text:
T206 Chick Gandil PSA 6 +++ RARE American Beauty 460
T206 Chick Gandil PSA 6 +++ RARE American Beauty 460
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Sold Date: 02/20/2008
Channel: Online Auction
Source: eBay
Category: Sports
You are bidding on a 1909 T206 card of Imfamous Black Sox Chick Gandil of Chicago Amer. graded PSA 6. As you can see from the scans this Gandil card has bright bold colors, great focus, tremendous eye appeal and near perfect centering. This Gandil card also features a Very difficult and Super Clean American Beuaty 460 Subjects back. Extremely difficult and popular card to own is any of these 1909 T206 cards especially any Black Sox members in very high end grade like this Gandil card. Please check my other auctions of T206 hall of famers and southern leaguers all with tremendous centering and eye appeal, as well as many high end graded tiffany rookies. NO returns on third party professional graded cards. Winning bidder to add $18. for insured shipping in the US, while international bidders add $14. for usps registered mail with no insurance. I gladly accept paypal, checks and money orders. If sending check or money order please use checkout for mailing address.
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I have the same lack of success with WMV files and wondered if you found a way to add them to iTunes. After solving the mystery of the avi movies, wmv is my only remaining non-iTunes entertainment folder.
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Religion is the dream of the human mind. But even in dreams we do not find ourselves in emptiness or in heaven, but on earth, in the realm of reality; we only see real things in the entrancing splendor of imagination and caprice, instead of in the simple daylight of reality and necessity.
This quote is about religion.
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Search on Google Books to find citations of this quotation.
Ludwig Andreas Feuerbach (July 28, 1804 September 13, 1872) was a German philosopher, the fourth son of the eminent jurist Paul Johann Anselm Ritter von Feuerbach. He was born in Landshut, Bavaria and died in Rechenberg (since 1899 a district of Nuremberg). Nietzsche is quoted to have said that Feuerbach means 'Fiery Brook'. Incidently, Feuerbach said the famous quote "you are what you eat".
I'm female, single


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I just started using this service today, their site makes no sense to me what so ever, so I did some googling and found this forum. Basically all I need to know is, is this the $50 dollars a month plan/the one with no data limits. I've emailed them and didn't really get any where and I can't call customer service, because I have no house or cell phone at the moment. So any short/helpful answers?
Short answer yes you have limits its set in the Acceptable Use Policy (AUP). Which you can read here »www.cableone.net/Pages/internetaup.aspx the A La Carte package is the 5mbps plan so your limited to 3 Gigabytes a day tracked from 8am to midnight. Now are they enforcing that well that depends on where you live and how often you hit the cap. I've hit the cap 8 times in one month and no letter or warning so far, your results may differ. Now if you want to see how much bandwidth cableone shows you used just go to www.cableone.net then click My Services, My Account log in and click on My Bandwidth.
You could email them at firstname.lastname@example.com if you did not already.


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It's a streak-day Saturday with 17 matchups gracing the big board and plenty of intriguing options to explore. The backbone of the picks is still definitely baseball with 10 picks from afternoon to evening. However, there's some less mainstream options if you'd rather find your green in the ongoing Tour de France, the PGA's John Deer Classic, MLS, or even Major League Lacrosse.
Yesterday, I lost my morning pick, but got the three after that right–even winning with the Cubbies and the Soriano-show at Wrigley. Hopefully today I can get another win to pick up my third five-game winner of the month. Here's the picks I like on this full Saturday of Sports
Picks for July 14
1:07- Cleveland Indians: The Tribe take the field behind Ubaldo Jimenez as they look to take the second game of their series in Toronto. Jimenez has picked it up as of late going 3-3 with a 2.93 ERA in his last seven starts. He'll face off with Aaron Laffey who has done decently as a fill-in in the Jays rotation and will face his former team tomorrow at the Rogers Centre. The Blue Jays have suddenly lost their offensive mojo and have dropped four of five. It's not a lock, but I think the Indians win behind Jimenez. Confidence Meter: 3 1/2 (out of 10).
4:05- Detroit Tigers: Detroit faces Baltimore in game two of their first series of the second-half. They'll send Max Scherzer has been rolling along winning three of his last four starts with a 2.00 ERA and 33 strikeouts in 27 innings. He'll be matched up with Wei-Yin Chen who struggled his last time out giving up five runs in four innings to the Angels. He did look great two starts again against Seattle, but I think the Tigers lineup is starting to come together and Detroit will get their seventh straight win tomorrow at Camden Yards. Confidence Meter: 7
9:10- Texas Rangers: Yu Darvish takes the ball for Texas as they face off with King Felix and the Mariners Saturday night in Seattle. Darvish finished the first half 10-5 with a 3.59 ERA. He'll face a Mariners lineup that his teammate Derek Holland shut down last night before they scored two in the ninth. In their last five games, the M's have reached three runs scored just once. Felix Hernandez may not need more than that as he's allowed one or zero runs in four of his last five starts. In the last three years he's made 16 starts against his division-rival Rangers with a 6-8 record and a 3.71 ERA. It should be an awesome game to watch if you like good pitching, but I'll take the better lineup to get me the green. Confidence Meter: 5
11:10- Portland Timbers win or draw: This is a trap pick so tread cautiously. A quick glance at the table show the Timbers second from the bottom with the Galaxy ahead of them by two slots. The Galaxy are the more well-known team and are the "big-name" favorite by 75-25 percent as of the time of this post. Here's the big kicker though, the game is in Portland. Portland at home has only lost two games all season, the last one April 7. Since then, the have won four and drawn two. The Galasy and Timbers have met twice this season with the Galaxy winning both, but both were in LA and the second (1-0) was much closer than the first (3-1). The Galaxy are struggling a bit right now having lost two in a row before beating the Fire in Chicago their last time out. This is a good matchup and since they're getting the draw and will be hyped up for the game, I'll go with the Timbers to keep their nice run at home going. Confidence Meter: 4
July Results
Overall Picks: 37-22
Picks with Confidence over 5: 12-9
Current Personal Streak: w4


