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Exercise training with negative pressure ventilation improves exercise capacity in patients with severe restrictive lung disease: a prospective controlled study
© Ho et al.; licensee BioMed Central Ltd. 2013
- Received: 29 November 2012
- Accepted: 18 February 2013
- Published: 19 February 2013
Exercise training is of benefit for patients with restrictive lung disease. However, it tends to be intolerable for those with severe disease. We examined whether providing ventilatory assistance by using negative pressure ventilators (NPV) during exercise training is feasible for such patients and the effects of training.
36 patients with restrictive lung disease were prospectively enrolled for a 12-week multidisciplinary rehabilitation program. During this program, half of them (n:18; 60.3 ± 11.6 years; 6 men; FVC: 32.5 ± 11.7% predicted ) received regular sessions of exercise training under NPV, whilst the 18 others (59.6 ± 12.3 years; 8 men; FVC: 37.7 ± 10.2% predicted) did not. Exercise capacity, pulmonary function, dyspnea and quality of life were measured. The primary endpoint was the between-group difference in change of 6 minute-walk distance (6MWD) after 12 weeks of rehabilitation.
All patients in the NPV-exercise group were able to tolerate and completed the program. The between-group differences were significantly better in the NPV-exercise group in changes of 6MWD (34.1 ± 12.7 m vs. -32.5 ± 17.5 m; P = 0.011) and St George Score (−14.5 ± 3.6 vs. 11.8 ± 6.0; P < 0.01). There was an improvement in dyspnea sensation (Borg's scale, from 1.4 ± 1.5 point to 0.8 ± 1.3 point, P = 0.049) and a small increase in FVC (from 0.85 ± 0.09 L to 0.91 ± 0.08 L, P = 0.029) in the NPV-exercise group compared to the control group.
Exercise training with NPV support is feasible for patients with severe restrictive lung diseases, and improves exercise capacity and health-related quality of life.
- Restrictive lung disease
- Negative pressure ventilation
- Exercise training
- Exercise capacity
- Health-related quality of life
Patients with restrictive lung diseases (RLD) often suffer from dyspnea, fatigue and impairments in muscle force, exercise tolerance, and activity of daily life (ADL), leading to a decrease in health-related quality of life (QoL) [1–3]. This is due to a complicated combination of impairments in ventilation and gas exchange and a number of secondary changes such as peripheral muscle, cardiac, nutritional, and psychological impairments [4]. Following the consensus of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) [5, 6], evidence is growing that patients with RLD, which share many manifestations and physiological impairments with COPD, may also benefit from PR. Early randomized control studies have reported an improvement in exercise capacity and QoL after 8–10 weeks of exercise training [7, 8]. The benefits disappeared after 6 months, however this could be overcome by longer programs extending to 24 weeks which showed even better results [9]. Although the latter studies were weakened by the non-randomized and non-controlled design, the message is important. As many of those likely to be enrolled tend to have early and profound exercise-induced oxygen desaturation, dyspnea and peripheral muscle weakness, an extended program may offset the low initial training load [4]. Alternatively, exercise training with some assistance, and in particular ventilatory support, may be useful, although this has not yet been extensively tested.
Non-invasive mechanical ventilatory techniques include the use of negative and positive pressure ventilators. Using non-invasive positive pressure ventilators (NPPV) as an aid during exercise training has been reported to enable a higher intensity of training for patients with severe COPD, leading to larger improvements in exercise performance [10, 11]. In patients with severe RLD, NPPV during exercise has been shown to improve oxygenation and exercise tolerance [12], whilst the effect on exercise training has not been studied. Nevertheless, some practical drawbacks such as discomfort from the mouthpiece or mask [10] can result in a substantial number of patients dropping out [13]. Alternatively, negative pressure ventilators (NPV) (iron lungs) have been shown to be as effective as NPPV in certain conditions such as acute exacerbation of COPD, and to play a role in those who cannot tolerate a facial mask [14]. Short-term intermittent NPV has been demonstrated to improve ventilation and increase PaO2 in patients with severe hypercapnic COPD [15].
We hypothesized that an exercise training PR program with NPV support in patients with severe RLD would increase exercise capacity, decrease dyspnea sensation, and improve the QoL. We tested this hypothesis by conducting a prospective controlled study with exercise capacity as the primary endpoint.
Materials and methods
This prospective, non-randomized, controlled study was carried out from 30 November 2008 to 30 May 2010 at Chang Gung Memorial Hospital, a university hospital in Linko, Taiwan. All patients with severe RLD referred by the chest physicians from the outpatient department for pulmonary rehabilitation were eligible for inclusion if they were clinically stable and presented with forced vital capacity (FVC) ≤ 50% predicted. Patients were excluded if they had a coexisting airway obstruction (forced expiratory volume in one second (FEV1)/FVC ≤ 70%), other respiratory diseases such as asthma, tuberculosis, COPD, bronchiectasis, cancer, and acute infection in the last 3 months. The decision to receive NPV-supported exercise training was made by the chest physician after discussing the program with the patients and their family. The protocol was approved by the institutional review board (CGMH 97-1032B). Each patient gave informed consent to participate.
Study design
All patients attended a 12-week, twice-a-week, outpatient, multidiscipline PR program, consisting of breathing retraining, limb exercise training and an education program (lectures and discussions on RLD, medication use and nutrition, relaxation techniques, and home exercise). The patients in the NPV-exercise group also received endurance exercise training consisting of 20 minutes of submaximal cycle ergometry, combined strength/resistance training of the upper limbs through a series of 10 repetitions against progressive resistance, and specific training of respiratory muscles and breathing technique exercises of the thoracic and abdominal muscles, guided by Borg's scale (score between 4 to 6 for dyspnea and fatigue), with the support of NPV (control + sign model delivered by −20 cmH2O delivery pressure and +3 cmH2O base pressure, 12 cycles per minute, inspiratory time to expiratory time (I/E) ratio 2.5). To determine the exercise capacity, a symptom-limited bicycle ergometry test as previous reported [16] was performed using a ramp 10, 15, or 20 protocol, depending on the patient's fitness. The load was increased every minute by 10, 15, or 20 Watts, respectively, in such a way that patients could reach their maximal workload within 10 minutes. The test was terminated on the basis of the patient's symptoms or at the physician's discretion. Maximal workload in Watts at maximal performance was taken for analysis. 40–60% of the maximal workload was used as the intensity of training. All patients were established on an unsupervised home endurance exercise program of 20–30 minutes walk, continuously or intermittently (in sessions lasting 10 or more minutes) per day, guided by 40–60% of target heart rate or 4–6 on the modified Borg scale, with the aim of achieving 3 to 5 exercise sessions per week. Oxygen was provided by a nasal cannula to maintain SatO2 ≥ 90% during the whole PR course for all patients.
Clinical assessments
FEV1, FVC and FEV1/FVC were recorded using a spirometer (ST-250, Fukuda Sangyo Co. Ltd.) and 6-minute walk test (6MWT) was performed with a pulse oximeter by a finger transducer (Criticare Systems Inc.) according to the ATS guidelines [17, 18]. The dyspnea score was rated by patients according to a modified Borg's scale [19], in which words describing increasing degrees of dyspnea were assigned to numbers between 0 (no dyspnea) and 10 ( maximal dyspnea).
Health-related quality of life (HRQoL) was assessed using St. George's Respiratory Questionnaire (SGRQ), a self-administered questionnaire measuring impaired health and perceived HRQoL for airways disease. It consists of 76 items including symptoms, activity, impact and total scores. The scores range from 0 (no impairment) to 100 (the worst impairment), in which higher scores connoted greater distress and worse HRQoL [20].
Maximal voluntary isometric muscle force of the right and left extremity of the following muscle groups was measured: extension of the knees and flexion of the elbows, using a handheld dynamometer (Hoggan Health Industry, West Jordon, Utah USA). The test was repeated three times, and the best result of either side was used in the analyses.
Statistic analysis
Descriptive statistics were expressed as mean ± SD. Between group changes in pulmonary functions, 6MWD, Borg score and SGRQ scores were analyzed using the Mann–Whitney U test. 6MWD, FVC, FEV1 and SGRQ at enrollment, and after 4 weeks, 12 weeks and 52 weeks were compared using the Friedman test with Dunn's multiple comparison post-test for the NPV-exercise group. SGRQ before and after the 12-week PR program was compared by the Wilcoxon signed rank test. Data were presented as mean ± SD. A p value less than 0.05 was considered significant. Data analyses were performed using the GraphPad Prism 5.01 software package (GraphPad Software, San Diego, CA).
Study population
Eighteen patients (6 males and 12 females, mean age 60.3 ± 11.6 years; FVC: 32.5 ± 11.7% predicted) in the NPV-exercise group, and 18 patients (8 males and 10 females, mean age 59.6 ± 12.3 years; FVC: 37.7 ± 10.2% predicted) in the control group were enrolled. Before entry into the program, most of the patients could not tolerate exercise training without NPV support. All of the eighteen patients in the NPV-exercise group completed the 12-week NPV-exercise program.
