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Given the choice, most of us would decide to earn more for our daily exertions.
Thankfully for employers though, we don't all just get to set our salaries as we please. But, importantly, neither do they.
Salary negotiation is an essential part of your working life, whether it be during a job interview, as part of a performance review, or something you raise with your HR department or line manager.
Negotiating your salary is the best way to ensure you are paid fairly, and that your hard work is adequately rewarded. It's not about being greedy or driving a hard bargain.
Done right, salary negotiations benefit everyone – including the employer. At the end of the day, they want you to be happy in your job and motivated to do your best work.
These 5 tips will help you negotiate your salary with success, avoiding that awkward feeling and maintaining a strong, positive relationship with the people responsible for paying you.
1/ Come prepared
Salary negotiation may take place in a number of different ways. It may very well be in person, especially if you're negotiating your salary with a current employer.
But negotiations often happen over the phone or via email too, particularly following an offer from a prospective employer.
However you get there, you must be prepared to negotiate. Don't turn up to an interview without considering your salary expectations, as you might be asked.
Do your research
The best way to know what salary you should receive is to look it up.
There are a number of free salary checkers, or "salary calculators", available online. Of course, salaries depend on two main factors: location and responsibilities. These tools often specialize in a given country, region or city, and will probably ask you to enter indicative job titles to arrive at an accurate figure.
Glassdoor offers a free salary checker service which covers a number of countries.
These calculators are only as good as the data they've collected, so be sure to check how many real salaries the final figure is based on. (Local sites will tend to have better data.)
For some jobs it may be harder to find accurate equivalents – or simply enough of them to get an accurate number. In that case, try to find relevant forum discussions, consider average salaries across industries or markets, or ask someone in your network if they can help.
Remember, you don't need to have an exact figure in your mind. Find a range that you think is fair and use that as a starting point.
2/ Play for time
Salaries are a big deal. Negotiations aren't something that should be treated lightly, and so should be expected to take a bit of time.
The best thing is for each party to take their time. After discussions, both should go away and consider the offer or expectation seriously before coming back.
That way everyone's aims are being respected, and a common agreement should be easier to reach.
Don't just take the first offer you get
If you're asked during an interview for your salary expectations, make sure you are happy to give an answer before you do. Don't feel forced.
You may prefer to hear their offer first, or you might just need to know more about the job before you can make a judgement.
After receiving an offer, give yourself the time you need – maybe a day or two – to think about it and consider whether or not to make a counter offer.
Likewise, don't expect your employer to just accept or reject the first figure you give them. It's a negotiation.
3/ Make your case
Arriving at a figure or range you'd be happy to receive is all well and good, but your preparation shouldn't end there.
You must be ready to stand by your stated expectations or proposed salary increase. This should never become an argument or a conflict between yourself and your employer. But they may expect you to justify your position.
Confidence is key
For most people salary negotiations are awkward. Many dread the question about their expectations.
This is understandable. It can be strange to state your value in monetary terms, and no one wants to be thought greedy or overly motivated by money.
That's why it's important to be confident about your salary expectations and your needs. Once you've decided on a figure or range that you think is fair, then it should be easy to respectfully make your case.
There's nothing selfish or greedy about ensuring you are rewarded fairly for your work. Your employer is unlikely to disagree on this point.
4/ Present the evidence
It's much easier to justify your salary expectations with the help of cold, hard facts.
Salary negotiations are not a test of your ability to drive a hard bargain and extract the most you can from your employer. Far from it.
Armed with an objective picture of the market rate, your value, and your needs, salary negotiations will become an amicable discussion based on the evidence.
Numbers don't lie
First, consider what you're earning now and ask yourself if it's enough. Are there any benefits beyond the salary that contribute to your wellbeing and sense of satisfaction?
It's important to your employer that you can afford to pay the bills, but you're also helping to pay theirs – and generate their profits.
Consider your role at the company and how far you are responsible for success. If you are vital to the business, your pay should reflect that.
The research you've done on salaries for similar jobs, or offers you've received from elsewhere, are also important here. This information should be shared during a negotiation to ensure everyone is happy with the final outcome.
5/ Take a long view
From your employer's point of view, your salary is an investment.
Whether you're a new hire or a long-time employee, your pay is factored into the bigger picture of a company's profits today and growth in the future.
Negotiations will be a lot easier if you consider the bigger picture, too.
What does the future hold?
Timing is important. What stage the company is at, and what stage your career is at, will shape the kind of discussion you should be having.
Try to plot a path for yourself, and ask what potential there is for your development. Should you expect your responsibilities to increase over time? Will there be chances for you to move up the ladder internally?
Consider what salary you're going to need, or expect, in a few years' time.
If you are negotiating your salary during a performance review, don't forget that there will be another chance to discuss this at the next one. What might have changed between now and then?
If you are in the process of being hired, consider when you might have a chance to discuss your pay in future. Is the company rapidly expanding? Perhaps you can use your probation period, or your first year in position, to demonstrate your true value.


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8 Things K-Pop From K-Pop History Fans Don't Like To Talk About
In K-Pop there are some topics that are a bit hush-hush. But to any fan that was around when these topics first came into the light, the moments have stayed in their memory forever. These moments may often be labeled as "we don't talk about that" but once you know about them, you won't ever be able to stop thinking about them.
1. Girl's Day's debut styles that forever haunt Minah
Girl's Day debuted in 2010 with their bop "Tilt My Head". Unfortunately, their debut styling was a little on the odd side. The memory of this moment seems to be particularly embarrassing for Minah since fans can recall her screams of embarrassment when she was presented with footage of it.
2. Some other debut styles that will always stick with us
Everyone loves RM but fans, and not even RM himself, are quite sure what to make of his debut hairstyle.
Of course, there's also the colorful suits B1A4 wore…and fans were glad when they eventually ditched them.
The interesting makeup choice used in VIXX's "Hyde" still has some fans scratching their heads.
3. The year 2014
The year 2014 is a year full of painful memories for K-Pop fans. It was the year that Ladies' Code had their tragic accident, Jessica Jung left Girls' Generation, and a number of different lawsuits among others. Let's just say that when you start thinking about all the things that happen in 2014, you'll definitely feel sad.
4. 4MINUTE's "Milkshake" cover
4MINUTE once covered "Milkshake" during a radio show and received a ton of criticism for their performance.
They didn't let that bother them and gave a second performance of the song in public but fans still keep both performances on the down low to prevent any more negative attention to the girls.
5. The family song
This performance was part of a CF for school wear and was a collaboration between GFRIEND and BTS. While it's undeniably cute, fans have also said that it's a tad bit cringy. And it also doesn't help that for the longest time, international fans had no clue what the CF was actually supposed to be for!
6. J.Y. Park's plastic pants
Okay, so we know we already mentioned fashion a couple of times but these pants will forever live on in K-Pop history!
7. "Dibidibidis my name is Minho."
Back in the day, some critics thought this line wasn't very good even though fans fell in love with it. But ever since the group worked it into an SNL skit it's become one of the most iconic lines in K-Pop history and loved by all!
8. "YouTube is my best friend."
When Girls' Generation won the best video of the year at YouTube's first YouTube Music Awards, Tiffany was the only member of the group to attend the event. Maybe it was the shock from the event but she said these words that have gone down in K-Pop history.

subset: commoncrawl


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Furnace Repair & Maintenance for the Holidays
December 15, 2015
The holidays are a time of cheerfulness, celebration, and gathering with friends and family. You've prepared the food, wrapped the gifts and decorated your home to give your guests an incredible holiday to remember. While you're making new memories this season, a furnace repair and a few simple tips will ensure you're making those memories in a safe and cozy home.
- Adjust your thermostat: If you'll be hosting this holiday, think about turning your thermostat down before your house fills up. A large crowd, warm oven, and perhaps some spiked cider can make the room feel stuffy. Preemptively reducing the thermostat can help keep everyone comfortable all through the evening.
If you'll be going on a trip for the holidays, lower your thermostat to keep energy costs down. Do not turn your system off altogether, though, as this could cause your pipes or appliances to freeze.
- Check your smoke alarms and carbon monoxide detectors: With all the holiday lights, decorations, and the whole chestnuts roasting on an open fire thing, December and January are dangerous times of year for home fires. The U.S. Fire Administration reports that December is peak month for home candle fires. To ensure your family's safety, you should use the test button on your smoke detector regularly and the batteries should be changed at least once a year to make sure your alarms are working properly.
The arrival of winter also means the furnace is on and windows are locked. If you need a furnace repair, your system could be emitting carbon monoxide fumes into your home. If your carbon monoxide detector does go off, leave the house immediately and call professionals to check your system's efficiency. And if anyone is feeling woozy or ill, call the fire department and make your way to an area with fresh air.
- Schedule a furnace inspection: We all know that along with the excitement of the holidays comes the holiday stress. Whether you are hosting family or traveling for the holidays, a furnace inspection and regular maintenance will give you the invaluable gift of peace of mind. A well-maintained furnace runs more efficiently and safely.
The holidays are the most magical time of the year and with a few simple precautions, you can make sure you're shaping nothing but the best memories. Use our convenient online scheduler today to arrange your furnace repair or maintenance and help ensure a safe holiday season. There's truly no place like a cozy home for the holidays.


