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Batya Medad
Against All Odds, We're Back!
March, 2017
Yesterday, Rosh Chodesh Nissan, while my friend and I were slowly making our way from the Mishkan, Tabernacle area of Shiloh Hakeduma, Tel Shiloh, we couldn't help but admire the wildflowers, some familiar and some not, defiantly decorating the otherwise barren terrain.
There was a time when our walk to and from the Mishkan, Tabernacle area during the months of February- April, Shevat-Nisan was like a magical adventure on an "oriental rug" of brightly colored flowers.
But then the administration of Shiloh Hakeduma decided that clearing the remains of the uncontrollable plants once they had dried and become more like a clans of dangerous octopi and medusas was an expense to be eliminated. So they had poisons spread along the paths and nearby rockery, which aborted the growth and flowering of the otherwise legally protected plants.
March, 2016
Therefore the last few years it has been terribly hard to recognize the season by flora, since almost nothing grew on that Biblical landscape, the same spot where Hannah had successfully prayed for a son, and Eli the High Priest had heard the runner approach and his horrendous news. Before weed, sic, killers had been spread on the Holy ground, it had been easy to imagine that Joshua, Hannah, Eli, Samuel, Elkana and all the other ancient Jews who had made their way to Shiloh had marveled at the beauty of the antecedents of the very flowers we were enjoying.
March, 2017
As we admired the tenacity and chutzpah of these amazing flowers, I couldn't help but to compare them to the Jewish People who have also defied all of the "rules" of nature, history and warfare.
- We have survived thousands of years of exile.
- We have been victorious in wars when "everything" was against us.
- We have revived a language that had been considered as dead, and today its speakers excel in the most modern and innovative technology imaginable.
- We have reestablished the Jewish State thousands of years after it was invaded and destroyed.
Wildflowers are the landscaping designs of Gd Almighty. And we, the Jewish People, are His People, too.


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Progress M-53
Progress M-53 approaching the ISS
|Mission type
|ISS resupply
|Spacecraft properties
|Spacecraft type
|Progress-M 11F615A55
|RKK Energia
|Start of mission
|Launch date
|16 June 2005, 23:09:34UTC
|Launch site
|Baikonur Site 1/5
|End of mission
|Decay date
|Did not recognize date. Try slightly modifying the date in the first parameter. UTC
|Orbital parameters
|Reference system
|Low Earth
|51.6 degrees
|Docking with ISS
|Docking port
|Zvezda Aft
|Docking date
|19 June 2005, 00:41:31 UTC
|Undocking date
|7 September 2005, 10:25:57 UTC
|Time docked
|3 months
Progress M-53, identified by NASA as Progress 18 or 18P, was a Progress spacecraft used to resupply the International Space Station. It was a Progress-M 11F615A55 spacecraft, with the serial number 353.[1]
Progress M-53 was launched by a Soyuz-U carrier rocket from Site 1/5 at the Baikonur Cosmodrome. Launch occurred at 23:09:34 GMT on 16 June 2005.[1] The spacecraft docked with the Aft port of the Zvezda module at 00:41:31 GMT on 19 June.[2][3] The docking was conducted using the backup TORU system, under the control of cosmonaut Sergei Krikalyov, due to a power failure at one of the spacecraft's ground control stations.[4] It remained docked for three months before undocking at 10:25:57 GMT on 7 September 2005[2] to make way for Progress M-54.[4] It was deorbited at 13:26:00 GMT on 7 September 2005.[2] The spacecraft burned up in the atmosphere over the Pacific Ocean, with any remaining debris landing in the ocean at around 14:12:40 GMT.[2][5]
Progress M-53 carried supplies to the International Space Station, including food, water and oxygen for the crew and equipment for conducting scientific research.
See also
- ^ a b McDowell, Jonathan. "Launch Log". Jonathan's Space Page. Retrieved 2009-06-06.
- ^ a b c d Anikeev, Alexander. """Cargo spacecraft "Progress M-53. Manned Astronautics - Figures & Facts. Retrieved 2009-06-06.
- ^ Wade, Mark. "Progress M". Encyclopedia Astronautica. Retrieved 2009-06-06.
- ^ a b Zak, Anatoly. "Progress cargo ship". RussianSpaceWeb. Retrieved 2009-06-06.
- ^ McDowell, Jonathan. "Satellite Catalog". Jonathan's Space Page. Retrieved 2009-06-06.

subset: commoncrawl


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We are going to start strong with a real wedding from 2011.
From the Bride:
"Hi Tammy! Now that Dave and I are back from our honeymoon and the dust has settled a bit, I wanted to write and thank you for being such an amazing part of our wedding day! And wedding week, month, etc. really. :) We had such a fantastic time on 9/17 and could not have done it without you -- thanks for taking so much off our hands and helping to make the night so wonderful for us. Our guests all raved about the welcome bags, by the way -- we're still getting compliments on them -- so thanks for that as well!
I hope all is well with you and that the rest of your weddings this fall went smoothly! Let me know if there are any websites you use where I can post our rave reviews of your work -- it's the least we can do! "
Want more? Check out Liz and David's beautiful video by the fabulous Megan of Hello Super 8.
This wedding was created by some of my favorites in the industry, thanks to the following wedding professionals for their commitment to this event.
Venue: The Foundry
Floral Design: Poppies and Posies
Catering: The Cleaver Company
Photography: Robert Sukrachand
Hair: Styles on B
Makeup: Blade Natural Beauty
Videography: Hello Super 8


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'The Watchmaker' is an elegant apartment that sleeps 6 and is ideal for a family ski holiday. There are two double bedrooms, one of which is en-suite and a third bunk room. The bunk room and second double room share a bathroom.
The balcony faces the Verbier valley with stunning views of the surrounding mountains.
Beautifully furnished throughout, this delightful and luxurious holiday apartment has a snug cosy atmosphere that feels more like someone's home. There is also a modern fully equipped kitchen.
For larger groups, this apartment can be joined to Chalet 'La Ruinette' The Clock Tower – to make a very spacious 5 bedroom living space that sleeps 10.
All of our Le Chable apartments have deluxe beds and high thread count bed linen.
Please complete the form below to request a showing for this property. We will review your request and respond to you as soon as possible. Please add any additional notes or comments that we will need to know about your request.


