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In preterm pattern quadriplegia, the legs are most involved and in full term pattern quadriplegia, the arms, hands, upper trunk and face more involved. The patterns are like bilateral hemiplegia and in some countries, they use this term instead of quadriplegia. Each of the children with spastic quadriplegia, dyskinetic quadriplegia and four-limb ataxia has different areas of their brain that has been damaged to produce their particular cerebral palsy pattern. Currently, only 24% of children with spastic quadriplegia score at GMFCS Level I to III.1 I will discuss the spastic forms of quadriplegia first.
What is the brain pathology and what does it mean?
In spastic quadriplegia, both sides of the brain are damaged. The key difference between the 2 patterns is the site of damage. Most doctors tend to focus on what abnormalities can be seen in a brain scan and for a very long time I was guilty of this as well. Gradually I came to realize that if I was going to be able to set realistic goals and create the best possible treatment plan for a child with four-limb involvement, I needed a brain scan. In the best of all possible worlds, it would be an MRI at about six months post term age or later. My goal with this scan would be to assess the early resolution of the initial injury and to determine the amount of remaining normal brain. I believe that we all have to focus much more on what is left available for the child to use when there has been damage to the primary motor system.
Preterm Pattern Quadriplegia
This pattern is caused by bilateral large Grade IV bleeds into the periventricular area and/or severe bilateral Periventricular Leukomalacia or PVL. In many babies, they co-exist. If you look at the diagram at this link, (Spastic Diplegia – Cure For Some, Improvement For All) preterm pattern quadriplegia has injuries in the same 2 areas, but they are larger. Damage is frequently asymmetric, with one side more affected than the other. The key point is the damage picks off the motor control of the legs more than the arms and hands. The trunk is always involved. As with all children with preterm pattern cerebral palsy, they may continue to improve in function, but at a slower rate than a child with diplegia alone.
Preterm Pattern Triplegia
This pattern is found when the brain injury is asymmetric. Usually this means that there is more damage (a bigger bleed) involving the leg, trunk and arm on one side and just the leg and trunk involved on the other. There is less damage on one side, which means that one arm and hand are relatively spared. This is nearly always seen in the preterm pattern with both legs more involved than the one affected arm. Many of these children will evolve into a preterm hemiplegia pattern as the less damaged side slowly improves. Their pattern in the teenage years is often that of a teen with preterm hemiplegia.
Full-term Pattern Quadriplegia
This is a more complicated problem. For infants admitted to a NICU, Hypoxic Ischemic Encephalopathy or HIE is by far the most common cause. (Hypoxic Ischemic Encephalopathy [HIE] or Neonatal Encephalopathy [NE]?) These babies, with diffuse cortical involvement are the ones that progress to full-term pattern spastic quadriplegia. In babies with HIE, there is a variable amount of damage to the cortical grey matter. This may be fairly circumscribed to the sensorimotor cortex on both sides or be more generalized. A very early brain scan may miss signs of injury as the process takes some time to evolve. The control of speech, upper trunk, arms and hands are most affected. Walking is hard initially as they do not have the same amount of control of their upper limbs to hold on.
Most of the other causes of spastic quadriplegia like infection, metabolic diseases, brain malformations and infant brain trauma have a different history and generally present later in infancy. Babies with brainstem damage or cerebellar damage develop dyskinesia or ataxia. I will write about this group next week.
What improvements are possible with repair, growth and maturation of the brain?
All brains attempt to repair after injury. In these children, with more initial damage, the period of active repair will take longer and it can be very discouraging as you wait for signs of improvement. Parents need to remember that the infant has also had significant damage to the body as well as the brain. These babies are weaker than normal, in the same way an adult would be after a prolonged ICU stay.
The overriding principle in the early days is to work with what works and the same is true for the older child now classified at GMFCS Level I to III. Alignment, which means keeping the body in as normal a position as possible, is the starting point. This group has a good potential for improvement over time, but it will take longer and it will require both more therapy and more interventions to get to their best possible level.
In my experience, starting with good trunk support works best. Therapists have many ways to stimulate trunk control and strengthen the muscles, but these children with 4 limb involvement need more than the therapists hands for a few hours a week. How can we expect them to move against gravity if all 4 limbs are attached to a weak trunk?
This is a rather long post on the importance of the core. Movement Starts With The Core
This is another with some of the available support garments noted. Core Support Options
It is a good idea to check out the websites to see what is new and discuss the options with your therapist.
Now here is a roadblock. Many parents and therapists think that an external support garment will weaken muscles, when in fact the opposite is true. A slumped over baby or child has all of the muscles in an abnormal position that adds to their weakness. Take a look at this blog to see how rapid the response can be. Good Enough Is Not Good Enough Any More – Function Follows Form In Cerebral Palsy
Where do you start with treatment if everything is involved?
Treating a child with quadriplegia almost requires a graduate degree in time management. A stable trunk is the first step and here is a simple test. Put the infant or child on his or her back and see what they can do out of gravity. Does arching diminish? Do the arms move more freely? Can the legs kick without posturing? Improvements in these areas are to be expected with good core support.
Next discuss with your therapist the options to help the limbs. Preterm children will have more issues and need more help with the legs and the full term children need early help and support to keep the thumbs in a functional position and the wrists stabilized. Once you have alignment under control, there are many different therapies that help. However, they will help more if the child has a stable base and support when needed.
Next week, I will go over the pathology of athetosis, choreoathetosis and ataxia with a few suggestions to improve motor control. Then I will write about the various co-morbidities that are so common in all the children with quadriplegia.
As ever, I look forward to your comments and questions.
The Full Series – Cerebral Palsy – GMFCS and Topography
Three R's of Baby Brain Neuroplasticity
What Is Your Child's Label?
Cerebral Palsy – The Best Possible Outcome and How To Get It
Cerebral Palsy – Diplegia – GMFCS I to III
Cerebral Palsy – Hemiplegia – GMFCS I to III – Part One
Cerebral Palsy – Hemiplegia – GMFCS I to III – Part Two
References for this Post
- Iona Novak, "Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy", Journal of Child Neurology, 29 (2014): 1141-1156.
Thank you for the informative article. Can you comment on how you would characterize an HIE event that occurred after birth? My son's injury happened when he was 12 weeks old when he nearly suffocated in a pack-n-play when he rolled over and got stuck in the edge. Would you characterize this as post term pattern quadriplegia?
Dear Amy, I think an MRI scan will give some clue as to what to expect. If he suffered widespread cortical damage, then he will most probably evolve into a full term pattern quadriplegia. However, he may have suffered brain stem and thalamic damage that I will write about next week. This type of injury evolves in athetosis of a mixed dyskinesia…it is still a quadriplegia, but very different in the type of involvement. Hope this helps.
Hi Karen,
Thanks for this great post! It's been widely circulated on the HIE sites. I wonder does preterm pattern always result from PVL? My son was early, 32 weeks, but his MRI did not show PVL.
Also, there are many children on the HIE sites who at age one receive a quad label that later is changed to either Diplegia or Hemi. Is this nueroplacticity or a misdiagnosis?
Alicia, good questions! At 32 weeks, PVL is the most likely cause. If the scan was too early, it may be missed. Or…if the baby has later apneas or illness after the time of the scan, the damage may occur then. I think the most important part is to determine whether the child has a preterm pattern or a full term one. That is what you have to work with now and should help determine some therapy priorities.
Changing diagnosis probably represents neuroplasticity…although no one is immune to diagnostic errors at times.I have seen this type of change more in children with the preterm pattern.
hi Karen
Thank you for these blog posts! I have a couple questions. I have a 2.5 year old son who has spastic quadriplegia from a perinatal stroke. He is not ambulatory but walks with assistance (i.e. with an adult, he manages his gait trainer but doesn't really utilize it for independence). I was wondering about habits – you talk a lot about waiting for the brain to recover, but how do you know when that is? We have amazing therapists but none have them have in-depth CP experience and I'm wondering how I know we're building good habits (despite his wanting to "run" after his twin sister) and continuing to work on movements he may be making without great form (we're in the process of getting DMOs). The other question I have is – how much does looking at an MRI help? Does it change any of the therapy we'd be doing? Thank you again.
Thank you Kirsten for your email.As we wait for brain recovery over the first few years of life, the brain is also growing and maturing. The goal is to minimize maladaptive habits by supporting normal body alignment. The DMO's are a great addition. Let me know how he is when he gets used to them.Having a twin is a great motivation – the challenge is to maintain form. Seeing an MRI at this point is of little help and requires sedation. When children are older and more cooperative, I like to get an MRI to document the degree of damage and more importantly to reinforce how much brain is apparently normal.This issue often comes up at school age. Hope this helps. Karen
Hi Karen,
My son has a dx of spastic quadriparesis – can you touch on how this is manifestas and affects differently than quadriplegia and how that changes prognosis?
Hi whs t do you know about ocular motor ataxia & v.t? She is nine with a diagnosis of h.I.e & c.p.
Hi Karen! I am so grateful that I stumbled across your site! I had modi twins and ended up with TTTS at 20 weeks gestation and surgery to correct. My donor twin Emma is the baby who was effected from this. They are 1yr now. She is a very social sweet baby, try's to play with toys, slowly is getting stronger through her core. She was dx with spastic quadriplegia and axial hypotonia from PVL and PMG. She has microcephaly but head growth is consistent and proportional to her body. She is in PT OT etc. I am just looking for more resources . I am curious about full term vs preterm as she is sort of a wild card. Most definitions include preterm infants(they were born at 36 weeks no NICU time) or damage during birth. She doesn't really fit into most categories. She seems to have more variability in tone than spasticity (low tone a lot) the neurologist only saw her 1 time for about 30 minutes and made the dx which I was surprised. I look forward to ordering your book!!!! – Kristen


