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Medicial Mistakes?
How many people each year suffer some type of preventable harm that contributes to their death after a hospital visit?
from 46,000 to 78,000
from 78,000 to 132,000
from 132,000 to 210,000
from 210,000 to 440,000
Zunin's Hawaii Blue Cross Pilot Shows Benefits from Integrative Outpatient Pain Program
The following is one in an ongoing series of columns entitled Integrator Blog by .
View all columns in series
In 2005, Hawaii's major Blue Cross Blue Shield carrier, HMSA, contracted with Manakai O Malama, the integrative clinic founded by Ira Zunin, MD, MPH, MBA on an unusual integrative, outpatient pilot for some of their most costly, pain-ridden, disabled members. The elaborate approach included diverse mind-body approaches, Feldenkrais and Yoga, and group acupuncture. Zunin, who was interested in a thorough biopsychosocial model, observes of the positive outcomes - reduced anxiety and depression, lower disability, reduced opiate use - that the ethical value in group process has both "carrot and stick" sides. Here is the pilot, with its outcomes.
Ira Zunin, MD, MBA, MPH
Ira Zunin, MD, MPH, MBA offers a global, strategic perspective as to why he has made a priority of forming partnerships with insurers and employers to advance his integrative practice model for disabling pain: "We know we can spend a decade in the legislature trying to fight for one small thing. This is an opportunity to solve big problems which big payers know they have and create a lot of latitude for integrative medicine."
Zunin's base is his
Manakai O Malama
integrative center on the island of Oahu.
Since it's founding in 2002,
the clinic has had over 100,000 patient visits to its array of practitioners. (See "Clinical Services" in the table). In 2005, the Zunin's team partnered with
Hawaii Medical Services Association
the island's Blue Cross Blue Shield carrier
, and two workman's compensation firms for an integrative pain pilot that targets a costly, disabled population .
Hawaii Blues Plan funded the pilot
"We viewed this as a chance to study a comprehensive biopsychosocial intervention," states Zunin, an
Hawaii Blues Plan funded the pilot
"We viewed this as a chance to study a comprehensive biopsychosocial intervention," states Zunin, an
The program is family, community and group-based.
Zunin adds that the approach particularly sought to "interrupt the pattern of social isolation" often found in such a population. Group process might shift the "pattern of suffering." Working with families might increase positive secondary gains. The emphasis was on mind-body strategies which might reduce "pain-related depression that can contribute to suffering."
Among the complementary and alternative components included are the use of Feldenkrais and Yoga, humor,
acupuncture in a group-delivery model
, and diverse mind-body therapies including a program with elements of the mind-body stress reduction programs developed by
Jon Kabat-Zinn, PhD
Manakai O Malama's HMSA Pilot at a Glance:
Intensive Outpatient Pain Program
Program Sponsor
Manakai O Malama Integrative Healthcare
Clinical Services
at Manakai O Malama
Pain management, preventive medicine,
primary care, occupational medicine,
family medicine, osteopathy, psychology,
acupuncture/Traditional Chinese medicine,
physical therapy, therapeutic massage,
nutritional counseling
- HMSA (Hawaii Medical Services Assn.
- 2 worker's compensation carriers
Individuals completing
the program
33 (in 5 cohorts)
Key services in the Integrative
Outpatient Pain Program
Medical management, psychotherapy, pain
education, self-management techniques,
mind-body (meditation/Ho'o pono pono),
therapeutic Yoga and/or Feldenkrais,
group-delivered/community acupuncture,
family education & support
Program elements
- Intake/selection (intensive)
- Cohorts: started 10-12
- Term: 12 weeks
- Frequency: 3x/week
- Sessions: 3hrs/day
- Goal: cultivate group synergy
Inclusion decision
and screening
- Physician interview
- If passed, 1/2 day of testing
- Beck Depression Inventory, Symptom
Checklist, Pain Patient Profile, Quality
of Life Inventory, Million Clinical Multiaxial
Inventory I
Program activities
(2 per 3 hour shift)
4 of the activities were "tracks"
- Psychology/group process
- Mind-body (breathing, mind-body stress
- Therapeutic movement (Feldenkrais, Yoga)
- Acupuncture (in a group room - all received
the same set of points)
Additional activies
Outcomes: Quality of Life
- Improvement on all subjective, quality
of life measures
- Especially strong with anxiety
Outcomes: Use of Opiates
- 79% were on these medications to start
- 50% of those on opiates ended use
Outcomes: Disability
- 64% were disabled, prior to study
- 85% of these returned to work
Program Cost
- Paid per diem, plus screening,
approximately $10,000 per participant
- Covered care and pilot development
and administration
Based on information provided by Zunin/Manakai O Malama.
Outcomes: anxiety, disability, opiate use down
Zunin reports that "the outcomes have been great." Among those found were:
Quality of life
Scores for the 33 who completed all of the 12 weeks improved on all standardized, subjective measures, with particular advances in diminishing anxiety.
Of the 64% who had been disabled or partially disabled in the prior 12 months, 85% returned to gainful activity or were cleared to work. 100% of those who returned to gainful activity were still "gainfully engaged" at one-year follow-up.
piate use
Of the 79% who had been under high level opiate analgesics during the 12 months prior, 97% had reductions in use of 25% or more, 81% of 50% or more and 50% had 100% reductions on high level opiate use. At one year follow-up, 100% of those who substantially-reduced opiates remained off of them.
Zunin, reports that these positive outcomes have led to a
discussions with HMSA to make the program a covered benefit, and with the
Veteran's Administration
about expanding the program and offering it to vets.
The carrot and stick values of the group intervention
Zunin believes that the group-method of service delivery was a significant factor in achieving these positive outcomes. "The thing about pain and extreme obesity is that they are socially isolating. So, on one side" - what Zunin called the "carrot" - "you are interrupting this pattern." He adds that he felt that acupuncture in a group model can particularly help: "There is something energetic that occurs as a group."
Then Zunin explains how he believes that group-focused treatment also has a "stick" dimension to it. Reflects Zunin: "The other side of the group ethic is the stick. In this population, you typically have people who have learned to manipulate one provider after another. They spot that manipulation in each other and whomp each other for it when it comes up." In short, the counseling from a fellow-patient may be much more direct and to the point than that from the patient's doctor.
Zunin described plans for modifying the program from lessons learned in this round. First, Zunin anticipates screening all participants at the first 4 weeks. This would give a chance to "graduate" some of the quick responders and to remove some from the program who are clearly not engaged. In both cases, costs would be saved. Zunin also anticipates producing the three 4-week sessions as "chapters" with more of a thematic continuity.
Zunin, who founded the
Hawaii State Consortium for Integrative Health Care
, continues to believe that pilots such as this, which analyze outcomes of whole systems of care, in partnership with insurers or other payers is the way to transform the system. Says Zunin: "The contribution I would like to see to our shared field is to lighten the path to rapid change."
For another article on Zunin's work, please see (
Zunin on CAM-IM Clinical Services in Healthy Living "Age Targeted" Communities
, April 24, 2006).
Zunin's comments about the value of the group reminded me of the astonishingly positive outcomes of the group-focused programs delivered to Chrysler employees onsite (
Chrysler Expands Group-Focused Integrative Pain Partnership with Henry Ford Health System CAM Group
, July 23, 2007; and
Chrysler's Health Leaders on Their Integrative Health Pilot Projects
, February 26, 2008
). Zunin agreed that there may be something in the individualized nature of the experience of pain which makes it particularly susceptible to group mind-body interventions.
To the extent that this may be true, our health professional educational programs must begin to train professionals to participate in and help lead these group interventions. The training in delivering such programs is essentially, as the
fundamental, economic law of clinical decision-making seems to be that practitioners of all stripes are most likely to recommend services that they, themselves are equipped to provide.
Kudos to Zunin for having the vision to put this together and see it through this round.
I agree with his strategic sense that these kinds of projects are the best way to light the path to quicker uptake of integrative practices.
Send your comments
for inclusion in a future
Your Comments Forum
View all "Integrator Blog" columns
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About The Author
Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields...
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text:
Asthma is a chronic disease that affects the function and lining of the airways or tubes of the lungs. It narrows the airways and makes it difficult to breathe.
There are different degrees of asthma. Some people may have mild asthma with rare flare-ups. Others may have a severe, constant asthma.
The exact causes of asthma are unknown, but genetics play a role.
Asthma symptoms are caused by an increased sensitivity of the airways to certain triggers. The triggers cause the lining of the airways to swell and produce extra fluid called mucus. At the same time, the muscles around the outside of the airway tighten in response to the irritation. All of these reactions narrow the airways and make it difficult to breathe. This response is often referred to as an asthma attack.
Possible triggers of an asthma attack in a person with asthma include:
- Viral illness
- Exercise
- Cold weather or changes in the weather
- Sinusitis
- Gastroesophageal reflux disease (GERD)
- Sulfites, preservatives used in dried fruits and wine
- Medications, such as aspirin, ibuprofen, and beta-blockers
Exposure to irritants or allergens, including:
- Cigarette smoke
- Smoke from a wood-burning stove
- Pet dander
- Dust
- Chemicals
- Mold and mildew
- Pollen
- Smog or air pollution
- Perfumed products
Risk Factors
Factors that may increase your chance of asthma include:
- Regularly breathing in cigarette smoke, including second-hand smoke
- Regularly breathing in industrial or agricultural chemicals
- A family member who has asthma
- History of bronchiolitis
- History of multiple respiratory infections during childhood, especially less than 1 year old
- Being overweight
- History of wheezing or asthma as a child
- Having allergies
- Premature birth
- Having a mother who smoked during pregnancy
Symptoms include:
- Cough
- Wheezing
- Tightness in the chest
- Trouble breathing
- Shortness of breath
- Chest pain
- Limited exercise tolerance
You will be asked about your symptoms and medical history. A physical exam will be done.
Your doctor may also do some tests to measure lung function. They may include:
- Peak flow assessment
- Pulmonary function tests (PFTs)
- Reversibility testing
- Bronchoprovocation tests
Your doctor may also do some allergy tests. The test will help determine if allergies are causing symptoms. The test may include skin pricks or blood tests.
The treatment strategy for asthma includes:
- Medications
- Avoidance of allergens and irritants and control of contributing factors such as gastroesophageal reflux and sinusitis
- Regular assessment and monitoring
You and your doctor should also create an asthma action plan. This is a plan you will follow to help control your asthma and handle asthma attacks.
Asthma Medications
These medications are used to avoid asthma attacks, but will not treat an existing attack. Medication may include any of or combinations of:
- Inhaled corticosteroids to prevent airway swelling and inflammation
- Inhaled long-acting beta agonists to relax the airways and keep them from tightening
- Oral leukotriene modifiers to prevent airway inflammation and swelling, decrease the amount of mucus in the lungs, and open the airways
- Inhaled cromolyn or nedocromil to prevent airways from swelling from contact with an asthma trigger
- Biologic agents, such as omalizumab, if asthma is not controlled by other medications
These medications are used to treat an asthma attack.
Medication may include:
- Inhaled quick-acting beta agonists and anticholinergic agents to open the airways
- Oral corticosteroids to reduce severe airway inflammation
Other Treatments
Bronchial thermoplasty to reduce excessive smooth muscle in the lungs and decrease the ability of the airways to constrict.
Prevention is an important step in asthma care. Allergy avoidance can be effective with asthma that is made worse by allergens. Some general tips for allergen avoidance include:
- Avoid outside activities if there are high levels of air pollution, pollen, or mold spores.
- Keep your windows closed during seasons with high pollen or mold spores. Air conditioning may help filter out allergens during warm seasons.
- Consider getting a portable HEPA unit air cleaner to use in sleeping areas.
- Consider getting HEPA filters for your heating/cooling system and your vacuum cleaner.
- Have someone else vacuum for you. Avoid a room that has been freshly vacuumed. If you do vacuum, use a dust mask.
- Keep the humidity down in your house. This may help prevent the growth of mold.
- Treat allergies and sinusitis as advised by your doctor.
- If allergies trigger your asthma attacks, ask your doctor about ways to manage your allergies.
It may be helpful to learn breathing techniques or doing breathing exercises. Improved fitness may also increase exercise tolerance and reduce attacks. Ask your doctor for advice.
Your asthma plan may need to be adjusted to adapt to changes in your life or health. Staying in contact with your doctor between visits can help you have better control of your asthma.
Your doctor may want to monitor you at home with a peak flow meter.
Online programs aimed at helping you manage your own symptoms can improve asthma control and lung function. Some examples of programs include American Lung Association or Asthma and Allergy Foundation of America.
There are no guidelines for preventing asthma because the cause is unknown. However, you can help prevent asthma attacks by avoiding things that trigger your attacks. Triggers can vary from person to person but some general guidelines include:
- Avoid strong chemicals or odors like perfume.
- Avoid strenuous outdoor exercise during days with high air pollution, a high pollen count, or a high ozone level.
- Get a yearly flu shot. Colds and flus can worsen asthma.
- Don't smoke. If you are pregnant, it is important that you do not smoke.
- Avoid secondhand smoke. Do not allow anyone to smoke in your home.
- Don't use a wood-burning stove or fireplace, including unvented gas fireplaces.
- If cold weather triggers your asthma, avoid strenuous activities in cold weather. If you must, use a scarf or mask to warm the air before it reaches your lungs.
Talk to your doctor about:
- The right level of exercise for you
- Ways to track your asthma to help identify and treat flare-ups right away
- Your work, hobbies, and home activities to see if any of these may be causing or worsening your asthma
Revision Information
- Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
- Review Date: 09/2017 -
- Update Date: 08/28/2017 -

