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The Transition Handbook
We live in an oil-dependent world, and have got to this level of dependency in a very short space of time, using vast reserves of oil in the process � without planning for when the supply is not so plentiful. Most of us avoid thinking about what happens when oil runs out (or becomes prohibitively expensive), but The Transition Handbook shows how the inevitable and profound changes ahead can have a positive outcome. These changes can lead to the rebirth of local communities, which will grow more of their own food, generate their own power, and build their own houses using local materials. They can also encourage the development of local currencies, to keep money in the local area.
The book has three sections, the Head, the Heart and the Hands. The Head explores the issues of peak oil and climate change, and how when looked at together, we need to be focusing on the rebuilding of resilience as well as cutting carbon emissions. It argues that the focus of our lives will become increasingly local and small scale as we come to terms with the real implications of the energy crisis we are heading into. The Heart looks at where we find the personal tools for responding to what can feel like overwhelming challenges. It argues that key to our success will be our ability to generate positive visions of future, to harness the power of engaged optimism, and overcome powerlessness. The Hands offers a detailed exploration of the Transition model, setting out its principles, its origins, the 12 Steps of Transition, how they were applied in the first year of Transition Town Totnes, as well as offering a taste of how the model has been applied in a range of other settings. The book also contains lots of �Tools for Transition�, exercises and activities that can help to deepen this work in your community.
Permaculture Design - a Step by Step Guide
Permaculture Design: A Step-by-Step Guide is a unique, full colour guide that takes the budding practitioner through the full permaculture design process. Let Aranya guide you through from beginning to end, using clear explanations, flowcharts and diagrams combined into this easy to follow (and carry) must have book.
Permaculture Design: A Step-by-Step Guide has been designed, refined and tested on students over time. Linking theory to practice, Aranya places the ethics, principles, philosophies, tools and techniques directly into the context of the process itself. While written for anyone with a basic grasp of permaculture, this book also has plenty to offer the more experienced designer. This book covers; systems and patterns, land and non-land based design, site surveying and map making, project management, placement and integration, amongst many other topics.
We reckon it�s un-put-downable!
The Beginners Guide to Being Outside
Megan is a 14-year-old girl who lives in Manchester with her mum and stepdad. Like most teenagers she is entirely reliant upon technology, until a family trip to the Scottish highlands reconnects her with nature and helps her to find solace during a turbulent time in her home life.
Gill Hatcher (Team Girl Comic, Go Wildlife) has created a wonderful story of a young girl coming to terms with life, her family and herself, set amidst the stunning scenery of the Scottish Highlands. Gill's own love of the outdoors and the animals that call the highlands home radiates from the beautifully drawn pages and will enchant and inspire even the most cynical, city shut-in.
40 pages, printed in full colour, perfect bound 239x168mm landscape format, with a stunning wraparound cover.
Playing For Time
In response to planetary challenges artists must reclaim their traditional role in communities as truth-tellers and agents of change. This ground-breaking handbook is a resource for artists, community activists and anyone wishing to reach beyond the facts and figures of science and technology to harness their creativity to make change in the world.
Sixty experienced artists and activists give voice to a new narrative shifting society's rules and values away from consumerism and commodity towards community and collaboration with imagination, humour, ingenuity, empathy and skill. Inspired by the grass-roots Transition movement, modelling change in communities worldwide, Playing for Time joins the dots between key drivers of change in energy, finance, climate change, food and community resilience and recipes for action for readers to take and try.
Sacred Earth Celebrations
Sacred Earth Celebrations is revised and updated version of Glennie Kindred's best selling classic book, Sacred Celebrations. It is an uplifting and inspiring source book for everyone seeking to celebrate and honour the changing rhythms and seasons of the Earth and her cycles. It explores the eight Celtic festivals, how they were celebrated and understood in the past, the underlying changing energy of the Earth, and the ways we may use this energy to create meaningful celebrations for today to deepen our connection to the Earth and our fellow human beings.
Jack and Boo's Wild Wood
Jack and Boo�s Wild Wood is a children�s picture book story, for ages 3-7 years, about two children exploring an ancient wood, smelling, tasting, collecting, exploring nature, poetically written and illustrated in full colour with real photos. Includes a woodland spotter guide, scavenger hunt and family activities.
The book includes a woodland spotter guide covering spring to autumn, a simple woodland scavenger hunt and ideas for activities to do in a wood.
Jack and Boo books are a fabulous mix of fact and fiction for children aged 3 to 7 that will inspire your children to get out and play, learn and imagine in nature. Perfect for bedtime stories, inspiration for outdoor play, and also challenging reading and information for children in Foundation and Key Stage 1 of Primary School.
A Druid's Tale
What do people think of when they hear the word Druidry? The real questions, not questions about the old men in white robes stereotypes. What makes a Druid? What do they do? Having been a practising Druid for over ten years, Cat Treadwell wondered too. Asked to present a talk at a national Pagan Festival, and unsure exactly what the audience would want to hear, she started a blog, asking friends and colleagues (Muggle and Pagan) what they would like to know about the Druid Path. Two years later they are still asking. This book answers some of those questions. Cat has compiled and expanded on the common queries (So, do you worship the sun?) as well as the day-to-day aspects of Druidry as a lived path. She reveals how Druidry is constantly evolving to be relevant and accessible in the modern world.
Science Revealed
Science Revealed considers the apocalypse in science as discovery. Biographies of scientists including Tesla and Einstein reveal how our most groundbreaking ideas result not from rational thinking and tapping on calculators, but from visions, dreams, feverish delirium and other non-rational revelations. The controversies that blow up when such insights clash with received wisdom are often resolved in a manner most unscientific, and this is just one of the ways in which what is simplistically called 'rationalism' often obscures truth in a fundamentally complex world.
Booze for Free
Home brewing and wine-making is fun, easy and hugely satisfying. If you garden or forage, can follow a recipe or make jam, and you enjoy a drink, this is the book for you.
Discover the secret language of home-brewing and drinks-making
Make over 100 wholesome, delicious drinks, to your preferred taste and strength, quickly, cheaply and with minimum fuss
Turn your garden into a drinkers' paradise
Learn where and how to forage with success
Impress your friends with the weird, wonderful and just plain tasty
See our chat with Andy here.


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Test case management software company Gurock has released TestRail 3.0, a new version of its web-based test management tool. Version 3.0 includes more than 100 new features, a new reporting engine, a redesigned API ,and more integration options for bug and project management tools.
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TestRail's reporting engine introduces several built-in reports to help answer testing questions. This includes reports to generate coverage statistics for requirements, test cases, and defects as well as reports to compare the performance of specific test cases over time.
Additional reports allow teams to gather and visualize statistics about the team's workload, to identify error-prone functional areas of projects, and to produce summaries of their tests.
The new reporting engine also comes with functionality to schedule and share reports. This allows testing teams to generate and email statistics to developers, the management team, or customers. The company also says that it's now also easier for teams to customize and develop their own reports and integrate them into TestRail.
According to Gurock, "TestRail 3.0 also adds a new redesigned REST API. This API can be used to automate various parts of the application and to integrate automated testing tools such as Selenium. The new version also introduces improved support for bug and project management tools such as Rally, Assembla, Bitbucket, GitHub, JIRA, and OnTime. Testers can now directly link test results and push new bug report to these tools."
Gurock has also implemented various additional improvements for the new version, such as full support for Microsoft's new web stack with Windows Server 2012, SQL Server 2012, and Internet Explorer 10. TestRail's new version also includes better support for mobile devices, adds more customization options, and comes with improved navigation. TestRail is used by software development teams and quality assurance departments to manage, organize, and track their software testing efforts. TestRail is available as a web-based SaaS/cloud edition or can be installed on a local server.


