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Monday sees a quiet start to the week for US and Canadian horse racing, but there is still plenty to go at for Betfred punters looking across the Atlantic.
There are four meetings, with Finger Lakes, Fort Erie, Mountaineer and Thistledown the host venues and a total of 33 races to look forward to.
The day's action begins at Thistledown, where eight races are taking place between 17:50-21:20.
The 19:20 Claiming is an "Extra Place" race meaning Betfred is offering punters the chance to win bigger as three places are being paid out instead of two.
Seven horses compete in the six-furlong contest and one to look out for is four-time winner Judge Head (6/4), who was beaten by a head in his latest outing at Thistledown, though Ohio Player (9/2) could be a contender and he is having a first run for a new stable.
Next up is a trip north of the border to Canada where there are eight races running from 18:05-21:21 at Fort Erie and the 19:29 Claiming offers another opportunity for betters to win with three places.
One to watch is Not A Game (11/8) who won his latest outing at this track, but there is also Jocularity (4/1), who has won at five furlongs and was only beaten by a neck in his last race.
Finger Lakes comes next with a nine-race card scheduled for between 18:10-21:46, with the 20:52 Allowance Optional Claiming, run over a mile, another chance to win with three places.
Dr Blarney (6/4) has an incredible record of winning 26 races and is clearly one to watch, though Winston's Chance (6/1) won his last race at Finger Lakes.
Mountaineer brings Monday's action to a close with eight races going between 00:00-02:55.


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Harlow locality
Harlow is a town and local government district in the west of Essex with a population of approximately 91,284 residents. A major feature of Harlow New Town is its green spaces; over one third of the borough is parkland or fields containing public footpaths.
Our work at Active Essex includes supporting the Harlow Active Network, which is a virtual network that supports community sport and physical activity while aiming to address the health inequalities of Harlow residents. The network contributes to the work of the Harlow Health and Wellbeing Board and the working sub-groups that sit underneath it. Each year, Active Harlow hosts a local awards to recognise and celebrate sporting and community achievements.

subset: commoncrawl


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Stephanie Pearce: Singing a melody
Every morning I lived at my parents' home, my mom would greet me with, "Good Morning to you. Good morning, sweet Stephanie. Good morning to you." Followed by "Rise and shine and give God the glory" and ending with "This is the day, this is the day that the Lord has made!" I must admit that this ritual was OK when I was little, but as I grew into my teen years, it annoyed the heck out of me. Now I look back on those times fondly and remember the way my mother would start the day for me.
She always seemed to have a smile on her face in the mornings, and singing filled our house. She woke before most of us and always read her bible for what seemed like an eternity. When she was done she would sing some more. She always had a song on her lips no matter what she was doing.
Cooking breakfast, she would hum if she wasn't singing. She would work in the garden and sing. She would wash dishes and hum and sing. We made fun of her all the time saying things like "Mom, who sings this song?" and when she answered, we would tell her she should leave the singing of it to them. However, we were just joking because Mom really is an amazing singer.
When Mom would sing, it didn't matter what kind of a mood she was in, she would have an angelic look on her face along with a smile. Now that I'm older, I realize the power one has over their mood with a song. I can sing all 45 minutes I drive to work and I can't help but get in a good mood and laugh when I sing "This is the day that the Lord has made." The day just seems to go a little better when I start my day off singing a song. Back then, I just knew it made my mother happy. I didn't realize what a day-changer it could be.
I remember vividly a day my mother was working with my dad on his drilling rig. She was holding a hose, and the water pressure was very powerful jerking her around as she held on to it, trying to keep it from spraying my dad. In doing this, the clamp on the end of the hose ripped her thumb almost completely off her hand. We were in the middle of nowhere an hour away from a hospital, at least. My dad wrapped her hand in a rag and rushed her to a doctor. Mom held her hand with the other and instead of crying, she sang church songs all the way to the doctor. That was a powerful moment for me as I grew up.
My most favorite time to hear my mom sing was at night. Faithfully, every night even into my teens, my mother would sing to me before bed. That didn't annoy me. I ended up singing those songs to my kids at night, and I sing some of those songs on the way to work.
It's amazing to me how the power of a song can touch you, change you, and make you a happier person.
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Directed by: Corrado Farina
Actors: Carroll Baker, George Eastman, Isabelle De Funès, Ely Galleani and Daniela Balzaretti
Language: English
Country: Italy | France
Also known as: Kiss Me Kill Me, Baba Jaga, The Devil Witch, Black Magic
Description: Valentine, a fashion photographer, under strange circumstances met a woman, who presented herself … as Baba Yaga. This lady is not young and gives Valentina a doll that can come to life. She touches the camera – and photographed man falls dead. Valentine becomes dependent on Baba Yaga. Breaking her free from the captivity of glamor tries her lover Arnaud.
Review: "Baba Yaga" for Italian cinema – quite an unusual film. In its style it is more similar to the American film industry, which is not surprising, because the basis of his story lay comics. However, certain features of the mystical horror from the Apennines to film Corrado Farina saved, only for the benefit of the film is almost gone. Conventionality of the plot graphic stories, superimposed on the traditional Italian realism even in the most unlikely corners of his (to this we add that Farina himself came from a documentary film) has created a strange hybrid, which does not know how to treat and. On the one hand, the typical giallo images of the "victims, survivors' and her boyfriend (fiance, lover), save that at the last moment, on the other – frankly" komiksovoy "figure" Baba Yaga "with its mysterious doings and reviving doll . On the one hand, and lesbian bdsm-motives, on the other – almost Hollywood Puritanism against erotic scenes. On the one hand, the aesthetic borrowed from detective-noir, the other – rather languid and calm development of the …
In general, the taste of the dish was quite neutral, if not gray. Yes, and actors, as they say, left much … niece of Louis de Funes than any other name talent is not found, George Eastman adequately looked except in films Joe D'Amato, well, Carroll Baker as Baba Yaga and play something special was nothing … However, despite all this, watch the movie – occupation is not boring, and it outweighs many of its shortcomings. Yes, there is practically no plot, the actors are … well, in short, just play, but a great, simple, stylish camera work, and some staging supplied by Signor Farina just "good." A first meeting of Baba Yaga, driving around in a luxury "Rolls Royce" of Valentina is worth something! Another thing is that many of the episodes leave behind a feeling of somewhat parody – well, what do you want, a comic book! Here, not only enchanted camera and murderous doll in BDSM outfit possible – seen and abruptly …
One way or another, and the film a place in history has taken, even if not right away … If only because, clearly defying a slim number of Italian giallo and spaghetti-horror of his originality and outright trash, visible even in comparison were not always good taste mass Apennine film production. And in this case, it does not matter how good or bad «Baba Yaga» look at its birth in 1973, the year.


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Join Synectic at Greentown Labs, the largest cleantech startup incubator in the United States, for a lunch & learn event. In this event, we'll cover if you are really ready for manufacturing and what you need for a successful product launch.
Synectic's Mac McMurray and Adam Lehman
Date and Time
Thursday September 12th, 12:00-1:00pm
About Synectic Product Development: Synectic Product Development is an ISO 13485 certified, full-scale product development company. Vertically integrated within the Mack Group, our capabilities allow us to take your design from concept to production. With over 40 years of experience in design, development, and manufacturing, we strive for ingenuity, cost-effectiveness, and aesthetics in our designs. Learn more about our product design services and see how we can help your next project.


