text:
CE Course 10
Mental Illness and the Dental Patient
Credit: Continuing Education Hours: 2
If you have specific questions about the CE requirements in your state, or if you're not sure if the course will be accepted, please consult your state dental board.
After reading this CE course, click this link to pay and take the test. Pay and take the CE test.
Table of Contents
- Course Goals
- Learning Outcomes
- Abstract
- Pre-Test
- Introduction
- The Mental Health
- Psychiatric Disorders— Practical Aspects
- Case Example A:
- Case Example B:
- Working with Patients who have Severe or Chronic Mental Illness
- Working with Patients with CMI and Their Case Managers
- Conclusion
- Suggested Reading
- Key Terms
- Authors
Course Goals
The purpose of this course is to improve dental hygienists' awareness of mental illness and how it affects patients' oral health and ability to accept oral health care. Examples of how dental hygienists can help patients affected by mental illness are reviewed and illustrated with examples.
Learning Outcomes
Upon completion of this course, the participant will be able to:
- List and describe the general types of mental illness.
- Explain how a person's mental health can affect oral health and treatment.
- Recognize oral conditions that may indicate mental health problems.
- Recognize medications often used to treat mental illness and the potential side-effects that can impact oral health.
- Explain how to take a mental health history.
- Describe the process of making a mental health referral.
- Recognize fear and suspicion in patients and respond appropriately.
- Describe ways to communicate with people who have chronic mental illness (CMI).
- Describe ways to work with CMI patients' case managers.
Assessment Method: Post-test only
Virtually every oral health care practice includes patients with mental illness. This continuing education (CE) course gives a practical overview of common psychiatric disorders, their effects on oral and dental health, and conditions associated with mental illness that affect oral health treatment. Following a brief description of mental illnesses, information on conducting a mental health interview and making a psychiatric referral are provided. Oral health problems associated with mental illness and factors affecting treatment delivery are discussed, as well as ideas for avoiding potentially dangerous medication interactions and working with fearful, suspicious, or cognitively impaired patients. Ways in which dental hygienists can work with case managers to provide much needed oral health care to patients whose illness is severe or chronic are covered. Examples are given of work with clients illustrating principles described in the text.
The purpose of this course is to provide oral health personnel the information they need to knowledgeably care for patients who have mental illness. Successful completion will be assessed with a post-test to be completed after reading the article in its entirety, including figures and case-reports. Two continuing education course credit hours will be awarded following successful completion of the post-test.
The purpose of this pre-test is to alert readers to important information in this continuing education article and to help them assess their own learning.
- True or False: Patients with chronic mental illness are more likely to have oral health problems than similar patients without mental illness.
- True or False: It is useful to include questions relating to mental health in the patient health history form.
- Are there oral health problems that can arise from mental illness and its treatment? If so, please list.
- Are there medical problems associated with mental illness and treatment for mental illness that can affect delivery of dental treatment? If so, please list them.
- There are potentially dangerous interactions between certain drugs used to treat mental illness and some drugs used in dentistry. Please list them.
- What is a mental health case manager? When and how might a dental hygienist work with one?
In any given year, one in five Americans will have a mental illness and about one in three will have a mental illness at some time in their life. For most, their illness will be transitory. But for about 1 in 30, it is a severe and chronic condition. Common as it is, mental illness is often unrecognized and misunderstood. Emotions, thoughts, health, behavior, and social relationships are all affected by mental illness and its treatment. Mental health and oral health are intertwined in many ways. This course is designed to improve understanding of mental illness and how it affects oral health and treatment.
Historically, the conditions now called mental illness or emotional disorders have been poorly understood. As a consequence, these illnesses still are highly stigmatized in society. In the last few decades, however, a great deal has been learned about characteristics of mental illness, its causes, and treatment. Although a large percentage of people with mental illness can now be effectively treated with psychotherapy and/or medication, about 60% or more of mental illness cases are undiagnosed and untreated. Dental hygienists are in an excellent position to help their patients who may have mental illness recognize and find treatment for their condition. Because mental illness and its treatment are often associated with oral health problems, dental hygienists also have a vital role in maintaining the oral health of patients at risk.
Virtually any oral health care practice will have patients with psychiatric disorders. Only about 3 in every 100 people have an obvious severe or chronic mental illness (CMI), but 20 in 100 will have a transient mental illness in any given year. Therefore, many patients who appear healthy will be dealing with an emotional disorder. These patients need oral health care from providers who understand mental illness and how it affects oral health and treatment. With such knowledge, dental hygienists can, for example, recognize tooth enamel erosion that indicates an eating disorder and facilitate a treatment referral for this life-threatening illness. They can develop communication skills, learn how to avoid potential adverse interactions between drugs used to treat psychiatric disorders and those used in oral health treatment, and become comfortable working with their most challenging patients, all the while understanding that this is where the need for preventive oral health care is likely to be greatest.
A brief overview of mental illness
What is mental illness? Mental illness has been defined as a clinically significant behavioral or psychological syndrome associated with distress, disability, or a significantly increased risk of suffering pain, disability, an important loss of freedom, or death. This syndrome must not simply be an expectable response to a particular event, such as the death of a loved one. Mental disorders are a manifestation of a behavioral, psychological, and/or biological dysfunction in an individual. Neither deviant behavior nor conflicts primarily between the individual and society are mental disorders unless they arise from a dysfunction in the individual.1
The Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) is a standard reference that describes many types of mental illness. It is not a treatment manual, but just as dental codes are used to communicate dental problems, the DSM IV-TR is intended to provide standardized descriptions of mental illness to improve communication about the disorders among treatment providers and researchers. Major categories of mental illness are briefly described below: (Characteristics of some of the more common mental disorders within the following categories are listed in more detail in (Figure 1.)
- Mood disorders include disorders that have a disturbance in mood as the predominant feature. They include the depressive disorders and bipolar disorders.
- Anxiety disorders demonstrate anxiety as the primary characteristic.
- Eating disorders are characterized by severe disturbances in eating behavior.
- Psychotic disorders are characterized by hallucinations, delusions, and other symptoms. Schizophrenia and schizophrenia-like illnesses fall into this category.
- Somatoform disorders are characterized by physical symptoms that suggest a medical condition but are not fully explained by a medical condition, direct effects of a substance, or other mental disorders.
- Cognitive disorders demonstrate significant decrease from previous functioning in ability to think or remember.
- Substance-related disorders are characterized by abuse of substances, including alcohol.
Each of these categories includes two or more mental illnesses defined by the DSM IV-TR (Figure 1). Many more illnesses have been described than can be covered in this CE course, so the emphasis here is on common disorders and those of special importance to oral health professionals. Dual diagnosis, not a category in the DSM IV-TR, is a term often used to characterize clients who have both a substance abuse disorder and a mental illness. The term may also be used in other ways to describe patients with developmental disability and mental illness or with two distinct mental illnesses. In this course, the first definition will be used.
The Mental Health
History and Interview Health history form Dental hygienists are accustomed to recording a medical history on each patient. It is helpful to have relevant mental health questions on the health history form along with the medical questions. These may include a question on psychiatric care and mental health status, an alcohol/ drug question, a question about dental fear and previous problems with oral health treatment, and specific questions about depression and panic attacks. Some suggestions are listed in Figure 2. The health history form should include a listing of prescription, over-the-counter (OTC) drugs, and alternative medications the patient has taken in the past 12 months; this information is also helpful for interviewing the patient. By taking a mental health history, important information can be obtained on conditions that affect oral health treatment, as later described.
The mental health questions elicit information in the patient interview that will help in treatment planning and working with the patient. When asking questions about mental health, use a nonjudgmental, matter- of-fact approach. "Stress" is a good word to use when discussing these issues with patients. One should listen carefully, but not pry, as patients will reveal what they feel comfortable discussing. Many patients with mental health conditions may not discuss their problem for various reasons, perhaps because of the stigma associated with such illnesses, from denial, or from lack of information. Their problems may become apparent later as they encounter stress in treatment or they may reveal them as they feel more comfortable with their providers.
If a patient says that he or she has a mental health condition, one should ask open-ended questions such as, "What can you tell me about this?" Doing so allows the patient to discuss the problem in his or her own way. If the patient is taking psychotropic medications, appropriate questions include:
- What condition is the medication treating?
- What are your symptoms?
- How long have you been taking the medication and does it help?
- Who is the physician treating the condition?
- When was your mental illness diagnosed?
- Are you receiving counseling or therapy, and how frequently do you see the physician or counselor?
- Bear in mind that "psychotropic" medications may be used for multiple purposes, including some unrelated to mental illness. Bupropion hydrochloride (Wellbutrin®), for example, is indicated for depression and as an aid in smoking cessation. Diazepam (valium) may be used as a premedication prior to medical or dental treatment or to treat convulsive disorders, muscle spasms, spasticity, or anxiety disorders. Hydroxyzine hydrochloride (Atarax) is used to treat pruritis (itching) or anxiety.2
Sometimes the oral health care professional may wish to consult with a patient's care provider about a medical or psychiatric condition. Patients with CMI, especially dementia, may be poor historians, so a consultation can be helpful. Patient consent for the consult must always be obtained.
For patients whose mental illness is a continuing and serious problem, questions about previous hospitalizations should be asked. For some patients, symptoms predictably wax and wane; these patients may need to schedule appointments when they are best able to cope with oral health care treatment.
It may be difficult to detect active substance abusers, but those in recovery will usually answer questions about their substance use.3 For alcohol abusers, these questions may include what they drink and how often. For any drug abuser, inquires should be made about what drugs are frequently or occasionally used and when the substances were last used. It is important to know that relapses (or "lapses") are a common part of recovery. Many of those who successfully discontinue substance abuse have done so after several such lapses. Patients can be encouraged to move toward harm reduction at any stage of substance abuse.4
Ask patients about their previous experiences with oral health treatment. This can be a good indicator of their current level of comfort with treatment and can aid in recognizing dental anxiety when it is present.
Psychiatric referral
With the escalation of substance abuse, especially among younger people, and the prevalence of mental illness, referrals may sometimes be necessary.
Although oral health care professionals may feel this is out of their scope of practice and fear they may offend the patient, referral is consistent with the health care provider role. It also demonstrates willingness to help a patient with a problem. Caring for a patient's total health can have a profoundly beneficial effect. It is helpful to identify respected mental health professionals in the community whose expertise matches the patient's needs. Several professional associations provide information on qualified professionals in the community (Figure 3).
The role of dental hygienists is to alert the dentist to problems observed. The best time for a dentist to make the suggestion of a referral is in consultation with the patient in a nonintimidating setting, preferably away from the dental chair.
Psychiatric Disorders— Practical Aspects
There are many ways mental health and oral health can impact each other. Medications used to treat mental illness may interact with drugs used in dentistry. Some oral health problems arise from the manifestations of mental illness, while others may be side effects of psychiatric medications. Unfortunately, patient psychiatric disorders also produce reduced rates of compliance for preventive oral health care, as well as a reduced ability to obtain and tolerate needed oral health treatment. For patients with severe or chronic mental illness, this combination of greater susceptibility to oral health problems and difficulty with oral health maintenance can be devastating. (See case example A: "Can You Help Me with my Teeth?") Working with oral health care professionals who understand the practical aspects of patients' oral health care can have tremendous payoffs for these patients. Most patients whose emotional problems affect their oral health care can be helped by oral health professionals who are knowledgeable and sensitive. (See case example B: "Terrified.")
Oral health conditions associated with mental illness
Certain oral health conditions are virtually diagnostic of a specific mental illness and some have a poorly understood association with mental illness. Others can indicate a personality type or a medication side effect. Atypical odontalgia demonstrates that inexplicable symptoms should not automatically be ascribed to mental illness.5
Enamel erosion, especially diagnostic if the pattern of erosion is on the lingual surfaces of the anterior maxillary teeth, can be an indication of self-induced vomiting, a characteristic of bulimia nervosa and sometimes anorexia nervosa (Figure 1). Patients with an eating disorder also may have increased dental caries, tooth hypersensitivity, margination of restorations, osteoporosis, cardiac abnormalities, muscle cramps, and numerous other health problems. Referring such individuals to a mental health professional, with permission of the patient, can be a service to those who have these serious, potentially life-threatening diseases.6-8
Gingival recession and tooth abrasion can result from aggressive brushing, often a characteristic of perfectionists. Since these individuals are generally eager to please, overzealous brushing may be readily corrected with an explanation from the dental hygienist of the harmful effects.9 On the other hand, these signs can also indicate mania or, in rare cases, cocaine abuse in the form of rubbing on gingival.10
Xerostomia is often seen in patients with mental illness. It can be associated with bulimia, depression, anxiety, systemic diseases, including diabetes, dehydration, and rheumatoid arthritis, or radiation treatment to the head or neck region. It is often a side effect of medications.11 Some of these medications are antidepressants, antipsychotics, sedatives, and hypnotics (Figure 3). The clinical sequelae of chronic, untreated xerostomia can be severe, including oral infection, inflamed, fissured tongue, glandular enlargement and infection, rampant caries, and enamel erosion.
Some patients who take psychotropic medications to improve their quality of life, risk lowering that quality if oral health problems are ignored. More than 400 medications, including most psychotropic drugs, cause xerostomia. For the patient with medication-induced xerostomia, effective, less xerostomatic, alternative drugs may be available; consultation with the patient's prescribing physician and pharmacist can be helpful. Preventive oral health maintenance with regular recall visits and meticulous oral hygiene is key. Temporary symptomatic relief may be obtained from sipping water and from products specifically formulated to relieve dry mouth symptoms, such as Biotene® mouthwash and dry mouth gum, Natrol DMR (Dry Mouth Relief)® and Roxane® Saliva Substitute. OralBalance® gel and Biotene® toothpaste from Laclede® have been shown to improve gingival health in xerostomatic patients.12
A typical odontalgia (AO) is an oral pain disorder that, if misidentified, can lead to unnecessary, irreversible treatment. AO is characterized by chronic throbbing or burning pain in the teeth, alveolar process, or mucosa without a clear cause. According to early reports, AO was thought to be a manifestation of psychiatric disorder.13 However, recent investigations indicate that the pain of AO is primarily neuropathic, that is, it originates from sensitization of nerves, often following oral health treatment.14 There was lack of knowledge concerning neuropathic pain until recently. Therefore, neuropathic pain is a relatively new term to many oral health care and medical professionals.5 The danger of AO is in misdiagnosis. The moderate to severe pain of AO may mimic dental disease sufficiently to prompt deadening or extraction of teeth without providing lasting relief for the patient.15
Although mental illness does not cause AO, this oral pain disorder is associated with depression or other psychiatric disorders, perhaps because the perception of pain is affected by the emotional state. Patients who have symptoms consistent with AO can be referred to a specialist pain center to test specifically for pain of neuropathic origin, as well as other forms of pain. Testing by a specialist may spare patients extensive and unnecessary dental treatment.14 It can be expected that making a differential diagnosis between atypical odontalgia and somatoform disorder with pain symptoms will lead many more patients to appropriate and effective treatment for their pain.
Temporomandibular disorders (TMD) involve the joints and/or muscles active in chewing. Pain, limited range of jaw motion, and temporomandibular joint noises are common symptoms. Several studies have shown an association between TMD and mental illnesses such as depression, anxiety, and substance abuse.16-18
It is not yet clear which comes first—mental illness or TMD. Life stressors related to mood disorders may lead to facial muscle tension, bruxism, etc., which then leads to TMD.19-20 On the other hand, the pain and stress associated with TMD may contribute to mood disorders. In any case, oral health care personnel should be aware that about half of individuals with TMD have or have had a mood disorder or other psychological diagnosis, especially patients whose symptoms are primarily muscle- and pain-related, as opposed to joint-related.17-18.
Bruxism, as mentioned above, may be related to stress or it may provide a means of coping for patients with constant intraoral pain.14 It can even be a side-effect of antipsychotic and antidepressant medication.21 If this is suspected, consultation can alert the prescribing physician to evidence of bruxism seen on oral examination.
