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RazorsCut Episode 23
10.04.2016 - By RazorWire: After Civilization Serialized Audiobook Podcast
As Rock and Caroline continue their journey with a new companion, they discover their world, which previously seemed so empty, is beginning to feel uncomfortably occupied. In RazorsCut, Rock and Caroline find themselves among a people seeking purpose in a "post-Wandering" world. And although all cultures have dealt with the horror of The Wandering in different ways and for different reasons, Rock and Caroline soon learn that no matter how many smiles you see, when lies are told eventually the truth must come out. And when truth is denied with a whisper, it will be revealed with a bang.


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domain: entertainment


US officials mull tech laws to guard against potential AI bias
Close aides of United States President Joe Biden have called for a technology-based “Bill of Rights” in order to frame laws against artificial intelligence use cases that could potentially cause security and privacy issues.
The main factor seems to be how AI helps with facial recognition and biometric tools to not only identify citizens, but goes even further to predict mental state of mind, emotions and even character.
Last Friday, the White House’s fact finding mission launched a ‘Request for Information’ inviting biometric solution providers and others to understand how biometrics are being used, planned use of biometric technology in the future and the stakeholders who could be impacted by their use.
The body said that it welcomed responses to help inform policies about “scientifically valid technologies approved for appropriate contexts with iterative safeguards against anticipated and unanticipated misuse or harms,”
Eric Lander, Chief Science Advisor to Joe Biden and Alondra Nelson, Deputy Director for Science and Society, also published an article in the Wired Magazine where they had stressed on keeping AI in check for its harmful and faulty use cases.
Some of the concerns were virtual AI assistants who couldn’t understand accents, facial recognition that convicted the wrong individuals and few healthcare algorithms that played down the actual severity of disease.
“Additionally, there’s the problem of AI being deliberately abused. Some autocracies use it as a tool of state-sponsored oppression, division, and discrimination,” the opinion piece on the Wired site read.
Back in India, a few parts are grappling with their own tech related issues. In the state of Karnataka, online gambling was banned, leading to experts to question the understanding of technology by the government.
Political groups seem to be taking laws into their own hands with the BJP’s Yuva Morcha wing passing a passed a political resolution last Tuesday aimed at “protecting the digital sovereignty” of India.
“It calls for localisation of all the critical data and decision-making in India. It asserts that tech-companies cannot overrule or circumvent the digital sovereignty of the Republic of India,” the resolution stated.
India currently does not have a national regulatory authority for protection of personal data. The draft of the Personal Data Protection Bill is still under work.


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'Good as Gold' rose Description
Photo courtesy of GShellrude
14 favorite votes.
Yellow blend Hybrid Tea.Registration name: WEKgobafaExhibition name:
Good as Gold
Orange, golden-yellow shading, red highlights. Flowers deep golden orange-yellow finished with a kiss of red. Mild, tea fragrance. 27 to 35 petals. Average diameter 5". Very large, full (26-40 petals), borne mostly solitary, classic hybrid tea bloom form. Blooms in flushes throughout the season. Long, pointed, ovoid buds.
Tall, bushy, spreading, upright, well-branched. Large, glossy, dark green foliage. 3 to 7 leaflets.
Height: 47" to 6'7" (120 to 200cm). Width: 5'11" to 6'11" (180 to 210cm).
Can be used for beds and borders, cut flower or garden.
United States - Patent No: PP 26,052 on 10 Nov 2015 VIEW USPTO PATENT
Application No: 13/998,681 on 13 Nov 2013
This invention relates to a new and distinct variety of Hybrid Tea Rose. It has as its seed parent the variety known as ‘KORberbeni’ (not patented) and as its pollen parent the variety known as ‘WEKosupalz’ (U.S. Plant Pat. No. 17,305).
...The following description is of 3 to 4 year-old rose plants of the new variety grown outdoors in Pomona, Calif. in the month of November.

domain: agronomy


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The present study examined anger expression and avoidant coping and their relationship to substance use and use-related consequences in a sample of 270 incarcerated adolescents. Outwardly expressed anger was significantly associated with both alcohol and marijuana use and use-related consequences. Avoidant coping was also significantly associated with all outcome variables. There were no significant interactions between anger expression (outward or inward) and avoidant coping. Collectively, results suggest that expression of anger and avoidant coping are independent risk factors for substance use and use-related consequences across two classes of drugs in adolescent offenders. © 2004 Elsevier Ltd. All rights reserved.
Mendeley saves you time finding and organizing research
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domain: literature


The Appalachian News-Express
Both Pikeville and Greenup County boys soccer teams were in uncharted waters on Tuesday night in the Semi-State 8 matchup.
Both schools won their first-ever soccer region titles last week and were playing at State for the first time. For Pikeville, the historical run continues, and for Greenup County, its stunning run ended. The Panthers topped Greenup County, 3-1, at Pikeville High School.
The outcome of the game was never really in doubt as Pikeville raced out to a 3-0 halftime advantage.
The first goal of the game came in the 20th minute as Richmond McAnallen drained a shot to give Pikeville a 1-0 advantage.
Pikeville senior Ethan Rowe put the Panthers ahead 2-0 with a goal in the 32nd minute.
The Panthers didn’t let their foot off the gas, scoring a goal just two minutes later to take a 3-0 lead. The third goal came off the foot of Carew Bartley. Bartley’s initial shot was blocked, but Bartley kicked the deflection through for Pikeville’s final goal.
The Panthers played keep-away in the second half, trying to protect their three-goal lead.
Greenup County got on the board late in the game. During the first minute of stoppage time, Wade Reed scored to make the final score 3-1.
Pikeville finished with 22 shots on goal to 19 by Greenup County.
Pikeville goalkeeper Luke Wheat finished with 13 saves. Musketeer goalie Will McCall finished with 10 saves in the losing effort.
Pikeville (14-3-1) advances to the round of eight which will be played on Saturday at Lexington Henry Clay. The Panthers are scheduled to play at 3 p.m. against Henderson County, the 2nd Region champion.
Greenup County finished the season with a 10-9-2 record and the 16th Region championship.


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Medicare Advantage plans (MAPD) have different service areas available to those who live within that area. Service areas are typically based on geographic regions, such as counties or states, depending on the plan. If you have clients that are moving to an area outside their current MAPD service area, you should inform them about the three coverage options changes they can make when they move:
Move to a New Medicare Advantage Plan
If a beneficiary is moving outside of their plan’s service area, they’ll need to enroll in a new Medicare Advantage plan. You can help a Medicare beneficiary research plans in their area by identifying their healthcare needs, researching plans, comparing costs and benefits, and explaining the enrollment process. This involves using online resources to search for plans, comparing premiums, deductibles, copayments, and out-of-pocket maximums, and explaining the benefits and costs associated with each plan. You can also assist with enrollment by completing the enrollment application and providing necessary documentation.
Return to Original Medicare and add a Drug Plan.
If a beneficiary is moving outside of their plan’s service area and doesn’t want to enroll in a new Medicare Advantage plan, they can return to Original Medicare. Beneficiaries can enroll in a Medicare Part D prescription drug plan to supplement their coverage. As an agent you should educate beneficiaries on the requirements for prescription drug plan coverage and assist them in finding a plan that fits their need as well as help them enroll.
Return to Original Medicare and add a Drug Plan and a Medicare Supplement
A beneficiary will be eligible for guaranteed issue into a Medicare Supplement Plan when moving out of their current MAPD plan service area. They will have Guaranteed Issue rights to enroll in a Medicare Supplement plan without medical underwriting for 63 days after they move out of their current plan service area. The rules for Guaranteed Issue into a Medicare Supplement can vary and the plan depends on when they turned 65. People who turned 65 prior to January 1, 2020, can choose Plan F as their Guaranteed Issue choice while people who turned 65 after January 1, 2020 can choose Plan G since Plan F is not available for them.
In conclusion, moving with a Medicare Advantage plan can be a complicated process, but there are steps beneficiaries can take to ensure they have uninterrupted coverage. As a Medicare agent, it’s your responsibility to help beneficiaries understand their options and make informed decisions about their healthcare coverage. By providing them with the information and guidance they need, you can help make the transition as smooth as possible.
Need more training and resources to increase your Medicare sales? Contact us HERE to learn more about contracting with our team!

