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Well… let's just ignore the nearly eight-month-long, uh, sabbatical, here, okay? I mean, no one likes excuses, and the fact is, I just didn't make time to write for the last several months.
Instead, let's just pick up right where we left off. With ice cream.
I made this ice cream last fall for a girls night with a few good friends. Of course, everyone has shortcomings, and, unfortunately for this chocoholic, several of these friends would pick vanilla and caramel over chocolate any day. So, in an attempt to liven up the world's most boring flavor, I swirled my standard custard-based vanilla ice cream with some caramel sauce and served it with a giant cookie.
Everyone enjoyed it, including me. (After all, I don't hate caramel or other flavors, but chocolate will always be my first love…) So, maybe that's a sign that I should start making ice cream (and blogging) more often. The old downside to this plan is the fact that I'm right in the middle of birthday season for some vanilla fans. I'm going to need a chocolate fix pretty soon.
I used a homemade caramel sauce (thanks to America's Test Kitchen), but you could definitely use your favorite, already-prepared caramel sauce. It'd also be good with an extra pinch of sea salt either in the caramel or on top of the ice cream, for that salty-sweet combo that everyone loves.
Caramel Swirl Vanilla Bean Ice Cream
5 egg yolks
1 cup of half-and-half
3/4 cup of sugar
2 cups heavy whipping cream, divided
pinch of salt
1 vanilla bean, split and scrapped
1-2 teaspoons (give or take) vanilla extract
1/2 cup caramel sauce, plus extra for serving if desired
In a medium saucepan, whisk together the half-and-half, sugar, salt, and one cup of cream. Set the pan over medium heat and add the vanilla bean seeds and pod. Heat, stirring occasionally, until the sugar dissolves and the mixture is warm. Remove from the heat, cover, and let steep for a little while (30 minutes or so).
In a glass 2-cup measuring cup, whisk the egg yolks together until they are smooth. If the milk mixture has cooled, reheat it until it's warm to the touch again. Slowly pour 1/4 cup of the warm milk into the egg yolks, whisking constantly. Continue to add the warm milk to the egg yolks, 1/4 cup at a time, whisking the entire time. When you've added about 1 1/2 cups of warm milk, pour the egg yolk mixture back into the saucepan, whisking the entire time.
Cook the mixture over medium heat, stirring it constantly with a rubber spatula. When the custard has thickened and coats the back of a spoon, remove it from the heat.
Pour the remaining cup of cream into the bottom of a mixing bowl or large measuring cup. Set a fine mesh strainer over the cream and pour the custard mixture through the strainer. Remove the strainer and add the vanilla bean back to the ice cream base. Stir in the vanilla extract.
Chill the ice cream base in the refrigerator until it's completely cold, at least a few hours or overnight. Churn the ice cream in an ice cream maker according to the manufacturer's directions. When the ice cream is finished churning, drizzle a couple tablespoons of caramel sauce into the bottom of the container you will store the ice cream in. Scoop about a third of the ice cream on top of the caramel, then drizzle another few tablespoons of caramel sauce on top of the ice cream. Repeat the process until all of the ice cream has been layered in the container with the caramel sauce. Drizzle a little more caramel sauce on top of the ice cream, then freeze until solid.
Serve with extra caramel sauce, if desired.
Ice cream base adapted from my Moose Tracks ice cream recipe, which is initially from David Lebovitz via Everyday Annie.
Click here for a printable version.


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5 Ways to be a better Ally
Updated: Jun 9, 2020
As members of a heavily marginalised community we are aware that change to the larger systems in place can not happen by us alone, therefore it is important we have allies who will also fight for the behalf of human rights as a whole.
Essentially this article was aimed at non-black people but as I review my thoughts I realise that this information is also very important to all people who aim to becoming better allies to other marginalised communities.
In the Cambridge dictionary Being an ally is defined as a person who helps and supports someone else. They are often not a member of a particular marginalised community but are willing to help end the oppression of those in the marginalised group.
Like all things, this work is a constant process and allyship can be interpreted differently to different people, sometimes it can be tough to know where to start or you ask yourself "how can I help?".
This list is not the only way to go but you can use it as a starting point.
1. Touch Base
Far too often it takes an act of discrimination to happen before allies remember to check in with their friends, try to check in with your friends even when no act of discrimination has happened. Offer support, comfort and listen. Ask them what do they need and try to be there for them in all the ways possible. And respect people's right to privacy, space to grieve, and time for self-care. Respect your friend's choices to take time for them. They may not respond to your messages of solidarity right away, and need their time to be respected and valued.
2. Do Your Research
Naturally you want to understand the most you can about your friends community, traditions, reasons why they face what they face, etc, but don't rely heavily on them to be your 'expert'. There is a vast amount of free resources available online, Google is really your friend, do your best to inform yourself before you ask others to explain to you.
We are all learning all the time, and it is OK to ask questions but make sure you have solid relationship with that person who is comfortable to want to guide you and be ready to accept that some people do not want to discuss those things with you.
3. Listen and Give Space
You've seen listen repeatedly in this article because it is truly important. Be quiet and let your friend speak, try not to offer up your own thoughts, or comment on every situation with your own perspective or go out your way to show how 'educated' you are. Too often allies feel that they are helping by speaking up for marginalised communities but a more powerful tool is to give space for that community to speak. Let them lead the way because they lived the experiences they are referring to, support them and use your resources to put them on a platform for their voices to be heard - in other words, give them the microphone.
4. Use Your Privileges
If you consider yourself to be an ally, then it is important to recognise you are coming from a place of privilege. Allyship is a process to progress, you will make mistakes along the way, take responsibility and use it as a learning time to do better in the future.
As you continue to listen to your friend, learn how you can use your privileges to support them in your private life. Even though it can be scary, stand up when you see injustices, find other allies or organisations you can work with and hold each other accountable, do the administrative and legislative work to implement structural anti-racist policies to make change, use your resources to uplift the marginalised community but remember to give space to the voices already leading the way.
5. Donate Your Money or Time
Your help can come in many forms but sometimes the simplest ways are the most effective. If you think your expertise can benefit your friend then do offer your time. Maybe you can help them pay their bills, or cover necessary costs, identify organisations that align to your with your goals and give what you can.
Here are some helpful resources to set you on your way CIJ, White Accomplice, BLM, Movement 4 Black Lives