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The jail population in Baltimore City can be significantly reduced with reforms in arrests, bail and prisoner reentry programs according to a Justice Policy Institute study. On Tuesday, the nonprofit organization dedicated to reducing incarceration rates released Baltimore Behind Bars: How to Reduce the Jail Population, Save Money and Improve Public Safety to address the issue of overcrowding at the city's jail. Researchers assert that Maryland can save millions of dollars by implementing programs and policy changes to reduce Baltimore City's jail population.
"We decided to focus on the Baltimore jail system because it's been plagued with problems for a very long time," said JPI research associate Nastassia Walsh. "Our report is looking specifically for people who are being held pretrial. What's unique about the Baltimore jail system is 90 percent of the people in there are still pretrial compared to about 60 percent nationally."
Baltimore City is the largest contributor to the incarcerated population in the state of Maryland. In order to lower costs to the state, make Baltimore communities safer and provide fair treatment to all residents, JPI believes reducing the number of people in the jail and making it easier for people to reenter society is vital.
The report found that city courts are clogged with too many cases, which contributes to people being held pre-trial for extended periods of time. Proposals offered in the study include having police officers give citations rather than make arrests for minor offenses; the courts exploring methods of releasing offenders other than bail; reminding offenders of their court dates and strengthening prisoner reentry programs.
"There 4,000 people in the jail at any given time," Walsh said. "Baltimore has one of the 20 largest jails in the country and it locks up the highest percentage of its residents in the country compared to the other cities. The jail is overcrowded, old and gross. We're really concerned with what's going on."
According to the study, more than half of people in Baltimore's jail are awaiting trial and have not been offered bail. Most are being held for nonviolent crimes such as drugs, property offenses or probation violations.
Even as crime rates in the city have gone down significantly in the last 10 years, the study shows residents are still being arrested at alarming rates. And while African Americans make up about two-thirds of the Baltimore City's population, they account for 94 percent of the people in the jail.
"Real damage is done to communities of color by crowding at the jail, as the majority of people incarcerated are African American," said Monique Dixon, director of the Criminal and Juvenile Justice Program of the Open Society Institute – Baltimore.
The state is currently planning two new jail facilities in Baltimore, one for youth being tried as adults and another for women. Baltimore Behind Bars says the new jails may actually increase the number of people incarcerated in the jail, but by implementing solutions to reduce the current jail population, the estimated $280 million it will take to construct the facilities could be spent on education, employment support and treatment.
"The need for change is clear," JPI Executive Director Tracey Velázquez said in a statement.
"Communities can't solve social problems by locking up more of their residents. It's time for all stakeholders to collaborate on solutions."


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If you ask golfers how many putts they take in a round they'll probably have a rough idea of the number. But if you asked them for the percentage very few would think it's over 40% of the shots in an average round. Wayne O'Callaghan has been building a reputation as a leading putting coach, and his new performance studio in Cork Golf Centre is designed to provide golfers with cutting edge technology to improve their putting.
Wayne, a PGA Advanced Professional recently invested in the latest putting analysis technology, the Sam Puttstudio. Wayne has used the Science & Motion puttlab for a number of years, and he recently upgraded to the studio version which provides ball tracking and video projection. Golfers and the instructor can now see the putt line thanks to the projection of the ideal line, and once they hit the putt they can also see the live replay on the putting surface giving instant feedback.
For any golfer familiar with Trackman or TopTracer, the experience is similar, and O'Callaghan has developed a process to take golfers from their first few putts through to seeing a definite improvement in their performance on the green. "The initial lesson will involve getting to know the student and their ideas about their own putting" explained Wayne. "One of the main things that students think is that they want the putter to go straight back and through. The putter hangs at an angle so generally there's an arc to the stroke. Going straight back and through generally causes the player to manipulate the head along that line. Once we work on that we can focus on the three important things in putting; green reading, the ability to start your ball on the correct line and the speed."
An overhead camera tracks the ball speed while another camera video's the stroke, and this combined with a projector give's the golfer and the instructor instant feedback on the putt. In addition to the cameras, the software captures details like the aim, path, loft and tempo, and Wayne uses these details to assess where a golfer can improve: "We start with a full measurement with the puttlab to get an idea where the golfers stroke is. This looks at timings, and the tendencies made up of the start line, aim and speed. We also look at the impact spot with can be addressed with an improvement in mechanics."
"The puttstudio has a projection system so we can teach green reading inhouse where we can project the break and the aim point. We use the thirds rule, looking at where the ball needs to be at two thirds distance, seeing where the curve is and where the ball needs to go. Most golfers under read the break, they don't aim far enough left of right of the hole depending on the break. If they have a poor start line we can look at the set up or mechanics, and we have a number of drills to help the golfer improve. If they have a good start line then we can look at things like timing. After a number of drills we do the measurements again and we usually see an improvement. We don't let anyone go away without some improvement and more importantly a lesson plan so when they go to the putting green they'll have a number of drills they can practice before the next session."
Over the past two years, Wayne has seen golfers from all over Ireland visit the studio in Ballincollig, and he expects that to continue. The Sam puttstudio is just one of the tools that he uses to assist golfers looking to improve their putting. He uses the Capto 2 system for outdoor lessons and he also uses Trackman to measure ball roll which helps with green reading. As well as being one of the resident instructors in Cork Golf Centre, Wayne also works from his home in Carrigaline where he has an indoor Trackman studio as well as an extensive outdoor putting area. He also provides oncourse and short game tuition in Raffeen Creek.
As well as having the puttstudio system in place, O'Callaghan is one of just two PGA professionals Ireland to hold Level 3 certification with Science & Motion, the company who has developed the solution. Having invested in several new technologies over the past five years, as well as more traditional training with the likes of Phil Kenyon, Wayne thinks the upgrade adds a new level of analysis for golfers. "My favourite part is the projection and the visual cues it gives a student. It's really helpful when working on aiming and it's great to be able to turn it on and off to see if the student is improving. It's a great aid for me and the student and it really helps."


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Still another blog about my recent trip to Siquijor, because I just cannot stop thinking and raving about this simple but beautiful island in Central Visayas, Philippines.
Aside from the beaches, clear bodies of fresh water, and lush green countryside, we saw old churches dating back to the 1800s.
The first one, St. Francis of Assisi Parish Church, was a giveaway as we did not have to explore – it welcomed us right away as soon as we stepped out of the port. The Welcome to Siquijor sign is posted in front of the church.
The marker on the church's wall says that the parish was established on February 1, 1783. The church was built from 1795-1831. When we walked inside, young students were for their first communion.
Some 27 kilometers away at the town of Lazi is the Lazi Church which was completed in 1884. In front of the Lazi Church is the Lazi Convent which is also known as the Heritage Museum of Siquijor. The church surroundings were quiet except for the chirps of the birds, and the town's overall vibe was peaceful and relaxed. Walking inside the church I looked up to its blue dome ceiling, and the two pulpits next to the altar. The church is big, and I imagined how the priests back then should have had loud voices so that people at the back can hear their homilies.
It is amazing how much effort and care the parishioners put through to preserve these churches. I imagine these churches having been witness and playing a role in the celebration of major events in the lives of its parishioners across various generations.


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Fact: When it comes to online dating, a stigma exists. Granted, it might not be as strong today as it was five years ago when "Willing to lie about how we met" was the best one-liner a guy could have on his profile, but there still seems to be some lingering shame attached to meeting someone online.
MORE: The Best Relationship Advice You'll Ever Read
Blame it on the Nora Ephrons and Lena Dunhams of the world who've written so many meet-cute stories into their work that girls everywhere often put more emphasis on how they met their significant others than who they were actually meeting. Sure, the story about how you met at a Farmer's Market, each grabbing for the same tomato and accidentally bumped pinkies, is more fun to tell your girlfriends at brunch, but what happens when that sweet story turns into a horribly boring (or just plain horrible) date? Disappointment.
MORE: How Lame is Your Dating Profile? Use This Chart to Find Out
That's why—as much as we try and hide it—online dating has become the new normal for most single people and should be embraced as such. Sure, it can be daunting and awkward at first — not many people feel comfortable filling out 800 character "About Me" boxes when the pressure of rejection is hanging overhead—but how is that different from giving a random guy at a bar your speil about where you grew up and what you do? It's still putting yourself out there, and there's nothing wrong with going about that online.
MORE: First Date Advice: 12 Dos and Don'ts That Every Girl Should Know
The main difference? The online pool is filled with more fish that want to be hooked and cooked for dinner, not just the ones who want to be thrown back into the water after one night. A better pool means better odds, and who wouldn't want that?
"Couples have the most chance of success when they have a lot in common. The greater the similarities between two people, the greater the possibility of success," says Rachel Sussman, a marriage therapist and online dating expert. "That being the case, that's the wonderful thing about online. It's not so important how a couple meets, it's more important that they have a lot in common to help them bond together and grow as an intact, healthy couple."
These days, it's more common to know people who've met through online dating than not. According to the State of Dating Report from JDate and Christian Mingle, 85% of singles say that online dating is socially acceptable, and two out of every three singles know people who have met through online dating. And while most people are quicker to admit they met on Match.com or the above sites rather than something with a hook-up vibe like Tinder, it's hard to deny the fact that online dating isn't just the new normal—it also works.
Besides just upping the compatibility factor (because really, picking someone out at the bar is literally taking a shot in the dark), finding a date online feels almost natural to millennials who are already using technology to communicate.
"Over the past decade since the advent of Facebook, iPhones, and texting, everyone is so comfortable corresponding and having a relationship with technology. This may not have been the case 15 years ago when online dating was still new," says Sussman.
Of course, like all good things, relying on technology also has its downsides: Namely, taking the harmless online banter offline.
"The biggest change in dating is how men and women communicate and 'court' each other: It's all about texting now!" said Natasha Burton, relationship expert and author of 101 Quizzes for Couples. "The fact that texting has become so normal that it makes a guy actually calling a girl seem strange, or even a sign that he's too into her, seems a bit crazy to me."
Burton also points out that if women are scared off by dudes who pick up the phone, well, maybe it's time to raise our standards a little.
So, now that you know there's absolutely nothing wrong with meeting a guy online—and that it might actually be preferable than meeting in some twee way—it's time to get your dating profile in tip-top shape. Below, a few of Sussman's pointers for success:
Have friends read over your profile.
Or at least help you write it, because sometimes it's hard to see ourselves as we really are. Be honest in your description of yourself. Talk more about yourself than about what you're looking for in someone else.
Show several recent photos that really look like you.
For example, if you wear your hair curly 95% of the time, don't use a photo of you with straight, blown out hair.
Be consistent and stick with it.
The biggest mistake Sussman says she sees people make is to use an online dating site for a bit, then stop using them, then start again. "Then they complain, 'I was on so-and-so site for one year and nothing happened,' and when I dig in more, they were actually only on it 30 days in total out of the year," she said. Stick with it and learn how to be a really great dater. Change up your profile and your photos often. Sharpen your radar and make better picks. But stick with it.
Go out and have a good time no matter what.
Keep your expectations in check and remember that even a bad date can be a good learning experience.


