there were no other return sites within a reasonable distance.
Online grocery shopping is a popular option for some consumers. Including online delivery vehicles as a return location would increase accessibility, particularly for those who are unable to access shops or other return points.
We will work with retailers and the system administrator to ensure those who shop online are not unfairly disadvantaged by the system. We are aware that a number of European systems already accommodate online shopping or are adapting their systems to do so and will therefore be able to learn from their experience and include measures from the outset of the scheme. One approach could be to require shops that provide delivery to take back items at the same time as delivering goods, with the refunds either being provided electronically or being taken off the next shopping bill.
Tim Chant


Federated Farmers says the Government must hold firm on a deal for agriculture at the Trans Pacific Partnership talks in Hawaii.
Federated Farmers' Dairy Chair Andrew Hoggard is adamant that the reason for New Zealand being at the 12 nation talks is to establish free trade in the region, and a trade deal that doesn't include meaningful access for dairy is not a free trade deal.
"We would hope that the Americans will show strong leadership and stand with New Zealand and Australia in looking for a comprehensive deal for dairy. Anything else is just not in their national interest, nor their dairy farmers' interests," Andrew Hoggard says.
Federated Farmers' President William Rolleston cites the public position of Canadian dairy farmers in the media this morning as unacceptable.
PreviousWill poor TPP dairy outcome stop National selling our homes?


text:
Brain topics
Spine topics
New Patient Guide
Brain Services
PM&R Services
PSA's
PATIENT Log in
Trigeminal Neuralgia (facial pain)
Trigeminal neuralgia is extreme pain and muscle spasms in the face. Attacks of intense, electric shock-like facial pain can occur without warning or be triggered by touching specific areas of the face. Although the exact cause of trigeminal neuralgia is not fully understood, a blood vessel is often found compressing the nerve. Medication, injections, surgery, and radiation may be used to treat the pain. Each treatment offers benefits, but each has limitations. You and your doctor should determine which treatment is best for you.
What is trigeminal neuralgia?
Neuralgia is severe pain caused by injury or damage to a nerve. The trigeminal nerve is the fifth (V) cranial nerve, which arises from the brainstem inside the skull. It divides into three branches and then exits the skull to supply feeling and movement to the face (Fig. 1):
Ophthalmic division (V1) provides sensation to the forehead and eye.
Maxillary division (V2) provides sensation to the cheek, upper lip, and roof of the mouth.
Mandibular division (V3) provides sensation to the jaw and lower lip; it also provides movement of the muscles involved in biting, chewing, and swallowing.
Figure 1. The trigeminal nerve supplies feeling and movement to the face. It has three divisions that branch from the trigeminal ganglion: ophthalmic division (V1) provides sensation to the forehead and eye, maxillary division (V2) provides sensation to the cheek, and mandibular division (V3) provides sensation to the jaw.
When the trigeminal nerve becomes irritated, an attack of intense pain results. Also called tic douloureux because of the uncontrollable facial twitching caused by the pain, trigeminal neuralgia is serious because it interferes with many aspects of a person's life. Typical trigeminal neuralgia involves brief instances of intense pain, like an electrical shock in one side of the face. This pain comes in repeated waves that last an hour or more. The patient may initially experience short, mild attacks, with periods of remission. But trigeminal neuralgia can progress, causing longer, frequent attacks of searing pain.
Patients describe an attack as a "pins and needles" sensation that turns into a burning or jabbing pain, or as an electrical shock that may last a few seconds or minutes. Everyday activities can trigger an episode. Some patients are sensitive in certain areas of the face, called trigger zones, which when touched cause an attack (Fig. 2). These zones are usually near the nose, lips, eyes, ear, or inside the mouth. Therefore, some patients avoid talking, eating, kissing, or drinking. Other activities, such as shaving or brushing teeth, can also trigger pain.
Figure 2. Facial areas of trigger zones. Trigger points (circles) have the greatest sensitivity.
