Occupational lung disease

Silicosis and black lung disease

Silica dust produces a distinctive reaction in the lung that eventually leads to the development of masses of fibrous tissue and distinctive nodules of dense fibrosis, which, by contracting, distort and damage the lung. Silicosis is a hazard in any occupation in which workers are exposed to silica dust, particularly rock drilling above or below ground, quarrying, or grinding with a wheel containing silica. Cases have also been reported in dental technicians, who use the material ground into a fine powder. Silicosis is usually fairly easy to detect on radiographs, and in its later stages it causes considerable shortness of breath and reduction of the vital capacity (a maximal breath). Sandblasting without respiratory protection is exceedingly dangerous, and fatal cases of acute silicosis caused by unprotected sandblasting have been reported. The dangers of silica are generally well recognized, and better protection has reduced the incidence of this condition. The disease may advance, with increasing disability, for years after the person has stopped inhaling the dust.

Coal dust alone, even if its silica content is very low, causes a distinctive pattern of change in the lung known as coal workers’ pneumoconiosis (also called black lung). Initially the dust is deposited in the terminal bronchioles, where it causes a fibrotic reaction. At this stage there is little disability, but later the disease may progress to a more-generalized form, and in some instances large masses of fibrotic tissue form in the lung. This condition, known as progressive massive fibrosis, is usually associated with severe disability and the risk of secondary heart failure. It is not clear whether this stage is more likely to develop if pulmonary tuberculosis is superimposed on the respiratory damage caused by coal dust inhalation. There is no curative treatment for silicosis or black lung disease.

Asbestosis and mesothelioma

The widespread use of asbestos as an insulating material during World War II, and later in flooring, ceiling tiles, brake linings, and as a fire protectant sprayed inside buildings, led to a virtual epidemic of asbestos-related disease 20 years later. The first disease recognized to be caused by asbestos was asbestosis, which produces characteristic changes in the lungs that can be identified in chest X-rays and that can impair lung function at an early stage. Later it was discovered that exposure to much less asbestos than was needed to cause asbestosis led to thickening of the pleura, and, when both cigarette smoking and asbestos exposure occurred, there was a major increase in the risk for lung cancer. The risks from smoking and from significant asbestos exposure are multiplicative in the case of lung cancer. A malignant tumour of the pleura known as mesothelioma is caused almost exclusively by inhaled asbestos. Often a period of 20 years or more elapses between exposure to asbestos and the development of a tumour.

As far as is known, all the respiratory changes associated with asbestos exposure are irreversible. Malignant mesothelioma is rare and unrelated to cigarette smoking, but survival after diagnosis is less than two years. In most cases, thickening of the pleura is not associated with disturbance of lung function or with symptoms of exposure to asbestos, although in occasional cases pleuritis is very aggressive and thus may produce symptoms. It is not yet understood exactly why asbestos devastates the tissues of the lungs. Asbestos has been suspected to play a role in stimulating certain cellular events, such as the generation of harmful reactive molecules and the activation of damaging inflammatory processes. These events could contribute to the scarring and fibrosis that are characteristic of inhalation of asbestos fibres. Not all types of asbestos are equally dangerous; the risk of mesothelioma in particular appears to be much higher if crocidolite, a blue asbestos that comes from South Africa, is inhaled than if chrysotile is inhaled. But exposure to any type of asbestos is believed to increase the risk of lung cancer, especially when associated with cigarette smoking. While the removal of asbestos from buildings has greatly alleviated the risk of exposure to asbestos for many people, inhalation of asbestos remains a significant risk for the workers removing the material. All industrialized countries have imposed strict regulations for handling asbestos, and the workforce is generally aware of the material’s dangers.

There is no curative therapy for asbestosis or mesothelioma. Treatment is aimed at managing symptoms, preventing infections, and delaying disease progression. Individuals with asbestosis often receive annual vaccinations against influenza and pneumococcal pneumonia. In some cases, aerosol medications that thin mucous secretions and oxygen that is supplied by a portable tank are necessary to maintain adequate oxygen intake. In other cases, lung transplantation is required. Individuals with mesothelioma often undergo chemotherapy and radiation therapy, which may prolong survival for a short period of time.

Respiratory toxicity of glass and metal fibres

The increasing use of man-made mineral fibres (as in fibreglass and rock wool) has led to concern that these may also be dangerous when inhaled; present evidence suggests that they do increase the risk of lung cancer in persons occupationally exposed to them. Standards for maximal exposure have been proposed.

The toxicity of beryllium was first discovered when it was widely used in the manufacture of fluorescent light tubes shortly after World War II. In susceptible individuals, beryllium causes the formation of granulomas in the lung and alveolar wall thickening, often with considerable disability as a result. Although beryllium is no longer used in the fluorescent light industry, it is still important in the manufacture of metal alloys and ceramics, and new cases of beryllium poisoning are occasionally reported.

Byssinosis and related diseases

It is not only inorganic minerals and dusts that may affect the lung. The dust produced in the processing of raw cotton, flax, or hemp may cause chronic obstructive lung disease. However, this does not have a characteristic pathology, and it does not give rise to emphysema. It is unclear whether the dust from the fibres alone or the combination of cigarette smoke and fibre dust is particularly dangerous. The disease that results is known as byssinosis, or “brown lung.” Workers in cotton plants in England used to complain of “Monday morning fever” and were found to suffer an easily measurable decrement in ventilatory function when they returned to work after spending a weekend away from the plant. The active particle or contaminant in the cotton dust that is responsible for the syndrome appears to be an endotoxin produced by bacteria in the fibres of cotton.

The dust from western red cedar may cause occupational asthma, and dust from the redwood and other trees may cause an acute hypersensitivity pneumonitis. Workers in the sugarcane industry may be affected by a similar syndrome, known as bagassosis; sisal workers also develop airflow obstruction.

Respiratory toxicity of industrial chemicals

Toluene diisocyanate, used in the manufacture of polyurethane foam, may cause occupational asthma in susceptible individuals at very low concentrations; in higher concentrations, such as may occur with accidental spillage, it causes a transient flulike illness associated with airflow obstruction. Prompt recognition of this syndrome has led to modifications in the industrial process involved.

Although the acute effects of exposure to many of these gases and vapours are well-documented, there is less certainty about the long-term effects of repeated low-level exposures over a long period of time. This is particularly the case when the question of whether work in a generally dusty environment has contributed to the development of chronic bronchitis or later emphysema—in other words, whether such nonspecific exposures increase the risk of these diseases in cigarette smokers.

Many chemicals can damage the lung in high concentration: these include oxides of nitrogen, ammonia, chlorine, oxides of sulfur, ozone, gasoline vapour, and benzene. In industrial accidents, such as occurred in 1985 in Bhopal, India, and in 1976 in Seveso, near Milan, people in the neighbourhood of chemical plants were acutely exposed to lethal concentrations of these or other chemicals. The custom of transporting dangerous chemicals by rail or road has led to the occasional exposure of bystanders to toxic concentrations of gases and fumes. Although in many cases recovery may be complete, it seems clear that long-term damage may occur.

Disability and attribution of occupational lung diseases

Miscellaneous conditions of the respiratory system

Idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis is also known as cryptogenic fibrosing alveolitis. This is a generally fatal lung disease of unknown cause that is characterized by progressive fibrosis of the alveolar walls. The disease most commonly manifests between the ages of 50 and 70, with insidious onset of shortness of breath on exertion. A dry cough is common as well. Sharp crackling sounds, called rales or “Velcro crackles,” are heard through a stethoscope applied to the back in the area of the lungs. Computerized tomography (CT) imaging shows fibrosis and cysts that characteristically form in a rim around the lower outer portions of both lungs. In addition, pulmonary function testing shows a reduction in lung volume. Lung biopsies confirm the diagnosis by showing fibrosis with a lack of inflammation.

The disease causes progressive shortness of breath with exercise and ultimately produces breathlessness at rest. Hypoxemia (decreased levels of oxygen in the blood) initially occurs with exercise and later at rest and can be severe. Some individuals have clubbed fingertips and toes. The average duration of survival from diagnosis is four to six years; however, some people live 10 years or longer. Aside from administration of supplemental oxygen, there is no effective treatment. Some individuals may benefit from single or double lung transplantation (see above Lung transplantation).

Sarcoidosis is a disease of unknown cause characterized by the development of small aggregations of cells, or granulomas, in different organs; the lung is commonly involved. Other common changes are enlargement of the lymph glands at the root of the lung, skin changes, inflammation in the eye, and liver dysfunction; occasionally there is inflammation of nerve sheaths, leading to signs of involvement in the affected area. The kidney is not commonly involved, but some changes in blood calcium levels occur in a small percentage of cases. In most cases the disease is first detected on chest radiographs. Evidence of granulomas in the lung may be visible, but often there is little interference with lung function. The disease usually remits without treatment within a year or so, but in a small proportion of cases it progresses, leading finally to lung fibrosis and respiratory failure. The granulomatous inflammation in sarcoidosis can be controlled by long-term administration of a corticosteroid such as prednisone.

