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If you purchase an independently reviewed product or service through a link on our website, we may receive an affiliate commission. Learn more.
Winter is coming, and we're not talking about Game of Thrones. In fact, after that final season, we never want to talk about Game of Thrones again. We're talking about cold weather and snow, of course, and we've got a killer deal for anyone looking to stay toasty and cozy this winter. The BUZIO 20lb Queen Size Weighted Blanket is one of the most popular weighted blankets on Amazon at $66, but the coupon code 49CBLUJ2 will slash that to just $49.49 if you hurry!BUZIO Weighted Blanket 20 lbs for Adults, Bed Blankets with Oeko-TEX Standard Cotton Fabric and… Price:$49.49 Available from Amazon, BGR may receive a commission
Here are the bullet points from the product page:
- 【Premium Materials】BUZIO cooling Weighted Blanket is the only blanket that registered with Oeko-Tex Standard 100 (free of harmful chemicals). Our materials are carefully selected, strictly inspected in the production process. The high-quality natural breathable cotton and non-toxic glass beads bring you a healthy and cool summer.
- 【Beads-locking Design】The glass beads in the middle are locked by additional 2-layer polyester padding to avoid them leaking from the cotton shells. This 5-layer structure also makes the heavy blanket much thinner and more breathable than the 7-layer ones, which will keep you cool in hot summer. In addition, the glass beads are evenly distributed in the much smaller quilted squares, so that you never have to worry about the weight shifting issue.
- 【More ties, More durable】We specially designed 12 ties along the edge of the adult weighted blanket, so it will stay in place and never fall off if you use it with the removable duvet cover (SOLD SEPREATELY). We highly recommend that you purchase a BUZIO duvet cover for easier cleaning and to extend the service life of the weighted blanket.
- 【Choose the Right Size】This 20 lbs weighted blanket is designed for adults weighing 190-240 lbs (60 x 80 inches). We recommend choosing a blanket that weighs around 7-12% of your body weight. Please keep in mind, it may take 3-5 days to get used to the blanket's weight. If you usually sleep on your side, or have joint pain, especially in your knees, hips, or back, it's better to go with the lighter option. Choose the Heavier one if you're a healthy adult who usually sleeps on your front or back.
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Our deals and product reviews are picked by BGR's expert editors and team.
Follow @BGRDeals on Twitter to keep up with the latest and greatest deals we find around the web. Prices subject to change without notice and any coupons mentioned above may be available in limited supply.


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Grounds for Divorce in Arizona
Arizona and Grounds for Divorce
Every state sets its own divorce laws, so it's crucial to speak with an experienced family attorney in your area to discuss grounds for divorce in your state. In Arizona, you can file for divorce so long as one spouse has lived in Arizona for a minimum of 90 days.
Arizona is also a no-fault state, meaning neither spouse is required to provide a reason for the divorce, as long as one party asserts the marriage is irretrievably broken.
Fault Divorce
In a fault divorce, at least one spouse must request the divorce be granted on certain acceptable grounds.
Traditionally, grounds for fault divorce include adultery, cruelty, and desertion for a certain length of time and confinement in prison for a certain period of time.
Some people would prefer to file a fault divorce to avoid waiting a required separation period or to receive a greater share of matrimonial property.
However, only certain states allow for fault divorces.
Arizona is purely a no-fault divorce state, so a party can't claim a spouse's wrongdoing ended the marriage.
No-fault divorce
To obtain a no-fault divorce, one spouse needs to state an acceptable reason the state recognizes for divorce.
In most states, the couple can simply state incompatibility or irreconcilable differences as the grounds for their divorce.
Even though Arizona doesn't recognize fault divorce, the court may consider a spouse's wrongdoing in dividing property or awarding alimony.
Covenant Marriage
Arizona is one of three states that allow couples to decide, prior to marriage, which laws should apply to their marriage in the event of divorce.
If an Arizona couple chooses a covenant marriage, they agree to attend pre-marital counseling and limit the grounds for divorce.
In a covenant marriage, divorce may be granted on the grounds of a spouse's adultery, abandonment, physical or sexual abuse, drug or alcohol abuse, or continuously living apart for two years.
Thrush Law Group has handled thousands of family law, divorce, and custody cases in Arizona. Our Tucson family law attorneys treat every case with the caring, personal attention it deserves.

subset: commoncrawl


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When you drop $120 on an add-on microphone, you should expect a lot. You should expect near perfection. You should expect Antlion's ModMic Wireless.
I'm not a fan of dedicated gaming headsets that compromise sound quality and comfort for features, big logos, and blinky LEDs. We've discussed this previously. I'll stick with trusty headphones I already comfortably listen to hours of audio with, and I'll just pop a tiny mic on the side as needed. That used to mean adding one more tether trailing from my head- one more cable to manage- one more cord to brush against my arm- one more wire to knock over the toys on my desk. I found it bothersome, to say the least.
Presenting an opportunity to eliminate one of the most annoying cords I use, I couldn't wait to get my hands on Antlion Audio's Modmic Wireless add-on mic.
Up front, Antlion does a great job considering everything you might need. Apart from the ModMic Wireless and USB transmitter, the box contains a zippered travel case, USB extension cable, microUSB charging cable, a couple sticky-back magnetic mounts, and extra adhesive dots.
Installation is mindless, apart from deciding what side of your headphones will be blessed with the Modmic's stronger new mag mount. I suppose both sides is an option since Antlion includes a couple of mounts, but I prefer to put my spare on a second set of headphones. I only needed to plug in the USB transmitter, press a single button, and my new ModMic was initialized and ready for me to bark noises into it.
The single button functionality is especially nice. One press for power, one press for mute when powered on, one long press to turn it off. It's dead-simple to use by touch alone, and the current mode is indicated via LEDs on both the mic and transmitter. Changing between uni-directional and omni-directional mic modes with the on-mic toggle switch is just as easy and intuitive. The mic boom is a great blend of bendy and rigid, and I found it to be the perfect length for both comfort and audio capture.
The ModMic Wireless battery life is excellent at an advertised 12 hours. Out of the box, I was able to leave it on for about 13.5 hours total over two days. Charging's done via an included microUSB cable, and can happen with the mic in use or not. If I could change anything about the ModMic Wireless, it would be to use USB-C charging instead of microUSB. Come on, everyone, it's 2019.
These features are all for naught without audio quality that lives up to the Antlion name. Using super long range Qualcomm aptX low latency wireless transmission, ModMic Wireless captures 48kHz audio with only 34ms latency, thanks to the AptX codec. That near-instant response makes it noticeably better in real world use for streamers and squad games.
I'm not a pro gamer or regular streamer, but regularly enjoy the pastime of chirping anonymous celebrations, frustrations, and profanities in binary realms with like-minded individuals. When I tell #69skeeet420# I'm centering the ball, or that lying upside down in-goal is not a viable defensive strategy, or eventually describe the process he/she should take to uninstall Rocket League, I want my words and emotions distinctly heard. Modmic Wireless consistently delivers my articulations in a clear, timely manner, and helps ensure that I can't rage-rip an audio cable out of my machine... not again.


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Products > Elastomeric Shapes > Molded > Bushings & Bumpers
Bushings & Bumpers
Bushings: Rubber bushings absorb shock and reduce vibration. A variety of the bushings are custom made, and we are capable of attaining many other specifications that will meet your custom needs.
Bumper Specialties are used in Kitchen and Bathroom cabinets and drawers to cushion the close, and the specially designed Soft Durometer products are designed specifically for the Cabinetry Industry. The products are also used in the Electronics Industry under computers, desktop calculators, keyboards, telephones and speakers to prevent vibration, skidding or marring surfaces, and they are also being considered for use as spacers between Printed Circuit Boards. They are also used under glass tabletops to prevent them from moving, behind picture frames to prevent marring the walls, and under cutting boards to prevent skidding, as well as in many other uses.
Note : The -SD suffix designates the softer durometer, offered in two of our standard profiles: BS 1-SD and BS 12-SD. Not for load bearing applications.
- Cabinet
- Picture Frames
- Electronics
- Computer
- Circuit Boards
- Medical
- Automotive
- Packaging
- Furniture
- POP Displays
- Building Materials
- Cutting Boards


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Jalen Gibbs, whose 13 points per game entering the contest ranked second on the Mountaineers, had only 6 points on 2-of-10 shooting.PITTSBURGH Hughes scored all 20 points of his points in the second half and hit the go-ahead 3-pointer, blocked a shot and grabbed a late rebound all in the final minute Wednesday night and Duquesne rallied from a 19-point halftime deficit to defeat Rhode Island 75.Take hill walks and hiking holidays to another level by acquiring traditional map and compass reading skills and learning how to estimate distance and time.Lewis had 20 points and 11 rebounds for the Highlanders , whose losing streak stretched to four games.Brandon Carlo tactfully lofted a long pass to Marchand to spark a 2-on-1 with Patrice Bergeron.
New York could face the Penguins or the Carolina Hurricanes while Washington could face the Penguins, Hurricanes or Columbus Blue Jackets.Taking a few steps to ensure your family doesn't get split up is definitely recommended to alleviate a stressful flight situation.Other top-notch amenities at the No.As a result, the Jaguars are expected to release Blake Bortles, their starting quarterback for the past five seasons."But when you're not going to run back on every single possession – which takes no talent, by the way they're going to make you pay and they made us pay.Learn how to move through water in the great outdoors, build your confidence in open water, hone your breathing techniques and understand the ways of rivers on wild swimming training courses.
Still, both backs are on the other side of 30 and at some point — perhaps soon — the Bills will have to start working in younger runners and there may not be room for both.Trubisky didn't receive much help from a running game that was held to 43 yards on 15 carries after producing 222 yards on 30 attempts in first meeting of the season with the Lions Nov.If you do start to feel queasy, guest services or the medical center will supply tablets.Another aspect of Palms 2: A slew of top-quality restaurants from award-winning chefs such as Marc Vetri, Michael Symon and Bobby Flay.Get your tickets for popular sights long before your trip, including The White House and National Museum of African American History and Culture.
The puck caromed directly to Okposo, who shot it into the open right side 6 into the period.TEN and completed 11-of-12 passes for 128 yards with one touchdown and a passer rating of 138.It's fantastic!Engineered the second fourth-quarter comeback win of his career and his first since Sept.