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Could two mental illnesses with quite different symptoms—schizophrenia and bipolar disorder—share some of the same genetic flaws? Mounting evidence bolsters just such a hypothesis.
A protein known to interact with dopamine receptors was found to demonstrate abnormally high activity in the prefrontal cortex region of brains of deceased persons who had been diagnosed with schizophrenia and of deceased individuals who had had bipolar disorder (Psychiatric News, February 7).
In May Elliot Gershon, M.D., a professor of psychiatry and human genetics at the University of Chicago, and coworkers reported that two genes on chromosome 13 with undetermined functions appeared to increase the risk for both schizophrenia and bipolar disorder.
And now Sabine Bahn, M.D., Ph.D., a clinical lecturer in psychiatry at the University of Cambridge in England, and colleagues have found that some genes that do not express themselves properly in the brains of schizophrenia patients also do not express themselves correctly in the brains of bipolar disorder patients. The genes in question help make the myelin sheaths that insulate brain nerve cells. The findings were published in the September 6 The Lancet.
A number of studies from various scientists had already suggested that certain genes that make nerve-cell myelin are abnormally expressed—that is, engage in abnormal messenger RNA transcription—in the brains of schizophrenia patients. So Bahn and her team decided to see whether this might be the case for brains from bipolar disorder patients as well.
To explore this, they took prefrontal cortex material from 15 deceased persons who had had schizophrenia, from 15 who had had bipolar disorder, and from 15 who had had neither illness. They then used three high-technology techniques to measure the expression of myelin-producing genes present in the brain material for the three groups. The techniques were differential display polymerase chain reaction, real-time quantitative polymerase chain reaction, and microarray analysis. (Differential display PCR is a method whereby two populations of RNA are compared. Real-time quantitative PCR is a method that measures specific amounts of DNA that have been reverse-transcribed from RNA. Microarray analysis is a method that allows for the measurement of mRNA in a sample on a massive scale.)
The researchers found a highly statistically significant reduction in the expression of a number of myelin-producing genes in schizophrenia brain material compared with control brain material.
They also found a highly statistically significant reduction in the expression of a number of myelin-producing genes in bipolar brain material compared with control brain material.
"The high degree of correlation between expression changes in schizophrenia and bipolar disorder provides compelling evidence for common pathophysiological pathways that may govern the disease phenotypes of schizophrenia and bipolar affective disorder," the researchers concluded.
"The observation that at least some myelin-related gene-expression deficits are common between individuals with schizophrenia and bipolar disorder is intriguing because schizophrenia and bipolar disorder have different symptom profiles and require treatments based on quite different neurotransmitter systems." So wrote Kenneth Davis, M.D., chair of psychiatry, and Vahram Haroutunian, Ph.D., an associate professor of psychiatry and neurobiology at Mount Sinai School of Medicine in New York City, in an editorial accompanying The Lancet report.
"I have seen the study [report from Bahn and team]," Gershon told Psychiatric News. "It is quite important. . . ."
In contrast—and not surprisingly—increasing evidence also shows that the genes underlying schizophrenia are not always those that underlie bipolar disorder.
For example, Bahn and her colleagues reported in 2002 that three genes that make lipoproteins (which in turn play a central role in cholesterol transport) appear to be overly expressive in the brains of persons with schizophrenia, but not in the brains of persons with bipolar disorder (Psychiatric News, April 19, 2002).
The recently reported study by Bahn and her team was funded by the National Alliance for Research on Schizophrenia and Depression, Britain's Biotechnology and Biological Sciences Research Council, and the Stanley Medical Research Institute.
A summary of the study report, "Oligodendrocyte Dysfunction in Schizophrenia and Bipolar Disorder," is posted on the Web at www.thelancet.com. ▪
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Former Husker football players Stanley Jean-Baptiste, Spencer Long and Quincy Enunwa are officially part of The League. The three Big Red alumni have all now inked deals with their respective teams and have hit OTAs hard. Jean-Baptiste signed a four-year deal with the New Orleans Saints. According to Overthecap.com, that deal's worth $3,636,732 including a $964,896 signing bonus. His yearly salary cap hits to the franchise would be $964,896, $661,224, $826,530, $991,836 and $1,157,142 through 2017.
Long's contract nets him a total of $2,873,800 with a bonus of $613,800. His hits to Washington's cap would be $573,450, $673,450, $768,450 and $858,450.
PHOTO: G Spencer Long (3rd-round pick) and RB Lache Seastrunk (6th-round pick) sign their contacts at #Redskins Park. pic.twitter.com/SuhpgmsaFF — Washington Redskins (@Redskins) May 16, 2014
Finally, Enunwa will bring in $2,298,680 plus his $78,680 bonus. The big-bodied receiver's cap hits would be $439,670, $529,670, $619,670 and $709,670.
Be sure to like Husker Corner on Facebook, follow us on Twitter, snag the FanSided app (iOS) (Android) and subscribe to our newsletter below to keep plugged into Husker Nation from all over the globe.
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Medicine Bottle Oakland Chemical Dioxygen Amber c1900
Medicine Bottle Oakland Chemical Dioxygen Amber c1900
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Sold Date: 08/17/2008
Channel: Online Auction
Source: eBay
Category: Glass
The Oakland Chemical Company Dioxygen 0 2
is a very clean amber medicine bottle, minus some inside dirt.
Two atoms of the element bind to form dioxygen , a colorless, odorless, tasteless diatomic gas with the formula O 2. Used by hospitals and then available to the public this bottle is a very early version and dates to the 1880 - 1890 period. B I M (Blown in Mold) 4 3/4"
Condition: No Chips, Dings, Cracks, etc. No Stain
Honest Ebayer looking for a pleasant transaction each and everytime.
Always happy to save the winning bidder money with combined shipping.
I have many other antiques for auction.
Thanks and Enjoy.
(Bottle on left only in auction)
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We will accept payment via PayPal or Money Order. PERSONAL CHECKS WILL NOT BE ACCEPTED.
We are honest people and wish that each transaction goes as smoothly as possible.
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Colombia coffee production drops by one thirdbeans See JavaBeans. , plunged 33 percent in the first four months of 2009, with exports sinking by 21 percent, officials said.
The National Coffeegrowers Federation, or Federacafe, said January-April production reached just 2.88 million 60-kilogram (132-pound) bags, compared with 4.25 million bags in the same period in 2008.
"The winter, low fertilization fertilization, in biology, process in the reproduction of both plants and animals, involving the union of two unlike sex cells (gametes), the sperm and the ovum, followed by the joining of their nuclei. and the renovation of coffee plantations PLANTATIONS. Colonies, (q.v.) dependencies. (q.v.) 1 Bl. Com. 107. In England, this word, as it is used in St. 12, II. c. 18, is never applied to, any of the British dominions in Europe, but only to the colonies in the West Indies and America. 1 Marsh. Ins, B. 1, c. 3, Sec. 2, page 64. had a strong impact on production in the first months of the year," said Federacafe, which represents the Andean nation's half million coffeegrowers.
Colombia comes second only to Brazil in coffee production. Much of the country's northwest is cloaked See cloaking. in the crop, which produces a subtle brew sought after by many buyers.
But the federation stressed the outlook for 2009 remained encouraging and that despite the first months of the year they would "maintain a production projection of between 10.5 and 11.5 million bags for the year."
International sales slipped to 3.178 million bags, down 21 percent from the 4.041 million exported from January to April 2008.
Total Colombian production last year dipped nine percent to 11.5 million bags from 12.6 million bags in 2007, but total harvest revenues swelled to a record 1.953 billion dollars, according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. official numbers.
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Does Facebook's 'Boost Post' Marketing Actually Work?
I spend a little bit of money marketing my website (ExPastors.com), not a ton but I hope to ramp it up as the end of the year approaches. Mostly that has been done through Facebook campaigns but I've began to dabble a bit in the Twitter universe as well.
Recently, to do a non-scientific test of my own, I paid $5 to promote a post on Facebook.
Why Did I Give Away My Book for Free on Amazon? Or, How I Lost $4,004
A few days ago, I gave away my book, Why Pastors Quit, for free on Amazon. In doing so, a handful of people asked why I would do such a thing. If I could give only one answer, although there are many, it would be this: The exposure was worth every penny.
And when I say "penny," I am speaking quite literally.
We Know Jesus the Savior, But Have We Met Jesus, Prince of Peace?
I'm not particularly fond of writing book reviews. There have only been a handful I've written and shared publicly. Some, off the top of my head, were: What Good Is God? by Philip Yancey, A Million Miles in a Thousand Years by Donald Miller (a book I heavily disliked), and now, A Farewell to Mars by Brian Zahnd.
Mostly, when I started reading Zahnd's book, I hated it.
Not the love-hate, like I really hate that I love this book kind of hate. No, it was more like the I really hate what he is saying kind of hate.
But that didn't last very long.
Are We Asking the Right Questions? My Interview with the Pastor Survival Guide
Recently I was interviewed by Scott and Aaron, the guys behind the Pastor Survival Guide. It's a great resource for pastors and leaders within the church as they tackle real issues that both positively and negatively affect those in ministry. Check it out.


