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We'll pull the plug on info-leak smart meters, warns UK.gov
Lose customer data and lose your licence
The government plans to place a specific obligation for data security on the suppliers of smart meters as part of its conditions for granting licences to install the technology and use it to monitor customers' energy supplies, it has confirmed.
In its latest consultation [18-page/118KB PDF] on use of the technology, the Department for Energy and Climate Change (DECC) has set out steps suppliers will have to carry out to ensure their systems are secure to an "appropriate standard" in the period running up until the launch of its Data and Communications Company (DCC).
Suppliers will have to conduct an initial risk assessment of their end-to-end systems as well as ongoing risk assessments as new threats emerge, and will have to have annual independent security risk audits conducted by external specialists.
Suppliers will also be expected to have incident management procedures, enabling them to identify and respond to security incidents in a coordinated manner, in place along with business continuity and disaster recovery procedures. They will also be expected to install physical security controls to protect equipment that interacts with the smart metering system.
"The government is committed to ensuring security is embedded into the design process for smart meters and their communication systems from the start, and to create a framework that allows systems and processes to continue to be fit for purpose as security risks, technology and the requirements continue to evolve," the DECC said in the document. "Given the potential for a security incident, of any nature, to undermine confidence in smart metering ... the government has proposed that obligations should be placed on suppliers in advance of DCC 'go live'."
Suppliers will have responsibility for security requirements, including requirements relating to the encryption of data and authentication of any commands received by the meters, at every stage of the process until the DCC takes on overall responsibility for security arrangements. Draft licence obligations for suppliers once the DCC is fully operational will be produced in the coming months, DECC said.
Smart metering technology is due to be installed across the UK from 2014, with every UK household and business – approximately 55 million meters – expected to have the technology by 2019. Smart metering enables a two-way flow of information that can deliver real-time information about energy consumption and demand for energy to suppliers and network operators. The government has said smart metering will help to slash unnecessary energy use, reduce emissions and cut consumers' energy bills.
Will this fill you with confidence?
Energy law expert Jeremy Chang of Pinsent Masons, the law firm behind Out-Law.com, said that by embedding the security requirements in supply licence conditions, DECC had sent out a "strong message" that data security was central to the smart metering programme.
"DECC recognises that tackling data privacy concerns around smart metering is key to maintaining consumer confidence in the system," he said. "Although the consultation only relates to the period before the DCC starts supplying data services, it marks an important step in addressing these concerns.
"We should also welcome the fact that DECC has been careful to balance the need, on the one hand, to be prescriptive so as to ensure that the systems suppliers put in place are secure and, on the other, giving them flexibility to determine what is required relative to their roll-out plans pre-DCC 'go-live'," he added.
Technology law expert Chris Martin of Pinsent Masons has previously indicated that smart metering systems will have to put in place "robust technical security measures" to prevent the data revealing intrusive information about individuals' lives.
"The data can reveal much about a household such as the make and model of their TV, the times during which a house is occupied and the number of people staying in a household," he explained. "This information is useful to energy suppliers but it is also potentially valuable to a whole host of other organisations too."
Earlier this week Consumer Focus published a new advice guide intended to raise consumer awareness of what the technology will mean for them. The advisory body said that nearly half of consumers had not heard of smart meters, according to its research, despite the fact that around half a million new meters had already been installed ahead of the full national roll-out.
Copyright © 2012, Out-Law.com
Out-Law.com is part of international law firm Pinsent Masons.
Sponsored: Beyond the Data Frontier


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Thanks to my friend Syrie at Taste Buddies, I savored some of the best Thai food that I have ever tasted in my life–at the famed Longrain Restaurant and Bar in Sydney today.
The food was so good that I just had to buy the cookbook right there and then.
I have to call your attention to the restaurant's signature dish–eggnet with ground pork, prawn, peanut, bean sprouts in sweet vinegar; it is practically to-die-for. Despite its "netty, creative, and somewhat fusion" appearance, it's every bit distinctively Thai–sweet, sour, spicy, and salty…
While in Sydney, one has got to try out the world-famous rock oysters, so I ordered one freshly shucked rock oyster with red chili, lime juice, and deep-fried eschalots (shallots)- they sure tasted heavenly on top of the silky smooth rock oyster. After this treat, I don't think I can go back to the plain cocktail sauce and lime with oysters anymore. It's heaven and earth.
Longrain Restaurant and Bar
85 Commonwealth Street
Surry Hills,
NSW, Australia 2010
Note: I am not a big fan of fusion food; those over-the-top and neither east-nor-west food. There are definitely Thai/Chinese fusion dishes at Longrain, but they still retain the signature flavors despite the western presentation and plating. Just reading through the recipes, I know that the cookbook is a keeper…just the eggnet recipe is worth shelling out $16 for.

subset: commoncrawl


text: Is it a work vehicle? A rec vehicle? Or something else entirely? Turns out, it's all of the above. Our ruthless Havoc side-by-side features a class-leading suspension system, King Shocks, 100HP and 2,000 pounds of towing capacity. It's built with a work ethic and a sense of adventure — so you can create Havoc however you want.


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Knit Cable Purse1:47 PM Edit This 3 Comments »
Finally, after a really, REALLY long and worrisome week at work AND at home, I've finally finished the Plait Cable Purse that I had started back in December. I haven't done any knitting or crocheting in about a week. And that is UNHEARD of for me! YIKES! Because upon waking at 6 am Thursday morning I received a phone call from my Dad saying he needed to go to the Hospital. I ended up taking him to the ER Thursday morning and they promptly registered him into the hospital to stay where he will be until hopefully only Monday. He has an intestinal blockage from the Arterial Bypass surgery he had back in November. I've been scared out of my wits. And needless to say, no crafting of any kind has been done of late. Plus on top of it all, I've been having horrible migrain-like headaches all week due to Sinus problems. UGH! After working all day I've just came home and crashed on the couch, barely able to read my emails and blogs because I feel as if my head is about to lift up from my shoulders and promptly explode!!! Anywho, on with the pics! I hope everyone else has been having a better, healthier week than i've been having!


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8pm – Open Mic With Derek Smith
Monday, September 23 @ 8:00 pm - 1:00 amFree
Invite your fans and friends and show us what you got!! One of the top open mic's in the Bay Area. Performers from all genre's are welcome every Monday night. To sign up or for more open mic info, call Derek at 415-455-0948.


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START Conference Manager
The Libraries of Second Life: How MUVE Could Shape the Future of Digital Libraries.
Miguel Ruiz, Allison Brueckner, S. Thompson, Lili Luo and Brian O'Connor
ASIS&T 2008 Annual Meeting (AM08 2008)
Columbus, Ohio, October 24-29, 2008
This panel will present an overview of Multi User Virtual Environments, specifically Second Life (SL), and its applications in Library services and education. The panel includes practitioners as well as educators that have been developing applications in Second Life. They will be presenting current applications of SL in Libraries and virtual campuses, and discuss usability issues associated to these environments.
Conference Manager (V2.54.6)


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A Scotsman is on holiday in New York City. It's a balmy spring day, and he's wearing a kilt.
A young woman comes up to him and boldly asks him if anything is worn beneath the kilt.
"No, lassie," he replies. "Everything is in fine working order."
© 2019 Comedy Partners. All Rights Reserved. Comedy Central and all related titles, logos and characters are trademarks of comedy partners.


