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OBJECTIVES Few studies have attempted to identify what premortem features best differentiate multiple system atrophy (MSA) from Parkinson's disease (PD). These studies are limited by small sample size, clinical heterogeneity, or lack of postmortem validation. We evaluated the sensitivity and specificity of different clinical features in distinguishing pathologically established MSA from PD.
METHODS One hundred consecutive cases of pathologically confirmed PD and 38 cases of pathologically confirmed MSA in one Parkinson's disease brain bank were included. All cases had their clinical notes reviewed by one observer (AH). Clinical features were divided into two groups: those occurring up to 5 years after onset of disease and those occurring up to death. Statistical analysis comprised multivariate logistic regression analysis to choose and weight key variables for the optimum predictive model.
RESULTS The selected early features and their weightings were: autonomic features (2), poor initial levodopa response (2), early motor fluctuations (2), and initial rigidity (2). A cut off of 4 or more on the ROC curve resulted in a sensitivity of 87.1% and specificity of 70.5%. A better predictive model occurred if the following features up to death were included: poor response to levodopa (2), autonomic features (2), speech or bulbar dysfunction (3), absence of dementia (2), absence of levodopa induced confusion (4), and falls (4). The resulting ROC curve based on individual scores showed a best cut off score of at least 11 of 17 (sensitivity 90.3%, specificity 92.6%).
CONCLUSIONS Predictive models may help differentiate MSA and PD premortem. Hitherto poorly recognised features, suggestive of MSA, included preserved cognitive function and absence of psychiatric effects from antiparkinsonian medication. Diagnostic accuracy was higher in those models taking into account all clinical features occurring up to death. Further studies need to be based on new incident cohorts of parkinsonian patients with subsequent neuropathological evaluation.
- multiple system atrophy
- Parkinson's disease
- clinicopathological study
- differential diagnosis
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Multiple system atrophy (MSA) is a clinically and pathologically distinctive neurodegenerative disease.1 Historically, it has been described in three different ways: olivopontocerebellar atrophy (OPCA),2 striatonigral degeneration (SND),3and the Shy-Drager syndrome, (SDS).4 The considerable clinicopathological overlap among these three subgroups led Graham and Oppenheimer to introduce MSA as an umbrella term.5 There is now general agreement that MSA is one distinct entity among many multisystem degenerations. In recent years glial cytoplasmic inclusions have been described in oligodendrocytes that are present in the brains of all patients with MSA of whatever denomination.6-8This abundant presence of glial cytoplasmic inclusions in all clinical subtypes of MSA has introduced further grounds for considering SDS, SND, and many cases of sporadic OPCA together as MSA.
It is often difficult to distinguish clinically between MSA and Parkinson's disease, particularly early in the disease. In the United Kingdom Parkinson's Disease Society Research Centre (UKPDSRC) study of 35 cases of MSA, one third of the patients died with a misdiagnosis. Even when a correct premortem diagnosis of MSA had been made, this still took an average of 4 years after presentation.9 Poor diagnostic sensitivity for MSA among movement disorder specialists has been reported by Litvan et al.10 Mean rater sensitivity in their study was 56% at the first clinic visit and this had increased to 69% by the last visit. However, primary neurologists, who followed up the patients clinically, achieved even lower sensitivities of only 25% and 50% at the first and last visit respectively. The reasons for such poor diagnostic accuracy have not been studied systematically. However, overlapping clinical features probably contribute.11-12For example, asymmetry of the cardinal features of parkinsonism normally associated with PD is also seen in most patients with MSA.13 In addition, atypical features that suggest non-idiopathic disease such as poor response to levodopa, autonomic failure, cerebellar incoordination, and pyramidal signs as well as severe immobility may all take several years to become evident. However, as prognosis and treatment response is different for patients with MSA compared with PD14 15 a correct diagnosis is important. We are aware of only three previous studies which have attempted to identify what premortem features best differentiate MSA from PD.10 16 17 All three have had 20 or fewer cases of MSA and have compared these either to other parkinsonian patients10 or to various other neurological conditions.10 17 The study by Albaneseet al provides the most realistic setting as it evaluated consecutive parkinsonian outpatients.16 However, features were compared with a clinical diagnosis, partially based on those features, without pathological confirmation, therefore resulting in an inherent circularity. In the present study we aimed to determine the sensitivity and specificity of different features in distinguishing pathologically established MSA from PD. We also determined the best combination of predictor variables using multivariate methods in an attempt to produce a fairly simple clinical diagnostic index.
We studied 100 consecutive patients with pathologically confirmed PD and 38 patients with pathologically confirmed MSA, whose brains were collected by the Parkinson's Disease Society Brain Bank (PDSBB) in London, UK, between June 1987 and July 1993. Most of the patients with PD and some of the patients with MSA were registered donors and many had been prospectively assessed annually by neurologists associated with the PDSBB. About a third of the patients with MSA, all with a clinical diagnosis of MSA, had been seen in life by one of us (NPQ). Selected clinicopathological features of some of the patients with PD or MSA have been previously reported.9 11 17-22
The defining histological characteristics for PD were depletion of pigmented neurons in the substantia nigra and locus ceruleus, with Lewy bodies in some remaining nerve cells and elsewhere in the nervous system. The striatum was normal and there were no glial cytoplasmic inclusions or additional pathology to account for the presence of parkinsonism.18
All cases of MSA satisfied the neuropathological criteria proposed by Gray et al 23 and modified by Quinn24: neuronal cell loss and gliosis in a selection (at least two) of the following structures: striatum, substantia nigra, locus ceruleus, pontine nuclei and middle cerebellar peduncles, cerebellar Purkinje cells, inferior olives, and dorsal vagal nuclei; in addition, the presence of characteristic glial cytoplasmic argentophilic inclusions in the primary or secondary motor areas and basal ganglia. Because the striatal MSA lesion may seem subtle or even absent using conventional histological methods25immmunohistochemistry for glial fibrillary acidic protein (GFAP) was performed in all patients in addition to routine stains such as cresyl violet (Nissl) and Luxol fast blue.26
All clinical notes were reviewed by one observer (AH) who classified all subjects to maintain standardisation of coding. The relatively large number of variables were initially grouped into logical subheadings to enable a more rational approach to data analysis. These were as follows: (a) sociodemographic, (b) clinical, (c) drug side effects, and (d) miscellaneous features. In some cases, the same variable was classified twice, either at onset or early in the course of the disease, or alternatively at any time in the clinical history. This distinction is useful in determining which features may be early predictors.
Autonomic failure was defined as the presence of any of the following: symptomatic postural hypotension, urinary urge incontinence, faecal incontinence, urinary retention requiring catheterisation, or persistent erectile failure.
Akinesia (usually with rigidity) was necessary for a diagnosis of parkinsonism. However, tremor was neither obligatory nor sufficient on its own. Response to levodopa, based on the estimate in the records of either the patient or physician, or both, was graded on a four point scale (1=0%-29%, 2=30%-49% (both "poor"), 3=50%-69% ("good"), and 4=70–100% ("excellent")). Subsequently, for the purpose of analysis, levodopa response was defined as poor (0%-49%) or definite (50%-100%). Early fluctuations, dyskinesias, neuropsychiatric toxicity, and dementia were defined as occurring within 5 years of onset. Cerebellar features recorded included limb ataxia, intention tremor, gait ataxia, and nystagmus, in isolation or in combination. Pyramidal features comprised equivocal or extensor plantar responses and hyperreflexia. Speech or bulbar features comprised dysarthria, dysphagia, and excessive sialorrhoea. "Other signs" is a catch all heterogeneous category that included any other features seen that were atypical for PD.
For each variable, the sensitivity, specificity, and positive and negative predictive values were calculated as well as the χ2 value. The diagnostic utility of each variable to correctly detect MSA is for a combination of pathologically established cases of MSA and PD only. The performance of each variable was summarised using the Youden index (sensitivity plus specificity−100). This measure gives equal weight to both sensitivity and specificity. Because of the collinearity between certain clinical variables, it was decided not to enter all variables into a stepwise model but rather, within each subgroup, to determine the best predictor or combinations of predictors using multivariate logistic regression analysis with the postmortem diagnosis (MSA or PD) as the outcome variable. The best predictor(s) from each subgroup were then entered into a new logistic model to produce the most parsimonious model. Those variables that remained significant were then weighted by their β coefficient, and these weightings were then used to produce a simplified clinical score. The exact values were not used, as the intention was to enable clinicians in a normal setting to calculate a score without the use of calculators. For each case, the score was calculated and an ROC curve was produced from which we subjectively chose the most sensible cut off for clinical practice. Because of missing data, the analyses were not always based on the total sample size. Where a clinical feature was not mentioned we assumed that the absence of its recording in the notes indicated that it was not present. However, we cannot be certain that the relevant clinician actually looked for this feature and thus its absence may simply indicate a failure to see or record it. For certain variables, such as initial Hoehn and Yahr score or levodopa response, we have omitted all observations with missing data from the multivariate analysis and have not attempted to impute results.