Characteristics of patients with restrictive lung disease in both groups
Non-NPV exercise group
NPV-exercise group
Number of patients
Age, years
59.6 ± 12.3
60.3 ± 11.6
Gender, M/F
BMI, kg/m2
19.7 ± 5.0
21.5 ± 4.6
1.05 ± 0.34
0.85 ± 0.37
FVC, % predicted
37.7 ± 10.2
32.5 ± 11.7
0.88 ± 0.26
0.72 ± 0.32
FEV1, % predicted
42.2 ± 2.4
36.9 ± 13.6
84.2 ± 8.3
83.1 ± 13.6
6MWD, m
362.8 ± 99.4
371.3 ± 77.9
Borg score, median(range)
0.5 (0–4)
1.25 (0–4)
Changes in 6MWD and dyspnea sensation
Changes in pulmonary function, 6-minute walk test, and health-related quality of life before and after 12 weeks of pulmonary rehabilitation
Non-NPV-exercise group
NPV-exercise group
12 weeks
12 weeks
(n = 18)
(n = 18)
(n = 18)
(n = 18)
FVC, % predicted
37.7 ± 2.4
37.9 ± 3.2
32.6 ± 2.8
35.1 ± 2.7a
FEV1, % predicted
42.2 ± 2.9
43.9 ± 4.3
36.9 ± 3.2
40.3 ± 3.3a
84.1 ± 8.6
83.6 ± 7.8
82.9 ± 9.4
83.5 ± 10.8
6MWD, m
362.8 ± 99.4
330.3 ± 94.4
371.3 ± 77.9
405.4 ± 78.1a
SaO2, % pre/post 6MWT
94.0/ 81.4
93.2/ 76.8
93.9/ 77.0
94.6/ 79.1
HR, pre/ post 6MWT
98.2/ 125.8
101.4/ 127.7
103.3/ 126.7
92.0/ 123.4
Borg, pre/ post 6MWT
0.5/ 5.0
1.5/ 7.0
1.25/ 5.0
0/ 4.5a
(0–4)/ (3–10)
(0–4)/ (2–9)
(0–4)/ (4–8)
(0–4)/ (1–8)
Limb muscle power
R-upper limb, lb
32.9 ± 1.8b
32.3 ± 1.6b
31.0 ± 2.1c
33.5 ± 2.2a, c
L-upper limb, lb
30.2 ± 3.5b
33.0 ± 4.7b
29.6 ± 1.6c
30.3 ± 1.6c
R-low limb, lb
44.3 ± 3.9b
46.2 ± 4.9b
38.5 ± 3.0c
41.4 ± 2.3c
L-low limb. lb
41.2 ± 3.4b
41.3 ± 4.6b
38.2 ± 2.7c
40.7 ± 2.2c
Symptom score
48.2 ± 6.0e
46.5 ± 6.1e
54.6 ± 5.0
24.5 ± 4.0a
Active score
61.6 ± 6.0e
72.3 ± 6.1e
53.7 ± 5.8
45.9 ± 5.6a
Impacts score
30.0 ± 4.2e
46.7 ± 7.0a,e
36.2 ± 5.7
22.6 ± 5.1a
Total score
42.6 ± 4.6e
54.4 ± 4.9e
44.6 ± 4.8
30.0 ± 4.4a
The improvement in 6MWD in the NPV-exercise group was accompanied by an improvement in resting dyspnea sensation as determined by the modified Borg scale (Table 1, 1.4 ± 1.5 points vs. 0.8 ± 1.3 points, P = 0.049). In contrast, there was no change in Borg scale (1.3 ± 0.4 points vs. 1.6 ± 0.4 points, P = 0.573) in the control group. Both groups of patients suffered from O2 desaturation during 6MWT, which was not improved in either group at 12 weeks.
Changes in pulmonary function
Changes in health-related quality of life
Effects of NPV-exercise training vs. Control in patients with interstitial lung disease and patients with chest wall deformities
Changes in pulmonary function, 6-minute walk test, and health-related quality of life before and after 12 weeks of pulmonary rehabilitation in patients with interstitial lung disease vs. chest Wall disease
Non-NPV-exercise group
NPV-exercise group
12 weeks
12 weeks
FVC, % predicted
40.3 ± 10.3
38.4 ± 13.5
36.3 ± 13.0
40.5 ± 11.6b, c
Chest wall
32.7 ± 8.6
37.0 ± 14.5
28.0 ± 8.5
28.3 ± 7.4
FEV1, % predicted
45.6 ± 11.8
43.8 ± 18.2
40.9 ± 15.8
45.9 ± 15.2a
Chest wall
35.3 ±11.3
44.2 ± 20.2
31.9 ± 8.6
33.3 ± 8.0
81.8 ± 6.8
84.4 ±7.9
82.3 ± 9.7
81.0 ±11.8
Chest wall
88.8 ± 10.6
82.2 ± 8.1
83.8 ± 9.7
86.6 ± 9.1
6MWD, m
385.2 ± 82.6
355.3 ± 85.0
352.3 ± 52.8
399.5 ± 45.1a
Chest wall
318.2 ± 122.4
288.0 ± 99.3
395.0 ± 99.9
412.8 ± 109.8
SaO2, % pre/post 6MWT
94.3/ 78.7
93.1/ 78.6
Chest wall
94.8/ 77.3
93.3/ 73.3
Borg, pre/ post 6MWT
0.9/ 5.1
1.7/ 5.5
Chest wall
2.0/ 5.8
1.1/ 5.3
Symptom score
47.6 ± 21.5c
42.1 ± 19.3c
61.7 ± 16.6e
29.5 ± 19b,e
Chest wall
50.3 ± 5.8d
64.1 ± 0.2d
53.7 ± 5.8f
45.9 ± 5.6a,f
Active score
62.2 ± 21.5
73.7 ± 12.8
61.4 ± 27.4
53.5 ± 23.2
Chest wall
59.5 ± 0.0
66.4 ± 18.8
43.9 ± 17.6
36.5 ± 22.0
Impacts score
29.3 ± 13.6
43.9 ± 19.2
48.3 ± 25.3
30.0 ± 25.3a
Chest wall
32.9 ± 16.7
58.0 ± 38.9
21.2 ± 11.7
13.5 ± 12.2
Total score
42.3 ± 16.0
52.6 ± 14.0
54.5 ± 21.3
37.0 ± 21.1a
Chest wall
43.8 ± 9.8
61.6 ± 26.4
32.2 ± 10.0
21.3 ± 11.5a
The present study investigated the effect of exercise training under the support of NPV for patients with severe RLD. This study was designed in a prospective controlled setting. The between group difference in Δ6MWD, the primary end point, reached statistical difference in favor of the NPV-exercise group. An improvement in SGRQ was also seen in the NPV-exercise group compared with the control group.
Although exercise training PR programs can improve exercise capacity and HRQoL in patients with RLD for those with severe disease [8], it tends to be intolerable. The patients enrolled for PR training in the present study (FVC 32.5 ± 11.7% predicted) appeared to be more severe than those in previous reports (FVC 48–68% predicted) [7–9]. Almost none of the patients were able to perform functional exercise tasks because of severe ventilation impairment accompanied with muscle weakness and deconditioning. Muscle weakness can be overcome by ventilation support as demonstrated by Borel et al [12]. With the assistance of NPV, all patients in the study group well tolerated the exercise PR program, and they also achieved even better results (difference in 6MWT between groups 66.6 m) than those demonstrated in earlier reports (35.0–46.3 m) [7, 8]. This difference is greater than the minimal clinical important difference (MCID) for COPD (54 m) [21] and that for idiopathic pulmonary fibrosis (24–45 m) [22]. Nevertheless, our patients comprised a heterogeneous group of patients with different diseases, for most of which the MCID has not been defined. Whether the improvement in exercise capacity reaches clinical significance needs further study to confirm.
Ventilation support by using NPPV can unload ventilator muscles, leading to a reduction in breathing work and dyspnea sensation [23]. This unloading has also been demonstrated to improve peripheral muscle oxygenation in the absence of changes in systemic oxygen delivery in patients with advanced COPD during high-intensity exercise, probably due to redistribution of cardiac output to appendicular muscles [24]. This will not only allow a greater intensity of exercise but also allow it to be sustained for longer periods to achieve a training effect [11]. Although not proven directly, NPV may also benefit patients with severe RLD through similar mechanisms such that patients may be able to tolerate exercise training to an extent of adequate intensity. Increased peripheral muscle oxygenation may also contribute to a better training efficacy. Although more data is necessary to support this theory, this concept may be a rationale to introduce NPV during exercise training for patients with RLD with less severity, or even other respiratory diseases such as COPD.
