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Thread: One California Democrat Admits Hes Tired of Trashing Trump
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One California Democrat Admits Hes Tired of Trashing Trump
by ASSEMBLYMAN TIM DONNELLY
17 Feb 2017Twin Peaks, CA
564 comments
At least one Democrat leader in California admits that hes tired of trashing President Donald Trump.
According to a Sacramento Bee article, Assembly Speaker Anthony Rendon had a message for the California Newspaper Publishers Association Wednesday:
Im tired of talking about Donald Trump . . . Were all doing a great job of talking about Trump and holding Trump accountable . . . If Hillary Clinton had gotten elected president of the United States, we would have started the year with 2.5 million children in California living in poverty. If Hillary Clinton had been elected president of the United States, we would have started the year with crumbling roads.
Rendons weariness of talking Trump doesnt seem to be shared by his colleagues. Minority Leader Chad Mayes (R-Yucaipa) took a cheap shot at Trump, according to the Bee: Alternative facts arent acceptable, he said. Facts are acceptable because the only time youre able to make decisions is based upon real information.
Another notable Democrat, Kevin de León who has been in the news of late for admitting half his family is living in the country illegally and using false documents to work explained why he will continue to trash President Trump at every opportunity.
When asked by the Bee if the anti-Trump talk is alienating the state from the federal government, de León said its his responsibility to protect the people and values of California.
Had John McCain run for the presidency or had he won eight years ago, as a partisan and as a Democrat, I would naturally be disappointed. But I think I would get over it rather quickly, try to find common ground, see how we can move forward as a nation together, said de León, before adding that he would have felt the same way if Mitt Romney, Jeb Bush or John Kasich became president.
It will be truly extraordinary if California politicians stop the anti-Trump talkor ever acknowledge that when given the opportunity to play politics with the Federal emergency funds for the Oroville Dam disaster, Trump refused to put millions of Californians at risk just to score some political points.
Tim Donnelly is a former California State Assemblyman.
http://www.breitbart.com/california/...rashing-trump/Support our FIGHT AGAINST illegal immigration & Amnesty by joining our E-mail Alerts at https://eepurl.com/cktGTn
Thank you Assemblyman Anthony Rendon! Thank you very very much!! I hope others follow in your shoes. Trump is going to help the people of your district, the citizens of all districts in California, because his policies and agenda are going to help ALL AMERICANS. It's way past time to stop kicking a gift horse in the mouth and get on the Trump Train to fix our country.
A Nation Without Borders Is Not A Nation - Ronald Reagan
Save America, Deport Congress! - Judy
Support our FIGHT AGAINST illegal immigration & Amnesty by joining our E-mail Alerts at https://eepurl.com/cktGTn
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subset: commoncrawl


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Latest News on Paypal
Showing of 0 - 10 from 179 results
Paypal - Total results - 179
Oct 11, 2018
Mumbai Metro to partner up with PayPal for online recharge paymentsMetro commuters can recharge their smart cards by logging onto the Mumbai Metro website.
Sep 20, 2018
Global tech firms like Facebook, Mastercard to oppose India's planned data lawFacebook, Mastercard, PayPal fear the data law will increase their compliance, infrastructure costs.
Aug 07, 2018
Facebook to deepen links with financial institutions to improve customer serviceThe Wall Street Journal had reported that Facebook had asked banks to share detailed financial information.
Jun 25, 2018
Puzzle-based games are more popular among Indian women: StudyFor the study, a survey was conducted across 25 markets involving nearly 25,000 active paying gamers.
Jun 05, 2018
Apple software updates will let older iPhones run faster, control social media tracking and help reduce screen time for childrenApple unveiled new steps to make it hard for advertisers to distinguish among users, building on its effort, begun last year, to prevent such tracking.
May 29, 2018
For the first time ever, street performers in London will accept cash via a contactless payment schemeFor the first time in London, select performers who are often seen busking in the London streets will be offered with a system of contactless payment.
Apr 04, 2018
PayPal makes it easier for Indian sellers and freelancers to receive payments from abroadAccording to PayPal, the certificate can be directly collected by the sellers and freelancers from their beneficiary banks.
Feb 01, 2018
EBay stocks hit an all time high as investors cheer the move to ditch PayPal as its main payments partnerAnalysts said that might bring in more revenue for eBay while lowering costs, adding to optimism from a strong holiday quarter for the e-commerce company.
Feb 01, 2018
eBay posts higher revenue in holiday quarter after website changes and marketing leads to more customersEBay said it would move as quickly as possible to complete the transition within the parameters of its deal with PayPal.
Feb 01, 2018
PayPal's profit jumps by 59 percent owing to strength in its merchant services businessPayPal net revenue climbed to $3.74 billion from $2.98 billion, while payments volume rose 32 percent to $131.45 billion.


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The Central Lincoln County YMCA is pleased to announce Sally Farrell as its new pre-K lead teacher. Farrell will assume this role in a full-time capacity beginning in August, as the new school year approaches.
Farrell has been intricately immersed in the community since 2000 and currently lives in Newcastle with her husband, Tom, a self-employed marine engineer/naval architect, and their three kids, Schuyler, Will, and Natalie. They are members of Water of Life Lutheran Church. All of the kids grew up involved in Y youth sports programs; Tom Farrell coached many sports programs at the Y over the years and continues to coach in the Y's youth lacrosse program.
Sally Farrell served on the CLC YMCA board from 2006-2012 (and recruited her sister-in-law, Ann Poole, to join the board upon her departure), and also served on the Great Salt Bay Community School Board from 2002-2014. Farrell's oldest daughter, Schuyler, is now a youth board member and teen leader chairman for the CLC YMCA.
