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Diving medicine
Diving medicine, also called undersea and hyperbaric medicine (UHB), is the diagnosis, treatment and prevention of conditions caused by humans entering the undersea environment. It includes the effects on the body of pressure on gases, the diagnosis and treatment of conditions caused by marine hazards and how relationships of a diver's fitness to dive affect a diver's safety.
Hyperbaric medicine is a corollary field associated with diving, since recompression in a hyperbaric chamber is used as a treatment for two of the most significant diving-related illnesses, decompression illness and arterial gas embolism.
Diving medicine deals with medical research on issues of diving, the prevention of diving disorders, treatment of diving accidents and diving fitness. The field includes the effect of breathing gases and their contaminants under high pressure on the human body and the relationship between the state of physical and psychological health of the diver and safety.
In diving accidents it is common for multiple disorders to occur together and interact with each other, both causatively and as complications.
Diving medicine is a branch of occupational medicine and sports medicine, and an important part of diver education.
- 1 Range and scope of diving medicine
- 2 Diagnostics
- 3 Treatments
- 4 Education and registration of practitioners
- 5 Training of divers and support staff in relevant first aid
- 6 Ethical and medicolegal issues
- 7 History of diving medical research
- 8 Research organisations
- 9 See also
- 10 References
- 11 Further reading
- 12 External links
Range and scope of diving medicine[edit]
The scope of diving medicine must necessarily include conditions that are specifically connected with the activity of diving, and not found in other contexts, but this categorization excludes almost everything, leaving only deep water blackout, isobaric counterdiffusion and high pressure nervous syndrome. A more useful grouping is conditions that are associated with exposure to variations of ambient pressure. These conditions are largely shared by aviation and space medicine. Further conditions associated with diving and other aquatic and outdoor activities are commonly included in books which are aimed at the diver, rather than the specialist medical practitioner, as they are useful background to diver first aid training.
The scope of knowledge necessary for a practitioner of diving mediciene includes the medical conditions associated with diving and their treatment, physics and physiology relating to the underwater and pressurised environment, the standard operating procedures and equipment used by divers which can influence the development and management of these conditions, and the specialised equipment used for treatment.
Scope of knowledge for diving medicine[edit]
The ECHM-EDTC Educational and Training Standards for Diving and Hyperbaric Medicine (2011) specify the following scope of knowledge for Diving Medicine:[1]
Scope of knowledge for hyperbaric medicine[edit]
The ECHM-EDTC Educational and Training Standards for Diving and Hyperbaric Medicine (2011) specify the following scope of knowledge for Hyperbaric Medicine additional to that for Ddiving medicine:[1]
- Physiology and pathology of diving and hyperbaric exposure.
- HBO-Basics - effects of hyperbaric oxygen - physiology and pathology
- Clinical HBO
- Chamber technique (multiplace, monoplace, transport chambers, wet recompression)
- Mandatory indications
- HBO Recommended indications
- HBO Experimental and anecdotal indications
- HBO Data collection / statistics / evaluation
- HBO General basic treatment (nursing)
- HBO Diagnostic, monitoring and therapeutic devices in chambers
- Risk assessment, incidents monitoring and safety plan in HBO chambers
- HBO Safety regulations
The signs and symptoms of diving disorders may present during a dive, on surfacing, or up to several hours after a dive. Divers have to breathe a gas which is at the same pressure as their surroundings, which can be much greater than on the surface. The ambient pressure underwater increases by 1 standard atmosphere (100 kPa) for every 10 metres (33 ft) of depth.[2]
The principal conditions are: decompression illness (which covers decompression sickness and arterial gas embolism); nitrogen narcosis; high pressure nervous syndrome; oxygen toxicity; and pulmonary barotrauma (burst lung). Although some of these may occur in other settings, they are of particular concern during diving activities.[2]
The disorders are caused by breathing gas at the high pressures encountered at depth, and divers will often breathe a gas mixture different from air to mitigate these effects. Nitrox, which contains more oxygen and less nitrogen is commonly used as a breathing gas to reduce the risk of decompression sickness at recreational depths (up to about 40 metres (130 ft)). Helium may be added to reduce the amount of nitrogen and oxygen in the gas mixture when diving deeper, to reduce the effects of narcosis and to avoid the risk of oxygen toxicity. This is complicated at depths beyond about 150 metres (500 ft), because a helium–oxygen mixture (heliox) then causes high pressure nervous syndrome.[2] More exotic mixtures such as hydreliox, a hydrogen–helium–oxygen mixture, are used at extreme depths to counteract this.[3]
Decompression sickness[edit]
Decompression sickness (DCS) occurs when gas, which has been breathed under high pressure and dissolved into the body tissues, forms bubbles as the pressure is reduced on ascent from a dive. The results may range from pain in the joints where the bubbles form to blockage of an artery leading to damage to the nervous system, paralysis or death. While bubbles can form anywhere in the body, DCS is most frequently observed in the shoulders, elbows, knees, and ankles. Joint pain occurs in about 90% of DCS cases reported to the U.S. Navy, with neurological symptoms and skin manifestations each present in 10% to 15% of cases. Pulmonary DCS is very rare in divers.[4]
Pulmonary barotrauma and arterial gas embolism[edit]
If the breathing gas in a diver's lungs cannot freely escape during an ascent, the lungs may be expanded beyond their compliance, and the lung tissues may rupture, causing pulmonary barotrauma (PBT). The gas may then enter the arterial circulation producing arterial gas embolism (AGE), with effects similar to severe decompression sickness.[5] Gas bubbles within the arterial circulation can block the supply of blood to any part of the body, including the brain, and can therefore manifest a vast variety of symptoms.
Nitrogen narcosis[edit]
Nitrogen narcosis is caused by the pressure of dissolved gas in the body and produces impairment to the nervous system. This results in alteration to thought processes and a decrease in the diver's ability to make judgements or calculations. It can also decrease motor skills, and worsen performance in tasks requiring manual dexterity. As depth increases, so does the pressure and hence the severity of the narcosis. The effects may vary widely from individual to individual, and from day to day for the same diver. Because of the perception-altering effects of narcosis, a diver may not be aware of the symptoms, but studies have shown that impairment occurs nevertheless.[6]
High pressure nervous syndrome[edit]
Helium is the least narcotic of all gases, and divers may use breathing mixtures containing a proportion of helium for dives exceeding about 40 metres (130 ft) deep. In the 1960s it was expected that helium narcosis would begin to become apparent at depths of 300 metres (1,000 ft). However, it was found that different symptoms, such as tremors, occurred at shallower depths around 150 metres (500 ft). This became known as high pressure nervous syndrome, and its effects are found to result from both the absolute depth and the speed of descent. Although the effects vary from person to person, they are stable and reproducible for the individual.
Oxygen toxicity[edit]
Although oxygen is essential to life, in concentrations significantly greater than normal it becomes toxic, overcoming the body's natural defences (antioxidants), and causing cell death in any part of the body. The lungs and brain are particularly affected by high partial pressures of oxygen, such as are encountered in diving. The body can tolerate partial pressures of oxygen around 0.5 bars (50 kPa; 7.3 psi) indefinitely, and up to 1.4 bars (140 kPa; 20 psi) for many hours, but higher partial pressures rapidly increase the chance of the most dangerous effect of oxygen toxicity, a convulsion resembling an epileptic seizure.[7] Susceptibility to oxygen toxicity varies dramatically from person to person, and to a smaller extent from day to day for the same diver.[8] Prior to convulsion, several symptoms may be present – most distinctly that of an aura.
Treatment of diving disorders depends on the specific disorder or combination of disorders, but two treatments are commonly associated with first aid and definitive treatment where diving is involved. These are first aid oxygen administration at high concentration, which is seldom contraindicated, and generally recommended as a default option in diving accidents where there is any significant probability of hypoxia,[citation needed] and hyperbaric oxygen therapy, which is the definitive treatment for most incidences of decompression illness.[citation needed] Hyperbaric treatment using other breathing gases is also used for treatment of decompression sickness if HBO is inadequate.
Oxygen therapy[edit]
The administration of oxygen as a medical intervention is common in diving medicine, both for first aid and for longer term treatment.
Recompression and hyperbaric oxygen therapy[edit]
Recompression treatment in a hyperbaric chamber was initially used as a life-saving tool to treat decompression sickness in caisson workers and divers who stayed too long at depth and developed decompression sickness. Now, it is a highly specialized treatment modality that has been found to be effective in the treatment of many conditions where the administration of oxygen under pressure[9] has been found to be beneficial. Studies have shown it to be quite effective in some 13 indications approved by the Undersea and Hyperbaric Medical Society.[10]
Hyperbaric oxygen treatment is generally preferred when effective, as it is usually a more efficient and lower risk method of reducing symptoms of decompression illness, but in some cases recompression to pressures where oxygen toxicity is unacceptable may be required to eliminate the bubbles in the tissues in severe cases of decompression illness.
Education and registration of practitioners[edit]
Specialist training in underwater and hyperbaric medicine is available from several institutions, and registration is possible both with professional associations and governmental registries.
- NOAA/UHMS Physicians Training Course in Diving Medicine
- This course has been presented since 1977, and has been influenced by internationally accepted training objectives recommended by the Diving Medical Advisory Committee, the European Diving Technology Committee, and the European Committee for Hyperbaric Medicine. The course is designed for qualified medical practitioners, but may be useful to others who work in the field of diving safety and operations.[11]
The course is to train physicians to recognize and treat diving medical emergencies. Subject matter includes:[11]
- Basic physics and physiology of the hyperbaric environment:
- the laws and principles;
- the differences between hyperbaric and hypobaric pressure;
- hyperbaric gases and their effects under pressure;
- links between the physiological effects of the hyperbaric environment and the pathology of the disease
- Basic decompression theory:
- historical development to current concepts
- factors affecting decompression safety including acceptable risks and thermal issues
- distinguish decompression sickness from barotrauma and arterial gas embolism;
- Dive computer theories and types, and comparison to dive tables
- Introduction to commercial diving and comparison to recreational and technical diving, including differences in procedures, equipment, and diver categories
- The clinical application of hyperbaric oxygen therapy and the treatment tables used;
- Participation in surface-supplied diving operation and hyperbaric chamber operations;
- Components, types, operational and safety hazards associated with hyperbaric chambers;
- Diving-related conditions resulting from the effects of long-term effects of diving, flying after diving, altitude, thermal conditions, age and gender
- Neurologic assessment on a diver with signs and/or symptoms of DCI
- Medical and fitness standards for diving, including:
- contraindications for both commercial and recreational divers
- differences in medical standards for recreational versus occupational diving communities
- legal implications for approving and denying fitness to dive in an occupational setting
- approaches for determining the safety of prescription and OTC medications used by divers
- Fellowship in Undersea and Hyperbaric Medicine
- The Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) offer 12 month programs in undersea and hyperbaric medicine associated with ACGME or AOA accredited programs in emergency medicine, family medicine, internal medicine, occupational medicine, preventive medicine, or anesthesiology.[12][13][14]
- ECHM-EDTC Educational and Training Standards for Physicians in Diving and Hyperbaric Medicine
- The standard drawn up jointly by the European Committee for Hyperbaric Medicine and the European Diving Technical Committee defines job descriptions for several levels of diving and hyperbaric physician: Education and assessment to these standards may be provided by institutions of higher education under the leadership of a Level 3 Hyperbaric Medicine Expert as defined below. Certificates of competence may be issued by a nationally accredited institution or an internationally acknowledged agency, and periodic recertification is required.[1]
Level 1. Medical Examiner of Divers (MED) minimum 28 teaching hours.
- The MED must be competent to perform the assessments of medical fitness to dive of occupational and recreational divers and compressed air workers, except the assessment of medical fitness to resume diving after major decompression incidents.
Level 2D. Diving Medicine Physician (DMP) minimum 80 teaching hours.
- A DMP must be competent to perform the initial and all other assessments of medical fitness to dive of working and recreational divers or compressed air workers, and manage diving accidents and advise diving contractors and others on diving medicine and physiology (with the backup of a diving medical expert or consultant).
- A DMP should have knowledge in relevant aspects of occupational health, but is not required to be a certified specialist in occupational medicine.
- A DMP should have certified skills and basic practical experience in assessment of medical fitness to dive, management of diving accidents, safety planning for professional diving operations, advanced life support, acute trauma care and general wound care.
Level 2H. Hyperbaric Medicine Physician (HMP) minimum 120 teaching hours
- An HMP will be responsible for hyperbaric treatment sessions (with the backup of a hyperbaric medicine expert or consultant)
- An HMP should have appropriate experience in anaesthesia and intensive care in order to manage the HBO patients, but is not required to be a certified specialist in anaesthesia and intensive care.
- An HMP must be competent to assess and manage clinical patients for hyperbaric oxygen therapy treatment
Level 3. Hyperbaric medicine expert or consultant (hyperbaric and diving medicine) is a physician who has been assessed as competent to:
- manage a hyperbaric facility (HBO centre) or the medical and physiological aspects of complex diving activities.
- manage research programs on diving medicine.
- supervise a team of HBO doctors and personnel, health professionals and others.
- teach relevant aspects of hyperbaric medicine and physiology to all members of staff.
- Gesellschaft für Tauch- und Überdruckmedizin e. V.
- Society for Diving and Hyperbaric medicine
German standards for education and assessment of diving medical practitioners are similar to the ECHM-EDTC Standards and are controlled by the Gesellschaft für Tauch- und Überdruckmedizin e. V.. They include Medical Examiner of Divers, Diving Medicine Physician, Hyperbaric Medicine Physician, Chief Hyperbaric Medicine Physician and Hyperbaric Medicine Consultant.[15]
- Schweizerische Gesellschaft für Unterwasser- und Hyperbarmedizin
- Swiss Society for underwater and hyperbaric medicine.