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The U.S. Census Bureau is hiring for a variety of temporary jobs, including census takers, recruiting assistants, office staff, and supervisory staff. To be eligible, you must be at least 18 years old, have a valid Social Security number, and be a U.S. citizen. To learn more and apply online visit the Census employment website.
FRANKFORT, Ky. (Oct. 9, 2018) – The Kentucky Education and Workforce Development Cabinet's Office of Vocational Rehabilitation (OVR) has been awarded a $2.5 million U.S. Department of Labor grant to help injured or ill employees remain in their job or return to work. Kentucky is one of only eight states to receive a federal Retaining Employment and Talent After Injury/Illness Network (RETAIN) demonstration grant to develop a pilot program.
"It is an honor to be one of the eight states at the forefront of exploring ways to help Kentuckians return to the workforce after a potentially debilitating event," said Josh Benton, deputy secretary of the Kentucky Education and Workforce Development Cabinet. "When employees are sidelined whether due to an injury or illness, it can have a long-lasting impact on them, their families and employer. With early intervention and a coordinated approach, we can help employees stay on the job or return sooner," he said.
Read more ...
FRANKFORT, Ky. — To further eliminate employment barriers for Kentuckians with disabilities, Governor Matt Bevin today issued an executive order streamlining the Office of Vocational Rehabilitation (OVR) and the Office for the Blind (OFB) into one centralized agency offering services to individuals with disabilities.
Effective Oct. 1, the Kentucky Education and Workforce Development Cabinet will consolidate services previously offered by OVR and OFB into a newly created agency, the Office of Vocational Rehabilitation. Continued services for individuals with visual disabilities will be offered through the agency's Division of Blind Services. The Office of Vocational Rehabilitation will operate under the leadership of Cora McNabb who previously served as the acting executive director for the Office for the Blind.
"The launch of the new Office of Vocational Rehabilitation is the result of many months of thoughtful collaboration among a wide array of public and private sector groups," said Gov. Bevin. "One of our Administration's cornerstone aims is to promote economic opportunities to empower all Kentuckians. This new one-stop agency will enable the Commonwealth to better equip disabled individuals with tools and resources for success, while ensuring that we continue to meet the specific needs of our citizens with visual impairments."
FRANKFORT, Ky. (Oct. 2, 2018) – The Kentucky HEALTH (Helping to Engage and Achieve Long-Term Health) leadership team will be in Somerset Thursday to share information and updates regarding the state's innovative Medicaid waiver program. The visit is part of a series of stakeholder forums held around the Commonwealth to keep citizens informed about Kentucky HEALTH and its potential impact to Medicaid beneficiaries, the healthcare community, employers and other stakeholders.
The Somerset forum will begin at 1 p.m. (EST), Thursday, Oct. 4, 2018, and will be held in the Center for Rural Development Ballroom, 2292 US-27 #300, Somerset, KY 42501.
Please continue to check the program's website, kentuckyhealth.ky.gov for updates about upcoming stakeholder forums and other information related to the Kentucky HEALTH program.
Two additional stakeholder forums are scheduled to take place in Frankfort later this year. Kentucky HEALTH staff will keep the public updated on any news or schedule changes regarding these events.
1 p.m. (EST), Nov. 1, 2018, Kentucky Transportation Cabinet Auditorium, 200 Mero St, Frankfort, KY 40601.
1 p.m. (EST), Dec. 6, 2018, Kentucky Transportation Cabinet, 200 Mero Street, Frankfort, KY 40601.
Governor Matt Bevin unveiled the demonstration waiver known as Kentucky HEALTH on June 22, 2016. Since then, the Commonwealth has incorporated valuable feedback from consumers, providers, advocates and other stakeholders in developing the program.
Kentucky HEALTH is an innovative approach that will put Kentuckians on a path to better health and is key to ensuring the long-term viability of the Medicaid program. In addition, Kentucky HEALTH will ensure availability of Medicaid resources to our most vulnerable citizens. Additional information is available at http://chfs.ky.gov/.
The Cabinet for Health and Family Services is home to most of the state's human services and healthcare programs, including the Department for Medicaid Services, the Department for Community Based Services the Department for Public Health, the Department for Aging and Independent Living and the Department for Behavioral Health, Developmental and Intellectual Disabilities. CHFS is one of the largest agencies in state government, with nearly 8,000 full- and part-time employees located across the Commonwealth focused on improving the lives and health of Kentuckians.
Google has created a new search tool designed to help veterans find civilian jobs when they leave the military. Service members can search 'jobs for veterans' on Google and then enter their specific military job codes (MOS, AFSC, NEC, etc.) to see relevant civilian jobs that require similar skills to those used in their military roles.
Learn more at: 9 to 5 Google
The Cumberlands Workforce Development Board is working to provide tools that will help connect our communities to local, state, national and international resources. The goal is to promote workforce development, education, and economic development through this investment in technology.
Civic groups, educators, businesses and organizations in the Kentucky Career Center - Cumberlands 13 county service area can now visit our Tech Connect Lending Library to check-out pieces of equipment that can be used for such activities as: computer training, video conferencing, virtual interviews, presentations, hiring events, plant tours and much more. Inventory and lending information can be found on our website.
In addition, the CWDB has plans to locate 25 video conferencing systems throughout the Kentucky Career Center - Cumberlands service area. The systems include a 55" screen, camera, speakers and mobile stand as well as access to the Zoom video conferencing platform. The board is seeking applications for site hosts and will be accepting applications through October 12, 2018. Any group or organization within the service area is eligible to apply. Click here for more details and application form.
Applications must be received by October 12, 2018.
Page 10 of 13
Give us a call or stop by your closest Kentucky Career Center and we'll be glad to help you with your career and employment needs.
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subset: commoncrawl


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Stamp of the Month Club! I'll add you to my club mailing list and you'll receive one email each month revealing the stamp set and card designs. You can choose when you want to participate by simply replying to that email.
Each month, I feature a different stamp set. Those who participate in March will receive the Petal Palette Clear Mount Rubber stamp set (or substitute a different set), pre-cut materials to make 6 cards (2 each of 3 designs), printed instructions with a color photo of each card, and Priority Mail shipping. Click here to learn more about Stamp of the Month Club.
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Gun Lap
Submitted by Robert Meeropol on
The RFC has begun the final lap of our 20/20/20 marathon. In September 2009 in Albany, NY, we held the first reception of our project to stage 20 events, in 20 cities, over 20 months to celebrate our 20th anniversary. We (usually me and my daughter Jenn, who will take over my duties as Executive Director in a couple of years) have met, thanked and discussed the RFC endeavor with a couple of thousand supporters and new friends since then.


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Isotopic signatures and trophic status of Ramaria
The genus Ramaria is composed of several subgenera that often correspond to specific trophic strategies. Because carbon and nitrogen isotopes can be used to assess fungal trophic status and nitrogen sources, we accordingly carried out an extensive survey of isotopic patterns in archived specimens of Ramaria from Germany and other locations. Isotopic patterns in species generally corresponded to subgeneric affiliations and to the range of different potential substrates, with fungi fruiting on wood and litter (subgenera Asteroramaria and Lentoramaria) much lower in δ15N (≈−3‰) than ectomycorrhizal taxa (≈12‰) (subgenus Ramaria) or taxa fruiting on soil (≈13‰) (subgenus Echinoramaria). Conversely, fungi fruiting on wood and litter were higher in δ13C (−23‰) than those fruiting on soil (≈−27‰), with ectomycorrhizal fungi intermediate (≈−24.5‰). Fungi colonizing mineral soil horizons were about 3‰ enriched in 15N relative to those colonizing both mineral and organic horizons. The high δ15N and low δ13C signatures of taxa fruiting on soil remains unexplained. The high degree of fidelity of isotopic signatures with subgeneric classifications and life history traits suggests that sporocarps are good integrators of patterns of carbon and nitrogen cycling for specific taxa. Archived specimens represent a useful trove of life history information that could be mined without requiring extensive supporting isotopic data from other ecosystem pools.
Earth Systems Research Center
Publication Date
Journal Title
Mycological Progress
Digital Object Identifier (DOI)
Document Type
Recommended Citation
Agerer, R., J. Christan J, C. Mayr, and E.A. Hobbie. 2011. Isotopic signatures and trophic status of Ramaria. accepted 11/10 to Mycological Progress 11: 47-59. DOI: 10.1007/s11557-010-0726-x.
© German Mycological Society and Springer 2010


