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"Employing the lean logistics business model to reduce risk and drive ROI [return on investment] remains very popular even as the global economy revives." –Simon Clark, business development manager–United Kingdom for software provider CargoWise
The above quote from Simon Clark (at right) – who's been quoted in this space before – is but a polite way of saying that the pressure on supply chains to keep delivering bottom line savings for business isn't going away, even though the global economy continues to improve (albeit slowly).
"While logistics service providers (LSPs) began to execute leaner logistics strategies during the economic downturn, that strategy is now being utilized more than ever in the logistics industry," Clark, business development manager–United Kingdom for software provider CargoWise, noted recently. "LSPs are looking for ways to provide customers more efficient supply chain solutions by capitalizing on existing resources and minimizing waste to reduce future expenses."
He stressed that strategic business operations are tightly integrated with lean manufacturing processes, incorporating the principles of storing fewer materials, which are handled less and delivered on a just-in-time basis.
[For different look at the demands placed upon logistics these days, take a look at what goes on behind the scenes on the Formula 1 racing circuit in Europe.]
This integrated supply chain practice is popular with LSPs as it provides a total view of overall waste for a company, Clark pointed out. For example, the inbound logistics process may be cost effective when serving a cost efficient manufacturing process; but if the outbound logistics process isn't equally efficient and inventory of finished product is stored for unnecessarily long periods, the cost of this outbound delay may outweigh the benefits attained in the inbound process.
"Ultimately, while the lean operating model does provide some requirements for business monitoring such as Key Performance Indicators (KPIs) and other significant benchmarking metrics, visibility of information through all supply chain operating functions is really the key issue for LSPs in today's global market," he explained.
"Recently, with margins in supply chain execution tightened to new levels, the need to incorporate lean logistics practices into the movement of materials and products is driving many LSPs to embrace enhanced lean logistics techniques," Clark said. "This ensures they have a profitable business which meets the demands of their clients and is sustainable for many years to come."
[Here's an interesting take on global supply chains, courtesy of Arizona State University's W.P. Carey School of Business.]
But today, there's an extra twist being added to the demand for "lean and mean" logistics services: proof of financial solvency. It's no surprise to anyone in the transportation and logistics worlds that many supply chain service providers took pummeling blows during the global economic downturn of the past few years, with some of the blows potentially fatal ones in the business viability sense.
According to a new report issued by Oliver Wyman, in collaboration with the Association for Financial Professionals (AFP) dubbed The New Weakest Link in Your Supply Chain: Supplier Credit, businesses are being warned that they can no longer rely solely on credit ratings from credit rating agencies to evaluate the financial vulnerabilities of their supply chain suppliers.
"Companies need to develop their own capability to monitor the variables that could cause their key suppliers to default," noted Hans-Kristian Bryn, a partner in Oliver Wyman's corporate risk consulting practice and a co-author of the report.
"By rationalizing their supply chains during the recession, many companies have inadvertently become more reliant on fewer suppliers at exactly the moment when their own finances have become shaky," added Michael Denton, another Oliver Wyman partner and report co-author.
"CFOs and treasurers should pay as much attention to evaluating the probability of supplier default as they do to potential disruptions in their suppliers' operations," he stressed. "Also, suppliers are not rated by credit rating agencies if they are located in lower-cost countries where financial data is often less available and unreliable."
Good stuff to keep in mind as the global economy continues to stumble towards a recovery of some sort.


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Area law enforcement agencies, fire departments, emergency workers and private citizens spent four hours Monday afternoon and evening separating two large vehicles that crashed broadside and left one of the drivers trapped.
The crash happened about 4:45 p.m. Monday south of Fort Morgan at the 13000 block of Morgan County Road 19, according to Morgan County Sheriff Jim Crone.
"A grain tender carrying flaked corn crashed broadside into a refrigerated trailer hauling frozen beef, with the cab of the tender, and it's driver, crushed and completely buried inside the trailer," Crone stated.
He said it took the rescue workers until 8:45 p.m. to free the trapped driver, who was then flown by helicopter to North Colorado Medical Center in Greeley in critical condition.
"Initial responders could only speak to the driver through the wreckage, and it was probably 30 minutes before rescuers could dig and climb their way through the trailer to cut a hole big enough to even see the driver," Crone said. "Two fire departments struggled for the next four hours — yes, four hours, before they were able to finally remove that young man from his seat."
But once they did, they were able to get him on the North Colorado Medevac helicopter and sent off to Greeley, Crone said.
The sheriff said he found out this morning that the unidentified man had survived the surgery he got at the hospital, but no other information about his condition was available as of press time Tuesday night.
"When he left Morgan County, he was in critical condition. I heard this morning that he was still alive, and hopefully, he's improving," the sheriff said late Tuesday afternoon.
Crone gave lots of credit to all the various people and agencies who helped with the rescue. They included: Colorado State Patrol, Brush and Fort Morgan volunteer firefighters and departments, Morgan County Ambulance Service, North Colorado Medevac, Morgan County Emergency Management, Morgan County Road & Bridge and Morgan County Sheriff's Office.
"When all was said and done, there were close to 50 personnel on scene," Crone said. "'Kudos, tip of the cap, good job', doesn't even come close to recognizing the efforts of all involved in trying to save the life of this young man. Brush and Fort Morgan firefighters, you guys rock."
But there were many other people who helped, too, the sheriff said.
"A special thanks to Brandon Kroskob, Chance Middlemist and Stratton Kraft, who brought large loaders in to help move and stabilize wreckage, and especially to Barry Lebsock of Lebsock's Repair for his big wrecker and truck expertise," Crone said. "Fort Morgan Pet Foods employees helped to off-load and move hundreds of pounds of blocks of frozen meat from the trailer. We could not have pulled this off without their help."
This crash left the sheriff a bit shaken.
"I have seen a lot of wrecks in my basically 40 years of emergency response, but this one was a once-in-a-career operation," Crone said. "I don't remember another incident where so many tools were used during a single rescue operation. Being able to watch the work of these guys and ladies was one of the most memorable I will have."
He also offered "prayers for this young man and his family," who the sheriff said likely has "a long road ahead of him" for recovery from the crash. "But this kid is a hell of a fighter, with the patience of Job, to maintain himself, badly injured, for that length of time."
Contact Times Staff Writer Jenni Grubbs at firstname.lastname@example.com, follow @JenniGrubbs on Twitter or check out tout.com/jennigrubbs

subset: commoncrawl


text: Feed Formulators Turn to Distillers' Grains to Replace Corn April 25, 2011 09:43 PM Tweet TAGS: Marketing, Overseas December 18, 2014 By Roy Leidahl Email Demand for dietary energy in feed rations is pulling distillers' grains into feed formulas in place of corn, but also displacing some soybean meal in the process. "The biggest product distillers' grain is replacing is actually corn," said Jim Ringo, director of marketing for distillers' dried grains and corn oil at Renewable Products Marketing Group, LLC, Shakopee, Minn. Recent weakness in soybean and soybean meal prices relates more to South America's crop than to competition from distillers' grains. May soybean meal futures climbed since June to their highs in early February, but backed off since then, and December futures are moving sideways in recent weeks. Soybean futures followed similar but more moderate patterns. May corn futures slipped from their highs set earlier this month, while December futures kept climbing. Distillers' grains carry significantly more protein than corn—about 30 percent for the dried, processed product versus 8 or 9 percent for corn—so distillers' grains replace some protein that might have come from soybean meal. However, "In today's market environment, the shortage is for carbohydrates and fats," said Ringo. When nutritionists formulate feedlot, swine, or poultry rations using distillers' grains in place of some corn, "They're not necessarily thinking about displacing protein," he said. However, they remove some soybean meal to balance the rations. In dairy rations, distillers' grains do replace soybean meal or other proteins, and the energy and fiber from distillers' grains provide a secondary benefit, said Ringo. Dairy nutritionists for many years have limited the levels of distillers' grains in rations because corn oil in the processed product could depress butterfat content in milk. However, many ethanol plants now extract that oil, so Ringo expects more distillers' grains will go into dairy feeds. Close to saturation Much of the increase in feeding products from ethanol plants occurred in past years, said Mark Ash, an oilseed specialist at USDA's Economic Research Service. "We're probably getting close to saturation levels for how much distillers' dried grains you can incorporate into feed rations in the United States," said Ash. "It's probably replacing more of the corn in rations now." However, soybean meal has competition from increased supplies of several competing ingredients. "We certainly have a lot of supply of cottonseed this year and that has provided some competition for soybean meal," said Ash. USDA estimates the U.S. supply of cottonseed from the 2010 crop at 3.29 million tons, up nearly two-thirds from two years ago. But cottonseed prices have risen since last summer to one-year highs in some U.S. markets this month. August-January imports of canola meal from Canada increased 42 percent from a year earlier. Prices for many grain-based feed ingredients also climbed while soybean and meal prices softened in recent months. Midwestern corn gluten feed prices soared from $40 to $60/ton in railcars last May and June to $140 to $165 last week. Eastern Iowa dried distillers' grain prices shot from about $100 per ton last June to $205 to $212 in recent weeks. Less domestic soy, corn demand Domestic feed demand for soybean meal and corn have both declined in recent years. USDA expects U.S. soybean meal demand to reach 30.5 million tons this year, off slightly from last year, continuing the decline from the peak of nearly 31.2 million tons in 2006-07. Domestic corn feed and residual use peaked at 6.16 billion bushels in 2004-05 and is projected at 5.15 billion bushels this year, about steady from last year. Meanwhile, U.S. distillers' grains production soared from 9 million metric tons in 2005 to 32.5 million in 2010, reported the Renewable Fuels Association. While beef and dairy cattle have provided the major domestic markets, USDA reported that exports surged from about 1 million metric tons in 2005 to nearly 5.5 million tons in 2009. Distillers' grains output moderating Growth in distillers' grain production is easing, wrote USDA economists in December. Linwood Hoffman and Allen Baker projected that production will increase from 33.3 million metric tons in 2009-10 to 38.6 million metric tons in 2019-20. Average dried distillers' grain prices had run at a premium to corn prices for the decade through August 2006, but in the past four marketing years they have averaged a discount to corn, reported Hoffman and Baker. They said that as distillers' grains became more of an energy feed, soybean meal prices lost some of their past connection to distillers' grains prices. Back to news


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Chris Brown Delays 'Fortune' Album Release
Bad news for Team Breezy. Chris Brown has pushed back the release date of his fifth album 'Fortune' until the summer. The R&B crooner went on his Twitter page today (April 22) to announce that he will delay its release by two months.
Brown gave no reason why he wanted to push back the release date. The singer was on a roll for the past several weeks, dropping a slew of tracks from the 'Fortune' album. The last songs, 'Til I Die' and 'Sweet Love,' garnered major hits on the Internet.
Brown tweeted to his followers that his new album will hit shelves in July:
Team Breezy! The official album date for FORTUNE is July 3,2012!!!!!!!!!!!!
— Chris Brown(@chrisbrown) April 22, 2012
Reactions to the news have been mixed. A fan from Sweden wrote, "omg you must be kidding me what happened to 8th may," while another tweeted with a sad emoticon, "omg that's AGES away." Another follower was more upbeat. "You did such a great job in ['Think Like a Man'] baby," she wrote congratulating Brown on his 3-minute cameo in the movie, which topped the weekend box office.
We wonder if the delay has anything to do with the iPhone-snatching incident a couple of months ago. Prosecutors are still investigating the case. Who knows?
At any rate, fans have plenty of songs to hold them over until the summer. And with the sequel to Brown's 2010 'Fan of Fan' mixtape on the horizon, we will definitely hear new music from him sooner than later.


