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Alexander Wang has been known to make statements in the fashion world. Since his debut in 2007, he's had the ability to create trends that
Tag: Fashion
Columbus: Fashion
June 6, 2016 Historically, the city of Columbus has rarely been credited for its hand within the fashion industry, as people often overlook the contributions,
Western Influence
February 18, 2016 Kanye West is single-handedly influencing the world of fashion within popular culture. Since the self-described "Louis Vuitton Don" debuted onto the masses,


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Weekend Staycation at Casa Belinda (Lipa, Batangas)Saturday, February 03, 2018
When I retire, I want to live in the countryside and experience country living. I want to have my own place where I can't hear cars honking right outside my window. A place where I don't have to worry about neighbors playing videoke too loud. A place where I can hear birds chirping or rooster crowing in the morning. A place where there is little light pollution so I could see countless stars at night.
|Casa Belinda's more enchanting at night :)
About Casa Belinda
Originally a ranch, Casa Belinda was acquired by the owner just 5 years ago. It used to be a place where the previous owners raise horses. Eventually, the current owner turned the farm into a cozy country abode combining country living elements and contemporary design. They also allotted a large area to grow organic lettuce and other crops for their family and friends. Many who have visited Casa Belinda urged the owner to open the place to the public so that people can experience country living at its finest.
|Although it was gloomy that day, we received warm welcome from the staff of Casa Belinda :)
The Modern Kubo
This 2 bedroom kubo, our home away from home, comes complete with wonderful views of Mount Malarayat Golf & Country Club. The country living inspired kubo is well-suited for families and groups looking for a peaceful respite just a few hours from the metro. It has balconies that overlook the pool and the golf club. It is furnished with a cozy living room, a modern kitchen, a gorgeous bathroom with a shower, and a barbecue grill for your samgyeupsal night. For only 8,000 pesos/night, up to 6 guests can enjoy this lovely kubo.
|warm and inviting room at Casa Belinda
One of my personal favourite parts of the kubo was the Master's Bedroom. It was spotless clean with big glass window overlooking the attractive garden of the property (you can always pull down the blinds if there's too much light). It has flatscreen HD TV and a spacious wardrobe. The mattress was good - not too hard and not too soft. I had an excellent uninterrupted night's sleep.
|the master's bedroom and the stunning views of the farm
Other Room Options
Although the main kubo of Casa Belinda is ideal for families and groups of 6, solo and couple travelers also have another options. The two extra rooms in the main house can accommodate up to 3 people each, which costs 4,000 pesos/night. These rooms have a private bathroom with shower, and have been decorated with modern furniture and earth colours. Just like the main kubo, these rooms have access to a veranda, which provides stunning view of the pool and the garden.
|Aside from the Modern Kubo, there are also two extra rooms open to visitors at the main house of Casa Belinda
I had a great weekend with my travel blogger friends at Casa Belinda. Although it rained during our entire stay, I still enjoyed the place. For someone who hates long bus rides, this charming property in Lipa, Batangas is definitely a great place to spend the weekend. If you would love to experience the Case Belinda, check the rates and availability here!
|Our complimentary breakfast :)
Travel Notes
How to get to Casa Belinda:
- Board a bus (JAM Liner) bound for SM Lipa from Cubao. One way fare is 132 pesos and travel time is 2 hours.
- Please be advised, exact location information is provided after a booking is confirmed.
Sample 2D1N Budget
Cubao to SM Lipa- 132 pesos
SM Lipa to Casa Belinda - 24 pesos (special fare of tricycle is 70 pesos which can be divided by 3-4 travelers)
Overnight stay at Casa belinda - 1,334 pesos (8,000 pesos can be divided if you're traveling in a group of 6)
Casa Belinda to SM Lipa - 24 pesos (special fare of tricycle is 70 pesos which can be divided by 3-4 travelers)
SM Lipa to Cubao - 132 pesos
Total: 1,646 pesos
*This estimate does not include food. As guests, you are free to bring food or buy fresh food from the market. The staff at Casa Belinda can cook it for you for only a minimal fee. :)
Casa Belinda
Address: Mount Malarayat Golf & Country Club, Lipa, Batangas
Airbnb Listing: https://www.airbnb.com/rooms/14931515
Facebook Page: https://www.facebook.com/casabelinda/
Check-in Time: 2:00 PM
Check-out Tine: 12:00 PM
If you are new to AirBnb, you can use this link to get 1,862 pesos in travel credit when you sign up (Sign up using Facebook, Google and Email). This will get you a discount on your first trip!
Disclaimer: This is a sponsored trip but as always, all opinions are my own.


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I am BEYOND excited to come home and see my family on Saturday. It's the first time I've gone three semesters in a row without a summer break. I had five classes and an internship this term and thought it would be easy, … Continue reading
After a month, I am back. I know it's been a while, but I have a great recipe to make it up to you: a SUPER easy chia seed pudding. I'm obsessed with cooking shows. I can't deny it. I … Continue reading


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© 1998-2009 Bob Hackett and Peter Cundall.Revision 4
22 October 1944:
Arrives at Brunei. At 0800, Kurita's Striking Force steams for Leyte Gulf via the Sibuyan Sea and San Bernardino Strait. Kurita orders Vice Admiral Nishimura Shoji's (39)(former CO of HARUNA) BatDiv 2, cruiser MOGAMI and four destroyers to sortie through Surigao Strait to Leyte Gulf to envelop the U.S. invasion forces. Vice Admiral Shima Kiyohide's (39)(former CO of OI) Fifth Fleet from the Pescadores is also to sortie through Surigao Strait to Leyte Gulf.
- Bob Hackett and Peter Cundall.
Back to the Oilers Page


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Matt's BMW 120D Project – Part Three
Glenn Rowswell at 10:21 am, 9th September 2014
Read More
I'm currently loving this car, not only does it handle well, it's got some decent power, and looks pretty cool too! People say these are a bit girly but I think not! Anyway, I have long hair and Mediterranean blood…


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I love this product it's so good for hair and quality is best
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Google Campus Established in Korea
Google Campus was established in Korea, the 3rd in the world and 1st time in Asia.
Except the Google Campus in the U.S., it is the 3rd Google venture center
preceded by London, U.K. and Tel Aviv, Israel.
The south of Seoul is called "Gangnam," and it is that Gangnam from
"Gangnam Style," which you are very familiar with.
The size of "Google Campus Seoul" is 2,000㎡ in Gangnam, Seoul.
The discussion on founding "Google Campus Seoul" was started in April 2013
when President Park, Geun-hye and Larry Page, the CEO of Google, met.
Korea has the fastest internet in the world.
It is home to Samsung, LG, Hyundai, and Kia Motor.
In other words, one of your cell phone, lap top, computer, TV, and car is made by a Korean company.
As you know Psy's Gangnam Style, Korea is a cultural powerhouse.
It is close to China. China trusts Korea.
Chinese people's favorite products, movies, and music are all Korean.


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33033 Grand River Ave
Farmington, MI 48336
Located in the TJMaxx & Dress Barn shopping center
*PRE-REGISTRATION REQUIRED: All guests must be registered for class prior to arrival to guarantee your registration and any special seating requests. You will receive an email confirmation if properly registered. Payment is due at the time of the reservation to guarantee your seat. If you choose not to pay online, please call our studio to make payment by phone (248 476-7928) or visit our studio in person for payment.
*WHAT TO BRING: (BYOB) You are welcome to bring in light snacks and drinks to enjoy during class. Beverages are limited to Beer and Wine ONLY!! Cups & Wine Openers are available for your use! You must provide your OWN plates and utensils for food. **ABSOLUTELY NO HARD ALCOHOL ALLOWED**
You must be at least 21 years of age with valid identification to consume alcohol in the studio.
*CLASS TIME: Painting begins PROMPTLY at class time! Please arrive 30 minutes prior to class time to park, check-in, unwind, uncork, & get smocked! If you are late to the class you may not be allowed to paint and your payment will be forfeited.
If you're coming with others, but making reservations separately, give us your group's name in the Special Request box. We'll seat you together. If you make a late reservation we may not be able to seat you with your requested group. No seat changes are guaranteed at class time!
*REFUND/CANCELLATION POLICY: A refund or store credit will be given for individuals canceling with at least 24-hour notice. "No shows" will not be issued store credit or refunds. Groups of 5 or more must cancel 3 days before the date of the class. (Please leave a voice message if calling after hours, 248 476-7928).
**PWAT reserves the right to cancel classes for unforeseen circumstances. Registrants will be notified at least 24 hours prior to class time when circumstances allow and refunds will be processed.
"We inspire people through ART to have more FUN and create lasting MEMORIES"
Get notified the next time we schedule this painting!
Paint this artwork at your own private event
REFUND/CANCELLATION POLICY: *REFUND/CANCELLATION POLICY: A refund or store credit will be given for individuals canceling with at least 24-hour notice. "No shows" will not be issued store credit or refunds. Groups of 5 or more must cancel 3 days before the date of the class. (Please leave a message if calling after hours, 248 476-7928).
BYOB is limited to beer and wine, no hard alcohol please. You must be at least 21 to consume alcohol in the studio. NO ALCOHOL ALLOWED during Family Day classes.
All classes or parties after 6pm Mon-Fri and 4pm Sat-Sun must be ages 18 or older. We recommend age 7 and older for Family Day or afternoon classes. For Kids Parties ages 7-12.


