text:
Clinical Study | Open Access
Katayoun Salem, Shaqayegh Kamranzadeh, Maryam Kousha, Shahnaz Shaeghi, Fatemeh AbdollahGorgi, "Two Oral Midazolam Preparations in Pediatric Dental Patients: A Prospective Randomised Clinical Trial", International Journal of Pediatrics, vol. 2015, Article ID 349795, 7 pages, 2015. https://doi.org/10.1155/2015/349795
Two Oral Midazolam Preparations in Pediatric Dental Patients: A Prospective Randomised Clinical Trial
Pharmacological sedation is an alternative behavior management strategy in pediatric dentistry. The aim of this study was to compare the behavioral and physiologic effects of "commercially midazolam syrup" versus "orally administered IV midazolam dosage form (extemporaneous midazolam (EF))" in uncooperative pediatric dental patients. Eighty-eight children between 4 to 7 years of age received 0.2–0.5 mg/kg midazolam in this parallel trial. Physiologic parameters were recorded at baseline and every 15 minutes. Behavior assessment was conducted objectively by Houpt scale throughout the sedation and North Carolina at baseline and during injection and cavity preparation. No significant difference in behavior was noted by Houpt or North Carolina scale. Acceptable behavior (excellent, very good, and good) was observed in 90.9% of syrup and 79.5% of EF subjects, respectively. Physiological parameters remained in normal range without significant difference between groups and no adverse effect was observed. It is concluded that EF midazolam preparation can be used as an acceptable alternative to midazolam syrup.
1. Introduction
Dental fear/anxiety and behavior management problems in pediatric patients are two major aspects of uncooperativeness in pediatric dentistry. Whilst Psychological techniques are the cornerstone of behavior management in pediatric dentistry, a number of children cannot cope with dental treatment using these techniques alone. Pharmacological methods have been used as an adjunct to enhance child cooperativeness and facilitate dental treatment [1, 2]. The primary aim of mild and moderate pharmacological sedation in pediatric dentistry is to modify the patient's behavior to an extent that allows applying behavior management techniques [1]. Evidence for best choice of sedative agents in children is still incomplete [2]; however, midazolam, a short-acting benzodiazepine, has been extensively used due to its therapeutic index and wide margin of safety [3–9]. Since oral dosage form of midazolam is not commercially available in many countries, therefore injectable midazolam in mixture with a flavoring agent, to mask the undesirable taste and adjust the pH, briefly known as extemporaneous form (EF) has been used as an alternative [3, 7].
Despite extensive administration of EF preparation, there is no consensus on its effectiveness [2]. Therefore the aim of this study was to(i)evaluate and compare the safety and efficacy of two midazolam oral preparations: "EF midazolam" versus "commercially prepared midazolam syrup" in pediatric dental patients by measuring physiological parameters and behavioral scales including North Carolina and Houpt behavioral scales. The latter ones evaluate the level of consciousness and cooperativeness in sedated patients.
2. Subjects and Methods
The research protocol was reviewed and approved by the Ethical Committee of the Guilan University of Medical Sciences, Rasht, Iran (Grant number 3910354611). The investigation was a randomized, double-blind study. Written informed consent was obtained from parents or legal guardians prior to enrollment of subjects in the study.
The study was conducted in 88 children (41 males and 47 females) aged 4 to 7 years and ASA class I (ASA: American Society of Anesthesiologists' Physical Status Classification System) that means a normal healthy subject. The patients were referred to Pediatric Clinic of Guilan Dental School due to uncooperativeness and difficulties in behavior management. Prior to sedation appointment, it was attempted to treat these children using behavior management methods including Tell-Show-Do and positive reinforcement. Eligible participants were rated as negative on the Frankl behavioral rating scale [10]. Children were required to have an adequate degree of understanding to communicate during the course of treatment. With regard to dental treatment, participants must have at least one primary molar with pulp treatment needs. Patients were excluded from the study if they had physical or mental disabilities, history of respiratory diseases in the past two weeks, and tonsil/adenoid hypertrophy that occupied more than 50% of pharyngeal space. Other exclusion criteria included anatomical deformities in face and neck such as micrognathia and macroglossia and any known allergy to midazolam.
Eligible patients were randomly assigned to one of two parallel treatment groups. Forty- four patients were randomly allocated to each group using 6 quadric blocks. Patients received 0.2 or 0.5 mg/kg midazolam syrup or EF midazolam according to their age up to a maximum dose of 12 mg. A dose of 0.5 mg/kg was administered to children less than five years of age (48 to 59 months) and 0.2 mg/kg for over the age of five years (60 to 84 months) (Saarnivaara 1998). Demographic information of the study patients is summarized in Table 1. Table 2 presents the age-adjusted distribution of children.
|Independent test, Chi-square.
|Friedman test.
Sample size was calculated based on a previous sedation study [8] with 80% study power and 95% confidence interval ( = 0.05) and the clinical difference between groups was considered 25%.
2.1. Drug Administration
Children received either regimen A: 0.2 or 0.5 mg/kg midazolam maleate syrup sugar free liquid (Amsed oral liquid 2.5 mg/mL; UK) or regimen B: 0.2 or 0.5 mg/kg midazolam EF 2.5 mg/mL that consisted of the injectable solution of midazolam hydrochloride (Ampule 15 mg/3 mL Midamax, Tehran Shimi, Iran) in combination with the same volume of concentrated viscous orange syrup according to their age. The pH of final EF preparation was 3.7 and the commercial preparation's pH was equal to 4. Both pH values were determined by automated pH meter (Acorn Ion 6 Meter). Drugs were administrated by a dental nurse who was unaware of the study design, using a needleless syringe placed in the lower buccal vestibule. After administration of midazolam, the patients remained under supervision in a quiet place. Thirty minutes after administration, children were transferred to dental operatory in accompany of their parents. Parents were asked to leave the operatory during the treatment session to eliminate any potential impact of parent's presence on child's behavior. All participants received similar restorative treatments including topical anesthetic gel (Benzocaine 10%) followed by local anesthesia (Lidocaine-Epinephrine 1/100.000) and pulp therapy followed by restoration of the tooth which included either fillings or stainless steel crowns. The maximum dose of local anesthesia was limited to 4 mg/kg. Treatment was planned to be accomplished in maximum thirty minutes and any type of physical restraints was not used.
2.2. Behavior Assessment
Behavior was videotaped and rated by a trained and calibrated examiner who was blind to the study design using two behavioral measures: North Carolina rating scale to evaluate behavior preoperatively and during critical moments of treatment including injection and cavity preparation (Table 3) and Houpt sedation rating scale to determine the level of sedation according to degree of sleep, crying, movement, and finally an overall appraisal of behavior through the treatment course (see Definition of Houpt sedation rating scale) [11]. The examiner was the senior dental student who was trained and calibrated via examination of five patients prior to study. The Cohen Kappa for intra-examiner reliability was 8.9.
|Undesirable behavior includes crying, screaming, head movement, torso movement, and foot movement.
Definition of Houpt Sedation Rating Scale Is as Follows [11]
Rating Scale for Sleep(1)fully awake, alert,(2)drowsy, disorientated,(3)asleep.
Rating Scale for Crying(1)hysterical crying that demands attention,(2)continuous, persistent crying that makes treatment difficult,(3)intermittent, mild crying that does not interfere with treatment,(4)no crying.
Rating Scale for Movement(1)violent movement interrupting treatment,(2)continuous movement making treatment difficult,(3)controllable movement that does not interfere with treatment,(4)no movement.
Rating Scale for Overall Behavior(1)aborted no treatment rendered,(2)poor treatment interrupted, only partial treatment completed,(3)fair treatment interrupted, but eventually all completed,(4)good, difficult, but all treatment performed,(5)very good some, limited crying or movement, for example during anesthesia or mouth prop insertion,(6)excellent no crying or movement.
2.3. Physiologic Parameters
Physiologic parameters including heart rate, respiratory rate, oxygen saturation, and blood pressure were monitored continuously during treatment using operating room design monitors (Massimo Set, Alborz B5 Saadat, Iran) through the course of treatment and every 15 minutes. Physiological parameters were recorded at baseline and at every 15 minutes. The parameters rated at the time of arrival when the child entered the operatory on the day of study for sedation appointment and before any drug administration. The measurements repeated at the beginning of treatment and then every 15 minutes. Hypoxemia was determined as oxygen saturation beyond 93% (except during crying) and Spo2 < 90% was considered as apnea [12].
2.4. Data Analysis
Data were analyzed using Kolmogorov Simonov, independent -test, Chi-square, Friedman test, Fisher's exact test, Mann-Whitney test, repeated measure Greenhouse Geiseer, adjustment Bonferroni, backward stepwise multivariate regression, and Mantel-Haenszel common odds ratio by SPSS version 21. Significance level was established at 0.05 in all tests.
3. Results
A total of eighty-eight children including participated in the study. Demographic characteristics of patients are presented in Table 1. There were no statistical differences in age, weight (Independent -test , and ), and gender (Chi-square ) between the two groups. Characteristics of participants under and above the age of 60 months in two study groups are presented in Table 2. Participants of syrup and EF groups did not show significant difference in age and gender.
The flow diagram of study participants is presented in Figure 1.
3.1. Rating of Behavior
3.1.1. North Carolina Rating Scale
Table 2 presents the behavior assessments by North Carolina rating scale at important moments of sedation appointments including "before sedation, when the child arrived to operatory at the day of sedation appointment and before any drug administration," "during injection," and "cavity preparation." The worst manifestation of child's behavior was recorded at each step. All children revealed more calm behavior at the times of injection and cavity preparation in comparison to their behavior at the time of arrival (Friedman test ).
3.1.2. Houpt Sedation Rating Scale
Figures 2–5 present the age adjusted categories of Houpt Behavior Rating Scale. There were 15 children under the age of 59 months and 73 aged 60 months and older. Ratings of sleep, crying, movement, and overall behavior domains were divided into two-dose (age) groups that did not differ significantly: Mann-Whitney test; , , , , respectively (Figures 2–5).
Acceptable behavior according to age was observed in 7 and 6 children younger than the age of 5 years and among 33 and 29 children at 5 years of age and older, in syrup and EF groups, respectively (Fisher exact; and ).
When adjusted for age (48–59 months children versus 60 months and older), the risk that a child displayed acceptable overall behavior after EF midazolam administration was 0.38 times compared to those who received syrup (OR = 0.388, SE (0.64) 95% CI: 0.11–1.37; ) (Mantel-Haenszel common odds ratio estimate).
The overall behavior regardless of age was dichotomized, and two categories of acceptable and unacceptable behavior were determined. The Acceptable behavior was defined as good, very good, and excellent. The unacceptable behavior included: fair, poor, and aborted categories of behavior. Acceptable behavior was observed in 90.9% of syrup and 79.5% of EF, respectively, Chi-square .
Stepwise backward regression was used to determine the best predictors of overall sedation success regardless of age dichotomization. Final model showed that the only predictor of sedation success was administration of commercially prepared syrup that increased the chance of success by 4.67 times: ; OR: 4.67 (95% CI: 1.05–20.6).
The palatability of drugs was rated as acceptable by 79.5% of those where syrup was administered and 59% of EF group children (Chi-square ).
3.2. Physiologic Parameters
Data on physiological parameters are presented regardless of age classification. Investigated physiologic parameters remained in normal range in both study groups. Up to 20% increase/decrease in normal limits for each age group was considered normal. A detailed explanation of physiological parameters is presented in the following.
3.2.1. Percent of Oxygen Saturation (SPO2)
There was no significant difference between two study groups in percent of oxygen saturation: (repeated measure Greenhouse Geiseer). Fluctuation of SPO2 in syrup group was not significantly different from one time to another. In contrast, significant (but within normal) changes in SPO2 were observed between minute 30 and other measurement times among EF group: values: 0.015, 0.006, and 0.009 for baseline, minute 0, and minute 15, respectively (adjustment Bonferroni test).
3.2.2. Heart Rate
Subjects in group A (syrup) had a higher baseline heart rate in comparison to group B. , and this pattern continued at all measurement times except minute 0. Intragroup measurements did not show any significant change from baseline to minute 30: repeated measure of Greenhouse .
3.2.3. Respiratory Rate
Respiratory rate was higher basically and in all other measurements except minute baseline, in group A. There was a mild descending curve from baseline to minute 30 in this group: Mann-Whitney test, .
3.2.4. Systolic and Diastolic Blood Pressure
The groups were not significantly different. Intragroup measurements revealed significant fluctuations in systolic and diastolic blood pressure in group B: repeated measure of Greenhouse value: 0.02 and 0.001 for systolic and diastolic pressure, respectively.
Serious adverse effects were not observed during and after sedation appointment. One case of hiccupping was observed shortly after drug administration.
4. Discussion
The results of this study indicated that both regimens were safe with reasonable level of sedation acquired. To the best of our knowledge, there are few published studies that have investigated safety and efficacy of midazolam syrup versus orally administered IV midazolam (EF midazolam). In comparison to commercial syrup with IV midazolam in the mixture of Syrpalta (pH = 5), Brosius and Bannister reported higher plasma levels and superior sedative effects from IV midazolam-Syrpalta [13]. Khalil et al. reported less preanesthetic anxiety at 15 minutes and at parental separation in children who received IV midazolam-Syrpalta mixture when compared to those who received the premixed midazolam solution [14].
The effectiveness of EF midazolam over commercial preparations is a controversial issue [2, 5]. Our results did not show a significant difference between two midazolam preparations; however, administration of the commercial syrup increased the chance of overall success when compared to EF preparation. Variability of sweeteners and juices added to IV drug resulted in diversity in pH, viscosity, and pharmacokinetics that may explain this controversy [15–18]. The pH of our oral dosage was 3.7 and the pH of commercially syrup was 4 and fruit juices usually added to midazolam had a pH about 2.8 that can justify the difference in absorption of drug [15, 19]. Mucosal absorption is a pH dependent phenomenon. Increasing the pH from 2.8 (IV formulation) to 4 results in formation of more than 95% of active lipophilic drug or closed ring that is readily absorbable from oral mucosa [13, 14]. Since significant amount of midazolam is absorbed by mucosal membranes of the oral cavity, esophagus, and stomach, pH variability may result in divergent observed responses to midazolam [19]. Another consideration in midazolam absorption is the drug's viscosity. Viscous preparations are retained in oral environment for longer periods of time that per se increases the local absorption of drug from permeable oral mucosa especially nonkeratinized tissue of buccal mucosa [16, 18, 20, 21]. Relative absorption of drug from direct drainage of oral blood vessels into the jugular vein is another priority over less viscous preparations which lead to better bioavailability of drug [20].
In the present study a dose of 0.5 and 0.2 mg/kg was chosen for children under and over five years of age, respectively, according to a pilot study as well as the previous works on this area [3, 22]. Age effects on dosage requirements have been discussed in the anesthesiology literature [17]. The midazolam dose should be individualized based on patient age, degree of anxiety, and the level of sedation desired [3]. Younger children may need higher doses of the drug for higher hepatic blood flow and metabolism rate [16, 23], in addition to lower expression, distribution, and coupling ability of type A GABA receptors [17]. It appears to be an optimal balance between anxiolytic activity and side effect liability in doses of 0.25 mg to 0.50 mg/kg [3]. We compared all aspects of sedation including sleep, movement, crying, and overall behavior by adjusting the effect of age. Similar results were achieved when the total dose was restricted to decrease the dose in older children. Although midazolam falls in a group of agents with broad margin of safety, lowering the dose may be desirable for decreasing the potential side effects [3, 5]. It may be logical to preserve the higher doses for those who do not respond favorably to lower doses of drug.
Mild and moderate sedation via oral route is an effective, safe, and convenience mode of midazolam administration that may fill the gap between psychological strategies and general anesthesia in many subjects.
More research is needed either by increasing the prescribed dose of drug or by administration of alternative agents in cases of unsuccessful sedations.
5. Conclusion
According to the results of this study EF midazolam preparations in a dose of either 0.2 or 0.5 mg/kg provided safe and effective sedation. Hence, lower doses may be advocated to older children.
Clinical Implications
(a)What is already known is that midazolam is widely used as a safe and effective sedative agent in pediatric sedation. However, oral form of drug is not available in many countries and it is also expensive and not cost effective for occasional use.(b)What this article adds is that injection formulation can be used for oral administration.(c)Implications for translation are as follows. This extemporaneous preparation may be effectively used by pediatric dentists and other professionals who work in pediatric area as a safe effective agent in management of uncooperative behavior. In addition, identifying the populations who benefit from this agent can help to target the responders. Further researches can focus on other doses of midazolam or alternative agents for children with those behavioral characteristics that are not responsive to midazolam.
Ethical Approval
Ethical approval was obtained from ethical committee of Guilan University of Medical Sciences reference number 3910354611 and IRCR reference number IRCT201302031861N4.
This investigation was based on a dissertation submitted by the second author to the Faculty of Dentistry of the Guilan University of Medical Sciences (GUMS) in Iran, in partial fulfillment of the requirements for receiving a doctoral degree.
Conflict of Interests
The authors declare that they have no conflict of interests.
The study is granted by Deputy of Research, Guilan University of Medical Sciences. The authors also express their appreciation to Mrs. Nastaran Mirfarhadi and dental nurses Mrs. Sarah Ataiee and Mrs. Masoumeh Rahmati for their contribution in blinding and drug administration.
- M. Raadal, S. Lundeberg, and G. Haukali, "Pain, pain control and sedation," in Pediatric Dentistry, A Clinical Approach, G. Koch and S. Poulsen, Eds., p. 54, Blackwell, Singapore, 2nd edition, 2009. View at: Google Scholar
- L. Lourenço-Matharu, P. F. Ashley, and S. Furness, "Sedation of children undergoing dental treatment," The Cochrane Database of Systematic Reviews, vol. 3, Article ID CD003877, 2012. View at: Publisher Site | Google Scholar
- A. Alzahrani and A. Wyne, "Use of oral midazolam sedation in pediatric dentistry: a review," Pakistan Oral & Dental Journal, vol. 32, no. 3, pp. 444–455, 2012. View at: Google Scholar
- D. E. Becker and P. A. Moor, "Anxiolytics and sedative-hypnotics," in Management of Pain and Anxiety in the Dental Office, R. A. Dionne, J. C. Phero, and D. E. Becker, Eds., pp. 129–260, W.E. Saunders Company, 1st edition, 2002. View at: Google Scholar
- C. Goho, "Oral midazolam-grapefruit juice drug interaction," Pediatric Dentistry, vol. 23, no. 4, pp. 365–366, 2001. View at: Google Scholar
- S. F. Malamed, Sedation: A Guide to Patient Management, Chapter 7, C. V. Mosby, Elsevier, San Diego, Calif, USA, 5th edition, 2010.
- M. Rosenberg, "Oral midazolam syrup as a safe sedative for pediatric dentistry," Dental News, vol. 7, no. 3, pp. 69–71, 2000. View at: Google Scholar
- S. A. Sheta and M. AlSarheed, "Oral midazolam premedication for children undergoing general anaesthesia for dental care," International Journal of Pediatrics, vol. 2009, Article ID 274380, 7 pages, 2009. View at: Publisher Site | Google Scholar
- S. Wilson and L. Ganzberg, "Pain Reaction control: sedation," in Casamassimo, Fields, Mctigue, Nowak; Pediatric Dentistry, Infancy through Adolescence, p. 115, Elsevier, Beijing, China, 5th edition, 2013. View at: Google Scholar
- J. A. Dean, D. R. Avery, and R. E. McDonald, Eds., McDonald and Avery's Dentistry for the Child and Adolescent, Mosby-Elsevier, Shanghai, China, 9th edition, 2011.
- M. I. Houpt, R. G. Rosivack, N. Rozenfarb, and S. R. Koeningsberg, "Effects of nitrous oxide on chloral hydrate sedation of young children," Anesthesia Progress, vol. 33, no. 6, pp. 298–302, 1986. View at: Google Scholar
- M. M. Sheroan, D. C. Dilley, W. J. Lucas, and W. F. Vann, "A prospective study of 2 sedation regimens in children: chloral hydrate, meperidine, and hydroxyzine versus midazolam, meperidine, and hydroxyzine," Anesthesia Progress, vol. 53, no. 3, pp. 83–90, 2006. View at: Publisher Site | Google Scholar
- K. K. Brosius and C. F. Bannister, "Midazolam premedication in children: a comparison of two oral dosage formulations on sedation score and plasma midazolam levels," Anesthesia & Analgesia, vol. 96, no. 2, pp. 392–395, 2003. View at: Publisher Site | Google Scholar
- S. N. Khalil, H. N. Vije, S. S. Kee, A. Farag, E. Hanna, and A. Z. Chuang, "A paediatric trial comparing midazolam/Syrpalta mixture with premixed midazolam syrup (Roche)," Paediatric Anaesthesia, vol. 13, no. 3, pp. 205–209, 2003. View at: Publisher Site | Google Scholar
- B. Isik, Ö. Baygin, and H. Bodur, "Effect of drinks that are added as flavoring in oral midazolam premedication on sedation success," Paediatric Anaesthesia, vol. 18, no. 6, pp. 494–500, 2008. View at: Publisher Site | Google Scholar
- K. Jain, B. Ghai, A. K. Saxena, D. Saini, and N. Khandelwal, "Efficacy of two oral premedicants: midazolam or a low-dose combination of midazolam-ketamine for reducing stress during intravenous cannulation in children undergoing CT imaging," Paediatric Anaesthesia, vol. 20, no. 4, pp. 330–337, 2010. View at: Publisher Site | Google Scholar
- Z. N. Kain, J. N. MacLaren, B. C. McClain et al., "Effects of age and emotionality on the effectiveness of midazolam administered preoperatively to children," Anesthesiology, vol. 107, no. 4, pp. 545–552, 2007. View at: Publisher Site | Google Scholar
- L. D. Mishra, G. K. Sinha, P. B. Rao, V. Sharma, K. Satya, and R. Gairola, "Injectable midazolam as oral premedicant in pediatric neurosurgery," Journal of Neurosurgical Anesthesiology, vol. 17, no. 4, pp. 193–198, 2005. View at: Publisher Site | Google Scholar
- J. Zhang, S. Niu, H. Zhang, and J. B. Streisand, "Oral mucosal absorption of midazolam in dogs is strongly pH dependent," Journal of Pharmaceutical Sciences, vol. 91, no. 4, pp. 980–982, 2002. View at: Publisher Site | Google Scholar
- A. H. Shojaei, "Buccal mucosa as a route for systemic drug delivery: a review," Journal of Pharmacy & Pharmaceutical Sciences, vol. 1, no. 1, pp. 15–30, 1998. View at: Google Scholar
- M. F. Levine, I. A. Spahr-Schopfer, E. Hartley, J. Lerman, and B. MacPherson, "Oral midazolam premedication in children: the minimum time interval for separation from parents," Canadian Journal of Anaesthesia, vol. 40, no. 8, pp. 726–729, 1993. View at: Publisher Site | Google Scholar
- L. Saarnivaara, L. Lindgren, and U.-M. Klemola, "Comparison of chloral hydrate and midazolam by mouth as premedicants in children undergoing otolaryngological surgery," British Journal of Anaesthesia, vol. 61, no. 4, pp. 390–396, 1988. View at: Publisher Site | Google Scholar
- C. J. CotE, J. Lerman, R. M. Ward, R. A. Lugo, and N. Goudsouzian, "Pharmacokinetics and pharmacology of drugs used in children," in A Practice of Anaesthesia for Infants and Children, C. J. Cote, J. Lerman, and I. D. Todres, Eds., Elsevier, 4th edition, 2008. View at: Google Scholar
Copyright © 2015 Katayoun Salem et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


