Check out the comments section for a special offer for this app! And for the iPhone’ers among us, there is a link to 15 promo codes
From primary care to orthopedics, diagnosing injury and pathology of the musculoskeletal system relies upon the ability to accurately perform and interpret the orthopedic exam. Learners of the orthopedic exam often become frustrated by the vast and eponym-laden terminology involved; and mastering the jargon and techniques requires a great deal of practice and memorization.
The team at Clinically Relevant developed an iPhone app to aid in the process of learning, re-learning, and perfecting the orthopedic exam. Android users will be grateful to hear that CORE (Clinical Orthopedic Exam) is available for the Android OS, and at a discounted price ($29.99) compared to the iPhone version.
Without repeating much of what we said about the iPhone app, we’ve put together a brief review of CORE for Android.
In the past we have focused on Free Medical Apps for Android. This review marks a change in that focus – hopefully a change that reflects an Android Market that is moving toward higher-performing medical apps.
CORE runs quickly on Android. From the desktop, the user can open CORE, find the a test, and be reading about its purpose and instructions in 5-10 seconds, regardless of Wi-Fi/3G/Edge connection. Even with several other applications running in the background, one can move quickly from screen to screen within the CORE application. In the health care setting speed is essential, and this app has got it figured out.
Visuals & Navigation
The layout and design of this app is strikingly similar to many iPhone apps. Finding tests is done alphabetically, by body region, or by diagnostic category. Favorites can be saved and accessed from the main menu. Additionally, the entire app can be searched easily from the main menu.
On each test page the user will find the Purpose and Instructions for completing the test. Additional information is available to assess the Test Properties (sensitivity, specificity, likelihood ratios, etc) for a given test. For less biostatistically-inclined clinicians and students, a Stats Legend is available with useful definitions of test characteristics.
The user can access non-audio video demos that are streamed from the Internet (not stored directly on the phone). Streaming videos, instead of storing videos within the app, has its pros and cons. Certainly, SD card space is saved by not having to download videos for over 250 orthopedic tests. Unfortunately, this also means that the videos can only be viewed when an connection to Wi-Fi/3G/Edge is available. Depending on your setting, this can be an issue – though many outpatient clinics today should have wireless, or at least a 3G signal. Due to the smaller storage size of most Android devices, the decision to stream instead of embed videos within the app is a necessary inconvenience.
Videos are high quality, brief, and helpful for instruction. The lack of audio is a bit frustrating at times, but written instructions within the app complement the content of the videos.
On Android, the user has the choice of opening the video demos directly from the YouTube app, or through any Android browser.
Interestingly, at the end of a video, several other videos (usually related to the same topic) are available for quick viewing. Frequent users of YouTube will be familiar with this feature. These “related videos” – while not explicitly made available by the makers of CORE – are typically relevant and helpful, providing additional video-based resources for learning a given portion of the orthopedic exam.
This app is great for…
- first-time and repeat learners of the orthopedic exam (clerkships in family medicine, sports medicine, orthopedics, etc.)
- Residents and physicians who use the orthopedic exam often, but want quick-access to information about the diagnostic performance of each test
- and as our iPhone reviewer put it, this would be a great app for primary care physicians who see many patients with musculoskeletal problems, but do not use orthopedic techniques or terminology frequently enough to memorize every appropriate diagnostic test
- This app is not as great for…
- Android users with OS v1.5 or older (not compatible)
- and those who have no access to Wi-Fi/3G/Edge in the clinical setting
The musculoskeletal exam is an integral component of a physician’s repertoire, and requires a great deal of practice and memorization. CORE provides a good experience for learners, and enough evidence-based information to make the app useful for frequent-users of the orthopedic exam. The breadth and depth of information in CORE is impressive.
On a larger scale, we think that this app has the potential to really open up the Android Market to higher-performing apps by showing other developers what is possible. Android developers have been slow to roll out medical apps in this price range, and barriers unique to Android remain, but we see this app as a sign of a brighter future for Android Medical Apps.
See: CORE Demo (YouTube) for more information
Price: $29.99 on the Android Market.


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Swollen Members’ Madchild announced recently the upcoming release of digital EP, titled Banned From America, following reports earlier this month that he was denied entry into the U.S.
The rapper, known as a member of Vancouver-based hip-hop group Swollen Members, was attempting to enter the States to catch up with his group members as they toured in support of their forthcoming album, Dagger Mouth.
After waiting hours, Mad Child was eventually denied entry.
“It’s extremely disheartening to me to know that after turning my life around, it feels like a second chance is evading me,” he said of the incident. “Unfortunately when entering the United States, I’m not judged on the person I am today, but rather on my appearance and whoever the customs officials perceive me to be, which is discrimination.”
Now, instead of mulling over the incident, Madchild will drop the digital EP, while putting the finishing touches on his debut solo album, Dope Sick, set to drop later this year.
“After being turned away at customs, I drove home that night feeling full of disappointment and frustration. I knew I had to do something positive as a way of dealing with it, so I started writing about the experience,” Madchild said of the music that turned into the upcoming EP.
“I started recording immediately and didn’t stop for six days. I was only sleeping a couple hours a day, because if I wasn’t writing or recording, I would have gotten myself into some trouble,” he continued. Looking back, this was the best thing I could’ve done for myself and some dope new songs came out of these recording sessions. Everyone at the label loved the material and I’m excited for fans to hear it.”
The Banned From America digital EP will be released on February 15th. It will features songs such as “Super Ill Villain,” “Mental Explosion”, and “Black Phantom”, among the five total tracks.
His group, the Swollen Members, will release Dagger Mouth on April 12 through Battle Axe/Suburban Noize Records.

domain: artistic


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While word on 20th Century Fox’s upcoming production “Elektra” production has been mostly quiet over the past 6 months, the film finally saw concrete movement Thursday morning with the news that Rob Bowman (“The X-Files”) is in talks to direct the film. Now, FilmJerk.com has learned that the “Daredevil” film spin-off is casting a number of lead roles and, more importantly, further details of the plot have been revealed, all in anticipation of a May 3 start of principal photography in Vancouver.
Taking a page from the storylines found in both the “The Elektra Assassin” and “The Elektra Saga” graphic novels, the film finds Elektra (Jennifer Garner) working for the Order of the Hand, the group that trained – and then abandoned – her. At the request of Kirigi, the film’s villain, she is told to target Harbor Island man named Mark Miller because, she is told, of an act his grandfather performed. A widower, Miller is a likeable man introduced to Elektra by his 13-year-old daughter Abby. After falling for him, Elektra becomes his protector and has to fend off four ninja assassins dispatched by Kirigi. But there is more to Mark Miller than he appears, as he has aligned himself with Stick, Elektra’s former mentor, and both he and his daughter are able to defend themselves. In the end, with Kirigi’s four assassins defeated, Kirigi faces off against Elektra.
In addition to Mark and Abby Miller, producers are now casting for several lead roles. According to our sources, they include:
- Kirigi: Described as being younger the other Hand leaders, he has designs on leading the clan of assassins. Favoring the old ways, he deceptively wears a Zen monk’s traditional robes and bears a hardened scowl.
- Tengu: One of Kirigi’s four assassins, he bears animal tattoos that mysteriously move about his skin. Given the ability to morph his tattoos into living creatures, Tengu uses his creatures as scouts to spy on his prey.
- Stone: An enormous man whose flesh seems to be made of something akin to stone, he makes the very floor buckle under his large feet. Because of his hardened skin, Elektra’s sais have no effect on him.
- Typhoid: Perhaps the most interesting part — as it looks to be based on the Marvel character Typhoid Mary — Typhoid is a woman wearing a kimono and a porcelain white mask. Offering a kiss that is ultimately poisonous, Typhoid can reduce a foe to a feverish corpse.
- Roshi: The elderly leader of The Hand’s counsel, he has long had an amiable competition with Stick.
We have not received word on how exactly the events come to play out here after her apparent death in 2003’s “Daredevil.”
In its news article Thursday, Variety made one error we’d like to correct: Zak Penn has re-written the most current draft of the script, basing his efforts on the original script scribed by Raven Metzner and Stuart J. Zicherman. Variety credited Penn as the project’s sole screenwriter there.
Producer: Gary Foster
Writers: Raven Metzner and Stuart J. Zicherman (with Zak Penn revisions)
Casting Directors: Michael Hothorn and Seth Yanklewitz
Start Date: May 3, 2004
Production Company: New Regency Productions
Distributor: 20th Century Fox

