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Application of real-time shear wave elastography in the assessment of torsional cervical dystonia
Cervical dystonia (CD) is the most common type of focal dystonia and characterized by abnormal head and neck movement and abnormal posture due to intermittent or persistent involuntary contraction of neck muscles, causing a significant physical and psychological burden or even loss of working ability (1). Botulinum toxin type A is still the treatment of choice for CD (2). In the anti-dystonia treatment, objective and accurate assessment of muscular tension and monitoring of muscular function is crucial for the treatment, efficacy assessment and guidance for further treatment.
In clinical practice, clinicians usually assess the affected muscles by clinical symptoms and palpation, but this is subjective. Electromyography (EMG) as an effective tool can aid the clinical assessment of affected muscle for clinicians (3,4). EMG can be divided into needle EMG and surface EMG, of which needle EMG has been widely used in clinical practice (5). Needle EMG can reveal the function and pathophysiological status of spastic neck muscles and contralateral antagonistic muscles, but the morphology of spastic and hypertrophic muscles cannot be identified. It is also invasive and may cause discomfort to patients (5). Surface EMG reflects the integrated myoelectric activity of muscles and is also non-invasive and easy to operate, but it cannot record the myoelectric activity of deep muscles and affected by some factors (6). Magnetic resonance elastography (MRE) is another method used for the assessment of spastic muscles and can detect muscular stiffness, but it is costly and time-consuming (7). Thus, it is necessary to develop non-invasive, intuitive, simple and convenient methods for observation of morphology, structure, and biology of muscles.
The muscular stiffness can objectively reflect the muscular status, and the spastic or twitching muscles have increased stiffness (8-10). Real-time shear wave elastography (SWE) is a new technique developed in recent years for measurement of tissue elasticity. This technique employs "Mach cone" principle and can collect the shear wave velocity by using ultra-fast imaging system for the calculation of elastic modulus of tissues, which can be used for the assessment of tissue stiffness. This technique has been a non-invasive, real-time, intuitive, simple and rapid one for assessment of muscular stiffness (11). It has been shown that SWE can be used for the measurement of shear elastic modulus of skeletal muscle (12-14). MSD stiffness was detected by using acoustic radiation force impulse in patients with congenital muscular torticollis (15). However, there was few studies reporting SWE applied in adult torsional cervical dystonia. In this study, (I) SWE was used for detection of shear elastic modulus of musculi sternocleidomastoideus (MSD) and musculi splenius capitis (MSC) in healthy controls; (II) the shear elastic modulus of MSD and MSC was compared between healthy controls and torsional CD (TCD) patients; (III) the relationship of shear elastic modulus of MSD and MSC with the degree muscular spasm determined by needle EMG parameters were assessed in CD patients. This study aimed to evaluate the value of SWE in the assessment of muscular status in TCD patients.
General characteristics
This study was approved by the Ethics Committee of Tongji Hospital of Tongji University. Written informed consent was obtained from each subject, and they understood the methods and examinations used in this study.
Patients with primary TCD were recruited from the Department of Neurology, Tongji University between March 2016 and March 2018, of whom simple TCD patients were recruited. Inclusion criteria were as follows: (I) patients were diagnosed with primary TCD; (II) simple TCD was confirmed. Exclusion criteria were as follows: (I) there were evident causes of TCD (such as brain trauma, spinal cord lesion, trauma, toxicity, perinatal injury, long term use of neuropsychiatric drugs); (II) there were comorbidities such as neurological diseases and systemic diseases; (III) there were nervous system positioning signs or cranial MRI showed abnormalities; (IV) patients received cranial or cervical surgery before recruitment; (V) patients received neck BTX-A treatment within the prior 3 months; (VI) patients were diagnosed with mixed TCD or simple TCD accompanied by continuous tremor.
In addition, healthy controls were recruited from the Center for Physical Examination of Tongji Hospital. There was no history of heart disease, diabetes mellitus, respiratory diseases, mental diseases, muscular dystrophy or head and neck pain in these patients.
Instrument and methods
SWE was performed by using the Aixplorer US system (SuperSonic Imagine, Aix-en-Provence, France) with an SL15–4 multifrequency linear probes operating at 4–15 MHz. MSD was superficial; thus the gen pattern was used in the general mode. MSC was relatively deeper than MSD, and superficial fascia was relatively compact. Thus pen pattern was adopted. The "penetration" mode was selected to deepen the penetration of the shear waves. The depth was 3 cm.
Patients were asked to sit on a chair with back leaning on the chair back. The neck was examined under pathological status, and patients should avoid the correction of head position. Some actions could induce pathological status. The probe was gently placed on the lateral neck to visualize the MSD with the depth of 3 cm and the elastic modulus of 0–600 kPa. On the cross-section, the thickness of MSD was measured at the middle of MSD. The MSD was examined along with the longitudinal axis up to the thoracic head and clavicular head. After examining the parallel muscle bundle, the examination was performed at elastography mode, and the lesion was determined in the area with the highest elastic modulus (Figure 1A). The region of interest (ROI) (10 mm × 10 mm) was determined, and the probe was maintained for several seconds. When the images became stable, the images were frozen, and round regions (diameter: 4 mm) were selected for the measurement of shear elastic modulus. The measurement was repeated 5 times. The system would automatically calculate mean Young's moduli, MaxYoung's moduli, minimum Young's moduli of muscle in the region of interest, while mean Young's moduli were used for statistical analysis. In the examination of MSC, the probe was placed on the back neck, and the MSC was examined from the linea nuchae superior to the spinous process of a fifth cervical vertebra. The thickness of MSC was measured on the cross-section. After examining the parallel muscle bundle along the longitudinal axis from the seventh cervical vertebra to the linea nuchae superior, the lesion was determined at the region with the highest elastic modulus (Figure 1B). The measurement was repeated 5 times, and a mean was calculated. The shear elastic modulus of MSD and MSC was also examined in controls with similar methods. Because the severity of lesions at upper, middle and lower part of MSD and MSC were different in CD patients, indicating that sometimes lesions focused at a specific segment, the muscular stiffness of upper 1/3, middle, and lower 1/3 part of MSD and MSC were usually detected, the maximal stiffness was chosen as ROI, and elastic modulus was measured. Meanwhile, the results of elastic modulus and electromyography were run for correlation analysis. During the examination, pressure should not be administered via the probe, and examination was done in the same room at the room temperature of 24 °C by the same physician who had a 10-year experience on the ultrasound examination of skeletal muscles.
Exploration by needle EMG and infusion after localization
Subjects were asked to achieve good rest on the day of examination. In addition, oral drugs (such as Baclofen, clonazepam, benzoresin hydrochloride, etc.) and excitatory nerve drinks (such as wine, coffee, tea, etc.) were discontinued on the day of examination. In this study, electromyograph and evoked potential detector (NTZ-2000, Shanghai Nuocheng Electric Co., Ltd.) were used. Patients were asked to sit on a chair, and the examiner stood beside or back of the subject. Electrode placement: generally, the electrode was placed at the detection site and injection site. Localization of the muscle: the head turned to the opposite side, and the needle was placed at the upper, middle, thoracic head and clavicular head of the muscle, followed by EMG at 2–5 points; the skin and muscle were fixed with a hand of the examiner, and then the needle was inserted into the MSC, followed by EMG at 3–6 sites. Diagnostic criteria: subjects were asked to relax or keep the neck at the abnormal status. The involvement of the examined muscle in the abnormal movement was determined according to the motor unit action potential (MUAP) measured by EMG. The cluster release of EMG signals with the rhythmic sound of released action potential on EMG suggested the involvement of the muscle in the abnormal neck movement (16). After examination, Botox injection was performed once the involvement of the muscle was confirmed.
Statistical analysis
All the data are expressed as mean ± standard deviation and statistical analysis were performed with SPSS version 21.0. In this study, continuous variables (such as body weight, BMI, shear elastic modulus, muscular thickness) were compared with the independent t-test, and correlation analysis was done with the Pearson correlation analysis. Categorical variables (such as gender, left/right handedness) were compared with independent Chi-square test, and correlation analysis was done with the Spearman rank correlation test. A value of P<0.05 was considered statistically significant.
General characteristics
Among these 120 patients with primary CD, 33 patients were diagnosed with simple TCD, and finally, 30 patients received ultrasound examination of the muscles after exclusion of 3 patients with continuous tremor. Right torsion was found in 18 patients, left torsion in 12 patients, and 11 patients had concomitant should elevation. The longest course of disease was 125 months, and the shortest one was 1 month (mean: 29.27±31.55 months). According to the Tsui scale (17), the score of these patients was 3–10 (mean: 6.47±2.76). The spasm mainly involved ipsilateral MSC, musculi levator scapulae, contralateral MSD, and cucullaris. 90 healthy controls were divided into 3 groups according to the age: 20–39 years group, 40–59 years group and 60–79 years group (n=30 per group). The age, gender, BMI and handedness of subjects are shown in Table 1.
Full table
In 7 patients, the shear elastic modulus was undetectable due to thick MSC. In TCD patients, the thickness of affected MSD was 1.49±1.53 cm thicker than that of intact MSD (max: 6.10 cm) (P<0.01); the thickness of affected MSC was 2.87±2.67 cm thicker than that of intact MSC (range: 0.10–8.70 cm) (P<0.01). In addition, the thickness of affected MSC and MSD in TCD patients was also significantly different from that in controls (P<0.01). The elastic modulus was comparable between MSD and MSC (P>0.05). The elastic modulus of intact MSD and MSC in TCD patients was also similar to that in controls (P>0.05). SD value was relatively high in the affected group, which was associated with disease severity according to Tsui scale. The difference of Young's moduli between severing and the mild lesion was big, leading to high SD value with a maximum >30 kPa, while the difference of mean Young's moduli in normal muscle tissues, leading to low SD value with a maximum >4 kPa (Table 2).
In healthy controls, the shear elastic modulus of MSC and MSD had no
Full table
The elastic modulus of affected MSD and MSC in TCD patients was significantly different from that in healthy controls (P<0.01) (Figure 4). ROC analysis showed the diagnostic threshold of MSD and MSC was 24.90 kPa and 25.07 kPa, respectively (area under ROC: 0.979 and 0.979; sensitivity: 90.0% and 91.3%; specificity: 95.6% and 96.7%) (Figure 5).
The intraclass correlation coefficient of MSD and MSC elastic moduli in the normal control group was 0.92 and 0.91 respectively. The intraclass correlation coefficient of contralateral MSD and MSC elastic moduli was 0.90 and 0.91 respectively. The intraclass correlation coefficient of affected MSD and MSC elastic moduli was 0.89 and 0.88 respectively (Table 3).
Full table
TCD is the most common type of CD (18) and mainly involves contralateral MSD, cucullaris, ipsilateral MSC and musculi levator scapulae. Especially, the MSC and MSD are the most susceptible to CD (18). Thus, in the present study, MSD and MSC were examined by SWE, and the shear elastic modulus of both muscles was determined, aiming to assess the features and muscular tension of both muscles in TCD patients.
The cause of CD remains still poorly understood (19). It has been widely accepted that the occurrence of CD is as a result of interaction between genetic and environmental factors. In the early phase of CD, the spastic muscles have weak strength and the corresponding contralateral muscles may counteract with it, and thus there is no significant difference in the muscular volume. The progression of CD may significantly increase the difference in the muscular strength between the intact side and affected side. The volume of spastic muscles may progressively increase due to the long-term uncontrollable movement, resulting in hypertrophy and stiffness of affected muscles. There is evidence showing that the distribution of spastic and hypertrophic muscles on CT is closely related to the type of CD (20). Generally, the hypertrophic muscles are mainly distributed in the posterior 1/4 region of rotator capitis side (such as MSC, musculi semispinalis capitis, musculus semispinalis cervicis, and musculi levator scapulae). In the present study, routine ultrasonography was done to measure the thickness of related muscles. Currently, there is no normal range for neck muscles on the cross-section. Thus, it is crucial to compare the muscles of both sides. Our results showed the thickness of spastic muscles increased significantly as compared to corresponding contralateral muscles in TCD patients, and the increase was more evident in the MSC of rotator capitis side.
