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My thoughts were triggered by our president's alleged use of a certain four-letter word for human waste that many people consider vulgar or obscene to describe certain undeveloped nations.
The word in question is not a newcomer to English. In …
Since my last column, I have given considerable thought to our use and abuse of the English language.
My thoughts were triggered by our president's alleged use of a certain four-letter word for human waste that many people consider vulgar or obscene to describe certain undeveloped nations.
The word in question is not a newcomer to English. In fact, it's older than English, dating back to the days when Anglo-Saxons brought their language to England. I rather doubt that those ancient people considered it a "dirty word." It was likely in daily use as the name for a rather common substance.
Then William the Conqueror showed up, speaking a language more like French than the language of the Anglo-Saxons. Gradually his language and the Anglo-Saxons' language merged, creating English. The French invaders became the ruling class, which is probably why their words for such things became the "nice" ones, and the Anglo-Saxon words became the naughty ones.
But back to the future, that is, now, when a row erupted over the use of this word.
Some defended the president, on the grounds that other presidents, Lyndon Johnson, for example, have resorted to such language in similar situations. One columnist I read noted that Hillary Clinton has used some pretty salty language herself. That may be, but it doesn't excuse anybody else for using it.
If you talk to most anyone who has been around for a while, he or she will complain that our language is becoming coarser. In their view, profane, obscene and vulgar words have been creeping into our daily discourse in situations where such words were religiously avoided. Men may have used such language in locker rooms, hunting camps or other all-male situations, but never when ladies were present, for example. I can remember those days, and, for a time, I was under the impression that ladies never used profanity, let alone used language such as the president uttered. Of course, it wasn't long before I realized that a group of girls could spout R- and X-rated language as well as boys could.
So, I don't fully agree that our conversations have become coarser by employing profanity or other bad language. Such language was always freely used in certain situations and avoided in others. What has happened is that people are more careless about using bad language, and will drop it into almost any conversation, no matter who is listening. You shouldn't use such language at all, although I have to admit being guilty on occasion, but if you do, be aware that it might come back to haunt you.
This brings us back to the present, and the president's words during his meeting with members of Congress. First of all, I object to the use of such language to denigrate people, which was exactly the president's intention if he used the crude language.
Second, he used it in a situation he should have known would become public, so he should have been aware many people would become aware of it and attack him for using it.
Most important, he should not have used it in the context that will have implications worldwide. The Islamic State is apparently trying to build a base in the very African nations he insulted, and we may require their help in dealing with the extremists. It's not wise to insult a nation that you may be asking for cooperation against terror someday.
When I was a kid, I was taught that the use of foul language was a sign of ignorance. It demonstrates that the person using it is unable to find more legitimate ways of expressing himself. I think that's still true, so in closing, I leave you with some words about Niger, one of those African nations the president referred to, one that I believe he knows little about. My daughter-in-law Jennifer Karsner is in her third year working in Niger, after two years of working in another of those nations, Haiti. She has this to say about Niger:
"Niger may be almost the least developed place on earth, but it's a country with the strongest social ties and community spirit I've ever seen. Resilience and strength and solidarity in the face of hardship? That's Niger. Yes, these countries have problems, but they are already contributing to the value of the world and do not deserve to be dismissed as lesser for being black or brown and poor."
I would only add that I'm sure the citizens of Niger are as patriotic toward their nation as we are toward ours, but that's a topic for another day. In the meantime, I'm watching my language more closely — even if I'm only talking to our cats.


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6 Simple Secrets to Making Goals You'll Reach
Resolutions! Goal-setting! Accomplishments! A new year invites us to plan for our future. We writers have lofty goals. We want to write books, articles, poems, and screenplays that will entertain and inspire the world for generations to come.
But everyone knows that wanting to do a thing is very different from doing it. Setting a goal without a plan of action for reaching it is the sort of good intention that paves the way to hell.
To kick off the new year, consider these 6 simple secrets of setting a reachable goal.
1. Be Specific. You can't accomplish something if you don't what you're striving for. Write down the One Big Thing you want to do this year. Be clear, quantifiable, and positive. For instance, "I want to write a novel" is too vague a goal to inspire anyone. "I will write at least 85,000 words of Nifty Novel Name and edit it before Christmas, 2011" is more like it.
2. Include Yourself. You should feature prominently in your goal. If you're tempted to say your goal is: "Complete at least 5 articles for publication in magazines with a circulation of over 250,000," reconsider, because you aren't mentioned anywhere. It's as if your goal exists without you. Beginning a goal with phrases such as "I will…" or "I commit to…" keep you connected with your dream from the beginning.
3. Be Responsible. "I will sign with an agent" and "I will sell my manuscript" are worthy aspirations but they make lousy goals. You cannot take responsibility for making them happen. Which means that you place your ability to reach your goals in the hands of someone else.
Make your goals something you alone can accomplish. Goals such as: "I will research and query 5 agents every month until I sign with one" or "each month, I will identify and contact at least 3 acquisitions editors of publishers in my genre until I have made a sale" mean the responsibility for making them happen is entirely up to you.
4. State Your Steps. Once you have spelt out your Grand Goal, identify the process you will follow to reach it. For instance, if your goal is to write and edit a full-length novel before the end of the year, you might break it into the following 12 monthly steps:
JAN: Outline the entire project and begin the required research.
FEB: Write the hook, complete the required research, create character notes.
MARCH – JULY: Write 20,000 words / month (5,000 words / week) until project is completed (100,000 word total).
AUG: Read and edit first 50,000 words. Solicit criticism on the edited draft.
SEPT: Read and edit final 50,000 words. Solicit criticism on the edited draft.
OCT: Rewrite. Incorporate necessary changes.
NOV: Polish prose until squeaky clean.
DEC: Edit for grammar and punctuation.
5. Know Your Penalty. Determine a suitable act of penance if for any reason you fail to meet your goal. It should be significant enough to motivate you to pursue your dream, but not something that demoralizes or depresses you. It should also be non-negotiable.
For instance, consider donating $100 to your favourite charity every month that you miss completing a "step" or making a $1000 donation at year's end if the goal remains unmet. That way, even if you don't do what you'd planned, your quest still holds great meaning and you still get to be a hero.
6. Plan for Success. Set your sights upon a worthy reward for making your goal. A mini-vacation, a night out on the town, signing up for lessons to learn something you've always wanted, or a (within reason) shopping spree might be appropriate. The key is to not allow yourself to indulge until your goal is achieved. Then the taste of success is doubly sweet.
So there you have it: start with a specific goal that you have the power to make happen, then devise a step-by-step plan, a penalty for falling short, and a reward for hitting the mark. See? Simple!
Why not take a few moments to share your goals for the following year below? Here's wishing you every success in your writing endeavours.

subset: commoncrawl


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What are the things that London escorts do not leave home without? Like all girls who work long hours, charlotte escorts need to make sure that they carry what they need to get through the day. It does not matter if you run an outcall service for charlotte escorts or incall service for London escorts, you do need to be ready for almost anything. Looking good is important to all of the girls, and makeup need to be part of the London escorts essential survival kit. One of the most essential things that London escorts do carry in their survival kit, is wet wipes. You can't have enough wet wipes when you work for a London escorts service says the girls. It is probably true. Have you ever stopped and thought about how versatile wet wipes are when it comes down to it? They can be used to freshen up your face, and wet wipes can even be used to mop up accidental spillages.
When it comes to makeup, the girls at charlotte escorts are on the ball as well. The natural look is all in, and as always, top London escorts like to make sure they keep with the times. Top makeup brands have launched some good quality products in recent years. Many things like powder and foundation now come in one handy package which is just great news for the young ladies at charlotte escorts. Are there some essential items it is worth paying more for? Brand cosmetics can be expensive to invest in, but there are some essential beauty items which you should buy from top brands.
There is nothing like a quality mascara. Keeping those lips soft and kissable is a top priority for not only the girls at London escorts, but for others as well. Always make sure you are packing a good quality moisturising lipstick. What about hand cream? Sure, it is a good idea to carry hand cream, but don't forget to pack a bottle of baby oil. Imagining finding yourself on a London escorts outcall, and not being able to moisturise your skin. Baby oil is still one of the most versatile essential beauty products.
It can be used to soften your skin, and be used to remove eye make up with when you need to freshen up. Use a little bit every day, and you will soon see all of those nasty wrinkles around your eyes will disappear in no time at all. It does not have to be expensive to look good, and when you know what products to invest in, your London escorts don't need to cost a fortune. Just find out what products are right for you, and make sure that at least some of them are "multi-functional" like the baby oil. Add an exotic aromatherapy product to your kit, and you will always be ready to delight someone with a relaxing sensual massage.
Don't forget that baby oil can have many other uses as well, and us girls must not lose sight of that.