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A parathyroidectomy is a surgery to remove parathyroid glands. There are 4 parathyroid glands located in the neck. The glands make a hormone that balances the level of calcium in the blood.
Reasons for Procedure
The surgery is done to remove one or more abnormal parathyroid glands. The glands may be overactive, or abnormal due to cancer or for other reasons.
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Bleeding
- Hoarseness
- Low calcium levels in the blood—more common if all 4 glands are removed
- Wound infection
- Reaction to the anesthesia
- Skin tethering—tissues and skin may become attached to the voice box or windpipe
- Scarring
- Blocked airway
- Damage to nerves, which can cause problems like paralyzed vocal cords
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:
What to Expect
Prior to Procedure
Your doctor will:
- Do a physical exam and ask you about your medical history
- Order imaging test such as ultrasound or parathyroid scan
- Have blood tests done
You should:
- Arrange to have someone drive you home from the hospital after surgery.
- Avoid eating or drinking 6-8 hours before surgery.
- Talk to your doctor about your medications, herbs, and dietary supplements. You may be asked to stop taking some medications up to 1 week before the procedure.
General anesthesia is used most often. It will block any pain and you will stay asleep through the surgery. The area will be numb but you will be awake.
Description of the Procedure
An incision will be made in the neck. Muscle and other tissue will be moved to locate all the glands. The abnormal gland or glands will then be cut out and removed. A drain may then be placed in the area. This will allow fluids to drain out of the area while you heal. The incision will be closed with stitches.
If all 4 glands were removed, a part of one gland may be placed in a different area of the neck or in the forearm.
How Long Will It Take?
20 minutes to several hours, depending on how many glands need to be removed
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
You may need to stay in the hospital for 1-2 days. Your doctor may choose to keep you longer if you have any problems.
Post-procedure Care
After your surgery, the the hospital staff will:
- Observe you in the recovery room.
- Check on your ability to swallow and speak.
- Test your calcium levels.
- Show you how to change your dressings and care for your wound.
- Remove the drain if one was placed during surgery.
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
- Washing your hands often and reminding your healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incision
To help your recovery at home:
- You may be given calcium supplements.
- Follow your doctor's instructions.
Call Your Doctor
Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
- Tingling or numbness in the fingertips, toes, hands, or around the mouth
- Twitching or cramping of muscles
- Redness, warmth, drainage, or swelling around the area where surgery was done
- Difficulty swallowing, talking, or breathing
- Signs of infection, including fever and chills
If you think you have an emergency, call for medical help right away.
Revision Information
- Reviewer: Michael Woods, MD
- Review Date: 06/2018 -
- Update Date: 12/28/2018 -


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text:
Chronic bronchitis is a long-term disease of the lungs. It is a problem with the airways of the lungs. Injury or irritation causes these airways to swell and develop extra mucus. This makes it difficult to move air in and out of the lungs. It will make breathing difficult.
Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD).
Chronic bronchitis is caused by damage to the airways. The damage is caused by:
- Cigarette smoking
- Inhaling toxins or other irritants
- Genetic predisposition can make a person's lungs more susceptible to damage from smoke or pollutants—one example of a genetic disorder is alpha-1-antitrypsin deficiency
Risk Factors
Cigarette smoking is the greatest risk factor for developing chronic bronchitis. The number of cigarettes smoked and years as a smoker increase the risk of disease. Frequent and long-term smoking also increase the chance of severe chronic bronchitis.
Chronic bronchitis is more common in people over 40 years old. Other factors that may increase the chance of chronic bronchitis include:
- Long-term exposure to chemicals, dust, and other substances that have been inhaled
- Long-term cigar or marijuana smoking
- Exposure to secondhand smoke
- Family members with COPD
- History of frequent childhood lung infections
- Long term asthma
Chronic bronchitis may cause:
- Cough
- Increased mucus production
- Shortness of breath or difficulty breathing, especially after mild activity or exercise
- Recurring respiratory infections that cause symptoms to worsen
- Wheezing when breathing
- Fatigue
To diagnose chronic bronchitis, symptoms of productive cough must have been present for 3 or more months in at least 2 consecutive years, and not have been caused by another condition. You will be asked about your symptoms and medical history. A physical exam will be done. Tests may include the following:
- Breathing tests to check lung function
- Blood tests
Images of the lungs may be taken with:
- Chest x-ray
- CT scan of the chest
There is no cure for chronic bronchitis. There are treatments that can reduce symptoms and improve lung function. The best way to reduce symptoms is to stop smoking.
Treatment options may include one or more of the following:
Medications may include bronchodilators or steroids. They may help manage chronic bronchitis by:
- Opening the airways
- Relaxing the breathing passages
- Decreasing inflammation
Some medication may be taken as pills or liquids. Others are inhaled medication that is delivered directly to the lungs.
Antibiotics are rarely prescribed to treat chronic bronchitis. They may be needed to treat a lung infection that has developed because of the chronic bronchitis.
Lung infections like pneumonia or other infections like the flu can make symptoms worse. Get vaccinated against pneumonia and the flu. The flu vaccine may also reduce flare ups.
Oxygen therapy may be helpful if blood oxygen levels are too low. It can relieve breathing problems and improve energy. Oxygen may only be needed for specific activities or it may be given throughout the day.
Special exercises can strengthen chest muscles. This can make it easier to breathe.
Regular physical activity can reduce the workload on the lungs by building endurance. Physical activity is also associated with improved quality of life. Follow the doctor's recommendations for activity levels and restrictions.
Breathing and Coughing Techniques
Special methods of breathing can help bring more air into the lungs. They can also help force trapped air out of the lungs. Effective coughing techniques can also help clear mucus from the lungs. Ask the doctor if these techniques will be helpful. Some examples include:
- Pursed lip breathing
- Controlled coughing technique
Lifestyle Changes
Symptoms can be managed by:
- Pacing activities.
- Learning relaxation techniques and other methods to manage stress.
- Seeking emotional support from professionals, family, and friends. Anxiety can increase the rate of respiration, making breathing more strenuous.
To help reduce the chance of chronic bronchitis:
- Quit smoking. The doctor can help with finding a successful program.
- Avoid exposure to second-hand smoke.
- Avoid exposure to air pollution or irritants.
- Wear protective gear if exposed to irritants or toxins at work.
Revision Information
- Reviewer: EBSCO Medical Review Board James P. Cornell, MD
- Review Date: 03/2018 -
- Update Date: 03/08/2016 -


text:
For most people, PTSD starts within about 3 months of the traumatic event. For some people, signs of PTSD don't show up until years later. PTSD can happen to anyone at any age. Even children can have it. Some people get better within 6 months, while others may have the disorder for much longer. Symptoms of PTSD may vary in frequency and intensity over time, and may fall into 3 categories:
Re-experiencing the event:
- Dreams or nightmares
- Intrusive memories
- Flashbacks
- Anxious reactions to reminders of the event
- Avoidance of external reminders of the event, such as places, situations, or people that can trigger memories
- Efforts to avoid feelings, thoughts, memories related to the event
- Negative changes in mood and cognition related to trauma including detachment, numbness, difficulties remembering relevant details of the trauma
- Difficulty falling or staying asleep
- Anger and irritability
- Difficulty concentrating or maintaining attention
- Being easily startled
- Hypervigilance
Physical symptoms may also occur such as:
- Impaired memory
- Stomach and digestive problems
- Rapid breathing or heart rate
- Sweating
- Chest pain
- Headaches
- Dizziness
- Immune system problems
Revision Information
- Reviewer: EBSCO Medical Review Board Adrian Preda, MD
- Review Date: 11/2018 -
- Update Date: 12/20/2014 -