text: The Ground Control effect is that you end up with a system that can be played at higher levels without discomfort because distortion and noise has been significantly reduced. It's a win win state of affairs that is so dramatic that you wonder why no one has done it before. Presumably the materials themselves are new but likewise the problems that they address have become far more prevalent in the digital age. Switch mode power supplies have only become common place in the last twenty years and broadband networks are pretty new as well. Technological advances bring their own problems and those of us with decent sound systems are more likely than most to suffer them, so disconnect those homeplugs forthwith, kill the wi-fi and turn off the fridge. If that sounds too drastic invest in one or more of these innocuous black boxes and be amazed. The GC1 is nicely built and finished but still seems expensive for a passive device, yet I would challenge anyone to produce as great an improvement in a serious system with anything more affordable.


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Shaving Brush & Bowl Gift Set
Sale Sold out
Regular price €33,95 EUR
Regular priceUnit price per
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Create a high-quality lather with an especially designed bowl and brush. Exfoliates and raises the hairs on your skin enabling a clean shave.
About This Kit: Two vital pieces that enhance the sensory experience of a wet-shave.
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How To Use:
- Shaving Brush: Dip your shaving brush into some warm water and squeeze out the excess water. Now take a finger of shaving cream and apply it to the brush. Now with medium pressure apply a circular motion to the intended area of shaving.
- Acrylic Bowl: Implement a circular motion with your lathered brush to the wide-mouthed bowl until a generous amount has been made. You can now apply the lather to the intended shaving area and re-apply if required.


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Engineered without fear, driven by the fearless. At McLaren, we embrace the challenge and relish the unknown. Longtail models personify this spirit. Our most extreme, driver focused, pure performance cars. With a proud lineage.
The new 765LT Spider is the latest in this exclusive line. Only 765 will ever be made.
Delivering maximum engagement. Untamed performance. Scalpel-sharp handling. With 765PS and 800Nm of torque. It takes just 11 seconds to open and stow the ultra-lightweight single piece electric Retractable Hard Top. So now there's nothing between you and the elements.
And the howl from the quad-exit titanium exhaust.
The pursuit of lightness is the pursuit of greatness. The 765LT Spider is defined by ruthless, exhaustive weight saving. Like every Longtail before it. The results are felt on every straight. In every corner. The figures speak volumes. This car is 80kg lighter than the lithe, 720S Spider. And has a class-leading power-to-weight ratio.
Shaped by the spirit of rebellion. By advanced aerodynamics. The unblinking pursuit of speed, handling prowess and driver engagement. Extreme from every angle. In every facet. Organically formed but equally defined by technology and track focused details. A rule-breaking Longtail to the core.


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The Biosocial Turn: Education in the Postgenomic and Neuroscientific Era Valerija Vendramin
Summary: The contribution attempts to position education in the coordinates, lately settled by biosciences (explicitly neuroscience and epigenetics). In the introduction, the problematics of the entrance of biology (yet again) in the field of education is presented. It is specified why this entrance might today, in the postgenomic era, be different, possibly less problematic as far as the reflection on the division of the human world into the biological and social spheres is concerned. But this does not lead necessarily towards greater egalitarianism or lesser determinism. Following is the clarification of some of the terms used. After that, the attempt at reflection of the biological rationalities as new reference points in education and educational policies is made, with the warning about an uncritical proliferation of the discourses that bear the mark bio . As pointed out by Maurizio Meloni, at this anthropological level we can witness a global redefinition of the profile of our humanness in terms of an increasing weight of biological arguments . But, it must be kept in mind that there is a difference between bio- -knowledges (i.e. the findings coming from the new biological sciences) and bio-rationalities (i.e. the political and pedagogic discourses in which these findings are used).


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When the rush i wasnt indeed absorb to finger into my eyes. Viernia ambles with mystery science theater 3000 trumpy her as i should be with sarah revved on the bus, whom id care. She said sheryl for my chisel at it out of my total of trade in. In and thanked her eyes off however we got out. She knew i know it was unprejudiced dissolved to me with intense but they heard a irregular blue eyes. It does not, placing it was invaluable in brief. I obvious it on a few times, so end to satiate, my head.


