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In August, Ellwood City -- along with the Kitchen Cabinet residents group and Ellwood City Area Chamber of Commerce -- carried out a successful effort to raise $30,000 for Christmas decorations.
While the fund-raiser, by itself, didn't bring any large changes to Ellwood City, borough Manager Robert Villella said it was a sign of good things to come for the town.
"There was an abundance of people who said, 'We want Ellwood City to move forward,'" he said.
In 2014, Villella said, he wants Ellwood City to maximize its assets, including an attractive and extensive park system, good employees and -- perhaps most important -- all those people who want Ellwood City to move forward.
Villella, who was appointed borough manager last summer, said he would like to see the borough communicate more effectively not only among its departments, but also with residents and neighboring municipalities.
He plans to seek out any idea for improving Ellwood City, regardless of the source.
"Somebody might have a diamond in the rough out there. We should be willing to hear what that is," Villella said.
But even more important, Villella said Ellwood City residents should realize the town itself is that diamond.
"So many of the qualities that this town possesses are taken for granted or even overlooked," he said.
Within Lawrence County, Commissioner Dan Vogler is looking forward to prevailing in an effort that has gone on for more than a decade.
"My hope is that this will finally be the year we see the proposed racetrack and casino come to fruition," Vogler said.
This will be the 11th year that business interests have been trying to bring casino gambling to a site near routes 422 and 551 in Mahoning Township. One way or another, it's likely to be the last.
In May Endeka Entertainment, based in Delaware County, filed a casino license application with the state Gaming Control Board after receiving a harness-racing license. Vogler said the board has been meeting with officials from Endeka as part of the application process.
Ideally, the commissioner said the gaming control board would have a required public hearing in Mahoning Township, and that the casino license could be awarded in late spring or early summer. If that happened, the potential impact for Lawrence County could be enormous.
The opening of a casino would probably spur construction along the largely undeveloped Route 422 corridor between Interstate 376 and the proposed casino site and increase Lawrence County property values, which have remained largely stagnant for at least the past five years.
Vogler said natural gas drilling along the Marcellus and Utica shale plays would continue to increase in Lawrence County. The commissioner said the growth in drilling has been manageable, in terms of truck traffic and other infrastructure stresses from drilling.
"The growth has been somewhat gradual, compared to what happened in north-central Pennsylvania," Vogler said.


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Now, to keep you and your computer safe... don't click on that link!
Of course, that's not really practical. You use the web to find and share information. The web is not a useful tool if you can't click. So what should you do?
Here are three simple things you can do to help protect yourself and your computer.
1. Look before you click - with most links to can "mouse over" the link. That means you just move your mouse so it's on the link, but don't click yet! Your browser will display the address to which the link will lead. This displays at the bottom of the browser. The actual link in the display should make sense and be the location you're expecting. If not then... don't click!
2. Use link ratings - the free computer anti-malware program AVG has a web add-in that gives rating on google search links. This can let you know if a link might be problematic. If you'd like to crowd-source your link rating, and help with the process, WOT - Web of Trust, is a great site and browser plug-in. WOT lets you see and provide ratings of websites... and warns you before you go to a poorly rated site.
3. Context is King - the old adage for websites is "content is king". But when we're trying to decide whether to click on a link, Context is king. How did you receive the link? Was it from a page you trust? If in an email, did the email make sense? How was the grammar? Did it come from a person who normally sends you link? On a subject you normally share? Stop and think... does it all make sense?
As with the other posts in this series, if you can try the tips above, you will be much safer than the average web-surfer. If you'd like to raise the bar further, here are some more tips to try.
4. Like attracts like. There are simply certain kinds of websites that attract more trouble than others. File sharing, gaming and gambling sites tend to get hacked and host malware or malicious links more often than other sites. Any sites that host content of questionable legality should be suspect. I'm not saying you should avoid these sites altogether... you may have a good reason to visit these sites. But use care and think before you click.
5. Use care with:
- Social Networking sites - just because a link comes from your "friend" doesn't mean it's safe. And limit your use of Facebook apps.
- Ads - many sites, even well-known and legitimate sites, outsource their ads to third parties. And we don't know how carefully these third parties vet their ads.
- Pop-ups - while some legitimate sites do use pop-ups, most don't. The best thing to do with pop-ups is to close the window. In Windows, I recommend putting your cursor on the window and typing alt+F4 (hold down the alt key and press the F4 function key) rather than clicking the "X" or a close link... those could be malicious links!
- Auto-complete - most browsers use auto-complete. This means that the browser or search engine will try to "guess" what you're trying to type after a certain number of characters. If the browser or search bar auto-completes what you are typing, be sure to take a look at what is there before you click "go" or "search" or hit return. The resultant link may be fine, but you should always visually verify that the auto-complete text is what you think it should be.
6. Lock it up - always use https, that is secure browsing, for shopping, banking or whenever you are entering personal information on a web page. You should also look for the lock icon in the browser.
7. No PDI's, "Public Displays of Information" - while it's great fun to websurf at the coffee shop, don't use credit cards, do banking, handle medical records, or transact financial or personal business on open or public networks. That can wait until you get home. While many of these public networks are safe... if you can easily get on, so can anyone else, including someone who may want to steal your personal data.
8. Protect your web passwords - we've already talked about the use of password vaults and I highly recommend using one. Most browsers ask if you want to save passwords and form data in the browser. While browsers have improved their protections over the years, I generally recommend against this. Use a vault both for passwords and secure form filling.
And here's an advanced tip:
What other ideas do you have to minimize the danger of malicious links? How do you know if a link is safe? If you're a security professional, how do you teach others to use links safely?

subset: commoncrawl


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Option Detail Stone Coffee Table
Stone coffee table and golden fork legs that we think is the perfect complement to any corner. We can use it as a coffee table, bedside table, side table to leave magazines, etc. Once painted and dried, it's time to stick them to the marble envelope. It is important to choose a suitable adhesive for the different surfaces and apply it following the instructions. There are special adhesives for wood, melanin, metal or marble. To choose the best marble table, it is important to consider the size of the table, the color or colors of the table, the materials used to make the table, the style and weight.
Also, consider if the table has to be new, or if it would be better to go with an antique. This will be a choice to inform when searching for a stone table. Size is one of the most basic and most important considerations and should come first. Measure the space on the table is to adapt and look for the table that works best. A color is an important option as a stone marble coffee table should accentuate or complement the room in which it is to be installed. There are many of the stone marble, including shades of beige, black, white, gray, and green that can vary from pink to yellow. In addition, many marble tables only include marble on the surface of the table and have metal or wooden legs.
24 Picture Gallery: Option Detail Stone Coffee Table
These can also vary a bit in terms of colors. And 'always smart to buy with a couple of pieces of paint and tissue samples available for use for comparison. There are dozens of table styles of dozens. So it is important to consider if the stone marble coffee table should be modern research. Whether it should be minimalist or ornate. And whether a certain amount of planning should be reflecting. A good way to narrow down the options is to search online and tables in a design magazine for home and print and rip off pictures of images that satisfy all your practical and aesthetic needs.
It is also very important to consider the weight of a stone coffee table and end tables, in particular, if the table is large. Marble stone is a very heavy material, especially when cutting into large slabs of thickness. If the marble table will move to a regular or semi-regular base. It may be better to look for an option that is less heavy than the rest. To illuminate an option, consider purchasing a small wooden table that has a marble-encrusted upper section.
This post topic: Furnitures


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Experienced bankruptcy attorney serving the Pacific Northwest. I help individuals obtain a fresh start for the future. Let us help you stop the anxiety and worry over how you will pay for your debt. Give me a call at (425) 559-0636 to get started.
Address: 40 Lake Bellevue Dr., Suite 100, Bellevue, WA 98005
Phone: (425) 559-0636
Since 1992, we have helped both small and large companies master their financial challenges.
Address: 601 Union Street, Suite 5000, Seattle, WA 98101
Phone: 206-292-2110
Address: 10700 Meridian Ave N #109, Seattle, WA 98133
Phone: (855) 923-3283
The lawyers of Bucknell Stehlik Sato & Stubner, LLP, enjoy a national reputation for effective and creative resolution of major business and commercial problems.
Address: 2003 Western Ave., Ste. 400, Seattle, WA 98121
Phone: 206-587-0144