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Now Chibis!
Now a Fluffy Dragon
All done because I was bored...
kozom1234 wrote:Great job! But why is the girl holding the ouch-that-hurts side of the sword?
Quaza wrote:Man saving bunny from a zombie (with what looks like a plasma-rifle) = EPIC
Man wielding BAN-hammer = EPIC
Girl holding sword like Donald = EPIC
cactus = not so epic
kozom1234 wrote:i have no idea what just happened. I loved it.
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Recently, the Institute for Supply Management (ISM), Tempe, Ariz., reported its June Purchasing Managers Index (PMI), based on a survey of approximately 350 of the nation's supply executives, had fallen below 50 — the number that signals a contraction in the manufacturing sector — for the first time in three years (Table). The index of manufacturing activity fell to 49.7 from 53.5 in May, which marks the lowest reading since July 2009, one month after the recession officially ended. According to the "June 2012 Manufacturing ISM Report On Business," respondents were divided on their answers. "Comments from the panel range from continued optimism to concern that demand may be softening because of uncertainties in the economies in Europe and China," wrote Bradley J. Holcomb, chair of the ISM Manufacturing Business Survey Committee and author of the report.
Despite reports of decreased regional manufacturing activity released two weeks previously (see Regional Manufacturing Reports Reveal Mixed Activity), the ISM index fell almost a full point below the lowest forecast for it in a survey of 70 economists conducted by Bloomberg, New York. Predictions in the Bloomberg survey ranged from 50.5 to 53.5, with the median totaling 52. As a result, some industry economists have reacted to the lower-than-expected ISM index number as an indication that U.S. manufacturing is faltering.
For instance, Nigel Gault, the chief U.S. economist for IHS Global Insight, Lexington, Mass., wrote to clients that the report suggests that — for the moment — the manufacturing recovery is "out of steam." Additionally, according to Neil Dutta, head of U.S. economics at Renaissance Macro Research LLC in New York, "Manufacturing is gearing down."
RDQ Economics, New York, points out that the drop in new orders in the ISM index is the biggest decline since October 2001 — and the second-largest slide since December 1980. The firm calls it "an event that occurs in roughly one in 100 reports." The important issue now, RDQ says, is whether this represents "volatility reflecting fears over Europe — the export order index fell six points — and will orders bounce back or is it a slide into something more worrying?" According to RDQ, the uncertainty about the market sector that has been driving the economic recovery "just got ratcheted up a notch with this report."
Comeback Kid
Though the ISM report revealed a contraction in manufacturing activity, only a sustained reading below 43 actually signals a lack of growth in the sector. Even at the lower number, the manufacturing figures were consistent with growth at an annual rate of 1.5%. "This is not good. Not good at all," said Dan Greenhaus, chief economic strategist at BTIG, an institutional brokerage. However, Greenhausgoes on to say that although it is a "terribly weak number," it "does not mean recession for the broader economy."
Accounting for about 12% of the overall U.S. economy, manufacturing has led the recovery that began June 2009. Until the ISM released the report on its June index, manufacturing had been reported as climbing at a steady pace, giving industry experts reason to be optimistic about its long-term prospects.
Recently, the National Electrical Manufacturers Association (NEMA), Rosslyn, Va., reported the manufacturing sector experienced a surge of activity in the first quarter of 2012, reaching a 10.4% annualized increase in industrial production for manufactured goods. For this surge, the organization credits unseasonably warm weather in January and February. Its forecast for manufacturing activity for the whole of this year and next is more tempered, expecting it to decelerate from its robust post-recession pace to a more sustainable level closer in line with long-run industry output trends. NEMA is expecting output growth to remain at an average of 3.4% in 2012 and 2013.
In addition, according to the Association for Manufacturing Technology (AMT), May U.S. manufacturing technology orders totaled $473.92 million, as reported by companies participating in the U.S. Manufacturing Technology Orders (USMTO) program. Analysis of manufacturing technology orders provides a reliable leading economic indicator as manufacturing industries invest in capital metalworking equipment to increase capacity and improve productivity, according to the organization. This marked a 14.5% increase from April and a 19% jump when compared with the total of $398.10 million reported for May 2011. With a year-to-date total of $2,235.37 million, 2012 is up 12.1% compared with 2011.
"The latest USMTO figures indicate both sound health and continued expansion in durable goods manufacturing," said AMT President Douglas K. Woods. "This is backed up by other key economic indicators, including an upward revision in housing starts and a strong showing in durable goods orders. Overall, indications are that manufacturing will continue to lead the way in the general economy."
Additionally, in its Nonresidential Construction Index (NRCI) Second Quarter 2012, FMI, Raleigh, N.C., calls manufacturing construction the "comeback kid" because of its steady improvement since the worst of the recession. "It looks like it's doing better than it has for a long time," says Phil Warner, FMI research consultant. "Our panelists are seeing more activity in that area, so they are more bullish and less pessimistic about it."
FMI is forecasting manufacturing to grow at a rate that just outpaces the GDP (see Figure at right). "That's not what you'd call a major boom, but we expect it to continue to increase right through 2015," says Warner. "It's nothing radical, but we expect steady growth."
Maximum Capacity
As a result of increased activity in the manufacturing sector, capacity utilization is improving. "It's not real high yet, but it's getting to the normal levels," says Warner, further explaining that once capacity reaches 80% to 85%, companies begin considering expansion. "It's not quite there yet, but it's better than it has been," he concludes.
In April, manufacturing capacity reached 79.2%, according to the Federal Reserve Bank of Chicago. Although
it hasn't yet reached the numbers indicated by Warner, there have been both retrofit and new construction projects since the end of the recession.
For Faith Technologies, Inc., Menasha, Wis., the recession brought about a sharp decrease in its contracts in the manufacturing sector. "As with the rest of the construction industry, we did see a downturn in the manufacturing sector," says Tom Clark, chief revenue officer. "For a period of time, there was a significant drop off in not only construction, but even the ongoing maintenance done for many of our clients."
However, by late 2010, the firm was starting to see gradual increases in its backlog. "There does appear to be a resurgence in manufacturing in the United States," says Clark. "Some of the projects we have looked at are manufacturing products to export — which wasn't the case a few years ago." Clark estimates his firm's current backlog in manufacturing/industrial projects to be up more than 100% compared to this time last year, making up about 25% of the total backlog. "It has been a mix of retrofits and new construction, although many of the opportunities we have been looking at in 2012 have been new construction," concludes Clark.
In the last nine months, Stephen J. Frantz, executive VP for the industrial, utilities, and service divisions of Detroit-based Motor City Electric Co., has seen a definite increase in the number of manufacturing projects up for bid. "The business activity that we've had with industrial companies — automotive, steel, and utility as well — has seen a minimum 50% increase. That's in the amount of available work for us to go after and bid. We're finally starting to see a significant change."
According to Frantz, the uptick in activity is economy driven. "For the automotive industry, it's all about sales and market share, and they're doing really well right now. As long as something doesn't happen in the economy — or we have some financial meltdown of some sort — I would say we'll probably continue to see that growth. It all hinges on could there be another terrorist attack, could there be an issue with the financial situation in our country? If those things don't change, I would say it's going to continue."
Gas and Steel
Overall, according to the Brookings Institute, Washington, D.C., the U.S. economy remains strongest in advanced manufacturing sectors with high technological and skills requirements, such as aerospace, industrial and energy equipment, automobiles, and medical devices. "We have seen a number of opportunities in the manufacturing/industrial market segments," says Clark. "But I can't say there is a certain segment that is better than another. It really is dependent on what is driving the project — i.e., fracking, outdated infrastructure, sustainability, etc."
According to Grady Saucier, VP marketing for electrical instrumentation contractors MMR Group, Baton Rouge, La., the energy and fracking sectors are big parts of his firm's business right now. "That's helped our industry and our company tremendously," Saucier says. "The feedstock of the chemical industry is getting cheaper, so it makes us more competitive than the international world. When natural gas comes down, you get long-term contracts, so there's a stability there in the energy that we haven't seen in a long time. You can get 15- to 20-year gas contracts, so you can really determine what your energy use is going to be — and your energy costs — so they can calculate what they can sell their products for."
MMR Group is also performing work for other manufacturing sectors as well. "The automotive industry is doing fairly well," Saucier says. "The metal business is doing well."
Contracts have come from Mercedes, ThyssenKrupp (TK) Steel Mill, and Nucor Steel. "TK built a $4 billion new sheet metal plant, which is largely for the automotive industry," Saucier explains. "It goes hand in hand there."
Motor City Electric Co. has also provided services for both automotive and steel industries. "Obviously, the automotives are doing a lot of retrofitting to their existing facilities, changing out their assembly lines and their assembly systems," Frantz says. "They're doing a lot of upgrading of existing systems and their existing facilities." His firm recently worked with Chrysler, building a new paint shop for one of its facilities, along with a new body shop.
Steel producers are also retrofitting facilities as well as expanding, according to Frantz. "I talk about automotive because I'm from Detroit, but we're starting to see a resurgence in certain other areas," says Frantz, who estimates an increase of 50% or more in the automotive, steel, and utility sectors. "Steel production is the same way," he continues. "Severstal Steel put a whole brand new facility in for a pickle line and cold mill line last year. We did that job for them."
Southern Hospitality
Detroit benefited greatly from the revival of the auto industry after the federal rescue of General Motors and Chrysler in 2009, and it has added jobs rapidly over the past year. Firms in the Cleveland and Charlotte areas have ramped up production to take advantage of the shale-gas boom sweeping much of the country. However, much of the recent upsurge in manufacturing activity seems to be located in the South.
One of Severstal's recently expanded plants is located in Columbus, Miss., in the state's "Golden Triangle," close to major North American automotive customers and the expanding Southern manufacturing region of the United States. The location offers access to rail, truck, and water routes for economical delivery throughout the region, Mexico, and the world.
Airbus recently unveiled plans for a $600 million factory to manufacture narrowbody aircraft in Mobile, Ala., its first U.S. factory to make passenger aircraft. It expects to employ 1,000 workers there.Fabrice Brégier, Airbus' chief executive, said the company had chosen a "competitive environment" for its factory, meaning Alabama is a "right to work" state where workers cannot be forced to join a trade union as part of their contracts. In addition, he described Airbus' U.S. investment as a geographically strategic move, bringing the assembly line closer to the firm's customers.
"They're coming down to the South — Alabama, Mississippi, and Georgia," says Saucier, whose firm's location in Baton Rouge, La., is due to the petrochemical industry. "We cut our teeth on oil refineries and chemical plants. That's why we're in Baton Rouge."
However, MMR Group boasts offices across the country and in international locations. Plus, the firm goes where the work is located. "We travel quite a bit," he explains. "We've got 19 offices around the country, and those small offices are geared to do the smaller projects. But from the Baton Rouge office, we can do the larger projects. So it's a good place to be. It's a good background of projects, staff and craftsmen here, and we ship them all over the world."
Faith Technologies is seeing an increase in projects throughout the United States, but Clark finds the highest percentage is found either in the Midwest or Southeast. However, when it comes to complex manufacturing or industrial projects, he feels location doesn't come into play as strongly as with a commercial or municipal project. "About 75% of the projects we are currently working on in this market are outside of geographies served by our branch locations," he says.
Frantz at Motor City Electric sees the resurgence occurring in different areas throughout the country. In Florida, the firm performs utility work. It has also worked on projects in Kentucky. "It's been pretty good so far," he says. In addition, the firm is starting to see new projects in Las Vegas, one of the places where construction was hardest hit by the recession. "You can start to see where Las Vegas is starting to come back a little bit," he says. Furthermore, international work, particularly north of the border in Canada, is strong. "It seems to be steady pretty much everywhere," Frantz concludes.
SIDEBAR: Regional Manufacturing Reports Reveal Mixed Activity
Several regional reports forecasted the decline in new orders in manufacturing in June. The New York Federal Reserve Bank's Empire State June report indicated new orders fell to 2.18 from 8.32, while new orders for June in the Philadelphia region tumbled to -18.8 from -1.2. New orders for June in the Richmond, Va.-based Federal Reserve's report fell to -12 from 1, and orders in the Kansas City region decreased to -7 from 10 in May. One anomaly, the Dallas Federal Reserve's survey, showed an increase in orders after three months of contraction.
The United States Manufacturing Technology Orders (USMTO) report, compiled by the Association for Manufacturing Technology (AMT), the trade association representing the production and distribution of manufacturing technology, provides regional and national U.S. orders data of domestic and imported machine tools and related equipment. The May U.S. manufacturing technology orders on a regional basis for five geographic breakdowns of the United States are as follows:
Northeast Region: Manufacturing technology orders in the Northeast in May totaled $63.68 million, down 6% from April's $67.72 million and down 0.6% when compared with the May 2011 figure. At $313.37 million, 2012 year-to-date is up 2.4% when compared with 2011 at the same time.
Southern Region: Southern Region manufacturing technology orders totaled $77.67 million in May, a 60.3% increase from the $48.44 million total for April and 40.0% more than the total for May 2011. The year-to-date total of $293.28 million is 14.3% more than the comparable figure for 2011.
Midwest Region: At $153.17 million, May manufacturing technology orders in the Midwest were up 19.8% when compared with the $127.87 million total for April and up 4.9% when compared with May a year ago. With a year-to-date total of $738.08 million, 2012 is up 7.9% when compared with 2011 at the same time.
Central Region: May manufacturing technology orders in the Central Region totaled $134.85 million, 2.3% more than April's $131.76 million and up 40.7% when compared with the May 2011 figure. At $675.93 million, the 2012 year-to-date total was 22.7% more than the comparable figure for 2011.
Western Region: Western manufacturing technology orders in May stood at $44.54 million, 17% more than the April total of $38.07 million and 21.6% higher than the figure for May 2011. The $214.70 million year-to-date total was 9.4% above the total for the same period in 2011.