Data were available on 38 patients with MSA and 100 patients with PD. The mean age of onset for patients with MSA was 55.9 years (SD 10.6) compared with 62.4 years (SD 9.3) for PD (p<0.001). Mean disease duration until death was also significantly shorter for the MSA than the PD group (6.8 years v 13.2 years, p<0.0005). The initial Hoehn and Yahr score was significantly worse for patients with MSA compared with those with PD (2.4v 1.9, p<0.01). The percentage of patients with age at onset less than 55 years was twice as high in the MSA than in the PD group (p<0.01). At the initial neurological examination, asymmetry was present in 72% of both patients with PD and those with MSA. A poor initial levodopa response was more common in the MSA group (58%), but it also occurred in some (23%) patients with PD (p<0.0005). Initial rigidity was seen more often among the MSA (57%) than the PD (30%) group (p<0.005).
The diagnostic value of each clinical feature by itself is shown in table 1. The following were the best predictors, in order of the Youden index, and were chosen to enter into the multivariate models: age of onset ⩽55 years, atremulous or akinetic at onset, asymmetric disease, initial Hoehn and Yahr stage 3 or greater, poor initial levodopa response, early fluctuations, absence of toxic (induced by dopaminomimetic and/or anticholinergic drugs) confusion or hallucination, speech or bulbar features, autonomic features, pyramidal features, cerebellar features, falls, absence of dementia, and other clinical signs. Most of the standard clinical features that are used in the diagnosis of MSA appear in the above list. However, some of these—for example, cerebellar features—are very useful when present (high specificity) but have limited sensitivity as they are only found in a smaller subgroup of patients than autonomic features. Their predictive value is therefore limited, and not all the standard diagnostic features remained in the final multivariate model.
The final selected logistic regression model, coefficients, and weightings are shown in table 2, where pathologically established cases of MSA were coded as 1 and PD cases as 0. If a patient had any of these specific features they were given the following score (otherwise they scored zero): poor initial response to levodopa (2), autonomic features present (2), speech or bulbar problems present (3), absence of dementia (2), absence of toxic confusion (4), falls present (4). A patient could therefore score between 0 and 17. By calculating an individual patient's score, it was possible to plot an ROC curve of sensitivity against 1-specificity (fig 1). We did this both using the exact coefficients and the rounded coefficients from table 2. As the results were almost identical we have only presented the rounded coefficients. The best compromise score is 11 or more out of 17, which results in a sensitivity of 90.3% and specificity of 92.6%.
It is clear that individual patient's scores can vary over time as they develop further symptoms and signs. Furthermore, these data are based on patients followed up until death and thus any features have had the maximal time to emerge. As such, the model is rather limited clinically as it is desirable to diagnose patients earlier than death. Absence of a feature at any one time does not mean it will not emerge in the future. Unfortunately the time from symptom onset to the development of autonomic, cerebellar, or pyramidal features was not recorded. We therefore repeated the modelling using the features that were recorded at presentation, after initial treatment, or within the first 5 years after onset of symptoms. We also included autonomic features as these have been shown to be almost always present in cases of MSA and are a very common presenting feature, therefore being present relatively early in the natural history of the disease. This repeat analysis identified four variables as significant predictors with the following weightings; autonomic features present (2), poor initial response to levodopa (2), early fluctuations (2), initial rigidity (2). A patient could therefore score between 0 and 8. The ROC curve for this initial clinical score is shown in figure 2. In this case, a cut off of ⩾4 results in a sensitivity of 87.1% and specificity of 70.5%.
Before considering the relevance of our findings we need to draw attention to the drawbacks of our study:
(1) We analysed clinical data that were based on a combination of retrospective extraction of hospital notes and, when available, annual prospective UKPDS BB report forms. Ideally, an incident cohort of parkinsonian patients should be established with standardised high quality data on symptoms and examination and neuropathological confirmation. However, no such cohort currently exists so current research is limited to clinicopathological series of patients.
(2) The sample of subjects we have analysed was collected by a brain bank specifically interested in parkinsonian disorders and is therefore likely to overrepresent atypical or complex cases. It is not known therefore if the features seen are representative of all patients with MSA or PD. The utility of some features, such as response to levodopa, which may have a better predictive value in a more typical community sample, may have been underestimated.
(3) Despite the relatively large sample of cases of MSA, this analysis is still only based on limited numbers and is therefore prone to random error. Further work should try to replicate and validate our results in a different independent sample of patients.
(4) We simplified the diagnostic problem by limiting our comparison to patients with MSA or PD, thereby excluding other causes of parkinsonism, particularly progressive supranuclear palsy (PSP) which may symptomatically overlap with both.
Despite these inevitable shortcomings, our study suggests that the following clinical features may help in the differential diagnosis of MSA versus PD: poor initial response to levodopa and absent psychiatric side effects from antiparkinsonian drugs; dysarthria and dysphagia; recurrent falls; autonomic failure; and preserved cognitive function on bedside testing. These features are similar to those independently determined in another clinicopathological study, although levodopa responsiveness and bulbar symptoms were not specifically mentioned.10 However, that study chose to overrepresent many rare causes of neurological disease, so that cases of PD only comprised 17% of the non-MSA group, a rather unrealistic situation. This means that the utility of certain clinical features is distorted by the balance of other conditions that may mimic MSA or PD.
Both that study and ours identified preserved cognitive function as a useful clinical feature hitherto poorly recognised among neurologists to differentiate MSA from PD (see later). Our multivariate analysis enabled us to derive a clinical score out of 17 which permitted good discrimination between groups. For example, a cut off of 11 or more had a sensitivity of 90.3% and a specificity of 92.6%. However, this model is based on a complete follow up of patients until death. Its utility in early disease is limited as absence of a symptom or sign at this stage does not mean that it will not develop later on. In this respect it is interesting to note that our second model, although weaker, still had reasonable sensitivity and specificity. Clinical suspicion should arise in patients, early in their natural history, who score more than 4 out of 8 on this simple score, and diligent follow up is necessary to detect further atypical features.
The following second visit features failed to differentiate between the groups: symmetric onset, akinesia, tremor, levodopa induced motor complications, and depression, indicating considerable overlap between PD and MSA. This suggests that except for producing levodopa unresponsiveness the striatal degeneration that is almost invariably present in MSA9 21 does not significantly modify the nature of parkinsonism (as recorded in the case notes) that is caused by the nigral pathology alone in PD. Therefore, based on the present data it seems unwise to diagnose MSA by analysing features of parkinsonism alone (without knowledge of levodopa response).
Those clinical features that differentiated PD and MSA over the long term course of the disease will now be discussed in more detail.
It is widely accepted that an excellent response to levodopa is expected in patients with PD. In fact, definite and sustained levodopa benefit is part of the UK PDS BB diagnostic criteria for PD.20 Surprisingly, 23% of our patients with PD showed a poor initial response to levodopa compared with 58% poor initial responders within the MSA group. There may be several reasons why patients with PD fail to respond to levodopa. Some patients with PD who are functioning at a high level at initial diagnosis may not have an impressive response to levodopa because of a ceiling effect. Similarly, clinicians may not push levodopa to adequate doses. However, some pathologically established cases of PD with no appreciable response to levodopa have been reported.27 Overall, patients with PD were more likely to show fluctuations than the patients with MSA, yet when these did occur in MSA, they almost always (93%) were noted within 5 years of onset. As early fluctuations more commonly occur in young patients with PD28 it is possible that the difference may reflect an age effect as patients with MSA were significantly younger than those with PD.
Our data suggest that dementia is common in advanced PD, but infrequent in MSA and early PD, in line with previous literature reports. The absence of dementia therefore fails to distinguish MSA from PD early in the disease process. Most recent estimates of the prevalence of dementia in clinically diagnosed PD are in the order of 20%, but the cumulative risk is about 40%.29 Visual hallucinations and other psychotic phenomena may be induced by antiparkinsonian drugs in otherwise uncomplicated PD, but can also occur in the absence of drug therapy in patients with dementia with Lewy bodies.30 By contrast, patients with MSA rarely develop dementia or psychiatric side effects from their medication,22 perhaps because the structural (particularly glial) change is largely limited to the brainstem and basal ganglia and related motor systems,6-9 and also because they tend to be younger. In addition, once a patient has been identified as having MSA many clinicians will stop or reduce levodopa or avoid increasing it to high dosages. Cholinergic deficits are less severe in MSA than in PD,31 although definitive neuropathological studies of the nucleus basalis of Meynert in MSA brains have not been reported.
Speech impairment develops in virtually all patients with MSA, in whom it tends to be dominated by hypophonic monotony or a scanning quality according to the parkinsonian or cerebellar subtype.32 Dysarthria tends to develop earlier, be more common, more severe, and be associated with more marked dysphagia and sialorrhoea in MSA compared with PD.