domain: health


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Dear like-minded friends,
I am Jeshua speaking. You are my brothers and sisters. I join you here as an equal, not as one who is exalted above you, but as a friend, a comrade. Feel the common source through which we are connected. Feel the life flow between us, the connection that heals and sets us free.
Have respect for yourself in the same way as you do for the others in this gathering. Respect means to value yourself by realizing who you really are and what you have taken on in this journey to be in a body of flesh and blood, here and now, on this Earth. It was a leap of faith, and deep within you is a belief, a force, a deep consciousness by which you have chosen to be here. Each of you said “yes” to this incarnation, to your present life. That moment of saying “yes” was based on a very deep knowing, yet doubts have since arisen due to old memories from experiences of other lives on Earth. Those doubts have veiled the clear and obvious “yes”, and have caused it to become cloudy and obscured. You have felt lost in this earthly adventure, alone and abandoned. I know this pain from having experienced it.
I have been portrayed too often as a saint, an enlightened one who knew everything. That was not so, for I have known deep doubts and fears. That was part of my journey, as it is part of yours, so see me in my imperfection, my brokenness. When I lived on Earth, I was inspired by a light to which I wanted to bear witness; a light that is beyond words, that contains love, wonder, beauty, humor, and wisdom. That light was not from me, but it was given from through me, just as is the case with you. But I also had moments of deep despair through experiencing a lack of understanding from those around me, of not feeling recognized, just as you do. Which is why I could reach out to people who were very lonely; despairing people who felt pain, both physically and emotionally; people who found themselves in a spiritual wasteland. I could understand those people, because I had experienced, within myself, the emotions, moods, and thoughts they were experiencing.
Human experience, with all its heights and depths, is necessary in order for your light to shine here. What you experience now in your life as darkness, as gloom, as obstacle, all that is part of your journey. It is not an obstruction you should try to avoid. It is more about your ability to accept these things and to bring the light of your heart to them, just as a stone can be lit up from within and become a beautiful gem. That is the task you are destined for: to experience the darkness, to understand it from within, and then to light it up and undergo the whole range of human experiences; to envelop them with consciousness and to feel them through and through. Then the Christ energy awakens in a human being – and being human is required for this to happen. You can not develop that energy, that particular unique power and brilliance of the Christ energy, in highly etheric realms where resistance and the depth of the human experience is lacking. See then that what seemingly holds you back, what causes you to resist, what discourages or bothers you, and what you might abhor, as precisely your destiny, the purpose for which you are here.
It is a magical experience to help another human to enlighten from within, who then becomes a being through which miracles can happen. There are stories told about me regarding miracles, and sudden physical and mental healings. But the power I had was not one of being a magician; it was not a mystical trick through which miracles happened. I could reach people who were ripe for it, who were about to experience a breakthrough on the inner level, through my deep understanding of their humanity. I made no judgment about who they were, their negative or positive sides; I was just there. And there were people who, in their contact with me, experienced love and that love made them whole. It was as if their true nature was called upon to suddenly awaken, and that is what happens in such a magical moment. It was not something I actually did, it was something that happened in the interaction between us.
The fact that I was open is what made it possible for me to receive the Christ light and to be able to pass it on to others. And this openness I am talking about is very often attained, as a human being, through an experience of crisis. You are usually caught up in all sorts of beliefs about what might or might not happen, or should or should not be, before you are actually open to the Christ light. You are full of ideas and patterns of thought that create a multitude of emotions and moods. You try to shape your world, your life, from such ideas and thought patterns until you come up against something that is so enormous you can not find a tidy way to avoid it, and then all your certainties, your beliefs and thought patterns, are swept away. You fall into a deep hole and this can bring up an overwhelming amount of fear.
You can also call this “the dark night of the soul”, and it is a frightening experience. At the same time, there is the possibility that you can become open and realize you no longer know the “right” way, and then a part of you gives up, while another part opens up. The part that gives up is the defensive, resisting part that always thinks it knows better, that is impatient, that wants and demands all kinds of things from life. That part often dies away in a crisis, and if you dare to let it die, the light can begin to shine inwardly. You can here see that a crisis experience, something that seems too much to be digested, also has the potential for an opening to the light. But it is a very intense experience, because the part that dies does not want to die, it wants to hold on – it resists.
I ask you to bring to mind the part in you that is opposed to your light and is against the light in general: the light of the cosmos that wants to flow through you. Something in you wants to protect itself against that possibility, so feel, if you can, the hesitation when I ask of you to imagine that the light flows through you very easily and freely, through all parts of your body and out into the world. What does this image call up in you? Can you allow that possibility? Do you feel it is even possible? Or is there something in you that wants to protect, to shield? And look at that protective part and see it before you as a guard. Ask yourself: “Why do I need this shield”? Take this defensiveness seriously, because there is something in you that feels the need to have this shield in place. Respect that part in you because the shield always has a purpose. It is there to protect a very vulnerable part of you.
What part in you will not permit the light? What part in you experiences it as too much to ask of you, or as threatening, or as even dangerous? And approach this part gently, as you would a child. See it as a child who has become discouraged, a child who has turned its life energy inward. Approach this child very gently and see how beautiful it is; it still radiates beauty even with this extreme vulnerability and defensiveness. Kneel down before this child and envelop it with your generosity and kindness. Kneel down in gentle acceptance without wanting the child to change, or wanting to impose anything on the child. Sit down quietly, in a relaxed way, with this child and feel how you can take the place of that shield. Until now, the child has felt protected by this defensive barrier between you and the outside world, but this shield is also a barrier between you and your deepest feelings.
Ask the child if you can take the place of this shield. Simply ask the child: “Will you allow me to take care of you, is that okay with you?” Ask honestly and openly: “Am I protecting you sufficiently?” And let it speak freely. Maybe it says: “No, I’m not safe enough, I’m afraid”. Ask what it needs, or what you can do, to make it feel safe. Take your time when doing this, because you can have this conversation with your inner child over and over again. It is a living being, a part of you that carries a lot of love, and so has a lot of love to give. But it should feel safe on Earth and that is why your gentleness and faithfulness are necessary.
When you have erected a defensive barrier, a shield, to protect and hide your inner child, you are no longer consciously connected to that child; it becomes hidden from you. You strike out, for example, from defensiveness, or you close off at certain times in your life, and you do not know why this is happening. You can become angry, or disappointed, or discouraged, and when this happens it is because there are automatic reactive patterns at work that stand between you and your inner child. By renewing the connection with this vulnerable child within you, and beginning the conversation over and over again, you can gradually find a way to resolve these automatic reactive patterns – the defensive barrier – but it demands patience and gentleness on your part. And it asks of you to understand, very deeply, that this vulnerable part of you is no obstacle which must be avoided or overcome, and it should not be eliminated.
It is intended that you grow by way of this child by enveloping it with understanding and love, and then the Christ light awakens in you. Gone are the fixed ideas and judgments and beliefs, and forever striving and struggling for something you think you need. Instead, there is now a willingness and openness in you to meet yourself over and over again through attention and wonder. By not thinking that you already know what you need and what is good for you, you allow yourself to be surprised by the answers of your inner child.
This is your path, because the soul has something to learn from the human experience. Sometimes you see heaven, the world in which the soul belongs, as a perfect world, but also as a place from where you have been cast out. You were then forced to survive in an imperfect and often alien world, the Earth, where so many emotions weigh you down, and this feels like a punishment. But the realm from where you came, the world of the soul, is not perfect, either. Something essential is missing there and that is why you have always taken the leap of faith into incarnation. It is life itself, this groping search, this deep and intense way of experiencing – which is possible especially on Earth – through which your understanding, your patience, insight, and compassion become deep and substantial. That is the spiritual meaning of life on Earth. The glimpses of perfection you can experience here – often in moments of simplicity, or through insight, or in an experience of pure enjoyment and beauty – such glimpses carry more weight than simply being in a euphoric state for years in the heavenly realms.
It is certainly wonderful to be in an atmosphere of harmony, with less resistance and fewer heights and depths, and you long for that. But do not deny the beauty and the deep spiritual value of life on Earth, of what you are going through. Take the experience, the wisdom, and the breakthroughs you experience here into the realms of light, and those realms will gain more substance and more aliveness because of that. There is an ongoing interaction between the realm of Earth and the realms “on the other side”. Treasure your own life as valuable. You are brave; you act powerfully; so acknowledge your own light.
I enjoy our being together here. When I am here, although I am not in a body, I become human in some small way, and I remember again how it is to be human. The burden, yes, but also the moments of lightness, friendship, and solidarity, which touch the soul very deeply. The bonds of friendship built up on Earth remain with the soul and continue doing their work forever, so precious is life on Earth.
I thank you all for being together and I greet each one of you from my heart.
Translation by Maria Baes and Frank Tehan.
» Source – Channel: Pamela Kribbe


