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Recently there have been public reports of a number of interventional cardiovascular programs that have been found to have serious deficiencies and, in some cases, evidence of highly inappropriate or even potentially fraudulent actions on the part of physicians. These quality lapses seemingly came as a surprise to those responsible for program oversight and to some cardiologists, in spite of published guidelines.
We all recognize that the process of external invited peer review can be unnerving to some, but it is important to acknowledge that increasingly we are all under external scrutiny, more than ever before. What can be done to ensure an effective ongoing quality review that will provide an "early warning" of issues that may become an important concern?
The non-profit American Medical Foundation for Peer Review and Education offers an inexpensive physician audit and appropriateness survey. We review a random sample of each operator's cases every 6 months. A report is sent to the physician along with the hospital for educational purposes. The number of cases reviewed is based upon an average volume of a physician's cases per year, and the cost per case and the overall cost are very low.
Physicians and entire departments can also choose to avail themselves of a comprehensive review under the component American Medical Foundation Patient Safety Organization (AMFPSO.org). Performing a self-audit under a PSO protects the information and findings from any discovery. Thus, hospitals and other providers that contract with the American Medical Foundation's Patient Safety Organization can provide information to the PSO and have that information, as well as reports back from the AMFPSO, protected from discovery in almost any kind of state or federal civil, criminal and administrative proceedings, including malpractice lawsuits.
The AMF views itself and its mission as one of identifying potential problems and offering collegial solutions before less supportive payer, consumer, or statutory entities become involved. There are also sound educational opportunities provided, based on the reviews. In this regard, readers might be interested to learn something more about the AMF's history and mission.
Evelyn Baram-Clothier, Executive Director of the non-profit American Medical Foundation for Peer Review and Education addresses frequently asked questions about the AMF peer review and the new self-audit program.
How did AMF come to be and where is it going?
The American Medical Foundation for Peer Review and Education was created in response to the Health Care Quality Improvement Act of 1986 and has operated for over 25 years. Almost immediately after the inception of this non-profit foundation, interventional cardiology began to develop as the most dynamic subspecialty in medicine. The AMF has been an active partner in the world of interventional cardiology since the beginning; we were participating in the process from the origin of balloon angioplasty, through the widespread adoption of stenting, to modern drug-eluting technology, and we remain at the forefront of the field today as new technology, unprecedented techniques, and the expansion of interventional practice continue to make interventional cardiology an exciting and pioneering discipline.
We have conducted over 3,000 hospital reviews in all 50 states, including over 375 cath labs and thousands of their cardiologists. The fact is that the rest of medicine has to race to keep up with the evolution of interventional cardiology into other vascular territories — in the peripheral vascular and cerebrovascular arenas — and into other cardiac territories such as transcatheter valve replacement. We can't point to any other specialty that has been a more profound example of the way a single specialty can deal with such a wide variety of conditions affecting the well being of so many patients.
How long has AMF performed peer review in interventional cardiology?
In 1989, only a few years after the first clinical application of balloon angioplasty, the non-profit American Medical Foundation for Peer Review and Education (AMF), working with several of the early pioneers, began assisting hospitals to improve quality of care in the fledgling field of interventional cardiology. AMF is now well known in the cardiology community for its dedication to this specialty and is the "go-to" organization with the experience and expertise to help.
AMF reviews coronary, peripheral vascular, carotid and other interventional procedures of individual practitioners or entire departments to determine:
- Quality of care;
- Appropriateness and necessity of procedures;
- Compliance with the current guidelines for interventional procedures;
- Responses to third party audit requests and state or federal investigations.
In performing its individually designed reviews, AMF has developed specialized processes to review cases efficiently and to limit case selection to obtain statistically significant audit results. Each review provides a comprehensive report with suggestions for quality of care improvement regarding issues such as medical necessity, patient selection, equipment and device selection, anticoagulant usage, operator technique and complication avoidance. Based on random case selection, the reports provide both educational opportunities as well as an audit that would satisfy third party challenges, whether for external peer review of individual physicians or entire departments. The AMF individual case analysis not only describes quality of care and appropriateness issues, but most importantly, serves as a guide for technical improvement in specific areas of care addressed by our physician reviewers, all of whom are the leaders and teachers in the field of interventional cardiology. AMF reviews and reports are designed to assist our hospitals and physicians to achieve quality results and withstand inspection if scrutinized by a governmental entity.
What is AMF's importance to cath labs?
The AMF offers particular relevance to cath labs because we are the only organization with the experience of peer reviewing cath labs for clinical competency. This is an exacting, logistically complicated service to offer, but we have been accomplishing it for years. Currently, we perform almost weekly reviews somewhere in the United States.
Because of the thoroughness of AMF protocols, the impartial philosophy of AMF non-profit status, and the quality and experience of the AMF review staff, we feel comfortable in saying that the AMF gives true meaning to the term "comprehensive laboratory review." We can say this because of the legacy of the thousands of doctors and hospitals we have evaluated and helped over nearly a quarter century.
How does the American Medical Foundation make peer review practical and valuable?
We conduct medical staff peer reviews, specialty department assessments, and hospital and laboratory quality of care evaluations. We offer review of a single case of concern, or a statistically significant portion of an individual's entire practice, or reviews of all the individuals in an entire service department, including the supporting staff. We use well known experts and teachers in the field of interventional cardiology and do all the leg work that is required to produce a final report that meets the needs of the practitioners, hospital system, insurers and government oversight bodies.
Tell us more about the AMFPRO.
Interventional cardiovascular physicians and entire departments can select a comprehensive review under our component American Medical Foundation Patient Safety Organization (AMFPSO.org). The advantage of participating in an audit under a PSO is that any information uncovered or conclusion drawn is entirely protected from any litigation-related scrutiny. The Federal Patient Safety and Quality Improvement Act of 2005 and the regulations there under that were issued in November 2008 allow organizations engaged in "patient safety activities" to use and share information related to those activities without fear that the information will be discovered in a lawsuit. As the preamble to the regulations states: "For the first time, there will now be a uniform set of Federal protections that will be available in all states and U.S. territories and that extend to all health care practitioners and institutional providers." The protected information is referred to as "patient safety work product."
Thus, in order to gain the protection for patient safety work product provided by the law, health care providers must first establish a relationship with a PSO. PSOs are organizations that share the goal of improving the quality and safety of health care delivery.
