The Foundation-stone of
Kochi Metro was laid by the Prime Minister of India, Dr. Manmohan Singh
at Kochi, Kerala today. While speaking on the occasion Union Urban
Development Minister, Shri Kamal Nath said that the Government of India
has decided to support Metro Rails for all the cities of the country
having a population of more than 2 Million. He said that efficient and
reliable urban transport systems are crucial for India to sustain a high
growth rate and alleviate poverty. To improve the current urban
transport situation the Government is giving much attention to Metro
projects. Metro projects are already under implementation across the
country - Delhi, Kolkata, Mumbai, Bangalore, Chennai, Hyderabad and
Following is the text of the speech of Shri Kamal Nath at the
Foundation-stone laying ceremony of Kochi Metro:
“It is a pleasure to be in the city of Kochi today for the laying of the
foundation stone of the Kochi Metro Rail Project. This is a fitting
tribute to the ongoing “Emerging Kerala” programme taking place in
Kochi. With this, Kochi will join the select list of cities where Metro
projects are under implementation. For this, I would like to thank the
Hon’ble Prime Minister who has been a great champion of the Kochi Metro
Rail project, the Chief Minister of Kerala, the Ministers from Kerala in
the Govt. of India, who relentlessly pushed for this and Mr. A. K.
Antony, the Hon’ble Defence Minister, who conceived and envisioned this
The Kochi Metro Rail Project from Alwaye to Petta (Tripunithura) of 25.3
km will be fully elevated and has a total completion cost of Rs. 5,181
crore. The project will be implemented through joint ownership SPV of
Govt of India and Govt of Kerala and is scheduled to be completed in 4
yrs. This will have the most modern fourth generation technology, after
the experience gained from Metro Projects in Delhi and Chennai. The
implementation mode will be decided by the Center and State Government
in a transparent manner. Kochi Metro is unique as it provides
multi-modal integration with roads and water ways.
India is urbanising rapidly. India’s urban population has increased from
285 million in 2001 to 400 million in 2011 and by 2030 is likely to
reach over 600 million. The number of towns has increased from 5161 in
2001 to 7935 in 2011. Even at this relatively low level of urbanization
(31%), India has the second largest urban population in the world.
The urban centres have emerged as engines of economic activity. The
urban sector contributes around 60% of GDP which is likely to further
increase to over 70% in the next decade. Over 70% of the new jobs are
expected to be created in the cities.
Efficient and reliable urban transport systems are crucial for India to
sustain a high growth rate and alleviate poverty. To improve the current
urban transport situation the Government of India is giving much
attention to Metro projects. Metro projects are already under
implementation across the country - Delhi, Kolkata, Mumbai, Bangalore,
Chennai, Hyderabad and Jaipur. The Government of India has decided to
support DPR preparation for Metro Rails for all cities having a
population of more than 2 Million.
Another mode of Mass Transport System that needs to be explored is
Mono-rails. I am informed that Mono rails is ideal as a feeder system to
larger metro networks as well as for stand-alone shorter networks in the
densely populated pockets of cities. One Mono-rail corridor has already
been identified in Delhi and work has been entrusted to DMRC.
The cities of Calicut and Thiruvananthapuram are also keen on setting up
Mono rails. Calicut proposes a Mono rail of 14 Km length at a cost of
Rs.1600 crore and Thiruvananthapuram proposes to have a Mono rail of 24
Km at a cost of Rs. 2500 crore. In principal approval has already been
accorded to Calicut Mono rail and I would urge the Chief Minister to
take-up this Mono rail project on priority and entrust its
implementation to Kochi Metro.
In order to make urban travel a more pleasant experience, Government of
India sanctioned buses with superior specifications to cities. Kerala
has been sanctioned 350 buses (200 for Kochi and 150 for
Thiruvananthapuram) with a total project cost of Rs.124 crore. The
Additional Central Assistance i.e. Govt. of India share is Rs.78.22
A major step taken to address the Urban Infrastructure deficit in the
country was the launch of the Jawaharlal Nehru National Urban Renewal
Mission (JNNURM) by the Government of India in the year 2005. This was a
reforms linked central assistance for development of urban
infrastructure. In the first phase of JnNURM, 36 projects have been
sanctioned for Kerala at an approved cost of Rs 1425 crore, with Central
Assistance of Rs 997 crore.
In Kochi, a total of six projects at a total cost of Rs. 509 crore have
been sanctioned. Four projects have been sanctioned in basic sectors,
one each in water supply, drainage, sewerage and solid waste management.
One project each has been sanctioned in road & transport sector and
We are now in the process of finalising the next phase of the Urban
Renewal mission. We are keen to explore innovative means to raise
resources such as monetization of land and would like to encourage
Public Private Partnership and Viability Gap Funding.
A major reform that the State governments need to carry out is in the
area of capacity building. We would like each State to create a
Municipal Cadre so that our efforts at Urban infrastructure development
are more effective and sustainable.
Before I conclude I would like to once again congratulate the people of
Kochi and Kerala on this momentous day”.


text:
Jack Griffin, who exited as Chief Executive of Tribune Publishing in February, is landing as a senior adviser at the boutique investment banking firm of DeSilva+Phillips.
Griffin oversaw the separation of Tribune’s newspapers from its TV assets. At Tribune, he thought he had a white knight when he brought in Michael Ferro as non-executive chairman.
The original thinking was that the $44.4 million cash infusion from Ferro’s Merrick Media would be used for the buyout of the Orange Country Register.
But then Ferro staged an insurrection 19 days after joining and forced Griffin out of Tribune.
The Shakespearean drama took another turn a month later when the Justice Department stepped in to stop Tribune, already the owner of the LA Times, from buying the Register, on antitrust grounds.
Then Tribune itself became the target of a takeover bid by USA Today publisher Gannett.
Griffin previously had a short gig as CEO of Time Inc. Earlier in his career, he was president of the national media group at Meredith.
In between his two CEO gigs, he put together an investment group that bid unsuccessfully for the Boston Globe.

domain: economics


text:
It is a rare occurrence for both Les and Martin to demonstrate together like this, so those from our mailing list who logged in to Zoom enjoyed a bit of a treat – for free!
Despite a minor technical glitch that was quickly rectified, the evening was a lot of fun. Plenty of information and techniques were given away and there were lots of questions from the viewers, too – thank you!
If you tuned in to watch, leave a comment below and tell us what you thought of it.
From the Hampshire Sheen YouTube channel:
“On the evening of 14th June, Hampshire Sheen developer Martin Saban-Smith teamed up the one and only Les Thorne to present a free demonstration for mailing list members of their business, The Woodturning Shop. This short video is a selection of highlights from the second part of their presentation.
Over 180 viewers tuned in to Zoom to watch the the two professional turners 2 hours free presentation. Les turned an ornamental Ziricote bud vase after which Martin finished it in three different ways using a combination of Hampshire Sheen products – Pre-Thinned Cellulose Sanding Sealer, Microcrysalline Wax, Gloss Finishing Wax and a Carnacrystalline Stick.
The end result is a super shiny piece that will shine on for years without needing to be refinished, even after lots of handling.
In the second half, Les turned an ogee shaped platter that was finishing on the top with a viewer’s choice of Intrinsic Colours – Pear Green and Plum. Martin demonstrated how, with careful blending, even two colours from opposite sides of the colour wheel can be made to work together. This was then sealed and a coat of our Electric Blue Embellishing Wax was added to the grain.
Many thanks to Les Thorne for the turning aspect of the demonstration and to the viewers for all their questions”

domain: artistic


text:
- Saiman Das
Jasprit Bumrah in WPL 2023: Mumbai Indians ace bowler Jasprit Bumrah was seen during the WPL Final 2023 in stands along with his fellow teammate Jofra Archer. This was the first public appearance of the Indian pacer after his back surgery.
Following his decision to withdraw from the home T20Is against South Africa in late September last year, Bumrah has been absent from competitive cricket. He was unable to participate in the T20 World Cup held in Australia and also missed out on the Asia Cup, which took place in the UAE last year.
The 29-year-old tried to make a return to the game in January this year for the ODI series against Sri Lanka. However, he was removed from the squad just before the opening match in Guwahati.
Unfortunately, The right-arm bowler has now been ruled out of the upcoming IPL season and the World Test Championship final in June. Jasprit Bumrah‘s absence from the field has cost the men in blues, as they could not win any tournaments in the previous year.
Also Read: India’s Experienced Paceman Bhuvneshwar Kumar Out Of BCCI’s Annual Contract List, Check Out Other Big Names That Were Not Included
On Sunday, Mumbai Indians posted a video on their Instagram account showing Jasprit Bumrah in the stands for WPL Final 2023. He had a conversation with England’s fast bowler Jofra Archer at the Brabourne Stadium.
Also Read: Didn’t Get This Much Angry Even When I Missed A Triple Ton: Virender Sehwag Recalls How Virat Kohli Denied Him A Milestone
Given that the 29-year-old Indian pacer will not be featuring in IPL 2023, Jofra Archer, who missed the previous season due to injury, will likely lead the bowling attack for the Mumbai Indians this year.
Mumbai Indians’ fans will have to wait one more season before the deadly duo of Archer-Bumrah will spit fire on the opposition teams. It was highly speculated that the duo will play together this year but Bumrah’s back surgery made it impossible.
The Mumbai Indians are set to commence their IPL 2023 campaign on April 2 against the Royal Challengers Bangalore at the M Chinnaswamy Stadium in Bengaluru.
Mumbai Indians’ Squad: Rohit Sharma (c), Tim David, Ramandeep Singh, Tilak Varma, Suryakumar Yadav, Ishan Kishan, Tristan Stubbs, Dewald Brevis, Jofra Archer, Arjun Tendulkar, Arshad Khan, Kumar Kartikeya, Hrithik Shokeen, Jason Behrendorff, Akash Madhwal, Cameron Green, Jhye Richardson, Piyush Chawla, Duan Jansen, Vishnu Vinod, Shams Mulani, Nehal Wadhera, Raghav Goyal
Also Read: IPL 2023: 3 Mumbai Indians Players Who Can Win the Man of the Tournament Award
1 of 4