text:
Shop Plans
Find a Health Plan
We offer a complete choice of plans to meet your coverage needs and fit your budget.
More Plans
Get a Dental Plan
We offer three Traditional plans and three Certified plans to meet your needs.
Pick a Medicare Plan
Thinking about your Medicare options? Find out which plan is right for you.
Find Doctor or Drug
Find a Doctor
Find a Doctor or Drug
Pick a directory to search or find other helpful information about drug resources, quality programs and more.
Louisiana Provider Directory
Quality Blue Directory
National Provider Directory
BlueDental Advantage Plus Directory
Davis Vision Directory
Hospital Based Physicians
ER/OR Information
Are you planning a hospital stay? If you just found out that you need surgery, or if you will be admitted to a hospital or ambulatory surgical center for any reason, you will most likely receive some care during your stay from a hospital-based physician. Learn more.
Other Directories
Blue Cross Blue Shield Global Core
Federal Employee Program (FEP)
Rx Drug Resources
Rx Drug Resources
Manage your medicine, find drug lists and learn how to save money.
Quality Programs
Quality Blue Programs
We work with doctors, hospitals and clinics around Louisiana to make sure you have a better healthcare experience.
Save Money
$25 Gym Memberships
Find a Gym
For just $25 a month and a $25 enrollment fee, you'll have access to 9,000 participating fitness locations around the state and nation.
More Money-Saving Tips
Find Discounts
Lower Drug Costs
Preventive Care Services
Primary Care Doctor
Pick a Primary Care Doctor
Picking a primary care doctor is an important step to staying healthy and saving money.
Choose the Right Care
Choose the Right Care
Where you and go and who you see for treatment is a big part of getting quality healthcare while saving money.
Save Money
Get discounts on gym memberships, fitness gear, healthy eating, prescriptions and more.
More Wellness Tips
Preventive Care Services
Member Programs
Find a Program
Whether you want to quit smoking or find the right doctor, we have many programs to help.
Wellness Library
Learn About Wellness
Read articles, take quizzes, watch videos and listen to podcasts about many health topics.
Insurance 101
Learn the Basics
Understand your plan, learn about health savings accounts, and watch helpful videos.
Find Us on Social Media
Join the conversation and stay connected with us for exclusive content.
Straight Talk
Get Straight Answers
If you're looking for a straight answer to your healthcare questions, this is the place.
My Account
My Account Information
Manage Account
Manage Your Account
Pay your bill, view your statements or update your email or password.
Other Coverage Questionnaire
Authorized Delegate
Health Assessment
Biliary atresia is a rare liver disease that occurs in infants. It is often found shortly after birth. The disorder affects tubes in the liver called bile ducts. If not treated with surgery, it can be fatal.
Bile is a fluid made by the liver. Normally the bile ducts take bile to the small intestine. Bile helps with digestion and also carries waste products. When a child has biliary atresia, the bile ducts in the liver are blocked. Bile becomes backed up in the liver. This damages the liver. Many vital body functions also are affected.
There are two types of biliary atresia:
Biliary atresia must be treated with surgery. It is the most common cause of liver transplants in children in the U.S. It is more common in girls than in boys.
Experts don't know what causes biliary atresia. It is not passed down from parent to child, so it is not an inherited disease.
Researchers are looking at possible causes, such as:
Babies with biliary atresia usually seem healthy at birth. Most often, symptoms start to occur between 2 weeks and 2 months of life. Symptoms may include:
Symptoms of biliary atresia may look like other liver conditions or health problems. Always see your child's healthcare provider for a diagnosis.
Your child's healthcare provider will give your child an exam and take a health history. The provider may also do several tests. These may include the following.
Without surgery, biliary atresia can be fatal. Two types of surgery are used to treat this condition. Your child's healthcare provider will discuss which surgery would be a good choice for your child.
This surgery connects the bile drainage from the liver directly to the intestinal tract. It goes around (bypasses) the blocked bile ducts. This surgery can allow a child to grow and be in fairly good health for a few years. At some point, bile will back up into the liver. This causes liver damage. A liver transplant may also be needed over time.
A liver transplant removes the damaged liver and replaces it with a new liver from a donor. The new liver can be one of the following:
After a liver transplant, the new liver begins working and the child's health often gets better quickly.
After a transplant, a child must take medicines to help prevent the body's immune system from attacking, or rejecting, the new liver. These medicines are called antirejection medicines. Rejection is part of the immune system's normal way of fighting against viruses, tumors, and other foreign substances. Antirejection medicines weaken the immune system's response.
It's important to have regular contact with your child's healthcare provider and members of the transplant team after a liver transplant.
Before your child has surgery, nutrition may be a problem. With biliary atresia, not enough bile reaches the intestine to help digest fats in the diet. Liver damage can cause a lack of protein and a lack of vitamins. Children with liver disease need more calories than a normal child because they have a faster metabolism.
Your child's healthcare provider may recommend that your child see a pediatric nutritionist. The nutritionist can advise you on your child's diet. A nutritional plan may include a balanced diet and added vitamins, as directed by your child's healthcare provider.
Some children with liver disease become too sick to eat normally. If this is the case, your child's provider may also recommend that you give high-calorie liquid feedings. These feedings are given through a tube called an NG, or nasogastric tube. The tube is guided into your child's nose, down the esophagus, and into the stomach. A high-calorie liquid can be given through the tube to add to your child's diet if your child can only eat small amounts of food. Or it can replace meals if your child is too sick to eat.
After surgery, your child's digestion may go back to normal. Or you may still need to give your child extra vitamins or adjust your child's diet. Talk with your child's healthcare provider for recommendations.
Many factors affect how well children with biliary atresia do over time. These factors include:
After a liver transplant, your child's health will typically improve. But your child must follow a strict medical routine. This includes taking:
It is important to work closely with your child's healthcare providers.
Call your child's healthcare provider right away if you see that your child has any of the following:
Also call your child's healthcare provider to ask what symptoms you should look for if your child:
Tips to help you get the most from a visit to your child's healthcare provider:

