text:
- Research Article
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Lower body functioning and correlates among older American Indians: The Cerebrovascular Disease and Its Consequences in American Indians Study
- R. Turner Goins1Email authorView ORCID ID profile,
- Mark Schure2,
- Paul N. Jensen3,
- Astrid Suchy-Dicey4,
- Lonnie Nelson5,
- Steven P. Verney6,
- Barbara V. Howard7 and
- Dedra Buchwald8
© The Author(s). 2018
- Received: 28 March 2017
- Accepted: 19 December 2017
- Published: 5 January 2018
More than six million American Indians live in the United States, and an estimated 1.6 million will be aged ≥65 years old by 2050 tripling in numbers since 2012. Physical functioning and related factors in this population are poorly understood. Our study aimed to assess lower body functioning and identify the prevalence and correlates of "good" functioning in a multi-tribe, community-based sample of older American Indians.
Assessments used the Short Physical Performance Battery (SPPB). "Good" lower body functioning was defined as a total SPPB score of ≥10. Potential correlates included demographic characteristics, study site, anthropometrics, cognitive functioning, depressive symptomatology, grip strength, hypertension, diabetes mellitus, heart disease, prior stroke, smoking, alcohol use, and over-the-counter medication use for arthritis or pain. Data were collected between 2010 and 2013 by the Cerebrovascular Disease and Its Consequences in American Indians Study from community-dwelling adults aged ≥60 years (n = 818).
The sample's mean age was 73 ± 5.9 years. After adjustment for age and study site, average SPPB scores were 7.0 (95% CI, 6.8, 7.3) in women and 7.8 (95% CI, 7.5, 8.2) in men. Only 25% of the sample were classified with "good" lower body functioning. When treating lower body functioning as a continuous measure and adjusting for age, gender, and study site, the correlates of better functioning that we identified were younger age, male gender, married status, higher levels of education, higher annual household income, Southern Plains study site, lower waist-hip ratio, better cognitive functioning, stronger grip strength, lower levels of depressive symptomatology, alcohol consumption, and the absence of hypertension, diabetes mellitus, and heart disease. In our fully adjusted models, correlates of "good" lower body functioning were younger age, higher annual household income, better cognitive functioning, stronger grip, and the absence of diabetes mellitus and heart disease.
These results suggest that "good" lower body functioning is uncommon in this population, whereas its correlates are similar to those found in studies of other older adult populations. Future efforts should include the development or cultural tailoring of interventions to improve lower body functioning in older American Indians.
- American Indians
- Lower body functioning
- Short physical performance battery
More than six million American Indians live in the United States with an estimated 600,000 who are aged ≥65 years old [1]. By 2060, the number of American Indians who are aged ≥65 years old will increase to 1.6 million, tripling in numbers since 2012 [2]. Physical functioning and related factors in this population are poorly understood. Limited data indicate that disability is more common in older American Indians than in older Whites. Disability is usually a manifestation of poor health, and is a risk factor for falls and further disability [3]. Disability also has robust positive associations with receipt of informal caregiving, hospitalization, nursing home placement, and mortality [4–6]. Two studies that examined the 2000 US Census data demonstrated that older American Indians experience higher rates of disability than their same-aged counterparts of other races and ethnicities [7, 8]. For instance, this research found that American Indians aged ≥55 years had higher prevalence of self-reported disability than same-aged Whites (functional limitation: 36% vs. 25%; mobility disability: 21% vs. 17%; and, self-care disability: 12% vs. 9%) [7]. The second study examined American Indians who were aged ≥65 years and the researchers found that 58% had a disability compared to 42% in all other racial/ethnic groups aged ≥65 years [8].
Compared to the widely used self-reported measures of functional limitation and disability, performance-based measures of physical functioning are less likely to be influenced by psychosocial factors of the patient or study participants' perception of their ability to perform certain activities [9]. Moreover, studies have demonstrated weak to moderate correlations between self-reported and performance-based physical functioning measures [9–11]. Identified American Indian cultural and social factors [12, 13] may influence the accuracy of such measurements and thus making it important to capture functioning in this population with performance measurements.
Yet, to date, there has only been one other study has used such measures to examine physical functioning in this population [14]. Thus, our objectives are to characterize the prevalence of good lower body functioning and identify its correlates in a multi-tribe, community-based sample of older American Indians. Our current will serve as a confirmatory study as well offering an examination with older American Indians who reside in three different geographic regions and the opportunity to examine some additional potential correlates.
Data source
Our data were collected as part of the Cerebrovascular Disease and its Consequences in American Indians (CDCAI) Study also known as the Strong Heart Stroke Study. The CDCAI Study was a cross-sectional study of cerebrovascular disease conducted with 1033 Strong Heart Study surviving participants who were aged ≥60 years [15], but 215 of the participants were removed from analyses due to one tribal community that subsequently withdrew study consent. We recruited participants from three study locations, including the Northern Plains, the Southern Plains, and the Southwestern United States. Participants were recruited for the study with trained field staff making the initial contact by telephone or during a planned home visit. The study's purpose was explained by the field staff who would then invite the individual to participate in the study. If the individual was willing, field staff would screen them for study eligibility. Study exclusion criteria included prior surgery for a cerebral aneurysm; an implanted cardiac pacemaker, defibrillator, or artificial heart; contraindicating metal prostheses; a cochlear implant, spinal cord stimulator, or other implanted electrical device(s); history as a metal worker given the possibility of retained metal fragments; body weight of ≥350 pounds; and/or physical or cognitive inability to complete study procedures. Between 2010 and 2013, all of the participants received clinical, cognitive, and functioning assessments. Study procedures were approved by 13 organizations that included five Tribal Review Boards or Tribal Councils, five academic or medical institutional review boards (IRBs), and three regional Indian Health Service IRBs. The primary institution that provided institutional review board approval for this study was the University of Washington. As stipulated in the tribal approvals, we are unable to identify the other approving entities for this study in order to maintain the anonymity of the participating tribes. The design and recruitment methods for the CDCAI Study are described in more detail elsewhere [16].
Physical functioning
The Short Physical Performance Battery (SPPB) measured lower body functioning using standing balance, gait speed, and chair stands [17]. SPPB scores are associated with falls [18], disability [17, 19], nursing home admission [17], and mortality [17, 20]. The validity and reliability of the SPPB have been established in large, community-based, geographically and racially diverse samples of older adults [17, 21].
Standing balance was assessed by asking each participant to attempt three increasingly difficult positions without the use of assistance devices and to hold each position for 10 s. Participants first had their standing balance examined with feet side-by-side, then in a semi-tandem position with the heel of one foot beside the big toe of the other, and finally in a tandem position with the heel of one foot directly in front of the toes of the other. For the side-by-side position standing task, participants were scored as 1 if they held the position for 10 s and 0 if they did not attempt or were unable to hold the position for 10 s. For the semi-tandem position standing task, participants were scored as 1 if they held the position for 10 s and 0 if they did not attempt or were unable to hold the position for 10 s. For the tandem standing task, participants were scored as 2 if they held the position for 10 s, 1 if they held the position for 3–9.99 s, and 0 if they did not attempt or held the position for <3 s. The three standing balance positions were summed to generate a total balance score that ranged from 0 to 4.
For gait speed, participants were asked to walk a 15-ft straight course at their usual pace continuing beyond the end of the course if they felt they could do so safely. Participants were permitted to use a cane or other walking aid as needed. Scores for the 15-ft walk were adapted from the 3- and 4-m walks by using the same pace requirements and extrapolating time limits to account for the additional distance covered. Participants were scored as 0 if they were unable to perform the walk, 1 if they completed the walk in more than 9.94 s, 2 if they completed in ≤9.94 s, 3 if they completed in ≤7.09 s, and 4 if they completed in ≤5.52 s.
For chair stands, study site field staff determined whether each participant could safely stand up from sitting in a chair without assistance. Those who could were then asked to stand up from the chair five times as quickly as possible without using their arms. Participants were scored as 0 if they were unable to complete 5 chair stands or completed 5 chair stands in >60 s, 1 if they completed in 16.7–60.0 s, 2 if they completed in 13.7–16.69 s, 3 if they completed in 11.2–13.69 s, and 4 if they completed in <11.2 s.
All SPPB task scores range from 0 to 4 and the total SPPB score is the sum of all three task scores, which ranges from 0 to 12 where higher scores are reflect better performance. We examined the individual SPPB tasks and total score as continuous measures as well as examined the total SPPB score as a binary measure such that ≥10 denoted "good" performance and ≤9 denoted "poor" performance [22].
Independent variables
Independent variables included demographic characteristics, study site, anthropometrics, cognitive functioning, depressive symptomatology, grip strength, hypertension, diabetes mellitus, heart disease, prior stroke, smoking, alcohol use, and over-the-counter arthritis or pain medication use. Demographic characteristics included age, gender, marital status, educational attainment, and annual household income. Anthropometrics included body mass index (BMI) and waist-hip ratio, which were directly measured during CDCAI assessments. BMI was calculated as measured weight in kilograms divided by measured height in meters squared; waist circumference was measured at the umbilicus with the participant in a supine position; and hip circumference was measured at the widest portion of the buttocks with the participant standing.
Cognitive functioning was measured with the Modified Mini-Mental State (3MS) examination, which has possible scores ranging from 0 to 100 where higher scores are reflective of better cognitive functioning. The 3MS includes screening items on temporal and spatial orientation, immediate and delayed memory, attention and concentration, language and naming, verbal fluency, and executive functioning [23]. Depressive symptomatology was measured with the Centers for Epidemiologic Studies Depression Scale (CES-D) [24], a 20-item instrument that describes the frequency of symptoms within the last week by using a 4-point scale ranging from 0 (rarely or none of the time) to 3 (most or all of the time). When scored, the CES-D ranges from 0 to 60, with higher scores indicating more depressive symptomatology. Scores were analyzed as a binary variable by using the standard cutoff score of ≥16 to reflect a clinically significant level of symptoms [24].