The present study showed that an NPV-assisted exercise program remarkably improved health-related quality of life (HRQoL), as demonstrated by the SGRQ scores. Patients in the NPV-exercise group had clinically significant decreases in total and almost all components of the scores, e.g. symptoms, activity and impact. This is consistent with most previous reports observing the effects of exercise training on HRQoL in a range of RLD using the Chronic Respiratory Disease Questionnaire [8, 9] or the SGRQ [7]. Both resting and post-exercise dyspnea sensation, determined by the Borg score, also improved. This improvement was not associated with changes of muscle power or O2 saturation. Interestingly, we observed a significant increase in pulmonary function, including FEV1 and FVC, after 12 weeks of training. Importantly, the increase in FVC (2.5% predicted) reached the recently defined minimal clinical important difference for IPF [25], in which the small changes of 2–6% were thought to be clinically important. This was not seen in previous reports on exercise training for RLD patients [8, 9]. Further study is needed to see whether this improvement in pulmonary function has clinical significance. Of note, Smith et al. reported their experience of treating kyphotic patients with nocturnal non-invasive ventilation, either with an individually constructed cuirass shell and a negative pressure pump or nasal intermittent positive pressure ventilation, long-term use of which resulted in a significant increase in FEV1 and FVC [26]. As the between group difference in FVC in the present study, albeit with a trend, was not statistically significant, further studies enrolling more patients is necessary to confirm our observations.
The present study did not include a group of NPV without endurance training. It is therefore not conclusive whether the study group got benefits from NPV and/or exercise training. Guzun et al. recently reported that physical training at mild intensity, even below the level expected for a physiological training effect, can induce comparable changes in skeletal muscles oxidative energy metabolism in patients with COPD and sedentary healthy subjects [27]. Thus it is interesting to conduct a study to explore the pure effect of NPV or NPV with physical activity of mild intensity.
A limitation of the study is the non-randomized design. This is dictated by the fact that few patients were willing to be randomized in such kind of intervention. Nevertheless, the baseline characteristics were similar between the two groups such that a skewed population in each group, although cannot be completely excluded, became less likely. In addition, there is heterogeneity of patients. Subgroup analysis revealed that NPV-exercise training benefited both ILD and CWD patients in HRQoL. Whereas this training improved exercise capacity and pulmonary functions in ILD patients, it only had a trend of improvement (exercise capacity) or no effects (pulmonary functions) in CWD patients. Whether this training has clinically relevant effects on exercise capacity in these patients needs to be confirmed in a larger scale of study.
Ventilation support with NPV during exercise training is feasible for patients with severe RLD who are profoundly intolerant to exercise. In such patients, exercise training with NPV support increases exercise capacity and HRQoL to a level of clinical importance, at least in patients with ILD. Thus, NPV should be considered for patients with severe RLD who are not able to tolerate exercise training with adequate intensity. Our study also raises the possibility that NPV enhances the training effect of exercise through redistribution of cardiac output to the limb muscles, and that NPV increases pulmonary functions. Further studies to confirm these findings are warranted and may potentially extend the use of NPV in pulmonary rehabilitation for patients with RLD, and potentially for other chronic conditions with impairment in exercise tolerance.
The authors wish to thank the patients and personnel of the hospital unit for their cooperation during the course of this study.
This work was supported by grants to S.-C. Ho. from Chang Gung Memorial Hospital (CMRPG371891).
Authors' Affiliations
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subset: commoncrawl


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Study Finds That Fast Food Ice Is Dirtier Than Toilet Water
A study by the UK's The Daily Mail found that ice from McDonald's, Starbucks, Burger King and KFC (to name a few) is dirtier than toilet water. Most fast food restaurants don't even offer real food, it's usually riddled with a number of industrial toxic chemicals and harmful GMOs. Anything that sparks the reader to question what they are consuming and where it comes from is useful info. Anything that encourages readers to stay away from fast food is useful. Not long ago, strange fibers were found embedded inside Chicken McNuggets. Hopefully this video gives you another reason to stay away from fast food.
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Real Salt, Celtic Salt and Himalayan Salt
In Brief
- The Facts:
This article was originally written by Dr. Mark Sircus, Ac., OMD, DM (P) (acupuncturist, doctor of oriental and pastoral medicine) and published at Greenmedinfo.com. Posted here with permission.
- Reflect On:
Do you know the difference between refined salt and unrefined salt?
This is what real salt looks like—we all know what regular white salt looks like—and we mistakenly think it is real salt when it is not. The fact is that refined white salt, such as commercial table salt is bad, very bad stuff. Unrefined natural salt on the other hand is good, very good stuff providing many health benefits.
Unrefined sea salt is healthy. The blood-pressure-raising effect of table salt can be due to its high content of sodium with not enough magnesium to balance it. This has a magnesium-lowering effect that can constrict the arteries and raise blood pressure. Real salt (of various kinds) contains plenty of magnesium and other important minerals, which is why it usually does not affect blood pressure in a negative way.[1]
Sodium is an essential nutrient required by the body for maintaining levels of fluids and for providing channels for nerve signaling. Some sodium is needed in your body to regulate fluids and blood pressure, and to keep muscles and nerves running smoothly.
Without appropriate amounts of sodium, your body may have a difficult time cooling down after intense exercise or activity. When the body is hot, you sweat. If you do not have enough sodium, your body may not sweat as much and you may then become overheated. This could result in a stroke or exhaustion as well as dehydration.
Sodium is an energy carrier. It is also responsible for sending messages from the brain to muscles through the nervous system so that muscles move on command. When you want to move your arm or contract any muscle in your body, your brain sends a message to a sodium molecule that passes it to a potassium molecule and then back to a sodium molecule etc., etc., until it gets to its final destination and the muscle contracts. This is known as the sodium-potassium ion exchange. Therefore, without sodium, you would never be able to move any part of your body.
Excess sodium (such as that obtained from dietary sources) is excreted in the urine.[2]Most of the sodium in the body (about 85%) is found in blood and lymph fluid. Sodium levels in the body are partly controlled by a hormone called aldosterone, which is made by the adrenal glands. Aldosterone levels determine whether the kidneys hold sodium in the body or pass it into the urine.
Dr. David Brownstein weighs in heavily on this matter saying, "Nobody makes a distinction between unrefined and refined salt. They 'lump' all salt together as a bad substance. This is a terrible mistake. There are two forms of salt available in the market place: refined and unrefined. Refined salt has had its minerals removed and has been bleached to give it the white appearance that we are accustomed to seeing with salt. It is the fine, white salt that is available at almost any restaurant or grocery store. Refined salt has been bleached and exposed to many toxic chemicals in order to get it to its final product. It has aluminum, ferrocyanide, and bleach in it. I believe this refining process has made it a toxic, devitalized substance that needs to be avoided."
Link to book: http://www.drbrownstein.com/Salt-Your-Way-to-Health-p/salt.htm
"Unrefined salt, on the other hand," Brownstein continues, "has not been put through a harsh chemical process. It contains the natural minerals that were originally part of the product. Its mineral content gives it a distinct color. The colors of unrefined salt can vary depending on where it is taken from. This is due to the changing mineral content of the various brands of salt. It is the minerals in unrefined salt that provide all the benefits of this product. The minerals supply the body with over 80 trace elements needed to maintain and sustain health.
Furthermore, the minerals elevate the pH (correct acidity) and lower blood pressure. Our maker gave us salt to use in our diet—unrefined salt—with its full complement of minerals. It should be the salt of choice. It is a vital ingredient that needs to be part of everyone's diet."
Dr. Brownstein says, "Years ago salt manufacturers decided that pure white salt is prettier than off-white salt and that consumers prefer pretty white salt. So they started bleaching it. They also added anti-clumping agents to increase its shelf life. The problem is that the chemicals added to keep salt from absorbing moisture on the shelf interfere with one of salt's main functions: to regulate hydration in your body. The sodium chloride in table salt is highly concentrated, denatured, and toxic to your body. Ever put salt on an open cut? It burns!!!
Refined salt has the same effect on internal tissues and causes a negative reaction: your body retains water to protect itself, and your cells release water to help dilute, neutralize, and break down the salt. This loss of water dehydrates and weakens your cells and can even cause them to die prematurely. Natural sea salt is far superior to chemically-treated iodized table salts as it contains all 92 trace minerals, and it's only 84% sodium chloride while table salt is almost 98%".
All this adds up to one thing. Table salt, whether marine or not, is toxic—it's poisonous to the body and is responsible, in great part, to the onset of many terrible diseases including thyroid and metabolic dysfunction.
In addition to sodium and chloride, Celtic Sea Salt® provides other nutrients that naturally occur in salt beds, including trace amounts of calcium, magnesium potassium, iron and zinc.