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I have high bloodpresure, RA and I,m overweight how much do I eat of Cal. Fat Salt and sugar. my bmi is 31
You could use the services of a Registered Dietitian. You might try finding one at your local hospital, or you can find one in your area by clicking here.


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Welcome to Deck 27
You and i have something in common, the need for knowledge.I collect videos that are worth watching. So far more than 5700 minutes or more than 90 hours of videos worth watching. If you have a web site and want to exchange links with us just put a Deck 27 -something- as a link to us and send us email with your link to email@example.com . Your link will be visible on every page of our website. ( in partners section )
Website worth calculator and seo analysis
Friday, 10 June 2011
6/11 1ADTrend magazine - We create, collect, sort, find and review creative ways to advertise.
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Drinks like Fruit2O claim to give your body the nutrients of 2 servings of fruit in a bottle. Is this really a true equivalent?
The new Fruit2O Essentials water claims that the waters are fortified with nutrients that are equivalent to two servings of fruit. While this doesn't mean that drinking a bottle of Fruit2O will count as two daily servings of fruit, it does mean, however, that the company has fortified its product with vitamins and minerals commonly found in fruits, such as vitamin C, E, or manganese, for example. However, that is only what this product is – a fortified water. Although this product may be a flavorful source of hydration, it is best to eat your fruits and vegetables in order to get all of the nutritional benefits that they have to offer, including vitamins, minerals and phytonutrients. Other vitamin waters may also have up to 33 grams of sugar and 125 calories, which again provides another reason why it is best to obtain nutrients by eating fruits and vegetables.


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MORE: College Premium Blog | Coaching Carousel | Subscribe to CB Ticket
It's always important to recognize coaches who are doing great things with their respective programs as yet another college baseball season nears.
Last week, in part one of our series on rising coaches, we took an inside look at some of the nation's fast-rising assistant coaches.
Now it's time to dissect some of the rising head coaches.
Samford's Casey Dunn, Duke's Chris Pollard, Sam Houston State's David Pierce and Indiana State's Rick Heller made their presence known in a big way last season.
Dunn guided the Bulldogs to the Tallahassee Regional title game against Florida State, Pollard led Appalachian State to an NCAA postseason appearance before joining the Blue Devils, Pierce led the Bearkats to the Houston Regional title game in his first season and Heller led the Sycamores to the NCAA postseason.
Those coaches may lead the pack, but they're certainly not alone.
Casey Dunn, Samford
It's tough to find a hotter mid-major coach than Dunn. The former Auburn player, who also spent time as an assistant at AU, has flourished at Samford over the past couple of seasons. Dunn is entering his ninth campaign with the Bulldogs, but has shown the most progress the last two seasons. The Bulldogs finished 37-23 in 2011 before taking a giant step forward in '12 with a 41-23 overall mark and a trip to the Tallahassee Regional title game against Florida State. Samford once again is expected to be solid in '13. Look for Dunn's stock to only rise.
Chris Pollard, Duke
Though the Blue Devils don't possess as good of full-time facilities as some other big-time private institutions such as Stanford and Vanderbilt, among others, many have long believed that Duke is a potential sleeping giant. The Blue Devils hope Pollard finally can put things on the right track. He certainly accomplished big things at Appalachian State during his eight seasons with the program. For instance, the Mountaineers went 33-27 two seasons ago before taking a big leap forward last season with an NCAA Regional appearance and a very good 41-18 overall record. Duke isn't an easy job by any means, but Pollard has a chance to do something special.
Monte Lee, College of Charleston
Charleston has been one of the nation's most consistent mid-major programs the past few years, and Lee only has continued that tradition. The Cougars have had a lot of success during Lee's tenure with the program. He guided the program to a very impressive 39-22 record two seasons ago before making an NCAA Regional appearance last season with a 38-22 overall mark. In addition to his time as head coach at Charleston, Lee also was groomed by former South Carolina coach Ray Tanner during his six seasons with the Gamecocks. It would be a safe bet to say Lee will get a legitimate ACC or SEC offer in the next few seasons.
Rick Heller, Indiana State
It'll be interesting to see what happens to Heller the next few seasons. Heller spent several seasons at Northern Iowa before it dropped the baseball program, guiding the Panthers to one Missouri Valley title -- a true accomplishment. Heller also has experienced success in three seasons at the helm of the Sycamores. Though ISU only went 29-28 two seasons ago, it blossomed in '12 with a 41-19 overall record and an NCAA Regional appearance. The Sycamores should be solid in '13, led by one of the nation's elite lefthanded pitchers in Sean Manaea. Heller could parlay the upcoming campaign into a very good gig.
David Pierce, Sam Houston State
The Bearkats made a slam-dunk hire last year when they went with former Rice pitching coach David Pierce as head coach. Pierce spent several seasons in charge of Rice's pitching staff, learning under coach Wayne Graham, one of college baseball's coaching legends. Pierce didn't disappoint in his first season with the Bearkats, assembling a 40-22 overall record and reaching an NCAA Regional. With a special group of pitchers back in '13, the Bearkats again should experience success. It's believed Pierce is next in line at Rice, but he could be in line for another premier job before that opportunity arises.
Mark Kingston, Illinois State
It's not much of a surprise to see Kingston experiencing much success in just a few seasons at Illinois State. Kingston blossomed as one of the nation's elite assistant coaches and recruiters during his seven seasons under Rick Jones at Tulane. Kingston has continued his successful ways at ISU. Kingston guided the program to an NCAA Regional appearance and conference title in his first season. The Redbirds also have had success the past two seasons, tallying overall records of 36-18 and 33-19, respectively, in '11 and '12. Kingston has already gotten some serious looks from big-time programs. That interest only will increase.
Rob Cooper, Wright State
Cooper has had several opportunities to take other head coaching jobs over the past few seasons, but has opted to stay committed to the Raiders. For Cooper, it's all about finding exactly the right fit. Cooper has experienced a wealth of success at Wright State. He has had eight successful campaigns with the program, including finishing the last two seasons with impressive marks. The Raiders went 36-19 with an NCAA Regional appearance in 2011 before going 37-21. Cooper is well respected in the coaching ranks, twice being named a Team USA assistant coach.
Andrew Checketts, UC Santa Barbara
Perhaps no young head coach has been groomed by better head coaches throughout his career. Checketts originally made a name for himself as pitching coach at UC Riverside, where he developed some premium arms and learned under coach Doug Smith. Checketts then spent a few seasons at Oregon learning from George Horton. Though the Gauchos only went .500 in Checketts' first campaign, there's no doubt the program is heading a positive direction. UCSB finished with the No. 29 recruiting class nationally in 2012, while the '13 class has some strong points. It's safe to say Checketts is on the fast track.
Jim Toman, Liberty
Assuming he'd be interested, any ACC or SEC school should think hard about giving Toman reins of their baseball program. Toman made a name for himself several years ago when he spent 11 seasons as an assistant coach under Ray Tanner at South Carolina. He has continued his impressive ways as head coach of the Flames. The Flames have experienced much success the past few seasons. For instance, they finished the '10 campaign with a 42-19 overall record. They also finished '11 with a 35-24 overall mark and last season with an impressive 41-19 record. Toman's consistency is impressive.
Jay Artigues, Southeastern Louisiana
There are several successful programs in Louisiana, but perhaps no program has made as many strides over the past five seasons as Southeastern Louisiana. The Lions have progressed into a consistent NCAA postseason contender, thanks to Artigues. Artigues is entering his eighth campaign with the Lions in '12, and is backed by quite an impressive resume. The Lions finished the 2010 campaign with a 40-19 overall record before going 35-22 in '11. Southeastern almost reached an NCAA Regional last season with a good RPI and 39-21 overall mark, but fell just short. Either way, Artigues has done some special things in Hammond, La.


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We are definitely looking forward to Summer with our hot celebrity picks! These styles are a must have for that perfect beach weather we are longing for. Whether you are lounging pool side or squishing your feet through the sand, we have the perfect swimwear to look sexy doing it! We look to celebs for inspiration on the red carpet to see who would be rocking what!
Since Kendall Jenner looks amazing in white, we thought the Summer Siren would be a perfect match all around. With it's triangle halter and teal stone hardware, we are sure this would be an awesome match when she's hitting the beach or exploring new exotic destinations. Kendall looks great wearing slim fitting clothing with embellishments, so we are certain she will feel sexy wearing Lady Lux. If you are looking for that luxury swimwear style that will make you look tan and sexy then a white two piece will become your best friend! It will make you look slim, tan and give you confidence to rock it!
It's no secret Rihanna is drop dead sexy no matter what she wears, since hitting the Video Music Awards she stunned everyone with her bra like crop top and high wasted to the floor sheer skirt. Since she does not only have a killer voice but a rocking body, we thought the Gold Digger Monokini would be perfect! It would accentuate her curves in the right places and since it has a plunge front, it will show the right amount of cleavage. So what are you waiting for, hit the beach with sexy designer swimwear that will make a fun bold statement!


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About NOOSA Amsterdam
NOOSA-Amsterdam is a company which wants to contribute to a better and more honest world. We do this by selling beautiful and meaningful fashion accessories. The NOOSA products are made using honest, natural materials wherever possible.
The Chunks® are unique and will allow you to personalise your own bracelet, bag or ring. All Chunks® have their own individual meaning; they are based on symbols and traditions from different cultures. The Chunks® are handmade by craftsmen from Nepal, Peru and Indonesia.