Impaired postural reflexes with resultant falls cause major disability in many patients with MSA, and in our clinical series postural instability had developed in 93% of patients.13 However, relatively few patients with MSA presented with falls in the first year, whereas this is more common in PSP.33
Autonomic failure occurred in 84% of the patients with MSA, but in only 26% of the patients with PD. The range of the autonomic deficit particularly affecting orthostatic blood pressure control, micturition, and defecation is similar in both PD and MSA, although urinary incontinence and retention are more common in the second. However, deficits occur earlier in MSA and tend to also be more severe and widespread in this disorder.34 Furthermore, the anatomical basis for autonomic dysfunction is more extensive in MSA, primarily affecting preganglionic sympathetic neurons35and the hypothalamus.4
The features that were identified as useful parts of our model to discriminate between MSA and PD are by themselves entirely non-specific. Poor levodopa response can occur in many situations, such as associated cerebrovascular disease or other atypical parkinsonian syndromes. Preserved cognition and lack of psychiatric side effects are not restricted to patients with MSA, as most patients with PD (60%-80%) will also remain cognitively intact.29Disturbed axial function is also an early hallmark of PSP,36 and also invariably accompanies end stage PD. Dysarthria, dysphagia, and falls are therefore by no means specific to MSA. Of the many different autonomic disturbances most also occur in PD and some also in PSP or other neurodegenerative disorders. However, patients with MSA are particularly prone to have severe early autonomic failure including presyncopal states, syncope, urinary incontinence or retention, impotence, and sweating disturbance.37
Our results suggest that improving diagnostic accuracy of MSA requires pattern recognition rather than defining unique pathognomonic symptoms or signs. In our data set matched against the gold standard of neuropathological confirmation the combination of poor or absent levodopa response, axial disturbance (dysarthria, dysphagia, dysequilibrium with falls), and intact cognition including lack of antiparkinsonian medication induced psychotoxicity yielded optimum predictive power. However, this proposed feature combination is based on follow up until death, and therefore of limited utility in early differential diagnosis. Repeat analysis restricted to early disease (<5 years) identified a weaker predictive model including autonomic dysfunction, poor initial levodopa response, initial rigidity, and early fluctuations. As many of the atypical parkinsonian syndromes that are seen in specialised PD clinics are due to MSA, our findings suggest that this combination could be a useful aid for "bedside" differential diagnosis. However, the utility of these features in distinguishing between MSA and PSP has not been tested, and would probably be considerably less.
These scoring systems need to be validated against different datasets. Similarly new diagnostic methods, such as neuroimaging, should be compared against simple clinical diagnosis. New incident cohorts of patients with movement disorders should be set up, so high quality prospective diagnostic data can be collected and linked to postmortem validation. Ideally this should be a multicentre collaborative venture to ensure large numbers of cases of MSA.


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Cameo Classics
Cameo Classics is now owned by The Lyrita Recorded Edition Trust which was founded by the late Richard Itter to promote British Classical Music through the Lyrita label and to curate the Itter Broadcast Collection. "We will operate Cameo alongside the Lyrita label, both of them being distributed under exclusive licence by Nimbus / Wyastone. The important British premieres that appeared on Cameo, works by Somervell, Blower, and Howell among others, will be re mastered and recompiled for immediate issue on the Lyrita label. The remaining Cameo titles will be re mastered and re-presented with a new design during 2018, alongside a new release programme drawn from the non-British material contained in the Itter Broadcast Collection." Adrian Farmer, Lyrita TrusteeItter Broadcast CollectionRichard Itter had a life-long fascination with recording and he acquired professional equipment for disc and tape recording for solely private use. From his home in Burnham he was able to receive a strong signal from the BBC Wrotham transmitter, which was constructed in 1951 and began broadcasting VHF/FM on 2 May 1955. His domestic recordings from BBC transmissions (including Proms, premieres, operas, symphonies and chamber music – more than 2000 works in total), date from 1952-1996. Everything was initially recorded on magnetic tape, but up to 1955 particularly important performances were transferred to acetate disc. These fragile discs were never played and have remained in excellent condition, as have the majority of the tapes which make up the bulk of the collection. In 2014 the Lyrita Recorded Edition Trust began to transfer this priceless archive and has put in place formal agreements with both the BBC and the Musicians Union to enable the release of these archived items to the public.
Items 1-12 of 16

subset: commoncrawl


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The week long visit follows two previous inspections, the Leisure Best Value Review and the Comprehensive Performance Assessment in 2003.
It will primarily involve assessing a range of cultural services either provided directly or in partnership with Woking Borough Council.
This includes assessing the borough's partnerships in youth services, arts, countryside and health as well as examining the opportunities the council provides for the community to socialise and evaluating leisure and well-being facilities.
Prior to the inspection, the council prepared a self-assessment for the inspectors, which outlined service strengths and identified challenges and opportunities.
The inspectors will base their assessment on how good the services are, focusing on the quality of services provided for the community and the prospects for improvement.
The inspection is important for the community services department and the council as a whole because the outcome will be fed into the next round of the CPA and will impact upon the council's score.
Results of the inspection are likely to be made available in November. For further information, contact Sue Barham, head of community services, on 01483 743810.


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Mom Cherishes Every Moment as a Parent
This Mom's Post-Drink Confession Will Have You Bursting With Parenting Joy
With all the chaos that comes with parenting, it's important to take a step back and appreciate the beautiful gift that is motherhood. Yvette Lamb is a mom of two boys and the brains behind the Big Trouble in Little Nappies blog. She frequently writes about never getting eight hours of sleep and the endless list of reasons why babies cry, but after all the humor, Yvette is opening up about the joys of motherhood, and it's really special.
Yvette was recently emotional about her baby's birthday, and after half of a glass of wine, she decided to write a post explicitly calling out what makes her happy to be a mother. Through all the temper tantrums and dinnertime fights, she wanted to talk about something incredibly important. "We are so lucky to be parents," Yvette wrote. "We are so privileged. And life really is very precious."
After her youngest son woke up in the middle of the night, Yvette held him and quickly put him back to sleep, but after feeling his heartbeat, she was swept with emotion. "The same heartbeat we saw flickering away on the grainy scan at six weeks pregnant," she wrote on Facebook. "The same heart that beat inside of me, cocooned against mine all those months. This same heart beats and grows and loves every single day. This heart, with its arrival, filled ours up to bursting point. Life and the universe hold so much beauty. We are all miracles. Yet then there are so many stories of loss, of sick children, of infertility. And it is sad and it is heartbreaking and it is humbling."
It's true: every day we hear another heartbreaking story about miscarriage or childhood cancer. Still, it can be so easy for parents to lose sight of just how lucky they are to be able to experience their child's temper tantrums and Lego messes — Yvette is making sure her readers know that.
"I think it's important to be honest about how tough this gig can be, and that to find it difficult doesn't mean we're getting it wrong or aren't good enough," she shared. "I completely champion sharing the grittier side of parenting, which is hard and exhausting and worrying. But I think it is also important to acknowledge that we are lucky, and gratitude can be shown without the pretense of perfection or of cherishing every moment. (Who, after all, really cherishes being puked on?)"
Yvette closed her note with one final thought: "Though I don't and never will have this whole thing sussed, tonight I need to say I truly appreciate my children. They are our biggest gift and I am so very thankful to have them in this world."


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- September 2013 (Revised June 2017)
- HBS Case Collection
IBM and the Reinvention of High School (A): Proving the P-TECH Concept
By: Rosabeth Moss Kanter and Ai-Ling Jamila Malone
IBM's Corporate Citizenship office created a social and organizational innovation in public education through a business-school partnership. IBM's Stanley Litow was the key architect in designing Pathways in Technology Early College High School, known as P-TECH. The open enrollment high school located in New York City's Brooklyn was launched in 2011 through a joint partnership between IBM, City University of New York (CUNY), and the New York City Department of Education (NYCDOE). The innovative design incorporated Career and Technical Education (CTE), STEM (Science, Technology, Engineering, and Math), and early college. Students could graduate with an associate's degree (essentially two free years of college) and be "first in line" for jobs at IBM. The school was already seeing remarkable results; one third of the inaugural class entered P-TECH below grade level and nearly all students were promoted to the 10th grade and more than half of them took college courses before the end of their sophomore year. This case explores the motivation behind P-TECH (a growing skills gap), how it was developed along with the challenges, and the attention generated by the unique school design.
Innovation; Partnerships; Leadership; Partners and Partnerships; Education; Business and Community Relations; Change; Innovation and Invention; Education Industry
Kanter, Rosabeth Moss, and Ai-Ling Jamila Malone. "IBM and the Reinvention of High School (A): Proving the P-TECH Concept." Harvard Business School Case 314-049, September 2013. (Revised June 2017.)
About The Author
Rosabeth M. Kanter
General Management


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Includes a free 6″ Coil for Black Friday!
Also Includes LG 28 11″ coil, lightweight plastic middle stem and original arm rest
Nokta Makro's first simultaneous multi frequency metal detector The Legend is loaded with features that makes it the best multi-purpose detector, adaptable for all types of targets and ground conditions.
This "legendary" metal detector offers exceptional performance in the toughest conditions in its world-praised robust and waterproof design and comes at a price that sets a new standard in the industry.
Its depth and advanced discrimination capability in trashy sites along with its silent and stable operation on the beach and underwater will captivate all land and beach hunters.
The Legend is equipped with specifications that are suitable also for gold prospectors to be able detect those small gold nuggets in highly mineralized gold fields.
- Fully submersible up to 3 meters (10ft) and protected from total dust ingress.
- Advanced Discrimination Settings
- All Metal, Ferrous Off, Ground Effect Off, Custom (Notch Discrimination)
- Frequency Shift & Noise Cancellation
- Get rid of EMI easily.