domain: entertainment


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You have searched for "convent girls schools"
Showing 21-30 of 312
Co-curricular commitments not stopping students from excelling in SPM exam.
While the IJS convent school institution is history, it has positively shaped the development of our country and its heritage can and must live on.
WISHING to inspire cancer patients, 177 students from five secondary schools in Penang presented their artworks to Mount Miriam Cancer Hospital (MMCH) in Tanjung Tokong, Penang.
No one would treasure the legacy of the Christian sisters more than the sisters themselves, so the controversy over the three convent schools in Penang is most unfortunate.
MELAKA: Former Convent students are doing their part to increase the enrolment in mission schools by preserving the legacy of Melaka’s legendary Canossian Sisters through the power of images.
Comment - By K. Suthakar
THE uncertain future of three iconic schools in Penang has brought gloom and doom for old girls, students, parents as well as current and former staff of the schools.
THREE convent schools in Penang are in the news with talk that they may have to close down, supposedly because of dwindling enrolment.
BUILT in 1928, the St Joseph School building in Batu Gajah, along with the main church building, has managed to survive the passing of time mostly intact.
GEORGE TOWN: Three iconic convent schools here are facing an uncertain future, although the landowners insist that the buildings will be maintained for education.
GEORGE TOWN: The school buildings of Convent Light Street (CLS) and Convent Pulau Tikus (CPT) are heritage premises.

domain: sociology


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Click on Image to Enlarge - See More Energy Rings
The Kundalini Wave Energy Ring is the newest addition to the Energy Ring collection. It is a pure copper 2 turn Energy Healing Ring with a stylized serpent’s head on each side of the central wave design. Also available in sterling silver and 14K gold.
Being a 2 turn design, this Energy Ring has an inductance of about .11 microhenries in a size 10. You can see how much inductance a different size has by using the
Inductance Calculator. Use ‘2′ for the number of turns.
To order your Kundalini Wave Energy Ring, visit the Kundalini Jewelry line at Energy Rings - Rings page.
Prices (may vary):
copper/silver / 14K gold
$35 / $58 / $860

domain: design


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domain: medical


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Horse Buying/Trying Service
The Most Important Factor In Polo
Andrew has played polo since he was 12 years old. He has played around the world on all different levels. Andrew has sourced horses to help mount 8 goal players right through to -2 goal beginners.
A service is provided to ride, stick and ball and chukka horses a player may be interested in purchasing. Horses of interest will be initially observed playing a chukka with their current owner/trainer. Advice as to whether a horse is thought suitable for a certain player and able to play to what level, can then be given. If a horse is to be pursued for purchase, Andrew is available to ride, stick and ball and chukka a horse to give a further assessment.
A brief check of the horse is undertaken to determine its ability to pass a vet check.
A vet check is organised and all relevant documentation is provided to the purchaser.
Alternatively, if you know what you require but can't seem to find it, contact Andrew to source a number of prospective ponies. Andrew plays state wide and interstate and watches endless ponies play. He is also frequently approached to sell on ponies.

domain: sports


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Summer time is for dancing and twirling in the sun - how about No-Sew Twirlers to excite little feet?
Learn letters, explore, and play with "The Frozen Alphabet"! All you need to get started are letters and water.
They are cold, smooth, and squishy! Your toddler will love to experiment with water beads!
There's something about looking for treasures that turns an ordinary
walk around the neighborhood into something exciting and magical.
Especially when you turn your treasures...
You and your toddler will have a blast playing this homemade Hidden Snowball Game together!


Snowfall Tuesday night will total a coating to an inch Details >
Rises at 6:55 AM with 11:37 of sunlight, then sets at 6:32 PM
Rises at 12:19 PM with 14:50 of moolight, then sets at 3:09 AM
Dozens of people are trying to put their lives back together after a raging apartment fire in Detroit. While police look for the arsonist involved, the victims got help from the community Saturday.
The drought in California has led to a record-tying surge in air pollution levels across the state, air quality officials said.Read Story >


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Open AccessThis article is
- freely available
Bacterial Toxins Fuel Disease Progression in Cutaneous T-Cell Lymphoma
Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark
Department of Dermatology, Aarhus University Hospital, Aarhus 8000, Denmark
Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
Department of Pathology, NYU Langone Medical Center, New York, NY 10016, USA
Department of Biomedicine, Aarhus University, Aarhus 8000, Denmark
* Author to whom correspondence should be addressed.
Received: 4 July 2013; in revised form: 2 August 2013 / Accepted: 6 August 2013 / Published: 14 August 2013
Abstract: In patients with cutaneous T-cell lymphoma (CTCL) bacterial infections constitute a major clinical problem caused by compromised skin barrier and a progressive immunodeficiency. Indeed, the majority of patients with advanced disease die from infections with bacteria, e.g., Staphylococcus aureus. Bacterial toxins such as staphylococcal enterotoxins (SE) have long been suspected to be involved in the pathogenesis in CTCL. Here, we review links between bacterial infections and CTCL with focus on earlier studies addressing a direct role of SE on malignant T cells and recent data indicating novel indirect mechanisms involving SE- and cytokine-driven cross-talk between malignant- and non-malignant T cells.
Keywords: cutaneous T-cell lymphoma; infections; Staphylococcus aureus; enterotoxins; superantigens
Citations to this Article
Cite This Article
MDPI and ACS Style
Willerslev-Olsen, A.; Krejsgaard, T.; Lindahl, L.M.; Bonefeld, C.M.; Wasik, M.A.; Koralov, S.B.; Geisler, C.; Kilian, M.; Iversen, L.; Woetmann, A.; Odum, N. Bacterial Toxins Fuel Disease Progression in Cutaneous T-Cell Lymphoma. Toxins 2013, 5, 1402-1421.
Willerslev-Olsen A, Krejsgaard T, Lindahl LM, Bonefeld CM, Wasik MA, Koralov SB, Geisler C, Kilian M, Iversen L, Woetmann A, Odum N. Bacterial Toxins Fuel Disease Progression in Cutaneous T-Cell Lymphoma. Toxins. 2013; 5(8):1402-1421.
Willerslev-Olsen, Andreas; Krejsgaard, Thorbjørn; Lindahl, Lise M.; Bonefeld, Charlotte M.; Wasik, Mariusz A.; Koralov, Sergei B.; Geisler, Carsten; Kilian, Mogens; Iversen, Lars; Woetmann, Anders; Odum, Niels. 2013. "Bacterial Toxins Fuel Disease Progression in Cutaneous T-Cell Lymphoma." Toxins 5, no. 8: 1402-1421.