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About Alexandra Dawe
After taking a break to have a family, Alexandra began painting the many fantasy and folklore images in locked away in her head, some of which you can buy here.
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text:
The management of foot pain varies. There are many conditions that can affect your feet. If you are generally healthy, proper shoes and over-the-counter foot products are usually all you need for most foot problems. Seek professional care if the problem persists or gets worse.
If you have diabetes, you need to take extra care of your feet on a daily basis. Many lower limb amputations in the United States are done on people with diabetes. Most of them can be prevented with proper foot care.
Treatment may involve any of the following:Lifestyle changesMedicationsOther treatmentsSurgery
Revision Information
- Reviewer: EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
- Review Date: 03/2018 -
- Update Date: 03/15/2015 -


text:
Bread pudding is one of my favorite throw-together, quick and easy recipes. If you have at least these three items on hand, you can make the base pudding: bread (preferably day old and dry), eggs, and milk or heavy cream. It's also a great go-to because it works for breakfast, lunch, dinner, or dessert. It just depends on the extra ingredients you throw in: sweet for breakfast or dessert, savory for breakfast, lunch, or dinner. Plus, prep time is ten minutes or less. How great and versatile is that?
For this version of bread pudding, I had a ton of strawberries on hand because they were on sale at the grocery store, and needed to use them up, so I just threw them in the mix. I had also picked up a gorgeous and aromatic loaf of French bread (the smell of good bread is heaven to me) and let it sit out for a day to get a bit stale (not moldy, there's a difference) so it wouldn't get too mushy in the liquid egg/milk mixture. Thus, strawberry bread pudding was born.
I wanted a garnish or topping for my bread pudding, so, thinking about what I had in my pantry, I decided to top it with a brown sugar "caramel" sauce. (I swear, I'm like the Iron Chef of cleaning out the refrigerator and pantry.) This sauce takes just two ingredients, butter and brown sugar, and cooks in just minutes on the stove top while your bread pudding bakes away in the oven. The actual bread pudding just has a hint of sweetness, so this sauce complements it by adding an extra kick of sugar (if you're into that).
For a sweet bread pudding, use the following base recipe; for savory, omit the sugar, vanilla, and spices. Then get creative with your additions: chocolate chips, fruit, liqueurs (for sweet); pre-cooked sausage, fresh herbs, vegetables (for savory). I hope you're inspired now, so get baking and bon appetit!
Strawberry Bread Pudding with Caramel Sauce
(makes one 8×8 square baking dish, 8-10 servings)
Strawberry Bread Pudding:
4 eggs
2 cups milk (or half milk, half heavy cream)
1/2 cup white granulated sugar
1/4 cup brown sugar
1 teaspoon vanilla extract (or complementing flavor of your choice)
2 teaspoons ground cinnamon
1/2 teaspoon ground nutmeg
1/2 teaspoon ground ginger
4 cups crusty, day-old bread (I used a 12 ounce French loaf), cut or torn into bite-sized pieces
1 cup (or more) fresh or frozen (thawed) strawberries, sliced
1. Preheat oven to 350 degrees. In a small bowl, whisk together the eggs, milk, sugars, extract, and spices until blended.
2. Put bread pieces into a large bowl; pour egg/milk custard mixture over the bread, tossing to combine (use your hands- free tools). Let sit for a few minutes to soak in.
3. Evenly fold in the strawberries and pour the mixture into the pre-greased baking dish.
4. Bake for 30 minutes, or until raised and puffy. Insert a toothpick into the center and if it comes out fairly clean, it's done. Let cool for a few minutes before serving.
Caramel Sauce:
1/2 stick of butter
1/2 cup of brown sugar (I used dark brown sugar)
1/8 cup heavy cream
1. Put butter in a small pan or sauce pan over medium heat and let it melt.
2. Add the brown sugar and stir until it's combined. Lower heat a bit, stir constantly, and let it slightly simmer.
3. When the sugar is completely dissolved (about 5 minutes), remove from heat and stir in the cream. Serve drizzled over the warm bread pudding.
Check out my blog, Culinary Piracy and follow me on Twitter: culinarypirate!


text: Thursday, September 06, 2012 APTA Urges CMS to Alter Data Collection Plan to Provide Meaningful Information, Ease Provider Burden In comments sent Tuesday to the Centers for Medicare and Medicaid Services (CMS) on the proposed 2013 Medicare physician fee schedule, APTA recommends multiple revisions to CMS' plan for collecting information on beneficiaries' functional limitations as part of payment reform. "While APTA strongly supports gathering information to develop an alternative to the current arbitrary payment limits (or "caps") on Medicare therapy services," the association says, "… CMS's proposal is overly complex and burdensome and may not result in the collection of meaningful and accurate patient information that could be used to develop an alternative payment system." Following the July 6 release of the proposed rule, APTA immediately began communicating with various stakeholder groups, including the American Hospital Association, the American Occupational Therapy Association, the American Speech-Language-Hearing Association, American Stroke Association, and APTA components about CMS' intention to require therapists to report patients' functional limitations. In a meeting with CMS officials on August 27, APTA urged the agency to keep this particular provision as simple as possible to ensure that the requirements are not excessively onerous for physical therapists and do not cause delays in payment for therapy services. Specifically, APTA recommends that therapy associations and organizations and CMS collaborate to develop core items in the future that could be used in any tool to standardize data collection. Instead of reporting on primary and secondary functional limitations as described in the rule, APTA recommends that therapists report the information regarding the patient's functional limitation using 1 of 4 specific categories and that CMS establish another G code that would be the "catch all" for functional limitations that do not fit into the 4 categories. Additionally, the association urges against the collection of goal data at this time, comments on the 12-level severity scale, and suggests changes to the proposed frequency of reporting. APTA also provides CMS with a detailed outline of how the agency could implement claims-based therapy data collection in 3 phases that would "decrease provider burden, while still providing CMS with some useful beneficiary information regarding functional limitations." APTA also remarks on the proposed 27% percent reduction in the Medicare physician fee schedule conversion factor, prepayment review, and the therapy cap. The association comments extensively on the extension and implementation of the Physician Quality Reporting System (PQRS)—voicing its concern over the use of 2013 data to inform the 2015 payment adjustments given the continued low participation rates and overall lack of awareness of programmatic changes to PQRS.


text:
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with alcohol. By talking openly and regularly with your doctor, you can take an active role in your care.
Here are some tips that will make it easier for you to talk to your doctor:
- Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
- Write out your questions ahead of time, so you don't forget them.
- Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
- Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.
- Do you think I have a problem with drinking?
- Have you helped others with AUD?
- Where can I get help for AUD?
- I'm concerned that I've done damage to my body because of my drinking habits. Do I need a physical exam and some tests?
- Do my health problems have anything to do with my drinking habits?
- If I continue with my current drinking pattern, am I putting myself at risk for more serious complications?
- What medical and nonmedical treatments are available for AUD?
- What are the benefits, risks, and side effects of medical treatments for AUD?
- How do the treatments work and how long will they take?
- Can you refer me to a support group for people with AUD?
- Can you refer me to a mental health professional that specializes in the treatment of AUD?
If you find a mental health professional that specializes in the treatment of AUD, ask the following questions:
- What type of training and how much experience do you have in treating AUD?
- What is your basic approach to treatment?
- How long will treatments last?
- How long and frequent are the treatment sessions?
- Do you accept health insurance?
- Do you have fee schedules and sliding scale fees to accommodate various financial circumstances?
- What changes can I make to reduce my use of alcohol?
- Is there anything I can do to enhance my recovery?
- Is there anything I can do to reverse any damage I may have done to my body because of AUD?
- What are my chances of successful recovery?
- What if I relapse?
- What are my chances of reversing any damage I may have done to my body because of AUD?
Revision Information
- Reviewer: EBSCO Medical Review Board Adrian Preda, MD
- Review Date: 03/2018 -
- Update Date: 04/10/2015 -