Farrell graduated from Lincoln Academy and then received a degree in elementary education from the University of Maine in Orono. Since 2000, she has been working as a lead preschool and pre-K/kindergarten teacher at Sheepscot Valley Children's House in Wiscasset.
"My goal as a teacher is to provide a safe environment where children can take risks to grow academically, socially, physically and emotionally to become self-sufficient students who love to learn," said Farrell. "With a dynamic leader, motivated staff, and gorgeous facility, now is a very exciting time for the CLC YMCA. The students in the class will have access to many resources: the nature walking trails, the FARMS at the Y program and teaching kitchen, Spectrum Generations, tennis. The collaboration possibilities are endless."
As the pre-K lead teacher, Farrell plans to utilize The Creative Curriculum for Preschool, a comprehensive, research-based curriculum that features exploration and discovery as a way of learning. The foundation helps teachers create a high-quality learning environment and build a thorough understanding of best practices. Daily resources help teachers plan and manage every moment of their day. Through studies, which are hands-on, project-based investigations, The Creative Curriculum for Preschool helps teachers build children's confidence, creativity, and critical thinking skills, and promote positive outcomes.
Farrell also plans to introduce the Handwriting Without Tears program, incorporating proven teaching strategies that benefit more than three million students each year and are currently used in AOS 93 schools. The guiding principle of the program states: "Children who master handwriting are better, more creative writers. The earlier we teach children to master handwriting, the more likely they are to succeed in school, and write with speed and ease in all subjects. We use fun, engaging, and developmentally appropriate instructional methods to enable children to master handwriting as an automatic and comfortable skill."
In Lincoln County, there is a great need for full-day child care and pre-K programs, and a pre-kindergarten program at the CLC YMCA will act as both a new and expanded service to the community. The town of Damariscotta was recently awarded funding from the Community Development Block Grant for a private, on-site pre-K program in the amount of $50,000.
The CLC YMCA will be able to offer a pre-K program designated specifically to pre-K-aged children, focused around a pre-K curriculum, and will include reading, writing, math and numbers, science, social skills, and creative arts.
"We are excited to bring a brand-new private pre-K program to our newly renovated Y. The classroom is a brightly lit and colorful space specifically planned and built for a pre-K class as part of the capital project," said Meagan Hamblett, CEO of the CLC Y. "It will also allow the YMCA's Child Care Center to have a larger capacity for their infant, toddler, and preschool classrooms, provide better separation of programming to meet the needs of each age group, and offer more space and growth at the Nobleboro child-care site — a win-win for the community."
The funding will support the staffing costs for a professional pre-K lead instructor and curriculum costs. The pre-K program is for children ages 4-5 who will be entering kindergarten in fall 2019. Both breakfast and lunch will be served daily. Before- and after-school care options are also available, as well as vacation-week camps held at the Y.
Enrollment is now open for the 2018-2019 school year. Pre-K packets are available at the Y's front desk (525 Main St., Damariscotta), Y Child Care (8 Sand Hill Road, Nobleboro) or online at clcymca.org. For more information, contact Sally Romero at firstname.lastname@example.com or call 563-8871.
To meet the YMCA's mission and adhere to the Community Development Block Grant's guidelines, the Y is accessible to all families, provided there is available space, and through a state contract and the Y's Annual Fund, subsidized slots are available, #wearemorethanagym, #weareacause.
For information about any of the Y's events, go to clcymca.org.


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Studio Session - $300
Studio portrait sessions are my favorite type of session! When you have total control of the lighting and environment, you can really get some awesome results! Since I added studio sessions to my offerings, I have had nothing but amazing reviews about these sessions.
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Feel free to pick the location or ask me and I can give you some options to choose from.
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A lot goes into a wedding day! The best thing you can do when trying to plan and budget your wedding is to send me an email so we can set up a consultation to go over the details of the day and figure out what works best for you.


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Two Vulnerable Senate Incumbents at Center of Tuesday PrimariesBut the 10 also heavily favored Hillary Clinton in the 2016 presidential election, voting for the Democrat by almost 10 points. Bruce Poliquin will attempt to defend his seat against the victor of a three-person Democratic primary featuring state Rep.
Neymar lands in Russia, Messi casts doubt over World Cup futureGabriel Jesus opened the scoring for Brazil during Sunday's 3-0 win over Austria . "Dreaming is not forbidden". However, he was a different player in Vienna and managed to score his 10th goal in 17 games for Brazil .
Kevin Durant says he would consider retiring at 35In a Lee Jenkins profile for Sports Illustrated , Durant revealed that he wasn't prepared for the series opener. But the Warriors' "light years" lead on the court is shrinking - down to mere light seconds.
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Washington opens de facto embassy in Taiwan, angering ChinaThe completion of the new AIT offices - built over nine years at a cost of $250 million - comes amid closer US-Taiwan ties. AIT's Taipei office has almost 500 American and local employees, while its Kaohsiung branch has more than 30 staff.
Griezmann: My Future Will Be Announced Next WeekAs Antoine Griezmann considers his future, the FC crew discuss the pros and cons of staying at Atletico and moving to Barcelona . But Griezmann has remained tight-lipped on his decision, refusing to reveal his future destination just yet.
Trump takes more swipes at Canada and Trudeau after tense G7 summitThe former Conservative prime minister said that while he believes the dispute is serious, that doesn't make it "lethal". Pre-summit reports from the White House suggested that the president even considered skipping the summit altogether.
Kim Jong Un commits to 'complete denuclearization' after meeting with TrumpTrump described the exercises as "very provocative " and said Pyongyang "very much appreciated" seeing the exercises end. USA forces in South Korea were also apparently clueless as to the decision to suspend the military exercises.


