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Last updated: September 4, 2018.
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https://www.stamfordadvocate.com/sports/highschool/article/Baseball-Games-to-watch-Fine-Performances-13786662.php
Baseball: Games to watch/ Fine Performances
By Scott Ericson
Published 7:16 pm EDT, Monday, April 22, 2019
Hand's Phoenix Billings celebrates after tagging out a runner at third base at Ledyard High School on Thursday, April 18, 2019. (Pete Paguaga, Hearst Connecticut Media)
GAMES TO WATCH
Ansonia at Wolcott, Wed. 3:45 p.m.: Both NVL teams enter the week with one loss.
Wethersfield at East Catholic, Wed. 3:45: CCC is loaded at the top of the standings and these are two of the best, both having won 5-in-a-row entering the week.
Southington at Bristol Eastern, Wed. 3:45 p.m.: Another matchup of one-loss CCC foes.
Waterford at Amity, Wed. 4 p.m.: Waterford's only loss is to Hand, now they take another shot at the SCC.
Cheshire at Hand, Wed. 4 p.m.: Doesn't get much better in mid-April than two top-10 teams going at it.
St. Joseph at Westhill, Wed. 4 p.m.: When they are sorting out playoff spots in May, who wins games like this matters.
Bethel at New Fairfield, Wed. 4:15: Two teams trying to establish dominance atop the SWC standings.
Ridgefield at Darien, Fri. 4 p.m.: Never know how pitching matchups will work out, but let's cross our fingers we get a matchup up of D-1 arms in this one.
Thomaston at Lewis Mills, Fri. 4 p.m.: One of the best rivalries in the Berkshire League picks back up.
FINE PERFORMANCES
Phoenix Billings, Hand: Junior went 3-for-3 with a walk and a go-ahead home run as the Tigers knocked off No. 1 Ledyard.
Ken Turner, Ledyard: Senior struck out 15, throwing 75 of 90 pitches for strikes as the Colonels beat previously unbeaten Montville 4-2.
Tanner Belcher, Notre Dame-West Haven: Went 5-for-5 with 3 RBIs as Green Knights rallied for 15-10 win at Law.
Ricky Torres, Ansonia: Senior threw a complete game 3-hit, 5-strikeout shutout on just 76 pitches in a 5-0 win over rival Derby.
Christian Hardiman, Warde: Hit a walk-off 3-run home run for The Mustangs, knocking off No. 10 St. Joes 13-12 after trailing by 5 heading into the bottom of the seventh.
Julian Stevens, Amity: Homered, doubled and had 3 RBIs for Amity in a 7-1 win against Foran.
Jack Carraturo, Bethel: Struck out 12 and allowed just 4 hits over six innings of work in a 13-3 win over Notre Dame-Fairfield. He also went 2-for-3 at the plate with a double and 3 RBIs.
Matt Garbowski, New Fairfield: Hit two home runs, a grand slam and 2-run homer, in a wild 15-10 win over New Milford.
Zach Merchant, Law: Took no-hitter into fifth inning, finishing with a 1-hitter and six strikeouts in a 15-0 run-rule win over Career.
Chad Knight, Staples: Pitched complete game 3-hitter with 9 strikeouts, also driving in the game's only run in 1-0 win over Trumbull.
Zach Samson, Guilford: Took a no-hitter into the seventh inning and ended up with a one-hitter in a 6-0 victory over Branford.
Jimmy Evans, St. Joseph: Senior threw a complete-game, 3-hitter with 10 strikeouts in 7-2 win over Wilton.
Wyatt Mills, Abbott Tech: Struck out 15 batters while pitching a complete game in 6-2 win over Kaynor.
Arthur Cordes, Sheehan: Junior lefty struck out 11 over seven innings of work in a 1-0 victory over Cromwell.
— Scott Ericson


CACI 4101 Failure to Use Reasonable Care—Essential Factual Elements
4101 Failure to Use Reasonable Care—Essential Factual Elements
[Name of plaintiff] claims that [he/she/nonbinary pronoun/it] was harmed by [name of defendant]'s breach of the fiduciary duty to use reasonable care. To establish this claim, [name of plaintiff] must prove all of the following:
1.That [name of defendant] was [name of plaintiff]'s [agent/stockbroker/real estate agent/real estate broker/corporate officer/partner/[insert other fiduciary relationship]];
2.That [name of defendant] acted on [name of plaintiff]'s behalf for purposes of [insert description of transaction, e.g., "purchasing a residential property"];
3.That [name of defendant] failed to act as a reasonably careful [agent/stockbroker/real estate agent/real estate broker/corporate officer/partner/[insert other fiduciary relationship]] would have acted under the same or similar circumstances;
New June 2006
The instructions in this series are intended for lawsuits brought by or on behalf of the principal. They also assume that the plaintiff is bringing a legal cause of action, not an action in equity. (See Van de Kamp v. Bank of America (1988) 204 Cal.App.3d 819 [251 Cal.Rptr. 530].) This instruction is not intended for cases involving insurance brokers or agents.
In appropriate cases, element 3 may be tailored to reflect the particular fiduciary duty at issue.
For a breach of fiduciary duty instruction in cases involving attorney defendants, see CACI No. 4106, Breach of Fiduciary Duty by Attorney—Essential Factual Elements.
While the advisory committee has not included "employee" as an option for identifying the defendant agent in element 1, there may be cases in which certain employees qualify as "agents," thereby subjecting them to liability for breach of fiduciary duty.
•"A fiduciary relationship is ' " 'any relation existing between parties to a transaction wherein one of the parties is in duty bound to act with the utmost good faith for the benefit of the other party. Such a relation ordinarily arises where a confidence is reposed by one person in the integrity of another, and in such a relation the party in whom the confidence is reposed, if he voluntarily accepts or assumes to accept the confidence, can take no advantage from his acts relating to the interest of the other party without the latter's knowledge or consent. …' " ' " (Wolf v. Superior Court (2003) 107 Cal.App.4th 25, 29 [130 Cal.Rptr.2d 860], internal citations omitted.)
•"An act such as breach of fiduciary duty may be both a breach of contract and a tort." (Kangarlou v. Progressive Title Co., Inc. (2005) 128 Cal.App.4th 1174, 1178 [27 Cal.Rptr.3d 754], internal citation omitted.)
•"Breach of a real estate agent's fiduciary duty to his or her client may constitute negligence or fraud, depending on the circumstances of the case." (Salahutdin v. Valley of California, Inc. (1994) 24 Cal.App.4th 555, 563 [29 Cal.Rptr.2d 463].)
•"Breach of fiduciary duty is a tort that by definition may be committed by only a limited class of persons." (1-800 Contacts, Inc. v. Steinberg (2003) 107 Cal.App.4th 568, 592 [132 Cal.Rptr.2d 789].)
•"Traditional examples of fiduciary relationships in the commercial context include trustee/beneficiary, directors and majority shareholders of a corporation, business partners, joint adventurers, and agent/principal." (Wolf, supra, 107 Cal.App.4th at p. 30, internal citations omitted.)
•" 'The relationship between a broker and principal is fiduciary in nature and imposes on the broker the duty of acting in the highest good faith toward the principal.' " (Twomey v. Mitchum, Jones & Templeton, Inc. (1968) 262 Cal.App.2d 690, 709 [69 Cal.Rptr. 222], internal citations omitted.)
•"A stockbroker's fiduciary duty requires more than merely carrying out the stated objectives of the customer; at least where there is evidence, as there certainly was here, that the stockbroker's recommendations were invariably followed, the stockbroker must 'determine the customer's actual financial situation and needs.' If it would be improper and unsuitable to carry out the speculative objectives expressed by the customer, there is a further obligation on the part of the stockbroker 'to make this known to [the customer], and [to] refrain from acting except upon [the customer's] express orders.' Under such circumstances, although the stockbroker can advise the customer about the speculative options available, he or she should not solicit the customer's purchase of any such speculative securities that would be beyond the customer's 'risk threshold.' " (Duffy v. Cavalier (1989) 215 Cal.App.3d 1517, 1538 [264 Cal.Rptr. 740], internal citations omitted.)
