text:
Ways to block out your neighbors
By Chaya Kurtz, Networx
I'm all for being a considerate summertime neighbor. Being mindful of how much noise one produces and inviting the neighbors to an occasional barbecue at your place are nice ways to increase the peace in one's neighborhood.
But what if your neighbor is a noisy, nosy, scary jerk? What if you have asked him nicely not to let his dogs use your yard as a bathroom, but you keep stepping in it when you mow your lawn? What if the neighbors are leering weirdos who watch you as bend over in the garden? What if your neighbors decided to start fixing all terrain vehicles in their back yard, and all you can hear is the grinding of dune buggy motors? What if all of your diplomatic efforts have fizzled into nothing, and it just doesn't seem worth it anymore? It's time to block out the neighbors.
The exceptionally great thing about building a barrier around your yard is that the barrier can actually make your yard look better. The barrier can add home value if it is attractive. The barrier can keep out pests that eat your garden vegetables in addition to the neighbor's dogs. Having a great fencing contractor work his magic, or embarking on an ambitious DIY project, might cost you in time, labor, and materials, but the investment is a sound one that pays off.
Now what are your options for building a fence to block out neighbors? You could modify a short fence by adding a privacy screen and plants. Or you could plant thick vegetation around your yard, install a tall fence, and build yourself a nice, chunky pergola to block out the neighbors. You could build a privacy screen out of old doors to give your yard that groovy DIY look. You could follow the lead of Rob L., who worked with an Atlanta carpenter who installed a nice, clean-looking, good old-fashioned wooden privacy fence around his property.
Combinations of tall fencing and vegetation create a nice sound and sight barrier between properties. Do this project with aesthetics in mind, and you might be thanking your obnoxious neighbor in the end.
Source: http://www.networx.com/article/ways-to-block-out-your-neighbors


text:
Independent financial advisors and wealth managers are well aware that they work in an aging industry full of baby boomers, so it's no surprise that succession planning is a popular theme in the business. What's not so popular is the struggle many advisors face when trying to do a quick and painless valuation of either their own practices or their boomer clients' businesses.
To address that problem, a company called CoreValue Software has developed a web application that asks just 90 minutes of an advisor's time and uses 18 value drivers to evaluate a business in terms of intellectual property, goodwill, market share, brand, ingenuity and customer relationships. The app assesses a company's ability to generate future profits, and assigns a core value rating on a scale of 1 to 100.
The point of this exercise, according to CoreValue founder and CEO Chuck Richards (left), is to help advisors assess where a business' value gap might lie in order to improve enterprise value and thus more effectively transfer a company to a new owner, raise capital or build for the future.
"Core Value Software launched with beta testing in early 2012, and we started to use it with advisors about a year ago in the fall of 2012," Richards said in a Sept. 5 interview. "We have been rolling it out to the market, and we're back-testing everything as we add advisors and businesses. We're measured in the hundreds of businesses so far, not the thousands, but we have very good data."
The cost of the product is approximately $1,000, although fees vary based on a tiered subscription model.
CoreValue's web-based business software platform began as a project of Richards' web tools firm Chairman's View Inc., based in Richards' home state of Vermont, in the town of Norwich, which is close to Dartmouth College and its Tuck School of Business.
Richards, who received a PhD in systems engineering from MIT but also has studied economics, believes that a business — including the intangibles — is like an algorithm and can be quantified. The company's patent-pending Web application targets small to medium private businesses in the U.S. and Canada, "the majority of which are owned by baby boomers nearing retirement and facing a transfer event," Richards said.
With the population of financial advisors expected to increase by 40% by 2016, the industry is looking at major oversaturation, Richards believes. Yet the attempted transfer of a middle-market company results in a 75% failure-to-sell rate, and if one adds in businesses that never bother to put themselves up for sale, that brings the total to 90%, he said.
"I've worked with a lot of advisors, and there are two issues: the demographic age of advisors, which is between 60 and 65, and the challenge of planners who have 85% of their net worth tied up in their business," Richards said. "If the business doesn't sell, the advisor's financial plan won't work, and the majority of financial plans are based on the sale of the business whether the advisor is retiring or going into a different line of business."
In August 2012, CoreValue completed its Series A financing led by Baker Capital, a New York-based private equity firm that has raised more than $1.5 billion in committed capital. Founded in 1995, Baker Capital invests globally in digital communications, media and technology. Other names in Baker Capital's portfolio are Interxion (INXN), a provider of Internet exchange points and data centers in Europe; Akamai (AKAM), a Cambridge, Mass.-based content distribution and streaming company; and Canal+, a pay television provider serving France, Sweden, Norway, Finland and Denmark.
Read executive search consultant Mark Elzweig on 12 Real-World Steps to Buying a Practice at ThinkAdvisor.

subset: commoncrawl


text:
Supplement Forms/Alternate Names
- Diosmetin
- Diosmin
- Hesperidin
- Naringin
- Narirutin
- Neohesperidin
- Nobiletin
- Rutin
- Tangeretin
- Bioflavonoid
Principal Proposed Uses
Other Proposed Uses
Citrus fruits are well known for providing ample amounts of vitamin C . But they also supply bioflavonoids, substances that are not required for life but that may improve health. The major bioflavonoids found in citrus fruits are diosmin, hesperidin, rutin, naringin, tangeretin, diosmetin, narirutin, neohesperidin, nobiletin, and quercetin.
This article addresses the first five bioflavonoids listed above. Please see the article Quercetin for information on this supplement. A modified form of rutin, oxerutin , is also discussed in its own article.
Citrus bioflavonoids and related substances are widely used in Europe to treat diseases of the blood vessels and lymph system, including hemorrhoids , chronic venous insufficiency , leg ulcers, easy bruising , nosebleeds , and lymphedema following breast cancer surgery . These compounds are thought to work by strengthening the walls of blood vessels. Bioflavonoids are also often said to act as antioxidants; however, while they do have antioxidant activity in the test tube, growing evidence suggests that they do not act as antioxidants in people. 45
Citrus fruits contain citrus bioflavonoids in varying proportions. Even different brands of citrus juice may vary widely in their bioflavonoid concentrations and composition. 1 For use as a supplement, bioflavonoids are extracted either from citrus fruits or other plant sources, such as buckwheat.
Therapeutic Dosages
A typical dosage of citrus bioflavonoids is 500 mg twice daily. The most studied citrus bioflavonoid treatment is a special micronized (finely ground) combination of diosmin (90%) and hesperidin (10%).
Therapeutic Uses
Double-blind trials suggest (but do not prove conclusively) that a micronized combination preparation of diosmin and hesperidin may be helpful for hemorrhoids . 2-6,43
Diosmin and hesperidin, as well as the bioflavonoid rutin, may also be helpful for chronic venous insufficiency , a condition in which the veins in the legs begin to weaken. 7-10,34,35
At least one good double-blind trial found diosmin and hesperidin also to be helpful for individuals who develop bruises or nosebleeds easily. 13
Citrus bioflavonoids have also been tried, with some success, for treating lymphedema (arm swelling) following breast cancer surgery . 14
Note : Do not use bioflavonoid combinations containing tangeretin if you are taking tamoxifen for breast cancer.
In addition, highly preliminary evidence suggests that citrus bioflavonoids may help reduce cholesterol levels, 15,16 control inflammation, 17,36 benefit people with diabetes , 18 and reduce allergic reactions , 19 and prevent cancer .
"Sweetie fruit," a bioflavonoid-rich hybrid of grapefruit and pummelo, has shown a bit of promise for treatment of high blood pressure . 42
What Is the Scientific Evidence for Citrus Bioflavonoids?
A 2-month, double-blind, placebo-controlled trial of 120 individuals with recurrent hemorrhoid flare-ups found that treatment with combined diosmin and hesperidin significantly reduced the frequency and severity of hemorrhoid attacks. 21 Another double-blind, placebo-controlled trial of 100 individuals had positive results with the same bioflavonoids in relieving symptoms once a flare-up of hemorrhoid pain had begun. 22 A 90-day, double-blind trial of 100 individuals with bleeding hemorrhoids also found significant benefits for both treatment of acute attacks and prevention of new ones. 23 Finally, this bioflavonoid combination was found to compare favorably with surgical treatment of hemorrhoids. 24 However, less impressive results were seen in a double-blind, placebo-controlled study in which all participants were given a fiber laxative with either combined diosmin and hesperidin or placebo. 25
Two studies claimed to find that diosmin/hesperidin reduces pain after hemorrhoid surgery. 38,39 In fact, these studies show little to nothing, as the researchers failed to use a placebo group, and simply compared treated participants to untreated participants. (For information on why this matters, see Why Does this Database Rely on Double-Blind Studies? )
Overall, the evidence remains incomplete, though promising. 43
Chronic Venous Insufficiency
A 2-month, double-blind, placebo-controlled trial of 200 people with relatively severe chronic venous insufficiency found that treatment with diosmin/hesperidin significantly improved symptoms as compared to placebo. 34
Another double-blind, placebo-controlled trial of diosmin/hesperidin enrolled 101 people with relatively mild chronic venous insufficiency. 35 The results showed little difference between the two groups; the authors theorize that diosmin/hesperidin might be more effective in severe chronic venous insufficiency.
A 2-month, double-blind, placebo-controlled trial evaluated the effects of diosmin/hesperidin in 107 people with nonhealing leg ulcers (sores) caused by venous insufficiency or other conditions. 26 The results indicated that treatment significantly improved the rate of healing.
Also, a 3-month, double-blind, placebo-controlled trial of 67 individuals evaluated buckwheat tea (a good source of rutin) for chronic venous insufficiency. 27 The results showed less leg swelling in the treated group.
One study supposedly showed that the supplement oxyrutin is more effective than diosmin/hesperidin for chronic venous insufficiency, but the study was too poorly designed to provide meaningful results. 40
Easy Bruising
Some people bruise particularly easily due to fragile capillaries. A 6-week, double-blind, placebo-controlled study of 96 people with this condition found that combined diosmin and hesperidin decreased symptoms of capillary fragility, such as bruising and nosebleeds. 28
Two rather poorly designed studies from the 1960s found benefits with a combination of vitamin C and citrus bioflavonoids for decreasing bruising in collegiate athletes. 29
Breast cancer surgery sometimes causes persistent swelling of the arm (lymphedema) caused by damage to lymph vessels. Citrus bioflavonoids as well as other natural supplements have shown promise for this condition. In a 3-month, double-blind study, 57 women with lymphedema received either placebo or combination therapy consisting of the modified citrus bioflavonoid trimethylhesperidin chalcone plus the bioflavonoid-rich herb butcher's broom . 37 The results indicated that use of the bioflavonoid combination resulted in significantly less swelling.
In a review of 12 studies involving over 5,000 cases, researchers found that people who consumed the highest amounts of flavonoids in their diets had a lower risk of lung cancer than those who consumed less. 46 The significance of these results is weakened by the fact that none of the studies were controlled trials, and the most favorable among them did not account for the quantity of fruits, vegetables, or vitamins in the participants' diets.
Safety Issues
Extensive investigations of diosmin and hesperidin have found them to be essentially nontoxic and free of drug interactions. 30 The combination has been given to 50 pregnant women in a research study, without apparent harm to mothers or babies. 31
Some evidence suggests that the bioflavonoid naringen may interact with medications in the calcium channel blocker family, increasing blood levels of the drug. 44 This may necessitate a reduction in drug dosage.
The citrus bioflavonoid tangeretin may reduce the effectiveness of tamoxifen , a drug used to treat breast cancer. 32,41
One highly preliminary study suggests that some citrus bioflavonoids in the diet of pregnant women might increase the risk of infant leukemia; hesperidin did not produce this effect, and diosmin was not tested. 33
Interactions You Should Know About
If you are taking:
- Calcium channel blockers : Use of the bioflavonoid naringen may necessitate a reduction in medication dose.
- Tamoxifen for breast cancer: You should avoid citrus fruits and juices and the citrus bioflavonoid tangeretin.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


