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- Emotional Issues Could Be Early Sign of MS
- In Mice, Gene Therapy Helps Restore Movement After Spinal Cord Injury
- Timing of Hot Flashes Could Give Clues to Alzheimer's Risk
- What Is 'Sexsomnia'? And 'Sleep Eating'? Can They Be Treated?
- Just 23% of U.S. Adults 'Definitely' Plan to Get New COVID Shot
- More Women Using Cannabis to Help Ease Menopause Symptoms
- Black Patients More Likely to Be Physically Restrained During ER Visits
- PTSD Can Harm a Woman's Sex Life
- Blood Tests for Long COVID Could Lead to Better Treatments
- Teen Boys With High Blood Pressure Face Danger Decades Later
Blood Thinner Dangerous for Patients With Artificial Heart Valves, Study Finds
THURSDAY, Sept. 26When used by patients with mechanical heart valves, the blood thinner Pradaxa raises the risk of both dangerous clots and bleeding around the heart, a new study says.
The bottom line for lead researcher Dr. Frans Van de Werf, chairman of the department of cardiovascular medicine at the University Hospitals Leuven in Belgium, is "don't use Pradaxa in patients with a mechanical valve."
In fact, the trial was halted early and the U.S. Food and Drug Administration subsequently issued a 'black box' warning that said this particular group of heart patients should not take Pradaxa because of an increased chance of a stroke or heart attack.
Pradaxa (dabigatran) is a drug that prevents clotting. It has been approved as an alternative to warfarin for patients with an abnormal heartbeat called atrial fibrillation, the researchers noted.
"It was hoped that a novel oral direct clotting inhibitor would provide similar or better protection for patients with mechanical heart valves without the need for [the] monitoring or dietary restrictions associated with warfarin," said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles.
After a heart valve replacement, patients are typically put on blood thinners or drugs that combat clotting to prevent a heart attack or stroke, but the danger of these drugs is a risk for severe bleeding.
"While the vitamin K antagonist warfarin is very effective at preventing clotting-related complications of mechanical heart valves, its use requires lifetime monitoring, with at least monthly blood tests, dietary restrictions and the potential for multiple medication interactions," Fonarow explained.
Unfortunately, this randomized clinical trial showed that Pradaxa was even more problematic than warfarin in terms of side effects, he said.
"As a result of these findings, the FDA added a 'black box' warning to the medication label warning against using dabigatran and similar medications in patients with mechanical heart valves," Fonarow said.
The report was published Sept. 26 in the New England Journal of Medicine and the trial was funded by Boehringer Ingelheim, the maker of Pradaxa.
For the study, an international team of researchers randomly assigned 252 patients who had an aortic or mitral valve replacement to either Pradaxa or warfarin. Some patients had the valve replacement within a week before the study began and others had the surgery three months earlier, the researchers noted.
Of those taking Pradaxa, 32 percent had their treatment stopped or dose changed. In addition, 5 percent of those on the drug suffered a stroke, compared with none of those taking warfarin.
Moreover, 4 percent of those taking Pradaxa had major bleeding around the heart, compared with 2 percent of those taking warfarin, the researchers found.
More information
For more on heart valve replacement, visit the American Heart Association.
Source: HealthDay
Copyright © 2023 HealthDay. All rights reserved.


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AC2e Felt Hat II - single strand - PDF
Fiber Trends Pattern AC2 Felt Hat II - PDF
Design by Bev Galeskas
Our lightweight felt hat offers a choice of three sizes and two brim variations.
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Three Sizes: Child (adult small, adult large).
The exact finished size is determined by the amount of felting and the form used for blocking. This can be a head form, bowl or ball. Choose one that is just slightly larger than recipient's head measurement.
Yarn Requirements: Approximately 250 (300, 340) yards (230, 277, 314 meters) of worsted weight wool or wool / mohair blend for the wide brim version. Approximately 30 (40, 45) yards (28, 36, 42 meters) less for the narrow brim hat.
Use only wool, mohair, alpaca or blends of these that will felt to a firm fabric.
Caution: To avoid disappointment always test felt a sample of your yarn before starting a project.
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subset: commoncrawl


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Your Pretty Hair Is Making You Fat
We well-meaning men have been trying to tell you this for years, ladies: your fancy hairdo is dumb. And it sucks up time that could be better spent on other things like, I don't know, just to pick an example out of thin air... doing some exercise to get yourself in shape, for once.
Now you're slapping us. Don't believe our well-intentioned advice that originates from a place of caring? Perhaps you'll believe THE US SURGEON GENERAL, A WOMAN:
Surgeon General Regina Benjamin gets it. She is a doctor whose mother was a hairstylist. She knows high-maintenance hair can be an obstacle to exercise, especially for African-American women like herself. She's performing a huge public service by calling women out on it.
"Oftentimes you get women saying, 'I can't exercise today because I don't want to sweat my hair back or get my hair wet,'" Benjamin told The New York Times. "I hate to use the word 'excuse,' but that's one of them."
This isn't me talking, ladies; this is US Surgeon General Regina Benjamin, telling it like it is! No, I mean... no... I didn't... I never said that you need to exercise, it's just... I'm not trying to tell you... no, look, seriously, it's not... I'm telling you it's not even about your looks at all, it's just a health thing, I want you to be healthy, because I love you, and... no, you look fine, I mean you look great... of course I love your hair! All I'm... okay, I'm not trying to argue, I know your hair takes time, I was just telling you... god, fine, yes, Jesus Christ, forget it. Forget it. Just forget it. Let's just go to dinner, okay? Let's go to that new Italian place.
Just don't take fucking forever doing your hair, please. Just run a brush through it. It looks fine.


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A media campaign to combat prejudice against Romani.
Since 1989 the position of Roma got worse. Housing is bad. Education
policy has contributed to the fact that almost no Roma kids get any further
than basic-school. Half of orphans are Roma. The splitting of Czecho-Slowakia
had dramatic concequences for many Roma. Ten-thousands of them are now stateless,
because government refuses to acknowledge them as Czech citizens. Non of
both countries is in fact willing to accept them. This longlasting stalemate
has led to distrust, fear and apathy among Roma. In the last years at least
25 Roma have been killed by violence based on racial motivs. Regularly,
the Czech press reports of violent attacks of youth, often skinheads. These
violent attacks are not wholeheartedly condemned and even sometimes tolerated
by many Czechs. Anti-Romani prejudices are widespread and the marginal socio-economic
status of many Romani only further enhances persisting cliches.
This campaign is organised by one individual: Juul Hondius. In 1994
he came for a period of six months to the Czech Republic to work and study
as a photographer. During this period he decided to undertake action against
the widespread discrimination of Roma. This campaign is a reaction on the
extreme situation of Roma in a society were they are not wanted, but do
With the help of many people;interpretors & local contactpersons, he
travelled along different Czech cities to make many photoportraits of Roma.
Young & old, and poor & rich, trying to show all existing variation
in Roma's social status. While photographing he tried to avoid to show the
actual circumstances of 'their' surrounding; he prefers to show real faces
of real people, The context of their reality today should not be mixed up
with romantic stereotypes of the wandering happy gypsy tramp.
in the way we see in many existing reportages.
The majority of Czech citizens prefers to ignore the Roma,
some would even prefer the Roma dissapear. Juul Hondius decided to fight
this ignorance by making Roma visible on the streets of Prague.
He made a selection from the many portraits and added thought-provoking
texts to them.
These posterdesigns where blown up to very large seizes; from 1.5m.x 2m.
up to 4 x 5 meter
Now, more than two years later, the photograhps are finally covering the
walls in the city of Prague.
As a follow-up project of the campaign, the posters will be photographed
again being they are taken down, in order to document any positive and/or
negative responses to this media-campaign. In this way, the feed-back of
the Prague population can be documented. Here can you see the results:
Juul Hondius isn't organising this campaign as a representative of The Netherlands,
but as a independent individual.