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Duluth Kids Martial Arts: The Fun, Exciting Classes
That Teach Kids Respect, Focus, Concentration &
Self-Defense - at the same time!
It's rare to find a program so fun that parents have to drag their kids away just to get them home. We see it all the time here. That's because our kids program is designed perfectly for kids:
It provides them with constant challenge, so they never get bored. Fun & games let their playful sides emerge. And structure gives them a foundation to grow and learn about respect, discipline, and more. Click to see what else makes our kids martial arts program so unique...Click for Kids Program


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cyscreen necesitaba un nuevo diseño de logotipo y lanzó un concurso de diseño en 99designs.
Un ganador ha sido elegido entre 137 diseños de 37 diseñadores freelance.
au hur
auhur.com will start as a local social community. It is located in Germany, Aachen. Near the border to netherlands and belgium.
The site should give information about the local area. upcoming events, news, points of interests, adresses AND work as a community where you can meet your friends.
It's for young people searching for local informations, friends, jobs, locations, events, parties, sports, ...
The logo can be a little bit agressive and should not include to much colors.
"Au Hur" is a kind of sentence that is only known in this area. It means: "oh dude", "oh shit" or "uh wow", "oh cool" as well. It can be written lower and upper case like: au hur, Au hur, au Hur or au' Hur. you may even add an "!" or took it into a speech bubble.
Some things that can be assosiated with "au hur" are:
- Aachen
- yellow + black
- an eagle emblem (search for "aachen wappen")
- the little finger showen by a fist
- "Aachener Dom"
- west
- the statue of "kaiser karl"
- students
--> EDIT: Please take a look in the public DISCUSSION for this job!
Descubre cómo funciona un concurso de diseño u obtén más información sobre nuestros servicios de diseño de logo.


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The Halo Combat Evolved for Windows Website now offers a new client and dedicated server patches updating the PC edition of Bungie's first-person shooter to Hotfix 1.07, presumably further closing off the exploit addressed by the HaloCE server hotfix released last week (story). Likewise, there is now also a client patch on the HaloCE Website to go with that server update. Thanks Frans.
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THE SQL Server Blog Spot on the Web
I've just been alerted by my colleague Kyle Harvie to a Visual Studio 2010 add-in that should prove very useful if you are an SSDT user. Its simply called Highlight all occurrences of selected word and does exactly what it says on the tin, you highlight a word and it shows all other occurrences of that word in your script:
There's a limitation for .sql files (which I have reported) where the highlighting doesn't work if the word is wrapped in square brackets but what the heck, its free, it takes about ten seconds to install….install it already!
If you would like to receive an email when updates are made to this post, please register here
Subscribe to this post's comments using
It will not handle variables properly either, but it's still a win!
Shame the Web (non-)Sense application blocks downloads for my work from visual studio gallery website.


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Ssholtis needed a new other design and created a contest on 99designs.
A winner was selected from 18 designs submitted by 5 freelance designers.
We have a few graphics which have been done for an iphone game. We want to have them replaced with something a little cleaner, better looking than what we got from the developer. The graphics files are attached.
This iphone game has about six existing graphics which we use as part of the game. The game is a dart game. The application buttons, intro launch image, targetboard, blowdart gun and darts could use some work. We are open new designs. The images are in a zip, which is located at http://www.astarfish.com/Image.zip
There is a sample screenshot in the zip which shows what the game looks like when running called screenshotOfGameRunning
- Redo intro splash screen
- Redo Dartboard and stand images
- Redo dart images
- Redo buttons
- Item 1...


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Norah Jones collects Ravi Shankar's posthumous Grammy Award
The celebrated sitar player was publicly announced as the recipient of the 2013 Lifetime Achievement honour just hours after his death at the age of 92 in December (12), and the prize was given out ahead of the main show on Sunday (10Feb13).
The musician's daughters, Jones and Anoushka Shankar, stepped up to accept the trophy on their father's behalf during the pre-Grammy Awards ceremony at L.A.'s Wilshire Ebell Theatre.
Jones, who has won nine Grammys of her own, said of her father, "We know he was very excited to be receiving this award. We really miss him. He lived and breathed music. He was tapping out rhythms on the breakfast table... We are very happy to accept the award for him."
Her sister added, "It was 60 days ago today that he passed away. It's kind of difficult to be standing up here, like Norah said, I am thrilled that he knew about this award before he passed away at least. But I wish we weren't standing up here for him."
Jazz musician Charlie Haden, 75, collected a Lifetime Achievement Award, while singer/songwriter Carole King and The Temptations also received awards in honour of their musical careers.
Other posthumous awards went to pianist Glenn Gould, blues rocker Lightnin' Hopkins and country singer Patti Page.


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I just got my landboard in the mail today and already got a quick sesh on it today.
I picked up the Switch board. Seems well put toghether and solid, and the price was right. Got out at 'front yards' in 12-15mph on an 11m. It took awhile to get my head around riding as it's a little different than on the water but after about an hour I was downwinding and tacking back up the beach. No airs yet but it'll come.
It takes a bit of power to get up and going and I had to stay in a 20 foot swath of sand that was not too wet or too dry. Downwind is pretty easy. It seems that the trick is to carve a little upwind on the power stroke and then drift back down wind as the kite goes back to 11-12. This kept enough tension on the lines to not drop the kite on the beach. Coming back upwind was actually more difficult as the harder I would 'edge' the more the wheels would dig in and scrub speed. It's a balancing act. Kinda like a twin tip I would imagine (can't really ride one of those!).
It also worked a lot better to keep the kite a little higher. I usually ride with my kite low but this just caused the wheels to either skid out or dig in to much. Kite at about 60 deg. seemed to be a good compromise. Also if a soft spot of sand was coming up moving the kite overhead for a second and sheeting in a little took some weight off the wheels and allowed me to glide over the soft stuff.
Overall, it was super fun and allowed me to get in a session when the wind was to light to get on the water. I'm totally stoked on it!
Sent from my iPad using Tapatalk HD


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The New Economy Mark Weisbrot and Dean Baker
In economic history, great myths are often made and sustained not so much by the difficulty of the subject matter, but by the failure of the discussants to look at the readily available data. America's longest business cycle expansion, which has now been officially certified as running from March 1991 to March 2001, is a case in point.
In the folklore of the business press, a widely held explanation has already congealed for the upswing that led optimists to proclaim the emergence of a "new economy."
The now conventional wisdom flows as follows: together with Congress, the Clinton Administration got the ball rolling by balancing the federal budget, and moving it towards surplus. This caused long-term interest rates to fall, which led to an investment boom–especially in the high-tech sectors–and stimulated such interest-sensitive purchases as housing.
All that new investment caused productivity to grow by leaps and bounds. Since productivity the amount of goods or services that an hour of labor can produce–is the basis of economic growth, this raised incomes across the spectrum.
The virtuous circle was completed by the response of the Federal Reserve: because of the surge in productivity, we are told, the Fed didn't have to worry about rapid growth leading to accelerating inflation. Thus the Fed was able to lower short-term rates, and allow for a record-long expansion, with unemployment falling to a 30-year low of 3.9 percent.
Sounds plausible, doesn't it? And familiar. Now let's look at the numbers. Over the course of the business cycle, real (inflation-adjusted) interest rates on mortgages and high-grade corporate bonds fell by only 0.8 percent. This certainly doesn't look like enough to stimulate an investment or housing boom, and it wasn't.
Housing barely increased at all, as a percentage of the economy. And if we look at both investment components of GDP (investment plus net exports), the investment share actually declined slightly.
Productivity growth did increase, as compared to the business cycle of the 80s. But it was still considerably lower than the growth of the 50s and 60s business cycles. If we adjust for the increased share of output that was used up in more rapid depreciation–mostly computers and software–the productivity growth of the 90s cycle does not even beat the 70s. And wage growth for a typical worker was a paltry 0.5 percent a year.
So much for the "new economy." Still, it was a long expansion, and a pleasant memory compared to what we are facing right now. So what was behind it, if the official story doesn't hold up to the numbers?
Most importantly, there was a consumption boom that was driven by an enormous bubble in the stock market. Personal savings rates fell to zero as upper-income households the ones that hold stocks saw the value of these assets soar.
The Fed's change in policy allowed the expansion to continue. Prior to 1995, it would slow the economy when unemployment fell below 6 percent, on the theory that this was the best we could do.
But this drastically important policy change–even today, we have millions of additional jobs as a result–could have been made at any time. It was not a result of 1990s productivity increases, but rather the Fed's belated realization that its prior theory was wrong.
Understanding the 1990s expansion, and its collapse, is vitally important to getting us out of the current recession. The evaporation of $8 trillion in stock market wealth translates into more than $300 billion in reduced consumption.
This means we need a stimulus package more than twice as large as the one that Senate Democrats are proposing (the House Republican plan contained hardly any stimulus at all, consisting mostly of tax breaks for corporations and high-income households).
Diehard policymakers and economists including many Democrats still cling to the notion that fiscal conservatism brought us prosperity. They ache to resume paying off the entire national debt at the earliest opportunity. Many others welcome the re-inflation of the stock market bubble–which still exists, and has lately been growing.
And while the Fed has been doing the right thing by lowering interest rates since the slowdown began, it could still revert to its old ways before the recovery is on track. This is especially true if our overvalued dollar–another largely unnoticed bubble from the 1990s expansion–were to drop sharply, raising the price of imports.
The new economy may be dead, but the mythology that created it survives. Let's hope that it doesn't cause us any further trouble.
For more information on this topic, see Dean Baker's "The New Economy Goes Bust" at http://www.cepr.net/new_economy_goes_bust.htm
[Source: Znet Daily Commentaries]


