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"Fast Chat: Annet Mahendru". Newsday. New York City / Long Island. p. 91. Retrieved May 5, 2014.dad Ghanshan 'Ken' Mahendru. Currently in Baltimore shooting the title role of the fact-based medical drama 'Sally Pacholok'." Guy, Mike (April 8, 2015). "Annet Mahendru on Playing 'The Americans' Seductress".. 3 9 In 2014, Mahendru was promoted to a series regular for the second season of The Americans. 10 She also starred in the comedy-drama film Bridge and Tunnel, had a voice role in the 2014 animated film Penguins of Madagascar, and guest-starred in the.. New York Post. Archived from the original on March 4, 2016. Retrieved May 5, 2014. "Annet Mahendru". (Resume) Actors Access (Breakdown Services, Ltd.). Retrieved "Annet Mahendru: A Funny Joke from a Beautiful Woman". Esquire. Archived from the original on January 12, 2016. Retrieved April 7..
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4 She then moved to Los Angeles and studied improv at The Groundlings. 4 Mahendru began her acting career in 2006, appearing in an episode of the sitcom Love Monkey, an episode of the drama Conviction, a Law Order spinoff, and the short film "The.
11 12 Mahendru stars in the seventh episode of the anthology series The Romanoffs, which begins streaming on Amazon Video Nov. 16, 2018. Filmography Edit Film Edit Year Title Role Notes 2006 The Art of Love Kala Short film 2008 El Padrino 2 Serge's Wife.
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I just wrapped up the fifth week of my internship at 3M in Integrated Marketing Development in St. Paul, Minnesota. Next week is officially the "Hump Week" of our 11-week internship. Time is really flying by!
The Work
Integrated Marketing Development is part of Corporate Marketing. We're a centralized group that works on project requests from 3M's 40+ divisions. Projects can involve any aspect of marketing, from market assessments to tactical pricing strategies. It's an interesting mix of marketing and consulting. The group has grown in size and visibility over the last few years because of the quality of work that has been produced. Marketing Strategists (our official title) spend 18-30 months in the role before moving out into a business unit. It's a great opportunity to work on a variety of projects and learn about the divisions and type of marketing roles before having to commit to one longer-term.
I have three projects, which I can't really talk too much about due to confidentiality. In broad terms, two involve market/industry assessments (Prof. Dial would be proud!), while the third is more related to value proposition. Two are in B2B, and one is in B2C (although that one has aspects of B2B within it as well due to the nature of the category). My first weeks were spent steeped in research, learning to efficiently navigate 3M's online libraries. It would certainly be much easier if everything were neatly outlined in a 30-page HBS case I could refer to, but what's the fun in that? The tricky part is that the industries I'm dealing with are super niche. High-level reports are helpful, but there's still a ton of dissecting that needs to occur to truly scope the markets my clients are in. Research also involves talking to many people at 3M. A lot of knowledge doesn't get written down and so wading through informational interviews is common practice. I'm also doing some Voice of Customer research with industry experts to answer various critical questions on the projects. At this point in my projects, I'm able to start converging the data into more tangible conclusions, which is definitely a more comfortable place for me to be. This past week, I had midpoint reviews with the clients involving pivot tables and Power Point decks (they LOVE their Power Point here!) of information outlining the path for the rest of the project. I hadn't really realized how much I had accomplished in a short period of time. It often feels like we're just spinning our wheels, but the full-timers keep reminding us that whatever information we find will be helpful to the clients because they simply don't have the time to dedicate to these projects themselves. It's good to know that my projects will have an impact after I leave.
The People
I love the people I work with. The full-timers are really great and the group has a laid-back vibe. The other interns in my group (there are 10 of us) are all awesome and we get along really well. There are also 10 MBA interns in another group called Strategic Business Development and 3 more MBAs in Health Care. We've done quite a few activities through work (this past Friday we did volunteer work in the morning and spent the afternoon on a yacht on the (nearly overflowing) Lake Minnetonka) as well as various non-work activities such as Monday night trivia. I also have a roommate which eases the anxiety of being in a new city. I'm just thrilled to be surrounded by so many fun and friendly people. My networking circle is definitely getting bigger!
The Location
Minneapolis is a very cool city. Our apartment building is right downtown and walkable to quite a bit. I will say that if I lived here full time, I would not pick our building (despite the awesome rooftop patio, there are some noise issues with the surrounding buildings and park), but the general location is nice. Minneapolis is becoming quite a foodie city, so there are plenty of restaurants to try (there's no way I'll get to everything on my list!). It's also very bike-friendly. The Nice Ride program really connects the city (far more than CoGo in C-bus), so it's really easy to get around. I've thoroughly enjoyed being able to walk to the grocery store and to Target on a regular basis and bike to the lakes and other neighborhoods. I still need to get to a Twins game though (I'm hoping to go when the Yankees come to town) and enjoy some of the numerous music venues in town as well.
3M is in St. Paul, so I have a 20-minute commute each day. However, there is always crazy traffic on the drive home, so it's usually 40 minutes on the return trip. St. Paul is a great city as well. We've done several happy hours downtown and our favorite trivia spot is there too. We also went to a St. Paul Saints game during our first week here, which was quite an experience. They're not affiliated with MLB, so things were a little interesting. We actually had seats on the field and one of our interns threw the "ceremonial last pitch"!
All in all, it's been a fantastic five weeks! I'll end with a few pictures from my time here.

subset: commoncrawl


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Welcome! I'm Lisa Dawson and I'm an interior obsessive writer, blogger and content creator. I write weekly about interior projects, home lifestyle and Instagram know how and I always have a revamp underway!
I'm co host of Revamp Restyle Reveal and will be launching Season 4 in January 2020. You can also find me at Real Homes magazine where I write a monthly column.
Latest Blog Posts


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The Faith of Dietrich Bonhoeffer
Usually I write to encourage people to give to Relief but today I would like to pay tribute to a great person who fought for Truth. I came across this blog by Eric Metaxas and I wanted to share an excerpt from it. Dietrich Bonhoeffer was a brilliant young pastor and a theologian, whose deep faith in God led him to get involved in the plot to kill Hitler. When Hitler learned of Bonhoeffer's involvement he flew into a typically violent rage. As one of his final acts of revenge -- just three weeks before he committed suicide -- Hitler condemned the young pastor to death. Bonhoeffer was hanged on April 9, 1945 at Flossenburg Concentration camp. But by all accounts, Bonhoeffer went to his death with the peace of God, with no regrets. How can that be? He was 39 years old, widely reckoned a theological genius. He had already written two of the classic books of the 20th century, "The Cost of Discipleship" and "Life Together." He was engaged to be married to a wonderful young woman. He had such a terrifically bright future! Bonhoeffer even had an opportunity to escape his fate. In my book I tell the story of how he had fled to America, but then decided to return to Germany, to face the horrors that lay ahead with his people. Why did he return when he didn't have to? And why didn't he have any regrets for doing so, even after he knew he would pay the ultimate price? Just before he died, Bonhoeffer told a fellow prisoner, "This is the end. But for me, the beginning of life." But on that day -- April 20, 1945 (Hitlar's last birthday mentioned earlier in the original post)-- who was happy and who was at peace, Hitler or Bonhoeffer? For that matter, which of them is happy and at peace today? It's something chilling to think about, the contrast between these two Germans, between these two lives and these two deaths. But at this time of year especially, it's appropriate that perhaps we do think about it. But at this time of year, when Passover and Easter are being celebrated it's especially appropriate that we do think about it. Do those of us who say we believe in God really believe it? Because if we do, it will affect how we behave today, this week, this month... If we believe in the word of God, as Bonhoeffer did, it will give us the courage do the right thing wherever we are. Like Bonhoeffer, we will do the right thing and trust God with the consequences. Faith and courage go together. Bonhoeffer's faith gave him the courage to stand against the greatest evil of the 20th century. And today we celebrate him and revile the inhuman tyrant he stood against. So this Easter season, dare to think about what you really believe. What you believe about your faith will affect how you behave today and how people regard you years from today. That's a fact. Let the life of Bonhoeffer, lived in faith and without fear, be a source of encouragement to you, so that your life in turn may be a source of encouragement to others in years to come.
I agree with Metaxas call to think about what you believe. Do you really believe in the truth and power of scripture? What would your life look like if you did? What do your actions show that you believe in – yourself or the Truth of God? I think that Easter is a time that we should reflect on our faith since it is the time when the curtain separating the Holy of Holies was torn in two giving us the opportunity to approach the throne of God with confidence and covered by his grace.
Bonnie Ponce is the Director of Support Raising for Relief and lives in Huntsville, Texas with her husband and betta fish. She has a BA in English from Sam Houston State University. After work she enjoys relaxing with a good book or working on her novel.