Eosinophilic granuloma

Also known as pulmonary histiocytosis X, this disease causes granulomas associated with eosinophil cells, a subgroup of the white blood cells. It sometimes also causes lesions in bone. Eosinophilic granuloma is a lung condition that may spontaneously “burn out,” leaving the lung with some permanent cystic changes. Its cause is not known; however, the incidence is greatly increased in cigarette smokers.

Pulmonary alveolar proteinosis

Pulmonary alveolar proteinosis is a disease of unknown cause characterized by accumulation in the alveolar spaces of surfactant. Small amounts of this lipid- and protein-rich fluid normally line the surfaces of the alveoli, reducing surface tension and thereby keeping the air spaces open. Buildup of this liquid within the air spaces interferes with gas exchange and causes progressive shortness of breath. The only effective treatment of this disease is whole-lung lavage. Under general anesthesia, the bronchus leading to one lung is isolated, and that lung is filled with sterile salt water. Drainage of the fluid removes some of the excess surfactant. Flooding and drainage are repeated up to 20 or 30 times until little or no more surfactant is removed. Then on another day the opposite lung is treated. Whole-lung lavage may be required at 6- to 12-month intervals for several years before complete remission occurs.

Immunologic conditions

The lung is often affected by generalized diseases of the blood vessels. Wegener granulomatosis, an acute inflammatory disease of the blood vessels believed to be of immunologic origin, is an important cause of pulmonary blood vessel inflammation. Acute hemorrhagic pneumonitis occurring in the lung in association with changes in the kidney is known as Goodpasture syndrome. The condition has been successfully treated by exchange blood transfusion, but its cause is not fully understood. Pulmonary hemorrhage also occurs as part of a condition known as pulmonary hemosiderosis, which results in the accumulation of the iron-containing substance hemosiderin in the lung tissues. The lung may also be involved in a variety of ways in the disease known as systemic lupus erythematosus, which is also believed to have an immunologic basis. Pleural effusions may occur, and the lung parenchyma may be involved. These conditions have only recently been recognized and differentiated; accurate diagnosis has been much improved by refinements in radiological methods, by the use of pulmonary function tests, and especially by improvement in thoracic surgical techniques and anesthesia that have made lung biopsy much less dangerous than it formerly was.

The common condition of rheumatoid arthritis may be associated with scattered zones of interstitial fibrosis in the lung or with solitary isolated fibrotic lesions. More rarely, a slowly obliterative disease of small airways (bronchiolitis) occurs, leading finally to respiratory failure.

Radiation damage

The lung may be damaged by radiation therapy in the treatment of cancer of the breast and other conditions. About three weeks or so after the end of the treatment, a pneumonitis may develop in the underlying lung, signaled by an unproductive cough. The condition may resolve, but in a few cases the lung becomes fibrotic and contracts to a small fraction of its normal volume. There is considerable individual variation in the response to the same dose of radiation.

Circulatory disorders

The lung is commonly involved in disorders of the circulation. The most important and common of these is blockage of a branch of the pulmonary artery by blood clot, which has usually formed in the veins of the legs or of the pelvis. The resulting pulmonary embolism leads to changes in the lung supplied by the affected artery. When severe, these changes are known as a pulmonary infarction. The consequences of embolism range from sudden death, when the infarction is massive, to an increased respiratory rate, slight fever, and occasionally some pleuritic pain over the site of the infarction. An individual is at an increased risk for pulmonary embolism whenever his or her circulation is sluggish. This occurs most often during a postoperative period when the affected individual is immobilized in bed. Early mobilization after surgery or childbirth is considered an important preventive measure. Repetitive pulmonary emboli may lead to chronic pulmonary thromboembolism, in which the pressure in the main pulmonary artery is persistently increased. Over time, a clot is replaced with an adherent fibrous material in the pulmonary arteries, causing shortness of breath on exertion and, ultimately, right ventricular heart failure. The obstructing lesions can be surgically removed in some instances, thereby relieving symptoms of breathlessness.

In primary pulmonary hypertension, a condition of unknown origin, a marked increase in pulmonary arterial pressure occurs as a result of progressive narrowing and obliteration of small pulmonary arteries. Primary pulmonary hypertension leads to enlargement of the heart and eventual failure of the right ventricle of the heart, usually after increasing disability with severe shortness of breath. In addition to chest X-rays and basic pulmonary function tests, a diagnosis of pulmonary hypertension is often confirmed following an electrocardiogram (EKG) to assess electrical function of the heart, an echocardiogram to determine whether the heart is enlarged and to evaluate the flow of blood through the heart, and cardiac catheterization to measure pressure in the pulmonary artery and right ventricle of the heart.

Treatment of primary pulmonary hypertension is aimed at alleviating symptoms. Because of the variability in physiological response to certain drugs and because of the progressive nature of the disease, affected individuals require careful, long-term evaluation and treatment. While some medications such as calcium channel blockers may be taken orally, others such as prostacyclin are given by continuous intravenous infusion supplied through a portable battery-powered pump. Prostacyclin can sometimes be given in oral or inhaled forms. In some cases, lung transplantation is necessary.

Congestion of the lungs (pulmonary edema) and the development of fluid in the pleural cavity, with consequent shortness of breath, follows left ventricular failure, usually as a consequence of coronary arterial disease. When the valve between the left atrium of the heart and the left ventricle is thickened and deformed by rheumatic fever (mitral stenosis), chronic changes develop in the lung as a result of the increased pressure in the pulmonary circulation. These changes contribute to the shortness of breath and account for the blood staining of the sputum.

Acute respiratory distress syndrome of adults

Bacterial or viral pneumonia, exposure of the lung to gases, aspiration of material into the lung (including water in near-drowning episodes), or any generalized septicemia (blood poisoning) or severe lung injury may lead to sudden, widespread bilateral lung injury. This syndrome is known as acute respiratory distress syndrome of adults. It was recognized as “shock lung” in injured soldiers evacuated by helicopter to regional military hospitals during the Vietnam War. Many causes of respiratory distress syndrome of adults have been identified. Acute respiratory distress syndrome carries about a 50 percent mortality. Life-support treatment with assisted ventilation rescues many patients, although superimposed infection or multiple organ failure can result in death. Recovery and repair of the lung may take months after clinical recovery from the acute event.

Air pollution

The disastrous fog and attendant high levels of sulfur dioxide and particulate pollution (and probably also sulfuric acid) that occurred in London in the second week of December 1952 led to the deaths of more than 4,000 people during that week and the subsequent three weeks. Many, but not all, of the victims already had chronic heart or lung disease. Prize cattle at an agricultural show also died in the same period as a result of the air pollution. This episode spurred renewed attention to this problem, which had been intermittently considered since the 14th century in England, and finally the passage of legislation banning open coal burning, the factor most responsible for the pollution. This form of pollution, common in many cities using coal as heating fuel, is associated with excess mortality and increased prevalences of chronic bronchitis, respiratory tract infections in the young and old, and possibly lung cancer. Today many industrial cities have legislation restricting the use of specific fuels and mandating emission-control systems in factories.

In 1952 a different kind of air pollution was characterized for the first time in Los Angeles. The large number of automobiles in that city, together with the bright sunlight and frequently stagnant air, leads to the formation of photochemical smog. This begins with the emission of nitrogen oxide during the morning commuting hour, followed by the formation of nitrogen dioxide by oxygenation, and finally, through a complex series of reactions in the presence of hydrocarbons and sunlight, leads to the formation of ozone and peroxyacetyl nitrite and other irritant compounds. Eye irritation, chest irritation with cough, and possibly the exacerbation of asthma occur as a result. Modern air pollution consists of some combination of the reducing form consequent upon sulfur dioxide emissions and the oxidant form, which begins as emissions of nitrogen oxides. Ozone is the most irritant gas known. In controlled exposure studies it reduces the ventilatory capability of healthy people in concentrations as low as 0.12 part per million. These levels are commonly exceeded in many places, particularly where there is a high automobile density and the meteorologic conditions favour the formation of photochemical oxidants. Although acute episodes of communal air exposure leading to demonstrable mortality are unlikely, there is much concern over the possible long-term consequences of brief but repetitive exposures to oxidants and acidic aerosols. Such exposures are common in the lives of millions of people, and the impact of these exposures is an area of intense scientific investigation.

The indoor environment can be important in the genesis of respiratory disease. In developing countries, disease may be caused by inhalation of fungi from roof thatch materials or by the inhalation of smoke when the home contains no chimney. In developed countries, exposure to oxides of nitrogen from space heaters or gas ovens may promote respiratory tract infections in children. Inhalation of tobacco smoke in the indoor environment by nonsmokers impairs respiration, and repeated exposures may lead to lung cancer. A tightly sealed house may act as a reservoir for radon seeping in from natural sources.