subset: commoncrawl


text:
The sandstone is fragile. To preserve the area (and the climbs) please follow the following rules:
Use chalk with caution and brush it off afterwards.
Chalk should only be used on hands, never directly on the rock!
Clean your climbing shoes on a doormat before any climb. This is essential to limit rock erosion.
First time here?theCrag.com is a free guide for rock climbing areas all over the world, collaboratively edited by keen rock climbers, boulderers and other nice folks.You can log all your routes, connect and chat with other climbers and much more...» go exploring, » learn more or » ask us a question
Check out what is happening in Black circuit ED-.


text:
Mar 1, 2007 at 6:53 pm
Hey thanks for the add! Loving the infiniti my friend had one a white one like that, fun ride. And Nice collection of Bikes too!
Dec 14, 2006 at 10:15 am
Nice pictures of the turned over car . Really happy to hear they weren't hurt. Does Lori just happen to have a broom with her?
Nov 20, 2006 at 12:55 pm
whats up man thanks for the hit love the bike ive always wanted one just cant affored one but maybe someday.


text:
It's been ages since I last talked about Microsoft certification programs, but a recent email message from the MCDBA program reminding me of the upgrade path available to me got my creative juices flowing. I thought that if I've been too busy to worry about upgrading my certification to SQL Server 2005, it's likely that many other SQL Server 2000 MCDBA professionals have also been too busy. So this week, we'll briefly explore the new certifications for SQL Server 2005 and some of the upgrade options that exist if you're currently a SQL Server 2000 MCDBA.
But first, let's examine the value of Microsoft certification in general. I'm somewhat laissez-faire on the topic. I've run across "certified professionals" who I'd barely trust to swap out the power cord on a server, whereas some of the most talented IT pros I've met couldn't care less about certification. So debating the relative value of Microsoft certification is something I decided to stop worrying about several years ago. But I typically recommend that you get it. I sense that certification tends to be most beneficial to novice and intermediary professionals because some companies are hesitant to hire junior or mid-level people who don't have a certification. So an MCDBA can certainly help land a mid-level job.
Likewise, even though I'm sure that true SQL Server experts will never be short of work simply because they aren't certified if you're an expert, you shouldn't have a hard time passing the exam. So you might as well do it. Me? I'll upgrade. Not because I need the certification, but because I know that my colleagues who are certified will tease me if I don't bother (which is perhaps the most compelling reason of all to become certified).
So once you've decided to take the plunge to avoid name-calling by your SQL buddies, where do you start? Microsoft offers a wider range of certifications options for SQL Server 2005 than it did for earlier releases. Instead of a single SQL Server MCDBA certification, SQL Server 2005 certifications include entry-level certifications:
Technology Specialist: SQL Server 2005 Technology Specialist: SQL Server 2005 Business Intelligence
and the slightly more advanced Microsoft Certified IT Professional (MCITP) certifications:
Microsoft Certified IT Professional: Database Developer Microsoft Certified IT Professional: Database Administrator Microsoft Certified IT Professional: Business Intelligence
Microsoft's multiple-track approach for SQL Server 2005 certification is certainly the correct approach. The single MCDBA track for SQL Server 2000 was a bit simplistic. I'd probably become a bigger fan of the certification process if Microsoft could ever create a certification that's a true reflection of world-class expertise instead of the mass-market certification mill that still exists today. But, I suppose Rome wasn't built in day.
Not surprisingly, Microsoft offers a lot of information to help you understand the certifications that exist and prepare for them. The following site hosts a condensed, useful summary of the Technology Specialist and MCITP options:
I also suggest a visit to the following site, which offers a summary of upgrade options that are available to you based on existing certifications that you already hold:
Both sites offer links to wealth of study and preparation information supporting the certification process. My favorite might be the SQL Server 2005 Learning Portal at
Visiting these sites will help you start down the certification road, regardless of whether you're nobly pursuing knowledge and self-betterment or you simply want to avoid having your SQL Server expert friends tease you because you didn't bother to get certified.


text:
STOCKTON - Lincoln High's only lead Thursday night was brief.
STOCKTON - Lincoln High's only lead Thursday night was brief.
Lamar Saffold sank two free throws with 3 minutes to play to put the Trojans up a point on Alameda-St. Joseph Notre Dame. However, the Pilots answered the following possession and won 55-50 in the opening round of the Bruin Shoot-out boys basketball tournament at Bear Creek.
St. Joseph's plays Fairfield at 6 p.m. today in the semifinals. Lincoln plays Tokay at 3 p.m.
"It was just a tough game," Lincoln coach Gary Greeno said. "They made more big plays than we did, especially the sequence after we went ahead."
The Trojans (8-3) trailed by as many as 11 points in the first quarter, but slowly chipped away until Saffold's free throws put them up 47-46. Nick Schultze made a 3-pointer that sparked a 13-6 Lincoln run in the fourth quarter. Temidayo Yussuf scored a put back to stop the run and give the Pilots (7-4) the lead for good.
Mark Voisenat blocked a shot on the next possession and scored St. Joseph's next five points. He finished with nine points.
Yussuf, a 6-foot-7 center, led all scorers with 21 points. He battled inside mostly with 6-foot-4 Lincoln center Julio Muao, who had nine points.
"(Lincoln) didn't go away," Yussuf said. "Their big guys were good and came at us with a lot of energy. We just tried to make a point of crashing the offensive boards at the end."
Joseph Harrison led Lincoln with 13 points. Schultze had eight points, but missed the final 5 minutes when he got hit in the head while going for a rebound. Greeno said he was taken after the game to be checked for a concussion.
Eagles senior guard Marcus Cotton scored 29 points - 20 more than the next highest scorer, DeShay Hicks of Clovis-Buchanan (4-4). Immanuel Valdivia had eight points for the Eagles (6-7), who play East Union at 7:30 p.m. today in the semifinals.
"I thought our defense tonight was the best it's been all year," McNair coach Matt Morelli said. "We did a great job of keeping their big guys off the glass."
Justin Nieto led all scorers with 21 points followed by Jordan Kron with 18 points to improve the Lancers to 10-0. Kron had four of East Union's nine 3-pointers. Clay Cueno had 15 points.
For Bear Creek (8-5), Dwayne Lee had 17 points and Quinn Ryan 13 points. The Bruins play Buchanan at 4:30 p.m.
The Tigers led by seven points going into the fourth quarter, before guard DeMoriaya Hart-Spikes took over for Fairfield. He had 23 of his game-high 27 points after halftime.
The Falcons (4-6) outscored Tokay 11-3 in overtime and made 3 of 4 field goals.
Center Kashif Afzal led the Tigers (6-8) with 18 points followed by Nico Brusa with 16 points. Kyle Rivers had 13 points.