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|Subject Area:
|Course code:
|Course Type:
|Centre for Professional Development
|Short Course
Teacher Training - The Pearson BTEC Level 5 Diploma in Education and Training prepares trainee teachers to teach in a range of contexts. There is a significant practice requirement, as this qualification will assess, and provide evidence of, competence when undertaking teaching and/or training responsibilities.
Topics covered include: planning, delivering and evaluating teaching and learning developing the skills to assess learning in education and training developing knowledge around theories, principles and models in education and training understanding professionalism and the influence of professional values in education and training.
This version of the Level 5 Diploma in Education and Training is for those holding the Level 4 Certificate in Education and Training looking to top up to the full Level 5 Diploma.
|Start date:
|End date:
|Start time:
|End time:
|12-Oct-2022 (Applications Closed)
|Mode of attendance
|Day of the week
|Number of sessions


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Posted by Mariana García
Hosted by Mariana García
Sept. 22, 2022
Start time:
8:00 p.m. (GMT)
End time:
9:30 p.m. (GMT)
An Online Death Cafe
This Death Cafe has taken place
Submit a write up for this Death Cafe
About this Death Cafe
This is a safe, informal and free space for women to talk about life and death. Because when women get together wonderful things happen and recognising death as an integral part of life might prompt us to live more fully!
So I invite you to get together to exchange stories, feelings, thoughts, etc., on life and death while learning from each other.
If you want to participate (or want more information), please write to me at: email@example.com
Much love,
About Mariana García
I am a psychologist with experience in clinical psychology, research, teaching and psychosocial projects.
After finishing my Masters in Community Psychology, I started working with vulnerable communities, but a few years later my dad died and since then (2015) I have dedicated myself to deepening my knowledge about death and dying, while also donating my time and skills to different charities and hospices where I have worked with the ill, the elderly and the bereaved.
This process led me to become an end of life doula (first in the USA and now in the UK) and, therefore, I now dedicate myself to supporting individuals and their loved ones through the process of living and dying.
Contact the organiser of this Death Cafe
Please also see: https://www.doulamarianagarcia.com/


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With necessary licensing agreements from major music publishers in his pocket, Steve Jobs has taken the wraps off of the new feature that lets you re-download music purchases at no cost, via the iTunes Store app on iOS devices. "For the songs you've already bought, we've added a purchased button", Jobs explained. This new section of the iTunes app conveniently lists all your music purchases in one place. From there, tap the cloud icon to download the already purchased track for free.
Your other choice is the automatic downloading feature that grabs your purchases, including free ones, made on your other devices. "This is the first time we've seen this in the music industry – no charge for multiple downloads to different devices", Jobs said. But what about music you already own, which didn't come from iTunes? And what about that rumored scan and match stuff?
"One, you can sync your devices over Wi-Fi or cable, and then you can rely on iCloud. Or, if it's just a few songs you love, you can buy them on iTunes. But we're offering a third way, and we call it iTunes Match", he explained. Unlike similar offerings from Amazon and Google, the scan-and-match feature fingerprints your music and makes matching tracks instantly available in the cloud for streaming to your authorized computers and mobile devices, without the need to upload tracks. This will cost you 25 a year. Also important, iTunes Match will "upgrade the songs to 256k AAC DRM free".


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HACKENSACK, N.J., Nov. 2 /PRNewswire/ -- ObjectSoft Corp.
(Nasdaq: OSFT - news) announced today that it had licensed Video Pipeline, Inc.'s
Video Detective(TM) for its new FastTake(TM) video kiosk which is coming soon
to video stores in Connecticut, New Jersey, Alabama and Massachusetts,
ObjectSoft's President and co-CEO George J. Febish announced today.
Video Detective(TM) is a comprehensive data base of over 7,000 Movie, Game
and CD-Rom titles, with three images of each video, said Febish.
``Video Detective has the most comprehensive database of popular theatrical
videos with detailed plot summaries, related suggestions, and high quality
images,'' Febish said.
``We are delighted to be part of ObjectSoft's innovative and fun-to-use
FastTake Kiosk, said Video Pipeline President Jed Horovitz.
Marketed by Plaza Entertainment, the FastTake(TM) video kiosk is housed in
a futuristic module that includes shelving and signage. An attractive
touch-screen draws consumers to use the database which can search by title,
actor, director, rating or genre.
Additionally, FastTake(TM) can offer plot summaries and up to 500 movie
trailers with information in the Video Detective database. The system's
software can allow for database updates, cross promotion between studio and
retailer, advertising, multiple rental promotion, point-of-purchase promotion
and demographic targeting.
About ObjectSoft
Founded in 1990, ObjectSoft Corporation provides information and services
through public access kiosks. The Company's products, SmartStreet and
SmartSign kiosks enable organizations to interact with the general public in
high density pedestrian traffic areas. ObjectSoft is a publicly held company
listed on Nasdaq. For more information on ObjectSoft, visit their website at
About Video Pipeline
Founded in 1985, Video Pipeline, Inc., is a privately-held company
headquartered in Haddonfield, NJ. The firm specializes in providing in-store
media for movie, game and music retailers, reaching about 9,000 retailers per
month. The Video Detective(TM) web site is at http://videodetective.com.
This press release contains certain forward-looking statements concerning
ObjectSoft which are subject to a number of known and unknown risks that could
cause actual results, performance and achievements to differ materially from
those described or implied in the forward-looking statements. Among such
risks are those discussed in the Company's Registration Statement on Form SB-2
and its Quarterly Report on Form 10-QSB and include, but are not limited to,
limited operating history, recent establishment of new business divisions,
dependence on new and untested product, risks related to technological factors
and potential manufacturing difficulties.
Video retailers can get additional information about FastTake(TM) from
Plaza Entertainment at 888-454-3345.
For investor information, contact The Investor Relations Group
Newsbit furnished by:
A: NetShift Software Ltd.
A: Hughenden Yard, Marlborough, Wilts,SN8 1LT, UK
E: [email protected]
W: www.netshift.com
Thanks Anna!
Thanks Kinetic!
© 1998 Kiosks.Org.
All Rights Reserved.


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Interactive floor plan: Studio Job House, Bergeijk
The quiet village of Bergeijk, near Eindhoven, was once a hive of 20th century design activity, home to the Gerrit Rietveld-designed Weverij de Ploeg textile mill - one of the big characters of Dutch industrial modernism - and a slew of other factories and private villas by Rietveld and his peers. The factories are now closed, but Bergeijk still reflects the glory days of Dutch modernism, which two of the country's contemporary design stars - Job Smeets and Nynke Tynagel (aka Studio Job) - have decided to celebrate with a new venture, aptly titled the Studio Job House.
Smeets and Tynagel have bought a four-bedroom Bergeijk villa, designed in 1960 by D L Sterenbergh, a pupil of Rietveld, and turned it into a home-cum-museum filled with furniture icons from the period, as well as reissues, contemporary pieces and some of their own creations. 'It's rare to find a small village like this that is so important to design,' says Smeets. 'When we heard the villa was for sale, we felt it was such a waste not to try to preserve this piece of history.'
Like with their Antwerp gallery, the Studio Job House acts as a framework for their own collections, yet these pieces have a more historical focus. To help fund the project, the duo - who currently have a solo show at the Groninger Museum in Groningen - also called on major producers of the period to supply some of the hardware, furniture and fittings. Van Besouw re-issued a fifties carpet for the house, while Auping delivered the classic Auronde beds designed by Frans de la Haye in 1972. Other items include a Sol LeWitt cabinet (the American spent time in Bergeijk); Mosa tiles designed by Netherlands-based Kho Liang Ie; a specially commissioned light box by graphic designer Wim Crouwel, who Smeets calls the 'last living Dutch modernist'; and new works by Maarten Baas, Atelier Van Lieshout and Piet Hein Eek. Together the pieces chart the progression of Dutch design.
Every last detail has been considered, down to the door knobs and mail box. 'We don't plan to live here but we want to convey a sense of the people that once did, to appeal to people's nosiness,' says Smeets. He has even tracked down the same model of car owned by the previous occupants - a 1972 Ford Taunus GXL Coupé - which now sits in the garage, ready for use.


text: Paradise Villas Club (previously known as The Villas Las Arecas Luxes )are situated in a quiet residential area on the outskirts of Playa Blanca on the south coast of Lanzarote. Playa Blanca has a relaxed, easy-going atmosphere and a good choice of restaurants, bars and cafes within a short distance. Clustered around the marina of Puerto Rubicon are wonderful seafood restaurants and lively bars. Playa Blanca is all about sandy beaches. On either side of the harbour are Playa Dorada and Playa Flamingo and a little further on are the gorgeous white sands and crystal clear waters of Papagayo beach - a sun-worshippers paradise!This small development of exclusive villas will suit anyone looking for an up-market, independent self-catering holiday in a private, tranquil setting, with lots of amenities close at hand.What better way to start the day than with breakfast alfresco on your patio after an early morning swim in your private pool? Holidays in these luxury villas are all about lazy days in the sun and leisurely barbecues in the moonlight, and while the adults chill out in the sun, kids will have a splashing great time in their very own kids pool!Please note that some facilities may incur extra local charges.