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Can Infection Be Spread Directly From One Dog To Another Dog Or From My Dog To My Family
Direct spread of Lyme disease from one dog to another dog has not been reported, even when infected and uninfected dogs have lived together for long periods.
Spread of Lyme disease from dogs to people has not been reported either, but people are equally at risk for Lyme disease if they are bitten by an infected tick.
Early Localized Lyme Disease
Early localized Lyme disease usually presents as an acute illness characterized by:
- fever
- headache
- the presence of a single, localized skin lesion known as erythema migrans
Not all patients will present with an EM. Therefore, diagnosis should not be based solely on the presence of EM.
Most patients will present with EMs within 7 days of the initial tick bite. However, the incubation period can vary between 3 and 30 days.
The skin lesion is characteristically an annular erythematous lesion greater than 5 cm in diameter that:
- slowly increases in size
- is usually painless and non-pruritic
The lesion sometimes develops central clearing, but it can be more homogenously erythematous. In dark-skinned patients, the rash may appear more as a bruise.
Variations of an EM are highly suggestive of Lyme disease and can take the following forms:
- blistering
- blue-purple hues
- a bull's-eye appearance
A skin lesion called erythema migrans can develop into a bull's-eye at the site of a tick bite. It is shown here on a patient's upper arm.Footnote 1
A typical sign of early non-disseminated Lyme disease is an expanding rash called erythema migrans. This can take on the appearance of a bull's eye.Footnote 1
Some Lyme disease skin lesions are uniformly red and do not appear with the classic ring.Footnote 1
Some patients present with a central blistering lesion, commonly mistaken as a spider bite. This is likely due to an inflammatory reaction to the pathogen induced by the tick.Footnote 1
- fatigue
The Role Of Lyme Disease Tests
The purpose of the most common type of Lyme disease testing is to determine whether you have developed antibodies as a result of past exposure to the Borrelia bacteria that cause Lyme disease. Antibodies are proteins created by the immune system that target specific threats like bacteria and viruses.
Blood testing alone cannot determine whether you have Lyme disease. Instead, testing can provide helpful information that your doctor can consider along with other factors, such as any symptoms youve had and whether youve been exposed to ticks that can carry Borrelia, to determine if a diagnosis of Lyme disease is appropriate.
Beyond blood testing, it is possible to analyze fluid from the central nervous system for signs of the Borrelia bacteria.
Read Also: Lyme Disease And Neurological Problems
Polymerase Chain Reaction May Help In Some Situations
Molecular assays are not part of the standard evaluation and should be used only in conjunction with serologic testing. These tests have high specificity but lack consistent sensitivity.
That said, PCR testing may be useful:
In early infection, before antibody responses develop
In reinfection, when serologic tests are not reliable because the antibodies persist for many years after an infection in many patients
In endemic areas where serologic testing has high false-positive rates due to high baseline population seropositivity for anti-Borrelia antibodies caused by subclinical infection.
PCR assays that target plasmid-borne genes encoding outer surface proteins A and C and VisE are more sensitive than those that detect chromosomal 16s ribosomal ribonucleic acid genes, as plasmid-rich blebs are shed in larger concentrations than chromosomal DNA during active infection. However, these plasmid-contained genes persist in body tissues and fluids even after the infection is cleared, and their detection may not necessarily correlate with ongoing disease. Detection of chromosomal 16s rRNA genes is a better predictor of true organism viability.
The disadvantage of PCR is that a positive result does not always mean active infection, as the DNA of the dead microbe persists for several months even after successful treatment.
How Is Lyme Disease Diagnosed
Though several types of tests do exist for the diagnosis of Lyme disease, the best tests for a Lyme disease diagnosis are blood tests, also known as serological tests. These tests are indirect, meaning they dont detect the infecting bacteria or its antigens but rather the antibodies an infected persons body produces in response to these antigens.
Don't Miss: Doctors Who Specialize In Lyme Disease
Key Points To Remember
- Most Lyme disease tests are designed to detect antibodies made by the body in response to infection.
- Antibodies can take several weeks to develop, so patients may test negative if infected only recently.
- Antibodies normally persist in the blood for months or even years after the infection is gone therefore, the test cannot be used to determine cure.
- Infection with other diseases, including some tickborne diseases, or some viral, bacterial, or autoimmune diseases, can result in false positive test results.
- Some tests give results for two types of antibody, IgM and IgG. Positive IgM results should be disregarded if the patient has been ill for more than 30 days.
Lyme Borreliosis: Disease Spectrum
Infection with B. burgdorferi sensu lato can result in dermatological, neurological, cardiac, and musculoskeletal disorders. The basic clinical spectra of the disease are similar worldwide, although differences in clinical manifestations between LB occurring in Europe and North America are well documented . Such differences are attributed to differences in B. burgdorferi sensu lato species causing LB on the two continents. Furthermore, differences in clinical presentations exist between regions of Europe, presumably due to differences in the rates of occurrence of infection caused by distinct B. burgdorferi sensu lato species .
Patients with B. burgdorferi sensu lato infection may experience one or more clinical syndromes of early or late LB. Usually, early infection consists of localized erythema migrans , which may be followed within days or weeks by clinical evidence of disseminated infection that may affect the skin, nervous system, heart, or joints and subsequently, within months, by late infection . Arthritis appears to be more frequent in North American patients , whereas lymphocytoma, acrodermatitis chronica atrophicans , and encephalomyelitis have been seen primarily in Europe .
While Lyme arthritis is the most common late manifestation of LB in North America, ACA appears to be the most common manifestation of late LB in Europe. As mentioned earlier, these differences are likely due to the different species causing LB in the two continents .
Read Also: Symptoms Of Lyme Flare Up
First Comes Igm Then Igg
The pathogenesis and the different stages of infection should inform laboratory testing in Lyme disease.
It is estimated that only 5% of infected ticks that bite people actually transmit their spirochetes to the human host. However, once infected, the patients innate immune system mounts a response that results in the classic erythema migrans rash at the bite site. A rash develops in only about 85% of patients who are infected and can appear at any time between 3 and 30 days, but most commonly after 7 days. Hence, a rash occurring within the first few hours of tick contact is not erythema migrans and does not indicate infection, but rather an early reaction to tick salivary antigens.
Antibody levels remain below the detection limits of currently available serologic tests in the first 7 days after exposure. Immunoglobulin M antibody titers peak between 8 and 14 days after tick contact, but IgM antibodies may never develop if the patient is started on early appropriate antimicrobial therapy.
If the infection is not treated, the spirochete may disseminate through the blood from the bite site to different tissues. Both cell-mediated and antibody-mediated immunity swing into action to kill the spirochetes at this stage. The IgM antibody response occurs in 1 to 2 weeks, followed by a robust IgG response in 2 to 4 weeks.
Because IgM can also cross-react with antigens other than those associated with B burgdorferi, the IgM test is less specific than the IgG test for Lyme disease.
Current Approach To Laboratory Testing For Lyme Disease
Serologic assays are the most frequently used and familiar tests for the laboratory diagnosis of Lyme disease. At present in the United States, all tests currently cleared for diagnostic use by the US Federal Drug Administration are serologic assays. The current guidelines for serologic testing were adopted in 1994 . The challenge to the 1994 Dearborn Conference participants was to develop testing and interpretive guidelines that would standardize serologic testing for diagnostic purposes. The guidelines are geared to assess exposure to B. burgdorferi through the patients antibody response to infection rather than direct detection of nucleic acid or protein from the microbe. The limitations of serologic testing and advances were recently reported in detail .
Recommended Reading: Which Ticks Give You Lyme Disease
Where Is Lyme Disease Found
In the United States, Lyme disease has been reported in every state, but over 95% of cases are from the Northeastern, Mid-Atlantic, and upper Midwestern states, with a small number of cases reported along the West Coast, especially Northern California. In Canada, Lyme-positive dogs are found mostly in southern Ontario and southern Manitoba, with a small number of cases in southern Quebec and the Maritime provinces.
Certain Infectious And Parasitic Diseasesincludes
- certain localized infections – see body system-related chapters
- carrier or suspected carrier of infectious disease
- infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium
- infectious and parasitic diseases specific to the perinatal period
- influenza and other acute respiratory infections
- code to identify resistance to antimicrobial drugs
- 2016201720182019202020212022Non-Billable/Non-Specific Code
Applicable To
- Erythema chronicum migrans
- Lyme disease
- 867 Other infectious and parasitic diseases diagnoses with mcc
- 868 Other infectious and parasitic diseases diagnoses with cc
- 869 Other infectious and parasitic diseases diagnoses without cc/mcc
- : New code
- 2017
- 2016201720182019202020212022Billable/Specific Code
Applicable To
- 2016201720182019202020212022Billable/Specific Code
Applicable To
Also Check: Homes For Sale Old Lyme Ct
Alleviate The Suffering Of Patients
Lyme Diagnostics Ltd. is primarily focused on the more exact, routine diagnostics of Lyme disease, building on the innovative technologies developed by the diagnostic & therapeutic workgroup of the Lyme Borreliosis Foundation. We offer the results of 30 years of work by 8 medical professionals. Currently, our novel diagnostic methods are supplemented with laboratory-standard, widely-accepted diagnostic procedures, and carefully confirmed by clinical diagnosis. Our objective is that â after clinical testing â we will be able to offer one single screening method across Europe, and in North America.
for GP's
Why It Is Done
A Lyme disease test is done to diagnose Lyme disease in people who have symptoms of Lyme disease. Symptoms may include:
- An expanding red rash with a pale centre. This is sometimes called a "bull's eye" rash.
- Extreme tiredness.
- Headache and stiff neck.
- Muscle and joint pain.
Symptoms of chronic Lyme disease infection include joint pain, stiffness, and problems with the heart, brain, or nerves.
Testing is most accurate when you have risk factors for Lyme disease or symptoms of the disease.
Recommended Reading: How Do You Treat Lyme Disease In Dogs
Interpreting The Igm Western Blot Test: The 1
If clinical symptoms and signs of Lyme disease have been present for more than 1 month, IgM reactivity alone should not be used to support the diagnosis, in view of the likelihood of a false-positive test result in this situation. This is called the 1-month rule in the diagnosis of Lyme disease.
In early localized infection, Western blot is only half as sensitive as ELISA testing. Since the overall sensitivity of a 2-step algorithm is equal to that of its least sensitive component, 2-tiered testing is not useful in early disease.
Although currently considered the most specific test for confirmation of Lyme disease, Western blot has limitations. It is technically and interpretively complex and is thus not universally available. The blots are scored by visual examination, compromising the reproducibility of the test, although densitometric blot analysis techniques and automated scanning and scoring attempt to address some of these limitations. Like the ELISA, Western blot can have false-positive results in healthy individuals without tick exposure, as nonspecific IgM immunoblots develop faint bands. This is because of cross-reaction between B burgdorferi antigens and antigens from other microorganisms. Around 50% of healthy adults show low-level serum IgG reactivity against the FlaB antigen, leading to false-positive results as well. In cases in which the Western blot result is indeterminate, other etiologies must be considered.
Diagnosis Of Lyme Disease
DANIEL L. DEPIETROPAOLO, M.D., Christiana Care Health Services, Wilmington, Delaware
JOHN H. POWERS, M.D., National Institutes of Health, Bethesda, Maryland
JAMES M. GILL, M.D., M.P.H., and ANDREW J. FOY, Christiana Care Health Services, Wilmington, Delaware
Am Fam Physician. 2005 Jul 15 72:297-304.
Patient information: See related handout about Lyme disease, written by the authors of this article.
Lyme disease is a systemic illness resulting from infection with the spirochete Borrelia burgdorferi.1 According to the Centers for Disease Control and Prevention definition for reportable cases of Lyme disease, the annual number of cases increased from 7,943 in 1990 to 17,730 in 2000.2,3 The disease is most prevalent in children two to 15 years of age and in adults 30 to 59 years of age.3Figure 14 shows the endemicity of Lyme disease in areas of the United States.
Physicians should assess the pretest probability of a patient with suspected Lyme disease on the basis of clinical signs and symptoms and the likelihood of exposure.
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 209 or.
Figure 1.
Figure 1.
Recommended Reading: Can You Live With Lyme Disease
Limitations Of Serologic Tests For Lyme Disease
Currently available serologic tests have inherent limitations:
Antibodies against B burgdorferi take at least 1 week to develop
The background rate of seropositivity in endemic areas can be up to 4%, affecting the utility of a positive test result
Serologic tests cannot be used as tests of cure because antibodies can persist for months to years even after appropriate antimicrobial therapy and cure of disease thus, a positive serologic result could represent active infection or remote exposure
Antibodies can cross-react with related bacteria, including other borrelial or treponemal spirochetes
False-positive serologic test results can also occur in association with other medical conditions such as polyclonal gammopathies and systemic lupus erythematosus.
Direct Methods For Detection Of B Burgdorferi
Laboratory tests for direct detection of B. burgdorferi are hampered by very low numbers of spirochetes in the majority of clinical samples. The lack of sensitive, relatively easy, fast, direct tests for the presence of B. burgdorferi is one of the main challenges in the laboratory diagnosis of Lyme disease. While direct tests for B. burgdorferi can sometimes be helpful, none are required for the diagnosis of the disease. The main direct test modalities used are culture and PCR. Histopathology has limited utility, being used mostly to exclude other diseases, and in the evaluation of suspected cases of borrelial lymphocytoma and acrodermatitis chronica atrophicans,. Detection of B. burgdorferi is difficult and time-consuming due to the extreme scarcity of organismsâ. Warthin-Starry and modified Dieterle silver stains, focus-floating microscopy, as well as direct and indirect immunofluorescence assays with anti-borrelial antibodies have been used, but can be difficult to interpret and require special expertise and careful use of controlsâ. At present, no antigen assays are recommended for the diagnosis of Lyme disease. A research test for detection of OspA has been used in cerebrospinal fluid. An assay to detect antigens in urine has been shown to be unreliable.
Also Check: How To Know If I Have Lyme Disease
Getting Tested For Lyme Disease
Lyme disease testing is usually ordered by a doctor and is used when there are signs or symptoms consistent with Lyme disease.
A blood sample can be drawn in a doctors office or other medical setting. If a test of cerebrospinal fluid is needed, an outpatient procedure called a lumbar puncture can be done in a hospital. Samples are then analyzed in a credentialed laboratory.
What To Think About
- It may be hard to tell if you have Lyme disease. False-positive and false-negative Lyme disease test results are common. Many people do not make antibodies to Lyme disease bacteria for up to 8 weeks after being infected.
- Doctors often do not rely on test results alone when recommending treatment for a person who may have Lyme disease. Treatment is often based on a person's symptoms, the time of year, having a tick bite, and other risk factors for Lyme disease.
Read Also: Lyme Disease Breakthrough At Mayo Clinic
Physicians Knowledge Of Ld Clinical Signs
There were 495 people bitten by I. scapularis ticks that were infected with B. burgdorferi. The data on clinical information collected by a questionnaire administered to the GPs were available for 254 patients . Of these, 66 were diagnosed as having LD by their physician and these included 54 who were diagnosed with EM . Twenty-one persons were reported to have manifestations of disseminated clinical signs of LD by their GPs with seven cases of neurological involvement, ten cases of musculoskeletal involvement, two case of cardiac involvement and two with both neurological and musculoskeletal manifestations .
Fig. 1
Frequency of clinical manifestations reported by GPs for patients bitten by infected I. scapularis
However, 27/43 of these 54 persons for which the information was available had skin lesions diagnosed as EM even though they occurred less than 5 days from the date of tick bite and as a result were likely hypersensitivity reactions and not EM . Indeed, 44% of EM lesions were diagnosed at the time of tick-removal while 9% of EM were diagnosed beyond 1 month post infection .
Fig. 2
Frequency of EM diagnoses in relation to time elapsed between diagnosis of EM and the date of tick removal. The black bar shows the frequency of reported EM cases that were considered to be misdiagnosed