The pain of typical trigeminal neuralgia usually has the following features:
Affects one side of the face
Can last several days or weeks, followed by a remission for months or years
Frequency of painful attacks increases over time and may become disabling
A less common form of the disorder, called atypical trigeminal neuralgia, causes a less intense, constant, dull burning or aching pain. This pain sometimes occurs with occasional electric shock-like stabs that may last a day or more. Atypical facial pain is more difficult to treat.
What are the causes?
Many believe that the protective sheath of the trigeminal nerve deteriorates, sending abnormal messages along the nerve. Like static in a telephone line, these abnormalities disrupt the normal signal of the nerve and cause pain. Several factors can cause the deterioration of this protective sheath: aging, multiple sclerosis, and tumors; but most doctors agree that it is most often caused by an abnormal vein or artery that compresses the nerve.
Some types of facial pain can result from an infected tooth, sinus infections, shingles or postherpetic neuralgia, or previous nerve injury.
Who is affected?
Trigeminal neuralgia affects 5 in every 100,000 people and occurs slightly more in women than men. Patients are usually middle age and older. Some people with multiple sclerosis also develop trigeminal neuralgia.
How is a diagnosis made?
When a person first experiences facial pain, a primary care doctor or dentist is often consulted. If the pain requires further evaluation, a consultation with a neurologist or a neurosurgeon may be recommended. The doctor examines and touches areas of your face to determine exactly where the pain is occurring and which branches of the trigeminal nerve may be affected.
The underlying causes of trigeminal neuralgia are rarely serious. However, the possibility of a tumor or multiple sclerosis must be ruled out. Therefore, a magnetic resonance imaging (MRI) scan is usually performed. An MRI FIESTA scan can detect any blood vessels compressing the nerve (Fig. 3). The diagnosis of trigeminal neuralgia is made after carefully assessing the patient's symptoms.
Figure 3. FIESTA MRI can detect blood vessels (arrow) that may be compressing the trigeminal nerve.
What treatments are available?
A variety of treatments are available, including medication, surgery, needle procedures, and radiation. First line treatment is medication. When medications fail to control pain or cause intolerable side effects, a neurosurgeon may be consulted to discuss other procedures.
Over-the-counter drugs such as aspirin and ibuprofen are not effective against trigeminal neuralgia. Anticonvulsants and muscle relaxants are prescribed to block the pain signals from the nerve. These medications are the initial treatment for trigeminal neuralgia and are used as long as the pain is controlled and the side effects do not interfere with a patient's activities. About 80% of patients experience at least short-term pain relief with medications. For effective pain control, medications must be taken on a regular schedule to maintain a constant level in the blood.
Anticonvulsants, such as carbamazepine (Tegretol), oxcarbazepine (Trileptal), gabapentin (Neurontin), phenytoin (Dilantin), lamotrigine (Lamictal), and pregabalin (Lyrica) are used to control trigeminal neuralgia pain. If the medication begins to lose effectiveness, the doctor may increase the dose or switch to a different drug. Side effects may include drowsiness, unsteadiness, nausea, skin rash, and blood disorders. Therefore, patients are monitored routinely and undergo blood tests to ensure that the drug levels remain safe and that blood disorders do not develop. Multiple drug therapy may be necessary to control pain (e.g., Tegretol combined with Neurontin).
Muscle relaxants, such as baclofen (Lioresal), are sometimes effective in treating trigeminal neuralgia. Side effects may include confusion, nausea, and drowsiness.
The goal of surgery is to stop the blood vessel from compressing the trigeminal nerve, or to cut the nerve to keep it from sending pain signals to the brain. Surgical procedures are performed under general anesthesia, involve opening a hole in the skull (called a craniotomy), and require a 1 to 2 day hospital stay.