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I spent 5 days in Swindon visiting family. I was staying with my Great Aunt and Great Uncle and travelled about to see other members of my family living in the the south of England. My Granddad was the eldest of five and had four sisters. Unfortunately two of them have passed, however Mary and Marian both stay in the south. We have a rather large family but we try and stay in touch as much as we can. Whilst Mary and Marian often visit us up in Scotland I hadn't been down this way to see family for a few years. I kept saying I was going to pop down but had never followed through with it! A couple of weeks ago mum was on the phone to Marian and I mentioned about possibly coming down to visit. 5 minutes later my flights were booked and I am really glad that I popped down for the visit.
Whilst I was down south we visited Castle Combe which formed part of the set of 'Warhorse'. There isn't a great deal in Castle Combe but it is worth a visit if you are in that sort of area in the Cotswolds.
I just need to try and make sure that I come down over a weekend next time so that I can see some of the others who were working through the week. I was kind of tight for time though with the exercise booked into my diary for the following week. We took a visit down to see Mary and caught Andrew her son quickly whilst we were there. Megan one of my cousins was there when I arrived – I don't think I have seen Megan for a lot of years although I cant quite work out when it last was!
We took a trip to visit Sade (my cousin) at her new flat and then she came round for dinner in the evening. Whilst I was looking forward to seeing everyone, I was looking forward to seeing Sade, for two reasons. I reckon it was about 16 years ago that I last saw her, but secondly because Sade has been battling with Breast Cancer for the last year. It was a pretty aggressive and rare cancer too which has made things pretty hard for her. She has dealt with it brilliantly as far as I am concerned and is on the mend. If you were ever needing a new strong female role model, Sade would fit the bill. I'm guessing positivity is in the genes because there is a lot of parallels in the way that both her and mum dealt with their cancers. With a positive outlook and an unwillingness to give in.
It was a good flight back from Bristol and Scotland didn't half surprise me! The weather was fantastic! A short drive up the road from Edinburgh and I was home after a great week down in the south. Normal duties resumed rather quickly chauffeuring dad into Dundee for a meal with one of his colleagues who is leaving to a new job. A busy Saturday double checking all of my bags before heading back down to Southampton for the Exercise with the UKISAR team. I have three bags for the ISAR team which are always packed in case of a job. But given I was away to head off for an exercise I thought it was a good opportunity to open them all up and double check all of my kit. It will all be repacked properly again once it is cleaned following the exercise. Generally, the ISAR kit is really good stuff, the only downside is that there is a lot of it! So it takes up a fair amount of space in the house. However, whilst my sister is still living abroad her room has become my overflow storage area and my kit lives in there.
I am not going to lie. The Stirling Marathon has got me a bit nervous… It's going to be the hardest few hours of my life I reckon and that is seriously daunting. I know I just need to keep my legs moving, but it is still a monumentally long way to run and I really admire those who take it up as their sport of choice. I am hopping to be able to raise some more money as I do it and reach out to new people who don't know about the fundraising that I am doing. I know that I am going to have a hard day when the 21st comes. I know that I will make it to the end and I know that I am not trying to do it in a record time, but 26.2 miles is scary I can assure you. I will be a glad when I am at the end. I've said before however about the fact that dealing with cancer is not easy and seeing my cousin Sade reaffirmed that in my mind. So when I hit the wall and I am starting to find it tough running around Stirling I intend to have that at the forefront of my mind.
The exercise with the ISAR team was a fantastic experience. In the end we ended up helping run the exercise as directing staff which is something I wouldn't normally do. But it gave me a really good opportunity to see the exercise from a completely different perspective, one that I wouldn't have seen had I been taking part in it. It confirmed to me that being a member of the ISAR team is definitely for me. Whilst I have been in the team for over a year now I hadn't been away to a large exercise like this one and I hadn't had the opportunity to experience the full team at work. Who knows when the next deployment will come or if it ever does, but I am quite happy to say that I am part of team who can respond to any major disaster around the world.
ISAR runs a 24 hour operation so team is split in two, working shifts. It meant that the directing staff were also working shifts and it meant that little sleep was had throughout the exercise. When the team exercises it is kept as real as possible and all checks are carried out in the same way that they normally would. Despite not being part of the 'deploying team' it gave me a better idea of how their systems work.
"Stay uncomfortable. Comfort breeds complacency" – unknown
The Stirling Marathon is just a week away and it has come round incredibly quickly! But if you have a few pounds to spare and would like to help me raise money for Cancer Research UK then just follow the link below! It really is quick and easy!
Many thanks as always.


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In memoriam: Professor Rui Santiago
Last month, we were saddened to hear that one of the professors of the HEEM programme, Professor Rui Santiago passed away. In this post, we commemorate his legacy as a colleague and mentor in the HEEM programme. – the world of higher education has lost a great scholar and a wonderful human being.
Recently the sad news reached us that our esteemed colleague Professor Rui Santiago had passed away. We have cooperated with Rui in a number of settings but remember him especially as one of the pillars of our joint ERASMUS MUNDUS joint degree programme HEEM. Rui did not only play a decisive role in securing the participation of Aveiro University in the HEEM programme. He has also throughout the 7 years of its existence coordinating the parts of the HEEM programme offered in Aveiro, represented Aveiro in the HEEM Board, and supervised many HEEM students' Master thesis work.
Rui was not only a highly appreciated academic colleague, he was also a warm and caring person whom we always enjoyed to meet personally. We remember for example fondly our first visit to Aveiro for discussing the HEEM programme with the university's leadership. Before any of the planned meetings had started Rui took us by car to the beach where we spent a wonderful hour drinking coffee, enjoying the sun, and talking about all kinds of things, from the history of the city of Aveiro, Portuguese politics, to the quality of Portuguese red wine (according to Rui white is only good for washing your hands). We arrived relaxed at the subsequent meetings and had very constructive talks with the Aveiro representatives.


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Today it is three months since my beautiful sister Lou left us to join our Martha in heaven. I feel them both with me every day and am grateful that Lou is at peace now, with Martha looking after her too. The thought of my two special sisters being together gives me so much comfort.
So on this special day I thought I would share this photo with you to celebrate our precious Lou, creative and talented in so many ways. Lou was a wonderful photographer, and gave each of us one of her framed prints last Christmas. The one she gave me is above, a bee on a lotus flower. All beautiful shots of nature, taken in her beloved Bali.
To see more of our precious Lou, you can see many lovely images of her life here. Please join me in sending Lou blessings and in celebrating all of the many good things about Lou today.
Sending so much love to you Lou-la. We miss you dearly and are slowly and gently coming to terms with our sudden loss of you. It will take a very long time. Know that you are so well loved by so many. You are in our thoughts and our hearts every single day.
God bless you precious Lou, my dear sister and friend


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arts, London, london eye, millenium bridge, pictures, south bank, st pauls catherdral, thames, tower bridge, uk, vacation
To continue from my earlier post about London, I wanted to share with you my favourite part of the city. It's hard to pick just one but I really loved the South Bank of the Thames. It's where the London Eye is located and stretches for kilometers.
I know the London Eye is a landmark but just about everyone who has been on it advised me not to spend the money. So we didn't (the line up was also forever long). The weather was actually perfect (by Canadian standards) so we ended up visiting everything you can see from the eye anyways. Continue reading


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ER-148 - VMP 2 Post Network Equipment Rack, 48
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Contractors: Get Dealer Pricing Here!
The VMP ER-148 is a 48 height equipment rack and is ideal for applications where space is limited or a small amount of rack-mounted components are used. The VMP ER-148 is EIA compliant and supports the standard 19-Inch industry specifications. This is the perfect equipment rack solution from small to medium size commercial or residential installations. The VMP ER-148 offers a steel powder coated construction with 27 available rack spaces for mounting patch panels, rack shelves, or any rack-mountable active devices.
If you need the VMP ER-148 equipment rack to be mobile use the caster kit part #ER-CASTER to add rolling wheels on it so you can slide the entire rack in and out of a room or closet for maintenance and equipment additions.
- Includes: (1) ER-148 2 Post Network Equipment Rack 48
- Rail height - 48" / 27 rack spaces
- EIA compliant
- Standard 10-32 threading
- Includes 32 rack screws
- Steel construction
- Load capacity 400 lbs evenly distributed
- Black static resistant powder coat finish
- Part#: ER-148


