It's easy to make your own string art projects with these 10 helpful tips! Design your own or make this project with a free printable pattern!
String art projects are such a fun way to create personal and customized decor. They make great gifts and are fun for kids elementary age and up!
About a year ago, I started collecting ampersands (& symbol) art. I love the symbol and what it stands for. And – there's more. And – no matter the crisis, this isn't the end. And – set your goal and follow through. So hopeful and motivating to think ahead! So, I wanted to create something to focus on moving forward. That's my inspiration for this project!
Measure to find the middle of your board lengthwise. Use a ruler to lightly draw a line across.
Stick painters tape on one side of the pencil line.
Using a dry brush, lightly brush paint along the angle you'd like your stripes to go. Do a few more lines to use as a guide.
*Hint – dry brushing can flip little specks of paint around so use a drop cloth or work in an area where this won't be a problem.
Fill in paint until you like how it looks. I left mine pretty rustic.
Let it dry, then peel off the tape.
Stick another piece of tape over the edge of the painted area. You want the paint to meet, so you can even leave a tiny bit of paint showing.
Use your ruler to help find what looks like the opposite angle of the stripes you've painted. You can be fancy and measure or just eyeball it.
Paint a few guide stripes then fill the area in.
Let it dry, then peel off the tape to see how it looks. If you need to do any touchups, now's the time.
Print your design, line it up where you like it on the board, and tape it down.
Hammer nails around the edges. I put mine about 1/3″ apart.
Once you have the nails in, pull your paper off. You don't want to skip this step – it would be really hard to get off after the thread is on.
Tie your thread tightly on one of the nails. Outline your project by threading around each nail, with the thread on the outside of the outline.
Fill in threads with a pattern, or randomly. I love the look of random for this project!
Work your way all around, change colors if that's part of your plan, then tie off tightly when finished.
Outline your project again to give a clean finishing look. Pull your threads to the inside of the work to hide them.
Use softer wood to make it easier to get the nails where you want them.
Be sure the nails aren't going through the back of the board.
Start with outlining your project by taking the thread around the outside of the nails, wrapping around each nail as you go.
Finish your project by outlining again. This gives it a nice, clean look.
Wrap the thread around each nail before moving on or occasionally throughout the process. It will help you keep the thread taut so you won't have to pull as hard.
Every so often, look at the board at an angle. The nails should be going in pretty straight. If they aren't, fix the problem ones.
Throughout the process, place your hand on the nails you've already put in to see if any feel way higher or lower than the others. It will help you stay consistent.
If you need to take a break, keep the thread taut and wrap it around your board a few times so you can set it down without the whole things loosening up.
Work from one side of your board to the other. It can be really awkward to get nails in the middle of an area that already has a few nails.
What projects have you made? Please share below!
Love this? Check these out too!
I have always wanted to do a String art project. I think it would be cool with a G for my last name. I'll have to try it.
That's a great idea, Julia! A G would look awesome!
I love how you painted the sign! What a cool technique! I just made my first string art last week, so fun!
Thanks Amy! How fun that you've been doing this too!
I love the look of string art! Who knew it was so easy. Thanks for sharing!!
Oh wow! This is so crafty! I didn't realize how much detail went into it! So cute!
Thanks Renee! The nice thing about string art is it can be more or less detailed, depending on the project you choose!
I've seen your projects – you'd do an amazing job!
This is so cool looking! We have been looking for ideas for our house decor!
Thanks Bethany! I love how versatility of string art – you can do any size, color, or theme you'd like!
I love this! You did such a great job! I love how clearly you wrote out the instructions – makes it seem like something that someone could easily recreate!
Thank you Mary! It's definitely a project most people could tackle!
Love string art! And great tips. Visiting from Inspire My Creativity.
What a fun and simple project! One trick I've learned to help get all my nails at the same height is to put another board on top and tap it with a hammer. This usually takes care of any little variances.
Cute! I love all things ampersand. String art is so relaxing (once you get those darned nails on there).
Thank you Jaclyn! I love ampersands too!
I love how string art has come back in style.
I do too, Pam! So much fun!
Can remember when this was quite popular in the 80's.Mr.Furry made a wonderful ship, wish we still had it. He's very good at some crafts I',m really bad at, maybe cause he has much more patience than I do.
think I would like to start out with an ampersand since I have a few of them and do our initials to start, get the feel for string art.
Been said everything comes back and string art sure has. like that it's a simple and inexpensive craft and can see how it would be habit forming.
Great way to add attractive art for very little.


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. No clue how long that will stay up. But really, it's ridiculously big for NYC and the money they're asking.
The thing that's got me in a bit of a funk is the why here. My current flatmate told me he'd need the room back at the end of the month - on the 20th - and in a really tactless and dismissive way, in a text message. I then agreed but asked if I could have more time and he said he wanted to talk about it but
never did and when I tried to never seemed to have time, meaning I've basically spent the last week walking on eggshells. I was actually thinking about looking for an efficiency I could afford on my own (which for the record does not exist in this city) and the bit that was holding me back was I didn't want to leave him stranded with no way to meet his rent.
If I'm being fair I can see where his issues were coming from. I don't think he's actually right and I could easily point out the ways the situation wasn't my fault or that he'd been a pretty crappy roommate himself over the year we'd lived together. I think it's the way it was handled, made it feel like I was just being brushed aside. And it's not made things easy. Everything had to happen so quickly and it's left me feeling like I had to jump at what's available rather than being as careful as I'd like, plus there's the money issue of moving on short notice. I'll have enough I think, but just barely. So not a lot of fun on that front.
Going to meet potential roomies has been pretty good, though, because I looked at a total of two places and got offers from both of them which makes me feel desirable, at least on a first impression. So there's that!", "url": "https://marta-bee.livejournal.com/435420.html", "image": { "@type": "ImageObject", "url": "https://l-stat.livejournal.net/img/sign.png" }, "author": { "@type": "Person", "name": "fidesquaerens", "image": "https://l-userpic.livejournal.com/122610501/34220230" }, "publisher": { "@type": "Organization", "name": "Journal marta_bee", "logo": { "@type": "ImageObject", "url": "https://marta-bee.livejournal.com", "contentUrl": "https://l-userpic.livejournal.com/122610501/34220230" } } }
The big news around here is I'm moving to a new flat. There's some practical benefits of it - slightly less isolated, slightly better part of town. This will come off sounding racist, I know, but a big part of the attraction is it's a "black" area of the Bronx rather than a "brown" one - for strictly language-based issues, mind, but it can be a bit exhausting to struggle to communicate when you don't speak the same language as a lot of people in stores and cabs and the like.
The building itself has a lot of character. Like, to get into the elevator you need to open a door, an actual door like you would to get into an apartment. It has a lovely courtyard off the street, too, which somehow feels more secure, and a backyard behind the building where you can grill out. I won't be umping games of stickball in the park like I'd been doing lately. But for the Bronx I seem to have found another spot with a bit of green. And the room itself is huge - easier larger than my studio back in Cleveland (which wasn't small), with enough space to bring my computer cart and bookshelf and probably replace the cart with a proper desk one of these days. Plus, you know, a dor that not only shuts but locks.
If you want more details and photos, here's the CraigsList ad. No clue how long that will stay up. But really, it's ridiculously big for NYC and the money they're asking.
Going to meet potential roomies has been pretty good, though, because I looked at a total of two places and got offers from both of them which makes me feel desirable, at least on a first impression. So there's that!

redpajama_set_name: RedPajamaCommonCrawl


"Low Inventory Impacts Housing Hopes"
Low inventory, shortages of land and labor, and high costs of lumber hurt home sales and construction in June.
New Home Sales also declined in June, hitting their lowest level since October 2017. Sales fell 5.3 percent from May to an annual rate of 631,000, the Commerce Department reported. Inventory of new homes for sale fared better than inventory of existing homes in June, with a 5.7-month supply of new homes available.
June Housing Starts, which measure when excavation begins on a home, also reached their lowest level since September 2017. Starts fell 12.3 percent from May to an annual rate of 1.173 million units, and they declined in all four major regions of the country. Starts were down 4.2 percent from June of last year.
Building Permits, a sign of future construction, fell 2.2 percent in June from May to an annual rate of 1.273 million. Building Permits were down 3 percent from a year ago.
Economic growth surged in the second quarter of 2018 due in part to a big rise in consumer spending. The Bureau of Economic Analysis reported that Gross Domestic Product (GDP) rose 4.1 percent from the 2.2 percent recorded in the first quarter. The report also showed that consumer spending jumped 4 percent in the second quarter from the dismal 0.5 percent in the first quarter. GDP is considered the broadest measure of economic activity.