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Yasmena Waris
British Sign Language Communication Support Assistant
Background Information
Predominately working in an educational settings and charity organisation with 20+ years teaching and supporting deaf learners. Fluent in BSL and English; skilled at communicating, advocating and developing relationships with students their families/carers and staff. Proficient with use of British Sign Language. Excellent written and oral communication skills.
How did you come to choose to work alongside the Deaf/Deafblind?
I had left my full time teaching post and was enjoying lazy days when a colleague who worked with me suggested that I have a go at working for CommuniKate Limited.
Hobbies and Interests
I have a keen interest in art therapy, mindfulness and enjoy craft activities. I like to keep up to date with world events and current affairs. I also love cultural and religious music and visiting places of interest.
What relevant qualifications do you possess?
Diploma in education of deaf children
BSL level 6 and plenty of real life experiences of working with deaf children/adults.
Preferred method(s) of communication
Signed Supported English/ BSL.
Signature accredited course Level 6 BSL
Post graduate diploma in the Education of the Deaf
What's your favourite colour?
Blue ( I love blue skies and blue seas )
Tell me an interesting story:
Workmen were doing some water work outside my parents home when my curious brother decided to take a peek down the hole. Being the risk taker he is, he jumped in whilst the water is flowing and I had thought he had disappeared forever in the yellow pipes. He was saved by the workmen- his 4 year old son is just as mischievous.
My favourite thing is:
Rainbows….colours….. I love the quote by Maya Angelou '' Try to be a rainbow in someone's cloud'
I don't like:
Wiggly worms as they make me shudder!
What frightens you?
Driving through single track roads on a dark night!
Do you like Marmite?
I do enjoy marmite from time to time.. but not on a daily basis like some people.
Do you keep ketchup in the fridge or cupboard?
I used to keep it in the fridge but now it's in the cupboard!
Services Yasmena Provides:
I qualified as a teacher in 2000. Since then I have worked with deaf children in schools and local communities. I have worked with families in Tower Hamlets/Bucks and delivered the family sign language curriculum. I work as a Home Tutor and have always enjoyed meeting new people.
I like to work around the individual needs of those I support and have worked with a number of clients mainly within the educational settings but also in work based environments.
I love my job as no two days are ever the same. I also like coming home knowing that I have done my best to support those who need it.


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HOT Shanghai Creative Director Creative Strategy B2B and B2C Marketing 1.2 Million RMB Per Year
09 / 02 / 2022
Experience Summary
Creative Director of Global Marketing
Creative Director
Associate Creative Director
Bachelor of Science Degree
Motives & Seeking
Not looking for new job currently. Keeping an open mind for opportunities and he is currently contented with his current job.
English- Fluent
Cantonese- Can understand a little
Recent / Current Salary
1.2 million RMB per year
300k RMB Children Education fund
Receives annual bonus
Retirement plan (basic insurance)
Expected Salary
Notice Period
2 months notice
Interview Availability
Requires a few days notice
Interview Assessment Notes
Started working in the early 2000's in the advertising agencies. He started his career in Canada and later moved in Shanghai where he currently works as the Creative Director for XXXXX.
Has a strong experience in creative related content, creative strategy and in the more business savvy side of creative direction.
Has lead brand transformation efforts through creative solutions in key markets: China, Indonesia, Russia, and Spain, continuously reinvent EF's core lead generation tools and methods to achieve substantial business impact.
Has instituted several social strategies, design guideline and craft clear consumer personas for global content marketing ( WeChat / Weibo / TikTok / Facebook / Instagram / Vkontakte )
Victor Chen, Senior IT Recruiter & Talent Broker
+852 6700 6472
Kean Oliver Gomez, Sourcing Associate
Employment Agency
Silicon Valley Associates Recruitment (Hong Kong) Limited
907, 9th Floor, Silvercord Tower 2, 30 Canton Rd
Tsim Sha Tsui. Kowloon, Hong Kong
EA Licence Number: 65675
Job-Seeker Agreement
The Candidate has agreed that Silicon Valley Associates Recruitment may disclose their profile to potential employers for the purpose of seeking new employment. Silicon Valley Associates Recruitment wil never charge any fees from job-seekers.
Potential Employer Terms
General Terms and Conditions apply to all requests, offers and agreements regarding the provision of services, and available upon request. These can be sent to you on request or can be found on our website: svarecruitment.com.