Factors that Affect Treatment Delivery
In addition to the behavioral aspects of psychiatric disorders (discussed later), factors that can affect treatment include neuromuscular side effects of medications, mitral valve prolapse (often associated with panic attacks), medication interactions, and alterations in pain threshold.
Some psychotropic medications can cause movement disorders that damage teeth or interfere with oral health care. Extrapyramidal side effects (EPS) often arise from the neuroleptic-antipsychotic drugs. Early effects can include muscle spasms of the face, tongue, and neck. A Parkinson's-like syndrome—including slowed movement, rigidity, tremor, and restless movement— can occur days or weeks after initiation of therapy.22 Since these effects are most commonly seen when the medications are started or the dosage is increased, oral health care appointments can be planned to avoid times when a patient's medications are being adjusted.
Tardive dyskinesia is a lateappearing side effect of neurolepticantipsychotic medications which occurs in 20 to 40% of patients taking high doses of these medications long-term. The characteristic sign of tardive dyskinesia is orofacial dyskinesia—an involuntary movements of the tongue, face, or jaws. Involuntary trunk and limb movements also may occur. Unfortunately, unlike the early appearing side effects of these medications, tardive dyskinesia is difficult to reverse once it has appeared, although it may resolve after months or years.23 The uncontrolled oral movements can interfere with oral health care treatment. Some control of the dyskinesia with medication adjustment may be possible; consultation with the patient's prescribing physician and pharmacist can be helpful. Note that the newer antipsychotic drugs now available (the atypical antipsychotic drugs) are believed to cause tardive dyskinesia less frequently.23
Patients with panic disorder may have mitral valve prolapse as well. Mitral valve prolapse (MVP), an abnormality of one of the heart valves, is often benign, causing no symptoms. However, significantly more patients with panic disorder or agoraphobia have coexisting MVP.24,25 Dental hygienists need to be aware of this condition, since prophylactic antibiotics are recommended before therapy that involves gingival bleeding that could result in exposure to transient bacteria in the bloodstream. To avoid potential cardiac complications, a cardiology consultation is advisable in patients with panic disorder to rule out MVP or to arrange appropriate preventive antibiotic therapy if it is present.26
The potential for interactions between medications used to treat mental illness and medications used in dentistry is a consideration whenever anesthetics or other drugs are used. Figure 4 provides information on potential drug interactions and side effects.
Orthostatic hypotension is a side effect of some medications used to treat mental illness; patients who have this symptom will need to have position changes (horizontal to vertical) made more gradually than usual to avoid dizziness or faintness.27
Pain perception in patients with mental illness may vary. Depressed patients, for example, may be especially sensitive to pain, as may patients with a history of substance use. (See below: "Working with Patients who have Severe or Chronic Mental Illness"). In contrast, patients with schizophrenia may have difficulty recognizing pain when it is present. One should be sensitive to these potential differences in pain perception and provide pain control as needed.
Working with fearful, phobic, suspicious, and cognitively impaired patients
Fear and distrust are common in patients receiving oral health care, especially in those with mental illness. Patients who are fearful and suspicious call for specific responses in oral health care personnel (Figure 5). Case example A illustrates a patient whose schizophrenia did not interfere with her ability to accept gentle oral health care. At the time she received this care, she was in a mental health treatment program and stabilized on medications. The second example is of a fearful patient who was treated in the second author's office. For patients whose problems with dental phobia seem beyond the expertise available, referral to a clinic specializing in treatment of such patients or working with a professional specializing in treatment of fears and phobias are helpful options.
The patient with a history of sexual abuse may not be aware of this history. The dental hygienist or other oral health care professional may suspect such a history if the patient develops sudden, inexplicable anxiety in response to such actions as lowering the back of the dental chair or working in the oral cavity. For any patient who becomes anxious, it is important to stop working, give control to the patient, and proceed only with the patient's explicit permission and at a pace that is comfortable for the patient. For severe or recurring anxiety, referral is advisable.
Cognitive impairments vary, but often patients with dementia have good recall for the distant past and for the past 15 to 20 minutes. For some patients, a reintroduction to the personnel and the procedures may be necessary if they take longer than the 15 to 20 minute window of shortterm memory. Instructions should be kept short and simple. Provide written instructions for the patient to use at home, and work in conjunction with family members or others who are helping with daily activities.
Case Example A:
"Can you help me with my teeth?"
This 30-year-old African American woman participated in the outpatient psychiatry program at a county hospital in Seattle. She approached PED, a volunteer dental hygienist in the program, with a request: "Can you help me with my teeth?"
Since she had avoided smiling, her oral health problems were not immediately obvious, but clinical examination revealed the worst dental condition in this clinician's experience—severe periodontal disease, gross caries, and nonrestorable teeth. She had a complex medical history that included schizophrenia with hallucinations, a fear of needles, lupus erythrematosus, Sjogren's syndrome, and substance abuse (though she last drank 10 years previously). She was eligible for Medicaid funded oral health care.
This married patient became pregnant before treatment could begin. Due to this and her pre-existing medical conditions, it was more than a year before treatment could proceed. The volunteer dental hygienist helped her coordinate appointments to deal with dental emergencies during this time. Eventually, the patient's teeth were removed under general anesthesia in an operating room. When her denture finally was delivered four months later, her smile was broad.
This is an extreme example, but this patient illustrates the potential for dental devastation that can result from years of medication effects, poor diet, substance abuse, and lack of professional care and dental maintenance.
Although the patient had hallucinations and delusions, she was very cooperative and treatment elicited no unusual behavioral problems. The dentist used a slow, gentle approach, and over time, the patient developed trust and came to know what to expect from the dentist. Several years later, this patient is now taking care of her two sons, and despite her health problems, appears to be doing well.
Case Example B:
Case example B: "Terrified"
This 37-year-old Caucasian woman came to a private dental practice of PED with a toothache. She had avoided the dentist for years and was apprehensive and fearful. Her appearance was not unusual. She was employed full-time in a responsible business position and her initial history was unremarkable except that she had dental fear.
It was not until her six-month recall visit that it was learned she had suffered from trichotillomania—noticeable hair loss from the recurrent pulling out of one's hair—since age 14. It is an impulse control disorder that affects 2 to 4 million people in the United States. The most common complication is damage to self-image that can lead to depression. She had tried at least eight different types of treatment, including medications, biofeedback, psychiatry, meditation, and support groups. As a result, she had excellent insight into her illness. In her early appointments, she used nitrous oxide, but over time, it was no longer necessary. The status of her trichotillomania has not changed, but her oral health problems were treated successfully, and she has maintained regular recall for more than 10 years.
This case can serve as an alert that even people who appear perfectly health can have underlying emotional or psychiatric problems that affect oral health treatment. This patient had been terrified that the dentist would notice her lack of eyelashes and hair. By discussing her illness in an accepting manner, the staff was able to normalize her experience and relieve much of her fear. Treatment for trichotillomania is effective for some patients, but in more than 33 years, this woman has not found a cure. The patient is in a support group, maintains her job and other responsibilities, and manages her illness well.
Working with Patients who have Severe or Chronic Mental Illness
Mood disorders
Both the patient with major depressive disorder and the depressed bipolar patient will frequently have difficulty maintaining oral hygiene or keeping appointments. Also, their recollection of instructions may be poor. These are symptoms of depression. Oral health care providers must avoid placing blame, and work to give the patient a sense of selfacceptance, worth, and of being in control. Their cognitive impairment may be temporary, but it is still important to keep instructions simple and to provide a copy for use at home as in the case of those with other cognitive impairments.
Bipolar patients in the manic phase of their illness may be highly distractible. Therefore, they also may benefit from simple, printed instructions.
Anxiety disorders
About 6 to 14% of the general population is estimated to have dental fear.28 The patient with an anxiety disorder is even more likely to fear dental treatment. (See case B for one example.) The principles listed in Figure 5 are helpful when managing patients who appear fearful or mistrusting. However, one should be prepared to refer such a patient to a mental health professional.
Psychotic disorders
Patients with psychotic disorders must live with thoughts and sensations that do not always accurately represent the world around them. As a result, their behaviors and beliefs may seem bizarre, but in context, they contain a certain logic. For example, people with auditory hallucinations hear apparently real voices with no evident source.1 Some may come to believe they have radio transmitters in their teeth. Their oral health care provider must accept that what they experience is real for them. Arguing is pointless and should be avoided. Instead, a supportive, predictable, non-stressful treatment atmosphere should be provided. With the patient's permission, oral health care providers may keep in contact with the patient's case manager or support person for help with oral hygiene and appointment reminders. This contact was very important for coordinating oral health appointments for the woman in case example A.
Dual diagnosis (mental illness and a history of substance abuse) A history of substance abuse is quite common among individuals with mental illness; they may try to use drugs or alcohol to self-medicate. In some cases, substance abuse may induce or amplify symptoms of mental illness.29 A history of drug use can create several problems in the oral health care setting, including cognitive impairment, abnormal bleeding problems, increased susceptibility to infections, and impaired liver detoxification of drugs.27 It is advisable to avoid the use of mood-altering drugs, such as nitrous oxide and IV sedation, and to use nonalcoholic mouthwashes. However, for patients with acute pain, "opiates remain central to therapy, including for addicted patients."30 Clinical impressions and animal research suggest that patients with a substantial past history of substance abuse may be likely to need more local anesthesia than other patients, although this has not been experimentally verified in humans.31 As always, the patient must be the judge of when pain control is needed.
Working with Patients with CMI and Their Case Managers
People who have severe or chronic mental illness generally live in the community. Some avoid treatment and formal assistance, but many do attend community programs designed for them. These programs may provide a place to go during the day, providing training in life skills and organized activities. Case managers assigned to clients with CMI help them obtain needed benefits such as social security disability payments, food stamps, housing, job training, medical and oral health treatment, and other basic services. Unfortunately, most case managers have not received specific training regarding the impact of mental illness on oral health. Studies have shown that case managers tend to underestimate their clients' need for oral health care and that clients rate their own need for dental care higher than case managers do.32 Oral health professionals may be able to work actively with patients' case managers, helping them understand the importance of dental maintenance and enlisting their aid to locate funding and help reduce obstacles to care.
Case managers help their clients obtain services for which they are eligible. Available funding for an individual client's oral health care will vary greatly, depending on such factors as eligibility for social security disability (with Medicare), supplemental security income (with Medicaid), as well as the availability of other funding. Some programs that cover only medically necessary oral health care (e.g., emergency care for the relief of pain) may cover dentures and extractions with preauthorization. It may be necessary to carefully schedule dental appointments to reduce out-of-pocket expenses for the patient. Other options for patients include saving money for oral health care, asking for family assistance, arranging for a payment plan with the dentist who provides care, or seeking treatment in a free or lowcost dental clinic.
The case manager should, with the permission of the client, supply information on medication and behavior problems to the oral health care provider. The mental health status of some patients may limit the extent of oral health treatment they can reasonably accept. The case manager also may need to arrange appointments, provide reminders and transportation, and possibly remain with the patient during appointments. For patients who fail to keep appointments because of diminished cognitive ability, it may be helpful to schedule appointments at the same time and day of the week, and to work with the case manager to pair oral health care appointments to other client activities and remind the client of appointments as necessary.
Most patients with CMI have poor oral hygiene, although occasionally patients maintain meticulous mouth care. Optimum self-care may not always be possible, but it can be improved with encouragement and monitoring by the case manager. Case managers also can help their clients become aware of how oral health is affected by the factors listed below:
- Poor nutrition (sugary snacks) can lead to tooth decay and periodontal disease.
- Medications can cause dry mouth, mouth sores, and tissue changes affecting denture fit, making regular hygiene especially important.
- Smoking increases the incidence of mouth lesions, staining of teeth, bad breath, and early death.
- Alcohol abuse can lead to periodontal disease, gumline cavities, and poor oral hygiene.
- Smoking combined with alcohol use leads to the highest incidence of oral cancer.
- Drug abuse can lead to decreased self-care contributing to tooth decay and periodontal disease and other soft tissue lesions.
It is an unfortunate fact that many patients who have chronic mental illness have increased oral health problems. In principle, this can be improved. By working with patients and their case managers to ensure regular oral hygiene and routine professional care, oral health care professionals can work toward maintaining the oral health of all of their patients.
Patients with mild to severe mental illness rely on providers in the community for their oral and dental health care. Providing appropriate care for patients who have mental illness can be complex and challenging, but these are people for whom oral health is especially important and whose risk of oral disease may be high. With understanding, knowledge, and care, working with these patients can be most rewarding.
1.Examine the health history form currently used in the office for questions relevant to mental health. Discuss adding appropriate questions to the form, if needed.
2. Think about a patient in your practice and what his/her mental health status might be. Using references noted in this course or articles in reputable clinical and scientific journals, research the condition to learn more about it, learn potential problems of oral health care management, and seek effective solutions.
3. Take a continuing education course on mental illness and/or treating the oral health needs of patients with mental illness.
Suggested Reading
- One self-study program, Dental Treatment of the Patient with a Psychiatric Disorder, is offered through the Dental Education in Care of Persons with Disabilities (DECOD) Program of the University of Washington School of Dentistry. For information, write Box 356370, University of Washington, Seattle, WA 98195, or call 206/543-1546.
- Another self-study course, offered through the Southern Association of Institutional Dentists, is Clinical Concerns in Dental Care for Persons with Mental Illness. Contact Donna Spears, DDS, Box 258, Butner, NC 27509-0258.
- Consider joining Special Care Dentistry, Academy of Dentistry for Persons with Disabilities. This association meets annually in Chicago and offers continuing education courses relevant to treating persons with mental illness.Write 211 E. Chicago Ave., 5th Floor, Chicago, IL 60611. 312/440-2660; Fax: 312/440-2824; e-mail email@example.com; on the Web: www.SCDonline.org
Key Terms
Atypical odontalgia
chronic throbbing or burning pain in the teeth, alveolar process, or mucosa without a clear dental cause. The cause of this pain is primarily neuropathic
severe or chronic mental illness
the Diagnostic and Statistical Manual of Mental Disorder, 4th Edition, Revision. This text, published by the American Psychiatric Association, is a guide to diagnosing mental illness
a false belief firmly held despite obvious proof or evidence to the contrary. In addition, the belief is not one ordinarily accepted by other members of the person's culture or subculture.
Extrapyramidal side-effects
muscle spasms, symptoms similar to those experienced in Parkinson's disease, or involuntary movements which are potential side-effects of certain antipsychotic medications.
a sensory perception in the absence of an actual external stimulus. It may occur in any of the senses, e.g., auditory, gustatory, olfactory, somatic, tactile, visual.
Mental illness
a behavioral or psychological syndrome associated with significant distress or disability. It is estimated that in any given year, one in five people have a mental illness.
Mitral valve prolapse (MVP)
a heart valve abnormality present in many patients with panic disorders or agoraphobia. Some patients with MVP may require prophylactic antibiotics before oral health treatment.
a pervasive and sustained emotion that, in the extreme, markedly colors one's perception of the world. Common examples of mood include depression, elation, and anger.
an antipsychotic drug.
Neuropathic pain
pain that originates from sensitization of nerves. It is not a consequence of mental illness.
a drug used to alter abnormal thinking, feelings, or behavior. It is traditionally divided into classes of antipsychotic, antidepressant, mood stabilizers, and anti-anxiety (anxiolytic) drugs.
Tardive dyskinesia
a late-appearing side-effect of certain psychotropic medications given long-term at high doses. The symptoms include persistent involuntary movements of the tongue, face, or jaws.
Temporomandibular disorder (TMD)
a disorder characterized by pain, limited range of jaw motion, and temporomandibular joint noises. Roughly 50% of patients with TMD have or have had a psychological diagnosis.
Alison J. Longley, BA, PhD, is a neuro- and behavioral scientist with the Pacific Sciences Institute, Seattle and Friday Harbor, Washington. Patricia E. Doyle, RDH, BS, FADPD, is a private practitioner in Seattle, Washington, a clinical instructor at the University of Washington's Dental Education in Care of Persons with Disabilities (DECOD) Program, and a technical consultant for Laclede, Inc.


