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Home Fitness
You do not have to work out for more hours in a day but you just need to work out smart. Experts say that not all of the exercises will be equal but some are more efficient. These exercises will help your body burn more calories.
This Article Sponsored by Happy Birthday Lawn Signs
Below are some of the most effective exercises to do at home;
Squats will target much of your muscles. When doing squats you will help your body burn more calories. They will work on your harm strings, quadriceps, and the gluteals and they will use most of your muscle groups. While doing squats make sure to keep the shoulder of your feet width apart and then straighten the shoulder at the back. Ensure that your knee is above the ankle when bending the knees.
If you do pushups in the correct way they will strengthen your chest and shoulders at the same time. You can do pushups when you are at any level of fitness. If you are a beginner start pushups at the height of your kitchen counter level. Afterward, move to your desk or a chair than at the floor while bending your knees. When you have done all that then try to be on your toes on the floor.
Everyone wants to have a flirt and firm abs. When you want to do a crunch start by lying on the back with your feet lying flat on the floor and let your figures tips support the head. Try to press your lower back then contract the abdominal by tucking the chin slightly followed by the neck, shoulders and finally the upper part of your back on the floor. Make sure that you won't pull the neck if you stick the chin out and don't try to hold your breath. Crunches are effective, however, if you won't do them in a correct way then your back might start aching. With crunches alone, you will not be able to attain a flat stomach but try and to burn more calories than your intake.
This will effectively work on all your major muscles at the upper back and the biceps. Standing with your feet shoulder at width apart, bend your knees as you flex your hips going forward. Keep in mind that if you won't be able to do this exercise while standing try and support your body weight by sitting on a bench while facing backward. Try to move your pelvis forward while engaging the abdominals. Extend the upper side of your spine for more support. While holding your dumb-bells under the shoulders, flex the elbows lifting the hands on one side of your body then pause then lower your hands slowly to the original position. If you are a beginner do not perform these exercise with weight.
You can walk anytime and you will not require any equipment. This can be one of the most effective exercises to do at home because you only need a pair of shoes. When you do a brisk walk more often you will be able to burn500 calories in an hour. Walking is a cardiovascular exercise and will help you in strengthening your heart.
Thank you for visiting our site. We hope you find some great tips for keeping your health nice and strong. We encourage you to contact us with any questions or comments. If you happen to have tips of your own, please share with us too.
Also if you are looking for a Baby Shower Yard Sign, please contact our sponsor.
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Monthly Archives: April 2017
Team Virtus takes on the Tour of Hermann
Last weekend, three Virtusans took on the final Tour of Hermann. Chuck and Jim bikepacked there Friday, rode Saturday, and then rode back home on Sunday.
You can check out Jim's write-up of his Tour to the Tour of Hermann here.
I took the easy way out and drove to Hermann on Saturday morning before riding both days.
It was mostly a sufferfest, but I finally managed to ride all five loops, a goal that had eluded me to this point. Here's my post about the race.
Check them out and maybe we'll see you at the next gravel race!

subset: commoncrawl


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Please select the country where your order will be shipped to.
Over the years, Easton has reduced the number of available ACE Insert options. We now carry stocks of H, J and L models.
Similarly with the Screw-in Points, we now have stocks of #2, #3, #4 and #5 models.
Listed below are the official Easton Model Specifications for ACE shafts and their accessories...


text: We live in the digital age. Technology is in existence in every part of our lives. Technology gives us rapid or instant access to a great amount of knowledge each and every day. The students in this class will be given a real world, national, state, or local problem to solve using technology tools. One of the President's initiatives education initiatives is "Race to the Top". We're goint to "Race to a Solution" as we attempt to resolve world, national, state, or local problems using technology tools.


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SEOUL, May 14 (Korea Bizwire) — South Korean financial firms plan to spend a total of 585 billion won (US$492 million) this year to adopt new technologies, such as artificial intelligence and big data analytics, data showed Tuesday.
The planned spending reflects efforts by financial authorities to take deregulatory actions and cut red tape to promote the fintech industry.
According to a survey of 108 financial firms, conducted by the Financial Supervisory Service (FSS) in March, 71 firms plan to further embrace new technologies this year.
Most firms plan to spend their budget to build platforms for AI and big data analytics as part of their efforts to cut costs and offer better customer services, the FSS said.
However, the FSS warned that risks of cyber crimes rose as financial firms are increasingly relying on new technologies.
The FSS said it will encourage financial firms to strengthen their internal control systems.
Risks of infringement of people's right to privacy by companies in the financial sector has been a major concern as many people who use online shopping or financial services put their privacy at risk.


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Monday – Thursday 8 – 4
Our established patients should call Dr. Sage's cell phone. That number is available on our after-hours phone message.
Permanent tooth knocked out
Rinse the tooth in cool water very gently (don't scrub or use soap). Handle only the crown portion of the tooth and not the root. If possible, place it back in the socket and hold in place with a clean gauze or a washcloth. If the tooth cannot be reinserted, place it in a cup of milk, saline solution or water. Act fast and get to the dental office immediately. This is the best way to save the tooth.
Primary tooth knocked out
Contact us as soon as possible. Do not try to reinsert a primary tooth, because you risk damage to the permanent tooth bud underneath.
Chipped or Broken Tooth
Rinse the mouth with warm water and apply a cool compress over the injured soft tissue area to reduce swelling. Contact us.
Possible Broken Jaw
Go immediately to the emergency room.


text: Leading a healthy life seems quite difficult with the modern lifestyle; we are always in a hurry, full of stress and work, with almost no time to relax, be ourselves or sometimes even eat well. That routine, we want it or not, wears away our health. The only way to have a balanced organism is


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We don't usually cover mainstream movies here on the site, but when an indie film comes to town that's about journalism and biking, we have to give it a shout.
The Program is a fictionalized portrait of an Irish reporter's battle to uncover Lance Armstrong's history of doping his way into yellow jerseys. It's at the Living Room Theaters this week.
The movie is directed by Stephen Frears (High Fidelity, The Queen, etc.) and stars Ben Foster as Armstrong, Chris O'Dowd as journalist David Walsh and Jesse Plemons as Armstrong's teammate, enabler and finally betrayer Floyd Landis.
Here's the promotional description:


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You can spin the wheel only once. If you win, you can claim your coupon for 1 day only!
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love this! :)
Fits great and gets the message out !
Super Cute!
My Friends always ask where I got it!
Womens polyester T-shirt is great for cosplay or for everyday wear.
Harry Potter Deathly Hallows bracelet Metal & Leather Bracelet
Are you of someone you love a huge Harry Potter fan ? Then this necklace is the perfect gift for yourself or someone you love. The vertical line represents the Elder Wand, the circle, the Resurrection Stone, and the triangle, the Cloak of Invisibility. Necklace and chain color is silver Get yours today!!! Note: Please allow 3-4 weeks for delivery.


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Braid Tuna Belt
Tuna Belt
Space-age plastic composites, and a wide one piece pad to spread out the forces, make Braid's Tuna Belt one of the most popular in the line. You can apply up to 40 pounds of drag pressure with this gear to fish 50- to 80- pound tackle easily. Receiver accepts gimbal rod butt. Matches up with #30800, #30750 or #30950 harnesses.