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Screech Owl (Red) Earrings
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Made from recycle cereal boxes, these earrings are truly unique. They are handmade in Jabebo's studio in Pennsylvania.
The Eastern Screech Owl has two color phases. The red phase is more common in the eastern parts of its range.

domain: design


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I realize in the flash of another lightning strike that I’m standing not far from another trail, one that branches off to the west. It seems to wander that way, and I think it slopes down. The lightning has picked up now, and I think it might be enough to lessen the effectiveness of Graham’s night vision equipment. He’ll have trouble picking me out in all the flashes.
I go low, hoping that even if he spots me he’ll think I’m a deer, and I make it to the point where the trail begins to curve down. If I can make it to the ridge, it’s possible that Graham’s one of those hide-a-key fools, and I can find a magnetic box in the wheel well that will let me steal the thing and get out of here, find help, find my children. He must have GPS. Maybe a record of where he’s been.
I fall halfway down the trail, slide, and my head slams hard into a jutting boulder. Sparks and stars, and a wave of icy, tingling pain that makes everything strangely soft. I lie for a moment in the cold rain, gasping, spitting out water like a drowning victim. I’m cold. I’m so cold, and I wonder, suddenly, if I’m going to be able to get up. My head feels strange, wrong, and I know it’s bleeding badly. I can feel the warmth running out of me.
No. I’m not dying here. I’m not. I don’t know if Graham is still tracking me; I don’t know anything except that I have to get up, cold or not, hurt or not. I have to get to the ridge and find a way to get help. Somehow. I will fucking shoot one of the Johansens’ prize paintings if I need to, to make my point.
I slip and slide my way to my hands and knees, and I remember that I had a shotgun, but I can’t find it now. It’s gone, pitched into the darkness by my fall, and there’s no way for me to find it now. I still have the pistol, which miraculously hasn’t blown a big, devastating hole in my thigh. I take it out of my pocket and hold it tight as I get up and rest against the boulder. Blood is sheeting down the side of my face in a warm torrent that the rain dilutes almost instantly.
I slither down the trail, grabbing for handholds.
It’s a nightmare that I can’t escape, this descent, and I form the idea that Graham is right behind me, grinning and taunting me. Then Graham morphs into Mel, the Mel behind the Plexiglas at the prison, grinning at me with bloody teeth. It feels eerily true, but when I finally, breathlessly twist around, I find that the next flash of lightning shows me there’s no one on the trail at all.
And I’m nearly to the ridge.
As I get to the thick undergrowth that marks the place where the forest clears, something makes me stop and crouch down as I stare through the leaves. I’m aware of my heart beating fast, but it also feels sluggish, weary, as if it might take a nap at any moment. I must have lost more blood than I thought, and the cold is making my body work harder and harder. I’m shaking convulsively. It is, I know, the last step before false warmth sets in, and the urge to sleep. I don’t have much time left. I need to get to the truck and get Kyle’s coat. It’ll help me for the next part: the run down the hill. Like it or not, I am going to have to depend on the Johansens for help.
A little flicker of movement by the truck freezes me in place. The rain is lessening a little, though the thick mutter of thunder overhead rolls almost continuously. The easing downpour lets me see a fraction of a curve that shouldn’t be there, braced on the far side of the truck and protected by the solid wall of the engine block. It’s a head, and it’s too big to be Kyle’s. Kyle ran up the hill, not down.
Lancel Graham is lying in wait. He’s taken a classic ambush predator approach. Watching him, I remember the calm, offhand way that Melvin talked about his process in an interview a few years back: he’d crouch in just that spot by a car and wait for the woman to approach, then attack like a praying mantis in an overwhelming rush. It almost always worked.
Graham is a real fanboy. He knows my ex-husband’s habits, his moves, his strategies.
But he doesn’t know me. I survived Melvin.
I’m going to survive this asshole, too.
I’m not far from the original trail we took up the hill, and I work my way carefully around to it. I position myself exactly right.
I hit my mark, and then I hesitate. I’m cold. I’m slow. I’m confused from the head wound. What if this doesn’t work? What if he just shoots me?
No. He’s been hunting me to capture me, not just dispose of a problem. With the night vision he was wearing, he could have cut me in half already. He wants me.
He likes games.
All right, Lance. Let’s play a game.
I come around a tree, limping, moving slowly; I make sure I look just as miserable and ill as I feel, and as I come into the opening right at the trail head, I brace myself and slide down to my knees. Weak. Beaten.
In just the right place.
I don’t look up to see where he is. I just wait, breathing heavily. I try to get up, but not very hard, and then I let myself fall over, left side down in the mud. The pistol’s beneath me, concealed where I’ve rolled forward enough to shade it. It looks like I’m trying to find the strength to rise.
I can’t hear him coming over the steady, slowing drum of the rain, but I sense him, almost like a heat source on the edge of my awareness. He’s careful. He circles at a distance. I can dimly see him through my eyelashes, smeared by the rain. He’s got the shotgun. He circles closer. Closer.
And then he’s there.
I see the muddy toes of his boots edge in closer and the hem of his mud-caked jeans. The barrel of the shotgun is aimed not at me but at the ground between the two of us. He can still kill me. It’s a small movement to bring the muzzle up and fire, but he’s enjoying this. He likes seeing me beaten.
“Stupid, stupid woman,” he tells me. “He said you’d fall for this shit.” Graham’s voice hardens. Sharpens. “Get your worthless ass up, and I’ll take you to your kids.”
Random thought: I wonder where Graham’s wife is. I feel an overwhelming surge of pity for his sons, raised by this man. But it’s all fleeting, because underneath that, I feel as cold and hard as the barrel of that shotgun. As much of a weapon.
Because I’m not dying here.
I don’t move much, and I make myself look weak, flailing, like I’m trying to obey him. I move my right hand and lift myself up to my knees, and as I come up I smoothly, calmly raise the gun.
He sees his mistake just before I fire.
It’s precise, where I put the bullet. I don’t go for the head shot, or even for center mass. I go for the nerve plexus in Graham’s right shoulder. He’s a right-hander, like me.
The bullet—a hollow point—goes in exactly where I want it. I can almost see the way it opens up on impact into a flesh-cutting scythe of destruction. It’ll destroy his shoulder, sever nerves, break bones. A shoulder wound isn’t the clean, simple thing they show in the movies and on television; you don’t walk it off. Done right, a shoulder wound can take away use of that arm forever.
And I’ve done it right.
Graham’s cry is short and sharp. He staggers back and tries to bring up the shotgun, and shock would have allowed for that except that I’d destroyed nerve and muscle necessary to make the physics work. He drops it instead and blindly fumbles for it with fingers that are no longer capable of picking it up. He’s hurt, and hurt bad, but one thing about shoulder wounds that the silver screen gets right: it’s probably not fatal.
Not immediately, anyway.
I roll to my feet. I feel warm now. Loose and calm, the way I do at the range. Graham keeps trying to pick up the shotgun until I pull it away, and then he gives me a weird, tired grin. “You fucking bitch,” he says. “You were supposed to be easy.”
“Gina Royal was easy,” I tell him. “Tell me where they are.”
“I let your boy go. I could have killed him.”
That registers a little. I see something move in his expression. It’s just a twitch, but it’s real.
“I’ll let you live if you tell me where my kids are. I don’t want you dead.”
“Fuck. You. They aren’t yours. They’re his. And he wants them back. He needs them. This isn’t about you, Gina.”