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Dijon Deep Seating Sectional Set by Caluco
The Dijon dark-java hued masterpiece is the perfect recipe for good looks, durability and comfort. Caluco uses only the finest aluminum alloy to craft the underlying frame. The frame is powder-coated for added durability. Over the frame, Caluco hand weaves a sun, rain and snow friendly polyethylene wicker. Caluco then tops it with comfortable 4" thick cushions. The result is a decadent delight; a robust, geometric, transitional collection of patio furniture that would add class and flavor to any home. Spice it up with your choice of weather-resistant fabrics in designer colors.
Featured Set Includes: Left Arm Chair, Right Arm Chair, 3 Middle Chairs, 2 Club Chairs, Coffee Table.
- Aluminum Frame
- Low Maintenance
- Sunbrella Cushions
- Versatile Configurations
- Three Year Warranty on Weave
- Ten Year Warranty on Frame
- All Weather Polyethylene
Also Available Individually:
- Corner Sectional # 825-C
W 35" x D 35" x H 28" Seat Height 13''
- Sectional Right # 825-R
W 35" x D 35" x H 28" Seat Height 13''
- Sectional Left # 825-L
W 35" x D 35" x H 28" Seat Height 13''
- Sectional Middle # 825-M
W 29" x D 35" x H 28" Seat Height 13''
- Club Chair # 825-21
W 40'' x D 35'' x H 28'' Seat Height 13''
- Ottoman # 825-G
W 35" x D 35" x H 13"
- End Table # 825-E
W 18" x D 18" x H 18"
- Coffee Table # 825-F
W 29" x D 35" x H 16"
- Deep Seating
- Outdoor Sectionals
- Outdoor Furniture
Corner Module 35" W x 35" D x 28'' H
Left & Right Modules 35" W x 35" D x 28'' H
Middle Module 29" W x 35" D x 28'' H
Cushion Fabric Sunbrella
Frame Aluminum
Weave Wicker
Wicker Color Java
Sectional Seat Height 13''
Free Shipping
This item requires freight delivery. This shipping method uses a full size semi - truck and product can be delivered to a street side location or into a room of choice based on the level of service requested. A representative will call to schedule your delivery which will require a signature upon receipt. Most delivery times within the Continental U.S. range from 5-7 days on in stock merchandise. Special order patio furniture ranges from 2-6 weeks depending on manufacturer.
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The French-Albanian choreographer Angelin Preljocaj insists that his abstract 2010 collaboration with the Bolshoi, And then, one thousand years of peace, is apocalyptic, but not in the way you might think. It is, he says, all about the "lifting" ("apo") of the "veil" ("calypsis") of things in our world that are hidden from view, a scrutiny of the id, you might say, rather than a depiction of biblical or global catastrophe.
There are two curious things about this. One is that, quite apart from its explicitly Second Coming title, his creation is in fact brimming with Revelatory images. The other is that these are among its most eye-catching elements.
After a wham-bam start with 10 dancers, in linear formations, striking fast and headstrong poses to Laurent Garnier's machine-gun beat, the piece serves up potent and often eerie images of angels and demons, bondage and freedom, life and death. Nations go on the move and come together orgiastically, and two real, bleating, understandably startled lambs are even ferried on to the stage.
Essentially, you can't help feeling that St John is seldom far away.
In fairness, though, for much of the work you see what Preljocaj means. An hour and 45 minutes long, and for 20 barefoot dancers, and then has no interval, opting rather for a sense of complete immersion in a strange, dynamically shifting world of sexual and power struggles. The bigger numbers generally play out to full-on percussion, with most of the more intimate passages set to less abrasive soundscapes.
One of the latter is accompanied by none other than the famous Adagio sostenuto from Beethoven's Moonlight Sonata, although slathered in nostalgic-sounding layers of reverb. As if in riposte to the preceding clutch of winged, scavenger-like apparitions, two angelically clad girls perform a solemn, contact-free, largely floor-based duet, part lament, part redemption perhaps, but with counter-intuitively mundane inflections, too.
Processed Beethoven? Reluctant ruminants? And (towards the close) flags soaking in basins? Preljocaj's piece is not the least pretentious thing you will ever see. It is also on the long side.
Still, I rather like it. It is grand, sexy and muscularly danced. It looks a treat, makes you think, and even offers something close to optimism at its end.


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Setting Up Website Thumbnails In Coda
kaser • Coda • No Comments on Setting Up Website Thumbnails In Coda
So I've been using Coda for over a year now and it just dawned on me today that my sites page, which displays all the different websites that I work with, is really confusing and unorganized and takes a lot of time for me to find what websites I want to work with. I realized that a large majority of my sites have no thumbnails, so I figured out what to set so that coda can generate the thumbnail, and it's as easy as setting the remote url to the domain you want to work on.
click the little "i" icon next to your website name to bring up the information panel
Once your information panel is open, find the remote url
replace the "ROOT URL:" place holder http://domain.com with the URL of the website you are connecting to
Now that you've set the URL, click save and let Coda generate the thumbnail for it. I've set all of mine up that I can, and now it looks a LOT better. I can easily find my websites now since I can recognize the thumbnail a lot faster than I can read all the titles of the sites.
Please let me know if you have any questions or if this helped you!


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Eye Care Specialties
ICON Eyecare provides a variety of services to help our patients see the world more clearly. Whether you have cataracts, glaucoma, dry eye, or are simply interested in sharper, better vision, we can help you achieve your goals. Get ready to enjoy the freedom and confidence that comes with healthier eyes.
Eyecare Services
Pterygium Removal
A pterygium is a dense, benign growth that appears on top of the thin membrane that covers the sclera (the white part of the eye). Caused by overexposure to irritants like dust and wind, a pterygium is not treatable with glasses or contact lenses. Symptoms include vision impairment, burning or itching, and a gritty or dirty feeling in the eye.
Glaucoma Treatment
Treatment options for glaucoma range from eyedrops to surgery. Your case will be unique to you, and the treatment plan we develop for you will be uniquely yours. Typically, we begin with glaucoma therapy, to preserve your current level of vision and prevent further peripheral, and sometimes central, vision loss. The rest of your treatment plan will depend on the type of glaucoma, the degree to which it has progressed, underlying risk factors, and more.
Dry Eye Treatments
You'll find many over-the-counter, homemade, and self-treatment options for dry eyes online. However, depending on the cause and extent of your condition, the best way to treat it will vary a great deal. To be safe and certain, we recommend you take the guesswork and risk out of dry eye treatments, and let our experts help you make an informed decision instead.
Corneal Conditions
The cornea is the transparent layer at the front of the eye. It helps control how light enters the eye and makes up a significant portion of the eye's overall focusing power. This major role means corneal damage or weakening can have a significant impact on your ability to see clearly. Although treatment depends on many factors, some corneal conditions will need to be surgically corrected. Learn more about some of our advanced corneal surgery options below.
We are experts in eye care and eye health, and we can help determine if you have keratoconus or another eye condition. Whether you are suffering from keratoconus, allergies, or something else, we have the resources and the knowledge to help you get back to seeing – and living – the life you want to live.
Retina Conditions
Our retinal specialists use the most advanced techniques and technologies to determine what's keeping you from seeing clearly. When it comes to retinal conditions, we make sure you have the most effective and customized treatment plan available.
Uveitis Treatments
Uveitis is a very serious condition, but we are trained and well-equipped to diagnose, treat, and help you understand the implications of uveitis. You deserve to see the world through better eyes, and we can help you do just that.
CLE Procedures
After undergoing CLE, patients can expect a relatively brief recovery time. Many can return to work within three days of the procedure, depending on your line of work. Over the next few weeks, you will begin to notice a gradual improvement in your vision. Finally, within four to six weeks, patients can expect to see the optimal and long-term results of CLE.
Wow, never in a million years would I thought my vision would be 20/15! This is all thanks to Dr. Campbell, Dr. Sturdy and their amazing team.
- Olivia C.
Dr. Campbell performed my surgery and he makes you feel at ease and calm throughout the whole process of the procedure.
- Kathy T.
Dr. Greeley is a very nice doctor, beautiful facility, and very caring staff. Thank you ICON for giving me great vision for so many years now!
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Our son has glaucoma as a result of his port wine stain birthmark. When adolescence and hormones kicked in at 13, so did pressure spikes. Dr. Reyes was quick and decisive. We needed a doctor that was aggressive and knowledgable. Dr. Reyes did so much for us! We are grateful for him! He saved our son's eye. Thank you soooo much!
- Vitals Verified Patient
I was very impressed with their cutting-edge facility and staff. They made me feel comfortable and at home. Thank you ICON Eyecare!
- Cody Donovan – UFC Fighter, High Altitude Martial Arts, Easton Brazilian Jiu-Jitsu
The staff from top to bottom provided me with care and knowledge every step of the way. A big decision? You bet! A great decision, you bet! I look forward to jumping in a pool, skiing down the slopes at Breck and never worrying if my contacts will slip or come out!
- Creigh Kelley – Emcee
I highly recommend it!! Thank you ICON Eyecare for making this year my very best one, so far!! Now, I can truly see a clear picture of where I want to go as a professional athlete.
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"As soon as I began considering laser correction, I knew ICON Eyecare was the right choice for me. I'm as busy now as I was when I was a pro athlete. So I can't imagine my active lifestyle without the convenience of clear vision and I'm amazed with the results.
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I had PRK eye surgery here in December 2018 and was very pleased with the whole process. Everyone was very Professional and friendly.
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A Team of Experts.
Icon's fellowship-trained specialists provide industry-leading care using the latest, advanced technology and techniques.


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A Constantly-Evolving Home in East Danforth, Toronto
When buying a first home, people often talk about finding the one or instantly falling in love with a property. For Catherine Cachia and Lionel McDonald, this was decidedly not the case when they purchased a 900-square-foot semi-detached home in the East Danforth neighborhood of Toronto. The couple had viewed dozens of sales and lost out several bidding wars in the area's competitive real estate market. They saw this century-old place in the rain late on a Sunday night, looked at each other, and said something like, "There doesn't seem to be anything wrong or weird about this one!" They were actually very excited that it had an ugly, outdated kitchen because that meant they didn't have to pay for someone else's renovation, and they got to make all the selections themselves with the money saved.
The pair knocked out half the wall between the kitchen and living room to create a breakfast bar as soon as they moved in, and installed all new cabinetry, countertops, and flooring in the kitchen. They then painted the interior walls white throughout the house. Considering how much Catherine loves color, it was a surprising choice, even to her. But it created a sense of consistency, kept the small spaces as bright as possible, and allowed her to decorate with eclectic, vintage details. A year and a half later, she's finding that turning a house into a home is an ongoing process that takes time and shouldn't be rushed. To understand how it should function and feel, it needs to be lived in first.
Catherine gets bored of looking at the same things fairly quickly, so her rooms are constantly evolving. Changing or rearranging a few simple things can provide new inspiration in spots that previously felt tired. For her, trying out lots of different ideas is the only way to see what works. She has thrown countless DIY projects in the trash, and scrapped many furniture configurations. The homeowners tried every conceivable floorplan on the main floor because there isn't an obvious dining or living room — just one open, continuous space. It is only now, on maybe the tenth try, that they suspect they've gotten it right.
Catherine wanted to create a colorful home that felt welcoming, above all else. As much as she loves vintage and usually leans towards mid-century modern pieces, she didn't want any room to be entirely from one period, and instead opted for a mix of different eras and styles, including contemporary. After renting in big cities for many years before buying, Catherine and Lionel have learned to appreciate every single inch of space here. Having a second bedroom and backyard for the first time in their lives has been a dream. And because they are expecting their first little babe in September, there will be lots more experimenting to do. —Annie
Photography by Catherine Cachia