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and should be enjoyed everyday.
Utah, Colorado, New Mexico and Arizona.
Wednesday, February 22, 2012
Going Up to the Sunset Grill
900 North Main Street
(Highway 191, north end of town)
Moab, Utah 84532
Phone: 435-259-7146
Website: http://www.sunsetgrillmoab.com/index.html
The Sunset Grill is the former home of Charlie Steen, who put Moab, Utah on the map when he found uranium. The restaurant opened in 1993, serving casual fine dining to locals and tourists alike. To reach the restaurant itself, prepare yourself for a winding climb 250 feet up into the Red Rocks. From its location, one can see for miles the city of Moab and the stunning Red Rocks; at night, the stars shine brightly overhead.
My husband and I found ourselves at The Sunset Grill for Valentine's Day; it was a wonderful choice. We were warmly greeted by the hostess and our waitress was a charming young lady. We were seated at the topmost dining area, so were able to see the city lights of Moab from our table.
We began the evening with a popular appetizer, Artichoke Gratin Baguettes; diced artichoke in a rich cheesy mixture, topped with mozzarella cheese, spread onto French bread slices and grilled; they are served with a marinara sauce. I say popular as it seems that almost every couple ordered this appetizer and understandably; it was absolutely decadent and delicious.
Roy chose one of the Valentine's Day special; Bacon Wrapped Filet Mignon with a Balsamic Peppercorn Sauce; I had a taste and wished I had ordered it also. The beef was so tender and juicy; the sauce was sweet, tart and tangy with a hint of the peppercorns; just perfect.
The main entrees were not small in portion, so we had to forego dessert...no regrets though.
The Sunset Grill has a warm, welcoming atmosphere and the staff reflect this well; no pretentious attitudes here. Whether it's for a special occasion or just a dinner out; dress fancy if you like, but jeans and a nice shirt would do just as well; The Sunset Grill will make your night. Better make reservations!
Mary Cokenour
Posted by Mary Cokenour at 5:47 PM 1 comments
Labels: Charlie Steen, filet mignon, fine dining, food blog, food porn, Mary Cokenour, Moab, prime rib, Red Rocks, restaurant, restaurant review, steamed vegetables, Sunset Grill, Uranium King, Utah, Valentine's Day
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|Home ▸ Catalog ▸ |Featured Collections| ▸ |Jyrki Muona Collection||View Options: | | |
The Jyrki Muona Collection of Roman Coins
We are pleased to offer a large selection from the Jyrki Muona Collection of Roman Coins. While the collection includes a wide spectrum of emperors and types, the primary focus of the collection is on the emperor Otho and the emperor Philip and his family. Mr. Muona's coins include many rarities and many attractive high grade examples. We hope you find that elusive coin you have been seeking for your collection!


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På denna hemsida används: HTML5, CSS 3.0 and JavaScript.Om någon av dessa teknologier är avstängda kan vi inte garantera full funktionalitet.
The technologies that this content relies upon is: HTML5, CSS 3.0 and JavaScript.If any of these technologies are turned off or not supported we can not guarantee full functionality.
To cross this queer bridge when a sharp growl made them all look up, and to their horror they saw running toward them two great beasts with bodies like bears and heads like tigers.
"They are the Kalidahs!" said the Cowardly Lion, beginning to tremble. "Quick!" cried the Scarecrow. "Let us cross over."
Holding Toto in her arms, the Tin Woodman followed, and the Scarecrow came next. The Lion, although he was certainly afraid, turned to face the Kalidahs, and then he gave so loud and terrible a roar that Dorothy screamed and the Scarecrow fell over backward, while even the fierce beasts stopped short and looked at him in surprise.
Bigger than the Lion, and remembering that there were two of them and only one of him, the Kalidahs again rushed forward, and the Lion crossed over the tree and turned to see what they would do next. Without stopping an instant the fierce beasts also began to cross the tree. And the Lion said to Dorothy:


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Members of the Binghamton University community have the right to participate in all that the campus offers without being subjected to physical violence, threats, intimidation, or damage to personal property, or any other form of harassing behavior.
Binghamton University is committed to creating a safe and supportive learning environment, to becoming a more inclusive community, and to fulfilling its obligations under federal and state laws, regulations and executive orders. Essential to these objectives is the maintenance of an environment in which individual dignity is respected, the richness of human diversity is welcomed, and harassment is not tolerated.
Accordingly, it is the policy of Binghamton University to prohibit harassment and to investigate allegations of such behavior promptly and thoroughly. This policy applies to students, faculty, staff, employees of the Research Foundation, contractors, vendors and visitors to the campus.
A) What is Harassment?
i) General Description
Harassment is generally understood to occur when the conduct of an individual or group of individuals has the intent or effect of unreasonably interfering with an individual's or group of individual's educational or work environment, or that creates an intimidating, hostile, or offensive environment. Some forms of harassment are prohibited by law. Understanding harassment begins with recognizing that there is no simple definition of the term, and that there is no finite list of behaviors that covers all potential forms of harassment. Rather, the circumstances of each case will determine whether specific conduct amounts to harassment.
Moreover, while the range of behaviors which may constitute harassment is broad, so is the range of speech protected by the First Amendment, and this is discussed in more depth in section "B" of this document. Finding the balance between harassment and protected speech can be challenging.
ii) Harassment Based on Protected Class.
The Equal Employment Opportunity Commission (EEOC) describes harassment based on protected class (including sexual harassment) as offensive conduct that is so severe, pervasive, or objectively offensive that it creates an unreasonable and substantial interference with the ability of members of a protected class to participate in the academic or employment setting. As with other forms of harassment, an individualized assessment of the circumstances in which the conduct occurred is essential to a final determination.
SUNY Sexual Harassment Response and Prevention Policy Statement
iii) Criminal Harassment
Harassment may also take the form of criminal behavior. As with any kind of harassment, the range of behavior that may constitute criminal harassment is broad. The New York State Penal Code, defines criminal harassment as conduct intended to harass, annoy, threaten, or alarm another person.
B) Harassment and First Amendment Considerations
The concepts of academic freedom and an open exchange of ideas are essential to the mission of any educational institution. Binghamton University is committed to these ideals, and as a public institution, is legally obligated to protect its members' First Amendment right of freedom of expression.
Respect for this right requires that members of the University tolerate the expression of views that are contrary to their own, and recognize that the expression of ideas that are intolerant, bigoted, or deeply offensive are entitled to First Amendment protection. Equally important, however, is the understanding that free expression carries with it the responsibility of civility and respect for others. The University views conduct intended to disparage or demean others as contrary to the pursuit of knowledge and rational discourse.
So called "speech codes" have been deemed unconstitutional by the courts. Therefore, while Binghamton University does not condone incivility within the campus community, it has not adopted a policy to prohibit offensive speech. Moreover, Binghamton has a proud history of inviting and encouraging the expression of diverse views.
C) Reporting Procedures
Individuals who feel they have been harassed are advised to seek guidance and information from one of the offices listed in section "E" of this policy before taking direct action on their own. Doing so does not oblige anyone to file a formal complaint. The University strongly encourages anyone who has information regarding an incident of harassment involving violence or the threat of violence, to report it immediately to the University Police. While in some cases, reports of harassment may be resolved through informal means, some circumstances call for the use of formal complaint procedures. Both options are outlined below:
i) Informal Complaint Resolution
Informal complaint resolution is intended to stop the behavior in question and to rectify the situation immediately rather than to determine culpability or intent. For advice in addressing harassment through informal means, inquiries may be directed to any of the offices listed in section "E" of this policy. In addition, the offices of the Employee Assistance Program (EAP), the University Counseling Center, and the University Ombudsman, routinely provide strictly confidential advice on a variety of sensitive topics.
ii) Formal Complaint Resolution
Formal complaint procedures, a more official route of intervention usually requiring a signed statement, are available through a number of campus departments. Departments from across campus often work together to address harassment. However, given that certain types of situations inevitably involve a particular campus department, the University recommends that complaints be addressed as follows:
Formal Complaint Procedures:
- Harassment occurring in residential areas — Appropriate resident/community director or other professional residential life staff
- Harassment involving student conduct outside of residence halls — Office of Student Conduct
- Harassment involving the conduct of an employee — Associate Vice President for Human Resources or appropriate supervisory personnel
- Harassment or discrimination based on protected class — Director of Affirmative Action/Title IX Coordinator
- Any incident of harassment may be reported to the University Police. The University especially encourages the immediate reporting of any incident involving violence or the threat of violence. Any incident may be discussed informally and in the strictest confidence with the University Ombudsman, and at the University Counseling Center or Employee Assistance Program.
D) Prohibition of Retaliation
Retaliation against any person who reports harassment, or who testifies, assists, or participates in an investigation, proceeding, or hearing relating to such a report, is strictly prohibited. False reports knowingly made in bad faith are also prohibited. Violation of the University's policy on harassment policy will subject the offender to the full range of penalties available, including criminal adjudication and separation from the University. In addition, certain types of harassment are criminal offenses and carry enhanced penalties under state and federal laws
E) Campus Resources
- Residential Life Office
- Dean of Students Office
- University Counseling Center
- New York State University Police
607-777-2393 (non-emergency)
911 (emergency)
- Human Resources Office
- Office of Student Conduct
- Employee Assistance Program
- Division of Diversity, Equity and Inclusion
- University Ombudsman
- Services for Students with Disabilities
- Title IX Coordinator


text:
hangzhou , Zhejiang
24/7 Customer Support
Online store always open
97.90€ 89.00€
15 in stock
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please pay attention the final prices should double check with our seals department. the prices of most spare parts are not stable, so after any purchase our sales department will send you official email and Proforma Invoices. The prices which mentioned on our website is retail prices if your order quantity is wholesale please send email to firstname.lastname@example.com to offer you our special wholesale prices. * Dismiss


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Roy Blunt Did Not Vote on this Amendment.
Read statements Roy Blunt made in this general time period.
Title: B-2 Bomber Program Termination Amendment
Vote to adopt an amendment that transfers funding from the B-2 bomber program, not including manufacturing costs for the fleet of 21 already in production, to the National Guard and Reserves for equipment purchases.
Title: B-2 Bomber Program Termination Amendment


text:
Let the Good Lord heal your wicked wounds with these Jesus bandages from Archie McPhee. One box contains 15 bandages that were blessed by the Pope during a special "Bless This Mess" ceremony at the Vatican. Also in the box is a free toy!
As you can see in the picture, portraits of Our Lord and Savior, which look like they were lifted from every scene in The Da Vinci Code, grace each and every bandage. These "designer bandages" (would Jesus approve of his face being used to sell trinkets?) might not heal you any faster, but then again, did he ever think that people would be promoting his name in sports arena with rock music blaring?
In any event, you can grab these spiritually fulfilling bandages for $4.95 per tin. Be on the lookout for Archie McPhee-branded indulgences this fall.
Jesus Bandages [Archie McPhee via productdose.com]