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Cardiac Care for Older AdultsTime for a New Paradigm
Author + information
- Received June 9, 2010
- Revision received January 27, 2011
- Accepted February 1, 2011
- Published online May 3, 2011.
Author Information
- Daniel E. Forman, MD⁎,†,⁎ (DEForman{at}partners.org),
- Michael W. Rich, MD‡,
- Karen P. Alexander, MD§,
- Susan Zieman, MD∥,
- Mathew S. Maurer, MD¶,
- Samer S. Najjar, MD#,
- Joseph C. Cleveland Jr, MD⁎⁎,
- Harlan M. Krumholz, MD†† and
- Nanette K. Wenger, MD‡‡
- ↵⁎Reprint requests and correspondence:
Dr. Daniel E. Forman, Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115
Advanced Age as a Primary Determinant of Cardiovascular Disease
Recent decades have witnessed striking growth in the number of older adults both in the United States and throughout much of the world, largely due to improved public health, nutrition, and medical care. Between 2000 and 2030, the proportion of the world's population age 65 years and older is expected to increase from 6.9% to 12% (1). In the United States, the "old age" demographic is accelerating even more rapidly (estimated to increase from 12.9% to 20% between 2000 and 2030) as baby boomers enter their senior years (2). Furthermore, by 2050, the subgroup of U.S. seniors age 85 years and older is expected to triple. Ironically, aging also catalyzes fundamental changes that increase susceptibility to cardiovascular disease (CVD) such that CVD is endemic in the burgeoning senior population (3). Already, the prototypical U.S. cardiology patient is an older adult, and management of cardiac issues is fundamentally linked to the frailties and multimorbidities associated with advanced age.
Cardiologists Are Frequently Regarded as the Logical Healthcare Leaders for the Rising Population of Older Adults With CVD
Although many assume that cardiologists are logical healthcare leaders for management of CVD in seniors, the current cardiovascular (CV) armamentarium fails to integrate complexities or needs specific to older patients. Conventional evidence-based standards of CV care were formulated using trial data derived from younger study populations and/or elderly patients who were rigorously screened to exclude common morbidities or frailties of old age (4). As a result, routine CV management often overlooks health problems without a cardiac focus (e.g., cognitive decline, functional limitations, pain, or multimorbidities) even if they bear on how patients experience and process CV healthcare decisions (5). Primary care providers may even choose to avoid cardiology consultation if they perceive that the cardiologist will recommend medications and procedures that are discordant with the patient's overall care priorities (6). Moreover, in some areas of the United States, third-party payers are considering steps to impede referrals to cardiologists for what are perceived to be invasive procedures that add little benefit to patient-centered care (7) such as the common use of stents in stable coronary artery disease patients, an issue particularly germane to older adults, given the high age-related prevalence of coronary artery disease.
It is indisputable that the attributable risk of CVD is highest in the senior population (8–10). Therefore, CV caregivers have the greatest potential to favorably impact mortality and morbidity by implementing preventive and interventional therapies in their oldest patients. Yet, this potential is counterbalanced by increased iatrogenic risks as well as myriad medical, social, and even economic concerns that can affect which issues a patient considers his/her paramount concerns. To navigate through these cross-currents, cardiologists require additional proficiencies, that is, insights and skills that require deliberate preparation and training.
The Institute of Medicine's recent report on retooling for an aging America emphasizes the need for fundamental reform in healthcare training and implementation to meet the needs of the older population (11). "The nation needs to move quickly and efficiently," the report indicates, "to make certain that the healthcare workforce increases in size and has the proper education and training to handle the needs of a new generation of older Americans."
We propose that fundamental tenets of CV training and patient management can and should be expanded to better address the complexities of all patients, including skills and insights to better treat the large and growing population of older adults who now comprise the largest subgroup of CV patients. Training should continue to emphasize state-of-the-art technological and medical expertise, but also their individual application, and should ensure that all providers have the skills needed to assess patient preferences, circumvent hazards of hospitalization, facilitate successful transitions from one care setting to the other, engage in useful risk-benefit discussions, and provide care collaboratively within a care team responsive to the needs of the oldest patients. Such enhancements will lead to more individualized care, with better coordination across multiple conditions.
Aging Leads to Changes in the Nature of CVD and its Management
Although chronology is relevant, the process of aging entails more than an accounting of years lived (12). Relative differences in biology (e.g., telomere length, oxidative stress, inflammation, genetic constitution) (13–15), lifelong health habits (e.g., nutrition, exercise, dental care), cardiac risk factors (e.g., hypertension, cholesterol, tobacco, insulin resistance) (16), comorbidities (e.g., infection, chronic obstructive pulmonary disease, renal disease, anemia, arthritis, depression, dementia, vision and hearing deficits), psychology (e.g., interpersonal capacities, self-efficacy, coping skills), social structure (e.g., class, community, access, spouse, family support), economic resources (personal, governmental), and culture (religion, ethnicity, transcendent sense of meaning and purpose) also impact the aging process. Therefore, a more meaningful way to conceptualize "aging" is as a continuum of changes that mount over time, with pace and nature of progression varying depending on each person's circumstances.
Despite such individual variation, 75 years is often cited as the beginning of old age, in part because it provides a convenient benchmark for research and clinical applications. Likewise, 85 years is often used as a convenient threshold to classify very old age. These designations presume that by 75 and 85 years, respectively, most adults have sustained sufficient aging changes to exhibit clinically relevant differences in physiology and organ function and reserves. Yet, aging remains idiosyncratic, and each senior adult has a unique constellation of age-related vulnerabilities and consequences.
High age-related incidence of CVD arises in part due to broader aging processes, including accumulating morbidities, diminishing homeostasis, and prolonged injurious effects of CV risk factors (3,17). Cardiac disease also stems from insidious age-related changes in CV morphology and function. Vascular stiffening of the central vasculature is, for example, an omnipresent aging phenomenon that usually starts by middle age and leads to progressive rise of afterload stress, myocardial workload, and changes in diastolic perfusion that predispose to functional decrements and ultimately to ischemia, heart failure, arrhythmia, and other CV disorders (18–20). Heart failure with preserved ejection becomes increasingly common as the mounting aortic impedance of senescence is more likely to uncouple from ventricular pumping performance (21). Parallel aging changes in myocytes, endothelial cells, and pacemaker cells further increase vulnerability to coronary artery disease, valve disease, heart failure, arrhythmia, peripheral artery disease, and cerebrovascular disease (20). The relative progression of each of these aging effects varies among individuals, resulting in a diverse range of CV clinical implications. For some seniors, CV aging is manifest only as functional decrements (22), whereas others develop subclinical (23) or overt CVD (3,17,20,24). Although, overall, CVD increases appreciably with age, cardiologists face the challenge of tailoring prevention and treatment priorities relative to each individual's circumstances.
CVD is also usually more hazardous in older patients. It often erupts with multiple simultaneous CVD processes (e.g., acute coronary syndrome, heart failure, and atrial fibrillation) and in combination with noncardiac pathologies (e.g., pneumonia, renal insufficiency, anemia, chronic lung disease, diabetes, and stroke) (24). Such multisystem disease combinations are more liable to overwhelm the diminished CV reserve capacity of aging, thus leading to adverse outcomes. Medications often compound problems, as age-related changes in absorption and metabolism alter the pharmacokinetics and pharmacodynamics of most drugs. As a result, medication dosing and effects, both beneficial and adverse, often differ from those in younger adults, and it cannot be assumed that the clinical utility of agents shown to be effective in younger individuals necessarily applies to the elderly. Moreover, especially given the likelihood of multiple cardiac and noncardiac diseases occurring simultaneously among older CVD patients, clinically significant drug–drug and drug–disease interactions are ubiquitous, adding to management challenges (25).
Limitations of the Current Therapeutic Paradigm
Despite the glaring pattern of age-related complexity and the precarious onset and progression of disease, the current paradigm of care for older CV patients is relatively rudimentary, mostly an extrapolation from conventional evidence-based CV guidelines. Even the recently revised non–ST-segment elevation myocardial infarction guidelines, which called for special considerations in care of older populations, provided little in the way of concrete recommendations (26). Essentially, cardiologists have begun to approach the margins of the issue, but have yet to deal with it programmatically.
Evidence-based care becomes considerably less certain when analyzed through a lens that exposes relevant aging dynamics. For example, although an impressive array of trial data suggests utility of statins to reduce mortality for older adults (27,28), therapeutic ambiguity persists if the statin constitutes the eighth pill in a complex regimen and/or if the patient has age-related renal insufficiency and/or nebulous muscle aches (29,30). Not only are the salutary effects of a multipill regimen for a frail elder unclear, but diminished access to care, costs, iatrogenesis in relation to age, polypharmacology, and morbidity remain substantial concerns, with absent clarification from the clinical trials on which treatment indications were based, that is, trials that systematically excluded older patients with such complexities (4). Furthermore, data pertaining to adults age 80 years and older remain generally absent, and benchmark mortality endpoints are often of less concern for seniors than quality-of-life issues (e.g., myalgias, polypharmacology, and medication costs).
Part of the challenge is that many CV interventions effective in younger patients are more likely to adversely affect older adults, especially those weakened or debilitated by age (31). Contemporary proliferation of drug-eluting stents and antiplatelet therapy, for example, is counterbalanced by increased bleeding risks in older patients (32). Beta-blockers can limit chronotropy and exercise performance. Nitrates can increase falls and syncope. Idiosyncratic effects of age must be anticipated. Complexities are exacerbated by cognitive decline, confusion, mood changes, and loss of appetite, especially in a context of common stresses of hospitalizations, loss of independence, functional declines, polypharmacology, and sensory impairments (vision, hearing, taste). Precise dosing of medications and monitoring are essential, as is thorough assessment of composite life events that impact on CV health and care.
Advanced age and frailty also often confound conventional processes of care. Access to caregivers is often more limited (hindering assessments and monitoring); vision, hearing, and cognitive limitations can complicate comprehension and compliance; arthritis impedes exercise goals; financial constraints and altered taste may frustrate dietary recommendations; finances may also prohibit use of vital ancillary services; even the ability to stand on a scale can become difficult for someone challenged by dizziness, stroke, or Parkinsonism. Therapy that merely extrapolates from standards oriented to younger populations might be fundamentally unsuitable for someone old and frail.