Grip strength was ascertained three times in kilograms for both hands by using a calibrated dynamometer. Measures of the participant's dominant hand were averaged for use in our analyses. Hypertension was assessed with measured blood pressure (systolic ≥140 or diastolic ≥90) or self-reported use of antihypertensive medication. Diabetes mellitus was defined as fasting glucose of at least 126 mg/dL or self-reported use of insulin or an oral hypoglycemic. Heart disease was determined with a "yes" answer to the question, "Has a medical person ever told you that you have (or had): congestive heart failure, a heart attack, any other heart trouble, a bypass, a valvular repair or replacement, and/or a pacemaker installed?" Stroke was also determined with a "yes" answer to the question, "Has a medical person ever told you that you have had a stroke?"
Participants were asked about current tobacco smoking and alcohol consumption in the past 30 days, with "yes" or "no" response options. Lastly, over-the-counter medication use for arthritis or pain was determined with a "yes" answer to the question, "Do you take over-the-counter medicines for arthritis or pain, like Advil, Motrin, or Aleve?"
Statistical analyses
We used mean, standard deviation (SD), count, and percent to describe participant characteristics, including total SPPB scores and scores on the three individual SPPB tasks. To assess associations of demographic characteristics, anthropometrics, cognitive functioning, depressive symptoms, grip strength, clinical conditions, lifestyle behaviors, and over-the-counter medication use for arthritis or pain with both individual SPPB task and total SPPB scores, linear regression models were used with adjustment for age, gender, and study site. Our result estimates were reported using 95% confidence intervals (95% CI) for each independent factor individually. Estimates for continuous independent variables were given per clinically meaningful change in unit, which tended to be close to the estimate of standard deviation for the entire sample population. To assess associations between selected independent variables and the binary total SPPB score (good versus poor), generalized linear models with Poisson distribution and log-link were used, with inclusion of all independent factors in the same model. Continuous variables were transformed based on their standard deviations in order to facilitate direct comparison of degree of effect from each of the different independent variables. Exponentiated Poisson coefficients were interpreted as relative risk under assumption of reasonably rare outcome (25%). All of our analyses were performed with Stata 13 [25].
Selected characteristics of participants from the Cerebrovascular Disease and its Consequences in American Indians Study
Women (n = 554)
Men (n = 262)
Age, mean (SD)
73 (6.1)
73 (5.3)
Study site
Northern Plains
Southern Plains
Highest education
Less than high school
High school graduate
College or greater
Annual household income
< $25 k
$25 k–50 k
≥ $50 k
BMI (kg/m2)
≤ 24.9
≥ 30
Waist-hip ratio, mean (SD)
0.9 (0.1)
1.0 (0.1)
3MS score, mean (SD)
88 (9.6)
88 (10.0)
CESD score, mean (SD)
11 (8.5)
10 (7.0)
Grip strength (kg), mean (SD)
20 (6.2)
34 (8.7)
Diabetes mellitus
Heart disease
Current smoker
Alcohol consumption in past 30 days
OTC pain medication use
Multivariate linear regression models of the Short Physical Performance Battery (SPPB) score among participants from the Cerebrovascular Disease and its Consequences in American Indians Study
Balance score
Gait score
Chair Stand score
Total score
Age (per 5 years)
(−0.38, −0.23)
(−0.37, −0.25)
(−0.36, −0.22)
(−1.07, −0.74)
Male gender
(−0.07, 0.31)
(0.26, 0.57)
(0.07, 0.42)
(0.37, 1.19)
Study site
Northern Plains
Southern Plains
(0.13, 0.50)
(−0.15, 0.16)
(−0.09, 0.26)
(0.00, 0.82)
(−0.43, 0.14)
(−0.37, 0.11)
(−0.33, 0.21)
(−0.96, 0.29)
(0.10, 0.48)
(0.10, 0.41)
(0.21, 0.57)
(0.52, 1.34)
Educational attainment
Less than high school diploma
High school graduate
(0.19, 0.71)
(0.16, 0.58)
(0.12, 0.61)
(0.62, 1.75)
Some college or greater
(0.32, 0.79)
(0.39, 0.78)
(0.21, 0.66)
(1.05, 2.10)
Annual household income
< $25,000
(0.11, 0.51)
(0.20, 0.53)
(0.19, 0.56)
(0.62, 1.48)
≥ $50,000
(0.12, 0.75)
(0.19, 0.71)
(0.40, 0.98)
(0.89, 2.25)
≤ 24.9 kg/m2
25–29.9 kg/m2
(−0.40, 0.15)
(−0.34, 0.12)
(−0.30, 0.23)
(−0.87, 0.34)
≥ 30 kg/m2
(−0.37, 0.15)
(−0.25, 0.18)
(−0.35, 0.14)
(−0.81, 0.32)
Waist-hip ratio (per 0.1)
(−0.41, −0.13)
(−0.32, −0.08)
(−0.38, −0.11)
(−1.02, −0.41)
3MS score (per 10 points)
(0.33, 0.51)
(0.30, 0.45)
(0.19, 0.36)
(0.88, 1.27)
CES-D score (per 8 points)
(−0.28, −0.11)
(−0.24, −0.10)
(−0.30, −0.14)
(−0.77, −0.40)
Depression (CES-D ≥ 16)
(−0.63, −0.21)
(−0.50, −0.15)
(−0.69, −0.30)
(−1.70, −0.79)
Grip strength (per 6 kg)
(0.23, 0.38)
(0.20, 0.33)
(0.18, 0.32)
(0.66, 0.97)
(−0.60, −0.16)
(−0.45, −0.08)
(−0.45, −0.03)
(−1.37, −0.40)
Diabetes mellitus
(−0.77, −0.42)
(−0.54, −0.26)
(−0.70, −0.38)
(−1.91, −1.16)
Heart disease
(−0.57, −0.19)
(−0.41, −0.09)
(−0.58, −0.23)
(−1.45, −0.62)
Self-reported prior stroke
(−0.94, −0.31)
(−0.59, −0.07)
(−0.65, −0.07)
(−2.00, −0.63)
Current smoker
(−0.36, 0.07)
(−0.05, 0.31)
(−0.26, 0.15)
(−0.56, 0.40)
Alcohol consumption in last 30 days
(−0.23, 0.29)
(0.02, 0.45)
(−0.10, 0.40)
(−0.16, 0.99)
Use OTC pain medications
(−0.25, 0.12)
(−0.16, 0.15)
(−0.25, 0.09)
(−0.55, 0.26)
Male gender and married status were associated with better function; higher BMI, more depressive symptoms, presence of hypertension, prior stroke, smoking, alcohol consumption, or OTC pain medications were associated with worse function. However, none of these associations excluded the possible role of chance, once adjusted for all other factors. Educational attainment and waist-hip ratio were not associated with lower body functioning. Lastly, there was no evidence of differences in SPPB by site, after adjustment for all other factors.
Our findings suggest that "good" lower body functioning was relatively rare in this cohort and varied by study site. Overall lower body functioning was poor in most men and women, although it was worse in women. When treating lower body functioning as a continuous measure and adjusting for age, gender and study site, the correlates of better functioning that we identified were younger age, male gender, married status, higher levels of education, higher annual household income, Southern Plains study site, lower waist-hip ratio, better cognitive functioning, stronger grip strength, lower levels of depressive symptomatology, alcohol consumption, and better cardiovascular health. When measuring lower body functioning as a binary outcome and adjusting for age, gender, study site and the remaining covariates, the correlates of "good" lower body functioning that we identified were younger age, higher annual household income, better cognitive functioning, stronger grip, and the absence of diabetes mellitus and heart disease.
Notably, the CDCAI Study cohort had a substantially lower prevalence of "good" lower body functioning than the sample of community-dwelling American Indians aged ≥55 years recruited for the Native Elder Care Study. In that sample, 48% of participants had SPPB scores of ≥10 [14] while only 25% of the CDCAI sample had total SPPB scores of ≥10. Since the CDCAI cohort is slightly older, it is unclear whether these differences in functioning derive primarily from differences in age. Studies using SPPB have also demonstrated lower levels of physical functioning in other racial and ethnic minority populations compared to same-aged Whites. For example, one recent study found that older African American men had lower SPPB scores than older White men after adjusting for age, rural residence, marital status, education, and income [26].
The correlates of better or "good" lower body functioning identified in our study are consistent with those identified by the Native Elder Care Study. Both studies identified higher socioeconomic status, fewer comorbid conditions, and less depressive symptomatology to be associated with better functioning while BMI and smoking status were unrelated with functioning [14]. No relationship between BMI and lower body functioning has been demonstrated in older American Indians. The undetected association between BMI and lower body functioning is not entirely surprising given that prior studies have not presented a consistent finding [27–29]. However, when measuring functioning with self-reported activities of daily living, the research appears to be clearer in demonstrating that overweight is associated with poorer functioning [30]. Our study is the first study to examine the association of waist-hip ratio with lower body functioning in older American Indians. Other research with older adults of other race and ethnicities have generally found a consistent significant relationship between higher waist-hip ratios with poorer lower body functioning [29, 31, 32]. Since BMI does not distinguish between muscle and fat and waist-hip ratio captures central adiposity, waist-hip ratio is considered a better measure when assessing correlates or predictors of lower body functioning. In light of our findings, future research would need to assess more closely the relative contribution and mechanism of influence of BMI versus waist-hip ratio on lower body functioning in older American Indians. Additional research may also examine in greater detail the observed differences in degree of associations between health measures with individual SPPB tasks to illuminate different mechanisms of biological effect. For example, such research may want to examine why cognitive functioning had a stronger association with balance and gait than with chair stands.
The present study has several strengths, including a population-based design and the use of a large, multi-tribe sample derived from three geographically distinct regions including the Northern Plains, Southern Plains, and the Southwest. Notably, the tribes in each region are also culturally and historically distinct from those in the Southeast as was examined in the Native Elder Care Study. Additional strengths of this study include the use of objective measures and the comprehensive inclusion of potential correlates. Objective measurement of lower body functioning is particularly important in American Indian geriatric research, given the potential effects that cultural factors may have on the validity of self-report physical functioning measures in this population. Previous work has identified constructs of "tolerated illness" and the "harmony ethic" in American Indian cultures, such that the ability to endure hardships and poor health without imposing one's needs on others is valued [12, 13].
Despite these strengths, certain limitations of our study must also be noted. First, all study participants were older adults who were survivors from the Strong Heart Study cohort and generalizing our findings may not extend to other groups. Second, our study data were cross-sectional, precluding our ability to directly examine temporal sequence in the reported associations. Third, cognitive measures such as the 3MS have not been validated or normed with American Indians making the clinical relevance of changes in the score unclear. Future research is needed that would identify appropriate normative standards in this measure as well as any necessary cultural adaptations. Also, study exclusion criteria limited participation to people who could travel to complete the study's complex medical, cognitive, and functional assessments. This factor might have artificially inflated our estimates of "good" lower body functioning. Last, the examination of a large number of covariates resulted in multiple comparisons, so some associations may have appeared due to chance. However, the directionality of these associations with "good" lower body functioning were similar to those reported in an independent sample of American Indians [14], suggesting it is unlike that these associations are spurious.