text:
June 16. 2014 1:17PM
Two-state chase ends in crash; Mass. man arrested; passenger claims kidnap
A Peabody, Mass. man is under arrest after a two-state police chase Sunday afternoon from Salem, N.H. to Boston's North End, where he allegedly crashed a stolen pickup truck and fled the scene, leaving behind a 27-year-old passenger who told investigators he'd been kidnapped.
The incident, which reached speeds of 85 mph along Interstate 93 South, actually began in Nashua, where a red GMC pickup was reported stolen, according to Salem Deputy Police Chief Shawn Patton.
Patton said the truck already was being pursued by Windham police on I-93 South when it crossed into Salem and a Salem officer took over. That officer followed it to the Massachusetts border while alerting Massachusetts State Police to the pursuit.
Salem police called off the chase at 4:38 p.m. at the border and Massachusetts State Police took over.
Several minutes later, Massachusetts troopers took a report from another vehicle that had been sideswiped by the pickup on I-93 near the intersection with Route 495.
At 4:52 p.m., Mass. Trooper Michael Rockett, assigned to the state police barracks in Medford ,Mass., reported he was behind the fleeing pickup truck heading south into Stoneham. He tried to stop the truck, but it kept going.
State police headquarters approved the pursuit and assumed command and control, according to a state police news release.
The truck sped up to 85 mph and, a few minutes later, it entered the Tip O'Neill Tunnel.
At 5:07 p.m., Boston police reported the truck had crashed on Lewis Street in the North End and the driver had fled on foot.
The passenger, who police said was a Peabody man, told investigator he he had been kidnapped.
Just before 6 p.m., Boston police arrested the driver, identified as Michael Daniels, 33, of Peabody, at North Station. Police said he had a pellet pistol on him.
Both Daniels and the passenger, whose name police have not released, were transported to the State Police Barracks in Medford, where police continue to investigate.
Daniels was to be arraigned Monday in Boston Municipal Court, Central Division, but a clerk said in the morning the paperwork had not been sent over and Daniels had not been transported.
Police have not said what charges Daniels is facing.


text:
128. Fact
Skylab, the first american space station, fell to the earth in thousands of pieces in 1979. Thankfully most over the ocean.
129. Fact
It takes approximately 12 hours for food to entirely digest.
130. Fact
Human jaw muscles can generate a force of 200 pounds (90.8 kilograms) on the molars.
131. Fact
The skylab astronauts grew 1.5 - 2.25 inches (3.8 - 5.7 centimeters) due to spinal lengthening and straightening as a result of zero gravity.
132. Fact
An inch (2.5 centimeters) of rain water is equivalent to 15 inches (38.1 centimeters) of dry, powdery snow.
133. Fact
Tremendous erosion at the base of niagara falls (usa) undermines the shale cliffs and as a result the falls have receded approximately 7 miles over the last 10,000 years.
134. Fact
40 to 50 percent of body heat can be lost through the head (no hat) as a result of its extensive circulatory network.
135. Fact
A large swarm of desert locusts (schistocerca gregaria) can consume 20,000 tons (18,160,000 kilograms) of vegetation a day.
136. Fact
The largest telescope in the world is currently being constructed in northern chile. The telescope will utilize four - 26 ft. 8 in. (8.13 meters) mirrors which will gather as much light as a single 52 ft. 6 in. (16 meters) mirror.
137. Fact
The hubble space telescope weighs 12 tons (10,896 kilograms), is 43 feet (13.1 meters) long, and cost $2.1 billion to originally build.
138. Fact
The longest living cells in the body are brain cells which can live an entire lifetime.
139. Fact
The largest flying animal was the pterosaur which lived 70 million years ago. This reptile had a wing span of 36-39 feet (11-11.9 meters) and weighed 190-250 pounds (86-113.5 kilograms).
140. Fact
The atlantic giant squid's eye can be as large as 15.75 inches (40 centimeters) wide.
141. Fact
Armadillos, opossums, and sloth's spend about 80% of their lives sleeping.
142. Fact
The starfish species, porcellanaster ivanovi, has been found to live in water as deep as 24,881 feet (7,584 meters).
143. Fact
The tentacles of the giant arctic jellyfish can reach 120 feet (36.6 meters) in length.
144. Fact
The greatest tide change on earth occurs in the bay of fundy. The difference between low tide and high tide can be as great as 54 ft. 6 in. (16.6 meters).
145. Fact
The highest temperature produced in a laboratory was 920,000,000 f (511,000,000 c) at the tokamak fusion test reactor in princeton, nj, usa.
146. Fact
The most powerful laser in the world, the nova laser at lawrence livermore national laboratory, ca, usa, generates a pulse of energy equal to 100,000,000,000,000 watts of power for .000000001 second to a target the size of a grain of sand.
147. Fact
The fastest computer in the world is the cray y-mp c90 supercomputer. It has two gigabytes of central memory and 16 parallel central processor units.
148. Fact
The heaviest human brain ever recorded weighed 5 lb. 1.1 oz. (2.3 kg.).
149. Fact
The deepest part of the ocean is 35,813 feet (10,916 meters) deep and occurs in the mariana trench in the pacific ocean. At that depth the pressure is 18,000 pounds (9172 kilograms) per square inch.
150. Fact
The largest cave in the world (the sarawak chamber in malaysia) is 2,300 feet (701 meters) long, 980 feet (299 meters) wide, and more than 230 feet (70 meters) high.
151. Fact
The hottest planet in the solar system is venus, with an estimated surface temperature of 864 f (462 c).
152. Fact
The ears of a cricket are located on the front legs, just below the knee.
153. Fact
The first electronic digital computer (called eniac - the electronic numerical integrator and calculator) was developed in 1946 and contained over 18,000 vacuum tubes.
154. Fact
The leg muscles of a locust are about 1000 times more powerful than an equal weight of human muscle.
155. Fact
The cosmos contains approximately 50,000,000,000 galaxies.
156. Fact
There are between 100,000,000,000 and 1,000,000,000,000 stars in a normal galaxy.
157. Fact
Sound travels about 4 times faster in water than in air.
158. Fact
Scientists have discovered that copper pollution of the atmosphere occurred about 2500 years ago.dis was discovered by analyzing ice cores from greenland the pollution was attributed to the romans who used copper for military purposes n to produce coins.
159. Fact
Hydrofluoric acid will dissolve glass.
160. Fact
In a full grown rye plant, the total length of roots may reach 380 miles (613 km).
161. Fact
In a full grown rye plant, the total length of fine root hairs may reach 6600 miles (10,645 km).
162. Fact
A large sunspot can last for about a week.
163. Fact
If you could throw a snowball fast enough, it would totally vaporize when it hit a brick wall.
164. Fact
Boron nitride (bn) is the second hardest substance known to man.
165. Fact
The female tarantula hawk wasp paralyzes a large spider with her sting. She then lays her eggs on the motionless body so that her developing young have a fresh supply of spider meat to feed on.
166. Fact
The seeds of an indian lotus tree remain viable for 300 to 400 years.
167. Fact
The only letter not appearing on the periodic table is the letter j.
168. Fact
Velcro was invented by a swiss guy who was inspired by the way burrs attached to clothing.
169. Fact
Hershey's kisses are called that because the machine that makes them looks like it's kissing the conveyor belt.
170. Fact
October 10 is national metric day.
171. Fact
If you stretch a standard slinky out flat it measures 87 feet long.
172. Fact
The microwave was invented after a researcher walked by a radar tube and a chocolate bar melted in his pocket.
173. Fact
Super glue was invented by accident the researcher was trying to make optical coating materials, n would test their properties by putting dem between 2 prisms and shining light through dem when he tried cyano-acrylate, he couldn't get the prisms apart.
174. Fact
No matter its size or thickness, no piece of paper can be folded in half more than 7 times.
175. Fact
A car traveling at 80 km/h uses half its fuel to overcome wind resistance.
176. Fact
Knowledge is growing so fast that ninety per cent of what we will know in fifty years time, will be discovered in those fifty years.
177. Fact
According to an old english system of time units, a moment is one and a half minutes.
Precautions while using Power Supply
Wonderful cars in the world
Most Beautiful Women in Sports
Best Shopping Malls of India
Grooming Tips
Benefits of Sapodilla fruits
Other Health Benefits
Magnesium contained in sapota is beneficial for blood and blood vessels whereas potassium helps in regulating blood pressure and promoting healthy circulation. Folate and iron prevent anemia. Sapota helps in strengthening the intestines and in improving their performance. In short, eating sapota or chikoo fruit helps in developing body resistance against many infectious diseases.