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I have had many people ask me how it is being a lady of leisure, and I have to say that I am surprisingly busy. The garden is in good nick, the washing is all done and the house is relatively tidy. I have been fielding emails with job offers - we live in a small place and fortunately there are lots of vet jobs. Many people refuse to believe that I could possibly not want to work for the next few months. I suppose it's better than struggling to find work.
Anyway, Matt took this photo demonstrating my fine multitasking skills which I utilise in order to fit in as many of my favourite activities at one time:
Basically I am: knitting, drinking gin, eating cherries, reading a book and (although you can't see it) listening to music. Not bad eh?
I only feel that my break has started this week as I have had two weddings to attend in the past week. Now that they are done I can concentrate on finishing off my Christmas presents, and continuing my Elderflower Cordial production line (which we had yesterday with gin and soda and lemon - not bad at all).
Our house is looking particularly spring like right now - I have somehow managed to decorate with large numbers of lovely roses. The kitchen table has lilac ones from one of the weddings (my bridesmaid bouquet) and pink peonies from our friends Jo and Alistair...
The mantelpiece and the sideboard has wild roses from Dot's garden:
Only six days left of spring then summer is here. I can't believe how time flies.
Monday, 24 November 2008
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PSA 33,Gleeson 3+4 =7, T3b L0 M0.
I was offered a choice of radiation or surgery but on balance decided on surgery.
The surgeon warned me that I had a 'significant' cancer and he planned to throw the 'kitchen sink' at me.
I started taking Bucalutamide 3 days ago and need to visit my GP in 2 weeks for a lutenising analogue injection which will work for 3 months in conjunction with the Bucalutamide which I will take for 1 month.
My Prostatectomy is planned for the end of September.
While I'm happy to have at last started treatment after 4 months in the diagnostic stages, I am bit concerned that my operation is still 3 months away!
Has anyone else had hormone therapy before surgery and how did it go? I've been told that nerve sparing surgery is not advisable for me.
Edited by member 03 Aug 2018 at 20:57
| Reason: Not specified
Hi HillsRob, you got there in the end. Your surgeon is a pleasant gentleman helping you into your anti-coagulant stockings and seeing you post op. I've never seen my surgeon since he interviewed me before the operation, not that I'm criticising him because if it gets one more operation done it's for the best. I didn't have an epidural either and had no pain at all, interesting how they use different techniques.
I used the term 'pleasant gentleman' as the surgeon who saw me post op used that term in the letter he sent my GP. I'm told they use the term a lot in letters so I'm not sure it's a compliment.
All the best for the trial without Catheter, don't strain those wounds including the sphincter.
Edited by member 28 Sep 2018 at 18:31
| Reason: Not specified
I was a polite professional gentleman, shows he didn't really know me 😂
At least you weren't GFPO 😂😂😂😂
Good news Hillsrob. Thanks for update.
I am just one year down the road, and I too am "cancer (and erection) free". Funnily enough I woke up today and dreamt I had a hard-on in what's left of it - it was not to be☹
No worries, still breathing.
As for alcohol - have just been to a tasting of 211 Champagnes - can't remember how many now...
Best of luck for the future.
Cheers, John.
Great result.
4 weeks ago I had a Triptorelin injection (3 month 11.25 mg) and to start with things seem to go quite smoothly. I am scheduled to have a Prostatectomy towards the end of September.
In the last 36 hours however I have had 4 quite severe nose bleeds and this morning I was taken by ambulance to A&E for one that I couldn't stop after trying in vain for 30 minutes or so. The diagnosis at A&E was high blood pressure i.e. 180/104. In fact my blood potassium was 2.8 mEq/L and should normally be in the range 3.8 to 5 mEq/L.
I am now 68 and have been on medication for raised blood pressure since I was 46 but the A&E doctor was clearly not happy with the way my BP and electrolytes have been allowed to get out of control. I'm not sure to what extent the Triptorelin has contributed to this but tomorrow I will be back to my GP for an urgent review of my meds.
Today the A&E department pumped 1 litre of a sodium chloride (0.9%) and potassium chloride (0.3%) into me over a period of 4 hours and doubled my daily Amlodipine dose from 10mg to 20mg which I take together with 2.5mg of Bisoprolol Fumerate and 100mg of Losartin Potassium to try to control my BP. It looks like I will need a Potassium controlling tablet from now on or eat lots of bananas and avocados. http://community.prostatecanceruk.org/Scripts/tinymce/plugins/emoticons/img/smiley-smile.gif
Edited by member 30 Jul 2018 at 09:15
| Reason: Grammer
It is very rare to have HT prior to surgery so perhaps it is worth contacting your nurse specialist (if you were allocated one) and / or ask for an appointment with the urologist to discuss whether you can stop taking the hormones.
Hi, I was reading your profile and that you had a psa test in February. It would be useful to put the dates of your appointments on your profile.
Assuming the psa test was at your GP the hospital should see you within 14days. They then have 30 days to diagnose and 30 days to treat. Instead of about 74 days your treatment is taking about 200 to your operation although the hormone treatment might be allowed as the treatment date.
If you asked to go to another hospital it might lose your slot and take as long so it's difficult. Although you could ask why it's taking so long.
Perhaps others might have a better idea.
In theory hormones are treatment, it's unconventional but that may be their excuse. I noticed a private surgeon offered hormones before surgery and when I mentioned it to my Consultant he said they must be very busy and holding for time. Perhaps that's true and is the case for you but your treatment has been slow all along. I hope you don't mind me saying the above but nothing can be done unless it's made known and it might effect us all.
All the best.
Thanks for your concern as always Lynne. The A&E doctor didn't see a connection between hormone therapy and raised blood pressure or even nose bleeds but these things are rarely understood. In any case stopping hormones is not an option because I was given 3 months treatment in a single shot.
I did a search on here for nose bleeds and found just one post asking if there was a connection with hormone therapy.
Following my initial post in this thread I did query with my support nurse if hormone therapy was usual before surgery and her response was that although it was not the norm, if my surgeon had prescribed it then it was for a good reason and that my treatment plan was discussed by the multi-discipline team at their weekly meeting before offering it to me.
The target of starting cancer treatment within 30 days is correct, but hillsrob's clock stopped ticking as soon as he was placed on HT so there is no target for when he has the surgery. As for reasons, although it is rare, some surgeons like men to have HT to reduce the size of the prostate before keyhole surgery.
Re the hormones this is because it's a T3B? I think hormones will shrink the tumour and make it more likely that negative margins can be achieved
Hi Peter, Good idea to summarise my appointments in my profile. I've prepared a summary and pasted it below but will also add it to my profile:
21/02/2018 Day 0, with: GP, Haematospermia. DRE. Blood taken for PSA.
22/02/2018 Day 1, with: GP, PSA result 33. Referred to GP Care (NHS) Ltd.
06/03/2018 Day 13, with: GP Care (NHS) Ltd, Consultant nurse. DRE. Referred to Southmead for MRI.
21/03/2018 Day 28, with: Southmead Radiology, mpMRI Scan.
24/04/2018 Day 62, with Southmead Urology, mpMRI Scan results: T3B M0, N0. TRUS Biopsy arranged.
10/05/2018 Day 78, with: Southmead Urology, TRUS Biopsy.
21/05/2018 Day 89, with: Southmead Urology, TRUS Biopsy results: Gleeson score 3+4 = 7. NM Full Body Bone Scan arranged.
02/06/2018 Day 101, with: Southmead Urology, NM Full Body Bone Scan.
05/06/2018 Day 104, with: Southmead Urology, Results of NM Full Body Bone Scan. Consultation with Oncologist Urologist.
18/06/2018 Day 117, with: Southmead Urology, Consultation with Surgeon. Surgery path opted for. Hormone treatment started.
Edited by member 30 Jul 2018 at 16:29
| Reason: Referencing quote
Hi francij1, That's was the reason the surgeon gave me.
Hi Hillsrob, The dates are interesting, Prostate Cancer UK should ask for this information from everyone and create a scorecard to highlight areas for improvement
Your timescale is about 106 days from GP to a hormone injection. In my case it took about 65 days from GP to operation. It's supposed to take 60.
Anyway you are now being treated and as your surgeon said he's throwing everything at it, which includes the hormones. Also you're confident in your surgeon which is important. All the best.
Regards Peter
P.s I didn't notice you'd added the day numbers when I wrote the above. Mine is slightly different.
Edited by member 31 Jul 2018 at 12:30
| Reason: Added post script.
When I complained on the phone to GP Care UK Ltd about how long things were taking, they advised me that they met the NHS requirements and added that if I didn't like it I should go private. I emailed them twice asking for answers to some specific questions and they didn't have the decency to reply. I copied my GP in on the questions and he did at least ask me if I had received a response. My email dated 24th March 2018 edited to remove names etc. is copied below:
On 22nd February, 2018 I was referred to your NHS Community Urology Service by my GP - Dr <n1>. My PSA test result was 33.
Without a prior consultation with a Urologist, I was asked to visit the GP Care clinic at Yate on 6th March 2018 and given instructions to prepare for a Trans-rectal Ultrasound Biopsy.
At the clinic I met with Consultant Nurse – <n2> and I queried a statement included in the information sent to me i.e.
These tests are the only way to obtain these results. No other test is available.
I had seen in the news and through the internet that a Multi Parametric Magnetic Resonance Imaging (mpMRI) scan may be less invasive and possibly a more accurate initial test:
In January 2016, the results of the Prostate MRI Imaging Study (PROMIS) were published in the Lancet and showed that giving a man a multi-parametric Magnetic Resonance Imaging (mpMRI) scan before a biopsy can radically improve the accuracy of the diagnostic process for prostate cancer.
<n2> performed a digital examination which indicated that my prostate was enlarged and proposed sending me to Southmead for an MRI scan which I attended on 21st March 2018. I now need to wait for up to 4 weeks for the results.
I have a number of questions about my treatment at this stage which I would be grateful if you could answer.
1. Do I have a Consultant Urologist overseeing my case? If so who is he/she? Which organisation does he/she report to for my case?
On my MRI scan reference information it stated GP Care - Dr <n2>. I have contacted his secretary at Southmead but was advised that his name would just have been used as a doctors name is required in order to access the radiology facilities at Southmead.
2. I would like to know if my scan was carried out using a multi-parametric Magnetic Resonance Imaging (mpMRI) scanner or a different type of MRI scanner?
The notes on my appointment say: MRI Pelvis Prostate , MRI Pelvis Prostate with Gadolinium.
3. According to the North Bristol Trust – NHS – Urology website there is a One Stop 2 Week Waiting Urology Service available at Southmead. Could I have been diagnosis sooner if I had been referred there?
Edited by member 30 Jul 2018 at 23:24
| Reason: paragraph numbering tidied up.
As I have posted previously, men in the South-West should try to avoid getting prostate cancer. Of course, this company has had the contract in your area for a number of years now and I suppose people tolerate it until it affects them directly.
With hindsight, I can answer all of my questions Lyne:
Q1. Did I have a urologist overseeing my case at that time? Answer: NO.
Q2. Did I have an mpMRI scan? Answer: YES.
Q3. Could I have been diagnosed sooner if I had been referred directly to the 2 week waiting service at Southmead? Answer: YES.
I didn't even know about this company until I was directly affected by it. You couldn't drag me there now.
Edited by member 31 Jul 2018 at 19:41
| Reason: Not specified
GP put me on 3 x Sando-K tablets a day to try to improve my blood Potassium levels. Suffered another nose bleed (5th in 7 days) last night at about 18:00. Put the nose clip on kept from previous episode and it seemed to stop quite quickly. Blood pressure was quite high maybe 160/100. I called 111 and a non-emergency ambulance was scheduled to take me to the BRI in Bristol where they have an ear nose and throat (ENT) department. By 01:30 the ambulance hadn't arrived and I got a call from a paramedic to check how I was doing. We agreed to cancel the ambulance so that I could get some rest. Visited GP nurse today to get results of blood test for Potassium. This was 3.4 so much better that last Sunday when it was 2.7. We agreed that the moment I got another nose bleed I would drive myself to the BRI with a peg on my nose and demand a cauterisation.http://community.prostatecanceruk.org/Scripts/tinymce/plugins/emoticons/img/smiley-smile.gif
I had my Prostatectomy last Friday the 3rd September 2018.
On arrival at Southmead at 7am I waited just a few minutes before I saw the familiar face of my surgeon. He cheerfully ushered me and my partner into a 'medi' room and explained that he had one procedure to do before mine so there might be a short delay. He talked about my Triptorelin injection and said that if my PSA were to be taken today it would probably be negligible. I said that I was still experiencing hot flushes and he explained that the overlap period after a 3 months injection is about 4 months. He said again that I had a significant cancer, my PSA had been very high but the cancer cells would now be lying dormant having been starved of testosterone for nearly 3 months. He told my partner that he would call him to update him as soon as his part of the procedure was completed which took about 2 hours. I signed the authority to proceed with the operation and he left the room.
I then saw the anaesthetist who went through a few checks and explained that I would also be having an injection in my spine it help with the pain after the op. Within half an hour the surgeon was back and helped me into my gown and put on my elasticated stockings. The anaesthetist came back into the room and fitted a canula to my left wrist.
I then started the short walk to the operating theatre. I kissed my partner goodbye and entered the room and immediately recognised the Da Vinci equipment. I was asked to sit sideways on the table and heard the words "Don't worry if you fall, we'll catch you". I then saw my canula being pumped with some liquid from a syringe and woke up back in the 'medi' room a bit dopey but completely out of pain. I had pipes and wires connected all over.
My sister arrived to see me and eventually the surgeon came and said the procedure had gone completely to plan using the words 'nothing mischievous'. I thought afterward he must have meant nothing more mischievous that Prostate Cancer.
The last few days have gone quite smoothly. I was discharged the next morning but was re-admitted when the catheter stopped working and I leaked quite a bit of fluid from one of my 6 wounds. I stayed in under observation for two more nights but am now comfortable back at home. Walking a bit and resting a lot.
The district nurse called today and changed by catheter bag to a valve saying it would help my bladder to work again on it's own. I called the Prostate Cancer UK helpline nurses and they said that post Prostatectomy it was not a good idea to do this. I called the support nurses at Southmead and they confirmed that although the method without a bag is good for some catheter cases it was NOT good after a Prostatectomy where open drainage is recommended to allow the bladder to heal. I have now changed back to a bag as originally planned and my Trial Without Catheter is planned for next Wednesday 3rd October at 8:30 AM.
Edited by member 27 Sep 2018 at 19:49
| Reason: Not specified
Thanks Peter. I remember the term pleasant gentleman being used in a letter to my GP so thanks for spoiling the allusion.
I seemed to have reached a plateau of improvement at the moment as it's now over 7 days since the operation. I seem tired most of the time but push myself to walk the few hundred yards to get a bit of shopping every day. At least with the catheter and bag fitted I am getting a complete nights sleep. I've switched to decaffeinated tea which tastes awful and am drinking plenty of water knowing it can't get me up in the middle of the night.
The district nurses are coming round on Monday to remove the staples from my wounds. I seem to have gained about 2kg in weight since before the operation even though I am eating less. I can't wait to get back on my bicycle and to go to the gym but that's probably 5 to 6 weeks away at least.
My partner has been wonderful, cooking and cleaning, waiting on me hand and foot, helping me dress, administering my Clexane injections and putting on my anti-coagulant stockings etc. This disease obviously tests the strongest of relationships.
Edited by member 28 Sep 2018 at 20:36
| Reason: Not specified
I'm now 11 weeks post surgery. At 8 weeks I had my second PSA test in preparation for the post op consultation with my surgeon on 19th November. I was worried about asking for the result but was relieved to hear that it was less than 0.1 ng/mL. In February 2018 it was 33.3 ng/mL.
The surgeon started the consultation by asking me about my incontinence. I explained that I wear Tena pants for men at night and get up 2 or 3 times for a pee but am otherwise mostly dry at night or when sitting. On the move it's a different story and my bladder quickly empties. He assured me that things would gradually improve over the next few months and recommended that in the meantime I try using Sainsbury's nappies for 3 to 4 year olds during the day.
I was keen to ask about my pathology results which confirmed the original T3b N0 diagnosis but I was concerned to hear that although the surgical margins were mostly negative there was a very small area where the margin was positive. The surgeon said that he was not concerned about this and was very pleased that my PSA was now undetectable. He told me that he was a worrier by nature but he was not worried about me. I said that I didn't know if this was due to the 3 months pre-op hormone treatment or the surgery. He was a bit non-committal on this but proposed a follow up appointment with him in 6 months time to ' make sure everything was progressing nicely'.
I am now waiting for the effects of the hormone treatment to wear off and hoping my PSA remains undetectable.
Well certainly some good news J. I'm obviously worried about the 'positive base margin'. I'm thinking of asking for another PSA test in three months time. My hormone treatment should be out of my system by then.
It's now nearly 9 months since my surgery. I had a PSA test at 2 months post surgery and two more at 5 months and 8 months. All results have been undetectable at < 0.1. I plan to have another test at 9 months just before having a check up with the surgeon. I face each test result with some trepidation but have to remind myself that in February 2018 my PSA was 33 probably rising rapidly and with hind sight my operation was still 7 months away.
I have now almost recovered full continence. I wear the smallest of Tena pads in case I cough or perform extreme gymnastics. I ride my bike to the gym and walk my two energetic Staffies (Sky and Oscar) 3 times a day. Both I and my partner gave up drinking alcohol a year ago.
ED is an ongoing problem but I'm having some success with a pump. Life is good for now and I'm living it just one day at a time.
At 11 months post OP I had my 3 monthly PSA test and the result was even better than the last 3 at: <0.01 ng/mL.
I have to remind myself that 7 months before my OP it was: 33 ng/mL .
2 months post OP it was <0.1 ng/mL.
5 months post OP is was <0.1 ng/mL.
7 months post OP is was <0.1 ng/mL.
I'm not sure if maybe they used a different lab for the test and it returned the result with more resolution this time but of course I was very pleased to receive the news. I will always face the 3 monthly test with trepidation but for now I have a few months to get on with life. One day at a time.
Thanks iod4. I went to see my GP today and queried the <0.1 and <0.01 results. He said that someone had written the <0.01 result down wrongly and it should have been <0.1. It seems that is a low as the lab they use go. Just as well they didn't make the error the other way! 😒
Edited by member 10 Sep 2019 at 17:53
| Reason: Not specified
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May 28th City Council MeetingUser: webmaster
Date: 5/30/2019 6:13 am
Views: 839
Rating: -1 Rate [ | ]
The Valley City Council held its second regular scheduled meeting of May on Tuesday, May 28, 2019, in the Council Chambers at Valley City Hall.
Mayor Riley called the meeting to order at 6:00PM. The invocation was given by Councilmember Henry Cooper and Councilmember Marquetta Madden led the Pledge of Allegiance. Councilmembers Randall Maddux and Jimmy Gilson were absent.
The May 28th financial audit report for the city was given as follows:
- Checking account previous balance............................ $4,147,675.45
- Total deposits all funds...................................................... $487,306.85
- Total expenditures all funds.............................................. $274,536.61
- Total on-hand all funds.................................................... $4,360,445.69
Mayor Riley called for a public hearing to be held Monday, June 10th at 6:30pm to discuss the city's Community Development Block Grant (CDBG).
The following actions were taken by the city council at the May 28th meeting:
- Approved the minutes from the May 13th council meeting
- Accepted the May 28th financial audit report
The mayor made the following announcement:
1. The next council meeting will be Monday, June 10th at 6:00 pm at Valley City Hall
Council adjourned at 6:10PM.


