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Samsung pretty much confirmed the release of the Note 8 after it announced an upgrade scheme in South Korea following the Note 7 debacle. The scheme allowed anyone who bought a Note 7 to get a Galaxy S7 or S7 edge for half price, after which they would be able to upgrade to the Galaxy S8, now available, or Note 8 when it is released.
The device is apparently codenamed “Great”, or Samsung Gr3at according Evan Blass, and SamMobile has claimed its model number is SM-N950F so that’s worth looking out for in any future leaks.
As to specifically when the Note 8 will be released, Samsung has sent out media save-the-dates on Twitter for an event on 23 August confirming it will “reveal the latest member of the Galaxy family”. The invite also shows a Note-like outline with a stylus and it teases the words “do bigger things”. It also recently released a teaser video that all but confirms the event will be for the Note 8.
In terms of price, VentureBeat has claimed the Note 8 will cost €1000 when it launches, which is around £895, or $900. Ouch. The site also claimed it would launch in late September, which would be around a month after it is announced based on the event date. It is said to be coming in Midnight Black and Maple Gold colours, with Orchid Grey and Deep Sea Blue follow.
A leak on Slashleaks shows off what it claims to be the Galaxy Note 8, featuring a very similar design to the Galaxy S8 and S8+ but with a seemingly wider stance, which would be likely given the S Pen would need to slot in somewhere. The Note 8 is pictured with the S Pen next to it and Bixby on the screen, as well as the same on-screen controls as the recent S8 and S8+ devices, making a good case for its legitimacy. You can never be sure though, so grab that salt just in case.


Leaks of the Google Pixel 4 just won’t stop this week and today we’re getting our first look at camera samples from the Pixel 4 XL in yet another hands-on video leak.
Just moments after a video leaked from a Vietnamese YouTuber, another YouTube channel based in Thailand posted an extensive hands-on with all three colors of the Pixel 4 XL (via @Samsung_News_)
This video goes over the hardware itself in depth giving us a clear look at the shiny glass back of the black variant and matte finishes on both the white and orange colors. Some of the features including Motion Sense are also detailed again.
What’s most notable about this leak, though, is that it gives us our first look at camera samples from the Pixel 4. The gallery below holds all of the samples, but do keep in mind that since they’re from a video, the quality probably isn’t as good as what we’d see from the images if they were natively uploaded.
Some shots show off the zoom from the Pixel 4 camera while other show improvements to Night Sight compared to the Pixel 3 XL, as well as slight improvements with the selfie camera and Portrait mode.
Alongside the camera samples, this video also helps us identify exactly which camera sensors the Pixel 4 XL will be using. Specifically, there’s mention of a Sony IMX481 for telephoto, a Sony IMX363 for standard shots, and a Sony IMX520 for the front-facing camera. This further confirms our findings of a 16MP telephoto camera, but also a 12.2MP primary camera and 8MP front-facing shooter. Notably, the standard sensor is unchanged from the Pixel 3.
An OVM7251 IR sensor is also detailed for the Face Unlock system.
More on Google Pixel 4:
- Pixel 4 bears all in 4K hands-on: new Camera app, ‘Screen attention’ feature, more [Video]
- Pixel 4 leak reveals some Face Unlock details, corroborates 90 Hz display
- Pixel 4’s ‘Motion Sense’ settings, features shown off in latest leak w/ more pics
FTC: We use income earning auto affiliate links. More.


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The duodenum is the first portion of the small intestine that follows the stomach. Duodenal atresia or stenosis occurs when the intestine does not develop normally and leads to a blockage in the continuity of the intestine. The incidence of duodenal atresia or stenosis in infants occurs in 1 in 6,000 births and is seen more frequently in infants with Down's syndrome or Trisomy 21.
Most cases of duodenal atresia are diagnosed on prenatal ultrasound which reveals polyhydramnios (extra fluid in the amniotic sac) and a dilated fluid filled stomach. At birth, infants may have vomiting with inability to feed.
Duodenal atresia or stenosis is treated surgically. A new connection between the upper duodenum and distal duodenum must be created to bypass the blockage. The operation may be performed either through an upper abdominal transverse incision, by minimally invasive surgery, or laparoscopy using small incisions which become barely visible with age. Other advantages of minimally invasive procedures in infants include less pain, less scarring, shorter hospital stays, and fewer problems with scar tissue leading to intestinal blockages in the future compared to open abdominal surgery.
Children's National offers both treatment options and assess with families to determine the best care plan for each individual patient.
"The thing I like most about Children's National is that they don't just take great care of the sick children, but they also take great care of the whole family."
Our fetal medicine team provides specialized, expert care for babies during pregnancy, delivery, and the postnatal period.
Invest in future cures for some of life's most devastating diseases
Run or walk with us on October 3rd and help local kids!

domain: biology


text:
If you are looking for a checklist about setting up a company in Brazil, click here.
Brazilian corporate law is based on partnership concepts: companies are called “sociedades” (“partnerships”). Operating a company in Brazil is more compliance-intensive than most modern jurisdictions, so careful consideration should be given whether to set up a company in Brazil. The type of legal entity to be adopted is also very important, with the main types being limited liability partnerships (sociedades limitadas) and corporations (sociedades anônimas). Other structures may be suitable for specific cases.
Should you set up a company in Brazil?
While from a tax point of view registering a company can be advantageous in many instances, setting up a company in Brazil can be costly, especially on an ongoing basis.
Seeking advice on tax and customs regulations prior to the decision to incorporate a company is made is especially important where goods are to be imported and where services and intellectual property rights are to be supplied from abroad, as these are generally heavily taxed (see further under Taxation). Depending on the chosen business model, setting up a company will add little other than costs.
Take a look at this article for a checklist addressing the key issues relating to setting up a company in Brazil.
Types of legal entities
(i) Limited liability partnership (sociedade limitada)
The most common legal entity in Brazil is a limited liability partnership (sociedade limitada). The limitada has some elements of general partnerships, but it operates as a company for tax purposes. It is an entity somewhat akin to an English limited liability partnership and a Delaware limited liability company. Limitadas are primarily governed by the Civil Code.
The “partners” (shareholders or “sócios”) of a limitada hold shares (quotas) in the entity. The shareholders’ personal liability is limited to the amount of unpaid capital. However, this “limited liability” has traditionally been less limited than that afforded to shareholders in common law companies: partners (even those who are not directors or officers) could still be held personally liable for some breaches by the limitada – including for employment, environmental, consumer protection, competition and, sometimes, tax-related obligations.
Since the Economic Freedom Law came into force this has been changing, with shareholders being provided with greater protection. As the Economic Freedom Law has not been in force for long, it is unclear how courts will interpret the protections afforded to shareholders by that Law.
A limitada can have one or more shareholders. Limitadas do not require Brazilian individuals or companies to hold any equity – shareholders may be one or more foreign individuals or entities (or a mixture of the two). However, all foreign partners must appoint a Brazilian resident to hold a power of attorney. Among other formalities, the power of attorney must:
- be for an indefinite period;
- set out the attorney’s tax file number (CPF); and
- grant to the attorney at least the power to be served with legal proceedings on the grantor’s behalf and the power to manage the assets and rights of the legal entity in Brazil and to represent it before Brazil’s Federal Revenue Department.
Non-residents also need to grant the attorney the power to represent them before financial institutions, the Central Bank and tax authorities due to the various filings required to be made.
Limitadas only need one director (administrador) but can have more. Directors no longer need to be permanent residents of Brazil and do not need to be shareholders of the entity.
(ii) Corporation (sociedade anônima)
Sociedades anônimas, or “SAs”, are Brazil’s equivalent to English companies and US corporations. The capital of an SA is divided by shares. SAs tend to offer greater protection to shareholders than limitadas. They are mainly governed by the Corporations Law.
SAs, even if privately held, have more prescriptive rules than limitadas. Also, SAs often have an executive board and a non-executive board as well an audit committee. As with the case of limitadas, non-residents (foreign or Brazilian citizens) can be appointed as executive directors of corporations. Like limitadas, SAs only require one director.
Non-executive boards of SAs are responsible for approving the major decisions of the executive directors as well as overseeing the company’s business. They do not, however, control the company’s day-to-day operations. Non-executive board members also do not need to be Brazilian or reside permanently in Brazil.
Only SAs may be publicly held. When they do, they are subject to the supervision of the Brazilian Securities Exchange Commission (Commissão de Valores Mobiliários , “CVM”). SAs may also have their shares exchanged in the over-the-counter market or listed on the Brazilian Stock Exchange (the “B3”). The B3 is a very sophisticated stock exchange, operating much in the same way as the large stock exchanges in developed countries.
(iii) Partnerships in participation (sociedade em conta de participação)
Partnerships in participation are similar to limited partnerships as they are known in most common law jurisdictions. Partnerships in participation are governed by the Civil Code.
A partnership in participation is not regarded as an independent legal entity for corporate law purposes (only for tax purposes). In partnerships in participation there is at least one ostensible partner (sócio ostensivo) and one participating partner (sócio participante). Unless the partnership agreement provides otherwise, only the ostensible partner is liable for the partnership’s obligations.
The profits from the partnership are shared with the participating partners. The partnership assets are treated as being held in a special account and they will be divided among the partners in accordance with the partnership agreement.
There are no formalities for forming a limited partnership in participation. Unfortunately, due to its nature as a non-personified partnership the Brazilian Central Bank does not accept that foreign legal entities be partners in limited partnerships. However, foreign legal entities can, for instance, incorporate an a limitada or an SA in Brazil and use that entity as a vehicle to act as the limited partner in a Brazilian limited partnership.
There are several other types of business structures available in Brazil. These should be analysed on a case-by-case basis. These include, for instance, structuring joint venture arrangements via consortia (generally used for public procurement processes) which are registered with the Companies Registries (Boards of Trade) and are not taxed as legal entities.

