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DIURETICS, POTASSIUM-SPARING (Systemic)
Some commonly used brand names are:
In the U.S.—
In Canada—
For quick reference, the following potassium-sparing diuretics are numbered to match the corresponding brand names.
|This information applies to the following medicines:
|Amiloride (a-MILL-oh-ride)‡
|Spironolactone (speer-on-oh-LAK-tone)‡
|Triamterene (trye-AM-ter-een)
|‡ Generic name product may be available in the U.S.
- Aldosterone antagonist—Spironolactone
- Antihypertensive—Amiloride; Spironolactone; Triamterene
- Antihypokalemic—Amiloride; Spironolactone; Triamterene
- Diagnostic aid, primary hyperaldosteronism—Spironolactone
- Diuretic—Amiloride; Spironolactone; Triamterene
Potassium-sparing diuretics are commonly used to help reduce the amount of water in the body. Unlike some other diuretics, these medicines do not cause your body to lose potassium.
Amiloride and spironolactone are also used to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If the condition continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.
Spironolactone is also used to help increase the amount of potassium in the body when it is getting too low.
Potassium-sparing diuretics help to reduce the amount of water in the body by acting on the kidneys to increase the flow of urine. This also helps to lower blood pressure.
These medicines can also be used for other conditions as determined by your doctor.
Potassium-sparing diuretics are available only with your doctor's prescription, in the following dosage forms:
- Oral
- Amiloride
- Tablets (U.S. and Canada)
- Spironolactone
- Tablets (U.S. and Canada)
- Triamterene
- Capsules (U.S.)
- Tablets (Canada)
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For potassium-sparing diuretics, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to amiloride, spironolactone, or triamterene. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Pregnancy—Studies have not been done in pregnant women. However, this medicine has not been shown to cause birth defects or other problems in animals.
In general, diuretics are not useful for normal swelling of feet and hands that occurs during pregnancy. Diuretics should not be taken during pregnancy unless recommended by your doctor.
Breast-feeding—Although amiloride, spironolactone, and triamterene may pass into breast milk, these medicines have not been reported to cause problems in nursing babies.
Children—This medicine has been tested in children and, in effective doses, has not been shown to cause different side effects or problems in children than it does in adults.
Older adults—Signs and symptoms of too much potassium are more likely to occur in the elderly, who are more sensitive than younger adults to the effects of this medicine.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking potassium-sparing diuretics, it is especially important that your health care professional know if you are taking any of the following:
- Angiotensin-converting enzyme (ACE) inhibitors (benazepril [e.g., Lotensin], captopril [e.g., Capoten], enalapril [e.g., Vasotec], fosinopril [e.g., Monopril], lisinopril [e.g., Prinivil, Zestril], quinapril [e.g., Accupril], ramipril [e.g., Altace]) or
- Cyclosporine (e.g., Sandimmune) or
- Potassium-containing medicines or supplements—Use with potassium-sparing diuretics may cause high blood levels of potassium, which may increase the chance of side effects
- Digoxin—Use with spironolactone may cause high blood levels of digoxin, which may increase the chance of side effects
- Lithium (e.g., Lithane)—Use with potassium-sparing diuretics may cause high blood levels of lithium, which may increase the chance of side effects
Other medical problems—The presence of other medical problems may affect the use of potassium-sparing diuretics. Make sure you tell your doctor if you have any other medical problems, especially:
- Type 2 diabetes mellitus or
- Kidney disease or
- Liver disease—Higher blood levels of potassium may occur, which may increase the chance of side effects
- Gout or
- Kidney stones (history of)—Triamterene may make these conditions worse
- Menstrual problems or breast enlargement—Spironolactone may make these conditions worse
Proper Use of This Medicine
This medicine may cause you to have an unusual feeling of tiredness when you begin to take it. You may also notice an increase in the amount of urine or in your frequency of urination. After you have taken the medicine for a while, these effects should lessen. In general, to keep the increase in urine from affecting your sleep:
- If you are to take a single dose a day, take it in the morning after breakfast.
- If you are to take more than one dose a day, take the last dose no later than 6 p.m., unless otherwise directed by your doctor.
However, it is best to plan your dose or doses according to a schedule that will least affect your personal activities and sleep. Ask your health care professional to help you plan the best time to take this medicine.
To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.
If this medicine upsets your stomach, it may be taken with meals or milk. If stomach upset (nausea, vomiting, stomach pain or cramps) continues, check with your doctor.
For patients taking this medicine for high blood pressure :
- In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.
- Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.
- Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life . If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.
Dosing—The dose of potassium-sparing diuretics will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of potassium-sparing diuretics. If your dose is different, do not change it unless your doctor tells you to do so.
The number of capsules or tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking potassium-sparing diuretics .
- For amiloride
- For oral dosage form (tablets):
- For high blood pressure or to lower the amount of water in the body:
- Adults—5 to 10 milligrams (mg) once a day.
- Children—Dose must be determined by your doctor.
- For high blood pressure or to lower the amount of water in the body:
- For spironolactone
- For oral dosage form (tablets):
- To lower the amount of water in the body:
- Adults—At first, 25 to 200 milligrams (mg) a day. This is divided into two to four doses. Your doctor may increase your dose as needed.
- Children—Dose is based on body weight and must be determined by your doctor. The usual dose is 1 to 3 mg per kilogram (kg) (0.45 to 1.36 mg per pound) of body weight a day. The dose may be taken as a single dose or divided into two to four doses. Your doctor may increase your dose as needed.
- For high blood pressure:
- Adults—At first, 50 to 100 milligrams (mg) a day. This may be taken as a single dose or divided into two to four doses. Your doctor may gradually increase your dose up to 200 mg a day.
- Children—Dose is based on body weight and must be determined by your doctor. The usual dose is 1 to 3 mg per kg (0.45 to 1.36 mg per pound) of body weight a day. The dose may be taken as a single dose or divided into two to four doses. Your doctor may increase your dose as needed.
- To treat high aldosterone levels in the body:
- Adults—100 to 400 mg a day. This is divided into two to four doses and taken until you have surgery. If you are not having surgery, your doses may be smaller.
- For detecting high aldosterone levels in the body:
- Adults—400 mg a day, taken in two to four divided doses. Your doctor may want you to take this dose for as little as four days or as long as three to four weeks. Follow your doctor's instructions.
- To treat low potassium levels in the blood:
- Adults—25 to 100 mg a day. This may be taken as a single dose or divided into two to four doses.
- To lower the amount of water in the body:
- For triamterene
- For oral dosage form (capsules or tablets):
- To lower the amount of water in the body:
- Adults— 100 mg twice a day. Your doctor may gradually increase your dose.
- Children—Dose is based on body weight and must be determined by your doctor. To start, the usual dose is 2 to 4 mg per kilogram (kg) (0.9 to 1.82 mg per pound) of body weight a day or every other day. This is divided into smaller doses. Your doctor may increase your dose as needed.
- To lower the amount of water in the body:
Missed dose—If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage—To store this medicine:
- Keep out of the reach of children.
- Store away from heat and direct light.
- Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
- Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly.
This medicine does not cause a loss of potassium from your body as some other diuretics (water pills) do. Therefore, it is not necessary for you to get extra potassium in your diet, and too much potassium could even be harmful. Since salt substitutes and low-sodium milk may contain potassium, do not use them unless told to do so by your doctor.
Check with your doctor if you become sick and have severe or continuing nausea, vomiting, or diarrhea. These problems may cause you to lose additional water, which could be harmful, or to lose potassium, which could lessen the medicine's helpful effects.
Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine.
Before you have any medical tests, tell the doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.
For patients taking this medicine for high blood pressure :
- Do not take other medicines unless they have been discussed with your doctor . This especially includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since these medicines may tend to increase your blood pressure.
For patients taking triamterene :
- This medicine may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you begin taking this medicine:
- Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.
- Wear protective clothing, including a hat. Also, wear sunglasses.
- Apply a sun block product that has a skin protection factor (SPF) of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your health care professional.
- Apply a sun block lipstick that has an SPF of at least 15 to protect your lips.
- Do not use a sunlamp or tanning bed or booth.
- If you have a severe reaction from the sun, check with your doctor.
Side Effects of This Medicine
In rats, spironolactone has been found to increase the risk of tumors. It is not known if spironolactone increases the chance of tumors in humans.
Check with your doctor as soon as possible if any of the following side effects occur:
For amiloride, spironolactone, and triamterene
Skin rash or itching; shortness of breath
For spironolactone and triamterene only (in addition to effects listed above)
Cough or hoarseness; fever or chills; lower back or side pain; painful or difficult urination
For triamterene only (in addition to effects listed above)
Black, tarry stools; blood in urine or stools; bright red tongue; burning, inflamed feeling in tongue; cracked corners of mouth; lower back pain (severe); pinpoint red spots on skin; unusual bleeding or bruising; weakness
Signs and symptoms of too much potassium
Confusion; irregular heartbeat; nervousness; numbness or tingling in hands, feet, or lips; shortness of breath or difficult breathing; unusual tiredness or weakness; weakness or heaviness of legs
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
More common (less common with amiloride and triamterene)
Nausea and vomiting; stomach cramps and diarrhea
Less common
For amiloride, spironolactone, and triamterene
Dizziness; headache
For amiloride and spironolactone only (in addition to effects listed above)
Decreased sexual ability
For amiloride only (in addition to effects listed above)
Constipation; muscle cramps
For spironolactone only (in addition to effects listed above for spironolactone)
Breast tenderness in females; clumsiness; deepening of voice in females; enlargement of breasts in males; inability to have or keep an erection; increased hair growth in females; irregular menstrual periods; sweating
For triamterene only (in addition to effects listed above for triamterene)
Increased sensitivity of skin to sunlight
Signs and symptoms of too little sodium
Drowsiness; dryness of mouth; increased thirst; lack of energy
For male patients :
- Spironolactone sometimes causes enlarged breasts in males, especially when they take large doses of it for a long time. Breasts usually decrease in size gradually over several months after this medicine is stopped. If you have any questions about this, check with your doctor.
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
Additional Information
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, spironolactone is used in certain patients with the following medical conditions:
- Polycystic ovary syndrome
- Hirsutism, female (increased hair growth)
- Congestive heart failure, severe
Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.
Revised: 04/26/2000
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.