text:
Have you been coming even before your partner is even having an orgasm? Have you been hearing complaints from your wife or partner regarding the climax which is pretty soon? These may be the symptoms of premature ejaculation. Rapid ejaculation,
premature climax
, rapid climax,
early ejaculation
are some of the terms by which premature ejaculation is known. Around 35 to 40 percent of the total world population is suffering from this condition in varying capacities. This means lack of control over voluntary ejaculation. Researchers say that a man ejaculating in two minutes of penetration is said to fall under or has
premature ejaculation
. A research by Alfred Kinsey proved and demonstrated that 75 percent of the men ejaculate before or within two minutes of perpetration in almost 50 percent of the times they had sex. Today we and the sex therapists know well the reason for the disorder that is when it's in lack of ejaculatory control, let it be sexual or emotional, this problem may cause serious consequences in any relationship.
So, if you're fed up with falling short and not performing to the best of your ability in bed, Derek Bijnaam has discovered a great guide with simple - easy to learn techniques. He reveals the resource at http://postponeejaculation.blogspot.com/
5. Practise the stop start technique. This is where you stop for about 30 seconds when you feel yourself approaching the point of no return and then continue after the moment has passed
The Squeeze Technique 1. Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate. 2. Have your partner squeeze the end of your penis, at the point where the head joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes.
3. Learn how to control your breathing by taking deep breathes, this will help to keep you more relaxed and focused on enjoying the moment. Sex is something to be enjoyed and not worried about
The greatest benefit of using a natural method to cure
premature ejaculation
is that the results are permanent. Do you want to cure your own
premature ejaculation
problem? If you would like to try a simple natural home program that so many men have used to successfully cure their premature ejaculation permanently. Click Here Now and see our featured story about one of these men. It's really easy when you know how.
4. Try and introduce more foreplay and oral sex. This helps you concentrate on pleasing your partner more. So you're not too concerned or anxious about your own performance. This helps take the pressure off you. When you do penetrate her, you should both enjoy it more
Sexual therapy may involve simple steps such as masturbating an hour or two before intercourse so that you're able to delay ejaculation during sex. And, you may want to make an effort to avoid intercourse for a period of time and focus on other types of sexual play (exercises/techniques) so that pressure is removed from your sexual encounters. One method is the squeeze technique.
Some effects it can have on a man are: 1. Total lack of self confidence as he is not able to sexual satisfy his partner 2. It is very frustrating for men as they are able to have an erection alright, but just can't perform long enough before ejaculating
The most effective way to stop
premature ejaculation
is hypnosis. Hypnosis has been very affective all over the world for the treatment of premature ejaculation. Hypnosis will help you create a certain pattern in your unconscious mind for your sexual performance. As you are a relaxed and in a pleasurable state of hypnosis, your unconscious mind can even learn more about e sex and sexual activities. You will start taking time in ejaculation and will enjoy sex and with the help of hypnosis you will be there for a longer time, even after your partner has orgasms. It will go on to be a truly pleasurable act and hypnosis for rapid climax will help you control this unpleasant condition, enabling you to explore the beautiful possibilities of passion and intimacy.
It is a sad fact that the most common sexual dysfunction in men today is
premature ejaculation
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As a means to curing their
premature ejaculation
many men result to using all types of pills and desensitize creams which end up costing ridiculous amounts of money. Apart from the fact that some of these pills can be harmful. The truth of the matter is they are a total waste of money as they only help in treating the condition they don't actually cure it.
3. After the squeeze is released, wait for about 30 seconds, and then go back to foreplay. You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, it soon regains full erection.
If you regularly ejaculate sooner than you and your partner wish such as before intercourse begins or shortly afterward you may have a condition known as
premature ejaculation
which is a common sexual disorder. Treatment options for premature ejaculation include medications and sexual therapy. For many men, it's the exercises practiced in sexual therapy that works best.
Some effects it can have on a woman are: 1. Most women become sexually frustrated as they feel cheated as they deserve to have a more fulfilling sexual relationship
One of the best known ways to get rid of
premature ejaculation
today is by using 100% natural remedies that can be used in the comfort of your home. Using a natural remedy is always the safest way, which is why it has now become the preferred method for most men suffering from premature ejaculation. Apart from the fact that it's a one off payment that is far cheaper than the cost of a bottle of pills, the results are permanent.
Premature climax
seems to be uncontrollable thing, but whatever happens it has causes related to it. Young people and adults who experience sex for the first time often ejaculate early. Those who are having an intercourse after a very long time ejaculate prematurely. There are some people who can even take control over this after their first encounter itself. According to the current research by IELT (intra vaginal ejaculation latency time) states that there is an average ejaculation time of six or six and a half minutes in an average adult ageing from 18 to 30. A man having 1.5 minutes as IELTs can report himself as a non premature climax person but however a person having 2 minutes as IELT has a very poor control over his ejaculation and will be diagnosed for the disorder.
The following tips can help your condition: 1. A very common method is by starting to exercise your PC (pubococcygeus) muscle. This muscle is mainly involved with sexual functions like orgasm and ejaculation. With consistent and prolonged exercising, this muscle will get much more stronger and help you to have better control over your ejaculations. The muscle you clench when you stop urine mid flow is your PC muscle. You can strengthen it by clenching and relaxing the muscle at different intervals.
For more on
premature ejaculation
cure and how to stop
premature ejaculation
visit the links.
4. If you again feel you're about to ejaculate, have your partner repeat the squeeze process. Repeat this as many times as necessary, because you will reach the point of entering your partner without ejaculating. Remember practice makes perfect and after a few practice sessions, the feeling of knowing how to delay ejaculation will become a habit that no longer requires the squeeze technique.
2. Masturbating about an hour before sexual intercourse is a good way to guarantee that you will last much longer as your sexual urges will have diminished
4. A woman can also loose interest in having sex with a partner that leaves her sexually dissatisfied 5. Some women do start to seek sexual fulfillment elsewhere
3. Many men tend to loose interest in sex after a while 4. Relationship problems start to arise as petty arguments begin to escalate to unnecessary rows
Some causes attributed to
premature ejaculation
is lack of experience, anxiety and the inability to control intense sexual arousal and stimulation. Whatever the causes are, the best way towards getting rid of the problem is taking action.
It is important to note that most men that want to get rid of
premature ejaculation
tend to look for natural cures. This is because the 100% natural cures are much safer than harming your system with different types of pills and creams. The fact that natural methods can be used in the privacy of your home makes them very appealing to men and they are also much cheaper than pills. It is also a one off payment.
If you suffer from
premature ejaculation
then a few tips on how to last longer in bed can help you improve your performance in bed. Many men that suffer from this condition dread the humiliation that comes with it. When a man comes too fast, both he and his partner are denied of the pleasure that sexual intercourse should normally give. Studies show that premature ejaculation is the most common sexual complaint of couples.
2. As no sexual satisfaction exists in the relationship the sense of complete intimacy that should be in a relationship can be wanting 3. As women are naturally more emotional than men it can make them suffer more emotional trauma
5. It can also cause distrust in a relationship as the man starts to think that his partner is not sexually satisfied an could possibly look for satisfaction elsewhere
The causes for rapid climax can be different even regardless to sex. During the first time you are having sex, it is going to be in the car or at your home when your parents are not in. While going ahead with sex there is a psychological pressure on you, will you be able to do it or not? What if someone suddenly comes when you are with your partner? These thoughts make you concentrate less on ejaculation control because you are subconsciously thinking of other consequences.
Premature ejaculation
can even be a reason because of environmental factors around the person.
Rapid ejaculation
can be because of depression, stress, financial problems, high expectations etc. even interpersonal problems can be a reason for premature ejaculation, unsolved problems, feelings being hurt due to some reason. These factors even contribute to early ejaculation.
Many men have been living with the humiliation that comes with premature ejaculation for years, the frustrating thing is that they do not have to anymore. Curing it permanently is very simple if you just know how and you're serious about making a change. Click Here Now to discover a simple natural home program that many men have successfully used to cure
premature ejaculation
permanently and see our featured story on one of these men.
James Kennedy
Learn More about Premature Ejaculation
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We never want to talk about it, but premature ejaculation (PE) is one of the most altering dysfunctions found in men. It is one that has the ability to cause low self-image, decrease in self-confidence, increase in depression, and even friction in a relationship or marriage. There are too many remedies out there, and not enough science to back them up. It seems, however, that when a problem of...
Frequently Asked Questions About Controlling Male Ejaculation - Increase Male Stamina Tonight!
Controlling male ejaculation is not very difficult to do, assuming you have the right specific knowledge about how to beat this problem from the inside out. Most of the purported miracle cures to increase male stamina are highly ineffective and will do nothing but cause frustration and a lot of wasted time and money. To help keep you from making the same mistakes I did when I first started...
The Top Three Premature Ejaculation Cures For Beginners - Start Satisfying Your Lover Tonight!
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4 Ways To Prevent Premature Ejaculation
Don t Let your Wife leave You! Master these 4 ways to prevent premature Ejaculation! Don t panic! There are many methods to cure this problem! The first method is Stop and Start Method This method really consists of controlling your sensations through sexual stimulation. Depending on how you feel more comfortable, you can accomplish it with or without a partner. The goal of this...
Free Exercises For Premature Ejaculation - Secret At Home Remedies Revealed
If money is tight and you are looking for some free exercises for premature ejaculation then you have come to the right place. There are exercises you can start today in the privacy of your own home that will help to correct your premature ejaculation. What am I talking about? Kegel exercises. Below I will explain what a kegel exercise is and how you can start using these free exercises for...
Deferol Climax Control for Men
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overcoming performance anxiety
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premature ejaculation hypnosis
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text:
Cast: Saptagiri, Roshini Prakash, Posnai Krishna Murali, Hema, Shiyaji Shinde and others
Music: Bulganin
Producers: Dr. Ravi Kiran
Direction: Arun Pawar
Noted comedian Saptagiri turned into a hero with the comedy film Saptagiri Express. The buzz on this film has increased ever since Pawan Kalyan attended the audio function. This film is a remake of the Tamil hit movie Thirudan Police. The movie has hit the screens today as a Christmas treat. Here's the review of it:
Saptagiri (Saptagiri) is a happy go lucky guy who graduates in theatre arts. He aspires t be an actor and tries to enter into the film industry. But his father Shiva Prasad, who is working as a head constable wants Saptagiri to become a Police officer. Meanwhile, a goon named Maanikyam runs all the illegal activities in the area Saptagiri lives in. He does all these activities with the help of DSP Papayamma (Posani Krishna Murali) and his wife.
One day, SP orders DSP Papayamma to deal with this case. Knowing that DSP is the one who is behind all these acts, Shiva Prasad prepares a file with eveidence to submit it to the SP. Then both Manikyam and Papayyama gets Shivaprasad killed. What happens next? Did Saptagiri take revenge? How did he deal wit Manikyam and Paapayamma? You hae to watch the film to know the answers.
Saptagiri does a neat job in the role of an aspiring actor. He did justice to his role. Though the heroines's role doesn't have much scope in this film, Roshini Prakash was good in her limited role. Shakalaka Shankar impresses the audience with his Srikakulam slang. Rest all did justice to their characters.
Technical and overall analysis:
Saptagiri wrote this script based on the Tamil film Thirudan Police. Director Arun Pawar executed the script and screenplay written by Saptagiri. During the initial scenes, Saptagiri will be seen in role of Parusharama. His dialogues in that sequences works really well. The cinematography is good.Music was bad as both songs and background score fails to impress. Editing is also sloppy.
The story moves on a snail pace during the first half but it races up in the second half. The makers tried to portray the lives of constables and it was shown quite well. The comedy sequences which come before climax audience entertains the audience. Saptagiri, who is known for comic roles, impresses in the audience in a hero's role. But the age old story and screenplay bores the audience. Overall, Saptagiri Express fails to impress the audience.
One-line verdict:
Boring Express
Rating: 2.5/5


