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Frankie J released his cover in 2020. ... Frankie J is no stranger to San Antonio. ... Frankie J Frankie J surprised diners at Mi Tierra with a quick performance earlier this month.
Frankie J, Becky J and Kap G performed a reimagined version of Selena's 1994 hit, produced by Play-N-Skillz at Rosedale Park on May 3, 2017. Frankie J, Becky J and Kap G performed a reimagined version of ...
; San Antonio favorite and former Kumbia Kings member Frankie J; and Clear Lake City native Natalie.
. - Customers at Mi Tierra weren't expecting to get performance from Frankie J, but they got one.
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Frankie J Frankie J Oscar De La Rosa of La Mafia and Frankie J. Baby Bash and Frankie J Frankie J, left, and Baby Bash. ... Frankie J.
Produced in conjunction with Univision Radio San Antonio, “La Mafia Music Legacy: 30th Anniversary” will include guest appearances by Little Joe Hernandez, Ruben Ramos, Los Palominos, Elida Reyna, Shelly ...
Produced in conjunction with Univision Radio San Antonio, “La Mafia — A Musical Legacy: 30th Anniversary” will included guest appearances by Little Joe Hernandez, Ruben Ramos, Los Palominos, Elida Reyna, ...
The show also produced the music video for the "Si Una Vez" remix featuring Frankie J and Kap G at Rosedale Park on the West Side in June 2017.
Joey Guerra, Staff Writer Frankie J scored solo pop hits with "Don't Wanna Try" and "Obsession (No es Amor)." ... Frankie J joined us for a performance on the Preview from the Houston Chronicle Facebook page. ...
Frankie J and Baby Bash collaborated on the top 10 singles "Suga Suga" in 2003 and "Obsession (No es Amor)" in 2005. ... Frankie J, left and Baby Bash have frequently collaborated. Chron concerts: Frankie J ...
Former Kumbia Kings member Frankie J has joined Jennifer Lopez and Enrique Iglesias on their North American tour.
Castello, Frankie J.
. $20-$60, theaztectheatre.com — Robert Johnson Back to the Future Lawsuit, “Back to the Future” Live in Concert: Audiences can make this a time-travel double feature as they go back to 1985 to revisit a ...
She also performed the song with Frankie J, Kap G and Play-N-Skillz in San Antonio in June 2017 at Rosedale Park for the re-imagined version's music video shoot.
TEJANOS FOR CHRIST Valentine’s Super Love Jam: An evening of old-school romantic sounds from the Delfonics, El Chicano, Sunny Ozuna (pictured), Rene Rene, Joe Bravo, Baby Bash, Frankie J, MC Magic and Amanda Perez. 7:30 p.m.
The partnership of Bash and Frankie J is unique in R&B and hip-hop. ... "Sangria means blood, and it represents the bond me and Frankie J have," he says. ... Baby Bash and Frankie J Frankie J, left, and Baby Bash.
Also slated to perform are Tejano singer Bobby Pulido, singer-songwriter JenCarlos Canela and Mexican singer Frankie J.
She took great pride in her beautiful children: Elizabeth, (Michel), Frankie J. II, and Teresa; granddaughter Mykaela, whom was the light of her life; her high school love and husband of 35 years, Frank J.
Latin singer Frankie J is 46.
Trouble-making Agustín (Frankie J. ... January, 2015 Frankie J.
Agustin, a 31-year-old out-of-work artist (Frankie J. ... Photo: Fox Murray Bartlett, Jonathan Groff, Frankie J.
Mary's Jazz Festival, Frankie J and the Paul Elizondo Orchestra.
He is survived by his loving wife of 30 years, Frankie J.


text:
GOP ticket faces growing pains as Dems attack
Published 08/14/2012, Superior Telegram
The newly shaped Republican presidential ticket is fighting growing pains amid charges from President Barack Obama's re-election team that challenger Mitt Romney favors his new running mate's controversial plans to overhaul Medicare and cut trillions of dollars from social programs.Word count: 1072
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domain: politics


text:
Here’s a good reason for children with attention deficit hyperactivity disorder (ADHD) to eat their fruits and vegetables: It may help reduce inattention issues, a new study from Ohio State University suggests.
ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.
The symptoms can be severe, and can cause difficulty at school, at home, or with friends.
About the study
As part of a larger study, researchers asked parents of 134 kids with ADHD symptoms to complete a detailed questionnaire about the typical foods the children ate, including portion sizes, over a 90-day period.
Another questionnaire asked parents to rate symptoms of inattention – a hallmark of ADHD – in their kids, such as having trouble staying focused, not following instructions, difficulty remembering things, and difficulty regulating emotions.
Results showed that kids who consumed more fruits and vegetables showed less severe symptoms of inattention.
Children in the study, all of whom met the criteria for ADHD, were recruited from three sites: Columbus, Ohio; Portland, Oregon; and Lethbridge, Alberta, Canada. Participants were either not taking medication or stopped using it two weeks before the study began.
Other studies linking nutrition to ADHD
The data for this research was collected as part of the Micronutrients for ADHD in Youth (MADDY) Study, which examined the efficacy of a 36-ingredient vitamin and mineral supplement to treat symptoms of ADHD and poor emotional control in the 134 kids aged 6 to 12.
The study that evaluated the effectiveness of the supplement showed that children who took the micronutrients were three times as likely to show significant improvement in their ADHD and emotional dysregulation symptoms than those who took a placebo.
Another study involving the same children, published earlier this year, showed that kids whose families had higher levels of food insecurity were more likely than others to show more severe symptoms of emotional dysregulation, such as chronic irritability, angry moods and outbursts of anger.
Combined, the three studies suggest that a healthy diet that provides all the nutrients that children require can help reduce the symptoms of ADHD in children.
The findings also suggest that it’s worthwhile for doctors to check the children’s access to food as well as the quality of their diet to see if it may be contributing to their symptom severity.
How can diet help ADHD?
Researchers believe that ADHD is related to low levels of certain neurotransmitters in the brain; vitamins and minerals play a key role as cofactors in helping the body synthesize those important neurochemicals and in overall brain function.
Food insecurity may play an additional role. “Everyone tends to get irritated when they’re hungry and kids with ADHD are no exception. If they’re not getting enough food, it could make their symptoms worse,” the researchers said.
Also, the stress of parents who are upset about not being able to provide enough food for their children can create family tension that could lead to more symptoms for children with ADHD.
The MADDY study is one of the first to look at the relationship between ADHD symptoms and diet quality among children in the United States and Canada. That’s important because Western diets are more likely than many others to fall short on fruit and vegetable intake, she said.
Source: Nutritional Neuroscience, May 10, 2022.
All research on this web site is the property of Leslie Beck Nutrition Consulting Inc. and is protected by copyright. Keep in mind that research on these matters continues daily and is subject to change. The information presented is not intended as a substitute for medical treatment. It is intended to provide ongoing support of your healthy lifestyle practices.