As compared to other elastographic techniques, SWE does not require manual compression, which reduces the operation error and increases the repeatability (21-23). In addition, it determines the shear elastic modulus which represents the biological characteristic of muscles, and thus it is applicable in the quantification of muscular tissues. Examiner intraclass repetitive researches were also conducted in this study. Results showed that ICC was over 0.75, indicating that elastic moduli measure with SWE was reliable and repeatable. Muscular tissues have anisotropy. It is speculated that during the measurement of shear elastic modulus, the measurement will be more accurate and have better repeatability when the acoustic beam plane is parallel to that of muscular fibers (24). In the present study, the probe was parallel to the muscular fibers in the measurement of MSC and MSD. SWE can quantify the shear elastic modulus of neck muscles in a non-invasive manner. Our results showed there was a significant difference in the shear elastic modulus of MSC and MSD between healthy controls and CD patients, and the diagnostic threshold was 24.92 and 25.22 kPa, respectively, with high sensitivity and high specificity. In our study, the subjects were asked to keep calm during the measurement because MSD was superficial, and thus the results were stable. However, the elastic modulus of MSC was undetectable in 7 subjects. This might be ascribed to that the MSC is deep (under the cucullaris), the muscles in back neck became thicker, and the vibration amplitude of tissues in back neck reduces because the connective tissues in the back neck are dense and the probe frequency is limited (4–15 MHz). In the present study, only simple TCD patients were included, and those with continuous tremor were excluded because our previous findings showed the shear elastic modulus on SWE was unstable in patients with continuous tremor.
Arda et al. (25) speculated that the mean elastic modulus of normal masseter, gastrocnemius, and supraspinatus had no relationship with age, and there was no significant difference in the elastic modulus among different muscular tissues. Our results showed the shear elastic modulus of affected MSD and MSC in TCD patients, and that of MSD and MSC in healthy controls had no relationship with age, and there was no significant difference in the shear elastic modulus between MSC and MSD in healthy controls.
Nordez et al. (26) applied SWE in the assessment of shear elastic modulus of musculus biceps brachii during the isometric contraction, and results showed the shear elastic modulus was positively related to the myoelectric activity during the isometric contraction and linearly associated with the myoelectric activity in a specific range of isometric contraction. Our results showed the elastic modulus of spastic muscles was significantly higher than that of contralateral muscles, which suggests that the stiffness of affected muscles is higher than that of intact muscles. In addition, it was positively related to the myoelectric activity on needle EMG.
There are still several limitations to this study. Although the patients were blind to examination, the double-blind examination was difficult for the examiner, which may cause bias in the explanation of results. Moreover, the sample size was small, and a single center was involved, which may cause subjective errors. Thus, our results should be further validated in more multicentered studies with large sample size.
Taken together, SWE is a simple and convenient method for the assessment of muscular strength. The measurement of muscular mechanical properties is helpful for the understanding of the interaction between muscular structure and function, and for quantification of muscular elasticity, which provide scientific evidence for the diagnosis of spastic muscles and following assessment of prognosis. Thus, SWE has applicable good value in clinical practice. Of note, there are several limitations to SWE which is also muscle selective, and more clinical trials with large sample size are warranted to confirm our findings.
Funding: This study was supported by the Building Project of Clinical Assistant Department Capacity of Shanghai Shenkang Hospital Development Center (No. SHDC22015009).
Conflicts of Interest: The authors have no conflicts of interest to declare.
Ethical Statement: The study was conducted in accordance with the Committee for Human Research at our institution and followed all regulations. Informed consent was obtained before scans.
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One of my favorite thing to do as I wander the docks before heading out on a sail is to check out the clever boat names and ponder over thier story. This boat was moored next to us recently, and I LOVE the name About Time!!
Was it a dream deferred for years? So many people are working for the weekend, or working for retirement. What are the sacrifices you are making, and which ones are worth it? Was it "About Time" the owner finally learned to sail, or gave themselves the gift of being a boat owner after years of dreaming? What dreams can you give yourself now? What are you doing to make your now dreams your future reality?
Or was the boat named after how we spend our time? Increasingly, I am valuing how I spend my time over how I spend my money. Is this name about About (how we spend our) Time? Certainly, whenever I can, I choose to spend my time at sea, with a handful of close friends who value adventure, meaningful conversation, and quality time.
"What is freerange coaching?" People keep asking me to explain free range coaching. Let's start with basic "industrial" coaching. Whether it is life coaching, executive coaching, or even transformational coaching, it usually happens every week. A client will get an hour on the phone, or on a video call with their coach. Lucky clients get to see their coaches face to face. My clients in this type of engagement are seeing the power of long term change, and there is tremendous value in that.
There are a few coaches out there who want to give more to their clients, and we find that an intensive or an immersive experience creates ten times the results!
When I first began to settle into coaching, it was in the alpine, and we were using back country skiing, mountain biking, and ice climbing as the experience to contain the coaching. After percolating with that, it became clear that I was meant to use outdoor activities in a focused on the specific agenda of the client sort of way. In that intentional shift into #freerangecoaching, I thought I would do it all. All of the adventures in all of the countries proved to be a bit much. The commitment to focus in on Sailboat Coaching was the right alignment for me, and still, all forms of freerange coaching hold fascination for me. I am inspired by my friends who are coaching on Canoe trips, in the tree tops, and with medieval swords! People are coaching through forest bathing, with horses, and actual wolves!
"What is the magic formula" for creating an excellent team? As I was laying awake one night wondering how to create the best teams, ACT popped into my head in near finished form. The importance of teamwork to sailing, and indeed most organisations, can not be overstated! Three simple ideas create teams that can do great things.
Since that fateful night, this poster has been fixed to the bulkhead of boats I am captaining, and to the walls of conference rooms where I am leading. What does it mean? In it's simplest form, it means that if we get these three things right, the work will (almost) do itself.
In any complex and collaborative project, it is so easy to focus on the skills. When someone asks me where sailing skills sits on my list of requirements for Co Leaders at Sailboat Coaching International, it is an easy answer. Skills are forth. Skills are complex, and take time to teach. Compared to Attitude, Communication, and Teamwork though; skills are the easy part.
If someone is an Olympic level sailor, and a world class coach, will they be welcome on our team? That depends, if they are also strong in priorities 1, 2 and 3, absolutely!
The same holds true of something like making a movie. You have a team of ~200 people who are all working to create the same vision, which keeps changing and adapting personal competence very quickly becomes a really small part of how WE come together to create the science which will render the art. But don't you want the best specialists? Sort of. You want the best specialists you can work with.
What does Attitude, Communication, and Teamwork actually look like??
ATTITUDE: When you sail long enough, and far enough, something will eventually go wrong. One day someone made a mistake, and emptied the holding tank overboard… into our dingy. (The holding tank is the boat's is where all of our sewer waste is stored until we get to a place where it can be emptied responsibly.)
SHHhit! Everywhere! Did they blame, delay, or complain? Nope. They immediately assumed responsibility, and said, "It's my mess, I'll clean it up." It would be hard to find a clearer example of the right attitude than this. It not about never making a mistake, it is about taking responsibility, and ensuring that your mistakes don't become everyone else's problem. There is always SOMETHING to complain about, but unless there is a solution, complaining just wastes your, and everyone else's energy. Attitude is about more than positivity, although that is part of it. It is about taking responsibility for your actions, your words, and your IMPACT!
COMMUNICATION: The first thing you can do to earn my trust on a boat, is be willing to ask when you don't know. There are some people, and it is surprising how often they are business owners, who will come back to me and say some version of "Here is the obstacle I encountered in learning how to do the thing that you asked me for, and this is how I handled it." This is really asking 2.0.
Communication has many components. Brene Brown says that clear communication is kind communication. Say what you mean, mean what you say, and don't use "I was just being honest" as your excuse to be mean.
Clear is Kind. Brene Brown
TEAMWORK: There are many times when I could literally sail the boat single handed. Getting everyone involved, and doing it together makes it more fun though! And sometimes the jobs are really simple. I'm just going to hold this, and pass it to you when you need it. Just like on land, two people can cook a meal, and two different people can volunteer to do the dishes and clean up.
Oh, AND, ACT spells act. Whether the thing you are trying to do, whether it is building a building, creating a movie, or racing a sailboat, the act of doing is made up of Attitude, Communication, and Teamwork. In many ways ACT…ion is a stronger word. Will there be an I O N added to this system? Stay tuned!
Does Attitude, Communication and teamwork mean you'll never have to work again? Probably not, but give it a try, and let me know how much easier and more fun your work is!
*My research has shown this idea not to to have been borrowed from any known sources. If in fact Brene Brown or Shawn Achor said it first, I would love to know where!
PURPOSE in the POST INDUSTRIAL ECONOMY
How does the end of the industrial economy effect life purpose? Just like Industrialism brought massive increase in employment diversity over the agricultural economy, so has Post Industrialist economy exponentially increased our vocational options!
Perhaps it is early to start speculating about what the time we now live in IS, but we are starting to see what it is NOT.
The time for complaining about the "good manufacturing jobs" being shipped overseas has past us by. Those jobs won't exist for much longer anyway. Before we know it, most of us will be in careers that haven't been invented yet. This revolution of vocation has happened before, and each time it happens both sooner and faster.
Very long ago, humanity made the shift from a hunter gatherer economy to an agricultural one. We still have hunters and gatherers among us, and I were to hazard a guess, I would say they make up between 0 and 2% of our labours.
By the time of my Grandparents, 60% of North Americans made their living farming. Any guesses what that number is now? 2%. At least twice in history (that we know of) we have set 98% of people free to pursue vocations that did not previously exist. And it is happening again. People who are alive today, will live to see 98% of all humans working in ways that had not yet been imagined when they were born.
So what does all of this mean? It means that vocation has changed. What we look for in vocation also needs to change. We have been sold a bill of goods. Let's call this the industrial package. You finish school, you go to work, you retire. And I'll tell you, if my job were to work 92000 hours on some assembly line somewhere, I'd be excited to retire too!
All of this is coming to end, and when it started coming to end was by best guess 1974. It is hard to say exactly, since I wasn't alive during the industrial era, but all my research points to the mid 70s as the tipping point.
So why are we still giving out advice that revolves around a bill of goods that is evaporating underneath us? Whether we call it the information age, the gig economy, or post industrialism, we are now more likely to create our own "job" than to find one. Our imaginations for what life could look like can also change in ways we have not yet imagined.
So open your imagination, if you retired from your industrialist job today, how would you spend your time? What matters to you? What space would you love to create and occupy? What is your purpose has gone from multiple choice to long answer creative. What purpose do you imagine for your life?