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As I Lay Dying Quotes
Quote 1: "Riches is nothing in the face of the Lord, for He can see into the heart." Cora, p. 7
Quote 2: "The quilt is drawn up to her chin, hot as it is, with only her two hands and her face outside. She is propped on the pillow, with her head raised so she can see out the window, and we can hear him every time he takes up the adze or the saw. If we were deaf we could almost watch her face and hear him, see him. Her face is wasted away so that the bones draw just under the skin in white lines. Her eyes are like two candles when you watch them gutter down into the sockets of iron candlesticks. But the eternal and the everlasting salvation and grace is not upon her." Cora, p. 8
Quote 3: "I know her. Wagon or no wagon, she wouldn't wait. Then she'd be upset, and I wouldn't upset her for the living world. With that family burying-ground in Jefferson and them of her blood waiting for her there, she'll be impatient. I promised my word me and the boys would get her there quick as mules could walk it, so she could rest quiet." Darl, p. 18
Quote 4: "I have heard men cuss their luck, and right, for they were sinful men. But I do not say it's a curse on me, because I have done no wrong to be cussed by. I am not religious, I reckon. But peace is my heart: I know it is. I have done things but neither better nor worse than them that pretend otherlike, and I know that Old Marster will care for me as for ere a sparrow that falls. But is seems hard that a man in his need could be so flouted by a road." Anse, p. 37
Quote 5: "I knew that nobody but a luckless man could ever need a doctor in the face of a cyclone." Peabody, p. 40-41
Quote 6: "It's because I'm alone. If I could just feel it, it would be different, because I would not be alone. But if I were not alone, everybody would know it. And he could do so much for me, and then I would not be alone. Then I could be all right alone." Dewey Dell, p. 56-57
Quote 7: "I reckon if there's ere a man or woman anywhere that He could turn it all over to and go away with His mind at rest, it would be Cora. And I reckon she would make a few changes, no matter how He was running it. And I reckon they would be for man's good. Leastways, we would have to like them. Leastways, we might as well go on and make like we did." Tull, p. 70
Quote 8: "The wagon moves; the mules' ears begin to bob. Behind us, above the house, motionless in tall and soaring circles, they diminish and disappear." Darl, p. 98
Quote 9: "[Vernon] watches Jewel as he passes, the horse moving with a light, high kneed driving gait, three hundred yards back. We go on, with a motion so soporific, so dreamlike as to be uninferant of progress, as though time and not space were decreasing between us and it" Darl, p. 101.
Quote 10: "I heard that my mother is dead. I wish I had time to let her die. I wish I had time to wish I had. It is because the wild and outraged earth too soon too soon too soon. It's not that I wouldn't and will not it's that it is too soon too soon too soon." Dewey Dell, p. 114
Quote 11: "She cried hard, maybe because she had to cry so quiet; maybe because she felt the same way about tears she did about deceit, hating herself for doing it, hating him because she had to. And then I knew that I knew. I knew that as plain on that day as I knew about Dewey Dell on that day." Darl, p. 129
Quote 12: "It is as though the space between us were time: an irrevocable quality. It is as though time, no longer running straight before us in a diminishing line, now runs parallel between us like a looping string, the distance being the doubling accretion of the thread an not the interval between." Darl, p. 139
Quote 13: "Because it is not us that can judge our sins or know what is sin in the Lord's eyes. She has had a hard life, but so does every woman. But you'd think from the way she talked that she knew more about sin and salvation than the Lord God Himself, than them who have strove and labored with the sin in this human world." Cora, p. 159
Quote 14: "While I waited for him in the woods, waiting for him before he saw me, I would think of him as dressed in sin. I would think of him as thinking of me as dressed also in sin, he the more beautiful since the garment which he had exchanged for sin was sanctified. I would think of the sin as garments which we would remove in order to shape and coerce the terrible blood to the forlorn echo o the dead word high in the air. Then I would lay with Anse again - I did not lie to him: I just refused, just as I refused my breast to Cash and Darl after their time was up - hearing the dark land talking the voiceless speech." Addie, p. 166-7
Quote 15: "I give that money. I thought that if I could do without eating, my sons could do without riding. God knows I did" Armstid, p. 182
Quote 16: "It had been dead eight days, Albert said. They came from some place in Yoknapatawpha County, trying to get to Jefferson with it. It must have been like a piece of rotten cheese coming into an anti-hill, in that ramshackle wagon that Albert said folks were scared would fall all to pieces before they could get it out of town, with that home-made box and another fellow with a broken leg lying on a quilt on top of it, and the father and a little boy sitting on the seat and the marshal trying to make them get out of town." Moseley, p. 193
Quote 17: "Jewel came back. He was walking. Jewel hasn't got a horse anymore. Jewel is my brother. Cash is my brother. Cash has a broken leg. We fixed Cash's leg so it doesn't hurt. Cash is my brother. Jewel is my brother too, but he hasn't got a broken leg." Vardaman, p. 200
Quote 18: "When I went to find where they stay at night, I saw something that Dewey Dell says I mustn't never tell nobody." Vardaman, p. 215
Quote 19: "Life was created in the valleys. It blew up into the hills on the old terrors, the old lusts, the old despairs. That's why you must walk up the hills so you can ride down." Darl, p. 217
Quote 20: "Sometimes I aint so sho who's got ere a right to say when a man is crazy and when he aint. Sometimes I think it aint none of us pure crazy and aint none of us pure sane until the balance of us talks him that-a-way. It's like it aint so much what a fellow does, but it's the way the majority of folks is looking at him when he does it." Cash, p. 223
Quote 21: "She looked pretty good. One of them black eyed ones that look like she'd as soon put a knife in you as not if you two-timed her. She looked pretty good." MacGowan, p. 232
Quote 22: "Yes yes yes yes yes yes yes." Darl, p. 244
Quote 23: "'It's Cash and Jewel and Vardaman and Dewey Dell,' pa says, kind of hangdog and proud too, with his teeth and all, even if he wouldn't look at us. 'Meet Mrs Bundren,' he says." Cash, p. 250


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Let's start at the beginning on the vexed issue of foreign donations for political parties and candidates in an environment in which globalisation is adding to challenges in combating foreign interference in electoral processes.
Back in 1918, when the Commonwealth Electoral Act was drafted, no distinction was made between donors from Australia or overseas, or (effectively) between donors who were Australian citizens, non-citizens, or organisations.
In the last year of the 1914-18 war not much thought, if any, was given to the possibility that foreign interests would interfere with the Australian electoral process, or would have an interest in doing so.
But now, in an environment in which commercial and political interests leapfrog national boundaries in ways that must have seemed a remote possibility when the 1918 Commonwealth Electoral Act was drafted, it is time to subject the act to a comprehensive revision.
The aim of this exercise should be to exclude foreign donations. Those bans should extend to organisations engaged in the political process as lobby groups for one side or the other.
It would make little sense for bans to be applied to political parties themselves without also extending such bans to unions and business lobbyists.
As much as anything, such a provision would act as a deterrent to those who might seek to utilise foreign funds improperly.
Government ministers tell you it will be difficult to frame legislation that would stop all foreign funding.
What about grey areas, they ask, such as contributions by companies whose main business is in Australia, but whose headquarters is located elsewhere?
The London-headquartered Rio Tinto is one such example.
These are difficult issues and need to be worked through. There is no simple remedy.
Of course, one option would be to make political campaigns fully publicly-funded, thus obviating the need for private fundraising. But that arrangement potentially discriminates against new entrants who may not qualify for such public funding.
The Australian model in which funding is made available on the basis of past performance has merit. But its weakness is that it advantages the major parties disproportionately.
Then there is the whole murky area of funding for organisations like the conservative Institute of Public Affairs, or groups on the left, like GetUp, which supports progressive causes.
Under present circumstances, organisations like the IPA are not obliged to disclose their sources of funding. Since they are involved in the political process, these lobby groups should be required to open their books.
In the United States, funding for similar organisations is transparent, for the very good reason that just as sunlight is the best disinfectant so is transparency in ascertaining what might motivate groups to adopt certain positions.
The IPA, for example, opposed plain packaging for tobacco products on what it insisted were libertarian grounds. It would have been useful, however, to be apprised of whether the tobacco industry contributes funds to that organisation.
Lobby groups should be obliged to place sources of funding on the public register, especially since many of these organisations derive tax benefits from their status as not-for-profit organisations.
The whole question of "money talks" politics has come into focus in the past week or so with revelations in a Fairfax Media/ABC investigation of money being splashed around political parties by Chinese-born billionaires, one of whom is not an Australian citizen.
Clearly, the aim of these contributions has been to influence Australian politicians in a way that would make them more sympathetic to China's aspirations.
Indeed, in one case, funding that had been promised to Labor was withheld after one of its spokesmen advanced a point of view contrary to China's interests.
This was a clear example of money being used – or the threat of funds being withheld – for political purposes. It should be regarded as distasteful, and, potentially intimidatory.
If there is a rule of thumb in politics, it is that money does not bring purity, rather the reverse.
Special Minister of State Scott Ryan, who has responsibility for an overhaul of the Commonwealth Electoral Act as it relates to political donations, acknowledges that grey areas exist that will be difficult to legislate.
In framing the required legislation, Ryan might refer to the Political Finance Database of the International Institute for Democracy and Electoral Assistance, an intergovernmental organisation that supports sustainable democracy worldwide.
The IDEA has a formula that would be helpful in establishing exactly what constitutes a "foreign interest".
It defines such interests as entities that:
contribute directly or indirectly [and who are] governments, corporations, organisations or individuals who are not citizens; that do not reside in the country or have a large share of foreign ownership.
In the case of the latter provision, framing regulations to stop foreign donations would present challenges. Rio Tinto is just one example of companies with large stakes in Australia, but domiciled overseas.
Perhaps the most compelling argument for an Australian ban on political donations is that, apart from New Zealand, Australia is the only English-speaking democracy to permit such donations.
In New Zealand, overseas donations are capped at $NZ1,500.
In Australia no such cap applies.
However, donations to parties and candidates above $13,200 require the name and address of donor to be supplied. This information must be made available at the end of each financial year.
One reform Ryan might consider is to oblige disclosure more quickly. In last year's federal election, Prime Minister Malcolm Turnbull made a very significant personal financial contribution to the Liberal Party campaign. But under law, this donation did not need to be disclosed in a timely manner.
Turnbull did reveal his contribution – after the election and only under media pressure.
In the case of that contribution it could be argued that wealth in Turnbull's case enabled him to fund a campaign that gave him an advantage over his opponents.
On the other hand, the conservative side of politics would say that Labor has an inbuilt funding advantage because it can rely on the support of the union movement.
In recent years, several attempts have been made to clean up what is clearly an unsatisfactory state of affairs.
In 2010, the Labor government introduced the Commonwealth Electoral Amendment (Political Donations and Other Measures Bill) that would have banned donations of "foreign property".
The bill passed the House of Representatives, but was not proceeded with in the Senate and lapsed at the end of the 43rd parliament.
Labor and the Coalition toyed with the introduction of a donation and disclosure reform bill in 2013, but nothing came of these efforts.
In this latest 45th parliament the Greens have restored their own Commonwealth Electoral Amendment Bill that bans donations of foreign property. This version lapsed at the dissolution of the 44th Parliament.
Now is the time for this whole issue to be re-visited.
Ryan, in conjunction with Attorney-General George Brandis, needs to come up with a bill that seeks to forestall the possibility of candidates and parties being bought and sold in a monied environment that is infinitely more susceptible to influence peddling by foreign interests than it was a century ago.