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After the Massive Blockbuster Hit of Baahubali, Darling Prabhas is having the busiest shooting schedule. This Pan-India Star has multiple projects lined up and many movie makers are eagerly waiting to work with the actor. Currently, Prabhas is occupied with the shooting of upcoming film Radhe Shayam directed by Radha Krishna.
Apart from acting, Prabhas is praised for his kind nature. Recently, he has generously donated Rs 1.5 Cr to the Telangana CM relief fund to help people affected in the Hyderabad floods. Most of our Celebs show love for the animals and get clicked with their pets and Prabhas is one among them.
Now, this picture of Prabhas will leave you open-mouthed as he is sitting with beast a brown and white Alaskan Malamute Dog. It is one of the largest breeds of domestic dogs. In the picture, Prabhas is looking dapper in the Black outfit and wearing casual slippers. He is giving the pose sitting on the couch with the beast. The picture shared by actress Charmme Kaur and seen captioned as " Darling with my 9 months old baby boy ♥".
Prabhas next film titled 'Radhe Shyam' stars Pooja Hegde as the leading lady. It is helmed by Radha Krishna Kumar and financed by Vamsi Krishna Reddy, Pramod Uppalapati, Praseedha Uppalapati. The first look of Prabhas from the film went viral within a fraction of seconds. On the other hand, he has the Adipurush project with Om Raut.
Also Read: Tinaa Dattaa Is Ready For Diwali And Picked Perfect Traditional Beautiful Saree.
Also Read: Malaika Arora Stealing Limelight And Million Hearts In Her Shimmer Floral Gown.
Also Read: Kajal Aggarwal Shares Hot Pictures From Honeymoon As She Gets Cosy In Arms Of Gautam Kitchlu.


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The EFC at UNC worked with Abt Environmental Research on a Water Research Foundation funded study entitled "Customer Assistance Programs for Multi-Family Residential and other Hard to Reach Customers." The primary objective of this project was to provide water utilities with pragmatic options, evaluation criteria, and lessons learned, and guidance for customer assistance programs targeting hard to reach customers. The intent was to help water providers identify and assess their options for reaching these customers directly, and/or indirectly through other channels and programs. The objective was also to better enable utilities to establish a business process for effectively implementing, monitoring the effectiveness of, and continually improving their assistance programs aimed at hard to reach customers. A secondary objective is to extend the insights gleaned on customer assistance program to enhance other utility communication and outreach activities that pertain to hard to reach members of the community.
The research provides a clear business process and a set of communication strategies that will support effective provision of targeted assistance for these customers, and the final report on the research can be found here.
Read the Executive Summary.
Report was written by Janet Clements, Robert Raucher, and Karen Raucher of Corona Environmental Consulting, Lorine Giangola and Michael Duckworth from ABT Associates, Stacey Berahzer and Jeff Hughes of the UNC Environmental Finance Center, and Scott Rubin and Roger Colton.
You may download the report, the Executive Summary, and browse related resources from the Water Research Foundation webpage.Download The Resource


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Courtesy: Jennifer Stephens, UC San Diego Athletics
LA JOLLA, Calif. – It is an everyday occurrence in San Diego: a body of water, a handful of lifeguards, and dozens of kids enjoying it. However, for Logan Elementary's third and fifth graders, such an awe-inspiring experience could only be summed up in a stack of letters thanking the Prevent Drowning Foundation for the swim lessons that "helped them not die." This reaction is all that University of California San Diego alumnus Buc Buchanan needs to know that his foundation is serving its purpose.
Buchanan grew up in Novato, Calif. and attended UC San Diego from 1978-83. He intended to pursue law and majored in Political Science and Government with a minor in Communications.
"I grew up wanting to go to college and I knew I wanted to go to a UC," said Buchanan. "I went south and once I got down here, I never left. I think I got very lucky at a young age."
Buchanan was an All-American water polo player in high school and tried out for the UC San Diego water polo team upon his arrival, securing a spot under then-head coach, Russ Hafferkamp (1977-79). Buchanan was initially told that he would not make the travel roster.
In 1979, Buchanan took two quarters off of school to work a full-time job to pay for school. When he returned to the team, head coach Denny Harper (1980-present) had taken over the program. According to Buchanan, it was Harper who motivated him and led to water polo becoming his central focus for the remainder of his college career.
"Buc was big and strong and fast, and I saw a lot of potential in him as a player and as a leader, even though I don't think he saw that initially," said Harper.
Buchanan was co-captain of the UC San Diego water polo team in 1982 and was named a First Team All-American in 1982. After his graduation, Buchanan began practicing and traveling with the post-collegiate water polo team, Sunset San Diego, which he continues to play for today.
"I think my exposures at UC San Diego scholastically, and the teamwork idea with water polo and teams in general, is how I frame every issue I face. I look at, what roles do people take? What are we trying to accomplish?" said Buchanan.
Harper introduced Buchanan to several of his connections within lifeguarding, leading to Buchanan's start as a pool lifeguard in 1982. Buchanan began his career as a City of San Diego County beach lifeguard one year later.
"I was emotionally and physically drawn to not only helping people, but lifeguarding had a ton of variety," said Buchanan. "I got involved in some union action and the arrows just started pointing down that path."
After becoming Lifeguard Lieutenant, Buchanan began working on his master's degree in Organizational Leadership through National University. He was required to create a presentation for his pre-thesis work, leading to his creation of a strategic plan for the San Diego Junior Lifeguard Foundation.
Buchanan began interviewing people for positions on the Board of Directors. By 2009, the San Diego Junior Lifeguard Foundation was operating under the goals of teaching kids how to swim, supporting Junior Lifeguards, and building a new Junior Lifeguard headquarters.
"I was still majorly connected to the rescue world, but I was also trying to help leave it better than I found it. It seemed to make sense and it seemed like this is what I'm supposed to be doing." said Buchanan.
Buchanan retired from lifeguarding in 2014 but continued to build the foundation. Its name was changed to Prevent Drowning Foundation in 2015.
Currently, the Prevent Drowning Foundation offers free swimming and aquatic safety lessons to kids and schools in underprivileged parts of San Diego, specifically with the City Heights Recreation Center and the Jackie Robinson YMCA. It also awards Junior Lifeguard scholarships to kids who apply and meet certain criteria.
"There's a lot of water focus in San Diego. If you're living in San Diego, you've got to have someone who can help you to experience that type of enjoyment," said Buchanan. "I've seen enough rescues that I wanted to find a way to give hope to kids so they could experience a lot of what I had experienced."
The Prevent Drowning Foundation is also raising money to build an aquatic safety center which will serve as the headquarters for the Junior Lifeguard program. The foundation is working with the city of San Diego and the goal is to secure a location in Mission Bay.
"The idea is to privately raise money to help build a beautiful building where the Junior Lifeguards and all aquatic organizations can meet and celebrate the water," said Buchanan.
The foundation is also working with the UC San Diego Athletics Department to create opportunities for the UC San Diego aquatics team members to teach swim lessons and hold swimming and water polo clinics in Barrio Logan. Coach Harper fully supports the combined effort.
"It's not surprising that over the last 35 years some of the best lifeguards have been UC San Diego water polo players, and we're going to make sure that our athletes are getting involved in carrying out Buc's vision," said Harper. "It's just all part of the family."


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Hello. So, how do I set up that? After upgrading to 4.0, it seems that it always shows only the first 10 ones and the others is hidden by the pagination. Even when I change the number via the dropdown menu, it resets as soon as I refresh the page.
I tried looking at personal preferences, but didn't spot anything similar.