In accordance with standards set by The World Health Organization and the Food and Agriculture Organization, independent analysis indicates that levels of heavy metals are non-detectable (e.g. arsenic, cadmium, mercury) or well below published safe limits in Celtic Sea Salt®. Perhaps most importantly, Celtic Sea Salt® is not exposed to refinement and bleaching used to manufacture typical table salt and there are no additives. Celtic Sea Salt® is harvested from the ocean using the sun, the wind and shallow clay ionizing ponds, a method passed down through the generations.
Many Americans over consume refined salt by eating processed foods, fast foods and canned foods with salt added. Celtic Sea Salt® is a good alternative as part of a healthier diet. Recommended use is a half teaspoon per day.
Himalayan crystal salt that is mined 5,000 feet deep below the Himalayan mountain range was subject to enormous pressure over millions of years and is over 99% pure. The higher the amount of pressure the more superior or excellent the state of order within the crystalline structure of salt. Many Himalayan salts are sold cheaply but are collected from higher up near the tops of the Himalayan Mountains instead of from the deeper mines. These salts contain more impurities, do not have the same structure and are not as easily assimilated by the body.
Himalayan salt contains 84 minerals and trace elements in ionic state and is a delightful pink color. People often state that they use less of this salt than of other types. Many sizes are available from 3 oz in a salt grinder to larger 1-kg bags (2.2 lb). Salt chunks are also available for making your own "sole," which is a saturated solution of purified water with Himalayan salt. A specific recipe (see below) must be followed to make sole and results in a solution that has much less sodium than just adding salt to water would have. Daily use of sole is believed to stimulate the peristalsis of the digestive organs, balance the stomach acid, support the production of digestive fluids in the liver and pancreas, regulate the metabolism and harmonize the acid-alkaline balance.
Start Each Day with a Healthy Sole
The ideal way to use Himalayan Crystal Salt is in the form of a sole (so-LAY). Drinking the sole when you awake each morning is like getting up on the right side of the bed. It provides the energizing minerals you need daily to recharge your body, and it helps set the stage for a day of vitality.
Essentially, a sole is water saturated with Himalayan Crystal Salt. The sole contains about approximately 26 parts of salt to 100 parts of water. Prepare the water and salt combination in advance (see directions to the right). Each morning place a teaspoon of the sole mixture in a glass and fill with 8 ounces of pure spring water. Drink it immediately or sip it while getting dressed, checking emails or preparing breakfast. The water helps transport the electrolytes throughout the body to all the many places they are needed.
How to Prepare Sole
Sole is a mixture of water and salt. The object is to saturate the water with dissolved salt so it can't hold anymore. You'll know that you've created sole when there are undissolved salt crystals in the water. You can't oversaturate the water with salt. The crystals will simply drop to the bottom of the container.
Place several Himalayan Crystal Salt stones or Himalayan Crystal Salt granules about an inch deep in a glass container. (A canning jar works well.)
Cover the salt with two to three inches of pure, spring water. Let the salt dissolve for 24 hours.
If all the salt dissolves in 24 hours, add more salt to the container. The sole is finished when the water can no longer dissolve the salt and the salt crystals drop to the bottom of the container. There will always be salt crystals in the jar. It doesn't matter if you have only a few crystals or many. The water is saturated and is now sole.
Cover the container to prevent the water from evaporating. Since salt is a natural preservative, the sole will keep forever. It can't spoil or go "bad."
The vibrational energy of the Himalayan Crystal Salt remains in your body for 24 hours.
A teaspoon of sole contains 480 mg of sodium, or 20% of the Daily Reference Value of 2400 mg based on a 2,000 calorie per day diet.
Redmond Real Salt is mined in the United States and is another good unrefined salt that I also recommend. It can be used as a table salt and for cooking and is available in coarse and fine grinds and in a variety of sizes.
Real Salt comes from a mineral rich salt deposit formed by an ancient sea in Utah. It contains 62 trace minerals, and is without additives, chemicals, or heat processing of any kind. Real Salt's unique pinkish appearance and flecks of color come from the more than 60 naturally occurring trace minerals. The result is a delicate "sweet salt" flavor that you may not have experienced before.
Special Note: I was very disappointed to hear Dr. Max Gerson's daughter Charlotte Gerson saying, "That sodium is never good, never in any form!" I have put Gerson in the best light in my writings and his organization does hold the high ground for organic raw juicing but there are some things they say that have no grounding in medical science or clinical reality. Talk to Dr. David Brownstein and he will tell you that often the first thing a patient needs is water and salt but its real salt not table salt he is talking about and prescribing for his patients.
I have written a full essay addressing this communication from Charlotte. And I have another essay on using seawater as a medicine and that will be seen in my Treatment Essentials book that is now finished and ready for publication on the 15th of February. To even think of discounting the medical miracles from the sea, which Charlotte is clearly doing, makes me shudder.
- [2] These processes in the body, especially in the brain, nervous system, and muscles, require electrical signals for communication. The movement of sodium is critical in the generation of these electrical signals. Too much or too little sodium therefore can cause cells to malfunction, and extremes in the blood sodium levels (too much or too little) can be fatal – http://www.medicinenet.com/electrolytes/article.htm
For more info from Greenmedinfo, sign up for their newsletter, here.
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AMA Says Mature 12-Year-Olds Can Consent to Vaccination Without Parents
At the recently concluded annual meeting of the American Medical Association (AMA) in Chicago, AMA delegates adopted a doozy of a new policy. The powerful trade group agreed to develop model legislation that pressures state legislatures into allowing minors to "override refusenik parents on vaccination."
In 2000, the Supreme Court reasserted the fundamental right of parents to oversee the care, custody and control of their children, a right recognized by states until children reach age 18. Where vaccines are concerned, the National Childhood Vaccine Injury Act—passed in 1986—legally requires health care providers to distribute vaccine information materials to the parent or legal guardian of any child to whom the provider intends to administer a vaccine "prior to the administration of such vaccine" [emphasis added].
Does it trouble the AMA that its pronouncement goes against legal precedent as well as social custom? Apparently unconcerned about "chipping away at parental rights," AMA representatives are gung-ho about the organization's new policy position. Not only do they want minors as young as 12 to be able to consent to vaccination regardless of their parents' "flawed beliefs"—while still expecting parents to pay for the vaccines—they also believe that doctors should be the ones declaring a child "mature enough" to consent to vaccination. A question that anyone familiar with the AMA's history should be asking is, why would we trust the AMA to make such vital decisions in parents' stead?
… one-fourth of the AMA's total revenues were CPT-related [the medical services coding system]—representing double what the organization received from membership dues. This gigantic conflict of interest, according to the Forbeseditorialist, makes the AMA more a tool of Washington's interests than those of doctors.
Outsized influence
The AMA's membership has been plummeting in recent decades. A 2011 analysis of its membership "woes" estimated that the Association captures just 15% of practicing doctors, down from 75% in the early 1950s. The AMA's membership challenges do not mean that the organization lacks clout, however. In fact, the AMA has a variety of potent tools at its disposal to ensure that it "remain[s] relevant at the national level." These include a political action committee and a vast lobbying war chest (with upwards of $20 million spent in 2018), all of which translates into outsized influence over both health care policy and public perceptions.
A 2016 report on Capitol Hill lobbyists rated the AMA one of the top "movers and shakers" in Washington, ranking among the "select few [that] have shown an ability to get things done." A former AMA president modestly admitted as much, stating that "What the AMA does, and does best, is in the advocacy arena." An analysis of the top 20 health care lobbyists found that the AMA ranked the highest in terms of "all-time spending" and ranked number five in spending "among all lobbyists, regardless of industry."
The lobbying firms that the AMA hires are often the same as those used by the pharmaceutical industry. The AMA Foundation's roster of high-level Corporate Roundtable members consists almost entirely of pharmaceutical industry members—including the four companies that manufacture all childhood vaccines in the U.S. (Merck, GlaxoSmithKline, Pfizer and Sanofi). Drug company advertising also dominates the pages of the AMA's flagship journal JAMA, even though many are "the very same drugs that are…killing tens of thousands of Americans each year, according to senior drug safety researchers at the FDA." Nor does the AMA hesitate to provide a "seal of approval" for products and drugs—earning sizeable advertising fees—"despite the fact that the organization has no capacity to test such drugs."
In 2011, Forbes pointed out that the AMA reaps huge financial rewards through its Current Procedural Terminology (CPT) medical services coding system, used by health care providers, payers, and facilities across the U.S. Given the CPT system's importance to large public programs such as Medicare, the system essentially amounts to a "government-granted monopoly" and AMA "windfall." In 2010, one-fourth of the AMA's total revenues were CPT-related—representing double what the organization received from membership dues. This "gigantic conflict of interest," according to the Forbes editorialist, makes the AMA "more a tool of Washington's interests than those of doctors."
The AMA also has a sordid history of racketeering. Economist Milton Friedman wrote some years ago of the AMA's concerted attacks on chiropractors and osteopathic physicians, and in a 1987 antitrust lawsuit brought by chiropractors, the judge agreed that the AMA had conspired "to contain and eliminate a profession that was licensed in all fifty states." The judge also decried the Association's "long history of illegal behavior." In the early 2000s, the courts again found the AMA (along with managed care companies) guilty of racketeering through manipulation of the AMA's coding software.