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MILWAUKEE, WI (AP) -- Tim Duncan had 21 points and 16 rebounds while playing just 24 minutes and Tony Parker added 15 points in the San Antonio Spurs' 109-77 rout of the Milwaukee Bucks on Wednesday night.
San Antonio had lost three of its last six games after starting the season 13-1, but dominated from the opening tip, scoring the first nine points. An 8-0 run extended the Spurs lead to 27-10.
The Bucks (5-17) trailed 32-16 after one quarter. The Spurs held a 17-4 rebounding advantage in the opening period, when the Bucks managed just one defensive rebound.
The Bucks pulled within 41-30 in the second quarter, but the Spurs responded with a 10-0 run. The Spurs, led 63-40 at the half and extended it to 92-54 entering the final period.
Rookie guard Nate Wolters led the Bucks with a season-high 18 points.
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subset: commoncrawl


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NM Agents Seize Over Half A Million In Drug Busts
February 29th 2012 · 0 Comments
Border Patrol Agents working at New Mexico checkpoints Friday seized over $560,000 worth of cocaine and marijuana in two separate incidents. Two suspects were arrested in the seizures.
The first incident occurred Friday morning at the Highway 54 Border Patrol checkpoint near Alamogordo, NM. Mexican citizen Jose Angel Villanueva-Gomez, 48, was arrested after a canine initiated a positive alert, subsequently leading to the discovery of cocaine bundles. The bundles, weighing in at just over 12 pounds, were valued at approximately $394,240.
In a separate incident later that afternoon, agents working north of Las Cruces, NM at the I-25 Border Patrol checkpoint, arrested Dushane Dawson, 36, after a canine alert led to the discovery of over 200 pounds of marijuana. The load was valued at about $168,000.
A version of this column originally appeared in www.kdbc.com.
Related Posts:
Tags: Agents Seize, Border Patrol Agents, Busts, Checkpoint, Checkpoints, cocaine, Cruces Nm, Discovery, drug, drug busts, Friday Morning, Gomez, Half A Million, Highway 54, José Angel, Las Cruces, Marijuana, Mexican Citizen, New Mexico, News, Pounds Of Marijuana, SEIZE, Seizures