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Basic parameters:
Size: 5.9 cm * 1.35 cm Net amount: 10g Color: white Product Type: YPJSQ01JY The longest continuous playing time: 4 hours Working distance: 10 meters Charging port: Micro USB Wireless connection: Bluetooth version 4.2 Input parameters: 5V1A Implementation of the standard: Q / WMSX007-2017 CMIIT ID: 2017DP3366 Bluetooth protocol: HFP / HSP / A2DP / AVRCP * Compatible with external headphones: support 3-segment 3.5mm plug stereo headphones; support 4-segment 3.5mm plug GB and American standard phone headset (OMTP / CTIA automatic identification switch) Package Contents Packing size: 97 * 70 * 21mm Millet Bluetooth audio receiver * 1 3.5mm audio cable * 1 Brochures and three packs of vouchers 97mAh built-in battery Maximum continuous playing time: 4 hours
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After all these years I still love chocolate crackles, I recently made these for my daughters 23rd birthday. Quite a few got eaten before I could take a photo. Who says you have to be a child to enjoy them. This recipe is on the back of the Kelloggs Rice Bubbles Cereal packet.
4 cups Kellogg's rice bubbles
1 cup desiccated coconut
1 cup icing sugar
250g Copha, vegetable shortening
3 Tablespoons cocoa
In a large bowl, mix the rice bubbles, icing sugar, coconut and cocoa.
Slowly melt the copha in a saucepan over low heat. Allow to cool slightly. Add to rice bubbles mixture, stirring until well combined.
Spoon mixture into paper patty cases and refrigerate until firm.
Makes about 24
Filed under: Chocolate, Kids, Sweets | Tagged: Cocoa, Coconut, Copha, Icing Sugar, Rice Bubbles, Rice Crispies |


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From the spring 2013 issue of Redlands Magazine
The Country Club at Soboba Springs is not what the name implies, and it is everything the name implies.
With perfectly maintained fairways, greens and surroundings that are populated with palm trees and cottonwoods, and spectacular water features spread throughout, it's a golfers' paradise. The majestic San Jacinto Mountains form a scenic backdrop for both the 18-hole course and clubhouse/restaurant.
"Although we have 'country club' in our name, and we have a private club element, we are open to the public," says Phil Vigil, the director of golf. "We want to attract community players, travel groups and large events."
On any given day, the player mix includes serious golfers – it was the home course for Brendan Steele before he landed on the PGA Tour in 2011 – and those who want to enjoy a morning on the links in a beautiful setting without keeping score. And for those so-inclined, it's only a chip shot away from the gaming action at Soboba Casino.
After making the 35- to 40-minute drive from Redlands, golfers may pair up with players from the local community and ones who have come from as far away as Los Angeles or San Juan Capistrano. What everyone finds are lush fairways, which remain emerald green even during the cold-weather months thanks to overseeding with winter rye, and competitive rates. A round costs $45 – and that's the top weekend rate.
"If you were to slice this golf course out – the facility, the venue and the service – and put it in Orange County, those players would be paying $90 during the week and $125 on a weekend," says Vigil.
He has first-hand knowledge of golf course pricing in Orange County. Vigil was the director of golf at Bella Collina Towne & Golf Club in San Clemente before coming to Soboba in mid-September.
The savings from one round could more than pay for a top-flight lunch or dinner plus cover the tip at the Maze Stone Restaurant, where filet mignon, Southwestern Chicken Fettuccini, four meal-sized salads, and six burger options (including lamb and salmon) are among the menu highlights.
"Contemporary comfort food with a California flair that's reasonably priced," is how Ray Shalizi, the clubhouse manager, describes it.
Shalizi arrived at Soboba in early November with a resume that includes a director of operations stint at a hospitality management company responsible for hotel and resort properties in Chicago, Palm Springs and Newport Beach. The Maze Stone also has recently welcomed an executive chef, Wes Cavins.
Cavins is in the midst of an effort to redo the entire menu – for breakfast, lunch, dinner and banquets. There also are plans to introduce a new martini menu and expand a wine program that will offer more than two dozen vintages.
A special "Six.50" menu was launched with 10 selections, including hand-battered calamari, Mac & Cheese Pancetta and bison sliders. Each item is $6.50 during an extended happy hour, from 2-6 p.m.
"We want to offer sophisticated menu offerings and services, but we never want to enter into that realm of becoming pretentious," Shalizi says. "That's not what we're all about."
It's the same on the course, too. The par-72 with a 73.5 USGA rating challenges golfers – beginners and veterans alike – to use every club in the bag.
It was designed by Desmond Muirhead, "the Frank Lloyd Wright of the golf course architecture world," says Vigil, and it opened under the Royal Vista Golf Course banner in 1966. In December 2004, the Soboba Band of Luise?o Indians purchased the course, which is adjacent to their reservation, and later embarked on an extensive $4.6 million makeover under the direction of Cary Bickler, a Muirhead disciple.
A new irrigation system was installed; bunkers were renovated and added, all filled with Augusta White bunker sand; tee areas were laser-leveled and tee boxes were added on each hole; the course was lengthened; and waterfalls, streams and other beautiful water features were developed.
In April 2008, a clubhouse opened just off the 18th hole with the Maze Stone Restaurant, banquet facilities, lounge and a terrace, plus amenities for golf including men's and women's locker rooms, and a pro shop. The 32,000-square-foot structure is Southwestern Colonial in design, with natural rock and with alderwood trim accents. A waterfall connects the clubhouse and golf course experiences.