By providing both privilege and confidentiality, PSOs create a secure environment where clinicians and health care organizations can collect, aggregate, and analyze data, thereby improving quality by identifying and reducing the risks and hazards associated with patient care. Hospitals and other providers that contract with the American Medical Foundation's Patient Safety Organization can provide information to the PSO and have that information, as well as reports back from the AMFPSO, protected from discovery in almost any kind of state or federal civil, criminal and administrative proceedings, including malpractice lawsuits. Information being collected by the provider for possible reporting to the PSO is also protected from discovery, as would any analysis of that information by the PSO. The protection provided by the PSQIA goes far beyond anything currently provided by state peer review laws. The information generated can then be safely used for educational purposes. This is a serious option for cath labs to consider and the cost of such a review is related to the number and type of specialties and procedures covered and the size of the program.
Full and comprehensive reviews are sometimes necessary; how can we do something more efficient to monitor our lab? Can you offer cardiologists and their cath labs an inexpensive self-assessment tool?
AMF's purpose is to provide individual hospitals and catheterization laboratories with a process for assessing and improving quality based on appropriate utilization, case selection, and ongoing evaluation of operator performance. In general, we believe that peer review and credentialing are best performed apart from laboratory certification by a professional society. Further, as is the case with individual board certification, a one-time certificate, while helpful, is no substitute for ongoing education and analysis. Yet it is unwieldy and quite expensive for a program to review comprehensively every case it performs.
From our extensive and longstanding experience, we have found that ongoing periodic review of an appropriately chosen subset of cases allows one to assess if there is a warning signal of a more extensive problem. For example, serious adverse events are fortunately uncommon in interventional cardiology and while it is important for organizations to review their own adverse events, it is often quite difficult for peers within an institution to voice their true sentiments because of a concern that next review could be theirs and they could be subject to retaliatory negative feedback. In addition, such internal reviews, no matter how well intentioned, do not take into account the experience of the national standard of care — they are sometimes limited by local practice and locally identified expertise.
We can provide an institution with a plan for identifying case samples for review and review the records and imaging for 10-20% of interventional procedures (up to ten) per operator per quarter, and provide an unbiased and objective review of performance with recommendations for improvement of technique and outcomes, as well as systematic recommendations for improvement of internal review. Rather than just a review of "statistics," we incorporate an assessment of the individual operator's response to the challenges presented by their patient substrate. This is not a substitute for a well functioning internal quality assurance program — it serves as an efficient but objective external validation of quality in comparison to a national experience.
This program is offered at a fee that is in keeping with our non-profit goals. In view of the professional responsibility we have to all patients, AMF's leading interventional cardiologists have offered to help and are willing to take time from their own duties to participate.
All cases will be reviewed by interventional cardiologists who are both educators and practitioners. Cases believed to be of particular concern will be reviewed by two experts before being returned with comments.
The objective is to review a representative sample of both complicated and reportedly uncomplicated cases to evaluate appropriate use based on current appropriate use criteria and angiographic documentation; to assess the overall adequacy and veracity of record keeping and documentation; the technical quality of imaging; interventional technique; and documentation of results — including institution of appropriate medical therapy. We also search for adverse quality markers such as the performance of unnecessary or ill-conceived primary and ancillary procedures, potential staged procedure abuse, appropriate and accurate determination of angiographic lesion severity; adequate and forthright documentation of adverse outcomes, and well-thought out explanations and rationale for the performance of unusual or controversial procedures.
We also recommend that the institution show commitment to quality improvement as evidenced by participation in submission of accurate data to the American College of Cardiology's National Cardiovascular Data Registry (NCDR). We will review reports from the NCDR and local database to assess for potential areas of concerns.
We will prepare individual case review reports for each physician and for internal review by appropriate clinical staff and provide timely bi-annual reports to the hospital documenting performance and recommendations for quality improvement.
What about the education side of the equation?
That's the part of AMF that sometimes gets overlooked, because physicians are often intimidated by the fact that their work is being reviewed. AMF reviews are also a significant educational opportunity. Most physicians have not had their work reviewed systematically since their fellowships. Even though they may go to educational meetings, there are many practical issues that arise in day-to-day practice that we can help address — not only for the individual practitioner, but also for a laboratory or an entire program itself.
For example, an apparent excess of vascular access complications in an individual cardiologist's experience could be tied to laboratory anticoagulation protocol(s), local habit or inadequate protocols for vascular access management by ancillary staff. We would seek to understand the cause of apparent issues of quality and outline solutions. Despite often being viewed with skepticism by those we review, we actually seek to be helpful and supportive and to foster improvement.
AMF utilizes the Appropriate Use Criteria Guidelines of ACCF/SCAI/STS/AATS/AHA/ASNC as a key metric in the assessments of whether survival and other health outcomes would be expected to exceed the potential negative consequences of revascularization procedures.
The AMF subdivision, the Foundation for Advanced Medical Education (FAME), conducts on-site mentoring (and soon telementoring) instruction of physicians. FAME also has a preceptor program and a practitioner skills assessment capability. In simple terms, the organization can assist in improving physicians' performance through knowledge of the field and its transmission to the physician. To help educate cardiologists in the development of peripheral skills in renal and iliac stent placement, AMF (through its FAME subsidiary) gave a $600,000 grant to the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC) and the Society for Vascular Surgery (SVS) to study the development of interventional skills in practicing physicians and surgeons. We are currently working with one specialty society to provide post-graduate education with remote presence telementoring.
What's in it for the cath lab and hospital?
The best possible use of services is to call AMF in before a catheterization laboratory or interventional program or hospital even perceives a problem. AMF's experienced reviewers can often see situations developing and bad clinical habits developing long before the people who are actually involved with the work itself do. That's just the nature of peer review — a dispassionate review can spot things that may be too difficult or politically sensitive for an effective internal audit. We can review and evaluate the entire staff, and offer practical suggestions to improve their skills to create better procedures and protocols. The AMF review staff is also skilled at identifying and discussing, with great sensitivity, the political and cultural obstacles that may be the primary impediments to true quality improvement. Much of this is very difficult, if not impossible, for any hospital to do on its own.
Why are cath labs a special problem?