Not only do higher risk–benefit ratios exist among seniors for virtually all CV procedures and interventions relative to the populations from which evidence-based standards were derived, but even if/when study endpoints are reproduced in seniors, many patients may not perceive them as benefits.
The manner and quality of death can also be affected by therapeutic choices in ways far removed from their original therapeutic intent. An implanted cardioverter-defibrillator may, for example, prevent sudden (painless) death, but this "benefit" inevitably increases the likelihood of dying from congestive heart failure, myocardial infarction, cancer, or other noncardiac causes (33,34). Such consequences are often not anticipated and discussed prior to undertaking therapeutic interventions.
Limitations of the current CV healthcare paradigm to care for seniors extend beyond decisions made for an individual patient and relate to the healthcare industry. Over the last decade, access to CV imaging, procedures, and devices have expanded for older adults. There has, for example, been enormous investment in nuclear imaging on the premise of quality (35), often usurping the role of traditional electrocardiogram exercise testing that still might have provided sufficient data to address the underlying clinical questions (e.g., prognosis, exercise capacity, and symptoms) without the added expense of imaging (36). These issues are now compounded by the growth of computed tomography and other imaging options that tout clinical benefits, but for which outcomes data are lacking. Although concerns regarding over-reliance on imaging are not exclusive to older patients, prevalence of CVD increases with age (such that application of imaging assessments also escalates) as does a common (but erroneous) assumption that older patients cannot exercise sufficiently for clinically useful nonimaging assessments.
Improving Care of the Older Cardiac Patient
A New Clinical Paradigm
Given the fundamental heterogeneity of aging and its direct bearing on clinical management, improved care for older CV patients is a priority (37). Considerable work lies ahead to achieve what are still sometimes idealized goals that must be better delineated and then promoted amid many contrasting and competing versions of healthcare priorities (Table 1).
Improved CV management for seniors must start with the capacity for comprehensive assessment of each individual's health as well as a multifaceted health context, with therapy then personalized to each patient's situation. Tools to gauge overall health and to link composite health profiles to customized and achievable therapeutic goals are needed. Patients must be engaged in the selection of the management choices bearing on their health, but the medical system (and cardiologists in particular) must achieve processes, organization, and standards that insure that seniors receive lucid, relevant information in a straightforward comprehensible manner.
Although longevity may remain the dominant priority for some older adults, the prospect of excessive pain, hardship (including perceived burden on loved ones), limitation of independence, and/or recurrent hospitalizations may limit appeal of life-prolonging therapies, particularly amidst chronic disease and progressive debilitation. Just as cardiology has cultivated vast insight and expertise oriented to extending longevity, it now is crucial to refine health goals oriented to a spectrum of alternate endpoints, that is, quality of life, functional capacity, reduced hospitalizations, and independence. The evidence-based foundation of CV medicine must expand to achieve insights and rationales that support and guide these nonmortality objectives.
Although in some cases, clarification of therapeutic objectives may be as simple as direct patient inquiry, this process will often be confounded by affect, cognitive decline, social pressures, and/or family dynamics, especially in situations involving advance directives or healthcare proxies. Furthermore, given that aging is dynamic, therapeutic goals may fluctuate relative to advancing age and circumstances. Interviewing techniques and assessment strategies must be efficient, sensitive, and reliable for recurrent assessments for a wide range of personalities and settings.
Risk stratification is a related dimension of assessment that is particularly important in assessing eligibility of older adults for CV procedures (38–40). The goal is not to restrict treatment, but to better select patients for therapy who are most likely to benefit. The decision to undertake revascularization should be based, not solely on results of imaging procedures and anatomical criteria, but on aggregate patient circumstances. Coronary anatomy is relevant, but so too are comorbid features (e.g., renal, pulmonary) that impact procedural success and complications. Likewise, even technically successful revascularizations may culminate suboptimally if cognitive, comorbid, and social limitations were not recognized and addressed prior to undertaking the procedure. Beyond conventional parameters of coronary anatomy and comorbidities, seminal work by Fried et al. (41) highlights that many aspects of frailty also impact CV outcomes; for example, unintentional weight loss, weakness, self-reported exhaustion, slowness of gait speed, low activity, and poor grip strength are important considerations. Assessments once seen as "soft" or subjective (e.g., fatigue, weakness, gait speed) are now increasingly acknowledged as providing important prognostic information. Such innovative assessments have been reinforced by tools to increase their reliably and objectivity (42–45), which are important refinements to refute those who still see them as soft and inconsequential. Cognition (delirium risk) (46), social support, and mood (depression) (47) must be considered in assessing risk. Concomitant pharmacotherapy should also be taken into consideration; for example, chronic need for warfarin increases bleeding risk following percutaneous coronary intervention, and may affect the choice of antiplatelet therapy or the type of stent to deploy (i.e., bare-metal vs. drug-eluting stent) (48).
For patients prioritizing quality of life, function, independence, and other clinical goals over longevity benefits, therapeutic strategies must shift. Although digoxin did not reduce mortality in the DIG (Digitalis Investigation Group) trial, more important may be its benefit in reducing heart failure symptoms and related hospitalizations in older patients (49). Although milrinone for systolic HF may be associated with increased mortality risk, its potential to increase function and quality of life may seem worth that risk to an elderly patient (50). Even therapeutic bastions like beta-blockers may seem less useful for frail heart failure patients whose vulnerability to chronotropic incompetence (and potential need for a pacemaker with associated procedural risks and other adverse outcomes) and functional decrement may outweigh their life-prolonging benefits.
Similarly, rationale for stents, devices, and surgery must be reconsidered in terms of their value with respect to the personalized clinical goals of each patient. Whereas the utility of revascularization to increase life expectancy may seem nebulous, its value may seem relatively clear cut if improved function, quality of life, and independence are the primary therapeutic objectives (51). Treatment pathways can be delineated in ways that help patients, families, and allied caregivers understand which older patients are most likely to benefit. Likewise, procedures can be refined and standardized to better facilitate these goals (e.g., type of stent, hybrid procedures, and/or adjunctive therapy). The onus is on cardiologists to achieve technological and methodological advances to best assure excellent outcomes for seniors, and to disseminate these refinements as priorities. Bivalirudin and fondaparinux may, for example, be better antithrombin agents for older adults undergoing percutaneous coronary intervention (52–54). Sheath sizes, antiplatelet therapy, and other clinical processes may be better tailored to specific patient criteria. Similar approaches to minimize age-related renal toxicity, delirium, and other morbidity are all mandated.
Fundamental strategies of therapy may also change to better manage the risks and limitations associated with age, and to achieve outcomes that are particularly valued. The recent report of success with transcutaneous aortic valve implantation (TAVI) in patients ineligible for traditional valve surgery provides an excellent example of how technological advances may better facilitate successful patient-oriented outcomes (e.g., improved independence and quality of life) for patients who would be unlikely to benefit from traditional therapeutic strategies (55).
Improving Communications and Transitions for Older CVD Patients
Improved communications are vital to all dimensions of care. Many older adults have natural barriers to optimal communication due in part to diminished cognitive and memory capacities, auditory and visual impairments, and limited social support, as well as the complexity of their medical issues (i.e., it is simply hard for many to understand the concepts). Communications are critical for patients to grasp complex concepts of aggregate health risk and be able to make personalized healthcare choices. Given these typical obstacles, language and learning tools can be refined and standardized to be more effective. Not only can doctors, nurses, and other staff be better trained to communicate with older patients by adapting to individual patient's health literacy, education level, cognitive function, and culture, but hearing, vision, and learning props can be integrated at key junctures of care. Well-coordinated information can also be provided to families, spouses, and others involved with a patient's care, being careful not to undermine the patient's autonomy and right to make choices, but rather to insure consistency, clarity, and a shared sense of information. Equally important, information should be readily available to all caregivers involved in each patient's care (i.e., primary care physicians, hospitalists, other specialists, nurses, physical therapists, and nutritionists) with the goals of consistency in information exchange and minimizing iatrogenesis. A related priority is that cardiologists communicate effectively with their medical colleagues. Optimal CV care demands a team approach to address the complexities of older patients. CV management must be coordinated within the caregiving team; unambiguous and timely information flow and documentation are essential (56).
Communications also relate to the ability of CV specialists to hear senior patients (i.e., not only as part of the process to determine personalized therapeutic goals, but as a means to gauge the efficacy of therapy). Especially given that many nonmortality endpoints rely on qualitative parameters, listening and hearing are elemental components to assess caregiving quality and effectiveness (57).
Cardiac rehabilitation can be better utilized to reduce morbidity and mortality, improve quality of life, increase functional capacity, reduce readmissions, and reduce healthcare costs for elderly patients (58). Cardiac rehabilitation specifically responds to challenges experienced by most older CVD patients, that is, multimorbidities and complex medication regimens. Unfortunately, access remains a substantial impediment, and there has been little in the current healthcare financial environment to ease this problem. Although many older patients are not referred because they are deemed too frail, these patients often achieve the greatest benefit.
Improved transitions of care have also been demonstrated to confer significant value for seniors (59–61). Certainly, cardiac rehabilitation can help in the transition of cardiac patients to home, but transitions also pertain to those entering the hospital, transferring between hospital units, or returning to home after rehabilitation. Transitions are often particularly detrimental among those with multimorbidities and frailty, especially those with cognitive and sensory (vision/hearing) limitations. Steps that reinforce communications, consistency in medications, diminished confusion and agitation, and timely follow-up will best ensure successful outcomes, as well as help relieve stress, improve quality of life, and increase long-term adherence.
Financial Emancipation From the Current Paradigm of Health Care
