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The RHS Flower Show Cardiff supported by wealth manager Brewin Dolphin will return to the Welsh capital with a celebration of spring from 12 – 14 April. The show will champion health and wellbeing and celebrate Visit Wales' Year of Discovery theme for 2019 as it explores some of the finest in Welsh horticulture.
Teaming up with Perennial, designer Peter Donegan will create a small private garden offering a relaxing space to enjoy and entertain complete with an outdoor kitchen. The Perennial Garden demonstrates what homeowners can achieve with a small, urban garden as it celebrates the organisation's 180th anniversary of helping people in horticulture.
Designer Anthea Guthrie returns with a Show Garden following her Silver Medal in 2016. Inspired by 'Bedtime Stories for Rebel Girls', this gothic and ghoulish garden for a 10-year-old girl features a skull-shaped hut set in the bottom of a family garden where she can crawl through to a space to bury herself in books.
Returning for its second year, the Regeneration Gardens category welcomes two recent garden design and landscape architecture graduates designing affordable spaces that use unexpected, everyday materials. Brent Purtell's The Urban Gallery will recreate a small public park in the heart of a city, combining recycled industrial materials with bold artworks from local artists for an enclosed escape.
Nature's Take Over by Diego Carrillo highlights the beauty behind nature's simplicity. The low-maintenance garden designed for an eco-friendly couple aims to attract wildlife to bring them closer to nature.
As a key show theme, features will highlight the benefits of gardening and outdoor spaces. The National Botanic Garden Wales' Gardd Lles, meaning 'Wellbeing Garden' in Welsh, provides secluded seating areas for contemplation and mindfulness. Meanwhile, Grow Cardiff will also promote the benefits of community gardening with a vibrant display created by patients from the Grow Well project and local gardening group Billy's Green Fingers.
Continuing the theme of community, a brand new Blossoming Beds Competition will offer community groups the chance to go head to head in creating colourful pockets of spring colour to inspire visitors. The ever-popular Wheelbarrow Competition also returns inviting local schools to transform them into adventurous creations using the Discovery theme as inspiration.
British wildlife is also embraced with Into the Nest by The Wildlife Trust of South and West Wales which features a design from a bird's perspective as it explores a variety of games to help visitors identify some of Wales' iconic bird species. RSPB Cymru will be back with snail-friendly Maenor Malwen, made up of shell-like curves and circles as families can discover UK land and water snail species hidden within.
Other features include Bridgend College who will recreate the legend of Caerphilly Castle's Green Lady and a vegetable plot for families to discover how to get growing no matter what age with Pennard Plants.
In addition, 12 nurseries in the Plant Village and 45 nurseries in the Floral Marquees will bring a bounty of colour and scents. In recognition of their achievements, R. & A. Scamp Quality Daffodils have been named as 2019's Master Grower. The multi gold medal-winning daffodil specialist will create a show-stopping display featuring hundreds of varieties of daffodils and a woodland walk feature for a behind the scenes glimpse into their nursery life. Alchemy Ferns and Kitchen Garden Plants are amongst the newcomers to exhibit at the show.
The popular Floristry Bench introduced in 2018 will also be back with a brand new Living Art Floristry Competition, as experts such as celebrity florist Jonathan Moseley creates floral masterpieces alongside a variety of workshops.
For more information or to buy advance tickets for the RHS Flower Show Cardiff visit www.rhs.org.uk/cardiff
Event: RHS Flower Show Cardiff 2019
Venue: Bute Park, Cardiff Castle
Date: 12-14 April 2019
Opening times:
Friday 12 and Saturday 13: 10am – 5.30pm
Sunday 14: 10am – 4.30pm (plant sell off 4pm)
Advance tickets: £12.00 (RHS members £11.00)
On the day: £15 (RHS members £13)
Each paying adult may bring two children aged 16 and under free of charge - no ticket required.
For further information and images, please contact the RHS Press Office at firstname.lastname@example.com
About the RHS
The Royal Horticultural Society, the world's leading gardening charity, was founded in 1804 by Sir Joseph Banks and John Wedgwood. Our vision is to enrich everyone's life through plants, and make the UK a greener and more beautiful place. This aspiration underpins all that we do, from inspirational gardens and shows, through our scientific research, to our education and community programmes such as Campaign for School Gardening and Britain in Bloom. We produce key publications, hold a world-class collection of horticultural books and botanical art, and sell the very best plants and gardening gifts.
The RHS is fundraising £40m to transform our gardens, outreach and education facilities, which includes redeveloping our flagship RHS Garden Wisley and opening a new garden, RHS Garden Bridgewater, in 2020. We are solely funded by our members, visitors and supporters. For more information visit www.rhs.org.uk.
RHS Registered Charity No. 222879/SC038262
About Brewin Dolphin
Brewin Dolphin is a UK FTSE 250 provider of discretionary wealth management. With £42.8* billion in total funds, it offers award-winning personalised wealth management services that meet the varied needs of over 80,000 account holders including individuals, charities and corporates.
We give clients security and wellbeing by helping them to protect and grow their wealth, in order to enrich their lives by achieving their goals and aspirations. Our services range from bespoke, discretionary investment management to retirement planning and tax-efficient investing. Our focus on discretionary investment management has led to significant growth in client funds and we now manage £37.6* billion on a discretionary basis.
Our intermediary business manages over £12* billion of assets for over 1,000 advice firms either on a discretionary basis or via its Managed Portfolio Service.