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Loosing the Safety Net: Adults with Autism
PBS Need to Know Series
Original air date July 29, 2011
What happens to autistic children when they grow up and leave the educational system where federal law requires they get the services they need? Need to Know's Alison Stewart visits two families struggling to provide a future for their adult sons with autism.
Although this originally aired in 2011 the information here is still relevant and poignant. When David (featured) was diagnosed as a toddler In 1986 autism was "rare" affecting 4 in 10,000. Today the statistics are 1 in every 68.


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Believe in Me (Forever and Ever #22)
- 4,99 €
- 4,99 €
Description de l'éditeur
Sean's killer finally makes his move at the most unsuspecting time. Sean will be pushed to the limit and have to fight to survive. But when his entire family is on the line what will he do? How will he protect them? Or will he lose everything he loves most?


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Servant of God János Brenner
Birth into heaven: 15 December 1957
János Brenner was born on 27 December 1931 in Szombathely, in a deeply religious family. Both he and his two brothers became priests. He attended the Episcopal Elementary School, then the grammar school of the Cistercian monks in Pécs, and, at last, the grammar school of the Premonstratensian canons regular in Szombathely. Following the nationalization of schools, he passed his school leaving exams in Zirc as a Cistercian oblate, and afterwards he was admitted to the novitiate, where he was given the name of Anasztáz. After the dissolution of the religious orders, he studied at the Theological Academy of Budapest for a year as a lay student, then he went on to study at the seminary of Szombathely as a seminarist of the diocese. When the seminary was closed, he continued his theological studies in Győr. He was ordained priest on 19 June 1955. The new priest started his ministry in Rábakethely as chaplain. He carried out a dynamic pastoral activity, especially among the young people. The authorities, which persecuted the Church, disapproved of his activity, especially amidst the reprisals following the revolution of 1956.
During the night of 15 December 1957, when he was preparing his Sunday homily for the next day, János Brenner was falsely called to a sick person. He took his bag that he used for visits to the sick, with the Blessed Sacrament inside, and left for the village of Zsida with his assistant through the path crossing the hills. He was attacked and brutally stabbed 32 times between the two villages. The people who lived nearby called the doctor, but it was already too late: the young chaplain had passed away. Even in his death he was defending the Blessed Sacrament with his left hand. He was buried on 18 December in the family crypt of the Salesian church of Saint Quirinus in Szombathely. The authorities tried to disperse the crowd of faithful gathered for his funeral, therefore they only gave permission for the funeral at a later hour than originally published. His priestly motto was inscribed on his tomb: "All things work together for good to those who love God".
In the course of the investigation following his death, the authorities tried to intimidate the inhabitants of the nearby villages, and the murder had probably served the same goal. Nevertheless, it proved impossible to cancel the memory of the young priest. On the contrary, his veneration continually increased. On the spot of the martyrdom of the "Hungarian Tarcisius", between the villages of Rábakethely and Zsida, the Chapel of the Good Pastor was built in 1989 in honour of his life sacrifice.
CCS protocol number: 2399
Diocesan inquiry
Competent forum: Diocese of Szombathely
Competent bishop: Diocesan bishop István Konkoly, Diocesan bishop András Veres
Postulator: László Gyürki
Diocesan inquiry: 3 October 1999 – 31 July 2008
Inquiry of the Holy See (CCS)
Decree on validity of diocesan inquiry: 30 September 2009
Promulgation of papal decree on martyrdom:
Let us pray for his beatification!
Prayer for his beatification
Almighty and eternal God, you gave your servant János the grace of the priestly vocation
and you deemed him worthy of the great gift of martyrdom. We ask you to glorify him in your Church.
May his faithful and exemplary life and his death as a martyr while fulfilling his priestly vocation
obtain for us the grace of growing stronger in our faith
and of accepting the struggle and the suffering for the coming of your kingdom.
Through Christ, Our Lord. Amen.
(Source: https://www.magyarkurir.hu)
Those who obtain favours through his intercession are asked to notify the
Diocesan Authority
9701 Szombathely, Pf. 41.
More information:


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Food Collection for Mort Elementary School's Food Pantry
May 2016
For the month of May 2016 we collected non-perishable food items for Mort Elementary School's food pantry. Mort Elementary School is located in Hillsborough County, FL. Most of the students who attend the school live in poverty, and currently 99% of their students are on the free/reduced lunch program. In February 2016 the Straz Center held a fundraising event so that the school could build a food pantry (see video for details). Wings of Service families helped stock that pantry for the students. Non-Perishable food donations were made to Wings of Service during the month of May. Wings of Service families will delivered the food donations to the school contacts at the close of the collection. We also attended a feild trip to the University Area Community Development Center. We worked in the community garden, had a tour and nutrition talk.