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Hey Yinz Guys and Happy Motivational Monday. Here on my blog, I will like to start using some Mondays to just post a short post sharing some of my favorite motivational quotes for not only my readers but for myself as well. Continue reading "Motivational Monday…"
Tag: me
New City, New Career, New Cat…
Hey Yinz Guys….ummmm yeah I know! It's been like a good 4 months since I've posted on this here blog of mine, BUT I HAVE A GOOD EXCUSE AS OF WHY! I guess the title is a HUGE give away huh? So let's just jump right into it shall we…well in July I moved to Philadelphia, I took over my sister's previous roommates room, a month later I started my new career with GrubHub with their Business Operations Team and then my sister and I got our new cat, Rory. Continue reading "New City, New Career, New Cat…"
Summer 2018 Goals…
Hey Yinz Guys…can you believe we're already in our 5th month of 2018? Crazy right? I feel like this year is flying by. And now that it's May and the sun has FINALLY decided to join us, it's just a matter of weeks before I'm out here being Summertime Fine yall. So with that being said, I thought I would share my Summer 2018 Goals here. This is going to be a very adventurous summer for me, I'm going to be doing a lot of traveling and I will also be taking a lot of chances this summer as well when it comes to heading into a different career path. But first I should share some good news…I now work for ULTA Beauty as a Beauty Advisor. I shared the exciting news on my Instagram last month, I'm so excited for this opportunity because I know I'm even one step closer to going to school for my Esthetician License. Yes, you heard that right, I plan on going to school to gain my esthetician certificate than to test for my license so I can start my career as an Esthetician and hopefully work in a spa and just go from there. Continue reading "Summer 2018 Goals…"
Feel Good Friday's: You Are More Than Your Short Comings
***Good Morning Yinz Guys! This past Monday I introduced one of the many new series I want to bring to this hear blog called "Mental Health Monday" if you haven't read it yet you can read it here. The second series I want to introduce is what I call "Feel Good Friday's" where I will share post that are motivational. It may be something I've written up myself or a quote I found. Either way, I want to use Friday's as a way to send good vibes to Yinz Guys so we can start the weekend on a good note. I hope you enjoy.***
You are more than your shortcomings and downfalls. You are more than the negative things people have to say about you and your mistakes. You are more than Your diagnoses and your illness. You are more than your past and who you use to be. You are more than that job you hate, and you are more than the lack of money you have. You are more than your degrees or lack of degrees. You are more than your relationship status and you are more than who you have dated. Continue reading "Feel Good Friday's: You Are More Than Your Short Comings"
Mental Health Monday: Over-Explaining
Mental Health Monday: Over-Explaining
***This is my first post for a new blog series I will be calling Mental Health Monday where I share my journey to healthier mental health. I hope you not only enjoy these post but take something as well.***
I have a horrible habit of over-explaining and trying to force people to understand what I'm trying to say. Especially when it comes to the men I've dated. So what is I trying to make sure there is no miscommunication or misunderstanding on how I feel, comes off as me being crazy. I'm not sure why or when exactly i started being like this, but recently it was brought to my attention and well I was taken aback at the thought of someone thinking I'm crazy. Now…don't get wrong I can be very passionate when it comes to my relationships, in the sense, I put my all into it. Which is probably why I find myself over explaining my thoughts and feelings, instead of maybe taking a step back and seeing if that's what he wants to hear at that moment. I'm sure this stems from my fear of breakup/being dropped like I have been so many times. So I feel like, if he knows exactly how much I care about him or how much something affects me…he'll then understand and this will all end well. I never take into consideration his feelings or his thoughts or his opinions and not because I think I'm right and he's wrong…but because I get so scared i just start vomiting at the mouth with my emotions. Continue reading "Mental Health Monday: Over-Explaining"
No New Makeup November…
Hey Yinz Guys & Happy Friday! We made it through yet another week, and can you believe it's already November? Like I swear January was just last week. So with this new month comes new routines and new goals, and also time to start saving and shopping for Christmas next month. My sister also celebrates her 30th birthday this month and I will be traveling to see her in Philly so I need to save all my coins and monies for all the upcoming spending I will be doing this month and next. Continue reading "No New Makeup November…"
November: A New Routine Is Coming…
Ayyyye Yinz Guys and Happy November 1st! Yes…I'm ignoring the fact that my last post was in July…so yeah lol! But a lot has been going on with me, and I mean A LOT. From my love life to my personal life to my work life. I now work from home full time, I got a promotion and a nice little raise, my mental health has come leaps and bounds and while my physical health has taken a turn for the worse(no I'm not dying thankfully) I'm still here thoting and bopping. And speaking of thoting my love life…it' still nonexistent. But I will hit on all these topics in their own blog post later this month, I promise. Continue reading "November: A New Routine Is Coming…"
All Summer 17…
Hey Yinz Guys, and Happy Wednesday! So we've once again made it to the end of another work week, and if you're lucky like I am, its Pay Day too. So this friday I wanted to touch on my Summer 2017 Goals. Recently I've been so determined to make a ton of lifestyle changes, so I figured writing them down and sharing them on here would how keep me motivated and accountable. So here's a list of my Summer 17 Goals. These are in no particular order.
- Go to the gym at least 3x a week
- Drink more water
- Get a personal trainer
- Become a better cook
- Go back to school
- New job
- Save at least $500 dollars by the end of the summer
- Get my passport(yes I know I'm slacking)
- Post at least 2x a week on my blog
- Wake up at 6am every morning on the weekdays and 8m on the weekends
- Rad at least 3 books this summer
- Visit Lake Erie at least twice this summer
- Visit family in Florida
- Visit DC
- Visit Philly
- Make it to at least one music festival
- Take my medication everyday
- Journal more
- Write in my prayer journal twice a day(once in the morning and once at night)
- Read 1 bible verse a day
- Make it to at least one Steelers preseason game
- Take one yoga class a week
So that's it for my Summer 2017 Goals. So far I've been doing really well with making it to the gym and drinking more water. I'll be looking into getting a personal trainer next month and I'll be headed to the library this weekend to pick up some new books. So what about you, what are some of your summer goals for this year. I would love to read them in the comment section below, I may even borrow some of them for my own lol. As always, thank you so much for the support.
Peace Yinz Guys
I'm Back…Again (Update Part 1)
****TRIGGER WARNING: I touch on a really personal subject dealing with my mental being and mental health. I briefly talk about suicide and suicidal thoughts. If that is something that may trigger you in any type of way I advise not to read this post.****
Hey Yinz Guys,
Yes…I know, I know…I once again went MIA. But this time it wasn't just due to a lack of inspiration, and since I like to keep it real on here…basically after ending a fairly new "situationship" with someone I had grown rather attached to and cared about, I had what one would call a mental breakdown and checked myself into the local psychiatric hospital. WHOA WHOA WHOA…wait…WHAT? Yes…I checked myself in after a long night of fighting off suicidal thoughts. Thankfully due to my background in the medical field for the past 4 years or so, I knew the thoughts that I was having weren't ok and I knew that I needed to seek professional help. So the morning of April 13th, 2017 I checked myself into my former workplace and then spent the next 2 days in a mental hospital. I don't want to get too much into all of that just yet because honestly, I feel that the whole experience deserves a dedicated post on its own…and right now I just want to keep this post upbeat and just a life update. I do want to make it clear that it wasn't being dropped that set me on such a downward spiral, more just so the straw that broke the camels back. BUT I PROMISE I WILL DIVE MUCH DEEPER INTO EVERYTHING AND WILL BE BLOGGING ABOUT THE WHOLE EXPERIENCE REALLY SOON. Continue reading "I'm Back…Again (Update Part 1)"
Goals For My 32nd Year…
Hey Yinz Guys & Happy Monday! How was your weekend…my weekend wasn't too exciting, but I did start my second job which is a part-time retail gig. Which I guess is exciting because that means I'll have some extra income coming real soon. Other then that I spent it at home trying to rest up for this week. I mentioned on Friday that for the next few weeks I will be sharing my 2017 goals for #MotivationalMondays. I guess it like a little blogging mini series lol, so today I'm going to start off with my "Personal Goals for 2017". These goals will actually fall into my more specific goals but this just sums up some of the most important goals from all the categories. Continue reading "Goals For My 32nd Year…"


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Make-A-Wish AUCTION
April 20, 2019
Boatwerks Waterfront Restaurant
Interested in Donating Click Here
6:30pm doors open
7pm business meeting,
8pm party and auction
Boatwerks Restaurant, Holland
The official 2019 season will begin at Boatwerks Waterfront Restaurant in Holland, and WMO has reserved the large banquet room, making sure there is plenty of room for all who'd like to attend this growing event. The bar will open at 6:30pm.
The Annual Business Meeting will begin at 7:00pm. Covering the inner-workings of the club, financial matters, upcoming events, and much more, this is a great opportunity for club members to become informed on what's going on. The meeting will conclude with a presentation by the Make-a-Wish Foundation as thanks for the club's dedication to charity.
The Season Kick-off Party will follow at 8pm. Hors d'oeuvres will be served, good music played, and various raffles and prizes will be given. This is the first official event of the 2019 season, and it's one you won't want to miss.
Two auction styles including a Ticket Auction and a Regular Auction will take place during the party from 8pm onward, and tons of awesome items will be up for grabs with all of the money raised going straight to the Make-a-Wish Foundation.
Although all WMO functions are members-only, this event is free and open to the public.