Did the zealous school nurse who recently administered a human papillomavirus (HPV) vaccine to an 11-year-old boy without parental consent—while telling the mother that all he got was an ice pack—follow "legal, ethical, and professional guidelines"?
Undermining parents
Efforts to circumvent parents' involvement in their children's health care have been underway for quite some time, notably in the reproductive health arena. For services related to contraception and sexually transmitted infections, health providers are only too happy to shout down parental objections, arguing that young people's need for confidential medical services is "more important" than parents' right to be informed of their child's condition.
Now, researchers are laying down the train tracks to make the same case for vaccines. In 2014, top-tier adolescent health experts described parental consent as a "barrier to vaccination" and called for "strategies that increase the ability of unaccompanied minors…to receive vaccines within the context of legal, ethical, and professional guidelines." Did the zealous school nurse who recently administered a human papillomavirus (HPV) vaccine to an 11-year-old boy without parental consent—while telling the mother that all he got was an ice pack—follow "legal, ethical, and professional guidelines"?
AMA critics argue that the organization has spearheaded a push for a "totalitarian medical pharmaceutical police state" almost since its inception in the mid-1850s. While such rhetoric is strong, it seems clear that on vaccine issues, the AMA is only too willing to stake out a draconian policy position. After the AMA announced its intent to ignore parents' wishes, one conservative writer underscored the contradictions: "So while individuals need to be 21 years old before they are allowed to drink, and 18 years old before they are allowed to purchase cigarettes and elect a president, children at any age can make a decision to partake in vaccinations, regardless of the associated risks, of which there are enough to warrant the need for a National Vaccine Injury Compensation Program." Legislators tempted to jump on the AMA's bandwagon might want to think twice before throwing parental rights under the bus in such a cavalier manner.
Sign up for free news and updates from Robert F. Kennedy, Jr. and the Children's Health Defense. CHD is planning many strategies, including legal, in an effort to defend the health of our children and obtain justice for those already injured. Your support is essential to CHD's successful mission.
Help Support Collective Evolution
The demand for Collective Evolution's content is bigger than ever, except ad agencies and social media keep cutting our revenues. This is making it hard for us to continue.
In order to stay truly independent, we need your help. We are not going to put up paywalls on this website, as we want to get our info out far and wide. For as little as $3 a month, you can help keep CE alive!
Studies Show We Can Heal With Sound, Frequency & Vibration
In Brief
- The Facts:
Multiple studies and examples have shown how sound, frequency and vibration can literally alter physical material matter. Research has also shown that sound, frequencies and vibration can be used as a significant healing method for various ailments.
- Reflect On:
How plausible would it be for these interventions to become a regular part of therapy, just as much as pharmaceutical drugs are now?
Cymatics is a very interesting topic. It illustrates how sound frequencies move through a particular medium such as water, air, or sand and as a result directly alter physical matter. There are a number of pictures all over the internet as well as youtube videos that demonstrate how matter (particles) adjust to different sounds and different frequencies of sound.
When it comes to ancient knowledge, sound, frequency and vibration have always been perceived as powerful forces that can influence and alter life all the way down to the cellular level. Sound healing methods are often used by Shamans, who employ drums and singing to access trance states. Research has even demonstrated that drumming and singing can can be used to slow fatal brain disease, and it can generate a sense of oneness with the universe . Sound therapy is getting more popular, and it can have many medical applications, especially within the psychological and mental health realms.
Sound, frequency and vibration are used all throughout the animal kingdom, and there are many examples. If we look at the wasp, they use antennal drumming to alter the caste development or phenotype of their larvae. Conventional thinking has held for quite some time that differential nutrition alone can explain why one larvae develops into a non-reproductive worker and one into a reproductive female (gyne). However, this is not the case, according to a 2011 study:
"But nutrition level alone cannot explain how the first few females to be produced in a colony develop rapidly yet have small body sizes and worker phenotypes. Here, we provide evidence that a mechanical signal biases caste toward a worker phenotype. In Polistes fuscatus, the signal takes the form of antennal drumming (AD), wherein a female trills her antennae synchronously on the rims of nest cells while feeding prey-liquid to larvae. The frequency of AD occurrence is high early in the colony cycle, when larvae destined to become workers are being reared, and low late in the cycle, when gynes are being reared. Subjecting gyne-destined brood to simulated AD-frequency vibrations caused them to emerge as adults with reduced fat stores, a worker trait. This suggests that AD influences the larval developmental trajectory by inhibiting a physiological element that is necessary to trigger diapause, a gyne trait."
This finding indicates that the acoustic signals produced through drumming within certain species carry biologically meaningful information (literally: 'to put form into') that operate epigenetically (i.e. working outside or above the genome to affect gene expression).
Pretty fascinating, isn't it? Like many other ancient lines of thought, this has been backed by modern day scientific research.
Another example comes from cancer research. In his Tedx talk, "Shattering Cancer with Resonant Frequencies," Associate Professor and Director of Music at Skidmore College, Anthony Holland, tells the audience that he has a dream. That dream is to see a future where children no longer have to suffer from the effects of toxic cancer drugs or radiation treatment, and today he and his team believe they have found the answer, and that answer is sound. Holland and his team wondered if they could affect a cell by sending a specific electric signal, much like we do with LCD technology. After searching the patent database for a device that could accomplish this, they came across a therapeutic device invented by New Mexico physician Dr. James Bare. The device uses a plasma antenna that pulses on and off, which, as Holland explains, is important because a constant pulse of electricity would produce too much heat and therefore destroy the cell. For the next 15 months, Holland and his team searched for the exact frequency that would directly shatter a living microorganism. The magic number finally came in the form of two inputs, one high frequency and one low. The high frequency had to be exactly eleven times higher than the low, which in music is known as the 11th harmonic. At the 11th harmonic, micro organisms begin to shatter like crystal glass.
After consistently practicing until they became efficient at the procedure, Holland began working with a team of cancer researchers in an attempt to destroy targeted cancer cells. First they looked at pancreatic cancer cells, eventually discovering these cells were specifically vulnerable between 100,000 – 300,000 Hz.
Next they moved onto leukemia cells, and they were able to shatter the leukemia cells before they could divide. But, as Holland explains in his talk, he needed bigger stats in order to make the treatment a viable option for cancer patients.
In repeated and controlled experiments, the frequencies, known as oscillating pulsed electric field (OPEF) technology, killed an average of 25% to 40% of leukemia cells, going as high as 60% in some cases. Furthermore, the intervention even slowed cancer cell growth rates up to 65%.
You can read more about the story, find sources, and watch that TEDx talk here.
Another example occurred in 1981, when biologist Helene Grimal partnered with composer Fabien Maman to study the relationship of sound waves to living cells. For 18 months, the pair worked with the effects of 30-40 decibel sounds on human cells. With a camera mounted on a microscope, the researchers observed uterine cancer cells exposed to different acoustic instruments (guitar, gong, xylophone) as well as the human voice for 20-minute sessions.
They discovered that, when exposed to sound, cancer cells lost structural integrity until they exploded at the 14-minute mark. Far more dramatic was the sound of a human voice — the cells were destroyed at the nine-minute mark.
After this, they decided to work with two women with breast cancer. For one month, both of the women gave three-and-a-half-hours a day to "toning" or singing the scale. Apparently, the woman's tumor became undetectable, and the other woman underwent surgery. Her surgeon reported that her tumor had shrunk dramatically and "dried up." It was removed and the woman had a complete recovery and remission.
These are only a few out of multiple examples that are floating around out there.
Let's not forget about when Royal Rife first identified the human cancer virus using the world's most powerful microscope. After identifying and isolating the virus, he decided to culture it on salted pork. At the time this was a very good method for culturing a virus. He then took the culture and injected it into 400 rats, which, as you might expect, created cancer in all 400 rats very quickly. The next step for Rife was where things took an interesting turn. He later found a frequency of electromagnetic energy that would cause the cancer virus to diminish completely when entered into the energy field. You can read more about that story here.
More Research
A 2014 study published in the Journal of Huntington's Disease found that two months of drumming intervention in Huntington's patients (considered an irreversible, lethal neurodegenerative disease) resulted in "improvements in executive function and changes in white matter microstructure, notably in the genu of the corpus callosum that connects prefrontal cortices of both hemispheres." The study authors concluded that the pilot study provided novel preliminary evidence that drumming (or related targeted behavioral stimulation) may result in "cognitive enhancement and improvements in callosal white matter microstructure."
A 2011 Finnish study observed that stroke patients who were given access to music as cognitive therapy had improved recovery. Other research has shown that patients suffering from loss of speech due to brain injury or stroke regain it more quickly by learning to sing before trying to speak. The phenomenon of music facilitating healing in the brain after a stroke is called the "Kenny Rogers Effect."
