text:
|Classification and external resources
Left sided mesothelioma with mediastinal node enlargement : CT scan.
Mesothelioma, more precisely malignant mesothelioma, is a rare form of cancer that develops from the protective lining that covers many of the body's internal organs, the mesothelium. It is almost always caused by exposure to asbestos.
Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart,[1] the pericardium (a sac that surrounds the heart) or tunica vaginalis.
Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. It has also been suggested that washing the clothes of a family member who worked with asbestos can put a person at risk for developing mesothelioma.[2] Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases the risk of other asbestos-induced cancers.[3] Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).
The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Symptoms or signs of mesothelioma may not appear until 20 to 50 years (or more) after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space (pleural effusion) are often symptoms of pleural mesothelioma.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of Peritoneal Mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
In severe cases of the disease, the following signs and symptoms may be present:
A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytopathology if this fluid is aspirated with a syringe. For pleural fluid, this is done by thoracentesis or tube thoracostomy (chest tube); for ascites, with paracentesis or ascitic drain; and for pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure). Unfortunately, the diagnosis of malignant mesothelioma by cytology alone is difficult, even with expert pathologists.
Generally, a biopsy is needed to confirm a diagnosis of malignant mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. Alternatively, the chest surgeon might directly open the chest (thoracotomy). If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
Immunohistochemical studies play an important role for the pathologist in differentiating malignant mesothelioma from neoplastic mimics. There are numerous tests and panels available. No single test is perfect for distinguishing mesothelioma from carcinoma or even benign versus malignant.
|EMA (epithelial membrane antigen) in a membranous distribution
|CEA (carcinoembryonic antigen)
|WT1 (Wilms' tumour 1)
|Cytokeratin 5/6
|HBME-1 (human mesothelial cell 1)
|TTF-1 (thyroid transcription factor-1)
There are three histological types of malignant mesothelioma: (1) Epithelioid; (2) Sarcomatoid; and (3) Biphasic (Mixed). Epithelioid comprises about 50-60% of malignant mesothelioma cases and generally holds a better prognosis than the Sarcomatoid or Biphasic subtypes.[4]
There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.[5] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells.[6]
Staging of mesothelioma is based on the recommendation by the International Mesothelioma Interest Group.[7] TNM classification of the primary tumor, lymph node involvement, and distant metastasis is performed. Mesothelioma is staged Ia–IV (one-A to four) based on the TNM status.[7][8]
The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibers in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fiber can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibers from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers.
Pleural contamination with asbestos or other mineral fibers has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).[9] However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.[10]
Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibers. It has been suggested that in humans, transport of fibers to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localized lesions of accumulated asbestos fibers in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumor.
Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibers remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibers has not yet been achieved. In general, asbestos fibers are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.
Analysis of the interactions between asbestos fibers and DNA has shown that phagocytosed fibers are able to make contact with chromosomes, often adhering to the chromatin fibers or becoming entangled within the chromosome. This contact between the asbestos fiber and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.
Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:
Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:
Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.
Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year.[11] For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades.[12] It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[13] Between 1973 and 1984, the incidence of pleural mesothelioma among Caucasian males increased 300%. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
Working with asbestos is the major risk factor for mesothelioma.[14] In the United States, asbestos is the major cause of malignant mesothelioma. Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a "signal" or "sentinel" tumor.[9][15][16][17][18] A history of asbestos exposure exists in most cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite. Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[19]
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. Others have noted as well that there is no evidence of a threshold level below which there is no risk of mesothelioma.[20] There appears to be a linear, dose-response relationship, with increasing dose producing increasing disease.[21] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.[9] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.[9]
The duration of exposure to asbestos causing mesothelioma can be short. For example, cases of mesothelioma have been documented with only 1–3 months of exposure[22][23]. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
Latency, the time from first exposure to manifestation of disease, is prolonged in the case of mesothelioma. It is virtually never less than fifteen years and peaks at 30–40 years.[9] In a review of occupationally related mesothelioma cases, the median latency was 32 years.[24] Based upon the data from Peto et al, the risk of mesothelioma appears to increase to the third or fourth power from first exposure.[21]
Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos. For example, in central Cappadocia, Turkey, mesothelioma was causing 50% of all deaths in three small villages — Tuzköy, Karain and Sarıhıdır. Initially, this was attributed to erionite, a zeolite mineral with similar properties to asbestos, however, recently, detailed epidemiological investigation showed that erionite causes mesothelioma mostly in families with a genetic predisposition.[25][26] The documented presence of asbestos fibers in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibers.
Exposure to asbestos fibers has been recognized as an occupational health hazard since the early 1900s. Numerous epidemiological studies have associated occupational exposure to asbestos with the development of pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumors, and diffuse malignant mesothelioma of the pleura and peritoneum. Asbestos has been widely used in many industrial products, including cement, brake linings, gaskets, roof shingles, flooring products, textiles, and insulation.
Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos related diseases.[27] This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
The prognosis for malignant mesothelioma remains disappointing, although there have been some modest improvements in prognosis from newer chemotherapies and multimodality treatments.[28] Treatment of malignant mesothelioma at earlier stages has a better prognosis, but cures are exceedingly rare. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease. The histological subtype and the patient's age and health status also help predict prognosis.
Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.[28] However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008). (For more information on multimodality therapy with surgery, see below). A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.[29] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery.[30] This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.[31]
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[32] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
This technique is also used in patients with malignant pleural mesothelioma.[33]
All of the standard approaches to treating solid tumors—radiation, chemotherapy, and surgery—have been investigated in patients with malignant pleural mesothelioma. Although surgery, by itself, is not very effective, surgery combined with adjuvant chemotherapy and radiation (trimodality therapy) has produced significant survival extension (3–14 years) among patients with favorable prognostic factors.[29] However, other large series of examining multimodality treatment have only demonstrated modest improvement in survival (median survival 14.5 months and only 29.6% surviving 2 years).[28] Reducing the bulk of the tumor with cytoreductive surgery is key to extending survival. Two surgeries have been developed: extrapleural pneumonectomy and pleurectomy/decortication. The indications for performing these operations are unique. The choice of operation depends on the size of the patient's tumor. This is an important consideration because tumor volume has been identified as a prognostic factor in mesothelioma.[34] Pleurectomy/decortication spares the underlying lung and is performed in patients with early stage disease when the intention is to remove all gross visible tumor (macroscopic complete resection), not simply palliation.[35] Extrapleural pneumonectomy is a more extensive operation that involves resection of the parietal and visceral pleurae, underlying lung, ipsilateral diaphragm, and ipsilateral pericardium. This operation is indicated for a subset of patients with more advanced tumors, who can tolerate a pneumonectomy.[36]
Mesothelioma, though rare, has had a number of notable patients.
Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote the "The Median Isn't the Message"[42] for Discover magazine, in which he argued that statistics such as median survival are just useful abstractions, not destiny. Gould lived for another twenty years eventually succumbing to metastatic adenocarcinoma of the lung, not mesothelioma. Author Paul Kraus was diagnosed with peritoneal mesothelioma in July 1997. He was given a prognosis of less than a year to live and used a variety of complementary modalities. He continues to outlive his prognosis and wrote a book about his experience "Surviving Mesothelioma and Other Cancers: A Patient's Guide" [43] in which he presented his philosophy about healing and the decision making that led him to use integrative medicine.
The first lawsuits against asbestos manufacturers were in 1929. Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the links between asbestos, asbestosis, and mesothelioma became known (some reports seem to place this as early as 1898). The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars.[44] The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases. However, to date, the US Congress has not stepped in and there are no federal laws governing asbestos compensation.[45]
The first lawsuit against asbestos manufacturers was brought in 1929. The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases. It was not until 1960 that an article published by Wagner et al. first officially established mesothelioma as a disease arising from exposure to crocidolite asbestos.[46] The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa. Some exposures were transient and some were mine workers. However prior to 1950 malignant mesothelioma was extremely rare and some experts even questioned its existence.[47] In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[48] The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.
In the town of Wittenoom, asbestos-containing mine waste was used to cover schoolyards and playgrounds. In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma.
Despite proof that the dust associated with asbestos mining and milling causes asbestos-related disease, mining began at Wittenoom in 1943 and continued until 1966. In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called "Is this Killer in Your Home?" in Australia's Bulletin magazine. In 1978 the Western Australian Government decided to phase out the town of Wittenoom, following the publication of a Health Dept. booklet, "The Health Hazard at Wittenoom", containing the results of air sampling and an appraisal of worldwide medical information.
By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims.
In Armley, Leeds, England the J W Roberts asbestos incident involved several court cases against Turner & Newall where local residents who contracted mesothelioma claimed compensation because of the asbestos pollution from the company's factory. One notable case was that of June Hancock, who contracted the disease in 1993 and died in 1997.[49]