domain: news


text:
- Hardcover: 128 pages
- Publisher: Aspen MLT, Inc. (July 10, 2012)
- Language: English
- ISBN-10: 0982362889
- ISBN-13: 978-0982362884
- Product Dimensions: 6.7 x 0.4 x 10.3 inches
- Shipping Weight: 14.9 ounces (View shipping rates and policies)
- Average Customer Review: 2.3 out of 5 stars See all reviews (6 customer reviews)
- Amazon Best Sellers Rank: #2,734,817 in Books (See Top 100 in Books)
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The Art of Abraham Lincoln: Vampire Hunter Hardcover – July 10, 2012
Top Customer Reviews
|Length: 0:31 Mins|
This book is a graphic novel made of storyboards from the film. The hardcover is even sized like a normal trade paperback. The movement arrows remain in some storyboards. Storyboards are also cut up to fit into comic panel shapes you typically see. There are no speech bubbles but the whole story is narrated. The story isn't too bad, at least it's complete.
The art is rough as you can expect from a graphic novel. If you're an artist, maybe you can learn a thing or two about staging the scene.
Overall, this book is a like a weirdly mixed cocktail. It's more of a graphic novel than artbook that's for sure. I wish publishers and authors would stop putting "Art of" in book titles when they clearly are not artbooks.
(There are more pictures of the book on my blog. Just visit my Amazon profile for the link.)
This is not one of those books.
It's a graphic novel. Uniquely, this is a graphic novel that follows the movie (sort of), but is told from the POV of a character who is not featured (or even mentioned) in the movie. It also hints at a sequel, which I'm guessing will not be forthcoming, since the box office wasn't great for this movie.
So, once again I've been surprised by Abraham Lincoln: Vampire Hunter. This is not the book story, and not the movie story. I can't wait to see which new story I stumble into next.
If you collect "Art of..." books, this will not be an addition to your collection. If you collect graphic novels, this might be right up your alley. It was difficult to rate this book, because it's not my thing, but I feel it succeeds at what it tries to be. Also: brief cartoon nudity, so be advised of that before you hand it off to a kid.
From the Amazon blurb:
"This deluxe edition contains never-before-seen storyboards, concept art, production illustrations, and costume designs, as well as drawings from visionary director Timur Bekmambetov. This behind-the-scenes glimpse into the creation of the hit film also features commentary by Bekmambetov, along with several others who helped bring this extraordinary film to life. Don't miss out on this rare, behind-the-scenes look into the creation of one of the most talked about new movies of the year, Abraham Lincoln: Vampire Hunter!"
It would appear that the publisher (or Amazon) didn't know what they were selling. Because the book described above would be awesome. I'd buy that book too.
Most Recent Customer Reviews
Amazon's description is way off here and this is not your typical movie companion book. The description from the back cover: "This deluxe edition utilizes never-before-seen... Read morePublished on July 29, 2012 by Scary Jerry
As other reviewers have stated this is a graphic novel (despite the product description which apparently is from the publisher as this same description is used on other sites). Read morePublished on July 19, 2012 by ArtGuy


text:
Russell Means passed away yesterday. I haven’t had the right words to express my sadness. My connection to the history and culture of the natives of North, Central, and South America is not something most people know about. It is not personal in that I don’t have any biological connection to these people groups, other than the land bridge that used to exist in the Bering Strait which probably connected the ancient peoples of Asia to North America. But I rarely speak of a very special time in which I developed a deep love for the Navajo people in New Mexico. Maybe I will write more about this later. I’m just sad about this news, and I will probably pay tribute to a great man by at least watching him be a badass in his first feature film, Last of the Mohicans.
If you want to know a little bit more about how he was a real-life badass, you can get a decent start on the wikipedia page.

domain: geography


It will cost $231,796,800 to run the City and Borough of Juneau in the next fiscal year.
The Assembly Monday night appropriated the funds for the FY 2013 budget, which begins July 1. The budget total includes debt service and capital projects.
City code requires it be adopted and funds appropriated by June 15. The Assembly Finance Committee – comprised of all nine Assembly members – approved the spending plan two weeks ago.
Property tax mills fund the budget. The Assembly formally established the rate last night – the same as recommended by the Finance Committee.
City manager Kim Kiefer said the operating mill rate will be 9.26, and debt service 1.29, for a total of 10.55 mills.
“This rate is the same total operating and debt service mill rates as levied in 2011,” Kiefer said.
CBJ property tax rates will stay the same: $1,055 dollars for every $100,000 of assessed property value.
The Assembly also adopted the list of capital improvement projects to be undertaken in the next fiscal year. The money will come from city sales tax and marine passenger fees. Click here for the list of projects and funding sources.
- Stereotypes about Mexican immigrants in the United States abound, but everyone has a unique situation. This is the tale of one couple with two very different stories.
- Attorneys for the two defendants in the Sockeye fire case have asked for more time from the court to prepare a case for trial.
- Sitka's new plant treats water with ultraviolet rays.
- Last week a group of scientists traveled to a small village in the Arctic to find as many different species as they could. It was happening all over the country in celebration of the 100th anniversary of the National Park Service.