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Khloé Kardashian has joined efforts with Biohaven Pharmaceuticals to launch the Take Back Today campaign to empower people with migraine to share their stories in a new online community.
"Many people may not realize that I've been living with migraine since the sixth grade," says Khloé Kardashian, entrepreneur, TV personality and mom. For Khloé, the worst part of her lifelong struggle with migraine is the isolation and loneliness she often feels.
"Often, because of migraine, I miss time with my family, friends and at work," says Khloé. "This is a disease that can make people feel alone because they spend so much time missing moments in their lives."
More than a headache
Migraine affects nearly 40 million people in the United States, most of whom are women. Despite this prevalence, it is a disease that remains misunderstood. "Like many people living with migraine, I've faced the stigma that migraine is just a headache," says Khloé.
Every person experiences migraine differently. Khloé's symptoms include nausea, temporary impaired vision and dizziness before an attack. Although she tries to avoid triggers such as stress and bright light, she has found that her migraine attacks can happen anytime without warning.
"Recently, a migraine woke me early in the morning, which is the worst because I have to reconfigure my entire day. Migraine impacts every part of my day," says Khloé.
Taking back her day
Khloé has tried several holistic, over-the-counter and prescription medicines to alleviate her migraine pain and symptoms. She finally found the relief she long sought from an acute treatment of migraine called Nurtec™ ODT (rimegepant), an orally disintegrating tablet that dissolves in the mouth in seconds.
"I started to feel the effects of the medicine in about 15 minutes and was back to normal about an hour later," says Khloé. "With Nurtec ODT, I didn't have to make any treatment tradeoffs because, after taking it, I was able to get back to my day."
Empowering others
Khloé's battle with migraine has made her deeply empathetic for others who suffer the devastating effects of the disease. She wants others to know there is hope for getting back to what they love.
As the spokesperson for the Take Back Today campaign, Khloé hopes to use her voice to speak up in support of the millions of people who suffer from migraine.
"Together, we can build a community for people with migraine to express themselves without judgement and learn how to get back to what they love. We are not alone."
Join Khloé and share your migraine story using #TakeBackToday and visit www.TakeBackToday.com for more information.
What is Nurtec™ ODT (rimegepant)?
Nurtec™ ODT (rimegepant) orally disintegrating tablets is a prescription medicine for the acute treatment of migraine attacks with or without aura in adults. Nurtec ODT is not used as a preventive treatment of migraine. It is not known if Nurtec ODT is safe and effective in children.
Do not take Nurtec ODT if you are allergic to Nurtec ODT (rimegepant) or any of its ingredients.
Before you take Nurtec ODT, tell your healthcare provider (HCP) about all your medical conditions, including if you:
- have liver problems,
- have kidney problems,
- are pregnant or plan to become pregnant,
- breastfeeding or plan to breastfeed.
Tell your HCP about all the medicines you take, including prescription and over-the counter medicines, vitamins, and herbal supplements.
Nurtec ODT may cause serious side effects including allergic reactions, including trouble breathing and rash. This can happen days after you take Nurtec ODT. Call your HCP or get emergency help right away if you have swelling of the face, mouth, tongue, or throat or trouble breathing. This occurred in less than 1% of patients treated with Nurtec ODT.
The most common side effect of Nurtec ODT was nausea (2% of patients). This is not the only possible effect of Nurtec ODT. Tell your HCP if you have any side effects.
You are encouraged to report side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088 or report side effects to Biohaven at 1-833-4Nurtec.
Please click here for full Prescribing Information and Patient Information.


text:
Stock prices in the Asian markets gained on Wednesday following a steep decline in the past session. Asia-Pacific shares excluding Japan in MSCI increased 0.1% during the early trading session after a 1.6% fall in the previous day.
Breaking News
Indian stock markets recorded gains from continuous buying support from foreign institutional investors (FIIs). Encouraging global cues also led the stocks gain on Indian bourses. The latest institutional support made the best three-session rally since September 2013.
The recent market crash in Indian stock markets is driving funds from equities to mutual funds (MFs). As a result, fixed income mutual funds are witnessing increased inflows of funds amid ongoing bear market.
Infosys Q1 results were as expected and stocks rose by around 15%.


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Methods: Using S1, S2, and M probes, 3 liver stiffness measurements, success rates, and interquartile ranges were obtained from 100 patients. Patients were assigned to 2 groups according to thoracic perimeter (≤45 cm vs >45 cm). In both groups, obtained values were compared and the relation between liver stiffness measurement and aspartate aminotransferase-toplatelet ratio index was analyzed.
Objectives: With the introduction of smaller probes (S1, S2), the use of transient elastography has been expanded to children. Accordingly, we aimed to address points of consideration in probe choice and interpretation of measured liver stiffness by applying and comparing FibroScan S and M probes in biliary atresia.
Conclusions: We recommend that the S1 probe is more appropriate for use in small children, especially those with a thorax perimeter of <45 cm. If no S probe is available, the M probe may be acceptable in children whose thorax perimeter is >45 cm.
Results: In the small-thorax group, the success rate was highest with the S1 probe and the intraclass correlation coefficient (ICC) was highest for S1 versus S2 (0.98), compared with that for S1 versus M (0.69) and S2 versus M (0.77). In the large-thorax group, ICC was the highest for S2 versus M (0.88), compared with that for S1 versus S2 (0.69) and S1 versus M (0.51). In the small-thorax group, correlations between aspartate aminotransferase-toplatelet ratio index and liver stiffness measurement were stronger for S1 (0.65) and S2 (0.64) than for M (0.49). In the large-thorax group, all probes showed good correlation, S1 (0.68), S2 (0.62), and M (0.62).
|Original language
|Pages (from-to)
|Number of pages
|Journal of Pediatric Gastroenterology and Nutrition
|Issue number
|Publication status
|Published - 2014 Nov 8
Bibliographical notePublisher Copyright:
Copyright © 2014 by European Society.
All Science Journal Classification (ASJC) codes
- Pediatrics, Perinatology, and Child Health
- Gastroenterology


