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Blogs HNN GREENBACK EFFECT VISIBLE IN OIL PRICESAug 20, 2009 10:28 am
Warren Buffett notes that most (i.e., not all) of the greenback effects"are invisible and could, indeed, remain latent for a long time." No question about it. Still, some of those invisible effects are currently blocking recovery and increasing unemployment. Moreover, the Chinese authorities, if not the American ones, are beginning to realize it.
One of those side effects is high commodity prices, most importantly, high oil prices. As analysts admit, and anyone following the numbers cannot fail to notice, the price of oil follows the market rather than the rules of supply and demand. It is true that OPEC has successfully reduced supplies but that is insufficient to explain the high price. That can be better explained by the Greenback effect. Indeed, the same can be said about the entire stock market.
Why? Because investors have to do something with the dollars sloshing out there and they assume, as Buffett hints, that a trashing of the dollar must be coming sooner of latter. So, why not bet some easily available certain to be dropping in value dollars on that eventuality?!
So what? So higher oil prices mean lower growth and lower employment:
Josheph Lazzaro writes:
Here's the economic reality: Every $1 per barrel rise in oil decreases U.S. GDP by $100 billion per year and every one cent increase in gasoline decreases U.S. consumer disposable income by $600 million per year.
Well, according to the AAA,"a gallon of regular unleaded is 16.3 cents more expensive than last month. . . ." You figure out what this rise cost Target. Phillip Davis writes:
People often forget that stocks are a commodity too and are also exchanged for currencies - when the dollar falls, at least initially, stocks tend to rise. Unfortunately so do our commodity costs but, as we saw in last week's data, wages do not keep up and that, sadly, leads to a deflation of consumer buying power.
Every $10 increase in the price of a barrel of oil rips $25Bn a month out of the hands of global consumers, enough money to employ 6M people a year at $50,000 each. Those jobs are torn away from other sectors as discretionary income goes to commodities and, by the time you add in refining mark-ups and the cascading effects on other raw material cost, the effect of a $10 per barrel rise in oil is doubled to what amounts to about 1M global jobs per dollar.
Rumors that the Chinese, if not the American, authorities understand these unintended consequences of the easy money policy and are getting ready to counter it, may have caused the recent drop in the Chinese market. Danske Research Team report:
Commodities are very sensitive to Chinese news these days. This morning Chinese stocks briefly entered a so-called bear market as stocks have dropped at the Shanghai bourse by 20% since August 4th. Chinese stocks are under pressure as the market is concerned that the authorities will curb the current excessive lending growth. There are a lot of rumours that money meant for real investments has ended up in the stock market.
The reaction has been a strong sell-off in the business sensitive base metals. Copper is down more than USD 200 to 5.875. Commodity markets naturally fear that the Chinese government will have to tighten monetary policy to avoid a bubble building up in housing and the stock market. Tighter Chinese monetary policy will hurt
Personally, I do not believe that any similar American response will follow. Certainly not before Bernanke is reappointed or replaced. I would be grateful, if at the very least, the Obama administration would act to insure increased domestic (rather than Brazilian) energy supply. Getting poorer is bad enough. Getting poorer to empower oil tyrants is really galling.
And it continues -
It's a world that's awash in oil, but you'd never know it from oil's price, currently around $70 per barrel. That's well above oil's historic 150-year real average of about $25-30 per barrel, and certainly above where the price would typically be as a recovery starts following a long, nasty U.S./global recession.
Actually, high oil prices will prevent or slow recovery, such as it is."Surprisingly," unemployment claims are up again.
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- This New York Times 'Hitler' book review sure reads like a thinly veiled Trump comparison
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- Annette Gordon-Reed tells historians the controversy over Harvard law school's shield is different from the fight over the Confederate flag
- Historian EP Thompson denounced Communist party chiefs, files show
- Voting opens soon for the leaders of the OAH in 2017


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Bank Holiday Opening Hours August 2016Written on Saturday, August 27th, 2016 at 10:51 am
Here are our opening hours for the best Bonk Holiday of the year!
Saturday 12-6pm
Sunday closed
Monday 12-4pm
Bloggers WantedWritten on Friday, August 26th, 2016 at 1:04 pm
Hey guys! We're on the lookout for a team of bloggers to review and recommend (or not) new products for Passion.
This will involve regular meetings at the Passion HQ where we will ply you with snacks and drinks (!) and hand over your latest gadget to review and inspect.
Sound like a dream job?
Contact us for details.
Fighting absurdity with absurdity using dildos as a protest weaponWritten on Friday, August 26th, 2016 at 10:43 am
Cardiff Photo Studio for HireWritten on Tuesday, August 2nd, 2016 at 2:21 pm
Studio to hire
Just outside central Cardiff on City Road
- On street parking available, or £4 all-day car park next door
1800 sq ft main studio
White walls, laminate floor, flooded with natural light
Self contained and private with toilets
Open 12-9pm Mon-Thu and until 6pm Fri & Sat
We have a large industrial staircase with grungy bricks, very popular with photographers and a choice of two other smaller rooms, with lighting variations
Cream leather sofa. White plastic seamless seat. Pop up green-screen. Small stools. Mirrors
Friendly meet & greet staff
- Cash machine on site
Free tea and coffee and kitchen facilities
A full day is £80 (up to 9 hours)
A half day is £45 (up to 5 hours)
Hourly rate £15
Prices include VAT at the current rate
Our venue is not suitable for children
Payment must be made in full before or on the day of the hire
No pornographic material can be filmed or photographed on our premises. Glamour is acceptable
Examples of work
- With thanks to the various photographers supplying these images
As Seen on BBC OneWritten on Tuesday, July 26th, 2016 at 3:17 pm
So now you can catch your favourite sexy shop on BBC I Player! Following last night's episode of City Road, about the country's most diverse road, the BBC now have the episodes so far available on the fab iPlayer service.
Play Saucy ScrabbleWritten on Thursday, July 21st, 2016 at 2:54 pm
How to play:
Play as usual but every word must be saucy, sexy or just downright filthy!
The rules:
Words are only allowed if you've both heard of them. Slang is in, as long as the word is rude.
Make it hotter:
If anyone has any tiles left over, they have to touch a body part of their partners body beginning with that letter. This applies to every letter they have left over.
Check out our virtual tourWritten on Thursday, July 14th, 2016 at 5:28 pm
Free Sex Toy ConsultationsWritten on Thursday, June 16th, 2016 at 1:38 pm
With seventeen years in the business, we know a thing or two about sex toys. We appreciate that sometimes it is hard to pluck up courage to visit an adult store, although if you were to visit our adult shop in Cardiff, our building also offers so many other services that no-one would ever know what you're coming in for (we have a dance studio, a gym, a photo studio and more on the premises!). Also, once you've stepped foot into the shop, you'll soon find that we're very friendly and welcoming, and can offer advice on any of our products.
Still feeling shy? You can now book us for a FREE sex toy consultation. This means one-to-one timeslot with our experienced owner, Faith Attwell who will guide you through the process of choosing the best toy for you. We have samples here that can be switched on/plugged in to demonstrate vibration levels if that is something of importance, depending on what you are looking for.
You should find that we have the best prices on adult toys anywhere in Cardiff.
We have the longest opening hours (noon until 9pm weekdays!) meaning you can visit us after work and we will even make you a cuppa to help you chill while you are here.
Please note, that we do not have a high pressure sales policy. We will show you products and help you choose what is best for you. We do not work on commission. We have many satisfied customers.
For an appointment please call Faith 029 2048 9669 or email us.
Nice Things to do for your ManWritten on Wednesday, June 15th, 2016 at 2:49 pm
In general, men are expected to do all the romancing in the relationship. Some are more romantic than others, and fear not, in a few days we'll be posting one for the ladies. But, for now we thought it's really nice to spoil your man now and again… so here's our top tips for sexy, fun and (mostly) free things you can do for your man to show you're a cut above the rest.