text:
MONDAY, Nov. 26, 2018 (HealthDay News) — An experimental Alzheimer’s disease vaccine shows promise in animal tests, and researchers say it could have the potential to reduce dementia cases by half.
In mice created to develop Alzheimer’s, the vaccine triggered an immune response that reduced accumulation of two toxic proteins associated with the fatal brain disease.
There was a 40 percent reduction in beta-amyloid proteins and up to a 50 percent reduction in tau proteins, with no harmful side effects, according to researchers at the University of Texas.
But there’s a catch: While such tests showed positive results in mice, research on animals doesn’t always produce the same effects in humans. More study is needed.
Still, the researchers remained optimistic. Reductions in these proteins could someday have significant benefits in people at risk for Alzheimer’s disease, said study senior author Doris Lambracht-Washington, of the UT Southwestern Medical Center Brain Institute in Dallas.
“If the onset of the disease could be delayed by even five years, that would be enormous for the patients and their families,” she said in a center news release. “The number of dementia cases could drop by half.”
Lead researcher Dr. Roger Rosenberg is founding director of the Alzheimer’s Disease Center at UT Southwestern.
“This study is the culmination of a decade of research that has repeatedly demonstrated that this vaccine can effectively and safely target in animal models what we think may cause Alzheimer’s disease,” said Rosenberg.
“I believe we’re getting close to testing this therapy in people,” he added.
Two previous studies from Rosenberg’s lab showed that the vaccine triggered similar immune responses in rabbits and monkeys.
UT Southwestern scientists are also working to create a test to detect abnormal tau levels in spinal fluid before the memory-loss symptoms of Alzheimer’s appear. They said such a test would identify people who could benefit from the vaccine.
In people with Alzheimer’s, the beta-amyloid and tau proteins spread in lethal plaques and tangles on the brain, the study authors explained.
“The longer you wait [to administer the vaccine], the less effect it will probably have,” Rosenberg said. “Once those plaques and tangles have formed, it may be too late.”
About 5.7 million Americans have Alzheimer’s disease. That number is expected to more than double by the year 2050, according to the U.S. Centers for Disease Control and Prevention. There is no effective treatment for the disease.
The study was published recently in the journal Alzheimer’s Research and Therapy.
The tiny hand and forearm slipped out too early. Babies are not delivered shoulder first. Dr. Terri Marino, an obstetrician in the Boston area who specializes in high-risk deliveries, tucked it back inside the boy’s mother.
“He was trying to shake my hand and I was like, ‘I’m not having this — put your hand back in there,’” Marino would say later, after all 5 pounds, 1 ounce of the baby lay wailing under a heating lamp.
This is the story of how that baby, Bryce McDougall, tested the best efforts of more than a dozen medical staffers at South Shore Hospital in Weymouth, Mass., that day last summer.
Bryce’s birth also put to the test a new method of reducing cesarean sections developed at Dr. Atul Gawande’s Ariadne Labs, a “joint center for health systems innovation” at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health in Boston.
The story starts before Bryce’s birth, on the last day of August at about 9:30 in the morning.
Melisa McDougall has just checked into South Shore, after a routine ultrasound. She’s in her 36th week, pregnant with twin boys. The doctors have warned Melisa that her placenta won’t hold out much longer. She’s propped up in bed, blond hair pulled into a neat bun, makeup still fresh, ordering a sandwich, when her regular obstetrician arrives.
“How are you?” asks Dr. Ruth Levesque, sweeping into the room and clapping her hands. “You’re going to have some babies today! Are you excited?”
The first of the twins — Brady — is head-down, ready for a normal vaginal delivery. But brother Bryce is horizontal at the top of Melisa’s uterus.
That’s one reason Melisa is a candidate for a C-section. Babies do not come out sideways. And there’s another reason most doctors would not consider a vaginal delivery in Melisa’s case, Levesque says. Four years ago, she delivered the twins’ sister by cesarean.
“[Melisa] has a scar on her uterus,” Levesque explains, “so there’s a risk of uterine rupture — very rare, but there’s always a possibility.”
And that possibility may be greater for Melisabecause she’s 37 and having twins. But the McDougalls hope to have vaginal deliveries for both boys.
“I just feel like it’s better for the kids — better for the babies,” Melisa says.
Melisa McDougall hears comforting words from her nurse at South Shore Hospital in Weymouth, Mass. Part of the focus of the Team Birth Project is on facilitating communication among parents, nurses and doctors.(Jesse Costa/WBUR)
How The ‘Team Birth Project’ Came To Be
Avoiding C-sections is also better for many moms. With cesareans, there’s a longer recovery period, a greater risk of infection and an association with injury and death. And most C-sections are not medically necessary, said Dr. Neel Shah, who directs the Delivery Decisions Initiative at Ariadne Labs.
“We’re fairly confident that, when you look nationally, the plurality — if not the majority — of C-sections are probably avoidable,” said Shah.
Those avoidable C-sections are the focus of the Team Birth Project, designed by Shah with input from roughly 50 doctors, nurses, midwives, doulas, public health specialists and consumer advocates who focus on childbirth. South Shore Hospital is one of the pilot sites for the project.
In describing the collaboration, Shah begins with an acknowledgement: Childbirth is complicated. You’ve got two patients — the mother and the baby — and an ad hoc, often shifting team that at a minimum includes the mom, a nurse and a doctor.
“So you’ve got three people who have to come together and become a very high-performing team in a really short period of time, for one of the most important moments in a person’s life,” Shah said.
And this team has to perform at its best during an unpredictable event: labor.
Shah says doctors and nurses generally agree about three things: when a mom is in active labor; when a mom can definitely try for a vaginal delivery; and when she must have a C-section.
“And then there’s this huge gray zone,” Shah said. “And actually, everything about the Team Birth Project is about solving for the gray.”
To avoid unnecessary C-sections when what to do isn’t clear, this hospital, in conjunction with Ariadne, has changed the way labor and delivery is handled from start to finish.
First, women aren’t admitted until they are in active labor. Secondly, the mom’s preferences — such as whether she’d like an epidural or not, whether she wants to have “skin-to-skin contact” with the baby immediately after birth — help guide the members of the labor team. The team members map the delivery plan — including mom’s preferences and the medical team’s guidance — on a whiteboard, like the one in Melisa’s room.
For the births of Bryce and Brady McDougall, the white erasable planning board gets a lot of use.
Under “Team,” Levesque and registered nurse Patty Newbitt write their names. Melisa and Shaun McDougall are also listed as equal partners. The names of other family members or nurses may be added and erased as labor progresses. Shah’s idea is that this team will “huddle” regularly throughout the labor to discuss the evolving birth plan.
The birth plan itself is divided into three separate elements on the board: Maternal (the mom), Fetal (the baby) and Progress (in terms of how the labor is progressing). A mom with high blood pressure, for instance, may need special attention — and that would be noted on the board — but she could still have a normal labor and vaginal delivery.
The whiteboard in Melisa McDougall’s hospital room details the birth plan, including her preferences and the medical team’s guidance.(Jesse Costa/WBUR)
Good Communication Throughout Labor And Delivery Is Key
Dr. Kimberly Dever, who chairs the OB-GYN department at South Shore, highlights a section of the whiteboard called “Next Assessment.”
That category is included on the board, Dever said, “because one of the things I often heard from patients is that they didn’t know what was going to happen next. Now they know.”
Asking the mom — and the couple — about their preferences for the delivery is crucial, too, Levesque said.
“It forces us to stop and to think about everything with the patient,” she explained. “It makes us verbalize our thought process, which I think is good.”
Shaun McDougall walks across the room to get a closer look at the whiteboard.
“Honestly, it seems like common sense,” he says. “I would always think the nurses would have something like this, but to have it out where mom and dad can see it — I think it’s pretty cool.”
With Melisa McDougall’s plan in place, everyone settles in, to wait. About four hours later, Melisa isn’t yet feeling contractions. Levesque breaks the water sac around Brady.
“Looks nice and clear,” Levesque reports. “Hey bud, come on and hang out with us,” she says to the baby.
“So, you’re going to keep leaking fluid until you leak babies,” the doctor explains to Melisa. “Whenever you start getting uncomfortable, we’ll get you an epidural at that point.”
Levesque moves to the board and adds updates: Melisa is 4 centimeters dilated; her waters broke at 13:26; the next assessment will be after she gets an epidural.
The medical team insisted ahead of time thatMelisa agree to be numbed from the waist down if she wants to deliver Bryce — the second twin — vaginally. Melisa agreed. The obstetricians may need to rotate the baby in her uterus, find a foot and pull Bryce out, causing pain most women would not tolerate.
One of those doctors — Marino — peeks into the room and waves.
“Just came to say hi,” says Marino, who has more experience than most obstetricians in delivering babies positioned like Bryce. Along with Levesque, Marino has been seeing Melisa regularly through office visits.
Shaun McDougall asks the physicians if they’ll pose for a picture with his wife.
“Can we make funny faces?” asks Levesque.
“I want you to,” says Shaun. “You guys are like her favorite people on the planet.”
As the hours tick by, there’s a shift change, and registered nurse Barbara Fatemi joins the McDougall team. She checks Melisa’s pain level regularly to determine when she’s ready for the epidural.
Melisa says she isn’t feeling much, but adds that she has a high tolerance for pain. Shaun tells Fatemi he sees the strain on his wife’s face. Fatemi acts on Shaun’s assessment, and calls an anesthesiologist to prepare the epidural, something Shaun later says reinforces his feeling that they’re a team.
Levesque soon arrives for the promised “next assessment.” Melisa is now 10 centimeters dilated and ready to deliver — but she must hold on until nurses can get her into an operating room.
The OR will be the right place if the second baby, Bryce, doesn’t shift his position, and the doctor needs to do a last-minute cesarean.
“I’ll see you in a few minutes. No pushing without me, OK?” Levesque says over her shoulder as she heads to the OR to prep.
“I’ll try,” Melisa says, weakly. In a minute, nurses are rolling her down the hall, following Levesque.
Almost five years ago, two women who were wheeled into this hospital’s operating rooms during childbirth died after undergoing C-sections. Though state investigators found no evidence of substandard care, Dever, the head of obstetrics, said the hospital scrutinized everything.
“When you have something like that happen, that expedites your efforts,” she said. “Exponentially.”
Now, Dever said, she sees an opportunity, through the Team Birth Project, to model changes that could help women far and wide.
“I would love women everywhere to be able to come in and have a safe birth and healthy baby,” she said. “That’s why I’m doing it.”
‘They Did Not Flinch’
Dever is about to see her pilot study of the Team Birth Project pushed to new limits by little Bryce McDougall. First, though, Melisa must deliver Bryce’s twin brother, Brady. Even his birth, the one that was expected to be easier, is more difficult than anticipated.
Bent nearly in half, her face beet red, Melisa strains for five pushes. She throws up, then gets back to laboring. And suddenly, there he is.
“Oh my goodness Brady, oh Brady,” wails Shaun. He follows a nurse holding his son over to a warmer.
Marino takes Shaun’s place next to Levesque, who has reached inside Melisa to get the next twin. Levesque’s mission is to grab Bryce’s feet and guide him out. But everything feels like fingers, not toes.
“That’s a hand,” she murmurs. “That’s a hand, too.”
Marino rolls an ultrasound across Melisa’s belly, hoping the scan will show a foot. But Bryce’s feet are out of sight and out of reach.
Marino has had more experience than most obstetricians with transverse babies and this procedure, known as a breech extraction; she asks to try. She reaches into Melisa’s uterus while Levesque moves to Melisa’s right side and uses her forearm to shift Bryce and push him down. Dever has come into the room, and takes over the ultrasound. At least six doctors and nurses encircle Melisa, whose face is taut. Shaun frowns.
“Babe, you OK?” he asks.
Melisa nods. Bryce’s heart rate is steady. But there’s still no sign of a foot. One little hand slips out and Marino nudges it back in.
“Open the table,” says Marino, her voice strained.
It’s open and ready, her colleagues say, referring to the array of sterile surgical instruments that Marino may soon need, to begin a C-section.
For 36 seconds, this room with more than a dozen adults grows oddly quiet. Everyone is watching Marino twist her arm this way and that, determined to find Bryce’s feet. Levesque leans hard into Melisa’s belly. Shaun bites his lip. Then Marino yanks at something — and her gloved hand emerges, clenching baby Bryce by his two teeny legs.
“Oh babe, here he comes, here he comes — Woo!” squeals Shaun.
Shaun is overcome with emotion again. Melisa manages an exhausted giggle. Baby Bryce keeps everyone waiting a few more seconds and then howls.
Levesque tends to Melisa, and Marino comes around to congratulate the new mom.
“He was fighting you, huh?” Melisa says, and laughs.
“I think I found at least five hands,” says Levesque.
Outside the OR, Levesque and Marino look relieved and elated. Both agree that most doctors would have delivered Bryce by C-section. But at South Shore, the McDougalls found a hospital that has challenged itself to perform fewer C-sections, and a doctor with experience in these unusual deliveries — one who knew and respected the parents’ preference.
