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Acord 40th anniversary.
- Filed Under
Mr. and Mrs. Douglas M. Acord, of Newark, celebrated their 40th wedding anniversary Saturday.
Carole (Palmer) Houston and Douglas M. Acord were married April 6, 1973, at Grace Lutheran Church in Thornville, by the Rev. Robert Pflueger.
They are the parents of Chris (John) Bailey and Wilda Armstrong, of Newark; Thomas Houston, of Utica; Leah (Greg) Keller, of Groveport; and the late Andrea (Brian) O'Connell, of Jupiter, Fla. They also have four grandchildren and seven great-grandchildren.
Mr. Acord retired from the Newark Police Department after 28 years of service.
Mrs. Acord is a homemaker and retired bus driver from Licking Valley Schools.
A dinner celebration was hosted by their children.


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It's that time of year: The nights are drawing in and for most of us the mercury outside is dropping. If you live North of the Mason-Dixon line, it also means that frost and snow are here. For many northern Corvette owners who have to endure winter weather for several months, there's a little more to winter storage than simply driving the car into the garage, locking the door, and walking away until next April.
Cars, including Corvettes, generally don't like sitting for extended periods and if care isn't taken, you can be faced with all kinds of problems come spring – flat spotted tires, stale fuel, hard starting, corrosion, musty interiors – these are just some of the problems that can result from not storing your Vette properly. And it doesn't matter whether your ride is a '62 Roadster or a 2004 Z06 – Mother Nature has no mercy.
However, if you take the time to make a few preparations before putting your car away for winter, then once the days start getting longer and the snow begins to melt away, you'll be able to pull your Corvette out of the garage and start driving it, instead of wasting precious spring days and nights trying to fix all the problems that resulted from not taking the time to prep it properly for storage. In this article, Corvette & Chevy tagged along with Bob Clemmens, a long-time Corvette fan, GM trained technician, and member of the Legendary Motorcar team, who showed us a few simple tasks you can perform to ensure your baby sleeps soundly and uneventfully through the winter months.
Special thanks to Bob Clemmens and Legendary Motorcar (www.legendarymotorcar.com)
Time to put your Vette away for the winter…do you know the proper way to do so?
Here's our subject vehicle, a 1990 L98 coupe with a four-speed automatic. Recently purchased, the car has approximately 90,000 miles on the clock and is in good condition for its age. We'll be taking a few winter storage steps to ensure that come spring, we can get as much seat time in it as possible.
Our first order of the day is to give the car a thorough inspection, to make sure there aren't any obvious issues that are likely to get worse while in storage. As a result, we've brought it into the garage and popped the hood.
The L98 motor appears to be in good working order with recent replacement service items, including the plug wires and a fairly new alternator, among other things. Still, there are a few things that need to be done before we put the car away.
Because our service bay features a hoist, we're going to jack the car up so we can have a look underneath to make sure there aren't any problems – obvious ones include rusty brake or fuel lines, worn bushings or fluid leaks.
Although Bob says it isn't mandatory on a C4 like this, if you choose to raise your car on jackstands while in storage, make sure you place them in the factory recommended location – usually the strongest part of the frame. This prevents damaging the floorpan or lines while the stands support the weight of the car.
One of the first things you should do before putting your Corvette away is change the oil. Clean oil provides better protection of the moving parts and also ensures that come spring, you can simply jump in the car and drive it. Make sure a catch can is in place under the pan before draining the oil.
On C4s like this, a single drain plug at the back of the oil pan needs to be unfastened in order for the old lube to pour out.
Although the oil filters in these cars are fairly accessible by modern standards, you'll still likely need a filter wrench to pull the old filter loose.
After a good tug with the wrench, you can unscrew the filter and pull it off.
Before putting the new filter on, make sure you coat the gasket with a small amount of fresh oil. If the car is going to be stored where it gets very cold and it will be started during the winter to rotate the engine, it's a good idea to use a thinner viscosity oil to better lubricate the moving parts – i.e. 5W30 instead of 10W30. Do bear in mind that if you generally run thicker oil you'll need to change back in the spring before you start driving the car again.
After coating the gasket, half fill the new filter with fresh oil before installing it – use your hand to screw it in place and make sure it's nice and tight, and a slight tighten with a filter wrench will ensure it doesn't come off.
Then refill the engine with fresh oil, checking the dipstick to ensure it reaches the full level. Start the engine for a few seconds until the oil light goes out, check the oil level and then fill the engine until it reaches the maximum level on the dipstick.
Here we go, perfect!
The next step is to check the antifreeze, not only the level but also the composition. If your Corvette has a modified engine and you run a 70/30 water/antifreeze mix, you need to make sure that you drain it and re-fill the cooling system with a 50/50 mixture for winter; otherwise, water will expand under cold temperatures and can crack the cylinder heads and block.
A good idea is to use an antifreeze tester to measure the freezing point of the coolant – the lower the temperature is, the better off your engine will be during winter storage. As antifreeze ages, its freezing point tends to rise and its anti-corrosion properties get diluted, so it should be replaced every couple of years. From using the tester, the coolant in our C4 indicated a freeze point of approximately -35 degrees Fahrenheit, more than adequate for our needs.
Another obvious task is to fill the washer fluid reservoir. Even though many Corvettes are fair weather drivers, you can't always avoid spring rain showers and having no washer fluid isn't much fun when driving through a downpour.
C4 Corvettes like this one (as well as older Vettes) require periodic greasing of the front end as part of scheduled maintenance. Because the car will be sitting for several months, it's a good idea to grease the nipples before you put it away for winter.
C4s have three grease nipples on each side – one at the top where the spindle attaches to the control arm…
One at the bottom where it attaches to the lower arm, and another where the spindle meets with the outer tie rod end.
C4 and newer Corvettes use composite leaf springs both front and rear. Not only are they incredibly strong but unlike the steel springs found on older Corvettes, they don't lose their memory, so it's not as important to jack the wheels off the ground during winter storage.
That said, care should still be taken when it comes to the tires, to prevent them from flat spotting. One of the first things to do is check the tire pressure at each wheel.
During winter storage, a good method of preventing flat spotting is to bump up the pressure. If normal operating tire pressure is around 30 psi, then inflating the tires to 35 psi for storage will help prevent spotting. Just remember to drop the pressure back down before you start driving the car in the spring. Another good idea is adding blocks of foam under the tires, to reduce the risk of flat spotting.
If you aren't sure what the correct tire pressure is for your car, most Corvettes should still have the factory tire pressure and loading label – on C4s it's located on the driver's side door jamb. If not, refer to the owner's manual for your model and year of car.
Another good precaution is to check the transmission fluid. If it's an automatic like this one, you need to start the engine and warm the car up before checking the fluid level.
You should not only make sure the fluid is up to the maximum level on the dipstick but also check the color. Red signifies the fluid is good – if it's brown you should drain it and replace the transmission filter before putting the car away.
On older cars, it's also wise to inspect the hoses for any signs of cracking or swelling, as a faulty radiator or heater hose can place additional strain on the car's cooling system, robbing you of both performance and comfort once you get the Corvette on the road again. Plus, cleaning up sticky antifreeze as a result of blown hoses is a really messy chore – as this author knows from personal experience.
Also make sure you check the drive belts for condition and tension. Like faulty hoses, an improperly adjusted or worn drive belt can cause serious problems if left unchecked and is cheap to replace.
A good indicator of the condition of the belt can be found on the grooves on the inside. This sample belt is in good shape. If you see cracks appearing in the grooves, it's time to replace the belt.
Another important element before putting your Corvette away for winter is to clean it. In fact, you should clean the car as if you're getting ready for a major show, removing every last bit of dirt, grease and other residue – leaving the car unattended for several months can often cause residue to discolor the paint or damage trim. A good first step is using a quality shampoo to wash the car.
Once the Corvette has been shampooed, rinsed and dried with a detailing cloth, the next step is to wax the body to protect the paint. Because of their fiberglass bodies, traditionally more care was needed to wax Corvettes – today, modern polishes and waxes have advanced to the point that there's a much greater degree of protection. A good quality wax, like those available from Mothers or Meguiar's, is more than adequate.
Before you start, make sure you have a number of terry cloths available for waxing and polishing.
Adding a dab of wax to a terry cloth, slowly apply it to one section of the car at a time.
Let it glaze on the surface for a few minutes…
Before using another terry cloth to buff the paint. Some people think that adding wax and leaving it glazed on the surface during storage is a good idea. It isn't. Come spring, that wax will have hardened to the point that it will be very difficult if not possible to remove and the car will look just awful.
On later Corvettes with black trim and moldings, make sure you remove any traces of wax or polish residue as they can cause it to turn gray, spoiling the otherwise great appearance.
Finally, use another clean terry cloth to remove any remaining traces of wax residue.
Another good idea is to clean the glass. Use specific auto glass foam or cleaner to get the best results; otherwise you'll just smear the windows.
Use a glass cleaner towel to wipe away the excess, leaving your windows nice, clear and streak free.
Don't forget to do the very edges of the windows too, as well as the mirrors.
Now it's time to turn your attention to the interior. Use a slightly damp or anti-static cloth to wipe the dash clean. Do not use an "Armor" cleaner, which actually dries out the material, causing the surface to burn and sometimes, eventually crack. This stuff is best used for dressing the tires.
Once you've finished with the dash you can move onto the console. Anti-static cloths can help when cleaning out little crevices such as around power locks, window or mirror switches. Sometimes you can use cotton buds to get into really small areas.
Next, give the interior a good vacuum and get rid of as much dirt as you can. A good idea is to start with the mats first, as they're often the items that absorb the most dirt and scruffy mats can detract from an otherwise nice interior. If you tend to park your car on a loose gravel driveway in the warmer months, pay special attention, as you'll be amazed at where small gravel particles get.
Once the mats have been pulled out, vacuum every inch of the carpet, including under the seats and around the console – loose change, old french fries, you name it – can often be found hiding under the seats. Removing any old food residue is especially important as it will decompose while the car is in storage, encouraging the formation of moisture and pungent smells, which will be harder to eliminate come spring.
Don't forget the trunk area too. On post-1982 Corvettes this is somewhat easier thanks to a lift-up glass rear window. On older cars it requires a bit more effort, usually by accessing the luggage space by folding the seats.
Another important tip is to coat the rubber seals to prevent them from drying out and sticking together, which can cause them to tear. One of the best things you can use for this is dielectric grease.
Carefully add a small amount of the grease to the weatherstripping, along the entire length.
After a few seconds, use a clean cloth to wipe away the excess. Now you're all set.
One of the biggest potential problems that can result from extended storage is corrosion of the fuel system – and ultimately, hard starting. To prevent this, fill the gas tank right to the brim and add a fuel stabilizer. This will prevent the fuel from breaking down and going stale (which happens in as little as 60 days). If you don't use a stabilizer, the fuel will lose its octane, the water content will increase and also a varnish type residue will build up, which can clog up fuel injectors and carburetor jets.
If the storage unit is cold and has a concrete floor, it can quickly drain the battery of energy, so the best thing is to remove it and place it somewhere warm while the car is in storage, ideally inside the house and supported on blocks of wood or carpet. Having a battery wrench makes things considerably easier. Always disconnect the negative terminal first. On C4 Corvettes, the battery can be pulled out sideways by unfastening the panel behind the front wheel.
If you aren't going to remove the battery, then at the very least, put it on a trickle charge. Extreme cold weather tests the battery's energy output and extended periods of sitting can drain energy which puts greater stress on the cells and plates within the battery, which shortens its operating life.
Before you finally put the car away and pull the battery for good, start the Corvette and warm up the engine for about 15 minutes to make sure the stabilizer gets absorbed into the fuel system. Then it's time to drive into the lockup for storage.
Now that we've performed all of our checks and winter storage maintenance, we put the cover over the car and leave it to hibernate. Make sure you use a good quality, breathable cover that allows air to vent through it. Otherwise moisture can build up between the cover and the surface of the vehicle, causing condensation, which can eventually lead to oxidation. Another good idea is to place carpet underneath the car as it will prevent moisture from rising up from the floor, coating such vulnerable parts as the fuel and brake lines and exhaust system components.
Thanks to a few careful maintenance steps, when it comes time to pull our Corvette out again in the spring it'll be ready for the road – looking fantastic and running perfectly!