The distinct circumstances of our study population that contribute to this high prevalence of poor physical functioning must be better understood. The literature on American Indian health continues to find higher prevalence of many chronic illnesses than in the all-races or White populations [33, 34], while older American Indians have lower educational attainment and income compared to their same-aged peers [35]. A better understanding of current physical functioning in older members of this population can be gained through a life course approach that follows people from birth to old age [36]. All racial and ethnic minority populations in the U.S. have an experience of life that differs markedly from that of Whites because of social and structural inequalities. Given their unique history, American Indians have endured hardships comparable to, or even more severe than, those in other populations. While interventional work has been conducted to improve mobility among older adults, these interventions have not been implemented in tribal communities [37–39]. Subsequent efforts should include translating such promising efforts for Indian Country with the goal of creating sustained community-based interventions that promote mobility and overall good physical health.
Not applicable
This work was supported by funding from the National Heart, Lung, and Blood Institute, HL093086 (D. Buchwald). The funding body did not participate to the study design, data collection, analysis, data interpretation, and in writing the manuscript.
Availability of data and materials
Since the participating communities are legally sovereign nations, our data do not entirely belong to our research institutions, even after being de-identified. The communities consider their data to belong to them, and have not relinquished that right to anyone. Therefore, the informed consents do not allow the data to be made generally available. Only internal analysts are permitted to access the data directly and any researcher who wishes to work with these data must work through our analyst teams. Interested researchers may contact Partnerships for Native Health, now at Washington State University, or the authors for more information about manuscript and data use procedures.
Authors' contributions
All authors contributed substantially to the conception or design of the study, or the acquisition, analysis, or interpretation of the data; drafted the work or revised it critically for important intellectual content. In particular, RTG, PNJ, MS, LN, SPV conceptualized the study. PNJ and ASD analyzed the data. RTG, ASD, PNJ, MS, LN, SPV drafted the manuscript. RTG, ASD, PNJ, MS, LN, SPV, BVH, and DB critically revised the manuscript for important intellectual content. LN, SPV, BVH, and DB contributed to the acquisition of the data. RTG, ASD, PNJ, MS, LN, SPV, BVH, DB contributed to the interpretation of the data. All authors (RTG, ASD, PNH, MS, LN, SPV, BVH, and DB) have read and approve this submitted version to BMC Geriatrics and agree to be accountable for all aspects of the work.
Ethics approval and consent to participate
The received approval from 13 entities, 5 of which were tribal review boards. The primary institution that provided institutional review board approval for this study was University of Washington. The participating tribes do not want to be identified. Written consent was obtained from participants.
Consent for publication
Not applicable
Competing interests
None of the authors have any financial or non-financial competing interests.
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Authors' Affiliations
- Ruggles S, Genadek K, Goeken R, Grover J, Sobek M. Integrated public use microdata series: version 6.0 [machine-readable database]. Minneapolis: University of Michigan; 2015.Google Scholar
- Ortman JM, Velkoff VA, Hogan H. An aging nation: The older population in the United States. Washington, DC. US Census Bureau. 2014. Report No: 25–1140.Google Scholar
- Rubenstein LZ. Falls in older people: Epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(S2):ii37–41.View ArticlePubMedGoogle Scholar
- Lubitz J, Cai L, Kramarow E, Lentzner H. Health, life expectancy, and health care spending among the elderly. N Engl J Med. 2003;349(11):1048–55.View ArticlePubMedGoogle Scholar
- Gaugler JE, Duval S, Anderson KA, Kane RL. Predicting nursing home admission in the US: a meta-analysis. BMC Geriatr. 2007;7(1):1–13.View ArticleGoogle Scholar
- Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Injury Prev. 2006;12(5):290–5.View ArticleGoogle Scholar
- Goins RT, Moss M, Buchwald D, Guralnik JM. Disability among older American Indians and Alaska natives: an analysis of the 2000 census public use microdata sample. Gerontologist. 2007;47(5):690–6.View ArticlePubMedPubMed CentralGoogle Scholar
- Moss MP, Schell MC, Goins RT. Using GIS in a first national mapping of functional disability among older American Indians and Alaska natives from the 2000 census. Int J Health Geogr. 2006;5(37)Google Scholar
- Wand BM, Chiffelle LA, O'Connell NE, McAuley JH, DeSouza LH. Self-reported assessment of disability and performance-based assessment of disability are influenced by different patient characteristics in acute low back pain. Eur. Spine J. 2010;19(4):633–40.View ArticleGoogle Scholar
- Amris K, Wæhrens EE, Jespersen A, Bliddal H, Danneskiold-Samsøe B. Observation-based assessment of functional ability in patients with chronic widespread pain: a cross-sectional study. Pain. 2011;152(11):2470–6.View ArticlePubMedGoogle Scholar
- Lee CE, Simmonds MJ, Novy DM, Jones S. Self-reports and clinician-measured physical function among patients with low back pain: a comparison. Arch Phys Med Rehab. 2001;82(2):227–31.View ArticleGoogle Scholar
- Loftin JD. The "harmony ethic" of the conservative eastern Cherokees: a religious interpretation. J Cherokee. Studies. 1983;8(1):40–3.Google Scholar
- Moss MP. TOLERATED ILLNESS™ concept and theory for chronically ill and elderly patients as exemplified in American Indians. J Cancer Educ. 2005;20(S1):17–22.View ArticlePubMedGoogle Scholar
- Goins RT, Innes K, Dong L. Lower body functioning prevalence and correlates in older American Indians in a southeastern tribe: the native elder care study. J Am Ger Soc. 2012;60(3):577–82.View ArticleGoogle Scholar
- Lee ET, Welty TK, Fabsitz R, Cowan LD, Le N-A, Oopik AJ, Cucchiara AJ, Savage PJ, Howard BV. The strong heart study: a study of cardiovascular disease in American Indians: design and methods. Am Journal Epidemiol. 1990;132(6):1141–55.View ArticleGoogle Scholar
- Suchy-Dicey AM, Shibata D, Best LG, Verney SP, Longstreth WT Jr, lee ET, Okin PM, Devereux R, O'Leary M, Ali T, et al. cranial magnetic resonance imaging in elderly American Indians: design, methods, and implementation of the cerebrovascular disease and its consequences in American Indians study. Neuroepidemiology. 2016;47(2):67–75.View ArticlePubMedPubMed CentralGoogle Scholar
- Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A Short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.View ArticlePubMedGoogle Scholar
- Van Kan GA, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M, Cesari M, Donini L, Gillette-Guyonnet S, Inzitari M. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an international academy on nutrition and aging (IANA) task force. J Nutr Health Aging. 2009;13(10):881–9.View ArticleGoogle Scholar
- Ostir GV, Markides KS, Black SA, Goodwin JS. Lower body functioning as a predictor of subsequent disability among older Mexican Americans. J Gerontol A Biol Sci Med Sci. 1998;53(6):M491–5.View ArticlePubMedGoogle Scholar
- Markides KS, Black SA, Ostir GV, Angel RJ, Guralnik JM, Lichtenstein M. Lower body function and mortality in Mexican American elderly people. J Gerontol A Biol Sci Med Sci. 2001;56(4):M243–7.View ArticlePubMedGoogle Scholar
- Ostir GV, Volpato S, Fried LP, Chaves P, Guralnik JM. Reliability and sensitivity to change assessed for a summary measure of lower body function: results from the Women's health and aging study. J Clin Epidemiol. 2002;55(9):916–21.View ArticlePubMedGoogle Scholar
- Bean JF, Leveille SG, Kiely DK, Bandinelli S, Guralnik JM, Ferrucci LA. Comparison of leg power and leg strength within the InCHIANTI study: which influences mobility more? J Gerontol A Biol Sci Med Sci. 2003;58(8):M728–32.View ArticleGoogle Scholar
- Teng E, Chui H. The modified mini-mental state examination (3MS). Can J Psychiatr. 1987;41(2):114–21.Google Scholar
- Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psych Meas. 1977;1(3):385–401.View ArticleGoogle Scholar
- StataCorp. Stata Statistical Software: Release 13. College Station: StataCorp LP; 2013.Google Scholar
- Clay OJ, Thorpe RJJ, Wilkinson LL, Plaisance EP, Crowe M, Sawyer P, Brown CJ. An examination of lower extremity function and its correlates in older African American and white men. Ethnic Dis. 2015;25(3):271–8.View ArticleGoogle Scholar
- Marsh AP, Rejeski WJ, Espeland MA, et al. Muscle strength and BMI as predictors of major mobility disability in the lifestyle intervention and independence for elders pilot (LIFE-P). J Gerontol A Biol Sci Med Sci. 2011;66:1376–83.View ArticlePubMedGoogle Scholar
- Mendes de Leon CF, Hansberry MR, Bienias JL, Morris MC, Evans DA. Relative weight and mobility: a longitudinal study in a biracial population of older adutls. Ann Epidemiol. 2006;16:770–6.View ArticlePubMedGoogle Scholar
- Lisko I, Stenholm S, Raitanen J, Hurme M, Hervonen A, Jylhä M, Tiainen K. Association of body mass index and waist circumference with physical functioning: the vitality 90+ study. J Gerontol A Biol Sci Med Sci. 2015;70(7):885–91.View ArticlePubMedGoogle Scholar
- Backholder K, Wong E, Freak-Poli R, Walls HL, Peeters A. Increasing body .weight and risk of limitations in activities of daily liviing: A systematic review and meta-analysis. Obes Rev. 2012;13:456–68.View ArticleGoogle Scholar
- Guallar-Castillon P, Sagardui-Villamor J, Banegas JR, Graciani A, Fornes NS, Garcia EL, Rodriguez-Artalejo F. Waist circumference as a predictor of disability among older adults. Obesity. 2007;15(1):233–44.View ArticlePubMedGoogle Scholar
- Lisko I, Tiainen K, Stenholm S, Luukkaala T, Hervonen A, Jylhā M. Body mass index, waist circumference, and waist-to-hip ratio as predictors of mortality in nonagenarians: the Viality 90+ study. J Gerontol A Biol Sci Med Sci. 2011;66:1244–50.View ArticlePubMedGoogle Scholar
- Center for Disease Control. American Indian and Alaska Native Death Rates Nearly 50 Percent Greater Than Those of Non-Hispanic Whites. Atlanta, GA: Center for Disease Control. 2014.Google Scholar
- Indian Health Service. Trends in Indian Health: 2014 Edition. Rockville, MD: Indian Health Service; 2014.Google Scholar
- Goins RT, Schure MB, Crowder J, Baldrige D, Benson W, Aldrich N. Lifelong disparities among older American Indians and Alaska natives. Washington, DC: AARP Public Policy Insitute; 2015.Google Scholar
- Thorpe RJJ, Duru K, Hill CV. Advancing racial/ethnic minority men's health using a life course approach. Ethnic Dis. 2015;25(3):241–4.View ArticleGoogle Scholar
- Fielding RA, Guralnik JM, King AC, Pahor M, McDermott MM, Tudor-Locke C, Manini TM, Glynn NW, Marsh AP, Axtell RS, Hsu F-C, Rejeski WJ. LIFE study group. Dose of physical activity, physical functioning and disability risk mobility-limited older adults: results from the LIFE study randomized trial. PLoS One. 2017;12(8)Google Scholar
- VanSwearingen JM, Perera S, Brach JS, Wert D, Studenski SA. Impact of exercise to improve gait efficiency on activity and participation in older adults with mobility limitations: a randomized controlled trial. Phys Ther. 2011;91(12):1740–51.View ArticlePubMedPubMed CentralGoogle Scholar
- Yeom HA, Keller C, Fleury J. Interventions for promoting mobility in community-.dwelling older adults. J Am Assoc Nurse Pract. 2009;21:95–100.View ArticleGoogle Scholar


