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As the shale energy revolution is gaining speed in the United States, transportation and logistics companies are experiencing an immediate and dramatic impact, according to a new PricewaterhouseCoopers LLP (PwC) report, Shale Energy: A potential game changer—Implications for the US transportation & logistics industry.
Since 2010, the United States has emerged as the largest natural gas producer in the world and the Energy Information Administration forecasts that by 2040, 50% of the country's natural gas supply will come from shale gas, dramatically impacting several segments of the transportation and logistics industry.
"Shale energy is having a major effect on the chemicals and manufacturing industries in the United States, with clear ramifications for transportation and logistics companies," says Jonathan Kletzel, US transportation and logistics leader, PwC. "This new source of abundant, low-cost energy provides a significant incentive for chemical producers and manufacturers to shorten their supply chain and bring production facilities back to the United States. A revived manufacturing sector would increase the need for rail and trucking to move more products domestically and to ship exports abroad."
According to PwC's report, the shale oil boom is creating considerable opportunities for the railroad, trucking, marine shipping, and airline industries as transport is needed to move gas, oil, and waste by-products.
Trucking—The low price of liquefied natural gas (LNG) relative to the more expensive diesel fuel has led many companies to switch to vehicles that run on natural gas. However, in order for trucking companies to expand their use of more affordable fuels, there needs to be infrastructure support. As part of America's Natural Gas Highway initiative, a network of approximately 150 LNG truck fueling stations on interstate highways are scheduled to be in operation by the end of 2013. In addition to changing fuel dynamics, trucking activity has increased as a result of shale production as trucks haul fresh water, frack sand, waste products, and heavy equipment.
Railroads—In addition to transporting people, equipment, and oil, railroads are being used to haul the chemicals needed in the shale extraction process and to carry away waste products. The railroad industry is getting a boost from the positive effects of shale on the US chemical industry as well, since rail is essential to the movement of chemicals, with nearly a quarter of US chemical shipments being transported by rail.
"The inbound and outbound use of rail has led to a surge in demand for cars that can carry crude oil, and rail car companies are reaping the benefits, experiencing a backlog of orders for petroleum carrying cars and reporting strong financial results," continued Kletzel. "In some shale-producing regions, the railroads have experienced such an uptick that they have had to build additional infrastructure to keep up with the increasing demand. Rail is quickly becoming a favored mode of transport because it is cheaper than trucking and more flexible than pipelines."
Marine Shipping—The North American shipping industry could become a major exporter of natural gas, driven by shale gas drilling activity. There are more than 20 proposed LNG export terminals seeking permits to allow total processing of about 30 billion cubic feet a day, according to the US Department of Energy. If currently pending applications are approved, US exports could result in approximately 3,600 new LNG tanker departures per year. The shipping industry also is expected to play an increasing role in the transportation of machinery and other products needed for exploration and production.
Airlines—The high price of jet fuel, the single largest cost component for airlines, coupled with the volatility of crude oil prices, is spurring a search for cheaper alternatives, such as those based on natural gas, states PwC's report. The use of natural gas for jet fuel is still years away from widespread commercial use, but the incentive is there for development, given today's concerns around carbon dioxide emissions. In the near-term, however, airports and airlines benefit from the increased traffic to and from the major shale gas regions. PwC's analysis shows that flights originating in North Dakota airports serving the Bakken shale field have experienced an increase in load factors of almost 10% over the last five years as traffic has nearly doubled.
"While pipelines may eventually move the bulk of shale oil and gas, it will take time to develop the infrastructure, and rail, trucks, and planes will still be needed to transport people and equipment while ships will carry LNG to other parts of the world," Kletzel said. "As shale energy helps to revive US manufacturing, it will impact most transportation modes, as they are needed to move products both domestically and abroad. Transportation and logistics executives should consider the opportunities currently presented by the rapid growth of shale energy, as the 'winners' will start developing strategic plans that consider the impact of shale on the overall economy and the potential it presents for the growth of their business now and for the foreseeable future."
For a copy of PwC's Shale energy: A potential game-changer - Implications for the US transportation & logistics industry, please visit: www.pwc.com/us/industrialproducts. ♦


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Here are a few examples, and how they can emerge in a finished room.
I love the art deco lines of the Deca condos along Park Boulevard.
The building's metal "bracelets" may show up in matching cabinet jewelry. This metal Mosaic knob by Siro Designs is available on IKDD's Miton MT900 series or at European Bath Kitchen Tile Stone in Solana Beach.
My daily walk also takes me past a Craftsman home that looks quite like this one.
I call it "curb candy!"
Craftsman style inspires me to use cabinets like these Miton MT500s, also at IKDD. They're the ones that will probably go into my next home -- in painted white.
In the neighboring community of Hillcrest is a succulent garden like this one. I love its year-round, hardy style.
This hardy, all-weather fabric from Sunbrella captures the garden's colors and could show up on a banquet or counter stool cushions in one of my kitchens.
I recently visited the Sierra Club's Foster Lodge in Pine Valley, Cal. I shot this rugged view from a hike there on my iPhone. (Puts life in perspective, doesn't it!)
The rocky view inspires my frequent use of stone countertops, especially easy maintenance quartz. This Sienna Ridge is by Silestone.
This local Greek Orthodox church reminds me of the ones I enjoyed in Santorini years ago.
I suspect those white walls and blue accents were the original inspiration for my love of white kitchen cabinets against blue walls. These Del Rays are from American Woodmark.
The building I'm living in at the moment has a courtyard filled with pink-flowered boxes like this one. They make me smile as I head out on my morning walk and return, tired but happy.
I love the whimsy of pink hardware dotting vintage-style cabinets -- perhaps in a butler's pantry or bathroom armoire. This one comes from CoolNobsAndPulls.com. They make me smile, too.

subset: commoncrawl


text:
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A.C. Lighting Inc. Showcases Next Generation LED Lighting & Control at USITT 2010
March 19, 2010 05:21
The A.C. Lighting Inc. booth at USITT 2010 will feature pioneering new LED lighting and control systems from Chroma-Q® and Jands. The Artistic Licence Art-Net range, which is also distributed exclusively by the company in North America, will be featured on the booth (580).
Now shipping is the new Chroma-Q Color Force™ 72 / 48 range of 6ft, 12,000 lumens output and 4ft 8,000 lumens output LED battens. With super bright light output, the range provides an extremely smooth, uniform coverage for washing areas up to 26ft high and is ideal for lighting cycloramas or as a border light.
Also previewing is the new Chroma-Q Color Charge™, a 600 lumens, rechargeable battery powered, ultra portable LED light source which combines wireless control with an environmentally friendly NiMH battery and interchangeable head design.
The new generation of Chroma-Q LED models, which includes the Color Block 2™ multi-purpose fixture, feature advanced RGBA color mixing and control management technologies. Together these provide a radically increased color palette, a high CRI of at least 90 and theatrical grade dimming, all in the same fixture. For more information visit www.chroma-q.com
Jands will be previewing a major upgrade of the Vista control system. Free to existing users, this completely re-written application builds on the innovative visual approach pioneered by Jands and takes it to a whole new level, introducing a true second generation of software. Faster and even easier to use, it is a lot more than just an upgrade of the existing Vista software. It provides an unrestricted, feature rich, reliable software platform for building an ever more sophisticated and powerful console in the years to come. For more information visit www.jandsvista.com
In addition to aforementioned products exclusively distributed in North America by A.C. Lighting Inc., the company carries a vast stockholding of the latest stage, studio and event lighting products, accessories and consumables. This choice of on-the-shelf products is coupled with competitive prices and the highest level of service and support.
All Chroma-Q LED products are licenced by Color Kinetics. Chroma-Q and all associated product names are recognised trademarks, for more information visit www.chroma-q.com/trademarks. The rights and ownership of all trademarks are recognised. The information contained herein is correct at the time of printing, however as we are constantly refining our product range we reserve the right to change the specification without notice. E&OE.
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Re: "Denver Public Schools gets $10 million grant from Gates Foundation," July 25 news story.
Denver Public Schools is receiving $10 million from the Bill & Melinda Gates Foundation ($20 million over the past few years) "to bolster its teacher evaluation system." Somehow the private sector can figure these things out on their own, but public schools require vast sums and an army of "experts" to do the same thing?
Every teacher out there knows who brings it to the classroom every day in their schools and who doesn't. Every teacher out there knows which of their co-workers are effective and which aren't. If we really want to support our teachers, why don't we give them the freedom to do their jobs?
This $20 million could give every DPS teacher almost a $4,400 annual raise. Or perhaps this money could be used to put actual librarians in charge of running libraries, or a hundred other worthwhile causes.
Instead of wasting tens of millions of dollars, let's bring freedom to the public schools and unleash the wisdom of millions.
John Conlin, Littleton
The writer is founder and president of the nonprofit End the Education Plantation.
This letter was published in the July 29 edition.
For information on how to send a letter to the editor, click here. Follow eLetters on Twitter to receive updates about new letters to the editor when they're posted.