“They specifically wanted to have a vaginal delivery of both babies,” Marino says — and that was on her mind during the difficult moments.
Bryce was fine, says Marino, so the deciding factor for her was that Shaun and Melisa did not panic.
“They did not flinch — they were like, ‘Keep going,’” Marino recalls. “Sometimes the patient will say ‘stop,’ and then you have to stop.”
The babies’ father says he came close to requesting that, in the very last minute before Bryce was born.
“That part with the arm — it was pretty aggressive,” Shaun says.
But in that moment, he adds, the feeling that he and Melisa were part of the team made a difference.
“It made us more comfortable,” Shaun says, and that comfort translated to trust. “We trusted the decisions they were making.”
Melisa says she’s grateful for the vaginal delivery.
“I did not want to have a natural birth and a C-section,” she says. “That would be a brutal recovery.”
Instead, 30 minutes after Bryce’s birth, Melisa is nursing Brady and talking with family members on FaceTime.
Next Assessment For The Team Birth Project
South Shore began using the Team Birth approach in April. Three other hospitals are also pilot sites: Saint Francis in Tulsa, Okla.; EvergreenHealth in Kirkland, Wash.; and Overlake in Redmond, Wash. The test period runs for two years. In the first four months at South Shore, the hospital’s primary, low-risk C-section rate dropped from 31 percent to 27 percent — about four fewer C-sections each month.
Experts who contributed to the development of the Team Birth Project are eager to see whether other hospitals can lower their rates of C-section and keep them down.
“Once you get past the early adopters, how do you demonstrate the benefits for others that aren’t willing to change?” asked Gene Declercq, a professor of community health sciences at Boston University School of Public Health.
Declercq noted that a few insurers are beginning to force that question, refusing to include in their networks hospitals that have high C-section rates, or high rates of other unnecessary, if not harmful, care.
The federal government has set a target rate for hospitals: No more than 23.9 percent of first-time, low-risk mothers should be delivered by C-section. The U.S. average in 2016 was 25.7 percent.
The target was put in place because research has shown that if a woman’s first delivery is a C-section, her subsequent deliveries are highly likely to be C-sections, too — raising her (and her baby’s) risk for complications and even death.
Declercq said the project’s focus on communication in the labor and delivery room makes sense because many physicians decide when to perform a cesarean based on clinical habit or the culture of their hospital.
“If you can impact that decision-making process, you can perhaps change the culture that might lead to unnecessary cesareans,” said Declercq.
This story is part of a reporting partnership with WBUR, NPR and Kaiser Health News.
KHN’s coverage of these topics is supported by
Heising-Simons Foundation and
The David and Lucile Packard Foundation
Cost and Quality Health Industry Public Health States
Audio Children’s Health Doctors Hospitals Women’s Health
(Reuters Health) – – Children whose parents often threaten and criticize them are more likely to become defiant and aggressive, research shows. But these effects can be buffered by warm relationships with teachers and school friends, a new study suggests.
Kindergartners who experienced harsh parenting but also had developed close buddies were less likely at the end of the school year to exhibit behaviors such as defiance towards adults, rule breaking and angry outbursts than those who did not have warm relationships, according to the study published in Development and Psychopathology.
“This highlights the potential utility of interventions that are more school based for oppositional defiant disorder behaviors,” said study leader Danielle Roubinov of the department of psychiatry at the University of California, San Francisco. “Parent management training programs are some of the most widely used interventions for these kids, but a large proportion of families don’t respond to these kinds of interventions.”
Roubinov and her colleagues studied the impact of school-based relationships on 383 kindergartners from 29 classrooms in six public schools in the San Francisco Bay Area. Seventy-one percent had been exposed to high levels of harsh parenting, while the other 29 percent had been exposed to lower levels of harsh parenting.
Overall, 10 percent of the children met the criteria for oppositional defiant disorder (ODD).
Young children with ODD often don’t outgrow it. ODD has been associated with an elevated risk of antisocial behavior, anxiety, depression, substance abuse, criminal offenses and incarceration in adolescence and adulthood.
To take a closer look at the possible buffering effects of warm relationships at school, the researchers collected information from the children themselves, parents, teachers and other students.
“First we asked parents to report on their parenting practices,” Roubinov said. “We asked about their discipline strategies, including how harsh, negative or critical their parenting was.”
Children were asked how warm, caring and positive they felt their relationships were with their teachers. Teachers were asked about their relationships with the children and about how well the children fit in with others in the classroom.
To get a sense of how well a child got along with peers, the researchers interviewed the entire class. “We went into the classroom and showed the children a big display board with pictures of all the classmates and told them to nominate which classmates they liked to play with,” Roubinov said. “From that we could derive how well accepted a student was among their peers.”
In the fall, at the beginning of the study, all three groups were asked about the children’s ODD behaviors. The groups were asked to rate the behaviors again in the spring.
When the researchers analyzed ODD symptoms from a composite of parent, teacher and children’s reports, they found harshly parented kids who were liked and accepted by their classmates had a 64 percent lower ODD symptom score than children who were not liked. Those who were exposed to harsh parenting but had a warm relationship with their teacher had a 29 percent lower ODD symptom score than counterparts without a positive teacher relationship.
The new study shows that “for kids who have parenting that is less than optimal, there are opportunities in both their friendships and relationships with teachers at school to get the support, engagement and reinforcement of their worth that may help blunt the negative impact of harsh parenting,” said Patrick Tolan, the Charles S. Robb Professor in the Curry School of Education and Human Development at the University of Virginia. “But I don’t think the message from this study is that having good friendships overcomes harsh parenting.”
The best solution, Tolan said, is to give parents the training they need so they will be less harsh with their children. “The first step is learning to monitor yourself and to calm yourself down,” Tolan said.
SOURCE: bit.ly/2AChWJB Development and Psychopathology, online November 21, 2018.
FILE PHOTO: The logo of Swiss drugmaker Roche is seen at its headquarters in Basel, Switzerland February 1, 2018. REUTERS/Arnd Wiegmann
ZURICH (Reuters) – Swiss drugmaker Roche is buying U.S.-based Jecure Therapeutics, joining Pfizer, Gilead Sciences and Novartis in pursuit of new drugs to treat fatty liver disease.
Roche did not say how much it was paying for Jecure, which gives it a preclinical portfolio of so-called NLRP3 inhibitors being developed for fighting inflammatory diseases like non-alcoholic steatohepatitis (NASH) and liver fibrosis as well as gout, inflammatory bowel disease and cardiovascular diseases.
Novartis and Pfizer last month teamed up to develop treatments for NASH, which many drug companies believe will become a hugely lucrative market, as it is tied to the obesity and diabetes epidemics. Unchecked, NASH can lead to advanced cirrhosis and liver failure.
“We’re excited to combine Jecure’s portfolio with our discovery and development capabilities, as well as our expertise in NLRP3 biology, to potentially help people with inflammatory diseases,” James Sabry, Roche’s head of partnering, said in a statement on Tuesday.
NASH, so far with no approved treatments, is poised to become the leading cause of liver transplants by 2020. [reut.rs/2HojtnT]
Jecure Therapeutics is focused on novel therapeutics for the treatment of NASH and liver fibrosis and was founded by Dr. Ariel Feldstein, who heads gastroenterology at the University of California San Diego School of Medicine.
Reporting by John Miller; Editing by Alexander Smith
SUNDAY, Nov. 25, 2018 (HealthDay News) — People caring for a loved one with Alzheimer’s or other types of dementia should focus on four main safety issues, an expert says.
Nearly 6 million Americans have Alzheimer’s disease, according to the Alzheimer’s Association. About 16.1 million Americans provide unpaid care for people with Alzheimer’s or other dementias.
“When approaching dementia families, I follow the safe and sane rule,” said Dr. Andrew Duxbury, a geriatrician in the Division of Gerontology, Geriatrics and Palliative Care at University of Alabama at Birmingham.
“Everything we do needs to make the patient safe and the family sane. In terms of safety, it boils down into the big four: meals, wheels, bills and pills,” he explained in a university news release.
In terms of meals, caregivers need to consider whether the person is capable of preparing food, eating healthy and appropriate amounts of food, and has the awareness that they need to eat, Duxbury said. “If any link in that chain breaks, the person may not eat,” he said.
When it comes to kitchen safety, the “biggest issue is leaving things on the stove and forgetting to turn the oven off; but if cooking is part of someone’s routine, let them cook on their own while monitoring what they are doing from another room,” he said.
“Think about it this way: Would you let your 12-year-old make dinner? You may, but you would definitely be in the next room listening for anything that could go wrong,” Duxbury said.
Other suggestions include planning meals that require minimal preparation or can be made in the microwave; removing scissors and knives from the countertop and drawers; putting labels on kitchen cabinets; and disguising the garbage disposal switch to prevent someone from turning it on accidentally.
It’s not safe for patients with late-stage dementia to prepare food on the stove or in the oven, Duxbury said.
When it comes to getting out of the house, the loss of independence caused by having to give up driving can be difficult for dementia patients.
“A lot of times, an older man may just want to have the car keys, feel them in his pocket and see the car in the driveway,” Duxbury said. “You can let him have the keys, just not the key to the actual car. Give him the keys to a different car or remove the car key from his set of keys. This way, he has the keys, hears them jingle in his pocket and sees his car, but can’t go anywhere.”
If a person can no longer drive, caregivers need to ensure there is another source of transportation, especially for medical appointments. Arrange to have medications, groceries or meals delivered.
Evaluate and monitor the person’s finances to make sure he or she has enough money to pay bills and is not being taken advantage of or scammed, Duxbury advised.
Many seniors take multiple medications. Those with dementia often forget to take their pills or take pills together that can cause harmful side effects. Caregivers need to ensure their loved one is correctly managing their medications and going to medical appointments. It’s also important to keep an eye on the person’s other health issues.
To help your loved one, set up a pillbox with a week’s worth of pills, sorted by day. Some pillboxes have timers and locks you can set to prevent him or her from taking the wrong day’s dose.
Duxbury said most people with dementia think they’re fine.
“Families need to remember that a person with dementia does not live in the same reality that we live in,” he said. “They live in a reality of their brain’s dementia. These individuals may have completely different perceptions of the world around them and what it means. … We have to accept their reality for what it is.”
The students listened attentively as Ryan Wong explained how casinos keep customers chasing that elusive jackpot.
Labyrinthine layouts force guests to walk past card tables and slot machines in search of well-concealed restrooms and exits, said Wong, an intern at the nonprofit NICOS Chinese Health Coalition, a San Francisco partnership of health and social service organizations. Casinos ply customers with free alcohol to loosen inhibitions, and clocks are nowhere to be found.
“You lose track of time,” Wong, 23, told the members of an Asian-American studies class at City College of San Francisco. “The more you gamble, the more it favors the casino.”
NICOS staff members and interns visit Asian-American studies classes around the San Francisco Bay Area to talk to students about gambling because studies suggest Asian-American college students have a higher rate of problem gambling than their peers. NICOS hopes to reduce their risk.
It’s not that they gamble more than others but that they are significantly more likely than their white, black or Latino counterparts to report unhealthy gambling behavior, according to a 2016 study in the Journal of Gambling Studies. It found that 8 percent of Asian-American students at a large public research university in Texas met the criteria for pathological gambling, compared with about 5 percent of whites and 4 percent of blacks and Latinos.
Problem gambling includes lying about losses, feeling guilty about gambling, and missing school or work because of it.
When problem gambling worsens into an addiction, also known as pathological or compulsive gambling, people fail repeatedly to curb their habit. And if they manage to stop, they have withdrawal symptoms, including restlessness and irritability. They gamble increasing sums to maintain the rush of excitement.
Why Asian-American students have a higher rate of gambling-related problems is not entirely clear, said Nolan Zane, a professor of psychology and Asian-American studies at the University of California-Davis.
He thinks cultural, social and psychological factors all play a role. In many Asian cultures, he noted, a “belief in good luck or fortune pervades customs and rituals.”
At family and social events, for example, many Asian-American adults bet money in games that involve skill and chance, such as mahjong. Often, they teach children to play, too. Exposing youngsters to gambling at an early age tends to normalize it.