domain: artistic


Renault’s all-electric Zoe gets an upgrade
It’s under the skin where things are really upgraded though. New Zoe has a more powerful 100kW motor – that can deliver a 0-100km.h time under 10 seconds and a top speed of 140km/h – and a Z.E. 50 battery which takes the car’s range up to 390 kilometres on the WLTP testing cycle. It now also offers fast direct current charging, an addition to the alternating current charging options already available at home or on the street.
10 Jul 2019


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Iceland - The Classics
Iceland’s landscape can best be described as truly otherworldly, and the immense scale of Iceland’s waterfalls and cliffs are breathtaking! I could not get enough of this incredibly photogenic country. The way soft, warm light spills onto the green moss along the cliffs, the beauty of the mysterious black volcanic beaches, the strength of the North Atlantic waves all create unique and unforgettable experiences.
Driving along the Golden Circle in 10 days was a massive feat, but I enjoyed every sleep-deprived minute of it.
Here’s a collection of some of my personal favourites from Iceland’s most famous sights.

domain: geography


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Just bought a used left mirror assembly for my 1996 K1100RS sans the mirrored glass. I popped the glass out of my busted old mirror and pushed it into the "new" one. Well it doesn't fit too tightly. On closer examination the "new" mirror assembly hole for the stem is visably larger and it doesn't have the two pins that go across the edge of the hole, inside, to hold the mirrored glass stem in. Same p/n's assemblies but different. The "new" mirror assembly didn't even have the recepticles to hold the pins. A different design. Did BMW change the design for holding the mirrored glass in some where along the way and didn't tell us?
It barely holds the glass in. I was thinking that maybe the hole was worn but once I saw it was missing the two cross pins then I knew it wasn't wear. Anybody run across this before?

domain: hobby


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There have been some chilly mornings of late, as Autumn arrives. I love a little chill in the air. It seems it was not so long ago that it was summer and I was spending relaxed mornings lying on the beach.
On my way I would grab a book from the shelf near the front door. My hand always seem to land on Elizabeth David; small, compact and you could open to any page and start a good read.
I truly love her writing. I used to get frustrated that she didn’t speak in more precise measurements but as I became a more confident cook I actually found it more useful. You can abandon the fineries of measuring out every ingredient and never ever changing the recipe for fear of it not working out. Elizabeth David provides you with inspirational ideas and leaves you to work out the details.
The obvious choice to take to the beach was ‘Summer Cooking’, first published in 1955. I seem to be particularly obsessed with her chapter on eggs. In it she has a paragraph entitled Poached Eggs in Cheese Soufflé. The first published version of this recipe was by Alfred Suzanne in his ‘Egg Cookery’, 1893. Elizabeth describes the dish so beautifully I read it over and over again.
I’m sorry I didn’t measure everything out at the time, so your going to have to roll with this one.
The Gruyère and Cauliflower
Put a saucepan on medium heat, add a tablespoon of olive oil and about 20g of butter. Once the butter is melted add 1/2 a finely chopped white onion or a shallot (or as they call it here a eschallot) with a large pinch of sea salt. Soften but do not brown. Chop half a small cauliflower head into small florets and add them to the pan. Pour in enough chicken stock, or water, to only just cover the cauliflower and bring to the boil, continue until you can push a fork easily through the floret stems. Spoon into a food processor leaving most of the liquid behind in the pan, and process until smooth. I like to add a large tablespoon of sour cream as well.
Separate two eggs.
The White Sauce
Rinse out the pan you just used and add about 20g of butter to the pan. Melt over medium heat, then add a heaped tablespoon of plain flour and stir together. After a minute of cooking add a splash of milk and whisk for another minute. Then slowly add about 350g warm milk and whisk to form a smooth white sauce. Then, off the heat, stir through your two egg yolks, add a very large handful of grated Gruyère cheese, the same amount of cauliflower puree and stir through. Check for seasoning. Add sea salt and pepper to taste.
Whisk egg whites until you get soft peaks. Add a third to the cauliflower, Gruyère mix to loosen, then add the remaining, gently folding through.
While all this is going on you can poach an egg. I’m not great at this and I rarely get my hands on super fresh eggs, which you need for the straight ‘drop in simmering water’ method. I like to use the oiled gladwrap method, perfectly described here by Not Quite Nigella.
Butter your chosen dish well. I used a breakfast bowl, don’t feel like you have to search out little ramekin dishes, go big and rustic. Fill half the dish with the mixture then carefully place in your poached egg, do not break it! Cover with more mixture to fill the dish. Grate fresh Parmesan over the top for extra flavour and a crisp brown top. Bake in an oven preheated to 200°C for 8-10 minutes. Remember not to open the oven door during this time or you will have a flat soufflé.
Makes one large serve or two modest ones.
Serve with a green salad and enjoy the runny yolk!

domain: food


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“THE BRAIN THAT CHANGES ITSELF BY Norman Doidge PDF Download” is one of the best books from the romance genre. “ Norman Doidge is the author of this romántico novel. Here is a short summary of this Amar/romántico novel..
THE BRAIN THAT CHANGES ITSELF BY Norman Doidge PDF DownloadNovel Full Episode PDF
A new science called neuroplasticity is overthrowing the old notion that the human brain is immutable. Psychoanalyst Doidge traveled the country to meet both the brilliant scientists championing neuroplasticity and the people whose lives they’ve transformed–people whose mental limitations or brain damage were seen as unalterable. We see a woman born with half a brain that rewired itself to work as a whole, blind people who learn to see, learning disorders cured, IQs raised, aging brains rejuvenated, stroke patients learning to speak, children with cerebral palsy learning to move with more grace, depression and anxiety disorders successfully treated, and lifelong character traits changed. Using these stories to probe mysteries of the body, emotion, love, sex, culture, and education, Dr. Doidge has written an inspiring book that will permanently alter the way we look at our brains, human nature, and human potential.–From publisher description.
Read THE BRAIN THAT CHANGES ITSELF BY Norman Doidge PDF DownloadOnline Full Episode
“THE BRAIN THAT CHANGES ITSELF BY Norman Doidge PDF Download” is a great novel that will keep you up all the night. It is a great novel by a great author. This fantastic novel is full of love, romance, drama and the real revenge. All the characters in this novel are well connected and timely injected by the great author.
We daily upload the new stories, novels and books to entertain our readers in a great way. All the novels and stories get regular updates. We upload new chapters of all the ongoing novels and books. You can read theses chapters and stories online on our website.
About the Novel
Let’s start with the basics:
- Title: THE BRAIN THAT CHANGES ITSELF
- Author: Norman Doidge
- Publisher: Alaniniz
- Genre: Nonfiction, Science Books, Psychology Books
- Language: English
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domain: library


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Make your own self-watering grow bucket
The buckets were assembled and donated by Hitt Contracting; seedlings were provided by HOH and planted by the Camelot Garden Club, neighbors, and master gardeners, and the project was supported from start to finish by Extension Agent Adria Bordas. So far this year, the HOH-FCMG partnership has distributed over 70 self-watering tomato buckets.
We're considering offering these buckets next year as a buy-one-donate-one program.
But if you can't wait for us to make up our mind or if you're the DIY type, here are instructions for how to assemble them.


