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Autographed Copies Available!
Book Jacket Description
From the moment writer Jenny Ceretti spots Susan Fredrickson at the Village Coffeehouse, her serene life begins to change. As their friendship explodes into a tempestuous love affair, Jenny discovers that all is not as it appears. While Susan is haunted by a terrifying past, Jenny comes face-to-face with past ghosts that no longer will stay hidden. Sweet Bitter Love explores a relationship that walks the fine line between compassion and co-dependence.
What People Are Saying . . .
Sweet Bitter Love by Rita Schiano This is a perfect title. It is sweet love, it is bitter love, and it is love. It also has some explicit lesbian love scenes, they are beautifully presented but you should know they are there if they would bother you. The main character, Jenny, is a writer and copy editor. The love of her life left her a year ago and she is now semi-open to a new relationship. Her friend Diane is a therapist living with Jenny's best friend Janey. Diane says something that I really find insightful and applies to everyone, we tend to search out relationships that mimic our childhood relationships until we get it right or have worked through the hurt and come out the other side. Good stuff. The relationship that Jenny develops involves love, alcoholism, Al Anon, obsession, deep emotional thoughts, and growth. The character is well written and well developed. I could feel her emotions, and understand them, even when I wanted to tell her to get on with it. But that's the sign of good writing, wanting to tell the character to grow up and get on with life. It's an interaction. I would recommend this book if you don't mind the lesbian aspect. - posted by Wyn Is Reading Books
"Sexy, passionate, and humorous, the book is a great 'fast read'." - Linda Wong, Sojourner
...Schiano captures the passion, pain and fragility of modern day romantic relationships...Readers will cycle through feelings of joy, bitterness, excitement and anger as they learn how and why the relationship unfolds as it does...Schiano presents this dramatic tale of love, pain and soul-searching in clear, easy-to-read prose with an energizing style that dares the reader to set the book down. Highly recommended! - Susan Phelps, author, A Lady Without a Latitude
Schiano serves up passion, courage, and clear-eyed honesty in this dramatic debut novel. A roller-coaster romance which vividly captures the rhythm and feel of love's sometimes rocky ride. - Womankind Books, New York
The reader sees the relationship from Jenny's point of view, from her beginning fascination with Susan, through to the end. It is an interesting look into the highs and lows of life with an alcoholic...This is not an easy subject ...It is, however, a situation common to many. Schiano has opened the door to an important subject that few want to discuss.
- R. Lynne Watson, Mega Scene, Palm Springs, Vol. #14
This is a debut novel by Rita Schiano - passionate, courageous and dramatic. Definitely a name to remember. When's the next book out? - ScotsGay Magazine, Scotland

domain: literature


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Today’s big story from Washington will be the release of a “comprehensive plan” for re-regulating the world of finance. The White House floated out an 85-page paper evidently meant to serve as a blueprint for a new regulatory structure. In keeping with this administration’s model of management-by-trial-balloon, the report appears in this morning’s New York Times and Washington Post.
It may not be worth examining the document in great detail, because (again in keeping with Obama standard practice) it most of the implementation details to Congress. So what is in here isn’t going to be close to what we’ll eventually get. But there are several things to note about the process and the philosophy at work.
The single most illustrative thing isn’t in the document at all, but in Obama’s own remarks, delivered in his trademark halting, somewhat diffident manner. The New York Times quotes him as saying:
Did you know, any considerations of sort of politics play into it? We want to get this thing passed, and, you know, we think that speed is important. We want to do it right. We want to do it carefully. But we don’t want to tilt at windmills.
In other words, it’s more important to get something out there and move on than it is to get it right. The president wants to do this quick and dirty.
You heard the same thing in January about the economic stimulus package. You heard it with the GM and Chrysler bankruptcy. You can see it in the president’s impatient desire to disengage from the truly hard problems in foreign policy, which have no quick and dirty solutions. And most of all, you see it in health care, which the president wants to completely reform before the end of July.
What was the process by which this paper was produced? It bears absolutely no marks of authorship. If Tim Geithner is the principal architect, his fingerprints don’t show. What Obama evidently did was to give every stakeholder in the financial industry a chance to express their desired outcome. Then he applied a political filter (“who are the people with the most powerful Senators on their side?”). And then he averaged the result.
What is the operative philosophy at work here? It’s evident from the paper that the blame for the financial crisis is being placed squarely on a lack of proper oversight by Federal regulators, of both financial firms and of financial markets. There’s no recognition of the role played by a powerful combination of low global interest rates caused by emerging-market reserve accumulation, together with rampant technical innovation that sharply increased the liquidity of financial instruments. There’s tangential recognition of the conflicted position of rating agencies, and also that there is such a thing as a “shadow banking system.”
But the real emphasis in the White House report is that there weren’t enough regulators minding the store, so they want to add a lot more of them. There is also a lot of talk about “protecting consumers and investors from financial abuse.” Now that’s so loaded that I don’t know where it really wants to go.
The bottom line is that the White House intends to tighten regulations on the financial system in accordance with the priorities of newspaper headline writers, while being careful not to step on the interests of the financial industry too much. An alternate, and preferable, approach would have been to take the time (even if measured in years) to actually understand the roots and the dynamics of the crisis and respond appropriately.

domain: finance


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Last June, at a time when it was clear the shitpile was a big fraud but before the perpetrators had destroyed the evidence, Michael Mukasey decided he’d rather play whack-a-mole with financial crime than pursuing it at a national level.
For some reason, Michael Mukasey doesn’t want to investigate and prosecute mortgage fraud using a comprehensive, centralized approach.
Attorney General Michael B. Mukasey rejected on Thursday the idea of creating a national task force to combat the country’s mortgage fraud crisis, calling the problem a localized one akin to “white-collar street crimes.”
Mr. Mukasey made clear that he saw the mortgage fraud problem at the root of the nation’s housing crisis as a serious one. But he said he was confident that the Justice Department’s current approach — using local prosecutors’ offices around the country to oversee separate F.B.I. investigations — was adequate.
Mr. Holder said the Justice Department is planning a new initiative to bring together federal and state prosecutors in combating financial fraud and white-collar crime.
"We will be working with them to come up with a way to deal with these fraud problems and white-collar problems. The federal government can’t do this alone," Mr. Holder said.
One change is likely to involve a task force on financial crime, akin to one that was organized during the Bush administration following the collapse of Enron Corp.
Mr. Holder’s predecessor in the Bush administration, Michael Mukasey, was disinclined generally to set up task forces because he thought they could be inefficient. He studied the idea of a national task force to focus on fraud and the mortgage crisis but decided against it because he said the crisis differed in various parts of the country.
Mr. Holder disagreed on the effectiveness of a national strategy and said an official announcement would be coming soon. "Based on my experience, I know that task forces work," he said, adding that state prosecutors have expertise on financial fraud that could benefit the federal government.
Gosh. What a novel idea. Investigating the "too big to fail" criminals at a level that’s almost as big as the crime.
And perhaps someday we’ll learn why Mukasey was so disinclined to focus federal attention on the shitpile just as it was about to collapse.

domain: law


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There is no question that some pain will certainly be experienced due to the fact that the location being dealt with has actually been constantly unpleasant. To relieve any signs, pain-killers can be taken just before you therapy if essential. Shockwave therapy is delivered straight onto the skin that covers the affected location. This type of pain alleviation therapy makes use of reduced energy audio, or acoustic, waves, instead of electrical waves. You may need to take regular pain alleviation medicine, which still doesn’t constantly eliminate your pain and pain, as well as can cause you to create adverse effects.
Many people experience chronic heel pain at some point, either via injury or the natural results of ageing. In ultimatemedgroup of however one of the most severe of instances would certainly surgical procedure be called for or even advisable. The potential of utilizing high strength acoustic wave as an efficient a non-surgical therapy has actually been comprehended for rather a long time. The degree of discomfort depends upon the type of injury, website of the injury and also exactly how agonizing or tender the location is before commencing the treatment.
In this evaluation, we discuss the concepts of ESWT, the pet as well as medical researches entailing the use of ESWT to deal with central as well as outer anxious system conditions, and also the suggested cellular and molecular mechanism of ESWT. We also talk about the obstacles came across when using ESWT to the human mind as well as spinal cord as well as the brand-new potential applications of ESWT in dealing with neurological problems. The generation of the shock wave is via a really concentrated impulse that targets the excruciating area. On a mobile degree shock wave treatment has been received researches to reduce the amount of nerve fibres that transfer agonizing impulses triggering a reduction hurting sensation.
Shock wave treatment is provided only when the various other traditional treatment methods such as remainder, pain drugs and also physical therapy do disappoint renovation even when utilized over a period of 6 months. Patients with moderate to extreme ED that do not respond to PDE-5 drug and rely on shots or various other topical treatments may come to be extra participant to PDE-5 medication after shockwave treatment. Many clients find substantial relief from shoulder discomfort, heel pain or Achilles tendon in simply eight to 10 days following the very first application. The acoustic waves advertised during the treatment promote recovery for several physical disorders including plantar fasciitis, tendonitis and also Achilles tendonitis.
Werner et al. additionally used fESWT to deal with mind stem (0.1 mJ/mm2, 4,000 pulses, 6 Hz) three times a week over 4 weeks with a penetration deepness of the emphasis of about 5.5 centimeters. Furthermore, the pet researches talked about over have also demonstrated the usefulness as well as safety of ESWT when it was employed to treat main nerve system illness. Because of the concerns regarding the potential damage to the human mind or spine by ESWT, couple of scientific researches were accomplished to explore the scientific use ESWT in the therapy of human central nerve system conditions. Nonetheless, pet studies have actually shown that ESWT worked when treating central nerve damage. Generally, analytical infarction and spine injury were the focus of the pet researches.
In 79% of individuals with death Shockwave treatment also enhances osteonecrosis of the femoral head. Calcifying tendinitis is a persistent uncomfortable problem that is characterized by calcifications in rotator cuff ligaments. Shockwave treatment is one of one of the most efficient treatments of calcifications. Acoustic waves create disruption of the calcified entities and also support their traction as well as removal by the body.
Schwann cells exert an important feature in the nervous system and also are also involved in nerve regeneration and repairment. It is thought that ESWT can initially cause ATP launch, boost purinergic receptors and trigger ERK1/2 signaling, and afterwards improve SCs spreading, ultimately promoting nerve regrowth. One more study additionally suggested that low-intensity ESWT played a role in the spreading of SCs using the activation of ERK/MAPK signaling and p75 neurotrophin receptor, making it possible for nerve regrowth. The spreading of SCs caused by ESWT leads to the upregulation of neurotrophic elements that are believed to improve the procedure of nerve regrowth as well as useful recuperation. Most individuals require 3 sessions of shockwave treatment, each a week apart, before substantial discomfort alleviation is seen.
And Kersh et al. have likewise shown that ESWT significantly increases angiogenesis in the shallow digital flexor ligament of steeds. The top quality of healing of the SDFT figures out whether the equine will certainly recover to near regular sports levels. Their research found substantially more blood vessels in the ESWT-treated ligaments than in the untreated controls. These rises in new members vessel development all suggest that ESWT can cause a valuable ligament recovery response.
This suggests that ESWT may subdue swelling by decreasing CGRP and SP. Nevertheless, unlike various other studies, the outcomes reported by Abed et al. located no histological adjustments in SP- and also CGRP-containing nerve fibers in lamb that got ESWT. It recommends that we still need a large buildup of evidence to prove whether ESWT can really suppress swelling by affecting CGRP and SP-positive nerve fibers. On the various other hand, tendinopathy can create discomfort, and also ESWT can alleviate the discomfort of tendinopathy by depleting SP. It was revealed that ESWT has analgesic effects comparable to capsaicin and can trigger SP deficiency by causing SP launch, which eventually creates analgesic results. This might explain the neighborhood discomfort and subsequent long lasting pain relief that takes place after shock wave application to tendinopathy.