subset: commoncrawl


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Yeah, I feel like there's a difference between a good when it comes to comics and most media. The fact that there is a comic that gets a 9.0 average on comic book roundup tells you all you need to know about the standards of the medium.
All of the stories you listed are enjoyable, but nothing to write home about. If you aren't a fan of the character, they aren't worth reading. Which is my criteria of good.
It does give a slight bias towards beginner friendly stories like Year One, but that truly is more memorable than anything else.
And I strongly agree that most of his best stuff is when he isn't Nightwing. Those are all great stories.


text:
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The Aqua Goat is the third goat that can be found in Mountains.
Appearance Edit
The Aqua Goat is mostly blue. It has dark blue areas on its body, and orange feet. Its horns are thin and long, curling back to behind the player's legs. To the side of its eyes are fins, coloured orange with dark brown lines possible representing blood vessels.
Description Edit
Aqua Goat. Does whatever an Aqua Goat does...
Requirements Edit
- Sky Zoo upgraded to Mountains 1 or greater.
- Mountain Goat tamed.
- Ride past 1600m in Mountains.
Note: Its chance of appearing is medium due to it being a tier 3 animal. It will appear in just over half the runs the player does, and never before 1600m.
Baby Aqua Goat Edit
Trivia Edit
- The description references the Spider-Man theme song.
- The Aqua Goat possibly plays on Aquaman.
- The Baby Aqua Goat's ability where animals are 8% faster in water also references aqua.
Notes Edit
- The Aqua Goat was released in version 1.1.0 on the 26th of July 2016 along with Mountains and all other Mountains species.
- The description contained several of the same error, with "Aqua Goat" being written as "Aqua goat", missing a capital letter.
- This was corrected in version 1.15.0 on the 22nd of March 2018.
Community content is available under CC-BY-SA unless otherwise noted.