domain: health


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ACEi indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, β-blocker; INTERMACS, Interagency Registry for Mechanically Assisted Circulatory Support; LVAD, left ventricular assist device; MRA, mineralocorticoid antagonists; RVAD, right ventricular assist device.
A, Fully adjusted survival curves accounting for time variation in patients’ medications throughout the follow-up period. B, Forest plot for fully adjusted Cox proportional hazards regression model. ACEi indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blockers; BB, β-blockers; HR, hazard ratio; INTERMACS, Interagency Registry for Mechanically Assisted Circulatory Support; LVAD, left ventricular assist device; MRA, mineralocorticoid antagonists; NHB, neurohormonal blockade.
Quality of life for patients receiving NHB therapy. A, Average Kansas City Cardiomyopathy Questionnaire (KCCQ) scores based on therapy from time of implant to 24 months. Error bars show bootstrapped 95% CIs. B, Average distance walked in 6 minutes for patients receiving different heart failure therapy. Error bars show bootstrapped 95% CI. The difference between medication groups at each interval was compared using a 1-tailed Mann-Whitney U test.
aP ≤ .001.
bP ≤ .01.
dP ≤ .05.
eMethods. Description of modified Charlson Comorbidities Index used for sensitivity analysis
eTable 1. Characteristics of Study Population by Cohort
eTable 2. Balance between Covariate Distributions for Propensity-Matched Patients
eFigure 1. Propensity Matched Cohort Analysis
eFigure 2. New User Analysis
eFigure 3. Competing Risk Analyses
Customize your JAMA Network experience by selecting one or more topics from the list below.
McCullough M, Caraballo C, Ravindra NG, et al. Neurohormonal Blockade and Clinical Outcomes in Patients With Heart Failure Supported by Left Ventricular Assist Devices. JAMA Cardiol. 2020;5(2):175–182. doi:10.1001/jamacardio.2019.4965
Does the association between the use of neurohormonal blockade (NHB) and improved clinical outcomes among patients with heart failure with reduced ejection fraction extend to patients with left ventricular assist devices (LVADs)?
In this cohort study of 12 144 patients with LVADs in the Interagency Registry for Mechanically Assisted Circulatory Support between January 2008 and June 2016, use of NHB was associated with significantly lower risk of death and higher quality of life compared with patients not receiving NHB. Survival at 4 years was greatest among patients receiving combination therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, β-blocker, and mineralocorticoid antagonist.
Use of NHB is associated with improved survival and quality of life among patients with LVADs, suggesting the potential for synergy between intensive NHB and mechanical unloading for patients with advanced heart failure.
Left ventricular assist devices (LVADs) improve outcomes in patients with advanced heart failure, but little is known about the role of neurohormonal blockade (NHB) in treating these patients.
To analyze the association between NHB blockade and outcomes in patients with LVADs.
Design, Setting, and Participants
This retrospective cohort analysis of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) included patients from more than 170 centers across the United States and Canada with continuous flow LVADs from 2008 to 2016 who were alive with the device in place at 6 months after implant. The data were analyzed between February and November 2019.
Patients were stratified based on exposure to NHB and represented all permutations of the following drug classes: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, and mineralocorticoid antagonists.
Main Outcomes and Measures
The outcomes of interest were survival at 4 years and quality of life at 2 years based on Kansas City Cardiomyopathy Questionnaire scores and a 6-minute walk test.
A total of 12 144 patients in INTERMACS met inclusion criteria, of whom 2526 (20.8% ) were women, 8088 (66.6%) were white, 3024 (24.9%) were African American, and 753 (6.2%) were Hispanic; the mean (SD) age was 56.8 (12.9) years. Of these, 10 419 (85.8%) were receiving NHB. Those receiving any NHB medication at 6 months had a better survival rate at 4 years compared with patients not receiving NHB (56.0%; 95% CI, 54.5%-57.5% vs 43.9%; 95% CI, 40.5%-47.7%). After sensitivity analyses with an adjusted model, this trend persisted with patients receiving triple therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, β-blocker, and mineralocorticoid antagonist having the lowest hazard of death compared with patients in the other groups (hazard ratio, 0.34; 95% CI, 0.28-0.41). Compared with patients not receiving NHB, use of NHB was associated with a higher Kansas City Cardiomyopathy Questionnaire score (66.6; bootstrapped 95% CI, 65.8-67.3 vs 63.0; bootstrapped 95% CI, 60.1-65.8; P = .02) and a 6-minute walk test (1103 ft; bootstrapped 95% CI, 1084-1123 ft vs 987 ft; bootstrapped 95% CI, 913-1060 ft; P < .001).
Conclusions and Relevance
Among patients with LVADs who tolerated NHB therapy, continued treatment was associated with improved survival and quality of life. The optimal heart failure regimen for patients after LVAD implant may be the initiation and continuation of guideline-directed medical therapy.
Patients with stage D heart failure (HF) have limited life-prolonging therapeutic options other than left ventricular assist devices (LVADs) and cardiac transplant.1 As few patients can undergo transplant and outcomes with mechanical circulatory support have greatly improved, the population of patients with durable LVADs is increasing.2 However, data on the use of pharmacotherapy beyond the use of anticoagulation to prevent thrombotic events are limited. Specifically, little is known about the association of neurohormonal blockade (NHB) with clinical outcomes in patients with LVADs.
Among patients with HF with reduced ejection fraction (HFrEF), using NHB leads to substantial improvements in long-term and short-term clinical outcomes.3 In patients with HF with LVAD support, studies have shown that the underlying HF phenotype remains.4-6 A subset of these patients can achieve myocardial remission that permits LVAD removal when treated aggressively with NHB.7 Therefore, it is highly plausible that using these therapies in the general population of patients with LVADs might lead to improvements in clinical outcomes. In this study, we sought to determine the role of guideline-directed medical therapy (GDMT) on survival and quality of life (QoL) among patients with LVADs who were included in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS).
We conducted a retrospective cohort analysis of the INTERMACS registry, a prospective database supported by the National Heart, Lung, and Blood Institute, the US Food and Drug Administration, the Centers for Medicare & Medicaid Services, medical industry, and participating centers. INTERMACS was established in 2005 to improve the quality of care and outcomes in patients with mechanical circulatory support devices.8 The registry includes patients with a US Food and Drug Administration–approved device throughout the United States and Canada. The data, analytical methods, and study materials are available via the Biological Specimen and Data Repository Information Coordinating Center.9 The institutional review board at Yale University School of Medicine approved the study and written informed consent was obtained by INTERMACS participating centers.
A Consolidated Standards of Reporting Trials diagram of patients included in our study is shown in Figure 1. Based on prior studies suggesting that the recovery of left ventricular function, medication use, and clinical status stabilizes by 6 months after LVAD implant, we included all adult patients with continuous-flow LVADs who underwent implant from January 2008 to June 2016 who were alive and still using the device at 6 months.10-13 Because of the small sample size and their unique pathophysiology, we excluded patients who had total artificial hearts, biventricular devices, right ventricular assist devices only, or pulsatile devices.
We considered NHB to include the HF medications listed as class I level of evidence A recommendations by the American College of Cardiology and American Heart Association guidelines.3 The medication groups consisted of all permutations of the following major medication classes: (1) angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEis/ARBs), (2) β-blockers (BBs), and (3) mineralocorticoid receptor antagonists (MRAs). A separate group comprised patients taking other medication classes that did not fit these criteria: digoxin, amiodarone, calcium channel blockers, hydralazine, and phosphodiesterase inhibitors.
Our primary outcome of interest was survival from baseline (6 months after LVAD implant) to 4 years. Our secondary outcome of interest was QoL as defined by the Kansas City Cardiomyopathy Questionnaire (KCCQ) and a 6-minute walk test from baseline to 2 years. After 2 years, QoL measures become scarce in the data set.
Continuous variables are summarized as means (SD) if normally distributed or median and interquartile range (IQR) if not normally distributed. Parametric variables were compared using the t test or analysis of variance and nonparametric variables were compared using the Wilcoxon rank sum and Kruskal-Wallis tests. Categorical variables are presented as frequencies with percentages and were compared using the χ2 test. We assessed associations between medication group and survival using a Kaplan-Meier survival analysis from 6 months to 4 years after implant. We censored patients who underwent explant because of recovery or transplant.
Given that the combination of medical therapies that patients receive changes over time, we treated medication group as a time-dependent variable in a Cox proportional hazards regression.14 Data for patients at each follow-up time were transformed into counting-process form using the survival package in R (R Foundation). Our multivariate sensitivity analysis adjusted for early hazards of mortality identified by the eighth annual INTERMACS report (age, sex, body mass index [calculated as weight in kilograms divided by height in meters squared], implantable cardioveter defibrillator (ICD), INTERMACS profile 1 or 2, albumin, dialysis, blood urea nitrogen, total bilirubin, history of cardiac surgery, concomitant cardiac surgery, and illness too severe to complete EQ-5D).15 In addition, we adjusted for modified Charlson Comorbidity Index (eMethods in the Supplement), institutional LVAD implant volume (averaged between 2014-2016), year of implant, and device strategy (bridge to transplant [BTT] or destination therapy [DT]).15,16 To ensure that the fully adjusted, time-varying Cox proportional hazards regression model did not violate the proportional hazards assumption, we applied time-transforms to coefficients for age, whether patients were too sick to complete the EQ-5D questionnaire, and dialysis prior to implant. In addition, we fit natural cubic splines to the modified Charlson Comorbidity Index score. To minimize skewness, blood urea nitrogen and total bilirubin levels were log-base-2–transformed. Using the Schoenfeld test for proportional hazards, all terms in the fully adjusted, time-varying Cox model upheld the proportional hazards assumption.17
To account for potential residual confounding in the multivariate regression model, we conducted a propensity-matched cohort analysis and, as a negative control, we assessed whether NHB is associated with events recorded by INTERMACS but without known association with the use of NHB (drive-line infection, psychiatric episode, device malfunction, and pump thrombosis). For the propensity-matched analysis, we used the early hazards for mortality identified by the eighth annual INTERMACS Report as covariates (age, sex, body mass index, ICD, INTERMACS profile 1 or 2, albumin, dialysis, blood urea nitrogen, total bilirubin, history of cardiac surgery, concomitant cardiac surgery, and illness too severe to complete EQ-5D) and used a genetic-matching algorithm to determine covariate weights (implemented with the MatchIt and Matching packages in R, respectively).15,18,19
We also conducted a Kaplan-Meier survival analysis using a new user cohort. After excluding patients receiving NHB before LVAD implant, we then performed a Kaplan-Meier survival analysis for 2 groups: those with incident NHB use and those without NHB use after 6 months of device implant. We calculated an adjusted hazard ratio (HR) based on the covariates used in our aforementioned multivariate regression model.
Lastly, to further understand association of NHB therapy with outcomes after LVAD implant, we performed a competing risks analysis by calculating the cumulative incidence of death, transplant, and explant due to recovery using the Aalen-Johansen estimate.20 For the competing risks analysis, we stratified patients according to whether their preimplant treatment strategy was BTT or DT and compared patients either receiving NHB, not receiving NHB, or receiving triple NHB therapy. We used R, version 3.5.3, and Stata, version 14.2 (StataCorp) for all the analyses. Two-tailed P values of <.05 were considered statistically significant.
We included 12 144 patients with continuous-flow LVADs between 2008 to 2016 who were alive and using the device 6 months after implant (Figure 1 and Table). There were 9618 men (79.2%) and 8088 (66.6%) were white. The indication for LVAD was BTT in 6800 (56.0%), DT in 5270 (43.4%), and bridge to recovery in 49 (0.4%). There were 2259 patients (18.6%) with chronic renal disease; 959 (7.9%) had severe diabetes, 2344 (19.3%) had pulmonary hypertension, and 1785 (14.7%) had atrial arrhythmias. Race/ethnicity, comorbidities, INTERMACS profile, and indication for LVAD implant were similar in the NHB and not receiving NHB groups (Table). The use of amiodarone, calcium channel blockers, and phosphodiesterase inhibitors were similar between those receiving NHB and those not receiving NHB, but there were significant differences in the use of hydralazine, warfarin, and digoxin between the 2 groups. Over the course of the study period, 17 patients (0.99%) not receiving NHB underwent explant because of recovery compared with 169 (1.62%) of those receiving NHB (P = .04).