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Tottenham's Gareth Bale adds Football Writers' flagship award to two PFA prizes
Tottenham's Gareth Bale has been named Footballer of the Year by the Football Writers' Association.
Last Updated: 03/05/13 6:31am
The award is Bale's third honour in a week following his coronation as the Professional Footballers' Association's Player and Young Player of the Year.
The Wales international, whose 19 Premier League goals have played a major role in maintaining Spurs' top-four challenge, becomes the 14th man to win the major journalists' and players' accolades in the same season.
FWA chairman Andy Dunn told Sky Sports News 96% of the vote was split between Bale and Manchester United's Robin van Persie, with the winner receiving 53% and the runner-up 43%.
Chelsea's Juan Mata was a distant third while Liverpool striker Luis Suarez, currently serving a ban for biting an opponent, received just two votes despite scoring 30 goals in all competitions.
Dunn said that small number could be partly explained by voting parameters which ask members to take into account a player's behaviour in addition to his performances.
He said: "Stanley Matthews was the first winner of the award in 1947/8 and, in the citation it reads 'the player who by precept and by example has been the Footballer of the Year'.
"It's not the be-all-and-end-all, but it does take into account the players' behaviour throughout the season."
And accusations of diving earlier in the season, he said, had probably cost Bale victory by a greater margin.
"I think it would have been more conclusive had he not been booked for simulation on occasions, but I think there's a feeling among the writers that he has addressed that issue.
"When something needs addressing, do players go away and address it? Clearly, in Suarez's case he didn't. In Bale's case, a lot of the writers think he has taken steps to confront it."
A huge honour
Bale becomes Spurs' first winner of the FWA award since David Ginola in 1999, and the first Wales international to be selected for English football's oldest individual trophy since Everton's Neville Southall in 1985.
The Tottenham star said: "It is a huge honour to receive the Footballer of the Year award from the Football Writers' Association.
"It means a lot to win this award when you consider the number of players that have been outstanding for their clubs in the Barclays Premier League this season.
"I have been very fortunate to be playing in such a fantastic team and I owe a lot to my team-mates and, obviously, the manager who has shown such faith in me.
"This award has been won in the past by some of the greatest names in football and I consider it a privilege that the FWA has selected me to be named alongside them."