- Recovery Speed Setting
- Enables you to detect smaller targets among trash by adjusting the speed of target response.
- 60 Target IDs & Harmonic Tones
- Accurate Target IDs and harmonic tones with adjustable frequencies allow you to identify targets easily.
- Adjustable Threshold
- Lets you set the threshold level and frequency in every mode.
- 4 Custom User Profiles
- Save your favorite settings for different locations and/or targets.
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- Saves valuable detecting time and makes the device suitable for novice as well as experienced detectorists.
- Vibration
- The Legend will vibrate upon detection of target! Ideal for the hearing impaired users as well as for detection underwater.
- Backlit LCD & LED Flashlight
- An awesome feature for those night hunts!
- Lightweight (1.4kg / 3.0Ibs)
- Well balanced – Enjoy detecting for extended hours without fatigue.
- Long Battery Life
- Easily charge it with a USB charger or powerbank. Provides up to 20 hours of use (Battery life will vary based on the operating frequency as well as other settings.)
- Online Firmware Updates
- Stay up-to-date with firmware updates (via USB) and get the most out of your detector.
Package Contains:
- System Box
- Waterproof DD Search Coil 28cm / 11″ (LG28) & Cover
- Bluetooth aptX™ Low Latency Headphones
- The LEGEND Hat
- USB Charging & Data Cable
- Headphones Soft Case


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Robert Moline is the president of HomeServices of America and CEO of its brokerage division. Moline is the driving force behind the Upstream project, which promises to streamline the backend home listing process and power brokers to play a more central role in the digital delivery of listing data.
First job: Boy Scout camp counselor


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Wednesday, April 30, 2014
Beyond Fandom: 'The Originals' 1.20: You Want Daddy Issues? We'...
Beyond Fandom: 'The Originals' 1.20: You Want Daddy Issues? We'...: CW If you've been watching The Originals then you'll notice that they're really big on daddy issues. With the finale approachin...
Posted by aboutnici at 11:27 AM No comments:
Labels: Daniel Gillies, Elijah Mikaelson, Hayley Marshall, Joseph Morgan, Klaus Mikaelson, Phoebe Tonkin, The Originals
Thursday, April 24, 2014
Phoebe Tonkin
HQ Photo (from this twitter post)
Phoebe with Paul Wesley (Stefan Salvatore) and his family on Easter Sunday.
Hayley with her child's father Niklaus "Klaus" Mikaelson (Joseph Morgan)
Klaus with his brother Elijah Mikaelson (Daniel Gillies)
Here are some photos of Australian actress Phoebe Tonkin who plays werewolf mother-to-be Hayley Marshall on The Originals.
Posted by aboutnici at 11:20 PM No comments:
Labels: Daniel Gillies, Elijah Mikaelson, Hayley Marshall, Joseph Morgan, Klaus Mikaelson, Paul Wesley, Phoebe Tonkin, Stefan Salvatore, The Originals
Dove Cameron
- Dove Cameron's Official Twitter
- Dove Cameron's Official Instagram
- Dove Cameron Online (and its gallery site)
- Dove Cameron France (and its gallery site) - French Site
- Dovely Cameron (and its gallery site)
- Dove Cameron Daily (and its gallery site)
- Dove Cameron - Liv and Maddie Wiki
- Dove Cameron - Facebook
- Dove Cameron - Just Jared Jr.
Posted by aboutnici at 10:15 PM No comments:
Labels: Dove Cameron, Liv and Maddie, Liv Rooney, Maddie Rooney
Tuesday, April 22, 2014
Diana Schade Renard
Mother in search for her child
Diana with Juliette Silverton (Bitsie Tulloch)
If you haven't seen the adorable twin babies who plays Diana, go to this blog.
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Phoebe Tonkin
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Hoops and yoyo leave on monday, for their world tour! We had a party for them and even had a band! Check in on sunday and I''ll let you know where they are off to FIRST!!!!
Saturday, May 3, 2008
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Ripley's Believe it or Not!
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How it all started! 1992
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By Maud Watson
The (Swiss) Cheese Stands Alone
After a week of sublime tennis in which his serve wasn't broken once, Roger Federer won the Masters Cincinnati title to become the first player to win that prestigious crown on five occasions. He also tied rival Rafael Nadal for most overall Masters titles. It's obvious the grass court season has once again infused confidence in the Maestro. His forehand has been a thing of beauty, and he's doing an excellent job of protecting his backhand. In short, he hardly looks 31 and instead appears closer to the man who dominated the game from 2004-2007. He's not a lone heavy favorite in New York with both Murray and Djokovic posting strong results earlier this summer, but don't be surprised if he leaves Flushing with major number 18.
Beautiful Partnership
Li Na had been without a title since Roland Garros last year. Struggling to find any consistency in her game, she recently hired Carlos Rodriguez (the man who coached Justine Henin to so much success) to help her out, and suffice it to say, their partnership has started off with a bang. After reaching the final the previous week in Montreal, she went one better in Cincinnati to claim her first tournament win of 2012. Cincy also marked the first time that Li and Rodriguez met face-to-face, and the Argentine coach must have liked what he saw. With any luck, his input will mean more consistent results for Li. She is a deceptively quick mover with penetrating ground strokes off of both wings. If she can learn to better harness that aggression, there's no reason she can't pick up more big titles, including another major. Keep an eye on this new partnership, because that combo already looks likely to pay dividends.
What's In A Name?
For Rafael Nadal, an answer is what's in a name. In a press conference last Friday, Nadal announced that he is suffering from Hoffa's Syndrome. While it's unfortunate one of the game's greatest is sidelined with this condition, it might have also come as a relief to the Spaniard. His doctor has said it is not significant, and being able to specifically pin down the problem means being able to provide more appropriate treatments. Of course, all of the treatment in the world will not make up for Nadal's style of play, which is apt to continue to cause problems, so it will be interesting to see if this diagnosis alters his approach to the game and/or his schedule. But for now, here's to wishing Rafa a speedy recovery and a happy return to the game.
Stirring the Pot
In recent years, Serena Williams has certainly made headlines at the US Open – and not because of her tennis. This year, she's getting a head start stirring the pot as she complains about the "bad things" that have happened to her at the US Open. She definitely got robbed on a poor line call in 2004, but her gripes about incidents in 2009 and for sure in 2011 are dubious. Her defense in 2009 (besides suggesting that she definitely didn't foot fault) is that she looked at the lineswoman after the first foot fault call to try and "warn" her not to do it again, and that the lineswoman just shouldn't make that call at that stage of the match and at that stage of the tournament. So basically, she threatened the lineswoman who should have known that late in a Grand Slam she needs to throw the rulebook out the window. As for 2011, Serena said she got a bogus hindrance call for grunting. She needs to go back and watch the tape. She didn't grunt – she loudly and intentionally yelled "c'mon!" Yes, plenty of other shriekers are louder, but Serena's actions made it clear as day that applying the hindrance rule was warranted. In both instances, more fans might have been behind her had she not gone on completely inappropriate tirades and showed a complete lack of remorse for doing so. And she wonders why people don't give her enough credit for being nice…
Missing the Boat
The WTA has started a celebrity campaign to bring more fans to the game. They're featuring celebrities like Donald Trump, Aretha Franklin, and Susan Sarandon among others. In a nutshell, the hope is that fans of the featured celebs will follow those celebs to tennis, and in turn, become tennis fans themselves. I applaud the WTA's creativity, but I wonder if they aren't glossing over one of the more real issues when it comes to fans of the WTA. I don't care how many celebs you have in your corner, if you want to bring fans to the game and more importantly, keep them, then they've got to do something about the awful screeching. The WTA is to be coming out with further info on a grunt policy in the very near future, so fingers crossed that they're actually going to be doing something concrete instead of just blowing smoke. After all, no amount of glitz and glamour can mask the ugly sound of someone who sounds like a shrieking banshee.


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Article Text
Background Many local authorities in England and Wales have reduced street lighting at night to save money and reduce carbon emissions. There is no evidence to date on whether these reductions impact on public health. We quantified the effect of 4 street lighting adaptation strategies (switch off, part-night lighting, dimming and white light) on casualties and crime in England and Wales.
Methods Observational study based on analysis of geographically coded police data on road traffic collisions and crime in 62 local authorities. Conditional Poisson models were used to analyse longitudinal changes in the counts of night-time collisions occurring on affected roads during 2000–2013, and crime within census Middle Super Output Areas during 2010–2013. Effect estimates were adjusted for regional temporal trends in casualties and crime.
Results There was no evidence that any street lighting adaptation strategy was associated with a change in collisions at night. There was significant statistical heterogeneity in the effects on crime estimated at police force level. Overall, there was no evidence for an association between the aggregate count of crime and switch off (RR 0.11; 95% CI 0.01 to 2.75) or part-night lighting (RR 0.96; 95% CI 0.86 to 1.06). There was weak evidence for a reduction in the aggregate count of crime and dimming (RR 0.84; 95% CI 0.70 to 1.02) and white light (RR 0.89; 95% CI 0.77 to 1.03).
Conclusions This study found little evidence of harmful effects of switch off, part-night lighting, dimming, or changes to white light/LEDs on road collisions or crime in England and Wales.
