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Come to your senses/
Do you remember learning about the five senses in grade school? I do, because my experience was highly disappointing. It was first grade, and we arrived at our desks to find several sensory items – a chocolate chip, a cotton ball, and other things I can't remember. I remember the chocolate chip very specifically because, when our teacher instructed us to eat it, I was so sad to discover that it was completely bitter. I had never had unsweetened chocolate before, and it definitely left me wanting.
In our busyness, our five senses often get left behind. This is not an email to reprimand you, and order you to take time to smell the flowers. What I want to remind you of is the gift these senses can give us if we are experiencing overwhelm, or stress, or rushing, or anything that takes you out of your body, out of the moment.
I was really wanting to write a blog post this week, and struggled with several half-baked ideas. I think I've written three blog posts, but nothing felt finished or quite right for this moment. Then, as Loki was fighting sleep tonight, I placed on hand on my belly, to remind me to soften into the moment, to relax my own body in order to help my baby. I've no idea if it helped Loki fall asleep or not, but it certainly helped slow my racing mind, and to enjoy the moment, even though bedtime wasn't going as I had hoped.
I've been noticing in my practicing how stopping to take several breaths helps calm my mind and slow me down. Along with the delight of having a nearly-one-year-old, I also have much more limited time. So when I sit down at the piano, I often have the sense of urgency, the strong awareness of how much I hope to accomplish before Loki demands my attention again.
All of this is to say, when you are stressed or overwhelmed or rushing or busy, take a moment to connect with one of your senses and see how that might make an impact on your activity.
Connecting to your senses calms your nervous system, helping you deal with stress. And it plays a role in activating the right hemisphere of your brain. We want this, especially when performing, as the right hemisphere is more aligned with being in the moment. Being in the moment is more likely to bring about Flow, the optimal state of performing, where all of our thoughts and energies are dedicated to the task at hand. No room for past and future thoughts, self-criticism, or distraction.
Here are some suggestions for a quick sensory connection:
- Three breaths noticing the movement of your body as your inhale and exhale.
- Three breaths noticing the sound of your inhale and exhale.
- Close your eyes and notice the sounds around you, let your ears take you to the farthest sound, and then to the closest sound.
- Close your eyes and notice what scent is in the air.
- Give yourself a hug and feel the texture of your shirt. Really, there is lots of research about how hugging yourself is very soothing to the nervous system.
- Feel your feet on the ground, the chair under your bottom, the clothes on your body, the glasses on your face. Notice the feel of your instrument in your hands.
- What do you see around you? Ask yourself, "Am I safe here?". This may feel silly, but it calms our lizard brain which is always on the lookout for any potential threat.
Pick one of these sensory suggestions, or listen to this 2.5 minute long guided exploration to come to your senses.


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Commodity rout extends to currencies led lower by Kiwi to Loonie.
JPMorgan's China internet research head Yao to join Cheetah.
Years left to go in S&P 500 bull market to RBC strategist Golub.
Microsoft posts largest-ever net loss after Nokia writedown.
Goldman said to upgrade Dark Pool, exit wholesale market-making.
Greece is bracing for even more economic pain this year.
Govt plans bond guarantee entity with Rs 5,000-Crore corpus.
Toyota delays move to build Lexus in China.
Yahoo suffers 2Q loss as revenue growth eludes company.
Infosys beats market maths, logs Rs 3,030 Crore Q1 net profit.
Promoters' stake in Unitech down by 12.93% as on June 30.
Vedanta may cut jobs at Aluminium unit as prices tank.
Airtel has the least call drops in Mumbai: TRAI.-------------------------------------------------------------
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subset: commoncrawl


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Miss Pradnya Apte is a GDC registered dentist who carries out facial aesthetics. She believes in working to the highest standards and has been Save Face accredited for three years running. She has carried out thousands of Botox and dermal filler treatments and has over 12 years experience in this field of cosmetic proceedures. Dr Pradnya owns an award winning clinic based in Exeter, Devon and divides her time between there and London.
For further information about the full range of treatments she provides please visit her web site www.skinsouthwest.co.uk
All consultations are free but require a £50 deposit to secure booking. This is then redeemable against treatment. These prices are only a guide and a more accurate price can be given at consultation.
All appointments need to be booked via her Exeter clinic on 01392 426285.
Future Clinic dates:
Monday 12th November 2018, Monday 10th December 2018
Dr Pradnya AptÉ, is increasingly regarded as one of South West's leading Advanced Medical Cosmetic practitioners.
Botox (Botulinum toxin A) is the most widely used method of treating lines and wrinkles. The treatment is a simple, nonsurgical procedure that smooths and softens the deep, persistent lines between your brows and around the eyes and forehead. A few tiny injections temporarily relax the muscles that cause these lines. There is no need for recovery time and the treatment can be done at any time during the day or on your way home from work. The results are visible within a few days.
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|3 areas - £290.00
|Hyperhidrosis treatment:
(Excessive sweating)
|Nefertiti Neck Lift
|Bruxism treatment
(teeth clenching)
|Areas Treated - Men
|1 area £220.00
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Mini BOTOX®
|Very small doses of Botox placed around the 3 areas as a top up to keep face looking fresh
Dermal fillers
Dermal fillers are designed specifically to soften lines and folds of the face that are caused by collagen and volume loss as we age. Popular areas to treat are: nose to mouth lines, frown lines, mouth to chin lines or enhancement and volumisation of the cheeks or lips.
Fillers for the face are ideal for patients that want to look fresher and younger without the need, or downtime, for surgery. The effects of filler placement are immediate and last on average 9-12 months and for lips approximately 6 months.
For lip treatments we administer a local anaesthetic in the mouth to numb the lip area.
|Lip augmentation
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1ml - £250 - £300*
|Cheek/Chin augmentation
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These are essentially collagen stimulants. The product is injected into areas that have lost volume, the same way as dermal fillers, but Ellanse injections stimulate the body's natural collagen production for a natural volume restoration and rejuvenation. There is a 1 year and 2 year product available.
|Price per syringe
|1 year treatment £400.00
2 year treatment £550.00


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While my girlfriends have been visiting from Chicago final week, we made a visit to Cashiers, NC, a luxury summer time community of great retailers, wonderful properties and excellent eating places. The local historical society was sponsoring a home tour of three cottages. We were excited to tour them. Properly, this one is for many who will not be in a position to make their own gear. If making your personal dumbbell will not be your factor, you may get this factory-made dumbbell. I have spent a substantial amount of my time analyzing health gear and I believe this equipment is essentially the most dependable dumbbell out there. It's low cost, compact and gives full-physique train.
So for now I just let him do his thing and the room is good and livable , it simply wants a number of finishing touches. Fingers crossed we've got these achieved before he heads off to school! However the most effective shock for the ladies- our good friend Lynda Sue drove up from Atlanta to hitch us! I take advantage of their vet who also boards animals. I leave a list of issues they want. Nail clipping, enamel cleaned and so forth.
Select a design that enables enough dirt over the house to make the most of the thermal properties so you won't must warmth or cool a lot. Since your cooling load will likely be small, you may want a dehumidifier, or a system with a multispeed distribution fan. With the fan on low, much less air will likely be cooled, but it would get colder, so more water will be removed. In different phrases you will get more humidification for a similar quantity of cooling.
I may also add that she is still not a year previous so do you assume perhaps she remains to be to younger to hold herself regular in toilet seat? Any solutions will probably be tremendously appreciated. Only family i maintain involved with is my mother (out of state) and a pair associates. We appreciated the parquet wood flooring all through the kitchen and dining area, the livingroom, hallway and grasp bath. Form of retro however in good shape. And the scratches we simply mounted with stain.
I endure from anxiety that has made it difficult to hold a job long-time period. Been working temp company's for over a decade with the occasional full-time job in-between. One hurdle many have to beat to acquire work is present documentation. A friend lets me use his deal with or it would be harder for me to work. Otherwise buy MMS (miracle mineral answer) use 6 drop mixture per 1/eight cup water, leave in hair for one hour plus. Rinse. That can kill a hundred% of every part!!!! Mixture could trigger slight burning to skin so be cautious. Do when severe outbreaks occur.


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We're delighted to say that we won Best Organic Eating Out at the Soil Association's BOOM Awards! The ceremony at Borough Market followed judging by a panel of experts including chefs, journalists and retailers of over 1000 entries across a range of categories.
The BOOM Awards are the UK's only dedicated organic awards celebrating people, producers, restaurants and brands working to produce food as it should be. We're very proud to be championing organic.