“If you look across cultures, anytime there’s a behavior that’s more acceptable, then people are more likely to develop problems with that behavior,” Zane said.
Zane’s research suggests that impulsivity is not a factor in problem gambling among Asian-American students, as it is for white students. Rather, they gamble to cope with negative feelings, such as anxiety, shame, loneliness or a sense of being disconnected from the college culture or mainstream society.
Asian-American studies departments at Bay Area colleges first approached NICOS more than a decade ago about educating students, said Michael Liao, the organization’s program director. “Instructors were noticing that gambling affected their students, either directly or through someone they knew, like a family member.”
Liao has firsthand experience: His stepfather attempted suicide after racking up insurmountable gambling debts and losing the family’s life savings.
Some immigrants who work at low-paying jobs are under financial strain and perceive gambling as a magic ticket, especially if their English is poor, Liao said. “‘Oooo, that next lottery ticket, that next trip to Vegas — that could be my way out, my way to send my kids to that school that they want to go to.’”
San Francisco State University graduate student Calvin Zhao and Michael Liao, NICOS Chinese Health Coalition’s program director, present study findings at the 2018 Nevada State Conference on Problem Gambling. (Courtesy of NICOS Chinese Health Coalition)
Even well-educated young Asian-Americans can get caught up in the allure of big money. College graduate Calvin Zhao’s ordeal began at age 21. He was an assistant and translator for an investor in a cosmetics company. The man was known as a high roller, or “whale” in casino parlance — a customer who wagered thousands of dollars in a single day. Zhao tagged along with his boss to the casinos.
“I would spend days, even all-nighters, in casinos,” Zhao recalled.
When he started betting his own money and lost several thousand dollars, he realized his gambling had become a harmful habit. “You lose money, you get sad,” he said. As his gambling habit grew, Zhao said, he became more isolated.
He ultimately broke the bad cycle by quitting his job and setting limits on his gambling. His scrape with problem gambling led Zhao, now a 23-year-old graduate student at San Francisco State University, to study unhealthy gambling among his Asian-American peers on campus for his master’s thesis.
If students visit casinos, NICOS offers these tips: Limit spending by leaving credit and debit cards at home, and set an alarm on phones or watches to signal when it’s time to quit.
When students ask Zhao for advice about their own gambling worries, he tells them that gambling itself isn’t a bad thing. Just “don’t do it excessively,” he said. “Even if you lose, you should be OK with what you lost.”
KHN’s work with California ethnic media is supported in part by The California Wellness Foundation.
(Reuters Health) – People entrusted with decision-making for incapacitated loved ones tend to believe they know what their loved ones would choose – but the vast majority of surrogate decision-makers in a recent study were wrong about loved ones’ wishes.
Researchers who interviewed patients and their surrogates separately found that just 21 percent of patients and surrogates were on the same page when it came to rating whether specific situations – for example, feeling daily pain, as with a broken bone or appendicitis – would be acceptable.
“Patients and their loved ones actually tend to overestimate how well they’ve talked to each other and how well the loved ones understand what the patient would want under circumstances of advanced illness and making decisions about those illnesses,” said the study’s lead author, Dr. Terri Fried, a professor of medicine at the Yale School of Medicine and an attending physician at the VA Connecticut Health Care System. “The thing that’s particularly disturbing in this study is we asked how confident they were and their confidence level was high.”
The problem is that many assume they’ve made their wishes clear when they haven’t, Fried said. “It’s not a conversation that comes naturally,” she added. “And people often mistake passing comments, when they see something on TV, as what their loved one would want. So some ER show might be on and the patient might say ‘O gee, I don’t want that to ever happen to me,’ and the surrogate thinks that means they’ve had a conversation.”
There are consequences for the surrogate who doesn’t really know what their loved one wants.
“It’s been found in other studies, that after having to make such decisions, surrogates often felt very burdened and afterwards felt like they didn’t know enough about the patient’s wishes to make an informed decision,” Fried said.
Instead of focusing on specific treatments, like mechanical ventilation, for example, the researchers focused on outcomes that a patient might or might not want to live with.
Those outcomes were: being bedbound and requiring assistance with bathing, dressing, grooming and toileting; being unable to recognize family members; daily pain feeling like a broken bone or appendicitis.
“It’s important to noted that the whole telephone survey probably took about 20 to 25 minutes and interviewers were asking questions about planning for the future and health care decisions,” Fried explained. “So, if people had questions, the interviewer could clarify anything the responder didn’t understand.”
As reported in JAMA Internal Medicine, the 349 patients in the study were randomly selected from a list of community-dwelling military veterans aged 55 and older who were receiving primary care through the VA Connecticut Healthcare System. At the outset, the patients were asked to provide the name of the person they would choose to make medical decisions if they were incapacitated. More half of the surrogates, 52 percent, were patients’ spouses.
Patients’ and surrogates’ responses were in agreement on single outcomes between 54 and 59 percent of the time. But surrogates got it right for all three outcomes just 21 percent of the time. Nevertheless, 75 percent of surrogates rated themselves as extremely confident that they knew what the patient’s wishes would be. And among those who were extremely confident, just 23 percent were correct in their prediction for all three outcomes.
Because people’s attitudes can change over time, Fried recommends people have not just one conversation about their wishes, but also to return regularly to the topic.
Dr. Albert Wu wasn’t surprised by the findings. “Americans are not comfortable thinking about death, especially their own,” said Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. “And I think we are very uncomfortable having these conversations.”
While it may be difficult to talk about the topic, “it will be much more difficult to have the conversation at a time of crisis,” said Wu, who was not involved in the new study. “We don’t have enough of these discussions and we don’t have them soon enough to learn what a loved one wants. If we were to do so, a lot more people would have the kind of death everyone really wants to have: to die in bed without too much pain surrounded by your loved ones.”
SOURCE: bit.ly/2TLZczV JAMA Internal Medicine, online November 26, 2018.
JOHANNESBURG (Reuters) – South African drugmaker Aspen Pharmacare on Monday launched a triple-combination tablet for the treatment of HIV in the country where the virus is most prevalent.
The company’s new Emdolten drug is a once-a-day tablet in the form of dolutegravir, an antiretroviral medication that counters the drug resistance that often develops with older HIV treatments, Aspen said.
The drug also contains lamivudine and tenofovir disoproxil fumarate alongside dolutegravir.
In May the South African Health Products Regulatory Authority and the European Medicines Agency issued a warning advising doctors not to prescribe dolutegravir to women seeking to become pregnant.
This followed preliminary data from a study in Botswana, which found four cases of neural tube defects in babies born to mothers who became pregnant while taking the drug.
The drug is found in the branded medicines Tivicay and Triumeq, which are sold by GlaxoSmithKline’s majority-owned ViiV Healthcare unit.
Aspen, which pioneered the development and manufacture of generic antiretrovirals (ARV) in South Africa, said that using dolutegravir was safe for men, women who are not of child bearing age and child-bearing women using contraceptives, adding that these groups represent more than 70 percent of HIV patients.
“The fact that it (Emdolten) has been registered means that SAHPRA is comfortable that it is safe to take to the public,” Aspen strategic trade executive Stavros Nicolaou told Reuters, referring to South African Health Products Regulatory Authority.
The company launched Aspen Stavudine – its first generic ARV drug in August 2003 – at a time when the country was grappling with a high rate of HIV infection.
South Africa has 19 percent of the global number of people living with HIV, 15 percent of new infections and 11 percent of AIDS-related deaths, the United Nations AIDS agency says on its website.
There is no vaccine to prevent HIV/AIDS. Current treatments only helping patients to manage the disease, but the fast-mutating virus has proved a challenge to the medical community because it often develops resistance to existing medicines.
Reporting by Nqobile Dludla; Editing by James Macharia and David Goodman
KINSHASA (Reuters) – Congolese authorities have authorized clinical trials for four experimental Ebola treatments, which will allow researchers to collect valuable data about their effectiveness, the health ministry said on Saturday.
FILE PHOTO: A doctor cares for a patient inside an isolate cube at The Alliance for International Medical Action (ALIMA) treatment center in Beni, North Kivu province of the Democratic Republic of Congo September 6, 2018. REUTERS/Fiston Mahamba/File Photo
Health workers have already administered therapeutic treatments to more than 150 Ebola patients since August in an effort to contain the worst of Democratic Republic of Congo’s 10 outbreaks of the hemorrhagic fever since 1976.
But until now doctors have decided which treatment to use on a case-by-case basis. In the clinical trial, the choice of treatment will now be randomized.
Treatment will still be free of charge, the ministry added in a statement.
“Precious information about the effectiveness of the treatments obtained during the clinical trial will allow for the development of these treatments on a wider scale to save more lives,” the ministry said.
The four treatments are mAb114, which was developed by the U.S. government; ZMapp, an intravenous treatment made by Mapp Biopharmaceutical; Remdesivir, made by Gilead Sciences; and Regeneron’s REGN-EB3.
As of last weekend, 151 patients had received one of the four drugs. Of those, 76 had recovered, 44 had died and 31 were still hospitalized — a mortality rate of 37 percent.
By contrast, among those who had not received treatment, the mortality rate was close to 80 percent.
The ministry said that the data from the current outbreak would probably not be sufficient to make definitive conclusions about the effectiveness of the treatments and that the trials could continue during future outbreaks.
Despite the use of the treatments as well as an experimental vaccine manufactured by Merck, authorities have struggled to contain the outbreak due to widespread militia violence in eastern Congo and community resistance to health workers.
At least 228 people are believed to have died, and the World Health Organization said last week that it expects the outbreak to last at least another six months.
Reporting By Giulia Paravicini; Editing by Aaron Ross
(Reuters Health) – A survey of people with food allergies who dine out successfully has found they employ quite a few strategies.
Those who never had an allergic reaction in a restaurant tended to employ an average of 15 strategies to avoid allergens, while those who have had a reaction tended to use only six different strategies before suffering a problem, researchers found.
“Physicians can encourage families to use several different strategies when dining out in an effort to prevent food allergy reactions,” the study’s co-author, Dr. Leigh Ann Kerns, a pediatric allergist and immunologist at Cleveland Clinic Children’s Hospital in Ohio, told Reuters Health by email.
“Family members spend a lot of time reading labels and reducing chances of cross contamination in the home, but it is more difficult to prevent unintentional exposures in restaurants due to poor understanding of food allergy, miscommunication, and possible cross contamination of ingredients,” Dr. Kerns said.
Her team surveyed 39 people with food allergies, 19 of whom had suffered an allergic reaction while dining in restaurants. Based on the responses, the researchers compiled a list of 25 strategies that diners use and reported them November 16 at the American College of Allergy, Asthma, and Immunology’s annual conference in Seattle, Washington. (The strategies can be found here: bit.ly/2zxyCCj.)
The top five are these: Speak to waiter on arrival (80 percent), order food with simple ingredients (77 percent), double-check food before eating (77 percent), avoid restaurants with higher likelihood of cross-contamination (74%), and review ingredients on a restaurant website (72 percent).
The least-used strategies reported were these: place food allergy order separately (23%), use a personal allergy card or chef card (26 percent), no longer eat at restaurants (39 percent), choose a chain restaurant (41 percent), go to restaurants during off-peak hours (44 percent).
Patients with food allergies need to be vigilant when going to restaurants, primary investigator Dr. Justine Ade, of University Hospitals’ Rainbow Babies and Children’s Hospital in Cleveland, Ohio told Reuters Health.
“Using more strategies before going out to eat and while dining may help prevent food allergy reactions. (And) always bring an epinephrine device when going out to eat,” Dr. Ade said.
The survey suggests that engaging in a wide variety of preventive efforts may reduce a patient’s risk, said Dr. Clifford Basset, Medical Director of Allergy and Asthma Care of New York in New York City and a spokesperson for the ACAAI, who was not involved in the study.
“Optimal preventive strategies are an integral part of a successful food allergen risk reduction program. Several of the identified preventive strategies feature proactive, clear communication between the patient/family and the restaurant staff,” Dr. Basset said.
Adapting an old maxim to the topic, the takeaway from the study may be that there are two kinds of diners with food allergies: those who take lots of precautions and those who have not yet had their first reaction.
SOURCE: bit.ly/2zxyCCj American College of Allergy, Asthma, and Immunology, November 16, 2018.


