Compare Giltner, stateshort} Medigap insurance companies within minutes. Quote comparison is the best way to locate affordable Medicare Supplmental insurance in Giltner. To begin enter your Zip Code and press "Compare Your Options". Our website will search for the best Medigap insurance carriers and providers in Hamilton county. Finding the best coverage and low cost premium that fit your needs and budget can literally take you 20 minutes or less.
If you do want to get quotes for Medigap policies, you can either contact local insurance providers in Giltner, Nebraska, or you can use the Internet to help you find them. Submitting your information to these insurance providers will allow them to calculate how much you are going to pay. They will have different policy levels that you can choose from just like any ordinary health insurance policy. The amount that you pay is usually reflective of how much coverage you will have. In many cases, it's better to go with the most expensive plan so that you eliminate the possibility of being blindsided by very expensive medical bills.
Although we had just stated that you should pay the most money for Medigap insurance, this is only reflective of contacting one particular health insurance provider. Your goal is to get multiple quotes from different companies and look at all of the rates collectively. You will see that there are policies that are virtually identical, but they could be several hundred dollars a month less then other policies that are the same. In this case, you will want to choose the Giltner, Nebraska Medigap policy that is the lowest price which will come from one particular insurance provider.
Selecting your overall health insurance plan can be quite puzzling. If you make the incorrect selections, you could end up paying out also much for your coverage, or even worse, you might not be coated for certain solutions that you want. Go through this post for some helpful ideas on getting the most out of your overall health insurance policy.
Consider out insurance policy to safeguard yourself from economic damage. Well being insurance policies need to be one particular of the highest economic priority on your listing. Health difficulties are always a chance and if health considerations occur, the cost of healthcare facility bills on your own could simply bankrupt someone who does not have overall health insurance policies.
The details of a well being insurance coverage coverage are usually modifying. That is why it is crucial you hold up with its adjustments. For illustration, you could go to your doctor and find out you require a method that your insurance policy will not go over. For any questions you may possibly have, you can get in touch with your insurance policies organization.
Your well being insurance coverage needs change as you move through existence. Periodically, take a search at your wellness insurance coverage protection to make certain it satisfies your demands, especially if you have a loved ones. Does it still make sense to continue to be on your work's well being insurance policies plan, or does your spouse's plan provide greater protection for this time in your lives?
Discover the variations among HMO's, PPO's, and POS programs and decide what will be the greatest in shape for your health wants. They all have positive aspects and negatives that will impact the way you spend for and use your insurance coverage. HMO's require provide much less versatility but increased value, PPO's give you a lot more alternatives nonetheless the charges can be expensive. A POS program brings together facets of equally HMO's and PPO's.
Understand the rigorous coverage specifics of your well being insurance plan. Even though your plan may possibly point out that it handles crisis visits, some hospitals and doctors cost individually for your treatment. Your policy could cover the hospital's fees, but not the doctor's. If you are uncertain about how your company handles this, contact them and inquire.
Do your investigation about what was contained in the recently handed healthcare laws prior to you buy a policy. Insurance firms are performing whatever they can to get out of this, and they could adhere it to you as a consumer if you buy your plan without having knowing. Do your homework just before committing.
When getting dental insurance policies, do not get attributes that you do not feel you are likely to use. For occasion, many dental strategies are packed with additional discounts for prescription drug strategies. If you feel like you do not need it, do not get it. It will just conclude up costing you far more.
If there is a possibility that you are likely to be laid off from the business that you work for, think about a wellness insurance coverage strategy with a reduced quality expense. The government has transformed things so that these who are laid off will have to pay their personal premiums through the COBRA strategy.
A lot of men and women who are self-utilized experience a quandary about well being insurance policies. They know they want to be lined in circumstance of overall health emergencies, and yet the cost of wellness insurance coverage for individuals is so large as to be prohibitive for numerous. Some men and women get about this by buying key medical protection only. This type of plan has a quite substantial deductible, handles no preventive treatment - however, it will protect conditions exactly where the individual will require admission to a healthcare facility.
Just before getting a little one you need to know about how much you will have to shell out even with wellness insurance coverage. If you have a PPO you could stop up spending about $one thousand or even much more for the birth. If you have an HMO your fees will probably be a good deal decrease. It is best to figure it out prior to you get pregnant.
As you have witnessed, overall health insurance does not have to be a resource of stress and stress. When you've got mastered the principles, it can truly be quite easy to locate the insurance policies you need. Just bear in mind what you have uncovered from reading this report and your wellness insurance policies difficulties will be a factor of the previous.


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Gary Hee. Supplied
Election 2018: Hee announces campaign for Township council
Was involved in campaigns for improved road safety and the repeal of HST and bridge tolls
Sep. 2, 2018 2:30 p.m.
Gary Hee has announced his campaign for a councillor position in the Township of Langley municipal election.
"After taking part in many team efforts to repeal the Harmonized Sales Tax, to remove Port Mann and Golden Ears Bridge tolls, and to upgrade road safety on 72 Avenue from 196 street intersection to 198 Street, I am encouraged to further serve Langley Township for a four-year term until 2022," Hee said.
"Despite my failed effort to revitalize a Block Watch program in Clayton Rise area, I am optimistic that better outcomes will occur in the future. So, I established the ABC Wild Fire Prevention and Watch Society to bring awareness to the struggles of the BC Wildfire Services and First Responders in our province. As a Canadian, born in New Westminster in 1944, I am honoured to serve Langley in this responsible manner."
Hee said one new challenge in the Township of Langley is the diversity of different cultures because of the migration of new residents coming into the Fraser Valley.
"I foresee the need for unity to bring a pleasant and peaceful transition of families working together with their neighbours," Hee said.
"Community leaders have a big responsibility to make the community safe, clean, peaceful, and progressive. The task of doing this duty is a serious issue which must be done effectively, affordable, and proper with a minimum of waste time and cost."
Election 2018: Rod Ross announces another run for the Langley School Board
Nomination period kicks off for B.C.'s 2018 municipal elections

redpajama_set_name: RedPajamaCommonCrawl


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Heavy D died from a blood clot
By Angel Jennings
Rapper Heavy D died last month of a blood clot in his lung that was likely formed during a long flight home from London, where he had performed a tribute to Michael Jackson, according to the L.A. County coroner's office.
Although some had speculated that Heavy D's weight or pneumonia played a role in his death last month, the autopsy report released Tuesday revealed that he suffered from deep leg thrombosis that caused a pulmonary embolism.
Known as the silent killer, a pulmonary embolism is the medical term for a blood clot in the lung. A blockage typically forms in the legs. During long periods of inactivity, the clot can break off and travel to the lung, where it can become fatal if not treated immediately, said Dr. Matthew Butteri, who specializes in internal medicine at UC Irvine Medical Center.
"It's the equivalent of a heart attack," Butteri said. "Just like when you have a blockage in your coronary arteries and you have a heart attack. Well, this is an infraction in your lungs, so it's really a lung attack because the blood clot is preventing getting oxygen to critical lung tissue."
Butteri recommended in-flight exercises and short walks during flights to prevent clots from forming.
Heavy D, who was born Dwight Arrington Myers, collapsed outside his Beverly Hills home Nov. 8 and later died at Cedars-Sinai Medical Center. He was 44.
At the time of his death, the musician was being treated by a private physician for a cough that some said may have become pneumonia. A toxicology report found the presence of medication in Heavy D's system, but it was at a therapeutic level.
He was 6 feet 3 and weighed more than 300 pounds at one point, but had slimmed down in recent years. His weight was not a factor in his death, authorities say.
Instead, Craig Harvey, chief of the Los Angeles County coroner's office, said the blood clot was "most likely formed during an extended airplane ride."
Heavy D helped shape rap music in the late 1980s and '90s with a fusion of New Jack Swing and reggae. He later became an actor, most recently appearing in the movie "Tower Heist."
Other well-known figures have died or suffered from the condition. Tennis star Serena Williams underwent emergency surgery in Los Angeles in March for a potentially lethal blood clot in her lung. In 2003, NBC correspondent David Bloom died of a pulmonary embolism in Iraq, three days after complaining about cramping behind his knee.
Factors that cause the condition include immobility, such as being bed-ridden or taking long flights; surgery; smoking; the use of birth control pills; and a genetic predisposition.
angel.jennings@latimes.com
Angel Jennings
Angel Jennings is a reporter for the Metro section of the Los Angeles Times. She covers issues that affect residents in South Los Angeles. Since joining The Times in 2011, Jennings has written for the Business section and covered education. She is a native of Washington, D.C., and graduated from the University of Nebraska.