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Q. The traffic signal at Valencia Drive and Magnolia Avenue in Fullerton favors traffic traveling down Magnolia – which makes sense because traffic is lighter along Valencia. Is this intersection on a timer? It seems to take forever for the light to change when I'm on Valencia, trying to cross at Magnolia. Just yesterday, I was walking and tried to cross this intersection, but waited for at least four minutes before the light changed. It didn't seem like traffic on Magnolia was heavy enough to justify this lengthy wait. Any reason for this, and is this something that can be reviewed?
– Elizabeth McMillan, Fullerton
A. You re absolutely correct, Elizabeth, that the traffic signals at this intersection are synched and coordinated with adjacent signals along Magnolia Avenue. It's been that way for several years, thanks to the half-cent sales tax you pay through Measure M, which was approved by county voters to pay for a wide variety of transportation projects, said Mark Miller, the traffic engineer for the city of Fullerton.
However, Miller said that you are incorrect in saying that you have to wait at least four minutes to cross Magnolia Avenue from Valencia Drive.
The longest you should have to wait is 100 seconds during the peak morning commute, which usually runs from 6:30 to 9 a.m. and during the evening commute between 3 and 7 p.m., Miller said. At the most, all other daytime delays are set to 90 seconds.
Q. I live in an old, established part of West Anaheim and have noticed a large RV that moves around the neighborhood to park. It showed up within the past couple of weeks. There's another large RV in the tract that also does this. I believe people are living in these RVs and simply move them around to make it appear that they do not live in them. Does the Police Department pay attention to this? If not, is there an ordinance to prevent it? It weirds me out to think that they can park and watch people go to work.
– Trish Green, Anaheim
A. That does sound pretty unnerving, Trish. Anaheim's municipal code bans overnight camping on city streets, so it might be best to call the police if you feel any immediate danger. You can also report suspicious vehicles through Anaheim Anytime, the virtual online connection to City Hall, via anheim.net or 714-765-4311.
Residents are able to submit questions about traffic, parking, speed limits and other concerns. You could also download the My Anaheim application, which is available on iPhone and Android mobile phones, said city spokeswoman Ruth Ruiz.
On the Road takes transportation questions from readers of our North Orange County weekly newspapers. You can email questions to email@example.com. Only the questions placed into the column are answered.

subset: commoncrawl


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LeTourneau University President Dr. Dale A. Lunsford has been selected by Longview Mayor Jay Dean to lead an I-20 Task Force to identify methods to draw more visitors into Longview from the interstate that passes through the south side of the city.
Lunsford served as the chairman of the Longview Chamber of Commerce for 2012. He has been outspoken in support for renovation of the city's entrances from the interstate since he became the university's president in 2007.
"Development of the I-20 corridor is a significant opportunity for the city of Longview to expand economic growth," Lunsford said. "I look forward to the work the task force will do in the next few months."
Lunsford said the Longview Chamber has launched a website www.longviewtexaslistens.com for members of the community to share their ideas for improving the community.
Online maps from the Texas Department of Transportation indicate that traffic along Interstate-20 is estimated at 37,000 vehicles per day.
LeTourneau University is an interdenominational Christ-centered university located in Longview, Texas, with undergraduate and graduate programs online and at education centers around the state.
Academic majors include aviation, business, communication, computer science, criminal justice, education, engineering, health care administration, health science-nursing, human services, kinesiology, the liberal arts, the sciences and psychology.
Claiming every workplace in every nation as its mission field, LeTourneau University graduates are professionals of ingenuity and Christ-like character who see life's work as a holy calling with eternal impact.
Categories: (none)