subset: commoncrawl


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Mansoor Rahi
While viewing Rahi's work one is struck by the prevalent dichotomy. Conventionality
as well as non- conformity to Cubism coexists within his artworks. So what does he borrow or reject from Picasso and Braque? Since his works are simultaneously imbued with these opposing attributes, a synchronized discussion is imperative. Cubism involves a fracturing of form along with its subsequent realignment into diminutive planes. A strong adherence to this is evident in works like The Thinker (1970) and the Wild Horse Series, while the series of drawings displays a certain degree of divergence from this standard. Both Picasso and Braque depicted a conceptual rather than perceptual view of nature and Rahi's several paintings show an affinity with this outlook, one such example is Mother and Child (1975). Color is monochromatic in Analytical Cubism and much of Rahi's works show a restrained use of color. A number of his paintings however, like Couple in Love (2002), show an augmented utilization of color that is analogous to Synthetic Cubism.


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Mothers 07240 California Gold Clay Bar System
In Stock
You've heard about clay bars—professional detailers, body men and your car buddies all talk about how well they work. Now use the clay bar everybody wants. Created to remove the particulate debris and contaminants that washing and polishing can't, our exclusive Clay Bar System will remove embedded grains of metal, tree sap, airborne environmental deposits and paint overspray. Better yet, our clay bar isn't hazardous to your paint—it's just firm enough to pick up the bad stuff, without being too aggressive. Use Mothers Clay Bar to get rid of paint-fouling grime and pave the way for complete waxing.
When used with clay bar, work in small sections and spray liberally in a sweeping motion, onto cool, clean, car panel before using clay bar. Ensure paint surface is thoroughly lubricated when used with clay bar. Use a microfiber towel to dry off excess Instant Detailer and move onto the next . area to be clayed.
- – To remove deposits, simply slide the clay bar over the lubricated surface. Be sure to knead the bar regularly to expose fresh clay.
Additional information
|.5 kg
|25.4 × 10.16 × 7.62 cm


text: We figured we cant stay drunk for all 7 days and we do both love to snorkel so we would like any feedback on a GREAT snorkeling tour to take while we are down there. We didnt reasearch enough in the Bahamas and went on a good one but it wasnt GREAT. Any help would be great. That is if anyone has ever left the resort,,,,,,lol


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The latest show to go up at Art on A, the gallery run by East Village punk/metal promoters Wendigo Productions, features artwork created by members of NYC hardcore band Yuppicide, who've been on the LES scene for some 20+ years. Step inside and you'll find original flyer sketches for shows at ABC No Rio, tour posters, album covers, and drawings and paintings with names like "Barfing Cat" and "Robot's Lament" — all created by band members Steve Karp, Joe Keefe and Jesse KFW Jones.
They describe their work as "a tattooed fist shaking at the sky, railing unabashedly at the utter madness and beauty of it all, refusing to go gently into that good night."
We're not sure that's the first thing that came to mind when we saw Keefe's "Guzzler" in the gallery's front window. But it definitely upstaged the display window over at the Ricky's Halloween store.
The green monster, who looks like the Philly Phanatic on crank, is riding a trike that Keefe customized himself, complete with a working barbecue rig on the back…
… and some brass knuckles on the front fender.
The whole thing will cost you the demonic sum of $6,666.66 — take it home so you can be the life of that Halloween party. The show will be at Art on A — at 24 Avenue A, near Houston Street — until the closing party on Oct. 16.


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Applying for Naturalization
Where do I file my naturalization application?
You should send your completed "Application of Naturalization" (Form N-400) to the appropriate USCIS Lockbox Facility that serves your area.
Remember to make a copy of your application. Do not send original documents with your application unless it is stated that an original is required. Always make copies of all materials you send to USCIS.
I have a disability. Will USCIS help me, or make accommodations for me?
USCIS will make accommodations for applicants with disabilities in order to demonstrate their eligibility in the naturalization process.
For example, if you use a wheelchair, USCIS will make sure you can be fingerprinted, interviewed, and sworn in at a location that is wheelchair accessible. If you are hearing impaired, the officer conducting your interview will speak loudly and slowly, or they will work with you to arrange for an American Sign Language interpreter. If you require an American Sign Language interpreter at the oath ceremony, please indicate that in your Form N-400 in the section where you are asked if you need an accommodation for a disability. If you use a service animal such as a guide dog, your animal may come with you to your interview and oath ceremony.
If you know in advance that you will need some kind of accommodation, write a letter explaining what you will need and send it to the USCIS district office that will interview you. If you have a physical or developmental disability or a mental impairment that makes it difficult for you to acquire or demonstrate the required knowledge of English and civics, you may be eligible for an exemption of those requirements. To request an exemption, you must file a "Medical Certification for Disability Exceptions" (Form N-648).
How much does the Naturalization process cost?
The cost is $595.00 for the application and $85.00 for the biometrics for a total of $680.00.
How can I pay my application fee?
You must send the fee with your application. Pay the fee with a check or money order drawn on a U.S. bank payable to Department of Homeland Security. Do not use initials. Do not send cash.
Application fees are not refundable.
How long will it take to become naturalized?
The time it takes to become naturalized varies by location. USCIS is continuing to modernize and improve the naturalization process and is working to decrease the time it takes to an average of six months after the N-400 application is filed.
Can I change my name when I naturalize?
The USCIS does not have the authority to change a person's name when that person naturalizes. Therefore, there are only two ways that USCIS can issue your Certificate of Naturalization under a new name:
1. If you present proof that you have already changed your name according to the legal requirements that apply to persons living in your State. USCIS can issue the Certificate of Naturalization with your new name. Such proof might include a marriage certificate or divorce decree showing that you changed your name when you married or divorced. It might also include some other State court order establishing that you changed your name,
2. If you are going to take the Oath of Allegiance at a Naturalization Ceremony that is held in Court, you may ask the Court to change your name. If the Court grants your request, your new name will appear on your Certificate of Naturalization.