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The PASC is a collective based in Quebec that works to create a direct solidarity network with Colombian communities and organizations struggling for life, dignity and autonomy.
Born out of the continent-wide organizing against the free trade agreements of the early 2000s, the PASC facilitates international accompaniment, disseminates information about Colombian social movements and confronts Canadian imperialist interests in the ongoing Colombian conflict.
The PASC uses a horizontal organizing model and makes decisions by consensus. The collective coordinates a larger network of allies who sustain projects like our Urgent Action Network and provide translation.
PASC is a member of GRIP-UQAM, Groupe de Recherche d'Intérêt Public du Québec à l'Université du Québec à Montréal.
Our strategies:
Accompaniment for communities and organizations at risk
International accompaniment is one of our most important activities. Accompaniment consists of establishing an on the ground presence along side social activists and communities a risk. Coupled with coordinated political pressure, the presence of foreign observers in Colombia can be a strong deterrent for perpetrators of political violence. In this way, accompaniment helps create space for social activists to carry out their work, while increasing their legitimacy in the eyes of local authorities. Accompaniment also facilitates dialogue between social movements in the North and South, building solidarity between the two. Learn more.
Information-sharing and popular education
Through our website, listserv, public events, and publications like La Piedra, the PASC distributes alternative information on the social and armed conflict in Colombia. This includes coverage of communities in resistance, as well as the economic interests behind systematic human rights violations in Colombia. The PASC organizes popular education activities on Colombia, including workshops, photo exhibits and film screenings. Upon their return to Canada, our international accompaniers speak with local media and share their stories with community groups, unions and student organizations.
Public pressure and denunciations
Through our Urgent Action Network the PASC distributes briefings on political threats and human rights violations issued by communities and organizations that choose to denounce these violations at an international level. Urgent Actions include form letters, which members and allies endorse and forward to relevant authorities.
The PASC believes that the conflict in Colombia is intimately connected to imperialist interests throughout the Americas. For this reason, we work to unmask the Canadian political and economic interests which profit from and fuel the violence in Colombia. Learn more.


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Northside General does not have an emergency department. You can learn more about the Northside Urgent Treatment Centre here.
*Please visit our temporary closures page for up-to-date information about any unexpected closures and service interruptions at this facility.
Urgent Treatment Centre
Northside General does not have an emergency department
You can learn more about the Northside Urgent Treatment Centre including hours of operation and how to make an appointment here.
Clinics and Services
View the list of NSHA programs and services.
Visiting Hours
Please note: There are currently visitor restrictions in place due to COVID-19. Please visit www.nshealth.ca/temporaryclosures for up-to-date information.
Visitors are welcome between the hours of 8 a.m. and 8 p.m. Please check with nursing staff, if you want to visit outside of the standard visiting hours.
*Learn more about NSHA's Family Presence Policy, which welcomes up to two people named by the patient to be their family or primary support person/people.
A $3 parking fee will be charged when you exit the parking lot. Please make sure you have the correct change before leaving the hospital.
You can buy weekly and monthly parking passes at the Northside Hospital Foundation office near the hospital's rear entrance. They can be purchased with cash, debit or credit card. The follow rates apply:
- $15 for weekly pass
- $30 for a monthly pass.
WiFi and Internet Access
There is free public Wifi. To request access, send an email to firstname.lastname@example.com requesting connection. There will be an automated reply with the information required.
Semi-private and Private Rooms in Nova Scotia Hospitals
- Private room: Includes one bed and one washroom. You can find current rates here.
- Semi-private room: Includes two beds separated by curtains and one washroom. You can find current rates here.
Space in our private and semi-private rooms is limited. The sooner we have your insurance information the more likely we are to be able to accommodate your request.
When the booking clerk calls with your hospital admission date, let them know you are interested in a private or semi-private room.
When you are admitted, be sure to have your private insurance card with you and let the admitting clerk know you have requested a private or semi-private room.TV & Phone in your Room
You can find updated information about costs associated with semi-private and private Rooms in the hospital here.
Fees and Bill Payments
You can find updated information about fees and bill payments for Canadians and out of country patients here.
TV and Phone in your Room
TV Service
TVs are available in most patient rooms. There is a cost to setting up TV services. Please check with your nursing staff.
Phone Service
Bedside phones are also available in most patient rooms.
To connect your phone service, dial 499 from your bedside telephone and a BellAliant representative will arrange to have your telephone service connected, transferred to another bed, or disconnected.
When you are discharged remember to dial 499 to request that your phone be disconnected so that billing is stopped.
Daily service and connection charges are billed to your BellAliant home telephone account.
If you are with another provider, BellAliant will create a separate account for the duration of your hospital stay.
Inpatients Meals
During your stay at the hospital, you will receive breakfast, lunch and supper daily. If you follow a special diet or have food-related allergies or sensitivities, let us know when you arrive. Food is provided based on your doctor's diet order. Please check with nursing staff if you have any questions about ordering your food.
Cafeteria and Vending Machines
Cafeteria, level 1
Hours of operation:
Monday to Friday: 9:30 a.m. to 10:30 a.m., 11:30 a.m. to 1 p.m. and 1:50 to 2 p.m.
Saturday and Sunday: 9:30 a.m. to 10:30 a.m. and 11:30 a.m. to 1 p.m.
Spiritual Spaces and Quiet Rooms
There is a chapel located on the 5th floor in the north wing.
Northside General is one of three community hospitals that operate as part of a four hospital complex that includes New Waterford Consolidated, Glace Bay and the Cape Breton Regional hospitals. It serves the communities of North Sydney, Sydney Mines and surrounding areas.


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News Releases
Mobility pricing in Metro Vancouver must be fair for drivers and public transit commuters, says new report
Congestion-induced delays have become the norm on Metro Vancouver roads and bridges and problems will worsen with a growing population and additional cars, says a new report on mobility pricing....April 16, 2018 | BC Office
Media advisory: Public policy experts available to comment on Kinder Morgan Trans Mountain Pipeline Expansion
OTTAWA AND VANCOUVER — With Prime Minister Justin Trudeau, B.C. Premier John Horgan and Alberta Premier Rachel Notley set to meet Sunday in Ottawa on Kinder Morgan's Trans Mountain Pipeline Expansion...April 13, 2018 | National Office, BC Office
Scientific "review" of fracking falls well short of what is needed: full public inquiry required, groups say
VANCOUVER – A scientific panel appointed by the provincial government to review natural gas industry fracking operations conspicuously avoids tackling human health concerns, which can only be...March 26, 2018 | BC Office
TORONTO – Teachers and education workers are rallying behind a new blueprint to fix Ontario's 20-year-old education funding formula and they're calling on all parties to commit to a review of public...March 26, 2018 | Ontario Office
March 19, 2018 HALIFAX—The Nova Scotia Alternative Budget 2018, released by the Canadian Centre for Policy Alternatives-Nova Scotia today, is a blueprint of a budget for the people. The report lays...March 19, 2018 | Nova Scotia Office
Important steps taken but Budget 2018 keeps Canadians waiting for the big investments required to build an inclusive economy
OTTAWA—Today's federal budget takes positive steps forward on gender equality and science funding but the bold policy moves that will make a real difference for Canadians —child care, pharmacare,...February 27, 2018 | National Office
Une politique fiscale progressiste et des investissements judicieux pourront sortir près d'un million de personnes de la pauvreté et résorber certaines inégalités : selon institut de recherches
OTTAWA — Le Budget fédéral alternatif (BFA) de 2018, publié aujourd'hui par le Centre canadien des politiques alternatives (CCPA), trace un itinéraire du chemin à parcourir jusqu'à la veille des...February 22, 2018 | National Office
Progressive tax code, smart investments will lift close to a million out of poverty and curb inequality: think tank
OTTAWA—The 2018 Alternative Federal Budget (AFB), released today by the Canadian Centre for Policy Alternatives (CCPA), delivers a roadmap to where the country could be on the eve of the next federal...February 22, 2018 | National Office
VICTORIA—Significant investments in child care and affordable housing in today's budget will greatly improve the lives of hundreds of thousands British Columbians as will progressive tax reform, says...February 20, 2018 | BC Office
OTTAWA — Precarious employment is on the rise in Ontario's post-secondary sector, a new study by the Canadian Centre for Policy Alternatives has found. The report examines the prevalence of...February 6, 2018 | National Office
Report reveals regions with highest share of fossil fuel workers by province; "just transition" plan needed
OTTAWA—Communities across Canada need a national strategy to ensure the move to a zero-carbon economy leaves no one behind, according to a new report by the Canadian Centre for Policy Alternatives (...January 25, 2018 | National Office
Dramatic change to regional-based forestry needed to best serve British Columbians and forest-dependent communities, says new report
VANCOUVER—BC must dramatically change how forestry is managed and governed if it hopes to reverse today's troubling trends, says Bob Williams, who served as the province's forest minister in the...January 22, 2018 | BC Office
OTTAWA – The federal government has spent more than $95 million in unrecoverable legal fees defending the ballooning number of investor-state lawsuits filed against Canada under NAFTA's controversial...January 16, 2018 | National Office
OTTAWA – For the first time, Canada's 100 highest paid CEOs netted 209 times more than the average worker made in 2016, according to a new report from the Canadian Centre for Policy Alternatives (...January 2, 2018 | National Office
OTTAWA - Pour la première fois de l'histoire, les 100 hauts dirigeants les mieux rémunérés du Canada ont gagné 209 fois plus que le travailleur moyen en 2016, révèle un nouveau rapport du Centre...January 2, 2018 | National Office