The proportion of patients treated with NHB increased from 8865 (73.0%) before LVAD implant to 10 419 (85.8%) at 6 months after LVAD implant (data not shown). At the 6-month point, 1967 patients (16.2%) were receiving triple therapy with all 3 medication classes; 2742 (22.6%) were receiving a BB and ACEi/ARB, 1200 (9.8%) were receiving a BB and MRA, 541 (4.5%) were receiving an ACEi/ARB and MRA, 2359 (19.4%) were receiving a BB, 1035 (8.5%) were receiving an ACEi/ARB, 576 (4.7%) were receiving MRA, and 1725 (14.2%) were not receiving NHB (Figure 1). In eTable 1 in the Supplement, we present demographic data, comorbidities, INTERMACS profile, New York Heart Association class, and laboratory data among the 8 varying medication groups included in the analyses. For most variables, there were statistically significant differences among medication groups. Patients receiving triple therapy with an ACEi/ARB, BB, and MRA had the lowest N-terminal pro–B-type natriuretic peptide values with a mean (SD) of 1252 (1442) ng/L compared with those without NHB with a mean (SD) of 3276 (4712) ng/L. The average creatinine level was lowest in those receiving triple with a mean (SD) of 1.18 (0.43) mg/dL (to convert to micromoles per liter, multiply by 88.4). The degree of anticoagulation based on the international normalized ratio was similar in all groups (range, 2.14-2.27; P < .001).
Unadjusted survival estimate curves by medication group are shown in eFigure 1 in the Supplement. The unadjusted 4-year survival estimate for patients receiving NHB was 56.0% (95% CI, 54.5%-57.5%) compared with 43.9% (95% CI, 40.5%-47.7%) for patients not receiving NHB (P < .001). This unadjusted model revealed that patients receiving triple therapy with an ACEi/ARB, BB, and MRA at 6 months had the longest survival estimate at 4 years (66.4%; 95% CI, 63.1%-70.0%).
Because the Kaplan-Meier analysis does not account for confounders or medication group switching over the study period, we performed a sensitivity analysis using a multivariate Cox proportional hazards regression that treated medication group as a time-dependent covariate. This analysis revealed that use of triple therapy with all NHB classes was associated with significantly improved survival compared with the other medication groups (HR, 0.34; 95% CI, 0.28-0.41; P < .001) (Figure 2). Every other medication group was associated with reduced hazard with the exception of MRA alone (adjusted HR, 0.88; 95% CI, 0.7-1.1). For all adjusted models of survival, there was improved survival among patients taking an ACEi/ARB alone or in combination with the other HF therapies compared with medication groups without an ACEi/ARB.
To account for residual confounding, we performed further sensitivity analyses using a propensity score–matched cohort. The results of the propensity-matched analysis indicated that use of any NHB was associated with significantly improved survival compared with medical regimens without NHB 4 years postimplant (59.3%; 95% CI, 57.8%-60.9% vs 50.4%; 95% CI, 46.6%-54.5%). When examining the survival estimate for patients specifically receiving triple therapy with an ACEi/ARB, BB, and MRA vs those not receiving NHB, the difference in survival rate was even greater (68.5%; 95% CI, 65.2%-72.0% vs 53.9%; 95% CI ,49.1%-59.4%) (eFigure 2 and eTable 2 in the Supplement).
Further sensitivity analyses were performed using drive-line infection, psychiatric episode, device malfunction, and pump thrombosis as negative controls (eTable 3 in the Supplement). We stratified survival based on exposure to either any NHB or triple therapy; no NHB was used as a reference. The cumulative incidence between 6 months and 4 years was 10.8% (n = 1307) for drive-line infection, 3.1% (n = 373) for psychiatric episode, 24.3% (n = 2965) for device malfunction, and 12.8% (n = 1557) for pump thrombosis. There were no statistically significant differences in the rates of these events across groups.
In an analysis restricted to patients with incident use of NHB 6 months after implant (ie, new users), the association between NHB and outcomes persisted. Of the 3381 preimplant NHB-naive patients, use of NHB was associated with a significant improvement in survival compared with nonuse of NHB (adjusted HR, 0.66; 95% CI, 0.56-0.78) (eFigure 3 in the Supplement).
To further describe the study cohort, we performed competing risk analyses by calculating the cumulative incidence of death, transplant, and explant due to recovery for those with a BTT or DT device strategy (eFigure 4 in the Supplement). Patients undergoing BTT receiving NHB were estimated to have a lower risk of death, a higher chance of undergoing explant due to recovery, and a higher chance of undergoing transplant (20.5% [95% CI, 19.3%-21.7%] vs 33.4% [95% CI, 30.0%-37.2%]; 3.6% [95% CI, 3.1%-4.1%] vs 1.8% [95% CI, 1.0%-3.2%]; and 51.7% [95% CI, 50.3%-53.1%] vs 43.3% [95% CI, 39.9%-47.1%], respectively; all P < .004). The patients undergoing BTT receiving triple therapy had even better estimated outcomes 4 years postimplant, with less than half of the probability of death, 3-fold probability of undergoing explant due to recovery, and greater than 10% probability of undergoing transplant compared with patients undergoing BTT not receiving NHB (15.1% [95% CI, 12.9%-17.7%] vs 33.4% [95% CI, 30.0%-37.2%]; 6.2% [95% CI, 4.8%-7.9%] vs 1.8% [95% CI, 1.0%-3.2%]; and 53.3% [95% CI, 50.2%-56.6%] vs 43.3% [95% CI, 39.9%-47.1%], respectively; all P < .001). The association between NHB therapy and survival also held for patients receiving LVADs for DT. Regardless of whether patients undergoing DT were receiving any NHB or triple therapy at 6 months postimplant, they had a lower estimated probability of death at 4 years and a higher chance of undergoing transplant compared with patients undergoing DT not receiving any NHB (P < .005). For those who underwent implant as DT, exposure to triple therapy was associated with a nearly 2-fold higher chance of undergoing explant due to recovery compared with patients undergoing DT not receiving NHB (P = .02).
To assess whether various combinations of HF therapies were associated with QoL outcomes for patients with LVADs, we measured the KCCQ score and a 6-minute walk test for patients at each follow-up time from 6 months postimplantation to 2 years. The median KCCQ score at 2 years for patients receiving NHB was 68.8 (IQR, 52.6-82.3) vs 64.9 (IQR, 48.1-82.8) for patients not receiving any therapies (P = .02) (Figure 3A). The average KCCQ score at 2 years for patients receiving NHB was 66.6 (bootstrapped 95% CI, 65.8-67.3) vs 63.0 (bootstrapped 95% CI, 60.1-65.8) for patients not receiving NHB (P = .02) (Figure 3A). The average 6-minute walk test at 2 years was 1103 ft (bootstrapped 95% CI, 1084-1123 ft) compared with 987 ft (bootstrapped 95% CI, 913-1060 ft; P < .001) (Figure 3B).
To our knowledge, this study is the first analysis of varying combinations of NHB therapies and patient-centered outcomes in patients with LVADs; it has 4 key findings. First, there is a significant association between NHB therapy and improved survival compared with LVAD implant without NHB. Second, our unadjusted and adjusted models showed the lowest hazard of death for patients with LVADs receiving triple therapy with an ACEi/ARB, BB, and MRA, similar to GDMT for HFrEF. Third, patients receiving NHB enjoyed a better QoL as defined by KCCQ scores and 6-minute walk test. Fourth, there is substantial variation in the use of HF therapies among patients with LVADs.
These results support the findings of other studies that sought to augment LVAD function with medical therapies. Several small trials have shown that the use of combination therapy with an ACEi, ARB, BB, MRA, and a β-2 agonist can lead to LVAD weaning and explant for recovery in a limited subset of patients with primarily nonischemic cardiomyopathy.7,10,21-24 In this study, very few patients underwent explant for recovery, but there were significantly more in the group receiving NHB compared with those not receiving NHB. The associations we found between HF medication therapy and improved outcomes are also supported by a recent prospective study comparing the association of NHB with mechanical unloading with mechanical unloading alone.4 The histopathological parameters of reverse remodeling were greater in those receiving NHB compared with controls, but the study was not powered to detect differences in mortality between the groups. Both our unadjusted and adjusted models showed an association between survival and use of NHB, with patients receiving triple therapy with an ACEi/ARB, BB, and MRA performing best. The survival benefit seen in these groups was not surprising based on evidence that the combination of these therapies reduces mortality in patients with HFrEF without an LVAD.
We were also concerned about confounding associated with illness severity. Recently published data from the CHAMP-HF registry consisting of patients with HFrEF without mechanical circulatory support revealed that factors, such as low systolic blood pressure and poor QoL, were associated with GDMT discontinuation, whereas stable or improving renal function were associated with medication initiation or dose increase.25 Neither the CHAMP-HF registry nor the INTERMACS registry can indicate a causal relationship between medication use and health status or vice versa. To address whether inherently healthier participants are able to tolerate a more intensive NHB regimen, we adjusted our analysis for factors that could contribute to health status. Our multivariate-adjusted model, negative control analyses, propensity-matched cohort analyses, and competing risk analyses showed similar trends in survival with the group receiving all 3 NHB therapies performing the best when compared with those not receiving any NHB. Although we used different approaches to reduce bias and address confounders in our analyses, our results indicate an association between NHB and improved outcomes after LVAD and cannot conclude causality. Surprisingly, there was a significant difference in the use of warfarin therapy in the cohort receiving NHB compared with the cohort not receiving NHB. This difference could not be accounted for with proportionately greater use of other forms of anticoagulation. Given the nearly identical values of international normalized ratio among all the medication groups, including those not receiving NHB, it is possible that relative lack of warfarin use was secondary to coagulopathy.
When comparing all the groups against each other, groups containing ACEi/ARB therapy had the longest survival. The association of ACEi/ARB use and survival may be multifactorial. Renin angiotensin-aldosterone system antagonism with lisinopril was also associated with decreased rates of gastrointestinal bleeding among patients with continuous-flow LVADs according to a recent retrospective analysis, but there was no association with survival during the 2-year period of interest.26 The difference in survival benefit between the former study and ours may be explained by the large difference in sample size. If use of an ACEi/ARB is associated with improved survival and a decreased risk of gastrointestinal bleeding, then ACEi/ARBs may be preferred if patients are only able to tolerate 1 agent that targets neurohormonal dysfunction.
Similar to the survival analyses, patients receiving NHB enjoyed a higher QoL compared with those not receiving NHB. We found a 3.6-point absolute difference in mean KCCQ score between the groups after 2 years. This statistically significant result is also clinically significant given that the difference of only a few points can reflect patients’ ability to independently bathe or participate in hobbies.27 The improvement in KCCQ score is substantiated by the improvement in the 6-minute walk test between the 2 groups. Both of these QoL measures suggest that medical regimens that include NHB can be additive to the improvement in QoL by LVADs alone based on the original clinical trials.28,29
Unlike for patients with HFrEF without mechanical circulatory support, there are no GDMTs for HF after LVAD implant. The International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support only recommend ACEi/ARBs, BBs, and MRAs for patients with another indication for the drug class, such as hypertension, coronary artery disease, or diabetes with vascular complications. While 85.8% of patients in INTERMACS are receiving either an ACEi/ARB, BB, or MRA, there is substantial variation in the combined use of these medications. Together with the results of small studies that use intensive NHB in patients with LVADs, our results indicated that there is potential synergy between the traditional GDMT for HF and mechanical unloading for patients with advanced HF.
Our sensitivity analyses were limited by a lack of site-level data, which prevented us from adjusting for differences in prescribing patterns and outcomes unique to the various LVAD centers. Furthermore, because change in medication exposure over time was likely not a random event, but rather associated with a patient’s clinical status, our time-varying covariate analysis is limited. INTERMACS does not contain data concerning medication dosage, medication compliance, nor the reason for medication initiation or discontinuation. Given these limitations, it was not clear whether patients receiving intensive NHB regimens were inherently healthier owing to their ability to tolerate these therapies. Conversely, it was not possible to conclude that patients not receiving NHB or less intensive NHB regimens had higher illness severity and were intolerant of such therapies. The interpretation of these results requires appreciation for the limitations of observational studies.
This large, nationwide analysis of patients undergoing LVAD implant demonstrates an association between varying combinations of HF therapies and patient-centered outcomes. Specifically, medical regimens with NHB similar to GDMT for HFrEF were associated with improved survival and QoL. These data suggest that there may be an optimal medical regimen for HF after LVAD implant that is similar to GDMT for HFrEF.
Accepted for Publication: October 30, 2019.
Corresponding Author: Nihar R. Desai, MD, MPH, 333 Cedar St, Yale University School of Medicine, New Haven, CT 06517 (firstname.lastname@example.org).
Published Online: November 18, 2019. doi:10.1001/jamacardio.2019.4965
Author Contributions: Drs Caraballo and Ravindra had access to the data and take responsibility for the accuracy of the analyses reported here.
Concept and design: McCullough, Caraballo, Ravindra, Miller, Mezzacappa, Gruen, Reinhardt, Ali, Ahmad, Desai.
Acquisition, analysis, or interpretation of data: McCullough, Caraballo, Ravindra, Miller, Mezzacappa, Levin, Gruen, Rodwin, van Dijk, Ahmad, Desai.
Drafting of the manuscript: McCullough, Caraballo, Ravindra, Miller, Rodwin, Ahmad, Desai.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: McCullough, Caraballo, Ravindra, Mezzacappa, van Dijk.
Obtained funding: Ahmad.
Administrative, technical, or material support: Gruen, Rodwin, Reinhardt, Ali, Ahmad, Desai.
Supervision: McCullough, Miller, van Dijk, Ali, Ahmad, Desai.
Conflict of Interest Disclosures: Dr Desai reported grants and personal fees from Amgen and personal fees from Boehringer Ingelheim, Novartis, and Relypsa outside the submitted work. No other disclosures were reported.
Meeting Presentation: This paper was presented at the American Heart Association’s Scientific Sessions 2019; November 18, 2019; Philadelphia, Pennsylvania.