text:
Red, White And Black With X's Design By Celeste KhonceptsCeramic ornaments make ideal keepsake and decorative gifts during the holiday season. Popular during the festivities such as Easter and Christmas, these accessories are also suited as in-house embellishing items.Images are imprinted onto surface using heat dye sublimation technique to prolong longevity. Image will not fade when rubbed or makes contact with water.Measures approximately 3" x 3".
Real Product Video:
If you order more than 50 pcs items (can be combined), please click here to contact us for whole price quotation, please include the SKU# and the quantity you want for each of them. For order less than 50 pcs, please order directly from our website.


text:
Advisors who see social media as a gimmick or a burden they'd rather not be saddled with should reconsider its importance to their marketing plan.
There are two main goals for a social media marketing strategy, according to Jill Jacques, vice president of wealth management and retirement lead at North Highland, a global consulting firm.
"One is around deepening the client relationship and eventually share of wallet, starting with the core clients that you have and want to continue to build those relationships," she told ThinkAdvisor on Tuesday. The second goal is client acquisition: "targeting the types of people you want to replicate in your book. Social media is a flexible way to both deepen client relationships as well as target the right kinds of clients for their ideal client profile."
For the firm as a whole, there is a third goal, Jacques said: "That is around experienced advisor recruiting and targeting the right kind of advisor to come into the firm."
Compliance, obviously, is a major issue for advisors who use social media in their marketing plans: FINRA announced in June that it was conducting "spot checks" on firms to make sure they were complying with social media regulations.
Jacques said that the first challenge for advisors adopting social media was "figuring out what can't be done, how tailored it can be to pull out their strengths and personalities online. Firms are working right now with different vendors on how to systematize the compliance piece of it: archive and retain the social media content. For advisors, that can create more work if the compliance processes aren't consolidated.
"A second challenge would be to figure out what they want their brand to be online and understanding that they need a through line and a consistent message, no matter what type of social media they're using, so it doesn't detract from their practice but enhances it."
She acknowledged that compliance scares a lot of advisors away from using social media at first. "They think that compliance will be so unwieldy and overwhelming, but if you can get a baseline through compliance, most compliance departments know that social media is a necessity, especially around websites and LinkedIn." Jacques said that many compliance departments are working more with advisors "to figure out a good solution, so you can get a template of some sort to get started. Get a baseline presence on social media, and then evolve to the more interactive social media that needs to be more of a daily or weekly update."
Jacques called LinkedIn the "front-runner" in social media for firms and individual advisors. "It does present itself as the professional social media outlet," she said. "That has been taking off more and more, to the extent that firms will allow FAs to use LinkedIn. There are plans in place across the industry for how to create a surround sound marketing message with Facebook and Twitter, but going back to what your brand and your messaging is, FAs are trying to figure out the types of folks they will attract on Facebook and Twitter, what kind of information they should be putting out there."
Jacques (left) encouraged advisors to focus most on LinkedIn over other social media channels. That network has seen the most growth, she said. It's also commonly used among clients and prospects, even if they're using it in different ways. "They are going to LinkedIn to see what kind of presence and specialties they have as a financial advisor. Prospects are going to LinkedIn to see who else knows this advisor: Are they in a network of friends of family? How connected are they to their community? As a client, they're looking for thought leadership: white papers and research. They are going to LinkedIn and Twitter, but for different reasons."
As social media and its value to marketing plans has risen in importance in the financial industry, some firms are trying to help advisors streamline those activities, Jacques said. "If you're in the RIA world, there are more firms coming out with holistic marketing tools and resources for financial advisor to create webpages to LinkedIn pages to Twitter feeds and how they all coordinate together."
However, before advisors jump into the full breadth of social media offerings, Jacques urges advisors to focus on two things.
"For FAs, what I would recommend is making sure that they have a website and a LinkedIn page at a bare minimum, and that those two are really professional and showcase not only their certifications and their networks, but also their interests and their personalities. Focus on the website and LinkedIn and get those right first, then move on to Social Media 2.0 and think about Twitter and Facebook."
Jacques encouraged advisors to be "cautious about excluding boomers or older generations because they are very active on social media." She said, "A lot of research we're seeing shows that baby boomers are involved in social media as much if not more than some of the Gen X and millennials when it comes to financial advisors and firms." That's good for advisors because "they don't need to necessarily tweet for one group or another. They can go out with a more holistic message and brand."
That's not an excuse for advisors to ignore the "know your customer" principle, though. "I would encourage advisors to understand what their ideal client profile is–if they do have a certain age group that they target or if they target small businesses, to bring that out in the social media presence, whether on their website or LinkedIn pages. That will naturally attract the people they want to be in front of."
Advisors should think of social media as a way to engage in a relationship online without letting it replace the in-person relationship they have with their clients, Jacques said. "They need to figure out if they want to use it as a one-way street, pushing out information, or a two-way street of dialogue." Those are the differences in how different age groups use social media, she said.
To learn more about how you can use social media to grow your business, we invite you to a free ThinkAdvisor webcast on Oct. 1 featuring social media experts Amy McIlwain, Clara Shih and Hardeep Walia.
Check out LinkedIn Payoff: Advisor Tells How He Landed $70M Account on ThinkAdvisor.


text:
Below is the third of eight new articles by Olivia Mellan and Sherry Christie that continue the discussion on Your Client's Brain that began with Investment Advisor's February 2013 cover story—Double Think: Getting Past the Conflict in Your Clients' Two Brains—and a feature article—Second Thoughts: Making Better Decisions—in the March 2013 issue of IA.
In those articles, Mellan and Sherry shared the latest findings on the brain and suggested how that knowledge can be used by advisors to better understand their clients, and to help their clients make better decisions.
David Rock, co-founder of the NeuroLeadership Institute and author of the marvelous book "Your Brain at Work: Strategies for Overcoming Distraction, Regaining Focus, and Working Smarter All Day Long," has researched, lectured and taught ways to improve thinking. He and Dr. Daniel Siegel, a psychotherapist, author and pioneer in this field, have created the Healthy Mind Platter, a takeoff on the USDA's recommended food pyramid, which I think every holistic financial planner should display front and center to promote healthy work-life balance.
Copyright 2011 David Rock and Daniel J. Siegel, M.D. (www.neuroleadership.org; www.drdansiegel.com). Used by permission.
Seven a Day: Essential Mental Activities to Optimize Brain Matter and Create Well-being
Activity 1: Focus Time
When we closely focus on tasks in a goal-oriented way, we take on challenges that make deep connections in the brain.
Activity 2: Play Time
When we allow ourselves to be spontaneous or creative, playfully enjoying novel experiences, we help make new connections in the brain.
Activity 3: Connecting Time
When we connect with other people, ideally in person, and when we take time to appreciate our connection to the natural world around us, we activate and reinforce the brain's relational circuitry.
Activity 4: Physical Time
When we move our bodies, aerobically if medically possible, we strengthen the brain in many ways.
Activity 5: Time In
When we quietly reflect internally, focusing on sensations, images, feelings and thoughts, we help to better integrate the brain.
Activity 6: Down Time
When we are non-focused, without any specific goal, and let our mind wander or simply relax, we help the brain recharge.
Activity 7: Sleep Time
When we give the brain the rest it needs, we consolidate learning and recover from the experiences of the day.
If you do life planning, you may want to discuss this platter with your clients. By helping them partake of all these components to create a better balanced life, you may promote more lasting health and happiness than by merely making sure they have as much money as possible. At the same time, you can help them see their wants and needs from a more holistic perspective.
We invite you to visit the Your Client's Brain landing page on AdvisorOne for additional archived and ongoing coverage of this important topic.