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text: Thursday, December 27, 2012 More Than 1,400 Hospitals Penalized Under Readmissions Reduction Program Medicare is rewarding 1,557 hospitals with bonuses and reducing payments to 1,427 others based on their readmission rates for heart attack, heart failure, and pneumonia, says a Kaiser Health News article. The biggest bonus is going to Treasure Valley Hospital, a physician-owned, 10-bed hospital in Boise, Idaho, that is getting a 0.83% increase in payment for each Medicare patient. Auburn Community Hospital, a nonprofit near Syracuse, New York, is facing the biggest cut, losing 0.9% of every payment. On average, hospitals in Maine, Nebraska, South Dakota, Utah, and South Carolina will fare the best. Hospitals in the District of Columbia, Connecticut, New York, Wyoming, and Delaware are among the worst, the article says. Results for hospitals within the same system often varied. For instance, in Rochester, Minnesota, the Mayo Clinic's Methodist Hospital will get a bonus. But Mayo's flagship St Mary's Hospital, also in Rochester, will lose money. Michael Rock, MD, an orthopedic surgeon at the Mayo Clinic, said that Medicare's scoring system tends to favor hospitals such as Methodist, which primarily does elective surgeries, over hospitals with lots of trauma and emergency cases, which St Mary's handles. Under the Affordable Care Act's Hospital Readmissions Reduction Program, Medicare will begin adjusting payments next month through September 2013 and will retroactively apply the changes to payments made in the last 3 months of this year. The bonuses and penalties do not apply to money Medicare pays hospitals for capital expenses, to teach residents, or to treat large numbers of low-income patients. Hospitals with too few cases and ones that only offer specific specialties, such as psychiatry, long-term care, rehabilitation, and cancer treatment, are exempted. Maryland hospitals also are excluded because the state has a unique reimbursement arrangement with the federal government. In August, Kaiser Health News reported that more than 2,000 hospitals were expected to be penalized. Physical therapists can help serve an important role in patient care transitions and care coordination and can help reduce readmissions by providing recommendations for the most appropriate level of care to the health care team prior to and during care transitions. For more information and to find clinical practice and patient education resources to reduce readmissions, visit APTA's Hospital Readmissions webpage.


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This is what Im going to wear out tomorrow night (unless plans change!) but I tried it out earlier and decided to snap it for today outfit post. I wore something spectacularly underwhelming as I've had meetings. The shorts are super flattering and perfect for party season, They aren't too sparkly and they aren't too matte so they are jazzy without being OTT. I just paired it with a simple plain black cropped t-shirt from Topshop. I find it really hard to wear anything cropped as I don't always like my midriff on show. However this one seems to work quite well on me! As it's a tee it also hides my problem area of my arms.
Yesterday I shot a campaign for Boohoo around London and I wore these shorts as one of my outfits. We shot in tons of iconic places around London including outside Big Ben which was pretty surreal! I cant wait to see the pictures and eventually share them all with you! Tonight Im having a sleepover with some of my best blogging buds Katie, Emma, Lina and Zoe. Cant wait to gossip, eat and have fun in our onesies!