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Epilepsy Surgery: The Emerging Field of Neuromodulation
Epilepsy is a devastating neurological disorder that afflicts nearly 1% of the population. While resective surgery has been demonstrated to have excellent seizure-control outcomes in selected patients, many others are not candidates because the epileptogenic zone is multifocal and/or includes eloquent brain regions. Furthermore, resective surgery can be associated with neurocognitive effects, which are sometimes irreversible.
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Júlio Leonardo B. Pereira


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19 Shocking Facts About Online Dating
Online dating has been around in some form since digital communication became a common fixture of the internet. Whether "meeting" someone in an online chat room or developing a relationship through regular emails, digital courtship certainly isn't a new thing. And before the internet, there were dating videos and matchmaking companies that did much the same thing.
It didn't take very long for internet savvy entrepreneurs to commodify online dating into a massive industry that seems to keep growing. It may have been an admission of failure in "normal" relationships to join an online dating site at one time, but with new apps like Tinder and sites like OKCupid plus hundreds more, it's now socially acceptable to at least give online dating a try.
Millions of people join (and leave) dating sites each year, looking for their long-lost love or at least new friends to spend the days with. The vast majority do so without knowing much about online dating, except for all those urban legends, a few word-of-mouth reports and, of course, whatever the convincing advertisements say. For them, this list of 20 shocking facts about online dating in the United States, according to Statistics Brain, will be very enlightening.
19. 54M Single People in the U.S.
Over 50 million adult men and women in the United States are without a significant other. That's far less than half of the U.S. population, but still a considerable number especially for the hundreds of internet dating websites looking to turn a profit on people seeking a mate.
Each of the 54 million single people is another potential customer who, perhaps out of frustration, will sign up to an online dating site to find a friend, husband, or wife. Being single often means being lonely, one of the biggest reasons to start making a profile.
18. 41M People in the U.S. Have Tried Online Dating
The vast majority of single people in the U.S. have tried online dating at one time or another. It's safe to say that many single people consider online dating a viable option when it comes to finding at least a sexual partner. Some may have tried it and decided it wasn't for them or were unsuccessful in finding a suitable date.
Others may have had better luck and have multiple profiles on different online dating services to increase their chances.
17. 15M eHarmony Members
eHarmony is one of the most popular online dating websites on the market. For a monthly membership that sells for as little $10.95 (for a 24-month subscription), eHarmony claims that it will use scientific algorithms to couple single people with their best relationship match.
The scientific viability of these online dating algorithms has met some criticism over the years, but it does help many people narrow down their options more than they might be able to through real-life romantic pursuits in a bar or at a party.
16. 21M Match Members
eHarmony is popular, but not as popular as Match, the very first online dating site to introduce the concept of relationship matching. It has been in operation for 17 years.
Members can join the site for $20.99 for 12 months (in addition to multiple subscription options) and complete their profiles, which include a series of questions. The questions form a summary of users' personalities. Similar to eHarmony and many other online dating sites, Match uses this data and compares it with other members to assign a "perfect match".
15. $238USD Spent Annually by An Online Dater
Some dating sites like OkCupid and PlentyOfFish are generally free to use with the option to purchase a premium membership, which unlocks reserved features like unlimited message storage and the ability to see who "likes" you back.
However, other sites like eHarmony and Match require a paid membership to use. Out of the 41 million Americans who have tried online dating, a large number have stuck to it, and tested their faith by spending an average of $238 a year for memberships and other perks. This isn't necessarily a large sum for people who might spend a lot more just for a night out.
14. 52% of Online Daters are Men
For one reason or another, men have a less trustworthy reputation when it comes to online dating than women. That may be true for some who use dating sites to simply find a fling rather than a long-term relationship, or for immature men with little respect for other users.
But with over 50 % of users being men, not all can be disingenuous. This percentage is good news for single women. They have a lot of options when choosing a man to engage or respond to, or when finding someone new if one man ends up being a dud after a face-to-face date.
13. 71% of Users Believe in Love at First Sight
This fact can say a lot about the people who go online to find love. Perhaps they are die-hard romantics who wear their hearts on their sleeves, and believe there is one person out there that's right for them.
A big part of online dating is finding someone who will go on dates which are "no strings attached". But the statistics don't lie: finding true love is the ultimate goal for most. There is still some romance left in the dating world, even when it's online.
12. 20% of Committed Relationships Began Online
Some people swear by the convenience and success of online dating websites, while others disregard them as equally or more ineffective than regular dating.
However, according to the statistics, internet dating does work for at least 20 percent of the people who make a commitment to keep at it. Starting a committed relationship with someone you met online is possible, just as it is with real-life dating.
11. 17% of Marriages are From Online Dating
Whether dating online or in person, the goal for many single people is marriage. They want to settle down, tie the knot, and start a family with the person they deeply love.
However, online dating may not be the best option for these people. Only an average of 17% of marriages are from relationships that began from online dating, and, with divorce rates in the U.S. skyrocketing, there's no telling if those marriages will actually last.
10. 18 Months Average Courtship Before Marriage
Marriages don't happen just like that – except with rare exceptions like those impulsive elopements to Las Vegas! Relationships take months and even years to develop before a couple finally decides to take the proverbial plunge. This is also true for online dating.
After moving from trading messages, to meeting, to dating in real life, it can take an average of 18 months before online daters get married. Couples take time to decide if they are as compatible as the website made them seem.
9. 38% of Women Prefer "Nice Guys"
Nice guys finish last? Not always. Squeaky-clean men don't have to hide their natural personalities to attract girls online. It's most likely a tired cliché that all girls like the "bad boy". In actuality, women are usually more attracted to confidence, a sense of humour, and men who know how to treat women with the respect they most certainly deserve.
The men who are planning to alter their personalities online just to get a date should look at this statistic and think again. As people often say, just be yourself.
8. 42% of Men Prefer "Modern Career Girl"
On the flip side, not all men prefer ditzy girls who follow their boyfriends and husbands according to their every whim.
This statistic tells us that a healthy percentage of men would rather date or commit to a modern career girl over someone who, perhaps, doesn't have their life quite figured out. Just like women, men seem to want their potential significant others to be confident, assertive, and extremely independent. Maturity seems to be the most desired trait for both genders.
7. Women's Online Desirability Peaks at Age 21
It's common for women to get more private messages than men, especially if these women are 21 years old and younger. The number of women being contacted peaks for those who list their age at 21, declining steadily after this point. It's a cliché, but it's commonly believed that men are biologically programmed to chase younger and consequently more fertile women, which may be the reason for this statistic.
6. Younger Women Have Most Online Pursuers
This is where the numbers get tricky. Although women's online desirability peaks at 21, they have the most active pursuers around the age of 26. Close to half of men prefer a modern career girl, and a woman in her late 20s is more likely to have a stable career (or at least working to develop one) than a younger girl. However, 26 year old still fulfil the 'youth' preference of many men.
5. Older Men Have Double The Online Pursuers Of Young Men
In a trend which opposes that of men seeking women, the older that a man is in the online dating world, the more women will seek him out. This may be because older men are perceived to be more financially and emotionally stable, having lived a longer life with more character-building experiences than men in their 30s and 20s.
Men at this age have likely had more relationships too. As a result, they may be perceived to have developed more maturity. Maturity in men is a good sign that they're more willing to commit to a long-term relationship or even marriage, which many single women will be seeking online.
4. Men Lie About Age, Height, Income
Men often lie about their personality or daily life in order to seem more attractive, just like with normal dating. It's quite natural to tell a few white lies here and there. However, with online dating, men lie about their major physical attributes and financial stability -including lies about age, height, and income.
Men might be sabotaging themselves when doing so. Within just one date, women will quickly work out the lies regarding height and age, at least.
3. Women Lie About Weight, Physical Build, Age
Women also lie in their online dating profiles. However, their lies differ from men's with exaggerations or misinformation focused on their weight, build, as well as their age. This may be a side effect of a dating culture that focuses on women's looks over their personalities and accomplishments.
As a result, they lie to seem more attractive to potential pursuers. It's easy to list false information in a general profile, but it's unclear how these lies impact the success of face-to-face meetings.
2. 10% of Online Daters are Sex Offenders
Despite safeguards, sexual predators still unfortunately lurk in the digital world seeking out a potential real-life victim. It would be judgemental to say that all sex offenders are repeating criminals, but many are, which leads online daters to be cautious when sharing personal information in a dating profile.
Up to 10% of online daters are sex offenders, a statistic which suggests it certainly doesn't hurt to be extra careful.
1. $1B Online Dating Annual Revenue
Online dating is a business. Each dating website offers a service for its customers to find a potential mate. As the social world changes, more and more people turn to online dating, and they're willing to pay the price to unlock every feature a dating website or app offers.
Millions of members generate about $1 billion USD in annual revenue from online dating alone. There's no sign that the industry is slowing down either. According to CNBC, online dating revenues are growing to between 10 and 15% per year.
The two biggest and wealthiest dating sites are still eHarmony and Match, although "free" sites like PlentyOfFish, OKCupid, and even Tinder are attracting millions of users.