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kirkwood, IL
Expecting that you or a companion or relative is interested by additional information on Pre-Settlement Funding, please click the association underneath and your requesting will be sent to a legitimate financing capable who will evaluate your advance at no expenditure or responsibility.
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Irregular Menses in an Adolescent: When to Consider Polycystic Ovary Syndrome
Article Author
M. Tracy Bekx
Related Information
Pediatric Polycystic Ovarian Syndrome (PCOS) Clinic
Educational Objectives
After reading this article and answering the review questions, the reader will:
- Recognize the clinical features and workup recommended for diagnosing polycystic ovary syndrome
- Explain the underlying pathophysiology of polycystic ovary syndrome
- Describe the appropriate metabolic workup in adolescents and young women presenting with polycystic ovary syndrome
Jessica is a 15-year-old female who presents to your office with the concern of lack of menstrual periods. She had her first menstrual period at 12 years of age. Periods initially occurred every month up until 1 year ago, when they became less frequent and now occur every 2-4 months. Her last menstrual period was 3 months ago. She also complains of worsening acne since menarche, increasing dark hair growth on her chin and abdomen, and escalating weight gain over the past several years. She is worried because she does not look like her other girlfriends and wants to know what to do.
Birth history is notable for a birth weight of 5 pounds 8 ounces; otherwise Jessica was a healthy infant and child. Family history is positive for a father with type 2 diabetes diagnosed at the age of 38 years and a mother who is obese and has a history of irregular periods.
Physical exam is notable for a BMI of 34kg/m2 (>99th percentile) and BP 138/82mmHg. General: obese adolescent girl who appears sullen. HEENT: acne noted on forehead, terminal dark hairs noted on chin and sideburn regions, acanthosis nigricans on back of neck (Figure 1). Abdomen: obese, pink-colored striae appreciated, hair growth noted near umbilicus and along lower abdomen. Extremities: darkening of skin on knuckles. There are no Cushingnoid features.
Figure 1
In summary, this patient is presenting with ovulatory dysfunction, clinical hyperandrogenism, and obesity with evidence of insulin resistance on exam, features characteristic of polycystic ovary syndrome (PCOS).
Introduction to PCOS
Polycystic ovarian syndrome affects 5% to 10% of adult women and is increasingly recognized in the adolescent population.1 Considerable debate has surrounded how to diagnose this syndrome in both adult women and adolescents. In 2003, the Rotterdam Criteria defined women with PCOS as demonstrating two of the following three criteria: 1) chronic anovulation, 2) clinical or biochemical evidence of androgen excess, and 3) polycystic ovaries on ultrasound2 in the absence of other causes. With this definition, a heterogeneous group, including women without evidence of hyperandrogenemia, meets the diagnostic criteria of PCOS. Experts from the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society believe the role of hyperandrogenemia is crucial in defining PCOS and its long-term associated health risks, and defines PCOS based on the presence of hyperandrogenism and ovulatory dysfunction, with other causes ruled out with appropriate testing.3
Adolescents with PCOS are an intriguing subgroup to define, as features that define PCOS often overlap with normal puberty. For example, several months of anovulatory irregular menses may follow menarche and findings suggesting androgen excess (e.g., acne) are common. What distinguishes adolescents with PCOS is the persistence of ovulatory dysfunction beyond two years and the onset or worsening of hyperandrogenism around menarche.
Etiology of PCOS
The precise etiology of PCOS remains unknown and is likely multifactorial. The hypothalamic secretion of gonadotropin releasing hormone (GnRH) is disrupted in women with PCOS.4 The increased frequency of GnRH promotes a predominant release of luteinizing hormone (LH) compared to follicle stimulating hormone (FSH) by the pituitary. LH acts on the theca cells and leads to increased steroidogenesis and testosterone production. High testosterone levels feed back to the pituitary and hypothalamus, suppressing the rise in LH mid-cycle and thereby disrupting ovulation.5 In spite of an absent LH surge mid cycle, LH levels remain chronically elevated relative to the FSH levels.
The ovary also plays a role in the pathogenesis of PCOS. In vitro studies of theca cells from women with PCOS demonstrate a higher expression of steroidogenic enzymes than normal, which promotes testosterone production.6 This expression is further augmented by not only the chronically elevated LH levels but by insulin as well. Theca cells from women with PCOS secrete higher androgen levels than women without PCOS when stimulated with insulin in vitro, supporting the direct role of insulin in ovarian androgen production.7
Insulin also acts indirectly in women with PCOS to promote a hyperandrogenic state by decreasing sex hormone binding globulin (SHBG) in the liver.8 SHBG acts as a carrier protein and determines the amount of free or bioavailable hormone; thus, lower SHBG levels can increase the bioavailable androgen. Interestingly, the role of insulin in the pathogenesis of PCOS is one of insulin action, whereas some metabolic consequences of PCOS are secondary to insulin resistance or lack of insulin action. This selective insulin resistance found in the PCOS population is an enigma for researchers.9,10
Finally, in recent years researchers have uncovered a relationship between intrauterine growth retardation (IUGR) and premature adrenarche and the subsequent development of PCOS and its metabolic consequences.11,12 The IUGR state reflects a nutritionally restricted state in utero. According to the Barker's hypothesis, the prenatal undernutritional state leads to reprogramming of the endocrine metabolic status, resulting in increased insulin resistance.13 This energy-sparing state may be beneficial in an in utero environment of limited caloric supply, but not in an energy surplus environment. Studies suggest that the development of insulin resistance may be secondary to up-regulation of the hypothalamus-pituitary-adrenal axis.14 Chronically elevated cortisol levels, coupled with the nutrient-deficient state, during critical times in utero may reduce beta cell mass and secretion, and increase gluconeogenesis and lipolysis.15 The compromised beta cell mass is vulnerable to future insulin-resistant states (puberty, PCOS obesity, aging) which may lead to type 2 diabetes.
Clinical Features of PCOS
Adolescents with PCOS present in a variety of ways. Patients most commonly seek care for menstrual abnormalities. Although oligomenorrhea predominates, these patients may experience frequent menses, prolonged menses, secondary amenorrhea, and even primary amenorrhea. In a study evaluating the characteristics of adolescents presenting to a multidisciplinary clinic for PCOS, 7% experienced primary amenorrhea (and all but one had a BMI above the 97%).16
Another common reason for seeking medical attention is worsening acne, intractable to over-the-counter therapy, or hirsutism, each of which can have a significant psychological as well as cosmetic impact on an adolescent. Hirsutism is defined as terminal hair growing in an androgen-dependent pattern and is graded by the Ferriman-Gallway score (Figure 2). A score greater than 8 indicates mild to moderate hirsutism. This must be distinguished from hypertrichosis, which is an overall excess of body hair and can be hereditary. The development or acceleration of acne or hirsutism near the time of menarche or after is consistent with possible PCOS. Other clinical signs of hyperandrogenism include 1) seborrhea, 2) alopecia (particularly in temporal regions), and 3) hyperhidrosis.
Figure 2
Buggs and Rosenfield. "Polycystic Ovary Syndrome in Adolescence" Endocrin Metal Clinic N Am 2005 34:677
Obesity is a common cormobidity of PCOS and affects over 50% of adults with this disorder.17 In an adolescent PCOS multidisciplinary clinic, over 80% of patients presented with a BMI above the 85% and over 70% with a BMI above the 95%.11 Women with PCOS often also have an increased waist circumference (defined as > 88 cm in adult Caucasian women). This truncal adiposity is a marker of metabolic risk, including insulin resistance.
Evaluation for PCOS
The evaluation of an adolescent with signs and symptoms suggestive of PCOS is aimed at demonstrating the presence of key diagnostic criteria (e.g., menstrual irregularity and hyperandrogenism) and excluding disorders that mimic PCOS (e.g., CAH, ovarian/adrenal tumors). To evaluate menstrual irregularities the following blood tests should be ordered: TSH, prolactin, LH, and FSH (to rule out primary ovarian failure). Although an increased LH to FSH ratio (reflecting the chronic LH secretion with lack of LH surge) is often seen in PCOS, it is not diagnostic. Pregnancy must always be considered when evaluating a teen with either primary or secondary amenorrhea.
Both the ovary and adrenal gland are sources of normal androgen production in the female. With hyperandrogenism, excess production secondary to a tumor must be considered and screened for by measuring serum androgen levels. Testosterone levels primarily reflect androgen production from the ovary; however, these levels need to be interpreted with caution. SHBG, a carrier protein for testosterone, is often lowered due to the inhibition on hepatic production by both androgens and insulin.18,19 This can lead to a lower total testosterone lab value. Therefore, a free testosterone level is more specific in identifying elevated bioactive testosterone levels. Total testosterone levels suggesting a malignancy are generally above 150 ng/dl.19 Comparable levels of free testosterone are unclear; thus, both may be useful.
Late-onset congenital adrenal hyperplasia (CAH) shares similar characteristics with PCOS. The evaluation for CAH includes measurements of 17 hydroxyprogesterone and DHEA-S levels, preferably drawn prior to 9:00 a.m. A 17 hydroxyprogesterone level above 2ng/ml warrants further workup with ACTH stimulation testing.20 When symptoms progress rapidly or are accompanied by severe hypertension, purple striae, or truncal obesity with extremity muscle wasting, Cushing's disease as well as adrenal tumor should be considered. These are evaluated with a 24-hour urine free cortisol or salivary cortisol measurement obtained at 11:00 p.m. and an adrenal androgen profile.
The Rotterdam Criteria includes cystic ovaries in its definition of PCOS. As cystic ovaries occur in 20% of the normal population,21 the Rotterdam definition in PCOS is the presence of 12 or more follicles measuring 2-9 millimeters in diameter, and/or an increase in ovarian volume > 10 ml in at least one ovary.2 As multi-follicular ovaries are normal in adolescence, applying this criteria to this age group can be a challenge.18 In addition, obtaining an informative transabdominal pelvic ultrasound in an obese patient may be difficult and a transvaginal approach can be traumatic for a young woman. Therefore, it is reasonable to weigh the pros and cons of this imaging study in the younger PCOS patients, particularly if the diagnosis of PCOS is well defined by the clinical presentation or laboratory evaluation. Patients with significant pelvic pain or elevated testosterone levels not consistent with PCOS should always undergo ovarian imaging studies.
Table 1: Laboratory Evaluation when Considering PCOS
Case by case: beta-HCG, pelvic ultrasound, salivary cortisol
Metabolic Consequences of PCOS
Women with PCOS are intrinsically insulin resistant. Guzick et al demonstrated this eloquently in measuring insulin sensitivity in normal weight and obese women compared to normal weight and obese PCOS subjects. Interestingly, the normalweight PCOS subjects had diminished insulin sensitivity compared to weight-matched controls; however, these same patients had similar values to the obese control patients. The obese PCOS patients were the least insulin sensitive.22 Thus the insulin-resistant state demonstrated in PCOS is intrinsic and further compounded by obesity. Mechanisms for this intrinsic insulin resistant state are not completely understood, but differences in post-receptor activity account for decreased insulin action in select organs.23 Furthermore, chronic insulin resistance challenges the beta cells in the pancreas, which respond with increased insulin secretion and compensated hyperinsulinemia. This leads to the clinical finding of acanthosis nigricans, which is a dark, velvety, thickened area of skin prominently found around along the neck, the axilla, and knuckles (Figure 1). Defining the degree of insulin resistance biochemically and quantitatively is challenging, and is often debated in the literature. Using comparative euglycemic clamp studies in adult women with PCOS, a fasting glucose to insulin ratio less than 4.5 was defined as significant insulin resistance.24 Similar diagnostic ratios have not been established in the adolescent PCOS population. Using measures that are clinically available, insulin resistance and compensated hyperinsulinemia are found in 50%-70% of adolescent and adult women with PCOS. 3, 11
With the chronic insulin resistant state and challenges to the beta cell, natural progression in PCOS can be development of type 2 diabetes mellitus. Over ten percent of adult women with PCOS have type 2 diabetes by the age of 40 years, with an overall 10-fold increased lifetime risk.25, 26, 27 Numbers of cases of type 2 diabetes in adolescents are less well-defined, but are areas of investigation and intervention.28
Dyslipidemia is common in women with PCOS, seen in almost 70% of the patients. Although elevated triglyceride with low HDL levels are the most frequent abnormalities and reflect insulin resistance, LDL levels may also be increased. In adolescents, a low HDL is particularly common (greater than 50% in one study).11 This is clinically significant, because low HDL alone is independently a strong marker of cardiac risk.
Metabolic syndrome (increased blood pressure, dyslipidemia, increased waist circumference, and impaired fasting glucose) occurs more commonly in women with PCOS. Its prevalence approaches 47%, twice that of a control population matched for BMI.29,30 In the younger population, the prevalence is lower, at 20%, which may simply reflect the stage of disease.31
Women with PCOS have an increased prevalence of nonalcoholic fatty liver disease (NAFLD), which can progress to the more serious nonalcoholic steatohepatitis (NASH). The risk for NAFLD is increased by obesity and hyperinsulinemia. In a study using ultrasound to identify NAFLD, 41% of young women with PCOS had evidence of liver disease vs. 19% in the control group.32 Further research is ongoing on how best to identify those with NAFLD and interventions to prevent progression to more serious liver disease.