domain: medical


The Spanish Ministry of Defence (MoD) has received its first THeMIS unmanned ground vehicle (UGV) from Estonia based Milrem Robotics.
The Spanish MoD’s Directorate General of Armament and Material awarded the contract to Madrid-based firm Paukner Group – Milrem Robotics’ representative in Spain. The vehicle was acquired under the aegis of the Spanish MoD’s Scorpion programme, launched in 2021 to evaluate the capabilities of UGVs.
The THeMIS is a medium tracked UGV capable of integrating a wide variety of mission systems. It has been acquired by the US, and it is the lead vehicle in the European Defence Fund’s continuing Integrated Modular Unmanned Ground System (iMUGS) programme for a common European UGV.


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Niels Posted April 20, 2022 Share Posted April 20, 2022 I am currently working on a project where the client has requested that we use the global horizontal irradiation, horizontal diffuse irradiation and wind temperature from PVGIS CMSAF. The client gave the following instructions which I followed: Start with the default PVGIS import “PVGIS:TMY Sarah,Cosmo or NSDRB” Then go to PVGIS (version 5.1): https://re.jrc.ec.europa.eu/pvg_tools/en/#api_5.1 to download the following monthly data (PVGIS-CMSAF) for the location: (i) Global horizontal irradiation; (ii) Diffuse/global ratio (use this to manualy calculate the monthly diffuse horizontal irradiation); (iii) Temperature; Then overwrite the first three columns in PVGIS with this external data. Windvelocity and humidity remain unchanged. I modified the site by going into choose site > open the specific site and changed the data in monthly meteo. This gave me a glob hor of 1134,7 a diffhor of 601,1 and an T_Amb of 10,8 Afterwards I ran the Pvsyst however on the main results page I can see that the used data is from the original PVGIS TMY import namely: globhor 1139,7 diffhor 557,4 and T_Amb 10,5 and not the modified version. Please advice on what went wrong and how I can get Pvsyst to use the modified data. Link to comment Share on other sites More sharing options...
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domain: geography


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Thousands of bikers are planning to come to Washington D.C. for Trump’s inauguration in support of the president-elect.
Chris Cox organized a rally for his group of more than 5,000 “Bikers for Trump” that will include “musical performances and speakers,” but he also said they will “stand up to dangerous protesters,” the Daily Mail reported.
“In the event that we are needed, we will form a wall of meat,” he told Fox & Friends. “We’ll be shoulder to shoulder with our brothers and we’ll be toe-to-toe with anyone who’s going to break through police barriers,” he said.
Cox said the group is non-violent and the bikers will only step in if protesters become violent, “assaulting women, spitting on them, and throwing things at them.”
Cox started “Bikers for Trump” in 2015, and he says the group has grown to about 200,000 members.
His group is also hoping to promote a bill that Cox lobbied for that would keep national parks and monuments open “even when Washington is closed.”
Groups of left-wing protesters are planning their descent upon Washington during the inauguration. One event, called #DisruptJ20, plans to create a series of human blockades across D.C. and destroy public property.

domain: news


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Age of Empires II: Definitive Edition celebrates the 20th anniversary of one of the most popular strategy games ever, now with stunning 4K Ultra HD graphics, and a fully remastered soundtrack. Age of Empires II: DE features “The Last Khans” with 3 new campaigns and 4 new Civilizations. Frequent updates include events, additional content, new game modes, and enhanced features with the recent addition of Co-Op mode!
Age of Empires II: Definitive Edition has a total of 201 achievements worth a gamerscore of 2035 points
Bookmark games of interest, track when "coming soon" games are due and see how long you have left to play games that are leaving Game Pass.

domain: game


INGIANT High speed slip ring usually to be applied for testing purpose.Long life of this kind of high speed slip ring is the critical parameter,and it is the design point. INGIANT provides different high speed design solution,speed up to 8000rpm.
Adopt special technology
Power and signal transmission stably
Low torque,low loss,high reliability,long life
Max rotation speed up to 10000rpm
Compact size,light weight


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Speaking of local farmers' markets (see yesterday's entry on Three Springs Farm and the Cherry Street Farmers' Market), one of our favorite writers has written a new book on the pleasures (and challenges) of growing your own food.
Writer Barbara Kingsolver, best known for her novels, is out with Animal, Vegetable, Miracle, a book about her family's year-long adventure producing their own food on a farm in southwestern Virginia. Actually, Kingsolver's story was was also written by two other members of her family, husband Steven Hopp, and her 19-year-old daughter, Camille.
This trio, along with their younger child, Lily, made a family decision to reconnect with food they ate. That meant months of serious gardening and animal husbandry on their Appalachian farm. It also meant learning to store food for the winter months and lots of old-fashioned home cooking.
From what we've read, the experiment worked. Kingsolver and family say they ate well, enjoying their bounty. They also grew together as a family.
It wasn't always easy or fun, Kingsolver says, but it was a fulfilling change in habit, well worth the trouble.
The book explains other advantages of local production, such as reduced transportation costs for food from California and other major agriculture areas. "Americans put almost as much fossil fuel into our refrigerators as our cars," Hopp writes.
We don't expect that most Oklahomans will adopt Kingsolver's home-grown eating plan. But even a few tomatoes on the patio is a way to connect with the joys of gardening. That, and regular trips to the farmers' market, helps local farmers and is a small step away from the mass-produced industrial food we all eat too much of.

domain: food


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Easy baguette using a bread machine or a stand mixer. A french baguette recipe that you can use in your bread machine or for hand kneading. We have tried many recipes and this recipe, by far has produced the..bread you will ever have, I have been making this for years with perfect results every time, sometimes it is not the ingredients used but the method Place the two long shaped loaves onto the pan seam-side down spacing apart. Make Parisian white bread in a half day with this simple recipe.
Add the yeast, salt, and enough flour to make a shaggy mass when stirred with a spoon. Baguette-style French bread is just as simple, ingredient-wise, but the process is a bit more And why use a bread machine when you have hands? A wide variety of baguette bread mixer options are available to you, such as united states.
Hello everybody, it is Brad, welcome to my recipe page. Today, I’m gonna show you how to make a distinctive dish, easy baguette using a bread machine or a stand mixer. It is one of my favorites food recipes. For mine, I’m gonna make it a bit unique. This will be really delicious.
A french baguette recipe that you can use in your bread machine or for hand kneading. We have tried many recipes and this recipe, by far has produced the..bread you will ever have, I have been making this for years with perfect results every time, sometimes it is not the ingredients used but the method Place the two long shaped loaves onto the pan seam-side down spacing apart. Make Parisian white bread in a half day with this simple recipe.
Easy baguette using a bread machine or a stand mixer is one of the most well liked of recent trending foods on earth. It’s easy, it’s quick, it tastes delicious. It’s appreciated by millions daily. They’re fine and they look fantastic. Easy baguette using a bread machine or a stand mixer is something which I’ve loved my entire life.
To get started with this recipe, we must first prepare a few ingredients. You can have easy baguette using a bread machine or a stand mixer using 11 ingredients and 12 steps. Here is how you cook that.
The ingredients needed to make Easy baguette using a bread machine or a stand mixer:
- Prepare 160 g (120 g) of strong flour*.
- Take 40 g (30 g) of plain flour (or wholemeal flour, strong flour).
- Get 1-1.5 g of malt powder (or 3 g sugar) (0.5-0.75%) (1g).
- Get 130 g of warm water (not ml)* (65%) (97.5g).
- Make ready 3 g of salt (1.5%) (2.25g).
- Prepare 2 g of dry yeast (1%) (1.5g).
- Get of 【Example of using 100% hydration starter dough】.
- Make ready 100 g of active 100% hydration starter dough.
- Get 110 g of strong flour (160g-50g=110g).
- Prepare 80 g of warm water (130g-50g= 80g).
- Make ready of The rest of the ingredients remain the same (no dry yeast).
You can also choose from high. But mixing bread dough has a lot of its own kinks and quirks, and there are some big decisions to be made about how we go about it. For those of you working with a stand mixer, start by placing the water into the mixing bowl, and then dump your flour on top. This will help to ensure that flour doesn't.
Steps to make Easy baguette using a bread machine or a stand mixer:
- Heat the water in a microwave 20 seconds to make it warm. Or heat it up in a saucepan. Please never make it too hot as yeast will die over 60 degrees. Around the temperature of bath would be perfect. If it is too hot, leave it till it becomes warm..
- Add yeast (or starter dough) and all other ingredients except salt in the bread machine pan and add warm water and mix them manually. You can find the recipe of Raisin yeast starter and starter dough at https://cookpad.com/uk/recipes/13322647.
- Knead for about 10 mins with a stand mixer using a kneading hook or bread machine to knead. Add salt after several minutes later (in the halfway). The total kneading time will depend on your machine. If you are using a stand mixer, knead well here until the dough becomes stretchy and gluten is formed. When gluten is formed, you touch the dough and it doesn't stick to bowl and become one. If you stretch it becomes a very thin sheet..
- If you are using a bread machine, you could put the salt(!) in the yeast dispenser (adding salt later method) or add salt after kneading for several minutes in its cycle. When you put salt in the yeast dispenser, please clean it very well with a dry cloth before you put yeast next as salt interfere with the yeast..
- Cover it with cling film and leave it for 60-70 mins until it becomes about twice. If you use proofer, about 40 mins at around 30℃ with proofer mode (humid)..
- Test the fermentation with a finger coated by flour. If it is the hole remains, the first fermentation has been done. After having tested the fermentation, take out the dough and punch it down..
- Divide the dough into 2 and leave for about 15 mins to rest..
- Shape each piece into a flat rectangle, roll up 2/3 tightly, seal the edges well and taper ends. Place the dough the stuck parts as down on the baguette tray or baking sheet..
- Allow it to rise until double size on the baking paper or tray. Leave around 45 mins depending on the room temperature..
- Start to preheat at the highest temperature of your oven (Mine is 250℃ and it needs about 10 mins to preheat.).
- Using a sharp knife or a curved cutter, make 3 or 4 diagonal cuts with about 0.5cm deep across the top of the loaves. Spray water on to the dough and around the dough well. Steam will create the crust. Or pour about 30ml of hot water in a baking tray underneath the loaves in the oven..
- Reduce the temperature to 230 and put the dough into the oven. Bake at least 230℃ for about 15-20 mins or until golden brown. I baked them at 230℃ for 8 mins first and reduce to 200℃ for further 7-12 mins depends on the shapes and oven..
Homemade French Baguettes using a stand mixer with dough hook is easier than you think. Homemade French baguette recipe from French Women Don't Get Fat using a stand mixer with a dough hook. This baguette recipe has all natural ingredients. For easier bread making, use an oiled or floured bench scraper or a long metal spatula to let you handle this sticky dough without making a mess. To make the dough, transfer the starter mixture to the bowl of a stand mixer with the dough hook attachment, or use a bread machine.
So that’s going to wrap it up for this exceptional food easy baguette using a bread machine or a stand mixer recipe. Thank you very much for your time. I am sure that you can make this at home. There’s gonna be interesting food at home recipes coming up. Don’t forget to save this page on your browser, and share it to your family, colleague and friends. Thank you for reading. Go on get cooking!