text:
What Is Hepatitis A?
Hepatitis A is a viral infection that affects the liver. The virus causes the liver damage. Liver function is reduced. Waste that is normally eliminated by the liver builds up in the blood. Jaundice , a yellowing of the skin and eyes, usually results.
Hepatitis A is passed from person to person through contact with infected stool. You can get the virus from an infected child by changing a diaper or by having sexual contact with an infected person. Contaminated food and water can also spread the virus.
The virus is very common in developing countries. It also occurs in the US.
Symptoms include:
- Fever
- Yellowing of the eyes and skin— jaundice
- Fatigue
- Abdominal pain or soreness
- Lack of appetite
- Nausea and vomiting
- Headache
- Chills
If you have been in contact with the virus and have not been vaccinated, a shot of the vaccine or immune globulin can prevent you from getting sick. It can also prevent you from spreading the virus. Either shot should be given as soon as possible.
If you do get sick, usually symptoms will resolve after rest, drinking plenty of fluids. You should also avoid medication that can damage the liver and alcohol.
At times, people with hepatitis A need to be hospitalized. Rarely, the infection can be fatal if the liver is severely damaged.
What Is the Hepatitis A Vaccine?
The vaccine contains an inactivated form of the hepatitis A virus. It is given as an injection in the arm.
A combined vaccine that protects against both hepatitis A and hepatitis B is also available.
Who Should Get Vaccinated and When?
The vaccine is recommended for all children aged 12-23 months. The 2 doses of the series are given 6-18 months apart. Children who have not been vaccinated can receive the shot at their next doctor's visit.
The following people should also get vaccinated:
- Children aged 24 months or older who are at high risk and have not been previously vaccinated.
- People traveling to areas where hepatitis A is prevalent. The CDC's Traveler's Health website shows which areas have high rates hepatitis A.
- Men who have sex with men.
- Injection drug users.
- People who are at risk because of their job.
- People with chronic liver disease.
- People treated with clotting factor concentrates.
- People who will have close contact with an adopted child from a medium- or high-risk area.
- People who want immunity to hepatitis A.
In general, people who are traveling should get the first dose at least one month before leaving the US. Getting the vaccine anytime before traveling may also result in some protection.
What Are the Risks Associated With the Hepatitis A Vaccine?
There is a very small risk of severe allergic reaction, with symptoms such as:
- Difficulty breathing
- Skin rash
- Rapid heartbeat
- Lightheadedness
- Wheezing
Moderate side effects include:
- Soreness at the site of injection
- Headache
- Loss of appetite
- Fatigue
Who Should Not Get Vaccinated?
The following people should not get vaccinated:
- Children under one year of age
- Anyone who has already had hepatitis A
- Anyone who has previously had a severe allergic reaction to the hepatitis A vaccine
- Anyone who has previously had a severe allergic reaction to any component of the hepatitis A vaccine, (including alum or 2-phenoxyethanol)
- Anyone who is very ill
What Other Ways Can Hepatitis A Be Prevented Besides Vaccination?
- Wash your hands with soap and water, especially after using the restroom or changing a diaper.
- IG given before and after exposure is another way of preventing and treating the virus.
- Twinrix is another vaccine that protects against both hepatitis A and B.
What Happens in the Event of an Outbreak?
If a food-borne outbreak occurs, the source of the contaminated food will be identified and eliminated. In any hepatitis A outbreak, the affected community will get vaccinated to prevent the virus from spreading.
Revision Information
- Reviewer: EBSCO Medical Review Board Daus Mahnke, MD
- Review Date: 03/2018 -
- Update Date: 05/08/2014 -


text:
Product Details:
Additional accessories available as options:
Pillows and duvet cover are for decorative purposes only and should be removed when a child under the age of 12 months is in the crib.
Would you like us to help you find a similar item? Talk with our Design Consultants toll-free at1-800-927-5164.
*Shipping transit time varies based on destination. Free shipping offers are limited to the 48 contiguous states of the USA.
International Customers (including Alaska and Hawaii) please contact a Customer Service Representative if you have any questions about placing an order with PoshTots.
This item is custom made especially for you upon order.Click here for our policy on custom made items.
Promotion codes cannot be used for sale item purchases.
*Free shipping offers are limited to the 48 contiguous states of the USA.


text:
Audeze LCD-2
Open Circumaural Headphones (2013-15)
Related Catalogues
If you have any problems opening files please read the download FAQ. All files are provided under strict licence and reproduction without prior permission or for financial gain is strictly prohibited.
If you have additional documentation please consider donating a copy to our free archive.


text:
AGP Pellet Stove
FoxFire™ Pellet Stove
Deerfield™ Pellet Stove
25 years of art & soul Meet some of the people who design and build our award-winning
fires. Meet the Makers.
The Lopi AGP pellet stove offers all the benefits of wood heating plus fuel that is clean, compact and easy to use.
616 Gas Insert showcases a fire that is 2nd to none, big heat output with 616 sq inches of viewing area.
Read Our Blog
© Copyright 2012. All Rights Reserved. Travis Industries


text:
Sub-Sector links:
"Welcome to my Traveller site; these maps and other graphics are only for playing Traveller/space type games. They are copyright and not to be used for other purposes."
Hi and welcome to my Traveller site ! Some GURPS Traveller, some classic Traveller. The planet maps are rather generic and can be used by any version of Traveller.
My other rpg sites below.
140 Planetary Surveys, 1656 UWPs, and 1656 planetary maps.
09/15/2018 02:30 PMJim Mars
My Traveller Universe, Vespucian Arm
« Vespucian Arm, Column B, Sector 05, Sub-Sector E map Planet: Zur-Zan-Hall: Vespucian Arm, Column G, Sector 06, Level 04, Sub-Sector P, 2839 »
While these items are made by me, feel free to download and use in your campaign.
Just mention the web site you got them from. Thanks.
I came up with Starship Wanderer in 1970.
The Traveller game in all forms is owned by Far Future Enterprises.
Copyright 1977 - 1998 Far Future Enterprises. Traveller is a registered trademark of Far Future Enterprises.
Far Future permits web sites and fanzines for this game, provided it contains this notice, that Far Future is notified,
and subject to a withdrawal of permission on 90 days notice. The contents of this site are for personal, non-commercial use
only. Any use of Far Future Enterprises''s copyrighted material or trademarks anywhere on this web site and its files should not be viewed
as a challenge to those copyrights or trademarks. In addition, any program/articles/file on this site cannot
be republished or distributed without the consent of the author who contributed it.


text:
- Fluid Retention
- Nutritional Supplement
The common dandelion, enemy of suburban lawns, is an unusually nutritious food. Its leaves contain substantial levels of vitamins A, C, D, and B complex as well as iron, magnesium, zinc, potassium, manganese, copper, choline, calcium, boron, and silicon.
Worldwide, the root of the dandelion has been used for the treatment of a variety of liver and gallbladder problems. Other historical uses of the root and leaves include the treatment of breast diseases, water retention, digestive problems, joint pain, fever, and skin diseases.
The most active constituents in dandelion appear to be eudesmanolide and germacranolide, substances unique to this herb. Other ingredients include taraxol, taraxerol, and taraxasterol, along with stigmasterol, beta-sitosterol, caffeic acid, and p-hydroxyphenylacetic acid. 1
What Is Dandelion Used for Today?
Dandelion leaves are widely recommended as a food supplement for pregnant women because of the many nutrients they contain. The scientific basis for any other potential use of dandelion is scanty.
Dandelion leaves have been found to produce a mild diuretic effect, 6 which has led to its proposed use for people who suffer from mild fluid retention , such as may occur in premenstrual syndrome (PMS). However, no double-blind, placebo-controlled studies have been reported on the effectiveness of dandelion for this purpose. (For information on double-blind studies, and why they are so important, see Why Does This Database Rely on Double-blind Studies? )
In the folk medicine of many countries, dandelion root is regarded as a "liver tonic," a substance believed to support the liver in an unspecified way. This led to its use for many illnesses traditionally believed to be caused by a "sluggish" or "congested" liver, including constipation, headaches, eye problems, gout, skin problems, fatigue, and boils. Building on this traditional thinking, some modern naturopathic physicians believe that dandelion can help detoxify or clean out the liver and gallbladder. 2 This concept has led to the additional suggestion that dandelion can reduce the side effects of medications processed by the liver, as well as relieve symptoms of diseases in which impaired liver function plays a role. However, while preliminary studies do suggest that dandelion root stimulates the flow of bile, 3,4,5 there is as yet no meaningful scientific evidence that this observed effect leads to any of the benefits described above.
Dandelion root is also used like other bitter herbs to improve appetite and treat minor digestive disorders. When dried and roasted, it is sometimes used as a coffee substitute. Finally, dandelion root is sometimes recommended for mild constipation .
A typical dosage of dandelion root is 2 to 8 g, 3 times daily of dried root; 250 mg, 3 to 4 times daily of a 5:1 extract; or 5 to 10 ml, 3 times daily of a 1:5 tincture in 45% alcohol. The leaves may be eaten in salad or cooked.
Safety Issues
Dandelion root and leaves are believed to be quite safe, with no side effects or likely risks other than rare allergic reactions. 7-10 Dandelion is on the FDA's GRAS (generally recognized as safe) list and approved for use as a food flavoring by the Council of Europe.
However, based on dandelion root's effect on bile secretion, Germany's Commission E has recommended that it not be used at all by individuals with obstruction of the bile ducts or other serious diseases of the gallbladder, and that it be used only under physician supervision by those with gallstones . 11
Some references state that dandelion root can cause hyperacidity and thereby increase ulcer pain, but this concern has been disputed. 12
Because the leaves contain so much potassium , they probably resupply any potassium lost due to dandelion's mild diuretic effect, although this has not been proven.
People with known allergies to related plants, such as chamomile and yarrow , should use dandelion with caution.
There are no known drug interactions with dandelion. However, based on what we know about dandelion root's effects, there might be some risk when combining it with pharmaceutical diuretics or drugs that reduce blood sugar levels. In addition, individuals taking the medication lithium should use herbal diuretics such as dandelion leaf only under the supervision of a physician, as being dehydrated can be dangerous when using this medication. 13
Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established.
Interactions You Should Know About
If you are taking:
- Diuretic drugs, lithium , insulin , or oral medications that reduce blood sugar levels : Use dandelion only under doctor's supervision.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