subset: commoncrawl


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Still Walking (Aruitemo, Aruitemo)
Dir. Hirokazu Kore-Eda. Japan. 2008. 114 mins.
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I moved here some six years ago and after my first trip down Riverside Drive, wrote a commentary about the unsightly railroad bridge which was in dire need of a paint job.
Well, today I was again driving down Riverside Drive and again viewed the terrible-looking bridge. Nothing has changed.
We have put a great deal of money in the RiverWalk, and it looks great and then you look up?
I believe that the Golden Gate even gets painted ever so many years, and it is much longer and taller. I believe some pressure should be put on the railroad company by the city and county governments.
Clarksville 37043


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Kids of all ages love snacking on these little pancakes that you dunk in pizza sauce. They're great for a quick lunch or appetizer.
No Italian seasoning? Use 1 teaspoon of either dried basil or oregano leaves instead.
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Hey everyone,
Quick question: For some reason, ST2 has decided to give me a colored box as a text cursor instead of the normal single line. I find it very distracting. This is what I mean:
Anyone know how to get it back to normal?
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Ohio State's Aaron Craft scrambles with Washington's Desmond Simmons sfor a loose ball during last year's game with the Huskies. / AP Photo
As Michigan winds down its Big Ten season, coach John Beilein has a habit of pointing out players hes glad he wont have to face again.
After tonight, U-Ms lone Big Ten regular-season meeting of the season against No. 22 Ohio State, he might be able to say good-bye to a four-year pain in his side, OSU point guard Aaron Craft.
The Big Ten player of the week despite averaging only 12 points in two wins, Crafts all-around game pushes the Buckeyes.
While he started his first few years as a defensive stopper and then expanded his offensive skills, he remains a major defensive presence, averaging 2.5 steals this season.
Last week he had nine steals, and his big scoring game with 17 points helped Ohio State upset Iowa in Iowa City.
With the Wolverines already struggling offensively in their past two road games, at Indiana on Feb. 2 and at Iowa on Saturday, facing the defensive-minded Buckeyes tonight at Value City Arena wont help.
The first problem preparing for this game was the Wolverines have no one on their roster who can play the pesky defender in practice.
(Assistant coach) LaVall Jordan does a pretty good imitation of him, Beilein said Monday. (Craft has) got that rare ability to be able to see that ball in slow motion and be able to grab it from you. He averages three steals a game again.
The one thing you had before was he and Shannon Scott werent in together a lot. Now theyre both in together, and (Scotts) stealing it almost two times a game.
Considering what Indiana did with point guard Yogi Ferrell and Iowa with bigger guard Devyn Marble shutting down Nik Stauskas, Craft is the latest challenger.
Despite giving up 3 inches to the 6-foot-6 Stauskas, Craft is adaptable and welcomes the challenge.
Hes going to guard, irregardless of who we put him on, coach Thad Matta said during Mondays Big Ten telelconference. Hes going to do what he does. Hes got a great understanding of moving him around on the ball, off the ballm and hes so cerebral that he gets it.
Crafts biggest weakness might be his desire.
During the tough times we went through, he took a lot of onus and put it on himself, Matta said. I had to sit him down and say, look, you cant carry the weight of the world on your shoulders you have to relax and play basketball.
Crafts overall numbers 9.3 points, 4.8 assists per game arent that impressive.
But as the Buckeyes have improved over the past few weeks, winning four of five, theyve done it defensively, stifling opponents from the three-point line. Foes have hit five or fewer in the four OSU wins.
Beileins biggest concern might be that Craft is not alone.
When they go to Lenzelle Smith or Shannon Scott ... those other guys are pretty good, too, Beilein said.


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New, Sharp, Science,A New Scientist Blog
Jo Marchant, consultant
From Swiss Army knives to iPhones, it seems we just love fancy gadgets with as many different functions as possible. And judging from the ancient Greek Antikythera mechanism, the desire to impress with the latest multipurpose must-have item goes back at least 2000 years.
This mysterious box of tricks was a portable clockwork computer, dating from the first or second century BC. Operated by turning a handle on the side, it modelled the movements of the Sun, Moon and planets through the sky, sported a local calendar, star calendar and Moon-phase display, and could even predict eclipses and track the timing of the Olympic games.
I gave a talk on the device at London's Royal Institution last night. One new clue I mentioned to the origin of the mechanism comes from the Olympiad dial – there are six sets of games named on the dial, five of which have been deciphered so far. Four of them, including the Olympics, were major games known across the Greek world. But the fifth, Naa, was much smaller, and would only have been of local interest.
The Naa games were held in Dodona in northwestern Greece, so Alexander Jones of the Institute for the Study of the Ancient World in New York has suggested that the mechanism must have been made by or for someone from that area.
Intriguingly, this could mean the device is even older than thought……
The Entire Short Article Can be Found Here With Alternate Video
Jo Marchant is author of Decoding the Heavens, a book about the Antikythera mechanism. It has been shortlisted for the 2009 Royal Society Prize for Science Books, and is out now in paperback.


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- Filed Under
A 52-year-old Jefferson man walking across Route 15 South was killed Thursday evening when he was struck by a van, authorities said.
Amir Khan was attempting to cross Route 15 near Tierney Road at about 5:27 p.m. when he was struck by a 2010 Ford van driven by Marcus Cintron, 41, of Jefferson, according to Eric Wilsusen.
Khan was pronounced dead at the scene, Wilsusen said. Cintron was transported to ...