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Recipe: Watermelon Salad with Feta & Mint
Recipes From The Kitchn
Earlier this week we tipped you off to what Slate calls the "ideal ingredient to complement watermelon" — feta. It's true: the salty creaminess of good feta turns watermelon from a simple treat into something dressed for a dinner party. It's still very simple — here's how I like to make my own watermelon and feta salad.
This salad is ultra simple. I cut up about half a small watermelon (see the easiest way to do that here) and toss it with a few things to bring out its flavor. A dash of rice vinegar balances the sweetness and makes the salad even juicier.
This salad is best made right before serving. If it sits in the fridge overnight I find it can get a little slimy and too juicy. Made just a few minutes before serving, the watermelon is crisp and fresh, and the cheese creamy and bright. The mint isn't just a garnish; its taste penetrates the watermelon quickly.
To me, this is up there with caprese salad as one of the ultimate expressions of summer.
Watermelon Salad with Feta & Mint
6 cups watermelon cubes, from about 1/4 of a large watermelon
1 tablespoon rice vinegar
3 ounces feta cheese, drained and crumbled
1 loosely packed cup fresh mint leaves
Freshly ground black pepper
Flaky sea salt
Pour off any juice that has gathered around the watermelon. Toss gently with the rice vinegar. Toss with the feta cheese crumbles, just until the watermelon begins to look lightly coated.
Chop the mint leaves very, very finely, into tiny ribbons. Toss with the watermelon and spread in a serving bowl. Garnish generously with black pepper. Taste. If desired, add a sprinkle of flaky sea salt. Serve immediately.
More Watermelon Recipes
• Sparkling Watermelon Sangria
• Watermelon Sundae with Ricotta Ice Cream
• Watermelon-Cucumber Refresher
(Images: Faith Durand)
Per serving, based on 4 servings. (% daily value)
15 Comments
I was just thinking "what will I make for supper tonight?" and this is definitely going into my stomach.
I'm also thinking steak. Mmm steak!
ricotta also goes well with watermelon.... so does pickled blueberries (mix equal portion of balsamic vinegar & sugar and let blueberries soak for a day). Oh my. Flavors explode in the mouth!! I love summer fruits!!!
@Cyclokitty this would be amazing with steak! What a gorgeous plate that would be.
I make this with Red Onion and a dressing of red wine vinaigrette. It is DELICIOUS.
I haven't tried mint, but I made a similar version: watermelon, baby arugula, goat cheese and a drizzle of balsamic vinegar. It's absolutely divine! -Anne www.hammer-and-heels.com
I've tried this but I just don't feel the love. Maybe my feta wasn't good enough. I won't say what the combo tastes like to me. I do love watermelon with mint, just not with the feta.
Another variation I've seen of this is with a balsamic vinegar drizzle, feta, and basil or cilantro.
Never knew that this was so good until I had it the first time at the Epcot Food and Wine Festival one year. Now there's a food truck in our area that has this on their menu! Yummy!
I make a variation on this salad as an one-bite appetizer. It's great for summer dinner parties! http://www.tiltedskillet.com/blog/2012/08/one-bite-wonders-melon-feta-and-mint.html
A variation on this has been one of my main summer dishes for several years now...ever since Trader Joes was giving it out as a free sample and I became obsessed. The way I learned to make it was watermelon, gorgonzola, fresh mint, sea salt and a balsamic reduction. Of course it's best if you reduce the balsamic yourself, but I've been known to just use a bottled glaze or even plain balsamic.
Seriously, I planted mint just for this purpose. I eat it several times a week.
You can also make it as a soup. I'm not too fond of cold soups, but this one was just superb !
This recipe is missing the red onions soaked 30 mins in lime juice (omit rice wine), a drizzle of olive oil and sliced black olives. Trust me on this one.
My SO is obsessed with honeydew and feta. I'm not a big honeydew fan, so the idea kinda grosses me out, but I have no problem with watermelon with feta for some reason. I hadn't read the Slate article, but I assumed the answer was going to be "salt" - so, not too far off.
Yum! I'm not the biggest fan of feta, I find that a soft goat cheese is a nice complement too. And totally agree about olives. http://smartestcleverest.com/2012/07/23/watermelon-salad/
or ricotta salata.
Making this soon - the grocery store near me didn't have any mint, so I drove down the road to a local farmers market and picked up 2 Chocolate Mint plants. Hopefully they work well!