Swiss standards for education and assessment of diving medical practitioners are controlled by the Schweizerische Gesellschaft für Unterwasser- und Hyperbarmedizin. They include Medical Examiner of Divers, Diving Medicine Physician and Hyperbaric Medicine Physician.[16]
- Österreichische Gesellschaft für Tauch- und Hyperbarmedizin
- Austrian Society for Diving and Hyperbaric medicine.
Austrian standards for education and assessment of diving medical practitioners are controlled by the Österreichische Gesellschaft für Tauch- und Hyperbarmedizin They include Medical Examiner of Divers, Diving Medicine Physician, Hyperbaric Medicine Physician, Chief Hyperbaric Medicine Physician and Hyperbaric Medicine Consultant.[17]
The American Medical Association recognises the sub-speciality Undersea and Hyperbaric Medicine held by someone who is already Board Certified in some other speciality.[18]
The South African Department of Labour registers two levels of Diving Medical Practitioner. Level 1 is qualified to conduct annual examinations and certification of medical fitness to dive, on commercial divers (equivalent to ECHM-EDTC Level 1. Medical Examiner of Divers), and Level 2 is qualified to provide medical advice to a diving contractor and hyperbaric treatment for diving injuries[19] (equivalent to ECHM-EDTC Level 2D Diving Medicine Physician)
Australia has a four tier system: In 2007 there was no recognised equivalence with the European standard.[20]
- GPs completing the first tier four- to five-day course on how to examine divers for 'fitness to dive' can then add their names to the SPUMS Diving Doctors List
- GPs completing the second tier two-week diving medicine courses provided by the Royal Australian Navy and the Royal Adelaide Hospital, or the two-week course in Diving and Hyperbaric Medicine provided by the ANZ Hyperbaric Medicine Group, qualify to do commercial-diving medicals.
- The third tier is the SPUMS Diploma in Diving and Hyperbaric Medicine. The candidate must attend a two-week course, write a dissertation related to DHM and have the equivalent of six months' full-time experience working in a hyperbaric medicine unit.
- The fourth tier is the Certificate in Diving and Hyperbaric Medicine from the ANZ College of Anaesthetists.
Training of divers and support staff in relevant first aid[edit]
A basic knowledge understanding of the causes, symptoms and first aid treatment of diving related disorders is part of the basic training for most recreational and professional divers, both to help the diver avoid the disorders, and to allow appropriate action in case of an incident resulting in injury.
Recreational divers[edit]
A recreational diver has the same duty of care to other divers as any ordinary member of the public, and therefore there is no obligation to train recreational divers in first aid or other medical skills. Nevertheless, first aid is training is recommended by most, if not all, recreational diver training agencies.[citation needed]
Recreational diving instructors and divemasters, on the other hand, are to a greater or lesser extent responsible for the safety of divers under their guidance, and therefore are generally required to be trained and certified to some level of rescue and first aid competence, as defined in the relevant training standards of the certifying body. In many cases this includes certification in Cardiopulmonary resuscitation and Oxygen administration for diving accidents.
Professional divers[edit]
Professional divers usually operate as members of a team with a duty of care for other members of the team. Divers are expected to act as standby divers for other members of the team and the duties of a standby diver include rescue attempts if the working diver gets into difficulties. Consequently, professional divers are generally required to be trained in fescuoe procedures appropriate to the modes of diving they are certified in, and to administer first aid in emergencies. The specific training, competence and registration for these skills varies, and may be specified by state or national legislation or by industry codes of practice.[citation needed]
Diving supervisors have a similar duty of care, and as they are responsible for operational planning and safety, generally are also expected to mange emergency procedures, including the first aid that may be required. The level of first ait training, competence and certification will generally take this into account.
- In South Africa, registered commercial and scientific divers must hold current certification in first aid at the national Level 1, with additional training in oxygen administration for diving accidents, and registered diving supervisors must hold Level 2 first aid certification.[19]
- Offshore diving contractors frequently follow the IMCA recommendations.
Diver Medic[edit]
A diver medic is a member of a dive team who is trained in advanced first aid.[21] A Diver Medic recognised by IMCA must be capable of administering First Aid and emergency treatment, and carrying out the directions of a doctor pending the arrival of more skilled medical aid, and therefore must be able to effectively communicate with a doctor who is not on site, and be familiar with diving procedures and compression chamber operation. The Diver Medic must also be able to assist the diving supervisor with decompression procedures provide advice as to when more specialised medical help should be requested, and must be fit to provide treatment in a hyperbaric chamber in an emergency, and must therefore hold a valid certificate of medical fitness to dive.[22]
Training standards for Diver Medic are described in the IMCA Scheme for Recognition of Diver Medic Training.[22]
Ethical and medicolegal issues[edit]
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History of diving medical research[edit]
- November 1992: The first examination for certification in Undersea Medicine by the American Board of Preventive Medicine.[18]
- November 1999: The first examination for Undersea and Hyperbaric Medicine qualification.[18]
Notable researchers[edit]
Research organisations[edit]
- Defence and Civil Institute of Environmental Medicine
DCIEM is a combined military and civilian research organisation to research the operational needs of the Canadian Forces in all environments.
- Divers Alert Network
The Divers Alert Network (DAN) is a non-profit organization supported by donations, grants, and membership dues, for assisting divers in need. The DAN Research department conducts significant medical research on recreational scuba diving safety, and the DAN Medicine Department provides support for divers worldwide to find answers to their diving medical questions.[23]
- Diving Diseases Research Centre
The Diving Diseases Research Centre (DDRC) is a British hyperbaric medical organisation located near Derriford Hospital in Plymouth, Devon. It is a registered charity and was established in 1980 to research the effects of diving on human physiology.
The main objective of DDRC is research into diving medicine, which is partially funded through 'The Friends of DDRC'. The centre has become a world authority on hyperbaric medical treatments with many publications detailing its work.[24]
The Centre is also an education and training base providing diving medical, clinical and hyperbaric courses.
- Diving Medical Advisory Committee
- DMAC is an independent committee with the purpose of providing advice about medical and safety aspects of commercial diving. They publish guidance notes about various aspects of diving and diving medical practice, and run a scheme for approval of courses in diving medicine.[25]
- European Committee for Hyperbaric Medicine
- The ECHM is an organisation to study and define indications for hyperbaric therapy, research and therapy protocols, standards for therapeutic and technical procedures, equipment and personnel, and related cost-benefit and cost-effectiveness criteria. It is a representative body with the European health authorities, and works toward cooperation among scientific organizations involved in the field of Diving and Hyperbaric Medicine.[26]
Membership of the committee includes doctors practicing diving medicine in Northern Europe, representatives of relevant health authorities, medical representatives from relevant navies, and a diving safety officer nominated by the International Marine Contractors Association.
- European Underwater and Baromedical Society
The European Underwater and Baromedical Society (EUBS) is a primary source of information for diving and hyperbaric medicine physiology worldwide. The organization was initially formed as the European Underwater and Biomedical Society in 1971.[27]
- National Board of Diving and Hyperbaric Medical Technology
The National Board of Diving and Hyperbaric Medical Technology (NBDHMT), formally known as the National Association of Diving Technicians, is a non-profit organization for the education and certification of qualified personnel in the fields of diving and hyperbaric medicine.[28]
- The Diver Medic Technician (DMT) program is designed to meet the specific medical care needs of commercial, professional and scientific divers that often work in geographic isolation.[29][30] DMT's are specifically trained for the various diving hazards found at remote work sites.[29] The curriculum covers a wide range of topics from barotrauma to treatment of decompression sickness.[31]
- The Certified Hyperbaric Technologist (CHT) program is tailored to meet the specific safety and operational needs for biomedical devices within the department, and the necessary knowledge and skills to administer clinical treatment.[32] The curriculum covers a wide range of topics including hyperbaric chamber operations to transcutaneous oxygen monitoring.[33]
- The Certified Hyperbaric Registered Nurse (CHRN) program is a subspecialty for registered nurses,[34] sometimes referred to as baromedical nurses.
- South African Undersea and Hyperbaric Medical Association
- SAUHMA is a voluntary association recognised as a Special Interest group by the Group Council of the South African Medical Association.[35]
- South Pacific Underwater Medicine Society
The South Pacific Underwater Medicine Society (SPUMS) is a primary source of information for diving and hyperbaric medicine physiology worldwide. The organisation supports the study of all aspects of underwater and hyperbaric medicine, provides information on underwater and hyperbaric medicine, publishes a medical journal and holds an annual conference.[36][37]
SPUMS offers a post graduate Diploma of Diving and Hyperbaric Medicine.
- Undersea and Hyperbaric Medical Society
The Undersea and Hyperbaric Medical Society (UHMS) is the primary source of information for diving and hyperbaric medicine physiology worldwide.
See also[edit]
- ^ a b c Educational and Training Standards for Physicians in Diving and Hyperbaric Medicine, Joint Educational Subcommittee of the European Committee for Hyperbaric Medicine (ECHM) and the European Diving Technical Committee (EDTC), 2011, retrieved 30 March 2013
- ^ a b c Brubakk, Alf O; Neuman, Tom S, eds. (2003). "9: Pressure Effects". Bennett and Elliott's physiology and medicine of diving (5th Revised ed.). United States: Saunders Ltd. pp. 265–418. ISBN 0-7020-2571-2. OCLC 51607923.
- ^ Abraini, JH; Gardette-Chauffour, MC; Martinez,, E; Rostain, JC; Lemaire, C (1994). "Psychophysiological reactions in humans during an open sea dive to 500 m with a hydrogen-helium-oxygen mixture". Journal of Applied Physiology (American Physiological Society) 76 (3): 1113–8. OCLC 8750-7587/94. PMID 8005852. Retrieved 1 March 2009.
- ^ Powell, Mark (2008). Deco for Divers. Southend-on-Sea: Aquapress. p. 70. ISBN 1-905492-07-3.
- ^ Neuman, Tom S (2003). "10.5: Arterial Gas Embolism and Pulmonary Barotrauma". In Brubakk, Alf O; Neuman, Tom S. Bennett and Elliott's physiology and medicine of diving (5th ed.). United States: Saunders Ltd. pp. 557–8. ISBN 0-7020-2571-2. OCLC 51607923.
- ^ Bennett, Peter B; Rostain, Jean Claude (2003). "9.2: Inert Gas Narcosis". In Brubakk, Alf O; Neuman, Tom S. Bennett and Elliott's physiology and medicine of diving (5th ed.). United States: Saunders Ltd. p. 301. ISBN 0-7020-2571-2. OCLC 51607923.
- ^ Clark, James M; Thom, Stephen R (2003). "9.4: Oxygen under pressure". In Brubakk, Alf O; Neuman, Tom S. Bennett and Elliott's physiology and medicine of diving (5th ed.). United States: Saunders Ltd. pp. 358–360. ISBN 0-7020-2571-2. OCLC 51607923.
- ^ Clark, James M; Thom, Stephen R (2003). "9.4: Oxygen under pressure". In Brubakk, Alf O; Neuman, Tom S. Bennett and Elliott's physiology and medicine of diving (5th ed.). United States: Saunders Ltd. p. 376. ISBN 0-7020-2571-2. OCLC 51607923.
- ^ Ernest S Campbell, MD, FACS. "HBO...Indications, contraindications, links references". Scuba-doc.com. Retrieved 2013-03-16.
- ^ "uhms.org". uhms.org. 2013-01-04. Retrieved 2013-03-16.
- ^ a b Staff (2011). "Underwater and Hyperbaric Medical Society". Retrieved 30 March 2013.
- ^ "Basic Standards for Fellowship Training in Undersea and Hyperbaric Medicine". American Osteopathic Conjoint Committee of Undersea and Hyperbaric Medicine. Retrieved 2 April 2013.
- ^ "Home". American Osteopathic Association. 2012. Retrieved 2 April 2013.
- ^ Stolp, Bret W; Taekman, Jeffery M; Hobbs, Gene W (2007). "Simulation, ACGME and the hyperbaric fellowship". Undersea and Hyperbaric Medicine. Retrieved 2013-04-03.
- ^ http://www.gtuem.org/1106/GTÜM-Diplome.html
- ^ http://www.suhms.org/
- ^ http://www.oegth.at/58/Aus-_/_Weiterbildungsrichtlinien.html
- ^ a b c Knight, John (June 2000). "Certification in diving and hyperbaric medicine in America and Australia". SPUMS Journal (South Pacific Underwater Medicine Society) 30 (2). Retrieved 2013-04-03.
- ^ a b "Diving Regulations 2009 of the South African Occupational Health and Safety Act, 1993", Government notice R41, Government Gazette (Pretoria: Government Printer) (#32907), 29 January 2010
- ^ Davis, Michael (September 2007). "The Editor's offering: Diving medicine education". Diving and Hyperbaric Medicine 37 (3). Retrieved 2013-04-03.
- ^ "International Marine Contractors Association". Retrieved 2013-04-03.
- ^ a b Staff (December 1999). IMCA Scheme for Recognition of Diver Medic Training - Guidance for Training Establishments. International Marine Contractors Association. Retrieved 3 April 2013.
- ^ Vann, Richard D (2007). "The History of Divers Alert Network (DAN) and DAN Research.". In: Moon RE, Piantadosi CA, Camporesi EM (eds.). Dr. Peter Bennett Symposium Proceedings. Held May 1, 2004. Durham, N.C.: (Divers Alert Network). Retrieved 2014-02-11.
- ^ "Links to DDRC Published Manuscripts online". Diving Diseases Research Centre. Retrieved 2013-03-27.
- ^ "Diving Medical Advisory Committee". Retrieved 2013-04-02.
- ^ "European Committee for Hyperbaric Medicine". Retrieved 2013-04-02.
- ^ Elliott, David (2011). "The foundations for today's future.". Diving Hyperb Med 41 (3): 118–20. PMID 21948494. Retrieved 2014-02-11.
- ^ "National Board of Diving and Hyperbaric Medical Technology". NBDHMT. Retrieved 2009-06-14.
- ^ a b "Diver Medic Technician Training and Certification". NBDHMT. Retrieved 2009-06-14.[dead link]
- ^ Clarke, Dick (1985). "All about the DMT". Pressure, newsletter of the Undersea and Hyperbaric Medical Society 14 (6): 2. ISSN 0889-0242.
- ^ "Diver Medic Technician Resource Manual". NBDHMT. Retrieved 2009-06-14.[dead link]
- ^ "Certified Hyperbaric Technologist Training and Certification". NBDHMT. Retrieved 2009-06-14.[dead link]
- ^ "Certified Hyperbaric Technician Resource Manual". NBDHMT. Retrieved 2009-06-14.[dead link]
- ^ Josefsen, L; Woodward, C; Lewis, D; Hodge, J; Camporesi, EM (1997). "THE NURSING ROLE IN HYPERBARIC MEDICINE". Undersea and Hyperbaric Medicine (Annual meeting abstract). Retrieved 2009-06-14.
- ^ "South African Undersea and Hyperbaric Medical Association home page". Retrieved 2013-04-02.
- ^ Knight, John (1996). "Twenty five years of SPUMS 1971-1996.". South Pacific Underwater Medicine Society Journal 26 (2). ISSN 0813-1988. OCLC 16986801. Retrieved 2008-06-16.
- ^ South Pacific Underwater Medicine Society. "South Pacific Underwater Medicine Society Home Page". Retrieved 2008-06-15.
Further reading[edit]
Brubakk, A. O.; T. S. Neuman (2003). Bennett and Elliott's physiology and medicine of diving, 5th Rev ed. United States: Saunders Ltd. p. 800. ISBN 0702025712.
External links[edit]
- Scubadoc's Diving Medicine Online
- Diving Diseases Research Centre (DDRC)
- Rubicon Research Repository Diving Medical Literature
- SCUBA Diving and Asthma
- infos scuba diving restrictions
- Edmonds, Thomas, McKenzie and Pennefather (2010). Diving Medicine for Scuba Divers (3rd ed.). Carl Edmonds. - free download of complete text