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You've got tech questions, we've found the answers. We help you make the most of your technology by answering your thorniest tech questions. So if you're wondering what to buy, how to plug it in, or how to fix it, we can help.
What should I buy on Black Friday?
Q. What are going to be the best deals on tech gear next Friday? Is there any tech gear I shouldn't buy?
A. You'll see big discounts on the previous year's hot video games, since they make great gifts for teens. With the next generation of consoles right around the corner, game systems will be hugely discounted, too. DVD and Blu-ray prices will see deep price cuts. Usually, you should stay away from laptops until January, but there might be some sweet deals on Windows 8 computers, if you're interested in upgrading. If you're giving a TV for Christmas, buy it now. However, if you're just looking to upgrade your home theater, wait until right before the Super Bowl. The first week of February is when TV deals are the best.
Do I need a screensaver?
Q. My screensaver kept turning on when I'm watching movies online, so I turned it off. Will this hurt my computer?
A. Screensavers used to be important when everyone had CRT monitors, because images could "burn into" your monitor. LCDs don't really have this problem, so, no, it doesn't hurt to turn your screensaver off. Many computer users love them, though. They're a fun way to show off your personality and customize your computer.
You can have a screensaver of your favorite pictures, sports team or hobby. You can even make your own with programs like PhotoJoy. Plus, when your screensaver turns on, it locks your computer to protect it from snoopers. You can lock your computer manually by going to Start>>Lock, but a screensaver protects you if you forget.
Stop ad tracking on your iPhone
Q. I heard a rumor that advertisers are tracking people in iOS 6. Is this true? Can I stop it?
A. Yes and yes. iOS 6 added a feature called Identifier for Advertisers. It's a unique number that follows you wherever you surf online. Advertisers can use it to track you. To disable it, go to Settings>>General>>About>>Advertising. Look for the section labeled "Limit Ad Tracking" and turn the slider to the "On" position (yes, I said "On"). Then, load http://oo.apple.com in your gadget's browser. A screen that asks if you want to opt out of Interest Based iAds will pop up. Move the slider to the "Off" position. You'll still see ads, but they won't be targeted.
Do memory card speeds matter?
Q. I went to buy a memory card for my new digital camera, but I kept seeing weird ratings for their read and write speeds. What do these really mean?
A. Read and write speeds for SD memory cards are measured in classes. A higher class means a faster card, so you'll see Class 2, 4, 6 and 10. Stick with 4 or 6 for photos and 6 or 10 if you shoot video with your camera. If your camera supports Class UHS-I, that's an even faster card. For CompactFlash cards, you'll see ratings like 50x, 133x, 266x, 300x and 600x. Take the speed and multiply it by 150KB per second - so 133x would be about 20 megabytes per second. 266x is a good speed for most people. Keep in mind that some CompactFlash makers advertise read speed instead of write speed. Make sure you know how a card is measured before you buy. Make sure you know the signs for a counterfeit memory card, too.
Watch DVDs in Windows 8
Q. I just upgraded to Windows 8. I'm trying to watch DVDs in Windows Media Player, but it's not working. Am I doing something wrong?
A. Microsoft dropped DVD support in Windows Media Player for Windows 8. If you want to play DVDs, you have to upgrade to Windows Media Center. That isn't free and isn't the most powerful or customizable option for watching DVDs. Instead, I recommend VLC Media Player. It works with more formats than the standard options that come with Windows, so it can play video from all over the Web. It can run in a window, unlike Windows Media Center, so it's better for multi-tasking, too.
Copyright 2012, WestStar Multimedia Entertainment. All rights reserved. Kim Komando hosts the nation's largest talk radio show about consumer electronics, computers and the Internet. To get the podcast, visit www.komando.com/listen. To subscribe to Kim's free email newsletters, sign-up at www.komando.com/newsletters.


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RABAT, Morocco (AP) — After more than a year of dialogue, Morocco's Islamist-led government has moved forward on a major campaign promise and unveiled a reform plan for the country's much-criticized judicial system.
The judicial system has been a major sore point for Moroccans because of a widespread perception that courts serve the rich and powerful. Critics allege that verdicts in civil trials can be purchased for a few thousand dollars while a phone call from a high-ranking official can ensure a guilty ruling in political cases.
The justice system was listed as one of the most corrupt sectors in the country by the 2013 World Corruption Index.
The Islamist Justice and Development Party won the right to head Morocco's next government in the 2011 elections and one of its main campaign promises was battling corruption and creating a truly independent judiciary.
Justice Minister Mustapha Ramid unveiled the new plan late Thursday describing it as a product of an extensive dialogue and had the backing of King Mohammed VI, who first pushed for judicial reform in a 2009 speech.
"This is a historic moment we are living as we meet to reform the judicial system," said Ramid at the conference's opening, which included high government officials and diplomats. "Our dialogue was distinguished by the fact that we all wanted a profound reform requiring the mobilization of all forces in society."
The ambitious plan addresses many of the criticisms of Morocco's justice system, including higher standards and more training for judges, prosecutors and lawyers, as well as greater transparency in appointments and penalties of members of the judiciary.
The charter, which has to be voted on by parliament, also talks about setting up a mechanism to oversee judges' expenditures and lifestyle to ensure they are in line with their income.
The plan also follows up on measures in the new 2011 constitution, which was amended in response to pro-democracy Arab Spring demonstrations, to get the judiciary out from under the shadow of the Ministry of Justice and make them more independent. In the past, executive control over judicial appointments and salaries ensured pliant judges.
One key aspect of the reform — one long demanded by human rights activists — is a revision of the penal code "to bring it into harmony with the new constitution and principles of international conventions" that Morocco has signed.
The presentation gave no specifics, but there has been repeated criticism of the criminalization of abortion, sex outside marriage and alcohol consumption for Muslims, as well as allowing rapists to marry their underage victims to escape prosecution.


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PET/CT scan is a type of imaging test that combines positron emission tomography (PET) and computed tomography (CT) techniques. Combined PET/CT scans can be performed on any part of the body.
PET scans use a radioactive tracer that is introduced into your body to measure the cellular activity of the cell type or body part being scanned. A CT scan takes a large number of x-rays. These are analyzed by a computer to create a 3-dimensional image of the body part being studied. When both tests are performed at the same time, the information about function and structure is integrated through computer models.
Reasons for Test
Because PET/CT scans provide a combination of information about the function and structure of a body part, they are useful for the early diagnosis of cancer. Not only can an abnormal tumor be seen, but the function of the cells that make up the tumor can be analyzed as well. This can help to differentiate between cancerous and noncancerous growths. PET/CT can also be used to see if cancer has spread into other areas of the body.
Brain, endocrine, and heart disorders are also studied using PET/CT scans.
Possible Complications
Some possible complications with this test include:
- Allergic reactions to the chemicals used
- Kidney damage from the contrast chemical used
- Long-term effects from radiation exposure
What to Expect
Prior to Test
Prepare a list of medications you are taking and bring the list with you to the test. If you have diabetes, discuss taking your diabetic medications and/or insulin with your doctor prior to the test. An abnormal blood glucose level may interfere with the tests results.
Let your doctor know if you have kidney disease. The doctor may need to take steps to avoid kidney injury during the test.
To prepare for your test, you may need to do the following several hours in advance:
- Not eat anything after a certain time
- Avoid beverages with high sugar and calorie content
- Drink plenty of water
If you are breastfeeding, talk to your doctor before you go for your test. Your doctor may recommend that you pump breast milk ahead of time and use it until the contrast materials are no longer in your body.
At the test center, the staff will ask if you have or ever have had:
- A reaction to a contrast materials or iodine
- Allergies to contrast materials, iodine, or seafood
- Asthma
- Claustrophobia or anxiety
Description of Test
- If you are anxious about being in enclosed spaces, you may be given a light sedative to help you relax.
- An IV will be placed in your arm.
- A small quantity of the tracer substance (used for the PET portion of the scan) will be injected through the IV. In some cases, the tracer substance will be inhaled or swallowed rather than injected.
- You will wait about 60 minutes after this injection.
- You will be positioned on a table.
- Another injection of contrast material (used for the CT portion of the scan) will be given.
- The table will move slowly through a doughnut-shaped ring. You will need to lie still for about 35 minutes while the PET/CT images are being taken.
After Test
- You should continue to drink extra water throughout the day after your scan. This helps to flush the tracer materials from your body.
- If you have received any sedation, you will need to have someone drive you home.
- You can expect to be able to resume your normal activities the same day as your test.
How Long Will It Take?
A PET/CT scan takes about a total of 2 hours to complete. The injection occurs about an hour prior to the start of the scan. The scan itself takes about 35 minutes.
Will It Hurt?
The placement of the IV may give you some discomfort, but there should be no other pain involved. You may feel some flushing when the tracer material is injected.
Based on the results, your doctor will decide if any further tests or treatments are needed.
Call Your Doctor
Call your doctor if any of the following occur:
- Signs of allergic reaction, including flushing, hives, and itching
- Swollen or itchy eyes
- Difficulty breathing or a feeling of tightness in your throat
- Nausea
- Less urine than normal
If you think you have an emergency, call for emergency medical services right away.
Revision Information
- Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
- Review Date: 03/2017 -
- Update Date: 03/18/2013 -