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Jayme Langford's trip to sluthood
All that Jayme Langford has ever wanted is to be turned into a slut. Today's lesson puts
her one step ahead of her competition and thankfully Jayme is a fast learner. With her
neatly trimmed pussy, she's taking this hot sex session to the next level. She has one of
her legs perched over his shoulder with her legs spread wide as he hammers her wet
snatch giving her good practice on her mission toward becoming a top notch slut.
She likes playing with her small tits as her teacher stud bangs her hot love hole. She
can't help but moan and groan while her pussy is being drilled relentlessly. But she
knows it's all for a good reason as she continues on her quest to become a pornstar
slut. Today's action is just one lesson and she has more to accomplish before she gets
to the top of the slutty board. Follow Jayme's hot sex antics and witness
her transformation to become a hot blonde slut because at the rate she's
going, it won't take long.
Priscilla and Margarete can't get enough of Joachim Kessef in this hardcore free interracial
tube sex video. No matter how hard they try, his big black cock is so addictive, they just
can't be satiated. Be a witness to the hot ass fucking he gives to this sweet blonde,
stretching her tight ass with his big black boner while her sexy brunette
girlfriend licks her shaved pussy and sucks Joachim's cock.
Taking cock ATM isn't her only talent but it certainly is one that she gets the most
practice doing today. That's okay, because she's just being patient as she waits for
Joachim to stretch out her blonde gal pal's poop shoot so she can offer up hers for
him to enjoy. These two babes are ready, willing and able to go as long as necessary
because they have enough horny holes to keep Joachim busy all night long.
If you need your fill of slut smut, then you've come to the right place and today we have
the sexy brunette MILF Georgina II in hardcore action with Rudy Strong. Georgina is
looking so hot today with her sexy lingerie and bright pink fishnet stockings. She's
down in a squat position with Rudy's stiff pole pumping in and out of her warm mouth.
Oh, she sure can blow. Rudy picks her up and puts her on the couch then slides off
her thong panties before he
munches on her snatch, making sure it's nice and wet. Once he's convinced its ready,
he slides his big hard cock in her precious love hole. Who wouldn't get turned on
watching his dick hammer Georgina's hot slit the way he is? She's so turned on, she
grabs her tits and tugs on her hard nipples to intensify the effect that she's getting
from this hardcore fucking. It'll be several more positions to assume before this
slut is done with Rudy's banging boner.
Lexi Love ass fucked by Michael Stefano
Hot brunette Lexi Love wants so badly to be turned into a slut and today it looks like Michael Stefano is just the man to do it. She's on her hands and knees with her nice round ass in the air as Michael tries to slide his dick in her booty hole. Initially, he has a difficult time because he didn't know how very tight she would be. But with a little perseverance he accomplishes his task and begins his ride down her Hershey Highway. His dick is so big, compared to her petite ass that she ends up with a gaping hole in no
time. It looks like Lexi is well on her way to being the slut she desires. She's seen enough action in her hairy pussy that she is excited to be able to put hardcore anal bitch on her resume. Michael loves her nice ass and after he pulls out to change positions, he eats her sweet ass before continuing with the fucking show. They move into a spoon pose and now Michael is eager to step it up a notch or two and hammers her hot ass hard and fast. Lexi will officially be a slut once he shoots his load all ever her nice ass.
Mark Wood turns Mikayla into a slut
Brunette beauty Mikayla wants to be turned into a slut and Mark Wood has just
the piece of wood to grant her that wish. In a hot hd porn She starts off with a gagging
deepthroat blowjob, sucking and stroking on his stiff boner and
licking his balls. Then she's positioned on her hands
and knees in a doggy style pose and Mark bangs her fast and hard from behind.
She loves the feel of that cock in her hot pussy and moans and groans in
excitement. Guess this hot brunette catches on fast and has moved
to the top of the slutty pornstars list!
Drew Butterfly gets a cock in her pussy
Drew Butterfly is a hot brunette babe and likes the feel of hard cock in her shaved
pussy. Watch her jiggly boobs bouncing as this stud pounds her wet pussy. He
starts off rather slow, but that doesn't last for long as he picks up speed and ends up
banging this bitch like his cock is on crack. Suddenly, he pulls his dick out of her snatch
and jump between her legs to do a hot tongue dance on her clit. She hopes he gets
back to the fucking action soon cuz her pussy is starting to miss his hard cock.
Mark Wood and Tyla Wynn fuck
Naughty brunette Tyla Wynn is hot and horny and has Mark Wood's woody crammed
down her throat. She slams her face down on that stiff rod and drips her spit on it to
get it nice and sloppy. Then she slides off her panties and spits on her own snatch
making sure it's nice and wet for his dick to slide in.
She's riding it fast and hard in a reverse cowgirl pose and tweaking her hard clit as she
bounces up and down. It gets really hot when he grabs her melons from behind and
spanks them a time or two. But she likes the taste of cock and pussy, so she hops
off and gets ready to lick her juices off his stiff boner.
Klara Gold POV handjob
Sexy brunette babe Klara Gold loves showing off her nice perky tits and her sweet ass,
but even more than that she loves to get between her boyfriend's legs when he has the
camera in hand and take his stiff tool in her hands and stroke it like a POV rock star.
Giving him a handjob makes her so horny she sits on his knee and masturbates while
jerking his meat. Then he's about ready to blow his load and she speeds up the action,
tugging his meat in a frenzy waiting for his creamy cum to rain on her.
Alexis Malone gets ready to drink cum
Hot blonde MILF Alexis Malone is riding cock in a reverse cowgirl position when she
gets off and licks and sucks the pussy juices off his hard boner. Then it's
back to the hardcore fucking action as he stuffs
his fat dick in her wet, trimmed snatch once again. He's pounding her hard and fast
when she grabs a cup and gets it ready for him to shoot his load in it so she
has a nice, creamy warm drink when they're done.
Pamela Blond eats dick and gets fucked
Naughty bitch Pamela Blond has a nice rack and a warm shaved pussy for fucking and
you'll get to see it all in this hardcore sex video. See her in her sexy pink bikini on
the beach as she chats with the cameraman and flashes her
big melons to surprised dudes. She's definitely not shy out in public but wait till he gets
her back home and she goes to town on his cock. She sucks his cock like a big tasty
lollipop and gets nailed in her hot shaved pussy by his rock hard meat.