Acute carbon monoxide poisoning

Acute carbon monoxide poisoning is a common and dangerous hazard. The British physiologist John Scott Haldane pioneered the study of the effects of carbon monoxide at the end of the 19th century, as part of his detailed analysis of atmospheres in underground mines. Carbon monoxide is produced by incomplete combustion, including combustion of gas in automobile engines, and for a long period it was a major constituent of domestic gas made from coal (its concentration in natural gas is much lower). When the carbon monoxide concentration in the blood reaches 40 percent (that is, when the hemoglobin is 40 percent saturated with carbon monoxide, leaving only 60 percent available to bind to oxygen), the subject feels dizzy and is unable to perform simple tasks; judgment is also impaired. Hemoglobin’s affinity for carbon monoxide is 200 times greater than for oxygen, and in a mixture of these gases hemoglobin will preferentially bind to carbon monoxide; for this reason, carbon monoxide concentrations of less than 1 percent in inspired air seriously impair oxygen-hemoglobin binding capacity. The partial pressure of oxygen in the tissues in carbon monoxide poisoning is much lower than when the oxygen-carrying capacity of the blood has been reduced an equivalent amount by anemia, a condition in which hemoglobin is deficient. The immediate treatment for acute carbon monoxide poisoning is assisted ventilation with 100 percent oxygen.

The carbon monoxide inhaled by smokers who smoke more than two packs of cigarettes a day may cause up to 10 percent hemoglobin saturation with carbon monoxide. A 4 percent increase in the blood carbon monoxide level in patients with coronary artery disease is believed to shorten the duration of exercise that may be taken before chest pain is felt.

David V. Bates John Hansen-Flaschen

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Tristan Geisler | CaringBridge

Tristan Geisler

First post: Apr 6, 2017 Latest post: Apr 24, 2017
Tristan Geisler is a 14 year old boy with refractory epilepsy.  Refractory epilepsy is just the term doctors use to say that medication isn't helping with the seizures.  Tristan has been on more than a dozen types of medication and none have stopped his seizures.  We've even tried non traditional medicine such as CBD, which doesn't work either.  Sometimes Tristan has 6 seizures a day, but sometimes he goes as long as a week without a seizure.  The medication helps somewhat but not completely.  The medication is also debilitating: Tristan was falling asleep for 1/2 the day in traditional schooling, so now he is home schooled.  Over the years Tristan has lost much of the social activity he used to have in school due to his condition and he's lost touch with many friends.

This all began in 2014.  At the time Tristan was a healthy 12 year old boy with amazing grades in school and a great network of peers.  He was enrolled in Lineville Intermediate School in Howard WI where he enjoyed playing the violin, running on cross country and being active in his boy scout troop.  One fateful day in September of 2014 Tristan had his first seizure.  He had been feeling ill and wasn't in school, his symptoms included a high fever and tiredness.  But urgent care said it was just a flu.  He had only been out of school a day when he had that first seizure.  We rushed him to the hospital where he was quickly transferred to the pediatric section of St Vincent's hospital in Green Bay.

The first day in the hospital was a living nightmare.  Tristan was having a seizure or more an hour and the few times he was awake he was just screaming.  Eventually, under direction of the doctors and after a couple days of too many seizures, he underwent a phenobarbital coma which is a medically induced coma meant to protect the brain.  His seizures stopped but he was in a coma.  After a few days they tried to take him out of the coma but he would keep spiking in seizures, some 40 seizures a day.  At this point Tristan had been diagnosed with viral Meningoencephalitis.  This is meningitis and encephalitis combined in what is sometimes one deadly combination, but at least it wasn't bacterial- if it had been he would have already been dead.

After a week of no progress and blunders by the medical staff (such as missed doses of medication which caused seizures) we insisted on a transfer to American Family Childrens Hospital in Madison WI.  There Tristan would remain in a coma for another 5 weeks.  This was a very trying time for the whole family, frankly it was hell on earth.   But miraculously through medication and the powers of the ketogenic diet, Tristans seizures became more controlled to the point where he stopped having them in the clinical setting.  They saved his life at American Family Children's in Madison. After he was on the road to recovery, one of the doctors came forward and told us how extraordinary it was that Tristan actually survived.  The Doctor said Tristan was so close to being gone so many times and she had seen it go that way before.  We are truly blessed that American Family Childrens Hospital and God saved him!

Tristan came out of his coma around the 6th week and he couldn't speak, he couldn't eat, he forgot absolutely everything.   I remember being absolutely thrilled when he simply said "Dad!  Dad!" to me and kept repeating it.  That's about all he could say, and of course soon after "Mom".  He had to relearn how to speak, he had to relearn how to eat, he had to relearn how to walk.  It was a whirlwind of a recovery and felt like we were rehashing things from long ago.  It was almost like all 12 years of his life were on fast repeat mode.  His favorite movies during recovery was goonies and his favorite show was sponge bob.  Eventually we got his laptop back to him and he played minecraft from the hospital!  He made good friends with his favorite nurse Matt.  Matt was so wonderful to him, he even brought in his guitar once and sang to Tristan.  Tristan liked going down to see the dogs in the hospital when they'd bring them.  Although he couldn't walk yet, we'd take him down there and he'd get so happy to see the puppies.

Anyway, Tristan was in the hospital out of his coma recovering by sometime around late October.   We spent thanksgiving as a family together in the hospital, some folks had donated turkey dinner.  Recovery in the hospital was tough but Tristan was a trooper.  By Christmas of  2014, after more than three months in the hospital, Tristan was finally ready to come home.  He had a AFO on his leg, which meant he had limited mobility making it hard to return to athletics, etc.  He returned to his house at school where he had forgotten who all his friends were.  This was a difficult time for Tristan.

He finished 6th grade and we moved him to private school thinking smaller class sizes might help, but this too had a host of problems such as no support for his needs.  He has been recovering since 2014 but sometimes progress is slow.  This year he enrolled at bay view middle school in 8th grade but after some issues caused by the medication we had to dis-enroll him and begin homeschooling.  The behavioral issues of the extreme amount of medication he is on combined with the sleepiness don't make for an ideal life for a 14 year old boy.

Last year I started a new job at Insitu, which is a division of Boeing corporation.  Prior to being a Boeing employee, my insurance only extended throughout Wisconsin.  But via the excellent health insurance provided by Boeing, it has enabled us to leave Wisconsin doctors and try the doctors at the world-class Mayo clinic in Rochester MN.  These doctors have suggested a potential cure: Temporal Lobe Resection.  If successful, this could mean an eventual ween off the medication and a return to life as normal for Tristan.  But it's still brain surgery which has risks, as low as they are.

We ask for your prayers and your thoughts during this time.

Tristan's initial surgery is on April 10th 2017 at Mayo clinic Rochester.  His followup surgery, the resection itself will be sometime 3 days to 2 weeks after the initial surgery.  Jen, his mom (my wife) will be with him the entire time and meanwhile his brother Nate and myself (Ben, Dad) will be coming and going throughout the process.

I will try to post journey updates as much as possible.

Side note for those wondering how this condition was caused in the first place, to a normal and healthy 12 year old boy:

Sometime near the end of his recovery we found out that his blood work for EBV (the epstein-barr virus) showed he might have had this illness.  EBV is also known as mono and has similar symptoms to what Tristan was experiencing and it was going through his school at the time, so this remains a possibility (actually it's the ONLY possibility since Tristan was tested for dozens of causes for Meningoencephalitis, including genetically causing symptoms such as immune issues).  But we'll never know for sure if EBV was the cause 100% sure since he could have contacted EBV at a prior date and he also received IVIg treatment earlier in his hospitalization which can cloud the results of the EBV test. In any case, EBV has a VERY low chance of causing Meningoencephalitis, but it does happen.  In my opinion as Dad, and the opinion of a couple of this doctors, this is what caused his Meningoencephalitis and the Meningoencephalitis eventually caused the refractory epilepsy condition.  His pediatrician is absolutely convinced this is what happened as is one of his neurologists.  Some are less convinced...  we'll never know for sure.

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Q. My 10-year-old daughter has become unhappy at school over the last few months. She has friends, but they don't seem to act very friendly.

Sometimes, they will decide they don't want to speak to her, often for a very trivial reason. She finds herself alone on the playground and sitting by herself at the lunch table. They have to interact with her in the classroom as they sit near one another and sometimes work in art or craft as a group, but even then they are cold and cutting when they have to talk.

At times, my daughter comes home and breaks down in tears telling me what's happened. I have telephoned the mothers of the two main ring leaders - it's a group of four and the other two are not as bad - and they have been concerned and have told me they will have a word with their girls.