The Country Club at Soboba Springs enjoyed its national debut the following year when it hosted the inaugural Soboba Classic. With coverage on the Golf Channel, the competition featured the first million-dollar purse in Nationwide Tour history, and had the likes of Rickie Fowler, Jerod Turner and Steele out on the course.
While the Nationwide Tour ended its run at Soboba in 2012, major events still roll through, such as the Big West Men's Golf Championship, set for April 28-30. And with recent improvements – including a new, all-grass driving range that meets PGA Tour specifications, and a new fleet of golf carts – the options for more are always open.
Says Vigil, "If the moon and the stars align and we wanted to host a PGA Tour, LPGA Tour or Seniors Tour event, this facility is ready to go."
The Country Club at Soboba Springs
1020 Soboba Road, San Jacinto


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Region - Financial Studies is an international Open Access journal which aims to communicate to its readers, state-of-the-art technologies and methods on Financial Studies. The journal welcomes original researches, reviews and important applications of Financial Studies related analyses.
The journal mainly reports on behavioral finance, corporate governance, derivatives, financial management, real estate finance and other academic science related to financial studies.


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Centreville, VA residents interested in hair regrowth can visit us for a great solution
Our physical appearance affects the way we feel about ourselves. If you are a victim of hair loss, your self-confidence has probably taken a pretty severe hit. Dermatology Associates of Northern Virginia, Inc., located in Centreville, VA, is committed to helping patients feel great about how they look. We offer our patients innovative and effective solutions to their dermatology needs.That's why we offer PRP therapy for hair regrowth.
Why is a hair regrowth method offered by dermatologists?
Many people think dermatologists only deal with the skin. However, dermatologists are specialists in diagnosing and treating diseases of the skin, hair, and nails. We can diagnose the cause of your hair loss and determine if PRP therapy is the solution for you.
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Monday, January 28, 2019
Rather Than Increase 1L Class Size, Some Law Schools Shrink Strategically
Following up on my previous posts (links below): ABA Journal, Rather Than Increasing 1L Class Size in 2018, Some Law Schools Shrunk Strategically:
While 117 law schools this year increased their first-year class sizes, following a growth of more than 8 percent in applications, a few others purposely had fewer 1L students in 2018.
"When we saw that the applicant pool was much stronger at the top, we set a goal to go up two points for the median LSAT, assuming that most schools would go up one point," says Melanie Leslie, the dean of Yeshiva University's Cardozo School of Law. The first-year class has 334 students, compared to 368 1Ls in 2017. The median undergraduate grade-point average increased, from 3.51 to 3.52, and the median Law School Admissions Test score rose from 159 to 161. ...
Of the 46 law schools that decreased first-year class sizes by 5 percent or greater this year, 31 increased their median LSAT by at least one point, according to the Spivey Consulting Group, which works with law schools and law school applicants. A total of 22 schools increased both their LSAT and undergraduate GPA medians. ...
Another benefit to shrinking an entering class size is the potential to rise on U.S. News & World Report's law school rankings. That happened in March 2017 for Washington & Lee University School of Law, when it went from 40th to 28th in the rankings. ,,,
[Michigan State shrank] the entering class, from 266 to 208. The school's median GPA decreased, from 3.56 to 3.52, and the median LSAT for both years has been 154.
Prior TaxProf Blog posts:
- Law School Enrollment Strategies In The Changed Legal Education Market (Oct. 4, 2018)
- ABA Releases Data On All 203 Law Schools (Dec.14, 2018)
- 1L Enrollment Increased 3%, Non-JD Enrollment Surged 8% In Fall 2018 (Dec. 15, 2018)
- 51% Of Law Schools Increased Their Median LSATs, 60% Increased Their Median GPAs (Dec. 16, 2018)
- 2018 ABA Data Show Continued Decline In Number And Percentage Of Transfers (Dec. 17, 2018)
- 2018 ABA Law School Disclosure Reports (Stats + Graphs) (Dec. 19, 2018)
- WSJ: Law Schools Find A Way To Fill Seats (No Lawyers Required) (Dec. 20, 2018)
- The Ten Law Schools With The Biggest Increases In 1L Enrollment (Dec. 22, 2018)
- The Ten Law Schools With The Biggest Decreases In 1L Enrollment (Dec. 22, 2018)
- Diving Into The ABA Enrollment Data (Dec. 28, 2018)
- The Ten Law Schools With The Highest Non-JD Enrollment (Jan. 8, 2019)
This is packaging. The schools are shrinking to prevent decline. It's simply another way of declining.
Posted by: Mike Livingston | Jan 28, 2019 4:06:24 AM
How sad that exclusivity would pass as an acceptable goal for a charity.
And to waste so much going through the motions for an accordingly overpriced degree instead of simply teaching everyone (within reason) and including the scores in job applications for whoever wants to know.
Posted by: Anand Desai | Jan 29, 2019 7:43:19 PM


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The University of Maryland's annual Giving Day raised more than $1.2 million this year for several academic colleges, departments, and student organizations.
Giving Day is when the university reaches out to faculty, staff, students and alumni, encouraging them to donate funds for specific programs. Last year, this university raised $2.2 million.
There was a sizable donation last year that did not occur again this year, said Brian Logue, the senior director of annual giving.
Donors raised a total of $1,254,906 this year for programs such as various academic colleges, Hillel Center, the athletic department, the Alumni Association, as well as student organizations such as the equestrian team, the WMUC Legacy Fund, and Greek organizations.
[Read more: UMD nets almost $400,000 in first Giving Day fundraiser]
"We create this huge day and [groups on campus] leverage some of the promotion and everyone does their best to make sure their communities are aware of this. Then, they will get that money they need to help their programs," Logue said.