domain: law


Your Dream Job awaits in McHenry County!
The McHenry County Division of Transportation seeks a qualified candidate for their next Transportation Planning Manager. The ideal candidate for this role oversees all transportation planning activities for the McHenry County Division of Transportation.
Salary Range: $73,540 – $88,247 +/-
Monday – Friday 8am – 4:30pm with the potential for partial remote work
Lead the annual development of the Department’s Five-Year Transportation Program and the McHenry County Moves 2050 Long Range Transportation Plan.
Represent McHenry County at regional coordinating bodies (CMAP, RTA, and IDOT).
Develop, interpret, coordinate, implement and monitor transit and transportation policy and planning work consistent with all approved McHenry County plans, including completion of written documents and reports; track, develop and analyze various local, regional, state, and federal funding programs and project details, including preparation of reports.
Oversee the Planning Liaison Program for the McHenry County Council of Mayors (MCCOM) and direct all planning assistance required for CMAP and the MCCOM.
Prepare plans and projections of future transit, transportation, economic or demographic conditions and trends; investigate and review federal and state legislation and regulations for potential impact on transit/transportation plans and programs.
Lead all public involvement efforts for Division of Transportation projects.
Performs other duties as assigned.
Minimum Qualifications Required:
Education and Experience
Master’s degree in urban planning, civil engineering, or a related field and five (5) years of progressively responsible related professional planning experience; OR
Bachelor’s degree in urban planning, civil engineering, or a related field and seven (7) years of progressively responsible related planning experience.
Candidate should possess excellent analytical, communication, public speaking, and organizational skills.
Knowledge of federal, state, and local government and transportation-related services and projects.
Use of computer hardware and software programs including word processing, document publishing, spreadsheets (Excel), databases, geographic information systems (GIS), email, presentation programs (PowerPoint), rendering programs (Sketch up, Lumion Pro, etc.), social media, video editing software, etc.
American Institute of Certified Planners (AICP) certification desired, or ability to obtain within 2 years.
Valid State of Illinois driver’s license.
Benefits at a glance
We offer an exceptional benefits package-
3 Medical plans
2 Dental plans
2 Vision plans
Accident and Life insurance
Free insurance for single coverage under the H.S.A. PPO plan
$250 insurance waiver paid quarterly to equal $1000
Health Savings and Flexible Spending Accounts
Employer contribution into the H.S.A
2 Retirement plans; IMRF and Nationwide Retirement Solutions (Deferred Comp and ROTH457)
Far-Reaching Wellness Program
Tuition Reimbursement and Student Loan Repayment programs
Paid vacation, sick and personal days
13 paid Holidays
McHenry County is an equal opportunity employer. No applicant for employment shall be discriminated against because of age, race, color, religion, sex, marital status, national origin, Veteran status or disability.
To apply for this job please visit www.mchenrycountyil.gov.


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I hope you had a great week!
Here are all the latest listings, sales, price adjustments in North Delta over the past week:
- Click here for all the newest North Delta listings in the past week.
- Click here for all the sold properties in North Delta in the past week.
- Click here for all the priced adjusted properties in North Delta this past week.
Have a wonderful weekend!

domain: geography


text:
And along with the film’s romance and drama come some stunning late-1920s fashions.
Anna Robbins, who has designed the cast’s costumes since the television series, returned for “A New Era” to dress the Dowager Countess, Lady Mary, Tom Branson, and other familiar favorites in a range of elaborate period clothing.
We first met the residents of “Downton Abbey” in 1912, with the characters’ wardrobes evolving as the years moved on to the ’20s.
Now, with the second flick taking place at the dawn of the ’30s, some bigger style changes are in store for the Crawleys and their staff.
From a Vogue-inspired wedding gown to the first-ever “Downton” swimsuit moment, we’re sharing a few of our favorite behind-the-scenes fashion facts from the set, below.

domain: entertainment


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Exploreo will offset your calculated CO2e at no cost.
How is the carbon footprint calculated?
About this tour
Uncover China's essence on this 13 day tour, starting in Beijing with visits to the Forbidden City, and historic Hutongs. Continue to Luoyang for Longmen's Caves and the Shaolin Kung Fu Temple, then explore Xi'an's Terracotta Warriors. Conclude in Shanghai after flying to Guilin and discovering the picturesque landscapes of Yangshuo and Longsheng. Experience China's natural beauty, culture, and modernity in one unforgettable journey.


JAMMU, Feb 20: Ek Sath Rang Mandal (ESRM) today presented Vijay Malla’s nukkad “Azadi Adhuri Hai” under its Monday Theatre series at a slum near Paloura link road, Janipur.
The nukkad opens with a young man who appears in the scene. “In our country even after 70 years of independence every citizen does not enjoy impendence,” the young man, who has come to city with his problems, questions. He says that people particularly those living in remote and far flung areas should not be deprived of their rights.
He adds that nobody should seize their rights of water, forest and earth (zameen). He questions the system that why agriculture land of the people is taken away on the name of development. What kind of development is this which will make a common man handicap?
The young man says that after independence rich people groomed their children with education from English medium schools with western culture which destroyed our culture in every respect and now the children even cannot speak their mother tongue.
“On one hand people are adopting latest technology of Google, Twitter and Face book (social media) and on the other hand we are still adopting traditional system for solving over problems”, he says, adding, he is proud to say that in all villages and remote areas people have love and respect for their traditions culture and mother tongue.
Actors who performed were Raju Mad, Anuroop Pathania, Mohit, Prabel Sharma, Vicky and Vijay Malla. The play was written and directed by Vijay Malla and assisted by Anuroop Pathania.