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Project 1974 Chevy K5 Blazer - Building A PremudderPosted in Project Vehicles on December 1, 2006
It was time for me to start another project. It had to be a '73-'75 Blazer for the full convertability and all-around great wheelbase, plus it was the first 4x4 I had ever owned. I had been planning on how I would build another one since I sold my original 10 yearsago, and my plan called for a crossover off-roader like nothing we have really tried before.
It couldn't be too expensive because I wasn't going to keep much of what was probably already on it. And I didn't want to be doing a restoration so it had to be pretty much rust-free. I basically needed a clean body and a frame.
Two months had passed and I had somehow bought two more trucks, neither of which would be my ultimate premudder-a cross between a prerummer and a mud truck. In desperation to get a foundation for Fabworx Off Road to start on, I accidentally found and bought the biggest Blazer pile in the world, in the middle of the night, ignoring all of my own rules about buying vehicles. I barely even turned the flashlight on before I offered the guy half of what he was asking, and later realized I had still gotten taken for a ride. It had tons of rust, it'd been rolled, it had been parted out and put back together with junk, and once we took the engine apart we would find out that the No. 1 piston had a hole in it. Awesome. I'm glad I bought such a gem to start with.
Two days later I had it at Fabworx's shop, and after the verbal berating I received for the quality piece of machinery I had bought, we were looking at the task ahead realizing that there was no real room for error with only seven weeks left to build the truck. The first thing to do was to attack the frame, fixing the horrendous cracks and shoddy repairs that occurred over the years, and get some suspension on it to hang the axles from. The next part of the plan was to pull the big-block 396ci and give it an Edelbrock spice-up while we fit the tranny, transfer case, and axles underneath it. Without a working powertrain, this truck wasn't going to go anywhere, and we were about to find out that the short block was worthless.
Yes, intentions had been good; this would be a fun thing for everyone, and we would have plenty of time to complete it. But the deeper we dug, the more work we found, and what was to be a somewhat economical and leisurely build got mighty expensive toward the end, just hours before the Ultimate Adventure started.
I think you'll like what we ended up with. The K5 (in the end) turned out to be a prerunner-themed 4x4 with mud-truck roots: It can roar 80 mph down the highway, churn big Boggers through thick mud, and hit desert whoops at 60 mph. But that's a ways off from where we are today.
10PhotosView Slideshow


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Midwest Region: No. 1 Louisville (28-5) vs. No. 16 Morehead State (20-15)
When: Friday, 7:10 p.m., EDT
Where: University of Dayton, Dayton, Ohio
1) Introducing T-Will Terrence Williams, better known as T-Will, is as exciting and athletic as any player entering the dance. He is Mr. Everything for this Cardinal team, whether it be due to his court leadership, quirky demeanor that keeps the team loose or scissor-kick windmill dunks that rile up the crowd and leave the opposition in amazement. The man is a triple-double waiting to happen (he holds two of the programs three all-time). In the Big East title game, he put up a ridiculous 11 points, 7 boards, 7 steals and 6 assists. A mid-season tweak of his shooting motion has turned a once poor stroke into a deadly weapon. T-Will is among the most complete players in the land and the Cards would be nothing without his leadership. It is very comparable to how David Padgett led the squad last year, but better in many ways. Some in Louisville think he was spited on postseason honors, but the man is not looking for high fives and handshakes from the media through awards and accolades. He's looking to finish off his senior year with a national title.
2) Defense Win Championships An overused cliche, but a perfect fit for Rick Pitino's team. Obviously making shots are a necessity in basketball, but when the Cards are hitting it allows them to throw on the most vicious, in-your-grill press in college hoops. Guards Andre McGee, Jerry Smith and Preston Knowles make life living hell for opposing guards causing frequent turnovers. They are like wild dogs—the kind Mike Vick would lay the heavy bread on. Pitino says getting 35 deflections on defense will get you the win 9/10 times. The turnovers caused by the ferocious press get the Cards easy buckets and harm the opposition's morale. The Cards have been known to go on 15-0 or 23-2 runs based solely off their press which completely cripple their opponents. If the Cards' shots are falling and the patented Pitino press is engaged the Cards will be extremely tough to beat.
The Mystery of Earl Clark Earl "E5" Clark might be the most talented player to come through Louisville in the last 25 years. How he uses that talent is a different story. Recently Clark has had a monster games and is a double-double machine. However, Earl has been known to make horrendous decisions at the most inopportune times (ie: walking, lazy passes). This is something that has to concern Pitino moving forward. Clark turned it up for the tourney last year by eating Blake Griffin's breakfast lunch and dinner then taking his girlfriend out for a steak dinner and never calling her back in the second round. That is the E5 that needs to show up for Louisville. When Clark is ready to play that way, he gets this Bruce Banner-like look in his eye and just starts grabbing board after board and dunking on people's heads. Yet you really never know when that's going to happen. His draft stock is at stake and so are the title hopes of the Fightin' Cardinals, so for the Cards' sake let's hope the good E5 shows up. — Rob Jones (The L Yes! Report)
1) Nobody Ever Cheered for Lesshead. OK, now that we've all had our giggle, and irritated our girlfriends by ordering the Morehead sweatshirt with the strategically placed zipper, let's figure out what it really means. The university is located in Morehead, KY ("The happiest town on earth"). Both are, then, named in honor of former Kentucky Governor James Turner Morehead, a rabid anti-abolitionist who personally went after runaway slaves who sought refuge in Ohio. Dang. That's not sexy at all.
2) Loose Balls. Beware 6'8" sophomore Kenneth Faried has a pretty sweet all-around game. He's third on the national rebounding list, averaging 12.8 per game. That's a fine complement to his 14 points, 2 steals, and 2 blocks that tend to come about in every contest. Not a bad get for the fourth-best team in the Ohio Valley, eh?
3) Your Grandpa Beat My Grandpa. By winning the play-in, the Eagles get to face nearby neighbor Louisville as a sixteen seed. This is not an entirely unprecedented matchup. In 1961, when the tourney had just 32 teams and had consolation rounds, Morehead beat Xavier, then lost to Kentucky in the Midwest region. They played for third place in the losers bracket against Louisville, and lost again. Unlike a modern bracket, all of those schools were close enough together that one could hop in the Studebaker and visit them all in a single weekend, making the "Midwest" designation a little more meaningful. — Eric Angevine (Storming the Floor)
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Transportation Needs and Funding Alternatives: A Survey
Jim Self Institute on the Future, Strom Thurmond Institute of Government and Public Affairs, Clemson University, 2001 - Infrastructure (Economics) - 114 pages
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$8 per month car purchases Clemson University Coastal counties Commuter Rail Commuter Rail Service Conditions of South Congestion/Traffic Flow County Size 60 David Sparks DK/NA/Ref Educational Attainment Favorable Ratings favorable responses ranged fees and taxes fuel taxes fund expenditures Fund Transportation Funding for Highway funding for safety Gasoline/Fuel Taxes Geographic Region 60.0 highway beautification Highway Impact Fees Highway Maintenance income taxes Increased Funding Interstate 85 Level of Educational Lexington Counties Mean Ratings mean response metro/inner city buses Option by Level Pedestrian Walkways percent of respondents percent unfavorable responses Percentage of Favorable Pool to Fund population property taxes Ratings for Increased Ratings of South responses were given road maintenance Roads and Highways Rural counties Rural residents sales tax significantly higher Significantly reduce funding South Carolina Roads taxes on automobiles Taxes to Fund Toll roads Total Urban Transportation by County Transportation by Geographic transportation infrastructure transportation needs Transportation Programs Upstate Figure Urban residents


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Not 15 minutes ago, I called up the Thrashers and inquired about season tickets, of which there are plenty still available. And the nice lady who answered the phone was more than willing to take down my credit card information to put in my deposit. This despite the minor detail that the Thrashers are moving to Winnipeg.
The nice lady told me that until the moving vans pull away, they're still going to sell 2011-2012 tickets as if nothing's happening. Which is just good business, because if the unforeseen should happen and the Thrashers stay, Atlanta doesn't want to play to an empty (emptier) arena.
The nice lady also told me that the ticket reps deal with Hawks tickets as well, so there's no plan for immediate layoffs in her office. But with the number of potential Philips Arena plans cut in half by the move, none of the sales staff are making any long term plans. Which is too bad, I hope that nice lady lands on her feet.
UPDATE: Apparently Puck Daddy did the exact same thing this morning. Fuck me.


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Pay Scales >> Browse Articles >> GS Pay Scale Information
Obama Sets 2 Percent Civilian Pay Hike for 2010
Alyssa Rosenberg | Government Executive
President Obama late Monday reiterated that he will limit the base pay raise for civilian federal employees to 2 percent in 2010.
In a letter to House Speaker Nancy Pelosi and Vice President Joe Biden, the president invoked his power to override the statutorily required annual across-the-board and locality pay increases in times of emergency or economic hardship.
"A national emergency… has existed since September 11, 2001," Obama wrote. "Likewise, our country continues to face serious economic conditions affecting the general welfare and most Americans would not understand or accept that federal employees should receive an average pay increase of 18.9 percent while many of their fellow citizens are facing employment cutbacks or unemployment."
Under the law governing pay for civilian federal employees, workers are entitled to an across-the-board raise equal to 0.5 percentage points less than the growth in the Labor Department's Employment Cost Index. This year, that would have been a 2.4 percent raise, plus an increase in locality pay, predicted to be 16.5 percent by a survey of the Bureau of Labor Statistics. As he argued in August, Obama said the $22.6 billion required to implement the statutorily required pay hike would be too costly.
Congress could still override the president's plan. But since July, competing pay provisions have languished in the fiscal 2010 Financial Services appropriations bill. The Senate's version of the legislation includes a 2.9 percent civilian raise for 2010, while the House bill follows Obama's initial budget request for a 2 percent increase. The House passed its bill in late July, but the full Senate has yet to vote on the measure, and it is likely to get wrapped into an omnibus spending package.
Federal employee groups have protested the administration and Congress' approach to pay, expressing concern that higher raises for military members have sent discouraging messages about the value of civilian employees' work. The 2010 National Defense Authorization Act included a 3.4 percent military raise, 0.5 percent higher than the 2.9 percent raise Obama requested for service members in his initial budget. Obama signed the Defense policy bill in October.
Previous administrations also have cited national emergencies to justify alternative pay plans. Max Stier, president of the nonprofit Partnership for Public Service, has criticized the practice, urging the president to take a more straightforward approach and simply say he does not want to increase pay.
Are you interested in a career in Government? Find out which degrees will get you ahead. Learn more.


text: Robert G. Brown wrote: > On Mon, 8 Oct 2007, Mike Davis wrote: > >> My experience is similar to Bill's. We've been using CentOs 3,4 for >> the past few years on our larger clusters. It is a good choice for >> stability, good performance, and since it is RH for SW compatability. > > The only thing I'd comment on that is negative about it is one of its > "advantages". There is a narrow line between stability and stagnation, > and you have to figure out which side of that line your cluster will > fall on. Specifically, the fact that Centos/RHEL is frozen for two year > intervals has two disadvantages for some people: > I don't see this as a problem in a production cluster. The fact is that I've been doing this stuff for a little over two decades and I can build anything that I need for an application. For me a manual library build for CentOs 3 is easier than trying to find support for FC4 or reinstalling FC 1x per year. My CentOs 3 nodes have had less than 2hours downtime in 2 years and that was due to a Power Upgrade at their location, that required a complete shutdown of all machines on the floor. Now I should say, that I don't use diskless nodes, each node has its own OS disk and most have a separate /tmp disk for scratch use. That is one reason that we differ on OS, I believe. Mike


