text:
Transmural Dispersion of Myofiber MechanicsImplications for Electrical Heterogeneity In Vivo
Author + information
- Received April 26, 2006
- Revision received July 5, 2006
- Accepted July 10, 2006
- Published online February 27, 2007.
Author Information
- Hiroshi Ashikaga, MD⁎,†,⁎ (ha8000{at}gmail.com),
- Benjamin A. Coppola, BS⁎,
- Bruce Hopenfeld, PhD†,
- Eric S. Leifer, PhD‡,
- Elliot R. McVeigh, PhD† and
- Jeffrey H. Omens, PhD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Hiroshi Ashikaga, Laboratory of Cardiac Energetics, NIH/NHLBI, 9000 Rockville Pike, Building 10/B1D416, Bethesda, Maryland 20892.
Objectives We investigated whether transmural mechanics could yield insight into the transmural electrical sequence.
Background Although the concept of transmural dispersion of repolarization has helped explain a variety of arrhythmias, its presence in vivo is still disputable.
Methods We studied the time course of transmural myofiber mechanics in the anterior left ventricle of normal canines in vivo (n = 14) using transmural bead markers under biplane cineradiography. In 4 of these animals, plunge electrodes were placed in the myocardial tissue within the bead set to measure transmural electrical sequence.
Results The onset of myofiber shortening was earliest at endocardial layers and progressively delayed toward epicardial layers (p < 0.001), resulting in transmural dispersion of myofiber shortening of 39 ms. The onset of myofiber relaxation was earliest at epicardial layers and most delayed at subendocardial layers (p = 0.004), resulting in transmural dispersion of myofiber relaxation of 83 ms. There was no significant transmural gradient in electrical repolarization (p = NS).
Conclusions Despite lack of evidence of significant transmural gradient in electrical repolarization in vivo, there is transmural dispersion of myofiber relaxation as well as shortening.
Over the past decade, the concept of transmural dispersion of repolarization (TDRepol), or electrical heterogeneity, of the ventricular myocardium (1,2) has provided a framework to understand normal and abnormal cardiac electrophysiology (3–7). Nevertheless, it is still unclear whether TDRepol is present in vivo, where myocardial cells are electrically coupled (8). Some studies suggest that there is no significant TDRepol in a healthy heart (9,10).
Although the primary function of the heart is mechanical, little attention has been paid to mechanical correlation of TDRepol (11), primarily because many studies of TDRepol were performed in vitro, using wedge preparations of perfused ventricular myocardium. Measurements pertaining to mechanical function in vivo might yield insight into transmural electrical sequence. Earlier studies suggest the presence of transmural dispersion of myofiber shortening (12) as well as myofiber relaxation (13) in vivo.
To test the hypothesis that there is transmural dispersion of both myofiber shortening and relaxation, we studied the time course of transmural myofiber mechanics in the left ventricular (LV) anterior wall of normal canine heart in vivo using transmurally implanted markers and biplane cineradiography with high spatiotemporal resolution.
All studies were performed according to the "Position of the American Heart Association on Research Animal Use." All protocols were approved by the Animal Subjects Committee of the University of California, San Diego, which is accredited by the American Association for Accreditation of Laboratory Animal Care.
Experimental protocol
We studied adult mongrel dogs (n = 14, 20 kg to 30 kg) to measure the time course of transmural myofiber mechanics in the anterior LV in vivo during normal sinus rhythm or atrial pacing with pacing wires sutured on the left atrial (LA) surface. To measure 3-dimensional (3-D) transmural myofiber mechanics, under general anesthesia and median sternotomy, 3 transmural columns of four to six 0.8-mm-diameter markers and a 1.7-mm-diameter surface marker above each column were placed within the anterior wall between the first (D1) and the second diagonal branches (D2) of the left anterior descending coronary artery (LAD) (Fig. 1)(13). To provide end points for a LV long axis, 2-mm-diameter gold beads were sutured to the apical dimple (apex bead) and on the epicardium at the bifurcation of the LAD and left circumflex coronary artery (base bead). To measure transmural electrical sequence (minimum sampling rate = 1 kHz), we studied a subset of 4 of the 14 dogs. For these 4 dogs, 3 pairs of bipolar plunge electrodes with terminal distance of 1 mm to 3 mm were inserted in subepicardial, midwall, and subendocardial layers of the myocardial tissue within the bead set. The transmural location of the electrodes was histologically determined after euthanasia. Each animal was positioned in a biplane radiography system, and synchronous biplane cineradiographic images (125 frames/s) of the bead markers were digitally acquired with mechanical ventilation suspended at end expiration. Left ventricular pressure, central aortic pressure, LA pressure, and surface and bipolar plunge electrocardiograms (ECG) were recorded simultaneously with the cineradiographic images. At the end of the study, the animal was euthanized with pentobarbital sodium and the heart was perfusion-fixed with 2.5% buffered glutaraldehyde at the end-diastolic pressure measured in the study (13,14). Because the heart was fixed at end-diastolic pressure, fiber orientations in the fixed hearts were assumed to represent the fiber structure in the end-diastolic reference configuration in vivo (13,15,16).
To avoid the distortional effects of dehydration and shrinkage associated with embedding, histologic measurements were obtained using freshly fixed heart tissue. In the transmural block of tissue within the implanted bead set, the mean myofiber angle was measured with reference to the positive circumferential direction and was determined from epicardium to endocardium at every 1-mm-thick section sliced parallel to the epicardial tangent plane (13,15).
Data analysis
The time reference was defined as the peak R-wave on surface ECG for both mechanical and electrical data. The digital images from biplane X-ray were corrected for magnification and spherical distortion (13) to reconstruct the 3-D coordinates (17) of the bead markers. Continuous, nonhomogeneous transmural distributions of 3-D strains were computed for each frame as a deformed configuration with the peak R-wave on surface ECG as the reference state (15). The strain with respect to the local fiber coordinate, or fiber strain, was calculated from the strains and histologically measured myofiber angles at each depth. The strain time course was determined at 10 transmural layers: from 0% (epicardial surface) to 90% wall depth (subendocardium) by 10% increments. By convention in continuum mechanics, a negative strain represents shortening, whereas a positive strain represents stretch. The onset of myofiber shortening at each depth was defined as the time of peak positive strain. The onset of myofiber stretch, or myofiber relaxation, at each depth was defined as the time of peak negative strain. Transmural dispersion of myofiber shortening (TDShort) was defined as the transmural range of the onset of myofiber shortening. Transmural dispersion of myofiber relaxation (TDRelax) was defined as the transmural range of the onset of myofiber relaxation.
We followed an established method of bipolar electrical analysis in published reports, most recently used by Sengupta et al. (18). Briefly, the electrical activation was defined as the first peak of the derivative of QRS in the regional bipolar deflection, and the electrical repolarization was defined as the steepest terminal phase of the T-wave of the bipolar electrocardiogram (Fig. 2)(19). The same definition was applied when the T-wave was inverted. A strong correlation exists between the activation-recovery intervals measured from the first-order derivatives of QRS and T waves on the bipolar electrograms and the refractory periods and transmembrane action potential durations measured directly in cardiac tissues (20,21).
Statistical analysis
Values are mean ± SD. To make our study comparable to previous similar studies (9,22), a sample size of 14 dogs was chosen for the mechanical data, and a sample size of 4 dogs was chosen for the electrical data. One-way repeated-measures analysis of variance (RMANOVA) was used to assess the effect of wall depth on the onset of shortening, relaxation, electrical activation, and repolarization. For the mechanical data, a paired ttest was used to compare the 2 transmural ends (i.e., 0% vs. 90% wall depth). For the electrical data, a paired ttest was used to compare the subendocardial layer to the subepicardial layer. For both the mechanical and the electrical data, ordinary linear regression was used to obtain an unbiased estimate of the absolute value of the slope of wall depth as a function of the time from the surface ECG R-wave. Statistical significance was accepted at p < 0.05. Statistics were performed using SigmaStat 3.0 (SPSS, Inc., Chicago, Illinois).
The site of fiber strain measurement was located 55 ± 18% of the distance from base to apex along the LV long axis, in a region of the anterior LV free wall 1 to 2 cm septal of the anterolateral papillary muscle. Mean wall thickness at the measurement site was 12 ± 3 mm. Hemodynamic parameters are summarized in Table 1.
Fiber orientation
The transmural fiber orientation (Fig. 3)was consistent among all the animals studied. The mean fiber angles ranged approximately from −60° to +60° from epicardium to endocardium, respectively, resulting in a transmural gradient of approximately 120°.
Myofiber mechanics
The onset of myofiber shortening typically occurred earlier in endocardium than epicardium (Fig. 4).The delay of myofiber shortening at epicardial layers resulted from a brief period of myofiber stretch (prestretch) that preceded myofiber shortening (Fig. 4A). Myofiber shortening (Fig. 5,open circles) started earliest at a subendocardial layer (90% wall depth, 6 ± 13 ms) and was progressively delayed toward the epicardium (p < 0.001 by RMANOVA). There was a significant transmural gradient in the onset of myofiber shortening (p = 0.003, 0% wall depth, 46 ± 42 ms vs. 90% wall depth by the paired ttest). The mean TDShort was 39 ms. Linear regression of the onset of myofiber shortening at each depth indicates that the mean propagation velocity of myofiber shortening from endocardium to epicardium was 0.25 m/s (Fig. 6,open circles).