Felting is a simple technique by which you can make wonderfully warm wool items to wear. The main advantage that felting has over other textile techniques is producing a finished article in much less time.
Suzanne Huggs, author of Hooked on Felt and a very talented felter, had shared with me a new technique using a resist rather than a foam form like I’ve previously done. She even offered to come to Alpaca Meadows and teach a Hat Felting Class so stay posted for that!
Leigh Oden, another alpaca breeder, came early so she could card some of her own alpaca fiber for the class. She used some wonderful soft fiber from one of her males named “Cookie Dough” as well as some alpaca fiber she had dyed at home so that she would have some color to use for the design on her mittens.
Making mittens custom fit to each of our hands, we used under layment for laminate flooring to cut our patterns from, carefully tracing around our own hand and wrist, keeping the line even and about three-quarters of an inch away from the hand. This allowed for the shrinkage of alpaca which does not shrink when felted as quickly or as much as wool.
Next we laid four separate layers of fiber crisscrossing each layer 90 degrees in the opposite direction across the hand and wrist. We did the same across the thumb being careful to maintain the shape of the thumb as well as add extra fiber where the hand and thumb meet and across the tip of the thumb to allow for wear. Alpaca is finer than sheeps wool so needs to have more layers laid on the pattern so as not to end up with holes. If you do get holes while felting, finish the process of wet felting, rinsing, drying, then turn inside out and repair by needle felting layers of the same fiber across the hole.
I found several great tutorials, complete with photos, on how to wet felt mittens.
Wet Felted Mittens – Full Photo Tutorial
I would add to this that when you are finished with your mittens, rinse them in a vinegar and water solution, to neutralize the soap in the mitten. Over time if not rinsed completely out, the soap will damage the fiber. Rinse completely then, with clear water. Roll mittens in a towel, then step on the rolled towel to squeeze out excess moisture. Reshape your mittens and lay in a warm spot to dry.
If your mittens turn out too short, you can knit or crochet a cuff and then hand stitch it to the inside of your mitten. Use the cuff portion of any mitten pattern that has a ribbed cuff, but only make it about half the width.
When mittens are dry, you can needle felt a design onto the mitten, embroider an edge or design, add buttons whatever you like. Cecilia cut out the letter “L” for her school, out of a flat piece of felt and felted it on during the wet felting process. Possibilities are endless!
I found these Needle Felted Butterfly Mittens on Ravelry. The design has been felted on knitted mittens but this could be done on felted mittens just as easily.
Felting by Hand
is a very informative little book, with lots of helpful tips on wet felting. The author has researched the felting qualities of sheep breeds available in the United States and explains how to choose what fiber for specific felting projects. There is also a chapter devoted to felt projects for children.
Some other felting books full of great ideas are below:


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Space Hulk (2016) GAME ONLY, NO MINIATURES by Games Workshop NEW nqgkch1004-40K Miniatures
New: A brand-new, unused, unopened, undamaged item (including handmade items). See the seller's listing for full details.See all condition definitions- opens in a new window or tab... Read moreabout the condition
Static Model 1 32 Bronze Armored Vehicle Tiger Tank Panzer Military Car
With a Democrat in the governor's office, Metra expects to finally get an influx of cash—but will it be enough to make up for the years-long backlog?


According to the latest reports, the well-known Japanese multinational corporation that designs and manufactures electronic products, of course, Sharp, has recently demonstrated a foldable screen that can be folded in a flip-like format, making a smartphone 50% less and more compact when stored.
Sharp Just Launched The Future Motorola Razr
The well-known Japanese multinational corporation that designs and manufactures electronic products, of course, Sharp, has recently demonstrated a foldable screen that can be folded in a flip-like format, making a smartphone 50% less and more compact when stored.
The prototype may be just what the well-known smartphone manufacturer Motorola needs for a revised Razr with modern features. The model presented by the famous Japanese smartphone manufacturer has a screen size of 6.12-inch, made with OLED technology with a resolution of 3040 x 1440 pixels, in addition to displaying colors in consent with the DCI-P3 standard.
Moreover, the most exciting point of this model is that it is not exactly what exists in manufacturers like Huawei, Xiaomi, or the South Korean giant Samsung, who have created devices that fold and become smaller.
Hence, the model presented by the well-known Japanese smartphone manufacturer, of course, Sharp puts what would be the standard screen of a smartphone that is not too big but can be folded vertically that simply allowing you to save the device saved by taking up less space in this orientation, just like all other flip phones did in the past.
Finally, the screen passed the bend tests (100 thousand times) with no apparent damage. That is equivalent to opening a smartphone with that screen 273 times a day in a year. It may sound like a lot, but if you open the device every time a notification arrives, you’ll certainly get that amount without much trouble.
Moreover, the South Korean giant Samsung promises that the Galaxy Fold screen has been tested in an environment where opening and closing are 200,000 times, which is twice the Sharp.
The screen does not have any date to appear in any model of Sharp itself or other companies. Still, it would be pretty interesting if a Motorola Razr could take its rebirth with this new display of Sharp. So, what do you think about this? Simply share all your views and thoughts in the comment section below. And if you liked this post, do not forget to share this post with your friends and family.


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Join us for a milestone evening with the TSO—100 years in the making! To mark the TSO’s Centennial, internationally beloved cellist Yo-Yo Ma joins Music Director Gustavo Gimeno and the Orchestra for Dvořák’s deeply emotive Cello Concerto. Plus, multi-award-winning Tobique First Nation artist Jeremy Dutcher makes a special appearance with Yo-Yo Ma to perform Honour Song.
Your ticket includes a concert after-party with the entire audience and TSO musicians—featuring special musical surprises, photo opportunities, and more. Don’t miss this opportunity to celebrate a century of music-making with your TSO!
For information on exclusive Gala Dinner Tickets and Gala Table Packages, including premium concert seating, visit TSO.CA/Gala. Funds raised will support the TSO’s concerts and community work which enrich thousands of lives each year through the power of music.
Symphonic Dances from West Side Story
George Paul / Jeremy Dutcher, arr. Owen Pallett


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We all love stories, we grew up listening to stories from a young age and then we started growing up reading stories, in the past we used to get story books, but as time went on, story books changed and we started reading stories online instead. Grandmother stories, love stories, ghost stories and so many more stories that we constantly read, these stories are the ones that make us read again and again no matter how much we read, so much so that we fell in love with the stories.
B4creation’s New App is focusing on those who love reading stories Said B4creations Director Mr Ayyappan Sreekumar. Now we can get stories on Facebook and Instagram, but it’s very difficult to choose the ones we like, we will read what they put in, but there is no need to bother with it anymore, a great app has arrived to make the stories available, the name of the app is Prime Stories, Stories in English and Malayalam in Prime Story Yes. In it you can read and write stories, and we can download the Prime Story app directly from the Play Store. Let us select the stories of our favourite storytellers.
Download Prime Stories From : http://play.google.com/store/apps/details?id=com.b4.primestories


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Clean Energy is partnering with Pilot-Flying J to make LNG (liquified natural gas) available along key interstate corridors nationwide. This is exciting new for CNG drivers because wherever LNG is sold, CNG should also be available. Unfortunately, Clean Energy has not yet confirmed that the LNG stations will also dispense CNG. The network will include two stations in Utah. As previously mentioned in this blog, one LNG station is already open in Salt Lake City. Another one is planned for Beaver, UT. If the expanded network of LNG stations also dispense CNG it will make it easier to travel cross country in your CNG vehicle.
Read the full press release here. (.pdf)