text:
Trial search results
Coronavirus (COVID-19)
We know that this is an especially worrying time for people with cancer and their family and friends. We have separate information about coronavirus and cancer. Please read that information alongside this page. We will update that information as guidance changes.
Find a trial
Filter results by...
Cancer type
Trial type
Trial phase
- Remove UK filter UK
- Remove Great Britain filter Great Britain
- Remove England filter England
- Remove Midlands filter Midlands
- Remove South East filter South East
- Remove South West filter South West
- Remove Yorkshire filter Yorkshire
- East of England (5) Apply East of England filter
- Greater London (5) Apply Greater London filter
- North East (4) Apply North East filter
- North West (5) Apply North West filter
- Remove Midlands filter Midlands
- Remove Wales filter Wales
- Scotland (5) Apply Scotland filter
- Remove England filter England
- Northern Ireland (4) Apply Northern Ireland filter
- Remove Great Britain filter Great Britain
Your search for "Breast cancer" found.
Your search found 5 trials
Showing 1 - 5 of 5


text:
Just a few bits I've picked up from Primark recently in video format! I went to my local "good" Primark in Telford while I was at home for Christmas and spotted a few bits and bobs I fancied. Funny enough most of the necklaces came to a measly £20! Compared to the ridiculous ammount of money I spend on jewellery from Urban Outfitters, Topshop and other places I was really impressed! While I don't think Primark jewellery is the best quality I find it's great for those few on trend pieces to get you from season to season. My favourite bits from this haul include the triangle necklace as it's going to look really nice layered over some plain dresses or jumpers for a statement necklace. I'm also super happy to find that Primark have finally started selling frilly ankle socks! They are super cute and half the price of the Topshop ones I normally buy! Also, I'm head over heels in love with my new studded clutch that I almost forgot to put in this haul! It's the perfect going out bag and goes with pretty much everything!
More details and stuff on the video page. Please like and subscribe to my channel if you enjoyed it (:


text:
If you need a reliable and budget window replacement company near 10044 New York City, New York, you found the right service. In the time it takes you to peruse this section, you can get access to free window replacement cost quote from pre-screened contractors. Simply by filling in your details on our form you will have an opportunity to select window contractor pros of your choice.
Supply necessary details about your project by filling the form.
Get precise updated and free window replacement estimate.
Choose the most suitable one after proper analysis of the quotes.
Your safety is our priority, as we are with you every step of the way. This is simply because every of the contractor you will be present with on our platform are already being pre-verified. Lastly, you are under no commitment to go for any of the services on our database as we only provide the information you need. You are free to take it or leave it.
Exposure to sunlight and weather inflicts significant damage on your windows, and as most windows are made of glass they are especially vulnerable to breakage. To avoid damages, windows are often replaced, and this usually saves cost which in return enhances the beauty of the home and saves maintenance options.
Anyways, It is expedient for you to have a full grasp of what you are doing and that's where we step in. Even though window is an inanimate object, hence it can't talk about its needs, but nevertheless, it gives you signs when something needs urgent fixing in the house, your window is most communicative. Of course, no window lasts forever, but a quality one, well maintained can last for long especially if they are installed by professional. Want to know when your windows need replacing? Here are vital signs to look out for:
A broken glass is the most common reason why people tend to fix or replace their windows. If it's a little damage, then it can be easily fixed, for example, getting new hardware or weather strips. in place of changing it However, getting a new window or frame is most preferred than trying to get it fixed.
Windows are one of the first noticeable features of a home, if they look out-of-date, so would your house Whether you're upgrading your home's appearance, or focusing on just your windows, this is the best time to replace your windows.
According to a survey by Energy.gov, it was gathered that a not too fixed window can put a raise on your energy bill to about 10% to 25% above the usual rate Why not consider getting another and very much enhanced window with energy proficient ones and reduce your overall heating and cooling bills.
Having decided to get your windows replaced, the unavoidable issue is 'what kind of window would be ideal for you?' There are several types of windows available today which depends on their usage and we have taken the time to list the popular ones for 10044 area below:
This provides the best illumination of light in the room as the sun revolves around the globe every day. These windows are known to have been in use in the castle during the English Renaissance period.
These are constructed in such a way that it is easy to climb out of in case of an emergency. they are usually large enough to allow a human to escape and they are easy to open and close.
These windows are not meant to be opened or closed because they are solid. They are usually fixed on outside of a building over standard windows.
This is a casement type of window which is usually mounted in vertical orientation with the hinge at the top for easy movement of the window. Especially useful for allowing air to flow without admitting seasonal debris or rainfall.
These windows are used is to offer privacy in some way and are mostly used in the office, bathrooms or simply as demarcations rooms for this purpose
They have two bands, assembled glass, and edge units, which goes up and down. These windows are easy to lift and to close and the tracks do not fill with dirt.
This is an American window style made of thin, arranged glasses that open and close together like a Venetian blind.
They are essentially a box made of windows that jut out of the side of your home. that provides a shelf space to a smaller room if needed in a home by the spaces available.
These are a popular sash kind of window that has one above the other and can be opened and closed by sliding them up and down in the frame. They are simple to handle and are famous around homes both far and near.
This allows in free flow of air in the rooms and offering a design focal point for a structure's exterior.
They help create more space and create a unique look while adding architectural interest to your home and giving a special effect on the overall outlook.
As the name implies, these are the best kind of windows if you desire enough light in your home They are very efficient in ventilating your home since they support cross ventilation.
These windows have been in existence for a long time since the 19th century precisely and till now, they are still very much around. These are known for offering excellent energy efficiency. Looking for a window choice to mount over a counter or sink? This is your most preferred choice.
This is made up of two glass panes separated by a vacuum or gas filled space to minimize the heat transfer that goes across any part of the building.
these are a step up from the double pane insulation. instead of 2 glass windows, they come in 3 glass window pane separated by a vacuum or gas filled space to reduce heat exchange in the home
This type of insulation is made up of multiple panes of very good performance, energy, and efficient glass making the preferable when compared to the normal single pane frames.
A window without a frame is nearly impossible, so choosing the right type of frame is very essential and we have just the best options lined up for you.
These are often made up of PVC & UV stabilizers. They require little or no painting as they have good moisture resistance.
This type is light and very strong. Hence it is durable which are also good heat conductors making it a very poor insulating material.
These types absorb heat perfectly, but they expand and contract in response to weather conditions which makes them require a frequent maintenance.
These frames are designed to be dimensionally stable with enough air cavities that can be insulation filled. When compared to wood or uninsulated vinyl, they have better thermal performance.


text:
Principal Proposed Uses
- Dysmenorrhea (Menstrual Pain)
- Osteoporosis (in Combination With Other Minerals)
Other Proposed Uses
Our bodies contain only a very small amount of manganese, but this metal is important as a constituent of many key enzymes. The chemical structure of these enzymes is interesting: large protein molecules cluster around a tiny atom of metal.
Manganese plays a particularly important role as part of the natural antioxidant enzyme superoxide dismutase (SOD), which helps fight damaging free radicals. It also helps energy metabolism, thyroid function, blood sugar control, and normal skeletal growth.
The official US recommendations for daily intake of manganese are as follows:
- 0-6 months: 0.003 mg
- 7-12 months: 0.6 mg
- 1-3 years: 1.2 mg
- 4-8 years: 1.5 mg
- 9-13 years: 1.9 mg
- 14-18 years: 2.2 mg
- 19 years and older: 2.3 mg
- 9-18 years: 1.6 mg
- 19 years and older: 1.8 mg
- Pregnant women: 2 mg
- Nursing women: 2.6 mg
The absorption of manganese may be impaired by simultaneous intake of antacids or calcium or iron supplements. 13-15
The best sources of dietary manganese are whole grains, legumes, avocados, grape juice, chocolate, seaweed, egg yolks, nuts, seeds, boysenberries, blueberries, pineapples, spinach, collard greens, peas, and green vegetables.
Therapeutic Dosages
A typical dosage used in studies on manganese is 3 to 6 mg daily. It is sometimes recommended at a much higher dose of 50 to 200 mg daily for 2 weeks following a muscle sprain or strain, but this dosage exceeds recommended safe intake levels (see Safety Issues).
Therapeutic Uses
Because manganese plays a role in bone metabolism, it has been suggested as a treatment for osteoporosis , a condition in which bone mass deteriorates with age. However, we have no direct evidence that manganese is helpful, except perhaps in combination with other minerals. 4
One small but rigorous study suggests that making sure to get enough manganese may help control symptoms of dysmenorrhea (menstrual pain) . 5
Manganese has also been suggested for the treatment of muscle strains and sprains , rheumatoid arthritis , and tardive dyskinesia , 6 but there is no reliable evidence as yet to indicate that it actually helps.
People with epilepsy7 or diabetes8,9 have lower-than-normal levels of manganese in their blood. This suggests (but definitely doesn't prove) that manganese supplements might be useful for these conditions. Unfortunately, the studies that could prove or disprove this idea haven't been performed.
What Is the Scientific Evidence for Manganese?
Although manganese is known to play a role in bone metabolism, there is no direct evidence that manganese supplements can help prevent osteoporosis . However, one double-blind placebo-controlled study suggests that a combination of minerals including manganese may be helpful. 10 Fifty-nine women took either placebo, calcium (1,000 mg daily), or calcium plus a daily mineral supplement consisting of 5 mg of manganese, 15 mg of zinc, and 2.5 mg of copper. After 2 years, the group receiving calcium plus minerals showed better bone density than the group receiving calcium alone. But this study doesn't tell us whether it was the manganese or the other minerals that made the difference.
Dysmenorrhea (Menstrual Pain)
One very small, but well-designed and carefully conducted double-blind study suggested that 5.6 mg of manganese daily might ease menstrual discomfort . 11 In the same study, a lower dosage of 1 mg daily wasn't effective.
Safety Issues
Manganese is thought to be safe when taken by adults at a dose of 11 mg daily or less. The maximum safe dosage of manganese for pregnant or nursing women has also been established as 11 mg daily, or 9 mg if 18 years old or younger. 12
Very high exposure to manganese (due either to environmental pollution or manganese mining) has resulted in a serious psychiatric disorder known as "manganese madness."
Interactions You Should Know About
If you are taking:
- Iron, copper, zinc, magnesium, or calcium: You may need extra manganese, and vice versa.
- Antacids: You may also need extra manganese.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


text: Along with our large quantity of in-stock online retail products, we offer the best price for our quality, brand-name products, with a price match guarantee. baby storage bins and hampers even start as low as $412.33. Your overall shopping experience is our #1 priority. Our vision is to engender and satisfy the loyal customer who know exactly what they want, when they want it and how they like it, right here on Unbeatablesale.com. Unbeatablesale.com offers around the clock online ordering and values your privacy; we will not sell or provide your information to any third parties. Shop secure and hassle-free today!