In contrast, the onset of myofiber relaxation typically occurred earlier in epicardium than endocardium (Fig. 4C). The onset of myofiber relaxation (Fig. 5, open squares) was earliest at a subepicardial layer (30% wall depth, 262 ± 48 ms) and was progressively delayed toward the endocardium (p = 0.004 by RMANOVA). There was a significant transmural gradient in the onset of myofiber relaxation (p < 0.001, 0% wall depth, 271 ± 65 ms vs. 90% wall depth, 345 ± 86 ms by the paired ttest). The mean TDRelax was 83 ms. Linear regression of the onset of myofiber relaxation at each depth indicates that the mean propagation velocity of myofiber relaxation from epicardium to endocardium was 0.10 m/s (Fig. 7,open squares); however, the relationship was not as linear as that for myofiber shortening. Of note, a second peak of myofiber shortening was observed at several layers in 8 animals during diastolic filling that was smaller in magnitude than the initial peak shortening. This second peak is also observed in epicardial layers (0 to 50%) in Figure 4.
Bipolar electrical recordings
There was a significant transmural gradient in electrical activation (p = 0.035 by RMANOVA) (Fig. 6); activation at subepicardium was significantly delayed compared with that of subendocardium (p = 0.029 by the paired ttest). Linear regression of electrical activation indicates that the mean electrical conduction velocity from endocardium to epicardium was 0.49 m/s (Fig. 6, open triangles). Electrical repolarization at subendocardial, midwall, and subepicardial layers was almost synchronous (227 ± 38, 225 ± 58, and 237 ± 41 ms, respectively), and there was no significant transmural gradient (p = NS by both RMANOVA and the paired ttest) (Fig. 7, closed triangles).
Although heterogeneity of the onset of shortening and relaxation between subendocardium and subepicardium has been studied (23–25), this is the first study to comprehensively examine the depth-dependent difference of myofiber mechanics in vivo. Our results demonstrate that myofiber mechanics are transmurally and temporally heterogeneous, and global events such as LV end-diastole and end-systole do not uniquely correlate with the regional myofiber mechanics at individual depths.
Transmural sequence of electrical activation and myofiber shortening
The mean electrical conduction velocity (0.49 m/s) (Fig. 6) was consistent with reported values for transmural conduction velocity (26,27). Because the transmural propagation velocity of myofiber shortening (0.25 m/s) was slower than the electrical conduction velocity (0.49 m/s), the electromechanical delay was longer in epicardium than in endocardium. This in vivo finding is contrary to derivations from finite element simulation (28) and in vitro studies (11). One explanation for this new observation is tissue tethering (23,29). Because myofibers are physically coupled, myofiber mechanics at one layer might induce complex interactions within and between the layers, alter loading conditions, and thus make epicardial myofibers shorten later than they would in vitro. Such tissue interactions can be seen in the relationship between the fiber and cross-fiber strains at epicardial and endocardial layers (Fig. 8).Overall, epicardial fiber strain (solid red line) and endocardial cross-fiber strain (broken green line) demonstrate a similar time course. Likewise, epicardial cross-fiber strain (broken red line) and endocardial fiber strain (solid green line) demonstrate a similar time course. During isovolumic periods, fiber and cross-fiber strains in the same layer were always in opposite directions. For example, during isovolumic contraction, the epicardial myocardium stretched in the fiber direction (blue arrow, solid red line), but shortened in the cross-fiber direction (orange arrow, broken red line). Similarly, during isovolumic relaxation, the endocardial myocardium shortened then stretched in the fiber direction (orange arrow, solid green line), while it stretched then shortened in the cross-fiber direction (blue arrow, broken green line). These findings are consistent with previous reports (23–25).
Previous studies imply that the transmural sequence of the fiber mechanics of the apical and the basal regions of the anterior LV may be in the opposite directions (18,30). However, the piezoelectric crystal pairs in these studies were not placed directly along the fiber direction. Therefore, these studies did not specifically examine the time course of true fiber strains and are fundamentally different from our study.
Transmural sequence of electrical repolarization and myofiber relaxation
We found no significant transmural gradient of electrical repolarization in the mid-anterior LV in vivo, which is consistent with earlier studies in canine (9,19), swine (18), and human (10,31,32). el-Sherif et al. (33) found that activation-recovery interval in canines in vivo was significantly longer at midmyocardium than epicardium and endocardium at longer cycle lengths, but transmural gradient was not significant at the range of cycle length in our study (600 to 700 ms). Of note, we found that electrical repolarization was later in subepicardium than subendocardium (Fig. 6), although the difference was not significant. This finding, although contradictory to in vitro reports, has been previously documented (18,34).
Despite lack of significant transmural gradient in electrical repolarization in vivo, our data indicate that there is a significant gradient in the onset of myofiber relaxation, which is progressively delayed in endocardial layers. This transmural sequence of myofiber relaxation is consistent with the reported data from isolated canine LV myocytes (11). This mechanical relaxation sequence is clearly different from the electrical repolarization sequence and requires exploration of possible mechanisms.
One possible explanation is that TDRelax is a direct consequence of TDRepol; that is, transmural electrical repolarization sequence has a significant impact on mechanical relaxation of the ventricle. TDRepol may exist in vivo, and the reported lack of it may simply reflect technical difficulties associated with obtaining transmural electrical measurements. For example, Van Dam and Durrer (35,36) noted that the spatial and temporal sequence of repolarization cannot be adequately studied by measuring the steepest portion of the T-wave using either bipolar or unipolar electrodes, because repolarization occurs much more slowly and is of lower voltage than depolarization. To overcome this limitation, Spach and Barr (37) measured potential distributions in closed-chest canine in vivo and found that repolarization was earlier in epicardium than endocardium. This result was consistent with refractory period measurements of Burgess et al. (38).
Another explanation is that TDRelax results from mechanical interactions between each myofiber and its loading conditions. Myofiber relaxation in vivo is primarily determined by the balance between the loading conditions and generated force within the myofiber during diastole; myofiber relaxation occurs when the afterload overcomes the generated force of the myofiber. The delay of endocardial relaxation may be explained by the fact that the end-systolic fiber stress is highest at endocardium (28). Moreover, the transmural propagation velocity of myofiber relaxation was even smaller than that of myofiber shortening (0.10 vs. 0.25 m/s, respectively). This very slow transmural propagation velocity suggests that TDRelax may be of mechanical origin, rather than electrical. These possible explanations are not mutually exclusive, and both may be in effect, at least partially, to cause TDRelax in vivo.
Clinical implications
The present study highlights a gap in our clinical understanding of electromechanical sequence in a normal heart, which was uncovered by recent studies on cardiac resynchronization therapy (39,40). Our results are consistent with recent reports presenting similar shortening-relaxation kinematics of the epicardial and endocardial layers (18,23,25). Delayed onset of relaxation is routinely encountered as a physiologic phenomenon in normal humans and has been referred to as post-systolic shortening (41,42); experimental studies have confirmed endocardial shortening after aortic valve closure (18).
There has been a great clinical interest in the myocardial band hypothesis (43,44), which has important surgical implications. This controversial hypothesis (45) is criticized as being oversimplified and having no anatomic foundation (46), and our anatomic data also do not fit with this hypothesis. For example, the smooth transition of myofiber orientation from epicardium to endocardium in the mid-anterior LV (Fig. 3), which are consistent with a number of published data (13,47–50), does not support the concept that there are discrete ascending and descending segments of the myocardial band, which would likely produce a more sudden change of transmural myofiber orientation in the midwall.
Study limitations
Our measurements were restricted to the mid-anterior LV; thus, our findings may not be applicable to other LV regions. It is possible that our electrical and mechanical measurements may have been affected by anesthetics and epicardial cooling associated with open-chest preparations. Some of our findings may have been affected by the damage caused by the bead implantation (51). However, measurements from noninvasive techniques such as magnetic resonance imaging have shown similar transmural gradients in regional strains (52); thus, we believe that our technique does not substantially affect the local mechanics.
There is transmural dispersion in the onset of myofiber relaxation as well as shortening in vivo, despite lack of evidence of significant transmural gradient in electrical repolarization.
The authors thank James W. Covell, MD, for excellent technical assistance and valuable discussions. The authors also thank their staff, Rish Pavelec, Rachel Alexander, and Katrina Go, for superb managerial and surgical assistance.
This study was supported by the following grants: AHA 0225001Y (to Dr. Ashikaga, Western States Affiliate), NHLBI R01-HL32583 (to Dr. Omens), and Z01-HL4004609 (to Dr. McVeigh). Frits W. Prinzen, MD, served as Guest Editor for this article.
- Abbreviations and Acronyms
- AoP
- central aortic pressure
- electrocardiogram
- left atrial
- left anterior descending coronary artery
- left atrial pressure
- LCx
- left circumflex coronary artery
- left ventricular
- left ventriclar pressure
- repeated-measures analysis of variance
- TDRelax
- transmural dispersion of myofiber relaxation
- TDRepol
- transmural dispersion of repolarization
- TDShort
- transmural dispersion of myofiber shortening
- 3-dimensional
- Received April 26, 2006.
- Revision received July 5, 2006.
- Accepted July 10, 2006.