text: Show Hide image 17 August 2012 Jaguar Land Rover launches all-new SUV The vehicle will be produced at Solihull. Sign-up The British automaker Jaguar Land Rover (JLR) has introduced an all-new Range Rover sport utility vehicle (SUV) model, which features a lightweight body design and all-new aluminium front and rear chassis architecture. The model is more fuel-efficient and emits less CO2. The SUV will be available to order from September, with customer deliveries scheduled to start from early 2013. Designed and engineered at Land Rover's development centres in the UK, the vehicle will be produced in a new manufacturing facility at Solihull. John Edwards, global brand director at Land Rover, said: The new Range Rover preserves the essential, unique character of the vehicle – that special blend of luxury, performance and unmatched all-terrain capability. However, its clean sheet design and revolutionary lightweight construction have enabled us to transform the experience for luxury vehicle customers, with a step change in comfort, refinement and handling. Gerry McGovern, design director and chief creative officer at Land Rover, said: Designing the next generation Range Rover, following over forty years of success, came with a huge responsibility to protect the DNA of such an icon. Our design team worked incredibly hard to capture the elegant proportions and pure surfaces which have been a feature of the best Range Rover designs. Subscribe £1 per month SUBSCRIBE More


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Where in the fitness manual does it say that getting fit has to mean suffering? Nope, being active is getting the heart rate up and keeping the mojo high. The Crossroads is your key to weeknight workouts and rides with the family, offering a refreshing change from treadmills and dumbbells. And with the benefits of a Body Geometry saddle and grips, it's one bike that'll keep you riding with a face that says 'joy' more than 'suffering.'
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Seattle, WA – Shoulder replacement surgery comes handy to the locals of Seattle, Washington, thanks to Doctor Daniel Grant Schwartz. Due to aging or trauma, shoulders can wear out and cause pain that progresses over time. Some activities can add to the pain, which also interferes with sleep. The patient may even suffer loss of motion. All of these issues can be addressed by Dr. Schwartz.
"A patient who is thinking about his or her shoulder more often due to pain and daily decision-making should already consider replacement surgery," says Dr. Daniel Grant Schwartz. "I can help review and diagnose shoulder problems and make recommendations as to what type of shoulder replacement applies. I will conduct a thorough review of the patient's physical examination, recent X-rays, and any advanced imaging."
The joints in shoulders are humeral heads which sit in the glenoid or shoulder cup. Each joint surface is lined with cartilage that produces frictionless movement. However, the cartilage can be lost and joint degeneration occurs. The human body does not know how to heal a cartilage breakdown and creates bone spurs instead as an attempt to repair it. This does not alleviate the pain or enhance motion but can, at times, let the opposite occur – more pain and decreased motion. The pain caused by bone spurs worsens the arthritis with symptom including muscle atrophy, swelling, tenderness to touch, and crepitus or a popping, crunching, or clicking sound.
For more information about arthritis visit: http://www.shouldermd.com/shoulder-arthritis/
Those who do not consider shoulder replacement surgery can have non-operative treatment, which is similar to treatment of other orthopedic conditions. NSAIDS like ibuprofen and naproxen, cortisone injections, and limitation of activity may help alleviate the symptoms. Otherwise, when the quality of living is already affected, surgery should be discussed. The following are common types of shoulder replacement or arthroplasty. Total shoulder arthroplasty is needed if the rotator cuff is intact. Reverse shoulder arthroplasty applies when the rotator cuff is torn and arthritis already occurs. This can also address the fractures and benefit those whose rotator cuff tears severely. Hemiarthroplasty is good for patients who may only have problems with just one shoulder. Patients who have humeral head issues sans problem of the shoulder cup or have no glenoid arthritis can also go for this type of surgery. Total shoulder arthroplasty generally yields greater results than hemiarthroplasty. However, there are certain cases that can be best treated with the latter.
Doctor Daniel Grant Schwartz – Shoulder Surgeon's office location is 1455 NW Leary Way #350, Seattle, WA 98107.
For more information about shoulder arthroplasty and arthritis, check out their official website at http://www.shouldermd.com/
Give their office a call at (206) 368-6100 or email them at email@example.com
Media Contact
Company Name: Doctor Daniel Grant Schwartz – Shoulder Surgeon
Contact Person: Dr. Daniel Grant Schwartz
Email: email@example.com
Phone: (206) 368-6100
Address:1455 NW Leary Way #350
City: Seattle
State: Washington
Country: United States
Website: http://www.shouldermd.com/


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URINETOWN, 2013 New Play Festival, GREASE and More Set for Coralville Center, Feb 2013
The Coralville Center for the Performing Arts stage will feature a wide variety of events in February 2013, giving members of the community many opportunities to participate in performances and enjoy cultural offerings.The schedule includes:· City Circle Acting Company of Coralville's production of the Tony-Award winning musical Urinetown, playing February 1-10 with performances Fridays and Saturdays at 7:30pm and Sundays at 2pm. Urinetown is a hilarious tale of greed, corruption, love, and revolution in a Gotham -like city where a terrible water shortage has led to a government-enforced ban on private toilets. Citizens must use public amenities regulated by a single malevolent company that profits by charging for one of humanity's most basic needs. Amid the people, a hero decides he's had enough and plans a revolution to lead them all to freedom! Directed by Jesse Jensen. Tickets are $12 - $27.
· Between weekends of Urinetown, City Circle also presents the 2013 New Play Festival, featuring 9 short plays centering on family bonds and making connections in our contemporary lives. Playwrights featured are Terry Riley, Rand Higbee, Barbara Lau, Matt Crowley, Matthew Falduto, Brian Tanner, Anthony G. Craine, Greg Freier, and Kent Forsberg. All nine have strong Iowa ties, and Lau, Falduto, Tanner, Craine, Freier, and Forsberg all currently live in Iowa. Performances are Monday, February 4 and Tuesday, February 5 at 7:30pm; tickets are $10.
· Wickham's Got Talent features talented Wickham Elementary students in a PTO fundraiser. Wednesday, February 13 at 6pm.
· On Thursday, February 14 at 6:30pm, Van Allen Elementary students will present a general music program featuring 5th and 6th grade students. The Wickham and Van Allen events are part of the CCPA's program offering free use of the theater to Coralville schools.
· On Sunday, February 17, the CCPA "Movie and Music" series continues with a showing of the 1959 film Some Like It Hot, featuring Marilyn Monroe, Tony Curtis, and Jack Lemmon. Prior to the movie, the Iowa City/Johnson County Senior Center's Silver Swing Band will perform a set. Concert at 2pm; movie at 3pm. Tickets are $6.
· West Music presents Doctors in Concert, a benefit performance for the UI Children's Hospital. Local physicians and medical professionals will showcase their musical talents with solos and ensembles featuring pianists, vocalists, and various instrumentalists. Kirk and Mary Ferentz will be the guest announcers. Tickets are $25; $15 for students with ID.
· Regina High School presents Grease February 28-March 3. Join Rydell High's senior class of 1959 in this rollicking musical. Performances are Thursday-Saturday at 7pm and Sunday at 2pm. Tickets are $10 - $22.
Further information on these events and details on other upcoming events are available at CoralvilleArts.org. Tickets for most CCPA events are available by phone at 319.248.9370, online at CoralvilleArts.org, and in person at the CCPA box office at 1301 5th Street and Coralville Recreation Center at 1506 8th Street.Owned and operated by the City of Coralville, the Coralville Center for the Performing Arts is dedicated to enriching the community and contributing to the vitality of Coralville by offering an accessible, affordable venue for a variety of performances, presentations, and public and private events. The 472 seat theater opened August 26, 2011 and has hosted performances from City Circle Acting Company, Orchestra Iowa, Cedar Rapids Opera Theatre, Dan Knight, Lola Astanova, Jim McDonough, MetroMix Chorus, Nolte Academy of Dance, and many others. Coralville schools are also able to use the Center free of charge up to three times per year; 13 school events took place at the Center in 2012. The Center was named 2012 Member of the Year by the Iowa City/Coralville Area Convention and Visitors Bureau.


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Angela Michael Music is a resource provider where singers, songwriters, performers, and artists (both professional and hobbyists) can better hone their craft. We offer vocal coaching, audition preparation, choreography/movement, songwriting and home studio setup. The Angela Michael Music team is comprised of A-List talent who have worked professionally in the entertainment industry, and every single one have major credits to their name!
Our goal is to provide exceptional teachers & services to our clients. Every teacher brings in their own expertise and hands on experience from the music industry. At Angela Michael Music we aim high to ensure you'll be working with the most talented teachers in town at a reasonable price.