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Oh, how the mighty have fallen. Our first-place brand from last year fell to fifth place because of a few poor review scores and unhelpful tech support. Although it was an off-year for Lenovo, the vendor still landed in the top half of our rankings, thanks to some innovative new features and the wide selection of laptops it has on tap.
Lenovo found its footing in the gaming sector with the Legion Y7000, an affordable rig with a sleek design and vivid display. And while the Yoga C930 impressed us with its soundbar hinge, the ThinkPad X1 Carbon and ThinkPad X1 Yoga's absence (both available in June) hurt Lenovo's average review scores this year.
Lenovo's Key Strengths
- ThinkPads and Legion: Lenovo's ThinkPad business laptops continue to impress us, and now the Legion brand is consistently producing reliable gaming machines.
- Great value and selection: From budget Chromebooks to premium 2-in-1s to beastly workstations, Lenovo offers something for everyone.
Lenovo's Key Weaknesses
- Poor phone support: Lenovo's support agents were unable to answer our questions about the company's own apps, and their social media support was slow to respond.
- Inconsistent quality: There's no denying the excellence of Lenovo's Thinkpad laptops, but some of the notebooks we reviewed this year missed the mark.
Top-Rated Lenovo Laptops
- Best Gaming: Lenovo Legion Y7000
- Best 2-in-1: Lenovo Yoga C930
- Best Budget Laptop: Lenovo Flex 6 11
Reviews (29/40)
Lenovo's ratings dropped drastically this year. The decline can be attributed to multiple 2.5-star reviews and the absence of some top models (X1 Carbon and X1 Yoga), which will be released later this year. Without those reliable performers boosting Lenovo's scores, the company averaged a laptop rating of just 3.5 stars, down from last year's 3.8 stars. It's not all bad news for Lenovo, however: ThinkPads continue to impress, and now Lenovo has some top gaming machines and midrange options to offer.
In fact, one of Lenovo's few Editor's Choice picks this year is a gaming laptop. The $1,100 Legion Y7000 is an excellent value, thanks to its slim aluminum chassis, colorful display and strong overall performance. For the everyday consumer, the Yoga C930 is a well-rounded machine and one of our favorite convertibles. A nice addition to Lenovo's portfolio is the beastly X1 Extreme, although business users may want to wait for the refreshed X1 Carbon.
Design (12/15)
Lenovo officially has two looks: business formal and business casual. First, the casual. With the Legion Y740, Y730 and Y7000, the company has successfully developed gaming laptops that could easily make it in an office meeting — provided you turn off the keyboard's customizable lighting. Yogas, like the C630, continue to be crowd-pleasers, so much so that Lenovo extended the design to the Chromebook C630. The Yoga Book C930 is one of the slimmest laptops of the year at 0.4-inches thick. ThinkPads like the X1 Extreme and the X380 are firmly business formal, delivering subtle beauty and MIL-SPEC toughness.
Our reviewers ran into several build-quality issues when handling Lenovo's midtier/budget laptops. In cases like the V330, the give in the lid was "alarming," while the IdeaPad 530s "wobbled when [we] applied pressure to the left of the touchpad." We also encountered a bit of difficulty when trying to extract the stylus from the 500e Chromebook. And "in tablet mode, the top and bottom of the [Flex 6 11's] chassis don't align well, causing a gap."
Support and Warranty (11/20)
The best support and help that Lenovo provides isn't from its agents, but from its online databases and mobile app. If you try their phone agents or social media accounts, you're going to get a whole lot of nothing: they failed to answer all three of our questions we asked over the phone, and their online agents were terribly slow at responding.
Lenovo laptops include either a 12- or 36-month hardware warranty, depending on the unit, with the former being the industry default and the latter being far more time than most include for free. Accidental-damage protection costs extra.
Innovation (9/10)
Lenovo deserves credit for making its wild Yoga Book C930 more practical by adding an E Ink display. That machine is also still amazingly light, at 1.7 pounds, and benefits from a precision pen. Still, the knock-to-open feature is gimmicky.
We're impressed by the regular Lenovo Yoga C930, which squeezes a Dolby Atmos soundbar right into the hinge. This laptop also boasts an active pen with onboard storage and a privacy shutter for the camera. Other Lenovo highlights include the ThinkPad X1 Carbon, which is now the world's lightest commercial 14-inch laptop.
What's around the corner looks amazing. Lenovo has unveiled the world's first foldable PC, which will be part of the ThinkPad X1 family. That machine's 13-inch OLED display can bend into multiple modes, and the PC supports pen input. The device will go on sale in 2020.
Value and Selection (15/15)
Lenovo has an enormous selection of laptops that dip into a variety of categories, satisfying virtually every need. On the budget side of things you have systems like the IdeaPad 130s, which starts at $199, along with the Flex 6 11 ($289) and 500e Chromebook ($309). Mid-tier mainstream options include the Ideapad 530S ($699), Yoga 730 13 ($709) and the Flex 15 ($719). If you want something a bit more premium, there's the Yoga C930 ($1,117), which provides stronger performance. Lenovo even boasts a premium Chromebook, the Yoga Chromebook C630 ($629).
MORE: Best Lenovo Laptops
Additionally, the company offers a flurry of gaming laptops, including the Legion Y530 ($799), the Legion Y7000 ($825) and the 17-inch Legion Y740 ($2,489) with its Core i7 CPU and a powerful Nvidia RTX 2080 Max-Q GPU.
Mobile professionals should check out the ThinkPad L380 ($779) as well as the slim powerhouse that is the ThinkPad X1 Extreme ($2,955). If you need a thin-and-light system, look no further than the ThinkPad T series laptops like the 3.3-pound T490 (starting at $846) or the 4.2-pound T580 (starting at $786). Not thin enough for you? Then check out the X1 Carbon with its barely-there 2.5-pound carbon fiber chassis. Oh, and let's not forget the ThinkPad P1 ($3,209) and its beastly power thanks to a monsterous Intel Xeon-2176M CPU, Nvidia Quadro 1000 GPU and MIL-SPEC tested, 4-pound chassis.


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Beacon Hill First Baptist Church
Welcome to the Beacon Hill First Baptist Church and our home on the web! We are delighted that you have discovered our site and hope that you receive a blessing just from stopping by! Beacon Hill First Baptist Church of Seattle, WA. is a church that loves Jesus, loves people and desires to connect both in worship, ministry and commitment. As you explore our web site we hope that you will get to know us better! We are located on Beacon Hill in Seattle and invite you to worship with us! It is our prayer that GOD will continue to bind us together in love as we continue to build upon the legacy of the church.


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Has this ever happened to you? My roommate and I occasionally save up the money to call in a woman to tidy up our apartment — kind of as gift to ourselves when the rush of New York living becomes a bit too overwhelming to get the energy up to clean the living room. Last month, I got a text from her asking if we needed her services any time soon… and I found myself suddenly submerged in an uncomfortable awareness.
The money that my roommate and I save up and set aside for a cleaning — that I usually see as simply "paying for a service" — that money was essential to this woman's livelihood. In paying her to clean my apartment, I was giving her the means through which she could pay the rent in her own.
It was a sharp moment of emotional clarity about the grander nature of our transaction that sent pinpricks up my arms. I got to thinking. What else might my transactions be directly responsible for? Why had the simple-yet-obvious knowledge of where my money was going been so invisible to me before? And why, now that I'd realized the emotional truth of the transactional nature of money, did I feel so disconcerted by it?
As I tried to answer these questions for myself, I found myself tumbling down a rabbit hole of existential unease (as I'm, apparently, wont to do). The story, it goeth thusly:
Money is such an abstract concept — especially in the age of credit cards, Venmo, and PayPal — that it's easy to forget the weight it holds. As I grow older, I discover all the ways in which my presence here impacts the world around me… and perhaps the most frightening, to me, is the power my money holds in society today.
Okay, Figmet of My Nonexistent Audience: I feel you, but hold the snark for a second. I realize I'm saying nothing revolutionary here. Obviously, "money is power," "money is scary," blah blah blah, you've seen this movie before and heard the villain monologue a ton, I know. I'm talking less about the broader concept and more about the personal emotional impact I've noticed that concept has had on me.
Like, for example: once I realized my money was directly contributing to the continuation of my cleaning lady and her family's lifestyle, I suddenly felt I had to continue providing her with a source of income. I recognized, logically, that I didn't really have an obligation to continue using her services if I didn't want to… and yet, I couldn't shake this odd sense of responsibility toward her.
I've noticed this sense of responsibility cropping up in all my transaction, recently. That coffee I pay for at my favorite coffee shop? The tip I leave goes to the amazing, friendly baristas working behind the counter, all finishing degrees at school or working a second job to pay for the kids at home. The personal trainer I visit? She's got rent to pay, an independent business to mantain, pets to feed. The classes I take? They've got electricity and rentspace in the building, postage, and that's not even mentioning the front desk workers they give salary to. Even my work at the theater is put into perspective when I start to think this way.
Maybe it's because we live in a society where big businesses seem to be making more of the rules than actual politicians. Maybe it's simply what happens when you create an artificial barrier between what is given and what is recieved — when you trade a few slips of paper or an increasingly-imaginary idealogical construct that we pretend is an essential marker of status or worth, for a concrete, usuable, consumable service or object. "Here, swipe this magnetic strip of 1s and 0s and keep track of how high your numbers are. The higher the number, the more you're allowed to participate in life!"
I don't know the exact whys behind it. But for some reason, it's very easy to see the world around us as a giant machine of cogs and wheels, like a looming behemoth of a 1960s IBM that gives you what you want if you push the right buttons or feed it the right ideas. When you give away something immaterial, what happens to it? It often feels like it simply disappears once it's not yours anymore. Dissolved into the machine.
There's something about recognizing the humanity behind the abstract that sometimes overwhelms me. The empathetic understanding of the ripples I make whenever I leave a footprint in the environment around me leaves me uneasy, sending me contemplating not just my own place within that environment, but also the invisible nature of the impact I can have over the place of others.
Is it wrong that we've created a system where I can have so much unknowing power over another person's life? Or is that the only way a society exists? Is there a way to create a world where we're immediately aware of our inherent responsibility towards each other, or is that awareness an inherently insidious kind of knowledge? Is it a kind of empathy you grow into? Or am I just a weirdo? Is it silly that I feel such a responsibility towards those I give money to?
I have no answers to these questions, and I can't help but continue to ask them. Maybe as I build my career and further interact as an adult in society, I'll figure out. Or maybe I'll never really get it. Either way, it's a truth of my life I'm having difficulty navigating recently.
And that's the story, morning glory!
Stay classy,
~ becca