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By Charles R. Rondeau
Last fall, the Legislature enacted Senate Bill 863 (SB 863), yet another major reform of the California workers' compensation system. Like SB 899, its predecessor in 2004, SB 863 was adopted as a reaction to, and an intended cure for, certain perceived "abuses" which were occurring in the workers' compensation system. One of these was the prevalence of so-called "add on" allegations of sleep disorders, sexual disorders and psychological/psychiatric disorders to physical injury claims (most commonly orthopedic in nature). Ironically, the primary reason that these secondary consequence claims were being pursued was in response to the drastic decrease in permanent disability compensation for the underlying physical injury claims when SB 899 ushered in the AMA Guides to the California workers' compensation system. And so the cycle of action and reaction perpetuates itself, as in the famous rabbit-wolf paradigm, with (unfortunately) no end in sight. This article will discuss the impact of SB 863 on psychological/psychiatric disorder claims for work-related specific injuries sustained on or after January 1, 2013 or for cumulative trauma injuries with an ending date on or after January 1, 2013.
Labor Code section 4660.1(c)
SB 863 effected several major changes to the system of permanent disability compensation by adopting a new statute, Labor Code section 4660.1, which is applicable for all injuries occurring on or after January 1, 2013. Among these changes is a severely limitation on the ability of injured workers to receive permanent disability compensation for sleep disorders, sexual disorders and psychological/psychiatric disorders which develop as a "compensable consequence" of physical injuries. Labor Code 4660.1(c)(1) states:
Except as provided in paragraph (2), there shall be no increases in impairment ratings for sleep dysfunction, sexual dysfunction, or psychiatric disorder, or any combination thereof, arising out of a compensable physical injury. Nothing in this section shall limit the ability of an injured employee to obtain treatment for sleep dysfunction, sexual dysfunction or psychiatric disorder, if any, that are a consequence of an industrial injury.
As is always the case when it comes to interpreting a statute, it is important to focus on its precise wording and to then consider the statute in the context of the greater body of law to which it belongs. So, let's deconstruct Labor Code section 4660.1(c)(1) a bit and then examine its importance against the backdrop of California workers' compensation jurisprudence.
The first phrase which must be emphasized is: "there shall be no increases in impairment ratings for sleep dysfunction, sexual dysfunction, or psychiatric disorder, or any combination thereof ….". The potentially pivotal nature of the highlighted verbiage will be discussed later, but the primary point to be made here is that the Legislature did not state that there shall be no permanent disability compensation for compensable consequence sleep disorders, sexual disorders and psychological/psychiatric disorders. Furthermore, Labor Code section 4660.1(c)(1) does not preclude an injured worker from receiving temporary disability compensation when, for instance, compensable consequence psychological/psychiatric disorders renders an injured worker to be temporarily totally disabled.
The next phrase which needs to be emphasized is: "arising out of a compensable physical injury ….". By its very terms, Labor Code section 4660.1(c)(1) does not preclude "increases in impairment ratings" for sleep disorders, sexual disorders and psychological/psychiatric disorders which occur as a direct result of the industrial injury itself. What this means in the specific context of psychological/psychiatric disorder claims is that an injured worker may still receive permanent disability compensation: (1) in cases where the primary injury is to the psyche (so called "mental-mental claims"); and (2) in cases of traumatic brain injury; and (3) in cases where the psychological/psychiatric disorder directly results from an underlying industrial event which is inherently psychologically traumatic (e.g., PTSD).
The last phrase which deserves mention is: "[n]othing in this section shall limit the ability of an injured employee to obtain treatment ….". Thus, whether or not an injured worker can receive permanent disability compensation for compensable consequence sleep disorders, sexual disorders and psychological/psychiatric disorders, that worker is still entitled to receive treatment for these conditions, provided, of course, that such treatment is deemed medically necessary. The fact that the right to such treatment has been preserved by SB 863 is crucial to both injured workers and the physicians who remain willing to treat them. As a matter of long-standing precedent in California workers' compensation law, to the extent that a non-industrial injury or condition must be treated to "cure or relieve" an injured worker of the effects of an acknowledged work-related injury or condition can be effectively treated, the employer is required to provide treatment for both injuries and conditions . Assuming that the physical injury in a particular case is significant, one can easily understand why psychological/psychiatric treatment would be necessary to alleviate the effects of that injury. As will be discussed later in this article, medical treatment guidelines applicable in the California workers' compensation system actually support the efficacy and necessity of psychological/psychiatric treatment in appropriate cases.
With respect to psychological/psychiatric injuries, there are two exceptions to the prohibition contained in Section 4660.1(c)(1). Labor Code section 4660.1(c)(2) states:
An increased impairment rating for psychiatric disorder shall not be subject to paragraph (1) if the compensable psychiatric injury resulted from either of the following:
- Being a victim of a violent act or direct exposure to a significant violent act within the meaning of Section 3208.3.
- A catastrophic injury, including, but not limited to, loss of a limb, paralysis, severe burn, or severe head injury.
As will be shown, these exceptions, particularly the "catastrophic injury" exception, will prove to be very difficult to apply in the short run and will cause tremendous controversy until the California appeals court provide specific guidance.
The "Violent Act Exception"
Labor Code section 4660.1(c)(2)(A) does not define the term "violent act". Rather, it simply references Labor Code section 3208.3, which likewise fails to define this term. Accordingly, what constitutes a "violent act" is subject to debate until such time as a precise definition is derived through the appellate litigation process.
To begin to understand the term "violent act" in its proper context, one needs to first review Labor Code section 3208.3(b) in its entirety:
- In order to establish that a psychiatric injury is compensable, an employee shall demonstrate by a preponderance of the evidence that actual events of employment were predominant as to all causes combined of the psychiatric injury.
- Notwithstanding paragraph (1), in the case of employees whose injuries resulted from being a victim of a violent act or from direct exposure to a significant violent act, the employee shall be required to demonstrate by a preponderance of the evidence that actual events of employment were a substantial cause of the injury.
- For the purposes of this section, "substantial cause" means at least 35 to 40 percent of the causation from all sources combined.
There are several points which need to be made. First of all, in cases where the injured worker was either "the victim of a violent act" or was "direct[ly] expos[ed] to a significant violent act", the causation threshold of compensability for any resulting psychological/psychiatric injury is different. Unlike all other claims of psyche injury which are subject to the "predominant cause" standard (>50%), where a psychological/psychiatric injury results from a "violent act" or exposure to a "significant violent act" the injured worker need only prove that the act was a "substantial cause" of their psyche injury (35% - 40%).
Secondly, although Labor Code section 3208.3(b) has been "on the books" since 1991, there are very few cases which address whether a particular work-related event constituted a "violent act". Most of these cases involved rather obvious situations such where the injured worker was threatened by armed gunmen in the course of a robbery or witnessed a drunk driver hitting a pedestrian .
Furthermore, there are very few other statutes which define the term "violent act". As one might expect, most of the statutes which define either "violent" or "violent act" appear in the Penal Code and do not involve sufficiently analogous situations such that those definitions are helpful in the context of a workers' compensation case. On the other hand, Business and Professions Code section 7500.1(y) defines a "violent act" as "any act that results in bodily harm or injury to any party involved." To the extent that a similar definition is adopted in the context of Labor Code section 4660.1(c)(2)(A), many workplace events could conceivably constitute a "violent act". Only time will tell.
The "Catastrophic Injury" Exception
It is likely, however, the exception provided for in Labor Code section 4660.1 (c) (2) for psychological/psychiatric conditions which result from "catastrophic injury" will spark even more intense and heated debate. Just as in the case of the "violent act" exception, Section 4660.1(c)(2) does not define the term "catastrophic injury". Instead, Section 4660.1(c)(2)(B) does no more than provide a non-exclusive list of examples of such injuries. Once again, what constitutes a "catastrophic injury" will be unclear until such time as the appellate courts intervene.
A few salient observations can, however, be made even at this time. The most important point is that what must be "catastrophic" is the outcome of a work-related injury and not necessarily the initial injury itself. Section 4660.1(c)(2)(B) speaks of a "catastrophic injury", as opposed to a "catastrophic event," a "catastrophic incident" or even a "catastrophic accident." Furthermore, it is clear from the examples of "catastrophic injury" set forth in Section 4660.1(c)(2)(B)(i.e., loss of a limb, paralysis, severe burn, or severe head injury) that it is the outcome of a work-related injury, and not the nature of the underlying injury itself, which must be considered when determining whether that injury is, indeed, "catastrophic". For example, a simple laceration to an arm or a leg which becomes infected may cause that limb to be amputated, or a slip and fall injury may result in paralysis. While neither the cut nor the slip and fall is "catastrophic", the outcome in each instance certainly is.
Other California statutes, and indeed case law from other States, may ultimately help shape the ultimate definition of "catastrophic injury" in this context. As will be demonstrated, the cited authorities define a "catastrophic injury" in terms of its adverse financial consequences. For example, California Education Code sections 44043.5(a)(l) and 87045(a)(l) and California Government Code section 19991.13(b)(1) all define the terms "catastrophic illness" or "catastrophic injury" as "an illness or injury that is expected to incapacitate the employee for an extended period of time to care for that family member, and taking extended time off work creates a financial hardship for the employee because he or she has exhausted all of his or her sick leave and other paid time off." Moreover, California Welfare and Institutions Code section 4785 (f) provides that the parents of a family receiving state welfare assistance are exempt from a particular annual assessment where they demonstrate: "the existence of a catastrophic loss that temporarily limits the ability of the parents to pay and creates a direct economic impact on the family." Section 4785(f) goes on to provide examples of "catastrophic loss", including: "natural disasters, accidents involving, or major injuries to, an immediate family member, and extraordinary medical expenses."
In addition, an Illinois appellate court described the "ordinary and popularly understood meaning" of the term "catastrophic injury" as follows: "The term 'catastrophic' is ordinarily understood to mean, in terms of an illness, 'financially ruinous.' Thus, the plain meaning of the term 'catastrophic injury' ...refers to an injury that is financially ruinous."
What constitutes a "catastrophic injury" within the meaning of Labor Code 4660.1(c)(2)(B) will be a hotly-debated question until the inevitable appellate litigation is concluded. Once again, only time will tell.
Impairment vs. Disability
Impairment and disability are clearly separate and distinct concepts. The AMA Guides 5th Edition defines impairment as: "a loss, loss of use, or derangement of any body part, organ system, or organ function." On the other hand, the Guides define disability as: "an alteration of an individual's capacity to meet personal, social, or occupational demands or statutory or regulatory requirements because of an impairment." In other words, an impairment represents a decrease in an injured worker's pre-injury normal bodily function, whereas disability represents a decrease in their situational functionality as a result of an impairment.
The point was made earlier in this article that when interpreting a statute one must first focus attention on the precise wording of the statute. Recall that what Labor Code section 4660.1(c)(1) precludes is "increases in impairment ratings for sleep dysfunction, sexual dysfunction, or psychiatric disorder, or any combination thereof ….". On the other hand, Section 4660.1(c)(1) does not by its terms preclude an increase in permanent disability due to any one of the aforementioned conditions or a combination thereof.
Furthermore, Section 4660.1(c)(1) must be interpreted in reference to Section 4660.1 as a whole, as well as in the context of the workers' compensation system generally. To begin, Labor Code section 4660.1(d) provides that the Permanent Disability Rating Schedule ("PDRS") adopted by the Administrative Director "shall be prima facie evidence of the percentage of permanent disability to be attributed to each injury covered by the schedule." This very language which appears verbatim in Labor Code section 4660 has been interpreted to mean that the permanent disability rating derived by strict application of the PDRS in a particular case is subject to rebuttal . Since impairment and disability are separate concepts, an injured worker should be permitted to present evidence of all disability factors, including psychological/psychiatric factors, to rebut the disability rating which is derived as a function of their legally ratable impairments and application of the PDRS.
Primary Psyche Injury Claims ("Mental-Mental")
Up to this point, this article has been devoted to discussing what SB 863 has changed with respect to psychological/psychiatric conditions. It is equally important, of course, to consider what has not changed. The obvious first place to begin is with psychological/psychiatric conditions which flow from work-related events that do not involve a physical injury. An injured worker's right to receive the full panoply of workers' compensation benefits, including permanent disability compensation, remains unaffected by SB 863. Therefore, applicant attorneys and the physicians who treat them must be mindful of this fact and carefully screen their cases to identify potential "mental-mental" claims which are independent of any physical injury claims, such as psychological/psychiatric conditions which result from "overwork", harassment, discrimination and otherwise hostile work environments.
"Mixed Factor" Cases
In many cases, a psychological/psychiatric condition is caused by multiple concurrent factors. For example, an injured worker may feel "stressed" both due to a work-related physical injury and the hostile nature of the employment environment. This situation is more common than one would hope when an injured worker returns to (or attempts to return to work) after suffering a work-related physical injury. In addition, non-industrial factors (e.g., family and personal life issues, general health issues, etc.) may also be contributory factors causing the psychological/psychiatric condition. In such cases, determining the relative contributions of the various factors in causing the psychological/psychiatric condition will be challenging indeed.
Physical Sequelae of Psychological/Psychiatric Injuries
While SB 863 bars permanent disability compensation for psychological/psychiatric conditions which arise from work-related physical injuries in many cases, the converse is not true. That is to say, where a primary psychological/psychiatric condition which is determined to be work-related and compensable causes physical injuries, the injured worker is entitled to receive permanent disability compensation for the mental and physical injuries. One can easily conceive of a whole range of physical injuries and conditions which might arise as a result of primary psychological/psychiatric condition and cause the injured worker to sustain permanent disability, including hypertension, diabetes, sleep dysfunction and sexual dysfunction. In this regard, it is important to note that even if these conditions were pre-existing on a non-industrial basis, the injured worker may still be entitled to permanent disability compensation if the work-related psychological/psychiatric condition aggravated or accelerated the development of the physical conditions. Furthermore, since the need for medical treatment (unlike permanent disability compensation) is not subject to apportionment as between industrial and non-industrial causes , the injured worker would be entitled to full medical treatment for any physical conditions which are caused by the work-related psychological/psychiatric condition.
Labor Code section 4662
Labor Code section 4662 specifies certain injuries which are conclusively presumed to cause permanent total disability (100% PD). These injuries include:
- Loss of both eyes or the sight thereof.
- Loss of both hands or the use thereof.
- An injury resulting in a practically total paralysis.
- An injury to the brain resulting in incurable mental incapacity or insanity.
The language of this statute was unchanged by SB 863. Indeed, Labor Code section 4660.1(g) provides: "Nothing in this section shall be preclude a finding of permanent total disability in accordance with Section 4662." Therefore, where a work-related injury directly causes "incurable mental incapacity or insanity" (e.g., a head injury which produces an organic brain injury and/or an affective mental disorder), the injured worker is entitled to an award of permanent total disability. On the other hand, where a psychological/psychiatric disorder arises from a work-related physical injury and results in "incurable mental incapacity or insanity", there appears to be a serious conflict between Labor Code section 4660.1(c) and Labor Code section 4662. A valid argument can be made that in such an instance the injured worker is not seeking an increase in the impairment rating otherwise applicable to the underlying physical injury (which would be prohibited by Section 4660.1(c)) but rather is seeking an award of presumed permanent total disability pursuant to Section 4662. The fact of the matter is that, in such instances, the injury would most likely be deemed "catastrophic" and therefore subject to the exceptions to Section 4660.1(c).
Temporary Disability
As was discussed above, nothing in SB 863 precludes an award of temporary disability benefits on the basis of a psychological/psychiatric condition provided that the condition meets the relevant causation threshold set forth in Labor Code section 3208.3(b) and does, in fact, render the injured worker temporarily totally disabled.
Psychological and Psychiatric Treatment
As was also discussed above, SB 863 explicitly preserves an injured worker's right to receive treatment for psychological/psychiatric conditions even if they may not be entitled to receive permanent disability compensation for them. For purposes of the California workers' compensation system, the scope of medically necessary treatment is defined by The Medical Treatment Utilization Schedule ("MTUS") . In the case of psychological/psychiatric conditions, the MTUS has adopted and incorporated the Stress Related Conditions Chapter of the ACOEM Practice Guidelines, 2nd Edition (2004) . Moreover, the Chronic Pain Medical Treatment Guidelines in the MTUS mandate that in chronic pain cases treatment should be provided according to the "biopsychosocial model" which: "recognizes that pain is ultimately the result of pathophysiology plus the psychological state, cultural background/belief system, and relationship/interactions with the environment" . The Chronic Pain Treatment Guidelines specifically state that psychological treatment is "recommended" in chronic pain cases and that cognitive behavioral therapy and self-regulatory treatments "have been found to be particularly effective."
Accordingly, both SB 863 and the MTUS recognize the important role of proper treatment of psychological/psychiatric conditions whether those conditions are the primary injury or a secondarily-occurring one.
Upon careful review, it is clear that a claim of psychological/psychiatric injury remain a viable and important aspect of an injured worker's benefit claim in appropriate cases notwithstanding the significant changes wrought by SB 863. There are many questions pertaining to these changes will remain unanswered and subject to debate while cases are litigated through the Workers' Compensation Appeals Board and the appellate courts. In the meantime, Applicant attorneys and treating physicians must familiarize themselves with the relevant legal principles and should, within the bounds of ethical practice, continue to address claims of psychological/psychiatric injury for the benefit of the injured workers they represent or treat.
iMr. Rondeau is a practicing applicant attorney and also advises providers of both medical treatment and medical-legal services in the California workers' compensation system. He is a certified specialist in Workers' Compensation Law and a recently appointed Commissioner of the Workers' Compensation Law Advisory Committee of the State Bar of California.
iiGranado v. Workmen's Comp. Appeals Bd., 69 Cal. 2d 399 (1968).
iiiCrandler v. The Customer Company/Cigarettes Cheaper, 2007 Cal. Wrk. Comp. P.D. LEXIS 47 (2007); Abushi v. Burger King (Case No. SFO 492440)(2007)(WorkCompCentral Panel Decision).
ivWoodland Joint USD v. WCAB (Royles) 65 Cal. Comp. Cas. 131 (1999) (writ denied).
vVillareal v. Village of Schaumburg, 325 Ill. App. 3d 1157, 1162-1163, 759 N.E. 2d 76 (2001).
viGuides to the Evaluation of Permanent Impairment, 5th Ed., p. 2.
viiGuides to the Evaluation of Permanent Impairment, 5th Ed., p. 8.
ixSee, e.g., Almaraz v. Environmental Recovery Services, et al., 74 Cal. Comp. Cas. 1084 (2009).
xGranado, supra.
xiLabor Code section 4600(b).
xiiTitle 8, California Code of Regulations, section 9792.23.8.
xiiiChronic Pain Medical Treatment Guidelines, p. 2. Chronic Pain Medical Treatment Guidelines, p. 101.