subset: commoncrawl


text:
From the process of natural aging, bearing children, or simply gaining excess weight, you might find that your figure is not as shapely and defined as you'd like it to be. At one point in time, you simply had to accept the facts and live with it. Today, fortunately, you have options to get the body of your dreams when diet and exercise don't help. Body contouring, which involves addressing one or more body parts to help you improve your image, is a very popular option for many people to get a better-looking body. Body contouring might involve liposuction, laser treatments, and other procedures to add lift where you want it and trim excess fat.
What Is Body Contouring?
Body contouring is a novel technique that uses primarily non-surgical methods to give patients a more aesthetically pleasing body shape. There are a variety of options available for contouring, which are designed to remove troublesome pockets of fat that don't respond to other weight loss tactics. There are four general categories that body contouring covers. They include: cryolipolysis, laser lipolysis, injection lipolysis, and radiofrequency lipolysis. Cryolipolysis is a technique that uses freezing to eliminate fat cells. CoolSculpting® is a popular type of cryolipolysis. The advantage of these non-surgical body contouring solutions is that they are a fast and effective way to shape the body. Unlike surgery, they don't require any downtime, and the results are usually apparent right away. Repeat sessions may be needed to further sculpt and refine the body.
Get In Touch for Further Information
With body contouring, getting the body that you want no longer has to be a pipe dream. Many people choose to get this procedure when they can't lose excess weight or find that their skin becomes looser and less firm over the years. At New Image Body Sculpting we offer CoolSculpting® for your body contouring needs. We are conveniently located in Glendale, CA. Contact us today to schedule your consultation!