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Article Text
Systemic antimicrobials are critically important in veterinary healthcare, and resistance is a major concern. Antimicrobial stewardship will be important in maintaining clinical efficacy by reducing the development and spread of antimicrobial resistance. Bacterial skin infections are one of the most common reasons for using systemic antimicrobials in dogs and cats. Appropriate management of these infections is, therefore, crucial in any policy for responsible antimicrobial use. The goals of therapy are to confirm that an infection is present, identify the causative bacteria, select the most appropriate antimicrobial, ensure that the infection is treated correctly, and to identify and manage any underlying conditions. This is the second of two articles that provide evidence-led guidelines to help practitioners address these issues. Part 1 discussed the use of clinical signs, cytology and culture in diagnosis. This article will cover the rationale for topical and systemic antimicrobial therapy, including choice of first-, second- and third-line drugs, the dose, duration of therapy, compliance and identification of underlying predisposing conditions. In addition, there is guidance on cases of therapeutic failure and environmental hygiene. These guidelines will help veterinarians avoid the development and propagation of antimicrobial-resistant bacterial strains.
- Bacterial diseases
- Antimicrobials
- Dermatology
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode
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Therapy: selecting an appropriate antibiotic
Systemic or topical treatment?
Once a pyoderma has been diagnosed, it is important to consider if the infection is deep, severe and/or generalised enough to warrant treatment with systemic antibiotics. Preferred alternatives for mild, surface and/or focal infections include topical antimicrobial shampoos and sprays, or even topical antibiotics if topical antiseptics do not clear the infection. Topical antiseptic treatments can hasten clearing the infection, or will greatly reduce the need for systemic therapy (Scott and others 2001, de Jaham 2003, Murayama and others 2010).
Systemic antibiotics
If systemic antibiotics are considered the best approach, there are five relevant points to take into consideration:
The vast majority of skin infections are associated with coagulase-positive staphylococci.
The skin is the largest organ of the body, and its blood supply is comparatively poor.
The length of the treatment will depend on the depth of the infection.
Most cases of canine pyoderma are secondary to other pathologies, which must be addressed to obtain a clinical cure.
Using topical antiseptic treatment will hasten clearing the infection.
Choice of antibiotic
The vast majority of skin infections in companion animals are associated with coagulase-positive staphylococci, with Staphylococcus pseudintermedius (part of the Staphylococcus intermedius group (SIG) the commonest causative agent in canine pyoderma (Devriese and others 2005, Bannoehr and others 2007).
There have been many studies describing the antibiotic susceptibility of SIG isolates (eg, Medleau and others 1986, Ihrke 1987, Ihrke 1996, Piriz and others 1996, Pellerin and others 1998, Ganiere and others 2005, Jones and others 2007, Norström and others 2009, Yoon and others 2010, Ghidini and others 2011). These show that the antibiotic sensitivity of SIG isolates vary. In particular, the number of drug-resistant, multidrug-resistant (ie, resistant to three or more classes of antimicrobial), and meticillin-resistant isolates has increased over time. Regular updates on susceptibility patterns to antimicrobials used in veterinary medicine are, therefore, required (Authier and others 2006). In addition, antimicrobial susceptibility patterns vary between countries, and clinicians should use data relevant to their location. A recent systemic review of systemic antibiotic therapy for canine pyoderma evaluated 17 clinical trials (Summers and others 2012). The authors concluded that there was good evidence supporting the high efficacy of subcutaneously injected cefovecin in superficial pyoderma and for oral clavulanate-amoxicillin in deep pyoderma. There was fair evidence for moderate to high efficacy of oral clavulanate-amoxicillin, clindamycin, cefadroxil, trimethoprim-sulphamethoxazole and sulfadimethoxine-ormetoprim in superficial pyoderma, and oral pradofloxacin, oral cefadroxil and subcutaneously injected cefovecin in deep pyoderma. It is possible to use this efficacy data and SIG susceptibility data to estimate the probability of successful management of staphylococcal skin infections with different antibiotics, and classify them into first-, second- and third-line antibiotics.
First-line antibiotics
First-line antibiotics include established and well-tolerated narrow and broad-spectrum drugs with antistaphylococcal activity. They are no less potent than higher-tier drugs in the correct circumstances, and are appropriate for empirical treatment of uncomplicated canine pyoderma. First-line drugs include cefadroxil, cefalexin, clavulanate-amoxicillin, clindamycin and lincomycin. Cefpodoxime and cefovecin can be included as first-line antibiotics where medication may be difficult, and/or compliance is, or likely to be, poor (Van Vlaenderen and others 2011). Long-term injectable or once-daily palatable oral antibiotics are useful if there is, or likely to be, poor adherence to the treatment regimen, problems with communicating the treatment regimen to the owner, and/or multiple therapies within a treatment regimen.
Inherent resistance of staphylococci limits the usefulness of tetracyclines (Kim and others 2005, Yoon and others 2010), some sulfonamides (Papich 1988) and simple penicillins (Abraham and Chain 1988, Yoon and others 2010). Tetracyclines and sulfonamides, however, may be useful for meticillin-resistant Staphylococcus aureus or S pseudintermedius infections when their use is indicated by in vitro sensitivity tests (Morris and others 2006).
Second-line antibiotics
Second-line antibiotics should only be used when there is culture evidence that first-line drugs will not be effective. These antibiotics are not appropriate for empirical antibiotic treatment (Authier and others 2006). Second-line antibiotics include newer broad-spectrum drugs important to animal and human health where the development of resistance is of greater concern. Second-line antibiotics include: cefovecin, cefpodoxime, difloxacin, enrofloxacin, marbofloxacin, orbifloxacin and pradofloxacin. The recent decline in staphylococcal susceptibility to fluoroquinolones is probably due to the common use of these drugs (Prescott and others 2002). To limit the emergence of resistance, fluoroquinolones should only be used where second-line antimicrobials are necessary (Authier and others 2006).
Third-line antibiotics
Third-line antibiotics are very important to animal and human health, especially for treatment of multidrug-resistant organisms. Resistance towards these drugs is of great concern and/or they have greater potential for adverse effects. Most of these drugs are not licensed for animals, and there are few safety and efficacy data. Third-line antibiotics must only be used when there is culture evidence of sensitivity, no first- or second-line antibiotics are effective, and topical antimicrobial therapy is not feasible or effective (Authier and others 2006). Third-line antibiotics include: aminoglycosides, azithromycin, ceftazidime, chloramphenicol, clarithromycin, florphenicol, imipenem, phosphomycin, piperacillin, rifampin, tiamphenicol and ticarcillin.
The development of resistant bacteria in human health is a big concern. In our ethical role of healthcare professionals, veterinarians should never use drugs deemed critically important to human health (eg, vancomycin, teicoplanin, linezolid etc) in animals. Some countries, moreover, expressly prohibit the use of human antibiotics not licensed for animals (eg, azithromycin, ceftazidime, clarithromycin, imipenem, phosphomycin, piperacillin, rifampicin, ticarcillin and others), so those antibiotics should preferably be avoided, even if there is evidence of sensitivity. Clinicians are responsible for ensuring that it is legal to use non-licensed drugs in their countries.
Escalation and de-escalation of treatment
Ideally, treatment should not be started until the results of bacterial cultures and antimicrobial sensitivity tests are available. If immediate treatment is necessary, the selection of an appropriate drug should be based on clinical signs and cytology, bearing in mind the most likely organisms and their likely antimicrobial sensitivity patterns in each case. When culture results become available clinicians should be prepared to escalate treatment by selecting a higher-tier drug, or de-escalate treatment to a lower-tier drug, as indicated.
Antibiotic dose, duration, adverse effects and compliance issues
Antibiotic dose
The skin is the largest organ of the body, and its blood supply is comparatively poor (Scott and others 2001). Antibiotics should, therefore, be used at the upper end of their dose range in pyoderma. Animals should always be weighed to allow accurate dosing. If necessary, slightly overdose – never underdose.
The following are effective doses for the most common antibiotics used in canine pyoderma:
Clavulanate-amoxicillin: 12.5–25 mg/kg every 12 hours orally (Lloyd and others 1997).
Cefalexin: 22–30 mg/kg every 12 hours, or 30–40 mg/kg every 24 hours orally (Toma and others 2008).
Cefadroxil: 22–30 mg/kg every 12 hours orally (Angarano and MacDonald 1989, Frank and Kunkle 1993), or 30–40 mg/kg every 24 hours orally (Noli and Scarampella 1999).
Lincomycin: 22 mg/kg every 12 hours orally (Harvey and others 1993).
Clindamycin: 11 mg/kg every 12–24 hours orally (Harvey and others 1993, Saridomichelakis and others 2011).
Cefovecin: 8 mg/kg every 14 days subcutaneously (Stegemann and others 2007, Six and others 2008).
Cefpodoxime 5–10 mg/kg every 24 hours orally (Brown and others 2007, Papich and others 2010, Kumar and others 2011).
Enrofloxacin: 5–20 mg/kg every 24 hours orally (DeManuelle and others 1998, Frazier and others 2000, Bidgood and Papich 2005, Boothe and others 2006).
