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Transcript of The Body's Live Chat on Fatigue and Anemia With Dr. Bob Frascino
Following is the transcript of The Body's live chat on fatigue and anemia, which took place on Sept. 27, 2006, at 6 p.m. Eastern Time. The chat was sponsored by Gilead Sciences, moderated by The Body's editorial staff and hosted by Dr. Bob Frascino. This transcript has been edited for grammar and clarity.
This is the eighth chat that The Body has moderated; to see transcripts of previous chats, click here.
Moderator: Thanks, everybody, for coming to our live chat on fatigue and anemia! Our speaker for today's chat is Dr. Bob Frascino, one of the most popular doctors in our "Ask the Experts" forums and an authority on fatigue-related problems in HIVers. Dr. Bob, before we begin answering everyone's questions, is there anything you'd like to say?
Dr. Robert Frascino: Hey there boys and girls. Welcome to the cross-dressing, Republican lesbian Mormon midget, casual-sex hook-up chat room. ... Oops. Sorry. Wrong chat. Let's see now. ... Wednesday, Sept. 27? Oh yes, here we go. Distinguished guests, welcome to The Body's live chat on HIV-related fatigue and anemia. Dr. Bob here, in the cyber-flesh. Chances are most of you already know me. Otherwise you'd be spending your Wednesday evening doing something more productive, like watching "Seinfeld" reruns or sitting in your parked car with sunglasses on and pointing a hairdryer at passing cars to see if they slow down. For those of you who don't know me, I'm an HIV/AIDS specialist physician with a quarter of a century of experience in the field of HIV/AIDS medicine. I became HIV positive in January 1991 following an occupational exposure while treating a patient with advanced-stage HIV disease.
I am president and founder of The Robert James Frascino AIDS Foundation, which to date has raised well over $1 million to help fulfill our mission (1) to provide crucial patient services for men, women and children living with HIV/AIDS worldwide and (2) to raise awareness of the AIDS pandemic through education and advocacy. (You can learn more about the foundation on our Web site, www.concertedeffort.org.)
In addition, I am the founder of two medical clinics devoted to the comprehensive and compassionate care of people living with HIV/AIDS. As an investigator in several HIV clinical trials, I have published medical journal articles on evolving new treatments and quality-of-life issues for people living with HIV/AIDS.
I reside in the San Francisco Bay Area with my life partner Steve (Dr. Steve Natterstad, an expert in The Body's "Tratamientos" forum) and our pooch Presto! I'm a five-foot-eight-inch, salt-and-pepper haired, hazel-eyed, 29-inch waisted, lean-muscled, gym-buffed Italian with ... oops -- TMI (Too Much Information)! OK, let's get this party started! Crank up the volume, Moderator. Let the games begin! Chatter up! (So to speak.)
Moderator: Thanks, Dr. Bob, for that extremely succinct intro. With that, let's open up the floor to your questions!
Question from crf: Is there any way to determine the source of fatigue (HIV, meds, etc.) if one's diet and testosterone levels are normal?
Answer from Dr. Robert Frascino: An easy way to determine the source of fatigue? Well, sometimes yes, but not often. If you just participated in a triathlon, sure, it's easy to know why you're worn out. However, if you're just an HIV patient who is fatigued, there are numerous possible causes. Worse yet, HIV-associated fatigue is often multifactorial. That means several underlying problems may be working in tandem to drain your energy. During the chat, we'll be touching on lots of underlying conditions that can potentially contribute to HIV-related fatigue. The most important thing to remember is that you'll need to work closely with your HIV specialist to identify all the underlying conditions and then treat each one specifically. Let me proceed to the next questions and I'll add details about HIV-related fatigue diagnoses as we proceed, OK?
Question from anonymous: I was infected around December 2004 or January 2005. My last counts [showed a viral load of 84,000 and a CD4 count of 590]. I followed up on my health while I lived in [one] European country, but now that I have moved to another European country, I can't get myself health coverage yet, so I'm not following up at all. Lately I've been feeling fatigued and having a mild headache most of the day. What do you think I can do to manage this fatigue? I can't follow up on my health anytime soon -- probably not for another six months or so. Kudos for your exceptional humor, doctor -- I think a Dr. Bob TV show on Comedy Central is your next step after quitting that tiring job of yours.
Answer from Dr. Robert Frascino: Hi. HIV-associated fatigue is astoundingly common! How common? Glad you asked! (Even if you really didn't.) The results of two epidemiological studies revealed that, among those of us who are "virally enhanced," 54 percent and 67 percent reported fatigue as a symptom at some point during the course of their illness. And you can certainly count me in as one of those who doesn't like having his "strive-to-thrive spirit" messed with! So what can you do about your power drain? Simplistically speaking, you identify the cause and treat it. The unfortunate reality is that it's not as easy as sipping a teaspoon of Lucy's Vitameatavegamin [of the television series "I Love Lucy"]. Why? Well, as it turns out, there are numerous possible causes of fatigue among persons with HIV infection. Often a person with fatigue has several problems that can interact to zap their zip. Fatigue can be caused by inappropriate attention to basic human requirements such as rest, diet and exercise. Anxiety and depression are associated with fatigue. It can also be a symptom of an opportunistic infection, hormonal imbalance or anemia. Add in drug side effects and toxicities and you can see this list of common underlying causes is already getting lengthy. I suggest you check the archives of The Body's experts forum on fatigue and anemia. There you can find information on all the common and many not-so-common causes of HIV-associated fatigue.
Mild headache? That also can be caused by a wide range of underlying problems, from chronic sinus congestion to needing glasses to listening to Dubya [U.S. President George W. Bush] and Cheney [U.S. Vice President Dick Cheney] babble on about how wonderfully things are going in Iraq. (Actually, that last one gives me migraines.) I can't diagnose the exact cause of your problem over the Internet.
Now what's this nonsense about not getting medical follow-up for the next six months? Even if you don't have health insurance in place, you shouldn't short change your health care. Pull out your credit card if necessary, but I urge you to establish care with an HIV specialist now. Assuming your physical examination checks out and your symptoms are stable, you can, for now, forgo the expensive CD4 counts and viral load tests if necessary, but being under the watchful, wise eye of a competent HIV specialist is, in my opinion, essential. The specialist will also help you identify the cause of your fatigue and headaches and institute specific treatment for the underlying problem.
Finally, if I quit my "tiring job" as expert on The Body's "Safe Sex and HIV Prevention" forum and "Fatigue and Anemia" forum, I would worry about the [fallout] from the "worried wells" who often frequent the forums. One recently told me that if I left, there would be more tears than when Diana [Ross] left The Supremes. Consequently, I can't leave or folks might get dehydrated. Besides, I think Jon Stewart and Stephen Colbert are doing a fine job keeping us informed and entertained on Comedy Central. Stay well.
Question from FrauG: Does anemia develop gradually while one is on meds, or can it happen quickly?
Answer from Dr. Robert Frascino: Anemia can indeed happen relatively quickly. For instance, if you met Count Dracula or Freddy Krueger in a dark alley, well, you could become anemic within moments. Kidding aside, HIV-associated anemia related to medications can occur relatively quickly. For instance, anemia induced by AZT [brand name: Retrovir; also known generically as zidovudine] can show up within days to weeks.
Other causes of HIV-associated anemia, like anemia of chronic disease (caused by HIV itself) can take years to evolve.
OK, next question! Wowza! You guys have lots of questions. I'm getting fatigued just perusing all of them. OK, let's try this. Anyone who didn't vote for Bush and Cheney [in the U.S. Presidential elections of 2000 and 2004] step to the head of the line. Apparently that's all of you. OK, then onward we go. Looks like I'll have to type faster!
Question from anonymous: I am an HIV-positive, 43-year-old, Hispanic male. I have been diagnosed with HIV for over 21 years. Recently, I have been diagnosed with stage 5 kidney disease. I may be undergoing dialysis within the year or next year. I am really hoping not to and am holding off. My question is that I've been taking Epogen [generic names: epoetin alfa, erythropoietin] shots for the last couple of months. I inject 1 mL every week. Is there a long-term effect from taking Epogen? Why do I feel tired even when I do get the Epogen injection? Also, which medication is causing my fatigue and anemia? I'm on Epivir [generic name: lamivudine; also known as 3TC], Retrovir and Reyataz [generic name: atazanavir; also known as ATV]. Thank you -- Rivy.
Answer from Dr. Robert Frascino: Hello, Rivy. There are no long-term consequences from taking epoetin alfa injections. This is a medication to stimulate the production of new red blood cells from the "red blood cell factories" in your bone marrow.
There are many potential causes for your HIV-related fatigue. These are discussed in detail in the archives of The Body's "Fatigue and Anemia" forum. Of the potential medication-related causes, Retrovir would be the prime suspect. That medication can suppress bone marrow function, thereby suppressing red blood cell production and thereby causing anemia. In fact, there are many potential causes that could be contributing to your anemia, including: anemia of chronic disease (related to your 21-year, HIV-positive status), kidney disease and, as mentioned above, use of Retrovir.
I would suggest you do two things: First, talk to your HIV specialist about your fatigue. Work cooperatively with him to identify all the potential underlying causes and make a plan to treat each of these specifically. You should also check to see how well your current dose of Epogen is working to treat your anemia. The normal range of hemoglobin for men is 14 to 18 g/dL. Your Epogen dose may need to be adjusted or you might need iron supplementation so that the Epogen can have its maximum desired effect in helping to correct your anemia. Second, review the archives of The Body's experts forums to learn more about HIV-associated fatigue, HIV-associated anemia, HIV medication side effects and epoetin alfa therapy. Good luck, Rivy! You can contact me at the "Fatigue and Anemia" forum if you need me, OK?
Moderator: The Body's "Ask the Experts" forums are live at: www.thebody.com/experts.html.
Question from anonymous: If your testosterone level is fine, your thyroid is fine and you are not anemic, what do you check next?
Answer from Dr. Robert Frascino: OK, you've ruled out exactly two of the 5,896 common causes of fatigue. After testosterone and thyroid, you should check for anemia, inappropriate attention to diet, rest, sleep, medication side effects, unrecognized infections, other hormonal problems (adrenal insufficiency), psychological problems and the realization that 2008 is still a long way off. All of these things can zap your zip! Next chatter up! We're on a roll now.
Question from anonymous: Do you think fatigue and anemia affect men or women more? Or does it make no difference? I know that the normal hemoglobin range for women is lower than for men, for instance. Does this mean it's easier for men to become anemic or does it mean it's worse for women because they have less to start with? Do you have any personal experience with whether, generally speaking, men or women are better equipped physiologically to cope with HIV? Or is it an equal opportunity disease?
Answer from Dr. Robert Frascino: Republicans are more fatiguing than Democrats, but HIV-associated fatigue is an equal opportunity annoyer.
Regarding HIV-associated anemia, in the era of HAART (highly active antiretroviral therapy), there is greater prevalence of anemia in women and African Americans [than in other demographic groups].
As for it being easier for one sex to become anemic -- no. It's how far the hemoglobin falls from the normal baseline that causes the problem.
[Are] men or women better equipped to cope with HIV? Women, of course. They handle everything better. Can you imagine Dick Cheney or Rummy [U.S. Secretary of Defense Donald Rumsfeld] going through childbirth?
Question from tlthom910: So often there's much that a poz individual has little or no control over ... what is it about fatigue that we can control?
Answer from Dr. Robert Frascino: How much coffee you drink and how aggressively you work to determine all the various causes of your fatigue. Next question!
Question from anonymous: Are there any herbal supplements, vitamins or protein stuff used by body builders that you can recommend? I am trying to avoid any form of prescription medication to deal with fatigue and want to avoid possible drug interactions.
Answer from Dr. Robert Frascino: Hi. The best way to treat any symptom is to find out what's causing it and then treat the underlying cause. So, if you're ass-draggin' because your diet consists only of Big Macs, super-sized fries, chocolate shakes and Snickers bars for dessert or, on the other end of the spectrum, because you're a pesco-ovo-lacto-vegan who only eats organic grass and drinks purified water, well then your diet could be a cause of your fatigue. An HIV-knowledgeable nutritionist can check the adequacy of your diet and recommend supplements if necessary. However, in general, body builder "herbal supplements, vitamins and protein stuff" are not the way to go to address HIV-related fatigue or, I might add, to avoid "possible interactions" either.
I suggest you peruse the wealth of information in The Body's "Fatigue and Anemia" experts forum archives. Make a list of potential causes of HIV-associated fatigue and then discuss this with your HIV physician. HIV-associated fatigue isn't like strep throat. It's often not all that easy to identify the underlying cause or causes. However, with some collaborative detective work, you and your HIV specialist should be able to figure out exactly what's wrong and how to make it right again. Finally, remember that gym-bunny, muscle studs aren't exactly known for their intellectual prowess, so to speak. Their raison d'etre is to look better naked at any cost, not to be energized and optimally healthy. (Otherwise they wouldn't be injecting growth hormone and anabolic steroids and gulping down mega-doses of vitamins, despite health warnings cautioning against such interventions.)
Good luck! Hope your batteries are recharged soon.
Question from L.B.: Dr. Bob: I've been positive for 21 years and I'm struggling with fatigue. I've tried exercising with a tread mill, but the neuropathy in my feet and legs makes this difficult. I'm also being treated (Wellbutrin [generic name: bupropion]) for depression. My question: What low impact exercise do you recommend that might best help with fatigue?
Answer from Dr. Robert Frascino: Swimming and sex. Not necessarily in that order.
Question from Rex: Should I have less fatigue with Atripla [generic name: efavirenz/tenofovir/FTC] than Sustiva [generic name: efavirenz; also known by the brand name Stocrin] and Combivir [generic name: zidovudine/lamivudine; also known as AZT/3TC]. Thanks -- Rex.
Answer from Dr. Robert Frascino: Hey Rex. Maybe! For instance, it's possible that the AZT in your Combivir could have been causing some anemia, which could in turn cause fatigue. Overall, we've had good luck with Atripla if folks don't mind the weird dreams associated with Sustiva. Personally, I loved them.
Question from anonymous: Because I get so tired and sometimes have to take three- to five-hour naps in the afternoon, it disrupts my sleep schedule through the night. Despite a dependence on sleeping pills, which does not work, what can I do to keep a normal sleeping pattern?
Answer from Dr. Robert Frascino: Hi. Five-hour naps in the afternoon? Wow, does the afternoon even last five hours? That's even longer than Dubya's post-lunch siestas. Of course Dubya really views consciousness as that annoying time between naps (when he tends to muck up the world order). But I digress ...
It sounds like you need to re-regulate your sleep cycle. This can be done gradually by shortening your afternoon siestas (use an alarm clock if necessary) plus by using a mild, long-acting sleep aid for a short duration of time (several weeks) until your sleep cycle normalizes again. You'll also need to evaluate what's disturbing your nocturnal rest. Exercise late in the day? Caffeine? Medication side effects? (Sustiva is a prime example.) Your pet cat jumping on your head every two hours? Sex-crazed neighbors doing a noisy mattress mambo? Whatever. Your HIV specialist or general medical doctor can review your daily habits, diet, exercise routine, anxiety/stress levels, etc. and make specific recommendations so you can get back to your restful z's. Pleasant dreams.
Question from anonymous: I was diagnosed in February 2006 after a bout of PCP [pneumocystis carinii pneumonia] and a lot of weight loss. I spent three weeks in the hospital. My CD4 count was 114 and my viral load was 100,000. I was anemic and had been fighting fatigue for many months, not knowing what was going on -- it was winter, so I just took it for the usual winter misery in England. I have been on meds now for five months and I feel a lot better, only getting oral thrush. I have stopped menstruating and my anemia has now disappeared. I am concerned that when I start menstruating again I will become anemic again. I have always been healthy, eaten right, [had a] good home life and [done] yoga. (I'm married.) I am in a demanding job where I have to be active (area manager). Is there anything I can do to prevent the anemia from reoccurring? I am on saquinavir [brand names: Fortovase, Invirase], ritonavir [brand name: Norvir; also known as RTV] and Truvada [generic name: tenofovir/FTC]. My blood [tests] in early August [showed a CD4 count of] 391 [and a viral load of] 198, which I am over the moon about. I love you and all you stand for. Thank you.
Answer from Dr. Robert Frascino: Hi. Are your menstrual cycles abnormally heavy? If so, you may need to check in with your gynecologist. Generally speaking, menstrual cycles should not produce significant anemia. Perhaps you have more than one cause for your anemia. Check with your HIV specialist. Your current HIV meds should not be a problem.
Moderator: While you're waiting for Dr. Bob's next answer, we hope you'll consider donating to the Robert James Frascino AIDS Foundation, which Dr. Bob has founded. To learn more about his foundation, open up a new browser window and go to www.concertedeffort.org.
Dr. Robert Frascino: There are lots of other potential contributing factors for anemia -- inadequate amounts of nutrients (iron, vitamin B12 and folic acid), insufficient production of certain hormones, complications of HIV infection and even HIV itself.
Question from anonymous: Exhausted, just normally tired or anemic? Which am I, Dr. McDreamy?
Answer from Dr. Robert Frascino: Hello. I really don't know. Am I supposed to guess or perhaps, instead of this forum, you were trying to reach the psychic hotline?
Regarding anemia, the diagnosis is really quite simple. A simple blood test called hemoglobin will give you the answer. If your hemoglobin level is less than the lower limit of normal, you're anemic. For men, the lower limit is 14 g/dL (12 g/dL for women). So just take a look at your blood test results and you can tell if you're anemic or not.
Now regarding tired versus exhausted, I'll once again quote an old Chinese proverb. Confucius say: Man who run behind car get exhausted, but man who run in front of car get tired.
Question from johnnycoyote: Hi, Robert: I've been on a regimen of Zerit [generic name: stavudine; also known as d4T], Videx [generic name: didanosine; also known as ddI] and Epivir since the beginning of my treatment 10 years ago. At the beginning of this year, I changed to Viread [generic name: tenofovir; also known as TDF] and Kivexa [generic name: abacavir/3TC; also known by the brand name Epzicom]. Everything's fine, results are great and I'm gaining some facial weight again, but I've been experiencing a little fatigue and a lower sex drive, so my doctor just prescribed Androtardyl [generic name: testosterone enanthate] injections twice a month. Could you tell me a little more about the effects and possible side effects please? By the way, you have been quite an inspiration for me over here in Paris, France. Thanks.
Answer from Dr. Robert Frascino: Hello, Paris. One of my very favorite destinations in the world!
Androtardyl is an androgenic steroid used to treat hypogonadism (low testosterone level). It can perk up men's moods, nutrient metabolism, sexual function and energy levels. (It also perks up Mr. Happy [the penis].)
Adverse side effects include pain upon intramuscular administration, hirsutism [excessive hair growth] and virilization [taking on masculine characteristics] (in women), priapism (Mr. Happy being too happy for too long), acne, premature epiphyseal closure [premature fusion of the parts of the long bones] in kids, increased serum triglycerides and some liver problems.
Therefore this can be great stuff, but should only be used if there is clinical justification to do so! Please send my best to the guys at Open Café in the Marais, OK? À bientôt [see you soon].
Question from anonymous: I am 60 years old and have been HIV positive for about 25 years, also diagnosed with hepatitis C in advanced stage three years ago. (No needles though.) I feel fortunate that I have not been hit with any major opportunistic infections other than neuropathy in my feet. But now I'm on a new drug regimen (out of necessity): Prezista [generic name: darunavir; also known as TMC114], Truvada, Norvir and Fuzeon [generic name: enfuvirtide; also known as T-20]. My T cells are holding around 330 and my viral load is 211, up from less than 50. I am experiencing daily fatigue around 3 p.m. (nap time comes early). This is not good, because I am self employed, working full time. Usually an hour or so of downtime keeps me up for another four to five hours. I have nixed antidepressants this time, but used them for severe depression several years ago with great results. I don't feel bad, just very tired and lethargic. Every day. Got any ideas? Thanks, from Houston man.
Answer from Dr. Robert Frascino: Hello, Houston Man. You've been positive for 25 years? Wow! The pandemic is only 25 years old. Talk about getting in on the ground floor! Added to that, you were diagnosed with hepatitis C (advanced stage) three years ago! OK, so let's talk about your fatigue!
In the immortal words of Joni Mitchell, "Don't it always seem to go, you don't know what you got till it's gone?" She may not have been singing about HIV-related fatigue, but it certainly seems applicable to me! Did you know that fatigue is the most common complaint of those of us who are "virally enhanced"? You have double trouble -- not just one chronic viral infection (HIV), but two (HIV and hepatitis C). This can be a double whammy on your strive-and-thrive get-up-and-go.
First off, I'd suggest you review the archives of The Body's "Fatigue and Anemia" experts forum. I have written extensively on a variety of common causes that could be contributing to your HIV-related fatigue. As it turns out, fatigue, in the setting of HIV (and hepatitis C, too) is often a multifactorial problem. That means there are often multiple causes working simultaneously to make you feel wiped out. Your first step is to talk with your HIV specialist and review the potential causes of your fatigue, including: anemia; inappropriate attention to diet, rest and sleep; medication side effects; unrecognized infections; hormonal problems; psychological problems; and HIV itself.
You report you "nixed antidepressants this time, but used them for severe depression several years ago with great results." Why nix them this time? Depression can cause significant fatigue and lethargy, even though you don't feel as "bad" as you did when you used antidepressants previously. To regain your energy, you need to specifically treat all the various components that may be contributing to your problem. An evaluation by an HIV-knowledgeable psychiatrist might help in determining whether your depression is resurfacing again.
As I mentioned above, you can read my comments about a variety of potential causes in the archives. In addition, you'll need to check with your physician about your hepatitis C to see how sick your liver is. A biopsy can gauge the degree of scarring and guide treatment. The best treatment for hepatitis C is pegylated interferon [brand names: Pegasys, Peginterferon, PEG-Intron] plus ribavirin [brand names: Copegus, Rebetol, Virazole]. Interferon [brand names: Roferon-A, Intron A, Alferon N] can cause side effects, such as depression and "the flu from hell." Ribavirin often causes anemia. Anemia is often associated with fatigue. On the upside is the fact that the liver is an awesome regenerator, but you'll need to treat it right. That means no booze, heroin or other substance abuse that might further damage it.
In your particular case of significant fatigue in the setting of HIV and hepatitis C coinfection, I would be particularly concerned about anemia. Check your hemoglobin level. If you are below the lower limit of normal (14 g/dL for men), then work with your doctors to find out why. Is it the ribavirin used to treat hepatitis C, HIV itself, nutritional deficiencies, etc.? Treatment of the anemia will depend on the cause. Iron supplementation for iron deficiency anemia, for instance. Or Procrit for drug-induced anemia (perhaps due to ribavirin) or anemia of chronic disease (HIV itself). Procrit is a medication that stimulates the body to make additional new red blood cells, thereby improving anemia-associated fatigue.
So, in the words of another immortal entertainer (Lucille Ball), you want to be one of "those happy peppy people who don't pop out at parties." To do so, you'll need to be aggressive at chopping away (i.e., evaluating and treating) all the things that are causing your fatigue. How aggressive do you need to be? Well, that leads me to my last immortal quote (Mommie Dearest): "Tina, bring me the ax!"
Good luck. Gosh, I've just used quotes from Joni Mitchell, Joan Crawford and Lucille Ball all in the same response.
Moderator: I'm afraid we only have time to answer one more question; sorry to all of you who have submitted questions that we couldn't get to today! We hope you'll use TheBody.com's "Ask the Experts" area at to get the answers to your questions. (Dr. Bob regularly answers questions in both our "Fatigue and Anemia" forum and our "Safe Sex and HIV Prevention" forum.)
Question from latingalnc: I was just recently diagnosed with HIV. I have been started on Sustiva and Truvada. I also have fibromyalgia. How do I know [if my fatigue is due to] the HIV meds or my fibro? What can I do about it!? I am an African-American woman in my 40s.
Answer from Dr. Robert Frascino: Hi. Tough question. This would take some collaborative detective work between you and your HIV specialist and fibromyalgia doctor. I would suggest you review all the potential causes of HIV-associated fatigue that I discuss in the archives of The Body's "Fatigue and Anemia" experts forum and then discuss those with your HIV doctor. For instance, could the Sustiva be interrupting your sleep with weird dreams, like dreaming you were married to Cheney? (Insert total body shiver here.)
You'll also need to optimize treatment for your fibromyalgia. Once you've done all the diagnostic evaluation and maximized your treatment, if you're still tired, I suggest a stiff double espresso on an as-needed basis and also realize that HIV "mystery fatigue" does exist -- even when we fight back with body, mind and soul!
We certainly need to fight with all three and realize we are living with a really nasty virus. But the key word is living! So even if we get pooped out from time to time, let's all be here for the cure, OK? One buddy just told me: "I plan to live forever. So far, so good." Hey everybody, thanks for tuning in! I hope you learned something along the way. I sure did. I learned I'm a shit typist. Thanks for your patience. (No use being a doctor, if there aren't any "patients.") Ciao. Be well. Stay well.
Moderator: Well said, Dr. Bob. With that, our interactive chat on fatigue and anemia is now over. Dr. Bob, thanks so much for taking the time to answer everyone's questions!
To all of you who asked questions or took the time to join our chat tonight: Thank you for spending the past hour with us! A full transcript of this chat will be available on TheBody.com within the next week. As soon as it's up, we'll provide a link to the transcript within our weekly e-mail newsletter, which you can sign up for at: www.thebody.com/subscribe/joinbody.html.
To those of you whose questions we were unable to answer tonight: Please try visiting TheBody.com's fatigue page (at www.thebody.com/treat/fatigue.html) or our anemia page (www.thebody.com/treat/anemia.html) for more information. You can also ask Dr. Bob a question at his "Ask the Experts" forum on "Fatigue and Anemia," which you can visit at: www.thebody.com/Forums/AIDS/Fatigue/.
Thank you all, again. Have a good night!