text:
I want to buy the "Wings Accounting Lite 16.0" license version. Can you, please, let us know where the branch is located in Gujarat (India) or can you provide any delivery information including a courier?
You can use the official website to buy the program. There is no need for additional delivery or purchase options since it's a program mostly used in the India region. However, there is also a free version of the software that can be downloaded from the official website.


text: Reason for Request*Two Exams Scheduled Back to BackTwo Exams Scheduled on Same DayIllness or Emergency (Please attach supporting documentation)Extraordinary and compelling reasons beyond the student's controlIllness or Emergency - Additional Details*Please explain:*Supporting documentation upload (if applicable):Name* First Last Access Card ID Number*Anonymous 4 Digit Grading IDNeeds Registered with Office of AssessmentYesNoPhoneSCU email address* Current Status (Full-Time or Part-Time)Current YearNumber of Requested Reschedules*OneTwoThreeFourCourse InformationSection No. of the First CourseProfessor's Name for the First CourseTitle of the First CourseFirst Course Date Scheduled Date Format: MM slash DD slash YYYY First Course Time Scheduled : HH MM AM PM Course 2 InformationSection No. of the Second CourseProfessor's Name for the Second CourseTitle of the Second CourseSecond Course Date Scheduled Date Format: MM slash DD slash YYYY Second Course Time Scheduled : HH MM AM PM Course 3 InformationSection No. of the Third CourseProfessor's Name for Third CourseTitle of the Third CourseThird Course Date Scheduled Date Format: MM slash DD slash YYYY Third Course Time Scheduled : HH MM AM PM Course 4 InformationSection No. of the Fourth CourseProfessor's Name for the Fourth CourseTitle of the Fourth CourseFourth Course Date Scheduled Date Format: MM slash DD slash YYYY Fourth Course Time Scheduled : HH MM AM PM Reschedule InformationAn examination may be rescheduled only for one of the following reasons: Administrative Conflict: 1) Two exams scheduled back to back; i.e., one exam at 6:00 p.m. and another at 9:00 a.m. the next morning 2) Two exams on the same day Personal Conflict: 3)The student's serious illness or other medical emergency 4) Extraordinary and compelling reasons beyond the student's control For (1) and (2) above, the student must request a reschedule 8 weeks prior to the start of the exam period. For (3) and (4) above, the student must submit a request for rescheduling of exam to the Student Services Office as soon as possible, but prior to the start of scheduled exam. The Director of Assessment, in consultation with the professor, will determine if the exam will be rescheduled. Note: Students who are ill at the time of their exam should consult the head proctor prior to opening their exam packet. Once students see the exam, it is not possible to reschedule. Whenever a required course or a bar course conflicts with an elective course, the elective exam will be rescheduled. If a required course conflicts with a bar course, the bar course will be rescheduled. We will respond to your request as soon as we have all exam information. An email will be sent to you with your rescheduled date and time.Please check the following three boxes:* I understand that, should my request be approved, my exam will be moved to the next available time that does not create an additional conflict in my schedule according to the policy set forth. * I understand that all administrative reschedule requests for Fall 2019 exams must be submitted by close of business on October 11, 2019 to be considered for approval. Spring 2020 requests are due by March 6, 2020. Summer 2020 reschedule requests are due by June 22, 2020. * I understand that I am obligated under the Code of Professional Conduct to refrain from discussing the exam with unauthorized personnel or being in the vicinity of students who have taken or are taking the examination I am rescheduling, from giving or receiving aid during an exam, from using unauthorized materials, and from furnishing false information to Law School faculty and staff. File


text:
Study Claims Twin Falls Lacks Fast Food And Bakery Options
I've read some off the wall statistics before, but this one takes the cake - no food pun intended. There's a website that's claiming that Twin Falls is falling behind when it comes to fast food and bakery options. I know. Crazy, right?
Find The Home calculated how many fast food establishments we have in Twin Falls compared to the rest of Idaho. Here's what they found.
According to their study, Twin Falls has 3.75 fast food restaurants for every 10,000 people. That sounds like plenty to me. But, that's nothing compared to Lewiston and Rexburg. Lewiston has 4.66 and Rexburg has a colon-blocking 4.94.
The story for bakeries is the same story. According to Find The Home, Twin Falls has 2.2 for every 10,000 people. That's way behind Idaho Falls which has 3.6 and Coeur d'Alene with 3.7.
I'm not sure how the geniuses that come up with this stuff determine what's a "good" number for bakeries and fast food, but Twin Falls has never felt like it lacked these things to me. What say you?


text:
2. T3 Mobile Travel Services ¥9.76B
Round: Venture
Description: T3 Mobile Travel Services offers car-sharing services powered by renewable energy. T3 Mobile Travel Services has now raised a total of ¥9.76B in reported equity funding.
Industry: Public Transportation, Renewable Energy, Ride Sharing
Founding year: 2019
Total equity funding raised: CNY
The TechWatch Media Group audience is driving progress and innovation on a global scale. With its regional media properties, TechWatch Media Group is the highway for technology and entrepreneurship. There are a number of options to reach this audience of the world's most innovative organizations and startups at scale including sponsoring a piece like this, which will be read by the vast majority of key influencers in the entrepreneurial universe. Find out more here.


text:
Hi everyone …. well, I've reached the end of my last nerve. About a year ago, I had to put my little dog down ….. she was a Cavalier, King Charles Spaniel, who was rescued from a puppy mill – she was 4 and had given birth to multiple liters. She never got out of the crate, and the day after I took her the mill was going to shoot her because she was no long producing what they wanted. She was a tri-color, and had the classical heart murmur. All Cavaliers have that, I guess from poor breeding practices ….. goes from level 1 to level 5. She was 11 when I had to put her to sleep. Well, you all know all the moving I've been doing … MD to VA, then another place in VA (which is quite unsafe I'm finding out). I have not been happy since I left my condo in MD. I'd lived in the Frederick, MD area for 30 years, and that move was a big mistake (now I know!). Well, I have 2 cats, but I so much miss that little girl. It's been a year now, and I still can't look at her picture without tearing up. So, I've been in touch with a Cavalier rescue group that lives quite close to where I used to live in MD, and I'm just praying that I can find one that I can both afford and whose murmur isn't passed 2. I'm lonesome …. I have a neighbor who is a friend and she has a dog. My kids are great people, and do what they can and have time for to either come over, bring me some food, or go somewhere with me, but they all have lives and families and I cannot expect them to fill in the gap. I'm used to taking in a puppy mill rescue, as my Molly was afraid of grass when I got her, I had to teach her how to walk up steps, and for a long time anytime someone lifted an arm to scratch their head or anything like that, she'd duck and run. Obviously, she'd been abused along with everything else. I so hope I can get one ….. I need a loyal friend down here, and one of them would be perfect.
Liked by Teresa, Volunteer Mentor, Jim, Volunteer Mentor, GailBL, Volunteer Mentor, Parus ... see all
@gailb Hello! I am sorry to hear about your wood finches. Forty years ago I had a cockatiel and a parakeet that brought much joy in my life. I didn't know a whole lot about them either but did with parakeets. The family grew up with them. I bought their food at the corner store not a pet shop. They both developed a beak disease from stale food and I had to put them both down. I think of them often and guilty for not looking after them better. I make sure now with Baby that his food is fresh. Nowadays we have expiry dates on food. We all make innocent mistakes and blame ourselves for a lifetime for them. I love cats. They make me laugh so much. They can cuddle also not like birds. Great companions and love the posse effect 🙂
I hope to have the left carotid artery done if the surgeon will agree. I live in Canada and the operation is free but not sure how far free is, if they do the left. It's 80% clogged and could have a stroke anytime so I hope he will. I could have a stroke tomorrow as well during the operation. What I am worried more about is if I do have one, there is really no one that could look after me. My brother is waiting for an operation to get a pacemaker and looking after his wife that is ill with COPD. I have it also. The only smokers in our family clan. My faith is with God and he knows best. I appreciate your thoughts for me tomorrow and best wishes. I also have plenty of plaque in the stomach also. It all started when my practitioner nurse decided to test both arteries for heart beats and from there I've never looked back with tests and more tests. We don't have many doctors here because they don't make the money like the U.S, so they all moved to the States. We have very little heart surgeons and the wait was 4 months to get this operation. Baby boomers in Canada beware!! They will die waiting to see the surgeon.
Ok done talking.. I am so stressed right now … have been eating sweet and salty foods all day and smoking too much!! Will be glad it will be over tomorrow Gail. Take care of your self and will keep you posted when I get back.
Liked by GailBL, Volunteer Mentor, JK, Alumna Mentor, Parus
Dogs are such wonderful companions, always there for us. Until you can get another dog why don't you share some of your love with your local shelter or rescue group if that is possible. I know they always need walkers or people to help them. It's a good way to give some of your love to those who need it and it will make you feel better too.
Liked by Teresa, Volunteer Mentor, GailBL, Volunteer Mentor, JK, Alumna Mentor, Ginger, Volunteer Mentor
HOORAY! I'm surprised I didn't post this before, but for Mother's Day, my 3 kids (all adults) got me a Cockalier …. a cross between a Cavalier and a Cocker Spaniel. She's about 17 lbs, white, red ears and red large spots on her. They didn't tell me where we were going that day …. they just said, "Mom, wanta' go for a ride?" When we got there – about 3 hours away, I could not believe my eyes ….. a little 7 lb ball of fur. She's now 10 months and, with the exception of not totally being potty trained – almost there, but not quite, she is a dream and such a blessing to my life. I know Frederick has it's draw for me, but with kids that are that thoughtful and loving, how could I even think of leaving? Wish I could put her picture up, but not being very tech. savvy, I have no idea how to do that.
Liked by Teresa, Volunteer Mentor, GailBL, Volunteer Mentor, JK, Alumna Mentor, ainsleigh ... see all
@amberpep I'm happy to hear you sounding more upbeat than you have been, that's great.
I would love to see a picture of your Cockalier. I've never heard of that cross-breed before. I had a cavalier, a wonderful, sweet dog, the Blenheim color. He lived to be 14! I know that's unusual for that breed. I would love to get another but my husband is vehemently opposed.
@gailb I read somewhere in the past week that people with cats have a 40% lower chance of having heart problems! They make such great little companions and I would imagine they can make a person feel more calm, just petting them.
@desirea Lorraine, I am way behind in reading these messages because I was away. I hope your surgery went well.
I am interested in these posts about carotid arteries because my sister had a problem with one of hers and has to go yearly for a check-up on it. I know she worries a lot but so far it's been fine, no changes for the worse.
@amberpep I found our cavalier very hard to totally potty train. Sometimes I wondered if he was training us or we were training him.
I hope your surgery has gone well and that we will be hearing from you when you're up to it. I'm thinking about you.
Liked by Teresa, Volunteer Mentor