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Last year, I posted about a side project that I was working on. Dubbed "Facebook Desktop", it is essentially a notification engine that I built that would give you updates about your Facebook friends in real time! It became quite popular and I ended up building it out over the next year, pushing out 6 new releases in that time (0.80, 0.81, 0.82, 0.83, 0.84, and 0.85). Well, I've decided to contribute to the community and open-source the primary component in Facebook Desktop, the notification engine!
Project M6D Magnum Sidearm
That's right, I codenamed my notification engine project "Project M6D Magnum Sidearm" (I have a weird naming convention for projects :p). Anyways, it is exactly how it sounds. It is a cross-platform, notification engine built on top of Adobe AIR. With a very simple interface, you can drop it into any AIR project and allow it to deliver messenger-style notifications to your users! Think Growl, but for all platforms :)
What can it do?
If you're familiar with the Facebook Desktop project that this engine was built for, it supports all of the features that you see being used in that project, including…
- Ability to display messenger-toast notifications as well as compact notifications.
- Variable display length for notifications.
- User-presence logic that detects when the user goes idle. If the user is away from the computer, notifications are held on-screen and queued for when the user returns.
- Ability to replay the most five recent notifications.
- Individual notification post settings, such as sticky, replayable, custom image, click URL, compact, etc.
- Operating system detection to set logical default display locations for notifications for the various platforms (i.e. bottom-right on Windows, top-right on Mac).
- Smart repositioning logic for extended length toasts.
- Ability to see a summary notification when the user returns from idle after an extended period of time.
- Support for changing notificaion images.
- Custom styling which can be applied at run-time.
- Optional notification sound.
These are just a few of the really cool features that we've built into this engine.
How can I use it?
Even though we've added a lot of powerful features to this library, using it is very easy! All you have to do is include the SWC (or source) into your project, and follow the patterns below…
// create engine with default settings var notificationManager:NotificationManager = new NotificationManager("/assets/style/dark.swf", // default style "/assets/m6d-magnum-sidearm-50x50.png", // default notification image "/assets/m6d-magnum-sidearm-16x16.png", // default compact notification image "/assets/sounds/drop.mp3" // (optional) default notification sound NotificationConst.DISPLAY_LENGTH_DEFAULT, // (optional) default display length NotificationConst.DISPLAY_LOCATION_AUTO); // (optional) default display location // now that we have an engine, let's create a notification and show it var notification:Notification = new Notification(); notification.title = "Derek ► Jacobim"; notification.message = "What is this? A center for ANTS?!"; notification.image = "/assets/images/profile/derek/avatar.png"; notification.link = "http://www.youtube.com/watch?v=_6GqqIvfSVQ"; notification.isCompact = false; notification.isSticky = false; notification.isReplayable = true; notificationManager.showNotification(notification); // we can also show notifications quickly using this API too notificationManager.show("Derek Zoolander Foundation", "Now open!", "/assets/images/dzf-logo-50x50.png");
And that's all it takes for you to add robust notifications to your application. You can even change many of the engines settings on the fly!
// let's change the default images, display length, and display location notificationManager.defaultNotificationImage = "/assets/images/dzf-logo-50x50.png"; notificationManager.defaultCompactNotificationImage = "/assets/images/dzf-logo-16x16.png"; notificationManager.displayLength = NotificationConst.DISPLAY_LENGTH_SHORT; notificationManager.displayLocation = NotificationConst.DISPLAY_LOCATION_TOP_RIGHT; // we can even change the style and sound settings on the fly too! notificationManager.loadStyle("/assets/style/light.swf"); notificationManager.loadSound("/assets/sounds/bing.mp3");
For those of you that want all the details, you can check out the ASDocs here.
I've also created a sample demo application that you can install and see the engine work in real time! It has an interface like this…
…where you can quickly test out all of the features of the engine! Take it for a spin and let me know what you think!
Code, please!
I've released the code under the Apache License, Version 2.0 and made it all available on GitHub! Please, fork and extend!
That's it for now! Hopefully some of you will find this project useful. And as always, I love hearing from you so let me know what you think! Until next time, happy coding =)


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Get $0.75 off THREE (3) Canine Carry Outs dog snacks Today by using our printable coupons. You can get double the discount if you print the coupons twice. You can do this by using the back button on your web browser.
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LITHONIA, Ga. - A man suspected of shoplifting DVD players at a Walmart died Sunday after a confrontation with workers at the Atlanta-area store.
WSB-TV (http://bit.ly/S52Hfl ) reported that the man died was pronounced dead after an altercation with workers outside a store in Lithonia.
The company said two workers were suspended with pay, and a security contractor will no longer work at the store, located about 15 miles east of downtown Atlanta.
"No amount of merchandise is worth someone's life," Walmart spokeswoman Dianna Gee said in a statement.
The station said a police report showed that a middle-aged man was caught shoplifting two DVD players from the store about 1:30 a.m. Sunday. He left, but three workers caught him and had an altercation in the parking lot.
Police arrived to find the store workers on top of the man, who was unresponsive and bleeding from the nose and mouth.
He was later pronounced dead at DeKalb Medical-Hillandale hospital.
Gee said two store employees who were involved in the confrontation were suspended with pay during an investigation, and a contractor who worked in security at the store "will no longer be providing services to us."
In the statement released to The Associated Press, Gee said the man's death was "truly a sad situation."
"Associates are trained to disengage from situations that would put themselves or others at risk," she said. "That being said, this is still an active investigation and we're working with police to provide any assistance."
The company said it was reviewing what happened to determine whether proper policies were followed.
Lithonia police did not return a message seeking comment.


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Federal authorities also were seeking records on three projects -- construction of a juvenile detention facility in Middletown, a juvenile center and court in Bridgeport, and a new garage for Bradley International Airport.
That subpoena set off a series of actions by Rowland, including paying Ellef more than $800 for two trips the governor had taken to vacation properties owned by the Tomasso family, the company that had gotten all three state contracts federal investigators were now interested in.
In March 2003, his former deputy chief of staff, Lawrence Alibozek, pleaded guilty to steering those contracts to The Tomasso Group. He is still the only person indicted by federal authorities.
After Alibozek's guilty plea, Rowland said he wasn't worried about getting caught up in the scandal himself. In the months after, federal authorities issued numerous subpoenas seeking records of any state work the Tomassos had done -- from cleaning up state lottery headquarters in the aftermath of a shooting rampage to taking over the state building at the Big E.
But there were still no indications federal authorities were focusing their investigation on the governor. That changed in late November when The Courant ran a story that raised questions about who had done the renovations at the governor's cottage on Bantam Lake in Litchfield.
The story revealed that the building permits seemed to indicate more work was performed than what the governor paid for. The Courant then revealed that FBI agents visited several of the contractors identified in the previous story.
On Dec. 2, Rowland held a press conference in his hometown of Waterbury to discuss the cottage controversy.
Rowland played down the story and said he had paid for all of the renovations himself, including purchasing a hot tub set on the deck at the cottage. He said the cabinets were from Home Depot, not custom-made, and he refused to answer a question about how a New Britain-based heating contractor had come to work at the cottage.
Less than two weeks later Rowland issued a statement acknowledging he had lied about the cottage renovations.
He admitted a staff member had purchased the hot tub, but in an even more damning revelation, he acknowledged some of the state largest contractors had done work at his cottage and either had never been paid or were paid years later -- after The Courant started asking questions about the project.
Among those contractors was William Tomasso, the man at the center of the federal bid-rigging investigation.
Rowland followed those admissions with a televised apology on Jan. 7, in which he somberly admitted he had lied and asked residents to give him another chance.
But his favorable rating in polls plummeted into the 20s. Nearly 70 percent of those polled said he should resign.
Rowland's revelations led the legislature to form an impeachment inquiry committee to investigate whether he should be impeached. Even as the committee hired a New York attorney to conduct an investigation, Rowland was steadfast that he would not resign.
By that time the impeachment committee was not Rowland's only worry. Federal authorities had subpoenaed his personal records and had begun delving into other areas, including the sale of Rowland's Washington D.C. condominium to Woodbury antiques dealer Wayne Pratt.
Pratt pleaded guilty in March 2004 to federal tax charges. Pratt admitted that Robert Matthews, a longtime friend of the governor's, had given him the money to pay for the condominium in June 1997.
While Matthews was orchestrating the purchase of Rowland's condominium, a state agency -- the Connecticut Development Authority -- was giving one of his companies a guaranteed loan worth more than $3 million. Later that same year, CDA gave another of Matthews' companies a $1 million loan.
The condo deal and loans to Matthews became the focal point of the impeachment inquiry committee hearing that started two weeks ago. As the impeachment proceedings slowly moved forward, Rowland still maintained he would not resign.
Then, late last week, the Supreme Court denied his appeal in an attempt to quash a subpoena from the committee to testify before it. The decision left Rowland in the position of having to plead the Fifth to protect his rights in any possible criminal case.