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Locum tenens opportunity for a full-time certified registered nurse anesthetist in New York. Hours are 7:30am-4pm, Monday through Friday. No call or weekends. Case mix consists of general surgery and bread and butter procedures. Candidates with military background preferred if possible.
Dates Needed: August - ongoing
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Intelligence Reform and Terrorism Prevention Act of 2004
Intelligence Reform and Terrorism Prevention Act of 2004
Public Law 108-458
Subtitle F - Presidential Transition
Sect. 7601. Presidential Transition
(a) SERVICES PROVIDED PRESIDENT-ELECT.- Section 3 of the Presidential Transition Act of 1963 (3 U.S.C. 102 note) is amended -
(1) by adding after subsection (a)(8)(A)(iv) the following:
"(v) Activities under this paragraph shall include the preparation of a detailed
classified, compartmented summary by the relevant outgoing executive branch
officials of specific operational threats to national security; major military or covert
operations; and pending decisions on possible uses of military force. This summary
shall be provided to the President-elect as soon as possible after the date of the
general elections held to determine the electors of President and Vice President
under section 1 or 2 of title 3, United States Code.";
(2) by redesignating subsection (f) as subsection (g); and
(3) þy adding after subsection (e) the following:
"(f)(1) The President-elect should submit to the Federal Bureau of Investigation or other appropriate agency and then, upon taking effect and designation, to the agency designated by the President under section 115(b) of the National Intelligence-Reform Act of 2004, the names of candidates for high level national security positions through the level of undersecretary of cabinet departments as soon as possible after the date of the general elections held to determine the electors of President and Vice President under
section 1 or 2 of title 3, United States Code.
"(2) the responsible agency or agencies shall undertake and complete as expeditiously as possible the background investigations necessary to provide appropriate security clearances to the individuals who are candidates described under paragraph (1) before the date of the inauguration of the President-elect as President and the inauguration of the Vice-President-elect as Vice President."
(b) SENSE OF THE SENATE REGARDING EXPEDITED CONSIDERATION OF NATIONAL SECURITY NOMINEES. - It is the sense of the Senate that-
(1) the President-elect should submit the nominations of candidates for high-level national security positions, through the level of undersecretary of cabinet departments, to the Senate by the date of the inauguration of the President-elect as President; and
(2) for all such national security nominees received by the date of inauguration, the Senate committees to which these nominations are referred should, to the fullest extent possible, complete their consideration of these nominations, and, if such nominations are reported by the committees, the full Senate should vote to confirm or reject these nominations, within 30 days of their submission.
(c) SECURITY CLEARANCES FOR TRANSITION TEAM MEMBERS.-
(1) DEFINTION.-In this section, the term "major party" shall have the meaning given under section 9002(6) of the Internal Revenue Code of 1986.
(2) IN GENERAL.-Each major party candidate for President may submit, before the date of the general election, requests for security clearances for prospective transition team members who will have a need for access to classified information to carry out their responsibilities as members of the President elect's transition team.
(3) COMPLETION DATE.-Necessary background investigations and eligibility determinations to permit appropriate prospective transition team members to have access to classified information shall be completed, to the fullest extent practicable,
by the day after the date of the general election.
(d) EFFECTIVE DATE.-Notwithstanding section 351, this section and the amendments made by this section shall take effect on the date of enactment of this Act.
Approved December 4, 2004
Intelligence Reform and Terrorism Prevention Act of 2004 (Full version)


text:
PHILADELPHIA (AP) - Andrew Bynum says he plans on making his season debut for the Philadelphia 76ers this year, though he's still a week or two away from practicing with the team.
The 7-foot center has been sidelined by knee injuries since the Sixers acquired him from the Los Angeles Lakers last summer. He worked out for 80 minutes on Tuesday and said afterward his knees are feeling better, but he doesn't expect to ever be pain-free.
Bynum's timetable for a return has been pushed back numerous times since training camp opened with him off the court. He says he won't rush his return just to help Philadelphia make a playoff push or to improve his status with his pending free agency.


text: These Books with Rack Miniatures are approx 3.0" x 1.0" x 1.0" in size, and come fourteen miniature pieces to a package. These miniatures have a realistic touch and are ideal for dollhouses, scenes, or shadow boxes.We carry a large selection of Wood Model Craft Kits, such as Wood Model Cars, Wood Model Boats, Wood Model Planes and Wood Model Trains. We also carry a complete line of Craft Supplies, Birdhouse Kits, VBS Crafts, and much more.


text:
Client Infographic: A Solar Innovation Story
Solar Savings: A Solar Innovation Story from ExtraSpace.com is a new infographic by InfoNewt and designer Jeremy Yingling. This one tells the story of how the company is adding solar panels to the roof space on some of it's self storage facilities all across the country. The environmental, financial and community benefits are huge, and this was only the first year of a multi-year plan.
Extra Space Storage is on a mission to produce solar powered clean energy and reduce the carbon footprint of our 850+ self storage facilities. We aim to install 20,000 solar panels this year, and increase the pace of panel installation every year. Energy efficient clean power is good for our customers and our neighborhoods, our planet, and our investors. By the end of 2011 this program will save 2,000 tons of carbon dioxide and 100 acres of fir trees.
An infographic is a fantastic way for Extra Space to tell their story to customers, investors and anyone interested in alternative energy solutions. It puts their efforts into context and shows the potential of how large their cumulative environmental impact could become.
You can follow Extra Space Storage on Facebook and Twitter (@extraspace)


text:
Well, probably not, but it makes for a catchy title regarding at least one subject in this post, specifically, the one about my husband suggesting I blog book reviews full time.
It's difficult for me to explain to him why the idea of book blogging being a responsibility. There's the time thing, but that's not really that important. I could handle the commitment to the clock. It's that whole thing with taking something you love and making it an obligation. Voluntarily. It's bad enough getting my editorial lobe to shut up (now I've learned so much about writing) while reading without throwing in purposely dissecting a book so I can take it apart later, publicly. I hate the thought of that.
But of course, my husband thinks, "Hey, she loves reading, she's great at it, she likes telling people about books, it's the perfect thing for her to do for some side cash," (thinking more of advertising, here). Um, no. His heart is totally in the right place, completely, but still no.
Turns out watching the whole nineteen episodes of My So-Called Life over about three days will totally help you if you're in a slump regarding introspective characters. Also with remembering the best flammables to fuel teen angst. So, like, thanks, or whatever, Angela and Jordan.
Personal Note: I hold completely useless grudges against people I don't even know. Or maybe it's better to say I lose respect for them, and after that I can't see them the same way ever again. Angelina Jolie and Brad Pitt, the way they handled the commencement of their relationship was just crude and callous. And speaking (indirectly) of Claire Danes, she and Billy Cruddup got together while Cruddup's girlfriend of many year was still pregnant with his baby. I used to love Claire Danes, and I'm fond of what little work I've seen of Cruddup's, but just knowing the man didn't keep to his obligations (as I consider them--we won't be getting into the "He can still be a great father," arguments--I know that), and Danes's complicity therein, it's like there's the cloud, this pall over all the professional stuff they do. These people (yes, I realize I'm a bit particularly tetchy about cheating) have lost honor in my eyes, and that makes a difference to me.
Anything You Can Read, I Can Read Better.
Well, probably not, but it makes for a catchy title regarding at least one subject in this post, specifically, the one about my husband suggesting I blog book reviews full time.