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2014 Recipient | AIA Small Project Awards
Topo House | Notes of Interest
The Topo House occupies a site embedded in the softly rolling hills of Wisconsin’s “Driftless Region.” The project explores how a building can literally merge with its context, blurring the boundaries between architecture and landscape, between tectonics and nature.
Two questions inadvertently arise when designing a house for the countryside: first, how to address the visual impact of a man-made structure on its natural surroundings; and second, how to mitigate the inherent environmental consequences of a building removed from the infrastructural amenities of an urban center. Black-anodized aluminum fins with interrelated contracting and expanding shapes organize the rainscreen building skin; depending on the time of the day and the angle from which they are viewed, the fins create a constantly changing veil that subverts the volumetric discipline of the house itself.
The award recipient addressed the first challenge by developing the building form out of the site’s natural topography, allowing it to become an integral part of the land rather than merely sitting on top of it as an object. The structure doesn’t hide that it’s an artificial construct, but it attempts to moderate the inherent antagonism between man-made building and nature.
The goal to minimize the ecological footprint of the house required a holistic design strategy addressing issues of orientation, thermal performance, stormwater mitigation, and on-site energy sourcing.
- Structural Engineer: Matt Christianson, Larson Engineering, Inc.
- Photo Credit: © Johnsen Schmaling Architects
- Architect: Sebastian Schmaling, AIA
- Firm: Johnsen Schmaling Architects
- Location: Blue Mounds, Wisconsin
Beautiful integration of a house into its landscape. Lives like it’s part of the landscape. A strong, clear design that seems to be simultaneously drivenby and embedded within its site. Sophisticated landform building that navigates between house and landscape. The home merges with its context: custom exterior panels reference biological and temporal movements of the surrounding landscape, positioning the house as both technologically savvy and contextually sensitive.
2014 AIA Small Project Awards Jury
- Linda Reeder, AIA, Chair
- Linda Reeder Architecture
- New Haven, Connecticut
- Deb Silber
- Fine Homebuilding Magazine
- Newtown, Connecticut
- Rene Gonzalez, AIA
- Rene Gonzalez Architect
- Miami, Florida
- Lisa Tilder, AIA
- Ohio State University
- Columbus, Ohio
- Craig Scott, AIA
- IwamotoScott Architecture
- San Francisco, California

domain: artistic


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| Rancho Mo Media Principal: Maureen Corley
Maureen Corley, owner of Rancho Mo Media, began her video production career in 1981 at The Movie Channel, a pay-cable TV network based in New York City. Starting as a production assistant in on-air promotion, she quickly rose through the ranks to become a promo writer-producer. By 1983 she received the first of many national awards. Later that year, she was hired by Home Box Office (HBO), where she continued winning plaudits for her work in on-air promotion, broadcast advertising and marketing.
In 1988 Maureen became an New York-based independent producer, creating promos and short-form documentary programming for clients such as Nick-At-Nite (Nickelodeon) and Turner Network Television. In 1990, Turner Broadcasting recruited Maureen to Atlanta as Senior Supervising Producer with responsibility for creating TNT's Program Production department.
While at TNT, Maureen continued to develop and produce creative interstitial programming, including the popular "Our Favorite Movies" franchise. By late 1991, Maureen chose to return to independent producing, and formed Rancho Mo Productions.
Throughout the 1990's Maureen continued to write and produce award-winning projects for Turner Broadcasting. In 1993 she teamed with TNT and LIFE Magazine to produce her first long-form documentary program, LIFE Remembers. By the mid 90's she was able to put her NYU Cinema Studies degree to good use while producing programming for Turner Classic Movies. In 1995 she teamed with TCM to produce and co-write the 1995 CableAce award-winning documentary, Inside the Dream Factory. Maureen also participated in TCM's unique Archive project, filming archival interviews with actors, directors and technicians from Hollywood's golden age.
Later in the '90s, Maureen partnered with two very talented and creative women, Michele Tedesco and Darla Gore, to create Three on a Match Productions, Inc. The "Match Girls" produced two successful home video projects for Time Life Video.
In 2002, Maureen Corley and Rancho Mo Productions moved into Corporate Communications work in the Atlanta area. She's developed a reputation for her creativity and strong story-telling skills, writing and producing projects for a variety of corporate clients. Now, as Rancho Mo Media, Inc., Maureen can provide production services for your next project, regardless of size or budget.


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I have really enjoyed cooking (and eating) last night and today. While I'm not a great cook, I think I do pretty good. And I do enjoy cooking and baking. Pies are my favorite thing to bake (and eat). Probably my forte in the kitchen though is putting together a tasty, somewhat balanced meal with what's on hand and doing it quickly. I was doing 30 minute meals way before Rachael Ray was popular. Albeit, probably not as fancy as hers. Truthfully, I usually have a lot on hand that I've bought when it was "on sale". We study the grocery store ads each week and often go to 3 different stores to stock up on the "sale items" that we use regularly. Throw in a few coupons for further savings and we are able to eat well on a limited budget. I seldom buy items that are not on sale, unless it is staples we have run out of or something I need to make a particular dish.
I sometimes make planned-overs, also. That is left-overs or extra food that is deliberately planned to make a different second meal.
Sometimes I tell hubby that a meal is "made from nothing". His response is " I'm glad we had 'nothing' to make it out of."
Today I made Chicken Soup. This is one of my "something from nothing meals". Truthfully, I didn't intend to make Chicken Soup this week, but the Chicken Breast I got out of the freezer yesterday turned out to be the bones and skins that I had saved for soup stock. You see, when Chicken breasts are on sale for $1 per lb. I buy several packages. I then cut the skin and bones off, leaving boneless skinless chicken breast which I put in appropriate sized packages to freeze for use in various dishes calling for boneless skinless chicken breast. I put the bones and skins in another package to use for soup stock. Or sometimes I cook it right then and make soup or put the stock in the freezer.
This morning early, I removed all the bones and skin. There was 3 to 4 cups of meat and veggies to put back in the stock. Later, I added a can of mixed vegetables, a can of diced tomatoes, and a couple of packages of Ramen Noodles with the seasoning pack and voila! Chicken soup. We like to crush the noodles into tiny pieces in the package before adding them to the boiling broth. Sometimes I have fresh frozen tomatoes from a local garden, but since those are all gone, we had to revert to canned ones. Also sometimes I use frozen mixed veggies. It just depends on what I have on hand. In any case, the canned or frozen foods have been bought on sale and ramen noodles are cheap, cheap, so the whole big pot of soup costs very little. This chicken soup turned out so, so yummy. I will definitely stick with the sea salt and the particular herbs I used. We ate some for lunch with whole wheat crackers and I took some to Mimi. Then late afternoon Paul and each had a second bowlful. UMMM Good. There is still enough for another meal. I may freeze it to use sometime when I don't have time to cook or we may eat it tomorrow.
For supper, I pulled 2 Tombstone pizzas out of the freezer and into the oven. Added a green salad and we had a real treat for a Friday night meal and avoided the expense of going out. I got the pizza recently on a special of 4 for $10. We will have left over pizza for breakfast too.
We had ham for Christmas dinner. Last week, I took the ham bone which still had a lot of ham on it and made 15 bean soup. I buy the package of 15 bean soup mix for that. It includes a seasoning packet and has the instructions on the package. We really enjoyed that also. I know it sounds like we do a lot of soup, but say hey, it is winter and a good bowl of hot soup is real comfort food. Of course, you could stretch the dollars a bit more by buying pinto beans or navy beans or whatever you like and seasoning them up yourself, but no more often than we have ham with the bone I sort of splurge and get the 15 bean soup package.
Happy Cooking Everyone---
This was actually written a week or so ago. I just now got the pictures put together, but hey that's okay.
Meantime I have enjoyed shopping,cooking and we have enjoyed eating a lot more good food.