•"Real estate brokers are subject to two sets of duties: those imposed by regulatory statutes, and those arising from the general law of agency. … 'The existence and extent of the duties of the agent to the principal are determined by the terms of the agreement between the parties, interpreted in light of the circumstances under which it is made, except to the extent that fraud, duress, illegality, or the incapacity of one or both of the parties to the agreement modifies it or deprives it of legal effect.' " (Carleton v. Tortosa (1993) 14 Cal.App.4th 745, 755 [17 Cal. Rptr. 2d 734], internal citations omitted.)
•"In order to plead a cause of action for breach of fiduciary duty against a trustee, the plaintiff must show the existence of a fiduciary relationship, its breach, and damage proximately caused by that breach; the absence of any one of these elements is fatal to the cause of action. The beneficiary of the trust has the initial burden of proving the existence of a fiduciary duty and the trustee's failure to perform it; the burden then shifts to the trustee to justify its actions." (LaMonte v. Sanwa Bank California (1996) 45 Cal.App.4th 509, 517 [52 Cal.Rptr.2d 861], internal citations omitted.)
•"Recovery for damages based upon breach of fiduciary duty is controlled by Civil Code section 3333, the traditional tort recovery. This is actually broader in some instances than damages which may be recovered for fraud. Also, punitive damages are appropriate for a breach of fiduciary duty." (Michelson v. Hamada (1994) 29 Cal.App.4th 1566, 1582 [36 Cal.Rptr.2d 343], internal citations omitted.)
•"While breach of fiduciary duty is a question of fact, the existence of legal duty in the first instance and its scope are questions of law." (Kirschner Brothers Oil, Inc. v. Natomas Co. (1986) 185 Cal.App.3d 784, 790 [229 Cal.Rptr. 899], internal citation omitted.)
•"[I]n actions against fiduciaries, a plaintiff may have the option of pursuing either legal or equitable remedies." (Van de Kamp v. Bank of America (1988) 204 Cal.App.3d 819, 863 [251 Cal.Rptr. 530].)
•"A minority shareholder's action for damages for the breach of fiduciary duties of the majority shareholder is one in equity, with no right to a jury trial." (Nelson v. Anderson (1999) 72 Cal.App.4th 111, 122 [84 Cal.Rptr.2d 753], internal citations omitted.)
3 Witkin, Summary of California Law (11th ed. 2017) Agency and Employment, § 70
10 California Forms of Pleading and Practice, Ch. 103, Brokers, § 103.31[2] (Matthew Bender)
37 California Forms of Pleading and Practice, Ch. 427, Principal and Agent (Matthew Bender)
Miller & Starr, California Real Estate 4th, § 3:26 (Thomson Reuters)


Home The Trumpet News
Oguntade commends progress in Epe
Nigeria's High Commissioner to the Court of St. James's – H.E. Retired Justice George Adesola Oguntade CFR, CON; has commended the "tremendous progress in Epe," and urged all to "Let us stand first as Nigerians."
Three convicted for fatal stabbing of David Bello-Monerville
Three men have been convicted at the Old Bailey for their roles in a violent fight that resulted in the fatal stabbing of David Bello-Monerville in north London. Read more
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4 Nov 2020 12:37 News
Black Britain and Beyond explores the meaning of Black Britishness
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21 Oct 2020 11:17 News
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Before joining policing, Eva worked in IT. At the time, she knew she wanted to do something that felt more rewarding and coincidentally, the police were holding an open evening for candidates from ethnic minority backgrounds. Eva said: "I went along Read more
17 Aug 2020 08:03 News
Victims of domestic abuse reminded #YouAreNotAlone
The government of the United Kingdom is reminding victims of domestic abuse that police response and support services remain available for victims and their children during the coronavirus pandemic through the ongoing #YouAreNotAlone initiative. Read more
10 Jun 2020 16:22 News
Pictures: Ade Omoloja
Protests against George Floyd killing at US Embassy
Protesters gathered at the United States Embassy in London and across the country, to demonstrate against the brutal killing of George Floyd in Minneapolis in the United States of America. Read more
8 Jun 2020 14:52 Ade Omoloja News
Appeal to find missing teenager
Police are urging the public to assist in finding 15-year-old Christopher Ugwu who resides in Harold Hill, Essex. Christopher suffers from Autism and may display behaviours of an eight-year-old. Read more
23 May 2020 09:17 News
Double tragedy as Nurse loses husband and son
Detectives continue to appeal for information following the fatal stabbing of 24-year-old David Gomoh. David's family were already reeling from tragedy, following the recent unexpected death of David's father from a COVID-19 related illness. Read more
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Claims of death of COVID-19 vaccine volunteer - Elisa Granato, are false
Claims about the death of Europe's first human volunteer in the trial of a potential COVID-19 vaccine - Elisa Granato, are false. In a tweet, Granato said: "Nothing like waking up to a fake article on your death... I'm doing fine everyone. Read more
26 Apr 2020 16:26 Femi Okutubo News
Boris Johnson: Stay at home
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23 Mar 2020 22:51 News
Man convicted after pushing woman from balcony
A man has been convicted of committing grievous bodily harm with intent after pushing an 18-year-old woman over a fourth floor balcony. 19-year-old Yusef Ali was found guilty of section 18 grievous bodily harm, affray and possession of an offensive Read more
5 Feb 2020 07:55 News
Fraudster and drug-dealer jailed
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Whistl and One World Express to offer tracked postal service from 220 countries
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Dr Titus Odedun celebrates son's accreditation as Consultant
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Govt orders release of Dasuki and Sowore
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Catalog > Photo & Video > Adobe Lightroom > Making Books In Lightroom > Building A Book
Making Books in Lightroom
Lesson 5 of 10
Building a Book
These are the images that we want to make a book with all the way down to there and we're going to then create a book by coming in here to our auto layout we want to make a proof book so we've already set up our constraints is how we want to do it and we're gonna auto lay it out so I'm gonna hit auto layout and it's just building a book right now and done and do you see what we did now we've got a see how it's got like all these random different styles so that is because I obviously started changing my layout and so it it did random random versions of it so it's four on this one and one on the air to on this one and so it kind of did its own style so I'm gonna clear that book again and we're going to try it again but we're going to go set this thing up again so we're gonna do a four up I think this one will work better and we're gonna know that one's not gonna work either. I think I messed it up when I was showing him so let's go back to our our proof book at it lay out and we're going...
to re edit this so that you can this will actually be good for you to sing, so we're going to go to four photos and we want them to be for photos like that and then on this one, we want four photos and we want four photos like that and we want to fit and we're going to add our text area and we're going to use the grey centered text and we're going to hit save and we're gonna call this preset for up vertical, I think I know why it did it because we're making a vertical proof book instead of a horizontal so freaked out because I was had this built for a horizontal okay, but that's good. So now we've got that and we're gonna hit auto lay out, see how it's building an auto layout see that so all of our images air getting auto laid out for up and once it's done there they are, so if we kind of scan up and we'll see the page here and we're going to zoom in on that page, you can see that I've got a nice per book of four images per page laid out nicely with the image number underneath ready to go easy enough, right and so that's really simple like ok, you made approved book, you made a contact sheet, but I made it in a book and so now all I have to do is go up to the top and I need to make a I didn't make cover so when I make the cover I simply doubleclick the cover and it opens up let me show you this really down in the tool bar you have three views, you have the grid view, you have this spread view and you have the individual image or page view so in this spread view I get to see the entire spread and at that point I can then grab an image and drag it to replace this image and now that's the front cover instead I can also decide to you know, take this image and just delete it so that we just have a white page in the background. I can also come into the cover here because it knows it's a cover and so if I come to the cover over here on the right hand side now remember, we've just talked to the auto layout that's a ce faras we've gone some now we're in the page view area and inside the page view area I have ah whole bunch of different options for different types of pages. So now we come into our templates these air covers only so I can click on here and say, I want to cover toe look like this so now it's just laid it out so that there's text area here there's text area here there's text area here and then there's room for one image here. So, let's, do you know this one right here? So then we dragged that one. And now see how auto filled number eighteen there, because that's, what we told it to do whenever I had a picture auto fill with the the file name. So at this point, now, we can say little angels, and here we could say, little angels.