- American College of Cardiology Foundation
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China and Vatican Reach Deal on Appointment of Bishops
By Jason Horowitz and Ian Johnson
- Sept. 22, 2018
ROME — The Vatican said Saturday that it had reached a provisional deal with the Chinese government to end a decades-old power struggle over the right to appoint bishops in China. It was the Communist country's first formal recognition of the pope's authority within the Roman Catholic Church in the world's most populous nation, Vatican officials said.
Under the deal, Pope Francis recognized the legitimacy of seven bishops appointed by the Chinese government. Because they had not been selected by the Vatican, they had previously been excommunicated.
The agreement was in keeping with pope's outreach to parts of the world where he hopes to increase the church's presence and spread its message. It gives the church greater access to a huge population where the growth of Protestantism is far outpacing Catholicism.
But for critics loath to share any of the church's authority with an authoritarian government, the accord marked a shameful retreat and the setting of a dangerous precedent for future relations with other countries.
If finalized, the deal would be the biggest breakthrough in often frosty relations between the two sides since they severed diplomatic ties in 1951. It could lead them to re-establish formal relations, but as a condition China would require the Vatican to cut ties with its rival, Taiwan.
If the Vatican agreed, that would mark a major victory for China.
Other big questions remain, including who will have the final say over appointing bishops in China: the pope or the Chinese government. Neither side provided a clear answer.
The deal comes at a time when the pope is under enormous scrutiny for the church's handling of clerical sex abuse, one of several issues that conservative forces within the church have seized on to weaken Francis. The agreement with China, which they deeply opposed, is likely to fuel that discontent.
Pope Francis has for years talked about his desire to visit China, where Roman Catholicism has steadily lost ground in the face of intensifying crackdowns and surveillance on religious groups under President Xi Jinping. Protestants, whose faith is spreading fast around the country, have largely eclipsed the percentage in China of Catholics, who number about 10 million to 12 million.
China's Catholics are divided among those who attend government-approved churches and underground churches that are loyal only to the Vatican.
For decades, many Chinese Catholics have risked arrest and persecution by worshiping in the underground churches led by bishops appointed secretly by popes. China's Communist government has erected a parallel structure: a state-sanctioned, state-controlled Catholic church. For years, dating back three papacies, the Vatican has sought to unify the two communities.
Traveling with the pope in Vilnius, Lithuania, a Vatican spokesman, Greg Burke, told reporters that the aim of the accord is "allowing the faithful to have bishops who are in communion with Rome but at the same time recognized by Chinese authorities."
Cardinal Pietro Parolin, the Vatican's secretary of state, said that the pope had committed "to make concrete fraternal gestures of reconciliation," and suggested that the truce would leave the church better able to function in China.
Each side had claimed an absolute right to choose bishops and control the church in China.
The Vatican's initial statements did not release many details of the accord. But for months, the two sides were discussing a resolution under which the Vatican would formally acknowledge the government-sanctioned bishops while the pope would retain the right to approve future appointments.
Reached in Beijing, Archbishop Claudio Maria Celli, a lead negotiator for the Vatican, said the agreement provided for "the intervention of the Holy Father for sure" in the selection of bishops. But when pressed, he would not say whether that meant a papal veto over appointments made by the Chinese government. He said only that "the Holy Father gets to say something about the appointment of bishops."
The Chinese government did not clarify the issue either. China's foreign ministry issued a two-sentence statement confirming that a "temporary agreement" on the appointment of bishops had been signed.
"China and the Vatican will continue to maintain communications, and promote progress in the process of improving bilateral relations," said the statement published on the Ministry of Foreign Affairs website.
The Vatican took a step in January in its efforts to unify the two Catholic communities in China, asking two underground bishops to step aside in favor of government-appointed bishops. One of the two preferred by the government was a member of the National People's Congress, China's parliament.
The state-sanctioned bishops who took the places of the two underground bishops were among the seven the Vatican formally accepted on Saturday. It was not clear what would become of more than 30 underground bishops working in China who were chosen by the pope but not recognized by the Chinese government.
The church's move toward rapprochement with China has run into resistance from clerics and parishioners who have worried about forfeiting the independence they have asserted — often at great cost — by defying the government.
"What are they going to do about the underground bishops not recognized by China?" the Rev. Bernardo Cervellera, a member of the Pontifical Institute for Foreign Missions and the editor of Asianews.it, said in an interview. "Or those that are in jail, or those who don't want to belong to the patriotic church, what will happen to them?"
Father Cervellera said the Holy See press office had underlined the fact the accord was provisional and "more like a promise" that a long-term solution would be found.
Although details of the deal were not made public by either side and may never be officially released, a person close to the negotiations said it would allow Beijing to nominate bishops and the pope to veto unacceptable choices. This would effectively mean a more formal version of a similar arrangement in the early 2000s, which allowed consultations between the two sides.
"What's important is the re-establishment of communion between the two churches," said Alberto Melloni, director of the Foundation for Religious Sciences "Giovanni XXIII" in Bologna. "The pope has brought home the greatest diplomatic success" in recent church history. He argued that the deal empowered the Vatican as a voice on the international scene.
But members of the Catholic community in China and Rome have urged the pope not to sacrifice the two underground bishops loyal to the pope in the dioceses of Shantou and Mindong, who have endured years of hardship.
Critics of the deal, including a prominent cardinal in Hong Kong, have argued that it would send a signal that the Vatican did not stand up for those who stood up for it.
Msgr. Antoine Camilleri, under secretary for the Holy See's relations with states, met Saturday with Wang Chao, deputy minister for foreign affairs of the People's Republic of China, and signed the provisional agreement, which foresees "periodic reviews of its application."
The deal, which has several times seemed on the brink of fruition only to collapse, comes after negotiation teams met in Rome in June, when the Vatican apparently assured the Chinese that the pope would lift the excommunications of the government-appointed bishops.
When the deal seemed imminent in February, the retired archbishop of Hong Kong, Cardinal Joseph Zen, excoriated a potential reconciliation as putting Chinese Catholics in a Communist-controlled "cage" and accused the Vatican of "selling out" those followers.
"A church enslaved by the government is no real Catholic Church," he said.
He also said at the time that the Vatican had asked one of the underground bishops to step aside to make way for one authorized by the Communist government. The Vatican had by then already received an official request from the Chinese to recognize the seven state-authorized Chinese bishops whom the Vatican had considered illegitimate.
The church has had a permanent presence in China for more than 400 years, when Jesuits, the order to which Francis belongs, arrived as advisers to the imperial court. After being banned in the early 18th century over the church's refusal to recognize certain Chinese cultural traditions, the church grew rapidly in the 19th century, when foreign armies forced China to allow in missionaries.
After the Communist takeover of China in 1949, ties between the two rapidly worsened and diplomatic relations were severed in 1951. The Vatican kept diplomatic ties with Taiwan, and often pursued an aggressively anti-Communist policy. For its part, Beijing began appointing bishops and priests, giving it control over the church's hierarchy.
Efforts to heal the rift go back to the papacy of John Paul II, but these efforts foundered on the issue of appointing the clergy, which the Vatican sees as fundamental to its control of the church but which Beijing does not want to see outsourced to a foreign state.
In striking the deal, Pope Francis did what his predecessors, Pope Benedict XVI and Pope John Paul II, did not. But he also went beyond their steps toward reconciliation.
In 2007, Pope Benedict recognized the celebration of sacraments inside the state's official churches, and selected Cardinal Parolin, a senior diplomat, to guide the negotiations with China. When Pope Francis selected Cardinal Parolin as his secretary of state, it was largely seen as a sign that he had moved a deal with China up the priority list.
In 2014, China allowed the pope to fly over its airspace on his way to South Korea.
Critics of an agreement with China are rife within the church. In the United States, it has been harshly criticized by Senator Marco Rubio of Florida. Opponents have argued that the pope risked setting a terrible precedent by folding to an authoritarian power with a record of human rights abuses and persecution of religious groups.
But the church has been making concessions to secular powers since before Pope Leo III crowned the Frankish king Charlemagne in the year 800. In the 16th century, the pope gave a French king the right to appoint major clerics and Pope Pius VII signed a similar agreement with Napoleon in the 19th century.
The Vatican accepted limitations to operate under Communist governments such as Vietnam's. Mr. Melloni also recalled the church's Ostpolitik, in which it dealt with communist regimes in Europe's east during the Cold War.
"The strategy of the Holy See," he said, "has always been to negotiate."
Jason Horowitz reported from Rome, and Ian Johnson from Beijing. Elisabetta Povoledo contributed reporting from Rome.
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When you wish to group business cards, we recommend that you make tags in advance on Sansan for "characteristics" or "industry", and then when you scan the business cards you receive, select an appropriate tag and add it.
If you group the business cards you have, you can take effective actions such as recommending services and products appropriate for each group.
|1. Create a tag on Sansan for PC
|2. Adding the tag when scanning
|3. Business cards will be grouped by characteristics or industry
|4. Take actions appropriate for each group
Flow and functions used
From the "Tag Management" screen, use "Add New Tag " to create a new tag. By grouping by characteristics or industry, the convenience will increase, and doing searches will be easier.
Examples: (characteristics) Customer / Client / End user / Agent / Retail / Partner / Purchaser
Examples: (industries) Finance / Real estate / Restaurant / IT / Services
When scanning the business cards you have received, select the appropriate tag from the Tablet PC. By doing this, the card will be digitized with the tag added to it. There will be no need to add a tag from Sansan later, and you will have business card groupings made.
|Functions used
|Step 1.