- Environmental epidemiology
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Within a context of cost constraints and increasing local accountability for climate change mitigation, technological innovation is enabling changes to the provision of street lighting in England and Wales in ways that may have important implications for public health. Emerging technologies, such as LED lighting and computerised central management systems, have created opportunities for local authorities to adapt their street lighting strategies in ways that can reduce energy costs and contribute to reductions in carbon emissions. However, there is also concern that reductions in street light at night might increase road traffic injury, crime and fear of crime.
Local authorities are able to draw on national guidance on lighting1 and professional standards2 when making decisions about street lighting, but ultimately make their own assessment of the most appropriate lighting regime on each road for which they have responsibility. Three street light adaptation strategies reduce the amount of light: switching lights off permanently ('switch off'), reducing the number of hours that lamps are switched on at night ('part-night' lighting), and reducing the power or output of lamps ('dimming'). A fourth strategy is to replace traditional sodium lamps (orange/yellow light) with more energy efficient lamps or LEDs ('white light').
Each of these strategies has prompted public and media concerns about the negative effects that focus on risks of night-time road traffic collisions, crime, and fear of crime.3 Road collisions have received particular attention, with a number of coroners concluding that reduced street lighting contributed to road deaths sparking inquests.4 However, health and well-being benefits from reduced light pollution (eg, improved sleep and being able to see the night sky) have also been noted.5 ,6 There are also putative benefits from reductions in artificial light at night, which have been linked to a range of health outcomes affected by disruptions to the circadian rhythms.7–9
Public concern that street lighting is necessary for road safety and crime prevention is, in part, supported by the literature: systematic reviews have identified some evidence for improved road safety10 and an overall reduction in crime11 with increased street lighting. However, with respect to crime, studies show that reductions in victimisation are observed during both hours of daylight and darkness,11 calling into question the mechanism through which improvements to street lighting might influence crime. Moreover, there is to date, no empirical evidence on whether the implementation of reduced street lighting has had any negative effects on these important public health outcomes. National research on the effects of reduced street lighting on road traffic collisions and crime is, therefore, timely.
Theoretically, street light adaptation strategies might influence the risk of road traffic collisions and crime in a number of ways. Reducing lighting levels by switch off, part-night lighting, or dimming can reduce visibility in an area, which may increase the risk of collisions if road users are no longer able to detect hazards. Reduced visibility may also decrease mobility if fear of collisions, falling over in the dark, or fear of crime deters people from making some journeys. Fewer people on the streets might reduce road casualties by reducing the potential for collisions, but may decrease the 'natural surveillance' in an area, leading to an increase in crime. Reduced visibility may also reduce crime, such as theft from vehicles or robbery, if criminals are less able to identify potential targets. The introduction of energy efficient lamps, or LEDs, can change the quality and colour of lighting (eg, from yellow to white light) without reducing visibility. White light might improve visual acuity, and by improving closed circuit television (CCTV) images can make criminals feel more conspicuous, thus deterring certain types of crime.
The broader cultural meanings of street lighting as one component of modern (sub)urban life may also link switch off, part-night lighting and dimming strategies to crime. Residents and visitors may feel that areas targeted for lighting reductions have been devalued; this may lower levels of community pride, leading to behavioural changes that influence crime. Alternatively, introducing new technologies, such as white light/LEDs, in an area may signal increased investment in a community to local residents, which may increase community pride and a willingness to use, and to monitor, their neighbourhood, leading to a reduction in crime.
In summary, street light adaptation strategies may have different effects on two public health outcomes, casualties and crime. In light of a lack of evidence, we used the reduction of street lighting by local authorities in England and Wales as a natural experiment to examine whether it was associated with any changes in road traffic collisions and crime. The project was called the LANTERNS (Local Authority collaborators' National Evaluation of Reduced Night-time Streetlight) project.
We designed a controlled interrupted time series analysis to examine associations between reduced street lighting and road traffic collisions and crime, adjusting for regional trends. Analyses were conducted at road level for traffic collisions and at area level for crime. Analyses were based on the patterns of change in monthly counts of collisions and crimes within each street, or area.
Data sources
Street lighting—all local authorities in England and Wales were invited to participate in the study (details of recruitment methods are reported elsewhere).3 From local authorities who had made changes to street lighting provision at night, data were requested on the geographic location of each street lighting column, the change to lighting (eg, part-night lighting), and the date the change was introduced. All local authorities who provided usable data by October 2014 were included in the analysis.
Traffic collisions—data on traffic collisions were obtained from STATS19, the official dataset of collisions on public highways in the UK collected by the police. Data were obtained on the dates, times, geographical coordinates of collision locations, and severity of casualties for all collisions that occurred during the period 2000–2013.
Crime—data on crime were obtained from the Police.uk website from December 2010 (the earliest date for which the data are available) to December 2013. Data included type of crime, year, month, name of road where the crime occurred, and approximate geographical coordinates.
Exposure variables
Street lighting—data were linked using a geographical information system (GIS) to a detailed road segment database derived from the Ordnance Survey Mastermap Integrated Transport Network.12 For each month between January 2000 and December 2013, road segments were categorised according to whether switch off, part-night lighting, dimming and white light had been implemented in the lighting columns along that segment. Where combinations of interventions had been implemented (eg, part-night lighting with white light), road segments were categorised as having both interventions. To facilitate area-level analyses, we also calculated the proportion of total kilometres of road in each area that had introduced switch off, part-night lighting, dimming and white light.
Outcome variables
Traffic collisions—collisions recorded in STATS19 were classified as 'night-time' (occurring between sunset and sunrise) or 'day-time' (between sunrise and sunset) according to the time and date of the collision. For this, we obtained the daily timings of sunrise and sunset in each region of England and Wales between 1 January 2000 and 31 December 2013. Using data on injury severity, we classified each collision according to whether any casualties suffered a fatal or serious injury. A casualty is classified as fatal if the person dies within 30 days of the collision. A casualty is defined as serious if the person is admitted to hospital or has suffered fractures, concussion, internal injuries, crushing, non-friction burns, severe cuts and lacerations, or is in severe general shock requiring medical treatment. A GIS was used to link collisions to road segments using a combination of spatial overlay and analysis of the text descriptor of each road location. In brief, the algorithm assigned a collision to the nearest road segment of the type indicated in the STATS19 report. Collisions occurring over 50 m from a road segment of the appropriate type were excluded from analysis. We calculated counts of collisions in road segments for each month from January 2000 to December 2013.
Crime—to preserve victim anonymity, the publicly available Police.uk data only includes approximate geographical coordinates of offences, and does not detail the time of day of offences. A study of the spatial accuracy of the data suggests that it is very good for large areal units, such as census Middle Super Output Areas (MSOA), that contain around 7500 people,13 but not for the postcode or street segment level. We therefore analysed crime at the MSOA level, assigning each offence to the relevant MSOA. We analysed offences most likely to occur during the evening or at night: burglary, theft of (or from) a vehicle, robbery, criminal damage, and violence, including sexual assault.14 We calculated counts of each offence in MSOAs for each month from December 2010 to December 2013.
Statistical methods
Our focus was to characterise the influence of changes in street lighting on collisions and crime after allowing for underlying trends over time. Analyses were based on the patterns of change in the monthly counts of collisions within each road segment, and in the monthly counts of crime within each MSOA. To control for confounding due to differences in areas chosen and not chosen for interventions, we analysed these road level (collision) and MSOA level (crime) counts as 'panel' studies, conditional on total counts in each road or MSOA, such that any of the factors that are constant over time (eg, road design) contribute no information to the analysis. Conditional Poisson regression models were used rather than standard Poisson models to allow variation in rates by road segment and MSOA without having to directly estimate a large number of nuisance parameters.15 Further details of the models are given in web appendix 1. We conducted sensitivity analyses by assuming a negative binomial, rather than Poisson model, by allowing for zero inflation and by fitting models without autoregression terms.
Traffic collisions—We estimated the association of each street lighting adaptation intervention with night-time collisions from a single model to avoid mutual confounding. To guard against bias due to changes concurrent with lighting interventions that impact on overall (ie, day and night) collisions, the data set included counts of daytime collisions and a binary variable indicating day/night. We estimated from our regression model the change in collision rate associated with each street lighting adaptation intervention during daytime as well as night-time, and the ratio of night-time and daytime changes. We consider this 'daytime collision' adjusted measure the most robust estimate of the change in night-time collisions following the lighting intervention. Models were adjusted for seasonal variation and temporal trends by fitting individual terms for year and month. Models were fitted for each region in England and Wales, and effect estimates were pooled in a fixed effects meta-analysis.
Crime—we estimated the association between changes in the proportion of total kilometres of road in each MSOA that had introduced each street lighting adaptation intervention, and counts of each criminal offence (and their aggregation), controlling for trends in crime over time. We fitted indicator variables for the number of months elapsed from the start of the study (ie, a step function for elapsed month, from December 2010). We fitted separate models for each police force in view of their different data collection systems and evidence for different background time patterns across these systems. We pooled effect estimates in a random effects meta-analysis. Given the large number of police forces and types of crime considered, we do not present forest plots of the meta-analyses in the main text, only the means for England and Wales.