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London Trauma Conference Day 3
Dr Louisa Chan reports on Day 3 of the London Trauma Conference
There was a jam-packed line up for the Pre-hospital and Air Ambulance Day which was Co-hosted by the Norwegian Air Ambulance Foundation.
My highlights were:
Dr Rasmus Hesselfeldt works in Denmark where they have a pretty good EMS system with ambulances, RRV's and PHC doctors. Road conditions are good with the longest travel distance of 114 miles. So would the introduction of a HEMS service improve outcomes? He did an observational study looking at year of data post-trial and compared this with 5 months pre-trial. Trauma patients with ISS > 15 and medical emergencies greater than 30 min by road to the Trauma Centre (TC). Primary endpoint was time to TC, secondary outcomes were number of secondary transfers and 30 day mortality.
Results: Increase in on scene time 20 min vs 28 min, time to hospital increased but time to TC was less – 218 min vs 90 min, reduced mortality, increased direct transfer to TC and fewer secondary transfers.
Full article here: A helicopter emergency medical service may allow faster access to highly specialised care. Dan Med J. 2013 Jul;60(7):A4647
Prof Dan Davis ran through pre-hospital intubation. It seems that this man has spent his life trying to perfect airway management. Peter Rosen was his mentor and imprinted on him that RSI is the cornerstone of airway management.
So surely pre-hospital intubation saves lives. The evidence however begs to differ, or does it? As with all evidence we need to consider the validity of the results and luckily Prof Davis has spent a lot of time thinking through the reasons why there no evidence.
During his research he opened a huge can of worms:
1. Hyperventilation was common – any EtCO2 <30mmHg lead to a doubling in mortality.
2. First pass intubation is great, but not if you let your patient become hypoxic or hypotension or worse still both!
3. Hospital practice had similar issues.
So really the RSI processes he was looking at weren't great.
The good news is that things have improved and he can now boast higher first pass rates and lower complication rates for his EMS system. His puts this success down to training.
The AIRPORT study was discussed at last years LTC. This year we have the results. 21 HEMS services in 6 countries were involved in the data collection including GSA HEMS. The headline findings are that intubation success rates are high (98%) with a complication rate of 10-12%. The more difficult airways were seen in the non-trauma group. 28.2% patients died (mainly cardiac arrest).
Matt Thomas reported on REVIVE – a pre-hospital feasibility study looking at airway management in OHCA (I-Gel vs LMA Supreme vs standard care). It was never powered to show a difference in these groups, the main aim was to see if research in this very challenging area was possible. And the answer is YES. The paramedics involved recruited more patients than expected and stuck to the protocol (prob better that docs would have!). A randomised controlled trial to look at the I-Gel vs ETT is planned.
Finally, Pre-hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) seems eminently possible – Dr Nils Petter Oveland showed us the training manikin they developed for training. Through training on this manikin they achieved an average skin to balloon time of 3.3mins. Animal data supports this procedure as a bridge to definitive care in non compressible haemorrhage.
London HEMS will be starting (P)REBOA in the New Year.
So now it's stand up science, I'm off for my glass of wine…………….
Check out what they're saying about the London Trauma Conference on Twitter
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Trauma before and beyond the hospital
Sydney HEMS physician Dr Brian Burns talks about the prehospital care of trauma in this 20 minute audio podcast recorded at SMACC 2013
Further talks from the SMACC conference are available for free download on iTunes.
Here are the accompanying slides:
RSI haemodynamics in the field
The noxious stimulus of laryngoscopy & tracheal intubation can precipitate hypertension, tachycardia, and intracranial pressure elevation, risking exacerbation of brain injury or haemorrhage. Physicians from an English Helicopter Emergency Medical Service examined the response of heart rate and blood pressure to prehospital rapid sequence intubation (RSI). While a retrospective study, the haemodynamic data were prospectively recorded and documented using standard monitor printouts, and time of intubation could be accurately determined by the onset of capnography recordings. Their standardised system documents blood pressure recordings every three minutes. Etomidate and suxamethonium were used for RSI.
They report their findings:
A hypertensive response occurred in 79% (70/89) of patients. MAP exceeded the upper limit of estimated intact cerebral autoregulation (150 mmHg) in 18% (16/89) of cases and 9% (8/89) of patients had a greater than 100% increase in MAP and/or SBP. A single hypotensive response occurred. A tachycardic response occurred in 58% (64/110) of patients and bradycardia was induced in one.
Of note, 97 of the 115 patients had injuries that included head trauma.
The authors note that opioids are often co-administered during in-hospital RSI and that this may offset the haemodynamic stimulation, while possible increasing the complexity of the procedure in the prehospital environment. They have modified their pre-hospital anaesthesia standard operating procedure to include the use of an opioid and will report the associated outcomes and complication rates 'in due course'.
This is interesting and important stuff, and something we should all be looking at in our respective prehospital critical care services.
The haemodynamic response to pre-hospital RSI in injured patients
Injury. 2013 May;44(5):618-23
BACKGROUND: Laryngoscopy and tracheal intubation provoke a marked sympathetic response, potentially harmful in patients with cerebral or cardiovascular pathology or haemorrhage. Standard pre-hospital rapid sequence induction of anaesthesia (RSI) does not incorporate agents that attenuate this response. It is not known if a clinically significant response occurs following pre-hospital RSI or what proportion of injured patients requiring the intervention are potentially at risk in this setting.
METHODS: We performed a retrospective analysis of 115 consecutive pre-hospital RSI's performed on trauma patients in a physician-led Helicopter Emergency Medical Service. Primary outcome was the acute haemodynamic response to the procedure. A clinically significant response was defined as a greater than 20% change from baseline recordings during laryngoscopy and intubation.
RESULTS: Laryngoscopy and intubation provoked a hypertensive response in 79% of cases. Almost one-in-ten patients experienced a greater than 100% increase in mean arterial pressure (MAP) and/or systolic blood pressure (SBP). The mean (95% CI) increase in SBP was 41(31-51) mmHg and MAP was 30(23-37) mmHg. Conditions leaving the patient vulnerable to secondary injury from a hypertensive response were common.
CONCLUSIONS: Laryngoscopy and tracheal intubation, following a standard pre-hospital RSI, commonly induced a clinically significant hypertensive response in the trauma patients studied. We believe that, although this technique is effective in securing the pre-hospital trauma airway, it is poor at attenuating adverse physiological effects that may be detrimental in this patient group.
Helicopters and improved trauma survival
April 18, 2012 by Cliff
Filed under All Updates, EMS, Trauma
A large retrospective study has shown increased trauma survival associated with helicopter transport. The reason is unclear and may be multifactorial: faster speed, greater access to trauma centres, higher exposure of crews to trauma, different crew skill mix and so on are all possibilities.
An interview of less than five minutes with one of the authors describes the study:
Context Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted.
Objective To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries.
Design, Setting, and Participants Retrospective cohort study involving 223 475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007-2009 versions of the American College of Surgeons National Trauma Data Bank.
Interventions Transport by helicopter or ground emergency services to level I or level II trauma centres.
Main Outcome Measures Survival to hospital discharge and discharge disposition.
Results A total of 61 909 patients were transported by helicopter and 161 566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17 775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score–matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14-1.17; P < .001; absolute risk reduction [ARR], 1.5%). For patients transported to level II trauma centers, helicopter transport was associated with an improved odds of survival (OR, 1.15; 95% CI, 1.13-1.17; P < .001; ARR, 1.4%). A greater proportion (18.2%) of those transported to level I trauma centers by helicopter were discharged to rehabilitation compared with 12.7% transported by ground services (P < .001), and 9.3% transported by helicopter were discharged to intermediate facilities compared with 6.5% by ground services (P < .001). Fewer patients transported by helicopter left level II trauma centers against medical advice (0.5% vs 1.0%, P < .001).
Conclusion Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders.
Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma
JAMA, April 18, 2012—Vol 307, No. 15 1602-10 Full Text
Body temperature in anaesthetised HEMS patients
March 4, 2012 by Cliff
Filed under All Updates, EMS, Trauma
Comments Off
This study raises an important issue – how do we keep patients with major trauma warm on the way to hospital? The authors from HEMS London identified mean temperatures in hospital of 35°C in patients who had been anaesthetised in the field, although only 38% of their patients had a temperature recorded on admission!
I emailed the author Audun Langhelle for practical information on the thermal protection package they use, who was most helpful in supplying the following information. Clicking on the link will take you to online supplements to the paper describing and illustrating their technique of prehospital rewarming.
Hi Cliff,
Thank you for your request and interest in our paper. Now fully repatriated to Norway, we're currently using the medium sized UniqueResc warming blanket (Geratherm, Germany) at my base, together with the bubble wrap. In Norway, Garatherm is the only company which has been able to provide us with the necessary paper work showing that their product complies with the rather strict pan European rules and regulations, the EN 13718-1: Requirements for medical devices used in air ambulances in particular.
Working as HEMS doc with LAA 2008-2009, we played with and introduced the policy using Diemme's (Italy)DM EMG >> http://emj.bmj.com/content/early/2010/10/19/emj.2009.086967/suppl/DC1, but I'm not sure what blanket they currently use.
Kind regards,
We reviewed this article in one of our Sydney HEMS Clinical Governance Days last year. One of our team presented a critical appraisal and if you're interested the deadly PowerPoint slides are here:
Background Hypothermia at hospital admission has been found to independently predict increased mortality in trauma patients.
Objectives To establish if patients anaesthetised in the prehospital phase of care had a higher rate of hypothermia than non-anaesthetised patients on admission to hospital.
Methods Retrospective review of admission body temperature in 1292 consecutive prehospital trauma patients attended by a physician-led prehospital trauma service admitted to The Royal London Hospital between 1 July 2005 and 31 December 2008.
Results 38% had a temperature recorded on admission. There was a significant difference in body temperature between the anaesthetised group (N=207) and the non-anaesthetised group (N=287): mean (SD) 35.0 (2.1) vs 36.2 (1.0)°C, respectively (p <0.001). No significant seasonal body temperature variation was demonstrated.
Conclusion This study confirmed that patients anaesthetised in the prehospital phase of care had a significantly lower admission body temperature. This has led to a change in the author's prehospital practice. Anaesthetised patients are now actively surface heated and have whole body insulation to prevent further heat loss in an attempt to conserve body temperature and improve outcome. This is an example of best in-hospital anaesthetic practice being carried out in the prehospital phase.