Create a new tag
|Only shared tags will be displayed on the Tablet PC, so please create a shared tag.
|Step 2.
Add the tag when scanning
|Adding tags when scanning
|Step 3.
Approach your targets separately
|By using the tags for grouping according to characteristic or industry, you can send emails to introduce products appropriate to the groups, and approach your targets more strategically.


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ThunderCats is considered among the top favorite animated cartoon series on television. Right from the start of its season one in 1985, ThunderCats has managed to get popularity among children. The basic reason behind the popularity of ThunderCats was that children were fed up from old and continuous cartoons like Donald Duck, Pink panther and Mickey Mouse etc and wanted to have a change in the style of cartoons. With the arrival of new cartoon series , the interest of children was rebuilt in cartoons. It was so much built that not only children loved to watch the cartoon series but also started to demand Thunder Cats coloring pages . keeping in view the demand of children , we have designed some very beautiful ThunderCats coloring pages for kids which they definitely will love coloring in .
Before the arrival of ThunderCats, their were no such cartoon series , which could teach children about the evil forces in the society and how to react against them. There were different entertaining cartoon series like Tom and Jerry whose aim was only to entertain the children and no moral massage was given through these cartoon series.
Every episode of ThunderCats comes with a new story. The main evil character Mumra along with his companions , always tried to spread evil however , the Thunder Cats team is always ready and anticipates their evil thinking and react within time to destroy all the evil intentions of the enemy. Due to moral learning children get from watching the cartoon series, parents also like the cartoon series a lot. Over a period of twenty Seven years, the popularity of ThunderCats has never gone down , yet it has always been on the rise. In this session you will find an exclusive collection of ThunderCats coloring pages. Also to add in your coloring experience , we suggest a tour of Superman coloring pages and Batman pages and do give us feed back as to how these pages can be improved in future.


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Black History Month is an annual observance in February, celebrating the past and present achievements of African Americans. In February 1926, Dr. Carter G. Woodson, founder of the Association for the Study of African American Life and History, proposed the establishment of "Negro History Week" to honor the history and contributions of African Americans to American life. Dr. Woodson, known as the "Father of Black History", chose the second week of February because it commemorates the birthdays of two men who greatly affected the African American community: Abraham Lincoln (February 12) and Frederick Douglass (February 14). Negro History Week became Black History Week in the early 1970's. In 1976, the week-long observance was expanded to a month in honor of the nation's bicentennial.
Black History Month is sponsored by the Association for the Study of African American Life and History (ASALH). The Association was founded in 1915 by Dr. Carter Woodson--historian, teacher, author and publisher. Each year the Association designates the national theme for Black History Month. The 2017 theme is "The Crisis in Black Education."
For meaningful ways to celebrate Black History Month with your family, visit our Community Events page here.


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Dr Bindu K
The first volume of Hahnemann's chronic diseases is devoted to the expositon of psora theory. He begins by assigning one eighth of these maladies to syphilis and its ally sycosis. He points out that each of these diseases depends upon a specific and contagious 'miasm'. This being received into the organism, after a period of incubation develops an external sign—the chancre and the condylomata respectively. If these are left alone or cured from with in by small quantities of their appropriate specific (Mercury in the one case, Thuja or Nitric acid in the other), no general evils result. On the other hand, the supression of external sign is followed by the well known constitutional symptoms. The maladies thus set up are far more difficult to cure, and are only curable at all by the same or similar specfic—selected not merely on the ground of their homoeopathicity to the existing symptoms, but also because of their relation to the primary taint, in like manner ascertained. Dr.Richard Hughes narrates with his own examples. It would be useless to attempt to cure a syphilitic angina with belladonna or a syphilitic psoriasis with arsenic.
In the remaining seven—eighth of chronic diseases, Hahnemann says that he found the same impossibility of effecting a permanent cure with the common homoeopathic specifics. He sought therefore for some constitutional miasm or miasms, which should explain the protean changes and inveterate duration of these maladies, as the syphilitic poison explained the character of, disorders resulting there from. In the common itch ( psora or scabies ) he thought he had found what he sought. Numerous authors testified to the evils resulting from repercussion of the itch eruption—these evils including nearly every ill to which flesh is heir. Again, many of his chronic patients confessed to having had itch, and in many others he ascertained the same fact by inquiry of parents and nurses. The itch was a specific disease, very contagious, having a period of incubation after infection, and then manifesting itself by one or more vesicles at the point of contact, –in all these features resembling syphilis and sycosis. Unable to discover any other chronic miasm but this to account for the host of chronic diseases which were neither syphilitic nor sycotic, Hahnemann propounded the theory that they were all psoric. Hence followed the treatment. Recent itch could nearly always be cured in a reasonably short time, by one or more infinitesimal doses of sulphur, and the same medicine was curative of many of the consequences of the suppression of the eruption. But these were too multifarious to be homoeopathically covered by any one remedy. Hence a number of other medicines were, on various grounds classed with it as anti psorics and with these, selected according to the law of similars, all chronic non venereal diseases were to be compacted.
The above is a fair presentation of Hahnemann's theory by Dr.Richard Hughes's "A Manual of Pharmaco dynamics". According to Dr.Richard Hughes Hahnemann's theory is a marvel of erudition, of thought and of reasoning if only the premises were sound. But here is the fatal flaw. Hahnemann lived at a time when the parasitic nature of scabies had been forgotten. His contemporaries Rayer and Biett regarded it as questionable; and Hoffmann, Juncker, Wenzel and Autenrieth had gone before him in tracing numerous diseases to the repercussion of eruption. Now, however, no reasonable doubt can exists but that the reception of the Acarus is the proximate cause of the whole phenomena of scabies. The disease is invariably treated by external applications, chiefly Sulphur ointment and the extensive experience of such men as Hebra and Erasmus Wilson may be taken as conclusive when they say that they never seen any ill effects from the practice, which, Dr.Richard Hughes adds, is as freely used by Homoeopathists as by others.
Is there then no truth in Hahnemann's theory? Just the reverse. Hahnemann based the logical superstructure of this theory upon thedistinct entity, scabies yet ever and anon he include other cutaneous affections under its name. Dr.Richard Hughes says that it may be thought strange that he considers doctrine of chronic disease as a fourth step of advance on Hahnemann's part ( the other three were individualization, positive efficacy of infinitesimal doses and treatment by single dose). But it would be so, he mean by so, doing to endorse the psora theory, in its definite dependence on the entity itch Hahnemann was indubitably in error about the pathological significance of this disease. But stripping his doctrine of all reference to this particular disease, it remains, in its essential substance, a most valuable induction from observation and guide to practice. It is the affirmation that when disease becomes chronic it is because of some morbid diathesis, some constitutional taint; that the manifestations of this conditions must not be treated as if they were mere local affections; that even the ordinary internal specifics of homoeopathy are most insufficient for their cure, and must be supplemented by new medicines, of a profound reach and long duration of action. It was this thought which led Hahnemann to introduce the so called antipsorics in to medicines—which enriched the materia medica with alumina, baryta, calc., graphites, kali carb, lyco, sepia, silica.
Dr. Richard Hughes continues, in his lecture " Homoeopathy what it is " as what I have said about the distinction between the speculative theory and the practical doctrine of chronic diseases applies to much else in Hahnemann's work at this time. His discovery of the efficacy and sufficiency of infinitesimal, for example, was mixed up with the hypothesis of all diseases being a derangement of the 'vital force' and of a 'dynamisation' effected in medicines by the process of trituration and succession to which he subjected now. All this may be rejected, as it generally has been rejected; but the discovery remains Dismissing, therefore, the theories of the master as of doubtful value and only speculative interest, let us fix our attention upon him in the sphere of his true greatness, and consider his practical rules.
In 'knowledge of the physician' Dr.Richard Hughes says that Every science – that is branch of knowledge, scientia from scire – consists of three parts,phenomena,laws,and causes. It is the first which, for positive theraputic action, chiefly concern us in disease.Not that the other two are worthless to us, even for this end .Our laws here are classifications-the recognition in morbid states of genera, species and varieties analogus to those of animated nature.These enable us to form groups of remedies associated with them, instead of having to wander through the whole materia medica for each prescription; they also give a continuity to medicinal treatment, without which the uses in morbis were of no avail.Hahnemann led the way here, by consantly insisting on the existence of fixed and definite type of disease, to which standing remedies should be applied ; and by giving us his group of antipsoric.According to Hughes, Hahnemann by explaining psora theory, rejected all enquiry into causes- the proximate causes, the noumena of the phenomena. In so doing we need not follow him .His ground for taking symptoms as true element of parallelism between disease and drug action was that they were surely known. In his day this was true, and his selection of them was most prudent. But to maintain that they only were knowable was unwarrantably to bar the advance of science.
His stricter followers have acted on the dictum, and have looked askance on the positive pathology of the present day, with its physical diagnosis and postmortem confirmations. They are always a decade or more behindhand in their recognition of such distinctions as those between typhus and typhoid, between chancre and chancroid, and in their use of such means as auscultation and thermometry. Now this is altogether wrong. An inference from symptoms, if sure, is as good a basis for treatment as symptoms themselves. This sureness is assumed in the prognosis given and the general management instituted: why should it not be also for purpose of drug selection ? By proceeding upon it we secure another route to the simile we desiderate.We use symptoms to reach it, because they are its most certain expression; but, it can be otherwise attained, the alternative access may often be useful. Morbid lesions sometimes occur almost, if not quite, without symptoms, as for instance caries of the vertebrae,and senile pneumonia.