Table 2: Screening for Metabolic Complications of PCOS
Treatment of PCOS
Management options for PCOS aim at treating individual symptoms while preventing the long-term metabolic sequelae. In adolescent girls with PCOS, treatment is primarily focused on management of irregular menses and reduction of symptoms related to hyperandrogenism. Most commonly this intervention is in the form of an oral contraceptive pill (OCP). OCPs regulate menses and reduce ovarian testosterone production by suppressing LH secretion. Another option to address menstrual irregularities is hydroxyprogesterone. Given at a minimum of once every 3 months, this progestin derivative induces withdrawal bleeding and prevents endometrial hyperplasia, a precursor to endometrial malignancy. Hydroxyprogesterone will not, however, inhibit ovarian testosterone production and thus has little impact on the clinical effects of hyperandrogenism.
Hirsutism may improve with suppression of ovarian testosterone secretion by OCP therapy, but may need more aggressive intervention. Spironolactone, a weak diuretic, acts to block the action of androgen at the hair follicle and inhibit future hair growth. This therapy may take several months to see noticeable results, usually recognized as a decrease in frequency of cosmetic treatments. As this medication is teratogenic for male fetuses, patients must be counseled on contraceptive therapy. Finally, patients on this medication are advised to avoid a high-potassium diet and may need to increase fluid intake given spironolactone's weak potassium-sparing properties.
Treating the underlying insulin resistance and metabolic consequences is a challenge, but should always begin with efforts to alter lifestyle. The Diabetes Prevention Program (DPP) demonstrated that diet and exercise decreased the incidence of type 2 diabetes in adults with prediabetes by 60%.33 It is logical to apply this diet and exercise recommendation to the high-risk insulin-resistant PCOS patient population, although formal studies have not been performed. Weight loss, which decreases insulin resistance and improves insulin levels, can affect ovulation and fertility in women with PCOS, as well as have a positive impact on lipids, blood pressure, and fatty liver.34, 35, 36 Therefore, lifestyle modification is a core element in treating women with PCOS.
Metformin, a biguanide that acts to inhibit hepatic glucose production and decrease peripheral insulin resistance, has been studied extensively in the PCOS population. Metformin diminishes insulin levels, and may improve ovulation, fertility, and hyperandrogenemia, and possibly prevent diabetes.37 An uncontrolled retrospective review of the impact of metformin on diabetes prevention in the adult PCOS population revealed evidence for effective diabetes prevention. Fifty women with PCOS treated with metformin for 43 months showed no progression to type 2 diabetes. In addition, the annual conversion rate of normal glucose tolerance (NGT) to impaired glucose tolerance (IGT) was decreased to 1.4%, compared to the expected rate of 16%-19%.38 Despite this research, there is no consensus on the use of metformin in patients with PCOS, and it is not approved for use in children less than 10 years of age. Young women at higher risk of developing diabetes mellitus (high risk ethnicity, obesity, strong family history, presence of acanthosis nigricans, elevated fasting, and 2-hour insulin levels) are most likely to benefit from metformin. Guidelines from the AE-PCOS recommend healthcare providers consider metformin in the prevention of type 2 diabetes mellitus in the PCOS patient, but emphasize that further studies are needed.39
Multidisciplinary Approach to PCOS
There are many aspects to evaluating and treating the adolescent with PCOS, including 1) regulating menses, 2) addressing future concerns (e.g., infertility, endometrial cancer), 3) screening for metabolic consequences (i.e., insulin resistance, dyslipidemia), 4) normalizing nutrition, and 5) behavioral counseling and modification(depression, anxiety, poor self image).40 With this in mind, a multidisciplinary adolescent PCOS Clinic was established at the American Family Children's Hospital at the University of Wisconsin in 2005. This team consists of two pediatric endocrinologists, a pediatric gynecologist, a nutritionist, and a health psychologist. Since 2005, over 225 patients have been evaluated and their health concerns addressed in this multidisciplinary clinic. An analysis of patient follow-up from 2005 to 2008 showed that 79 (72%) of 110 patients diagnosed with PCOS returned to clinic after the initial consultation visit. Of these, 57% percent demonstrated weight loss and 70% demonstrated no weight gain.41 Halting the weight acceleration seen commonly in this population is a positive step.
With the ever-rising tide of childhood obesity, identification and treatment of adolescents with PCOS is of prime importance. Early intervention and counseling for patients with PCOS may prevent the emergence of co-morbid medical conditions. Educating the adolescent about PCOS and its associated metabolic risks, as well as providing emotional support, empowers the patient to make informed choices in regard to establishing and maintaining a healthy lifestyle.
CME Questions
Go to CME Quiz page
1. Knochenhauer ES et al. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998;83:3078-82
2. ESHRE/ASRM. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reprod. 2004;19:41
3. Azziz R et al. The Androgen Excess and PCOS Society criteria for polycystic ovary syndrome: the complete task force report. Fertil and Steril. 2009;91(2):456-88
4. Waldstreicher J et al. Hyperfunction of the hypothalamic-pituitary axis in women with polycystic ovarian disease: indirect evidence for partial gonadotroph desensitization. J Clin Endocrinol Metab. 1988;66:165
5. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;354:1223
6. Jakimiuk AJ et al. Luteinizing hormone receptor, steroidogenesis acute regulatory protein, and steroidogenic enzyme messenger ribonucleic acids are overexpressed in thecal and granulosa cells from polycystic ovaries. J Clin Endocrinol Metab. 2001;86:1318
7. Baillargeon JP, Nestler JE. Polycystic ovary syndrome: a syndrome of ovarian hypersensitivity to insuln? JCEM. 2006;91:22
8. Nestler JE et al. A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab. 1991;72:83-9
9. Poretsky L. On the paradox of insulin-induced hyperandrogenism in insulin-resistant states. Endocr Rev. 1991;12:3-13
10. Nelson VL. The biochemical basis for increased testosterone production in theca cells propagated from patients with polycystic ovary syndrome. J Clin Endocrinol Metab. 2001;86(12):5925
11. Goodarzi MO, Azziz R. Diagnosis, epidemiology, and genetics of the polycystic ovary syndrome. Best Pract Res Clin Endocrinol Metab. 2006;20:19
12. Warren-Ulanch J and Arslanian S. Treatment of PCOS in adolescence. Best Pract Res Clin Endocrinol Metab. 2006;20:311
13. Barker DJ et al. Fetal nutrition and cardiovascular disease in adult life. Lancet. 1993;341:938
14. Kapoor A et al. Fetal programming of the hypothalamo-pituitary-adrenal function: prenatal stress and glucocorticoids. J Physiol. 2006;572:31
15. Kanaka-Gantenbein C. Fetal origins of adult diabetes. Ann N Y Acad Sci. 2010;1205:99
16. Bekx MT et al. Characteristics of adolescents presenting to a multidisciplinary clinic for polycystic ovarian syndrome. J Pediatr Adolesc Gynecol. 2009; 23(1):7-10
17. Azziz R et al. Troglitazone improves ovulation and hirsutism in the polycystic ovary syndrome: a multicenter, double blind, placebo-controlled trial. J Clin Endocrinol Metab. 2001;86:1626
18. Buggs C, Rosenfield RL. Polycystic ovary syndrome in Adolescence. Endocrinol Metal Clin N Am 2005;34:677
19. O'Driscoll JB et al. A prospective study of the prevalence of clear-cut endocrine disorders and polycystic ovaries in 350 patients presenting with hirsutism or androgenic alopecia. Clin Endocrinol (Oxf). 1994;41(2):231-6
20. Azziz R et al. Clinical review 56: Nonclassic adrenal hyperplasia: current concepts.
J Clin Endocrinol Metab. 1994;78(4):810-5
21. Polson DW et al. Polycystic ovaries-a common finding in normal women. Lancet. 1988;1:870
22. Guzick DS. Polycystic ovary syndrome. Obstet Gynecol. 2004;103(1):181-93
23. Mukherjee S, Maitra A. Molecular and genetic factors contributing to insulin resistance in polycystic ovary syndrome. Indian J Med Res. 2010;131:743
24. Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1998;83:2694
25. Ehrmann DA et al. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999;22:141
26. Legro RS et al. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999;84:165
27. Nestler JE. Metformin for the treatment of the polycystic ovary syndrome. N Engl J Med. 2008;358:47
28. Nur MM et al. Glucose metabolism in overweight Hispanic adolescents with and without polycystic ovary syndrome. Pediatrics. 2009;124(3):e496-502
29. Wild RA et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: A consensus atatement by the androgen excess and polycystic ovary syndrome (AE-PCOS) society. J Clin Enocronol Metab. 2010;95:2038
30. Moran LJ et al. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: A systematic meta-analysis. Human Reprod Update. 2010;16 (4):347
31. Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab . 2005;90:1929-35
32. Cerda C et al. Nonalcoholic fatty liver disease in women with polycystic ovary syndrome. J Hepatol. 2007;47:412
33. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393
34. Vause TD et al. Ovulation induction in polycystic ovary syndrome. J Obstet Gyn. 2010;32(5):495-502
35. Shephard RJ, Balady GJ. Exercise as cardiovascular therapy. Circ. 1999;99:963-72
36. Haus JM et al. Free fatty acid-induced hepatic insulin resistance is attenuated following lifestyle intervention in obese individuals with impaired glucose tolerance. J Clin Endocrinol Meta.2010;95(1):323-7
37. Nesgler JE. Metformin for the treatment of the polycystic ovary syndrome. N Engl J Med. 2008;358:47
38. Sharma ST, Wickham EP III, Nestler JE. Changes in glucose tolerance with metformin treatment in polycystic ovary syndrome: a retrospective analysis. Endocr Pract. 2007;13:373
39. Salley KE et al. Glucose intolerance in polycystic ovary syndrome: a position statement of the Androgen Excess Society. J Clin Endocrinol Metab. 2007;92:4546-56
40. Rofey DL et al. Cognitive-behavioral therapy for physical and emotional disturbances in adolescents with polycystic ovary syndrome: a pilot study. J Pediatr Psychol. 2008;1:1
41. Geier L et al. The role of a multidisciplinary clinic in achieving weight loss among adolescent girls with polycystic ovarian syndrome. Pediatric Academic Society National Meeting, Vancouver, Canada, May 2010; abstract
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Getting in Touch
At Aitchison Law Office, our Oshawa lawyers understand that for many of our clients, coming to see a lawyer can be uncomfortable. We know that for many of our clients, the situation they find themselves in may be unfamiliar and sometimes overwhelming. We do our best to help you feel more at ease by answering your questions in your own language and helping you make good, informed decisions about your future.
If you need information about Ontario family law, business law, wills and estates, immigration, tax appeals, civil litigation or employment law, contact us to learn more about how we can help you.
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Dumpling Soup
Grilled Asian Flank Steak
Asian Cucumber Salad
I'm already drooling. So, I figure I'll just park my butt on the couch with my girls, pop in a movie, grab a glass of wine, and...vegg.
(wanna know a secret though? I really love cooking...and I'll kinda miss being in the kitchen tonight...well, just a little) :)
Dumpling Soup
- 4 cups low-sodium chicken broth
- 1/4 pound thick-sliced ham, diced
- 2 tablespoons dry sherry or Chinese rice wine
- 1 tablespoon sugar
- 1 1-inch piece ginger, peeled and thinly sliced
- 4 3-inch strips orange zest
- Kosher salt and freshly ground pepper (there's already a ton of salt in this, so I'm not adding any more)
- 2 scallions, sliced, white and green parts separated
- 1 cup sliced button mushrooms
- 2 medium carrots, thinly sliced
- 2 to 3 napa cabbage leaves, thinly sliced
- 24 frozen chicken or vegetable dumplings or pot stickers Soy sauce, for drizzling (optional) (you can find some brands that are lower in salt if you're worried about sodium, also, make sure to use low-sodium soy sauce)
Combine 2 cups water, the broth, ham, sherry, sugar, ginger, orange zest, 1/2 teaspoon salt, and pepper to taste in a large pot. Cover and bring to a boil over high heat. Add the scallion whites, mushrooms and carrots. Reduce the heat and simmer, uncovered, until the carrots are crisp-tender, about 4 minutes.
Add the cabbage, dumplings and scallion greens. Cover and cook until the dumplings are soft and heated through, 4 to 5 minutes. Divide the dumplings and soup among bowls. Drizzle with soy sauce, if desired.
Per serving: Calories 256; Fat 9 g (Saturated 3 g); Cholesterol 56 mg; Sodium 1,011 mg; Carbohydrate 24 g; Fiber 3 g; Protein 18 g
- 1/4 cup Worcestershire sauce
- 1/4 cup reduced-sodium soy sauce
- 3 tablespoons honey
- 1 tablespoon sesame oil
- 1 teaspoon Chinese five-spice powder
- 1 teaspoon minced garlic
- 1/2 teaspoon minced fresh gingerroot
- 1 beef flank steak (1-1/2 pounds)
- 2 tablespoons hoisin sauce, warmed
- 3 green onions, thinly sliced
- 1 tablespoon sesame seeds, toasted, optional
- In a large resealable plastic bag, combine the first seven ingredients; add steak. Seal bag and turn to coat; refrigerate overnight.
- Drain and discard marinade. Grill steak, covered, over medium heat for 6-7 minutes on each side or until meat reaches desired doneness (for medium-rare, a meat thermometer should read 145°; medium, 160°; well-done, 170°). Let stand for 5 minutes.
- Thinly slice steak across the grain. Drizzle with hoisin sauce; garnish with onions. Sprinkle with sesame seeds if desired. Yield: 6 servings.
Spago Cucumber Salad - Cucumber Salad Recipe
Ingredients:2 cups thinly-sliced cucumbers (I prefer mine thick cut...your choice)
1 teaspoon salt
1 tablespoon granulated sugar
1 tablespoon soy sauce
1/4 cup rice wine vinegar
1 teaspoon sesame oil
2 teaspoons sesame seeds
Preparation:In a large bowl, combine cucumbers and salt; mix well. Add sugar, soy sauce, rice wine vinegar, and sesame oil; mix well.
Sprinkle with sesame seed and mix. Let marinate for 20 minutes before serving. NOTE: If you desire, drain off some of the vinegar mixture before serving.
To serve, divide salad among individual chilled plates.
Makes 4 servings.