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The report which shows a terrible flaw in Cameron’s refugee policy
David Cameron's refugee programme is simple and, on a superficial level, persuasive. It's the 'head and heart' plan. On the head side, he won't take many Syrian refugees coming on the boats to Europe or participate in any EU quota system. But on the heart side, he'll direct high levels of funding to regional humanitarian programmes and accept 20,000 refugees to the UK through a UNHCR system operating from refugee camps in the Middle East.
The problem is that neither of these policies – helping in the region and relocating especially vulnerable refugees at home – are being properly delivered. It's a classic example of simplistic political messaging crashing into complex political realities.
Today's international development select committee report lays it out in black and white. Behind the rhetoric and the bluster, it offers a very good account of why Cameron's promises on refugees are running into problems.
Helping integrate at home
The refugee relocation programme to the UK is very slow, comprising just 20,000 over the next five years. Ministers insist this lengthy timetable is needed to properly integrate them into communities. As minister for Syrian refugees Richard Harrington said:
"I know it is in everybody's interests, not least the people from Syria, to make sure they are brought here in a proper, well-ordered and decent way."
So eyebrows have been raised now that the government has substantially cut funding for English for Speakers of Other Languages (ESOL) courses, despite massive demand. This is foolish. Language integrates refugees into the community and prepares them to get work, which will eventually reduce their cost to the taxpayer. But the short-termism of government spending cuts takes precedence over long-term strategy.
Helping the most vulnerable
One of Cameron's arguments against an EU quota system is that it helps those who can make it to Europe rather than those most in need of help. It's actually not a bad point. Those able to pay to get here are typically the middle classes. Instead, the prime minister insists we can help the most vulnerable refugees in the region by working with the UNHCR on the ground and pinpointing the most vulnerable. The trouble is: that doesn't seem to be happening.
Save the Children found that many refugees are confused and distrustful of the registration process required to be part of the UNHCR programme. In Lebanon alone, there are thought to be 200,000 to 400,000 unregistered Syrian refugees.
LGBT refugees are particularly badly affected. Homophobia is rife, both among the refugees themselves and in their regional host countries. There's evidence LGBT refugees are being ostracised from sources of support. Christians are understood to often avoid the camps because they are run by Sunnis, whose military groups typically controlled camps in the past. Disabled people are also badly affected. Twenty per cent of refugees in Lebanon have some sort of impairment, but just 1.4% of the UNHCR-registered refugees are recorded as having a disability. Something is clearly going wrong there. As Aleema Shivji of Handicap International said:
"They are hidden, they are not visible and they are not picked up in registration systems."
Helping in Syria
But even centring your refugee programme on camps is a problem, because most refugees aren't in them. The worst affected and most vulnerable are still in Syria, where they are at massive risk of being killed in fighting or falling victim to one of the other myriad of disasters which has struck the country: water infrastructure in a state of collapse, a decimated health system, an economy which has contracted by 40%. Best estimates are that 13.5 million people in Syrian need humanitarian assistance.
About 50% of British government aid is being spent in Syria, at considerable risk to those delivering it, but the truth is that the country is largely inaccessible. As Matthew Wyatt, Department for International Development (DfID) deputy director for the Middle East told MPs:
"The problem in reaching the most vulnerable is when they are in those areas where there is either active conflict or where parties to the conflict, particularly Isil, just make it impossible to work. That is the biggest constraint that we are facing."
Now that the UK is participating in airstrikes in Syria, those access challenges are obviously heightened. As the parliamentary report says:
"The recent escalation of military efforts will have an impact on conditions faced by civilians in Syria, and may well make it more difficult for DfID and other agencies to deliver humanitarian aid."
Helping outside of Syria
Outside of Syria, the problems are different but nearly as severe. Lebanon has simply banned the UNHCR from registering refugees in its territory, so the programme is comatose there. Refugees accessing the country in the last six months have been unable to access international assistance and protection. We can't identify them and we can't help them.
But in other countries, where registration is allowed, most refugees are not in the camps where it would take place. Only ten per cent of Syrian refugees are thought to live in the camps. Many just can't afford it – Lebanon is charging as much as $200 (£136) per month for rent, which is on average 90% of the refugee's income. UNHCR assistance to get to the camps works well in some areas and terribly in others. And there are threats in the camp too – from water shortages to cholera and polio.
DfID appears to be on the ball here. It is directing 75% of overall humanitarian assistance towards non-camp areas outside of Syria. But the same cannot be said for many of the agencies receiving UK financial support, like the UNHCR.
Show me the money
Despite its cold approach to taking in refugees, the UK has thrown cash at the Syrian problem at source – totalling £1.1 billion as things stand. But other donors, particularly major European countries, have failed to follow suit. Basic humanitarian assistance is failing and refugees are therefore more likely to make the dangerous journey across the Mediterranean that the funding is designed to discourage.
Refugees who make it to neighbouring countries are often just sentencing themselves to impoverishment. They can rarely work and the aid is limited, so they are being asked to pick from three unappealing options: work illegally, send their children to work illegally, or scratch out a living with whatever meagre sustenance they can find.
Of course, many take the first option. But that doesn't just put them in danger, it threatens to destabilise the host country. With so many refugees working for meagre wages illegally, the fragile local economies of these neighbouring states are fraying at the edges. What started amicably enough is quickly descending into severe tension with a strong chance of violence.
The solution is not necessarily to demand that these host countries open their labour market to refugees. Many experts believe that would worsen the chaos and probably heighten the resentment. But western countries could create refugee employment programmes in neighbouring states. There are options in the Jordanian economy in transport, alternative energy sources and recycling, for instance, which could even attract private sector involvement. The government appears to be considering exactly that, but any such solution is still at least a year away. For the time being, and possibly indefinitely, we are subjecting these people to a choice between poverty or illegality.
For now, Cameron's 'head and heart' plan seems highly unsatisfactory. We are not equipping refugees for integration or work here. We are not singling out the most vulnerable over there. And we are forcing those who do reach safety to make terrible choices in order to survive.

domain: sociology


text:
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domain: design


text:
While responding to a distress call on Saturday, the Police Anti Crime Team attached to Agbado Division of Ogun State, engaged a 12-man robbery gang in a gun battle at Oluke,Okugbolu and Onireke areas of Agbado at about 6.20 pm.
After the duel,five of the robbers died while one of them was arrested with their weapons. Others fled with bullet wounds.
Street Journal gathered that the armed robbers had launched an attack on the people of these areas when a call was made to the Divisional Police Officer in Agbado Division who then put a call to alert his men on routine patrol to comb the entire area.
In the process of combing the area,members of the Vigilante Service of Ogun State in the area rendered assistance to the police team.
The spokesman of the Ogun State Command of the Nigeria Police Force, DSP Muyiwa Adejobi as Oladeide Rasheed. The name suspect, a resident of Ijoko Otta hails from Abeokuta and he works as a motor boy.
Adejobi described him as a “strong member of the robbery gang” He also stated that Rasheed will help the police to get the fleeing members of the gang.
A statement signed by Adejobi reads: “According to police preliminary investigation,it was gathered that the robbers went to the remote areas on motorcycles with arms and that they had been terrorizing the people of the area for a long time; particularly snatching cars and bikes from people in the area and other parts of Agbado community in Ifo Local Government of Ogun State before meeting their Waterloo.
Items recovered from the robbers include 5 locally made guns,30 live cartridges,12 expended cartridges,3 laptops, jewelries, a cash sum of #85,000,5 unregistered motorcycles, cutlasses and assorted charms.
The Commissioner of Police Ogun State CP Ikemefuna Okoye has commended the good people of the area who alerted the police on time, and the police operatives with the Vigilante Men who carried out the successful operation. CP Okoye also restated his readiness always to tackle crimes and social vices in Ogun State to provide adequate security for all and sundry in the state and Nigeria at large”.

domain: news


Robel Okubay Almazey Ethiopian Music Mp3
Robel Okubay Almazey Mp3 Download. Robel Okubay, the Eritrean singer is giving us something to vibe to all week long as he releases his new song titled Almazey.
Listen online and enjoy The Lyrics, Video of your favorite Ethiopian Music
Stream, Listen and Download Below.