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WND Exclusive
Good news: Algerian elections turn back jihadists
Bad news: Christians still not celebrating
Algeria's 50-year ruling party pulled out an election win and appears to have turned back a challenge from a strongly jihadist party.
Declaring an Algerian Spring, the government announced that preliminary results show the National Liberation Front, the party that has ruled Algeria since its independence from France, took 220 out of the 462 seat parliament. Another pro-government party took another 68 seats.
The radical Green Alliance won only 48 seats.
As good as that news appears to Western observers, International Christian Concern's Middle East analyst Aidan Clay believes either way, the election results won't make life easier for Algeria's Christians unless certain specific changes are made in the law.
"Algeria's Christian population, which consists of about 45,000 Catholics and between 80,000 – 100,000 Protestants, is slowly obtaining greater religious freedoms to worship and practice their faith," Clay said, noting positive developments at the federal level.
Clay illustrates his point by citing a 2011 government decision.
"For example, in May 2011, the governor and police commissioner in the Béjaia province demanded that seven unregistered Protestant churches be permanently closed. However, the decision was not only overturned by the secular ruling elite in the Ministry of Interior, but documents of legalization were presented to the Protestant Church of Algeria (EPA) in July, enabling them to apply for official registration for the first time in twenty years," Clay said.
Clay also cites a reversal of a blasphemy conviction.
"In another example, a five year prison sentence given to Siagh Krimo, a Christian convert from Islam who was charged with blasphemy, was postponed indefinitely after Christians and moderate Muslims protested the decision outside the Ministry of Justice in Algiers," Clay said.
"The outcry for human rights and religious freedom again persuaded the ruling elite to overturn the provincial judge's decision in hope that the charges of blasphemy filed against the Christian would be forgotten," Clay said.
Mideast Beast: The Scriptural Case for an Islamic Antichrist
But, Clay says, the federal government's actions do not reflect popular sentiment in the rest of the country.
"Both examples show that, while the secular federal government has at times tried to temper anti-Christian animosity, provincial authorities and courts, on the other hand, which are often led by Islamists, tend to stress and impose restrictive laws to limit the freedoms of the country's religious minorities," Clay said.
Former Pentagon analyst and American Enterprise Institute's Middle East scholar Michael Rubin says that even though there were reports that Algeria invited 500 observers, the election process in the North African country is still restricted.
"I wouldn't read too much into this," Rubin said. "Elections in Algeria are not fully transparent; the Algerians tried to restrict many observers."
The UAE-based Gulf News reports that the Green Alliance charged the government with election fraud.
Clay says that even if the elections were open, the Christians are still concerned.
"There is fear among Algerian Christians that an Islamist-majority parliament may favor provincial authorities and place further pressure on the ruling elite to enforce laws that can be used to criminalize Christian worship, activities, or conversion from Islam," Clay said.
Clay says that regardless of the election results, until some of the country's religion laws are repealed, the country's Christians are still "living dangerously."
"No matter what the election's outcome was, there will not be positive change for Algeria's Christian minority until certain laws in Algeria's constitution and penal code are repealed," Clay said.
"Among them is Ordinance 06-03, which was established in 2006 to regulate the worship of non-Muslims by requiring churches to obtain government permission to hold services. While EPA churches are now allowed to officially register, the ordinance can be enacted against churches at any time. The seven churches in the Béjaia province were closed in accordance to this law," Clay said.
"Another restrictive law is Article 144, Section Two of Algeria's Penal Code, which criminalizes acts that 'insult the prophet and any of the messengers of God, or denigrate the creed and precepts of Islam, whether by writing, drawing, declaration, or any other means.' Siagh Krimo's five year prison sentence for blasphemy was issued in accordance to this law," Clay said.
Clay says that Algeria's Christians were still urged to vote.
"EPA President Mustapha Krim recently told me: 'As Christians and Algerian citizens, it is our duty to vote. We must take part in the decisions of the country that we belong. I hope there will be progress in a democracy and that the newly elected deputies will work together to improve the situation of the country,'" Clay said, quoting Krim.
Clay says that now is the time for Christians to campaign for an overturn of the restrictive laws.
"More than ever, it is imperative that the Algerian government stands behind Article 36 of its own Constitution, which states that freedom of creed is inviolable, by repealing Ordinance 06-03 and Article 144 bis 2 of the Penal Code," Clay said.
"We fear that after the elections, which may render an Islamist majority in parliament, it will become increasingly more difficult for the Algerian government to repeal these oppressive laws and uphold the equality of all religious faiths," Clay said.
Rubin points out that the climate in Algeria reflects a holdover from the colonial era, and may have voted for stability over "change."
"More importantly, the dynamic in Algeria is different than elsewhere in North Africa: Algerians are still reeling from the civil war of two decades ago, and so are less likely to risk rocking the boat, even as they remain dissatisfied with the ruling order," Rubin said.