text:
Chevrolet trucks, backbone of GM sales, turn 100
DETROIT — Forget the '57 Chevy. Even the Corvette or Camaro.
With 100 years of production and the auto industry's oldest continually used nameplate, the archetypal hero vehicle for General Motors' biggest brand is a Chevrolet truck, and it's celebrating a century on the market.
Chevy trucks turn 100 this fall, just in time for the brand to capitalize on its hard-earned, hardworking reputation with new models in the hottest parts of the market, such as the Traverse SUV on sale now and a new generation of pickups coming soon.
"GM's been in the truck market forever, even when it was less popular," IHS Markit senior analyst Stephanie Brinley said. "The Silverado pickup and Suburban SUV grew up with America."
The first truck Chevrolet engineered was about as basic as it gets: a one-ton flatbed with no cab, roof, doors or padding on its wooden bench seat. It was literally a horseless carriage, a mild adaptation of the age-old design that put a 36-horsepower, 3.6-liter 4-cylinder engine in front of the driver, where a horse would have gone a year earlier.
Prices started at $1,325, a pretty penny at the time, and more than double the $600 that Ford charged for the Model TT that had debuted as its first pickup a few months earlier.
"Chevrolet's trucks have been a critical part GM's business model for much of the company's history," said Karl Brauer, executive publisher of Autotrader and Kelley Blue Book. "The Ford/GM rivalry has forced both companies to repeatedly up their game over the past century."
Until Ford and Chevrolet hit on essentially the same idea of developing a vehicle specifically to haul and tow, pickups had been modified cars. A customizer would buy a car from the factory, chop its frame up to create a longer cargo bed and get rid of unnecessary frills such as rear seats and doors. The 1918 Chevy One-Ton and Model TT created a new class of more capable and durable vehicles.
GM built a whopping 384 of those Chevy trucks in 1918, all at a factory in Flint, Mich., not far from where GM still has a huge pickup plant. A second plant in Oakland started building Chevy trucks for customers on the West Coast in 1919.
People began to expect more from their trucks by the 1930s. The vehicles began doubling as family transportation for farmers, and Chevy responded with niceties such as windows, doors fenders and running boards on its second-generation pickup. Prices started at $400.
The Chevrolet Suburban essentially invented the sport-utility vehicle and the luxurious, truck-based people hauler when it went on sale in 1935. "It was built on a truck chassis and shared lots of sheet metal and mechanical parts with the pickups," GM Heritage Center director Greg Wallace said.
The Suburban is the auto industry's longest continually used model name and the progenitor of modern family-carrying 4-wheel-drive vehicles.
Pickups gained style and panache when legendary GM design chief Harley Earl lent his magic to the 1938 half-ton pickup, which shared some design cues with Chevrolet cars.
When Detroit reinvented itself as the Arsenal of Democracy during World War II, civilian vehicle production stopped and GM plants built engines, axles and more for hundreds of thousands of troop- and cargo-carrying Chevy and GMC trucks.
After the war, aerodynamic styling wraparound windshields made pickups more socially acceptable and introduced the first trucks enthusiasts would customize and turn into hot rods. Chevy's 1955 Cameo Carrier pickup was called "the Gentleman's Truck," thanks to features such as an automatic transmission and chrome bumpers. It was a signature vehicle for future GM design chief Chuck Jordan, whose other work included the ultimate expression of tail fins on the 1959 Cadillac.
Pickups and SUVs grew more popular for the next four decades despite a few lulls when fuel prices rose and the economy faltered.
More:GM plant strike could create shortages of hot Chevrolet Equinox SUV
More:Review: Chevrolet Traverse High Country is high in price, features
More:Report: GM may kill Chevy Volt, Sonic and four other cars
I can't argue with any of those, but there's one glaring omission: the underappreciated 2002 to 2013 Avalanche, which reshaped the pickup market by making 4-door crew cabs the dominant body style.
Before the Avalanche, 4-door crew cab pickups were limited to heavy-duty pickups carrying grimy work crews. Based on the Silverado 1500, the Avalanche's roomy interior introduced families to a pickup that could carry as many as six people in more comfort than many contemporary sedans.
Wise guys make fun of the Avalanche's goofy "midgate," which opened the rear of the cab onto the bed to make room for long loads. That feature tanked, but the 'Lanche was the predecessor of the $50,000-plus luxury trucks that have become some of the auto industry's most popular and profitable vehicles.
It was the most recent step in Chevy trucks' 100-year evolution from a doorless buckboard that just happened to have an engine instead of a horse.