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Detroit Cass Tech's David Dawson, on Wednesday, Dec. 12, 2012. / JULIAN H. GONZALEZ / DFP
Even after a few months of serious observation, David Dawson still doesn't know which university he will attend.
Cass Tech's outstanding offensive guard, who was committed to Michigan for much of 2012 and then decommitted in October, said he's hearing primarily from three schools -- Michigan, Alabama and Ohio State -- and probably won't decide until later in January.
"Those are the three I'm listening to," he said Wednesday at the Free Press/National Football Foundation Dream Team banquet at the Dearborn Inn. "All three programs have a lot to offer, in football, academics, and Ohio State and Michigan are close to home. Alabama, that's a great program."
The decision probably will be delayed until at least late January, once his official visits are done.
Michigan will be this weekend, Alabama on Jan. 11 and Ohio State on Jan. 18.
"So my decision date will be maybe around Jan. 20 or even signing day," he said.
His criteria for the schools?
"My position coach, his record for putting kids in the league, a college and distance, even though Alabama is quite far, and other than that, the family atmosphere," he said.
But going through the process remains an important part after realizing the first time he wasn't completely certain.
While U-M's policy for decommitments is that it will not guarantee it will hold the spot for the player if he takes other visits, Dawson's Rivals.com ranking as the nation's No. 6 offensive guard means his spot probably will be available.
"After I decommitted, I knew I was going to take as many visits as I could to make sure the next decision I made would be the right one and I didn't have to go through anything like this again," Dawson said.
Contact Mark Snyder: firstname.lastname@example.com. Follow him on Twitter @mark__snyder.
Free Press beat writer Mark Snyder will answer your U-M questions in a live chat at 10 a.m. Friday at freep.com/sports. Submit early questions here.