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Best How To Make Press Pot Coffee
Nowadays, there are so many products of how to make press pot coffee in the market and you are wondering to choose a best one.You have searched for how to make press pot coffee in many merchants, compared about products prices & reviews before deciding to buy them.
You are in RIGHT PLACE.
Here are some of best sellings how to make press pot coffee which we would like to recommend with high customer review ratings to guide you on quality & popularity of each items.
Large French Press Coffee Maker – Vacuum Insulated Stainless Steel, Silver, 34floz
- Hate boring, cold coffee? Us too. Our huge capacity kit is vacuum-layered and double-filtered for flavor fuller than a centipede’s sock drawer and a piping-hot brew for longer. Oh yeah, you even get a mini canister for storing your next caffeine hit
- Keep coffee (or tea) hot for 60 minutes longer than glass. 304 stainless steel is 33% thicker and 20% heavier than the competition. A cool touch handle protects your hands and the spring-loaded, double-screen filter brews a cleaner cup
Secura Stainless Steel French Press Coffee Maker 18/10 Bonus Stainless Steel Screen (1000ML)
- Secura stainless steel French Press coffee maker is made from top quality 18/10 stainless steel, both the interior and exterior. It is made to outlast other coffee maker.
- 3-LAYERED STAINLESS STEEL FILTER STRUCTURE traps the smallest coffee grounds to produce an exceptional full-bodied flavor.
- BONUS Stainless Steel Screen included with this French coffee press. Filter screen is easy to dissemble and clean. Stack one or more screens together gives your coffee espresso more refined taste.
Takeya 10311 Patented Deluxe Cold Brew Iced Coffee Maker with Airtight Seal & Silicone Handle, Made in USA, 2-Quart, Black BPA-Free Dishwasher-Safe
- The new deluxe cold brew Coffee maker is a durable BPA-free Tritan pitcher with an airtight lid & non-slip silicone handle. It produces 8 servings of smooth cold brew with any type of Coffee grounds and is less acidic than traditional coffee brewing.
- The fine-mesh Coffee filter in this cold brew Coffee maker keeps grounds out of your freshly brewed pot - differing from other coffee machines. Tritan plastic withstands hot temperatures if you want a hot cup of Coffee. Fits in most refrigerator doors.
Taste the difference with Takeya cold brew Coffee maker. The traditional hot brewing process releases undesirable acids and oils, resulting in bitter flavor and acidity that is intolerable to many. With cold brewing, only the naturally delicious Coffee flavors are extracted, leaving behind the bitter oils and fatty acids, creating a perfectly balanced, smooth extraction of concentrated Coffee. Once brewed, concentrated Coffee can be kept fresh in the Takeya airtight cold brew Coffee maker for up to 2 weeks and used for both hot and iced coffees.
Vremi Stovetop Espresso Maker – Moka Pot Coffee Maker for Gas or Electric Stove Top – 6 Cups Demitasse Espresso Shot Maker for Italian Espresso Cappuccino or Latte – Silver
- CLASSIC ITALIAN COFFEE - Stovetop espresso maker moka pot delivers 6 demitasse cups of rich espresso in less than 5 minutes
- EASY GRIP HANDLE - Espresso maker pot features rubberized handle with finger grip and 8-sided octagon shape to diffuse heat and enhance coffee aroma
- QUALITY MATERIALS - Durable aluminum body in slick high polished silver with black handle and accents
- VERSATILE STOVETOP USE - Great for gas or electric stove tops, and can be used on small induction cooktops with max 4 inch diameter (NOT for use on larger induction cooktops)
A morning without espresso? That’s just plain depresso. Make every day more brew-tiful with the Vremi Stovetop Espresso Maker moka pot, and get moving with an authentic Italian buzz, no matter which side of the bed you wake up on. A simple espresso machine that makes full-flavored espresso in no more than 5 minutes, reliable to brew excellent coffee fast so you’ll be ready to face the day ahead.
Product Safety and Care
- Store out of reach of children. This is not a toy.
- DO NOT use steel wool or abrasive products to clean.
- DO NOT place hot espresso maker on unprotected surface.
- Never use the pot without water.
- Never place extracts, powders, oils or instant coffee in the filter or vessel as they can clog the filter plate.
- After use, do not open the pot until it is cool. Periodically check the funnel to ensure it is functioning properly and replace if necessary.
- Clean regularly after each use.
- The warranty for this product will not be valid if any part is replaced with non manufacturer approved spare parts.
- Do not touch when hot.
Cold Brew Coffee Maker By Coffee Bear – Protective No Slip Base – 1.3L / 44oz Heavy-Duty Glass Pitcher with Easy To Clean Reusable Mesh Filter – Dishwasher Safe – Iced Coffee and Tea Brewer
- ➤ RICHER, SMOOTHER, LESS ACIDIC COFFEE IN JUST 12 TO 24 HOURS ⇒ Tired of traditional brewing methods that produce hot coffee with bite and acidity? Coffee Bear's Cold Brew Coffee Maker yields a smooth and sweet batch of cold brew concentrate higher in caffeine content and 60% less acidic than hot coffee. Store your cold brew as long as you need – Our NEW flavor-locking lid helps maintain freshness and seals in those delicate coffee flavors for weeks at a time.
French Press Double-Wall Stainless Steel Mirror Finish (34oz) 20% Heavier Duty Coffee/Tea Maker: Multi-Screen System 100% No Coffee Grounds Guarantee, 18/10 Stainless Steel, Rust-Free, Dishwasher Safe
- ☕ IF YOU REALLY CARE ABOUT YOUR COFFEE – We tested enough mechanisms and filters to make your head spin to tweak and uniquely design our press with a triple layered filter structure to stop the sediment, but let the yummy coffee oils through for a full-bodied delicious brew that will make you a very happy camper. And to share the java love, we give you a bonus matching travel canister that holds enough beans or grounds for two full batches.
Put a little magic back in your mornings with hand-pressed Mueller French Press coffee (and tea!) brewer. Watch a column of water disappear and transform into a floating column of coffee as you press. Take control with hands-on brewing that combines the best of handcrafted coffee with truly morning (and pre-caffeine) friendly convenience: Just add hot water and coffee, press, and pour.
AeroPress Coffee and Espresso Maker – Quickly Makes Delicious Coffee without Bitterness – 1 to 3 Cups Per Pressing
- Rapid, total immersion brewing process makes delicious full flavored coffee without bitterness
- Makes 1 to 3 cups per pressing in about one minute, Brews regular American style coffee
- Brews espresso style coffee for use in lattes and other espresso based drinks, the brewing process takes about 30 seconds
- Microfilter means no grit in your cup (unlike a French press), Clean up takes just seconds
- Available with zippered nylon tote bag - great for travel, Made in the U.S.A
Popular with coffee enthusiasts worldwide, the patented AeroPress is a new kind of coffee press that uses a rapid, total immersion brewing process to make smooth, delicious, full flavored coffee without bitterness and with low acidity. Good-bye French Press! The rapid brewing AeroPress avoids the bitterness and high acidity developed during the long steep time required by the French press. Plus, the AeroPress paper Microfilter eliminates grit and means clean up takes seconds. Makes 1 to 3 cups of American coffee per pressing in about a minute, and unlike a French press, it can also brew espresso style coffee for use in lattes, cappuccinos and other espresso based drinks. Perfect for home kitchen use, the AeroPress is lightweight, compact, portable and durable, making it also ideal for traveling, camping, backpacking, boating and more! Includes the AeroPress press, funnel, scoop, stirrer, 350 microfilters and a filter holder. Mug not included. Assembled measurements: 9 1/2″ h X 4″ w X 4″ d
Veken French Press Coffee Maker (34 oz), 304 Stainless Steel Coffee Press with 4 Filter Screens, Durable Easy Clean Heat Resistant Borosilicate Glass – 100% BPA Free, Black
- ☕Be the leader of your own coffee - The glass beaker allows you to monitor the whole procedure of making your coffee. Watching the hot water and coffee grounds separate as you press the stainless-steel filter arm. The aroma of the coffee fills your being, and your troubles have altogether disappeared.
- ☕Enjoy a quiet and peaceful coffee making experience - Our Veken French Press is made of borosilicate glass, so it will not make a noise - unlike metal presses which may generate unbearable scratching noises as you push the filter down.
Bialetti 06800 Moka stove top coffee maker 6-Cup Silver
- Makes 9.2 ounces of Moka Coffee – enough for 1 mug with a little left over
- Moka coffee is a strong, rich, and velvety brew
- Takes less than 5 minutes to brew on your stovetop
- High quality polished aluminum in the classic Bialetti octagon shape
- Patented safety valve
- Easy to clean and disassemble
This Bialetti Espresso maker is the original and best way to make authentic espresso coffee in your home. This model makes 6, 2-ounce cups of delicious coffee.
Bodum Chambord French Press Coffee Maker, 1 Liter, 34 Ounce, Chrome
- French press: Chambord French press brews a premium cup of Coffee in just 4 minutes, simply add course ground Coffee, hot water and press
- Stainless steel: 3-part stainless steel plunger has a mesh filter that helps extract your coffee's aromatic oils and subtle flavors instead of being absorbed by a paper filter
- Durable design: Coffee press features Bodum Patented safety lid to keep contents from spilling and is dishwasher safe for easy cleaning
Chambord is a true original – the classic French press Coffee maker designed in the fifties. And we still produce it with the same painstaking craftsmanship we used way back when with the original. The frame and lid, made of steel, undergo several Chrome Plating processes to obtain a durable shiny surface that will last for many years of intense use. The only difference in the production process since the fifties is our commitment to the highest standards of environmentally correct manufacturing, which is especially important during the Chrome Plating process. The black CHAMBORD polypropylene handle comes in a matte finish that not only gives a comfortable grip while serving but adds to the classic quality of the design. The French press system has always been the simplest and ultimate way of brewing an excellent cup of Coffee. Using fresh coarse ground beans with water between 92 and 96 degrees Celsius brings out the very best in all types of Coffee.
Hamilton Beach (49976) FlexBrew Coffee Maker, Single Serve & Full Coffee Pot, Compatible with Single-Serve Pods or Ground Coffee, Programmable, Black
- Two ways to brew. Brew a full pot using your favorite grounds on the carafe side, or make a cup for yourself using a Keurig* K-Cup pack or grounds on the single-serve side with this 2-In-1 Coffee maker. Dimensions (inches) : 13.9 H x 10.24 W x 10.63 D
- Single-serve: brew with K-Cup packs or without. Pack holder and single-servegrounds basket are included. Features cup rest that adjusts to fit tall mugs and doubles as storage. Pack-piercing needle removes for easy cleaning to prevent clogging
No two coffee drinkers are the same so when you make coffee at home, the flexibility to customize how and what you brew is key. From fresh grounds to K-Cup pods, the FlexBrew 2-Way Coffee Maker gives you the options to please fans of all types of coffees.
French Press Coffee Maker With 4 Level Filtration System, 34 Ounce
- 4 LEVEL FILTRATION SYSTEM - We use double stainless steel screen filters on a durable plunger supported by a spring loaded base plate to seal the edges, followed by a final top lid strainer to give you a pure brew with no grounds unlike other cheap presses. Perfect to make fresh French coffee, tea, espresso or even cold brew.
- ONLY THE FINEST QUALITY MATERIALS - Every single metal piece is 304 grade stainless steel giving the coffee press a resilient shine and protecting it from rust. The large carafe is made of thick borosilicate glass that can withstand boiling water! It is also portable and small enough to fit in a travel bag or backpack, making it easy to bring on camping, hiking or backpacking trips, outdoor activities, or to work or the office.
Farberware 2-4-Cup Percolator, Stainless Steel,FCP240
- 4-Cup capacityand 1000 watts
- Durable stainless steel construction and maintains consistent brew speed: 1-cup p/min.
- Automatic keep warm mode
- Cool-touch handle and lid knob with rolled edges for safe and easy handling
- Product Built to North American Electrical Standards
- Product note: the logo design of this item may vary depending on when the product was manufactured
Rediscover the robust aroma and taste of percolated coffee with the FARBERWARE 2-4 Cup* Stainless Steel Electric Percolator. This premium unit produces about one cup per minute, so there’s no waiting around for delicious coffee. The automatic “keep warm” function gently warms coffee after perking, and the detachable cord makes for easy pouring and storage. *Cup equals approximately 5 oz (varies by brewing technique) For Farberware percolators: “FARBERWARE and FARBERWARE are used under license from Farberware Licensing Company, LLC
Cuisinart DBM-8 Supreme Grind Automatic Burr Mill
- Removable grind chamber holds enough ground coffee for 32 cups. Dimensions : 6.00 L x 7.13 W x 10.75 H inches
- Removable 8 oz. bean hopper. Includes scoop and cleaning brush
- Electric timer automatically shuts off when grind cycle is complete
- 18-position grind selector
- 4- to 18-cup slide dial
- Removable grind chamber holds enough ground coffee for 32 cups
Starbucks Pike Place Roast Medium Roast Single Cup Coffee for Keurig Brewers, 1 box of 32 (32 total K-Cup pods)
- Well-Rounded Flavor—Starbucks Pike Place Roast is well-rounded with subtle notes of cocoa and toasted nuts balancing the smooth mouth feel
- Medium Roast—Medium-roasted coffees are smooth and balanced with rich, approachable flavors
- K-Cup Pods—Starbucks K-Cup pods are designed for use with the Keurig Single Cup Brewing System
- Starbucks at Home—Enjoy the Starbucks coffee you love without leaving your home or office
Keurig K-Classic Coffee Maker K-Cup Pod, Single Serve, Programmable Black
- Brews multiple K-Cup Pod sizes: (6, 8, 10 oz.) – The most popular K-Cup Pod brew sizes. Use the 6oz brew size to achieve the strongest brew.
- Large 48 oz. Water reservoir: allows you to brew 6+ cups before having to refill, saving you time and simplifying your morning routine. The water reservoir is removable, making it easy to refill whenever you need to.
- Simple button controls: just insert a Pod, select your desired brew size, and brew a fresh, great-tasting cup in under a minute.
BODUM 11100-01BUS Tea and Coffee Press, Plastic Insulated Travel Mug, Black, 15 Ounce
- Travel Coffee maker: brew Coffee or tea on the go and drink from same container when ready
- enjoy your daily fix wherever you are
- Quick and easy: simply add coarsely ground Coffee, hot water and seal the lid for a delicious, freshly pressed cup in minutes
- BPA-free plastic: made of double-wall construction, this BPA-free plastic Travel mug keeps beverages hot or cold for several hours
- Durable design: French press mug features a spill resistant lid, built-in plunger and colorful, silicone, non-slip grip for easy Travel
French Press Double-Wall Stainless Steel Mirror Finish (1L) Coffee/Tea Maker: Double-Screen System 100% No Coffee Grounds Guarantee, 18/10 Stainless Steel, Rust-Free, Dishwasher Safe, 2 Bonus Screen
- *This French Press has been reviewed as:"Best Overall" by Amazon Verified Expert. Please check"Expert Recommendations". INNOVATIVE DESIGN: Getting coffee grounds in your mouth while drinking coffee is something no one wants. The unique two screens system is the first of its kind on the coffee press market. The first screen brushes the wall evenly and tightly
- the second screen catches any tiny grounds that may have passed through the first screen. This leaves your coffee 100% free of grounds!
What Kind of Coffee Press Won The Hearts Of All Coffee Lovers?
The Most Reliable & Durable Coffee Press In The Market
– The best stainless steel(18/10)interior and exterior–Won’t rust and dishwasher safe.
– The first Double Screens System—No more GROUNDS in your coffee
– Solid Packing–No broken gifts to your family members and friends.
100% Guaranteed No Grounds coffee From SterlingPro
What is the worst coffee drinking exprience? Coffee grounds in mouth! That is why SterlingPro introduces the innovated and unique Double Screens System which is the ONLY one in coffee press market. By adding the second screen, the primary screen will touch the wall more tightly and evenly. At the same time, the second screen will filter the tiny grounds which pass through the primary screen. No more grounds in your coffee by using Sterlingpro coffee press. You will love it after using it. Your loved ones will appreciate it and think of you happily everytime when they enjoy the coffee from your gifts–SterlingPro coffee press.
2 Pieces BONUS Stainless Steel Screens(Over $25 Value)—FREE!!
– When you receive SterlingPro coffee press it will be delivered in a solid packing and it comes along with 2 pieces extra screen. You will find they are over $25 value if you search on Amazon.
– The limited quantity for this valuable bonus. SterlingPro French coffee press is “Great as Wedding, House Warming, Retirement & Birthday Gifts for Coffee Lovers” ***We are pleased to announce: This French Press has been reviewed as:”Best Overall” by Amazon Verified Expert–Please check “Expert Recommendations” to find how the amazon expert test this item and why they believe this item is the “Best of all”
Click The “Add to Cart” Button before the bonus screens run out!
KRUPS F203 Electric Spice and Coffee Grinder with Stainless Steel Blades, 3-Ounce, Black
- The Coffee bean grinder perfectly grinds beans for drip Coffee makers in less than 10 seconds
- The electric Coffee grinder has a large grinding capacity yields up to 12 cups of Coffee
- Grinds up to 3 ounces of Coffee beans in seconds
- Oval design and stainless-steel blades of this Espresso grinder ensure uniform grinding
- Stainless steel blades that can grind beans but also spices, herbs, nuts, grains and more
KRUPS F203 Electric Spice and Coffee Grinder with Stainless Steel Blades, 3-Ounce, Black. Grind whole coffee beans quickly and efficiently with this powerful KRUPS coffee grinder. A nice alternative to pre-ground coffee, brewing freshly ground beans promotes maximum rich aroma and delicious full-bodied flavor for better-tasting coffee. When making any type of coffee drink, from simple drip to espresso and cappuccino, grinding beans right before brewing is a must for any true coffee lover. And it’s easy with the KRUPS coffee grinder. Simply add whole beans, secure the lid, and press the side lid button to start. Grind for a few seconds, or a few seconds more, depending on desired consistency—from coarse to fine. The oval-shaped grinder offers a large 3-ounce capacity, while its precision stainless-steel blades ensure even results. For safety, the blades won’t spin without the lid securely in place. In addition to coffee beans, the versatile grinder can be used for chopping or grinding nuts, seeds, herbs, and spices—perfect for everything from summer salads and gourmet entrees to yummy baked goods. Compact and sleek looking, the KRUPS coffee grinder makes a convenient and useful addition to any kitchen.Product can only work on 120V per US’s standard
Best how to make press pot coffee: Top-Rated Brands & What to Buy