text:
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). People with OCD feel they cannot control these obsessions and compulsions. Repetitive behaviors, such as hand washing, counting, hoarding, touching objects, seeking preassurance, making lists, checking, or cleaning, are often performed in the hopes of reducing anxiety or anxiety-provoking obsessions. However, performing these so-called rituals provides only temporary relief. Left untreated, the obsessions and compulsions can take over a person's life. OCD is often a chronic, relapsing illness.
The cause of OCD is not known. It is believed to develop from genetic, biologic, environmental, and psychological factors.
OCD may be associated with other disorders, including:
- Tourette syndrome —characterized by multiple motor and vocal tics
- Trichotillomania—the repeated urge to pull out scalp hair, eyelashes, eyebrows, or other body hair
- Body dysmorphic disorder—imaginary or exaggerated defects in appearance
- Eating disorders—such as bulimia nervosa or anorexia nervosa
- Hypochondriasis —morbid concern for one's own health, including delusions that one is suffering from a disease or diseases for which no physical basis is evident
- Substance abuse
Additional disorders that may accompany OCD include depression , attention-deficit hyperactivity disorder (ADHD), and other anxiety disorders.
According to the Obsessive Compulsive Foundation, one in 50 Americans has OCD during the course of a given year. The first symptoms of OCD often begin during childhood, adolescence, or early adulthood.What are the risk factors for OCD?What are the symptoms of OCD?How is OCD diagnosed?What are the treatments for OCD?Are there screening tests for OCD?How can I reduce my risk of OCD?What questions should I ask my doctor about OCD?What is it like to live with OCD?Where can I get more information about OCD?
Revision Information
- Reviewer: Adrian Preda, MD
- Review Date: 12/2016 -
- Update Date: 05/20/2015 -


text:
See also Norfolk Parish Links: Civil Registration
There may be more people living in detached parts of the parish (if there were any) and, if so, the number may or may not be included in the figures above. It is quite difficult to be sure from the population tables.
Copyright © Pat Newby.
October 2008


text:
Puzzle Levels
Puzzle Categories
Download a FREE Solution for your puzzles!
Watch video review! Write your own review! Request the FREE solution for this item!
Cast Coaster
Product Information
|Disassemble and Reassemble the Puzzle
|Level 8 - Demanding
|Serhiy Grabarchuk, Hanayama Metal Puzzles
|2 1/2 in x 2 1/2 in x 1/8 in / 6.4 cm x 6.4 cm x 0.5 cm
Product Description
Note: Our level rating system is different than Hanayama's. Hanayama's level 1 is equivalent to our level 5.... level 6 is equivalent to our level 10.
Serhiy Grabarchuk is a famous Ukrainian puzzle designer who lives in Uzhgorod. The puzzle depicted on the piece of drawing that he sent me looked like a strange adornment weaved into a "coiffure"design.
If you put a glass carefully onto the completing puzzle, it becomes, indeed, a coaster. Using this when serving drinks to guests will no doubt create stimulating conversation. Theme: "Coiffure".
-Hanayama Co., Ltd.-2006
Customer Reviews |Write your own review!
Disclaimer: These reviews are written by our customers. Puzzle Master makes every attempt to keep these posts informative and relevant. If you find a post objectionable or inappropriate, please let us know by sending an email to email@example.com
This puzzle is fun to play with. I find it difficult than Cast Ring and Ring II, which follow the same idea I guess. I like how it looks when solved - like a real expensive coaster. It requires some logic and dexterity to solve.
I received this as a birthday present years ago. At the time I was far too young, and very confused. But today I picked it up and started tinkering with it as I read this webpage, and I solved it! Brilliant puzzle - very beautiful. I recommend it!
I really like this one. I only have about 4 or 5 of these puzzles, but the coaster is my favorite. It took me almost a year to solve (of course, I never worked on it for very long at a time, got too frustrated), but now I can get it either in 10 seconds or with my eyes closed. It's so beautiful when completed, and frustrating if you don't know the trick when apart.
This is the first Hanayama I ever tried and now i own about 20 of them, so yes I like the coaster. The solve is challenging enough and it's aesthetic in the solved state.
This one is beautiful in its look and has an intriguing effect.Easy to get apart but, difficult to put back together. Highly recommended!!
Disassembly is easy, in fact mine tends to fall apart a little too easily. Assembly is another matter and quite tricky. Nicely made.
This puzzle was a joy. It was small and flat, so I could carry it in my pocket or purse and pull it out any time I was waiting anywhere. I would also rate it an 8 in difficulty; it certainly took some tinkering. Highly recommended!


text:
National service helps consumers find high-quality pros, such as doctors & mechanics, with live support & certified data-collection process
Customer Reviews
What You'll Get
National service helps members find high-quality pros such as doctors and mechanics, with live support and certified data-collection process
$14 for One-Year Bundle Membership ($29 Value)
Membership grants access to more than 500 home and personal services in categories such as home, health and wellness, auto service, and pets.
The Fine Print
Promotional value expires Mar 27, 2013. Amount paid never expires. Limit 1 per person. Must activate by the expiration date on your Groupon, subscription expires 1 year from activation date. Online only. Must provide credit card number, membership will auto-renew if not opted out of. New Members only. Not valid for adding cities to already existing accounts. Valid only for the Louisville area. Merchant is solely responsible to purchasers for the care and quality of the advertised goods and services.
About Angie's List
Angie's List helps consumers find high-quality contractors, doctors, mechanics, veterinarians, and other professionals by collecting reviews from the people who have hired them in the past. More than two million members nationwide grade experiences on a scale from A to F, with optional marker-drawn smiley faces awarded for especially outstanding achievements. By forbidding anonymous reviews, allowing companies to respond to customers' posts, and screening each submission for red flags, the location-specific site ensures its members a transparent and balanced information resource.
Perks such as a mobile app, complaint resolution, and live call-center support (available six days a week) keep service providers safeguarded and consumers in the know. Additionally, the included weekly Angie's List digital magazine provides helpful tips to readers, with articles covering topics such as in-home etiquette for visiting contractors and the key differences between doctors and mad scientists.


text:
The thyroid gland is a butterfly-shaped gland in the front of the neck. Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormones. A healthy thyroid produces the hormones thyroxine (T4) and triiodothyronine (T3), which control metabolism. This affects how many calories you burn, how warm you feel, how much you weigh, and how the body handles functions of the cardiovascular, gastrointestinal, and nervous systems. Hypothyroidism results in a slower metabolism and a slower heartbeat.
Hashimoto thyroiditis occurs when the immune system produces antibodies that attack cells of the thyroid gland. This results in thyroid swelling. Other less common causes include hypothyroidism as a result of radiation therapy to the neck for lymphoma, treatment of hyperthyroidism with medication or surgery, and treatment of thyroid cancer with medication, radiation therapy, or surgery.
Other causes of hypothyroidism include:
- Subacute thyroiditis —Inflammation of the thyroid gland after a viral upper respiratory tract infection.
- Drugs —Drugs used to treat hyperthyroidism, lithium (used to treat certain psychiatric disorders), certain cardiac medications (such as amiodarone), and other medications (such as interleukins and alpha interferon).
- Medical treatments —Treatments that include medications, radiation therapy, or surgical removal of part of the thyroid gland (called subtotal thyroidectomy) to treat other thyroid diseases.
- Idiopathic thyroid atrophy —The thyroid tissue shrivels up for unknown reasons.
- Iodine deficiency —The thyroid gland does not get enough iodine to produce thyroid hormone (this is rare in the United States).
- Iodine excess —Certain foods (such as shellfish) and certain medications (such as cough medication) containing large amounts of iodine, which can block thyroid hormone production (rare).
- Infiltrative illnesses —Cancers and certain infections.
- Pituitary adenoma —A benign tumor of the pituitary gland that can cause a problem signaling the thyroid to make thyroid hormones.
- Postpartum thyroiditis —This condition usually improves but may be long lasting.
- Congenital hypothyroidism —An infant that is born with problems making normal amounts of thyroid hormones.
About 5% of Americans have hypothyroidism. This condition usually occurs in adults. However in some cases, children or infants may have hypothyroidism (called cretinism). Children need treatment as quickly as possible or intellectual disability may result.What are the risk factors of hypothyroidism?What are the symptoms of hypothyroidism?How is hypothyroidism diagnosed?What are the treatments for hypothyroidism?Are there screening tests for hypothyroidism?How can I reduce my risk of hypothyroidism?What questions should I ask my doctor?Where can I get more information about hypothyroidism?
Revision Information
- Reviewer: James P. Cornell, MD
- Review Date: 02/2017 -
- Update Date: 02/17/2017 -