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Robert (Bob) Young is graphic designer and works for a gasket company. He is also a freelance cartoonist. His professional focus is aimed at business graphics, technical illustration and drawing cartoons but is slowly widening into web design and 3D-animation.
Bob Youngs hobbies are drawing, sewing, playing african drums and didgeridoo.
Bob in Frank's office


Fossil Fuel Interests Spent Millions on Social Media to Push Climate Denial, Misinformation Around COP27
Climate denial, “delayism,” and pro-fossil fuels messages are making a “stark comeback” across social media platforms, according to a report released Thursday by the Institute for Strategic Dialogue.
The report’s findings reveal “negligence from Big Tech companies who not only continue to monetize and enable, but in some cases actively recommend, such content to users,” its authors write. “What’s happening in the information ecosystem poses a direct threat to action,” ISD’s Jennie King told the AP. “It plants those seeds of doubt and makes people think maybe there isn’t scientific consensus.”
In the leadup to and during COP27, entities connected to fossil fuels spent at least $3 million on Facebook and Instagram ads between Sept. 1 and Nov. 21 of last year in the leadup to and during COP27. That content included ads by oil industry groups, ads from oil and gas firms like Shell, Chevron, and Exxon touting their claimed green credentials, and ads from accounts like PragerU claiming, for example, a “New poll debunks the 97% consensus claim about #climatechange.”
The report also highlights how changes at Twitter since emerald mining scion Elon Musk took over the company have, as Imram Ahmed, head of the Center for Countering Digital Hate, described it, “put rocket boosters on the spread of lies and disinformation.”
As reported by The Verge:
Energy Citizens, a front group for the American Petroleum Institute, ran the most ads during the timeframe studied. It largely focused on stoking fears that transitioning to clean energy threatens America’s “energy security.” On the contrary, extreme weather events — which are exacerbated by climate change — have led to more power outages in the US. And research shows that oil, gas, and coal development need to be phased out to prevent such climate disasters from reaching a new level of severity.
America’s Plastic Makers, meanwhile, spent $1.1 million on climate-related ad campaigns. It pushed the myth that recycling solves the plastic waste problem. Plastic is actually pretty difficult to reuse; just 9 percent of all the world’s plastic waste is recycled. Nevertheless, the fossil fuel industry has tried to lean more on its plastics business lately to hedge against clean energy cutting into its profits.
For a deeper dive:


Dump Car | Article about Dump Car by The Free Dictionary
dump car[′dəmp ‚kär]
Any of several types of narrow-gage rail cars with bodies which can easily be tipped to dump material.
McGraw-Hill Dictionary of Scientific & Technical Terms, 6E, Copyright © 2003 by The McGraw-Hill Companies, Inc.
The following article is from The Great Soviet Encyclopedia (1979). It might be outdated or ideologically biased.
an open railroad car with a rectangular-shaped body and a pneumatic unloading device. A dump car is tilted to one side or the other when freight is unloaded, and the side is opened or raised at the same time. Dump cars are used mainly for hauling ore and loose building materials on the ground of large enterprises. Dump cars have a capacity of 40 to 80 tons.
The Great Soviet Encyclopedia, 3rd Edition (1970-1979). © 2010 The Gale Group, Inc. All rights reserved.
References in periodicals archive
Moved by her plight, Richard and Lucia decide to help her dump car
The cost of the seized drugs is around 90 million Russian rubles (US$3.061 million), according to Russian media reports.Some 80 kg of heroin and 27.5 kg of hashish were found in cache under the vessel of the dump car
coming from Kyrgyzstan.
4), which is used in the rotary-style dump car
on unit trains.


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Is hummus good for you, and is hummus good for weight loss? The simple answer for us is definitely, YES! Hummus is good for you! Let’s find out why we believe that in this article.
Before we deep dive into it, here’s a little information on the origin of hummus.
Hummus is an ancient traditional dish that is eaten a lot in Middle Eastern Cuisine. Although there is an ongoing debate on its origin, some sources date it back to 13th century’s Egypt.
Besides Egypt, other countries such as Israel, Palestine, Lebanon, Greece, Turkey, and many more claim it as their own. So, still today, there’s no right or wrong answer to hummus origin.
But regardless of where it came from, hummus is a delicious dip or spread enjoyed by many cultures.
The main ingredients in the traditional recipe are chickpeas, olive oil, tahini, lemon juice, garlic, and salt.
In the Middle East, it’s usually eaten as a dip with pita bread, whereas in the West, it’s served as a snack or appetizer with crackers or spread into sandwiches.
Benefits of Hummus
Not only is hummus delicious, but it is also a healthy dish that is packed with nutrients and has many health benefits.
|Source: USDA Food Date Central, 2019
|Hummus, commercial (100 g)
So, is hummus healthy?
Chickpeas, the main ingredient in hummus, are very nutrient-dense, meaning they offer lots of nutrients in even small portions.
Hummus keeps you full for longer
They are a great protein option, especially for vegans and vegetarians, because chickpeas contain eight of the nine essential amino acids, the structural components of protein.
High in plant-based protein and fiber, chickpeas help with appetite control and keeping you full longer. And how much protein is there in hummus? About 7.8g per 100g.
One study that compared chickpea consumption over white bread concluded that eating chickpeas may help with bodyweight management by suppressing appetite and energy intake.
Another review concluded that including legumes like chickpeas in the diet increased feelings of fullness after a meal by 31%.
Takeaway: Hummus is a satiating dip
Hummus doesn’t disturb insulin levels
Since dietary fat delays gastric emptying and slows carbohydrate absorption, hummus accounts for improved blood glucose and insulin response. Balanced insulin levels are important in losing weight, especially for type-2 diabetic patients.
Takeaway: Unlike sugary sauces and dips (hello ketchup), hummus helps to keep your insulin levels low.
Hummus supports a nutrient-rich diet
Moreover, many other studies concluded that people who consume hummus have higher intakes of dietary fiber, protein, polyunsaturated fatty acids, vitamins A, C, E, and folate, and minerals such as iron, magnesium, and zinc, compared to non-consumers.
They were also less likely to be obese and had lower body mass index (BMI) and waist circumference.
Takeaway: it’s only guesswork, but people seem to dip more healthy foods into hummus than they dip into mayonnaise. Joining the hummus dippers might help you look for healthier foods.
How to Eat Hummus?
Hummus is a very versatile recipe, and there are many ways to enjoy it while you’re losing weight. You can enjoy it as a filling meal or snack during the day.
A good portion size of hummus, alongside a healthy diet, is around 2-4 tablespoons. Hummus calories vary from brand to brand or the amount of olive oil you put in if you’re making it yourself. But on average, a tablespoon of hummus provides 30-40 kcal.
For example, when eating hummus as a snack, you can have about 2 tablespoons served with sliced vegetables such as red pepper, cucumber, or carrot.
If you are eating it for lunch or dinner, you can have up to 4 tablespoons and serve it again with sliced vegetables or a bowl of mixed green salad.
If you haven’t tried or made hummus yet, it’s best to start with our delicious homemade hummus recipe. It takes 5 minutes to make! But, be aware that if you share with others, it won’t last on the table for long as people will devour it in just a couple of minutes!
Now that you rock a delicious hummus, it’s time to jazz it up. When mixed with vegetables, hummus turns into a fun party for your taste buds!
Jazz up the classic: Avocado Hummus
My top three veggies that go well in hummus are avocados, roasted red peppers, and roasted beets. Here is our take on avocado hummus, and we are obsessed with it!
You can also use your hummus as a dressing for your favorite dishes. If you dilute it with some lemon juice and water, you will have a delicious hummus dressing. Check out our Smoked Tofu & Hummus Buddha Bowl for a tasty and filling meal.
Is hummus fattening?
Hummus adds great nutritional value and benefits to your weight loss plan. But although healthy in general, hummus is high in carbohydrates and fat and can add up easily if you don’t consider your serving sizes.
So, to lose weight, like any food, it is important to balance your serving sizes when eating hummus.


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1066 Killian Hill Rd - Suite 101 - Lilburn, GA
Get in Touch
8 oz Grilled Burger with Pickled Jalapeño Beer Cheese, Grilled Onions, and Whole Grained Mustard on a Toasted Pretzel Roll served with our Pommes Frite
© 2024 Three Blind Mice Restaurant. All Rights Reserved.


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🠈 Carlson Group History 🠊
- 1938: Curt Carlson started Gold Bond Stamp Company with a $55 loan from his landlord.
- 1962: Carlson bought a Radisson Hotel in Minneapolis.
- 1975: Carlson invested in TGI Fridays.
- 1977: Carlson acquired Country Kitchen restaurant chain.
- 1981: Carlson acquired an incentive management company called E.F. MacDonald Motivation Co..
- 1986: Carlson established Country Inns & Suites brand.
- 1989: Edwin C. "Skip" Gage became CEO.
- 1994: Carlson merged with a division of Accor called Compagnie Internationale des Wagons-Lits.
- 1997: Carlson launched GoldPoints.com (which became Club Carlson in 2011.
- 1997: Carlson sold Country Kitchen.
- 1997: Carlson acquired Regent Hotels & Resorts from Four Seasons Hotels and Resorts.
- 2000: Carlson acquired Park Inn by Radisson and Park Plaza Hotels & Resorts.
- 2005: Carlson acquired 25% stake in Rezidor Hotel Group
- 2012: The company became Carlson Rezidor Hotel Group
- 2014: Sentinel Capital Partners and TriArtisan Capital Partners acquired TGI Fridays for a reported $800 million.
- 2016: Carlson divested its hotel division.
1960 Arne Jacobsen designed the The Royal Copenhagen in Denmark was hailed as the world’s first designer hotel
Carlson entered the hotel business in the Americas through a 50 percent interest in the Radisson Downtown Hotel in Minneapolis
Carlson Hotels and SAS International Hotels signed a partnership to bring the Radisson® brand to Europe
Carlson Hotels launched the Country Inns & Suites® By Carlson brand
SAS International Hotels signed a franchise agreement with Carlson Hotels to manage the Radisson brand in EMEA, which would later become Radisson Blu
Carlson Hotels launched the guest loyalty program now known as Radisson RewardsTM
SAS International Hotels became The Rezidor Hotel Group and acquired franchise rights to Regent Hotels & Resorts, Park Inn and Country Inns & Suites By Carlson
Carlson acquired 25 percent ownership of The Rezidor Hotel Group, solidifying the company’s commitment to global growth
The Rezidor Hotel Group completed an initial public offering on the Stockholm Stock Exchange. Carlson purchased additional shares, increasing its ownership to 35 percent
Carlson increased ownership in The Rezidor Hotel Group to 41.7 percent
- 2009: Carlson sold its marketing business to Group Aeroplan of Canada for $175 million.3
Radisson SAS brand name was updated to Radisson Blu
First Hotel Missoni opens in Edinburgh to great acclaim
Radisson Blu became the Largest Upscale Hotel Brand in Europe, per MKG
Park Inn becomes Park Inn by Radisson
Rezidor named one of the Most Ethical Companies of the World by Ethisphere Institute
Carlson increased its ownership in The Rezidor Hotel Group to 51 percent, and the two joined forces in a strategic partnership and went to market as Carlson Rezidor Hotel Group
Carlson Rezidor Hotel Group is named Hotel Group of the Year at Worldwide Hospitality Awards 2012
Carlson Rezidor Hotel Group announced a new brand in the luxury segment, Quorvus Collection
Carlson Rezidor Hotel Group announced a new brand in the upscale lifestyle select segment, Radisson RED
HNA Tourism Group acquired Carlson Hotels, Inc.
The Rezidor Hotel Group entered the economy segment with a 49% stake in prizeotel
Federico J. González became Rezidor’s President & CEO and Chairman of the Global Steering Committee
HNA Tourism Group Co., Ltd. announced a mandatory public offer to acquire all shares in Rezidor
Country Inns & Suites By Carlson becomes Country Inn & Suites by Radisson
Carlson Rezidor Hotel Group becomes the Radisson Hotel GroupTM
A new global brand architecture, introducing Radisson in EMEA and launching a Radisson Collection
Radisson Hotel Group rebrands Club Carlson loyalty program to Radisson Rewards
Rezidor Hotel Group AB (publ) renames to Radisson Hospitality AB (publ) on 7 May 2018.
A consortium led by Jin Jiang International Holdings Co., Ltd (Jin Jiang International) completed the acquisition of Radisson Hospitality, Inc.
~ ~ Index
~ ~ Next