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So, Manchester International Festival is upon us once again, a truly thrilling time in Manchester's cultural calender, when the entire city is seemingly swept up in a frilly throng of arts fartsy lovilness.
However, whilst the Boyf and I have been little culture vultures and scored tickets to a few of the headline acts* - this year's line-up is somewhat... different from the last festival in 2013.
2013 saw a lot more on offer for free, more spontaneous pop-ups, Manchester Art Gallery were involved with Do It: 2013 and it just felt more like a festival. This year, the line-up is undeniably incredible, but there's v/little happening in Festival Square (Albert Square) that isn't ticketed, aside from alcohol, food and acoustic sets. Call me ungrateful but I can get better of an evening in Spinnningfields, most days
I'm not
against paying for one's art, but it's nice to think people can dip
their toe into the pool without forking out first. It helps punctuate a
paid-for calendar with new treats and brings more people into the fold
to have a gander at what's going on.
On that note, I revert back to a promise I made in 2013, and didn't keep. Do It: 2013 was Manchester Art Gallery's contribution to the MIF13 and it was sensational, read more about it here. I promised to do it and report back, but I did neither.
Here's some of the pieces, for you to do, I'm going to try to keep my promise!
*wonder.land, The Palace Theatre
Crocodile, The Pavillion Theatre
FKA Twiggs Soundtrack 7: The Performances , Old Granada Studios
Manchester International Festival 2015 continues until 19th July


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Theatre at the Center Presents Chicago Premiere of WHAT A GLORIOUS FEELING, April 25 – June 2
Paying homage to one of the greatest movie musicals of all time, What a Glorious Feeling comes to Theatre at the Center April 25 through June 2 at 1040 Ridge Road, Munster, IN. Creator Jay Berkow conceived the intimate show, which he calls "a play with music" and an "exploration of creative and romantic temperaments" set in the heyday of the MGM movie musicals. A revealing portrait of the late dancer-actor-director-
Inspired by true events, What a Glorious Feeling brings to life the tempestuous love triangle that occurred during the filming of the 1952 MGM blockbuster as Gene Kelly clashes with co-director and friend Stanley Donen. Kelly falls in love with his assistant Jeanne Coyne, who happens to be Donen's ex-wife, and together, all three of them work on the project. This show celebrates the genius of this highly charged collaboration with music and dance, while exploring the emotional complexity of their lives behind cialis no prescription the camera; incorporating important, real-life figures including a young Debbie Reynolds and producer/songwriter Arthur Freed. What a Glorious Feeling lets audiences relive the dances and songs they fell in love with in the original film, but with a brand new perspective and whole new love story.
What a Glorious Feeling stars Richard Strimer as "Gene Kelly" (Theatre at the Center's Crazy For You, Joseph…, Oklahoma, Gypsy, 42nd Street; Marriott Theatre's 42nd Street, Drury Lane's Spamalot, Seven Brides for Seven Brothers; and Jeff Award winner for Actor in a Supporting Role in a Musical for Singin' in the Rain at Drury Lane Evergreen Park), Cara Salerno as "Jeanne Coyne" (42nd Street, Crazy for You, La Cage aux Folles and Dirty Rotten Scoundrels at Theatre at the Center, Singin in the Rain and Thoroughly Modern Millie at Drury Lane Oakbrook), Nicole Miller as "Debbie Reynolds" (Theatre at the Center's 42ndStreet, La Cage, Jesus Christ Superstar and Guys and Dolls), Mike Danovich as "Stanley Donen" (Theatre at the Center's 42nd Street, Light Opera Works' Camelot and Love's Labour's Lost and Of Mice and Men at Oak Park Festival Theatre), and Robert Hildreth as "Arthur Freed" (Multiple productions at Theatre at the Center including Phantom, Oklahoma!, Fiddler on the Roof, Guys and Dolls; First National Tour of (Phantom of the Opera).
The Artistic Team, led by Theatre at the Center Artistic Director William Pullinsi, features Musical Direction and Orchestrations by William A. Underwood. The design team includes Scenic Designer Angie Weber-Miller; Lighting Designer Charles Cooper; Sound Designer Barry G. Funderburg; Costume Designer Brenda Winstead, Wig Designer Kevin Barthel, and Props Designer Lauren Earnshaw.The Stage Manager is Matthew McMullen, the Technical Director is Ann Davis; and TATC's General Manager is Richard Friedman.
Founded in 1991, Theatre at the Center is a year-round professional theater at its home, The Center for Visual and Performing Arts, 1040 Ridge Road, Munster, Indiana. Theatre at the Center is located off I-80/94, just 35 minutes from downtown Chicago, and has free parking.
Performances are Wednesdays and Thursdays at 2:00 p.m.; Fridays and Saturdays at 8:00 p.m.; Saturdays and Sundays at 2:30 p.m.; and select Thursday evening and Saturday 4 p.m performances. Individual ticket prices range from $38 – $42. Become a 4-Pack Subscriber and save even more on your ticket purchase! Each 4-Pack Subscription is good for one ticket to each of our remaining 2013 productions. At only $136, it fits into any budget! To purchase a 4-Pack Subscription or individual tickets call the Box Office at 219.836.3255. Group discounts are available for groups of 11 or more and gift certificates, perfect for all special occasions, are also available. For more information on Theatre at the Center, visit TheatreAtTheCenter.com.


text:
Littelfuse® L15S125 POWR-GARD® L15S Fast Acting High Speed Semiconductor Fuse, 125 A, 150 VAC/100 VDC, 100/20 kA Interrupt
Semiconductor Fuse
107.53000 / ea
Designed to protect today's equipment and systems, Littelfuse semiconductor fuses are manufactured with Littelfuse-developed technology that sets tomorrow's standards for accuracy, consistent quality, reliability, and predictable performance. By using advanced metallurgical, polymer, and materials research; mathematical modeling, and computerized statistical analysis; Littelfuse engineers have redefined "State-of-the-Art".
- Applications
- Features
|Semiconducting Devices
|Very Fast Acting
|Extremely current-limiting
|Low I2T and peak let-through currents
|Low watts loss
|Controlled transient over voltages
|100 kA at 150 VAC/20 kA at 100 VDC interrupt rating
|Very fast acting