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Audio Samples
Album Summary
- Barbara Hendricks
- Michael Chance (Countertenor)
- Jeffrey Black (Baritone)
Notes & Reviews:
No other 20th century work delights music-lovers as much as Carl Orff's "Carmina Burana". The opening number, "Oh Fortuna", is a huge classical hit in its own right. The recording conducted by Austrian shooting star Franz Welser-Möst brings out the thrilling drama of the whole score.Notes & Reviews:
Recording information: No. 1 Studio, Abbey Road, London (11/1989).
ReviewsThere are currently no reviews, be the first one!
Works DetailsOrff, Carl : Carmina burana
- Performers: Barbara Hendricks; Michael Chance (Countertenor); Jeffrey Black (Baritone)
- Conductor: Franz Welser-Möst
- Ensemble: London Philharmoniic Orchestra Chorus
- Running Time: 49 min. 30 sec.
- Period Time: Modern
- Form: Cantata/Oratorio
- Written: 1935-1936


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Review: Keane, Capital FM Arena, by George Solomon
Posted: November 29, 2012|
ALL five of Keane's albums have shot straight to number one in the chart, so it's no surprise that, firstly, they know how to put on a show and secondly, that the crowd lapped up every second of their Capital FM Arena gig on Wednesday night.
Their trademark sound is perfectly suited to arenas, with their classic anthems like Somewhere Only We Know (the highlight of the night) booming out to all corners, and the varied set, covering plenty of their healthy back catalogue, hitting the right note.
Their latest album, Strangeland, despite going to number one, hasn't quite hit the critical heights of their previous efforts and when they ran through some of the tracks from it, things became a little subdued for all but the biggest fans.
But a string of their biggest singles towards the end had the crowd out of their seats singing along, likeable singer Tom Chaplin urging them into action.
He is a fine front man and had the audience hooked when he shed the band for a solo number with his acoustic guitar.
He briefly reminisced between songs about their first big gig in Nottingham, at Rock City, when his voice went halfway through. That certainly didn't happen here, as he continued to hit the notes all night long.
The stage in the middle of the arena made for a great spectacle, and the lighting - often taken for granted at gigs - was of the highest order, perfectly matching each song.
Keane are a slick outfit and the sound couldn't have been tighter. If there could be one criticism, it's that they were almost too well rehearsed, with little deviation from the 'script'.
But that's a minor gripe on what was a fine night for all. You can't help but smile as they do their thing; uplifting, feelgood music, similar in tone to Elbow who'd rocked the same stage just two nights previously.
As they neared the end of their set, Chaplin said: "It's been an incredible pleasure. We wish we could stand up here forever and sing our songs."
So did we.