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Iceland is a country of unique characters as well as unique features, both natural and manmade. These features are often shaped by conditions in country and its sometimes harsh climate. The unpredictable weather, the need to be flexible, adaptable and self-sufficient—it all cultivates a special kind of resilience and approach to life.
We recently met one such person shaped by life in Iceland: Guðni, a 94-year-old retired lighthouse keeper. He lives on the southern peninsula of Reykjanes in a small village called Garður. The village is famous for being home to the oldest lighthouse in Iceland, built in 1897. It is a square structure made of concrete, situated right on the shore. For 47 years it shone its light for local fishermen and sailors, allowing them to safely navigate this difficult part of the Icelandic coastline. As the ocean continued to erode into the coast a new lighthouse was built in 1944—a tall, cylindrical affair that is to this day the tallest lighthouse in Iceland. This is the lighthouse that Guðni would tend for a period of 25 years. Born in December 1923, Guðni started as the keeper of the "new" lighthouse in 1979. The job consisted of keeping everything clean and ensuring that the light was functioning properly—local fishermen and other sailors couldn't navigate their vessels safely without it. It was a job Guðni sincerely enjoyed, and it meant that he needed to go to the lighthouse every other day to clean the glass and make sure everything was in working order.
Traditionally, the keeper would live in a house adjacent to the lighthouse, as was the case with the old lighthouse at Garður. One of the reasons for this was that the old lighthouse needed constant supervision and the light had to be reset and rewound every four hours—all year long. However, since the new lighthouse required much less care, Guðni was able to live in a house he had built farther away in the village. In fact, he was so far away that he couldn't actually see the lighthouse directly from his garden, so he decided to set up a tall mirror that allowed him to see his lighthouse—a testament to his resourcefulness and creative spirit, as well as the dedication he had for his work.
We visited the two lighthouses together with Guðni to take a his portrait there. He insisted on having his picture taken by the old lighthouse, even though it wasn't the lighthouse he actually tended for 25 years. "The old lighthouse has been around as long as I can remember and it has a very special place in my heart," says Guðni. "It's incredibly beautiful." At 94, Guðni can't see or hear very well—but even with these difficulties he knows his way around the lighthouse.
As is often the case with colorful characters, there is more to Guðni's story than his role as a lighthouse keeper. In the area he is also known as "Guðni with the truck" because of his famous ride, which he used to drive all over the peninsula. When asked about the truck, Guðni started to glow like a lighthouse himself. In 1954 he purchased what everyone simply knew as "the truck", an old, sky blue GMC military truck built in 1942 with a winch and crane on the front. It served Guðni faithfully for a period of 50 years. During this time he used the truck all over the peninsula to perform all kinds of construction and maintenance jobs, like helping raise telephone poles, digging holes and lifting and carrying all manner of heavy things. Guðni even helped haul a loose ship up from the shore, which was undergoing some maintenance and had come unmoored from the shipyard. "I remember it as if it had happened yesterday," Guðni told us, and explained that due to some terrible weather, the ship had broken loose and needed to be recovered. During the rescue mission Guðni's truck almost got washed out at sea by the waves, and that another, much newer truck had already started taking on seawater. Guðni's old truck, however, didn't give up the ghost and in the end he managed to haul the ship up and tow it back to the shipyard—an accomplishment few thought possible. Guðni's fascination with machines did not end with the truck. In the workshop next to his house he rebuilt and restored a number of incredible machines. Even with his hearing and sight severely impaired at age 94, he invited us to see the machines in his workshop, which he knew like the back of his hand. "Do you want me to switch it on?" Guðni asked with sincere excitement.
Today the truck and many of his machines have been enshrined at the local museum, known as "Bæjarsafnið", after Guðni donated them to the exhibition. Since then he has been named an esteemed citizen of Garður, but everyone in the area still knows him as "Guðni with the truck". When asked about his longevity, Guðni says that he has always been healthy and eaten a lot of fish—normally around five times a week—but also mentions that he comes from a family where many of his forefathers and siblings were especially long-lived.
In his 94 years of life, Guðni hasn't traveled far. He has never left Iceland and has rarely ventured beyond the peninsula. But when it comes to his local stomping grounds and his machines, you can be sure he knows every single inch.


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River Sweep
Havre de Grace | Website
This event occurred in the past.
Lower Susquehanna Heritage Greenway's 17th annual River Sweep, a volunteer shoreline and roadside clean-up in honor of Earth Day, will take place in Havre de Grace, Conowingo, Perryville, Port Deposit and Garrett Island. Over the past 16 years, River Sweep volunteers have removed more than 95 tons of trash from area roads and waterways. River Sweep volunteers are encouraged to wear old clothes and to bring work gloves. Volunteers who sign up in advance will receive lunch.


text: The travel itinerary template I use to plan all my trips (free download!) My travel itinerary template just got a big upgrade. And you can download it for free. Read More How To, Travel TipsMegan Van GrollNovember 15, 2017itinerary template, travel itinerary, how to, practical tips, travel hack, travel tips


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Do you ride? We have a list of some cool bike related events in support of Norfolk Bike Month. Take a look below:
NORFOLK, VA – Cyclists of all ages and abilities are invited to a variety of rides and bike-related events in Norfolk throughout May. Norfolk Bike Month , now in its eighth year, is a community celebration of biking, which gets easier all the time in Norfolk. Cyclists can take beginner courses in commuting and bike maintenance, join social rides, bike-in to a movie, and more! Activities are coordinated through a partnership with municipal agencies, the Downtown Norfolk Council, and HRT TRAFFIX.
A sample of community events are planned throughout May, such as:
- Fish & Sticks Bike Polo Tourney , May 5 & 6
- Norfolk Bike Expo , May 9
- Bike-in Movie , May 11
- Bike Swap Meet , May 10
- Ride of Silence , May 16
- Glow Ride III , May 18, The Plot (NEON District)
- Bike to Work Day , May 18
- Kids' Bike Rodeo @ Tarrallton , May 19
- Learn to Ride Family Workshop , May 20
- Bikes, Brews, and Baseball , May 31
A complete calendar of events can be found here . Details for Norfolk Bike Month, the new bike share program, and bike safety can be found at norfolkbikemonth.com .
Brought to you by:
The City of Norfolk
Office of Marketing & Communications
810 Union Street Suite 409
Norfolk, VA 23510


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Here in New England, we rely too much on fracked gas to heat and power our homes and businesses. If we want to avoid a climate catastrophe, we need to end fossil fuel use by 2050.
A Tale of Two Portlands
South Portland, Maine, and Portland, Oregon, are just two of the most recent cities to take a stand against Big Oil and new fossil fuel infrastructure.
Massachusetts Stands with CLF Against Climate-Damaging Pollution
Last week, the highest court in Massachusetts unanimously ruled that power generators must drastically cut their carbon pollution year after year through 2050. In doing so, the high court recognized the incontrovertible fact that carbon pollution damages our climate, threatens our health, and hurts our economy. It was the second time the Massachusetts Supreme Judicial…
Invenergy Heads for Final Approval Hearings
The Final Hearing to decide if Invenergy will be allowed to build its fracked gas and diesel oil power plant in Rhode Island is underway. By law, the most important questions to be answered by the state's Energy Facility Siting Board: Is this plant really needed (it's not) and would the plant cause unacceptable environmental harms (it would).
Troubled Gas Pipeline Given Greenlight by Vermont Supreme Court
"Climate change demands that we set aside harmful, unnecessary fossil fuel pipelines, and today's decision is a step in the wrong direction," said Sandra Levine, Senior Attorney at Conservation Law Foundation. "Without a fresh look at what has become an entirely new project, the troubled Vermont Gas pipeline will saddle Vermonters with higher costs and more pollution for decades."
Invenergy Starts 2018 Flailing
Invenergy's proposed power plant barely avoided a near-fatal blow to its proposed dirty energy power plant in January, though it still has big hurdles to overcome before it can push shovels in the ground.
No Looking Back: New England Leading the Way on Climate
A year after the election of Donald Trump, at least one thing is clear: New England is not buying into his nostalgia for an America we left behind a long time ago. Despite the President's rhetoric, the end of the fossil fuel era has already begun. With the region's last two coal plants sitting today…
Rick Perry Wants to Prop Up Old Coal and Nuclear Plants at Taxpayers' Expense
In a stealth move that went virtually unnoticed by major media outlets, Energy Secretary Rick Perry last week used an obscure provision of law to essentially put the government's thumb on the scale in favor of coal-fired and nuclear power plants. Secretary Perry directed the Federal Energy Regulatory Commission (FERC) to issue a new rule…
UPDATE: Fighting the Vermont Gas Pipeline – at the State Supreme Court
UPDATE: CLF argued our case this morning, taking Vermont gas to task for trying to charge hardworking vermonters for a polluting pipeline. The Vermont Supreme Court was engaged in our argument – we're asking that the Vermont Public Utilities Commission follow its own rules and re-examine this project based on ballooning costs. We'll let you…
New Bill in Rhode Island General Assembly May Stop Invenergy Power Plant
A new bill, H-5897, just introduced into the Rhode Island General Assembly, may be enough to kill Invenergy's proposal to build a 1,000-megawatt fracked gas and diesel oil power plant in rustic Burrillville, Rhode Island.


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A one-day conference focused entirely on Instagram in San Antonio, Texas, with experts, Carly Anderson, Jennifer Borget, and LaShawn Wiltz.
It's more important than ever to grow and maintain an authentic audience on Instagram. Creative, beautiful, like-worthy photos help. But how do you maintain an account that consistently engages your current audience and continues earning new followers? And what steps should you take to keep your audience engaged, interested, and thirsty for more?
Learn from experts who have mastered the art and rhythm of storytelling and growth of their personal brands on Instagram. What guides them as they choose what to post each day. Where do they find ideas for the content they share? And how do they seek out those perfect photos and videos to add to an ever-growing stream of awesomeness? How have they adapted to changing technology and algorithms that affect which photos display in someone's feed?
Join us in San Antonio for an entire day focused just on Instagram. Discover how these three professionals spot their photo-worthy moments, make an art and a sizable following of their Instagram content, and how this open doors to new opportunities.