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Change in absolute Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Anxiety Scale (HAM-A), and Hamilton Scale for Depression (HAM-D) scores across the study (84 weeks). A, Change in the open phase (32 weeks). B, Summed increases (weeks 32-34) and decreases (weeks 34-36) during the crossover phase. C, Changes in the maintenance phase (weeks 36-84).
Customize your JAMA Network experience by selecting one or more topics from the list below.
Denys D, Mantione M, Figee M, et al. Deep Brain Stimulation of the Nucleus Accumbens for Treatment-Refractory Obsessive-Compulsive Disorder. Arch Gen Psychiatry. 2010;67(10):1061–1068. doi:10.1001/archgenpsychiatry.2010.122
© 2023
Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder that affects 2% of the general population. Even when the best available treatments are applied, approximately 10% of patients remain severely afflicted and run a long-term deteriorating course of OCD.
To determine whether bilateral deep brain stimulation of the nucleus accumbens is an effective and safe treatment for treatment-refractory OCD.
The study consisted of an open 8-month treatment phase, followed by a double-blind crossover phase with randomly assigned 2-week periods of active or sham stimulation, ending with an open 12-month maintenance phase.
Academic research.
Sixteen patients (age range, 18-65 years) with OCD according to DSM-IV criteria meeting stringent criteria for refractoriness to treatment were included in the study.
Treatment with bilateral deep brain stimulation of the nucleus accumbens.
Main Outcome Measures
Primary efficacy was assessed by score change from baseline on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Responders were defined by a score decrease of at least 35% on the Y-BOCS.
In the open phase, the mean (SD) Y-BOCS score decreased by 46%, from 33.7 (3.6) at baseline to 18.0 (11.4) after 8 months (P < .001). Nine of 16 patients were responders, with a mean (SD) Y-BOCS score decrease of 23.7 (7.0), or 72%. In the double-blind, sham-controlled phase (n = 14), the mean (SD) Y-BOCS score difference between active and sham stimulation was 8.3 (2.3), or 25% (P = .004). Depression and anxiety decreased significantly. Except for mild forgetfulness and word-finding problems, no permanent adverse events were reported.
Bilateral deep brain stimulation of the nucleus accumbens may be an effective and safe treatment for treatment-refractory OCD.
Clinical Trial Registration
isrctn.org Identifier: ISRCTN23255677
Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by persistent thoughts (obsessions) and repetitive ritualistic behaviors (compulsions). It has an estimated lifetime prevalence of 2% and affects men and women equally. If left untreated, OCD can destroy a person's capacity to function at work, socially, and even at home. Specific treatments for OCD have been developed, such as cognitive behavior therapy (CBT) and pharmacotherapy with selective serotonin reuptake inhibitors. It is estimated that these treatments provide a mean of 40% to 60% symptom reduction in half of the patients. However, even when the best available treatments are applied, approximately 10% of patients remain severely affected and experience treatment-refractory OCD.1
For a small proportion of treatment-refractory patients, deep brain stimulation (DBS) may be appropriate. This is a neurosurgical treatment involving the implantation of electrodes that send electrical impulses to specific locations in the brain, selected according to the type of symptoms to be addressed. There is evidence that DBS is effective in patients with treatment-refractory OCD when it is targeted to the anterior limb of the internal capsule, the ventral striatum, the nucleus accumbens, or the subthalamic nucleus.2-7 Because there is evidence of dysfunction of the reward system in OCD, DBS to the nucleus accumbens might be promising therapy.8 In a pilot series, stimulation of the nucleus accumbens, which is thought to have a critical role in the pathogenesis of OCD, led to significant reduction in the severity of symptoms in 3 of 4 patients.9
The objective of the present study was to confirm these results in a larger series. We also assessed the efficacy and tolerability of bilateral DBS of the nucleus accumbens in severely disabled patients with treatment-refractory OCD.
Patients were recruited from the outpatient clinic for anxiety disorders at our university hospital. All patients consented to participate in this study and signed an informed consent form. The medical ethics review committee of our hospital approved the study, which was registered under trial number ISRCTN23255677 in the international controlled trial registry.
Participants were female or male outpatients, aged between 18 and 65 years, who were diagnosed as having primary OCD according to DSM-IV criteria using the Structured Clinical Interview for DSM-IV Axis I disorders.10 Only patients with a score of at least 28 on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), measured twice at least 2 weeks apart, were included in the study. Patients were required to have at least a 5-year history of OCD and to experience substantial functional impairment according to DSM-IV criterion C and a Global Assessment of Function score of 45 or less. Refractoriness to therapy was defined as no response or insufficient response following at least 2 treatments with a selective serotonin reuptake inhibitor at maximum dosage for at least 12 weeks, plus 1 treatment with clomipramine hydrochloride at maximum dosage for at least 12 weeks with assessment of plasma levels to control for sufficient bioavailability, plus at least 1 augmentation trial with an atypical antipsychotic for 8 weeks in combination with an selective serotonin reuptake inhibitor, plus at least 1 CBT trial for a minimum of 16 sessions.
Except for those with major depressive disorder and mild anxiety disorders, patients with clinically significant comorbid DSM-IV diagnoses (such as schizophrenia, bipolar II disorder, alcohol or substance abuse in the last 6 months, current tic disorder, or body dysmorphic disorder) were excluded from the study. Patients with severe personality disorders, assessed using the Structured Clinical Interview for DSM-IV Axis II disorders,11 were excluded. Other reasons for exclusion were clinically significant and unstable neurologic or medical illnesses.
The study consisted of 3 sequential treatment phases. After electrode implantation, patients entered an open phase of 8 months during which they were evaluated every 2 weeks for severity of symptoms and optimal stimulation parameters. Once an initial and substantial decrease (on average, 6 points) in Y-BOCS score had been obtained, which was usually after 8 weeks of stimulation, a standardized CBT program was added. Because OCD is a context-related disorder, it is common for patients to actively avoid stimuli or social contexts to cope with their disease. To realize the full potential of the DBS treatment, the program was designed to confront patients with their feared stimuli and consequently to force them to deal with their obsessive-compulsive symptoms. Treatment with CBT consisted of weekly individual sessions of 60 minutes for 24 weeks and was conducted by a CBT practitioner (M.M.) and a trained nurse.
After the open phase, patients entered a 1-month, double-blind, sham-controlled phase. Patients were randomly allocated to 2 periods of 2 weeks with the stimulators blindly turned on (active stimulation) in one period and turned off (sham stimulation) in the other period. Block randomization was used with computer-generated random sequence, providing adequate concealment. Patients were assessed 3 times (at baseline, after a 2-week period of active or sham stimulation, and after the second 2-week period of reversed active or sham stimulation). The assessor (M.M.) was blinded to stimulation conditions. Treatment with CBT was continued during the crossover period.
The ensuing maintenance phase lasted 12 months, during which patients were evaluated at 3-month intervals. The stimulators were turned on for all patients, and stimulation parameters were adjusted if necessary.
Implantation of the electrodes was performed according to standard stereotactic procedures using frame-based magnetic resonance imaging for target determination. All patients underwent bilateral implantation of 4 direct-contact electrodes (model 3389; Medtronic Inc, Minneapolis, Minnesota), with contact points 1.5-mm long and separated from adjacent contacts by 0.5 mm. The contacts are coded from 0 (ventral) to 3 (dorsal) and are independently programmable. Target coordinates for the electrode tip were 7 mm lateral to the midline, 3 mm anterior to the anterior border of the anterior commissure, and 4 mm inferior to the intercommissural line. Electrodes were implanted following the anterior limb of the internal capsule into the target nucleus, with an anterior angle of approximately 75° to the intercommissural line. The target coordinates were uniformly used in all patients, as there was not yet a rationale available for relative positioning within the nucleus accumbens given the individual variation of anatomy relative to the stereotactic atlases. Electrodes were connected via subcutaneous extensions to stimulators (Soletra, Medtronic Inc) placed bilaterally in an infraclavicular pocket under general anesthesia. Postoperative frame-based computed tomography images (n = 9) or radiographs (n = 7) were used to verify the position of the implanted electrodes, which were all located at a shorter distance from the intended target than the size of the electrode contact, with an error within the limits of precision of the imaging technique. To restrict variability of the study design, stimulation parameters were standardized to a frequency of 130 Hz and a pulse width of 90 microseconds. Optimization was limited to changes in active contact points and voltage, ranging to a maximum 5.0 V.
Obsessive-compulsive symptoms were measured using the Y-BOCS,12,13 with scores ranging from 0 to 40; higher scores indicated more severe symptoms. Patients were defined as responders if they had a score decrease of at least 35% on the Y-BOCS. Depression was rated using the 17-item Hamilton Scale for Depression (HAM-D),14 and anxiety was evaluated using the Hamilton Anxiety Scale (HAM-A).15 The Brown Assessment of Beliefs Scale (BABS) was used to assess delusional characteristics of obsessions.16 The Sheehan Disability Scale17 was used to assess overall symptomatic and functional impairment; the Sheehan Disability Scale consists of 3 separate ratings that evaluate the effect of symptoms on work, social life, and family life. A trained blinded investigator (M.F.) completed the scales at baseline and at each visit. Information on adverse events was derived during each visit by questioning the subjects in general terms, by spontaneous reports of the subjects, or by observation. Any change in behavior reported by the patient was rated as an adverse event.
The sample size was based on the assumption that a mean (SD) reduction of 9 (6) points on the Y-BOCS (based on drug studies1) is a clinically relevant response and that a placebo response in this treatment-refractory group will be close to zero. Therefore, 16 patients were judged to be sufficient to assess the potential efficacy of this procedure with a type I error of 0.05 and a type II error of 0.80.
In the open phase, the primary outcome measure (the Y-BOCS score) was analyzed for all patients using paired t test. Categorical analyses determined the number of responders based on at least a 35% decrease in the Y-BOCS score. Pearson product moment correlation χ2 test, Fisher exact test, or 1-way analysis of variance was used to compare clinical characteristics and responder rates for the treatment groups. In the blinded sham-controlled phase, the absolute difference between active and sham stimulation in the entire group was calculated by comparing the end point of weeks 3 and 4 in the on-off group and of weeks 1 and 2 in the off-on group with the end point of weeks 1 and 2 in the on-off group and of weeks 3 and 4 in the off-on group using paired t test. To control for period effects, we used a mixed-model regression analysis in line with that by Díaz-Uriarte18 with Y-BOCS weekly comparison scores as dependent variables and with period and treatment as independent variables. Dependency between data at weeks 1 and 2 vs at weeks 3 and 4 is modeled by a compound symmetry covariance matrix specification. The interaction term treatment × period tests for carryover effects. An analogous procedure was performed for the HAM-A and the HAM-D. Data are presented as the mean (SD) at a 2-tailed 5% level of significance. All statistical analyses were conducted using commercially available statistical software (SPSS, version 16.0; SPSS Inc, Chicago, Illinois).
One hundred one patients were screened for eligibility, and 16 were included in the study (Figure). The demographic and clinical characteristics of the sample are summarized in Table 1. Patient 4 fulfilled DSM-IV criteria for OCD and avoidant personality disorder. To cover different subtypes of OCD, we deliberately included patients with a wide diversity of content and type of obsessive-compulsive symptoms.
Stimulation in the open phase resulted in a mean Y-BOCS score decrease of 15.7 (10.8) (95% confidence interval [CI], 9.9-21.5) points (46%) (P < .001) (Table 2). A categorical analysis revealed 9 patients with at least a 35% score decrease on the Y-BOCS, with a mean decrease of 23.7 (7.0) points (72%) compared with a mean decrease of 5.4 (3.1) points (24%) in the nonresponder group. In the open phase, 6 of 16 patients reached a final Y-BOCS score below 10 (mean decrease, 81%), 3 patients reached a final Y-BOCS score between 10 and less than 20 (mean decrease, 51%), 3 patients reached a final Y-BOCS score between 20 and 30 (mean decrease, 22%), and 4 patients reached a final Y-BOCS score greater than 30 (mean decrease, 10%). No patients worsened under stimulation. To test which electrode contacts were to be used, all patients started with monopolar stimulation, with ventral contacts 0 and 1 set negative and case (ie, battery) set positive, at which setting no changes were observed in any patients. In all patients, active contacts were then switched to dorsal contacts 2 and 3 after 2 weeks of stimulation, after which the improvements described herein were achieved. Contacts used were limited to a change from contacts 0 and 1 to contacts 2 and 3 at 2 weeks after implantation. Voltage ranged from 3.5 V to a maximum of 5.0 V, with a mean voltage setting of 4.3 V. With the voltage set at 3.5 V, the mean life span of the batteries is estimated to be 2 years. With amplitudes higher than 3.7 V, the mean life span of the batteries is between 1 year and 2 months and 2 years.
There were no differences in demographic and clinical characteristics between responders and nonresponders except for the content of OCD symptoms. Patients experiencing egosyntonic obsessive-compulsive symptoms such as perfectionism, need for symmetry, seeking reassurance, and hoarding (patients 4, 9, 10, and 16) had a mean score decrease of 10% on the Y-BOCS. At baseline, these 4 patients scored significantly higher on the BABS, 11.5 (2.5) vs 6.6 (5.8) (P = .04) (BABS, 95% CI, 0.3-9.5). Baseline scores, end point scores, and the mean changes on the HAM-A, HAM-D, BABS, and Sheehan Disability Scale are listed in Table 2. A significant decrease was observed in all outcome measures.
In the original protocol, a crossover period of 3 months was planned, but after the noted effects of stimulation in the open phase, it was deemed impossible to acquire continuing patient cooperation for 3 months of sham stimulation. Even with this shortened crossover period, patient 7 refused to participate in the double-blind, sham-controlled phase because of the risk of losing the improvements gained during the open phase (Y-BOCS score decrease, 90%). Patient 9 refused to participate because of disappointment owing to the lack of efficacy (Y-BOCS score decrease, 23%). Therefore, 14 of 16 patients entered phase 2 of the study. The mean Y-BOCS score difference between active and sham stimulation in the whole sample was 8.8 (9.1) (95% CI, 3.6-14.1) points (P = .003) (Table 3). Because we found no carryover effect (P = .32 for treatment × period interaction), the effect of stimulation on Y-BOCS score was assessed using a mixed-model regression analysis with treatment and period as independent variables. After correction for period effects, treatment (stimulation) caused a substantial (mean, 8.3 [2.3] points [25%]) and statistically significant (P = .004) reduction in the Y-BOCS total score. Adding prerandomization Y-BOCS score as a covariate (to adjust for initial differences between sequence groups) had no effect on the treatment effect estimate or its SD. The mean difference in HAM-A scores between active and sham stimulation was 12.1 (9.1) (95% CI, 6.8-17.3) (P < .01); the mean difference in HAM-D scores between active and sham stimulation was 11.3 (7.2) (95% CI, 7.1-15.5) (P < .01). Because of hypomania (or abrupt worsening of symptoms), the blinded status of the stimulators was lifted for most but not all patients. The status of the stimulators remained unclear for patients 4, 11, 12, and 16, in whom the effect of stimulation was not subjectively noticeable.
As summarized in Table 2, the improvement observed in the open phase was sustained over the 12-month maintenance phase, in which all outcome measures showed a statistically significant mean reduction vs preoperative baseline values. The Y-BOCS scores throughout the study and at the end point were significantly associated with HAM-A scores (ρ = 0.772) and with HAM-D scores (ρ = 0.745) (P = .001 for both), suggesting a strong relationship between change in obsessive-compulsive and anxiety measures and mood symptoms.
All reported adverse events are listed in Table 4 regardless of their relationship with the treatment procedure. The most prominent transient adverse event related to stimulation was elevated mood or hypomania. This occurred shortly after the switch of the contact points from 0 or 1 to 2 or 3 and lasted for 2 days. Elevated mood or hypomania never required the addition of a mood stabilizer, and the adverse event was rated as mild. Elevated mood was frequently reported during reactivation of the stimulation after an off period. Permanent adverse events were related to stimulation and disappeared during the off periods. Increased libido was reported by 7 patients, but this was not experienced as uncomfortable. Mild forgetfulness was reported by 5 patients and word-finding problems by 3 patients. An extensive neuropsychological test battery was performed in the DBS-treated sample and in a control sample at fixed time points (before and after surgery, at the double-blind crossover phase, and at the end of the maintenance phase). Given the extensiveness of the data, the outcomes of the neuropsychological effects will be published in a separate article.
To our knowledge, this study is the first double-blind, sham-controlled trial to demonstrate that bilateral stimulation of the nucleus accumbens can be an effective and safe treatment in treatment-refractory patients with OCD. All patients underwent electrode implantation in the same target area, and stimulation settings were applied uniformly throughout the study. During the treatment period of 21 months, obsessive-compulsive symptoms decreased by 52%, and 9 of 16 patients responded, with a mean improvement of 72%. Anxiety and depressive symptoms decreased by half. The surgical procedure and stimulation were well tolerated. Permanent adverse events were limited to mild forgetfulness and word-finding problems. Increased libido was reported by several patients but may be interpreted as a return to normal functioning rather than an adverse event.
Our results are consistent with previous studies on DBS in patients with treatment-refractory OCD. Greenberg et al6 described 26 patients with OCD in whom stimulation targeting was progressively more posterior over time, moving from the internal capsule to the ventral striatum. On average, they observed a 12.5-point decrease on the Y-BOCS, a 53% decrease in HAM-A scores, and a 40.0% decrease in HAM-D scores, with better results obtained with more posteriorly located electrodes, comparable to our surgical target. In a 2008 study by Mallet et al,7 16 patients with OCD underwent bilateral stimulation in the subthalamic nucleus. The mean Y-BOCS score change between sham and active stimulation was 8.9 points. Contrary to our results, neither anxiety and depression scales nor functional impairment (measured by the Sheehan Disability Scale) showed improvement in their study. Transient hypomania has been a consistent finding in DBS for OCD,5,7 as was also seen in our study. We did not observe deterioration of depression or suicidal ideation, as had been previously reported.7
In the blinded sham-controlled phase, patients who were assigned to the stimulation on-off group differed from patients who were assigned to the stimulation off-on group. The patients whose stimulators were turned off in the first 2 weeks immediately experienced an increase in symptoms and then rapidly regained clinical improvement during the ensuing blinded active stimulation. Patients who continued having active stimulation during the first 2 weeks showed a minor increase in obsessive-compulsive symptoms, probably due to uncertainty and doubt about entering the blinded phase of the study. In this group, the baseline Y-BOCS scores at the start of the crossover period were higher, which was in part explained by the higher proportion of nonresponders from the open phase. Four of 6 were nonresponders in the on-off group and 2 of 8 in the off-on group. These factors, along with the small sample size, may have contributed to the nonsignificant difference between active and sham stimulation in the on-off group. The score changes on the HAM-A and HAM-D were statistically significant, suggesting a more robust and immediate effect on anxiety and mood than on obsessive-compulsive symptoms.
The beneficial effects on mood and anxiety, along with improvement in obsessions and compulsions, are striking. All patients, even nonresponders, experienced substantial mood improvement. Therefore, no patients requested to discontinue stimulation, despite the lack of response of obsessive-compulsive symptoms. It is likely that improvement of obsessive-compulsive symptoms depends on changes in mood and anxiety. We observed in our sample a fixed pattern in treatment response and in time at onset of response. Symptoms decreased in a sequential order (depressive symptoms first, anxiety symptoms second, obsessions third, and compulsions fourth) and in a fixed sequence (mood improved within seconds, anxiety within minutes, and obsessions within days, while compulsions took weeks and even months to improve). Finally, avoidance failed to decrease spontaneously and required CBT to disappear. For most patients in this study, compulsive behavior and avoidance had been present for decades; they gradually became part of a "normal" daily pattern and a force of habit. Cognitive behavior therapy proved particularly effective in decreasing compulsive behavior and avoidance. Without stimulation (such as in the placebo-controlled phase), the gained successes with the addition of CBT disappeared rapidly, suggesting that efficacy of CBT depends on stimulation. Our observation of an immediate profound effect with nucleus accumbens stimulation, along with the reported specific effect of subthalamic nucleus stimulation on compulsions observed in the French sample,7 hints at the involvement of 2 different anatomical circuits in OCD. One circuit might be associated with a mood and anxiety spectrum responding to accumbens stimulation, and another circuit could be related to a compulsive habit spectrum responding to subthalamic nucleus stimulation.
Obsessions and compulsions are heterogeneous symptoms, and a large body of work has delineated subtypes of OCD.19 We found a clear relationship between DBS nonresponse and type of obsessive-compulsive symptoms. Patients with perfectionism, hoarding, or symmetry did not respond well to the treatment. Patients with this subtype of OCD believe in the worthiness and soundness of their symptoms and were more likely to describe their obsessions and compulsions as egosyntonic, in harmony with their needs and goals and consistent with themselves. The robustness of their obsessions and the lack of insight into the meaninglessness of their obsessions were expressed in higher BABS scores, the only baseline score that was significantly different from baseline scores of other patients. High baseline scores on the BABS predicted nonresponse in our sample and may be of value for patient selection in DBS.
The great appeal of DBS vs lesions is that it permits focal and adjustable modulation of the brain. In our sample, improvement was observed using only dorsal electrode contacts 2 and 3, with active stimulation more in the area of the nucleus accumbens core around the border of the internal capsule and bed nucleus stria terminalis rather than in the shell of the nucleus accumbens, as previously published.9 The difference in location of the center of the brain tissue volume that is being stimulated between the lower and upper contacts with the 3389 electrode is 4 mm and seemed to determine nonresponse or response in our sample. This finding demonstrates the significance and importance of exact targeting with DBS. In future studies, larger samples are needed to further narrow the "target space" so that the most efficient DBS parameters may be used.
A limitation of this study is that the double-blind periods were short, giving rise to the possibility of a carryover effect, which may have led to an underestimation of the effect of stimulation. This study was originally planned in a sham-controlled design with 3-month periods of on-off stimulation. We changed the 3-month duration to 2 weeks because, once a considerable improvement had been experienced in the open phase, patients did not tolerate off phases owing to massive worsening of symptoms. These findings are consistent with observations by German investigators treating major depression with nucleus accumbens stimulation.20 Another aspect that may have led to an underestimation of the effect of stimulation is that rating scales such as the Y-BOCS do not fully reflect improvement in patients with severe OCD. The Y-BOCS typically attributes a maximum score of 4 points to duration of symptoms of 8 hours or more. Patients with OCD described herein sometimes experienced 14 to 16 hours a day of obsessions or compulsions. Because the Y-BOCS fails to detect changes beyond 8 hours, reductions remain unnoted by the Y-BOCS. New scales designed to capture changes in severe obsessive-compulsive symptoms are needed.
In summary, the results of this study indicate that bilateral stimulation of the nucleus accumbens may be an effective and safe treatment in patients with highly refractory OCD and support the therapeutic potential of DBS in patients with incapacitating chronic psychiatric disorders. Further research is necessary to optimize this therapy with respect to patient selection and management, target location, and investigation of new potential indications.
Correspondence: Damiaan Denys, MD, PhD, Departments of Psychiatry and Neurosurgery, Academic Medical Center, University of Amsterdam, PO Box 75867, 1070 AW Amsterdam, the Netherlands (firstname.lastname@example.com).
Submitted for Publication: November 10, 2009; final revision received February 19, 2010; accepted April 27, 2010.
Financial Disclosure: Dr Schuurman is an independent consultant for Medtronic Inc on educational matters and received travel grants from the company.
Funding/Support: This study was supported by an unrestricted investigator-initiated research grant by Medtronic Inc (Drs Denys and Schuurman), which provided the devices used herein, and by grant 916.66.095 from the Netherlands Organization for Scientific Research ZON-MW VENI program (Dr Denys).
Role of the Sponsors: The funders of this study had no role in the design or conduct of the study; in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.
Additional Contributions: Maarten Koeter, PhD, provided statistical advice.