Logue added that the programs Giving Day focuses on are important priorities of this university: research, arts, athletics, student life and scholarship.
The behavioral and social sciences college received the greatest amount of money and the second highest number of gifts with a total of $299,433 raised, which will go toward funding scholarships for students within the department as well as other needs, such as funding additional programs of the college, Logue said.
The Clarice Smith Performing Arts Center raised $6,180, which is about 60 percent more than what was raised in 2017, said Cecily Habimana, the assistant director of institutional giving for The Clarice. It will go toward The Clarice Fund, which supports performances and arts in the community. These performances include funding for student dance and orchestral performances, as well as funding performances for students to enjoy.
"Our budget is close to $7 million, so it's not a large dent, but it's good to be able to talk to our patrons and students about the arts," Habimana said.
The athletic department received $62,855, which will primarily go toward funding scholarships for student athletes, said Zack Bolno, the senior associate athletics department spokesman.
Student organizations were also able to take advantage of Giving Day. The equestrian team received 195 gifts for a total donation of $3,050, said Chloe Bates, the team's public relations chair. It also received $1,250 from this university for getting the highest number of gifts of any student organization.
Bates, a sophomore communication and Spanish major, believes the team was able to raise the amount of money it did because of the additional publicity from Giving Day. The team will put the money towards subsidizing and funding skills workshops for team members as well as replacing their old and outdated equipment, she said.
"It's a really great opportunity for us. It's really hard to seek out donations, and this just makes it so much easier to get support," she said, noting they were able to subsidize the price of a riding clinic last year from several hundred dollars to $25 for team members.
[Read more: University of Maryland to receive $219.5 million donation — the largest in its history]
The Clarvit family, a family of alumni from the university, amongst other donors, helped match certain funds given to organizations. They matched gifts donated to various funds by students, giving over $25,000 to funds including other student organizations and academic programs.
Beta Theta Pi received the most gifts of any Greek organization, which will go to student scholarships, Logue said, adding Giving Day donations funded 17 scholarships for Greek life students last year.
The fraternity received 167 gifts, and will use the money to fund a scholarship for "someone who has dedicated a lot of time and effort to Beta," said Brad Weissel, the fraternity's philanthropy chair. Beta Theta Pi was able to raise so much money by turning the day into a competition with other Greek organizations and sending leaderboard updates to alumni throughout the day, Weissel added.
"By making it a competition we were able to get a lot more support. Many of our alumni are very competitive and they did not want to lose," Weissel said.


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Tag Archives: coffee
The Surprising Benefits of Drinking Coffee
Do you need a cup of coffee to get you through the morning at work? Do your friends constantly tell you that you drink too much of it? Well, you can fire back at them with the benefits of drinking … Continue reading
National Irish Coffee Day
I had no idea there was a day for Irish coffee. Did you? This warming beverage was first served in the 1940's at the Shannon airport in SW Ireland. Intending to warm the weary travelers stopping in, Chef Joe Sheridan … Continue reading
Posted in Beverage, Cold - with alcohol, Warm - with alcohol Tagged coffee, irish coffee 1 Comment
Do The Healthy Alternatives To Your Favorite Foods Really Stack Up?
January is the time where most people end up thinking more about their health and diet than they have in months. After the holiday season, most us of feel like we could do with a bit of a break from … Continue reading
Posted in Informational Tagged chips, coffee, fries, healthy 2 Comments
Who Needs Starbucks? Improving Your Coffee At Home
A visit to a coffee shop is part of a daily ritual for many people, including me! But it can become an expensive habit. With most people spending $2-5 on their daily cup of joe, it's something that can really … Continue reading
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Hot Drink And Treat Combinations For Winter
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Irish Coffee
A wonderful way to end your day – or a Sunday brunch – and just in time for St. Patty's Day!
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Invest in bitcoin or ethereum 2017
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Case Study
An Unusual Case of Esophageal Rupture
Nizar Tejani1, Sylvia Bowditch1, Kai Engstad2 and Leonard Ranasinghe1*
1California Northstate University College of Medicine, California, USA
2Legacy Emanuel Medical Center, Portland, Oregon, USA
*Corresponding author: Leonard Ranasinghe, Department of Emergency Medicine, California North state University College of Medicine, 9700 W Taron Dr, Elk Grove, California, USA, Tel: +916 686-7929; E-mail: firstname.lastname@example.com
Citation: Tejani N, Bowditch S, Engstad K, Ranasinghe L (2018) An Unusual Case of Esophageal Rupture. J. J Clin Case Rep Case Stud 2018: 19-22. doi: https://doi.org/10.29199/2637-9309/CCCS-101015
Received: 15 April, 2017; Accepted: 25 May, 2018; Published: 05 june, 2018
Boerhaave Syndrome is a rare entity which occurs as a result of rupture of the distal esophagus leading to a high rate of morbidity and mortality. It occurs most frequently in patients with bulimia or alcoholism because of the increased episodes of emesis and underlying esophageal fragility. We present a unique case of a 38-year old firefighter / paramedic with no prior risk factors for esophageal rupture who sustained this injury after three bouts of emesis. The diagnosis of Boerhaave Syndrome was initially missed by the emergency physician, who attributed the patient's condition to nephrolithiasis. A radiologist's attention to detail ultimately led to the correct diagnosis. Our patient underwent surgery to repair the tear and required extensive follow-up care. Pathophysiology, epidemiology, imaging, management, and complications are discussed in this case report.