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New Releases January 2021
The Bride of the Sun
by Gaston Leroux - adapted by Jean-Marc & Randy Lofficier - read a chapter - cover by Mike Hoffman- 228 p. - US$20.95.
Young engineer Raymond Ozoux, accompanied by his uncle, arrives in Peru to meet his fiancée, Marie-Thérèse. Meanwhile, descendents of the Incas are preparing a great feast during which a virgin will be sacrificed to the Sun, walled up alive in a secret temple. At the same time, a mysterious Inca bracelet is sent to Marie-Thérèse purporting to be a gift of the Sun to his future bride… The young girl is then kidnapped by the Incas and Raymond, his uncle and Marie-Thérèse's father set out on a trek across Peru to free her while a revolution shakes the country. A suspenseful thriller in the vein of H. Rider Haggard by the creator of Rouletabille and the Phantom of the Opera.
Tales of the Hexagonverse #2: Family Business
short story collection edited by Romain d'Huissier & J.-M. Lofficier - translated by Michael Shreve; - cover by Alfredo Macall. - 240 p. - US$20.95.
An implacable enemy is stalking the Black Lys... The Sea King faces his deadliest challenge… Jessica Puma and Roxy confront a dark sorcerer in South Central L.A.… How did Jean Vlad become The Other… Wampus strikes in Italy… Sibilla and the rest of the Enchanters invade the world of nightmares… Plus Kidz, the Time Brigade, Aster & Pinky, Joanni Bourask, Zembla and more… Hexagon Comics is one of the oldest French comics universes, with origins going back to the 1950s. Reinvented and modernized in the early 2000s, some of its best and most original characters are featured in this collection that brings together the talents of 12 international authors.
Guardian of the Republic/Kit Kappa/Night Prince
A HEXAGON COMICS STORY - written by Jean-Marc Lofficier - art & cover by Eduardo Garcia & Roberto Castro - 48 p. b&w - US$9.95
On Christmas' Eve, the GUARDIAN OF THE REPUBLIC, his sidekick MARIANNE, and the powerful NIGHT PRINCE must stop s mechanical killer. But behind it looms the sinister shadow of its creator, ASTAROTH, long thought to be dead. The GUARDIAN and MARIANNE, now assisted by KIT KAPPA and AGENT BOURASK of C.L.A.S.H., must uncoverthe villain's real goal, and defeat him before he can inflict more destruction on the City of Lights…
New Year Promotion
40% OFF IF YOU BUY FIVE BOOKS OR MORE -- ANY BOOKS! (EXCEPT EBOOKS OR ARTBOOKS). USPS FREIGHT FREE (but no guarantees). UPS FREIGHT $10. E-mail me the title(s) and I'll send you a paypal invoice, or order as usual from our site, and I will refund you the excess money.
Available in EPUB or PDF formats. Please specify which when ordering.
Félicien Champsaur: The Alluring
Gaston Danville: Double Head
Jules Hoche: The Bad Dream
Frank J. Morlock (ed.). Vidocq and the Lemonade Girl
Brian Stableford: The Painter of Spirits
Brian Stableford: The Quiet Dead
Brian Stableford: Living with the Dead
Brian Stableford (ed.): Automata
Brian Stableford (ed.): The Bald Giants
Brian Stableford (ed.): Weird Fiction in France


Highly recommended! Mystik Affair. Sophia Thomas does great work. Make sure you book her for your next special event planning.
Mystik Affair orchestrates every element of the event, starting with menus, invitations, programs, linens, lighting, flowers just the way you want it.
Has a Masters of Business Administration specializing in providing outstanding customer service, and organizing memorable events that meets every clients quality expectation.
Since opening, Mystik Affair has designed and executed weddings with a guest count up to 200, and small family affairs.
A very creative, and motivated person. She loves to see the joy in people Sophia is known for her compassion and creative ways to make your event within your budget and will create a custom package that will suit the needs of your next event.
Mystik Affair is a a family owned event planning company from Kissimmee, FL founded in 2006 with a passion to see peoples dreams come alive before their eyes. Our desire is your desire. We give our clients the attention they need. We're ready to handle every detail of an event, including rentals of round tables and accessories.
We're a locally based business that has strong ties to other companies in the area that can provide the services and items that you need for your function.
Kissimmee, FL – November 29, 2016 – WeddingWire, the nation's leading online wedding marketplace, is thrilled to announce that Mystik Affair has received the WeddingWire Rated™ Blue badge for excellence in Event/Wedding Planning and Coordinating.
As a member of WeddingWire, the world's largest wedding review site with over one million reviews, Mystik Affair achievement of Rated™ is an impressive milestone and an indication of the positive experiences expressed by their past clients. As a recipient of the Blue badge, Mystik Affair is highlighted on WeddingWire, which is comprised of over 200,000 wedding professionals throughout the United States and Canada.
"With the growing importance of online reviews, WeddingWire is pleased to celebrate the successes of the wedding professionals who have received positive reviews on WeddingWire," said Sonny Ganguly, CMO, WeddingWire. "We are honored to recognize Mystik Affair for their impressive work within the wedding industry."
Frank has a degree in Office Administration and a very keen eye for detail in set up. Now offers photography packages and video editing for every occasion.


Englishman Paul Casey has been forced to withdraw from the 2012 US Open Championship with a recurrent shoulder injury.
58th ranked Casey's withdrawal has opened the door for history to be created with Andy Zhang, an amateur from Reunion, Florida taking his place after qualifying as the first alternate in sectional qualifying.
14-year-old (born Dec. 14, 1997) Zhang, originally from the People's Republic of China, will now become the youngest competitor to play in a US Open since World War II.
Tadd Fujikawa previously held that distinction when he played at the 2006 Open at Winged Foot Golf Club, won by Geoff Ogilvy, at age 15.
The news of Zhang's historic elevation to the main draw comes 24 hours after Shanshan Feng became China's first major champion, male or female, after winning the Wegmans LPGA Championship in Rochester, New York.
Casey's withdrawal comes shortly after the USGA also announced the withdrawal of Brandt Snedeker with a rib injury, his place being taken by 2011 US Walker Cup team member Jordan Spieth from Dallas, Texas.


4BR Members represent familiar and diverse sectors in our business communities.
They provide products and services that we all need daily, monthly or on occasion. They are licensed in their chosen fields as required, dedicated to their profession and most importantly they choose to improve their skill sets continually.
Your needs as a consumer are as common and diverse as our members. You should know that they understand the importance of treating you like they'd like to be treated themselves. They are the best of business professionals, and you should feel confident in talking with them about your wants and needs on any scale.
Wednesday 4pm - Fate Brewing Co.


The salon will take place at the Methodist Church on Wine Street, Sligo at 7:30 pm on Thursday 28th March and will consist of an open forum discussion and will include food, music, and spoken word.
It will last about 2 hours and will be live streamed.
Funding for this event has been provided by the Sligo PEACE IV Programme's Small Grants Fund under the Building Positive Relations theme.


Submitting your website to Crystal Window is easy and straight forward. All you have to do is fill the form below to proceed.
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Crystal Window is committed to giving the best companies a platform to reach their desired customer and potential customers easily. We are a trusted platform and customers trust us to only provide them with the best window service companies.
That means that irrespective of whether you deal in sash windows, uPVC, VELUX windows and their parts, you will always have targeted eyeballs on your submitted site.
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With hundreds of thousands of people searching for high-quality tradesmen on Crystal Windows, there is no reason why you shouldn't be a success by getting in front of your ideal prospects.
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With our help and tools, we can help you reach more prospects by positioning you properly.
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This Bangladeshi Taka and United States Dollar convertor is up to date with exchange rates from April 22, 2019.
Enter the amount to be converted in the box to the left of Bangladeshi Taka. Use "Swap currencies" to make United States Dollar the default currency. Click on United States Dollars or Bangladeshi Taka to convert between that currency and all other currencies.
The Bangladeshi Taka is the currency in Bangladesh (BD, BGD). The United States Dollar is the currency in American Samoa (AS, ASM), British Virgin Islands (VG, VGB, BVI), El Salvador (SV, SLV), Guam (GU, GUM), Marshall Islands (MH, MHL), Micronesia (Federated States of Micronesia, FM, FSM), Northern Mariana Islands (MP, MNP), Palau (PW, PLW), Puerto Rico (PR, PRI), United States (United States of America, US, USA), Turks and Caicos Islands (TC, TCA), Virgin Islands (VI, VIR), Timor-Leste, Ecuador (EC, ECU), Johnston Island, Midway Islands, and Wake Island. The United States Dollar is also known as the American Dollar, and the US Dollar. The symbol for BDT can be written Tk. The symbol for USD can be written $. The Bangladeshi Taka is divided into 100 paisa (poisha). The United States Dollar is divided into 100 cents. The exchange rate for the Bangladeshi Taka was last updated on April 22, 2019 from Yahoo Finance. The exchange rate for the United States Dollar was last updated on April 22, 2019 from The International Monetary Fund. The BDT conversion factor has 4 significant digits. The USD conversion factor has 6 significant digits.
I like this website. Helps me alot! but do they show the most recent rates?
When converting Crore, multiply by 10M.