In line with the premium we place on personal relationships, we've built a network of 30 offices across the UK, Jersey and Dublin, staffed by qualified investment managers and financial planners. We are committed to the most exacting standards of client service, with long-term thinking and absolute focus on our clients' needs at the core. The value of investments and any income from them can fall, and clients may get back less than they invested.
*as of 30th September 2018
The RHS believes that gardening improves the quality of life and that everyone should have access to great garden experiences. As a charity we help to bring gardening into people's lives and support gardeners of all levels and abilities; whether they are expert horticulturists or children who are planting seeds for the very first time.
RHS membership is for anyone with an interest in gardening. Support the RHS and secure a healthy future for gardening. For more information call: 0845 130 4646, or visit www.rhs.org.uk


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Vincent Lupisella is the Don of the Lupisella Family. He is the uncle of Mark Lupisella and the grand uncle of Dani Lupisella.
LCPD Database Record
- Vincent Lupisella is probably based on Genovese crime family boss Vincent Gigante, since he also claimed to have mental problems, to avoid prosecution.
Community content is available under CC-BY-SA unless otherwise noted.


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The official Lost: Via Domus website has been updated, offering trailers, screenshots and details about the game based on the hit TV series. In Lost: Via Domus, as a passenger of Oceanic flight 815, you survived the crash and find yourself on an uncharted island somewhere in the Pacific Ocean. As you begin to unravel mysteries of the island, you begin to discover secrets of your own. You will have to understand your past mistakes in order to survive and find your way home. Lost: Via Domus is developed by Ubisoft's Montreal studio.
Lost: Via Domus web site re-launched
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Home > Home & Education > Science > Satellite view of my House download
Satellite view of my House free download
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Updated:2011-03-18 20:19:04
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Nick.staples needed a new logo design and created a contest on 99designs.
A winner was selected from 90 designs submitted by 30 freelance designers.
Fleet Check is a new business targeting mainly companies (and individuals to a lesser extent), to reduce costs for both obtaining new vehicles and also their on-going running costs
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Find out how a design contest works or learn more about our logo design services.


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Natural remedy for cats with diabetes live,diabetes management guidelines malaysia 4d,type 1 diabetes no complications,m & m cupcakes - How to DIY
Make sure you like Herbs & Oils World on Facebook to be updated every time we find a fantastic tutorial for exciting and innovative ways you can use herbs and essential oils. Keeping fleas off of your feline friends is more difficult than keeping them off your dogs. But I've just found a fantastic article revealing five natural ways to prevent and get rid of fleas on your cats. 105+ Natural Home Remedies -treat almost any illness with natural ingredients you probably already have in your kitchen. 75+ Natural Beauty Recipes - Get the best hair and skin you've ever had and look younger with these insanely clever natural beauty recipes. DIY Organic Beauty Recipes reveals 50+ step-by-step recipes for making your own all natural, non-toxic, organic beauty products that are fun to make and cheaper than their store bought counterparts. Natural remedies are certainly the way to go since they will not have the negative side effects associated with steroids or other less desirable and even organ damaging alternatives. If your dog or cat is very bad off or cannot breath, please make sure you take them to a vet for a basic x-ray. Whenever there is a lung problem, you can use 1 drop of elecampane tincture in some water for cats and small dogs, or up to 7-10 drops in some water for full size dog breeds (approx.
You will want to also give your dog or cat fresh water afterward as well to thoroughly send it through the tissues and to fully hydrate the animal's system for full effectiveness. Comfort and calm them and make sure there is fresh enough air available and the elecampane should do the rest from there. Be certain that there are no other ingredients or herbs with the elecampane however, as many products contain other herbs that can alter or diminish the effects of the elecampane in some cases. Keep in mind that the freeze dried liver is simply a vitamin-mineral option and does not interfere or conflict with use of elecampane or other herbs. While these work quite well, we do not believe that the solid tablets have the potency and absorption immediacy that elecampane has for an actual asthma attack and so we recommend elecampane tincture more highly in such cases.
Amazapet contains elecampane (in lower concentrations), it also contains marshmallow root and magnesium-phosphorus salts. If your dog or cat continues to exhibit symptoms even when elecampane or other options are used, you will want to take them to the vet as it may be a more physical problem causing the airway to be obstructed and a routine x-ray can let you know what that problem is.
When a cat begins to furiously scratch, their owner should investigate the source of their discomfort at once. The cat flea (Ctenocephalides felis) primarily attacks the domesticated cat, but also causes trouble for dogs, humans, rabbits, rodents, and other animals [1]. When a cat suffers a flea infestation, you will notice scratching and a noticeable discomfort on their part.
While cat fleas do not typically find a home on humans, they still bite cat owners who have a habit of picking up and stroking their cats. Cats face the higher risk of fleas when felines are placed in environments that promote the growth and spread of these common household pests. The repeated bloodsucking that accompanies heavy infestations of fleas can cause iron deficiencies and anemia in cats. Cat fleas are known to transmit other parasites to their host, including cats, dogs, and humans. Cat fleas are responsible for causing flea allergy dermatitis (also known as FAD) in both cats and dogs. When a stray cat has kittens under or close to an uninfested home, the chances of suffering a flea infestation becomes much greater. In the outdoors, cat fleas thrive when the weather is humid and rainy, which causes the southern parts of the United States to suffer flea infestations more than the north. A cat that frequents the outdoors will heighten the risk of bringing fleas into their home environment. When it comes to using home remedies to treat cat flea problems, you should know that the fleas present on your feline only represent a minute piece of the entire flea population within your home. A regular vacuuming of carpets, upholstery, and pet bedding helps remedy flea infestations and aids in removing flea cocoons.