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By Zoe Papadakis |
Thursday, 25 October 2018 02:36 PM
A Greensboro, North Carolina, woman who was left on the doorstep of a church daycare as a baby nearly three decades ago has tracked down her biological parents after years of searching.
The story begins 27 years ago, when Pam Tonkins discovered the abandoned baby, Precious Bradley.
"I'm like what is that? Is that an animal or did somebody leave a cat or what?," Tonkins told WFMY.
Bradley was adopted and went on to live a successful life, but she always wondered about her biological parents.
It was one of the reasons she chose to further her studies at NC A&T, so that she could search for her them in Greensboro.
Bradley previously told WFMY that she shared a close bond with her adoptive parents but she just needed to know who her family was.
In 2014, Bradley launched a social media campaign in hopes of obtaining information about her birth parents, Fox 8 noted.
She started by posting a photo that read; "Hi! My name is Precious J. Bradley. I was abandoned at 719 Dillard St., Greensboro, NC on January 19, 1991 when I was about two weeks old. I am searching for my biological family. Please like and share. Spread the word. Any info is better than no info. Support me by tweeting #FindingPrecious."
Her efforts have since grown and, through the help of the community, she was eventually able go for DNA tests and see a genealogist, all thanks to public donations, WFMY noted.
Earlier this year she got a hit on ancestry.com, which led her to her birth father and enabled her to locate her birth mother, both who live in North Carolina.
Bradley said she harbors no ill feelings toward her parents for leaving her on the doorstep of a church daycare all those years ago.
"I definitely think this was a cry for help," she told WFMY, adding that her biological mother felt it was the best option she had.
"At the end of the day, I'm perfectly fine with that option because I'm able to live because of her," Bradley said.
Bradley has slowly been getting to know her birth parents but as she explained, it was not something "you just go out there and do."
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I was doing some MAJOR spring cleaning today, but not the kind where my house actually gets cleaned. I was cleaning out my email inbox. See, if I can't use my phone to accomplish a task, the task gets put off for another time. This is because I am a lifetime member of Procrastinator's Anonymous.
So here I am, weeding through the many emails I should have responded to much sooner, and came across Amy Labrasciano's email about nominating me for the Sunshine Blogger Award! Honestly, I don't feel deserving of it, simply because my procrastination affects how often I post on my blog! But since I found Amy on Instagram, where I post quite often, I feel a bit better about this.
I have a confession to make: I stopped using Facebook. Like many people, I joined to make connections with people who have touched my life, both presently and in my past. However, over time, Facebook changed. Or maybe my expectations for it changed. Either way, it became a less positive place to visit. I began to see more and more personal rants, and I had had enough.
That's where Instagram comes in. When I joined, I had no idea how the community of teachers, moms, and bloggers would influence me, nor the magnitude of the positive connections I've made. It's a place I enjoy visiting regularly, because of the people who support each other and build each other up. That's where I see this award coming from.
Being nominated for the Sunshine Blogger Award requires a few tasks to complete. (Ironic, isn't it?)
Here are the rules:
1. Post 11 random facts about yourself.
2. Answer the 11 questions posted by the blogger who nominated you.
3. Nominate 11 bloggers you think bring sunshine to the world.
4. Post 11 questions for nominees to answer.
11 Random Facts (if you follow me on Instagram, this info is old news!)
1) I still live in the state in which I was born (PA).
2) I married my soul mate, who is just as much a Disney World fanatic as me.
3) I was married at 22, and had my twin girls at 24.
4) We are now empty nesters.
5) Homemade chocolate chip cookies and Hershey's Kisses are my absolute favorite foods.
6) I have visited 10 states.
7) I visited Canada and Mexico. I was in Canada for only a few hours to see Niagara Falls, and Mexico for less than an hour when I realized I don't speak or read Spanish.
8) I listen to a variety of music genres, but don't like heavy metal or rap.
9) I enjoy staying down the shore for vacation but I'm not a big fan of the beach, and rarely go in the water.
10) I appreciate spending time by myself.
11) I originally wanted to be an art teacher.
11 Questions from Amy:
1) If you could visit any place in the world, where would you go?
2) What is your absolute favorite book (that I should read next)?
I can't answer this, because I have so many favorites. But if I absolutely had to choose, I guess I'd say The Giving Tree.
3) Why did you start blogging?
I wanted to make connections with other teachers, specifically learning support teachers. When I found that there weren't many blogging, I decided I would.
4) What is your favorite part about blogging?
I really appreciate the connections I've made with other teachers, regardless of specialty or grade level. We all have so much in common, and I love how supportive we are with each other.
5) What advice do you have for new bloggers?
Don't procrastinate! Set a schedule, and stick to it.
6) Do you hate packing your lunch as much as I do?
Yep. I don't like the time it takes, but then I always appreciate opening up my lunch box at school and finding healthy food.
7) What is your favorite part about working with kids?
Their innocence and innate goodness (even the stinkers!).
8) What is your favorite weekend activity?
I always enjoy spending time with my husband, regardless of what we do together.
9) Which social media site is your favorite?
No hesitation: Instagram!
10) What is one thing about you that people are surprised by?
I suppose people are surprised that I am an empty nester already.
11) If you could go back in time, would you?
No, I don't think so. I am enjoying the present too much!
I'm cheating a bit here, because, since I'm typically late on the bandwagon with these things, I'm not sure who's already been nominated:
11 Questions for my nominees:
1) If you were to choose a different profession, what would it be?
2) What superhero power would you like to have?
3) What would you do if you won the lottery?
4) What talents do you have?
5) Do you enjoy watching (or playing) sports?
6) What is one accomplishment you are most proud of?
7) Are you good at telling jokes?
8) What is your favorite weekend activity?
9) Which social media site is your favorite?
10) Is the glass half empty or half full?
11) Always early or perpetually late?
Now to get through the 469 posts of the blogs I'm following on Bloglovin'!


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The ultra-modern design always depends upon unusual designs and very minimal designs; this exceeds the current style to produce even a more sophisticated atmosphere within the place. This particular decorating design has certainly a lot followers around the world, that's the reason why the Italian organization Karol presented this particular washbasins' collection known as Kalla which is influenced by the type of the Panton Seat. This selection is based on exactly the same idea the integration from the washbasin in the walls mirror within an elegant method. There are many styles for washbasins within this collection just about all having the exact same ultra-modern look; these come in oval, spherical and sq . shapes along with curved sides similar to the Panton seat ones. They are available in different appealing colors ideal for the ultra-modern design like shiny black as well as red. Kalla washbasins can also be found with storage space cabinets within same colours as well as stunning lamps designing the decorative mirrors. As we see, the actual mirrors as well as faucets are experiencing very simple as well as minimalist styles in razor-sharp rectangular designs without particulars which complement the ultra-modern appear of the restroom
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@ Yonge Street
Gibson Square condominium towers are located between Finch and Sheppard at the corner of Yonge St. and Park Home Avenue. One of the towers is on the parking lot between the front of Gibson House and Yonge Street and the other one is on the park to the south.
Explore Gibson Square condos standing tall above the city and directly connected to the North York City Centre subway. Adjacent to the site of the historic GibsonHouseMuseum (built in 1851) and park, at the very heart of the city center, Gibson Square condos introduce a landmark presence on the city skyline and North York's most desirable condominium address.
Luxurious Residence Finishes
The Kitchen – An Epicurean Delight
The Sumptuous Bathrooms
Premium Floor Coverings
In-Suite Laundry Convenience
Exceptional Safety & Security Measures
Electrical & Connectivity Systems
Menkes M-Link – Tomorrow's Technology Today
* where applicable based on individual floor plan
Specifications are subject to change without notice. All room measurements and sizes are approximate. Builder may substitute materials for those provided in the plans and specifications provided such materials are of quality equal to or better than the material provided for in the plans and specifications. Decorative and upgraded items displayed in the furnished model suites and sales office are for display purposes only and are not included in the purchase price. E. & O. E.
Exclusive Bonus Offers at Gibson Square!!
*As per plan. Prices and specifications subject to change without notice. E. & O. E. The area of any unit as stated herein is approximate only. Actual useable floor space may vary from any stated or represented floor area or gross floor area and the extent of the actual or useable living space or net floor area within the confines of a unit may vary from any represented square footage or floor area measurements made by or on behalf of the vendor. For more information on the method of calculating the floor area of any unit, reference should be made to Builder Bulletin No. 22 published by Tarion. August 6, 2015
Last Updat: August 17, 2015
To See Gibson Square South Tower Podium and Upper Penthouse Layouts Click HERE
Gibson Square North Tower Floor Plans
Floor Plans are not to scale and is subject to architectural review and revision, including without limitation, the Unit being constructed with a layout that is the reverse of that set out above. All materials, specifications, details and dimensions, if any, are approximate and subject to change without notice in order to comply with building site conditions and municipal, structural, Vendor and/or architectural requirements. Actual floor area may vary in accordance with Bulletin 22 published by the Tarion Warranty Corporation. Bulkheads are not shown on floor plans and may be located in areas of the Unit as required to provide venting and mechanical systems. Balconies, Terraces and Patios if any are exclusive use common elements, shown for display purposes only and location and size are subject to change without notice. Window location, size and type may vary without notice. E.&O.E.
New Developments:
return from Gibson Square to West Village
To Receive South Tower's Floor Plans,Podium and Upper Penthouse Layouts ,Please Complete The Following Form