Whether you are planning to sell or even buy a house, you ought to get the realtor to assist you. The good thing about getting assistance from a realtor is that you will be linked with other home traders. The nature of the real estate agent to work with is one that has expert knowledge in trading homes. As you value your house ensure that you are so considerate in hiring the real estate agent. In this article, you will discover more on how you can select the best real estate broker. Here are some of the elements that you need to look for when you are hiring McKenna Realtors.
The first consideration that you need to make as you are choosing the best real estate agent is the technical experience. It is advisable that you select the real estate agent that has an experience that exceeds two years. When you are planning to employ the real estate agent you have to know the number of clients that the realtor has assisted. Again, the best real estate agent is the one who has the necessary experience on the figures to ensure that they help you in trading the house.
Price of services marks another area that you need to put more emphasis as you are hiring the top real estate broker. It is worth noting that you are making a financial transaction since you are pumping in some finances and hence you need to be careful so that you do not waste your money. Before choosing any realtor of your choice, consider having a budget of the finances, you are comfortable in spending. The good thing about having a budget is that you will be able to understand the real estate agent that you are comfortable with. Be sure to see page here!
Another factor that you need to think of when you are choosing the best real estate broker is the professional reputation. This means that you need to inquire more from your family members as well as your friends of the most reputable real estate agent that they know. If you see a person who has benefited from the real estate agent then ask for referrals. If you ask them you will be shown the real estate agent that you need to work with. Visit the internet for more helpful information concerning the competent real estate agent. The good thing about gathering more information is that you will be directed to the best real estate agent that will advise you on the best home to buy. Be sure to watch this video at https://www.youtube.com/watch?v=fWpExOqtQwE for more info about real estate.


Making more sustainable choices for your landscape can have a positive impact on the environment, those who use or live on your property, your landscape crew, and your budget.
Reduced labor, water, and fertilizer costs and lower hauling expenses and disposal fees thanks to composting, mulching, and recycling.
Less exposure to workmen's compensation claims as a result of crew lifting heavy loads of plant material.
Grasscycling (a mowing method that results in natural recycling of grass clippings), composting, and mulching return valuable organic material to the soil, which in turn increases the soil's water-holding capacity, reduces erosion, and conserves water.
Proper watering, fertilizing, and pruning, along with integrated pest management practices, encourage healthier, disease-resistant plants and reduce the amount of toxic run-off entering storm drains and polluting watershed, creeks, lakes, and rivers.
Making more organic choices in landscaping products and fertilizers reduces the amount of chemical exposure to maintenance crews and those who work, live, or play on or near your property.
Working with experts and doing a Sustainability Audit can help create a strategic, cost-efficient approach focused on long-term benefits.
In addition, LEED®-certified consultants can help you ensure best practices for any landscape/hardscaping initiatives you undertake and help you earn your LEED credits.
The benefits add up, not to mention the social and consumer response to your efforts. People are noticing brands that go green, according to Nielson, and they are willing to pay up for more sustainable options. So, when you're planning your budget for your next project or fiscal year, consider greener possibilities.


How would you go on if everyone you loved disappeared in a flash? June Reid's life is destroyed when her whole family is killed in a unforeseen disaster. This novel examines the tragedy through the eyes of June, and also through the eyes of people around her.
Another novel that makes us see how fragile life is. Although immensely sad, this book is also about the love we share. How we not only hurt each other, but we also save each other.
This is Bill Clegg's first novel and he is a keen observer. His observations make this a book worth reading. I thought this was a really good book, but I would warn that it is also a sad book.
"The weekenders from the city not only take the best houses, views, food, and, yes, flowers our little town has to offer, but they take the best of us, too. They arrive at the end of each week texting and calling from trains and cars with their demands- driveways to be plowed, wood to stack, lawns to mow, gutters needing cleaning, kids to be babysat, groceries to be bought, houses to be cleaned, pillows needing fluffing. For some, we even put up their Christmas trees after Thanksgiving and take them away after New Year's. They never dirty their hands with any of the things the rest of us have to, nor shoulder the actual weight of anything. We can't bear them and yet we are borne by them. It makes for a testy pact that for the most part works."
Which character was the most tragic?


After a long day shooting in Yosemite, its always a good idea to see what's happening at Valley View. Around sunset in clear conditions, the Merced river picks up the blue sky's reflections, mixed beautifully and complimented by the warm hues reflecting off Leaning Tower across the valley. When you shoot a slightly longer exposure, it reveals something uniquely rich about water, something we can't experience when we observe it in real time.
So you might be asking why am I telling a color story when showing you a black & white image. You'll also find this image's color brother in this same gallery, but I found something unique in also telling the black & white story. Multiple award winning Canadian photographer, Ted Grant, shared some of his creative insights about Black & White photography when he said, "When you photograph people in color, you photograph their clothes. But when you photograph people in black and white, you photograph their souls!". I found this to be equally applicable to images of our natural world too. What do you think about color vs black & white?


Like many bloggers out there, I've just started using the Disqus comment system here. Seems like it is a popular subject on Twitter and FriendFeed, so I thought I'd give it a try. It didn't take long before I wanted to start searching through the comments to find other bloggers commenting on similar topics (Apple iPhone vs the latest from Noikia, or the latest Canon digital SLR, for instance), but they don't have a real comment search up and running yet, so I created a form here that use Google to do the search.
Bart and bottle caps the new UI input devices?
I don't know about you, but my desk is a mess. I embrace the mess as the sign of an active mind, but today I realized it is more than that --- I'm ahead of my time. I'm not sitting here taking a break for lunch amongst garbage, but amongst the UI input devices of the future! Never mind multi-touch displays, iPhones, or even Wii video game controllers. It looks like garbage will form the basis for the new UI!
I consider myself a 'power' FireFox user, but I had no idea you could run an OpenSearch search of text you highlight. It even opens the search results in a new tab! Here's a quick video of the functionality in use, followed by the really easy steps to follow.
Summary: In about 5 minutes I got Apture set up and running in this Drupal blog -- it was quick, easy, and best of all, it works!
Reload the main page in Firefox or IE and the Apture links were working!
It really was that easy (and no, I'm not in any way associated with Apture).
Summary: A quick tutorial on how I put together a PHP script to serve a Google Earth KML file updated live with all the geo-tagged photos from my photo-blog, stored in MySQL. Rather than having people store the whole, static data file on their local machine, I've created a small, second XML file that uses the <NetworkLink> element to have Google Earth re-load the data file every hour, so that newly geotagged photos are included as well.
If you have Google Earth installed you should just be able to load the KML data file on this page to see a live version of the links.
We went for a hike in the Glendon Forest today, north of Sunnybrook, south of the York University Glendon College campus. Some nice red and yellow fall colours, but more interestingly, they are improving parts of the trail (that, plus we saw a huge dead Salmon in the Don River).
all about immortal children stalking the bones of ruined cities in lethal mechas.
and subsequently moved to Disneyland, then Walt Disney World."
There are lot of great trails in Southern Ontario, and not suprisingly they are used by hikers, mountain bikers, dog walkers, trail runners, ATVs, snow mobiles and cross country skiers, and even on horseback. Usually things go smoothly, but sometimes there are bound to be conflicts.
Cory Doctrow is wonderful science fiction writer (among many other things - see his Wikipedia entry for all the details). He has posted a number of his short stories and novellas free on the web for download to your iPod or other music player.
While you can subscribe to his podcast and use iTunes to get the stories, I use the excellent Songbird XUL application to download collections of MP3, so I thought I'd collect the sets of MP3s to make downloading them easier. I'm about half way through the list; I'll update this page as I go.


1. Pumping of a hydraulic drive of switching off of system should be carried out each time after removal of its components and also when liquid level in the tank of the main cylinder falls so that air gets to assembly. A pumping principle the same, as used at air removal from a brake path.
2. Fill in in the main cylinder fresh brake DOT 3 liquid.
Do not use the liquid repeatedly already extorted from system, and also, liquid, a long time stored in leaky closed container.
3. Remove a dustproof cap and pull on the gate of pumping of the cylinder the end of a plastic hose suitable on the size. The second end of a hose lower in transparent vessel partially filled with brake liquid. Track, that the cut of a hose appeared entirely is shipped in liquid.
4. Ask the assistant to squeeze out a pedal of coupling and to fix it in the bottom situation. Slightly open the gate of pumping and let out liquid from the cylinder in drain capacity. When the effluence of the liquid mixed with air bubbles will stop, again densely tighten the gate and allow to release to the assistant a pedal.
5. Continue pumping in the same manner until liquid leaving the cylinder completely will not be released from air bubbles. Constantly watch closely liquid level in the tank of the main cylinder, without allowing its excessive lowering, air dangerous by hit to the highway and data to zero of all undertaken efforts.


Our LaMonica New England Clam Chowder is a quick and easy addition to your menu. Easy to make, our condensed New England Clam Chowder requires milk or cream before it is ready to heat and serve. It also works great as a base for a more complex Chowder. Simply add bacon, potatoes, or other additions to create an customized chowder perfect for your menu.