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Inflammation of the heart muscle is medically known as myocarditis. It can be mild with less intensive symptoms or quite severe and associated with certain complications such as heart failure or arrhythmia.
The condition affects otherwise healthy individuals. Myocarditis is classified into acute myocarditis, chronic active myocarditis, chronic persistent myocarditis and fulminant myocarditis. Acute myocarditis leads to ventricular deficiency and may progress into dilated cardiomyopathy. Chronic active myocarditis is characterized with clinical relapses and associated with ventricular dysfunction and chronic inflammatory changes. In chronic persistent myocarditis there is no ventricular dysfunction even though there are symptoms such as chest pain and palpitations. And finally, fulminant myocarditis develops after a viral prodrome. It is responsible for severe cardiovascular compromise and ventricular dysfunction and may lead to lethal outcome.
Clinical Characteristics and Diagnosis of Myocarditis
Many patients report a previous infection accompanied by fever. They often turn to their doctors complaining about flu-like symptoms such as weakness, fatigue, shortness of breath with activity all of which point to some degree of heart failure.
The diagnosis of myocarditis is many times delayed because it develops as a result of initial infection. By performing a physical exam a doctor may detect rapid heart rate and by listening to the heart he/she can identify irregular or so called 'galloping' heart rhythm. Auscultation of lungs may point to the presence of fluid in lung tissue (pulmonary edema). Patients require additional tests and exams such as chest X-ray and Doppler echocardiogram. Definitive diagnosis is set after endomyocardial biopsy.
Acute Myocarditis Treatment
Treatment for myocarditis is symptomatic, meaning that it deals with current symptoms and signs of heart damage. In case the causative microorganism is known, patients may be treated with specific medications.
Patients with heart failure require different drugs such as digitalis, beta blockers, calcium channel blockers and antiarrhythmics. Diuretics, corticosteroids and anticoagulants may be administered as well. Additional measures include rest, plenty of sleep and reduction of stress. Severe cases of myocarditis cause irreversible damage to heart muscle and may be only treated with heart transplantation.
Prognosis and Potential Complications
Certain number of patients completely recover and damage to the heart muscle is minimal. On the other hand, others may develop progressive heart failure. Even when left untreated the condition may either resolve on its own or cause congestive heart failure and subsequent death. Similarly, in spite of proper treatment, even lethal outcome may be possible.
Complications associated with myocarditis include dilated cardiomiopathy, acute heart failure, cardiogenic shock and death.


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"I like Santos (STO)," Michael says. "Rising production, falling costs and $1.1 billion in free cash flow in the fourth quarter are all good reasons to consider STO, despite the gains from below $7 to touch $9 per share.
"However, the Joint Federal/state announcement of co-operation puts STO's CSG assets at Narrabri in a new light.


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"That is also a huge part of my mission at Meri Sanskriti, it's to help people to love themselves and embrace their uniqueness. Because when we stop judging and start loving that is when we are able to truly be the best version of ourselves, and shed everything that is not us INCLUDING excess weight"... Continue Reading →
Emotional Stability through Indian Dance & Mythology
Our emotions control everything. Emotions are literally the thermometer to our body, why do we do what we do? It's usually an outcome of some emotion. If we are upset, we do certain things after we are upset, if we are sad, happy or whatever we do. If we are happy, we may choose to... Continue Reading →
2nd Gen Experiences of Desi Immigrants
...but we can also set a platform for the Indian kids of the next generation to grow to even higher levels representing Indian Americans without the limits we felt we had growing up.."
Meri Sanskriti-My Culture & Heritage
"Champion Capri's & Sperry's with mismatched socks in the middle of a historic gali (narrow street)in my desh(country), this picture accurately describes me in a nutshell"-Amruta Panth So, I'm Indian...but I'm also American. I'm 150% Indian from the inside out, but I wasn't raised there. I was raised always being " The Indian Girl"'in a... Continue Reading →


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Singapore-based Katrina Group Ltd, an established and recognised Food & Beverage (F&B) group of companies with multi-cuisine concepts, has lodged its preliminary offer document in connection with its proposed initial public offering (IPO) and listing on the SGX Catalist board.
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text: The fender standard telecaster guitar is unique in the lineup of electric guitars from this World renowned guitar maker. Fender's long history of providing quality stringed instruments is evident in this affordable and very popular electric solid body guitar. Fender's standard telecaster guitar incorporates the old and the new with a fast action maple neck, cast sealed machine heads, 2 single coil classic pickups and combination six saddle string through body bridge. Guitars just don't get any better. You can buy the fender telecaster guitar online in a safe secure environment. If you can't find the instrument of your choice on these pages, we'd be happy to find that special model for you. Simply contact us and state your preference. We'll track down your information and get back to you with our findings.Feature Model


text: Sweet-natured Cinderella lives the life of a servant at the home of her downtrodden father and cruel stepmother, teased and tormented by her two foolish stepsisters. Will she make it to the ball to meet the handsome Prince? With a little help from her fairy-godmother, she just might. A glittering comic opera celebrating the power of fantasy, Cinderella is Jules Massenet's musical fairytale. An enchanting retelling of the familiar Cinderella story, it balances the exquisite beauty of its romantic and fantasy scenes with deft, witty portraits of Cinderella's stepmother and stepsisters.


text:
Arthritis is one of the most common diseases that is affected by more than 50 million adults in America. The terrible fact about this health issue is that it is not a single disease; rather it is referred to as a kind of joint disease or joint pain. You will be surprised to know that there are more than 100 types of arthritis along with many other disease conditions related to them. It can affect patients irrespective of their sexes, ages, and races. Arthritis is currently observed to be the most common cause of disability among Americans.
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This blog features observations from Randy Turner, a former teacher, newspaper reporter and editor. Send news items or comments to email@example.com
Sunday, August 26, 2018
Ruling expected on former Jasper fireman's lawyer's request to withdraw from child molestation case
Judge Gayle Crane will also rule on a motion by Taffner's attorney, Elizabeth Turner, to withdraw from the case.
Taffner was bound over for trial after he waived his preliminary hearing August 2.
An underage girl described her molestation to interviewer at the Children's Center, according to the probable cause statement, saying Taffner used his mouth and fingers on her, put her on the bed, "laid on top of her for about 25 seconds and was moving a lot."
The child described four incidents she said had taken place within the last year.
After the police read Taffner his rights, according to the probable cause statement, he admitted that officers might find evidence indicating he had been on the girl's bed.
Taffner is being held in the Jasper County Jail without bond.
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14 in. H College Football "Letterman" the Gnome Home and Garden Gnome 50's tatue
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text: Lang Technik From raw material to finished product – A fitting solution for all challenging clamping tasks. Unbeatable in 5-sided manufacturing. With its compact build, the 5-Axis Vice has ideal workpiece accessibility. In addition, this clamping package is completed with (multiple) clamping systems for profile and round parts (Avanti, Profile Clamping Vice, Ino-Grip chuck), along with the […]Read More