text:
Reactions: Julian Assange Released on Bail
The price is £200,000
According to a Guardian update, Julian Assange has been released on £200,000 bail with strict conditions that include a 10 pm curfew, daily reporting to police and surrender of his passport. The WikiLeaks founder was arrested in Britain for allegations of serious (but also, apparently, debatable) Swedish sex crimes and has been held in solitary confinement. Outside the courtroom, supporters reportedly erupted in cheers when the news of his bail was announced. In a statement procured from from Assange's mother by Australia's Sunshine Coast news, Julian declared: "My convictions are unfaltering. I remain true to the ideals I have always expressed. These circumstances shall not shake them. If anything, this process has increased my determination that they are true and correct."
Here's what observers and live-bloggers have said about the goings on at the City of Westminster Magistrates' Court:
- Outside the Courtroom: Crowds of Journalists, Media Crews, Assange Supporters The New York Time's Ravi Somaiya and Alan Cowell details the outcome of the court order:
Judge Howard Riddle ordered that Mr. Assange appear again in court on Jan. 11. He also said that, between then and now he must reside at Ellingham Hall, a Georgian mansion in Bungay, eastern England, owned by Vaughan Smith, the founder of the Frontline Club, which is used mainly by journalists. Mr. Assange must spend every night at the mansion and will be electronically tagged so that police can track his movements, the judge said.
- What Christine Assange Had to Say About Her Son The Sunshine Coast News' Kieran Campbell interviews Christine Assange and pulls these quotes from the mother of the Wikileaks founder. First, on the Australian government: "Is it more important to suck up to the Yanks than to look after your own people?" Then, on her son in prison: "It would be depressing for him. He likes his freedom and wide open spaces...He's now in a cramped, cold, forbidding place." And finally, on the charges: "This hearing is a forerunner for the US to extradite him. If the US get their hands on him he will be jailed forever or he will be killed … that's how serious this is."
- Assange, Meanwhile, Keeps Up the Rhetoric The Guardian's Matthew Weaver notes in his live-blog at 12:06 U.K. Time that, "in a statement from his prison cell Assange criticised Visa, MasterCard and PayPal as instruments of US foreign policy."
- What Assange's Attorney Is Saying Wired's Kim Zetter quotes what Assange's attorney Mark Stephens told Al-Jazeera, which is that "what we have here [in Sweden] is nothing more than a holding charge" favored by the U.S., which wants to "get their mitts on him."
- What About the Guy Who Leaked the Documents to Assange? Salon's Glenn Greenwald notes that Julian Assange's incarceration isn't anything compared to the serviceman Bradley Manning who allegedly leaked the documents to Assange:
Julian Assange--whose renewed bail hearing is taking place right now--has been held in solitary confinement under quite repressive conditions. As will be detailed shortly, the conditions under which Bradley Manning is being held have been far worse. Both of them, of course, have been convicted of no crime, yet are being subjected to inhumane incarceration.
- I'm Proud of WikiLeaks, and I'm Posting Some of Assange's Bail, declares Michael Moore in The Daily Beast, who apparently contributed $20,000. "Furthermore, I am publicly offering the assistance of my website, my servers, my domain names and anything else I can do to keep WikiLeaks alive and thriving," he writes. His reasoning goes something like this: If we had WikiLeaks in 2002 the "warmongers" might not have been able to "pull off" bringing our nation to war in Iraq. "Might WikiLeaks cause some unintended harm to diplomatic negotiations and U.S. interests around the world? Perhaps," he concedes. But that's government's "punishment" for taking the country to war based on a "lie." He concludes: "WikiLeaks, God bless them, will save lives as a result of their actions. And any of you who join me in supporting them are committing a true act of patriotism. Period."


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"The numbers registered in September have been particularly positive. Poker & Bet recorded collections from online bets for 4 million euros, a very important datum if you consider that up to a year ago it was around 600-700 thousand euros.
Certainly our very intuitive gaming platform has had an important impact. "
This is what Lucio Pellecchia, Administrator of the Pixelo software platform, told to Agimeg, who also underlines "a big increase on live, thanks to the management of our platform, but the results of the collection on casino games are also very comforting".
What is the secret of this success?
"With live betting we offer up to 13 thousand events per month on our platform and 3 thousand exclusive ITF Tennis events, providing operators and therefore players with one of the richest offer packages on the market. They range from the main leagues, such as Serie A and Premier, to the third or fourth category leagues, or to the women's leagues, which have a great response from the players ".
How has the online betting market evolved?
"The game on live is mainly online, professional players have always been there, but many occasional players also play on live, the market has moved compared to traditional canons. The offer is increasingly varied and new bets can be placed during events. "
What news do you have in store and how do you judge the current regulatory situation in the sector?
"We will soon also offer services for the management of the physical game, an activity that will be carried out mainly when there is finally a call for the new physical network, even if in reality in our opinion there is an excess of supply in the area. Everything changed when the territorial location ended, the identification of the stores on a provincial and municipal basis: having removed the territorial constraints, the game concentrated where there is greater collection, however in this way the collection is divided among several operators, not to mention the existence of an illegal network, which practices unfair competition. In addition, many illegal stores have been legalized, with the result that today we have an exaggerated offer. The ban is expected, but it will not be the panacea for all evils. We will offer services such as online game management connectivity and back office and in the future, for the management of the physical network, we will implement new games, offering services that according to our concessionaires have made them grow considerably ".
What are the next scheduled appointments?
"We will be present next week at the Enada in Rome, a fair where we will offer back office management potential (billing, top-ups, payments) for operators"
This post is also available in: Italiano


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One of our favourite moments from Saturday's victory over Cardiff was the ridiculous piece of skill Roberto Firmino showed on his own touchline.
The Brazilian, while on the floor, managed a no-look, back-heel nutmeg that set Liverpool on a counter-attack!
Gerrard's epic Rangers interview blows up & Liverpool fans love it
LFCTV have released another video angle, which shows just how impressive the trick actually was.
You can check it out below:
Add no-look nutmegs to the list! 😎😱
Outrageous skill from Firmino 🤙 pic.twitter.com/Q0xCunxIxW
— Liverpool FC (@LFC) October 30, 2018
We'd suggest that Firmino has actually not reached his best level yet this season.
To think, in 2017/18 he bagged 27 goals in all competitions, but is so far on four and only one in his last eight.
Jurgen Klopp has been using him in a more withdrawn role recently, which maximises his defensive output and creativity.
So long as Sadio Mane and Mo Salah are finding the back of the net, this isn't a problem.
We expect him to have a very big game against Arsenal at the weekend.