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Journal of Otolaryngology - Head & Neck Surgery
Impact of neuroradiologist second opinion on staging and management of head and neck cancer
John T Lysack1,2,3,4,
Monica Hoy2,
Mark E Hudon1,
Steven C Nakoneshny3,
Shamir P Chandarana2,3,
T Wayne Matthews2,3 &
Joseph C Dort2,3
Journal of Otolaryngology - Head & Neck Surgery volume 42, Article number: 39 (2013) Cite this article
Patients with head and neck cancer frequently present to academic tertiary referral centers with imaging studies that have been performed and interpreted elsewhere. At our institution, these outside head and neck imaging studies undergo formal second opinion reporting by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging. The purpose of this study was to determine the impact of this practice on cancer staging and patient management.
Our institutional review board approved the retrospective review of randomized original and second opinion reports for 94 consecutive cases of biopsy proven or clinically suspected head and neck cancer in calendar year 2010. Discrepancy rates for staging and recommended patient management were calculated and, for the 32% (30/94) of cases that subsequently went to surgery, the accuracies of the reports were determined relative to the pathologic staging gold standard.
Following neuroradiologist second opinion review, the cancer stage changed in 56% (53/94) of cases and the recommended management changed in 38% (36/94) of patients with head and neck cancer. When compared to the pathologic staging gold standard, the second opinion was correct 93% (28/30) of the time.
In a majority of patients with head and neck cancer, neuroradiologist second opinion review of their outside imaging studies resulted in an accurate change in their cancer stage and this frequently led to a change in their management plan.
Despite advances in diagnosis and treatment, head and neck cancer remains an important cause of death and disability worldwide. The most recent global estimates from the World Health Organization indicate that 845,000 new cases of head and neck cancer are diagnosed each year, with a mortality rate approaching 50% [1].
Head and neck cancer may present with a variety of symptoms and signs depending, in part, on the site of the primary tumor. The diagnosis is usually made or suspected on the basis of the clinical examination and confirmed with a biopsy of the primary lesion or a metastatic lymph node. The most important prognostic factor, after primary site, tumor type, and tumor grade, is cancer stage and, all else being equal, high-stage cancers have a poorer prognosis than low-stage cancers. Cancer stage is also a major consideration when determining appropriate treatment. For example, for some primaries, the recommended management is surgical for low-stage cancers and nonsurgical (e.g. chemoradiotherapy) for high-stage cancers. Because the primary site is usually identified clinically, and the tumor type and grade are determined by pathology, the main role of imaging in the initial management of patients with head and neck cancer is to facilitate accurate staging.
At academic tertiary referral centers, patients frequently present with imaging studies that have been performed and interpreted elsewhere [2]. At our institution, all outside head and neck imaging studies undergo formal reinterpretation by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging prior to discussion of the case at a weekly multidisciplinary tumor board. At the weekly tumor board, the multidisciplinary team reviews the clinical, pathological, and imaging data, the cancer stage is determined, and a treatment recommendation is made. The purpose of this study was to determine how frequently the neuroradiology second opinion changed staging and management, and to estimate how frequently the second opinion was accurate when compared with surgical findings.
Our institutional review board (The University of Calgary Conjoint Health Research Ethics Board) approved the retrospective review of patient data for this study, and waived the requirement for informed consent. All cases (n = 94) of biopsy proven or clinically suspected head and neck cancer presenting to our academic tertiary referral center with outside computed tomography (CT) or magnetic resonance (MR) imaging during the 2010 calendar year were retrospectively identified from our institutional head and neck cancer database (Table 1). As part of our routine practice, a fellowship-trained academic neuroradiologist with expertise in head and neck imaging and three years of post-fellowship experience had issued a formal second opinion report in all cases. Hardcopies of the original and second opinion reports were collected, randomized, and distributed to three reviewers: a fellowship-trained academic head and neck surgeon with 20 years of post-fellowship experience, an otolaryngology-head and neck surgery resident with four years of residency experience, and a fellowship-trained academic neuroradiologist with 15 years of post-fellowship experience (a different neuroradiologist than the one who had issued the second opinion reports).
Table 1 Patient and tumor characteristics
The three reviewers independently analyzed each of the 188 randomized reports (94 original radiology reports and 94 second opinion reports) and recorded the primary site, T-category (extent of primary tumor), and N-category (extent of cervical lymph node metastases) using the most recent American Joint Committee on Cancer definitions [3], as could be determined from the information found in each radiology report. To determine the reliability of the data, the inter-rater agreements for T-category and N-category for the original and second opinion reports were calculated using Fleiss' κ for multiple raters [4]; the opinion of the head and neck surgeon was considered the gold standard.
The cancer stage ('Stage 0-IV') was calculated from the T-category and N-category data according to the most recent American Joint Committee on Cancer definitions [3], as all patients had no evidence of distant metastases. Staging data were then dichotomized into low-stage (Stage 0, I, or II) vs. high-stage (Stage III or IV) groups ('Low/High Stage'), and into node-negative (N0) vs. node-positive (N1, N2, or N3) groups ('Node Negative/Positive'). The staging data derived from the original reports were compared with those from the second opinion reports, and discrepancy rates with 95% confidence intervals (95% CI) were calculated using the modified Wald method [5]. If there was a change in staging from the original report to the second opinion, the direction of change (up-staging vs. down-staging) was determined.
The head and neck surgeon also made a recommendation for patient management based on the information provided in each radiology report. He was asked, "Assuming that the information in the radiology report is correct and agrees with your clinical impression, and that the patient is agreeable, otherwise healthy, and has no contraindications, what initial management would you recommend?" His choices were: (a) surgery (resection of the primary tumor +/−lymph node dissection); (b) radiotherapy (+/−chemotherapy); (c) no treatment; and (d) don't know. For the 'don't know' cases, the surgeon recorded the reason. The surgeon's management recommendations based on the original reports were compared with those based on the second opinion reports, and discrepancy rates with 95% confidence intervals (95% CI) were calculated using the modified Wald method [5]. Fisher's exact test [6] was used to reject the null hypothesis that the surgeon's management recommendations based on the original and second opinion reports were the same.
For the subgroup of cases (n = 30) in which surgery was subsequently performed, pathologic staging data were acquired from pathology reports. The radiologic staging data were compared to the pathologic staging data and the accuracies of the original and second opinion reports were calculated. Fisher's exact test [6] was used to reject the null hypothesis that the accuracies for cancer stage of the original and second opinion reports were the same.
All tests were two-sided tests using a threshold for statistical significance of P < .05. Statistical analysis was performed using Stata 11 (StataCorp, College Station, TX).
The staging data that were extracted from the radiology reports were found to be reliable. There was 'moderate' to 'substantial' inter-rater agreement for the original reports (κ = 0.44 for T-category and κ = 0.78 for N-category) and 'substantial' to 'almost perfect' agreement for the second opinion reports (κ = 0.62 for T-category and κ = 0.89 for N-category) [7].
The discrepancy rate for cancer stage (Stage 0-IV) was 56.4% (95% CI, 46.3% − 65.9%); the discrepancy rates for staging ranged from a low of 34.0% (95% CI, 25.2% − 44.1%) for both Low/High Stage and Node Negative/Positive to a high of 66.0% (95% CI, 55.9% − 74.8%) for T-category (Table 2). Up-staging was common, occurring in 90.6% (48/53; 95% CI, 79.3% − 96.3%) of discrepant cases.
Table 2 Discrepancies in cancer staging between the original and second opinion radiology reports
Pathologic staging data were available for the 30/94 (31.9%) of cases in which surgery was subsequently performed (Table 3). When compared to the entire group, the surgical subgroup had a higher proportion of oral cavity primaries and a lower proportion of oropharyngeal primaries (Table 1), which reflects the fact that oral cavity cancers are usually treated surgically while oropharyngeal cancers are usually treated with radiotherapy +/−chemotherapy at our institution. In the surgical cases, the original radiology reports agreed with the pathologic stage (Stage 0-IV) 40.0% (12/30) of the time (Table 4) whereas the second opinion reports agreed with the pathologic stage 93.3% (28/30) of the time (P < .001). Following the second opinion, the cancer stage changed in 56.7% (17/30) of the surgical cases, and these changes were pathologically proven to be correct 94.1% (16/17) of the time (Figure 1).
Table 3 Cancer staging and recommended management based on the original and se1cond opinion radiology reports compared to the pathologic staging gold standard (n = 30)
Table 4 Accuracies of the original and second opinion radiology reports compared to the pathologic staging gold standard (n = 30)
Axial contrast enhanced CT images of the neck in an 81 year old male (Patient Z in Table 3); a fine needle aspiration biopsy of a clinically enlarged right submandibular lymph node had shown squamous cell carcinoma. (a) A plaque-like (2.5 cm in diameter × 0.5 cm in maximum thickness) enhancing mucosal lesion involving the right retromolar trigone (arrow) was not mentioned in the original radiology report but was identified as the primary tumor in the second opinion report. (b) An enlarged (2.3 cm × 1.5 cm) right level IB lymph node (arrow) was interpreted as metastatic in both the original and second opinion reports. (c) Two sub-centimeter but rounded and asymmetrically prominent right level IIA lymph nodes (arrows) were not mentioned in the original report but were interpreted as metastatic in the second opinion report. Staging was TxN1 based on the original report and T2N2b (Oral Cavity) based on the second opinion report, and the recommended management was 'don't know' based on the original report (because the primary tumor location and T-category were unclear) and 'surgery' based on the second opinion report. Surgery was subsequently performed and the final pathologic staging was T2N2b (Oral Cavity).
The discrepancy rate for patient management was 38.3% (36/94; 95% CI, 29.1% − 48.4%); most changes (77.8%; 28/36) were from 'don't know' based on the original report to one of surgery or radiotherapy (+/−chemotherapy) based on the second opinion report (Table 5). It was not possible for the surgeon to make a management recommendation based on either the original report or the second opinion report in 29.8% (28/94) of cases. In most of these cases (75.0%; 21/28), this was because of a technically inadequate or incomplete scan for which the radiologist recommended additional imaging, or a post-treatment recurrence for which the surgeon needed details of prior treatment before making a treatment decision. Despite this, the management recommendation based on the second opinion reports agreed with the actual management 60.0% (18/30; 95% CI, 42.3% − 75.4%) of the time, as compared to 33.3% (10/30; 95% CI, 19.1% − 51.3%) of the time for the original reports (P = .069).
Table 5 Differences in recommended management based on the original and second opinion radiology reports
Our study demonstrates the value of reinterpretation of head and neck imaging studies by a fellowship-trained academic neuroradiologist; such reinterpretation led to more accurate staging and better treatment decision-making. We found that, following formal second opinion reporting of outside imaging studies, there was a change in cancer stage in 56% of cases, resulting in a change in management in 38% of patients; for the surgical cases, the second opinions were pathologically proven to be correct 93% of the time.
These findings add to the evidence that subspecialty radiologist interpretation of imaging studies has a positive impact on patient care. In the head and neck cancer domain, this was first reported by Loevner et al [8]; the authors found a change in cancer stage in 34% of cases and a change in management in 40% of patients following expert radiologist reinterpretation. More recently, Wheless et al [9] showed that, following case review at a multidisciplinary head and neck tumor board, 27% of patients had a change in tumor diagnosis, stage, or treatment plan. In other oncological and non-oncological domains, studies of radiologist second opinions have found discrepancy rates of 11–49% for diagnosis or staging and 7–37% for patient management [10–16]. These rates are similar to those found for expert second opinions in pathology, with reported discrepancy rates of 7–66% (including changes from a benign to a malignant diagnosis or vice versa) resulting in a change in patient management in 1–28% [17–28]. There is much less literature on the effect of expert second opinions in clinical practice, but one study [29] has shown discrepancy rates for diagnosis and patient management of 35% and 67%, respectively.
New insights into differences in biological behaviors of head and neck cancers are leading to personalized treatment options that are becoming increasingly diverse. Parallel to this trend are advances in biologic imaging of head and neck cancer that are used to select the most appropriate treatment regimen for each individual patient [30]. As imaging techniques become more complex, the frequency of clinically significant differences in interpretation are expected to increase. Although a change in diagnosis following subspecialist reinterpretation of an imaging study does not necessarily imply a correct change in diagnosis, "second opinion best reflects a measure of diagnostic precision, which is a practical surrogate for diagnostic accuracy, given the difficulties of defining a gold standard" [31]. Thus, despite their costs in terms of increased and often uncompensated workload [2], it is likely that subspecialist second opinions will become increasingly important for high-quality patient care.
In general radiology practice, where there is the usual mixture of normal with abnormal cases, the discrepancy rate is only 3% [32]. However, for patient populations with 100% prevalence of disease, like those served by multidisciplinary tumor boards at academic tertiary referral centers, the discrepancy rate can increase by an order of magnitude [33]. The benefit of a subspecialist model of radiology practice is highlighted by a recent study [34] that showed the discrepancy rate between fellowship-trained academic neuroradiologists was only 2% despite the high prevalence of disease (92%) in that environment. A strength of the present study is that each radiology report was independently analyzed for staging information by three physician reviewers; an experienced fellowship-trained academic head and neck surgeon, a senior otolaryngology-head and neck surgery resident, and an experienced fellowship-trained academic neuroradiologist (a different neuroradiologist than the one who had issued the second opinion reports). The greater inter-rater agreement found for the second opinion reports supports the assertion that imaging reinterpretation by a subspecialist radiologist results in improved diagnostic precision.
The weaknesses of the current study are its retrospective nonblinded design and the absence of a pathologic gold standard in the nonsurgical cases. We chose a retrospective design to decrease the potential bias of secondary gain by the reinterpreting neuroradiologist who, if he knew his second opinion reports were to be subsequently scrutinized in a prospective study, might be motivated to exaggerate differences of opinion. The trade-off was to accept that the type of report (original vs. second opinion) could not be adequately blinded to the reviewers. Even if the name of the reporting radiologists and the location of the study were removed from the reports, it would be clear, based on the content and style of the report, which were second opinions. For example, imaging findings or interpretations from the original radiology reports (both correct and incorrect), as well as clinical information that might only be known at the time of the second opinion, were routinely acknowledged and discussed in the body of the second opinion reports. It was therefore not possible to redact such identifying information without substantially changing the content of the reports. Because of this, it is possible that the reviewers were biased to assign a greater degree of certainty to information contained in reports they knew to be second opinions. This would be expected to be more of a problem for the patient management recommendation component of the study than for the cancer staging component and might, at least in part, explain the relatively high frequency of 'don't know' recommendations for the original reports. However, this bias reflects the reality of clinical practice in which subspecialists may more frequently seek out additional information as is needed to provide a definitive opinion. Arguably, therefore, blinding the reviewers in this way would make the results less generalizable by inaccurately reflecting routine practice. The randomized presentation of the reports to the reviewers partially offsets this bias.
Establishing a gold standard for staging is difficult for many head and neck cancers. Using surgical pathology as the gold standard is problematic, as many patients do not undergo surgery (e.g. some tumors are primarily treated with radiotherapy) and, in those cases where surgery is performed, pathologic staging might be incomplete (e.g. local tumor resection but no lymph node dissection), inaccurate (e.g. is the muscle being infiltrated by tumor on this slide an intrinsic or extrinsic muscle of the tongue?), or insufficient (e.g. was there impaired vocal cord mobility or vocal cord fixation?). Even in cases where complete and sufficient pathologic staging information is available, it is only accurate at the time of surgery and not at the time of the scan. However, an error introduced by a scan-to-surgery delay would apply equally to the original and second opinion reports so, at minimum, the relative increase in accuracy found for the second opinion reports in this study is valid.
More than one-half of patients with head and neck cancer had a change in clinical stage following second opinion review of their outside imaging studies by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging, and this led to a change in management in greater than one-third of patients. In patients with a biopsy proven or clinically suspected malignancy, subspecialty radiologist interpretation of imaging studies has a positive impact on patient care.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010, 127: 2893-2917. 10.1002/ijc.25516.
DiPiro PJ, VanSonnenberg E, Tumeh SS, Ros PR: Volume and impact of second-opinion consultations by radiologists at a tertiary care cancer center: data. Acad Radiol. 2002, 9: 1430-1433. 10.1016/S1076-6332(03)80671-2.
AJCC: Head and neck. AJCC cancer staging manual. Edited by: Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. 2010, New York, NY: Springer, 21-100. 7
Fleiss JL: Measuring nominal scale agreement among many raters. Psychol Bull. 1971, 76: 378-382.
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Fisher RA: On the interpretation of χ2 from contingency tables, and the calculation of P. J R Stat Soc. 1922, 85: 87-94. 10.2307/2340521.
Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics. 1977, 33: 159-174. 10.2307/2529310.
Loevner LA, Sonners AI, Schulman BJ, Slawek K, Weber RS, Rosenthal DI, Moonis G, Chalian AA: Reinterpretation of cross-sectional images in patients with head and neck cancer in the setting of a multidisciplinary cancer center. AJNR Am J Neuroradiol. 2002, 23: 1622-1626.
Wheless SA, McKinney KA, Zanation AM: A prospective study of the clinical impact of a multidisciplinary head and neck tumor board. Otolaryngol Head Neck Surg. 2010, 143: 650-654. 10.1016/j.otohns.2010.07.020.
Loughrey GJ, Carrington BM, Anderson H, Dobson MJ, Lo Ying Ping F: The value of specialist oncological radiology review of cross-sectional imaging. Clin Radiol. 1999, 54: 149-154. 10.1016/S0009-9260(99)91003-6.
Tilleman EH, Phoa SS, Van Delden OM, Rauws EA, Van Gulik TM, Lameris JS, Gouma DJ: Reinterpretation of radiological imaging in patients referred to a tertiary referral centre with a suspected pancreatic or hepatobiliary malignancy: impact on treatment strategy. Eur Radiol. 2003, 13: 1095-1099.
Gollub MJ, Panicek DM, Bach AM, Penalver A, Castellino RA: Clinical importance of reinterpretation of body CT scans obtained elsewhere in patients referred for care at a tertiary cancer center. Radiology. 1999, 210: 109-112.
Briggs GM, Flynn PA, Worthington M, Rennie I, McKinstry CS: The role of specialist neuroradiology second opinion reporting: is there added value?. Clin Radiol. 2008, 63: 791-795. 10.1016/j.crad.2007.12.002.
Zan E, Yousem DM, Carone M, Lewin JS: Second-opinion consultations in neuroradiology. Radiology. 2010, 255: 135-141. 10.1148/radiol.09090831.
Newman EA, Guest AB, Helvie MA, Roubidoux MA, Chang AE, Kleer CG, Diehl KM, Cimmino VM, Pierce L, Hayes D, Newman LA, Sabel MS: Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer. 2006, 107: 2346-2351. 10.1002/cncr.22266.
Brook OR, Hakmon T, Brook A, Dudnik E, Kuten A, Engel A: The effect of a radiology conference consultation on cancer patients management. Ann Oncol. 2011, 22: 1204-1208. 10.1093/annonc/mdq581.
Kronz JD, Westra WH, Epstein JI: Mandatory second opinion surgical pathology at a large referral hospital. Cancer. 1999, 86: 2426-2435. 10.1002/(SICI)1097-0142(19991201)86:11<2426::AID-CNCR34>3.0.CO;2-3.
Bruner JM, Inouye L, Fuller GN, Langford LA: Diagnostic discrepancies and their clinical impact in a neuropathology referral practice. Cancer. 1997, 79: 796-803. 10.1002/(SICI)1097-0142(19970215)79:4<796::AID-CNCR17>3.0.CO;2-V.
Coblentz TR, Mills SE, Theodorescu D: Impact of second opinion pathology in the definitive management of patients with bladder carcinoma. Cancer. 2001, 91: 1284-1290. 10.1002/1097-0142(20010401)91:7<1284::AID-CNCR1130>3.0.CO;2-E.
Lueck N, Jensen C, Cohen MB, Weydert JA: Mandatory second opinion in cytopathology. Cancer. 2009, 117: 82-91.
Selman AE, Niemann TH, Fowler JM, Copeland LJ: Quality assurance of second opinion pathology in gynecologic oncology. Obstet Gynecol. 1999, 94: 302-306. 10.1016/S0029-7844(99)00318-X.
Bejarano PA, Koehler A, Sherman KE: Second opinion pathology in liver biopsy interpretation. Am J Gastroenterol. 2001, 96: 3158-3164. 10.1111/j.1572-0241.2001.05273.x.
Layfield LJ, Jones C, Rowe L, Gopez EV: Institutional review of outside cytology materials: a retrospective analysis of two institutions' experiences. Diagn Cytopathol. 2002, 26: 45-48. 10.1002/dc.10022.
Hahm GK, Niemann TH, Lucas JG, Frankel WL: The value of second opinion in gastrointestinal and liver pathology. Arch Pathol Lab Med. 2001, 125: 736-739.
Westra WH, Kronz JD, Eisele DW: The impact of second opinion surgical pathology on the practice of head and neck surgery: a decade experience at a large referral hospital. Head Neck. 2002, 24: 684-693. 10.1002/hed.10105.
Hamady ZZ, Mather N, Lansdown MR, Davidson L, Maclennan KA: Surgical pathological second opinion in thyroid malignancy: impact on patients' management and prognosis. Eur J Surg Oncol. 2005, 31: 74-77. 10.1016/j.ejso.2004.08.010.
Bajaj J, Morgenstern N, Sugrue C, Wasserman J, Wasserman P: Clinical impact of second opinion in thyroid fine needle aspiration cytology (FNAC): A study of 922 interinstitutional consultations. Diagn Cytopathol. 2012, 40: 422-429. 10.1002/dc.21820.
Jones K, Jordan RC: Patterns of second-opinion diagnosis in oral and maxillofacial pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010, 109: 865-869. 10.1016/j.tripleo.2009.12.023.
Wieske L, Wijers D, Richard E, Vergouwen MD, Stam J: Second opinions and tertiary referrals in neurology: a prospective observational study. J Neurol. 2008, 255: 1743-1749. 10.1007/s00415-008-0019-3.
Srinivasan A, Mohan S, Mukherji SK: Biologic imaging of head and neck cancer: the present and the future. AJNR Am J Neuroradiol. 2012, 33: 586-594. 10.3174/ajnr.A2535.
Manion E, Cohen MB, Weydert J: Mandatory second opinion in surgical pathology referral material: clinical consequences of major disagreements. Am J Surg Pathol. 2008, 32: 732-737. 10.1097/PAS.0b013e31815a04f5.
Borgstede JP, Lewis RS, Bhargavan M, Sunshine JH: RADPEER quality assurance program: a multifacility study of interpretive disagreement rates. J Am Coll Radiol. 2004, 1: 59-65. 10.1016/S1546-1440(03)00002-4.
Berlin L: Accuracy of diagnostic procedures: has it improved over the past five decades?. AJR Am J Roentgenol. 2007, 188: 1173-1178. 10.2214/AJR.06.1270.
Babiarz LS, Yousem DM: Quality control in neuroradiology: discrepancies in image interpretation among academic neuroradiologists. AJNR Am J Neuroradiol. 2012, 33: 37-42. 10.3174/ajnr.A2704.
This material has never been published and is not currently under evaluation in any other peer-reviewed publication.
Division of Neuroradiology, University of Calgary, Calgary, Alberta, Canada
John T Lysack & Mark E Hudon
Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
John T Lysack, Monica Hoy, Shamir P Chandarana, T Wayne Matthews & Joseph C Dort
The Ohlson Research Initiative, University of Calgary, Calgary, Alberta, Canada
John T Lysack, Steven C Nakoneshny, Shamir P Chandarana, T Wayne Matthews & Joseph C Dort
Department of Diagnostic Imaging, Foothills Medical Centre, 1403-29 Street NW, Calgary, AB, T2N 2T9, Canada
John T Lysack
Monica Hoy
Mark E Hudon
Steven C Nakoneshny
Shamir P Chandarana
T Wayne Matthews
Joseph C Dort
Correspondence to John T Lysack.
The authors declare that they have no competing interest.
JL and JD are responsible for study design, data collection, data analysis, and manuscript preparation. MH and MEH are responsible for data collection and manuscript preparation. SN is responsible for statistical analysis and manuscript preparation. SC and TWM are responsible for manuscript preparation. All authors read and approved the final manuscript.
Lysack, J.T., Hoy, M., Hudon, M.E. et al. Impact of neuroradiologist second opinion on staging and management of head and neck cancer. J of Otolaryngol - Head & Neck Surg 42, 39 (2013). https://doi.org/10.1186/1916-0216-42-39