text:
Tom Philpott's Mail Call
Sun | Military
This supplement to Tom Philpott's military news column gives readers a chance to sound off. To submit a comment, write to Mail Call at the postal or e-mail addresses at right with the Philpott column. Letters may be edited for clarity or length.
I am writing in response to your column about the Joint Chiefs, military retirement and pay.
I agree we are underpaid. I also realize this has been true since the beginning. We aren't here for the money, though I believe we need some raises.
The retirement issue, however, is totally different. If we serve our country, we should be taken care of. I fall under the Redux plan, and what happens to it will help me decide whether to stay or get out.
If America wants to stay ahead of the rest of the world, we need to make sure soldiers, sailors, airmen and Marines know they will be taken care of after full careers.
I have less than six years in the Army. I see many peers leaving because pay, retirement and other benefits are getting cut. And losing midcareer leaders is more costly than raising pay or retirement so they stay.
I have been in Gen. Shelton's command before, at Fort Stewart, Ga., when he was 18th Airborne commander, and here in Tampa when he was commander in chief of the U.S. Special Operations Command. He's a real "soldiers' soldier" who keeps in mind the best interests of all troops. He knows what commanders need to win: troops that are highly skilled, highly motivated.
Gen. Shelton will fight our battles in Washington. Others there should follow his lead.
Staff Sgt. Brendan R. Vande Kamp
MacDill Air Force Base, Fla.
Regarding Gen. Shelton's concern that midgrade noncommissioned officers see Redux retirement as too little to stay in service for: One possible solution is to ask Congress to exclude military retirement from federal taxes. That would send a message to the troops that everyone, from the top down, is interested in their well- being, while leaving the military budget largely unaffected.
Master Sgt. Dave Boyer
Palmdale, Calif.
I must say it's good to hear that senior leadership is beginning to stand up and tell the facts. As a company-grade officer, I know I don't have the overall picture. But I see that if anything is killing our armed forces these days, it's the idea we can do more with less and for less.
Most of us aren't paid comparable to civilian counterparts. It's disgusting to think some junior airmen need food stamps to feed their families but are expected to be the most professional, selfless segment of American society.
Retirement is another bone of contention. It is shortsighted and selfish of lawmakers to quarrel over whether we are "worth" a retirement increase. Those who stay long enough to retire are the glue that keeps this machine together. Their experience and leadership ensure that the same damn mistakes aren't made over and over.
So how much is national security worth? A lot of policy makers forget the world's fanciest, most accurate weapon systems still need a finger to push the button. Is it wrong to ask that the 1.5 million volunteers who protect a nation of 250 million be reasonably compensated? If it is wrong, disband it. Fight the next war with conscripts.
A volunteer force has an option when things look bad: Don't re-enlist. If our country continues to ignore the signs, soon the only ones left in our military will be die-hard patriots and those who can't make it anywhere else.
Capt. Kareem Brooks
Alamogordo, N.M.
The pay problems Gen. Shelton speaks of are true. My pay is enough to get by but below what friends make as civilians doing the same work with much less risk.
In today's job market, the hidden benefits that the armed services say we receive are not enough. My family needs tangible goods or compensation. I'm not greedy, but I don't enjoy living from paycheck to paycheck, having to work a second job to make ends meet.
The bonuses Secretary Cohen's aides speak of are not enough to keep middle-tier NCOs. In two years, I will finish my degree. And with my Air Force experience, I'll be able to go to work for someone willing to pay me what I am worth.
David Walbeck
Fort Walton Beach, Fla.
I assure you Redux is not the only retirement plan causing heartburn with the active force. I view "High-3" retirement as a criminal breech of contract.
I entered active duty under a delayed enlistment in September 1980. I was told then, and again in 1984 when I reenlisted, that I would receive 50 percent of my retirement. Later I learned I have to wear my final rank for three years to receive the full effect at retirement.
Of all the lost benefits, all the reductions, all the cost-saving initiatives, this program hurts the most. It lessens my ability to provide for my family. And the program changes were not well-advertised. I've only known about High-3 a few years. My comrades all fell in the same way. It's a breech of contract in its purist form.
I have been proud to serve my country for 18 years. But this High-3 program seriously sours that sense of pride.
Master Sgt. Patrick J. Kern
Chuuk, Micronesia