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A doctor usually will take a
medical history and do a physical exam if you have symptoms of
If your medical problem
affects your abdomen, your doctor will ask questions (medical history) about:
A dietary history includes questions
about the amount of fiber, fat, and salt in your diet. If your symptoms are
mild and occur only sometimes, your doctor may recommend that
you try a high-fiber, low-fat diet.
During the physical exam to learn the cause of an abdominal
problem, your doctor will:
A history and physical exam are
needed for anyone who sees a doctor about abdominal pain or
tenderness or a change in bowel habits.
Your medical history and physical exam can
provide your doctor with clues about the cause of your symptoms.
Your doctor then may decide to do more tests (especially if there
are several possible causes for your symptoms or if the cause is still
unclear), begin treatment, or both.
If your symptoms are not severe,
your doctor may recommend a change in your diet and watchful
Complete the medical test information form (PDF)(What is a PDF document?) to help you prepare for this test.
Last Revised:
July 19, 2012
Healthwise Staff
Medical Review:
Adam Husney, MD - Family Medicine & Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
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Terminal 1 Tour
Approximate time to complete: 35 minutes
Stop 1
As you enter Terminal 1 turn to your right and walk to the food court near Gates 40-48. Enter the food court. Can you find an area from which to view airplanes? What airlines do you see?
Stop 2
Follow the signs for the "AirTrain" and take the escalator up to the AirTrain platform. AirTrain is a"people mover;" it operates 24 hours every day and takes passengers between terminals, to the terminal garages, and to the Rental Car Center. AirTrain is free to ride and can be boarded from any terminal.
Passengers riding AirTrain get a great view of the airport, including the runways. If you have time, take a ride on AirTrain. A full loop on the Red Line, which circles SFO's four terminals, takes approximately 9 minutes; a return trip on the Blue Line, which goes to SFO's Rental Car Center, takes about19 minutes. If there is space, sit at the front of the first car for the best view. Exit AirTrain back at the Terminal 1 station.
Stop 3
Take the escalator or elevator down to Level 1 for the Arrivals/Baggage Claim area. Walk along the wall by the exit doors until you find the Children's Art exhibit. This gallery, part of SFO Museum, provides San Francisco schools and other community youth organizations with children's art programs the opportunity to exhibit their art at SFO.
Stop 4
Exit the terminal through the last door, go outside and follow the paw prints to the animal relief area. SFO has two animal relief areas, one at the end of Terminal 1 and one at the end of Terminal 3. Many people travel with pets or service animals, and this area provides the animals with a fully enclosed rest space and drinking water.
Stop 5
Go back into the terminal and take the escalator or elevator to Level 2, Departures Level. Turn to your right and follow the signs for the International Terminal. Walk through the connecting corridor. The mosaic on the wall is by Joyce Kozloff and is a representation of three styles. The left panel, "Bay Area Victorian," portrays the style and ornamentation of old houses in several San Francisco districts. The right panel, "Bay Area Deco," refers to the architecture of downtown Oakland and the center panel, "Area Funk," is a collection of Berkeley memorabilia from the 1960's.


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Abstract and Keywords
Adult day care centers provide important health, social, and support services for functionally and cognitively impaired adults and their caregivers. The adult day care services are underutilized, however, because of the shortage of centers, caregivers' lack of awareness of and resistance to using services, and the mismatch between the needs of potential consumers and their informal caregivers and the services provided by the centers. To foster and support the expansion of adult day care centers, lessons learned from national demonstration programs need to be disseminated, and social workers need to be trained to provide essential services at the centers.
Keywords: adult day care center, medical and social model of care, continuum of care, outreach service
Access to the complete content on Encyclopedia of Social Work requires a subscription or purchase. Public users are able to search the site and view the abstracts and keywords for each book and chapter without a subscription. If you are a student or academic complete our librarian recommendation form to recommend the Oxford Research Encyclopedias to your librarians for an institutional free trial.
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I was wondering how to identify small structures (eg. beacons) in a water body? I have worked with RGB images and its almost impossible to classify waterbodies in these images.
How does the IR band help here? Will they be good enough to say that this pixel belongs to water body and this pixel doesn't?
I hope I am clear enough. Kindly ask if you need more information.


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Chicago Fire alum Monica Raymund has booked her first major gig since leaving Dick Wolf's firehouse procedural, and it looks like the actress formerly known as Dawson ditched Chicago for... P-town?
According to Deadline, Raymund is set to lead Starz's new opioid epidemic drama P-Town as Jackie Quinones, a lesbian National Marine Fisheries Services officer who often trolls "P-Town" -- the gay mecca of Provincetown, Massachusetts -- to pick up girls. When she finds the body of an opioid addict washed up on the beach, Jackie's life begins to circle the drain.
A description for the show reads: "As she faces her own addictive behaviors, she becomes increasingly obsessed with solving the murder. Jackie's forced to confront the dark side of the idyllic summer spot -- all the while putting herself and her sobriety in danger." Production on the new series is slated to begin in March.
Everything We Know About Chicago Fire Season 7Monica Raymund, Chicago Fire" data-image-credit="Elizabeth Morris/NBC" data-image-alt-text="�Monica Raymund, Chicago Fire" data-image-credit-url="" data-image-target-url="" data-image-title="�Monica Raymund, Chicago Fire" data-image-filename="180615-chicagofire-news.jpg" data-image-date-created="2018/06/15" data-image-crop="" data-image-crop-gravity="" data-image-aspect-ratio="" data-image-height="1380" data-image-width="2070" data-image-do-not-crop="" data-image-do-not-resize="" data-image-watermark="" data-lightbox="">
We're obviously heartbroken to see Raymond leave Chicago Fire, especially since she starred as a badass paramedic and firefighter candidate for six seasons. However, this new gig is a serious step forward in Raymund's career -- get it, girl -- so here's hoping Fire fans will turn out for her new series.
"It has been an honor to play Dawson on Chicago Fire and one of the most meaningful experiences of my life," Raymund tweeted about her departure back in May. "I am so thankful for the journey and especially to all of you for watching, but I have made the decision that it's time for me to move on to the next chapter in life."
See how Chicago Fire addresses Raymund's departure when Season 7 premieres Wednesday, Sept. 26 at 9/8c. Then catch Raymond in action when P-Town debuts in the near future.
Other Links From TVGuide.com Chicago FireMonica Raymund


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STUART Beavon is unlikely to be making a return to Wanderers after the club tried to take him back on loan.
Blues confirmed this week they had made enquiries about bringing their former striker back to Adams Park from Preston North End.
But it's believed Beavon, who scored 25 League One goals for Wanderers in the 2011/12 season, still features in the Lancashire side's plans and they want him to stay at Deepdale.
It's also being reported Wycombe made enquires with Preston over defender Ben Davies.
Blues boss Gareth Ainsworth is in the market for a left back and it's understood he asked about signing Davies on a season-long loan.
However that potential transfer also seems to have been knocked back.
Teenager Davies spent last season on loan at York City, who he helped reach the League Two play offs.


text:
TriZPUG January 2013 Meeting: Python AI and Deco
Joseph Tate will demonstrate the Python solver for Pacman he made as a part of his BerkeleyX CSS 188 Artificial Intelligence course. Andy Leeb will present Deco, a drag-and-drop layout composition system for Plone. As always, spontaneous lightning talks of ten minutes or less on other topics are also welcome. Anything you've learned about Python, no matter how trivial, can be a lightning talk. There's plenty of parking at Caktus and we can walk to nearby after-meeting watering holes.
- What
- Meeting
- When
- 2013-01-24 from 19:00 to 21:00
- Where
- Caktus Group, 209 Lloyd St, Suite 110, Carrboro, NC
- Name
- Tobias McNulty
- Contact Email
- firstname.lastname@example.com
- Contact Phone
- 951-0052