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When humans first settled in New Zealand in the 13th century, they found a wonderland of strange creatures—including a green, bumbling parrot with the face of an owl and the mien of an old gentleman. That was the kakapo—the world's largest parrot, and its only flightless one. It had a set of endearing traits—a disc of whisker-like facial feathers, a ponderous slow-motion gait, and a habit of awkwardly climbing trees with its beak and large wings—that made it easy to love. It also had a set of unfortunate traits—an inability to fly, a naïveté toward danger, a distinctive earthy smell, and a habit of freezing when threatened—that make it easy to kill.
And speaking of the sex lives of kakapo, please do not miss this video (click here to see if reading in email).


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The Steamboat Grand brings a new level of service to one of the West's best resorts for powder skiing. Upon arrival, Western atmosphere and warmth pervades your stay at Steamboat Grand, from the grand lobby entrance and the 327 deluxe guestrooms and condos to our Korbel Grand Ballroom and 17,000 square feet of meeting space. Whether it's business, pleasure or both, the Steamboat Grand is an excellent setting for your next getaway, gathering, function or event. Offering hotel rooms, studios, 1 to 5 bedroom condominiums and penthouses, featuring gas fireplaces, whirlpool tubs and walk-in closets. All units feature Direct TV and in room DVD players, stereo, coffee makers, dual phone lines with fax/modem and voice mail capabilities, hair dryers and iron and board. Many larger units include fully equipped kitchens with GE Profile appliances, hardwood cabinetry and granite countertops and much more. After a satisfying, full day on the slopes, nothing compares to treating your ski muscles to some R&R at the spa or soak in a hot tub. Rejuvenate your mind, body and spirit at the onsite Grand Spa, and book an appointment for one of their signature treatments, facials or massages. The Grand Hotel is also home to wonderful Restaurants. The Grand Café features a full line of Starbucks specialty coffee drinks as well as treats to take along with you for your day. The Cabin Restaurant features a creative menu for every palate, from casual family to special occasions and Happy Hour daily. We also offer an in room dining option Additional hotel amenities include ADA accessible rooms, bathrooms, shuttle services, daily housekeeping, valet and bell service, underground parking and slopeside ski valet.
Canyon Creek at EagleRidge is located just one block from the shops and restaurant of Gondola Square. On-site amenities are great, with a seasonal outdoor pool, outdoor hot tub, exercise room, and heated underground parking garage. Each condo has a gas fireplace and washer/dryer.
Champagne Lodge at Trappeur's Crossing is located just two blocks from Steamboat ski resort's Gondola. This well-located lodge offers condominiums with fully equipped kitchens, private balconies and gas fireplaces. Each unit includes a washer and dryer. Guests will enjoy the numerous outdoor swimming pools and hot tubs. There is also a sauna, fitness facility, computer lounge, library, fitness center, and underground heated parking.
The Crosstimbers Townhomes are ideally located just two blocks from the Steamboat Ski Resort Gondola. Stroll to shops and restaurants in Gondola Square and Torian Plum Plaza at the base of the ski resort. These sunny multi-level townhomes have spacious living and dining areas, and views of the southern Steamboat valley and Flattops mountain range through large windows and private balconies. At the end of the day, relax in the seasonal outdoor pool and hot tub. In-unit amenities include private balconies, a gas fireplace, washer/dryer and two-car garage.
Considered one of Steamboat Colorado's best locations for families, ski clubs/groups, reunions or business retreats, The Phoenix offers vacation rentals ranging from spacious 4-bedroom condominiums to 2-bedroom condominiums. The property is conveniently situated directly across the street from the Steamboat Ski Area, and offers comfortably furnished accommodations, an easy walking distance to the Steamboat Gondola, Steamboat Snow School, Kids Vacation Center, and all base area shops and restaurants. Property amenities include a seasonal outdoor heated pool and hot tubs. Each condo has a gas fireplace, balcony or patio, and one-car heated garage.
The Terraces at EagleRidge combines the elegance of fine country living with the convenience of first-class services and amenities. These 28 luxury condominiums are nestled in a premier location near the base of Steamboat's Mount Werner. Although The Terraces is only a short stroll to the Steamboat Gondola, a winter-season private shuttle is also available to whisk you comfortably to the ski area base or anywhere in Steamboat Springs. After an exhilarating day of enjoying Steamboat's legendary powder, relax in the outdoor heated pool or hot tub, or wander the serene Burgess Creek walking path to one of the many fine restaurants and shops in Steamboat's mountain village. For added convenience, guests at the Terraces have access to ski lockers in the garage level of the complex.
Torian Plum is a premier Steamboat Springs condominium complex located in the heart of the Plaza. Torian Plum Steamboat provides guests with easy access to the town's restaurants, bars and shops. There is plenty to enjoy onsite, too, including a heated outdoor pool, indoor and outdoor hot tubs, a steam room/sauna, and fitness room. Each condo features a private balcony, living and dining areas and a full kitchen. While staying at the property, all Torian Plum guests enjoy complimentary Wi-Fi, underground parking, concierge service, ski storage and skier shuttle service.
The Trails at Storm Meadows maintain a quieter, more secluded atmosphere just a little bit away from the hustle and bustle of the ski area base. Guests enjoy ski access trails leading to all base area lifts, with easy routes back home from the main runs. These beautiful condominiums offer spectacular views of the Yampa Valley and the Steamboat ski slopes from a large private balcony. A private scheduled shuttle to the ski area base and downtown is also available to guests at The Trails.
Get away from it all up at The West Condominiums; this mountaintop retreat is located right above the Steamboat Mountain Village, offering a private hillside location with spectacular views of the ski area and Yampa Valley. The Mountain Village is just a short stroll away by an access path, leading you down to the Gondola, shops and restaurants in the base area. Guests at The West resort have access to a seasonal outdoor heated pool, two outdoor hot tubs, and a fitness facility.