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Today I purchased the Ultimate FB plugin & am trying to get the Events widget to display. Right now the site doesn't look like much but want to see how the plugin will work. I am getting the following error : "Warning: usort() expects parameter 1 to be array, null given in /home/content/37/10240137/html/wp-content/plugins/wpmu-dev-facebook/lib/class_wdfb_widget_events.php on line 175"
Searched support forum & saw others w/ same error but no solutions posted. Please help!


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The ideas gallery
Fantastic Bathroom Interior Rendering Design
by Yantram 3d exterior modeling Brisbane, Australia.
The bathroom is an often overlooked room in terms of interior design, yet can be one of the most beautiful rooms in the house if treated and furnished correctly. The range of bathroom vanity furniture that is available these days allows some truly excellent design ideas to be incorporated into the room and not only is this to be enjoyed, but it can be a fantastic selling point should you wish to sell.
Bathroom area, interior, design, rendering, ideas, 3d interior designers, 3d interior rendering services, offices interior designer, interior design studio, interior design firms, interior design for home, 3d interior modeling, interior concept drawings, architectural design home plans, residential interior design studio.
View more: http://www.yantramstudio.com/3d-interior-rendering-cgi-animation.html


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My SciELO
Services on Demand
- Cited by SciELO
Related links
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Revista Cubana de Medicina Militar
Print version ISSN 0138-6557On-line version ISSN 1561-3046
SAMPER NOA, Juan A et al. Value of the minimental examination applied in combatants with slight cognitive deterioration. Rev Cub Med Mil [online]. 2009, vol.38, n.2. ISSN 0138-6557.
The minimental state examination is a simple and fast test (five or ten minutes), and is very used to assess the cognitive decline. The aim of present research was to characterize those combatants presenting with a mild cognitive deterioration according the results achieved in minimental state examination. Authors made a cross-sectional prospective and descriptive study in combatants aged ³ 50 assessed by its consecutive order seen in the dementia consultation at "Dr. Carlos J. Finlay" Central Military Hospital during 2002-2003. The forty six combatants included were divided into two groups: 26 presenting with mild cognitive deterioration and 20 without this state. We found alterations in register, attention, calculation, and memory. The register and the memory were affected in group with mild cognitive deterioration. Total score of minimental state examination was significantly lower in patients with mild cognitive deterioration than those in the group without it.
Keywords : Minimental state examination; mild cognitive deterioration; work memory; Alzheimer's disease..