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Ivan Limbakh Publishing House is oriented on publishing books pertaining to the humanities with high level of scientific and editorial preparation and high polygraphic performance. The publishing house was founded on the 2nd of August, 1995.
197342, St.Petersburg, Beloostrovskaya st., 28, of. 340. Phone/fax: +7 (812) 496-25-62.Web: www.limbakh.ru email@example.com © Ivan Limbakh Publishing House, 2007Site map

subset: commoncrawl


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Will I finally go home to my real Mom?
The nice people at Turtle Gardens Animal Rescue let me stay with them for about a month. That was until they found a suitable Foster Family for me. Well this is it. I'm living here in Lillooet for the time being. My foster mom is going to try to post weekly updates about my life. That will allow my REAL mom to watch and read about me while she recovers up north.
I miss my real mom and I can't wait to get back home to her comfort again. I'm very happy these people have let me stay with them. It's REALLY cozy here! I'll try to talk more about it each week. I hope you enjoy this blog and I look forwrd to reading your comments.
Thank you so much for my Foster Family Mamma Yvette :-)
Please visit these links to see my photos and videos as the get uploaded regularly
http://s422.photobucket.com/albums/pp302/Katog/Duchess%20Sammy - Photos
http://www.youtube.com/user/katogster - Videos


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Since our son has a size 86/92, I've noticed that the children clothing is becoming more adult-like than when he wore a smaller size. So I prefer good basics like these from Kidscase or make a shirt of my own.
Do you have any tips for typical children clothing with funny prints for children?


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This apartment is extremely quiet, so no more loud, beeping Tesco delivery trucks and exhaust fumes at 4:30 in the morning; no more old drunk guys hanging out right behind the building wailing tunelessly and leaving behind piles of garbage that never get picked up; no more men urinating against the wall of the building; no more bright Tesco lights blasting right outside the window; no more disgruntled Tesco employees on the nightshift sending large crates of garbage crashing into the dumpster at odd hours of the night.
|Terezia was upset with me for not making the pillows look nicer for this photo.
The stairwell is also infinitely nicer than the one in the last place. (I don't have a photo of the last one, but trust me, it was kind of a dismal puke green and looked like something from a college dorm).
And there are views of cool things from the stairwell windows.
Here are some other plusses:
The new place has recycling! Slovakia's waste management ranks pretty poorly among EU countries, and recycling is not a mandatory thing the way it is in much of California. In the Stare Mesto, public recycling bins can be fairly elusive, depending on where you live. Many residential buildings have them, but many others don't. It's up to the owner of each building to obtain recycling bins, but that of course increases the garbage bill, and if the owner or a majority of the building's tenants don't want them, then you're out of luck. At the Dunajska apartment, there were unfortunately no recycling bins, and it always pained me to see other tenants just throwing bottles and cardboard into the trash.
The nearest public recycling bins to our former apartment were about five blocks away, and as a result we tended to let it accumulate to the point where we'd have too much to shlep on foot. That meant we had to sweet talk Terezia's brother Tony into coming by in his car periodically to help us transport it. And even then, sometimes those particular bins were full to overflowing, in which case we'd have to find some others, which usually meant driving up into the hills. It's absolutely crazy that Bratislava is so appallingly backwards in this regard, especially in this day and age, but it's not at all surprising.
But since the new place has recycling bins on the premises, that particular hassle is a thing of the past.
No centralized heating! It's not uncommon for residential buildings in Slovakia (and elsewhere in Europe) to have centralized heating, whereby heating for all of the apartments is controlled from a central system. In such buildings, tenants have no control over the heat in their apartments, and are completely at the mercy of what I always imagine to be this grumpy, soot-encrusted troll who controls the thing from the dimly lit basement. This was the situation in our old apartment, and it was far from ideal. I envisioned the heating system control panel to consist only of one massive, black vintage dial with two settings: off and sweltering. It seemed liked there was no in-between. This meant that from November through March, the apartment was so stiflingly hot that we always had to crack open a few windows and that, even if it was 15 below outside, we were walking around the place in t-shirts and shorts like it was summertime. It also meant that when it started to get cold in October, we had to wait for the outdoor temperature to be cold enough (something like below 13 degrees celsius for three consecutive days) before the soot-encrusted troll in the basement would turn the heat back on. This situation was obviously absurd on many levels, and it always struck me as extremely wasteful.
At the new place, each apartment controls its own heat, so we have full control over the climate, which is much preferable. Of course now we have to make a point of remembering to adjust it and to turn it down if we go out of town. Gas is included with all other utilities in our rent, but if we go over a certain amount, we have to pay the difference at the end of the year.
There is a balcony! What can I say, balconies are nice to have.
Some of the windows have screens! For whatever reason, windows in most European dwellings lack screens, which is odd to me because that means if it's summer and if you live near water, and if it's so hot that you have to keep your windows open at night, you will be invaded by a swarm of mosquitos. This was an ongoing problem at the Dunajska apartment. Every night we were eaten alive by mosquitos, and we would kill them by the dozens each day. Given that we are now closer to the Danube, I imagine that the mosquitos will only be worse in the summer, so the screens are awesome.
The bed in this apartment is way more comfortable! Not only does the bed look much more acceptable, but the mattress is so much more comfortable. The bed in the Dunajska apartment was offensively hideous, resembling the backseat of a 1970s pimp's Cadillac (the only thing it lacked was a pair of retractable coke mirrors in the built-in side tables). And its mattress was so hard that it was scarcely different from sleeping on the floor. It may have even contributed to my back blow-out last May.
The interior walls are about two feet thick, which is just kind of neat.
Oh, and there's this bizarre sculpture in the entryway to the building. I'm curious to know the story behind it.
See, it's actually a machine.
So, yay! We dig the place. Click here to see the full set of photos.


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Our chocolate is a rich and smooth dark chocolate vanilla, coffee and hibiscus undertones. This 62% has just enough sugar in it to attract those who want dark chocolate but have more of a sweet tooth. It is also for those who are not use to eating dark chocolate but have heard about the benefits of dark chocolate to your health and want the benefits.
Save Money on shipping buy by he case.


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I have been a fan of country music my entire life. As a young boy I remember one of the biggest things we did each summer was attend the Missouri State Fair and remember seeing concerts by Charley Pride, Ronnie Milsap, Tom T. Hall, Barbara Mandrell, The Statler Brothers and others. I remember seeing Billy Walker at the Moniteau County Fair and listening to country music radio stations a lot. The radio was always on around our house, in the car, in the truck, and even in the garage. I spent hours listening and singing along and trying to memorize the lyrics to my favorites.
I remember listening to 78 rpm recordings of Ernest Tubb and Johnny Cash at my grandmother's house and remember that I always wanted to learn to play guitar, so I could be on the radio some day. I even went so far as to write a story about how Johnny Cash was going to come to my house, pick me up in his tour bus, and take me to Nashville with him, so that I too could be a big star and be on the radio. I was envious of the rhinestone suits, cowboy boots and cowboy hats worn by the stars of the era.
I watched the country music awards on television and tuned in to Lee Mace's Ozark Opry and The Porter Wagoner Show every chance I got on Saturday afternoons.
I don't recall ever hearing Sammi Smith on the radio during this time period, but she must have been on the radio a lot. I never really knew her music until discovering it several months ago while listening to the Roadhouse channel on Sirius Satellite radio, which I can pick-up on DishNetwork. After hearing her sing for the first time, I wondered why I was just discovering her. How had I missed her music?
One Saturday afternoon, I researched her career, her music, and read everything I could find on the Internet about her, which wasn't much. I've told many people about her music and urged them to listen to her recordings. They're so different from anything you'll hear on the radio today, but very familiar at the same time. I received a Greatest Hits CD as a gift recently and listen to it a lot.
Gretchen Wilson and Martina McBride have both recorded tributes to her songs and Waylon Jennings had a hit with one she wrote for him. In all, Sammi Smith had 37 hits on the charts during her career and none were bigger than the Kris Kristofferson penned hit titled "Help Me Make It Through The Night", which earned her a Grammy Award and CMA award in 1971. She also recorded "City of New Orleans", "Today I Started Loving You Again", "Long Black Veil", "You Walk In" and "My Window Faces the South", which are some of my favorites.
I sat down today to do some more searches on the Internet hoping to find out more about Sammi Smith. I was shocked to learn that she had passed away this past weekend after battling a long illness.
If you're a country music fan like I am, you owe it to yourself to find out about Sammi Smith and listen to her recordings. I believe her music and her career are underrated. From my perspective, her contribution to the country music genre is under appreciated by us all.