Although a comprehensive discussion of the implications of aging on healthcare finances is beyond the scope of this manuscript, reimbursement for healthcare services must become better aligned with, and more mindful of, age-related dynamics. Current reimbursement strategies provide incentive for performance of high-tech diagnostic and therapeutic procedures and disincentive for physicians to spend extra time discussing management options and patient preferences with older patients Furthermore, low-tech therapies, such as patient education, smoking cessation, and cardiac rehabilitation are poorly compensated or not compensated at all, despite their proven benefit in reducing CVD risk and/or improving outcomes. The fact that cardiac rehabilitation enrollment falls to <12% of eligible elderly CVD patients is a glaring example (58,62) of an underutilized low-tech therapy that has been clearly associated with both life-enhancing and life-prolonging benefits. Although an abundant literature speaks to typical barriers, including limited physical access (many cannot drive), spousal responsibilities (particularly women who cannot participate due to caregiving obligations for their husbands), and finances (even the co-pay is prohibitive to many) (59), there has been little effort to overcome these obstacles as an integral component of healthcare reform legislation. Other low-tech options that merit greater application include community and home-care exercise programs, transportation services, spousal care services, and homecare providers (to help older patients organize medications, shopping and cooking, and physician appointments and bills). Although additional study is needed, all of these services would likely be greatly valued by many elderly CVD patients, thereby improving quality of life. There is also significant potential for these services to improve clinical outcomes, including hospitalization rates, and lower overall costs of care.
Including Family in the Spectrum of Care
In general, goals to improve CV care for seniors pertain not only to the older patient, but to the family caregivers whose lives are commonly consumed with and/or mired in the patient's health issues. Cardiology has rarely addressed the extensive caregiver burdens that result from complex CV medication regimens, CV-related functional impairments and dependencies, procedures, and other aspects of CV care, despite awareness that associated morbidity and mortality risks for caregivers are significant (63). Steps to personalize therapeutic goals, enhance communications, and improve transitions will benefit not only patients, but family caregivers as well.
End-of-Life Planning in the Spectrum of Care
End-of-life issues should also be better incorporated into routine management. Open discussion about mortality can help ease feelings of isolation, depression, and even self-blame for treatment failure among patients nearing the end of life (64). Accepting the inevitability of death as part of the normal human life trajectory, rather than as an enemy to be avoided at all times, can help refocus management choices away from options that may no longer be useful or relevant. A recent study highlights that implantable cardioverter-defibrillators are rarely deactivated for hospice patients, with many futile and painful shocks in the last months of life (55). Thresholds for therapeutic curtailment for devices as well as medications should be established a priori and implemented when appropriate, without drama, guilt, or delay. Often this requires that physicians and allied caregivers teach patients and families about reasonable expectations. This requires insight, nuance, language, and end-of-life sophistication to help patients make well-informed decisions.
Personalized approaches to care may also help contain costs. Many have decried disproportionate soaring CV healthcare expenditures during the last weeks of life (65,66). More widespread use and implementation of advance directives, including honoring patients' expressed wishes, will facilitate appropriate curtailment of aggressive care, including hospitalization, in patients approaching the end of life. Additionally, alternative approaches to care, such as home hospital and hospice, should become increasingly accepted by the medical community and supported by payers as being valid and cost-effective methods for providing medical care in appropriately selected patients.
Integrating Geriatrics Into CV Care
Although cardiologists have a long tradition of providing outstanding care for CV disorders, cardiology has not prioritized tools and techniques to manage CVD as part of a multisystem approach to care. Cardiologists could learn from geriatricians, that is, clinicians specifically trained to assess different systems in juxtaposition to one another, and to design management plans that extend across different dimensions of health. Geriatricians also have better tools to modify care relative to cumulative aging changes, mounting disabilities, and to consider quality of death as part of standard care. In other words, geriatricians provide a useful language and process that can be used to augment quality and capacity of cardiac specialists to meet the needs of their older patients (67).
The American College of Cardiology recently launched a new Council on Cardiovascular Care for Older Adults. Almost simultaneously, the American Heart Association established a new committee on Cardiovascular Disease in Older Populations. These steps reflect awareness of the need to address the aging issue programmatically. Both groups are in their infancy, but provide opportunity to advance the issues addressed in this document and to facilitate integration of geriatric cardiology into mainstream CV care.
Research and Education
Research is essential to determine optimal strategies to care for older patients with CVD. It is critical that clinical datasets include comorbidity, polypharmacy, and frailty in order to better define the impact of these factors on prognosis and response to therapy. Outcomes must also be broad, and inclusive of function, quality of life, and iatrogenesis, since these dynamics are integral to the assessment of therapeutic efficacy.
Today's expanding arena of clinical datasets at the American College of Cardiology and throughout the world provide abundant opportunity to assess the efficacy of diagnosis and risk stratification, to assess the impact of specific treatments on relevant clinical outcomes (e.g., quality of life and health status), and to help refine overall clinical decision making to optimize older patients' care and outcomes. However, inclusion of functional and health status indexes into large registries and trial databases often remains encumbered by concerns regarding additional costs (who should pay for exercise assessments?), lack of standardization (how can qualitative measures be as objective as a mortality endpoint?), and high variance (particularly in regard to functional measures such as a 6-min walk). Yet, in the face of the prominent upsurge in the geriatric demographic, these methodological challenges must be resolved (68,69); steps to integrate functional (70) and qualitative measures as standards are essential research goals.
Research can also address the complex relationship between aging and disease such that CVD in the elderly may be prevented by constitutive steps that modulate mechanisms of aging that predispose to disease. It is fascinating, for example, that caloric restriction may better allay age-related alterations in left ventricular diastolic filling parameters than pharmacological modalities (71). Modification of oxidative stress and/or telomere shortening by caloric restriction or other novel therapies outside the current therapeutic paradigm may prove to be more effective than conventional medications for moderating morbidity in older CV patients (72).
The aging theme can also be trivialized by studies that do not focus on the real complexities of age. Whereas many studies claim merit simply on the basis of studying subsets of older patients, the challenge is to determine if and how less highly-selected seniors may be distinct and whether there are fundamentally better healthcare choices and processes for senior patients. Research must facilitate the tools, skills, systems, and capacities needed to better deal with the complex older adults who are our real patients.
It is conspicuous that several major CV syndromes that are relatively exclusive to older adults (e.g., isolated systolic hypertension, heart failure with preserved ejection fraction, calcific/degenerative aortic stenosis) (73,74) remain poorly understood and/or treated. Improved understanding of the biology of these disorders should lead to opportunities for new therapies, both pharmacological and biological (75), as well as a greater appreciation for the benefits of lifestyle modifications (76). In a related theme, many CV issues that increase in prevalence with aging often become categorized as primarily CV issues, such that pertinent geriatric dimensions are overlooked. For example, although atrial fibrillation increases markedly with age, it is usually managed as a complex CV issue, typically emphasizing electrophysiological, cardiac, hemodynamic, and vascular parameters. In contrast, age-centric dimensions of atrial fibrillation care, such as polypharmacology, functional capacity, and bleeding risks, are less routinely stressed.
In view of the crucial need for clinical and basic research on CV disease in the older population to address its rapidly escalating impact, it is increasingly important to forge collaborative relationships amongst the key federal institutes, such as the National Institutes of Health, the Food and Drug Administration, Center for Medicare Services, Agency for Healthcare Research and Quality, and others, as well as nonprofit organizations to spawn research that will better inform clinical decision making, policy, and reimbursement issues.
Linked to these broad clinical and research objectives is a need to disseminate principles of geriatric cardiology to CV caregivers and patients so that they are better equipped to work together in developing a care plan most suited to the patient's needs and expectations. Despite an increasingly robust literature focused on geriatric cardiology, it is remarkable that aging has yet to become a top educational priority for CV providers. Ironically, there is no longer a mainstream geriatric cardiology journal in the United States, in part because publishers are skeptical that such a journal can be published profitably; yet, it is critical that geriatric perspectives be infused into management of all forms of CVD prevalent in older adults.
Mainstream cardiology has become, de facto, geriatric cardiology, but it still lacks a systematic approach that incorporates age-related complexities into routine clinical decision making. The cardiology community must grow and adapt standards of evidence-based care to older patients, who now constitute the dominant patient population. Cardiology must embrace a broader paradigm that extends beyond the CV system, synthesizing multisystem aging, comorbidities, polypharmacy, psychosocial factors, and personal preferences into an individualized approach to care. Transitioning to this new paradigm is essential to ensure provision of optimal care for our older patients with CVD, both for clinical outcomes and patient satisfaction. A new generation of clinical trials and high-quality observational studies and registries are essential if we are to refine standards and methods for requisite care. New approaches and skills geared toward the elderly must be refined and inculcated into routine care if cardiologists are to preserve a benchmark of excellence and clinical relevance.
The authors wish to express their thanks to James McClurken, MD, as well as William Hazzard, MD, for their review and thoughtful comments during the preparation of this manuscript.
All authors have reported that they have no relationships to disclose.
- Received June 9, 2010.
- Revision received January 27, 2011.
- Accepted February 1, 2011.
- American College of Cardiology Foundation
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- Centers for Disease Control and Prevention
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Citation Manager Formats
Article Outline
- Top
- Advanced Age as a Primary Determinant of Cardiovascular Disease
- Cardiologists Are Frequently Regarded as the Logical Healthcare Leaders for the Rising Population of Older Adults With CVD
- Aging Leads to Changes in the Nature of CVD and its Management
- Limitations of the Current Therapeutic Paradigm
- Improving Care of the Older Cardiac Patient
- Research and Education
- Conclusions
- Acknowledgments
- Footnotes
- References