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Mandevilla Alice Dupont is tender. It
likes its roots cool and the top warm. A greenhouse would be great but there are plenty of places
that can keep this beauty out of doors, just not my house during the winter. The
blooms are 2" or more across and hot pink. Near the coast the
upper part of the plant will take full
sun, inland a little shade is required. Regardless I plant the
rootball where the ground is shaded. Much of a frost and this beaut is a gonner.
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Better In The Dark #131
Episode 131: TOM AND DERRICK VS. THE SAFE HOUSE, GRECIAN ARMORED ROSAMUND PIKE, THE PAST HIS PRIME MEDICAL GENIUS, THE INDIAN HOTEL, AND JOSS WHEDON
In this massive Review Episode, The Boys Outta Brooklyn discuss the movie everyone's been waiting five years for…The Best Exotic Marigold Hotel!
Just kidding…we do cover that film, as well as others and the House Series Finale, but the bulk of over two hours of talk concerns the two films of Joss Whedon, Cabin In The Woods and The Avengers! And if that isn't enough, there's lots of writing talk and bitching about comics. It's Shwarma-rific, so get to clicking!
Two Guys Outta Brooklyn Talk Movies
Two Guys Outta Brooklyn Talk Movies
Silver Age Comics Through Modern Eyes
Silver Age Comics Through Modern Eyes
Join us now at www.earth-2.net!
Nocturne, The City That Lives By Night….needs a darker shade of protector
THE SHADOW LEGION http://welcometonocturne.blogspot.com/
THE SHADOW LEGION http://welcometonocturne.blogspot.com/


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Martha Coakley concedes. She has graciously given Scott Brown her congratulations. It'll be hard in these circumstances to delay seating him, no? At some point the gamesmanship just doesn't work.
And not to rub salt in the wounds, but sometimes a concession speech is the candidate's finest moment (e.g., Al Gore). This deadly dull, rambling speech isn't one of those.


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Results: 11 - 20 of 24
News & Tours
Golf World Monday Podcast: Zinger's Corner
Listen to the podcast: Zinger's Corner The PGA Tour's messy start to 2013 didn't dampen Paul Azinger's excitement for the season overall. In Golf World Monday's first Zinger's Corner podcast of the new year,...
Tuesday, 1/8/2013 at 8:19AM
- keywords:
- PGA tour,
- belly putters,
- golf world,
- golf world monday,
- jaime diaz
News & Tours
Podcast: Paul Azinger and Jaime Diaz talk Matt Kuchar's win, Kevin Na's slow play, and Tiger's troubles
In a new weekly podcast in Golf World Monday, PGA Championship winner and victorious U.S. Ryder Cup captain Paul Azinger will discuss the week in golf with Golf World Editor-in-Chief Jaime Diaz.This week, Azinger and...
Monday, 5/14/2012 at 10:46AM
- keywords:
- golf,
- golf digest,
- golf world monday,
- jaime diaz,
- paul azinger
News & Tours
Podcast: Ron Sirak on the return of Tiger Woods
Tiger Woods won his first PGA Tour event in more than two years on Sunday. Is he back? Is he now the runaway favorite to win the Masters? Golf World Executive Editor Ron Sirak, who...
Wednesday, 3/28/2012 at 10:57AM
- keywords:
- Arnold Palmer Invitational,
- golf,
- golfdigest.com podcast,
- podcast,
- ron sirak
News & Tours
Podcast: Geoff Shackelford talks Olympic golf course design
In the wake of the announcement that Gil Hanse (and Amy Alcott) have been chosen to design the Rio Olympic golf course, Geoff Shackelford, a frequent Hanse collaborator, discusses why this is such a big...
Thursday, 3/8/2012 at 3:30PM
- keywords:
- geoff shackelford,
- gil hanse,
- golf,
- golf digest,
- golfdigest.com podcast
Courses & Travel
Podcast: More on the WM Phoenix Open
I talk to Sam Weinman, editor of GolfDigest.com, about my recent blog post and more on why the Waste Management Phoenix Open is good for the game. Listen to the podcast--Matty G.(Follow me on Twitter...
Friday, 2/10/2012 at 4:44PM
- keywords:
- Golf Digest,
- Matt Ginella,
- Podcast,
- Sam Weinman,
- Waste Management Phoenix Open
Gear & Equipment
Podcast: Stina Sternberg on PGA Shows past and present
Golf Digest Senior Editor Stina Sternberg's history at the PGA Merchandise Show dates back to her childhood in Sweden, when she'd accompany her father to Orlando to the show on an annual basis.Now one of...
Friday, 1/27/2012 at 12:11PM
- keywords:
- golf digest,
- pga merchandise show,
- podcast,
- sam weinman,
- stina sternberg
News & Tours
Podcast: Geoff Shackelford on course rankings, Humana, and Matt Every
Following the release of Golf World's inaugural PGA Tour course ranking, Geoff Shackelford joins GolfDigest.com editor Sam Weinman to talk PGA Tour reaction, the new-and-improved tour stop in Palm Springs, and why he thinks a...
Thursday, 1/19/2012 at 5:12PM
Gear & Equipment
Podcast: Discussing the 2012 Hot List
The beginning of a new year means the release of our annual Hot List, Golf Digest's complete guide to the best new equipment on the market. The full Hot List is available now in the...
Tuesday, 1/3/2012 at 2:59PM
News & Tours
Podcast: Where is Tiger Woods headed?
JOHNS CREEK, Ga. -- Tiger Woods checked out of the PGA Championship on Friday, but his baffling play at Atlanta Athletic Club, where he missed the cut at 10-over par 150, remained a topic of...
Saturday, 8/13/2011 at 1:59PM
- keywords:
- bill fields,
- golf,
- jaime diaz,
- pga championship,
- podcast
News & Tours
Listen: Golf World's Ron Sirak on NPR's 'Morning Edition'
Few men, if any, have watched Tiger Woods more closely during these bizarre last two years than Ron Sirak of Golf Digest and Golf World.The veteran writer, who first covered Woods as an amateur, was...
Thursday, 8/4/2011 at 12:41PM
- keywords:
- Ron Sirak,
- Tiger Woods,
- bridgestone invitational,
- golf,
- pga championship
Results: 11 - 20 of 24


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Passing Chords / Reharmonizations(4 posts)
Kurt could you describe some of your techniques for using passing chords in standards..
Your truly a mad scientist.. can't wait for a solo cd..
Well, any dominant seventh chord can have its relative II before, so whenever we see e.g. |G7| we can play |Dm7 G7|
As we know, secondary dominants are dominants outside of the key that go to a chord other than the I. So, before any chord, we can put its relative V. Again, in the G7 example: |G7| can become |D7 G7|. Or, we could use the secondary dominant over the relative II of the dominant chord, giving: |A7 Dm7 G7/ |
All of this is basic, but if we see the notes in a staff we can start to see patterns, and use them to our advantage. Basically, passing chords will be the departure chord or the arrival chord but with some voices displaced, as appogiaturas, passing notes... or we can change a chord by itself to make the substitution less obvious. The most common is the tritonal substitute, e.g. changing G7 for Db7, the tritone is the same, the other two notes are displaced (Db instead of D, Ab instead of G).
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Fort Wayne, IN (SportsNetwork.com) - Luis Jacobo came off the bench to score 23 points as the IUPU-Fort Wayne Mastodons made easy work of the Dartmouth Big Green, 80-64, in a non-conference clash at Memorial Coliseum.
Jacobo shot 7-of-13 from the field and 6-of-8 from the foul line for IPFW (7-4), which snapped a two-game losing streak. Pierre Bland, Isaiah McCray and Mo Evans each scored 11 points, while Joe Edwards netted 10.
For Dartmouth (3-3), Connor Boehm tallied 15 points and eight rebounds, while Eli Harrison had 12 points on 4-of-6 from 3-point range.
IPFW outshot Dartmouth from the floor in the first half, 56.5 percent to 34.5 percent, as it carried a 40-24 lead into intermission.
The Big Green never got closer than 13 points in the second half, while the Mastodons' advantage swelled to as many as 25.
IPFW shot 19-of-31 from the free-throw line on the night, while Dartmouth was just 8-of-15 from the stripe.
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Cora Dance and its artistic director, Shannon Hummel, announced the studio's latest work, ''Down Here.''
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A RNLI personalised charity Christmas card is a simple and effective way of supporting your favourite charity at the same time as promoting your business or sending your good wishes to friends and family.
Simply choose a card design, personalise your selection and up to 50p per card (inc VAT) will go to support RNLI. On an average order of 100 cards the donation could be £50! There are over 200 designs in our high quality card range from traditional to photo upload suitable for corporate and personal use, with prices starting from as little as 78p.
This programme is run by CCA Occasions Ltd who has raised over £10million over the last 30 years for a variety of charities.
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It provides, on call, 24/7 lifeboat search and rescue service to 100 miles out from the coast of the UK and Republic of Ireland and a seasonal lifeguard service on over 200 of the busiest beaches in the UK and Channel Islands.
* Payments are made to RNLI (Sales) Limited, which pays all its taxable profits to the RNLI.
RNLI name and logo are trademarks of RNLI used by CCA Occasions Limited under license from RNLI (Sales) Limited.