text:
James Coman's son has an unusual skill. The 7-year-old, his father says, can swallow six pills at once.
Diagnosed with autism as a toddler, the Chicago boy had been placed on an intense regimen of supplements and medications aimed at treating the disorder.
Besides taking many pills, the boy was injected with vitamin B12 and received intravenous infusions of a drug used to leach mercury and other metals from the body. He took megadoses of vitamin C, a hormone and a drug that suppresses testosterone.
This complex treatment regimen -- documented in court records as part of a bitter custody battle between Coman, who opposes the therapies, and his wife -- may sound unusual, but it isn't.
Thousands of U.S. children undergo these therapies and many more at the urging of physicians who say they can successfully treat, or "recover," children with autism, a disorder most physicians and scientists say they cannot yet explain or cure.
But after reviewing thousands of pages of court documents and scientific studies and interviewing top researchers in the field, the Tribune found that many of these treatments amount to uncontrolled experiments on vulnerable children.
The therapies often go beyond harmless New Age folly, the investigation found. Many are unproven and risky, based on scientific research that is flawed, preliminary or misconstrued.
Laboratory tests used to justify therapies are often misleading and misinterpreted. And though some parents fervently believe their children have benefited, the Tribune found a trail of disappointing results from the few clinical trials to evaluate the treatments objectively.
Studies have shown that up to three-quarters of families with children with autism try alternative treatments, which insurance does not usually cover. Doctors, many linked to the influential group Defeat Autism Now!, promote the therapies online, in books and at conferences.
Intensive regimens are so common that one doctor recently joked at an Autism One conference in Chicago that "you know you have a child with autism if ... your child takes more pills than your grandmother."
The Tribune found children undergoing daylong infusions of a blood product that carries the risk of kidney failure and anaphylactic shock. Researchers in the field emphatically warn that the therapy should not be used to treat autism.
Children are repeatedly encased in pressurized oxygen chambers normally used after scuba diving accidents, at a cost of thousands of dollars. This unproven therapy is meant to reduce inflammation that experts say is little understood and may even be beneficial.
Children undergo rounds of chelation therapy to leach heavy metals from the body, though most toxicologists say the test commonly used to measure the metals is meaningless and the treatment potentially harmful.
Last year, the National Institutes of Health halted a controversial government-funded study of chelation before a single child with autism was treated. Researchers at Cornell University and University of California, Santa Cruz, had found that rats without lead poisoning showed signs of cognitive damage after being treated with a chelator.
Doctors associated with the autism recovery movement often say they know that more research is needed on their treatments, but they can't wait because children need help now.
"We feel some urgency that we can't wait for 10 or 20 years," pediatrician Dr. Elizabeth Mumper, medical coordinator for the Autism Research Institute, testified in a special federal court that examined the issue of autism and vaccines. The nonprofit institute is the parent organization of Defeat Autism Now!
Other physicians -- as well as scientists and bioethicists -- disagree.
"They really should be seeing treatment of patients with unproven therapies as dangerous experimentation," said pediatrician Dr. Steven Goodman, a clinical trial expert at the Johns Hopkins Berman Institute of Bioethics. "The problem with uncontrolled experiments ... is that it is experimentation from which we can learn nothing."
Misleading scienceMany parents who try alternative therapies cite an analogy popularized by a luminary of the movement, a physician who wrote a book on recovering children from autism. They say they feel as if their child has jumped off a pier. Science hasn't proved that throwing a life preserver will save the child, but they have a duty to try, right?
Critics say that's the wrong way to think about it.
"How do they know the life preserver is made of cork and not lead? That is the issue," said Richard Mailman, a neuropharmacologist at Penn State University. "However desperate you are, you don't want to throw your child a lead life preserver."
One in 100 U.S. children is diagnosed with autism spectrum disorder by age 8, according to the U.S. Centers for Disease Control and Prevention. That figure has increased in recent decades, though experts do not know whether more children actually have autism or more cases are being diagnosed.
There are no cures for the disorder, which is characterized by communication problems, difficulties interacting socially, and rigid, repetitive behavior.
Researchers do not know what causes most cases of autism. They suspect the diagnosis actually applies to different disorders that create similar symptoms, but in most cases scientists cannot yet tell one from another. Research has yielded clues, but the search for hard answers continues.
By contrast, clinicians and others in the recovery movement readily offer explanations, treatments and hope.
Autism is not a mysterious disorder of the mind, they say; it is related to a complex array of medical problems. Address those undiagnosed immune, digestive, neurological and metabolic issues, and the symptoms of autism may improve, Jane Johnson, executive director of Defeat Autism Now!, wrote in an e-mail.
Johnson said more than a thousand parents have contacted the Autism Research Institute to say their children have recovered or nearly recovered from autism. "It is growing by word of mouth," Johnson said of the movement. "If you see a child improve dramatically using our approach, you might jump in yourself."
Both Johnson and Teri Arranga, director of Autism One, said solid science supports their approach to autism; Arranga sent the Tribune a list of hundreds of studies. Autism One, whose Web site declares "Our Children Get Better," sponsors conferences in the U.S. and Canada.
But the science cited by the recovery movement was extensively reviewed by some of the world's top scientists in a unique venue known as vaccine court. The government formed the court to address claims from people who think vaccines caused them harm, including families that blame children's autism on the shots.
The scientists who testified sharply criticized the research behind alternative treatments, using words like "careless" and "misleading."
"So much of what's said doesn't make scientific sense," testified Dr. Robert Rust, a chaired professor of neurology at University of Virginia. "There is what I regard as cherry-picking, picking little pieces from the paper and ignoring the rest of it, and in some instances I think misrepresenting what the paper says."
Mailman, the Pennsylvania neuropharmacologist, who also testified, said in an e-mail that "it was the scientific offensiveness that I felt most keenly."
The scientists found no proven value in many specific therapies for autism, from sauna treatments to chelation to the ingestion of worm eggs.
"There is no evidence for (the treatments') efficacy, no evidence for the reason for them to work," testified Dr. Eric Fombonne, head of the division of child psychiatry at McGill University and a prominent autism expert. "There (are) no published studies which would suggest that (they) would change the course of autism."
Notably, Arranga's list included studies authored by Dr. Mark Geier, a geneticist, and his son, David Geier. Dr. Geier opened clinics across the U.S. that promote treatment of autism with Lupron, a powerful testosterone suppressor. When the Tribune profiled the Geiers earlier this year, top pediatric endocrinologists deemed their work to be baseless.
'Exactly wrong'No other treatment is more emblematic of the world of alternative therapies for autism than chelation. It is also a potent example of the approach's flaws and risks.
Chelation is one of the highest-rated treatments on the Autism Research Institute's parent survey, and a Defeat Autism Now! consensus statement calls removing metals from the body "one of the most beneficial treatments for autism and related disorders."
Parents trade stories and advice about chelation on large Internet groups. One Yahoo! group has more than 8,000 members. The treatment takes many forms, including creams for the skin, capsules, suppositories and intravenous infusions of powerful medicines usually reserved for people with severe metal poisoning.
Families often embark on this course after seeing test results that make children with autism look like they spend their days playing in smelting plants.
For example, a boy named Jordan King was chelated after his lab reports showed apparently high levels of mercury and tin, according to vaccine court testimony.
It was "shocking" to see tin turn up, Rust testified.
"It's seen almost exclusively in people who spend their careers for long periods of time working with tin ... especially when people are working on tin with hot torches," Rust said.
In fact, Jordan's troubling results were based on a lab test that is common in the world of alternative autism treatments and is practically guaranteed to give incredible results. It's called a provoked urinary toxic metals test, and here's how it works.
First, a child is given a chelating drug that "provokes" the body to excrete some of the metals that nearly everybody -- healthy or not -- has in the body in trace amounts. Those metals are excreted in urine, which is sent to a lab offering these tests.
Nobody knows what normal results of this test would look like, toxicologists say. There is no accepted reference range. Nonetheless, the lab sends back color-coded charts that show alarming peaks of metals graphed against a meaningless reference range that was calculated for people who had never been given a chelator.
"That is exactly the wrong way to do it," said Dr. Carl R. Baum, director of the Center for Children's Environmental Toxicology at Yale- New Haven Children's Hospital. "There is a whole industry that preys on people's fears of heavy metal poisoning."
Though most labs note that the reference range used is for unprovoked results, the apples-to-oranges comparison still can set off panic in parents.
With Jordan and another child whose case was examined in vaccine court, "there was absolutely no reason to chelate them for any mercury-related reason," testified Dr. Jeffrey Brent of the University of Colorado, Denver, former president of the American Academy of Clinical Toxicology.
Alarmed by the rise in the use of the provoked test to justify chelation, the American College of Medical Toxicology this summer criticized its use as "fraught with many misunderstandings, pitfalls and risks."
Toxicologist William Shaw, lab director of The Great Plains Laboratory in Lenexa, Kan., said determining appropriate reference ranges for provoked tests will take more research but noted that it is difficult to get such studies approved by ethics boards and to get parents to enroll their children.
Both Shaw and Johnson of Defeat Autism Now! said the labs are identifying real problems, saying they have seen children benefit from chelation. Johnson also pointed to improved test results.
"Our only bedrock here is the observation by clinicians and parents that their children get better when they are given agents which are known to remove heavy metals from the body," Johnson wrote in an e-mail.
But that kind of anecdotal evidence is "at best good for generating hypotheses," Baum said. "Where's their control group? Their randomized controlled trial?"
Baum and other toxicologists urge physicians in the alternative movement to do standard, unprovoked tests for metals. "I guarantee you the results ... will not be so dramatic," Baum said.
In fact, a study published in the peer-reviewed journal Environmental Health Perspectives in October found that children with autism had lower levels of mercury in their blood than those developing typically. The reason? The children without autism ate more fish, a source of mercury.
Pain and night sweatsChelation's popularity as a treatment for autism is driven by the unproven idea that the disorder is tied to accumulation of heavy metals in the body. Mercury, once common in vaccines as part of a preservative called thimerosal, is often pegged as the culprit.
Yet the federal Institute of Medicine reported in 2004 that a review of dozens of studies had failed to show a link between vaccines, thimerosal and autism. Subsequent studies also found no connection. After thimerosal was removed from childhood vaccines except for some flu shots, autism diagnoses continued to rise.
Last spring, after hearing hundreds of hours of testimony, three "special masters" presiding over vaccine court ruled conclusively that they found the argument that the measles-mumps-rubella vaccine and thimerosal cause autism unpersuasive.
"Sadly, the petitioners in this litigation have been the victims of bad science, conducted to support litigation rather than to advance medical and scientific understanding of autism spectrum disorder," special master Denise Vowell wrote.
Even when tests show normal or low levels of metals, doctors who support chelation as an autism therapy sometimes take the results as proof that the child is poisoned. Their hypothesis is that the child cannot excrete metals, and that is why they do not show up in tests.
Colten Snyder, another child whose case was evaluated in vaccine court, underwent chelation after tests on his blood and hair over six years came back normal for mercury, court records state.
Given that the boy was immunized with vaccines containing thimerosal, "his hair mercury was exceptionally low," said his physician, Dr. J. Jeff Bradstreet of Florida. "That's pathological." Bradstreet also disputes that all of the test results were normal.
Toxicologists and experts on vaccines said studies show that if a vaccine contains mercury, the metal is quickly excreted.
Colten went "berserk" after being given a chelator, according to a nurse whose notes were cited in court records. He also had incontinence, night sweats, headaches and back pain. Bradstreet testified that the boy did not do well with chelation but later said it is "impossible to know" what caused the problems.
In her decision, Vowell sharply criticized Bradstreet: "The more disturbing question is why chelation was performed at all, in view of the normal levels of mercury found in the hair, blood and urine, its apparent lack of efficacy in treating Colten's symptoms and the adverse side effects it apparently caused."
Pediatric toxicology experts say all chelation drugs carry risks -- even when used to treat severely lead-poisoned children. Treatment with the medication is carefully monitored, as some drugs can dangerously deplete the body of essential metals, toxicologists said.
When rats with no lead exposure were treated with succimer, a common chelator given to children with autism, the animals showed lasting impairments of cognitive function and emotional regulation, said the study's lead researcher, Barbara Strupp at Cornell University.
Strupp said that finding raises concerns about administering chelators to children with autism unless they clearly have elevated levels of heavy metals. "I was just astounded and concerned for these kids," she said.
After she learned that the National Institutes of Health planned to conduct a clinical trial of chelation in children with autism, she alerted the researchers to her findings. The study was later canceled.
"Really, they are putting their children at serious risk," Baum said.
Harvard pediatric neurologist Dr. Martha Herbert, who has given speeches at Autism One conferences, is often cited by advocates in the recovery movement as proof that people with stellar credentials support them.
Herbert said she endorses the movement's push to look at environmental toxins as a possible factor in autism and supports researching whether various treatments can improve the health of children with the disorder. Chelation, she wrote in an e-mail, "is a very special case" and should not be used "to praise or damn other approaches."
In an earlier e-mail she wrote that she would sue the Tribune if she was portrayed as "an uncritical booster and fan of potentially dangerous unorthodox treatments."
"I'm not defending chelation," Herbert said in an interview. "I will sue you if you say that."
Stars of the movementJames Coman says he is so concerned about the possible long-term effects of his son's treatments, including chelation, that he filed complaints with state medical boards against the boy's two Defeat Autism Now! doctors, Dr. Anjum Usman of Naperville and Dr. Daniel Rossignol of Melbourne, Fla.
"I worry very much," Coman said as his son played nearby with his younger brother and a neighbor's children. "There may be latent physical harm," he said. "We don't know."
Coman said he thinks his son, now a playful, funny and outgoing 7-year-old, would have progressed developmentally without any medical treatments.
His wife declined to be interviewed but has said in court documents that she believes the boy's many alternative therapies benefited him. She argued that her son's treatment must continue on a regular basis. "Abruptly halting medications (he) has been on for years will do great harm to the child," she said in court documents.
But the boy has stopped some of his treatments, according to court records, and Coman says he has not regressed.
Rossignol declined to be interviewed for this story. Usman's practice, True Health Medical Center, said it would not comment on a specific case, citing office policy and laws designed to protect patient privacy.
"We base our treatment protocols on the lab results, parent reports and physical examination of our patients -- nothing out of the ordinary in the practice of medicine," Usman wrote in a separate e-mail. "I am deeply troubled by any suggestion that the medical profession should not treat the medical problems these children clearly face."
Both family practice doctors are stars of Defeat Autism Now!, having trained thousands of clinicians, according to Johnson. They are listed on the group's online clinician registry, a first stop for many parents of children with autism seeking alternative treatment.
To be listed, doctors need only attend a 13-hour seminar held by the Autism Research Institute, sign a statement saying they agree with the group's philosophy and pay a $250 annual fee.
Johnson told the Tribune that doctors linked to her group mostly focus on diet and vitamins. Yet a recent clinician seminar held in Dallas covered many highly technical specialties: immune problems, digestive issues, methylation abnormalities, mitochondrial dysfunction and detoxification.
As long as doctors continue to attend seminars every two years, they can remain listed. As of this month, 350 physicians, naturopaths, chiropractors, nurses and others were listed on the Defeat Autism Now! U.S. registry for state-licensed health care providers.
Many sell supplements to patients, which most practitioners consider a serious conflict of interest. Of 300 U.S. Defeat Autism Now! clinicians who answered a question about supplement sales for the registry, 80 percent indicated they sold the products to patients. Some even sold proprietary formulas.
"This is one of the most ... grave violations of our code of conduct, codes and ethics," Rust, the neurologist, testified in vaccine court.
A disclaimer on the registry site states that the Autism Research Institute does not "guarantee competence, skill, knowledge, or experience" of those listed. Johnson said the providers sell supplements to ensure quality control.
One physician on the registry was Dr. Roy Kerry of Pennsylvania. In 2005, a 5-year-old with autism had a heart attack and died while being intravenously chelated in his office, according to court records.
Less than a year later, Kerry was added to the registry. In 2008 he voluntarily surrendered his medical license pending criminal charges of involuntary manslaughter in connection with the boy's death, according to the Pennsylvania Board of Medicine.
Those charges were dropped, but in July of this year the state board suspended his license for six months, with 2 1/2 years of probation, state records show.
Kerry's lawyer, Al Augustine of Chicago, said there was no proof chelation killed the child and that Kerry agreed to the suspension to avoid the cost and emotional hardship of contesting it.
Defeat Autism Now! continued to list the doctor until Nov. 5, a day after the Tribune inquired about his inclusion.
Johnson said the group had already planned to drop him this month because he had not filled out paperwork on his medical license.
James Coman's son has an unusual skill. The 7-year-old, his father says, can swallow six pills at once.