subset: commoncrawl


text: Health Insurance How Health Insurance Works When You Live in Multiple States You may find yourself needing more than one policy By Louise Norris Louise Norris LinkedIn Twitter Louise Norris has been a licensed health insurance agent since 2003 after graduating magna cum laude from Colorado State with a BS in psychology. Learn about our editorial process Updated on August 29, 2021 Print David Sacks / Getty Images Table of Contents View All Table of Contents Individual Health Insurance Medicare Medicare Advantage Medicaid Travel Insurance If you live in more than one place, how does your health insurance coverage work? That's a question that you might not think of until you're contemplating the possibility of having homes in multiple states, but it's worth considering well in advance, as it can be complicated. If you have employer-sponsored health insurance and you have to move back and forth between two or more locations due to your job, your employer has probably already worked out the details. If they have employees in that situation, they likely have a plan with a nationwide network and coverage in all the areas where their employees live and work. But what if you buy your own health insurance or are covered by Medicare or Medicaid? The specifics vary depending on the coverage you have and where you live. Having homes in two states isn't just reserved for retirees seeking beautiful weather. It also includes college students who spend the school year in a different state, people who relocate on a seasonal basis for work, and a variety of other situations. Individual Health Insurance Individual/family health insurance is coverage that you buy on your own, either through the health insurance exchange or directly from an insurance company (ie, "off-exchange"). Nearly 13 million Americans have individual market coverage through the exchanges, and a few million have individual market coverage purchased outside the exchanges. Although the Affordable Care Act added numerous federal regulations that apply to individual market coverage nationwide, plans are also regulated at the state level, and the plans that are for sale vary widely from one state to another. Types of Plans In the last several years, insurers in the individual market have tended to shift away from preferred provider organization plans (PPO plans), and have begun offering mostly health maintenance organization plans (HMOs) and exclusive provider organization plans (EPOs). In short, HMOs and EPOs don't cover non-emergency out-of-network care, while PPOs do. Although there are still PPO plans available in the individual markets in some states, there are other states where there are no longer any individual market plans available with out-of-network coverage. The networks for individual market plans tend to be fairly localized, rarely extending into other states unless there's a major metropolitan area that straddles two states. So what does that mean if you buy your own health insurance and live in more than one state? In 2016, the federal government issued a series of FAQs about residency and permanent moves, and they addressed the scenario of a person who switches between homes in more than one state during the year (see FAQ number 11). The Difference Between HMO, PPO, EPO, and POS Residency Rules If you live primarily in one state and only travel to the other home(s) "for a short duration," that's essentially just considered a vacation, and your residency continues to be based on your primary home. But what constitutes a "short duration?" The guidelines further clarify that if you have a second home where you spent "an entire season or other long period of time," you can choose to establish residency in that state. If you split your time between your summer home and your winter home, you have the option to establish residency in either state or both. Early retirees who aren't yet eligible for Medicare, and who have opted for the snowbird lifestyle (moving to warmer climates during cold months), may very well find themselves having to purchase individual health insurance with exactly this situation. While it's good to have the flexibility to establish residency and purchase insurance in either or both states, there are some points to keep in mind. Tips for Living in 2 States If you choose to buy a plan in one state and keep it all year long, you might not have coverage for anything other than emergency care when you're living in the second state. If the plan has a network that is limited to providers within the state (which is true of most individual market plans), you'll have to return to your first home in order to receive in-network medical care. If you experience a medical emergency at your second home, your plan will cover your emergency care, but the out-of-network emergency room and physicians have generally had the option to balance bill you for the portion of their bill that is above the "reasonable and customary" amount that your insurer pays. This will no longer be the case as of 2022, however, when new federal rules that protect against "surprise balance billing" take effect, prohibiting balance billing from out-of-network providers in emergency situations. Before opting to rely on a health insurance plan from your home state while you're at your second home, you'll want to carefully discuss the ramifications with your insurance company and make sure you understand all the ins and outs. You can opt instead to establish residency in both states and buy a new health insurance plan each time you move from one house to another. This would ensure that you always have a plan with an adequate provider network in the area where you're currently living. The United States Department of Health and Human Services (HHS) has clarified that your move counts as a "permanent move" because you intend to reside in the area for at least "an entire season or other long period of time." So, you're eligible for a special enrollment period triggered by a permanent move, assuming you've been maintaining health insurance year-round (the special enrollment period due to a permanent move only applies if you already had minimum essential coverage in your prior location). However, buying a new health insurance plan each time you move between your homes means you'll also be starting over with a new deductible and maximum out-of-pocket each time you move. Individual market health plans are sold with calendar-year deductibles and out-of-pocket maximums, which means they reset each year on January 1. If you keep the same plan from one year to the next, you only have to meet your deductible and out-of-pocket maximum once during each calendar year (although if you incur out-of-network costs, those will either apply to a separate out-of-pocket maximum, might not be capped, or might not be covered at all, depending on your plan). But what if you live somewhere warm from October through March, and then return to your northern home state from April through September? If you opt to buy a new plan each time you move, you're potentially going to have to meet three deductibles and out-of-pocket maximums in any given calendar year if you end up needing expensive and ongoing medical care. You'll have one set of out-of-pocket expenses for the plan you have from April through September, another for the plan you buy in October when you arrive at your winter home, and a third for the time you have that plan from January through March, as it will renew and reset in January (for the new calendar year) even though you only purchased it a few months earlier. So while the option to buy a new plan each time you move does ensure that you'll have access to in-network care year-round, it's important to understand that it could get very expensive if you end up needing extensive medical care. Medicare The snowbird lifestyle is popular with retirees and it's easy to see why: who wouldn't want nice weather year-round? Original Medicare's nationwide coverage area makes seamless health coverage considerably easier than it is for people who aren't yet eligible for Medicare. If you're enrolled in Original Medicare (Medicare Part A and Part B), you essentially have access to a nationwide provider network. Nationwide, most doctors and hospitals are participating providers with Medicare, which means they agree to accept Medicare rates. You just need to make sure that you find medical providers who participate with Medicare in each area where you live. Medigap and Part D Medicare supplements, also known as Medigap plans, will pick up the tab for some or all of your out-of-pocket costs for covered Medicare expenses, as long as you see a provider who accepts Medicare. Medigap plans are sold based on where you live, with different health insurers offering plans in different states. But once you have the coverage, you can use it nationwide, which allows Medicare beneficiaries a lot of flexibility, including the option to live in another state for part of the year. Original Medicare plus a Medigap plan will cover most costs, but not prescription drugs. For that, you need a Medicare Part D prescription drug plan. Those are sold by private health insurance companies, and your options are based on your primary location (Medicare has a tool that you can use to see what Part D plans are available in your area). Part D plans have pharmacy networks, and it's important to pay attention to the scope of the network if you plan to live in more than one area during the year. Some Part D plans have nationwide networks, while others have networks that are more localized. Even if your Part D plan has a limited pharmacy network, you can look into the option of using the plan's mail-order pharmacy option and having the medications forwarded to your second home. Medicare Advantage In most areas of the country, Medicare Advantage is an alternative for Medicare beneficiaries who would prefer to receive all of their Medicare coverage in one plan, offered by a private insurer. However, Medicare Advantage plans have provider networks that are more limited than the nationwide network of providers who accept Original Medicare. Medicare Advantage plans use managed care, which means they can be HMOs, PPOs, (etc.), and the scope of the network varies from one plan to another. If you're enrolled in a Medicare Advantage PPO, you'll have some coverage for out-of-network care, although your costs can be significantly higher than they would be if you remained in-network. There are also certain Medicare Advantage plans that are specifically designed for people who live in more than one place, but they're not available in all areas. If you have or are considering Medicare Advantage coverage and you're also thinking about splitting your time between homes in more than one state, you'll want to carefully read the fine print. Talk with the Medicare Advantage insurer to see how you'll be covered when you're outside of your home state. Medicaid Although Medicaid is available in every state, it's quite different from Medicare. Medicare is run by the federal government, which is why Original Medicare coverage is the same in every state and includes nationwide access to providers. On the other hand, Medicaid is jointly run by the federal government and each state. Each state has its own Medicaid program, so benefits, eligibility, and provider access vary from one state to another. This means that Medicaid generally only covers care received in the state that provides the Medicaid coverage, although there are some exceptions in cases where an out-of-state provider is closer or a metropolitan area straddles two states. Emergency care is covered outside the state, just as it is with private plans. Non-emergency care is generally not covered outside of the state that provides the Medicaid coverage. If you move from one home to another and can establish residency according to the rules of the new state, you can apply for Medicaid coverage each time you move. Medicaid coverage typically takes effect at the start of the month in which you apply, so you can have seamless coverage if you apply in a timely manner (note that you cannot have Medicaid coverage in two states simultaneously, so you must terminate your coverage in one state before coverage can start in another state). However, it's important to understand that although you may qualify for Medicaid in one state, that doesn't mean you'll qualify in every state. The Affordable Care Act called for Medicaid eligibility to be extended to 138% of the poverty level in every state, but the Supreme Court ruled that states couldn't be forced to expand their eligibility guidelines, and some have refused to do so. In states that have not expanded Medicaid, non-disabled, non-elderly adults without minor children generally aren't eligible for Medicaid at all, regardless of their income level. This is the case in 11 states as of late summer 2021. For low-income seniors, children, and people with disabilities, there is less disparity in terms of Medicaid eligibility from state to state, but eligibility rules do still vary. For these populations, however, Medicaid eligibility is more strict than the rules that apply for the population that's eligible in most states under the ACA's expansion of Medicaid. If you're enrolled in Medicaid and considering the possibility of living part-time in another state, it's important to talk with the Medicare offices in both states to see how you can maintain continuous coverage. Travel Insurance If you're going to spend part of the year in another state and are concerned about having coverage for more than just emergencies, you might want to consider a domestic travel medical policy—or an international travel policy, if you're living overseas for part of the year. These plans are less expensive than individual major medical coverage because they're more limited. They typically don't cover pre-existing conditions, and they come with caps on the total benefit amount that the plan will pay. However, they can provide additional peace of mind depending on the circumstances. If you opt to keep the individual major medical plan or Medicare Advantage plan that you purchased in your home state, supplementing it with a travel policy will offer additional protection beyond the emergency-only coverage that you're likely to have with your existing coverage—without switching to an entirely new major medical policy each time you move. Reasonable and Customary: What It Means for Insurance Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 17 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Sprung, Andrew. xpostfactoid. Total Marketplace Enrollment Likely Approaches 13 Million. Mark Farrah Associates. Individual Health Insurance Enrollment Trends and Market Insights. American Academy of Actuaries Individual and Small Group Markets Committee. An evaluation of the individual health insurance market and implications of potential changes. Centers for Medicare and Medicaid Services, Department of Health and Human Services. FAQs on the Marketplace Residency Requirement and the Special Enrollment Period due to a Permanent Move. Norris L. How to keep your health insurance when you move to another state. healthinsurance.org. Centers for Medicare and Medicaid Services. CMS Newsroom. HHS Announces Rule to Protect Consumers from Surprise Medical Bills. Norris L. How your 'big move' can trigger an SEP. healthinsurance.org. Boccuti, Cristina; Fields, Christa; Casillas, Giselle; Hamel, Liz. Kaiser Family Foundation. Primary Care Physicians Accepting Medicare: A Snapshot. Jacobson, Gretchen; Freed, Meredith; Damico, Anthony; Neuman, Tricia. Kaiser Family Foundation. Medicare Advantage 2020 Spotlight: First Look. Medicare Rights Center. Differences between Original Medicare and Medicare Advantage. Q1Medicare.com. I travel between two states throughout the year (Connecticut and Florida). Is there a Medicare Advantage plan that can provide coverage in both states without additional cost? Center on Budget and Policy Priorities. Policy basics: Introduction to Medicaid. Backman M. Can I use my Medicaid coverage in any state?. healthinsurance.org. Garfield R, Orgera K, Damico A. The coverage gap: uninsured poor adults in states that do not expand Medicaid. Kaiser Family Foundation. Kaiser Family Foundation. Status of State Action on the Medicaid Expansion Decision. Kaiser Family Foundation. Status of State Medicaid Expansion Decisions: Interactive Map. Norris L. Don't forget to pack travel health insurance. healthinsurance.org. Additional Reading American Council on Aging. Maintaining Medicaid Coverage When Moving Between U.S. States.