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With what, and what was the result?adnapemit wrote:I targeted LaserGuy last night.
@bessie - do you see all visitors of your target, or only one? Also, I assume SDK revealed who he targeted during the course of the game? If so, who? Last night's action in particular.
@Carlington - what do you have to claim?
I don't think I've had a single successful action all game (excluding the unexpected Znirk alliance N1). N2 I redirected Carlington but he was blocked. N3 I tried to redirect adnapemit to freezeblade, which would have confirmed plytho's action had I not been blocked, as presumably freezeblade would have died...


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Beware of the Dog
Written by Roald Dahl. DOWN below there was only a vast white undulating sea of cloud. Above there was the sun, and the sun was white like the clouds, because it is never yellow when one looks at it from high in the air. He was still flying the Spitfire. His right hand was on the


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I hosted a picnic in Alta Plaza park in San Francisco via Birthright Israel NEXT Shabbat. It's a great program that allows alumni to host Shabbat meals and get reimbursed based on the number of people that attend the event (up to 16 people). This was my second Shabbat meal this year. This time I got catered food from Beautifull and made cupcakes. The cupcakes I made were chocolate and vanilla marbled cake, with vanilla frosting as well as some topped with slivered almonds covered in cinnamon sugar.
Category Archives: Bay Area Tribe
C is for cookie, and that's good enough for me!
Purim was celebrated on Saturday and what a day it was!
In the morning, I ran with the Jews For Run group in their Pacing For Purim "race". It was the first time I went running (other than going to the gym) and I had a great time (even getting drenched in the rain)! It was motivational to run in a group and to get inspiration from runners of all kinds of experience.
The main highlight of the day was Purim Palooza (see pictures here -I'm in some!) I went to the show at Temple Emanu-el as Cookie Monster, but took the hat off that made the costume, and became just someone in a onesie at the after party at the Rockit Room. Anyway, as Cookie Monster, I thought it was a good idea to show up with a bunch of cookies, and since it was Purim, I decided on Hamentashen. I used the same recipe as before, and used chocolate chips as the filling and put some poppy seeds in the dough. I found that the ones that were more closed tasted better, since you got chocolate in each bite.
This post was brought to you by the letter H, for Hamentashen!
Schmoozing in Sonoma
I went on a Sonoma wine tour with Birthright Israel/Bay Area Tribe. The "theme" of this year's trip was "I heard it through the grapevine." We (sorta) learned a bit about gossip/it's connection to Judaism, hence the title of this post, "Schmoozing in Sonoma". Also, it's just what happens when you get a bunch of (tipsy) Jews together. 🙂
Yes, it has nothing to do with dessert (though there was really good gelato) but it does have to do with food, so I felt like it was okay to add to my blog. 🙂
There were almost 200 people on the trip, so we were divided up into four different buses. Each bus went to two wineries and all of us met up for lunch at an olive oil company. (this is where the gelato comes in)
My bus went to Landmark and Mayo wineries.
The first was bigger (I think) and had better wine. Though, my judgment might have been thrown off a bit because it was about 11:45am and I had not really eaten anything before we left. The other winery we went to after a quick lunch-catered by Beautifull!-so I only had one (half) glass and it was only okay. But, based on others' reviews, I would say that overall, the first wines really were better. Also, at lunch, there was wine on from a keg (like beer) made by this guy. It was a cool experience overall. I would've liked some sort of tour/more background about the wine, and not just tasting, but I guess there was not enough time for all of that. I'll have to find time and a way to get back there again someday.


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The Frivolous Idiocies Of Identity Politics & "Apartheid Israel" Boycotts
"In the US, one of the great uses of racism was (and is) to induce poor white people to feel a crucial and entirely specious fellowship with rich white people; one of the great uses of anti-racism is to make poor black people feel a crucial and equally specious fellowship with rich black people. Furthermore, in the form of the celebration of 'identity' and 'ethnic diversity', it seeks to create a bond between poor black people and rich white ones. So the African-American woman who cleans my office is supposed to feel not so bad about the fact that I make almost ten times as much money as she does because she can be confident that I'm not racist or sexist and that I respect her culture. . ."
Uri Avnery on the latter idiocy, a current mania in 'anti-imperialist' circles:
"The Jews amount to more than 80 per cent of Israel's citizens and constitute a majority of some 60 per cent throughout the country between the Mediterranean Sea and the Jordan River. And 99.9 per cent of the Jews oppose a boycott on Israel. They will not feel that 'the whole world is with us,' but rather that 'the whole world is against us.'
"In South Africa, the worldwide boycott helped in strengthening the majority and steeling it for the struggle. The impact of a boycott on Israel would be the exact opposite. It would push the large majority into the arms of the extreme right and create a fortress mentality against the 'anti-semitic world.'