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On March 16, the meeting of the Expert Council of subprogram "Preservation of the Unity of Peoples and Ethnic Communities of Karelia" for 2014-2020 ("Karjala – Our Home") of the State Program of the Republic of Karelia "Development of Civil Society Institutions and Development of Local Self-Government, Protection of Human and Civil Rights and Freedoms "For 2014-2020 to summarize the competitive selection of non-profit organizations to provide subsidies in 2017 for the implementation of socially significant projects took place.
By decision of the Expert Council of the subprogram "Karjala – Our Home", one of the winners was recognized the project "Podium of National Costumes. Bright paints of KROO Society of the Tatar culture "Chulpan", the volume of subsidy – 190 000,00 rubles.


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1/22/13 ASHLAND, Ohio - Students in the Ashland University Schar College of Education's new Teacher Network participated in a "Drive for Supplies" as part of the National Day of Service on Jan. 19.
Approximately 25 students from the AU's Teacher Network, a program that places first semester freshman teacher education students in a living-learning community, collected school and office supplies from on-campus offices and organizations and donated them to Harmony House in Mansfield on Saturday.
"The purpose of this event is to help disadvantaged students and employment seekers with supplies such as papers, envelopes and pens; to reduce disposal costs associated with waste in our community landfills; and to promote community action," said Adam Sikula, director of academic advising for the Schar College of Education.
The National Day of Service began four years ago to honor the life and legacy of Rev. Dr. Martin Luther King.
Ashland University, ranked in the top 200 colleges and universities in U.S. News and World Report's National Universities category for 2013, is a mid-sized, private university conveniently located a short distance from Akron, Cleveland and Columbus, Ohio. Ashland University (www.ashland.edu) values the individual student and offers a unique educational experience that combines the challenge of strong, applied academic programs with a faculty and staff who build nurturing relationships with their students.


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- RT @TPO_Hisself NYT Admits to Spiking Story Alleging Illegal Obama-ACORN Connection http://digg.com/u1CfvN #tcot #
- @bradlaw hey there! Long delay but things are good. Finally loaded Twitter on new done/laptop. How've you been? in reply to bradlaw #
- RT @TPO_Hisself un freaking believable !!! Obama to spend $18 Million to update recovery.gov !! http://digg.com/d1w8Mf #
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Cleveland Police's former Assistant Chief Constable Bryan Bell was today appointed to a new top job in the fight against terrorism.
Home Secretary David Blunkett has appointed Mr Bell to a new national post co-ordinating regional Special Branches.
The move came as part of a package of measures and new laws proposed to take on the threat of an al Qaida attack on Britain.
MI5 - Britain's domestic security service - is to take on and train hundreds of new recruits and increase its strength by 50pc over the next few years.
The security services will work with a new regional network of Special Branch intelligence cells.


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2212 Ensign St Has Hardwood Floors, Huge Master Bed, Big Back Deck, and More!
2212 Ensign St is a 2 bed, 1 3/4 bath home with a 2 car garage in Piedmont! The kitchen has a breakfast bar and lots of counter top and cabinet space. A gas stove in the living room adds cozy ambiance on cool evenings. Hardwood floors on the main floor, with brand new tile in the front entry and breakfast bar areas. Upstairs is a big master bedroom with a huge walk-in closet. Plenty of room for an office space upstairs as well. The basement has a second living room with a wet bar, a brand new 3/4 bathroom with tiled shower, and lots of storage space. Outside is a big back deck and lots of paved off-street parking space in addition to the 2 car garage. This great house is move-in ready and just waiting for you to make it your home. Schedule a showing today!
For more information on 2212 Ensign St, go here. To schedule a showing, or for additional questions, call, text, or email Brok at 218-390-1132, email@example.com.


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'A platform for Indo-Pak friendship'
Hockey players from Pakistan, who arrived in the country on Wednesday for the WSH, said they were thrilled to be a part of the inaugural edition of the tournament.india Updated: Mar 01, 2012 00:28 IST
Hockey players from Pakistan, who arrived in the country on Wednesday for the WSH, said they were thrilled to be a part of the inaugural edition of the tournament.
Former Pakistan skipper Zeeshan Ashraf and midfielder Adnan Maqsood of Karnataka Lions crossed over from the Wagah border, while star forward Rehan Butt, striker Shakeel Abbassi and Waseem Ahmed flew into Delhi from Lahore earlier on Wednesday.
"Bridgestone WSH is the first of its kind league to be held in the history of hockey and we are thrilled to be participating in the tournament," said Zeeshan Ashraf.
"It's fantastic that hockey can provide a great platform for forging friendship between India and Pakistan. I hope our cricketers will also get to play together in the IPL. 'Yeh silsila chalta rahna chahiye' (This association should continue)," he added.
Another player Adnam Maqsood added that WSH would help in the growth of the Pakistani players.
"WSH will help Pakistani players since all the top players are playing here. I'm confident about giving my best to my team, Karnataka Lions, and it will be fantastic to play with the legendary Dhanraj bhai," Adnam said referring to former India captain Dhanraj Pillay.
Pune skipper Diwakar injured
Pune Strykers suffered a major blow when they lost the services of their captain and ace drag-flicker Diwakar Ram to an injury.
Diwakar, who was part of the India World Cup squad last year, has suffered a wrist fracture and has been ruled out for at least three weeks. He has been replaced by Simrandeep Singh.
First Published: Mar 01, 2012 00:27 IST


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Bruce Ellington A Risky Play In Week 2
9/13:Houston Texans wide receiver Bruce Ellington's Week 2 outlook is murky at this point as the team waits to see if receiver Will Fuller (hamstring) will be ready to go in Sunday's matchup with the Tennessee Titans. Though Ellington found the end zone against the Patriots with Fuller out, he struggled in a similar situation last season against the Titans, finishing three catches for 44 yards in an October meeting that Fuller missed. Ellington has upside in this matchup, but he'd need a lot to go right, making him a risky play in season-long leagues, though he could provide decent value in DFS lineups if Fuller is ruled out ahead of Sunday's game.
Source: NFL.com
Source: NFL.com


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J. Joksimović: 55% of the citizens support Serbia's membership in the European Union
27. August 2018. | Belgrade
According to the latest survey conducted by the Ministry of European Integration every six months, 55 percent of Serbian citizens support Serbia's membership in the EU, which is three percent more than in the second half of 2017, while at the same time the percentage of citizens who oppose this has dropped and currently amounts to 21 percent, stated Minister of European Integration Jadranka Joksimović.
Joksimović has told Tanjug that in the past seven or eight years, citizens' support for EU membership has varied considerably and that the changes and amplitudes of attitude have been substantial, in line with the changes in the EU itself and in the position of Serbia.
The results of the latest survey on citizens' support for European integration in the first six months of this year represent a significant change for the Minister, given that, in the previous two years, this percentage has ranged between 42, 45 and 47 percent.
The Minister has said that the latest results are very good because they show, above all, the maturity of Serbian citizens, and that they understand the process of European integration, although it is undoubtedly a political process.
She is of the opinion that, regardless of the problems that actually exist, citizens still perceive that the time of lamenting over fate and injustice is a thing of the past and that we, as a society, need to reach an agreement and tread in a direction that definitely provides a better perspective.
"Will everything play out in the most successful way we want, no one can guarantee that, but I think it is crucial to take the direction that provides us with more opportunities, obligations and work, as well as more chances", underlined Minister Joksimović, who also acts as the national coordinator for pre-accession funds.
The biggest benefits that citizens see from potential membership in the EU are, as the minister has pointed out, that it primarily provides a path to a better future for young people, the opportunity for new jobs and free movement within the EU.
"You can travel and, when you become a member, possibly work in another country, but on the other hand, if you remain in your country you will have more chances, as new standards, new investments, new jobs will arrive", noted the minister.
Joksimović has emphasized that citizens attach considerable importance to the fight against corruption, healthcare system reforms, rule of law, agriculture and environmental protection.
"All these are vital areas for citizens, who believe that they will certainly be better regulated if Serbia becomes a member of the EU or regulated in this period while we are negotiating membership", Joksimović has stated.
She has recalled that the credible enlargement strategy was presented in February, that Serbia receives EUR 200 million in EU grants from EU pre-accession funds annually, further mentioning cross-border cooperation projects and the rehabilitation of local infrastructure - roads, hospitals, schools and public administration reform.
"All these are benefits that citizens ultimately see as an important segment of development", stated the Minister.
She has also emphasised the importance of good relations with EU Member States, and in this regard stated that President Aleksandar Vučić and the Government of the Republic of Serbia have continued this trend with both Germany and France, with which relations are intensifying, as well as with many other EU Member States.
"That, of course, provides better political stability, which results in new investments and new jobs", said Joksimović.
She has highlighted that European integration is indeed a process that benefits everyone.
"Why would the citizens of Serbia miss this opportunity when a chance already exists", wondered Joksimović.
Source: Tanjug


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They say it's first impressions that count, and Sparrow's Philly Cheesesteaks makes a dramatic first impression. When you walk into the restaurant in St Kilda, the first thing you see is a giant grill. Although the offerings here include everything from American-style brewed coffee to hockey matches on the TV at night, the grill is the heart and soul of the operation.
It's been almost three years since Sammy Lynch and Geno Sparrow opened Sparrow's kitchen within The Catfish, a local Fitzroy pub. They also have a Sparrow's Philly Cheesesteaks food truck, which makes appearances at various festivals around Melbourne. Now, with the new St Kilda spot, they're bringing the Philadelphia favourite south of the river. It's just the latest step in their quest for world domination.
"Our plan is pretty much to take over the world, one step at a time," jokes Lynch. "We've got a good foothold in the north – it's coming up on three years since we opened at The Catfish on Gertrude Street – so it was just time. There are a lot of American-style joints around St Kilda, but no one is doing Philly cheesesteaks."
In fact, Lynch claims there's nowhere else in the country doing Philly cheesesteaks. At least, not in what he says is the traditional manner.
"Everyone in Philadelphia has their own favourite way of doing [the cheesesteak], depending on where you go," he explains. "But the traditional Philly cheesesteak is all based around meat, cheese and onion on a soft, hoagie roll. We're calling it the first authentic Philly cheesesteak in Australia [due to] the fact that we use the actual American imported cheese, and we also go one step further with the quality of meat we use. We get a lot of people that are hardcore cheesesteak people from Philly, saying that [ours] are better than in Philadelphia."
But the cheesesteaks aren't the only things that make theirs authentic. It's also how the cheesesteaks are served here: with a side of sass.
"We try to keep everything the same: from the style of cheesesteak to the delivery to the banter you get when you're ordering. There's a lot of attitude in Philadelphia, it's a real working-class city, so we try to incorporate that banter into our own delivery."
There's a range of indoor and outdoor seating, but the vibe remains intimate. For the inside space – which only seats around 20 people – there's a series of custom-upholstered family-style booths. There's a mural of photographs of Philadelphia taken by Sparrow's friend and Philly local Robert Fitzgerald. As the final touch, a mounted flat-screen television plays a variety of American sports matches – from hockey to football – in the evenings.
"We try to show as much relevance [to America] as possible, and I guess showing American sport is another part of that. We're trying to cultivate a bit of a family vibe," says Lynch.
Sparrow's Philly Cheesesteaks
240 St Kilda Road, St Kilda
Mon to Sun 12pm–12am
This article was updated on March 26.