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World Bulletin/News Desk
The U.S. government warned iPhone and iPad users on Thursday to be on the alert for hackers who may exploit a vulnerability in Apple Inc's iOS operating system that would enable them to steal sensitive data.
There was the potential for hacks using a newly identified technique known as the "Masque Attack," the government said in an online bulletin from the National Cybersecurity and Communications Integration Center and the U.S. Computer Emergency Readiness Teams.
The network security company, FireEye Inc, disclosed the vulnerability behind the "Masque Attack" earlier this week, saying it had been exploited to launch a campaign dubbed "WireLurker" and that more attacks could follow.
Hackers could potentially steal login credentials, access sensitive data stored on iOS devices and remotely monitor activity on those devices, the government said.
Such attacks could be avoided if iPad and iPhone users only installed apps from Apple's App Store or from their own organizations, it said.
"We designed OS X and iOS with built-in security safeguards to help protect customers and warn them before installing potentially malicious software. We're not aware of any customers that have actually been affected by this attack," Apple said in an emailed statement to Reuters.
Users should not click "Install" from pop-ups when surfing the web. If iOS flashes a warning that says "Untrusted App Developer," users should click on "Don't Trust" and immediately uninstall the app, the bulletin said.Güncelleme Tarihi: 14 Kasım 2014, 10:05


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Doctor Who
Box of Jhana
by Kyla Ward
First Appeared in Burnt Toast#5, 1990
'If we shadows have offended
The experience of dreaming is constantly undervalued in our culture. It is as though the emotional, and other sorts of mental work, that is done whilst in a state of sleep is somehow intrinsically worthless. Secondary, a mere illusion, without a 'real' cause. What is said to a child woken screaming from night terrors? 'There, there, it's only a dream.' The point overlooked is that yes, it was a dream. But something frightened the child.
Dreams work symbolically. Even the Women's Weekly publishes lists of common symbols and their meanings, so you can 'read' your dreams. This is not entirely folly. Certain images do have certain usual meanings in their culture or origin and context. It is certain that any movie or book of the horror or fantasy genre will draw upon them for part of their effect. But dreams can also draw on experiences of your own life, which will operate as symbols. Dreams, in these senses can hold meaning, though whether they can predict the future is a matter for personal metaphysics. Fortune-telling 'dream books' survive from New Kingdom Egypt, indicating what fate a dream of attacking crocodiles, for instance, foretells and what can be best done about it.
The attraction, for fantasy writing, film and art, of the concept of a state where the information received by the mind does not arise from the 'real' world, but from memory and imagination, should be obvious. Apart from this, it is traditional for fantasy and science fiction to explore what science cannot -- whether yet, or ever. Future World (Paul N. Lazarus, 1976), the sequel to the science-fiction film Westworld (1973) involves a sequence where the heroine is hooked up to a machine that allows others to see her dreams. These images involve a series of subconscious memories that are an important clue to the secret goings on in the park (she recalls a medical examination she underwent while drugged).
Dream sequences used in this way appear in a number of movies and books as reinforcements of their symbolism. They are frequently precognitions of later events, and explain graphically the situation as the hero/ine is not yet prepared to believe it. One of the most effective visions of this sort occurs in Ken Russel's Lair of the White Worm. It is also perhaps one of the most dream-like, as it casts the situation symbolically, into the most unlikely bounds of a small version of the Concord sitting in a misty void. In the airline-sterile interior out young hero finds the protagonists; Lady Sylvia and the local girl with whom he is investigating the disappearance of her parents, as air-hostessess. Also present are her parents themselves, strapped into seats. She, at the front, is going through the motions of demonstrating the use of a life vest, while Lady Sylvia pours black, evil-looking drinks down the throats of the hapless pair, then wheels them out through the curtain at the back. He takes a seat, whereupon his seat-belt slides around and locks him in. The lady approaches, smiling, with another black drink... The lady is, of course, the vampiric snake-creature who has sacrificed the girl's father to the god she serves and turned the mother into a like creature by means of her contaminating venom.
A step further is taken by the fabled Nightmare on Elm Street series. This is, that the reality of dreams is not metaphoric. The reactions to dream information becomes so literal they can kill. In Nightmare I this is brought to the point where what is in the dream-reality can come out. The heroine, in one sequence, is battling Freddy Krueger and grabs his hat just as she wakes -- and finds it in her hand back in the laboratory where she is undergoing observation. There is a particularly effective doubling between the scientific setting with it's professionally concerned doctors and graphs, and the hideous activity of her dreaming which they can only see as a tremendous increase in the reactions they are monitoring.
Nightmare on Elm Street I had a particular logic of dreams. It was the children's own fears and weaknesses that allowed their gruesome nemesis to gain hold. Dreams are, after all, the creation of the mind supplying its own data. The heroine survives Nightmare because she, alone of her friends, confronts Freddy and then turns her back on him. And the spectre fades. If this is a moral, it is one very basic to dreaming and one that informs much children's literature but also much fantasy.
By Nightmare III, however, this logic has been broken by the demand for sequels, and Freddy must be laid by bell, book and candle of the advice of the ghost of a nun. But it is another concept of dreams, to see them as gateways which another entity may use. This is what Nightmare on Elm Street turns into, unfortunately halfway through. One of the best examples of this type of 'dream' is the H. P. Lovecraft short story Dreams in the Witch House. A young physics student becomes so caught up in theories of impossible geometry, which he links to local legends of the witch, Keziah, that it begins to intrude on his sleep. He experiences the same dream, night after night, each time progressing a little further. He sees the witch and her familiar in a corner of his room, crossing the floor closer and closer towards him. By the time he realises that what he has been doing by his arcane experimenting is drawing himself into the witch's realm and under her power, it is irredeemable. The dream state here is taken to being a special type of perception, that allows that which is normally hidden to be revealed. (Kinda (yet again) is also an example of this. Not only is Tegan's dreaming a gateway for the Mara but its actual content is a symbolic representation of her three travelling companions as she sees them. And whilst I'm here, Fright Night II, against all expectation a very good movie, has a twist on the normal dream sequence well worth checking out -- Ed)
What dreams undoubtedly are is a marvellous resource for imaginative narratives. Sometimes the link is even more direct then the provision of a useful structuring device. Anne Radcliffe, the C18th author whose credits include The Castle of Udolpho, is reported to have purposefully eaten bad meat to induce the frightful raw material of her books. Robert Bloch, a Weird Tales contributor in the 50's attributed his classic tale The Headsman (some men collect paintings and objects of art. Others collect stamps, matchbooks, buttons. But these things were not for a connoisseur like Otto Krantz. He collected human heads! [1]) directly to a dream, and of course there is the almost legendary tale of Mary Shelley's creation of Frankenstein. It is hard to give reasons for valuing dreams, or a least respecting them. They cannot be attributed to a single, creative act, as can a painting or suchlike. They often contravene logic. But they are nonetheless a piece of your own mental work, and as such should be appreciated even just for what they tell you about your own knowledge of, and adaption of, symbols. A shadow is always cast by something.
[1] pp. 138-9 A Pictorial History of Horror Stories: Peter Haining, Treasure Press, London, 1985.
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November 29, 2010
Partnerships Securely United
Pisces Daily Horoscope
Today you may find that you are comforted by the love and support of your partnerships, helping you appreciate the secure bond you share. The feeling of being united with another person in a relationship, especially a romantic partnership, is an experience that at its best can give us a glimpse of being at one with the universe. Our physiology gives us incentive to want to merge with another and let down our walls. It helps us to feel less alone in the world. But the truth is that we are never, and have never, been alone. We are connected with everything all the time. The bond of relationships feels so good that many people forget that this is not the goal of life itself but merely an aspect that points to our ultimate union. Today you can enjoy the relationships in your life and see them as glimpses of the warmth and security of your bond with a loving universe.
Relationships with friends, family, and partners may change with life, but we always carry the experience and energy of love with us. As long as we know love, we don't need to feel bereft if a relationship changes or ends. Our relationship with the universe comes through our connections with people, and when one person leaves, there are others ready to be the channels of that universal love as well as reflections of ourselves to help us grow. Today you can be grateful for the love and support that helps you realize your oneness with the universe.
Un chouette clin d'oeil de l'Univers… une jolie preuve d'amour aussi… une porte se ferme, une autre s'ouvre….