The last time I did this things were better for a few weeks, and my daughter was happy once more. But it has started again. This time she has begged me not to intervene as she says it will make things worse. She is worried she will be accused of being a baby, always crying to mummy.

I have spoken to the class teacher but all she can suggest is splitting up the group in the classroom. She told me that girls often behave like this, and you just have to wait for them to grow out of it.

A. It's true that this nasty behaviour is quite common, but I don't agree that the only strategy is to wait until they get a bit older.

It can last for years, anyway.

Does the school have an anti-bullying policy you can look at? It should do - all schools are required to have one. It will almost certainly cover this, as being unpleasant and unfriendly, and excluding people is a form of bullying.

You might want to talk to the headteacher about ways the policy can be put into practice. Some schools have anti-bullying weeks, or incorporate the policy into the curriculum in different ways.

You can ask your daughter again about calling the parents - I think it's worth a try. Also, help her with strategies for making new friends, so she doesn't rely on these ones for keeping her happy at school.

Q. I have heard of the toddle tantrums, but my daughter is only 14 months and she can already be naughty and stubborn.

She gets an idea into her head and screams and cries to get it - she'll see a biscuit on a plate and want it, and point to biscuits and sweets in shops and cries. People joke I mustn't be feeding her properly! I try not to give in, but I don't always succeed.

A. Your daughter is definitely not too young to have a clear idea of what she wants and how to get it. She can't use words to ask for things so she yells and cries for whatever she feels she needs at the time. Your job is to accept that she is a proper little person with preferences and likes and dislikes - but also to make sure she knows you are the grown up and in charge!

Her screaming isn't being naughty - but it isn't something you should obey either. Your daughter realises the louder she yells, the more easy it is to get her own way.

Instead of giving in say no and distract her with a game, a cuddle, a tickle or a book, and stay calm.


Rhys Lawrey, adventure rider

My idea to travel the world on my motorbike stemmed from my father, who also rides, travels and holds world records. I wanted to share and inspire others. I took the plunge and thought let’s do it – I had nothing to lose. Once I had my mum’s approval, I was off.

My mum was my biggest convincer. I sort of said: “I have something to tell you. I want to ride around the world”. She was stunned but she ended up supporting me, she told me I had nothing to lose, that I was young and to seize the opportunity, so I did.

Travelling the world on a motorbike is a very different experience. I was more exposed to different countries rather than just flying in somewhere. I felt every temperature, every cold and hot breeze, I felt the bumps on the road, I learned which roads were safe and which roads were dangerous. When people realised I had travelled by bike, I was warmly welcomed into every country I arrived in.

No one has done such a thing at my age solo on a motorcycle. The BMW GS motorcycle was the popular choice of bike, however I chose a Triumph Tiger.

It’s really trial and error. I never was an expert rider, an off roader or a racer. It was a jump in the deep end because that was the only way it was going to work, I learned to adapt to any given situation.

I was never threatened, going at a young age, I learned people skills quickly because I had to. I learned common sense, how to judge people and how to respond in different scenarios. When you turn up with a motorbike, I did get looked at in a more welcoming way and I learned to smile. I didn't do tourist things like whipping out loads of money or waving around a fancy camera, I kept it simple and basic.

Loneliness was the biggest challenge. As a young person I was used to going out and socialising whereas I had to get used to going out and socialising with new people every day and after months, it became very tiring.

I feel a lot more mature. Travelling changed my perspective on the world, I can talk to all types of people, I feel more cultured and I’m more open to the world around me.

Living on the road is easy, budgeting is doable especially going to places like central Asia. Food was cheap, I wasn’t paying Western costs. I’m still paying off my trip, but it’s one of those risks I don't regret. I didn't go to university so I didn't take out student loans and instead look at what I did. It’s a huge achievement, that will always be the staple of it all. I’ll probably do smaller trips, I’m always keen for travel by all means.

When my adventure reached its end I felt pure relief. I slept for a minimum of 12 hours every day for the first week. I was ready to come home once I broke the records. I was knackered, broke and speechless, it was one of the most emotional days of my life and it will forever be in my memory.

Rhys Lawrey was 22 when he travelled around the world on a Triumph Tiger 800, from London, to Asia then Australia to Central and North America in 441 days.


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If you’re looking for a simple, yet memorable coverage of just your ceremony, the Basic package is what you need. It will cover your entire ceremony and more. This package is great for park ceremonies, outdoor ceremonies or short ceremonies overall. A typical civil ceremony is between 10-25 minutes long. This means our videographer will have extra time to set up, get some set-up shots (flowers, chairs, trees etc…), guest arrival and mingling, processional and ceremony. All of this extra footage will contribute to a better movie production.

If you’re staying at a nearby hotel and would like some preparation coverage – Deluxe package is a better fit as it includes up to 2 hours of continuous coverage. This, in most situations will give our videographer enough time to film bridal prep, maybe some grooms prep and ceremony. This of course is based solely on your timline and locations. Driving should also be taken into account.

Premium package is a great choice as it offers up to 4 hours of coverage. This is good if your ceremony is followed by a reception with short cocktail hour. In most cases (depending on your timeline) this will give our videographer enough time to shoot your ceremony and the most important parts of your reception, such as toasts, first dance and cake cutting. Premium package also comes with raw footage. This means you get to see and keep all of the footage that didn’t make it to the highlights movie. And believe us, there is usually plenty of that.

Who will be filming my wedding?
Any one of our lead team members. Our lead shooters have at least 2 years of experience shooting with us, besides their previous experiences. They start their journey with us as 3rd shooters, then 2nd shooters and eventually graduate to become lead shooters. They spend the same amount of time editing as much as shooting.

Which package is best for my wedding?

If you’re planning an intimate wedding with a civil ceremony following a short cocktail hour and reception, and only interested in a short, highlights movie of the most important and memorable moments, the Basic package will fit best.

Deluxe package is perfect for a bit more logistically complex situations such as multiple venues. You will have a team of two videographers that can split and cover two events at the same time, for example: brides’ preparation and grooms’ preparation. Or couples photo session and cocktail hour. Having two videographers allows for better coverage and more creative editing, as we end up with more footage, more angles and perspectives. Deluxe package also includes a documentary ceremony edit as well as all raw footage.

The Premium package offers the the same coverage as Deluxe but also includes our award winning feature film edit. The feature film is a masterfully crafted cinematic wedding movie which takes about 6 months to produce. We carefully review all of the footage from your wedding, create a story line based on the ceremony, vows and toasts and put them together to your choice of music. Main feature movies are generally between 15-25 minutes long, depending on the wedding.

Who will be filming my wedding?
Any one (or two) of IQvideography studio members. Our lead shooters have at least 2 years of experience shooting with us, besides their previous experiences. They start their journey with us as 3rd shooters, then 2nd shooters and eventually graduate to become lead shooters. They spend the same amount of time editing as much as shooting. Packages with two videographers include a lead videographer and 2nd shooter.

Please keep in mind that you can customize any of these packages to fit your needs. Just send us an email ([email protected]) and we will be happy to discuss.

Which package is best for me?

This is simple:

Deluxe package offers the most important aspect of our craft – out style of shooting. Let’s face it, you can not make a great movie from crappy footage. With our vision, you will have footage that can be turned into a beautiful main feature movie later on. In the mean time you will enjoy a short highlights movie or SDE (just like the ones on the blog) that we’ll edit for you shortly after the wedding, or better yet, at the wedding. Remember, while the Deluxe package does not include the main feature movie, you are still able to purchase one in the future.

Premium package includes everything the Deluxe has and adds our award winning main feature movie and a documentary edit of your ceremony and all toasts.

Finally, Supreme package comes with the most entertaining option videography has to offer these days: the same day edit. If you’re not familiar, SDE means we will have a short highlights movie ready to play at the reception. Keep in mind, SDE requires 3-4 hours of editing time, so it might not work with every wedding timeline. Supreme package also includes a 3 videographer (someone has to keep shooting while one of us edits your movie) and all raw footage. The whole deal basically.

A La Carte options:

Crane – $1000 requires 3rd shooter/operator

Love Story/Pre Wedding Video – $2500

Main Feature Movie – $2000

Same Day Edit – $1000

Save The Date Video – $750

Super 8mm film coverage – starting at $900

Raw Footage – $500

Destination fee outside of Bay Area – $500

Destination fee outside of CA – $1000

Q:Why do we need two videographers?

A: It’s similar to the way theatrical movies are made. The second camera gets a second angle, a second opinion, another view, another vision and, importantly, more footage which is valuable in the editing and production process. Two videographers help each other with equipment and set-up, saving important time that can be spent on shooting more of your wedding. Two videographers working in tandem create a more complete, more detailed, story of your day.

Q: What is SDE?