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Whether you have a large living area or you have to deal with a tiny space, you can implement different living room decoration ideas that will satisfy your taste and will fit in your budget as well. You can opt for a cozy décor to warm up the space or simply go with an open-plan having vaulted ceilings along with an area of hardwood floor. Once this project ends, you will have a space where you can live comfortably and it is perfectly decorated in accordance to the available space that you may have. If you are planning to have your perfect peaceful retreat that has all the harmony and serenity in it then you should use the basic information given below to your full advantage.
First of all, it is advisable to opt for cooler colors like the greens and the blues that you can use in various shades for achieving your desired comfortable and elegant look. Another thing that should be kept in mind is that when you have to decide on the paint for the ceiling of the room, choose the main color of the room in some lighter shade. For instance, if the color scheme of your room is blue then you can go for light eggshell blue and also opt for a bit deeper shade to go on the walls. If there are moldings that have to be dealt with as well, paint the in complete white or choose some darker blue shade for the ceiling as well as the walls. Another good idea would be to paint the walls using matt paint and for moldings choose a paint having some sort of sheen.
When decorating your Portland Oregon apartments for rent, it is inevitable to deal with the windows as well. You can add height to windows by placing curtain pole at maximum possible height and making sure that it is as close to ceiling as possible. This way, curtains can be allowed to have lots of drop for achieving that elegant drape. As far as the modern décor is concerned, it is always suggested that you should allow the fabric to pool down on floor. However, this idea for fabric is a kind of dust collector. Also, if there are dogs in your rental apartments then they will simply use that pooling fabric to make their bed. So, it is advisable to adapt the styles for suiting to your own lifestyle.
When decorating Portland OR apartments, one would think that placing a big picture on wall of a small room will just overpower it. Well, it's not like that. In fact, even in the tiniest of spaces, a large picture, showing lots of stuff going on, will certainly look fantastic giving you a feeling as if that room was made only for fitting that picture.
So, decorating rental apartments is just as fun as decorating a big house. All you have to do is to consider your options well and implement what suits your apartment better!


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Titusville offers many hotels for visitors to stay just off the I-95 freeway. (Photo: Jupiterimages/Photos.com/Getty Images )
Titusville is in Brevard County, along Florida's Space Coast, and is home to the Space Walk of Fame Museum (spacewalkoffame.com). The city is also minutes from the Kennedy Space Center, and within an hour's drive of Orlando's Disney World theme park. Travelers to the city can stay near the I-95 freeway exits to be just a short drive from Titusville's waterfront and all the area attractions.
The Best Western Space Shuttle Inn (bestwestern.com) is just off I-95 at Exit 215. This AAA 2-Diamond rated property features pet-friendly rooms for a small additional fee each night. The reception desk operates 24 hours a day and guests enjoy cable TV and free high-speed Internet access in their suites. A complimentary Continental breakfast is served every morning.
Small pets are allowed at the Days Inn Titusville Kennedy Space Center (daysinn.com) for a low nightly fee. This hotel is also at Exit 215 and features a 24-hour IHOP Restaurant on-site, plus an outdoor swimming pool, sundeck and free coffee in the lobby. Guests are treated to free wireless Internet access, local calls and complimentary newspapers.
The Super 8 Titusville (super8titusville.com) offers rooms that cost less than average, yet provides all the amenities of large properties. Each room is simply decorated and equipped with free Internet access, plus cable TV with HBO, coffeemakers and cooking facilities. Guests who stay here also receive complimentary breakfast each morning. This Super 8 hotel is on Garden Street, just off Exit 220 of I-95.
Business travelers can stay at the Hampton Inn Titusville (hamptoninn.hilton.com) and have full access to the on-site business center and meeting rooms. Printing, fax and mail services are offered here, as well as audiovisual equipment rental. The hotel also has a fitness room and swimming pool, and serves complimentary breakfast. Take Exit 215 off I-95 to access the property.
The Fairfield Inn and Suites (marriott.com) is a four-floor hotel off Exit 215, and ideal for the business traveler. A full-service business center is on the property, featuring copy, fax and printing services, plus notary and postal services. A meeting room is also available here. Wireless Internet access is provided throughout this AAA 3-Diamond hotel, and daily Continental breakfasts are served.
Take the kids on holiday to Titusville and stay at the Ramada Inn (ramadaksc.com), just off I-95 along Cheney Highway. The property features a playground for the kids, as well as a heated swimming pool. The on-site Denny's Restaurant is open 24 hours for early risers and the hotel also provides free wireless Internet access and cable TV in all guestrooms. The Ramada Inn is an hour's drive from Disney World and Sea World.
Leaf Group is a USA TODAY content partner providing general travel information. Its content is produced independently of USA TODAY.


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Danielle + Mitch's Colorful Key West Wedding
Danielle and Mitch's wedding was an absolute dream. The two married at Danielle's parents' stunning home in Islamoranda, FL with elegant pops of color throughout. The color palette in Danielle's tropical wildflower bouquet carried perfectly into the ceremony and reception's romantic beach aesthetic.
Danielle chose a bohemian, silk tulle and French Lace, off-the-shoulder gown by Galia Lahav. The gown features a corseted top with a daring front slit which reveals an embroidered tulle mini skirt underneath. Danielle's gown was sweetly topped off with a classic veil by Love Veils. Congratulations Danielle and Mitch, may your life be as colorful and sweet as your wedding day!
Photographer: Care Studios
Gown: Aria, Galia Lahav
Veil: Love Veils
Planner: Blue Water Weddings
Flowers: Studio South Islamoranda
Hair and Makeup: Elizabeth Arnold Styles
Bridesmaids Dresses: The Dessy Group
Stationery: Ivory House Creative
Catering: Caribbean Catering
Cake: Unique D'Elites
Rentals: Key Audios Party Rentals


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The modern day country of England, appears to derive its name indirectly from the Vanic deity, Freyr who was widely worshiped among the Scandinavian, Germanic and Anglo-Saxon peoples.
From works by both Pliny and Tacitus we know that we have a West Germanic cultural group (or a confederation of tribes) called the Ingaevones and we know they were worshippers of Ing/Yngvi (who most scholars and practitioners believe is an aspect of Freyr). We see the god Ing Frey specifically mentioned in both the Lokasenna and Olafs saga.
Therefore, it is most accurate to say that England directly gets it's name from the Angles (as in the tribe), and indirectly that name stems from the fact the Angles (or Ingvaeones) had been worshippers of Yngvi (or Frey) once upon a time.
Similarly, there are some theories that the country of Scandinavia could be named for the Goddess Skadhi, but this theory is far less substantial than the connection of the God Freyr to England.


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Do you know what your hidden costs and liabilities are?
Offering employees a 401(k) plan is a benefit you are proud to offer and your employees appreciate. But what are the real costs and responsibilities associated with this benefit?
It Starts with The Fiduciary
What's a fiduciary and who is ours?
A fiduciary is an individual (CEO, CFO, HR Exec, Owner) or entity (Board of Directors) that function on behalf of the plan to operate and control its operations. According to the Department of Labor, the fiduciary has specific obligations under ERISA to consider the fees and expenses paid by the retirement plan. Fiduciaries are held to a high standard of care and diligence and must ensure that they do not let preoccupation with other things or personal connections to a plan vendor prevent you from discharging their duties solely in the interest of the plan participants and their beneficiaries.
If you don't know who your plan fiduciary is, it might be you. If you have no co-fiduciary to protect you from that liability, it might be wise to call (760) 809-8734 before you get distracted and are left unprotected.
Be Aware – It's Personal!
Many fiduciaries have no clue that their level of liability is personal. As the fiduciary of a 401(k), your house and your personal assets are on the line, not your vendor's. You have a personal liability for your plan. It is also important to note that the fiduciary is personally liable for any fines in the event the Department of Labor audits your business.
But I Have a Vendor for That
Has your vendor ever notified you of your personal liability?
Are you aware of all of the costs and fees associated with your plan?
In a typical plan with $5MM in funds, the average business might overpay $10,000 each year. The employees might overpay $50,000. How is this still a "Benefit," and does the fiduciary of your plan understand all the costs paid by the employer and employees well enough to explain them?
Lower costs matter to employees too…
Who's responsible when employees discover that 20% of their 401(K) gains are being handed back in the form of fees?
It's important that companies, and especially the fiduciary of the company's plan understands and takes this responsibility seriously. There may A business offering a 401(k) with even a few million in funds should discover all the costs BEFORE an employee discovers this on their own.
My employees would never sue me, right?
I would caution any company with a plan to assume a worst-case scenario so they are prepared. In 2016 some owners who disregarded this advice paid a huge price, as shown in this article[i] and this one[ii].
An Independent Audit Can Save Costs and Reduce Risk
If you haven't had your plan analyzed by an independent analyst in the last 3 years, you are overdue and overexposed. You might be overcharged, too. Brokers are compensated by commissions, so they are likely making recommendations first based upon how they are incentivized, and second (maybe a far second) by what is best for you.
Without an audit and benchmark, it is unlikely you will catch overpayments. Your staff is likely too busy and may not have the knowledge or experiences to find these types of errors, so they are likely to do what all humans do – rely on the status quo. This is what commissioned sales people rely on and it is why you mustn't burden internal HR staff with the type of audit and benchmark best done by an outside analyst.
Whomever you call, I recommend that you make sure you are not having your commissioned broker "audit" the plan he/she is selling you. The truth is that "advisors" often have no responsibility other than to collect commissions on products they "advise" you to buy.
Your Best Outcome
Knowledge is power. Once your costs have been analyzed and reduced, and measures have been taken such as installing a co-fiduciary to protect you, you can remove worry and unnecessary risk and feel good about the benefit you've set up for your employees. Having the best education, participation, and service for the reasonable fees you and the plan participants pay is not just your best outcome, it should be your only acceptable outcome.
For a no-cost assessment of your 401(k) plans costs and liabilities, call DCI Solutions www.dcisolutions.net, (888) 395-0809


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HUSH FOREVER, "Life Is A Black Curtain." Their new album "Find The Gap" is available now. It's awesome! We are so grateful for his generous donation of the haunting closing song. More on that story and his beautiful music in our Patreon page (for patrons). Follow them and their tour schedule on Facebook.
LEE ROSEVERE, "Night Caves," "In A Moment," and "Places Unseen." Lee has been making music for years in my hometown of Vancouver and he's incredibly generous with his talents. Visit his website and enjoy.
CHRIS ZABRISKIE, "Stories About the World That Once Was," "Cylinder Four," and "Cylinder Seven." His album "Music From Neptune Flux" is available now.
KAI ENGEL, "Denouement." His latest album, "The Run," is available now.
THE PANGOLINS, "Beneath Dark Clouds."
AMBIENTEER, "Ecclessia."
ARS SONAR, "Gash Park."
EROIKA, "Horror Drone."