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Telephone Torah Study: Korach
This week on our Telephone Torah Study (Thursday 4-5pm) we'll study Parshah Korach, Numbers 16:1 – 18: 32. We'll face the serious rebellion of Korach against Moses, God's dramatic punishment, and how Aaron saves the congregation.
Jump to: Suggested reading | Selected Verses of the Week | Portion Summary
To join in on the conference call, please dial 702-851-4044, when prompted punch in 2, then our pass code 22252#.
We'll base our discussion on "He stood between the living and the dead", Rabbi Lisa's commentary used last year as the URJ's official D'var Torah.
In the middle of Parashat Korach comes a short story that I find to be one of the most moving in all of Torah. It arrives unexpectedly in the midst of yet another chilling story of rebellion. The parashahbegins with more than 250 "Israelites, chieftains of the community, chosen in the assembly, men of repute," who, under the leadership of Korah, Dathan, Abiram, and On turn against Moses and Aaron, saying: "You have gone too far! For all the community are holy, all of them, and the Eternal is in their midst. Why then do you raise yourselves above the Eternal's congregation?" (Numbers 16:1-3).
In their accusation, the leaders of the rebellion might seem to echo God's own language at Mount Sinai, calling the Israelites "a kingdom of priests and a holy nation (goy kadosh)" (Exodus 19:6). Their logic, that when all are holy, none is above another, sounds right. But if the "rebels" merely echo God's earlier sentiment, why does their rebellion anger God so much that the earth opens up and swallows them?
Twentieth-century Jewish theologian Martin Buber1 explains God's remarks at Mount Sinai by calling our attention to the "if" clause: " If you will obey Me faithfully and keep My covenant, you shall be My treasured possession . . . you shall be to Me a kingdom of priests and a holy nation," (Exodus 19:5-6). Korah's error, teaches Buber, is in thinking that holiness is a given rather than a state that each of us must strive toward, working in partnership with God.
Continue reading on Reform Judaism
Selected verses of the week:
16:22. They (Moses and Aaron) fell on their faces and said, "O God, the God of the spirits of all flesh, if one man sins, shall You be angry with the whole congregation?"
17:13. He (Aaron) stood between the dead and the living, and the plague ceased.
17:23. And on the following day Moses came to the Tent of Testimony, and behold, Aaron's staff for the house of Levi had blossomed! It gave forth blossoms, sprouted buds, and produced ripe almonds.
Summary of Korach Torah Portion:
The Levite Korah son of Izhar joined with the Reubenites Dathan and Abiram sons of Eliab and On son of Peleth and 250 chieftains of the Israelite community to rise up against Moses. Moses told Korah and his band to take their fire pans and put fire and incense on them before God. Moses sent for Dathan and Abiram, but they refused to come.
The next day, Korah and his band took their fire pans and gathered the whole community against Moses and Aaron at the entrance of the Tabernacle.
The Presence of the Lord appeared to the whole community, and God told Moses and Aaron to stand back so that God could annihilate the others. Moses and Aaron fell on their faces and implored God not to punish the whole community. God told Moses to instruct the community to move away from the tents of Korah, Dathan, and Abiram, and they did so, while Dathan, Abiram, and their families stood at the entrance of their tents. Moses told the Israelites that if these men were to die of natural causes, then God did not send Moses, but if God caused the earth to swallow them up, then these men had spurned God. Just as Moses finished speaking, the earth opened and swallowed them, their households, and all Korah's people, and the Israelites fled in terror. And a fire consumed the 250 men offering the incense. God told Moses to order Eleazar the priest to remove the fire pans — as they had become sacred — and have them made into plating for the altar to remind the Israelites that no one other than Aaron's offspring should presume to offer incense to God. The next day, the whole Israelite community railed against Moses and Aaron for bringing death upon God's people. A cloud covered the Tabernacle and the God's Presence appeared.
God told Moses to remove himself and Aaron from the community, so that God might annihilate them, and they fell on their faces. Moses told Aaron to take the fire pan, put fire from the altar and incense on it, and take it to the community to make expiation for them and to stop a plague that had begun, and Aaron did so. Aaron stood between the dead and the living and halted the plague, but not before 14,700 had died.
God told Moses to collect a staff from the chieftain of each of the 12 tribes, inscribe each man's name on his staff, inscribe Aaron's name on the staff of Levi, and deposit the staffs in the Tent of Meeting. The next day, Moses entered the Tent and Aaron's staff had sprouted, blossomed, and borne almonds.
God instructed Moses to put Aaron's staff before the Ark of the Covenant to be kept as a lesson to rebels to end their mutterings against God. But the Israelites cried to Moses, "We are doomed to perish!" God assigned the Levites to Aaron to aid in the duties of the Tent of Meeting. God prohibited any outsider from intruding on the priests as they discharged the duties connected with the Shrine, on pain of death. And God gave Aaron and the priests all the sacred donations and first fruits as a perquisite for all time for them and their families to eat. And God gave them the oil, wine, grain, and money that the Israelites brought. But God told Aaron that the priests would have no territorial share among the Israelites, as God was their portion and their share.
God gave the Levites all the tithes in Israel as their share in return for the services of the Tent of Meeting, but they too would have no territorial share among the Israelites. God told Moses to instruct the Levites to set aside one-tenth of the tithes they received as a gift to God.


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Over the past two weeks, we've heard from diverse voices speaking on their experiences at mosques throughout North America (South Africa, Europe and the UK as well).
Many are driven out of the mosque by an insular and disengaged mosque culture, by misogynist and patriarchal structures, or were never involved with the mosque to begin with — either because they chose not to, or circumstance has kept some Muslims isolated from larger pockets of the community.
Others argue that the unmosqued movement is flawed, and that it's not the responsibility of the mosque to cater to every type of Muslim. Commenter Sabina feels that her struggles with the mosque is her jihad, and that it's worth it to remain connected to the community despite some negative experiences.
Regardless of the reasons, it is clear that there are growing numbers of Muslims who feel excluded. Discussions like this blog series and the Unmosqued movie are needed to help bring this discussion out into the public — so mosques can recognize, and hopefully address the facts that they are becoming insignificant, are failing community members and will slowly be replaced by other community institutions, unless something drastic happens to change the situation.
As an active proponent for inclusive women's spaces in the mosque, I was not the least bit surprised to hear that both men and women are unmosqued because an overwhelming amount of mosques are unfriendly toward women. When half of the ummah is excluded from positions of power, from participation in sacred knowledge, from even entering a mosque — why then are people surprised when entire families stop attending the mosque? The Hubby and I refused to get married at a mosque because we wanted a mixed setting — one where my non-Muslim parents could sit together during the ceremony, and not one mosque agreed to accommodate us.
Commenter FloweryHedgehog said it perfectly:
When mosques are set up in ways that make it difficult for women to participate,… and then our further exclusion is justified by the fact that we don't show up to the mosque anyway, then something is seriously wrong in our communities.
Just because mosques overflow during Ramadan and the two 'Eids, it's not reason enough to rest upon these laurels. Muslims are disappointed in their mosques as the central community institution and are actively pronouncing their disappointment by leaving.
It's time to reshape and reclaim the mosque.
According to our participants, mosques need to change attitudes, create positive spaces for women and concentrate on outreach programs — be consciously committed to creating, open, fun, inclusive spaces and evolve to include the growing and diverse Muslim population. They need to become involved in the greater human community — to champion social causes and be known for their good works. To become welcoming interfaith spaces and community build. They need to actively serve their people so their community can become empowered materially, ideologically and spiritually.
I want to thank all of our participants again for this thrilling discussion and extend a warm thank you to all the commenters. We'll close up this roundtable with just one more discussion question — but let's keep the discussion going. Share your opinion in the comments. And if you have a mosque that you're absolutely in love with, tell us all about it!
What do you think mosques need to do in order to be relevant today? How can mosques reconnect? Do we even need them anymore?