A: A same day edit (SDE) is essentially your wedding video, edited on the day of and ready to view at the reception. In my opinion, this is one of the best ways to entertain your guests. The look on their faces when they see you walking down the isle and realizing it just happened a few hours ago, is priceless.
With that said, a same day edit requires a lot of skills and experience. The movie has to be completed before your guests leave and in most cases that leaves us about 3-4 hours hours to edit! Talking about pressure…

Q: What is the main feature?

A: The main feature is a fully edited and produced, 20-40 minute long video that covers your entire wedding day; from the preparation, through the ceremony, to the reception. It includes the most memorable and important parts of the ceremony, the announcement of the new couple at the reception, the first dance, cutting the cake, the toast and so on. One thing to keep in mind that it takes 6-8 months to produce.

Q: What is a Love Story and how long does it take to produce one?

A: A Love Story is a video that we shoot and produce before your wedding. What it contains is entirely up to you, although we have lots of experience and plenty of good ideas to lend should you want them. It can be a story of how you met, how you planned your wedding, your favorite romantic spots, or just the two of you enjoying each other—taking a walk, playing around, dancing, kissing. It takes anywhere from four to twelve hours to film, depending on the story that you want to tell, the locations, and so on.

Q: What is a highlights video?

A: The highlights video is a summary of your wedding day, set to a song of your choice. It includes the most powerful images of your wedding. It’s usually pretty upbeat and energetic, although that depends on the combination of the images and the music that’s chosen. The best part is that it’s small and short and you can share it with anyone online. You can also put in your iPod or iPhone.

Q: What is Save The Date video?

A: It’s a fun and short video to let your guests know the date of your wedding so they can put it on their calendars before you send out your invitations. It can replace a Save the Date mailed announcement or can be in addition to it. We can film a Save the Date video during the engagement or Love Story session, or at another time.

*All prices are subject to CA sales tax


Carrigan G, Whipple S, Capra WB, Taylor MD, Lu M, Arnieri B, Brown JS, Abernethy AP, Copping R, Rothman KJ. Potential for using external control arms derived from electronic health records to replace control arms from randomized controlled trials. Poster presented at the 34th Annual ICPE Conference; August 26, 2018. Prague, Czech Republic. [abstract] Pharmacoepidemiol Drug Saf. 2018 Aug; 27(52):357.

BACKGROUND: The gold standard clinical trial includes a randomized control; however, oncology drug development is increasingly forced to rely on single arm clinical trials. Interpretation of single arm trials can be challenging. Comparison with external controls (EC) may provide context for study findings.

OBJECTIVES: Replicate overall survival (OS) results from multiple RCTs in advanced non‐small cell lung cancer (aNSCLC) using EC groups derived from an electronic health record (EHR).

Design: All Roche aNSCLC RCTs enrolling from 2011 onward were reviewed. Trial selection criteria included sufficient follow‐ up, ≥1 US trial site, and relevant biomarkers captured in both the trial and EC group databases. Trial specific eligibility criteria were applied to the EHR data to form the EC cohorts for each trial. Setting: EC patients were identified in the Flatiron Health (FIH) an EHRderived longitudinal database which reflects cancer care received and patient outcomes. The FIH lung cohort contains aNSCLC patients diagnosed from 1/1/11. Exposures: Various Outcome: The primary outcome was OS, defined as time from randomization (trial pts) or treatment initiation (EC pts) to death. Patients were censored at the end of trial follow‐up, FIH analysis cutoff date (10/31/17), or last contact date. Statistical Analysis: Propensity score (PS) methods were used to adjust for differences between the trial population and EC pts. The Kaplan‐Meier (KM) method was used to estimate survival. Adjusted Cox models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) comparing the trial experimental arms with the EC arms. For each study, HRs and KM plots derived using the EHR EC were compared with the RCT results.

RESULTS: Nine aNSCLC trials met the trial selection criteria. Findings from the first 2 trials showed concordance between the adjusted HR comparing the trial experimental arm with the EC arm with the corresponding RCT HR. For example, trial NCT02008227 reported a HR = 0.79. The estimated HR for the corresponding EC analysis was 0.80 (95% CI: 0.65, 0.98). Similarly, the result within trial NCT01903993 produced a HR = 0.72 compared with the EC derived HR = 0.74 (95% CI: 0.54, 1.00). Results for all 9 trials will be presented.

CONCLUSIONS: For the trials investigated, HR estimates based on the EC group closely matched those from the RCT. Hence, control arms ABSTRACTS 357 derived from contemporaneous EHR data may be useful for interpreting findings on OS from single arm trials in aNSCLC.

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DR. FANTASTIC IN BESLAN Prof. Dr. Robson Barbosa As scenes seen in the town of Beslan shocked the world.

Some events break the paradigms September 11 and the fall of the Berlin Wall are other examples. In Beslan children and adults hostages were used in an unprecedented horror and the facts showed the world that international terror is at an unprecedented escalation. After the tragic outcome came to public a recording of video produced by the kidnappers where we can see them bearing arms, the horror of the hostage and with more emphasis on huge quantity of explosives that had been armed in strategic locations such as proximity to the hostages, the roof of the gym, next to the doors, windows and even the table of the basketball court, the detonators may also be seen at various points up and under the feet of terrorists. At this point we can draw up some comments, the terrorists probably thought out to achieve in life because of that act in scenes appear with the faces covered to prevent identification later, suicide bombers tend to show and even recorded tapes with messages showing up, with the intention to be recognized as heroes and martyrs, well, there was the expectation of an exit with life, what the purpose of such quantity of explosives? One possible answer can be found on the plot of the movie "Dr. Fantastic, "by Peter Selers star. In this movie, what happens during the cold war, an official with psychological problems, commander of a U.S. airbase, orders on its own initiative that their planes bombardeiem the Soviet Union, the intention is to beat the Russians by surprise attack, the High U.S. seeks to control all forms prevent this attack occurred as telling the USSR and collaborating of all forms so that if the aircraft failed to be warned in time and return to base, were overturned. It occurs that an aircraft suffers a malfunction in its communication system and can not receive the notice of return and continues in its mission to the stubbornness that was to be expected. During the tense negotiations the U.S. president considers that "only" an aircraft continued with the attack and that what is not a declaration of war and not even a surprise attack by weight, but the Russian representative announced that the USSR had installed a device called the "machinery of the final judgement" that consisted of a network of sensors that any attack even if isolated, would the immediate firing of all nuclear weapons as a way of counter attack aimed at mutual destruction, it would be impossible to be automatic and avoided. This device had the intention to deter U.S. attacks. However, this trick only makes sense if the opponent knows that it exists, therefore, their effectiveness depends on the idea that an attack would, of course, not a disaster that it is worth, is that the Russians installed the device, but were awaiting a date for the special international notice, and the attack occurred prior to this announcement. As in the film, one hypothesis is that the tape would be released with the intention of preventing an attack by the troops that cercavam the school giving an advantage to the kidnappers, but as in the movie, unexpected events precipitated the tragedy, the escape of some children , The barbarity of the terrorists to atirarem the back, has caused the events to be developed in the saw. The "machinery of the final judgement" came into operation and the result, all witnessed.

Life imitated the art, and as well as in the movie, in Beslam the outcome was a tragedy that the world can not and will not forget, we can only learn and fight for events like this become single events that are not repeated. ________________________________________ The Prof. Dr. Robson Barbosa is a master's degree in administration scholar of international conflicts, Dr. in cooperative security and senior researcher of the core of policy and strategy NUPRI / USP.


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An Innovator’s Necessity: Getting Employees Out of the Box

people in org chart boxesYou don’t think of your employees as a crowd because you have organized them into neat little boxes which fit into larger boxes which interact laterally with other boxes through a few leaders who own the box into which the other boxes fit.  And while that gives us a sense of order and control, what have we lost and how do we get it back?

You and your colleagues are in your box because you have a set of skills and a common focus.  But you have other skills.  You have other interests and passions.  Still, does anyone know about them?  Does anyone in your box or another have a means of engaging you to leverage those skills, interests and passions?

Disengaged worker

The Towers Watson 2012 Global Workforce Study would suggest the answer is “no”.  According to the study, only 35% of employees are highly engaged.  Meanwhile, the 2012 Gallup Meta-Analysis found that companies with high employee engagement significantly outperform those with low engagement realizing 21% higher productivity, 22% higher profitability, 41% fewer defects and 25% to 65% lower turnover.

 So why don’t companies engage their employees?  Among the variety of reasons, one would have to be, because it takes time and effort.  If we engage  employees in solving problems or addressing opportunities, leaders have to filter through the good, bad and mediocre ideas alike to get to the brilliant because no one is brilliant all of the time.

Crowd Sourcing Innovation:
The good news is, the crowd of employees is very good at knowing brilliance when they see it.  They are very good at collaborating and making the good ideas great.  They are great at voting so that the ideas which become brilliant can come to the attention of leadership.  Fortunately today there are tools that enable us to engage employees at scale without the time and effort that would otherwise overwhelm leadership.