To attempt to "cover"these from the results of the provings of the drugs would be futile.But toxicology and experiments on animals here come to our aid. But we should never, if possible, rest content with identity of seat between disease and drug: we should aim also at making their kind of action the same, and this can only be done by securing similarity in their symptoms.In this way we elevate the simile to a similimum, and proportionately enhance its energy in cure.
According to Dr.Richard Hughes two types of homoeopathy is present before us ie the teachings and practise of Hahnemann from the period 1806 – 1828 and the period from 1830 – 1843.The first three editions of organon upto1824 and all other Hahnemann's work during the first quarter of 19th century is of enduring worth; it is positive, experimental and sound. But from this time onwards we see a change. The active and public life he had led at Leipzig, with the free breath of the world blowing through his thoughts, had been exchanged, since his exile to Kothen in 1821, for solitude , isolation, narrowness. The reign of hypothesis began in his mind- hypothesis physiological, pathological, pharmacological.Dr.Richard Hughes says that making Hahnemann of 1830-43 is our guide, we commit ourselves to his senility.
The sum of what has now been said thus: homoeopathy is a theraputic method, an instrument for the selection of the most suitable remedy for each case of disease. But in adopting this method of Hahnemann as our chief guide in therapeutics, we do not necessarily become followers of his, in other departments of thought; we are homoeopathists, not Hahnemannians. The steam engine of today is not altogether that of Watt. Homoeopathy , like the candlestick of Hebrew Tabernacle, has been shaped by hammering not by casting: or rather, it is a vital thing, growing as the years go on, and legitimately influenced by its environments. It is in our hands some what different from what it was when it dropped from Hahnemann's; but it is Hahnemann's still. All study, exposition, practice of it must start from and the results it achieves must be accounted a monument reared to his honour.
1 .The principles and practice of Homoeopathy- Dr Richard Hughes
2. A manual of pharmacodynamics – Dr Richard Hughes
3. The knowledge of physician – Dr Richard Hughes published in IHMA panorama
Dr Bindu K BHMS,MD(Hom)
Medical Officer, Department of Homeopathy
Government of Kerala


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Eva Gutowski & Victoria Justice Pose in The Phone Booth at Alice + Olivia's NYFW Show
Eva Gutowski wows in a bright red suit at the Alice + Olivia By Stacey Bendet fashion show during New York Fashion Week on Tuesday (September 12) in New York City.
The TRL social correspondent and social star joined actresses Victoria Justice, Landry Bender and Skai Jackson at the presentation, checking out the new collection.
PHOTOS: Check out the latest pics of Eva Gutowski
Eva is truly living it up at NYFW this weekend and has been sharing a ton of pics on her Twitter.
Go check them out right now!
Fashion Week Day 4 ???????? pic.twitter.com/TdFszfSf1w
— Eva Gutowski (@lifeaseva) September 12, 2017
Posted to: 2017 New York Fashion Week September, Eva Gutowski, Landry Bender, Skai Jackson, Victoria Justice


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Posts Tagged 'anxiety'
They Tried to Make Me Go to Rehab and I said, "What the Fuck is Up with All this Gendered Sexist Bullshit?"
I'm sitting on a sofa in the upstairs room newly outfitted with IKEA living room furniture, a sign on the wall that reads "HUMBLE" in the style of an old gas station advert and a weird looking clock that is impossible to read which is really fucking annoying…I had to have my husband ship me a watch because TIME IS OF THE ESSENCE.
I am waiting for class to begin. And by class, I mean a 22 year old young middle class white woman who is triggered by Trap Music (the genre, not T.I.'s album with a 'Z') is going to speak to me and a room full of other women aged 19-40 somethings about…what?
Ah. Relationships with women. When we are in full blown addiction we will find women to be bitchy and take our boyfriends. I am not straight, but okay. I never found my friends to betray me in that way, but…
Now we are learning about addictive behavior and…clothing?
I shit you not.
Stop wearing short skirts and Holy Respectability Politics, Batman! Dammit, girls, if you'd just dress like a lady, you probably wouldn't shoot up so much and get facedownplasteredinthecar.
I bet you're surprised that there's research on the gendered ways we deal with addiction, just like there are racialized and sexualized ways…and those things intersect. Insert shock and awe here please.
Cis/straight/middleclass/white men are the bulk of all addiction treatments from AA to Passages. They are overwhelmingly run by that same demographic. And women, who raise the bulk of our children, suffer far greater instances of domestic violence, need assistance (that is often tied to drug testing or treatment completion) from the social safety net more often and experience sexual assault related to drug or alcohol misuse and abuse at astronomical rates are often completely left out of conversations about how best to deal with very specific issues when it comes to addiction. Well, unless they are being drug tested and having their babies taken away by DFCS. Wait, only poor women and WoC? Okay. Then we talk a lot about it. Mainly about taking them to prison and chaining them to beds if they are pregnant.
In the US, the ''good woman'' is a gendered construct characterised as one who upholds exceptional moral standards; the good woman embodies an image of sexual purity, trustworthiness and innocence (Harris-Perry, 2011; Raddon, 2002; Thetford, 2004). Some scholars articulate that these images are also racialised, placing white woman as the hallmark image of the ''good woman'' – a mutually reinforcing construct of sexual and racial purity characteristic of societal ideals of whiteness (Anderson, 2001; Harris-Perry, 2011; HillCollins, 2000). Though scholars have long critiqued these societal ideals of femininity as discriminatory and unrealistic, the good woman image persists as a cultural identity that both women and mene spouse (Hill-Collins, 1990; Raddon, 2002; Thetford, 2004).
It is these gendered understandings of morality that get in the way of good sobriety, of good treatment and of trauma healing inside a facility. Already treatment is viewed as a moral failing, a neo-liberal understanding of individual responsibility with little biological/medical understanding of addiction (See Dr. Carl Hart's work on addiction) and a pseudopsychologic/sociologic misunderstanding of social and psychological behavior. Basically, you are bad and you should feel bad. Jesus can help. Go to another meeting.
And it did make me feel bad. Even though I knew it was bullshit.
I watched girls, young women really, but barely old enough to be out of my Mama range, who had been violently assaulted or engaged in sex work (for which they had no reason to be ashamed) or engaged in sex for reasons they felt ashamed of (for their own reasons that I would honor) already be further shamed by talks delivered by completely unqualified techs with nary a background in women's studies, addiction treatment, sexuality, sociology…or social work.
We are nowhere near being able to distinguish the brains of addicted persons from those of non-addicted individuals. Despite this, the 'diseased brain' perspective has outsized influence on research funding and direction, as well as on how drug use and addiction are viewed in society. Dr. Carl Hart
Even though:
Your risk of experiencing intimate partner violence increases if you are:
- Poor
- Less educated
- An adolescent or a young adult
- Female
- Living in a high-poverty neighborhood
- Dependent on drugs or alcohol
I sat and listened to this talk and then an activity whereby a fictional woman on a fictional island is fictionally coerced into having sex with a man with more power and resources than she in order to go to the other fictional island where her fictional fiancè is located, who proceeds to abandon her and shame her for her rape and she is then rescued as a distressed damsel by a third man all while her mother encouraged the entire scenario.
I later found out that the worst person in the story according to the LICENSED ADDICTION COUNSELOR was the woman–for a lack of integrity.
These two instances happened on the same day, back to back.
I've been sexually assaulted in the context of addiction a number of times. I've been coerced into sex in the context of addiction a number of times. I've been RAPED UNDER THE INFLUENCE A NUMBER OF TIMES. I've also been violently assaulted by a loved one in the context of addiction and I've had my mom counsel me to "carefully consider my options" when it came time to probably leave. I've had horrific and shameful encounters with women friends in the context of addiction. I've been blamed for all of these things as a woman and as an addict/alcoholic by any number of people throughout my time in that world.
So. Yeah. Triggered. Sobbing. And attempted to make some kind of headway with the head of program direction…but, you know, as an addict/alcoholic my word really didn't mean shit. As a victim. As a survivor. AS A FUCKING SOCIOLOGIST.
"What can you do to gain knowledge in these situations?
Honestly, I dunno you ignorant fuck, what can you do to protect your clients from further trauma and respect the knowledge we have as experts in our own lives and hey these degrees that are costing me three times your fucking yearly salary? Yeah?
Okay no then.
I heard the words slut, bitch, and whore more times than I can count and I don't mean in a take back the night wild hairy underarmed feminist kind of way either.
I listened as male clients inspected the bodies of female clients, who touched them inappropriately, who bragged about having sex on property with young women who were clearly vulnerable and had limited opportunities for non-sexual physical contact (more on that and the rampant queerphobia later).
I know of at least two women kicked out for what amounted to specifically labeled gendered behavior that was not allowed and women shamed for not being ladylike and women who relapsed immediately after their discharge.
There was only one group who regularly "succeeded" and I'm not even sure we can call it that.
Source Material
A. J. Gunn & K. E. 2015. "Intra-group stigma: Examining peer relationships among women in recovery for addictions." Drugs: Education, Prevention & Policy. 22(3): 281–292.