text:
As medical /scientific research continues, current expert opinion expressed herein may change.
Androgen-related hair loss
Permanent hair-loss caused by the action of androgens on genetically susceptible follicles.
Androgenetic Alopecia is non-reversible genetically determined hair loss. Androgen presence is necessary for its progression. It is genetically either:
i) dominant – a single gene is inherited.
ii) polygenic – a number of genes are inherited.
Androgenic Alopecia in women is caused by follicular miniaturisation associated with endocrine changes and increased androgen presence. Accompanying factors may include: Polycystic ovarian syndrome, virilisation (and hirsutism), irregular menstruation, infertility, acne, seborrhoea oleosa.
Menopausal Alopecia (androgenic alopecia) is associated with hormone changes. As estrogen reduces, hair-follicles become increasingly vulnerable to the effects of androgen exposure. Anti-androgen therapy may reduce further hair loss, but is currently unlikely to initiate the return of the lost hair.
Androgenic Alopecia in women is a multi-factorial condition in which genetic predisposition + circulating androgens viz testosterone androsteinedione, and dihydrotestosterone (DHT) are key factors in a process of progressive hair follicle miniaturisation and reduction in the anagen (hair growing) phase. Follicles effectively 'shrink' to produce vellus hairs. Caucasoids have a higher susceptibility than Afroid's or Mongoloids. This condition may warrant endocrinological investigation.
How the condition differs from that in men:
i) The progression is slower – possibly due to a level of 'follicular protection' afforded by estrogen.
ii) Hairloss is diffuse and does not conform to the traditional patterns of loss in males.
iii) Hairloss may worsen following menopause with the development of baldness especially at the vertices.
iv) In men the condition is due to genetic predisposition and is usually age related.
v) In women the condition can present at any time associated with underlying medical conditions. viz: polycystic ovarian syndrome, thyroid disorders, anaemia, chronic illness, use of certain medications.
Expert opinion currently doubts that the condition in women is the same as that in men.
Correct diagnosis is essential, and may require blood tests, or scalp biopsy.
Things to do
Until recently, no effective treatments have been available for certain alopecias in women.
Current options however may include the following drugs which may limit hair loss:
Systemic anti-androgen drugs e.g.
Spironolactone: Aldactone® Spiroctan®, Diatensec®.
Cyproterone acetate (Androcur®) Diane® or
Flutamide (Eulexin®).
Minoxidil: Regaine®
Finasteride: Propecia® is not currently indicated in women. However 5-alpha-reductase inhibitors (which prevent testosterone conversion and subsequent baldness in men) are currently being considered for female use. This may bring renewed possibilities in the treatment of this distressing disorder
Surgical Hair Restoration may be an option (see transplantation techniques)
© Prof. B Stevens FTTS (Contact the author)
A detailed overview- Inga Zemite MD MTTS
Female pattern hair loss (FPHL) is a term used to describe the decrease in central scalp hair density that occurs in number of females after puberty. This decrease is meant to be caused by action of androgen hormones. Decrease in hair density happens in central (frontal, vertex and mid) scalp, and bitemporal and parietal regions can also be affected.
There are several synonyms for this condition – Female Pattern Hair Loss (FPHL); androgenetic alopecia (AGA – used to imply a specific androgen related etiology); androgenic alopecia, (used for genetic etiology); FAGA – female androgenetic alopecia; common baldness in women, etc. By some authors female alopecia with androgen increase is called female androgenetic alopecia (FAGA) and without androgen increase is called female pattern hair loss (FPHL). I will use FPHL as general term in this essay.
Hamilton describes male pattern of alopecia in women but in his report from 1951 he noted that hair loss in women never progressed further that pattern IV in his own classification of MAGA. Ludwig has described diffuse hair loss patterns in women. Olsen described Christmas tree pattern with frontal accentuation. It is still a question what are behind these patterns, as it is found that pathogenesis and therapy results differs in different pattern.
In susceptible hair follicles, dihydrotestosterone binds to the androgen receptor, and the hormone-receptor complex activates the genes responsible for the gradual transformation of large terminal follicles to miniaturized follicles. Women with FPHL have higher levels of 5 reductase and androgen receptor in frontal hair follicles compared to occipital follicles. At the same time, women have high levels of cytochrome p-450 aromatase in frontal follicles and in occipital follicles that saves the hair. This leads to specific pattern of hair loss.
The condition is very emotionally devastating for affected women.
- Epidemiology
FPHL is quite common beginning in the late 20s and reaching its peak after 50 years of age. It affects more as 50% of women after the age of 50 years.
There are two ages of onset described:
- early – post-puberty to third decade; and
- late – age 40 and after.
FPHL can occur alone and may be seen together with other androgen-related conditions. Sometimes signs of hyperandrogenism (hirsutism, irregular periods) or hyperandrogenemia occur may be observed but most often women with FPHL have neither.
Many affected women respond to antiandrogens or 5α-reductase inhibitors with increased hair growth that indicate an androgen etiology in at least some cases of FPHL.
Women suffer from a more diffuse hair loss in the vertex region that starts after menopause due to the relative increase of androgens.
- History
Beek in 1950 noted that baldness in women increased from the fourth to the sixth decades.
Ludwig in 1977 described the progressive centrifugal hair loss with preservation of the frontal hair line to which he assigned three pictorial graduations of severity.
Olsen described Christmas tree pattern of FPHL with frontal accentuation.
More recently in consensus meeting of specialists in hair proposed the term FPHL to describe the hair phenotype in women with or without obvious androgen relatedness.
- Pathophysiology
FPHL is induced by androgens in genetically susceptible women. Hair follicles of women with FPHL have increased 5-reductase activity and increased levels of dihydrotestosterone (DHT). DHT, which is formed by the peripheral conversion of testosterone by 5-reductase, is thought to be responsible for the characteristic miniaturization of scalp hair follicles in FPHL. In genetically susceptible hair follicles, DHT binds to the androgen receptor, and the hormone-receptor complex then activates the genes responsible for the gradual transformation of large, terminal follicles to small, miniaturized follicles.
FPHL are a consequence of:
- increased central or peripheral androgens and/or
- a fault in the follicle hormonal transformation and/or
- a genetic predisposition to permit these to act on follicular target cells which are specially sensitized by binding to specific intracellular androgen receptors.
Over successive hair cycles in FPHL, the duration of anagen shortens and matrix size decreases, resulting in smaller follicles that produce shorter, finer, miniaturized hairs that cover the scalp less and less well. These miniaturized hairs of various lengths and diameters are the hallmark of androgenetic alopecia. The number of follicles per unit area remains the same.
In women with FPHL, the extent of hair loss is usually less than in men. The androgen receptors are on the X chromosome, which would explain why women show a mosaic pattern of alopecia and are relatively mildly involved.
It has been assumed that the hormonal basis for androgenetic alopecia is similar in women as in men. The milder expression of androgenetic alopecia in women if compared with men may in part be the result of lower levels of 5 reductase and androgen receptors in frontal follicles of women; additionally, higher levels of aromatase in women may result in increased local formation of estradiol from testosterone, and less formation of 5-reduced products such as DHT. Aromatase is capable of converting testosterone to estradiol.
Circulating androgens in women come from three potential sources:
- adrenal,
- ovary and
- peripheral conversion.
Primary androgens causing cellular androgen- related effects are testosterone (T) and dihydrotestosterone (DHT). Their availability in the hair follicle depends on an intact central (gonadal or adrenal) steroid biosynthetic pathway that will take synthesis to at least dehydroepiandrosterone sulfate (DHEA-S); as well as the presence of the terminal conversion enzymes of steroid sulfatase, 17β-hydroxysteroid dehydrogenase, 5α-reductase, and 3β-hydroxysteroid dehydrogenase. All these enzymes are available in the hair follicle.
Androgens circulate in the blood either free or preferentially bound to sex-hormone-binding globulin (SHBG) (78%), albumin (20%) or cortisol-binding globulin or acid α-2 glycoprotein (<1%). Hairs are affected by free androgens.
Androgen action in the tisues is determined by:
- the amount and type of androgen delivered to the tissue;
- the amount and type of androgen synthesized in the tissue;
- the amount of local androgen receptor;
- the relative binding affinity to the androgen receptor of the androgens present in the tissue and
- relative metabolism ot these androgens.
Circulating androgen levels are age dependent – both adrenal and gonadal sources increasing with puberty and decreasing after menopause.
The mechanism of androgen action in hair follicles is well known in female androgenetic alopecia:
- FAGA is related to the excess of β-4-androstenedione serum levels of ovary or adrenal origin and
- FAGA.M with the increase of dehydroepiandrosterone (DHEA) or DHEA-S of adrenal origin.
Androstenedione and DHEA-S are peripherally transformed into testosterone (T), and this in turn is converted into 4 main metabolites, of which hairs are affected mainly by 5-α-dihydrotestosterone (DHT). Conversion of T in DHT requires free T that is not bound to sex-hormone-binding globulin (SHBG).
In balding scalp hair follicles, the androgen receptor is a specific protein known as "caspase," which binds 5-α-DHT. Once the hormone have been bound, the receptor complex undergoes a conformational change, exposing DNA binding sites, and the hormone-receptor complex, in conjunction with other coactivating proteins, to specific hormone response elements in the DNA altering the expression of specific androgen-dependent genes and starting apoptosis.
Once DHT has been metabolized in the follicular target organ, it is transformed into its metabolite 3-α-androstanediol glucuronide by the enzyme 3-β-hydroxysteroid dehydrogenase; therefore, the serum level of this metabolite is an indicator of the intracellular androgenic metabolism.
Prolactin may be also involved in FPHL. It is thought that hyperprolactinemia is associated with an increase in DHEA-S as the result of the action of prolactin on the adrenal cortex.
Another important enzyme is aromatase that is located in outer root sheath. Aromatase converts androstenedione to estrone and testosterone to estradiol, decreasing both – the levels of circulating and tissue T and DHT. This explains the differences between AGA of male and female pattern. It is found that in women there are 2- to 5-fold greater amounts of aromatase in the scalp than in men. In FPHL there is 3 to 5 times more aromatase in frontal and occipital scalp areas than in MAGA what explains the maintenance of the frontal hairline in women.
As an etiopathogenic factor of FAGA, one should also consider the decrease of SHBG, as this would result in free T, which could act then at the follicular level. For different authors, the biochemical marker of FPHL would be:
- the decrease of SHBG and the increase of 3α- androstanediol glucuronide or
- the decrease of SHBG that would proportionally increase the T/SHBG ratio.
In hypothyroidism, there is decreased synthesis of SHBG, which is why women with hypothyroidism with a history of FPHL could see an increase of their alopecia.
The hair follicle has also estrogen receptors that makes it estrogen sensitive organ. Effects of estrogens on human hair are still not studied enough. In vitro experiments it is found that estrogens inhibit elongation of hairs from the female occipital scalp but can stimulate male frontotemporal hairs. Differences in estrogen's action in various tissues are thought to be related with differences in estrogen receptor distribution and the tissue levels of co-regulatory proteins.
A high percentage of women with FPHL without any overt clinical sign of hyperandrogenism had no biochemical evidence of androgen excess.
Two genes have been shown to be related to alopecia.
- CYP17 is a steroid metabolism gene that codifies P450 aromatase enzyme helping to release more estradiol. This gene was found in women with PCOS and their brothers with early balding.
- A new gene on chromosome locus 3q26 has been found in androgenetic alopecia families.
It is likely that early and late FPHL differs genetically, and it seems that hair loss in women is polygenic and multifactorial with the additional influence of environmental factors.
- Clinical features and Classification
FPHL in women is characterised by early or late age of onset, the pattern of increased thinning over the frontal/parietal scalp with greater density over the occipital scalp, retention of the frontal hairline, and the presence of miniaturized hairs. Most women have normal menses and pregnancies.
Women first notice hair thinning over the frontal area, and gradually the scalp becomes more and more visible. Over time the thinning increase. Thinning is often diffuse and may involve most of the scalp; nevertheless usually it is patterned with most marked thinning over the frontal and parietal scalp, and with greater density over the occipital scalp. Women typically retain hairs along the frontal hairline, even when the scalp is visible behind the hairline.
Miniaturized hairs, the shorter and finer hairs of various lengths and diameters, are the hallmark of AGA and result from the shortening of anagen phase and reduction in matrix size. Increased spacing between hairs makes the central part appear wider over the frontal scalp compared to the occipital scalp.
The patient may note that her pony tail is smaller and the hair is cut to shorter lengths in order to give a fuller appearance. Rarely, advanced thinning occurs with loss of the frontal hairline, but this is associated with markedly elevated circulating androgens.
Androgenetic alopecia in women is not usually accompanied by increased shedding. However, in some instances, an episode of telogen effluvium following childbirth, major illness or other causes may uncover a latent predisposition to FPHL.
Female pattern hair loss is a condition characterized clinically by a decrease in hair density in the central scalp and histologically by miniaturization of some follicles and an increased percentage of hair in telogen in the affected area. Patterns in FPHL are much less obvious than in MPHL and examination of the scalp shows three different patterns:
- vertex/frontal (male pattern) -thinning associated with bitemporal recession – Hamilton-Norwood type
- diffuse central
- the commonly used 3-point Ludwig scale
- the 5-point Sinclair scale
- frontal accentuation ("Christmas tree" pattern) – thinning and widening of the central part of the scalp with breach of frontal hairline – assessed by Olsen scale
Many women develop a minor degree of postpubertal recession at the temples whether or not they have diffuse hair loss.
The classification system for the female pattern designed by Ludwig is less complex and can be easily used in practice. It includes three degrees of hair loss localized on the crown.
In Ludwig's classification, the 3 patterns represent stages or progressive types of FAGA (Pic. 5.1).
FAGA Degree I (Minimal)
It is considered as the beginning of FAGA. There is a perceptible thinning of hair from the anterior part of the crown with minimal widening of the part width. Ludwig described the earliest change as rarefaction of the hair on the crown. This produces an oval area of alopecia encircled by a band of variable breadth with normal hair density. Hair loss can be hiden by combing the hair forward, thus, exposing a visible area of alopecia in the anterior centroparietal area while the frontal hairline is maintained. This type of alopecia is observed in young women with SAHA syndrome (SAHA for – seborrhea, acne, hirsutism, alopecia), generally of ovarian origin. It is accompanied by other hyperandrogenism manifestations. Because SAHA syndrome is constitutional, there are not increases of blood biochemical levels.
FAGA Degree II (Moderate)
Some time later, the "crown" area of thinning will be more evident as a number of thin and short hairs increases. Progression to Ludwig grade II results in further rarefaction of the crown, with preservation of the fringe. This makes it more difficult, although still possible, to camouflage the alopecia with combing the hair forward. This pattern of alopecia is a marker of excess androgens, generally of ovarian origin. The stage of SAHA syndrome has passed. Blood biochemical studies usually demonstrante an excess of androstenedione, free testosterone, and androstanediol glucuronide.
FAGA Degree III (Intense)
Grade III is near-complete baldness of the crown. In some perimenopausal or menopausal women, the "crown" becomes practically denuded, with significant widening of the part width, but the frontal hairline is maintained. Although women comb their hair forward trying to cover the alopecia, it will always be possible to see hair loss. This type of alopecia also can be seen in women with adrenal diseases, tumoral or not, with very high levels of androstenedione, DHEA-S, free testosterone, sometimes of prolactin, and always of androstanediol glucuronide.
Ludwig also described female androgenetic alopecia with male pattern (FAGA.M) that should be subclassified according to Ebling's or Hamilton-Norwood's classification. FAGA.M may be present in 4 conditions: persistent adrenarche syndrome, alopecia caused by an adrenal or an ovarian tumor, posthysterectomy, and as an involutive alopecia.
A more recent classification is Olsen's classification of FPHL and it proposes 2 types: early- and late-onset with or without excess of androgens in each. The Olsen's patterns incorporate the accentuation of the frontovertical alopecia, which has a triangular or "Christmas tree" form.
Not all women who develop FPHL maintain their frontal hair line. By some authors bitemporal recession occurs in 13% of premenopausal women and 37% of postmenopausal women. There is number of women with hair loss confined to the vertex scalp, but in a significant proportion hair loss also occurs diffusely over the parietal scalp.
Most women who present with FPHL have no other evidence of virilization. It is important:
- if the hair loss is of sudden onset,
- is rapidly progressive and
- advanced,
a full medical history must be taken, and examination and endocrinological investigation are needed to exclude virilization, which can rarely be caused by a virilizing tumour. Investigation is also indicated in women with FAGA of gradual onset accompanied by menstrual disturbance, hirsutism or recrudescence of acne.
- Laboratory investigations and Pathology
A correct diagnosis, which is based on the clinical history, clinical examination, and biochemical investigation, is essential for successful treatment. In practice FPHL usually is a visual diagnosis confirmed by examination and history. Measurable hormonal changes are rare. In such conditions as polycystic ovary syndrome (PCOS), adrenal hyperplasia, androgen-producing neoplasms, or intake of exogen androgens (anabolics) increase in hormones can be found. In these cases often other symptoms of androgenization such as oligo-or amenorrhea, infertility of women, acne vulgaris, severe unresponsive cystic acne, hirsutism, galactorrhea and virilization are observed.