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More Michael Jackson footage is on the way in time for the holiday shopping season, and the latest offering features a never-released clip for the song "One More Chance."
The "Michael Jackson's Vision" boxed set, due out Nov. 22, includes more than four hours of material, including the full version of "Black or White," which was cut short after its initial release due to violent imagery and Jackson's gyrations.
Jackson made a short film for the song "One More Chance," but it was never released. He was charged with sexual molestation in 2003, right around the time the single was released. He was acquitted in that case.
Other videos include Martin Scorsese-directed "Bad" and the Gloved One's most famous video, "Thriller."
Selected Reading: The Associated Press, Popeater, michaeljackson.com.


text:
FORT WORTH, Texas, May 8 (UPI) -- The Dallas-Fort Worth area, with high spring temperatures following a wet winter, has seen an increase in the number of venomous snakes, a report said Tuesday.
"They like rain and humid conditions. The rains we've had recently tend to be conducive to snake activity," said Jonathan Campell, a biology professor at the University of Texas at Arlington, of the snakes.
With more snakes, one a 5-foot-long copperhead found Sunday obstructing a garage door in suburban Providence Village, the Fort Worth (Texas) Star-Telegram reported Tuesday, come more snake bites.
Cook Children's Medical Center in Fort Worth said it admitted five snake bite victims in April, compared to 17 in all of 2011.
Texas Health Harris Methodist Hospital Fort Worth reported treating five snake bite cases this spring.
The newspaper said that snake bites in Texas are largely from rattlesnakes and copperheads, that the snakes are nocturnal and tend to avoid humans, and are rarely fatal. They are, however, extremely painful and can cause serious tissue damage.


text:
Microsoft gives us a closer look at the Windows Phone 7.8 start screen
posted by Charlene S. / Jun 25, 2012, 10:01 PM
For you Windows Phone owners it's definitely a bummer that not all the current devices will see Windows Phone 8. The good news is it's not as bad as being stuck in Gingerbread limbo like many of your Android counterparts. You do have some upgrades to look forward to with Windows Phone 7.8.
One of the biggest changes will be the addition of the Windows Phone 8 style start screen. Ben Rudolph with the Windows Phone Blog got a hold of a Nokia Lumia 900 that's running an early build of Windows Phone 7.8 to give everyone a closer look at the start screen and how it behaves.
source: Windows Phone Blog
23 Comments
1. pongkie
Posts: 663; Member since: Aug 20, 2011
They should also add lock tile so the most important tiles don't go away while you scroll
posted on Jun 25, 2012, 10:10 PM 14
7. Captain_Doug
Posts: 1037; Member since: Feb 10, 2012
An amazing idea. kudos.
posted on Jun 25, 2012, 11:18 PM 0
8. jove39
Posts: 2146; Member since: Oct 18, 2011
Write to MS about it...hope they include this feature in future update!
posted on Jun 26, 2012, 12:05 AM 0
9. kartik4u98
Posts: 511; Member since: May 19, 2012
yes..write to microsoft about this great idea..good LucK !!
posted on Jun 26, 2012, 1:08 AM 2
10. AppleConspiracy
Posts: 637; Member since: Oct 18, 2011
You mean something like docked icons on iOS? How would you solve this in Windows Phone LiveTile concept and configuration? I don't see the other way except introducing something like fixed dock, and that would be killing the basic idea of Metro Style in the first place...
posted on Jun 26, 2012, 3:20 AM 2
19. pongkie
Posts: 663; Member since: Aug 20, 2011
not really there are other ways. like you can lock them on top, sides, or even in the middle. you dont have to sacrifice an entire row or column. if you lock a tile on a certian spot other tiles "give way" by resizing temporarilly or skip as you scroll. I wish I could explain better what i see in my mind but im poor in writing this visual stuff
posted on Jun 26, 2012, 8:36 AM 0
21. poddey
Posts: 77; Member since: Mar 22, 2012
I don't know... that sounds kind of messy and confusing if you have tiles resizing themselves when scrolling. :p If you are having to scroll a lot then I'd say you've put way too many tiles on, or at least a lot more than you would typically use day to day. MS should have just implemented folders that opens up a larger tile above or below the folder tile when you tap it.
posted on Jun 26, 2012, 9:04 AM 0
12. kanagadeepan
Posts: 1260; Member since: Jan 24, 2012
So M$ has cheated their early adopters with just one eye-candy instead of many more useful features in WP8...
posted on Jun 26, 2012, 4:45 AM 0
16. Santi_Santi unregistered
Not necesarilly. in fact, they are looking for a more looking reaction so at the end, features can be solved by mere apps or updates.
posted on Jun 26, 2012, 7:41 AM 0
13. AppleConspiracy
Posts: 637; Member since: Oct 18, 2011
Generally, I think Microsoft is making a mistake with enabling more customization options to the users. Those users that actually need customization and freedom are very rare in comparison to users that only THINK they need it. Apple and iOS proves that - they are based on strong restrictions, and they won't let users mess with the carefully designed UI just to give "freedom" to make UI look the way we want. Good product is based on strong visual and functional identity that comes served before the end user and stay that way. The "product" that don't have strong identity and is fully customizable, is not actually a product, but tool. And users generally don't want tools, they want products, something that has a design. By abandoning the perfectly designed Metro UI in WP7/7.5 with two columns asymmetrically placed in relation to the screen surface, Microsoft is introducing mess and visually downgrades the best feature WP has - superiorly designed UI. As a product designer, I must mention this, despite apparent illogic - beacuse we allways thin that good products means great freedom for user that gets what it wants, but this is only a Grand Fairy Tale of consumersim. Products actually must tell users how to use it and how to accept it, and that's the real and only true wish of the consumer, that he won't admit of course. But industrial designer musnt' fall in this trap and listen to the users. And Apple knows it very well.
posted on Jun 26, 2012, 5:24 AM 1
14. PhoneArenaUser
Posts: 5498; Member since: Aug 05, 2011
"And users generally don't want tools, they want products, something that has a design." Not all.
posted on Jun 26, 2012, 7:07 AM 1
18. poddey
Posts: 77; Member since: Mar 22, 2012
Although you could say a lack of customisation options in IOS hasn't hurt iPhone sales, the availability of a tonne of customisation options on Android hasn't hurt Android sales either. In fact, customisation is a differenting factor that Android has used to its advantage and very successfully at that. Besides that though, all Microsoft has done with WP8 is widened the live tile grid an extra 2 spaces across and allowed the tiles to be resized. That's not a whole lot more than before on WP7 & 7.5. They haven't gone whole hog like Android. You still can't have wallpapers (not that they would be visible behind the tightly packed tiles) and any colour you choose will be rendered solidly all around with no option for even any gradients. I'd say WP8 retains the strong identity established by WP7. Having said that, I do think the new wide grid is a bit too much. There is not enough "white space", which is a fundamental part of the Metro DNA if I'm not wrong. It's the white space that gave the original UI in WP7 it's elegance. Yet I always thought it looked slightly awkward being offset to the left just to include an arrow on the right. For my money, the dimensions the MS designers went for when zoomed out on the live tiles in customisation mode is what they should have gone with as the default.
posted on Jun 26, 2012, 8:29 AM 0
15. AppleConspiracy
Posts: 637; Member since: Oct 18, 2011
@PhoneArenaUser Well, I said "generally" for a reason. Furthermore, the "real" users (those who want maximum functionality and "openess") are very illusive, because you cannot pinpoint what exaclty they need in opposition to what they desire, and you certainly cannot reduce them to one homogenous mass because they are fundamentaly differentiated by what they want their smartphone to do. Most users - and this "most" is the key word - are what makes all important stuff to smartphone manufacturers. Most users want to be told what they want. They want product for sure, not a tool. The real "user" in everyone of us is latent, hidden, neutral and transparent toward this "visible" dimension that is a true product. Making products invisible is therefore only an illusion, and leads to poor marketing. Consumers are defined by their desire, but their desire is NOT defined by their actual needs. They need something else - an object of their desire, but with a catch - to look like they need something, becuse admiting that we are consumers and not "true users" is unacceptable for us. Android user is a "true user", but doesn't look that way. iPhone is not a true user, but he looks that way. And this other scenario sells products, first - not so much.
posted on Jun 26, 2012, 7:31 AM 0
17. Santi_Santi unregistered
Looks great! but i have to share many things said here like lack of features and closed ecosystem. But i have to say MS is trying hard to get in the market. So lets wait. I guess this will be a hard battle
posted on Jun 26, 2012, 7:45 AM 0
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Related Resource
Nonnative Oysters in the Chesapeake BayReport in Brief
The native oyster species of the Chesapeake Bay has been depleted to less than one percent of its original population. As a result, the Chesapeake Bay states are looking for ways to revive the oyster industry. This report discusses the proposed plan to offset the dramatic decline of the Chesapeake Bay's native oysters by introducing disease-resistant, reproductive Suminoe oysters from Asia. It is recommended that the introduction be delayed until more is known about the environmental risks, even though carefully regulated cultivation of sterile Asian oysters in contained areas could help the local industry and researchers. It is also noted that even though oysters also consume some of the excess algae caused by pollution, it could take decades before there are enough of them to improve water quality.