text:
Almost Transparent Blue
improgjazzrock from Vancouver BC
Broken Up - Confirmed: Apr. 23, 2014 (Archived)
Contact DetailsKelly, Skye or Masa
Almost Transparent Blue was formed in 1999 in Vancouver. Masa J. Anzai (alto saxophone, electronics), Kelly Churko (guitar, electronics), and Skye Brooks (drums) had all played together in various Vancouver-based groups for several years but wanted to play more challenging repertoire that combined group improvisation with the freedom to express individual compositional influences in a unified setting. The group takes its name from the award-winning novel by Murakami Ryu about the alternative lifestyles of some Japanese youths. The music is surely the companion soundtrack to the book - full of heavy, rhythmic syncopations and beautiful melodic soundscapes wrapped in a hallucinogenic blanket of electronic effects and exotic percussion.
No audio samples have been linked to this profile.
Status: Broken Up
- Last confirmed Apr. 23, 2014

domain: artistic


text:
BACKGROUND: Robotic therapy can improve upper limb function in hemiparesis. Excitatory transcranial direct current stimulation (tDCS) can prime brain motor circuits before therapy.
OBJECTIVE: We tested safety and efficacy of tDCS plus robotic therapy in an adult with unilateral spastic cerebral palsy (USCP).
METHODS: In each of 36 sessions, anodal tDCS (2 mA, 20 min) was applied over the motor map of the affected hand. Immediately after tDCS, the participant completed robotic therapy, using the shoulder, elbow, and wrist (MIT Manus). The participant sat in a padded chair with affected arm abducted, forearm supported, and hand grasping the robot handle. The participant controlled the robot arm with his affected arm to move a cursor from the center of a circle to each of eight targets (960 movements). Motor function was tested before, after, and six months after therapy with the Wolf Motor Function Test (WMFT) and Fugl-Meyer (FM).
RESULTS: Reaching accuracy on the robot task improved significantly after therapy. The WMFT and FM improved clinically meaningful amounts after therapy. The motor map of the affected hand expanded after therapy. Improvements were maintained six months after therapy.
CONCLUSIONS: Combined tDCS and robotics safely improved upper limb function in an adult with USCP.
Cerebral palsy (CP) is the most common pediatric-onset neurological disorder affecting movement. CP is caused by a nonprogressive brain injury or stroke before birth or during early life. People with unilateral spastic cerebral palsy (USCP), the most common subtype, have movement impairments primarily on one side of the body. Importantly, motor deficits can have profound, permanent consequences on quality of life and independence, particularly in adults. Few therapies exist for upper limb rehabilitation in adults with USCP. The goal of this pilot study was to determine feasibility and efficacy of combined upper limb robotic therapy and excitatory transcranial direct current stimulation (tDCS) for adults with USCP. Here we preset a case study of one participant. We examined changes in robotic task performance, clinical motor outcomes, and motor map neurophysiology after 36 sessions of tDCS plus upper limb robotic therapy.
Motor rehabilitation that follows the basic principles of motor learning appears to be optimal for recovery (Kitago et al., 2013). This requires repeated practice sessions that are sufficiently distributed to allow memory consolidation (Censor, 2013), resulting in a higher state of functional performance. Robotic therapy is an effective method to facilitate this in chronic hemiparesis (Turner et al., 2013). Robotic therapy devices can sense the amount of force a patient produces in a functional motor task and adjust the amount of assistance accordingly, such that an independently non-attainable functional goal is achieved (Aarts et al., 2010). There is mounting evidence that robotic therapy leads to a sustained positive effect on movement function in chronic stroke (Norouzi-Gheidari et al., 2012). Movements trained in robotic therapy translate to functional outcome measures in patients with hemiparesis (Bosecker et al., 2010).
TDCS modulates the excitability of a targeted brain region non-invasively by altering neuronal membrane potentials (Paulus, 2004). TDCS can prime brain motor circuits before robotic therapy. This innovative combination of two emerging technologies improves upper limb function in adult stroke survivors (Giacobbe et al., 2013; Liew et al., 2014). Since USCP has a similar clinical presentation as hemiparetic stroke, we hypothesized that this therapy can also improve upper limb motor skill in adults with USCP.
A key difference between adult-onset stroke and pediatric-onset USCP is the organization of the motor system. In adult stroke, the contralateral wiring of the motor system has been established, but pediatric USCP disrupts motor system development. In as many as 30% of people with USCP, the contralesional hemisphere controls movement of both hands, controlling the impaired hand via ipsilateral connections (Staudt, 2007; Staudt et al., 2004). We have shown these ipsilateral connections to be adaptive and plastic (Friel et al., 2016; Smorenburg et al., 2016). Since the wiring of the motor system is variable among people with USCP, in this study we used single-pulse transcranial magnetic stimulation (TMS) to first identify the locus of control of the impaired hand, then we targeted tDCS to stimulate this location. This personalized, targeted approach is hypothesized to optimize recovery for an individual.
The study participant was a 37 year old male who acquired USCP at age 18 months due to complications from a motor vehicle accident. The left side of his body is impaired. This study was approved by the Burke Rehabilitation Hospital Institutional Review Board. The participant provided written informed consent for all study procedures.
We conducted a battery of assessments: 1) Clinical outcome measures –the Wolf Motor Function Test, the Upper Limb Fugl-Meyer, and grip strength of the affected hand; 2) kinematic movement assessments on the robot; and 3) brain motor mapping with single-pulse transcranial magnetic stimulation (TMS). Assessments are described below.
2.1Clinical outcome measures
Clinical outcome measures were taken before the first day of the intervention, immediately after the final day of the intervention, and six months later. The Fugl-Meyer is a validated and reliable evaluation instrument used for measuring performance-based impairment in stroke patients (Dong et al., 2013; Gladstone et al., 2002; Malouin et al., 1994). The Wolf Motor Function Test assesses upper extremity function by asking the participant to complete 15 motor-based tasks and 2 strength-based tasks (Morris et al., 2001). Grip strength was assessed using a Jamar hydraulic hand dynamometer (Lafayette Instrument, Lafayette, IN). The average of three trials was computed.
2.2Upper limb robotic assessments and therapy
We used In Motion Technology (IMT; Massachusetts Institute of Technology) planar and wrist robots in this study (Volpe et al., 2009). For both assessments and training, the participant sat in a foam-padded chair facing the robot and a video screen. The impaired arm was abducted, forearm supported, and hand lightly grasping the robot handle, and velcro straps lightly held the forearm and fingers secure. A cursor on the video screen displayed the targets and tracked the movement of the patient’s upper limb.
The participant performed unassisted movements toward targets presented in 8 positions equally spaced around a 14-cm radius circle (“star reaches”) or around an ellipse with major axis corresponding to wrist flexion/extension of 22.5 degrees and minor axis corresponding to radial/ulnar deviation of 12.5 degrees (“circle drawing”) (Krebs et al., 1999). Targets were presented in clockwise order similar to a robot-assisted therapy session (see below). A total of 80 movements of star reaches (done on both the planar and wrist robots) and 20 circle drawings (done only on the planar robot) were performed in each evaluation session.
Robotic evaluations (star reaches plus circle drawing) were done on each arm before the first day of the intervention, midway through the intervention, immediately after the final day of the intervention, and six months later. Additional circle drawing evaluations were done using the impaired arm at weeks 3, 5, and 10 of therapy. These were done to track transfer of skill from the trained task (star reaches) to an untrained task (circle drawing).
The participant received a total of 36 sessions comprising 1 hour of interactive robotic training, using the shoulder-elbow (planar) MIT Manus robot (30 mins), followed by the wrist robot (30 mins). The interactive robot features have been discussed at length elsewhere (Krebs et al., 1999) and involve visuomotor tasks, moving the robotic manipulandum according to targets on a computer screen mounted at eye level. A key feature of MIT robots is the low near isotropic inertia and reduced friction in the robot arm so that, when appropriate, it can “get out of the way.” The force required to move the robotic arm is minimal, comparable to moving unrestricted, and if a patient cannot move the robot arm, it will guide the limb to provide an adaptive sensorimotor experience.
The participant alternated using the planar and wrist robots at each therapy session. Thus, the participant completed 18 training session on the planar robot and 18 sessions on the wrist robot. At the beginning of each session, the participant completed five rounds of target reaching without the assistance of the robot, followed by three blocks of 320 trials in which the robot assisted movement as needed. After each block, the participant completed five rounds of target reaching without the assistance of the robot. Thus, each session consisted of 64 unassisted reaches and 960 assisted reaches.
2.5Robotic kinematic measures
We used a set of MATLAB programs (The Mathworks Inc., Waltham, MA) to extract measures of reach accuracy and movement smoothness (ratio of mean speed to peak speed) for each session. For star reaches, we measured the distance between the endpoint of the participant’s reach and the location of the intended target. We also measured smoothness of reaching toward each target. We calculated overall reach error and smoothness, as well as reach error and smoothness in each reach direction.
For circle drawing, we measured circularity of drawn ellipses, the ratio of the length of the major axis to minor axis. For a perfectly round circle, circularity would equal 1.
2.6TMS motor mapping
TMS motor mapping was done before the first day of the intervention and immediately after the final day of the intervention. Single-pulse TMS was conducted with a MagStim 200 and a 70 mm Figure-of-Eight stimulating coil (MagStim, Dyfed, United Kingdom). During TMS, muscle activity was recorded using surface electromyography (EMG) electrodes. A multi-channel recording system (NeuroConn, Germany) simultaneously recorded EMG activity bilaterally in the first dorsal interosseous (FDI) and extensor carpi radialis (ECR) muscles. These muscles were selected to yield a motor map with proximal and distal musculature.
The TMS device triggered the recording system, such that EMG activity was recorded at 4000 Hz 400 ms before and 400 ms after each TMS pulse is delivered. The position of each stimulation point over the scalp was recorded in xyz coordinates and overlaid on a standard MRI using neuronavigation software (Brainsight, Rogue Resolutions, Montreal, Canada).