text:
Gov. Nathan Deal used the word "cautious" several times on Thursday to describe his approach to Hurricane Matthew. Even as he urged coastal residents to escape the coming storm, he also urged them not to go overboard.
"We are being cautious but we don't want anyone to panic," said Deal. "We are prepared as we can be for this crisis."
South Carolina Gov. Nikki Haley has pleaded on camera several times this week for coastal residents to evacuate. And Florida Gov. Rick Scott bluntly warned Floridians on Thursday: "This storm will kill you."
But public pleading and colorful sound bites are not Deal's style. Although he has ordered one of the largest evacuations in state history, the governor has stayed largely behind the scenes as state officials ramp up their preparations for the storms. He was on camera only once before hosting two press conferences on Thursday.
In his later press conference Thursday in coastal Georgia, Deal noted, "It's the first time I've had a hurricane on my watch. We have been fortunate. But we don't need to be lackadaisical… . We have been cautious in our declaration."
Perhaps too cautious, one coastal resident suggested on Thursday.
Keith Crosson, 46, who lives near downtown Savannah, was waiting at an evacuation shelter.
"We should've been warned more loudly – police, firemen, city officials, and the governor definitely," he said.
At his news conference, though, Deal was asked whether he was satisfied with Georgia's preparations, now that he has seen what Haley did in South Carolina.
"I am. We believe we made the declaration (at) the right time for the evacuation," Deal replied. "… It's very disruptive to pick up and leave homes and business."
With Hurricane Matthew, Georgia probably isn't facing the same peril as Florida. But Deal said he has been "very cautious" messages to the public and is loath to use the same sharp warnings other Southern governors have directed at their hurricane holdouts.
Asked what message he had for holdouts in Georgia, he said "Mother Nature" will answer that.
"I have not been one who has overreacted," he added. "But we want to imply this is serious."
The governor has taken few chances after the poor communication and slow government response to the 2014 ice storm that transformed a dusting of wintry weather into an embarrassing disaster.
Under the state's new weather response strategy, Deal seems to have embraced a better-safe-than-sorry policy. He has declared emergencies and called for workers to stay home long before severe storms rumbled through.
As Matthew neared on Thursday, the state was taking a broad range of precautions.
Hundreds of state emergency staffers deployed near the coast. Pilots moved state aircraft to higher ground in case they're needed for search-and-rescue missions. Dozens of Georgia National Guard soldiers were called to duty. Deal ordered 100,000 residents living east of Interstate 95 to leave and urged another 400,000 in low-lying areas to follow suit.
And Deal, again, walked the line in his message to the public, trying to strike a balance between a firm warning and his concern about inciting panic.
"We aren't going to go dragging anyone out of their houses against their will," Deal said. "But the mandatory evacuation is significant. It's the highest warning we can give to people on the urgency of evacuating."
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Travel with Landrail Safaris to explore different parts of Kenya. Landrail is inclined towards giving the best services to our clienteles putting all requests into consideration. Book with us and we'll guarantee you a memorable experience. Isn't that thrilling!
You will be picked from your city hotel and drive to Olpajeta conservancy located in the outskirt of Nanyuki town arriving in time for lunch. A visit to the Sweetwater's game reserve and later to the Chimpanzee Sanctuary. Expect to see the white rhino, elephant, hyena, antelopes, Buffalo and Chimpanzees in their confined area with help of the guide. There are number of activities in the sanctuary i.e. bird watching, walking horse and camel ride along side others. Drive back for dinner and overnight stay at the lodge.
Pick up from the hotel after breakfast and proceed to Lake Nakuru National reserve. Arriving in time for lunch. Afternoon games drive in Lake Nakuru National Park that is known to be the home of white and black rhinos and different bird species. Some of the animals found here Lions, Waterbuck, buffalos and baboons alongside others that you will be setting your eyes on while on the game drive. Dinner and overnight stay at the lodge.
After breakfast leave for a game drive and later proceed to Lake Naivasha arriving time for lunch. A visit to Hells gate national park with an optional boat ride. A nature walk to one of the famous island would be perfectly awesome way to see the different wildlife in their natural habitat without any feeling of jeopardizing your life. The island is a private game sanctuary that has different animals like wildebeests, monkeys, zebras, waterbuck and giraffe. Dinner and overnight stay at the Lodge.
Depart from the lodge after breakfast and drive to Masai Mara National Reserve arriving during time for lunch. Go in through check in formality and proceed for afternoon game drive in the reserve. Mara is known to be the home of the big five and large number of antelopes in the same ecosystem. It is in this reserve that we find the wonder of the world being the wildebeest migration that occurs almost annually forming the major part of the most phenomenal event in Mara National reserve. Dinner and overnight stay in the lodge.
You will be picked from the lodge by the driver guide for a game drive in the reserve. The landscape here is scenic grassland on rolling hills qualifying it to the best game viewing reserve in Kenya. Later picnic lunch at the hippo pool with aim of seeing the crocodiles and hippos. A visit to Masai village to see the Marr community exhibiting their culture in full swing. Pose for a photo with them would make no harm. Dinner and overnight stay at the lodge.
Early morning game drive as you trail the animals in their hide out. The driver will drop you off to the Lodge for breakfast and check out from the lodge. Depart for Nairobi arriving in the evening with lunch on board. Drop off to hotel or transfer to the airport to catch your flight.
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Events for Dec 14, 2019
Events Search and Views Navigation
8:00 am
Guardian's Halo Project
"Most of us are so focused on our goals and where we need to go, we rarely take a moment to do something for others. Just. Because. Doing something nice for others, without an agenda, simply feels good." - National Today Spreading kindness and caring for others can be found at every level of the […]Find out more »
9:00 am
Shop in your jammies! This is your chance to shop in your pajamas! Get your cozy flannels on and come to the Junction for Pajamarama! At participating merchants receive a free limited edition diner mug w/ $20 purchase (you must be wearing your PJs). Or simply bring a mug with you. Either way, we'll fill […]Find out more »
10:00 am
Leavenworth Christmas Tree Lighting Getaway!
Address for Seattle departure: 1043 Harrison Street Seattle, WA 98103 Bellevue departure: Eastgate Park & Ride Bellevue, WA 98007 Info: Bellevue or Seattle departures available! Light up your December with Leavenworth's famous Christmas Tree Lighting. For the ultimate day trip, hop on our luxury bus with your friends and family and head […]Find out more »
11:00 am
Pierre Leguillon: Arbus Bonus
Pierre Leguillon's artwork-as-exhibition Arbus Bonus calls attention to the major role famed twentieth-century photographer Diane Arbus's work has played in defining the image of American postwar popular culture. Bringing together every published magazine spread that features her photography, Leguillon's project considers the ways in which cultural histories are assembled and disseminated, and proposes more inclusive counter-narratives.Find out more »
Unsettling Femininity: Selections from the Frye Art Museum Collection
Bringing together varied depictions of women from the Frye Art Museum's collection, Unsettling Femininity examines historical conventions of representation during the late nineteenth and early twentieth centuries and the deeply entrenched beliefs and power structures they reflect.Find out more »
Donald Byrd: The America That Is To Be
Seattle-based choreographer Donald Byrd works at the forefront of contemporary performance. For four decades, he has created innovative and startling dance theater works that explore the extraordinary capacities of dancers' bodies, the complexities of Africanist aesthetics, and the ways that theatrical dance can open audiences toward social change. Presenting selected works from across his prodigious […]Find out more »
Dress Codes: Ellen Lesperance and Diane Simpson
Clothing is both a highly personal and socially constructed system of communication: a signifying point of contact between individual identities and collective attitudes, customs, and trends. Dress Codes brings together the work of two artists who perform acts of translation in relation to clothing's form and ornamentation, pressing images of historical garments—and the values encoded within them—through […]Find out more »
7:30 pm
Jomama Jones Black Light
Developed by UW Creative Research Fellow Daniel Alexander Jones and starring Jones's alter ego — legendary singer Jomama Jones — Black Light is a captivating musical journey that fuses the Black American Freedom movement, Afromysticism and goddess mythology with the musical influences of Prince, Sade, Diana Ross and Tina Turner. Black Light removes the barrier between artist and audience, […]Find out more »
Scott Shoemaker's War on Christmas!
Shoes and Pants Productions Presents: "Scott Shoemaker's War on Christmas!" December 5 – 22 (Thursdays, Fridays, Saturdays at 7:30pm; Sundays at 2pm) Back by popular demand, it's "Scott Shoemaker's War on Christmas!" Last year's inaugural run of this all-star variety spectacular was such a hit that it has become a bona fide Yule Tide tradition. […]Find out more »
Howl's Moving Castle
In the fantastical land of Ingary, being the eldest of three means your destiny has already been decided. Or so Sophie Hatter believed, until she was hit by a curse from the Witch of the Waste. When she seeks refuge in the dread Wizard Howl's castle, she finds unlikely allies, and friends, in the sorcerer, […]Find out more »
Star Light, Holiday Bright – Believe in the Magic!
Brighten up your holidays with this festive concert from The Northwest Firelight Chorale. Our ever-popular holiday program will include stunning arrangements of seasonal favorites, a glorious gospel showstopper, a rousing sing-along, and the kind of joyful surprises that we are known for! Saturday, December 14 St. John the Baptist Episcopal 3050 California Ave SW Seattle, […]Find out more »
Post your event to The Seattle Globalist calendar »
Make a correction, delete your event, or report a problem with an event listing on The Seattle Globalist calendar »
Calendar event posts are submitted by members of the public and/or by organizations unaffiliated with The Seattle Globalist. Questions about individual events, postings and images used in calendar items should be directed toward the event organizers, who are responsible for the content.