Idea Management Systems:
Douglas C. Engelbart’s prophetic 1992 paper “Toward High-Performance Organizations” spoke to the “strategic role for GroupWare”  in “achieving tomorrow’s high-performance organizations.”  Today, notable in this set of GroupWare is the Idea Management System (IMS).  An IMS enables an enterprise to engage employees in an on-line space for collaboration where  employees are challenged to solve the problems and address the opportunities of the enterprise.  The crowd of employees work free of their boxes bringing their unique skills, judgement, expertise and passion to act as a collectively intelligent enterprise.    They create value for the enterprise and customers while creating career opportunities for themselves.

If you want to learn more, Contact Us and follow me on Twitter at Ed Boze @IdeationNation.


From Southeastern Michigan (the suburbs of Detroit), Glitterflies are small, unknown types of butterflies.

Appearance & DescriptionEdit

Glitterflies are small, with dark bodies and orange, yellow-dotted wings. The undersides of their wings are pale that seem to sparkle with glitter.

Respected Cryptozoologist Karl Shuker suggested they could be Atlas Moths, which are "Asian, but are commonly bred in captivity on account of their spectacular appearance and size. Their markings are variable, and the tips of their forewings are semi-transparent, so that in certain lights they glitter." On another occasion, he said, "Also, they are powerful fliers, so it could have travelled quite a distance away from its original escape locality." Others suggest they are a new species of butterfly.


What is ISO?

ISO 9001:2000 certificateThe International Organisation for Standardisation, a standards development body, formed in 1947 with a central secretariat in Geneva, Switzerland. National standards bodies from 148 countries, including developing countries and leading industrial nations are among its members.

ISO external site >>> www.iso.ch

The only school of Prosthetics and Orthotics in the world

CSPO is the only school of Prosthetics and Orthotics in the world to hold ISO 9001:2000 certification for its education programme. ISO 9001:2000 is a set of universally understood and accepted quality practices; a comprehensive set of rules that, if followed, will improve the performance of an organisation. The main goals of the ISO 9001:2000 standard are customer satisfaction and continual improvement.

This has helped us to strengthen our operations and build capacity amongst our staff, ensuring that our work is technically and managerially sustainable. ISO certification gives us a system we can use to continue to improve our work and demonstrates that we are a quality organization, recognized to an international standard.


Our research team runs several related projects studying the cellular and molecular mechanisms involved in the development of axonal connections in the brain. In particular, our aim is to uncover the principles underlying thalamocortical axonal wiring, maintenance and ultimately the rewiring of connections, through an integrated and innovative experimental programme.

The development of the thalamocortical wiring requires a precise topographical sorting of its connections. Each thalamic nucleus receives specific sensory information from the environment and projects topographically to its corresponding cortical.

A second level of organization is achieved within each area, where thalamocortical connections display an intra-areal topographical organization, allowing the generation of accurate spatial representations within each cortical area. Therefore, the level of organization and specificity of the thalamocortical projections is much more complex than other projection systems in the CNS. The central hypothesis of our laboratory is that thalamocortical wiring influences and maintains the functional architecture of the brain. We also believe that rewiring and plasticity events can be triggered by activity-dependent mechanisms in the thalamus.

Three major questions are been focused in the laboratory:

i) the transcriptional control of thalamocortical guidance and topography;

ii) the activity-dependent mechanisms involved in thalamocortical guidance and wiring and

iii) the role of the thalamus and its connectivity in the neuroplastic cortical changes following sensory deprivation.

Within these projects we are using several experimental programmes, these include: optical imaging, manipulation of gene expression in vivo, cell and molecular biology, biochemistry, cell culture, sensory deprivation paradigms and electrophysiology (see Nat Neurosci 15, 1134-43 (2012); J Neurosci 32, 4372-85 (2012); Curr Biol 21, 1748-55 (2011); PLoS Biology 7, e98 (2009), J Neurosci 27, 3395-407 (2007), Cell 125, 127-42 (2006), Nat Rev Neurosci 4, 276-8 (2003). Furthermore, our team has successfully set up the technique of in utero electroporation to specifically target thalamic neurons in vivo.

We expect that the results derived from our investigations will contribute to our understating of how reprogramming of cortical wiring takes place following brain damage and how cortical structure is maintained.

Our research is supported by grants from the Spanish Ministry of Economy and Innovation, and the European Research Council. In the past, we also received funding from the Human Frontier Research Program. Thanks to their support, we have been contributing to understand the mechanisms by which our brain is wired during development.

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Why Wait? Director Ken Marini talks about Quintessence Theatre’s brilliant WAITING FOR GODOT

Quintessence Theatre’s production of WAITING FOR GODOT just closed. Henrik Eger spoke to the director about his background and his experiences directing Samuel Beckett’s classic.

Ralph Malachowski see’s the Pride Night performance of Sam Shepard’s SIMPATICO.

Theater in Sketch: HIR (Simpatico)

HIR (Simpatico): We are all everything


11 Habits You Need To Give Up To Be Happy

1. Worrying about… everything. Worry is the biggest happiness slayer ever. Worry steals all of your attention and gives theillusion that you are working through a problem when you are not. As Van Wilder said, “Worrying is like a rocking chair. It gives you something to do, but it doesn’t get you anywhere.” People worry for all sorts of reasons: to escape reality, fear of the unknown, resistance to change, lack of confidence, etc. Stopping worry, like everything else takes practice; the more you do it, the better you will become at discerning when you are no longer controlling your thoughts and they are controlling you. Tip:To jolt yourself out of worry, ask yourself what you can do “right now” to make your life more pleasant and then do that! 2. Constant, deliberate, people-pleasing. Contrary to what you may think, saying “yes” to every request that is made of you is not nice. First, it is not nice to you because it can leave you emotionally, mentally and physically drained. And second, it is not nice to the other person, because it deceives them into thinking that you have the time, energy and otherresources available to make what they want happen, when you do not. Generally people who carry out the duties of others at the expense of themselves have low self-esteem and high levels of unhappiness. They need the approval of others to make themselves feel worthy. Tip:To combat people-pleasing behavior, learnto say “no.” Oftentimes when you say “no” to someone else, you are really saying “yes” to YOU. 3. Procrastinating. Procrastination is stagnation. There is no other way to say it. When you procrastinate, nothing good in your life is happening. We procrastinate for all sorts of reasons. When we are afraid of the outcome, we are unsure how to complete the task and when wejust don’t feel like taking action. And the thing is, we spend more time aggravating ourselves with worry about how long or how difficult the task is going to be rather than just doing it. More often than not, if you just start your task, you will be pleasantly surprised at how easily you are ableto accomplish it. Tip:When you feel yourself getting ready to procrastinate, silently say “stop” to yourself, refocus and begin again by taking calculated action that will lead to the results you desire.(Read Getting Things Done.) 4. Living in the past. The past is gone for good and yet we spend so much time thinking about what happened yesterday, at the complete expense of today. Keeping your thoughts stuck in the past is especially detrimental to your contentment. You are a product of your environment. Your environment has helped to shape how you think and feel about yourself. Everyone has been presented with life challenges along their journey – you aren’t alone. It is whether you are stuck in the patterns of the past or have moved past them. Tip:If you are harboring resentment, anger, frustration or other negative feelings from your past, don’t ignore these feelings. Do something constructive about itso that you can move into the present. 5. Always looking past the present moment in anticipation of the next. We spend so much time in this moment, wanting to be in the next one, that we are missing our lives. For example, while taking a shower, you mightbe thinking about that cup of coffee you want to make, and while you are drinking your coffee, you might be thinking about your commute to work. You are never consciously present right where you are and therefore cannot enjoy the moment you are in – the moment we call “life.” Tip:Now is the only time you have. Now is life.Make sure you are fully experiencing it. 6. Judging others. When you judge someone else, you suffer. It is an outward display of inward inferiority and anger. No one person is better than another. The individual who cleans the bathroom at a fast food restaurant is no less of a person than the CEO that uses it. Tip:Understand that we are all part of the collective human race. We are one. Your joy is my joy and your suffering is my suffering.(Read Buddha’s Brain.) 7. Comparing your story to everyone else’s. It is good to notice what others are doing from time to time. After all, that is what helps us outline what we want and don’t want in our own lives. But comparing yourself to everyoneelse every step of the way takes it too far. Youknow when this happens – when you stop living your dreams or start living theirs. Tip:You are unique. No matter how hard you try to be like someone else, you will never be them, and you shouldn’t want to be. 8. Shame. Shame is a deep, debilitating emotion, with complex roots. Its cousins are guilt, humiliation, demoralization, degradation and remorse. After experiencing a traumatic event, whether recent or in the distant past, shame can haunt victims in a powerful and often unrecognized manner. Shame impairs the healing and recovery process causing victims of trauma to stay frozen, unable to forgive themselves for being in the wrong place at the wrong time. Shame leaves victims with feelings of sadness and pain at the core of their being. They are unable to feel the fullness of joy in their lives. If you feel any shame at all, acknowledge it upfront. Decide to experiment on forgiving yourself and letting go of the shame. How long can you go without reminding yourself about the shameful thoughts and feelings? How would life be different or better if you were able to forgive yourself? Who can you talk to about this? Tip:The more you forgive yourself, the more time you have to focus your mind on happier times. 9. Disorganization and laziness. We complain that there are not enough hours in a day to accomplish all that we want, yet our laziness often leads us to many wasteful hours of disorganization. The discipline it takes to sort through a messy desk, counter, closet or mind take time. Becoming organizedis a habit. Start with something small, like your office desk or even making your bed afteryou get up. Tip:Studies have shown that people who maketheir beds are statistically more productive, profitable and peaceful in their lives and careers. Interesting, isn’t it? But not surprising. 10. Fear of… everything. Fear is one of the biggest reasons why we don’t move ahead in our lives. Fear of failing and fear of succeeding. Fear of the unknown. Fear of fear. As long as we are alive, we are prone to some level of fear. Ironically, to feel alive we must overcome that fear with action. As Bill Cosby once said, “Decide that you wantit more than you are afraid of it.” Tip:Courage is not the absence of fear, but rather the judgment that your happiness and growth is more important than it. Do something every day that stretches your comfort zone and helps you face what your fear.(Read Daring Greatly.) 11. The need to be busy. Busyness is often confused with productivity. They are two different things. Busy is running in place on a treadmill; productivity is actuallygetting somewhere worthwhile. These days technology gives us this constant feeling that there is so much to do and not enough time to do it. We are always connected to something that wants our attention, or something that could be done. This feeling creates stress. The more behind you think you are, the more stressed out you are going to feel. Stress is not good for you. It makes it difficult to think, connect with others and it is associated with a plethora of physical ailmentsthat lead to unhappiness. Tip:Stop trying to be busy. Put first things first and give up the rest. Organization, meditation, improved time management and efficiency and a change in perception are all ways to manage stress. You must learn to let go. Release the excess. You were never able to do it all anyway. (M&A).