text:
|Fri Jul 6 2018, 11:00am–9:00pm
|Sat Jul 7 2018, 11:00am–9:00pm
|Sun Jul 8 2018, 11:00am–8:00pm
No.1 leading & largest baby fair in Singapore is back and will be held at Singapore Expo between 6 to 8 July 2018!
Be overwhelmed with 150,000s of products from over 1000s of leading and boutique baby brands, this Largest Baby Fair 2018 gives a huge range of choice to new and expectant families. Find and Grab all your essentials—strollers, buggies, travel systems, car seats and nursery furniture as well as lots of stylish, handy and innovative products from adorable clothing to feeding accessories.
Get ready for exciting perks:
- Free Pregnancy Goodie Bag
- Free Mystery Gifts – Up To $50,000 Worth Of Baby Products to Giveaway!
- Craizest Pre Order Deals, Unbeatable Starbuy Deals, Craziest Deals and Early Bird Special Deals
Hurry & Grab all Unbeatable Starbuy Deals and Amazing Perks at Biggest Baby Fair Singapore
Before you go, would you like to subscribe to our free weekly newsletter with events happening in your area, competitions for free tickets and CD giveaways?
No thanks - I'm already an Eventfinda member (or I don't want to join)
Enter your email below, click on the Sign Up button and we'll send you on your way
Continuing confirms your acceptance of our terms of service.


text:
The Turk Who Loved Apples
WORD (126 Franklin St., Brooklyn)
From his first trip as a young child (driving through New England in the backseat of his family's station wagon) to his trek to Marijampolė, a small town near the Polish border where he learned about his Lithuanian heritage, Matt Gross has turned travel into an art form. He presents his new collection of essays with a presentation and signing.
Click here for more free New York City events & things to do.


text:
Girls Night Out Blouse In Navy
$7.99 $49.99
A short sleeve blouse that features a round neck, ruffle sleeves and ribbon trim on sleeves and bottom.
Styling Tip: Pair with our white distressed jeans and Spencer sandals
First model is wearing a size small, second model is wearing a size medium
97% Polyester, 3% Spandex
Fitting: True to size. Not a fitted blouse. Room for move, little stretch.
Bust: True to size Waist: True to size. Hips: True to size
Small: Bust 38" Waist 41" Hips 42" Sleeve 9.5" Length 25.5-26"
Medium: Bust 40" Waist 42" Hips 44" Sleeve 9.5" Length 26.5-27"
Large: Bust 42" Waist 44" Hips 46" Sleeve 10" Length 26.5- 27"


text:
Added to Cart
Extended Care
Learn more about .
More deals you may like
Samsung Galaxy Watch Active 2 R820 - Leather Band (Steel, 44mm, Bluetooth, Black)
$399+ Shipping
The Samsung Galaxy Watch Active 2 R820 tells you what you need to know when you need it. Stay connected with a lifestyle partner on your wrist that gives you advice in the moment.
- 1.4" Super AMOLED display
- 0.75GB RAM and 4GB internal storage
- 1.15GHz dual-core processor
- Built-in running coach
- Advanced fitness tracking
- IP68 rated waterproof
- Long-lasting battery
Get a jump on life with the Samsung Galaxy Watch Active 2 R820, a smart assistant on your wrist. Remotely control your smartphone's camera, view and like on social media and translate on the go.
Widen your space
Maximise your screen space with an uninterrupted view on a sleek body fitted with a touch bezel for quick control. Galaxy Watch Active 2 features an enlarged display with a pure black screen and a border that's hardly there for more space to get the insight you need.
Track your workout on your wrist
Galaxy Watch Active 2 automatically detects and tracks seven popular workouts, letting you focus on enjoying your fitness. You can also manually track more than 40 different workouts to get credit for every move. Plus, the built-in running coach gives you real-time feedback on your runs using the advanced accelerometer.
Wellness support from the inside out
By measuring four different sleep stages, including REM sleep, the Galaxy Watch Active 2 helps you evaluate your sleep patterns and form better habits. When you need a break, the Galaxy Watch Active 2 can guide you through interactive meditation and breathing exercises, helping you feel refreshed.
Heart rate tracking for peace of mind
Monitoring your fitness is at the core of Galaxy Watch Active 2 with a full eight photodiodes on the rear side of the new curved design while keeping an eye on your heart rate.
Keeps up where you go
Take your watch along on the road less travelled. Galaxy Watch Active 2 goes where you go with a 5ATM water resistance rating plus military grade durability to handle a range of conditions, so you can keep it on to go further and experience more.
Power that lasts for days
Go non-stop with a long-lasting battery that lasts for days on a single charge. Need a quick charge? Just place your Galaxy Watch Active 2 on the compact magnetic wireless charger to bring it back to full, no charging jacks or wires required.
This product is an international model
Related CategoriesSmart WatchesIn-Ear HeadphonesPrepay PlansAndroid PhonesiPhonesSIM CardsFitness TrackersCables & AdaptersCasesChargers


text:
"The Man in the Hole", so called because of the holes he digs to hide in and trap animals, is believed to have survived the attack last month in Tanarú, an indigenous territory in the Amazonian state of Rondônia, but more are expected to follow.
On a routine visit to the area, protection officers discovered empty shotgun cartridges were found on the rainforest floor. Officials believe the attack was carried out by ranchers whose lands surround the Indian's territory.
They have frequently complained that one lone Indian is blocking the expansion of their ranches and in October they were incensed by the renewal of a protection order that prevents farming on indigenous territory, the Times reports.
"This is a serious situation. The Indian's life is being put in danger by the interests of the ranchers," Altair Algayer, a Funai official, said.
Little is known about the "Man in the Hole". He has rejected all attempts at contact by Brazilian officials, leaving his story to be pieced together from accounts of the nearest tribe, the Akuntsu, who themselves have been reduced to five members by a series of slaughters.
The tribe says that the man's relatives were wiped out in repeated massacres in the 1970s and 1980s as ranchers and gunmen moved on to indigenous lands.
His small fragment of territory, now encircled by five cattle farms, is the last barrier to ranchers.
"He should be allowed to live out the ends of his days in peace, but the ranchers are clearly not happy with that," said Fiona Watson, research director of Survival International, a UK-based organisation that monitors uncontacted tribes.
"On a number of occasions the ranchers have complained that it's one man sitting on 8,000 hectares of land," she explained, adding: "I don't think its any coincidence that this restriction order was renewed and this attack came weeks later."


text:
Distributors and manufacturers continue to look for acquisition opportunities, with activity picking up in several sectors. Power transmission distributors Applied Industrial Technologies (No. 8 on MDM's top 40 industrial distributors list) and Kaman (No. 16 on the list) have been particularly active in that sector.
|We Deliver Distribution News to Your Inbox
Sign up below to receive MDM Update, your free weekly distribution news update by email.
Other areas of pickup: electronics (Avnet's latest deal), industrial gases (the Airgas-Air Products back-and-forth), and industrial manufacturing in general. See the latest in distribution and manufacturing M&A from MDM here.
According to Thomson Reuters, announced deals and offers in August – which is usually a slow month – were at $262 billion worldwide, which is the highest value announced during an August since 1999. The number of deals however is still lower than last August, according to this report.
Though we are definitely seeing private equity firms back in the game, most of the activity has been driven by strategic buyers – or large public companies. In the Thomson Reuters report, those interviewed said that some deals are being driven by companies "seeking to offset limited internal opportunities to expand," due to a low-growth environment.
In fact, manufacturers such as GE are reporting plans to spend billions of dollars on acquisitions. (Read that report here.)
And large public distributors have recently been open about their plans to seek out acquisition opportunities.
In my recent interview with Jon Skelly of Vetus Partners, he offered a reason that many distributors have been seeking acquisition opportunities (echoed in many articles on the topic): "The strategic buyers have a lot of cash at their disposal. During downturns they deleveraged their balance sheets. They collected receivables and did not buy as much inventory. Those receivables and inventory that were on their balance sheets turned into cash. They have to find ways to invest it and earn their cost of capital or better. Some are doing share repurchases, and some are paying dividends. And some are doing acquisitions or some combination of the above."
But M&A has the greatest potential to create long-term value, he says.
Read MDM's full interview with Skelly here: M&A Valuation Trends


text:
Field Notes
This photograph is very special to me; on one level it typifies England; a medieval castle perched on a hill surrounded by rolling green landscape. On a personal level it is special for being entirely my own creation and free from any prior artistic influence on how to photograph this scene. Often, castles like Dunstanburgh, for example, are so well photographed that it's virtually impossible to come up with something entirely new and original; they are more variations of existing work, however good they might be. For this photograph, my location searching and previsualising led me to this idea for a composition. It was May and I needed dawn light. After two failed attempts the third morning brought with it just the light I was after and I remember walking back to the B&B for breakfast with a real spring in my step. This is one of the few photographs I feel will be hard to reproduce and, therefore, I offer it for sale as a limited edition (250 print run) print. Nikon D200, 17-50mm lens, 1/15 sec, f8, ISO 100. Six exposures merged