domain: food


DONALD Trump WON’T dodge London when he comes to Britain in July, a top ally insisted today. The US ambassador said the President would be able to handle street protests – because he’s “very thick-skinned”. Last night Downing
THE long wait is over for Marvel fans as Avengers: Infinity War is in cinemas NOW. But what’s the film about and who’s in the cast? Here’s everything you need to know… Is Avengers: Infinity War in cinemas? What was the UK release d
WUHAN, China (Reuters) - Indian Prime Minister Narendra Modi will get a tour of a museum and dinner with President Xi Jinping on Friday, the first day of an ice-breaking visit to China in which the giant neighbors will seek to re-set a troubled relations
ACTOR Bill Cosby has been convicted of drugging and sexually assaulting female friend at his suburban Philadelphia mansion in 2004. Here is all you need to know about the entertainer known as “America’s Dad” for his role in the top-ra
Warning: There are major spoilers ahead for "Avengers: Infinity War."
Though "Avengers: Infinity War" manages to juggle over two dozen characters, you still may find yourself bummed when a few familiar faces fail to show up in the nearly three-hour


text: hello! I am very new to "fish keeping" and I recently set up a new 10 gallon tank. this is my second tank, my first was a 3.5 gallon TopFin tank with 2 male guppies and a mystery snail. all 3 of these pets died in the first three hours due to what turned out to be too much water conditioner. I then waited about 2 weeks to clean out and re-set up my tank. I then trusted the employees at petsmart (I now realize they have no idea what they are talking about) and I bought an apple snail and 3 glofish danios. they got aggressive and we had to return them. so, I bought a bigger tank and put my apple snail in the 3.5 gallon. I'm curious as to if I can put 3 platies in my 10 gallon and if there is a way I can speed up the cycling process. will a bubbler help? tetra safe start? anything helps! thanks!

domain: pet


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“Ingram Dunes is one of the only remaining areas that shows what the natural environment was like here before development occurred,” says Morgan Livingston, a lifelong neighbor.
Ingram Dunes runs along Hillside Drive between 9th and 10th avenues south in North Myrtle Beach.
In August, 50 trees were removed from Ingram Dunes with a permit that was approved in May. The fight to preserve the remaining 9.4 acres continues.
SupportingIngram Dunes at the annual St. Patrick’s Day Parade.