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DATAVLT foresees a correlation crunch in the era of hyper-personalization
Blockchain data analytics will be a game changer for understanding customer needs
The key to customer engagement lies in knowing and understanding the customers. The companies that can personalise their services to their desired customers will ultimately win. But how do marketers make sense of so much data to create something that is truly personalised?
Known as hyper-personalisation, it is no longer sufficient to have only a superficial understanding of customers. Companies are now at a stage in marketing technology where they have the data to truly dig deeper and to intimately understand the drivers of consumer behaviour; to not only meet their expectations, but to anticipate those expectations, and to ultimately engage with them.
Many consumers want brands to understand them better, and to know when and when not to approach them. Similarly, equally large numbers of marketers are focused on their data analytics capabilities, bespoke communications technologies, and customer profile data management platforms to deliver personalized customer experiences. Despite this however, the overwhelming majority of these professionals are still finding it difficult to engage with their consumers in a genuinely personalised manner, in real time.
The difficulty arises in gathering insights quickly and efficiently, having enough relevant data, and the problem of inaccurate data. Blockchain technology addresses this challenge head-on, allowing marketers to make personalization a streamlined process by taking the complexity out of data analytics, and making sense of it all.
"Data is everything in our modern-age, this is especially the case for marketers," said DATAVLT co-founder, Michelle Yeo. "The problem with current methods of data analytics, and storage, is the way in which they are stored and siloed based on different departments. This creates a situation where companies do not have a proper, broad understanding of their own data."
She should know too. Yeo spent a significant part of professional career in marketing and communications before being compelled to create a data analytics platform on blockchain technology.
Hyper-personalization requires quality data and targeted data technology. DATAVLT's distributed ledger technology ensures that all stored data is transparent across siloes, and any changes made are verified and immutable. DATAVLT can help marketers supercharge their efforts in hyper-personalizing their offerings to consumers by providing advanced, yet user-friendly data analytics.
Metis builds capacity for professionals to:
- understand, manage, and negotiate fair and profitable contracts
- understanding complex infrastructure finance arrangements
- strategically planning impactful cities
- understand and utilise business finance
Our clients include:
AECOM, Jacobs, WSP, GHD, Laing O'Rourke, Fulton Hogan, Vision Australia, NSW Health Infrastructure, The City of Parramatta, The Department of Infrastructure and Regional Development, SMEC, Norman Disney and Young. Learn more.
Our programs are:


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Major League Baseball 2K7
The leap forward from the Playstation to the Playstation 2 was substantial enough to say that the games we played were in many ways vastly different. From the past generation of consoles to now the current I wouldn't say that was necessarily the case. For example, last year we had MLB 2K6 for the Xbox 360, a game that had a lot of potential but still felt too much like a past generation baseball game. Now in 2007 we are here once again with 2K Sports Major League Baseball 2K franchise, hoping to rewrite last year's history with an even better game of baseball in 2007. So how does 2K Sports do this year on the Xbox 360? Read our full review to find out!
Last year in MLB 2K6 you had a group of people, including myself, who were very anxious and excited to see what 2K Sports was going to do on the Xbox 360. Unfortunately last year's game just didn't feel all that "next gen", and many complained that the new version created more problems than it solved. Now a year later we have MLB 2K7 and it hopes to right the wrongs of last year's game, and create a much more next generation baseball experience, especially since now it has competition.
The mechanics of last year's game was really the biggest issue that plagued the game, mainly because much of the game was filled with glitches and weird animations that stopped this game from feeling completely authentic. In fact, much of MLB 2K7 was focused on the gameplay that has changed almost every facet of the game. First off, I want to talk about fielding, which before was plagued with weird animation problems now has much better control and much more consistency. For example my first game I made a few diving plays with my shortstop that did a small toss to second and then over to first for the double. What made this a treat was how smooth the animations were to make this feel more like a routine double, whereas last year's game would have either missed the diving catch or had something that stopped you from getting the double. There are several of these examples here, ranging from pick off plays to cutting the ball off, which all is just a huge step forward from last year's game.
The pitching in MLB 2K7 has a bit more consistency, and due to the signature style feature that is now in MLB 2K7, you do have much more of the pitcher's traits portrayed in the game. As we all know each pitcher has their own unique style, and the fact that MLB 2K7 captures that as well as it does is another good addition. The pitching to me needs to be more consistent, and I believe there needs to be more of a gap between how the top tier pitchers perform in comparison to how just the mediocre pitchers perform. The game definitely seems to favor the hitters, and pitching I feel still needs more work.
One thing I absolutely despised about last year's game was the base running, which although hasn't been perfected in this year's game, is still much better. You now have much smarter base runners who won't get caught up with each other, nor will you have the constant problems of having runners continue running the bases even after they are commanded not to. The base running is blended into the display of the game on screen, and manages to really bring forth a much more involved and steady appeal.
So we have talked about the mechanics of the game, which are much better then last years game but still have several things to work on, now let's talk about the franchise mode, which for most will be the primary place the game is experienced in. The developers have done an absolute amazing job with the menu system that makes the entire franchise mode a lot more accessible. The one thing I didn't like about the franchise was the fact that the only real "managing of assets" outside of signing players was setting ticket prices, which felt just totally slapped on. The franchise mode however works very nice, and the depth will keep you occupied for quite sometime.
In the end, MLB 2K7 is a much-needed step in the right direction for the franchise. The game still has so many areas to improve on that I wouldn't be surprised if many fans were still dissatisfied with this game. It has a lot of smooth new mechanics, however things just still don't feel like they are totally on par with how well the game could have been.
Visually the game has come a long way from where it was in last year's experience that to me just felt like a slight upgrade from what were than the current generation consoles. This year however we are seeing a much detail rich experience that makes for a much better looking game than last year. Also the animation in the game has gone in the right direction with a lot of new animations, making the game of baseball look a lot better. The game still needs work with some choppy effects, and some awkward plays but overall the game still looks quite good.
Fun Factor
I wasn't really sure what to expect from MLB 2K7 this year, especially being that it had such an off year last year. MLB 2K7 however goes back to what it has done right in the past, and makes for a much more enjoyable game of baseball. I am still waiting for a full-fledged online support, which doesn't seem to be all there this year. The gameplay is on the right track with much better mechanics and just an overall better baseball experience. Also what happened to the World Baseball Classic mode, which is nowhere to be seen this year, which I thought, made a nice addition to the game last year.
In the end, MLB 2K7 is a good solid game of baseball that still offers plenty of room to grow for future versions. It's a bit disappointing that more depth wasn't added to the franchise, and that there were still a handful of glitches. MLB 2K7 is a good game that fans of the franchise will continue to enjoy in 2007.
The owner and editor-in-chief of Darkstation.com. I've been apart of the website since 2002 and purchased the website in 2010. Owning and running Darkstation is a dream come true. I love video games and I love writing and talking about them even more.