A cath lab and interventional program can rarely simply shut down for review and education. The continuous needs of patients in crisis supersede any notion of doing so. It is precisely because of the AMF's ability to work within the strictures and constraints of this never-ending cycle of care that we can provide the type of services that we offer with a level of effectiveness that respects the particular needs of the laboratory and hospital staff and operation — and above all, the welfare of patients.
Why would a catheterization laboratory, hospital or physician contact the AMF before they believe they have an issue of quality?
Never before have the expectations of receiving optimal care and treatment been higher. Patients, their elected representatives in government, insurers and third-party payers of all types, as well as the media, have all become watchful observers of every action that takes place in medicine. By the time a quality concern reaches one of these constituencies, if the hospital is not already aware of it and taken action to remediate, the level of public concern escalates. The AMF can be an institution's best colleague and partner in this vigilance, providing an honest, accurate, dispassionate and confidential assessment. And it is through AMF's educational commitment that we can also provide specialty department review, credentialing support, on-site clinical education and continuous professional improvement.
For most hospitals, we present a rare opportunity for an institution to measure its performance, have experts review its medical personnel and solidify its level of patient care through teaching and instruction. In the absence of the participation of nationally prominent reviewers on behalf of AMF, these opportunities might not even exist. They profoundly understand the non-stop nature of patient care and hospital utilization. It all begins with the quality and experience of AMF reviewers.
What distinguishes the AMF reviewers?
Our reviewers are not "employed" by the AMF — most of our review committee members head distinguished programs, administrate and teach in fellowship programs, or serve in the top positions in academic medical practices throughout their distinguished careers. Many have been past presidents of SCAI or have had significant academic and practical quality assurance experience and all actually practice interventional cardiology. Reviewers participate in AMF reviews out of a sense of service to their profession and to the wider group of patients — they review charts, conduct on-site visits and interviews, provide preceptor programs, mediate and arbitrate problems of both individual practitioners and the entire specialty service, and offer the kind of continued guidance that other physicians can respect. Our reviewers are dedicated teachers who are willing to take the time and trouble to "go on the road" to share their knowledge.
What's the hardest part of the job?
Not all peer reviews are positive. We sometimes find that after careful consideration and re-consideration, a physician cannot perform up to the standard of care that is medically appropriate, and some of these physicians may end up losing privileges. That is always a difficult situation and never an easy thing to be responsible for. But we always act with both the physician and the patients' best interests foremost in mind.
Why wouldn't I just have a professional organization perform a lab survey?
While these groups are fine organizations and do an excellent job, there is an inherent conflict between a certifying professional organization and a peer review organization. Our sole purpose is to provide a framework for continuous quality improvement. Our job is to identify how a group of practitioners and a laboratory can develop a policy of excellence. In the past, several hospitals applied and failed to get certification, because they were not prepared. If a laboratory then wishes to apply for certification, we believe it will more easily achieve that result once any quality and appropriateness issues are identified by AMF.
What are the costs?
While each survey program and its charges are individualized, our physician appropriateness survey costs are very low — for a ten-case periodic review, cost is on the order of $2500 per physician, per review period. For on-site or comprehensive review of an entire department or practice, our fees are only $350 per reviewer hour. Given our non-profit status, our fees have remained consistently low over the years.
Is the American Medical Foundation peer review limited to cardiology?
We also have an expert faculty of reviewers in almost all sub-specialties of internal medicine and surgery (including radiology and pathology), and can offer similar expertise in these fields. However, I'd have to say that cath lab review is the "favored child" of this Executive Director. I'm so grateful, personally and on behalf of the AMF, for the support we've received from the nation's leaders in the field of interventional cardiology. They have traveled around the country with me, in three- and four-day review sessions, to help other cardiologists improve their skills. Many luminaries in interventional cardiology have spent hundreds of hours reviewing cases, studying angiograms, assessing systems, and writing reports to help hospitals improve their lab and their staff.
If I have questions or would like to discuss a potential review, how do I contact you?
The American Medical Foundation's main office is in Philadelphia at the Barclay, 237 S. 18th Street. Our phone number is (215) 545-6363. We are online at www.medicalfoundation.org. You may also email us at email@example.com.


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A collaborative effort that's brought together Western North Carolina elected officials, as well as leaders in higher education and business, got a Monday morning update on a push to bring gigabit internet service to the region.
The gist of the update was relatively dry: a consultant has been hired (Magellan Advisors) and a request for a proposal from potential providers will likely go out next spring. But interest in the effort was high, and a UNC Asheville conference room was filled with about 100 leaders of public schools, universities and businesses, as well as local elected officials from the mountains.
Collectively, the group sees gigabit internet service delivered over fiber optic lines as a critical infrastructure need and, at least for now, it appears united in its desire to work for it.
The "infrastructure of the future" is a topic of real interest in the community, Buncombe County Board of Commissioners Chairman Brownie Newman told the group. Officials in the business, health and education communities particularly see it as crucial for the region's economic development, he said.
The effort is known as the West Next Generation Network. It came together after developer Jack Cecil, president of Biltmore Farms, noticed the work of North Carolina Next Generation Network to bring the next generation of broadband to the state. Cecil brought the idea to a local economic development group known as The HUB, or the HUB Community Economic Development Alliance.
That led to six municipalities banding together to see if they could attract a broadband provider to serve Asheville, Biltmore Forest, Waynesville, Fletcher, Hendersonville and Laurel Park. Those cities and towns lie along an existing fiber optic pipeline, explained unofficial coordinator Bill Sederburg, who led the meeting. Sederburg has worked as a university president for several institutions, including interim chancellor at the University of North Carolina Wilmington. He's also a former Michigan state senator.
Sederburg acknowledged that gigabit internet service will eventually be offered in the region, but said the collaborative effort's goal is to make it happen faster and use it as a competitive advantage over other regions.
What's the best way to attract a service provider? Sederburg said the WNC group has to show that there's a market for it, and make it affordable and easy to use. (Thus the collaborative effort of the six municipalities, as well as a broader regional effort to work together.)
Mike Dempsey, dean and director of the Center for Graduate Studies at Lenoir-Rhyne University in Asheville, and a group of Lenoir-Rhyne and UNC Asheville students presented findings from a survey of about 400 respondents. The survey found that the Western North Carolina region struggles to attract companies due to the lack of high-speed fiber optic networks, and that some existing companies don't expand due to that need. The education and health care sectors of the economy can particularly benefit from gigabit internet, the students noted.