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Essah wrote:Toxic (Britney Spears)
http://www.youtube.com/watch?v=rPQw6WgwEYQ - Cover by CallmeKat
http://www.youtube.com/watch?v=zqKZ_WIK5ms&list=RD02VEpMj-tqixs Cover by Yaël Naïm
Funny how two unrelated artists cover the same track in a very similar fashion. Both of them better than the original.
I love the Yael Naim version, but I also really love the Melanie Martinez cover: https://www.youtube.com/watch?v=Z6dcgD6-ZXM


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Hubby had Father's Day and his birthday within a few short days of each other, last weekend we had a family BBQ to celebrate both occassions which was fantastic, I love the in-laws and as my sister-in-laws get partners or have babies etc our family meetings grow and grow! This was the card that I made for hubby's birthday from myself.
I was browsing through the Two Peas Digital Section and found this kit which was under Fonts but was full of swirls and patterns like the one above so I download that and added some manly bling and printed onto linen cardstock. The base part of the card was printed with a wash from Pink Petticoat and I added ribbon too.
Although it was his birthday, I was thoroughly spoilt when Hubby came home with a new i-pad for me! I had bought him one for his birthday and he liked it so much he bought one for me too! We had a lovely dinner out as a family and then spent some time relaxing in the garden and in our little pool.
I have loads of card orders at the moment and am starting to panic as my youngest only has a couple of weeks left at school before he breaks up for summer and I am helping out on a school trip for one of those days. I made this card for my hairdresser to give to her Nephew on his 18th. She wanted the age on the card and happy birthday so I came up with this.
This is another download from 2 Peas and the kit is here. I printed this onto linen cardstock and added a bit of bling to jazz it up. Happy Birthday was printed from the computer.
Sorry the photo is a bit blurry, it was taken just before I had to rush it round to her!
Finally yesterday was my dear friend's son's Bar Mitzvah. The ceremony was lovely and her son read a long passage from the Torah. He did brilliantl! Its amazing that he has learnt to read and speak a whole new language for this ceremony and he didn't just read, he chanted the words. I have never been to a Bar Mitzvah before and had no idea how much work was involved, I admire him for all his hard work which is alot for a 13 year old, who now in the eyes of his religion, is considered a man. Well Done J!
I copied some text from the Torah onto linen card stock and printed a border around it. I then made the star with four different colours of cotton and twisted them and sewed them onto the card. I matted this onto some silver and red cardstock and then placed it all onto some linen card. The sentiment was made on the computer.
Tonight we are going to his party at a bar and restuarant on the beach, the weather is gorgeous, there is entertainment for the kids we are all going to have a fab time, I can't wait!
I hope that you are all having a great weekend too!
Tracey x


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As a public institution historically dependent on tuition and state appropriations, Bloomsburg University strives to maintain fiscal responsibility and enhance academic excellence. New sources of funding must be identified and developed while being good stewards of existing resources.
Bloomsburg University shares a common challenge with public universities nationwide: a decreasing amount of revenue from taxpayer dollars. At a time when Bloomsburg receives less than one-third of the overall budget from state appropriations, tuition must remain affordable for students, the majority of whom receive some form of financial aid, yet sufficient to deliver high-quality degree programs, student support services and learning experiences. These two factors, along with a steadily increasing enrollment, stretch the institution's budget and resources and make stewardship paramount to university financial success.
Bloomsburg University will renew its commitment to allocating resources according to institutional priorities, including sustainability, and assessing the efficiency of programs, services and operations. Following standard practice, budget officers will continue to inform the campus community regarding the current budget situation and welcome input from faculty, staff and students as part of the budget process. The institution will develop new financial resources through relationships with external stakeholders, partnerships, grants and private sources.
To achieve excellence while ensuring fiscal sustainability, Bloomsburg University will:


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We have made this application from the book of Sahih Al Bukhari. The user can choose the volume, the book of that volume and then the individual hadith of that book. The user can also change the volume by swapping from left to right or right to left. The user can make a list of favorite hadith as well as the user will be able to keep a bookmark in each book which will facilitate the user to resume his/her reading. He/she will also be able to share the hadith via facebook, email, twitter and other sharing social networks. There is also a facility to change the font color and the font style.
Sahih Bukhari is a collection of sayings and deeds of Prophet Muhammad (pbuh), also known as the Sunnah. The reports of the Prophet's (saw) sayings and deeds are called ahadeeth. Imam Bukhari lived a couple of centuries after the Prophet's (saw) death and worked extremely hard to collect his ahadeeth.
Bukhari (full name Abu Abdullah Muhammad bin Ismail bin Ibrahim bin al-Mughira al-Ja'fai) was born in 194 A.H. and died in 256 A.H. His collection of hadeeth is considered second to none. His criteria for acceptance into the collection were amongst the most stringent of all the scholars of ahadeeth.
Sahih Bukhari is divided into nine volumes, each of which has several books. Each book contains many ahadeeth. The ahadeeth are numbered consecutively per volume. The books really only serve to group ahadeeth together, but the volumes impose the numbering.
Volume 1
1. Revelation
2. Belief
3. Knowledge
4. Ablution (Wudu')
5. Bathing (Ghusl)
6. Menstrual Periods
7. Ablution with dust
8. Prayer (Salat)
9. Prayer Hall (Sutra)
10. Times of the Prayer
11. Call to Prayer
12. Characteristics of Prayer
Volume 2
13. Friday Prayer
14. Fear Prayer
15. The Two Festivals (Eids)
16. Witr Prayer
17. Dua' for Rain (Istisqaa)
18. Eclipses
19. Prostration
20. Shortening Prayers
21. Night Prayer (Tahajjud)
22. Actions while Praying
23. Funerals (Al-Janaa'iz)
24. Tax (Zakat)
25. Tax (Zakat ul Fitr)
26. Pilgrimmage (Hajj)
Volume 3
27. Minor Pilgrimmage
28. Pilgrims Prevented
29. Prilgrims Hunting Penalty
30. Virtues of Madinah
31. Fasting
32. Ramadan Prayer
33. Stay in Mosque (I'tikaf)
34. Sales and Trade
35. Paid in Advance
36. Hiring
37. Debt Transfer
38. Business by Proxy
39. Agriculture
40. Distributing Water
41. Loans, Bankruptcy
42. Lost & Found
43. Oppressions
44. Partnership
45. Mortgaging
46. Freeing Slaves
47. Gifts
48. Witnesses
49. Peacemaking
50. Conditions
Volume 4
51. Wills
52. Jihaad
53. One-fifth of Booty
54. Begining of Creation
55. Prophets
56. Merits of Sunnah
Volume 5
57. The Companions
58. Merits of Al-Ansaar
59. Expeditions
Volume 6
60. Prophetic Commentary
61. Virtues of the Qur'an
Volume 7
62. Marriage
63. Divorce
64. Supporting Family
65. Food, Meals
66. Sacrifice on Birth
67. Hunting, Slaughter
68. Al-Adha Sacrifice
69. Drinks
70. Patients
71. Medicine
72. Dress
Volume 8
73. Good Manners
74. Asking Permission
75. Invocations
76. Softening the Heart
77. Divine Will (Qadar)
78. Oaths and Vows
79. Unfulfilled Oaths
80. Inheritance Laws
81. Punishment Laws
82. Disbelievers (war)
Volume 9
83. Blood Money
84. Dealing with Apostates
85. Under Duress
86. Tricks
87. Interpretations of Dreams
88. End of the World
89. Judgments
90. Wishes
91. Truthfull Word
92. Holding Steadfast
93. Oneness of Allah
bukhari sharif, sahih-al bukhari.