domain: medical


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Blend of seeds.
We suggest serving it as a small sandwich accompanied by pancetta, melted cheese, lamb’s lettuce, olive oil and salt.
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Wheat flour, natural ferment and 6 seeds mix.
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SIX GRAINS BREAD DELUXE
Triticum is a small Spanish company created with one simple aim: to supply quality frozen bread for the best restaurants. This young, enterprising business was founded in 2006 and it has grown rapidly since then in terms of projects, clients and products. Triticum offers the best bread you can find in Hong Kong and now it can be delivered right to your door.

domain: food


Welcome to FindLaw's Cases & Codes, a free source of state and federal court opinions, state laws, and the United States Code. For more information about the legal concepts addressed by these cases and statutes, visit FindLaw's Learn About the Law.
(1) The commissioner shall grant or deny an application for a certificate of authority within 180 days of the date that a completed application, together with the items designated in 33-35-205, is submitted to the commissioner.
(2) The commissioner shall grant the application of an arrangement that satisfies the applicable requirements of 33-35-202, 33-35-203, 33-35-205, 33-35-209, and 33-35-210.
(3) The commissioner shall deny the application of an arrangement that does not satisfy the applicable requirements of 33-35-202, 33-35-203, 33-35-205, 33-35-209, and 33-35-210. Denial of an application for a certificate of authority is considered a contested case under the Montana Administrative Procedure Act.
(4) A certificate of authority granted to an arrangement is effective unless revoked by the commissioner under 33-35-302.
Cite this article: FindLaw.com - Montana Title 33. Insurance and Insurance Companies § 33-35-211. Issuance of certificate of authority - last updated April 27, 2021 | https://codes.findlaw.com/mt/title-33-insurance-and-insurance-companies/mt-code-ann-sect-33-35-211/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature or via Westlaw before relying on it for your legal needs.


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The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.
Zaheer S, Ginsburg LR, Wong HJ, et al. BMJ Open Qual. 2018;7:e000433.
Establishing a culture of safety within health care organizations requires strong leadership support. This cross-sectional survey study of nurses, allied health professionals, and unit clerks working in the inpatient setting at a single hospital found that positive perceptions of senior leadership support for safety and positive perceptions of teamwork were associated with positive perceptions of patient safety. In addition, when staff perceived senior leadership support for safety to be lacking, the positive impact of direct managerial leadership on staff perceptions of patient safety was more pronounced.
Psychiatric patients are vulnerable to particular safety hazards. This news article reports on unintended consequences associated with a strategy to help patients adapt to being discharged home by providing passes for them to adjust to independent living.


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Livingston is holding its 3rd annual community clean-up day: "Pick It Up, Livingston!"
Volunteers must register via the SignUpGenius page.
What: This event gives community members the chance to pitch in and help keep our town beautiful! Volunteers can sign up online in advance, either with a team or as individuals, and choose one of the designated clean-up areas. Location team leaders will advise volunteers on additional details and provide supplies.
Where: There are eight locations in town that have been identified and will be cleaned up. These are listed on the registration page.
When: Sunday, April 28, 2019 from 8:30 am - 11:00 am (rain date is May 5).
What else: Residents, local civic clubs and organizations, youth groups, and students are welcome to join in and help clean up our town. Get community service hours for participating! Sign up now and help us spread the word!
We look forward to another successful event this year, helping to keep our beautiful town the way it's meant to be -- clean, green and garbage free!
Read more and register now.

domain: news


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Should there be no online availability for your chosen timing or zone of the restaurant, please drop us a WhatsApp message or call us at +65 6100 4242.
Coming with a bigger group of friends? That’s great! Please take 2 minutes to fill in this form, choose your menu (or a la carte pre-order) and our Reservation Team will contact you as soon as they can!
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We cook & pour all day!
Only Tapas Bar Menu is served from 15:00 to 18:00 and on Fri & Sat from 22:30 to 00:00.
Sun, Tue-Thu Dinner last food/beverage order: 22:00/22:30
Fri – Sat Dinner last Restaurant Menu: 22:30
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DNR: Survey shows highest waterfowl population in 59-year history
MADISON – Waterfowl breeding populations in 2014 are mostly good to excellent in Wisconsin and North America, according to recent surveys by state, federal and Canadian wildlife officials.
The surveys were conducted by Wisconsin Department of Natural Resources, the U.S. Fish and Wildlife Service and Ontario Ministry of Natural Resources. The USFWS survey showed the highest North American duck population estimate in the 59-year history of the survey.
"While some recent variations in state level waterfowl surveys are difficult to interpret overall, we have excellent news regarding waterfowl populations in North America," said Kent Van Horn, DNR migratory waterfowl biologist. "Population data is good to excellent across North America with good wetland conditions to support promising local and continental duck and goose populations."
The full report is available by searching the DNR website dnr.wi.gov for 'waterfowl breeding population survey.'
In addition to Wisconsin's breeding population study, two additional sources of information regarding yearly waterfowl breeding conditions are used to determine fall season structure.
A cooperative survey organized by the Ontario Ministry of Natural Resources provides annual data on Canada geese. Roughly 60 percent of Wisconsin's regular goose season harvest is supported by Canada geese nesting in northern Ontario.
A final piece of supplemental information is provided by the USFWS through their breeding waterfowl survey for the northern U.S., Canada and Alaska.
Waterfowl breeding areas in North America showed mostly good to excellent conditions in 2014. The quality of duck breeding is expected to be high overall. Wetland conditions were on the rise in all regions of Wisconsin's breeding waterfowl survey - this should provide good brood rearing habitat. However, widespread flooding, a late winter and irregular migration timing impacted survey conditions and created challenges in generating state population estimates.
The four most abundant ducks in Wisconsin's fall hunting harvest make up close to 75 percent of the total harvest and include mallards, wood ducks, green-winged teal and blue-winged teal. Van Horn notes that many of the mallards and wood ducks harvested in Wisconsin come from birds that breed in Wisconsin, while about two-thirds of the blue-winged teal harvested in Wisconsin are raised in other prairie regions. Most green-winged teal migrate into Wisconsin from boreal forests in Canada.
"The recent trend of wet conditions, increasing duck numbers and liberal regulations is very exciting," said Van Horn. "Many older waterfowl hunters have experienced years with drought, shorter seasons and low breeding populations -- with the help of many agencies, conservation organizations and hunters, we have placed ourselves in a position to enjoy great hunting all over the continent."
In Wisconsin, the spring waterfowl survey provided mixed results, with a total breeding population estimate of roughly 395,000 ducks. This estimate shows a decrease from 2013 and is below the long term average.
"These are population estimates, not exact counts, so changes of 20 percent (whether an increase or decrease) may not reflect any real change in the actual population and are best viewed as trends," Van Horn said.
The trend in the total breeding duck population in Wisconsin has been relatively consistent the last ten years in the range of 500,000 total ducks. The mallard and wood duck portions of this state total have provided more stable contributions, while the blue-winged teal and "other duck" survey estimates have been more variable.
Mallards are the number one duck in the fall bag, accounting for nearly 40 percent of the total fall duck harvest in Wisconsin. The 2014 continental mallard population estimate of 10.9 million is the second highest on record. The Wisconsin mallard population estimate of 159,000 is statistically unchanged from 2013 and consistent with a stable trend experienced over the past ten years.
The second most abundant duck in Wisconsin, registering at close to 20 percent of the total fall harvest, is the wood duck. The 2014 breeding population estimate of 104,000 is similar to 2013 and consistent with a stable trend experienced over the last ten years.
The continental blue-winged teal estimate of 8.5 million was the third highest for that species, while the 2014 Wisconsin blue-winged teal breeding population estimate of 34,000 is down from 2013. A trend in the state population estimate for blue-winged teal for the last 10 years is not clear, due to challenging survey issues and high annual variation in population estimates.
Conservation funding and the efforts of Wisconsin's waterfowl hunters have protected and managed wetland and upland habitats crucial to the maintenance of these breeding duck populations statewide.
The 2014 Wisconsin breeding Canada goose population estimate of 126,000 was similar to 2013 and the average spanning the last decade. Wisconsin's resident breeding Canada goose population may be stabilizing at 120,000 after a long term increase.
"We expect a healthy Canada goose population this fall, particularly for the Early September Canada goose season (Sept. 1-15 with a five-bird daily bag limit), which makes up one-third of our total statewide goose harvest" said Van Horn.
According to Van Horn, two populations of Canada geese represent most of the geese in Wisconsin during the fall. Wisconsin's locally breeding Canada geese represent over 90 percent of the goose harvest for the early season from Sept. 1-15 and about 40 percent of the harvest during the later regular goose season.
Most of the remaining 60 percent of regular season goose harvest is supported by a second population of Canada geese that breed along the Hudson Bay coast in northern Ontario. Although Wisconsin shares this population with other states, it is unique in that these birds comprise over half of the state's annual harvest. In neighboring states, like Minnesota, locally breeding birds comprise the majority of harvest. This breeding population of Canada geese appears to be at normal levels, with an estimated 2014 breeding population of 323,099. These data are similar to estimates in 2013 and the long term average.
Overall, 2014 looks to be an excellent year for duck and Canada goose populations. With survey data now available, federal and state biologists are conducting analyses and harvest projections to help form hunting season structure in the coming weeks. As a part of this process, DNR staff will meet with state, federal and provincial agencies at the Mississippi Flyway Council meeting in late July. Following the council meeting and USFWS Regulations Committee meetings, these organizations will use further coordination to guide 2014 waterfowl hunting regulations.
For more information, please visit dnr.wi.gov and search keyword 'waterfowl.'
For more information:
Kent Van Horn, DNR migratory game bird ecologist, 608-266-8841