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Hollister Outlet Online A complete guide to wholesale fashion clothing for kids
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"There is always the risk that you will run out of arrows. There is never a risk that The Incredible Hulk will run out of Hulk." Hawkeye from the Avengers suffers the slings and arrows of outrageous Nintendo president in the latest installment of Nintendo Gamer's lost Iwata Asks files.
No one is safe from the razor-sharp interview tactics of Nintendo president Satoru Iwata, not politicians, filmmakers, industry rivals, not even one of Earth's Mightiest Heroes.
Iwata: At this point I normally say 'thank you for making time today', but it is not like you are in huge demand. [Laughs]
Hawkeye: Evil can strike at any time.
Iwata: And I am sure that if The Incredible Hulk, Captain America, Iron Man and Thor need any arrows, they will get in touch. [Laughs]
Completely unfair, though those of you that have seen the Avengers movie can attest to the fact that Hawkeye's most important function was pretty much acting as...well, hawk eyes. Sure, he takes out a few bad guys with arrows, but Captain America, Iron Man, the Hulk and Thor would have gotten to them eventually.
In fact, he was more effective as [spoiler spoiler spoiler] than he was as [other spoiler].
Damn it, everyone hurry up and see the movie.
Iwata Asks... Hawkeye from the Avengers [Nintendo Gamer]