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SkyCable is the Philippine's Premier Cable provider now offers the Digibox. The reception is clearer and the images are sharper - these are the things I noticed after its initial set up two weeks ago. Indeed, this is a sign that the Philippines will soon shift from analog TV signal to digital.
From what I heard months ago, some of the Philippines' top media giants are slowly shifting and preparing themselves from delivering HD TV services in the very near future.


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Dr. Kurt Benirschke
Comparative placentation is an important research area in its own right and as a background to animal models of human placentation. I will not be posting detailed information about the placenta of different mammals. That function is served by a web site maintained by Dr. Kurt Benirschke (above), a retired placental pathologist with strong links to San Diego Zoo. You will find the web site at this link.
The index page currently lists over 150 species and the site is especially strong on primates and artiodactyls (even-toed ungulates). Each entry lists the relevant literature and includes some older papers that may not be found on PubMed or by other search engines.
White-faced saki Wikimedia Commons.
For a few species the entries on this web site constitute the only information available. As an example, one family of Neotropical primates is represented by the white-faced saki (Pithecia pithecia). I know of no other information on placentation in this family (Pitheciidae).


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Lesbea – Licky Lex, Lovita Fate Big natural tits lesbians tribbing (05.05.2018)
Freckled lesbian Lovita Fate is brushing her lover Licky Lex's hair sensually in their bedroom. The feeling of the brush through her hair makes Licky feel adored, and in turn, turned on. Getting up, Licky pushes Lovita onto the bed, and climbs on top of her to make out. Licky sucks Lovita's pretty pink nipples, then Lovita loses herself between Licky's big natural tits. Lovita then pulls Licky's panties to the side and licks her pierced pussy, then gets into doggiestyle position so Licky can eat her pussy and ass. The ladies grind their pussies together with some sensual tribbing, then take our a clear dildo to bring each other to glorious orgasm!


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About Our Site
PetsAndKids was formed to offer a unique reference point on keeping animals around children.
Owning pets, gives children an interest and also a responsibility as they learn how to care for the animal and provide the pet with its daily needs. Here on the PetsandKids site we aim to show you how children and pets can co-exist safely and also give children an insight into the world of animals.
PetsandKids is a website you and your kids will want to come back to time after time because it contains so much information on such a wide variety of topics, encouraging them to take an interest in their pets environment and what they personally can do to protect it.
Training for the child and for pets such as cats and dogs is vital and the PetsandKids site will show you how to achieve this without too many tears from the child or the pet!
The PetsandKids site is the ideal place to visit when deciding if to make a pet part of your family.
Our concern was that there was no single UK resource for interesting features and practical advice on this subject.
Our features and articles are written by experts - who have experience, or a particular interest in this area.
Our BackgroundPetsAndKids was founded by John Rowlinson, the founder of PtS.
John, through PtS, is involved in a number of ventures including software and property companies. A percentage of revenue from these activities goes towards funding PetsAndKids and a number of similar sites.
Our focus is simply on having experts create the highest quality information possible that is widely read.


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This is a module with one function that will give you some more functionality than what you can do with the App.LogEvent method in VB6.
1. You will be able to specify the EventLog (Application, Security or System)
2. You are able to specify the Source (Your own Application identifier instead of the VBRuntime)
This module is also used in the ExeptionHandler dll.
Click here to download the complete source code.
Here is some sample code:
Visual Basic
writelog EventLog_Application,"My Special APP", vbLogEventTypeError, "Oeps, Something went wrong"


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Indian Oil Corporation Limited, Bongaigaon Refinery, Dhaligaon is going to recruit for the post of Junior Engineering Assistant, Junior Materials Assistant & Junior Quality Control Analyst. The candidates may apply till 23rd January 2017.
Minimum 3 years regular/sandwich Diploma in relevant engineering or B.SC (Math, Physics, Chemistry or Industrial Chemistry) from a recognized university with a minimum of 50% marks for General & 45% for SC/ST candidates. Refer to the official notification to get post wise educational information.
Selection will be made through written test or skill/Proficiency/Physical Test.
Payment should be made through Demand Draft in favor of IOCL Bongaigaon Refinery payable at State Bank of India, BRPL Complex Branch (Branch Code: 7171, IFSC Code: SBIN0007171). No other bank will be applicable.
The candidates need to send their application form in prescribed format with required documents attached to the address given:
Chief Human Resource Manager,
IOCL (Bongaigaon Refinery), Post Office – Dhaligaon,
District – Chirang,
Total No. of Posts: 56 Posts
Post wise vacancies
- Junior Engineering Assistant-IV (Production) - 28 Posts
- Junior Engineering Assistant-IV (P&U) - 13 Posts
- Jr. Engineering Assistant-IV (Electrical) - 01 Post
- Junior Engineering Assistant-IV (Fire & Safety) - 02 Posts
- Junior Engineering Assistant-IV (Instrumentation) - 02 Posts
- Junior Materials Assistant-IV - 09 Posts
- Junior Quality Control Analyst - IV - 01 Posts
Qualification or Eligibility
Age Limit: 18 to 26 years as on 01st October 2016.
Selection Procedure
Pay Scale
Application fee
How To Apply
IOCL (Bongaigaon Refinery), Post Office – Dhaligaon,
District – Chirang,
Pin code – 783385,
Last Date: 23/01/2017


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UPDATED: Henry Cavill leaves DCCU and Superman behind!
In what many might argue as an event long coming, it was revealed today in an exclusive from The Hollywood Reporter that Henry Cavill will be shirking off the big S and red cape for good and leaving Superman behind.
According to the report, Warner Bros. is not planning on making a Superman film for quite some time. A studio insider also noted that Warner Bros. recognized that 'some parts of the previous movies didn't work' and that the studio is aiming on hitting a reset button on their current DCCU and steer the franchise into another more standalone focused direction. Whatever they decide though will no longer include Cavill.
As of the initial publication of the story, Warner Bros has come out with an official statement regarding the situation:
"While no decisions have been made regarding any upcoming Superman films, we've always had great respect for and a great relationship with Henry Cavill, and that remains unchanged."
via THR
Henry Cavill has plenty of work coming at him despite leaving the role of Superman behind. Just a week ago, it was revealed by Netflix that Cavill would be taking on the role of Geralt of Rivia in their upcoming adaptation of The Witcher.
Geralt of Rivia, for those who are unfamiliar, is a solitary monster hunter who has struggled to find his place in a world where people often prove more wicked than beasts. But when destiny hurtles him toward a powerful sorceress, and a young princess with a dangerous secret, the three must learn to navigate the increasingly volatile Continent together. Netflix is aiming for a 2020 release, which provides fans of Cavill certainty as to when we will see him next.
Superman is not the only one that may be phased out. Within the same exclusive, it was mentioned that Ben Affleck might be on his way out as Batman. However, this news might also not come out as a surprise given how many difficulties have been had behind-the-scenes on the solo Batman movie that Affleck was trying to make with Warner Bros. If Affleck does leave, one does wonder how Warner Bros. will attack the casting process if they plan on bringing both big-time DC superheros back into the fold.
Henry Cavill has portrayed Superman since Warner Bros. launched their DC Cinematic Universe with 2013's Man of Steel. He appeared two more times in the DCCU in Batman v Superman: Dawn of Justice and Justice League.
What do you think of this news? Do you think this restructuring from Warner Bros will finally fix the DC Cinematic Universe or will it further aggravate the problems it already has? Let us know in the comments below or tweet us at @LegionofLeia.


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Mobility as a tool for Pandemic Management
With the frequencies of pandemic diseases increasing, governments, world over should look at effective tools that can enable them manage the diseases more effectively. Mobile phones even the most basic ones can aid governments across key pandemic management activities. This is truer in developing countries where the mobile penetration has been more rapid than traditional telephony. For example over 40% of Indian population including people in the remote rural areas has access to mobile phones.
So, what can a mobile do?
Managing a pandemic covers 3 main facets - precaution, treatment and prevention.
1.Precaution to avoid spreading,
2.Treatment covers early identification, isolation and treatment of the affected and
3.Finally Prevention ensures the right vaccination to be delivered in an effective time-bound manner across the country.
The main challenges for effective management of the above activities are:
•Creating awareness and enabling public to take the necessary precautions at a national level within a short span of time
•In case of affliction ensuring that help is on-hand whenever and wherever a person requires it
•Ensuring that vaccinations are effectively done covering the entire population
Mobile phones can be an effective delivery aid for all the above:
•Government in partnership with mobile service providers can effectively and continuously reach out to the entire population through SMS (text and voice)
•Help desks and multi-lingual IVR (Interactive Voice Response) systems can deliver much needed advisories to the public.
•A central pandemic management system can enable real-time update and delivery of disease specific information to the entire population.
•Location awareness of callers can be used to direct people to the nearest health center capable of diagnosing and treating the disease.
•Service provider infrastructure can be leveraged to effectively identify help desks at the nearest health center and route help calls appropriately.
•Information on vaccination clinics can be delivered in a guaranteed manner significantly increasing the reach and awareness of the government's vaccination program.
•Feedback via SMS and IVR can effectively close the loop - enabling the central pandemic management committee to track the progress of the initiative and identify bottlenecks early in the cycle. This also cuts the tapes and enables public to directly voice their concerns and viewpoints to powers that matter.
All the technologies and infrastructure required to do the above currently exist and can be rolled out rapidly. It is important for governments to include the above as part of their disaster management planning. Regulations along the lines of E911/CALEA can ensure compliance and readiness of communication and healthcare service providers to support such scenarios.