To ensure all representations of the hand were found, stimulation began in a medial portion of the affected (right side) primary motor cortex (M1). The coil was moved laterally to search for a motor evoked potential (MEP) in the affected (left) FDI. In this participant, there was no MEP in the affected M1, which is common in people with USCP. We then stimulated the contralesional (left) M1, and found MEPs of both the left and right FDIs. We determined the resting motor threshold (rMT), which is the minimum stimulator output required to evoke an MEP over 50 μV in the FDI muscle in 6 of 10 trials in relaxed muscles (Kleim et al., 2007).
We superimposed a circular grid of 1 cm-spaced sites, radius 10 cm on the MRI (in Brainsight). The grid was centered around the point of strongest activation of the affected FDI (“hotspot”). The coil was used to deliver 2-3 TMS pulses at an intensity of 110% rMT at each grid point until MEPs were no longer found.
We processed MEP data by exporting EMG to MATLAB for filtering and processing in a custom-written analysis program. The MEP for each muscle at each stimulation site was defined as the peak-to-peak amplitude of the EMG response. Trials were excluded if the participant was not relaxed before the TMS pulse. MEPs will be averaged for stimuli delivered at the same site. If the average MEP is greater than 50 μV for a muscle at a site, that site was categorized as controlling that muscle. Total area enclosing digit and wrist sites for each hand was measured.
2.7Colocalization of tDCS and motor map of affected hand
Before each therapy session, the participant received 20 min of 2 mA excitatory (anodal) tDCS (Soterix 1×1 Limited Total Energy device, New York, NY). We placed the excitatory sponge over the location of the motor map of the impaired hand, which was located with single-pulse TMS. The anodal sponge was placed on the contralateral forehead. Both sponges were moistened with saline and held in place with a headband. Before and after stimulation, we asked the participants to rate the presence of any symptoms related to tDCS (headache, tingling, itching).
For clinical outcomes and TMS measures, statistical differences could not be evaluated in this single-participant case study. For robotic kinematics, since many trials were done over the 36 days of training and four days of assessments, it was possible to examine statistical differences. We used repeated measures ANOVA with Bonferroni-corrected post-hoc comparisons to evaluate differences in kinematics over the intervention.
In this pilot study, we found that combined tDCS and robotic upper limb therapy can safely improve upper limb function in adult USCP.
3.1Improvements in clinical outcomes
Clinical outcomes are summarized in Table 1. After the intervention, all measures improved. The Wolf improved 7.0 points, which is a clinically meaningful change, while the Fugl-Meyer improvements of 3.0 pointes neared a clinically meaningful change (Clinically meaningful change: Fugl-Meyer 4.25 points (Page et al., 2012), Wolf 4.36 points (Lin et al., 2009)). Improvements were maintained six months after intervention.
|Outcome Measures||Before Therapy||After Therapy||Six Months After Therapy|
|Wolf Motor Function Test||45||52||52|
|Fugl-Meyer Upper Limb||10||13||13|
|Grip Strength (kg)||9.5||10.4||10.8|
3.2Improvements in kinematic measures
We examined movement smoothness and reaching error of robotic assessments and training, since these outcomes have been most responsive to change and correlated with clinical outcomes (Edwards et al., 2012). Figure 1 shows representative example movement trials for the planar and wrist robot star reaches and planar robot circle drawing.
Over the course of the intervention, there was no significant change in movement smoothness on the planar (Fig. 2A) or wrist (Fig. 2B) robot. In contrast, reaching accuracy on the planar (Fig. 2C) and wrist (Fig. 2D) robots improved significantly. During the first half of the intervention (pre to mid), there was a statistically significant decrease in reach error on the planar robot (F(3,126) = 34.6, p < 0.0001) and on the wrist robot (F(3,126) = 55.0, p < 0.0001). Beyond the midpoint of the intervention, there was no further improvement in reach error (p > 0.05).
We noted that reach error may be different depending on the direction of reach. Therefore, we examined reach error in each of the eight task directions (Figs. 3 and 4). For the planar robotic task (Fig. 3), reach error was significantly elevated in the top and right directions (F(3,16) > 5.0, p < 0.0001), indicating that the participant had most difficulty extending his left (impaired) arm. For the wrist robotic task (Fig. 4), reach error was similar in all directions during the first half of the intervention (pre to mid, F(3,16) > 5.0, p < 0.0001).
3.3Performance on an untrained task
Since the star reaching task was performed 1024 times per session (960 assisted trials plus 64 unassisted trials), we examined performance on circle drawing. Circle drawing was performed only 20 times every two weeks. Figure 5 shows improvements in circularity of the drawn ellipses over the intervention. Circularity improved over the first half of the intervention (F(3,16) > 4.0, p < 0.0001). Beyond the midpoint of the intervention, there was no further improvement in circularity (p > 0.05).
3.4Changes in the motor map of the impaired hand
Using single-pulse TMS, we examined the areal size and excitability (MEP size) of the motor map of the impaired hand. There was an increase in the area of the impaired FDI and ECR muscle motor map after therapy (Table 2 and Fig. 6) and six months later.
|TMS Measures||Before Therapy||After Therapy||Six Months After Therapy|
|FDI map size (cm2)||27||34||25|
|FDI MEP amplitude (μV) (SD)||95.6 (53.4)||120.9 (64.5)||191.8 (110.6)|
|ECR map size (cm2)||19||25||31|
|ECR MEP amplitude (μV) (SD)||211.6 (54.8)||148.0 (66.3)||241.7 (48.7)|
There were no adverse events in this study. Mild skin tingling and itching were reported after tDCS, and mild muscle soreness was reported after some robotic therapy sessions, particularly wrist robot therapy.
In this pilot study, we aimed to determine safety and efficacy of combined tDCS and upper limb robotic therapy in an adult with USCP. This pilot study will inform future similar studies. We found that our innovative combination of excitatory tDCS and robotics was safe and produced long-lasting, clinically meaningful improvements in upper limb function.
4.1Efficacy of combined tDCS and robotic therapy
The combination of tDCS and upper limb robotic therapy has been shown to improve motor outcomes in individuals with stroke (Yozbatiran et al., 2016) and spinal cord injury (Raithatha et al., 2016). Our findings indicate that this combination of technologies is also a feasible, effective intervention for adults with USCP. More work is needed to parse out the contributions of the tDCS and the robotic therapy to the recovery process, such that therapy can be provided in an optimal manner for each individual.
4.2Dosing of therapy
We adopted our protocol from our work in stroke rehabilitation. We do not know if this dose and duration of therapy is ideal for people with USCP. Our findings in this participant indicate that he reached maximum accuracy on the robotic measures by the midpoint of the intervention period. Thus, for this individual, six weeks of therapy may have been sufficient to achieve optimal recovery. However, we do not know if the effects of therapy would have persisted for six months if the training period had been shorter. More work is needed to identify “stop signals” that indicate a participant has achieved their optimal improvements. The optimal dose is likely to vary among individuals, and a personalized approach is the ideal way to maximize each person’s recovery. Indeed, Straudi et al. demonstrated that the efficacy of tDCS and upper limb robot-assisted therapy depended on the type of stroke and length of time since stroke, with individuals with chronic subcortical stroke showing better recovery than individuals with acute cortical stroke (Straudi et al., 2016). It is plausible that a longer duration of therapy may have boosted the recovery of individuals with acute corticalstroke.
4.3Therapy drives cortical plasticity
Although this single case cannot be over-interpreted, our findings indicate that brain stimulation and skillful use of the impaired upper limb expands the motor map in adult CP. This finding is consistent with a robust body of literature that demonstrates expansions in cortical maps after skillful, repetitive use of the impaired limb (Friel et al., 2016; Jones et al., 1999; Liepert et al., 2000; Nudo, 2003; Sawaki et al., 2008).
4.4Individualized targeting of tDCS stimulation
Although the clinical symptoms of USCP and stroke are similar, there are some key differences between adult-onset stroke and pediatric-onset USCP that is important to understand when translating a successful stroke therapy to USCP. In adult-onset stroke, the motor system has already achieved its mature, crossed pattern. In adult stroke, the loss of a contralateral pathway and reliance on an ipsilateral motor pathway to control the paretic side is thought to be a marker of severity and poor prognosis (Takeuchi et al., 2012). However, in USCP, developmental injury derails normal motor development. As many as 30% of people with USCP control the paretic side via ipsilateral motor pathways from the less-affected motor cortex (Staudt, 2007; Staudt et al., 2004). We have shown that these ipsilateral pathways have the potential to be functional and adaptive (Friel et al., 2016; Smorenburg et al., 2016).
Different studies have adopted different montages for tDCS application. In adult stroke, damage to one hemisphere causes downregulation of activity in that hemisphere and an imbalance in intracortical inhibition between the two hemispheres (Takechi et al., 2014). One commonly-used neuromodulation strategy in stroke is to suppress activity in the contralesional hemisphere, to decrease the inhibition of the ipsilesional hemisphere by the contralesional hemisphere (Zimerman et al., 2012). However, as described above, in people with CP, developmental neuroplasticity often leads to reorganization of the motor system (Eyre et al., 2007). If the contralesional motor cortex controls movement of both upper limbs, suppression of activity in the contralesional hemisphere may not be of benefit. We propose a personalized approach: to target excitatory (anodal) tDCS to whichever hemisphere controls movement of the impaired upper limb. Importantly, in our pilot study, there was no decrement in skill of the less-impaired upper limb (data not shown), indicating that tDCS over the less-affected M1 did not interfere with motor control of the less-impaired upperlimb.
While our findings indicate that combined tDCS and robotic upper limb therapy was effective for improving motor function in an adult with CP, it is necessary to study a larger number of individuals. We posit that evaluating clinical outcomes, kinematic improvements, and neurophysiological effects of the intervention will poise us to best understand the factors that contribute to recovery, the optimal therapy schedule and dose, and the optimal brain stimulation parameters. There is an urgent need for more effective therapies for adults with CP, and we believe that combined tDCS and robotic therapy shows promise as a way to improve motor function and quality of life in adults with CP.
Conflict of interest
No authors have a conflict of interest with regards to this work.
Funded by R03 HD084971. We are grateful to the participant for his involvement in this study.
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domain: medical