text:
More incumbent Md. senators lost their primaries than in any other state
by admin | Sep 30, 2010 | News | 0 |
By Len Lazarick
More incumbent state senators in Maryland lost their primary elections than in any of the 43 states electing their senates this year, according to a study by Ballotpedia.
Of the 1,167 state senate seats at stake across the country, only 19 incumbent senators lost their primary to a challenger and six of them – nearly a third – were in Maryland. Of those 1,167 seats, only 459 had an opponent challenging an incumbent in the primary, indicating how secure their seats are.
Incumbent senators lost primaries in 11 states, but none of the other states lost more than two incumbents.
The incumbent senators that lost primaries in Maryland, with their challengers winning percentage of the vote, were: Republican Sen. Don Munson to Del. Chris Shank, 57% (District 2); Democrats Sen. Rona Kramer to Del. Karen Montgomery, 50.59% — 116 vote margin (District 14); Sen. Mike Lenett to Del. Roger Manno, 54% (District 19); Sen. Nathaniel Exum to Del. Joanne Benson, 53.7% (District 24); Sen. George Della to newcomer Bill Ferguson, 59% (District 46); and Sen. David Harrington to Del. Victor Ramirez, 63% (District 47).
It's worth noting that 14 of the 43 states with senate elections this year have term limits on their state senators, according to a chart by the National Conference of State Legislatures. Those 14 states have 523 senate seats in play, according to Ballotpedia figures. Since some states elect only a portion of their senators every two years, just three of the 43 states have more senate seats on the ballot than Maryland.
Twelve states with eight-year limits would have kept four of the six veteran Maryland incumbents off the ballot, and only Kramer would have been allowed to run in the two states with 12 year limits, Oklahoma and Nevada.
UPDATED: On Wednesday, a group of 16 candidates for the Maryland General Assembly called the Maryland Term Limits Coalition signed a pledge to support a constitutional amendment that would limit state senators to no more than two consecutive terms in office. All but one are Republicans.
Led by Ed Priola, a Republican candidate for delegate in Howard County's District 13, most of those signing the pledge were first-time candidates for the House of Delegates. Priola had once been the field director for U.S. Term Limits, an organization that pushed term-limits for state legislatures and Congress around the nation during the 1990s.
He calls his proposal "term out" — a lawmaker could serve more than two four-year terms if he or she sat out one term.
The pledge states that "the proper role of elected officials is to represent their constituents and their communities, serving for a limited period of time and then returning to private life," but "the primary focus of too many elected officials has become re-election and gaining political power in their respective parties."
UPDATED: The state Senate candidates (and their districts) signing the pledge are: Dee Hodges, 8; Rick Martel, 12; Kurt Osuch, 18; and Jay Bala, 28. The House of Delegates candidates (and their districts) are: Jeanne Turnock, 10; Michael Collins, 11; Albert Nalley 12A; Bob Wheatley, 12B; Ed Priola and Jeff Robinson, 13; Herb McMillan, 30; David Starr, 32; Democrat Joseph Gutierrez, 35A; Dustin Mills, 37A; Michael McDermott, 38B; and Al Phillips, 39.
Fifteen states now have term limits for legislators ranging from 6 to 12 years. Most of those were passed from 1990 to 1996, at the height of the term-limits movement.
Two states, Idaho and Utah, have repealed the term limits enacted at that time, and in four other states — Massachusetts, Oregon, Utah and Wyoming — they were overturned by the state Supreme Court.
"As term limits begin to take effect, many of their impacts on the legislative institution are negative," said the website of the National Conference of State Legislatures.
Over half the members of the Maryland legislature would lose their seats if a two-term limit passed.
PreviousState Roundup, September 29, 2010
NextState Roundup, September 30, 2010
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New campaign tech firm seeks to improve ground game in Md. races