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November 30, 2015
A Fort Worth Police officer injured chasing a kidnapping suspect from College Station has been released from the hospital.
The nearly four-year FWPD veteran had been in the Intensive Care Unit at John Peter Smith Hospital in Fort Worth this weekend but was released as of Sunday.
The suspect that hit the officer head on during the chase near Mansfield, Stanley Robertson of College Station, is still in the hospital in critical condition.
Police were chasing Robertson because he is accused of kidnapping 59-year-old Anne Toliver of College Station from the Wal-Mart on Brothers Blvd. on Friday.
She was found dead behind a shopping center in West Fort Worth early Saturday morning. The Tarrant County Medical Examiner's Office has ruled Toliver died from multiple stab wounds.
Robertson has been charged with aggravated kidnapping and is likely to face several more charges once investigators from Fort Worth and College Station wrap up their investigation into Toliver's death and the crash involving the FWPD officer.
For more video and to read our prior coverage of this story click the link below:
Body of College Station Kidnapping Victim Found in Fort Worth (Saturday Coverage)
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After the introduction of novel effective immunosuppressive therapies, kidney transplantation became the treatment of choice for end stage renal disease. While these new therapies lead to better graft survival, they can also cause a variety of complications. Only small series or case reports describe pulmonary pathology in renal allograft recipients on mTOR inhibitor inclusive therapies. The goal of this study was to provide a systematic review of thoracic biopsies in kidney transplant recipients for possible association between a type of immunosuppressive regimen and pulmonary complications.
A laboratory database search revealed 28 of 2140 renal allograft recipients (18 males and 10 females, 25 to 77 years old, mean age 53 years) who required a biopsy for respiratory symptoms. The histological features were correlated with clinical findings including immunosuppressive medications.
The incidence of neoplasia on lung biopsy was 0.4% (9 cases), which included 3 squamous cell carcinomas, 2 adenocarcinomas, 1 diffuse large B-cell lymphoma, 1 lymphomatoid granulomatosis, and 2 post transplant B-cell lymphoproliferative disorders. Diffuse parenchymal lung disease was identified in 0.4% (9 cases), and included 5 cases of pulmonary hemorrhage, 3 cases of organizing pneumonia and 1 case of pulmonary alveolar proteinosis. Five (0.2%) cases showed histological features indicative of a localized infectious process. Patients on sirolimus had neoplasia less frequently than patients on other immunosuppressive combinations (12.5% vs. 58.3%, p = 0.03). Lung biopsies in 4 of 5 patients with clinically suspected sirolimus toxicity revealed pulmonary hemorrhage as the sole histological finding or in combination with other patterns.
Our study documents a spectrum of neoplastic and non-neoplastic lesions in renal allograft recipients on current immunosuppressive therapies. Sirolimus inclusive regimens are associated with increased risk of pulmonary toxicity but may be beneficial in cases of posttransplant neoplasia.
Virtual Slides
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3320012126569395 webcite.
Keywords:Kidney transplantation; Pulmonary neoplasia; Pulmonary hemorrhage; Mammalian target of rapamycin (mTOR) inhibitors; Sirolimus
Kidney transplantation is considered the treatment of choice for end stage renal disease (ESRD), which is in part due to availability of more effective immunosuppressive regimens. The mammalian target of rapamycin (mTOR) inhibitors, rapamycin, also known as sirolimus, and everolimus, have been recently widely utilized in immunosuppressive regimens providing adequate immunosuppression and avoiding nephrotoxic side effects of calcineurin inhibitor therapy [1-4]. However, prolonged graft survival leads to increased incidence of complications related to both immunosuppression and drug toxicity. Drug induced immunosuppression halts tumor surveillance leading to an increase in tumor development. Epidemiologic studies show that posttransplant lymphoproliferative disorder (PTLD) and skin cancers increased most dramatically following kidney transplantation [5-8]. In addition to immunosuppression, sirolimus exhibits antineoplastic properties in vivo [9] and newer rapamycin analogs have been evaluated in clinical trials for treatment of renal cell carcinoma [10]. Clinical experience with these medications is limited; but it has been shown to cause regression of PTLD and Kaposi sarcoma [11-14]. The incidence of pulmonary toxicity in patients on mTOR inhibitors has been reported to be up to 11% [15,16]. Risk factors for the development of sirolimus-associated pneumonitis include higher dose, greater trough levels and older age [17]. While the contribution of other causes in the setting of mTOR inhibitor induced immunosuppression is difficult to separate from direct drug toxicity, a range of pulmonary histopathologic changes has been suggested as manifestations of drug toxicity. Depending on biopsy modality these include descriptive diagnoses or better-defined histological patterns such as organizing pneumonia and diffuse alveolar hemorrhage [15,16,18-20]. Pulmonary hemorrhage has been reported as a sole histological finding [21] but also in combination with others [18]. Other rare pulmonary manifestations include pulmonary alveolar proteinosis [22], desquamative interstitial pneumonitis [23], hypersensitivity pneumonitis [24], necrotizing granulomas and vasculitis [25], diffuse alveolar damage [26] and non-necrotizing granulomas [19]. Since the reported histological manifestations are not specific for sirolimus toxicity, drug discontinuation with or without steroid therapy is the mainstay of treatment in suspected cases and typically leads to resolution of symptoms within 2 to 4 months [18]. To the best of our knowledge, only small series or case reports describe pulmonary pathology in renal allograft recipients and the concept of sirolimus-associated pulmonary complications is still evolving. Therefore, the goals of this study were to provide a systematic review of pulmonary histological findings in the setting of kidney transplantation and elucidate the possible contribution of the current immunosuppressive regimens to the spectrum of the observed histological changes.
Material and methods
A laboratory information system database search from January 2002 to September 2010 revealed 28 renal allograft recipients who required a lung biopsy for respiratory symptoms. In total, 42 biopsies were performed, including 8 (19%) video-assisted thoracoscopic biopsies, 28 (67%) endobronchial biopsies, 5 (12%) needle biopsies, and 1 (2%) mediastinal lymph node biopsy. Sixteen (38%) biopsies were nondiagnostic. Biopsies were considered non-diagnostic if they had limited tissue or minimal nonspecific histological changes such as chronic inflammation or focal interstitial fibrosis. Hematoxylin-eosin (H&E) stained slides (range, 1-19; mean, 3 slides) and special stains for microorganisms including Gomori methenamine silver, Ziehl-Neelsen and gram stains, performed on formalin-fixed, paraffinembedded tissue were re-examined. The radiology studies including chest computed tomography (CT) were reviewed in respect to localized versus diffuse changes. Localized lesions included nodules or masses while the diffuse lesions were comprised of diffuse or patchy bilateral ground glass opacities, reticular densities, bilateral consolidations, mosaic attenuation, and traction bronchiectasis. Retrospective analysis of electronic clinical records and correlation with histological findings and type of immunosuppressive therapy were performed. The electronic medical records were reviewed with special attention for evidence of systemic diseases and infectious complications including microbiological cultures and serologies for viral and fungal pathogens. Review of immunosuppressive regimens included an active list of medications pre-and post-lung biopsy. Clinical and pathological findings were analyzed utilizing mean ± SD for continuous variables, and number or percentage for categorical variables. Comparisons were performed using Yates' chi-square test for categorical variables, and the two-sample t test for continuous variables. The study was approved by The Ohio State Biomedical Sciences Institutional Review Board in compliance with Health Insurance Portability and Accountability Act regulations.
Clinicopathological findings in patients with kidney transplant
The main clinical and pathological findings are summarized in Table 1. Twenty-eight of 2140 (1.3%) kidney transplant recipients over the period of 105 months underwent a lung biopsy for pulmonary symptoms. They included 18 males and 10 females with an age range from 25 to 77 years old (mean age of 53 years). The time from kidney transplantation to lung biopsy ranged from 4 to 345 months (mean 81 months). In 19 cases (68%) the biopsies were performed to obtain tissue diagnosis for localized lesions, and in 9 cases (32%) for diffuse lesions. The majority of patients (18/28 or 64%) received a deceased donor kidney. Eight patients (29%) received kidneys from living related donors; two patients (7%) received kidneys from living unrelated donors. One patient received three transplants, including two cadaveric and one living related. Twenty-five (89%) patients had kidney-only transplant, while three patients (11%) had a combined kidney and pancreas transplantation. The most common cause of ESRD was diabetic nephropathy (10/28; 36%). Other causes included hypertension (2/28; 7%), polycystic kidney disease (2/28; 7%), glomerulonephritis (4/28; 14%), granulomatosis with polyangiitis (Wegner's granulomatosis) (1/28; 4%), IgA nephropathy (1/28; 4%), chronic reflux (1/28; 4%), p-ANCA-positive microscopic polyangiitis (1/28; 4%), and interstitial nephritis (1/28; 4%).
Table 1. Clinical pathological findings in kidney transplant recipients
Neoplasia on lung biopsy was identified in 9 (0.4%) of 2140 kidney transplant recipients. Among 9 cases there were 5 non-small cell carcinomas and 4 PTLD. Non-small cell carcinomas included 3 cases of squamous cell carcinoma and 2 cases of adenocarcinoma (Figure 1A). PTLD included 1 case of diffuse large B-cell lymphoma, 1 case of lymphomatoid granulomatosis (Figure 1B-C) and 2 cases of post transplant B-cell lymphoproliferative disorders. Diffuse parenchymal lung disease was identified in 9 (0.4%) cases. In 2 cases, pulmonary hemorrhage (PH) was the sole histological finding. In 1 case PH was associated with capillaritis. In 1 case PH was associated with pulmonary alveolar proteinosis (PAP) and in 1 case with diffuse alveolar damage (DAD). PH associated with capillaritis was documented in a patient with WG and was considered a pulmonary manifestation of the disease. Organizing pneumonia (OP) as the main histological finding was identified in 3 cases and PAP was identified in 1 case. Five (0.2%) cases showed histological features indicative of an infectious process including tissue necrosis, necrotic cellular debris, acute inflammation, and granulomas. In 1 of 5 cases, granulomatous inflammation was associated with Pneumocystis jiroveci (Figure 1D). Lung biopsy showed minimal findings in 5 (0.2%) patients.
Figure 1. Neoplastic and non-neoplastic localized lesions in renal transplant recipients. (A) adenocarcinoma with predominantly micropapillary pattern (case 22, hematoxylin-eosin, original magnification x200); (B) lymphomatoid granulomatosis showing angiocentric proliferation of atypical lymphoid cells associated with Epstein-Bar virus (C), (case 25, hematoxylin-eosin and colorimetric in situ hybridization, original magnification x200 and x400, respectively); necrotizing granuloma (D) associated with Pneumocystis jiroveci (case 21, hematoxylin-eosin and Gomori methenamine silver, inset, original magnification x100 and x600, respectively).
Clinicopathological findings in patients on sirolimus
All patients with a lung tissue diagnosis received combination immunosuppressive therapy. The immunosuppressive regimen of 16 of 28 (57%) patients included sirolimus (Table 2). Other immunosuppressants were comprised of cyclosporine (25/28; 89%), prednisone (23/28; 82%), dexamethasone (4/28; 14%), mycophenolate mofetil (6/28; 21%), and mycophenolic acid (2/28; 7%). The groups of patients receiving sirolimus versus other immunosuppressive medications were of similar age and gender (Table 2). However, the mean time from the transplant to lung biopsy of patients on sirolimus was shorter (44.7 ± 52.04 vs. 128.3 ± 89.32, p = 0.01). Patients on sirolimus less frequently than patients on other immunosuppressants had neoplasia (12.5% vs. 58.3%, p = 0.03). Tumors in patients on sirolimus included 1 squamous cell carcinoma and 1 post transplant B-cell lymphoproliferative disorder. Tumors in the non-sirolimus group included 2 adenocarcinomas, 2 squamous cell carcinomas, 1 posttransplant B-cell lymphoproliferative disorders, 1 diffuse large B-cell lymphoma and 1 lymphomatoid granulomatosis. Patients on sirolimus had a tendency to have diffuse parenchymal lung disease (37.5% vs. 25.0%), including hemorrhage (25.0% vs.8.3%). The results, although suggestive of an association, did not achieve statistical significance.
Table 2. Clinicopathological findings in patients on sirolimus versus other immunosuppressive therapy
Sirolimus toxicity and response to treatment modification
Sirolimus toxicity was suspected clinically in 5 (31.3%) of 16 patients. Their mean trough sirolimus levels were not statistically different from the other 10 cases on sirolimus (10.3 ± 5.72 ng/ml vs. 7.6 ± 3.56 ng/ml). Among these 5 cases, lung biopsies in 4 revealed pulmonary hemorrhage and OP, in 1. All 5 patients showed clinical and radiological improvement after the drug discontinuation. Their clinical course and response to treatment modification is detailed below.
In case 4, a 54 year old woman was admitted with recurrent shortness of breath for the fourth time in the five months following kidney transplant. The patient had a past medical history of chronic obstructive pulmonary disease and congestive heart failure with basic oxygen requirements of 3-4 l via nasal cannula. On her current admission she was in severe respiratory failure, requiring mechanical ventilation. Her trough sirolimus levels following transplantation were within range from 4.0 to 17.1, (mean, 8.8), normal 3-20 ng/ml. A chest CT on admission showed diffuse ground glass opacities and pleural effusions. Endobronchial biopsy was nondiagnostic, while a subsequent open lung biopsy showed collections of hemosiderin laden macrophages occupying alveolar spaces as well as hemosiderin granules within interstitium (Figure 2A). Evaluation for infectious organisms and vasculitis was negative. Since treatment for infection did not produce any significant improvement, sirolimus toxicity was suspected and sirolimus was discontinued. The patient returned to baseline respiratory status (3-4 l of oxygen) with improvements in bilateral opacities radiologically within 6 months. Following discharge, the patient required a single readmission for respiratory symptoms over the subsequent 33 months. At that time she was admitted for respiratory failure and subsequently expired. Postmortem examination revealed extensive hemosiderin deposition and a left upper lobe adenocarcinoma.