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Quarterly Recap - 4th Quarter 2014
1 Morningstar Direct (all performance percentages are total return based, which include reinvested dividends, interest)
Stocks fell 1% during the final session of the year, erasing a December gain, yet optimism over the economy, rising corporate earnings and cooperative policy from the Federal Reserve helped the S&P 500 score double-digit 2014 returns. Equity valuations were remarkably resilient despite intense market volatility, primarily driven by dire overseas events. Recall the stark headlines ranging from Russia's incursion into Ukraine, an Ebola outbreak and renewed Middle East conflict by the ISIS terrorist army. Global valuations have been most recently challenged by the bear market in oil. Caused by burgeoning U.S. shale oil production and OPEC's refusal to trim output, crude oil has fallen to a five-year low of $53.27 per barrel, down 40% during the quarter (-45% YTD). While the events threatened to derail the equity bull market, they were unequal to the strength in America. U.S. job growth has continued to expand and the economy surged by 5% during the third quarter, the fastest growth pace since the same quarter in 2003. The S&P 500 has advanced for an eighth quarter, the longest rally since the 14-quarter rally that ended in 1998. Small-cap U.S. companies widely outperformed large-cap stocks during December and the quarter. The Russell 2000 Index, a broad measure of small-cap equity performance, rose 2.9% last month, surged 9.7% during the fourth quarter and finished 2014 near an all-time high, up 4.9% for the year. The Russell Mid Cap Index rose just 0.2% in December, gaining 5.9% during the quarter and nearly matched the annual performance of the S&P 500, up 13.2%. Value outperformed growth last month, last quarter and for the year. The Russell 1000 Value Index rose 0.6% in December and 5% during the 4Q, whereas the Russell 1000 Growth Index lost 1% and rose 4.8% for the same two periods respectively. For 2014, the Russell 1000 Value Index advanced 13.5%, edging out the 13.1% return on the Russell 1000 Growth Index. Utilities (+13.2%), Consumer Discretionary (+8.7%) and Consumer Staples (+8.2%) displayed the most strength last quarter, while Energy (-10.7%) stumbled. Utilities (+29%) also took the top prize for best 2014 sector performance, followed by Healthcare (+25.3%) and Technology (+20.1%). Telecom (+3%) gained the least, while Energy (-7.9%) was the only YTD laggard. Developed markets outside the U.S. and Canada, as measured by the MSCI EAFE Index, continued to underperform the U.S. during the month (-3.5%), quarter (-3.6%) and year (-4.9%). For its part in the index, Europe's STOXX 600 returned 7.9% in 2014, including dividends. The MSCI Emerging Markets Index also slumped last quarter (-4.5%), creating a 2.2% YTD loss. The Barclays U.S. Government Bond Index rose 0.1% last month, slightly building its quarterly return to 1.9% and its 2014 advance to 4.9%. Ten-year Treasury yields fell by 18 basis points last quarter to 2.17%, extending its 2014 yield loss to 87 basis points. Below-investment grade high-yield corporate bonds lost 1.5% last month, trimming its YTD gain to 2.5%, as measured by the Barclays U.S. Corporate High Yield Index. Investment grade bonds, as measured by the Barclays U.S. Aggregate Bond Index, gained 1.8% last quarter, extending YTD returns to nearly 6%. The Barclays Municipal Bond Index rose 1.4% during the 4Q, capping a 2014 surge of 9.1%.
This information is compiled by Cetera Investment Management.About Cetera Investment Management Cetera Investment Management LLC provides passive and actively managed portfolios across five traditional risk tolerance profiles to the clients of financial advisors, who are affiliated with its family of broker-dealers and registered investment advisers. Cetera Investment Management is part of Cetera Financial Group, Inc., which includes Cetera Advisors LLC, Cetera Advisor Networks LLC, Cetera Financial Specialists LLC, and Cetera Investment Services LLC.About Cetera Financial Group Cetera Financial Group is the retail advice platform of RCS Capital Corporation (NYSE: RCAP) that delivers the benefits of scale to its family of independent broker-dealer firms and registered investment advisers while providing a framework that nurtures relationships, unique cultures and unbiased objectivity. As the second largest independent financial advisor network in the nation by number of advisors and a leading provider of investment programs to financial institutions, Cetera Financial Group provides award-winning wealth management and advisory platforms, comprehensive broker-dealer and registered investment adviser services, and innovative technology to its family of broker-dealer firms nationwide. Through those firms, Cetera Financial Group offers the stability of a large and well-capitalized broker-dealer and registered investment adviser, while serving independent and institutions-based financial advisors in a way that is customized to their individual needs. Cetera Financial Group is committed to helping advisors grow their businesses and strengthen their relationships with their investor clients. All of Cetera Financial Group's broker-dealer firms are members of FINRA/SIPC. For more information, visit ceterafinancialgroup.com.No independent analysis has been performed and the material should not be construed as investment advice. Investment decisions should not be based on this material since the information contained here is a singular update, and prudent investment decisions require the analysis of a much broader collection of facts and context. All information is believed to be from reliable sources; however, we make no representation as to its completeness or accuracy. The opinions expressed are as of the date published and may change without notice. Any forward-looking statements are based on assumptions, may not materialize, and are subject to revision. All economic and performance information is historical and not indicative of future results. The market indices discussed are unmanaged. Investors cannot directly invest in unmanaged indices. Please consult your financial advisor for more information. Additional risks are associated with international investing, such as currency fluctuations, political and economic instability, and differences in accounting standards. Affiliates and subsidiaries and/or officers and employees of Cetera Financial Group or Cetera firms may from time to time acquire, hold or sell a position in the securities mentioned herein.
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Classic Sonic comes to the Nintendo DS for the first time! Sonic The Hedgehog, one of the world's most recognized and successful video-game characters returns to the Nintendo DS in this new collection of his original adventures. Sonic Classic Collection is the complete compilation of the original SEGA Genesis Sonic titles, consisting of the following genre-defining games.
For the first time the best of classic Sonic comes to the Nintendo DS for a new generation of gamers!