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Chemotherapy is a two-edged sword. As an oncology trainee I've seen a few patients die solely because of it. And yet aggressive treatment is sometimes necessary to save a life; in the right settings it often succeeds. Patients with Hodgkins' disease, testicular cancer, acute leukemias, and early stage colon, lung, or breast cancers, among others, are often cured because of chemotherapy and other aggressive treatments. Like any useful tool though, it must be properly applied in order to be effective and avoid harm. You wouldn't use a screwdriver to drive a nail; similarly, chemotherapy shouldn't be given to all patients in all situations, nor should it be a substitute for good discussions about goals of care and the likelihood of deriving benefit.
Yesterday's cancer SIG presentation cut to the core of many issues that create tension between oncologists and palliative care clinicians. Most of us have probably seen difficult situations involving chemotherapy; it can be very upsetting! We tend to point the finger at oncologists when things go wrong, but we must recognize their unique perspective. To paraphrase one of today's presenters, "Sometimes I can give a patient 5 different rounds of chemotherapy over 7 years and see them respond well each time." In other words, chemo often really helps patients, even when its intent is palliative. I promise, we're not monsters….oncologists are people too! 🙂
Data support the use of chemotherapy in a number of advanced disease settings, even many solid tumors. Yes, chemotherapy can and should be part of good palliation in many settings. There are significant symptom benefits, QOL improvements, and survival benefits to be had in cases of lung, breast, colon, and prostate cancer; many other solid tumors respond to chemotherapy as well. Of course, the devil is in the details. An emerging quality indicator in oncology practice is the proportion of patients receiving chemotherapy in the last 2 weeks of life. Too many patients are receiving chemo just before death.
Here's the conundrum: we know chemotherapy can be beneficial, but only in certain settings. Unfortunately we're not very good at predicting how well a particular patient will tolerate treatment, nor how well their tumor(s) will respond. How should we proceed?
The SIG speakers recommend following a framework: First, look to published guidelines like those from the NCCN, which tell us when chemotherapy is no longer recommended (link). If treatment is pursued, it must be done with full informed consent regarding its palliative intent. Treatment must be viewed as a time-limited trial, with specific criteria for measuring response and planned discontinuation if none is seen. Transitions to hospice should be discussed early, at the first signs of decline in function. And the palliative care team should be involved! As Dr. Smith pointed out, recent data on early palliative care in advanced lung cancer shows a resultant reduction in chemotherapy usage in the last 60 days of life. We still don't really know how this works, but it works, and it doesn't impair survival.
Going forward, palliative care will become more integrated into comprehensive cancer care, as per recent recommendations (link). This requires palliative care clinicians to better understand the role of chemotherapy as part of good palliative care for many cancer patients. Let's be constructive, and increasingly work side-by-side with our oncology colleagues in caring for patients with incurable cancer. Hug an oncologist today! 🙂Thomas W. LeBlanc, MD, MA Fellow, Medical Oncology and Palliative Medicine Duke University


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PowerPoint templates get corrupted over time. It usually starts with a template that was designed by a print graphics designer as an after thought after designing the logo and the business cards: creating slide layouts without paying much attention to the technical issues of programming a template that can be (ab)used by thousands of employees. Then over, slowly but gradually, "foreign" templates infect the original until nothing is left of the original.
I go back to zero every time I design a new presentation. The file that I put up in the SlideMagic template store is pretty much the one I start every new presentation design project with. It is really simple. You can customise it with your own colours and you are good to go.
When creating a new slide, go to the "Layout" button in the top left of the menu to create a select a new slide layout.