Marbofloxacin: 2.5–5 mg/kg every 24 hours orally (Schneider and others 1996, Carlotti and others 1999, Frazier and others 2000, Paradis and others 2001, Horspool and others 2004, Boothe and others 2006).
Difloxacin: 5 mg/kg every 24 hours orally (Boothe and others 2006).
Orbifloxacin: 2.5–7.5 mg/kg every 24 hours orally (Boothe and others 2006, Scott and others 2006).
Pradofloxacin: 3 mg/kg every 24 hours orally (Mueller and Stephan 2007, Restrepo and others 2010).
Azithromycin: 10 mg/kg every 24 hours orally (Girard and others 1987, Shepard and Falkner 1990).
Chloramphenicol: 50 mg/kg every eight hours orally.
Rifampin: 5–10 mg/kg every 12–24 hours orally.
Tobramycin: 9–14 mg/kg every 24 hours subcutaneously.
Netilmicin: 9–14 mg/kg every 24 hours subcutaneously.
Amikacin: 15–30 mg/kg every 24 hours subcutaneously.
Gentamicin: 9–14 mg/kg every 24 hours subcutaneously.
The duration of treatment will depend on the depth of the infection. Superficial pyodermas typically need 2–3 weeks of treatment. Deep pyodermas can be greatly improved after two weeks, but full resolution often takes 4–6 weeks or longer (Carlotti and Ovaert 1988, Angarano and MacDonald 1989, Guaguère and Marc 1989, Paradis and others 1990, Scott and others 1994, 2006, Carlotti and others 1995).
Treatment has to be continued until the infection is visually and palpably cured, and cytology is normal. It is conventional to continue treatment for another seven days in case of superficial infections, and 14 days if there was deep infection (Scott and others 2001), although the evidence for this is largely anecdotal, and overly long treatment regimens may increase selection pressure for resistance among commensal bacteria. Treated cases should be checked every 1–2 weeks. If there is any doubt that complete resolution has not occurred, treatment should be continued, checking cytology and/or culture to confirm that remission is progressing. It is important to note that the clinical signs associated with an underlying disease may still be present and must be differentiated from the clinical signs of the pyoderma.
Owner compliance
Poor compliance or adherence to treatment is likely to compromise efficacy and encourage resistance. Compliance problems include underdosing, missed doses and stopping treatment early (Barter and others 1996; Grave and Tanem 1999), and compliance declines with twice daily or more frequent dosing and treatment regimens with more than one drug. Furthermore, owners may find it difficult or dangerous to administer drugs to some animals. Thus, discussing potential problems openly and honestly with owners helps to select the most appropriate drug and dosing regimen. Compliance can be improved by:
Using long-duration injectable drugs.
Using once-daily drugs.
Using palatable drugs.
Using drugs that the owner is able to administer safely.
Convincing the owner of the importance of correct treatment.
Giving written instructions.
Using precise terminology – for example, 'every 12 hours' instead of 'twice daily'.
Good follow-up and communication.
Minimising the number of different drugs or treatments.
Adverse effects
Owners should be warned about common and mild adverse effects, such as transient gastrointestinal tract upsets, to avoid them prematurely ceasing treatment. Adverse effects arise from effects on non-target bacteria, pharmacological activity (usually predictable and dose-related) or immune-mediated drug reactions (usually unpredictable and not dose-related). Adverse effects can be age, breed and species associated. Common adverse effects of antibiotics include, but are not limited to:
Gastrointestinal tract upsets – vomiting and diarrhoea may be associated with broad-spectrum antibiotics. This is usually mild and of short duration in dogs and cats, but may be more severe in hind-gut-fermenting species (eg, rabbits, rodents, horses etc).
Fluoroquinolones can cause neurological problems (especially enrofloxacin in cats and in dogs with a history of seizures) (Ihrke and others 1999), and cartilage abnormalities in skeletally immature dogs (Gough and others 1992).
Sulfonamides can be metabolised into immunologically reactive derivatives that cause skin reactions, polyarthritis, anaemia, thrombocytopenia and glomerulonephropathy, especially in dobermans (Noli and others 1995, Trepanier 1999). Keratoconjunctivitis sicca (Berger and others 1995) and hypothyroidism (Hall and others 1993) can also be seen, particularly with long-term treatment.
Penicillins and cefalosporins occasionally trigger allergic and immune-mediated drug reactions (Torres and Blanca 2010). Cross-reaction between penicillins and cefalosporins occurs in 1–10 per cent of human patients (Adkinson 1998).
Cefalosporins can induce positive Coomb's tests, but haemolytic anaemia is rare (Johnson and others 2007).
Cefalosporins can induce renal tubular damage, but clinical toxicity is very rare (Barza 1978).
Chloramphenicol can induce dose- and time-dependant bone marrow suppression (Holt and others 1993), although irreversible aplastic anaemia is not generally recognised in animals.
Aminoglycosides may cause renal toxicity (Martínez-Salgado and others 2007), and renal function should be checked before and during treatment (Noli and Morris 2011). For this reason, systemic aminoglycoside antibiotics should only be considered when there is evidence from bacterial culture and sensitivity testing that other antimicrobials would not be appropriate, and when topical antimicrobial or antibiotic therapy is not appropriate (eg, in deep pyoderma) or has not been effective.
Tetracyclines may cause hepatotoxicity, photosensitivity, discoloured teeth in young animals and teratogenicity.
Rifampin may cause hepatotoxicity, so hepatic function should be checked before and during treatment.
The potential for drug interactions and/or dose adjustments should be considered in animals on multiple drugs, and/or with renal or hepatic impairment. Reduced metabolism and/or excretion and extended half-life can cause cumulative dosing and increase the potential for adverse effects. It is therefore advisable to use drugs with an alternative route of excretion in animals with impaired renal and/or hepatic function, or to decrease the dosing interval and/or the dose. However, this may compromise efficacy if adequate tissue levels are not achieved and maintained.
Identification of the underlying cause
The vast majority of skin infections are secondary to a primary condition, such as a hypersensitivity, ectoparasitic infestation, endocrinopathy or keratinisation defects and so on. Successful long-term management requires that these are addressed. It is therefore important that the history and clinical signs are evaluated for clues to the underlying condition. These should then be investigated and managed as appropriate. It is beyond the scope of this article to discuss potential primary problems, and clinicians should consult other texts where necessary.
Treatment failures and recurrence
Poor response to treatment
In cases of poor response to treatment, a variety of reasons should be carefully considered:
Is there a bacterial skin infection? Carefully re-evaluate the clinical signs, cytology and bacterial culture.
Are resistant organisms present? Perform or repeat bacterial culture and antibiotic sensitivity.
Was the antibiotic given correctly? Was the owner compliant? Improve communication with the owner.
Were the dose and the duration correct? Re-evaluate the treatment regimen.
Was there the concurrent inappropriate use of immunosuppressive drugs, especially systemic glucocorticoids?
Poor distribution to the target tissue: deep pyodermas often feature extensive necrosis, scarring and debris that may limit penetration and activity of some antibiotics. Clindamycin, cefovecin and fluoroquinolones penetrate well to sites of skin infection and inflammation and could be used in these cases.
Recurrent pyoderma
In recurrent pyoderma, it is important to evaluate the time between drug withdrawal and relapse of the skin infection. If the pyoderma relapses after a few days, then the antibiotic course was too short. A longer course, following bacterial culture and sensitivity testing to check that the drug will still be effective, should be administered. If the pyoderma relapses weeks or months after antibiotic withdrawal, then there probably is an undiagnosed or uncontrolled underlying cause. In order to decrease the number and frequency of pyoderma relapses, topical antimicrobial shampoos or rinses can be used until the underlying cause is controlled.
A small number of cases, however, will suffer relapsing pyoderma if an underlying cause cannot be found (primary pyoderma) or cannot be controlled. Immunostimulants, such as Staphphage Lysate (DeBoer and others 1990) or autogenous bacterial vaccines (Curtis and others 2006) can be used in these cases. Topical antibiotics can be suitable for focal lesions, and may be useful to treat mucosal reservoir sites (Saijonmaa-Koulumies and others 1998). Pulse therapy with systemic antibiotics is not recommended for managing idiopathic recurrent pyoderma, as long-term systemic antibiotic treatment is a risk factor for the acquisition of antibiotic-resistant organisms. However, as a last resort, full-dose bactericidal antibiotics, such as clavulanate-amoxicillin or cefalexin may be given on 2–3 consecutive days each week ('weekend therapy') (Carlotti and others 2004). Long-duration injectable antibiotics are not suitable for pulse dosing.
Hygiene measures
Antibiotic resistance is an emerging problem in veterinary and human medical care, and constitutes a threat to animal welfare and public health. Good hygiene routines are necessary to prevent and control infections and minimise zoonotic risk. Suggested measures to improve hygiene standards in veterinary healthcare premises are based on minimising the risk of contamination of clothes, skin (especially the hands), instruments, clipper blades and the environment.