domain: economics


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Court says Black woman’s hair..
A Black man reportedly is suing American Airlines..
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Singer R. Kelly has been moved out..
Mass shootings are happening at..
African American actress Garcelle Beauvais is about to..
Police in Vancouver, Washington have arrested a say a..
Two employees of color at an Old Navy store in Philadelphia..
Actress Keisha Knight Pulliam and Arian Simone..
How does this happen in a country where a Black person..
Harlean Harris Wilson, wife the late singer Jackie Wilson..
The era of paper money and coins being..
News agencies, including the Hill.com, are all over a New Jersey school..
Actress Viola Davis has signed on to play former..
Children all over the world can now play with the newest Barbie dolls..

domain: sociology


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Where To Eat
Serving dinner only, La Jolla focuses on offering consistent quality & customer service. The menu offers something for everyone from small plates to meats cooked to perfection from The Big Green Egg to exquisitely created entrees that have become synonymous with La Jolla. The wine list includes 100+ wines focusing on American wines with 8 beers on tap.
Happy Hour is daily 4 -6 pm. Stop by for a cocktail and order from our menu & take it TO GO, sure to make your family and/or significant other delighted when you walk through the door.
For more information visit:
6854 Eastchase Parkway
Montgomery, AL 36117
- Monday-Friday, 11 a.m.-2 p.m. (lunch) & Monday-Saturday, 5:30 p.m.-9 p.m.
- American Express
Ahi Tuna Spring Roll
This dish makes the list as a highly recommended, local favorite.


Washington - Rep. Keith Ellison (D-MN), Co-Chair of the Congressional Progressive Caucus, released following statement on the wage theft and worker protections in the National Defense 4 Traders, 1 week ago
Muslim Congressmen on hate in the Trump era - MSNBC, 1 day ago
Meet Keith Ellison, the progressive congressman who's a podcasting star in the making - Daily Dot, 3 weeks ago
1 images for "congressional progressive caucus"
Florida: Grayson, Murphy catch flak. In a meeting last week of the Congressional Progressive Caucus, US Rep. Alan Grayson (D), a candidate for the senate, denounced Senate Minority Leader Harry Reid for calling for his resignation over allegations ...Southern Political Report, 1 week ago Florida rep. channels 'Breaking Bad' in tiff with Harry Reid USA Today, 2 weeks ago Harry Reid Thinks Alan Grayson Is A Loser, Tells Him So Huffington Post, 2 weeks ago Reid fundraising pitch: 'I want Alan Grayson to lose' The Hill, 1 week ago
Alex Singer, Progressive Democratic Candidate Running In Nevada's 3rd Congressional District I am excited, honored and humbled to announce that I have been endorsed in the Democratic Primary in Nevada's 3 rd Congressional District by the Clark ...Daily Kos, 20 hours ago Im Pro-Bernie NOT Anti-Hillary. Daily Kos, 4 weeks ago
A budget watchdog group says the Congressional Progressive Caucus's federal budget for FY 2017 could help bring more infrastructure jobs to Illinois. (iStockphoto) April 14, 2016 SPRINGFIELD, Ill. As Illinois continues to grapple with a ...Public News Service, 1 month ago Stark Choices: People's Budget vs. Republican Plan Insurance News Net, 1 week ago Budget Watchdog: House Plan Out of Step with Most Americans Public News Service, 1 month ago Watchdog: House Budget Plan Misses Mark on Americans' Priorities Public News Service, 1 month ago
As the group faced new arrests with a sit-in today at Capitol Hill, another group called the Congressional Progressive Caucus protested this afternoon outside the Supreme Court. "We the people demand a democracy free from the corrupting influence ...Equilibrio Informativo, 1 month ago Celebrities Join #DemocracySpring at US Capitol, Sit In for Arrest on Day 5 Sputnik, 1 month ago 600+ Arrests in Nation's Capital Aimed at Rapidly 'Shifting Political Weather' Common Dreams, 1 month ago Mass Arrests at Democracy Spring D.C. Protest Courthouse News Service, 1 month ago
Press Contact: Brett Morrow (Ellison) 202-225-4755 Dan Lindner (Grijalva) 202 225-2435 Congressional Progressive Caucus Statement on Striking Verizon Workers Washington, DC - The Co-Chairs of the Congressional Progressive Caucus (CPC), Reps. Raul M.4 Traders, 1 month ago CPC Members Call for Robust Notification System for Medicare Eligibility Insurance News Net, 1 month ago
, outside the U.S. Supreme Court, members of the Congressional Progressive Caucus joined with working Americans to call on Senate Republicans to do their job and hold hearings and an up-or-down vote on President Obama's Supreme Court nominee, Chief ...MoveOn.org, 1 month ago At Supreme Court, Congressional Progressive Caucus Members, American Workers Urge Senate Republicans to Do Your Job and Hold Hearings, Vote for Merrick Garland People for the American Way, 1 month ago
Contact: Tom Caiazza Phone: 202.481.7141 Email: email@example.com New Center for American Progress Polling Shows Overwhelming Bipartisan Support for Protecting National Parks Washington, D.C. — A new analysis by the Center for ...American Progress, 1 month ago
'This is going to be an opportunity to hear from the prime minister of the new India and the progress made in the last two years of the growing cooperation between the US and India in several areas, including areas that would have seemed implausible a few years ago.'US Congressman Ed Royce, who led the campaign to have Prime Minister Modi address a joint session of Congress, speaks to Aziz Haniffa/Rediff.com in an exclusive interview. IMAGE: The last time an Indian prime minister addressed a ...Rediff.com, 3 weeks ago Modi to meet Obama at White House June 7 Asian Age, 5 days ago Modi US visit from 7 June, to address US Congress The Statesman, 5 days ago Narendra Modi to visit Qatar, US in June Livemint.com, 5 days ago
The Philippines may be a conservative, deeply religious country, but it is also a progressive one. While the international spotlight was fixed firmly on incoming President Rodrigo Duterte aka "Duterte Harry" or "The Punisher" Geraldine Roman ...International Business Times UK, 1 week ago Geraldine Roman elected first transgender politician in the Philippines International Business Times India, 1 week ago
on your WebpageAdd Widget >Get your members hooked!


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Democratic presidential nominee Joe Biden will deliver a speech to the country in the coming hours.
The speech from the former vice president, scheduled for 8 p.m. ET Friday from his hometown of Wilmington, Del., comes as he creeps closer to defeating President Trump to win the White House.
Biden has narrowly pulled ahead of the president in the vote totals in the uncalled key battlegrounds of Pennsylvania and Georgia, and has slightly increased his razor-thin margin over Trump in Nevada, which has also yet to be called for either candidate.
Biden to deliver speech as ballot count shows him ahead of Trump
originally posted by: gortex
originally posted by: OtherSideOfTheCoin
Interesting; I wonder if he is going to announce his victory
Seems likely , we'll probably hear the "Reeeeeeeee!" from here.
originally posted by: Bobaganoosh
a reply to: OtherSideOfTheCoin
You will get your evidence, real investigations take time.