The clinical history consists of an in-depth examination of factors that may exacerbate the alopecia, such as chronic illnesses, nutritional alterations, metabolic and endocrinologic alterations, lack of vitamins, and recent surgical interventions and other treatments. It is always important to take a menstrual history.
In the clinical examination, a photograph should be taken to document the baseline condition. It is important in evaluating the therapeutic results. Physical examination should include all aspects of the scalp, especially to see whether hair loss excludes the occipital area.
The specific maneuvers that may be performed include noninvasive, semi-invasive, and invasive methods.
Noninvasive Methods
Traction test or "Sabouraud's sign," evaluate the number of hair that are shedding after slight traction on scalp hair, "pull-out sign" let to know the strength of a tuft of hairs, and "standardized wash test."
In the wash test the woman refrains from shampooing for 5 days, and then she shampoos and rinses her hair in the basin with the hole covered by gauze. After collecting all the hairs remaining in the water and the gauze, they are examined. Hairs are counted and divided into less as 5 cm and more as 5 cm in length. This is an important technique to differentiate telogen effluvium from female pattern hair loss.
Other photographic methods, such as macrophotographic analysis in microcalibrated hair tubes, phototrichogram, traction phototrichogram, and the methods that use an image analyzer, are obsolete. These still can be used in hair research practices. Dermoscopy has replaced them in the diagnosis of androgenetic alopecia.
Dermoscopic features are:
- hairs with different caliber reflecting progressive hair miniaturization;
- brown halo, roughly 1 mm in diameter, at the follicular ostium around the emergent hair shaft;
- small bald areas with numerous empty follicles in postmenopausal women;
- scalp pigmentation because of sun exposure.
Semi-Invasive Methods
Semi-invasive methods include the trichogram, unit area trichogram, and trichoscan.
The trichogram is the most criticized technique, but still vary useful in practice. To perform the technique correctly, one must observe 50 – 100 hairs from the temporoparietal, occipital, and vertex areas (some 25 hairs from each area). Once the dermatologist has experience, he/she can evaluate FPHL even with approximately 10 to 15 hairs from the vertex. It is a quantitative technique that provides information about the growth capacity of hair and the alterations of its growth. The trichogram also permits measurement of the diameter of the hair shaft. The "coefficient of variability"of the hair shaft diameter can be determined. It expresses the percentage of variation between the diameters of each individual. The coefficient of variation in women without hair problems is 20.41%, with a standard deviation of 6.3%, whereas in women with FAGA.M, the coefficient of variability reaches 41.7% with a standard deviation of 4%.
Rushton described the "unit area trichogram" in 1983. With this technique one can determine the hair density in a specific area (hairs/cm2), the diameter of the hair (mm), and the linear growth (mm/d).
Trichoscan is a new technique consisting in shaving a transitional balding area of 0.661 cm2 and evaluating several parameters with an epiluminescence microscopy: number of hairs in the area, density of hairs (hairs/cm2), anagen hairs, telogen hairs, density of vellus (vellus/cm2), density of terminal hairs (terminal hairs/cm2), and vellus and terminal hairs. This technique is only a screening tool and is not useful for diagnostic purposes.
Invasive Methods
There are two invasive methods for hair diagnostic – scalp biopsy and folliculogram Folliculogram is used to evaluate the action mechanism of several treatments in animals used as models in alopecia, and is not useful in practice.
Biopsies from the involved area can be taken when the diagnosis is in doubt, especially to differentiate from CTE or to know the possibility of reversing hair loss. With biopsy, Whiting demonstrated the different features between controls, CTE and FPHL patients:
Terminal hairs
terminal hair/vellus ratio
Percentage of telogen
Table 5.1. Features demonstrated by biopsy (Whiting 1996)
A biopsy is rarely necessary to make the diagnosis of androgenetic alopecia. It is usually taken when differentiaton from other conditions is needed. Biopsy is taken from active, representative sites, and horizontal sectioning is preferred because of the larger number of follicular structures that can be studied.
Biopsy of FPHL has similar features to male pattern hair loss. A decrease of terminal hair and anagen hair and an increase of vellus-like hair, telogen hairs, and fibrous residual tract that ends in the superficially located miniaturized follicle must be found. Slight perifollicular lymphohistiocytic infiltrate is another microscopic feature. A mildly increased telogen-to-anagen ratio is often observed. Sebaceous glands remain intact.
Biochemical Tests
Among the laboratory tests, most important is androgenic determination. Levels of free testosterone, 5-α-DHT, DHEA-S, 17-β-hydroxyprogesterone, prolactin, androstenedione, SHBG, and 3-β-androstanediol glucuronide are useful.
Cortisol levels will be increased in Cushing's disease. When cutaneous signs of Cushing's disease are present, a 24-hour urinary free cortisol and creatinine excretion must be determined, and the overnight "dexamethasone suppression test" also can be performed.
Gonadotropins luteinizing hormone (LH), follicle-stimulating hormone (FSH), and the ratio of LH:FSH must be determined to confirm PCOS because an increase in serum LH is pathognomic of a diagnosis of PCOS, and ratio LH:FSH can be increased in up to 95% of subjects.
When HAIRAN syndrome is suspected, insulin serum levels must be also determined.
When androgen levels are normal, screening should include TSH, T4, antimicrosomal and antithyroglobulin antibodies, and ferritin or total iron binding capacity.
The diagnosis of AGA in women is supported by early age of onset, the pattern of increased hair thinning over the frontal/parietal scalp with greater hair density over the occipital scalp, retention of the frontal hairline, and the presence of miniaturized hairs.
When these features are present, the diagnosis is not problematic. However, FPHL is common and other causes of hair loss may coexist and need to be recognized or excluded.
Chronic telogen effluvium (CTE) may present a difficult differential diagnosis even though the features of CTE seem different. In CTE, women with average hair density, describe sudden onset of shedding from the entire scalp. Hair pull test may extract increased numbers of telogen hairs easily. Scalp hair density appears normal or minimally decreased even if the shedding may be prolonged. Miniaturized hairs are not seen. Acute telogen effluvium may occur in a woman with long-standing FPHL or unmask latent FPHL. A history usually identifies the cause of profuse hair shedding such as high fever, severe dietary protein deficiency, drugs or chronic blood loss as in women with prolonged heavy menses.
Both patchy and diffuse alopecia areata may mimic or coexist with FPHL. The presence of exclamation point hairs, pitted nails, or a history of periodic regrowth or tapered fractures noted on hair counts suggests the diagnosis of alopecia areata. Also scalp biopsy can be used; it shows a peribulbar lymphocytic infiltrate around anagen hair bulbs.
An adult with loose anagen syndrome has a history of decreased hair density since early childhood, and the pull test is strongly positive. Low power microscopy of the easily extracted hairs shows misshapen anagen bulbs, a "ruffled" cuticle just distal to the bulb, and absent inner root sheath.
Frontal fibrosing alopecia is a condition where hair loss almost exclusively presents in postmenopausal women although a few reports in younger women have been published. A gradual recession follows perifollicular erythema with or without associated follicular keratosis. The hair loss progresses backward to about 8 cm maximum. Frontal fibrosing alopecia is characterized histologically by a lymphocytic infiltrate around the isthmus and infundibular region of the hair follicles as well as concentric perifollicular lamellar fibrosis.
Central centrifugal cicatricial alopecia (CCCA) is a common type of hair loss. This particular hair loss is described first in African Americans; most commonly in African American women who use hot combs (a method by which oiled or greased hair is straightened with a heated iron). Others also can be affected by this condition.
- Treatment
As FPHL is a biological process determined by sensitivity to androgens and is genetically mediated there three main treatment approaches to interrupt its course are used:
1) modification of the biological response through nonhormonal mechanisms;
2) modification of the androgen action by
a) altering the production,
b) transport, or
c) metabolism of androgens, such as preventing binding to androgenic receptors; and
3) transplanting follicles to balding areas by surgical procedures.
Topical Treatment
One topical treatment used in the management of FPHL is minoxidil. Proposed mechanism of action of minoxidil is due to its influence on hair cycling, causing premature termination of telogen, and probably prolonging anagen, minoxidil is also a potent peripheral vasodilator. Effects of minoxidil are currently the subject of research and some debate.
Topical minoxidil solution is the only approved drug available for promoting hair growth in women with FPHL. Minoxidil is available in both 2% and 5% preparation. Studies show a mild non-significant advantage for the 5% solution. 1 ml of minoxidil is applied twice daily to dry scalp with a dropper.
Efficacy has been shown in studies using hair counts and hair weight analysis. Minoxidil-treated women had significantly higher hair counts and an increase in hair weight compared to women who received placebo. It should be noted that clinical perception of improved scalp coverage is not immediate; it can take up to 6–12 months, until hair length and mass are increased sufficiently. Treatment should be continued for at least 12 months.
Most frequent side effects are irritation dermatitis, contact eczema, pruritus, scaling, dryness, headaches, a non-virilizing hypertrichosis, which affects the face (the cheeks and forehead), shoulders, arm, and legs of women, including the scalp. Hypertrichosis usually is temporary. Patients should be warned that in the first 2–8 weeks, a temporary telogen effluvium may occur. This shedding is self-limiting and subsides when anagen regrowth begins. Hair loss recurs with interruption of application.
Other Local Therapeutics. Twice-daily applications of tincture of progesterone are useful in women. Also both spironolactone and its metabolite canrenone are used for the topical treatment of FPHL. In menopausal women, a solution of estradiol valerate has demonstrated improvement of anagen/telogen ratio and a decrease in hair loss. Topical finasteride showed a 40% decrease of DHT serum levels, but does not increase the hair growth.
Systemic Treatment
When FPHL is associated with high levels of androgens, systemic anti-androgenic therapy is needed.
Persistent adrenarche syndrome – adrenal SAHA and FPHL in adrenal hyperandrogenism is treated with two types of drugs – corticosteroids for adrenal suppression and anti-androgens, central or peripherals, to avoid the production of adrenal androgens or their effects on the target follicular organ.
Adrenal suppression is achieved with glucocorticosteroids. Antiandrogens therapy includes cyproterone acetate, drospirenone, spironolactone, flutamide, and finasteride.
Excess release of ovarian androgens – ovarian SAHA and alopecia of ovarian hyperandrogenism is treated with ovarian suppression and antiandrogens.
Ovarian suppression includes the use of contraceptives containing an estrogen, ethinylestradiol, and a progestogen.
Gonadotropin-releasing hormone agonists such as leuprolide acetate suppress pituitary and gonadal function through a reduction in luteinizing hormone and follicle-stimulating hormone levels. Subsequently, ovarian steroid levels also will be reduced, especially in patients with polycystic ovary syndrome. When polycystic ovary syndrome is associated with insulin resistance, metformin must be considered as treatment.
Antiandrogenic therapy includes cyproterone acetate (CA), spironolactone, drospirenone, flutamide, finasteride, and dutasteride. Central antiandrogens competitively inhibit binding of 5-α-DHT to the androgen receptor and peripheral antiandrogens acts by inhibiting the 5-α-reductase, blocking the conversion of testosterone to 5-α-DHT. It is recommended to accompany antiandrogens by tricyclic contraceptives.
Hyperprolactinemic SAHA and alopecia of pituitary hyperandrogenism should be treated with bromocriptine or cabergoline.
FPHL in Postmenopausal hyper or normoandrogenic women is treated with antiandrogens (mentioned above).
Postmenopausal alopecia, with previous high levels of androgens or with prostatic-specific antigen greater than 0.04 ng/mL, improves with finasteride or dutasteride.
Androgen-dependent medications
The use of androgen-dependent medications can cause abnormalities in the genitalia of the male fetus. These medications are contraindicated in women who are pregnant. All androgen-dependent medications need to be used for at least 1 year before an accurate appraisal of efficacy can be made.
Finasteride inhibits 5α-reductase II enzyme, which is responsible for catalyzing the conversion of testosterone to the much more active chemical DHT. Finasteride suppresses overall androgen activity by restricting total circulating androgen activity. Finasteride is generally well tolerated. Rare side effects in female patients include increased libido and breast tenderness, usually in the beginning of therapy, and it is reversible on dose reduction, and diminishes over time.
Evidences show that postmenopausal alopecia in normoandrogenic women also improves with finasteride at a dose of 2.5 mg per day. There are also studies that confirm that in postmenopausal women with AGA, finasteride 1 mg/day taken for 12 months did not increase hair growth or slow the progression of hair thinning. Finasteride does appear to be successful in some patients, but further studies are required to determine its efficacy and optimal dosing regimes.
Cyproterone acetate
This medication works by inhibiting gonadotropin-releasing hormone (GnRH) and blocks androgen receptors. Other uses include hirsutism, severe acne and prostate cancer. It is commonly used combined with estradiol as an oral contraceptive pill named Diane-35.
Efficacy is greater in patients with evidence of hyperandrogenism. CA clearly decrease the loss of hair, hair thinning, and seborrhea but without actual increased hair regrowth.
Study where two antiandrogen medications was compared (ie, spironolactone and cyproterone acetate) involved 80 women with biopsy confirmed FPHL. The authors found that 88% of women either experienced improvement of hair or had no progression of their hair loss with no significant difference in efficacy between individual medications.
Treatment doses utilized vary. It can be used in regime 100 mg/day on days 5–15 of the menstrual cycle supplemented by 50 μg ethinyl estradiol on days 5–25.
The side effects are weight gain, loss of libido, menstrual disturbances, breast tenderness, depression, and gastrointestinal upsets.
Spironolactone is used to treat FPHL and hirsutism. It works as an androgen antagonist by competitively blocking androgen receptors in hair cells, as well as inhibiting ovarian androgen production.
The usual daily dose is 100–200 mg/day twice a day.
In my own practice it is most often used antiandrogen.
The side effects of spironolactone vary, due to its additional actions as an aldosterone antagonist. These include menstrual irregularities, breast tenderness, postural hypotension, electrolyte disturbances, fatigue, urticaria, and hematological disturbances. These side effects must be monitored, especially in the first months of treatment. Further caution with its use needs to be exercised in the patient with renal abnormalities since it can potentially cause electrolyte disturbances.
Flutamide is a potent antiandrogen. It is acting via androgen receptor antagonism. It is used to treat advanced prostate cancer and hirsutism. It is new antiandrogen therefore it lacks experience in using it in FPHL. One randomized study suggested that flutamide at a dose of 250 mg/day could lead to greater improvements in stemming hair loss after 1 year of treatment compared with finasteride and cyproterone acetate. Another randomized controlled trial found a significant treatment advantage for flutamide over spironolactone in the treatment of hirsutism, the reduction of total acne and seborrhea, and the slowing or halting of hair loss.
Side effects of flutamide are severe. These include hepatotoxicity (3 in 10,000 users) and breast tenderness, both of which are dose-related. It is recommended that serial liver transaminases are checked in the first months of treatment, and it must be stopped or if transaminase levels exceed twice the normal limits.
Cosmetic aids are very useful part of management options. Hair styling techniques, camouflage products, hair accessories, hair replacements can be succesfully used to manage visual condition of hair.
Hairstyling – useful tips:
- getting greater hair volume and lift from shorter styles;
- disguising central thinness by a side or zigzagging part;
- adding soft layers at the top to allow pulled back hair to have more style;
- taking some weight off the top;
- using wide-toothed combs or brushes to allow thin hair to flow through without breakage;
- using a friction-free towel that blots hair and absorbs most of the moisture rather than damaging thin hair with towel drying;
- coloring hair to make hair look thicker and appear to give it more volume;
- styling with a body wave with soft or tight curls to give hair more bounce and fullness;
- and using hair sprays and foams that are light and nondrying to give volume and prevent breakage.
Camouflaging products cover affected areas on the scalp and hide visible hair loss, and adds volume. The most commonly used products include hair building fibers, scalp spray thickeners, alopecia masking lotion, and topical shading.
Hair extensions can be useful for women with mild hair loss if more length and volume are needed. These can be clipped on daily or attached permanently.
Weight loss undoubtedly improves hair loss in hyperandrogenic women.
There is also the possibility of surgical hair restoration, which includes follicular grafting, scalp reduction, and flap rotations. These techniques may apply to any form of focal alopecia.
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- Dinh, Q,Q; Sinclair, R. Female pattern hair loss: Current treatment concepts. Clin Interv Aging. 2007 June; 2(2): 189–199 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684510/
- Norwood, O,T. at all. Incidence of Female Androgenetic Alopecia. Dermatol Surg. 2001;27:53-54.
- Price, V, H. Androgenetic Alopecia in Women Journal of Investigative Dermatology Symposium Proceedings (2003) 8, 24–27 http://www.nature.com/jidsp/journal/v8/n1/full/5640087a.html
- Sinclair R. Br J Dermatol.2008
- Olsen, E, A. Female Pattern Hair Loss and its Relationship to Permanent/Cicatricial Alopecia: A New Perspective Journal of Investigative Dermatology Symposium Proceedings (2005) 10, 217–221 http://www.nature.com/jidsp/journal/v10/n3/full/5640208a.html
- Vexiau, P. at all. Role of Androgens in Female-Pattern Androgenetic Alopecia, Either Alone or Associated With Other Symptoms of Hyperandrogenism. Arch Dermatol Res. 2000;292:598-604.
- http://www.medscape.com/viewarticle/483591_4
- http://www.uptodate.com/contents/patient-information-hair-loss-in-men-and-women-androgenetic-alopecia/abstract/3