text:
Human rights and disability advocacy
- Language
- English.
- Edition
- 1st ed.
- Imprint
- Philadelphia : University of Pennsylvania Press, c2014.
- Physical description
- xvi, 304 p. ; 24 cm.
- Series
- Pennsylvania studies in human rights.
Available online
More options
- Contributor
- Sabatello, Maya.
- Schulze, Marianne, 1975-
- Bibliography
- Includes bibliographical references and index.
- Contents
- A short history of the international disability rights movement / Maya Sabatello
- Our lives, our voices : people with intellectual disabilities and their families / Anna MacQuarrie and Connie Laurin-Bowie
- Living in the community, access to justice : having the right makes all the difference / Tirza Leibowitz
- Inclusion or choice? : securing the right to inclusive education for all / Belinda Shaw
- An eye toward effective enforcement : a technical-comparative approach to the drafting negotiations / Tara J. Melish
- Children with disabilities / Gerison Lansdown
- Women with disabilities : the Convention through the prism of gender / Mi Yeon Kim
- Including deaf culture and linguistic rights / Liisa Kauppinen and Markku Jokinen
- Imagine : to be a part of this / Lex Grandia
- Indigenous people with disabilities : the missing link / Huhana Hickey
- At the United Nations : "the South also exists" / Pamela Molina Toledo
- Voices down under : an Australian perspective / Heidi Forrest and Phillip French
- Monitoring the Convention's implementation / Marianne Schulze
- The role of national human rights institutions / Andrew Byrnes
- The new diplomacy / Maya Sabatello.
- Summary
- "The United Nations adoption of the Convention on the Rights of Persons with Disabilities (CRPD) constituted a paradigm shift in attitudes and approaches to disability rights, marking the first time in law-making history that persons with disabilities participated as civil society representatives and contributed to the drafting of an international treaty. ... Human Rights and Disability Advocacy brings together perspectives from individual representatives of the Disabled People's Organizations (DPOs), nongovernmental organizations (NGOs), indigenous peoples' organizations, states, and national institutions that played leading roles in the Convention's drafting process. The contributors provide vivid and personal accounts of the paths to victory, including stumbling blocks--not all of which were overcome--and offer a unique look into the politics of civil society organizations both from within and in its interaction with governments. Each essay describes the nonnegotiable key issues for which they advocated; the extent of success in reaching their goals; and insights into the limitations they faced. Through the plurality of voices and insider perspectives, Human Rights and Disability Advocacy presents fresh perspectives on the shift toward a new diplomacy and explores the implication of this model for human rights advocacy more generally."--Publisher website.
- Subject
- People with disabilities > Civil rights > History.
- People with disabilities > Legal status, laws, etc. > History.
- Human rights advocacy > History.
- Convention on the Rights of Persons with Disabilities and Optional Protocol (2007 March 30)
- Non-governmental organizations > Political activity.
- Civil society.
Bibliographic information
- Publication date
- 2014
- Responsibility
- edited by Maya Sabatello and Marianne Schulze.
- Series
- Pennsylvania studies in human rights
- 9780812245479
- 0812245474