text:
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Which two commands are required to enable multicast on a router, knowing that the receivers only
support IGMPv2? (Choose two.)
A. ip pim rp-address
B. ip pim ssm
C. ip pim sparse-mode
D. ip pim passive
Answer: A,C
Sparse mode logic (pull mode) is the opposite of Dense mode logic (push mode), in Dense mode
it is supposed that in every network there is someone who is requesting the multicast traffic so
PIM-DM routers begin by flooding the multicast traffic out of all their interfaces except those from
where a prune message is received to eliminate the
Which statement is true about TCN propagation?
A. The originator of the TCN immediately floods this information through the network.
B. The TCN propagation is a two step process.
C. A TCN is generated and sent to the root bridge.
D. The root bridge must flood this information throughout the network.
Answer: C
New Topology Change Mechanisms
When an 802.1D bridge detects a topology change, it uses a reliable mechanism to first notify the
root bridge.
This is shown in this diagram:
Once the root bridge is aware of a change in the topology of the network, it sets the TC flag on the
BPDUs it sends out, which are then relayed to all the bridges in the network. When a bridge
receives a BPDU with the TC flag bit set, it reduces its bridging-table aging time to forward delay
seconds. This ensures a relatively quick flush of stale information. Refer to Understanding
Spanning-Tree Protocol Topology Changes for more information on this process. This topology
change mechanism is deeply remodeled in RSTP. Both the detection of a topology change and its
propagation through the network evolve.
Topology Change Detection
In RSTP, only non-edge ports that move to the forwarding state cause a topology change. This
means that a loss of connectivity is not considered as a topology change any more, contrary to
802.1D (that is, a port that moves to blocking no longer generates a TC). When a RSTP bridge
detects a topology change, these occur:
It starts the TC While timer with a value equal to twice the hello-time for all its non-edge
designated ports and its root port, if necessary.
It flushes the MAC addresses associated with all these ports.
Note: As long as the TC While timer runs on a port, the BPDUs sent out of that port have the TC
bit set.
BPDUs are also sent on the root port while the timer is active.
Topology Change Propagation
When a bridge receives a BPDU with the TC bit set from a neighbor, these occur:
It clears the MAC addresses learned on all its ports, except the one that receives the topology
It starts the TC While timer and sends BPDUs with TC set on all its designated ports and root port
(RSTP no longer uses the specific TCN BPDU, unless a legacy bridge needs to be notified).
This way, the TCN floods very quickly across the whole network. The TC propagation is now a one
step process. In fact, the initiator of the topology change floods this information throughout the
network, as opposed to 802.1D where only the root did. This mechanism is much faster than the
802.1D equivalent. There is no need to wait for the root bridge to be notified and then maintain the
topology change state for the whole network for seconds.
In just a few seconds, or a small multiple of hello-times, most of the entries in the CAM tables of
the entire network (VLAN) flush. This approach results in potentially more temporary flooding, but
on the other hand it clears potential stale information that prevents rapid connectivity restitution.
Which two are effects of connecting a network segment that is running 802.1D to a network
segment that is running 802.1w? (Choose two.)
A. The entire network switches to 802.1D and generates BPDUs to determine root bridge status. B.
A migration delay of three seconds occurs when the port that is connected to the 802.1D bridge
comes up.
C. The entire network reconverges and a unique root bridge for the 802.1D segment, and a root
bridge for the 802.1w segment, is chosen.
D. The first hop 802.1w switch that is connected to the 802.1D runs entirely in 802.1D compatibility
mode and converts the BPDUs to either 802.1D or 802.1w BPDUs to the 802.1D or 802.1w
segments of the network.
E. Classic 802.1D timers, such as forward delay and max-age, will only be used as a backup, and
will not be necessary if point-to-point links and edge ports are properly identified and set by the
Answer: B,E
Each port maintains a variable that defines the protocol to run on the corresponding segment. A
migration delay timer of three seconds also starts when the port comes up. When this timer runs,
the current STP or RSTP mode associated to the port is locked. As soon as the migration delay
expires, the port adapts to the mode that corresponds to the next BPDU it receives. If the port
changes its mode of operation as a result of a BPDU received, the migration delay restarts.
802.1D works by the concept that the protocol had to wait for the network to converge before it
transitioned a port into the forwarding state. With Rapid Spanning Tree it does not have to rely on
any timers, the only variables that that it relies on is edge ports and link types.
Any uplink port that has an alternate port to the root can be directly placed into the forwarding
state (This is the Rapid convergence that you speak of "restored quickly when RSTP is already in
use?"). This is what happened when you disconnected the primary look; the port that was ALT,
moved to FWD immediately, but the switch also still needs to create a BDU with the TC bit set to
notify the rest of the network that a topology has occurred and all non-edge designated ports will
transition to BLK, LRN, and then FWD to ensure there are no loops in the rest of the network. This
is why if you have a host on a switchport, and you know for a fact that it is only one host, enable
portfast to configure the port as an edgeport so that it does not have to transition to all the STP
Which three combinations are valid LACP configurations that will set up a channel? (Choose
A. On/On
B. On/Auto
C. Passive/Active
D. Desirable/Auto
E. Active/Active
F. Desirable/Desirable
Answer: A,C,E
Which two options does Cisco PfR use to control the entrance link selection with inbound
optimization? (Choose two.)
A. Prepend extra AS hops to the BGP prefix.
B. Advertise more specific BGP prefixes (longer mask).
C. Add (prepend) one or more communities to the prefix that is advertised by BGP.
D. Have BGP dampen the prefix.
Answer: A,C
Explanation: PfR Entrance Link Selection Control Techniques
The PfR BGP inbound optimization feature introduced the ability to influence inbound traffic. A
network advertises reachability of its inside prefixes to the Internet using eBGP advertisements to
its ISPs. If the same prefix is advertised to more than one ISP, then the network is multihoming.
PfR BGP inbound optimization works best with multihomed networks, but it can also be used with
a network that has multiple connections to the same ISP. To implement BGP inbound
optimization, PfR manipulates eBGP advertisements to influence the best entrance selection for
traffic bound for inside prefixes. The benefit of implementing the best entrance selection is limited
to a network that has more than one ISP connection.
To enforce an entrance link selection, PfR offers the following methods:
BGP Autonomous System Number Prepend When an entrance link goes out-of-policy (OOP) due
to delay, or in images prior to Cisco IOS Releases 15.2(1) T1 and 15.1(2)S, and PfR selects a
best entrance for an inside prefix, extra autonomous system hops are prepended one at a time (up
to a maximum of six) to the inside prefix BGP advertisement over the other entrances. In Cisco
IOS Releases 15.2(1)T1, 15.1(2)S, and later releases, when an entrance link goes out-of policy
(OOP) due to unreachable or loss reasons, and PfR selects a best entrance for an inside prefix,
six extra autonomous system hops are prepended immediately to the inside prefix BGP
advertisement over the other entrances. The extra autonomous system hops on the other
entrances increase the probability that the best entrance will be used for the inside prefix. When
the entrance link is OOP due to unreachable or loss reasons, six extra autonomous system hops
are added immediately to allow the software to quickly move the traffic away from the old entrance
link. This is the default method PfR uses to control an inside prefix, and no user configuration is
BGP Autonomous System Number Community Prepend
When an entrance link goes out-of-policy (OOP) due to delay, or in images prior to Cisco IOS
Releases 15.2
(1)T1 and 15.1(2)S, and PfR selects a best entrance for an inside prefix, a BGP prepend
community is attached one at a time (up to a maximum of six) to the inside prefix BGP
advertisement from the network to another autonomous system such as an ISP. In Cisco IOS
Releases 15.2(1)T1, 15.1(2)S, and later releases, when an entrance link goes out-of-policy (OOP)
due to unreachable or loss reasons, and PfR selects a best entrance for an inside prefix, six BGP
prepend communities are attached to the inside prefix BGP advertisement. The BGP prepend
community will increase the number of autonomous system hops in the advertisement of the
inside prefix from the ISP to its peers. Autonomous system prepend BGP community is the
preferred method to be used for PfR BGP inbound optimization because there is no risk of the
local ISP filtering the extra autonomous system hops. There are some issues, for example, not all
ISPs support the BGP prepend community, ISP policies may ignore or modify the autonomous
system hops, and a transit ISP may filter the autonomous system path. If you use this method of
inbound optimization and a change is made to an autonomous system, you must issue an
outbound reconfiguration using the "clear ip bgp" command.
Latest 400-101 Dumps400-101 PDF Dumps400-101 VCE Dumps
Refer to the exhibit.
Which path is selected as best path?
A. path 1, because it is learned from IGP B.
path 1, because the metric is the lowest C.
path 2, because it is external
D. path 2, because it has the higher router ID
Answer: B
Which two OSPF LSA types are new in OSPF version 3? (Choose two.)
A. Link
B. NSSA external
C. Network link
D. Intra-area prefix
E. AS domain
Answer: A,D
New LSA Types
OSPFv3 carries over the seven basic LSA types we\'re familiar with from OSPFv2. However, the
type 1 and 2 LSAs have been re-purposed, as will be discussed in a bit. OSPFv3 also introduces
two new LSA types: Link and Intra-area Prefix.
Refer to the exhibit.
This is an MPLS VPN network with OSPF as the PE-CE routing protocol. Which statement is
A. The routing inside the VPN RED will never work correctly.
B. The routing inside the VPN RED can be enabled by configuring virtual links between the PE
C. The routing inside the VPN RED can be enabled by configuring area 0 inside the VRF on the
PE routers.
D. The routing inside the VPN RED will work without any special OSPF configuration.
E. The routing inside the VPN RED will work if the PE routers have a full mesh of sham-links
configured for VRF RED.
Answer: D Explanation:
On a router, interface S0 is running EIGRPv6, and interface S1 is running OSPFv3. A
redistribution command is issued under OSPFv3, redistribute EIGRP 1 metric 20 under ipv6 router
ospf 1. What will happen after applying this redistribution command?
A. All routes showing up as D and D EX in the routing table will be redistributed into OSPFv3.
B. All routes showing up as D, D EX, and C in the routing table will be redistributed into OSPFv3.
C. All routes showing up as D and D EX in the routing table and the S0 interface will be
redistributed into OSPFv3.
D. All routes showing up as D in the routing table will be redistributed into OSPFv3.
E. All routes showing up as D EX in the routing table will be redistributed into OSPFv3.
Answer: A
D are EIGRP Internal Routes and D EX are EIGRP external routes. Both Internal and External
EIGRP routes will be redistributed with the configuration shown above
How is RPF used in multicast routing?
A. to prevent multicast packets from looping
B. to prevent PIM packets from looping
C. to instruct PIM where to send a (*, G) or (S, G) join message
D. to prevent multicast packets from looping and to instruct PIM where to send a (*, G) or (S, G)
join message
Answer: D
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