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Stack the dishes on the waiter's hands, but don't be the one to tip him over!
This clever stacking game is made entirely of wood. Super fun and unique. Great for ages 6 plus. Game measures approximately 2.6 by 4-inches Made from beechwood. For 1 or 2 players. For Ages 6+
Check items to add to the cart or select all
Harry Potter Playing Cards
"Play That Tune" Kazoo Game
Book Where's Warhol
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text:
What is the only disney animated feature film whose title character does not speak?
Dumbo is the first and only protagonist in a Disney animated feature film to have no spoken dialogue. This was Walt Disney's favorite film made by his studio
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Slaven Bilic insists West Ham United won’t be buying new players for the sake of it in this January transfer window.
The Hammers are currently sixth in the Premier League table, with their fans dreaming of European football as they prepare to move to their new home at the Olympic Stadium in time for the start of next season.
But Bilic is adamant he won’t waste money in a bid to safeguard that position.
Speaking exclusively to talkSPORT, he said of this campaign, his first in charge of the Hammers: “So far, so good. We are only halfway through, but we are very confident. The main thing is to stay away from injuries and, if we do that, we have a really good team that can compete with any team in the league.
“We have a good squad, a big squad, and [it’s] 99 per cent [certain] we will leave it like this and make our signings in the summer.
“If something exceptional comes along, whether that’s a long-term deal for one great player, or a loan deal for a back-up player for six months, we will do it. But we won’t buy just because it’s the transfer window.”


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The Milwaukee Public Library recently named Mario “The Poet” Willis as the new Poet Laureate of Milwaukee.
Willis is a poet, podcaster, performance coach and spoken word artist who was born and raised in Milwaukee. He is a two-time member of Milwaukee's National Poetry Slam Team; a Poetry Unplugged All-Star; and a mainstay community member of one of the longest-running open mic venues in the city, Poet’s Monday at Linneman’s Riverwest Inn.
He is also the co-creator and host of “Pancakes & Poetry,” a community celebration during Milwaukee's annual Bronzeville Week Festival.
For more than 16 years, Willis has studied with several nationally recognized spoken word artists and award-winning poets, including the most recent Poet Laureate and current Wisconsin State Poet Laureate Dasha Kelly Hamilton, Buddy Wakefield and Patricia Smith.
Willis has published three chapbooks: “Love More Coffee, and Dreams,” “Size Matters,” and “A Limited Engagement." He has also produced two spoken word CDs (“Forgiveness” and “Don’t Panic, Be Awesome”) and maintains a blog about poetry, performance and personal truth called “Don’t Panic, Be Awesome."
Willis is also a father of three, a Brewers' fan, community activist, volunteer with Hunger Task Force and a member of Autism Speaks (being the father of an autistic child).
"My philosophy is that love is the only thing that can truly save you and forgiveness makes love that much easier," he says.
Visit www.mpl.org/poetlaureate for more information about the program.
Molly Snyder started writing and publishing her work at the age 10, when her community newspaper printed her poem, "The Unicorn.” Since then, she's expanded beyond the subject of mythical creatures and written in many different mediums but, nearest and dearest to her heart, thousands of articles for OnMilwaukee.
Molly is a regular contributor to FOX6 News and numerous radio stations as well as the co-host of "Dandelions: A Podcast For Women.” She's received five Milwaukee Press Club Awards, served as the Pfister Narrator and is the Wisconsin State Fair’s Celebrity Cream Puff Eating Champion of 2019.


Happiness continues! Just eight months after the Jonas Brothers released their first album in ten years — Happiness Begins — following their highly anticipated reunion, the bros are back in the studio working on their next one!
During an appearance on NBC's Today (on Feb. 25), Nick Jonas opened up about joining The Voice, but also talked about what the Jonas Brothers have been up to lately and revealed that they've been working on their new album with Ryan Tedder, AND fans will find out the record's details in a mere few WEEKS!
Jonas said, "We have been back in the studio with Ryan Tedder, working hard on the new record, which is going to be announced in the next couple weeks — title, track list, all that."
WHAT DID WE DO TO DESERVE THIS AMAZING NEWS?!
As fans already know, the trio recently released their latest single, which Nick also made mention of at the end of his Today interview, back in January. The song will presumably be on the band's forthcoming new album, but we'll find out for sure in the coming weeks as they reveal more information.
Elsewhere in his interview Nick also opened up about the Jonas Brothers' hiatus and why it was necessary in order to get to the place where they are now, both professionally and personally. He explained, "That was the thing I think we were all aware of. When the band split up, I think it was important just for us to go on those journeys and figure out who we were as people. And inevitably, it led us back to each other, which is a dream scenario for family. But this, kind of, has exceeded all our expectations."
He added, "I mean, who gets to share these memories with their family like this? Travel the world. And I think we all realized how fortunate we are. And the fact that things weren't so good and we found a way to make them good once again to share this incredible journey."
Photo: Getty Images