domain: politics


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Nationwide Impact of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines on Stroke Survivors
Background In this study, we aimed at estimating the prevalence and number of stroke survivors with hypertension, recommended pharmacological treatment, and above blood pressure target, according to the 2017 American College of Cardiology/American Heart Association guidelines and the seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure guidelines.
Methods and Results We included participants aged ≥20 years to the National Health and Nutrition Examination Surveys between 2003 and 2014. The National Health and Nutrition Examination Surveys is a series of publicly available, cross‐sectional, national, stratified, multistage probability surveys. The National Health and Nutrition Examination Surveys received approval from the National Center for Health Statistics Research Ethics Review Board. Stroke was determined by self‐report. Blood pressure was estimated according to National Health and Nutrition Examination Survey protocol. Assessment of pharmacological treatment of hypertension was by self‐report. The proportion and number of stroke survivors with hypertension was 49.8% (95% confidence interval [CI], 45.4%–54.2%) and 2 361 075 (95% CI, 2 035 251–2 686 899) per the 2017 American College of Cardiology/American Heart Association guidelines versus 29.9% (95% CI, 26.2%–33.7%) and 1 415 974 (95% CI, 1 191 721–1 640 227) per seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines. Proportion and number of stroke survivors who were not at target blood pressure was 56% (95% CI, 51.2%–60.6%) and 1 824 106 (95% CI, 1 558 846–2 089 366) per 2017 American College of Cardiology/American Heart Association guidelines versus 36.3% (95% CI, 31.6%–41.4%) and 1 184 655 (95% CI, 984 128–1 385 182) per seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines.
Conclusions Compared with seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the 2017 American College of Cardiology/American Heart Association hypertension guidelines would result in a nearly 67% relative increase in the proportion of US stroke survivors diagnosed with hypertension and 54% relative increase in those not within the recommended blood pressure target.
What Is New?
The implementation of the 2017 American College of Cardiology/American Heart Association guidelines will result in a greater number of stroke survivors with hypertension, at goal, and requiring antihypertensive treatments.
What Are the Clinical Implications?
There are anticipated challenges in implementing into practice the new 2017 American College of Cardiology/American Heart Association guidelines, with potential positive impacts on cardiovascular risk reduction and mortality among stroke survivors.
Hypertension is strongly associated with stroke.1, 2 It also carries a high mortality among patients with stroke and arguably has a stronger association with stroke than any other symptomatic vascular disease entity.2, 3 It is fortunately amenable to interventions including pharmacological treatments. Antihypertensive drugs are among the most prescribed medications in the United States.4 It is purported that greater blood pressure (BP) awareness and treatment has significantly contributed to the decline in stroke mortality in the United States over the past decades.2 Indeed, a meta‐analysis of 14 randomized controlled trials has shown a nearly 30% reduction in the risk of stroke recurrence with BP treatment.5 In the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) guidelines, hypertension was defined for systolic BP (SBP) ≥140 or diastolic BP (DBP) ≥90 mm Hg, and pharmacological treatment in stroke survivors was recommended for SBP ≥140 or DBP ≥90 mm Hg.6 However, epidemiological data have demonstrated that the risk of stroke begins with levels of BP lower than these values.7 In light of these data, the American College of Cardiology/American Heart Association8 guidelines for prevention, detection, evaluation, and management of hypertension have lowered the cutoff for BP definition of hypertension in individuals at high risk of cardiovascular events, including patients experiencing stroke. In the new guidelines, a SBP ≥130 or DBP ≥80 mm Hg defines hypertension in stroke survivors. The new American College of Cardiology/American Heart Association (ACC/AHA) guidelines also recommend initiating antihypertensive treatments and targeting SBP/DBP to <130/80 mm Hg for stroke survivors. It is anticipated that these changes will affect BP distribution among stroke survivors, with significant policy and economic implications. In this analysis, using data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2014, we estimated the percentage and number of US adult stroke survivors according to the 2017 ACC/AHA guidelines and the JNC7 guidelines. Moreover, we estimated the percentage and number of stroke survivors with hypertension recommended for pharmacological treatment on the basis of the 2017 ACC/AHA versus the JNC7 guidelines. We also estimated the percentage and number of US adult stroke survivors taking antihypertensive medication with BP above target, according to 2017 ACC/AHA and the JNC7 guidelines. Finally, we extrapolated the potential impact of the 2017 ACC/AHA guidelines on mortality among stroke survivors.
Data Source and Blood Pressure Measurement
We analyzed a 10‐year period from 2003 through 2014 of the NHANES's data set of adult participants who had at least 3 consecutive BP measurements. NHANES is a series of publicly available, cross‐sectional, national, stratified, multistage probability surveys. As publicly available data, the NHANES data set, the methods used in the analysis, and materials used to conduct the research are available to any researcher for purposes of reproducing the results or replicating the procedure. Details pertaining to the survey are available at the NHANES website.9 NHANES received approval from the National Center for Health Statistics Research Ethics Review Board. All participants were asked to sign an informed consent form. Per NHANES protocol, BP is measured by trained physicians (who are annually retrained and certified) using a mercury sphygmomanometer of appropriate size, determined by the participant's mid–right arm circumference. BP is calculated as the mean of the 3 consecutive BP measurements, obtained after 5 minutes of rest and at a 30‐second interval.
History of stroke was determined by self‐reported diagnosis by a healthcare provider. Individuals who had missing data for previous stroke were excluded. Age was divided into 4 categories: 20 to 44, 45 to 64, 65 to 79, and ≥80 years. Race/ethnicity was categorized as non‐Hispanic white (white), non‐Hispanic black (black), Mexican American, and other. Assessment of pharmacological treatment of hypertension was by self‐report. Participants who answered “yes” to both questions “Have you ever been told by a doctor or other healthcare professional that you had hypertension, also called high blood pressure?” and “Are you now taking prescribed medication for high blood pressure?” were considered to be taking antihypertensive medication.
Hypertension Definitions, Recommendations for Antihypertensive Medications, and Blood Pressure Treatment Goals
The JNC7 defined hypertension for levels of SBP ≥140 mm Hg or DBP ≥90 mm Hg. According to the 2017 ACC/AHA guidelines, hypertension was defined for levels of SBP ≥130 mm Hg or DBP ≥80 mm Hg. On the basis of the JNC7 guidelines, pharmacological treatment was recommended for stroke survivors for SBP ≥140 mm Hg or DBP ≥90 mm Hg. It was deemed reasonable to achieve a SBP <140 mm Hg and a DBP <90 mm Hg. The 2017 AHA/American Stroke Association guidelines recommend initiating antihypertensive treatment in stroke survivors for SBP ≥130 mm Hg or DBP ≥80 mm Hg and set new target at SBP <130 mm Hg and DBP <80 mm Hg.
The study was approved by the National Center for Health Statistics Institutional/Ethics Review Board. A detailed description of the survey is available at the NHANES website.9
Frequency distribution and 95% confidence interval (CI) of BP were calculated across the following BP levels of SBP/DBP: <120/<80, 120 to 129/<80, 130 to 139/80 to 89, and ≥140/90 mm Hg. They were calculated overall and by sex, age, and race/ethnicity. Frequency distribution of hypertension was calculated according to cutoff points defining hypertension in each of the guidelines, overall and by sex, age, and race/ethnicity. Next, we estimated the number and 95% CI of adults with hypertension overall by type of guidelines to the 2007 ACC/AHA guidelines by treatment status. We also calculated the percentage, number, and 95% CI of stroke survivors with hypertension recommended for pharmacological treatment on the basis of the 2017 ACC/AHA and JNC7 guidelines. We then proceeded and calculated the percentage, number, and 95% CI of stroke survivors taking antihypertensive medication with BP above target, according to 2017 ACC/AHA and the JNC7 guidelines.
A binary variable of final “mortality” status (0=alive, 1=deceased) was created from publically used linked mortality NHANES files (2003–2010); a code of 1 indicates that the mortality status was ascertained through a probabilistic match to a National Death Index record (National Center for Health Statistics Surveys 2011 Linked Mortality Files, public‐use data dictionary).10 Mortality rate was computed by BP levels, as defined by the JNC7 and the 2017 ACC/AHA guidelines.
We identified a total of 6 250 751 weighted participants aged ≥20 years with stroke, including 2 600 312 men (41.6%). Nearly 3 of 5 participants (57.6%) were aged ≥65 years. Overall during the period 2003 through 2014, 34.2% (95% CI, 29.7%–38.9%), 16.0% (95% CI, 13.3%–19.0%), 19.9% (95% CI, 16.5%–23.7%), and 29.9% (95% CI, 26.2%–33.8%) of stroke survivors had SBP/DBP levels of <120/80, 120 to 129/<80, 130 to 139/80 to 89, and ≥140/90 mm Hg. In general, older participants, non‐Hispanic blacks, and women had BP in the higher levels (Table 1).
Prevalence and Number of Stroke Survivors With Hypertension and Recommended Pharmacological Treatment, According to 2017 ACC/AHA and JNC7 Guidelines
According to the JNC7 guidelines, 29.9% (95% CI, 26.2%–33.7%) of stroke survivors, corresponding to 1 415 974 US population, had hypertension and would be recommended pharmacological treatment. On the other hand, on the basis of the new recommendation, 49.8% (95% CI, 45.4%–54.2%; ie, 2 361 075 stroke survivors) met the criteria for hypertension and would be recommended pharmacological treatment. The total prevalence of hypertension increased by 66.7%, and the number of stroke adult population increased by 945 101, with the new guidelines (Table 2, Figures 1 and 2). An increase in the prevalence and number of stroke population with hypertension and recommended pharmacological treatment was observed across all age, sex, and races/ethnicities in the new recommendation.
Prevalence and Number of US Stroke Survivors Taking Antihypertensive Medication With BP Above Target, According to the 2017 ACC/AHA and JNC7 Guidelines
The total prevalence of adult stroke population taking antihypertensive treatment with BP above goal, according to the JNC7 guidelines and 2017 ACC/AHA guidelines, was 36.3% (95% CI, 31.6%–41.4%) and 56% (95% CI, 51.2%–60.6%), respectively. This represented a 53.9% relative increase in adult stroke survivors with BP above goal. The corresponding number of stroke survivors on antihypertensive medication and above goal was 1 184 655 (95% CI, 984 128–1 385 182) and 1 824 106 (95% CI, 1 558 846–2 089 366), respectively, representing a 639 451 increase in stroke population on antihypertensive medications with BP above goal (Table 3, Figures 1 and 2).
Mortality Rate by 2017 ACC/AHA and JNC7 Guidelines Among Stroke Survivors
Mortality rate during the period of 2003 through 2010 was 5.55% among those with a SBP <130 mm Hg or DBP <80 mm Hg; meanwhile, for those with a SBP <140 mm Hg or DBP <90 mm Hg, mortality rate was 8.25%, corresponding to a 32.72% relative mortality reduction.
In this top‐down analysis, we found that implementing the 2017 ACC/AHA guidelines would result in a nearly 67% increase in the proportion of stroke population with hypertension, and recommended antihypertensive treatment. The number of stroke survivors not at goal would increase by 54% with the 2017 ACC/AHA guidelines.
It is established that hypertension increases the risk of stroke in a dose‐response pattern. For example, in a meta‐analysis of individual data of 1 million adults from 61 prospective studies, the risk of stroke was evident for SBP levels as low as 115 mm Hg and DBP starting at 75 mm Hg.7 Cardiovascular prevention benefits in patients with at usually recommended BP goals compared with those at lower goals have been evaluated in 3 pivotal clinical trials. The SPS3 (Secondary Prevention of Small Subcortical Stroke) trial, which included patients within 18 months of index symptomatic lacunar infarction, found no benefit of intensive BP on cardiovascular prevention. The ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial and the SPRINT (Systolic Blood Pressure Intervention Trial) did not include patients with stroke and, therefore, no data on stroke secondary prevention were available. In the ACCORD trial, which included only patients with hypertension and diabetes mellitus, no benefit on cardiovascular prevention was found.13, 14, 15 In the SPRINT, lowering SBP to <120 mm Hg versus 140 mm Hg in people with a SBP of ≥130 mm Hg and an increased cardiovascular risk, but without diabetes mellitus, resulted in significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause.15 In subgroup analyses, no benefits on stroke prevention were apparent in both the SPRINT and ACCORD trial. In all, aforementioned studies were limited by the noninclusion of participants with stroke or the inclusion of only a subpopulation of patients with stroke. Their results need to be contrasted with the findings from a recent meta‐analysis of 14 randomized controlled trials of secondary stroke prevention that demonstrated a linear and positive association between BP reduction and the risk of recurrent stroke and cardiovascular events. The authors suggested that a target of <130 mm Hg may be effective for secondary stroke prevention.5 Altogether, these studies were among the catalyzers that helped revise hypertension definition, pharmacological treatment recommendation, and BP targets in the 2017 ACC/AHA guidelines. In addition to setting new cutoffs for BP definition, pharmacological treatment recommendations, and targets, the new guidelines have provided a new categorization into 4 levels. As in the JNC7 guidelines, the aim for defining these categories was to facilitate clinical practice and public health decisions. The JNC7 report categories included SBP/DBP levels of <120/80 mm Hg (normal), 120 to 139/80 to 89 mm Hg (prehypertension), 140 to 159/90 to 99 mm Hg (hypertension stage 1), and ≥160/100 mm Hg (hypertension stage 2). The only category unchanged is the “normal BP.” Interventions, including pharmacological and nonpharmacological, are recommended for lower levels of BP.6, 8 The finding that less than one third of stroke survivors have normal BP, according to the new guidelines, is expected to trigger earlier pharmacological interventions (for SBP/DBP >130/90 mm Hg) and lifestyle modifications among stroke survivors. Lifestyle modifications to prevent cardiovascular events in stroke survivors have been well summarized in 3 recent meta‐analyses.16, 17, 18 One of the main findings from these meta‐analyses is a 1.34– to 4.21–mm Hg reduction in SBP with lifestyle changes. Although these studies found no benefit of lifestyle changes on cardiovascular events rates, the reduction in BP observed may be of significant importance at a population level because a 1–mm Hg reduction in SBP has been associated with a 4% reduction in stroke recurrence rate19 and a 10% reduction in mortality rate.20 The duration of follow‐up in studies included in these analyses was usually short, and the pooled number of participants was relatively small, ranging from 2478 to 6373 participants. The benefits of lifestyle interventions on cardiovascular rate reduction in stroke survivors would be more robust with prolonged and multimodal intervention, including pharmacological interventions. This was observed in other secondary prevention programs, such as those for coronary heart disease.21 There is also evidence from observational studies that lifestyle modifications, including abstinence from smoking, low body mass index, moderate alcohol consumption, regular exercise, and healthy diet, decrease the risk of stroke and stroke‐related death.22 Such benefits would, in theory, be greater in stroke survivors than in the general population. However, as shown in this study, fewer than half of stroke survivors would be at goal with the 2017 ACC/AHA guidelines, outlining the magnitude of efforts to deploy to implement and disseminate the new guidelines. Lessons from prior guidelines have taught us that improving hypertension control is a complex task that includes, among other factors, patients’ motivation, appropriate communication between clinicians and their patients, and careful cost of medication considerations.6 On a positive note, estimates from NHANES suggest that achieving BP control at a large scale is possible. For example, between 1976 to 1980 and 2007 to 2008, in the general population, the rates of hypertension awareness, treatment, and control have increased from 51% to 81%, 31% to 73%, and 10% to 50%, respectively.23 Attributing these changes to the 7 JNC reports on the detection, evaluation, and treatment of high BP, published between 1977 and 2003, is difficult because several government or professional society programs were ongoing during the same period of time.2 In the general population, the new guidelines will result in a substantial increase in the prevalence and absolute number of people with hypertension in the United States (from 31.9% according to the JNC7 guidelines to 45.6% according to the new guidelines) but in only a small increase in the percentage of Americans recommended pharmacological treatment (from 34.3% to 36.2%).8, 24 These conclusions contrast with a much higher proportion of stroke survivors who will require pharmacological treatment; the percentage of stroke survivors who will be recommended antihypertensive treatment will increase from 29.9% to 49.8%. The societal gain if the new guidelines were fully implemented would be reflected in the lower stroke recurrence rate, as suggested by prior studies that have found that every reduction of 1 mm Hg of BP was associated with a 4% reduction in stroke recurrence.19 Although there may be several barriers to implementing these new guidelines, financial burden is arguably one of the most important hurdles to putting these guidelines into practice. Subsequent simulation analyses from the SPRINT do suggest that intensive BP control would be cost‐effective in the mid‐ and long‐term.25 Subsequent evaluations of the level of adherence to the new guidelines among stroke survivors as well as short‐ and long‐term economic cost analyses are needed.
This study has limitations. The diagnosis of stroke was by self‐report. Despite the lack of validation data on self‐reported diagnosis of stroke specifically conducted by NHANES, the use of self‐report in stroke epidemiology studies, including in the United States, has been shown to have a sensitivity and specificity ranging from 78% to 96% and 96% to 98%, respectively.26, 27, 28, 29 Furthermore, we were not able to provide estimates by stroke subtypes. The current study relies on BP obtained at a single visit, unlike the recommended average of multiple BP measurements by the JNC7 and ACC/AHA guidelines. Despite these potential limitations, our study has major strengths, including the rigorous, validated, standardized, and consistent methods for collecting data in NHANES each year and nationwide reach.
In conclusion, our findings suggest that implementing the ACC/AHA hypertension guidelines will result in significant increase in the proportion of stroke survivors with hypertension, recommended pharmacological treatment, and above BP target. Our results call for preemptive actions to successfully implement the new guidelines in stroke survivors.
Lekoubou: Study concept and design, data interpretation, and critical revision of the article for important intellectual content. Bishu: Statistical analysis, data interpretation, and critical revision of the article for important intellectual content. Ovbiagele: Study concept and design, critical revision of the article for important intellectual content, and study supervision.
- ↵Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER III., Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB; American Heart Association Statistics Committee; Stroke Statistics Subcommittee . Executive summary: heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:447–454.
- ↵Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG, Howard G, Kissela BM, Kittner SJ, Lichtman JH, Lisabeth LD, Schwamm LH, Smith EE, Towfighi A; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; Council on Functional Genomics and Translational Biology . Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke. 2014;45:315–353.
- ↵Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease . Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2160–2236.
- ↵Katsanos AH, Filippatou A, Manios E, Deftereos S, Parissis J, Frogoudaki A, Vrettou AR, Ikonomidis I, Pikilidou M, Kargiotis O, Voumvourakis K, Alexandrov AW, Alexandrov AV, Tsivgoulis G. Blood pressure reduction and secondary stroke prevention: a systematic review and metaregression analysis of randomized clinical trials. Hypertension. 2017;69:171–179.
- ↵Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr., Jones DW, Materson BJ, Oparil S, Wright JT Jr., Roccella EJ; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee . Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–1252.
- ↵Whelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr., Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr., Williamson JD, Wright JT Jr.. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–1324.
- ↵National Center for Health Statistics. National Health and Nutrition Examination Survey Data . http://www.cdc.gov/nchs/surveys.htm. Accessed November 13, 2017.
- ↵National Center for Health Statistics . https://www.cdc.gov/nchs/data/datalinkage/Public_use_Data_Dictionary_11_17_2015.pdf. Accessed February 12, 2018.
- ↵Centers for Disease Control and Prevention (CDC) . National Center for Health Statistics (NCHS) National Health and Nutrition Examination Survey Questionnaire, Examination Protocol, and Laboratory Protocol. Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2011. http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm. Accessed November 13, 2017.
- ↵StataCorp . Stata: Release 14. Statistical Software. College Station, TX: StataCorp LP; 2015.
- ↵Deijle IA, Van Schaik SM, Van Wegen EE, Weinstein HC, Kwakkel G, Van den Berg‐Vos RM. Lifestyle interventions to prevent cardiovascular events after stroke and transient ischemic attack: systematic review and meta‐analysis. Stroke. 2017;48:174–179.
- ↵Lawrence M, Pringle J, Kerr S, Booth J, Govan L, Roberts NJ. Multimodal secondary prevention behavioral interventions for TIA and stroke: a systematic review and meta‐analysis. PLoS One. 2015;10:e0120902.
- ↵Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta‐analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665.
- ↵Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson DR, Taylor RS. Exercise‐based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011;6:CD001800.
- ↵Towfighi A, Markovic D, Ovbiagele B. Impact of a healthy lifestyle on all‐cause and cardiovascular mortality after stroke in the USA. J Neurol Neurosurg Psychiatry. 2012;83:146–151.
- ↵Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT Jr., Whelton PK. Potential U.S. population impact of the 2017 ACC/AHA high blood pressure guideline. J Am Coll Cardiol. 2018;71:109–118.
- ↵Bress AP, Bellows BK, King JB, Hess R, Beddhu S, Zhang Z, Berlowitz DR, Conroy MB, Fine L, Oparil S, Morisky DE, Kazis LE, Ruiz‐Negrón N, Powell J, Tamariz L, Whittle J, Wright JT Jr., Supiano MA, Cheung AK, Weintraub WS, Moran AE; SPRINT Research Group . Cost‐effectiveness of intensive versus standard blood‐pressure control. N Engl J Med. 2017;377:745–755.
- ↵Engstad T, Bønaa KH, Viitanen M. Validity of self‐reported stroke: the Tromsø Study. Stroke. 2000;31:1602–1607.
- ↵O'Mahony PG, Dobson R, Rodgers H, James OF, Thomson RG. Validation of a population screening questionnaire to assess prevalence of stroke. Stroke. 1995;26:1334–1337.