Work clothes should be changed at least daily (or more often if contaminated), and should not be used outside the clinical setting. Wearing short sleeves and restricting jewellery to simple wristwatches and wedding rings are important for proper hand hygiene. Alcohol-based (propanol 60 per cent w/w, ethanol 70–90 per cent w/w or isopropanol 60–80 per cent w/w) hand disinfection is effective in reducing transient microbial flora (Rotter and others 1998, WHO 2009, Kampf and Loffler 2010), but hand washing with warm water and a detergent is necessary if the hands are visibly soiled. To minimise the drying effect of alcohol, humectants and/or emollients can be added (Kampf and others 2005). Chlorhexidine should be avoided for hand disinfection of personnel, as chlorhexidine contact allergy can occur (Liippo and others 2011). Gloves do not substitute for hand hygiene. Hands should be disinfected before and after contact with a patient, before gloves are put on (as the integrity of gloves can be breached during the procedure), and after the use of gloves. After handling contaminated material, personnel should dispose of gloves and disinfect hands before touching a clean area. Unnecessarily frequent or prolonged use of gloves should be avoided as this can lead to development of hand eczema (Cleenewerck 2010).
Frequently touched surface areas in the environment, such as door handles, lamp handles and buttons, and microscope knobs need extra attention, and should be cleaned daily with non-corrosive disinfectants. As disinfectants can be partly inactivated when in contact with organic debris, mechanical cleaning (for example, with alcohol in combination with a surfactant/detergent) is important prior to disinfection. Spraying or pouring disinfectants on top of a dirty surface will not suffice in many instances. Non-disposable instruments should be cleaned and sterilised. Ear cones and clipper blades should ideally be autoclaved after use in veterinary practice. Computer keyboards have also been shown to be contaminated frequently with Pseudomonas species and Enterococcus species, and should be disinfected regularly (Fraser and Girling 2009). Washable keyboards should be used in clinical areas.
Patients with known or suspected contagious diseases and infections with multiresistant bacteria should be booked last in a day if possible, and ideally evaluated in a special consult room. Extra hygiene measurements should be undertaken when handling the patient. After the consult, the room should be cleaned before the next patient is allowed in. At this point, it is unknown for how long a dog which had an infection with a multiresistant Staphylococcus species can be an asymptomatic carrier of the bacteria. Owners of such patients can be asked to shampoo the dog with an antibacterial shampoo before coming into the clinic. Those dogs should not spend time in the waiting room. If possible, the dog should wait in the car, or outside with the owner, and then go straight into the consult room (FECAVA 2010, BSAVA 2011).
Clinic hygiene measures will only be successful if the board of the clinic is supportive, and all members of the staff stick to the protocol. Correctly implemented hygiene routines are an important contribution to patient and staff welfare, and are mandatory for high-quality veterinary healthcare.
The authors are thankful to Prof Dr Ralf S Mueller for his contribution to this work, and to Pfizer Animal Health for financial support of this project by means of sponsorship of travel and accommodation.
Provenance: Not commissioned; externally peer reviewed
Competing interests The authors are all recognised specialists in veterinary dermatology who were given an independent brief to develop a comprehensive guide to the use of systemic antimicrobials in bacterial skin infections. The meetings of the authors to produce these guidelines were kindly sponsored by Pfizer Animal Health (PAH). However, the guidelines are exclusively the opinion of the authors. The treatment options may include off-label or off-cascade suggestions. The authors believe that any decision on treatment protocols for a particular case remains the complete responsibility of the prescribing veterinarian. In particular, veterinarians must be aware of relevant medicines legislation, and whether it is legal to administer certain treatments in their country of work.
Open Access This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
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SYDNEY (Reuters) - Australia obliterated England's batting in a shade over 31 overs to claim a thumping 281-run fifth test victory with more than two days to spare and seal only the third 5-0 sweep in the long history of Ashes series on Sunday.
The triumph at a sunbaked Sydney Cricket Ground completed a remarkable turnaround for Australia, who were in disarray after being swept themselves in India and going down 3-0 in England to lose a third successive Ashes series last year.
A big clue to how Australia managed that turnaround came when paceman Mitchell Johnson was awarded the Compton-Miller medal as Man of the Series after taking 37 wickets at a shade under 14 apiece over the five tests.
Johnson's ferocious pace again played an integral part in Australia's victory in Sydney but it was no one man show and his fellow quick Ryan Harris won Man of the Match honours after taking five for 25 as England were skittled for 166 on Sunday.
"It's very special after the roller-coaster ride, the ups and downs of 2013," said Australia captain Michael Clarke, who also played in the 2006-7 sweep but clearly not that of 1920-21.
"It's been a lot of work to get us where we are today. I said to the bowlers at the start of the series that I thought they were the best attack in the world and I think they've shown that in five test matches."
Johnson's revival was even more remarkable than that achieved by Australia, turning him from a figure of ridicule for England's travelling Barmy Army into a bowler who struck fear into the touring batsmen.
It was his intervention after tea on Sunday that turned what had been a stately progression to victory into another humiliating rout for the tourists.
After finally dismissing Chris Rogers for 119 and bowling Australia out for 276, England stumbled to the break on 87 for three chasing a highly improbable 448 for victory.
A fifth thumping victory had always looked on the cards after Australia's pace attack tore through England's top order in the first hour of day two.
A more spectacular collapse in 11 balls after the second interval on day three made it certain with Johnson dismissing opener Michael Carberry for 43 and Gary Ballance three balls later in the first over.
"Mitchell's bowled a couple of spells in this series that are without doubt as good a spells as I've seen in my career," said Clarke.
"And I've been lucky enough to play with Glenn McGrath, Jason Gillespie, Brett Lee and Shane Warne."
Spinner Nathan Lyon took over for the next over and he dismissed Jonny Bairstow (zero) and Scott Borthwick (four) to reduce the tourists to 95-7 in a matter of minutes.
With England's top order having failed yet again, Ben Stokes (32) and Stuart Broad (42) provided their country's stiffest resistance down the order but they could only delay the inevitable.
Harris bowled them both before performing the coup de grace on debutant Boyd Rankin and the SCG, bathed in pink in honour of Glenn McGrath's breast cancer charity, rose to hail the Australia team.
"I think today's batting was a culmination of being under the kosh for four and a half games," said England captain Alastair Cook.
"Credit to Australia, I can't even count on how many sessions we won in the series. That's a pretty daunting stat to take but a very realistic statistic."
Australia had already reclaimed the coveted urn after winning the Brisbane test by 381 runs, the Adelaide match by 218 runs, in Perth by 150 runs and taking an eight-wicket triumph in Melbourne.
For a dispirited England, their triumphs in India in 2012 and in Australia in 2010-11 will appear a distant memory and they face an immediate future of recrimination and rebuilding.
Aside from criticisms of his captaincy, Cook's miserable series was a reflection of that of a vaunted batting line-up which simply failed to fire in the face of sustained pressure from the Australians.
The England skipper's seven runs on Sunday gave him 246 at an average of 24.6 for the series, a paltry return compared to the 766 runs at 127 he accumulated on his last trip to Australia in 2010-11 when he returned home a 3-1 winner.
England's other top batsmen did not fare much better with Jonathan Trott returning home after the defeat in the opening test to deal with stress-related issues and Ian Bell and Kevin Pietersen failing to live up to their billing.
The England bowlers have little more to crow about and one of the many statistics being bandied about to illustrate Australia's supremacy in the series will embarrass them.
While Australia took all 100 wickets in a five-test Ashes series for the first time, England failed to dismiss their opponent's number 11 batsman, Lyon, even once.
"It's tough knowing you've played your five matches and lost them all badly," Cook added. "We just weren't good enough to turn it around."
Editing by Amlan Chakraborty


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Brooklyn resident Pam McAllister's book The Bedside, Bathtub & Armchair Companion to Mark Twain came out last March, but the Brooklyn Daily Eagle has just published a piece on the author that's worth a read.
McAllister talks about her love of Mr. Clemens, and what it's like being an author in Brooklyn's gentrified Park Slope community.
"Of my 10 published books, this was the most fun to research and write," she says. "I have been a 'Twainiac' since my teen years. My book is a tribute to the world's first global celebrity, 'the People's Author.'"
I see I'm not the only one to adopt the "Twainiac" moniker!
You Oughta Be in Pictures
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Even after living here for ages now, I just cannot make it through this time of year without serious pangs of homesickness.
I don't know what sets it off. Maybe it's the change in weather (two pairs of tights weather), hearing the NFL theme song, or the official smell of fall – the Starbucks PSL – wafting through Wimbledon station. It all makes me want to get off this island and return the good old US of A.
And missing Thanksgiving is the worst of all.


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