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Chemistry lab write up

Textbooks, the lab manual, AND CURRENT JOURNALS should be consulted. The "references" section is for items which you "footnote" in the text. WEB PAGES SHOULD NOT BE USED (with the exception of the online versions of printed materials) as they are neither static nor peer-reviewed. MANY OF YOU HAVE NEVER USED ANYTHING OTHER THAN GOOGLE FOR RESEARCH UP TO THIS POINT IN YOUR EDUCATION... THAT IS VERY SAD. GOOGLE DOES NOT PROVIDE AN EXHAUSTIVE EDUCATIONAL OR SCIENTIFIC SEARCH. Online research can be useful in locating reference data, but caveat emptor- the base source should be cited and you should verify that the material you are citing is actually in the base source . (ie- How you found the source is irrelevant, but claiming that "the internet said the info was in that source" when the information is not, or the source doesn't exist or is incorrect, is a great way to get your paper rejected.) An "articles consulted" or bibliography section may be included for reference materials you used but which you do not directly reference in the text of your report, though this is nonstandard . The references should be in the following format, per The ACS Style Guide . Please note that different journals have different standards- there is no universal agreement on reference format, but you should use ACS format. If you don't want to buy the book, the references section is available online for free (as of 9/2011).

Chemistry lab write up

chemistry lab write up

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Condos: Why It is Better to Live Closer to The City

When your traditional house with the white picket fence was introduced to people, it was advertised as a great location for you to avoid the noise and traffic from the city and a tranquil place for you and your family to live. It was shown as a great place to have your family and raise them because it provided a better and safer environment as opposed to the chaos of the city, and it did work. People started moving towards the suburbs and having a house there was considered to be a strong indicator of success and prestige. However, now that many decades have passed, a lot of young people today no longer see the appeal of owning a house in the suburbs, and have instead, voluntarily started living in the city.

They choose to stay in apartments, and if they happen to be interested in permanent property ownership, opt for condos instead since they happen to be located close to and around the city as well. In fact, condos have become so popular, you will see a number of new condos in Toronto being launched every year.

Living closer to and in the city has a lot of advantages, the most obvious one being that you do not have to spend over an hour every day commuting back and forth from work. So, you end up saving a lot of time, and a lot of fuel as well because you do not have to drive as much. In fact, you can easily just take public transport and reduce the need for having a car in general. Lastly, you end up saving yourself from a lot of emotional disturbance since the amount of stress that would accumulate from driving long distances will no longer be there.


Aria Pullman

Aria Pullman is an American musician and songwriter based out of East Los Angeles. Growing up on a hippy farm in Upstate New York, Pullman credits those roots for her love of crafting songs. Pullman’s vocals have been compared to Karen O, Radiohead and Stevie Nicks. She is currently the frontwoman for the dream-pop duo Some Go Haunting, who released their full-length record “Wandering Souls” in 2015. She also co-writes for the band Mondo Cozmo who will be releasing their much anticipated EP early 2017.


Institute/Issuers Authentication Process

Firstly I wasn’t able to figure out if there already exists a process for adding yourself as an institute or an issuer of certificates in this project. Secondly, If such a process does exists how is it possible to authenticate an institute/issuer to avoid fake certificate issues.


Art by Katie Loyd

Laurence Claxton is confused.  For 6 months now he has wandered the countryside becoming increasingly detached from reality.  He fluctuates between periods of revelatory spiritual enlightenment (during which he believes in the certainty of his salvation) and times of crushing despair when he is paralysed by the certainty of his assured damnation.

His appearance reflects his state of mind(s): his attire, ostensibly that of a dandy (all fine black silk and velvet), shows signs of serious wear, being soiled, threadbare, and torn.  He has not washed in months.

He will be courteous (to the point of fawning) or foul-mouthed and loathsome, and there is a chance (1 in 6 with whatever modifiers the DM deems appropriate) he will attack the PCs on sight.

If encountered he will approach the PCs and attempt to engage them in a spiritual debate (even if he has already attacked them).  The slant of his argument will depend upon his current psychological state (50% chance he is assured of salvation or damnation).  He will offer to join the party and can be added as a henchman for no charge.  He acts as a level 2 Cleric (give him 9hp and something useful like Cure Light Wounds) but the party will incur a penalty of -2 on all attempts to move quietly and to all CHA-based checks due to his strange (and loud) behaviour.

Each PC must pass a CHA check every day; failure means Claxton’s ranting drives that PC (or PCs) to attempt to murder him, with the associated implications for alignment etc.

Assume he’s wearing the equivalent of leather armour, and that he’s carrying a medium weapon (whatever suits your milieu – I’d suggest a rapier and flintlock pistol).


Deconstructing Voting Behaviour – Didier Eribon

At Room for Discussion we will engage in a discussion about voting behaviour, populism and the future of the left. Why do people vote in the first place? And which factors determine whether someone votes to further their own self interest or in line with their idea of an ideal society?
The last decade has seen populist parties on the rise all across Europe and their success does not seem to come to a hold. How can we explain the support that this movement seems to gain across different social strata? What are the factors fuelling the populist outcry amongst the population?
During the 20th century there was a clear cut distinction between parties on the left and on the right of the political spectrum. Further, there was a clear voter base of the left – namely the working classes. Since we see this notion of the traditional working class fade away, how can people at the lower ends of our economies unite and fight for their rights in a globalised economy? And how can the parties that we consider “left-wing” today reconstruct a coherent narrative and gain back political support?
These and more questions will be discussed at Room for Discussion on Thursday, March 22nd!
Our guest will be Didier Eribon, a renowned French author and philosopher and Professor of Sociology at the University of Amiens. He is well known for his biography of Michel Foucault, which has been praised as “the best biography of Foucault” by Le Monde. Further, he has written numerous other books such as Insult and the Making of the Gay Self. His latest work, Returning to Reims (which became a bestseller in Germany and has just been translated into Dutch) assesses how class, sexual identities and one’s social environment influence people’s voting behaviour. The book is a sociological study of the the working classes analysing their voting patterns (from voting for Communist Parties to the Nationalist Parties, e.g. the Front National).

Room for Discussion is made possible by


Claudia Toscano on being a Scrum Master for a team of Agile Coaches

You’d think that a team of Agile Coaches understands the importance of facilitation. However, that’s not always the case. In this episode we explore how a team of Agile Coaches went through the process many teams go through: from no facilitator, to an external Scrum Master and …

Listen it to learn what happened next.