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This guide contains selected core reference and other literature finding aids for this subject area.
Ecology is "the subdiscipline of biology that concentrates on the relationships between organisms and their environments; it is also called environmental biology."¹ more
Evolution is "the process by which different kinds of living organism are believed to have developed from earlier forms during the history of the earth."³
Also see "History of Ecology" and "Natural Selection: Introduction" from the Encyclopedia of Life Sciences.
1. Samuel J. McNaughton, "Ecology", in AccessScience@McGraw-Hill, http://www.accessscience.com, DOI 10.1036/1097-8542.212500 (accessed October 18, 2010).
3. "Evolution," in The Oxford Dictionary of English (revised edition), Oxford Reference Online. Oxford University Press, 2005, http://www.oxfordreferenceonline.com (accessed March 10, 2008).


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Marvel has enjoyed success on the big and small screen in recent years, thanks to the Marvel Cinematic Universe. On the TV side, the MCU encompasses a long-running show on ABC in Agents of S.H.I.E.L.D. and a collection of gritty New York-based superhero TV shows on Netflix that includes Daredevil, Jessica Jones, Luke Cage, and the upcoming adaptation of Iron Fist.
The Iron Fist comic book source material has presented a unique set of challenges during its adaptation process, due in no small amount to the more fantastical elements inherent to Iron Fist as a property in general. These elements, in turn, have need to be tweaked and evolved accordingly, in order to make the Iron Fist TV show better jive with the comparatively grounded tone established by the previous individual The Defenders Marvel/Netflix series.
In the comics, Danny Rand earns the mantle of the Iron Fist after years of training in the mystical land of K'un-Lun. Rand's final test in acquiring his otherworldly power was to defeat an immortal dragon known as Shou-Lao. In order to gain the creature's power, Rand plunged his fist into the dragon's heart and emerged as the Iron Fist. In a recent interview with Yahoo UK, Iron Fist himself, actor Finn Jones explained why we shouldn't be expecting to see Shou-Lao in the first season of Iron Fist:
"I'd love to have the budget for these shows to have a full-on Game of Thrones style dragon...But unfortunately you know, we have budget restraints. That's the nature of the show."
The actor went on to elaborate if and when there will be an allusion to the hero's comic origin story:
"We do allude to it in Iron Fist, in a very intelligent way...And definitely in The Defenders… but I think, you know, we've got to be realistic."
Danny Rand is one of the most accomplished martial artists in the Marvel Comics Universe and possesses the ability to channel his Chi into a fiery fist, whose strike delivers insane amounts of destruction. It's unclear how high Rand's actually power level is in the Iron Fist TV show, but judging by the trailers for the series, it's significant.
It's also possible that the series' "budget constraints" will generally force the Iron Fist showrunners to find ways around showing Danny frequently using his mystical powers, in order to solve his problems. Early reviews for Iron Fist have been pretty underwhelming, raising questions about the various decisions that were made in adapting Rand's origin story for live-action (including, the choice to not include Danny Rand's classic costume during the first season, too).
Iron Fist's origin story could also be ripe for contextual humor, as he inevitably will have to explain that he gained his magical powers from fighting a dragon, to his fellow Defenders and straight-shooters such as Colleen Wing (Jessica Henwick) and Luke Cage (Mike Colter). The first season of the final Defender, Iron Fist, is only a few days away, so get ready to punch the buttons on your remote for the next Marvel adventure.
NEXT: What We Want to See in Iron Fist Season 1
Daredevil seasons 1 and 2, Jessica Jones season 1, and Luke Cage season 1 are now available on Netflix. Iron Fist season 1 premieres on March 17. The Defenders arrive sometime in the summer, with The Punisher coming later this year. Premiere dates for the newest seasons of Jessica Jones, Daredevil, and Luke Cage have not yet been revealed.
Source: Yahoo UK