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Compiling & Filing: Jan St. Werner's Favourite Albums
Nick Hutchings
, April 30th, 2015 11:23
With his operatic performance-cum-radio play Miscontinuum released as an album earlier this year, the Mouse On Mars man takes Nick Hutchings on a trawl of his favourite avant-garde and experimental records
Morton Feldman - Why Patterns?/Crippled Symmetry
When they played it the three players had no combined score. They had fully notated parts so they knew what to play but not how to play it together.
It's a masterpiece of repetition that doesn't come across as repetitive and I like the mood of it and the harmonic and melodic structure too. It has a kind of gloomy Californian sunrise light to it. I like it not because it's a strong intellectual statement, but because it works so incredibly well and I think it's a profound understanding of how the human brain likes to be teased. Feldman gives you enough information that you're kind of triggered and teased, but then you do the rest and you understand that you don't need to get all the shit in sync. We perceive things in life as running on different speeds and we're perfectly capable of syncing these elements and making them sync to a steady beat, but we sync them quite casually and unconsciously like a good cook. Like spicing up the dish while you're already preparing the pan. You heat up the oil in the other pan and you're also peeling something at the same time and thinking about placing the plates. All these things have their own timing and their own rhythms and Feldman is giving you this. He is super-arrogant and magnificent because he's doing it with a twist of his hip, as if it was nothing, but it's a major act of self-definition.
If you love our features, news and reviews, please support what we do with a one-off or regular donation. Year-on-year, our corporate advertising is down by around 90% - a figure that threatens to sink The Quietus. Hit this link to find out more and keep on Black Sky Thinking.


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The Wolfson Centre for Mathematical Biology (WCMB) at the University of Oxford is part of the Mathematical Institute. Researchers working at the WCMB are interested in the development and utilisation of mathematical and computational techniques for the exploration of biological systems. Collectively, our aim is to further our understanding of the mechanisms underlying biological processes by building biologically realistic mathematical/computational models, testing and refining them using currently available experimental data, and making experimentally verifiable predictions. Most of our projects involve collaboration with both theoretical and experimental researchers working in Oxford, the UK and further afield.
The WCMB also has a blog, which can be found here, with the associated twitter handle @WCMBlog.
Philip Maini's 60th birthday workshop.
On 18th-19th September 2019 we will hold a workshop to celebrate the fundamental contributions that Professor Philip Maini has made to mathematical biology. Details of the meeting, including how to register, can be found here.


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People Power
Daniel Agyei reads his speech People Power, on politics being too important to be left to just politicians.
Daniel is a member of our Young Leaders programme. The Almeida Young Leaders is a scheme giving young people with something vital to say the tools and platform to do so. Each young leader has been mentored by a writer and director to develop their ideas, structuring a speech and skills in public speaking.
About Daniel:
Daniel is a young European and hopes to serve his fellow citizens in the future. His hobbies include learning Italian, reading poetry, and keeping up with current affairs. He especially loves the poetry of the Romantics; his favourite poet is Lord Byron.
You might also like...


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Welcome to Ian's world of awesome film reviews, mostly of films that left the cinema ages ago. First up we have this one, about US army bomb disposal guys in Iraq. I saw it in Bristol, of all places. The Hurt Locker is not quite as brilliant as some people think it is, but still an impressive war film; its lack of a Big Point about the war in Iraq was most laudable. I also thought it was great that the film did not turn into a battle of wits between the bomb disposal guy and some sinister terrorist mastermind.
image source


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When I was a student at General Assembly, our biggest project involved teaming up with a local company to give a product of theirs (i.e. a website or app) the UX treatment. Mine was a career development and recruiting platform, and the company hired me off my team when the 3-week project ended.
The Client
For this project, myself and three other UX designers teamed up with Step.com, a new career development and recruiting platform. They aim to bring transparency into the marketplace and make it easier for NYC tech talent and startups to find each other.
My Role
UX designer on a team of four and lead graphic designer.
I oversaw all visual design, created the wireframes and prototype, and was heavily involved in comparative and competitive analyses, solution ideation, creating user personas, constructing user surveys, conducting user interviews, heuristic evaluations, guiding users through usability testing, paper prototyping, and assembling final deliverables.
The Brief
We began this project with three main objectives:
1. Make the process of onboarding and creating a profile more engaging.
2. Make one of the site's main interactive elements, the timeline, more attractive and intuitive to use.
3. Create incentives for users to fill out more of their profiles.
Tools Used
Adobe Illustrator, Adobe Photoshop, whiteboards, dry erase markers, camera, lots of post-its, InVision
The Result
In this prototype, you can:
Go through the initial onboarding process, see your results on the timeline, add a new job, observe how that affects the timeline, hover over a job on the timeline to see how it affects the page, and view the improved dashboard.
The Step.com team was impressed with our work, and was happy to have our research and interview findings. After this project was completed, they hired me off our team to continue doing freelance UX and design work for them and consult in the implementation of some features my team had come up with.


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A 4,625sf penthouse with old-world, Euro loft charm suffused throughout with ornate wall moldings, forged black steel, and rustic herringbone flooring. Clean, white plaster walls are dressed with traditional, geometric designed moldings.
Expansive glass doors, framed in custom black steel, separate interior spaces while framing exterior window walls that showcase historic LA views. Sleek white spaces throughout are punctuated with pops of dramatic black accents.
The kitchen space is dominated by a Carrara marble slab island of exaggerated proportions that pairs perfectly with the modern, lacquered cabinetry.
The Master Bath's focal point is its elevated tub, prominently set on a stone slab base and framed with an antique mirror backdrop. But, not to be outdone, the oversized steam shower offers an alternate experience in luxury immersion.


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HENRY KOEHLER b.1927 AMERICAN
Superb Examples of a Fine Pair of Oil Paintings on gesso panel complete with their original gilt frames.
"Arthingworth Meet of The Pytchley Hunt" & "Baybrook meet of The Pythchley Hunt" Both pictures are signed Henry Koehler.
Condition: Good condition, recently professionally cleaned.
Height: (entire including frame) 14" (36m). Width: (entire) 18" (46cm).
Henry Koehler. American Born 1927
A sporting artist who lives in Southampton, New York, Henry Koehler was born in Louisville, Kentucky. He graduated from Yale University, and shortly after that had illustrations published by "The New Yorker", "Town and Country", and "Sports Illustrated".
His first exhibition was in 1961, and since then has exhibited in over 60 venues in London, Paris, Dublin, Johannesburg and the United States.
He has painted several commission portraits of well-known thoroughbreds but prefers genre pieces depicting horse-racing, polo games, and hunting in the field with horses. He also does studies of jockey figures before and after their race. sensitive studies of jockeys before and after racing.
His loyal following of collectors has included, Ralph Lauren, Jacqueline Kennedy Onassis, Paul Mellon, John Hay Whitney, President John Kennedy, the Duke of Beaufort, Sir Evelyn de Rothschild, the Duchess of Cornwall, Senator Edward Kennedy, Mrs. George Baker, the Duchess of Windsor, the Bancroft Family, The Queen and HRH The Prince of Wales.
His works can be seen to-day in the collections of the National Racing Museum in Saratoga USA and at the National Horse Racing Museum at Newmarket in Great Britain.