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Neighbours - 29/07/15 —
Tyler decides to move out of the Kennedy house; the Brennan boys are surprised by a visitor; Kyle asks Amy to stay longer and keep working for him.
Alan Fletcher on all things Karl —
Today is Karl Kennedy's birthday and to celebrate we sat down with the one and only Alan Fletcher.
Backstage with Arial Kaplan aka Imogen Willis —
We head behind the scenes with Ariel Kaplan as she gives us the low down on Imogen's latest love triangle!
Don't miss a minute of your favourites
You're looped in. Go to My TV
Set an email reminder
Don't fret. Reminder set! Edit
Wednesday 29 Jul
Neighbours spoiler video Thursday 30th July 2015
Backstage with Arial Kaplan aka Imogen Willis
Interview Tim Phillipps (Daniel) and Meyne Wyatt (Nate) Part 2
Latest Photos
Tyler decides to move out of the Kennedy house; the Brennan boys are surprised by a visitor; Kyle asks Amy to stay longer and keep working for him.
Tyler buries his feelings for his brother's sake; Ben's more troubled than Karl and Susan realise; Toadie and Sonya grapple with putting Nell into childcare.
Amber reaches a decision about her pregnancy treatment; Daniel gate-crashes university; Paige confronts Brennan with surprising results.
Daniel vows to fight for Imogen; Joshua embraces his new career; Ben reveals the source of his upset to Tyler.
Paul learns Sheila has feelings for him; Karl and Susan are surprised by an unexpected visitor; Joshua kicks off a new career as a dancer.
Lauren admits her attraction to Brad; Amy is forced to question her parenting skills; Paul is shocked to learn Sheila's secret.
Brad is torn between Paige and Terese... leading him to Lauren; Daniel and Imogen deal with their feelings; Amber gets to the bottom of Nell's misbehaviour.
Thursday 30 Jul
Season 4, Episode 12
Season 3, Episode 21
Season 1, Episode 21
Season 7, Episode 62
Season 1, Episode 7
Season 2, Episode 7
Neighbours – 2014 ©FremantleMedia Australia Pty Ltd and Network TEN
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powerHouse Magazine Issue 5: Busted Exhibitionby: Evan Kessler
Being up to no good entails a sort of madness and inspiration that often goes hand in hand with making great art. Sure nefarious leanings often lead to a fall in the wrong direction, but sometimes that's half the fun. In celebration of things that go so wrong, they just have to be right, powerHouse magazine is hosting a show in conjunction with the release of their fifth issue entitled, Busted. The exhibit runs from May 26th until June 21st and features not so innocent, but certainly excellent work by the likes of Keiji Ando, ONE9 and Derek Erdman, amongst others; all of which take a peek at all the things that go awry when you're not exactly operating with the best of intentions. If you find yourself aching to do something undesirable on May 28th, we suggest you curb that negativity by making it to the opening reception from 7-9pm at the powerhouseArena on 37 Main Street in the Dumbo section of Brooklyn, but you might want to RSVP first to avoid any unnecessary confrontation. (Big poster after the jump.)
We Heart Urbanismby: Matt Gierhart
We really do love urbanism, but this isn't just about our love of cities, it's about an art opening. The Dalston Superstore is cutting the red ribbon with a show featuring five artist's creating in cities around the world. Martin Wolerstam, Julia Corsado, Alex Bartolomei, Alex Nobel and Bigote Rojo (sorry no online presence) have all focused their lasers on art inspired by their urban surroundings. Very fitting for the ultra urban and uber hip Dalston district of London.
Details below:
We Heart Urban
Private View: Tuesday May 5th, 7 till 10 pm (facebook invite)
Dalston Superstore "" 117 Kingsland High Street, London, E8 2PB
San Francisco: Pop-Up Magazineby: Emily Goligoski
Literature and multimedia-loving San Franciscans will enjoy Wednesday's Pop-Up Magazine, a night of live presentations from contributors to Wired, All Things Considered, Harper's, et al. Award-winning artists and authors on stage at the Brava Theater will include New York Times Magazine contributors Michael Pollan and Peggy Orenstein; The Kitchen Sisters, Davia Nelson and Nikki Silva; and photographer Todd Hido. Lest you be upset that the Pop-Up Magazine is a one-night only event, This American Life Live will be shown at theaters around the country on Thursday to provide your smart independent culture fix.
Boogie Comes to Manhattan!by: Josh Spear
Prolific street photographer (with incredible access), Boogie, who we covered several years ago has a best-of show coming up in Manhattan on Greene Street at the Altamont Showroom that is sure to be amazing.
Details below:
Thursday, April 30th.
9:00 p.m. – 12:00 a.m.
Altamont Showroom in SoHo
29 Greene Street
New York, NY 10013
(Between Grand and Canal)
Drinks and Entertainment provided…
Full flyer after the jump.
Resin Collective Group Toy Showby: Jeremy Brautman
Rumor around the toy scene is that resin is the new vinyl. The economy plays a big part in this trend. Vinyl is expensive and often involves overseas manufacturing, while resin artists make the toys themselves. With lower costs passed on to collectors, we are again seeing a vibrant global community of art toy creators and fans. This weekend Red Hot Robot in Phoenix will host the first Resin Collective group toy show. The roster of artists is amazing and includes (among many, many more): Cris Rose (UK), Das Mo (Germany), Emilio Garcia (Spain), Itokin Park (Japan), Suckadelic (USA), Tan-Ki (France) and WeKillYou (Canada). Each artist has been sending out sneak previews leading up to Saturday's opening, and one of my favorites so far is this crew by Pacific Northwest artist, Arbito. You may recognize the psychedelic designs of Arbito from his collaboration with Nike and Danny Kass.
Zombie Butt Touchby: Abdullah Saeed
If you're in Philadelphia this weekend, there's one party happening that trumps any ordinary night out. For its third year DJ Tritton's Zombie Butt Touch is moving from the underground warehouse to a major venue: the 941 Theatre. Tritton's own team of make-up artists will zombify every party-goer willing to rock like the dead. Dance to a dozen DJs spinning everything from dubstep to psytrance. Notable acts include Native State's KiloWatts and lyricist Amagine for a project called Super Galactic Expansive. This is one of those parties that will set the tone for the rest of the summer. Let's go nuts.
Hush x Veiled Beautyby: Matt Gierhart
At first glance, British artist Hush's paintings have an obvious Japanese animation influence, but the chaotic backgrounds belie his street art roots that made his name in London. Take a look through a couple paintings made available as prints here. This year Hush is taking his art to America, beginning with the West Coast. Recently, he opened a show in L.A. (which included an original piece done just for gallery (check the video here). His Veiled Beauty project opens on April 2nd (Thursday) and running until April 26 at the Fifty 24 in San Francisco. We wouldn't be surprised if a Hush wall piece ends up somewhere in San Francisco permanently. Keep your eyes peeled.
Full flyer for Fifty 24 show after the jump.
San Francisco Ballet's Nights Outby: Emily Goligoski
The San Francisco Ballet is facing many of the same issues confronting cultural and arts organizations all over the country: aging audiences, global recession, pricey tickets. To counter act these trends, they introduced some great programs to build community interest. The Fridays at the Ballet evening performances are aimed at young professionals and the Nite Out series is for members of the LGBT community. They start with pre-show talks with choreographers and company members and close with cocktails at the War Memorial Opera House. The evening's presentation of three brief works ensure that even if you don't love one of the pieces, you and your friends are bound to find something that makes you want to do fouettés on your way home. Next Friday will be no exception with Jerome Robbins's West Side Story Suite and Christopher Wheeldon's Within the Golden Hour, one of the hits presented for the Ballet's 75th anniversary. Looks like everything old is new again.
Swan Day 2009by: Emily Goligoski
This Saturday marks the second international Support Women Artists Now (SWAN) day, a commemoration and series of celebrations to raise visibility for women artists around the world. Whether you're in Austin, Jerusalem, or Nairobi, there are a series of events near you. From jazz fests to Girls Write Now Days, use the SWAN Day online map to find out what's happening locally. The project, which was started by San Francisco's collaborative network Fund for Women Artists, also has a local partnership with the upcoming SF Women's Film Festival to highlight filmmakers behind and in front of the camera.
Underground Rebel Bingoby: Matt Gierhart
London's got a reputation for having a seedy underground. Anything goes: drugs, hookers, knives … bingo? Last week I ended up in the underbelly of the Underground Rebel Bingo Club. Under the guise of a neighborhood watch meeting the "too hip to trip" set up shop and play bingo. Of course there's plenty of booze and dancing to give even the most hardcore of bingo nerds something to wake up to the next morning. We woke up with this amazing space galaxy laser cloud nebula projector. Tickets are £7.50 and the club only runs on the occasional weekend. Check the website for dates. The location is secret and the whole event is hush hush. I hope they don't mind me blogging about it.