Boerhaave Syndrome; Case Report; Emergency Medicine; Esophageal Rupture; Esophageal Tear; Gastroenterology
Boerhaave Syndrome is characterized by transmural rupture of the distal esophagus. It was first coined by Dr. Herman Boerhaave in 1724, who described the death of nobleman Baron Jan von Wassenaer. Wassenaer died after a bout of excessive drinking and consumption of food. While performing the autopsy, Boerhaave discovered a tear in the distal esophagus with spilled food particles in the chest cavity causing mediastinal emphysema [1]. In accordance with this original case, Boerhaave Syndrome continues to be associated with an overindulgence of food and alcohol and is therefore most frequently seen in individuals with bulimia and alcoholism [2]. Boerhaave Syndrome is thought to be due to failure of the cricopharyngeus muscle to relax during emesis, which leads to a pathologic increase in esophageal intraluminal pressure and subsequent rupture.
Spontaneous esophageal ruptures are extremely uncommon, with fewer than 150 cases reported per year in the US [3,4]. Boerhaave Syndrome is a frequently overlooked diagnosis due to its rareness and nonspecific symptoms. Early recognition and intervention are critical for patient survival. It is the most lethal gastrointestinal perforation, with a mortality rate of nearly 100% if left untreated for more than 48 hours [5].
A 38-year old firefighter / paramedic felt nauseated after lunch and vomited three times. He then experienced an excruciating pain in his left flank and upper abdomen and was immediately taken to the nearest Emergency Department (ED). The patient was in excellent health prior to this incident; his past history showed only seasonal rhinitis. His sole medication was a steroid nasal spray. On arrival to the ED his vital signs were: BP: 100/80, P: 140, RR: 16. Suspecting a possible left-sided kidney stone, the ED physician prescribed intravenous narcotics and ordered a CT of the abdomen and pelvis without contrast. Although the patient was a narcotic-naïve individual, his pain was not completely resolved with the medication he received.
The radiologist reported that the CT of the abdomen and pelvis did not show any kidney stones, but there was evidence of pneumomediastinum. A subsequent chest CT with contrast showed an approximately 6 cm esophageal tear (Figure 1). An esophagogram (Figure 2) confirmed the distal esophageal tear. That night, the patient was brought to the operating room, where he underwent a left thoracotomy and primary two-layer repair with a
pedicled intercostal muscle flap. The tear was found to be located 3-4 cm above the GE junction. The chest was grossly contaminated with large amounts of food and the surrounding tissues were inflamed. After three weeks of close monitoring, the patient was deemed stable for discharge. At this time, he had a small right pleural effusion. About ten days after discharge, the patient's father noticed that he appeared ill, diaphoretic, and tachycardic. The patient was immediately taken to a nearby ED and found to be septic secondary to a right-sided empyema. Chest tubes were placed for drainage, and the patient was admitted to the ICU. A few days later, a chest CT and another esophagogram revealed a leak at the previously-repaired distal esophageal tear. An esophageal stent was placed under endoscopy by a gastroenterologist to facilitate healing of the tear. The empyema improved significantly, but the patient continued to have tachycardia. A repeat chest CT showed resolution of the empyema. However, it also showed two new developments: a markedly elevated left hemidiaphragm and a pericardial effusion. The latter was confirmed by an echocardiogram. A pericardial window procedure was done by a cardiothoracic surgeon and 700 ml of pericardial fluid was removed. Culture of the fluid was negative and the patient recovered from the effusion without any complications. A few weeks later a follow-up CT indicated that his esophageal stent had migrated into the stomach. A second endoscopy was done to remove the migrated stent and it was replaced with a longer one. After nearly one month in the hospital, he was discharged. He had close follow-ups with his primary care physician, pulmonologist, gastroenterologist, and cardiothoracic surgeon. Six weeks after discharge, the second esophageal stent was removed and he continued to improve. At this point he had lost forty pounds. During a follow-up chest fluoroscopy, which included a "sniff test," it was noted that the patient's elevated left hemidiaphragm still persisted. The pulmonologist attributed this persistent elevated hemidiaphragm finding to either phrenic nerve neuropraxia or paralysis. The patient was determined to return to work and began his recovery training with short walks, which he gradually increased to jogging. His stamina improved significantly during this period. He successfully completed a physical examination which allowed him to return to work full-time work as a paramedic / firefighter. Nevertheless, the patient's left hemidiaphragm persisted seven months after his esophageal tear (Figure 3).
Typically Boerhaave's patients will have a history of nausea and vomiting followed by dyspnea and sudden, severe epigastric pain that may radiate to the back or left shoulder. In most cases, air enters the mediastinum and leads to subcutaneous emphysema, which may present as crepitus in the neck [6]. Patients may also exhibit Hammon's sign on auscultation, a pericardial crunching sound that reflects the heart beating against air trapped in the mediastinum. Chest pain, severe vomiting, and subcutaneous emphysema are collectively referred to as Mackler's Triad, a diagnostic hallmark of Boerhaave Syndrome [7].
Figure 1: A CT of the chest shows leakage of contents into the mediastinum from a ruptured esophagus. This is highly suggestive of Boerhaave Syndrome and warrants a confirmatory esophagogram.
Figure 2: An esophagogram that shows extravasation of contrast, confirming the diagnosis of Boerhaave Syndrome.
Figure 3: An elevated L diaphragm can be seen on this chest xray.
There are a number of differential diagnoses based on the nonspecific presentation of a patient with Boerhaave Syndrome. The chest pain and dyspnea may mimic cardiorespiratory etiologies, including myocardial infarction, pericarditis, spontaneous pneumothorax, pulmonary embolism, or pneumonia. Detection of amylase from spilled mediastinal contents may arouse suspicion of acute pancreatitis [1]. Based on its gastrointestinal symptoms, Boerhaave Syndrome is most commonly misdiagnosed as a perforated ulcer [8].