Marc Hoit, vice chancellor for information technology and chief information office at N.C. State University, urged the group to find ways to creatively work together, and to think of the project not as a technology project, but as an economic development collaboration. He also noted that at least 50 other regions and communities across the U.S. are working on the same issue. He also urged the group to start working together now, rather than waiting for a provider.
"If you can't figure out how to work as a community, it's going to be too hard to overcome the inertia. There's going to have to be some give and take," he said.
Connectivity is only half the equation, he noted, adding that "if people don't have devices, training and education, then connectivity is useless." The community can start working on some of those issues now, he said.
The group should consider picking an economic sector that's already a strong local asset – climate change or the outdoors, for example – and start working in that sector now, Hoit said.
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subset: commoncrawl


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RealtyMogul REIT appoints President
RealtyMogul, a commercial real estate private markets investing platform, has appointed Aaron Halfacre as President.
As RealtyMogul's President and a member of the executive team, Halfacre will be responsible for crafting company-wide strategy, driving execution and augmenting business growth. He will be a voting member of the firm's investment committee, which has invested in over USD1.4 billion of real estate since 2013. Additionally, with direct oversight of capital markets activity, he will be particularly focused on further growing assets under management and real estate transaction volume.
With over 20 years of investment industry experience and a reputation for strategic insight, Halfacre most recently served as President and Chief Investment Officer at Campus Crest, a publicly traded student housing Real Estate Investment Trust or "REIT," where he was instrumental in shepherding the successful USD1.9 billion take-private transaction of the company. Prior to Campus Crest, Halfacre was an executive of Cole Real Estate Investments, a publicly traded net lease REIT, where he acted as a key member working on transactions in excess of USD10 billion total market capitalisation.
"I am excited to be joining the RealtyMogul team and contributing to the continued success of the company," says Aaron Halfacre. "I believe my industry experience across real estate and alternatives, debt and equity, retail and institutional, and both public and private markets is a perfect fit for RealtyMogul's future."
Prior to his public REIT experience, Halfacre spent time at BlackRock, the world's largest investment manager, serving as the Chief of Staff and Head of Product Development for BlackRock's Global Real Estate Group, where he led the development of over USD3 billion of private real estate product. During his time at BlackRock, he also served as the Chief Operating Officer of a USD14 billion global equities investment team. In addition to BlackRock, Halfacre worked at Green Street Advisors, a leading independent REIT research and analytics firm. Halfacre holds both the Chartered Financial Analyst and Chartered Alternative Investment Analyst® designations and an MBA in Finance from Rice University.
"We are very pleased to have Aaron join the team; he has a stellar track record and incredible depth of real estate and capital markets industry expertise that will prove invaluable to the company," says Jilliene Helman, CEO of RealtyMogul. "We will benefit immensely from his experience, and I am confident he will help the company reach new heights."


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Hotels in Trutzhain
Find a place to stay
Find out more about Trutzhain
Where to stay in Trutzhain
What's Trutzhain like?
If you're looking to discover somewhere new, look no further than Trutzhain. Whether you're planning to stay for a night or for the week, the area around Trutzhain has accommodations to fit every need. Search for hotels in Trutzhain with Hotels.com by checking our online map. Our map displays the areas and neighborhoods around all Trutzhain hotels so you can see how close you are from landmarks and attractions, and then refine your search within the larger area. The best Trutzhain hotel deals are here with our lowest price guarantee.
When is the best time to visit Trutzhain?
- • Hottest months: July, August, June, September (average 60°F)
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text: Mitochondrial NADP+-dependent isocitrate dehydrogenase 2 (IDH2) is a major producer of mitochondrial NADPH, required for glutathione (GSH)-associated mitochondrial antioxidant systems including glutathione peroxidase (GPx) and glutathione reductase (GR). deletion and HIR affect NADPH production in the liver. NADPH production was significantly reduced in the post-HIR livers of both gene deletion and HIR on the mitochondrial GSH-associated antioxidant system. The ratio of GSSG to total glutathione (tGSH, GSSG + GSH) in the mitochondria increased after HIR and this increase was greater in the knockout and HIR affects GR activity in the mitochondria of liver cells. HIR significantly reduced GR activity which decrease was better in the knockout impacts the cytosolic NADPH-GSH program, we determined the consequences of gene and HIR deletion in the cytosolic IDH2-NADPH-GSH antioxidant program. HIR induced a rise in the proportion of GSSG to tGSH (Fig. 3D), and reduces in the actions of GR (Fig. 3E) and GPx (Fig. 3F) in the both gene deletion might not impact the cytosolic antioxidant systems including GPx, GR, G6PD, and catalase actions. 3.4. gene deletion augments mitochondrial oxidative tension after HIR To help expand concur that the impairment in the NADPH-GSH antioxidant program impacts hepatocyte oxidative tension, we assessed 1) the H2O2 level in the complete lysate, 2) proteins oxidation by oxidized peroxiredoxin (Prx-SO3, a well-known sign of AZD6738 irreversible inhibition oxidative harm) [28] in the mitochondrial small fraction, 3) lipid oxidation, as indicated by MDA creation in the complete lysate, and 4) DNA oxidation with the intracellular appearance design of 8-hydroxy-2-deoxyguanosine (8-OHdG). Right here, we discovered that HIR resulted in the boosts in H2O2 amounts (Fig. 4A), 8-OHdG-positive indicators (Fig. 4BCompact disc), Prx-SO3 appearance (Fig. 4E, F), and MDA amounts (Fig. 4G) in both knockout exacerbates mitochondrial damage after HIR To verify whether defects from the IDH2-NADPH-GSH-GPx program after HIR and IDH2 knockout affect mitochondrial damage, we evaluated the morphology of mitochondria by TEM at 1 and 5?h after HIR. TEM pictures indicated bloating, cristae reduction, and fragmentation of mitochondria in the hepatocytes of both gene deletion exacerbates liver organ susceptibility to HIR. 3.6. gene deletion Typically exacerbates apoptosis, mitochondrial harm stimulates apoptotic signaling pathways [29]. As a result, we evaluated whether IDH2 HIR and insufficiency influence the activation of apoptosis. AZD6738 irreversible inhibition We discovered that the appearance of cytochrome in the mitochondrial small fraction of liver organ lysate reduced in both in the cytosolic fractions elevated in both was better for the discharge