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Released: January 20, 1983 by Mercury/PolyGram Records
The idea behind this blog was hatched years ago and has moved in fits and starts ever since. As a result I have a number of reviews already written and waiting to be posted, but for the first one I wanted something that felt a little special, at least when compared to the randomness of what is in my cue. So it seemed fitting to start with the very first album I ever owned.
Growing up in the 70’s, radio was a dominant force in my life. We didn’t get cable TV until 1984, a VCR until 1987, and the internet for another decade after that. So for the first ten years of my life, even though I was only marginally aware of it, I was being groomed to love music thanks to the FM airwaves. Now had things been left entirely up to mother, you’d be reading a blog about the greatness that is Anne Murray or the wonderful world of Barry Manilow. Thankfully I had an older brother and older sister who set me straight before that kind of long-term damage could be wrought. My formative years were spent building Lego masterpieces while the strains of 70’s and 80’s arena rock slowly seeped into my consciousness. I knew what Led Zeppelin was before I knew what a zeppelin was and I’m all the better for it.
Now even though I owe a huge debt of gratitude to my siblings for introducing me to the music I would come to love, there comes a point where you forge an identity of your own and for me that came sometime in 1983 when I first heard that magical phrase “gunter glieben glauten globen”. I mean really, what more needs to be said? Between that bit of gibberish and the accompanying guitar riff, I had discovered my musical destiny and its name was “hard rock”. The song “Rock Of Ages” from whence the bizarre intro comes had been a solid radio hit for awhile when I was introduced to the rest of the album by a friend who had a vinyl copy. I still have a vivid memory of listening to it the first time and being completely sucked in by the grit of the guitars and the roughness of Joe Elliott’s vocals. I would never consider Def Leppard a true heavy metal band, but they were certainly tougher and darker than the likes of REO Speedwagon or Night Ranger, and as a result they drew me in. Tracks like “Too Late For Love” and “Die Hard The Hunter” had a slightly sinister quality, something a little more menacing than what I was used to. So off I went one day, armed with a $10 bill and the freedom to spend it however I chose to make the first of many, MANY musical purchases: my very own copy of Pyromania on cassette, making me one of ten million people and counting who have done so.
Obviously a record that has sold that many copies doesn’t really need a sales pitch from me to move a few more units, but if you’re a fan of rock music at all and don’t own a copy, I’m sorry, but you’re a moron. The riff from “Photograph” alone is required listening for any true fan, and the album is chock full of other classic pop-metal tunes such as “Foolin'” and “Rock! Rock! (Till You Drop)”. Legendary producer Mutt Lange was still perfecting his 80’s uber-polish when he helped make this album, so it retains quite a bit of the dirt and grime that the Leps carried with them from their days slogging through the scene known as the New Wave Of British Heavy Metal. By the time the follow-up, Hysteria, was released 4 years later they would leave that party completely, but the stench still lingers here. Not quite as raw as the previous record High N’ Dry, the songs on Pyromania were all shaped by Lange to be hits, his often stated goal being to create a rock record where every song was a possible single. Of course, this approach tended to turn off the band’s original fans (as did the ousting of guitarist Pete Willis mid-way through recording) and for many this album is seen as the turning point that took them from burgeoning metal band to pop-star sellouts. Given the sales figures that accompanied both this and Hysteria, it’s kind of hard to blame the guys though.
As for me, it’s hard to really listen to Pyromania with a truly critical ear given its arrival in my life at such a pivotal moment and the way it truly shaped my listening habits going forward. This album with all its crunchy guitars and attitude was the gateway that lead me to discover bands like Kiss, Quiet Riot, Ratt, and the Scorpions, and then later true metal acts like Iron Maiden and Metallica. It solidified my undying love of heavy guitar riffs and melodic songs that packed a punch. It’s really not hard to trace so much of what I own and listen to today back to this very first purchase. You only get one chance at something like that and I thank the rock n’ roll gods that my mother wasn’t there to steer me towards The Carpenters section, thus ruining what has been a lifetime of rock majesty. Rock Of Ages indeed.
ALBUM RATING 10.
1) Rock Rock (Till You Drop)
7) Rock Of Ages
8) Comin’ Under Fire
9) Action! Not Words
10) Billy’s Got A Gun
Joe Elliot (V), Steve Clark (G), Phil Collen (G), Pete Willis (G), Rick Savage (B), Rick Allen (D)
Produced by Robert John “Mutt” Lange

domain: hobby


Emphasizing musicians’ gender is an increasingly debatable practice. After all, “female” isn’t a genre. Still, though, we here at ’77 Music Club believe that women have made incredible contributions to music that, for too long, have lingered in the shadows of their male peers. We’ve strived to have a hand in the telling of musical stories from a different perspective in all of our episodes; often, that means gravitating towards telling stories about other women.
Earlier this year, we celebrated International Women’s Day with an excessively long Twitter thread lauding some of our many favorite women who have made (and continue to make) music that has shaped our world. Today, we’re back to soundtrack IWD’s sister holiday, International Day of the Girl. We rounded up our favorite episodes featuring women who have challenged the status quo and let the world know that you don’t need to be a generic white dude to make some goddamn great music. These women have inspired countless girls to pick up guitars or basses or microphones and speak their truths. Tune in, turn it up, and join our musical girl gang. If we get enough people, we’re getting jackets.
Episode 1: Buckingham Nicks – Buckingham Nicks
Episode 2: Betty Davis – They Say I’m Different
Episode 4: Tom Tom Club – Tom Tom Club
Episode 13: Grace Jones – Nightclubbing
Episode 15: Carole King – Music
Episode 2.4: Fleetwood Mac – Tango in the Night
Episode 2.5: Blondie – Parallel Lines
Episode 2.6: Joni Mitchell – “River”
Episode 2.7: Patti Smith – Easter
Episode 2.10: Siouxsie and the Banshees – Juju
Episode 3.1: Laura Nyro – Eli and the Thirteenth Confession
Episode 3.2: Viv Albertine discusses The Slits, Dionne Warwick, feminism, and more
Episode 3.4: Nico – The Marble Index
“River” – Joni Mitchell – Reprise – 1971
“It’s comin’ on Christmas, they’re cutting down trees. They’re putting up reindeer and singing songs of joy and peace. Oh, I wish I had a river I could skate away on.”
In 1970, while at work on what would be one of her greatest pieces of work, Blue, Joni Mitchell wrote lyrics to “River,” an achingly confessional song of longing and loss that just happened to be set during the holiday season. In the ensuing decades, it took on a life of its own, accidentally entering into and securing a spot in the Christmas music canon as a modern classic. An unconventional carol, its heartbreak has served as a touchstone for all those bereft during what is proclaimed to be the most wonderful time of the year, a deeply personal song that has become a universal reassurance that it’s okay to not be okay.
In this special holiday episode, we unpack Joni Mitchell’s iconic song and its history and meaning beyond its attachment to Christmas, discuss the pop culture circumstances that allowed for it to be adopted by the holiday, and why it has remained a source of comfort for a vast array of people this time of year.
Listen to River: iTunes | Spotify | YouTube
Episode notes and postscript correction
- It’s pretty hard to write a new Christmas song that will make it into the Christmas canon — check out our master playlist for a few examples.
- See our further reading links below for some more deep reads about how “River” came to represent Christmas.
- Here’s one essential appearance in pop culture that helped cement its place in Christmas.
- Sometimes it’s nice to just listen to music that makes you feel your feels. Here’s a playlist for that.
- And, yes, if you feel like it, a 37 track long playlist that’s just “River” on repeat actually exists.
- Many thanks to all who have listened to our podcast this year, especially to those who have shared it or have reached out to us to talk about this music we love (and so much more). You all made this a small glimmer of goodness in an otherwise garbage fire of a year, and we hope we provided a little bit of the same relief to you, as well.
“River” live at the Royal Albert Hall (no visuals, just audio) | 1970
‘River,’ the ‘thoroughly depressing’ Joni Mitchell song that somehow became a Christmas classic | Washington Post (December 2016)
The Music Midnight Makes: In Conversation With Joni Mitchell | NPR (December 2014)
The Only Covers of Joni Mitchell’s “River” You Need | MTV (December 2012)