text:
Fairfield hair stylist celebrates 50 years of business
FAIRFIELD — When Charles Tuozzoli walks through HAIR, his enthusiastic and open energy fills the brightly lit, two-story salon that he's owned since 1969. In stylish horn-rimmed glasses, a patterned shirt and a necklace chain with a big ring - "to hold my glasses," he explained - Tuozzoli says hello to each customer and greets everyone with a smile.
Tuozzoli is the heart and soul of HAIR, a Fairfield institution on 39 South Pine Creek Rd. that recently celebrated its 50th anniversary. His influence is clear, affecting everyone from his staff to HAIR's loyal customers, some of whom he's been serving all of those 50 years. The salon sees 700 to 800 clients a week, and this year they're on track to reach 39,000 visits. Throughout 50 years of business, Tuozzoli has led with confidence, creativity and, above all, compassion.
Emphasis on employees
Creating the best learning and working environment for his more than 40 staff members has always been Tuozzoli's top priority. Many of them have been with the salon for decades - some over 40 years. Over time, HAIR has evolved into somewhat of a family business, with Tuozzoli's brother and cousins poised to take over operations when he retires.
Every HAIR employee is welcomed into this family. In addition to becoming part of the community of hairdressers, new hires also go through specialized training. Tuozzoli believes that this education program both guarantees quality service and ensures that the business will continue to grow for years to come.
And grow that business has. Fifty years later, customers are still pouring in, but Tuozzoli says that teaching the next generation of hair stylists has always been more important to him than making a profit. It is exactly this emphasis on his employees that has allowed his business to boom.
"My goal was to teach people in our industry and be the best that we can be, and by doing that it helped us stay vital," he explained of his success.
HAIR's influence has spread throughout Connecticut and beyond, as over the years Tuozzoli's protegees have moved away or started their own business. Alumni came from as far as New Mexico and California to celebrate HAIR's 50th anniversary on May 19, giving Tuozzoli the chance to see the impact that his training has made on employees' lives.
"It was one of the best days of my life," Tuozzoli reminisced of the celebration, where he heard about the career strides made by hairdressers he trained right out of beauty school.
Fight for gender equality
Nowadays, anybody can walk into HAIR, or another salon in Connecticut, and get a stylized haircut. What most don't know is that this is only the case because of Charles Tuozzoli's advocacy for gender equality in salons.
In 1974, it was illegal for salons to cut men's hair. Men, who were expected to have short, un-styled hair, were only permitted to patronize barber shops. When Tuozzoli opened his shop in the late 1960s, however, more and more men were beginning to seek out salon cuts. Many had started growing their hair long, and barbers had no idea how to handle fad styles such as the shag cut.
Eager to serve these patrons, Tuozzoli would secretly cut men's hair upstairs in the salon. While he loved this work, it was always clouded by the fear of losing his license, or even being arrested, if he were to get caught.
After a few years of frustration, Tuozzoli's lawyer had an idea: sue the state to change the law. That's exactly what he did, and his legal victory changed the face of Connecticut's beauty industry. Now, men and women can both get their hair cut wherever they please.
"The reason why men can go into salons now is because of me," Tuozzoli explained proudly.
Looking good, feeling good
From the 1974 lawsuit to now, Tuozzoli has sought out opportunities to serve any and all customers. At the root of this pursuit lies his belief that a haircut is more than just a superficial change - it can affect a person's inner life, too.
"If people look good, they feel good," Tuozzoli often reminds his staff.
For Tuozzoli, making someone feel good is no small feat. He believes that his work has truly changed lives, and watching a customer walk out of HAIR with a smile on their face brings him immense satisfaction. Making people happy, he holds, is the ultimate job of a hairdresser.
And he doesn't plan on stopping anytime soon.
"[I'll work] as long as I have people who want to sit in my chair," he said, "It's my passion."
He has, though, reduced his hours as time has gone on, and he's started the process of passing the business on to his brother and cousin. When asked what he imagines for the salon down the line, Tuozzoli smiled and said that he has complete faith in the next generation of HAIR's leadership.
"I think it'll be around for another 50 years," he predicted.


text:
RV Models
What's Included
One Way
Management Program
Airport Delivery/ LAX
Client Resources
Click Here for More
November 30, 2016
Joshua Tree
Zion National Park
Bryce National Park
Grand Canyon
Antelope Canyon
Sequoia National Park
Meteor Crater Winslow AZ
Death Valley National Park (Great place to see the Milky Way!)
I'm considering RVing, but I've never done it before…
It's easy to imagine yourself renting an RV if perhaps you've grown up around RVs or campers bu...
First Time Renters
December 5, 2017
Going somewhere with an RV opens the door to an incredible experience that can only be available with this type of travel. It can seem intimidating, e...
First time renting an RV? Start here.
December 16, 2017
How will the RV be powered? Electric hook up, generator and battery explained. (unfinished)
Far away lands that are worth seeing on your weekend get away
Places to check out on a weekend getaway
9 National Parks around Los Angeles
December 2017 (3)
November 2016 (3)
first time rv rental
motorhome rental
new renters
rv rental


text:
2013 Jameson Empire Awards Celebrity Pictures and Winners
Skyfall Wins Big at the Jameson Empire Awards in London
Skyfall Wins Big at the Jameson Empire Awards in London
The Jameson Empire Awards were held in London last night and some of the UK's brightest film stars were on hand for the big event. The big winner was Skyfall, which picked up best film, best director for Sam Mendes, and a special Empire Inspiration award. The Hobbit: An Unexpected Journey picked up best sci-fi/fantasy film and best actor for its lead Martin Freeman, while an absent Jennifer Lawrence was honoured with best actress for her work in The Hunger Games.
Helen Mirren's contribution to film was acknowledged when she was dubbed an Empire Legend. Newcomers Tom Holland from The Impossible and Samantha Barks from Les Misérables were also handed statuettes, and Daniel Radcliffe won an Empire Hero award. Others who attended include Tom Hiddleston, Sam Claflin and Kevin Spacey. Click through to see the best pictures and see the full list of winners here.


text:
DeLeon v. Colvin
Filing 21
MEMORANDUM DECISION AND ORDER - the decision of the Commissioner is AFFIRMED and this action is DISMISSED in its entirety, with prejudice. Signed by Judge Ronald E. Bush. (caused to be mailed to non Registered Participants at the addresses listed on the Notice of Electronic Filing (NEF) by (cjs)
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.


text:
Greetings, survivors! Survarium 0.44 is just around the corner, and we are going to test the update on the PTS soon. Read all about the main features and changes coming in Survarium update 0.44 now!
What can you expect? A new trophy search, C-4 plastic explosives with remote detonator, bots for newcomers and high-tier pistols for the in-game factions!
Bots for Newcomers
One of the most important changes of the upcoming update is introduction of characters controlled by AI. These bots will not be able to challenge the players, since initially AI's abilities will be limited. But the bots will become ideal sparring partners for the new players, so they can learn the game mechanics in a less stressful environment.
Starting with Survarium 0.44, all newcomers will play their first matches against bots. As the player completes more matches, the bots will be replaced with other players. This way newcomers can better adapt to the game's increasing difficulty.
Please keep in mind that this is the first iteration of computer-controlled enemies. In the future we will continue improving the AI: the bots will learn to take cover, use special items, pick up and deliver batteries, and purposefully capture and hold key points. All of the above will allow use of the bots both in PvP and other game modes.
Treasure Hunt
One of the ways to acquire new equipment will also be significantly changed. Search for trophies after battles will no longer be available, and there will be a weekly event instead called Treasure Hunt.
Treasure Hunt is a lottery with a high quality item (unique or premium) as the best possible reward and other prizes. The number and quality of the prizes depend on your character's maximum rank in a faction. For instance, you are able to get a tier 10 item only when you have reached the highest rank in one of the factions.
The cost of each search stays the same: 100 gold (or a stash map), and you will be able to get a few stash maps each week for free! As you get items, the number of available trophies will decrease with each search, and you will get a higher chance to get the main prize. Naturally, you can get it on your first try provided you are lucky enough.
Rewards after battle will be also increased. In addition to bonus experience, silver and reputation the winners will get several spare parts and, with a small chance, a free stash map. The number of stash maps one can get per week for free is limited.
New Pistols
Survarium Update 0.44 will for sure please people who love pistols. The game never used to have them as an effective weapon type on the higher equipment tiers. So in the upcoming update we will finally increase the number of available pistols.
Beretta 93R is a new rare tier 7 pistol. You can obtain in via the Treasure Hunt or buy with gold. Despite its age, the Beretta 93R is still a formidable weapon thanks to a huge magazine with 20 cartridges and automatic fire mode with 3 bullets burst.
CZ-75 is a semi-auto tier 7 pistol with a 16 ammo magazine; available from the Scavengers faction upon reaching Veteran rank. High muzzle energy together with a long sighting line provide both high armor penetration and accuracy. The tradeoff is big weight of the weapon.
Yarygin pistol (MP-443) is a semi-auto tier 7 pistol with 18 ammo magazine. Available from the Renaissance Army upon reaching Captain rank. A high firepower and huge magazine size make MP-443 a dangerous weapon.
Moreover, Colt Python revolver will be changed. The weapon is moved to tier 7 and its stats are adjusted accordingly.
A New Special Item: C-4 Explosive
Survarium Update 0.44 brings a new special item for Black Market fighters. C-4 explosive with a remote detonator is available on equipment tier 8 and takes the whole explosive slot. We hope you will like new tactical opportunities that present themselves with the introduction of this special item.
As always, expect to see other changes to the game, which we will list in the final change log for the update 0.44. Stay tuned for more news and participate in the testing on the PTS to check out the new features and changes in Survarium 0.44!