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OCEAN CITY – The issue of outdoor displays of merchandise was revisited this week with the Planning and Zoning Commission making the unanimous decision to table the issue once again until after an upcoming meeting with the Mayor and City Council.
A public hearing was held last month to garner thoughts and opinions on outdoor displays of merchandise from both business owners and town officials. The result was numerous business owners protesting against prohibition of outdoor displays and instead requesting enforcement and uniformity.
Outdoor displays of merchandise are not a rarity in Ocean City, particularly not along the Boardwalk, where merchandise and signs are displayed, sometimes in excess, in an attempt to draw in customers. Although the displays are considered harmless advertising, regulation has become increasingly difficult for the town.
Discussion over a solution to the increasing problem began this week with Zoning Administrator Blaine Smith presenting the Planning and Zoning Commission with several suggestions and options.
"The first thing is whether you want to consider prohibition at all," Smith said.
Smith explained that the commission must first decide whether it wishes to completely prohibit outdoor displays or rather work with the local businesses to create better criteria and guidelines. The commission agreed that prohibition was not a route that it wanted to take.
At the public hearing held last month, it was decided that a committee needed to be established to help with enforcement and guidelines. Smith explained this week that a design committee will be set up by the Mayor and Council.
"I really think everything about this is consistency and enforcement," Smith said. "If we had enforcement a year ago, we wouldn't be here tonight."
Smith presented the Planning and Zoning Commission with a variety of options and numbers outlining the amount of space that could be allowed for displays and signage. The commission went back and forth over what is considered too much or too restrictive.
Commission member Peck Miller questioned what impact restrictions would have on businesses, such as Malibu's Surf Shop or The Kite Loft, which are both located on the Boardwalk and have been for years.
"That's the last thing we want to do is discourage things like that," Miller said, pointing out that the quality of display outside both businesses is what they want along the Boardwalk and that restricting it would be a taking a step back.
Commission Chairperson Pamela Buckley suggested the city get the design committee in place and work on enforcing the current restrictions with a few additions for one more year rather than completely changing the code.
"I don't want to go out here and just put numbers on things," Buckley said, noting that more research should be done before drastic changes are made.
Commission member Lauren Taylor pointed out that some standards, such as poor signage must be addressed before next summer.
Buckley suggested that the properties along the Boardwalk be delineated so that a clear line is indicated how far out displays could be placed. She also agreed that signage, such as hand written signs, should be addressed.
The commission agreed that any major changes to the code would be futile without effective enforcement.
"If we can beef up the enforcement, we can at least clean-up some stuff and see what's working and not working," Buckley said.
Taylor agreed, saying significant cleanup was needed on the Boardwalk. Taylor referred to display items such as shoddy signs made out of non-permanent materials, rusty racks filled with faded T-shirts and storefronts cluttered with displays
"The Boardwalk always used to be very neat, ordered and clean," Taylor said.
A motion was made to table the discussion until after the meeting with the Mayor and Council next month. The commission unanimously agreed, with Joel Brous absent and Chris Shanahan abstaining, to table the discussion and revisit it after the meeting with the Mayor and Council.
Shanahan will be abstaining from all discussion over the issue due to his comments during the public hearing as a citizen and business owner. The public hearing was prior to his selection as a commission member.