Photo books can be used as a portfolios, client proof books, personal travel logs, children's books, or as gifts. Learn how to design one in Making Books in Lightroom with Jared Platt.
Jared will take you through the process of designing and printing your book in an organized and efficient way. You'll learn how to use all of the tools in the Adobe Lightroom Book Module – from typesetting to custom page design. Find out how fast and simple publishing your book can be.
Software Used: Adobe Lightroom 5
The Tactile Effect of Photo Books
Getting to know the Book Module in Lightroom
Auto Layout Preset Editor
Learn about working with Auto Layout and setting preferences for making photo books in Lightroom.
The Importance of Setting Book Preferences
Changing Text Attributes
Adding a Page in LR Books Module
Creating Custom Layout
How to Add Your Logo to Your Book
Reviewing the Book Module
pedro ariza
Concrete and clear, Worth it!


Simon Bailey MMath BFP FCA CTA
Simon is committed to assisting his clientele with their business and tax affairs and has extensive experience with farming companies, Solicitors and other professional practices, including Audits under the Solicitors' Accounts Rules.
After studying his Master of Mathematics, Simon joined Burgess Hodgson in September 2002, putting his natural proficiency with numbers into practise, qualifying with first time passes as a Chartered Accountant in November 2005. He qualified as a Chartered Tax Adviser in May 2011, and was made an Associate in the same year, before being invited to join as a member of the LLP in April 2016.
Simon lives in Herne Bay with his wife and two children. He is a keen golfer and snooker player and plays 5-a-side football and cricket for the firm when time allows.
Email: SJB@burgesshodgson.co.uk
Master of Mathematics from the University of Warwick
Fellow of the Institute of Chartered Accountants in England and Wales
Chartered Tax Adviser
Certificate in Wills, Probate and Estates Administration
Charities to get sympathy treatment?


Teen Dating Violence Awareness - National Resources
Alianza, the National Latino Alliance for the Elimination of Domestic Violence, addresses the needs of Latino/a families and communities.
Anti-Violence Project based in New York City, The Anti-Violence Project (AVP) provides an extensive range of services, programs and initiatives, including such as crisis intervention, counselling, community advocacy as well as national technical assistance.
Asian & Pacific Islander Institute on Domestic Violence is a national resource center and clearinghouse on gender violence in Asian American, Native Hawaiian and Pacific Islander communities.
Casa De Esperanza mobilizes Latinos/Latinas to stop domestic violence and leads the National Latin@ Network for Healthy Families and Communities.
Corporate Alliance to End Partner Violence is a national nonprofit organization dedicated to reducing the costs and consequences of partner violence at work – and eliminating it altogether.
FORGE delivers monthly training webinars and monthly fact sheets designed to increase providers' knowledge of transgender people and issues, and to improve their ability to provide respectful and culturally-competent care to survivors of domestic violence, dating abuse, sexual assault, and stalking.
The Gay Men's Domestic Violence Project is a grassroots, non-profit organization founded by a gay male survivor of domestic violence and developed through the strength, contributions and participation of the community.
Institute on Domestic Violence in the African American Community focuses on the unique circumstances of African Americans as they face issues related to domestic violence.
Men Can Stop Rape pioneered a novel way of looking at the epidemic of violence against women, dispelling the myth that it is solely a women's issue.
National Center for Victims of Crime works with individuals, families and communities harmed by crime to help victims rebuild their lives.
National Center on Domestic and Sexual Violence provides training to adult professionals on how best to incorporate abuse intervention and prevention into their work.
National Network to End Domestic Violence brings together all state coalitions against domestic violence and other stakeholders to foster an environment in which violence against women no longer exists. They also provide information on staying safe from technological stalking and abuse.
National Resource Center on Domestic Violence hosts many valuable initiatives including the VAWnet Resource Center and the Women of Color Network.
The National Resource Center to End Violence Against Native Women is a Native nonprofit organization addressing domestic violence and safety for Indian Women.
The Network La Red is a survivor-led, social justice organization that works to end partner abuse in lesbian, gay, bisexual, transgender, BDSM, polyamorous, and queer communities. They strengthen these communities through organizing, education, and the provision of support services.
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The Pennsylvania Coalition Against Rape (PCAR) is working to eliminate all forms of sexual violence and advocate for the rights and needs of victims of sexual assault. To that end, they host RYOT Against Rape and Teen Esteem for youth.
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Dan Snyder's Not Happy
No, I do not equate the Dan Snyder Era in Washington DC with the Third Reich (remind me to tell you my family history one day). And yes, there are a million variations of this Hitler meltdown scene out there. I just think this one is superb.
As a Redskins fan it's so funny it hurts.
Eagles vs Redskins: Random Reactions
Eagles 27
Redskins 17
Yuck.
Some day-after reaction, shotgun-style:
Can I get you all to raise your right hands for a second?
Everyone who reacted to Eagles WR DeSean Jackson's 67-yard end-around TD romp up the left sideline less than two minutes into the game last night by turning to whoever you were watching with and saying, "Game" ... please put your hands down.
Okay, now those of you who turned to whoever you were watching with when QB Jason Campbell's deflected pass/INT went the other way for an Eagle touchdown to put the Redskins down 14-0 before the end of the first quarter, please put your hands down.
Due respect, some of you with your hands in the air aren't being honest.
Each and every time I see WR Antwaan Randle El go back to field a punt these days (muff or no muff), as another season slips away, and WR Santana Moss, CB DeAngelo Hall and even WR Devin Thomas stand idly on the sidelines, I get more irritated.
With an understanding nod to Redskins Official Blogger Matt Terl—having written for Redskins.com for three seasons myself, I am well acquainted with the fine line he has to walk—no, the playcalling thing with Sherman Lewis was not a debacle. Unfortunately, that's rather like pointing out that the trees in the Fire Swamp are really quite lovely.
Here's to the day Redskins fans can once again celebrate something good happening ... not just failing to be as godawful as it might have.
So I'm trying to figure out how to spell the admittedly derisive, disgusted involuntary snort/guffaw I seem to be making more and more often during games these days. The one I made—suspecting I'm not alone here—last night when the Redskins botched the fricken SNAP on fourth-and-goal.
Here's the best I've come up with so far:
"Kchnmpt!"
Meh. Not satisfying in print.
No, the defense is/was not the problem. That said, unless I've overlooked something the last defensive touchdown scored by the Washington Redskins came back in the late Cretaceous. In Game 4 of the last season of Gibbs II, Oct. 7, 2007, CB Carlos Rogers (oh irony) returned an interception 61-yards with less than a minute left in the game to put the exclamation point on a 34-3 romp over the hapless Detroit Lions at a rocking FedEx Field.
For those keeping score, that was 2161 game minutes, or 36 games ago.
As to the last meaningful defensive touchdown—one that made a difference in the outcome of a game—I have not completed my research yet. Meanwhile, if anyone has that information at hand, please feel free to share.
S LaRon Landry must suck at pool.
It's pretty clear where the problem areas lie, be it reflected in the latest unsurprising loss or the general direction of the organization at large.
In no particular order ... neglected for a decade, the offensive line was/is a predictable failure, the game moved/moves too fast for the erstwhile Franchise Quarterback, the Official Brain Trust has been/remains in over its collective head and ... oh never mind.
Nine to go.
Strength, my friends. There will come a day.
Redskins '09: Dead Team Walking
By the end their embarrassing week three loss to the Detroit Lions, a team doing its best to threaten the expansion Tampa Bay Buccaneers' all-time NFL futility standard, it was becoming clear the 2009 Washington Redskins were not going to contend for a championship.
By the end of their stultifying, belly-up week six loss to the Kansas City Chiefs, winless in 2009 and losers of 28 of their last 30 coming in—compounded by the Redskins brass' knee-jerk reaction to humiliate Head Coach Jim Zorn, "strongly suggesting" he cede playcalling duties to a man five years removed from the game, living out of a suitcase and (presumably) still busy learning the names of the players he will be directing this weekend—it was clear the 2009 Redskins were not only going to fail to make the playoffs, but have a chance to go down in history as the single most embarrassing Redskins team in the storied history of the franchise.