Let us know how you get on. We'd love to hear from you!
- Wake him with a blowjob. This one is every man's dream! Costs you nothing and really is rather hot. Whether or not he usually wakes up with a boner, he'll soon have a raging hard-on and this is one gesture he certainly won't forget.
- Leave him a little handwritten note, in his pocket telling him how much you're looking forward to having him for dessert tonight. Old-fashioned maybe, but spritz it with a spray of your usual perfume for a sensory reminder of good things to come.
- Doll yourself up like it's your first-ever date. Wear your hair the way he likes it. Wear heels if he likes them. Dress sexy, he will be proud to show you off and he'll remember why he began to fall for you in the first place.
- Take a day off for yourselves, and do… nothing. It's very rare, in these busy lives we lead that you can actually lazy around the place doing nothing at all.
- Visit the beach because nothing beats a romantic stroll around the coast to enjoy each other's company. The sea air will blow in your hair and you will feel wild and free – and may this feeling continue for a few hours when you get home, unless you can find a secluded cove to make wild and free love in!
- While you're chilling at home, tell him to sit on the floor and give him an impromptu massage.
- Cook him his favourite meal. OK we know that guys often love to eat naughty, unhealthy food and skip the veggies. Let him off just for one night and prepare his favourite meal the way he likes it. Just once in a while it's fine!
- Send him a text in this day and age, where we receive a million texts that just get lost or merge one into the other, send him a little one-liner in the middle of his working day, with something naughty and slightly out of character for you. A pic in your underwear? A photo of your boobs? Or even a porn pic depicting something you'd like to try. Sure to raise his blood pressure, and something else and have him thinking of you all afternoon.
New Pole Dancing Beginners Course Coming SoonWritten on Tuesday, May 3rd, 2016 at 8:00 pm
We have a large, airy and self contained studio at our premises in Passion and one of our teachers, who also happens to be an award-winning pole dancer, is running lessons in blocks of 5 weeks.
Siana has a new course starting on 25th May for absolute beginners! This will be a popular block and we recommend you book early.
Contact Siana on 07530 320557 to book or email firstname.lastname@example.com

subset: commoncrawl


text:
Emergency Physician
4 years of experience
4 years of experience
4301 W Markham Slot
Little Rock, AR 72205 Phone number & directions
Little Rock, AR 72205 Phone number & directions
License & Identifications
A medical license is required for a doctor to practice medicine in a particular state. Requirements vary by state but most require, at a minimum, post-graduate training in the doctor's specific specialty. An NPI number is a national identifier unique to an individual health care provider and is managed by the Center for Medicare & Medicaid Services (CMS).
Learn more about Dr. Brian Tulbert:
View the full profile to get information on:
- Qualifications
- What's important to you
View full profile
Patient Reviews
Patient comments (0)
The overall average patient rating of Dr. Brian Tulbert is Average.
Education & Awards
Dr. Tulbert graduated from University of North Texas, Fort Worth.
Dr. Tulbert has 1 hospital affiliations:
- St Vincent Infirmary Medical Center
Home > Find an Emergency Physicians > AR > Little Rock Emergency Physicians > Dr. Brian Tulbert, DO
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- Additional Information
- Dr. Brian Wesley Tulbert DO is a male Emergency Medicine Specialist, has 4 years of experience and practices in Emergency Medicine.
- Where does Dr. Brian W. Tulbert practice?
- Dr. Brian Tulbert has 1 office location.
Dr. Brian Tulbert practices Emergency Medicine near Little Rock, AR.
See Little Rock Emergency Physicians.


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Authentic Coach Purse Maggie Madison Collection
This item has been shown 0 times.
Authentic Coach Purse Maggie Madison Collection:
This is an Authentic Coach purse in the Maggie Madison Collection. It comes with a dust bag to store it in. It is brown leather with a dark brown lining on the inside. It has a pleated design in the front, and zips closed. It is organized into 3 separate compartments on the inside. The middle compartment zips closed, and it has an inside zip pocket and multifunction slip pockets. It has a 10" shoulder drop, 4" wide, and 9.5" tall. This purse retails for over $400 and is selling on Amazon for $285 currently.
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Seven Eu Nations Nullify Border Controls
In a move lauded as a breakthrough in the European Union's drive for unity, border controls between seven EU nations are being abolished today.
Travelers will be able to keep their passports in their pockets when moving from any one of the seven - France, Germany, Spain, Portugal, Belgium, Luxembourg and the Netherlands - to another.
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But the move comes five years after it was originally scheduled, and it's on a much smaller scale: Several EU members are unready or unwilling to join borderless Europe.
Britain has vowed to stay out, and because of its customs links with Dublin, is expected to keep Ireland effectively out as well.
The three other EU members, Denmark, Sweden and Finland, are expected to abolish the controls, too.


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One of the major principles of the universal balance is free choice, at the unconscious level people enjoy different roles and is a wonderful thing, this is what allows us to see the diversity and creative power. It is possible that when you have decided to transform his life then it is filled with great enthusiasm, that is fine and should enjoy it, but it also has to be careful to present their ideas, mainly when you are on the road or process. While you have not achieved the materialization of an idea means that the internal energy levels have not yet reached the optimal state, then if you share your project ideas with some people and if someone questions it, then it is possible that their internal levels go down because affects it the power of the word, it is true that you are causing this condition internally, but it is also true that it has not yet developed capabilities to take good control of his mind. If you would like to know more about Ray Dalio, then click here. At the prospect of losing power because they contradict us an idea, then what we can do? Well, you have to seek help in people that understand their objectives and that drive to climb the Hill instead of putting an additional weight to the load that is rising. When you focus on an idea gives a signal and the universe will respond to that frequency, here is where you must be attentive to the unconscious vibrations, when a person is interested in something then you will perceive it, a common phrase tells us that he who seeks finds. Bradley Tusk often expresses his thoughts on the topic. Book changing our system of beliefs to achieve the success of Steve Alpizar contains the principles that govern the inner energy, i.e.
you will know that actions are needed to accumulate energy with respect to a target and this is met, reading this book will see special conditions in people who go beyond the obviousYou will find inspiration to generate great opportunities, internal power will guide you, protect and give you everything you want. Remember that opportunities arise only for the prepared minds, we have read so many stories phenomenal men and women who lost their fortunes in their noses, treasures, promotions, travel, lotteries, etc. But why? Because internally they were not prepared to receive, in the book changing our system of beliefs to achieve the success of Steve Alpizar will also find great secrets to having an abundant mind and how to program those super wishes in your subconscious, everything we see in the material plane is just an idea, a belief, by reading this book you will learn to transform information into the immaterial plane to observe it in your conscious lifeYou will overcome huge barriers limiting. It must always be attentive to the messages that your mind sends you, remember that you should not attempt to impose ideas on anyone, might you want to elaborate on their own abilities or not doing so, is its decision, this article is an example of an invitation, but so it will flow it is necessary that the person is ready to sail, you must do exactly the same, observe the play of others and if at any point someone looking for then find answers and if you are in the harmony of those responses then people will unconsciously touching your door.


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Re: Matejka 1876 and up.
In reply to:
Re: Matejka 1876 and up.
This is somewhat of a stab in the dark. I have a Frank
MATEJKA married to Anne Halamick in Chicago on 12 Feb 1887. They lived in "West town" and he coowned a soda water manufactury with my gr-grandfather Jakob Gruener. I am looking for any one connected to this family. They had a daughter Helena and a son Frank according to the 1880 census.


text:
Was Quentin Tarantino Disappointed by Prometheus?