Since fleas thrive in moist, wet environments, you may treat the exterior of your house to lower the flea population outside of your home. While ants and spiders put a dent in the flea population, so do birds, such as songbirds, sparrows, and starlings.
In a spray bottle, place equal parts of white vinegar and water, which is then used to mist flea-infected bedding, pets, and carpets. The local home improvement, home and garden, or feed shop can provide homeowners with cedar shavings, which makes an effective remedy for cat fleas. Some individuals have found results when placing their cat in a tub and administering hydrogen peroxide to their coats. Applying borax to cat bedding and surrounding floor spaces, carpeting, rugs, and furniture is known as an effective home remedy for fleas [5]. It is suggested to wash your pet's bedding and treat surrounding areas with a product that prevents the growth of fleas. When it comes time to remove fleas, many cat owners underestimate the power of a good flea comb, which provides a great non-toxic method of ridding your pet of cumbersome cat fleas. Since fleas tend to thrive under warm conditions, it is suggested to wash pet bedding in hot, soapy water once per week, followed by a session in a hot dryer. Place a pan filled with water and a few drops of dish soap in the center of a room infested with cat fleas. As for treating carpets for fleas, in addition to borax from the pharmacy department, you can use Twenty Team Borax laundry detergent booster. Without a lamp involved, I can catch 10-20 per hour, at the cost of distraction every time a feel a tickle on my leg. At our last house we worked in borax into the carpet and after 6 weeks the fleas stopped for more than a year. Steinernema carpocapsae is a Nematode that kills the larve of fleas but should only be used outside. We discovered our cat had fleas we used lemon scented dawn dish soap gave her a bath every other day.
I have a cat and three kittens i did the dawn dishsoap thing and it started ta work and it seems the baby kittens have gotten even worse HELP they we need to get rid of them in 2 weeks what do i do????????
For those with animals with tiny livestalk taken resisdance,I agree with most of the above remedies, I know when i had fleas on my girls in 2007, i stuck everything cloth i could into plastic 20gal storage cantainers and put it in the corner i could keep the cleanest from fleas, but becarful when you put things in storage, the eggs stay for sometime years from what I am told and when russeled or disturbed, and in a warm enivironment they can repop up and continue thier evil reign, but it was effective for keeping the basement apartment cleared of easy hiding spots for them.
Homeopet Skin and Itch Relief Natural Remedy for Cats and Dogs (15ml)Homeopet Skin and Itch Relief provides your pet with natural relief from allergies and pollutants that cause skin irritation and scratching. In addition, many dog, cat and horse owners use homeopathic remedies to protect their animals from acute infectious diseases such as kennel cough, cat flu or equine flu and tetanus.
We are unable to guarantee delivery times, but as a guide, First Class delivery typically takes 1-2 working days. We aim to dispatch 95% of our orders the next working day, and 100% of orders within 3 working days.
We are happy to accept returns up to 7 days after purchase providing the item is returned unused and in the original packaging. We are also happy to offer exchanges providing the original item is returned unused and in the original packaging. When making a return, please include details of your name and reason for returning the item.
Advantage Flea treatments are highly effective at providing fast relief from fleas as well as lasting protection. Had been looking for medium dog doors at a reasonable price for a long time , on my last google search it threw up Mr Pets and how glad it did.
Cats are too sensitive to expose them to essential oils and the fact they lick themselves so much makes it even more difficult to keep fleas away.
Save a fortune AND your families health with these super simple homemade cleaning products that work BETTER than store bought! From there, it is a good idea to start adding a bit of extra virgin coconut oil to their diet to be sure they are getting enough nutrients appropriate to their internal membrane tissues.
A small amount of water is enough, but if they want to drink from their dish afterward, certainly let them. Please keep an eye on your dog or cat for any allergic reactions or the like, however this is the tried and true herb used in nearly every case for natural asthma solutions. However, make sure that you do not mix herbs if you are planning on using options other than the elecampane or your chosen herb. However, these do work quite well for most lung disorders and for keeping asthma or asthma attacks at bay long term. All extremely beneficial and healthy materials for the lungs and against asthma conditions! However, in most cases it is simply asthma and the proper diet, fresh air, exercise and an herbal remedy will take care of things just fine. If your cat is not suffering a skin infection, the root of the problem is most likely the cat flea, which becomes increasingly possible when your cat likes to roam about the great outdoors. Once a female flea comes in contact with a cat, she lays her eggs, which become dry and later fall to a more protected shelter on the host. After a newly emerged flea breaths its first swallow of fresh air, it is motivated to jump about its host, where it takes minutes for the new flea to feed on blood. Human cat flea bites produce small, red, itchy bumps that often plague the ankles and lower legs.
When left untreated, cat fleas have the ability to pose medical concerns and affect the humans living within the same space. This is especially seen in young felines, which eventually leads to the death of some pets.
This type of allergy is believed responsible for more than 50% of all the dermatological cases reported to veterinarians.