The constellation of symptoms in a patient with Boerhaave Syndrome warrants a chest radiograph. Abnormalities on imaging will depend on three critical variables: time between rupture and imaging, location of rupture, and mediastinal-pleural integrity [9]. Chest radiographs of esophageal rupture will commonly exhibit a left-sided pleural effusion with atelectasis [7]. This can be attributed to the relative lack of anatomical support to the left posterolateral aspect of the distal one-third of the esophagus. A pneumomediastinum may also be present on film showing the characteristic, albeit, nonspecific, V sign of Naclerio [10]. This radiographic sign describes subtle mediastinal widening caused by collections of air between the fascial planes of the mediastinum and pleura behind the heart [1]. Water-soluble contrast studies and computerized tomography are used to localize a rupture and to confirm diagnosis of full thickness tear [7].
Primary management of any patient with Boerhaave Syndrome includes fluid resuscitation, initiation of empiric antibiotics, and placement of nasogastric tube [1]. Aseptic patients with minor ruptures and lack of mediastinitis are candidates for conservative medical management using endoscopic stents [11]. However, these stents must be placed early in order reduce the risk of stricture development and ischemia of the esophageal tissue [11]. Migration of stents is variable but not uncommon and can occur in stents with diameters of less than 28 cm [12,13]. In more complicated cases, the primary determinant of treatment choice and outcome is time after perforation [7]. In patients who present within 24 hours of rupture, emergency transthoracic primary repair remains the gold standard [14]. This procedure involves an approximation of healthy mucosal and submucosal tissue with a reported leak rate of 20%. Patients who present after 24 hours of rupture undergo reinforced primary repair with autologous tissue. In severe cases, the surgical treatment of choice is esophagectomy with delayed reconstruction using colon or supercharged jejunum [7]. Early surgical intervention is strongly recommended to reduce the risk of mortality. However, there are numerous case reports showing successful recovery with nonsurgical management [15]. Healing is monitored through water-soluble contrast imaging [7].
This patient's diagnosis of Boerhaave Syndrome was a challenging one to arrive upon for several reasons. It is unlikely to be included on a differential diagnosis because of its low incidence. In addition, our patient lacked the typical risk factors for Boerhaave Syndrome because he had no prior history of bulimia or alcoholism. However, Boerhaave Syndrome has been reported to be caused by straining, childbirth, weight lifting, coughing, blunt trauma, seizures, asthma, forceful swallowing, and even just a single bout of emesis [10]. It is prudent to consider Boerhaave Syndrome even in absence of obvious risk factors. Our patient's presentation was typical of Boerhaave Syndrome: severe epigastric and back pain following postprandial emesis. It is likely that the patient's flank pain led to the emergency physician's suspicion of nephrolithiasis rather than an upper GI pathology. Had the radiologist not recommended a chest CT, treatment would have been further delayed and risk of mortality would have increased.
Our patient experienced numerous complications that delayed his recovery, some of which may have been prevented. Sepsis, empyema, leakage of surgical site, and stent migration were consistent with other reported complications of Boerhaave Syndrome [1,11,16]. In retrospect, our patient's discharge may have been premature, as he had a small right pleural effusion on discharge and subsequently developed empyema and septicemia. Given the degree of pneumomediastinum, bacterial seeding into the right pleural space may be a likely cause.
Although the esophageal leak was discovered after the appearance of these symptoms, it was later attributed to be their cause. This 'cause and effect' has been described in numerous case reports [1,16]. The endoscopic placement of this patient's stent differs from most reported cases. The literature describes the use of stenting as a conservative management technique in early onset. Instead, our patient's stent (23 mm x 100mm) was placed following the leak and subsequent empyema and septicemia. He required a second stent placement (23 mm x 150mm) as his original stent had migrated into his stomach nine days after its insertion. This longer stent did not migrate and was removed without complications more than a month later. Our patient's case demonstrates that the length of stent may be a critical variable in prevention of migration. This is not entirely supported by the literature. One particular study comparing stent placements in the treatment of esophageal perforations and ruptures suggested that stent diameter rather than length may be important in the prevention of migration. Based on their limited sample size, Johnsson et al., noted that 28mm may be an optimal diameter [13]. Investigation into comparing the efficacy of stent length and diameter may be a promising source of further research. Our patient experienced other complications, including the pericardial effusion and left hemidiaphragm, which are atypical in reported cases [17]. The etiology of these conditions in this case is unclear. The pericardial effusion was treated without further complications. In contrast, the left hemidiaphragm could not be treated as easily and proved to be the greatest barrier to recovery for our patient.
The early diagnosis of Boerhaave Syndrome is paramount and can be aided with a high index of suspicion. Contrast esophagograms remain a crucial tool in diagnosing the rupture and guiding the treatment options. The extravasation of contrast in our patient's esophagogram mandated urgent surgery. Even if the diagnosis is caught early, patients can still develop numerous complications. Boerhaave patients should be treated in centers that have experience in the management of esophageal injuries and access to the full breadth of surgical, endoscopic, and radiologic treatment.


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By Nur Febriani Wardi
Indonesia is a true exemplar when it comes to having a comprehensive legal system for disaster risk management (DRM). Having learnt from first-hand experience and many disaster operations, national authorities have continued to ensure the country is well-prepared to face the inevitability of future disasters.
Over the years, Palang Merah Indonesia (PMI) has been actively at the forefront of the various processes to develop and strengthen the legal framework for DRM in Indonesia. Most recently, they have been advocating for the review and update of Indonesia's landmark disaster management law, Law No. 24/2007. PMI is part of a National Platform for DRR ('PLANAS-PRB'), and one of the key members of working group or 'alliance' for the strengthening of the law called AMPU-PB (or 'Community Alliance for Strengthening Law on Disaster Management').