20 Movies You Need To Watch At Home This Week
Kaley Cuoco Shows Off Her Tennis Skills
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Quentin Tarantino Got Offered The Biggest Movies After His Biggest Flop
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5 Blocked Movies That Became Easily Available Thanks to the Internet
Robert Downey Jr. Confirms Iron Man 4 is on the Way!
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This Japanese Star Wars: The Force Awakens Trailer May Have Dropped a Huge Spoiler
10 Actors Who Played a Movie Character Until They Died
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Tom Hiddleston Reveals Why Loki Was Cut from Avengers: Age of Ultron
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|Home | About | Journals | Submit | Contact Us | Français
Leg pain associated with low back pain (LBP) is recognized as a risk factor for a poor prognosis, and is included as a component in most LBP classification systems. The location of leg pain relative to the knee and the presence of a positive straight leg raise test have been suggested to have clinical implications. To understand differences between such leg pain subgroups, and whether differences include potentially modifiable characteristics, the purpose of this paper was to describe characteristics of patients classified into the Quebec Task Force (QTF) subgroups of: 1) LBP only, 2) LBP and pain above the knee, 3) LBP and pain below the knee, and 4) LBP and signs of nerve root involvement.
Analysis of routine clinical data from an outpatient department. Based on patient reported data and clinical findings, patients were allocated to the QTF subgroups and described according to the domains of pain, activity limitation, work participation, psychology, general health and clinical examination findings.
A total of 2,673 patients aged 18–95 years (median 47) who were referred for assessment of LBP were included. Increasing severity was consistently observed across the subgroups from LBP only to LBP with signs of nerve root involvement although subgroup differences were small. LBP patients with leg pain differed from those with LBP only on a wide variety of parameters, and patients with signs of nerve root involvement had a more severe profile on almost all measures compared with other patients with back-related leg pain.
LBP patients with pain referral to the legs were more severely affected than those with local LBP, and patients with signs of nerve root involvement were the ones most severily affected. These findings underpin the concurrent validity of the Quebec Task Force Classification. However, the small size of many between-subgroup differences amid the large variability in this sample of cross-sectional data also underlines that the heterogeneity of patients with LBP is more complex than that which can be explained by leg pain patterns alone. The implications of the observed differences also require investigation in longitudinal studies.
Low back pain (LBP) is commonly triaged or classified into LBP due to serious pathology, LBP with nerve root compression, and non-specific LBP (NSLBP) [1]. Most patients with NSLBP and many with nerve root compression are treated with conservative care, but the demonstrated effect sizes are often small, sometimes moderate and important differences in effects between interventions have not been convincingly demonstrated [2-5].
The belief that NSLBP consists of a number of subgroups, with different prognoses and different treatment responses, has increased over the last decade, and this has been mirrored in a proliferation of studies reporting research into NSLBP subgroups aimed at identifying homogeneous groups of patients with similar trajectories or who would benefit from a certain intervention [6-10]. It is well-established that patients with leg pain in addition to LBP have a poorer prognosis than patients with local LBP only [11] and leg pain is a component of most LBP classification tools [12-15]. However, the LBP patient group with leg pain has been defined in diverse ways, from those with any leg pain to those with radiculopathy and an MRI-confirmed clinical diagnosis of nerve root compression [16].
The report of the 1987 Quebec Task Force suggested distinguishing between pain referral above and below the knee [17]. This has since been shown to be associated with prognosis [18,19], and a recent study in primary care showed that patients with leg pain referred above or below the knee differed on symptom severity as well as psychological characteristics compared with each other and compared with patients who had no pain referral. Importantly, this primary care study also showed that these baseline differences explained most of the variability in outcomes [20]. Other studies have shown that patients with distal leg pain and a positive straight leg test had more severe symptoms, heavier psychological distress and more health care utilization than those without a positive straight leg raise [21,22]. One application of knowledge of such potentially modifiable characteristics associated with different leg pain patterns is that they may provide direction for the development of treatments targeted to different types of radiating leg pain.
Put simply, knowing the distinctions between patient groups with LBP only, those also with leg pain above the knee, those with leg pain below the knee and those with nerve root involvement, would clarify which subgroup classifications are useful. This information could assist in clinical decision making for individual patients, in quality assurance and in the design of research projects.
The objective of this study was to describe physical, psychological and social factors in LBP patients when they first had contact with a secondary care outpatient clinic. The cohort was described using the Quebec classification subgroups of (a) LBP only, (b) LBP and leg pain above the knee, (c) LBP and leg pain below knee, and (d) LBP and signs of nerve root involvement.
This study was based on data collected as part of the daily clinical routine in the conservative care department of The Spine Centre of Southern Denmark. This outpatient, secondary care department is a non-surgical unit in a public hospital with a geographic catchment area with approximately 1.2 million inhabitants [23]. The department principally performs multidisciplinary assessment of patients with spinal pain after referral from general practitioners, chiropractors, and medical specialists in primary care. A structured clinical examination and use of MRI are core elements, and short courses of conservative treatment can be offered to test a patient's response to treatment.
Data were collected in the Spine Centre's electronic clinical registry named the SpineData database (Regional Ethics Committee Project ID S-200112000-29). Patients answered a comprehensive self-reported baseline questionnaire on a touch screen in the waiting area prior to their first consultation. The clinicians entered results of a core set of clinical tests either when examining the patient or after the first consultation. Clinicians in the department were physical therapists, chiropractors, rheumatologists, orthopaedic surgeons and general medical practitioners.
Patients aged 18 years or older who were seen in The Spine Centre between December 15th 2008 and November 4th 2011 with LBP as their main complaint were selected for the analyses. The main complaint was defined by the patient's response when asked to indicate on the touch screen body chart the area for which the patient was seeking care. To be included in the study, patients had to have completed the Centre's electronic patient questionnaire with no missing data on pain intensity or in the pain drawing. An additional inclusion criterion was that data from a clinician's neurological examination needed be present. For patients who were referred to the centre for more than one episode of LBP during the study period (< 2% of the cohort) only data for the latest episode was included.
The cohort was described on six health domains (pain, activity limitation, work participation, psychological factors, quality of life, and clinical examination). Except for the clinical examination findings, all items were self-reported by patients.
Pain items were: duration of the present episode (months), previous LBP episodes (yes/no), intensity of low back pain (score on 0-10 Numerical Rating Scale (NRS) for each of 'LBP now', 'worst in the last 14 days', 'typical in the last 14 days', which were collectively averaged to form a single 0-10 scale) [24], intensity of leg pain (measured in the same way as for LBP), severe leg pain (intensity of leg pain > 3) [25], dominating leg pain (proportion reporting higher intensity of leg pain than intensity of LBP), and pain irritability (requiring a yes-answer to both' pain is easily aggravated by physical activity' and' it takes a long time before it settles again') [26,27].
Activity limitation was measured with the 23-item Roland Morris Disability Questionnaire (RMDQ) [28] and calculated as a proportional score (0% = no activity limitation; 100% = maximum activity limitation) [29].
Work participation was assessed by questions on: Regular employment (proportion of the working population, i.e. not studying or retired, being employed without public benefits), sick listing (proportion of persons in regular employment who reported any sick listing within the previous three months), and sick days (days off work during the preceding three months among the regular employed).
Psychological characteristics were depressive symptoms and fear of movement. Depressive symptoms were measured by the two PRIME-MD 1000 screening questions [30] using a 0–10 NRS (proportion of patients with a score above 6 on both questions). These cut-points were derived in an unpublished study in our patient setting based on a comparison with population-based thresholds for the Beck Depression Index [31] and the Major Depression Inventory [32]. Pain-related fear of movement was measured using NRS 0-10 scales (proportion with a total score on two screening questions from the Fear Avoidance Belief Questionnaire equal to or above 14) [33]. This threshold was also derived in an unpublished study in our patient setting based on a comparison with a primary care score threshold (mean plus 1 standard deviation) on the physical activity subscale of the Fear Avoidance Belief Questionnaire.