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Mitochondria are often depicted as static, cylinder-shaped organelles, but time-lapse studies reveal that the important energy generators may change shape and move about the cytoplasm on an almost continuous basis. These activities often appear to involve the cytoskeletal microtubules, which influence the characteristic direction and dissemination of the mitochondria in various kinds of cells. The number of mitochondria present in a cell is related to the metabolic needs of that cell, and may range from a single large mitochondrion to thousands of the organelles. Their size generally ranges from 1 to 10 micrometers, making mitochondria large enough to be observed with a light microscope. The organelles were originally identified during the 1800s, and were commonly believed to transmit hereditary information until after the beginning of the twentieth century. Most of the modern understanding of the functional role of mitochondria did not develop until after a method for isolating the intact organelles was developed in 1948.
In what has become a favorite standard fluorescence staining protocol, the log phase monolayer adherent culture of GMMe cells presented above was labeled with MitoTracker Red CMXRos before fixing, and the cells were subsequently permeabilized and stained with Alexa Fluor conjugated to phalloidin, followed by DAPI, a popular DNA-binding counterstain. Images were recorded in grayscale with a QImaging Retiga Fast-EXi camera system coupled to an Olympus BX-51 microscope equipped with bandpass emission fluorescence filter optical blocks provided by Omega Optical. During the processing stage, individual image channels were pseudocolored with RGB values corresponding to each of the fluorophore emission spectral profiles.
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Customers expect you to know about all the interactions they've had with you. But with different solutions handling different parts of their journey, this can be challenging. The Adobe and Microsoft partnership integrates your marketing and sales data, so you can get a complete view of your customer — and create a seamless experience for them — whether they are responding to your marketing campaigns or speaking with your sales team.
Unify your data to connect customer experiences at every interaction.
The partnership between Adobe and Microsoft gives marketers long-needed access to vital sales data that was once locked away. By integrating Adobe Campaign, part of Adobe Experience Cloud, with Microsoft Dynamics 365 and Power BI, you can build experiences that customers are looking for — and give marketers the tools and insights they need.
Integrated customer view
Get a unified customer profile and infuse sales data into campaign executions.
More actionable reporting
Measure the impact of your cross-channel campaigns and the contribution marketing makes to the pipeline.
Better customer experiences
Connect all touch points to improve conversion, retention, customer loyalty, and lifetime value.
Unified support across your entire integrated platform.
Adobe Customer Care and Microsoft Customer Service & Support have expanded their partnership to provide customers with access to experts and troubleshooting across all integrated solutions. Together, Adobe and Microsoft are combining the power of two companies to help the one who is most important — you.


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Shouvlin Hall, Wittenberg University
200 W Ward Street
Springfield, OH 45504
United States
Dr. Darlene L. Brooks Hedstrom of Wittenberg University will present this lecture on the monastic residence at Wadi Natrun. The Desert Fathers of Egypt were the first Christian monks to establish a community in the fringes of the desert. Wadi Natrun, ancient Scetis, was home to thousands of monks from 500-1100 CE. Archaeological work in the region at the Monastery of John the Little demonstrates monastic life in multi-roomed homes with spectacular wall paintings and complex kitchen facilities. Dr. Brooks Hedstrom will present Egyptian monasticism under the Islamic caliphate in the tenth century CE.
The lecture is free and open to the public. A cash wine bar opens at 5:30 pm with dinner at 6 pm, and lecture at 7 pm. Dinner is $22, with a $5 discount for first-time guests. The dinner and lectures are held in Shouvlin Hall at Wittenberg University. Please send questions or reservation requests to Janet Dobson at email@example.com or call Gary Linn at 937-390-3506.
AIA Tours


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The Mavericks missed out on all their top free agents. So they're getting inventive to remake the roster.
Draft Express reported and both SI.com and the Indianapolis Star confirm Wednesday night that the Mavericks have agreed to terms on a sign-and-trade deal of reserve center Ian Mahinmi to Indiana for Darren Collison and Dahntay Jones.
The news comes with a great deal of surprising elements.
For starters, the Pacers just traded Darren Collison who was the starter for the majority of last season and he's arguably the best player in this deal. It leaves the Pacers with only Lance Stephenson as backup point guard after releasing A.J. Price. Yahoo Sports reports that the Pacers are talking to the Bobcats about a sign-and-trade for D.J. Augustin.
It also means the Pacers are taking on a reported $4 million per year for 4 years deal for a backup seven-footer without a go-to offensive game, after Ken Berger of CBSSports.com reported they came to an agreement with Roy Hibbert to provide him with the same deal offered by the Blazers in a separate contract. It gives the Pacers tons of length, but also a lot of money invested on two centers without a lot of experience (though Mahinmi is hardly green and played a pivotal role on the Mavs' 2011 championship team).
As for the Mavericks, they get a faster point guard with great scoring potential to pair with Dirk Nowitzki. Collison's pick and roll play suffered since being traded to Indiana as part of the system in place. But he can be an excellent pick and roll guard and is capable of the drive-and-kick offense that Rick Carlisle often likes to employ. It's a roster remake as the Mavericks, who signed Chris Kaman earlier Wednesday, redistribute their salary to a younger base in light of recent events. It's a smart move as the Mavericks have never been fully sold on Mahinmi.
Now they have a point guard to replace Jason Kidd, they can play Rodrigue Beaubois at combo-guard, and Dahntay Jones gives them a versatile defender behind Shawn Marion.


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Hot Head had always been a short tempered fire giant. But it was when magical oil was discovered in Skylands that fuel was really added to the fire. As exciting as the discovery was, the celebration lasted only 5 minutes - coming to an abrupt halt when Hot Head needed to cool off and plunged into the thick black pool, causing the entire island to explode! Though it would be another 2,000 years before magical oil was discovered again, the impact that it had on Hot Head was immediate. He was instantly infused with magical oil, giving him the ability to generate an infinite supply of fuel - making him incredibly volatile, highly combustible, and ready to torch anything that got in his way.
WARNING: CHOKING HAZARD - Small parts. Not for children under 3 yrs.
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The Bluffview Lodge
The Bluffview Lodge located adjacent to the historic Driftwood Inn, is situated on the bluff overlooking Bishop's Beach in the heart of Old Town Homer. Offering a relaxed, homey atmosphere with spectacular views overlooking beautiful Kachemak Bay with its mountains, glaciers and coves.
Deluxe spacious suites include private bathrooms, cable tv, and clock radios and feature queen size beds. Two of these rooms also include a loft with additional beds. A pack-n-play is available upon request. Enjoy the BBQ grill, large deck and common area stocked with tea & coffee. A fridge and microwave is available for your convenience.The Lodge includes five deluxe suites with private bathrooms and accommodates up to 17 people. Perfect for small business/conferences/meetings or family reunions and parties. See our special group/wedding rates.
2 night minimum during the summer; however on occasion there may be a one night space available
The Bluffview Lodge also features:
- Conference room that can be reserved for up to 12 people
- Free wireless Internet & local phone calls.
- Coin-operated guest laundry
- Fish cleaning area and freezer nearby
- Covered Deck
- Smoke-free building
- In-Room Keurig Coffee Pots
- Common area featuring a coffee pot, frig, microwave and spacious sitting area
The lodge is designed to accommodate individual visitors, honeymooners, families, or groups, making it perfect for family reunions, weddings, business retreats, small conferences and meetings.Back to Rates Page
View Rates & Make Reservations


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10:00 am
Outdoor Idaho "A Middle Fork Journey" OUTDOOR IDAHO explores 100 miles of the free-flowing Middle Fork of the Salmon. Cameras follow rafters, on both guided and independent trips, who meet the challenges of the river, experience the changing scenery, and encounter wildlife. The show also explores the surrounding countryside, considers the effects of fire, and reports on a dramatic logjam.G
10:30 am
Dialogue "Livable Communities" Host Marcia Franklin talks with Robert McNulty, the founder of Partners for Livable Communities, about what makes communities "livable."G
11:00 am
Linkasia NULL
11:30 am
Religion & Ethics NewsWeekly Methodist Gay Marriage Controversy - As gay marriage ceremonies remain forbidden in the United Methodist Church, Betty Rollin speaks with Rev. Tom Ogletree, a United Methodist scholar and former Dean of the Yale Divinity School and the Drew Divinity School, in New Jersey. He faces a possible church trial for officiating at the marriage of his gay son. D
12:00 pm
Earthflight, A Nature Special Presentation "Europe" Cranes and geese rise over Venice, Dover, Edinburgh and the monkey-guarded Rock of Gibraltar. In Rome, the Loire Valley, Holland and Hungary, birds gather by the millions to breed and two by two to raise their families. D
1:00 pm
Global Health Frontiers: Foul Water, Fiery Serpent GLOBAL HEALTH FRONTIERS: FOUL WATER, FIERY SERPENT, the first in a series of public television specials chronicling the devastating illnesses affecting the world's poor, follows a cast of engaging, passionate characters as they confront the disabling parasitic infection known as Guinea worm disease. The film, narrated by Academy Award-winner Sigourney Weaver, documents the efforts of American health workers and community partners over the course of three years as they track the last-known reports of guinea worm in Ghana and Sudan. Through a relentless cycle of success and failure, facing ignorance and tribal superstitions in a harsh, vast landscape ravaged by war, these dedicated young men and women struggle to drive an ancient enemy into extinction. D
2:00 pm
Global Voices "Egalite for All: Toussaint Louverture and the Haitian Revolution" Ryuichi owns a company that rents out fake family members and friends, but his own family doesn't know. Ryuichi and his employees are professional stand-ins, part of a growing service industry in Japan that rents out fake spouses, best men, relatives, friends, colleagues, boyfriends and girlfriends, all to spare their clients embarassment at social functions such as weddings, funerals, or other family gatherings. D
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Charlie Rose NULL
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Frontline "Dropout Nation" What does it take to save a student? Every year, hundreds of thousands of teenagers in the United States quit high school without diplomas -- an epidemic so out of control that nobody knows the exact number. What is clear is that massive dropout rates cripple individual career prospects and cloud the country's future. At Houston's Sharpstown High, once a notorious "dropout factory," a high-stakes experiment is under way to rescue students from the edge. D
7:02 pm
Is School Enough? This program examines a new frontier that could reshape education --- the importance of breaking out of the classroom and connecting students into the wider world. This new educational approach encourages young people to make a difference by learning from what they care about most. As one expert puts it, there's a new understanding that school should not just be preparation for life --- but "life itself. D
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PBS NewsHour NULL
9:00 pm
Nightly Business Report Tonight on Nightly Business Report, a tale of two tech stocks. Struggling smartphone maker, Blackberry, finds a buyer on the same day Apple reports record sales of its new iPhones. And, as investors wait on Washington, NBR will tell you where things stand on a possible government shutdown. D
9:30 pm
Journal NULL
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Charlie Rose NULL
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Frontline "Egypt In Crisis" It took 80 years to rise to power, but now, after only 12 months, the Muslim Brotherhood has been ousted by its longtime foe - the Egyptian military. Veteran Middle East correspondents Martin Smith and Charles Sennott examine the rise and rapid fall of Egypt's Muslim Brotherhood.G