domain: health


text:
Oprah’s Book Club helps promote the work of many reputable authors to viewers who admire Winfrey’s taste in literature as well as her warm, fuzzy personality.
So when Winfrey-endorsed author James Frey admitted in 2006 his memoir, “A Million Little Pieces,” featured lies and serious exaggerations, Winfrey publicly apologized to her fans for lending Frey her support. And, for good measure, she tore into the fabulist author during a tense interview on her television show.
Winfrey will not stand for lying in print. So why is she so silent about “Dreams from My Father” and its famous author?
President Barack Obama’s 1995 memoir, we’ve learned in recent days, is chock full of “lies and serious exaggerations.” Thirty eight to be exact.
Yesterday, Rush Limbaugh noted that David Maraniss, the “liberal,” Obama-suppporting Washington Post journalist who wrote the new book Barack Obama: The Story, is “unexpectedly” rather angry that his work is being taken seriously. “Maraniss has come along, he’s documenting lies and falsehoods, and as far he’s concerned, all he’s doing is getting the record straight,” Rush tells his listeners. “He is now a little shocked here that people are reacting to his book the way that they are:”
MARANISS [appearing on CNN]: He wrote it when he was in his thirties before he was running for president. He had no clue that people like me would be coming along later and trying to tell the real story. But it is a legitimate question about where the line is in memoir. My major point is, yes, there are discrepancies between what really happened and the way he presented it. I don’t think they’re venal. I think he did it for reasons of trying to tell a story about his search to find himself. I don’t think he was trying to create this mythological character. Many of the mythologies in the book were just passed along to him by his own family.
RUSH: Are you following? Am I the only one who’s incredulous over this? We’re now gonna debate where the line is in memoir? Have we gotten so smart, become so intellectual that a memoir does not have to be true? No, he’s just trying to find himself. Of course there are discrepancies. We can’t hold that against him. He didn’t know that he was gonna run for president. BS. …. Well, family told the lies, not him, big whoop. Let me tell you one of the lies. There’s a bunch of ’em that Maraniss has found. You know, one of the things that everybody has been led to believe because Obama says it in his book, Obama said that his grandfather, Hussein Onyango Obama, was taken prisoner and tortured by the British during the Mau Mau rebellion. It didn’t happen!
* * * * *
An outfit called BuzzFeed has listed the nine lies uncovered accidentally by Maraniss. You know, it is fascinating, Maraniss doesn’t understand what he’s done here. He thought he was writing an election year valentine for Obama. He’s pointed out fundamental flaws, very serious misstatements, lies, prevarications, and he doesn’t understand why people are focusing on it that way. Right wing people are cherry-picking it, exactly. There’s literary license in memoir. My God, the more we listen to the left, the less reason there ever is for truth. Truth floats, and wherever you want it to be is where it ends up, and whatever you want it to be, it is.
As Investor’s Business Daily notes, “The most frightening aspect of [Obama] may not be his radical ideology but his rank dishonesty in selling that ideology.” In the 1990s, Bill Clinton’s supporters circled the wagons and excused Clinton’s postmodern dissembling when he lied to defend himself against Monica Lewinsky. Today, Obama’s supporters defend his postmodern dissembling in crafting the narrative that launched his political career. When does it end?

domain: literature


text:
(PartiallyPolitics.com) – On Thursday the Food and Drug Administration (FDA) approved the first vaccine that could be used against chikungunya, which is caused by a virus carried by mosquitoes.
The mosquito-borne illness affects over 300,000 people each year across the globe and it is most prevalent in the global south. However, the virus infection has recently increased its prevalence in the north which is why the FDA ended up approving the new vaccine.
FDA Center for Biologics Evaluation and Research director Peter Marks stated that an infection could end up prolonging health problems and could lead to a number of diseases. He added that this was a big problem for older adults and those who had underlying medical conditions.
He then pointed out that with the approval of the vaccination, they would be addressing a medical need that had been previously left unmet and that the move was a crucial advancement in preventing the “debilitating disease” that does not have many treatment options.
The Centers for Disease Control stated that around 28 Americans are infected by the disease each year. The common virus symptoms include joint and fever pains.
Ixchiq, the new vaccine is going to first be made available to vulnerable populations who have traveled to destinations with a large infection mosquito population or those who have predisposed risks. The virus is known to cause an increased risk to Europeans and Americans because of the effects of climate change. In June the European Union warned about the effects of the virus as it was becoming more common due to the global increase in temperatures.
Copyright 2023, PartiallyPolitics.com


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Divorce Done Right provides parents with an opportunity to ease a family’s tensions through the early stages of a separation or divorce. Some families benefit from mediation as a method of reaching an agreement, and custody is often the first area where a separating family with children can benefit from mediation.
Our mediators have served many families by mediating any custody issues that arise. Each mediator has a distinguished background in helping families and children. Resolving custody issues early on in the separation process can create a positive precedent.


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Fancy Feast Elegant Medleys Whipped Egg Souffle Adult Canned Cat Food
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domain: pet


Windows 10: change file type
change file type
I was looking through a file within the file called" Windows8 OS". The file was called "Microsoft.SqlServer.Compact.400.32" and it was a "LFL" file type. In trying to open it I inadvertently changed it to a "BC" file type.
Question, how do I change it back to it's original file type?
Second question, since it was in a windows 8 OS file does it matter or is it still relevant in my Windows 10 OS ?
Do you have your File Explorer set to show the file extensions [hidden by default for a new Windows install]? Having 2 or more periods/dots in a file name makes the letters after the last period the file extension. File extensions can be anything the program uses to create the files. That file in the Windows Folder may no longer be changeable. But you might be able to open a Command Prompt as Administrator and run sfc /scannow to see if it can be repaired.
Thanks, I'll give it a try.......Logman
What is Windows8 OS. Doesn't exist on my Windows 10 Pro X64 computer? Where is it located?
The" Windows 8_OS (C:) is in "This PC" file along with documents, pictures, downloads, music etc..
Thats the name of your hard drive. Single click on that name in ThisPC and press F2 to rename it. Usually hard drive names dont have file extensions.
Thank you, I will do that.
that would be a single right to rename any file
How to Restore Default Apps for File Extension Type Associations in Windows 10
A default app is the program that Windows uses automatically when you open a particular file type or protocol.
This tutorial will show you how to restore the...
How to Change Account Type of Users in Windows 10
When you set up Windows, you were required to create a user account. This account is an administrator account that allows you to set up your PC and install any apps that you would like to use....
In Windows 7, and before, in Explorer, I could start to type a name of a file that I wanted and Explorer would jump down to that file, but under Windows 10, it automatically starts doing a search of the folder. As such, I am forced to scroll down...
Hello, i'm using windows 10 insider now in build 10547, recently some file with specified extension showing the wrong icon, all the wrong icon is same as in the screenshoot:
All error files have icon same like this picture, but all file is...