through the mitochondria in to the cytosol and gene deletion augments this technique. Furthermore, we discovered that HIR elevated pro-apoptotic elements, Bax and cleaved-caspase 3 (c-casp. 3), in both gene deletion exacerbates HIR-induced apoptosis. Open up in another home window Fig. 6 Apoptosis in the livers of(cyto-c) antibody. COX GAPDH and IV had been utilized as launching handles for mitochondrial and cytosolic fractions, AZD6738 irreversible inhibition respectively. (B, C) The densities from the rings had been assessed using ImageJ software program. (D) Whole liver organ tissue samples had been analyzed by western blot using anti-Bax, -Bcl2, -Bcl-xL, and -cleaved caspase-3 (c-casp. 3) antibodies. GAPDH was used as a loading control. (E to I) The densities of the bands were measured using ImageJ software. (J) Apoptotic cell death was evaluated using a terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay. Arrows (green) in box indicate TUNEL-positive cells. DAPI (blue) was used to stain the nuclei. (K) TUNEL-positive cells were counted. The results are expressed as the mean SEM (n = 6). *, p 0.05 vs. respective sham-operated mice. ?, p 0.05 vs. ischemia-operated gene-deleted mice than in wild type mice In order to confirm that the increased susceptibility of knockout mice to HIRI is due to a reduction in mitochondrial antioxidant capacity, we tested whether mito-TEMPO, a mitochondria-targeted antioxidant molecule [17], mitigates the increased susceptibility due to deletion. Mito-TEMPO Ace treatment dramatically increased survival rates in both mice and this survival rate increase was greater in the gene-deleted mice to hepatic injury is associated with the increased mitochondrial oxidative stress due to impairments in the mitochondrial antioxidant system. In conclusion, we suggest that HIR-induced hepatic cell damage is associated with AZD6738 irreversible inhibition impairments in the IDH2-NADPH-GSH axis and that.


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Employees Demand Google Stop Working With Pentagon On AI For Autonomous Weapons
Google is working with the Pentagon on the government's artificial intelligence program and thousands of Google employees aren't too pleased.
In fact, Google employees have signed a letter to Sundar Pichai, the company's CEO, protesting Google's role in the Pentagon's Project Maven program, which may be used to improve drone strike targeting.
In all, more than 3,100 employees signed the letter, which has been circulating internally for weeks before becoming public via the New York Times publishing the letter. This is a small fraction of the company's 70,000 staff members.
The letter reads: "We believe that Google should not be in the business of war…We cannot outsource the moral responsibility of our technologies to third parties. Google's stated values make this clear: Every one of our users is trusting us. Never jeopardize that. Ever. This contract puts Google's reputation at risk and stands in direct opposition to our core values."
The letter requests that Google withdraw from Project Maven. Google, however, said its work on Project Maven as "non-offensive" in nature. Google's contract with the Pentagon was revealed in March, and it is contrary to the company's previous shas worked with the U.S. military.
"Both Google and the Pentagon said the company's products would not create an autonomous weapons system that could fire without a human operator, a much-debated possibility using artificial intelligence," The New York Times reported.
The letter, which was also signed by dozens of Google's senior engineers, said Google is getting into the business of war by teaming up with the Pentagon.
"According to company employees, Project Maven is a specialized AI surveillance system that uses 'Wide Area Motion Imagery' data captured by military drones to find and track objects for the Department of Defense (DoD)," CBS News reported.
In a released statement, Google said the Pentagon was using "open-source object recognition software available to any Google Cloud customer…The technology is used to flag images for human review and is intended to save lives and save people from having to do highly tedious work."
The Pentagon is expected to spend $70 million for the first year of Project Maven and Google is widely expected to compete with other tech giants, including Amazon and Microsoft, for a multiyear, multibillion-dollar contract to provide cloud services to the Defense Department, Gizmodo reported.
Project Maven was launched in April 2017 to accelerate the Department of Defense's integration of big data and machine learning.
Despite the possibility of major military contracts, some Google employees say it isn't worth it. In the letter, they argue that embracing military work could backfire by alienating customers and potential recruits.
The protesting employees used the letter to remind Google of its former motto, "don't be evil," and its current motto "do the right thing."
Instead of writing a letter to protest the use of AI to help coordinate Drones, why aren't @Google employee's working on an anti drone system @TheFive?
— Cookie Distribution Inc. (@ChristoR20) April 6, 2018
Rut rho, FTA "Thousands of Google employees…have signed a letter protesting the company's involvement in a Pentagon program…"
Apparently, Google never told their employees that that Google is a CIA company.#MAGA #Trumptrain #qanon #Qanon8chan https://t.co/tWFgloORuE
— Marguerita (@MzMollyAnna) April 6, 2018


text:
Become a freelancer in an area where you have expertise. If you have a skill that's in demand, you can sell your services directly to clients who need them. Advertise your services on a personal website and look for freelancing jobs on sites like Upwork, Freelancer, and Fivrr. Additionally, hand out business cards and encourage happy clients to tell others about your work. Here are some ways you can earn money as a freelancer:[8]
…Marketing an eBook is definitely the hardest part. Ebooks have exploded in popularity and the market is unfortunately saturated with crap from people who thought they could write a quick eBook, put it on an affiliate network, and make millions. However, if you CAN find a good way to market (or possibly have others market by having it listed on affiliate networks) then an eBook can be a great way to make some residual income.
Take it seriously. Yes, you're applying for an online job. Yes, you can do the work in your underwear, but that doesn't mean it's not a "real job". You must treat it as such or they aren't going to treat you as a serious candidate. You aren't the only one who wants to work in their underwear. In fact, the competition online is likely higher than it is in your local area.
Most of these ideas can be scaled up to meet the needs of more customers and can have a huge impact on your financial prosperity. People who land on this page are looking for ways to make money right now. Some of these may be cliche, but that's because they are proven. You can start making money tomorrow with most of these ideas. You can then, overtime, scale/pivot these active jobs into more passive entrepreneurial efforts. For example, you could start bar tending tomorrow and then one day become a bar owner or beer/wine producer or event planner or whatever you dream up. The point is to get going with something and look for ways to add more value to more people.