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(This article was cross-posted at the Score.com)
Alain Vigneault's extreme method of doling out ice time and circumstances has been mentioned in this space before. Aside from the Sedin twins, no player better represents the Vancouver coach's habits better than Manny Malhotra. While the twins enjoyed some of the most favorable starting positions in the entire league this year, Malhotra was at the other end of the spectrum. As a result, his value to Vancouver isn't quite revealed in counting numbers.
Malhotra scored just 11 goals and 30 points this season from the Canucks third line. Not terrible results, but it seems like a drop in the bucket given Vancouver's league leading 258 goals. However, Malhotra's role wasn't to score points: it was to do all the dirty work so the Canucks top-six could have the high ground as much as possible. The Sedin's league leading zone start ratio of 70%+ was paid for by Malhotra, whose 25% ratio was the lowest amongst regular skaters in the league this season. Only two other guys were below the 30% mark: The Flyers Blair Betts (26.9%) and Malhotra's regular line mate Raffi Torres (29.6%). In raw numbers, that means Malhotra saw 311 more defensive zone versus offensive zone draws during the regular season.
Upon first glance, Manny's underlying possession numbers seem worse than mediocre (-9.50 corsi/60). However, if we correct for his extreme circumstances, we see that he was actually pretty capable. Here is his corrected corsi rate, which "zeros out" the effect of all of those extra defensive zone face-offs:
|corsi per 60
|ES ice time
|corsi raw
|correct corsi
|CC per 60
Malhotra's corrected corsi rate is +6.89, a much healthier number. To put his results in perspective, Blair Betts (the only other center within spitting distance of Malhotra in terms of starting ratio) managed a much uglier -18.19/60.
One of the reasons Malhotra is so effective in his "defensive only" role is his incredible ability to win draws. Most of the time I consider face-off skill to be rather unimportant since most players are +/- 50% on the dot. Malhotra, though, is an extreme outlier. This season he finished with a 61.7% win rate, trailing only Washington's David Steckel (62.3%) by that measure. As a result, Malhotra won the second most defensive zone draws amongst centers this season with 296 and he likely only trailed the leader (Steve Ott) because he missed the final 10 games of the year. Malhotra's win rate in the defensive zone was even higher, a mind-boggling 63.5% at even strength. This is notable because as Gabriel Desjardins has noted in the past, losing a defensive zone draw can spike shots and chances against in the immediate aftermath. As Gabe says "it's as though you gave the other team a 10-15 second power-play. For several seconds, the rate of shots allowed is as high as it is on a 5-on-3."
This issue is especially pertinent in one goal games and, obviously, when killing penalties. Naturally, Malhotra also figured prominently on the Canucks penalty kill this season, averaging a team high 2:45 a game a man down. He won the second most draws on the club (136) on the PK behind only Ryan Kesler (138), again primarily because Kesler played the whole season and Malhotra didn't.
The effect of Malhotra's absence ripples across the Canucks line-up. It means guys like Ryan Kesler and Maxim Lapierre are forced into more defensively oriented positions at even strength. It means less defensive zone face-off wins in general and it lowers everyone elses zone start ratio across the board. Kesler and the Sedins are hovering about below their season ratios in the playoffs so far, for example. In addition, Lapierre has filled in as Malhotra's de facto replacement, with a zone start of about 29%. His face-off win rate is just 50% and his corsi rate is abysmal (-20.14/60), which again reiterates just how tough Malhotra's job was.
As such, if Malhotra can return for the finals he probably won't kick in a lot of goals or assists. What he will do, however, is imporve the PK, help tilt the ice in the Canucks favor at even strength and put their scoring forwards in a better position to succeed.


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Google glitters, other dot-coms face risks
Internet stocks are as volatile as ever, with growth-starved investors flocking to the sector in the hope they've bought shares in the next online blue chip.
In Google they may have found one, but the question may be whether some of the other recent internet flyers deserve the same level of trust from investors.
"Investors have to be smart and be careful that the euphoria doesn't become so all-encompassing that they lose the difference between the good and the bad." Bob Davis, founder and former CEO of Web portal Lycos and now a venture capitalist at Highland Capital Partners.
It may be too simplistic to compare the run-ups of recent the internet issues like Google, Shopping.com and Travelzoo.com to those of high-flying - and unprofitable - stocks from the dot-com boom. Analysts said investors are wrestling with new risks and assumptions this time around.
For a start, more internet companies have real revenue and profits this time around. Google, for example, posted a third-quarter profit that jumped 155 percent from a year ago to $US52 million on revenue that doubled to $806 million.
Some analysts think market values of some of these companies may be out of sync with their size. Internet travel site Travelzoo Inc., for example, has a $US1 billion market capitalisation, but had third-quarter net income of only $2.1 million on revenue of $9.5 million.
Travelzoo now trades at a multiple of 173 times projected 2004 earnings - dwarfing market darling eBay's current multiple of 80.
"I think there are pockets of over-valuation," said Mark Mahaney, an analyst at American Technology Research, referring to internet stocks. But at the same time, he said, companies like Google had the fundamentals to justify the lofty prices.
Google's stock has more than doubled from its mid-August debut as investors chase hard-to-get shares that are now flirting with $200.
"The difference today is that the companies that we're talking about ... are not only profitable but are generating margins that would be the envy of any brick & mortar store," Highland Capital's Davis said.
During the internet bubble of the late 1990s, investors regularly bid up shares of companies like Yahoo and Amazon.com Inc. to heights unseen for new ventures with limited revenue and frequent losses.
When the bubble burst in 2000, internet stocks came crashing to Earth and many presumed the markets would never again see such speculation.
Then came Google.
At its closing price on Friday of $190.64 a share, Google's $51.7 billion market capitalization is bigger than Yahoo's and trades at a multiple of 76 times projected 2004 earnings. The company is more expensive than any of the companies in the Nasdaq-100 index.
Shopping.com, a price-comparison search engine, is up 50 percent from its $18 debut this week. The company which had revenue of just over $84 million in the last four quarters carries a market valuation of $750 million.
Expected long-term growth rates for Google and the internet sector are in line compared with rates in the past, said Caris & Co. internet services analyst David Garrity, pointing to former fast-growing "Nifty 50" companies like Coca-Cola and Polaroid from the 1960s.
"While these price levels are high, if you compare them to how major growth stocks were priced in the past, they're not at extended levels," he said.
Highland Capital's Davis, for his part, also downplayed the potential for another bubble.
"I think there's a good sense of investor wisdom that was developed over some painful years," he said.


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Incident follows a shooting the night before; couple had children in the apartment
Two people are in custody following a nearly six-hour standoff Saturday in the 500 block of East Ridgecrest Boulevard.
The standoff started when officers attempted to execute a search warrant as part of a followup to a shooting incident late Friday night in the 300 block of North Robalo Street.
Two children were also in the apartment.
Officers arrived at the apartment shortly after 10 a.m., and the Kern County Sheriff's Office Special Weapons and Tactics unit was called in soon after. By the end of the long ordeal, Ridgecrest police officers arrested 32-year-old Jason Bostick and 23-year-old Stacey Campbell after the two refused to allow officers to execute a search warrant at their apartment.
"We're still working on it," said Ridgecrest Police Department Sgt. Justin Dampier. "The charges are all related to the warrant and not to the shooting at this point."
Bostick is charged with being a felon in possession of a firearm, a felon in possession of a firearm, possession of a controlled substance and possession of a controlled substance for sale.
Campbell is charged with resisting, delaying or obstructing peace officers, child endangerment and possession of a controlled substance.
During the alleged standoff, officers blocked off East Ridgecrest Boulevard in both directions from Sunland Street to American Street, and Police and Community Together volunteers diverted traffic around the scene. Officers also blocked East Commercial Avenue in both directions.
A man was allegedly shot several times after 10 p.m., Friday. The man was transported to Ridgecrest Regional Hospital and airlifted to Kern Medical Center where he is in critical, but stable condition.
It is unknown if Bostick is a suspect in the shooting. The investigation is continuing.
Bostick is in custody in the Kern County Jail Central Receiving Facility in Bakersfield in lieu of $545,000 bail. Arraignment is scheduled for Sept. 25 in Kern County Superior Court Ridgecrest Branch.
The California Highway Patrol, Kern County Sheriff's Office, California Department of Fish and Game, Kern County Fire Department Engine 74, Inyo County Sheriff's Office and Indian Wells Valley Community Emergency Response Team also responded.


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Monday, July 26, 2010
LIVE from SF: Ariel Pink's Haunted Graffiti, Jonathan Richman
Catching a performer at their most creative, representative moment is a tricky business. There are many factors which can influence a performance, everything from a band's experience playing music together, the energy and visible appreciation of an audience, how an artist chooses to take care of himself (or not) while touring. Last week, at the venerable Bimbo's in San Francisco's North Beach neighborhood, Ariel Pink was in what I suspect to have been a very representative moment for his unique brand of experimental folk, pop and 70's influenced rock. Fresh off a major label contract with 4AD, and heaps of critical praise, one could sense that Ariel clearly thinks he's hot shit. At least that's how he acted, complaining throughout the set about not having a decent sound check, not having enough reverb, and whatever else he was babbling about. Between complaints, he snacked on a sandwich, guzzled some beer, and decided that he would knock the mic down, all of which made it a miserable show for the sound guy, the crowd and his backing band. A portion of the crowd was really into it, dancing to the admirable jams laid down by Ariel's Haunted Graffiti (his backing band), despite his best efforts to shout, scream, and distract from any sort of musicality or genuinely interesting musical expression going on around him.
Last Wednesday at the Swedish American Music Hall, I saw a whole other type of weird: cheerful, playful, offbeat and intelligent. A performance from someone who has been writing and performing music for over thirty years. Who else but Jonathan Richman can write catchy songs meandering from Vermeer ("so much perspective, you know, for the times"),to urban living ("my little two year old mind was thinking I love this place, the dirt, the greasy pizza smells...") to Keith Richards ("love those internal melodies and minor 6ths"). In his trademark partially sung, part conversational, spoken style, Jonathan confidently entertained a small-ish crowd (who in true SF fashion were mainly seated on the floor until he urged them to stand up and clap because, "you know, you'll feel better"). All Richman needs is his classical guitar, a mic, and drummer Tommy Larkins to put on a show. Between the engaging lyrics, which come out clear as a bell, proficient if not flashy or perfect guitar playing, and some killer dance moves, Jonathan Richman is someone you need to see next time he plays in your area.
In this battle of the weird, I'll take Jonathan over Ariel any day, even if it means sacrificing some cool points with the cool kids amongst my readership.
Posted by Joe Manekin at 7/26/2010 12:03:00 PM 1 comment:
Labels: ariel pink, jonathan richman, sf concert reviews
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Congratulations to the Workshop Makeover Giveaway Winner!
A hearty congratulations goes out to Bill Ketler of Silver Spring, Md., winner of our Workshop Makeover Giveaway, sponsored by JET Tools and Bessey Tools. He will be adding $6,000 worth of tools to his shop including a table saw, planer, band saw, dust collector and jointer from JET Tools, and a K Body REVO Framing Kit, four-piece H-style clamp set, 24″ x 4″ light-duty step-over clamps and a bar clamp assortment with mobile rack from Bessey Tools.
Ketler entered the woodworking fold in the early 1980s after retiring from his job as an oceanographer. With only a Craftsman table saw and a few other basic tools in the basement, he began tinkering around with household projects. Before too long though, he found himself building cabinetry and shelving for friends – a second career was born.
"It came so natural," Ketler said. "I didn't advertise… it just led by word of mouth for many years."
Now 82, Ketler's commercial woodworking days are mostly behind him, but he's still plenty busy in the shop. Some of his recent work includes a nicely built crib for his first granddaughter, Ellie, who just celebrated her first birthday last Sunday. Happy Birthday, Ellie!
As far as the new tools go, Ketler can't wait to put them to use. He's particularly excited to finally have a planer, a tool his shop has been missing. Coming up: new shelving for the house.