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Join the Land Conservatory as they celebrate the longest night of the year, as well as the 150th anniversary of the end of the Civil War. Celebrations include a live choir, bonfire, hot chocolate, and the lighting of the evergreen tree. All proceeds benefit the Bucktoe Cemetery.
$5 for members; $10 for non-members.


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Last night's award show wasn't all about Trump bashing. Some people did actually win awards.
A few may have also received awards that they didn't win. Which is exactly what happened for 'Best Picture' category.
Presenters Warren Beatty and Faye Dunaway announce 'La La Land' as the winners, however 'Moonlight' was really the winner. Now the conspiracies have ensued and somehow it might just be President Trump's fault.
A new conspiracy theory about Sunday night's disastrous ending at the Oscars is making the rounds in Hollywood, according to a report in the East Bay Times: President Donald Trump sabotaged the "Best Picture" award as revenge against host Jimmy Kimmel for mocking him.
Trending: Man Shoots Buck Only to Find It Has Two Heads – But Not In The Way You Think!
The Times's Chuck Barney writes:
In a shocking mixup that had jaws dropping at the Dolby Theatre and in living rooms everywhere, "Moonlight" was honored as the best picture — but not before "La La Land" was first mistakenly announced as the winner.
And we're still not quite sure what happened.
Did presenters Warren Beatty and Faye Dunaway blow it big time? Was this the revenge of Steve Harvey? Or did the White House play a role — seeking retaliation for all those zingers Kimmel tossed President Trump's way?
Conspiracy theories will undoubtedly abound as sleuths seek to get to the bottom of this Oscar fiasco.
Of course this all might just be tongue-in-cheek commentary, with a dash of smart-ass added to it.
If you missed what happened last night during the award show, because you were protesting the 'We Hate Trump' idiots, here is what went down last night.
We were several minutes into the thank-you speeches when — oopsie! Let's just say the last time we were all this surprised, Hillary Clinton was biting the top off a bottle of the hard stuff. Millions must have gone to bed already: The Oscars were over except for a few thank-yous. Or so it seemed.
When "La La Land" producer Jordan Horowitz interrupted his own crew to say "Moonlight" had actually won Best Picture, it at first seemed like a dull replay of the Grammy Awards, where Adele said Beyoncé deserved to win and almost (but not quite) said she was going to give Lady B the award.
But — hey! No! — "This is not a joke, 'Moonlight' has won Best Picture," Horowitz said, holding up the card (as though we could all read the tiny writing on our TVs.) The "La La Land" folks suddenly looked as forlorn as the Atlanta Falcons at the end of the Super Bowl.


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A historic East Neuk tavern re-opened its doors this week after being shut for more than a year.
The Dreel Tavern in Anstruther was closed in January 2016 following a well-publicised fight against mounting costs and council tax.
However, the pub opened its doors this week under new ownership.
Allison and Hannah Mitchell took over the lease at the beginning of June, and gave the Dreel Tavern a "face-lift" ahead of its opening last week, giving it a "modern twist".
Allison explained why the pair decided to take on the historic tavern.
"The reason for taking on the lease is my sister and I both have considerable experience in hospitality and being from Cellardyke, we have a local connection," Allison said.
"We are keen to contribute to the positive reputation for good food and drink available in this vibrant community and growing holiday destination."
Allison said that there has been a positive reaction from the Anstruther community to the re-opening, adding: "people are very happy to see this well-missed pub's doors back open".
She also confirmed that the tavern is having a "soft-opening", with a celebration to mark the official re-opening of the pub, which used to host musical acts including celebrated musician King Creosote, planned for the near future.


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Distinguished Alumni Lecture
The Materials Science and Engineering Department Distinguished Alumni Lecture is an award to recognize alumni who have made seminal contribution to materials research, as evident by published scholarship, patents/technology transfer, mentoring of early career materials researchers and service to the materials profession. The award recipients will be mid-to-late career researchers in academia, government or industrial R&D.
The alum to be recognized will be selected by the department chair based on nominations from the MSE faculty.
The awardee will be the department's invited guest of honor on the day of the annual graduation dinner in the spring. The lecture will be presented during the day as a graduate seminar followed by lunch with the graduate students and one-on-one meetings with select faculty. In the evening, the award will be presented at the graduation dinner followed by brief remarks by the distinguished alum to the graduating seniors.
2018 (Fall) - Nikhilesh Chawla
Nikhilesh (Nik) Chawla is director for the Center for 4D Materials Science and is the Fulton Professor of MSE at Arizona State University. He is also a Professor of Mechanical Engineering. Prof. Chawla received his Ph.D. in Materials Science and Engineering from U-M in 1997. He is currently serving as acting chair of the MSE program at ASU. Prior to joining Arizona State University in 2000 he was a postdoctoral fellow jointly at Ford Motor Company and U-M, and a senior development engineer at Hoeganaes Corporation. Prof. Chawla's research interests encompass the deformation behavior of advanced materials at bulk and small length scales, including Four Dimensional (4D) materials science, environmentally-benign metallic alloys, composite materials, and nanolaminates. He has co-authored over 230 refereed journal publications and close to 470 presentations. He is the author of the textbook Metal Matrix Composites (co-authored with K.K. Chawla). Prof. Chawla is a fellow of ASM International and past member of TMS Board of Directors. His most recent awards include the Acta Materialia Silver Medal for 2017, and New Mexico Tech Distinguished Alumnus Award for 2016. He was named 2016 Structural Materials Division Distinguished Scientist/Engineering Award, as well as the 2016 Functional Materials Division Distinguished Scientist/Engineering Award, both from TMS.
Prof. Chawla is editor of Materials Science and Engineering A. He also serves on the Editorial Boards of Materials Characterization and Materials Chemistry and Physics. He has served or is serving on several external advisory boards, including that of Naval Research Laboratory, the Advanced Photon Source at Argonne National Laboratory, and New Mexico Tech. His work has been featured on the show "Modern Marvels" on the History Channel, R&D News, Fox News, and the Arizona Republic.
2018 (Spring) - Keith J. Bowman
Keith J. Bowman is dean of the College of Engineering and Information Technology (COEIT) and Constellation Professor of Information Technology and Engineering at UMBC, the University of Maryland, Baltimore County. Dr. Bowman began his academic career as a Purdue University Assistant Professor after receiving B.S. and M.S. degrees from Case Western Reserve University (CWRU) and a Ph.D. degree in materials science and engineering from U-M. He served as a visiting professor and received Alexander von Humboldt stipends for research at the Technical University of Darmstadt, Germany in 1996 and 2002 and he served as a visiting professor at the University of New South Wales in Sydney, Australia in 2003. He is a Fellow of the American Ceramic Society and has held several division and society-wide positions. Awards at Purdue University include receiving the MSE Best Teaching Award and Purdue's highest teaching award, the Charles Murphy Undergraduate Teaching Award. Professor Bowman's name is also listed in the Purdue Book of Great Teachers. In 2007, he received the Purdue College of Engineering Mentoring Award and he became the first Professor of Engineering Education (by courtesy) from MSE. From 2007 to 2011 he served as Head of the Purdue School of Materials Engineering. In 2012 he was invested as the first Duchossois Leadership Professor in the Illinois Institute of Technology (IIT) Armour College of Engineering soon after joining as chair of Mechanical, Materials and Aerospace Engineering. Prior to UMBC he served two years as dean of the College of Science & Engineering at San Francisco State University wherein he led more than four hundred faculty and staff and about six thousand majors.
2017 - Dawn Bonnell
Dawn Bonnell is the Vice Provost for Research at the University of Pennsylvania. In this capacity Dr. Bonnell shapes policy and advances administrative initiatives for the University's $900+ million per year research enterprise. Dr. Bonnell is the Henry Robinson Towne Professor of Engineering and Applied Science. She was the founding director of the Nano/Bio Interface Center that directed $30M to research at the intersections of technology and biology at the nanoscale or molecular level. An editor of seven books and an author of more than 200 papers, Dr. Bonnell was elected in 2013 to the National Academy of Engineering, one of the highest honors in the engineering profession, is one of only seven awardees of the Staudinger-Durrer Medal from the Swiss Federal Institute of Technology, and has served as President of the American Vacuum Society and Vice President of the American Ceramics Society. As Vice Provost for Research she is leading Penn's initiative on innovation and commercialization, which includes the establishment of the Penn Center for Innovation.
2016 - Elizabeth A. Holm
Elizabeth A. Holm is a Professor of Materials Science and Engineering at Carnegie Mellon University. Prior to joining CMU in 2012, she spent 20 years as a computational materials scientist at Sandia National Laboratories, working on simulations to improve processes for lighting manufacture, microcircuit aging and reliability, and the processing and welding of advanced materials. Her research areas include the theory and modeling of microstructural evolution, the physical and mechanical response of microstructures, atomic-scale properties of internal interfaces, and the intersection between computer science and materials science. Dr. Holm obtained her B.S.E in Materials Science and Engineering from the University of Michigan, S.M in Ceramics from MIT, and dual Ph.D. in Materials Science and Engineering and Scientific Computing from the University of Michigan. Active in professional societies, Dr. Holm has received several honors and awards, is a Fellow of ASM International, 2013 President of The Minerals, Metals, and Materials Society, an organizer of numerous international conferences, and has been a member of the National Materials Advisory Board. Dr. Holm has authored or co-authored over 120 publications.