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Tubi Takes $25M Loan, Prepares to Spend More Than $100M on Content
Ad-supported streaming platform Tubi said its viewership is way up, and it's making plans for expansion.
The San Francisco-based startup said it will spend "over nine figures on content in 2019," as it looks to bolster a library that now includes around 12,000 movie and TV show titles from more than 200 suppliers.
Tubi doesn't release specific base metrics, but it said viewership was up by a factor of 4.3X in 2018, while its advertising revenue increased 180%. Tubi, which was founded in 2010 and has raised $26 million to date, also said it was profitable in the fourth quarter "marking a major milestone."
To fund it's expansion, Tubi has closed a $25 million loan with Silicon Valley Bank.
"In 2018 we at Tubi saw tremendous growth as consumers, fatigued by SVOD subscriptions and services, sought alternative entertainment choices," said Farhad Massoudi, CEO and co-founder of Tubi, in a statement. "We will continue to use profits to make bigger bets on content, enhance viewing experience, and continue to press ahead into new grounds in what is our core advantage: technology and data."
Tubi is a free-to-consumer streaming platform that's playable on most popular OTT, gaming and mobile devices. Notably, the service is natively embedded into Comcast's X1 video platform.
With media companies interested in ad-supported video on demand (AVOD) amid a competitive subscription streaming market, Tubi recently talked to Viacom about possible acquisition. Viacom ended up paying $340 million for another AVOD start-up, Pluto TV.
For his part, Massoudi told MCN last week that the company is prepared to soldier on as an independent.
Daniel Frankel is the managing editor of Next TV, an internet publishing vertical focused on the business of video streaming. A Los Angeles-based writer and editor who has covered the media and technology industries for more than two decades, Daniel has worked on staff for publications including E! Online, Electronic Media, Mediaweek, Variety, paidContent and GigaOm. You can start living a healthier life with greater wealth and prosperity by following Daniel on Twitter today!
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text:
- Commentary
- Open Access
- Published:
From NELA to EPOCH and beyond: enhancing the evidence base for emergency laparotomy
Perioperative Medicine volume 5, Article number: 23 (2016)
2409 Accesses
11 Citations
10 Altmetric
Around 35,000 patients undergo emergency laparotomy surgery in the UK each year with an in-hospital 30-day mortality estimated as between 11 and 15 %. The recent publication of the First Patient Report of the National Emergency Laparotomy Audit (NELA) has provided a detailed description of individual hospital performance against national standards of care in emergency laparotomy in England and Wales. Although the standards used for audit purposes in NELA are based upon the best currently available evidence, none of the source data derives from randomised controlled studies. This commentary explores the evidence base for the standards evaluated by NELA and highlights recent and forthcoming studies that may substantially contribute to improving the evidence base in this area, thereby improving patient care and strengthening the validity of the NELA audit standards.
The First Patient Report of the National Emergency Laparotomy Audit (NELA) was launched on 30 June 2015 (NELA project team 2015). Data from over 20,000 patients, across 192 National Health Service hospitals in England and Wales, informed the most comprehensive review of perioperative care for emergency surgery to date. This commentary highlights the limitations of the evidence underpinning the standards against which NELA evaluates the care of patients undergoing emergency laparotomy (EL) and highlights some important recent and forthcoming studies that will both improve patient care and feed into the process of updating the standards against which NELA audits process and outcome.
Main text
Central to understanding of the First Patient Report of NELA (NELA project team 2015) is an appreciation of the methodological framework around which the project is based. NELA was not designed to address a specific research hypothesis but rather to provide a powerful resource of structure, process and outcome measures to drive quality improvement in the care of patients undergoing EL in the England and Wales. Key standards of care for EL patients were identified from national guidelines and policy documents and were then used to define questions answerable by audit of individual hospital performance. The national picture provided by NELA on the size and nature of problems surrounding perioperative care of EL and the provision of high-quality risk-adjusted outcomes is in itself valuable. More importantly, NELA provides benchmarking process and outcome data to drive local quality improvement initiatives that should improve patient outcomes. Yet, much like the Hip Fracture Anaesthesia Sprint Audit of Practice (ASAP) (ASAP collaboration team 2014), the design of NELA, imposed by the audit framework, is also a limitation: the constraint of only being able to collect data linked to existing standards of care.
It is therefore relevant to consider the quality and grade of evidence underpinning the auditable standards applied within NELA. Nine of the 19 chapters in the First Patient Report contain recommendations, linked to a total of 22 standards, which are in turn derived from 9 different standards documents. The standards documents fall into a relatively limited number of categories; three are reports of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (NCEPOD 2007; NCEPOD 2010; NCEPOD 2011), two are consensus statements from the Association of Surgeons of Great Britain and Ireland (ASGBI) (ASGBI 2007; ASGBI 2009), two are outputs from the Royal College of Surgeons of England (RCS) (RCSEng and Department of Health 2011; RCSEng 2011) (one guidance document and one report from a collaborative working group with the Department of Health (DoH)) and two are DoH or National Health Service England (NHSE) documents (Department of Health 2001; CQUIN 2015). However, despite the importance and influence of these national documents that are the sources of the standards for NELA, not one of the recommendations used as an auditable standard is underpinned by evidence from a study with a randomised controlled trial (RCT) design.
For example, chapter seven in the First Patient Report of NELA contains the auditable standard that "Patients admitted as an emergency should be seen by a consultant at the earliest opportunity. Ideally this should be within 12 hours and should not be longer than 24 hours". This standard is taken directly from the NCEPOD Emergency Admissions report from 2007 (Emergency Admissions: A journey in the right direction 2007). NCEPOD reports are highly regarding for shaping clinical care in the UK. However, from a critical perspective, the NCEPOD methodology of post hoc review by a panel of experts of a non-control matched series of cases constitutes a low grading of evidence, with a lack of blinding and inherent risk of reporting and observer bias. The standard that "All high risk patients should be considered for critical care and as minimum, patients with an estimated risk of death of ≥10 % should be admitted to a critical care location." which is taken from "The Higher Risk General Surgical Patient" report published jointly by the RCS and DoH in 2011 is unreferenced: trials of the efficacy or effectiveness of critical care and notoriously challenging and randomization may not be feasible. Whilst these standards make intuitive sense to the practitioner and are likely to improve patient outcome, we cannot know this for sure. Moreover, such changes may have significant resource implications (e.g. requirement for additional critical care beds) and carry the risk of unintended consequences. For example, admission of lower risk patients to Intensive Care following EL may divert resources from other patients that might have been admitted to the same bed and may have gained more benefit from that admission than the EL patient. Such dilemmas are the bread and butter of clinical decision-making, but when this decision-making is constrained by external influence of national standards, the importance of ensuring that these standards are based on the highest quality of available evidence is clear.