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I've rounded up some of my favourite artists, zine makers and independent publishers.
I've included some pictures of these self-published and small press zines and comics as well as links on where to buy them or find out more information on the creators.
The publishing industry is not an easy one to break into, especially when it comes to graphic novels, alternative comics and marginalised voices. The option to be able to publish your own work or do so via a small press publisher is not necessarily profitable, but one I am extremely thankful for. It means that unique voices and artistic talents are more accessible.
There is a healthy network of independent small press UK publishers and creators that form part of a strong and inclusive community. There is very little money in it, but the levels of passion, creativity and support seem high. The freedom to create and publish work largely on your own terms is something worth shining a light on.
I love the fact that these bursts of creativity – that can make me laugh, cry and think, sometimes all at the same time – arrive through my letterbox on a regular basis. Thank you.
Ioan Morris
Up first is Ioan Morris, a brilliant Welsh cartoonist whose work combines elements of sci-fi, noir, otherworldliness, and wrestling. Some works are self-contained, with the economy of a good short story. Others are serialised such as his latest award-winning Biggol, allowing you to descend deeper into these alternative realities. Ioan's panels are always powerful, with expert use of space.
Ioan's work is self-published as Dry Comics and available via http://ioanmorris.com/. Biggol volumes 1 and 2 are available through the brilliant Carp Publishing Endeavours alongside Josh Hick's excellent Glorious Wrestling Alliance.
Tim Bird
Tim's brilliant self-published works complement his superlative and award-winning longer books from Avery Hill Publishing. Tim likes to explore themes of space, time and place, often with a psychogeographic leaning, in his comics and art. There's usually a good chunk of nostalgia too. His drawings are always perfectly balanced with beautiful details, often exploring the intersection of the natural environment and the man-made.
Buy Tim's work https://www.timothybird.co.uk/ or via averyhill.
Henry is an artist and zine creator that brings humour and fine art to his output. His works include a riotous visual celebration of a Gideon Coe radio show and a directory of Bullseye contestants and their prizes.
You can buy his work alongside that of his uber-talented son Stanley Miller over at https://www.millertown.co.uk/
Colossive Press
Colossive Press is an innovative and compelling DIY publisher.
Personal favourites include Tom Murphy's brilliant and very funny account of the rise and fall of the Croydon Spaceport alongside a risograph take on Waiting for Godot with Torvill and Dean – Skating for Godot.
Colossive's ongoing cartographies series is a fantastic celebration of talent in the UK illustration and zine scene, and well worth purchasing too.
Buy from colossive.com
Harley Maryon & Tom Benjamin
Zines and small books aren't just for illustration – here we have some excellent photography-based publications.
As a massive fan of Brutalist architecture, these two works by Harley Maryon and Tom Benjamin capture the architectural style expertly.
Harley Maryon's Concrete Abstractions features brutalism from across Bristol and Southampton including many of my favourite buildings.
Tom Benjamin focusses exclusively on the now-demolished Tricorn Centre. The photography in both cases is of the highest quality as are the publications.
Buy Harley's work here https://www.harleymaryon.co.uk/
Buy Tom's work here Our Shadows Will Remain/
Hannah Kate Sackett
Hannah Kate Sackett is an educator and comic artist that brings the past to life with bold imagery and engaging narratives spun from her academic research. Her skill is in making prehistory a human experience and sparking emotional resonance through her characters.
Readers of all ages will love Bertha the Brave and Tales from the Rockface, the latter uses mesolithic rock carvings from Norway as its inspiration. Elsewhere, devils dance across ancient landscapes and archaeological treasures reveal their secrets.
Find out more about Hannah and her comics and buy them https://www.etsy.com/shop/prehistories/
CJ Reay and Black Lodge Press
The output from Black Lodge Press is always good. CJ Reay's illustrative style can be both beautiful and devastating.
CJ Reay's Twin Peaks paeans, the dark erotic risograph beauty of Laid and the stunning A Garden By The Sea, inspired by Derek Jarman are personal favourites.
Buy from http://blacklodgepress.bigcartel.com/.
Also a big shout out to Bristol's Specialist Subject record store for stocking CJ Reay's works alongside many other excellent zines including from LBGTQ+ creators.
Olivia Sullivan
Olivia Sullivan's work plunges you headfirst into fractured, poetic worlds. With a striking visual style, the reader attempts to make sense of glitches in the fabric of consciousness, non-linear explorations of self. These psychedelic journeys are equal parts intriguing as disorientating. A truly original talent.
Buy from https://oliviasullivanillustration.co.uk/
SIMON Moreton
Simon's ethos and his output represent much of what I love about zines. In the spirit of independence, Simon prints the majority of his zines at home, offering pricing tiers based on what people are able and willing to pay. His work is personal and honest, and his art never fails to take me somewhere. Within just a few marks on a page, he is able to evoke a landscape, an emotional state, a moment in time.
Artistically, Simon is always pushing himself to find new forms of expression, different ways to capture internal and external worlds, the seen and unseen. In his early SMOO zines, collated in part in the excellent Days, you see a diverse range of more traditional drawing styles. Nearly a decade later, we have 2020's brilliant Leylines that combines photographs, found text, paintings into an arresting and unique visual style. You can see this ongoing evolution across the Minor Leagues and Where? series.
Simon doesn't shy away from difficult topics either, covering relationships, mental health, and grief in his zines. In using zines as a way of processing and understanding, Simon provides a form of companionship and solace via the printed page.
Buy from SMOO at Big Cartel
Nick Soucek
Environmentally conscious, innovative, and fun – I love Nick's work and wish I had more and that he produced more. Nick always finds different ways to make the reader question their relationship to nature, the environment and the past. I love the way that man-made structures cut through our landscapes, both violently and beautifully.
Buy from https://nicksoucek.com/shop/
Pirrip Press
The amazing Bristol studio Pirrip Press features the stellar talents of George Hounsome and Alex Higlett.
Beautiful, minimalistic, impactful illustrations fill their zines, prints and artworks providing calm poetry, fun instructional advice and moments of still clarity in a muddled world.
Buy from http://www.pirrippress.co.uk/
Read my review and analysis of Owen D. Pomery's Victory Point or check out my collaboration with Laura Morgans in Inktober – bringing together daily micro fiction and illustrations.


Cambria® is the leading producer of made-in-America natural stone that is handcrafted from start to finish for the absolute highest quality. It is made of pure, natural quartz, one of the hardest and most durable minerals on Earth and requires the bare minimum of upkeep—warm water and a clean cloth are all that is needed. Cambria designs are 100% nonporous, scratch and stain resistant, completely maintenance free, and never needing sealing, polishing, or reconditioning—for a lifetime of beautiful design and function.
Cambria offers a wide range of color, tone, and movement, including the vibrant Skye™ and Annicca™, and stunning marble alternatives like the Brittanicca™ and Queen Anne™ designs. Cambria designs range from subtle and soft to show-stoppingly bold. Clareanne™ and Bridgewater™ are one-of-a-kind designs, perfect for gray kitchen palettes.
Designs like Swanbridge™, Torquay™, and Ella™ set an elegant tone in kitchens or spa-like master baths. With powerful veining and movement, Brittanicca Gold™ and Rosedale™ make lasting statements in both modern and traditional spaces. Ten new designs have been released over the course of 2018, including the arresting black-and-white Mersey™, the muscular Levven™, and the watery Skara Brae™ address emerging, cutting-edge trends in surfaces.
Cambria offers two surface finish options–high gloss or its revolutionary Cambria Matte™. Cambria Matte™ is a velvety, low-sheen finish that's anything but dull. Known for its distinctive, sleek look and modern sensibility, it also has the same performance benefits as Cambria's high gloss finish. High gloss, with its reflective surface and classic pristine look, is a great option to visually expand a smaller space or brighten one that's low on natural light.
With advanced technology, Cambria manufactures its products with sustainably sourced, naturally clear quartz. Additionally, Cambria is Declare certified, as well as NSF 51 certified safe for use as a food preparation surface, as well as Greenguard certified for low VOC emissions. The company recycles 100% of its water used in manufacturing and fabrication, saving an estimated 1.6 billion gallons annually.
Explore the current design palette and learn more about all of Cambria's products for everything from residential kitchen and baths to commercial accent wall applications and even furniture. See more inspiration and learn about the advantages of Cambria on Cambria's new blog, Refine + Define. To view Cambria locally contact Polybuilding by phone or email, or by visiting their showroom.


Antioch Church supports World Ministry Partners across the globe. These are seasoned, long-time ministry friends and partners that receive our prayers, encouragement and financial support. We also support a number of people working in closed-access countries. Click on a picture below to find about more.