General health was assessed using the Euroqol health thermometer (Euroqol VAS) that measures self-reported health state today (0 = worst imaginable; 100 = best imaginable) [34].
Directional preference was recorded from the clinical examination and defined as being present if either centralisation or peripheralisation of pain occurred with tests of end-range movements or postures as described in the Mechanical Diagnosis and Therapy system by McKenzie [15]. Centralization has been defined as "the abolition of distal pain in response to the deliberate application of movements or postures. If pain is only in the back this is centralized and then abolished" [35]. Peripheralisation is the opposite pain response to movements or postures.
Patients were classified as having local LBP only if their pain drawing only included local LBP and their worst leg pain intensity in the preceding 14 days was zero (0-10 scale). LBP with leg pain above the knee (LBP + pain above knee) was defined as persons who indicated on the pain drawing that they had pain in the anterior or posterior thigh but no pain in the calf or feet, and rated their worst leg pain intensity as being one or more (0-10 scale). LBP with leg pain below the knee (LBP + pain below knee) was defined as a person with a pain drawing indicating pain in the calf and/or foot and their worst leg pain intensity being at least one. LBP with signs of nerve root involvement (LBP + NRI) was arbitrarily defined as any person with any leg pain present on their pain drawing, their worst leg pain intensity was one or more, and at least one of the following findings was present on the painful side during the clinical examination: muscle weakness, impaired tendon reflexes, altered sensation to touch or pinprick, a straight leg raise test that provoked their familiar leg pain (at 60 degrees or less as judged visually), or a positive prone knee bend test combined with pain to the anterior thigh (Reverse Laségue Test). The term 'signs of nerve root involvement' should be considered a label given to patients fulfilling these criteria rather than a definition of a diagnostic entity. There is always imprecision for the classification of radiculopathy when only clinical signs are available [36] and our necessarily arbitrary definition was a pragmatic choice using the clinical findings available within a routine care setting. In this LBP + NRI subgroup single signs of NRI occurred as a positive SLR in 117 patients, altered sensation in 149, muscle weakness in 3 patients, and impaired tendon reflexes in 4, while the rest of the group had two or more signs.
Patients, whose pain drawing and pain scales were ambiguous, for example where their leg pain intensity was reported as zero but they indicated leg pain on the pain drawing, were excluded from the analysis. People excluded for this reason did not necessarily give contradictory or inaccurate answers. For example, a person could have reported having leg pain within the previous two weeks but did not have leg pain on the exact day when the pain drawing was made. However, allocation of such a person into a classification group would have been ambiguous and we opted to exclude such patients in order to obtain the most definitive data.
Results are reported either as proportions with 95% confidence intervals (95% CI) or medians with inter-quartile ranges (IQR) (since most continuous variables were not normally distributed). Differences between the subgroups were tested using Kruskal-Wallis one-way Analysis of Variance. When group differences were significant at the 5% level, pairwise comparisons were performed using Chi Square Tests for proportions and, t-test or Wilcoxon Ranksum Test for ordinal and continuous variables. Group differences were considered statistically significant at p<.05. As the high number of variables tested increases the risk of mass significance, between-subgroup comparisons should be interpreted as only hypothesis-generating. Analyses were performed using STATA IC 11.2 (StataCorp, Texas, USA).
A total of 9,377 people above 18 years were registered in the database as new LBP patients during the study period. Due to a staged implementation of the electronic questionnaires across the four geographic sites of The Spine Centre during this period, there were both patient and clinician questionnaires available in electronic format for only 4,294 of them. People completing the electronic questionnaire had the same gender distribution as the entire patient population and were on average one year younger. We excluded 964 people from the analyses because of ambiguous data. After excluding such patients and those with missing data, 2,673 people fulfilled the criteria for allocation to subgroups. The study flowchart is shown in Figure 1. Those allocated to the subgroups had worse leg symptoms and slightly more activity limitation as compared with patients who could not be categorised into the subgroups (Table 1). A detailed description of the whole cohort and the subgroups is shown in Table 2.
The included cohort consisted of 56% females and was aged 18-95 years (median 47 years). Patients with local LBP only and those with LBP + NRI were less often females than patients with LPB + pain above knee and LBP + pain below knee, whereas the median age of patients in the LBP + pain below knee subgroup was higher than in the other groups (Table 2). Of the patients allocated to the LBP + pain below knee subgroup, 52% had pain also in the foot according to their pain drawing, and for those with LBP + NRI this was the case in 55% of the participants.
Patients with local LBP only had the longest duration of pain at the time of first consultation, and those with LBP + NRI the shortest duration. About three-quarters of the cohort reported previous LBP episodes, which were less frequent in the local LBP only group as compared with patients with leg pain (Table 2). Pain irritability was also common in all groups but more in the subgroups with leg pain. LBP intensity was similar across subgroups whereas patients in LBP + pain above knee reported less intensive leg pain than those with LBP + pain below knee and LBP + NRI. Within the pain domain there was a general trend of worsening from the local LBP only to the LBP + NRI group on all parameters (Figure 2A and B).
The median RMDQ proportional score was 65 (Table 2). There was a trend for more activity limitation across the groups from local LBP only having the least, to the LBP + NRI group, which had the most activity limitation (Figure 2B).
Sixty-six percent of patients belonging to the working population were in regular employment with higher work participation in the group with local LBP only than in the leg pain subgroups. Around half of those working had been sick-listed within the previous three months with more frequent sick listing and the highest number of sick leave days reported in the LBP + NRI group (Table 2).
Symptoms of depression and fear of movement were most frequently reported among patients with LBP + NRI and were least frequently reported in the local LBP only patients (Table 2 and Figure 2A).
Self-reported general health was of almost the same magnitude in all groups, although the highest score was observed in the LBP only group and the lowest in the group with LBP + NRI (Table 2).
Less than half of the population was tested for directional preference, from 36% of LBP only patients to 42% of patients with LBP + pain above knee. A directional preference was present in about 50% of tested patients with LBP + NRI and in less than 20% with local LBP only. The proportion of patients with a directional preference did not differ between the groups with LPB + pain above knee and LBP + pain below knee (Table 2). One reason that all patients were not tested for directional preference was that not all clinicians were trained in the Mechanical Diagnosis and Therapy system.
An additional finding within the clinical examination domain was that 51% of all patients with pain below the knee and 32% of patients with leg pain only above the knee had sign of nerve root involvement.
This study described patients with LBP seen in a secondary care outpatient department using four predefined subgroups based on the Quebec Task Force classification [17]. Overall, the differences observed between these groups were small. However, people who had local LBP only differed from those in the leg pain subgroups on almost all the described characteristics. Furthermore, there was a consistent trend in all health domains of increasing severity from the subgroup with local pain, across the subgroups with pain referral above and below the knee, to the subgroup with signs of nerve root involvement.
Different patient profiles were observed among patients with leg pain depending on whether they had signs of nerve root involvement or not. Patients with signs of nerve root involvement had a more severe profile on measures from all health domains. Similar findings were observed in a previous study using the Quebec Task force classification [19], and in studies that demonstrated that the presence of a positive straight leg raise identified patients with a characteristic profile [21,22].
Comparing people with pain above the knee and those with pain below the knee revealed higher leg pain intensity and more activity limitation in the group with more distal pain. There were little differences in other parameters according to location above and below the knee, although generally patients with LBP + pain below knee in this secondary care setting tended to be more severely affected than those with LBP + pain above knee as previously observed in other settings [20,21].