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Read and follow all instructions that accompany any fuel-burning device. Everyone new teen drivers in Texas, its a great study practice test. Parents can become their instructor. Be alert for oncoming traffic. The open-ended questionnaire with the proposed sign image was administered to 116 students in driver education classes at three local high schools, 43 undergraduate students in an engineering class at the local university, and 50 older drivers at a local Senior Center.
Avoid changing radio stations, using a cell phone, etc. Recognize common hazards in your driving environment and react to prevent collisions. This Learners Permit Study Guide helps you to get ready for your Learners Permit driving permit. Get ready for your permit test today! An open-ended format was used for the sample groups to provide the researchers valuable information as to what extent the multiple choice format influenced the responses to the mail-out survey. Almost a quarter of the respondents viewing the existing sign indicated that they had never seen it. Taking a Safe driving course has become an inevitable requirement of any driver to drive safely and to learn defensive driving and all essential traffic rules as well.
The leading cause: driver inattention. As a driver nears the tag, the app would pick up an audio message and speak it to the driver. . More than 30 percent of the study subjects associated the paddle sign with a school crossing. A sample of the multiple choice format questionnaire for the proposed sign is presented in Figure 2. Of the 4,500 total surveys mailed out, 813 were returned from the Post Office as a result of an insufficient address, lack of forwarding address, or other problems with locating the addressees. Patience is the key in construction zones.
You may also see electronic signs that display changing messages. The percent distributions of correct, substantially correct, and incorrect responses to question 2 for the existing and proposed signs are shown in Figure 4. Hazards will come from all directions; from construction workers and vehicles entering the road and from impatient, speeding, or distracted drivers. Traffic is traveling in both directions on a roadway that is normally one way. These listings were then recorded and stored for use in the mail-out survey.
Remember the construction zone crew members are working to improve your future ride. Accuracy of Answer Sign Correct Substantially Correct Incorrect Existing Sign 76. Figure 7 shows the traffic control layout for a typical flagging operation on a two-lane road in Virginia. Fumes can build up very quickly in the garage and living area of your home. Both signs were correctly identified as being associated with road work operations in the current study. Approximately 200 additional proposed sign questionnaires were mailed out in the Charlottesville area and 71 completed surveys were returned. Comparing a Single Sign Versus a Series of Signs in a Work Zone In this study, survey data were obtained on a single sign, either for the existing or the proposed advanced flagger warning sign.
The lights used to illuminate the construction zone could blind drivers and prevent them from seeing workers in time. The needs and responses of older drivers to traffic control are receiving much attention. Drivers should also be on the lookout for construction trucks entering the roadway. These signs are normally posted well ahead of the construction zone to alert drivers to the dangers ahead and to give them time to slow. Leave extra time so you don't need to worry about running late.
The percentage distribution of correct responses to this question for the existing and proposed signs is shown in Figure 5. The combination of these two answers suggest that what the respondents say they would do is correct, although what they say the sign means is incorrect. Responses that included the correct answer in addition to an incorrect answer were coded as substantially correct, with the assumption that the respondent knew to expect the sign in a work zone, but thought it might also be used in other applications. Most Common Types of Crashes by Work Zone Area Problem: A driver in clear weather during mid-afternoon comes upon slow or stopped traffic due to a work zone and crashes into another vehicle, or in the process of avoiding such, crashes into a barrier, equipment or pedestrian. Why are there flashing arrow panels on the road? What if there were a better way to alert drivers and get their attention? They also performed better when changing lanes and holding their speed, and they remembered audio messages better than drivers who read road signs.
It is important that you understand these two laws because if you do not have the proper auto insurance, you can lose your driver's license and vehicle license plate s and have to pay large fees to get them back. That means that there will be more highway construction projects than ever beginning in the near future. Use the proper fuel and keep doors to the rest of the house open. Older drivers probably would have encountered many flagging operations over the years, whereas younger drivers most likely would have encountered few of these while driving. As a result, increasing numbers of motorists have been exposed to this new sign.
A list of 10 names and addresses were obtained for each random number pairs until 4,800 listings had been recorded. The survey results indicated that the proposed sign was for the most part understood by Virginia drivers and appeared to be effective at conveying its message. A total of 1,383 questionnaire replies were received 759 contained the existing sign and 624 depicted the proposed sign. Whenever possible, choose appliances that vent fumes to the outside. The advanced warning sign is intended to alert drivers to the presence of flaggers and to prepare drivers to stop if necessary prior to reaching work zone operations. These signs are orange with a black legend.
The danger in these zones come about when drivers become impatient and take risks;. Acquire the skills and knowledge you need to be a defensive driver. Start your free car insurance quote online in just 15 minutes. The purpose of driving safety program is to increase road safety awareness by reducing traffic violations and to keep your auto insurance premiums low. Some rules are: Never idle the car in a garage, even if the garage door is open. Therefore, the total number of responses desired was 1,200 600 for each sign , requiring a target mail-out distribution of approximately 4,800 questionnaires.