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|put all pieces in compartment
|Level 8 - Demanding
|Jean Claude Constantin
|European Wood Puzzles, 3D Wooden Puzzles, Jean Claude Constantin
|17.75 cm x 10 cm x 1.5 cm / 6.99 in x 3.94 in x .59 in
Product Description
This unusual packing puzzle is restricted by a clear acrylic cover that only has a small hole in it. The pieces must therefore not only fit into the frame, but they must also be inserted in the correct order in order to solve the puzzle.
Made in laser-cut wood, acrylic, and stainless steel by Jean-Claude Constantin. Jean-Claude Constantin lives in Germany, where he designs and manufactures many different wood and metal puzzle, as well as magic tricks.
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|Pick the right color from flipped over tiles
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Warning! The instructions are in German.
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Welcome to A Blogtastic Extravaganza - New Year, New Start
Did you make resolutions this year? Regardless, I bet you want to make some improvements in your life. I have a great giveaway package that will help you do just that.
One winner will receive the following items ~
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Items purchased through our website can be returned within 30 days from the shipment date of your order for a refund or exchange. Items must be in their original form, unworn, unwashed & with the original tags in order to receive refund or exchange. Shipping & handling on returns is non-refundable unless the wrong item was sent or the items received were damaged. Refunds will be made to the original payment method only. All sale items are final.
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Saturday, June 20, 2009
Coleslaw with Creamy Buttermilk Dressing
From the kitchen of One Perfect Bite...When thinking about a salad to accompany a picnic or barbecue, coleslaw is arguably everyone's first choice. It's inexpensive to make and easy to assemble. This version uses a package of shredded cabbage and a simple buttermilk dressing that you can put together in minutes. The dressing is wonderful for any salad. If you'd like to wilt the cabbage before dressing the slaw, put it in a colander, toss it with a teaspoon of salt and let it sit for an hour or so at room temperature. Then rinse it with plenty of cold water and pat it dry. If your packaged slaw contains red cabbage be forewarned that it will bleed into your finished salad if allowed to sit too long. You may or may not want that. Here's the recipe for the slaw and the buttermilk dressing.
Coleslaw with Creamy Buttermilk Dressing...from the kitchen of One Perfect Bite
1 (10-oz.) package confetti slaw
2 tablespoons finely minced shallots or scallions
1-1/2 tablespoons low-fat sour cream
1-1/2 tablespoons low-fat mayonnaise
1-1/2 teaspoons white wine vinegar
1/4 teaspoon granulated sugar
1/4 cup low-fat buttermilk
1/8 teaspoon freshly ground black pepper
1) Place confetti slaw in a large bowl. Set aside.
2) Place shallots, sour cream, mayonnaise, vinegar, sugar, buttermilk and pepper in a 2 cup jar with a lid. Shake to combine.
3) Pour dressing over slaw and toss to combine. Refrigerate until well chilled. Yield: 4 servings.
40 comments :
- Netts Nook said...
Love the buttermilk sounds and looks perfect.
- June 20, 2009 at 11:16 AM
- theUngourmet said...
I'm the only one in my family that enjoys coleslaw. Your recipe looks great! I like the buttermilk in the dressing.
- June 20, 2009 at 11:39 AM
- Penny said...
Mary, this sounds very healthy and good. Great picture too - a little pink coleslaw.
- June 20, 2009 at 11:44 AM
- Baking Monster said...
Yum!this is perfect for summer!Picnic time!
- June 20, 2009 at 11:49 AM
- Schnitzel and the Trout said...
That is a wonderful dressing recipe. Once again, I am adding to my "buttermilk file." P.S. I have a blueberry cobbler in the oven using your blackberry cobbler recipe :-)
- June 20, 2009 at 11:53 AM
- Abby Lanes said...
Oh yum, you have a beautiful blog! I'll be back :-)
- June 20, 2009 at 12:03 PM
- The Wrought Iron Gate said...
Mary, I'm making Coleslaw for lunch, but after reading your blog, it will have buttermilk dressing. Can't wait to try it.
I'm from the south.....where everything is better with a splash of buttermilk.
Best Wishes,
- June 20, 2009 at 12:16 PM
- Creative Classroom Core said...
Ive been looking for a ggod coleslaw recipe! Thanks for sharing!
- June 20, 2009 at 12:58 PM
- Lynne (lynnesgiftsfromtheheart) said...
Thanks for sharing your fun recipe. I'm making coleslaw later this afternoon for my grandson's 9th birthday party. Thanks for the visit to my blog. Happy Pink Saturday. hugs ~lynne~
- June 20, 2009 at 1:15 PM
- Elle said...
What a great slaw dressing & just in time for summer! I'll bet the buttermilk gives it a great tang.
- June 20, 2009 at 1:39 PM
- Lynn said...
T red cabbage makes it such a lovely PINK!!
- June 20, 2009 at 1:49 PM
- Country Wings in Phoenix said...
OOOHHH Mary!
This sounds absolutely amazing, and I have a BBQ to go to in 2 weeks. Guess what I am taking? Thank you so much for sharing with. I'd also like to thank you stopping by and saying hi for my first PS. I hope you will stop back by soon. I feel like I have received so many wonderful gifts. Each comment, a gift to open and cheerish. Thanks for sharing. I will check back often. "Country Hugs" from Country Wings in Phoenix, Sherry
- June 20, 2009 at 2:05 PM
- {Bellamere Cottage} said...
Oh my! That does sound delicious. I'm going to give it a try!
- June 20, 2009 at 2:19 PM
- Marta said...
Oh what a gorgeous colour this slaw has!!!! Perfect for summer and very cute! I imagine the buttermilk dressing must give a nice tang to the salad and make it memorable
- June 20, 2009 at 3:13 PM
- Katy ~ said...
Oh, how we love coleslaw here. Your buttermilk dressing sounds creamy delicious. I would not be able to resist.
- June 20, 2009 at 3:24 PM
- Karen said...
Coleslaw isn't one of my favorites because I always compare it to what we got in a little deli when I was a kid. It didn't have the raw taste of cabbage and it had the creamiest dressing. The cabbage was cut into long slices and it was delicious! I'm going to give this a try - it might just be what I'm looking for with the buttermilk and by salting the cabbage and 'wilting' it, it may be the consistency I'm looking for. Thanks, Mary!
- June 20, 2009 at 4:01 PM
I agree with everyone, the buttermilk sounds great in the dressing. I have some leftover from the cobbler, so this will be great for tomorrow's dinner.
- June 20, 2009 at 4:22 PM
- Kranky Granny said...
Always looking for new recipes. I have a BBQ to go to next week and will try your pink slaw. I have copied the lemon buttermilk ice cream and sent it to my BIL who keeps his ice cream churn hopping each weekend and loves new favors to try.
- June 20, 2009 at 4:47 PM
- Tara said...
This looks yummy! I'll have to peruse your other posts for some great recipes. Thanks for coming by Loveleigh Treasures and have a wonderful weekend!
- June 20, 2009 at 4:57 PM
- Candy said...
Love coleslaw and as always on these delicious food posts I frantically look for the tasting button.
- June 20, 2009 at 7:31 PM
- juliaD said...
And a H.P.S. to you too...your blog is wonderful, though it's breakfast time and making me hungry, that shredded meat burger and the raspberry sherbet look yummmmm///LOL... lovely to meet you.....xx
- June 20, 2009 at 7:54 PM
- Martha said...
I'll have to try this coleslaw the next time I make it -- the buttermilk dressing sounds wonderful
- June 20, 2009 at 8:09 PM
- Unknown said...
Thank you so much for stopping by my blog today. I am just browsing around your blog. What beautiful presentation and your recipes sound positively yummy! I don't think I've ever tried buttermilk dressing in coleslaw but it sure sounds delicious.
Cheers! =D
~Kitty Kellie
The Artful Paper Doll
- June 20, 2009 at 8:12 PM
- Dreamgirl said...
Mmmm... that looks good!
Thanks for leaving a comment on my blog Sweeterliving.
Have a Pink Saturday and a blessed Sunday too!
Greetings from Norway!
- June 20, 2009 at 9:05 PM
- Mary | Deep South Dish said...
Sounds perfect!
- June 20, 2009 at 11:50 PM
- Lisa said...
Coleslaw is a great summer recipe. Thanks for sharing an easy version to start off picnic season.
- June 21, 2009 at 3:11 AM
- Deb in Hawaii said...
It looks crunchy, cool and delicious!
- June 21, 2009 at 6:30 AM
- Sam Hoffer / My Carolina Kitchen said...
Great looking slaw Mary. You're right, the red cabbage will bleed if you aren't careful. I like yours because it isn't too sweet. Perfect just like I like it.
- June 21, 2009 at 7:26 AM
Happy Pink Saturday on Sunday. What a very yummy post that was! Hope your day is full of love and happiness.
- June 21, 2009 at 8:48 AM
- noble pig said...
I love a good coleslaw! It's always the welcomed dish with so many summer recipes.
- June 21, 2009 at 11:23 AM
- Cathy said...
Looks like a yummy, light dressing for crunchy cabbage. So good with barbecue.
- June 21, 2009 at 2:20 PM
- Boo-Bah AKA Iris said...
I love coleslaw and this dressubg sounds so good. I always have coleslaw when we have burgers or Sloppy Joes.
- June 21, 2009 at 4:33 PM
- Unknown said...
This looks delicious. It would be a great summer recipe. Thank You.
- June 21, 2009 at 4:38 PM
- Mary Bergfeld said...
Yira, I'm so glad you found us. I hope you'll visit often.
- June 21, 2009 at 4:47 PM
- Trish said...
I love it. This looks like my kind of recipe to be sure!
- June 21, 2009 at 5:41 PM
- The Old Parsonage said...
Mmm, just stopping by for Pink Saturday and am soo glad that I'm a day late! The coleslaw looks yummy! Thanks for sharing the recipes.
I'd love to have you visit The Old Parsonage.
Enjoy your day!
- June 21, 2009 at 6:38 PM
- Ivy Lane said...
Oh... I am so gonna visit you often... what fabulous recipes here!!! LOVE your blog!
- June 21, 2009 at 10:31 PM
- suesueb said...
that cake looks scrumptious!! i'm always looking for something to serve on wednesday (breakfast club day) and i know my family would love this! thanks for sharing and good luck winning the brooch!
p.s. i hope you get your seeds one day!
- June 22, 2009 at 7:53 AM
- Ginger said...
Hi Mary!
Here is what I have to say about your Coleslaw. . . . YUMMY! I really like the Buttermilk Dressing. This recipe is a "keeper" for me.
- June 22, 2009 at 8:24 AM
- Culinary Wannabe said...
I love coleslaw! Pair this with a BBQ sandwich, and you have yourself one heck of a meal!
- June 22, 2009 at 1:55 PM


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My favourite looks are the one I wore to the Glossy Box birthday bash, can never go wrong with that sparkly polka dot Topshop number. I adore the electric blue Topshop boutique dress from this outfit post, however it shrank in the wash so I had to return it before I could wear it again. These were the few months when I stated getting into trousers. From when I first got my disco pants or any of the other dupes I ended up trying out, they stuck and I literally love wearing them more than dresses or skirts now. Another of my favourite outfits was my Paisley Topshop dress, but I was super teeny tiny skinny (for me anyway) during that month so I doubt it would fit me still! I adored the cut of waist of the ASOS dress I wore while I was away on holiday in Turkey with my parents too.
My go-to going out but not out out outfit that I wore to a Puma party is also one of my favourite outfits. It's something I wear all the time, and the jacket was a mindless thrift store purchase I made! I must make a mental note to look in more vintage shops! Gahh and how much do I love my grey silk midi dress! I think I have a really bad thing for Topshop Boutique and anything silk! Another outfit I loved was the bargain boucle and leather jacket that I got from Primark and wore with my Transformer necklace. My hair looks absolutely dreamy too. Why does it not look like that normally!
Gah summer months, I loved so many of these outfits for someone who isn't a summer/hot weather dresser at all I seemed to embrace bare legs quite a bit as well as get into trousers!
Any favourites from this lot? I'll be posting one more of these style posts before the new year!