Similar limitations pertain for all the other NELA standards. Even the most strongly evidenced standard—that relating to antibiotic prescription in septic patients—is not based upon RCT evidence. The standard covers "the number of patients who present to emergency departments and other wards/units that directly admit emergencies with severe sepsis, Red Flag Sepsis or Septic Shock who received intravenous antibiotics within one hour of presenting." This standard is derived from the NHSE 2015–16 Commissioning for Quality and Innovation (CQUIN) guidance (CQUIN 2015) and is supported by several references. Three of these references are observational studies describing sepsis prevalence but are unrelated to the timing of antibiotics (Vincent et al. 2006; Hall et al. 2011; Intensive care national audit and research centre 2015); three are parliamentary reports or NHSE Patient Safety Alerts on the magnitude of sepsis as a problem (Parliamentary and Health Service Ombudsman 2013; Parliamentary and Health Service Ombudsman 2014; NHS England 2014); and the final report comments on the cost and impact of sepsis (Esteban et al. 2007). The Royal College of Physicians Acute Care Toolkit on Sepsis (Acute Care Toolkit 9: Sepsis 2014) is also referenced and contain further sources, but again, only one (Kumar et al. 2006) of the four observational studies cited (Vincent et al. 2006; Trzeciak et al. 2006; Daniels et al. 2011) contains any detail on timing of antibiotics. Whilst this single retrospective study presents a convincing pattern of results and a strong treatment effect, which is compatible with a credible pathophysiological mechanism, the design is not randomised and is therefore theoretically open to confounding factors that may bias results: causation is not proven and the level or grade of evidence could be higher. A Cochrane review on the topic of early antibiotics in sepsis published in 2010 (Siddiqui and Razzak 2010) is not cited in any of the source documents but concludes that "we are unable to make a recommendation on the early or late use of broad spectrum antibiotics in adult patients with severe sepsis in the ED pre-ICU admission." The authors concluded that there was a need for appropriately designed trials to address this question and that "…it makes sense…" to start antibiotics early but that this was based on "…anecdotal suboptimal evidence". Again, the recommendation to give early antibiotics makes intuitive sense and is supported by some observational data but in the general context of a very limited evidence base on the topic. Much the same can be said for all the NELA recommendations; they are pragmatic, logical and based upon a hopefully balanced and unbiased judgement reflecting the best available evidence by practicing clinical experts.
Part of the problem restricting the current evidence base underpinning the NELA standards is the difficulty of conducting trails in emergency laparotomy patients specifically or in critically ill patients in general. Patients undergoing emergency laparotomy are a heterogeneous group with a range of surgical pathologies and exposed to a variety of clinical care processes: large numbers of patients may be required to separate signal from noise. The emergency context brings particular challenges to the consent process, but recent large trails in critical care show that these are not insurmountable. Randomisation of individual emergency laparotomy patients to different packages of care may be substantially undermined by washover of care practices within hospital wards and teams over time. The solution to this last problem may lie in less conventional research trial designs (see below).
Despite the complexities of doing clinical studies in patients undergoing emergency laparotomies, the evidence base is growing with one recent important publication and two other studies close to reporting results. None of these studies uses a classical parallel group randomisation of patients to intervention or control. A non-randomised "before and after" evaluation of implementation of best practice guidelines, the Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) bundle, recruited 726 patients in four centres and published results in 2014 demonstrating a mortality reduction in the implementation phase (Huddart et al. 2015). The follow-on study for this pilot, a 2-year quality improvement project being conducted in 24 NHS hospital trusts in three Academic Health Sciences Networks (AHSNs) in southern England, will be completed in 2017 (Emergency Laparotomy Collaborative (ELC)). Finally, the hugely ambitious Enhanced Perioperative Care for High-risk patients (EPOCH) study (Pearse 2015), which has a planned sample size of 27,540 patients in 90 NHS Hospitals in a stepped wedge cluster randomised trial design, has recently completed recruitment and should report during 2016. The design of this study is important, overcoming the restrictions around protecting group allocation by gradually designating geographic clusters of hospitals to the invention over time, providing an effective method of evaluating the implementation of a package of care despite logistical constraints (Hemming et al. 2015).
The current evidence base underpinning national standards around the care of patients undergoing emergency laparotomy is weak, in terms of both the quantity and grade of evidence. However, this situation is rapidly improving. The next 24 months will see important evidence emerging from EPOCH and the ELC. Clearer definition of what is best practice in this patient group will be of great value to clinicians and healthcare providers and may also pave the way for financial incentives for Trusts (Murray 2014), in a similar manner to those shown to improve care for patients having hip fracture surgery (Khan et al. 2013). The challenges of conducting clinical studies in this context should not prevent the development of a more solid evidence base to underpin standards and guide clinical care, through the conduct of appropriately designed and carefully conducted clinical trials.
National Emergency Laparotomy Audit
Emergency laparotomy
Hip Fracture Anaesthesia Sprint Audit of Practice
National Confidential Enquiry into Patient Outcome and Death
Association of Surgeons of Great Britain and Ireland
Royal College of Surgeons of England
- DoH:
Department of Health
National Health Service England
Randomised controlled trial
Commissioning for Quality and Innovation
- ELPQuiC:
Emergency Laparotomy Pathway Quality Improvement Care
- AHSNs:
Academic Health Sciences Networks
Emergency Laparotomy Collaborative
Enhanced Perioperative Care for High-risk patients
- ELPQuiC:
Emergency Laparotomy Pathway Quality Improvement Care
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No acknowledgements are made.
No funding was used during the preparation of this article.
Authors' contributions
PMO wrote the initial draft. PMWG edited and added to the initial draft. Both authors read and approved the final manuscript.
Competing interests
MPWG is chair of the NELA project team and director of the National Institute of Academic Anaesthesia Health Services Research Centre at the Royal College of Anaesthetists. MPWG is also an elected council member of the Royal College of Anaesthetists and an elected Board member of the UK Faculty of Intensive Care Medicine.
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Odor, P.M., Grocott, M.P.W. From NELA to EPOCH and beyond: enhancing the evidence base for emergency laparotomy. Perioper Med 5, 23 (2016). https://doi.org/10.1186/s13741-016-0048-x
DOI: https://doi.org/10.1186/s13741-016-0048-x
- National Emergency Laparotomy Audit
- Evidence-based medicine
- Emergency surgery