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A healthy lifestyle is key in enjoying the later years in life. Don't burden yourself with life-threatening diseases and cancers – look after yourself. Treat your body well, and it'll most definitely look after you in the twilight years. There are five everyday habits that need to hop it.
Published in the medical peer-reviewed journal BMJ, researchers analysed the impact that five bad lifestyle habits had on the chances of living a longer life free from diabetes, cardiovascular disease, cancer and other health issues.
The study focused on these five unhealthy habits: smoking, not exercising, being overweight, drinking too much alcohol and eating an unhealthy diet.
Researchers examined prior data – where a study followed more than 38,000 men for 28 years and 73,000 women for 34 years – to see how chronic disease affected the quality of life during the study period.
"We found that following a healthy lifestyle can substantially extend the years a person lives disease-free," said Dr Frank Hu, who chairs the department of nutrition at Harvard T.H. Chan School of Public Health.
Findings reveal that women who refrained from those bad habits "gained over 10 years of disease-free life, and men who did so gained almost eight years", added Dr Hu.
So what healthy habits did those who lived a longer, disease-free life adopt? For one, not smoking. Another was keeping a healthy BMI below 25, doing at least 30 minutes of exercise each day, drinking alcohol moderately and eating a healthy diet.
The results of the study couldn't be more apparent. Women at the age of 50, who dropped unhealthy habits and turned them around into healthy habits, lived 14 years longer than women who didn't.
READ MORE: High blood pressure: Avoid this breakfast staple if you want to lower your reading
And men who followed all five healthy lifestyle factors at age 50 lived for 12 years longer than men who followed none.
"It's never too late to adopt these habits," Hu said. "For smokers, the single most important thing that one should do is to stop smoking. For nonsmokers, eating a healthy diet and being physically active are important for keeping a healthy weight."
Delving into the data even more, women who practised four or five of the healthy habits over the next 20 to 30 years gained an average of eight years free from cancer, 10 years with no cardiovascular disease and 12 years without diabetes.
Men who practised four to five healthy behaviours gained an average of six more years without cancer, almost nine more years free of heart issues and over 10 years without diabetes.
"This is a positive health message because it means healthy lifestyle habits not only prolong life, but also improve the quality of life and reduce sufferings related to chronic diseases," Hu added.
Even those diagnosed with cancer lived an additional 12 years if they adopted the healthy lifestyle habits compared to those who didn't.
I need to quit smoking
There's lots of support out there to help kick the filthy habit once and for all. Of course, any support must be aligned with a dogged determination to eliminate the unhealthy habit for yourself.
Will power is paramount, as well as consistency – taking each day at a time. To find out how you could take steps to say goodbye to smoking, visit the website Stop Smoking London or attend your local NHS stop smoking service.
Simple swaps, such as walking up stairs instead of taking the escalators or lifts, can make all the difference. How about walking to the local shop instead of driving?
Am I drinking moderately?
Drink Aware is a great resource to see how many units is in your favourite tipple. At present, UK guidelines suggest women and men drink no more than 14 units in a week.
A healthy diet
It can't be stressed enough how important eating at least five portions of fruit and vegetables per day is. The nutrients and minerals packed in these food types are incredible for helping you to live a longer, healthier life.


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Trails By Region
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Trail Finder
Fill in one or more of the fields below to find matching rail trails.
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- Queensland
- North Queenland
- Herveys Range Rail Trail
Herveys Range Rail Trail
|Rail trail
|Townsville, 1356km from Brisbane
|Hervey Ranges to Hervey Ranges
|Length open:
|Coarse gravel
|hilly forest
|Contact Region:
|North Queensland
This Rail Trail is now CLOSED and is back as a possible actice transport corridor. It is ILLEGAL to enter this rail corridor as of 2019
- 5 Tunnels (1 collapsed due to landslide)
- Spectacular views
- Will be 11km in length when open.
August 2019
This trail is now CLOSED permanently August 2019
This rail trail is located up in the Herveys Range, west of Townsville on a short section of the former Greenvale railway corridor.
However it is not actually open to the general public yet. The Heritage Tea Rooms once had permission to conduct tours traveling through 5 tunnels in an 11 seat ford transit bus but unfortunately in 2009 a landslide caused one tunnel to collapse and the tours no longer operate. This is visible on the satellite view of the map. The closure of the trail due to the landslide is sad because it apparently is spectacular sight. The Tea Rooms are based on the top of Hervey Range and the first tunnel passes under their property. Refer to the link below for more detail.
The Tea Rooms have apparently lobbied for a few years to have the corridor opened to the public and will continue to do so. We are not aware if any investigations have been undertaken into this or other sections of the corridor.
All the remaining tunnels and bridges are in situe and, given the railway's relatively recent and high standard construction, apparently in excellent condition.
Background Information
The railway has a relatively recent and short history. It was 213km long and opened in 1974 to transport ore from a nickel mine at Greenvale to a refinery north of Townsville. It closed in 1993.
The Heritage Tea Rooms web site and contact details
To advertise your rail trail support business on this page, please click here.
Contact Us About This Trail
Email or click here: firstname.lastname@example.com.


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We may tend to think that bullying happens mostly in the playground, but sadly that is far from the whole picture. Bullying at work and within our personal life is not uncommon and now that we are thoroughly engulfed in the cyber world there are even more ways in which we can be reached and intimidated.
Harassment is another term often used interchangeably with bullying, and can be defined as unwanted conduct that affects the dignity of men and women within the workplace. It may be related to age, sex, race, disability, religion, sexual orientation, nationality or any personal characteristic of the individual, and may be persistent or an isolated incident. The key is that the actions or comments are viewed as demeaning and unacceptable to the recipient.
So what counts as bullying or harrassment?
In the workplace it can be very subtle, or profound and yet hidden from the view of others. Acas list examples of:
- spreading malicious rumours, or insulting someone by word or behaviour (particularly on the grounds of age, race, sex, disability, sexual orientation and religion or belief)
- copying memos that are critical about someone to others who do not need to know
- ridiculing or demeaning someone - picking on them or setting them up to fail
- exclusion or victimisation
- unfair treatment
- overbearing supervision or other misuse of power or position
- unwelcome sexual advances - touching, standing too close, the display of offensive materials, asking for sexual favours, making decisions on the basis of sexual advances being accepted or rejected
- making threats or comments about job security without foundation
- deliberately undermining a competent worker by overloading and constant criticism
- preventing individuals progressing by intentionally blocking promotion or training opportunities.
There are several different platforms that can be used for bullying which include face-to-face, letters, phone calls, emails and social media. The social platform is often used to targeting someone in a nasty, or derogatory fashion or to undermine them or their credibility, and can quickly be whipped up into a powerful "campaign" that has a devastating effect on the individual.
What is abuse?
Abusemay be physical, sexual, mental, emotional, financial or spiritual.
Physical abuse is non-accidental harm to the body. It can range from physical injuries such as hitting, pushing, wounding etc. to things such as misuse of medication, inappropriate use of restraint and dehydration/malnourishment.
Sexual abuse includes sexual assault or sexual acts that have not been consented to. It also encompasses rape and non-contact abuse such as sexual harassment or pornography. In the workplace it commonly begins as seemingly innocent and accidental inappropriate touching, which can leave the victim wondering why they feel uncomfortable as it was "only an accident" and not maliciously or sexually meant. This can ratchet up to quite blatant sexual touching, verbal and physical innuendos and threats. The victim can already feel ashamed and confuse that they allowed it to happen on the first place and so find it more difficult to deal with it as time goes on. There is always the possibility that the perpetrator may actually sexually or physically assault the victim even if the touching seems "low-level" initially.
Mental/emotional abuse focuses on the mental aspect of abuse such as threats, abandonment, intimidation, humiliation, deprivation of physical or emotional contact and cultural needs. It can also include verbal abuse. Psychological abuse can be harder to spot as it is often done in private, where there are no cplleagues around, and has no physical signs.
Financial abuse includes withholding entitled finances to employees or threatening to do so unless certain inappropriate requirements are met.
Spiritual abuse involves anything that damages a person's sense of spirituality and can use religion and spirituality to excuse and justify their behaviour.
How does harassment, bullying and abuseaffect someone?
Harassment, bullying and abuse can make someone feel humiliated, anxious, scared, out of control, confused and belittled. They may wonder what they have done wrong to attract this unwanted attention, and feel unable to talk to others about it through feelings of shame and embarrassment. They may feel it is their own fault and that they should be able to deal with it themselves or even deserve it. They may feel angry and frustrated that they are not able to cope or stop the behaviour or may become frightened and demotivated. Common consequences include los of confidence and self-esteem, insecurity, absence from work and breakdown or strain in their personal relationships.In some cases people quit their jobs or even contemplate/ carry out suicide attempts.
Often victims are not even able to talk to their loved ones about it, be it their partners, friends, parents or trusted acquaintances such as priests and doctors. Whilst others may not be able to understand this, it is common for the shame and confusion to prevent people seeking help.
There may also be a sense of fear and embarrassment about what may happen if they were to talk – would they be deemed as ridiculous, over sensitive, exaggerating or even making it up? What will happen to the perpetrator; perhaps they will be left having to face them within the workplace and things might get worse? These are very real concerns.
What can be done?
The workplace has a duty of care to each of its employees. It should have policies and procedures in place that will allow the space, time and understanding for anyone to be able to approach the appropriate person in the full knowledge that they will be cared for and kept safe. If the bullying, harassment or abuse is coming from the top then it is important to find someone you can trust to turn to. Your safety and well-being are paramount. It is useful to keep a record of what has been happening and, if possible, seek support from colleagues .You may also find it helpful to seek professional advice from a counsellor who will help you to understand your feelings and make sense of what happened to you. This process can take time and needs to be conducted in a safe environment.
There are also many informative websites that give general and legal advice as to how to seek help and what your rights are.