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From the drive and control concept to machine commissioning: Find out more about our application for Deloro Wear Solutions GmbH!
7 Oct 2016
Deloro Wear Solutions relies on Pilz drive technology
Best advice for plants with vertical axes
Deloro Wear Solutions GmbH is one of the world's leading manufacturers of carbide tools and wear-resistant solutions. It decided to use a Pilz solution to safeguard its XYZ welding equipment.
The package includes the following services:
- Advice on the safe drive and control concept
- Safeguarding the vertical axis
- Performing a risk assessment
- Adapting the entire operating concept
- Selecting and programming the systems and components
- Commissioning of the machine
Safe motion monitoring on vertical axes
The solution focuses on the motion control system PMCprimo DriveP in conjunction with the control system PSSuniversal multi. As the higher level control system, PMCprimo DriveP controls and monitors both the safety and the control processes on the machine. The drive system controls up to ten vertical and horizontal axes.
Safe motion functions such as the safety functions SSR (Safe Speed Range), SLS (Safely Limited Speed), SBC (Safe Brake Control), SBT (Safe Brake Test) and Safe Stop SS1 and SS2 meet the highest safety requirements in the application up to Performance Level PL e. They are implemented directly within the drive. Safeguarding of the vertical axis is ensured by a combination of a safe operating stop and the control of two brakes – including a safe brake test.
Increase productivity thanks to safe "teach-in"
Also, the availability of the machine is increased significantly with the help of the "teach-in process". If the welding profile contour can be calculated from the teach-in points and the system is then started, teaching can occur with safely limited speed SLS while the safety gates are open . The operator can observe the process perfectly and setup time is minimised.
PMCprimo DriveP is supported by the configurable control system PSSuniversal multi in the automation system PSS 4000. This control system monitors safety functions such as E-STOP and automatic/setup mode in the PTA plant. The whole welding machine plus the control/drive section are monitored by our safe sensor technology PSEN on swing gates and sliding gates. The operator terminal PMI is also used for safe diagnostics.
Visit us at Motek 2016!
We would be delighted to provide individual advice on our drive solutions. Visit us at Motek from 10 to 13 October 2016. You'll find our experts in Hall 8, Stand 8410. We look forward to your visit!
Further information:
Pilz South East Asia Pte. Ltd.
25 International Business Park, #04-56 German Centre
Singapore 609916
Telephone: +65 6839 292-0
E-Mail: email@example.com