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Last year, to the day to be precise, I left for Italy with Auntie L and her friend Stirfry. I was excited because I had been wanting to go to Italy for, well, ever. But I was also very nervous. It was the first time I was leaving the girls for more than a couple of nights. Add to that- The Rugby Star wasn't home when I left. He was at a conference in Germany. So not only was I sneaking away in the middle of the night, but I was leaving them with the nanny for two days until he got back. Even though I clearly trust the woman with my kids on a daily basis, we had never left them with her for days. It was terrifying.
And then it wasn't. The nanny sent pictures through Whatsapp and The Rugby Star got home safe and sound and the girls had a blast with their dad for the week. I had an amazing time in Italy and everyone was very, very happy to be reunited when I got home.
This year, when Auntie L suggested a trip somewhere for Spring Break, I didn't even hesitate before saying, 'YES! YES! A THOUSAND TIMES YES!' But then the question became- where exactly. We contemplated Europe… but she had just traveled around Eastern Europe over Christmas and I'm moving there in a few months, so it didn't seem like the best idea. We thought about Dubai, but no. We looked at prices to Oman, Jordan, Abu Dabhi but nothing really called to us. We discussed a stay-cation- spending a couple of days at one of the fancy hotels here in Bahrain, doing brunch, ordering room service.
But we wanted off the island.
Then, my new friend B spoke up. 'Why don't you guys come to Dahab with us?'
Dahab? Where's that? Oh. Egypt. No thanks.
But then Auntie L did some research, as she is wont to do. And Dahab didn't look like Cairo, which is noisy and busy and, let's be honest, dirty. Dahab is on the Red Sea. It's a beach town and people go there for the cheap but beautiful snorkeling and scuba diving. That's why B and The Mayor were going (she's not really the mayor but she's been to Dahab so many times it was like walking with a celebrity through the streets). It looked quaint and clean and sunny and shiny. It looked like the kind of place where we could relax and lay by the pool, catching some rays and reading a book. B and The Mayor suggested a very new hotel, we looked it up on the interwebs, and suddenly we were buying tickets.
After spending almost a week in Dahab, I have come up with 8 Reasons Why You Should Visit Dahab, Even If You've Never Heard of It:
- Scuba Diving is AWESOME! I did two introductory dives while we were there with Bassem and Samir from Liquid Adventures and I'm totally hooked! The instructors were kind and patient, even while I freaked out during the first 15 minutes… because breathing under water is WEIRD! But once I got the hang of it, I saw purple jellyfish, clown fish, and the most beautiful coral reef I've ever seen (which was also the first coral reef I'd ever seen anywhere but on The Octonauts)! Whether you already dive or want to learn, Dahab is the place to go and Liquid Adventures is the place to be!
- There are mountains in Egypt. Specifically Mt. Sinai- aka Moses Mountain- can be found in this part of the country. But aside from that, there are huge, beautiful, red mountains rising from all around you as you drive from Sharm El Sheikh to Dahab. I felt like I could've been driving through the Colorado Rockies… if there had been a few more trees.
- 'Downtown' Dahab. I don't know if anyone else calls it that, but it's my name for that area. It was the tourist area with the bars, shops, and restaurants. This street was magical. I cannot tell you why. Maybe it was the friendliness of everyone you passed, from the shopkeepers who tried to entice you in to buy banter pants or tunics (No, not today? Maybe tomorrow, okay? Have a wonderful day!) or the kids running around, riding bikes in their bathing suits. It could've been the tranquility of each ocean-side restaurant, almost all of which had cushions on the floor so you could really stretch out and relax. Take your time, have a drink. Have ten drinks. Have some shisha. Or don't. Whatever.
- As you like. Anything you asked for, anything you requested, was met with the response, 'As you like.'
- The Acacia Hotel. If you go to Dahab, stay here. Of course, I didn't stay anywhere else so I can't say that it was the best hotel in Dahab, but I can say that it was wonderful. From the friendliness of the staff, to the cleanliness of the rooms, to the towel pets I found every day, this hotel is one of the best I've stayed at. Auntie L and I splurged and each got a single deluxe which featured a porch overlooking the pool. It was totally worth it.
- The vibe. Everything and everyone was in beach vacation mode. But not crazy American-Destin-Florida beach mode (i.e. hurry everyone, out the door with all the sunscreen and tents and towels and toys and snacks- we will RELAX at the beach for several hour with the sandcastle building kit, a kite, football, grill, a beach ball, two boogie boards and the surf boards we rented last night before cooling off in the pool with sandwiches we packed in a cooler; Uncle Ed is already drunk so we'll leave him on the beach. We will all run up to the time share apartment at 5:15 so everyone has a chance to shower before dinner at the Sizzler at 6:45pm then bowling and go-carting and maybe some ice cream before bedtime so we can do it all again tomorrow!). We laid by the pool, got a falafel sandwich for lunch, walked to town when we felt like it, took a nap on a beach chair, got massages. I got a job, briefly, at the English pub where we played Heads Up and the bartender, my former boss, helped me cheat. There were a couple of nights of fried bananas and Cards Against Humanity in a restaurant that served Indian, Thai, and Chinese food, and most nights we were all in bed by ten. I have never been so relaxed.
- Egyptian breakfast. This one is debatable depending on your food preference. Egyptian breakfast is falafel, pita, a feta-like cheese, and ful (pronounced 'fool') which is fava beans. I ate it five out of the six mornings we were there. It was delicious. Except the ful because they mixed it with green peppers and onions and, if you know me, you know what a great sadness that brought to my life.
- The Sharm El Sheikh airport is one of the smallest and cutest airports I've ever been in, second only to the Kingston airport in Ontario.
I had never even heard of Dahab before B and The Mayor invited us on their vacation and I'm already trying to figure out when I can get back.


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That Time I Worked In TV or Seeing Blessings in The Unmanifested
by P. Braithwaite
I went to college for print journalism and never, in my wildest dreams, did I think I'd end up working in daytime television. Overnight I was in this crazy environment . My fabulous friend knew I was looking for a job, and he told me where to send my resume. I did. And, somehow, with very little production experience I set off working for Rachael Ray. I passed celebrities in the hall and everyone I worked with was well-coiffed and sophisticated. I didn't feel like I fit in. I wasn't very comfortable in my awkwardness. I didn't have a background in television and so everything felt so foreign. I second-guessed myself constantly, and I didn't know how to connect with my coworkers. I felt like everyone could see that I was an outsider. All of my energy and vibrancy hid inside of itself where it felt safe. I wasn't so comfortable with my awkwardness back then.
I was miserable. I felt isolated, so I checked out.
In hindsight, working in production was not for me. I'm a poet and writer who prefers to live inside the clouds. I'm a delicate flower that needs rest and sunlight and peace of mind. TV production is a beast – it moves quickly, is cutthroat, and the personalities are overwhelming. It just wasn't my cup of tea.
Even so, its important to acknowledge my role in my own unhappiness. I could've made the best of the uncomfortable situation. I didn't feel good enough (smart enough or pretty enough) for my job, and so I never truly claim it as my own. I worked hard (overcompensated), but I felt I didn't deserve to be there.
I can't blame ALL of my unhappiness on the job not being "for me." I let the voices in my head get the best of me, and in some ways sabotaged my own enjoyment because I couldn't receive the opportunity I'd been given.
I don't write this with an overwhelming sense of regret. The environment wasn't conducive to my disposition, but I share this because I know that I wasn't present or open to the experience I was having. Being present, even if its not where you want to be, makes the difference between an obstacle and an opportunity.
I tell this story for two reasons: I know there are some of you who are frustrated by what you haven't received, and there are some of you so busy telling yourself you aren't worthy – that you're ruining your own prosperity as you read my words. Sometimes our defense mechanisms convince us that where we are isn't good enough and other times we tell ourselves that we're not good enough for where we are.
Either way you are EXACTLY where you're supposed to be. So your task is to receive the gift in the present moment.
If you aren't open and ready to receive your blessings you will sabotage whatever comes your way. No matter how awesome something is, or how long you've waited for it – if you're not ready to receive it, it won't be yours for long. If you're not open and ready to receive what you desire, you will not recognize it when it's being offered.
I'm sure there were gifts for me at my job that I just wasn't open to receiving.
Readiness involves being able to see potential in unexpected places. If you aren't open to receive what you desire, you'll miss out when it shows up in an unexpected place.
There are gifts in every place you find yourself, but it's your job to be open to receiving what is yours.
One last thing: With all the talk of law of attraction and positive thought, we run the risk of assuming that what we haven't received is a result of something we're doing wrong. We burn incense and say affirmations while glancing at the clock. We make vision boards and focus wheels while vibrating at the frequency of fear. What if I'm not good enough. Why hasn't this happened yet. There is nothing wrong with ritual and setting your intention, but we must also see the blessing in the absence of what we want.
We must learn to see the absence is a blessing.
Sometimes absense is an expression of God's grace – His kind way of giving us time to prepare to receive. While we're all waiting for whatever it is we're waiting for – a job, a soul mate, a big break or a good time – know that NOW is the time to make ourselves ready. Now is the time to be the person who can claim the thing you want.
Otherwise you might find yourself in someone else's dream, too afraid to claim what's rightfully yours.
What are you preparing to receive?