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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Kaposi sarcoma (KS) was first described in 1872 by the Hungarian dermatologist, Moritz Kaposi. From that time until the current human immunodeficiency virus (HIV) disease epidemic identified with the Acquired Immunodeficiency Syndrome (AIDS), KS remained a rare tumor. While most of the cases seen in Europe and North America have occurred in elderly men of Italian or Eastern European Jewish ancestry, the neoplasm also occurs in several other distinct populations: young black African adult males, prepubescent children, renal allograft recipients, and other patients receiving immunosuppressive therapy. The disseminated, fulminant form of KS associated with HIV disease is referred to as epidemic KS to distinguish it from the classic, African, and transplant-related varieties of the neoplasm. In addition, KS has been identified in homosexual men apart from the HIV disease epidemic.[1]
Although the histopathology of the different types of the Kaposi tumor is essentially identical in all of these groups, the clinical manifestations and course of the disease differ dramatically.[2] A key piece to the puzzle of KS pathogenesis was the 1994 discovery of a gamma herpes virus, human herpes virus type 8 (HHV-8), also known as Kaposi sarcoma herpes virus.[3] HHV-8 was identified in KS tissue biopsies from virtually all patients with classic, African, transplant-related, and AIDS-associated KS but was absent from noninvolved tissue.[4,5,6,7]
Classic Kaposi Sarcoma
Considered a rare disease, classic KS occurs more often in males, with a ratio of approximately 10 to 15 males to 1 female. In North Americans and Europeans, the usual age at onset is between 50 and 70 years. Classic KS tumors usually present with one or more asymptomatic red, purple, or brown patches, plaques, or nodular skin lesions. The disease is often limited to single or multiple lesions usually localized to one or both lower extremities, especially involving the ankles and soles.
Classic KS most commonly runs a relatively benign, indolent course for 10 to 15 years or more, with slow enlargement of the original tumors and the gradual development of additional lesions. Venous stasis and lymphedema of the involved lower extremity are frequent complications. In long-standing cases, systemic lesions can develop along the gastrointestinal tract, in lymph nodes, and in other organs. The visceral lesions are generally asymptomatic and are most often discovered only at autopsy, though clinically, gastrointestinal bleeding can occur. As many as 33% of the patients with classic KS develop a second primary malignancy, which is most often non-Hodgkin lymphoma.[8,9,10]
African Kaposi Sarcoma
In the 1950s, KS was recognized as a relatively common neoplasm endemic in native populations in equatorial Africa and comprised approximately 9% of all cancers seen in Ugandan males. African KS is seen as either an indolent neoplasm identical to the classic disease seen in Europe and North America or as an aggressive disease with fungating and exophytic tumors that may invade the subcutaneous and surrounding tissue including the underlying bone. In Africa, both the indolent and locally more aggressive forms of KS occur with a male-to-female ratio comparable to that observed with the classic KS tumor seen in North America and Europe. In general, however, patients in Africa are significantly younger than their European counterparts. A lymphadenopathic form of KS is also seen in Africa, primarily in prepubescent children (male:female ratio 3:1). In these cases, the generalized lymphadenopathy is frequently associated with visceral organ involvement. The prognosis is very poor with a 100% fatality rate within 3 years.[11,12]
Immunosuppressive Treatment–Related Kaposi Sarcoma
In 1969, the first case of KS in association with immunosuppression in a renal transplant patient was described. Since that time, a number of renal and other organ allograft recipients who received prednisone and azathioprine developed KS shortly after the onset of immunosuppressive therapy.[13] Estimates of the incidence of KS in immunosuppressed renal transplant recipients are between 150 and 200 times the expected incidence of the tumor in the general population. The average time to develop KS after transplantation is 16 months. Although the KS tumor in iatrogenically immunosuppressed patients often remains localized to the skin, widespread dissemination with mucocutaneous or visceral organ involvement is common. In some cases, the KS tumors have regressed as a result of reduction or changes in immunosuppressive therapy. Clinical management of renal transplant patients who develop KS is difficult and requires a balance between the risk of death from generalized KS and the risk of graft rejection and complications of renal failure that may occur if the immunosuppressive therapy is discontinued.
Epidemic Kaposi Sarcoma
In 1981, a fulminant and disseminated form of KS in young homosexual or bisexual men was first reported as part of an epidemic now known as AIDS.[14] The etiology of AIDS is a T-cell lymphotropic retrovirus known as HIV. The underlying immunologic deficiency that characterizes HIV disease is an acquired profound disorder of cell-mediated immune functions. This immunologic deficiency and immune dysregulation predisposes the host to a variety of opportunistic infections and unusual neoplasms, especially KS. HIV may play an indirect role in the development of KS.[15]
Approximately 95% of all the cases of epidemic KS in the United States have been diagnosed in homosexual or bisexual men. In the past, approximately 26% of all homosexual males with HIV disease presented with, or eventually developed, KS during the course of their illness. By comparison, fewer than 3% of all heterosexual intravenous drug users with HIV disease developed KS. The proportion of HIV disease patients with KS has steadily decreased since the epidemic was first identified in 1981.[16] About 48% of AIDS patients in 1981 had KS as their presenting AIDS diagnosis. By August 1987, the cumulative proportion of AIDS patients with KS had diminished to fewer than 20%. The introduction of highly active antiretroviral therapy (HAART) has delayed or prevented the emergence of drug-resistant HIV strains, profoundly decreased viral load, led to increased survival, and lessened the risk of opportunistic infections.[17,18,19] The use of HAART has been associated with a sustained and substantial decline in KS incidence in multiple large cohorts.[20,21,22,23,24,25]
The lesions that develop may involve the skin; oral mucosa; lymph nodes; and visceral organs, such as the gastrointestinal tract, lung, liver, and spleen. Most patients with HIV disease who present with the mucocutaneous lesions of KS feel healthy and are usually free of systemic symptoms, as compared to patients with HIV disease who first develop an opportunistic infection. The sites of disease at presentation of epidemic KS are much more varied than the sites seen in other types of this neoplasm. In an early report on the clinical manifestations of the disease, 49 patients were described.[26] Of these patients, 8% had no skin involvement, 27% had localized or fewer than five skin lesions, and 63% had innumerable skin lesions widely distributed over the skin surface area. Of these patients, 61% had generalized lymphadenopathy at the time of the first examination. Four of these patients, who had generalized lymphadenopathy in the absence of skin lesions or detectable visceral organ involvement at the time of presentation, were found to have biopsy-proven KS localized to the lymph nodes. In 45% of the patients studied, KS lesions were found in one or more sites along the gastrointestinal tract. Of these patients, 29% had either unexplained fever or unexplained weight loss when first seen. While most patients present with skin disease, KS involvement of lymph nodes or the gastrointestinal tract may occasionally precede the appearance of the cutaneous lesions.
Eventually, most patients with epidemic KS develop disseminated disease. The disease often progresses in an orderly fashion from a few localized or widespread mucocutaneous lesions to more numerous lesions and generalized skin disease with lymph node, gastrointestinal tract disease, and other organ involvement. Pleuropulmonary KS is an ominous sign usually occurring late in the course of the disease, especially in those patients whose death is directly attributed to KS.[27] Most patients with epidemic KS die of one or more complicating opportunistic infections.
Nonepidemic Gay–Related Kaposi Sarcoma
Several reports documented KS in homosexual men who persistently had no evidence of HIV infection. These patients had an indolent and cutaneous form of the disease, which caused new lesions to appear every few years. Lesions occur most commonly on the extremities and genitalia but can occur anywhere on the skin.[1] These cases may indicate the presence of causal factors other than HIV that homosexual men may be exposed to because of their lifestyle.
The staging evaluation of patients with classic Kaposi sarcoma (KS) should be individualized. The advanced age of most of the patients, localized nature of the tumor, rarity of visceral involvement, and usually indolent course of the disease should temper the extent of the evaluation. A careful examination of the skin and lymph nodes is sufficient in most cases. For the rare patient with rapidly progressive tumor or signs or symptoms of visceral involvement, appropriate evaluation is indicated. No universally accepted classification is available for epidemic KS. Staging schemes that incorporate laboratory parameters as well as clinical features have been proposed. Since most patients with epidemic KS do not die from the disease, factors besides tumor burden are apparently involved in survival.
The conventions used to stage KS and the methods used to evaluate the benefits of KS treatment continue to evolve because of changes in the treatment of human immunodeficiency virus (HIV) and in recognition of deficiencies in standard tumor assessment. The clinical course of KS, the selection of treatment, and the response to treatment are heavily influenced by the degree of underlying immune dysfunction and opportunistic infections.
The AIDS Clinical Trials Group (ACTG) Oncology Committee has published criteria for the evaluation of epidemic KS.[1] The staging system incorporates measures of extent of disease, severity of immunodeficiency, and presence of systemic symptoms. As shown in Table 1 below, the ACTG criteria categorizes the extent of the tumor as localized or disseminated, the CD4 cell number as high or low, and a systemic illness as absent or present.
A subsequent prospective analysis of 294 patients entered on ACTG trials for KS between 1989 and 1995 showed that each of the tumor, immune system, and systemic illness variables was independently associated with survival.[2] Multivariate analysis showed that immune system impairment was the most important single predictor of survival. In patients with relatively high CD4 counts, tumor stage was predictive. A CD4 count of 150 cells/mm³ may be a better discriminator than the published cutoff of 200 cells/mm³. A study is in progress to determine if viral load adds predictive information. None of the prior studies were conducted at a time when highly active antiretroviral therapy (HAART) was readily available. The impact of HAART on survival in KS requires continued assessment.
Classic Kaposi sarcoma (KS) usually is limited to the skin and has an indolent course. Patients with this tumor are predisposed to the development of a second primary malignancy, and the treating physician should consider this factor when arranging a schedule of follow-up treatment for the patient.
Equivalent standard treatment options:
Solitary lesions:
Widespread skin disease:
EBRT used in this manner gave long-term results that were superior to those obtained with radiation therapy administered to successive individual lesions as they appeared.[2]
One patient was treated repeatedly with intralesional injections of 0.25 to 0.50 mg of vincristine, which resulted in complete disappearance of the treated lesion.[8] Multiple courses of therapy were required because of the recurrence of disease in untreated areas.
Lymph node and gastrointestinal tract involvement:
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with classic Kaposi sarcoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Some patients with Kaposi Sarcoma (KS) have noted spontaneous and lasting remissions following discontinuation of immunosuppressive therapy. In managing these patients, if immunosuppressive therapy is not critical, its discontinuation is a reasonable first step.
Standard treatment options:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with immunosuppressive treatment related Kaposi sarcoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Treatment may result:
No data are available, however, to show that treatment improves survival.[1] In addition to antitumor treatment, essential components of an optimal Kaposi sarcoma (KS) treatment strategy include highly active antiretroviral treatment (HAART), prophylaxis for opportunistic infections, and rapid recognition and treatment of intercurrent infections.
Most good-risk patients, as defined by the AIDS Clinical Trials Group, show tumor regression with HAART alone.[2] Poor-risk patients usually require a combination of HAART and chemotherapy with discontinuation of the chemotherapy after disappearance of the skin lesion.[2]
Local modalities
Small localized lesions of KS may be treated by electrodesiccation and curettage, cryotherapy, or by surgical excision. KS tumors are also generally very responsive to local radiation therapy, and excellent palliation has been obtained with doses at 20 Gy or slightly higher.[3,4,5] One report demonstrated a response rate higher than 90%, with a median time to progression of 21 months. Although no difference in response was noted with a variety of fractionation regimens, a single fraction of 8 Gy is indicated for cutaneous lesions and is associated with significantly fewer severe reactions.[6] Radiation therapy is generally reserved to treat localized areas of the skin and oral cavity. It is less often used to control pulmonary, gastrointestinal tract, or other sites of KS lesions. Localized KS lesions have also been effectively treated with intralesional injections of vinblastine.[7] Alitretinoin 0.1% gel provided local control in a randomized prospective multicenter trial.[8][Level of evidence: 1iiDiv]
In epidemic KS, the already profoundly depressed immunologic status of the host limits the therapeutic usefulness of systemic chemotherapy. Systemic chemotherapy studies in epidemic KS have used as single agents or in combinations doxorubicin, bleomycin, vinblastine, vincristine, etoposide, paclitaxel, and docetaxel.[9,10,11,12,13][Level of evidence: 3iiiDiv]
Randomized multicenter trials showed an improvement in response rate (45%–60% vs. 20%–25%) and a more favorable toxic effects profile for pegylated liposomal doxorubicin or liposomal daunorubicin, compared to the combination of doxorubicin, bleomycin, and vincristine or bleomycin and vincristine.[14,15,16][Level of evidence: 1iiDiv] During HAART, both pegylated liposomal doxorubicin and paclitaxel are active single agents with response rates close to 50%.[17][Level of evidence: 1iiDiv]
Biologic therapy
The interferon alphas have also been widely studied and show a 40% objective response rate in patients with epidemic KS.[18,19] In these reports, the responses differed significantly according to the prognostic factors of extent of disease, prior or coexistent opportunistic infections, prior treatment with chemotherapy, CD4 lymphocyte counts lower than 200 cells/mm³, the presence of circulating acid-labile interferon alpha, and an increase in beta-2-microglobulin. Several treatment studies have combined interferon alpha with other chemotherapeutic agents. Overall, these trials have shown no benefit with the interferon-chemotherapy combinations as compared to the single-agent activities.
Recombinant interferon alpha-2a and interferon alpha-2b were the first agents approved for the treatment of KS. Approval was based on single-agent studies performed in the 1980s before the advent of antiretroviral therapy. The early studies demonstrated improved efficacy at relatively high doses. High-dose monotherapy is rarely used today, and instead, interferon is given in combination with other anti-HIV drugs in doses of 4 to 18 million units. Neutropenia is dose limiting, and trials of doses of 1 to 10 million units combined with less myelosuppressive antiretrovirals are in progress. Response to interferon is slow, and the maximum effect is seen after 6 or more months. Interferon should probably not be used in the treatment of patients with rapidly progressive, symptomatic KS.
Interleukin-12 had a response rate of 71% (95% confidence interval, 48%–89%) among 24 evaluable patients in a phase I and phase II trial.[20][Level of evidence: 3iiiDiv]
Treatment options under clinical evaluation:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with AIDS-related Kaposi sarcoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
The prognosis for any treated Kaposi sarcoma patient with progressing, recurring, or relapsing disease is highly variable. Deciding on further treatment depends on many factors, most importantly the clinical setting (i.e., classic, immunosuppressive treatment, or AIDS) in which the tumor arises as well as individual patient considerations.
Clinical trials are appropriate and should be considered when possible.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent Kaposi sarcoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of Kaposi sarcoma. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Kaposi Sarcoma Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Kaposi Sarcoma Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/treatment/kaposis/HealthProfessional. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov Web site can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site's Contact Form.
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).
Last Revised: 2012-07-12
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Precision Rotario Match Football FIFA Quality Training & Practice Soccer Ball
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Precision Rotario Match Football FIFA Quality Training & Practice Soccer Ball FIFA Quality ball. Anli 1mm Quick Silver PU outer with Hempton embossing High rebound 2mm EVA plus polyester and 4mm EVA foam linings. Polyester thread bonded 25% butyl bladder. Weight: 400-440gms
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Kodak Is Back, But Not the Kodak You Remember
By Rachel Feintzeig and Tom Gara
There's a new Kodak in town, and it doesn't look much like the one you might remember. Gone are the company's units making cameras, film, and other consumer photography products that made it famous. In their place is a smaller, leaner company, focused on commercial printing and imaging technology.
Back in August, a judge approved Kodak's plan to exit from the bankruptcy protection it entered last year, and today the company officially emerged in its new form.
"I'm very, very happy today," Kodak's CEO Antonio M. Perez told the WSJ. Instead of the struggling, debt-laden company that entered Chapter 11, the new company, he said, "comes with a great capital structure and with a great balance sheet"
More on this after the jump…