Body temperature of trauma patients on admission to hospital: a comparison of anaesthetised and non-anaesthetised patients
Emerg Med J. 2012 Mar;29(3):239-42
Full text link
Utstein-like template for physician EMS
February 24, 2012 by Cliff
Filed under All Updates, EMS
Many European and Australasian emergency medical services deploy physicians to the scene. In order to facilitate consistent data reporting and future collaborative research, a working group produced a recommended reporting template. The group consisted of 'sixteen European experts in the field of pre-hospital care', and the nine authors of the study were seven Scandinavians, one Italian and one Brit.They established an Utstein-like template for documenting and reporting in physician-staffed pre-hospital services. The core data set consists of 45 variables grouped in five different categories: "fixed system variables", "event operational descriptors", " patient descriptors", "process mapping", and "outcome measures and quality indicators".
A consensus-based template for documenting and reporting in physician-staffed pre-hospital services
Andreas J Kruger, David Lockey, Jouni Kurola, Stefano Di Bartolomeo, Maaret Castren, Soren Mikkelsen, Hans Morten Lossius
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011, 19:71 Full Text
Full text PDF
Pre-hospital thoracotomy
September 10, 2011 by Cliff
Filed under All Updates, EMS, Resus, Trauma
The London Helicopter Emergency Medical Service provides a physician / paramedic team to victims of trauma. One of the interventions performed by their physicians is pre-hospital resuscitative thoracotomy to patients with cardiac arrest due to penetrating thoracic trauma. They have published the outcomes from this procedure over a 15 year period which show an 18% survival to discharge rate, with a high rate of neurologically intact survivors1.
The article was submitted for publication on February 1, 2010, and in the discussion mentions a further two survivors from the procedure performed after conducting the study. It is likely therefore in the year and a half since submission still more patients have been saved. It will be interesting to read future reports from this team as the numbers accumulate; penetrating trauma missions are sadly increasing in frequency.
Having worked for these guys and performed this procedure in the field a few times myself, I can attest to the training and governance surrounding this system. The technique of clamshell thoracotomy is well described 2 and one I would recommend for the non-surgeon.
BACKGROUND: Prehospital cardiac arrest associated with trauma almost always results in death. A case of survival after prehospital thoracotomy was published in 1994 and several others have followed. This article describes the result of prehospital thoracotomy in a physician-led system for patients with stab wounds to the chest who suffered cardiac arrest on scene.
METHODS: A 15-year retrospective prehospital trauma database review identified victims of stab wounds to the chest who suffered cardiac arrest on scene and had thoracotomy performed according to local standard operating procedures.
RESULTS: Overall, 71 patients met inclusion criteria. Thirteen patients (18%) survived to hospital discharge. Neurologic outcome was good in 11 patients and poor in 2. Presenting cardiac rhythm was asystole in four patients, pulseless electrical activity in five, and unrecorded in the remaining four. All survivors had cardiac tamponade. The medical team was present at the time of cardiac arrest for six survivors (good neurologic outcome): arrived in the first 5 minutes after arrest in three patients (all good neurologic outcome), arrived 5 minutes to 10 minutes after arrest in two patients (one poor neurologic outcome), and in one patient (poor neurologic outcome) the period was unknown. Of the survivors, seven thoracotomies were performed by emergency physicians and six by anesthesiologists.
CONCLUSIONS: Prehospital thoracotomy is a well-established procedure in this physician-led prehospital service. Results from this and other similar systems suggest that when performed for the subgroup of patients described, significant numbers of survivors with good neurologic outcome can be expected.
1. Thirteen Survivors of Prehospital Thoracotomy for Penetrating Trauma: A Prehospital Physician-Performed Resuscitation Procedure That Can Yield Good Results
J Trauma. 2011 May;70(5):E75-8
2. Emergency thoracotomy: "how to do it"
Emerg Med J. 2005 January; 22(1):22–24
Full text available here
Pre-hospital physician triage
March 22, 2011 by Cliff
Filed under All Updates, EMS, Trauma
Comments Off
A Swiss study examined the on site triage decision making of pre-hospital emergency physicians. Dispatch of the physicians was coordinated by trained nurses or paramedics.
OBJECTIVE: Accurate identification of major trauma patients in the prehospital setting positively affects survival and resource utilization. Triage algorithms using predictive criteria of injury severity have been identified in paramedic-based prehospital systems. Our rescue system is based on prehospital paramedics and emergency physicians. The aim of this study was to evaluate the accuracy of the prehospital triage performed by physicians and to identify the predictive factors leading to errors of triage.
METHODS: Retrospective study of trauma patients triaged by physicians. Prehospital triage was analyzed using criteria defining major trauma victims (MTVs, Injury Severity Score >15, admission to ICU, need for immediate surgery and death within 48 h). Adequate triage was defined as MTVs oriented to the trauma centre or non-MTV (NMTV) oriented to regional hospitals.
RESULTS: One thousand six hundred and eighti-five patients (blunt trauma 96%) were included (558 MTV and 1127 NMTV). Triage was adequate in 1455 patients (86.4%). Overtriage occurred in 171 cases (10.1%) and undertriage in 59 cases (3.5%). Sensitivity and specificity was 90 and 85%, respectively, whereas positive predictive value and negative predictive value were 75 and 94%, respectively. Using logistic regression analysis, significant (P<0.05) predictors of undertriage were head or thorax injuries (odds ratio >2.5). Predictors of overtriage were paediatric age group, pedestrian or 2 wheel-vehicle road traffic accidents (odds ratio >2.0).
CONCLUSION: Physicians using clinical judgement provide effective prehospital triage of trauma patients. Only a few factors predicting errors in triage process were identified in this study.
Accuracy of prehospital triage of trauma patients by emergency physicians: a retrospective study in western Switzerland
Eur J Emerg Med. 2011 Apr;18(2):86-93
Performance measures for HEMS services
March 15, 2011 by Cliff
Filed under All Updates, EMS
Comments Off
A recent study highlights the need for uniform standards of outcome data collection in Helicopter Emergency Medical Services (HEMS) in Great Britain and aero-medical retrieval services in Australia. Suggested patient outcome measurements by Britsh and Australian air medical respondents to the survey included:
- Mortality versus TRISS predicted mortality
- APACHE/ TRISS predicted mortality versus actual mortality.
- Use of national audit tools (eg, TARN)
- Nationally agreed Key Performance Indicators (KPIs)
- Clinical outcomes benchmarked against other services
- In-mission clinical indicators (eg, unanticipated procedures, adverse events)
- Physiological scoring linked to outcome measures
- ISS versus survival/disability
- KPIs from a national body. Mortality in isolation is not a useful marker of quality
- Clinical KPIs provided there is a reliable method of data collection
- Long-term outcome
- Interventions performed by doctors that contribute to patient mortality/morbidity.
Background Performance outcome measures are an essential component of health service improvement. Whereas hospital critical care services have established performance measures, prehospital care services have less well-established outcome measures and this has been identified as a key issue for development. Individual studies examining long-term survival and functional outcome measures have previously been used to evaluate prehospital care delivery. There is no set of standardised patient outcome measures for Helicopter Emergency Medical Services (HEMS) in the UK or Air Medical Services (AMS) in Australia. The aim of this study is to document the patient outcome measures currently in use within British HEMS and Australian AMS.
Methods This is an observational study analysing point prevalence of practice as of November 2009. A structured questionnaire was designed to assess the method of routine patient follow-up, and the timing and nature of applied patient outcome measures.
Results Full responses were received from 17/21 (81%) British services and 6/7 (86%) Australian services. The overall response rate was 82%.
Conclusions HEMS in Britain and Australian aeromedical retrieval services do not have uniform patient outcome measures. Services tend not to follow-up patients beyond 24 h post transfer. Patient outcome data are rarely presented to an external organisation and there is no formal data comparison between surveyed services. Services are not satisfied that the data currently being collected reflects the quality of their service.
Performance measurement in British Helicopter Emergency Medical Services and Australian Air Medical Services
Emerg Med J. 2011 Feb 3. [Epub ahead of print]
Delayed door-to-balloon even with helicopters
March 5, 2011 by Cliff
Filed under Acute Med, All Updates, EMS
For a whole bunch of reasons, patients with ST-elevation myocardial infarction who undergo interhospital transfer for primary percutaneous coronary intervention may not meet the required 90 minute door-to-balloon time. In a new study of patients transferred by helicopter, only 3% of STEMI patients transferred for reperfusion met the 90-minute goal. Should this result in an increase in the use of fibrinolysis at non–percutaneous coronary intervention hospitals?
STUDY OBJECTIVE: Early reperfusion portends better outcomes for ST-segment elevation myocardial infarction (STEMI) patients. This investigation estimates the proportions of STEMI patients transported by a hospital-based helicopter emergency medical services (EMS) system who meet the goals of 90-minute door-to-balloon time for percutaneous coronary intervention or 30-minute door-to-needle time for fibrinolysis.
METHODS: This was a multicenter, retrospective chart review of STEMI patients flown by a hospital-based helicopter service in 2007. Included patients were transferred from an emergency department (ED) to a cardiac catheterization laboratory for primary or rescue percutaneous coronary intervention. Out-of-hospital, ED, and inpatient records were reviewed to determine door-to-balloon time and door-to-needle time. Data were abstracted with a priori definitions and criteria.
RESULTS: There were 179 subjects from 16 referring and 6 receiving hospitals. Mean age was 58 years, 68% were men, and 86% were white. One hundred forty subjects were transferred for primary percutaneous coronary intervention, of whom 29 had no intervention during catheterization. For subjects with intervention, door-to-balloon time exceeded 90 minutes in 107 of 111 cases (97%). Median door-to-balloon time was 131 minutes (interquartile range 114 to 158 minutes). Thirty-nine subjects (21%) received fibrinolytics before transfer, and 19 of 39 (49%) received fibrinolytics within 30 minutes. Median door-to-needle time was 31 minutes (interquartile range 23 to 45 minutes).
CONCLUSION: In this study, STEMI patients presenting to non-percutaneous coronary intervention facilities who are transferred to a percutaneous coronary intervention-capable hospital by helicopter EMS do not commonly receive fibrinolysis and rarely achieve percutaneous coronary intervention within 90 minutes. In similar settings, primary fibrinolysis should be considered while strategies to reduce the time required for subsequent interventional care are explored.
Reperfusion Is Delayed Beyond Guideline Recommendations in Patients Requiring Interhospital Helicopter Transfer for Treatment of ST-segment Elevation Myocardial Infarction.
Ann Emerg Med. 2011 Mar;57(3):213-220