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A Praça das Flores é uma praça localizada no município brasileiro de Nova Petrópolis, no Rio Grande do Sul. Situa-se no centro da cidade. Seu nome original é Praça da República.

A praça abriga a Casa do Artesão e o Labirinto Verde, um local constituído de ciprestes formando paredes do labirinto, sendo um dos principais atrativos do município.

Galeria de imagens

Flores
Geografia de Nova Petrópolis

redpajama_set_name: RedPajamaWikipedia


The first-half was played at a fast pace and the high-energy nature of the game continued in the second-half, with AK in particular full of running in the early minutes. They came close to increasing their lead when Mark Curran's shot was parried by Donie Lenihan and then cleared off the line by Cathal Finn and when Brendan McCarthy headed against the crossbar from a cross by substitute Niall Maher.
Shountrade also had their chances, David Lynch's 20-yards shot drawing a great save from Paudie Ivess, Denis Hayes glancing a header against the post from a corner by Shire and Declan Mullane firing over from a cross by Riedy but, as time ticked away, it looked as if the second-half would remain scoreless and AK's half-time lead would be enough to see them to victory. However, there was an equaliser in Shountrade and it came four minutes into injury-time. Adam Reidy somehow managed to squeeze an angled free-kick inside the far post and his pumped-up celebration showed how much it meant to him. Shountrade were delighted to have earned extra-time but their readiness for it was diminished when Mark Mullane was dismissed for a second yellow in the last minute of normal time.
It was easy to see from last Saturday night's performance why AK are top of the table in Division 1. They have a class player in Downes, who is fast on the ground, strong in the air and intelligent in his positioning. His defensive heading, in particular, on Saturday night was of the highest order. Alongside Downes, Alan Ryan was a forceful and energetic presence, while striker Curran was a serious threat in the second-half and was deserving of his extra-time goal. John McCarthy and Anthony Cregan are both solid centre-halves, while O'Keeffe was a very prominent figure because of his dead-ball expertise and attacking forays from right-back. AK manager Ronan Hanley and coach Pat McMorrow showed that they have strength in depth with the impressive substitute performances of Maher and Collins.
Shountrade are managed by Kevin Lenihan, who is assisted by Joe Hogan and Tim Shiels. Their charges had a good go at winning the three-in-a-row but can't have any complaints about the result. Their two scorers were probably their best players, Reynolds doing his best to make the most of what came his way, while Reidy's increasingly-influential second-half performance culminated in the free-kick goal that will live long in the memory for its execution and significance.
While being a stalwart Shountrade clubman, Hogan is more widely known as the Limerick Desmond League Chairman and he exchanged his club jacket for his League jacket when it was time to present the trophy to AK captain, Kenneth O'Donoghue, who could yet have more acceptance speeches to deliver as AK are through to the semi-finals of the League Cup as well as being in pole position in the League.


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November 4, 2019 2:01AM EST
Uganda: Security Forces Attack Students, Journalists
Investigate University Raids, Beatings; Hold Those Responsible to Account
The campus of Makerere University in Kampala, Uganda. © 2019 Oryem Nyeko for Human Rights Watch
(Kampala) – The Ugandan police and military have cracked down on student protests over fee increases at Makerere University in Kampala on multiple occasions since October 22, 2019. The security forces have fired teargas into student residences, raided dormitories, and beaten and arrested students, detaining dozens for days without charge.
The police have also arrested journalists and prevented them from entering the university to cover the protests. The authorities have accused opposition politicians of paying students to protest and the media of reporting false news about security forces attacking students. The Ugandan government should urgently carry out fair and transparent investigations and hold accountable security forces who have used excessive force against protesters and otherwise abused their authority.
"Uganda's armed forces are apparently using disproportionate violence against student protests and journalists trying to cover them," said Oryem Nyeko, Uganda researcher at Human Rights Watch. "The government should immediately end abusive crackdowns and hold those responsible for any abuses to account in a fair and transparent manner."
Human Rights Watch interviewed multiple witnesses to the attacks.
The crackdowns started on October 22, when 12 female students staged a protest on campus over a fee increase. Police arrested them but released them later that day.
Siperia Saasiraabo, a student leader who was among the 12, gave a TV interview in which she said she had received threatening text messages telling her not to protest. The next day, Saasiraabo was reported missing and found unconscious, without her mobile phone, in a neighborhood near the university. Police denied that she was abducted, and university authorities have since suspended Saasiraabo and eight other students for participating in the protest.
On October 23, students continued to protest, and police arrested 20 of them. On October 24, as protests continued, soldiers surrounded two residence halls and fired teargas into the students' rooms. Media also reported that soldiers forced students to roll on the ground outside a hall half-dressed.
One student told Human Rights Watch that, after soldiers fired teargas into his room, he jumped out of the window to escape the smoke and was arrested by soldiers waiting outside. He said soldiers took him to a military vehicle, where they beat and taunted him.
"They would ask questions and tell us to sing the national anthem and beat us whether we responded or not," the student said. "They would say things like, 'You say this. Why were you guys throwing stones at us?' Some were saying, 'You guys think you can overthrow this government?'" Police then drove him and five others to the police station in Wandegeya, a kilometer from the university, where several other students were also detained.
Later that evening, students said, soldiers stormed Lumumba Hall, a student dormitory, and attacked the residents. Witnesses said that the soldiers indiscriminately beat students, including those with disabilities, and destroyed their property. Several students were admitted to the Makerere University Hospital with injuries. Human Rights Watch visited Lumumba Hall on October 26 and saw broken doors, mirrors, and television sets.
On October 25, the Chief Magistrate's court ordered police to unconditionally release 46 students arrested over the course of the week. Eron Kiiza, a lawyer representing the students, said that police released the students, but the following week detained at least 22 more, who remain in detention.
On the morning of October 25, security forces blocked from the university journalists trying to attend a news conference by students with disabilities who had been attacked the previous day and ordered journalists already there to leave. Outside the room, police then attacked a journalist, Davidson Ndyabahika, as he took photos of a policeman striking a blind student, damaging Ndyabahika's equipment, Ndyabahika and other witnesses said.
"I started taking photos of the incident as other journalists were recording clips of what was happening," he said. "This [officer-in-charge], with three stars, [was] coming for me and held my left arm and twisted it. I think his intention was to arrest me." The police did not arrest Ndyabahika after a group of other journalists intervened.
University authorities have continued to block journalists from entering the campus, and on October 29, police arrested at least three journalists, but released them later that day.
In a statement, police denied beating students who were at the news conference and said that "none of the disabled students was arrested or manhandled."
On November 1, the military spokesman, Richard Karemire, announced that Capt. Ronald Lubeera, who he said led troops at the university, had been arrested and detained at the military barracks in Makindye in Kampala and that a board of inquiry had been set up to "establish details of what happened and findings will guide the next course of action." The government has promised to investigate allegations of abuse by the military in the past, but these investigations have not released their findings.
Human Rights Watch has previously documented that Ugandan forces beat and arrested journalists covering protests. In April, the Uganda Communications Commission ordered 13 media organizations to suspend their staff after they reported on the arrest of opposition politicians. In October, it directed five of the media outlets to explain why their licenses should not be suspended, cautioned several others, and suspended a radio show.
Media reports have alleged that Ugandan security forces used excessive force to break up student protests in the past, including in Kyambogo University in March, where soldiers and police fired teargas and live bullets at students protesting a fee payment policy.
Ugandan and international law protects basic freedoms of speech and assembly and the right to protest peacefully. Security forces may only use force where necessary and proportionate, but they again appear to have far exceeded these limits.
"The government should allow students to protest peacefully and should not use excessive force to infringe on their right to protest," Nyeko said. "The authorities should allow the media to cover these events, conduct credible and transparent investigations of the alleged abuses by security forces, and publicize the findings."
October 15, 2019 News Release
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October 14, 2019 Dispatches
Uganda Tightens Clampdown on Media
December 14, 2020 Report
"What Crime Was I Paying For?"
Abuses by South Sudan's National Security Service
October 6, 2020 Report
Living in Chains
Shackling of People with Psychosocial Disabilities Worldwide