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Written by: Justin Seltzer, MD (NUEM PGY-1) Edited by: Quentin Reuter, MD, (NUEM PGY-4) Expert
Review by: Alexander Lo, MD
Undifferentiated altered mental status (AMS) is among the most common and vexing problems faced by emergency physicians. The differential is incredibly broad and complicated by varied clinical presentations ranging from mild confusion to coma. Given this, patient stabilization and rapid diagnosis of life threatening etiologies (i.e. glycemic emergencies) are the initial priorities.[1-4] A full description of the initial diagnostic evaluation has been well summarized here previously by Trinquero, Alkawham, and Fant.[5]
Sometimes the initial evaluation will fail to determine the etiology responsible for the patient's with AMS. This blog is intended to highlight four "can't miss," but relatively uncommon, conditions you should consider when standard labs and imaging leave you without a clear diagnosis.
1. Methanol and Ethylene Glycol
When should I consider this?
High-risk populations: chronic alcoholics, homeless, and patients with previous ingestions/suicide attempts.
Classically, methanol is associated with blurred "snow field" visual disturbance and acute renal failure from calcium oxalate crystals.
However, varied clinical presentations, from mild inebriation/sedation to hyperpnea, seizure, and coma, make clinical diagnosis difficult. Significant ingestions can present with mild symptoms, as the toxic metabolites take time to form. Ethanol co-ingestion competitively inhibits alcohol dehydrogenase, slowing toxic metabolite formation; as a result, chronic alcoholics may show minimal symptoms and have delayed formation of an anion gap.
How do I confirm this?
Toxic alcohol levels are usually not available quickly and therefore have limited clinical utility in the emergency department.
If possible, identify the product ingested. Common sources are automotive antifreeze and de-icing solutions, windshield wiper fluid, solvents, cleaners, and fuels.
Classically, methanol and EG present with "double gap," or both an osmolar gap and anion gap metabolic acidosis. As the toxic alcohols are metabolized, the osmolar gap resolves and an anion gap forms as toxic metabolites are created, as shown in Figure 1. Depending on the timing of ingestion, either gap may not be present at the time of evaluation.
Strongly consider toxic alcohol ingestion if a large osmolar gap (>50 mOsm/L) is present. An ethanol level should also be checked and factored into the osmolar gap calculation by adding the ethanol level in mg/dl divided by 3.7 to the equation in Figure 2. Late ingestions may show a predominate anion gap metabolic acidosis with little or no osmolar gap.
Other EG ingestion clues include hypocalcemia, as EG metabolite oxalic acid binds blood calcium to form calcium oxalate, and an elevated lactate, as the EG metabolite, glycolate, can be mistaken for lactate by laboratory instruments.
How do I treat this?
If suspicious for toxic alcohol ingestion, treat empirically with fomepizole.
Emergent dialysis is indicated for severe symptoms, such as new renal failure, hemodynamic compromise, vision changes, or persistent acidosis.
EG ingestions require serum calcium monitoring and repletion.[6-8]
2. Chronic salicylate toxicity
When should I consider this?
High risk populations: elderly or anyone who requires chronic aspirin or salicylate use, especially those with liver or renal impairment.
Acute toxicity presents classically with GI upset, vertigo, and tinnitus progressing to pulmonary edema, hyperthermia, alerted mental status, coma, and death. It also has a mixed respiratory alkalosis, due to stimulation of the central respiratory centers, and anion gap metabolic acidosis, from the disruption of aerobic respiration. Chronic toxicity mirrors this toxidrome but is more insidious and difficult to recognize as there is no acute ingestion event.
Remember, salicylates are present in high concentrations in many other over the counter products besides aspirin, including oil of wintergreen and Pepto-bismol.
An important pitfall is failure to consider chronic salicylate toxicity in patients with pulmonary edema, respiratory distress, and altered mental status.
How do I confirm this?
Diagnosis is based on history, presentation, and presence of mixed anion gap metabolic acidosis and respiratory alkalosis.
Obtaining a salicylate level for altered patients without etiology is recommended, though levels alone are not diagnostic. Toxic levels from chronic ingestion are usually lower than those for acute toxicity.
Given these diagnostic challenges, a delay in diagnosis is common and results in higher overall morbidity and mortality as compared to acute toxicity.
How do I treat this?
Sodium bicarbonate is used to alkalinize the urine and serum to improve excretion.
Dialysis is indicated for severe symptoms such as altered mental status, severe acidosis, and pulmonary edema, or in those with renal impairment requiring dialysis.[9-12]
3. Thrombotic thrombocytopenic purpura (TTP)
TTP is a platelet aggregation disorder that leads to microangiopathic hemolytic anemia (MAHA). TTP is due to autoimmune destruction of ADAMTS13, a von Willebrand factor multimer cleaving enzyme, which results in abnormal platelet and clot formation, subsequent MAHA and thrombocytopenia, and CNS and renal dysfunction.
When should I consider this?
High risk populations: Often idiopathic. Hereditary TTP is a rare disease without specific high-risk groups. Acquired TTP is associated with HIV, malignancy, SLE, transplantation, and many drugs.
TTP has a high mortality rate (>90%), which drops to 20% with treatment.
It presents classically with "pentad" of sudden onset of :
- Fever
- Altered mental status
- Thrombocytopenia
- Renal failure
- Microangiopathic hemolytic anemia
However, this occurs in only up to 40% of cases. A review of 77 TTP patients showed 80% had neurologic sequelae, with 53% having a major symptom (AMS, TIA/stroke, seizure, coma).[13] However, neurologic findings can fluctuate and be transient. Importantly, neuroimaging is often normal.
Always consider TTP as the cause of thrombocytopenia (<50k) or anemia in an alerted patient, especially if other concerning signs and symptoms of the classic pentad are present. Consideration should not hinge on renal function; the creatinine can be normal or only slightly elevated.
How do I confirm this?
Clinical suspicion should be based on presentation and laboratory findings. . Don't forget to send a blood smear to evaluate for schistocytes.
Confirmation of diagnosis in the emergency department is unlikely as laboratory testing is specialized.
How do I treat this?
Emergent consultation with a hematologist is necessary.
In the emergency department, fresh frozen plasma infusions and steroids can be used as a temporizing measure until definitive management (plasma exchange) can be arranged.
Avoid platelet transfusion unless there is active, severe bleeding, as this can worsen the condition. [14,15]
4. Non-convulsive status epilepticus
Status epilepticus (SE) is a seizure longer than five minutes or two or more seizures without intervening full recovery. A small subsection of people have a diagnostically challenging variant known as non-convulsive status epilepticus (NCSE), during which persistent cerebral seizure activity is not manifested as muscular convulsions.
When should I consider this?
Consider the diagnosis especially in high risk populations such as: known seizure disorder, alcoholics, known intracranial masses or hemorrhage, CNS infections, critically ill patients, toxin exposures, and certain medications (ex. cefepime).
NCSE itself does not have any specific risk factors beyond those for seizures generally. However, those who experienced convulsive SE (CSE) are at higher risk of subsequently developing NCSE; one study showed 14% of those with CSE had persistent NCSE after termination of convulsions. [16] Similarly, up to 20% critically ill comatose patients have been shown to have epileptiform activity on EEG. [17]
NCSE presents primarily with altered mental status. The patient may have positive (automatisms, blinking, echolalia, facial twitching, nystagmus, eye deviation) or negative (coma, confusion, lethargy) symptoms.
NCSE can also occur after a generalized seizure, appearing as a prolonged postictal period; if level of consciousness doesn't improve after 10 minutes or if mental status remains abnormal after 30 minutes, NCSE should be seriously considered.
How do I confirm the diagnosis?
EEG is the only definitive diagnostic test.
How do I treat this?
Early anti-epileptic administration is key; the longer SE lasts, the more refractory it becomes to treatment.
Benzodiazepines are the first line treatment, supplemented with fosphenytoin, phenytoin, or levetriacetam. Valproate may be useful for NCSE as well. Agents such as propofol, phenobarbital, or ketamine may be necessary if the previous drugs are unsuccessful.[18-21]
Final Thoughts
There are countless etiologies for altered mental status in ED patients. Defining what is uncommon depends on patient population characteristics. For example, isoniazid toxicity is common in prison populations because of the higher prevalence of tuberculosis but much rarer among healthier and un-incarcerated communities. Delirium is relatively common among older adults, often due to infection, but it is far less common among younger patients from infectious or metabolic causes (in younger patients delirium is more likely from toxic causes). An open mind and deep fund of knowledge provides a strong clinical foundation, but knowing your patient population is key. Hunting for the proverbial diagnostic 'zebras' is irresistible and exciting, but always remember a few fundamental emergency department approaches:
The emergent (the first 5 minutes):
- Airway (and B-C-D)
- VS (don't forget the temp!)
- Arrhythmia (telemetry monitor or EMS rhythm strip)
- Glucose
The urgent (the next 30 minutes)
- New and old medications
- Tox, tox, tox
- Labs (shotgun labs)
- CT (remember that CT is quite useless for many posterior circulation etiologies)
One lesson I've learned is that people are creatures of habit, so often the patient has done the same thing before. Reviewing previous visits or talking to family/friends (if available) may be helpful.
One final thought: If the AMS turns out to result from a toxic overdose of either home medications or easily available substances/chemicals, look for any diagnosis of depression or prescriptions for anti-depressants. If you find either, it's reasonable to suspect a self-inflicted overdose and now you may have an overt act of self-harm; so order the sitter, document your concerns and communicate this to the admitting team.
Posts You May Also Enjoy
How to cite this post
[Peer-Reviewed, Web Publication] Seltzer J, Reuter Q (2017, Nov 27). When Algorithms Fail: Uncommon, Can't Miss Causes of Altered Mental Status. [NUEM Blog. Expert Review By Lo A]. Retrieved from http://www.nuemblog.com/blog/AMS
- Huff JS. Altered Mental Status and Coma. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th (2016), Chapter 168.
- Initial Diagnosis and Management of Coma. Stephen J. Traub MD and Eelco F. Wijdicks MD. Emergency Medicine Clinics of North America, 2016-11-01, Volume 34, Issue 4, Pages 777-793
- Lei C, Smith C. Depressed Consciousness and Coma. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th Ed. (2017), Chapter 13.
- Tindall SC. Level of Consciousness. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd Ed. (1990), Chapter 57.
- Trinquero P, Alkawham L (2016, August 30). The ED Approach To The Comatose Patient [NUEM Blog. Expert Commentary By Fant A]. Retrieved from http://www.nuemblog.com/blog/the-comatose-patient/.
- Nelson ME. Toxic Alcohols. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th Ed. (2017), Chapter 141.
- Cohen JP, Quan D. Alcohols. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th (2016), Chapter 185.
- Mount Sinai Children's Environmental Health Center. CEHC FACT SHEET: Ethylene Glycol. Retrieved from https://www.mountsinai.org/static_files/MSMC/Files/Patient%20Care /Children/Childrens%20Environmental%20Health%20Center/ethylene%20glycol.pdf.
- Boyer EW, Weibrecht KW. Salicylate (aspirin) poisoning in adults. UpToDate. Updated January 9th, 2017. Retrieved from https://www.uptodate.com/contents/salicylate-aspirin-poisoning-in-adults.
- O'Malley GF. Emergency Department Management of the Salicylate-Poisoned Patient. Emerg Med Clin North Am. 2007;25(2):333-46.
- Temple AR. Acute and Chronic Effects of Aspirin Toxicity and Their Treatment. Arch Intern Med. 1981;141(3 Spec No):364-9.
- Carstairs S. Salicylates. Published in CALL US: The Official Newsletter of the California Poison Control System (Fall 2009). Retrieved from http://www.calpoison.org/hcp/2009/callusvol7no4.htm.
- Page, E. E., Kremer Hovinga, J. A., Terrell, D. R., Vesely, S. K., & George, J. N. (2017). Thrombotic thrombocytopenic purpura: diagnostic criteria, clinical features, and long-term outcomes from 1995 through 2015. Blood Advances,1(10), 590-600.
- Kappler S, Ronan-Bentle S, Graham A . Thrombotic microangiopathies (TTP, HUS, HELLP). Emerg Med Clin North Am. 2014;32(3):649-71.
- Saha M, McDaniel JK, Zheng XL. Thrombotic thrombocytopenic purpura: pathogenesis, diagnosis and potential novel therapeutics. J Thromb Haemost. 2017;Epub ahead of print.
- DeLorenzo, R. J., Waterhouse, E. J., Towne, A. R., Boggs, J. G., KO, D., DeLorenzo, G. A., Brown, A. and Garnett, L. (1998), Persistent Nonconvulsive Status Epilepticus After the Control of Convulsive Status Epilepticus. Epilepsia, 39: 833–840.
- Gaspard, N., Jirsch, J., Hirsch, L. J.. Nonconvulsant Status Epilepticus. April 4, 2017. uptodate.com
- Kornegay JG. Seizures. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th (2016), Chapter 171.
- Button KC, Mannix R. Neurologic Disorders. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th Ed. (2017), Chapter 69.
- Peets AD, Berthiaume LR, Bagshaw SM, Federico P, Doig CJ, Zygun DA. Prolonged refractory status epilepticus following acute traumatic brain injury: a case report of excellent neurological recovery. Crit Care. 2005;9(6):R725-8.
- Gaspard N, Jirsch J, Hirsch LJ. Nonconvulsive status epilepticus. UpToDate. Updated April 4th, 2017. Retrieved from https://www.uptodate.com/contents/nonconvulsive-status-epilepticus


text:
Open To Trust
A joy, a depression, a meanness,
some momentary awareness comes as an unexpected visitor.
Welcome and entertain them all!
Even if they're a crowd of sorrows,
who violently sweep your house
empty of it's furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.
The dark thought the shame, the malice,
meet them at the door laughing,
and invite them in.
Be grateful for whoever comes,
because each has been sent as a guide from beyond.
I had thousands of thoughts running through my head this morning. I took them all with me on a short run beneath the rising Indiana sun.
The usual breathing techniques weren't working, so I simply started repeating, "Open. Trust." with each breath. I envisioned leaving any anxiety, any to-dos behind me like footprints on the pavement.
Open. Trust. Every time you sit down to create - a painting, a sculpture, a drawing. Each time a bill comes due and you have no idea from where the money is going to come. With each movement - each yoga pose or each step. Open. Trust.
We have visitors of anxiety, fear, and doubt. We have more welcome visitors of inspiration, enthusiasm, joy, and excitement. But at the end of it all, the visitors leave and we remain.
Keep opening the door.
Welcome those experiences and listen to what they have to say. Trust that they are sharing with you exactly what you need to hear.
Today I will turn to my wax and let it melt where it may. Today I will join in conversation and let it flow with what needs to be said.
Today, I open. I trust.
And I invite you to do so with me.