Cats who live in a heavily flea infested home will also sometimes escape their surroundings to seek relief, usually bringing an infestation to an uninfested residence when rescued as a stray. This is why it is important to follow home remedies associated with both your pet and household. Since vibrations trigger the emergence of new adult fleas, you may use the clipped ends of an all-natural flea collar as a deterrent. To create a drier yard, you should cut the grass, trim shrubs, and avoid leaving piles of gravel and sand about the house for long periods of time.
If you encourage birds to settle in or close to your yard, you will also help lessen the fleas outside of your home because birds consider them a fine source of food. It is suggested to sprinkle the shavings about the house, in the garden, and inside flowerbeds. The proper way to use the tool is to comb your pet and then place dislodged fleas into a bowl of water filled with detergent, which kills the pests. You should always keep in mind that 90% of fleas in a household congregate where your pet sleeps. Next to the pan, situate a bright light onto the water as the only source of light in the room. They can be shredded and put in the grass or flower beds around the outside of your residence. Sprinkle it generously yet as evenly as possible across the carpet and let it stay there overnight. If i catch a flea on my foot, I grab it and flick it into the water, and laugh as they struggle against certain death, which pleases the evil madman in me.
With a compact flourescent desk lamp, adjusted for the bulb to be about 8 to 9 inches above the floor, centered over the dish, the li'l bastards happily commit suicide! We don't have any carpet and only a few rugs at our new house so the animals must be bringing them in from outside now. It has so far but I stopped for awhile and they are back, I am trying to find away to help heal the sores she is developing from an allergic reaction to the fleas before I continue bathing.
The kind you can get in garden shops and pool supply stores are indeed, toxic to humans and pets. 24 hours later that kitten still has fleas, but my other one is completely clear, what the hell is going on?
Typical symptoms are: Constant chewing, itching and scratching, licking and gnawing, Seborrhea, dry flaky skin or oily, greasy coat, or a build-up of ear wax. Had just what I wanted at almost 50% off from other outlets and was delivered very fast indeed, I was kept informed at every stage of the delivery process by email . The use of a HEPA air cleaner or similar, opening windows to air things out, the use of an ozonator from time to time to clean allergens from the air (or the continual use of a very low concentration ozonator), a good and balanced diet with as few colorants, hydrogenated items or the like as possible and regular exercise are of course first and foremost. So these tablets are the next recommendation to aid in helping your best friend and family member live a happier life. It is this destructive pest that is known as one of the most widespread of flea species in the world.
As the eggs hatch into larvae, the immature fleas feed on the organic substances they find on the cat, including adult flea waste and dried blood.
This is an indication that fleas are reproducing on your pet, as these remnants are actually flea eggs and droppings. If a person suffers an allergy to flea bites, they experiences extreme rashes, hives, or generalized itching [3]. Heavy infestations also mean that the fleas have spread to other parts of a household, often biting human occupants.
Simply place the flea collar clippings inside of your vacuum bag, which will destroy new fleas on the spot. Additionally, remove any unnecessary organic debris, including leaves, grass clippings, and straw, which easily becomes a haven for fleas. Lawns kept shorter than two inches encourages a lowering of the population of ants and spiders in a yard, who become susceptible to ground-feeding birds. You should offer seeds, water, and shelter throughout the year to promote birds frequenting your yard. As a rule of thumb, regular checks and cleaning of the basement, garage, car, and pet carrier is needed to remedy any possible flea infestations. The cat fleas are attracted to the light, causing them to jump into the water and drown because of the added dish soap. Vacuum the next day and either discard the bag or clean out the canister when you are finished.
Maybe 20-30 in the last hour, and fewer jumping on me, and that higher kill rate takes no effort. I am going to put borax on the lawn before i go to the do-it-yourself-pest control to get liquid death for the lawn.
But anyways I usually take a large bowl of boiled water add about a cup of salt (usually use a mixing bowl) and about 3 tablespoons of vinegar then let it cool to a warm temperature, something that is comfortable to the touch. I have small children and live in the country where our gray water runs into our field so for this reason we look for non-toxic alternatives. I know it can be harsh on skin, but maybe a tiny dab in lots of water may make a difference. We highly recommend these for any and every dog (or even cat and ferret) for energy and health. This often makes the cat owner in distress readily welcome any home remedy before spending a large amount of money on commercial products and professional assistance.
While most cats live life as usual with a few fleas, untreated infestations may cause a variety of problems. Usually, an allergic reaction to flea bites appears 12 to 24 hours after a bite and may last more than a week.
It is important to use all-natural flea collars, as toxic fumes may arise when using other selections. This home remedy should be avoided if you are worried about lightening the coat of your cat, which may last for a couple of weeks. Diatomaceous earth is suppose to work but kills the earth worms too so i am not ready for that but it is cheap in the pool supply area. The life span of an adult flea is short, so this remedy addresses the source of the problem. 1 pint of water to a good size lemon boil water with lemom slices in it and leave over nite to make solution. Leave the salt on your floors for 3-5 days to ensure the adults do not reproduce, then vacuum up. One small piece daily for a cat or small dog and up to several treats daily for a full sized dog breed should be more than sufficient. It did create a nice film of dust everywhere and dried our feet out horribly, almost burned. Do not exceed this amount of the freeze dried liver however, as the large amount of vitamin A (liver is extremely high in iron and vit A) will become a bit excessive otherwise.