text: "; _cf_contextpath=""; _cf_ajaxscriptsrc="/CFIDE/scripts/ajax"; _cf_jsonprefix='//'; /* ]]> */ 111 Waterline Dr, St Johns, FL 32259 - Search Access Every Home Instantly! Free Access in Seconds Name E-Mail Phone Number(will be used as your password) Continue to Homes ›› Already a Member? Login ›› X CLOSE Member Login Login E-Mail Login Phone Number(your phone number is your password) Login Now ›› Create an Account ›› X CLOSE email@example.com Favorites Recent Homes Sign In Home Search Homes Search All Homes Search Condos / Townhomes Search Neighborhoods Search Schools Featured Homes Foreclosures Short Sales Waterfront Oceanfront Homes Navigable to Ocean New Homes Homes Just Listed Golf Course Homes Sell Your Home Contact Us904-501-9331 Menu HOME SEARCH SELL CONTACT GO BACK SEARCH ALL HOMES SEARCH CONDOS / TOWNHOMES SEARCH NEIGHBORHOODS SEARCH SCHOOLS FEATURED HOMES FORECLOSURES SHORT SALES WATERFRONT OCEANFRONT HOMES NAVIGABLE TO OCEAN NEW HOMES HOMES JUST LISTED GOLF COURSE HOMES Search St. Johns County St Johns Dorado Waterline Dr 111 WATERLINE DR 111 Waterline Dr, St Johns, FL 32259 For Sale $493,470MLS Number 100526 4 Bedrooms3 Bathrooms0 Half BathsSquare Footage - 2,551 *estimated PHOTO GALLERY Ready in SEPTEMBER!!! Lennar Homes, Abaco floor plan, 4 Bed, 3 bath and 2.5 car garage. Everything's Included� features: Glass front entry door, Quartz kitchen counter tops, ElectroLux Kitchen Appliances , 42' cabinets, ceramic wood tile through family/dining/halls emser, quartz counters on all bath vanities, Pre-wired security system, Alexa� Home Automation, pavered & screened lanai, window blinds throughout, sprinkler system, and pavered driveway. 1 year builder warranty, dedicated customer service prog CountySt. Johns NeighborhoodDorado Year Built2019 Lot Size.5 to 1 Acre TaxesUnknown High SchoolAllen D. Nease Middle SchoolAlice B. Landrum Elementary SchoolOcean Palms New ConstructionYes WaterfrontYes Lake / PondYes Community PoolYes Community TennisYes Community GatedYes 111 Waterline Dr - Map & Directionsview in Google Maps From I95, take Exit 329 and head east on County Road 210. Travel about 2 miles and entrance to Beachwalk community is on your left. Turn left onto Beachwalk Blvd. and turn left onto Caribbean Place. Summary of 111 Waterline Dr 111 Waterline Dr is a 2,551 (*estimated) square foot home with 4 bedrooms and 3 bathrooms located in St Johns FL, ST. JOHNS County. This property is listed for sale at $493,470 and is currently active and accepting offers. courtesy of lennar realty inc Patsy Wilsoncall for more info904-501-9331 Ask a Question Add to Favorites Send to a Friend Schedule a Showing Request More Info Dorado Homes Contact Us Patsy Wilson email@example.com direct. 904-501-9331 Office Keller Williams Realty Atlantic Partners 100 Southpark Blvd Suite 201 St Augustine FL 32086 office. 904-797-7442 Quick Links Search for Homes List with Us Search All Neighborhoods Read Our Blog Contact Us The data relating to real estate for sale on this web site comes in part from the Internet Data Exchange (IDX) program of the Northeast Florida Multiple Listing Service, Inc. Real estate listings held by brokerage firms other than |||| are marked with the listing brokers name and detailed information about such listings includes the name of the listing brokers. Data provided is deemed reliable but is not guaranteed. At the option of MLS, any MLS logo, icon or symbol may be displayed next to this disclosure. Copyright Northeast Florida Multiple Listing Service, Inc. All rights reserved. Each brokerage is independently owned and operated.Site updated Nov/17/2019. Website by Mega Agent Websites © 2019 - Site Map - Agent Login


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A gas leak near 111th and Homan has prompted a big response from emergency crews. About 16 homes have been evacuated, authorities said. No injuries have been reported. Read »
A man was shot and killed in Longwood Manor by another driver who cut him off early Monday morning, according to witnesses. Read »
A man in his 60s was hospitalized Saturday after several people broke into his home in what appeared to be a robbery and shot his pit bill, police said. Just after midnight, police said several men knocked on the door of the Douglas Park man's... Read »
Eight people were injured in a rollover accident on the Dan Ryan Expressway Friday night, according to Illinois State Police. All were reportedly under the age of... Read »
An off-duty Markham police officer did not act improperly when he shot three people who were committing a robbery, according to Markham Deputy Police Chief Tony DuBois. Read »
An engineer has determined that a northwestern Indiana pedestrian bridge did not have structural defects when it collapsed after a Fourth of July fireworks show, spilling about 50 people into a lake. Read »
A task force formed by Gov. Pat Quinn is responsible for examining operations at all Illinois cemeteries and making recommendations about regulating the industry. Read »
The Army released one more photo of Gov. Quinn, this time during a visit with the troops in Iraq. The photo shows the governor posing with servicemembers from Illinois who are part of the 1st Air... Read »


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Pioneers Feature Duel Threat Nicole Sidor
NEW HAVEN, Conn. – There is little question who Yale's focus will be on when Sacred Heart visits Dewitt Family Field for Wednesday's doubleheader. Nicole Sidor stars both at the plate and in the circle for the Pioneers. The first pitch of the first game is slated for 3 p.m., and CPTV Sports will televise the games on tape delay to its Connecticut viewers.
Sidor is certainly a dual threat. She leads the team in batting average (.388), hits (47), doubles (11) and total bases (76). She also is the team's top pitcher with a 1.46 earned run average and 135 strikeouts in 139 innings.
The Bulldogs (8-26) had a pair of record setting performances over the weekend. Sarah Onorato set the single season school record with her 11th home run in Saturday's second game against Harvard. Onorato, who was named to the Ivy League Honor Roll on Tuesday, is fifth in the nation in doubles per game (0.41) and 15th in slugging percentage (.874). Her 14 doubles on the season are two shy of the school record.
Christy Nelson became Yale's all-time home run leader when she belted her 18th career homer in Sunday's second game with Harvard. She broke the mark that was shared by Shayna Filson '04 and Katie Edwards '09.
As a team, Yale has hit 22 homers this spring, which is seven shy of the school record set in 2006.
The long ball also is a big part of Sacred Heart's offense. The Pioneers (18-20) have hit 18 home runs. Annie Dreher is the leader with eight.
Yale split a doubleheader with the Pioneers last year in Fairfield. Chelsey Dunham tossed a three-hit shutout in the second game for the Bulldogs. Kylie Williamson had the key hit in the game, a two-run triple. Sacred Heart won the first game 7-4.
CPTV Sports will air of the games on Friday starting at 7 p.m. and again on Sunday at 7 p.m.
Report filed by Tim Bennett, Yale Sports Publicity