By October 2014, we had had direct contact with 125 (72%) of the 174 local authorities in England and Wales, resulting in data submissions from 71 local authorities of which 62 provided usable data (figure 1). Data for nine authorities were excluded due to missing information on dates of changes, and changes implemented after the end of the study. Local authorities from each region provided data. The participating local authorities were evenly distributed across deciles according to population density (persons per hectare), covered the range of deprivation levels as measured by the Index of Multiple Deprivation 2010, and covered each of the six urban–rural classifications of areas.
Street lighting—of the 62 local authorities with usable data, 5 (8%) had introduced switch off, 30 (48%) had introduced part-night lighting, 40 (65%) had introduced dimming, and 52 (84%) had introduced white light. The introduction of street lighting adaptation strategies increased steadily from 2009 (figure 2). By December 2013, the local authorities participating in this study had implemented white light on a total of 15 833 km of road (7% of total road km in the 62 participating local authorities); part-night lighting on 12 101 km of road (5%); dimming on 10 519 km of road (4%); and switch off on 946 km of road (0.4%). The proportions of total kilometres of road in each MSOA that had lights switched off ranged from 0% to 60% (median 0.03%; IQR 0.01–0.05%). For part-night lighting, the proportions ranged from 0 to 84% (median 0.2%; IQR 0.1–18%); for dimming, the proportions ranged from 0 to 93% (median 0.14%; IQR 0.07–5%); and for white light, the proportions ranged from 0 to 81% (median 1%; IQR 0.15–11%).
Traffic collisions—during 2000–2013 there were 859 935 collisions in the 62 local authorities included in the analysis; of these, 161 049 (19%) were night-time collisions; 153 442 (18%) collisions had resulted in a serious injury or fatality. Of the night-time collisions, 1202 (0.7%) occurred on roads along which switch off had been introduced by December 2013; 5670 (4%) were on roads with part-night lighting; 11 634 (7%) were on roads with dimming; and 12 423 (8%) were on roads with white light.
We found little evidence for any associations between street light adaptation strategies and day-adjusted night-time collision rates (figure 3). There was no evidence from any of the regional models, or the overall estimates, for an association between switch off (rate ratio (RR) 0.97; 95% CI 0.82 to 1.15), part-night lighting (RR 0.95; 95% CI 0.84 to 1.07); or dimming (RR 1.00; 95% CI 0.91 to 1.10). There was weak evidence in London for an association between the introduction of white light and increased night-time collisions (RR 1.30; 95% CI 1.03 to 1.65); however, the overall national estimate provides no evidence for such an association (RR 1.01; 95% CI 0.93 to 1.09). Similarly, models estimating associations between street light adaptation strategies and collisions causing a serious injury or fatality found no evidence for associations with any lighting intervention (see web appendix 2).
Crime—across the 62 local authority areas there had been 581 837 burglaries; 475 657 thefts of or from a vehicle; 67 470 robberies; 486 367 criminal damage offences and 730 280 violence offences during the period December 2010 to December 2013.
Figure 4 shows the estimated mean associations between changes in the proportion of total kilometres of road in each MSOA that had introduced each street lighting adaptation intervention, and counts of each offence across England and Wales. The rate ratios indicate the expected change in crime if 100% of total kilometres of road in an area were to receive the lighting intervention.
There was no evidence from the overall estimates for an association between the aggregate count of crime and switch off (RR 0.11; 95% CI 0.01 to 2.75) or part-night lighting (RR 0.96; 95% CI 0.86 to 1.06). There was weak evidence for a reduction in the aggregate count of crime and dimming (RR 0.84; 95% CI 0.70 to 1.02), and white light (RR 0.89; 95% CI 0.77 to 1.03). We found significant heterogeneity between the estimates at police force level (see web appendix 3); there was strong evidence for an association between part-night lighting, dimming and white light, and a decrease in crimes in some police forces, and strong evidence for an association between part-night lighting, dimming and white light, and an increase in crimes in others.
When specific offences were considered, the estimates provide suggestive evidence that part-night lighting may be associated with an increase in robbery (RR 1.48; 95% CI 0.99 to 2.21), and that dimming may be associated with a decrease in violence (RR 0.78; 95% CI 0.60 to 1.01). At the national level, we found consistency in the direction of the estimated associations between crime and dimming, with all point estimates indicating reductions in crime. There was similar consistency in the estimated associations with white light, all suggesting reductions in crime. Again, however, we found substantial statistical heterogeneity between estimates of associations between all lighting adaptations on all crime types at police force level (see web appendix 3).
Small differences were apparent in sensitivity analyses, but the results for collisions and crime were not materially different from the main results. We found no evidence for zero inflation.
The results provide no evidence that switch off, part-night lighting, dimming, or white light adaptations to street lighting were associated with night-time traffic collisions. The results also provide no evidence that these lighting strategies are associated with an increase in crime at an area level. Results suggest that in the aggregate, dimming and white light regimes were associated with reductions in crime, though estimates were imprecise.
Selection bias: this study was able to obtain usable data on street lighting changes from 62 of 174 local authorities. It is possible that local authorities may have declined to participate because of expected or known increases in collisions or crime in their areas due to lighting changes. If changes in collisions or crime are greater in the non-participating authorities, our study may have underestimated the effects of reduced lighting on collisions and crime.
Information bias: our study used routine data sources on road traffic collisions and crime. These data sets have several limitations; in particular, they may be incomplete due to under-reporting of incidents. However, for under-reporting to affect the results of our analysis this would require differential changes over time in the recording of crime and collisions in the streets where lighting has been changed, compared with streets without changes to street lighting, which seems unlikely.
To address the potential for under-reporting to bias estimates of effect on collisions, we analysed separately those collisions where casualties were fatally or seriously injured, as these collisions are more likely to be reported to the police. These analyses found no evidence for associations between street lighting changes and night-time collisions. We also analysed crimes that are more likely to be reported to the police (ie, burglary and vehicle theft reports are required for insurance claims). The estimated effects were not consistently larger for these two types of crime.
We were unable to specifically examine crime occurring at night using the Police.uk data. Our analyses were, however, limited to crimes that the crime survey of England and Wales suggests are more likely to occur in the evening or at night. It is unlikely that another data set would have been able to address this limitation, as the exact times of many offences (such as property or vehicle thefts) are unknown to victims. The Police.uk crime data have a further limitation: they are geographically obscured to protect the anonymity of victims. To address this, we analysed the data at an area level for which the spatial accuracy of the data is known to be good,13 though this diminished statistical power.
Confounding: We did not take into account the potential impact of other road safety or crime prevention initiatives, such as improved road markings, policing interventions, or CCTV. If such measures have been introduced more often in streets where lighting has been changed than elsewhere, it is possible that some of the changes in crime in areas where lighting has been changed may be attributable to these other measures.
Despite the limitations of this study, we utilised two large publicly available data sets to provide evidence on the relationship between recent street lighting adaptation strategies, road traffic collisions and crime. Systematic reviews of the evidence on the effects of increased street lighting on road traffic collisions and crime suggest relative reductions of 32% and 38%, respectively.10 ,11 The current study showed CIs sufficiently narrow to exclude changes in collisions of such magnitude. The results for crime were highly heterogeneous and limited in power due to the need to aggregate to MSOA level, but the average effects estimated overall do not suggest any increase in crime at an area level with reduced lighting. Again, CIs were sufficiently narrow to exclude an increase in crime of such magnitude as may have been expected. The estimates for switch off, however, are imprecise because of the small number of areas in which switch off was implemented, and so should be treated with caution.
Despite using 14 years of data on road traffic collisions in 62 local authorities, we found no convincing evidence for associations between street lighting adaptations and road traffic collisions. As we have no direct measures of the number of trips taken, or modes of travel before and after implementation of street lighting interventions, we cannot know whether this reflects reduced mobility or changes in mode (eg, from walking to car travel) in areas where either switch off or part-night lighting had been implemented. It is possible that the numbers of pedestrians, cyclists, motorcyclists and car drivers who travel within the streets where street lighting was reduced declined at the same time as the lighting was reduced, resulting in fewer collisions in those streets. If so, any increase in hazards to road users due to lower lighting conditions may have been obscured by a reduction in numbers of people exposed to road injury risk at night. However, qualitative and survey evidence3 ,16 suggests that changes to mobility overall, and mode choice in areas affected were likely to be minimal.
This study did, however, suggest an association between some street lighting adaptations and crime. While there was significant statistical heterogeneity in effects estimated at police force level, results overall were suggestive of an association between dimming and reductions in crime, particularly for violent crime. These results may lend support to the hypothesis linking lower levels of visibility to difficulties in identifying 'suitable' targets from those on the street at night. Results also suggested an association between white light and reductions in crime, particularly burglary, which may provide support for the credibility of mechanisms linking increased visibility or increased investment in local communities to reductions in crime. If reduced street lighting displaces pedestrian activity to better-lit streets, this might reduce the risks of victimisation and interpersonal crime on those streets, and increase guardianship on the better-lit streets. Different causal mechanisms may apply in different contexts, and these need to be assessed by further research.