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By Elise Labott
Efforts to transition from dictatorship to democracy after the Arab Spring have endangered religious minorities, the State Department says in its annual report of religious freedom.
The annual survey of religious liberties around the world also warns against deteriorating religious freedom in China and Iran, the increased use of anti-blasphemy laws to restrict the rights of religious minorities and a rising tide of anti-Semitism in Europe
"In times of transition, the situation of religious minorities in these societies comes to the forefront," says the State Department's first report since the Arab Spring uprisings. "Some members of society who have long been oppressed seek greater freedom and respect for their rights while others fear change. Those differing aspirations can exacerbate existing tension."
While the report notes Egypt's interim military leaders had made gestures towards greater inclusiveness, it points to an uptick in sectarian tensions and violence in Egypt, particularly against Coptic Christians.
By Jamie Crawford
A U.S. government watchdog says more than $200 million was wasted on a program to train the Iraqi police force, with security concerns and a lack of interest by the Iraqi government the main culprits for the program's shortcomings.
In an audit released Monday by the office of the Special Inspector General for Iraq Reconstruction, or SIGIR, auditors also said the Police Development Program faced challenges at the outset due to the lack of an assessment of Iraqi police force capabilities, and of a written commitment from the Iraqi government for the program to move forward.
Stuart W. Bowen Jr., who as inspector general leads the SIGIR office, signed the report that was sent to Secretary of State Hillary Clinton and the U.S. Embassy in Iraq.
The purpose of the program is to help Iraqi police services develop the capabilities needed to lead, manage and sustain internal security and the rule of law. The State Department is hoping to reach those goals by 2016.
U.S. Secretary of Defense Leon Panetta says that when Bashar al-Assad loses his grip on power, he wants the Syrian military to remain in place.
"I think it's important when Assad leaves - and he will leave - to try to preserve stability in that country. And the best way to preserve that kind of stability is to maintain as much of the military, the police, as you can, along with the security forces, and hope that they will transition to a democratic form of government. That's a key," Panetta told CNN's Pentagon Correspondent Barbara Starr in an exclusive interview in Tunis, Tunisia, Monday.
He said the United States shouldn't allow a repeat of the Bush administration's moves in Iraq, where it disbanded the Iraqi military.
"It's very important that we don't make the same mistakes we made in Iraq," he said. "And that, particularly, when it comes things like the chemical sites. They (the Syrian military) do a pretty good job of securing those sites. If they suddenly walked away from that, it would be a disaster to have those chemical weapons fall into the wrong hands - hands of Hezbollah or other extremists in that area."
Panetta had some advice for the Syrian dictator whose nation is in the midst of a deadly civil war. "I'm sure that deep down Assad knows he's in trouble and it's just matter of time before he has to go," Panetta said. "I would say if you want to be able to protect yourself and your family, you better get the hell out now."
Panetta is in Tunisia for the start of a week-long trip to the Middle East and North Africa.
Earlier, on the flight to Africa, Panetta told reporters traveling with him that Syria will be on his agenda on every stop.
"The United States and the international community has made very clear that this is intolerable, and have brought their diplomatic and economic pressure on Syria to stop this kind of violence, to have Assad step down and to transition to a democratic form of government," he said. "The key right now is to continue to bring that pressure on Syria, to provide assistance to the opposition, and to provide whatever kind of humanitarian aid we can to assist the refugees."
Watch Barbara Starr and her exclusive interview with Secretary of Defense Leon Panetta tonight on CNN's Situation Room with Wolf Blitzer.
By Mike Mount
As roadside bombs continue to be the top killer of U.S. troops in Afghanistan, a Republican House member is asking for a congressional inquiry into why an Army report favoring a system that increases detection of the bombs was altered to seem less effective, presumably to push an already existing Army system that troops said was inferior.
Rep. Duncan Hunter, R-California, a member of the House Armed Services Committee, also is asking congressional investigators to look into why some Army units that requested the bomb-detection system were denied access to it by the Pentagon bureaucracy.
The investigation request surrounds a new privately developed software system called Palantir, which according to U.S troops and commanders who have used it, is more effective in helping troops in Afghanistan track and predict the location of deadly roadside bombs than the existing Army system.
Earlier this year, after ordering the system pushed out to units in Afghanistan that had been urgently asking for it, Army Chief of Staff Gen. Raymond Odierno requested the Army's Operational Test Command to report on Palantir by surveying troops who have used it.
By CNN's Gregory Wallace
Presumptive Republican presidential nominee Mitt Romney clarified his March remark that Russia is the nation's top foe, saying in an interview which aired Monday on CNN's "The Situation Room with Wolf Blitzer" that Iran potentially poses the greatest national security threat to the U.S.
"The number one national security threat, of course, to our nation is a nuclear Iran," he told CNN's Wolf Blitzer, speaking in Jerusalem about the nearby nation.
Asked about Israel's borders, the broader Israeli-Palestinian conflict, withdrawal of U.S. troops from Afghanistan, the London Olympics, and campaign finance, Romney offered little new policy or criticism of President Barack Obama.
"I'm on foreign soil, and because it's long been a policy of both political parties to leave politics at the water's edge, I'm not going to go through specific foreign policy prescription," he said in response to one question, echoing a similar caveat he affixed to other answers.
By Ivan Watson reporting from Northern Syria
Rebels captured a government military base Monday on the outskirts of Aleppo, the hotly contested Syrian metropolis that has seen more than a week of bloody clashes.
The base had about 200 Syrian troops and appeared to be under attack by rebels from three sides overnight.
"The battle lasted around nine hours," said Fazad Abdel Nasr, a rebel commander working in the northern Aleppo suburbs. Nasr said six regime soldiers and four rebel fighters were killed.
The rebels also gained heavy equipment to supplement the lesser weapons they had been fighting with.


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Haridwar Rishikesh Tour includes the famous tourist spots are Asharms, temples, Har ki Paudi ghat, markets, himalayas view, Ganga aarti,Rafting, camping, wildlife tour and much more attraction.
Haridwar city positioned in the foothills of the Shivalik, represents the point where the Ganga reaches the plains. It is famous for being blessed by trinity of Lord Shiva, Vishnu, and Brahma. The name Haridwar (Hardwar) has been derived from two words, 'Har' means Shiva, 'Hari' means Vishnu, and Dwar means gate. Haridwar is thus the gateway to the two holy shrines of Shiva and Vishnu in Badrinath and Kedarnath, respectively. Places to See in Haridwar are Har-ki-Pauri ghat is one of the most sacred Ghats in India as Maha arti is performed on this ghat every evening. Haridwar is famous for its Ganges ceremony (Ganga Aarti) that is celebrated at 7 pm each night. Other places to see include Mayapuri and Kankhal, which are near Haridwar. Mansa Devi is a temple located on top of a hill called the Bilwa Parvat. One can reached the temple, by the rope way or one can take the normal trekking route to the top.


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4 Tips to Engage People Looking at Your Roller Banners
The reason why you put up banners is that you want people to stop, read what you have written and eventually decide to buy what you offer. The problem is when people see the banners and think that they are boring, they might decide to just skip them and move ahead.
People are busy, and they won't take the time to pause just to look at information on rollup banners. This is compounded by the fact that these days, more people are focused on the use of digital media for advertising. The traditional marketing techniques are easily left out because they are deemed ineffective.
The truth is that if you are creative enough, you can see that these techniques would still work. Here are some ways for your business to maximise print media if you decide to use it.
- Write something catchy
The headline speaks volumes! It is important to have something that catches the interest of many people. You can ask a question or put up information related to discounts and promotions. This helps a lot to make sure that people will be curious enough that they will spend their precious time to at least read what is written on the banners.
- Use bright colours
You can use colours to your advantage. Avoid dark and dull colours since they easily get lost especially when placed next to other banners. People's attention is easily caught by bright colours. Using them will also create a more positive impression of your business. They will see it as a warm, fun and welcoming business as opposed to colours that are dull and boring.
- Highlight your brand
What makes your business unique? If you want your business to be known by many as the "cheaper alternative" to other competing products, highlight the cost and the discount. If you want the business to be seen as a top choice when it comes to quality, focus on that aspect. The moment people read the information on the banners, they need to know what they are getting if they decide to patronise what you offer.
- Bigger is better
Since you are using banners to advertise, the best way to attract attention is by using large banners. You might have to spend more, but you will get more attention. Since you are already spending money on this advertising technique, you might as well use it to present something that can really catch attention. If you opt for smaller banners, you might spend less, but you will have lost the chance to advertise and get people's attention.
You just have to be creative in using print media to your advantage. Some people think that it is already obsolete and is no longer useful, but it still works in many cases. This is true especially if you are looking for local audiences. They still read information through print media and they would love to know more about you.