That isn't hyperbole. There is more to being a "bad team" than taking up regular residence on the wrong end of the scoreboard. Every team goes through hard times. The pendulum inexorably swings. Eras come and go. But few modern sports franchises have wandered as far off the reservation as the 2009 Washington Redskins in such vital areas as professionalism, direction, accountability ... basic competence.
There are a million earnest opinions out there as to why and how this train wreck came to pass; even more about what ought to be done about it. What I keep coming back to this week, however, is exactly how emotionally invested fans of this team will approach the long remainder a lost campaign.
With the competitive part of the season realistically over, just six weeks in, what exactly does a passionate fan of this team watch for? How does he view each game, each month, the totality? It isn't like we are in week thirteen and there are just three meaningless "playing out the string" games left. There are ten games left—an NFL eternity.
Now before you get upset with me, oh positive and ever-faithful burgundy and gold aficionado, for the record, yes, I recognize there could still be a midnight call from the governor.
Perhaps newly installed playcaller Sherman Lewis will find a rhythm and rapport with Jason Campbell that will at long last allow / motivate / cattle-prod the strong-armed young quarterback to throw the damn ball on time.
Maybe mercurial running back Clinton Portis will look in his hall closet for a new antihero outfit or pithy Monday-after quote, and instead find the step he lost two years ago.
Perhaps rumored young pass-catchers Malcolm Kelly, Devin Thomas and Fred Davis will have epiphanies, understand they are not facing Oklahoma St., Purdue or Stanford this weekend, and finally dial it up to NFL speed.
Maybe star-crossed Jim Zorn will discover that in not calling plays, he gets a fuller sense and feel for the flow of the NFL game from a head coach's perspective, "figures it out" and emerges as a top-flight NFL sideline leader.
Perhaps grumpy old man defensive coordinator Greg Blache will decide, "hell, only ten weeks left before Miller Time; think I'm gonna just turn the dogs loose." What's the worst that could happen ... the Redskins could lose?
So yeah, it's possible. It could happen.
Just don't hold your breath.
What seems far more likely that the 2010 Washington Redskins will hit the field next September with a new head coach, new coordinators and position coaches, new offensive and defensive schemes, a new quarterback, a new lead running back and other skill position players, a revamped linebacker corps ... perhaps even a reworked offensive line and—a man can dream—front office structure.
So what will this fan do with the next ten weeks? I know one thing I won't do: With the sea changes sure to come, watching this year's team for indicators of future success is next to meaningless.
On the aforementioned Malcolm Kelly, to name just one of many possible examples ... if the Redskins were going to be heading into Year Three of Zorn/Campbell Era next year, Kelly's development the rest of this year would be highly pertinent. If next year brings a new system, new coach/coordinator, quarterback, line, etc., as seems likely, how Kelly fares in this modified West Coast Offense, triggered by Campbell or Todd Collins (and called by Sherman Lewis or whoever else is handed a headset between now and then), could mean absolutely nothing.
But I am going to watch the games. Why? Quite possibly because I'm a fool. I'd like to think, however, it's because I'm a fan—it's what we do. And because, be they championship-caliber, well-oiled machine or broken-down heap of scrapmetal, they remain my Washington Redskins.
One good thing about getting (a little) older is that perspective—not to mention vision—changes.
When I squint (or drink) enough, truth is I can still "see" Lombardi and Jurgensen on the RFK sidelines.
I can "see" George Allen and this Over the Hill Gang overachieving, kicking Dallas' ass in the '72 NFC Championship Game, on their way to a date with destiny and the only undefeated team in modern NFL history.
I can "see" Dexter Manley steamrolling Danny White in the '82 NFC Championship Game, and John Riggins sloughing off Don McNeal on his way to Super Bowl immortality.
I can "see" Doug Williams throwing ropes through, over and around the Denver Broncos in what remains the greatest football high of my life ... the magic and madness that was the second quarter of Super Bowl XXII.
I can "see" the overwhelming machine that was the 1991 Championship team, the culmination of the once-in-a-lifetime fusion of men and circumstance orchestrated by young football genius that was Joe Gibbs.
For those of us who have watched the cartoonishly inept Redskins offense of recent vintage, the words of venerable SI writer Rick Telander, describing that offense after it dismantled the Detroit Lions 41-10 in the NFC Championship are particularly poignant ...
A gigantic Redskin-red farm machine, a shiny, newfangled thresher with zillions of arms and gears fully hydraulic, with AC, AM-FM radio, CD player, tinted glass, the works—methodically rolling up and down a field, ripping something silver and blue to pieces. At the wheel sits quarterback Mark Rypien, and every now and then he peers out of the cab, adjusts the toothpick in his mouth, sees all is well and turns up the volume on the rap version of Hail to the Redskins.
And yes, I can also "see" the precipitous fall from grace that followed Gibbs' retirement after the '92 season, and the steady descent into mediocrity, irrelevance and now embarrassment that has befallen this proud franchise ever since.
This coming Monday night my favorite team will hit their home field under the national TV lights, and will in all likelihood get rolled by a Philadelphia Eagles team that does possess underlying organizational competence. The difference in the two programs will be stark, and particularly painful to those of us old enough to remember a time not that long ago when it was the burgundy and gold that set the standard for NFL professionalism, class, competence and their inevitable byproduct—success.
My instincts may be conflicted at times. In the privacy of my own darker moments, I will probably find myself thinking that the Redskins should just go ahead and get blown out, finish the year 2-14, and have things spiral so preposterously out of hand that owner Daniel "I Seriously Don't Care What You Think—I'm 44 Years Old And Own The Washington Frickin' Redskins" Snyder finally finds it in himself to do what every thinking person outside of the Executive Suite at Redskins Park knows has to be done ... swallow his pride, subsume his ego and turn operation of his favorite asset over to someone qualified for the job.
But I also know that during those few hours when the game is being played, I will be unable to really wish for a loss. It would go against everything I have spent a lifetime building ... an unyielding, if sorely tested, desire to see "my" team, wearing "my" colors, do itself proud.
So for ten more gamedays I will squint at the men currently wearing those colors, pretend they care about them as much as I do, and hope for a taste of victory.
Then I will turn the page and steel myself for the purge.
Because unless the gridiron gods are truly just toying with us, and plan to snap Their fingers on our behalf very soon, what I will be watching for the remainder of 2009 is not so much a team, but a bunch of guys, staring down a long cold prison corridor toward a certain fate ... and the phone lines are down.
Dramatic? Sure. But dammit, some of us still care.
Posted at 12:18 PM 2 Comments
What Redskins Fans Know
If you haven't read this piece from my dear friend and BGO partner John "Boone" Jeffries, may I humbly suggest you should.
Nobody does it better.
"The fans don't know. They think they do. But they don't."
These were the words of a Redskins bigwig during a meet and greet over more than a few drinks 6 years ago. The staff of another burgeoning Redskins site had been invited up to Landsdowne Resort in Ashburn to discuss a possible relationship. I was lucky enough to tag along for the ride, and get a glimpse at the views of a man behind the man running an NFL franchise.
Over and over we heard the same thing, categorically, emphatically, knowingly, smugly.
'The fans don't know. They think they do. But they don't'
Bigwig's point was (beyond fans being glorified idiots who lack the sheer brain power to comprehend such weighty matters as managing an NFL team) that fans lack the insight, wisdom, and information needed to have a viable opinion.
His example (he only had one that I recall) was the departure of Champ Bailey. While fans felt the front office was stupid, perhaps even irresponsible trading a Redskins Pro Bowler and DC icon like Bailey for some systems back in Clinton Portis, Bigwig begged to differ. Bailey (per Bigwig) had gotten into some naughty business which the wife was understandably none too fond of. According to our man, Bailey was told, he'd either find a new team in a different city to play for, or he'd be looking for a new wife. We fans were too stupid to have considered factors like this, Bigwig smugly informed us.
And he had a point. We don't know these players, coaches, or key players. We really don't know the details of their lives, the daily dynamics of their existence, or the inner-workings, politics, and relationships within the Redskins organization.