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Paisley's Abbey Close is to be transformed back to medieval times with knights, jesters and musicians for a special event celebrating the town's historic Abbey.
A medieval fair featuring historic re-enactments and old-fashioned children's games, will be held in and around Paisley Abbey on Saturday 15 May as part of a weekend of events taking place in Renfrewshire, Ayrshire and Glasgow.
From Friday 14– Sunday 16 May the ancient abbeys of Paisley and Crossraguel, in Ayrshire, will be the focus of European attention as part of celebrations taking place to mark the 1,100th anniversary of the founding of the Abbey of Cluny in Burgundy, France.
The Scottish abbeys, the only two Cluniac houses in Scotland, are the furthest flung from Cluny which once had a network of over 1,400 priories stretching from Poland to Portugal, from Scotland to Italy.
The medieval fair is open to everyone and will include historic re-enactors such as an apothecary, a calligrapher, musicians, an arrow maker, a blacksmith and weavers as well as knights in combat.
There will also be a craft fair and a range of children's activities. Coach tours will run from Paisley Abbey to Crossraguel, Dundonald Castle and Kelburne Castle in Ayrshire with historic re-enactments taking place at the various venues.
Renfrewshire's Provost Celia Lawson said: "Paisley Abbey has a very rich and varied history and, along with Crossraguel in Ayrshire, is one of the only two of these monasteries in Scotland.
The Cluny celebrations in Paisley will also see leading historians and archeologists flock to the town for a major conference in Paisley Town Hall on Scotland's Cluniac Heritage.
There will also be an exhibition of medieval treasures in Paisley Museum called Chamber pots and Charters, including the Arbuthnot Missal, a French book of Hours and the chamber pot rescued from Paisley Abbey's unique Great Drain.
The evening of Saturday 15 May will see an impressive choral and organ concert in Paisley Abbey with French music of the 13th and 14th century being performed as well as the Requiem by the French composer, Duruflé.
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text:
Burwell, Butter Cross
This octagonal brick butter cross was built c1700.
The building was later adapted for use as a dovecote, and more recently has been used as a village hall.
It stands uncomfortably close to the busy A16.
Frank Robinson, January 2015
Burwell, St Michael
View of St Michael's from the south-east.
Lying above the village and built into the side of the Wold, St Michael's church, Burwell, is built partly in Spilsby sandstone and partly in brick.
It has a Norman chancel arch which is the oldest feature, Perpendicular (Georgian brick-topped) tower and signs of a vanished south aisle.
It is now in the hands of the Churches Conservation Trust.