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Governor Tom Corbett's May 21 newsletter offered up responses to five "myths" the administration claims are circulating about his proposed budget for next year. The Pennsylvania Budget and Policy Center examined these myths and the myths behind the myths to give you a clear picture about what is fact and what is fiction in Harrisburg.
Governor Tom Corbett's May 21 newsletter offered up responses to five "myths" the administration claims are circulating about his proposed budget for next year. The Pennsylvania Budget and Policy Center examined these myths and the myths behind the myths to give you a clear picture about what is fact and what is fiction in Harrisburg.
Governor's Myth #1: Pennsylvania spends more money building prisons than building schools.
We're not sure where this one came from, but we will give it a whirl.
Fact: The Corbett administration's budget includes a moratorium on new school construction projections, and NO FUNDING for school district projects in the pipeline.
Fact: If the Governor's proposed plan for higher education is adopted, Pennsylvania will spend twice as much on prisons as it does on colleges. In 2009-10, the state's corrections budget was $1.8 billion and college funding was $1.5 billion. If the Governor had his way, Pennsylvania would spend $1.9 billion on corrections and $980 million on colleges in 2012-13.
Fact: It costs the state much more to house prisoners than it does to educate a child. In 2011-12, Pennsylvania will house 49,000 inmates at a cost of $35,188 per inmate and spend $9.3 billion to educate 1.8 million students at a cost in state dollars of $5,305 per child.
Fact: It is better to build schools than to build prisons.
Governor's Myth #2: The reductions in higher education funding will cause universities to raise tuition.
Well, cutting college funding is certainly not going to help keep tuition down.
Fact: Public subsidies keep college tuition more affordable. In 2009-10, the average cost (nationally) of a public four-year college education was $15,014, while the average cost of a four-year private college was more than double at $32,790.
Fact: From 1999 to 2011, Pennsylvania's state funding for higher education fell by 12%.
Fact: The Governor and General Assembly cut public colleges by 20% last year, and the Governor proposed to cut 30% more this year.
Fact: Pennsylvania ranked 46th in public college funding as a share of personal income in 2011-12.
Fact: Our economy can't grow if our children don't have a college education.
Governor's Myth #3: The proposed budget reduces funding for K-12 education and will force school districts to raise property taxes.
That's no myth, that's a fact.
Fact: The budget proposed by Governor Corbett and enacted by the General Assembly in June 2011 gave school districts $860 million less than they received the previous year. That included a reduction of 7%, or $421 million, in the basic education subsidy.
Fact: The Governor's cuts killed jobs. School districts cut programs, raised taxes and eliminated positions. In 2011, the state lost 14,000 jobs in public schools and universities.
Governor's Myth #4: The elimination of cash assistance will mainly hurt children and victims of domestic violence.
Fact: In February, the Governor proposed eliminating the General Assistance program. The Governor is right: most of those affected are people with a permanent disability waiting for approval for Social Security disability benefits, or those who have an addiction and are eligible to receive the $200 monthly grant for seven months, in their lifetime.
Fact: Women and children lost their health care, not cash assistance, when the Department of Public Welfare did a quick and dirty eligibility review and threw 88,000 kids out of state health insurance programs. Moms, seniors and people with disabilities (the only ones who can get health care coverage through Medical Assistance) lost their coverage too.
Fact: The budget cuts vulnerable adults as well as children. Do you feel better now?
Governor's Myth #5: The proposed budget reduces funding for the arts.
Fact: The Governor has level-funded grants for the arts for two years. What has gone by the wayside is arts and music education that have been slashed by school districts as a result of the cuts to education (see Myth #2).