A 2012 study published in Evolutionary Psychology found that active performance of music (singing, dancing and drumming) triggered endorphin release (measured by post-activity increases in pain tolerance), whereas merely listening to music did not. The researchers hypothesized that this may contribute to community bonding in activities involving dance and music-making.
According to a study published by the National Institute of Health, "Music effectively reduces anxiety for medical and surgical patients and often reduces surgical and chronic pain. [Also,] Providing music to caregivers may be a strategy to improve empathy, compassion, and care." In other words, music is not only good for patients, it's good for those who care for them as well.
Below is an interesting interview with Dr. Bruce Lipton. You can view his curriculum vitae here.
The Takeaway
The information presented in this article isn't even the tip of the iceberg when it comes the the medical applications of sound, frequency and vibration, which are all obviously correlated. One thing is clear, however, which is that there are many more methods out there, like the ones discussed in this article, that should be taken more seriously and given more attention from the medical establishment. It seems all mainstream medicine is concerned about is making money and developing medications that don't seem to be representative of our fullest potential to heal. "Alternative" therapies shouldn't be labelled as alternative, they should be incorporated into the norm.
Help Support Collective Evolution
The demand for Collective Evolution's content is bigger than ever, except ad agencies and social media keep cutting our revenues. This is making it hard for us to continue.
In order to stay truly independent, we need your help. We are not going to put up paywalls on this website, as we want to get our info out far and wide. For as little as $3 a month, you can help keep CE alive!
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Events and Resources for Job Seekers
Placement Services
Provided by the ALA Office for Human Resource Development and Recruitment (HRDR), the Placement Services Center will be available during the Midwinter Meeting, to assist job seekers and employers, as well as provide career assistance.
Job seekers should register and search for jobs on the JobLIST website at http://www.joblist.ala.org/. All services are free to job seekers. Registration is not required, but is recommended. Registration will give employers who choose the Placement Service subscription access to your resume information. It will also allow for direct communication between job seekers and employers. There will be an orientation for job seekers on Friday, January 23, 4:00 - 4:30pm in the Placement Center.
Employers who want to post positions should post them on the JobLIST website at http://www.joblist.ala.org/. Employers who want to use the interviewing facilities must have an active ad placed on JobLIST at the time you schedule an interview. Employers who want a booth in the Placement Center should complete the space reservation form, or contact Beatrice Calvin at 800/545-2433 ext. 4280.
Policy 54.3 states, "ALA is committed to equality of opportunity for all library employees or applicants for employment, regardless of race, color, creed, sex, age, physical or mental handicap, individual lifestyle, or national origin." By advertising through ALA services, the organization agrees to comply with this policy. All available salary ranges shall be listed. For more information, contact Placement Service Manager, Beatrice Calvin at firstname.lastname@example.com or 800/545-2433 ext. 4280.
Careers at OCLC
Jump-start Your Career at OCLC
8:00 pm – 10:00 pm, Sheraton Denver Downtown, Tower Court B
Interested in learning more about careers at OCLC? Join Jerome Offord, Jr., OCLC Manager of Corporate Inclusion, to learn about the diverse opportunities available at OCLC.
Requires Registration at https://www3.oclc.org/app/ala_registration/


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An easy-to-use deck of cards to strategically make you a better leader…
Despite your level of proficiency as a leader or manager, there is always room for improvement and growth. Become more influential and enhance your performance.
Determine motivating forces, team dynamics, mutual goals, and the best methodology and steps to achieve your objective.
Learn some of the basics so your first assignment as a leader or manager is a successful experience.
Understand personal preferences, their impact upon communication and acquire skills that will make you more effective in the many ways you communicate with others.
The one-on-one exchange of ideas, methods, and viewpoints were most beneficial to me. Doni is well-prepared. Her knowledge and care are obvious in her presentation. She's a real pro. ~ P. Bondi - Bonita Springs, FL
I had two areas in mind (career and dissertation) and I was not disappointed by the outcome. I was given the leeway to set goals with gentle nudging from Dr. Landefeld and open-ended questions to move me forward. The BAM and strengths list has been invaluable to me. I was able to reach my goals of developing a good representation of what I have to offer to potential employees for my career change. I was also able to have a sounding board for my dissertation frustrations and run my ideas by Dr. Landefeld. She also offered advice here and there about possible solutions without being overbearing and the final decisions were left to me. I am grateful for the experience and I would definitely recommend Metamorphosis Coaching, LLC to my family and friends! ~ E.J. - Missouri City, TX
Doni has vision, a very positive personality, and is full of enthusiasm and energy. She accepts challenges and confronts obstacles by breaking them down into easy, attainable goals. Doni has been a great mentor and enjoys working through and helping you achieve your goals; her attitude is "can-do." Her follow-through skills are superior and she is a person who is committed to helping you achieve what you want in life, both personally and professionally. She is down-to-earth, easy to talk to and always stays on top of goals. ~ Nikki Gaston - Elkins Park, PA
I have found that Dr. Landfeld encouraged me to challenge my skills and abilities. We worked together to make certain that we set achievable goals and established measurable objectives for the projects and programs that we work on. ~ C.D. - Pottsville, PA
Doni is a natural. Her coaching skills are exceptional. She is a true motivator and always encouraging, a true results oriented professional at all times. ~ G. Achilles - Philadelphia, PA


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Ear Infections: What? How? and Who?
Macey Barnes
Otitis externa: Inflammation of the ear canal that can be caused by a variety of factors.
What Causes an Ear Infection?
Most commonly, the cause of ear infections in dogs and cats are allergies, an overgrowth of bacteria/fungal cells, or a combination of both. Ear mites rarely cause ear infections in dogs. However, in cats they can be more of a concern, especially in cats that are outdoors and exposed to stray cats.
Treating Ear Infections:
1. It is important to first schedule an appointment with your veterinarian, so that the cause of the ear infection can be determined. This allows the veterinarian to decide the proper form of treatment for your pet.
2. After the cause is determined, the veterinarian will form a treatment plan that may include any or several of the following: daily ear drops, oral medication, ear cleaning, a one-time ear treatment applied by the veterinarian.
3. Follow the treatment exactly as prescribed by your veterinarian.
4. A follow-up appointment should be made 3-4 weeks after treatment to ensure your pet's ear infection is resolved. This appointment is important, even if you believe your pet is 100% normal, to ensure the cause of the ear infection is under control. It can sometimes take multiple rounds of treatments or even changing treatments to clear up some infections.
5. Prevent reoccurring ear infections by consulting with your veterinarian about any underlying condition(s) that may be causing the ear infections. Pets with allergies need to have the allergies controlled by medication or allergy elimination. Pets with bacteria/fungal overgrowth may need their ears cleaned once weekly or every other week with a medicated ear cleanser. Pets with ear mites should be kept separate from other pets until treatment is completed to prevent spreading to other pets.
Dog Breeds Predisposed to Ear Infections
- Coonhound
- Basset Hound
- Blood Hound
- Cocker Spaniel
- Boston Terrier
- Akita
- German Shepherd
- Australian Shepherd
- American Bulldog
- English Bulldog
- Golden Retriever
- Labrador Retriever
- Lhasa Apso
- Poodle
- Schnauzer
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Commissioner John Slidell
John Slidell served as agent to Mexico in the months preceding the outbreak of war between that nation and the United States. A native of New York City, Slidell had gone south after the War of 1812 and rose to become a scrappy New Orleans politician. He entered the U.S. Congress in 1842, and became a close ally of James K. Polk.
Slidells connections landed him the official task of negotiating a deal with Mexico. He was instructed to offer a settlement of all U.S. claims against Mexico, in exchange for recognition of the Rio Grande as the boundary between the two nations. In addition, Polk instructed Slidell to try and buy California for $25 million.
The Mexicans rejected Slidell and his mission outright. He responded to President Polk by hinting that the Mexican reluctance to negotiate might require a show of military force by the United States. Based on this intelligence, Polk ordered General Zachary Taylor to head for the Rio Grande. Slidell remained in Mexico until March 1846, but left as war became unavoidable.
After the U.S.-Mexican War, Slidell rose to prominence in Louisiana politics. When that state seceded from the Union in 1861 and joined the Southern Confederacy, Slidell served as minister to France. He remained in Europe until his death in 1871.


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Army of Revolt
An army of girls from all over the Land of Oz that Jinjur assembled to conquer the Emerald City, depose the Scarecrow, and run the government to suit themselves. They looted the city upon its capture, picking out the emeralds and other jewels which decorated the streets and buildings. Their uniforms include a green sash around the waist and a skirt in four colors; blue, yellow, red, and purple representing the four countries of Oz. Each of the four companies of girls wear their skirts so that the color of their country are to the front. Their weapons are two long, glittering knitting-needles stuck through the knot of their hair at the back of their head.