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Heather Starmer Research Lab
Head & Neck Surgery
In addition to providing state of the art clinical care for communication and swallowing, our speech-language pathology team is engaged in clinical research to determine strategies to improve patient outcomes after a diagnosis of head and neck cancer. Our team recognizes the difficulties of going through cancer treatment and has particular interest in developing strategies to help patients make it through their treatment doing the therapies that will provide the best long-term outcomes. We collaborate closely with our surgeons, radiation oncologists, medical oncologists, and other team members to investigate how we can improve the patient experience of head and neck cancer care.
"Nothing would be more tiresome than eating and drinking if God had not made them a pleasure as well as a necessity.
Our objective is to improve swallowing outcomes and patient satisfaction with swallowing after treatment for head and neck cancer.
Swallowing disorders are a common consequence of head and neck cancers and the treatments used to eradicate it. Swallowing issues may be related to the removal of structures in the mouth or throat, scarring or fibrosis of the mouth and throat, or swelling of the mouth, throat, or neck. Swallowing problems after head and neck cancer are cited as being the primary determinant of poor quality of life and may be associated with poor nutrition and development of aspiration pneumonia. Given this reality, our work seeks to identify practical strategies to minimize dysphagia and it’s complications.
Harnessing the Power of Technology
Technology has the potential to influence healthcare in many different ways. Approximately 10 years ago, Professor Starmer initiated work on a mobile application to support patients with head and neck cancer undergoing radiation therapy. This application, called The Head and Neck Cancer Virtual Coach™, provides patients with access to video workouts to perform to maintain the strength and mobility of their swallowing muscles, high-quality content about how to manage side effects during treatment, recipes and videos of foods that are well tolerated during treatment, and reminders to perform important therapy tasks. The impact of The Head and Neck Virtual Coach™ on patient outcomes and their experiences during treatment is currently under investigation at Stanford, Massachusetts Eye and Ear Infirmary, and the Fox Chase Cancer Center.
The Head and Neck Cancer Virtual Coach™ application screenshots.
Starmer HM, Klein D, Montgomery A, et al. Head and Neck Virtual Coach: A Randomized Control Trial of Mobile Health as an Adjunct to Swallowing Therapy During Head and Neck Radiation [published online ahead of print, 2022 Aug 12]. Dysphagia. 2022;10.1007/s00455-022-10506-5. doi:10.1007/s00455-022-10506-5.
- Vibrent Health
- Dr. Jeremy Richmon (Massachusetts Eye and Ear Infirmary)
- Tessa Goldsmith (Massachusetts Eye and Ear Infirmary)
- Barbara Ebersole (Fox Chase Cancer Center)
Effective Treatment Requires Precision Diagnostics
The ability to effectively manage swallowing disorders depends on diagnostic precision. Swallowing is typically evaluated using either fluoroscopy, an x-ray movie, or endoscopy. Both of these tools rely on an experienced clinician interpreting their images. Without use of reliable, standard rating systems, these interpretations can be subjective and lead to poorer patient outcomes and inadequate communication between clinicians. Further, research of advanced cancer treatments requires the ability to accurately assess the functional impact of the treatment. To address these challenges, our lab strives to establish and validate measurement tools to be used in patients with swallowing disorders. This work has resulted in the development of the DIGEST-FEES tool, which allows swallowing clinicians to reliably rate the safety and efficiency of an individual’s swallow using endoscopic assessment of swallowing.
Endoscopic Evaluation of Swallowing.
Dr. Katherine Hutcheson (MD Anderson Cancer Center)
ADAPTATION AND VALIDATION OF THE DYNAMIC IMAGING GRADE OF SWALLOWING TOXICITY FOR FLEXIBLE ENDOSCOPIC EVALUATION OF SWALLOWING: DIGEST-FEES. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR Starmer, H. M., Arrese, L., Langmore, S., Ma, Y., Murray, J., Patterson, J., Pisegna, J., Roe, J., Tabor-Gray, L., Hutcheson, K. 2021: 1-9
Purpose While flexible endoscopic evaluation of swallowing (FEES) is a common clinical procedure used in the head and neck cancer (HNC) population, extant outcome measures for FEES such as bolus-level penetration-aspiration and residue scores are not well suited as global patient-level endpoint measures of dysphagia severity in cooperative group trials or clinical outcomes research. The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) was initially developed and validated for use during videofluoroscopic evaluations as a way to grade safety, efficiency, and overall pharyngeal swallowing impairment. The purpose of this study was to adapt and validate DIGEST for use with FEES. Method A modified Delphi exercise was conducted for content validation, expert consensus, adaptation, and operationalization of DIGEST-FEES. Three blinded, expert raters then evaluated 100 de-identified post-HNC treatment FEES examinations. Intra- and interrater reliability were tested with quadratic weighted kappa. Criterion validity against the MD Anderson Dysphagia Inventory, Functional Oral Intake Scale, Secretion Severity Scale, and Yale Residue Rating Scale was assessed with Spearman correlation coefficients. Results Interrater reliability was almost perfect for overall DIGEST-FEES grade (kappaw = 0.83) and safety grade (kappaw = 0.86) and substantial for efficiency grade (kappaw = 0.74). Intrarater reliability was excellent for all raters (0.9-0.91). Overall DIGEST-FEES grade correlated with MD Anderson Dysphagia Inventory (r = -.43, p < .0001), Functional Oral Intake Scale (r = -.43, p < .0001), Secretion Severity Scale (r = .47, p < .0001), Yale Vallecular Residue (r = .73, p < .0001), and Yale Pyriform Sinus Residue (r = .65, p < .0001). Conclusion DIGEST-FEES is a valid and reliable scale to describe the severity of pharyngeal dysphagia in patients with HNC. Supplemental Material https://doi.org/10.23641/asha.14642787.
View details for DOI 10.1044/2021_JSLHR-21-00014
View details for PubMedID 34033498
Lymphedema can occur following surgery or radiotherapy for head and neck cancer. Internal lymphedema can contribute to swallowing, voice and breathing difficulties. Unlike external edema, there is no method currently available to measure internal edema. In conjunction with researchers in the United Kingdom, our lab is working to develop a scale that can be used to quantify the severity of internal edema impacting the throat and voice box.
Dr Joanne Patterson (University of Liverpool)
Starmer, Heather, Mary Gemma Cherry, Joanne Patterson, Bridget Young, and Jason Fleming. “Assessment of Measures of Head and Neck Lymphedema Following Head and Neck Cancer Treatment: A Systematic Review.” Lymphatic Research and Biology, June 9, 2022, lrb.2021.0100. https://doi.org/10.1089/lrb.2021.0100.
DEVELOPMENT AND RELIABILITY OF THE REVISED PATTERSON EDEMA SCALE. CLINICAL OTOLARYNGOLOGY : OFFICIAL JOURNAL OF ENT-UK ; OFFICIAL JOURNAL OF NETHERLANDS SOCIETY FOR OTO-RHINO-LARYNGOLOGY & CERVICO-FACIAL SURGERY Starmer, H. M., Drinnan, M., Bhabra, M., Watson, L., Patterson, J. 2021
OBJECTIVE: The Patterson Edema scale was developed in 2007 to address the lack of a reliable, sensitive scale to measure laryngeal and pharyngeal edema in patients with head and neck cancer. The objective of this study was to revise the existing Patterson scale to improve its reliability and utility.DESIGN: Prospective investigation SETTING: Academic medical center PARTICIPANTS: Speech-Language Pathologists, Otolaryngologists, and Radiation Oncologists MAIN OUTCOME MEASURES: Ratings using the Revised Patterson Edema Scale METHODS: A consensus group reviewed existing literature regarding the performance of the original Patterson scale and revised the existing scale in regard to items to be included and descriptors for each severity level. The scale was then utilized by 18 speech language pathologists from the US and UK with >2 years-experience working with dysphagia and dysphonia with endoscopy. Each SLP rated a total of eight parameters (epiglottis, vallecula, pharyngoepiglottic folds, aryepiglottic folds, arytenoids, false vocal folds, true vocal folds, and pyriform sinuses) using the Revised Patterson Edema Scale. Feedback was solicited from raters regarding areas where clarity was lacking for further scale revision. Scale revisions were completed and additional ratings were completed by otolaryngologists, radiation oncologists, and less experienced SLP providers to establish reliability across disciplines. Quadratic weighted Kappa values were obtained to establish interrater reliability.RESULTS: Feedback received from raters included suggestions for clarification of how to rate unilateral edema, use of a standard task battery to visualize and rate structures consistently, and clarification of true vocal fold edema rating parameters. Overall interrater reliability was established using quadratic weighted Kappa with good agreement noted for the epiglottis, vallecula, arytenoids, andfalse vocal folds; moderate agreement noted for aryepiglottic folds, pharyngoepiglottic folds and pyriform sinuses; and fair agreement noted for true vocal folds.CONCLUSIONS: The Revised Patterson Edema Scale demonstrates moderate-substantial interrater reliability for most parameters across multiple disciplines and experience levels, with the exception of the true vocal folds where agreement was fair. We believe the Revised Patterson Edema Scale provides a reliable tool for clinicians and researchers to rate edema in the supraglottic larynx and pharynx following treatment for head and neck cancer.
View details for DOI 10.1111/coa.13727
View details for PubMedID 33529494
Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
2023; 168 (4): 571-592
To develop an expert consensus statement (ECS) on the management of dysphagia in head and neck cancer (HNC) patients to address controversies and offer opportunities for quality improvement. Dysphagia in HNC was defined as swallowing impairment in patients with cancers of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, or hypopharynx.Development group members with expertise in dysphagia followed established guidelines for developing ECS. A professional search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements targeted at providers managing dysphagia in adult HNC populations. The development group prioritized topics where there was significant practice variation and topics that would improve the quality of HNC patient care if consensus were possible.The development group identified 60 candidate consensus statements, based on 75 initial proposed topics and questions, that focused on addressing the following high yield topics: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. After 2 iterations of the Delphi survey and the removal of duplicative statements, 48 statements met the standardized definition for consensus; 12 statements were designated as no consensus.Expert consensus was achieved for 48 statements pertaining to risk factors, screening, evaluation, prevention, intervention, and surveillance for dysphagia in HNC patients. Clinicians can use these statements to improve quality of care, inform policy and protocols, and appreciate areas where there is no consensus. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to dysphagia in HNC patients.
View details for DOI 10.1002/ohn.302
View details for PubMedID 36965195
- Internal oedema and dysphagia characteristics in patients with head and neck cancer. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 2023 Hide More
- Letter to the Editor re: Intra and interobserver agreement of the Dynamic Imaging Grade of Swallowing Toxicity Scale (DIGEST) in fiberoptic endoscopic evaluation of swallowing (FEES): the importance of observer-tailored training. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2023 Hide More
Head and Neck Virtual Coach: A Randomized Control Trial of Mobile Health as an Adjunct to Swallowing Therapy During Head and Neck Radiation.
Dysphagia is a common consequence of head and neck radiation and may be mitigated by performance of swallowing exercises during radiation treatment. Given historically poor adherence to such exercise protocols, we created a mobile health application, HNC Virtual Coach as an adjunct to standard clinical care. This randomized control trial investigated the impact of HNC Virtual Coach on adherence as well as swallowing outcomes by comparing those using the mobile app to those receiving only standard clinical care and paper logs. Both treatment groups were provided with the same exercise protocol as well as the same baseline educational information. Outcome measures included adherence rates, physiologic measures obtained during a Modified Barium Swallow Study (PAS, MBS-ImP, DIGEST), patient-reported outcomes (MDADI), diet levels (FOIS, PSS-HN), and quality of information received (INFO-25). Patients using the HNC Virtual Coach tended to have better adherence to treatment recommendations during radiation therapy. Increased adherence was associated with better patient-reported quality of life, but not physiologic function 2-3months following completion of radiation. Results suggest that a mobile health application may provide benefit for some patients undergoing head and neck radiation.
View details for DOI 10.1007/s00455-022-10506-5
View details for PubMedID 35960394
Transoral Robotic Surgery for Recurrent Tumors of the Upper Aerodigestive Tract (RECUT): An International Cohort Study.
Journal of the National Cancer Institute
BACKGROUND: Transoral robotic surgery (TORS) is an emerging minimally invasive surgical treatment for residual, recurrent, and new primary head and neck cancers in previously irradiated fields, with limited evidence for its oncological effectiveness.METHODS: A retrospective observational cohort study of consecutive cases performed in 16 high-volume international centers before August 2018 was conducted (registered at clinicaltrials.gov [NCT04673929] as the RECUT study). Overall survival (OS), disease-free survival, disease-specific survivals (DSS), and local control (LC) were calculated using Kaplan-Meier estimates, with subgroups compared using log-rank tests and Cox proportional hazards modeling for multivariable analysis. Maximally selected rank statistics determined the cut point for closest surgical resection margin based on LC.RESULTS: Data for 278 eligible patients were analyzed, with median follow-up of 38.5months. Two-year and 5-year outcomes were 69.0% and 62.2% for LC, 71.8% and 49.8% for OS, 47.2% and 35.7% for disease-free survival, and 78.7% and 59.1% for disease-specific survivals. The most discriminating margin cut point was 1.0mm; the 2-year LC was 80.9% above and 54.2% below or equal to 1.0mm. Increasing age, current smoking, primary tumor classification, and narrow surgical margins (≤1.0mm) were statistically significantly associated with lower OS. Hemorrhage with return to theater was seen in 8.1% (n=22 of 272), and 30-day mortality was 1.8% (n=5 of 272). At 1 year, 10.8% (n=21 of 195) used tracheostomies, 33.8% (n=66 of 195) used gastrostomies, and 66.3% (n=53 of 80) had maintained or improved normalcy of diet scores.CONCLUSIONS: Data from international centers show TORS to treat head and neck cancers in previously irradiated fields yields favorable outcomes for LC and survival. Where feasible, TORS should be considered the preferred surgical treatment in the salvage setting.
View details for DOI 10.1093/jnci/djac130
View details for PubMedID 35944904
We would like to express our gratitude to the Toole Family Foundation, whose continuous generosity supports us in our battle against HPV related cancers.