This study does not support concerns around impacts of switch-off, part-night lighting, dimming and white light on crime and road safety. Local authorities informally (and sometimes formally) assess risks when adapting street lighting in local areas, drawing on local experiments and trials,17 and national and professional guidance on the selection of lighting classes.1 ,2 Considerations of the appropriate 'lighting class' for roads reflect a number of factors, including speed limits, traffic volume, composition of motorised versus non-motorised traffic, junction density, presence of parked vehicles, ambient luminosity (lighting from other sources such as shops), and how easy the road is to navigate.1 Results from this study suggest that when risks are carefully considered, local authorities can safely reduce street lighting saving both costs and energy using switch off, part-night lighting, dimming, and white light strategies without necessarily impacting negatively upon road traffic collisions and crime. The participating local authorities included a good range of communities in terms of population density, geographic location, and economic resources. Our results may, therefore, be generalisable to other communities considering street lighting reduction strategies.
This study was able to shed light on the impact of reduced street lighting at night. More research is needed on how different lighting regimes affect opportunities for crime and crime prevention, and on other public health impacts of changes in light at night, given the suggestive evidence that artificial light may be linked to health outcomes as diverse as obesity,7 sleep and cancer.8
What is already known on this subject
There is evidence that introducing street lighting at night is associated with reductions in road traffic crashes and crime.
Many local authorities in England and Wales are reducing street lighting at night to save energy costs and reduce carbon emissions.
What this study adds
There is no evidence that reduced street lighting is associated with increases in road traffic collisions or crime.
Dimming the amount of light or switching to white light/LEDs may reduce crime in an area.
When risks are carefully considered, local authorities can safely reduce street lighting, saving energy costs and reducing carbon emissions, without impacting negatively on traffic collisions and crime.
The authors wish to acknowledge the advice and support of the Institution of Lighting Professionals and the London Lighting Engineers Group. The authors thank the members of the project advisory group: Denise Kendrick, Emily Conner and Mark Norris for their advice throughout the project, and the local authority street lighting managers who provided data for the project.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
- Data supplement 1 - Online Appendix 1
- Data supplement 2 - Online Appendix 2
- Data supplement 3 - Online Appendix 3
Contributors All authors contributed to the design of the study and the writing of the manuscript. RS, CP and LT collected, managed and linked the GIS and outcome data. CG provided advice on data management. RS, BA and PE conducted the statistical analysis. SJ advised on analysis of crime data.
Funding The LANTERNS project was funded by the National Institute for Health Research (NIHR) Public Health Programme (project number 11/3004/02). The views and opinions expressed in this report are those of the authors and do not necessarily reflect those of the Department of Health.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.


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Last year, I investigated book signing ediquitte and received a couple of helpful comments. Last year's post applies to an event where there's only one author. Today, I want to talk about book signing etiquette when there is more than one author present and I'm hoping you guys will be just as knowledgeable as last time (because I have no idea).
Buying Books
I know that you are generally supposed to buy the newest book (or the one the author is on tour promoting) at the bookstore where the event is held. But when there are multiple authors, do you have to buy multiple books (at least one from each person)? I mean, technically, the bookstore is still making money regardless of which book you buy, but I feel like its a bit unfair to the authors if you only purchase one author's book(s) and not the others'. This brings me to my next question. The question of the day is…
Getting books signed
My million dollar question of the day is do you have to get all the authors present to sign at least one book? I attended an event with a panel of authors and only interacted with a few of them (and unintentionally snubbed the others). To be fair, I didn't really want to spend a hundred dollars on books I knew I wasn't going to enjoy reading. But, I still felt extremely guilty afterward. When I went to a signing with Amie Kaufman and Jay Kristoff for Illunimae, a book they co-wrote, I made sure to buy one of Jay's other books (Stormdancer) beforehand. I planned on getting Amie to sign the first two books in her These Broken Stars series with Meagan Spooner and knew I woiuld feel really bad, (especially after the panel signing) if the only thing I had Jay sign was Illuninae.
Wait, I'm not quite done. Yet.
They say pictures are worth a thousand words and while I don't always agree with that statement, it is true that pictures hold a lot of sentimental value. That is why I like taking pictures with authors I get to meet. Not to say, "hey world, look, I met this author", but to remember that meeting. When there are multiple authors, do you take pictures one by one (which I think would be more efficient) or with all of them at the same time? Or does it depend on the number of authors? While I kind of liked taking a picture with Amie Kaufman and Jay Kristoff together (with Illunimae) because they were coauthors, I personally think it would make sense if it was more common for people to take individual pictures with each author rather than with all of them at once. Especially if they don't have much in common besides a publisher.
What do you consider book signing etiquette for multiple authors?
Do you have any tips for a signing?


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"Imagine what it would be like to have a bookshelf filled only with books that you really love. Isn't that image spellbinding? For someone who loves books, what greater happiness could there be?"
~ Marie Kondō, The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing
Five years ago we had over 15 large bookcases throughout our house. Our hundreds of books have made their way out the door, on their way to homes where folks can appreciate them. We've shifted to ebooks, relying heavily on our public library. Don't even have to leave the house to check those out. Yay, Boise Public Library! Now we have three small shelves, holding only those few things we love.
The other shelf-hoggers on our bookshelves were photo albums. I used to do the whole scrapbooking thing. Large colorful and decorative pages with fun, cute, embellishments. Many, many photo albums with many photos and many pages. Until today.
Finally, our explosion of photo albums has been eliminated. Thank you, Shutterfly and Snapfish. Each one of our big, bulky, shelf-stealing photo albums has been reduced to its own photo book. How much of a difference in shelf space? Take a look.


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There are few things I enjoy more than Parents' Weekend at Boston College. My loving guardians ask if I know every single student that walks by us, whisper to each other as each prospective wife passes, and have some sort of magnetic attraction to the tasteless dining hall food I face every day, as opposed to, like, anything else (I'm not asking for the Capital Grille here, Dad, just T.G.I. Fridays or something). No, I kid. Parents' Weekend is fun with those empty nesters—I mean, there are so many activities! BC football always plays some random team from the Midwest, and … and there's another thing … oh, right, the Pops!
Before this year, I had yet to witness the magic of Keith Lockhart pantomiming his sweaty toosh to a lackadaisical crescendo, nor had I seen an aging artist try to compete with a tuba, but I had heard it was a magical evening. I was one of the highly unfortunate cases that only benefits from the festivities instead of experiencing it first-hand. Pops on the Heights is a fundraising event for student aid, and, boy, do they raise funds. Last year alone the event produced $14 million to go toward student scholarships that allow kids like me to study at an acclaimed institution and write mediocre articles about poorly informed opinions.
This year, however, I got to look on as my parents rioted to the soothing vocals of Lionel Richie belting "Dancing on the Ceiling" with some blaring trumpets to boot. I was lucky enough to receive complimentary tickets in exchange for offering my thanks to the donors to whom my aid is attributed and who I will keep anonymous (hint: their namesake is a multidirectional building where they serve chocolate at a bar). I am, obviously, very thankful for everything the donors give, but, as this time of year comes and I'm asked to profess my gratitude (which I have), I always wonder if it's possible for benefactors not to benefit.
It's no secret the rich use charitable causes for their own interests—here's looking at you, Tommy—or to prop up their image under the veil of productive humanitarian work—sup, Brad—but that's obviously not the case here. The exercise of donating to one's alma mater is philanthropic on the most basic level—granted, with a hint of tax incentives. My issue is with the non-monetary rewards and the inherent self-interest within charitable endeavors, and the equating of philanthropy and altruism. You could claim it's an academic exercise to look at the difference, but you'd be wrong, because I don't possess the talent to etymologically deconstruct each word nor can I give subtle, well-researched anecdotes. What I can do is use my affinity for pop culture references to turn it into something trivial, which might be synonymous, I don't know.
In Curb Your Enthusiasm, Larry David lambasts his pet-peeves or anything viewed as a cultural wrong, and it's hilarious. So, when it came to hypocritical celebrities donating to causes, David couldn't help himself. The premise of this particular episode (Season 6, Episode 2) is that Larry donates a wing in a hospital under his name, but his friend Ted Danson donates one anonymously and tells everyone about it. One appears to be self-absorbed, the other altruistic, but each serves to inflate his ego. What this does, apart from splitting your sides, is show that no matter how good the deed is, there is almost always an element of self-interest.
The practically definitive ranking of charity, and the lens to view those philanthropic decisions in Curb, is given to us by Maimonides, the famous 12th-century Jewish scholar, in his Eight Levels of Charity. I learned about this in my PULSE class—I'm not exactly a casual reader of medieval theology—and it's the reason I'm even questioning the way my aid is generated. The second-holiest of the eight rungs in relation to a gift is an anonymous donation to an unknowing group. David's contribution would fall in the middle: He was asked, and then he donated willingly. When Danson begins to disclose his anonymity, he drops down back to David's level, but with the taint of dishonesty. The BC donors aren't trying to immorally claim selflessness, as Danson is, but they're not near the highest step.