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Add to Calendar
August 29, 2023 @ 5:30 pm – 7:30 pm
Varsity 10′ wheelchair basketball (Lakeshore Lakers) is for youth age 13 to 18 with a lower extremity physical disability who can function independently during practice and competition. No specialized equipment is necessary. In addition to weekly practice, the team competes in tournaments locally and throughout the country.


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Replacement refs decide game as Seahawks top Packers on Hail Mary
SEATTLE -- Golden Tate shoved a Green Bay defender out of the way, wrestled another for the ball and was awarded a disputed touchdown on the final play. But it was another 10 minutes before the game actually ended, when the Seattle Seahawks and the stunned Packers were called back on the field for the extra point.
Replacement ref rage may have peaked Monday night.
Just when it seemed that NFL coaches, players and fans couldn't get any angrier, along came a fiasco that trumped any of the complaints from the weekend. The Seahawks' 14-12 victory featured one of the most bizarre finishes in recent memory, and was certain to reignite frustrations over the locked-out officials.
"Don't ask me a question about the officials," Green Bay coach Mike McCarthy said. "I've never seen anything like that in all my years in football."
"I know it's been a wild weekend in the NFL and I guess we're part of it now," he said.
Russell Wilson threw the 24-yard touchdown pass to Tate. The crew of replacement officials agreed that Tate caught the pass.
"We both had possession of it. I don't even know the rule but I guess the tie goes to the receiver," Tate said.
Asked later if he got his hands on Wilson's pass first, Tate wasn't so sure.
"I think so. ... Oh, well maybe he did. But I took it from him," Tate said.
Wilson scrambled from the pocket and threw to the corner of the end zone as the clock expired. Tate shoved Green Bay's Sam Shields out of the way, then wrestled with M.D. Jennings for possession. It was ruled on the field as a touchdown and after a lengthy review, referee Wayne Elliott came out from under the hood and announced "the ruling on the field stands" and CenturyLink Field erupted in celebration.
Seattle (2-1) won its second straight, while Green Bay (1-2) and saw its streak of wins in six straight road openers snapped.
Wilson's heave came at the end of a final frantic drive after Seattle had previously missed on a fourth-down attempt from the Green Bay 7 with 2 minutes left. The turnover on downs appeared to end Seattle's hopes and cap an impressive second-half comeback by the Packers and Aaron Rodgers, who was sacked eight times -- all in the first half.
"I was just trying to keep possession of the ball. The guy who was fighting me for it, he's strong. I was just trying to hold onto it until our guys pulled them off of me," Tate said. "I didn't know if they called touchdown, interception, incompletion. I didn't know what was going on. Couldn't hear anything and I just tried to keep fighting for the ball."
Elliott told a pool reporter after the game that the play was ruled as simultaneous possession that was confirmed by the replay official.
"They both possessed it," Elliott said.
The Packers were far from convinced that Tate had possession. Jennings said he had the ball pinned to his chest the entire time. A handful of Packers players began venting on their Twitter accounts right after the game, posting protest messages to their followers -- many of them too profane to print. Offensive lineman T.J. Lang even challenged the NFL to "fine me and use the money to pay the regular refs."
"Just watching in the back room, I think if you asked Golden Tate to take a lie detector test and ask him did he catch that ball or did M.D. catch that ball, M.D. caught that," Packers' wide receiver Greg Jennings said. "It was clear as day ... at least that is what my eyes saw."
Seattle instantly celebrated while the Packers argued with anyone in a striped shirt. Both teams were eventually shoved to the sidelines as Tate stomped through the end zone in celebration. Following the review, Elliott's announcement sent the stadium into delirium and even more confusion ensued until the teams finally returned to the field for the extra point.
"From what I understood from the officials it was a simultaneous catch. Tie goes to the runner. Good call," Seattle coach Pete Carroll said.
Rodgers had quite a different opinion.
"It was awful. Just look at the replay. And then the fact that it was reviewed, it was awful," he said. "That's all I'm going to say about it.
"We shouldn't have been in that position."
It was Tate's second touchdown of the game after catching a 41-yard TD in the second quarter to give Seattle a 7-0 lead. He finished with three catches for 68 yards, while Wilson was 10 of 21 for 130 yards.
Green Bay averted disaster when Cedric Benson fumbled on the Packers first play after Seattle missed on fourth down from the Packers 7, but center Jeff Saturday recovered. The Seahawks held and forced Green Bay to punt from the 4 with 57 seconds left. The 41-yard punt set Seattle up at the Green Bay 46 with 46 seconds remaining.
Wilson hit Sidney Rice for 22 yards on a slant then went for Tate in the end zone but the ball was batted away with 18 seconds left. He threw over the head of Evan Moore on second down leaving 12 seconds remaining and missed Tate again at the 5.
Wilson took the final snap with 8 seconds remaining. He appeared to be looking for Rice on the right side of the end zone, but rolled left and threw for Tate, who was in a crowd of three Packers defenders. His shove of Shields was obvious and it was never clear who had possession between Tate and Jennings.
"I just ran my route on the backside. Wilson came back and wanted to give me one more chance, especially after I dropped the first one and I just competed," Tate said. "I make sure I practice on high balls and catching balls at the highest point. Thankfully I came down with it."
Others spoke their mind by tweeting.
Hall of Fame quarterback Troy Aikman tweeted "These games are a joke," while NBA MVP LeBron James tweeted "I simply just LOVE the NFL to much to see these mistakes. I'm sick like I just played for the Packers"
Wisconsin State Senator Jon Erpenbach tweeted NFL commissioner Roger Goodell's office phone number, saying in a separate tweet that if the ending Monday did not spark an end to the lockout "this season will be a joke."
Game notes
The eight sacks of Rodgers in the first half matches the most in his career for any game. He was sacked eight times by Minnesota in 2009. ... Seattle DE Chris Clemons tied an NFL record with four sacks in the first half. Derrick Thomas had four sacks in the first half against San Diego in 1992. ... Green Bay WR Jennings finished with six catches after being a question mark coming into the game with a groin injury.