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Anyone who has read my diaries knows that Ken Livingstone has not always been my flavour of the month. And during this campaign for the London Mayorlty, in some of the things he has said and done, he has thrown up reminders of that resistance to his charms.
But as the election nears, there are two questions that matter: of the two men who have been London Mayor, who has done more for London? And who is best placed to be Mayor for the near future?
On the first question, I am in no doubt whatever that the answer is Ken, which leads inevitably onto the same answer for the second question. With the possible exception of the Boris bikes (which weren't his idea) I am struggling to think of anything that Boris Johnson has actually done for London, other than add to a sense of gaiety to the nation's capital. That is not unimportant, but hardly merits re-election on its own.
I asked a Tory friend the other day what Boris had actually done, to which the reply was 'he makes people laugh, and he taps into the anti-politics mood.' Oh great, a cynical comedian, as if there aren't enough of them.
Of course the other thing he has done, during part of his Mayorlty, is distance himself from the rest of his Party. But his high profile stance on the lowering of the top rate of tax, duly delivered in the Budget, had eroded that strategy. Ken is Labour, and is motivated by the interests of all Londoners, but particularly those denied jobs, opportunities, and decent living standards. Boris is a Tory, motivated by the things Tories have always been motivated by.
I spent three hours cycling round London yesterday, and after an hour or so realised that I had not seen a single Boris poster in a single London window. Now I am not pretending the place was festooned with Ken posters either, but they were there, every now and then. But in the various parts of North, West and East London where my pedals took me, not once did I pass the home of a Londoner so moved by Boris's charms and abilities that they devoted window space to urging a vote for him.
That says to me that people have seen through the act. There is little enthusiasm for him, beyond the celebrity bit. For all his abilities to say the wrong thing from time to time, Ken Livingstone used the power he had as Mayor to do good things for London and Londoners, and would do so again.
The one candidate I did notice on my travels was the Lib Dem, Brian Paddick. People say the Lib Dems have had it, but judging by the number of billboard sites they've hired, they're getting big money from somewhere. So at various points there he was, stern-faced, playing up his credentials as a London copper (a brand somewhat tarnished by Yates of the Yard among others) and vowing to keep Londoners safe.
To those minded to vote for him, I would just remind them that the last time people voted Lib Dem in decent numbers, they helped put a Tory Prime Minister in power. This time at least, they have the chance of a second preference. If they want a progressive London Mayor, then it can't be Boris. It has to be Ken.


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Binds when used
Use: Teaches you how to summon this companion.
Idles about.
Whirring (constant); vocalizations (periodic and on-click)
Item Level 1
Use: Teaches you how to summon this companion.
Right Click to summon and dismiss your Mechanopeep.
Players can participate in the Argent Tournament, a permanent event in northeastern Icecrown, to earn Champion's Seals. A representative of each race sells a race-specific pet. Alliance characters may purchase this and other alliance-based Argent Tournament pets once they have successfully "championed" that race's cause through various quests. Horde characters may purchase this pet through a neutral auction house and on occasion through their own auction house.
I gotta say, I have to question the wisdom of putting Batter and Overtune in the same moveslot, especially since this guy doesn't seem to be built for speed anyway.
I have a fair few Mechanicals I want to stone before I get to this guy, but looks like Peck - Overtune - Wind-Up might be the best moveset for it.