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Price Range * Dinner over $30 (AUD)
Floating on top of the Noosa River is where you'll find this award winning, three level waterfront dining hub offering an espresso bar and takeaway fish and chips on the front deck, a lunch and dinner bistro, stunning wedding and events spaces and a rooftop Sunset Bar, so there's something for everyone.
Noosa Boathouse showcases a modern Australian menu that lets seasonal produce shine and offers a strong emphasis on locally harvested produce, fresh seafood and quality beef, combined with an ambition to deliver excellent experiences and service.
Functions and Events: Boasting three unique waterfront event spaces, Noosa Boathouse represents a destination that can play host to a unique and brilliant event. Offering flexible venue options and layouts that can easily be configured to cater for a small and intimate affair of 20 guests through to a spectacular gala event for 350 people. Their private jetty allows your guests the option of a cruise along the river or boat transfer from Hastings St with exclusive direct access to the venue.
Sitting on an idyllic waterfront location, with a fresh Australian menu, Noosa Boathouse is a iconic bistro, bar and events destination that is a must do, when visiting Noosa.
|Opening Hours
|All year
|6am - 9pm
|6am - 9pm
|6am - 9pm
|6am - 9pm
|6am - 10pm
|6am - 11pm
|6am - 9pm
|26 December 2018
Note: Information on listed products and services are provided by the operator and were correct at the time of publishing. Rates are indicative based on the minimum and maximum available prices of products and services. Please visit the operator's website for further information. All prices quoted are in Australian dollars (AUD).


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Solzhenitsyn at Harvard: the address, twelve early responses, and six later reflections
Ethics and Public Policy Center, 1980 - History - 143 pages
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No Place for Truth: Or Whatever Happened to Evangelical Theology?
David F. Wells
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Sheet music downloads have become the preferred method of acquiring classical music repertoire. Created by professional musicians, EveryNote.com presents classical sheet music download of over 20.000 popular and hard-to-find music scores over 1000 composers. A major Internet provider of classical sheet music files download online, EveryNote.com offers the largest and most complete digital sheet music download library on the Web in the world. Instantly download, view and print your favorite classical music score. Everynote.com currently offers thousands of classical music compositions for Piano, Violin, Cello, Flute, Clarinet, Classical Guitar, Voice, Chamber and Choral music.Many more instruments, composers, genres added every day! EveryNote.com has been featured in The New York Times, Globe and Mail, Musical America and many other publications.
Angel Barrios
Angel Barrios short biography
Angel Barrios Fernandez was born in Grenada, the son of a flamenco guitarist. Barrios studied in Paris. In 1900 Barrios founded the Trio Iberia for which he made many arrangements. The Trio enjoyed a very favorable reputation all over Europe. Barrios was quite a productive composer. Barrios's works include operas, zarzuelas, a number of orchestral scores and solo works for piano and guitar. They are all written in a style influenced by the Romantic era, and relied heavily on a populist Spanish folk influence.
More Classical Guitar sheet music download on EveryNote.com
Classical Guitar sheet music download on EveryNote.com
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16/05/2012 Centre targets sustainable improvements
As preserving water and improving soil becomes increasingly vital, Challenger is supporting the Soil and Water Management Centre in the UK.
Created in response to a report on the current status of soil and water management, the Centre, based at Harper Adams University College in Shropshire in the English Midlands, aims to provide 'sustainable improvements' in farming and ecosystem efficiency through better knowledge co-ordination, transfer and development.
Challenger has committed to backing the Centre for three years and will be involved in knowledge transfer days, ongoing research and extensive educational programmes for farmers and agronomists.
"Challenger's mission statement: 'Your Soil, Our Territory' fits particularly well with the project," explained Martin Hamer, Challenger Manager National Sales, UK. "Our tracked machines are already helping farmers to look after their most valuable resource – the land."


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Getting discounts on royalty-free music
Affiliates get 10% off everything:
First, there is the 10% affiliate discount, that anybody with a website can get. Basically, you sign up with our Affiliate Program under which we pay you 10% of the value of all orders placed by anybody who has followed a special affiliate link from your website to ours — including your own orders! When you sign up, we will give you a unique link that you place on your website. If somebody follows that link and ends up buying a product on our site — no matter how small or large the order — we will pay you 10% of the order value. Many of our regular customers use this program to basically earn themselves a 10% discount on all their orders. Before placing an order on our site, they arrive at our site by following their own affiliate link – thus effectively getting back 10% of their order value, with the added bonus of also getting 10% of any orders placed by anybody else who might follow that link and end up placing an order with us.
I should add at this point, that whilst you are welcome to use our affiliate program for your own orders to earn yourself the 10% discount, we do require that you actually place the link on a public page on your website, so that other people can use the link, too. You can't just keep the link only for your own use.
To become a Shockwave-Sound.com affiliate, just go to our Affiliate sign-up page and fill in the form there.
Bulk discounts on ready-made collections:
Now, as for larger discounts and bulk discounts. What is "Bulk order"? Unfortunately, we don't consider 3 tracks to be bulk. Nor 5 tracks, really. Nor even 10 tracks. If you're placing those kinds of orders, please consider using the affiliate program described above, to get yourself 10% discount on everything.
However, if you buy 5 or more ready-made collections, we would accept that this is a bulk order and we are prepared to give the following discounts:
Number of collections with Standard License: with Mass Market License * Any 5 collections: US$ 439.00 US$ 999.00 * Any 10 collections: US$ 799.00 US$ 1999.00 * Any 15 collections: US$ 1049.00 US$ 2499.00 * Any 20 collections: US$ 1299.00 US$ 2999.00 * More than 20 collections: contact us contact us
These collections are normally either $99/$129 each with Standard License, or $249/325 each with Mass Market License. Each collection typically contains 10-15 tracks, plus all the different edits/versions/cuts of every track, to give you options in editing (such as 60-secs version, 30-secs version, Loops, Stingers etc.) You can see a complete list of our ready-made collections here: http://www.shockwave-sound.com/collections.html
The collections can be delivered to you as physical CDROM/DVDROM's, on an external USB hard drive or a USB memory stick – whichever you prefer.
Should you be interested in taking us up on either of these offers, please get in touch with us. These "bulk orders" of 10-15-20 or more ready-made collections are not available to buy through the shopping cart on the site. You'll have to talk with, us or email with us, to discuss your selections and arrange payment.