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Momentum Stack
|The formula for momentum is ...
|P = mv
|momentum is .............. conserved
|Is momentum a scalar or a vector?
|A Vector
|Force can be equated to ....
|Rate of change of momentum F = P/t or F = m(v/t)
|............... energy can be related to momentum
|Kinetic energy =
|Combine the formulas for kinetic energy and momentum to give
|E = p^2/2m
|In an inelastic collision what is conserved?
|Momentum but not kinetic energy
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The positive side to moving out to the 'burbs....now there's TWO wineries within 10 miles of my house! One of my personal favorites, Paradise Springs, was claimed to be the closest winery to DC but now they have some competition with The Winery at Bull Run.
The Winery at Bull Run neighbors the Manassas Battlefield Park and has been open to the public since June 2. As you pull into the property, baby vines are growing to the left and the tasting room and patio area are straight ahead. Picnic tables are scattered about to enjoy wine and a picnic on a nice afternoon.
The property was originally an old farm house dating back to the 1800's. The new tasting room was built on those ruins. Gorgeous, intricate details were preserved in the stone work of the frame and patio. Inside, the tasting room is spacious, with a lounge area and high top tables for wine lovers to enjoy a glass. A large copper tasting bar grabs your attention and a beautiful mural behind it is a great backdrop.
Now, let the tasting begin! Normally priced at $12/person, the tastings include 3 whites, 1 rosé, 4 reds and 1 port. The tasting sheet was very informative including the vineyard, area, alcohol content, residual sugar, tasting notes and prices.
Pearmund Cellars and LaGrange. I'm sure you remember my love for Pearmund as I've written about it before. Currently, The Winery at Bull Run is sourcing their grapes from all over VA and Chris is making the wine off-site at Pearmund and LaGrange for now.
First of the whites is a 100% Chardonnay aged in French oak barrels. Typical Burgundian-style Chardonnay with vanilla and buttery notes, full-bodied but crisp enough to enjoy on a summer afternoon. The Chardonnay has gone through full maloactic fermentation giving it that buttery mouth feel. It is also sourced from Meriwether Vineyard in Broad Run, VA. This wine has already won a Bronze medal at the 2012 NextGen Wine Competition. Great job!
On to their "Cuveé Blanc" or a fancy way of saying white blend. 2010 Delaney is named for the youngest member of the Hickox Family (the owners). A blend of 40% Traminette, 30% Vidal Blanc, 20% Viognier, and 10% Riesling. This wine has 1.2 g/l residual sugar making it a semi-dry white wine. A little too sweet for my tastes but it does have a very fruity and juicy mouthfeel with hints of citrus and stone fruit. This wine won the Silver medal in White Table Wine Blends at the 2012 New York International Wine Competition.
The 2010 Viognier is a blend of 75% Viognier, 15% Chardonnay and 10% Gewurztraminer, having slightly more residual sugar than the Delaney at 1.5 g/l. Even though it has a little more residual sugar, I felt like it wasn't as sweet tasting, maybe because it wasn't as juicy. This Viognier is a great representation of what VA is known for, peachy, honeysuckle notes with a floral bouquet nose.
Sourced from the Glebe Vineyard in Eastville, VA the 2010 Rosé is 90% Merlot and 10% Chambourcin. During fermentation, the skins sit with the juice for only 4-5 hours leaving a light pink color. Light, crisp and hints of strawberry, this rosé would be perfect for the patio or light appetizers.
Now time for the reds. First up is the 2009 Cabernet Franc. The grapes came from Colucci Vineyards in Upperville, VA and this wine is 100% Cabernet Franc. Aged in American oak, this wine is medium-bodied with dark fruit flavors and hints of spice. Very typical of Cab Francs. The Cab Franc won the Bronze medal at the 2012 New York International Wine Competition.
The next wine is the 2009 Merlot from Carter's Mountain Vineyard in Charlottesville, VA. Again 100% varietal aged in American oak, this wine is a bigger than the average Merlot. It has lots of black cherry and spice on the palate with a soft, easy finish.
Norton is the native grape of Virginia and gaining more traction so it's no surprise to see the 2010 Norton. Sourced from Keswick Vineyard in Charlottesville, VA, this wine is 77% Norton and 23% Cabernet Sauvignon which helps to round out the flavors. Dark fruit flavors with hints of vanilla from the American oak, the Norton has a long finish and will age well.
Last of the reds is their 2010 Meritage which is a Bordeaux-style blend of 15% Merlot, 15% Malbec, 20% Cabernet Franc, 20% Petite Verdot, and 30% Cabernet Sauvignon. The booziest of them all at 13.9% alcohol, this blend is complex and jammy. The tannin structure shows that it will age well. I'm always a sucker for VA Meritages. For some reason, the complexity, dryness, oaky flavors just suits my palate.Others agree, it won the Bronze medal at the 2012 NextGen Wine Competition!
The final wine on the list is the 2010 Fort, a port-style wine made from 100% Chambourcin also from Colucci Vineyards in Upperville, VA. This sweet wine is served with a small piece of dark chocolate which compliments the flavors perfectly. The cocoa flavor in the wine is showcased after you take a bite of the chocolate. Another award-winning wine, the Fort also won Bronze medal at the 2012 NextGen Wine Competition.
Wow, what a lineup! I wish we could have stayed longer but they close at 7pm. But that's all the more reason to make another visit! You should too, only 20 miles from DC and a few miles off 66, the location and wine are great. I'll see you there.


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Jackpot Futurity in a nutshell
The ADHHA Jackpot Futurity is a limited breeders stake for:
- weanlings in hand
- three year olds in fine harness
The funding for the Jackpot Futurity is realized from the stallion service fees donated and sold at the ADHHA Jackpot Futurity Auction.
Owners of high stepping breeding stallions (of any breed) can sign up their stallions.
Mare owners of any breed or cross can buy a service fee and participate in the Jackpot Futurity provided the resulting foal is registered with ADHHA.
Jackpot Futurity Auction 2013
36 stallions service fees were sold in 2013. DK Jordan's by Uromast was the winner of the competitive ADHHA Jackpot Futurity.


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This young adult novel raises questions about who is sane and who is disturbed. Stephen's mother has been locked away in a mental hospital. He and his father move to Spencer, a tiny town in the middle of nowhere, moving in with Stephen's bitter grandmother. His father never stands up for himself or Stephen, but just gives in to his own mother's many demands. Stephen meets people in town, hoping to make friends. But he is struck how backwards-thinking they are, and how difficult it is to fit in with the local teens. The two people who he finds himself interested in are brother and sister Devon and Cara. Their father has recently died, and he can empathize with them. But they are both trouble-makers. Devon leads a band of other teens, hanging out in the local cemetery, hatching plans and smoking clove cigarettes. They also seem to have supernatural powers. Cara is estranged from her brother, but is ready to make friends with Stephen; in fact, she is extremely attractive and seems ready to get into a relationship with him. But many people in town warn Stephen against the brother and sister, and they do seem to dice with danger. As Stephen finds out more, he clashes with most of the important people in his life, and he is increasingly isolated. The Cemetery Boys has many elements of supernatural thrillers, and has many of the excesses of drama and symbolism that plague that genre. But Brewer manages to raise her novel a bit above the hundreds of the books of magic and vampires that are so popular in young teen fiction.
While the book raises interesting questions, its treatment of mental illness is problematic. Its depiction of psychosis is stereotyped and stigmatizing. The crazy people are scheming and evil. The topic of when it is OK to lock people up because they are mentally ill is not explored carefully. It might be a bit much to expect a teen novel to go into all the difficulties involved in that kind of decision-making, but it could be a bit less simplistic.
Kirby Heyborne performs the unabridged audiobook and brings to it plenty of exclamation and drama in his reading. It is rather heavy handed, but it keeps the implausible plot moving along.
© 2015 Christian Perring
Christian Perring, Professor of Philosophy, Dowling College, New York
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Narrowboat Gecko was our home for twelve years whilst we cruised the inland waterways. Now we are moving ashore and GECKO IS FOR SALE
Wednesday, 21 June 2017
It Ain't Alf Ot Mum!
Whilst in Banbury we say the narrowboat Whio from Aylesbury which is owned by two Kiwis who are in the last year of a five season plan to cover all the waterways in England. We saw them last summer on their way to the Lancaster canal. They are now en route to Cambridge and Ely.
Whilst we were waiting for the Aynho Weir lock to be vacated nb Hampshire Rose passed by. This was originally owned by Ann & Gerald who we also wintered with in Aylesbury until they sold it last year.
On the agricultural front this field of flax was just coming into bloom. Presumably for the production of linseed oil. The almost lavender colour is a welcome change from the ubiquitous and garish rape.
What this Heron was hoping to catch I am not sure.
4 comments:
Hi Margaret and Peter. It has been incredibly hot. We are having our new generator fitted at Stockton Marina and wow it was hot in the open. The Heron maybe looking for frogs. Happy cruising to you both :-)ReplyDeleteReplies
Jo & KeithDelete
Hope the new genny is working out for you. I didn't know herons would eat frogs. That could certainly explain what he was doing standing alert in the middle of a field.
Hi Peter. Going into dry dock Monday for blacking. We are having a hole put in the hull for the raw water cooling for the generator. The we can fire it up, so fingers will be crossed. Herons will eat Frogs, Worms, voles, and amphibians. I guess if you are hungry you will eat pretty much anything.Delete
Don't forget to fit a sea-cock!Delete
Heard of a boat with raw water inlet in bottom of boat. (amongst the mud) No sea-cock. Pipe burst and boat sank.