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Case Management
If you're managing a serious health condition, our registered nurses can help you better understand your diagnosis, so you can follow your doctor's treatment plan.
If you have a serious or complex health condition, we can help you get the care and services you need. Our specially trained Care Managers from our Case Management Program will help coordinate your health care services with your doctor. The Case Management Program provides eligible¹ members the education and guidance they may need when faced with a complex medical situation such as:
- A high-risk pregnancy or a newborn with medical issues
- A cancer diagnosis
- The need for heart surgery, an organ transplant, ventilator management, extensive home care or home infusion
- A severe injury or paralysis
- Chronic Kidney Disease (CKD)
- End-Stage Renal Disease (ESRD)
- Supportive care
- Other general and pediatric conditions
Our trained Care Managers are fully licensed health care professionals and registered nurses. They will work with you and your treating doctor so that you have access to the best care possible.
Through the program, our Care Managers can:
- Regularly discuss your overall medical situation with you and your doctor(s) to help you make decisions about your health care
- Provide educational material, advocacy and professional guidance about managing your health and information about your medical condition
- Help you locate and coordinate appropriate care for your needs
- Help you get prior authorizations for services
- Refer you to other programs or services when needed
- Assist you in understanding how to maximize your plan benefits to minimize your out-of-pocket costs related to your condition
This is a free and voluntary program available to all eligible members. Prior Authorization may be required.
Eligible members may enroll themselves or an eligible dependent in the Case Management Program by calling 1-888-621-5894 and selecting option 2. Representatives are available for assistance Monday through Friday, from 8 a.m. to 5 p.m., Eastern Time. All medical and personal information is confidential and shared only with those involved in your care.
Members can also be referred to our Case Management Program from other departments, including our Utilization Management department and Care Management Plus Program department, the 24/7 Nurse Line, as well as, rehabilitation facilities, facility discharge planners, behavioral health providers, practitioners, caregivers and pharmacy vendors.


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Up to the Lord, that reigns on high,
And views the nations from afar,
Let everlasting praises fly,
And tell how large his bounties are.
[He that can shake the worlds he made,
Or with his word, or with his rod,
His goodness, how amazing great!
And what a condescending God!]
[God, that must stoop to view the skies,
And bow to see what angels do,
Down to our earth he casts his eyes,
And bends his footsteps downwards too.]
He overrules all mortal things,
And manages our mean affairs;
On humble souls the King of kings
Bestows his counsels and his cares.
Our sorrows and our tears we pour
Into the bosom of our God;
He hears us in the mournful hour,
And helps us bear the heavy load.
In vain might lofty princes try
Such condescension to perform;
For worms were never raised so high
Above their meanest fellow worm.
O could our thankful hearts devise
A tribute equal to thy grace,
To the third heav'n our songs should rise,
And teach the golden harps thy praise.
|First Line:
|Up to the Lord, that reigns on high
|God's Condescension to Human Affairs
|Isaac Watts
|Public Domain


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Glenn Beck Doesn't Pull Them In Like He Used To
It's been a different world for Glenn Beck ever since he vacated his post at Fox News, under the vaguest of circumstances. (Certainly, Roger Ailes bluntly and dismissively telling an AP reporter that he only hired Beck because he "was hot and got ratings" didn't help much to mend fences.) But life goes on for America's foremost babbling dipshit. One simply pumps oneself up with a rousing selection from the original cast recording of Spider-Man: Switch Off the Lights, silently wishes a painful and prolonged death upon one's enemies (all 85 million of them), and then steps out onto the stage of a near-empty ballroom at the Omni Shoreham Hotel in Washington, D.C., for a scheduled appearance at the 2011 Values Voter Summit.
Next stop: Dinner theater! [Slate, photo via daveweigel1981/Flickr]


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Peter Bolin
Assigned to: Coach Mentor - SwitzerlandTeam Sweden – 2005-10 (Senior Team) Medals won: Olympic Winter Games (2006 Silver)…IIHF World Women's Championship (2007 Bronze, 2005 Bronze)Other Hockey Experience: Head Coach Malmö Redhawks U18 2010-11…Director of Player's Education at Malmö Ice Hockey Gymnasium and Director of Youth Hockey in Malmö Redhawks (2004-10)…Head Coach IF Malmö Redhawks Junior team U15…Head Coach Team Iceland, Director of Sports for club team in Iceland (2001-03)…Coach Boy's team Lunds IS (1996-2001)…Head Coach Lunds IS in Third league…Head Coach for Trelleborgs IK in Third League…Played 10 games with Leksands IF in First League 1979-82…Played 3 U20 Swedish National team games…Played junior ice hockey for Leksands IF – Swedish junior champion with Leksands IF for Juniors U16…Played for Insjöns IF, Leksands IF, University of Denver, Vita Hästen, Malmö IF, Olofströms IK, IK Skäret, Lunds IS, Skautafelag Reykjavik IcelandPersonal Information: Currently resides in Borås, Sweden…Hometown Insjön, Sweden…Has one daughter (Matilda) and one son (Viktor)…Assistant Coach Boras HC Allsvenskan Swedish Second LeagueWhy have you joined AMP? I believe that I have a lot experience from women's hockey that I can share. And even though I´m not involved right now with women's hockey this is a way for me to still be involved in something that I have been a part of for many years.