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Albuquerque International Sunport
Albuquerque International Sunport is one of the best-loved airports among travelers, both for its handsome regional architecture and its permanent art collection. Even the car-rental facility, opened in 2001, has its own art collection. The Sunport recently completed a $10.5 million expansion of the security area. Pilots consider Albuquerque a safe and easy place to land because the Sunport has four runways, more than most cities, and enjoys a good relationship with Kirtland Air Force Base, which handles all fire and rescue.
The Sunport is 600,000 square feet with 22 gates in two concourses.
The Sunport has a U.S. Port of Entry with its own customs facility, so that exporters can ship freight directly and pay duties locally. And there is a foreign trade zone on 60 acres near the air cargo center.
Double Eagle II Airport
Double Eagle II Airport on Albuquerque's West Side is a general aviation facility used for training, military, air ambulance, charter, private and corporate flights. It's slated to become the center of the city's budding aviation manufacturing cluster, with the development of the Aerospace Technology Park.
Currently the airport has two runways and two fixed-based operators that include flight training and charter service, avionics service, airframe and powerplant repair, tie downs, hangars, catering, and aircraft rental.
Rail Service
The Burlington Northern Santa Fe Railroad, with north-south and east-west lines, hauls 90 percent of freight originating in the state and 80 percent of cargo terminating here.
Albuquerque is a stop on Amtrak's Chicago-to-Los Angeles route.
Commuter Rail
The New Mexico Rail Runner currently operates in the Rio Grande corridor from Belen to Santa Fe with several stops in Albuquerque. The Rail Runner serves 1.2 million commuters a year. Bus connections are available from the Albuquerque stops.
Two interstate highways cross Albuquerque: I-40, one of the nation's major east-west arterials, and I-25, a north-south route from Canada to Mexico.


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Remember when Houston was Choke City?
If you don't I won't even go into why. (If you don't know, you don't need to know.)
Well, the Rockets got the city out of that with a splendid comeback to beat Phoenix and loudmouth Charles Barkley, then went on to claim back-to-back NBA championships.
It has been a long, painful decade and a half since that last title.
It used to be fun when the Rockets were always in the hunt. Star players like Scottie Pippen and Barkley looked at Houston as a place where a Larry O'Brien Trophy could indeed be won.
Now, however, star players like Chris Bosh and Pau Gasol turn their noses up at Houston. Superstar players like LeBron James, Chris Paul and Dwight Howard make lists of five or six preferred destinations, and Houston isn't among them.
So what is a smart general manager to do? Load up enough decent players so he can trade a couple of them for a star who doesn't have enough leverage to just say no to Houston.
It took Daryl Morey quite a while to get this done. But when he finally pulled it off – a tricky move too, as he piggybacked on the Paul-to-the-Lakers deal to get a top-10 (at worst top-15) player in Gasol – David Stern stepped in and nixed the deal.
The Rockets are a Tad (Brown) peeved, ticked off to the highest of tickstivity, and rightly so.
It doesn't matter that the Hornets managed to get what could be viewed as a better deal to trade Paul to the Clippers. (It's arguable, but I admit the lottery pick could be a game-changer.) That is a makeup call and rather beside the point.
A trade was agreed to and all but completed when the NBA sideswiped Houston with a ridiculous ruling. Instead of being in the mix with the big boys in the Western Conference, the Rockets are likely to be a .500 team and a fringe contender for a playoff spot.
Chump City.
When the New Jersey Nets and the L.A. Clippers, or now Lob City as Blake Griffin said when he heard Paul was coming, are more desired your team is in bad shape.
All of this because the NBA wants to keep the Hornets attractive for a buyer and to keep them in New Orleans. Why the league is hell-bent on not selling the Hornets to any buyer interested in moving the team makes little sense to me, but so does much of what comes from the NBA office.
The sooner the league sells the franchise and gets out of the ownership business the better, but that won't make the Rockets feel any better. And it shouldn't. They got hosed.
For now, the Rockets Red neighborhood of Clutch City remains closed. Any other top-10 players available via trade?


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HOUSTON — After moving to Houston about a year ago, Francisco Navas Cobo has been a whirlwind.
He signed with the Houston Dynamo, made his debut and received several call-ups from the US U-20 National Team. He was with the American side that won last month's Milk Cup in Northern Ireland.
MLSsoccer.com caught up with the young midfielder before he joined the U-20s for a tournament in Peru ahead of qualifying for the 2011 U-20 World Cup.
MLSSoccer.com: What does the tournament in Peru mean for you and your development?
Navas Cobo: It's good to be called up again, and to improve and prove that I'm capable of playing for the national team.
MLSSoccer.com: The US U-20 team for Peru is comprised of all professionals. How important is that to the development of youth players such as yourself?
Navas Cobo: It's great [in the camps] to be around all professionals. It's a good environment to be around other young professionals and it is hard because the other players are all really good. It probably makes it easier for the coach because we are all professionals.
MLSSoccer.com: What will this tournament mean for the upcoming U-20 World Cup qualifying?
Navas Cobo: To get the team together and to start building a team and working together, it will be good for next year to hopefully qualify for the World Cup.
MLSSoccer.com: Obviously you haven't gotten a ton of playing time with the first team for Houston. How do you think you are developing here with the Dynamo?
Navas Cobo: Yesterday was the one-year [anniversary] of when I got [to Houston]. Great things have happened for me. I've been here training with the professionals and getting called up with the national team—what else can I ask for? I know I'm not getting much playing time, but I'll be patient, work hard and day by day build. Whenever they give me the chance, I'll be ready.
Dwain Capodice is a contributor to MLSsoccer.com. Questions or Comments can be sent via email to email@example.com.


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"Ua'aihue" - Hawaii Five-0 S5 E11
When a tourist is killed after unknowingly transporting a stolen Van Gogh, an undercover Kono and Chin enter the world of black market priceless art and are taken hostage. Also, McGarrett asks Iron Chef Masaharu Morimoto to help train Kamekona to beat Chef Sam Choy in a shrimp cook-off, on HAWAII FIVE-0, Friday, Jan. 9 (9:00-10:00, ET/PT), on the CBS Television Network. Pictured (l-r) Taylor Wily as Kamekona and Masaharu Morimoto as Himself Norman Shapiro/CBS ©2014 CBS Broadcasting, Inc. All Rights Reserved


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Janelle Wilder Coughlin, Ph.D.
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- Johns Hopkins University School of Medicine / Psychiatry (2004)
Research & Publications
Selected Publications
- Coughlin, J.W., Edwards, R., Redgrave, G., & Guarda, A. (2009). Pain severity in eating disorders predicts longer inpatient hospitalization. International Journal of Eating Disorders, 43(8), 737-42.
- Svetkey, L.P., Stevens, V.J., Brantley, P.J., Appel, L.J., Hollis, J.F., Loria, C., Vollmer, W.M., Gullion, C.M., Funk, K., Smith, P., Samuel-Hodge, C., Myers, V., Lien, L.F., Laferriere, D., Kennedy, B., Jerome, G.J., Heinith, F., Harsha, D., Evans, P., Erlinger, T., Dalcin, A, Coughlin, J.W., Charleston, J., Champange, C.M., Bauck, A., Ard, J.D., & Aicher, K., for the Weight Loss Maintenance Collaborative Research Group. (2008). Comparison of strategies for sustaining weight loss: Main results of the Weight Loss Maintenance Randomized Trial. JAMA, 299, 1139-1148.
- Appel L.J., Clark J.M., Yeh H.C., Wang N.Y., Coughlin J.W., Daumit G., Miller E.R., Dalcin A., Jerome G.J., Geller S., Noronha G., Pozefsky T., Charleston J., Reynolds J.B., Durkin N., Rubin R.R., Louis T.A., Brancati F.L. (2011). Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 365(20).
- Coughlin, JW., Schreyer, C., Sarwer, D., Heinberg, LJ, Redgrave, GW, & Guarda, AS. (2012). Cosmetic surgery in inpatients with eating disorders: Attitudes and experience. Body Image: An International Journal of Research, 9(1):180-3.
- Coughlin JW, Guarda A, Clark J, Furtado M, Steele KE, Heinberg L. (in press). A Screening Tool to Assess and Manage Behavioral Risk in the Postoperative Bariatric Surgery Patient: The WATCH. The Journal of Clinical Psychology in Medical Settings.
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Third Year Law Student Lands On-Air Spot with Glenn Beck's TheBlaze TV
February 15, 2013
Brian Bosché, a 2013 Juris Doctor candidate, has accepted an on-air job for a new show called "For The Record" on Glenn Beck's TheBlaze TV. The program will be, in Beck's words, a "60 Minutes replacement" and will focus on quality, hard-hitting journalism.
"It is an amazing opportunity for a Liberty law student to land such a strategically influential job as a media reporter and correspondent for a national newscast with Glenn Beck's network," said Mat Staver, dean of Liberty's law school. "Immediately upon graduation Brian Bosché will beinfluencing the country through investigative and documentary news stories. I could not be more proud of Brian."
Soon after graduating in May, Bosché will have a national television presence —delivering long-form investigative pieces and written stories for TheBlaze.com. For him, the opportunity came at the perfect time. Bosché grew up in Roanoke, Virginia and studied broadcast journalism at Virginia Tech. He worked internships in national and local media—including one at the NBC News Washington Bureau during the 2008 Presidential Election. As for his career choice, he said, "My family encouraged me early on—to discover the passion that Go d knit on my heart. Though I certainly don't know what's to come, I've known that I was to impact television journalism since I started college."
As for law school, he came to Liberty University
School of Law with a purpose. Bosché wanted to add a legal education to his journalistic skill-set—an often powerful combination. However, he did not want just any legal education. He chose Liberty University because of its foundational approach to teaching law. Reflecting on what has transpired and his acceptance of this opportunity, he said, "God has orchestrated amazing people and opportunities around me. It's humbling."
Launched over a year ago, TheBlaze TV now has more than 300,000 subscribers, giving it a paid audience that's larger than most free cable channels. Satellite company, DISH Network, carries the network on channel 212. Plus, many top cable providers have inquired about adding TheBlaze TV to their line-up.
For Liberty's complete News Story, click here.
Press photos provided by David Duncan of Liberty University Marketing.