text:
Coalition foreshadows trip to Nauru
Federal Opposition immigration spokesman Scott Morrison is considering a trip to Nauru to discuss the island's offer to reopen its immigration detention centre.
Opposition Leader Tony Abbott has been calling on Prime Minister Julia Gillard to pick up the phone and talk to Nauru about a processing centre.
Mr Morrison says the Coalition would do so, but from Opposition it had not been feasible to start negotiations with another country.
But that has now changed because the election is underway; the Government is in caretaker mode and the way is open for the Opposition to have those talks.
Mr Morrison says the Prime Minister should have accepted Nauru's offer to talk to Australia about the issue.
"The Government has completely ignored, they've dismissed, that approach from Nauru," he said.
"I think that is very disappointing. Obviously the Coalition would be pleased to take an early opportunity to discuss these matters with Nauru given their expressed interest."
He is not ruling out a trip before polling day.
"We've always said that from Opposition, from formal Opposition, that there are constraints in the sort of discussions you can have," he said.
"We're now in caretaker mode and that puts us in a different environment.
"But obviously getting to a position of any agreement and taking appropriate adivice from officials and the like could only be done once you are in government."
He says details would have to be finalised after an election.
Immigration Minister Chris Evans has dismissed the idea as a stunt.
"A quick visit by an Opposition spokesman, with an idea that somehow by visiting in the middle of an election campaign they're offering a solution, I think is obviously a nonsense," he said.
"They're more focussed on the election than real policy outcomes.
"As I understand it the Nauru government is also in a caretaker position as a result of their domestic political situation."
Meanwhile, Labor frontbencher Tanya Plibersek has not ruled out the idea of setting up a people's assembly on asylum seeker issues in the same way the Government wants to deal with climate change.
The Nauru detention centre was the centrepiece of the Howard-era Pacific Solution, but was closed in 2008.
Before the election campaign began, the Labor Government said Nauru was not suitable for processing refugees because it was not a signatory to UNHCR refugee laws.
East Timor reluctant
Ms Gillard announced this month the Government was negotiating with East Timor on setting up a centre there, to handle new boat arrivals before they arrived in Australia.
A delegation of senior Australian officials visited East Timor earlier this month for initial discussions. The Government says those talks were productive and they are ongoing.
But East Timor's deputy prime minister Mario Carrascalao now says if given the chance he would vote against any proposal to establish the centre in his country.
Mr Carrascalao says there has been no progress in the talks and he says he will vote against the proposal if it comes to East Timor's Council of Ministers.
"As far as I am concerned I feel the timing is not good for that," he said.
"One day maybe you can discuss things like that, but not now. We are on the way to solve a lot of problems we are facing here."
He has warned against drawing any conclusions that East Timor is in negotiations with Australia.
"This is, as I say, not an issue here in Timor-Leste. Nobody is talking anymore on that because practically we know the majority of people are going to refuse and reject the proposal," he said.
Topics: federal-elections, community-and-society, immigration, refugees, government-and-politics, elections, federal---state-issues, federal-government, australia, nauru
First posted


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Victoria Road, Aldeburgh, Suffolk, IP15 5BR
Tel: 01728 452027 Fax: 01728 452041 Out of Hours: Click here
Tel: 01728 452027 Fax: 01728 452041
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Please click here to read our August Merger Edition newsletter. A massive thank you to the PPG members who have helped to put this together. For information about our patient group see the PPG section of this website.
Advance Care Planning
Have you thought about what will happen to you if you become ill and are unable to make any decisions about your future health care? This document Advance Care Planning, which is in Adobe Acrobat Format will give information about Advance Planning and Advance Directives and contains a format for you to devise one for yourself.
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text:
Please note this ad has been reposed here from ClassicCars.com – Please contact the seller directly regarding any additional questions or to purchase.
Key Vehicle Facts
- Model Year: 1969
- Mileage Estimate: 93,421
- Engine: 340 cu in (5.6 L) LA V8
- Transmission: 3-Speed 727 Automatic
- Color(s): Yellow (Exterior) / Black (Interior)
Ad Information
- Source: ClassicCars.com
- Vehicle Location: 12 Carrier Drive Rexdale, Ontario M9V2C1 Canada
- Asking Price: $30,900
- Seller Type: Dealer (Summit Classics)
- Contact Information: No Longer Available
Description: This is one wicked ride built for performance but still numbers matching. It is equipped with a 340 Cu. In. Engine, D32 – A727 Torqueflite Automatic Transmission, D91 – Sure Grip with 4.10:1 axle ratio, black vinyl bench seat, black upper door frame color, Y3 – cream roof and body paint, V8X – black longitudinal sport tape stripe, heavy duty manual drum brakes, dual exhaust, R11 – Music Master AM Radio, S13 – Rally Suspension with front sway bar and S25 – Firm Ride shock absorbers. This is a mostly original car with the numbers matching engine being rebuilt completely. The engine is now .30 over with Holley Intake, Holley 750 CFM Carburetor, Holley electric fuel pump, Keith Black pistons, Mopar Performance hydraulic cam (.508 lift, 292 duration), Roller Rockers, Hooker Competition Headers, Flowmaster Exhaust and only 5,000 miles since rebuild. The car was painted eleven years ago with the correct Y3 color, and still looks fantastic. There is no rust in the car and the panel fit and paint is excellent. We also have the original broadcast sheet, a Ziebart Certificate dated 9/25/69 and a complete decode from Galin Govier.
Photos / Images
Last Updated


text:
Trousers London
This variant is currently sold out
Urban grey Italian denim, these slim fitting men's jeans are simple, light and effortless. Part of a limited edition run, hand made and garment dyed in our family run factory just outside Naples in Italy.
This pair is part of our latest range named 'overground/underground' inspired by London's Metro system and landmarks that have been significant to the brand and makers.
98% Cotton 2% Elastan


text:
Search Results
Author: Michael Carroll
Michael Carroll
Absolute Power
(New Heroes)
Once all the superheroes in the world were wiped out. Colin is still reeling from the shock of discovering his parents were part of those world famous superheroes. He is coming to terms with his own inherited superpowers and those of his best friends when the media pick up their story and force the teenagers into hiding in Sakkara, a strange place with secrets of its own. Deciding whether to use his powers for good or evil is vital, especially when confronted with the evil Victor Cross who in this latest in the series seems be acting very strangely indeed. Carroll's highly visual and spare writing style make this the perfect series for leading comic book fans into fiction.
HarperCollins · 9780007210947