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San Joaquin County's only trauma center is up and running at full strength after a partial shutdown last year due to a staffing shortage.
The trauma center is making great strides in improving the level of care.
The San Joaquin General Hospital Trauma Center now has three full-time doctors skilled in general and critical care surgery and another surgeon joining the team in August.
Additionally, three neurosurgeons, trauma nurse clinicians, and radiology techs make up about a 30-person trauma team.
Hospital CEO David Culberson says he hopes to raise the Level 3 center to Level 2 to provide more care for critically injured patients.
"We have injuries that are resulting from shootings and stabbings, but we also have a lot of industrial accidents," says Culberson. "Our No. 1 volume, of course, is going to be motor vehicle collisions."
Culberson says the trauma center is important when time is so critical and with the closest trauma centers located in Modesto or Sacramento.


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This week began with several big-name polls showcasing dire news for Democratic incumbents. But the results weren't all that surprising to those who have been following the much-discussed surveys of Scott Rasmussen. By 10:00 a.m. most mornings, the fantastically prolific firm has already brought news that will probably ruin some candidate's day. Rasmussen took a few moments to talk with National Review Online about polling in the current environment.
JIM GERAGHTY: For much of this cycle, your polls have seen things a little bit better for Republicans than those of a lot of other pollsters. This seems to stem in part from your polling likely voters; many other pollsters survey registered voters and some, simply adults. Do you feel vindicated by the fact that seemingly every pollster has now come out with ever-worsening doomsday scenarios for Democrats?
SCOTT RASMUSSEN: I reject the notion that we have seen things more favorably for Republicans. It's just that if you were to take a poll of registered voters and compare it to a poll of likely voters, the raw numbers of the registered-voter poll would look better for Democrats. Now that they're all switching to a likely-voter model, sure, they're going to end up pretty much in the same place. A great example of that was this morning's Washington Post poll. I think it showed Republicans plus two on the generic ballot among adults, but plus 13 among likely voters. And that's the kind of gap we have been seeing all through the year.
#ad#GERAGHTY: Are pollsters wasting people's time when they give the registered-voter numbers and let people think they're getting a good sense of how the electorate's going to look on Election Day?
RASMUSSEN: There are valid reasons to poll different samples. I think what needs to be clear is just what it is you're doing. We poll all adults for our consumer- and investor-finances polls, because whether you're a voter or not, you have an impact on economic trends. There are people who would argue that you can't do a likely-voter poll until after Labor Day, because you don't really know what the turnout is going to be, so a registered-voter model is preferred in their mind. That's not a bad argument, except that it implies too much precision. We didn't know earlier in the year precisely what turnout would be; we still don't know precisely what turnout will be. We knew that a likely-voter model would be more favorable to Republicans than a registered-voter model — partly because it's a midterm. I would think that anybody covering those races would acknowledge that as part of the coverage of a poll.
GERAGHTY: In the coverage of these numbers, certainly in the cases of the two big polls out this morning [ABC News/Washington Post and NBC/Wall Street Journal], there seems to be a tone of shock. Is the sense of shock so intense because some people spent much of the year looking at polls of registered voters and getting an erroneous sense of where the electorate is?
RASMUSSEN: I think there's been shock because people can never really believe that things are going to turn out differently than they have in the past. In 2006, Republicans looking at the polls that were coming out had a hard time believing that they really were going to be in that much trouble. They could look at their team and say, You know, I know that George Allen shouldn't have said "macaca," but here's why he could pull it out. They would have all of these reasons. But at some point, there begins to be a change.
You've got to remember, if you go all the way back to the beginning of this year, we had a shock factor in the Massachusetts Senate race. People just couldn't believe that. In the middle of 2009, Talking Points Memo did a story saying it was inappropriate for us to measure the strongly approve and disapprove numbers of the president rather than just his overall approval. My response was that it measured the intensity, it gave you an indicator of what was going to happen. And it worked out to be that way.
#page#GERAGHTY: When a politician criticizes your polls, and your poll ends up being pretty close to the final result, do you ever feel like calling him up and saying, "Neener-neener-neener"? It seems that no matter how closely you track to the actual election results, every year it's back to square one, "Oh, we can't trust that guy."
RASMUSSEN: You have to have a thick skin to be in this business. You have to realize it's nothing personal. In 2006, [then-senator] Conrad Burns [of Montana, a Republican] attacked our credibility because we showed him in trouble in January. He just didn't believe it. Then, of course, it turned out to be right. We had the same thing happen with [North Carolina Republican senator] Elizabeth Dole in 2008.
#ad#It is part of the process, and you have to understand that people don't care about polls, they care about what we poll about. The politicians are not truly commenting on the credibility of the poll; they're trying to spin their version of the story any way they can. If attacking the pollster helps them out, well, that's what they'll do.
GERAGHTY: Pollsters weight by age, race, and gender, and sometimes by geography. How important is it to weight by party?
RASMUSSEN: There is a legitimate industry discussion on that. We all know that if you can tell what the partisan makeup [of the electorate] is going to be, it is a great indicator of how the results will turn out. What most pollsters struggle with is, what are the appropriate targets? . . . We do a lot more polling than just about anybody else, so we have enough data that we can provide some ongoing estimates of where the party trends are.
Whether or not you weight by party, it is certainly reasonable for an analyst to look at the results and say, "You know, I just don't believe that there will be more Democrats turning out in 2010 than in 2008, and I ought to look at that when I consider the results."
GERAGHTY: Have you ever re-polled a race after getting results that didn't sit well with your gut?
RASMUSSEN: We release the data and then we go poll it again if something is going on. There are two races right now where I am very curious about what our next polls will show, one in West Virginia and one in Alaska. In both cases, I can come up with a logical argument as to why the numbers are the way they are; I can also come up with a logical argument as to why they show the race as closer than it really is. But we want to get the information out there and let other people engage in that discussion, and we'll poll again and see where it ends up.
#page#GERAGHTY: What result has surprised you the most this cycle?
RASMUSSEN: When we did the Scott Brown poll in early January and it showed a nine-point race and a two-point race among the most likely voters, I thought, "Boy, we're going to be way out there on a limb!" That was not where the expectations were, so that was a shock in the early part of the cycle.
#ad#Another race that surprised me — right from the start — was Russ Feingold's. He wasn't in the Harry Reid position, he didn't have big-name opposition once Tommy Thompson dropped out, and yet here he is in a toss-up race. I had expected that once Thompson dropped out, we wouldn't be seeing that.
The other race that has been a real shock to me this year is Barbara Boxer's in California. I've said a million times — I know she always polls poorly, but it's still California — and I was saying early in the year, if we're still talking about this race in September and October, it means things really are going to be bad for Democrats. Well, here we are, and she's still tied.
GERAGHTY: Can Republicans blow it in the last two months?
RASMUSSEN: It depends on how you define "blow it." Is it possible that they will blow it to such extent that this ends up being just a "normal" midterm, with the Democrats losing 15 to 20 seats? No, I don't think that's possible. I don't think that they're going to have only minimal gains in the Senate. But how close they get to gaining control of the Senate and whether or not they gain control of the House, that's still up in the air. But that ultimately has less to do with Republicans than with Democrats, because this election is all about the party in power.
This election is a referendum on the Democrats — it's not a referendum on incumbents as much as on the Democratic party. We put out a poll last week that I think captures some of the basic mood. Most Americans believe, as they have for decades, that cutting government spending and cutting taxes is good for the economy. That's just sort of a bedrock belief of the American people. At the same time, they believe that the Democrats in Congress want to increase spending and increase taxes. That creates a tough road when you're the party in power, when you've got that kind of perception out there.
GERAGHTY: In 2006, voters seemed to tune out GOP incumbents' criticism of their Democratic challengers. In a year when one party has clear momentum, like this year, do voters disregard criticism of the party they're not angry at? In other words, does the tie go to the challenger in a race like Sharron Angle vs. Harry Reid?
RASMUSSEN: The things that scare people about Sharron Angle aren't at any risk of becoming law right now, but the things Harry Reid is boasting about — passing the health-care law, for example — are very real. So yes, the tie goes to the challenger at this point in time.
That Nevada race is the mud-wresting match of this year. Both candidates are growing so unpopular that if voters go into the booth thinking about Harry Reid, then Sharron Angle will win. If voters go into the booth thinking about Sharron Angle, then Harry Reid will win.
#page#GERAGHTY: Rasmussen doesn't poll primaries or non-statewide House races very often. Is there a reason for that?
RASMUSSEN: The reason we don't do most House races is simply that we've committed to polling every Senate and governor's race in this cycle, and that's where our focus has been. We've been pretty consistent over the years. We may have done a couple of House races in 2004, I can't remember, but I don't think we did anything in the 2006 or 2008 cycles, other than the statewide races. But remember, we are a media polling organization, not a political organization.
#ad#There are two different audiences that read our material. One audience is political junkies — an audience we share with you — and they have one view on things. The other is local and state media coverage. You know, we actually get more people introduced to Rasmussen Reports through our state polls than through any of our national data. A state poll about a general election gets a tremendous amount of interest generated. It also lets us poll on other issues: If we're polling statewide on a general-election race, we can ask what people think of health care, the economy, or whatever else the issue of the day is, and it gives reporters in that state lots of things to write about.
GERAGHTY: Is it easier to get a clear reading on the percentages of a close, hard-fought race than on a blowout?
RASMUSSEN: One of the reasons that the margins are different in lopsided races is that they're not polled as frequently. It's also harder to determine turnout, because you have to allow for people who end up saying, "Our guy's going to win by 50 points, so why bother showing up?" You tend to do a lot of polling in tighter races. You want to make sure you get the partisan mix right. So, generally, the more competitive races are easier to call, or easier to get results closer to the final levels of support.
Still, it looks a whole lot different if you're projecting a candidate to win by two points and he loses by a point, than if you have an 18-point race in your poll and it turns out to be a 27-point race.
GERAGHTY: What do you see happening between now and November? Volatility? Swings? "October surprises" that could change all this?
RASMUSSEN: When you talk about an "October surprise," it would have to be something on a really significant scale. I can't imagine what it would be. We know from lots of polling that when the American people get bad news about the economy, their confidence drops right away. If they get good news, it takes five or six months of good economic news to make up for that one bit of bad economic news. What that tells me is that if there is a really bad unemployment report at the end of September, that could be really bad for the Democrats. If there's a moderately good report, it probably won't change things all that much.
The question is going to be how individual campaigns play in the larger environment, which is friendly to Republicans. The environment is going to continue to change, become a bit more or less friendly than it is today, but still stay generally friendly to Republicans. Democratic candidates are going to try to find ways to localize those races and get away from that trend, and how successful they are at doing that will determine the final numbers.
GERAGHTY: Any under-the-radar race you're keeping your eye on? Any upset special?
RASMUSSEN: The race that I would potentially put in that category right now is the West Virginia Senate race. We have one poll out showing it a very competitive race. It's clear that President Obama is not a welcome figure in West Virginia politics. But [Democratic nominee] Joe Manchin is so popular as governor that it was thought to be a safe seat. So that's a potential upset special.
The one thing that's being underreported in this election cycle is not a race but something about the economy. It goes like this: People today are less pessimistic about the economy in general, far less pessimistic than they were a year ago. However, they have not seen any improvement in their own personal finances. People are feeling worse about their personal finances than they felt a year ago and worse than they felt two years ago, and they continue to believe that their own finances are getting worse. Only half of homeowners believe their home is worth more than the mortgage. We can talk all we want about grand issues and economic indicators, but when people aren't feeling good about their own personal finances, it creates a sour mood for all politicians.
— Jim Geraghty writes the Campaign Spot on NRO.