domain: medical


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With just 3 days to the much talk about June 7 Save the State Protest, a local student group in Margibi County identified as the “Margibi Student Union” (MARSU) has distanced itself from the process.
MARSU President Oretha Tenway during a press conference in Kakata on Monday June 3, 2019 said protest in Liberia has not helped the student community in Liberia but has rather caused several damages on them as such; students are advised to stay away from the process.
She explained that during the regime of former President Sirleaf, a protest was staged by students of the University of Liberia where according to her several students sustained wounds.
“We don’t want our students to be affected by this protest that’s why we are saying they should abstain from the protest” she noted.
The Margibi Student Union President narrated that the Union understands the financial crisis in the Country adding that despite this situation she wants all students in Margibi County to remain peaceful during and after the June 7 protest.
Tenway said even though it is constitutional for every citizen to protest, her leadership is asking every student in Margibi to abstain from the protest and remain peaceful as they observe the days of the protest noting that the wellbeing of every student in the County is the priority of MARSU.
Additionally, Tenway said she engaged the leadership of various students in the County and she was assured by them that they will adhere to whatever decision she takes.
She then called on Liberians to learn how to think positive about Liberia which is the common denominator stating that the Union remains resolute in its quest to promote a peaceful co-assistance and remain focus on promoting the wellbeing of every student in the County.

domain: sociology


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Doughnuts. Mic drop.
Alright, and we are back. There is no food that quite calls to the Hillsborough Hominid than the doughnut – the smells, the sugar crystal fireworks – yum. And, for our visual learners, no food is more glazed, gussied and lacquered for photos than the doughnut, either, so let your peepers navigate you, if you can’t decide.
Here is our official Tampa Doughnut guide that will make you stop going to Dunkin’ Donuts (sorry) and support local businesses bringing the hole-y thunder.
Dough, the sweet sister to Datz, is not afraid to “go there” with flavor. The Apple Fritter, Vanilla Cake, Cinnamon Cake, Jelly-Filled, Cereal and Maple Bacon Bar are all unhealthy classics that are begging for ice cream a la mode, which they will gladly do for you.
Also, if you are feeling a little too hype, Dough is serving up some fancy CBD doughnuts in Matcha with Honeycomb Toffee and Acai Coconut.
See them make the magic happen at 2616 S MacDill Ave.
The reigning Queen of Tampa doughnuts, Nicola’s is – you know what, just go grab a chocolate long john. Also, after you eat here, you smell like doughnuts all day like some sort of extra treat from making such a great dietary decision.
We highly recommend the cronuts and, if you can get lucky enough, a fried Oreo doughnut. You must – MUST – get here early. Don’t look at the hours and don’t try to go after 11am because they will be sold out.
Visit Nicola’s Donuts at 902 W Busch Blvd.
Slinging doughnuts out a custom 1963 Airstream in Riverview, Remi’s Minis is worth the drive, peeps. We are personally big fans of the mini doughnut experience as it is like a tasting of doughnuts – a fling, if you will – versus a full-on commitment. And Remi’s has a wonderful selection of flavors like Pineapple Buttercream, Churro, Maple Bacon and S’more – ok, and we are a sucker for the chocolate emoji mini – we give in.
Check them out at 11267 Winthrop Main St, Riverview, FL 33578.
Hole in One Donuts
Getting its recipes from a former Plant City doughnuteer, this is maybe the most dreamed about doughnut shop in Tampa. Pilgrimages have been made.
We are addicted to the doughnuts filled with things here – raspberry filling, blammo, lemon filling, baddabing. Besides doughnuts bursting with fresh fruit, Hole in One offers unique one-off doughnuts that are always a surprise when you walk in like blueberry fritter doughnuts, Samoa doughnuts,
We recommend getting there early – whichever location you choose – because doughnuts can sell out.
Visit them at 14406 N Florida Ave, Tampa, FL 33613 or in Tarpon Springs at 39024 U.S. Highway 19 N. or at their other location in Seffner at 1113 W Dr Martin Luther King Jr Blvd.
Little Donut House
SALTED CARAMEL PRETZEL DOUGHNUTS – sheesh, we live in great times. Yes, you can get those here. The doughnuts are mini or little, hence the name, but they are mighty with fresh flavor. The South Tampa location has many of the flavors you will see in the area like maple bacon, Fruit Pebbles and Cookies & Cream, but they will also sneak a sly strawberry cheesecake doughnut in front of you. The menu is growing with sandwiches and salads, but doughnuts and coffee are still the focus.
Check ‘em out at 4048 W Kennedy Blvd.