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Turkmenistan Weekly News Analysis
For the third week in a row President Berdymukhamedov vented his frustration with his subordinates, shuffling many key government positions as well as regional, municipal, and district officials. Such public reprimands and personnel shuffling are reminiscent of Berdymukhamedov's predecessor, the mercurial Saparmurat Niyazov, and this most recent round is noted by the volume of firings and transfers of very high placed government officials from the justice, oil and gas, transportation, and finance sectors.
Such dismissals are usually announced in the state-controlled media, with officials, such as Deputy Justice Minister Begli Ballyev named, and the standard (and vague) rationale given for their dismissal is, for "shortcomings in his work." Others named in purges this month included Deputy Chairman of the State Concern Turkmen Cotton, Ashyrmyrat Cherkezov and Mary power plant chief Altymyrat Gurbangeldiyev – most likely for the failure of the Mary power station. Berdymukhamedov issued reprimands to the Energy Minister, Murad Artykov, and the Minister of Public Utilities, Arslan Yagshimammedov, and dismissed Vice-Premier Rozymyrat Seyitkulyev from his post as the Deputy Chairman of the Turkmen State Committee on Emergency Situations. Seyitkyulyev was once again reprimanded, only this time in his capacity as the Vice Premier in charge of transport and communications, likely the disadvantage of holding two high-profile positions and failing at both, is two high-profile reprimands; this time, he was accused for the poor organizing of the construction of the international North-South transport corridor (i.e., the Kazakhstan – Turkmenistan – Iran international railway), and he was dismissed from both positions.
Berdymukhamedov's wrath also fell upon Sakhetmyrad Mammedov, fired from his post as Chair of Turkmengaz State Concern; Shadurdy Alalov, Chair of State Committee for TV, Radio, and Cinematography; and Arslan Yagshimammedov from the post of Utilities Minister, all "for shortcomings in work." Some officials were transferred, including Deputy Head of Balkan District in charge of education, culture, healthcare, and sports, Maisa Saryeva; the Minister of Economy and Development, Biashimmyrat Hojamammedov; and the Chairman of the Board of the Garagum Bank, Rovshen Nuriagdyev; the state media did not specify what their new positions would be. In addition, Berdymukhamedov transferred Durdyly Durdylyev from his positions as Deputy Finance Minister and Deputy Manager of Turkmenistan's Monetary Fund, to a new appointment as Deputy Chairman of the Supreme Control Chamber.
Despite dissatisfaction with the personnel he has managing the country, the President nonetheless to boast about Turkmenistan's economy and its vast energy resources. Despite the global crisis, Turkmenistan did not scale back its construction plans, he noted at a government meeting, adding that some 397 large facilities worth over $5 billion were commissioned in 2012, including new gas turbine stations, new industrial enterprises, railway stations, bridges and other facilities. The president, in harmony with his state-controlled media, expresses high confidence in Turkmenistan's growing chemical industry and its hydrocarbon resources that the media boasts is so plentiful that there is more than enough to " provide fuel for China, Russia, and Europe in the near future."
Nonetheless, in order to find foreign clients for its resources, the country will need to shape up in terms of its reputation for doing business. Turkmenistan finds itself at the bottom of lists such as The Wall Street Journal's annual Index of Economic Freedom, —placing at 169 out of 177 countries ranked as "repressed." This index is based on criteria including the country's trade freedom, business freedom, investment freedom, and property rights. Maplecroft, a UK-based political risk consultancy think-tank, said in a survey published January 9, that investors operating in Turkmenistan face an "extreme risk" of having their businesses expropriated. Maplecroft concluded that it had found several reasons to be wary of the business climate in Turkmenistan after "evaluating the risk to business from discriminatory acts by the government that reduces ownership, control or rights of private investments either gradually or as a result of a single action."
Our latest International News From Turkmenistan
Our latest Domestic News From Turkmenistan
Our latest Economic News From Turkmenistan
For breaking news see our blog Sifting the Karakum
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NOW Foods Diet Support
Product Details
- Brand: NOW Foods
- Product Code: diet-support-NOW
- Servings per Container: 60
- Quantity per Container: 120 Veg Capsules
- Supports Weight Management*
- Vegetarian Formula
- Quality GMP Assured
Nutrition Facts
Supplement Facts:
2 Veg caps contain:
Calories 5
Total Carbohydrate 1g
Niacin (as Niacinamide) (Vitamin B-3) 10mg 50%
Vitamin B-6 (from Pyridoxine HCl) 10mg 500%
Pantothenic Acid (from D-Calcium Pantothenate) 10mg 100%
Iodine (from Kelp) 150mcg 100%
Chromium (from Amino Acid Chelate) (Chelavite) 200mcg 167%
ForsLean (Extract of Coleus forskohlii) (Root) 125mg
---(min. 10% Forskolin)
L-Carnitine (Carnipure) (from L-Carnitine Tartrate) 250mg
Super Citrimax (Garcinia cambogia Extract 375mg
---containing 225mg (-) Hydroxycitric Acid)
Green Tea Extract (Camellia sinensis) (Leaf) 200mg
---(min. 50% EGCg) (up to 2mg of naturally occurring caffeine)
Uva Ursi Leaf Extract (Arctostaphylos uva-ursi) 50mg
Other Ingredients: Cellulose (capsule), Ginger Root (Zingiber officinale), Cayenne (Capsicum anuum) (Fruit), Cinnamon (Cinnamonium cassia) (Bark), Magnesium Stearate (vegetable source) and Silica.
Not manufactured with: wheat, gluten, soy, milk, egg, fish, shellfish or tree nut ingredients. Produced in a GMP facility that processes other ingredients containing these allergens. Vegetarian/Vegan Product.
Recommended Use:
Adults:As a dietary supplement, take 2 veg caps daily, preferably in divided doses.
For adult use only. Do not exceed recommended dose. Consult a physician prior to using this product if you are pregnant/nursing, taking medication, or have a medical condition. Discontinue use two weeks prior to surgery. Contains caffeine. Do not use in combination with other caffeinated products. Keep out of reach of children.


text: January 06, 2012 - 17:12 GMT hellomagazine.com The Ukranian-born beauty has been chosen to front the luxury label's spring campaign Her standout performance in Black Swan propelled her to super stardom, earning her both Oscar and Bafta nominations for 'Best Supporting Actress'. Now Mila Kunis has taken on her most fashionable role to date – she is the new face of Christian Dior. Following in the footsteps of her Black Swan co-star Natalie Portman, the actress stars in the French luxury label's spring campaign, toting the new Miss Dior handbag. Captured by photographer Mikael Jansson for the series of sophisticated shots, she admitted to Womens Wear Daily that she is "Honestly just learning about fashion". "In my daily life, I don't wear the most feminine pieces. But I love to feel feminine when I'm on the red carpet." Delphine Arnault, the deputy general manager of Dior, explained why the Ukranian-born beauty was their number one choice: "Mila Kunis is a very talented young actress: she embodies the true modern woman. "Her performance in Black Swan was remarkable. She is very gifted."


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We are glad to share with you summary of a survey done by NITO – The Norwegian Institute of Biomedical Science (NITO BFI).
The survey was sent to 19 Norvegian microbiology laboratories that test for SARS-CoV-2. The survey was designed with help from BLS students as a part of their bachelor assignment and sent through Questback on 5 Mai 2020. The purpose of the survey was to get facts about methods, biosafety and capacity of SARS-CoV-2-testing in Norway. The survey was summarized on 2 June 2020.
The results from the survey was published in Norwegian in an article in the Scientific Journal "Bioingeniøren" in June 2020.


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Norbiosk has proven UI/UX experts put their years of experience behind every project to deliver impressive, eye-catching and desired outcome. We go through a lot of idealization and puts in lot of thoughts for the User Interface that we build for each of our client's for Desktop and Mobile projects. We are passionate and bring in high level of enthusiasm to each project. This is what we can do for you to showcase your business while helping to maximize your return on investment.
We provide more than just a lavish front-end design. We also build everything with an intuitive architecture that guides the user through the flow of actions you want them to follow. Your application needs to be intelligently designed to stay consistent with your brand and represent your business in a professional way because your application is always communicating. The final result is a clean, smart application that grabs the attention of the end users.


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Sigmund Freud Marries Martha Bernays
In 1877, Sigmund Freud was an ambitious 21 year-old who planned to devote his life to science.
When Freud was 26, his commitment to laboratory science came to an end. He had met the love of his life.
Twenty-one-year old Martha Bernays was peeling an apple when Freud first saw her. Soon, he was sending her roses everyday and calling her "Princess." Within two months, they were engaged.
Martha Freud (born Martha Bernays) (26 July, 1861, in Hamburg – 2 November, 1951, in London) was the wife of Austrian psychoanalyst Sigmund Freud. Bernays was the second daughter of Emmeline and Berman Bernays. Her paternal grandfather Isaac Bernays was a Chief Rabbi of Hamburg. Sigmund Freud and Bernays met in April 1882, and after a four year engagement (1882-1886), they got married on 14 September 1886 in Hamburg.
Freud and Bernays's love letters sent during the engagement years, according to Freud's official biographer Ernest Jones, who read all the letters "would be a not unworthy contribution to the great love literature of the world." Freud and Bernays had six children: Mathilde (b. 1887), Jean-Martin (b. 1889), Oliver (b. 1891), Ernst (b. 1892), Sophie (b. 1893), and Anna (b. 1895). Bernays's younger sister, Minna Bernays, is known to be one of Sigmund's important intellectual companions.
He left the university in 1882, secretly engaged, and found a job at the Vienna General Hospital in hopes of earning enough money to be marriageable. Nonetheless, he did not marry until September of 1886, and then only thanks to the generosity of his friends. He and his wife, Martha Bernays, went on to have six children.