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Map Minecraft Pixel Art Pokemin
Telecharger map minecraft pixel art pokemin fichier online vostfr francais
Download Minecraft maps and projects shared by Minecrafters! Browse the largest collection of Minecraft Maps! Become a member and share your Minecraft . Download Minecraft maps and projects shared by Minecrafters! Browse the largest collection of Minecraft Maps! Become a member and share your Minecraft . A pixel art world I plan on filling with every pokemon i can get my hands on. If i can honest to goodness put every pokemon on this map. well . this is a pokemon pixel art please enjoy and subscribe thank you D Download map now! The Minecraft Map, pixel art pokemon, was posted by . Pengi's Pixel Art is a Minecraft map featuring pixel art with the theme of Pokémon. This map contains 10 Pokémon currently, but will be updated . Aug 22, 2015 - many more pixel art on our channel View map now! The Minecraft Map, Pikachu from pokemon Pixel Art, was posted by TheArtCollection. Pokemon from the game Pokemon yellow. Placed in grid format to make it easier for pixel-arters to create on minecraft, in hama form, cross-stitch or oth. Seadra. Here are some of my Pokemon pixel art i have done on various servers!Hope you like dem :3.
Parlons saisons pdf. Beyblade evolution 3ds. Theme nuked klan. Ambiense samsung. Open office 2016 grauitement site officiel. Rdv caf. Serie tunnel saison 1 french. Explorer.exe windows 7 starter. Nuisible au reseau internet. L'application gogo iptv sur fire stick.

domain: game


text:
With Mitt Romney, the Republican presidential nominee, vague on details concerning his plans for reducing the federal deficit and shrinking government, speculation is running heavy, and it's not encouraging for the National Park System.
Hot, Dry Conditions Prompt Fire Restrictions In Canyonlands And Arches National Parks, Natural Bridges And Hovenweep National Monuments
If you're planning a visit to southeastern Utah's national parks, be aware that the Southwest's hot, dry conditions have led National Park Service officials to issue restrictions on open fires in Arches and Canyonlands national parks as well as Natural Bridges and Hovenweep national monuments.
A number of national parks are clustered around some of the 10 rivers whose health is being threatened by mining operations, pollution, dredging, proposed dams, and other impacts that American Rivers found them deserving to be listed as America's Most Endangered Rivers.
National Parks Week Offers You An Opportunity To Save On A Float Trip Through Canyonlands National Park or Dinosaur National Monument
National Parks Week, which kicks off Saturday, brings you an opportunity to save on a float trip through either Dinosaur National Monument or Canyonlands National Park with one of the oldest raft companies in the West.