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- This article is a Work in Progress, and may be unfinished or missing sections.
HA-Linux How-To For Testing And Educational Use
- HA-Linux Project Homepage
- Howto: Highly available Zimbra cluster using Heartbeat and DRBD
- DRBD Homepage
- DRBD currently unsupported at this time.
- 1. "disaster recovery through server to server sync (beta)"
- 2. "add active-active support to zcs" , marked as a dup of the above.
- DRBD currently unsupported at this time.
Actual HA-Linux How-To For Testing And Educational Use Homepage
Please see Ajcody-Notes-HA-Linux-How-To
Motive Behind How-To
I hope this gives an easy way to setup through some clustering concepts for an administrator to gain some real-world experience when they currently have none. I plan on walking through each "function" that is behind clustering rather than jumping to an end setup (Linux-HA, Shared Storage, And Zimbra).
The structure will be:
- Setup two machines (physical or virtual)
- Emphasis physical hostname / ip vs. the hostname and ip address that will be for HA.
- Setup virtual hostname and ip address for HA.
- Explain and do ip failover between the two machines.
- Setup a disk mount, we'll use probably use a nfs export from a third machine.
- This will give us an example of expanding the HA conf files to move beyond the ip address failover.
- Adjust HA conf's to now export via nfs a local directory from each server. This will not be a shared physical disk of course.
- Setup a shared disk between the two servers and include it in the HA conf files.
- Can use drbd or maybe figure out a way to share a virtual disk between the two vm's.
- Setup a very simple application to include between the two machines. Something like apache or cups.
- Go back and now readjust all variables between monitoring type (automatic) failover and simple manually initiated.


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- This topic has 2 replies, 3 voices, and was last updated 10 years, 7 months ago by aositing.
- AuthorPosts
- February 27, 2013 at 2:18 am #128449AnonymousInactiveCharlotte Area Cars and Coffee – Uptown Charlotte
Mattie's Diner / NC Music Factory Uptown Village-Main Lot
1000 NC Music Factory Blvd, Charlotte NC 28206
Saturday March 2nd, 2013
7:30am until!
1st Saturday of every month!(weather permitting- rain date the 2nd Sat)
Hello All! This Saturday March 2nd is supposed up to be a very clear and crisp day, the low 50's and sunshine are expected. We continue to like our new home at the NC Music factory and the word is getting out more and more to other car enthusiast in the surrounding areas. It is fun to continue to meet new people from all over as well as to see what interesting and beautiful vehicles they pull up in. Please if you know friends and family that would enjoy this event and would like to bring their cherished rides out, please do. We are quickly filling the lot and by spring I expect us to crest the hill in the back of the lot. Come out and enjoy and continue to spread the word. We are getting more and more interesting vehicles from classics, to groups, to muscle and one off creations, keep them coming! Hope to see you Saturday!
Mattie's Diner was trilled to have us . They would ask that the parking spaces adjacent to the Diner in front and beside be reserved for some of Mattie's regular customers. Many drove up thinking that it was a private event and took off. Also please bare with the bathroom situation, the diner is small but will try to accommodate us the best that they can. If we need to there will be alternatives across the street at the Music Factory.
Many asked me if it was possible to reserve spaces for like makes and models and I would leave that up to the 'early bird get the worms'. You can organize as you see fit with particular makes and models, but as far as roping off before hand that is a bit hard due to the unknown size of a group or location desired. I would suggest that if you have a group that wants to park together that you designate a meet up spot close to the Music factory and ride in together, with 700+ spaces you should not have an issue. Last month it sort of fell together as such without much planning.
Mattie's Diner is a fantastic old school eatery that is located at the front of the property. Matt has made some slight changes to accommodate the size of our crowd so bare with them as they learn our needs. There will be coffee as expected, carry out baked items and sit down full breakfasts if you desire, the space is cozy so be prepared. The owner of NC Music Factory has graciously offered the use of this property and in order to respect the jester we need to do our part. Below are a few bylaws we have to follow in order to continue to use the facility. If we ware out our welcome here we are pretty much without options! I can not begin to tell you how much of a challenge it has been to relocate and find a new car friendly location!
Here are the very simple rules:
Absolutely no burnouts or horse play in the lot or the roads out front. It is irresponsible and safety is a huge concern for us. We trust your car is fast and you have unbelievable skills, there is no need to show us!
No vendors will be allowed to set up tables, booths or tents. As before you can hand out fliers if you wish but no signage or structures allowed.
The Uptown division of the Mecklenburg police department are well aware of our event and will patrol the area. Speeding and unlawful behavior will not be tolerated.
We need to leave the facilities better than we find them on each visit. NC Music Factory is letting us use this facility free of charge so we need to respect it There are trash cans throughout the property please do please do not litter.
Parking nearest to the Diner is reserved for regular restaurant patrons. We have the other 662 spaces!
That's it for now, very simple. Sometimes you don't know how good you have something until it is gone. I miss getting my monthly fix of beautiful machines and wonderful car crazy individuals. The weather looks great so far for Saturday morning, tell your friends, family, co- workers and neighbors to come out and enjoy. Looking forward to enjoying our wonderful new home for Charlotte cars and Coffee.
See you Saturday
MichaelMarch 4, 2013 at 9:47 pm #134560aositingParticipant
Has this been rescheduled for 3/9? I assume it was a rainout on the 2nd.March 5, 2013 at 1:05 pm #134559InspectorParticipant
Nope, it went on in the snow! Still a great time.
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PARIS, France — The world's biggest triceratops skeleton, known as "Big John," was sold for 6.6 million euros ($7.7 million) Thursday to a private collector at a Paris auction house.
The enormous skeleton, estimated to be over 66 million years old, was found in 2014 in South Dakota. The triceratops is known for its three horns on the head.
Big John, named after the owner of the land where it was found, is certified by the Guinness World Records as the largest documented skeleton of a triceratops. The dinosaur died in an ancient flood plain on the island continent stretching from present-day Alaska to Mexico, allowing the conservation of its skeleton in mud.
The skeleton is 7.15 meters long (23 feet) and stands 2.7 meters high (8 feet) at the hips. The skull represents more than one third of its total length, with two large horns over 1.1 meter long (3.6 feet).
The hammer price at the Drouot auction house, before commission and other costs, was 5.5 million euros.
"It's a record for Europe," auctioneer Alexandre Giquello said.
Big John's skeleton is more than 60% complete and its skull more than 75% complete, making it unique.
"The overall quality of Big John really deserved this price," Iacopo Briano, a paleontology expert, said. "For a triceratops and for an herbivore. This is unbelievable record," he said.
Last year, a Tyrannosaurus rex skeleton reached almost $32 million in an auction in New York, becoming the most expensive dinosaur ever sold.
Big John was sold to a private U.S. buyer who requested to remain anonymous.
Djuan Rivers, a representative for the buyer, said "it's being acquired by an American collector... absolutely thrilled with the idea of being able to bring a piece like this to his personal use."
"The history behind this and the duration of it is absolutely impressive. So to be able to be a part of preserving something of this nature... it's also something extremely special," Rivers added.