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Read Book Morrigan Blade of Grace (Daughters of Lilith # 2) [MP3 AUDIO] Fully free!
Morrigan would give everything to get out of Chicago for a few weeks of R&R. Of course, she jumped at the chance to fly to Saint Petersburg to let off some steam. All work and no play can make even this immortal long for the excitement of the Russian nightlife.
She just has to ditch Kam her guardian angel and slip out for some fun after dark. No problem there for a red-blooded elemental like herself. Bring it!
Morrigan won't slow down though, not even for Cain or the danger that surrounds him. She's young, hot and knows what she wants, no reason not to live life to the max and have some fun while doing it.
Robin A. Dilks grew up in the small town of Midland Park New Jersey. She is a lifetime resident of the garden state.
She writes two blogs and currently works for the Ocean County Library System. When she is not at her antique store in Galloway, New Jersey she is writing fiction, blog posts, short stories, testing recipes, watching sci-fi movies or chasing her two bulldogs who are always into mischief.
She collects Japanese vintage porcelain, samurai swords, and loves target shooting with her family.She lives with her husband Tom at the shore and two of their, seven children.
Patton and Annabelle her two dogs, are her writing partners. They are always hard at work providing valuable incite into her efforts. Having been a closet writer for over twenty-five years, she began writing publically almost four years ago and has never looked back.
Her favorite saying "If you do nothing more in life do what you love. It may not make you rich, but it will always make you happy."


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Many old, decrepit buildings are seeing new life! Here are three buildings in particular that seem to have some promising results in mind.
As we've written many times before, Brooklyn is more than exciting enough to rival Manhattan's popularity; but whereas Manhattan is increasingly defined by its skyscrapers, Brooklyn's new construction rentals take on contextually aware low-rises. Here are three of our favorite new rental projects in Brooklyn in the works right now.


Both teams didn't manage to reach this summer World Cup and they are looking forward to getting prepared for another cycle of the Euro 2020.
They endes at 4th place without big chances to make more than that.They finish six points behind Sweden and Holland and take only 4 wins in 10 games.Bulgaria were playing excellent at home and they've booked all their victories at home ground. This match will be a good test since the rivals are pretty good.
Bosnian team have bigger chances and they fighting for their spot in to playoff till last round ,however they've finished two points behind Greece.Since this campaign is considered as a failure, Robert Prosinecki took over the head coach role. He already has the experience in managing national teams since he was sitting on the Azerbaijan's bench.
These two sides faced each other only once and it was also in a friendly game. Bulgaria took a win from that one in the match where both sides were able to score.
Hosts take some impressive wins at home and take in count this is frendly game I expect they to take the win here with both teams to score give decent odds.


text:
NFL insider notes: Major Cardinals concerns emerge, Steelers win despite unfixable offense, more from Week 15
It might be time to start worrying about the Arizona Cardinals. They may have peaked a little too soon.
Kyler Murray's MVP chatter has subsided. The offense, without stud receiver DeAndre Hopkins, is pedestrian at best. It's fair to wonder about how good this offensive line really is, especially on days where Murray is merely mortal. They have lacked some energy and verve in recent weeks. And the defense tends to rely on the turnover or big play, which haven't come with nearly as much regularity these days.
Sunday's stinker in Detroit brought all of the recent concerns to light, and one could ask some significant questions about the direction of this offense, and the ability of a young team with an inexperienced coaching staff – especially when it comes to the playoffs – to handle the suddenly heightened expectations created by their 7-0 start. Something has clearly been off, all around, the past few weeks and I can't help but wonder if the Cardinals aren't doubting themselves a bit, too, in terms of being a real Super Bowl contender.
I'm wondering if we've already seen the best of them. Arizona is 3-4 in its last seven games. And sinking.
Murray has been quite streaky since coming back from a month off with an ankle injury; frankly the offense achieved some sustained highs during his absence that they have had a difficult time reaching since his return. Hopkins is absolutely essential to everything they do, and with him out at least into the playoffs, this staff had better figure something out, and fast. A team that ran its offense through its receivers – using that and Murray's legs to set everything else up – now has just one receiving TD from a receiver in the last seven games??? The Cardinals had all of 85 yards in the first half against a porous Detroit defense, and their 17-0 deficit felt much deeper than that, despite the Lions' predilection to blow any and every lead possible. At 17-3, with a chance to drive midway through the third quarter, Murray threw a pick; Detroit immediately scored off it in precisely the kind of momentum change that Arizona rode during its winning streak.
Consider as well, the Lions had allowed a TD or field goal on all 43 red-zone possessions up until the end of the second quarter, when the Cardinals were stopped on fourth-and-goal. Running out of ideas, perhaps? Arizona had three trips inside of the 10, and settled for two field goals after that initial turnover on downs. Maybe running out of steam? This offense didn't look cunning or ruthless or confident.
Regardless, it may be the case, as it has become for the Chiefs and the Cowboys, that this defense will have to carry the Cardinals as far as they can go. I'm not sure that's close to where many may have predicted at the midpoint of the season. But I'm not liking the looks of this group.
Steelers stay alive despite utterly broken offense
The Steelers offense is broken. Beyond repair. And yet their season survives.
They haven't been able to muster any attack in the first half of a game for over a month. They have been outscored in the first half of their last six games by a staggering margin of 91-19. They don't have a pulse or a heartbeat, they look lost and lethargic and opponents are swarming their offensive line and torpedoing the run game with abandon. Ben Roethlisberger can't do much, but he's not even the biggest problem.
Pittsburgh, playing at home with the season on the line, mustered all of 35 net yards on its first four drives, on 14 plays. Do the math. That's yucky. The Titans held the ball for 10:17 on their scoring drive to bleed the clock in the second quarter; the Steelers held the ball for 8:41 the entire half. The Steelers converted their first third down with six minutes left in the third quarter. It's untenable and, it seems, unfixable. At least on the fly with just three weeks left, and yet somehow they beat the Titans, 19-13.
It took another Herculean defensive effort to force this comeback; the offense was barely along for the ride. Four takeaways did the trick. Late in the game the Steelers forced turnovers on successive possessions and the offense mustered not a single first down. Kicker Chris Boswell pretty much is the offense these days. Yet somehow the Steelers are still alive. TJ Watt keeps fighting for sacks and chasing history, and Mike Tomlin keeps staving off his first losing season, somehow.
Pittsburgh had just 12 first downs in the game and just 168 yards of offense and went 2-for-11 on third down and had the ball for just 20:52, and won. They had 35 net yards rushing … and won. Winning the turnover margin, 4-0, was the difference. Hard template to duplicate week in and week out, but enough to give them hopes of reaching the postseason, still, in Big Ben's last ride.
More insider notes from Week 15
Dak Prescott still is in a funk. The Cowboys can couch it however they like, but it's not good and he's missing on easy throws and simple screens and they are no longer a big play offense …
The Houston Texans may not have a player on the roster who registers even 500 yards from scrimmage this season, despite a 17-game season. Crazy. But Davis Mills continues to look each week like a quarterback who might stick around for a while. The kid battles and makes plays under duress and if nothing else might be a quality long-term backup …
Still looking for evidence that Joe Judge is indeed qualified to be an NFL head coach. Baffling game management week after week, coupled with bizarre word-salad press conferences. I'll believe that he is absolutely safe when we see him at the combine. He hasn't captured the imagination of anyone, and owner John Mara should keep an open mind about where his team stands and who could actually get it where they need to go. They ain't close.
The Dolphins came out sloppy after their bye week, but showed plenty of guile in the second half. Tua Tagovialoa ran the ball with authority – yes, ran it at people – and fired that team up. They pulled away from the Jets late to keep their improbable playoff hopes alive. That defense is legit. They won a game with COVID taking away some of their key players. And I suspect they fall short of their goal but are a tough out from here on out …
Thought the Jaguars might be good for a win, and a decent showing, with Urban Meyer finally gone. Not so much. Getting swept by the Texans is a rough way to go, but it does but them in great position to nab the first-overall pick for a second straight year.
Duke vs. Florida State odds, line: 2022 college basketball picks, Jan. 18 predictions from proven model
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The State Government has announced a review into the way building companies pay their subcontractors, in the wake of the financial troubles impacting some major players in the industry.
BCL Group stopped trade on Monday, just weeks after veteran WA builder Cooper & Oxley went into administration.
Commerce and Industry minister Bill Johnston told Mornings with Gareth Parker, they're also setting up an Industry Advisory Group.