text:
THE period after Christmas and New Year traditionally sees something of a lull in the music biz. With the headaches and hangovers starting to kick in, bands, promoters and record companies all tend to take a well-earned sabbatical, and plot strategies for the year ahead.
Plus, frankly, who really wants to be out attending sweaty rock gigs when you could be indoors watching Preston on Celebrity Big Brother?
The one exception to all this, though, is rising Manchester music empire MancPunkScene. In operation for just over two years, the website-cum-promotions team are one of the most active music enterprises in the city (if not the country) right now, organising underground gigs, releasing albums, and discovering the great new metal/punk stars of tomorrow.
Not that many people will know (or have even heard) of MancPunkScene. As vibrant and brilliantly fertile as Manchester music is right now, there's still a strong sense that a lot of the city's punk scenes are increasingly marginalised.
You could blame it on fashion snobbery, or simply the fact that Manchester has traditionally never nurtured a strong punk scene - and then you realise that we created The Buzzcocks, so that's that argument out of the window then.
When former design student Paul McManus moved to Manchester three years ago from his home town of Wakefield, he realised this straight away. An ardent follower of ska, emo and metal music, he felt oddly alienated within Manchester's live music scene.
Paul explains: "When I first moved to Manchester I was really eager to learn about the city's punk scene, but there wasn't any obvious resource to find out. It seemed like a lot of the city's punk and metal bands were being ignored simply because they didn't conform with what was considered cool. People have a lot of negative preconceptions about musical genres like punk, especially in Manchester."
MancPunkScene was born out of this frustration, plus a palpable realisation that Manchester youth culture was crying out for this sort of enterprise (just check out the vast crowds of metal and emo kids hanging around Cathedral Gardens on a Saturday afternoon).
In an age when the mainstream seems to be gobbling up the alternative in record time, Paul and MancPunkScene seem to be tapping into a genuine underground counter-culture.
With the aid of local bands like Day For Airstrikes, 52 Teenagers and The Maple State, they've created the sort of autonomous DIY punk movement that you definitely WON'T find being written about in the fashionable music press. And that's exactly the way they like it.
"I think what separates us from other Manchester music websites is that we've got the foundation of a real community behind us," argues Paul. "There's no better place for bands, promoters or music industry people to interact. That's what our website is built on... building communications between all these people, it breaks down all the barriers.
"The band Day For Airstrikes got their first ever exposure with MancPunkScene and since then, they've been played loads on Radio 1. That's the most important thing. A lot of the bands who approach us don't know how to get on the first rung of the ladder. I'd like to think we give these kids a chance."
Paul's use of the term 'kids' is entirely deliberate. One of the most startling revelations at MancPunkScene since it started has been the amount of (very) young musicians who've contacted them for career advice. Which is all very good and encouraging, but unfortunately Manchester's draconian venue policy means very little can be done to help these young starlets.
Paul notes: "About 75 per cent of the people involved with MancPunkScene are between the ages of 14 and 18. The cruel thing is, most Manchester venues have an over-18s age policy, which means most of these bands can't play gigs and get the experience. This is one of the biggest and silliest problems within the Manchester music scene at the moment and not enough people realise it. It's an issue we'd like to get resolved."
The culmination of MancPunkScene's beefy manifesto is their yearly and much-awaited new bands compilation. Last year's effort helped to launch future punk heroes like Pendleton, No One Lost and the aforementioned and very ace Day For Airstrikes, and this year's compilation promises to be even better.
MancPunkScene is currently compiling the album as we speak, and any new bands interested in appearing should firstname.lastname@example.com
. Closing date for submissions is February 1, so budding punk heroes, get a move on!
Paul concludes: "We've helped out so many new bands who are now successful, that it made perfect sense to release them all on a compilation. The first compilation received about 4,000 downloads, and all the bands involved got great feedback from all over the world.
"We've got a tagline at MancPunkScene and that is 'embrace the next generation'. That's something we really believe in. We're not doing this for the money or the publicity. We just want to provide a healthy cocoon for all these bands to grow in and move on to bigger things. That's the real satisfaction."
More info at


text:
The US State of Colorado has entered the New Year on a high note by becoming the first state to legally sell marijuana and open the retail spots for pot. Washington is set to follow suit and open its own recreational shops later in 2014.
At the start of New Year day, at 8 am local time, pot lovers from across the state lined up to be one of the first residents to legally participate in a $578 million market. Some people had been waiting since 1 am.
"I wanted to be one of the first to buy pot and no longer be prosecuted for it. This end of prohibition is long overdue," said Jesse Phillips, cannabis enthusiast from Colorado.
State residents can now legally indulge themselves with up to an ounce of marijuana from more than 30 shops that have opened their doors statewide. Residents from other states can buy up to one-quarter of an ounce.
However, weed enthusiasts can increase their daily limit by shop hopping and purchasing legally allocated amounts from different vendors. Legally under state law, buyers are only allowed to possess up to one ounce of the plant on them.
Source: http://rt.com/usa/marijuana-stores-open-colorado-068/


text:
Have you ever heard that story about subconscious Coca Cola advertising in the cinema? Well, if you haven't here's a bit of text quoted from Businessinsider.com:
The birth of subliminal advertising as we know it dates to 1957 when a market researcher named James Vicary inserted the words "Eat Popcorn" and "Drink Coca-Cola" into a movie.
Continue reading Brainwash Yourself – Google Chrome Extension


text:
Desktop, Sapphire Nitro Radeon RX 580 8Gb, Intel i5-2500, 8Gb RAM, Benq GW470H display, SSD, Windows 10 64bit, Radeon Software Adrenalin 2019 Edition 18.12.2
I have a problem with big Input Lag in all games when i use Vertical Synchronization. When its OFF everything is fine, but when its ON i have big input delay, even on low graphics. FPS stay same. Tried a lot of drivers, used DDU, nothing helped me.


text:
Physically-based retrievals of Norway spruce canopy variables from very high spatial resolution hyperspectral data
Publication Details
Malenovsky, Z., Homolova, L., Cudlin, P., Zurita-Milla, R., Schaepman, M. E., Clevers, J. G. P. W., Martin, E. & Gastellu-Etchegorry, J. (2007). Physically-based retrievals of Norway spruce canopy variables from very high spatial resolution hyperspectral data. IEEE International Geoscience and Remote Sensing Symposium: IGARSS 2007 (pp. 4057-4060). USA: IEEE.
This study was conducted to answer two research questions: (1) what is the spatial variability of the leaf optical properties between 400-1600 nm (hemispherical-directional reflectance, transmittance, absorption) within young Norway spruce crowns, and (2) how to design a suitable physically-based approach retrieving the total chlorophyll content of a complex coniferous canopy from very high spatial resolution (0.4 m) hyperspectral data? It was proved that sun-exposed needles of current age-class statistically differ (alpha-level = 0.01) from rest of the needles in reflectance between 510-760 nm. Last four age-classes of sun-exposed needles were also found to be significantly different from almost all age-classes of sun-shaded needles in transmittance from 760-1350 nm. An operational estimation of chlorophyll a+b content (Cab) from an airborne AISA Eagle hyperspectral image was proposed by means of a PROSPECT-DART inversion employing an artificial neural network (ANN). A spatial pattern of estimated Cab was successfully validated against the Cab map produced by a vegetation index ANCB650-720. Coefficients of determination (R2) between ground measured and retrieved Cab were 0.81 and 0.83, respectively, with root mean square errors (RMSE) of 2.72 mug cm-2 for ANN and 3.27 mug cm-2 for ANCB650-720.


text:
NZGB notices - December 2018
Final determinations on official geographic names
Gazetted on 20 December 2018
Notice of Final Determinations of the Minister for Land Information on Official Geographic Names
Official Geographic Name
Geographic Feature Type
A small village at the southeast corner of Lake Hāwea, approximately 4.5km northeast of Lake Hāwea (town), Central Otago. NZTopo50-CA13 075555. Alteration from Gladstone (recorded name).
A stream flowing for approximately 5.5km generally westwards from the valley north of Breast Peak, then northwest through John Creek (village) into Lake Hāwea, Central Otago. NZTopo50-CA13 115567 to 075556. Alteration from Johns Creek (recorded name).
A river in two parts flowing generally northwards for approximately 45km from Tatare Range into the Tasman Sea. From NZTopo50-BW16 823929 (source) to 788081 [21km] and NZTopo50-BW16 836090 to 754200 [24km] (mouth). Altered from Waitangitaona River (recorded name).


text:
RiTFT-70H-LV-CAP-UX is a high-resolution, high-brightness 7″ TFT display with an LVDS interface, a capacitive touchscreen, and a decorative cover glass that comes in two versions: black and white.
It offers a resolution of 1024x600px.
RiTFT-70H-LV-CAP-UX is a high-resolution, high-brightness 7″ TFT display with an LVDS interface, a capacitive touchscreen, and a decorative cover glass that comes in two versions: black and white.
It offers a resolution of 1024x600px.
The RiTFT-70H-LV-CAP-UX is a high-quality Riverdi 7'' TFT display module with high brightness. It features a backlight of 27 white LEDs. Typical surface luminance is 900cd/m2.
The full viewing angle allows the user a natural and intuitive way to interact with the display.
Main features:
For more information about the RiTFT-70H-LV-CAP-UX see the documentation section.
TFT display module with a capacitive touchscreen. These types of screens are extremely touch-sensitive and allow for clear and bright images. We recommend a capacitive touchscreen display if your application needs multi-touch, gestures, and high-precision.
Capacitive touchscreens react to the slightest touch, and no pressure is needed for detection.
A uxTouch display is a specially designed LCD TFT display which has a Projected Capacitive Touch (PTC). They are the perfect choice for your project if you intend to have an interactive design and technology, thanks to their absolute flat design and multi-touch feature.
As you can see they feature a modern and sleek design without any holes in the housing.
On the technical side, they are a great option for industrial spaces, since there is no dirt accumulation possible. They also feature chemically strengthened glass, which has increased durability, thanks to the process of ion-exchange. They are easy to assemble, easy to clean and easy to implement into your design.
You can customize LVDS displays in many different ways.
As you can see the possibilities are endless. All you need to do is choose.
We will help you to get the perfect tailor-made product.
|220 g
|Basic | Size (inch.)
|Basic| Resolution
|Brightness (cd/m²)
|Basic | Viewing direction
|Dimensions (mm)
|Active area (mm)
|Basic | Interfaces
|Basic | Touch Screen
|Basic | Addons
|Additional Information | Operating temp. (°C)
|Additional Information | Dot pitch (mm2)
|Additional Information | LCD type
|Additional Information | Input Voltage (V)
|Additional Information | Gray Scale Inversion Direct.
|Additional Information | Backlight Type
|Additional Information | Pixel Arrangement
|Additional Information | Driver IC
|Additional Information | Surface Treatment
|Basic | UX Touch


text:
Drama bursaries available from Waterford County Council
The Arts Office of Waterford County Council is offering grant assistance to members of drama groups in the County, who wish to avail of the week long residential Summer School held by the Drama League of Ireland in the University of Limerick. This year the school runs from Saturday 30th July to Saturday 6th August 2011.
A variety of drama courses are available, full details on http://www.dli.ie/.
Application forms and guidelines can be downloaded from http://www.waterfordcoco.ie/ .
The closing date for applications to this scheme is Monday 11th July 2011.
Subscribe to: Posts (Atom)