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Mechanical service
We offer Machine Support shaft alignment services for the full range of on-board machinery, from the main propulsion shafts and drives, to the smaller yet critical support equipment such as air compressors and cargo equipment. An optimal shaft alignment increases the life of bearings, seals and couplings, but also reduces energy consumption, noise, vibrations and excessive wear. This, in turn, reduces the risk of costly downtime. The Machine Support service team is a specialist with decades of experience in solving alignment issues, and combined with the ShaftDesigner software we provide a range of technologies to provide precision shaft alignment solutions. Measurements performs include:
- Dynamic alignment measurements (on vessels in operation)
- Static alignment measurements
- Geometric measurements
- Optimal advice on replacement parts based on the ship's history
- Excellent OEM quality
- High availability of replacement parts and fast express delivery
- Qualified service engineers worldwide
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- Fast, competent maintenance and check that all components are inworking order
- Technical advice, fault finding and system optimisation
- Provision of regular service information
A third area of mechanical services is related to mounting, which is one of the critical stages of the machinery and bearing lifecycle. If the bearing is not mounted properly using the correct method and tools, the bearing's service lifetime will be reduced.
These services range from mounting and dismounting of large size bearings during dry-docking, as well as supervision services at machine builders, helps to ensure bearings are installed properly. SKF Marine also provides services for developing mounting instructions and guidelines, to help operators minimise the risk related to handling of bearings.


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Mechanical engineers design, develop, build, and test mechanical and thermal sensors and devices including tools, engines, and machines.
A Data Support Specialist works with the user community to understand their science needs with the goal of providing support for NASA data and information services. They represent the user in product
Data scientists work with data captured by scientific instruments or generated by a simulator, as well as data that is processed by software and stored in computer systems. They work with scientists to analyze databases and files using data management techniques and statistics.
Be a Scientist: The GLOBE Program encourages you to use
Helping students build their understanding of Earth's spheres and how they are connected is difficult. Review the graphics below to help identify the parts of the Earth System and the processes that connect them at the local, regional, and global scales.
The My NASA Data visualization tool, Earth System Data Explorer (ESDE), helps learners visualize complex Earth System data sets over space and time.
NASA Worldview is a free online visualization tool that is a great launchpad for learners who are new (or


text:
Depth: 14.00cm
Height: 34.00cm
Width: 27.00cm
Handle Drop: 12.00cm
Handbag Style: Tote
Colour: Purple
Material: Leather
Condition: Excellent
This bag is located in our Leeds Store.
A simply styled, open top bucket bag with zip front pocket with smooth nappa leather lining. Crafted from sturdy, thick leather this will stand up when empty so holds its shape well, there's acres of space inside so perfect for everyday. This tote is in excellent condition and will make a great day to day bag!
All items are sent out to you via our trusted partners DPD. If you order before 2pm the item will be dispatched the same day, for next day delivery. Otherwise, it will be sent the following day. No items will be shipped on a Saturday or Sunday.
Spend over £300 to qualify for FREE delivery.
Returns - 28 Day Return Policy
We spend a lot of time to ensure every item we sell is clean and matches the description and photos we provide. However, we understand you won't know if you completely love the item until you have it in your hands; so, for peace of mind we give all our customers 28 days to return the item to us, even if it's just because you changed your mind!
And we make the process simple and hassle free too. You can either drop the item off at one of our stores, or request a ship at home label and our delivery partner will come and collect the item from you.
We started as a handbag restoration company, before buying and selling bags too. For our reputation as handbag restorers we would never sell an item below our standard and we use our restoration expertise to ensure every item we sell has been cleaned and deodorised before going on sale.
We sell bags listed under the following grades:
Brand New: These bags have never been used and will come with all the original tags.
Excellent: These bags have had their tags removed, but show no signs of use.
Very Good: These bags will show very minor signs of wear.
Good: These bags will show small signs of slight damage and wear.
Fair: These bags are still in great condition but will show signs of use and some damage.


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Diarrhea is more than 3 loose, liquid stools in a single day. It depletes the body of fluids and electrolytes. Diarrhea can be:
- Acute—occurring suddenly and lasting briefly
- Chronic—long-term
- Recurring—periods when diarrhea is present and absent
If the body loses too much fluid, it can become dehydrated . Dehydration is especially dangerous for babies, young children, and elderly people.
Causes may include:
- Food intolerance, such as lactose intolerance
Medication, including:
- Antibiotics
- Magnesium-containing antacids
- Chemotherapy
- Laxatives
- Irritable bowel syndrome , which is episodes of diarrhea often alternating with periods of constipation
- Injury to the bowel after radiation treatments for cancer
- Malabsorption syndromes, such as celiac disease
- Diseases of the pancreas and/or gallbladder
- Inflammatory bowel diseases, such as ulcerative colitis and Crohn disease
Chronic diseases, such as:
- Liver disease
- Diabetes
- Hyperthyroidism
- Colon cancer
- Intestinal surgery
- Infections such as:
Risk Factors
Risk factors include:
- Traveling to a developing country where the water and food supply may be contaminated
- Taking certain medications
- Hospitalization
- Having a severely weakened immune system, such as with AIDS or after an organ transplant
Symptoms may include:
- Frequent, loose, liquid stools
- Abdominal pain, cramping
- Urgent need to have a bowel movement
- Blood and/or mucus in the stool
- Fever
- Dehydration
- Nausea, vomiting
- Muscle aches and pains
- Weight loss
When Should I Call My Doctor?
Call your doctor if you:
- Have diarrhea that lasts longer than 3 days
- Are not able to eat or drink to stay hydrated
- Have a fever
Call your doctor if your young child:
- Has diarrhea lasting longer than a day
- Has pus in his or her stool
- Is dehydrated—no wet diapers in 3 hours, dry mouth, crying without tears, skin that stays up after being pinched
- Is unusually sleepy or irritable
- Has a fever
When Should I Call for Medical Help Immediately?
Call for medical help or go to the emergency room right away if you or your child has:
- Severe abdominal pain and cramping
- Bloody or black stool
You will be asked about your symptoms and medical history. A physical exam will be done. The doctor may insert a gloved finger into your rectum to examine it. This is called a digital rectal exam.
To determine the cause of your diarrhea, the doctor will ask questions, such as:
- Does anyone else in your family have diarrhea?
- What kinds of food have you eaten recently?
- Do you drink well water?
- Do your children attend daycare?
- Have you traveled recently?
- Do you use laxatives?
- What medications do you take?
- Do you have any symptoms other than diarrhea, such as fever, rash, or aching joints?
- What is your sexual history?
- Have you ever had abdominal surgery?
Your bodily fluids, tissues, and waste products may be tested. This can be done with:
- Laboratory analysis of a stool sample
- Blood tests
- Biopsy
You may need to have your rectum and colon examined. This can be done with:
You may need to have images taken of your colon. This can be done with:
Treating the underlying condition may help to relieve the diarrhea.
General recommendations for treating diarrhea include:
Drink Plenty of Fluids
Plain water will not replace the electrolytes lost through diarrhea. For adults and children, look for age-specific oral rehydration solutions. Avoid fruit juices, soda, and drinks containing caffeine. For young children, continue with breastfeeding or formula feeding as advised by your child's doctor.
Ask Your Doctor What You Should Eat
Doctors differ in their approach to treating diarrhea. For example, your doctor may recommend that you:
- Drink only clear fluids during severe phases of diarrhea.
- Avoid certain foods, such as: spicy foods, fatty foods, greasy foods, high-fiber foods, dairy products in large amounts, and caffeinated drinks.
- Eat certain foods, such as: complex carbohydrates like pasta and rice, yogurt, fruits and vegetables, and lean meats
Ask your doctor which dietary guidelines you should follow. As your diarrhea subsides, your usual healthy foods can be reintroduced.
Your doctor may advise:
- Antidiarrheal medication
- Antibiotics—may be needed if a bacterial infection is causing diarrhea
- Probiotics may be beneficial in some cases
Children should not be given medication unless specifically advised by the doctor.
Diarrhea can cause severe dehydration. You may need to be hospitalized. Fluids will be delivered through an IV.
To reduce your chance of getting diarrhea:
- Practice good handwashing.
- Practice safe food preparation and food storage.
- If you have diarrhea, do not prepare food for others.
If you are traveling:
- Drink bottled water.
- Use bottled water when brushing your teeth.
- Avoid drinks that contain ice.
- Do not eat food purchased from street vendors.
- Do not eat raw vegetables or fruits. All produce should be peeled and/or cooked.
- Make sure meats and seafood are cooked thoroughly.
- Eat only pasteurized dairy products.
- If you eat seafood, make sure it is very hot.
Rotavirus is a common cause of diarrhea in children under 5 years of age. There is a vaccine to prevent rotavirus. The first dose is given at age 2 months. Make sure your infant has received this vaccine.
Revision Information
- Reviewer: EBSCO Medical Review Board James Cornell, MD
- Review Date: 11/2018 -
- Update Date: 12/20/2014 -