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Raising Ninjas..
I wondered if it was because they watch Teenage Mutant Ninja Turtles or Ninjago is the new favourite but having banned it and pulled back from TV as a whole they are just seriously physical kids.. It doesn't matter whether playing Pirates, Jungle Games or whatever they end up leaping from things they shouldn't onto items that aren't for landing on. They never walk, they only ever run. They don't stand on escalators they jump the steps like frogs. They have no quiet voices everything is always so exciting!!
I don't even know why I am surprised.. I am not the quietest person and hubby and I are sports nuts (well he has taken a bit of a back seat of late.. ahem yes young man.. get back out there before you are an old man).
Why am I writing this? I needed to and wondered if anyone else has the same issue. What do you do to manage it? I don't have money for gymnastics classes or the likes and I go to the playground to let them run of steam whilst I freeze my butt off but surely they should be able to spend more than a few hours at home without me loosing the plot on them for fighting?
9 comments
I wish I had the solution......ReplyDelete
I can only offer empathy.
I know exactly what you mean. It drives me nuts when my two fight all the time!
Tania xxReplies
Seriously huh?!.. good to know I am not alone xDelete
Its all part of growing up I think.ReplyDelete
Testing the boundaries of what is acceptable / what hurts / what doesn't.
Just a pity it wrecks moms heads at the same time! ;)Replies
so true, so true xDelete
- Betty Harrington8 July 2012 at 20:05
What can you expect, it is in the genes...your brother at the age of 4 and you at 9 were skateboarding down the driveway of our house with a 1 in 9 gradient and a 7' brick wall being the only thing at the end of the drive, that is unless you could negotiate a 90 degree right handReplyDelete
bend and hope the garage door was open for the run off !!!!!!! You were not there when Pa handgliding off a hill and landed in a cow!!!!!!!
- Anonymous10 July 2012 at 18:47
in a cow?!!!! ouch!ReplyDeleteReplies
LOL I thought that too!!Delete
I don't know about the fighting siblings but my son is also very physical. He NEEDS to move, to run and jump and climb and bounce. He is at his absolute happiest when outside. And unfortunately his father and I, in our then childless wisdom, bought a house with NO Yard. So that means daily trips to the park. I do a mums and bubs training twice a week in the park so that manages to kill two birds with one stone.ReplyDelete
It's a really wonderful attribute, to have such boundless energy, but I agree, it's pretty taxing as a mum. I am still so amazed at the young children who sit for seemingly hours with their parents at restaurants. I keep thinking our next child (whenever that may happen) will be placid and easy going, but it's pretty delusional. And then, no doubt, I will be dealing with the same challenges of energetic siblings squabbling.Replies
That you will but I love the personality as I am sure you do too.. the grass is always greener huh?!Delete


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The news from boffins in America that running enhances the memory will come as a surprise to anyone who has run a marathon. They will acknowledge that the overwhelming mental state for anyone crossing the line at the end of the race is one of total amnesia. The awfulness of the training, the mind-numbing boredom of all that control exercised over diet and alcohol intake, not to mention the excruciating discomfort that came from missing the comfort station at Mile 21, are all forgotten in a cloud of misplaced euphoria in which you find yourself succumbing to a persuasive voice in your head going: "You're going to do this again next year. And you'll do it quicker."
Mind you, the fact that the reward for all that pointless rodent-on-a-wheel effort comes in cerebral expansion somehow makes sense. Something has to benefit from the relentless misery that is jogging, and since we know it is not the body – grumbling, aching and sagging with every flat-footed step – it must be the brain. After all, it is the brain doing the prompting to make us go out there in the first place.
Running is a continuous battle between the body and the mind, with the mind feeding all sorts of lies to the wary, cagey, risk-averse body. These past few weeks of frozen winter, for instance, the lie it has propagated has been this: wrap yourself in layers of unforgiving Lycra, slip on a bobble hat, then weave unconvincingly out for a five-mile trek across the tundra. All this in order to enjoy all the more that spot on the sofa in front of a crackling fire, with wine mulling on the hotplate and chocolates winking from their Christmas selection box.
Yet any application of logic would suggest this is untrue. The sofa can be enjoyed just as heartily if approached directly from under the duvet. In fact, all the more so, as your knee is not encased in ice to ease the pain of that nagging injury.
Now we know why the brain behaves like that – but somehow, the news that jogging does buff up the brain cells will come as a disappointment to those of us in thrall to its brutal lure. Sure, we tell ourselves that the best way to clear the head is to don the trainers and hit the pavement. Even if a double espresso can usually serve the same purpose. But actually, what we want out of running is the war stories. What we really like is not to feel we are enjoying any perks; it is to revel in the pain.
Pain is what drives us runners. Or rather, it is the opportunity of talking about it to other people. As with adherents of a particularly fierce religious sect, or those who boast of living in Hackney, the main purpose of running is loudly to explain to non-believers how miserable, dangerous and uncomfortable it is. Nobody who runs likes to keep his masochism to himself. We bore at parties about our damaged joints, our dodgy heels, the searing pain that runs up the back of the calf about Mile 15. Pain has long been our purpose, not self-improvement.
In truth, though, we joggers have long since exaggerated the pain of our calling. When I finished the marathon a couple of years ago, I was standing in line waiting for a massage behind two blokes and their female friend. The men were complaining about the agony of it all and one of them said to the woman: "That was the most painful thing I have ever done. I'm interested to know, how does it compare with childbirth? Is it worse than that?"
"Worse than childbirth?" came back the reply. "Sweetheart, it's not even as bad as breast-feeding."


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We're an online company created solely for the purpose of guiding PhD students through the doctoral process faster and easier.
If you're a doctoral student somewhere in the world working on a dissertation or thesis, a professor who wants to find help for your most challenging students or a university that wants to raise doctoral graduation rates then you've come to the right place and we look forward to hearing from you.
The DoctoralNet Team


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Posted by Danny Kaye on March 04, 2005
Hey all. First time at this site. Pretty cool.
I would love to know the origin of the phrase "forked-tongued". I understand it to be an old American Indian phrase that means to lie, but when was it used first and about whom?
Also, I think it could be added to the 350+ body parts phrases you have.
Anyway, great site. Will visit often.


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The Best Yogurts
Spoonful by spoonful, Real Simple sampled and scooped ― and came up with winners in nine categories.
Custard Style
Winner: Dannon La Creme Vanilla (each 4-ounce cup contains 15 percent of the daily value for calcium and 5 grams of fat). Testers were enamored of its puddinglike consistency and sweet flavor but viewed it as an indulgence rather than a quick, healthy snack.
Winner: Dannon Light Fit (each 6-ounce cup contains 15 percent of the DV for calcium and 0 grams of fat). While testers liked Dannon best, they wished the essence of vanilla could have been stronger and a bit less "artificial tasting." Testers were put off by the intense sweetness of most light yogurts (which generally contain aspartame).
Winner: Dannon La Creme French Vanilla Mousse (each 2.6-ounce serving contains 10 percent of the DV for calcium and 5 grams of fat). Comments ranged from "Melts in your mouth" to "Wow! Is this yogurt?" One tester called it "hands down the best flavor." Another, however, called the consistency strange, "like spongy Jell-O."
For Kids
Winner: Yoplait Yumsters Strawberry/Vanilla (each 4-ounce tube contains 20 percent of the DV for kids of calcium and 2 grams of fat). Adults found the taste of most kids' yogurts too artificial and the colors too funky. Yoplait, with a silky-smooth texture, was the best. Kids had distinctly different opinions: A 12-year-old liked rich YoBaby, even though it's meant for babies and toddlers.
Single Flavor
Winner: Brown Cow Lemon Twist (each 8-ounce cup contains 35 percent of the DV for calcium and 2.5 grams of fat). Testers liked its "thick, tart, refreshing," and "real lemon" flavor. This was not a landslide win: Yoplait's Lemon Burst came in a close second.
Fruit on the Bottom
Winner: Dannon Strawberry (each 6-ounce serving contains 20 percent of the DV for calcium and 1.5 grams of fat). Testers easily voted this best. It was not exceedingly sweet and had a "natural strawberry flavor."
Winner: Horizon Organic Strawberry (each 6-ounce cup contains 25 percent of the DV for calcium and 0 grams of fat). The majority of testers liked Horizon for its "natural fruit flavor" and smooth consistency that was "not too thick and not too thin."
With Crunch
Winner: YoCrunch Strawberry (each 6.5-ounce cup contains 15 percent of the DV for calcium and 2 grams of fat). Testers noted a lot of "artificial" and "very fake" tasting crunchies in this category. But when pressed to choose a favorite, they singled out YoCrunch's entry, with its cinnamony crunchies.
Winner: Fage Total Authentic Greek Yogurt (each 7-ounce serving contains 20 percent of the DV for calcium and 20 grams of fat). Testers loved the thick texture and tart flavor of this imported cult hit (not surprising - its fat content rivals that of ice cream, though low-fat versions are available, too). One tester likened it to rich, thick sour cream. Another said, "This is how yogurt is supposed to taste."