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About Bruinupacup
Button Buck
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How can we reduce property taxes?
Bruinupacup replied to Batsto's topic in News, Media, and PoliticsShared services and Regional based school systems like they do in every other state. There are so many duplicated services in this state because no one will cede control its ridiculous. Every little po dunk town doesn't need their own school, PD, road department etc.
Freak Nasty Turkey
Bruinupacup replied to hammer4reel's topic in Turkey HuntingBeautiful Bird Congratulations!
Dog food options
Bruinupacup replied to Rdfhunter's topic in Gun Dogs ~ Hunting, Training & EventsFromm is a top notch food made by a family owned American company with quality ingredients. It's also affordable I feed it to both my dogs and couldn't be happier.
Bruinupacup replied to Stevo's topic in LoungeStevo you are an inspiration. It is stories like yours that have given me a new outlook. I was laid off 2 weeks ago and you know what even after 20 years being with the same organization and having 3 kids and a wife to support I realize that a job/career certainly isn't the most important thing in this life. Your faith, health, family and friends are what is and should always be most important. It took me being almost 44 years old to realize that because even 10 years ago I sacrificed everything for the almighty dollar. Weeks away on the road away from my family I will never get back. I missed many sporting events, birthday parties etc and I kick myself today for it because no matter how much you give or what you do in corporate America no one gives a damn. Fight until you have nothing left to give if for no one else but the ones that love you and you will come out on top I'm sure of it!
Self Made Western Mount
Bruinupacup replied to Chicken Little's topic in BowhuntingLooks great. Knowing you did it yourself makes the pride in your trophy all the more satisfying.
Where to get fertilizer?
Bruinupacup replied to JerseyJaysTaxidermy's topic in Wildlife and Habitat ManagementJay did you try the Agway in Blairstown? They have a very wide selection.
so who is fishing tomorrow
Bruinupacup replied to rgw's topic in Freshwater FishingI looked at them all and the Paulinskill, Pequest and Muconetcong are unfishable in my opinion. You would definitely be risking your life. Perhaps Aeroflex or Columbia Lake are safer option until things calm down a bit.
Highview Rod & Gun Club 32nd Annual Venison Dinner Tickets
Bruinupacup posted a topic in ClassifiedsWe have some last minute tickets that have become available due to some health and hardship cancellations. Dinner is Saturday 4/22 from 7-11pm and will be held at the Whippany American Legion Post 155, Legion Place Whippany, NJ. Tickets are $45 each and include all you can eat and all the beer and soda you can drink. All food is professionally prepared by our long time member Executive Chef William Leahy and his team of employees from Thistle Catering. Attendees will exceed 250. There will be a large 50/50, an extensive selection of table prizes and a large tricky tray selection to choose from. Items include all types of hunting and fishing gear, guns, bows, etc. etc. It is truly a first class event that is sold out each and every year. Once you come you will want to make it an annual thing I guarantee it. If you would like tickets please PM me ASAP. These will go fast. I am located in Fredon, Twp. Sussex County you will need to pick them up and make payment promptly. If you are located a distance from me we can make arrangements for you to pick up your tickets at the door the night of the event but will need to make payment prior too. IMG_4533 copy.pdf
Central AC Filters.........
Bruinupacup replied to BHC's topic in Hot Deals - Products & ServicesI bought an April Air unit. It installs right next to your air exchanger in the attic. The filters are like $30 and last all season. My kids have asthma and I needed something better than the standard air filters. It works great and really takes many particles out of the air that a standard filter just wouldn't get.
Meeting is tonight at the Whippany American Legion at 7:30. We will be taking new members so if your interested and want to get in a great club now is the time.
Best price on .223/5.56 ammo
Bruinupacup replied to mightyhunter's topic in LoungeAmmoseek.com
Browning Silver
Bruinupacup replied to Silver Belly62's topic in ClassifiedsPM me I have a beautiful.410 you may be interested in but I don't want to be rude a hijack the kind mans post.
Established hunting club that just celebrated its 32nd year is now accepting applications. Club properties are located in Southern Sussex and Warren Counties. 4 pieces of land totaling approximately 800 acres. Dues are currently $800 per year + 1 time $150 initiation fee. If you are interested email your application to [email protected] and we will send you an application to complete. Email the application back along with a contact number should you have any questions. Meeting accepting new members will be held on March 22. We are meeting people on March 18th to walk and show you the properties. You will have the full year to hunt. Club is large game only Deer, Turkey, Bear, Predators etc. We are not Semi-wild and no birds are stocked. Deer zones are 2 (1 farm) and zone 5 the rest. Bear zones are 1, 2, & 4, Turkey zones 2,4,& 5. Please do not send me PM's email the address as requested. We will respond get you scheduled for a walk through and answer all of your questions.
Ruger AR-556 $550
Bruinupacup replied to mightyhunter's topic in LoungeIs it NJ compliant?
Remington 1100 .410 Sporting
Bruinupacup posted a topic in ClassifiedsI have a practically new .410 Sporting I bought a few years ago that I just really don't use. I intended for it to be for my son but he prefers his single shot 20ga. The gun has beautiful wood a 27" barrel, 3" chamber and comes with 5 extended chokes, box and all paperwork. Gun retails for $1250 new I will do $900 but that is firm. Not interested in cash low ball offers so save us both the trouble. I am located in Sussex County and am willing to meet within a 1/2 hour of my home. I can send pictures upon request but what you see on the Remington website is what you get. Gun is flawless


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Fill in lead data into a spreadsheet which can be easily found on google.
Бюджет $10-30 AUD
I need you to fill in a spreadsheet with data.
I run a small business and i need a list of leads generated for businesses for me to contact in the allied health industry.
I have a spreadsheet with 7 fields, which i need filled out for each lead. The task is easy and all the information can be found by searching google. Whilst the task is not difficult, it is just labour intensive and I dont have the time to do it myself.
I need data collated on 300 businesses in Sydney, Australia.
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Mint is definitely a fab color this year and I don't think it has ever looked more fresh or fun as in today's southern mint wedding! I love the way the bride incorporated this fun hue! From shoe clips to straws to tic tac mint favors, this wedding is adorably detailed in all things mint. She even painted her nails the color! And don't you just love the bridesmaid outfits? They all have the same high-low skirt paired with an ivory lace top of their choice. What a gorgeous look!
The radiant bride Samantha shares:
I knew before Trip ever proposed to me, that I wanted to get married in January. Trip and I love music, and one song that remained a constant favorite to us was "January Wedding" by The Avett Brothers. After the proposal, Trip and I set the date, January 19th, 2013, the day after my parents wed 27 years prior.
I had the absolute honor of wearing my mom's veil as my "something old". It was just a beautiful as it was 27 years ago on her. It wasn't until she placed it on me that everything began to set it. I was getting married!
Trip and I chose to do the "first look" and I am SO glad we did. It was so much fun tapping on his shoulder and getting to actually talk through our reactions of seeing each other. It also allowed us to take several fun, relaxed pictures. It was still just as special seeing him waiting for me at the alter!
As everyone was getting in place to line up and walk down the aisle it hit me- I had to go to the bathroom! Whether it was the nerves setting in or the Dr. Pepper I carefully drank in my wedding dress, I had to go. Without hesitation my bridesmaids were up for this challenge! So as the grandparents were being seating, I had two bridesmaids holding my dress up as they guided me to the toilet. I was reminded from this moment that not only do I have a small bladder, but I also had the best bridesmaids ever.
To play on the fact that my now husband's last name is Doyle, I wanted to incorporate doilies into the wedding. I had my nails painted mint green since the day I got engaged so choosing my colors was easy. I have been passed down a love for all things shabby chic and vintage so I used that to tie in the doilies and mint green. So soon everything began falling into place just the way I imagined it!
Growing up my mom always told me, "A little goes a long way". I often reminded myself of this during all my planning stages. My advice to future brides would be to keep it simple and keep it fun. When it stops being fun, it's not simple enough.
Photography | Ashley Upchurch | Venue & Caterer | Balinese Ballroom | Florist | Butterflies Florist | Dress | Allure | Bridesmaids Skirts | Miss Me | Hair | Dawn Dunaway | DJ | Dale Sojourner
April 30, 2013 9:37 am
I am so in love with this wedding. Mint is so refreshing! Especially love the idea of the bridesmaids outfits!
May 1, 2013 1:03 am
Love those mint-colored high-low bridesmaids dresses!
August 4, 2013 2:44 pm
Where did you get those bridesmaids dresses?! I'm in love!
August 23, 2013 2:48 am
I love the bridesmaids skirts, where are they from??!!
January 13, 2014 3:41 pm
?Where did you get the tops for the bridesmaid dresses?