But we're a hell of a lot smarter than Bigwig thinks. We might be smarter than a lot of those who hush their voices and appear busy at Redskins Park when he walks by. We might even be smarter than some of them he's helped hire.
Lets take a look at what we fans did know...
Jason Campbell, Speed, Defense & Hope
Some general, getting-back-in-the-saddle thoughts, heading into the second quarter of a dispiriting start to the 2009 Redskins season:
The game is still moving too fast for Redskins QB Jason Campbell. On the rare occasions he drops, reads and throws on rhythm, he's pretty good—not Aikmanesque in accuracy, but certainly NFL caliber. Problem is, Jason doesn't throw on rhythm very often.
Whether the offensive line gives him time or not, he is pretty much always a beat late, or even worse, has developed a dangerous habit of pulling the ball back down, double-clutching and starting to drift in the pocket. The young quarterback's distinct lack of progress—and, arguably, regression—in his second year in Jim Zorn's offense has been the 2009 season's biggest disappointment to date.
I had hoped to see more team speed on display this year, an area in which the Redskins have been sorely lacking for years. I haven't seen it .
Offensively, the Redskins look slow from the time they break the huddle to the time the whistle blows each play dead.
WR Santana Moss has great speed but doesn't get the ball in space often enough to show it.
Sophomore WR's Malcolm Kelly and Devin Thomas don't get the ball at all.
Pro Bowl TE Chris Cooley gets open, catches well and is a deceptively good open field runner, but couldn't outrun a congressional health bill.
Veteran RB's Clinton Portis and Ladell Betts are efficient at best, plodding (by NFL standards) at worst. The "speed back" option the team entered the offseason looking to add turned out to be one RB Anthony Aldridge ... who has yet to see the ball.
The starting offense is running in sand.
On punt returns, the potentially dynamic three-headed monster of Antwaan Rangle El (4 returns, 8.8 avg., long of 15, NFL rank: 23), Santana Moss (2 returns, 2.5 avg., long of 4, NFL rank: 48) and DeAngelo Hall (no returns) has effectively pulled its own teeth, opting to use Randle El's admittedly good hands to make safe fair catches, regardless of field position or game situation.
While the result has limited negative plays, it has also bypassed a major opportunity to put pressure on the opposition and give Redskins playmakers, sorely missing in action, a few more chances a game to touch the ball and actually make plays. On an offensively challenged team, this strikes me as a serious oversight.
Oh, and one of my favorite Redskins "character guys," RB Rock Cartwright, bless his heart, continues to field kickoffs, run straight upfield into the pile, and fall down. Love ya Rock, but geez.
The same frustrating pattern we have seen over the past few seasons from the Gregg Williams/Greg Blache defensive philosophy has emerged again, despite lip service paid in the aftermath of DT Albert Haynesworth's arrival, that the scheme would be tweaked in 2009 to allow more aggressive upfield pass rushing.
The reality through four weeks is that the team still cannot pressure the passer ... partly due to the bizarre decision to use the sole true speed rusher on the roster, rookie DE Brian Orakpo, as a run-stopping SAM linebacker, and the limited opportunities afforded promising rookie DE Jeremy Jarmon.
But mostly, what this observer has seen is the same thing that has been the case for the past few seasons—the NFL has long since figured out the Williams/Blache pass rushing scheme.
The linemen are not aggressive or effective going upfield, be it by design (directed to stay in their lanes at all costs), physical limitations or both.
And if anyone can remember the last time a Blache-schemed blitzer came free up the middle for a cheap sack and even (gasp) the occasional resulting forced turnover or even momentum-swinger, as other teams seem to do week in and week out, please let me know.
I may still have it on tape somewhere and could go back and relive it come bye week.
Pretty negative stuff, I admit. But, given the expectations (again), it's hard to get excited about a team pretty damn lucky to be 2-2 and struggling mightily to field an offense that can even be deemed NFL competent.
Hope remains, however ... squarely on the shoulders of two men, Jason Campbell and Head Coach Jim Zorn.
Campbell could still have a "Eureka!" moment. The light bulb could still come on and the game could still slow down, allowing Jason to see the field and make his throws when they're supposed to made, to the guys they're supposed to go to, in the spots the twain are supposed to intersect.
I'm just not counting on it. Until I see otherwise, I'm 98% convinced the nice young gentleman has maxed out.
The second man, therefore, is Head Coach Jim Zorn. He's the only guy in Washington (this side of owner Dan Snyder, who I know some of you are convinced will do so himself) who can pull the trigger and sit Campbell down in favor of the only other option at the moment, veteran Todd Collins.
That Zorn opted not to pull Campbell at halftime last week against the Buccaneers, with his quarterback conjuring echoes of Heath Shuler, was a bit stunning given his team was looking at 1-3 ... trailing arguably the worst team in the league by ten points at home, his offense was ten games into the highly dubious streak of not scoring a first-quarter touchdown, was averaging less than 15 points a game, and, candidly, was well on its way to redefining NFL awfulness.
Campbell did have a brief stretch in the third quarter when he looked like a pretty good NFL quarterback, however ... which is why I'm holding on to the missing 2% noted above.
He seemed to catch a spark, throwing two TD passes to rally the team to a lead ... but then promptly handed the momentum, good vibes and potentially the game back to the moribund Bucs with an awful interception—his third of the day. Had they had a quarterback, we would in all likelihood be talking today about a 1-3 team looking a whole lot like Chuck Wepner after his brief dance with destiny.
The short third quarter renaissance did show one thing clearly, though, and that's the impact real NFL-level quarterbacking has on not just on an offense, but an entire team and the thousands watching.
When Campbell hit Moss on the 59-yard TD bomb to take the lead the entire Redskins universe—from the owner to the coaches to the players on both sides of the ball to the fans—were uplifted, energized, rocking.
That is what a big-time NFL quarterback brings to a team in the 2000's. And it's the single most glaring missing ingredient—as it has been for many, many years—keeping this team from breaking out of the rut they've been in so very long.
We saw The QB Effect not that long ago in the 2007 stretch run. Campbell went down, and an offense that had been stuck in neutral, and an entire team (at 5-7) that had lacked energy, focus or synergy in a fading season suddenly caught fire, won four straight in impressive fashion and stormed into the playoffs. There are those convinced the reason for the surge was the tragic death of S Sean Taylor.
With respect, I have never agreed.
Todd Collins was, and is, no superstar—he was not and is not the kind of QB who can put a team on his shoulders. But he was, in 2007, and may well still be, a steady, smart veteran who can read the field, get rid of the ball quickly, efficiently and accurately, and jump start a unit stuck in neutral.
In short, he was, and may well be, everything I'm afraid we have seen Jason Campbell is not .... at least not today, not in this "modified West Coast Offense" he appears so miscast running. This offense isn't about arm strength, it's about timing, savvy, precision.
So I will watch Campbell hit the field Sunday against the Carolina Panthers, hopeful as always this will be the week he turns it around ... but expecting to see what I have seen over the past couple of years—a gifted athlete with a big arm and decent mobility, struggling to orchestrate an offense badly suited to his strengths. A quarterback who does not process the field fast enough, and is, as a result, holding his team back.
I don't buy into the argument you don't bench your starting quarterback for fear of ruining his confidence. If my starting quarterback can't or won't take a benching as a challenge and come back chewing nails, ready to show me the error of my ways, and instead sulks and lets it get the best of him ... I don't want him as my quarterback anyway.
But, I fully expect to watch Jim Zorn, for whatever reasons he might have, continue to hang his own head coaching career over the precipice, unwilling to "make the move" to Collins. Even if only temporarity ... and even if for no other reason that to see if he can breath life into an offense currently bereft of speed, pace, rhythm, dynamism, success.
I would dearly love to write a humble pie entry next week, however, so please, gentlemen ... feel free to prove me wrong. I'll be big enough to admit it.


Vertebral compression fractures after spine irradiation using conventional fractionation in patients with metastatic colorectal cancer
Radiat Oncol J. 2014;32(4):221-230
Radiat Oncol JJournal ArchiveRadiat Oncol J. 2014;32(4)
Publication date (electronic) : 2014 December 30
doi : https://doi.org/10.3857/roj.2014.32.4.221
Woo Joong Rhee, MD, Kyung Hwan Kim, MD, Jee Suk Chang, MD, Hyun Ju Kim, MD, Seohee Choi, MD, Woong Sub Koom, MD
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.