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Invoice in a Second!
E-invoicing allows you to generate an invoice online, send it to your customer, and receive payment within seconds. After receiving the invoice via e-mail or SMS, they simply click «Pay» to enter card data. You will receive a payment confirmation instantly.
For Small and Medium Businesses
Goods and service vendors
Private service providers
Sellers of handmade goods
Designers and artists
Beauty industry specialists
Telecom providers
Coaches and tutors
Other entrepreneurs
No extra meetings
We can conclude an agreement integrate our solution remotely. Save time for meetings that really count
All services in a single browser window
Bilderlings goes beyond acquiring – with a current account and e-commerce solutions available within one system
Fast onboarding
85% of our clients are onboarded in less than 7 days.
Speed up payments and improve conversions
All a customer needs to do is click the pay button and input their details – no website or store registration needed. With such simple procedure, more customers will be able to pay on the spot.
Speak their language
Bilderlings Invoicing allows you to issue an invoice in any language your customer prefers, including English, German, Latvian, or Russian. We can always expand this list based on your needs.
Keep track of debtors
Bilderlings Invoicing is the only e-invoicing service in the Baltics that calculates late fees and updates the amount payable. Our system of reminders and late payments will warn them about current payables.
Streamline your accounting
Keep track of invoices and received payments, download as PDF, and ask payers for additional information by adding extra fields to your invoice.
Automatic recurring payments
Create subscriptions that will automatically send invoices to customer at specific intervals. A wonderful feature for monthly service fees or periodicals, rental establishments and gyms.
Connect several businesses or users
Our user-friendly interface enables the management of multiple companies from a single user account; you can also specify key staff at your company as distinct users with access to the account.
Issue identity-branded invoices
Adapt your invoices and payment page based on your corporate identity: familiar colours and styles will boost payer confidence and readiness to pay.
Get registered – fast!Sign up
Upload documents and sign the agreement
Set up your payment page
You only pay monthly invoicing fees and transaction fees.
- Unlimited invoices
- Subscriptions
- SMS-notifications
- Custom payment page design
- Custom invoice design
- Invoices overdue fee
- Access to API
- Unlimited invoices
- Subscriptions
- SMS-notifications 300
- Custom payment page design 50 €
- Custom invoice design 50 €
- Invoices overdue fee
- Access to API
- Unlimited invoices
- Subscriptions
- SMS-notifications ∞
- Custom payment page design 0 €
- Custom invoice design 0 €
- Invoices overdue fee
- Access to API
Check your card acquiring fees
This information is provided for reference only: actual rates are set on a case-by-case basis
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at Connection fee – 200 €


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HostExchange needed a new logo design and created a contest on 99designs.
A winner was selected from 87 designs submitted by 40 freelance designers.
Discussing the entries with the client, will be back shortly with a result.
Thanks to everyone who entered, a great contest!
Desired Color Scheme:
Any bright colours - thoughtfully selected
Desired Style:
Fun, youthful, relaxed
Accepted File Formats:
psd, ai
This company is an importer/wholesaler of party supplies. Eg, baloons, hats, poppers, paper cups/plates, streamers, decorations, etc.
They are re-branding with the name "pRtee" (web-version: "pRtee.com".
The have no particular preconceived ideas, just that it be lively, colourful and fun. Go for bright primary colours and party-type themes, but do keep it simple.
Things I'll be looking favourably on are:
- clean, simple design (avoid streamers, bubbles and fireworks!)
- Approx 4:3 or 4:2 dimensions
- a clear & simple symbol
- thoughtful use of colour
Find out how a design contest works or learn more about our logo design services.


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Many digital pattern resources may only provide .PNG graphic file format for you, because of that I want to share a quick tutorial of how to define a digital graphic pattern as .PAT file in Photoshop so you can apply it in larger canvas dimension for further editing process.
Step 1 - Open the digital graphic pattern file
Any graphic digital pattern file format, such as: .GIF, .JPG or .PNG can be defined as pattern in Photoshop. To have good quality result, be sure that they are available as seamless pattern as they will be repeated in all direction later.
Step 2 - Define pattern
Once your digital graphic file is opened, go to the Photoshop main menu bar, find: Edit > Define Pattern
Another dialog box will be shown, and this time you have to name your new defined pattern then click OK when it's done.
Step 3 - Creating .PAT file for a set of patterns
Whenever you define more than one pattern, you will see all of the defined patterns in Preset Manager. Go to Edit > Preset Manager select 'Pattern' for the Preset Type option and you can see all the previous defined patterns are listed. Click the Save Set button to create the .PAT file.
You can group certain pattern type (based on the shape or design style for instance) and save them as different .PAT file. Click the Load button to add another set of .PAT file pattern in your Preset Manager.
How to fill canvas with Photoshop pattern
After you understand how to define pattern as .PAT file in Photoshop, it will be very easy for you to apply the defined pattern into any size of Photoshop canvas dimension.
First of all, create any size dimension of new blank transparent canvas file: File > New.
There are several ways to apply the pattern:
1. Use Fill tool (Shift + F5) - with this tool you can select Blending Mode type or set the Opacity of the pattern before you apply it to the canvas.
2. Use Paint Bucket tool (G) - Beside Blending Mode options and Opacity control, there are also more different options if you use Paint Bucket tool to put pattern in your blank canvas.
3. Use Shape tool (U) - The advantage of using this tool is that you can apply Pattern Overlay using Layer FX tool and scale the pattern to seamlessly appear smaller. I'm not suggesting you to scale the pattern bigger because the resolution quality will not be nice to see.
How to add color to your pattern
Basically, it is very easy to add color to your pattern by setting the opacity of the pattern layer above another layer that has solid color background. The bottom line is to make the pattern layer to look transparent with this technique.
When you fill pattern using shape tool, you can also add other effects using Layer FX tool, for instance: use Color Overlay effect, after you decrease / adjust the opacity of the Pattern Overlay effect.
I hope you will find this short tutorial useful. Use the comment form below if you have more questions and be sure to subscribe to GraphicIdentity Blog Feed because there will be another follow up tutorial related to 'pattern' soon.
Related Post:
- 50 Modern and Minimalist Patterns
- 12 Digital Stripes Texture Sets
- Subtle Seamless Patterns - Part 1: Free Geometric Pattern


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Arrochar Community Hydro welcomes Scottish Renewables CEO
Arrochar Community Hydro, a scheme conceived by Luss Estates and on land leased to the community development trusts at a peppercorn rent, recently welcomed a visit from the new CEO of Scottish Renewables, as well as representatives from Loch Lomond & The Trossachs National Park.
Scottish Renewables is the voice of renewable energy in Scotland and is committed to realising the full economic, social and environmental benefits of renewable energy for our country. CEO Claire Mack joined Scottish Renewables in June this year from her position as Director of Policy and Place at the Scottish Council for Development and Industry. She believes in the role of the renewable energy sector in driving wider economic growth in Scotland.


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According to Inner Body, the uterus is located behind and slightly above the bladder, centered between the hips in a woman. It is above the cervix and the vagina, according to WebMD. The top of the uterus is connected to the fallopian tubes.
The uterus is also known as the womb as it carries the baby once an egg has been fertilized, and it is about the size and shape of a pear, notes WebMD. The uterus is also responsible in part for the menstrual cycle as the lining thickens each month in preparation for a fertilized egg to implant in the uterus, according to Inner Body. If the egg is not fertilized, both the egg and the lining pass out of the body during menstruation.