subset: commoncrawl


text:
Returns April 12
Called flat-out brilliant, and the funniest out-of-the-box comedy in a good while. Silicon Valley is a new, half-hour satire of the tech world from Mike Judge, creator of Office Space and King of the Hill.
"Season 2 is sort of the rise of Richard," explains creator and executive producer Mike Judge on set. "It's not any kind of easy rise."
How'd Richard Hendricks' company land a Weisman Score of 5.2? Take a spin through the company's website to learn more.
All About Pied PiperGet updates from the series cast and creators. Explore #SiliconValley on Twitter.
Join the Silicon Valley ConversationWant to hear Pied Pipers creation story? Download all eight episodes of Mike Judges comedy series on iTunes today.
Download Season 1 NowEasier to understand than a compression algorithm: Get an exclusive Pied Piper tee from the HBO Shop�.
Give the Gift of Silicon ValleyThe actor behind 'Jared' delves deep into the mind of the Pied Piper pushover.
Interview with Zach Woods
The actor who plays Erlich talks about the reaction to Silicon Valley and much, much more.
A Chat with T.J. MillerEnjoy every episode of Silicon Valley. Free with your HBO subscription through participating television providers. It's HBO. Anywhere.�
It's Silicon Valley.' Anywhere.


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wolf vs blue star range...
We are in the process of choosing a 36" range. Right now we are choosing between blue star and wolf...I would love to get bs platinum, but their 36" version did not come out yet...
So i am completely torn between bs and wolf...we know we want griddle..
Do you think griddle on one is better then on the other? Is it convenient to have griddle in the middle...i would think it's much better to have it on the side, but not sure if one of the companies offers this configuration... If you only compared griddles, which one is better?
My understanding is that if you compare 2 perfectly working ranges then BS is better, but if you are having troubles then Wolf's customer service is better, is that correct?
BS does not have dual fuel option, right? If i was to buy Wolf i would get dual fuel...
i so want the decisions part to be over...
ps i am also getting steam/combo oven, so i'll have additional small oven...
Wolf griddle gets hotter because they use an infrared design while BS uses standard gas burner.
Wolf 100-450 degrees.
A few BS owners said they can't get BS griddle above 350 degrees.
But you are better off searing or stir frying on Bluestar's 22k btu burner than Wolf's griddle. You don't want to make breakfast at 450 degrees anyway.
You can custom configure BS to put the griddle where you want it but not the Wolf.
Wolf customer service was almost universally praised a few years ago some not happy recently over how Wolf handled some chipping in blue porcelain in the ovens.
BS customer service was panned a few years ago but seems much better now.
BS does not offer dual fuel but if you are getting an electric wall oven I would especially recommend the gas oven.
Thank you for your input!
Are there any foods you make on griddle that would require 450F?
I am still debating if i should get a range or range top with separate oven (in that case i think i would get BS rangetop+miele or wolf oven)...So hard to decide....
350 is good for pancakes but if I had a griddle I'd want the ability to sear things on it and play tepanyaki chef. If all I was doing was some eggs, pancakes and bacon I'd stick with my $125 nonstick electric griddle rather than sacrifice two burners.
I believe one problem with having four burners together rather than split is you won't be able to fit two large pans up front side by side.
"......if you are getting an electric wall oven I would especially recommend the gas oven."
We are in contemplation mode for a kitchen remodel and I could do either two ovens and a range top or 1 range and 1 oven. The 2nd oven will be a steam oven - probably Gaggenau or Wolf. What do you think the advantage of having a gas oven and electric oven would be over two electrics?
I can 100% promise you that anyone that cant get their bs griddle above 350 has an adjustment issue, most likely being t-stat. I can easily get over 500 on mine. I do think the wolf griddle being infrared is likely superior tho.
I think wolf would have a slightly superior grill and griddle, bs would have vastly superior burners, as for ovens, (gas vs gas) would probably be similar.
Even with some quality and service issues wolf seems to have had latley, if I was betting I would put my money on wolf for service. (however my limited experience with bs service has been outstanding) Fwiw, I own a 48" bs with grill and griddle for over 5 yrs now. Very happy wih it and would buy over wolf.
Both ranges are excellent.
I was on the fence about a griddle, but went with the 6 burners and then bought a vintage (1930's) cast iron griddle. It is the best decision I have ever made. Is it perfect, not, but for how often I use the griddle it works best for us.
If I had to make a decision between the Wolf and the BS I would go BS just for the burners and the ease of clean-up, imho, of the BS and the cast iron grates. We have the Wolf L-Series oven as well as the Wolf Microwave/convection and Wolf Steam oven, so we really like Wolf a ton. But after doing their cooking demo at their showroom and seeing how much discoloration there was on their 5 burner gas cooktop with the stainless steel top and how it was showing swirl marks from cleaning we were sold on the BS at that point. That doesn't even go in to open vs. closed burners, which to me is more personal preference. But that being said I love my open burners on my BS rangetop and would never look back.
Why not do the best of both worlds? Get the BS range top and put a Wolf oven under it? That is what we did, kind of at least, our Wolf oven is in our Island and not directly under our range top. We actually love it that way, as now I can be cooking on the range top and the wife can be baking or getting things out of the oven and neither of us are in each others ways.
If you don't have the room to move them you can set them up like a range, with the range top above the wall oven. It won't be 100% the same as a range, but you now get a Wolf oven and a BS range top and as I said kind of the best of both worlds based on your choices.
I don't think there is enough space under range top to put oven â¦.
I spent half a night on the plans of the kitchen and i think i figured the way to fit range top and have ovens (regular and steam) in a separate high cabinetâ¦yay to me :)))) If only my contractor agrees to move the sink to the islandâ¦.i should be all setâ¦
I have a 36" 6 burner BS that is just turning 4YO. Not being a griddle person, I can not comment on how good it works. When I need a griddle I have a nice old Griswold cast iron griddle that I place over 2 burners. Works for me, the few times I wanted a griddle.
My main concern were good burners. Love the 22K burner and the small simmer burner. Plus the BS was the most mechanical (simplest) design. No circuit boards to worry about failing. To date, no service issues. The oven heats well. The only thing I can say is in heating up and cooling down the oven will make a few noises as the metal expands and contracts sometimes.
I also have the 36" bluestar RNB. When I ordered mine I had it arranged so the middle burners are both 22k. I can put a cast iron griddle across both 22k burners. It gets pretty smoking hot when I throw on a steak. If I don't need the griddle I take it off. Then I have room for a couple large stock pots for clam chowder or what not.
I'm not sure what temperature that equates to when compared to the built-in griddle. (I think built in grill is 30k? BTU so the dual 22K should be hotter)
In the past three years I have had to replace one spark igniter and one of the oven lights. Both were technically free since I got a free spark igniter with purchase and bluestar service sent me a replacement oven light free. (Not sure if they normally do that under warranty but they did for me) No other service has been done to my unit.
This post was edited by moelarrycurly on Wed, Nov 27, 13 at 20:27
This is a message to TYGUY regarding blue star griddle heat achieving five hundred degrees. You mention a potential problem with "tstat" for those of us whose griddles don't feel hot enough. Can you tell me what that is? Bluestar has actually offered to stop by to look at it but if I can address myself despite being under warranty,mi would prefer that...always a learning experience...thank you for the reply.
I have had wolf double ovens for 10 years and had major problems with cleaning them-bottom line is you can't...(I live at 7200 ft and the self cleaning blows out the ovens) Wolf's service is great and would be the only reason I would consider buying them again. I also have the 6 burner wolf cooktop, also 10 years old and it is wonderful-would buy again in a heartbeat. I have purchased a new home and am totally redoing the kitchen. I am considering a Bluestar 36" range with a Miele Steam Convection for a second oven-or a wolf 6 burner cooktop and Miele steam/convection and miele regular oven. Any feedback on these choices? Also, any current feedback on Bluestar and Miele Support/Service if there is a problem? I will be at 5200Ft which may make baking/cleaning easier. Thanks.
I don't recall whether the Miele has a broil element, I think the Wolf combi does, and that may be something to consider if you do a lot of broiling. I have the BS 30 inch RNB range, and am sure you would be happy with the 36 inch range for its top burners and oven with the one full extension rack , though the broiler on the 30 inch range is powerful, it is pretty small. For example, it can evenly broil about 1/2 a rack of pork ribs, but not much bigger. Not sure how big the broil element is in the 36 inch BS. I haven't had a problem with my BS, so can't comment on support.
Dungan, I would say start a new thread for yourself, state what your cooking style is like,w hat you normally cook, how many people do you cook for, what is your budget, what are the things you want in a range, what are things you don't want in a range and anything else you think is helpful, it will get a lot more responses compared to your post above.
Just my opinion.