domain: travel


text:
- Open Access
Effects of cognac on coronary flow reserve and plasma antioxidant status in healthy young men
Cardiovascular Ultrasound volume 6, Article number: 25 (2008)
The cardioprotective effects of certain alcoholic beverages are partly related to their polyphenol content, which may improve the vasodilatory reactivity of arteries. Effect of cognac on coronary circulation, however, remains unknown. The purpose of this randomized controlled cross-over study was to determine whether moderate doses of cognac improve coronary reactivity as assessed with cold pressor testing (CPT) and coronary flow reserve (CFR) measument.
Study group consisted of 23 subjects. Coronary flow velocity and epicardial diameter was assessed using transthoracic echocardiography at rest, during CPT and adenosine infusion-derived CFR measurements before drinking, after a moderate (1.2 ± 0.1 dl) and an escalating high dose (total amount 2.4 ± 0.3 dl) of cognac. To explore the bioavailability of antioxidants, the antioxidant contents of cognac was measured and the absorption from the digestive tract was verified by plasma antioxidant capacity determination.
Serum alcohol levels increased to 1.2 ± 0.2‰ and plasma antioxidant capacity from 301 ± 43.9 μmol/l to 320 ± 25.0 μmol/l by 7.6 ± 11.8%, (p = 0.01) after high doses of cognac. There was no significant change in flow velocity during CPT after cognac ingestion compared to control day. CFR was 4.4 ± 0.8, 4.1 ± 0.9 (p = NS), and 4.5 ± 1.2 (p = NS) before drinking and after moderate and high doses on cognac day, and 4.5 ± 1.4, and 4.0 ± 1.2 (p = NS) on control day.
Cognac increased plasma antioxidant capacity, but it had no effect on coronary circulation in healthy young men.
Moderate consumption of alcohol is associated with reduced coronary artery disease mortality [1, 2]. The cardioprotective effects of alcoholic beverages are partly related to their polyphenol content, which may be associated with improved vasodilatory reactivity of arteries [3, 4]. A moderate (ethanol 0.5 g/kg)  and a high dose of red wine (ethanol 1.0 g/kg) has been shown to increase coronary flow reserve (CFR), but pure vodka and white wine had not such effect . The effects of cognac on coronary circulation, however, have not been evaluated, although many elderly patients with coronary artery disease drink habitually cognac to releave cardiac symptoms.
The beneficial endothelial effects of polyphenol containing beverages, such as red wine, have been attributed to both ethanol and antioxidative polyphenols [6, 7]. However, their relative contributions in vivo remain to be established. Cognac is known to contain polyphenols , but the bioavailability of the antioxidant content of cognac has not been previously addressed.
Cold pressor test (CPT) and CFR measurements are widely used methods to study coronary circulation [9–11]. Impairment of coronary artery reactivity as shown by insufficient vasodilation, or vasoconstriction in CPT, or decreased CFR occurs in various cardiovascular diseases, such as hypertension , diabetes , hypercholesterolemia , coronary artery disease , and even in otherwise healthy subjects with increasing waist to hip ratio . Abnormal response in these tests is related to impairment in coronary vascular smooth muscle or endothelial function or both .
The purpose of this randomized controlled cross-over study was to determine with transthoracic echocardiography whether cognac ingested in moderate or high doses improve coronary vasodilatory responses in healthy humans. We also studied the bioavailability of antioxidants by determining the plasma antioxidant capacity.
Subjects and study protocol
The study included 23 healthy, non-smoking Finnish men (mean age 23 ± 1.8 years, body mass index 24 ± 2.3 kg/m2, total cholesterol 4.2 ± 0.8 mmol/l, HDL cholesterol 1.6 ± 0.41 mmol/l, LDL cholesterol 2.3 ± 0.65 mmol/l, triglycerides 0.77 ± 0.21 mmol/l and plasma glucose 5.0 ± 0.46 mmol/l). None of the subjects were taking any medication. The study was carried out in accordance with the Declaration of Helsinki (2000) of the World Medical Association and approved by the Ethics Committee of the Southwest Finland Health Care District. All subjects gave their written informed consent. We calculated sample size of 16 subjects with a known SD of 1.0 (for CFR) and an assumed difference of 1.0 between the interventions (α = 0.05, β = 0.80). To deal with the loss of data during the analysis, we enrolled 23 subjects.
Figure 1 outlines the study protocol. The subjects had an overnight fast. They were instructed to avoid caffeine for 12 h, and alcohol for 36 h before the studies. There were at least one week between the study days. The subjects were assigned to take two escalating doses of cognac. A moderate dose of cognac contained 0.5 g/kg of ethanol and a high dose 1.0 g/kg. Accordingly, the full doses of cognac were 2.4 ± 0.3 dl, respectively. CPT and CFR measurements were performed before drinking and again 30 minutes after each dose. As a control, the measurements were assessed in a random cross-over design repeatedly with 2 h interval when the subjects were not drinking. Blood pressure and ECG were monitored at rest and throughout the measurements. The rate pressure product was calculated as systolic blood pressure multiplied by heart rate.
The concentration of phenolic substances of the study cognac (Remy Martin VSOP, France) was determined according to the Folin-Ciocalteau method  (Sigma, St. Louis, MO). The total amount of phenolic substances given to the subjects was 100 mg ± 10 mg, including Ellagic acid 2.51 ± 0.28 mg, Hydroxybenzoic acid 0.70 ± 0.09 mg, Procyanidines (oligomers) 0.48 ± 0.06 mg, Hydroxycinnamic acids 0.12 ± 0.02 mg. In addition, the ability of the cognac to act as free radical scavengers against 1,1-diphenyl-2-picrylhydrazyl radical (Extrasynthèse, Genay, France) was tested spectrophotometrically . The free radical scavenger capacitiy of the cognac was 7.0 ± 2.7%.
Coronary flow velocity and epicardial coronary artery diameter were measured in the distal left anterior descending coronary artery (LAD) with transthoracic echocardiography using the Sequoia C 512 ultrasound device (Acuson Inc., Mountain View, California, USA) with a linear 8.0 MHz transducer. The distal LAD was localized with color Doppler mapping using a modified apical two-chamber view scanning the interventricular sulcus as previously described . The LAD flow velocity profile was recorded using a pulsed wave Doppler with angle correction. Moreover, the end-diastolic diameter of the LAD was measured in 2D images at the end of expiration from the largest distance between the luminal edges from the black-white interface of the near and far walls using ImageJ software (ImageJ 1.30 N, National institutes of Health, USA) . The flow velocity profiles and 2D images of the LAD were obtained alternately at rest and throughout adenosine infusion as previously described (see Figures 2 and 3) . Maximal mean diastolic velocities were used to calculate the percentage increase of coronary flow velocity during CPT to baseline and coronary flow velocity reserve (CFR) as previously described . The variability of repeated CPT and CFR measurements was moderate (CV 13.4 ± 10.4 and 11.4 ± 8.9%, respectively), and the intra-observer variability was low (CV 3.0 ± 2.0 and 2.6 ± 4.0%, respectively), indicating small methodological and greater physiological variation as previously described .
All study data were stored in a digital workstation and analyzed offline in random order by an investigator blinded to the information of the day or the dose. In some studies, image quality was insufficient for analysis, and therefore, complete data could be recorded in 108/115 (94%) and 111/115 (97%) studies for CPT and CFR, respectively.
Cold pressor test and CFR measurement
Baseline values were detected as an average of three separate diameter and three flow velocity measurements. After the baseline measurements, the subjects' right hand was placed into ice-cold water for 120 s. During the hand immersion, both diameter and flow velocity were measured in turn continuously. Epicardial coronary artery diameter during the CPT is expressed as an average of the measurements between 30 and 180 s and flow velocity as an average of the measurements between 10 and 150 s after placing the hand into the cold water. Minimum of three measurements was used. After hand immersion, there was at least 7 minutes interval before adenosine infusion. Intravenous adenosine (adenosin item 5 mg/ml, Item Development AB, Sweden) was infused at a rate of 0.14 mg/kg/min for 5 min and diameters and flow velocities were measured in turn continuously during the infusion. The results of the measurements are expressed as an average of three separate maximum diameter and flow velocity measurements.
Venous blood samples were obtained for measurement of total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride and glucose levels before the study. Serum ethanol concentrations were determined after the high dose of cognac using a standard photometric test (Modular P800, Roche Diagnostics GmbH, Mannheim, Germany). The antioxidative capacity of EDTA plasma was measured using a commercially available colorimetric assay kit (ImAnOx, Immundiagnostik, Bensheim, Germany) before drinking and after the high dose of cognac. The assay was done and results calculated according to the manufacturer's instructions. The lower detection limit of the assay was 130 μmol/l. The intra-assay coefficients of variation were 0.9% and 2.3% and the inter-assay coefficients were 1.63% and 2.43% for low and high levels, respectively. Optical density was determined using the Multiskan Ascent spectrophotometer at 450 nm (Thermo Labsystems, Helsinki, Finland). All samples were collected and stored in a similar manner and analyzed in randomized order.
The data are presented as means ± SD. ANOVA for repeated measurements was used to assess differences of CPT and CFR between the doses. P-values indicating trend were calculated using the repeated measures regression analysis. A paired T-test was used to compare plasma antioxidant levels before and after beverage ingestion. The association of antioxidant capacity levels to CPT and CFR measurements was tested assessing the Pearson correlation coefficient between the differences in antioxidant capacity levels and the differences in CFR before and after drinking the beverages. P-values lower than 0.05 were considered significant. The statistical analyses were done using the Statistical Analysis System, SAS.