About Claudia Toscano

Darryl Sherborne and the Reporting Hell that many Scrum Masters need to face, and overcome

As more traditional companies adopt Scrum, we – the Scrum Masters – are in a particularly tough position. We need to bridge the old world, and the new reality of Scrum. In the old world (PRINCE2, PMI, IPMA Project management, etc.) there were reports. And lots of them. In Agile we believe that the only measure of progress is “running, tested software”. How do we combine the two?

In this episode we talk about how Darryl faced, and ultimately adapted to that reality.

We mention the white paper by Maarit Laanti and Rami Sirkiä about Lean and Agile Financial Planning (PDF Download), which describes a new way to account for software development in the financial planning and tracking of your company.

About Darryl Sherborne

Joanna Koprowicz on the pressures teams suffer and how a Scrum Master can help

When the deadlines approach, there’s a lot of pressure on the teams. It’s understandable that there is pressure, but why does that happen when the software the team produces often waits for weeks before being put in production or released?

What is a Scrum Master to do in these situations? Listen in while we discuss the pressures teams suffer, and what are the alternatives we have to help organizations and teams through that easy temptation to pile on more pressure

About Joanna Koprowicz

Maximilian Fritzsche: from minute-level plans for Retrospectives, to being more open to what is really needed

Max’s first Retrospective was an exercise in the limits of planning. He shares with us how he prepared for that, and ultimate how it all failed. From that failure, however, came an important lesson that he still applies today.

Listen in to learn what Max learned about effective retrospectives after the failure despite the detailed plan for his first retrospective.

About Maximilian Fritzsche

You can link with Maximilian Fritzsche on LinkedIn.

Abbas Ghahremani on the impact of individual rewards on the Scrum Master role

The way we reward people for the work they do, directly impacts how they act. In this episode we explore the impact of an individual reward system on how Abbas acted, and what he learned from that situation.

We explore motivation, relationships and most of all, the systemic impact of the reward systems we create in corporate environments.

About Abbas Ghahremani

Andrew Hudson how to find your groove as a Scrum Master

After a successful assignment with one team, Andy moved on and started work with a new team. However, things were not as easy, or as simple as he expected. In this episode we talk about how every new team is a new experience, and we need to find our groove, rhythm and approach as Scrum Masters, to ensure that we are not surprised by the differences between teams and contexts.

Learning to adapt to new organizations, and new teams is a key skill for Scrum Masters and we discuss how we can do that.

About Andrew Hudson

Gilberto Urueta: how to overcome the “new guy” syndrome as a Scrum Master

When we start our role as Scrum Masters in a new team, sometimes we suffer from the “new guy” syndrome. The new guy is the person that everyone tries to tolerate, but mostly ignore. That’s what happened to Gilberto. How can a Scrum Master recover from “new guy” syndrome in a hierarchical culture? Listen in as we discuss the process with Gilberto.

In this episode we refer to the interview with Karin Tenelius where we discuss a new approach to management of self-organized teams.

About Gilberto Urueta

Zeshan Ilyas on learning about and removing fears we face as Scrum Masters

Agile adoption is a process that can create fear in the organization. Not the least of which because it changes team composition (from component and functional teams to cross-functional teams). How do we identify the fears in the organization and address them may be the difference that makes Agile succeed or fail.

About Zeshan Ilyas

David Spinks: facing failure as a Scrum Master is a key part of the journey

When we start our journey as Scrum Masters, we are not only learning something that is new to us, but we are also learning something that is new to everyone else. Scrum is new, even in it’s 20 or so years of life, there’s not been time to develop enough knowledge to claim a “definitive body of knowledge about Scrum”. Therefore, learning something that is yet undefined is a critical part of our journey as Scrum Masters.

Despite that realization, it is common to feel “we” are the failure, when in fact, we are just learning a new art. In this episode we discuss the impact of failure in ourselves, not just our learning, and we touch on how to bring the insights that Scrum helps uncover to the rest of the organization.

About David Spinks

Jem D’jelal and the temptation of taking on the Product Owner role as well as the Scrum Master Role

As an unlikely Scrum Master Jem went through a journey of adapting to a new industry, and a new role. In his eagerness to bring value to the organization and teams he worked with he focused on taking on more responsibility. But is that a good idea? What happens when the Scrum Master also takes the Product Owner role? Listen in as we discuss the anti-pattern of the Scrum Master that is also the Product Owner.

About Jem D’jelal


Professor Krishna Palepu and Dean Nohria. Birds of a Feather

Professor Palepu is the Ross Graham Walker Professor of Business Administration at Harvard Business School. He also was a Senior Associate Dean at the Harvard Business School for several years, overseeing the school's research, and its global initiative. Ironically, he has also been quoted often for his views on corporate governance.

We have already properly introduced Dean Nohria. What connects Dean Nohria and Professor Palepu? They both have been key players in serious cases of insider trading and corporate malfeasance but still manage to be employed and adored at Harvard Business School. Let us explain. Professor Palepu was the key figure in the biggest corporate fraud case in India’s history. Prof Palepu was found guilty and fined $430,000 for his role as an independent director in the Satyam scandal. Yet he still teaches at Harvard and is often quoted regarding cases of corporate governance. What gives? How about Dean Nohria?

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Mr. Palepu played a major role in the biggest fraud cases ever in India’s history. He was found guilty and fined $430,000 for his part in the Satyam scandal.

In an email to the Tata Group board (Nohria is a Tata board member) former Tata Group Chairman, Cyrus Mistry stated, “I have often presented to the trustees, before and after Tata Sons board meetings. This created alternative power centers without any accountability or formal responsibility, invalidating the very governance role of nominated directors, who I would assume would use their own independent judgment and discharge their fiduciary duties, were reduced to mere postmen. As an example, once, the trust director (Nitin Nohria) stepped out of a Tata Sons board meeting in progress that too for more than an hour, keeping the rest of the Board waiting, in order to obtain instructions from Mr. Tata. Such a work pattern has also created the added risk of contravening insider trading regulations and exposed the Trust, apart from exposing the trustees to potential tax liabilities. These circumstances forced me to circulate a note on corporate governance in order to clarify the distinct roles of Tata Trusts, Tata Sons Board, and the Boards of the operating companies”.

Independent directors are paid to protect shareholder interests. Dean Nohria has his PhD in Corporate governance. How can he and Professor Palepu continue to be looked to as experts in the field of corporate governance after having committed these acts? Alumni and students need to demand an explanation especially as Dean Nohria is being seen as the new President of Harvard.

And what about Harvard? What is the University doing to explain or justify their continued employment at Harvard? Are there any policies in place?

Governing external behavior or engagements for profit? Mike Milken, the respected inventor of ‘junk bonds’ who was later jailed for insider trading, ever be allowed to represent our University regarding ethics unless he, at the very least, addressed and admitted his wrongdoing?

One thing is clear, we need to adhere to a code of ethics at such a prestigious institution or our brand will remain up for sale globally.

An example of Harvard being sold out is in the case of Professor Nohria becoming Dean of Harvard Business School. Dean Nohria was named Dean 2 months after Tata donated $50 million to the school. Shortly thereafter Tata appointed Dean Nohria as a Tata Director. A glaring conflict of interest that no other university would allow. In a similar case Professor Palepu was found guilty similar conflicts of interest and insider trading and was fined a much higher amount than other directors on the board of Satyam for his role. Why did Harvard not do anything?

It would not be a surprise to have Prof. Palepu now canvassing and lobbying for Dean Nohria’s elevation to the President’s Post.

It’s time Harvard drafted and enforced a code of conduct for Professors and Deans who serve as company consultants and board members. If any member lends his name to a board, (s)he is also lending the name of Harvard, and should be made more accountable. Similarly, in cases of corruption or unethical behavior they should be debarred from the pious Academic institution.

Will Harvard act against people like Professor Palepu or Dean Nohria?

If Dean Nohria becomes the President of Harvard, do we expect he will enforce ethical standards? It’s like a cat amongst pigeons. Irreparable damage is being done. It is time to align our efforts to safeguard Harvard’s reputation.


Sailor Malan: a Battle of Britain Pilot

The unique skills and command of Adolph ‘Sailor’ Malan resulted in No.74 Squadron’s numerous victories during the Battle of Britain. What were the secrets to this success and how has his legacy stood the test of time?

Battle of Britain Day

The afternoon of aerial combat that destroyed the Luftwaffe’s morale and became the day that sealed Britain’s victory of the Battle of Britain

The Battle of Britain: Timeline

From the day the order to attack the RAF was given, to the British victories of September and October 1940: follow the events of the Battle of Britain.

From Lawrence to the Taliban

Liar and self-promoting charlatan? Or military genius and romantic revolutionary? Dr. Neil Falkner explores T E Lawrence’s relevance to contemporary warfare.

Why did Boudica lose?

The future of Britain for 350 years decided in minutes: the last stand of Britain’s warrior queen.

A Hurricane Pilot's Dramatic Story

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