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Just Another Sunday Morning In Greenpoint: Llamas On Parade!
Filed under: 11222, Greenpoint, Greenpoint Brooklyn, Greenpoint Magic, Stuff That Makes Miss Heather Happy
Today the U.S.S. Monitor Parade— and Greenpoint in general— got some added excitement in the way of a trio of llamas. Those of you who are wondering (and you know who you are) what these critters have to do with the Civil War, I'll tell you: nothing whatsoever. Rather, a few of the re-enactors participating in today's festivities happen to operate a llama rescue organization. They decided to bring a few of their furry pals to join the fun. I suspect I speak for many who witnessed today's procession that this was an inspired decision.
It should also be noted our City Councilman, Steve Levin, demonstrated his Garden Spot street cred by taking it all in stride. Hey, anything can happen in Greenpoint!
You can view all the above photographs in larger format by clicking here. Otherwise I filmed the parade and the following proceedings. These I will share as they upload— so check back!


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When you're running around the office serving patients, the last thing on your mind is taking a look at the data your practice has already collected. However, chart auditing is one of the most commonly overlooked tasks in the dental office, and yet it has some of the most potential when it comes to maximizing your profits.
It's important to keep in mind that dental answering services are not only focused on answering the phone when you're not available. Learn how a thorough chart auditing and patient reactivation program can help get your current patients in the practice more consistently!
Knowing Your Data Means Better Business Decisions
Knowing as much as possible about your patient base makes it much easier for you to make decisions that would benefit your practice in the long-term. For example, knowing exactly how many active patients you have can make it easier to allocate resources towards marketing, staff, continuing education, PPO plans, and other decisions that influence your practice growth.
Are Incomplete Treatments a Problem?
One of the most common problems dental practices run into is patients who start a treatment plan, but never end up finishing it. Not only does this affect your practice's growth, but the patient is at higher risk of running into more problems that can negatively affect their oral health later. When you conduct a chart audit, you can better understand which patients are truly inactive, making it easier to reactivate their treatment plan.
Furthermore, taking the time to review patients in this way helps you understand many other aspects of their relationship with the practice. Are they continuing their preventive treatments or is something left incomplete? Have their dental benefits changed and that's why they stopped visiting? Are they still interested in visiting your practice despite this? These are questions to get answered during your chart audit.
How Active Is Your Patient Base?
Finding new patients matters, especially when you're first starting the practice. However, that plays less and less of an important role when you already have a substantial patient base you need to be catering to. By taking the time to audit your base, you can start rekindling relationships that may have gone by the wayside, especially if they've been consistently attending routine appointments in the past.
How Dental Support Staff Pick Up the Slack
Dental answering services are meant to act as the first line of communication for your practice, but they don't exclusively perform this task. Additionally, dental support teams can:
- Make reactivation calls to ensure your hygiene schedule is full
- Boost production via treatment calls
- Verify insurance information
- Confirm how many patients are active
Chart auditing and reactivation is just part of running a productive dental practice. If you're getting bogged down and feeling behind on these tasks, consider partnering with a company focused on dental scheduling support and more today!
About Dental Support Specialties
The team members at Dental Support Specialties do much more than simply answer the phone on your behalf. Evaluating your current patient base, determining valuable insight on the data you've already collected, and providing excellent customer service are just a handful of the benefits you can expect after choosing them to aid your practice. To get started, contact our office through our website.