Figure 2. Pathological findings in patients with sirolimus toxicity. In case 4, open lung biopsy shows diffuse alveolar hemorrhage represented by collections of hemosiderin laden alveolar macrophages (A, inset) and occasional hemosiderin granules within interstitium, (hematoxylin-eosin, original magnification x100 and x400, respectively). In case 10, open lung biopsy shows pulmonary hemorrhage in association with pulmonary alveolar proteinosis and organizing pneumonia: there are areas with hemosiderin deposition within interstitium (B) and cholesterol granulomas, finely granular proteinaceous material with cholesterol clefting (C) and foci of organizing pneumonia (D) in adjacent alveolar parenchyma, (hematoxylin-eosin, original magnification x100, x200 and × 40, respectively). Computed tomography of the chest at the time of open lung biopsy shows diffuse ground glass and "crazy pavement" opacities (E). Follow up computed tomography in 8 months (F) shows marked decrease in alveolar opacities; both scans are at the level of aortic arch for comparison. In case 16, open lung biopsy shows a combination of diffuse alveolar damage and pulmonary hemorrhage: there are edematous alveolar septae lined by hyaline membranes (G) and hemosiderin-laden macrophages (H) within alveolar spaces (H&E, original magnification x200 and x400, respectively).
Case 10 is that of a 39-year-old African-American male, 80 months post kidney transplantation, hospitalized for increasing shortness of breath with increasing creatinine levels. His progressive hypoxia resulted in intubation. A chest CT showed diffuse bilateral ground glass opacities, "crazy pavement" pattern and focal nodular consolidation. His trough sirolimus levels within 6 months prior to admission were 8.1-11.8, (mean, 10.2) normal, 3-20 ng/ml. Hemosiderin laden macrophages associated with rare cholesterol granulomas were seen on transbronchial biopsy. His respiratory status continued to deteriorate and open lung biopsy was performed that showed alveolar and interstitial hemosiderin deposition accompanied by patchy organizing pneumonia, cholesterol granulomas and eosinophilic proteinaceous granular material (Figure 2B-D). The findings were compatible with a combination of PH and PAP. He underwent therapeutic bronchioloalveolar lavage and the decision was made to discontinue all immunosuppressive medications other than prednisone. During his nearly 2 month hospital stay, he was gradually weaned from ventilation support and his oxygen requirement at the time of discharge was 2 l of oxygen. Over the ensuing 8 months he showed clinical and radiological improvement (Figure 2E-F) on mycophenolate maintenance therapy. At 3.5 years of follow up, the patient was on maintenance mycophenolate therapy, had intermittent problems with recurrent lower respiratory tract infections, residual restrictive lung disease, and continued to use 2-3 l of oxygen via nasal cannula mostly with exercise.
Case 12 represents a 58-year old female who was hospitalized 24 months post kidney transplantation with shortness of breath, hypoxia, and renal failure. Her trough sirolimus level before admission was elevated to 19.7 ng/ml, normal 3-15 ng/ml. A bronchoscopic biopsy revealed occasional hemosiderin granules. Her symptoms did not improve and an open lung biopsy revealed histological evidence of PH with alveolar and interstitial hemosiderin deposition. Respiratory and blood cultures remained negative throughout the patient's stay. Sirolimus was stopped and over the following 4 months she showed significant clinical improvement despite continued baseline oxygen requirements.
Case 16 is that of a 34-year old female who was admitted in respiratory failure 17 months post kidney-pancreas transplant with two episodes of acute rejection. Her trough sirolimus levels were within range 2.4-6.7 ng/ml, mean 4.2 ng/ml, normal 3-15 ng/ml. Hemosiderin laden macrophages were present in the bronchioalveolar lavage fluid. Sirolimus toxicity was suspected and sirolimus was discontinued. Despite extensive work-up for infectious and rheumatologic etiologies and treatment with wide spectrum antibiotics she remained in respiratory failure. An open lung biopsy showed a combination of DAD and PH with hyaline membranes, architectural simplification with alveolar septal collapse, diffuse myxoid thickening, type 2 pneumocyte hyperplasia, and alveolar and interstitial hemosiderin (Figure 2G-H). The patient's treatment also included mechanical ventilation, volume and blood pressure control. After 2 months at a rehabilitation facility, her shortness of breath and cough were significantly improved and chest CT revealed resolution of the bilateral infiltrates. On further follow-up, the patient reported minimal respiratory symptoms.
Case 28 represents a 31-year-old male, 220 months post kidney transplantation, started to experience cough and dyspnea. He received a course of antibiotics for community-acquired pneumonia with no improvement. His trough sirolimus levels within previous 6 months were 4.4-13.2 ng/ml, (mean 8.6 ng/ml), normal 5-30 ng/ml. He underwent an extensive evaluation including a CT scan of the chest revealing extensive ground glass densities in a multifocal distribution. Evaluation for collagen vascular disease and infectious etiologies were negative, including a bronchoscopic examination with microbiological cultures. Transbronchial lung biopsy showed patchy organizing pneumonia and chronic inflammation. Since no systemic or infectious causes for his symptoms were found, sirolimus toxicity was suspected. Sirolimus was discontinued and he was given a course of oral corticosteroids. Over the following 2 months, his respiratory status improved significantly, with no reported shortness of breath, cough or wheezing and discontinuation of supplemental oxygen.
Kidney transplant recipients are known to be at increased risk for malignancy with up to 2 fold increased incidence rates for lung cancer and 20-fold increased incidence rates of PTLD [5]. Our retrospective review shows a wide spectrum of neoplastic and non-neoplastic lesions in the lungs of kidney transplant recipients on current immunosuppressive regimens. Among the neoplastic lesions there were 5 cases of non-small cell lung carcinoma and 4 cases of PTLD with incidence of approximately 0.2% each. The incidence of lung carcinoma in our series was similar to what was previously reported in other single center cohorts [27,28], exceeding the incidence seen in general population [5]. The incidence of PTLD was lower, which is likely due to the fact that our study examined only lung biopsies and therefore couldn't account for the PTLD involving other sites. PTLD reportedly affects 1.8% of patients with up to 50% of cases presenting with extranodal masses, including lung nodules [29-31].
When correlated to the type of immunosuppression, the frequency of neoplasia in patents on sirolimus was lower (12.5% vs. 58.3%, p = 0.03) relative to patients on other immunosuppressants. It is possible that the longer transplant to lung biopsy time in the non-sirolimus group may have contributed to increased tumor detection. Nevertheless, our findings are in agreement with studies supporting antineoplastic properties of mTOR inhibitors in pre-clinical testing [9,32,33] and clinical studies of patients with post transplant solid organ tumors [28,34-36], suggesting that sirolimus may be beneficial in preventing posttransplant malignancies.
Our study also demonstrates that pulmonary hemorrhage is a common histological finding in cases with clinically suspected sirolimus toxicity. In this cohort, it can be seen as the sole histological finding or in combination with other histological patterns including DAD and PAP. Based on their own experience and review of the literature, Pham and colleagues list pulmonary hemorrhage, organizing pneumonia, and lymphocytic pneumonitis among the most common histological patterns of sirolimus toxicity [18]. From a clinical management point of view, the histological diagnosis of pulmonary hemorrhage carries a task of elucidating its possible causes which generally include alveolar hemorrhage syndromes or secondary causes associated with infections, toxic inhalation, coagulopathies, renal failure with volume overload, and venous congestion due to heart disease to name a few [37]. In our series only one case with PH was linked to Wegener's granulomatosis. During their clinical course, the study patients experienced renal failure with wide fluctuation of serum creatinine levels; however, the renal function was generally well controlled, and none had clinically documented sustained fluid overload. In our cases pulmonary hemorrhage could not be explained by any other causes, and sirolimus discontinuation lead to the gradual clinical improvement. In case 4, the patient had congestive heart failure, which histologically can be associated with pulmonary hemosiderin deposition. Therefore, it is difficult to completely exclude the contribution of the patient's underlying heart disease to the observed histological findings. In that regard, this case is similar to that reported by Hashemi-Sadraei N and colleagues [38]. They described a renal transplant recipient who was on chronic anticoagulation therapy for a prosthetic aortic valve, and who developed pulmonary symptoms following initiation of sirolimus therapy. An open lung biopsy showed diffuse alveolar hemorrhage with fibrin deposits in the alveolar spaces and small bronchi. Even though the underlying disease, congestive heart failure or heart valve requiring anticoagulation therapy, may have contributed to the pulmonary hemosiderin deposition, in both of these cases the response to sirolimus discontinuation suggests a causative association between the drug and pulmonary hemorrhage.
Other histological patterns identified within a spectrum of the diffuse parenchymal lung disease in patients on sirolimus were OP, DAD, and PAP. The spectrum of etiologic considerations in OP includes infection, collagen vascular disease, toxic inhalation, aspiration pneumonia, hypersensitivity pneumonitis, and drug toxicity [39,40]. Additionally, OP can be a minor component of other interstitial lung diseases. OP is one of the relatively frequently reported manifestations of sirolimus toxicity [18]. We identified OP as a main histological feature in 3 cases; however, it was also observed as a minor component in other cases including cases of pulmonary hemorrhage and DAD. This could be a reason for some discrepancy between reported frequencies of OP, especially if a diagnosis is rendered on a small endobronchial or transbronchial biopsy [18]. DAD is a well recognized histological pattern known to be associated with drug toxicity [41]. Among tissue reactions associated with sirolimus toxicity, only one case of DAD has been documented in the literature. Manito and colleagues [26] reported a fatal course of DAD in a 52-year-old man heart transplant recipient following a loading-dose of sirolimus administration. We observed DAD in one patient on sirolimus (case 16) where an open lung biopsy revealed a combination of DAD and pulmonary hemorrhage. No infectious or systemic disease was documented with extensive clinical evaluation. Despite wide spectrum antibiotics coverage, the patient showed a protracted clinical course but gradually improved over 2 months after sirolimus discontinuation showing only minimal pulmonary symptoms.
PAP is a rare poorly understood disorder that is characterized by accumulation of lipoproteinaceous surfactant-like material within alveolar parenchyma. Impaired macrophage function due to antibodies to granulocyte macrophage-colony stimulating factor is thought to be a key mechanism in primary PAP. Macrophage dysfunction due to immunosuppression is considered as one among many other causes of secondary PAP. It has been linked to sirolimus toxicity in 2 previously reported cases [22,42]. PAP histology in our series was documented in both sirolimus (1 case) and non-sirolimus (1 case) groups, suggesting that this is a secondary immunosuppression related tissue reaction that is not directly related to sirolimus toxicity.
Sirolimus induced immunosuppression results from the inhibition of T and B lymphocyte proliferation through the same mechanisms as it inhibits cancer cell proliferation. These effects are thought to be mediated through the rapamycin-FKPB12 complex altering the mTOR signaling network which includes tumor suppressor genes (PTEN, LKB1, TSC1, and TSC2) and proto-oncogenes (PI3K, Akt, and eIF4E) [43]. While the exact mechanisms of sirolimus toxicity are not known, several hypotheses have emerged. Clinical improvement after sirolimus dose reduction provides evidence for a dose-dependant pulmonary toxicity. Clinically and radiologically documented pneumonitis in kidney transplant recipients has been reported to improve dramatically after sirolimus dose reduction and the maintenance of lower trough levels [44]. BAL fluid analysis in cases of the drug induced alveolitis showed a predominance of CD4-positive lymphocytes allowing the authors to suggest that a cell mediated autoimmune response may be one of the factors responsible for sirolimus induced pulmonary toxicity [44]. Furthermore, it has been speculated that the drug's high affinity for plasma proteins may render sirolimus immunogenic as a hapten eliciting cascade of T-cell mediated delayed type of hypersensitivity reaction [18]. These hypotheses appear to capture the state of current knowledge; however, detailed mechanisms of sirolimus toxicity and their relationship to the spectrum of histological patterns of parenchymal lung disease are yet to be elucidated.
Our study documents that kidney transplant recipients show a range of pulmonary neoplastic and non-neoplastic lesions, which are likely associated with the type of immunosuppressive regimen. Current mTOR inhibitor inclusive regimens may account for decreased number of tumors in kidney transplant recipients but also carry a risk of pulmonary toxicity manifesting histologically by pulmonary hemorrhage, organizing pneumonia and other less common histological patterns.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
SK reviewed cases, analyzed findings and drafted the manuscript. AS, SB, AP-H, DN, RP, TN and KS designed the study, participated in data collection and edited the manuscript. CH and PR participated in data collection and edited the manuscript. KS also reviewed the cases, developed and approved the study protocol, revised and edited the manuscript. All authors have read and approved the final manuscript.
The authors are thankful to Rick Marshall and Cheryl Reeder for help with database searches. The findings of the study were presented in part at the 100th United States and Canadian Academy of Pathology Annual Meeting, February 27 to March 4, 2011, San Antonio, Texas.
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An Indonesian National Search and Rescue Agency worker scans the seas from a boat on patrol in the Malacca Strait off Aceh, Indonesia. / Chaideer Mahyuddin, AFP/Getty Images
It's Day 6 of the search for Malaysia Airlines Flight 370, and there's still a lot of confusion around what happened.
Enter DigitalGlobe. The company is getting imagery from the Gulf of Thailand from its five satellites and wants your help to sift through it for clues using the crowdsourcing platform Tomnod.
This isn't the first time DigitalGlobe had issued such a challenge. Last year, the company urged users to analyze damage from Typhoon Haiyan.
This time, users can tag anything they see in the imagery, from plane wreckage to oil slicks. A computer algorithm will cross-check the tags, which will be reviewed by expert analysts.
As of Wednesday, Shay Har-Noy, DigitalGlobe's senior director of geospatial big data, says the site has seen more than 2 million participants, more than 98 million map views and more than 645,000 tagged features, but those numbers are rapidly changing.
"We've seen great progress," Har-Noy says. The challenge is "we're looking for a needle in a haystack, except the haystack is a giant body of water."
Despite that, the outpouring of support for the effort has been "unprecedented." So much so, that at one point, users couldn't access the site or maps.
Since then, Har-Noy says, the kinks have been worked out, and users are back in stride.
On Twitter, Tomnod users share what they've seeing. Canadian Maven (@cdnmaven), for instance, reported finding leftover debris from the 1999 crash of Egypt Air Flight 990.
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Read the original story: How to help find Malaysia Airlines Flight 370