Babcock, Marguerite L and Connor, Bernadette. 1981. "Sexism and treatment of the female alcoholic: a review." Social Work. 26(3):233-238.
McKim, Allison. 2014. "Roxanne's Dress: Governing Gender and Marginality through Addiction Treatment." Signs: Journal Of Women In Culture & Society 39(2): 433-458.
They Tried to Make Me Go to Rehab and I Finally Said Yes: A Series
I don't know how to start a description of deciding to go into rehab. I'd had years of meth use behind me…working on my second decade of being clean. I couldn't stop drinking and eventually I found myself handcuffed on the side of the interstate with my 10 year old precious boy in my car.
Seemed like I should get my shit together. This was clearly beyond acceptability.
You should see my admission photo. I look like Bambi met a MACK truck on a dark Smoky Mountain road and truly had no idea which way was left.
So, I went right.
I'm not a wallflower. I'm anything but. But you couldn't force me to talk that first day, though force me they did.
I was frantic to find anyone who seemed like me. On the inside. I was determined to take this for all it was worth and force myself to ignore whatever bullshit I heard.
And heard it I did.
Racist, sexist, ableist, queerphobic, antitheistic, antiatheist bullshit.
It was horrific and traumatic and beautiful and freeing and stifling and one of the greatest experiences of my life.
I stopped having panic attacks. I leaned on people very different from me. I learned just how deep my racial and class and educational privilege is and how far that shit would carry me at the expense of others.
I fell in love.
I fell in love with myself.
These are my experiences. These are my analyses. These are my words.
Hold on. I think I'm back, Bitches.
Welcome to the New Semester
I am super overwhelmed.
I, once again, took on as many classes as they would let me teach. At $2300 per three hour class, I felt like I had no choice. At this point, I'm going to have to do the same thing in the Spring, assuming they even want me back.
What if they don't want me back?
After last semester's devastating evaluations, I am afraid and desperately trying to find the balance between connecting with five classes of 32 students and holding true to my policies.
Due to family struggles, I don't feel like I can teach fewer classes. Due to those same struggles, I feel less sure of myself, much more anxious and borderline hopeless at reaching my students.
Then, I have a good day. Thank Bob for those days.
I feel like I'm getting the hang of being a face-to-face teacher. I've implemented the things I said I would (grade policies, talking to my students about how the class is going, being kind and understanding even when I have to say, "no") and I'm succeeding at some of them.
I'm still struggling with names. I guess I can't get it all.
If you're a student, please know that it's hard to stand in front of a room full of twenty-somethings, sometimes with sweat stains, occasionally saying the inappropriate thing, driving difficult discussions about heated topics…and feel confident.
I love what I do. I think I can be really good at it. I just want to know that my new institution will give me the time to grow into that person…preferably while not driving me to the poor-house in the meantime.
Also, to my fellow adjuncts some resources:
Culture: The Urinal Game
Social Inequality: Cut-Throat Monopoly (yes, even more than the original game)
Please give me all your activity suggestions for Social Problems and Intro.
I'm Allowed My Crazy, Too.
This entry is going to be intensely personal, probably not very profound and definitely clumsy. I apologize in advance.
Those of you who read my parenting blog (pecantheparent.com) know my family is really struggling. Those of you who read this blog know my issues with anxiety.
Anyway, I have a number of friends who are going through difficult patches; break-ups, make-ups, relationship working through-ups. Many of them also suffer from anxiety, some have PTSD and/or depression.
I have tried to be a good friend when my whole world feels like it is crashing down around me. I have invited friends to my home and tried to create a safe, but honest, space where issues could be discussed. I have a bad habit of taking on responsibility, pain, anxiety…that isn't mine.
This week I knew, eventually, probably…certainly my own feelings were going to erupt. I tried to reach out and let my loved ones know that it was coming, it would be ugly and that I would be a hot mess.
My child is in a psychiatric facility and has been for a week. He assaulted me. He ran away for 24 hours. I haven't run in 6 days.
Last night, at a party, it all came to a head…I was verbally abusive to my spouse when I became over stressed. I had a minor altercation with a new friend. Then, my attitude towards my husband became too much for him.
Needless to say, we left. On the way home, the badness ensued and I'll spare the details…but the most painful thing of the entire night was being told I treated someone I care about like shit.
Not told. Berated.
Not my husband (who I had actually treated badly). But someone who has needed my friendship recently and I have provided that in all the ways I know how. If those have been inadequate, that moment was not the time…and anyway, I HAVEN'T been inadequate. I have been selfless. Yes, I'm going to give myself some props for that.
Because I'm ALLOWED that. It's okay to say "I am a good person. I have done a good job."
I'm not perfect, but I am a good friend and in my time of crisis I put my own mental health aside to be there for others. I've been yelled at (because I can "take it" apparently) at least three times by stressed out friends, I've been yelled at for not wanting to talk before I was ready, I've been told to calm down, to chill out, to "just breathe".
Well, no. I told everyone my day would come and all my shit would surface and it would ugly and I would need that support. It came, it was ugly and instead…I got whatever last night was.
I am fortunate to have the spouse and many friends I do who have reached out today.
But, I will NOT apologize for something that not only did I not do, but even if I had done would be completely forgivable, given my current level of personal crisis and the number of times I've allowed others to work through their own crises with me.
Fuck. That.
I'm allowed a little bit of crazy, too.


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My wife and I have always loved vintage Volkswagens. When looking for a toad, we wanted something light so a Beetle was an obvious choice. Since we bought our Beetle, I have run into several others that frequently towed Beetles. I was at a vintage VW get-together this weekend and talked to a gentleman whose father frequently towed Beetles behind motorhomes.
I also read numerous threads over at http://www.thesamba.com/vw/forum/ that reaffirmed our hope that the Beetle was a good choice.
Our 1974 Beetle needs a few more things done to it and it will be ready to go. I already bought the tow bar off Amazon for $110.


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To All Our Community Leaders, Members, and Supporters:
2016 has been an interesting and busy year for us all, and on behalf of the Micronesian Islander Community (MIC), I would like to wish everyone a Happy Holidays and a Happy New Year.
MIC would like to make several announcements:
We hope you join us as we move forward with the 2017 year! It will be an exciting time indeed.
All the best to you and yours,
Jackie (MIC Co-Chair)


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by James VanderKam, University of Notre Dame
VanderKam delivers a point-by-point comparison of the Dead Sea Scrolls and the New Testament. He asserts that while the scrolls should not be directly linked to the Bible, they reveal a community living before, during and after Jesus, and cast much light on the early relationship of Christianity to Judaism.
James VanderKam is the John A. O'Brien Professor of Theology at the University of Notre Dame. He is one of the world's leading authorities on the Dead Sea Scrolls and the world of Jesus. The author of several books on the Dead Sea Scrolls, including The Dead Sea Scrolls Today (Eerdmans, 1994), VanderKam is the editor of the Jubilees texts from Qumran Cave 4.
AUDIO CD, 56 minutes.
This is also available in DVD format.


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Dodger Savage will be left intrigued by a new arrival in Hollyoaks next month.
The wheeler-dealer will take pity on 14-year-old Nico after he realises that she is desperate for food.
Dodger (Danny Mac) first meets the newcomer when she suddenly ambushes him in the village and snatches his lunch.
Refusing to let Nico get away, Dodger grabs her but is left alarmed when she faints.
Once Nico has regained consciousness, kind-hearted Dodger gives her something to eat at the antiques emporium.
The teen tearaway accepts Dodger's support, but when he mentions taking her home to help further, she appears to be spooked and immediately runs off.
Young actress Persephone Swales-Dawson will be playing the role of Nico, but fans will have to wait and see how her storyline develops after her first meeting with Dodger.
A Hollyoaks source told Digital Spy: "Is this girl just a passing tearaway teenager? Or could there perhaps be something more?"
Hollyoaks airs these scenes on Friday, June 6 at 6.30pm on Channel 4.


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Sony Entertainment CEO Michael Lynton is stepping down from his position to focus on another role: Chairman of Snap Inc.
Lynton has been a trusted adviser to Snap's Evan Spiegel and on the board of Snapchat's parent company since 2013. He's now been recognized officially as chairman of the board at Snap, according to The New York Times.
In a memo to staffers, published in the Hollywood Reporter, Lynton said he was leaving Sony to focus on his growing responsibilities as chairman of the company on the edge of an IPO.
"As some of you are already aware, I have been involved with Snapchat since its early days. Given Snapchat's growth – and my growing role and responsibilities in it – I recently determined that the time was right to make a change," Lynton said in his note to the company.
He'll remain with Sony for the next six months to oversee the transition. Snap declined to comment.
Lynton's close ties with Snapchat were infamously exposed following the Sony hack in December 2014. Lynton's leaked emails exposed the inner-workings of the secretive company, including the unannounced acquisition of Vergence Labs which became the basis of Snap's recently released Spectacles smart glasses.
Get the latest Snap stock price here.


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A great meeting this morning with CCLA , the biggest investment banker to the sector. They have 45000 clients in the charity sector and importantly , they are a mutual . So they are part of our sector. Michael Quicke , the Chief Executive is a member and the splendid Andrew Robinson is one of their key advisers ( not sure what his title is , you know what they are like! ).