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Qatar has unveiled investment opportunities for the private sector to develop three beach resorts in Fuwairit, Ben Ghanem and Ras Abrouq as part of the broader public-private partnership ...
Officials of the Qatar Chamber and the Qatari Businessmen Association (QBA) held a meeting on Sunday with Indian External Affairs Minister Dr S Jaishankar, who invited companies in Qatar to invest in India.
Qatar, whose exports to Italy jumped more than five-fold during 2012-19, on Monday invited more Italian firms to scout for the abundant investment opportunities that exist for them in Qatar.
A delegation from Qatar Chamber was part of a two-day field tour of the Lusail Commercial Boulevard project, which aims promote the investment opportunities available for Qatari and foreign investors.
Qatar may attract foreign direct investments (FDIs) through public–private partnership (PPP) initiatives in order to meet the increasing demand of healthcare services and share the financial burden on State finances, Alpen Capital has said in a report.
Current challenges to worldwide investments began a while before Covid-19. This year, investment flows of all forms fell to a new low between the USA and China.
The Qatar International Court and Dispute Resolution Centre is now celebrating its 10th year anniversary.
Britain has announced the biggest investment in its military since the end of the Cold War, despite the coronavirus crisis pummelling the economy, as the government seeks to define its post-Brexit role on the world stage.
The Los Angeles World Affairs Council & Town Hall welcomed HE Ahmad al-Sayed, Minister of State and Chairman of Qatar Free Zones Authority (QFZA), for a discussion on Qatar's innovative Free Zones.
During the meeting, they reviewed the co-operation relations between Qatar and the banking group in the financial and investment fields, in addition to a number of issues of mutual interest.
Plans are in the pipeline for the staging of a series of workshops by the US-Qatar Business Council (USQBC) Doha office aimed at providing information to the Qatari private sector and its stakeholders on the investment climate and business opportunities available in the US market...
The Investment Promotion Agency Qatar (IPA Qatar) has signed an agreement with New York Stock Exchange-listed Palantir Technologies, a world renowned American software company specialising in big data analytics.


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This week I had one of the more satisfying creative experiences I've had in a while. It involved about a half dozen people and a few giant sticky notes.
No, I'm not setting up a punchline.
Without revealing too much, I'll say that several of us from different functional areas are up against a shared -- and short -- deadline. We had to come up with a relatively detailed plan in a short time.
We had done some preliminary discussions over email, and some subsets of the group had met previously. But this was the first time the entire group was in the same room at the same time.
We put two giant sticky notes -- maybe two feet high and a foot-and-a-half wide -- on the wall, and drew a very basic chart. (My handwriting has been described as "distinctive," so I can't take credit for that piece.) We were all standing, probably nobody more than four or five feet from the wall. Knowing we were under time pressure, and knowing that we had a common interest in getting this done well, we were all constructive. Each suggestion built upon, refined, or improved upon something that was already there. As happens in the best conversations, people actually put aside their own suggestions when a better idea came along.
It was one of those wonderful cases in which somebody's suggestion would either trigger a thought in someone else, or solve a dilemma in which someone else had been trapped.
The particular case is all well and good, but I've been thinking about how to generate more moments like that.
Some of the elements are at least partially external. There was a tight, non-negotiable deadline that was out of our control. The stakes were significant. The problem was real.
But others were internal. The size of the group was big enough to generate worthwhile exchanges, but small enough that everybody could stand within a few feet of the sticky notes. It wasn't the usual mix of people. A couple were my direct reports, but others were not. One was from a university in another state. This was not an established group with well-worn grooves. It had some rapport, and a healthy sense of mutual trust, but had never worked as a single unit before.
Since there wasn't much choice but to get right to it, we did. We're not done yet, but the progress on a great idea in a short time has been amazing.
The Boy figured out a while ago that he's most effective as a pitcher when he doesn't always throw the same pitch. Follow something fast with something slow, then change locations, and each pitch will be more effective than it otherwise would have been. The contrast is the key.
I'm thinking there may have been a similar lesson here. Mixing the membership, changing the format, and replacing the usual protocol with standing in front of sticky notes energized the interaction. If that became the new normal, it would lose its effectiveness; sticky notes can become as hackneyed as anything else. But as a change of speeds, it worked wonders.
Wise and worldly readers, have you found equivalents of the giant sticky notes?