Through these groups, PMI is one of the main organizations leading discussions around the strengthening of the DM Law. This type of 'collective advocacy' used by PMI and its partners has yielded some influential results. By the end of 2016, PMI, together with AMPU, had held several forums to reflect on previous disasters and how prevention and response is considered in the existing disaster management law. Furthermore, they also presented the results of a study undertaken by PMI and IFRC on 'Strengthening Law and DRR in Indonesia', which was also the topic of a stakeholder consultation in February 2016.
In commemoration of the 10th anniversary of the disaster management law in late April 2017, PMI and AMPU conducted a reflection on disaster management in Indonesia and how to strengthen the national disaster management law. As a leading actor in Indonesia, PMI is also often invited to provide insights into how the disaster management law could be improved. Key issues that have been advocated for as part of the law reviews include issues around definitions, status and level of disaster, budget, community participation, and the shifting paradigm from response to DRR (which links with other sectors, especially climate change).
These discussions are being had in the hope that an amended law will accommodate the full spectrum of disaster risk management, including new and emerging trends. The discussion also highlighted the importance of improving the institutional aspects of BNPB (the Indonesian national disaster management authority) in an effort to strengthen cross-sectoral coordination. This feedback was echoed by PMI's Secretary General Dr. Ritola Tasmaya, who has outlined the need to strengthen institutional coordination among sectors.
As a result of their advocacy, the 2007 law was entered into the national legislation program (prolegnas) for 2015-2019 as one of the main acts to be amended. Although the law is far from the top of the list, its presence there brings hope that the success of PMI's advocacy will yield further positive results.
There is no doubt that Indonesia already has an extremely comprehensive disaster management law, and broader frameworks which relate to the full DRM spectrum. In light of this, PMI maintain that a review of the existing law is not intended to undermine this system, but rather to consolidate and also improve implementation. This will then provide an even better legal basis which reflects new and emerging risk, and enables resilience.
About the IFRC
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Started in April 27th harvested 2ND November in lovely northern Ireland :) was always told it would never grow, boy were they wrong! She had a tough time, from snapped branches til surviving a hurricane! Eventually Ireland's famous rain and 85-95 humitidy called her to a halt! Best £15 I ever spent, came from a bud that I bought she has repaid me 50fold so I can't complain! Gonna be trying aload of autos next season that should be fine over the summer months! True sativas here I doubt would finish, Maybe an indica of some sort! Thanks again to everyone who helped! Wish I could have a doobie with use all lol until next year peace out everyone :) :) had no scales to weigh the wet weight but I got just over 2.5ounces dry, well pleased!! The taste is really nice a real pleasant high, can't stop yawning everytime I have a smoke :) thanks again000
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This is the Cab basket for the SportRack System for Tacoma and Tundra trucks. The cab basket for the SportRack is a required part when installing our SportRack system. 2-Inch diameter tubing makes this basket very strong. The basket is large, and strong enough to carry a spare tire or camping gear. There is a front windshield to reduce noise and to keep some of the bugs off of the gear bags. We have included 4 welded light tabs for those that want more light for the trail. The basket like the SportRack is painted in our dual process textured black powder coat finish. The Sport Rack system for the Tacoma requires Part Number 5129 & TC-6124.
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Today the liquidsonics.com website moved to a completely new server infrastructure and set of web technologies.
LiquidSonics has grown rapidly in the last 18 months with the very well received launch of Reverberate 2, and we are now welcoming an increasingly large number of additional visitors from Slate Digital keen to download the Fusion-IRs for VerbSuite Classics. For the last six months or so web demand has dramatically outstripped server capacity at times.
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We look forward to some fantastic high profile product launches in 2017 that wouldn't be possible without the move, so this year is set to be the best yet!
Thanks for your support!


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A scene from Fantastic Beasts and Where to Find Them Photo: CFP
Released on Sunday, the latest trailer for Fantastic Beasts and Where to Find Them gives audiences an ambiguous hint into the background of lead character Newt Scamander, the character played by Oscar-winning British actor Eddie Redmayne。 Just why is Professor Albus Dumbledore so fond of him and whats the secret behind the magical suitcase he carries?
Fantastic Beasts is a spin-off of the Harry Potter series created by J.K。 Rowling。 The film was directed by David Yates and stars Eddie Redmayne, Katherine Waterston, Alison Sudol, Dan Fogler and Collin Farrell。
This is the first installment of an upcoming trilogy inspired by Rowlings book of the same name。 It also marks her debut as a screenwriter。
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KUALA LUMPUR, April 10 (Xinhua) -- Home-favorite Lee Chong Wei defeated world Number 1 Chen Long in two straight sets on Sunday, winning his 11th Badminton Malaysia Open Champions.
Lee lightened up the home fans by winning six consecutive points after he tied with Chen 2-2 in the opening set.
The defending champion seemed unable to mount any real challenge and Lee won the match 21-13 and 21-8 in 42 minutes.
Lee admitted he was surprised to win by such a margin. But Chen seemed satisfied with the runner-up, saying he had achieved his goal for the tournament by grabbing points to qualify for the Olympic Games.
China shuttlers won their only title in the tournament after Tang YuantingYu Yang delivered a handy victory over Jung Kyung EunShin Seung Chan from South Korea, winning 21-11, 21-17 in Women's Doubles final.
"It was the first we play against this (South) Korean shuttler since we paired, so we had prepared to face difficulty," Yu said.
"But the strong wind within the stadium make it impossible to apply our tactics, we win because we managed to control the shuttle better."
In Men's Doubles, Chai BiaoHong Wei .
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