CPT and CFR
Table 1 shows the effects of cognac on coronary mean diastolic velocities and epicardial coronary artery diameter during CPT and CFR measurement. There were no significant difference between the before drinking and moderate and high doses values in coronary reactivity (see Table 2, Figures 4 and 5). The percentage increase in flow velocity during CPT was 21 ± 26%, 9 ± 30% and 17 ± 29% (p = NS) before drinking and after moderate and high doses, respectively, compared to control day (23 ± 20% and 25 ± 24%, p = NS). The corresponding values of CFR were 4.4 ± 0.8, 4.1 ± 0.9, and 4.5 ± 1.2 (p = NS) on cognac day, and 4.5 ± 1.4, and 4.0 ± 1.2 (p = NS) on control day. Moreover, the epicardial vasodilation was not significatly affected during CPT or CFR measurements before drinking and after moderate and high doses.
Effects of cognac on rate pressure product are presented in Figure 6. No significant changes were detected in the corresponding values at rest, during CPT or CFR measurement before drinking, after moderate and high doses, respectively.
Plasma antioxidant capacity increased from 301 ± 43.9 μmol/l to 320 ± 25.0 μmol/l by 7.6 ± 11.8%, (p = 0.01) after cognac. Serum alcohol levels increased to 1.2 ± 0.2‰ after the full doses of cognac. There were no significant association between the increase of plasma antioxidant capacity and coronary microcirculatory or epicardial vasodilation during CPT or CFR measurements.
We determined the effects of cognac on coronary reactivity, because epidemiological studies have indicated that any alcohol containing beverage may be beneficial for the heart . In addition, many elderly patients with coronary artery disease use cognac to releave cardiac symptoms. It appeared that cognac had no effect on coronary reactivity in healthy young men, but it increased plasma antioxidant capacity. Furthermore, we found no association between the increase of plasma antioxidant capacity and coronary microcirculatory or epicardial vasodilation during CPT or CFR measurements.
Non-significant changes in CPT and CFR measurements reflect that cognac has no effect on coronary reactivity. Cognac contains antioxidative polyphenols, although in much smaller quantities than red wine , which is known to improve CFR [3, 5]. In a recent in vitro study, the authors found that cognac induced vasodilation in the rat aorta . Moreover, polyphenols from cognac are able to directly increase NO production without affecting O2 - and to enhance the capacity of bradykinin to produce NO in human endothelial cells . We could not verify these findings in vivo in human coronary arteries. This can probably be explained by the low polyphenol content of cognac, which is insufficient to improve the reactivity to CPT or CFR. Moreover, cognac may contain too low levels of certain polyphenol subgroups, which are related to improvement vasodilatory reactivity. For example, oligomeric procyanidins of red wine have been shown to reduce vasoconstrictor endothelin-1 production in vitro . Other polyphenol groups mediating improving vascular reactivity in vitro may include resveratrol, quercetin, and catechins . It is also possible that the changes after cognac ingestion may be very small and, therefore, undetectable by the measurements. However, the variability of CPT or CFR measurements was moderate with low intraobserver variability and greater physiological variation. On the other hand, ethanol may blunt the vasodilatory effects cognac polyphenols .
We tested coronary vasodilatory responses by two distinct tests: CPT and CFR measurements. CPT is used as a physiological measure to assess coronary reactivity. In the CPT, the subject's hand or foot is placed in ice water, which produces a pain sensation. Nociception induces sympathetic stimulation and release of adrenalin and noradrenalin from the adrenal medulla [27–29], which increase heart rate, arterial blood pressure and myocardial oxygen demand. Increase in myocardial oxygen demand increases coronary blood flow. Moreover, sympathetic stimulation of α-adrenergic-receptors in the endothelium leads to the release of NO, which facilitates vasodilation of the resistance arteries . Vasodilation of the resistance arteries increases blood flow in the conductance arteries as well, secondarily leading to vasodilation of the epicardial arteries by shear stress, despite α-adrenergic-mediated constriction of smooth muscle cells. In the normal heart, the net effect is vasodilation and increased coronary blood flow. In patients with endothelial dysfunction, a disturbance in vasodilator mechanisms leads to insufficient vasodilation, or vasoconstriction. CFR is defined as a ratio of coronary blood flow during maximal pharmacologically-induced vasodilation to baseline blood flow. Adenosine infusion is used to measure CFR, due to its capability to induce the maximal dilation of small coronary arteries. Secondarily, adenosine increases flow velocity in the epicardial arteries, also leading to flow-mediated vasodilation. Impairment of coronary artery reactivity as shown by decreased CFR occurs in various cardiovascular diseases, such as hypertension , diabetes , hypercholesterolemia  and coronary artery disease , and may be due to impairment in vascular smooth muscle or endothelial function or both.
Transthoracic echocardiography is a widely used non-invasive bedside method for assessing CPT and CFR responses and it correlates with invasive measurements using a Doppler guide wire  and myocardial blood flow quantified with PET . This was the first time that changes in both coronary flow velocity and epicardial coronary artery diameter were measured simultaneously in a clinical trial using transthoracic echocardiography.
Some limitations of the present study should be pointed out. First, we studied young men only. However, as the purpose of the study was to determine the acute effects of cognac on coronary reactivity and plasma antioxidative capacity, using a homogenous sample may have diminished the role of confounding factors. Moreover, atherosclerotic processes begin early in life, and the attenuation of vasodilatory responses may be one of their early signs. Therefore, it makes sense to study subjects in this age group. Secondly, we saw marked variation in CFR (range 2.3 – 7.8) and moderate variability in totally reproduced CFR studies (CV 11.5 ± 8.7%), but intra-observer variability was low (2.6 ± 4.0%) indicating a small methodological error and greater physiological variation.
In conclusion, despite an improvement in plasma antioxidant capacity, cognac has no significant effect on coronary reactivity.
Gronbaek M, Becker U, Johansen D, Gottschau A, Schnohr P, Hein HO, Jensen G, Sorensen TIA: Type of alcohol consumed and mortality from all causes, coronary heart disease, and cancer. Ann Intern Med. 2000, 133: 411-9.
Klatsky AL, Friedman GD, Armstrong MA, Kipp H: Wine, liquor, beer, and mortality. Am J Epidemiol. 2003, 158: 585-95. 10.1093/aje/kwg184
Shimada K, Watanabe H, Hosoda K, Takeuchi K, Yoshikawa J: Effect of red wine on coronary flow-velocity reserve. Lancet. 1999, 354: 1002- 10.1016/S0140-6736(99)03478-9
Agewall S, Wright S, Doughty RN, Whalley GA, Duxbury M, Sharpe N: Does a glass of red wine improve endothelial function?. Eur Heart J. 2000, 21: 74-8. 10.1053/euhj.1999.1759
Kiviniemi TO, Saraste A, Toikka JO, Saraste M, Raitakari OT, Pärkkä JP, Lehtimäki T, Hartiala JJ, Viikari J, Koskenvuo JW: A moderate dose of red wine, but not de-alcoholized red wine increases coronary flow reserve. Atherosclerosis. 2007, 195: e176-81. 10.1016/j.atherosclerosis.2007.06.004
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This study was supported by The Turku University Hospital Research foundation, the Tampere University Hospital Medical Fund, the Turku University Foundation, the Emil Aaltonen Foundation, the Orionpharma Research Foundation, the Instrumentarium Research Foundation, the Finnish Foundation for Cardiovascular Research and the Paulo Foundation.
The authors declare that they have no competing interests.
TOK participated in the design of the study, acquisition, analysis and interpretation of data. He performed the statistical analysis and drafted the manuscript.
AS participated in the acquisition, analysis and interpretation of data. He participated in the drafting of the manuscript.
JOT participated in the acquisition and analysis of the data. He made a critical revision of the manuscript for important intellectual content.
MS participated in the acquisition of the data. He made a critical revision of the manuscript for important intellectual content.
TL performed the laboratory analyses of the plasma antioxidant capacity samples, participated in the interpretation of data and obtained funding. He made a critical revision of the manuscript for important intellectual content.
OTR participated in the design of the study, statistical analysis and interpretation of data. He made a critical revision of the manuscript for important intellectual content.
JPP participated in the acquisition of data. He made a critical revision of the manuscript for important intellectual content.
JJH participated in the design of the study and interpretation of data. He made a critical revision of the manuscript for important intellectual content, obtained funding and supervised the study.
JV participated in the interpretation of data. He made a critical revision of the manuscript for important intellectual content.
JWK participated in the design of the study, acquisition, analysis and interpretation of data. He participated in the drafting of the manuscript and supervised the study.
All authors read and approved the final manuscript.
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Kiviniemi, T.O., Saraste, A., Toikka, J.O. et al. Effects of cognac on coronary flow reserve and plasma antioxidant status in healthy young men. Cardiovasc Ultrasound 6, 25 (2008). https://doi.org/10.1186/1476-7120-6-25
- Leave Anterior Descend
- Coronary Flow Velocity Reserve
- Cold Pressor Test
- Adenosine Infusion
- Coronary Flow Velocity Reserve