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Hemolytic-uremic syndrome
|Hemolytic-uremic syndrome
Schistocytes as seen in a person with hemolytic-uremic syndrome
|Classification and external resources
Hemolytic-uremic syndrome (or haemolytic-uraemic syndrome), abbreviated HUS, is a disease characterized by hemolytic anemia (anemia caused by destruction of red blood cells), acute kidney failure (uremia), and a low platelet count (thrombocytopenia). It predominantly, but not exclusively, affects children. Most cases are preceded by an episode of infectious, sometimes bloody, diarrhea acquired as a foodborne illness or from a contaminated water supply and caused by E. coli O157:H7, although Shigella, Campylobacter and a variety of viruses have also been implicated. It is now the most common cause of acquired acute renal failure in childhood. It is a medical emergency and carries a 5–10% mortality; of the remainder, the majority recover without major consequences but a small proportion develop chronic kidney disease and become reliant on renal replacement therapy.The primary target appears to be the vascular endothelial cell. This may explain the pathogenesis of HUS, in which a characteristic renal lesion is capillary microangiopathy.[1]
HUS was first defined as a
- GeneReviews/NCBI/NIH/UW entry on Atypical hemolytic-uremic syndrome
- Haemolytic Uraemic Syndrome Help (UK Based Charity for Information and Support)
- aHUS UK – A Patients and Families Support Group for atypical Haemolytic Uraemic Syndrome
- Atypical HUS and Complement Deficiencies - Clinical Immunology
External links
- ^ a b c Corrigan JJ, Boineau FG (November 2001). "Hemolytic-uremic syndrome". Pediatr Rev 22 (11): 365–9.
- ^ Anagnou NP, Papanicolaou N, Fessas P (1991). "Recurrent attacks of hemolytic uremic syndrome". Haematologia (Budap) 24 (2): 101–5.
- ^ Gasser C, Gautier E, Steck A, Siebenmann RE, Oechslin R (September 1955). "Hemolytic-uremic syndrome: bilateral necrosis of the renal cortex in acute acquired hemolytic anemia". Schweiz Med Wochenschr (in German) 85 (38–39): 905–9.
- ^ Robbins and Cotran pathologic basis of disease. (2010) (8th ed.). Philadelphia, PA: Saunders/Elsevier.
- ^ Shimizu, M; Yokoyama, T; Sakashita, N; Sato, A; Ueno, K; Akita, C; Ohta, K; Kitano, E; Hatanaka, M; Kitamura, H; Saikawa, Y; Yachie, A (October 2012). "Thomsen-Friedenreich antigen exposure as a cause of Streptococcus pyogenes-associated hemolytic-uremic syndrome". Clinical nephrology 78 (4): 328–31.
- ^ a b c d e f g Noris, M; Remuzzi, G (2009). "Atypical hemolytic-uremic syndrome".
- ^ a b c d e f g Benz, K; Amann, K (2010). "Thrombotic microangiopathy: new insights". Current Opinion in Nephrology and Hypertension 19 (3): 242–247.
- ^ a b c d e Zipfel, PF; Heinen, S; Skerka, C (2010). "Thrombotic microangiopathies: new insights and new challenges". Current Opinion in Nephrology and Hypertension 19 (4): 372–378.
- ^ a b Boyer, O; Niaudet, P (August 2011). "Hemolytic Uremic Syndrome: New Developments in Pathogenesis and Treatments". Int J Nephrol 2011: 908407.
- ^ a b Kumar, V; Cotran, RS; Robbins, SL, eds. (2002). Robbins Basic Pathology. Philadelphia, PA: Saunders.
- ^ Nathanson, S.; Kwon, T.; Elmaleh, M.; et al. (2010). "Acute neurological involvement in diarrhea-associated hemolytic uremic syndrome". Clin J Am Soc Nephrol 5 (7): 1218–1228.
- ^ a b c Ohanian, M; Cable, C; Halka, K (2011). "Eculizumab safely reverses neurologic impairment and eliminates the need for dialysis in severe atypical hemolytic uremic syndrome". Clin Pharmacol 3: 5–12.
- ^ a b c d e Loirat, C; Noris, M; Fremaux-Bacchi, V (2008). "Complement and the atypical hemolytic uremia syndrome in children". Pediatr Nephrol 23 (11): 1957–1972.
- ^ a b c d e f g h i j k Caprioli, J.; Noris, M.; Brioschi, S.; et al. (2006). "Genetics of HUS: the impact of MCP, CFH, and IF mutations on clinical presentation, response to treatment, and outcome". Blood 108 (4): 1267–1279.
- ^ a b c Ariceta, Gema; Besbas, Nesrin; Johnson, Sally; et al. (2009). "Guideline for the investigation and initial therapy of diarrhea-negative hemolytic uremic syndrome". Pediatr Nephrol 24 (4): 687–696.
- ^ a b c d e Sellier-Leclers, A.-L.; Fremeaux-Bacchi, V.; Dragon-Durey, M.-A.; et al. (2007). "Differential impact of complement mutations on clinical characteristics in atypical hemolytic uremic syndrome". J Am Soc Nephrol 18 (8): 2392–2400.
- ^ a b c d e f g h Noris, M.; Caprioli, J.; Bresin, E.; et al. (2010). "Relative role of genetic complement abnormalities in infrequent and familial aHUS and their impact on clinical phemotype". Clin J Am Soc Nephrol 5 (10): 1844–1859.
- ^ a b Ståhl, A.-L.; Vazir-Sani, F.; Heinen, S.; et al. (2008). "Factor H dysfunction in patients with atypical hemolytic uremic syndrome contributes to complement deposition on platelets and their activation". Blood 111 (11): 5307–5317.
- ^ a b c d e Dragon-Durey, M.-A.; Sethi, S. K.; Bagga, A.; et al. (2010). "Clinical features of anti-factor H autoantibody-associated hemolytic uremic syndrome". J Am Soc Nephrol 21 (12): 2180–2187.
- ^ a b c d Zuber, J; Le Quintrec, M; Sberro-Scussan, R; Loirat, C; Fremaux-Bacchi, V; Legendre, C (2011). "New insights into postrenal transplant hemolytic uremic syndrome". Nature Reviews Nephrology 7 (1): 23–35.
- ^ a b c Sallee, M; et al. (2010). "Myocardial infarction is a complication of factor H-associated atypical HUS". Nephrol Dial Transplant 25 (6): 2028–2032.
- ^ a b c Neuhaus, TJ; Calonder, S; Leumann, EP (1997). "Heterogeneity of atypical haemolytic uraemis syndromes". Arch Dis Child 76 (6): 518–521.
- ^ a b c Noris, M; Remuzzi, G (2005). "Hemolytic uremic syndrome". J Am Soc Nephrol 16 (4): 1035–1050.
- ^ Mache, CJ; et al. (2009). "Complement inhibitor eculizumab in atypical hemolytic uremic syndrome". Clin J Amer Soc Nephrol 4 (8): 1312–1316.
- ^ a b c Tsai, H-M (2010). "Pathophysiology of thrombotic thrombocytopenic purpura". Int J Hematol 91 (1): 1–19.
- ^ George, JN (2010). "How I treat my patients with thrombotic thrombocytopenic purpura". Blood 116 (20): 4060–4069.
- ^ Michon, B; et al. (2007). "Complications of apheresis in children". Transfusion 47 (10): 1837–1842.
- ^ Collins, Allan J.; et al. (2010). "Excerpts from the US Renal Data System 2009 Annual Data Report". Am J Kidney Dis 55: S1–S7.
- ^ European Renal Association- European Dialysis and Transplant Association Registry (2011). ERA-EDTA Registry Annual Report 2009. Amsterdam, The Netherlands: Academic Medical Center Department of Medical Informatics.
- ^ "Soliris (eculizumab) prescribing information" (PDF). Cheshire, CT: Alexion Pharmaceuticals. 2011.
- ^ a b Palermo, MS; Exeni, RA; Fernandez, GC (2009). "Hemolytic Uremic Syndrome: pathogenesis and update of interventions". Expert Rev Anti Infect Ther 7 (6): 697–707.
- ^ Robert Koch Institute. "Technical Report: EHEC/HUS O104:H4 Outbreak, Germany, May/June 2011" (PDF). Berlin, Germany: Robert Koch Institute.
- ^ Psotka, MA; et al. (2009). "Shiga toxin 2 targets the murine renal collecting duct epithelium". Infect Immun 77 (3): 959–969.
- ^ Zoja, C; Buelli, S; Morigi, M (2010). "Shoga toxin-associated hemolytic uremic syndrome: pathophysiology of endothelial dysfunction". Pediatr Nephrol 25 (11): 2231–2240.
- ^ Guessous, F; et al. (2005). "Shiga toxin 2 and lipopolysaccharide induce human microvascular endothelial cells to release chemokines and factor that stimulate platelet function". Infect Immun 73 (12): 8306–8316.
- ^ Orth, D; Würzner, R (2010). "Complement in typical hemolytic uremic syndrome". Semin thromb Hemost 36 (3): 620–624.
- ^ Stahl, AL; Startz, L; Karpman, D (2011). "Complement activation on platelet-leukocyte complexes and microparticles in enterohemorrhagic Escherichia coli-induced hemolytic uremic syndrome". Blood 117 (20): 5503–5513.
- ^ Thurman, J.M.; et al. (2009). "Alternative pathway of complement in children with diarrhea-associated hemolytic uremic syndrome". Clin J Am Soc Nephrol 4 (12): 1920–1924.
- ^ a b Mache, C; et al. (June 2010). "Eculizumab in diarrhea-associated hemolytic uremic syndrome". Presented at the 2nd International Conference on HUS-MPGN-PNH (Innsbruck, Austria).
- ^ a b Tan, AJ. "Hemolytic uremic syndrome in emergency medicine". Medscape eMedicine.
- ^ a b Kanso, AA; Abou Hassan, NM; Badr, KF (2008). "Micro and macrovascular disease of the kidney". In: Brenner BM, ed. the Kidney, 8th edition (Philadelphia, PA: Saunders Elsevier): chapter 32.
- ^ Mead, PS; Griffin, PM (1998). "Escherichia coli O157:H7". Lancet 352 (9135): 1207–1212.
- ^ Ruggenenti, P; Noris, M; Remuzzi, G (2001). "Thrombotic microangiopathy, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura". Kidney Int 60 (3): 831–846.
- ^ Al-Akash, AI; Almond, PS; Savell, VH Jr; Gharaybeth, SI; Hogue, C (2011). "Eculizumab includes long-term remission in recurrent post-transpant HUS associated with C3 gene mutation". Pediatr Nephrol 26 (4): 613–619.
- ^ Gangnadoux, MF; Habib, R; Gubler, MC; Bacri, JL; Broyer, M (1996). "Long-term (15-25 years) outcome of childhood hemolytic-uremic syndrome". Clin Nephrol 46 (1): 39–41.
- ^ Zhen,, XL; et al. (2010). "Multiple domains of ADAMTS13 are targeted by autoantibodies against ADAMTS13 in patients with acquired idiopathic thrombotic thrombocytopenic purpura". Haematologica 95 (9): 1555–1562.
- ^ a b Panos GZ, Betsi GI, Falagas ME (September 2006). "Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection?". Aliment. Pharmacol. Ther. 24 (5): 731–42.
- ^ Gruppo RA, Rother RP (2009). "Eculizumab for congenital atypical hemolytic-uremic syndrome".
- ^ Lapeyraque, A-L; et al. (2011). "Eculizumab in Severe Shiga-Toxin–Associated HUS".
- ^ a b Parmar, MS (2010). "Hemolytic-uremic syndrome". Medscape eMedicine.
- ^ Chu, P; Hemphill, RR (2004). "222: Acquired hemolytic anemia". Emergency Medicine: A Comprehensive Study Guide (6th ed.). New York, NY: McGraw-Hill.
- ^ Rivero, MA; Passucci, JA; Rodriguez, EM; Signorini, ML; Tarabla, HD; Parma, AE (2011). "Factors associated with sporadic verotoxigenic Escherichia coli infection in children with diarrhea from the Central Eastern Area of Argentina". Foodborne pathogens and disease 8 (8): 901–6.
- ^ Rivas, M; Caletti, MG; Chinen, I; Refi, SM; Roldán, CD; Chillemi, G; Fiorilli, G; Bertolotti, A; Aguerre, L; Sosa Estani, S (2003). "Home-prepared hamburger and sporadic hemolytic uremic syndrome, Argentina". Emerging Infectious Diseases 9 (9): 1184–6.
- ^ Rivero, MA; Padola, NL; Etcheverría, AI; Parma, AE (2004). "Enterohemorrhagic Escherichia coli and hemolytic-uremic syndrome in Argentina". Medicina 64 (4): 352–6.
- ^ http://www.lusuh.org.ar/tripticoingles.pdf
- ^ Buchholz, U; et al. (2011). "German outbreak of escherichia coli O104:H4 associated with sprouts". N Engl J Med 365 (19): 1763–1770.
- ^ Frank, C; et al. (2011). "Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany". N Engl J Med 365 (19): 1711–1780.
- ^ Alexion Pharmaceuticals Inc. (June 20, 2011). "Alexion initiates clinical trial of eculizumab as a potential treatment for patients with STEC-HUS in expanded response to EHEC crisis in Germany (press release)". Cheshire, CT.
See also
In May, 2011 an epidemic of bloody diarrhea caused by E. coli O104:H4-contaminated fenugreek seeds hit Germany. Tracing the epidemic revealed more than 3,800 cases, with HUS developing in more than 800 of the cases, including 36 fatal cases. Nearly 90% of the HUS cases were in adults.[56][57] In response to the crisis, Alexion Pharmaceuticals, Inc., the makers of Soliris (eculizumab), initiated of an open-label clinical trial to investigate eculizumab as a treatment for patients with Shiga-toxin-producing E. coli hemolytic uremic syndrome (STEC-HUS). Alexion also initiated an eculizumab access program whereby the company provided eculizumab free of charge throughout the crisis. The study was designed to include all patients treated with eculizumab during the 2011 STEC-HUS outbreak.[58]
HUS and the E. coli infections that cause it have been the source of much negative publicity for the FDA, meat industries, and fast-food restaurants since the 1990s, especially in the contaminations linked to Jack in the Box restaurants. The disease was also featured in the Robin Cook novel Toxin. In 2006, an epidemic of harmful E. coli emerged in the United States due to contaminated spinach. In June, 2009, Nestle Toll House cookie dough was linked to an outbreak of E. coli 0157:H7 in the United States, which sickened 70 people in 30 states.[1]