text:
I recently saw a patient who was sent to the ER for treatment of an acute DVT. I was surprised that he was not already on warfarin because he had a history of multiple previous DVTs and even two pulmonary emboli, with no clear explanation as to why he had recurrent clots. He explained that his primary care doctor was opposed to warfarin and had put him on a "natural blood thinner," which was also good for his cholesterol. I looked this med up (I can't remember the name) and found some references which stated that this substance was essentially worthless for either of these indications. He was being treated by a local naturopath, he added, who had told him that the warfarin was damaging his kidneys and his liver. He seemed a bit skeptical of this, since he had been maintained on warfarin for many years without any side effects. I explained to him that he was going to need to go back on the coumadin (and low molecular weight heparin) for at least the next six months, and probably, given his history, for the rest of his life. He seemed quite content with this plan.
His wife expressed some concern about the quality of care her husband was getting from his doctor. He was rather medically complex, with blood pressure, heart and vascular disease, diabetes, and other chronic medical conditions, and I was frankly surprised that a naturopath would care for such a complex patient. They both wondered whether he would be better off going to an internal medicine doctor, and his wife openly asked if I trusted naturopaths. She hoped that I could set him up with an internist to manage the initiation of coumadin; the patient himself seemed amenable to this, and looked to me for a recommendation.
Tough one. I hate to steer someone away from their doctor; it feels unprofessional or discourteous. But it was the patient and his wife who had opened the door...
So what do you think I should have done in this situation? I have the standard MD bias that naturopaths are credulous purveyors of woo, which in this case was supported by the fact that his hypercoagulable state was being treated with a placebo. In addition, this gentleman was quite genuinely complex from a medical management point of view, and I felt he would probably menefit from an internist's expertise. On the other hand, I am completely ignorant about the training and scope of practice of NDs, and a review of the records showed that a reasonably competent work-up had been done for hypercoaguability (Factor V, Homocysteine, anticardiolipin, though not a complete work-up), and that he had been seen by appropriate medical specialists when needed. Calls to the ND's answering service were not returned.
So how would you handle this? Would you send him back to the ND? Would you set him up with an appointment at the local internal medicine clinic? Is there a compromise position here?
Cast your vote in the comments, and show your work.
10 December 2008
How would you handle this?
I recently saw a patient who was sent to the ER for treatment of an acute DVT. I was surprised that he was not already on warfarin because he had a history of multiple previous DVTs and even two pulmonary emboli, with no clear explanation as to why he had recurrent clots. He explained that his primary care doctor was opposed to warfarin and had put him on a "natural blood thinner," which was also good for his cholesterol. I looked this med up (I can't remember the name) and found some references which stated that this substance was essentially worthless for either of these indications. He was being treated by a local naturopath, he added, who had told him that the warfarin was damaging his kidneys and his liver. He seemed a bit skeptical of this, since he had been maintained on warfarin for many years without any side effects. I explained to him that he was going to need to go back on the coumadin (and low molecular weight heparin) for at least the next six months, and probably, given his history, for the rest of his life. He seemed quite content with this plan.
Posted by shadowfax at 3:45 PM
41 comments:
They call it "complimentary health care modalities" for a reason. I'm sure the naturopath has many useful and helpful suggestions about how to stay healthy, but without consulting an allopathic doctor as well, he's putting himself in serious danger, as evidenced by his recurrent DVTs. Lucky he didn't die, eh?ReplyDelete
Unfortunately, people are often put into the position of having to think critically about their own health and the care they're receiving, a task most people simply aren't cut out for (that's why they have a health care delivery system, right?).
I'd say a good compromise is to use the services as they're intended: a compliment to regular medical care, not a replacement. The fact that your patient was being treated for a problem that someone else told him would go away but didn't - was probably the wake-up call he needed to fold in more allopathic medical care in with his usual regimen.
I don't think you are in danger of being either discourteous (you were asked) or unprofessional. It is your job to get this man the best possible definitive care you can.ReplyDelete
My opinion, plug him into a good internist. I suppose the "compromise" could come by way of the internist agreeing to allow the patient to continue the placebo if the patient had strong feelings about it. But it seems at least in this case that this man could really benefit from some good old fashioned, allopathic, evidence-based, woo.
One way might be to present it to the patient as you did in your post.ReplyDelete
Neglecting to point out the risk of the clotting condition, for which he is receiving untreatment, is being more respectful to the naturopath, than to the patient, in my opinion.
One of the mistakes the naturopath appears to have made is that he looked at the side effects of warfarin without taking the history of the patient into consideration. That the patient has been taking coumadin (without apparent problems) suggests that his body is not predisposed to the side effects. Side effects might develop later on, but many side effects are evident early.
Naturopaths do not even have any sort of license/monitoring in most states in the US (they do in your state). The training is not really associated in any way with traditional medical training.ReplyDelete
They're throwbacks to the days before antibiotics, diagnostic testing, and evidence-based practice.
I actually had a friend who went to a naturopath (that someone he knew recommended) for his depression and he ended up turning into a reclusive drunk who lost his rather prestigious management job because the naturopath had him convinced that there was a "worm" in his head causing his symptoms and prescribed him some mumbo-jumbo to deal with that. No anti-depressants nor counseling was ever recommended and there essentially had to be a family/friend intervention to get him to see a "real" doctor where he was appropriately treated.
A patient has a right to do what he wants, but you have a DUTY to direct him to the care that is going to get him well/prevent illness or death. Since naturopaths aren't trained medically, they may not even know that he needs the life-saving therapy that you recommended. I don't consider a naturopath a part of any sort of credible medical team.
Ha! Leave it to Gruntdoc to cleave the Gordian Knot.ReplyDelete
I was always more of a Gaugamela guy, myself. :-)ReplyDelete
I'd simply tell the patient and his wife that when it comes to medicine, you respect everyone equally, but you follow the evidence.ReplyDelete
Really? If a patient asks you for a referral to an internist you consider this a huge moral dilemma and don't, out of courtesy toward the person (neighbour, health food store clerk, naturopath or doctor) who is currently counselling the patient but who the PATIENT DOES NOT TRUST AND WANTS TO SWITCH FROM???ReplyDelete
Really? So if I told you I would rather see a "real" doctor you would consider honoring my request for a referral to be UNETHICAL TOWARDS THE WOO PRACTITIONER?
Shadowfax, you are one of the nicest medbloggers out there. But you have just announced that you consider protecting the practice of someone who IS NOT TRUSTED BY THEIR PATIENT to be more important than the health of the patient, when the patient is asking you for help.
As a patient myself, I find this terrifying.
What happened to "always ask for a second opinion," "second opinions are a win-win, either they agree with the first doctor and confirm their judgement, or the first doctor gets a chance to learn something"? All of a sudden when someone is asking for a second opinion — they apparently don't even trust their naturopath for an appropriate referral — honoring the patient's request becomes unethical?
Anyway. Terrifying.
In the future, when seeing a new doctor, I will deny every having seen a doctor in the past. I want any doctor I see to have my best interests at heart; I don't want them worrying about hurting another doctor's feelings.
There can be excellent reasons for a patient to flee a particular doctor, even an MD, never mind a woo practitioner. The MD may be too old, or impaired, or just very very weird or prejudiced. If all other doctors are honor-bound to return the patient to the doctor they are trying to escape from...
Anyway. Terrifying.
- Anonymous12/10/2008 7:09 PM
I would feel no professional loyalty or duty toward this naturopath. He's obviously trying to kill this guy. Totally agree with Alison Cummins. Even if the pt liked the naturopath, I would encourage him to follow up with internal medicine, and I would explain to him in plain and scary terms what he risks by not being treated appropriately. The pt is there for my medical opinion, and it's my job to give it to him.ReplyDelete
--Midwest ER Doc.
- Anonymous12/10/2008 7:54 PM
This guy needs a REAL doctor! Don't worry about hurting some guy's feelings who is either, best case, incompetent or, worst case, trying to kill this guy. He needs an internist and DON'T feel bad about refering him to one.ReplyDelete
I think that the principle of "first, do no harm" applies here. By sending him back to someone who will not treat his DVT/hypercoag. with the gold standard and accepted treatment is setting him up for harm.ReplyDelete
Multiple PEs and not being appropriately managed for the next one which may just kill him, and put on essentially a placebo as treatment? Get the patient as far away as possible from the ND. You have to know your limits as a physician--MD, DO, or even ND--and clearly this one doesn't.ReplyDelete
- Anonymous12/10/2008 8:31 PM
They practically asked you to refer them to a traditional medical internist because they had their own doubts about the naturopath.ReplyDelete
Is your duty to the other doctor, or to the patient, whose best interests (in your opinion, if I read that correctly) weren't being served by the current treatment modality.
I vote refer. What did you do?
This one's easy. The naturopath isn't a doctor. This guy needs one. Refer. Quickly. Do not pass go; do not collect $200.ReplyDelete
I think a conversation like this might be directed along risk analysis lines. You could talk about there being risks in any treatment, and any "health care provider" has a clear duty to help the patient manage, balance, and choose between those risks. The NP clearly doesn't grasp this, and seems to think that any possible side effects from "evil western medicines" are completely unacceptable. You might point out that while warfarin has side effects that must be monitored, the side effect of being acutely dead from his placebo treatment might be slightly more distressing.ReplyDelete
So what do you think I should have done in this situation?ReplyDelete
I would have politely explained that my 5 year-old was available for
consultation at a much lower rate than his Naturopath, and since the
quality of care would be the same, that would benefit everyone. Of
course that would be a lie, because your son might actually generically
recommend "medicine" which would be an improvement over Naturopathy.
Also, your son's general confusion over what "natural" means probably
more closely resembles the actual distinction between "natural" and
(what?), "unnatural", so there'd be better information flowing between
"doctor" and "patient". Oh, and don't discount the additional benefit
that the "patient" would actually *know* he was a victim of
malpractice, so there's a benefit there as well.
All in all, I guess I'm saying he should hang out a shingle and
start pulling his own weight around your place.
One of the mistakes the naturopath appears to have made is that he looked at the side effects of warfarin without taking the history of the patient into consideration.ReplyDelete
I think the main mistake the naturopath has made is that he is practicing medicine with no actual qualifications to do it.
- Anonymous12/11/2008 8:32 AM
ShadowFax, as I've posted before I'm not a health care professional, so this is only how I imagine I'd handle the situation.ReplyDelete
I appreciate your reluctance due to ethical concerns. For example, who knows how accurate the patient's report to you is? Who knows what the patient even told his ND? Who knows whether that ND even knows the patient is going around saying the ND is the primary care provider.
The ND loses credibility, though, and big time in my book, by not returning your phone call. What's the usual turnaround on a call back to another doc? You had to call the answering service a 2nd time, so that sounds like a delay. So I say you're in the clear for referring the patient elsewhere.
The patient wants some kind of complementary care and allopathic care too. And the patient needs his providers to talk to each other.
Why not refer the patient to an internal medicine doc who works closely with CAM providers? In the Pacific NW there are clinics of integrated medicine like this around. I don't know what state you live in, but if you're in Seattle, why not figure out which MDs are associated with a program like this --
http://www.fammed.washington.edu/predoctoral/cam/ --
and tell the patient these MDs have experience working with NDs too.
IMHO you're following the spirit & the letter of your work in connecting these dots.
- Anonymous12/11/2008 10:14 AM