We do a lot with them ; for example they sponsored and hosted our recent Governance review. So we were there to chew over the recent developments and to consider how we both help provide support and advice to the sector . It is clear that acevo now needs to review its plans for events and publications for next year and we agree that providing sound advice to third sector bodies in preparing their budgets for next year and reviewing their business and strategic plans is crucial given changed circumstances.
In this crisis the lead sector bodies need to work together and so Stuart Etherington ( ncvo ) and I have been in touch on issues . Stuart has called a summit to discuss how to move forward. And we are working with ncvo , the Charities Aid Foundation and the Finance Director's group to compile a full list of the losses from the Icelandic banks. By mid day our tally was up at £60ml from 20 charities , but much more is to come.
I'm glad to say the press are still interested in our story , and I try to steer them onto the need for an emergency package of support in advance of my meeting with Liam and Kevin . I point out that the Charities Aid Foundation estimate that £700 ml lies around in HMT in unclaimed gift aid . And I push home the point on higher rate tax earners. Lets see if we can get action from Government on this. We have an opportunity . Lets use it . Stuart will be seeing them this week too , so we will be pushing the message home that support is needed . And it is a longer term project , as the Summit in November Stuart has called, will discuss .
I also put the finishing touches to an article for The Guardian . It will be provocative . And set out a challenge for Government . Read it Wednesday .
An amusing interlude as I rush from meeting to meeting ; I get an email from a good friend Keith Smith , who works for Compass , the sector consultants . His partner is Barbara Frost , who is CEO of WaterAid and a very effective former Vice Chair of acevo . They live in Marston Biggot , which also happens to be the last resting place of my Great Great Great Grandparents , George and Elizabeth Chambers. Its a gorgeous part of the country ; just outside Frome in Somerset. I have stayed with Keith and Barbara when I tidied up their grave. Elizabeth was born in the year of the Battle of Waterloo and lived into her 90s so I have photos of her with my grandfather ! A bit wizened looking she was , but a character . I have photos of their house in the village . I gave one to Keith and he has located it . In fact it is currently being sold ; a marvellous place it looks too. Regret ably sector salaries do not run to buying splendid houses in Somerset.
It is always interesting to pick up comment from other Blogs. I note some interesting ones on what is described as " CentreRight" which is hosted on " conservativehome.com . There is an attack on me in a pompously entitled comment headed " Not in my Name" ( what , am I supposed to have started the Iraq war ? ) . This attacks my call for an emergency fund for the sector . According to this particular right winger this is "An enormous bung" and a comment further down attacks this as , "greedy and insensitive ." Well you guys , consider this . The Treasury has around £700ml in unclaimed gift aid relief and a further large amount in the unclaimed higher rate tax reliefs . So asking for some of this back at a time of serious decline in donations seems entirely reasonable . Unless your on the centre right of course where presumably we are supposed to suffer in silence and not complain like good little charities ; seen but not heard.
But I guess you have to sympathise ; in times when Gordon Brown implements Michael Foot's election manifesto promise to nationalise the banks and the Tory Leader denounces city types and their fat bonuses it must be difficult to work out what being centre right is these days !


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Our Calendar
Clubs and organizations are invited to list drives, clinics, competitions and other activities in this calendar on a space available basis. Please email information (date, name of event, contact information) to . Items advertised in Driving Digest are listed in bold type. Some calendar items are obtained from listings made available by associations and publications such as ADS, AHSA, CAA and Rural Heritage Magazine. Driving Digest attempts to check the accuracy of these listings but cannot be responsible for cancellations and corrections. Readers are advised to call ahead before driving long distances to ensure the event is still scheduled.
August 11-17 | Doc Hammill Horsemanship Work, Driving and Training Horses Workshop
Date: Sunday, August 11, 2019 8:00 am
Duration: 8 Hours


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Unlike MDF, cardboard furniture can't kill you and, even better, if you're moving house you can make your children carry the sideboard. Reinhard Dienes has designed a range of cardboard furniture for Fashion for Home that is light weight, eco friendly and – not always a given with eco ranges – it looks good. Below is the Georgia sideboard which costs £149.
The furniture company, which has recently started selling online in the UK and Ireland, is not just about cardboard. With offices in Berlin and China the company aims to sell designer looks at affordable prices. German founders, Marc Appelhoff and Christoph Cordes have recruited designers such as Reinhard Dienes and Danish designer, Tobias Jacobsen, grandson of Arne, to supply the good looks. Costs are kept down by selling online only, saving on retail space, and a made to order production means low storage costs. Below are the Bentwood Shelves at £159.
Below Dickens Cardboard bookshelf from £179.
Below Gran 2 seater sofa starts at £599.
Below, Copine Dining Table and Chairs. Table starts at £419 and £259 for a pair of chairs.
Below, Richmond 3 seater sofa starts at £659.
Below Easy 3 seat sofa starting at £949.
Below, Dowel 2 seat sofa £749.
Can't afford £5,000 for that Eames original? What about a Jacobsen for under £200?
Via Button Chair Set for £199 designed by Tobias Jacobsen.
This post is sponsored.


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PESTILENCE "The Never Ending Plague"
Interview by Dr. Mality
Everybody makes a mistake now and then. Everybody. But extreme metal fans have a hard time forgiving and forgetting. Just ask Patrick Mameli, guitarist, vocalist and all around overlord of Holland's legendary death metallers Pestilence.
For a while, Patrick got sick of "playing the game" and also bashing out endless blastriffs and vomitous vocal eruptions. And so Pestilence took a long nap while he explored other sounds and other paths in life. Well, I guess this is NOT an option for any death metal icon, as rabid fans castigate and persecute the fallen with the relentless vigor of Inspector Javert from "Les Miserables". C'mon, fanatics, is it just possible that somebody can maybe take a break for the mayhem?
Patrick now has returned to the death metal fold and Pestilence has unleashed one of its most brutal albums ever, "Resurrection Macabre". I dare any true extreme cult motherfucker to tell me this album doesn't belong with the acclaimed "Consuming Impulse" and "Malleus Maleficarum" from Pestilence's past. Thing is, once you talk to Mr. Mameli, you find out not only that he is a very nice guy, he's also a very honest one. He knows the mistakes he's made concerning Pestilence and he's willing to take some of the blame. But he's NOT going to apologize for doing things his way. And isn't this rebellious spirit at the very heart of the heavy metal ethos?
I had a great time speaking to the re-energized Patrick about the return of Pestilence and the band's plans for the future, as well as his tumultuous past. Read on to discover how this plague is just getting started...
WORMWOOD CHRONICLES: Now that Pestilence has been back in action for a while, do you feel the comeback went pretty much the way you envisioned it?
PATRICK MAMELI: Actually yes, but it's been quite a strange story. We never actually thought that this would happen, that after 15 or 16 years, Pestilence would come back together and record another album. We didn't think there would be enough interest in us for us to tour or come over to the States. The line-up changed again, it's been a pretty turbulent year for us, but thank God we now have a very steady line-up with two great new musicians in the band. One can never really envision how things will turn out exactly. I think the new album "Resurrection Macabre" turned out to be a really good comeback album. It's very brutal, the way Pestilence should be. It's what Pestilence should have been after "Testimony of the Ancients" . This album should have come out after "Testimony..." and then we would have been way, way bigger.
WC: It was a very brutal album indeed. Was that the intention all along? Were you in an angry mood when you put this together?
PM: It's very difficult to explain the process of composing music for us. I definitely thought of what all the older fans would expect from us. There was a a lot of speculation when we decided to come back, a lot of anticipation. A lot of our old school fans from the 80's and early 90's wondered, what are these guys going to come up with? Is it going to be "Spheres" Part 2 or the sequel to "Testimony..." or whatever? You're always going to probably disappoint some people no matter what. Some people have favorite albums and whatever you do, you can't top those albums. They've been in the hearts of these people for so many years. But we wanted to make a brutal comeback. In the back of our minds, we always thought, why did we start Pestilence? The band started back in 1986, listening to hardcore punk and bands like Possessed and Death. We grew up on that brutal music and once you develop your own style, things kind of shift. You want to show how good you are with your instrument, you'll be a bit more melodic. In the end, you find yourself on a side road you didn't plan on. That's not really what we wanted to do. We wanted to do very brutal music but play it with technicality. We want it catchy so people can shout the lyrics. So we went back to the roots on "Resurrection Macabre" and we pretty much succeeded with that.
WC: The album does have its own style, it's not just a rehash. It's not a "Consuming Impulse" Part 2 or a "Testimony..." Part 2. All the Pestilence albums have their own style and I imagine that's something that's really important to you.
PM: Yeah, you hit the nail on the head. You have to reinvent yourself all the time...staying true to your style but discovering new ground to keep it interesting for yourself as well. You don't want to have the repetition that a lot of bands have over the years. They keep on in their small boundaries and their fanbase will stay steady. One can expect the next album will sound like whatever you did before. With Pestilence, it has always been a little bit different. We always wanted to come up with new stuff while staying true to the Pestilence kind of riffing. In September, we're recording a new Pestilence album called "Doctrine", which is going to top all the other stuff we've done. It's going to be different again, it's going to be haunting, it's going to be eerie. It's going to be really, really slow in parts...something we really haven't done before. It's going to be ultra-fast, also something we haven't done before. Yet it will all stay true to the Pestilence style. The vocals will change again a little bit. I like to see what my range is. If you stay in the same range all the time, you'll sound like any other death metal vocalist. It will be a bit more original.