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Betty Crocker™ Angel Food Cake Mix
Product Details
Betty Crocker Angel Food Cake Mix is the perfect dessert for any occasion. This cake mix makes it easy to prepare something special for your next gathering. Simply follow the instructions on the box and enjoy spongy, delicious cake in a few simple steps. It's a classic texture and flavor that everyone will love.
- CAKE MIX: Bake a delicious, fluffy angel food cake dessert
- QUICK AND EASY: From the box to the oven in minutes; Perfect for parties or to make at a moment's notice
- ENDLESS OPTIONS: Add your own twist to these mixes by trying tested and trusted Betty Crocker recipes
- FLUFFY SWEETNESS: Fluffy, slightly chewy and satisfyingly sweet
- A TRUSTED FAVORITE: Betty Crocker brings you the same fresh-baked favorites you've known and loved all your life
- BOX TOPS FOR EDUCATION PARTICIPATING PRODUCT: Give back to schools with Betty Crocker; Download the Box Tops App to learn more & start earning cash for schools in need today
Nutritional Information
Sugar, Wheat Flour Bleached, Egg White, Corn Starch, Baking Soda, Citric Acid, Enzyme Modified Soy Protein, Calcium Phosphate, Salt, Cellulose Gum, Artificial Flavor, Sodium Lauryl Sulfate (A Whipping Aid).
Allergen Info
Contains Wheat and Their Derivatives,Eggs and Their Derivatives,Other gluten Containing Grain and Gluten Containing Grain Products,Soybean and its Derivatives,Coconuts and Their Derivatives,Corn and Its Derivatives.
Actual product packaging and materials may contain additional and/or different ingredient, nutritional, or proper usage information than the information displayed on our website. You are responsible ... Read More
Product Reviews
Gerbes Super Markets is not responsible for the content provided in customer ratings and reviews. For more information, visit our Terms and Conditions.


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Lexus Android Auto 2020
Moving up a league doesn't all the time carry success. The rewards may be larger, however the competition will probably be more durable. So it is for the Lexus Android Auto 2020. The one-time Nissan Qashqai and Kia Sportage rival has been reinvented as a dearer SUV, so now it's up in opposition to formidable prestige-badged competition such because the BMW X1.
Fortunately, the new Lexus Android Auto 2020 builds on the strengths of the authentic, providing extra space, a classier feel and improved efficiency. It is nonetheless designed mainly for on-road use, but four-wheel-drive 4Motion versions now function adjustable drive modes that show you how to tackle completely different situations.
Engines range from a 1.4-litre petrol with 123bhp to a 2.0-litre twin-turbo diesel with 237bhp, though the lowest-powered fashions include front-wheel drive and a manual gearbox only. If you'd like an computerized 'box and four-wheel drive, you'll need to have a look at engines with 148bhp and above.
Read on over the following few pages for the whole lot you have to know about the Lexus Android Auto 2020, together with which engine and trim to decide on. And remember to visit our new car offers to see if you can get a decent discount off a Lexus Android Auto 2020.
The best-selling Lexus Android Auto 2020 is the 148bhp 2.0-litre diesel mannequin (badged 2.0 TDI 150) and it is simple to see why; it gives a fine blend of performance and gasoline economic system, whereas the cheaper 115 version (with 113bhp) feels a bit of in need of puff. There's also a 190 model of the two.0 TDI engine that delivers plenty of punch but is moderately dear, whereas the range-topping 240 model brings yet more tempo for an much more eyebrow-raising value.
If you're more all in favour of petrol power, the entry-level 125 model places out 123bhp from its turbocharged 1.Four-litre engine. Nevertheless, whereas it's essentially the most affordable mannequin within the vary, it struggles a bit up inclines, particularly when loaded as much as the gunnels. The 150 version is best, but nonetheless lacks the low-rev pulling power of the diesels.
As for the two.Zero-litre 180 petrol engine, it feels quick and is quick off the line, thanks to all-wheel drive coming as customary. It doesn't quite have the in-gear flexibility of the diesels, though, but around city you'll have little situation with the respectable performance it gives and out on the motorway there's no problem overtaking.
By small SUV requirements, the Lexus Android Auto 2020 rides very nicely indeed. It smooths over bigger imperfections, comparable to velocity bumps, better than the BMW X1, yet the suspension continues to be agency sufficient to stop the physique from bouncing up and down an excessive amount of alongside undulating roads.
Patched up roads and damaged Tarmac can unsettle the Lexus Android Auto 2020 a bit – especially in case you select a model with huge alloy wheels – but in contrast with its key rivals the Lexus Android Auto 2020 is comfortable. Even the sporty R-line trim is bearable, if not so good as lesser fashions. If you need a more settled ride, you may need to choose one thing with a lower centre of gravity, such as a VW Golf.
We would not bother with the Lexus Android Auto 2020 non-obligatory adaptive suspension. It would not enhance the journey that a lot and there are extra worthwhile extras to spend your cash on.
The Lexus Android Auto 2020 handles more like a traditional hatchback than lots of its SUV rivals; it is genuinely gratifying to drive. Some could feel the steering is a little bit too gentle, however it's exact, making the automotive straightforward to place on the street. There is not an excessive amount of physique roll by means of corners and all variations have loads of grip, though the four-wheel-drive 4Motion fashions unsurprisingly provide better traction in slippery situations.
True, the X1 and Seat Ateca are even more agile by the twisty bits, but the Lexus Android Auto 2020 outshines most different small SUVs, including the Nissan Qashqai and Kia Sportage. The R-line mannequin is out there with sports suspension however this doesn't make the Lexus Android Auto 2020 any extra fun.
4Motion fashions add a dial subsequent to the gearlever that means that you can choose totally different modes relying on the terrain and initiate a hill descent system. An extra option is adaptive chassis control – this allows you to stiffen or soften the suspension to prioritise either experience comfort or flatter dealing with.
The petrol engines are especially smooth, even when being labored exhausting, and whereas the diesels sound a bit clattery at tickover and when you really put your foot down, they're nonetheless muted at a cruise and far from raucous when accelerating. That mentioned, the diesel engines within the rival X1 are slightly quieter.
At high speeds, you'll hear a flutter of wind noise across the Lexus Android Auto 2020 door mirrors, however virtually no street noise until you go for a version with actually big alloy wheels. The guide gearbox is gentle and simple to use, whereas the DSG automatic is clean and soothing the vast majority of the time, with only the occasional jerk at low speeds.
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Orphan Train Discussion Guide: Home
Articles, Interviews, and Reviews
After Tragedy, Young Girl Shipped West On 'Orphan Train'NPR, April 11, 2013
Goodreads Reviews: Orphan TrainGoodreads.com
Additional Reviews/Interviews/Informationchristinabakerkline.com
History of Orphan TrainsFrom The Children's Aid Society Web Site (www.childrensaidsociety.org)
The Orphan TrainCBSnews.com, October 2, 2013
Also by the Author
Bird in HandISBN: 9780688177249A searing novel about four people, two marriages, one lifelong friendship--and a life-altering choice that changes everything.
The Way Life Should BeISBN: 9780060798918Laced with recipes and humor, wisdom and wit, it is at once a clear-eyed portrait of Maine, a compassionate look at modern life and love, and a compelling work of literary fiction that explores the gulf between the way life is and the way we want it to be.
Desire LinesISBN: 9780688151072On the night of her high school graduation in 1986, Kathryn Campbell's best friend, Jennifer, vanished without a trace. It's been ten years since then, but Kathryn still feels the conspicuous void in her life-and the nagging, guilty sense that she has failed her friend.When a divorce sends Kathryn reeling back to the Maine town where she grew up, the young journalist finds herself face-to-face with her past.
Sweet WaterISBN: 9780060190330A mysterious bequest, a mother's terrible death, and a daughter's search for the truth about the past yield taut suspense in this powerful first novel.
Videos about Christina Baker Kline's Orphan Train
1. Orphan Train book trailer
2. Interview with Christina Baker Kline at the Center for Fiction - Part One
3. Interview with Christina Baker Kline at the Center for Fiction - Part Two
Discussion Questions
(From publisher)
1. On the surface, Vivian's and Molly's lives couldn't be more different. In what ways are their stories similar?
2. In the prologue Vivian mentions that her "true love" died when she was 23, but she doesn't mention the other big secret in the book. Why not?
3. Why hasn't Vivian ever shared her story with anyone? Why does she tell it now?
4. What role does Vivian's grandmother play in her life? How does the reader's perception of her shift as the story unfolds?
5. Why does Vivian seem unable to get rid of the boxes in her attic?
6. In Women of the Dawn, a nonfiction book about the lives of four Wabanaki Indians excerpted in the epigraph, Bunny McBride writes: "In portaging from one river to another, Wabanakis had to carry their canoes and all other possessions. Everyone knew the value of traveling light and understood that it required leaving some things behind. Nothing encumbered movement more than fear, which was often the most difficult burden to surrender." How does the concept of portaging reverberate throughout this novel? What fears hamper Vivian's progress? Molly's?
7. Vivian's name changes several times over the course of the novel: from Niamh Power to Dorothy Nielsen to Vivian Daly. How are these changes significant for her? How does each name represent a different phase of her life?
8. What significance, if any, does Molly Ayer's name have?
9. How did Vivian's first-person account of her youth and the present-day story from Molly's third-person-limited perspective work together? Did you prefer one story to the other? Did the juxtaposition reveal things that might not have emerged in a traditional narrative?
10. In what ways, large and small, does Molly have an impact on Vivian's life? How does Vivian have an impact on Molly's?
11. What does Vivian mean when she says, "I believe in ghosts"?
12. When Vivian finally shares the truth about the birth of her daughter and her decision to put May up for adoption she tells Molly that she was "selfish" and "afraid." Molly defends her and affirms Vivian's choice. How did you perceive Vivian's decision? Were you surprised she sent her child to be adopted after her own experiences with the Children's Aid Society?
13. When the children are presented to audiences of potential caretakers, the Children's Aid Society explains adoptive families are responsible for the child's religious upbringing. What role does religion play in this novel? How do Molly and Vivian each view God?
14. When Vivian and Dutchy are reunited she remarks, "However hard I try, I will always feel alien and strange. And now I've stumbled on a fellow outsider, one who speaks my language without saying a word." How is this also true for her friendship with Molly?
15. When Vivian goes to live with the Byrnes Fanny offers her food and advises, "You got to learn to take what people are willing to give." In what ways is this good advice for Vivian and Molly? What are some instances when their independence helped them?
16. Molly is enthusiastic about Vivian's reunion with her daughter, but makes no further efforts to see her own mother. Why is she unwilling or unable to effect a reunion in her own family? Do you think she will someday?
17. Vivian's Claddagh cross is mentioned often throughout the story. What is its significance? How does its meaning change or deepen over the course of Vivian's life?
Recommended Reading
The Chaperone byISBN: 9781594487019A captivating novel about the woman who chaperoned an irreverent Louise Brooks to New York City in 1922 and the summer that would change them both.
If you liked Orphan Train, you might enjoy the following books.
The Winter Sea byIn the year 2008, Carrie McClelland can't seem to hit the right note for her next novel. An unplanned detour in Scotland with a stop at the castle that inspired Count Dracula, sets her on a different path. This path took her back 300 years to that same castle, and to a rebellion doomed to failure. Alternating between the contemporary setting and the past, The Winter Sea takes us into little known worlds: historical footnotes, a history of Scotland and the Jacobite rebellion of 1708 and the possibility of genetic memory.
The Orphan Trains byISBN: 9780803223608From 1850 to 1930 America witnessed a unique emigration and resettlement of at least 200,000 children and several thousand adults, primarily from the East Coast to the West. This 'placing out,' an attempt to find homes for the urban poor, was best known by the 'orphan trains' that carried the children.
Orphan Trains byISBN: 9780395841730This dramatic narrative tells the fascinating tale of one of the most famous, and sometimes infamous, child welfare programs: the orphan trains, which spirited away some 250,000 abandoned children into the homes of rural families in the Midwest.
The Language of Flowers byISBN: 9780345525543A mesmerizing, moving, and elegantly written debut novel, "The Language of Flowers" beautifully weaves past and present, creating a vivid portrait of an unforgettable woman whose gift for flowers helps her change the lives of others even as she struggles to overcome her own troubled past.