text:
About Old Tanker
The notorious speed trap used to be in Waldo, just down the highway.
... "Bill, The Galactic Hero." Everyone in on the plot was an undercover agent.
The TSA has an impossible task. Complaints against the TSA will continue to grow more strident right up until the first successful attack, then everyone will want to know where the TSA was and why their own pet projects and common-sense best practices were not in place. It is no surprise to this frequent flyer that the checkpoint staff ain't the best and brightest -- who in their right minds would want to to that job if they had other options?


text:
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Our Health Library information does not replace the advice of a doctor. Please be advised that this information is made available to assist our patients to learn more about their health. Our providers may not see and/or treat all topics found herein.
Dementia: Support for Caregivers
Topic Overview
Taking care of a loved one who has Alzheimer's disease or another dementia can be a difficult, stressful, and tiring job. It affects the caregiver's health and ability to rest and can be a source of stress and conflict for the entire household.
The demands of caring for a person who has dementia may cut off caregivers from friends, leisure activities, and other responsibilities. For a caregiver who has health problems, the physical and emotional strain of caregiving can make those problems worse. Fatigue, depression, and sleep problems commonly develop, and caregivers often carry an added emotional burden of feeling worried, guilty, and angry about taking care of the person.
If you are a caregiver, you can benefit by learning as much as you can and taking care of yourself.
Educate yourself
- Learn all you can about the type of dementia your loved one has and what the future may bring. Organizations such as the Alzheimer's Association and the Family Caregiver Alliance can provide educational materials as well as information on support groups and services. For contact information, see the Other Places to Get Help section of the topics Alzheimer's Disease and Dementia.
- Find out what services your community has to offer. Many offer education, counseling, and respite services such as adult day care and home health aides.
- Find a support group in your area. Support groups allow caregivers to share their experiences and exchange practical information on coping with the disease and caring for the person.
Care for yourself
- Take care of your health. The demands of caregiving can be both physically and emotionally draining. Be sure to eat healthy foods and get enough rest and exercise.
- Recognize that it is normal to feel anger, guilt, grief, frustration, and helplessness. These feelings are a sign that you need to take a break from caregiving, even if it's just for an evening to attend a support group.
- Don't carry the entire weight of caregiving on your shoulders. Discuss caregiving responsibilities with family and interested friends.
- Take time for yourself. Respite services provide someone to stay with the person for a short time while you get out of the house for a few hours. You also may be able to arrange a short stay in a nursing home for your loved one while you address your own medical and other needs.
Related Information
Current as ofMay 28, 2019
Author: Healthwise Staff
Medical Review: Anne C. Poinier MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Peter J. Whitehouse MD - Neurology
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Next Section:Related Information
Previous Section:Topic Overview
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Current as of: May 28, 2019
Author: Healthwise Staff
Medical Review:Anne C. Poinier MD - Internal Medicine & Kathleen Romito MD - Family Medicine & Peter J. Whitehouse MD - Neurology
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B Vitamins in Diabetes: Just "Expensive Urine"? (part 1)
B vitamins are essential vitamins in human nutrition. The most commonly referenced B vitamins include:
thiamine (B1)
riboflavin (B2)
niacin (B3)
pantothenic acid (B5)
pyridoxine (B6)
biotin (B8)
folic acid (rarely referred to as B9)
cobalamin (B12)
B vitamins are critical to normal cellular function, replication, repair, metabolism and energy production. Some B vitamins, particularly B1, B6 and B12, are especially important to normal nerve function and repair. In people with diabetes, often due to increased urination from the osmotic effects of high blood sugar, the water-soluble B vitamins may be lost more rapidly than in people without diabetes even if intake is technically adequate.
When reading supplement bottles or published descriptions of the functions of B vitamins, it is tempting to believe that we should be taking large quantities of B vitamins to "offset stress", "improve energy", "improve metabolism", "assist in normal adrenal function", etc. Unfortunately very little clinical trial research supports these claims. Few quality clinical trials have been performed on single B vitamins, let alone "B complex" combinations in diabetes.
Further complicating matters is homocysteine - a byproduct from protein/amino acid metabolism influenced by B vitamin intake - that has been implicated in causing direct damage to the thin endothelial lining of the small arteries particularly vulnerable in diabetes. Does lowering homocysteine actually reduce the risk of having a heart attack or stroke? Should homocysteine still be measured and checked?
In Part 1 of this article I will highlight the role of B vitamins in diabetes, focusing on those for which we have the most clinical research data (thiamine, niacin, biotin and vitamin B12). Next month, in Part 2 of this article I will discuss the state of the science regarding homocysteine, discuss special considerations in diabetes and give my opinion on when extra B vitamins are appropriate.
Thiamine is a water-soluble vitamin essential for normal metabolism of fat, glucose and protein as it is involved in key pathways of cellular energy synthesis. Specifically, thiamine is a cofactor in the actions of the enzymes:
pyruvate dehydrogenase and alpha-ketoglutarate decarboxylase in the breakdown of carbohydrates,
branched chain alpha-keto acid dehydrogenase in the metabolism of some amino acids,
and transketolase which acts to breakdown more complex sugars for energy production.
Abnormalities of transketolase activity have been identified in diabetes, and are partially responsible for the accumulation of sorbitol contributing to cataract formation.
In addition, classic thiamine deficiency has been long associated with heavy alcohol consumption and is known to cause Wernicke's encephalopathy, a condition marked by nervous system symptoms including numbness, tingling and muscle weakness.
Food Sources:
Thiamine can be found in fortified wheat products, lentils, peas, pork, brazil nuts, pecans, spinach, cantaloupe, pork, milk and eggs[1].
In recent studies, 75% of patients with diabetes were shown to have reduced levels of thiamine and increased urinary excretion of thiamine relative to controls[2]. Low thiamine levels correlated with increased levels of vascular adhesion molecules, known markers of vascular disease and dysfunction. In a clinical trial performed by Arora et al., intravenous administration of thiamine improved functioning of the inner, endothelial lining of small arteries in patients with diabetes during induced hyperglycemia, reinforcing the role of thiamine in normal vascular function [3]. In addition, a randomized, controlled trial of thiamine (25mg/day) combined with pyridoxine (B6) (50 mg/day) in patients with diabetes demonstrated significant improvements in perceived pain, numbness and paraesthesia (extra nerve sensations)[4].
Recently, a fat-soluble, synthetic form of thiamine called benfotiamine has become available as a nutritional supplement. Interesting research exists on benfotiamine, including research that suggest benfotiamine protects the small and large arteries from the damage caused by elevated blood glucose and increased advanced glycosylation endproduct consumption in food [5](See Complementary Corner December 2006). Benfotiamine appears to be better absorbed than standard water-soluble thiamine, however high dose thiamine appears to have a similar effect and may have advantages. The jury is still out of the safety of benfotiamine, however only minimal safety concerns have been reported in the literature to date.
Niacin, or nicotinic acid, is another ubiquitous cofactor in human cellular energy production. Niacin functions as an intermediate, in the form of nicotinamide adenine dinucleotide (NADH), in reactions in glycolysis and the Kreb's cycle, two fundamental energy production cycles in human biochemistry.
Niacin is also necessary for fat metabolism and normal DNA synthesis and repair in the form of nicotinamide adenine dinucleotide phosphate (NADPH).