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A man died Thursday in a fire that destroyed three houses in Highland Park.
Fire Chief Derek Hillman said fire crews were called at 10:37 a.m. to the 100 block of Portage, near Hamilton Avenue, where a colonial style home was fully involved in flames. The houses on either side of it were also burning.
Firefighters found a man deceased in the center house. Hillman did not release the man's name or age Thursday night, saying officials were still ...


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On top of being a gifted filmmaker, Geyrhalter is also a skilled businessman. In 1994 he founded Nikolaus Geyrhalter Filmproduktion, a production company specializing in theatrical feature and documentary releases and quality broadcast films. The company has gradually taken in other like-minded filmmakers who associate quality with films that have the power to surprise, move and inspire the audiences. Geyrhalter adds another important element to the mix – the ability to entertain.
His approach is evident as early as in his 1990s films, Washed Ashore (1994), The Year After Dayton (1997), and the internationally awarded Pripyat (1999). Geyrhalter works with a series of microstories, with a chain of episodic sequences internally divided by a black visual break, and separated between each other by a sharp cut. He gradually works his way towards unfolding a series of microfilms before the viewer, with each bit impressive by itself. Once combined, their impact is all the stronger, like pieces of caviar. Each film cell has its own microstory, joke and even a punchline, its own protagonists and purpose. First, the filmmaker selects the subject for his testing, mostly a geographically defined entity, whether it be a village, a military area, the Danube landscape, Europe, etc. In Pripyat, the entity of choice is a real zone, a place surrounded by clear boundaries that had been set up for a clear purpose. It is a thirty kilometer radius around the Chernobyl nuclear plant. The post-apocalyptic essence is conveyed through black-and-white cinematography. Compared to his earlier films, it is apparent that Geyrhalter's method has matured, and his observation and directing skills have become more refined. What could still seem as an experiment in Pripyat later turns into purposeful use of possibilities. Individual images come to show more planning and focus, along with a better thought-out and more ingenious structure. At this stage, the mise-en-scene does not yet have its conceptual power, the authorial style is still settling to find its shape and form.
Geyrhalter assumes complete mastery of his filmmaking method in the award-winning Our Daily Bread (2005) and all films that follow. Our Daily Bread and 7915 km (2008) both look at well-known issues from an angle that is not too common, predictable or widely acceptable. The first film deals with the livestock industry, the cold and mechanical encounter of a machine, man, and an animal that will be processed into food. Few of us could claim that they have nothing whatsoever to do with the industry. Few of us could give a clear answer on whether chickens or workers get abused at the chicken plant. The second film follows the famous Dakar Rally. Confrontation is used as a device – people watch the rally at a European snobbish party, while somewhere in Africa, others watch it on a small TV set.
The filmmaker presents images with an apparent intent to make the viewer aware of her position in the depicted material, that is, her attitude towards European cars and European (Western) culture on its way across Africa. What's at stake for the people who are being passed? In other words, what's Africa like beyond the expensive and closely watched rally race business that storms through? The stops Geyrhalter makes are defined by the rally route. Like in his other films, Geyrhalter once again proves his talent for an uncommon perspective and a light joke (extended shot length, carefully composed mise-en-scene). Those who are usually quiet now get to speak. Their seemingly casual small talk emanates pure magic of being able to share something unique and rare. The filmmaker has conjured up closeness, interest and empathy, which is what makes the protagonists people just like us. In this newly enriched perspective, the world suddenly looks a little different.
One of Geyrhalter's most impressive techniques is a good sense of paradox and subtle irony. In 7915 km, for instance, the camera follows a young Senegalese girl as she is walking down the road used by rally trucks. Yet while she is talking and pointing to different directions and different places, the camera does not turn away from her but keeps staring at her. This generates a feeling of goofy, casual humour based on gag-specific principles (every time, the viewer expects to see the thing pointed at but his expectations fail). The unmoving stare is also the author's way to make people say more than they'd ever meant to say.
Allentsteig (2010) is a prime example of Geyrhalter's refined method. It deals with a German military area in Austria, since the 1950s used by Austria's military. This television documentary is built around static, meticulously composed shots with a great potential for goofy humour. A snow covered winter landscape, a romantic white plain that carries the sound of exercise shots is just one of many examples of soft irony. And another image: one after another, soldiers pop out of a small green tent as clowns from the Trabant.
Geyrhalter's method slides to another mode in Abendland (2011). While it uses the same devices and film cells that make up the whole (which is more than just the sum of its parts), the territory and subject of Abendland are much broader and rather vaguely defined: Europe at night. Yet, such an immense colossus would require more building blocks and Geyrhalter's "map" sorely lacks in density. Then again, it would be an impossible density; using Geyrhalter's method, the film would be unbearably long because Europe at night involves an unimaginably infinite number of things – it sleeps, has fun, eats and drinks, dances and sings, debates and guards its borders, protects the peace of the just born, the sick and the dying, safeguards individuals as well as the system, builds and destroys. Europe by night glows and flickers. Europe by night is as alive, if not livelier, as it is by day. It raises questions that are not always pleasant. How often does a CCTV operator watch our drunken joyride through the city? How often is our privacy merely an illusion? Geyrhalter does not declare a simple premise about our supervised culture, he does not condemn it and stop there. The system has multiple faces and simple answers are rarely right. Are we not happy that a security camera watches in case an armed attacker jumps out of the bushes? Should monitors not watch over a preterm infant day and night? This is only a tiny fraction of many possible questions that spring to mind. What's undeniable is the remarkable scope of locations and the amount of energy invested by the crew in shooting an odd bit here and there where another filmmaker might make a four-part film; take, for example, the sex industry and call lines not to be dialed before 10 p.m. (a snippet shot in the Czech Republic). Geyrhalter's power lies in the way he treats the subject. He does not suck his topics dry but leaves them with an enigma and possibilities that can be hijacked by the viewer. He stops before he becomes dull. It is another expression of smartness that characterizes his films.
Geyrhalter always captures a living mechanism that is displayed in all its diversity and multiplicity, in which even contradictory elements serve the whole. All is held together by Geyrhalter's ability to hold a thought, yet he is in no way forceful. The sum of information and the treasures he has gathered are laid before the viewer who is free to link the individual film cells and finds, create a narrative and motivation, and arrive at an opinion. The director nudges the viewer without pushing. And while viewers may choose to remain on the level of cells and disregard the body, to do so would be to their own loss.
Written by Kateřina Surmanová
Related Articles:
Marcin Koszalka and Family Cinema Therapy
Audrius Stonys and Visual Immediacy