I have heard that These two things will get rid of fleas for good if you put them out every 6 weeks during the summer months. We left a nice layer in our mud room where we clean up from yard word and it has cut back the fleas majorly there.
Keeping things low, such as one crushed up piece with food a couple of times per week will keep things proper and keep anemia and several other disorders from coming into being as well in any case. It's best to do this in the tub starting with the neck and down to help control fleas that jump. I do this every week to two weeks during flea season and this keeps down the majority of fleas on my cat and the house. It is also necessary to vacuum every day to every other day paying close attention to where your animal stays. Finally, use a flea comb and tweezers to frequently comb your animal to remove additional fleas. You don't water bubbles in the glass, but the detergent will cause the fleas to sink to the bottom where they are poisoned and drowned.
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New Management Capabilities for RDS in Windows Server 8 BetaPublished on 13 Mar 2012
Since I have begun working in the virtualization business, customers have been asking for reasons why to spend money for Citrix XenApp and whether Remote Desktop Services (RDS) cuts it for them. For a long time, the answer was easy as hosted sessions on Windows Remote Desktop Services – formerly Terminal Services – have only provided basic functionality. But beginning with Windows Server 2008, Microsoft has put a lot of effort into that space. The underlying roles were steadily improved in every version, e.g. to support rich graphics and virtual desktops. With the public beta of the next Windows Server (8), Microsoft has improved the performance of RDP and built new management capabilities into Server Manager.


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Tuesday, November 3, 2015
Deluxe Tunnels & Trolls Hardcover in Hand and it's a Beast
Sure, I've had my 10 pack of Deluxe Tunnels & Trolls softcovers for a few weeks now but the hardcover is something special. One thing that is striking right off the bat (and it applies to the soft covers too) is that the font sized used is perfect. Easy to read, no squinting - simply a pleasure. I guess you need old folks to edit books for old folks to get books that are easily readable by us old folks ;)
Look how well the hardcover lies flat. Plop this on your desk or table and you are ready to go, no need to hold the pages down. I really need to budget some time to give this more than a scan - I really need to dig deep into the new edition of T&T.
Strangely enough, it came pack in a 5e T&T box (there are also some character sheets and some poster-y stuff packed inside the box. Except for a razor cut on one of the four sides, this 5e T&T box is in better condition than any in my collection. Go figure.
And now you can consider the Deluxe Tunnels & Trolls Kickstarter fulfilled ;)
9 comments:
Nice. I'm still waiting, probably by the end of the week.ReplyDelete
I liked mine quite a bit, as well (was surprised by the 5e box). 8')ReplyDelete
Still waiting, too, but I did get the email notice I'd be receiving two shipments soon.ReplyDelete
Glad you liked it. Part of what makes it special is the fact that this is the first time T&T has been in hardcover. The book feels like it belongs in hardcover due to its thickness. Hope more of you will share you thoughts when you get the books too.ReplyDelete
I have PDFs of T&T 1st, 4th, and 7.5th editions. Is this something I need to get? I like big awesome books, but I'm also running out of shelf space...ReplyDeleteReplies
I have 1e reprint, Ken's copy of 2e, multiple 4e copies, multiple 5 / 5.5e in many flavors and printings, 7e, 7.5e - all in printDelete
yes, get a print copy of Deluxe ;)
I once had a copy of 5th in print. I have no idea what happened to it... it vanished some time after the summer between when I was in 8th and 9th grade... (early-mid 90's) I still dearly wish I had it.Delete
I'll take it into consideration, because I also kind of want a print copy of OpenQuest 2... even though I need another fantasy roleplaying game like I need a fourth nipple.
Arrrrgh I was totally ready to impulse buy that mofo, but it doesn't look like a print copy is available yet. Anybody know if there are any plans to make it available in the future?Delete
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text:
Buy What the Best College Students Do by Ken Bain from Australia's Online Independent Bookstore, Boomerang Books.
Book DetailsISBN: 9780674066649
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Ken Bain is Provost and Vice President for Academic Affairs at the University of the District of Columbia.
© 2003-2019. All Rights Reserved. Eclipse Commerce Pty Ltd - ACN: 122 110 687 - ABN: 49 122 110 687


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text:
HRC on Trump-Pence 2020 Campaign LaunchJune 18, 2019
Boston's Curtis Guild School Earns HRC Foundation's Welcoming Schools Seal of ExcellenceJune 13, 2019
HRC: Hails Reintroduction of the Every Child Deserves a Family ActJune 5, 2019
Protecting LGBTQ Youth and Families from Harmful LegislationMay 31, 2019
On the 50th Anniversary of Stonewall, HRC Celebrates Half a Century of PrideMay 31, 2019
Colorado Gov. Jared Polis Signs Pro-Equality Legislation into LawMay 31, 2019
HRC Foundation and National Partners Launch Project THRIVEMay 31, 2019
Maine Gov. Janet Mills Signs Legislation Protecting LGBTQ Youth from "Conversion Therapy"May 29, 2019
Supreme Court Upholds Lower Court Ruling Affirming Trans StudentsMay 28, 2019
HRC Foundation Youth Ambassador Spotlight: Sameer JhaMay 23, 2019
Over 1,000 Parents & Caregivers of Transgender & Non-Binary Youth Thank Gender-Affirming ProvidersMay 23, 2019
Transgender Children & Youth
Boston's Curtis Guild School Earns HRC Foundation's Welcoming Schools Seal of Excellence
- June 13, 2019
Read Article
Guild is the 18th school in the nation to earn the Welcoming Schools Seal of Excellence and the third in Boston Public Schools, following John F. Kennedy School and Gardner Pilot School.