While writing a post for you about ladies' makeup in the Edwardian era (you'll see that post in the near future) I was perusing the California Digital Newspaper Collection online. And there I found this treasure of an article that was in the Sacramento Union, Number 63, 25 April 1909.
The Edwardian makeup text is hard to read on the old newsprint, so I've transcribed it for you. You can find the original at the bottom of this page. Don't you love the way they wrote back then?
Once upon a time it was no sin to use cosmetics. Great ladies stained their cheeks, kohled their eyes, and dusted on their "white" in the presence of distinguished visitors; and to appear in society without these aids to Beauty was actually to establish oneself as a person of defective taste.
This picture shows us how Edwardian makeup looked.
A decent restraint in the use of cosmetics is not as easy as you would think, for the eye grows drunken at last with color, and taste is blunted by excess. So since the actual offense lies in LOOKING painted and powdered, start your toilette of loveliness with the idea that you will underdo it rather than overdo it. A little pallor or sallowness is far better than a mass of red and white which stands out from the face like a foolish mask.
The stage gives magnificent suggestions for the use of cosmetics. The most harmless rouge advised is grease paint, which comes in stick form and in small pots. This is said to be less drying than a dry rouge and more natural than a liquid one. Three grades of red – light, dark and medium – suits it to every complexion. Black, brown or blonde cosmetic are the stage names for the pencils which darken eyebrows and eyes, and when buying these many a society woman goes to the good places which sell theatrical supplies. "Complexion sticks" are tinted cosmetics which suggest as nearly as possible the natural coloring of the skin.
These are often applied first – after the cold cream rub, of course – to give a foundation to the other things used, but for day they are only advised where it is necessary to cover up some disfiguring mark, such as the dark red birthmarks which so distress a pretty woman. In such a case, the complexion stick is rubbed directly upon the blemish until it has paled or is hidden, and then the spot is covered with powder.
As to powder, the simpler the ones used with rouge the better, as it is really the thick, fast-sticking white which gives the improper and clownish look.
Scented talcum, rice, or wheat powder and prepared chalk are the only secure powders for sensitive skin. If you must have something more concealing and fast than these, be sure you match your complexion with the powder tint, blonde, brunette or pink. Buy always the best cosmetics, for it is only in this way, and through a careful preparation of the skin first, and an even more careful cleansing of it at night, that you will keep your complexion. The delicate pores of the skin have no fondness for the grease and dust blanket.
Edwardian makeup – rice powder.
Start the cosmetic toilette by washing the face with warm water and a good soap. This rests and softens the skin so that the red and white will blend with it and not lie outside in a solid, unnatural sheet. Then rub in cold cream with brisk, yet gentle massage, and sit down to your dressing table to a good twenty minutes of toil, seeing to it that all the implements of war, as well as a hand glass, lie in line before you.
Pears' Soap – a must for Edwardian ladies who wished to take care of their complexion.
The rouge is put on first, the brows and eyelids darkened next, and the powder applied last of all. A soft spun silk, linen or cotton rag is indispensable, for this must smooth down hard edges till the line between the color and natural skin is lost.
To apply the rouge, dig a right-hand finger into the red and rub it over all the points which have ever displayed a hint of natural rosiness. Some faces need a touch of rouge upon the chin and lips, a faint tinting of the eyelids, and a decided rosiness for the lobes and curl of the ear. The lid-tinting is to give the ball of the eye fullness, and the chin, lip, and ear touches make the cheek blush seem more natural.
Leave this application to sink into the skin and proceed with the dark cosmetic. Except for the fairest women, who use a blonde pencil, brun (brown) is the best color for this. Follow the natural eyebrow line with the pencil, and never make a mark, if you can help it, on the bare skin. Then rub the dark pencil across the palm of the left hand, and with a clean finger of the right gather up this soft brown, blonde, or black dust and rub it delicately over all the eye covering.
A hard line is made by a dark pencil under the eye is very bad, but few persons not in Beauty's secret will be able to suspect the artificiality of the improving over-shadow made in this way. But the red and the black are only a breath – they must seem the reflection of the ball of the eye through a thin lid.
I think I just discovered that I need an Art Deco Mermaid mirror from the Edwardian period for my dresser.
You now come to the important "make-up" rag, and with one corner of this go over the rouge, and with another over the lids till your own mother could not tell where her daughter begins and art ends. Then dust on the powder, smoothing that with still another corner of the rag.
Thus should a woman use cosmetics, if at all, and thus the offense of employing them is lessened appreciably; though I would that all my sisters left the rouge pot and the face powders severely alone. But, alas, how many make use of them – and execrable use at that!
I hope you enjoyed this article – tell me your thoughts about Edwardian makeup in the comments below!
Next PostNext Still working on getting Lightning on the Levee published!


The nearly year-long research consisted of detailed telephone interviews with 1,200 contractors in the U.S. and Canada. Contractors were interviewed in 7 specialties including plumbing & heating, HVAC, residential GC's, commercial GC's, remodeling electrical, and industrial maintenance. Contractors were also interviewed by size within each type, small, medium, large and very large in the U.S. and small, medium and large in Canada.
Charter Subscribers had input into the research design including the specific questions asked and thedesign of the sample plan.
The study documented contractor purchases of 19 cordless and corded power tools including batteries, drills and drill drivers, hammer drills, impact wrenches, recip saws, circular saws, jig saws, portable band saws, screw guns, grinders and cutoff tools as well as combo kits.
Sales of the power 19 tools captured power tool sales by brand and by the sales channel through which the contracting establishment purchased the tools including catalogues, contractor/building supply, hardware retailers, HVAC supply, industrial supply (STAFDA), Internet, lumberyards, mass merchants, plumbing supply, electrical supply, Home Depot, Lowes and farm & fleet.
In addition to unit sales for 2016 the study captured battery voltages, battery technologies, motor technology, chuck size, blade diameter, grinder diameter and nail gun gage.
The study also captured brand selection factors the value of "Made in America", favorite brands and reason for changing purchase channels.


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Home/Bollywood News/Cooli No. 1 (2020) Full Free Movie Download 1080p, 720p, 600MB KuttyMovie, FilmyWap Bollywood News
Cooli No. 1 (2020) Full Free Movie Download 1080p, 720p, 600MB KuttyMovie, FilmyWap Bollywood News
The trailer of Varun Dhawan and Sara Ali Khan's much awaited film Coolie No. 1 is out. Coolie No. 1 is a remake of the film of the same name in 1995. The original film had Govinda and Karisma Kapoor in the lead roles. David Dhawan, who helmed the original film, also directed the remake.
The trailer begins with Paresh Rawal recounting how his daughter (Sara) has found the world's richest man who owns the world's tallest building, Burj Khalifa, and may also buy the White House in the near future. Then we see that Varun Dhawan is bent on his wealth. In one scene, he also said, "I am on a conference call with ATM – Ambani, Trump, Modi."
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In the next scene, Paresh finds Varun working as a porter at a railway station. Paresh confronts Varun but he ends the confrontation by saying that he is not the person Paresh is looking for. The rest of the trailer features Varun Dhawan with this song, which depicts a laughter riot.
Initially, the trailer gives us the feel of the original Coolie No. 1 film. The new film, however, is shot in picturesque locations, which was missing in the original. Apart from this, a twin fairy can also be seen in the film's trailer.
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Coolie No. 1 was scheduled to be released in theaters in May, but the release was postponed due to the spread of the novel Coronavirus. Now, cinemas have opened in some states of the country, but the makers have decided to adopt the digital route and release the film on Amazon Prime Video on 25 December this year.
ये भी पढे - The Song Of Scorpions Full Movie Download Filmyzila, In HD 720p- 480p And 600MB Bollywood News Report
Sara and Varun are very busy promoting their new film. This is the first time they are acting in a film together. Yesterday, he announced the trailer release date with a hilarious clip.
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शिल्पा शेट्टी ने 'चुरा के दिल मेरा' गाने पर धर्मेश के साथ रोमांटिक डांस किया, थ्रोबैक वीडियो हुआ वायरल
Ranveer Singh Birthday – रणवीर सिंह की साली अनीशा पादुकोण ने अपने जीजू को दी जन्मदिन की शुभकामनाएं, तस्वीर देख दीपिका भी मुस्कुरा देंगी
TV Show Kundali Bhagya 5 October 2020 Written Episode Update: Janaki Goes To Save Preeta
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Yeh Rishta Kya Kehlata Hai 12 Sep 2020 Episode Update: Karthik and Naira send TV show Star Plus