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Good afternoon y'all! I hope you are having a good day. I did not do any posts yesterday because I was processing the update I did finally receive from my Neurologist. Although I did not expect good news, I do not think I was prepared for what I heard.
Thankfully, my husband did come to my appointment with me to the Neurologist yesterday. The doctor went over my MRI results, from Saturday's MRI. There was not any good news during this appointment. The doctor explained, that there is a tremendous amount of new and active activity on my brain and a large lesion on my spinal cord. She actually told us, that my MRI was one of the worse she has ever seen. Talk about making a patient feel better in any way, this was not a good way to do it! She then carried on about how the Tecfidera, that I decided to changed to about a month and a half ago, was not strong enough to control my disease. She went on to explain things she thought I need to switch to. One of which is completely out of the question, considering it was just released and I am not comfortable with this. I made the decision to go back on Gilenya. Moving forward, she has ordered an incredibly high dose of steroids, to get my inflammation under control and adjusted some of the other medications I was prescribed. She has also written me out of work for the next week, so that I can get plenty of rest and heal. I still do not understand fully how I can have this much activity, in such a short amount of time and she could not explain any of it.
As I said, I did expect to hear that the MS was active, but I did not think it had gotten that bad. Of course, I am scared about what the future holds now and honestly, it is so hard to be positive right now. Even though I do know steroids help the healing, I really hate how awful they make me feel. Steroids make me anxious, nauseous and really moody. Luckily, I am out of work so I do not have to be in contact with people, which is probably the best idea the doctor had.
Now, do not get me wrong, I am glad I have answers, I just wish there was better news somewhere in the mix. I will continue to keep you posted as to what is going on and when I am feeling better. I am hoping the healing process will be a quick one. If you have any comments, please feel free to leave them and I will respond as quickly as I can. There is a chance that I will do another post later with explanations on healing from a flare up, but it depends on how I am feeling. I hope you have a good day!!
Always, Alyssa


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The Frameline Film Festival wraps up this weekend in San Francisco with a fascinating array of docs and features about gay lives both closeted and open. (Read previous coverage of the fest here.) Given the recent overturning of DOMA and the renewal of same-sex marriage in California, this is an especially joyous time to celebrate independent LGBT cinema. Here are a few films to look forward to this weekend as well as "Gore Vidal: The United States of Amnesia," which should expect distribution in some form later this year. Trailers after the jump.
Born This Way (Dirs. Shaun Kadlec and Deb Tullmann)
Named of course after Lady Gaga's billboard-topping gay anthem, "Born This Way" is a fascinating, fearless documentary about the homosexual taboo in Cameroon. Though in California we have much to celebrate this week — and rightly so — LGBT populations of the rest of the world continue to struggle. In the West African nation, where HIV/AIDS is thought to have originated, gay people are at risk of imprisonment of up to five years, often with little evidence other than local rumors. The film's first shot establishes the shame-enshrouded closet to which gay people are relegated in Cameroon. Lit only by candlelight, two women discuss the clandestine way of lesbian life, how if seen even hugging in public, they could go to jail.
"Born This Way" highlights one organization that has been able to thrive in the shadows: Alternatives Cameroon offers care to individuals with HIV/AIDS as well as prevention methods. But in terms of counseling and community building within the center, the country's health ministry has been less than favorable. "They allow us to exist, but we have to be discreet," according to one volunteer. Because of the risky nature of making a film like this, many of the employees and patients of Alternatives must remain anonymous, with their faces blurred. At the aching heart of this troubling yet important documentary is Cedric, a young man who ponders the dangers of coming out to his Christian mother. Thankfully, the LGBT people of Cameroon have places they can dance and be together, but as far as social visibility and acceptance go, they have a perilous road ahead.
G.B.F. (Dir. Darren Stein)
Directed by Darren Stein (1999's "Jawbreaker) and written by first-timer George Northy, Frameline's closing night selection "G.B.F." is pure pleasure, and one of the festival's gems. Though we have seen the story of a high school boy's difficult coming-out time and again at Frameline and in the dubious selection of gay titles on Netflix Instant, this is a sweet, snappy take on that much-tilled genre. In "G.B.F.," Tanner (Michael J. Willett) is inexplicably outed by his classmates but rather than become the social pariah of his high school halls, he's suddenly the class hero, and every girl in the popular clique wants him as her gay best friend.
With quick-witted dialogue and a scene-stealing Molly Tarlov of MTV's "Awkward," the film shrewdly avoids the cliches of the dime-a-dozen coming-out-and-of-age film. There is no sexually awkward first gay love here — instead, it's a celebration of friendship among queer kids, with ample doses of heart and humor thanks to a great cast and especially the always irreverent, frenzied Megan Mullally as a mom coming to terms with her son's sexuality.
Test (Dir. Chris Mason Johnson)
"Test" smartly sets the moody tale of a brooding loner against an historical backdrop, and then gives its characters real lives to lead. A dancer in 1985 San Francisco, Frankie (Scott Marlowe) is sick with an escalating sense of dread as the outbreak of the then elusive and unknowable AIDS virus begins to spread. He also feels the stress of his craft weigh down on him after his dance instructor tells him to make it look more "manly" even though the metaphoric choreography, with all its male musculatures on sweaty display, is totally gay.
The film's ominous atmosphere — almost oppressively sinister at times — makes for an unsettlingly realistic look at the miasma of AIDS panic in San Francisco. The 80s were a time when no one knew what really caused the virus, how it was transmitted or how it could be treated. Every mole and skin blemish was suddenly a life or death matter, and the possible beginnings of Kaposi's sarcoma, one of the telltale signs of the virus.
The lithe Marlowe and his staggering cheek bones give a nuanced performance as a relatable young gay man who isn't some stock character out of the book of queer cinema. Like "Keep the Lights On" and "Weekend" — the two best English-language films about gay male life of this century, by the way — "Test" captures the rhythm of gay reality, the sloppy vacuity and fleeting fulfillment of one-night stands, spikes of self-loathing and a sense of freedom amid a sprawling urban anonymity. I couldn't help but think of Agnes Varda's "Cleo from 5 to 7," because like Corinne Marchand's character, Marlowe's endures a series of life-affirming encounters in the time between taking the AIDS test and painfully awaiting the results. Director Chris Mason Johnson nails the period details of the 80s — the touch-tone phones, the Walkman that soundtracks Frankie's jaunts through the city, the initial gay resistance to the condom — making for an authentic film about gay life.
Gore Vidal: The United States of Amnesia (Dir. Nicholas D. Wrathall)
In the documentary section, "Gore Vidal: The United States of Amnesia" is a thoughtful film about the legendary writer, cultural theorist and political thinker, though its talking heads-style approach smacks a bit of made-for-TV quality. Intercut with candid interviews with the late Vidal (who died last year) as well as rare footage of his Hollywood heyday — and the subsequent existential crisis that came with his move from novelist to script-scribing serf — the doc traces his incendiary career and personal life. But refreshingly, it doesn't make a big splash about his gay life. Instead, this is a portrait of Vidal as artist and critic, rife with his droll, biting aphorisms and intimate conversations with close friends like Tim Robbins and Christopher Hitchens. For Vidal neophytes and aficionados alike, "United States of Amnesia" offers an entertaining X-ray of one of America's most fearless intellectual leaders. Read our TOH! take from the film's premiere at Tribeca here.
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Today, on The Eric Holtzclaw Show, Eric had the pleasure of hosting Anthony Flynn, Founder and CEO of The Execution Pipeline and The Gifted Foundation. Anthony, who has been recognized as a Self-Discipline and Execution Management Expert, hopes to add value to others. Anthony dished on The Execution Pipeline and The Gifted Foundation and how you can get involved.
During today's Tech Tip Tuesday, Eric and Assistant Producer Tiana Bogino discussed the pros and cons of voice-command.
The Eric Holtzclaw Show airs weekday mornings, 11am-12pm. Listen on the go when you have time with the biz 1190 mobile app, available at the App Store and on Google Play.


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Jio Laptop Is Launch Soon?Now Jio enters ready to launch Jio Laptops, with so many features and less price with the high-speed 4G Internet. They want to launch Reliance Jio-Powered laptop into the Indian market. Reliance didn't announce but some experts and information coming that as soon as possible jio launched Jio Laptop with Sim slot at the left side of the laptop.
Jio laptop like 13.3-inch display with resolution 1920*1080 Pixel. The laptop will be user can handle easily at any place. Sim slot will give to Jio laptop at left side and it works with 4G high-speed internet, These means no need to use dongle to laptop. It allows VoLTE Calls.


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PANAMA CITY, Fla. (AP) - A former Florida prison guard has been found guilty of assaulting and inmate and then planting evidence in a failed attempt to claim self-defense.
Willie Walker is facing up to 10 years in prison after being convicted Friday in federal court of violating the inmate's rights.
The Panama City News-Herald reports that in March 2015 the 58-year-old Walker sprayed a Gulf Correctional Institution inmate with a chemical agent and then struck him repeatedly, fracturing his nose and causing a head wound that required stapling. Officials say he then planted a homemade knife.
Walker is scheduled to be sentenced in December.


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This is a PSA from Lil Pump: If you take drugs at one of his shows, please drink water.
The "Gucci Gang" star was performing Sunday at the 2018 Wireless Festival in London when he shut down the music to alert the on-site paramedics that someone in the audience was suffering from what appeared to be a seizure.
A man's lifeless body was seen passed from the back of the crowd and was eventually intercepted by security who rushed him off to the side. Pump followed to survey the situation.
The hip-hop artist came back on the microphone shortly after, and said he was told the guy is going to be "good." However, he then announced that if "anyone takes any type of drugs or anything, please drink water."
The 17-year-old then had security start passing out water to the massive crowd. The exact status of the fan with the medical emergency is unclear.