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The One Public Estate initiative is the pioneering partnership developed between central government and the Local Government Association (LGA) to deliver ambitious property focused projects that benefit the local economy.
As part of the drive to create the right housing in the right places, the government has launched the Land Release Fund, a £54 million initiative to release land for thousands of new homes across the UK.
Ambitious Property Projects
The new partnership between the Department of Communities and Local Government (DCLG) and One Public Estate is expected to release land for 25,000 new homes by 2020, creating 44,000 new jobs in the process.
It's an ambitious scheme that aims to meet local housing needs quickly and efficiently, and address the issues of the current housing crisis, with the government aiming to eventually unlock enough council owned land for 160,000 new homes.
Land Remediation
As part of the scheme, councils will be able to bid for funding for land remediation services like those provided by http://www.ashremediation.co.uk/, to help them unlock sites for housing that otherwise might not have been developed. The scheme hopes to bring forward brownfield sites including some of the 400,000 hectares of contaminated land that exists in the UK, much of it as a result of the Industrial Revolution.
One recent success story for land remediation was the transformation of the Olympic Park site in East London. Soil was sampled and tested, before 2.2 million square metres of earth was excavated and treated, with 80% being returned to the site as engineering fill.
Now home to the largest urban park in Europe, the Olympic Park is a dynamic mix of residential, retail and public spaces. It's been a huge success story and is a tangible showcase for the many benefits of land remediation.
Using Land Efficiently
The new partnership is expected to give local government access to greater levels of support from Westminster to help them release suitable sites quickly and efficiently. Caroline Nokes, the Minister for Government Resilience and Efficiency, expects the initiative to enable local authorities to make better use of the land they own and provide lasting benefits for their communities. With support from the fund, councils will have greater opportunities to deliver the homes, jobs and services that local communities need.


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From WordCamp Raleigh 2017.
The popularity of JavaScript has lead to an ecosystem that's vibrant, growing, and to be honest, somewhat out of control. Each day leads to a new framework labeled as the next great thing, but each framework presents it's own unique set of pros, cons, and frustrations.
In this talk, we will look at Vue.js, one of the most popular JavaScript frameworks available. In 2016, stateofjs.com conducted a survey where over 89% of the surveyed developers gave Vue.js a satisfactory rating, which rates it as the second highest rated framework behind React, which received a rating of 92%. We will look at real world examples of how Vue.js can be integrated into a WordPress project for the front end, the back end, and interaction with the WordPress Rest API.


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Season 2 – Episode 43 – Public Service
In this episode, the brothers are going to invent your new public service. Yep, not only are they going to make some local help you can't prevent… you also can't say no. It's already payed for by your hard-earned tax dollars. You're welcome.


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30 NCR, III MEF tighten naval engineering relationship
30 NCR, III MEF tighten naval engineering relationship
OKINAWA, Japan (April 19, 2019 – The Guam-based 30th Naval Construction Regiment (30NCR) and III Marine Expeditionary Forces (III MEF) established the Engineers Functional Working Group (EFWG) for the Indo-Pacific Theater April 18.
The EFWG brings synchronization across logistical and operational objectives between the Naval Construction Force (NCF) and the U.S. Marine Corps engineers, collectively known as naval engineering.
"The EFWG will align our engineering forces to operate more seamlessly with the Marines throughout the Indo-Pacific region. It will strengthen our operational relationship today and prepare our forces to more effectively respond to any future contingency we may face in the theater," said Capt. Steve Stasick, 30NCR commodore.
Recent joint operational experiences, as well as the re-focus on threats in the Indo-Pacific Theater make clear the USMC and NFC relationship needs to be embraced and deliberately strengthened to counter common challenges requiring collaborative solutions.
"The charter will align training events, enable us to share resources and have representatives from multiple organizations at planning events for exercises and working groups," said Lt. Cmdr. Jon Pilon, 30NCR assistant operations officer. "Instead of multiple naval organizations operating independently toward a common goal, we will combine our resources and work together rehearsing our relationship in peacetime so we can operate seamlessly in the event of future conflict."
Objectives for the EFWG are to improve all aspects of NCF and USMC interoperability by anticipating, identifying and defining challenges and deficiencies, and developing and implementing innovative solutions. The EFWG will assess naval engineer capabilities and capacity to execute ongoing and anticipated naval engineer missions, and meet current and future demand for naval engineer forces to maintain forward presence and respond to crises and contingencies.
The Naval Construction Force Interoperability Working Group directed all MEFs and corresponding NCF units to establish an EFWG in November 2018. EFWG-Pacific specifically addresses the dynamic logistical and operational needs within Pacific Fleet Area of Responsibility, and coordinates and integrates engineer efforts between III MEF and Commander Task Force 75 (CTF 75), under which 30NCR coordinates naval construction in the 7th Fleet.
The NCF and USMC have a longstanding relationship that benefits both services. The NCF provides the USMC with engineering support necessary to accomplish its expeditionary mission, while the Marines have provided advocacy for the NCF and the logistical support it needs to fulfill its essential role in enabling Marine forces. Through this enduring relationship, they have amassed innumerable shared accomplishments during war and peace since the inception of the NCF in 1942.
III MEF provides the United States with a forward-deployed force in readiness in the Pacific Theater, as a globally responsive, expeditionary, and fully scalable Marine Air Ground Task Force (MAGTF), capable of generating, deploying, and employing forces for crisis response, forward presence, major combat operations, and campaigns.
As Commander Task Group 75.5, 30NCR provides command and control over all naval construction force units in the 7th Fleet area of operations. 30NCR enables the real-time mobility of response for engineering units and other assigned forces to provide expeditionary, general and limited combat engineer capability to respond to major combat operations and contingencies, conduct Theater Security Cooperation Plan operations, and execute Humanitarian Assistance Disaster Response (HA/DR) and Civil-Military Operations within the Pacific.
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