do naturopath's have liability in your state? i wonder what standard of care is considered? same as for physicians or whether they have their own standards? do they need evidence based therapies?ReplyDelete
- Anonymous12/11/2008 1:02 PM
I was wondering if you were refering to a Osteopathic medicine doctor (D.O.) as opposed to a Naturopathic one.ReplyDelete
I can imagine having a similar thought pattern there.
Doesn't matter is this provider was a md, do, no, pa, rn, etc...
The patient wanted a new doc, they came to the ER with something serious.
I agree he is a good canidate for and internal medicine doc (as opposed to a family prac)
Just do it
- Anonymous12/11/2008 2:14 PM
Doc, I understand that it was the wife that wanted to know about the ND vs. an IMED doc, and not the patient. That does put you in a grey area.ReplyDelete
I would present what an internist could do for the patient and what you recommend as the therapy. Present it as a second opinion and let the patient make the decision.
It is my opinion that internists specialize in the management of multiple complex medical problems. Doesn't sound like his current doctor would be willing to manage appropriate f/u (INR,etc) as he doesn't believe in that particular treatment. So a referral to IM would definitely be in the patient's best interest if he wanted to persue full-dose anticoagulation. I don't think you'd be doing anything other than following through on a complete plan of care. Of course, I may be a little biased as I'm an internist:)ReplyDelete
- Anonymous12/11/2008 8:10 PM
This is pansy-assed liberalism at its worst. Why are you even wringing your hands over this? Naturopathy is quackery and the dude should be seeing a medical doctor. Believing anything differently and you are delegitimizing your own degree.ReplyDelete
- Anonymous12/12/2008 5:19 AM
Not a doc, but maybe you could say that the naturopath treatment just wasn't strong enough anymore, and now he needs to have an internist take over. I think many people can buy into a disease getting worse and having to do more to treat it.ReplyDelete
- Anonymous12/12/2008 10:26 AM
This is a big load of PC bullsh1t. A "naturopath" is NOT a real doctor. You have an ethical duty to inform him that he is seeing a quack and that he is being mismanaged. Refer him to a *real* doctor immediately.ReplyDelete
- Anonymous12/12/2008 12:27 PM
MD = Me DoctorReplyDelete
ND = Not a Doctor
Would you send your mother with a C3 fracture to a chiropractor?
It has been said enough, but as another medical provider I have to echo the many comments here. I would feel zero professional responsibility towards a generic naturopath, and towards this particular individual especially. I would use very polite language with the family, of course, but I would also make it clear that naturopaths do not necessarily follow science based medicine.ReplyDelete
- Anonymous12/12/2008 4:30 PM
I must preface this by saying I generally agree with your stances and love your blog. However, holy smoke, Shadowfax, there is such a thing as being so open-minded that your brains fall out. Send this guy to a real doc immediately, please, so he doesn't sue you for keeping him on placebo for real problems, if nothing else.ReplyDelete
In Canada, the vast majority of traditionally-trained MDs have no respect for CAM and no compunction about saying so. Our MD programmes often include modules on various theories underlying the different modalities, and the evidence regarding them. My teacher for said module was Joe Schwarcz, chemist and woo-buster extraordinaire (http://www.canada.com/montrealgazette/columnists/joe_schwarcz.html).
And for the record, on almost everything else I am a textbook candy-ass liberal.
- Anonymous12/12/2008 8:04 PM
Send him to a real physician, and Internist. JeveReplyDelete
i respectfully disagree - not with the comments per se, but with the tone of the discussion here.ReplyDelete
i think that the ND did the best s/he could with the tools and experience s/he had under the circumstances, and that once the pt was under your care it was right for you to do the best you can with your tools and experience.
however, i feel that - while we cannot ignore our own biases - we can't let them rule our actions. referring may be the right thing, but the way that it has been suggested here (saying that the ND was "obviously trying to kill" the pt or that considering the repercussions of your actions is "pansy-assed liberalism") speaks volumes of the rift within healthcare in the US (just as your concern for being unprofessional and discourteous speaks volumes about your professionalism and the caliber of your pt interactions).
like it or not, pts are going to see multiple types of healthcare providers and while you are justified in feeling that you are superior, pettiness and snkariness will do nothing to serve the pt at any point. i'm not suggesting that anyone be "so open-minded that [their] brains fall out", i'm merely suggesting that as a doctor your pt deserves factual, unbiased information about their options and that you're right to consider all providers with some respect...even when you disagree with them.
Naturopaths are for healthy people. He's not trained to manage a medically complex patient, and will probably kill him if this continues. No loyalty to someone who won't call it when he's in over his head.ReplyDelete
- Anonymous12/14/2008 8:54 AM
Shadowfax, thanks for your professionalism.ReplyDelete
I agree with the poster who pointed out NDs do wellness and preventive medicine. I agree that professionals, including MDs, must say so when they face a patient who needs something else, or something more.
But for the record, I'm with Sarah in disagreeing respectfully with the tone of many responses in this thread.
If we open up the notion that licensed practitioners such as NDs are "not real doctors," then we have to ask, how'd they get licensed?
Let's say we think the NDs got licensed through political influence. I tried that idea on, but it presents a problem. As soon as we allow for political influence in health care. . .
(1) we also have to acknowledge the political influence of the AMA.
(2) We have to look at the political influence of drug companies creating trials with such low enrollments that they have insufficient power to find differences in adverse effects between control and drug conditions. Then the companies say they found no significant differences in adverse effects. And this is what some of us are calling evidence-based medicine. Not evidence-based enough, unfortunately.
(3) We have to look at the inadequate funding for evidence based medicine on herbals etc. NCCAM of NIH is not funded at an institute level. Can we agree that if we don't ask the questions, we won't get the answers? Can we agree to support asking the questions?
(4) Then I start thinking about the drugs patients get from some MDs, because the MDs accept free samples from the drug reps. When MDs participate in medical marketing, are they still "real doctors."
(5) I'm trying to remember the naturopathic equivalent of the DES disaster or thalidomide babies. MDs, so-called real doctors, prescribed these drugs and they harmed a lot of people. Not evidence-based enough, unfortunately.
I respect my own MD(s) enormously. But I don't see a basis to call MDs real docs and NDs not. My own request of MDs who are so dismissive of others' training is: let's all take 3 deep breaths and respect our own professional training while considering the possibility that other professions may also have perspectives to offer. I think this ought to be covered under "do no harm."
Thanks for reading.
From my reading of your post, it sounds like this patient has an unidentified coagulopathy. I'd be tempted to refer him to a hematologist as well as an internist. You did mention that he had been referred to specialists as appropriate; I can't imagine that a competent specialist hadn't recommended coumadin. If the ND isn't listening to his consultants, he's dangerous. Either way, not sending this guy to follow up with a board-certified IM guy (at the very least) strikes me as less than standard of care.ReplyDelete
Which leads us to the "respect" issue. The comments have some backlash about taking naturopaths (and other CM types) seriously, and respecting them appropriately. Yes, they're trained. Yes, they're licensed. Yes, they are permitted to call themselves "doctor". But a doctor is only someone who has studied extensively, not necessarily an expert in the healthcare field. PhDs are doctors too, but I wouldn't want a biochemist treating my diabetes, no matter what he knew about the tertiary structure of insulin. Patient care should be guided by physicians, by which I mean MDs or DOs.
The licensing process for physicians is not perfect, and the evidence-based process is flawed, but this shouldn't lead us to throw out the entire stew and try to practice medicine based on the doctrine of signatures and other folk hokum. What it should do is encourage us to be thorough in our reading of the literature, vigilant in our practice, and aware of our limitations (which the ND in this example apparently isn't).
- Anonymous12/14/2008 3:31 PM
What is the ethical concern in referring your patient to a competent doctor as opposed to sending him back to the quack he was seeing?ReplyDelete
Why is this any moral or ethical dilemma at all. I am really at a loss here.
You say you don't know much about naturopathy. Why not? Your lack of curiosity once again amazes me. Perhaps instead of blogging about how much you don't know you should spend your time reading and studying.
- Anonymous12/16/2008 3:39 PM
Having read many comments, here's what I think about MDs & naturopathy. On this topic I see 3 subgroups of MDs:ReplyDelete
(1) MDs who know a fair bit about naturopathy (small group it seems),
(2) MDs who don't know much at all but think they do (large group it seems), and
(3) MDs who don't know much at all and say so (small group it seems).
Cheers Shadowfax, you're in subgroup 3, a decent place to be.
- Anonymous12/19/2008 6:49 AM
This is what i think:ReplyDelete
its optimal that MD's and CAM practitioners dialogue about their pts and attempt to coordiante care(you tried and were unsuccessful, thats cool that you were willing to do so!)
I would (and have in a few situations thus far) provide medical education (depends on how much time you have available) addressing the risks of not treating a medical condition w/o meds yet express openness to hearing the pts motivation for pursuing CAM
the compromise position is: Send the pt (or recommend they find) a health care provider trained in Complementary and Alternative Medicine (CAM) AND allopathic medicine ( aka: MD's that practice "Integrative Medicine"). They will be more informed about the risks and benefits of managing pts condition via allopathic vs CAM therapies, and potential interactions if they are combined.
good luck, this is one of the new frontiers of medicine!
As a psychologist who is more than happy to scream for a psychiatrist when it seems they might be needed, I certainly agree that if the patient seems at risk, you address the risk not the relationship with a ND who won't even call back! That's unprofessional no matter what the profession.ReplyDelete
As a tangent, I should mention I know someone in acupuncture school who often gets patients with what MH people call Axis II disorders ( eg non-psychotic paranoid personalities )
Sometimes these people have wrapped medical personnel "into their complex" as I call it. They've become so suspicious of MD's, sometimes because of their offputting personalities, or their paranoia, or their shame about poverty or some other failing; that they've decided to go an alternate route-- many times with negative effects.
On the other hand, I've had psychiatrists recruit me to complement their practices, as they get tired ofreducing patient sumptoms with medication, and establishing enough stability for the patient to progress in their life, only to see them stagnate because "pills don't give you skills", in other words, the remedial social learning needed that didn't occur because of mental illness.
You never followed up explaining 1) what the ethical dilemma you saw was or 2) how you handled it. Your post genuinely frightened me. The confabulated example you gave was of a patient with complex physical conditions. As someone who takes an antidepressant and a mood stabilizer, I have long feared that a doctor is going to write something dismissive of me in a chart somewhere and that "something" will stay there forever and I will never be able to make myself heard over the voice of medical authority. Now I learn from you that isn't necessary. That all patients' wishes and best interests - whatever their diagnosis, with or without psychiatric elements - will be ignored as necessary to protect the reputation and income of even the most unethical, incompetent non-doctor.
That ultimately, patients may never have confidence that the doctor they are consulting is acting in their interests, and must always assume a sinister cabal.
If that's not what you meant to communicate to the public, or the example you meant to set for other doctors, please set us straight.
I want to be able to trust my doctor, but if I must not... well, that's good to know, I guess. But then, like, what are we supposed to do? There is no alternative.
- Anonymous2/11/2009 8:21 PM
Non doctor here:ReplyDelete
coumadin and LMWH are SOP for a DVT. No exceptions, or rare, if they exist. It's the standard of care, and is also reasonable and necessary.
Why would a doctor risk a PE by deviating from what is most beneficial and life-saving for such a patient? I'd do a cardio consult as well.
- Wow...12/11/2009 4:14 PM
My opinion: you answered the question yourself. When you call a practitioner's answering service, and get no response, then that practitioner is not equipped to care for any type of patient who might have any kind of urgent or emergent condition. End of story. If it were the patient sitting at home, wondering why their breathing has become difficult, waiting for the naturopath to call back, imagine the consequences. These practitioners who want to have equal privileges to care for patients often abdicate the responsibility of the consequences of their care when it gets complicated.ReplyDelete