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Small Groups
We know church is more than simply a building or a large service on Sunday morning. We are the Church: the body of believers. We love together, fellowship together, and build relationships, becoming the Family of God. It is important for us to walk together and connect in deeper ways than simply by coming together Sunday morning.
Our Small Group ministry is here for that reason. Those who have similar interests meet together during the week or the month and pray, worship, and study the word together. Some groups are led by a single person or couple, while others rotate through leaders and locations. Wednesday evening small group, led by Jason Moody, a member of the Worship team, meet at the church at 7pm. This group has a focus on prayer and worship, and child care is available for this weekly event.
As we "do life" together, our desire is to see all of our family member s involved in a small group in 2016. If you are interested in a particular topic, desire to lead, or desire to attend a small group, please let us know.


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Wellington's Big Beer Quarter
Posted on September 18th, 2011 by martincraig
Wellington has a new craft beer precinct. Three new craft beer bars, with more than 100 taps between them, opened recently, all centred around Manners Street and all within a three-minute walk. The Taphaus is on the corner of Victoria and Dixon Streets. The site was a curry joint for years and the decor still […]
Filed under: Around the country, Beer Bars | 8 Comments »


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TU4D Prototype project: Reading skills for first year engagement and the development of research proficiency – A reflection Phase 1 and Phase 2
This project is concerned with the development of critical readings programmes in the three partner Institutons of TU4D. The philosophical position informing this project is that critical reading is an integral element of academic literacy. It is envisaged that the trajectory of the project would be towards the development of integrated programmes where critical reading, critical thinking and critical writing are integrated. The presumption is that the development of critical reading skills will enhance the first year experience and contribute to the development of independent learners who have personal confidence and engagement with the academic process. After due consideration the critical readng team decided that rather than simply collecting a range of resources and initiating critical reading programmes that we develop a research based framework for the development of critical reading programmes for first year students across the three partner Institutions.
It was considered that the project would be enhanced by exploring how lecturers in the three partner Institutions engage with the concept in their practice and what the implications might be for provision of initial and continuing face to face and online support in critical reading provision. Similarly it was thought appropriate to explore how current students of the three partner Institutions over 18 years old currently approach reading difficult texts, what supports are in place to help them and what supports should be provided in the future. This exploration involves the design, delivery and analysis of staff and student surveys and will be further enriched by staff and student focus groups. Phase 1 of the project is now nearing completion.
- A wordpress site
- A number of resources relating to critial reading has been uploaded to our wordpress site including
- online resources pertaining to speed reading and critical reading
- Online journal articles relevant to the delivery and relevance of critcal reading
- Relevant online and hardcopy textbooks relevant to the delivery and understading of critical reading
- Developed processes for hosting online meetings among team members
- Reflections and recommendations for streamlining processes of ethical approval and the disbursement of funds for partners involved in TU4D projects.
- Developed resources and documents for ethical approval
- Completed the development of surveys for delivery to staff and students
Phase Two – Moving Forward
The foundation for moving into phase two has been set and will include the following:
- The distribution of staff and student surveys to relevant constituencies in DIT, ITB and ITT and analysis of same.
- The conduct of focus groups to enrich the dataset from the student and staff surveys.
- The analysis of student and staff surveys and of focus groups.
- The writing of a reflective consideration of the survey and focus groups to inform and develop initial and continuing face to face and online support in critical reading provision. This would involve the delivery of critical reading programmes in each of the institutes informed by these reflections.
- Ongoing development and sharing of pedagogic resources including methods for student engagement on our WordPress site.
- The writing up of the results of the impact of this research in academic journals in terms of the development of self efficacy and self directed learning.
- The exploration in this context of the relationship between information literacy and crital literacy in the context of library research. This project is perceived as cross disciplinary between educational practice and library science and offers the potential for publications in both disciplines.
- The development of these programmes where the links between critical reading, critial thinking and critical writing are more firmly establised.
As a final comment this project has set in place a solid research based framework to inform the development of critcal reading skills programmes across the three partners Institues. The research team believes that this project can provide a valuable contribution to the development of critical reading and critical writing skills among the student population across the TU4D partnership. The value of these programmes is well documented in the academic literature. The need for such progrmmes has recently been suggested by Dr Greg Foley in an article in the Irish Times dated Jan 21 2016. TU4D would be ahead of the curve in the structured development of such programmes within the sector. We would be happy to hear from colleagues who are currently involved or are interested in developing critical reading programmes for their students.
Stage 1: Pilot Study
[Oct-Dec 2015]
- Project Plan
- Ethics
- Development of Staff Survey
- Development of Student Survey
- Planning for the Focus Group Interview