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Learning is defined as a process that brings together personal and environmental experiences and influences for acquiring, enriching or modifying one's knowledge, skills, values, attitudes, behaviour and world views. Learning theories develop hypotheses that describe how this process takes place. The scientific study of learning started in earnest at the dawn of the 20th century. The major concepts and theories of learning include behaviourist theories, cognitive psychology, constructivism, social constructivism, experiential learning, multiple intelligence, and situated learning theory and community of practice.
The behaviourist perspectives of learning originated in the early 1900s, and became dominant in early 20th century. The basic idea of behaviourism is that learning consists of a change in behaviour due to the acquisition, reinforcement and application of associations between stimuli from the environment and observable responses of the individual. Behaviourists are interested in measurable changes in behaviour. Thorndike, one major behaviourist theorist, put forward that (1) a response to a stimulus is reinforced when followed by a positive rewarding effect, and (2) a response to a stimulus becomes stronger by exercise and repetition. This view of learning is akin to the "drill-and-practice" programmes. Skinner, another influential behaviourist, proposed his variant of behaviourism called "operant conditioning". In his view, rewarding the right parts of the more complex behaviour reinforces it, and encourages its recurrence. Therefore, reinforcers control the occurrence of the desired partial behaviours. Learning is understood as the step-by-step or successive approximation of the intended partial behaviours through the use of reward and punishment. The best known application of Skinner's theory is "programmed instruction" whereby the right sequence of the partial behaviours to be learned is specified by elaborated task analysis.
Cognitive psychology
Cognitive psychology was initiated in the late 1950s, and contributed to the move away from behaviourism. People are no longer viewed as collections of responses to external stimuli, as understood by behaviourists, but information processors. Cognitive psychology paid attention to complex mental phenomena, ignored by behaviourists, and was influenced by the emergence of the computer as an information-processing device, which became analogous to the human mind. In cognitive psychology, learning is understood as the acquisition of knowledge: the learner is an information-processor who absorbs information, undertakes cognitive operations on it, and stocks it in memory. Therefore, its preferred methods of instruction are lecturing and reading textbooks; and, at its most extreme, the learner is a passive recipient of knowledge by the teacher.
Constructivism emerged in the 1970s and 1980s, giving rise to the idea that learners are not passive recipients of information, but that they actively construct their knowledge in interaction with the environment and through the reorganization of their mental structures. Learners are therefore viewed as sense-makers, not simply recording given information but interpreting it. This view of learning led to the shift from the "knowledge-acquisition" to "knowledge-construction" metaphor. The growing evidence in support of the constructive nature of learning was also in line with and backed by the earlier work of influential theorists such as Jean Piaget and Jerome Bruner. While there are different versions of constructivism, what is found in common is the learner-centred approach whereby the teacher becomes a cognitive guide of learner's learning and not a knowledge transmitter.
Social learning theory
A well-known social learning theory has been developed by Albert Bandura, who works within both cognitive and behavioural frameworks that embrace attention, memory and motivation. His theory of learning suggests that people learn within a social context, and that learning is facilitated through concepts such as modeling, observational learning and imitation. Bandura put forward "reciprocal determininsm" that holds the view that a person's behavior, environment and personal qualities all reciprocally influence each others. He argues that children learn from observing others as well as from "model" behaviour, which are processes involving attention, retention, reproduction and motivation. The importance of positive role modeling on learning is well documented.
In the late 20th century, the constructivist view of learning was further changed by the rise of the perspective of "situated cognition and learning" that emphasized the significant role of context, particularly social interaction. Criticism against the information-processing constructivist approach to cognition and learning became stronger as the pioneer work of Vygotsky as well as anthropological and ethnographic research by scholars like Rogoff and Lave came to the fore and gathered support. The essence of this criticism was that the information-processing constructivism saw cognition and learning as processes occurring within the mind in isolation from the surrounding and interaction with it. Knowledge was considered as self-sufficient and independent of the contexts in which it finds itself. In the new view, cognition and learning are understood as interactions between the individual and a situation; knowledge is considered as situated and is a product of the activity, context and culture in which it is formed and utilized. This gave way to a new metaphor for learning as "participation" and "social negotiation".
Experiential learning
Experiential learning theories build on social and constructivist theories of learning, but situate experience at the core of the learning process. They aim to understand the manners in which experiences – whether first or second hand – motivate learners and promote their learning. Therefore, learning is about meaningful experiences – in everyday life – that lead to a change in an individual's knowledge and behaviours. Carl Rogers is an influential proponent of these theories, suggesting that experiential learning is "self-initiated learning" as people have a natural inclination to learn; and that they learn when they are fully involved in the learning process. Rogers put forward the following insight: (1) "learning can only be facilitated: we cannot teach another person directly", (2) "learners become more rigid under threat", (3) "significant learning occurs in an environment where threat to the learner is reduced to a minimum", (4) "learning is most likely to occur and to last when it is self-initiated" (Office of Learning and Teaching, 2005, p. 9). He supports a dynamic, continuous process of change where new learning results in and affects learning environments. This dynamic process of change is often considered in literatures on organizational learning.
Multiple intelligences
Challenging the assumption in many of the learning theories that learning is a universal human process that all individuals experience according to the same principles, Howard Gardner elaborated his theory of 'multiple intelligences' in 1983. His theory also challenges the understanding of intelligence as dominated by a single general ability. Gardner argues that every person's level of intelligence actually consists of many distinct "intelligences". These intelligences include: (1) logical-mathematical, (2) linguistic, (3) spatial, (4) musical, (5) bodily-kinesthetic, (6) interpersonal, and (7) intrapersonal. Although his work is speculative, his theory is appreciated by teachers in broadening their conceptual framework beyond the traditional confines of skilling, curriculum and testing. The recognition of multiple intelligences, for Gardner, is a means to achieving educational goals rather than an educational goal in and of itself.
Situated learning theory and community of practice
"Situated learning theory" and "community of practice" draw many of the ideas of the learning theories considered above. They are developed by Jean Lave and Etienne Wenger. Situated learning theory recognizes that there is no learning which is not situated, and emphasizes the relational and negotiated character of knowledge and learning as well as the engaged nature of learning activity for the individuals involved. According to the theory, it is within communities that learning occurs most effectively. Interactions taking place within a community of practice – e.g. cooperation, problem solving, building trust, understanding and relations – have the potential to foster community social capital that enhances the community members' wellbeing. Thomas Sergiovanni reinforces the idea that learning is most effective when it takes place in communities. He argues that academic and social outcomes will improve only when classrooms become learning communities, and teaching becomes learner-centered. Communities of practice are of course not confined to schools but cover other settings such as workplace and organizations.
21st century learning or skills
Exploration of 21st century learning or skills has emerged from the concern about transforming the goals and daily practice of learning to meet the new demands of the 21st century, which is characterized as knowledge- and technologically driven. The current discussion about 21st century skills leads classrooms and other learning environments to encourage the development of core subject knowledge as well as new media literacies, critical and systems thinking, interpersonal and self-directional skills. For example, the Partnership for 21st Century Skills (P21) defines the following as key: core subjects (e.g. English, math, geography, history, civics) and 21st century themes (global awareness, civic literacy, health literacy, environmental literacy, financial, business and entrepreneurial literacy); learning and innovation skills (creativity and innovation, critical thinking and problem solving, communication and collaboration); information, media and technology skills (e.g. ICT literacy, media literacy); and life and career skills (flexibility and adaptability, initiative and self-direction, social and cross-cultural skills, productivity and accountability, leadership and responsibility). One main learning method that supports the learning of such skills and knowledge is group learning or thematic projects, which involves an inquiry-based collaborative work that addresses real-world issues and questions.
Source: The Office of Learning and Teaching, 2004. Melbourne: Department of Education and Training; OECD, 2010. Nature of Learning, Paris: Author; http://www.p21.org/


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While other two-year-olds are just learning to walk and talk, the children of the nomad Vadi Tribe are introduced to the centuries-old art of snake charming.
All the children of the Vadi Tribe come face to face with a poisonous cobra at age two, and go through a ten-year ritual, in which they learn all the secrets of snake charming. Both boys and girls must learn to handle snakes. While men must be able to manipulate cobras by playing the flute, the women must know how to take care of the reptiles when their husbands or brothers are away.
The Vadi treat snakes like their own children, never keeping them away from their natural habitat for more than seven months. Any longer than that would be disrespectful to the snakes, according to Babanath Mithunath Madari, the 60-year-old Vadi chief-charmer. In fact, the only time a snake actually bit his charmer, was when he kept it for more than seven months.
Vadi snake-charmers don't cut the fangs of their snakes, instead they feed them an herbal mixture which, they say, makes their deadly poison harmless.
Unfortunately, in 1991, the thousand-year-old tradition of snake-charming was banned in India, and the Vadi tribe are stripped of their snakes whenever they are confronted by the police. They never spend more than six months in the same place.
Photos by BARCROFT MEDIA
via Telegraph.co.uk