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Advantages of Vertical Growing System
Most of the individuals are using vertical growing system. People are appreciating vertical growing system since they have additional benefits as compared to traditional system of growing crops. Vertical growing systems are a bit complicated when you compare the system with others hence you should be careful when you are implementing the system. When you want a vertical growing system, you should perform an in-depth analysis of the system. The following are the benefits of vertical growing system.
Due to the fact that lighting hangs vertically, they have a cutting edge design. This is very easy since the plants are hanged around a pillar for illumination. Due to proper lighting that are offered to the plans, they will offer you with numerous advantages. Growers who are growing plants will utilize space that has been allocated to them well. Plants will also get enough energy since they will be placed directly in the presence of the source of energy.
Vertical growing system saves space and is very affordable when you are using this method. You will increase the yield of your plants when you are using the system. You will get productive results since your plants will thrive well. Due to the fact that plants will be offered with three dimensions, they will grow well. Growers will speedily work to move little gals, when there are transplants needed. Plants can also be placed on the vertical grow system in order to grow when they are 12/12 days.
Vertical growing system can be used for commercialization. You get high uniformity of the cutting edge. When you commercialize vertical growing system, you will have room of growing more and more plants. You will grow so many plants when you are using vertical growing system which is very important.
When you are using vertical growing system, you will get reliable harvest. You will get enough food that is of high quality since the system is well designed. There will be constant flow of products from the vertical growing system, this will help commercial grows to have yields constantly. Crop pest and diseases will be controlled when you are using vertical growing system since they are closed. Plants will be able to grow well which will help you get quality produce.
Less water is used for vertical growing system. When you are using vertical growing system, they will use minerals in order for photosynthesis. Plants will be able to grow well in a closed environment. You will also reduce transport cost, due to the fact that vertical systems are normally located in strategic location. You will easily get transportation services when you are using vertical system, this is important since you will get cheap services when it comes to transportation.
How I Achieved Maximum Success with Products


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Right Now!
How to be closer to God is the question everyone has and the answers are not specific.
There are 10 ways that are specific to being closer to God.
1.) Give up everything that's about what's important to you and what you want.
2.) Make God Priority #1 period!
3.) Worship and Praise him for All he has done and does.
4.) Acknowledge his Son; Jesus.
5.) Walk-in Spirit and Truth by Faith and not by sight.
6.) Meditate on his word (Bible) both day and night.
7.) Know, Trust and Depend he is God.
8.) Live Righteous & Holy presenting your bodies a Living Sacrifice.
9.) Serve him with your Whole Heart.
10.) Pray. Pray to God without Ceasing.
How hard is Sacrifice?
If sacrifice was easy there would be a world of people bowing before God's throne in Worship to Our Almighty God, throwing themselves on his alter because of Love for who he is and what he has done for us. Unfortunately; that is not the case in Earth for the numbers are few in comparison, who make the daily sacrifice as lambs of slaughter. In this world of Sin, the opposition to truth, is a distraction, to make easy, false sacrifice to the pitfalls which appear glamorous and promising, the a-luring false hope of righteousness with a one-way ticket to Hell.
As a born again Child of God, how does one persevere in such turmoil, destruction and devastation, in a land that has no reverence or respect of God?
For I shall lift up mine eyes unto the Lord. For my help cometh from the Lord. Oh, ye people of this Earth; Know that there is a God of Salvation. For he is the God of his People. Be ye steadfast and always abounding in his Love for Our Redeemer Lives. One day the trumpet will Sound and Jesus will return for his Church; God's People to take them away from this place. Just as Moses led the Children of Israel from Egypt out of bondage, oppression and slavery; So will Jesus lead his people into Eternity.
Will you be Ready?
Before leaving I have two appeals:
Firstly; it is my desire for those who are not saved, to be saved. That is the mission of this ministry; that you know Jesus. If you have not received Jesus in your life it is my desire that you know Jesus and ask him to come into your life, pray and seek a Church that will worship, support your faith and increase by knowledge in Jesus Christ. This is the only chance we have to live a life, in this life, that is pleasing to God. Live it to the utmost with Jesus Christ by your side, waste not another moment if you have not received him as your personal Savior.
Secondly; This is a ministry to advance the Kingdom of God by reaching out to those by word and deed, who do not know the Kingdom of God is at hand.
Your charitable contribution would be sharing this message for others to hear.


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Sydney Has Ruled Out Appealing The Dane Rampe Sanctions
Accepted the fines
Image: Channel 7
Sydney has opted not to appeal against the sanctions handed out to Dane Rampe.
The co-skipper was fined $1000 wholly suspended for climbing the post at the end of the game, and $10,000 with $5000 suspended for saying that an umpire talks "like a little girl".
The Swans released the following statement:
The Sydney Swans will not appeal the sanctions handed to Dane Rampe by the AFL in relation to two incidents during our Round 8 match against Essendon.
The Club in no way condones the comments Rampe made to an umpire as they do not reflect our values of respect and inclusiveness.
Rampe has acknowledged he made a mistake and apologised unreservedly. He is an outstanding leader of our football club and is disappointed in himself for his actions.
However, the Club remains of the view that the fines imposed are excessive, because they are not in line with the AFL's response to other recent incidents.
We have raised our concerns with the AFL and hope the league will continue to show leadership with a consistently strong stance on such matters in the future.
Make sure you download the Triple M Footy app on iTunes or Google Play to stay across all the best footy stuff!


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Who better to guide consumers into this new and multifaceted arena than the technicians they already rely on for one of their most expensive and complex home-related purchases? HVAC systems are a natural fit with smart home technology, and dealers have the necessary HVAC expertise.
Integrated diagnostics allow technicians to proactively alert homeowners to maintenance issues that could be compromising efficiency, wasting energy, and may lead to costly future repairs.
Read more: http://contractingbusiness.com/residential-hvac/hvac-contractors-can-lead-smart-home-revolution


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- No Suggestions
- No recommended searches
Kensington's award-winning TrackballWorks™ is being consolidated into KensingtonWorks™ to provide you with a simplified software solution to accommodate all of your Kensington trackballs, mice, and presenters. We are phasing in versions of KensingtonWorks™ to accommodate different products and models. We aim to provide you with devices that work the way you do to enhance your productivity and increase workflow efficiencies. KensingtonWorks™ is a tool for personalizing your experience with Kensington® trackballs, mice and presenters. Designed with productivity in mind, KensingtonWorks™ allows you to customize button functions, modify pointer settings and tailor your device functionality to meet your individual needs.
One integrated software application works for all of your Kensington trackballs, mice and presenters. An Update Reminder process provides notifications to ensure that you have access to the latest customization options for your devices, and Connect Tutor will automatically launch when a new device is selected to easily guide you through the setup process.
A modern and user-friendly interface allows you to customize button functions, modify pointer settings and tailor device functionality to meet your individual needs within minutes.
The Bind-to-Cloud feature saves your personalized settings to a cloud account (OneDrive) so they can be retrieved at any time.
KensingtonWorks™ provides you with endless function combinations to enhance productivity and customize your workflow options. All settings can be assigned per application so you can customize your device buttons based on the application you are using. Here are a few personalization options available to help you work like a pro!
Mouse & Keyboard
Web Browser
Windows & Virtual Desktop
Text Snippets
Web Browser Controls
|KensingtonWorks™ for Windows
|KensingtonWorks™ for MAC
Windows Compatibility
Mac Compatibility
|KensingtonWorks for Ultimate Presenter- Windows
|KensingtonWorks for Ultimate Presenter- Mac
Windows Compatibility
Mac Compatibility
Pre-Sales Support: email@example.com
Post-Sales Support: US 1-800-535-4242 // Canada +1 905-364-2719
US Product Support // Canada Product Support


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This video provides a brief overview of the four-day festival presented by the Geva Theatre Center in Rochester, New York. "Journey to the Son: A Celebration of Son House" occurred from August 26-29, 2015 and …Continue Reading
AHA Heart Walk/Run
This t-shirt design was the University of Rochester's 2016 contest winner for the American Heart Association's Heart Walk/Run event. The 2-color design highlights the University of Rochester and heart health. It was the official 2016 …Continue Reading