More on Transgender Children & Youth
Find resources that transgender children, families and other youth-serving professionals need to support one another in their journeys.
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text:
Alexander Ivanov, Andreas Linninger, Chih-Yang Hsu, Sepideh Amin-Hanjani, Victor A. Aletich, Fady T. Charbel and Ali Alaraj
The use of digital subtraction angiography (DSA) for semiquantitative cerebral blood flow(CBF) assessment is a new technique. The aim of this study was to determine whether patients with aneurysmal subarachnoid hemorrhage (aSAH) with higher Hunt and Hess grades also had higher angiographic contrast transit times (TTs) than patients with lower grades.
A cohort of 30 patients with aSAH and 10 patients without aSAH was included. Relevant clinical information was collected. A method to measure DSA TTs by color-coding reconstructions from DSA contrast-intensity images was applied. Regions of interest (ROIs) were chosen over major cerebral vessels. The estimated TTs included time-to-peak from 0% to 100% (TTP0–100), TTP from 25% to 100% (TTP25–100), and TT from 100% to 10% (TT100–10) contrast intensities. Statistical analysis was used to compare TTs between Group A (Hunt and Hess Grade I-II), Group B (Hunt and Hess Grade III-IV), and the control group. The correlation coefficient was calculated between different ROIs in aSAH groups.
There was no difference in demographic factors between Group A (n = 10), Group B (n = 20), and the control group (n = 10). There was a strong correlation in all TTs between ROIs in the middle cerebral artery (M1, M2) and anterior cerebral artery (A1, A2). There was a statistically significant difference between Groups A and B in all TT parameters for ROIs. TT100–10 values in the control group were significantly lower than the values in Group B.
The DSA TTs showed significant correlation with Hunt and Hess grades. TT delays appear to be independent of increased intracranial pressure and may be an indicator of decreased CBF in patients with a higher Hunt and Hess grade. This method may serve as an indirect technique to assess relative CBF in the angiography suite.
Daniel M. Birk, Matthew K. Tobin, Heather E. Moss, Eric Feinstein, Fady T. Charbel and Ali Alaraj
The most commonly described indications for surgical management of closed depressed skull fractures are hematoma evacuation and repair of extensive cosmetic deformity. Venous sinus injury, which occurs in a subset of depressed skull fractures, is not typically listed as an indication for surgical treatment due to the potential for major venous hemorrhage associated with surgery near these structures. However, if patients exhibit signs and symptoms of intracranial hypertension and radiographic findings demonstrate sinus compromise, surgical elevation of the depressed skull fragments is indicated. The authors present the case of a 25-year-old woman with a depressed skull fracture secondary to a gunshot wound with symptomatic compromise in venous outflow of the posterior one-third of the superior sagittal sinus. The patient was treated with surgical decompression via bilateral craniectomy along with intracranial pressure–lowering medical therapy and had almost full resolution of her presenting symptoms with documented improvement in flow through the superior sagittal sinus. While the use of surgical treatment for these types of injuries is highly debated, the authors demonstrate here that safe, effective surgical management of these patients is possible and that surgical decompression should always be considered in the case of symptomatic venous sinus flow obstruction.
Omar M. Qahwash, Ali Alaraj, Victor Aletich, Fady T. Charbel and Sepideh Amin-Hanjani
The goal of this study was to demonstrate feasibility and evaluate technical aspects of early endovascular access through extracranial-intracranial (EC-IC) bypass grafts.
Patients undergoing endovascular interventions through the graft in the acute postoperative period following EC-IC bypass are presented. Results, complications, and technical nuances are reviewed.
Fourteen endovascular procedures were performed in 5 patients after EC-IC bypass for ruptured aneurysms in 4 patients and posterior circulation ischemia in 1 patient. In 2 patients, a saphenous vein graft (SVG) was used to bypass the common carotid artery (CCA) to the middle cerebral artery (MCA). One patient underwent a superficial temporal artery (STA)–MCA bypass, and in 2 other patients the STA stump was connected to the intracranial circulation via an interposition SVG. The interval from surgery to endovascular intervention spanned 2–18 days; the indication was intracranial vasospasm in all patients. One case involved angioplasty of the proximal anastomosis on postoperative Day 14. All other interventions entailed proximal access through the bypass conduit for intraarterial infusion of vasodilators. Significant vasospasm of the STA itself was encountered in 2 patients during endovascular manipulation, and it was treated with intraarterial nitroglycerin. There were no cases of anastomotic disruption.
Endovascular catheterization and intervention involving a recent EC-IC bypass is feasible. The main limitation in this series was catheter-induced vasospasm involving the STA. A vein graft may be the more appropriate option in patients with subarachnoid hemorrhage who may require subsequent endovascular intervention for vasospasm.
Angiographic features of "brain sag"
Clinical article
Ali Alaraj, Troy Munson, Sebastian R. Herrera, Victor Aletich, Fady T. Charbel and Sepideh Amin-Hanjani
Cerebrospinal fluid hypotension, or "brain sag," is a recently described phenomenon most commonly seen following craniotomy for the clipping of ruptured aneurysms along with preoperative lumbar drain placement. The clinical features and CT findings have been previously described. Clinical presentation can be similar to and often mistaken for cerebral vasospasm. In this study, the authors report on the angiographic findings in patients with brain sag.