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Sheet Music
This sheet music category is discontinued. Please see our CATALOG for updated links!
Chopin: Complete Impromptus (ed. Mikuli)
Chopin: Complete Impromptus (ed. Mikuli)
• Complete Impromptus, Op. 29, Op. 36, Op. 51, Op. 66, by Frédéric Chopin, for solo piano.
• Facsimile of G. Schirmer's edition from 1894 (1934).
• Contents: Title page, 2-page essay on Chopin by Carl Mikuli, 2-page essay on the Impromptus by James Huneker, thematic index (table of contents), 29 pages of music.
• Printable e-reader edition, high-quality PDF good for a lifetime.
Presented here is a facsimile of G. Schirmer's groundbreaking and informative edition from 1894 (reissued in 1934) of Chopin's Complete Impromptus (4) edited by Carl Mikuli (1819-1897), which includes the beloved Fantaisie Impromptu, Op. 66. Mikuli, a student and teaching assistant of Chopin, knew Chopin's playing style intimitely, which is why his editions are often regarded by scholars as the finest authoritative editions available today. Contents include:
1. Essay on Chopin by Mikuli
2. Essay on the Impromptus by Huneker
3. Thematic index
4. Impromptu, Op. 29
5. Impromptu, Op. 36
6. Impromptu, Op. 51
7. Fantaisie-Impromptu, Op. 66
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Written on: 06/05/2012
It all started well when I contacted this company to arrange a 3-day trip to Komodo National Park in Indonesia to see Komodo Dragons. Mr. Evan (a representative) told me that I would share the trip with another traveler and it looked pretty cheap compared to other companies. I booked the trip and paid the total amount due in advance. It was very hard to communicate with him as his English was very limited, but luckily I had an Indonesian friend that could help me with this. The day before departure, he gets in touch with me telling me that the other guest had canceled, then he stopped all emails and text messages suddenly. Had my Indonesian friend not been there, Mr. Evan would probably have completely ignored me and I don't know what all this nonsense would have ended up. He asked me for additional money to cover the single surcharge without even apologizing. I did pay the surcharge and I was expecting a nice private trip with an additional value given the fact that the trip was then all mine. What I got, instead, was a very young completely inexperienced local guide whose English was virtually nonexistent. He spent the whole time rushing around so that he could get back home. Result, boredom throughout the whole trip as there was no one to talk to plus frustration. When I tried to get in touch with him to seek clarification, he never replied. Therefore, if you are really looking for quality service, you'd be much better off with other companies.
Written on: 21/05/2013
Do NOT use triptokomodo. We booked a trip in December 2012. They asked me for payment in advance ($800 for two) which I foolishly paid to their bank account. On the day before the trip we arrived back in Kuta, only to be told that the morning flight to Labuan Bajo (for Komodo) has been cancelled and the trip had to be postponed. Since we cannot postpone the trip due to our flight bookings, we had to cancel it. They never refunded us in spite of repeated emails and phones!
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The Vice President of Physician Revenue Cycle is responsible and accountable for the strategic planning, leadership and ongoing continuous quality and process improvement for the physician revenue cycle of RWJBarnabas Health Medical Group. This position will ensure optimal coordination of the following components: physician credentialing, charge entry, coding, billing, collections, denials management and billing compliance.
Essential Functions:
Leadership, Staff Management and Organizational Strategy
Electronic Health Record (EHR)/Other RCM Technology
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Job Requirements:


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The electric grid, which keeps beer cold, houses warm, and city traffic from turning to chaos, depends on about 2,100 high-voltage transformers spread throughout the country.
But engineers in the electric business and officials with the Department of Homeland Security have long been concerned that transformers are vulnerable to disruptions from extreme weather like hurricanes, as well as terrorist and computer attacks and even electrical disturbances from geomagnetic, or so-called solar, storms. One such storm, in 1989, blacked out the entire province of Quebec, and this week, a transformer fire of unknown origin blacked out parts of Boston.
And while replacing transformers is not technically difficult, it is a logistical and time-consuming nightmare that can take up to two years.
So this week the industry and the government have been carrying out an emergency drill unlike any that electrical engineers can remember, to explore how quickly the country could recover from a crippling blow to the power grid. Twelve trucks drove 800 miles from St. Louis to Houston to deliver three "recovery transformers." When they arrived on Tuesday afternoon, workers began to install them as quickly as possible — reducing a task that normally takes weeks to several days.
"If you have to order a transformer from someplace, it's two years to do it," said Richard J. Lordan, a senior technical expert at the Electric Power Research Institute, a nonprofit consortium based in Palo Alto, Calif.Continue reading the main story
Transformers were seen as a potential problem to the grid as far back as 1990, said Sarah Mahmood, a program manager at the Department of Homeland Security, which paid for about half of the cost of the $17 million drill, with the rest picked up by the electrical industry. Transformers are about the size of a one-car garage and usually painted some drab industrial color, but without them, intersecting power lines would be like elevated highways with no interchanges.
For the test, the Electric Power Research Institute ordered three "recovery transformers" from a supplier, ABB in St. Louis. This week they were trucked to a substation owned by CenterPoint Energy near Houston. For security reasons, the company will not say precisely where.
Shipping the replacements was a problem. Ordinary transformers are often too big and heavy to travel by road, and they require special rail cars. But because the transformers typically last 50 years, only a few dozen are shipped each year, so even the appropriate rail cars are in short supply. Ratcheting up the degree of difficulty, many of the places where a replacement transformer might have to go are no longer served by rail.
So the research institute tried a different approach, substituting three smaller, more mobile transformers for one conventional one, and specifying a size that would fit on a modified truck trailer. (A standard transformer costs roughly $5 to $7 million; buying and combining the three singles is slightly more expensive.)
Using a different transformer for each phase allowed shrinking the weight of the transformer from about 400,000 pounds for a single one to roughly 125,000 pounds for each of the three-phase units. In operation, the transformers are oil-filled, but in this case, the oil was shipped in tanker trucks in the convoy, to decrease weight.
With three transformers, three crews can work simultaneously to set them up, and setting up a small transformer is faster than setting up a big one.
In addition, installing a transformer usually requires pouring a concrete foundation, but one of these transformers was mounted on skids, eliminating that need..
Even with all these shortcuts, there were speed bumps. One is that utility executives think a stockpile is a good idea, but nobody is quite sure what to stockpile, or where.
The industry rule of thumb is that for every 13 transformers in the field, there are 10 designs. And the initial model that they will stockpile will only work as a replacement for about 500 of the 2,100 transformers in the system.
The next step will be a transformer unlike almost any in the field, that can be configured to work between more than two different voltages — say, operating not just between 138 kilovolts and 345 kilovolts, but also between 115 kilovolts and 345 kilovolts. That would cover a few hundred more.
In recent years, electric companies have been required to build entire duplicate control centers, at least 10 miles from the primary center, to reduce the possibility of a catastrophe that would knock down sections of the grid for months. After a flurry of fines and public embarrassments, the utilities have become better at maintaining their power lines. But this is the industry's first major effort to solve the transformer problem.
A study for the Energy Department last year reinforced the need for speed, suggesting that hundreds of transformers could be lost to a "geomagnetic storm," an eventuality that experts say could leave large parts of the North American continent blacked out for months.
Many engineers doubt that that could happen, but see a value in trying to compress the replacement schedule. CenterPoint was reluctant to provide a precise schedule but it is trying to do in a few days what often takes six to eight weeks.Continue reading the main story