text:
Next Episode of Holland's Got Talent is
Johnny De Mol(Presenter)
Gordon Heuckeroth(Judge)
Chantal Janzen(Judge)
Angela Groothuizen(Judge)
Gerard Joling(Presenter)
Robert ten Brink (Presenter)
Dan Karaty(Judge)
Henkjan Smits(Judge)
Robert Ronday (Judge)
Patricia Paay (Judge)
Amira Willighagen(Winner - S06)
Looks like something went completely wrong!
But don't worry - it can happen to the best of us,
- and it just happened to you.
Please try again later or contact us.


text:
Patients & Visitors
Department History
Neurology Faculty
Neurological Institute
Clinical Facilities
Clinical Programs
Clinical Laboratories
Clinical Trials
UnitResearch Programs
Residency and
Medical Student
Current Residents and
CME Events
Epilepsy Grand Rounds
Grand Rounds
Department Conferences
/ Residents Only
Department of Neuroscience
Case Center for
Imaging Research
Cognitive Science
National Prion
Disease Surveillance
Stem Cell
and Regenerative Medicine
School of Medicine
Medical Center
Welcome to the Department
of Neurology at Case Western Reserve University. The
Department of Neurology is integrated into the
Neurological Institute at University Hospitals
Cleveland Medical Center.
The Case Department of Neurology includes approximately
60 full-time faculty
based at six sites in Cleveland: University Hospitals -
Cleveland Medical Center, Louis Stokes Cleveland Veterans Affairs
Medical Center, Chagrin Highlands Health Center, Richmond Medical
Center, Bedford Medical Center, St. John's Medical
Center and Case Western Reserve School of Medicine.
Clinical consultations and laboratory services are also
available in the surrounding community at the University
Suburban Health Center in South Euclid, the Westlake
Health Center in Westlake, Ohio, the Park East Medical
Building in Beachwood, and the Chagrin Highlands Health
Center in Beachwood.
Clinical areas of expertise include cerebrovascular
disorders, critical care neurology, epilepsy, neuromuscular disorders, multiple sclerosis, movement disorders, autonomic disorders, myasthenia gravis, neuro-oncology, sleep, neuro-ophthalmology, and memory and aging disorders. Laboratory services include electroencephalopathy (EEG), video-EEG monitoring, nerve conduction studies and electromyography (EMG), neuromuscular ultrasound, single-fiber EMG,
neuromuscular ultrasound and autonomic testing.
The Department is also dedicated to teaching and
research. We have the second largest neurology residency training
program in the country, and offer several subspecialty fellowships. Most
of our faculty are actively involved with either
clinical and/or basic science research.
Department of Neurology | 11100 Euclid
Avenue | Cleveland, Ohio 44106-5040
Phone: (216) 844-3192
| Visits
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© 2005 Case Western Reserve University |
Cleveland, Ohio 44106 | 216.368.2000


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Just wanted to say thanks for your comment on my note about the ER trip -- the wrapping her up to be still for the glue (which they thought would be stitches) was horrible -- I can't get that image out of my head. Good to know I am not the only one who fell apart :)
Flag as inappropriate Posted by Nataly on 10th April 2008


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Aetna Adds Loyola University Health System to Its Network
Aetna Adds Loyola University Health System to Its Network
-- Contract Expands Chicagoland Network --
CHICAGO--(BUSINESS WIRE)-- Aetna (NYSE: AET) and Loyola University Health System announced today that Loyola will soon join Aetna's network.
As of March 1, Aetna's members can receive services, at in-network rates, from Loyola University Health System's facilities and physicians. Approximately 500 primary care and specialist physicians will be added to the Aetna network.
"This is exciting news for Aetna and our customers in Illinois," said Suzanne Hall, VP of Aetna's Great Lakes networks. "Adding Loyola to our network is part of our strategy to grow our Chicago-area network and gives Aetna customers access to one of the most recognized health systems in the state."
Jay Sial, Loyola University Health System's senior vice president and chief financial officer, said improving access to care is at the core of Loyola's mission. "Joining with Aetna will help us to extend care to the communities we serve through our two hospitals and our suburban network of 28 primary and specialty care facilities in Cook, DuPage, and Will counties," he said.
Aetna provides health benefits to 436,000 members in the Chicago area. Commercial insurance members have access to a network that includes 112 hospitals and more than 19,674 primary care and specialist physicians.
Aetna also employs more than 400 people in the Chicago area.
About Aetna
Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 37.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services and health information technology services. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.
About Loyola University Health System
Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 28 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 569-licensed-bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.
Scot Roskelley, 312-928-3034
KEYWORDS: United States North America Illinois
The article Aetna Adds Loyola University Health System to Its Network originally appeared on Fool.com.Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.
Copyright © 1995 - 2013 The Motley Fool, LLC. All rights reserved. The Motley Fool has a disclosure policy.


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Okay, so most of us don't spend our lives in front of HD cameras a la the Hollywood elite—but we all deserve perfect, glow-y, baby butt-smooth skin. And since approximately no one is born with a Gwyneth-like glow, we're giving one lucky Cosmo girl the skincare makeover of a lifetime.
Since launching her super-luxe skin clinic in Beverly Hills 30 years ago, Sonya Dakar has become the go-to professional of the stars—as much of a red carpet staple as cleavage and Spanx (but a better kept secret). With awards show season in full swing, Sonya is offering up an Oscar-worthy prize: A personalized skincare consult via Skype and over $500 worth of Sonya Dakar products.
Celebs pay up to $1000 for this kind of, ahem, skintimate care, but all you need to do to enter is tweet @Cosmopolitan @SonyaDakar #OscarsBeautyGiveaway. (Make sure you follow both accounts, too.)
The contest ends next Monday, February 25, at 11:59 p.m., so get your tweet on now! And check out the official contest rules here.