text:
Time magazine’s cover story shows the U.S. Constitution and asks, “Does it still matter?” Reading this story, we kept waiting for Emmanuel Goldstein to show up for the Two Minutes of Hate. It was difficult to discern whether we were reading Time, or Orwells’ 1984.
It portrays the Constitution as an outmoded document that we should ignore to whatever extent is expedient to pursue someone’s vision of a better society: “We cannot let the Constitution become an obstacle to a future with a sensible health care system, a globalized economy, and evolving sense of civil and political rights.”
The story shows all sorts of poll questions that present a false choice, such as, “The 14th Amendment says that any person born in the U.S. automatically becomes a U.S. citizen… Should [it] be revised?” The Citizenship Clause says no such thing, because it adds that anyone “not subject to the jurisdiction” of the U.S. is not a citizen.
That’s why children of foreign ambassadors, prisoner soldiers and heads of state born here do not become citizens. The question is how broad that “jurisdiction” clause is. Could Congress exclude illegal aliens? It’s an active debate in legal circles, with no clear answer.
Instead, the questions should have included: “Are you more interested in the Constitution today that you were four years ago?” “Do you agree or disagree with candidates discussing the Constitution more in their campaign speeches this year?” “Are you now aware that the Constitution only vests the federal government with power of specific areas of life, leaving the states sovereign to decide all other issues?”
Or questions on enduring constitutional principles. “Do you agree with the Supreme Court’s 1803 pronouncement that any law contrary to the Constitution is null and void?” “Every government officer (including every judge) takes an oath to support and defend the Constitution. Should they apply its original meaning to current challenges?”
Does the Constitution still matter? Look at huge crowds of Americans cheering at rallies, whether it’s a spending protest or a pro-life rally. It matters to them, and they vote.
The story was so riddled with distortions that it obscured its message. For example, it says we must raise the debt ceiling because, “the idea that we can default on our debt is not only reckless; it’s probably unconstitutional.” It twists a provision from the 14th Amendment that has nothing to do with the debt ceiling.
The reality is, revenue government collects every month so vastly exceeds our debt payments that we could easily meet our monthly obligations. We would just have to cut discretionary spending on other programs. But it’s deceptive to suggest that not raising the ceiling automatically causes default, and it’s wrong to suggest it’s unconstitutional.
The most disappointing part of the article mischaracterizes the Obamacare legal fight. It says Obamacare’s individual mandate requiring you to buy health insurance is constitutional because government takes your money in taxes and requires you to buy car insurance.
The writer obliviously ignores that the Constitution expressly creates a federal government of enumerated powers. The feds can tax you because of the Taxing Clause of the Constitution (though even then only four types of taxes are legal—not the mandate). And states have authority to make you buy car insurance under state police power, but if the feds required it, such a law would be illegal because the feds have no police power.
Since there is no Healthcare Clause in the Constitution, the feds try cramming it in the Commerce Clause. That’s the whole fight: Whether Congress can control your personal decisions whenever Congress declares such decisions impact interstate commerce.
Every decision in your life has some tangential relationship to interstate commerce. Does that mean the Constitution allows the government to control your every decision? It makes a mockery of the concept of limited government.
The story concludes, “The Constitution serves the nation; the nation does not serve the Constitution.” The connotation is that we shouldn’t be too slavish in our fidelity to the Constitution.
Like the rest of this article, its conclusion misses the point. The Constitution serves the American people as an unbreakable constraint on those in power, dictating their duties and the limits on their authority. The Constitution serves We the People by requiring every government official to take an oath to obey its every word.
The picture art at the outset of Time’s story showed the Constitution cut in dozens of narrow vertical strips. Clearly it had been run through a paper shredder.
Evidently this is wishful thinking for some on the Far Left. The only problem is that it’s false. Interest in the Constitution is resurgent, and that renewed interest is the key to America’s renewal in our third century.
A rebellion against "tax & spend" at State level
It can be done
In what we should all hope happens at the national level, Minnesota Shuts Down after failing to pass a balanced budget by the June 30 deadline.
Minnesota's state government began a broad shutdown on Friday going into the July 4th holiday, after Democratic Governor Mark Dayton and Republican legislative leaders failed to reach a budget deal.
Parts of the government had already begun to shut down on Thursday ahead of the midnight budget deadline, including some websites and dozens of highway rest stops on one of the biggest travel days of the year.
The budget impasse means that some 23,000 of the roughly 36,000 Minnesota state employees will be furloughed, and state parks and campgrounds will be closed ahead of what is usually their busiest stretch of the year for the Independence Day holiday.
All but the most critical state functions will be suspended while the spending impasse continues into the new fiscal two-year period that starts on Friday, which would make the 2011 shutdown much broader in scope than one in 2005.
NJ Cuts Aid to Local Governments, Family Planning
Controversial Governor Chris Christie signed a $29.7 billion budget, averting a government shutdown, after slashing $900 million using his line-item veto authority from the budget Democrats had presented to him.
"I will not give in to the Democrats' tax-and-spend agenda no matter how many times they and their allies and special interests demagogue me for refusing to do so," Christie told the Associated Press. "
The new budget adds $150 million in public school financing, and includes $447 million in funding for some of the state’s poorest districts. Among the items cut by Christie were $139 million in aid to local governments, $50 million allocated for crime-fighting initiatives, $7 million for an AIDS drug distribution program, and $3.8 million for Senate and Assembly staff salaries.
Ohio Privatizes Prisons, Sets Plan to Abolish Estate Tax
Ohio Governor John Kasich signed a $55.8 billion budget hours before the midnight deadline, closing an estimated $8 billion deficit without raising state taxes. He used his line-item veto power to eliminate spending on a number of initiatives, including economic development and funding for certain special needs programs.
As part of the plan, the state will privatize five prisons, but the governor vetoed a proposal that would have given the state first choice on repurchasing prisons after they are sold to private parties.
Pennsylvania Budget Slashes Funding for Schools
Pennsylvania Governor Tom Corbett enacted a $27.15 billion state budget, which reduces spending more than $1 billion from the current fiscal year and includes severe cuts to higher and basic education.
Corbett, a Republican whose party controls both houses of the state legislature, signed the budget within an hour of Pennsylvania's midnight deadline for the 2012 fiscal year, which starts July 1.