text:
- Study at Deakin
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- About Deakin
Due to current Alliance budget constraints the 2013 model of Alliance operation is not sustainable for 2014. Annual funding contributions from members for Alliance Coordinators and a Project Officer are not available at this time. Alternative 2014 operational options were tabled for discussion at the end of year Alliance Executive Meeting in October 2013.
The Executive agreed on a Work schedule for 2014 which supported using existing budget surplus funds to maintaining Executive meetings as a forum for intelligence sharing and identification of common priority projects as well as continuing the Peter Quail Oration under the Alliance banner.
Key features of the Works Schedule for 2014
Project Collaboration Advisory Group
Executive participants reached consensus agreement to replace the former three advisory groups with one reconfigured Project Collaboration Advisory Group with well-defined Terms of Reference as below:


text:
Analysis: For Obama, scandal complicates moves on Cabinet, national security
No one cared about 4 dead Americans in Libya for 2 months; why care about this?
Nobody cared that the individual with the highest possible security clearance perjured himself about an affair while in office. The whole press and the public gave Blue-Dress Bill Clinton a pass on both his escapes in the Oral Office as well as lying under oath.
The left has been taught that they need not fear any wrong-doing. They're the popular party that's not to be held accountable for anything.
Our enemies must be loving all of this upheaval in our military. You wanted four more years..well, Mr. President,now you got it.
On a frivolous note how about someone gives the jilted wife a makeover! There is an attractive woman waiting to jump out and no doubt make a new start.
One would have thought appointing him to be CIA chief was a calculated move.
Petraeus is especially military smart, but not that intelligence smart. A seemingly poor White House judgment (in retrospect), the president's choice could have been politically motivated. (vzc1943)
I have a novel idea, how about we immediately end these illegal, imperial wars and put a whole bunch more of these "commanders" out of work.
What national security would matter more than this soap opera in the top military when more than twenty states signed a petition online for independence of this Disunited States ?
The Obama administration knew this information on Petraeus months ago. They chose to publish this now in an effort to publicly humiliate him in an effort to silence him before he could testify on the Benghazi situation. The corrupt press is running with the salacious story as a smokescreen to avoid covering the tragic reality of what happened in Benghazi.
It is not complicated at all. Here is the "leadership", a bunch of dead beats. The creme de creme out of 300 million people.
Hard choices is something Obama does well. You disagree? I give you the decision to PROCEED with: 1.) Auto bailout 2.) Raid for bin Laden 3.) Bringing all the debt and deficit into the open by making them a PART of the deficit (see 2009 decision on how the debt/deficit is calculated).
This does complicate things. But I believe there is a depth of quality qualified people "in the system" and those selected will rise to the challenge.
Seems like there are enough major problems in our country to have the president cancel his trip verseas and take care of business right here and now. We need our politicians – from the top down – concentrating on our own country, not taking victory laps around the world.
Sandal is DEFINING Obama's cabinet, lol.
- Judge rejects strict limits on nurse who treated Ebola patients |
- Virgin Galactic spaceship crashes during California test flight
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- Dow, S&P 500 end at record highs; BoJ move adds fuel to rally |
- Judge issues order enforcing Ebola isolation of defiant Maine nurse


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Florida (15-7/3-1 SEC) plated a pair of runs in the 11th inning to defeat Texas A&M (15-8/1-3 SEC), 5-3, in game one of the teams' weekend series on Friday night at Olsen Field at Blue Bell Park.
Click here for the original story.
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Some 500 data analytics gurus representing the health care ecosystem including hospitals, physician practices, life science companies, academia and consulting came together on the lush campus of SAS in Cary, North Carolina, this week to discuss how Big Data could solve health care's Triple Aim, as coined by keynote speaker Dr. Donald Berwick: improve the […]
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Improving health care through Big Data: a meeting of the minds at SAS
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About Jane & Health Populi
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text:
Yesterday I blogged about showing up for life. Every day.
Today's is also a tie-in to a KALIGIRL blog entry, this one about Listening. www.sparkpeople.com/mypage_public_journal_individual.asp?blog_id=4372438
The importance of listening to our bodies, hearing what it is they really are needing, and providing it is an important factor in living LIFE, and maintaining those life support systems. And in some cases, the body, the mind or the spirit says, "SLOW DOWN, ALREADY!"
Sometimes it is hard to recognize when you're overdoing. You can get so pumped up with a sense of accomplishment. Ever feel like you're being lazy if you don't run a race every day? This is a marathon, not a sprint, this LIFE thing. It is meant to be savored and balanced... it's not a race to see who finishes first.
When one gets overtired or out of balance, it makes the whole of the program more difficult. Like walking at the bottom of a swimming pool, or through sand. It is essential to give oneself rest and recognition and rewards. Sleep is an essential part of identity, too: the deep dreaming sleep is part of putting together the pieces and events of life and learning something about oneself.
A healthy balance requires some time alone to put the things in perspective. This is particularly vital for those of us who have elements of "people pleasing" or a history of allowing others to define us. In the end, each must find his or her own identity.
Here's to pacing ourselves, being conscious of what's going on in any given day or moment, carefully weighing our options, making good choices that support LIFE, and allowing ourselves enough quiet time to get to know who we really are.
As we keep saying, here on Spark, ... and you're worth it.
This is for those of us who are very focused on work, or volunteer work, or projects. Yesterday my friend KALIGIRL blogged about LIFE... her L in the alphabet blog series.
As usually happens when I read blogs here on Spark, I got to thinking... and my reverie on LIFE goes something like this. LIFE is a series of decisions. Life is something that happens every single moment of every single day.
It is not something that is going to happen at some future point ("When I get done with this project", "When tax season is over", "When I retire", "When I graduate")... it is happening right now. With every breath you take.
My brother MOBYCARP and I have talked at times about "project" versus "process" thinking and getting things done. We may have slightly different takes on what's interrupting which (see his blog www.sparkpeople.com/mypage_public_journal_individual.asp?blog_id=4368648 ).
In my case, weight loss was a project, weight maintenance a process... and processes can easily be interrupted by shiny new projects. In his case, weight maintenance was a side effect of how he naturally lived his life... until recently. Now he's working on what it will take to make health maintenance a priority... weight being an element in the mix.
Back to LIFE. What I am discovering as I Spark on is that there are some systems of life support that are requirements, no matter what. We may get away with ignoring them but if they are not maintained, eventually LIFE breaks down. These life support systems have to be maintained.
A nutritious and calorie-range appropriate way of eating is essential for a healthy life. So is sufficient sleep. A certain amount of moving around is also vital. One important shift that has taken place in my thinking which gives me hope is the recognition that it is not WEIGHT that I am seeking to maintain. It is these life support systems.
Also important to my mind-shift (which is what is required to go from being an apparently naturally thick person to an apparently naturally thin one) is the concept of showing up to LIFE, the same as I would show up to WORK. I would not dream of skipping work!
Yet, when I avoid making the decisions which make up my LIFE, am I avoiding or putting off living? Food for thought... and part of the impetus behind the "do one thing" initiative.
Life's good. Spark on!
On the third of July, I did what I always do in the morning. Bathroom, step on scale in the minimum, write it down. I write my weight on the calendar. I walked back into my bedroom to mark it. I am writing about this because I had a Freudian slip that particular morning. Instead of writing "121" (which the scale said), I jotted down "221".
Double take. But there is a point to this. "221" is a number that's been on the calendar in a genuine sense in the past. Multiple times. I had this happen once before during the losing process... instead of writing "148", I had automatically written "198"... or some such.
If the theory is true (again, don't remember where I read it) that it takes a year to adjust to your new body size for every 25 pounds lost/regained... I have three years to go to adjust to the 120's range. Will I make it through those three years without drifting back the other way and undermining these changes? I don't know. I can only live one day at a time. I have more hope than ever before, I can say that.
Several exercises I have been going through recently have me pondering and meditating on identity and body size (again) and adding to my reflections on the topic. The National Weight Control Registry survey questionnaires had me digging through my old calendars. My brother's visit, and seeing his graphs of his daily recordings of weight (with a similar "life happens" pattern of gains and losses, just not as extreme as mine) added a piece. I think I already knew that "normal" eaters also cycle with life events, also eat for comfort at times... they just don't go as crazy as those of us who self-identify as compulsive eaters.
Yesterday I streamed the video of the most recent episode of "Extreme Makeover: Weight Loss Edition" where the subject, Wally, is indeed a compulsive eater. Like me. The trainer ended up leaving him at an addiction center and abandoning the transformation project, 9 months into the year. I'm very glad they showed one like this, because for those of us who are compulsive eaters, weight is a symptom, not the whole problem. For us, a solution has to be more than the mechanics of losing pounds.
What's the point of all this? I suppose that it is a huge uphill battle to change one's concept of oneself. When you look statistically at those who have successfully maintained, long-term, a significant change in weight / body size, it is under ten percent. Which is why I joined the study... may as well contribute to learning about it.
It makes me think: is my identity from the inside out, or from the outside in? From the outside, I am thin and fit, as my brother and others can see. From the inside, I occasionally write down erroneous weight numbers that reflect how I see myself. From the inside I know what I am capable of doing to myself with food, and I choose each day to pray the serenity prayer.
I think I finally know what it means to be "abstinent" in an OA sense, for me (but don't get cocky, Barb). Fitness is a joyful element of reward for living this way, and I live one day at a time.
Life's good. Spark on!
We are in an excessive heat warning week... it is predicted we could top the century mark on the Fahrenheit scale every day from Monday through Thursday. Today they said "99"... yeah. Like that makes a huge difference.
I had been troubled by the state of this tree's undergrowth for some time. It makes it harder for the cars coming down the street to see children playing, people jogging, other cars approaching the intersection, etc.
As with yesterday's Volkswalk, the better part of valor for yard work this week is to do it EARLY. So I did this between 7 and 8 a.m., before church time. Humming "Baa, baa Black Sheep" because I thought so: a three bag job.
I'd say I got my morning "one thing" done for today.
Life's good. Spark on!
This morning I had my second "in the flesh" meeting with another Sparkler. Photo above to prove it now has a place on my front page, too. We've been writing and commenting on one another's blogs for over a year now... and when we both discovered we were participating in the same 10K Volkswalk today, we opted to meet and walk it together. We knew we were in the same town. What we didn't know was that we live essentially in the same neighborhood!
About time we Sparked together! It was a blast getting to know KALIGIRL better. Of course by now she knows I'm just as chatty in person as I am on the blog. But she still says we can exercise together in future! I love tolerance.
Of course from reading HER blogs, I already knew she's a kindred spirit... full of insight and intelligence and spunk. So, those of you who haven't yet met a Spark friend in real life? I recommend it. Spark people are real people living real lives, and sharing this piece of it right here!
I only had the one snapshot taken, not knowing how much of the 10K we might jog & didn't want to carry the camera. I got to see parts of the city that I don't normally, including part of the full marathon route. We spotted a HUGE turtle (gotta go back and snap its picture one of these days for the Turtle team). Passed a chum from my work place who pointed out a rainbow to us. Met a few of her running class. We got back safe before the heat got too heavy, and even got sprinkled on... and now, post-shower, I'm still bubbling with good feelings and endorphins.
This journey is so worth it, fellow Sparklers. Live well, Spark on!