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BACKGROUND: We previously reported improved neurodevelopmental outcomes at 2 years among infants treated with the erythropoiesis-stimulating agents (ESAs) darbepoetin alfa (darbepoetin) or erythropoietin. Here we characterize 4-year outcomes.
METHODS: Former preterm infants randomly assigned to receive darbepoetin (10 μg/kg, once per week), erythropoietin (400 U/kg, 3 times/week), or placebo through 35 weeks' postconceptual age were evaluated at 3.5 to 4 years of age. For comparison, healthy children formerly delivered full term (term controls [TCs]) were also recruited. All participants were assessed by using measures of full-scale IQ (FSIQ) and general language from the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, and an overall measure of executive function, on the basis of tests evaluating inhibitory control and spatial working memory. Rates of neurodevelopmental impairment were compared across groups.
RESULTS: Multivariate analysis of variance compared children randomly assigned to ESAs (n = 39), placebo (n =14), and TCs (n = 24). FSIQ and performance IQ were significantly higher in the ESA group than in the placebo group (FSIQ: 91.1 ± 17.5 vs 79.2 ± 18.5, P = .036; performance IQ: 93.0 ± 17.0 vs 79.5 ± 19.5, P = .018). Follow-up analyses revealed that the children receiving ESAs performed better than those who received placebo on executive function tasks. The ESA group's performance was below that of TCs, but the results did not reach significance on executive function. The incidence of neurodevelopmental impairment was greater in the placebo group than in the ESA group.
CONCLUSIONS: ESA-treated infants had better cognitive outcomes and less developmental impairment at 3.5 to 4 years of age compared with placebo-treated infants. ESAs show promise in improving long-term cognitive outcomes of infants born prematurely.
- BRain Imaging and Developmental Follow-up of Infants Treated with Erythropoietin
- Bayley Scales of Infant Development III
- erythropoiesis-stimulating agent
- full-scale IQ
- General Language Composite
- Kruskal-Wallace
- neurodevelopmental impairment
- performance IQ
- term control
- verbal IQ
- Wechsler Preschool and Primary Scale of Intelligence, Third Edition
What's Known on This Subject:
We and others previously reported that erythropoietin administration to preterm infants improves short-term developmental outcome. There are limited data on outcomes in preschoolers, and the effects of the longer-acting erythropoietic agent, darbepoetin, have not been evaluated.
What This Study Adds:
Children previously randomly assigned to either darbepoetin or erythropoietin treatment as preterm infants had significantly higher cognitive scores and improved executive function compared with children previously randomly assigned to placebo at 3.5 to 4 years of age.
Although major morbidity such as cerebral palsy, intellectual disability, and learning and attention deficits during school age are common outcomes of extremely low birth weight infants, successful neuroprotective interventions have yet to be developed. Recent studies in animals and humans evaluating the nonhematopoietic effects of erythropoiesis-stimulating agents (ESAs) suggest a neuroprotective potential via such mechanisms as increased oligodendrogenesis, decreased inflammation, decreased oxidative injury, and decreased apoptosis.1–9
We previously reported 18- to 22-month outcomes on our prospective, randomized, masked study in preterm infants randomly assigned to receive ESAs or placebo10 and hypothesized that ESA recipients would have higher composite cognitive scores measured by using the Bayley Scales of Infant Development III (BSID-III).11 Indeed, those very low birth weight infants receiving erythropoietin or darbepoetin alfa (hereafter "darbepoetin") had significantly higher composite cognitive scores, including higher scores on a scale of executive function.12 Moreover, neurodevelopmental impairment (NDI) was significantly lower in ESA recipients than in placebo recipients, and cerebral palsy was only identified in placebo recipients.
In the current study we sought to determine if neurocognitive improvement persisted into preschool age (3.5–4 years). We compared full-scale IQ (FSIQ) and the General Language Composite (GLC) scores measured by the Wechsler Preschool and Primary Scale of Intelligence, Third Edition (WPPSI-III), along with a composite measure of executive function, in former preterm children randomly assigned to receive ESAs or placebo. In addition, we enrolled children previously born healthy at term to serve as typically developing term controls (TCs). We hypothesized that former preterm children who received ESA therapy would perform significantly better than former preterm children who received placebo on measures of general cognitive ability, language, and executive function at 3.5 to 4 years of age. We further hypothesized that TCs would perform better than both the preterm-treated and untreated groups.
Initial Study
Preterm infants <32 weeks' gestation and with a birth weight of 500 to 1250 g were enrolled at ≤48 hours of age. Infants with trisomies, significant congenital anomalies (including known neurologic anomalies), hypertension, seizures, thromboses, or hemolytic disease, or who were already receiving erythropoietin, were ineligible for study. Randomization stratified by center (New Mexico, Utah, and Colorado) was performed by using a computer-generated permuted block method. Twins were randomly assigned to the same treatment group. All caregivers and investigators (except for the research pharmacists and coordinators administering the study medicine) were masked to the treatment assignment. An investigational new drug application was approved by the Food and Drug Administration (IND100138), and the study was registered at clinicaltrials.gov (NCT00334737).
Dosing of Study Drug and Supplements
Infants were randomly assigned to 1 of 3 groups: erythropoietin (400 U/kg, given subcutaneously 3 times/week), darbepoetin (10 μg/kg, given subcutaneously once per week, with sham dosing 2 other times/week), or placebo (consisting of 3 sham doses/week). Dosing continued until 35 completed weeks' gestation, discharge, transfer to another hospital, or death. All infants received supplemental iron, folate, and vitamin E.
Present Study
Children previously enrolled in the above study were eligible for the BRain Imaging and Developmental Follow-up of Infants Treated with Erythropoietin (BRITE) Study (NCT01207778), performed at the Utah and New Mexico sites. In addition, healthy children previously born term (TC) without hospital complications (hypoglycemia requiring glucose, hyperbilirubinemia requiring phototherapy, sepsis evaluation, or in utero drug exposure) were enrolled at the New Mexico site. Children were evaluated at 3.5 to 4 years of age by certified examiners (J.L. and M.S.) blinded to the treatment group. The study was approved by institutional review boards at the University of Utah and University of New Mexico, and informed consent was obtained from parents.
Demographic information and medical history were obtained from the family. Anthropometric measurements were obtained and a detailed neurologic evaluation was performed. Assessments of hearing impairment (characterized functionally as requirement of a hearing aid or unilateral or bilateral deafness) and visual impairment (defined as blindness or vision requiring significant correction) were based on examination and parental report.
The WPPSI-III, a widely used scale of general cognitive abilities, was administered.13 The WPPSI-III is standardized for children aged 2 years 6 months through 7 years and yields FSIQ, verbal IQ (VIQ), performance IQ (PIQ), and GLC scores. Our primary analysis focused on the summary variables of the FSIQ and GLC. Two other developmental measures were performed to assess executive function. The Memory for Location Test14 was used as a measure of spatial working memory. Children had to locate a toy hidden under 1 of 6 cups after 1-, 5-, and 10-second delays. A principal components analysis revealed that scores from the 3 conditions loaded on a single, large factor (75.46% of variance). The Gift Delay Test15 was administered as a measure of inhibition. This test requires a child to hear a "gift" being wrapped out of their view, and the child is timed to see how long they can wait before touching or opening the gift placed in front of them. Four variables captured performance: seconds before peeking, seconds before touching, number of peeks, and the number of reminders needed. Principal components analysis revealed a single, large factor accounted for test performance (68% of variance). Thus, the first principal component emerging from analysis of each test was used to represent performance in these 2 specific domains of executive function. Finally, an overall measure of executive function expressed as a standard score was derived by summing and averaging performance from these correlated (r = 0.23, P < .05) tests of spatial working memory and inhibitory control. All cognitive data are presented as standard scores.
NDI was defined as ≥1 of the following: bilateral blindness, severe hearing loss, any cerebral palsy, or WPPSI-III FSIQ <70. A board-certified child neurologist (JP) or developmental pediatrician (S.Winter, MD) performed detailed neurologic examinations.
Statistical Analysis
After planned analyses revealed no significant differences between erythropoietin and darbepoetin recipients they were combined as a single ESA group. Baseline characteristics, growth, and medical outcomes were compared among the 3 study arms (ESA, placebo, TC), and the significance of any differences was determined by using analysis of variance or Kruskal-Wallis (K-W) rank-sum tests (depending on distributional characteristics) for quantitative dependent variables and χ2 tests for nominal and categorical dependent variables. When significant differences were discovered (at an α level of 0.05) among the 3 study arms, we performed post hoc pairwise tests by using 2-tailed Fisher's exact tests for nominal and categorical dependent variables and 2-tailed t tests or K-W tests for quantitative dependent variables. Our primary hypothesis was that general cognition (FSIQ), language (GLC), and executive function (as described above) would be greater among subjects in the ESA-treated group than in the placebo group. To evaluate this hypothesis, we used a multivariate general linear model. Significant cognitive effects were followed up with more detailed analyses.
The number of children eligible for the study and evaluated at 3.5 to 4 years of age are shown in Fig 1. Reasons for nonenrollment included parent refusal (7 subjects) or lost to contact (20 subjects). Of the 80 preterm infants evaluated at 18 to 22 months in the original randomized study, outcomes were determined for 53 (66%) at 3.5 to 4 years.
Characteristics of the 77 children (n = 14 placebo, 39 ESA-treated, and 24 TCs) comprising the BRITE study are shown in Table 1. Analyses using χ2 tests revealed no significant differences in gender (P = .31), maternal ethnicity (P = .24), or maternal racial background (0.58) among the 3 groups. Maternal education was significantly different between placebo and ESA groups (P = .019). Eighty-nine percent of the ESA group mothers completed high school, compared with 71% of the placebo group. Fifty percent of the placebo group mothers had graduate degrees, compared with 15% of the ESA group mothers. All analyses were adjusted for maternal education.