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Back to All Events
Earlier Event: May 24Gullwing - not available
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New Forest, Fawley
Gullwing and Little Tern Availability
Our two beach huts, Gullwing and Little Term are booked individually or together. Blank days mean both huts are available. Hover over shaded days for more information or give us a call.
Cadland Estate is set within the New Forest and on the Solent, offering picturesque and unique properties to let, excellent partridge and pheasant shooting, riding on the new forest, and spectacular coastal parks. With multiple facets to the agricultural business such as solar energy, potato farming and conservation, Cadland Estate is a very special place, run by the Drummond family.
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The discrepancy between the exercises of the political and financial power: Roma political parties in Macedonia
The relationship between money and politics is inevitable, widespread and probably endless. In this regard, such a relationship is logical given the fact that political parties need money to participate in politics and maintain cohesion among the party members. The position of holding the power in the society that is given to the political parties, demands also a certain extent of responsibility and accountability towards its constituency (Carey & Reynolds, 2007). Therefore, the way in which political finances affect the relationship of political parties, and their members, constituents and the general public is essential for the quality of democracy functioning (Burnell, 1998). As such, political finances sustain and enhance the political debate and stimulate the internal democracy within the party.
In this context, the political parties in Macedonia follow the well-known pattern between money and politics - access to political power facilitates access to money, and access to money buys political influence. Frequently, governing parties use the administrative resources—state powers and funds in "rewarding allies" and "punishing opponents". Until now, the political battle in Macedonia is between the two biggest Macedonian and Albanian parties. The other small parties (including the Roma ones) are the "outside players", usually joining the coalition government. It follows that the small political parties are just illustrative marionettes of the bigger parties, even though they can be a game changer during the elections (local or presidential). Although the small political parties manifest monopolistic power within the party (all the power is in the arms of the leader) they do not know to use their power or are limited in practicing it within the coalition government.
Regarding the role and responsibility of the Roma parties in the current coalition government in Macedonia, this analysis indicates the imbalance between the exercises of their political power given the financial opportunities. In other words, this means that Roma political parties take the legitimacy from the Roma electorate while the roles and responsibilities are delegated by the coalition parties in the government. Hence, it appears that the "greater responsibility" of Roma political parties and the weak financial power results in reduced credibility in the Roma community. In the case of the Roma political parties, promises are determined by the major coalition partners and serve their interests. These developments point out that Roma political parties have post – election agreements for sharing the financial "cake" after the election. However, typically the position of political parties is determined from the costs-benefit logic, calculation the future benefits (power, authority, positions in public administration, public policies) with their costs (administration, political campaigns)
Therefore, in this analysis we argue that party financing has a crucial role in the internal democratization of the Roma political parties and contributes to better practice of their power in the coalition government. Furthermore, this analysis provides an analytical framework through which party finance can be analyzed and propose strategies for financing the Roma political parties.


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The Mating Season is Here!
According to the World Association of Zoos and Aquariums, Spring time brings lots of new faces in the zoo and I am not talking about visitors. There are about 600 million people passing through the gates of over 1,300 parks around the world and spring time is usually the time when the newborns are revealed. There is a reason 2009 has been named as the "year of the gorilla" by the United Nations, the reason of course is the gorilla baby boomers… If you ever seen a gorilla in real life you will stand there stunned, visually examining it and being in disbelief of how much this animal resembles us. Of course 2009 brings us newborns from all different kinds of animals around the world, this gallery is dedicated to them… [ Continue Reading ]


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|Home > International Organizations
According to the Union of International Associations (UIA), there are over 50,000 international organizations (IGOs, NGOs and other bodies). An inter-governmental organization (IGO) is generally a public or governmental organization created by treaty or agreement between States. An non-governmental organization (NGO) is established by individuals or associations of individuals. This section of EISIL will focus on core IGOs and resources for locating NGOs. See the other topical sections of EISIL for more information on NGOs in particular areas of international law.
In-depth assistance on researching international organizations is available in the ASIL Guide to Electronic Resources for International Law�s continuously updated chapter on this subject.