@Philip Taylor The point is that this is design is specialized job and is not just a side job. Just because an individual may know a thing or two about the technical aspect of a program does not warrant them to fill that role as a designer. There's more than just drawing a mark in a program. There's strategy in brand development, marketing, etc… This is insulting to the creative industry to label logo and branding as a scheme to make extra money.
My local Craigslist.org is the first place I go to sell something. It's best for items you think will appeal to everyone (therefore justifying the smaller audience) and large items that can't be shipped. Craigslist.org is great for taking your yard sale items online for local sales. For example, a friend recently bought two fans from people that live close to him. These one-off type items do very well on Craigslist. Just remember to use common sense and be safe out there.
I see a comment made by Stella including some freelance sites. This does work. I use oDesk and it's been a big help in bringing in a little extra money. I also agree with some of the other comments that mention people should think of or view more ideas of making extra money, because it really is possible to make extra money instead of just sitting around moping about not having money to pay the bills or buy something special.
Oh, my! That is quite a comprehensive list of ways to make extra money. I think many folks are looking to make an extra buck – especially online. And somehow just because it is online, they think it should be easy as well. My experience is that most of the money making ideas are good but need persistence and follow up before they start generating serious coin.
With just a few paint and stencil supplies you could walk the neighborhoods with curbs and solicit your curb number painting services. Obviously, you need to be somewhat handy with a can of spray paint and stencils, otherwise, you might have people coming after you if you mess up their curb. However, there is a business for this as people are out there making it happen.
Whether you want to become your own boss, start a side hustle, or earn extra money on the side, any of the strategies listed above can help. By finding ways to increase your income, you can free up more cash to pay down debt, save for the future, or invest for retirement. Saving money is only half of the equation. And if you truly want to get ahead, you might want to figure out how to make money – and hopefully, lots of it.
Do you have baby items taking up space in your garage, but you aren't ready to part with them yet? After all, you might want another kid . . . maybe one day. Instead of selling that high chair or baby jumper, why not rent them? Oh, we're serious. On websites like goBaby, cribs can go for $10 to $50 a day, and strollers can collect $15 to $40 a day.7


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This baby legiana is more interested in flying around than fighting anything! Indulge in a little Monster Hunter World cuteness with this design–part of our Baby Monster Hunter World group! These lil guys would be perfect for the Monster Hunter World fan in your life!
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WWE 2K20 Deluxe Edition - Xbox One (Digital Code)
Platform: Xbox Live
2K invites players to Step Inside the ring with WWE 2K20. Your favorite WWE Superstars, Legends, Hall of Famers and NXT's best will join the festivities and celebrate the evolution of the WWE 2K franchise! WWE 2K20 will feature key gameplay improvements, streamlined controls, and the most fun and creatively expansive entry in the franchise to date. WWE 2K20 will also feature a brand-new 2K Showcase focused on the story of the Four Horsewomen/Women's Evolution, the return of 2K Towers, including a story-driven tower based on the career of Roman Reigns an all-new MyCAREER that prominently features both male and female playable characters, and Mixed Tag Matches featuring male and female competitors.
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The Colorsonic MP3 player concept displays colours around its ring-shaped body, which can be matched up with a certain mood of music, like an old-school mood ring. Read on to see what it's all about.
This MP3 player is designed to match user-created playlists with mood-appropriate colours. Users would then choose music by selecting the colour closest to their mood at the time, rather than by so-called "normal" and "intuitive" methods like Artist or Album. Exactly how this works, I don't know; but according to Yanko, "it's got special software." Hmm, ok. [Yanko via Wired]


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- April 22, 2020
Why Microsoft Teams Archiving is More than Capturing Chat
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Happy New Year!
We're already one week into 2016 and I'm wondering how those New Year's resolutions are working out for you.
Apparently the tradition of making New Year's resolutions stretches back more than 4000 years to the ancient Babylonians. I'm not sure how their resolve to pay off their debts and return borrowed objects to their owners worked out for them. If they were anything like we are today, the majority would already have given up on their well-intentioned resolutions by now.
If an email archive migration is in your plans for 2016, I'd like to suggest a different type of resolution, namely planning for success. Now that may sound obvious, but our experience shows that too many organizations apparently don't. Archive migrations are notoriously tricky, so planning for success does require you to do your homework.
This week our team can be found at the Office 365 Conference in Cologne, Germany. The conference is a community event, organized by Microsoft MVPs for anyone interested in the broad topic of Office 365. It's free to end users and provides two days packed with educational sessions covering everything from successful Office 365 adoption, to using PowerShell, to migrating your email archive to Office 365. Events like these provide you with the opportunity not only to attend some really good informative sessions, but also to network with other end users.
The Microsoft community does a great job of organizing events like this one throughout the year. If you're interested in locating one in your region, let us know and we'll get you connected. To make the most of your time at these events, we've prepared a cheat sheet of questions you might want to address with your fellow end users (as well as any vendors) in attendance.Speed
Doing your homework and speaking with other users about their experience of migrating archival data will help you better prepare for a successful migration. This will ensure that you keep at least one your resolutions this year!
Click to edit your new post...
Your legal, compliance and security teams rely on having an immutable copy of all of your emails. Office 365 archiving does not support journaling. So what should we do?
This eBook provides actionable tips to empower IT to solve the problem.


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Printers-manual.com sites provide some instructions on the type of Brother printers in the form Brother MFC-L2700DW Manual service manual, user's manual, and the Instruction Manual.
Please see and download Brother MFC-L2700DW Manual PDF at the link.
Brother MFC-L2700DW Manual PDF
User Guide
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The 35-page car document feeder rests on top of the MFC-L2700DW framework, as well as lifts up to disclose the scanning glass. This whole assembly pivots up to provide access to the output tray, which is a cavity took of the middle of the chassis. A little flap pivots upwards to maintain paper from befalling of the front of the outcome tray.
A control panel includes devoted switches for each and every function as well as navigating buttons for altering setups. You can accumulate to 10 email addresses in the device for usage with the scan-to-email function, and you can access your entire personal digital assistant using the included software program. When you scan to a COMPUTER, your indigenous email application launches on your computer system, with the check included in a brand-new email.