In the United States, the overall incidence of HUS is estimated at 2.1 cases per 100,000 persons/year,[42] with a peak incidence between six months and four years of age.[1]
The country with the highest incidence of HUS is Argentina [52][53][54][55] and it performs a key role in the research of this condition.
Acute renal failure occurs in 55-70% of patients with STEC-HUS, although up to 70-85% recover renal function.[50] Patients with aHUS generally have poor outcomes, with up to 50% progressing to ESRD or irreversible brain damage; as many as 25% die during the acute phase.[50] However, with aggressive treatment, more than 90% of patients survive the acute phase of HUS, and only about 9% may develop ESRD. Roughly one-third of persons with HUS have abnormal kidney function many years later, and a few require long-term dialysis. Another 8% of persons with HUS have other lifelong complications, such as high blood pressure, seizures, blindness, paralysis, and the effects of having part of their colon removed. The overall mortality rate from HUS is 5-15%. Children and the elderly have a worse prognosis.[51]
There are case reports of experimental treatments with eculizumab, a monoclonal antibody that blocks part of the complement system, being used to treat congenital atypical hemolytic uremic syndrome,[48] as well as severe shiga-toxin associated hemolytic uremic syndrome.[49] These have shown promising results. Eculizumab was approved by the U.S. Food and Drug Administration (FDA) on March 13, 2007 for the treatment of paroxysmal nocturnal hemoglobinuria (PNH), a rare, progressive, and sometimes life-threatening disease characterized by excessive hemolysis; and on September 23, 2011 for the treatment of atypical hemolytic uremic syndrome (aHUS) It was approved by the European Medicines Agency for the treatment of PNH on June 20, 2007, and on November 29, 2011 for the treatment of aHUS. However, of note is the exceedingly high cost of treatment, with one year of the drug costing over $500,000.
In most children with postdiarrheal HUS, there is a good chance of spontaneous resolution, so observation in a hospital is often all that is necessary, with supportive care such as hemodialysis where indicated. If a diagnosis of STEC-HUS is confirmed, plasmapheresis (plasma exchange) is contraindicated. However, plasmapheresis may be indicated when there is diagnostic uncertainty between HUS and TTP.
Treatment of HUS is generally supportive, with dialysis as needed. Platelet transfusion may actually worsen the outcome.
The effect of antibiotics in E. coli O157:H7 colitis is controversial. Certain antibiotic may stimulate further verotoxin production and thereby increase the risk of HUS.[40][47] However, there is also tentative evidence that some antibiotics like quinolones may decrease the risk of hemolytic uremic syndrome.[47]
Diagnostic work-up supports the differential diagnosis of TMA-causing diseases. A positive Shiga-toxin/EHEC test confirms an etiological cause for STEC-HUS,[23][31] and severe ADAMTS13 deficiency (i.e., ≤5% of normal ADAMTS13 levels) confirms a diagnosis of TTP.[46]
The similarities between HUS, aHUS, and TTP make differential diagnosis essential.[7][8] All three of these systemic TMA-causing diseases are characterized by thrombocytopenia[14] and microangiopathic hemolysis,[6][14] plus one or more of the following: neurological symptoms (e.g., confusion,[6][22] cerebral convulsions,[22] seizures[19]); renal impairment[14] (e.g., elevated creatinine,[15] decreased estimated glomerular filtration rate [eGFR],[15] abnormal urinalysis[44] ); and gastrointestinal (GI) symptoms (e.g., diarrhea,[17][20] nausea/vomiting,[19] abdominal pain,[19] gastroenteritis[14][17]).The presence of diarrhea does not exclude aHUS as the etiology of TMA, as 28% of patients with aHUS present with diarrhea and/or gastroenteritis.[16][17] First diagnosis of aHUS is often made in the context of an initial, complement-triggering infection, and Shiga-toxin has also been implicated as a trigger that identifies patients with aHUS.[39] Additionally, in one study, mutations of genes encoding several complement regulatory proteins were detected in 8 of 36 (22%) patients diagnosed with STEC-HUS.[45] However, the absence of an identified complement regulatory gene mutation does not preclude aHUS as the etiology of the TMA, as approximately 50% of patients with aHUS lack an identifiable mutation in complement regulatory genes.[17]
[14][8][7], and/or the presence of schistocytes.hemoglobin hemolysis, which is characterized by elevated LDH levels, decreased haptoglobin, decreased microangiopathic and evidence of [14] (platelet count below 150,000 or a decrease from baseline of at least 25%)thrombocytopenia Early signs of systemic complement-mediated TMA include [25][16][7] This leads to [6] Unlike typical HUS, aHUS does not follow STEC infection and is thought to result from one or several genetic mutations that cause chronic, uncontrolled, and excessive activation of complement.
STEC-HUS most often affects infants and young children, but also occurs in adults. The most common form of transmission is ingestion of undercooked meat, unpasteurized fruits and juices, contaminated produce, contact with unchlorinated water, and person-to-person transmission in daycare or long-term care facilities.[23]
HUS occurs after 3-7% of all sporadic E. coli O157:H7 infections and up to approximately 20% or more of epidemic infections.[42] Children and adolescents are commonly affected.[43] Grossly, the kidneys may show patchy or diffuse renal cortical necrosis. Histologically, the glomeruli show thickened and sometimes split capillary walls due largely to endothelial swelling. Large deposits of fibrin-related materials in the capillary lumens, subendothelially, and in the mesangium are also found along with mesangiolysis. Interlobular and afferent arterioles show fibrinoid necrosis and intimal hyperplasia and are often occluded by thrombi.[10]
In contrast with typical disseminated intravascular coagulation seen with other causes of septicemia and occasionally with advanced cancer, coagulation factors are not consumed in HUS (or TTP) and the coagulation screen, fibrinogen level, and assays for fibrin degradation products such as "D-Dimers", are generally normal despite the low platelet count (thrombocytopenia).[41]
[41] As in the related condition TTP, reduced blood flow through the narrowed blood vessels of the [40] The consumption of platelets as they adhere to the thrombi lodged in the small vessels typically leads to mild or moderate thrombocytopenia with a platelet count of less than 60,000 per microliter.
Shiga-toxin directly activates the alternative complement pathway and also interferes with complement regulation by binding to complement factor H, an inhibitor of the complement cascade. Shiga-toxin causes complement-mediated platelet, leukocyte, and endothelial cell activation, resulting in systemic hemolysis, inflammation and thrombosis.[36][37][38] Severe clinical complications of TMA have been reported in patients from 2 weeks to more than 44 days after presentation with STEC-HUS, with improvements in clinical condition extending beyond this time frame, suggesting that complement activation persists beyond the acute clinical presentation and for at least 4 months.[39]
The typical pathophysiology of HUS involves the binding of Shiga-toxin to the globotriaosylceramide (Gb3; also called ceramide trihexoside which accumulates in Fabry disease) receptor on the surface of the glomerular endothelium.[33] This action includes a cascade of signaling events leading to apoptosis and binding of leukocytes to endothelial cells. The Shiga-toxin-activated endothelial cells then become thrombogenic (clot-producing) by mechanism that is not fully understood,[34] though they have been shown to induce the release of cytokines and chemokines that are implicated in platelet activation.[35] Additionally, the binding action of Shiga-toxin inactivates a metalloproteinase called ADAMTS13, the deficiency of which causes the closely related TTP. Once ADAMTS13 is disabled, multimers of von Willebrand Factor (vWF) form and initiate platelet activation, causing microthrombus formation. The activation of platelets resulting from inhibition of ADAMTS13 is due to the hyperactivity of large multimers of uncleaved vWF. The arterioles and capillaries of the body become obstructed by the resulting complexes of activated platelets, which have adhered to the endothelium via large multimeric vWF. Through a mechanism known as microangiopathic hemolysis, the growing thrombi lodged in smaller vessels destroy red blood cells (RBCs) as they squeeze through the narrowed blood vessels, forming schistocytes, or fragments of sheared RBCs.[25] The presence of schistocytes is a key finding that helps to diagnose HUS. Typically, this hemolysis results in a hemoglobin level of less than 80 g/L.
HUS is one of the thrombotic microangiopathies, a category of disorders that includes STEC-HUS, aHUS, and thrombotic thrombocytopenic purpura (TTP). STEC-HUS is usually preceded by a prodrome of diarrhea, which is often bloody, and is caused by Shiga-like toxin-producing bacteria such as enterohemorrhagic Escherichia coli (EHEC), of which E. coli O157:H7 is the most common serotype.[31] Other serotypes also cause disease and can emerge as new causes of STEC-HUS, as occurred with E. coli O104:H4, which triggered a 2011 epidemic of STEC-HUS in Germany.[32]
Historically, treatment options for aHUS were limited to [26][27] and has not been proven effective in any controlled clinical trials. Patients with aHUS and ESRD have also had to undergo lifelong dialysis, which has a 5-year survival rate of 34-38%.[28][29] In recent years the monoclonal antibody eculizumab (INN and USAN, trade name Soliris), a first-in-class terminal complement inhibitor, has been shown in clinical studies to block terminal complement activity in children and adults with aHUS, and to eliminate the need for PE/PI and new dialysis. In these studies eculizumab was associated with reduced TMA activity, as shown by improvement in platelet counts and kidney function, as well as hematologic normalization, complete TMA response, and TMA event-free status in a majority of patients.[30]
[18][8] Patients who survive the presenting signs and symptoms of aHUS endure a chronic thrombotic and inflammatory state, which puts them at lifelong elevated risk of sudden blood clotting, kidney failure, other severe complications and premature death.[20] and 65% of patients will die, require dialysis, or have permanent renal damage within the first year after diagnosis despite plasma exchange or plasma infusion (PE/PI) therapy.[21][20](ESRD) with the first clinical manifestation of aHUS,end-stage renal disease Despite the use of supportive care, an estimated 33-40% of patients will die or have [14][8][7] and evidence of microangiopathic hemolysis, which is characterized by elevated LDH levels, decreased haptoglobin, decreased hemoglobin (the oxygen-containing component of blood), and/or the presence of schistocytes.[14] (platelet count below 150,000 or a decrease from baseline of at least 25%)thrombocytopenia Early signs of systemic complement-mediated TMA include [25][16][7] This results in platelet activation [6] and is largely due to one or several genetic mutations that cause chronic, uncontrolled, and excessive activation of complement.[6] Atypical HUS (aHUS) represents 5-10% of HUS cases
Atypical HUS
[24][16][13][7][6] elevated [13] low platelet count,[12] Patients with HUS commonly exhibit the signs and symptoms of thrombotic microangiopathy (TMA), which can include abdominal pain,
STEC-HUS occurs after ingestion of a strain of bacteria, usually types of E. coli, that expresses verotoxin (also called Shiga-like toxin). Bloody diarrhea typically follows. HUS develops about 5–10 days after onset of diarrhea, with decreased urine output (oliguria), blood in the urine (hematuria), kidney failure, thrombocytopenia (low levels of platelets) and destruction of red blood cells (microangiopathic hemolytic anemia). Hypertension is common. In some cases, there are prominent neurologic changes.[9][10][11]
Signs and symptoms
- Signs and symptoms 1
- Atypical HUS 2
- Pathogenesis 3
- Diagnosis 4
- Treatment 5
- Prognosis 6
- Epidemiology 7
- See also 8
- References 9
- External links 10