First appears in: The Marvelous Land of Oz
Piglet Press Tour Guide
[Topic Head][Home Page]
[Library] [Movies] [Characters] [Places] [Things] [Audio] [Author] [Oz Club] [Book Store] [Web Links] [Feedback]
Comments to author, W.R. Wright: firstname.lastname@example.com (C) 1996.
Revised: 01-22-1996


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Let's be honest up front: the studio output this year left much to be desired. Sure, wide releases from the Coens, Shane Black, Denis Villeneuve, and Robert Zemeckis fulfilled expectations, but we had to dig deep for the studio films that caught us pleasantly off-guard. While much of our year-end coverage will be focusing on the overlooked gems, today we're kicking things off by highlighting the few major releases that left us surprised.
Note that the below ten features are strictly films that received a wide release on their opening weekend and not ones that eventually expanded with a roll-out. Some, for various reasons, arrived with virtually little-to-no anticipation around these parts, while others wildly exceeded our standard expectations, and a few managed to be among our favorites of the year.
Check out our selections below and let us know what surprised you most in 2016.
10 Cloverfield Lane (Dan Trachtenberg)
Blockbuster sequels often feel more like cash grabs than genuine attempts at quality filmmaking, but 10 Cloverfield Lane is a brilliant anomaly. First-time director Dan Trachtenberg ratchets up the suspense to unbearable levels, ingeniously exploiting viewer uncertainty about, firstly, whether the heroine's imprisonment within a bomb shelter is really meant to protect her from the radioactive fallout of an unseen nuclear apocalypse, and secondly, whether the next moment in the film will glide uneventfully by or erupt into violence. 10 Cloverfield Lane controls our emotions like a puppeteer does his marionettes, and the fiber keeping the wires intact is John Goodman. Playing the captor with unclear motivations, the actor exudes an off-putting earnestness that invites our trust in one instance (he can't be lying, right?) and paralyzes us with fear in the next (we realize he can't be reasoned with). As for the film's finale, some people scoff at it, but I found it exhilarating: a bonkers paean to female badassery that proves Mary Elizabeth Winstead is a genre leading lady on par with the likes of Sigourney Weaver and Charlize Theron. – Jonah J.
Don't Breathe (Fede Alvarez)
Don't Breathe would make a great double bill with Jeremy Saulnier's Green Room, given that both confine their characters' fight for survival to tight indoor spaces. But whereas Saulnier's picture uses this initial constraint of place as a point of departure for raw, naturalistic violence, artifice remains ever-present in Fede Alvarez's horror hit. From an ostentatious long take that maps out exactly where both hunter and hunted can maneuver within the given space to the crutch of blindness so pointedly written into the villain's characterization, Don't Breathe often feels less like an act of storytelling than a cinematic exercise whose rules have been self-consciously spelled out. Accordingly, plot development exists largely as a string of increasingly tense set-pieces, where each successive segment feels like Alvarez testing his chops, showing us what he can do. Ultimately, the success of Don't Breathe's craftsmanship lies in the balance it strikes between immersiveness and distanciation, on the one hand not being so self-referential in its showiness as to break a sense of narrative consequence, on the other heightening the intensity by keeping us aware that we are at the filmmaker's mercy. – Jonah J.
The Edge of Seventeen (Kelly Fremon Craig)
Say what you will about comic-book adaptations and the like, but there may not be a genre more tired in Hollywood than the coming-of-age film. Thanks to their relatively cheap budgets and aims to connect with a pre-determined movie-going (though, that is up for debate) audience, many often feel like they are hitting checkboxes and not much else. Enter The Edge of Seventeen, which depicts teenage angst with such pinpoint accuracy one wonders why it's never been handled precisely this way before. A debut no less, writer-director Kelly Fremon Craig's script — which never dumb downs or generalizes the high school experience — is brought to life perfectly by Hailee Steinfeld in an emotionally honest performance that even outpaces her break-out in True Grit. – Jordan R.
Neighbors 2: Sorority Rising (Nicholas Stoller)
Even after Neighbors emerged in 2014 as a summer comedy standout, it was hard to expect a sequel as thoughtful, progressive, and funny as Neighbors 2: Sorority Rising. This time around, a sorority determined to party as hard as the boys has moved in next to new parents Mac (Seth Rogen) and Kelly (Rose Byrne). Meanwhile, Teddy (Zac Efron) continues to struggle with his post-college identity. Chloe Grace-Moretz, Kiersey Clemons, and Beanie Feldstein are standouts, and director Nicholas Stoller does not shy away from real, current issues in our American college institutions while never taking anything away from the laughs to be had. – Dan M.
Nerve (Ariel Schulman and Henry Joost)
Chalk it up to being released around the height of the Pokémon GO craze this summer — perhaps its targeted audience was a bit too consumed with their phones — but Nerve seemed to come and go fairly quickly. The latest film from Catfish duo Henry Joost and Ariel Schulman isn't shy about making fairly pronounced remarks regarding this generation's technology obsession and its pervasion in our social lives. Where it does succeed is in its manic energy — a dare featuring a 60mph blind motorcycle stunt with geographical authenticity and a Philippe Petit-esque walk come to mind — proving that this summer, if one wanted genuine thrills, they had to drop down a few budget levels. – Jordan R.
Welcome to The B-Side, from The Film Stage. Here we explore movies from established stars that flopped at the box office, have been forgotten by time, or remain hidden gems. These aren't the films that made them famous or kept them famous. These are the other ones. Today, we talk about one of the movie […]
Since any New York City cinephile has a nearly suffocating wealth of theatrical options, we figured it'd be best to compile some of the more worthwhile repertory showings into one handy list. Displayed below are a few of the city's most reliable theaters and links to screenings of their weekend offerings — films you're not […]
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Cannes Lions 2019: The WGSN talks you must see
Jun 10, 2019 | By Nina Giglio
Jul 09, 2015
Calvin Klein has released its Autumn/Winter 15 underwear campaign featuring Kendall Jenner in her second posting for the brand and is joined by Joan Smalls, Isabeli Fontana and long time Calvin Klein model Edita Vilkeviciute.
Regular US Vogue and Interview magazine photographer Mikael Jansson in New York shot the images.
The campaign is centered on the idea of the 'original sexy'; some might even say they're trying to bring sexy back.
Chief Marketing Officer of Calvin Klein Melisa Goldie said, "Calvin Klein originated sexy and we're going to reclaim, re-imagine and re-image it."
Wonder how Justin feels about that. Timberlake that is not Beiber, thought the latter did also star in the brand's campaign last season, one of its most successful ones to date gaining over 3.6 million new followers across the brand's social media.
Although Jenner may not be quite as big as Beiber (yet) her sizeable 30.9 million Instagram followers are sure to help make the campaign a success considering that both of the images of Jenner posted to her account already have over 1 million likes each just 24 hours later.
The ads continue the brand's #mycalvins hashtag used over the last few campaigns and it will be interesting to see how much Jenner's social following will impact its use around the launch of the ads, created together with branding agency Laird + Partners.
Know what's next. Become a WGSN member today to benefit from our daily trend intelligence, retail analytics, consumer insights and bespoke consultancy services.


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03 Oct New Website, New Digs
Posted at 18:00h in News
Hey everyone sorry about the delay in getting the new site up and going but things have been crazy busy at Babb Bros and our new digs. As we approach our 3 year anniversary, I would like to thank our customers that have supported us no matter what. Through all the menu changes, construction, parking and more things to come I am sure. Our business depends on loyal customers and staff. And we have been Blessed with both.


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I invited Expat Girl to join me in the March which was to lead us from the Trocadero Esplanade of human rights to the Wall for Peace Monument on the Champ de Mars. Rather sheepishly she declined because she didn't feel safe to walk with such a big crowd of people. I respect that. The terrorist attacks had had an impact on her young life and there were things she was not prepared to do.
As I walk towards the terrace where the United Nations General Assembly adopted the Universal Declaration of Human Rights on December 10, 1948 I was surprised to hear only murmurs and relaxed conviviality. Usually during demonstrations you can hear shouts and chants a block away from the Trocadero.
Sure enough, as I came around the Musée de l'Homme - ten minutes before the March was suppose to begin - I saw a little crowd, women of all ages holding various signs and flags. Were the Parisiennes suitably late or was this just not on the city's agenda I thought a wee bit disappointed?
True to French style, however, people were late, and half an hour later thousands had turned up and it was impossible for the tourists to even attempt to get a picture of the Eiffel Tower from the Trocadero Esplanade.
With grace, dignity and conviviality women AND men from France, the USA, Mexico, Spain, New Zealand and many other places walked the walk side by side, each with their own belief and their own cause at heart. There was no aggressiveness, no arguments, no shouting or screaming. People were talking with their neighbours, smiling at one another, kids were asking each other where they were from in English, journalists were taking snapshots to capture the serene and peaceful mood of the colourful crowd blessed with sunshine and a wonderful and rare blue winter sky.