Charity, to Maimonides, is basically giving to someone else without expecting anything else in return. It's good to show thanks to another for aid, but this gratitude is a contingent reward for said donation, which wouldn't be possible had it been concealed. We are, sadly, self-preservative, genetically reaching back to our Neanderthal nth great-grandparents. This quality carries into our cushy lives today as selfishness. But, unless you're Ayn Rand, the ice queen of prioritizing self over others, I do think we're capable of the highest form of donation—maybe even delving into pure altruism, which involves an element of actual sacrifice that a gift does not.
I understand if people want their name on a building to solidify it in the hearts and minds of future students, or if they meet the beneficiaries of their generous funds. As long as it's recognized that there is self-interest inherent in that transaction, it's fine. But if they strive to truly embody charity and Maimonides himself, they must take it a step further and do what Ted Danson couldn't, as ridiculous as that sentence sounds.
Now, these are some fairly serious claims. If I'm accusing others of a lack of genuine giving, then surely I must begin to practice this philosophy and not reciprocate the thanks they're anticipating. To this, I'd like to respond that I hope to, in my dealings with posterity. But as my friend Augustine said, not yet. I still had to watch the ex-Commodore tear up Conte all night long (all night).
Featured Graphic by Anna Tierney / Graphics Editor


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Cheney ran a secret death squad• Rawstory
2 Comments in Response to Cheney ran a secret death squad
Those of us who have ever been in the special forces community or hung out with those that are have known this. One associate of mine says that while his operational tempo has stalled since the change of administrations, that is merely due to the new command needing to re-orient and re-task the black ops community. He's currently riding a desk until the mission orders start comming in again. (All his tasking had been domestic with just a few Mexico jobs during the Bush years.)
Why am I not surprised, shocked or outraged any more? The CYA culture of greed and corruption in Washington has an infinite line of these issues. No one is ever held accountable, no one is ever arrested and no one ever goes to jail. It is the system of the corrupt protecting the corrupt. There will come a time that the true patriots can not take this anymore.


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Hidden Valley Lake Finance Committee
Meeting Minutes
August 15, 2017
Members Present: Linda Hartmann, Jennifer Reuter, Mary Anna Taylor, Bonnie Starks, John Reiniger
Members Absent: Kyle Packer
Board Liaison: Bob Starks
Guests: Bruce Keller
Approval of the June Finance Committee Minutes
Motion by: Jennifer Reuter
Second by: Bonnie Starks
Voting record: all in favor
Review and Approval of the June & July Financial Reports
Questions presented in advance by John along with responses from Moe and Bruce are available in Appendix A. Additional questions from MaryAnna, Bonnie and Linda are included at the end of the list.
Motion by: MaryAnna Taylor
Second by: Bonnie Starks
Voting record: All in favor
Report from Bruce Keller – Bruce distributed the first draft of the 2018 budget and asked everyone to review it and submit questions before the next meeting. He noted that the YTD numbers would be impacted by upcoming expenditures for paving, tree removal and required Crystal Lake dam upgrades. He also indicated that our salt supplier has waived the annual minimum purchase requirement fee for 2017 as we have signed a new contract with them. Bruce also recommended that the paving of the new handicapped parking spots in front of Willies be accelerated because the gravel base has settled and compacted better than expected.
Report from Bob Starks – Bob has agreed to chair a new task force focused on developing fund raising strategies for new outdoor activities and facilities. The group is considering having project initiators raise development and maintenance funds rather than have these funded by POA dues. If approved, the likely organizers of such projects would be the Civics Club. The focus will include new amenities for senior residents.
Old Business: John noted that there were errors in the financial information (dates and totals) presented in Echoes. Bruce will review the submission procedures to ensure accuracy in the future.
Since he was ill for the last meeting, John asked the committee to review how we determined the interest rate HVL is charging HVGC for the tractor loan. The rate was set to cover the opportunity cost of lost interest on the funds.
New Business: Main Source Bank and First Financial Savings are merging. As we maintain accounts at both banks, our total would exceed federal bank insurance guarantee limits. Bruce will investigate establishing a relationship with another bank to redistribute funds and present a report in October.
Jennifer Reuter presented and reviewed the comparative HVGC financial statements for the first half of 2017. Overall, net profit is lower for the first half of 2017 than for the comparable period in 2016 with the majority of the difference due to timing of insurance payments and prepayment of chemicals and fertilizer. Overall, membership/dues are stable. Income from golf activities, the pro shop, and the snack bar are slightly higher this year. Outing income is up for the first half of the year, but will likely be offset with some 2nd half cancellations. General expenses are up due to plumbing maintenance in the clubhouse, upgrades to the website, and the previously mentioned prepayments for chemicals. Equipment maintenance is down due to new capital purchases (golf carts and tractor). The planned capital replacement of the pump house was $9,500 less than anticipated.
Motion to accept the 1st half HVGC P&L statement:
Motion by: Bonnie Starks
Second by: MaryAnna Taylor
Voting Record: all in favor
Motion to Adjourn
Motion by: Jennifer Reuter
Second by: Linda Hartmann
Voting record: All in Favor
Meeting adjourned at 7:00 p.m.
NEXT MEETING TO BE HELD ON TUESDAY, October 17, 2017 at 6:00
Appendix A – Questions on June/JulyFinancials
June questions from John
On the vehicles, it appears only small amounts appear for the second quarter of 2017 except for the $556 for a boat seat bracket. So, what is this? John these were brackets and seats bought for the Lake Patrol Boat.
Can some of the funds allocated/adjusted be used for the repair of the Alpine Drive land slippage of $20,000 +/- rather than from the emergency fund? Bruce can determine that – I have not received the bill as of yet.
On the exception report, I believe a line should be added for admin fees income which was over the budget for the month by $2.325. (actually $3200 over). Year-to-date we are over the budget by $8,710 ( $17.650 over), so I wonder if the fees could be $17,000 for 2017? Sorry, Missed adding to exception report.
Good news? We are over the budget for the year-to-date by $93,000 plus add in the $20,000 paid to HVGC for the tractor. Add to this additional assessment fees projected for the last half of 2017, so maybe I am too optimistic, but doesn't it look good for 2017? I agree.
July questions from John
Another beating the budget month in July by $14,000 and better yet year-to- date by $98,000. Am I too encouraged by this or are there some unforeseen items which might temper by enthusiasm? Bruce would have a better handle on that. I know of the Alpine slip that was fixed about $24,000? I will let him answer that. [Bruce Keller] Most of the big stuff left will come out of escrow, i.e. paving and Crystal Lake.
My basic questions for July refer to the charges as found on page 38 from Visa. I can't read an explanation on the $3,526 charge from BYO Playground as listed at the bottom of page 38. Can you explain what this is for? And if it is for a capital expenditure, would it not come from the escrow funds? Actually that is a shade structure that was purchased and will be reimbursed by the Civic Club. You will notice a note on the escrow sheet about the expenditure. It was accounted for as a capital item under swimming pool/beach since it will be owned by the POA. Check to date has not been received.
So what is a MailChimp charge and is it a monthly charge? Mail Chimp is our old list serve type service and we pay a monthly fee for that service. Allows us to send unlimited broadcasts to all.
Questions from Linda
Are the charges labeled NPC related to bank handling of monthly prepayments? Yes.
To what does the $4,938 deposit on the July statement refer (pg. 4)? It is labeled as HVL first billing pull. During the billing month, we have residents who have an auto withdrawal taken out of their account for dues. We pull these on the 5th and the 25th of the billing month.
General question – our auditor has requested that someone other than Moe do bank reconciliations periodically throughout the year as an internal control. Has this been done this year? Bruce – has already done this 3 times this year and will also do July since this is a billing month.
On page 11 of the June exception report there is a line item that says "Adjustment to correct wrong actuals for current". What does this mean? Moe – I took the budget amount and divided by 12 months to equal budget, but I had to adjust that since the increase was coming in July and not the beginning of the year. This account 5010 is where the billing is generated, does not have cash actually received. That is reflected on the Income sheet. I just adjusted that number to reflect the correct amount.
On pg. 16, there is a $13,000 discrepancy between budget and actual in the Marina/Maint./Repair account. Is this due to the purchase of floating docks and if so, shouldn't this be capital rather than expense? Yes, this will be adjusted and moved to escrow.
July statement – To what does the "mapping work" like item on the exception report (pg. 12) refer? Bruce- this was a special color- coded map detailing current land usage develop for the Land Use Task Force.
Questions from MaryAnna
What is the $3,527 expenditure listed as playground equipment? See response to John's question above, this is for the shades structures on the beach.
General – there have been 9 write-offs due to sheriff sales in the past few months. Is this more than usual? Bruce – about the same as we have experienced over the past few years. The good news is that some of the properties that have been vacant longest are being sold. Bruce has been contacting banks when properties are removed from the preliminary sheriff's sale lists and issuing fines for violations to HVL property rules. He gave an example of the A-frame on Ventura that has been vacant for 8 years.
On the July exception report, there are reversals of fines granted by the Judicial Committee. Why? Bruce – the Enforcement Officer is issuing significant fines for major violations of HVL property rules in order to get the violators to attend Judicial Committee meetings to discuss the fine(s). Fines may be reversed after the violator has corrected the infraction.
Questions from Bonnie
Did the expenditure for water wheel repair relate to the balance issue that we had several years ago? Bruce – this was for painting and general maintenance and was not related to any structural problems.