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If there's any one state in this august union that could be properly termed socialist, California would certainly be in the running.
After all, the Golden State is where taxes are high, the so-called "safety net" is wide, economic growth is low and anyone who disagrees with leftist orthodoxy is chased off of state-run college campuses.
Well, if you want to call California socialist, all we can say is this: We've seen the future, and it doesn't work.
If you don't believe me, take a look at this video showing the homelessness in Orange County, California. It's a 10-minute bike ride through one of the largest shantytowns in America:
The encampment in question is along the Santa Ana River right by Angel Stadium.
According to the Los Angeles Times, authorities decided to shut down the encampment last November, although we wish them good luck with that.
In a now-deleted post, the Retired Orange County Deputy Sheriffs blamed local officials for it: "Orange County is now a s*** hole country thanks to Sheriff Sandra (Hutchens) and her co-conspirator Don Barnes," the description for the video reads, taking a slight page from Donald Trump.
However, while enforcement of transients laws may be local, it's kind of hard to blame Hutchens and Barnes, or really any county government. Homelessness in California is a massive statewide problem.
At one point, the largest homeless camp in America was in South San Jose; The Atlantic blamed the 68-acre shantytown on those darn Silicon Valley firms and the rising housing prices that came with it.
Maybe that had something to do with it, but Oakland isn't exactly Silicon Valley. Yet, a homeless encampment there is spilling out onto the street.
OK, but that's still the Bay Area. What about Los Angeles? Well, here's 37 minutes of footage from a Skid Row homeless encampment there:
These are four places scattered over 400 miles apart. What's the one unifying factor? They all share the same state government — a state that's more than $400 billion in debt and has the largest homeless population in the United States.
According to The New York Times, one in four homeless people in America — 114,000 in total — live in California. Los Angeles County alone has 55,000 homeless, a number that rose by 13,000 from 2016 to 2017.
Lest you think that these homeless encampments just create a visual blight on the California landscape, consider the fact that a recent wildfire that destroyed six homes in Bel-Air was started by cooking from a nearby homeless encampment.
And state government doesn't appear to be getting any saner in the near future. While Democrat Gov. Jerry "Moonbeam" Brown is term-limited and can't ruin the state any further beyond 2018, the odds-on favorite to replace him is former San Francisco Mayor Gavin Newsom, who will likely be worse.
Despite a movement to draft conservative actor James Woods to challenge Newsom, the likelihood of a Republican victory is probably slim at best. Thus, there's likely going to be another four years of Democrat "leadership" that's going to be tasked with solving the homeless problem.
In other words, you can definitely expect to see a lot more videos of shantytowns popping up on social media, no matter what local authorities choose to do.
For more from CT click below…
What are your thoughts fellow Seekers? Make sure to comment on and or share this story. We here at DSJ want to hear from you. Contact us…
Categories: anti-conservative, California, Conservative, conservative tribune, democrat, Democratic, Democratic Party, Deplorables, Deplorables Seeking Justice, globalist, homeless population, justice, left, Left Wing, leftwing, liberal, Los Angeles Times, open borders, Seeking, shantytown, Silicon Valley, socialist, The New York Times, Uncategorized


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Mental Health Issues
Mental health issues can affect any family, at any time. Buts stigmas around these issues can prevent parents from reaching out for help, for fear that they or their child will be judged.
Fortunately, there's hope. People are breaking down barriers and talking more openly about mental illness and mental health issues. And with increased awareness and visibility comes greater access to resources for parents who struggle with these challenges.
These videos offer parental support and information on topics such as depression, self-harm, and how to obtain the help your child needs.
Click Here for Parental Support On
Want to talk with other parents about this topic?
How Do I Carve Out Time for Each Child When I Have Multiple Kids and Two Have Specific Needs?
Lisa Eaton, MSW, LCSW, CADC
Agor Behavioral Health Services, Inc.
How Do I Carve Out Time for Each Child?
A common dilemma faced by almost all parents is how to find time in our busy lives to give each of our children special, quality time. This is especially difficult when you are the parent of children with special needs. But we also know that this special playtime can be invaluable to the parent-child relationship, and to the child's self-esteem – all of which impact behavior in the home and the quality of family life for everyone. What I often tell parents is this – carving out time for each child does not have to be long and complicated. Often, spending 10 minutes each day or a few times each week can impact our children in powerful ways. We often think that we have to devote long periods of time, or take our children out of the house to do special things, for this time to be considered "quality time." Not so! In fact, this particular mindset often creates a lot of guilt and feelings of being overwhelmed in parents. Let's review a couple of strategies that hopefully you will find to be realistic and manageable for you and your family.
- 10 minutes goes a long way!
- Provide undivided attention to your child for 10 full minutes; no screens or other distractions.
- Schedule special play times that make sense for your family.
- These 10 minutes can be anywhere – in the car, at bath time or bedtime, while waiting at the doctor's office; anywhere you can give your child 10 minutes of your full attention.
- Identify an appropriate distraction for your other children.
- This is key to creating 10 minutes of undivided attention for the specific child.
- Create a situation where the other children can be safe and entertained while you are providing one-on-one attention to the specific child.
- Provide clear instructions ahead of time to the other children about what the expectations are during this 10 minutes.
- Allow your child to lead the play and choose the activity during this special play time.
- This is a time to show your child you are interested in what they are doing and who they are.
- If you are at home, sit on the floor to build Legos with them or draw with them for 10 minutes.
- If you are in the car, allow them to pick a song on the radio to sing together.
- Get excited about this special play time!
- Announce it to your child each time you are deliberately engaging in this special time with them.
- Get excited about it, and they will too!


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The words of his that are most likely familiar to you are "The cat is in the cradle and the silver spoon – little boy blue and the man in the moon – when you coming home dad – I don't know when - but we'll get together then son..."
Harry Chapin stands alone in my mind with the few true storytellers in the music profession. His music is not only made of melodies that can be as haunting as inspiring, but of words, beautifully crafted words that cast a spell of magic – taking the listener on a journey into themselves, into life lived and life often lost. He was a troubadour of American life at the time when we needed a voice of conscience. Most of his songs were too long for radio broadcast, so only those willing to invest time in an album or a concert truly got to know Harry Chapin. If you don't know his music, give him a listen – it will be unlike anything being written and sung today.
A consummate entertainer, Harry Chapin died early in an auto crash in 1981. He was an advocate for political change, ending hunger and human rights. He was awarded the Congressional Gold Medal after his death, in 1987.
Of his songs, I recommend to you – "A Better Place to Be," "I Wanna Learn a Love Song," and "W*O*L*D" to get you started.


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Hail Caesar! Follows a day in the life of Eddie Mannix, a Hollywood fixer for Capitol Pictures in the 1950s, who cleans up and solves problems for big names and stars in the industry. But when studio star Baird Whitlock disappears, Mannix has to deal with more than just the fix.
IMDB Rating: 6.6
Release Date: 05 Feb 2016
Genre: Comedy, Mystery
Runtime: 106 min
Actor : Josh Brolin, George Clooney, Alden Ehrenreich, Ralph Fiennes
Writers : Joel Coen, Ethan Coen
Director : Ethan Coen, Joel Coen
Language : English
Country : UK, USA, Japan
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I am in search for a acupuncturist who is looking to SUBLET OFFICE SPACE. If you are looking to branch out into private practice, or are all ready in one and looking to sublet a new space, please contact me. My office is located in Copley Sq. and is fully equiped with table, ect, and is beautifully decorated. I have had my own massage therapy practice for 20 years. I am flexible regarding: full days / half days /quantity of days per week for subletting. I look forward to hearing from anyone who is fully licensed/certified and insured!
Maria Perini:
(617) 733-1317
Now Hiring Part-Time Acupuncturist
We are seeking a Part-Time Acupuncturist in Decatur, GA., available on Tuesdays and alternate Saturday mornings beginning October 7. Pay rate is $25 per hour, plus bonuses. Initially, the commitment is for 4-7 hours per week. Additional hours may be added if desired.
Are you looking for a way to give back? We are a community acupuncture clinic and believe that ALL people should have access to healing. We are committed to serving and building relationships.
If you would like to join our community for a few hours each week, we would love to hear from you. Please email your interest to: firstname.lastname@example.com.
Applicants must be licensed to practice in Georgia and have liability insurance.
Great opportunity
We are currently renting office space to alternative practitioners looking to establish or expand their practice in Wurtsboro, NY. We are located 1-1/2 hours from NYC in Sullivan County. If you are interested in visiting us please call Eileen at 631-742-3263
We are seeking a Part-Time Acupuncturist, available on Tuesdays and alternate Saturday mornings beginning October 7. Pay rate is $25 per hour, plus bonuses. Initially, the commitment is for 4-7 hours per week. Additional hours may be added if desired.
Are you looking for a way to give back? We are a community acupuncture clinic and believe that ALL people should have access to healing. We are committed to serving and building relationships.
If you would like to join our community for a few hours each week, we would love to hear from you. Please email your interest to: firstname.lastname@example.com.
Applicants must be licensed to practice in Georgia and have liability insurance.
Acupuncturist needed F/T by professional company in Flushing, NY. Must have Master's deg. in Acupuncture. Administer specific therapeutic treatment of symptoms and disorders amenable to acupuncture procedures, etc. Apply to H&G PT & Acupuncture PLLC at 147-14 Sanford Ave., Flushing, NY 11355
Seeking Acupuncturist in Greenville, SC
Successful Acupuncture and Oriental Medicine practice in Greenville SC offers opportunity to join our practice as an associate.
Benefits include:
Opportunity to quickly develop a successful practice in a rapidly expanding market.
Full administrative support, including patient scheduling, insurance billing, and fee collection.
Multiple treatment rooms available allowing you to see 2 patients at the same time.
No room rental fee or need to lease private office space on your own.
Attractive, professional clinic with many amenities.
We actively market our acupuncture services through various direct and internet campaigns and have an active relationship with the Greenville Health System.
Compensation based on a fee split arrangement, commensurate with experience.
Interested applicants should:
Hold or be eligible for a South Carolina acupuncture license.
Be highly motivated to develop a patient base through active marketing and promotion.
Be willing to work in a team based practice.
Desire to build a 30+ hour per week practice.
Have two years' experience.
Have a strong interest in working within an integrative medicine model.
Be committed to continuing professional growth and education.
Interested parties should submit current CV to: firstname.lastname@example.com
Please respect our practice and refrain from follow up calls or emails.
If we feel you are a good fit we will contact you to talk further.
30 year established chiropractic office in beautiful Venice, FL has 3 treatment rooms plus private office (approx. 925 sq ft) plus common areas available in free standing 3200 sq. ft. building. Optional extra room available to use as your own waiting room or community treatment room, adds to the square footage available by 220 sq ft. Previous LAc/DOM has just left the office. Great opportunity for an experienced acupuncturist or someone just starting out. Space is available immediately.Live and work in paradise- 10 minutes to the beach!
Please email firstname.lastname@example.com or call (941) 445-3643 for more information.
Offering the best in Beauty and Wellness, our location has been established for 15 years in a premier location in Fairfax City, Northern Virginia. We are highly visible with a large amount of traffic and just 2 blocks from George Mason University and the Fairfax County Courthouse.
2 Treatment rooms are available for rent: approximately 200 sq.ft. and 300 sq.ft. for $1,500 per month.
Our wellness facility has previously leased space to Chiropractors, Acupuncturists, Nutritionists, Internal Medicine Physicians & Nurse Practitioners.
A growing physical therapy office on Long Island, Nassau County, is looking for a NY licensed acupuncturist. Looking for a well trained licensed acupuncturist experienced in no-fault insurance. A Master's degree and 5 years of relevant work experience is required. The candidate should be able to work in fast pace environment seeing 60 patients per day and be able to spend long hours on feet. The acupuncturist should be comfortable working with e-stim, heat lamps and auricular therapy. Demonstrate personal characteristics including compassion, empathy and the ability to relate to patients are essential. The candidate should have an even temperament with a true passion of healing and be comfortable working with minimal supervision. We are looking for a flexible, well organized team player with a willingness to work with other providers. Initial compensation is $ 20/hr commensurate with experience and accomplishments. This is a full time position with Saturdays involved. The candidate needs to have malpractice insurance. Some fluency in Spanish is preferred. Please submit your qualifications and contact information to firstname.lastname@example.com
Dr. Heather Carr, owner of One to One Physical Therapy, is seeking a Naturopathic Physician to join her as she opens a center for restorative therapies (Resonate Health Center) in Spring 2017. Located in Alexandria, Virginia, the center will be comprised of various health care professionals, operating their own practice in a shared space.
Dr. Carr, a Physical Therapist and Nutritional Therapy Practitioner, has been an independent practitioner for over 5 years and has been practicing as a PT for 15 years. Her practice is very integrative in nature, incorporating Postural Restoration, Nutritional Therapy, and Biofield Tuning. She works closely with other health care professionals such as Optometrists, Dentists, Physicians, Osteopaths, Chiropractors, Acupuncturists, Psychotherapists, Nutritionists, and Massage Therapists. Dr. Carr welcomes all types of holistic and integrative-minded practitioners to work alongside her as she opens her new center.
Please contact Dr. Carr at email@example.com for more information and to set up a phone interview. Please also share your education, experience and interests. You can learn more about Dr. Carr's practice at http://www.one2onephysicaltherapy.com/. She also has a blog at www.HeatherCarrDPT.com and can be found on twitter at @heathercarrdpt.
PO Box 96503 #44114, Washington DC 20090-6503
Reach us at email@example.com