LBP with any leg pain tended to be more severe than local LBP only, regardless of how severity was measured, and was also associated with higher frequencies of psychological risk factors. This does not clarify any causal direction and it may simply be that more distal pain actually is experienced as more severe and results in heavier psychological distress, and therefore these are mutually interdependent covariates. The relationship between pain and depression was demonstrated to be reciprocal in a study by Kroenke [37], but the potential causative influence of leg pain on psychological risk factors or the reverse needs to be investigated, including potential differences in this relationship between leg pain subgroups.
The main strength of this study was the large sample size which is likely to produce more trustworthy estimates. Moreover, we expect the results to be generalisable to other secondary care settings since data were collected as part of the everyday routine of the department and not constrained by the strict inclusion criteria that are often necessary in clinical trials. The downside of using registry data is less control of data quality and so, in order to describe subgroups with very clearly defined profiles, we took the approach of excluding patients who reported any ambiguous data. By so doing, we chose to maximise the 'signal' in data (clear subgroups) by reducing the 'noise' (ambiguous data).
A limitation of this study was the definition of nerve root involvement. Classification into the group with signs of nerve root involvement required the presence of just one positive finding in the neurological examination, and the reliability of these findings in this setting is unknown. The unquantified reliability of our examination procedures is an inherent limitation of data from large clinical databases that were not collected for a specific research project. However, the data were also inherently more representative of routine care and our results demonstrate that even this 'loose' definition of signs of nerve root involvement defines a distinctive subgroup. It is possible that our definition of 'nerve root involvement' led to underestimation of subgroup differences, but the findings indicated that even very simple clinical examination data can add valuable information.
Another potential weakness of this study is that the inclusion criteria and the gradual implementation of the electronic database over the study period meant that only about 25% of the patients seen during this time period were described in this study. All known selection biases have been reported. There were no clinically important differences on gender or age between those who filled in the electronic questionnaires and those who did not. People who could be unambiguously allocated to the defined subgroups had slightly more severe symptoms and more disability than those who could not be allocated. This bias towards those with a more severe profile means that the proportions allocated to each group may not truly reflect the whole patient population.
A further weakness is that some constructs, notably the psychosocial constructs, were measured using screening questions only, though such an approach has been used in other contexts including in the Bournemouth Questionnaire [38]. The screening questions used had high overall accuracy (86.8% to 88.0%) for predicting the scores on the reference standard questionnaires for depression and fear avoidance [unpublished data]. The main reason for using screening questions is that it is simply not possible in our setting to collect comprehensive psychological data on all patients as part of a multi-domain assessment procedure. Our experience suggests that we are at the limit of responder burden that is acceptable to our patients.
Lastly, it should be recognised that some differences between subgroups may have been a result of referral patterns. For example, patients in the cohort with local LBP only had longer pain duration when seen at the department which was probably because leg pain prompts referral at an earlier stage than local LBP.
In summary, the findings in this study confirm that leg pain in addition to LBP is an important indicator of a more severe condition than LBP only, almost regardless of health domain. Moreover, we found that clinical signs of nerve root involvement defined a subgroup of people more severely affected than other leg pain patients on activity limitation, work participation and psychological factors. Although between-subgroup differences were small, collectively these findings underpin the concurrent validity of the Quebec Task Force Classification. However, the results also show that variability in these cross-sectional data between individual patients with LBP is more complex than can be simply explained by the presence of leg pain patterns. There is also a need to investigate the clinical importance of the observed subgroups differences in longitudinal outcome studies.
The authors have no financial or non-financial competing interests to declare.
AK and PK formed the study idea. All authors were involved in the design of the study, interpretation of data, revision of the manuscript, and gave final approval of the manuscript. AK performed the data analysis and wrote the initial draft of the manuscript.
The pre-publication history for this paper can be accessed here:
Thanks to the patients and clinicians of the Spine Centre of Southern Denmark who participated in the data collection. Peter Kent is partially supported, and Alice Kongsted and Tue Secher Jensen are fully supported, by grants from the Foundation for Chiropractic Research and Post Graduate Education, Denmark.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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A trio of former Pennsylvania high school students were sentenced to probation after they admitted to putting human feces on a cake they gave to a classmate.
Common Pleas Judge William Mahon stipulated the 200 community service hours required under the probation must be served performing tasks such as cleaning toilets, urinals and bed pans at local senior centers.
Flores and Mireles were also ordered to spend the first two months of their probation sentences on electronic home confinement.
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Trade Fairs for Machine Construction in Greece – Appointments from April 2018
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Coyotl Tezcatlipoca Loses But So Does City in Ruling Over Costa Mesa Law Targeting Dissent
The Costa Mesa City Council was legally in the right to twice remove immigrant-rights activist and punk rocker Coyotl Tezcatlipoca (a.k.a. Benito Acosta) from council meetings in 2006 under a municipal ordinance that makes it a misdemeanor for members of the public to engage in "disorderly . . . or disruptive behavior," a federal appeals court has ruled. How disorderly? At one meeting, he called then-Mayor Allan Mansoor a "fucking racist pig."
Surprisingly, fucking racist pigs did not sue Tezcatlipoca for slandering them.
Smiley Coyotl: When is a prosecutor not a prosecutor? The answer spared a Santa Ana activist/punk rocker from criminal charges
But Tezcatlipoca, a founding member of Colectivo Tonantizin, did sue in federal court, alleging city officials, police officers who escorted him out of the council chambers and the city ordinance known as § 2-61 all violated his constitutional rights under the First and Fourth Amendments.
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A federal jury sided with the city, and this week so did a three-judge panel of the 9th Circuit Court of Appeals in Pasadena.
Judge Richard Tallman, writing for a three-judge panel, found the city is constitutionally protected 86'ing members of the public for being "disorderly" or "disruptive," but he has a problem with the inclusion of a word sandwiched between the other two in § 2-61.
"Prohibiting 'insolent' behavior cannot be narrowed to include only an actual disruption," Tallman writes. "Insolent is defined as 'proud, disdainful, haughty, arrogant, overbearing; offensively contemptuous of the rights or feelings of others' or 'contemptuous of rightful authority; presumptuously or offensively contemptuous; impertinently insulting.' This type of expressive activity could, and often likely would, fall well below the level of behavior that actually disturbs, disrupts, or impedes a city council meeting."
However, because the offending "insolent" cannot be removed without altering the meaning of the ordinance, the panel chose not to toss it entirely.
"Removal of 'insolent' does not defeat the central purpose of § 2-61," Tallman observes. "The central purpose is to prevent actual disruptions during and impediments to conducting an orderly council meeting. The remaining portion of § 2-61 stands on its own and is independently applicable, unaided by the word insolent."
But Judge N. R. Smith writes in his dissent the law cannot be saved and is "unconstitutional in its entirety, rather than just in part."
Besides the meeting with the f-bomb dropped on a future California assemblyman, Tezcatlipoca was escorted out of the council chambers by police at a second for trying to get the attention of Jim Gilchrist, co-founder of the Minuteman Project.
Friday's Headlines & Surprises: Who the Hell Does Benito Acosta Think He Is?
In both cases, Tezcatlipoca was there to oppose a Mansoor-led proposal to have Costa Mesa police officers enforce federal immigration laws.
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Our first Team Captains Meeting is this Tuesday February 9, 2016. Meeting time is 6:30 to 7:30 and will be at the Liberty Hospital Education Center. It is located at 2529 Glenn Hendren Dr, Liberty, MO 64068. (Take main entrance and follow the curved drive past main hospital entrance to the Dialysis Center. The Education Center entrance is right next to the Dialysis Center. *Look for the Relay signs to guide you there!*
The American Cancer Society Relay For Life movement is the world's largest and most impactful fundraising event to end cancer. It unites communities across the globe to celebrate people who have battled cancer, remember loved ones lost, and take action to finish the fight once and for all. With the support of thousands of volunteers like you, the American Cancer Society is helping save more than 500 lives a day. Please join us and take action against a disease that has taken too much!