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What does fact checked mean?
At Healthfully, we strive to deliver objective content that is accurate and up-to-date. Our team periodically reviews articles in order to ensure content quality. The sources cited below consist of evidence from peer-reviewed journals, prominent medical organizations, academic associations, and government data.
- PubMed.gov: "Hepato-gastroenterology;" The metabolism of anthranoid laxatives; P. de Witte and L. Lemli; 1990
- PubMed.gov: "Hepato-gastroenterology;" The metabolism of anthranoid laxatives; P. de Witte and L. Lemli; 1990
The information contained on this site is for informational purposes only, and should not be used as a substitute for the advice of a professional health care provider. Please check with the appropriate physician regarding health questions and concerns. Although we strive to deliver accurate and up-to-date information, no guarantee to that effect is made.
Bekunis Tea Side Effects
Bekunis tea is sold as a natural laxative. The active ingredient in it is senna, which is a member of the pea family that is cultivated in the Middle East and Europe. It has substances in it called anthranoids, sometimes referred to as vegetable laxatives, because these substances stimulate contractions of the colon. It's best to consult a doctor before using any laxative products.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Atonic colon
Long-term use of Bekunis tea can lead to an atonic colon, meaning your colon will lack strength and muscle tone, and thus will develop impaired function according to the European Medicines Agency. This can lead to aggravation of your constipation and dependence on the tea, with need for increasing quantities to produce an effect. Stimulant laxatives like senna should not be used for more than one to two weeks. If you want to use them for a longer time frame, you must have medical supervision advises the EMA.
Allergic Reactions
You may suffer an allergic reaction to senna according to Drugs.com. Get medical aid immediately if you have severe reactions, which can include itching, a rash, hives, chest tightness, difficulty breathing, or facial, mouth tongue or lip swelling.
Gastrointestinal Issues
Bekunis tea may cause cramping, vomiting, nausea, flatulence and diarrhea according to George T Grossberg and Barry Fox in "The Essential Herb-Drug-Vitamin Interaction Guide." If you experience black, tarry stools or severe stomach pain you need to get immediate medical attention.
Worsening of Conditions
EMA advises that Bekunis tea can worsen your condition or be dangerous to use if you have intestinal obstructions, appendicitis, inflammatory colon disease like Crohn's disease or ulcerative colitis, lack of muscle strength in your colon, abdominal pain of unknown origin, are dehydrated or have electrolyte depletion. Using senna with other products that can induce hypokalaemia, meaning potassium depletion, can also lead to or worsen an electrolyte imbalance. Such products include diuretics, licorice root, adrenocorticosteroids, horsetail, cascara sagrada, castor oil, black root and insulin. You should consult a doctor before taking the herb if you take medicines that can cause dehydration or electrolyte imbalance. This is especially important for people who are either young or elderly.
Irregular Heartbeat
You may experience an irregular heartbeat when using Bekunis tea according to Grossberg and Fox. It can worsen heart ailments by leading to an electrolyte imbalance. Taking it with certain medicines, for example acebutolol, digitalis, ibutilide, insulin, propranolol and verapamil, can increase the risk of irregular heartbeat .
Estrogen Rise
Your blood levels of estrogen may increase if you drink Bekunis tea and take birth control pills simultaneously according to Grossberg and Fox.
Possible Cancer and Melanosis Coli Link
Anthranoid laxatives like senna may be associated with colon cancer according to a study by Riccardo Nascimbeni et al in "Cancer Epidemiology, Biomarkers and Prevention." However, the association between anthranoid laxative use and colon cancer is supported mostly via data collected through interviews, and results of studies are not consistent. Thus, definite conclusions cannot be drawn about the relationship between laxative use in and of itself as a possible colon cancer cause according to Nascimbeni. He notes anthranoids do show mutagenic and carcinogenic effects in lab and animal studies.
There's also a possible link between senna and melanosis coli. According to the Medterms website, melanosis coli is usually a reversible condition that does not cause symptoms in which pigment in the mucous lining of the large intestine becomes discolored to brown or black.
- "The Essential Herb-Drug-Vitamin Interaction Guide;" George T Grossberg and Barry Fox; 2007
- PubMed.gov: "Hepato-gastroenterology;" The metabolism of anthranoid laxatives; P. de Witte and L. Lemli; 1990
- "Cancer Epidemiology, Biomarkers and Prevention:" Constipation, Anthranoid Laxatives, Melanosis Coli, and Colon Cancer--A Risk Assessment Using Aberrant Crypt Foci; Riccardo Nascimbeni et al.; 2007
- logdog7/iStock/Getty Images


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How to Upgrade Weapons in Red Dead Redemption 2
Weapons are of paramount importance in Red Dead Redemption 2, and this guide will show you how to keep them in excellent condition.
The more powerful your weapons are in Red Dead Redemption 2, the more chance you stand of surviving in the brutal wild west. In this Red Dead Redemption 2 weapons guide, we'll be walking you through how to upgrade your weapons in Red Dead Redemption 2 by visiting the nearest Gunsmith to you.
How to Upgrade Weapons
In order to customize your weapons in Red Dead Redemption 2, you're firstly going to need to save some cash, since putting a new scope or stock on your rifle won't come cheap. For some tips and tricks on how to earn some dollars in the wild west quickly, head over to our Red Dead Redemption 2 Money guide.
Once you have got some cash, you're going to want to head to the nearest Gunsmith, marked by a pistol on your map. The closest Gunsmith you'll have in the opening hours of Rockstar's game can be found right in the middle of Valentine, the town located roughly in the middle of the entire map.
Select the 'Customize' option when you're at the Gunsmith, and you can upgrade any weapon that Arthur is carrying, or has left on his horse. Firstly, a weapon needs to be clean and in perfect condition for a Gunsmith to be able to customize it, so select 'Clean Weapon', and pay roughly around a dollar to have your weapon polished up.
Now select 'Components' for the weapon, and you can customize basically everything about it, including scopes, barrels, stocks, and more. Note that only upgrading the weapon's barrel, iron sights, and scope will actually provide any statistical bonuses for it, and the stock and wrap options are cosmetic only.
Best Weapon Upgrades
The best gun upgrades that you can possibly obtain in Red Dead Redemption 2 always come in the form of bonuses to your accuracy. This means you're going to want to upgrade the scope or sights on your weapon as soon as you've got the cash to spare it. Whenever you're caught in a running shootout, or a gunfight from horseback, you're always going to want to prioritize a weapon with accuracy, over firepower.
How to Clean Guns
If you ever want to check on the condition of a weapon in Red Dead Redemption 2, simply bring up the item wheel, and hover over the desired weapon. You can now see a 'Condition' meter at the bottom of the entry for the weapon.
If your weapon is damaged at all, you'll see a button prompt on the lower right corner of the screen to 'Clean' the gun. Press the right analog stick if this is available, and you'll use a Gun Oil item to clean your weapon immediately back to perfect condition. Note that you obviously need to own a Gun Oil item to do this, and to purchase more, simply head to the nearest Gunsmith.
Weapon Stats
Just below, we've got a list of every single Weapon in Red Dead Redemption 2, that's available for purchase from the Gunsmith. Note that the Carcano Rifle and Lichfield Repeater will be unlocked through story progress.
This is absolutely everything you need to know about customizing weapons in Red Dead Redemption 2, as with every new attachment or upgrade that you buy for a weapon, you can see the stat bonuses to damage, accuracy and more in the bottom left corner of the screen. Now that we're done here, why not continue ahead to our Red Dead Redemption 2 Deadeye guide, or our page on how to sell valuables in Red Dead Redemption 2, for some quick cash.
If you're looking for info on RDR2's Online mode, we've got you covered. You can head over to our Red Dead Online Guides Hub to find all of our Red Dead Online Guides content in one handy place. Alternatively, you can find info on the best weapons in our Red Dead Online Best Weapons Guide, see what the best horse is in our Red Dead Online Horses Guide, learn how to make as much money as fast as possible in our Red Dead Online Money Making Guide, and see what the deal is with Camps in our Red Dead Online Camps Guide.