The governor said the spending plan streamlines government, includes no tax increase and places limits on local property tax increases.
Any property-tax increase above the rate of inflation must be approved by local voters, the governor said.
Praise for Privatizing Prisons
Special praise goes to Ohio Governor John Kasich for privatizing prisons. California desperately needs to do the same. If things go well, Ohio's plan could be and should be a model for other states.
It is time to eliminate massive salaries and pension benefits of prison workers, most of whom are currently way overpaid and equally uneducated with nothing more than high school diplomas.
Hopefully transit workers will be next.
America and the Golden Age of Capitalism
Some thoughts for July 4
I was trading in the S&P pit at the Chicago Mercantile Exchange on the day the Berlin Wall fell. I had a sense that something truly historical was taking place—it would have been impossible not to—but with the pressure of the session and a newborn baby whom I couldn’t wait to get home to, I didn’t stop to grasp the enormity of the events that were unfolding.
It wasn’t until I spoke with my father, an Armenian immigrant who loved the United States more than anyone I’ve ever known, that the big picture came into focus.
“America won,” he said. Sounds simple, but it was really quite profound. He wasn’t talking about one army vanquishing another. He wasn’t talking about the arms race or the space race or any of the hot conflicts that erupted during the 50-year Cold War. He was talking about an idea.
This was a man whose parents survived the Turks but lost 40 members of their family. A man who experienced terrible loss and religious persecution first hand. A man who waited seven years to come to this country as a refugee and kissed the ground when he arrived.
My father was a man who truly cherished his inalienable rights and never took them for granted a day in his life.
He was talking about an idea because, to him, America itself was an idea. On November 9, 1989, communism became a failed experiment. The American experiment would carry on. We had just won the ideological war.
Like in any war, to the victor goes the spoils. But since this was a different kind of war, there was also a different kind of prize. Instead of cultural artifacts or new territories, the reward was more abstract: an entire world that would soon be open for business.
No longer would the entrepreneurial spirit that made this country great be contained by our borders. America was free to export the twin miracles of democracy and capitalism to every corner of the world.
And export we did. In the 22 years since capitalism triumphed, just about every country on Earth has embraced a U.S.-style freemarket economy—and with passionate enthusiasm at that.
Corporations are reporting record earnings thanks to exploding consumer demand in emerging markets that were barely on the radar 30 years ago—places like Brazil, India and China (which is communist in name only). Social mobility, the great ancillary effect of a free market, has not only created a middle-class consumer culture in those places, it’s actually created wealth.
Growing up, I always considered the golden age of capitalism to be that post-World War II period of expansion. But it wasn’t. The golden age of capitalism is in front of us.
As the global growth story continues at a break-neck clip, we find ourselves in the relative infancy of what I believe will be a prolonged period of prosperity. Looking back in history, as the Jesuits at Loyola University taught me to do, the Pax Romana—a 200-year stretch of tranquility and plenty throughout the Roman Empire that followed the fall of Athens—immediately comes to mind.
Today, the entire world—including our former enemies in China and Russia—has decided our way is the right way. They’ve taken our invention and run with it. The conditions of opportunity that once only existed in the United States now exist all over the globe. And those conditions will only grow more favorable going forward.
Why, then, is my fellow Chicagoan trying to rebuild those walls of socialism?
By embracing policy that favors higher taxes, increased regulation and protectionism, the Obama administration has spent two years systematically dismantling everything this country has been building since the Founding Fathers unleashed their libertarian concept of enlightened self interest 250 years ago.
Earlier, I mentioned Pax Romana and how this period in front of us echoes that era. Take a look at what one of the early architects of that earlier golden age, the political philosopher and statesman Marcus Tullius Cicero, had to say about the way government should be run:
The national budget must be balanced. The public debt must be reduced; the arrogance of the authorities must be moderated and controlled. Payments to foreign governments must be reduced, if the nation doesn't want to go bankrupt. People must again learn to work, instead of living on public assistance.
This was written in 55 B.C., but it’s as true today as it was then. A diminishing usefulness of the private sector and the redistributing of wealth by a bloated central government is unacceptable and should be resolutely resisted by every American.
The golden age of capitalism, what I believe will be our finest hour, is in front of us. We know that an occasional liberal in the White House cannot destroy the American entrepreneurial spirit, but we still must stand together to defend it.
America, today, is in its rightful place as the leader of a free-market world. We conquered our adversaries and created a new order. The entire world is open for business.
Journalism and the state: A loving embrace: "With rare exception, most of the journalists I have known are not only intellectually lazy but tend to have an almost doctrinaire government supremacism welded to their worldview. For every Fred Reed, there are hundreds of Rachel Maddows. I suspect it is one reason why the USSR did not necessarily have to actively recruit 'useful idiots' but the very notion of communism or socialism found a natural resonance in the human parrots known as journalists."
Abolish the payroll tax altogether: "Some will argue that cutting the tax while keeping spending up will lead to even greater deficits, which is a valid enough point, but it never before stopped Republicans from advocating tax cuts while failing to have the guts to cut spending enough to make up for them. Another supposed problem, articulated by liberals, is that it will weaken the solvency of Social Security and thus undermine their beloved program’s credibility. Hear, hear! Indeed, there is a strong argument for eliminating the payroll tax altogether, regardless of what else transpires: It is more fiscally honest"
My Twitter.com identity: jonjayray. My Facebook page is also accessible as jonjayray (In full: http://www.facebook.com/jonjayray). For more blog postings from me, see TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, GUN WATCH, FOOD & HEALTH SKEPTIC, AUSTRALIAN POLITICS, IMMIGRATION WATCH INTERNATIONAL, EYE ON BRITAIN and Paralipomena
List of backup or "mirror" sites here or here -- for readers in China or for everyone when blogspot is "down" or failing to update. Email me here (Hotmail address). My Home Pages are here (Academic) or here (Pictorial) or here (Personal)
The Big Lie of the late 20th century was that Nazism was Rightist. It was in fact typical of the Leftism of its day. It was only to the Right of Stalin's Communism. The very word "Nazi" is a German abbreviation for "National Socialist" (Nationalsozialist) and the full name of Hitler's political party (translated) was "The National Socialist German Workers' Party" (In German: Nationalsozialistische Deutsche Arbeiterpartei)