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Download amazon books free Shibuya Goldfish, Vol. 2 9781975354077
Par brown margie le vendredi, janvier 17 2020, 12:28 - Lien permanent
Shibuya Goldfish, Vol. 2 by Hiroumi Aoi
- Shibuya Goldfish, Vol. 2
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- Page: 208
- Format: pdf, ePub, mobi, fb2
- Publisher: Yen Press
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text:
|Compnay Name
|Service Focus Rate
|Vy Systems
|Data Analytics, 5%
|19 Years
|117 reviews
|Anubavam Technologies Pvt.Ltd.
|Data Analytics, 5%
|15 Years
|49 reviews
|Orion India Systems Pvt Ltd
|Data Analytics, 11%
|10 Years
|73 reviews
|Three Cube IT Lab Private Limited.-
|Data Analytics, 17%
|4 Years
|2 reviews
|Expedux Technologies
|Data Analytics, 5%
|6 Years
|1 review
|GRMC Technology Solutions Pvt. Ltd
|Data Analytics, 5%
|5 Years
|4 reviews
|C2E Software Solutions Pvt Ltd..-
|Data Analytics, 20%
|9 Years
|9 reviews
Home - Vy systems
Innovation is a collective resource that Vy provides to its customers in bringing them world-class solutions and services. Vy Systems is being run by Kumaravel Ramasamy and Mahendra since 10-06-2002 headquarter Ap-136, 11th Street,2nd Sector, K.k.nagar, Chennai-78. Chennai-78. Tn In 600078 and primarily deals with Consulting, Web Development and Mobile App. . View More About Info | View Legal Details
|Ajithsai Sai
|I have been working with Vy for more than 2 years. Started with Vy without having any knowledge or experience in recruitment. I was very lucky to learn about US staffing from experts who had over decades of experience
|priya dharshini
|Vy is the best place for a fresher. it's a very good company to start your career also they can get a good opportunity to gain their knowledge.It provides platform to show your expertise, your skill, Your suggestion and feedback
Anubavam is an end-to-end web, mobile & cloud solution provider to global customers, Data Analytics
Anubavam launches initiatives to develop mobile solutions with enterprise-class capabilities. Anubavam Technologies Pvt.Ltd. established by Jaiveerapandian, Veerappan Sivakumar and Hansa V Magar on 10-02-2006 and erp service provider company Anubavam Technologies Pvt.Ltd. has cin no U72200TN2006PTC058826 and mostly works with Erp, Mobile App, Testing, Drupal, Chatbot and Consulting. . View More About Info | View Legal Details
|Clotilda Suvin
|A great place to explore newer opportunities. Offered me a perfect work-life balance.
|Sabastin Amalraj
|work and life balance here very well. good place for learning .
Orion Business Innovation
. Orion India Systems Pvt Ltd started by Malarmangai Chandrasekaran and Balamurugan Chandrasekaran on 22-06-2011 and analytics service provider company Orion India Systems Pvt Ltd has cin no U72900TN2011PTC081181 and do the business of Analytics, Erp, Testing, Data Management and Data Analytics. . View More About Info | View Legal Details
|Jayendra Natraj S
|Nice ambience.. Good and positive minded people working... The floor are decorated in sportive model... Attractive to work..
|madhu sudanan
|I attend interview through campus interview.all hr s are cool.hope i may be selected and work at chennai
Three Cube Managed Service and Solution
Three Cube Managed Services and Solutions Private limited is a consulting and outsourcing company. Three Cube IT Lab Private Limited.- mostly works with Outsourcing, Analytics, Consulting and Data Analytics. . View More About Info | View Legal Details
|Sreejith RS
|using this EMR for past 5 years for my ophthalmology hospital, satisfied and highly recommended. good backup and resonable cost.
|Solomon Thomas
Top Rated Software, Application Development Agency | Expedux, Data Analytics
Expedux Technologies is a Full Stack Driven technology solutions and data science organization serving as a trusted technology & data partner for products & platforms organizations, e-commerce players and manufacturing enterprises. Expedux Technologies found by Palaniappan Muthiah and Ayarappan Rajarajendran Baraneetheran in 11-02-2015 headquarter No.61, Gangatharan Naicker Street, M.t.h. Road, Villivakkam Chennai Chennai Tn In 600049 and primarily develivers Analytics, Web Development, E-commerce and Data Science. . View More About Info | View Legal Details
|Raghulraj Palanisamy
|Very friendly company
GRMC | Home| Data Analytics
Founded in 2010, Global Resources Management Consultancy Inc (GRMC) is an international company providing specialised geospatial and geo-intelligence services needed to industries such as architectural, engineering, mapping, surveying, construction, compliance and project control. GRMC Technology Solutions Pvt. Ltd do the business of Mobile App, Web Development, Outsourcing and Analytics. . View More About Info | View Legal Details
|Ashwin Vijayakumar AK
|It's a old address.GRMC moved to the new location.but they didn't mentioned it.
C2E Software Solutions Pvt Ltd
Providing end-to-end data analytics solutions and dashboard solutions. C2E Software Solutions Pvt Ltd..- is registered from RoC-Chennai in 30-07-2012 started by Gnanagopal Sundararajan and Ramakrishnan Jayakarthi with 100000 INR capital and currently there are 3 of board members and primarily deals with Software Solutions, Analytics and Data Analytics. . View More About Info | View Legal Details
|parthiban r
|Good place for learning.
|Senthil Kumar
|Good company


text:
Rs. 599.00 Rs. 1,199.00
We understand the need for smart fashion for millennial divas like yourself and brings this purple colored floral printed top exclusively for them. Fashioned from polyester, it features a V neckline, and short sleeves. Pair it with denim, and accessorize the look with chunky studs, a sling bag, and strappy heels. Fabric - 100% Viscose
Machine Wash. Do not bleach. Wash separately.