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2 Reviews
Very easy to make with simple ingredients that I always have on hand. Struggled slightly with the gnocchi sticking to the pan but just added a bit more oil to fix this. I didn't have any thyme so used some beautiful basil that I had growing in my garden. Made a great Sunday evening dinner, thank you.
Very nice dish. The only thing I did different was, I used the dried version of gnocchi instead of frozen. Thanks for posting the recipe and photo in the Photo Forum, otherwise I might not have tried it, which would have been a shame. :)


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October 17 – 19, 2016
Northern Kentucky Convention Center, Covington, KY
- Link to the 2016_KAMP_Conference Flyer for information.
- Link to the 2016 GIS Conference Workshop Flyer for details of over 20 workshops on October 17.
- Register for the conference on KAMP's website: www.kampro.org.
Thank you for Attending the 2016 KAMM Annual Conference
The Changing Climate of Mitigation
August 22 – 25, 2016
Kentucky Dam Village State Resort Park – Gilbertsville, KY
Links to Conference Info and Agendas:
- 2016 Conference Information
- August 22 – Pre-Conference Agenda
- August 23 – 25 – 2016 KAMM Conference agenda final
Link to the entire 2016 KAMM Conference packet.
KAMM Conference Sponsors: We appreciate our sponsors! Link here to see the 2016 Sponsors.
Announcing Hazard Mitigation Grant Program (HMGP) Funding- DR 427
September 6, 2016
Availability of Hazard Mitigation Grant Program (HMGP) funding as a result of DR 4278 Severe Storms, Tornadoes, Flooding, Landslides, and Mudslides, July 2-9, 2016 is open. Link to the Kentucky Emergency Management (KYEM) Notice of Funds Available (NOFA).
To be considered for funding, the Mitigation Actions Forms (MAF) must be submitted in the Community Hazard Assessment and Mitigation Planning System (CHAMPS) by Friday, October 14, 2016. CHAMPS can be accessed at this website address: http://kyem.ky.gov/champs/Pages/default.aspx
Applicant Briefings
KYEM Recovery Branch will conduct briefings for all prospective applicants seeking hazard mitigation assistance related to FEMA-DR-4278-KY (Severe Storms, Tornadoes, Flooding, Landslides, and Mudslides, July 2-9, 2016.) Mitigation is available for state and local governments, and certain private non-profit organizations throughout the Commonwealth.
Please find attached the schedule of applicant-briefing-dr-4278_september_2016 for our recent disaster, DR-4278. During these briefings we will discuss the Hazard Mitigation Grant Program (HMGP) and how to apply for grant funding.
President Declares Disaster for Kentucky
August 26, 2016
WASHINGTON, D.C. – The U.S. Department of Homeland Security's Federal Emergency Management Agency announced that federal disaster aid has been made available to the Commonwealth of Kentucky to supplement commonwealth and local recovery efforts in the area affected by severe storms, tornadoes, flooding, landslides, and mudslides during the period of July 2-9, 2016.
The President's action makes federal funding available to commonwealth and local governments and certain private nonprofit organizations on a cost-sharing basis for emergency work and the repair or replacement of facilities damaged by severe storms, tornadoes, flooding, landslides, and mudslides in Adair, Butler, Caldwell, Calloway, Christian, Clay, Crittenden, Daviess, Edmonson, Hart, Hopkins, Livingston, Lyon, Marshall, Metcalfe, Ohio, Todd, Trigg, Union, and Webster counties.
Federal funding is also available on a cost-sharing basis for hazard mitigation measures for the entire commonwealth. Warren J. Riley has been named as the Federal Coordinating Officer for federal recovery operations in the affected area. Riley said additional designations may be made at a later date as warranted by the results of further damage assessments.
Following is a summary of key federal disaster aid programs that can be made available as needed and warranted under President Obama's disaster declaration issued for the Commonwealth of Kentucky.
Assistance for the Commonwealth and Affected Local Governments Can Include as Required:
- Payment of not less than 75 percent of the eligible costs for debris removal and emergency protective measures taken to save lives and protect property and public health. Emergency protective measures assistance is available to state and eligible local governments on a cost-sharing basis. (Source: FEMA funded, commonwealth administered.)
- Payment of not less than 75 percent of the eligible costs for repairing or replacing damaged public facilities, such as roads, bridges, utilities, buildings, schools, recreational areas, and similar publicly owned property, as well as certain private non-profit organizations engaged in community service activities. (Source: FEMA funded,commonwealth administered).
- Payment of not more than 75 percent of the approved costs for hazard mitigation projects undertaken by commonwealth and local governments to prevent or reduce long-term risk to life and property from natural or technological disasters. (Source: FEMA funded, commonwealth administered)
How to Apply for Assistance: Application procedures for commonwealth and local governments will be explained at a series of federal/commonwealth applicant briefings with locations to be announced in the affected area by recovery officials. Approved public repair projects are paid through the commonwealth from funding provided by FEMA and other participating federal agencies.
Link to FEMA's website for detailed information. https://www.fema.gov/disasters/grid/state-tribal-government/49.
Link to the Kentucky Division of Emergency Management (KYEM) Recovery Branch website for detailed information. http://kyem.ky.gov/recovery/Pages/default.aspx.
Declaration Process: To gain knowledge and have a better understanding of the declaration process and the county components and data needed to successfully be included within a disaster declaration link to http://kyem.ky.gov/recovery/Pages/New-Declaration-Process-.aspx.
NIST Seeks Disaster Resilience Grant Proposals
August 26, 2016
The National Institute of Standards and Technology (NIST) is making up to $3 million in grant funding available for research aimed at (1) advancing the principles of disaster resilience in the design of building and infrastructure systems, and (2) developing building codes and standards that will lead to reduction of impact caused by windstorm and coastal inundation, wildland urban interface fires and earthquakes. The Federal Funding Opportunity (FFO) also seeks grant proposals for the development of innovative measurement methods and technologies to collect and evaluate building and infrastructure performance data in the wake of a hazard event. NIST anticipates funding five to 15 awards in the range of $300,000 to $1 million each for up to three years.
Applications for the Disaster Resilience Research Grants Program must be received in Grants.gov no later than 11:59 p.m. Eastern Time on September 23, 2016.
For more information, see the DR Research Grants Program webpage or contact Millie Glick, firstname.lastname@example.com (301) 975-5962.
August 23, 2016
Using HMGP to enhance disaster resilience related to building codes
The Additional 5 percent Initiative is funding that has been set aside under the Hazard Mitigation Assistance Grant Program (HMGP) to help communities enhance disaster resilience related to building codes, such as adopting the current International Building Code® and improving a community's Building Code Effectiveness Grading Schedule (BCEGS) score. A building is considered disaster resistant when it not only protects its occupants but can also be quickly repaired and re-occupied because damage from natural disasters is minimized.
Fact Sheets:
- Additional 5 percent Initiative Fact Sheet provides Recipients and subrecipients of HMGP funds with additional information on how to implement the Additional 5 percent Initiative as changed by the Fiscal Year 2015 Hazard Mitigation Assistance Guidance. FEMA's intention in supporting the adoption and enforcement of building codes is to promote resilience by using disaster-resistant practices.
- Clarifying the Additional 5 percent Initiative Resources is a companion document to the Fact Sheet highlighting where to find more information on resilient building practices.