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Let us see what's happening on Russian roads nowadays...
A great road repair was done in St. Petersburg: builders scattered a pile of cement on the road, and the street sprinkler watered it in the morning. Now cars take a concrete bath.
"Black Raven" is a unique hand-made car, built by a handyman from Karaganda. Actually, it is necessary to talk not about the car, but about this amazing person. He is one of those people with golden hands who is thought of being a bit crazy. Vladimir ( the name of this wonderful master) has already more than one home-made car at his account.
The master can bring any mechanism back to life. For his knowledge and skills friends nicknamed him "Professor".


text:
Kari L. Nelson, NP Print Friendly Page
Pediatric Cardiothoracic Surgery
UW Health Clinics
American Family Children's Hospital
(608) 263-6420
| (800) 323-8942
| Map
UW School of Medicine and Public Health
Department of Surgery |
Professional Certifications and Education
Education |
Marquette University, Milwaukee, WI
Medical interpreters are available to help patients communicate with hospital and clinic staff. For more information, please contact interpreter services at (608) 262-9000. |


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What is the Avvo Rating?
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I was contacted by this attorney who was representing my tenant. He was rude and unprofessional. I cannot recall ever being treated so badly by...
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I was referred to Steven by another one of his clients. Steven helped me negotiate a contract deal that allowed me to earn 5 times what the company...
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Steve is an exceptional attorney who has a unique understanding of the legal issues that CEOs, entrepreneurs, investors, developers, and real estate... more
25 years since Steven P Katkov was first licensed to practice law.
We have not found any instances of professional misconduct for this lawyer.


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American Nutrition is recalling peanut butter flavored dog treats. The peanut butter used in these treats is from Peanut Corporation of America, the company involved in the massive peanut butter recalls.
You'll find the release regarding the American Nutrition recall on the FDA website. The FDA also has a list of peanut butter products recalled. At this point, I don't see anything about the recall on the American Nutrition website. Technorati Tags: peanut butter recall, American Nutrition, Peanut Corporation of America, salmonella |
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@Cafe41 - I used to work supporting a brand manager and my favorite aspect of working in the department was doing competitive analysis. Learning about what are competitors were doing and the market share that they had as opposed to what we had was really motivating.
It was like a benchmark that told you how close the competitor was getting. We always analyzed our advertising campaigns as well as our competitors and after a while you do develop insight as to what a customer would want. It is really a field for very creative people.
I think that when you work in this field long enough you develop instincts for creating the right product image.


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Land Lot - Statesboro, GA
Inside Statesboro Crossing near Cracker Barrel/Olive Garden. Frontage on 301 Bypass and Henry Blvd. Lot has use of common storm water detention and full utilities. Lot has 124,458 sq. ft. and is 2.86 acres.
Data Provided by Georgia Multiple Listing Service
More Information for this listing


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MY VIEW is that bookmakers have got the probabilities roughly right, and have listed a top flight set of candidates. My money would be on Kemal Dervis as he has the right experience and qualifications and Turkey might be considered close enough to Europe to satisfy Europeans. Some candidates are non-starters for reasons of their nationality (the World Bank and the IMF cannot both be run by Americans). Others are rightly long-shots for different reasons, even those that are spectacularly well qualified like Stan Fischer (who has been there before, as Deputy Managing Director) or former heads of state like Gordon Brown.
Keep in mind that the World Bank will look to appoint a new head in only a year. Some of the candidates from developing countries might be better suited for the World Bank, which focuses more on long-run development than crisis management. Montek Ahluwalia or Trevor Manuel, for instance, are both great non-American candidates to head that organisation.


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Linkin Park, Thirty Seconds to Mars, Carnivores Tour - Cruzan Amphitheatre, West Palm Beach - August 8
Sayre Berman
Thirty Seconds to Mars took the stage a little earlier than scheduled this past Friday night at Cruzan Amphitheatre in West Palm Beach. Fans hungrily lurking about the Carnivores tour's merch table and those grabbing their second round of beers ran back to their seats to provide Jared Leto and co. with a very warm welcome.
The man who doesn't age, Leto, rushed out donning a gold crown and what looked like a priestly purple robe, nothing exceptionally new for a guy whose well known for being a little eccentric. He bears a great resemblance to a white Jesus with his long hair, full beard, and that angelic mug. The ecclesiastical getup highlighted his holy, natural look.
See also: Linkin Park and 30 Seconds to Mars (Slideshow)
Sayre Berman
The crowd was pumped as the band started things off with a song from its new album Love Lust Faith + Dreams entitled "Birth." Fans went crazy as Leto sung his heart out, providing raw and beautiful vocals. Next, it performed "Night of the Hunter" and "Search and Destory." While the majority of the songs played during the set were off the newest album, the band did make a point to please older groupies with a very special acoustic performance of "The Kill" which Leto presented alone on stage. It was just a singing Jesus, an acoustic guitar, and the backing vocals of the crowd, which sung along and hung on to his every lovely word.
The set felt a bit like a party as the crowd was rewarded with giant beach balls which seemed to appear out of nowhere and a giant supply of confetti. And while that might sound like something you'd expect to find at gay pride or a Ke$ha concert, it was a helluva lot of fun. Everyone got even more amped as the band performed new hits like "City of Angles," "Conquistador," and "End of All Days."
Sayre Berman
But nothing topped what happened when Leto decided that he really wanted to get us excited. After cracking a few jokes -- pointing out one guy who was "smoking a joint under a palm tree" and letting a certain dude know that, "She's never going to call you back if you don't get up off your ass and jump" -- he rushed off the stage jumping into the crowd. He bypassed the pit completely and went further, past the box seats, and further, until he was directly in front of our seats.
See also: Linkin Park's Chester Bennington on New Album: "We Wanted to Make a Statement"
The ladies went absolutely nuts with lust as Leto jumped onto a chair and continued to serenade everyone as he was being pawed at and holding hands with some very lucky females, including myself and my guest. Because when Jared freaking Leto is right in front of you, you have to take advantage of that opportunity.
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Telstra rivals push for fair go on NBN
PUBLISHED: 20 May 2011 00:14:54 | UPDATED: 20 May 2011 10:36:53PUBLISHED: 20 May 2011 PRINT EDITION: 20 May 2011Labor is facing mounting pressure from Telstra's rivals to ensure the former monopoly provides fair and equal access to its copper network.
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Companies | Telstra Corporation. |
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Traditional mixed yeast culture. British style character, slightly fruity, with a hint of sulfur production. This yeast can be used for many different beer styles. The most traditional choices would be English style ales including milds, bitters, porters, and English style stouts. North American style ales will also benefit from fermentation with WLP017. The beer will clear easily.
A listing of how this style ranks amongst different brew styles, on a scale from 0 to 4.
Style | Rating | Style | Rating |
Brown | 4 |
Feedback and experiences from previous customers. Want to leave a review of your own?
Looks like there aren't any reviews for this strain. Feel free to leave one here.
Optimum Ferment Temp.66-70°F (19-21°C)
Alcohol ToleranceMedium


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Allergic Reaction
: An allergic reaction is an overreaction to a harmless substance. Symptoms and signs of an allergic reaction include hives, rashes, swelling, itching, wheezing, nausea, and even anaphylactic shock in severe reactions. Treatment involves avoiding triggers, taking oral antihistamines, applying antiinflammatory steroid creams, and using an EpiPen.
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Asthma is a disease that affects the breathing passages of the lungs (bronchioles). Asthma may be caused by genes and environmental factors. Asthma causes wheezing, shortness of breath, and other symptoms. Treatment includes avoidance of triggers and medications to control and prevent symptoms.
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Donk is 150BPM hardcore rave music which is huge in Northern England , Spain, Russia and Poland. Also know as bounce or scouse house.
Blackout Crew - Put a donk on it. BANING TUNE
av Donkhead
4 november 2013
To throw up
I was drinking my chocolate milkshake and then i donked everywhere. My cat donked all over my bed sheets last night. If you donk in my car your walking home.
av Benliambillytom
30 september 2013
Big big big big ass. Like super XXXL ass.
The girl I blasted last night, had a donk.
av Asian Profession
6 april 2009
The sound a Donkey makes when it has a bucket on its head.
Donkey: DONKKKKKKKK DONK!
av BirdLover637
12 maj 2012
emma wright's backside
Emma Wright's butt is almost as big as the moon.
Man, I know! Look at that donk!
Man, I know! Look at that donk!
av ILoveEmmaWright
5 maj 2010
meaning to hit someone on the head with somthing
i donked him with a snow ball/put a donk on it
av tyty2010
12 januari 2010
A name given to only the finest and most crazy badass in the world. He must know random facts that makes him look very smart. He must be able to get wicked drunk off of twisted tea and beat the shit out of random peoples trucks. He is a man of mystery..
Ryan: "Did you know the average penis size of a white male is 6 inches..?"
Anthony: "Nope.. but you are now the new Donk."
Donk: "I'm the fucking man!"
Anthony: "Nope.. but you are now the new Donk."
av Antonio69s
6 december 2010