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Although same-sex couples could have obtained a marriage license from the Morgan County clerk between Dec. 23 and the morning of Jan. 6, none did. And because of a Supreme Court ruling Jan. 6, it is not likely to happen again until a federal appeals court can rule on whether the Utah law banning same-sex marriage violates the Constitution.
Morgan County offices were closed Friday when a federal judge ruled the state's ban on same-sex marriage had been overturned. But Morgan County Attorney Jann Farris was watching the news with the rest of the state.
Morgan County offices were closed Friday when U.S. District Court Judge Robert J. Shelby ruled that the 2004 Utah State Constitutional amendment defining marriage as only a legal union between a man and a woman was unconstitutional. He ruled that the amendment violates due process and equal protection under the fourteenth amendment. Salt Lake County immediately began issuing licenses.


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To browse through our classes and register online, click the following class categories.
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Learn more about the reimbursement options available to you through Physicians Plus Insurance Corporation, Unity Health Plan and GHC.


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Horror Movies Forum » General Horror Movie Discussion » Gene Simmons
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yes I'm remeber that part lol..and then Regan came down the steps and pissed on the floor and said to them that there all gonna die up there..
Why did they make two versions of EXORCIST IV ? Two directors ,two versions.
Courtesy of IMDB:
Morgan Creek Productions fired Paul Schrader after he had submitted a completed movie, saying that he had given them "footage without any of the bloody violence the backers had wanted". He had already made it clear in interviews that he was making more of a psychological drama than an all-out gore-fest. He was fired and Renny Harlin was hired to re-shoot the movie. Almost 90% of the movie was re-shot and at least two characters have been dropped from Paul Schrader's version of the movie. Following the lackluster reception to Harlin's version, though, Schrader's version was finally released as Dominion: Prequel to the Exorcist (2005).
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I'm getting ready to watch Paul Schrader's version right now. I'll review it later. Thanks.
Both EXORCIST prequels were boring and humorless. The first one had gore , theological points and a hell of alot of humor. The 3rd one got back to that a bit because WILLIAM PETER BLATTY got back to the roots a bit. So, the 2nd and both 4th EXORCISTS blow. I'd say let us try another one without the pretentious drivel.
Ya sure Gene in his prime was a shocker and different, but what about alice cooper he came BEFORE gene simmons, all gene is for is the mighty Buck, he's a big sell out, alice cooper is a more original shocker then gene simmons and i saw trick or treat eww and what a part he had in that a cameo as a disc-jockey the movie was good for the time it was released.But for now Rob Zombie has the Brains,Imagination, and Not wanting to sellout to tell a "True" Horror story where the good guys dont always win.I think Rob Zombie Should try do a crow movie with "a perfect circle " doing the soundtrack would be pretty serious!, Or Collaborate with King Diamond on some real Sinister music or Writings...Gene simmons can keep on trying to sell that warehouse full of 20 year old kiss labeled underwear thats still collecting dust, While Rob Zombie can keep makeing our nightmares come true...
\ROB ZOMBIE wants like hell to sellout: sellout every theatre on opening day. He wants to make money and have fun. Why do you think he is creating all the hype about casting and script changes. He wants to sell tickets and makes no bones about it. I would love to sellout as well. What's wrong with money? Try making a movie without it or eating without it. The starving , misunderstood artist is a boring cliche. You can do it all: make a great movie that makes money. LOVE AND KISSes, TOD1.