FIMA Releases Climate Resilient Mitigation Activities Job Aids
August 15, 2016
The purpose of these job aids are to help communities applying for CRMA activities under Hazard Mitigation Assistance (HMA) grants comply with the technical feasibility and effectiveness, and environmental and historic preservation requirements of the application. The job aids provide a checklist of information required by FEMA to determine grant eligibility and to complete a thorough review of the application. The available job aids include:
The Climate Resilient Mitigation Activities are available for HMPG funding resulting from a major disaster declared on or after September 30, 2015, and for competitive PDM and FMA funding for which the application period opened on or after September 30, 2015.
If you have any questions or comments on the CRMA Job Aids, please contact the HMA Grants Policy staff at firstname.lastname@example.com.
Protecting Drinking Water from Harmful Algal Blooms
August 2016
Algal toxins are a growing problem in the US. Harmful algal blooms (HABs) produce algal toxins that can cause fish kills and contaminate drinking water supplies. EPA has released a comprehensive strategic plan outlining actions to address algal toxins in drinking water. Solving this complex challenge to our drinking water will require action at all levels of government and approaches that are collaborative, innovative, and persistent.
The Kentucky Division of Water (KDOW) continues to monitor Kentucky's waters for Harmful Algal Blooms
- For additional information about HABs, visit http://water.ky.gov/ waterquality/pages/HABS.aspx or contact firstname.lastname@example.com
- For updates on water levels and HABs at USACE lakes visit http://www.lrl.usace.army.mil/Missions/Civil-Works/Water-Information/HABs/
E273 Training – Managing Floodplain Development through the NFIP
12 CECs for CFMs
Application Deadline: September 16, 2016
This course provides an opportunity for local officials responsible for administering their floodplain regulations. The course will focus on the National Flood Insurance Program (NFIP) and concepts of floodplain management, maps and studies, ordinance administration, and the relationship between floodplain management and flood insurance.
This course will describe important aspects of basic floodplain management practices necessary to begin a participant's floodplain management career. The course includes an overview of the NFIP, outreach and risk communication techniques. Using Flood Insurance Studies and maps to determine the flood hazard risk at given sites. NFIP minimum floodplain insurance rating, and legal implications of regulatory actions. For a basic permit process. Use of FEMA elevation and other.
Prerequisites: The following free, independent study course and online tutorials are required prerequisites to be completed before the start of the course:
- IS-1103: Elevation Certificate for Surveyors
- Flood Insurance Rate Map tutorial
- Federal Insurance Studies tutorial
Target Audience: Local officials responsible for administering local floodplain management ordinances, including but not limited to floodplain management administrators, building inspectors, code enforcement/zoning officers, planners, city/county managers, attorneys, engineers, and public works officials. Federal and State floodplain management professionals are also encouraged to attend. The course is designed for officials with limited floodplain management experience. Participants should have less than 3 years of full-time experience in the field of floodplain management.
FIMA Announces Availability of Benefit Cost Analysis Tools for Drought and Ecosystem Services
June 10, 2016
FEMA has developed Benefit Cost Analysis (BCA) Tools and Guidance to calculate benefits for climate resilient mitigation activities, including drought mitigation, ecosystem services, and pre-calculated benefits for cost-effectiveness evaluation of soil stabilization, flood diversion, and reforestation projects in wildfire impacted areas to support expedient implementation of post-wildfire mitigation actions. The tools and guidance include:
- Aquifer Storage and Recovery BCA Calculator Tool
- Ecosystem Service Benefits Calculator
- Supplemental BCA Guidance for Floodwater Diversion and Storage Projects
- Supplemental BCA Guidance for Floodplain and Stream Restoration Projects
- Pre-calculated benefits for post-wildfire mitigation actions
If you require the Microsoft Excel version of either of the calculator tools, or if you have any questions on details of the Benefit Cost Analysis (BCA), visit the BCA website, contact the BCA Helpline at 1-855-540-6744 or email@example.com. These additional BCA Tools are available for Hazard Mitigation Grant Program (HMGP), Pre-Disaster Mitigation (PDM), and the Flood Mitigation Assistance (FMA) for which the application period is open on or after the date of the May 12, 2016. Please note that not all mitigation activities are eligible under all three programs. For example, wildfire mitigation is eligible under HMGP and PDM, but not FMA.
The Climate Resilient Mitigation Activities are available for HMPG funding resulting from a major disaster declared on or after September 30, 2015, and for competitive PDM and FMA funding for which the application period opened on or after September 30, 2015.
NFIP Announces Oct. 1, 2016 Program Changes
May 10, 2016
FEMA releases Oct. 1 2016 program changes. Go to http://www.nfipiservice.com/Stakeholder/FEMA8/W-16032.html to view the cover memo and four attachments, including:
- Attachment A – Transaction Record Reporting and Processing Plan Revisions
- Attachment B – Edit Specifications Revisions
- Attachment C –Updated Preferred Risk Policy and Newly Mapped Application Form
- Attachment D –Sample Form for No Mandatory Purchase Requirement
FEMA Issues an Addendum to HFIAA Program Changes: Clear Communication of Risk
Bulletin-16021: Addendum 4 to April 1, 2016, Program Changes – Revised Underwriting Procedures for HFIAA Section 28, Clear Communication of Risk
March 30, 2016
Bulletin W-15046 described the initial implementation of Section 28, Clear Communication of Risk, of the Homeowner Flood Insurance Affordability Act of 2014. Section 28 requires FEMA to clearly communicate full flood risk determinations to individual property owners regardless of whether their premium rates are full-risk rates. Ensuring clear and accurate communication of flood risk requires correct underwriting information. This bulletin describes how FEMA will rate policies using correct information. The full bulletin includes specific procedures for insurers to follow as part of this effort.
FEMA initially proposed that NFIP insurers report current flood zone and current Flood Insurance Rate Map information, including Base Flood Elevation, if applicable, for all new business policies effective on or after April 1, 2016, and for all renewals effective on or after Oct. 1, 2016. After further consultation with NFIP insurers, and out of concerns for our customers, FEMA determined that a phased approach would best implement these requirements.
Read the full bulletin here.
Training Opportunities
Links on KAMM's Website
Kentucky Business One Stop
The Kentucky Business One Stop Portal is here to create an easy-to-use environment where Kentucky's businesses can find the requirements and tools they need to own and operate a business in Kentucky. The mission of the Kentucky Business One Stop is to promote economic development and job creation, and at the same time create efficiencies for both businesses and government.
Environmental Licenses/Permits: You may be required by state and federal law or regulation to have an environmental permit to operate in Kentucky. The Kentucky Business One Stop Portal is a great resource for identifying which environmental permits are required: http://onestop.ky.gov/start/Pages/environmental.aspx.
2016 Uniform Relocation Act (URA) Low Income Limits Issued
Effective Date – March 28, 2016
The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (Uniform Act or URA) – FY 2016 Low Income Limits, used in connection with rental assistance payment calculations under 49 CFR 24.402(b), have been issued with an effective date of March 28, 2016.
Additional information and guidance for making URA low income calculations are available on the Federal Highway Administration's (FHWA) web page.
EPA Survey Shows $271 Billion Needed for Nation's Wastewater Infrastructure
January 13, 2016
The U.S. Environmental Protection Agency (EPA) released a survey showing that $271 billion is needed to maintain and improve the nation's wastewater infrastructure, including the pipes that carry wastewater to treatment plants, the technology that treats the water, and methods for managing stormwater runoff. The survey is a collaboration between EPA, states, the District of Columbia, Puerto Rico, and other U.S. territories. To be included in the survey, projects must include a description and location of a water quality-related public health problem, a site-specific solution, and detailed information on project cost.