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Alkermes Receives Fast Track Designation For ALKS 5461 For Major Depressive Disorder
Alkermes plc (NASDAQ: ALKS) today announced that the U.S. Food and Drug Administration (FDA) has granted Fast Track status for ALKS 5461 for the adjunctive treatment of major depressive disorder (MDD) in patients with an inadequate response to standard therapies. Fast Track is a process designed to facilitate the development, and expedite the review of drugs to treat serious conditions and with the potential to address an unmet medical need.
"We are extremely pleased to have been conferred Fast Track status for ALKS 5461 as we believe that ALKS 5461 may represent an important option for the treatment of major depressive disorder," said Elliot Ehrich, Chief Medical Officer of Alkermes. "This designation supports our position that there is a clear and compelling need for a novel mechanism for the treatment of depression."
About ALKS 5461
ALKS 5461 is a proprietary investigational medicine with a novel mechanism for the treatment of major depressive disorder (MDD). The mechanism of action for ALKS 5461 in the treatment of depressive symptoms is based on modulation of the opioid system in the brain, employing a balanced combination of agonism and antagonism of opioid receptors. ALKS 5461 consists of buprenorphine, a partial agonist, and ALKS 33, a potent mu-opioid antagonist, and is designed to be a once-daily, non-addictive medicine. Early clinical development of ALKS 5461 was funded through a grant from the National Institute on Drug Abuse.
About Fast Track Fast Track is a process designed to facilitate the development, and expedite the review of drugs to treat serious conditions and fill an unmet medical need. The purpose is to get important new drugs to the patient earlier. Fast Track addresses a broad range of serious conditions. For more information about Fast Track, please visit www.fda.gov/forconsumers/byaudience/forpatientadvocates/speedingaccesstoimportantnewtherapies/ucm128291.htm. About MDD According to the DSM-5 ® ( Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), major depressive disorder (MDD) is a condition in which patients exhibit depressive symptoms, such as a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a two-week period, and demonstrate impaired social, occupational, educational or other important functioning. An estimated 16.1 million people in the U.S. suffer from MDD in a given year, 1,2 the majority of whom may not adequately respond to initial antidepressant therapy. 3 About Alkermes Alkermes plc is a fully integrated, global biopharmaceutical company that applies its scientific expertise and proprietary technologies to develop innovative medicines that improve patient outcomes. The company has a diversified portfolio of more than 20 commercial drug products and a substantial clinical pipeline of product candidates that address central nervous system (CNS) disorders such as addiction, schizophrenia and depression. Headquartered in Dublin, Ireland, Alkermes plc has an R&D center in Waltham, Massachusetts; a research and manufacturing facility in Athlone, Ireland; and manufacturing facilities in Gainesville, Georgia and Wilmington, Ohio. For more information, please visit Alkermes' website at www.alkermes.com. Note Regarding Forward-Looking Statements Certain statements set forth in this press release constitute "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995, including, but not limited to, statements concerning the therapeutic value and market potential of ALKS 5461. The company cautions that forward-looking statements are inherently uncertain. Although the company believes that such statements are based on reasonable assumptions within the bounds of its knowledge of its business and operations, the forward-looking statements are neither promises nor guarantees and they are necessarily subject to a high degree of uncertainty and risk. Actual performance and results may differ materially from those projected or suggested in the forward-looking statements due to various risks and uncertainties. These risks and uncertainties include, among others: the results of ALKS 5461 development activities may not be predictive of real-world results or of results in subsequent clinical trials; ALKS 5461 may have unintended side effects, adverse reactions or incidents of misuse; adverse decisions by regulatory authorities may occur; clinical development activities with respect to ALKS 5461 may not be commenced or completed on time or at all; the company may be unable to manufacture successfully ALKS 5461; and those risks described in the Alkermes plc Annual Report for the year ended March 31, 2013, and in other filings made by the company with the U.S. Securities and Exchange Commission (SEC), which are available at the SEC's website at www.sec.gov. The information contained in this press release is provided by the company as of the date hereof, and, except as required by law, the company disclaims any intention or responsibility for updating any forward-looking information contained in this press release. DSM-5 ® is a registered trademark of the American Psychiatric Association. 1 Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun; 62 (6): 617-27. 2 U.S. Census. 3 Rush AJ et al (2007) Am J. Psychiatry 163:11, pp. 1905-1917 (STAR*D Study).Check Out Our Best Services for Investors
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Multiplication and Addition
Here's a more challenging review of times tables for master math students. Each problem is a combination of multiplication and addition, a great way to help your child memorize the times tables and exercise her aptitude for arithmetic. Be sure to remind her of the order of operations!
Common Core:
Updated on Apr 26, 2012
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Poll: Do you have a home-theater PC? With the exception of my desktop, the next most often-used PC in my home sits in the living room. I've had one in there for... Poll Question: • Do you have a home-theater PC? Type: News story Tags: Multimedia Systems |
103 |
A first look at USB 3.1 performance | 23 |
And Samsung makes new phone with no sd slot lol whaw whaw whaw | +59 |


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Share your reviews,
photos and videos here!
Involvement:Expert (understands the inner workings) - Ownership:1 day to 1 week
Pros:Descent build quality, Open circuit it outputs 12.5 volts. Has overload protection, resets if overloaded instead of becoming a paper weight. When loaded it only generates a modest amount of heat.
It does not output 5 amps as advertised, only produces 3-4amps before shutting down. As stated above, overloading does not smoke the unit, which would make it a "do not buy".
I plan to use this to power LED strips for under cabinet lighting, which should be fine. Will need to
Ok for price, so long as you only need 3amps.
Get great weekly deals and offers like: Collections


text:
Princess Lilian has Alzheimer's Disease
The Swedish Royal Court has revealed that Princess Lilian, the 94-year-old widow of King Carl XVI Gustaf's uncle Prince Bertil, has Alzheimer's Disease.
It was revealed to newspaper Aftonbladet by Elisabeth Palmstierna, the Marshall of the Court. "Lilian is very tired… She is old and frail," Palmstierna said; also confirming that Princess Lilian will not be attending the June 19th wedding of Crown Princess Victoria and Daniel Westling.
The Princess has not had much luck with her health in recent years, being rushed to hospital in February 2009 after a fall. She also underwent a hip replacement the previous summer.
Alzheimer's "destroys brain cells, causing memory loss and problems with thinking and behaviour severe enough to affect work, lifelong hobbies or social life", according to the Alzheimer's Association.
Filed under Swedish RoyalsTagged Health, Princess Lilian, Swedish Royal Wedding 2010.
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One Response to Princess Lilian has Alzheimer's Disease
That's awful to hear. My grandmother died of this disease — they do have medications to slow the disease but no cure yet — it really does affect those around the diagnosed person. Good wishes and prayers go out to the family. I know how hard it can be.


text:
Please use this identifier to cite or link to this item: http://hdl.handle.net/1928/9323
Title: | Synthesis, characterization and fluorescence performance of LaF3:Ce3+ nanocrystals |
Author: | Yang, Fan |
Advisor(s): | Al-Haik, Marwan |
Committee Member(s): | Leseman, Zayd Luhrs, Claudia |
Department: | University of New Mexico. Dept. of Mechanical Engineering |
Subject: | Fluorescence Performance Nanocrystals |
LC Subject(s): | Nanocrystals--Synthesis. Lanthanum compounds--Synthesis. Cerium. Radiolabeling--Materials. Fluorescence. |
Degree Level: | Masters |
Abstract: | Fluorescent labeling agents have greatly affected many biological applications in recent years. Among different types of labeling agents, Cerium-doped LaF3 nanocrystals (NCs) are considered to be a promising new class of luminescent materials. Usually, lanthanide-doped nanocrystals production entails the use of ligands and high-temperature, which limits their biological applications and lowers their processability. This thesis proposes a simple and affordable synthesis of water-soluble LaF3: Ce doped nanocrystals without using ligands and at low temperatures. Dispersion of the nanoparticles was carried out in three different solvents including methanol, distilled-water and DI-chitosan. The effects of different levels of dopant on the particle size, morphology and their luminescent properties were investigated. Parametric performance of the synthesized materials was investigated in light of several parameters: different Ce concentrations, different solvents and different fluorophores concentrations as well. In general higher fluorophores concentration dispersed in DI- water solvent yielded better emission and better quantum efficiency. |
Graduation Date: | May 2009 |
URI: | http://hdl.handle.net/1928/9323 |
Files | Size | Format | View |
FanYang_Master_thesis.pdf | 4.262Mb |
View/ |