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The threat of terrorism has made the FBI more aware than most agencies of the need to share information across jurisdictions, but terrorism isn't the only reason the bureau shares data. To confront crime on many fronts, the bureau has developed the National Data Exchange (N-Dex), part of a four-year effort to gather the crime and incident data from the nation's 18,000-plus law enforcement agencies into a single, Web-accessible investigative tool.
How it works: Entity resolution helps FBI's N-Dex system connect the dots
Project at a glance
See the full list of agency winners
See the GCN Executives of the Year
"The development of N-Dex marks the first time in U.S. history that local, state, tribal and federal criminal data has been openly shared," said Andre Haynes, program manager at Raytheon Information Solutions, the prime contractor for N-Dex.
The project presented major challenges in data standardization, systems integration and security, and required a finely tuned search mechanism that was both fast and analytical.
The team behind the FBI's N-Dex system includes, from left, Development Manager Jim Preaskorn, Assistant Director Daniel Roberts, Program Manager Jon Kevin Reid and Deputy Assistant Director Jerome Pender.
N-Dex resulted from work by more than 140 employees at the FBI's Criminal Justice Information Services (CJIS) division in West Virginia; 60 people from Raytheon, which was hired in February 2007; and contractors including Hewlett-Packard, IBM and Oracle.
To gain insight into user needs, the development team held meetings with local law enforcement officers who serve on CJIS's Advisory Policy Board, conducted extensive technology and product research, and built several prototypes. "The challenge came in finding solid products that met the needs of the program, with the ability to scale sufficiently to accommodate the projected growth in data holdings, concurrent users and performance requirements," Haynes said.
With so many agencies contributing data, integration would undoubtedly be a problem. "Standardization within the law enforcement community, with respect to electronic recordkeeping, was in its infancy when N-Dex was first conceptualized," Haynes said. So the team helped local agencies map their record management systems to data-sharing specifications of the National Information Exchange Model (NIEM).
Because contributing agencies work under strict privacy and security rules, N-Dex would need a way to determine who could view what information. According to N-Dex development manager Jim Preaskorn, the team wrote an extension in a Security Assertion Markup Language-like language to leverage the security in the FBI's Law Enforcement Online (LEO) portal. Roles are handled with two-factor authentication in the FBI's Next Generation Identification (NGI) biometrics system, and users must go through LEO to reach N-Dex.
A three-tiered, color-coded system labels information according to its eligibility to leave the local jurisdiction. For example, yellow provides a basic pointer to information that fits the search criteria, but for details, the user must contact someone from the state agency that owns the data, Preaskorn said. Red means only people in that state can view the entire record.
N-Dex Increment One went live in March 2008, and by 2009 the system had 51 million records — five years' worth from 14 contributing agencies, Haynes said. This summer, Increment Two added subscription and notification features that alert users when new information matches their search queries. "It will let me know when someone searches on 3 Main Street," Preaskorn said. "You [also] get notified when someone searches your data." Arrest, booking and incarceration data were added, and user capacity doubled to 100,000. N-Dex also has chat room-like features that let investigators collaborate online, Preaskorn said.
Enterprise foundation
Much of N-Dex's success is due to its reliance on CJIS's enterprise architecture, which includes LEO for single sign-on and storage capacity for more than a billion records, according to Raytheon officials. Haynes said the off-the-shelf and custom software in N-Dex is built out of clearly defined components arranged in a Java Enterprise Edition framework, with separate layers for user interfaces, application processing and data. "Processes that are common across multiple functions have been identified and designed to be reusable by multiple higher-layer components," he said.
N-Dex is one of CJIS's first large systems to eschew proprietary mainframes for cheaper blade servers, in this case Hewlett-Packard hardware running Red Hat Enterprise Linux. The fault-tolerant cluster can support 3,250 concurrent users, provides 99.8 percent availability, and is scalable enough to support each increment's doubling of capacity simply by adding servers, Haynes said. Computer Associates provides the security software, IBM provides security and data "ingest" appliances, and F5 appliances handle load balancing. Oracle Real Application Cluster (RAC) database servers provide six-second responses and can take in a million new records a day. Preaskorn said the system is centralized, with agencies submitting information to N-Dex's data center, which then processes user queries.
Initiate Entity Resolution software from Initiate Systems currently serves as N-Dex's search engine, but Preaskorn said Autonomy will be swapped in for the search component next year. Still, few will argue that the Initiate software's ability to correlate seemingly unrelated information plays the key role in N-Dex.
It takes graphics to show relationships among data, and for that, Raytheon turned to ESRI's ArcGIS Desktop for geospatial visualization, and i2's Analyst Notebook. Haynes said an investigator might use ArcGIS to map locations of incidents involving a certain vehicle, or to confine searches on names to specific areas. Analyst Notebook highlights links within data to make them easier to identify, such as a suspect's ties to others who were involved in similar crimes or who used a similar vehicle. "Using the i2 product, the investigator can pull back additional information on the vehicle or other people to help develop other leads in the case," Haynes said. "The ability to display graphically the non-obvious ties within the data is a powerful tool."
Next steps
Increment Three, slated for 2010, will again double the number of users while adding probation and parole data. Haynes said improvements to the correlation and visualization tools will help users spot crime networks, patterns and trends.
Investigators have been reaping the benefits that N-Dex was designed to deliver. In one success story, the system helped West Virginia investigators link a false name given by the driver in a routine traffic stop to his long rap sheet. In another, police in one large city used utility records to connect the aliases of people arrested in a drug house to known associates in another state.
Haynes and Preaskorn are fond of saying N-Dex helps law enforcement "connect the dots." Eventually, they hope to offer it to the entire justice system, including courts, parole boards and prisons. It's an ambitious dream, but not a surprising one for a project rolled out in giant steps called "increments," and comprising millions of simple facts, any one of which, when linked to others, might turn out to be the clue that stops the next terrorist attack.
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Part 5 - Building Rich Internet Applications with Naked Objects
A couple of years ago one of the authors was working for a large global consulting company when it introduced an internal browser-based application for expenses processing: a customized version of the popular expenses processing package, Concur. The launch of the application was accompanied by much trumpeting of the 'millions of dollars' that it would save the corporation - a statement greeted with skepticism by a few of the more seasoned consultants. Within a few weeks, however, some of those skeptics were declaring that the company might well save its millions of dollars but in an unforeseen fashion: the joke being that the process of constructing an expense claim online was so frustrating that for small claims some consultants might choose just to write off the expense instead.
A couple of years ago one of the authors was working for a large global consulting company when it introduced an internal browser-based application for expenses processing: a customized version of the popular expenses processing package, Concur. The launch of the application was accompanied by much trumpeting of the 'millions of dollars' that it would save the corporation - a statement greeted with skepticism by a few of the more seasoned consultants. Within a few weeks, however, some of those skeptics were declaring that the company might well save its millions of dollars but in an unforeseen fashion: the joke being that the process of constructing an expense claim online was so frustrating that for small claims some consultants might choose just to write off the expense instead! (There is no evidence that that actually ever happened, but the user frustration was real enough).
The story is not intended as a dig at that particular package: the arguments we are about to make apply to most contemporary business applications, whether packaged or bespoke. Concur is a functionally rich package, and doubtless the vendor has spent a great deal of effort in seeking to optimize the design of its user interface. The problem is that both the vendor and the customer have fallen victim to the mantra of 'thin client'.
Someone defined a mantra as 'a content-free phrase that, if repeated often enough, takes on the appearance of profundity'. That may be a little harsh: mantras often start as an attempt to embody a set of truths in a memorable form. The risk is that people forget what those original truths were and thus lose the ability to evaluate them in the context of changing circumstances.
The rush to the thin-client architecture for business systems, starting in the mid-late 1990s, was motivated by several truths, among them:
- Systems must be designed to be accessed from an increasing number of locations both inside and outside the organization, and from an increasing range of platforms.
- Maintaining client-side software for each type of platform is costly, as is the process of updating the software on each client device.
- Users will not tolerate long start-up delays each time they run an application.
- Putting all the business functionality on the client and the data on a server (as many first generation client-server systems did) can lead to poor performance.
- Mixing up presentation and business logic makes applications hard to extend or maintain.
At the time the idea of accessing all applications through an HTML browser looked like an attractive solution to all of these concerns. But looking at these points afresh in 2004 we get a very different perspective.
- A rich front-end written in Java will run on any platform that an HTML browser will run on, and more besides. When Safeway Stores in the UK developed their award-winning in-store pricing and stock management system they were forced to contravene the corporate 'thin-client' policy because the hand-held lacked sufficient flash memory to run the multi-megabyte Internet Explorer. So they built a Java client running on an open-source cut-down Java VM called Waba - which needed just a few kilobytes. Ironically, the new system was still classified as 'thick client'!
- There are now plenty of technologies that will automatically and transparently take care of client updates, from comprehensive software management solutions such as Marimba Castanet, to lightweight solutions such as Java WebStart.
- Typical available bandwidths have increased. Moreover, with Java WebStart the application is cached locally and updated from the server only when there is a new version.
- Whether thick-client or thin, most business systems are now multi-tiered, allowing appropriate business logic to be located close to the database server.
- As we showed in an earlier article in this series (Challenging the Dominant Design of the 4-Layer Architecture), even a well designed 4-layer architecture typically fails to achieve the intended separation of business and presentation logic: any business change almost always involves traversing all four of the layers, often iteratively. The thin client architecture doesn't improve this: it merely moves the physical location of the presentation layer.
What is really beginning to force the issue, however, is the growing awareness of the limitations of the browser interface from a user perspective. Our opening example is one of many. A couple of months ago we met with a large company in the engineering supplies business. They had launched an online application that allowed their frequent customers to order supplies, and provided other functionality to help those customers manage certain aspects of their own businesses. The new application has already been very successful in business terms. With a familiar browser-based interface it was easy for their customers to learn. Within weeks of the launch, however, the most active customers were beginning to express frustration with the user interface: not just because of the slow response time but with the strong modality. Keeping multiple jobs open at once, moving or copying objects between those jobs, dealing with a phone enquiry in the middle of a task - all the realities of their customers' businesses - are difficult if not impossible on the browser-based system.
The web browser was designed for navigating hypertext documents; it has adapted well to very simple business transactions, but not to more complex tasks. Alan Cooper made a useful distinction (see http://www.cooper.com/articles/art_your_programs_posture.htm) between 'sovereign' applications (used intensively) and 'transient' applications: his point being that they have very different user interface needs. The thin client architecture can often meet the needs of a transient application: Amazon.com and its one-click ordering is possibly the epitome of this approach. But a browser-based interface, with its strong sequentiality and modality, is totally unsuited to sovereign applications.
Sovereign applications are not just limited to those that the users deal with all-day every-day, such as order-taking, reservations and customer-service systems at call centres. An expenses processing program is sovereign: you might only touch it once a week or once a month, but the task of constructing a claim is often quite an intensive one. (All the more-so because the introduction of an expenses-processing system seems to encourage management to ask for much more data than they were getting on the paper version - the name of the hotel, the names of all the people you were dining with, the airline and flight number for the sector - because they now have tools to analyze it). A home banking system is a sovereign application - at least if you want to categorize and analyze your expenditure - as is an online grocery-ordering system. Such applications need the richness of a direct manipulation interface: allowing the user to engage directly with the elements that make up the business domain, and to undertake any legitimate action at any time and in any context.
Starting a couple of years ago, a number of analysts have been predicting the return of the rich client or the emergence of 'Rich Internet Applications' (RIAs) - see, for example, http://www3.gartner.com/5_about/press_releases/2002_04/pr20020402a.jsp or http://download.macromedia.com/pub/solutions/downloads/business/idc_impact_of_rias.pdf. New tools are appearing, such as Macromedia's Flex, that make it easier to build these RIAs . Each of these tools has its own strengths and its own application niches.
If you are building transient applications then three things are important: strong user guidance (because the users have little incentive to learn how to use the system), exciting visual design to attract the attention of browsing customers, and fast response so that they don't lose interest. Many of the new RIA tools are concentrating on these capabilities: especially the middle one.
For sovereign applications, however, the needs are quite different: fancy graphics are unnecessary and potentially irritating to the frequent user; strong guidance is less necessary because the users have more incentive and more opportunity to learn how to use the system. Indeed strong guidance can be a distinct negative: what the user of a sovereign application values most is a sense of being in control, and one of the keys to this is direct manipulation techniques. So why are direct manipulation interfaces so rare? In part it is because too many software designers think of applications only in transient terms. In part it is because writing a direct manipulation interface is really quite difficult.
Naked Objects changes that. All you write are the domain objects and you get a rich, direct manipulation interface for free. Many of the people who criticize the Naked Objects user interface are looking from the perspective of transient applications: it doesn't provide enough guidance, or it doesn't allow enough graphical customization. If all you want is a rich web application that offers simple transactions to occasional users then Naked Objects is not the optimal choice. But for sovereign applications the story is quite different. And as we demonstrated in (Challenging the Dominant Design of the 4-Layer Architecture) in addition to making it easy to build a direct manipulation interface, the Naked Objects approach results in a far cleaner object model, and applications that are much easier to change in response to subsequent unforeseen changes to business requirements.
The first part of the headline to this article ('Fat is the new thin') is tongue-in-cheek: we copied it from a recent headline in the fashion world.. But we do claim that by using Naked Objects it is possible to gain all of the advantages of a rich-client interface, without sacrificing the advantages of the thin-client approach - and with other architectural advantages to boot.
When we first started showing Naked Objects in late 1999 we got a lot of positive reactions, but the most common objection was 'we could never get this into our company, because we have a thin-client-only policy'. We still get that response, but much less frequently than four years ago. Now a growing number of people are learning that Naked Objects is a more effective way to build new sovereign applications, and some are investigating the possibility of using the framework to build new rich-client interfaces to existing applications. This works best when the existing application has a strong underlying object model that would make sense to the user: it took us only a matter of hours to build an effective demonstration of such an interface for the aforementioned engineering supplies company, because in their application the objects were so obvious and concrete.
Oh, and we've decided to have a go at the expenses processing domain. A screenshot from the prototype is shown below and we'll soon be releasing a demo version running remotely over the internet and showing the full approval cycle.
Different types of expense item (representing hotels, airfares, taxis and so forth) are dragged into a claim. You can copy any expense from a previous claim, or just drag one expense onto another to have it copy all the fields that aren't already filled. You can split and merge claims, or look up similar items in any context. We haven't been at it long and it's already quite nice to use. Perhaps too nice: it might encourage employees to file their claims early and often. ;-)