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Located just south of the North Georgia Mountains, Marietta is home to many historic landmarks, houses, theaters and parks. This suburb of Atlanta combines small-town charm with urban opportunity and is strongly dedicated to preserving its rich cultural history. Marietta abounds with interesting museums like the Marietta Museum of History, the Marietta Fire Museum and the Gone with the Wind Museum.
You'll find diverse shopping opportunities, from antiques to boutiques and upscale shopping in Marietta Square. Guests can enjoy golfing with great views amidst the pines and rolling hills of City Club Marietta. Whether you're planning a romantic wedding in beautiful Glover Park, a family reunion or corporate convention, Marietta has the accommodations and amenities that you need for a unique and successful event. Visit Marietta Tourism.
Eventective has the venues and vendors you need to have your perfect event
Linens, Moon-bounces, Tables, Tents, Lighting, Chair Covers, Dance Floors, Photo Booths
A/V rentals, Projectors, Video Equipment, Audio Equipment, Computers, Sound and Lighting


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Home Page Chess Life Online 2009 September Field Set for US Women's
|Field Set for US Women's
|September 3, 2009
The field is set for the 2009 U.S. Women's Championship, scheduled for October 3-13 in Saint Louis, Missouri. The players will compete for the largest purse in championship history, $64,000, with $15,000 going to the winner. Browse through the links to player bios below. See the full press release here and look for live coverage of the event on CLO, the official website, Monroi and the Internet Chess Club.
Rusadan Goletiani
Camilla Baginskaite


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Be brave, inspirational printable quote art featuring watercolor flowers - Personal use
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Instant digital download for personal use. "Be Brave", femenine printable art, featuring watercolor flowers and whimsical digital calligraphy in faux gold foil.
Please note that this fake gold foil will not be printed as actual gold ink. It will print with standard colors, as a photography of foil. My foil is kind of vintage: please zoom in the images to see them better :)
Size 8x10", to be printed on A4 paper. Image area is 8x10 inch. It will fit frames with mat for 8x10 inch prints.
- Purchase this listing
- Once your order is placed, you'll get a link to the download page. Easy, simple and fast!
Please note:
- You will get JPG and PDF files that you can print at home or at a shop
- Digital download. No physical item will be sent. This listing is for a hi-resolution, digital, printable file for PERSONAL USE ONLY. Commercial use reprint/resell is NOT allowed.
- Files are 300 dpi, perfect quality for printing, clean and crisp.
- This item will be shipped automatically via
instantdownload and it is not customizable. It is sold as shown, in listed sizes, quote and colors.. If you are interested in custom size, color or quote, please, message me. I'm happy to help!
You can print the design yourself on your home printer, or have it printed by any photo finisher of your choice (online or local shop).
License: Personal use only.
Do you have any question? Would you prefer other colors? not exactly what you are looking for? custom work? Message me!


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Safe door of the bank
Washington Federal Promotes Hernandez to Assistant VP
Washington Federal announced Debbie Hernandez has been promoted to Assistant Vice President, Branch Manager. Hernandez has been with Washington Federal for more than 12 years.
In her position, Hernandez is responsible for increasing loan production and client base by growing the business checking and savings accounts and consumer checking and savings accounts. She is also responsible for increasing Washington Federal's presence in the West Valley. Prior to joining Washington Federal, Hernandez was an insurance agent in Ohio.
"Debbie is a huge asset to our team here at Washington Federal," said Trevor Bush, senior vice president and manager of Arizona retail banking division. "We are excited to see her continue to expand the presence and reach of Washington Federal."
Hernandez earned her bachelor's degree with honors in business from the Trumbull Business College in Warren, Ohio. She is also involved with the Arizona Hispanic Chamber of Commerce and is a volunteer for St. Mary's Food Bank.
Hernandez is a Surprise resident.


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The Number of Uninsured Americans Is At An All-Time High
Data released today by the Census Bureau show that the number of uninsured Americans stood at a record 46.6 million in 2005, with 15.9 percent of Americans lacking health coverage. "The number of uninsured Americans reached an all-time high in 2005," said Robert Greenstein, executive director of the Center on Budget and Policy Priorities. "It is sobering that 5.4 million more people lacked health insurance in 2005 than in the recession year of 2001, primarily because of the erosion of employer-based insurance."
Census data show that 46.6 million Americans were uninsured in 2005, an increase of 1.3 million from the number of uninsured in 2004 (45.3 million). The percentage who are uninsured rose from 15.6 percent in 2004 to 15.9 percent in 2005. The number of children who are uninsured rose from 7.9 million in 2004 to 8.3 million in 2005.
"The increase of 360,000 in the number of uninsured children is particularly troublesome," Greenstein said. "Since 1998, the percentage of uninsured children has been dropping steadily, from a high of 15.4 percent to 10.8 percent in 2004. The new Census data show that the uninsured rate among children moved in the wrong direction in 2005, rising to 11.2 percent."
Greenstein warned that matters could get worse. In fiscal year 2007, which begins October 1, children's health insurance programs in 17 states face federal funding shortfalls totaling an estimated $800 million, equal to the cost of covering more than 500,000 low-income children. Congress has known about the shortfall since early February, when the Administration took note of it and proposed a measure to address it, but Congress has so far failed to act.
"Unless Congress takes action this year to avert the impending shortfall," Greenstein said, "the increase in the number of children without health coverage is likely to accelerate in the year ahead."
Key Findings from the New Census Data
- The number of people without health insurance was 46.6 million in 2005, compared to 45.3 million in 2004, and 41.2 million in 2001 (see table below).
- The percentage of Americans without insurance rose to 15.9 percent in 2005, higher than the 15.6 percent level in 2004 and much higher than the 14.9 percent level in 2001.
- The percentage of Americans who are uninsured rose largely because the percentage of people with employer-sponsored coverage continued to decline, as it has in the past several years.
- The percentage of children under 18 who are uninsured rose from 10.8 percent in 2004 to 11.2 percent in 2005, while the number of uninsured children climbed from 7.9 million in 2004 to 8.3 million in 2005, an increase of 360,000.
- Lack of insurance is much more common among people with low incomes. Some 24.4 percent of people with incomes below $25,000 were uninsured in 2005, almost triple the rate of 8.5 percent among people with incomes over $75,000.
- African-Americans (19.6 percent uninsured) and Hispanics (32.7 percent) were much more likely to be uninsured than white, non-Hispanic people (11.3 percent).
- The percentage of native-born citizens who were uninsured rose in 2005, while the percentage of non-citizen immigrants who lacked coverage was unchanged. Nonetheless, non-citizen immigrantswere far more likely to be uninsured (43.6 percent uninsured) than native-born citizens (13.4 percent). The principal reason so many immigrants lack insurance is that they are less likely to be offered health insurance by their employers.[1]
- Insurance coverage declined in the South and the West in 2005, while remaining steady in the Northeast and Midwest. Unfortunately, the South and the West already had poorer health insurance coverage than the other two regions in earlier years, so this further widened the gap between regions.
- Significant changes in the percentage of people who are uninsured occurred in a number of states. Comparing the 2004-5 period with the 2003-4 period, the percentage of people who are uninsured increased significantly in eight states (Arizona, California, Delaware, Florida, Georgia, South Carolina, Utah and Vermont), while it declined significantly in three states (Idaho, Iowa and New York).
- In 31 states, the percentage of residents who are uninsured was significantly higher in the 2004-2005 period than in 2000-2001, before the current economic recovery began. The 31 states with significant increases were Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Indiana, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia, and Wisconsin.[2]
- While Hurricane Katrina had severe consequences for a large number of its victims in the Gulf region, it should not have a significant effect on the number or percentage of people who are uninsured, as measured by the Census Bureau. In the March 2006 Current Population Survey, the Bureau asked whether people had any health insurance coverage in calendar year 2005. An uninsured person is defined as a person who had no coverage at all in 2005. Thus, a person who had health insurance from January thru August 2005 — before Katrina hit — but became uninsured after that would be counted as insured in 2005.
Changes in Private Insurance Coverage
The percentage of Americans with private health insurance declined to 67.7 percent in 2005, marking a pattern of erosion for the past several years. A new research study by Jack Hadley, a health economist at the Urban Institute, found that the main reason that adults' private insurance coverage has faded in recent years is that the costs of insurance premiums have climbed, making coverage less affordable for employers and employees alike. Hadley also found that rising private insurance premiums have led to higher Medicaid enrollment of adults, as low-income workers are squeezed out of private coverage and into Medicaid.[3] Data from the Kaiser Family Foundation show that, on average, employers are requiring employees to contribute more in cost-sharing (i.e., premiums, deductibles, and/or copayments) for their health insurance and that fewer small businesses are offering health coverage.[4]
The Census data also show that individually-purchased health insurance, a small component of the overall private insurance market, has been essentially stagnant. In 2005, the percentage of people covered by such policies was 9.1 percent, a figure largely unchanged over the past several years. The individual market continues to suffer from significant problems. Older individuals and people in poorer health may be unable to afford coverage in the individual market, as coverage may be offered to them at very high prices, or they may be excluded entirely, due to the use of medical "underwriting" (i.e., the use of practices by which private insurance companies charge higher premiums, or fail to offer coverage at all, to individuals who are sicker and likely to incur higher health care costs).[5]
Changes in Medicaid and SCHIP Coverage
The number of Americans covered through either Medicaid or the State Children's Health Insurance Program (SCHIP) remained about the same in 2005 (38.1 million) as in 2004 (38.0 million). Among children under 18, the number covered appeared slightly lower (19.7 million) in 2005 than in 2004 (19.9 million), but these differences may not be statistically significant.[6]
Over a modestly longer horizon — from 2001 to 2005 — Medicaid and SCHIP enrollment climbed from 11.2 percent of Americans to 13.0 percent. These increases helped to offset the reductions in employer-based coverage and kept the number of uninsured people from rising faster. Enrollment in these programs did not climb because of eligibility expansions; some states initiated Medicaid or SCHIP eligibility expansions in this period, but others scaled back eligibility.[7] Enrollment in the public programs rose because of the increase since 2001 in the number of people who are poor and the reduction in the number with employer-based health insurance.
Of particular note, the number of children who are uninsured declined sharply from 11.1 million in 1998 to 7.9 million in 2004, but rose to 8.3 million in 2005 (Table 2). During this period, the main factor driving health insurance coverage downward was erosion in employer-sponsored coverage. Until 2005, these drop-offs were more than outweighed by strong growth in Medicaid and SCHIP coverage of children, rising from 14.3 million in 1998 to 19.9 million in 2004. Between 2004 and 2005, however, the number and percentage of children covered by Medicaid and SCHIP eroded slightly. The number of children covered by these two public insurance programs edged down from 19.9 million in 2004 to 19.7 million in 2005, although it is not clear if this change is statistically significant.
Problems Loom for Children's Coverage
Unlike Medicaid, an entitlement program in which the federal funding provided to states rises or falls as states' needs expand or contract, the SCHIP program is a block grant with capped federal funding. Current projections by the Congressional Research Service, the Department of Health and Human Services, and the Center on Budget and Policy Priorities indicate that federal funding for SCHIP will not meet current needs in at least 17 states in fiscal year 2007, which starts October 1. These states are projected to face federal funding shortfalls totaling an estimated $800 million to $950 million, an amount equal to the federal share of the cost of insuring about 530,000 children.[8] (The 17 states are: Alaska, Georgia, Illinois, Iowa, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, North Carolina, North Dakota, Rhode Island, and South Dakota.)
In the budget it sent to Congress in February, the Administration proposed that additional funds be made available to help fill the shortfalls in the coming year.[9] Congress, however, has not acted to avert the impending shortfall. If it does not do so before fiscal year 2007 begins, the number of uninsured children could rise substantially, and several years of gains in children's coverage could be reversed.
Medicaid enrollment among children also could decline in the coming year because of changes enacted earlier in 2006 as part of federal budget-cutting legislation (the Deficit Reduction Act enacted in February). In particular, one provision of that legislation requires U.S. citizens who are enrolled in, or applying for, Medicaid to document their citizenship by producing documents such as birth certificates or passports. Analyses based on a national representative survey suggest that one to two million U.S. citizens covered by Medicaid, including poor children, pregnant women and mothers, could have their coverage delayed or denied because they do not have these documents readily available.[10] This new requirement is just beginning to be implemented by states and its impact is not yet known.
End Notes
[1] Claudia Schur and Jacob Feldman, "Running in Place: How Job Characteristics, Immigrant Status, and Family Structure Keep Hispanics Uninsured," Commonwealth Fund, May 2001.
[2] Based on analyses of Current Population Survey data by the Center on Budget and Policy Priorities.
[3] Jack Hadley, "The Effect of Recent Employment Changes and Premium Increases on Adults' Insurance Coverage," Medical Care Research and Review, 63(4):447-474, Aug. 2006.
[4] Kaiser Family Foundation/Health Research and Educational Trust, "Employer Health Benefits, 2005," Sept. 2005.
[5] Karen Pollitz and Richard Sorian, "Is the Individual Market Ready for Prime Time?" Health Affairs Web Exclusive, October 23, 2002.
[6] Administrative data from the Centers for Medicaid and Medicare Services show about 6 million children were served in SCHIP in both 2004 and in 2005. Administrative data for children's enrollment in Medicaid in these years are not available.
[7] Donna Cohen Ross and Laura Cox, "In a Time of Growing Need: State Choices Influence Health Coverage Access for Children and Families," Kaiser Commission on Medicaid and the Uninsured, October. 2005.
[8] Matt Broaddus and Edwin Park, "SCHIP Financing Update: In 2007, 17 States Will Face Federal Funding Shortfalls of $800 Million in Their SCHIP Programs," Center on Budget and Policy Priorities, June 5, 2006. CRS estimates $944 million in federal shortfalls in fiscal year 2007 (Testimony of Chris Peterson, Congressional Research Service, to the Senate Finance Health Subcommittee, July 25, 2006). The U.S. Department of Health and Human Services estimates $906 million in shortfalls in 2007 (Testimony of Mark McClellan, Centers for Medicare and Medicaid Services, HHS, to the Senate Finance Health Subcommittee, July 25, 2006). Neither CRS nor CMS estimated the number of children who might be affected.
[9] The Administrations proposal would accelerate the redistribution of SCHIP funds from states with unused funds to states with shortfalls. Alternatively, Congress could appropriate the additional SCHIP funding needed to avert shortfalls in fiscal year 2007, as it did for fiscal your 2006.
[10] Leighton Ku, "Revised Medicaid Documentation Requirement Jeopardizes Coverage for 1 to 2 Million Citizens," Center on Budget and Policy Priorities, July 13, 2006. This assumes that states implement strategies such as data matching to ease the burden of this provision on Medicaid beneficiaries.