Correspondence: Woong Sub Koom, MD, Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-8116, Fax: +82-2-312-9033, mdgold@yuhs.ac
Received 2014 May 20; Revised 2014 September 08; Accepted 2014 September 25.
To evaluate the risk of vertebral compression fracture (VCF) after conventional radiotherapy (RT) for colorectal cancer (CRC) with spine metastasis and to identify risk factors for VCF in metastatic and non-metastatic irradiated spines.
We retrospectively reviewed 68 spinal segments in 16 patients who received conventional RT between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of an existing fracture. The target volume included all metastatic spinal segments and one additional non-metastatic vertebra adjacent to the tumor-involved spines.
The median follow-up was 7.8 months. Among all 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0% respectively, compared with 5.2% and 4.7% for segments without prior irradiation or pre-existing compression fracture, respectively (both p < 0.05). The 1-year fracture-free probability was 87.8% (95% CI, 78.2-97.4). On multivariate analysis, prior irradiation (HR, 7.30; 95% CI, 1.31-40.86) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52) were independent risk factors for VCF.
The incidence of VCF following conventional RT to the spine is not particularly high, regardless of metastatic tumor involvement. Spines that received irradiation and/or have pre-existing compression fracture before RT have an increased risk of VCF and require close observation.
Keywords: Spinal neoplasm; Compression fractures; Spinal fractures; Radiotherapy; Colorectal cancer; Risk factors
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females, with over 1.2 million estimated new cases worldwide per year [1]. Among more than 2,500 CRC patients in Italy, approximately 10% had bone metastasis and spinal segments were the most common site of bone metastases, with an incidence of 65% [2]. Radiation therapy (RT) is thought to be an important palliative treatment modality for spine metastasis. Although conventional RT is traditionally the standard of care for palliative treatment of spine metastasis [3,4,5,6], spine stereotactic body radiation therapy (SBRT) is an emerging treatment option for patients with spine metastasis [7,8].
With the increased use of SBRT, the occurrence of vertebral compression fractures (VCFs) after SBRT has become an important issue. Memorial Sloan-Kettering Cancer Center (MSKCC) reported the first data on VCFs, demonstrating that 27 VCFs developed in a total of 71 spinal segments (39%) after SBRT [9]. The MD Anderson Cancer Center (MDACC) subsequently reported similar findings of 25 VCFs in 123 spinal segments (20%) treated with SBRT [10].
The Spine Oncology Study Group (SOSG) introduced the Spinal Instability Neoplastic Score (SINS) criteria to predict the stability of metastatic vertebral segments [11]. The SINS criteria consist of six components: location, pain, bone lesion, radiographic spinal alignment, vertebral body collapse, and posterolateral involvement of spinal elements. SINS class is determined by the sum of the component scores, and ranges from 0 to 18. A score of 0 to 6 denotes class 1 (stable), 7 to 12 denotes class 2 (potentially unstable), and 13 to 18 denotes class 3 (unstable). Researchers at the University of Toronto evaluated not only the incidence and risk factors of VCF after SBRT, but also the validity of SINS criteria [12]. However, there are no clear data on VCF development after conventional RT, which is still commonly used in real practice.
In this study, we aimed to determine the incidence of VCF after conventional RT for CRC with spine metastasis. In addition, we investigated the risk factors for VCF in both metastatic and non-metastatic irradiated spinal segments. Lastly, we evaluated the role of SINS criteria as an additional predictive factor for VCF in metastatic irradiated spinal segments.
1. Patient selection
We retrospectively reviewed 98 spinal segments in 24 patients who were treated with conventional RT between March 2009 and October 2012. All patients were diagnosed with CRC with spine metastasis and had more than 6 months of clinical follow-up. Spinal segments that had a fracture event within the 6-month follow-up period after RT were also included in our study cohort. This study included not only the metastatic vertebra, but also all non-metastatic vertebra involved in the RT volume even if they had pre-existing fractures. Patients with a double primary cancer, a diagnosis of osteoporosis, and those who were receiving bisphosphonate therapy were excluded. Spinal segments that had previously undergone surgery or a procedure related to vertebral stability, or were treated with SBRT, were also excluded. After patient selection, our final cohort consisted of 68 spinal segments in 16 patients.
2. Treatment and evaluation
All patients were treated with conventional RT. The target volume included all metastatic spinal segments and one additional level of non-metastatic vertebra adjacent to the tumor-involved spines. We evaluated the latest computed tomography (CT) and/or magnetic resonance image (MRI) scans that were taken before planning to determine target volume. The total dose and fractions were determined depending on the patient's performance status and presence of pre-existing fracture and/or irradiation history. Patients with good performance status were treated with 30 Gy in 10 fractions (n = 52 segments) and patients with poor performance status received either 20 Gy in five fractions (n = 5) or 8 Gy in one fraction (n = 3). For patients with pre-existing fracture or a previously irradiated spine in the RT field, a lower fraction dose was used as follows: 25 Gy in 10 fractions (n = 5), 30 Gy in 25 fractions (n = 2), and 45 Gy in 25 fractions (n = 1).
Pretreatment evaluation of vertebral status was performed by planning CT and diagnostic CT/MRI studies. A VCF was defined as the development of a new VCF or fracture progression in a previously fractured vertebra after irradiation. Fracture progression was defined as more than a 20% reduction in vertebral body height; the same definition was used in MDACC study [10]. In addition, we used CT images to distinguish the type of bone lesion (lytic, blastic, or mixed). MR images were examined to determine paraspinal extension, vertebral body collapse, and posterior element involvement. Both CT and MR images were used to determine the degree and presence of vertebral compression fracture and spine alignment. Development of VCF was identified by follow-up imaging studies (CT or MRI), which were performed at 2- to 4-month intervals. Every vertebral segment with a metastatic lesion was scored according to SINS criteria. We also evaluated the primary tumor pathology, body mass index (BMI), total dose, fractional dose, and use of chemotherapy. Information on general patient characteristics (i.e., age, sex) and presence of pain was collected from medical records.
3. Statistical analysis
All factors were compared by the Fisher exact test. In addition, these factors were also analyzed with logistic regression analysis. Time-to-event data were calculated in months from the start date of RT to the date of the event or last imaging follow-up if there was no fracture event. Fracture- free-probability (FFP) was analyzed using the Kaplan-Meier estimation method. The log-rank test was used for univariate analysis to compare FFP for each potential risk factor. The multivariate Cox proportional hazards regression model was used to determine the associated effect of potential risk factors that were identified as significant factors on univariate analysis. For all analyses, statistical significance was determined by a p-value <0.05.
The median follow-up duration was 7.8 months (range, 4.9 to 47.1 months). Among 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Patient and treatment characteristics are summarized in Table 1. The median age was 60 years and seven of the 16 patients were male. Among the total 68 spinal segments, 42 vertebral segments (61.8%) showed metastatic involvement, 10 (14.7%) had prior irradiation, and four (5.9%) had pre-existing fracture.
The observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0%, respectively, compared with 5.2% for those without prior irradiation history and 4.7% for those without pre-existing compression fracture (p < 0.037 and p < 0.002, respectively) (Table 2). The use of chemotherapy during RT and each chemotherapy regimen (data not shown on table) were not related with the development of VCF. After logistic regression analysis, pre-existing compression fracture (p = 0.002) and prior irradiation (p = 0.028) were confirmed as risk factors for VCF. The 1-year FFP was 87.8% (Fig. 1A). The median time to VCF after RT was 5.65 months (range, 4.9 to 8.9 months). In univariate analysis of risk factors for VCF, prior irradiation (p = 0.015), pre-existing compression fracture (p < 0.001), fractional dose less than 3.0 Gy (p = 0.004), and total EQD2 less than 32 Gy (p = 0.006) were identified as significant factors (Fig. 1B, 1C). Multivariate analysis revealed prior irradiation (HR, 7.30; 95% CI, 1.31-40.86; p = 0.024) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52; p = 0.001) as significant risk factors for VCF (Table 3).