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This month's guest article by Vanessa Davis will help both existing and prospective webmasters select and decide on a hosting service for their web site. First, however, I would like to preface the article with a few of my hard-learned tips to add even more value to Vanessa's article. I'm sharing my thoughts because changing hosts can be a tedious and frustrating venture. Not only will your site be down while the DNS circulates, you may spend hours and hours reconfiguring, backing up, and deploying files to the new host. Nothing on the web is worse than a bad host, or a bad relationship with a host.
Trial by Fire
Almost all web hosting services will answer all your questions with answers you "would like to hear" ... so you should be a little aware that they are in a selling position, and of course will provide good answers. I have used eight different host services over the years. I've liked them, and I've hated them. Some were great in the beginning but then changed for the worse. So don't rely on 'subjective' answers you receive. First make sure the specs of the service meet your technical requirements. Then test it.
One of the famous rules set by Leo Burnette, Madison Avenue advertising great is :
Two rules for successful advertising:
1) TEST everything
2) See rule #1
Test it
This will be a pain in the rear. And, it will take some time and effort. But if you go through these motions in advance, it can save you a lot of woes later on. The worst scenario is to jump into your hosting situation, only to find -- six months later -- that your hate the host. Remember however, this is non-destructive testing until you have entered the name-server information. So, until you fully commit a domain, your existing site continues unaltered.
Check the Guarantee: Select hosts who offer a 30-day money-back guarantee.
Kick the tires: enter a domain, and start using the admin control panel. If you don't like it, you'll have a miserable time later. Try different departments, and functions. Do they load quickly? Are they logical? Also count the number of clicks required to accomplish a task. Are there unnecessary pages and clicks to get where you want to go?
Test the FTP: Set up an FTP account and test that as well. FTP will be your 'local' means of uploading files to the host server. Do NOT rely on their built-in FTP widgets or File Management functions. Although they may work, and may be wonderful, remember you have extra work and time getting into the account to use them. An FTP program running locally on your computer is the most direct, and fastest, way of uploading files to the server.
Test the EMAIL: I keep some 'junk' domains just for such testing. If you have but one domain, you cannot fully test the email services of the host until you've trickled the DNS. This is probably too late. One reason we're busy getting OFF of Network Solutions is their email system really sucks.
... make sure you can log in from remote locations
... make sure they offer filtering
... make sure they have a means of back-up
... make sure they allow whole folder downloads
CALL for SUPPORT: this one is MOST important. Are they 24/7? Did a human answer? How many voice menus did you have to go through? Do they speak your language clearly? Did they understand, and act upon your question? You really, really need to feel comfortable with help services. Nothing's worse than having a crisis, and no one at the other end to help.
Webhosting nightmares
Do your homework. Search for 'hacks' and other terms that will implicate certain hosts. Nothing is worse than having your web site disappear.
Both GoDaddy and Network Solutions were recently hit with several series of hacks that took tens-of-thousands of web sites into oblivion. It knocked out two of our sites, on NetSol, which took weeks to re-adjust and clean. It ruined BOTH sites in Google because Google BLOCKED them due to the hacks. So find out who got hacked. Next time it could be YOU.
Who blocks you? Be alert to the host's security policy and resolution path. If your email address happens to get slammed by spammers, your host could instantly turn your site OFF. This happened to one of our client's sites recently, and after hours and hours of telephone holding with the hosts security staff the only recourse was to move to another host. This devastates your site, your visitors and your search engine rankings. You're dead in the water until the issue is resolved.
Who holds you hostage? Check out prospective hosting transfer policies. If you should decide to move, they may hold you hostage. Network Solutions locks your domain and site 40 days out from a renewal. You can renew a domain for $6 at Moniker, but Network Solutions charges $35! So if you forgot to transfer before the 40 days, you have to pay. They will NOT allow transfer.
Email Hostages: If you're hosting on Network Solutions, or many others who have proprietary email clients, or ones like "Squirrel Mail" be very aware that if you used the web interface rather than popping your mail, you can NOT retrieve mail in bulk. If you decide to switch hosts, you cannot capture mail that is stored on their server unless you go one-by-one saving or deleting.
Sage advice
These are just a few tips -- all of which will help you make the best -- long term -- relationship with a host. And remember, this IS INDEED a relationship! You need to make it a good one!
Now, let Vanessa guide you through Choosing a Web Hosting Plan
... continues on the next page!


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D Cole (Feat. Charlie Clips, Marv Milly. Nino Man, Knocka & Slim Dollars) - 7 Digits Remix
d cole - 7 digits remix (feat charlie clips,marv milly,nino man,knocka & slim dollars)
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