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What's the word most associated with the
phrase 'January sales'? Is it 'great bargains' or 'horrible panic buy made just
to get out of the shop with something'? For most, it's the latter. Bright lights and awful music can make for
some terrible shopping decisions. So why not take some time out, turn your
lights down low, put on whatever music you like and take a seat. Although you
should have been sitting down already, unless you use a PC standing up. And
that's just bizarre.


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BUENOS AIRES, Argentina (AP) — A nationwide strike paralyzed Argentina's economy on Thursday, shutting down air, train and bus traffic, closing businesses and ports and emptying classrooms. The strike also stopped all non-emergency hospital attention, left garbage in emptied streets and complicated many other aspects of life in the South American nation.
Labor leaders want higher pay, lower taxes and millions of dollars they say are owed to union-run health care providers. The government disputes this debt to the funds, which the unions lost total control of after being accused of misusing the money.
All Argentines are struggling with 30 percent inflation, but any money for pay raises has to come from somewhere, and analysts say the economy has almost stopped growing for lack of confidence in the country's future.
Many worry that President Cristina Fernandez, who rules with decree power over many aspects of Argentina's economy, is squeezing the middle class by raising taxes and fees and cutting subsidies as she seeks funds to appease the unions and other sectors that could threaten her government.
Fernandez was dismissive of the strike.
"If everything is going so badly, who are these thousands and thousands of Argentines I see in the capital, when no restaurant has any empty seats?" she challenged.
But a survey of 450 people last week found 62 percent agree that the president is "really losing control of things," the Polldata firm reported.
"We have to think it over 25 times before going out to eat," Maria Eugenia Diez, a middle-class housewife, complained in an Associated Press interview.
She said she's sympathetic to the union workers' salary woes and supports many of the government's efforts to direct resources to the poor, but thinks the strike just takes more money from everyone's pockets. She's also deeply worried about how inflation is reducing everyone's power to spend, which keeps the economy going.
Her two boys lost nearly two weeks of school when public teachers struck last month, symptomatic of a society in trouble. Years have passed since they've been able to save any money, and even though her husband's job as a software engineer seems stable, they drive a 30-year-old car and have cut sharply back on family spending, she said. "I really worry that one day the inflation will be so steep that we won't be able to reach the end of the month."
The 24-hour strike was called by the opposition branch of the nation's largest union conglomeration, which claimed that more than a million workers stayed home. If the government doesn't answer their demands, labor boss Hugo Moyano vowed more and longer strikes in the future.
Moyano was a close ally of Fernandez's late husband, President Nestor Kirchner, but he and Fernandez grew apart after he died in 2010, and many see Thursday's strike as only the latest power struggle between them.
Cabinet Chief Jorge Capitanich dismissed the strike Thursday as "a huge blockade" led by labor leaders who respond to Peronist Party politicians opposed to Fernandez.
Juan Carlos Schmid, who leads the dredgers and navigators' union, denied that, blaming barricaded streets on non-union leftist groups and saying that even pro-government unions joined the strike.
Union leaders who have held onto power for decades aren't very well liked by many Argentines — even union members themselves, and even those who are already getting steep raises this year.
The strike depressed sales at the downtown candy and sandwich shop where Sebastian Gonzalez, 29, showed up to work on Thursday. His commerce workers' union already secured 27 percent pay raises this year, nearly matching inflation.
The strike "is not a good idea, because many people have to work, and I don't agree with stopping all transportation. It's a big blow from the labor sector, which as far as I'm concerned doesn't represent all the workers and protects its own interests."
Many Argentines are trying to adjust to utility hikes of as much as 500 percent as the government withdraws energy subsidies it has paid since the last economic crash in 2002. Rather than spending to keep water, gas and electricity low for people who can afford it, Fernandez's Economy Ministry wants to redirect that money to construction loans, university scholarships and cash welfare payments to the poor.
The constant price increases and a sharp devaluation in the peso in January set off hundreds of smaller protests before Thursday's national strike. In March alone, there were 656 street demonstrations, said Patricio Giusto, an analyst with the Diagnostico Politico consulting firm.
"Social pressures are heating up," he said. "It's a really high statistic and the trend is increasing. There are many salary negotiations that remain unresolved."
Associated Press journalist Paul Byrne contributed to this story.


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Skinny jeans with raw-cut edges and rips on the knees. They feature two side pockets, two back pockets, one coin pocket and belt loops. Zip fly and top button fastening in the front.HEIGHT OF MODEL: 189 cm. / 6′ 2″ SIZE 40