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The Trans-Atlantic Slave Trade
Extracts from this document...
The Trans-Atlantic Slave Trade The Trans-Atlantic Slave Trade was the trade of African supplied to the colonies of New England occurred around the Atlantic Ocean. This lasted from the 16th century to the 19th century. Most slaves were shipped from West Indies, West Africa and Central Africa. Many European countries are involved in this. Spain, Portugal, Madeira, England, Brazil, France and Dutch are some countries that involved in slave trade. Between 9.4 and 12 million slaves arrived in New England. African slaves are considered unintelligent human being. However, they brought their culture and belief to the New World. Slaves are captured from many different places in Africa so they share many different ideas, belief. Slaves are needed by the American Colonist because of many reasons. Slaves suffered incredible hardships in the New World. Slavery was actually practiced in Africa before the Trans-Atlantic Slave Trade. Slave in Africa were war captives. They lose all of their personal rights. ...read more.
Most ships provided slaves with enough room to sit upright, but not enough to stand. Other slaves were forced to lie in chain with barely 20 inches space between them. Slave merchants Attempted to keep as many slaves alive as possible to maximize profits, but treatment was extremely cruel. Sick slaves were thrown into the ocean to prevent infection from spreading. Some slaves refused to eat so slave merchants used tools to pry open their mouth and force food down their throat. After the slaves get off the ship, they got branded with hot iron to identify them as slaves and then placed in a pen. These things are how most slaves are treated. The Triangular Trade is a famous trade route. European manufactured goods, namely cloth, metal wares and guns. They go to Africa and trade these stuffs for slaves. Then they brought the slaves to the Caribbean and Americas. There they trade slave for money, sugar, molasses, American products, and etc. ...read more.
African Slaves are needed by other countries also. In the West Indies, slaves are needed to make rums, molasses, and many other things. Britain needed slaves to trade with other countries to gain profits. Slaves are necessary in America because it strengthen New England's economy. Even though slaves are forced to go to America, they brought many things with them. Slaves come from many different part of Africa. Because of that, slaves speak different languages and shared different culture and belief. Many slaves are forbidden from carry anything when they are shipped to America. However, they still brought folk poems, folk's story, traditional song and ballads to America. Many of these songs, poems, and stories are about their tradition, culture, and what would it like to be free. When being forced to work in a field, they shared many songs to ease away the pain and keep them collapsing. They also brought their religion to America. For example, some slaves are Christians. They also brought many other things to America such as their traditional foods and customs. ...read more.
This student written piece of work is one of many that can be found in our International Baccalaureate History section.
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Psychology, Department of
Date of this Version
August 1992
Published in Journal of Marriage and Family 54 (August 1992), pp. 652-663. Published on behalf of the National Council on Family Relations. Copyright © 1992 Blackwell Publishing, Ltd. http://www.blackwellpublishing.com/journal.asp?ref=0022-2445&site=1 Used by permission.
This study examined sibling conflict and relationship qualities in early adolescence. One hundred four 10- to 15-year-olds (mean age 11.7 years) completed questionnaires assessing the quality of their relationship with their closest sibling, and were interviewed about a recent, specific conflict with that sibling. Analysis suggests that sibling conflict fulfills several functions in early adolescence, including reinforcing family and relationship rules and delineating interpersonal boundaries. Few differences attributable to age or gender constellation of the sibling dyad emerged, and rivalry did not appear to be a primary impetus to conflict during this age period. Instead, sibling conflict appears to create a context where age-appropriate issues of individuation and differentiation are played out.


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Valor Poses has this amazing new couples pose release at the main store. Of course, like pretty much all poses from Valor, I didn't have to alter this one at all, what you see is exactly how it posed from rez to sit. Amazing quality and perfect for all couples. So gorgeous and sensual, definitely a must have ♥
Full Credits & Links
Shirt: Scandalize. Anna. Black – Mainstore
Pants: Scandalize. Anna. Black – Mainstore
Shoes: Astralia – Divina feet harnesses – Mainstore
Bracelets: Astralia – Spring wings Hand Jewel – Mainstore
Hair: little bones. Vortex – The Blondie – Mainstore
Tattoo: TAOX – TaTToo Appliers Body Only – Leia VG – Mainstore
Body: Maitreya
Head: Catwa Catya
Watch: Virtual Disgrace – Vintage Watch
Jeans: CA Renegade Jeans – Mainstore
Hair: Modulus – Scott Hair – Browns – Mainstore
Tattoo: TAOX Tenebrae Aeternus VU – Mainstore
Ears: +AH+ Loke Ear Piercing – Mainstore
Body: Slink
Head: Catwa Daniel
Couch: Iron Patio Sofa (PG) CHEZ MOI – Mainstore
Fireplace: ROOST – New Port BBQ plain – Mainstore
Tree: 3D Trees Store flamboyant – Mainstore
Pose: Valor Poses-The Lotus – Mainstore


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Welcome to our new E-Commerce Insider newsletter, a morning email with the top news and analysis on the e-commerce industry, produced by BI Intelligence.
ART E-COMMERCE IS BOOMING: The high-end art market has seen all-time record sales in recent years. A growing number of younger buyers are looking for ways to buy art more easily and at a wide range of prices. Online art sales are expected to more than double to $3.76 billion annually in the next five years, according to a newly released report by British insurer Hiscox. Artsy, Artspace, and UGallery are among the competitors who have taken a digital-first approach to selling art, and then there's Amazon which launched its own art marketplace last year, and eBay is said to be working on one as well.
Christie's, the iconic art auction house, says its auction and exhibition sales are growing as fast as online. "The number of active parties is much greater [online] than the audience we've been serving," says Christie's CEO Steven Murphy. "We're living in a moment where we're having a cultural shift, world-wide, towards an interest in art, museum, and the experience of being in front of pictures." Murphy acknowledges that Christie's exclusive auctions are the sort of venues that have created an aura of unattainability for novice art buyers. Rather than turn his back on this fast-growing market, Murphy says Christie's this year will begin a "real surge" in online art sales. (Wall Street Journal, Reuters)
Apple's new head of retail, Angela Ahrendts is transitioning into her new role this week. Ahrendts is coming from Burberry where she was CEO.
UBER FACES HEADWINDS IN FRANCE: On-demand car and delivery service Uber is having a difficult time doing business in France. After a string of protests by registered taxi cab drivers and companies, the French government issued a report forbidding "digital hailing" of cars for cab rides. The city of Paris in particular has very strict regulations concerning how many cabs can be on the streets at any given time (three cabs for every 1,000 inhabitants, compared to New York City which has 13.5 for every 1,000 residents). The taxi companies want to maintain complete control over short-term rides in Paris which has put pressure on the government to regulate Uber and other car hailing services. (Monday Note)
ALIBABA INVESTS IN MAJOR VIDEO SITE: Alibaba is leading a $1.22 billion investment in video site Youku Tudou, giving the e-commerce giant a 16.5% stake in the company. Youku Tudou is the largest video site in China, so the deal is akin to Amazon acquiring a stake in YouTube. Alibaba's interest in Youku Tudou is driven by its need to attract new consumers to its e-commerce sites, such as Tmall and Taobao. Alibaba doesn't own the merchandise it sells, rather it provides a platform where retailers and merchants can sell to millions of potential customers (mostly in China). This means that Alibaba relies on its massive user base to keep sellers happy, and so it has been turning to consumer Internet companies, such as video sites and social networks, through which it can acquire new users. (Reuters)
WELCOME, E-COMMERCE INSIDERS: This is our new newsletter covering all things e-commerce. Please email email@example.com with news and tips.
YELP ACKNOWLEDGES BITCOIN: Yelp now allows merchants and restaurants to note on their business listings whether they accept Bitcoin or not. The new attribute is a hat tip to the new currency/payments platform, which some businesses have started to accept at their businesses. (Yelp)
EARNINGS TO WATCH TODAY: Both eBay and Twitter will release their quarterly earnings today after the market closes. For our e-commerce coverage, we'll be focusing our analysis on eBay's core marketplace business — as it's facing rising competition from Amazon and other e-commerce companies. Management might also address Carl Icahn's very public, now discontinued campaign to split eBay and PayPal into two separate companies. As for Twitter, we are looking for the company to show that user growth is reaccelerating, as it missed the mark last year on its goals for audience growth.
REMITTANCE WARS — MONEYGRAM, WESTERN UNION VS. WAL-MART, FACEBOOK: MoneyGram and Western Union, giants of the $50 billion international remittances business, face challenges from new competitors, who say the international and domestic money transfer sector has bloated fees. We wrote about a new generation of peer-to-peer money transfer apps in our last report. Many of these, like Venmo, are popular with younger consumers. Facebook is seeking European regulatory approval for an electronic money license that would allow it to participate in peer-to-peer international remittances, according to the Financial Times. Wal-Mart announced the launch of its own domestic money-transfer service, despite an existing contract with MoneyGram. Pam Patsley, CEO of Dallas-based MoneyGram, tells the Dallas Morning News that the Wal-Mart contract drives up to 9% of the company's revenue. Elizabeth McQuerry, at payments consultancy Glenbrook, says retail banks should also offer competing online peer-to-peer money transfer services, and many already are.
Here's what else BI Intelligence subscribers are reading …
Top Retail Sites Are Taking Way Longer To Load
REVISED FORECAST: Global Payment Terminal Shipments Will Grow Fast