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IAEA praises China's nuclear power progress
China has made notable achievements in the safety of nuclear power generation and its regulatory framework, according to an International Atomic Energy Agency review.
The IAEA review team announced its findings at a joint news briefing with the Ministry of Environmental Protection in Beijing on Thursday.
Ramzi Jammal, leader of the review team and chief regulatory operation officer at the Canadian Nuclear Safety Commission, praised the progress in nuclear safety regulation and the efforts in increasing the human and financial resources made since 2010.
China is also working on strengthening the legal framework for these efforts with a Nuclear Safety Act, which is expected to be submitted to the top legislative body for a first read by the end of this year, said Liu Hua, chief engineer of nuclear security of the Ministry of Environmental Protection.
In a news release accompanying the briefing, Greg Rzentkowski, director of IAEA's Division of Nuclear Installation Safety, said China had "demonstrated a strong commitment to invest and innovate in nuclear safety to meet infrastructure development challenges posed by its expanding nuclear power program."
After its review in 2010, the IAEA made 79 recommendations and suggestions for improvements to China's nuclear power program. All but eight of those had been satisfactorily accomplished, the agency found in its latest review.
The eight remaining items focused on aspects such as adopting a Nuclear Safety Act, making a long-term policy for the radioactive waste, and improving the research on recycling the nuclear waste.
"We have made the plans targeted by each of these issues and take the suggestions and recommendations from the follow-up review seriously to improve the security," said Liu.
At present, China has 32 nuclear reactors in operation at power plants, but the number is expected to reach 90 by 2020. Along with this expansion are plans to increase the capacity for storage of nuclear waste.
China already has three tanks to store the low-level radioactive waste, and five more are planned, said Liu.
Within five to 10 years, China will build an underground laboratory to deal with the high-level radioactive waste, he said, adding that the authority will further tighten the management of radioactive waste.
China has grown into a global leader in nuclear power utilization in its pursuit of green growth with expansion of clean energy and reduction of greenhouse gases emission.
Currently, China has 32 nuclear power reactors in operation and another 24 under construction, the highest number in the world.
- China Institute of Atomic Energy
- Nuclear Power Institute of China
- Southwestern Institute of Physics
- China Nuclear Power Operation Technology Corporation, Ltd.
- China Nuclear Power Engineering Co., Ltd.
- China Institute for Radiation Protection
- Beijing Research Institute of Uranium Geology (BRIUG)
- China Institute of Nuclear Industry Strategy (CINIS)
- China Nuclear Mining Science and Technology Corporation