text:
Good Halloween morning. Volleyball coming up, but we have some other news to start the day.
First, we hit the pool. Mount Si High School's girls' swim team will have competitors at this weekend's district swim meet after qualifying performances at this past weekend's Kingco 4A meet at Mary Wayte Pool.
Campbell Brenne will be competing for the Wildcats in the 200 yard individual medley, after coming in sixth in the "D" final of the event, 24th overall, with a time of 2:29.51. Despite not making the finals in her 100 yard butterfly event, Theodora McCabe swam a time of 1:06.58 in preliminary competition in that event and earned a district berth with that time. She finished 28th overall in those preliminary heats.
Others according to the school that may be competing this weekend include Tatum Dalgleish, Clara Lourenco, Amelia Moulton, Alison Winder, Emi Yoshikawa and Caroline Smith.
Mount Si relay crews also competed in this past Saturday's meet. Dalgleish, Brenne, McCabe and Moulton teamed up for the 200 yard medley and that Wildcat foursome took second in the "C" final, 14th overall, with a time of 2:06.22, and Yoshikawa, Smith, Lourenco and Dalgleish worked together as the Mount Si 200 yard freestyle relay foursome; they finished fourth in that race's "D" final, 16th overall, with a time of 1:57.58.
The SeaKing meet starts Friday and finishes Saturday in Federal Way.
Cedarcrest girls' soccer's push to state takes detour
The Liberty Patriots went to Duvall last night and left with a 1-0 win over the Red Wolves, knocking CHS into a winner-to-state, loser out game on Saturday against another familiar Northwest District playoff foe, Burlington-Edison. Stats were not available.
The Red Wolves and Tigers will meet Saturday at Sedro-Woolley High School for the opportunity to move on to state. Game is at 3:00 p.m.
College soccer
Kansas Wesleyan 4, Sterling (KS) men 2: It was a special Senior Day for Valleyite Colton Oord, as he played his final game as a collegian in the Warriors' home loss in Sterling, KS, that knocked them out of the playoff chase. Oord, from North Bend and a 2015 Mount Si HS grad, scored a goal for Sterling in the 61st minute, and worked the full 90 recording three shots, with the goal coming on his lone shot on goal. The Warriors finished 4-11-1 on the season, 3-8-1 in conference play.
Fresno Pacific 2, Hawaii Pacific women 1: Fresno handed the Sharks a loss as their California road swing continued; junior Camryn Buck, from Ames Lake and a 2016 MSHS alum, started and worked the full 90 for HPU with no stats of note reported.


text:
5 Pax beat the fartsack to show up for YHC's VQ at Turning Point.
Registering to Q happened very fast and on a whim for YHC the day before TP. YHC would be lying if he said he hadn't been thinking about adding his name to the Q sheet for the past couple weeks, but he hadn't made the jump. YHC checked the weather the night before, and the forecast was promising. Around 41 degrees is a nice break from the frigid temps experienced last week. YHC woke up to slightly different conditions than forecasted. Work was done. Laughs were heard. Betterment was achieved.
Conditions: COLD and damp 33 degrees with a wind chill of 23.
The Thang:
Mosey around to the staff lot. Circle up.
- SSH x 20 IC
- IW x 20 IC (The cough cadence was introduced when YHC got choked; pax were forgiving.)
- LBAC x 15 IC (hold 'em up. Quis arrived and wanted to converse, YHC was happy to oblige but pax requested to continue the workout since arms were still up.)
- Reverse LBAC x 15 IC (hold 'em up)
- Overhead Clap x 15 IC (hold 'em up)
- Dirty Bird x 15 IC (hold 'em up)
- Moroccan Night Club x 16 IC (YHC got a little excited and forgot to change tone, recover)
- IW x 15 IC
- Merkins x 10 IC
- Mountain Climbers x 10 IC
- Shoulder Taps x 10 IC
Mosey to the track. Take one easy lap around together. Line up at the end of the field by the soccer goal, opposite the stairs. YHC explained to the pax that he tried to pick an exercise that reminded him of each one of the pax present or each pax influential in his posting at a workout. Quis commented that Treadmill is not here so no Bearcrawls were needed. YHC disagreed.
- Bear Crawl to the first tree. Plank for the 6.
- 10 Merkins OYO.
The idea was to repeat for all 4 trees. YHC realized at tree 2 that the shoulders would need a break so we stood up to recover for a moment. Then we repeated for the next 2 trees.
Mosey to the bottom of the hill. At the bottom of the hill, YHC explained that he would always remember an exercise called at the bottom of this hill during Dear Diary's VQ, the "Apollo Creed Burpee". In honor of DD the Apollo Creed Burpee was called for "0" reps.
- Bernie Sanders up the hill
- Crawl Bear down the hill
Mosey one easy lap around the track back to the end of the field by the stairs.
YHC then told the pax about a particularly miserable exercise from a punishing workout called: the "Burpee Broad Jump." It really sucked, so let's do it!
- Burpee Broad Jump from 1st tree to 2nd
- Plank for the 6.
- 10 Squats OYO.
- Rinse and repeat until reaching the 4th
Mosey to the stairs. Grab a stair.
YHC told the pax about a particularly memorable exercise when Quest was QIC of a workout. The pax started at the bottom of the stairs doing 1 calf raise and climbed the stairs adding one additional rep for each stair that was climbed (1 rep on 1st stair, 2 on 2nd, etc). YHC completed that exercise but could not walk for days afterward. That is not what is going to be done today. YHC called calf raises in cadence until 2 calf raises were done. Pax were then instructed to recover.
Mosey one easy lap around the track (YHC believes it was in this lap that Quis was told that the running of laps was for him. Trying to access the block pile, which would have been a more fitting tribute, was a little too treacherous for YHC's liking given the moist conditions. YHC also discussed The Closer's favorite exercise so that it could be included in the workout). YHC aims to please!
Starting at the tree closest to the stairs again, YHC called the inchworm. Several pax were familiar with a different form of the inchworm, but this seemed to be a new exercise for most. It involves lining up head to feet in the plank position and the last pax in line then bear crawls to the front of the line.
- Inchworm from tree 1 to 2
- Broad Jump from tree 2 to 3
- Inchworm from tree 3 to 4
After the inchworm "The Swanson" was introduced and embraced by the pax. Mosey for one more easy lap. At this point Quest needed to leave so YHC decided to keep everyone together and mosey to the shovel flag. All pax got in position for Mary when Swanson suggested that it would probably be a good idea to let Quest drive away before laying down on the ground in the parking lot. Aye Swanson, thanks for having our backs.
- Merkin x 10 IC
- Dolly x 15 IC
- High Dolly (aka Rosalita) x 15 IC
- LBC x 25 IC
- Dying Cockroach x 15 IC
- Merkin x 10 IC
- Freddie Mercury x 15 IC
- American Hammer x 10 IC
- Boat Canoe OMC
- Count-o-Rama
- Name-o-Rama
- "The Swanson" was born and may be the favorite exercise of the pax.
- The Closer wore shorts. The wind chill was 23.
- Quest is a quick bear crawler.
- Quis taught YHC the correct count for the dying cockroach.
- TClaps to all the guys who showed up on a cold Saturday morning!
- YHC is blessed to be surrounded by such great, encouraging men.
- 1/27/18 – GrowRuck
- 2/3/18 – MGC Long Run (Twitter: @MGCLongRun)
- 2/24/18 – Dam to Dam 100K Relay
- 3/3/18 – 4 Year Convergence at Graveyard
- 3/2018 – P200: See SayWhat?! for more info
Prayer Requests:
- Healing for sick or Injured Pax.
- Jones
- Quis B-I-L.
Love God-Style from
@BibleInsp https://dailybible.co/p/H1EuHXFTml


text:
Boost and optimize your android with Systweak Android Cleaner App
Android phones have come as a bliss, but not a perfect one. Ohh Yes, we say that!
Albert Einstein has once said, "Everything should be made as simple as possible but not simpler."
The developers of Android devices might have taken inspiration from his words. And no wonder they came up with Android phones. They are simple and connect the world altogether. But down the line, lack in many spheres. Just in the time when the letters you type, appears on the screen after a sec or 2. Or say when you have to wait for an app to start working for you.
These smartphones need some kind of care and attention. Apparently, you can count on apps exclusively developed for the purpose. And yes we talking about none other than CLEANER APPS. Google Play Store has many such apps. Some of them are efficient, while some just claim to be efficient. Today we have brought to you one such worthy app. You can download Systweak Android Cleaner and optimize your phone aptly.
Systweak Android Cleaner: An efficient cleaner app
With a search like 'Android Booster' or 'Android Phone Optimizer', you would find myriad apps on play store. Amongst all, Systweak Android Cleaner could win the badge from us. Its interface and ease of use made it a preferred one for us. The home screen of the app strikes off with almost all of its features, expect Battery Saver. Users just need to tap on these features to bring them in use. Saying that, Systweak Android Cleaner is equipped with a Phone Boost, Junk Files, Game SpeedUp, Storage Manager, App Manager and Battery Saver features.
For us, these features make up to be the essential ones as a cleaner and optimizer app. Above all, Systweak Android Cleaner could perform skillfully on these features. But before you begin to use this app, you must know little more about these features.
Phone Boost: Phone Boost is basically a RAM Cleaner. It helps you clean RAM on your phone and optimize it to give you the best performance.
Junk Files: Junk Files are unavoidable. They corner themselves before you even get to know about it. This feature in the app helps you get rid of them in no time. A simple tap on it will let you do all that is need.
Game SpeedUp: Games are absolutely saviors. But what if these games don't respond promptly? Game SpeedUp features allows you to speed up all your games in a single tap.
Storage Manager: Data management is very much needed in Android phones. This canny feature lets you have an organized and well managed data on your phone.
App Manager: Android phones are app based phones. Some apps on your phone might not be in use and some are not used often. You can delete or archive any app with this feature in a jiffy.
Battery Saver: Unlike others, Systweak Android Cleaner's Battery Saver is proficient. It helps you save battery notably.
In nutshell, Systweak Android Cleaner is a great app. It is free on Google Play Store with a rating of 4.4 stars. We look for some more worthwhile updates in the app. For now, we'd like to suggest the developer to add a lock feature as well. This will equip the app further.
For users, we'd say, it is a reliable and available for free. You can download it and optimize your phone to the best.


text:
Deb Schwenka's Hole in One
Deb Schwenka hit a 148-yard hole in one using a 3 Wood on the 7th hole at Minden Country Club in Minden, NE. The ace was reported on July 17, 2009. Witnesses: Dick Schwenka, Jr., Rich Cruise.
Know more about this ace? Share the details and we'll post them on this page.