TCs had greater birth weight, gestational age, weight at follow-up, and height at follow-up than either placebo or treated children, and these differences were found to be significant with the use of using K-W tests. TCs were also younger at follow-up (median = 45.5 months) than treated (median = 47 months) and placebo (median = 48.5 months) children, and this difference was significant (P < .001, K-W test). At follow-up there were no significant differences between ESA and placebo groups in weight, height, or head circumference; however, a greater proportion of children in the placebo group had a head circumference less than the 10th percentile (5% in the ESA group versus 29% in the placebo group; P = .036).
Of the 80 former preterm subjects seen at the 18- to 22-month follow-up,12 53 enrolled in BRITE (n = 14 placebo; n = 39 treated, of whom 24 were erythropoietin recipients and 15 were darbepoetin recipients), whereas 27 did not (10 placebo, 17 treated). The characteristics of the children evaluated at 3.5 to 4 years were similar to those not evaluated. Of those not evaluated, 13 (48%) were female, compared with 23 (76.6%) who were evaluated (P = .81). Children not evaluated had a mean gestational age at birth of 28.0 ± 1.9 weeks, compared with 27.8 ± 1.7 weeks for children who were evaluated (P = .45). Children not evaluated had a mean birth weight of 947 ± 191 g compared with 946 ± 203 g for children who were evaluated (P = .94).
Table 2 provides detailed information on cognitive performance. As mentioned previously, analyses of darbepoetin and erythropoietin groups revealed no differences in developmental testing (Table 3), so the groups were combined into 1 ESA group. Children in the ESA group scored significantly better than the placebo group in FSIQ (P = .011), PIQ (P = .006), and overall executive function (P = .035). To test our primary hypothesis we conducted a multivariate analysis of variance with 3 dependent variables (FSIQ, GLC, and executive function) with group (placebo, ESA, TC), gender, and maternal education as factors, along with the gender by group and maternal education by group interaction terms. The multivariate effect of group was significant across the set of cognitive measures (F[6, 112] = 4.87, P < .001), as were the univariate effects for FSIQ (P < .001), GLC (P < .001), and executive function (P = .003). We followed up these analyses with specific group comparisons. For the critical comparison of ESA versus placebo, the overall effect was significant (F[3, 38] = 3.98, P = .015), as were univariate effects for FSIQ (P = .017) and executive function (P = .045) but not GLC (P = .26). Comparison of the ESA group with the TC group revealed significantly better FSIQ among the TC group (P = .011; Table 2), although differences did not reach significance in tests of executive function (P = .083; Table 2). Thus, ESA-treated children had better cognitive performance than placebo-treated children but still had lower cognitive performance than the TC group. No interactions of group with gender or of group with maternal education were observed in any analysis. The overall pattern of results for cognitive abilities across groups is shown in Fig 2.
Because our primary interest was the comparison of placebo versus ESA-treated children, we conducted a more detailed analysis of performance difference between the 2 groups. The FSIQ is composed of both verbal and nonverbal tasks, as reflected in VIQ and PIQ. Analyses of variance (with group and gender as fixed factors) revealed a significant effect for PIQ (F[1, 52] = 5.03, P = .029) but not for VIQ (F[1, 52] = 2.41, not significant). We next examined the 2 components of executive function. Neither component was significantly different (spatial working memory: F[1, 52] = 3.43, P = .07; inhibition: F[1, 52] = 2.31, P = .13).
The incidence of NDI was significantly greater in the placebo group than in the ESA group. Four of 14 children (29%) in the placebo group had an FSIQ of <70, compared with 3 of 39 children (8%) in the ESA group (P = .07). Three children (21%) in the placebo group had mild cerebral palsy, compared with 0 children (0%) in the ESA group (P = .016). No children in the study were deaf or blind at follow-up. No disabilities were identified in the TC group.
Finally, we compared cognitive test results at 2 years versus 4 years and found a significant correlation between BSID-III composite language score and VIQ (R2 = 0.592, P < .0001) and between BSID-III composite score and FSIQ (R2 = 0.414, P < .0001; Fig 3).
This study is the first, to our knowledge, to report neurocognitive outcomes of darbepoetin and erythropoietin treatment in former preterm children at preschool age. Using a double-blind, placebo-controlled design, we showed that darbepoetin and erythropoietin improve neurocognitive outcomes at 3.5 to 4 years of age in former preterm infants. Similar to 2-year outcomes,12 children formerly born preterm who were randomly assigned to receive ESAs during their initial hospital stay scored significantly better than children formerly born preterm randomly assigned to placebo in scores of FSIQ, PIQ, and measures of executive function at 4 years of age.
Although overall growth among former preterm children was similar, we did identify a greater percentage of children in the placebo group with a head circumference below the 10th percentile. This percentage increased in the placebo group from the 18- to 22-month assessment, from 20.8% to 29%, whereas the percentage of children with a head circumference less than the 10th percentile actually decreased in the ESA group, from 10.7% to 5%. This finding requires further evaluation. In addition, differences in maternal education between ESA and placebo groups require further inquiry. Although a greater number of placebo group mothers had graduate degrees, a larger number of mothers in the placebo group did not complete high school. There were no differences in maternal education between TC mothers and ESA or placebo group mothers. As expected, former term-born healthy children scored better overall than former preterm children, although the statistical comparison fell just short of significance when comparing executive function between TCs and ESA recipients. ESAs closed the gap between preterm and term children.
This study is the first, to our knowledge, to report outcomes that support the use of ESAs to improve developmental outcome in preterm children at preschool age. A number of clinical trials evaluating ESAs for neuroprotection are ongoing. Fauchère et al16 in Switzerland recently completed a study that used high-dose erythropoietin for neuroprotection in preterm infants. Although the primary outcome (neurodevelopment at 2 years) is still forthcoming, imaging results in a subset of the infants are encouraging. Leuchter et al17 reported decreased gray and white matter injury in 77 of the erythropoietin-treated infants compared with 88 placebo-treated infants, and O'Gorman et al18 reported improved white matter development as assessed by diffusion tensor imaging and tract-based spatial statistics in 24 of the erythropoietin-treated infants compared with 34 placebo-treated infants. A US multicenter trial of high-dose erythropoietin for neuroprotection in 960 extremely low gestational age infants (PENUT [Preterm Epo Neuroprotection Trial]; NCT01534481) is ongoing, and neurodevelopmental outcomes are expected in ∼3 years.
Randomized studies of either erythropoietin19,20 or darbepoetin21 for treatment of hypoxic ischemic encephalopathy have reported pharmacokinetic evaluations that suggest neuroprotection, and safety profiles showed no adverse effects of either ESA in term infants. Doses in the DANCE (Darbepoetin Administration in Neonates undergoing Cooling for Encephalopathy) study were similar to the darbepoetin doses administered in our original randomized controlled trial,8 although term infants only received 2 doses 1 week apart in the DANCE study, compared with up to 10 weekly doses in our study. Long-term developmental assessments of infants enrolled in these term neuroprotection studies are ongoing. Our study coupled with previously published studies in preterm infants22–25 provide growing evidence for ESAs to be neuroprotective in term and preterm neonates.
In animal models, ESAs are protective in the developing brain, suggesting the possibility that they might be of benefit to very premature infants who are at risk of intraventricular hemorrhage, hypoxic-ischemic injury, and developmental delay. The neuroprotective mechanisms of ESAs include decreased neuronal apoptosis, decreased inflammation, promotion of oligodendrocyte differentiation and maturation, and improved white matter survival.1–9 These biological mechanisms of neuroprotection may be revealed through MRI.26 All children enrolled in the BRITE study underwent MRI, and analyses of total and regional brain volume, cortical thickness, surface area, spectroscopy, total and regional cerebral blood flow, and diffusion tensor imaging are nearing completion. All children are being seen again at 5.5 to 6 years for developmental testing and MRI to provide longitudinal assessments. Regardless of neuroimaging findings, we found significant and clinically important improvement in cognitive function with ESAs and believe these findings would be of great clinical importance to both families and care providers.
Diminished executive function skills (encompassing working memory, inhibition, and cognitive flexibility) have contributed to academic failure and behavioral problems in children born preterm, over and above the impact of FSIQ.27 Executive function deficits are commonly observed at school age28 and may be found as early as 18 to 22 months.29,30 These findings are consistent with our previous study in this same cohort, which found the ESA group (darbepoetin recipients in particular) had better early working memory skills at 18 to 22 months.12 In a longitudinal study from 4 to 12 years of age, children born preterm were found to have difficulty in verbal fluency, inhibition, and cognitive flexibility or shifting.31 Our current study showed that the ESA group at 3.5 to 4 years continued to score higher on intellectual and executive function skills, as they did at 18 to 22 months,12 and in fact were similar to TC subjects in tests of executive function. The higher executive function skills we saw in the ESA group were promising with regard to future reasoning and coping skills, which are obviously important to school success. We are hopeful that this pattern will persist as we continue to follow this cohort of children into early school age.
We conclude that ESA administration to preterm infants resulted in higher cognition at 3.5 to 4 years of age. Given its significantly longer half-life,32–34 darbepoetin may be the more attractive and practical choice of ESA for preterm infants. We speculate that ESAs may serve as a beneficial therapy for preterm infants, not only in acute hospitalization where the risk of anemia exists but also as possible neuroprotective agents to improve long-term neurodevelopmental outcomes.
We thank the research coordinators and bedside nurses involved in the original randomized study and are indebted to the parents for their willingness to allow their children to participate in this study. We wish to acknowledge US taxpayers for providing the funding to support the National Institutes of Health and this study.
- Accepted December 9, 2015.
- Address correspondence to Robin K. Ohls, MD, Department of Pediatrics, MSC10 5590, 1 University of New Mexico, Albuquerque, NM 87131-0001. E-mail: rohls{at}salud.unm.edu
This trial has been registered at www.clinicaltrials.gov (identifiers NCT01207778, NCT00334737, IND100138).
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD059856), the University of New Mexico Clinical Translational Science Center (UL1 TR000041), the University of Utah Center for Clinical and Translational Sciences (UL1TR001067), and the University of New Mexico Department of Pediatrics. Funded by the National Institutes of Health (NIH).
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
- Copyright © 2016 by the American Academy of Pediatrics