Risk factors for vertebral compression fracture in all spines (n = 68)
Fracture-free probability (FFP) according to various risk factors. (A) Total irradiated spine. (B) With or without prior irradiation to total spine. (C) With or without pre-existing fracture in total spine. (D) FFP according to the Spinal Instability Neoplastic Score (SINS) class.
Significant risk factors for vertebral compression fracture in univariate and multivariate analysis
Among the 42 metastatic spinal segments we observed five VCFs (11.9%), including two new VCFs and three fracture progressions (Table 4). The rate of VCF in vertebral segments with prior irradiation history was 33.3%, compared with 6.1% for those without prior irradiation history (p = 0.003). After logistic regression analysis, no component was confirmed as the risk factor for VCF. The 1-year fracture-free probability was 84.4%. The mean and median time to VCF after RT was 6.7 months and 6.2 months, respectively (range, 5.1 to 8.9 months). Univariate analysis confirmed the significance of prior irradiation history (p = 0.031), and pre-existing compression fracture (p < 0.001). Multivariate analysis also demonstrated that prior irradiation (HR, 33.34; 95% CI, 1.77-630.48; p = 0.019) and pre-existing compression fractures (HR, 23.13; 95% CI, 1.56-342.81; p = 0.022) were significant risk factors for VCF (Table 3).
Risk factors for vertebral compression fracture in metastatic spine (n = 42)
Among the components of SINS criteria, vertebral body collapse (p = 0.003), SINS classification (p = 0.039) were identified as the significant predictive factors for VCF development in this study (Table 5). However, there was a trend towards more frequent fractures at the junctional spinal level than at other levels. Furthermore, spines with bilateral posterior element involvement showed more fractures than those with no involvement or unilateral posterior element involvement. Finally, SINS class showed statistical significance for an increased development of fractures in metastatic spines by univariate analysis (p = 0.002), but failed to show statistical significance in multivariate analysis (Table 3, Fig. 1D).
SINS criteria in metastatic spine (n = 42)
Pain symptoms were reported in almost all of the patients that received palliative RT (14/16). After irradiation of these 14 patients, pain reduction was reported in 12 patients (85.7%); consisted of 7 partial reductions (50.0%) and 5 complete reductions (35.7%). After development of VCF, fracture-induced pain was observed in five vertebral segments with a total of six VCFs and consisted of two cases of pain aggravation and three cases of development of new pain. In addition, two cases of spinal cord compression with weakness in both legs occurred and were successfully treated with decompressive surgery (Fig. 2, Table 6). There were 2 cases of tumor progression until the development of VCF among all spinal segments with fracture event, consisted of one metastatic spine and one non-metastatic spine. Vertebral segments with VCF events are summarized in Table 6.
(A) A newly developed vertebral compression fracture (VCF) in the T3 vertebral segment at 4.9 months after irradiation with 25 Gy in 10 fractions. There were no meta static lesions, prior irradiation, or pre-existing fractures before radiation therapy. Upper back pain and weakness in both legs were observed after VCF and were successfully treated by decom pressive laminectomy (case 6 in Table 6). (B) VCF progression was observed in the L5 vertebral segment at 8.9 months after irradiation with 30 Gy in 10 fractions. This ver tebral segment had a metastatic lesion and pre-existing fracture. Lower back pain and weakness in both legs were observed after VCF and were successfully treated by de compressive laminectomy (case 1 in Table 6).
Summary of vertebral segments with vertebral compression fracture events
The present study identified the incidence and risk factors for VCF after conventional RT in homogenously characterized colorectal cancer patients, and clinical significances as described below. Because conventional RT still has a dominant role in palliative treatment for bone metastases, the results of our study will provide useful information for physicians. Moreover, although the use of bisphosphonate can delay or decrease development of VCF [2], our cohort contained only CRC patients who rarely use bisphosphonate. Furthermore, it was confirmed that bisphosphonate was not used in all patients. So we could identify the effect of RT on VCF without this confounding factor. The incidence of VCF in our study was 8.8%, suggesting that VCF after conventional RT is not particularly common. Additionally, we identified two risk factors for VCF, prior irradiation and pre-existing compression fracture. Therefore, timely management and close follow-up are required when planning to treat vertebral segments with these risk factors.
Previous studies that focused on VCF after SBRT analyzed several risk factors including SINS criteria and revealed that lytic spinal lesion, spinal misalignment, pre-existing VCF, and vertebral body involvement increased the risk of VCF [9,10,12,13]. In this study, we identified prior irradiation and pre-existing compression fracture as risk factors for VCF, thus pre-existing compression fracture was a consistent risk factor among studies. However, prior irradiation was not identified as a risk factor in the studies of MDACC or the University of Toronto, although both studies evaluated the clinical significance of prior irradiation in VCF development. As the uncontrolled bone metastasis after RT can be the risk factor for VCF, the presence of prior irradiation history have the meaning of both severe radiation induced change and tumor progression even if prior RT. However, exact underlying mechanism of VCF is not well defined, and further research into this association is obviously necessary.
Recently, the SOSG introduced the SINS criteria to predict instability of the metastatic spine. Evaluation of their reliability and validity indicated that the sensitivity and specificity of these criteria in an unstable and potentially unstable group were 95.7% and 79.5%, respectively [14]. Although several groups have studied the relationship between SINS criteria and development of VCF after SBRT, whether SINS criteria can help predict VCF after conventional RT has not been validated. At our best knowledge, there is the only 1 published study that revealed the relationship between SINS criteria conventional RT [15]. They showed that a higher spinal instability score increased the risk of RT failure and retreatment, independent of performance status, primary tumor, and symptoms. Our study revealed that vertebral body collapse score could predict VCF after conventional RT, consistent with data from MSKCC. In addition, overall SINS class was significantly related with VCF (p = 0.002) in univariate analysis; however, the small number of vertebral body collapsed or class III spinal segments limited the statistical analysis. Further researches with large cases should be performed to confirm our results about the relation between conventional RT and SINS criteria.
In contrast to SBRT, by defining target volume as the involved vertebral segment only, conventional fraction RT traditionally includes 1 to 2 levels of adjacent non-metastatic spines as well as all metastatic spines. Thus, it is important to know the risk and predictive factors for VCF in non-metastatic spines, and to date these factors have not been clearly defined. In our study, development of VCF after irradiation of non-metastatic spine was observed only in one case (4%) among a total of 26 vertebral segments (case 6 of Table 6). Furthermore, not only the VCF development, but also tumor progression was observed in this case, suggesting that tumor progression is more reasonable cause for the development of VCF than radiation effect. Thus, there was no VCF on non-metastatic vertebral segment without tumor involvement in our study cohort, suggesting the inclusion of adjacent metastasis-free vertebra seems to be safe. On the other hand, after irradiation of metastatic spine, VCF was observed in five cases (12%) among a total of 42 vertebral segments, suggesting that irradiation of the metastatic spine is somewhat riskier. One possible cause of VCF is weakening of the bone structure induced by radiation. Al-Omair et al. [16] investigated the pathophysiology of VCF development after SBRT by spine tissue biopsy and revealed that radiation-induced necrosis and fibrosis contributed to VCF development after SBRT with a high fractional dose. However, the fractional dose in conventional RT is much lower than that of SBRT, suggesting the possibility of another mechanism related to VCF after conventional RT, other than tumor regression. However the exact mechanism is currently unclear and our study did not identify any risk factor for VCF in non-metastatic spines.
We reviewed all cases of VCF in this study and found six fractured vertebral segments. Among these, pain aggravation was observed in five cases, and spinal cord compression presenting with weakness in both legs was observed in two cases (case 1, 6), especially for case 6, there was newly developed tumor involvement in non-metastatic spine. Decompressive laminectomy and tumor removal were successfully performed. A prophylactic stabilizing procedure (e.g., vertebroplasty) should be considered when the targeted vertebral segment has risk factors for VCF, because VCF can cause pain and neurologic symptoms. In addition, regular interval imaging and clinical follow-up is needed to inspect for the development of VCF.