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Contact Microsoft Support or call STAR Customer Solutions at (888) 395-2447 for assistance.
By itself, e-mail is an insecure communications channel. Messages sent via standard e-mail travel in "plain text" and cross many networks before reaching their final destination. As a result, an opportunity exists for prying eyes to eavesdrop on e-mail messages as they traverse these various networks. Since confidentiality cannot be guaranteed, standard e-mail should not be used to exchange sensitive or private information, such as Social Security numbers, bank account numbers, financial statements, etc. At STAR, we primarily utilize our encrypted online banking system and encrypted Live Chat feature to securely communicate with our customers. In addition, STAR offers a secure channel for exchanging confidential information online using Office 365. With Office 365, the use of Zix is no longer necessary to encrypt secure email, as we will have the latest email security measures that are offered within the new system.
If you currently use Office 365, your secure emails will be delivered to you without any need for additional action. If you are not using Office 365, you will need to perform a one-time login to your Microsoft account to view your email and secure documents. If you do not have a Microsoft account, you will be prompted to create one, or you can request a one-time passcode.
To open an encrypted email from STAR, Save/Download the file attached to the email, then open the message.html attachment.
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If you choose Use a one-time passcode, an email from Microsoft will be sent to the same address as the encrypted email. The one-time passcode will need to be entered on the screen that is presented when clicking on the one-time passcode option. The encrypted email will then be opened. Please note: if you choose this less-secure option, you will have to request a passcode each time you receive a secure email.
Select Microsoft account. The following form will need to be completed to register the email address as a Microsoft account.
Once the form is completed, an email will be sent to verify the account. This screen will also give the option to resend the verification email, if needed. The verification email will need to be opened and the option to verify the email address will need to be selected. Once the account is registered as a Microsoft account, it can be used to open all encrypted emails from STAR.
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A five-judge Constitution Bench of the Supreme Court, headed by Chief Justice of India Ranjan Gogoi, will hear the Ram Janmabhoomi-Babri Masjid case on Thursday. Among the first decisions to be taken by the bench will be deciding the schedule for the decades-old title dispute and decide whether it should be taken up on a daily basis. The four other judges on the Constitution Bench are Justice SA Bobde, Justice NV Ramana, Justice UU Lalit and Justice DY Chandrachud.
The case is pending before the apex court since 2010 when 14 cross-appeals were filed against the Allahabad high court's 2010 judgement dividing the 2.77 acre land equally among the three parties – the Sunni Waqf Board, the Nirmohi Akhara, a Hindu religious denomination, and Ram Lalla, or infant Ram, represented by the Hindu Mahasabha – for the construction of a Ram temple.
However, on Tuesday, CJI Gogoi announced the setting up of a five member bench, which also comprises justices SA Bobde, NV Ramana, UU Lalit and DY Chandrachud – all potentially the next four chief justices of India.


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Chris Barrett Stephen B. & Janice G. Ashley Professor of Applied Economics and Management, International Professor of Agriculture at the Dyson School of Applied Economics and Management, and Professor in the Departments of Economics and Global Development at Cornell University
Jessica Fanzo Bloomberg Distinguished Professor of Food Policy and Ethics at Johns Hopkins University
Rikin Gandhi Co-foundeder and Executive Director of Digital Green
Mario Herrero Professor of sustainable food systems and global change at Cornell University
Alexander Mathys Professor in the Department of Health Sciences and Technology at ETH Zürich
Alexander Mathys Professor in the School of Integrative Plant Science (Plant Pathology & Plant-Microbe Biology and Plant Breeding & Genetics Sections) and the Department of Global Development at Cornell University
Philip Thornton Leads CGIAR's "Priorities and Policies for Climate-Smart Agriculture" Flagship Research Program on Climate Change, Agriculture and Food Security (CCAFS)