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Thursday, November 15, 2012
Stuffing Pasta
Apparently, I've been born without the genes that makes one enjoy stuffing. Or dressing, as the case may be. I don't know why that happened in life. But I just can't seem to like it. No matter what wonderful things go into it. Not even my gram's famous stuffing. None of it. But stuffing (or dressing) has been deemed a necessary component of the Thanksgiving feast. And I can't bring myself to make it any more, to once again be disappointed that my genetic makeup prevents me from savoring each bite of this dish. To once again, get my hopes up, to think that this one stuffing is the one I will like... then have those hopes dashed. So instead of stuffing, I like doing a pasta dish that I like to think captures a bit of the essence of stuffing. But not in stuffing form. In pasta. So here is a simple dish with brown butter, pancetta, fresh herbs, hazelnuts, and parmesan cheese. Never disappoints.
2/3 pound farfalle pasta
4 ounces cubed pancetta
1 tablespoon extra virgin olive oil
1/4 cup torn sage leaves
1 tablespoon fresh thyme and/or rosemary leaves
pinch nutmeg
white pepper, to taste
kosher salt, to taste
1/3 cup chopped hazelnuts, toasted
juice from 1/2 a lemon
2/3 cup grated parmesan cheese
Bring a large pot of salted water to boil and cook pasta according to package directions. Meanwhile,
heat olive oil over medium high heat in skillet and add the pancetta. Cook until the pancetta has a nice golden brown color (about 5 minutes). Take off heat and set aside.
In large sauté pan, melt butter over medium-low heat. Add sage, thyme, and rosemary and let the butter brown, about two minutes. You will see brown specks that have formed on the bottom of the pan. Be careful to not burn the butter. Add pepper, salt and nutmeg, as well as the reserved pancetta. Sprinkle chopped and toasted hazelnuts. Take off heat and add lemon juice. Add pasta to the brown butter mixture and toss with cheese. Adjust seasonings to taste.
22 comments:
Simple but delicious. Right up my alley.ReplyDelete
Best part about this - you can enjoy it any time of year! Great flavors in the pasta.ReplyDelete
I don't like stuffing or dressing either... great option! ;)ReplyDelete
I'm with you when it comes to stuffing. I'd gladly take this pasta over "dressing" any day!ReplyDelete
That pasta looks totally yummy!ReplyDelete
This looks so delicious. The best part of stuffing mixed with pasta? Count me in!ReplyDelete
Lovely flavors in this pasta dish!!Love the idea of serving this during Thanksgiving :)ReplyDelete
Lovely flavors in this pasta dish!!Love the idea of serving this during Thanksgiving :)ReplyDelete
Holy cow! I'll have to try it. They look delish.ReplyDelete
Surely scientists have gene replacement therapy for this? ;) what a great alternative, I'm so glad you added sage, that's my fav part!ReplyDelete
Mmm I have to try this and devour it :DReplyDelete
Choc Chip Uru
Who knew pasta could be so delicious despite being so healthy?ReplyDelete
You never disappoint me with you fantastic recipes!
Keep up the good work!
This is a perfect alternative to stuffing, I love the idea and the chopped hazel nuts are cool. Is it the actual taste of the stuffing you don't like or the texture? I am not all that fond of it either, I like your pasta idea better. Have a wonderful weekend.ReplyDelete
I love this dish. It will never replace my grandmother's stuffing but it sounds terrific.ReplyDelete
Hi there. The current Food on Friday is all about pasta and noodles! There is already a great collection of dishes but it would be great if you linked this in. This is the link . Have a good week.ReplyDelete
Thanks for linking in. Have a good oneReplyDelete
I'm sure this is delicious but my family and guests would leave me if I didn't give them stuffing! :)ReplyDelete
I'd take your pasta stuffing over regular stuffing any day! LOVE all of the fall flavors in this.ReplyDelete
I hate stuffing too! But I LOVE the idea of this pasta, omg it looks sooooooooooo good. And there's brown butter so...obviously.ReplyDelete
I love stuffing, but I would LOVE this too!ReplyDelete
This is such a nice addition thanks!!!
غلا الروح
شات صوتي
شات الغلا
صوتية الغلا
غلا الصوتيه
شات الروح
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شات غلا
سعودي كام الصوتي
شات تمنيتك
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سحر الكون
بنت ابوي
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شات مغربي
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After four years of college, many graduates are ending up in jobs that only require the ability to operate a cash register with a smile.
After commencement, a growing number young people say they have no choice but to take low-skilled jobs, according to a survey released this week.
Some families are forgoing pricey student loans in favor of alternative strategies. Photo: AP.
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• Insurance you don't need: skip this, buy that
• What it costs to lose your smartphone
• How to switch elite status to another airline
• Want to get out of jury duty? Here's how
• 8 tips for finding cheap airfares
• What car mechanics don't want you to know
• What not to say when pulled over by a cop
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And while 63% of "Generation Y" workers — those age 18 to 29 — have a bachelor's degree, the majority of the jobs taken by graduates don't require one, according to an online survey of 500,000 young workers carried out between July 2011 and July 2012 by PayScale.com, a company that collects data on salaries.
Read more: Why go to college if I can't get a job?
Another survey by Rutgers University came to the same conclusion: Half of graduates in the past five years say their jobs didn't require a four-year degree and only 20% said their first job was on their career path. "Our society's most talented people are unable to find a job that gives them a decent income," says Cliff Zukin, a professor of political science and public policy at Rutgers.
The jobs that once went to recent college graduates are now more often going to older Americans. Over the past year, workers over 55 accounted for 58% of employment growth, says Dean Baker, a co-director of the Center for Economic and Policy Research, a nonprofit think tank in Washington, D.C. Why? Employers think older workers are a safer bet and more likely to stay, he says. Unemployment hovered at 6.2% in July for workers over 55, according to the Labor Department, but was more than double that rate — 12.7% — for those ages 18 to 29.
As a result, college graduates are finding themselves locked into lower-paid jobs. "The shaky economy has forced many of them into a world of underemployment," says Katie Bardaro, lead economist for PayScale. The starting salary for a graduate is $27,000, 10% less than five years ago, the Rutger's study found. "Unlike those who graduated five years ago," Zukin says, "the long-term expectations of this generation are not being met."
Graduates must either face years of underemployment or go back to graduate school, experts say.
"This generation of young Americans are trapped," says Paul T. Conway, president of Generation Opportunity, a nonprofit think tank based in Arlington, Va.
Dave Marshall, 23, earned a bachelor's degree in sociology from the University of Florida in Gainesville last year, works in private security and is a reservist in the U.S. Army's National Guard. "My education is almost irrelevant in the private security field," he says, "but it's a job."