text:
Michael de Young and family
with former President Benjamin Harrison and party In 1894, San Francisco Chronicle Publisher, Michael de Young, spearheads a movement that brings San Francisco its first World's Fair—the California Midwinter International Exposition in Golden Gate Park. Business leaders agree that it will be a tonic for the economic ills gripping the City and the nation. Conservationists like John McLaren fear for the preservation of the park. The Midwinter Fair opens on January 27, 1894, with its own Midway Plaisance, featuring attractions from the Chicago Fair the year before—and more.
Ephemera from Midwinter Fair of 1894
"The Midway is an education in its way. It affords peeps into lands and customs that have hitherto been myth as far away and impalpable as the man-in-the-moon."
Midway scene from Midwinter Fair of 1894
Midway scene from Midwinter Fair of 1894
Dante's Inferno
The experience gives San Franciscans and visitors who think they're in Heaven, a glimpse of Hell.
'49 Mining Camp Bob Jones, your host, says, "Put up or shut up. Let go of your dust and make Gold Gulch howl... HURRAH FOR BOOZE."
Lamarcus Thompson's Scenic Railway This ride is a bargain, for a nickel you get a view of the entire Fair and a roller coaster ride at the same time.
Japanese Village If booze isn't your cup of tea, have a cup of tea—and cookies—at the Japanese Village. Its legacy, the Japanese Tea Garden, offers serenity—and tea and cookies—in Golden Gate Park still today.
Makoto Hagiwara and daughter Longtime guardian of the Japanese Tea Garden, Makoto Hagiwara, to stimulate business in his own teahouse, puts fortunes into cookies. San Francisco's Chinese restaurateurs capitalize on this idea.
The successful Fair closes on July 4th, 1894, known as "San Francisco Day" and "Sunset Day."


text:
The long-awaited American College of Cardiology (ACC) and American Heart Association (AHA) guidelines on treatment of high blood cholesterol(circ.ahajournals.org) to reduce atherosclerotic cardiovascular risk in adults may significantly shift how family physicians treat patients.
The updated cholesterol guidelines, which were published online Nov. 12 in the AHA's journal Circulation, suggest physicians use a new risk assessment tool and grading system to determine who qualifies for statin treatment. The changes could significantly increase the number of people taking the cholesterol-lowering drugs.
In addition, guidelines on screening for(circ.ahajournals.org) and managing cardiovascular risk(circ.ahajournals.org), as well as on identifying, evaluating and treating(circ.ahajournals.org) obesity in adults, were published the same day in AHA's journal Circulation.
story highlights
- New American College of Cardiology (ACC) and American Heart Association (AHA) treatment guidelines for high blood cholesterol in adults suggest physicians use a new risk assessment tool and grading system to determine who qualifies for statin treatment.
- The ACC/AHA also released three other guidelines: two on screening for and managing cardiovascular risk, and one on the identification, evaluation and treatment of obesity.
- The AAFP is reviewing the guidelines for possible endorsement and likely will publish its determinations during the first quarter of 2014.
According to Doug Campos-Outcalt, M.D., M.P.A., of Phoenix, clinical methodologist to the AAFP's Commission on the Health of the Public and Science (CHPS), the proposed changes may be warranted, but the Academy currently is not in a position to endorse the updates. Although Patrick McBride, M.D., M.P.H., of Madison, Wis., served as the lone family physician member on the ACC/AHA Task Force on Practice Guidelines expert panel that developed the cholesterol recommendations, he did not do so as an official representative of the AAFP. The Academy and other primary care organizations were not invited to participate in the guideline development process after the National Heart, Lung and Blood Institute (NHLBI) handed that specific task over to the specialty societies earlier this year.
Moreover, Campos-Outcalt said the ACC/AHA provided all four guidelines to the AAFP -- including several hundred pages of supporting evidence for each one -- with only a limited amount of time for review before publication. CHPS currently is reviewing the guidelines.
"The Academy will assess this cholesterol guideline, along with all of the others, and make a decision as to whether we can endorse or not," Campos-Outcalt told AAFP News Now. That said, he added, "(the expert panel) did a lot of things better than last time. They performed a much more comprehensive and rigorous assessment than in 2003, but I think it will take at least a couple of months to get through this."
Path to Simpler Management
McBride said he thinks the changes will reduce the complexity of therapy at his own Madison, Wis.-based practice, noting that the panel updated the risk assessment tool to be more contemporary.
"The evidence strongly supports not only the use of risk assessment for primary prevention, but that the level of (initiation of) treatment for primary prevention is a 10-year risk assessment of 7.5 percent, which will make treatment for high-risk individuals in primary prevention simpler," said McBride. "We won't have to constantly use follow-up cholesterol measures for LDL treatment targets."
McBride took exception to concerns voiced in the popular press that the risk-reduction threshold is too severe and will result in too many people being started on statin therapy.
"I think a lot of the arithmetic that's been done in the popular press is wrong, because this (recommendation) is, in fact, putting more appropriate people on treatment and making sure that those who are not appropriate for treatment don't get put on medication," McBride said. "There are a lot more people at risk today than there were 10 years ago because of obesity and other age-related risk factors. There are more people with hypertension and more people with metabolic syndrome today because of changes in our population.
"Family physicians are well aware of those population changes," he said. "This guideline is all about putting the appropriate people on treatment."
The evidence for setting the new treatment threshold was clear, said McBride.
"The cut point was previously set at 10 percent … and we dropped it based on very good evidence that there was a strong benefit to statin treatment for a person with a 7.5 percent 10-year risk, because we also looked at lifetime risk," he said. "I also want to point out to family physicians that this (cut point/recommendation) is true for both men and women, basing the guideline on risk, not gender."
Furthermore, said McBride, the data used to create the guideline also indicate that it is the overall management of cholesterol -- regardless of blood cholesterol levels attained -- that resulted in strong evidence of reductions in heart disease and associated mortality.
"No clinical trial tested whether treating to a specific LDL level made a difference," he said. "(Researchers) used specific doses of cholesterol medicines, so the new guidelines reflect that."
Note of Caution
Campos-Outcalt said that although it's impossible to digest the new cholesterol guideline in a single reading, he does have some concerns.
"I count 46 total recommendations, 20 of which are graded 'E,' meaning they are based on expert opinion," Campos-Outcalt said. "So I do have to raise some questions when nearly half of your recommendations are based on expert opinion.
"This guideline also has some recommendations in it that rest upon evidence presented in the other guidelines that were just released. So, you basically have to assess all of them at once, which is a bit unusual."
AAFP EVP Douglas Henley, M.D., said the Academy has expressed its concern to the NHLBI that it wasn't given the opportunity to serve as a full and equal partner in the development of the guidelines.
"The reason physicians from a wide range of specialties typically work together on projects like this is to ensure special interests don't interfere with good science," Henley explained. "When you have organizations representing one specialty develop and release these kinds of guidelines, credibility can become an issue."
That concern notwithstanding, Campos-Outcalt said his own initial impression is that the expert panel largely followed the Institute of Medicine standards the AAFP uses to develop its own recommendations and, in the process, improved on the 2003 version of the cholesterol guideline.
"I think the lesson here is that if you don't base your (original) guidelines on good, solid evidence, they are going to change drastically (from one version to another)," he said. "I think it is fair for people to ask, 'Why did you make those recommendations the last time around?' Sometimes it is better to say nothing than to guess, because these 'revolving guidelines' can cause a lot of confusion."
According to CHPS Chair Alan Schwartzstein, M.D., the commission should make its recommendations on the ACC/AHA guidelines to the AAFP Board of Directors in the first quarter of 2014.
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