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The silver 1994 Chevrolet Cavalier was going about 70 mph when it drifted slowly from the right lane to the left lane of westbound U.S. 36 turnpike between Louisville and Boulder that Friday night.
Sparks flew as the car careened against a concrete jersey barrier for a couple hundred yards in the dark.
After the car finally came to a stop near the crest of Davidson Mesa at 10:18 p.m. on July 9, 2004, a witness stopped and called 911. The man who called in had no idea why the car had suddenly started drifting to the right shoulder of the road.
Another witness would tell investigators that he figured the victim may have had a heart attack.
But what was wrong with the driver, Francis "Frank" Santos, 37, a father of five, wasn't linked to health concerns.
Santos' car window was shattered. He had been shot in the left side of his head.
A second witness who was three cars behind Santos, told police he saw glass "spraying on the highway" beneath the other cars before Santos` vehicle started to weave and hit the median, West said.
The man pulled over behind Santos' car.
When the first witness learned why the crash happened he was surprised to learn the cause. He hadn't seen or heard a gunshot.


text:
Principal Proposed Uses
People have been drinking tea for thousands of years, but in the last couple of decades a number of potential health benefits have been attributed to this ancient beverage. Black tea and green tea are made from the same plant, but a higher level of the original substances endure in the less-processed green form.
What Is Green Tea Used for Today?
Green tea contains high levels of substances called catechin polyphenols, known to possess strong antioxidant, anticarcinogenic, antitumorigenic, and even antibiotic properties. 1,2 Based on these findings, as well as observational studies, 3-8 green tea has become popular as a daily drink for preventing cancer and heart disease . However, some observational trials failed to find indications of benefit with green tea. 9,10,11 Furthermore, only double-blind, placebo-controlled studies can prove a treatment effective, and there is little direct evidence of this type regarding green tea and cancer or heart disease prevention. 52 (For more information on why double-blind studies are so important, see Why Does this Database Rely on Double-blind Studies? )
Researchers have studied the potential benefits of green tea in people with high cholesterol . The overall evidence has been positive. One study found that green tea produced short-term improvements in cholesterol profile, but the benefits disappeared after 4 weeks. 26 Another study evaluated a form of green tea enriched with the substance theaflavin. 21 In this large, 3-month trial, use of the tea product resulted in significant, ongoing reductions in LDL ("bad") cholesterol as compared to placebo. In a somewhat flawed double-blind study, a green tea extract enhanced with catechins also showed promise for reducing LDL levels. 42 Lastly, a 2011 review of 20 randomized trials involving 1,415 people found evidence that green tea catechins (145-3,000 mg/day for 3-24 weeks) reduced total and LDL cholesterol. 56
Preliminary studies suggest that certain green tea polyphenols may help prevent skin cancer if they are applied directly to the skin. 12 In addition, there is some evidence that green tea constituents might help protect the skin from sun damage . 13,14,15 Unlike normal sunscreen preparations, green tea does not physically block ultraviolet light. Rather, it seems to protect cells from some of the damage caused by ultraviolet light. Because it works by such a different mechanism of action, green tea might offer synergistic benefits if combined with standard sunscreens. However, in an 8-week double-blind, placebo-controlled study of 40 women who already had symptoms of aging skin, combined use of oral green tea and a topical green tea cream failed to prove more effective than placebo. 27 Some possible benefits were seen in microscopic evaluation of skin condition.
Topical green tea extracts have also shown a bit of promise for the treatment of cervical dysplasia , 22 while oral green tea extracts might reduce risk of prostate cancer, according to a small pilot study. 28 Combining the results of 13 observational studies, researchers found conflicting evidence for green tea's effect on the risk of stomach cancer. 53 In a Japanese pilot study, green tea extract supplements lowered the risk of recurrent colorectal polyps. 54 In a review of nine observational studies involving over 5,600 cases of breast cancer, researchers failed to find reliable evidence for a reduction in the incidence of breast cancer. However, they did find weak evidence for a decrease in breast cancer recurrence among women who consumed more than 3 cups of green tea daily. . 55
For more information on green tea's capacity to fight cancer see the Cancer Prevention article.
On a completely different note, one interesting study tested the effectiveness of gargling with green tea catechins as a means of preventing influenza . 39 In this double-blind, placebo-controlled study, 124 residents of a Japanese nursing home gargled with green tea catechins or placebo for three months. All participants received standard influenza vaccine. The results showed that residents who gargled with the tea extract were less likely to develop influenza than those using the placebo. In addition, another double-blind study found preliminary evidence that oral consumption of a green tea extract might help prevent colds and flus . 44
A small double-blind, placebo-controlled trial found weak evidence that green tea chew candy might reduce gum inflammation in individuals with periodontal disease (gingivitis). 16
Oral use of green tea extracts has shown a bit of promise for treating borderline diabetes. 41 However, one double-blind study failed to find that a combined extract of black and green tea was helpful for controlling blood sugar levels in people with type 2 diabetes . 43 And a subsequent study failed to find any benefit for green tea extract in controlling blood sugar levels in obese people with diabetes. 57
Green tea has been proposed as means of preventing liver disease , but the evidence for this use remains unconvincing. 17,48
Green tea is sometimes recommended for weight loss on the basis of rather theoretical evidence that it speeds up metabolism. 23 However, there is little direct scientific backing for this use. If green tea increases metabolism at all, the effect is extremely small. 29-30 One study conducted in Thailand reported weight-loss benefits with green tea, 45 as did a second study of oolong tea enriched with green tea extracts. 24 However, a Dutch study failed to find green tea helpful for preventing weight regain after weight loss. 46 In another study, use of green tea failed to produce significant weight loss in overweight women with polycystic ovary syndrome . 31 Green tea extract enriched with catechins has done somewhat better, enhancing weight loss in one substantial, but flawed trial. 42 However, a study in overweight Japanese children did not support the effectiveness of green tea catechins for weight reduction. 47 Similar results were obtained in another placebo-controlled trial involving 78 overweight women after 12 weeks of treatment. 49
One preliminary study, available only in abstract form, found some evidence that green tea cream may be helpful for rosacea . 25 The results of another study weakly hint that green tea extracts taken orally might reduce symptoms of benign prostatic hyperplasia . 32
One study found that inhaled tea catechins could reduce levels of resistant staph carried in the sputum of disabled seniors. 33Note : Do not attempt to inhale green tea products.
Studies weakly suggest that 3 cups of green tea daily might provide protection against cancer. However, because not everyone wants to take the time to drink green tea, manufacturers have offered extracts that can be taken in pill form. A typical dosage is 100 mg to 150 mg 3 times daily of a green tea extract standardized to contain 80% total polyphenols and 50% epigallocatechin gallate. Whether these extracts offer any benefit remains unknown. Furthermore, there are growing concerns about liver toxicity with use of green tea extracts. (See Safety Issues.)
Warning : In an analysis performed in 2006 by the respected testing organization ConsumerLabs.com, some tested green tea products were found to be contaminated with lead. 34
Safety Issues
As a widely consumed beverage, green tea is generally regarded as safe. It does contain caffeine, at perhaps a slightly lower level than black tea, and can therefore cause insomnia, nervousness, and the other well-known symptoms of excess caffeine intake.
Green tea extracts, however, may not be safe. There are a growing number of case reports in which use of a concentrated green tea extract was associated with liver inflammation. 35,40,50 In most cases, liver problems disappeared after the extract was discontinued. But, in two cases, permanent liver failure ensued requiring liver transplantation. 36,40 While it is not absolutely certain that the green tea extract caused the liver problems, nor how it might do so, these reports do raise significant concerns about use of green tea extracts, especially by those with liver disease or prone to it.
Green tea should not be given to infants and young children. There are theoretical concerns that high dosages of EGCG might be unsafe for pregnant women. 37
Dried green tea leaf contains significant levels of vitamin K on a per-weight basis. On this basis, it has been stated that people using blood thinners in the warfarin (Coumadin) family should avoid green tea, because vitamin K antagonizes the effect of those drugs. However green tea taken as a beverage provides such small amounts of the vitamin that the risk seems minimal for normal consumption. There is one case report of problems that developed in a person on warfarin who consumed as much as a gallon of green tea daily. 38
Interactions You Should Know About
If you are taking:
- MAO inhibitors : The caffeine in green tea could cause serious problems.
- Warfarin (Coumadin) : Avoid drinking large quantities of green tea.
- Folic acid : Green tea may decrease the absorption of folic acid into the blood stream. 51
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