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Is it correct to say that there is no need to take any additional safety measures (safety fence, light grid, pressure sensitive edge) against crushing by a downward or upward moving load if the lifting speed of a manually operated box lifter is low (limit value 2m/min)? Is there a relevant C standard (e.g. DIN 1570 for lifting tables)?
Generally a risk assessment must be produced for the lifting device. The lifting device must be built and safeguarded based on this risk assessment.
If the lifting device falls under the requirements of EN 1570-1, then this standard should be applied.
Further information:


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Meiji Tokyo Renka (Dub)
Related episode
Meiji Tokyo Renka (Dub)
Category: Fantasy , Romance , Shoujo , Historical
Anime info:
Mei Ayazuki is just your ordinary, everyday high-school girl. That is until one night, when the moon is full and red, she's transported through time to the Meiji Period by Charlie, a self-proclaimed magician. She ends up in a strange, Meiji-era 'Tokyo' where the existence of ghosts is accepted. Led by Charlie, she finally arrives at the Rokumeikan. There, waiting for her to arrive, are the historical figures Ougai Mori, Shunsou Hishida, Otojirou Kawakami, Kyouka Izumi, Gorou Fujita, Yakumo Koizumi, and Tousuke Iwasaki. Whilst interacting with these men, she discovers she is a Tamayori - someone who can see ghosts - a skill that is highly valued in the Meiji Period. Due to these powers, her relationship with the men begins to change… As she gets to know these handsome men in a new era she just can't get used to, a love begins to grow within her. Will Mei be able to return to her time? What will become of her love - a love that crosses the boundaries of time and space?


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Matthew Bankirer Wins Trail Runner Scavenger Hunt
Heading out the door? Read this article on the new Outside+ app available now on iOS devices for members! Download the app.
In our December 2012 issue, Trail Runner hosted a Scavenger Hunt. Partnering with 15 advertisers, readers were set loose to peruse ads for a small TR snowflake logo (pictured above) and a chance to win $1000 in trail-running gear. Hints were posted weekly on Facebook and Twitter, and entrants filled out an online form indicating where they found the icons in the magazine. On December 21 after all entries were collected, Trail Runner staff announced our winner—Matthew Bankirer, pictured below running a section of the Appalachian Trail near Roan Mountain in North Carolina.
Photo by Tony Ulchar
Bankirer will receive the following prizes:
Redfeather: V-Tail Snowshoes
Amphipod: Hydraform Handheld Thermal-Lite
Salomon: Mission
Brooks: PureProject
Polar: Polar FT7 heart-rate monitor
Nathan: Endurance Hydration Vest
inov-8: 2013 Trailroc
Scarpa: Spark
Vestpac: JacksonPac
Vi Endurance: Three cartons of energy gel (three flavors)
Injinji: Injinji 2.0 Welcome Package (includes trail, run and compression performance toe socks)
CW-X: One free product
UltrAspire: Hydration unit
HOKA: Trail-running shoes
Altra: Trail-running shoes
Atlas: Snowshoes


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If It Ain't Country Music Tee- XL
Sale Sold out
Regular price $20.00 USD
Regular priceUnit price per
Sale price
23 x 28
width x length (inches)
please note all flaws pictured
due to the pre-worn nature of vintage clothing, Grandpa's only offers exchanges for store credit
no returns
free shipping on all orders over $50
Shipping & Returns
Shipping & Returns
Orders can be picked up locally in Fayetteville, AR or shipped through USPS. All shipped orders will be given a USPS tracking code with 5-7 day shipping.
Returns are valid for store credit only. No refunds.


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When you think about swimming pool safety, protecting your eyes may not be the first thing that comes to mind. But spending time in the pool and in the sun can cause trouble for your eyesight and eye comfort.
What is "swimmer's eye"?
This is the eye irritation that can follow a day of fun in the pool. You might feel it as stinging, burning, itchiness, and redness.
But why is playing in the water so tough on the eyes? The chlorine that keeps the pool water clean actually messes with the eye's natural tear production. We have a tear film coating the surface of our eyes, keeping our eyes moist and clear. But chlorine actually washes away that film, which is why pool time often leads to dry eyes.
Chlorine is only part of the problem. Exposure to chlorine and chloramines can cause an eye infection called chemical conjunctivitis (pink eye caused by chemical irritants). Chloramines are chemicals that are formed when chlorine binds to the bodily fluids people bring into the pool. Nope — it's not pleasant, and neither are the effects on our eyes if we expose them to those chemicals.
Even with the presence of chlorine, certain bacteria can linger and enter the eye, leading to bacterial conjunctivitis.
Protecting your eyes from pool water
So how can you protect your eyes from swimmer's eye, and what should you do if you or your child has eye problems after spending time in the pool?
First, always wear swim goggles. Our tear film is designed to protect our eyes, but swim goggles help provide an additional layer of protection when our natural protection can be compromised.
Next, don't wear contact lenses in the pool. Contact lenses can act as traps for bacteria, which then sit on your eyes, and this risk is even greater when you're in a pool, hot tub, or even the ocean or a lake. Ask your eye doctor about prescription swimming goggles and wear those to prevent the corneal infection that can result from wearing contacts in water.
Sport your sunglasses whenever you're poolside. Protect your eyes from the UV rays that reflect off the water by using sunglasses. Look for sunglasses that are labeled "100% protection against UVA and UVB," or "100% protection against UV 400." Sunburned eyes plus swimmer's eye make for a miserable combination.
Splash your eyes with fresh water after swimming. This will help rinse the chlorine and chloramine off your eyelashes and eyelids.
Use soothing eye drops. You can use over-the-counter eye drops or tear gel before and after swimming to protect your eyes and help them to feel more comfortable.
Place a cold compress over your eyes. If your eyes do feel irritated, a compress applied intermittently can reduce redness and inflammation, make your eyes more comfortable and encourage tears to form.
When to see your eye doctor
If the redness and pain don't decrease, or if you have blurred vision, swelling, discharge, or sensitivity to light, make an appointment with your eye doctor so he or she can rule out infection.
Need prescription swim goggles or sunglasses for you or your pool-loving kiddos? Make an appointment to see your eye doctor to learn about your options.


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Great discussions are par for the course here on Lifehacker. Each day, we highlight a discussion that is particularly helpful or insightful, along with other great discussions and reader questions you may have missed. Check out these discussions and add your own thoughts to make them even more wonderful!
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