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Appealing a Tricare decision to the highest level within the Defense Health Agency may take nearly a year but that doesnt necessarily mean those decisions go against beneficiaries in the end, according to a report recently provided to Congress.
In fact, of the 124 cases that made it to the highest level of appeal from 2009 to 2013, 106 or 85 percent of lower-level appeals rulings in favor of beneficiaries were upheld.
During that time, Tricare beneficiaries appealed 65,336 denials of claims, resulting in 3,913 formal reviews and 303 hearings at the Defense Health Agency level, according to the report.
As part of the 2014 Defense Authorization Act, the Senate required the Pentagon provide a report on the Tricare appeals process after beneficiaries and advocacy groups raised concerns about fairness in the process.
A few well-publicized cases, including one involving a disabled Texas teenager whose horse-based physical therapy was recommended by a Tricare hearing officer but later was denied by the Tricare appeals director, prompted the Senate requirement.
The appeals process can involve up to three levels. After beneficiaries receive an initial denial for reimbursement, they can appeal to their regional Tricare contractor; if the denial is upheld, the appeal goes to Defense Health Agency Appeals or Quality Monitoring Contractor, depending on the nature of the case; and finally, an appeal can be made to an independent hearing officer.
In 2013, just 27 hearings reached that final level. The hearing officer adopted the lower-level recommendations in 23 of those cases and overturned previous decisions in the other four.
Theres no evidence that the director of the Tricare Management Activity summarily overturned hearing officers decisions, Undersecretary of Defense for Personnel and Readiness Jessica Wright wrote in a letter accompanying the report.
Still, those facing the appeals process can wait a long time and Tricare is working to improve work flow and case management efficiency, Wright said. According to the report, beneficiaries waited nearly 70 days for a formal review and 298 days for a hearing in 2013. Thats actually an improvement over 2012, when those wait times were 83 days and 342 days, respectively.
Air Force chaplain Capt. Mark Traeger is all too familiar with the lengthy appeals process and what he perceives to be arbitrary decisions by Tricare contractors and the Defense Health Agency.
His son Toby, 1, has Down syndrome and Hirschsprungs disease and needed surgery last September to allow him to defecate properly. The surgery was approved, but a second procedure that entailed using Botox to relax his muscles was denied because it was deemed cosmetic.
Then, when his parents took Toby home from the hospital the same day as the previously approved surgery, Tricare denied that claim as well, because the approval was for an in-patient procedure only.
The Traegers now face a $17,000 bill for the operation and are at a loss to understand why their claims and appeals have been denied.
As his parents, were really familiar with Tobys medical requirements and we knew how to care for him post-surgery, so the doctors allowed us take him home. But it makes no sense. Tricare would rather we have kept our baby in the hospital overnight? Traeger said.
Tricare officials could not comment specifically on Traeger case but said the appeals process exists for a reason.
If the recoupment of payments is based on the care not meeting coverage criteria, a beneficiary should have been provided appeal rights and we would encourage them to do so, Tricare officials said in a written response to Military Times.
Traeger said he remains in talks with Tricare and Health Net Federal Services, contractor for the Tricare North Region, to determine what comes next. But in the meantime, the couple paid the bill.
I dont know whats going to happen, but anything Tricare could do to at least streamline the process for everyone would be good, Traeger said.
In her letter to Congress, Wright said DHA has implemented procedures to enhance the performance of the Tricare regional contractors that handle initial appeals.
We will continue to closely monitor this process to ensure it is carried out in a manner required by regulation, she said.
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DoubleStar Saiga Enforcer Muzzle Brake M22x7.5 Thread Saiga 12 Gauge Steel Matte
Product #: 966305 DoubleStar #: Saiga 12 Enforcer Brake UPC #: 841348100430
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The DoubleStar Enforcer muzzle brake for the Saiga 12 gauge shotguns fits the standard M22x7.5 threaded barrels. The Enforcer features 4 ports to reduce muzzle climb and 4 aggressive points that can break glass or be used as a compliance device. A knurled outer surface makes installation and removal easy. Constructed of steel with a black phosphate finish.
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Kim Hagerich
Topics in This Section
- Breast Cancer Patient Stories
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- Breast Cancer with Metastasis
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Patient Stories: Kim Hagerich
Plastic and Reconstructive Surgery Patient Stories, Breast Cancer Patient Stories
Moving half way across the country with 2 small children for her husband's new job can be stressful for some, but Kim Hagerich took it in stride. Kim and Todd settled into a friendly family-oriented neighborhood in a northern Philadelphia suburb.
Kim quickly made many friends by getting involved in a book club, mother's group and preschool. She and her husband wanted a third child, and based on her fertility history, she began taking progesterone (a hormone that is connected to pregnancy). Not soon after, Kim found a lump in her breast.
"I had a burning sensation in my chest and felt a tiny lump."
"My doctor brushed it off because I was only 36, had no knowledge of family history of breast cancer and because cancer usually doesn't present with pain," explained Kim. She took her doctor's advice and waited.
Coincidentally, Kim's husband, Todd, who worked at Bristol-Myers Squibb, attended a breast cancer educational seminar at work. Todd learned that progesterone actually can feed a tumor, and that if her lump was in fact cancer, the drug was helping the cancer to grow.
Her husband urged Kim to get a mammogram.
The mammography results were shocking. Kim had multiple tumors in her breast and in her lymph nodes. As someone new to the area, Kim was not sure where to go for treatment.
"I knew I was in good hands at Fox Chase. I didn't have to look anywhere else."
"My husband asked for a referral from the President of Oncology at Bristol-Myers Squibb. He suggested I see Dr. Lori Goldstein at Fox Chase Cancer Center. As soon as I met Dr. Goldstein and the other members of her team, I knew I was in good hands at Fox Chase," said Kim. "I didn't have to look anywhere else."
In November 2005, Kim underwent a single mastectomy and reconstructive surgery at Fox Chase. After a quick recovery, Kim began an aggressive course of chemotherapy, which was successful. Because the cancer spread to her lymph nodes, Kim's last step was radiation therapy under the medical supervision of Dr. Gary Freedman, radiation oncologist.
"I feel blessed to have such fantastic doctors and nurses treating me."
"I am so thankful we ended up in Pennsylvania. Our kind neighbors and friends showed their support by preparing meals, decorating our house for the holidays and helping to care for my children," recalled Kim. "Fox Chase is the other reason I'm happy we came to Pennsylvania. I feel blessed to have such fantastic doctors and nurses treating me. Everyone at Fox Chase is friendly and helpful," she continued.
"At one appointment, Kim's mother watched Dr. Goldstein reach out to hold my hand and give me a hug. My mother was amazed. She'd never seen that warmth and compassion from a doctor," recalled Kim. Kim successfully finished treatment by the fall of 2007.
Creating a place for young women with breast cancer to gather
"After attending several breast cancer support groups, I realized my issues were very different than those of the other women. It was a factor of my age. While they were concerned about seeing their grandchildren grow up, I was worried that I would miss the first day of my daughter's kindergarten," explained Kim. "I wanted to create a place where young women with breast cancer could meet, trade ideas and discuss pertinent issues in their lives. With my friend Stacy, we've done that."
Kim started a local chapter of Young Survival Coalition, an international, nonprofit network of breast cancer survivors and supporters dedicated to the concerns and issues that are unique to young women and breast cancer. Kim's group has over 80 members and meets monthly at various locations in the Philadelphia area. They have begun to reach out to college-age women at health fairs.
The next chapter in Kim's life
"This is a whole new and exciting part of my life," said Kim. Last year, she completed the breast cancer 3-day walk. She also spent a day at Fox Chase as a 'researcher for a day' at Fox Chase Cancer Center. After that, Kim represented the Linda Creed Foundation in Washington to lobby for funding for breast cancer research. In the fall of 2009, Kim began a part-time job working for the Linda Creed Foundation.
"Before breast cancer, I was not looking forward to turning 40. Now that I'm almost there, I can't wait. I feel so fortunate to be alive and well," said Kim.
Kim's family kept breast cancer a secret.
After going through treatment, Kim was surprised to learn she did in fact have a family history of breast cancer. She lost 2 great-aunts to breast cancer. But because that generation did not talk about cancer, she never knew how they died. Another great-aunt and cousin were diagnosed after Kim.
Kim recently underwent genetic testing through the Breast and Ovarian Cancer Risk Assessment Program at Fox Chase. Fortunately, she does not carry the BRCA gene, which would have increased the risk of cancer for her daughters and herself.
Grateful to be alive.
Kim is grateful to her husband Todd, as well as her team of doctors at Fox Chase. "The thought of missing out on being a mom was more devastating than dealing with cancer. I still cry every time I help out in my daughter's kindergarten class," said Kim. "I feel so fortunate to be alive and well today.


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Shake up the social scene with this cute Born to Moto tank, featuring vibrant Metal Mulisha lettering and logos surrounded by a low puff screen print.
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Amphipod ArmPod SmartView PlusItem #AMP124
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AMPHIPOD® ARMPOD SMARTVIEW PLUS™ :: Snag the ultra-comfortable hands-free solution to bringing your smartphone with you on your next run by arming yourself with the Amphipod® Armpod Smartview Plus™. You'll coast through your workout catching a clear view of the cyber action through the protective View-Thru™ front panel that offers full screen access and touch control to ensure you don't miss a thing. Scoring the perfect fit will be a cinch thanks to the fully adjustable chafe-free armband, and size won't be an issue because the Amphipod®'s Smartview Plus™ is specifically designed for larger format iPhone 5, Android™, Windows™ and similarly sized systems.
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Comments about Amphipod ArmPod SmartView Plus Holders:
Worked just OK. Keeps slipping and sliding about even though it's attached by Velcro. Had to tear the earbud hole bigger because mine wouldn't fit. I could, however, easily swipe my phone screen thru the plastic window. This is the third attempt at using these things. I've given up...
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Comments about Amphipod ArmPod SmartView Plus Holders:
This is a great armband. I use it daily on my runs. It is tight, stays in place and doesn't bounce. I have an iPhone 5 with a fairly large case for it. It fits in the band perfectly.
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Comments about Amphipod ArmPod SmartView Plus Holders:
product description states dimensions as 6"x3.75". Package clearly indicates 5"x3" as size. Larger android phones do not fit in this product. Had I known the true dimensions I would have known my phone would not fit before I ordered the product.
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Comments about Amphipod ArmPod SmartView Plus Holders:
This fits my iphone4S even when it's still in the OtterBox. I put the phone in upside down so that it's easier to use the screen, and this holder can accommodate the wire from my headphones with no problem. Stayed in place on my arm. I didn't experience chafing, but I did wear it over a long sleeve so I'm not sure if that would be a problem on bare skin.
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AMPHIPOD® HANDPOD SMARTVIEW PLUS™ :: Finally, you've found an ultra-comfy carrying solution for your larger sized smartphone or player! Check ...


text: Tech Forecast Does Ikea Hold The Secret To The Future Of College? Social entrepreneurs in Africa, backed by the likes of Microsoft and Ikea, are attempting to satisfy a huge demand for learning across the continent. Could they find the next Steve Jobs in the process? Read More » By Anya Kamenetz


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Topic: Read: Halloween Horror Contest Winner
I am pretty sure this is one of the most bad ass contests we have ever run. In fact we even made it so that by telling your friends about the contest you get a shot at winning the grand prize, and your friends you refer can also win.
We have had a ton of great entries, the problem we are running into is it seems everyone missed the boat on the "refer a friend". Although we got a ton of entries those referring people to the contest is very very small. So it looks like somebody who referred 3 people is going to win the big prize.
That said I am sure everyone just missed the boat on that The winner will be chosen in the next couple days. So throw a link in your sig, post on your blog, send a myspace bulletin and tell folks to enter and include your "username" when they do. You win, they win, we all win. Either way lots of entries, just hate to see the grand prize for referring folks to the contest go so easily.
Contest is here for those who missed it.


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Darrell Wallace Jr. stands next to his car while waiting to qualify for a NASCAR Nationwide Series race in Newton, Iowa. He finished ninth, then returned in August for another race at Iowa Speedway where he finished seventh.
- Filed Under
NASCAR's best hope for a successful African-American driver isn't shying from the magnitude of what he could accomplish.
Darrell Wallace Jr., named a full-time driver in Kyle Busch Motorsports' Camping World Truck Series entry Saturday, said he embraces the opportunity to throw the doors wide open for other minorities who want to race.
He is the fourth African-American driver in NASCAR history to land a full-time ride in one of the sport's three national touring series. ...