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By Gina Pongetti Angeletti
The sport just keeps getting harder.
Feature photo by Grace Chiu
The sport just keeps getting harder.
Some of this is because of the apparatus aspect like equipment changes, making landings more tolerable with springs and floor technology. Some of this is because of strides in the health and wellness category like recovery and injury prevention techniques that allow the body to be "less beaten up".
Some new skills that are dreamt up start from the drawing board. Others simply add a twist or small change to existing skills.
Potential elements usually fall into one of a few categories:
- an improvement in mastering gravity, technique and creativity (cue amazing pommel horse work)
- the "higher, bigger, faster, stronger category (adding half twists to things, "half twisting out" of things, etc.)
There is a catch to this, however. The higher we are, the bigger the block, and the more the "spring," the more time in the air, in theory. So adding another movement to what may be an already-complicated skill relies even greater on:
- Perfecting timing of jump, set, etc.
- Perfecting height to allow for extra movement in the air
- Order and timing of change of direction (i.e. flip first, then twist at a certain time)
An athlete may be able to "squeak" around an extra ½ turn in a wolf position, possibly resulting in a wobble or two, however still no more risk to one's safety. But, there is no "squeaking" around of a handspring double front when you add the ½ out, if you are not high enough. This is where not only major deductions happen… the risk of injury escalates.
The official rules for the creation of a new skill are as follows:
Cannot be an existing skill
Has to be submitted to the Technical Committee (Men's or Women's) prior to the event for review with description.
MTC or WTC will then evaluate it, approve it (skill and name), and then "value" it for a D score, or difficulty level on all events except for vault, which gets a start value.
Must be performed at a World or Olympic competition. For the men, it can also be where a member of the MTC is present (arranged in advance).
Must be performed without major deductions (gray area).
Then, voila! Do it!
Here were the skills submitted for the Men at this World Championships:
- The Kranzlmueller – C value
- Athlete: Severin Kranzlmueller, Austria
- Floor Exercise
- Endo roll through to a Japanese Handstand
- The Kurbanov – E value
- Athlete: Nariman Kurbanov, Kazakhstan (SPELL)
- Pommel Horse
- In cross support position, travel backwards over both pommels.
- The Pham – E value
- Athlete: Phuoc Hung Pham, Vietnam
- Still Rings
- Keeping a straight body and arms throughout, start with a slow roll forward, pass through cross position, end is holding swallow for two seconds
- The Nin Reyes- 6.0 Value
- Athlete: Audrys Nin Reyes, Dominican Republic
- Vault
- Add a full twist to the Roche
- The Muntean – C value
- Athlete: Andrei Vasile Muntean, Romania
- Parallel Bars
- Do a front upraise immediately into a backwards straddle cut, end in a hang
- The Koudinov – G value
- Athlete: Mikhail Koudinov, New Zealand
- High Bar
- Add a full twist to a Gaylord
- The Miyachi – I value (Highest submitted value in competition)
- Athlete: Hidetaka Miyachi, Japan
- High Bar
- Lay out a Kovacs, and add a double twist
Here were the seven skills for the women:
- The Alt – C value
- Athlete: Tabea Alt, Germany
- Uneven Bars
- Stoop through on high bar, dislocate and release with half turn in flight between the bars to catch low bar in hanging position
- The Alt 2 – C value
- Athlete: Tabea Alt, Germany (*second skill)
- Uneven Bars
- Dismount: Clear straddle underswing into a front tuck with a half turn
- The Andrade – G value
- Athlete: Rebeca Andrade, Brazil
- Floor
- Double back flip on floor, 1 ½ twists within. Like combining a double back to start, and an arabian to end!
4. (and 5) The Derwael – F value and The Fenton
- Athlete (s): Georgia-Mae Fenton, Great Britain and Nina Derwael, Belgium
- Uneven Bars
- Combine a stalder handstand backwards, next do a reverse Hecht, add on a half twist, and then grab in L-grip
- The Fan – D value
- Athlete: Fan Yilin, China
- Uneven Bars
- Start by doing an L-grip front giant… turn it into a dismount by letting go, flipping forward only a half of a flip, then continue with a double back tuck.
- The Sugihara – E value
- Athlete: Aiko Sugihara, Japan
- Balance Beam
- Do a double turn, but hold your leg in a full 180 degree split position
- The Sugihara 2 – E value
- Add an extra half turn to The Sugihara (making it a full 2 ½)
- The Wevers – D value
- Athlete: Sanne Weavers, Netherlands
- Balance Beam
- 2 ½ turn, leg in position of choice
Also submitted, belatedly, though not performed:
The Olsen – 6.2 value
- Athlete: Shallon Olsen, Canada
- Vault
- Yurchenko – Layout salto with 3 twists
Inside Gymnastics is on-site at the 2017 World Championships and will be bringing you non-stop coverage of the premiere competition of the year! Follow Inside Gymnastics (@insidegym) on social and bookmark insidegym.com on your desktop or laptop for previews, recaps, features, photos and more!


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The next big earthquake could be today..tomorrow..
Living here in quake country, as well as already slide prone territory, we as a community need to be aware of the level of preparedness each one of us has. You have all read the booklet, On Shaky Ground – Putting Down Roots in Earthquake Country — haven't you? Here's a link to read online or down load.
Putting Down Roots in Earthquake Country
Here's some information from the USGS site on what to have on hand:
What emergency supplies do I need?
- Fire extinguisher
- Adequate supplies of medications that you or family members are taking, don't forget reading glasses!
- Crescent and pipe wrenches to turn off gas and water supplies
- First-aid kit and handbook – take a first aid class!
- Flashlights with extra bulbs and batteries (hand crank radios and flashlights are good too)
- Portable radio with extra batteries
- Water for each family member for at least two weeks (allow at least 1 gallon per person per day) and purification tablets or chlorine bleach to purify drinking water from other sources
- Canned and package foods, enough for several days and MECHANICAL can opener. Extra food for pets or livestock if necessary.
- Camp stove or barbecue to cook on outdoors
- Waterproof, heavy-duty plastic bags for waste disposal. Don't forget the toilet paper!
I also think that these booklets and info guides are really set up for more urban areas than ours. A few other things to keep on hand and in full supply living here in Southern Humboldt would be:
- chainsaws and fuel
- tarps for roof repairs
- water systems repair kit
- back up fuel for generator
- back up propane for house hold use (test all lines with soap and water first)
- back up home heating plan (if chimmey is damaged) – MR.Heaters and propane tank with base (open windows)
- extra stove pipe and sealant
Living as far away from the urban areas as we do, it is important to note that we may become more isolated if the 101 corridor is damaged in both // or either direction.
Food and fuel may not be delivered to Garberville or Redway. Remember what a mess it was just last year when 101 north of Redway was out for 5 days, and when Briceland Road was gone how hard it was to get to town. And that section of road hasn't been properly repaired as of this writing.
Being the resilient and self sufficient lot that we are, we may overlook some little things or even big things that could make our having to go it alone for 2-3 WEEKS a lot more pleasant. And just because 'we' have it together doesn't mean our neighbors will.. that is why I encourage every one to get prepared. And stay that way.. it's easy to become complacent, to live off the pantry supplies, to wait too long to refuel, to 'know' you can just run into town and get the meds or toilet paper.
The more each household prepares, the better we are as a community to help each other.
Sheltering in place is always preferred, if the house is still standing and safe.
Having some supplies in your vehicle is also very wise.
Especially rain gear, foot gear, water, energy bars, flashlight and radio, blanket, garbage bags, toilet paper, perhaps a stash of meds and reading glasses and anything you or your family would need if you were to be stranded.
Being Prepared — It's not just for earthquakes.
14 May 2012 : Training and Courses .. The Regional Training Institute – Community Disaster Preparedness and Training to 'prepare, survive, thrive' – Story and photos by Clay McGlaughlin/The Times-Standard
20 October 2011 : A great article about local attitudes..
Disaster Attitude by Heidi Walters – North Coast Journal
15 November 2011 : Community Emergency Response Teams (CERT) training being offered in Shelter Cove.