Microvascular decompression (MVD) is a surgery to gently reroute the blood vessel from compressing the trigeminal nerve by padding the vessel with a sponge. A 1-inch opening is made in the skull behind the ear, called a craniotomy. This opening exposes the trigeminal nerve at its connection with the brainstem. A blood vessel is often found compressing the nerve. After the nerve is freed from compression, it is protected with a small Teflon sponge (Fig. 4). The sponge remains in the brain permanently.
MVD provides immediate pain relief in 95% of patients [1]. About 20% of patients have pain recurrence within 10 years. The major benefit of MVD is that it causes little or no facial numbness. The major disadvantages are the risks of anesthesia and of undergoing an operation near the brain.
Figure 4. During MVD, a sponge is inserted between the trigeminal nerve and the blood vessel to relieve the compression that causes the painful neuralgia attacks.
Sensory rhizotomy is the irreversible cutting of the trigeminal nerve root at its connection to the brainstem. A small opening is made in the back of the skull. A stimulation probe is used to identify the motor root of the nerve. The motor root, which controls the chewing muscles, must be preserved. The sensory root fibers, which transmit the pain signals to the brain, are severed (Fig. 5). Cutting the nerve causes permanent facial numbness and should only be considered for recurrent pain that has not responded to other treatments.
Figure 5. During sensory rhizotomy, the sensory root fibers are cut, but the motor root is preserved.
Peripheral neurectomy is a type of surgery that can be performed to the nerve branches by exposing them on the face through a small skin incision. Cutting the supraorbital nerve (branch of V1 division) may be appropriate if pain is isolated to the area above the forehead. Cutting the infraorbital nerve (branch of V2 division) may be performed if pain is limited to the area below the eye along the upper cheekbone. Cutting the nerve causes complete facial numbness in the region the nerve supplies.
Radiosurgery is a noninvasive outpatient procedure that uses highly focused radiation beams to destroy some of the trigeminal nerve root fibers that produce pain. The two main technologies are the Leksell Gamma Knife and linear accelerator systems such as the BrainLab Novalis. A stereotactic head frame or facemask is attached to the patient's head to precisely localize the nerve on an MRI scan and to hold the head perfectly still during treatment. Highly focused beams of radiation are delivered to the trigeminal nerve root (Fig. 6). In the weeks after treatment, a lesion (injury) develops where the radiation occurred.
Pain relief may not occur immediately but rather gradually over time. As a result, patients continue to take pain medication for a period of time. The success of radiosurgery becomes clear when pain medication is reduced or eliminated. After 4 weeks, about 50% of patients will experience pain relief without medication or with reduced medication. After 8 weeks, 75% will have pain relief without medication or with reduced medication [3]. Complications include facial numbness and dry eye. In about 30% of patients, pain recurs 3 to 5 years after treatment [4]. Repeat radiosurgery can be effective; however, the risk of facial numbness is increased.
Figure 6. During radiosurgery, the patient's head is immobilized and beams of radiation are focused on the trigeminal nerve (top). The MRI (bottom) shows a red circle radiation dose delivered to the cisternal segment of the trigeminal nerve to damage the nerve fibers.
Outpatient needle procedures
Needle procedures are minimally invasive techniques for reaching the trigeminal nerve through the face without a skin incision or skull opening. They are performed with a hollow needle inserted through the skin (percutaneous) of the cheek into the trigeminal nerve at the base of the skull (Fig. 7). The goal of rhizotomy or injection procedures is to damage an area of the trigeminal nerve to keep it from sending pain signals to the brain. Damaging the nerve causes mild to major facial numbness in that area. A degree of facial numbness is an expected outcome of the procedure and is necessary to achieve long-term pain relief. These outpatient procedures are typically performed under local anesthesia and light sedation. Patients usually go home the same day.
Figure 7. For needle procedures, a hollow cannula is inserted near the corner of the mouth. It is passed through the cheek and into a hole in the skull to reach the trigeminal ganglion. Through the cannula an electrode, liquid glycerol, or balloons are passed.