I recently took some time off to look after a grandchild with chickenpox, and it was borne in on me how much things have changed even during my lifetime. A mere half century or so ago all children in the UK could expect to catch measles, mumps, whooping cough, German measles, chickenpox, and possibly scarlet fever or rheumatic fever, and to be vaccinated only against smallpox and diptheria. Many would die from polio and meningitis. Only when I was almost out of primary school did the Salk vaccine arrive from America to immunise against polio, which my sister had caught as a baby and I too had probably suffered from. In secondary school I was vaccinated against TB and tetanus, and already antibiotics were available to fight bacterial infections and pneumonia, saving many lives. My Scottish great grandmother lost only one of her twelve children – little Catherine died at eleven months of Cellulitis, Septicaemia of the arm an infection probably resulting from a small scratch or insect bite, which now would be easily treatable.
Now every child in the West, and many in the developing world, can expect to be vaccinated against virtually all of these childhood diseases and new vaccines are coming on stream all the time. However we should beware of becoming complacent since antibiotic resistance is becoming more and more common, and if it becomes entrenched we may find ourselves in a similar position to the parents of small children in 18th-century Jamaica.
There was for a time a strand of academic thought that claimed that because infant mortality in the past was so high, and so many pregnancies and infants were lost, that parents were inured to it and did not care for their small children unprepared to make any 'investment' in them until they grew up and were likely to reach adulthood.
I really do not believe this. Take for example the death of little Charles MacKay, which was mentioned recently on the Facebook group of the Jamaica Colonial Heritage Society, following the discovery of some marble tomb fragments from a site that had been bulldozed. The gravestone had sadly been lost but it had previously been recorded and so we know that so precious was little Charles Mackay that he was not recorded as being simply two years old at his death but precisely two years five months and twenty-seven days.
Browsing through Philip Wright's Monumental Inscriptions of Jamaica (Society of Genealogists 1966) shows that many children were commemorated with their ages given to the day in this way.
It is hardly surprising that parents, faced with the repeated loss of children born in the British colonies, sent them back to Britain in the hope that their chances of survival would be greater. This was a practice not only among 18th-century Jamaican parents, but one which continued throughout the nineteenth and into the early twentieth century. My own grandfather and his siblings were sent back from India to school in England, not because the schools were so much better but because their health was likely to be improved.
More heartbreaking was the position of Lady Nugent, whose diary of her Jamaican experiences is well known. Having apparently lost several pregnancies she had two children born in Jamaica with whom she returned to England. When they arrived her health had been so debilitated that she weighed a mere six stone, and when subsequently her husband was posted to India she left her four surviving children including a five week old baby behind in England for the sake of their health.
And later she wrote, This book I shall seal up, and send to Westhorpe to be put into the desk, that is in the little breakfast room, where my dear children may find it, one of these days, should I not return; and along with it various little articles, as keepsakes, which they will value, I am sure, as relics of the father and mother, devoted to their interest and welfare.
The Nugents did return safely to England and spent the rest of their lives with the four of their children who survived to grow up. Because of their social position and Lady Nugent's Journal we know more about them than about many of Jamaica's colonists and their children.
Often we can only deduce the deaths of children when we read a Jamaican Will that leaves an estate to nieces and nephews, distant cousins or friends, from which it can be assumed that no immediate heirs had survived. Such children were often buried on the planter's estate in a family plot and it was not uncommon for the grave to be unmarked, the grave marker lost or the death and burial to have gone unrecorded in the parish register. This makes it difficult to estimate levels of child mortality. How much more difficult is it to estimate mortality among Jamaica's slaves and their children, particularly in the earlier part of the 18th-century for which fewer plantation records survive.
What can be said with certainty is that malaria, smallpox, yellow fever, measles and other infections killed adults and children alike. Poor hygiene and a lack of knowledge of how infection was spread, or understanding of the role of mosquitoes in transmitting malaria and yellow fever, meant people were unable to take preventive measures and survival was often due to luck rather than a strong constitution.
 Lady Nugent's Journal of her residence in Jamaica from 1801 to 1805. New and revised edition edited by Philip Wright, Institute of Jamaica, Kingston, 1966.
With Lent fast approaching I thought it would be good to dip once again into the cookbook of Hannah Glasse to see how she made pancakes.
This is an 18th century Dutch dish such as Hannah Glasse might have used to serve up her pancakes*.
Traditionally of course pancakes were made on Shrove Tuesday, when western Christians were shriven of their sins and used up foods they were forbidden to eat during the fasting period of Lent. Because the date of Easter is moveable so is the start of Lent, which this year begins on Ash Wednesday, February 13th.
This time of year is also known as the 'hungry gap', when foods stored over the winter are running out and new spring crops have not yet come in.
Hannah Glasse lists seasonal foods in her book and mentions a huge range of fish available during the winter – many now unavailable or ignored, including a surprisingly large range of freshwater species the fishing for which, of course, would not be so adversely affected by winter weather.
She mentions dorey, brile, gudgeons, gollin, smelts, crouch, perch, anchovy and loach, scallop and wilks, periwinkles, cockles, mussels, geare, bearbet and hollebet. She also advises on how to chose for freshness salmon, pike, trout, carp, tench, grailing, barbel, chub, turbot, cod, ling, skate and thornback, sole, sturgeon, herring, mackerel, lobsters, prawns and more.
Of January Fruits which are yet lasting, she lists some grapes, fifteen varieties of apples (most of which I regret to say I have never heard of) and five kinds of winter pears. In February she adds to the list the Pomery, the Winter Pipperning and the Dagobent Pear. Even in March, and with no refrigerated storage, she expected to have available five apple varieties and two pears. By April her list of available vegetables and salads is increasing and includes cucumbers, mushrooms and purslane grown on hot beds – making use of the huge quantities of manure available to 18th century farmers and market gardeners.
We are not so used now to having to think seasonally about our food, but even in our relatively sheltered economy the UK is suffering some shortages due to having experienced an eighteen month drought followed by many months of exceptionally high rainfall. Farmers are still unable to lift root crops from saturated ground, two weeks of heavy snow meant crops such as leeks and greens could not be harvested, and until the ground dries out new seed cannot be sown as cultivation with heavy machinery only compacts the soil destroying its structure. In any case the ground is so wet that seed would rot if planted.
Although food prices are pushed up by such conditions, the wealthy West can today afford to import food to make up any shortfall. It is worth remembering that 18th century Jamaicans too were heavily dependent on imports, despite the island's potential for growing its own food, with planters preferring to give their land over to the monoculture of sugar, coffee and other cash crops. Some native foodstuffs, such as the green turtle, were exported to the profitable markets of London, and in the fifth edition of her book Hannah Glasse included lengthy instructions on preparing a turtle in the West Indian Way. This was for a turtle weighing sixty pounds!
And so back to pancakes. Hannah Glasse included several pancake recipes in her book, most of which are far more generous with cream, eggs and butter than is fashionable now. Most use spices such as cinnamon, mace and nutmeg as well as sugar, and in the case of at least one recipe the quantity of nutmeg is quite large.
If you are thinking of trying the recipes remember 18th century eggs would have been smaller than today, and spare a thought for Hannah when you reach for the packet of caster sugar. She would have had to shave her sugar off a Jamaican sugar loaf and to pound it with pestle and mortar to achieve the desired fineness; her nutmegs would have been bought whole and her cinnamon as curled bark, all to be grated and pounded by hand.
Several of the recipes make use of 'sack' which was a fortified white wine approximating to a sweet sherry. It was imported into England, but would also have been imported into Jamaica from the Canaries which were on the shipping route for the outward journey of many of the supply ships.
18th Century Cream Jugs recently sold by Lacy Scott and Knight.
Take half a Pint of Cream, half a pint of Sack, the Yolks of eighteen Eggs beat fine, and a little Salt, half a pound of fine Sugar, a little beaten Cinnamon, Mace and Nutmeg; then put in as much Flour as will run thin over the pan, and fry them in fresh Butter. This sort of Pancake will not be crisp, but very good.
Take a Quart of Milk, beat in six or eight Eggs, leaving half the Whites out, mix it well till your batter is of a fine thickness. You must observe to mix your Flour first with a little Milk, then add the rest by degrees; put in two Spoonfuls of beaten Ginger, a Glass of Brandy, a little Salt, stir all together, and take your Stew-pan very clean, put in a piece of Butter as big as a Wallnut, then pour in a Ladleful of Batter, which will make a Pancake moving the Pan around, that the Batter be all over the Pan; shake the Pan, and when you think that side is enough, toss it, if you can't, turn it cleaverly; and when both sides are done, lay it in a Dish before the Fire, and so do the rest. You must take care they are dry; when you send them to the Table, strew a little Sugar over them.
Take a Pint of Cream, six eggs, three Spoonfuls of fine Flour, three of Sack, one of Orange-flour Water, a little Sugar, and half a Nutmeg grated, half a pound of melted Butter, almost cold; mingle all well togeether, and Butter the Pan for the first Pancake; let them run as thin as possible; when just coloured they are enough: And so do with all the fine Pancakes.
Interestingly her pancakes seem mainly to have been served on their own with sugar rather than with sweet or savoury fillings.