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The Immortality of the Soul
VII. Sir John Davies
Proved by Several Reasons:
st, The Desire of Knowledge;
nd, The Motion of the Soul;
rd, From Contempt of Death in the righteous;
th, From Fear of Death in the wicked; and
th, From the General Desire of Immortality.
onely end is neuer-ending blisse,
Which is th eternall face of God to see;
Who last of ends, and first of causes is:
And to do this, she must eternall bee.
How senselesse then, and dead a soule hath hee,
Which thinks his soule doth with his body dye;
Or thinks not so, but so would haue it bee,
That he might sinne with more securitie!
For though these light and vicious persons say,
Our soule is but a smoke, or aiery blast,
Which during life doth in her nostrils play,
And when we die, doth turne to wind at last:
Although they say, Come, let vs eat and drinke;
Our life is but a sparke which quickly dyes:
Though thus they say, they know not what to thinke,
But in their minds ten thousand doubts arise.
Therefore no heretikes desire to spread
Their light opinions, like these Epicures;
For so their staggering thoughts are comforted,
And other mens assent their doubt assures.
Yet though these men against their conscience striue,
There are some sparkles in their flintie breasts,
Which cannot be extinct, but still reuiue;
That, though they would, they cannot quite be beasts.
But whoso makes a mirror of his mind,
And doth with patience view himselfe therein,
His soules eternity shall cleerly find,
Though th other beauties be defact with sinne.
First, in mans minde we find an appetite
To learne and know the truth of euerie thing,
Which is connaturall and borne with it,
And from the Essence of the Soule doth spring.
With this desire shee hath a natiue might
To find out euerie truth, if she had time;
Th innumerable effectes to sort aright,
And by degrees from cause to cause to clime.
But since our life so fast away doth slide,
As doth a hungry eagle through the wind,
Or as a ship transported with the tide,
Which in their passage leaue no print behind:
Of which swift litle time so much we spend,
While some few things we through the sense do straine,
That our short race of life is at an end,
Ere we the principles of skill attaine:
Or God (which to vaine ends hath nothing done)
In vaine this appetite and powr hath giuen;
Or else our knowledge, which is here begon,
Hereafter must bee perfected in heauen.
God neuer gave a powr to one whole kind,
But most part of that kinde did vse the same;
Most eyes haue perfect sight, though some be blind;
Most leggs can nymbly run, though some be lame.
But in this life no soule the truth can know
So perfectly, as it hath powr to doe:
If then perfection be not found below,
An higher place must make her mount thereto.
Againe, how can shee but immortall bee,
When with the motions of both will and wit
She still aspireth to eternitie,
And neuer rests till shee attaine to it?
Water in conduit-pipes can rise no higher
Than the well-head from whence it first doth spring:
Then since to eternall God she doth aspire,
Shee cannot be but an eternall thing.
All mouing things to other things do moue
Of the same kind, which shewes their nature such:
So earth fals downe, and fire doth mount aboue,
Till both their proper elements do touch.
And as the moysture which the thirstie earth
Suckes from the sea to fill her emptie veines,
From out her wombe at last doth take a birth,
And runnes a nymph along the grassie plaines:
Long doth shee stay, as loath to leaue the land,
From whose soft side she first did issue make:
Shee tastes all places, turnes to euery hand,
Her flowrie bankes vnwilling to forsake;
Yet Nature so her streames doth leade and carry,
As that her course doth make no finall stay,
Till she herselfe vnto the ocean marry,
Within whose watry bosome first she lay:
Euen so the soule, which in this earthly mold
The Spirit of God doth secretlie infuse,
Because at first she doth the earth behould,
And onely this materiall world she viewes;
At first our mother-earth shee holdeth dere,
And doth embrace the world and worldly things;
Shee flyes close by the ground, and houers here,
And mounts not vp with her celestiall wings:
Yet vnder heauen shee cannot light on ought
That with her heauenly nature doth agree;
She cannot rest, she cannot fixe her thought,
She cannot in this world contented bee.
For who did euer yet in honor, wealth,
Or pleasure of the sense, contentment find?
Who euer ceasd to wish, when he had health?
Or hauing wisedome, was not vext in mind?
Then as a bee, which among weeds doth fall,
Which seeme sweet floures, with lustre fresh and gay,
She lights on that, and this, and tasteth all,
But pleasd with none, doth rise and sore away:
So, when the soule finds here no true content,
And, like Noahs doue, can no sure footing take,
She doth returne from whence she first was sent,
And flyes to him that first her wings did make.
Wit, seeking truth, from cause to cause ascends,
And neuer rests, till it the first attaine:
Will, seeking good, finds many middle ends,
But neuer stayes, till it the last do gaine.
Now God the Truth, and first of Causes is;
God is the last good end, which lasteth still;
Being Alpha and Omega namd for this,
Alpha to wit, Omega to the will.
Sith then her heauenly kind shee doth bewray,
In that to God she doth directly moue,
And on no mortall thing can make her stay,
Shee cannot be from hence, but from aboue.
And yet this first true Cause, and last good End,
She cannot heere so well and truly see:
For this perfection she must yet attend,
Till to her Maker shee espoused bee.
As a Kings daughter, being in person sought
Of diuerse princes, which doe neighbour neare,
On none of them can fixe a constant thought,
Though shee to all doe lend a gentle eare;
Yet can she loue a forraine Emperour,
Whom of great worth and powre she heares to be,
If she be wood but by embassadour,
Or but his letters, or his pictures see;
For well she knowes that when she shal be brought
Into the kingdome where her Spouse doth raigne,
Her eyes shall see what shee conceiud in thought,
Himselfe, his state, his glorie, and his traine:
So while the virgin Soule on earth doth stay,
Shee wood and tempted is ten thousand wayes
By these great powers, which on the earth beare sway,
The wisdome of the world, wealth, pleasure, praise:
With these sometime she doth her time beguile,
These do by fits her phantasie possesse;
But she distasts them all within a while,
And in the sweetest finds a tediousnesse:
But if vpon the worlds Almightie King
She once doe fixe her humble louing thought,
Who by his picture drawne in euery thing,
And sacred messages, her loue hath sought;
Of him she thinks she cannot thinke too much;
This hony tasted, still is euer sweete;
The pleasure of her rauisht thought is such,
As almost here she with her blisse doth meete.
But when in heauen she shall his Essence see,
This is her soueraigne good and perfect blisse;
Her longings, wishings, hopes, all finisht bee,
Her ioyes are full, her motions rest in this:
There is she crownd with garlands of content;
There doth shee manna eate and nectar drinke;
That presence doth such high delights present,
As neuer tongue could speake, nor hart could thinke.
For this, the better soules do oft despise
The bodies death, and doe it oft desire;
For when on ground the burthened ballance lyes,
The emptie part is lifted vp the higher.
But if the bodies death the Soule should kill,
Then death must needs against her nature bee;
And were it so, all soules would flie it still,
For Nature hates and shunnes her contrarie:
For all things else, which Nature makes to bee,
Their being to preserue are chiefly taught;
And though some things desire a chaunge to see,
Yet neuer thing did long to turne to nought.
If then by death the Soule were quenched quite,
She could not thus against her nature runne,
Since euery senselesse thing, by Natures light,
Doth presentation seeke, destruction shunne.
Nor could the worlds best spirits so much erre,
If death tooke all, that they should all agree
Before this life their honor to preferre;
For what is praise to things that nothing bee?
Againe, if by the bodies prop shee stand;
If on the bodies life her life depend,
As Meleagers on the fatall brand,
The bodies good she onely would intend:
We should not find her halfe so braue and bold,
To leade it to the warres, and to the seas,
To make it suffer watchings, hunger, cold,
When it might feed with plentie, rest with ease.
Doubtlesse all soules haue a suruiuing thought;
Therefore of death we thinke with quiet mind:
But if we thinke of being turnd to nought,
A trembling horror in our soules we find.
And as the better spirit, when she doth beare
A scorne of death, doth shew she cannot dye;
So when the wicked Soule deaths face doth feare,
Euen then she proues her owne eternity.
For when Deaths forme appeares, she feareth not
An vtter quenching or extinguishment;
She would be glad to meete with such a lot,
That so shee might all future ill preuent.
But she doth doubt what after may befall;
For Natures law accuseth her within,
And saith, Tis true that is affirmd by all,
That after death there is a paine for sinne.
Then she which hath bene hudwinckt from her birth,
Doth first herselfe within Deaths mirrour see;
And when her bodie doth returne to earth,
She first takes care how she alone shal be.
Who euer sees these irreligious men
With burthen of a sicknessse weake and faint,
But heares them talking of religion then,
And vowing of their soules to euery saint?
When was there euer cursed atheist brought
Vnto the gibbet, but he did adore
That blessed Power, which he had set at nought,
Scornd and blasphemed all his life before?
These light vaine persons still are drunke and mad
With surfettings and pleasures of their youth;
But at their deaths they are fresh, sober, sad;
Then they discerne, and then they speake the truth.
If then all soules, both good and bad, do teach,
With generall voyce, that soules can neuer dye;
Tis not mans flattring glose, but Natures speach,
Which, like Gods oracle, can neuer lye.
Hence springs that vniuersal strong desire,
Which all men haue, of Immortalitie:
Not some few spirits vnto this thought aspire,
But all mens minds in this vnited bee.
Then this desire of Nature is not vaine;
She couets not impossibilities:
Fond thoughts may fall into some idle braine,
But one assent of all is euer wise.
From hence that generall care and studie springs,
That launching and progression of the mind,
Which all men haue so much of future things,
As they no joy doe in the present find.
From this desire that maine desire proceeds,
Which all men haue suruiuing fame to gaine,
By tombes, by bookes, by memorable deedes;
For she that this desires doth still remaine.
Hence, lastly, springs care of posterities;
For things their kind would euerlasting make:
Hence is it that old men doe plant young trees,
The fruit whereof another age shall take.
If we these rules vnto ourselues apply,
And view them by reflection of the mind,
All these true notes of immortalitie
In our hearts tables we shall written find.
And though some impious wits do questions moue,
And doubt if soules immortal be, or no;
That doubt their immortalitie doth proue,
Because they seeme immortal things to know.
For he which reasons on both parts doth bring,
Doth some things mortal, some immortal call:
Now, if himselfe were but a mortall thing,
He could not iudge immortall things at all.
For when we iudge, our minds wee mirrours make;
And as those glasses which material bee,
Formes of materiall things do onely take;
For thoughts or minds in them we cannot see;
So when wee God and angels do conceive,
And think of truth, which is eternal too,
Then doe our minds immortal forms receive,
Which, if they mortal were, they could not doo.
And as, if beasts conceived what reason were,
And that conception should distinctly shew,
They should the name of reasonable beare;
For without reason none could reason know;
So when the Soule mounts with so high a wing,
As of eternal things she doubts can moue,
She proofes of her eternity doth bring,
Evn when she strives the contrary to prove.
For evn the thought of immortality,
Being an act done without the bodies aid,
Shews that herself alone could moue and bee,
Although the body in the graue were laid.
Note 1.
VII. Sir John Davies.An eminent lawyer, he was born in 1570, and died in 1620. His Nosce Teipsum, or The Soul of Man and the Immortality thereof, from which the extracts in this volume are taken, first appeared in 1599, and it was dedicated to Queen Elizabeth. [
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When German farmers and activists descended upon Chancellor Angela Merkel's office building Wednesday morning, they brought along some special guests — 17 pigs. The stunt was the latest European backlash against a proposed free trade deal with the U.S. that could lift restrictions on American meat sold in Europe.
Under the watchful eye of German police officers, the pigs munched happily on straw strewn across the pavement to keep the herd from running amok.
The protesters said the pigs at today's protest were meant to symbolize wholesome farming, rather than to insult Merkel. Germany is a huge consumer of pork, with the country slaughtering more pigs annually than any other country in Europe, according to the Heinrich Boell Foundation, which is part of the Green political movement.
But there is little doubt that traditional German farmers and environmental groups are unhappy with the chancellor and her government. They object to the German government's support of industrial farming and some genetic engineering, as well as the secret conversations with the U.S. and other European leaders. Those conversations are laying the groundwork for official free trade negotiations that are expected to start in June.
A trade deal between Europe and the U.S. would create the world's largest single market. But civil society organizations in Europe fear their governments will go too far and sacrifice existing labor and consumer rights.
Meat production is not technically a major issue in the talks, but it's a key consumer issue activists can use to mobilize Europeans against a trade deal, says Olaf Boehnke, who heads the Berlin office of the European Council on Foreign Relations.
A recent "meat atlas," for example, released by the Berlin-based Heinrich Boell Foundation, stated that Europeans do not want American meat pumped full of growth hormones, just as American consumers do not want antibiotics in their food.
Merkel's press office declined to comment about today's pig protest.
The herd in attendance belongs to Rudolph Buehler, who heads the farmers' cooperative in the southern Germany community of Schwaebisch Hall. He's an organic farmer who says his family has raised livestock and tilled its 123 acres since 1378.
"We are doing sustainable agriculture and we are fighting for our indigenous rights," he says.
Protest organizer Jochen Fritz says farmers like Buehler are worried not just about quality, but unfair competition.
"In Europe, the consumers don't want to have this stuff in their food, so we will always be more expensive in production," he says.
Buehler said he and other farmers believe the trade deal won't be a fair partnership. "Even Obama — the Nobel Prize winner for peace — says 'America first,' " he said. So "[what] chance have we farmers in Germany to resist?"
Buehler added they prefer a free zone with Eastern European countries to "strengthen European culture."
Organizers said the German protest will continue on Saturday, although without the pigs.
This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.
And I'm Audie Cornish.
The U.S. and Europe are moving closer to a free trade deal that would create the world's largest single market. Some European activists are stepping up protests against that agreement. They say it would strip consumers of their rights and workers of their livelihoods.
Farmers and environmental groups used pigs to make their point today in front of the office of the German chancellor in Berlin. NPR's Soraya Sarhaddi Nelson was there.
SORAYA SARHADDI NELSON, BYLINE: Activists sweep hay into a fluffy pile in front of Angela Merkel's office building to welcome more than a dozen squealing protesters.
NELSON: Organic farmer Rudolf Buehler hustles the pigs past amused police officers who are here to make sure things don't get out of hand. The pigs appear happy to oblige. They huddle in an orderly group, drinking water and munching on hay.
RUDOLF BUEHLER: (Foreign language spoken)
NELSON: Buehler tells onlookers that the pigs are from his southern German farm, which his family has worked for nearly seven centuries.
BUEHLER: They are a symbol of free farmers.
NELSON: They also might be seen as a symbol of insult to the chancellor, no?
BUEHLER: Yes. I think she might watch and even NSA will watch us. I'm very sure about that.
NELSON: But he says his trip here with the pigs is no joke. Buehler says he doesn't know how else to convince Merkel that a U.S.-European free trade pact, opening the market to more American meat, could end up wiping out traditional German farms like his. He says it costs a lot more for small farmers to produce pork and other meat products that meet E.U. standards and customers' tastes. And those European tastes are increasingly anti-American when it comes to beef, chicken and pork.
A report released last week by the Green Movement's Heinrich Boll Foundation charge that Europeans do not want U.S. meat pumped full of growth hormones.
BARBARA UNMUESSIG: (Foreign language spoken)
NELSON: At a Berlin news conference, foundation president Barbara Unmuessig said people need to know what animals eat because what they eat, we eat. These concerns, coupled with the secrecy clouding backroom talks between U.S. and European officials in advance of formal trade negotiations, are fueling unease. And while meat production may not be the biggest issue for the governments, it's one that trade pact opponents are latching on to, says Olaf Boehnke, who heads the Berlin office of the European Council on Foreign Relations.
OLAF BOEHNKE: Even if it's a minor issue or not a major one in the entire agreement, it might be one of the few stakes which the protesters can use, actually, to mobilize against the entire agreement.
NELSON: He adds that rumors on Twitter last week suggested Merkel and President Obama had struck a deal on agricultural matters. Such rumors contributed to the anger at today's protests. Again, farmer Buehler.
BUEHLER: So far, we see the discussion is dominated by the large industrial companies and we farmers are not being asked, you know?
NELSON: Buehler says he prefers that Germany forget about striking an all-encompassing trade deal with the U.S. and instead form a free zone with eastern European countries to strengthen the continent's ties.
Merkel's press office, meanwhile, declined to comment about the pig protest or the trade talks. The farmers and environmental activists outside her building said they will hold a second larger demonstration on Saturday but without the pigs. Soraya Sarhaddi Nelson, NPR News, Berlin. Transcript provided by NPR, Copyright NPR.