Radiofrequency rhizotomy, also called Percutaneous Stereotactic Radiofrequency Rhizotomy (PSR), uses a heating current to selectively destroy some of the trigeminal nerve fibers that produce pain. While asleep, a hollow needle and electrode are inserted through the cheek and into the nerve. The patient is awakened and a low current is passed through the electrode to stimulate the nerve. Based on your feedback, the surgeon positions the electrode so that tingling occurs where your painful attacks are located. Once the pain-causing area is located, the patient is put back to sleep and a heating current is passed through the electrode to damage only that portion of the nerve (Fig. 8A).
PSR provides immediate pain relief for 98% of patients [1]. About 20% of patients experience pain recurrence within 15 years. Medication, repeat PSR, or another surgical procedure can be considered. Complications may include double vision, jaw weakness, loss of corneal reflex, dysesthesia (troublesome numbness) and very rarely anesthesia dolorosa. Partial facial numbness in the area where the pain existed is expected. Other complications, such as blurred vision or chewing problems, are usually temporary.
Glycerol injection is similar to PSR in that a hollow needle is passed through the cheek to the nerve. The needle is positioned in the trigeminal cistern (a fluid-filled area in the ganglion) (Fig. 8B). Glycerol is injected into the cistern to damage some of the trigeminal nerve fibers that produce pain. Because the location of the glycerol cannot be controlled precisely, the results are somewhat unpredictable.
Glycerol injection provides immediate pain relief in 70% of patients [2]. About 50% of patients experience pain recurrence within 3 to 4 years. As with PSR, partial facial numbness is expected and complications are similar.
Balloon compression is similar to PSR in that a hollow needle is passed through the cheek to the nerve. However, it is performed under general anesthesia. The surgeon places a balloon in the trigeminal nerve through a catheter. The balloon is inflated where fibers produce pain (Fig. 8C). The balloon compresses the nerve, injuring the pain-causing fibers. After several minutes the balloon and catheter are removed.
Balloon compression provides immediate pain relief for 80% of patients [2]. About 20% of patients experience pain recurrence within 3 years. Complications may include minor numbness, chewing problems, or double vision.
Figure 8. A. In radiofrequency rhizotomy, a heating current selectively destroys nerve fibers in V1, V2, or V3. B. In glycerol injection, alcohol (green) damages nerve fibers in the cistern; it is not selective to a specific division of the nerve. C. In balloon compression, inflation compresses the nerve fibers; it may be selective.
Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are found on the Web. Studies can be sponsored by the National Institutes of Health (see clinicaltrials.gov) as well as private industry and pharmaceutical companies (see www.centerwatch.com).
No one procedure is best for everyone and each procedure varies in its effectiveness versus side effects. Microvascular decompression (MVD) and radiofrequency rhizotomy (PSR) have comparable rates of long-term pain relief that are highest among the available options. In a study of approximately 100 patients or more published in the past 10 years, the rates of pain relief were 77% in 7 years for MVD and 75% in 6 years for PSR rhizotomy. Of patients treated with radiosurgery, an appropriate treatment for those who cannot undergo MVD or who wish to avoid the facial numbness associated with PSR, 60% have pain relief for 5 years.
Trigeminal neuralgia can recur in divisions of the nerve previously free of pain. This can occur following all treatments and may represent progression of the underlying disorder rather than recurrence.
Sources & links
If you have more questions, contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.
Support groups provide an opportunity for patients and their families to share experiences, receive support, and learn about advances in treatments, pain control, and medications. Please contact the TNA Facial Pain Association at 800-923-3608.