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Ladies Lacoste 12.12 Watch 2001004
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Lacoste 12.12 2001004 is a beautiful and attractive Ladies watch. Material of the case is Plastic/Resin, which stands for a high quality of the item and the Blue dial gives the watch that unique look. 30 metres water resistancy will protect the watch and allows it to be worn in scenarios where it is likely to be splashed but not immersed in water. It can be worn while washing your hands and will be fine in rain. The watch is shipped with an original box and a guarantee from the manufacturer.
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The Lacoste watch debuted in 1993, inspired by the traditional polo shirt and featuring a distinctive green trim with textured detailing. Since that time Lacoste watches have been developed in numerous sporty and decorative styles (such as the Goa line ) centred around that famous crocodile, from the bold and provocative to the tastefully subtle (see the Montreal range ). The French Lacoste brand has a history that begins on the tennis courts, where founder René Lacoste first made a name for himself. The tennis pro was given the nickname 'The Crocodile' for his tenacious performances. This would eventually become the iconic logo of his fashion label, established initially for the creation of his trademark tennis polo shirts in 1933. This collection of Lacoste watches features the crocodile emblem within bold and exciting designs for men and ladies.
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Science Friday® and SciFri® are registered service marks of Science Friday, Inc. Site design by Pentagram; engineering by Mediapolis.
How large is your 'carbon footprint' -- the amount you contribute to greenhouse gas emissions? Even the people in the US with the lowest energy usage have a carbon footprint about twice as high as the average global citizen, according to a new survey. But why is that?
It's no surprise that people with a higher standard of living tend to use more resources and require more energy, and per capita carbon emissions in the US are significantly higher than in the rest of the world. The exact numbers, however, and the reasons behind them, are surprising. The researchers, a group of students at MIT, looked at the carbon footprint of people in the US with different lifestyles, from those of Oprah-Winfrey-level celebrities to those of monks and a homeless person living in a shelter. While the emissions of someone like Bill Gates were over 10,000 times that of the world per capita average, even a Buddhist monk who lived in the forest for half of every year had a carbon footprint of 10.5 tons of carbon dioxide per year. The average per capita carbon footprint globally is just 4 tons. Regardless of an individual's personal efforts at reducing their carbon footprint, the effects of shared services from courts, the military, roadways, and other public resources increased overall numbers in the United States, creating a baseline level of consumption that is impossible to avoid. We'll talk with one of the researchers behind the study about what it means, and what kinds of changes a person -- and a society -- might need to make to have a significant effect on emissions.


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Scientists are planning further observations of this rock, which they hope will yield more insight into the hematite's origins as well as how the enigmatic nuggets formed.
This image was taken by Spirit's microscopic imager on sol 163 (June 18, 2004). The observed area is 3 centimeters by 3 centimeters (1.2 inches by 1.2 inches).
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Modern Style for Classic Rooms
Go Big and Bold
Pulled together, tailored and masculine are the words that come to mind when describing this successful transformation by Matt and Michael. By limiting the color palette to grays, blacks and whites with a powerful hint of red, these two competitors demonstrate that making fewer and bigger statements is a smart way to dramatically transform a space in a limited amount of time. Furniture with clean and simple lines adds to the elegance of the room and balances nicely with the more ornate detailing. Painting the fireplace mantel white creates a severe contrast to the black walls, making the beautiful, pre-existing architectural details of the room very prominent. The incredible chandelier, the deep crown molding and, of course, the fireplace step forward instead of being lost against the horribly busy wallpaper that dominated the pre-transformation space. Even the sculpture sitting on top of the mantel, made from their bizarre yard sale finds, looks innovative and perfectly appropriate, illustrating the point that real design talent can manipulate almost anything to work in a room.
Work With the Architecture
Make a Statement
There is nothing horribly wrong with this room, but then again, there is also nothing wonderfully right. Trish and D. Paul tame the bright paint that dominated their room before and streamline the overdone drapery, but fail to make a new statement to illustrate why they should be in this competition. Bland and expected furnishings paired with a bland and expected rug create a bland and expected room that you would see in any hotel lobby.
Don't Play It Safe
With the exception of D. Paul's majorly mangled bow, which could have been a wonderful addition to the fireplace surround, this room's only other major blunder is that it fails to demonstrate any design inventiveness by playing it too safe. Since this is a competition for the next great, undiscovered designer, the judges are looking for something inventive and creative that demonstrates you have a firm grasp of design knowledge and can introduce high-quality design information through these challenges. An unexpected color pairing with the traditional furniture chosen or mixing in less traditional furniture with this classic paint color would have given the room much-needed visual interest.
Build a Strong Foundation
Mikey V. and Stephanie have many winning moments in their very fresh approach. By minimizing contrast between their wall and trim paint colors and keeping their furnishings light and airy, they put a modern spin on a very staid and classic space. This team has also smartly set the stage for a singular and dramatic statement in the form of an organically shaped wood bench that serves as both sculpture and additional seating and also contrasts nicely with the clean-lined sofa opposite it. This room has a strong foundation that clearly illustrates this team knows design and has great instincts.
Know When to Stop
Instead of building on their great start by selecting a few purposeful accessories, Mikey V. and Stephanie infuse a world of mismatched, small-scale accessories that litter the visual landscape and detract from the great bone structure of their room. Keeping the wood bench unadorned with pillows, removing the gaggle of accessories surrounding the fireplace and replacing the over-grown plant with something of equal scale but more manicured would have finished this room perfectly and given their fresh and airy transformation an idyllic ending. Sometimes it is just as important to know when to stop as it is to know how to begin.
Bring It All Together
This room looks as if Tracee and Jennifer threw everything but the kitchen sink at it. Although eclectic design is a wonderful and very smart way to go with a transformation, a great designer will ultimately find a way to pull disparate elements together. They valiantly attempt to include a wide variety of furnishings in their space, from the clean-lined sofa and outdoor metal coffee table to the ornate arm chairs and painted mannequin on the mantel, but eventually come up short because they can not find a way to pull all of their very disparate elements together with a central color, fabric, wood tone or idea. Teamwork is a key component of challenges and this transformation clearly shows a team in distress and unable to work together.
Pay Attention to Proportions
The incredibly tall and dramatic ceilings in the space are diminished because Tracee and Jennifer fail to hang drapery all the way to the ceiling line, leaving them short and stumpy in appearance by hanging them only at window height. Rooms of this magnitude and proportion can be difficult to work with, as this team illustrates.


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Pregnancy Week By Week
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Discover the many stages of your pregnancy with Your Pregnancy Week by Week - A personalized pregnancy calendar created just for you! Our pregnancy guide details fetal development, changes in your body, pregnancy symptoms, and so much more, broken down week by week. Pregnancy questions are answered, and we'll even show you some pictures & videos along the way!
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