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CBD is one of the best cures for various health issues. Bionatrol CBD has launched a 100% natural Cannabidiol oil that is safe for your whole family, including kids. Hemp oil can reduce inflammation and pain, plus it’s also useful for individuals suffering from anxiety and stress. All the products available in this store are lab tested and do not contain any amount of THC. Moreover, to get a discount on the price of these items, use Bionatrol Coupon & Promo Code. Avail such necessary CBD products that are helpful for your health.
You are just ONE STEP away from exclusive DEALS!
Join our mailing list and get inside scoop on trending offers and budget shopping hacks before any one.

domain: medical


The Mackinac Center Legal Foundation filed a lawsuit concerning documents about the Flint water crisis, and one likely result is that state employees will be quicker to process Freedom of Information Act requests. Still, legislation is probably needed to improve the situation further.
The lawsuit began after the Michigan Department of Environmental Quality took over 105 days to provide documents that it said would take four and one-half hours to compile. The request covered emails from two department officials. We wanted to determine if they had been transferred or reassigned as a consequence of their actions related to the water crisis.
The department sought to have the case dismissed, but Court of Claims Judge Cynthia Stephens rejected the attempt. She noted that there was sufficient evidence that the department engaged in arbitrary and capricious conduct, leading to an inordinate delay.
While this lawsuit was proceeding, Rep. Gary Glenn, R-Midland, requested an official opinion from Michigan Attorney General Bill Schuette. Glenn asked him when state agencies must turn over documents requested via FOIA. The FOIA statute is unclear on this issue. Courts that have interpreted the law have said a government agency must “respond” to a FOIA by sending a cost estimate within 5 to 15 business days. They have also said that when agencies send a cost estimate, they must also send a nonbinding estimate of how long it will take to provide the documents. But, courts have said, there is no statutory deadline for when the actual documents themselves must be provided to the requestor.
Seeking an official opinion from the attorney general has several advantages over filing a lawsuit. First, the process is faster. Second, an opinion would bind the entire state government, unlike a lawsuit, whose resolution would be limited to the particular facts of the case and the agency being sued. Further, while a court can impose fines on a government agency for malfeasance, these fines are mostly symbolic since they are deposited in the state government’s general fund. Because the attorney general will not issue an opinion on a matter under litigation, on Nov. 8, 2017, the Mackinac Center agreed to dismiss its FOIA suit.
On December 12, 2017, Schuette issued Opinion No. 7300, which stated that government officials must act diligently in fulfilling FOIA requests and without the intent to unnecessarily delay a response:
[A] public body’s “best efforts estimate” . . . as to the time it will take to fulfill a request for public records, must be a calculation that contemplates the public body working diligently to fulfill its obligation to produce the records to the requestor. The estimate must be comparable to what a reasonable person in the same circumstances as the public body would provide for fulfilling a similar public records request. In addition . . . the best efforts estimate must be made in “good faith,” that is, it must be made honestly and without the intention to defraud or delay the requestor.
While it is better to have this opinion rather than complete uncertainty, a statutory fix would be preferred. A hard deadline would let both the government and public know when documents must be provided. Further, a statute would apply to all state and local governments as opposed to an attorney general opinion, which is only binding on state entities.
The Mackinac Center has sued both environmental quality department and the University of Michigan over FOIA matters recently. Our goal is to have the stated purpose of the law fulfilled: “The people shall be informed so that they may fully participate in the democratic process.” That purpose is thwarted when government officials bury FOIA requests. If the Legislature fails to fix this matter, we’ll continue to do our best to keep those officials in line.


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Orange County Business Journal
Portal Languages in Costa Mesa plans six franchised locations to add to three sites it has opened so far in OC.
Portal provides foreign language instruction from retail storefronts. The three open are in Costa Mesa, Fullerton, and Mission Viejo. The six are planned for Whittier, L.A., Long Beach, San Marcos, Antioch, and in Portland, Oregon.
The company is aiming for 20 locations, most in California, in the next 18 months, targeting language teachers—it calls them “educator-entrepreneurs”—and entrepreneurs with an offering on the smaller end of franchising’s range.
It costs $25,000 to $50,000 to open a location, including a $15,000 franchise fee; royalties and marketing are about 8% of gross sales; average unit volumes are $200,000.
Schools teach a “natural approach … [that] emphasizes communication rather than grammar,” the company said.


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Possibly the most delicious dessert ever. Just fabulous. More than two bites gives you instant diabetes though, so watch out. =P
Raffaello, desert, coconut flour, powdered milk
Peanut Butter Krispie Cake
Apple cinnamon breakfast bars
Perfect for winters, this recipe is full of calories that I don't dare count.
easy,fast and cheap snack
yes, I can't find the recipe either. Bummer
Just follow the link to the original. I think...
why am I not seeing the recipe? Am I doing something wrong?


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East Berlin Borough 250th Anniversary Celebration! For a
Full Listing of Events Beginning May, 2014, Click on
For information about the East Berlin 250th Anniversary
Coverlets, see our Coverlet Page.
where the past comes to life!
EAST BERLIN is an historic town located in Adams County, Pennsylvania.
The main street was placed on the national register of Historic Place in recognition of its many early buildings. East Berlin Historical Preservation Society was organized in 1975 in an effort to preserve the unique heritage of the town and is responsible for the following historic buildings:
Red Men's Hall (Location 1)
Church / School House (Location 2)
Log House (Location 3)
Swigart's Mill (Location 4)
Liberty #1 Engine House (Location 5)
For more information contact us at:
East Berlin Historical Preservation Society
Post Office Box 73, 332 W. King Street
East Berlin, PA 17316
Click on the Location in the center of the page
to view the building.
|Major Upcoming Events:|
Mark your calendars:
The East Berlin Historical Preservation Society Antique Show will be held on May 1, 2 and 3, 2014. Here's the 2014 Flyer (in pdf format).
East Berlin Borough 250th Anniversary Celebration! For a Full Listing of Events Beginning May, 2014, Click on May Events
Our next Colonial Day Celebration will be on September, 13, 2014. See our Colonial Day page and link to the latest photos from September 14, 2013!
A Christmas Craft Show was held Nov. 29, 30 and Dec. 1, 2013 and was a great success!. See flyer from 2013 for more information. This show is lots of fun and there are lots of beautiful crafts available for purchase! The next Christmas Craft show will be Nov. 28, 29 and 30, 2014 from 10 am to 4 pm at the Log House in East Berlin.
Sneak Preview of 250th Anniversary Quilt (not fully completed yet):
Raffle Tickets Available Soon
Last Updated 3/3/2014


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Double Vision: Dancefusion at the Philly Fringe
The clarity of the movement’s attack and its clear lines and arcs in gestures, body shapes, and pathways reminded me of the power of classic modern dance in its search for expression of the universal...
September 9, 2012
Resurrecting the Past
Dancefusion Breathes Life into Historic Modern Dance
January 4, 2012


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Medical Website Templates
Medical Website Templates.
Free blog post template charity layout pack den. Themes psychologists therapists counselors. Psychologist template templates. Themes psychologists family mentors daddy. Free download psychologist website template city. Psychology counselor life coach themes march. Free psychologist layout pack elegant themes blog.

domain: psychology


text:
Find thousands of books, manuscripts, visual materials and unpublished archives from our collections, many of them with free online access.
Search for free, downloadable images taken from our library and museum collections, including paintings, illustrations, photos and more.
The lord of humanity, or, The testimony of human consciousness / by Frederick James Gant.
- Gant, Frederick James, 1825-1905.
Public Domain Mark
About this work
London : Longmans, Green, 1891.
iv, 163 pages ; 19 cm
Where to find it
Location Status AccessClosed storesK37606

domain: library


text:
I have dedicated 2019 as my Year of Romance (#YOR) here on Supernatural Underground, specifically Romance in Fantasy Fiction (#RIFF) because Fantasy fiction is how I roll. ;-)
I began in March with JRR Tolkien’s The Lord Of The Rings (aka when romance is missing-in-action) and continued last month with Laini Taylor’sDaughter of Smoke and Bone, which is romance of the kind I loosely describe as “my enemy, my love.”
This month’s story, which is in fact a trilogy like both the preceding works, is Patricia McKillip’s Riddlemaster series, which comprises three instalments: The Riddlemaster of Hed, Heir of Sea and Fire, and Harpist In The Wind. It also (roughly) bridges the first two books covered in terms of time period, with The Riddlemaster of Hed published in 1979. And it’s one of my favorite romances, as well as my favorite Fantasy series, so it had to be part of my #RIFF on #YOR. J
When I first read The Riddle-Master of Hed, I thought this was going to be very much in the style of The Lord Of The Rings (LoTR) with the romance very much in the background. (Don’t get me wrong, btw, I adored the story anyway, and still do.) In fact the treatment of Raederle, the romantic interest for our hero, Morgon, the eponymous Riddle Master of Hed, is initially very similar to that of Arwen in LoTR, i.e. she’s there in the background but she doesn’t play an active part in the story.
Although at least the reader knows that Morgon cherishes romantic notions in that direction – in fact it’s what kicks off the story. Morgon, who has won a supposedly unwinnable riddle game, learns that the King of neighboring An had promised to marry his daughter, Raederle, to whoever wins that game. I am sure you pick up on the classic fairytale overtones here! As it turns out, Morgon has actually met Raederle because he and her brother studied together at the Riddle-Master’s College, and yes, he is definitely interested in marrying her – although somewhat less sure of her views on the same matter. (In a very unfairytale-like way he actually thinks she should have a say in the matter…)
So he sets sail to meet Raederle again and ascertain her inclination, which is when (of course!) matters gang awry, with Morgon first being shipwrecked then finding out that a mysterious and powerful people are trying to murder him. Rather than marrying the woman of his dreams, he is instead swept up in a complex and dangerous riddle game, which takes him a quest journey across the face of the Realm (which is the name of the world in this series.)
So we never get to meet Raederle at all in Book 1, although she’s always there in the background of the story. He also makes friends with another young woman called Lira, so as reader you think maybe that’s where the real romance going to be, although she reminds Morgon of his kid sister, which is hardly a promising indication…
So you can imagine my surprise – and yes, delight, dear readers – when I opened Heir Of Sea and Fire and started reading, and boom!, there I was in Raederle’s point of view. And not only is she the main character in this book, she’s setting out – with Lira and Tristan, Morgon’s kid sister – to find and rescue him. This mission naturally takes them on a quest-journey across the Realm where they also run foul of Morgon’s mysterious enemies and Raederle finds out that she, too, has a destiny…
I mean, only think, dear readers – a heroine and love interest with a destiny as well. If not for Eowyn, I would have thought the great JRR must be spinning in his grave at this point. It’s nothing new now, but back in 1979 I imagine it must have been quite revolutionary, especially in epic fantasy literature.
The third book, Harpist In The Wind, returns to Morgon as the point-of-view character, but he and Raederle are together throughout most of the story – and part of why they ultimately win through is because they’re together. I’ve always found their romance really satisfying for that reason, but also because it’s very much a relationship between equals. In terms of the style of romance, because of Morgon and Raederle’s relationship before the story starts, I think it has elements of the “boy and girl next door”, as well as “friends and lovers” that transitions into “ever after.”
As romances go, I would also describe Raederle and Morgon’s love as gentle, rather than tumultuous. The events of the story provide the tumult, while Morgon and Raederle’s constancy, as well as their power, enable them to ride the storm – and yanno, that makes for pretty satisfying reading.
So if you haven’t read the Riddle-Master series yet – which you probably have since it’s now regarded as a classic – hie thee and read it. It’s a gorgeous tale, with gorgeous writing, and a worthy addition to the #YOR look at #RIFF.
Helen Lowe is a novelist, poet, and blogger whose first novel, Thornspell (Knopf), was published to critical praise in 2008. Her second, The Heir of Night (The Wall Of Night Series, Book One) won the Gemmell Morningstar Award 2012. The sequel, The Gathering Of The Lost, was shortlisted for the Gemmell Legend Award in 2013. Daughter Of Blood, (The Wall Of Night, Book Three) is Helen's most recent book and she is currently working on the fourth and final novel in The Wall Of Night series. Helen posts regularly on her “…on Anything, Really” blog and is also on Twitter: @helenl0we

domain: literature