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Frequently Asked Questions
If you find that your question has not been answered here, please call 800.330.2020 or fill out our contact form and we'll get back to you within a business day.
What is pre-employment testing?
Pre-employment testing is a tool used by thousands of companies across the world to hire more efficiently and accurately. Job applicants complete an assessment to evaluate certain behavioral traits like cognitive ability, personality, and motivation, or hard skills like Microsoft Excel and coding in a certain information technology language. Pre-employment tests can vary widely in the traits assessed, quality of the questions used, and length, among other elements. The Optimize Hire pre employment tests are customizable and can assess whatever traits or skills you'd like to see in your employees.
How much does it cost?
Optimize Hire sells its service as an annual license, which allows your hiring managers to assess an unlimited number of applicants for all of your job openings each year. Give us a call at 800.330.2020 to get more specific pricing information for your organization.
How many applicants can I assess?
You can assess an unlimited number of applicants. In fact, the more the better! Whether you assess 1,000 applicants or 100,000+ applicants per year, the annual license cost is the same. Instead, the annual license cost is based on the number of people you expect to hire over the next 12 months.
How long does it take to complete the pre-employment test?
Optimize Hire boasts one of the shortest pre-employment assessments on the market. It takes applicants approximately 8-10 minutes to complete an Optimize Hire Pre Employment Test and the national completion rate is 96%.
Is Optimize Hire better for small or large organizations?
Our clients range from multi-billion dollar companies who hire thousands of people per year to small businesses hiring only a handful of people per year. Regardless of the size of your company, our pre-employment tests are strong predictors of job performance.
Do you work with my industry?
Yes, Optimize Hire works with companies in all industries. Visit our Industries Page to learn more about our assessments and specific results related to your industry. If you don't see your industry, send us an email by filling out this form, or call us at 800.330.2020. In our ten-year history, we've likely worked with a company like yours, even if your specific industry isn't currently listed on our website. We're happy to share our results from your specific industry.
Does Optimize Hire cover the posting fees for 3rd party sites?
No, Optimize Hire does not cover the posting fees for 3rd party sites like CareerBuilder®, Craigslist®, and Monster®. Clients are responsible for 3rd party posting fees.
How does it work?
Optimize Hire will automatically guide you through every step of the hiring process, and our goal is to make it as easy as possible for you and your team. To learn more, visit our How It Works page. If you'd like to schedule a demo with Dane, our head of sales, click here.
How long until I can start assessing applicants?
You can sign up and start assessing your job applicants in about 5 minutes. If you use an ATS like iCIMS or Greenhouse, the process may take slightly longer, but no more than two weeks.
Does Optimize Hire have a pool of applicants?
Optimize Hire does not have a pool of applicants. Instead, we help you evaluate the applicants who apply to your job openings using our scientifically proven pre-employment tests that are tailored to your industry and the given job. We leave it up to our clients to recruit applicants.
Where is candidate information stored?
Optimize Hire stores basic candidate information (e.g. name, email) from your Applicant Tracking System. We do not collect sensitive information from candidates (e.g. social security number, etc). Optimize Hire servers and network are located in Class A data centers in Chicago and Dallas which are secured by 24x7x365 security, controlled access, and egress to registered parties only, and software firewalls and user passwords. We utilize HTTPS server certification, customer authentication and authorization, and encryption.
Optimize Hire monitors its systems 24x7x365 through a combination of third‐party tools to provide early detection and notification of potential issues, with technical personnel available to prevent issues or correct an issue quickly if it arises. We conduct a backup at least once per day and maintain seven days of daily backups.
What is the validation process? How do you make sure it's compliant with government regulations?
Optimize Hire experts and researchers at the Wharton School will conduct a job analysis with your project team to profile the various roles.
Additionally, Optimize Hire conducts validation studies to prove how accurately the pre-employment test scores predict job performance outcomes. All Optimize Hire Pre-Employment Tests are validated, meaning they are scientifically proven predictors of job performance and also meet the U.S. Equal Employment Opportunity Commission guidelines.
The Optimize Hire team, along with researchers at the Wharton School, can conduct a validation study to prove how well our pre-employment tests predict job performance outcomes and turnover among your job roles. Experts at the Wharton School hold their studies to the accepted scientific standard of 95% confidence, also known as statistical significance.
Optimize Hire Pre-Employment Tests are strong predictors of retention, sales revenue, supervisor performance ratings, customer service ratings, promotion likelihood, safety outcomes, and more.
There are two ways to conduct a validation study depending on what's easiest for your HR team:
Option 1: Validation study with your current employees
1. Several hundred of your current employees take an Optimize Hire Pre-Employment Test.
2. You send Optimize Hire any job performance data that you collect on individual employees (e.g.sales revenue, supervisor ratings, etc).
3. Researchers at the Wharton School analyze the links between your employees' test scores and job performance data and report back their detailed findings.
Option 2: Validation study with your new hires
1. Your applicants take an Optimize Hire Pre-Employment Test over the next 12 months.
2. You hires several hundred new employees over the next 12 months.
3. At the end of 12 months, Optimize Hire and experts at the Wharton School will compare your new employees' test scores with their job performance data to prove how well the test predicted job performance.


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Hello everyone. Thank you for joining us on our weekly dev blog updates. Today we want to show off our new and improved AI.Read More
Hello everyone, and welcome to our first Dev Blog Update!Read More
UPDATE: Hey #dreamhack, we're on our way back. We were able to secure another spot at 6pm Today. I know it's sudden, but we'll be back. Same booth, same hall, Booth 403, Exhibit Hall 4.Read More