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These guys should be the Poster Boys for Corona 19 safety measures. They wear masks and wash their hands.
Raccoons are nocturnal but hunger can bring them out in the daytime. This young one, already with a notched ear, appeared just after a flood.
I've always suspected the raccoons out hunting in the Spring and early Summer are trying to get enough nourishment to feed their babies hidden somewhere.
Another early Spring phenomena is the appearance of yearling raccoons in trees, as if they have been driven from their mothers and must find new homes. The expression of the face of the one below suggests that.
This one appears to have crawled into a tree and died.
No, he was just sleeping. Dead tired, it was.
Should you think the life of a raccoon is easy, this mauled, ear-shredded, tailless fellow might have another story.


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Rep. Alexandria Ocasio-Cortez Grills Michael Cohen, Laying Out Plan to Probe More Trump Crimes
https://democracynow.org – Congressmember Alexandria Ocasio-Cortez questioned Michael Cohen about President Trump's shady tax dealings at Wednesday's hearing, presenting a roadmap for investigators to look further into Trump's crimes. We speak with independent journalist Marcy Wheeler, who says, "In five minutes, this freshman congresswoman just laid out a whole investigative plan for three more topics into Donald Trump's potentially criminal activities." Wheeler covers national security and civil liberties on her website EmptyWheel.net.
Democracy Now! is an independent global news hour that airs weekdays on nearly 1,400 TV and radio stations Monday through Friday. Watch our livestream 8-9AM ET: https://democracynow.org
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LBB Editorial
Fri, 03 Jul 2020 13:27:56 GMT
Yukiko Ochiai has had an exciting career throughout her time at GREY Tokyo since joining in 2011. However, despite rising through the ranks to president and CEO she pinpoints the exact moment she realised she was a 'female powerhouse' at a meeting with Japan Advertising Agency Association last year. That one fleeting moment as the only woman in a room with 35 men proved to her just how much work there is to be done – and how much power and responsibility she has to change things for female creatives.
Perhaps it's this drive and also Yukiko's understanding of how the Japanese public do not embrace differences well, that has given her the ability to create campaigns that uplift and celebrate individuals in all their shapes and forms.
Yukiko speaks to LBB's Natasha Patel about how Covid-19 has the power to change the Japanese advertising industry's obsession with working long hours and why she believes postponing the 2020 Olympics has given the industry motivation to be even more creative.
LBB> Tell us about your start in the industry.
Yukiko> My first job was as an assistant director at Fuji Television, producing live sports broadcasts for the network. Assistant director sounds very fancy and sophisticated, but my real job was to take care of the staff's meals and beverages and to keep the breakroom clean and organised.
One day, I forgot to put out three separate trash bags (one for plastic, one for burnable waste and one for cans), and I had to go through and separate the recyclable garbage. I was feeling very sorry for myself, studying and graduating from top schools, getting a job at the top TV station, and doing a job I had not foreseen myself doing this!
The producer of the program came up to me and said, "do you realize how great this is for you. Everybody is watching and will remember that you picked through the garbage all day for them. People will know that you are not just a privileged girl but a humble person that doesn't run away from rolling up your sleeves and doing what no one else wants to do. So, when you become a director, your staff will listen to you and do their best for you. Take your time, and make sure everybody sees you doing this." His words still live with me today, and I would like to pass on this advice to the younger generation. Nothing is a waste, and any experience can become valuable if you can find meaning to it. The skills needed to succeed in our industry is much more complex, and there is no quick and easy way to get it - it isn't a place for instant rewards.
LBB> You've been at GREY since 2011, how would you describe the journey you've been through in the past nine years?
Yukiko> I have loved the career journey so far and enjoyed a series of moments rather than one in particular. Perhaps I can tell you the most recent standout moment. This summer, GREY Tokyo won a YELLOW PENCIL for their Hankograph (Wild Aid) campaign and its extra special because its the first D&AD win in GREY Tokyo's history and the first D&AD win for our ECD, Masanori Tagaya.
It was uplifting news, especially appreciated during these times and a super accomplishment for the GREY Tokyo team. I'm really proud of them! Also the recent wins at the One Show felt really good because the hard work put in by the team and that too for a great cause paid off. Shows creativity can definitely help with raising awareness and can help towards solving real issues.
LBB> In that time have any particular campaigns stuck out to you as being poignant?
Yukiko> I have been fortunate enough to have worked on many great campaigns, it's difficult to choose, but I like the ones that help make a difference or start you thinking. But just a few weeks ago, we launched a powerful campaign that gave me goosebumps - so let me explain.
The campaign is for a P&G skincare brand SKII, it's an amazing brand that works on your skin DNA and supports you to "Change Destiny" of your skin and life. The brand partnered with Ikee-san, a 19-year-old promising female swimmer, who was aiming to win medals at the Tokyo Olympics 2020. However, she had to give up her dreams of Tokyo 2020 as she was diagnosed with leukaemia and had to undertake cancer treatment instead. The campaign re-introduces Ikee-san to the world after a long and hard battle with the disease, as she accepts her new self by taking off her wig in public for the first time. It is a powerful gesture that encapsulates the idea "Change Destiny" and gives hope to people, not only to people suffering from illnesses, but even people facing difficulties say, due to Covid-19, right now.
The campaign inspires people, who have been taken away something important because of the pandemic, to stay strong and push forward to change our destiny. The campaign was well received and had a big response and reaction from consumers and the media. I think the most effective campaigns are born when brand purpose and consumer insights are in sync and are executed in an impactful way. These great campaigns have the power to ignite a change in your fundamental behaviour - the SKII campaign is one of the many examples of how Grey has successfully done this.
LBB> You've been CEO at GREY since 2015 and last year were announced as president, would you describe yourself as a 'female powerhouse'?
Yukiko> I have never viewed myself as a "female anything" until I became the board member of the JAAA (Japan Advertising Agency Association) last year. There is only one female board member (myself) among the total 35 members. It made me realise how difficult it is for women to succeed in the Japanese advertisement industry, and that I have a responsibility to change things.
Personally, I count myself very lucky to be surrounded by people, both clients and in the agency, who have valued me for my work. I also have a great support system to keep going. But, I am now aware that this is not the case for many other women who work in our industry. Grey Tokyo has implemented more than 40 measures to support work-life balance, and for female advancement in our company. I am very proud that we have one of the highest female (employee) ratio and the highest female-manager ratios in Japan. But we still have a long way to go. Our client P&G is now pushing for gender equality in advertisement production, specifically to increase work with female directors. I am very excited and want to support this mission by working with P&G, and I think this will help open up our industry further too.
I also want to mention a campaign we did for Pantene a few months ago "#HairWeGo: My Hair Moves Me Forward" which took up the challenge against the unspoken rule of conforming to uniformity and a specific 'job hunting hairstyle' which is a neatly tied up ponytail. Pantene collaborated with government departments and companies to co-create the diversified job-hunting hairstyle project which featured actual employees in out-of-home and newspaper ads, showing a wide variety of hairstyles, to encourage job seekers to be their authentic selves. What was also heartening to see was that more than 139 companies, a mixture of established, emerging and start-up companies, across different industries, participated in the project. I can see we are evolving in many ways, and that change is taking place.
LBB> Wow, it seems campaigns centered around hair have been important to your career as you always worked on Hairy Tale. Tell us about what and what inspired it?
Yukiko> The Hairy Tale project all began when a US magazine clip was sent to us from the P&G Beauty Care CEO, Alex Keith. Alex was the one who got the idea and asked our team to think about a Baby Chanco campaign. We interviewed Chanco's mom, and this deeply inspired the creative team. Chanco's mom is truly an amazing woman who has embraced and loved the differences in her baby. To be different in Japan is very difficult, and people try to conform to normality as much as possible.
I almost cried listening to the mother's interview, remembering how emotionally fragile I could get when my son was little and often compared to other babies. I think what made this work extraordinary was the team hitting the right balance between positivity and seriousness. The idea of inviting viewers (not just mothers) to pause and think deeply about individuality but also ensuring it's not preachy, instead, to introduce the idea in a warm and gentle way. The learning from this project is that inspiration can come from anyone -even the client CEO. That work that is authentic and developed with creative passion -resonates with the viewers. Finally, one should never underestimate their audience because they will know the difference.
LBB> Do you think the industry in Japan will become more progressive once impacts of Covid are over?
Yukiko> While Covid-19 will have a negative financial impact on our industry for this year, I believe that the changes we have all had to adapt to during this period will empower the industry in the long run. The Japanese advertising industry is famous for its long working hours and unpredictable schedules, giving it a reputation for being unhealthy and sometimes even dangerously stressful. It is especially challenging for parents with small children.
The Covid-19 situation has forced the entire industry to work remotely, has pushed us to make priorities, sharpen our internal communication and drive efficiency. Also, cutting transportation time from-and-to the office has given us more flexibility. Post-Covid, I believe our industry will change for the better and become a much more appealing workplace, and an industry where people can succeed while still leading an enriched personal life. In this respect, Grey Tokyo is one of the pioneers as we have always encouraged remote work - employees can work from home for two days a week. I see a huge opportunity to push even further for a flexible and efficient work style, and I hope this will also attract a lot more people to our industry.
LBB> How has the postponement of the Olympics impacted the industry? Is there a lot of uncertainty?
Yukiko> There is no doubt that the postponement of the Olympics has had an effect on our industry and our clients. We have been planning largescale Olympic campaigns for years, and postponing all the plans and developing replacement campaigns under the Covid situation has been at times, challenging.
But I am also feeling creatively inspired by how this sudden and unexpected postponement has given a deeper meaning to the Tokyo Olympics. The first Tokyo Olympics in 1964 was extremely emotional as it symbolized Japan's progress and re-emergence, and reacceptance into the global community post-WWII. In comparison to 1964, the Japanese public was not finding a deep meaning for 2020, and what it stood for. The message Tokyo/Japan wanted to say to the world was not clear and not as convincing.
Assuming that the Tokyo Olympics resumes after the world overcomes Covid-19, there will be a new, deeper, richer and more meaningful reason of why all nations are gathering in Tokyo, and why we are celebrating the greatness and significance of sports. I, for one, am looking forward to my team's creativity and insights on this new challenge of finding the true and meaningful reason of Tokyo 2020, and how it will deepen our Olympics campaigns. For the world to have gone through Covid -I think it will affect the way we all will see things, perhaps through a kinder and more authentic lens which is also full of gratitude.
LBB> Covid aside, what are your plans for the future?
Yukiko> I honestly love what I am doing and can't think of anything more exciting than what I do. I love it because I am exposed to the highest level of creativity, and we are solving a wide range of problems through our creativity every single day. I love the complexity and sensitivity of Japanese communication and the push for the creative excellence that excites Japanese consumers. So, I don't have any plans for now. I will continue doing what I am doing until I don't love it anymore.view more - 5 minutes with...LBB Editorial, Fri, 03 Jul 2020 13:27:56 GMT