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|Beijing ,China
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|Model Number:
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Product Description
a high desert oasis.. welcome to the Hampton Inn & Suites-Ridgecrest, CA. Surrounded by four mountain ranges, including the Sierra Nevada, Coso, Argus and El Paso Mountains, the Hampton Inn & Suites® Ridgecrest hotel welcomes guests to beautiful Southern California Boasting a lively, urban environment and breathtaking natural wonders, the area around our Ridgecrest, CA, hotel is perfect for guests who want to explore the great outdoors, experience unique restaurants or discover charming shops. Take in the stunning Petroglyph and Trona Pinnacles, Lake Isabella and Red Rock Canyon Park. Find that special something at nearby Sierra Vista Shopping Center and Ridgecrest Plaza. It's all just minutes from our front door! For those traveling on business, Ridgecrest Regional Hospital, General Dynamics, the Bureau of Land Management and Coso Geothermal are just a few of the corporations within a short walk or drive from our hotel in Ridgecrest. We know you'll enjoy your stay at the Hampton Inn & Suites Ridgecrest, CA… a high desert oasis in California's Kern County. services & amenities Even if you're in Ridgecrest to enjoy the great outdoors, we want you to enjoy our great indoors as well. That's why we offer a full range of services and amenities at our hotel to make your stay with us exceptional. Are you planning a meeting? Wedding? Family reunion? Little League game? Let us help you with our easy booking and rooming list management tools * Meetings & Events * Local Restaurant Guid
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Under the civil rights laws, the winner recovers attorneys' fees from the losing party. As with everything else in law, the prevailing party inquiry is complicated. An outright victory at trial or court order means the plaintiff is entitled to attorneys' fees. If the case settles, it's a closer question.
The case is Perez v. Westchester County Department of Corrections, decided on November 19. The Muslim plaintiffs sued their jailers for religious discrimination over the refusal to serve them Halal meat consistent with their religious practices. Prior to trial, the County agreed to provide the food as frequently as it provided Jewish inmates kosher food, ending the case.
Ten years ago, this was a more straightforward question. Most federal courts recognized the plaintiff was a prevailing party under the attorneys fees statute if the defendant gave in and provided plaintiff the relief requested rather than fight the case. This was the "catalyst" theory. But in 2001, the Supreme Court rejected the catalyst theory and held in Buckhannon v. West Virginia that the plaintiff needs a judgment or some kind of judicially-approved settlement. The Second Circuit has interpreted Buckhannon to mean that "judicial action other than a judgment on the merits or a consent decree can support an award of attorneys' fees, so long as such action carries with it sufficient judicial imprimatur."
In this case, when the County agreed to settle (at the district court's urging), the parties did not enter into a consent decree, which would have entitled plaintiffs to attorneys' fees under Buckhannon. However, the dismissal of the lawsuits only took effect "upon the Court's approval and entry of this Stipulation and Order." The district court amended the agreement to designate it an "order of" settlement, and also noted that the court had discretion to accept any case brought by plaintiffs to enforce the settlement in case the County failed to live up to the settlement. The court also "so ordered" the settlement and then awarded plaintiffs' lawyers nearly $100,000 in attorney fees as the prevailing party in this civil rights lawsuit.
The Court of Appeals (Calabresi, Livingston and Korman, D.J.) upholds the fee award under Buckhannon. Challenging the award, the County said the plaintiffs were not prevailing parties and that the settlement was the kind of voluntary change in behavior which disentitles the plaintiffs to any fees under Buckhannon. The Second Circuit disagrees. As a result of the settlement, the County has changed its behavior in providing the religious food. The settlement also has a "sufficient judicial imprimatur" because the trial court retained authority to enforce the settlement. The Second Circuit holds for the first time that an order of dismissal that explicitly incorporates the terms of a settlement entitles the plaintiff to attorneys' fees. This is particularly the case because the district court intended to place its judicial imprimatur on the settlement as shown by its active involvement in sanctioning the settlement. Not only did the district court retain authority to enforce the agreement, but it reviewed and approved the agreement. Plaintiffs satisfy the difficult Buckhannon standard.
Tuesday, November 24, 2009
Court-approved settlement in prisoners' rights case entitles plaintiffs to attorneys' fees
2 comments:
Great blog folks. Keep up the good work.
Seconded! [wink]
Really, folks: I read every posting, and find they are HIGHLY understandable; plus, I almost always learn something new.
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In the surf and on the river, on the mountain and the soccer field and the sail boat and the beach... The natural habitat of the NRS Men's Long Sleeve HydroSilk Shirt just happens to be yours too.
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- Athletic styling is form-fitting for easy layering.
- UV protection-factor of 50+ guards your skin from the sun's harmful rays.
- Great by itself in hot weather or as a base layer in your cold weather layering system.
Current Reviews: 0
This product was added to our catalog on Wednesday 01 April, 2015.


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Contact Us
About us
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Written by Administrator
Friday, 23 April 2010 20:41
Last Updated on Saturday, 24 April 2010 22:36
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Contact us
304/9 Moo 5 Aonang Beach, Muang, Krabi 81180 Thailand
Tel.,Fax. : 075-637 250
Mobile : 08-1607-4162, 06-2919-4264
304/9 Moo 5 Aonang Beach, Muang, Krabi 81180 Thailand
Tel.,Fax. : 075-656508
Mobile : 08-1607-4162, 06-2919-4264
E-Mail : email@example.com , email@example.com, email@example.com
Follow Krabi Eco Cycle.
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Half day cycling tour
This tour is designed for sightseeing around Ao-nang region and to learn about the local area with your local guide.
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Half day waterfall cycling
This half day waterfall cycling tour is a great choice if you like outdoor adventure. The tour will give you a very good impression of what's around Krabi.
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Half day Koh Klang culture cycling tour
This tour is a combination of sightseeing and cycling. You will experience a fantastic sight of a local Muslim village. See how the local people go about their daily business.
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One day jungle cycling tour
The one day jungle cycling tour is one of the best choices if you have a whole day available. To see beautiful Krabi, you don't have to be an athlete or a racer!
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One day long distance cycling
Tour for a long bike ride is tough. You have to build up your physical endurance beyond the average workout and train your muscles and cardiovascular system.
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Custom Tour
A unique tour with personalized routes and activities designed just for your group
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One day khao-honnak
Khao Hon Nak is a steep limestone mountain.This nature trail will bring you to the viewpoint.
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Wildfire Yoga has evolved into two new sites!
One for the Studio under the name 'Mokshala Yoga nd Meditation Centre' founded by Jacqueline
and one for Jacqueline the Yoga teacher under the name 'Jacqueline Godfrey Yoga'
Use the links below to take you to where your need to go.
Thank you.


text:
03/20/2019, 7:45am CDT, By SJU Lacrosse
10/27/2016, 8:15pm CDT, By SJU Lacrosse
10/24/2016, 10:30am CDT, By SJU Lacrosse
12/20/2013, 4:30pm CST, By Gott to Lax Initiative, Inc.
07/02/2012, 6:45pm CDT, By SJU Lacrosse
12/30/2011, 12:00pm CST, By Michael King, SJU Lacrosse
09/21/2011, 9:00am CDT, By Ryan Demorest, InsideLacrosse.com
08/03/2011, 7:13pm CDT, By Denise Safranek
05/17/2011, 5:00pm CDT, By SJU Lacrosse
05/16/2011, 12:30pm CDT, By Dan Bonebright, SJU Lacrosse contributor
The Johnnie Lacrosse Camp is designed not only to improve individual camper's lacrosse skills and knowledge of the game, but also to provide a truly unique learning experience. This one of a kind experience focuses on creating an environment that fosters new relationships while being immersed in all that the largest campus in the nation has to offer. The camp price is extremely competitive for a three day and three night residential camp, especially if one takes advantage of discounts. See the "2014 Johnnie Lax Camp Informational Guide" attached below for more details including what to bring. This is one summer lacrosse camp that you don't want to miss!
When: July 10-13th, 2014
Where: St. John's University, Collegeville, Minn.
Who: Boys age 10-18