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text: Friday, March 22, 2013 Physical Therapy 'Good First Choice' for Meniscal Tear and Knee OA The New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and osteoarthritis (OA) of the knee "should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis," APTA President Paul A. Rockar Jr, PT, DPT, MS, said in response to the study. "Surgery may not always be the best first course of action," Rockar stated. "A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery." An APTA press release quotes APTA member Clare Safran-Norton, PT, PhD, OCS, lead physical therapist in the study, who said their findings "suggest that a course of physical therapy in this patient population may be a good first choice … These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options." The Meniscal Tear in Osteoarthritis Research (METEOR) trial, widely publicized after appearing in NEJM this week, showed no significant differences in functional improvement after 6-12 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone. Comments Re: menicus tear. I have a tear and arthritis. The Dr. did MRI and said too much arthritis and I need a replacement knee. (ortho Dr.) I took the article to my family Dr. and he told me to try the therapy. Do you believe this is the right way to go. I have no swelling and feel I do pretty good and I really don't want surgery.77 years old and in good shape!! Please reply. Appt with PT on Tuesday/ Thank you Posted by Barbara Williams on 5/12/2013 12:13 AM


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The Tryst is back and ready to ring in 2018 with new music from Ruby Boots.
Ruby Boots
Sean Rowe
John Knefel comments on how the Trump Administration's poor response to COVID-19 has impacted Americans and will continue to do so in the coming months. | watch
This music video will keep you sane by being totally insane during this quarantine season. | read
Matt Ruby on COVID-19. J. McVay and Jacqueline Soller on new movie, 'Swallow.' Plus a preview of Workman ong's upcoming BTR Live Studio session. | listen
Two NYC ER doctors created an Instagram account for healthcare workers to share stories and stay connected. | read
NYC band Activity is a supergroup of sorts, with Travis Johnson, Steve Levine, Zoë Browne, and Jess Rees coming from the excellent bands Grooms, Field Mouse, and Russian Baths. This particular… | watch
This week we're kicking off the episode with a preview of the upcoming SAVAK album, Rotting Teeth In The Horse's Mouth, out April 10th from Ernest Jenning Record Company, complete with a conversation… | listen


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My Twitter feed. I try to read all the "@" mentions. Chances I'll respond to you? Slim, but you never know.
I drop into the Comment threads once in awhile. I've started a new format where I can just respond to you directly on the thread, so expect more of that.


text:
Home » Sound Art - Radio Art » DUNN, DAVID: The Sound of Light in Trees
DUNN, DAVID: The Sound of Light in Trees
The author of the groundbreaking Chaos and the Emergent Life of the Pond (an '80s soundscape classic) and inventor of many highly specialised microphones, here reveals another unexpected and complex sonic universe, that of the navigable layers between the outer bark and the inner xylem of a single species of American pine. It's a world that bustles with an amazing variety of noisy life as it goes about its (mostly destructive) business. The main players are pinyon engraver beetles (size: about one rice grain), though there are walk-on parts for other species. What is extraordinary - and this is the aesthetic point of the recording - is how varied, intense and mysterious this soundworld is. Superficially similar to some of the more radical 'small sound' sampling experiments released in the last years, this CD offers both a more interesting and a more meaningful experience; it's subtle, but you can hear the purposiveness and the life of these sounds, a dimension wholly lacking in the narrow world of samples, glitches and algorithms. And these are sounds inaudible to the human ear, however close you approach their source. A fascinating work, it comes with a serious and excellent essay by Dunn on the ecology and possible significance of the sounds, and the technical details of their capture and collage.
Code: dunnSoundLight
Price: £14.50


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Discs lie between the spinal bones (vertebrae). They serve as shock absorbers. Discs protect the spine and help it stay flexible. Degenerative disc disease is wear and tear on these discs. This wear and tear causes pain and other symptoms. Some degeneration is normal as you age. Not all degeneration will result in symptoms of this disease.
The disc loses fluid and is not as resilient as a normal disc. The fibrous tissue, which holds the disc material in place, may suffer small tears. These tears lead to further damage. There is some evidence that genetics may play a part for some people.
Risk Factors
Factors that may increase your chance of degenerative disc disease include:
- Increased age
- Family history of degenerative disc disease
- Sports
- Back injury
- Smoking
- Heavy physical work
- Obesity
Degenerative disc may cause:
- Pain in the low back, buttocks, thighs, or neck
- Pain that worsens when sitting, bending, lifting, or twisting
- Pain that feels better when walking, changing positions, or lying down
- Periods of severe pain that gets better after a few days or months
- Numbness and tingling into the legs
- Weakness in the legs
- Inability to raise the foot at the ankle
You will be asked about your symptoms and medical history. A physical exam will be done.
Images may be taken of the disc and surrounding area. This can be done with:
Your bodily fluids may be tested. This can be done with:
- Blood tests
- Urine tests
Your nerves may be evaluated. This can be done with an electromyogram and nerve conduction studies.
Talk with your doctor about the best plan for you. Treatment options include:
Physical Therapy
Therapy for this condition is focused on teaching how to manage back pain. This may involve:
- Posture training
- Exercise
- Ice packs
- Warm compresses
- Electrical stimulation
- Relaxation
- Other forms of physical therapy
Steroid injections may be used for some short-term pain relief. They are injected around the nerves exiting the spinal cord.
Surgery may be required for some. Surgery may involve removing the degenerated disc and fusing 2 of the vertebrae together.
To help reduce your chance of degenerative disc disease:
- Begin a safe exercise program with the advice of your doctor.
- Maintain a healthy weight .
- If you have osteoporosis , follow your doctor's instructions for treating the condition.
- If you smoke, talk to your doctor about ways to quit.
- If possible, make changes to your workplace to reduce symptoms, such as using proper posture and safe methods of lifting.
Revision Information
- Reviewer: EBSCO Medical Review Board Laura Lei-Rivera, PT, DPT, GCS
- Review Date: 11/2018 -
- Update Date: 12/20/2014 -