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Freedom, flexibility and fun; a road trip is the best way to really get away from the classic tourist trails in New Zealand. It's a great travelling option if you have friends to share the cost with and a desire to be spontaneous. You can make all the stops you want on your road trip to take pictures. Believe us, there's lots to take photos of in New Zealand.
Sure, a road trip is a desirable option for travelling around New Zealand. But the question is: should you buy a car or rent a car?
Do you want a car for several months? Plan to take your road trip slowly? Then buying a car is probably your best option, if you're set on doing a road trip. What most backpackers and some of our Members do is buy a used car, travel around New Zealand with it, then sell it before they leave New Zealand.
For tips and more information on buying a car, take a look at our article: How to buy a car in New Zealand.
Car rental is a good road trip option if you are planning on hitting the road for two weeks at the most. If you're travelling mainly by bus in New Zealand, but want to take a side trip, you can still give yourself that freedom by renting a car.
Like a lot of things, there are pros and cons. The great thing about renting a car is that you don't have to go through all the hassle necessary for buying your own car. Plus, it can be an affordable option if you have friends to drive with and share the costs. However, there are a few things to remember when looking for a car to rent:
And remember: if you have any questions about buying or renting a car in New Zealand, just ask us!


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How To Kick Your Thyroid's Ass: Update to the Two-Month Liver Detox Challenge
As of today, we're a month and a few days (give or take, depending on when you started) into the Two-Month Liver Detox Challenge. That means about three more weeks to go. I just want to offer a few reasons to keep at it, for those who are participating. For those who aren't, it's never too late to get on the detox bandwagon. Let's remember why we're doing this in the first place and why we, as thyroidians, even give two shits about the liver: it processes thyroid hormone. , A weak liver, or a liver too busy and distracted by chemicals and toxins in the body won't be able to ensure our thyroid hormones are distributed properly. That's a big deal because no matter how many times Mr. Endocrinologist ups the dose, a toxic liver still won't be able to distribute that pill's contents.
The past month, for me, has been spent eating healthy (whole and organic) detox foods; things like avocados, onions and garlic, lettuce, celery, parsley, ginger, squash, peas, broccoli and cabbage (sparingly and/or cooked thoroughly), wild-caught fish, seeds, sea salt and herbs and spices, anti-inflammatory oils like olive and coconut and palm, and tons of purified water and lemon. I've also included an herbal tea that supports liver function, as well as a supplement that contains liver-stimulating herbs and amino acids.
The first two weeks, the noticeable difference was that, apparently, detoxing makes you have to use the bathroom alot (in more ways than one). It also ended up making me extremely thirsty. But, once I got over those difficulties (they did go away), I actually have ended up with more energy. Trust me, it's not miraculous; I'm not running marathons or drafting my memoir. But, there has been an increase in my mental and physical energy. I have been able to concentrate more, and I don't get tired as easily in the mornings and afternoons. Even if the improvement has been small, it is still worth celebrating in my book. , And if I had to make a judgement about the future, I have a feeling I may even stay at this after the two-month marker, just because I will take all the mental and physical stamina I can get. , Also, since most everything in our food supply and environment and personal beauty products contain toxic chemicals (and don't forget the untested synergies), I'm pretty convinced that one can never do enough purifying — our immune systems, organs, and brains are constantly bombarded with these toxins. (Side note: a great book that addresses this very issue of toxins in our food, water, environment and homes, and the chemical synergies that result and damage our bodies is The Hundred Year Lie. I would highly suggest buying it. I own it. It's amazing. It's loaded with info on endocrine disruptors).
For those who are partaking in this challenge with me, and even for those interested in learning more, here are some great resources on detox and the liver — great incentives to keep at it. These are taken directly from the Two-Month Detox Challenge blog:
- Probiotics May Protect Your Live
- Foods to eat and avoid on a detox diet
- Ten Alternative Plants that Cleanse the Liver, Part I
- What are Toxins in my Body? Detox 101. Facts and Myths.
- Fast Track Liver Detox: Part One
Until Next Week,
Love Always,
Have a question, comment, story, love letter, or rant/rave to send me?: firstname.lastname@example.com
Tags: liver detox challenge thyroid patients, liver process thyroid hormone, Liz Schau thyroid nutrition writer, thyroid patients liver issues
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8 Responses to "How To Kick Your Thyroid's Ass: Update to the Two-Month Liver Detox Challenge"
One c0mment I have about this is the part about wild caught fish. Given the state of the world's fisheries, this is becoming more and more like insisting on fruits and vegetables picked growing wild. If we eliminated all the farmed fish and substituted wild caught fish for all the farm fish, most of the fish species we eat would soon be on the verge of extinction.
Not that I'm against eating wild caught fish. I eat them and also wild caught red meat (venison, elk, moose and so on) which do not have many of the problems that even free range beef and pork have.
Of course for a vegetarian this is a non issue. But for those of us who eat meat and fish, the answer is not to shun farmed foods but to push for better farming practices. Lets face it, the world just can't support a population of hunter gatherers anywhere near the current population.
I also wondered why frozen fruits are okay but frozen vegetables are not-I eat a lot of frozen vegetables.
hey liz, it's just me again. enjoying your posts on this topic very much. in fact doing this is changing my whole approach to food and all my habits. i now look at what i eat not just as a pleasure thing (which it still is!) but i now look at food as medicine. and it definitely is that. i gotta figure, if i can feel this good after three surgeries and still manage to lose weight, there's something amazing going on inside me. i want to stand up and shout to the world about this, i feel so good. and i'm healing so fast and effectively that my doctors and physio think i'm a freak!! maybe i have the zeal of the newly converted, but converted i AM!
keep up the great work liz. you're making a difference.
I have just found your entertaining and very informative blog from my Google Detox alert.
Congratulations for sticking to your liver detox. It is undoubtedly one of the best things you can do for any health problem because the liver has so many functions.
We are all subjected to and retain toxins in our bodies regardless of how careful we think we are.
A liver detox cured my chronic fatigue. I know it works. I look forward to many more great posts.
Liver Function and Thyroid
A few years ago I was watching Valerie Saxion on her television program, where she mentioned lack of hair on the top of the head can be indicative the liver needs to be cleansed, and on that show she said the better functioning the liver is, the better functioning the thyroid will be. http://www.valeriesaxion.com/showNotes.html
Also a few years ago I heard Teresa Tapp in a seminar stating in Germany milk thistle is used for liver detoxing, and there has been lots of research in Germany regarding milk thistle. https://store.t-tapp.com/categories/Seminars/ If I remember correctly, this information is on the Personal Profile Seminar CD.
Tonight I found these two articles.
http://www.springboard4health.com/store/iyb_8_98.html mentions the liver converts the thyroid hormone thyroxine (T4) into its more active form, triiodothyronine (T3). Inadequate conversion may lead to hypothyroidism, chronic fatigue, weight gain, poor memory and other debilitating conditions.
http://heartspring.net/detoxification_liver_health.html discusses liver health and milk thistle.
Hi Liz,
I have had high liver enzyme values for the last ten years, and many of the doctors that I ran into just told me to curb my drinking. While I drink a bit, I don't consider myself a heavy drinker, so I was always annoyed when the doctors would say this. More to the point, they never did anything about it, despite my increasing blood pressure.
When I first visited our thyroid specialist here in Germany, he did an ultrasound on my thyroid (noting its enlargement), and also did one of my liver. While he took blood tests to confirm everything, Dr. Neufeldt pointed out the wide strip of fat on my liver, and said due to its appearance as a strip, it was caused specifically by the thyroid.
I was diagnosed with Hashimoto's when the blood tests came back, and also with non-alcoholic fatty liver disease, which was causing liver hypertension (and increasing my blood pressure). Dr. Neufeldt said that he tested for three liver enzymes (GGT, SGOT, SGPT) and all three were very high. Knowing all three levels would indicate if one does drink too much, or consume too much fatty food, have thyroid related fat, or indicate that one might have a liver virus (Hepatitis).
I think an interesting medical website describing the values and interactions is: http://www.medicinenet.com/liver_blood_tests/article.htm
Due to my liver issues, Dr. Neufeldt immediately put me on a T3/T4 combination as my liver condition would inhibit impaired T3 production. He also put me on Lagosa, which uses an extract of the milk thistle plant. The specific active ingredient(s) is Silymarin: http://en.wikipedia.org/wiki/Silibinin
I've been taking the Lagosa now for three full months, and after upping the dosage, my liver enzyme values are starting to decrease finally. Luckily so, otherwise Dr. Neufeldt would have put me on a transfusion. I hope that with lower enzyme levels, the strip of fat and my high blood pressure will recede as well!
While my thyroid values are now in line, I am still a bit tired. Dr. Neufeldt says that it is probably the liver dysfunction, and I should start feeling more energetic when the liver is functioning properly. After the liver enzyme values are in check, he'll look once more at thyroid function.
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