Redevelopment Needs Public Scrutiny
At the time, an ambitious concept called “Downtown Station South” was under discussion. It involved a large area between the main train station and East Seventh Street, but was attracting little public notice. I was paying attention because the needs study included the building where I have lived since 1992. In the end, my building was not declared in need of redevelopment, but most of the target area was and still is considered in need of redevelopment based on certain criteria which open it to taking by eminent domain.
After the June 2005 primary, redevelopment plans went into abeyance until the new administration took over in January 2006. By mid-2006, redevelopment activity was entrusted to the Union County Improvement Authority, whose executive director is Union County Democratic Party Chairman Charlotte DeFilippo. Several new proposals soon joined the dozen or so left over from the previous administration, most involving condo development near train stations.
Certainly the blog had other topics of interest to Plainfielders over the months since June 2005, but redevelopment in all its phases has remained a centerpiece.
A private proposal to build a senior center topped by three floors of condos has advanced through site plan approval. Other proposals are following the state redevelopment process with steps that can lead to use of eminent domain to clear a tract for an approved project.
In these days of hard decisions for newspapers, Plaintalker has an advantage in being able to commit the time necessary to follow redevelopment closely and report on it in detail. Of course, it is all voluntary and is still driven by this writer’s feeling that the public needs to know what is going on. Public hearings are part of the redevelopment process, but can become an empty formality if residents are uninformed on the proposals.
So how does anyone find out what is going on with redevelopment? City Council and Planning Board agendas offer clues. Legal notices alert citizens that they may examine applications on file at City Hall. Documents available under the Open Public Records Act give more details. Once a developer is known, his track record can be looked up. Residents can attend meetings to hear what the developer has to say. Eventually, larger concepts such as smart growth or transit-oriented development emerge as themes.
Only a few citizens have the time or inclination to do all that. But these proposals to add hundreds of new condos – and cars – to the city could drastically alter daily life as we know it.
Since June 2005, Plaintalker has posted more than 550 entries on various aspects of life in the Queen City. Currently, it is a solo operation. Right now, this writer needs a break.
But then along comes another legal notice. It's about a hearing on a possible expansion of the North Avenue redevelopment tract to include most of the PNC Bank block and the south half of the block bordered by East Front and East Second streets and Park and Watchung avenues. I’m interested because both of my downtown banks may be affected. I’ve also seen a reference to a 500-car parking garage in an expanded North Avenue tract. The company that has conditional designation to redevelop the blocks by the main train station has proposed hundreds of new condos as well as an entertainment center to draw visitors from all over the metropolitan area.
The hearing is 8 p.m. April 19 in City Hall Library "at which time any interested person or any person who would be affected by a determination that the delineated area is a redevelopment area may be heard."
Hmmm. Guess I better check it out for the blog.


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Travelers not wanting a good dose of skin cancer causing x-rays, not wanting their naked body pictures shared among lonely government agents or being groped by TSA agents should stay far away from American airports.
TSA boss John S. Pistole testified before Congress saying the TSA will enforce the new policies despite complaints that the search methods are too invasive and a violation of the Fourth Amendment. I believe these technologies being rolled out today worldwide are a pre-cursor of the end-time antichrist system of command and control as described in Revelation 13:16-17.
When you enter an American airport these days and purchase an airline ticket, you are relinquishing your Constitutional rights and are no longer protected by the Bill of Rights.
The TSA warns that any “would-be commercial airline passenger” who enters an airport checkpoint and refuses to be subjected to “the method of inspection designated by the TSA will not be allowed to fly and also will not be permitted to simply leave the airport.”
The TSA has warned Americans that they may be arrested and fined $11,000 if they refuse to cooperate with the agency’s invasive and humiliating techniques.
“Once a person submits to the screening process, they can not just decide to leave that process,” Sari Koshetz, regional TSA spokesperson, told the Palm Beach Post. The policy includes people who decide not to fly. The TSA will work with local police in order to make sure the person remains on the premises and answers questions. “Anyone refusing faces fines up to $11,000 and possible arrest.”
“All of us have a right to travel without such crude invasions of our privacy,” the ACLU said in a statement. “You shouldn’t have to check your rights when you check your luggage.”
Perhaps we should all take the advice of the former Department of Homeland Security Secretary, Janet Napolitano, and if you don’t want to pass through an airport scanner that allows security agents to see an image of your naked body or to undergo the alternative, a thorough manual search, you may have to find another way to travel.
Tell the TSA and the airlines, “Hell no, I won’t go.”
Rep. Duncan Blasts TSA “Pat Downs,” Scanners on House Floor


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Individual Psychological Therapy
Please click on the link below if you are seeking support in the form of a talking therapy.
There is information about your first appointment and what this may involve. We also have information about the range of therapeutic approaches we offer as part of treatment.
We currently offer appointments through different methods including:
- Face to Face Therapy
- Telephone Therapy
- Video Therapy (Skype or Zoom)
Information to follow

domain: psychology


'I Like To Dance', the new song from Sydney artist Alex The Astronaut, tells the story of an unnamed, hypothetical woman who experiences violence at the hands of her partner. “You scream ‘Why don’t you leave!’ / My kids are two and three / I just can’t pay for what they need / We both know he’d find me,” Alex sings.
This song isn't Alex's story: she wrote the song after a social encounter with a magistrate, who told Alex that he saw a devastating amount of cases of domestic violence each week. Alex spoke to her friends and realised how many of them had experienced domestic violence themselves.
One in three Australian women has experienced physical violence; one woman a week is murdered by a current or former partner. With this story, Alex zooms in on the experience of the women behind those statistics and brings into view the women who should be known for their strength, kindness, talents, and dreams, not the violence that they've experienced.
A talented footballer Alex moved from Sydney to New York on a soccer scholarship in 2017 and studied Maths and Physics at Long Island University. It was while she was in the US that she turned a streak of bold new life experiences into songs under the name Alex the Astronaut.Superficially her music is naive and off-the-cuff, on second listen it is honed and worldly, its quirks and melodic ticks revealing tough themes and darker sentiments.
European Live Dates:
11th AUGUST - GLASGOW, Broadcast, UK
14th AUGUST - LONDON, Assembly Camden, UK


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We are society, and more than that, we are the change. We hold in our hands the potential for a better future. We’ve been systematically conditioned in our right to be alive, and in our capacity to explore our human potential. Without realizing, we’ve slowly become trapped in a vicious circle, a subjugating system. What does it mean to have a normal life anymore? Where are we heading for? Question everything and emancipate your mind. Learn to see behind the social veil, and understand the big picture. Awakening is an inside job !!
Knowledge is empowering !!

domain: sociology


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08 Feb Procrastination to Productivity
How many times have we caught ourselves thinking “I should really do that” but we divert our attention somewhere else or ignore “that” all together? I am sure if we are being honest, we have all procrastinated, pushing “that” off one-to-many times. That’s why today we want to talk about some of the best way to turn procrastination into productivity.
Start small. We all come across projects we dread and want to push off. Whether we fear failure, or we simply don’t know where to begin. The key here is to start small, by breaking the project up into smaller goals/objectives we instantly make the project feel more doable. By doing this we can accomplish each of the little goals/objectives faster making us feel more productive and tricking our brain into continue forward with the project. Suddenly, the procrastination turns into productivity because we have effectively removed the barrier that was making us feel overwhelmed.
Make a list. Making a list puts our goals right in front of us and forces us to focus on the day ahead. A list proves to be a great reminder that the tasks of the day are doable, it allows us to sperate our tasks out and can be a great planning tool. Let’s take something as simple as cleaning the house. Looking around at all the things needed to be done before the house can be considered clean can get overwhelming but by taking 5 minutes to sit down and write it all down. I.e. laundry, dust, sweep, vacuum and mop we can see that’s only 5 things which seem way more achievable. This same strategy applies at work, there are days we have some much on our plate that needs to be completed. Making a list of the task ahead can help organize the brain opening ourselves for more productivity.
Limit distractions. In today’s world there are endless distractions that aid in procrastination. Maybe we think we are going to sit for a minute and watch a video on our phone but before you know it 15 minutes has passed. By limiting our distractions, we can turn that time into productivity. Some ways to limit distractions are, turn off the phones and social media, find a quiet room away from other people and create a dedicated workspace.
When hitting a wall with a project, trying to move. Talking a walk or exercising can immediately energize the body and mind. Not only is it good for our body and mind but it can spur creativity and possibly get us to a breakthrough.
Let’s try these tips and all watch our productivity reach new heights!


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FXUS65 KFGZ 130330
Area Forecast Discussion
National Weather Service Flagstaff AZ
830 PM MST Tue Dec 12 2017
.SYNOPSIS...A series of dry weather disturbances will brush
northern Arizona over the coming days. Wednesday will provide
another day of mild weather before a cold front brings breezy and
colder weather on Thursday. For Friday, temperatures will warm
some before yet another cold front ushers in windy and colder
weather later on Saturday through Monday.
.UPDATE...Clear skies and cold temperatures are in store
overnight. No forecast updates are needed at this time.
.PREV DISCUSSION /244 PM MST/...Over the coming week Arizona will
tend to be positioned between high pressure along the west coast
of the United States and a general low pressure trough to the
east. The main impact of this pattern will be that a series of
dry weather systems will brush the state bringing periods of
colder and windy conditions.
For tonight and Wednesday...A mild northerly flow regime will
remain over northern Arizona producing light winds, clear skies,
above normal daytime temperatures and below normal overnight
On Thursday...A fast moving shortwave trough and associated cold
front will move across much of Arizona from north to south. The
result in northern portions of the state will be daytime
temperatures 5 to 10 degrees cooler and northeast winds at 10 to
20 mph locally gusting to over 30 mph with stronger pressure
gradients behind the cold front. The strongest winds will be
found along and south of the Mogollon Rim and are expected to last
through Thursday night.
From Friday into next Monday...Temperatures will warm some on
Friday as the cold front moves eastward. However, another
shortwave disturbance will approach Arizona. Winds will generally
remain light on Friday but as the shortwave approaches on Saturday
pressure gradients will support afternoon southwest winds in the
10 to 20 mph range. Temperatures will remain a bit above normal
both days. From Saturday night into Monday, yet another cold
front will cross the area with daytime temperatures dipping to
near to below normal levels. Associated with the cold frontal
passage another round of gusty northeast winds will develop. With
little moisture to work with no precipitation is expected.
For the 00Z package...VFR conditions are expected for the next 24
hour period. Expect winds to be light and easterly becoming more
variable overnight at 5 to 10 kts under clear skies. Aviation
discussion not updated for TAF amendments.
.AVIATION...For the 06Z package...VFR conditions are expected for
the next 24 hour period with clear skies and light winds of 10 kts
or less. Aviation discussion not updated for TAF amendments.
.FIRE WEATHER...On Wednesday, expect similar conditions compared
to Tuesday as the upper air pattern remains unchanged. Maximum
temperatures will be 8 to 15 degrees above normal. Poor to marginal
ventilation values to persist. On Thursday, a dry cold front to
sweep southward through the northland. Strong northeast winds to
develop Thursday afternoon and continue overnight across areas along
and south of the Mogollon Rim.
Friday through Sunday...Northeast winds to slowly diminish on
Friday. Another dry front may move through from north to south over
the weekend. Cooler temperatures are possible, especially across
For Northern Arizona weather information visit