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Patient will present as → a 25-year-old male graduate engineering student who is at your office for the fourth time in 1 week to be sure he does not have chlamydia. Despite having one sex partner, he learned there is an increase in the incidence of STDs on campus. He reports that he has only had sex once but learned that chlamydia is hard to culture. He reports he may have dysuria intermittently but is not sure. He has been evaluated at each visit, and physical and laboratory examination has been completely normal each time.
- Patient's are worried about having or developing a serious illness and
- This preoccupation is present for at least 6 months and
- Is not better explained by another mental disorder (e.g., obsessive-compulsive disorder and somatic symptom disorder)
DSM-5 Diagnostic Criteria
- Preoccupation with having or acquiring a serious illness.
- Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.
- There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.
- The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).
- Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.
- The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.
- Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used.
- Care-avoidant type: Medical care is rarely used.
The goal is to improve coping skills while never dismissing their fears -caregivers should closely follow their patients and develop a therapeutic alliance
- Group/insight-oriented therapy
- Regular appts with provider for reassurance
- Medications: (SSRIs) if concurrent/underlying anxiety or major depressive disorder


text:
Getting comfortable with uncomfortable
One of the things I often say in class when I see struggle on my student’s faces as they work into a challenging asana is to try to relax and be comfortable with the temporary discomfort. Get comfortable with uncomfortable.
It’s one of the wonderful paradoxes in yoga . . . the more we struggle against the discomfort of an asana, the harder it becomes . . . by relaxing the mind, breath and body and accepting the few seconds of discomfort, that is where the magic is and where we can stretch, grow and go further.
So often I find these yoga class principles mirrored in life. When we allow ourselves a moment of pause within discomfort, we can give ourselves the opportunity to stretch and grow as people in a way we didn’t anticipate.
We are so used to making an instant decision to make ourselves feel better in order to avoid experiencing discomfort — turning on the TV the second we get in to avoid feeling lonely; eating because we are feeling bored; having a wine when we have had a stressful day at work.
I am not saying don’t do all these things, I am just highlighting the opportunity that mental yoga gives us to pause before we grab the remote or the corkscrew and to be comfortable in that discomfort momentarily; to feel it, and to feel what we really feel.
It may be that by pausing and choosing to actively be in that initial discomfort we find we are craving connection and that calling for a chat with mum will satisfy much more than the TV. That our body is not physically hungry but would actually feel better having a walk to release some tension before we sit down to eat. That we need to take action and schedule a conversation with our boss about workload rather than drowning that overwhelmed feeling in vino!
It’s not necessarily easy. I struggle as much as the next person with reaching for instant comfort after a difficult day, but I am trying hard to get increasingly comfortable in the pause of discomfort so I can assess what I really feel, and try to meet that true need. It’s a real life-changer and it saves on chocolate/wine and endless Facebook escapism time. I end up with more of what I want in my life, for sure.
Next time you feel an urge to make an instant decision to escape discomfort, ask yourself two questions:
What feeling am I trying to avoid feeling here?
And, what do I really want to feel?
Then go give yourself what you really need.
Louise is a life coach, author and corporate escapee. Visit louisethompson.com for more.

domain: psychology


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In today’s NHL rumors rundown, the Buffalo Sabres have reportedly reached out to Patrick Kane about signing with the team. The Colorado Avalanche kicked tires on Mikael Backlund before making other moves. The Vancouver Canucks made their trade and as such, are holding onto Tyler Myers. The Calgary Flames have released a statement regarding Oliver Kylington not being at camp. Finally, the Edmonton Oilers are in the news for a few reasons on Thursday.
Oliver Kylington Will Miss the Start of Camp
The Calgary Flames have released a statement regarding defenseman Oliver Kylington, which has some fans concerned considering why he missed all of last season. The statement read, “Following yesterday’s medical and fitness testing, it was determined that Oliver is unable to participate in the opening of training camp today. As this is a private personal matter, no further information will be provided.”
This update comes after Kylington made his personal mental health issues known during a recent interview with Swedish publication HockeyNews.se. Throughout this period, the Flames organization consistently expressed their unwavering support for Kylington’s leave of absence and pledged to honor his privacy until he felt prepared to make a return. They will continue to do so.
There’s really no way to put a timeline on his return.
Sabres Showing Interest in Patrick Kane
The Buffalo Sabres have formally indicated their interest in acquiring the services of seasoned forward Patrick Kane, as reported by TSN’s Darren Dreger. Kane, presently in the midst of rehabilitation following hip surgery in the Toronto vicinity, is anticipated to necessitate at least another month of recovery before he can make his comeback on the ice.
Latest News & Highlights
Dreger writes, “Patrick Kane continues to rehab from his hip surgery. He’s been doing so in the Toronto area since July and requires at least another month. We know Buffalo has interest. He could help a lot of teams when healthy.” This development is hardly unexpected, given the persistent speculations connecting Kane with the Sabres throughout the summer, varying in intensity but consistently present.
Avalanche Tried to Trade For Mikael Backlund
In their pursuit of strengthening their center depth during the early stages of the summer, the Colorado Avalanche explored the prospect of acquiring seasoned two-way center Mikael Backlund from the Calgary Flames. According to the latest installment of Sportsnet’s “32 Thoughts” column by Elliotte Friedman, the Avalanche initiated discussions with the Flames before ultimately securing the services of Ross Colton and Ryan Johansen.
Related: Best NHL Goalies of the 1980s
The primary objective was to reinforce their center position, particularly in light of the apparent departure of J.T. Compher. Compher eventually inked a significant five-year contract with the Detroit Red Wings on July 1. Concurrently, while he says he’ll wait to see how the season unfolds, it was widely known that Backlund had expressed dissatisfaction with the state of affairs in Calgary under the leadership of Darryl Sutter.
Canucks Not Trading Tyler Myers
Per Thomas Drance of The Athletic, the Canucks have elected not to trade Tyler Myers. Following a move that sent Tanner Pearson to the Montreal Canadiens, the Canucks are going to cap compliant without the need to move the defenseman, and GM of the Vancouver Canucks, Patrik Allvin said:
Regarding Tyler Myers, we have no intention of moving him. He was good for us, especially after Sergei Gonchar and Adam Foote came in. He had a really strong World Championship and I was happy for him that he won the gold there. I know he’s excited to be back here, and working with Foote and training camp will dictate our opening night roster.
source: ‘Canucks GM Patrik Allvin 1-on-1: On Elias Pettersson, Tyler Myers and camp competition’ – Thomas Drance – The Athletic – 09/20/2023
These comments come as Myers and the Canucks open training camp and get ready for the 2023-24 NHL season. All summer, speculation has surrounded Myers, who was paid a bonus in September and now becomes an affordable contract for a team looking for a player with a higher cap hit, but not much actual money owing on the deal.
Oilers Dealing With Injuries, Make Huge Analytics Hire
Mattias Ekholm is contending with a minor hip injury that may require some time to recover from before he can participate in the commencement of training camp. While the injury is not deemed severe and is considered more of a maintenance issue, any lingering issues would be problematic for the Oilers.
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On another note, Sam Gagner, who underwent surgery on both hips, is slated to partake in practices during the camp but will not participate in games. Currently at camp on a professional tryout (PTO) contract, Gagner’s progress will be assessed over the course of a month, with the possibility of being assigned to the Bakersfield Condors.
Ryan McLeod was also not in camp on the first day.
The Oilers also made a huge hire on Thursday. They appointed Michael Parkatti as the Senior Director of Data & Analytics. This announcement comes as part of the team’s efforts to revamp their approach to analytics under the leadership of CEO of Hockey Operations, Jeff Jackson.