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From Wikipedia, the free encyclopedia - View original article
Carpathians | |
Highest point | |
Peak | Gerlachovský štít |
Elevation | 2,655 m (8,711 ft) |
Dimensions | |
Length | 1,700 km (1,100 mi) |
Naming | |
Native name | Munții Carpați |
Geography | |
Countries | |
Range coordinates | 47°00′N 25°30′E / 47°N 25.5°ECoordinates: 47°00′N 25°30′E / 47°N 25.5°E |
Borders on | Alps |
This article may be expanded with text translated from the corresponding article in the Romanian Wikipedia. (December 2014) Click [show] on the right to read important instructions before translating.
Carpathians | |
Highest point | |
Peak | Gerlachovský štít |
Elevation | 2,655 m (8,711 ft) |
Dimensions | |
Length | 1,700 km (1,100 mi) |
Naming | |
Native name | Munții Carpați |
Geography | |
Countries | |
Range coordinates | 47°00′N 25°30′E / 47°N 25.5°ECoordinates: 47°00′N 25°30′E / 47°N 25.5°E |
Borders on | Alps |
The Carpathian Mountains or Carpathians are a range of mountains forming an arc roughly 1,500 km (932 mi) long across Central and Eastern Europe, making them the second-longest mountain range in Europe (after the Scandinavian Mountains, 1,700 km (1,056 mi)). They provide the habitat for the largest European populations of brown bears, wolves, chamois and lynxes, with the highest concentration in Romania,[2][3][4] as well as over one third of all European plant species.[5] The Carpathians and their foothills also have many thermal and mineral waters, with Romania having one-third of the European total.[6][7] Romania is likewise home to the largest surface of virgin forests in Europe (excluding Russia), totaling 250,000 hectares (65%), most of them in the Carpathians,[8] with the Southern Carpathians constituting Europe's largest unfragmented forested area.[9]
The Carpathians consist of a chain of mountain ranges that stretch in an arc from the Czech Republic (3%) in the northwest through Slovakia (17%), Poland (10%), Hungary (4%) and Ukraine (11%) to Romania (53%) in the east and on to the Iron Gates on the River Danube between Romania and Serbia (2%) in the south. The highest range within the Carpathians is the Tatras, on the border of Slovakia and Poland, where the highest peaks exceed 2,600 m (8,530 ft). The second-highest range is the Southern Carpathians in Romania, where the highest peaks exceed 2,500 m (8,202 ft).
The Carpathians are usually divided into three major parts: the Western Carpathians (Czech Republic, Poland, Slovakia), the Eastern Carpathians (southeastern Poland, eastern Slovakia, Ukraine, Romania), and the Southern Carpathians (Romania, Serbia).[1]
The most important cities in or near the Carpathians are: Bratislava and Košice in Slovakia; Kraków in Poland; Cluj-Napoca, Sibiu and Braşov in Romania; and Miskolc in Hungary.
The name "Carpathian" may have been derived from Carpi, a Dacian tribe. According to Zosimus, this tribe lived until 381 on the eastern Carpathian slopes. The word could come from an Indo-European word meaning "rock". In Thracian Greek Καρπάτῆς όρος (Karpates oros) means "rocky mountain"[10]. The Carpi tribe may be similar to or identical to another tribe which lived in the area called the Carpodaces, literally "the Carpi Dacians".
The range is called Karpaty in Czech, Polish, Slovak and "Карпати" in Ukrainian, Carpați [karˈpat͡sʲ] ( ) in Romanian, Karpaten in German and Dutch, Kárpátok in Hungarian (kárpátok means "Carpaths", kárpáti means "Carpathian"), Karpati in Serbian and Карпати in Bulgarian .
The name Carpates may ultimately be from the Proto Indo-European root *sker-/*ker-, from which comes the Albanian word karpë (rock), and the Slavic word skála (rock, cliff), perhaps via a Dacian cognate[which?] which meant mountain, rock, or rugged (cf. Germanic root *skerp-, Old Norse harfr "harrow", Middle Low German scharf "potsherd" and Modern High German Scherbe "shard", Old English scearp and English sharp, Lithuanian kar~pas "cut, hack, notch", Latvian cìrpt "to shear, clip"). The archaic Polish word karpa meant "rugged irregularities, underwater obstacles/rocks, rugged roots or trunks". The more common word skarpa means a sharp cliff or other vertical terrain. The name may instead come from Indo-European *kwerp "to turn", akin to Old English hweorfan "to turn, change" (English warp) and Greek καρπός karpós "wrist", perhaps referring to the way the mountain range bends or veers in an L-shape.[11]
In late Roman documents, the Eastern Carpathian Mountains were referred to as Montes Sarmatici (meaning Sarmatian Mountains). The Western Carpathians were called Carpates, a name that is first recorded in Ptolemy's Geographia (2nd century AD).
In the Scandinavian Hervarar saga, which relates ancient Germanic legends about battles between Goths and Huns, the name Karpates appears in the predictable Germanic form as Harvaða fjöllum (see Grimm's law).
"Inter Alpes Huniae et Oceanum est Polonia" by Gervase of Tilbury, has described in his Otia Imperialia ("Recreation for an Emperor") in 1211. Thirteenth to 15th century Hungarian documents named the mountains Thorchal, Tarczal or less frequently Montes Nivium.
The Carpathians begin on the Góra Świętego Marcina 384 m. in Tarnów - northern edge of Pogórze Ciężkowickie. They surround Transcarpathia and Transylvania in a large semicircle, sweeping towards the southeast, and end on the Danube near Orşova in Romania. The total length of the Carpathians is over 1,500 km (932 mi) and the mountain chain's width varies between 12 and 500 km (7 and 311 mi). The highest altitudes of the Carpathians occur where they are widest. The system attains its greatest breadth in the Transylvanian plateau and in the south of the Tatra group – the highest range, in which Gerlachovský štít in Slovakia is the highest peak at 2,655 m (8,711 ft) above sea level. The Carpathians cover an area of 190,000 km2 (73,359 sq mi) and, after the Alps, form the next most extensive mountain system in Europe.
Although commonly referred to as a mountain chain, the Carpathians do not actually form an uninterrupted chain of mountains. Rather, they consist of several orographically and geologically distinctive groups, presenting as great a structural variety as the Alps. The Carpathians, which attain an altitude of over 2,500 m (8,202 ft) in only a few places, lack the bold peaks, extensive snowfields, large glaciers, high waterfalls, and numerous large lakes that are common in the Alps. It was believed that no area of the Carpathian range was covered in snow all year round and there were no glaciers, but recent research by Polish scientists discovered one permafrost and glacial area in the Tatra Mountains.[12] The Carpathians at their highest altitude are only as high as the middle region of the Alps, with which they share a common appearance, climate, and flora. The Carpathians are separated from the Alps by the Danube. The two ranges meet at only one point: the Leitha Mountains at Bratislava. The river also separates them from the Balkan Mountains at Orşova in Romania. The valley of the March and Oder separates the Carpathians from the Silesian and Moravian chains, which belong to the middle wing of the great Central Mountain System of Europe. Unlike the other wings of the system, the Carpathians, which form the watershed between the northern seas and the Black Sea, are surrounded on all sides by plains, namely the Pannonian plain to the southwest, the plain of the Lower Danube (Romania) to the south, and the Galician plain to the northeast.
Important cities and towns in or near the Carpathians are, in approximate descending order of population:
This is an (incomplete) list of the highest peaks of the Carpathians (limited to summits over 2,500 m), their heights, geologic divisions and locations.
This is a list of the highest national peaks of the Carpathians, their heights, geologic divisions, and locations.
Peak | Geologic divisions | Nation (Nations) | County (Counties) | Height (m) |
Gerlachovský štít | Fatra-Tatra Area | Slovakia | Prešov Region | 2,655 |
Moldoveanu | Făgăraş Mountains | Romania | Argeş | 2,544 |
Rysy | Fatra-Tatra Area | Poland | Lesser Poland Voivodeship | 2,503 |
Hoverla | Beskides | Ukraine | Chornohora | 2,061 |
Beljanica | Homolje mountains | Serbia | Braničevo District | 1,344 |
Kékes | North Hungarian Mountains | Hungary | Heves | 1,014 |
In the Romanian part of the main chain of the Carpathians, the most important mountain passes are (starting from the Ukrainian border): the Prislop Pass, Rodna Pass, Tihuţa Pass (also known as Borgo Pass), Tulgheş Pass, Bicaz Canyon, Ghimeş Pass, Uz Pass and Oituz Pass, Buzău Pass, Predeal Pass (crossed by the railway from Braşov to Bucharest), Turnu Roşu Pass (1,115 ft., running through the narrow gorge of the Olt River and crossed by the railway from Sibiu to Bucharest), Vulcan Pass, Teregova Pass and the Iron Gate (both crossed by the railway from Timișoara to Craiova).
The area now occupied by the Carpathians was once occupied by smaller ocean basins. The Carpathian mountains were formed during the Alpine orogeny in the Mesozoic[13] and Tertiary by moving the ALCAPA, Tisza and Dacia plates over subducting oceanic crust (see maps).[14] The mountains take the form of a fold and thrust belt with generally north vergence in the western segment, northeast to east vergence in the eastern portion and southeast vergence in the southern portion.
The external, generally northern, portion of the orogenic belt is a Tertiary accretionary prism of a so-called Flysch belt created by rocks scraped off the sea bottom and thrust over the North-European plate. The Carpathian accretionary wedge is made of several thin skinned nappes composed of Cretaceous to Paleogene turbidites. Thrusting of the Flysch nappes over the Carpathian foreland caused the formation of the Carpathian foreland basin.[15] The boundary between the Flysch belt and internal zones of the orogenic belt in the western segment of the mountain range is marked by the Pieniny Klippen Belt, a narrow complicated zone of polyphase compressional deformation, later involved in a supposed strike-slip zone.[16] Internal zones in western and eastern segments contain older Variscan igneous massifs reworked in Mesozoic thick and thin-skinned nappes. During the Middle Miocene this zone was affected by intensive calc-alkaline[17] arc volcanism that developed over the subduction zone of the flysch basins. At the same time, the internal zones of the orogenic belt were affected by large extensional structure[18] of the back-arc Pannonian Basin.[19]
Iron, gold and silver were found in great quantities in the Western Carpathians. After the Roman emperor Trajan's conquest of Dacia, he brought back to Rome over 165 tons of gold and 330 tons of silver.[20]
The largest range is the Tatras.
A major part of the western and northeastern Outer Carpathians in Poland, Ukraine and Slovakia is traditionally called the Beskids.
The geological border between the Western and Eastern Carpathians runs approximately along the line (south to north) between the towns of Michalovce, Bardejov, Nowy Sącz and Tarnów. In older systems the border runs more in the east, along the line (north to south) along the rivers San and Osława (Poland), the town of Snina (Slovakia) and river Tur'ia (Ukraine). Biologists, however, shift the border even further to the east.
The border between the eastern and southern Carpathians is formed by the Predeal Pass, south of Braşov and the Prahova Valley.
Ukrainians sometimes denote as "Eastern Carpathians" only the Ukrainian Carpathians (or Wooded Carpathians), meaning the part situated largely on their territory (i.e., to the north of the Prislop Pass), while Romanians sometimes denote as "Eastern Carpathians" only the part which lies on their territory (i.e., from the Ukrainian border or from the Prislop Pass to the south), which they subdivide into three simplified geographical groups (north, center, south), instead of Outer and Inner Eastern Carpathians. These are:
Wikimedia Commons has media related to Carpathian Mountains. |