By Richard Moore. Last Updated: August 5, 2012 10:18am
Michael Phelps: Won his 18th Olympic gold medal and bowed out on a high
And so farewell, Michael Phelps -- the Flying Fish, the Baltimore Bullet -- who splashed his size-14 feet and 6ft 7ins wingspan through the water for the final time in competition on Saturday evening in London.
As he left the pool, and walked straight through the zone where reporters wait for snatched conversations, he told the US team's press attaché: "Better go do the last warm down." And off he went, dripping water.
Phelps had just won his fourth gold medal of these Games, in the men's 4x100m medley: the 18th Olympic gold medal of his career and 22nd medal of any colour, from Athens to Beijing to London.
All of which meant that, on Saturday evening in the pool, we were witnessing the final bow of a legend on a par with Carl Lewis or Steve Redgrave, though there is a strong argument that, on medal count alone, he is the greatest Olympian of all time.
And yet it was all so low key. Not so much in the Aquatics Centre itself, which filled with people and noise and appreciation for Phelps, but there were no laps or lengths of honour, no bouquets, just some tears on the podium and some blown kisses from the American fans in the stands. There seemed to be admiration and awe rather than love and affection.
Being in this arena is like being inside the belly of a whale. It has a beautifully curving, swooping roof that is somehow reminiscent of a whale's underbelly. On the outside, it protrudes into the Olympic Park, like a giant tongue.
The atmosphere was as raucous as it has been every night, but that's the point. "Come on people, this is the final night of the swimming at the Olympics," said the announcer at one point, as though urging them to acknowledge that they were bearing witness to an historic moment.
Perhaps it didn't help that a stone's throw away, in the Olympic Stadium, was unfolding arguably the greatest night in British athletics' history, the roars from which occasionally penetrated the arena that stands closest to it. In the swimming pool, there was a nagging feeling that we were missing out on something.
Yet Phelps did what he had to do, swimming the butterfly leg of the relay to put his team in the lead, and on course for gold. Earlier, he had addressed his teammates -- a rare occurence, they said later. "I said to them, 'We all want to win, let's go out and do it,'" Phelps recalled. "We were excited. We were going to end like we always end."
After the race, Phelps' fellow swimmers were quizzed about Phelps. And the big question was: does he mean it? Is he really retiring, or will he be back for Rio?
But they were also asked what he was like. "He's a joy to have at practice," said one. "When I'm hurting I can deal with it because I know he's gone through that pain many times before me."
"Watching Michael swim is beautiful," said another. "You can tell he was meant to do it. We're all going to miss him so much."
"I'd be ecstatic if he came back," said another. "He really has opened up our sport, and let the world know that swimming is a sport."
Eventually the man himself appeared, still looking a bit like a big, goofy teenager. But before he was asked if he meant it, he was asked why he was bowing out when he is still at -- or close to -- the top of his game. "I told myself I never want to swim when I'm 30," said the 27-year old. "No offence to those people who are 30. But I don't want to swim another three years.
"And I've been able to do everything I wanted." This was the crucial point. He and his coach, Bob Bowman, have, he said, "managed to do every single thing we set out to do, and I think if you can say that about your career, it's time to do other things.
"It's kind of weird looking at this and seeing [myself described as the] greatest Olympians of all time," Phelps continued. "I've looked up to Michael Jordan my whole life, the greatest basketball player who has ever played the game, and I said to Bob tonight: 'I've become the greatest swimmer of all time,' and I thanked him. He said, 'That's not fair: you're wearing goggles.' Because the tears were streaming down his face.
"I love him to death, and I'm thankful I have someone who cares for me, and who has put up with all my crap over the last 15 years."
Once Phelps had disappeared, his teammates were asked if they thought he was serious about retiring. "Yes," said Matt Grevers.
Before he left, Phelps was asked what he would write in the journal he keeps. "Just a few words: 'I did it.'"
His final outing did seem low key, but maybe that is the way to do it. These Olympics have been Phelps' retirement Games, which meant that he went out without the bang with which he could have gone out in Beijing, where the quest for eight golds made his campaign relentless, stressful, and -- ironically -- quite joyless.
Here in London Phelps has been liberated from chasing an impossible target; he has seemed relaxed. He has won a couple of medals that were silver rather than gold, and looked happy. He hasn't pouted on the podium, but instead proved himself to be the most gracious of losers. Despite not hitting the heights of Beijing, he leaves the sport with his reputation enhanced.
He did it.
Now for the serious business in the Aquatics Centre: the synchronised swimming gets underway on Sunday.
DOB: 17/5/1956 Event: Boxing Medals: 1 gold Flag: USA
A week into the Games of the XXX Olympiad, Richard Moore brings us his half-way highs and lows
Linford Christie sprinted to 100m gold for Britain at an Olympic Games best remembered for America's basketball dream team.