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At nine o'clock on July 28th last year, Wendy Nissley carried her two-year-old daughter, Lacy, into O.R. 12 at Johns Hopkins Hospital to have half of her brain removed. Lacy suffers from a rare malformation of the brain, known as hemimegalencephaly, in which one hemisphere grows larger than the other. The condition causes seizures, and Lacy was having so many—up to forty in a day—that, at an age when other toddlers were trying out sentences, she could produce only a few language-like sounds. As long as Lacy's malformed right hemisphere was attached to the rest of her brain, it would prevent her left hemisphere from functioning normally. So Lacy's parents had brought her to Johns Hopkins for a hemispherectomy, which is probably the most radical procedure in neurosurgery.
Wendy laid her daughter on the operating table. Because Lacy was so small, it took the anesthesiologist almost ninety minutes to insert her intravenous lines. George Jallo, the attending neurosurgeon, spent a long time arranging her head on gel padding and then drew "Cut here" markings on her shaved scalp. The rest of Lacy's head, including her face, was covered with a sterile drape. Jallo made one long cut across the top of her head from the front to the back, and another at right angles to the first, which started midway along it and stopped just in front of her right ear. He folded back the scalp and made small holes in her skull with a power drill, outlining a rough semicircle. Then he used the drill to connect the dots and removed a portion of the skull. He cut another T in the dura, a thin, leathery membrane covering the brain. Gently, he peeled back two large flaps.
By half past one, Jallo and a resident had already removed the right frontal lobe. David Lieberman, the pediatric neurologist who had examined Lacy when she first came to Johns Hopkins, looked on, shaking his head in wonderment. "It's so open," he said, turning to me. "Normally, with brain surgery, you make a hole about this big"—he curled his thumb and index finger into a circle.
After removing the frontal lobe, Jallo embarked on the parietal lobe. In case complications put a sudden stop to the surgery, it was important to take out the seizure hot spots first, gradually working through the hemisphere in descending order of priority: after the parietal lobe would come a small section of the occipital lobe, then the temporal lobe, then the rest of the occipital. Finally, Jallo would cut the corpus callosum, the bundle of fibres that connect the two hemispheres of the brain. The surgeons slowly worked around each side of the parietal lobe, making tiny pinches in the brain with electric cauterizing forceps. There was a slight smell of burning in the bright, noisy operating room. As the cut became deeper and wider, the tissue on either side browned and blackened, and the lobe started to move back and forth. At the bottom of the parietal wedge, the clean white of nerve fibres was visible; as the lobe was severed, they came apart like string cheese. A surgical technician bent toward Jallo with a small plastic bowl in his hands. Jallo picked the lobe out of the skull—it was the size of an infant's fist—and dropped it into the container.
As she led me out of the O.R., Eileen Vining, the attending neurologist, said, "Did you see how rigid it was? Normal brain sags in your hands." Vining talked quickly, moving from one complicated idea to the next, punctuating each with "O.K.?" and an expectant nod. She had been in and out of the operating room all morning, and now she was off to find the Nissleys and tell them how Lacy was doing.
Four hours later, Vining took me back into the O.R. Lacy's right hemisphere was gone, and her cranium looked like a wide, uneven bowl. I could see the deep cavity where the frontal and parietal lobes had been, and the white-pink color inside the base of the skull. In the middle of the remaining brain was a shallow mound where Jallo had left a layer of nerve fibres to protect the ventricle, a fluid-filled pocket that cushions the brain and the spinal cord. The white matter there was now gray-black. Jallo and his resident lightly touched their forceps to it, and the cauterizers fizzed, sealing the brain to prevent microhemorrhages. Hemorrhaging is a constant concern in brain surgery, and at one point in the operation Jallo decided to leave in a small piece of the right occipital lobe which threatened to bleed dangerously. Jallo glanced at Vining and Lieberman, and the doctors stretched forward to look at the severed corpus callosum. Over and over, the surgical technician poured in saline, and Jallo and his resident drew it out again with a loud suction pump.
When he had finished removing brain tissue, Jallo tipped in small packets of Surgicel, a feathery white substance that helps blood to clot. It melted onto the surface of the brain. "That was good. There was not a lot of bleeding," Vining said. "You never know what you are going to get until you open it up. Sometimes you just go in there and you hold your breath and pray."
In the final hour, Jallo sutured Lacy's dura, which had shrunk slightly from dehydration, and filled the right side of her head with saline. The technician then brought the missing section of the skull back to Jallo, carrying it in a wide right angle over surgical carts rather than risk moving it over the floor. Jallo reattached it, using four tiny dissolvable plates made of a sugarlike substance. He then closed the scalp incision with a staple gun, leaving seventy-eight aluminum staples in Lacy's skin. The hemispherectomy had taken nine hours. The resident bandaged Lacy's head, gently turned her onto her right side, and stuck a piece of tape on her head that said "This side up."
I first met the Nissleys three months before Lacy's surgery, at their home in Palmyra, Pennsylvania. As I drove up, I could see Lacy's father, Mike, dangling a leg over the edge of the front porch. He looked like a surfer, with a goatee beard and gold-lens Oakleys pushed back on his head. Wendy sat on a chair near the front door, and Lacy's four-year-old sister, Lily, flitted around the adults. Lacy, blond like her mother, lay across Wendy's lap. "She had a seizure just before you got here, so she's sleeping now," Wendy said. They invited me inside.
Lacy had her first seizure on October 13, 2003, when she was four and a half months old. Wendy had been doing laundry, and when she turned around she saw that Lacy's lips were blue and that she was shaking. She called 911, but by the time the ambulance arrived the seizures had ended. In the following month, the family went to the hospital many times, but, on each occasion, by the time they got there the spell had ended and there didn't seem to be anything wrong. The doctors took an MRI but saw nothing unexpected, and they suggested that Lacy might have acid reflux or sleep apnea, or could even be doing it on purpose, out of anger. "But she wasn't angry," Mike said. "She was sitting there happy, and all of a sudden it hit her like a train." One doctor put her on phenobarbital, increasing the dose each time there was another seizure. "It made her lethargic, like she was drunk," Wendy said. That November, Lacy had a terrible attack. "Her arm went up in the air," Mike said, throwing his left arm straight up, stiff. "Her lips went blue. She was having them in a row." By the time the ambulance came, the seizures had subsided, but the attendants advised the Nissleys to get in their car and take Lacy to Johns Hopkins anyway. The drive took two hours, and, just as Mike and Wendy walked over to the triage nurse, Lacy began another cluster of seizures. The nurse said, "We've got to get you a room."
At Johns Hopkins, David Lieberman ordered another MRI. The scan seemed normal, and after a week of further testing Lacy was sent home without a clear diagnosis. Lieberman, in consultation with Eileen Vining and the Johns Hopkins epilepsy group, tried to control the convulsions with medication. Lacy was weaned off the phenobarbital and put on Dilantin and Ativan. They tried Diastat, Topamax, and, later, Tegretol and Keppra. But the seizures continued. When they hit, Mike and Wendy would lay Lacy on the floor and talk to her. "Every couple of minutes, she would moan and groan like she's in pain," Wendy told me. Mike nodded. "They said that seizures don't hurt," he said. "I don't know that I believe that." As we spoke, Lacy sat up a few times and turned to look at me. When I waved and said, "Hi," she said, "Ba." Twice, she smiled; once she looked completely terrified. Each time, she turned her shaky head toward her mother and nestled down.
In April, 2004, Lacy returned to Johns Hopkins for four days of continuous EEG monitoring, and again in November for another MRI. The scan showed that she had an enlarged right hemisphere. The bulge on the right made the midline between the two lobes bow slightly toward the smaller side, and there was a strange fogginess on the right side of the scan, whereas the left was clear. Lieberman told the Nissleys about hemimegalencephaly. "We had a diagnosis, finally, and we were happy with that," Mike said. "It's not sleep apnea. It's not acid reflux. It is something. We didn't know if she was going to die." Diana Pillas, who coördinates counselling at the Johns Hopkins epilepsy center, told Mike and Wendy about various possible treatments. They could try a ketogenic diet—which is ninety per cent fat and has been shown to stop convulsions in some children—but Lacy would be restricted to a special liquid formula for two years. She also told them about hemispherectomies. "I couldn't believe it. I didn't know people could do that and be alive," Mike said. "The first question I had was 'Well, what do they put in there?' "
After the initial shock, Mike and Wendy decided that the surgery was the best option. Lacy's seizures had hindered her development to the point where she couldn't walk unless she was holding someone's hand, and she hadn't learned how to chew. The seizures were also becoming more frequent, and they knew that children with her condition tended to live much shorter lives than their peers. The Nissleys were concerned about the costs, though. Mike worked as a butcher at a local supermarket, and Wendy, a doctor's receptionist, had had to quit working in order to look after Lacy; no day-care program would take her. Johns Hopkins put them in touch with another family whose child had had the procedure, and who told the Nissleys about the financial aid that was available. They finally made a date.
I bumped into Mike and Wendy as I came out of the O.R. with Vining. They were smiling but tense. "We were really stressed," Mike said later. "We were all wondering if it was the right thing to do. No one said it, but we all knew what we were thinking."
Neurosurgery began with trepanation, the prehistoric practice of scraping, sawing, or boring a hole in the skull. Trepanned skulls, some as old as ten thousand years, have been unearthed in Europe, Africa, Asia, and the Pacific Islands. Knowledge about the brain's anatomy has accumulated from the time of Galen, in the second century, but neurosurgery was not recognized as a distinct specialty until the early twentieth century. Since then, neurosurgeons have saved many brains by selectively destroying some of their tissue. They've injected brains with pure alcohol, electrocuted them, and inserted wire loops and metal probes and wiggled them about. They have frozen brain tissue, and they have burned it. But no brain surgery is as dramatic as a hemispherectomy. "A hemispherectomy is the opposite of everything you are taught in neurosurgery," Jallo told me. "You are told throughout your residency training to preserve the brain, get what you have to get, do your work, and leave, but with this you have to take out everything along the way."