Special consideration is needed when interpreting the results of this study because of the inherent limitations of a retrospective study. In spite of our best efforts to perform regular follow-up imaging studies with uniform modalities there were some inconsistencies in imaging modality and follow-up interval among patients. Therefore, the incidence of VCF might be underestimated because of incomplete assessment. As a result of the exclusion criteria, only 68 vertebral segments of 16 patients were included in our study, limiting our statistical power to analyze prognostic factors. However, most patients in our study cohort might be relatively long-term survivors, suggesting that our results address a clinically relevant problem after palliative RT. As our study did not focus on event per patient but rather event per vertebral segment, the reliability of data on the patients' characteristics could be diminished in cases of multiple fractures in one patient. However, we found six fractures in five patients in this study, indicating only a single case of multiple fractures, thus the reliability of this study is not significantly compromised. Conversely, our study revealed that the presence of a risk factor in a certain vertebral segment does not increase the fracture risk at other spinal levels.
Overall, the incidence of VCF after conventional RT is not very high. However, close observation is warranted in patients with prior irradiation to the spine and/or pre-existing compression fracture in the spine. In addition, SINS criteria can be used as an option for predicting fracture risk before performing conventional RT. Further studies are required to confirm these findings and examine the validity of extrapolating our results to bone metastasis in the setting of other tumors.
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4. Chow E, Harris K, Fan G, Tsao M, Sze WM. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 2007;25:1423–1436. 17416863.
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7. Sheehan JP, Shaffrey CI, Schlesinger D, Williams BJ, Arlet V, Larner J. Radiosurgery in the treatment of spinal metastases: tumor control, survival, and quality of life after helical tomotherapy. Neurosurgery 2009;65:1052–1062. 19934964.
8. Kim MS, Keum KC, Cha JH, et al. Stereotactic body radiotherapy with helical tomotherapy for pain palliation in spine metastasis. Technol Cancer Res Treat 2013;12:363–370. 23448578.
9. Rose PS, Laufer I, Boland PJ, et al. Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases. J Clin Oncol 2009;27:5075–5079. 19738130.
10. Boehling NS, Grosshans DR, Allen PK, et al. Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases. J Neurosurg Spine 2012;16:379–386. 22225488.
11. Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 2010;35:E1221–E1229. 20562730.
12. Cunha MV, Al-Omair A, Atenafu EG, et al. Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors. Int J Radiat Oncol Biol Phys 2012;84:e343–e349. 22658511.
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16. Al-Omair A, Smith R, Kiehl TR, et al. Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation. J Neurosurg Spine 2013;18:430–435. 23495889.
Copyright © 2014. The Korean Society for Radiation Oncology
(open-access, http://creativecommons.org/licenses/by-nc/3.0/) :
EQD2, equivalent dose in 2 Gy per fraction.
FFP, fracture-free probability; HR, hazard ratio; CI, confidence interval; NA, not applicable; SINS, Spine Instability Neoplastic Score.
C, cervical spine; T, thoracic spine; L, lumbar spine; S, sacrum; SINS, Spine Instability Neoplastic Score.
T, thoracic spine; L, lumbar spine; S, sacrum; SINS, Spine Instability Neoplastic Score; fx, fractions; RT-Fx. time, monthly time interval between start date of radiation therapy and fracture event; LBP, lower back pain; UBP, upper back pain; f/u, follow-up.
a)Case 2 and case 3 were different vertebral segments from the same patient. b)Newly developed spine metastasis was observed in case 6.


ESA	> Space in Images > 2002 > 11 > Close-up of a single solar-array cell
Close-up of a single solar-array cell
Title Close-up of a single solar-array cell
Released 19/01/2004 9:00 am
Copyright ESA
Close-up of a single solar-array cell.
Rosetta will be the first space mission to journey beyond the main asteroid belt and rely solely on solar cells for power generation, rather than the traditional radio-isotope thermal generators. The new solar-cell technology used on the Orbiter's two giant solar panels allows it to operate over 800 million km from the Sun, where sunlight levels are only 4% those on Earth.
Activity Space Science
Keywords Astronomy targets, Comets and Asteroids
Rating: 5/5 (1 votes cast)
24 April 2008 Herschel solar array and sunshield 455 Votes: 7
24 April 2008 Sunshield being assembled with the solar array 367 Votes: 6


Live in Wembley Park
Just 12 minutes tube ride from Central London, Wembley Park is a buzzing new creative neighbourhood, home to amazing food, culture, shopping and entertainment - somewhere you'll be proud to call home.
Think you know Wembley Park? Think again.
Foodie heaven. Spoilt for choice
Explore over 50 places to eat and drink, with the latest Boxpark featuring 20+ global street food traders. Renowned bakery Bread Ahead from Borough Market with its all-day restaurant and bakery school, artisan pasta specialists Pasta Remoli and the London Designer Outlet's 20+ restaurants from Wagamama, Zizzi, Nandos and more.
The team behind Wembley Park's new 2,000 seat capacity theatre, has brought War Horse in 2019 and is working in collaboration with well-known and emerging production companies and artists to stage world-class entertainment.
London Designer Outlet (LDO)
LDO features 70+ high street brands from Nike, Converse, Kurt Geiger, Gap and more – all up to 70% off, all year round. And with its 9-screen Cineworld and 20+ restaurants, you'll be able to fill your boots (and your bags), day or night.
Wembley Park Market
A market and community of independent merchants, makers, and doers, ranging across the likes of fashion, arts and crafts, health and wellness, food and more. The focus is on sustainable, ethically sourced products.
Wembley Park is changing every day with new retail brands, cultural events and things to do. Here's a snapshot of what's on, what's coming soon, or a feature on who's recently arrived in this exciting new neighbourhood of London. Swipe or scroll through to see what's happening.
Rise The Opening event
RISE tells the story of how, for generations, people of different countries, faiths and backgrounds came to build their future in Brent together. Set to an incredible soundtrack, against the backdrop of Wembley Stadium.
Getty Gallery Exhibition
The new exhibition 'Heroes' features over 100 intimate photographs of global artists who've played at Wembley from The Beatles, Bowie and The Rolling Stones to Queens of the Stone Age, Beyonce and The Prodigy.
Luxe barbers & hairdressers without the price tag. Pick from 24 styles, 20mins for £20. Book through their app, with a virtual queue, automated payment and they take care of the rest.
Bad axe throwing
These guys are the world's biggest urban axe throwing club. What was a Canadian backyard pastime is now a fun (and safe) night out. With the help of talented axe throwing coaches, it's great fun.
Pasta Remoli
Chef Simone Remoli (formerly of Locanda Locatelli and Bocca di Lupo) serves some of the best pasta you can buy in London. Authentic, artisan – you can eat in the restaurant or take home.
Twenty3C bike shop
This specialist bike shop, workshop, and coffee shop is run by real cycling enthusiasts.
Wembley Park transforms into an immersive multi-sensory playground of art installations, from the acclaimed Sonic Runway (from Burning Man festival) to London's tallest-ever LED light Christmas Tree. 20 Nov '19 to 3 Jan '20.
Selected Tipi buildings have gyms included such as the Ferrum gym featured here. But there are also others locally, from The Gym group and Better gym. And there's the fantastic, newly opened More Yoga studio and The Yellow's run club.
The Yellow is like no community center you've ever seen before. It's a vibrant community hub for anyone and everyone, hosting regular classes, workshops, and events to get you fit, learn new skills or get creative.
Life's essentials
There's Sainsbury's, Co-op, Tesco, Asda, Lidl, Costco all within a short distance of your Tipi apartment. Along with nurseries, a post office, IKEA, ATMs, petrol stations, etc. Everything you need is on your doorstep.
Iconic entertainment
Wembley Park is home to iconic, world-class sporting & music entertainment thanks to Wembley Stadium and the SSE Arena, Wembley. So at Tipi we give residents the chance to win free tickets via monthly prize draw to fantastic events every month. Our residents have been to see everyone from NFL and Ed Sheeran to Robbie Williams and Mickey Flanagan.
We're 7 mins walk away from Wembley Park tube station which has Met and Jubilee lines, easy peasy.
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