WC: It's more about pushing the envelope. How far do you feel you can experiment with Pestilence, though? Do you think the fans can be closed-minded sometimes? How do you know where the boundary is?
PM: That's very difficult. There are two Pestilence camps. You've got the Martin van Drunen Pestilence camp and then there's the Patrick Mameli Pestilence camp. There's a lot of people that stick to the Martin van Drunen sound, which is cool. But he was in Pestilence for a couple of years and sang on two albums. And after that, I kind of took over and I did three or four albums, including live stuff. It's difficult to look into the minds of fans...they're the ones who have to buy the album. One can kind of experiment a bit, but you have to stay true to the style. If you go crazy like we did on "Spheres", it will backfire. "Spheres" came after "Testimony...", which up to that point was our most advanced album. We combined the eerie melodies with brutal death metal. There were some other bands doing that as well. A great example of a band that finds the right balance is Immolation, for example. They have changed over the years yet stayed true to their style. When they came out with their new album, it features their best production, it's got great songs. Even so, there will always be fans that say "Dawn of Possession", their debut, was the best album!
WC: But what can you do? You can't just write music for a real small clique. Some people think if it doesn't have a really raw production, it isn't worth anything. You've got to please yourself, too, correct?
PM: That's true, you're the one that's gonna have to do all these shows. If after two shows, you're like, man, I shouldn't have written the music like this, then you messed things up yourself. It has to come from the heart and there's hopefully gonna be a bunch of guys (and gals) liking that stuff, because you want the venue to be packed and everybody having a blast. That's what it's all about, the energy that comes from live shows. You can gauge from that if people are into the new stuff. Hopefully they got the new CD or at least ripped the MP3's. I don't mind people getting the MP3's as long as they get it, they understand why you do what you do.
WC: Do you think the modern fans of today accept more experimentation and different influences than fans back in the old days?
WC: It's funny you should mention Immolation. I talked to Ross Dolan not long ago and he mentioned that Pestilence was one of his favorite bands.
PM: That's crazy! When we were on the Neurotic Deathfest together here in Holland, in Tilburg, we shared a backstage room with Immolation. We never really met or sat down and talked extensively but there was a mutual respect. I like those guys a lot, man...they have a great sound, they have great technical skills and their music is catchy! It's as catchy as hell. It's brutal, played technically and it has a kind of melody, so it's somewhat similar to what Pestilence is doing.
WC: They also ignore whatever the current trend is and stick to their own thing...
PM: Which is really good. I think on their last album, "Majesty and Decay", that they are topping themselves. They are adding to their style. Some bands, when their new album comes out, it sounds almost exactly like their second or third album. It's almost like they reversed one of their old songs on a computer, said "oh, that';s a great riff" and it's just a reversal of what they've done in the past. We are not that way. We want to reinvent ourselves while staying true to our style, which is very, very difficult. You will always have fans that like the first album the best.
WC: What were the highest point and lowest point in the history of Pestilence?
PM: The highest point we still have to reach. One of the highlights was when Pestilence got back together after 16 years, getting a record deal and recording "Resurrection Macabre"...that gave me such a kick. I think the new album is going to be over the top...crazy, insane music. I've got five songs written already and they are crazy, man! I like them, the other guys like them, the insiders say it's gonna be our best effort ever. But after the album "Spheres", when the fans dropped us and we pretty much knew the album wasn't going to do anything, that was pretty much one of the most depressing and low moments. We were so fed up and frustrated with the music industry at that time. We didn't get the proper support from the record company because they were signing all these bands and the market was saturated with death metal bands. We felt our musical creativity was gone. It took us 16 years to get our appetite back for making music again.
WC: Around 1993 and 1994, the industry changed radically anyway. A lot of death metal bands had trouble back then. But there's a real grass roots support for it. I'm optimistic that it will be around in some form.
PM: I pretty much agree on that. There are certain musical styles where you will always have fans that stick on that band until they die. Now you have metalheads that are over 50. They still like to listen to Slayer and go to the shows. That's an amazing phenomenon that shows the effect this music has on people. It's almost like a drug.
WC: I'm 47 and I've been into heavy music since 1973. I still try to go see shows. I think though that the giant arena metal shows are just about at the end. Recently, Dio passed away. There are not any guys coming up who can take the torch from him, I think.
PM: That's so true, that is so true.
WC In the 80's, I first encountered the real heavy stuff and just like you said, I became addicted to it. It was a shock the first time I picked up the Venom "Welcome To Hell" album. The first two weeks, I thought, what is this noise? But I kept coming back to it time and time again. And now it's grown into areas you couldn't have imagined before. The scene is healthy, but the age of gods like Dio is passing.
PM: Yeah, and he was one of the few guys that was there from the start. Not even bands like Slayer and Metallica have the mystique of Dio, Judas Priest, those bands.
WC: I think we have finally come to the end of Black Sabbath. I don't think Ozzy will rejoin them and I can't really see Ian Gillan or Tony Martin doing that. I hope they don't keep dragging themselves out by getting somebody new.
PM: That's with any band, really. Sometimes it's good to call it quits and not relive those good old days that you can't really top. But there are some bands...and I include Pestilence in that group.,..that still have that holy fire and still have the same intensity when they started out. Now I'm 42, you know, and I'm a little older as well. I don't have my long hair any more so I can't do my head spins. (laughter) But it still feels great to play death metal, it still gives me a rush.
WC: When you don't feel that anymore, that's the time to hang it up, I guess.
PM: Yeah, definitely.
WC: You guys are coming over for the Maryland Deathfest. What can the fans expect to see?
PM: Last time we set our foot on American soil we were interrogated for four hours because we didn't have our visas in order. That was a bummer. They put us on the next plane right back. Now there's great anticipation on both sides. I think we're going to destroy. I have such fond memories of the fans in the States. Not only are they loyal, but they really appreciate the music a lot. Especially the bands coming from Europe.
WC: It kills me that I can't make that show. The line up is just unbelievable!
PM: Isn't it? That is true! I remember when we did the Blood Brother tour with Autopsy opening up for us. We were friends with Chris (Reifert) for a long time and we lost track, but it's gonna be great seeing those guys. We're older, they're older, it's going to be fun. Everybody's gonna be coughing on stage and sweating!(laughs) Too bad you can't be there.
WC: Are you playing on Saturday night?
PM: No, I believe we're playing on Sunday. They've stretched things out a little bit. On Sunday, everybody's already dead from the two days before. Hopefully we can still make an impact.
WC: I'm not too worried about that! Are you still producing bands, are you working with anybody right now?
PM: Actually, no. The whole composing effort for Pestilence takes so much time. I have a regular job, I got a wife, I got two kids...my time is so limited. I'll be producing the new Pestilence album of course, but no other bands at the moment.
WC: The other project you were involved with, C-187, is that no more?
PM: Yeah, that band is no more. It's such a shame because I thought it was such a great album, but people want to see me in a death metal and not making crossover music. I think Sean did a great job on that album drumming. I think we only sold 2000 copies of it. It's like no use if you're playing in front of 50 people, I can't even pay the guys in the band.
WC: Do you think as time goes on that people will be more accepting of it?
PM: Well, I would have thought people would have been more accepting of it considering I was gone for 15 years! But metal fans will always be metal fans and the shit you did 15 years ago will still be fresh in their minds. They will never forget if you do something wrong, They will never forget! There will definitely not be any more C-187 albums.
WC: What was the last CD you got just because you wanted to hear the band?
PM: Wow, I think that was a while ago. I think it was the Hate Eternal album "I, Monarch". I'm a big fan of Derek Roddy, you know. That record kind of turned me back on to playing extreme metal. Some of the people who knew from the past said, "I know you're into drummers and I know you listen to a lot of jazz and fusion and blah blah blah, but check this guy out!" When I heard it, I was like, what is this? I've never heard this stuff before! This guy is so fast and so brutal! That kind of turned me back on to making extreme music again. I guess I gotta give props to Erik Rutan and Derek for that!
WC: I'm sure they'll take that as a big compliment. What was the last band you saw live because you wanted to check them out?
PM: Ummm, OK, that's difficult. I've seen so many bands live and there's just a few that stick in your head. Years ago, I saw Kreator on the "Pleasure to Kill" tour and that made a huge impact on me. Also Ozzy Osbourne with Jake E. Lee when they did the "Bark At the Moon" tour. But seeing Hate Eternal live was something I really wanted to see as well. That was a great show. I loved every second of it!
WC: In the history of Pestilence, has there ever been a Spinal Tap moment that you can share with the fans?
PM: Well, most things that went wrong happened in the Martin van Drunen era. When you have Martin around, you know something is about to go wrong. (chuckles) With the new line-up, we're a little bit older. Martin would do all kinds of crazy stuff and he wouldn't even know why he did it. Right before a show, he would pick up a rock and start throwing it through a fancy car windshield. Then he'd have to run because people would be fuckin' chasing him. Those things happen! We did our share of crazy things but not as crazy as some of the other bands around.
WC: Any last words?
PM: We will make it back to the States after the Maryland Deathfest. We'll be touring for our new album "Doctrine" next year probably around February. The Pestilence is back and we still have a couple of albums to go!