Five cases of brain sag were diagnosed (range 1–4 days) after the surgical treatment of ruptured aneurysms at the University of Illinois at Chicago. All patients met the clinical and CT criteria for brain sag. Admission cerebral angiograms and subsequent angiograms during symptoms of brain sag were obtained in all patients. In 3 patients, angiography was performed after the resolution of symptoms.
In all 5 patients, the level of the basilar artery apex was displaced inferiorly with respect to the posterior clinoid processes during brain sag. This displacement was significant enough to create a noticeable kink in the basilar artery ("cobra sign") in 3 patients. Other angiographic findings included foreshortening or kinking of the intracranial vertebral artery. In all patients, the posterior cerebral arteries were displaced medially and inferiorly. Three patients were treated for simultaneous severe radiological vasospasm. In 4 patients, the brain sag was recognized, and the patients' conditions improved when they were placed flat or in the Trendelenburg position, at times combined with an epidural blood patch. Patients with follow-up angiography studies after the symptoms had resolved displayed a reversal of the angiographic features.
Brain sag appears to be associated with characteristic angiographic features. Recognizing these features may help to diagnose brain sag as the cause of neurological deterioration in this patient population.
E. Sander Connolly Jr.
Michael Chan, Ali Alaraj, Mateo Calderon, Sebastian Ramon Herrera, Weihua Gao, Sean Ruland and Ben Zion Roitberg
Patients with subarachnoid hemorrhage treated using external ventricular drainage due to obstructive hydrocephalus commonly remain shunt-dependent. Based on identified risk factors for external ventricular drain (EVD) challenge failure, the authors sought to determine the likelihood that a patient will require a permanent shunt.
The authors reviewed 89 consecutive cases of aneurysmal subarachnoid hemorrhage with obstructive hydrocephalus for parameters associated with EVD challenge failure and permanent shunt requirement. Significant parameters were combined in a discriminant function analysis to create a failure risk index (FRI). Linear regression analysis was performed correlating the FRI with the actual rate of shunt dependency.
Patients requiring a permanent shunt had: a larger third ventricular diameter (7.0 vs 5.4 mm; p = 0.02) and a higher Hunt and Hess grade (3 vs 2; p = 0.02) at the time of admission; and a larger third ventricular diameter (6.6 vs 5.2 mm; p = 0.04), a larger bicaudate diameter (31.9 vs 30.2 mm; p = 0.03), and higher CSF protein levels (76.5 vs 40.3 mg/dl; p < 0.0001) at the onset of EVD challenge. These patients were also more likely to be female (p = 0.01) and have a posterior circulation location of their aneurysm (p = 0.01). The FRI score was calculated based on a weighted combination of the above parameters. Linear regression analysis between FRI values and the percentage of patients who required a permanent shunt had a correlation coefficient of 91%; the risk of a permanent shunt requirement increased linearly with a rising FRI score.
An FRI score created by discriminant function analysis can predict whether or not a permanent shunt is required, even if separate factors are not in agreement with each other or show a weak correlation when considered separately. An increased FRI score was strongly and linearly correlated with the risk of EVD challenge failure. A prospective study is necessary to validate the FRI.
Mateo Calderon-Arnulphi, Ali Alaraj, Sepideh Amin-Hanjani, William W. Mantulin, Chiara M. Polzonetti, Enrico Gratton and Fady T. Charbel
There is great value in monitoring for signs of ischemia during neurovascular procedures. Current intraoperative monitoring techniques provide real-time feedback with limited accuracy. Quantitative frequency-domain near-infrared spectroscopy (Q-NIRS) allows measurement of tissue oxyhemoglobin (HbO2), deoxyhemoglobin (HHb), and total hemoglobin (tHb) concentrations and brain tissue oxygen saturation (SO2), which could be useful when monitoring for evidence of intraoperative ischemia.
Using Q-NIRS, the authors monitored 25 neurovascular procedures including aneurysm clip placement, arteriovenous malformation resection, carotid endarterectomy, superficial temporal artery–middle cerebral artery (MCA) bypass surgery, external carotid artery–MCA bypass surgery, encephaloduromyosynangiosis, and balloon occlusion testing. The Q-NIRS technology provides measurable cerebral oxygenation values independent from those of the scalp tissue. Thus, alterations in the variables measured with Q-NIRS quantitatively reflect cerebral tissue perfusion. Bilateral monitoring was performed in all cases.
Five of the patients exhibited evidence of clinical ischemic events during the procedures. One patient suffered blood loss with systemic hypotension and developed diffuse brain edema intraoperatively, one patient suffered an ischemic event intraoperatively and developed an occipital stroke postoperatively, and one patient showed slowing on electroencephalography intraoperatively during carotid clamping; in two patients balloon occlusion testing failed. In all cases of ischemic events occurring during the procedure, Q-NIRS monitoring showed a decrease in HbO2, tHb, and SO2, and an increase in HHb.
Quantitative frequency-domain near-infrared spectroscopy provides quantifiable and continuous real-time information about brain oxygenation and hemodynamics in a noninvasive manner. This continuous intraoperative oxygenation monitoring is a promising method for detecting ischemic events during neurovascular procedures.