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Science AMA Series: Hi, I'm Dr. John Adler, inventor of the CyberKnife, Founder and Editor-in-Chief of the Cureus Journal of Medical Science and Professor of Neurosurgery at Stanford University. Ask me anything!
r/Science
John_Adler
Hi reddit!
Since 1987 I have been an academic neurosurgeon at Stanford University. During my professional career I also invented the CyberKnife, and in doing so, the field of image-guided radiation. To date the CyberKnife has been used to treat more than one million patients, and derivative technologies have treated millions more. During my years in academia and the medical device industry I have come to appreciate the importance and power of peer-reviewed journals in guiding the practice of healthcare worldwide. From my own experience and frustration with the medical publishing process, I recently co-founded a next generation Open Access medical journal called Cureus.
Peer-reviewed journals are an essential element of the bedrock underlying scientific progress. However, publishing in traditional journals has long been a time-consuming, complex and costly process. Although an unpaid workforce of highly skilled authors and reviewers does the hardest work in medical publishing, very expensive subscription fees typically limit the scope of readership. The alternative Open Access publishing system requires authors, many of whom lack significant research funding, to "pay to play."
Tragically, so many financial and procedural barriers are preventing the widespread generation and dissemination of medical knowledge, which as a point of fact, can be life saving in many cases. To my way of thinking something is very wrong with this existing system; access to advanced medical knowledge can and should be a human right! With this objective in mind, Cureus aspires to disrupt the status quo by making both the publishing and reading of quality peer-reviewed journal articles free, and thereby opening up the floodgates of medical knowledge to all of humanity.
Now that you know what I'm up to, I turn the floor over to you - ask me anything about neurosurgery, Cureus, the CyberKnife, medical publishing or anything else that you can think of.
I'll be back at 1 pm EST to answer your questions. Bring it on!
No questions for you. Just came here to give my thanks. My mother had brain tumors (chordomas). CyberKnife added years to her life. I believe she actually went to Stanford for her first treatment.
JaySuds
That's great - thanks for the words of encouragement and glad to hear that it made a difference.
What was your role as the inventor of the cyberknife? How many physicists, engineers, basic scientists, etc.were involved in the process. Where did the concept originate?
porkly1
The basic concept originated with me and was embodied in a patent that was issued in the early 1990s. Subsequently, this project involved a sizable community of engineers and physicists - I'd say it required about 25 engineers to develop the first prototype.
What are your thoughts on Valery Spiridonov, the man that's to have a head transplant? In the unlikely event of its success, do you believe it could pave the way in new treatments for terminal neurological disease or permanent paralysis?
PM_ME_FRESH_PRODUCE
I don't consider any procedure that leaves the patient in a perpetually immobile state of existence as much of a breakthrough. Until we're able to get nerves to regenerate significantly, procedures like this are little more than surgical freak shows.
I was told, in a recent lecture, that there would be three types of medical jobs in the future: those programing robots, those maintaining robots, and those taking orders from robots. To some extent, this was a joke about technology and automation in medicine. However, as the inventor of CyberKnife, does that sound like a realistic possibility to you? To what extent is the human element realistically replaceable?
Follow up question, if I may? I am profoundly interested in the prospects of open access to academic literature, but I've heard many in the field dismiss open-access plans for reasons including lack of funding, and lack of trust in non-traditional operations. May I ask how Cureus will overcome these issues?
Wodnescild
Ha! Robots will have an immense future role throughout surgery, no doubt about it. However, I am less convinced that A.I. will in the short-term have as big an impact throughout medicine as its measure proponents are suggesting these days.
In terms of Cureus, internet technologies have paved the way to introduce new processes for developing trust among disparate individuals. Cureus has done its best to incorporate these concepts into its design. Look, Open Access is inevitably the future of academic publishing, but to break down the last barriers is going to require a more efficient, lower cost option. And that is what Cureus aspires to be.
Thanks for coming here for an AMA! I have a couple questions about each of your projects.
What inspired you when creating Cyberknife? How does the Cyberknife deliver radiation to a 3D space with linear delivery by a beam of radiation? Is there a second source with a radiation maximum at the intersection?
What is the review process for Cureus? Does the journal lean toward any type of medicine or is it open to surgery, medicine, therapy, etc? Recently the evidence based practice world had a lot to say about not publishing negative results in many journals. What will the stance be for publishing negative results in Cureus?
Thanks for the question! My ambition was to make surgery less invasive and more effective. It would take me all day to adequately explain how the CyberKnife does what it does. Read our articles in Cureus on the CyberKnife to learn all the ins and outs - going back to an earlier question, this demonstrates the importance and value of Open Access publishing.
The review process is single-blind and completed entirely online. We just developed a new interface that works in a similar manner to making comments in MS Word. Cureus welcomes all medical disciplines, but we greater penetration in procedural specialties.
The failure to publish negative results is emblematic of the problems with traditional medical journal publishing which is obsessed with status. In contrast, Cureus has a post-publication review system (called SIQ) that allows our journal to publish more liberally the negative studies which generally speaking have a smaller readership.
Had a couple of doses of steriotactic radiotherapy from a Gamma knife on a rather large AVM in my head, in conjunction w/ about 6 internal embolizations. They obliterated it over the course of 3-4 years, but when I woke up from the last embolization, my left arm had basically quit working. Ugh. How would the damage from the radiation over time, assuming it's even possible, impact the brain's capacity for neural plasticity necessary to rewire the damaged nerve connections? I can raise my arm after 2.5 years of therapy, but still can't get my hand to work. On a scale of 1-10 (surely the go-to metric in neurosurgery), how likely would you estimate is it that my cortex is screwed to the point that it can't rewire itself in that particular area? Only Cost me an arm and a leg, literally!
gonzotheape
Oh boy, I'm sorry to hear about your predicament. You are correct that it your brain is unlikely to repair itself and I since you insist, I'd give a score of 8. Good luck!
Good morning Dr Adler,
First off, I want to thank you with all of my heart.
Thanks to your invention my mother was able to live a longer life while fighting multiple benign meningiomas for over 20 years. This very technology helped her live long enough to go on a cruise (first vacation since getting diagnosed in 1994) and see me get married. Here she is on the cruise with me (my dad and fiance were there too). http://imgur.com/a/Tdjvm
We lost her 2 years ago this coming September. Your work, and countless doctors and nurses, let me have my mom through my childhood and into my adult life.
As a fellow scientist, in Pharma for over 10 years, my question is:
What did it feel like when you first saw your machine working to help a patient?
Thank you for everything you do.
Sevreth
Wow, thanks for the kind words. So happy to hear it. Wishing you and your family much love.
What made you call it the Cyber Knife and can you go into a little more detail on its medical uses today?
AashyLarry
The word "knife" emphasizes the surgical applications at hand and when I chose to use the word "cyber" it was long before the word "cyberspace" existed and it seemed like a cool and hip expression of the future. And apparently, the term worked.
Thank you for taking part in an AMA.
With respect to Cureus, will the reference limit imposed on submissions (Review articles: 50 references, Original articles: 30 references, Technical reports: 20 references, Case reports: 10 references, Editorials: 5 references) be lifted as the journal grows?
On a different note, as an accomplished professor, what activities would you recommend an eager medical student to engage in to help when applying for neurosurgical training programs down the line?
P-whiz
The reference limit is in place for a few reasons, chief among them is our size relative to the increasing number of submissions we receive. As a journal that doesn't charge for publication, we need to keep our editorial overhead down and reference-checking is an expensive part of publishing.
The reference limit reinforces the efficiency of using articles as a communication tool. Rarely do large numbers of references help the reader. This very decision highlights the unique aspects of Cureus, which aspires to the most efficient yet legitimate (and accessible) form of medical publishing.
Hello Dr.Adler; my wife (32 y/o, from UK) has undergone two craniotomies this year to remove a grade 2 astrocytoma from the right front lobe. We believe this has been successful and now expect regular monitoring through MRI, but hold hope that it will be some time before we have to face another tumour.
If you you able to sum up briefly, what significant advances are expected in the next 5/10/15 years that will have a real impact on the treatment of patients with tumours, such as my wife's?
whit123
Unfortunately, radiosurgery is unlikely to have much of an impact on a disease like astrocytoma because it is so diffuse. The good news is that there are important new chemotherapies that may address the problem in time.
What is your most important accomplishment? Science or Personal achievement?
chocolatemilk67
Neither of my kids are in jail.
Firstly, very cool tool. Preface: I am a microbiologist/mass spectrometrist.
I am wondering a) if you were aware of it and b) if so whether it could be used in tandem: I was at a talk recently where a surgeon from Britain had been using a ionising surgery knife (user operated) which profiled the lipid structure of ionised tissue to give a 95% CI of whether tissue was cancerous or not.
Would your technology be able to work in tandem with such methods of rapid screening to irradiate target tissue? How do you currently map areas for irradiation to your surgical robot? Is it guided by CT or some other form of imaging?
BucketChemist
Cool idea but I honestly have no idea at present. Worth following up on though!
I had a brain tumor treated using Cyberknife a few years ago. During the diagnosis phase I met with radiologists and neurosurgeons. The neurosurgeons advised open brain surfery, the radiologists advised Cyberknife. I understand that for certain tumors open surgery is required, but I was not one of those cases. I was very confused about my options because I couldn't understand why one doctor would advise something as extreme adn risky as open brain surgery, when there was a much less risky alternative.
My question is, why the great disparity in the suggested treatment?
Mightbehittingonyou
The devil's in the details, but generally speaking the bigger the tumor, and the safer the location in the brain, the more useful conventional surgery. Meanwhile, the smaller the tumor, and the more critical location in the brain, the more radiosurgery/CyberKnife is indicated.
I'm puzzled that you invented the Cyberknife, but now you work with Varian, a competitor to Cyberknife. Do you have reduced confidence in the Cyberknife these days?
TigerB65
No, I have every bit of confidence in CyberKnife. It remains the best tool for precision radiation, but stay tuned for my next act!
The treatment regimens for prostate cancer are shorter for the CyberKnife than other methodologies.
What data is there to suggest that this is comparable to outcomes of traditional radiation therapy?
This is particularly interesting with regards to earlier stage prostate cancers where recent multi-center data suggest that prostatectomy and radiation can be equivalent in terms of outcome (with radiation trending towards better), but with variations in the side effect profiles.
Thank you and great work!
Check out this article in Cureus for more info, specifically the references.
I fervently believe that the evidence supports short courses of (hypofractionated) radiosurgery are the equivalent of, if not superior to, conventional radiotherapy.
The problem we face is that the radiation oncology industry makes more money by delivering conventional radiotherapy than it can make with radiosurgery and this represents a serious headwind to the wider adoption of radiosurgical techniques.
Unfortunately, even in medicine it is necessary to follow the money sometimes.
Hi thanks for the AMA! I have 2 questions:
As a neurosurgeon at Stanford, what were some of your hardest cases?
Ben Carson is the secretary of the HUD, and is supposedly a prolific neurosurgeon, what do you think of him?
jake354k12
My hardest cases would be the many patients I failed. As for Dr. Carson, he's a great pediatric neurosurgeon who has been a good friend to me at times.
Hey John! I worked at Accuray 97-01! Those were exciting times, and I am proud of my small part. It was powerful motivation when you brought in patients who's lives had been dramatically improved using the Cyberknife. When I was there, it seemed like a huge obstacle in getting Cyberknive's in hospitals was that Neurosurgeons really preferred a craniotomy to stereotactic radiosurgery, because it was their talent that saved patients through surgery, rather than the technology through radiosurgery. Is that still a big problem or is adoption easier now?
threemuch63
I would say that the drama of neurosurgery is a huge attraction for neurosurgeons and it is hard to give up the adrenaline rush. No matter, radiosurgery is now the most common operation for brain tumors today, which is testament to just what a good procedure it is.