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Install dig On Windows 7, Get dig Working On Windows 7 64-Bit OS
I have been wanting to get the use of dig on Windows 7 for awhile but hadn't taken the time to do so until now. The problem is nslookup is not as helpful in terms of TTL of zone files, etc. and while you can accomplish your tasks with nslookup using dig makes life much easier on Windows 7 when troubleshooting DNS type issues. The other night I was in the middle of a time critical launch of a new web cluster and needed dig on the Windows 7 laptop I was working on so I decided to get it working while I was waiting for some data to transfer. I actually had slipped on setting the TTL, which was for a single sub domain that was part of the transfer, from a TTL of a entire day (86400 seconds) to a TTL of one hour (3600 seconds). Anyhow below is more information on installing dig on a Windows 7 computer.


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The purpose of the North Georgia Relic Hunters Association (NGRHA) is to further the enjoyment of responsibly collecting Civil War relics, old bottles and coins as well as other items from years gone by. The NGRHA is dedicated to preserving Georgia history through responsible excavation.
The North Georgia Relic Hunter's Association was formed in 1972 in partnership with the City of Marietta Department of Parks and Recreation. The association has over 120 members from all walks of life.
Meetings are open to the public and are held the first and third Tuesday of each month, 7:30 p.m., at the FOP Lodge (2350 Austell Road, Marietta, GA 30008). This is on the corner of Austell Rd and Wanda Circle.


text: You're a discerning reader. Do you look for out-of-the-way, original novels? That's great; so do we. But just because a book makes it onto a best-seller list doesn't mean it's pedestrian. If you're wanting to delve into some hypnotic, fast-paced stories, check out our list of teen novels that are excellent—they just happen to be really popular, too. All of the books featured on this week's list are the opening books of series, so you can start off where the story begins.


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A dog breeder will face all animal mistreatment charges against him on a single day next year, including animal cruelty, resisting an officer and 30 counts of failure to vaccinate.
A dog breeder will face all animal mistreatment charges against him on a single day next year, including animal cruelty, resisting an officer and 30 counts of failure to vaccinate.
All 38 counts filed this year against Warren "Chris" Michot, 368 Little Choupic Road, Thibodaux, have been consolidated, and he will face trial March 14, court records show.
Michot keeps between 30 and 40 dogs, which neighbors say are Brittanys, in one pen outside his trailer. Some neighbors have complained about the barking and the smell, and the Lafourche chapter of the Humane Society has alleged the way he houses them is cruel.
Michot and his attorney, David Ardoin, could not be reached for comment.
The dogs' barking is incessant, making it hard to sleep, and the smell of dog feces is unpleasant, said neighbor Joey Sanchez. The dog feces have backed up Michot's sewers, and it has overflowed into other neighbors' property in the past, he said.
"The barking, barking every day — you can't think. We can't concentrate," Sanchez said.
Sanchez said he has thought about moving.
Michot is a former Lafourche sheriff's deputy, and past complaints to the Sheriff's Office have not spurred any changes to his kennel practices, said one neighbor who declined to be named.
"He didn't have many (dogs) at first," the neighbor said. "Then it wound up being 20, then 30, then 40."
In addition to the above charges, Michot is also charged with trespassing, four counts of animal noise and letting many dogs run free, which is not permitted in any town with a population of more than 1,000.
He was booked into the Lafourche Parish jail Wednesday on charges of animal noise, then bonded out the same day, jail officials said.
This year, he's been cited March 22, March 28, April 17 and Oct. 23.
The Lafourche chapter of the Humane Society called the Sheriff's Office, complaining about the conditions of the animals. Its goal is not to take his dogs but to make sure he treats them well, said chapter President Pamela George,.
"Our ultimate goal is that he would ... provide adequate shelter for the animals, provide medical treatment for his animals and clean up the atrocious smell" to kill any bacteria, George said. She added he should also find a way to keep the dogs from barking.
"Dogs start fighting with each other" when they're all caged together, George said. "When you have that many animals together, they form a pack and sometimes more than one pack. You can't control all those dogs because they're not in individual cages."
Michot told her he had been sick for a while, George added. She said volunteers with her organization would be happy to help him clean the dogs and provide them with food.
Neighbor Paula Terracina, who lives farther away and across the street, said the dogs don't bother her.
"He's a really nice man," Terracina said. "People all the time give him trouble, but it's in his nature to love dogs."
Michot's trial is scheduled on March 14.
Staff Writer Katie Urbaszewski can be reached at 448-7617 or firstname.lastname@example.com.


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Science Friday® is produced by the Science Friday Initiative, a 501(c)(3) nonprofit organization.
Science Friday® and SciFri® are registered service marks of Science Friday, Inc. Site design by Pentagram; engineering by Mediapolis.
Did we evolve our sense of right and wrong, just like our opposable thumbs? Could scientific research ever turn up new facts to resolve sticky moral arguments such as euthanasia, or gay marriage? In this hour of Science Friday, we'll talk with philosophers and scientists about the origins of human values. Our guests are participating in an international conference entitled "The Origins of Morality: Evolution, Neuroscience and Their Implications (if Any) for Normative Ethics and Meta-ethics" being held in Tempe, Arizona on November 5-7. Listen in to their debate, and share your thoughts.


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YogYes.com is a travel portal to Yogyakarta with more than 100 places to stay, rent a car, and buy a tour. We have all their phone numbers. You can rent a house or car via WhatsApp, and easily negotiate with the owners.


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The Apache Software Foundation: History, Purpose, and How We Can Help the Planet
Brian Behlendorf founded CollabNet, with O'Reilly & Associates, in July 1999. The company provides tools and services based on open source methods. Before launching CollabNet, Behlendorf was co-founder and CTO of Organic Online, a Web design and engineering consultancy located in San Francisco. Durig his five years at Organic, Behlendorf helped create Internet strategies for dozens of Fortune 500 companies. During that time, he co-founded and contributed heavily to the Apache Web Server Project, co-founded and supported the VRML (Virtual Reality Modeling Language) effort, and assisted several IETF working groups, particularly the HTTP standardization effort. Before starting Organic, Behlendorf was the first Chief Engineer at Wired Magazine and later HotWired, one of the first large-scale publishing Web sites.
Behlendorf is Director of hte Apache Software Foundation.


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2012 is over. 2013 is here. With that in mind, here are my five most enjoyable movies from the year that was and five to keep an eye on in the next 12 months.
2012 is over. 2013 is here. With that in mind, here are my five most enjoyable movies from the year that was and five to keep an eye on in the next 12 months.
My top 5 from 2012:
1. �The Perks of Being a Wallflower�
Starring: Logan Lerman , Emma Watson, Ezra Miller
Directed by: Stephen Chbosky
Why you should see it: �Perks� poignantly delves into the struggle for genuine friendships among a group of not so popular high school students who view themselves as �misfit toys.� It strongly advocates embracing the moment and finding people who want to be around you.
2. �Argo�
Starring: Ben Affleck, Bryan Cranston, John Goodman
Directed by: Ben Affleck
Why you should see it: This incredible true story of a CIA agent helping U.S. embassy workers pose as a Canadian film crew to escape from Iran during the hostage crisis in 1979 is unbelievably entertaining. Affleck is stellar both as an actor playing the agent in charge of the mission and the director of this Oscar-worthy film.
3. �Silver Linings Playbook�
Starring: Bradley Cooper, Jennifer Lawrence, Robert De Niro
Directed by: David O. Russell
Why you should see it: It�s an incredibly honest look at the sometimes painful dynamic of relationships among families and friends. A man (Cooper) and woman (Lawrence) each facing challenging extremely challenging circumstances form an unlikely connection in this dark comedy.
4. �The Hunger Games�
Starring: Jennifer Lawrence, Josh Hutcherson , Woody Harrelson
Directed by: Gary Ross
Why you should see it: Expectations were sky-high for this adaptation of Suzanne Collins� wildly popular book, and it delivered. Lawrence�s performance as lead character Katniss fighting for her life against other children was one of a multitude of standout performances, including those by Harrelson and Lenny Kravitz .
5. �The Amazing Spider-Man�
Starring: Andrew Garfield, Emma Stone, Rhys Ifans
Directed by: Marc Webb
Why you should see it: Many wondered whether this reboot should be made just five years after �Spider-Man 3.� Garfield and Stone�s natural chemistry, an intriguing villain ( Ifans as �Lizard�) and solid directing answered that question with a resounding �yes.� Following up a strong trilogy, this Spidey flick may have been the best yet.
5 to watch in 2013:
�Identity Thief�: The ever-hilarious Melissa McCarthy plays the title role while stealing the identity of Jason Bateman�s character. I�m not kidding. (Out Feb. 8)
�Safe Haven�: Julianne Hough and Josh Duhamel star in the latest Nicholas Sparks adaptation, about a woman running from a troubled past while maybe finding love. (Out Feb. 14)
�Star Trek into Darkness�: It�s the sequel to J.J. Abrams� well-received film, bringing back actors Chris Pine, Zoe Saldana and others to face down a new enemy. (Out May 17)
�Superman: Man of Steel�: This reimagining of Clark Kent�s alter ego hands the cape to Henry Cavill, with Amy Adams as Lois Lane. Zack Snyder directs and Chris Nolan is a producer. (Out June 14)
�The Hunger Games: Catching Fire�: The fallout begins from the unpredictable ending to the 74th Games in this sequel. Jennifer Lawrence and Josh Hutcherson�s characters are in danger again as seeds of rebellion against the Capital are sown. (Out Nov. 22)