text: AFA-CWA Sets Out Initiatives For FAA Reauthorization Date: March 22, 2007 Washington, DC – The Association of Flight Attendants-CWA (AFA-CWA) today testified before the House Aviation Subcommittee on issues concerning flight attendants' that need to be addressed in the upcoming reauthorization of the Federal Aviation Administration (FAA). "Flight attendants, as first responders in the aircraft cabin, have a unique perspective on a number of the safety programs of the FAA," said Patricia Friend, AFA-CWA International President. "Unfortunately, the FAA has repeatedly failed to take action on several fronts that would improve the overall safety of the employees that work under its jurisdiction." Issues that have been repeatedly ignored by the FAA include flight attendant fatigue, workplace safety and health protections, cabin air quality, and carry-on baggage requirements. For more than 30 years, AFA-CWA has pleaded with the FAA to address workplace safety and health protections. Flight attendants suffer numerous occupational injuries and illnesses while working aboard commercial flights at rates several times higher than those for all private industry workers, yet are not covered under Occupational Safety and Health Administration (OSHA) guidelines. In spite of these facts, the FAA has repeatedly refused to take any significant action to enforce standards protecting the occupational safety and health of flight attendants since claiming exclusive jurisdiction of the workforce in 1975. "In light of the continued stonewalling on the part of the FAA, we believe that it is time for Congress to force the FAA to relinquish the exclusive jurisdiction over flight attendant workplace safety and health," testified Friend. For over 60 years, the Association of Flight Attendants has been serving as the voice for flight attendants in the workplace, in the aviation industry, in the media and on Capitol Hill. More than 55,000 flight attendants at 20 airlines come together to form AFA-CWA, the world's largest flight attendant union. AFA is part of the 700,000-member strong Communications Workers of America (CWA), AFL-CIO. Visit us at www.afanet.org. Share this page: More News


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The Triangle of Well-Being is a chapter in Daniel J. Siegel's superb book, Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind. This triangle of well-being is a three pointed figure that is a metaphor for the idea that mind, brain, and relationships are each part of a whole. The notion is that this triangle is a metaphoric map that signifies one reality with three interdependent facets. The triangle represents the process by which energy and information flow. This process changes over time. Relationships are the sharing of this flow. The brain refers to the extended nervous system distributed throughout the body that serves as the embodied mechanism of that flow. The mind is an emergent process that arises from the system of energy information flow within and among people. A critical aspect of the mind is the emergent process of self-regulation that regulates that from which it arises.
So the mind can regulate and change the brain, which is the process of neuroplasticity. The energy information flow within us, our thinking and behavioral process, along with our communication with our fellow human beings can produce resultant changes in the brain for better or worse. The worse part is when maladaptive emotions, thoughts, and behaviors occur. The better part is when we acquire new knowledge, modulate our emotions, and foster beneficial and enjoyable relationships.
Siegel is a psychiatrist who is the Co-Director of the UCLA Mindfulness Awareness Research Center. He uses this conceptual treatment both in his treatment of psychiatric patients and in the development of healthy mindfulness. His pocket guide goes into great detail regarding the parts of the brain and how they are modified in the process.
Permit me to elaborate on this triangle using the lingo of the healthymemory blog. Interpersonal relationships are part of transactive memory, but transactive memory includes technology as well as live interactions among individuals. Books and other technical media allow us to establish relationships with humans who have long departed. Admittedly, these relationships are uni-directional, but they are nevertheless valuable. We can also establish relationships through technology with living individuals throughout the world, and these relationships are definitely bi-directional. Relationships among groups are omnidirectional. Such relationships can be valuable, but they need to be distinguished from relationships in social media, such as Facbook, where "friending" can be largely superficial.
Tags: Brain, Interpersonal Relationships, Mind, Mindfulness, Neurobiology, Neuroplasticity, Siegel, Transactive Memory


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我最喜欢的食物 My Favorite Food
In our country, there are plenty of delicious foods. They are popular among Chinese people. I like eating very much. There are many food I like, such as chicken, fish, beef, tofu, noodle and so on. Among them, fish and tofu are the food I like most. Fish is delicious as well as rich in nutrition. It's good to our health. There are various cooking methods and I think the simplest way is the best one. Tofu is my favorite as well. It can be cooked with many other dishes. Different tastes combine with each other to make the food more delicious.
I like many different kinds of food, eggs is my favorite kind. Egg is contains a lot of essential nutrients needed by the human body, and it's commonly found in almost any part of the world.
Eggs are oval shaped spheres with a light brown color depending on the egg.Eggs is the basic ingredient to many dishes, like omelet and french toast. You can easily get eggs at any supermarkets, and they are sold for a very cheap price too. After the eggs are acquired, it is best to crack it open into a pan or plate and stir it evenly. If the egg is to be pan fried, then just crack the egg into the boiling pan, and remember to flip sides.
Eggs contain lots of nutrients and is a very good source of energy. Soldiers used to carry eggs to the frontline as their food. Egg is my favorite kind of food.
My favorite food is Chinese dumpling; its pronunciation is jiao zi in Chinese. It is a traditional Chinese food and essential during holidays in Northern China. And it is also popular in other Chinese holidays or festivals, so it is part of the Chinese culture or tradition.
I like eating dumpling not because I am from Northern China but because it is really very delicious and stand for reunion. My family usually eat dumpling when all the members of family come together. Making dumplings with my sisters is the happiest thing for me.
Chinese dumpling is one of the most important foods in Spring Festival. Since the Spring Festival marks the first day of a brand new year, the first meal is rather important. People from north and south have different habits of the food, so they eat different foods on this special day. In Northern China, people usually eat dumplings.
Chinese dumpling is a delicious food. You can make a variety of Chinese dumplings with different fillings. It depends on your taste and how various ingredients mixed together by you.
Usually if you have Chinese dumpling for dinner, you will not have to cook anything else except for some big occasions. The dumpling itself is good enough for dinner. This is one of the advantages of Chinese dumpling over other foods, though it may take longer time to make them.
Making dumplings is really teamwork. All family members often make dumplings together. It is also a good time to share their stories with each other. I started to make dumplings when I was a kid in my family, so most Chinese like me know how to make dumplings.


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Semplice & Bio ®- Organic Orange Compote Without Pectin
New compotes without pectin in the classic bestelling tastes.
Composta di arance biologica senza pectina aggiunta.
- Code: 1COMARA
- Quantity: 220g
Tech notes
Oranges with rind in pieces * (60%), concentrated apple juice *, concentrated apple puree *.
Keep away from heat and light source. Once opened store in the fridge and consume within 10 days.
- Carbohydrates tot. 35
- Soluble carbohydrates (gr) 40
- Energia Kcal 174
- Energia Kj 736
- Lipids tot. 0.5
- Protein tot. (gr) 1
- Saturated tot. (gr) 0.1
Ideal to spread on bread or rusks for breakfast or for a sweet snack.
The informations contained in this schedule are informative purposes only.
For consumption / use of the product we suggest you to read the label.


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