text:
Hello and welcome to the new HYIPsTalk.com Forum! We decided to switch from vBulletin to XenForo. In this upgrade process I also removed a ton of spam and old topics. If you see spam please use the Report link available on each post.
From now on there will always be a moderator present on the forum. If you have any problems or questions you may start a conversation with user hyipstalk.
croninvest - croninvest.com
Discussion in 'HYIP Discussion' started by Mega-Hyip, Jan 24, 2020.
Page 1 of 5
Page 1 of 5


text:
zh-CN:MySQL MySQL is a widely spread, multi-threaded, multi-user SQL database. For more information about features, see the official homepage.
- 1 Installation
- 2 Configuration
- 3 Backup
- 4 Troubleshooting
- 5 See also
- 6 External links
The MySQL implementation choosen by Archlinux is called MariaDB. Install mariadb, libmariadbclient, mariadb-clients packages from the official repositories. Alternate implementations are percona-server and Oracle mysqlAUR.
# chattr +C /var/lib/mysql
Start the
mysqld daemon, run the setup script and restart the daemon afterwards:
# systemctl start mysqld # mysql_secure_installation # systemctl restart mysqld
Frontends available are mysql-gui-toolsAUR and mysql-workbenchAUR.
Upgrade from Oracle MySQL to MariaDB
Users who want to switch will need to install mariadb, libmariadbclient or mariadb-clients and execute mysql_upgrade in order to migrate their systems.
# systemctl stop mysqld # pacman -S mariadb libmariadbclient mariadb-clients # systemctl start mysqld # mysql_upgrade -p
On update
You might consider running this command after you have upgraded MySQL and started it:
# mysql_upgrade -u root -p
Once you have started the MySQL server, you probably want to add a root account in order to maintain your MySQL users and databases. This can be done manually or automatically, as mentioned by the output of the above script. Either run the commands to set a password for the root account, or run the secure installation script.
You now should be able to do further configuration using your favorite interface. For example you can use MySQL's command line tool to log in as root into your MySQL server:
$ mysql -p -u root
Disable remote access
The MySQL server is accessible from the network by default. If MySQL is only needed for the localhost, you can improve security by not listening on TCP port 3306. To refuse remote connections, uncomment the following line in
You will still be able to log in from the localhost.
Enable auto-completion
The MySQL client completion feature is disabled by default. To enable it system-wide edit
/etc/mysql/my.cnf, and replace
no-auto-rehash by
auto-rehash. Completion will be enabled next time you run the MySQL client.
Using UTF-8
In the
/etc/mysql/my.cnf file section under the "mysqld" group, add:
[mysqld] init_connect = 'SET collation_connection = utf8_general_ci,NAMES utf8' collation_server = utf8_general_ci character_set_client = utf8 character_set_server = utf8
Using a TMPFS for tmpdir
The directory used by MySQL for storing temporary files is named "tmpdir". For example, it is used to perform disk based large sorts, as well as for internal and explicit temporary tables.
Create the directory with appropriate permissions:
$ mkdir -pv /var/lib/mysqltmp $ chown mysql:mysql /var/lib/mysqltmp
Find the id and gid of the "mysql" user and group:
$ id mysql uid=27(mysql) gid=27(mysql) groups=27(mysql)
Add to your
/etc/fstab file.
tmpfs /var/lib/mysqltmp tmpfs rw,gid=27,uid=27,size=100m,mode=0750,noatime 0 0
Add to your
/etc/mysql/my.cnf file under the "mysqld" group:
tmpdir = /var/lib/mysqltmp
Then reboot or ( shutdown mysql, mount the tmpdir, start mysql ).
The database can be dumped to a file for easy backup. The following shell script will do this for you, creating a
db_backup.gz file in the same directory as the script, containing your database dump:
#!/bin/bash THISDIR=$(dirname $(readlink -f "$0")) mysqldump --single-transaction --flush-logs --master-data=2 --all-databases \ | gzip > $THISDIR/db_backup.gz echo 'purge master logs before date_sub(now(), interval 7 day);' | mysql
See also the official
mysqldump page in the MySQL manual.
MySQL daemon cannot start
If MySQL fails to start and there is no entry in the log files, you might want to check the permissions of files in the directories
/var/lib/mysql and
/var/lib/mysql/mysql. If the owner of files in these directories is not
mysql:mysql, you should do the following:
# chown mysql:mysql /var/lib/mysql -R
If you run into permission problems despite having followed the above, ensure that your
my.cnf is copied to
# cp /etc/mysql/my.cnf /etc/my.cnf
Now try and start the daemon.
If you get these messages in your
[ERROR] Can't start server : Bind on unix socket: Permission denied [ERROR] Do you already have another mysqld server running on socket: /var/run/mysqld/mysqld.sock ? [ERROR] Aborting
The permissions of
/var/run/mysqld could be the culprit.
# chown mysql:mysql /var/run/mysqld -R
If you run mysqld and the following error appears:
Fatal error: Can't open and lock privilege tables: Table 'mysql.host' doesn't exist
Run the following command from the
/usr directory to install the default tables:
# cd /usr # mysql_install_db --user=mysql --ldata=/var/lib/mysql/
Unable to run mysql_upgrade because MySQL cannot start
Try run MySQL in safemode:
# mysqld_safe --datadir=/var/lib/mysql/
And then run:
# mysql_upgrade -u root -p
Reset the root password
Stop the mysqld daemon. Issue the following command:
# mysqld_safe --skip-grant-tables &
Connect to the mysql server. Issue the following command:
# mysql -u root mysql
Change root password:
mysql> UPDATE mysql.user SET Password=PASSWORD('MyNewPass') WHERE User='root'; mysql> FLUSH PRIVILEGES; mysql> exit
Start the mysqld daemon.
Check and repair all tables
Check and auto repair all tables in all databases, see more
# mysqlcheck -A --auto-repair -u root -p
Optimize all tables
Forcefully Optimize all tables, automatically fixing table errors that may come up.
# mysqlcheck -A --auto-repair -f -o -u root -p
See also
- LAMP - Arch wiki article covering the setup of a LAMP server (Linux Apache MySQL PHP)
- PhpMyAdmin - Arch wiki article covering the web-based tool to help manage MySQL databases using an Apache/PHP frontend.
- PHP - Archi wiki article on PHP.