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This promotional laptop backpack can be custom imprinted with your company's name and logo. A great custom computer bag that's great for schools and students.
This popular matte finish, laminated paper logo tote bag features matching macrame handles and cardboard bottom insert enabling extra carrying weight.
All the details at an affordable price with these custom messenger bags.
Get noticed easily with this compact sized custom drawstring backpack featuring dual reflective stripes.
4GB Custom USB Flash Drives flips open and is available in several colors for a very nice and colorful promotional giveaway.
Keep yourself and your company logo cool with this Gildan 100% preshrunk heavyweight 5.3 oz cotton logo t-shirt.
Inexpensive and soft to the touch, this logoed embroidered custom polo is a great value. Made of 65% polyester and 35% cotton. 5 oz.
This attention-getting Wooden Mental Block Promotional Puzzle focuses people's attention on your logo! Six imprints for the price of one.

domain: design


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Taetiseo (Taeyeon, Tiffany, Seohyun), SNSD’s unit group, will appear on M Countdown.
On May 3, Mnet tweeted pictures with the comment, “You’ve been waiting for a long time. SNSD’s special unit Taetiseo will perform for the first time on M Countdown, which will air live tonight at 6:00 p.m.”
In the pictures, Taetiseo members are posing in purple outfits. Tiffany has her orange hair tied back and Taeyeon is wearing long brown wavy hair. The youngest member Seohyun looks innocent.
People responded: “I can’t wait to see them” “Their song is daebak! You are beautiful” “I’m eagerly anticipating their performance. Taetiseo is the best.”
The group will perform their title song “Twinkle” and “Baby Steps” in the May 3 episode of M Countdown.

domain: celebrity


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- Lightly fry the beef or chicken cubes with the margarine, onion, garlic and salt in a large saucepan over medium heat.
- Add ½ cup of water just to make a thick sauce, add the remaining ingredients except the sour cream and ketchup.
- Cook for about 5 minutes and check the meat for doneness.
- When done, add the sour cream and ketchup.
- Mix briefly and take the saucepan out of the heat. The cream should stay on the heat just enough to warm up. Do not let it cook too long.


A one-of-a-kind lighting sculpture, commissioned by the City of Atlanta for the Arrivals Hall at the Hartsfield-Jackson International Airport. Inspired by the otherworldly formation of mammatocumulus clouds, and grounded in the physics of catenary curves, Mammatus was designed in RHINO using Grasshopper parametric modeling software. Made with over 8 miles of nickel-plated bead chain, the sculpture weighs 3000 pounds.
8'H x 24'W x 42'L. Aluminum, Philips Color Kinetics RGB LED computer controlled luminaires, nickel-plated brass bead chain.


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Israeli Prime Minister Binyamin Netanyahu came to the US on Monday to lobby Washington against a diplomatic resolution of the conflict over Iran’s civilian nuclear enrichment program. Netanyahu insisted that Iran’s “military nuclear” program be completely dismantled, even though the UN inspectors continue to certify that no Iranian uranium has been diverted to military purposes. That is, there is no proof that Iran has a “military nuclear” program, and Iran has consistently denied that it is trying to get an atomic bomb. Netanyahu also insisted that the Draconian sanctions on Iran, which are hurting ordinary Iranians’ ability to afford expensive imported medicine be kept in place. Netanyahu’s Iron Wall appears actually to be an iron wall for other people’s children living decent lives.
The irony, which no one wants to talk about, is that Israel has several hundred nuclear warheads, whereas Iran has none. Israel refuses to sign the Nuclear Non-Proliferation Treaty or be inspected, whereas Iran has signed and is regularly inspected. Frighteningly, Secretary of State John Kerry recently demanded that Iran’s Fordow facility be opened to inspections by the International Atomic Energy Agency. But Fordow has been regularly inspected! If a worldly US official of such long experience in foreign affairs can make such a serious error because he has swallowed too much propaganda, what hope do we in the alternative media have at correcting the record? US media and even President Obama have now routinely begun referring to Iran’s alleged “announced” desire for a nuclear warhead, something that Iranian authorities have repeatedly denied they want. They say they want what Japan and South Korea have, the ability to fuel nuclear power plants to make electricity. Iran has been demonized in the US. But Israel has repeatedly invaded neighbors and usurped their territory or attempted to. Iran hasn’t invaded another country since at least the 1850s. Despite Iraq’s invasion of Iran in 1980, Iran has occupied no Iraqi territory nor made any territorial demands. Compare that to Israel’s illegal occupation of Arab territory in 1956 and 1967.
So that the Israel Lobbies and the US Congress have imposed a financial blockade on Iran’s petroleum sales and have so damaged the value of the Iranian currency that the lives of ordinary civilians are being harmed, is viewed by most of the global South as a travesty.
Just to put things in perspective, here is a reprint of a post from last year with pertinent statistics:
… It is worthwhile revisiting the issue of how weak and how much of a nothing the Iranian military is compared to powerhouse Israel. Statistics mostly 2011 from Global Firepower. Note that some comparisons are invidious, as with Israeli reservists, who are quite professional and Iranian reservists, who typically are not. Or, comparing Israeli fighter jets and other aircraft to old broken down Iranian ones is silly. If Israel’s and Iran’s air forces were close enough to tangle (they are not), Iran’s wouldn’t last a day.
And here it is as a jpeg in tabular form:


One of the most amazing things about Justin Townes Earle is how he reinvents himself on every album. For a singer/songwriter, this truly is a feat, but JT Earle has managed to do it for better or worse on pretty much every album. This time around, he’s managed the biggest turn of his career. And although it may be a bit jarring the risk pays off.
The title track of the record features an out and out soulish croon that I didn’t know JT Earle was capable of. It’s also one hell of an anti-love song. He starts out “It’s a shame babe / Nothin that you could do / Things change babe / Such is my feelings for you” and he gets to the chorus “I never loved you / I never loved you.” It’s a stinging message but one that feels refreshing in the normally happy confines of the saturated soul-love song category. It’s a tune that features JT Earle as a singer and puts his normally incendiary guitar work in the background.
Leadoff track “Am I That Lonely Tonight?” has horns and a R&B feel as well. Townes singing stands up just as well in front of horns as he does with textured acoustic guitars. “Look the Other Way” continues in a similar tone with JT Earle taking the reins of the song in his own vocal chords and keeping the guitars jangly and upbeat.
On the second half of the record, JT Earle tones down the tempo and the horns to song a bit more like he has. The tunes “Down on the Lower East Side” and “Won’t Be the Last Time” mine a progression in this direction. They’re more similar to the quieter moments on Midnight the Movies. While they give the album a different feel, they’re certainly some of the less compelling moments.
Luckily, JT Earle turns it back up and the soul energy shines through “Memphis in the Rain.” JT Earle can really hold a note. It allows his songs to stand on in a different way. The record leaves a bit of a negative lonely vibe that lingers. The forlorn nature of the album is certainly affecting.
About the author: Jeff is a teacher in the Boston area. When not buried correcting papers, Jeff can be found plucking various stringed instruments and listening to all types of americana music.