domain: biology


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What is Ultrasound Therapy?
Ultrasound therapy is the use of sound waves to treat musculoskeletal problems, especially inflammation. Based on the principle of ‘stimulating’ tissue with sound waves, ultrasound has been shown to cause:
- Increase in tissue relaxation;
- Increase in local blood flow – can be used to help reduce local swelling and chronic inflammation; and
- Aids scar tissue breakdown.
What is ultrasound used to treat?”
Fresh injury with acute inflammation;
- Joint sprains;
- Scar tissue e.g. injuries and post-surgery;
- Muscle spasm;
Benefits of Ultrasound Therapy
A typical ultrasound treatment will take from 3-5 minutes depending on the size of the area being treated:
- Painless and non-invasive;
- Reduces pain;
- Reduces muscle spasm; and
- Speeds up healing.


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Handbook of Parapsychology has 6 ratings and 0 reviews: Published July 1st by Van Nostrand Reinhold Company, pages, Hardcover. Find Handbook Of Parapsychology by Wolman, Benjamin B at Biblio. Uncommonly good collectible and rare books from uncommonly good booksellers. Results 1 – 30 of 35 Handbook of Parapsychology by Wolman, Benjamin B. and a great selection of similar Used, New and Collectible Books available now at.
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(MENAFN- Gulf Times) Ashraf Amgad Elseify secured a silver medal for Qatar at the Hangzhou Asian Games, hurling 72.42m in men's hammer throw final Saturday. There were more good performances from other Al Annabi athletes with Mohamed al-Garni and Abdirahman Hassan entering the men's 1500m final. Qatar also notched up crucial wins in 3x3 basketball, basketball and handball events Saturday.
Elseify's silver took's Qatar tally to 5 medals including a gold, two silver and as many bronze medals. China's Wang Qi took the gold in the event with a throw of 72.97 while Uzbekistan's Sukhrob Khodjaev claimed bronze after clearing 70.79.
Elseify, who won Asiad gold four years ago, was happy with his achievement.“I dedicate this medal to our wise leadership, Qatar Olympic Committee (QOC) President HE Sheikh Joaan bin Hamad al-Thani, the Athletics Federation, and all the supporters who have played a major role in providing full support to me,” Elseify said Saturrday.
"I am very happy to achieve a medal in this edition of the Asian Games, especially since it is the first continental championship in which I participated after my return from injury. Despite that, I succeeded, praise be to God, in achieving the silver medal, even though I was hoping for gold and I was close to that, but I was not lucky," he added.
Also competing in the event, his brother Ahmed ended up in seventh place with a throw of 67.86. Meanwhile, Al Garni and Hassan cruised into the final of 1500m after clocking 3:56.02 secs and 3:52.08 secs in their respective heats.
There was a disappointment for Al Annabi in men's 100m as former Asian champion Femi Ogunode failed to reach final after clocking 10.40 secs, finishing fifth in the semi-finals.
At the Hangzhou Olympic Sports Park Main Stadium, Ismail Abakar (46.48 secs) also finished at dismal eighth in the men's 400m with Saudi Arabia's Yousef Masrahi winning the title with a time of 45.55 ses.
In men's pole vault, Seifeldin Abdelsalam, 18, showed impressive performance finishing at creditable sixth position with a 5.45m clearance.
“I am very happy with my first participation in a major tournament such as the Asian Games, and I feel satisfied with what I achieved during the tournament, and I consider this motivation for me for the future,” he said.
“I am certainly proud that I am the youngest among the contestants, and I am happy with what I have achieved. I aspire to achieve an Olympic medal, and I will make every effort for that,” he added.
Qatar's 3x3 team storm into semis
Meanwhile, Qatar's 3x3 basketball team stormed into the semi-final after outclassing Japan 21-15 in the quarter-final. They will look for a place in the final as they meet Mongolia in the semi-final Sunday. The other semi-final will be played between Chinese Taipei and South Korea with the final also slated to be held Sunday.
Also Saturday, Qatar basketball team defeated Indonesia 74-67 victory in their third and final Group D match Saturday. They will square off with Philippines in a qualifying match for the last-8 stage. The winner of the game will meet Iran in the quarter-final tomorrow.
Qatar handball team also maintained their fine form as they defeated China 37-20 to top their group. The defending champions will meet Japan in their third and final main round match.
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Purposefully releasing incorrect information in news reports is a clever little trick officials have long used to verify the credibility of what they are told. These are - most often - not accidents. A few slight adjustments to true evidence can help the police wade through hundreds of crazies who would claim responsiblity for a crime (this technique is most famously used with serial murders, such as with the Zodiac Killer or the Son of Sam), and also to prevent a vengeful person from pointing their fingers at enemies innocent of the crime. In Kirstin Lobato's case, the police did the same thing.
One example: Seperate news reports claim the victim's body was found in the trash bin, and in other cases, behind or vaguely "near" the trash bin. Only the police - and the murderer - know for sure. (If you'd like more examples, scan the various news reports for the locations of Bailey's stab wounds).
Enter Korinda Martin, jailhouse informant and the prosecution's star witness.
Martin described Kirstin as bragging about the murder, in effect setting herself up as a hearsay witness. Martin, however, is hardly a poster girl for witness credibility. She had a history of doing everything she could to alleviate her own sentence, including the mailing of forged letters to a judge. She also quoted some of the newspapers' misrepresented facts as though Kirstin had told her about them. And jurors would probably not realize the weakness inherent to Martin's claim to have been unable to read the papers, mostly because your average juror doesn't think about - or know about - the nuances of reality in a prison.
So how could Korinda Martin's self-involved and obviously falsified testimony be taken legitimately by a jury, when Kirstin Lobato's own alibis (six of them) were never put on the stand to defend her innocence? Well, that can be summed up with two words:


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Delicious Kayden Kross lets her twisted suspicions run wild when she thinks her virile husband, Tommy Gunn, is having an affair. After partying at a sexy event, she meets up with the gorgeous and sexy Selena Rose, a high priced call girl who services one of the husband's best friends. She hires her to toy with and possibly trap Tommy into having a lusty affair to prove Kayden's growing distrust. Naughty Selena has a dirty plan of her own, and turns the seductive tables on Kayden, after Kayden spreads her hungry legs for thick membered Manuel. Beautiful Riley Steele gives in to her tawdry desires, too, engaging in horny sex with handsome, hung studs.
Watch the official Escort 2011 trailer in HD below.
Industrious high school senior, Vee Delmonico, has had it with living life on the sidelines. When pressured by friends to join the popular online game Nerve, Vee decides to sign up for just one dare in what seems like harmless fun.
Phillip Filmore is a naive, 15-year-old, preoccupied with sex, who develops a crush on Nicole Mallow, the new 30-something, French housekeeper and sitter to look after him when Phillip's father is out of town for the summer on a "business" trip.
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The Escort A full-length feature inspired by the short story "A Week in the Life of K" by Lance Collins starring Miko Pasamonte Danniel Derramayo Jommel ...
In the 4th installment of the Mission Impossible series, Ethan Hunt (Cruise) and his team are racing against time to track down a dangerous terrorist named Hendricks (Nyqvist), who has gained access to Russian nuclear launch codes and is planning a strike on the United States.
Long before he even met Shrek, the notorious fighter, lover and outlaw Puss in Boots becomes a hero when he sets off on an adventure with the tough and street smart Kitty Softpaws and the mastermind Humpty Dumpty to save his town.
There is a new criminal mastermind at large--Professor Moriarty--and not only is he Holmes’ intellectual equal, but his capacity for evil and lack of conscience may give him an advantage over the detective.