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Welcome to the FOCAL archive
The Canadian Foundation for the Americas (FOCAL) is no longer in operation. This website documents FOCAL's activities and accomplishments throughout its existence. Thank you for your interest in the work of FOCAL.
Whither North America?
Robert A. Pastor
Photo: Department of Foreign Affairs and International Trade Canada
The rise of China in the 21st century has coincided with the decline of North America. While China's commercial success is one reason for the decline of our continent, the far more important cause is the absence of leadership by the latest prime ministers of Canada and by the presidents of the United States and Mexico.
Since the signing of the free trade agreement between Canada and the United States in 1988 and that of the North American Free Trade Agreement (NAFTA) in 1992, the three parties experienced an acceleration of economic integration that comes close to the European Union's. By 2001, intra-regional trade rose to 46 per cent of the three countries' international trade —up from 36 per cent in 1988. But by then the North American experiment was exhausted, and since 2001, regional integration declined to 40 per cent.
The reduction of trade and investment barriers originally fueled the rise of a North American market; the fall was more complicated. First, China applied its energy to outcompete the world in trade. Second, 9-11 unhinged the United States, resulting in heightened border restrictions so severe that trading among neighbours became more costly than trading with China. Third, the three countries decided to pursue the easier path of widening free trade with other countries instead of the difficult but more productive strategy of deepening North American economic integration. Fourth, although intra-regional trade had tripled, of which 80 per cent transited overland, the three countries did not invest in continental roads or infrastructure or even plan for it.
The fifth reason for the decline of the trilateral project was the most consequential: with the exception of former Mexican president Vicente Fox, North American leaders have thought small in the past decade. When former U.S. president George W. Bush proposed the Security and Prosperity Partnership at Waco, Texas in 2005, he instructed his Cabinet to think incrementally, exclude Congress, and not ask for money. More recently, President Barack Obama and his advisors have been preoccupied with so many crises that they have missed the continental picture and reverted to the old "dual-bilateral" approach of dealing with one crisis —now drugs— and one country at a time. Canada's latest prime ministers —Liberal and Conservative— excluded Mexico from their definition of North America, believing that association with Mexican drug violence would undermine its "special relationship" with the United States. The fact that this bilateral relationship has yielded little more than nice rhetoric has not led Canada to question its assumption or policy.
So when the three current leaders met in Guadalajara in August 2009, they had very little to say to each other except to promise another summit in Canada in 2010. Canadian Prime Minister Stephen Harper apparently forgot to issue a formal invitation but, at least, the three foreign ministers met in Ottawa last December. They talked about Central America, Haiti, and natural disasters, but they too forgot to set a date for a summit perhaps because they forgot to talk about North America. In brief, the three governments have reminded us why North America is declining: they lack imagination and leadership.
What should they do? Incrementalism has failed repeatedly. The three governments cannot even agree on a single standard for truck safety. The U.S. and Canada cannot agree on pre-clearance facilities in the Niagara area. The U.S. cannot even implement NAFTA's provision to open the border to Mexican trucks that are certified as safer than American trucks.
We need to start over with a big North American idea, one based on the simple premise that all three countries benefit when one succeeds, and we are all hurt when one fails. Hence we should turn to the paramount challenge for North America: how to construct a Community that will narrow the development gap between Mexico and its northern neighbours, that will re-discover the region's competitive advantage, and that will fill the institutional vacuum by lean and effective trilateral advisory groups.
Trade is not enough to achieve these goals. The three leaders need to make substantial commitments. They could set up a 10-year, $20 billion per year investment fund to connect by roads and infrastructure the poor southern part of Mexico to its northern neighbours. They could commission a 10-year North American plan for transportation and infrastructure, which can provide the foundation for a great leap in commerce that would be facilitated by a common external tariff. They could assemble and train border and customs officials to manage the borders like partners not adversaries. They could replace the dozen identity cards currently needed to transit the borders with a single agreed-upon North American pass.
Existing institutions on trade, environment and labour would also need strengthening. A new North American regulatory commission to harmonize —when desirable— national regulatory policies could be set up and eventually lift environmental, labour and safety standards. A North American Parliamentary Group could be created to provide a forum for legislators from all three countries, and an Advisory Council to propose continental initiatives and build a North American consciousness could be established.
Public opinion surveys demonstrate that the peoples of North America would like their leaders to be bolder in integrating North America, but the leaders have been intimidated by an intense minority who fear any co-operation with our neighbours. It is time for our leaders to lead and design a North America that will lift the continent and its people to new heights. Let us start with a new bold North American idea: not a bureaucratic one, but one that stirs blood.
Robert A. Pastor is Professor and Director of the Center for North American Studies at American University in Washington, D.C. Dr. Pastor is the author of the forthcoming book, The North American Idea: A Vision of a Continental Future.
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Saaaamarolllllliii.. (sung with stage worthy hand gestures and deep bass vocals). Got to love these Italians and their take on Scotch Whisky. Silvano was widely praised as having one of the best palates on earth and with some of their offerings being the best examples of Scotch Whisky I have ever had I would tend to agree.
Today we are getting into a combination of two distilleries.Tormore and Alt A Bhainne We have had Single Malt Expressions of both of these distilleries in previous editions that were both big time favorites with a lot of you. Lets see what happens when Samaroli puts them together. Keeping in mind of course that the Alt A Bhainne in the 3rd edition was only 8 years old and this expression is 21 years.
Samaroli Spey 1995 – 21 year old Blended Malt Scotch Whisky bottled at 45% and non-chill filtered with no added colour.
Colour: Grassy Gold
Nose: As per usual with Samaroli it takes time to get into everything that's going on. Warm up that Spey glass and get your shnoz in there. Floral honeysuckle and lavender blossom with notes of sweet barley and vanilla cream wafers.
Palate: Spine tingling and a touch tongue tingling as well. "After 8" dark chocolate mints complete with the creamy texture and sweetness. Some baking spices like the tiniest dash of cinnamon and nutmeg.
Finish: Keeps evolving with the bed time pillow mint and dark chocolate thread whirling around the continuing spice.
This is a very nice dram especially for those that love a little mystery in their glass and love to spend time unraveling. I found that this one needed even a touch longer than the normal "Samaroli contemplation" which was cool. This is why the vast majority of you do not work through our calendar in just 25 days but prefer to take your time.
This will be available for those lucky few that want it. Just email me as usual and we can sort you out.
On Day 22 in the 3rd edition we had the incredible Adelphi Cambus closed distillery 27 year old Single Grain. Wish I could have had a bottle of that but alas there just wasn't enough.
Remember to get your Star wars geek on today at Scotch Trooper.
So for tomorrow we are showcasing the single lonely dram in this 4th edition from those naughty boys at Single Cask Nation. They promised me this would be a dram to remember so I cant wait to get stuck in.
Thanks for taking the journey with us so far as we get closer to a special time for many. It is such a pleasure and privilege to be able to share my passion with you.
See you tomorrow


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Non–small cell adenocarcinoma of the lung (arrowhead) that caused symptoms attributed to chronic Lyme disease.
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Nelson C, Elmendorf S, Mead P. Neoplasms Misdiagnosed as "Chronic Lyme Disease". JAMA Intern Med. 2015;175(1):132–133. doi:10.1001/jamainternmed.2014.5426
© 2022
Clinical features of Lyme disease include erythema migrans rash, facial palsy, arthritis, and peripheral neuropathy. In endemic areas, patients with erythema migrans can be diagnosed clinically. Otherwise, diagnosis is based on the history of possible exposure, compatible clinical features, and positive 2-tier serologic testing.1
Chronic Lyme disease is a loosely defined diagnosis given by a small number of physicians—who are not usually infectious disease experts—to patients with various nonspecific symptoms, including patients with no objective evidence of Lyme disease.2 In addition to adverse outcomes from unconventional treatments for chronic Lyme disease,3,4 patients misdiagnosed with chronic Lyme disease may be harmed when their actual condition remains untreated.
We report 3 cases in which diagnosis of the patients' actual conditions was delayed due to the misdiagnosis of chronic Lyme disease. Institutional review board approval was not obtained for this case series because it did not meet the regulatory definition of research and was outside the scope of institutional review board requirements. All 3 patients gave written informed consent to share their medical records for this case series.
A man in his late 30s presented with a 12-year history of joint pain and memory loss, as well as 2 years of paresthesias in both hands. A physician diagnosed him with chronic Lyme disease and prescribed oral tetracycline hydrochloride after a telephone consultation despite negative Lyme serologic test results. Following an in-person evaluation 2 months later, the physician initiated extended antibiotic treatment (Table). The patient's symptoms gradually worsened, and he developed syncope and visual field deficit. Evaluation by a different physician revealed a 1.4 × 0.8-cm pituitary tumor and elevated insulin-like growth factor 1 (835 ng/mL [to convert to nanomoles per liter, multiply by 0.131]), consistent with acromegaly. Successive Lyme serologic test results were negative. Only a portion of the tumor could be removed; the patient has permanent facial changes, cardiomyopathy, joint pain, and obstructive sleep apnea.
A man in his late 30s presented with a 4-year history of fatigue, abdominal pain, and loose stools. Previous evaluations demonstrated stable mesenteric lymphadenopathy. Although he lived in an area where Lyme disease is rare, reported no history of erythema migrans, and had negative Lyme serologic test results, he was diagnosed with chronic Lyme disease by a physician and treated with antibiotics (Table). Subsequently, the patient discontinued treatment and was reevaluated by a gastroenterologist and an oncologist. Findings from a gastric biopsy demonstrated stage IV mucosa-associated lymphoid tissue lymphoma; successive Lyme serologic test results were negative. Findings from a mesenteric lymph node biopsy and positron emission tomographic scan demonstrated stage IV classic Hodgkin lymphoma, for which the patient underwent chemotherapy. He died 2 years later of complications of advanced lymphoma.
A man in his late 50s presented with a 2-week history of fatigue and a 3-day history of fever, headache, and myalgias. He had no known tick bite but worked outdoors in a Lyme disease–endemic area. Serum enzyme immunoassay results for Lyme disease were positive, and he was prescribed doxycycline. Shortly afterward, an expanding 18 × 15-cm erythematous rash appeared below his left shoulder. The rash resolved but malaise and fatigue recurred. Two additional doxycycline courses provided only transient improvement. Five months after his initial diagnosis, the patient was referred to an infectious disease specialist for presumed chronic Lyme disease.
The results of the physical examination and laboratory evaluation were normal except for a slightly elevated white blood cell count. Results of serologic testing for Lyme disease were consistent with previous infection (Table). The patient had a remote 18 pack-year history of smoking. The chest radiograph revealed a 1.1-cm nodular mass in the right upper lobe confirmed by computed tomographic scan (Figure). Further evaluation demonstrated stage I non–small cell adenocarcinoma, which was successfully resected.
Patients 1 and 2 had no evidence of ever having Lyme disease. Patient 3 likely had true Borrelia burgdorferi infection for which antibiotic therapy was appropriate; however, subsequent symptoms were incorrectly attributed to persistent infection.
Chronic Lyme disease is a misleading term that should be avoided.2Posttreatment Lyme disease syndrome is the proper term for patients with a verified previous B burgdorferi infection who experience fatigue, arthralgias, or other symptoms 6 months or more after antibiotic treatment when all other conditions have been ruled out.1,2,5
We are not suggesting that every patient with nonspecific symptoms, such as fatigue, joint pain, or abdominal pain, should be aggressively evaluated for cancer. Rather, we present these cases to demonstrate delays in diagnosis that come from assuming that patients have chronic Lyme disease.
Corresponding Author: Christina Nelson, MD, MPH, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 3156 Rampart Rd, Mail Stop P-02, Fort Collins, CO 80521 (email@example.com).
Published Online: November 3, 2014. doi:10.1001/jamainternmed.2014.5426.
Author Contributions: Dr Nelson had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Nelson, Elmendorf.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Nelson, Elmendorf.
Critical revision of the manuscript for important intellectual content: All authors.
Administrative, technical, or material support: Nelson, Elmendorf.
Study supervision: Mead.
Conflict of Interest Disclosures: None reported.
Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Additional Contributions: We are extremely grateful to the patients for sharing their experiences. We also thank Denise Levitan, MD, and Richard Krumdieck, MD, for their helpful input. Neither Dr Levitan nor Dr Krumdieck received compensation.


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Anti-spit tobacco crusader Bill Tuttle
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