A unique and unforgettable afternoon in the French capital born of a solidarity movement with the Women's March in the USA which will go down in history and in my memory as a very special moment of this complex, modern world.
As one of the signs said: "Maintenant, il ne faut plus se trumper!
Some say we were 7000 at Trocadero today!
A sign that sums it all up
Il faut du tout pour faire un monde
Best script board
The beauty of this march is that everybody can have their own agenda!
Recognise this Spanish sign?
Every person has their own personal reasons to participate
The French are part of the party as well!
An impressive view
Ready to march the March
The beauty of this sign is that it was carried by a man!
Arriving at the Wall of Peace with police escort
Greeting our sisters in Washington DC
A peaceful Saturday afternoon march comes to an end
The Wall of Peace, a favourite site of rendezvous for militants of human rights
Picture of the day: "Je suis une femme"


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Symptoms: Lower blood pressure. Diminished pain. Lifted spirits. Increased socialization. Reduced loneliness.
Diagnosis: Puppy love.
Having a pet has proven to help get senior living community residents into shape all over the country when it comes to boosting morale and decreasing anxiety. That's why most Capital Senior Living communities — from Spring Meadows Summit in Summit, NJ to The Waterford on Highland Colony in Ridgeland, MS and Crosswood Oaks in Citrus Heights, CA to Independence Village of Olde Raleigh in Raleigh, NC — allow small pets in residents' comfortable apartments. Some accommodations, including Sugar Grove in Plainfield, IN; The Harbor Court in Rocky River, OH; and Buffalo Creek in Waxahachie, TX; even go so far as to have community pets for residents who may not be able to house an animal on their own but love the attention of an animal friend from time to time. We take our promise seriously when it comes to enriching the lives of our residents by providing an environment that is physically, mentally, spiritually and emotionally stimulating, and our attitude toward pets is a natural continuation of that mindset.
Animals provide a lot of love every day of the year in our communities. So it's quite apropos that February, a month already designated for human love, also includes a day where humans can show their affection for man's best friend. Love Your Pet Day, set to be celebrated on Feb. 20, 2015, encourages Capital Senior Living residents to give their pets an extra hug or kiss, share a special treat or even get out and enjoy an extra 30 minutes or hour walking and playing in well-manicured courtyards — as long as the weather cooperates.
It's the 365-day cooperation of our furry friends, though, that really hits home for so many of our Memory Care residents. While therapy animals have long been used to assist the blind or disabled, they are fast becoming a popular means of engaging residents with Alzheimer's disease. Individuals with dementia tend to be more apathetic, restless, irritable and depressed and therefore tend to pull themselves out of the mix of social interaction. Research has shown that, with regular interaction with a pet, these individuals become more like their old selves again because dogs are non-judgmental and show unconditional love.
Having a pet or pets in the community can also be great motivation for our seniors to exercise. It gives residents a great reason to get out and take their best friend on a short stroll — great cardio exercise. Four-legged friends also are great for jogging the memories of individuals who had positive childhood experiences with their animal.
According to Paws for People, a volunteer pet-assisted visitation service based in Newark, DE, pet therapy can have strong physical and mental benefits for all residents — whether in Independent Living, Assisted Living or Memory Care. When residents pet a four-legged friend, it produces an automatic, calming relaxation response that helps put seniors at ease, thanks to an endorphin release. Lower blood pressure and improved cardiovascular health can be some of the other positive effects.
Residents who don't receive a lot of visitors or don't have enough communication with their loved ones normally find four-legged friends to be great companions that reduce loneliness. While the vast array of recreational and entertainment programming at our communities keeps residents plenty busy, pets sometimes help reduce the boredom that can set in. Don't forget, though, that therapy or companion pets must have a pleasant temperament, be comfy with strangers, not be startled easily and prove to be generally quiet.
While sharing the month of love with your friends and family, it's important to remember your four-legged friends can help celebrate as well.
Source: www.alzheimersproject.org; www.pawsforpeople.org; www.aplaceformom.com
This website contains information, facts, opinions and recommendations of various individuals and organizations regarding senior care, health, nutrition and exercise. Capital Senior Living and its affiliates, agents and licensors cannot, and do not, guarantee the accuracy, completeness, timeliness, merchantability or fitness for a particular purpose of, or otherwise endorse, any opinions or recommendations, nor does Capital Senior Living constitute the giving of medical, health or fitness advice. Users of the website must consult their physicians regarding the applicability of any opinions or recommendations with respect to their conditions.


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Product Description
The reflective leg band has dual reflective stripes increase your visibility to motorists at night whilst (for cyclists) your trousers stay out of the chain. Made from new seatbelt webbing, they won't just disappear off your leg whilst riding as they are both sturdy and elasticised. One size fits all with the adjustable hook & loop fastener on every legband. Many people just wear one on the gear cog side of the bike.
— 35cm long x 5cm wide
— fits ankle with trouser circumferences from 22cm to 32cm
— sold singly
Flouro pink, flouro yellow, flouro lime, flouro orange, black, white, red, wine, purple, royal, cyan, navy, electric blue, golden yellow, bright yellow, khaki, beige, brown, emerald and bottle green
For cyclists, pedestrians, horse riders and indeed horses too.
Materials list
Body – new polyester webbing (Australian Made)
Hook & Loop – polyester/nylon Velcro brand (Taiwan)
Heavy duty elastic – (China)
Reflective tape – polycotton (3M brand, US)
Label – woven polyester (Australian Made)
Thread – nylon (Australian Made)
Rubber band – rubber (Thailand)


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Nicole Scherzinger: I Stand By My Decision Not To Support Rachel Crow
Nicole was vilified for her inability to make a vote, and now she's speaking out about her controversial choice!
When Rachel Crow was eliminated from the Dec. 8 episode of The X Factor, fans were outraged that Nicole Scherzinger allowed the vote to come down to deadlock. But now Nicole's saying that she stands behind her decision!
Nicole, 33, said in a press conference after the show that she wouldn't change her vote.
"If I were to do it all over again, I would have done the same thing," she said. "Because how did I know what America was going to do? Anyone can see that I didn't send Rachel home — don't get it twisted. I didn't send her home and I wasn't going to send either of them home. I have a big heart and I care and I care so much."
Even so, her new year's resolution is that 14-year-old Rachel has incredible success, she tells HollywoodLife.com EXCLUSIVELY.
"Make sure Rachel Crow makes it on the biggest show ever," she said.
What do YOU think, HollywoodLifers — is Nicole is a bad judge?
— Reporting By Russ Weakland, Written By William Earl
More 'X Factor:'


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Marketing professionals have long studied the specifics of spending habits among consumers and most agree that somewhere around three-quarters of all purchasing decisions are made once the customer arrives at the store. In addition, about 40 percent of all purchases are spontaneous.
It is these spontaneous purchases that often occur as a result of an attractive display promoting particular types of point of sale merchandise. It is also these kinds of sales that help to increase a retailer's profit, often with relatively little effort as far as advertising dollars spent and interaction between customer and staff.
However, despite the ease of POS sales, if you're considering just how to be the most effective, you will want to be sure to showcase displays that truly highlight your point of sale merchandise. You'll also want to choose your POS items carefully so as to get the most out of your marketing dollars.
The latter might involve tracking sales of certain items you're considering for these impulse-buying displays to determine where your money is best spent. After all, you want your display to be successful and that means a combination of both good marketing and a wonderful, artistic design.
So what attracts customers to your point of sale merchandise?
Well, marketing surveys show that there are a number of factors that draw interested parties to a display and make them stay there and eventually make a purchase.
• A "gimmick" – You need to include something that catches the eye of the customer. It might be a large sign that blinks. It could be a digital display. It might include a small giveaway or some other sort of promotional incentive. Discuss this with your marketing staff to figure out what will work best for you and for the particular product you're promoting.
• A good price – Point of sale items will rarely move off the shelves if you're not providing an incentive to buy, and that usually means offering a good price. As a matter of fact, a "sale" should always be part of your point of sale displays. Whether you're promoting a new product or trying to move something you over-purchased, attract your customers with the best deal you can offer. Buy one, get one is always a good idea if the profits can sustain such an offer. (Similarly, "buy four, get the fifth free" or something akin to that works well, too.)
• The human touch – If the point of sale merchandise you are promoting lends itself to this, you might enhance your display with a presentation. Food items are easy to promote as you can simply allow a staff member to pass out samples. But you can also do demonstrations with certain products where applicable, such as cleaning products or certain electronics.
Think about the above before you purchase a display. Remember, point of sale merchandise displays come in all shapes and sizes, from "throwaways" made of heavy cardboard to much more long-lasting displays that cost a lot to produce.
There are some you may be able to reuse with different products and others that will certainly be geared to one particular item or brand. As you consult with your shop fitter, talk about your intentions and decide which will work best for you. It may be a combination of both.