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Abt Associates' Kathleen Flanagan on international-development contracting
Friday - 2/22/2013, 4:07pm EST
Kathleen Flanagan, CEO of Bethesda, Md.-based Abt Associates, joins Industry Chatter to discuss the issues facing contractors working in international development.
From Flanagan's official bio:
|Kathleen L. Flanagan assumed the position of President and Chief Executive Officer of Abt Associates on October 1, 2009. She has worked across the broad range of markets and policy areas that reflect the company's business today. Prior to being named President and CEO, she served as Group Vice President for Social, Economic and Health Policy and has been a member of the company's senior executive team since 2001.
Flanagan joined Abt Associates in 1983 as a Policy Analyst in the Health practice. In 1989, she became Managing Vice President of the Labor Economics Research Area, overseeing research on workforce development and income security programs. In the mid-1990s, she launched the International Workforce and Education practice, winning projects from clients including USAID, The World Bank, and the U.S. Department of Labor. In 1998, she started the Housing and Community Revitalization practice. The practice became a team of more than 75 researchers and technical assistance staff working on affordable housing and community development policies at the federal, state, and local levels.
She is a member of the Massachusetts Women's Forum.
Flanagan received a B.A. in Economics and Political Science and an M.S. in Public Policy from the University of Rochester in New York.


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Friday 20th July 2012
A parade of 70 Ferrari F40s is just part of the fun at this weekend's Silverstone Classic - here's a pic to get you in the mood!
If the Goodwood Revival fancy dress party isn't your thing and you prefer an even broader range of cars doing some proper racing, this weekend's Silverstone Classic is well worth a visit. And if you hadn't committed due a (perfectly reasonable) expectation of a washout and F1-style parking chaos then - whisper it - the weather's actually looking OK and organisers are assuring us all the parking is on hard standings and therefore weatherproof.
taking part in event, including classic F1, Group Cs, 60s tin-tops and more besides. But it's raining in that one and we didn't want you to think that's what's in store weather-wise.
So instead we've gone with another pic from an earlier meet at Silverstone to tease the fact Silverstone will host a very special parade of at least 70 Ferrari F40s to celebrate the car's 25th birthday. A pic of one F40 would have been nice. But we've done a bit better than that!
Tickets and further info can be found on the official site - let's hope that weather forecast is right!
Traditional (4:3)
Computer widescreen (16:10)
TV widescreen (16:9)
Portrait (smartphone etc)


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Fashion and personal style blog based in Cape Town (for now) with sprinkles of my daily life & fitness obsessions.
♀ Intersection of Popular Culture, Fashion, online memes & gen-y inspiration!
My name is Sianna WU and I'm 20-something online fashion & lifestyle marketer @Social_WOO.. based in Cape Town and part-time love doctor to my closest friends. Have a serious thing for miu miu, shoe porn and a serious addiction to beauty products.
Spreading the ♥ of Fashion, Ideas, Fitness & Smiles.
Send me a tweet to contact.
#MovieFriday ♥ Watch [video] HD Friends With Benefits 2011 with Stunning Mila n Justin ————————————————-
If you wanna check out other movies for free to stock up for a weekend in,
watch other free online full movies here.


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|Behavioral Sciences Department
|Batmale Hall 336
|(415) 239-3795
| Fall 2014
Office Hours
Fall 2014 Teaching Schedule
ANTH 1 Biological Anthropology 3.0 70073 501 Lec T 06:10-09:00PM SCIE 302 Deadlines Final Book WAIT LIST ANTH 2 Archaeology and Prehistory 3.0 73798 002 Lec T R 12:40-01:55PM ARTX 268 Deadlines Final Book ANTH 3 Cultural Anthropology 3.0 71717 004 Lec T R 09:40-10:55AM ARTX 268 Deadlines Final Book 74723 501 Lec W 06:10-09:00PM 808 Kearny Street 1104Deadlines Final Book 75919 831 Onl HOURS ARR Deadlines Book
ANTH 3-831 is an online class with required orientation on-campus. Students must check the instructor's website for class details at https://sites.google.com/a/mail.ccsf.edu/barbara-lass/anthropology-3. For more information about online classes go to https://www.ccsf.edu/online/courses.ANTH 12 North Amer Indian Cultures 3.0 76170 001 Lec T R 11:10-12:25PM CLOU 221 Deadlines Final Book
B.A., Sociology/Anthropology, University of South Dakota
Prof. Lass has been teaching full-time at CCSF since Fall 2011.
I like students to leave my classes with something they apply to today's world and to their own lives, regardless of whether they pursue further study in anthropology or ever take another anthropology class.
Faculty adviser, Anthropology Club
One monograph, several articles, and conference papers on Hawaiian archaeology


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* We think our greatest service to children has been the more effective way we have monitored learning in the classroom, promoting greater self esteem and slowly improving aspirations. There is a range of complementary experiences:
* Visits to support topics in the curriculum. These include Sherwood Pines Forest Park, Chatsworth Park, Mansfield Museum, and a Chinese new year visit.
*Social visits included a very successful visit with parents to Twycross Zoo, and to the Nottinghamshire Christmas Concert in The Royal Concert Hall - which never fails to impress pupils.
* Children are now regular visitors to Oxclose Woods, a local attraction born out of re-landscaping of an old mining area.
* We continue to provide assemblies, workshops and theatre groups who provide drama based activities
* Year 6 pupils visit Kingswood Residential Centre in South Yorkshire where they enjoy activites such as fencing, archery, wall-climbing and computer based ICT simulations.
* Parents organise a summer holiday, after school and a weekly youth club.
*Our sporting activities are listed above.
* We are proud of our French language provision and acknowledge the excellent support from our Secondary School.
Share your experience!