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Virtual FM Ltd – Facilities Services the way you'd do it yourself.
Virtual FM builds facilities services bespoke to you and uour business. You didn't buy your company off a shelf, so why should you have to buy your services that way? We deliver exactly what your business needs while you focus on your core business. Virtual FM is a national service provider delivering throughout the UK across three regional offices with an established infrastructure of mobile engineering teams and regional cleaning personnel.
Our team have extensive experience in operations and facilities management, both as clients and service providers. It means we know what needs to be done, how it should be done and when it needs to be done. We prioritise compliance, operations and satisfaction for our partners, because we want to do things right. And given that almost all of our business comes from client referrals, we're proud to say our partners agree with us.
Calling in the specialists can save you time and money. We can take on the hassle of managing even the most demanding of properties, so you don't have to. Pick up your non-core busines operations, optimise your building systems, deliver operational efficiencies and cost savings. All self-delivered, so it happens when it needs to. Quickly. And in the right way.
Our services that are tailored to your business needs, to make your life easier – and your organisation more efficient:
- Cleaning
- Window Cleaning (Ionic Filtration Reach & Wash pole systems)
- External Specialist Cleaning (i.e. gutters, steam/pressure cleaning etc)
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- Planned Maintenance Services
- HVAC Services (Oil/Gas Heating & FGAS qualified engineers)
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- Property Repair Services (Plumbing, flooring, joinery, painting & decoration)
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- 24/7 Helpdesk Services & Asset Monitoring
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- Fit out and refurbishment services
Call us today on 0141 465 3397 or email us at [email protected] for a discussion on our services and how we can deliver cost savings for your business. Or visit us online at https://virtualfm.co.uk


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1200cc Cylinder and Piston Conversion Kit Silver fits Harley-Davidson
Increase your horsepower with our V-Twin 883cc to 1200cc big bore conversion kit. Our kit includes 2 silver finished cylinders with milled edge fin.Cylinders are pre-fitted with Wiseco 10:1 piston and ring set. Order head base gasket separately. Unit Of Measure: 1 - KIT. Does not require any machining. The item "1200cc Cylinder and Piston Conversion Kit Silver fits Harley-Davidson" is in sale since Wednesday, February 1, 2017. This item is in the category "eBay Motors\Parts & Accessories\Motorcycle Parts\Engines & Engine Parts\Other Engines & Engine Parts". The seller is "autocom_performance" and is located in Newburgh, New York. This item can be shipped to United States, Canada, United Kingdom, Denmark, Romania, Slovakia, Bulgaria, Czech republic, Finland, Hungary, Latvia, Lithuania, Malta, Estonia, Australia, Greece, Portugal, Cyprus, Slovenia, Japan, China, Sweden, South Korea, Indonesia, Taiwan, South africa, Thailand, Belgium, France, Hong Kong, Ireland, Netherlands, Poland, Spain, Italy, Germany, Austria, Bahamas, Mexico, New Zealand, Singapore, Switzerland, Norway, Saudi arabia, United arab emirates, Qatar, Kuwait, Croatia, Malaysia, Brazil, Colombia, Barbados, Bangladesh, Bermuda, Brunei darussalam, Bolivia, Ecuador, Egypt, French guiana, Guernsey, Gibraltar, Guadeloupe, Iceland, Jersey, Jordan, Cambodia, Liechtenstein, Sri lanka, Luxembourg, Monaco, Macao, Martinique, Maldives, Nicaragua, Oman, Peru, Pakistan, Paraguay, Reunion, Viet nam, Uruguay.
- Brand: V-Twin Manufacturing
- Manufacturer Part Number: 11-0565


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The Horsetail/Triple Falls Loop - Hiking
Made possible by
One of the more popular stops on the Oregon side of the Gorge, the Horsetail Falls parking lot fills up quickly during the warm summer months, with people coming to enjoy this really great 4.5 mile hiking trail.
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4.5 miles
Destination Distance From Downtown
28.4 miles
2 of 5 diamonds
Time To Complete
1 hours
1 - 3 hours.
All Seasons
All Seasons with proper gear.
Dog Friendly
Fees Permits
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The Amazing Benefits of Magnesium Oil
This oil promotes health, vitality and there's a recipe
Magnesium oil is a term for a mixture of a highly saturated solution of magnesium chloride in distilled water, which has a texture similar to oil. Using an oil spray is very convenient because it's applied topically to your skin for fast absorption. Also, this allows your body to absorb what it needs as it needs it.