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AKILA is a bead accessory hub for men and women. (It means: 'intelligent girl' in the Egyptian Language). Our vision is to be the leading producer of handmade beaded accessories in West Africa and beyond, while projecting our Ghanaian culture and heritage. Please note that our products are made-to-order and could take between 10 - 15 working days to be delivered.
To provide you with as much convenience as possible, we work hard to give you the best experience with the most flexible payment options available locally and globally.
As a payment gateway provider, expressPay is an official Visa Payment Technology Provider (PTP) and the leading Visa eCommerce processor in Ghana. expressPay supports mobile money payments and all major international card networks - Visa, MasterCard, American Express, Discover, etc. expressPay serves as a one stop shop for the payment needs of eCommerce merchants. expressPay meets all the international security standards and is PCI DSS certified.


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Ok here is some feedback, been playing quiet a bit of RF. I have to say, i really enjoy it for now.
I do have a couple of issues though:
- Add a "Restart/Reset" option to the menu, if you die in the first couple of seconds. You want to be able to start from scratch again.
- I have lowered the volume, it does save partially, but when I reboot the game, the volume is @ max again, when I then go into settings. The volume slider is actually lowered, but volume does play @ max volume.
- The difficulty is way too dynamic, some games are really easy, some games tend to be insanely difficult. Let me give you an example:
I have reached 129k points without running into the a "boss" (you know, the big purple guy that follows you around). Sometime I get the boss after 20-30K points.
This makes getting a high score luck based!
Unclear things:
- Burst, what does it do exactly? Cant really tell ingame.
- Green Powerups: They, say damage, fire rate, is this a temporary buff or are these permant? How much do I gain when I pick them up?
- Yellow Powerups? What do they do? They dont have a text when I pick them up!
Thats it for now, keep up the good work!


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Caribbean teal decorations and tableware with dots, spots, stripes and chevron patterns.
Cups, plates, tablecovers, candles, treat boxes, bunting, napkins and more for all different kinds of occasions.
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text:
Educational Psychology: Theory and Practice
Pearson/Allyn & Bacon, 2006 - Education - 609 pages
";Slavin writes in such a way that concepts are very clear and examples illustrating the concepts are engaging and relevant."; Karen Huxtable-Jester, University of Texas at Dallas ";For the teacher candidate, who is often encountering this material for the first time, the tables, organization, and formatting of the chapters make this text eminently accessible."; Richard Battaglia, California Lutheran University ";The major strength of this text is its relevance to effective teaching. Slavin touches on various approaches and types of teaching and the consistent message of intentional teaching is evident."; Joshua S. Smith, University at Albany This edition continues to have in-depth, practical coverage with a focus on the intentional teacher. It presents up-to-the-minute research that a reflective, intentional teacher can apply. The eighth edition of this popular text from renowned educational psychologist Robert Slavin translates theory into practices that teachers can use in their classrooms and focuses on the concept of intentionality. An ";intentional teacher,"; according to Slavin, is one who constantly reflects on his or her practice and makes instructional decisions based on a clear conception of how these practices affect students. To help readers become ";intentional teachers,"; the author models best practices through classroom examples and offers questions to guide the reader. New to This Edition: NEW ";Teaching Dilemmas"; in all chapters introduce controversial issues of practice and ask students to reflect on their own beliefs with Reflective Questions. NEW ";Certification Pointers"; throughout the text note text content likely to appear on state certification tests. NEW ";Personal Reflections"; describe chapter-related events from the author's own experience, helping students relate to the text as the product of a real author's work. Updated throughout with important new coverage on programs for English language learners (Chapter 4), technology and No Child Left Behind (Chapter 9) to keep students abreast of current trends and issues. NEW IDEA updates are included in Chapter 12. NEW certification guides for state-specific tests in California, Texas, New York, and Florida as well as a general certification guide based on Praxis are available free with the text so that students can readily keep and use this text to prepare for their state certification tests. Please visit the companion web site for this book at www.ablongman.com/slavin8e to find practice quizzes, web links, activities and more! Package this text with MyLabSchool--a powerful set of online tools that bring the classroom to life! See the inside cover and visit www.mylabschool.com for more information!
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Are you ready for something a little different on this blog?
The fall is a great time to be motivated and inspired with new catalogues, collections and, well, generally new things. This time of year also kickstarts cosy, homely feelings, when we all start to hibernate a little more. The weather starts being a bit more unpredictable and to me when the weather gets cold, rainy and blustery it just makes me feel like an even smaller, more vulnerable person on this huge planet of ours, always at the mercy of our beautiful nature.
This fall, IKEA is launching their new catalogue along side something really amazing - a time travel experiment. IKEA gave some of their customers the opportunity to experience their future. How? Well, world-renowned hypnotist, Justin Tranz put young couples into a hypnotic trance before presenting them with life-changing every day events in bedrooms and bathrooms, the rooms where the day begins and ends....
The idea is that those big moments that happen in all our lives have a dramatic affect on how we live and how we live has a dramatic affect on how our homes evolve.
Take a look at this video which films Adam and Sofi dealing with various milestones in their daughters life, I think it's absolutely fascinating and so clever. I'd love to hear what you think.
Some words from Johan Wickmark, catalogue manager at IKEA..."At IKEA, we believe that life happens everyday. That it's on those seemingly ordinary days the magic happens, when life takes shape and changes, and it's for those moments we create our products and solutions"


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Daytona International Speedway and International Speedway Corporation got the final yes vote they needed out of City Hall to charge forward with their plan to tackle a major overhaul of the Speedway's front stretch grandstands.
DAYTONA BEACH — Daytona International Speedway and International Speedway Corporation got the final yes vote they needed out of City Hall to charge forward with their plan to tackle a major overhaul of the Speedway's front stretch grandstands.
The unanimous approval of the site plan Thursday night from the city's Planning Board was the last of several hurdles ISC and DIS had to clear before they could move from engineers' drawings to bulldozers in their hopes of redesigning the front stretch grandstands, adding new vendors, creating five new fan entrances, possibly doubling seating and renovating restrooms.
"We're so excited to get to this point," Speedway President Joie Chitwood III told Planning Board members. "We're well on our way for what Daytona can be for the next 50 years."
The grandstand overhaul is just one piece of a larger vision DIS and ISC have for 663 acres around the track and across the street on the north side of International Speedway Boulevard.
The racing giants are planning a transformation of the properties, which now include a good share of open land, into a racing and entertainment complex that could eventually include new hotels, restaurants, nightclubs, movie theaters, shops and possibly a casino or two if state law changes to allow them.
The sprawling complex could include up to 2 million square feet of retail space, 1,785 hotel rooms, 1,500 multi-family residential units and movie theaters with a combined 5,000 seats.
Speedway officials say it could take decades to reach that full vision, and they're just now beginning to talk to potential developers and businesses. Those future phases of the project will also require the city to approve additional site plans.
The first phase, the grandstand overhaul, could lead to a second pedestrian bridge arching over International Speedway Boulevard, the front stretch grandstands extending at least a few hundred feet toward International Speedway Boulevard, escalators being added for fans and the stadium's exterior being covered with metal panel screening to give it a sleek modern look. All that work is likely to take a few years, city officials have said.
The start of the grandstand makeover could be a year or more away. The Board of Directors for International Speedway Corporation still needs to OK the reincarnation, and the board probably won't get a formal presentation and vote until "later 2013," Chitwood said after Thursday night's meeting.
First, Speedway officials need to do more design work, develop a budget for the project and put together what Chitwood called "a business case."
"We have 12 racetracks in our company," Chitwood said, and DIS needs to show the board why it should allocate significant funds to Daytona Beach.
"We're not going to slow down or stop now," he said.
On Thursday night, Chitwood was enjoying the moment of looking back at the string of Planning Board and City Commission votes that began over the summer and led to the green light for the grandstand project.
Chitwood said he couldn't "imagine what it must have been like for Big Bill France" when the huge open area beside Daytona International Airport was turned into the Speedway in the late 1950s.
But he said: "I think I do understand the excitement he must have felt. The chance for our team to be involved is very exciting."


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NEW YORK—New York City Mayor Michael Bloomberg has announced a $500 million emergency plan to pay for critical repairs to public schools and hospitals damaged by Superstorm Sandy.
The plan would allocate $200 million for the Department of Education and $300 million for the New York City Health and Hospital Corporation to repair extensive damage. The repairs would include structural restorations, new boilers, new electrical systems and roof repairs.
The city council will vote on the plan on Tuesday. Bloomberg says the city has already spent $134 million on storm-related emergency relief.
City Comptroller John Liu says the city will work to recover these funds from FEMA.