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Algeron pit ( Shiremoor ) - Suscram.
The sundial on the site of the old pit heap of the Algernon pit which is now part of the Silverlink park.
By 1810 the Murton royalty was leased by a group of partners:- Maude, Lamb, Taylor, Plumer and Buddle. In the short term the partners began a new sinking east of Allotment farm which was to become the Algernon pit. Coal drawing began in June 1810.
In 1896 the workings of the Shiremoor Coal Company were absorbed into the Backworth company. The Shiremoor Coal company, formed in 1874, had opened the Blue Bell Pit just south of Shiremoor and had reopened the old Algernon Pit, to the south, for drainage purposes.
Upon taking over, the Backworth Company were quick to connect it to their own railway system. This was done by building a new line running north from Murton Row but on the east side of the Blyth and Tyne with a connection into the Algernon Pit en-route. The Blue Bell Pit was not however long lived as manpower shortages during the First World War caused its closure in 1915 never to reopen. The Algernon Pit though, was to last until nationalization.
The 1920 O.S. map shows the pit now owned by Backworth Colliery. The new track has been laid to the east of the B&T line.


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Why Moving Stresses Us Out So Much—and How to Make it Easier
Aimée Lutkin
Filed to:moving
Image: Rawpixel/Pexels
Americans are rather notorious for being frequent movers, and many of us will pick up and re-locate over great distances at some point. Even knowing it's a pretty common adventure, moving is supposedly the third most stressful event in a person's life, after death and divorce. Here's how to deal with it.
Lifehacker spoke with Rosalie Knecht, LMSW, and a program director of a mental health clinic in New York City. Many of Knecht's clients have either immigrated thousands of miles and "left everything behind" or they've conversely never moved out of their parents' homes. She sees certain anxieties occur in most people who are making a huge geographical change, or even just considering it. Here are some of the things that make you feel so stressed out when you move, along with some potential salve for your distress.
What to Buy (and What Not to Buy) After a Move
So you're in your brand-new apartment or house. Some of the boxes are still waiting to be unpacked,
Plan for the financial strain
Unsurprisingly, Knecht says moves often involve a lot of economic anxiety, even if you have a safety net. Many people move without a job, and some are forced to do so without a savings or much of anything at all. The cost of travel, especially if you are trying to move a big chunk of your things, is often astronomical no matter how you've planned for it. Expenses crop up.
This is probably one of the most obvious things we worry about when moving, so if you have the privilege of lining up work and building a nest egg, do it. Planning ahead enough to send things or sell things is great, as is shedding yourself of certain belongings. I say this as someone who has just moved across the country—most of my furniture was old and given to me for free. I didn't transport or store it. After deciding it wasn't worth the cost, it went curbside. Everyone's situation is different, but try to be practical about what you really need when you go.
Everywhere You Need to Change Your Address When You Move
Most of us know that you can change your address with the United States Postal Service by visiting…
Brace yourself for a sense of social loss
A move disrupts the safety net you're used to relying on, whether it's babysitting help from your parents, someone to hang out with on Friday nights, or a neighbor who helps you carry in groceries from the car. Big and small connections create a sense of belonging that we depend on, according to Knecht:
We are intensely social animals, and when we're removed from our social context we feel exposed, inadequate, and sometimes even unstable in our identity, since our identities are often formed in exchange with other identities. I think it's definitely worse over a long distance, because a very short move could leave those networks intact.
But Knecht adds that she has found even a short move creates dysphoric feelings for people.
"Context is everything and it takes a while for a person to make sense of an integrate themselves into a new context," she writes. "During the transition, we're all hermit crabs without shells."
How to Calculate How Much It Will Cost to Move to a New City
Let's say you have your sights set on a new city and you're ready to pack your bags, get out of…
Stay in touch and get out there
To combat this feeling, Knecht recommends getting away from those hermit-y feelings as quickly as possible:
I think staying in touch with your people is key, which is easier in the modern age, and getting out and about as quickly as possible so that you can start to build that sense of who you are in this new environment and where you fit in. Easier said than done!
Yes, it is, but I try to think of it like when your foot falls asleep—moving it around hurts, but you'll be able to stand on it sooner. If you go to church, find a new one in your neighborhood; look for community events by searching Facebook for local groups that might catch your interest; maybe try doing some volunteering. Nothing like sweating side-by-side at a beach clean up to make friends. If you're feeling really bold, you could even introduce yourself to your neighbors. Heck, help them with their groceries.
Remember why it's still good to go
So, why does anyone move unless they absolutely have to? Well, not all big or small moves have to be just stress and misery. They can help you grow as a person:
A big change forces a rearrangement of mental schema, and often involves reexamining what makes you happy and what doesn't, and what you need and what you don't. Identities naturally shift over time and external changes can provide a space for that to happen for a person who's been avoiding it.
Change isn't easy, but it can still be very, very good.
More from Lifehacker
The Stress-Free Guide to Settling Down in a New City
Seven Things I Learned After Moving Across the Country
How to Adjust to a New City After the Excitement Wears Off
Contributing Writer, writing my first book for the Dial Press called The Lonely Hunter, follow me on Twitter @alutkin


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We all know that trimming excess calories from your diet can help you lose inches from your waistline. But now a fascinating new study suggests that cutting your daily calorie intake could also add years to your life.
Researchers from the Washington University School of Medicine in St. Louis set out to see if a calorie-restricted diet would make a difference in longevity, something previous studies have shown in mice. So they assigned 22 people, with an average age of 51, a calorie-restricted diet of around 1,800 calories a day, and had had another group eat about 2,500 daily calories. Study participants were then tracked for seven years.
The results? People on the calorie-restricted diet had significantly higher (better) heart rate variability—how your heart handles stress—and lower heart rates. "The heart rate variability in these 50 year-olds following a calorie-restricted diet was that of someone 20 or 30 years younger," says senior study author Luigi Fontana, MD, PhD.
Here's why heart variability matters: When you stand up, for example, your brain has to tell your heart to increase blood pressure and circulation—the lower your heart rate variability, the less well your system's able to adapt to different situations. "As we age, the cross-talk between our brainsand heart becomes less efficient; the heart isn't fine tuning this response," says Dr. Fontana. This makes finding a way to improve your heart rate variability to that of someone 25 years your junior, well, potentially huge.


Yesterday was a sunny day, perfect weather for a visit the medieval village of Todi where I hadn't been for years.
From the Porta Romana we walked up to the centre. It is about 20 minutes walking up hill to get to the centre of town. If you are not particularly fit, you may consider driving up.
Todi is a beautiful hill town in the province of Perugia in Umbria. It was first an Etruscan and than a Roman settlement in the Southern Tiber valley. The views over the rolling hills from the Piazza Garibaldi are amazing.
The main square is the "Piazza del Popolo", the square of the people, which was built on top of Roman cisterns. On this square is the famous Duomo, the "Cattedrale della Santissima Annunziata" dating back to the 12th century. The building works continued for centuries. It is a beautiful Gothic church with a lovely rose window finished in the year 1515 and an enormous fresco depicting Judgement Day, painted by "Faenzone" and finished in 1596.
At the opposite side of the square is the Palazzo dei Priori dating back to the same period as the Duomo, once the palace where the town's dignitary governed Todi and now home to the magistrates' court.
The second church we visited was The Temple of St. Fortunato (bishop of Todi). This Gothic church is located on top of a prominent staircase. Inside is the tomb of St. Fortunate but also from Jacopone di Todi who was a known notary in Todi in the 13th century. It is said that he lost his head after the sudden and dramatic death of his wife dedicating himself to penitence and humiliation. At his brother's wedding he showed up naked with grease and feather's all over.
Unfortunately we didn't have time to visit the Tempio di Santa Maria della Consolazione which is outside the city walls and from where you can also start your walk to the centre.
A nice destination for a picnic is the "Parco della Rocca", a public garden. We had lunch here: the typical Umbrian street food "panino con la porchetta", a sandwich with roasted pork meat.
Todi has a lot of good restaurants. We'll have to come back to try one of these and to visit the Tempio di Santa Maria della Consolazione.
Just such beautiful images! Todi is a gem and you've presented it perfectly!
I'll be visiting the first two weeks of March 2016 and asking if their are any expats 65 or older to chat with.
Todi is wonderful! There should be expats in Umbria, but where and how to contact them I really don't know. I'll inform you as soon as I have some news..


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Q: Refraction of light from going to one medium to another On the basis of ray theory can somebody please explain my why does light bend from going to one medium to another.Why can't it move in a straight line but with different speed ?

A: I interpret "ray theory" as the ray approximation used in geometric optics (see Wikipedia). In this framework, refraction is assumed to be true, so it is an axiom. It is not derived from any lower-level principle.
The principle can be usefully expressed in terms of shortest path (see the answer of Joe Iddon). However, this is still an axiom, not a consequence of other known facts.
In order to derive the refraction from a lower-level concept, we must at least consider wave optics (no need for quantum concepts). In the eikonal approximation (see Wikipedia), we get the usual refraction laws.

A: This is a tricky question to answer at the high level without delving deeply into Quantum Electrodynamics (QED).
Fermat's principle of least time states that out of all possible paths that it might take to get from one point to another, light takes the path which requires the shortest time.
The way Feynman explains it in his book QED is as follows:
You are a lifeguard trying to save someone in the water and are currently up the beach. You can run on land faster than you can swim.
As the extract from the book below shows, running extra on land in order to minimise distance in water may be faster than minimising distance in total (i.e. a straight line), but it is clear that the fastest route is to run to somewhere in between those two points.
And due to Fermat's principle of least time, is the path which light takes.

You can read a bit more about the principle of least time in Feynman's Lectures on Physics here, but I think the book where he really delves in to detail on the matter, QED, is not available for free online.

Note that Fermat's principle of least time (1650) still holds for lots of cases, but has been superseded by QED (1940) which can now predict the outcomes of every experiment of this nature to unbelievable accuracy.

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