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Curating the best monochromatic graphic design from around the world. Pick a color family and get inspired.
About // Topswatch is the only blog dedicated to discovering the best monochromatic design from around the world and sharing it with you. The blog is run by four graduates of Tyler School of Art.
Max Amato never loses his temper, unless he loses a game of ping-pong. Though many designers try to follow in his footsteps, they simply can’t because he has too many shoes. Favorite swatch: PMS 572C. Portfolio: www.maxamato.com
Nicholas Lomboy’s bedhead has inspired many a designer to throw away their conditioner and comb. Preferring the road less traveled, he aspires to skate switch. Favorite swatch: PMS 485C. Portfolio: www.nicholaslomboy.com
Brendan Mcauliffe is our rep from the Pacific Northwest. A world explorer, his favorite method of transportation is his bike, Josie (like the Blink song). Favorite swatch: PMS 651C.Portfolio: http://www.brendanmcauliffe.com/
Justin Nowak spends his free time playing first-person shooters while cuddling with his hamster, Snuggles. An aspiring egg chef, he still has Dominoes on his speed dial. Favorite swatch: PMS 7494C. Portfolio: www.nowakcreative.com
As a Maryland native, I've been inspired by the work of Baltimore-based Post Typography for quite some time. One particularly Topswatch-relevant project is their environmental design for MICA Career Development. Along with a series of icons and numeral designs, the folks at Post Typography created a system of wall graphics that perfectly illustrate the progress and possibility that become accessible through MICA's career development program. Be sure to check out the rest of Post Typography's extremely diverse portfolio.

domain: artistic


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Eyes on a Cure: Patient & Caregiver Symposium
Save the Date!
The 2024 Eyes on a Cure: Ocular Melanoma Patient & Caregiver Symposium will be on May 3-5, 2024 in Boston, MA! Join OM patients and caregivers from across the US for three days of learning about the latest news in research and treatment development, OM education, patient support resources and more. Participants are also invited to join the Miles for Melanoma Boston 5k on the morning of Saturday, May 4 to raise funds and increase OM awareness in the broader melanoma community. More details about each event will be available in the near future; mark your calendars today and we look forward to seeing you in Boston!


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Skye Tunes has been doing her thing for a while, and is a hard-working entertainer hailing from Houston, TX. She’s definitely not new to this, but true to the industry. When Tunes was just 16, she was in a band called “Sophia Fresh” which later received the attention of the legendary Clive Davis at J Records. She has worked with some of the hottest artists in the industry such as Chris Brown, T-Pain, Eric Bellinger, YG, and Ty Dolla $, to name a few. She has internationally toured as a solo artist with rapper/singer T-Pain, and recently finished a U.S. tour performing with Grammy Nominated rapper/actor/exec. producer T.I. She’s graced the stages of both Jay Leno’s The Tonight Show and the Jimmy Kimmel Show. Currently, she tours with Je’caryous Johnson’s national theater production company for Redemption of a Dogg starring the legendary Snoop Dogg and Tamar Braxton.
We had a fabulous time chatting with Ms. Tunes on everything that she has been working on and what she has coming up next with some of the hottest artists in the industry.
MillBuzz: We know you are in the play, with Snoop Dogg, Redemption of a Dogg, how has it been to work alongside of a hip-hop mogul? And what role do you play?
Tunes: My role, well I will get into how it was in a second. But my role, I was one of the girls that his wife kind of despised. The whole play is about the real story of Snoop’s life; the redemption story. It tells you everything you questioned the past two decades, about what really happened in his marriage. So, my role was one of the girls that was always hanging at the studio. I was a dancer, maybe he did things with those girls or whatever. It doesn’t get too detailed in the actual play, but that’s the actual role I played along with two other girls. Working alongside someone like that is nothing short of a blessing. He is so wise and so smart, and to come from being the number one gangster rapper back in the day, and still now being relevant in today’s hip-hop and social media today. He’s got a huge social media following. I just feel blessed and I am very inspired. He really does live his best life every single day, so that song, that’s how he is high or not high, even though he’s always high, he’s always so positive, so inspiring, and he’s everyone’s Uncle. He has everyone calling him Uncle Snoop. It’s a blessing.
MillBuzz: You are doing your thing and have worked with quite a few amazing people, let’s talk about your favorite person that you’ve worked with so far?
Tunes: To name one person is going to be kind of rough, because I have so many features. But I’ve worked for so many writers and producers. I used to be in a girl group, and we were executive produced by T-Pain. We had a deal with Atlantic Records. He’s such a genius as a writer, a singer, a rapper, and as a performer. I have to put him in his top five as far as creating music with somebody. Despite all the political things going on with Kanye, that was nothing short of a blessing, and a thrill. He is so talented. Outside of his personal beliefs, now that is someone who really made me feel like oh my God, I’m really doing this for real. I’d have to save Chris for last, because he is by far the most talented person I think I’ve ever so closely worked alongside of. He writes, he sings, he directs, he acts, he flips, and he dances. Chris does so many different things, and he’s still so young. Despite the controversy that he faces often, he still manages to remain relevant, and keeps three plus songs on the radio in rotation. He never misses a season of being hot, and that’s how I want to be. His bar is so high just like Beyonce who is from Houston, like me. Even if I’m not making music, at some point, I still want to be able to have the world love me and recognize me for more than just my music. Just like people recognize Beyonce and Chris for many things, I want the same thing. So, I would have to say Chris has been my favorite to work with thus far.
MillBuzz: Tell us about the path you’ve taken to get to where you are and how it feels to be recognized as one of the top talents out right now?
Tunes: So, coming from a girl group, well first let me go into how I was discovered. I must always give recognition to “Sophia Fresh”, the girl group that I was in. That was how I got active in the industry at a professional level. We got our first deal with Clive Davis at J records, when we were all young teenagers. We lost our deal at J records, and not even a month later we got signed to Atlantic Records, and they appointed T-Pain as our executive producer. Maybe about four years ago we decided to go our separate ways as a group because we had a lot of issues when it came to pay and the label agreeing on the sound. Nobody else was checking for girl groups and we kept trying to make music and shows and gain followers, but we are in a time now where people don’t really accept groups of boy bands and girl bands as they did before. We’ve been doing it for so long since we were little kids. We were real friends and sisters and were like okay it’s time to do something else. I have kept my relationships and I call people on holidays and birthdays, not just when I need something. So now I’ve built so many relationships with people that they respect, that now when I need a favor or something, they ask me to be a part of it. I’m able to go to them and have resources like Chris brown, DJ Khaled, and YG. I’m not new to this. I’ve been working in it professionally for so long. Transitioning from a girl group to a solo artist is a little bit difficult because I can’t look to my left or my right if I’m slacking, and I don’t have the energy, so I can’t feed off anybody but me. But the beauty in that is, if I rise or if I fail, it’s all on me. I can go out at the end of the day and win or lose, it was my idea, and I put my whole idea and creativity into this and this is my baby, this is Skye. You can see exactly who I am. Sometimes in a group some of the songs are not you, it might be what your group member is going through, or you must dumb certain things down for certain things, and now I can be Skye all the time, and show the world who I am as an individual.
MillBuzz: Let’s talk about “Fairytale”. You got to work with Chris Brown and DJ Khaled. Tell me what that song means to you and how that experience has shaped you moving forward?
Tunes: I met DJ Khaled a long time ago when I was in the group. He is still very close to T-Pain who I was signed to, and we lived in Miami for a while, like a year and a half. He would always be at Hit Factory or Circle House Studio, and he would always remember us because we always had crazy colored hair and were loud and just country or whatever. So, I didn’t bring Khaled on this record, Chris did. Khaled didn’t produce this record, I know a lot of people ask. But when he was asked to get on, it was nothing short of “of course”. He remembers, and like I said, I keep my relationships close. Now with “Fairytale”, its basically as a woman or a man, girl or boy, we all have our sisters, brothers, and friends telling us don’t talk to this guy or girl, and you’re basically saying I believe this fairytale. For me I feel like everyone has a different ending of their story. But everyone does have a happy ending. I don’t know if you are familiar with Jada Pinkett’s Red Table Talk, but I think that is the prime example of my how fairytale might be different from the next person’s fairytale. I do believe in giving love a shot. Chris wrote the song, and we all know the controversy with his love life and past relationships, but it’s still like I don’t care what people are saying, I’m going to cancel out all the noise and I’m going to give you a shot and give love its fair chance and something beautiful can come of it. Instead of putting a negative touch on love, that’s me just trying to bring light to knocking out the kinks in love and making something work.
MillBuzz: Who are your inspirations and what made you start singing?
Tunes: I have a few. There are two people, a female and male who is of course Michael Jackson and Mariah Carey. When I saw Mariah Carey, I was like oh my God, that’s what I want to be. That’s how I want to do it, I want to touch the world just like her. Living in Houston, a lot of people were very familiar with Destiny’s Child, which is why I got into a girl group. Destiny’s Child and Beyonce both inspired me so much to keep going. I grew up a street over from Beyonce, so to see where she is now, and we came from the same place, it made me feel like I could do that too. Its confirmation of hope when I see all the things she is doing. She’s an icon and actually bigger than an icon. The movie Bohemian Rhapsody is out right now, and I just saw it the other day. It was so inspiring, and I like to tell people when they ask me what’s my genre and targeted audience, I say I make real music just like the band Queen. I don’t limit myself to the urban world. I don’t limit myself to just being a pop star. I want to make music for everybody and I think that people like Beyonce, Rihanna, Michael Jackson, and Queen because they make music for everyone, not just one small group of people or not just one area. I’m black but I want to reach more than just my people.
MillBuzz: What’s next for Skye? Anything that we should be looking out for?
Tunes: Right now, I am working on a full album. I will be dropping more music soon after the top of the year. I’m going to drop a surprise song at the end of this week, and a Christmas song in December. But there’s so much more to Skye. I have features by Ty Dolla, YG, and Eric Bellinger. I have a lot of stuff that’s waiting for the world to experience everything that I’ve been working on. So, you’ll definitely get a couple more songs before I put out the full project.
To stay connected to Tunes, follow her on social media @SkyeTunes.