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Because I live most of the year in the United Kingdom, I must deal with the fact that an unelected, uneducated, uninviting, and undistinguished monarch is on one side of the currency. So I try to look exclusively at the obverse of pound notes, which represents people who are prominent for what they did, rather than who their papas were. (Jane Austen, for instance, is on the tenner.)
Ordering currency in a billfold became especially complex recently. From 2001 through 2016, the five-pound note featured the 19th-century social reformer Elizabeth Fry. But she was replaced by arch-imperialist and staunch 1930s fan of Hitler and Mussolini, Winston Churchill. I don't want that person staring up at me each time I open my wallet, any more than the unelected, uneducated, et cetera person.
Plus, the new five-pound note initially contained tallow, which led to protests by animal-rights activists. Thankfully, the Bank of England caved in quickly, consenting to return to vegan currency.
But then things got even more complicated in terms of money in my pocket.
Already locked in an oleaginous divorce, I was removed as director of the Institute in London where I worked.
Losing jobs has happened to most of us — whether as short-order blue-collar chefs or short-order national-security chiefs. We are used to being told how many times we must retrain in our lives, that secure employment no longer exists, and so on.
But it hadn't happened to me since late 1987, just after "Black Monday" on the Stock Exchange.
A new head of sociology, who had been on leave during my year there, got up at a farewell lunch for someone in a vaguely fancy restaurant. Announcing that she would be a more humane chair than the norm, she then asked where I was; looked across to me among the 30 gathered; and offered as a peroration of her speech to the multitude, "Oh, and Toby, we're not renewing your contract." These were the first and last words she spoke to me. An anti-abortion health sociologist with a minor in occupational prestige and theories of scapegoating, she was later revealed to be the beneficiary of large sums of money from a bordello.
But I digress.
Back to the fall of 2017, and getting 86'd as director. My sacking took the initial form of a three-line Decanal email proposing that I "step down." No reason was given. I had not received any formal or informal evaluation of my work over the two and a half years of my time there.
The dean provided some detail of the poverty of my performance three weeks later, during a meeting I asked for with him and the president of our union local.
I was described in person as "woefully inadequate."
I've been looking for antonyms of "woefully." I can't find any. Not really. Once that adverb's been applied, you're shit out of luck finding a binary opposite.
This dean — the man who by contrast with me is ipso facto superordinately adequate — leveled the following charges (an advisory: please be seated when reading this):
- Refusing to use Cisco's Jabber
- Abjuring Microsoft's Outlook
- Declining a free cell phone, tablet, and laptop from the university
- And not attending sufficient meetings
As the dean enumerated this extraordinary set of failings, he warmed to his task — leaning ever further forward, as if sharing gossip with a group of intimates or inmates. Encouraged, no doubt, by a sense of rightness and righteousness, the faithful apparatchik's eyes lit up like a chap embarked on a quest with like-minded souls.
But the union president reacted bug-eyed to this list of incompetence. He couldn't believe it. And when I suggested that these things were distortions or, just possibly, completely fucking unimportant, and anyway that my boss hadn't bothered to communicate such matters to me beforehand, or indeed breathed a word of criticism, we settled on the need for a professional development review of my work by the superordinately adequate one (something that should have been done annually).
The dean clarified that he wanted me out no matter what, insisting that must be the outcome. But presumably he realized that his superordinate adequacy had not accounted for a little zinger known as "due process."
The dean then described me as "exceptional" in representing the interests of the Institute internally, and the school externally.
But I was "not a team player." As a consequence, the entirety of senior management, plus anonymous faculty members, wanted me gone.
I figured the professional development review would either be an opportunity to set targets for overcoming my manifold, manifest deficiencies, or an exit interview. Either way, the school would rid itself of me as director, sooner or later.
I had a little while to decide what to do.
It seemed likely that I'd remain "woefully inadequate" in the eyes of the big man on campus (cf. the dude at Ohio State who directs the tuba players at football games, marching in a quasi-military outfit).
When added to the detritus of my break-up, the denunciations convinced me not to struggle on.
My resilience was lacking and I was not entirely supported by colleagues (who were the anonymous faculty, and what had they said?). A bloc had been broken; a formation was quickly falling apart.
I went to the meeting with the dean, this time alone, in January, having filled out the form that was a required prelude to my review. He wanted me to step aside immediately and be replaced on an acting basis by a company man. I dissuaded him of this, while consenting to depart in mid-March.
The figure who typifies me as "woefully inadequate" still hasn't completed his part of the form-filling at the time of this writing: mid-April, three months after the review meeting.
I guess that once you've come up with the perfect, antonym-free denunciation, trying to improve on it might make a chap appear, you know, inadequate by contrast.
Now I'm on what the British call "gardening leave." An offer is on the table for me to return in 2019 as a jobbing prof. But not as director.
What is the underlying political economy and culture of this story — assuming you accept that Cisco, Microsoft, and various phone, laptop, and tablet manufacturers and marketers did not conspire to bring me down in revenge for my heartless rejection of their services, and you consent to move beyond the discourse of Decanal denunciation?
Here's the scoop.
British citizens had basically enjoyed a free ride through undergrad from the 1960s to the 1990s. (This remains the case for the Scots.) Then fees were introduced. Since that time, colleges have come to embrace the idea of students as customers and other universities as competitors. They seek to attract as many international students as possible, who pay double what locals do ("international" currently means "outside the European Union" — think "out of state tuition"). Although that implies folks from the rest of the world, it refers to Chinese citizens more than anybody else.
There's considerable debate about how many Chinese nationals are studying in Britain. Some put the number at 90,000; the government says 95,000. In 2015, the Chinese embassy told me the figure was 150,000. By comparison, there are 100,000 international students in the United Kingdom from the United States, Hong Kong, India, Malaysia, Nigeria, Saudi Arabia, Singapore, and Thailand combined. (Last year, the official number of Chinese students in the States was 350,000. In Canada, it's over 120,000.)
In Australia, where the Chinese student stat is in-between Britain and the United States, there's a moral panic that they're spies for the Party and state.
Closer to home, we see controversy over the dozens of Confucius Institutes that have appeared across US colleges since 2005. The American Association of University Professors is worried about the role of the Politburo and the state in these alleged Trojan horses, to the point where the Institutes are said to "ignore academic freedom," despite being located on liberal campuses.
When I speak to colleagues from the PRC and Hong Kong, they tell me spying does indeed go on in their classes.
Hong Kong schools increasingly rely on money from mainlanders coming to study, some of whom describe the ideological tenor of lectures to their Party handlers. One department chair I know says to his class each semester: "I realize you're going to be reporting on me to the Party. I only ask that you do so accurately."
The Chinese situation is not unprecedented. We recall that leftist academics across the United States were subject to intelligence evaluation by clandestine informants during the Cold War; while on the other side of politics, CIA-sponsored scholars proliferated among the professoriate. Today, colleges gleefully spy on students appropriating copyrighted material, and school pupils' internet use is subject to intense corporate surveillance.
Back in Britain, 007-like or not, many Chinese students arrive in the boonies. Finding little of interest in places laden with white cloning, insular monolingualism, and active xenophobia, they take off for the Big Smoke. Cue these colleges doing the same — establishing satellite campuses in London to grab a piece of the action. Hence our Institute.
We just teach grad school. This year, approximately 90 of our 92 MA students were from the PRC.
And do we have a deal on offer!
An MA for 17,500 pounds (about $25,000)! Just 10 short weeks of tuition (that's right)! When students arrive, they get ranked as gold, silver, or bronze in terms of employability! And among their first classes — a forced collective internship where they can do research for a corporation looking (just possibly) to sell things in their country! Best of all — they don't need a relevant first degree.
Wait a minute. "They don't need a relevant first degree?"
Again, I hope you were sitting comfortably as you read that.
Here's the deal. The university's regulations state that graduate admission is decided by the faculty. But that doesn't happen in the case of a "postgraduate taught programme" (gobbledygook for a terminal MA). This is where they make a lot of loot. And other than in a few cases, at my school, bureaucrats determine these admissions, based on targets they are expecting/expected to meet.
I asked around about this among friends in my field, and found it was pretty much the norm elsewhere. Nobody liked it; everyone thought it was improper; they all objected — and eventually went along with it. Like me, they were ultimately complicit. Cue Lucky Jim. (Cue also legacy admissions in the US, of course.)
The result? Extremely pleasant and interesting grad students arrive, virtually none of whom can write English using conventional syntax or grammar, and who lack familiarity with democracy, postcolonialism, liberalism, queer theory, scholarly research and writing, justice, human rights, and a few other funky things we favor.
These folks have been launched into a place where most of the faculty (who hailed from Korea, Colombia, Ireland, and Turkey, inter alia) were used to studying, teaching, and publishing in second languages — but unused to teaching students without significant experience of liberal education, civil rights, the third sector, or political participation.
In US terms, we are profoundly multicultural — and profoundly ignorant of the desires of our customers/clients/paymasters, the actual existing student body. Our very international and cross-cultural graduate curriculum is not devised for people who have trouble with the language and ideology of instruction, and minimally relevant undergraduate preparation.
As I indicated above, these are nice, smart students, from whom I have learned quite a lot.
But I'm not sure I've taught them much. Why? Because I operate as I have done while teaching in Mexico, Chile, Hong Kong, Singapore, Colombia, Iceland, Norway, Brazil, Sweden, Australia, India, Peru, Ireland, France, and the United States — whether the students are local or foreign.
It is tough when, for example, the folks in front of you have never heard of any major political figure, economic trend, intellectual tendency, artistic format, social movement, sports team, religion, political party, architectural trend, literary theory, or popular genre beyond their own country prior to, say, 2016. And can't easily understand what you say or what is in the readings. In graduate seminars of over 70 people.
In search of help, I spoke to PRC intellectuals I knew. I was aware of the politically awkward nature of my impressions (albeit that some were shared by colleagues from the Global South). And that I was getting paid thanks to people whose credentials for study I doubted.
My Chinese friends and colleagues told me three things:
- The only way to urge liberal education, political economy, non-corporate knowledge, or cultural studies onto these folks is to build such norms into mandatory assessment
- Regardless, the game is up. Top students now know that a UK degree isn't worth the 3,500 tallow-laden, Churchillian fivers that pay for it, due to lax admission and language policies and the insular nature of monolingual British academics. As a consequence, alums from top schools in China are increasingly heading to Canada and the United States for graduate study
- And yes, what I profit from is corrupt
I aired my concerns about these matters on campus — often, and frequently in a febrile manner.
So that is partly what got me nixed.
I think there was something else.
I kept acting as if I were still in the United States.
When I left Britain in 1978, my prevailing experience of the country could best be represented by a hand raised as a stop sign. You were supposed to behave, dammit.
That hasn't changed, though something is different about it.
The Brits got both sides of the neoliberal memo — redistribute income upward, as part of public proclamations of individual economic freedom operating under the invisible sign of socialism for corporations; and continue to regulate ordinary conduct and self-expression to the max.
Plus a creepy Orwellian doublespeak emerged in universities, derived from the mimetic managerial fallacy. That fallacy imagines corporations to be worthy and emulable models for public institutions. It has an entirely mad and maddening vocabulary of capitalist organizational clichés: check and challenge, light touch, sector norm, business-like, enterprise, world-leading, partnering, knowledge transfer, student-facing, create impact, metrics, thought leader, comfortable with, best practice, relaxed about, maker place, hot desking, work-ready graduates, start-ups, our community, industry-centered problem-solving, I am the lead on x, agree a catch-up, industry-facing, this is the available spend, schedule a one-on-one — student experience; on, and on, and on, ad infinitum.
Such language conceals a powerful drive toward central control of everything. Students have commercial rights — but put away that cell phone! Students are customers — but lock the doors if they dare to arrive late! Students are sovereign — but punish them if they speak "privately" in class. Students are consumers — but take attendance and require them to download an application that monitors their movements.
You get the point, and a similar infantilizing discourse applies to the profs.
A while after I started the job in Britain, a guy I knew from the principal campus of my school, the one in the boonies, popped in for lunch. He had just spent his first months as dean at a big state school in the United States after 25 years at superordinately adequate U in Britain. The president of his college had said, "Stop pestering me by asking whether you can do something. Just go ahead and do it. If it doesn't work, then come see me."
In addition to trying things out without asking form-filling, non-publishing nothings, noodges, and nobodies, I'd left the United States assuming faculty democracy as a right, with curriculum and research autonomy part of professional sovereignty.
That wasn't really the case in London. The idea was to do what daddy state and mommy company asked for — and do it, you know, really quickly and well! Then you might get an elephant stamp in your penmanship book. Maybe even a gold star.
I didn't want a gold star. Or an elephant stamp.
So I think that's another reason why I got 86'd. Along with software, hardware, and attendance issues, I had called out instrumentalism and wrongly presumed faculty democracy.
But there is good news: two friends who read this gave me passing grades. One called it "blessedly sufficient"; the other, "adequately extraordinary." Maybe there are antonyms to "woefully inadequate" after all.
Toby Miller lives in London and Barranquilla. His most recent books are Greenwashing Culture, Greenwashing Sport, Global Media Studies, Greening the Media, and Blow Up the Humanities.
Banner Image: "Lucky Jim, Amis," Loyola University Chicago Digital Special Collections, http://www.lib.luc.edu/specialcollections/items/show/1156.


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I'm white.
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I'm last on the list.
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I'm white.
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I'm White.
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I'm White in the 21st century
Why do you accuse me of promoting slavery?
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This article has 40 comments.
also use less line breaks it didn't flow well bc of that
As a black female, I can honestly tell you that your quote bothers me. Quite a lot actually.
Maybe they receive special treatment because historically they never had. You are white. You should be proud; however, black and hispanics haven't had that opportunity to be proud about their heritage until recently. Less than 70 years ago, blacks and hispanics were saying the same thing you are. Are you telling me that you have the same mindset of a person stuck in the 1960's?


text:
Keeping your body healthy
is an expression of gratitude to the whole cosmos;
the trees, the clouds, everything.
-Thich Nhat Hanh
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Professional Academic Society Increases Opportunities and Resources for Part-Time College Educators
CHICAGO, Ill., May 7 (SEND2PRESS NEWSWIRE) — SoCAFE, The Society of Certified Adjunct Faculty Educators, has announced two major enhancements to its web-based certification program for adjunct instructors in higher education. These include expansion of membership eligibility and addition of a Director of Faculty Resources. Both are in response to a growing need for very high quality adjunct faculty in a shrinking educational marketplace.