Adequate wastewater infrastructure plays a vital role in the health of streams, rivers, and lakes, where discharged wastewater and stormwater runoff often end up. Wastewater infrastructure must also become more resilient to the impacts of climate change, including sea level rise, stronger and more frequent storms, flooding, and drought. Wastewater infrastructure improvements also support healthy economies. Construction projects create good-paying jobs, and where new facilities are built, workers are needed to operate and maintain them. Upgraded infrastructure results in cleaner water, which is essential for many businesses and sectors of the economy.
EPA launched the Water Infrastructure and Resiliency Finance Center in January 2015 to work with states and communities to identify innovative financing strategies for drinking water, wastewater, and stormwater infrastructure. The center recently selected regional Environmental Finance Centers to help communities across the country develop sustainable "how-to-pay" solutions to meet environmental goals. This financial expertise and technical assistance helps communities make informed funding decisions for resilient infrastructure projects that best meet local needs. In addition, EPA offers financial assistance to address the types of infrastructure needs covered in the survey.
The Clean Water State Revolving Fund has provided more than $111 billion in low-interest loans since its inception in 1987, with $5.8 billion in FY 2015 alone. Grant funding is available through the Alaska Native Villages and Rural Communities program, the Clean Water Indian Set-Aside, and the U.S.-Mexico Border Water Infrastructure program.
The $271 billion is primarily for projects needed within five years. The survey reported the following infrastructure needs:
- Secondary wastewater treatment: $52.4 billion to meet secondary treatment standards. Secondary treatment uses biological processes to meet the minimum level of treatment required by law.
- Advanced wastewater treatment: $49.6 billion to provide upgrades so treatment plants can attain a level of treatment more protective than secondary treatment. Advanced treatment may also treat nonconventional or toxic pollutants such as nitrogen, phosphorus, ammonia or metals.
- Conveyance system repair: $51.2 billion to rehabilitate and repair conveyance systems.
- New conveyance systems: $44.5 billion to install new sewer collection systems, interceptor sewers and pumping stations.
- Combined sewer overflow correction: $48 billion to prevent periodic discharges of mixed stormwater and untreated wastewater during wet-weather events.
- Stormwater management programs: $19.2 billion to plan and implement structural and nonstructural measures to control polluted runoff from storm events.
- Recycled water distribution: $6.1 billion for conveyance and further treatment of wastewater for reuse.
Visit http://www.epa.gov/cwns for more information on the report.
Green Infrastructure Wizard Connects Communities to Resources
October 2015
EPA released a new web-based tool, the Green Infrastructure Wizard (GIWiz), to help local officials and community members find tools and resources more easily. GIWiz offers quick, direct access to Green Infrastructure tools and resources that can support and promote water management and community planning decisions. Users can produce customized reports that include links to the resources they want to use. Click to Use the Wizard to search for resources for your community.
New Mitigation Publications – 2016
For more mitigation resources and other publications, go to KAMM's Mitigation Resources page.
Follow the links ….
Unified Federal Review Process Newsletter Dec 2015 The UFR Newsletter serves as outreach to multiple federal, tribal, state and local stakeholders as a way to showcase UFR Process efforts aimed at supporting communities affected by disaster. The newsletter allows agencies to stay involved with efforts to further develop a UFR Process across the nation.
Flood Loss Avoidance Benefits of Green Infrastructure for Stormwater Management. December 2015. This EPA modeling study estimates the flood loss avoidance benefits from application of small storm retention practices for new development and redevelopment nationwide. Twenty HUC8 watersheds were modeled in areas where significant growth is expected between 2020 and 2040, using the FEMA Hazus model and national-scale datasets. The area of the watersheds ranges between 500 and 3,000 square miles. The study was conducted in consultation with other federal agencies including the US Army Corps of Engineers, NOAA, and FEMA.
The approach was vetted by a panel of experts from government, academia, and industry. The results show that, over time, the use of green stormwater infrastructure can save hundreds of millions of dollars in flood losses, while just applying the practices to new development and redevelopment only. If retrofitting were to occur, the avoided losses would be even more significant. Download the document: Flood Loss Avoidance Benefits of Green Infrastructure for Stormwater Management.
Flood Resilience Guide to protect utilities. Introducing EPA's tool, Flood Resilience: A Basic Guide for Water and Wastewater Utilities, which was designed for small and medium drinking water and utilities and includes interactive worksheets, instructional videos, and flood maps. With a user-friendly layout, embedded videos, and flood maps to guide you, EPA's Flood Resilience Guide is your one-stop resource to protect your critical assets.
- Flood Resilience Guide Fact Sheet. Download the EPA Fact Sheet – Build Flood Resilience at Your Water Utility
USGS publishes "Identifying and preserving high-water mark data: techniques and methods 3-A24" March 18, 2016. The report serves as a field guide for identifying high-water marks and presents guidance and proper techniques for preserving, evaluating, and recording the data collected for use in surface-water modelling, flood documentation and much more.
FEMA Releases Damage Assessment Operating Manual. March 31, 2016, FEMA released the FEMA Damage Assessment Operating Manual. The manual establishes national damage assessment standards developed from lessons learned and best practices already in use and is intended to increase the accuracy, consistency, and efficiency of damage assessments by empowering emergency management at all levels with clear information and defined roles and responsibilities. The standards put forth in the manual will be the national standard utilized by states and tribes conducting damage assessments after disasters.
Handy Guide to NFIP Changes that Took Effect on April 1, 2016. Download "Making Sense of NFIP Regulatory Changes." A great e-book – a readable and understandable publication.
Hazard Mitigation Assistance Cost Share Guide. May 2016. The Hazard Mitigation Assistance Cost Share Guidance is a tool for Applicants, Subapplicants and FEMA to assist with understanding match requirements for FEMA's Hazard Mitigation Assistance (HMA) grants. The Guide encourages early coordination for cost share strategies and provides helpful examples for various approaches such as donated resources for the non-Federal cost share. Download the Hazard Mitigation Assistance Cost Share Guide.
Incorporating Environmental Justice into Regulatory Efforts. EPA recently issued its first-ever Technical Guidance for Assessing Environmental Justice in Regulatory Analysis. This guidance represents a significant step towards ensuring the impacts of EPA regulations on vulnerable populations are understood and considered in the decision-making process. The EJ Technical Guidance improves our ability to perform some of the most important work we do. Better integrating environmental justice in EPA's core regulatory function is essential to ensure that all Americans, regardless of their race, ethnicity, or income level, have access to clean water, clean air, and healthy communities.
KAMM mailing address: KAMM, PO Box 1016, Frankfort, KY 40602-1016.
Have questions, contact us at email@example.com. Don't forget to join the KAMM group on LinkedIn.
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Multistrand is a software package for simulating the kinetics of multiple interacting nucleic acid strands. It was developed by Joseph Schaeffer while in Erik Winfree's lab at the California Institute of Technology.DNA and Natural Algorithms Group @ Caltech
Key Features
This is the simplest way to use Multistrand for short simulations. A Multistrand server has been provided on terminal.com, configured as an interactive python environment that is configured with a number of useful packages including Multistrand, NUPACK, and various plotting libraries.After signing up with a free account, Multistrand can be launched in a single click by launching an instance of the Multistrand snapshot.
For longer simulations and better integration with your analysis pipeline, Multistrand can also be installed locally on your system.
Choose your preferred archive format.Download this project as a zip file Download this project as a tar.gz file
MD5 for tarball:
MD5 for zipfile:
Interactive versions of these tutorials are available.


text:
Julio César Abatte
From Wikipedia, the free encyclopedia
This article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)(Learn how and when to remove this template message)
Julio César Abatte (born in Mendoza, Argentina) is a former Argentine footballer currently played for Clubs of Chile.
- Ferrobadminton 1946-1948
- Universidad de Chile 1949-1951
- Rangers 1952-1953
External links[edit]
- Profile at BDFA Profile at
|This biographical article related to Argentine football is a stub. You can help Wikipedia by expanding it.