Taha JM, Tew JM Jr: Comparison of surgical treatments for trigeminal neuralgia: Reevaluation of radiofrequency rhizotomy. Neurosurgery 38:865-871, 1996
Tew JM: Therapeutic Decisions in Facial Pain. Clinical Neurosurgery 46:410-431, 2000
Tuleasca, C., Resseguier, N., Donnet, A., Roussel, P., & Gaudart, J. Patterns of pain-free response in 497 cases of classic trigeminal neuralgia treated with Gamma Knife surgery and followed up for at least 1 year. Journal of Neurosurgery, 117 Suppl, 181–188, 2012
Gronseth G, et al.: Practice Parameter: The diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review). Neurology 71:1183-90, 2008
TNA Facial Pain Association, www.fpa-support.org
American Pain Society, www.ampainsoc.org
Trigeminal Neuralgia Diagnostic Questionnaire
anesthesia dolorosa: constant pain felt in an area of total numbness; similar to phantom limb pain.
anticonvulsant: a drug that stops or prevents convulsions or seizures.
dysesthesia: a numbness, crawling, or unpleasant sensation that a person considers disturbing.
glycerol: an oily fluid that can be injected into a nerve to destroy its pain-producing portion.
multiple sclerosis: a chronic degenerative disease of the central nervous system in which the myelin (sheath) surrounding the nerves is destroyed.
neuralgia: nerve pain.
neurectomy: cutting of a nerve to relieve pain.
percutaneous: through the skin.
postherpetic neuralgia: chronic pain that persists after shingles rash and blisters have healed.
radiofrequency: radiant energy of a certain frequency.
neurectomy: cutting of a nerve for the relief of pain.
rhizotomy: interruption or destruction of a group of nerve fibers by chemical or radiowaves.
percutaneous: by way of the skin (e.g, injection).
shingles (herpes zoster): a viral infection that causes a painful skin rash and blisters along the course of a nerve; a reactivation of chickenpox.
tic douloureux: French for trigeminal neuralgia.
updated > 7.2018
reviewed by > Steven Bailey, MD and Ronald Warnick, MD, Mayfield Clinic, Cincinnati, Ohio
Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. We comply with the HONcode standard for trustworthy health information. This information is not intended to replace the medical advice of your health care provider.
Mayfield services
At Mayfield Brain & Spine, our approach to facial pain is grounded in compassion and personalized care. Our neurosurgeons are experts at diagnosing the various types of facial pain, including trigeminal neuralgia, glossopharyngeal neuralgia, cluster headache, and hemifacial spasm. We offer all available treatment options: microvascular decompression, percutaneous rhizotomy, and radiosurgery.
We treat more than 150 people with facial pain each year.
To make an appointment call 513-221-1100.
Dieter's Story : Trigeminal Neuralgia
Treatment Options for Trigeminal Neuralgia w/ Dr. Steven Bailey
Dr. Ron Warnick discusses the use of Gamma Knife in the treatment of trigeminal neuralgia on Local12 WKRC TV - 'Radiosurgery for painful nerve condition'
Q & A: Gamma Knife radiosurgery as a treatment for trigeminal neuralgia with Dr. Ron Warnick
Q. Is trigeminal neuralgia pain tougher to treat the longer you wait to have surgery?
A. TN is a progressive disorder that is associated with a mix of painful periods and remissions. The condition commonly increases in severity and becomes resistant to medications. The results of surgical therapy are best in the early stages of the disease but even the most advanced patients usually respond favorably to the best medical and surgical approaches.
Q. Does the success rate of MVD surgery go down if I first have a percutaneous procedure, such as radiofrequency rhizotomy, glycerol injection or balloon compression?
A. There is considerable evidence that failure of any procedure is associated with less success when other procedures are attempted. The basic principle of the two surgical approaches are different but interrelated. Microvascular decompression seeks to repair the basic cause of the pain, while percutaneous rhizotomy and other procedures, which block the nerve, seek to separate the pain site from its recognition in the brain. Therefore failure of one procedure effectively performed is more likely to be associated with a less satisfactory outcome with another. However recurrence of pain after a successful treatment such as percutaneous rhizotomy usually responds to another source of treatment.
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