Niacin, like thiamine, is water-soluble. Niacin deficiency, very rare in this country due to food fortification, is called pellagra.
Food Sources:
Include animal foods, fortified wheat products, coffee, lima beans, lentils and peanuts[1].
Niacin is best known in medicine as a treatment for high blood cholesterol, or hypercholesterolemia. Niacin is available over-the-counter and as a prescription. The doses typically available in a B vitamin supplements range from 5-50 milligrams, whereas the doses used for cholesterol reduction range from 500-2500 milligrams. Most cholesterol lowering treatments impact only one risk factor; niacin has advantages over other cholesterol-lowering because it lowers LDL cholesterol, raises HDL cholesterol, tends to lower triglycerides and improves LDL particle size and lowers lipoprotein a (Lpa), an additional risk factor of cardiovascular disease [6, 7]. (See Complementary Corner 11/06 for more information on cholesterol and the importance of healthy levels).
In other studies, people with diabetes taking niacin had less progression of the artherosclerosis than those taking placebo, despite poor blood glucose control[8]. Niacin accomplishes these excellent effects because it decreases clearance of HDL cholesterol in the liver and therefore more HDL is in circulation, scavenging less healthy LDL particles.
Niacin is considered a safe and effective treatment for hypercholesterolemia in patients with diabetes, especially at lower doses of 1000-1500 mg/day. Flushing is a common side effect of niacin treatment, and it can be quite uncomfortable for some people. However most people get used to the flushing and it typically does lessen in severity. Niacin treatment for high cholesterol (or low HDL cholesterol or high Lp(a)) should only be implemented with the supervision of a physician who can titrate your dose safely and monitor your cholesterol regularly to be sure it is working as expected.
In addition, niacin in higher doses can cause increases in liver enzymes, a sign of liver inflammation; since liver enzymes are commonly elevated in people with diabetes and the metabolic syndrome (due to deposition of fat in the liver), liver enzymes should be monitored periodically for elevations by a physician.
If you haven't already figured this out, many of the B vitamins work together as co-factors in the function of many critical metabolic enzymes. Biotin is no exception. Biotin, like thiamine and niacin, is also required for normal function of:
pyruvate decarboxylase (an enzyme involved in carbohydrate and fat metabolism),
propionyl-coA carboxylase (an enzyme involved in fat metabolism),
and acetyl-coA carboxylase (also involved in carbohydrate and fat metabolism).
Biotin is known to bind to specific sites in these enzymes in order to optimize function, and supplementation of biotin is known to increase the activities of these enzymes in people with diabetes as well as those without diabetes[9, 10].
Food Sources:
Food sources of biotin include animal products, avocado, wheat bran, baker's yeast, raspberries, artichoke and cauliflower[1].
Most of the research available on biotin in diabetes comes from recent research supported by Nutrition 21, Inc., a company who manufacturers a nutritional supplement that is a combination of chromium picolinate and biotin (Diachrome®). Recent studies have demonstrated in people with diabetes, the combination of chromium picolinate and biotin resulted in an average 0.54% reduction in HbA1c, significant reductions in LDL and VLDL cholesterol and triglycerides [11-13].
Cobalamin, or vitamin B12, is required for normal nervous system functioning and normal cell proliferation. Vitamin B12 requires a special protein called intrinsic factor for its absorption (pernicious anemia, an autoimmune anemia, results when your body produces antibodies against intrinsic factor impeding absorption).
Intrinsic factor is produced by a special cell type in the lining of the stomach; as we age the lining of our stomach can atrophy or weaken. This atrophy can result in abnormal B12 absorption resulting in deficiency, thus older adults are particularly vulnerable to vitamin B12 deficiency.
Additionally another type of anemia, called a macrocytic anemia, results from vitamin B12 deficiency; macrocytic anemias are characterized by very large red blood cells (macrocytes, or large cells).
Vitamin B12 is also required for normal homocysteine metabolism, a topic covered in great detail in Part 2 of this article next month.
Food Sources:
Sources of vitamin B12 include animal foods such as seafood, beef, pork, chicken, dairy products and eggs[1]. Vegan (non-animal) sources of B12 are extremely limited. Some sources speculate spirulina is an adequate source of B12, however this may be due to contamination by small sea animals.
Vitamin B12 has been mostly studied in diabetes as treatment for neuropathies. In recent systematic review, vitamin B12 was found to be an effective treatment for diabetic peripheral neuropathy, with pain and paraesthestias reduced the most from treatment[14].>/p>
Also relevant to diabetes, metformin, the first-line prescription medication for treating elevated glucose in diabetes, is known to cause vitamin B12 deficiency and elevate homocysteine[15].
Conclusions (for now…)
As you can tell, the clinical research world has a lot of work to do in order to fully assess the benefits and risks of B vitamin intake and supplementation on the health of people with diabetes. Unfortunately, as is the case with many natural substances that are not patentable and therefore do not generate large profits, B vitamins are not of particular interest to most funding agencies.
Fortunately, innovative researchers do have friends like Diabetes Action to ensure vital research gets performed on important questions of optimal health in diabetes!
Read Part 2 where I will discuss the homocysteine debate in detail as well as offer my recommendations on when extra B vitamin supplementation may be worth trying!
Ryan Bradley, ND, MPH October 2007
LPI, Micronutrient Information Center. 2007.
Thornalley, P.J., et al., High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease. Diabetologia, 2007. 50(10): p. 2164-70.
Arora, S., et al., Thiamine (vitamin B1) improves endothelium-dependent vasodilatation in the presence of hyperglycemia. Ann Vasc Surg, 2006. 20(5): p. 653-8.
Abbas, Z.G. and A.B. Swai, Evaluation of the efficacy of thiamine and pyridoxine in the treatment of symptomatic diabetic peripheral neuropathy. East Afr Med J, 1997. 74(12): p. 803-8.
Stirban, A., et al., Benfotiamine prevents macro- and microvascular endothelial dysfunction and oxidative stress following a meal rich in advanced glycation end products in individuals with type 2 diabetes. Diabetes Care, 2006. 29(9): p. 2064-71.
Grundy, S.M., et al., Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes: results of the assessment of diabetes control and evaluation of the efficacy of niaspan trial. Arch Intern Med, 2002. 162(14): p. 1568-76.
Pan, J., et al., Niacin treatment of the atherogenic lipid profile and Lp(a) in diabetes. Diabetes Obes Metab, 2002. 4(4): p. 255-61.
Taylor, A.J., et al., Relationship between glycemic status and progression of carotid intima-media thickness during treatment with combined statin and extended-release niacin in ARBITER 2. Vasc Health Risk Manag, 2007. 3(1): p. 159-64.
Baez-Saldana, A., et al., Effects of biotin on pyruvate carboxylase, acetyl-CoA carboxylase, propionyl-CoA carboxylase, and markers for glucose and lipid homeostasis in type 2 diabetic patients and nondiabetic subjects. Am J Clin Nutr, 2004. 79(2): p. 238-43.
St Maurice, M., et al., Domain architecture of pyruvate carboxylase, a biotin-dependent multifunctional enzyme. Science, 2007. 317(5841): p. 1076-9.
Albarracin, C., et al., Combination of chromium and biotin improves coronary risk factors in hypercholesterolemic type 2 diabetes mellitus: a placebo-controlled, double-blind randomized clinical trial. J Cardiometab Syndr, 2007. 2(2): p. 91-7.
Albarracin, C.A., et al., Chromium picolinate and biotin combination improves glucose metabolism in treated, uncontrolled overweight to obese patients with type 2 diabetes. Diabetes Metab Res Rev, 2007.
Geohas, J., et al., Chromium picolinate and biotin combination reduces atherogenic index of plasma in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Am J Med Sci, 2007. 333(3): p. 145-53.
Sun, Y., M.S. Lai, and C.J. Lu, Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Acta Neurol Taiwan, 2005. 14(2): p. 48-54.
Sahin, M., et al., Effects of metformin or rosiglitazone on serum concentrations of homocysteine, folate, and vitamin B12 in patients with type 2 diabetes mellitus. J Diabetes Complications, 2007. 21(2): p. 118-23.


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School officials say there's progress emerging from the dust and rubble of the multimillion dollar Henry County High renovation project.
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