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Virgin of Guadalupe
Virgin of Guadalupe
In Mexico, December 12, Virgin of Guadalupe Day, is a national holiday, and often as many as five million Mexicans— many crawling on bloodied knees—make their annual pilgrimage to the country's most venerated shrine, a basilica for the Virgin Mary in Mexico City. In 1996, eight people were killed and 15 were injured in the press of pilgrims gathered around the site.
The story of the Virgin of Guadalupe is one of a mystery within a miracle. In 1531, a 57-year-old Aztec Indian named Juan Diego (1474–1548), whose native name Cuauhtlatoatzin means "eagle that sings" (or in some translations, "eagle that talks"), claimed to have encountered the Blessed Virgin Mary on four occasions in desolate regions outside of Mexico City. At first she appeared as a beautiful, dark-skinned 14-year-old Mexican Indian girl, who then revealed herself as the "ever-virgin Mary, Mother of God." During later appearances, Mother Mary told Diego that she wished a church built to her in the place where she appeared to him–Guadalupe, the river of the wolf. As proof of her holy appearances, the Queen of Heaven projected an image of herself upon his tilma (cloak). It is that artifact that brought Bishop Juan de Zumarraga (1468–1548) of Mexico City and his entire household to their knees when he asked for some kind of tangible sign from the Holy Mother. It is that same image on the tilma, set in gold at the center of an elaborate altar, that still awaits today's pilgrim at the basilica of the Virgin of Guadalupe.
It has been said that the dark-skinned image of Mother Mary as a virginal Native American girl helped the Spanish priests convert millions of Mexican Indians to Catholicism. After an extensive examination, the committee from the Holy See in Rome declared the apparitions seen by Juan Diego to be authentic, thus making the miracle one of seven appearances of Mother Mary officially recognized by the Vatican.
Then, in 1929, an image was discovered within the right eye of the image of the Virgin on Juan Diego's tilma. Alfonso Marcue, official photographer of the old Basilica of Guadalupe in Mexico City, discovered what appeared to be a clear image of a bearded man reflected within the right eye of the Virgin. At first doubting his own senses, Marcue made many black-and-white photographs of the image; and after he had examined them exhaustively, he went to the authorities of the basilica with his incredible finding. He was told to remain silent about his discovery, and out of respect for the church officials, he did.
On May 29, 1951, Jose Carlos Salinas Chavez was examining a particularly good photograph of the face of the Virgin and rediscovered what clearly appeared to be the image of a bearded man reflected in both the right and left eyes of Mother Mary. Since that time, more than 20 experts, including a number of ophthalmologists, have carefully inspected the eyes and the mysterious image.
On March 27, 1956, Dr. Javier Torroella Bueno, a prestigious ophthalmologist, certified the presence of the triple reflection (Samson-Purkinje effect) characteristic of all live human eyes and stated that the resulting images of the bearded man were located precisely where they should be according to such an effect. Bueno also pointed out that the distortion of the images agreed with the normal curvature of the cornea.
In that same year, another experienced ophthalmologist, Dr. Rafael Torrija Lavoignet, using an ophthalmoscope, studied the apparent human figure in the corneas of both eyes, with the location and distortion of a normal human eye, and found that the Virgin's eyes appeared "strangely alive" when he examined them.
While working at IBM in 1979, Dr. Jose Aste Tonsmann, a graduate of environmental systems engineering of Cornell University, scanned a photograph of the Virgin's face on the tilma and was astonished to discover what he believed to be other human figures reflected in the eyes. Aste Tonsmann has since theorized that Our Lady of Guadalupe not only left a miraculous image as proof of her apparition to Juan Diego, but may also have left some important messages hidden in her eyes that could not be revealed until new technologies would permit them to be discovered.
Another mystery that had puzzled academic researchers into the phenomena surrounding the Virgin of Guadalupe was how the colored image of the apparition could have been impressed upon the simple tilma of a poor Aztec tribesman and how it could have lasted for centuries without falling apart. As early as the eighteenth century, scientists discovered that it was impossible to paint such an image in a fabric of such texture. The ayate fibers used by the Aztecs at that time deteriorated after 20 years. Richard Kuhn (1900–1967), a Nobel Prize winner in chemistry, stated in his report of the tilma that it had not been painted with natural, animal, or mineral colorings. Since there were no synthetic colorings in 1531, the possibility of a native artist accomplishing a hoax seems out of the question.
In January 2001, Dr. Jose Aste Tonsmann, now with the Mexican Center of Guadalupan Studies, revealed at a conference at the Pontifical Athenaeum Regina Apostolorum in Rome that advances in digital photography now revealed that the images in the Virgin's eyes were those assembled with Bishop Juan de Zumarraga when Juan Diego first unfurled his tilma and displayed the miraculous image. By magnifying the iris of the Virgin's eyes 2,500 times and, through mathematical and optical procedures, Aste Tonsmann feels that he is able to identify all the people imprinted in the eyes. In other words, the Virgin's eyes bear a kind of instant photograph of what occurred the moment the image was unveiled before the bishop.
Delving Deeper
Delaney, John J., ed. A Woman Clothed with the Sun. New York: Doubleday, Image Books, 1961.
Our Lady of Guadalupe. http://www.sancta.org/eyes.html. 14 August 2001.
"Science Stunned by Virgin of Guadalupe's Eyes: Engineer Sees a Reflection, Literally, from a Scene in 1531," Zenit News Agency, 15 January 2001.
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