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Product Information
Ingredients: Mica, Titanium Dioxide, Iron Oxide, Tin Oxide, Carmine, Aluminum Powder, Silica, Boron nitride, Nylon-12, Magnesium Myristrate, Carnauba Wax, Lauroyl Lysine, Magnesium Stearate, Boron Nitride, Nylon-12, Kaolin, Zinc Stearate, Isododecane, Cyclomethicone, Dimethicone, Isopropyl Myristate
Size: 5g full size
Other: NOT Vegan Friendly, NOT Lip Safe
About Hello Waffle Cosmetics
Hello Waffle is named after owner Christine's amazing cat Waffle whom she's had since he was 9 weeks old. The phrase 'Hello Waffle' is commonly said around her household as he likes to lurk around corners and scare you when you least expect it. Hello Waffle specialize in making collections based off fairytales, because everyone loves a great story.
Product swatches courtesy of Hello Waffle & Mollie.


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Time Warner Cable said it would boost the maximum download speed for its standard Internet service by 50 percent in Maine and other markets.
The areas to be boosted to 15 megabits per second (Mbps) from 10 Mbps for its most popular level of service
"Standard Internet is our most popular Internet service because it's ideal for everyday use, watching videos online, downloading apps, online banking and definitely for online holiday shopping," said Carol Hevey, executive vice president of operations for Time Warner Cable's East Region.
"And now that our maximum download speed for standard Internet is 50 percent faster, customers can have a better Internet experience on all their devices."
Standard Internet customers will receive the faster speeds automatically this month. Customers who want the faster service immediately can get it by pushing the "reset" button on their modems, or by unplugging the power cord from the modem for 10 seconds, plugging it back in and then
rebooting the computer, Time Warner Cable said.
Time Warner Cable declined to comment on how many customers subscribe to its standard service. Customers spend about $54.99 a month for standard Internet, the company previously said.
In October, Time Warner Cable said it would begin charging Internet customers across New England, New York and the Carolinas an Internet modem lease fee of $3.95 a month. Customers can continue to lease their modems from Time Warner Cable and pay the monthly fee, or they can buy modems from retailers to avoid the monthly expense.
Our View: University's nursing plan right way to face a crisis
Another View: Poliquin way off when touting the benefits of food stamp cuts
Maine Voices: Kavanaugh has misled the Senate in his testimony under oath
View from Away: Trump's latest offensive in war on Russia investigation
Maine Compass: Kavanaugh a threat to abortion rights


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|Debra Rapoport, Jane Folds, Ilona Royce Smithkin, and Joyce Carpati
|The Idiosyncratic Fashionistas and Debra Rapoport are rarely seen without hats.
This Friday at 2pm I will be doing an informal signing of the Advanced Style Book at Strand Books near Union Square. Some of the ladies will be there too! Let me know if you can make it!!!
|My Style Icon, Richard Cramer
|Debra and Ilona enjoying a laugh!
|Elke Kuhn in a design of her own
|Christina Viera and Debra Rapoport
|Aren't Carol Markel's gloves dreamy?
|New Friends!
|Christina and Valerie


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MDS makes every effort to publish accurate information on the website. "Google Translate" is provided as a free tool for visitors to read content in one's native language. Translations are not guaranteed to be 100% accurate. Neither MDS nor its employees assume liability for erroneous translations of website content.
Release Date: February 14, 2013
Media Contact:
Elizabeth Clausen
Tel: +1 (414) 276-2145
MILWAUKEE, WI – A study published today in the New England Journal of Medicine shows that the use of deep brain stimulation (DBS) in earlier stages of Parkinson's disease significantly improves the overall quality of life and social functioning in patients.
This German-French study (EARLYSTIM), led by Prof. Günther Deuschl, Kiel, Germany, and Prof. Yves Agid, Paris, France, demonstrates results in favor of DBS compared to medical treatment among patients in the early stages of Parkinson's disease. To date, DBS is only used for patients who have already undergone personal, professional and social degradation due to severe motor complications with disease duration of more than 11 years. The aim of the EARLYSTIM study was to assess the use of this therapy in earlier stages, when motor complications have just developed and before patients are significantly affected in their social and occupational functioning.
The study randomized 251 patients to DBS or best medical treatment. These patients had a much shorter disease duration of 7.5 years. The main outcome was quality of life measured with a Parkinson QoL-questionaire (PDQ-39). DBS patients had an improvement of 26% of their life quality versus no improvement in the medically-treated group and a similar improvement of social functioning (SCOPA-PS). Mobility under worst conditions (UPDRS II, without medication) was improved by 53%, activities of daily living (UPDRS II) were improved by 30% and Levodopa-induced complications were improved by 61% (UPDRS IV).
Largely, all of these outcome measures were significantly better compared to the control group, and depression was also improved. Among the side effects, suicides or suicide attempts were found in both groups with a similar frequency, suggesting it is not neurostimulation itself that is associated with an increased risk for suicides, but patients seeking this treatment. This has important implications for counseling of patients.
"The study showed surprisingly homogeneous results in favor of DBS compared with medical treatment. The most important result is that quality of life of these patients and their social functioning was significantly improved. It is also meaningful that the operation has fewer side effects in this younger population than in advanced disease," says Deuschl.
Matthew Stern, MD, of the University of Pennsylvania states, "This study extends observations on the effects of DBS in Parkinson's disease and documents the benefits of surgery even in patients earlier in the course of disease with mild motor fluctuations. Further, using a quality of life scale as the primary analysis emphasizes the meaningful impact of surgery on the lives of affected patients."
Deuschl says, "This study has the potential to change the international guidelines for the treatment of Parkinson's disease and will put DBS as a treatment option at a much earlier stage of disease severity."
Stern adds, "While it is premature to recommend DBS to all patients with motor complications, particularly earlier in the course of PD, it can now be considered a treatment option in this group of individuals. The EARLYSTIM trial will surely fuel the debate on the impact of DBS on disease progression further and underscores the need for long term follow up of the EARLYSTIM patients."
Further information:
Prof. Günther Deuschl
Department of Neurology, Christian-Albrechts-University Kiel,
24105 Kiel, Germany
Tel. ++49-(0)431-597-8500
E-mail: firstname.lastname@example.com
About the International Parkinson and Movement Disorder Society:
The International Parkinson and Movement Disorder Society, a society of over 4,000 clinicians, scientists, and other healthcare professionals, is dedicated to improving patient care through education and research. For more information about the International Parkinson and Movement Disorder Society, visit www.movementdisorders.org.
555 East Wells Street, Suite 1100
Milwaukee, WI 53202-3823 USA
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The International Parkinson and Movement Disorder Society (MDS) is a professional society of over 7,000 clinicians, scientists and other healthcare professionals dedicated to improving the care of patients with movement disorders through education and research.
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