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Letting It Go
My routine has been totally off for a couple of weeks now and it isn't pleasant. Taking the bus and jogging isn't an option at the moment because of foot issues, and that has somehow translated into a motivational crisis where I suddenly can't even seem to peel myself out of bed at 5:30 like I'd been doing for the past year. That lack of time also means I'm barely (or hardly depending on how you look at it) keeping up with my post-commute gym routine.
On the plus side I finally went in to the doctor for the first time in like a billion years, no longer afraid of being told what a horrible job I'm doing at taking care of my own body. Everything was "excellent" except my cholesterol, which is only slightly high (in the "nearly optimal" range).
It's time to admit that I have a lot of fears, and I want to let them go. I'm not going to be afraid to say "no" any more because as much as I hate disappointing other people, there is just too much burden that comes from trying to make everyone I care about happy. Fearing rejection and abandonment is another thing that has to go. I've always had a problem with over-needing acceptance. Recently, for obvious reasons, that has blossomed into a lack of self-confidence.
I stayed in a pretty bad seven year relationship, trying desperately to make things work, worried I wasn't good enough to do better. More recently my open-minded and trusting nature blinded me to the implosion of a six year relationship (and almost 5 year marriage).
At first I thought that maybe time to myself was what I needed, to get away from all the external pressures to find "myself". I'm realizing instead I need a crash course in fearlessness. Personality isn't just natural tendency, it is the active choices we make every day. I need to remember that. Being afraid to make mistakes and get hurt just isn't me. I'm not looking to make mistakes, but I'm not going to try to avoid them either.
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- mattyscondom said: youre so cute
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- thomcubby said: You're looking very handsome :) Glad your health is decent. And I think letting go and going with whatever comes at you is very healthy considering the state of things. If a mistake happens, it happens. its how you react to that mistake that matters.
- jthurteau posted this


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IP Address - Change IP in Windows Quick and Easy
How to Change Windows IP Address Automatically
Published by seventrad
30 May 2011
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Dr. Ross Rudolph, MD
Plastic Surgery, Scripps Clinic Torrey Pines
- 10666 N Torrey Pines Rd
La Jolla, CA 92037
- 2 Office Locations
- Email a Friend
- (858) 455-9100
Dr. Ross Rudolph has been practicing medicine for 48 years. Dr. Rudolph graduated from the Columbia University College of Physicians and Surgeons in 1966. He practices medicine in La Jolla, CA and 1 other location and specializes in Plastic Surgery. Dr. Rudolph is affiliated with Scripps Mercy Hospital, Scripps Green Hospital and Scripps Memorial Hospital. He speaks English and Spanish.
Gender: Male
Years in Practice: 48 Years
Languages Spoken: English, Spanish
Medical School: Columbia University College of Physicians and Surgeons
Graduation Date: 1966
Hospital Affiliations: Scripps Mercy Hospital, Scripps Green Hospital, Scripps Memorial Hospital
Specialties: Plastic Surgery
*This physician has multiple office locations. See Appointments for details.
©2005-2014 WebMD, LLC. All rights reserved.
WebMD does not provide medical advice, diagnosis or treatment. See additional information.


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Watching This Goat On A Blow Up Chair Will Make You Want A New Pet [VIDEO]
If you thought goats only ate tin cans, you are missing out on so much entertainment.
If you thought goats only ate tin cans, you are missing out on so much entertainment.
Sure, those special effects dinosaurs were impressive, but these goats will blow your mind!
Stampedes have been known to destroy enormous swaths of land across the plains. Not this kind of stampede, though. This stampede is a baby-goat stampede, and all it destroys is sadness.
When Frostie was hit with a condition that left his back legs immobile, a solution was found to get him back on his feet.
So these goats balancing on a flexible steel ribbon is a thing.
Before the goat craze of 2013 began, Anderson Cooper went after a goat in Utah, saying that the images of the goat may haunt your dreams.
Goats yelling like humans? That's so last week. Now it's humans yelling like goats yelling like humans!
A new trend is sweeping the interwebs...goats.
I think that goat at the petting zoo was from New York...


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Nitromist 400mcg spray is available in a 4.1gm Bottle, 90 Metered Doses and 8.5gm Bottle, 230 Metered Doses.
Inside mesh pouch for storage of prefilled syringes, vials, atomization devices, CPR barrier devices, exam gloves and other pertinent items.
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Steelers draft Michigan State RB Le'Veon Bell
The Pittsburgh Steelers have taken running back Le'Veon Bell in the second round of the NFL draft.
The 6-foot-1, 244-pound Bell ran for 3,346 yards and 33 touchdowns in three seasons with the Spartans and caught 78 passes for 531 yards. The Steelers are looking to replace Rashard Mendenhall, who signed a free agent contract with Arizona last month.
Bell is the highest running back taken by the Steelers since they took Mendenhall in the first round in 2008. Pittsburgh offensive coordinator Todd Haley says Bell's size and versatility makes him a good fit.
Bell ran for 1,793 yards last season, the second-highest total in school history and was a first team All-Big Ten selection. He will compete with Isaac Redman and Jonathan Dwyer for the starting job in Pittsburgh.
The views expressed below are not those of Click On Detroit, WDIV, or its affiliated companies. By clicking on "Post," you acknowledge that you have read the Terms of Service and your comment is in compliance with such terms. Readers, please help keep this discussion respectful and on topic by flagging comments that are offensive or inappropriate (hover over the commenter's name and you'll see the flag option appear on right side of that line). And remember, respect goes both ways: Tolerance of others' opinions is important in a free discourse. If you're easily offended by strong opinions, you might skip reading comments entirely.


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Start summer off right & stay active while tracking it all with your BodyMedia FIT armband to earn a chance at winning great prizes!
|A Trip to The Biggest Loser Resort of Your Choice*
|New BodyMedia CORE 2 Armband (coming Fall 2013)
|Entry in RunWalk Race Series + The Biggest Loser Workout DVD
- Once you link your BodyMedia FIT account to Earndit, you'll automatically receive points for being active while wearing your armband.
- Be sure to upload your data to BodyMedia often so that your points are current.
- For any minute where your MET level is 3.0 or higher, Earndit will give you a point equal to 0.1 x MET Level. All points corresponding to all minutes are then added together for your daily total. There's a limit of 60 points per day.
- Try to earn as many points as possible throughout the month. If you reach at least 750 points, you could win one of the ten 2nd-tier prizes. If you reach at least 1,000 points, you could win one of the ten 1st-tier prizes. If you reach at least 1,500 points, you could win the grand prize. Note that you can be entered into all of the drawings you're eligible for (i.e. if you get 1,600 points, you'll have 21 chances to win something!)
- Have fun!
Latest Chatter
Hey Tara H, I got an email from Lexi, in July saying she'll be contacting me in the Fall right before it's supposed to come out. Then that's the last I heard from her. Have you heard anything? Or have they requested your mailing info yet?
Any idea on when we will get the Core 2 armband winners? I can't wait for mine!!!
Aaron, ok how the heck did you do 20lbs a month! Man, it took me 8 months to lose 90 and that was like doing 3000 a day calorie burn and 1200 intake. Can you tell I'm jealous?
I finally hit my weight loss goal for a total of 110 lbs in 5 months.
Congratulations everyone! I am down 29 pounds as of this morning! Yay! So I did win too!
Great job to all prize winners. But everyone deserves credit for working so hard. Just found out I could be a winner if I go 0-58 in challenges.
DRATTTS GRRRRRRRRRRRRRRRRRRRRRRRRRR Got nothing, nada, buttsky. LOL Oh well, congrats to all the great winners, I'm just jealous! On to the next one.
Ann T, Thanks for the sleeping tip. It doesn't usually bother me on the arm sleeping but then there are times when I must turn just right and it doesn't record. I'll have to give it a try.
Hey everyone. Great job! I'm helping run an accountability group on Facebook. Shoot me a friend request if you are interested in joining. http://facebook.com/yahkin
Congratulations to all of you! What a super great motivated group. It seems we have all won. Whether it is weight loss or a habit now to exercise or a trip or the core. We are all winners. Good luck to you all.
Thanks Ann T for the info about uploading your points by 12p July 1st. I didn't read that! :)
Congratulations Jennifer O! On reaching your 90lbs weight lost goal.