text:
Hillsborough County
Riverview, Florida is considered an Unincorporated Area of Hillsborough County. For more information visit the Hillsborough County website: www.HillsboroughCounty.org
Important Numbers:
Affordable Housing: 274-6600
Animal Services: 744-5660
Job News Line: 272-6975
Code Enforcement: 274-6600
County Information Line: 272-5900
Emergency: 9-1-1
Emergency Management: 272-6900
Environmental Protection (EPC): 627-2600
Family & Aging Services: 272-5040
Fire Rescue: 272-6600
Libraries: 273-3652
Neighborhoods: 272-5860
Parks, Recreation & Conservation: 635-3500
Public Works Construction—Hotline: 272-5275
Sheriff's Office: 247-8000
Solid Waste: 272-5680
For a complete list of Hillsborough County Departments: www.HillsboroughCounty.org/departments
Riverview Community Plan
In 2005, the Riverview community adopted a community. For more information: CLICK HERE
Board of County Commissioners
Meet the Hillsborough County Board of County Commissioners: www.HillsboroughCounty.org/bocc
NOTE: Regular meetings of the Board of County Commissioners are open to the public and are held on the first and third Wednesdays of each month, beginning at 9 a.m. Speakers generally are limited to 3 minutes. The Commissioners' offices and boardroom are located on the second floor of the County Center, 601 E. Kennedy Boulevard in downtown Tampa. The meetings also aired live on Hillsborough Television. Check your cable listings for the appropriate channel in your area.
Clerk of the Circuit Court
For Public Records visit the Clerk of the Circuit Court website: www.hillsclerk.com
Consumer Protection
Hillsborough County Consumer Protection information: www.HillsboroughCounty.org/consumerprotection
Parks, Recreation and Conservation Department
Hillsborough County Parks, Recreation and Conservation Department: www.HillsboroughCounty.org/Parks
Sheriff's Office
Hillsborough County Sheriff David Gee
In a case of an emergency dial 911. Hillsborough County Sheriff's Office Non-Emergency
telephone number is 813-247-8200. For more information visit: www.hcso.tampa.fl.us


text:
TWDG Blank OC Bio TemplateGeneralName: [And pronunciation. Meaning is optional]Gender:Birth date:Age:Sexual Orientation:Status:Series Lifespan:Family:Former Home:Current Location:Group Role: [If in a group]Portrayed By: [Optional]Appearance[Brief description of what your character looks like]Race:Ethnicity:Eye color:Hair color:Height:Weight: Build:Extra Anatomy:Deformities:Scars/Birthmarks:Tattoos/Piercings:Preferred clothing:Personality[Brief description your character's personality. Don't forget to try and balance the positives with negatives.]Strengths:Weaknesses:Goals:Fears:Habits:Quirks:Talents:Hobbies:Phobias:Addictions:Other Ailments:Speech[Describe how your character speaks. Optional but it can be fun to come up with unique speech patterns for your characters.] Verbosity:Vocabulary:Grammar:Dialect:Native Language:Other Languages:Pre-Apocalypse[Describe what your character was like before zombies took over. What did they like
Shingeki no Kyojin / Attack on Titan (C) Hajime Isayama


text:
Showing 1-24 of 97 items found in Food & Drink
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Cache River Basin Vineyard and Winery
The winery is known for its white wine made from grapes grown in Southern Illinois. The winery and vineyard are located in a scenic setting just south of the Heron Pond turn-off.
CITY: Belknap
Wineaux's Restaurant
Located at Cache River Basin Vineyard and Winery, Wineaux's offers American cuisine, including certified Angus Beef steaks and burgers, ribs and seafood. Specializing in food cooked with wine!
CITY: Belknap
Crab Orchard Golf Club
Located between Marion and Carbondale, this 18-hole, semi-private par 70 course features lush zoysia fairways and a practice area with target greens. Crab Orchard made Golf Digest's 2008/09 "Best Places to Play" list.
CITY: Carterville
Country Cupboard Restaurant
Family style, dine in, carry out. Home cooked meals, pies made from scratch.
CITY: Carterville
Mimmo's Pizza
Authentic Italian food and excellent pasta. Family oriented, dine in or carry out.
CITY: Carterville
San's Chinese Restaurant
Family dining, dine in or carryout. Buffet everyday and always different.
CITY: Carterville
S.I. Bowl
This 32 lane facility offers bowling and a bar. There is a Pro-shop with ball drilling on site. Offers Highway 66 bowling for children on four mini lanes. There is a game room with three billiards tables, air hockey, arcade, and more. There is a bar and lounge on the premesis. They have youth programs, tournaments, leagues, and parties. Offers cosmic bowling. Also, four sand volleyball courts with seating for approximately 100 people.
CITY: Carterville
Walkers Bluff Winery
Local winery with a General Store, 5 star cuisine at Legends Restaurant, wine cave, open air pavilion, gazebo and much more. Enjoy a glass of wine while listening to live entertainment. Boasts a large childrens play area, large handcarved sculptures, and even a full service gas station at the general store. You must visit to see the magnitude of this destination.
CITY: Carterville
Mis Cuates
Authentic Mexican style restaurant. Mis Cuates serves fresh, handmade, authentic Mexican fare in a convenient location between Marion and Carbondale. Choose from the extensive menu for dinner or visit during lunch for the Mexican Buffet and enjoy your selection in our beautiful dining room.
CITY: Carterville
Crossroads Coffee
Crossroads coffee is a locally owned coffee shop that offers a variety of coffee and specialty drinks. Offering a fine selection of Novus and Stash teas available hot or "on the rocks" and served with a variety of fresh bakery items, smoothies, hot chocolates, Italian sodas and Granitas. Breakfast items include Sausage Egg Croissants, Bagels and Cream Cheese, Scones, Muffins and Fresh Fruit. Lunch includes a signature chicken salad served on a croissant, our freshly grilled Paninis or a hearty bowl of our homemade soup. Hours are Mon-Sat 6am-8pm, Sun 8am-2pm. Local Delivery Available.
CITY: Carterville
SI Tours
Locally owned tour bus that can seat up to 12 people. Services available include wine trail tours, scenic tours, as well as sporting and special events.
CITY: Carterville
Pizza and Pasta Express
We offer an alcohol-free, family environment with speedy service and positive attitudes. Children and adults of all ages enjoy our large-scale model train display that is suspended from above and in full operation while they dine. So come in and enjoy some of the best homemade Pizza and Pasta dishes found in the area. Be sure to try our famous Double Decker Pizza & award-winning Italian beef subs and salads.
CITY: Carterville
Grumpy's Smokehouse
Grumpy's Smokehouse BBQ started out with a love for BBQ and cooking which led to the creation of a successful catering business and a restaurant which opened in 2010.
CITY: Carterville
Legends at Walker's Bluff
The Bluff's fine dining restaurant, Legends, offers the area's most gourmet cuisine, largest selection of fine wines and spirits, elegant atmosphere, and most spectacular service.
CITY: Carterville
John John's BBQ & Catering
Visit our family restaurant in Colp, Illinois for quality catering services and delicious barbeque.
CITY: Colp
Windy Hill Vineyard & Winery
This family-owned vineyard harvests three acres of grapes each fall. The varieties include Vignoles, Chambourcin, Catawba, Concord, Niagara and Cayuga. Windy Hill is located on the Southern Illinois Wine Trail.
CITY: Creal Springs
Kay's Sugar Creek Cafe
Family dining, carry out or dine in. Delicious home cooked meals. Pies and cakes are made from scratch. Friday and Saturdays all you can eat fish fry.
CITY: Creal Springs
Moon Dog Farm & Vineyard
This farm offers fine Illinois wine-making grapes, organic vegetables and a small selection of fruits.
CITY: Creal Springs
Bella Terra Winery
Bella Terra Winery is nestled in the beautiful surroundings of Johnson County, Illinois. With a scenic view of ponds, trees, and our vineyard we provide the perfect setting for sipping wines or celebrating special occasions. Bella Terra Winery was not created just for wine connoisseurs, we offer food and activities for the whole family. You can play bocce ball, throw a game of washers, watch your favorite team on T.V., or just relax under a tree and enjoy the breeze.The manicured grounds of Bella T Winery combined with beautiful shade trees create a striking backdrop for any occasion.
CITY: Creal Springs
Bear Branch Log Cabin Restaurant
Bear Branch Log Cabin Restaurant is a rustic, authentic, log cabin restaurant set on the highest hill in Pope County. It is the centerpiece in The Bear Branch Horse Resort, a horse camp with 80 campsites and 6 cabins. It features down-home country cooking including catfish and steaks. The Rustic Log Cabin Restaurant, open Friday through Sunday, offers a quiet setting, great food, and a spectacular view. On regular weekends the restaurant is open Friday & Saturday at 4 p.m. for dinner, Saturday and Sunday 7 a.m. to 11 a.m. for breakfast. Extended restaurant hours are also offered on Holiday weekends. Open all week during May and October (when reservations permit).
CITY: Eddyville
E'Town River Restaurant
Floating restaurant right on the Ohio River, with fresh catfish served daily.
CITY: Elizabethtown
Nesler's Polar Whip
Family owned for over 75 years. Nesler's Polar Whip offers great cheeseburgers, hamburgers, and fries at an affordable price.
CITY: Energy
The Red Onion
Two-inch pork chops prime rib, steak, and catfish dinners. Also sandwiches.
CITY: Equality


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Exclusive: up close with Loeb's Peugeot 208 T16
No one else has got this close to Seb Loeb's 875bhp Pikes Peak, or knows how fast it's going to get up the hill…
Posted: 13 Dec 2013
By how much? Famin smiles. "Like Le Mans, you prepare for six months for just one race," he says. "Le Mans, it's 24 hours, but at Pikes Peak it could be just... eight minutes?"