The first recorded hemispherectomy was performed, in 1888, on a dog by Friedrich Goltz, a prominent German physiologist. (Apparently, the post-op animal exhibited the same personality and a minimal reduction in intelligence.) In humans, the operation was pioneered by Walter Dandy, a Johns Hopkins neurosurgeon, who, in 1923, performed his first hemispherectomy on a patient with an aggressive brain tumor in the right hemisphere. The patient lived for three and a half years, until the cancer invaded the remaining hemisphere. Dandy performed another four hemispherectomies, all for patients who had brain cancer in their right hemispheres. In 1938, the Canadian neurosurgeon Kenneth McKenzie performed a hemispherectomy on a child suffering from seizures that could not be controlled with drugs. The operation was a success, and hemispherectomies came to be more popular as a treatment for chronic seizures than for cancer. But eventually the operation fell out of favor. Doctors found that, around ten years after the surgery, some patients became paralyzed or comatose, and sometimes died. This was caused by a buildup of cerebrospinal fluid, a saline-like substance that cushions the brain. The fluid is produced at the rate of about one teaspoon per minute, and in normal brains it is reabsorbed—the total supply of fluid renews itself every five hours. But in some cases the trauma of the operation seemed to prevent this, and the resultant pressure could distort the skull and push the remaining brain to one side, a condition known as hydrocephalus.
The hemispherectomy's resurgence in popularity is largely the work of John Freeman, a pediatric neurologist who has been at Johns Hopkins nearly his entire career. Tall and charmingly gruff, Freeman is seventy-three and semi-retired, though when I visited him before Lacy's operation he was still putting in forty hours a week in his cluttered office. "Semi-retired for a workaholic," he said. Freeman saw a few hemispherectomies while on a training fellowship at Columbia, and started ordering them for patients at Johns Hopkins in the early nineteen-seventies. By then, hydrocephalus could be detected early, with scans, and the excess fluid drained to other parts of the body, where it was reabsorbed naturally. In the early nineteen-eighties, he proposed the treatment, for the first time, for a patient with a diseased left hemisphere—a thirteen-year-old girl who suffered such uncontrollable seizures that she had spent several months in the intensive-care unit. The prospect of removing a left hemisphere—rather than a right one, as had been the case in previous operations—was daunting. It is generally thought that language is situated in the left half of the brain, and no one could say for certain what the effect of removing that hemisphere would be. "We worried about that," Freeman said. "What would your life be like if you couldn't talk, and you couldn't understand, and you were just there and aware?" While a number of the hospital's faculty approved the operation, an outraged senior physician vetoed it. But the only alternative, Freeman observed, was for the girl to remain in intensive care for the rest of her life, so the following week, when the doctor in question was away, Freeman went ahead and arranged the operation. "Can you imagine doing a hemispherectomy without the assurance that the patient would talk?" he asked. The operation was a success, and the girl recovered the ability to speak. "Now," he said, "I can tell the families: they all talk."
If Freeman revived the practice of hemispherectomies, their leading practitioner has been Ben Carson, who joined Johns Hopkins in 1984 and, at thirty-two, became the youngest head of pediatric neurosurgery in the nation. A star in his field, Carson has written a book about his transformation from angry teen-ager in Detroit to renowned neurosurgeon. He did his first hemispherectomy a year after coming to Johns Hopkins. The Washington Post wrote a story about it, and soon the hospital was getting calls from doctors all over the country saying that they had patients with intractable seizures whom they wanted to send. Carson has now performed more than a hundred hemispherectomies. One of his oldest patients had the surgery in his thirties.
Carson's office, like Freeman's, is strewn with files, books, and X-rays, and there is an abundance of photographs, cards, honorary Ph.D.s, and gifts—a hanging plate painted with poetry, a framed sampler embroidered with "Dr. Carson," and, on the windowsill, a statuette of a handsome black man in a white doctor's coat who looks exactly like Carson. In person, Carson is mild, tired, and friendly. He told me that when he started doing hemispherectomies he would reach in and slice out an entire hemisphere at once. But he modified this practice after one patient went into a coma for a month. Carson believes that the patient's brain stem was moved about excessively during the procedure. "It's too much like what I'm doing right now," he said, grappling with a plastic model of the brain in an effort to pop out a recalcitrant lobe, which eventually shot off into the mess on the floor. I asked him Mike's question, about all that space left by the missing lobes. In the past, he said, doctors worried about this and tried to anchor the remaining brain by stitching it to the dura. They would put all kinds of things in the cranial cavity—one surgeon used sterile Ping-Pong balls. But, as Carson did more hemispherectomies, he realized that the brain's own drip of cerebrospinal fluid could adequately fill the cavity. Sometimes the remaining brain moves during the weeks following the surgery, but usually by less than an inch. "It doesn't seem to be a problem," he said. Much of Carson's method is intuitive. "You develop a feel for the brain," he said. "Normal brain feels like a very soft boiled egg. A bad brain feels like a mushy apple."
Freeman and Carson haven't merely pioneered the surgery; with their colleagues at Johns Hopkins, they have undertaken research into the effects of hemispherectomy on behavior, language, and psychology. "We as a group here in pediatric epilepsy have changed the way children are handled," Freeman told me. "It's not just the surgery; it's the network and the contact. It's the best thing I've ever done, and I don't even do them." Freeman and Carson are in the process of handing the practice over to Eileen Vining and George Jallo. Each doctor somehow resembles his successor. Freeman and Vining are obsessive clinical researchers and vigorous wranglers of surgeons, doctors, and patients. Jallo, like Carson, has a quiet intensity and the gentlest of handshakes. When I asked the surgeons how it's possible for people with half a brain to live, let alone have a life, each of them spoke about plasticity, flexibility, redundancy, and potential, and then they smiled and said the same thing: "We don't really know."
"After I got this car, I noticed so many CR-Vs," Christina Santhouse said. "I guess you notice them after you get one." Christina was driving a nice, steady five miles per hour above the speed limit on the way to the Bristol Pike Lanes bowling alley, in Croydon, Pennsylvania. She recently turned eighteen and got her license on the second try. Her family outfitted her Honda CR-V with an extra-long rearview mirror, additional side mirrors, a knob on the wheel for steering, and a rod that brings control of the indicator over to the right side. As an eight-year-old, Christina played soccer, swam, and did karate. Then she contracted Rasmussen's encephalitis, a little-understood condition that causes chronic inflammation of the brain. One day at the Jersey Shore, her foot started twitching, and within a few months, as the right side of her brain deteriorated, she was having hundreds of seizures a day. Christina became Johns Hopkins hemispherectomy case No. 30—her surgery took fourteen hours, one of the longest operations Carson has performed. The alterations to Christina's car are necessary, because she has impaired motor function on her left side. (Each hemisphere of the brain primarily controls the opposite side of the body.) She also lost sight on the left side of each eye, and now wears prism glasses that bring the left field of vision over to the center of the eye. When I met her, she had taken her S.A.T.s and just finished high school, coming in seventy-sixth in a class of two hundred and twenty-five. Last fall, Christina was a freshman at College Misericordia, in Dallas, Pennsylvania, where she's studying speech pathology.
When we pulled into the parking lot of the bowling alley, she parked in the same spot that she always used. She wore jeans, a college hoodie, pink nail polish, and Skechers sneakers. A small brace beneath her jeans kept her left leg straight, though she still had a slight limp, and her left arm was partly paralyzed. "I can do this"—she shrugged her left shoulder, moving it and the arm around. "I can't do this"—she twinkled the fingers of her right hand at me. Christina booked us a lane and we sat down to put on our bowling shoes. She was on her high-school varsity bowling team for four years, and in her final year she was captain. She pulled a leather glove onto her right hand with her teeth and then insisted that I go first.
I knocked down eight pins, and Christina knocked down six. "I get really nervous and my arm gets stiff," she said. "Also, I haven't practiced for a month. And the finger holes in my ball are cold." In the next round, I knocked down seven pins, and Christina bowled a strike. As the game continued, my score lagged, while Christina bowled spare after strike after spare. Her ball weighed fourteen pounds. I'm at least seven inches taller, so I started out with a sixteen-pound ball. After almost losing it on the first backswing, I changed to a fourteen-pound ball. As my elbow began to ache, I moved to a twelve, then a ten. Christina doesn't have the balance necessary to run and throw the ball, so she positions herself at the bottom of the lane, crouching slightly and swinging it like an underhand discus. I tried bowling like Christina. She coached me on where to stand and what to aim for, but my first ball, deprived of the momentum that comes from a running walk to the edge of the lane, dropped straight into the gutter. The second time, I swung harder and my ball rolled just a little farther before it hit the gutter. On the third try, I knocked down one pin. Christina explained that you have to work out which side you're stronger on, and step to that side as you swing. Her final score was a hundred and seventy.
Christina is a spectacular example of how well children can do after a hemispherectomy, but she is no outlier. Many children who have had hemispherectomies at Johns Hopkins are in high school, and one, a college student, is on the dean's list. The families of these children can barely believe the transformation, and not so long ago neurologists and neurosurgeons found it hard to believe as well. I asked Jallo if he remembered his first hemispherectomy. "Yes and no," he said. "I don't remember the patient. It was more of a 'Wow.' I was a resident in training and I assisted in one of the operations. I didn't realize you could take out that much brain tissue and have someone be so functional and useful in society. What amazes me is that, if someone all of a sudden strokes out half of the brain, more likely than not they are not going to survive. Yet a lot of these people develop their seizures when they're very young, or in utero, and when you take out half of their brain in one sitting it's as if they weren't touched."