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Why do white starches get a bad rap???
Updated: Aug 20, 2019
Flour used to be many by grinding wheat between 2 stones; this wheat contained all of the wheat (seed, bran, germ). It was dense and tougher to chew. Removing the bran and germ made bread softer and was an expensive luxury (expensive because it took a lot of work and time to do this). Sometime in the 19th cnetury they began milling the wheat so the bran and grain would drop to the bottom (and fed to cattle). In return they could rapidly produce this "softer" bread for a fraction of the price. The part that's left after is mostly carbohydrates, which turns into glucose (which is important but like everything, it's best in moderation). White flour has an indefinite shelf life wheel wheat flour can turn rancid because it still contains all the good stuff. In a nutshell, you should choose the brown stuff because it still has most of it's nutrients!


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If you feel awkward interacting with homeless people, you may not be alone. This list breaks down homeless etiquette to help you navigate interactions with homeless people. After all, there's no reason to feel awkward - homeless people are just as human as the next person, and deserve the level of courtesy and respect afforded to strangers and passerbys.
Cities with the highest rates of homelessness tend to be over-populated cities with warm temperatures, like Los Angeles, San Diego, Honolulu, and Las Vegas. New York City, Washington D.C., and Chicago experience their fairs hare of the homeless population as well. Unfortunately, these places have resorted to some inhumane methods to hide homeless in cities, such as installing spikes where people sleep and making less comfortable benches.
With population rates rising and no signs of homelessness decreasing, knowing exactly how to socialize with homeless people is a valuable skill. Check out this list of do's and do not's make that next conversation with a homeless person go smoother for both parties.
Don’t Avert Your Eyes And Pretend They’re Not Even There
If homeless people make you feel uncomfortable, your initial reaction may be to advert your eyes and walk right by. In fact, many people will simply pretend homeless people aren’t even there, simply because they don’t know how to deal with the situation. This can leave the homeless person feeling subhuman. As one man recounted, "It’s like being invisible. The non-homeless person almost never looks the homeless in the eye. If you just look a person in the eye and sort of nod, it’s the most respectful thing you can ever do."
Do Acknowledge Their Presence, Make Eye Contact, And Smile
So, now you know that you shouldn’t straight-up ignore homeless people, even if they make you uncomfortable. But what should you do? Well, treat them like you would any other human being: acknowledge their presence. Look their way and nod your head, maybe even smile. Yes, smile. Offering a warm smile to a person living on the streets can make their day. Greeting people on the street is a normal and healthy societal behavior that shouldn't exclude homeless people.
Do Initiate Conversation Through Questions
If you have time to have a short conversation with a homeless person, it’s suggested that you initiate conversation through polite questions as opposed to assuming they want to talk to you. Contrary to popular belief, not every homeless person will be completely up for chit chat. It’s best to approach the situation through questions, which allow you to gage just how much this person actually wants you to talk to them.
Of course, there are some questions that work better for others. You could start with an open-ended, "How are you today?" "Lovely weather, isn't it?" or simply, "Would you like to talk?"
Don’t Try To Make Any Weird Jokes
If you are trying to initiate a conversation with a homeless person, it's best to not start it off with a weird joke. They’ve definitely heard all the weird jokes before and, news flash, they aren’t that funny. One homeless man recounted his experiences with jokesters, describing how they would say, "Can't get a job, mate?" and laugh.
Even if your joke if lighthearted, don’t make any jokes that can be taken the wrong way.


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Rathnew is a large rath, with a deep embankment and fosse and a smaller, conjoined section about half its size on its western quarter. Not much remains of the houses that once stood here, but there is much of intrigue to make the megalithic adventurer happy.
In the western 'annex' is a circle of low stones, mostly embedded into the ground, some proud of the ground by about a maximum of 20 cms. It's about 5 metres in diameter with a standing stone at its centre. This stone is about three quarters of a metre tall and is a place for offerings, coins of varying worth on the day I visited. MacAllister notes it as a "dolmen-like stone". Like a few places on Uisneach that day, it had a magical air about it. It also must be pointed out that the ring is probably modern, as mentioned elsewhere and it doesn't appear in MacAllister and Praeger's plan.
The annex has two entrances, at the west and south. The defensive works here are impressive – an outer bank, a fosse (now darkened and alley-like under the covering trees) and an inner bank. The fosse continues onto the bigger part of the rath at the north, but starts to fill up fairly quickly in this sector.
Slightly north of east, there is an opening, with two seeming jambstones or gate stones. South of the entrance the fosse clears out again. Inside this large rath there are the remains of habitation structures, one of which MacAllister and Praeger excavated and left with quite an extensive plan. In its western sector, before it meets the annex, is a souterrain, now filled in and inaccessible. Pity.
This is a fascinating place, somewhere I'd like to explore in greater depth, and intend to do so now that I have the plans of the place.
Entry on the National Monuments database, interesting because it lists the monuments on the Hill of Uisneach (I believe there are more):
Description: One of a cluster of monuments situated on the Hill of Uisneach. Nearby monuments include a barrow (WM024-173----) 200m to the N, an earthwork (WM024-068) is 390m to the SE, an ancient road (WM024-067) runs onto the S side of the monument, a ringfort (WM024-063) and holy well (WM024-60) are located 390m to the SSW, an earthwork (WM024-065) is 290m to the W, a second earthwork (WM024-062) is 270m to the WNW, a pond (WM024-064002-) is 170m to the NW. The monument was described in 1963 as a 'large pair of conjoined ringforts, with hut-foundations (WM024-066002-) visible in the either part' (SMR file 1963). This ringfort was excavated in 1925-8 by R. A. S. Macalister, who believed that the larger ringfort was the mythological 'palace of Tuathal Techtmar'. On the 1837 edition of the OS 6-inch map the monument is depicted as a large circular ringfort with D-shaped annexe on the E side of the ringfort. On this map a 'Cave' or souterrain is annotated and depicted in the centre of the ringfort, the E quadrant of the ringfort interior has been divided into two small areas defined by earthen banks which run off the N & E side of a rectangular shaped platform located in the S quadrant of the ringfort. This rectangular platform appears to be the foundations of a hut site. A second possible hut site is depicted in the centre of the W annexe on the 1837 edition of the OS 6-inch map.
Compiled by: Caimin O'Brien
Date of upload: 26 January 2011

domain: history


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When a patient requires CPR it is literally a life or death situation! Ensure the greatest possible outcome for your patients by utilizing the most up-to-date technology in medical treatment.
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Jim Jordan wrote a damn novel telling the Jan. 6 committee to screw off
Next time just RSVP “no,” dude.
If, as they’re widely expected to do, Republicans manage to wrest majority control of Congress from the pliant, unresponsive hands of the Democrats, there’s a not insignificant chance that Ohio Rep. Jim Jordan — he of “credibly accused of ignoring a prolific sex abuse scandal” fame — will become the next speaker of the House. Given that likelihood, you almost have to respect the transparent chutzpah on display in his just-released letter to the House committee investigating the Jan. 6 insurrection.
Insisting that “I have no relevant information that would assist the select committee in advancing any legitimate legislative purpose,” Jordan rambles on in his letter for several paragraphs of self- pity and indignation in the sort of performative outrage that comes from someone who definitely doesn’t have anything to hide, nope, no siree, nuh-uh. Beside, as Jordan made clear in his missive, “[e]ven if I had information to share with the select committee, the actions and statements of Democrats in the House of Representatives show that you are not conducting a fair-minded and objective inquiry.”
Just what, exactly, can we learn from Jordan’s novella? Nestled within his barrage of rhetorical “neener neener neeners” are a few key takeaways. Among them:
- The man who would be speaker thinks he can pick and choose which congressional committees he believes in, which doesn’t bode well for imagining his potential tenure as the third-most powerful elected official in the country.
- Jordan is a master of flooding the zone with enough obfuscation, whataboutism, and official-sounding legalese to almost — almost! — make a casual reader forget that he’s being asked to comply because, per the committee itself, he “had at least one and possibly multiple communications with President Trump on Jan. 6” and also might possess “information about meetings with White House officials and the then-President in November and December 2020, and early January 2021, about strategies for overturning the results of the 2020 election.”
- This is someone who has no remorse for his vote against certifying Joe Biden’s electoral victory, and in fact apparently doesn’t even feel any political pressure to downplay it. Which is to say: Jordan remains a proud seditionist, even while insisting he’s got nothing to hide, and wouldn’t share his seditionist secrets to begin with.
Jordan had initially been scheduled to meet with the Jan. 6 committee after they reached out to him at the end of last year. At the time, the chairman of the committee, Mississippi Rep. Bennie Thompson (D), noted in his request for Jordan’s cooperation that “We would also like to ask you about any discussions involving the possibility of presidential pardons for individuals involved in any aspect of Jan. 6 or the planning for Jan. 6.” Late last year. Rolling Stone reported that Rep. Paul Gosar (R-Ariz.), an unapologetic white nationalist and enthusiastic seditionist, had promised Jan. 6 organizers blanket pardons from Trump for unrelated charges, as enticement for coordinating the rally-cum-riot.
In a statement to NBC News, a spokesperson for the Jan. 6 committee criticized Jordan’s apparent about-face on agreeing to participate with their investigative work, saying, “Mr. Jordan has admitted that he spoke directly to President Trump on Jan. 6 and is thus a material witness.”
“Mr. Jordan has previously said that he would cooperate with the committee’s investigation,” they continued. “But it now appears that the Trump team has persuaded him to try to hide the facts and circumstances.”
In Republican politics, that’s called “planning ahead.”


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Wonderful album full of great message songs including:
We can touch the World
I choose you
God wants to hear you sing
to list a few.
Her beautiful saprano voice delivers smooth songs with great lyrics.
A must for any Christian album collection
Click here to add a video. Click to add lyrics if not listed.