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Ace the 9 to 5 workwear look wearing this elegant green solid top with a unique embellished neckline and three-fourth sleeves. Pair it with black...View full product details
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text:
Magic sport
An entertaining adventure in which nine young football players attempt to fulfil their dream of taking part in the "Wood Cup"— the animals' famous football tournament. Anyway they fear they haven't a chance against their prorivals. So they go in search of Snipp the Moose, one of the best forwards ever, who had disappeared without a trace after withdrawing from the official competitions. in order to discover the secret to becoming real champions. Thus begins an entertaining adventure where our friends gradually learn the lessons of teamwork, the secret being "exhibiting 'togetherness' as a whole team"
genre:little kids


text:
Recipes and Posts Tagged tofu
Lemon Basil Tofu
If you're looking for an amazing and delicious tofu recipe, then you've come to the ...Toni Okamoto Read more
Soy Myths Debunked
Dr. Matthew Nagra is a Naturopathic Doctor in Vancouver, BC, and is a passionate advocate for plant-based nutrition. He is a public speaker, author, graduate of the T. Colin Campbell Center for Nutrition Studies Plant-Based Nutrition program, and volunteer for the non-profit Nutritionfacts.org. Soy has become one of the most... moreRead more
Nopalitos Tofu Scramble
We all love a good classic tofu scramble recipe but this one has an amazing ...Toni Okamoto Read more
Tofu & Pesto Sandwich
This sandwich will absolutely blow your mind! It's simple and delicious and, most importantly, super ...Zhoro Apostolov Read more
Breaded Tofu Strips
This post is sponsored by ADM, but all opinions are my own. For the longest ...Toni Okamoto Read more
Garlicky-Ginger Tofu Triangles
I am so excited to let you know that I have teamed up with Michelle ...Toni Okamoto Read more
No Bake Chocolate Pie
This pie is super easy to make and will satisfy all your guest if you ...Stephanie Lundstrom Read more
Tofu Omelette
I know a lot of people get their chonies in bunch over vegans who make ...Stephanie Lundstrom Read more
Holy Tofu Scramble
Breakfast tofu forever.Drew Wilkinson Read more
The PBB: Plant Based Bowl
This is super high on the 'comfort food' chart, and for a reason. It's ...Jake Read more


text:
This description has been unpublished.
MagicHandMay 31, 2020
Thank you. The lipstick is by me - https://www.thesimsresource.com/members/MagicHand/downloads/details/category/sims4-makeup-female-lipstick/title/%5Bmh%5D-lipstick-n11/id/1491347/
And the 3d lashes are by Leah Lillith - https://www.patreon.com/posts/36029756
DanSimsFantasyMay 26, 2020
Greetings! you can find the pants here http://www.thesimsresource.com/downloads/1489226
DarkNighTtFeb 08, 2020
Thank you so much! Eyebrows's creator is Merci. You can find him on TSR. -Merci-
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text:
Someone turn on a Kiss Cam! Karlie Kloss and beau Joshua Kushner can't keep their hands off each other at the 2014 US Open
While tennis is not a sport that indulges in the light-hearted fun of the Kiss Cam like others do, there was certainly one needed for opening night of the 2014 US Open.
Karlie Kloss, 22, and her boyfriend Joshua Kushner would have been easy targets, as they attended the tennis championships at the USTA Billie Jean King National Tennis Center in New York City Monday.
Clearly smitten with one another, the loved-up pair were spotted snuggling and smiling in the stands.
Scroll down for video
Lovers: Karlie Kloss and her boyfriend Joshua Kushner got cosy as they attended the 2014 Us Open in New York City Monday night
As they watched Russia's Maria Sharapova play Russia's Maria Kirilenko, Joshua, 29, was snapped resting his head on Karlie's shoulder.
The businessman and investor looked preppy in a blue button-down, grey cardigan and matching trousers.
Coordinating, the Victoria's Secret stunner opted for a conservative chic look as well, donning a fitted pale grey dress with a heather grey cardigan.
Best seat in the house? Joshua couldn't help but rest his head on his girlfriend's shoulder
Star-studded: Kelly Bensimon was seen in the row behind the model and her beau
For a summery feel, the brunette beauty sported brown sandals with studded ankle straps.
And Karlie accessorised with thin gold hoop earrings and a matching bangle, as her highlighted locks were styled in a messy bun.
Aside from sharing a few laughs, the pair seemed to be enjoying the game, spotted clapping from their seats.
Seeming to be a star-studded event, The Real Housewives Of New York's Kelly Bensimon was spotted a row behind.
Having a ball: Karlie and Josh smiled and laughing in the stands
Appetite: The model was seen holding onto a snack as she watched the tennis match
According to US Weekly, the couple reportedly attended a Victoria's Secret after-party at the end of 2012 and have been seen together ever since.
In an interview with Metro.com in February, the model admitted to believing in love at first sight.
'Yeah, I do, I was definitely not planning on falling in love [with Joshua]. But I think that's the thing about it. You can't plan or anticipate it.'
Joshua is a business mogul and principal owner of Kushner Properties, his family's real estate company. And his sister-in-law is Ivanka Trump.
Something to smile about: The pair seemed to be having a lively conversation as they enjoyed the match
Good work! The two weren't shy about showing their support either, spotted clapping in their seats
Thirsty: Karlie was seen sipping a beverage from a plastic white wine glass
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text: $INTC ex dividend day coming up next Thursday 8/7. This is clearly a shakeout before big players accumulate and get in on that 33 cent/share dividend. I'm holding 3400 shares here and am gonna get a nice $1000 dividend, effective next Thursday Once they scare enough weak hands out, this will recover bigly. That massive gap on that daily will get filled at least halfway. IMO


text:
Bridging the hearts and minds of all people.
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text:
Arsenal Firearms (thought it was EAA... maybe they are related to each other) actually had multiple double 1911s to fondle at the NRAcon. I had known they made one, but didn't know they were going for production runs.
It's about as big around as a Sig. But I always thought of Sigs as fatter than they need to be. There was a half dozen at this display.
Look at that double mainspring housing.
Lots of parts on the gun look stock, but obviously others have to be made for the model. Like that mainspring housing. It looked like one piece, no welded seam I could see, but I could be wrong. I think it's a pretty slick build. I wonder what it feels like to shoot? Sorta solves the whole "only got 7 rounds" but really, you only get 7 shots as both barrels go off at once. Some slow primers would make that double bang feel weird I bet. At least your 'double tap' time are simultaneous. No split.
And check out my social finger in the first pic. I was an actual ink-stained wretch...
Advice about laser eyewear - I used to work with Nd:YAG lasers so I have some familiarity but this is not my area of expertise. All protection like all security is a balance of differe...
4 hours ago