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The Humanistic View of Human Behavior
Humanistic psychology is a value orientation that holds a hopeful, constructive view of human beings and of their substantial capacity to be self-determining. It is guided by a conviction that intentionality and ethical values are strong psychological forces, among the basic determinants of human behavior. This conviction leads to an effort to enhance such distinctly human qualities as choice, creativity, the interaction of the body, mind and spirit, and the capacity to become more aware, free, responsible, life-affirming and trustworthy.
Humanistic psychology acknowledges that the mind is strongly influenced by determining forces in society and in the unconscious, and that some of these are negative and destructive. Humanistic psychology nevertheless emphasizes the independent dignity and worth of human beings and their conscious capacity to develop personal competence and self respect. This value orientation has led to the development of therapies to facilitate personal and interpersonal skills and to enhance the quality of life.
Since there is much difficulty involved in inner growth, humanistic psychologists often stress the importance of courageously learning to take responsibility for oneself as one confronts personal transitions. The difficulty of encouraging personal growth is matched by the difficulty of developing appropriate institutional and organizational environments in which human beings can flourish. Clearly, societies both help and hinder human growth. Because nourishing environments can make an important contribution to the development of healthy personalities, human needs should be given priority when fashioning social policies. ,This becomes increasingly critical in a rapidly changing world threatened by such dangers as nuclear war, overpopulation and the breakdown of traditional social structures.
Many humanistic psychologists stress the importance of social change, the challenge of modifying old institutions and inventing new ones able to sustain both human development and organizational efficacy. Thus the humanistic emphasis on individual freedom should be matched by a recognition of our interdependence and our responsibilities to one another, to society and culture, and to the future.
Methods of Inquiry
All of these special concerns point toward the need for a more complete knowledge of the quality of human experience. Humanistic psychology is best known as a body of theory and systems of psychotherapy, but it is also an approach to scholarship and research, to inquiry informed by a strong sense of purpose. The purpose is to provide a level of understanding that can promote the power of personal choice and the care and effectiveness of social groups. Humanistic psychology recognizes that human existence consists of multiple layers of reality: the physical, the organic and the symbolic. In considering these components it advocates the use of a variety of research approaches to study their characteristics and intentions. It contests the idea–traditionally held by the behavioral sciences–that the only legitimate research method is an experimental test using quantified data. It argues for the use of additional methods specifically designed to study the organic and symbolic realms.Humanistic psychology is strongly supportive of phenomenological and clinical approaches to the study of the human position in the order of life. It also encourages the discovery of new research approaches which seek to further understand the richness in the depth of human being. The symbolic dimension of consciousness is of special interest . It is in this realm of our lives–a uniquely human realm– that meaning value, culture, personal decision and responsibility are expressed and manifested. The humanities are thus important resources in humanistic psychology research. Another thing the humanistic approach brings into account is the fact that society's ideas about what count s as legitimate knowledge constitutes a certain kind of power over our lives.
The assumption that knowledge is confined to what can be directly perceived and publicly measured leads easily to the conclusion that personal values, meaning and decision lack a larger significance or interpretation. The value-based position taken by humanistic psychology implies a commitment to the use of research approaches that provide access to all characteristics of human existence.
Humanistic Psychotherapies
During the 1950s and 60s, Carl Rogers introduced Person Centered Psychotherapy, Roll May imported Existential Psychoanalysis from Europe and Fritz Perls developed Geslalt Therapy in his workshops and training programs at the Esalan Institute and elsewhere. In the decades to follow, humanistic psychologists have transformed the field of psychotherapy by breaking down the societal stigmas attached to "therapy", thereby popularizing the usage of humanistic approaches in healing. First Force (behaviorism) has achieved some important successes in addressing specific behavioral problems using behavior modification and cognitive behavioral therapy, which are practical applications of B.F. Skinner's important research on operant conditioning. The Second Force (psychoanalysis) has also achieved important advances by incorporating theoretical perspectives such as ego psychology and object relations theory.
But the whole person, multi-dimensional perspective of the Third Force (humanistic psychology) has generated a broad spectrum of approaches that enormously expand the range of options for dealing with psychological, psychosomatic, psychosocial and psycho-spiritual conditions. In addition, it has emphasized that psychotherapy is not only of value in dealing with emotionally crippled, neurotic and psychotic populations.
It is equally relevant to the interests of relatively healthy people who are interested in exploring the farther reaches of human potential and examining the intrinsic role we have as humans in maintaining homeostasis on the planet, otherwise known as Ecopsychology. Approaches embraced by humanistic therapists include: Bioenergetics (Wilhem Reich, Alexander Lowen), Sensory Awareness Through Movement ( Moshe Feldenkreis), Focusing (Eugene Gendin), Authentic Movement (Mary Whitehouse), Encounter (Carl Rogers, Will Schultz, National Training Lab, and many others at Esalen and elsewhere), Rational-Emotive Therapy (Albert Ellis), Reality Therapy (William Glasser), Analytical & Archetypal Psychology (C.G.Jung, James Hillman), Psychosynthesis (Roberto Assagioli), Gestalt Art Therapy (Janie Rhyne), Existential Analysis (Rollo May, James F.T.Bugental), Logotherapy (Viktor Frankl), Self-Disclosure (Sidney Jourard), Conjoint Family Therapy (Virginia Satir), and Neuro-Linguistic Programming (Richard Bandler & John Grinder).
Humanistic Psychology Today
During the 1970s and 80s, the ideas and values of humanistic psychology spread into many areas of society in the United States. As a result humanistic psychology is no longer "Humanistic Psychology". It is, of course, still represented by the Association for Humanistic Psychology and the Journal of Humanistic Psychology , as well as APA Division 32, the Division of Humanistic Psychology. However, it is also represented in a variety of APA divisions concerned with psychotherapy and issues of social concern. And it is in Transpersonal Psychology (Association for Transpersonal, Journal of Transpersonal Psychology, New Age, East-West, the Consciousness Movement, Noetic Sciences); the Growth Center and Human Potential Movements; the Self-Esteem and Addiction Recovery Movements; Family Therapy, Holistic Health and Hospice, and Organizational Development and Organization Transformation.
It is philosophically aligned with the post-modern philosophy of science, constructivist epistemology, structuralism, and deconstructionism. We also could include green politics, deep ecology, the feminist and gay rights movements, and the psycho-spiritual wing of the peace movement. Perhaps this is what Rollo May was pointing to when he suggested that AHP has accomplished the mission for which it was founded. This breadth, depth and diversity is representative of the world we live in and takes into account an integrated and balanced view of human nature and maintaining balance and harmony in the grand scheme of existence.
"As the world's people demand freedom and self-determination, it is urgent that we learn how diverse communities of empowered individuals, with freedom to construct their own stories and identities, might live together in mutual peace. Perhaps it is not a vain hope that is life in such communities might lead to the advance in human consciousness beyond anything we have yet experienced. "


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Our front yard faces west and the northern half is dominated by a large mountain ash. This is a lovely old tree (about 50 years, we think) but it has been succumbing to fireblight. I've pruned the blight a number of times but it keeps coming back and I think we'll have it removed this autumn before the wind takes it out.
This portion of the lawn is mostly an iris bed with a small vegetable plot and about 45 square feet of lawn abutting the city sidewalk. In preparation for taking the tree out, I decided to convert the lawn to a garden bed. The soil is fairly nasty so we decided to try a small hugel kultur bed.
Basically the sod and dirt is lifted out, old branches are dropped in (which create spaces for air and water and release nutrients slowly over time), the sod is reversed and replaced and then the whole thing is topped with soil and compost. True hugel kultur beds are large mounds but apparently every small beds will work. Above you can see the sod stripped out and the wood dropped in place. Below, a very exhausted looking Jessica has helped me replace the sod and swept up.
That took most of Saturday. This morning I put some manure and dirt in top, dug the rest of the bed and we're good to plant in a week to two. Relatively new wood apparently grabs a lot of the nitrogen from the soil as it starts to rot so we're going to plant bush beans (yellow, green and purple) to fix some back in. Along the brick walk we'll do some tomatoes (plum on stakes and cherry in cages). When the trees comes out in the autumn (and assuming my body recovers from this weekend's work...), we'll look at putting in three fruit trees along the hedge line.
We also puttered and cleaned and planted some more onions. The first of the onions we planted in the old garden bed have poked up. In the cold frames, the garlic is up about seven inches (the wood in behind is a 2x6").
I will likely remove the glass on this frame in about a week when temperatures stabilize--the garlic is bumping up against it. The kale has also germinated and will need to be thinned in a week or so. Lovely to see things growing!
The chives in the new garden bed are up and a bunch of them went into the potatoes we're roasting tonight. If you look closely, you can also see a tiny spider on the tallest chive on the right--he has spun a web between the two tallest chives. I also some bees of some kind buzzing about today.
We managed to get some lettuce and chard seeded into the left-most new cold frame (below). Not sure what will go in the frame to the right. I wonder about seeding in some rutabagas?
Hopefully we will see some bulbs flower out this week--lots are up and the daffodils have buds. Now I'm off to have a nap.


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5 Champion Tips for great Email Layout
Among other marketing plans, email marketing is considered as the best to compel your audience give attention to your products or services. But it's not easy. You will have to make a strategic plan for design, layout and content of an email to make it a 'wow' for your marketing. Email marketing requires a lot of things to line up exactly as needed. Email layout is one of them.
Let's have a look at the tips that can make your email layout awesome.
Give your call-to-action a real importance:
Since most of the readers first take a look at the top sentences and the end para of emails thus these are your power spaces. To trigger the interest, add clear and striking call-to-action at the start and end part.
Make the most of the little time you get to attract the reader to go ahead further and complete the required action of click at your link or subscribe through a simple and repetitive CTA.
The ideal width:
Scrolling from left to right and vice versa can lead your reader to unsubscribe your emails!
To stay at the safe corner, keep your email width 600 pixels wide only and ensure that all of your content can be read easily without scrolling.
Studies showed that the content on the left gets high focus than the content on the right. Fix this in your mind and place the core of your email either content or image on the left side of email.
Content to image balance:
From not too much content to, not too many images, the designers got stuck in the middle most of the time.
Don't be confused.
It is often recommended that keeping the text in the limit of 500 characters will pass the spam. On the other side, 2-3 images have high chances to get the second glance of the reader. Avoid adding one big image.
Place this content to image formula deep in your head to prevent layout confusions.
Not too many columns:
Create the email design that is enough to impact the decisions of your readers in your favour.
More than 3 columns make deign crowded and break the rule of focus grabbing design. With 600 pixel width, 2-3 columns are sufficient.
Create the mail in the fast reading pattern:
Well it's true that visuals have more attention gaining power than the text. But you cannot completely avoid the text.
Studies depict that majority of the readers do not read the full email rather they move the eyes in 'F' shape pattern.
Therefore make the starting text at the left bold and use strong words to persuade the reader to take action and convert them into your potential customers.
Yasir Jamal is an experienced web designer and developer in Dubai-UAE. Knowing exactly the do's and don'ts, he design the websites and emails that resonates with the business demands and keep the designs elegant and inspiring based on the latest design trends.