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Access to justice fundamental to social change
In conversation with Narnia Bohler-Muller
As the supreme law of the land, the Constitution of the Republic of South Africa provides both the framework and foundation for the transformation of state, law and society. The preamble of the Constitution and the socio-economic rights entrenched in the Bill of Rights - including health, housing, water, social assistance and education - reflect the characteristics of South Africa as a developmental state. At the centre of the transformation agenda is a need to establish a united, non-racial, non-sexist, democratic and prosperous society founded on human dignity, the achievement of equality and the advancement of human rights.
Despite interventions at all levels of government, inequality and poverty still persist. This challenge is summarised in three main concerns emerging from the National Planning Commission draft plan (Vision 2030) in that South Africa needs to grow its economy; reduce poverty; and improve the quality of lives of all South Africans.
It is within this broader context of socio-economic transformation that the Department of Justice and Constitutional Development’s (DoJCD) discussion document entitled The Transformation of the Judicial System and the Role of the Judiciary in the Developmental South African State should be viewed.
The discussion document highlights the department’s mandate for further research and investigation into the impact of judgments by the Constitutional Court (CC) and the Supreme Court of Appeal (SCA), including assessing the role of the CC in advancing transformation and promoting access to justice as a fundamental value in attaining social change.
In an opening address at the 2011 Access to Justice Conference former Chief Justice Ngcobo stated:
‘We owe the people of South Africa a justice system that is just in the results that it delivers; that is fair to all litigants regardless of their station in life; that is inexpensive; that delivers results in the shortest possible time; that people who use it understand; that responds to their needs and that is effective’.
The Cabinet statement of 23 November 2011 announced the ‘review of the courts’ which, read together with the Minister’s discussion document, provides for government’s review of the judicial system and an assessment of its ultimate objectives and whether they have been achieved.
The DoJCD tender invitation of 23 March 2012 is narrower in focus and calls for research to assist with the assessment of the impact of the two apex courts (CC and SCA), particularly related to socio-economic rights within the context of the developmental state.
In a media statement released on 2 May 2012, the DoJCD emphasised that the research request related to the impact of court decisions - and the implementation of directives by the other branches of government - on South African society and did not constitute a review of the courts, which would not fall within the mandate of the department.
Media and public commentary
Since the Cabinet announcement in November 2011 there has been much public debate related to the process and in response to the DoJCD discussion document. The reactions have been mixed. In a speech at UCT in March, Justice Zak Yacoob stated that there is ‘absolutely nothing wrong with an evaluation of the work of the Constitutional Court or any other court. I would take results of evaluations of this kind extremely seriously’. He also cautioned against encouraging an approach that requires too much co-operation between the judiciary, the legislature and the executive. However, his cautionary note seems to be limited to discussions with the judiciary directly and outside a court hearing, ‘in an effort to influence it’. One would assume that conversations can take place between the three branches of government as to how to attain constitutional objectives in order to secure a better life for all, but that there should be no attempts to influence the work of the judiciary in respect of specific cases.
Usually a severe critic, UCT academic Prof Pierre de Vos sees no problem with the terms of reference as set out by the department. His only concerns were related to the methodologies of measuring levels of ‘service delivery’ at national, provincial and local levels of government; as well as whether it would be practically possible to achieve the objectives.
In a similar vein, Steven Friedman has reiterated his stance that the reform agenda should be broader. His position, articulated at an Institute for Security Studies’ seminar on the transformation of the judiciary on 26 April, remains that ‘ … we ought to judge our judiciary and our justice system by its legitimacy among the citizenry, not by the peer review of the legal profession’. In order to increase public trust, the system should be more efficient, accessible and transparent. Friedman questions the notion that lawyers and the judiciary should be left alone to apply their knowledge unhindered as judges make moral choices and these choices can be questioned.
Some commentators, among them Sandra Liebenberg from the Centre for Socio-Economic Rights and Justice (SERAJ), have remained critical. Liebenberg states that it is not appropriate for the legislative or executive branches of government to prescribe or even recommend to the court how it should exercise its responsibility to adjudicate disputes in terms of the Constitution.
Loammi Wolf strongly criticised the current attempt to ‘judge the judiciary and emasculate the courts’, stating that ‘[t]he mere idea that assessment of judgments of the highest courts in the country should be granted to a tenderer by way of a state contract is probably the ultimate slap in the face of the judiciary’. A better position in terms of post-1994 jurisprudence is that judges and courts are accountable to the people for the consequences of their decisions.
Transformative constitutionalism, a term developed by Prof Karl Klare, describes ‘a long-term project of constitutional enactment, interpretation, and enforcement committed (not in isolation, of course, but in a historical context of conducive political developments) to transforming a country’s political and social institutions and power relationships in a democratic, participatory, and egalitarian direction. Transformative constitutionalism connotes an enterprise of inducing large-scale social change through non-violent political processes grounded in law’.
Despite misgivings about this research project, an endeavour to measure the impact of judgments is by no means unique or unusual. A World Bank report by Gauri and Brinks illustrates that law can be used to achieve social change through what they call the ‘judicialisation’ of policy-making.
The World Bank study analyses the results of healthcare and education litigation in five countries (South Africa, Brazil, Nigeria, India, and Indonesia) and shows that courts are generally pro-poor, with South African courts faring very well. Although South Africa only has a small number of cases, the effects of the cases have been felt widely through the modification of public policy as a result of court orders. South African judgments, through adopting a philosophy of transformative constitutionalism, reach a large number of the relevant policy area beneficiaries, including the poor.
Former Justice Pius Langa has described ‘transformation’ as ‘a social and an economic revolution’. South Africans have to contend with unequal and insufficient access to housing, food, water, healthcare and electricity and it has become necessary to level the economic playing fields that were so drastically skewed by the apartheid system.
The establishment of an equal society and the provision of basic socio-economic rights to all is a necessary part of legal transformation. Langa argues that legal culture must change in order to facilitate the role of courts in creating a better life for all.
What is required is a change in legal mindset. In terms of the new value-oriented approach to interpretation, courts must ensure a just outcome of the legal process. As such, constitutional values are meant to serve a transformative role in the sense that the values, goals, and analytics of social change must inform the process of adjudication. Transformative constitutionalism places emphasis on attaining socio-economic justice and has been described as having a ‘pro-poor’ orientation that focuses on addressing inequalities within the post-apartheid context.
Measuring the socio-economic impact of court decisions would be a way of facilitating debate in order to engage in the ongoing conversation to improve the lives of all South Africans.
A number of post-1994 cases have shown that some judges are reluctant to deviate from traditional legal reasoning and fail to be sensitive to the context, and potential and real consequences, of their judgments. Many judges tend to stick to the comfort of old methodologies (taught to them in law faculties) and this results in three problems:
- A reluctance to interrogate the distributive consequences of private law rules on lived experiences;
- The emergence of a neo-liberal strand in the application of the constitution; and
- A lack of critical sharpness when it comes to issues related to the separation of powers.
Author: Dr Narnia Bohler-Muller, acting executive director, Democracy, Governance and Service Delivery programme, HSRC


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Tuesday Morning Quarterback: Gregg Easterbrook explains why the Seahawks will have a tough time repeating as Super Bowl champs and previews the 2014 NFC season.
Outer-padded helmets could help solve football's concussion issue.
How can 8-8 teams make the postseason, while 10-6 and 11-5 teams are left home? TMQ demands a new playoff format.
The seriousness of Bill Belichick's unethical behavior could lead to a decline in popularity of the NFL.
Gregg Easterbrook's Tuesday Morning Quarterback returns, with the mock draft to end all mock drafts and a Mr. Irrelevant prediction.
TMQ is tired of people complaining about parity ruining the NFL. Just look at how good some of these playoff games have been!


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Life of the Party (PG-13) After her husband abruptly asks for a divorce, a middle-aged mother returns to college in order to complete her degree. Starring Melissa McCarthy, Matt Walsh, Molly Gordon Breaking In (PG-13) A woman fights to protect her … Continue reading
A TV show based on the novel by Elmore Leonard about a mobster turned movie producer. Starring Sean Bridgers, Carolyn Dodd, Isaac Keys, Chris O’Dowd, Lidia Porto, Goya Robles, Ray Romano, Lucy Walters. Epix tends to create good quality series, and this show is no exception. O’Dowd puts … Continue reading
Jacob discovers a mystery that crosses time when he finds Miss Peregrine’s Home for Peculiar Children. Based on the book by Ransom Riggs. Starring Eva Green, Asa Butterfield, Samuel L. Jackson, Judi Dench, Rupert Everett, Allison Janney, Chris O’Dowd. This is … Continue reading
Florence Foster Jenkins (PG-13) The story of Florence Foster Jenkins, a New York heiress who dreamed of becoming an opera singer, despite having a terrible singing voice. Starring Meryl Streep, Hugh Grant, Simon Helberg Barney Thomson (NR) Barney Thomson, awkward, … Continue reading
Angie Tribeca: The Complete Season One (TV-14) Lone-wolf detective Angie Tribeca and a squad of committed LAPD detectives investigate the most serious cases, from the murder of a ventriloquist to a rash of baker suicides. Starring Jere Burns, Deon Cole, … Continue reading
For the last few years, I’ve compiled a list of the best films that I watched during the year. These were not all released this year; they are just movies I have watched during 2015. The Heart of the Matter … Continue reading