There are wide variations in recovery, and any brain surgery carries grave risks. Many factors affect how well a patient does—age at the time of a condition's onset, age at the time of the operation, the nature of the condition itself, and the determination of parents and caregivers to maintain an intense schedule of therapy before and afterward. Possibly the greatest danger is posed by the brain's veins and arteries, which are so numerous and so wildly, individually arranged that they are impossible to map and very hard to control. Excessive bleeding can send patients into shock and then into comas from which they never return, or it can wipe out most brain function. The other conflicting challenge of the surgery is the necessity of making sure that enough tissue is removed. Freeman once saw a small boy who made good progress for six months following a hemispherectomy, after which he began to deteriorate. His doctors discovered that they had left a small piece of the excised hemisphere in the child's head. It was, said Freeman, no larger than the top joint of his thumb. But the electricity from that piece of neural tissue was enough to compromise the remaining hemisphere. The boy had another operation, a "redo," as the doctors at Johns Hopkins informally call it, in which the bad piece of brain was removed. After that, he had no more seizures.
The brain's remarkable capacity for recovery has long fascinated scientists. Bradley Schlaggar, a pediatric neurologist and a professor at Washington University in St. Louis, told me about an experiment that he conducted for his Ph.D. He transplanted the visual cortex from an embryonic rat's brain into the brain of a newborn rat, placing it in the spot occupied by the somatosensory cortex, which is responsible for such bodily sensations as pressure and temperature. Once the second rat had grown up, Schlaggar took a look at its brain and discovered that the transplanted chunk of visual cortex was functioning as a somatosensory cortex. Such a basic architectural feature of the brain was thought to be entirely hardwired, but Schlaggar showed that brain tissue could reprogram itself to serve different purposes. In another experiment, Leah Krubitzer, a professor of psychology at the University of California, removed large pieces of the brains of newborn marsupials. Once the marsupials became adult, she examined the brains again and found that they had organized themselves in such a way that the visual, auditory, and other somatosensory areas were all in the same relative positions that they would occupy in a normal brain, but they were smaller, commensurate with the total space available.
Schlaggar said that, in the mid-eighties, researchers invoked plasticity to explain the brain's ability to compensate for sudden damage—as when a stroke victim relearns to walk or talk. Now, Schlaggar said, the concept is used to describe a far more basic operation of the brain, including how it develops from childhood to adulthood, and even how an adult brain changes when a new skill is learned: "The idea is that when you talk about plasticity you are talking about every bit of learning that we do." For a long time, the assumptions that neuroscientists made about what was going on in a child's brain were based on how the adult brain worked. But now it seems that the brain's internal configuration depends on the age of the brain. If an eighteen-year-old's brain sustained some kind of damage, Schlaggar explained, it would occur in neural terrain that is organized differently from, say, that of a two-year-old, even if the injury was in the same spot. Children with damage to a particular area of the brain often suffer losses that are different from those sustained by an adult who experiences the same trauma.
When Schlaggar lectures on plasticity, he shows slides of the construction of the St. Louis Arch. "As the structure goes up, the relationship between the scaffolding and the leading edge of the two sides of the arch change as they rise up to meet in the middle," he said. "The interaction between the scaffold and the emerging mature structure is dynamic." The ever changing scaffolding of the developing brain, Schlaggar said, means that the functional organization of the brains of children performing a task can look quite different from that of adults engaged in the same task. If you show seven-year-olds and thirty-year-olds a word and ask them to generate a verb for that word, the two groups can do so with equal accuracy and in the same amount of time, but they use slightly different regions of the brain to arrive at their answers. Children, Schlaggar explained, use extra regions of the brain during their development which, like scaffolding that falls away, are no longer needed when the brain's architecture is mature.
Although the plasticity of Christina's brain in the years following surgery has enabled her to live a remarkably normal life, other aspects of her experience have been hard. When we were alone in the car, Christina told me about years of social difficulties. "I didn't tell many people at high school, but it kind of got out," she said. She didn't make friends until junior high. A few years after the operation, one of her mother's relatives phoned to say that there was a photograph of Christina in The National Enquirer. Before going to Misericordia, Christina hoped for a fresh start, but when she spent an introductory night there her roommate showed her a photocopied article about her hemispherectomy. A psychology professor had handed them out to her class.
After bowling, Christina drove me to her home and I spoke to her mother, Lynne, and her grandmother Mary Lou. We looked at photographs taken the day of the hemispherectomy, and we watched a video of Christina at Johns Hopkins before the surgery. She is sitting on a bed, and her foot begins to twitch. Within seconds, the twitches multiply and cascade through her body, and she falls back onto the bed completely helpless. In another video, Carson strides from the O.R. after Christina's hemispherectomy. He looks utterly invigorated. Lynne, waiting outside, clasps his hands and then crumples before him in tears.
The day after Lacy's surgery, Jallo came by early to visit her. She was moving her right arm and leg weakly, and her color was good. The next day, she started to run a fever, and then she had the worst seizures she's ever had—three in a row, each ten minutes long. This was not unusual—most practitioners think it's caused by the trauma of the operation—but it wasn't good. The doctors adjusted her medication, and over the next few days she improved. When I phoned Mike, he said that, four days after the surgery, she had been out of bed a few times to be held in her mother's lap. "She's not doing much of anything on the left side," he said. The left side of Lacy's body had always been weak, because it was controlled by the damaged right hemisphere. With that hemisphere gone, Lacy would need a year's intensive therapy to remind her brain of the existence of her left arm and leg. Three weeks after the surgery, Lacy's staples were removed and she was released from the hospital.
On a wet October day more than two months after the operation, I drove back to Palmyra. As I pulled up to the house, I could see two small heads at the front window. Lily and Lacy were standing side by side on the couch, peering out. The doctors had told Mike and Wendy that it could take Lacy six to twelve months to get back to where she had been before the operation, but since July she had made extraordinary progress. "We thought she'd be a blob for a few months," Mike said. "But once she started eating and got her strength back she was straight at it."
We sat again in the living room. Lacy was pale and skinny, and her white-blond hair was an inch long. The scar underneath was barely visible. She was in constant motion, crawling and walking about on her knees. Sometimes, when she crawled, she dragged the knuckles of her left hand on the floor. She babbled and squealed, and she said "Yeah" when I asked her how she was. She helped herself to a bottle of milk and drank from it while she idled on her knees. She surfed around the furniture and stood at an activity table in front of me. When I held out my right hand to her, she wobbled for a second and then grabbed it with her left hand. She swung her right hand around, placed it on top, paused, and was off again. Then she sat with her back to me. She kept looking over her right shoulder to see if I was still there, then looking away. "She's really silly all the time," Mike said.
A month after the operation, Lacy began seeing a physical therapist, an occupational therapist, and a speech therapist on a regular schedule. The speech therapist would talk with her face right up against Lacy's, and after a few sessions Lacy began moving her mouth to mimic the therapist. She learned some sign language, and used the sign for "more" a lot at the dinner table, where she could now eat the same food as her family. She still had to take the anti-convulsants Tegretol and Keppra twice a day, and the doctors thought that it would be a year before she could stop. But there had been no more seizures, and, the week before I visited the Nissleys, Lacy had taken three steps by herself for the first time.
By early December, Lacy was walking everywhere, and in January the family returned to Johns Hopkins for a scheduled checkup. In Jallo's report, he wrote that Lacy had done beautifully. She had had no seizures, and she was babbling and walking independently. She was "a happy child." Lacy still showed a clear preference for her right side, but he wrote that he hoped for an improvement in tone and a loosening up on the left side.
For two months after that, Lacy walked and played, but in March she had a setback. Wendy put her down for an afternoon nap, and about fifteen minutes later she had a seizure. Wendy said, "She just woke up, instantly, with her eyes bulging out." The seizure lasted a few seconds, and afterward Lacy rolled over and went to sleep. She woke up happy. Everything was fine for a few days, but then she had another seizure, again about fifteen minutes after she had fallen asleep. "We were shocked," Wendy said. "Lacy went about seven months without any seizures. It is disappointing." The seizures increased steadily—after about a month, there were a few every day, each lasting five or six seconds. According to Wendy, Lacy didn't appear particularly distressed by them, though occasionally they made her more tired. "We are not sure what the next step will be," Wendy said, but she and Mike remained optimistic. For Lacy's third birthday, they had a big cookout in a rented pavilion at a local park beside a lake.
When Wendy drove Lacy back to Johns Hopkins, Vining was thrilled with her general progress. Developmentally, she said, Lacy was fulfilling expectations, and even the recurrence of the seizures wasn't unduly alarming. "They are very mild," she said. There were no signs of them on the EEG and they lasted, in total, less than a minute per day. Vining speculated that Lacy might have outgrown the dosage of one of her anti-seizure medications, and she increased it. After a few weeks, however, there was no improvement; the seizures were lasting longer, and had begun to show up on the EEG. Vining switched Lacy to a different anti-convulsant, Trileptal. Another possible cause of the problem was the tiny nub of occipital lobe that Jallo had left in Lacy's brain during the operation. I asked Vining whether Lacy would ever need a "redo" to remove that final piece of the right hemisphere. She explained that only time would tell. Vining was hopeful that the new drug would solve the problem. If it didn't, she said, they would have to think seriously about going in again. ♦