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Four V LLC
Four V LLC is a web design firm and digital marketing company with its sights set on success for their clients.
Digital Marketing Company
A Dazzling Website Is Just The Beginning
Four V creates website that demands a second look and get found online with marketing tools that put your business in all the right places.
Web Design Company
Be Relentless With Your Business and Website
When it comes to your business you need to be relentless. The business needs to have a rock-solid, unique, high preformance website.
Helping Businesses Through Web Design
Four V LLC is a modern web design firm with their sights set on success for their clients. We make it a priority to serve our friends and neighbors with reasonable pricing and the best quality web designs available.
Partnering with a marketing company is one of the best investments of time and resources that you could make.
We Are A Growing Company
Our staff continually monitors the newest design trends and marketing developments to stay ahead of the curve.
Four V LLC continues to grow. Currently, we have clients located in six states. We have room to keep growing. We would like to add you to our client's list.
Website Design & Development Company
Four V LLC is a web design firm that could make the biggest difference in the success and betterment of your company presence. We are a web specialist company that offers some of the best website designs and development. Publishing some of the best website design for small business is very rewarding.
We will be your partner and dedicated to providing you with a Quality Website. Our goal is to deliver and maintain a quality website for you, our client. Get the power of a digital marketing company behind you. Four V Puts Power In Your Website.
How important is your website? Do you have a plan in place to keep your website updated? Website Care/Website Maintenance that is simple and hassle-free. Look at our various Web Care pricing plans. Specializing in WordPress website design.
Let us serve you with our Google Ads marketing services. Our goal is to maximize your investment no matter what your budget. Russell and Melinda are Certified Google Ads Professionals.
Designers Of Quality Websites
⊕ Professional website design.
⊕ We build the website for you and keep it updated.
⊕ Everything you need to be successful online.
⊕ SEO Search Engine Optimization is included.
⊕ You will be found on Google, Yahoo! and Bing.
Four V is Passionate about creating websites. Having a website gives you the ability to connect to people that you did not know existed.
List Of Website Services
Google My Business
Website Hosting
Password-Protected Pages / Client Area
Shopping Cart / Online Ordering System
Event Booking System
Event Calendar
Membership System
Blog / News Management
Business Directory / Listings
Social Media Integration — Facebook, Twitter, Youtube, etc.
Social Media Management – SMM
Email Newsletter
Mobile-Optimized Website
Mobile Application / iPhone App
Brand Identity
Four V LLC is a Brand Identity company. Brand Identity is the way a company designs its logo, the colors, shapes and other visual elements in its products. Create communication and marketing campaigns that boost awareness.
Employee Owned
We are an employee-owned web development company, Four V LLC is a West Virginia Website Design Agency specializing in WordPress website design. We offer digital services that will benefit your company.
When we start working with you, you are a priority. Your questions and concerns are our priority.
"Great folks to deal with. Friendly, knowledgeable and professional". – Tiffeny Papuc,
The Miami Corporation
A fine honest service run by a man who understates his extensive web building capabilities. We at Rush Enterprises LLC highly recommend! – Jesse Marks, Rush Enterprises LLC
Great Website Design Company to do business with. Very professional, and builds high quality sites with many functions and options available to satisfy your specific needs. Highly recommend. Josh Adkins, Millennium Oil Company
The staff at Four V LLC. are both knowledgeable and friendly. I currently run two sites and the assistance I receive is excellent. Lee Ball, Ten-Thirty Ministries, and Down Jotter.
Helping You Be There When New Customers Are Searching for You
Web Design & Digital Marketing
WordPress use to be just a blogging platform? WordPress has evolved throughout the years into a versatile content management system (CMS).
Pay Per Click Advertising, SEO, Search Engine Optimization, Local & National Search Marketing, Social Media Marketing.
We know the web is no longer just on the desktop. We put a huge emphasis on responsive design, viewers will get the best possible browsing experience on desktop, tablet, and mobile.


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Vastavam web: Prime Minister Narendra Modi today congratulated President Vladimir Putin and Russia for playing host to the FIFA World Cup 2018 beginning next month and hoped for the successful organisation of the sporting extravaganza.The 2018 men's FIFA World Cup will be held in Russia from June 14 to July 15. A total of 64 matches will be played by 32 teams in 12 venues located in 11 cities.Prime Minister Modi, who is here for the first informal summit with Putin, said that the world is eagerly waiting for the sporting event.
"The entire world is eagerly waiting for the FIFA World Cup 2018 and you are going to organise the event. You will be at the centre of the world's attention and I congratulate you for that," Modi said.


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Join up to experience the big top! This circus-themed slot has animal trainers, clowns, animals and many more!
Take a trip to Ancient China in this treasure hunt game, where you'll be on the lookout for hidden golden animal statues.
Head into wild Scandinavian nature for an exciting slots game. Be on the lookout for the Northern Lights to unlock the bonus game.
Part of the Foxin games, Foxin Wins Again will see you return with this furry character and his five fox pups on a luxury liner.
Based on the 2005 film, the King Kong slots game will take you on an adventure to the mysterious Skull Island.
With fairies sprinkling their magic lucky dust, you just may win big money in this mysterious and enchanted meadow slot.
This simple gem-themed slots machine has some of the best graphics around, and game variations to mix things up a bit.
Funny alien-like Goonz take centre stage in this game. It's fun, unique, and will certainly keep you entertained.
in one place, choose from a huge selection of both free & real money online slots, including your favourite classics!
At OnlineSlots.com, we aren't just concerned with finding the top slots sites in 2020. We also love hunting out great real money slots that keep the gamblers coming back. On these pages you'll find details and reviews on the most popular online slots.
From the original progressive jackpots to big branded titles and huge multi-payline games that offer up to 1,024 lines every spin, we make sure you're up to speed on who's playing what.
Unlocking a great welcome bonus is the best part about playing real money slots online. When you sign up to one of our top-rated slots sites you can access a bonus just by making a deposit. You'll need to play your favorite slots to trigger the cash, but how good is it to earn free money just by doing what you love?
At OnlineSlots.com we only recommend casinos with the best bonuses for slots players. With our picks you can save time and money and put the extra effort into activating that great welcome bonus. You can even grab free spins on the top new slots when you join up.
How many more reasons do you need to open an account with one of our slots online casinos today?
Any casinos listed in this section have not passed our meticulous inspections and should be avoided at all costs. Our stringent checks cover legitimacy, licensing, security, software, payout speed, customer support and more.
You can easily play slots games online. The controls are very easy to learn since you only have to set the size of the bet you want to place and then press the "Spin" button. The reels will spin for a bit and then stop to show random symbols on the screen. Payouts are granted automatically and a new round is ready to begin after that.
Yes, they do. Online slot machines will pay real money when betting real money. Although it is possible to play for fun and just practice, the excitement of the games comes from the potential to win money on every spin. Payouts are granted for combinations of symbols on active lines.
Slots players can win a lot of money online. The fact that each spin can result in a big win is part of the fun. It starts with learning how to win at slots. Then, with a bit of luck, large sums of money can be won from just a one round, so it is safe to say that users can make a profit from online slots.
Slots machines have random outcomes. Every result is determined by a random number generator so that it is impossible to predict things ahead of time. With that being said, some online slots strategies recommend increasing the size of the bet after a few non-winning spins in order to make up for the losses on the next win.
A loose slot machine normally pays more than a standard machine. Slots have theoretical return to player rates, also known as RTP, that represent how much money they pay back to customers over a longer period of time. It is normal for the RTP to be above 90%, but loose machines will easily go over 95%, thus making it more likely to win.
Progressive slots, such as the famous Mega Moolah, have jackpots that increase when real money bets are placed. Instead of offering a set amount as the top prize, progressive slot games will show a growing number that can reach higher levels. Depending on the game, winning the progressive jackpot can be done by getting a set combination or from within the bonus game.
The paylines are the imaginary lines drawn through the reels where prizes can be won. Winning combinations of symbols can only be achieved on these diagonal, horizontal and occasionally vertical lines. Some slots have more paylines than others as well, increasing or decreasing your chances.
The odds of winning on a slot machine vary dramatically depending on the game, but usually the house edge is 3% or lower, giving you decent odds of winning more than you lose. Generally newer machines offer worse odds than the older ones.


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I've been thinking a bit more on this.
Many years ago the PSI stated that the ability to speak English (or Gaelige) was the responsibility of the employer. Now they have finally got around to making it a condition of registration. How many more years before they make Garda vetting a condition of registration.
I'm guessing 10 years.
I'll have a running bet with myself. Which will come first, Garda vetting carried out by the PSI or my retirement? A pint for the winner.


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The "Windy City" of Chicago has one of the most iconic skylines in America, with towering skyscrapers piercing the heavens and waves lapping onto the shores of Lake Michigan. Nature and architecture go hand in hand in Chicago, along with famous museums, art galleries and renowned shopping promenades. Here are a few of the top attractions in Chicago for any type of traveler.
Arts Alive
Regardless of your creative inclinations, it's hard to resist exploring culture in the "City of Museums." You can dive headfirst into eclectic world cultures at the Field Museum, or get your brain-game on with an afternoon at the Museum of Science and Industry. Above all, don't miss a trip to the Art Institute of Chicago, where you'll view originals by the world's greatest masters, including Van Gogh, Seurat and Renoir.
Magnificent Mile
If you can't resist the pull of what's arguably the glitziest shopping strip in America, then put on some walking shoes and march along the Magnificent Mile on North Michigan Avenue. Even if you don't have lots of cash to splash, it's worth the experience of gazing at dazzling displays, elegant boutiques and famous fashion houses selling designer originals. There are plenty of cafes, cocktail bars and espresso shops along the Magnificent Mile, so snag a window seat and watch the parade of people strutting their stuff.
Sports Heaven
Shopping and culture aren't the only games in town when visiting Chicago. Sports aficionados get their kicks at Wrigley Field while watching the Chicago Cubs knock it out of the famous ballpark. You can also pick up tickets to see action from the Bears, Blackhawks and Bulls while you're in town. On down days for actual games, there are still plenty of sports-related venues to explore, including the Blackhawk's Store on Michigan Avenue and the Chicago Sports Museum, located next door to Harry Caray's 7th Inning Stretch
Kid's Attractions
Chicago certainly doesn't ignore the little ones, with family attractions such as Navy Pier. A 150-foot high Ferris wheel whirls and twirls through the sky, while ground level is home to at least 50 acres of family fun, arcade games, souvenir shops and kid-friendly cafes. Lincoln Park Zoo is another family favorite, with free admission and entrance to the Kovler Seal Pool, Lion House and more than 200 different species of animals.
Also at Lincoln Park, you can take a stroll on the Nature Boardwalk and have a picnic at the pavilion. If you're into botanicals, don't miss the orchid and palm rooms at Lincoln Park Conservatory, a Victorian-era glass structure with thousands of treasured plant species. Let millions of artifacts, manuscripts and documents bring history alive at the Chicago History Museum, including Chicago's first railroad locomotive.
Chicago is a city that reinvents itself over and over again, meaning you'll always return to the Windy City with more to see and explore. Attractions in Chicago run the gamut from traditional arts to cutting-edge technology, with plenty of action day and night. It's the perfect vacation destination for visitors of all ages.