Young researcher here. I agree that current systems for peer reviewed articles are fucked. Besides all the usual issues there is also the issue of journals charging ridiculous fees just to publish a paper. This has been a common problem in india where students often must publish a paper to graduate. They submit them to junk journals and pay money to have it published.
With the advent of junk journals and articles how would Cureus prevent authors from flooding the portal with low effort articles?
_neutral_person
As long as an article contains legitimate medical science, we are committed to publishing it. We believe our SIQ system (our post-pub review system) is the best way for readers to discern article quality.
But in the end, it's important to understand many times one man's junk is another man's treasure. When you have deep interest in a narrow domain, oftentimes even rare but trivial findings are important.
How much of the invention of the cyber knife were you involved in? Were you involved in every piece of the process of was some of it beyond your control?
90059bethezip
In the earlier stages, I was involved with everything. However, I was blessed to work with a lot of smart engineers and physicists.
Thank you for helping to contribute to society and attempting to do it on what could even be a more grand scale with your new project, it sounds amazing.
I guess I need a question...
What do you think is one of the most important medical information/study publicized in these journals that isn't getting a wide enough reach to the medical or overall community ?
retrofuturenyc
This is a good opportunity to talk about one of my passions: the need for more "small science" in the medical literature. The vast majority of journals look down at small case series as being inconsequential anecdotes, however, such articles almost always contain important nuggets of truth and in aggregate, represent a treasure trove of medical knowledge.
Imagine for a second that there existed a repository of literally hundreds of millions of validated, peer-reviewed clinical vignettes. One could draw upon this resource to answer literally almost any new medical problem that one encountered. This is the potential power of Cureus.
I saw the title of your AMA and just wanted to stop in and say thank you! My mom was diagnosed with Gastric Cancer 5 weeks ago. After finishing a couple of MRIs, they were able to determine that it was localized and completely treatable. Because of this, she will begin the CyberKnife treatment in 2 weeks and we are all thankful for your procedure and really excited that this is going to go so well. The device is amazing and truly a 21st century life saving technique.
God Bless you and the amazing technology you've brought to this world!
Gortanis
Thank you! So happy to hear it!
Thankyou for this AMA. If i can ask, what has been the response to you offering the new service Cureus, from other professionals and organisations who may support the existing pay and play system and be reluctant to support a free system ? Have you had much hostility? I would of thought as you that having a free and open publishing system would be good for all.
Wagamaga
This reminds me of the Gandhi quote (and I'm paraphrasing here so don't kill me if it's slightly inaccurate), "First they ignore you, then they laugh at you, then they fight you and then you win."
So it is true at present that we're starting to enter a period of mild hostility from the rich and entitled old guard of publishing who are intent on preserving the status quo. Viva la revolucion!
Thanks for your time. What will be Cureus business model? Will it be like PLOS ONE?
eddie_00p
Well, PLOS ONE has only a subset of medicine. It's a broader scientific journal. Cureus believes that its focus in medicine presents a unique opportunity for funding that isn't available to broader scientific journals.
In particular, our highly clinical focus can be a communication resource between the broader physician community and the life science industry. Cureus has built the appropriate firewalls to preserve the integrity of this interaction.
In addition, we work with medical institutions, hospitals, and medical societies to provide a branded medical journal publication that enables them to demonstrate their clinical competencies and build their institutional brand.
What made you realise the need the cyberknife's creation? Would you have any advice for young surgeons aspiring to contribute to innovative changes in their field?
Additionally, did you know/train Paul Kalanithi? Have you read his book? And if so what did you think of his portrayal of the life of a resident neurosurgeon?
RedditName12
I saw too many patients suffer from both cancer and the surgery we once used to treat their cancer. I believed there had to be a better way and that a less invasive procedure would have an important role to play. I was lucky early in my career to work with Professor Leksell in Stockholm, who provided the inspiration for me to go on and develop the CyberKnife.
Re: advice - become a fully-trained surgeon and learn your craft well. Before you can make meaningful improvements in the field, it is important to have the deepest domain knowledge possible.
Yes, I knew Paul well and we collaborated on a few academic projects together. I also served as a mentor to him. Yes, I've read most of his book, and I think he did a credible job of portraying the life of a neurosurgical resident.
Hi Dr. Adler! Thanks for doing this. As an incoming MS1, I was wondering if you could talk about how/when in your medical education you decided/realized neurosurgery was for you. Did you know in undergrad? Beginning, middle, or end of medical school? Do you have any advice for medical students on what criteria to use to pick a specialty? A lot of the fields I'm interested in, like neurosurgery, are intensely competitive to match into-- so the earlier one can discover their interest the better. It's just so difficult when so many specialties overlap, have their own unique pros and cons, and above all, are incredibly interesting!
Seraphenrir
I chose late in my career. I was a first year resident in general surgery when I made the decision to specialize in neurosurgery.
Why did you want to become a doctor? Also, more specifically, what drew you to specialise in neurosurgery? Would you recommend this field to medical students?
I'm currently a pre-med student (studying in Australia). I'm hoping to get into medicine, and while I have my own motivations for wanting to do so, I'm always interested to hear what initially motivated doctors I meet to study medicine.
Thanks for the AMA!
Krakyn
Neurosurgery is great, but it is as much a calling life as it is a profession. It is an intellectually and physically demanding avocation with the power to dramatically impact human life. What more could you ask for in life?
Do you have a "worst student" that still gives you nightmares?
illyafromuncle
One of my worst residents went on to a extremely successful tech career. (I'm talking one of the first employees at a very large company you've heard of.) He found his calling.
Did you know Michael Lim tells all his patients he trained with the inventor of the CyberKnife but he never mentions you by name?
tealgreen
Well, shame on him! Ha! What does he say about Ben Carson?
Do you think that more open-sourced journals will lead to better informed doctors? How do you think we can address the issue of physicians who are not research-minded and not keeping up with the literature?
What were some of the factors that paved the way for you to invent the CyberKnife?
MtGroovius
There's too much information that isn't directly relevant. So let's do a thought experiment - a patient comes into your clinic with an unusual medical problem and they want to understand prognosis.
At present, you're forced to rely on a literature that blends the case stories of literally hundreds/thousands of patients that may have had a similar diagnosis, but a broad spectrum of confounding variables. Wouldn't it be sweet to find a near exact duplicate case (or several cases) for the patient that sits in your clinical at this very moment? Then you really could nail a prognosis.
A lot of hospitals buy new equipment to attract skilled personell interested in trying new pieces of equipment.
From an outsiders perspective, it seems like a lot of it is driven by doctors "vanity" and gadget-interest, more than an actual need in a clinical setting.
In countries where these costs come from taxpayers money it seems prudent to assess the actual added value from these items. Do you know of any research done on this, and is it something you try to quantize for your own product(s)? What should public hospitals be aware of when balancing the need to attract skilled personell, and spending taxpayers money in a responsible matter?
Dam0cles
I'd say you've raised good questions here and there is no simple answer, however, it is worth reminding ourselves that technologies that once seemed to be physician vanity projects have profoundly impacted human health over the last generation.
For example, when CT was first invented, it was seen as an extravagant (almost vanity) and extremely expensive technology even at the biggest medical centers. Yet today even in some of the poorest countries in the world, CT scanners are seen as necessities.
Dr. Adler, my father is a Stage 4 lung cancer patient who's primary site was fully removed via a lobectomy. The cancer, as lung cancer often does, metastasized in the brain. Because of the blood-brain barrier, chemo was not a primary treatment and cyber knife came to the rescue. Because of CyberKnife, my dad has so far experienced 3 years of a great quality of life with hopefully many more to come, so thank you for your amazing invention! 2 tumors so far have been treated this way, with the 1st original tumor found was surgically removed and tested as lung cancer.
The limits (if I understand my dad's Doctors correctly) that we are finding right now are on the imaging and targeting of tumors with approx 1 cm being a sweet spot for both - smaller targets are too hard to see clearly on MRI/CT and I believe CyberKnife must have limitations too with how small a target it can hit without impinging on healthy brain matter.
So - my question is - do you think there is a path for the technology to improve in both correctly identifying tumors sooner and in the CyberKnife's minimum target size?
My second question is public policy related - My father is being treated in Canada, and we are fortunate to live in an area of Canada with good access to great healthcare. His treatment is fully paid for by taxpayers so we share the benefits and burdens of health costs in Canada - and feel privileged to do so.
In the US one of the fears of publicly funded healthcare is if governments fund healthcare the thought is that innovation will not happen. Do you think we can get the best of both worlds, from your position of a creator of new healthcare technology? Can we support innovation and have public healthcare in the US?
Thirdway
It's possible to treat tumors much smaller than a centimeter and we routinely use the CyberKnife to treat brain tumors that are only a few millimeters in size. I'm sure that in the years to come things will only get better.
Public healthcare systems are always going to be confronted with the need to ration healthcare at some level and unfortunately one of the first things to be sacrificed is innovation. So yes, I think there is a contradiction between government-funded healthcare systems and innovation.
No matter, it's important that society provide medical care for the less privileged. So for me, I believe we need a healthcare system that ensures everybody (all citizens) have a basic level of healthcare, but still leaves open the possibility for those who wish to pay more to have access to the most innovative (some of which are unproven) technologies.
No questions, just thanks for being a badass. My old man had a hemorrhagic stroke a while back, and found out he had an arteriovenous malformation. CyberKnife-like technology is apparently the absolute go-to for certain circumstances of this.
andybmcc
Good stuff! And I'm far from a badass, just ask my kids!
Hello! I have no question, but I just want to say Thankyou for the CyberKnife! I am a radiation therapist, and I have had the pleasure of using one of these in London, and they are amazing! The accuracy and homogeneity opens up so many new pathways for radiation oncology and helps us treat benign tumours and ones that are difficult with EBRT. Not to mention the reduction in morbidity and fractionation.
Again, Thankyou!
-Mamihlapinatapei-
Thanks for the kind words and your hard work!
Hi Dr. Adler! I don't have any questions but I did want to tell you that you're one of the reasons my little pupper is still alive. I have a seven year old Welsh Corgi named Kooper. Last year he had a bump on his nose and started sneezing up blood. After numerous trips to the vet., we were referred to CSU (which is only about an hour away) and little Koop was diagnosed with Adenocarcinoma. My wife and I were heart broken but we were in a position to provide whatever was needed for treatment. The gold standard was SRT.
Long story short, Kooper is in full remission! The tumor shrunk down by 90%.
I wanted to personally thank you for everything you've done. If this treatment wasn't available, we would have to use the traditional approach which could have made him sick and might not have been as effective in treating his cancer.
I_am_trying_to_work
Yay! That's wonderful to hear. Give Kooper my best!
Your invention helped to save my dad's life. When he was diagnosed with a severe AVM in his brain which caused a series of aneurysms, the CyberKnife (combined with embolization) successfully shrunk it to a manageable size and prevented any further aneurysms.
10 years later he's still here with no lasting neurological damage.
(I need a question in here or this will be automatically deleted, so how's the weather where you're at?)
torgis30
That's amazing to hear! And it's a beautiful day in San Francisco!
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r/Science , John_Adler , Science AMA Series: Hi, I'm Dr. John Adler, inventor of the CyberKnife, Founder and Editor-in-Chief of the Cureus Journal of Medical Science and Professor of Neurosurgery at Stanford University. Ask me anything!, The Winnower 8:e149942.28257 (2017). DOI: 10.15200/winn.149942.28257
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