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programs for which longitudinal studies were conducted to determine program effect appears in Table 4-1, along with program features.
We can conclude with confidence that early intervention programs can produce modest to large effects (effect sizes of 0.2 to over 1.0 standard deviation) on children's cognitive and social development. Larger effect sizes are associated with better subsequent performance in school, particularly when the schools are of good quality (Campbell and Ramey, 1994, 1995; Lazar et al., 1982). Variation in effect size and duration is associated with the particular program features reviewed below (Ramey and Ramey, 1992).
Interventions that begin early and continue for a longer duration result in greater benefits to participants. The five major studies that demonstrated some of the largest effects of early intervention on cognitive and social development all enrolled children during infancy (the Abecedarian Project, the Brookline Early Education Project, the Milwaukee Project, Project CARE, and the Infant Health and Development Program). Data on early cognitive development for program and control children in the Abecedarian Project displayed in Figure 4-1 suggest that, without intervention, high-risk children fall substantially behind as early as the second year of life. Since no experimental design has tested for a critical period or threshold effect, however, no precise timing for intervention can be supported empirically.
Programs that provide more hours of service delivery produce larger positive effects than do less intensive interventions. Within programs, children and parents who participate the most actively and regularly are the ones who show the largest developmental gains. All of the programs mentioned as effective with regard to timing also provided intensive intervention services. In addition to these, the Perry Preschool Project (Weikart et al., 1978) and the Early Training Project (Gray et al., 1982), both of which began when children were 3 or 4 years old, also provided intensive services and registered substantial program impact. Numerous examples of early intervention programs that had little or no effect on cognitive, social, or later academic performance were less intensive.1
The Utah State Early Intervention Research Institute (White, 1991), for example, found no significant effects in the 16 randomized trails of early interventions for children with developmental disabilities. None of these interventions provided full-day programs or multiple home visits per week. Similarly, a brief prenatal and postnatal program for urban teen mothers failed to affect their children's cognitive performance or social development (Brooks-Gunn and Furstenberg, 1987). For other examples, see Ramey and Ramey (1998).


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Tags r&b, pop, blues, soul
Artists Aretha Franklin, Amy Winehouse, Corinne Bailey Rae
May 19, 2011
Ten tracks including music by Amy Winehouse, Aretha Franklin, and Corinne Bailey Rae.
You can see the boot mark on my face by MHsu
Ten tracks including music by Death Ray Vision, Metallica, and Municipal Waste.
punk, rock, metal, thrash, speed metal
They Certainly Don't Make Them Like This Anymore by MHsu
Eleven tracks including music by Billie Holiday, Bob Wills & His Texas Playboys, and Bukka White.
jazz, blues, country
The Ladies Got Trouble by MHsu
r&b, pop, blues, soul
There's Still Some Hair In The Grill by MHsu
Thirteen tracks including music by Bad Brains, Black Flag, and Blood For Blood.
alternative rock, metal, rock, punk, obnoxious


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It's one of music history's great cosmic ironies that jazz pianist Art Tatum was born blind in one eye and nearly without sight in the other. Even if his vision was obscured, Tatum was a true musical visionary, introducing new harmonic ideas and a quirky embellishment style that were far ahead of their time back in the 1930s when Tatum first earned notoriety. And when it comes to sheer technique, Tatum remains the gold standard even today. His effortless piano runs whiz by with such speed and control, his arrangements are so densely packed with notes and imagination, that you'd swear you were hearing at least two pianists. Piano Starts Here compiles Tatum's very first solo recordings from 1933 and a stellar live set recorded in Los Angeles in 1949, capturing the brilliant pianist at his virtuosic best.
Even more amazing than Tatum's phenomenal piano playing is that his style was more or less fully formed at the age of 23, when he cut the first four tracks on Piano Starts Here. Tatum's reading of "St. Louis Blues" colors the gaps in the tune's midtempo stroll with jaw-dropping right-hand cascades, turning its genteel charm into a never-ending fireworks display. And "Tiger Rag" is even more impressive. After a rapturous opening improvisation full of impressionistic, Debussy-like chord changes, Tatum cranks up his internal player piano to full speed and pulls out all the stops—wild ragtime syncopations crash headlong into blurs of dizzying chromatic runs that collide with one another and then slide between the top and bottom of the keyboard. It's no wonder that this was the piece that won him his first "cutting contest" in 1933.
Tatum's versatility shines through in the remarkable live tracks on Piano Starts Here. Dvořák's famous classical melody "Humoresque" becomes a playground for Tatum's creativity, with jazzy reharmonizations and ornamental curlicues granting the piece a sense of wistfulness and mischief; "The Kerry Dance" peppers a popular Irish folk tune with abrupt cutoffs and quirky dissonant chords that somehow come off as faithful to the original, proving that he has more than technique up his sleeves. Of course Tatum will always be best remembered for the lightning-in-a-bottle pieces like "The Man I Love," with a beautiful, lyrical line that keeps getting interrupted with jumpy asides and those trademark piano runs. Tatum's hinting at the intense mania of being in love. Or he could be depicting the effect of listening to his music: swooning one moment, jumping out of your chair in disbelief the next.
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Artwork by Wang Chang-Ming


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RSU News
April 19, 2010
Final Spring RSU Jazz Ensemble Concert Monday April 26
The Rogers State University Jazz Ensemble will present its final concert of the spring semester on Monday, April 26.
The concert, which is free and open to the public, will be held at 7:30 p.m. in the Centennial Center on the RSU campus in Claremore. However, donations will be accepted.
The title of the concert will be "Jazzapalooza" and will celebrate the eclectic history and development of the one truly American musical art form -- jazz. Music performed will range from a Dixieland flavored rendition of "Basin Street Blues" to a jazz version of the Rodgers and Hammerstein classic, "My Favorite Things." Music performed will represent the decades of the 40's, 50's, 60's, 70's and 80's.
"We're looking forward to this concert as a continuation of the outstanding performances from extremely successful fall and spring season," said Dr. Phillip Payne, director of RSU bands. "We hope everyone will come out to support the jazz ensemble as well as enjoy some great music."
The concert will feature Sonny Rollins' hit "St. Thomas," Herbie Hancock's hit "Cantaloupe Island," Duke Ellington's timeless hit "In a Mellow Tone," and Robert Parissi's hit "Play That Funky Music." In addition, selections by Charlie Parker and Rodgers and Hammerstein will be performed.
For more information, contact Dr. Payne at (918) 343-7723 or firstname.lastname@example.com.


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Currclick Online Homeschool Classes Do you ever wish that you could supplement your child's education without having to leave home? Currclick Online homeschool classes may just be the solution you are looking for. As a homeschooling family currently living in Germany (where homeschooling is illegal to local nationals) we have had an increased need for interaction in the online homeschooling world due to extreme isolation and lack of opportunities for homeschoolers. This need has led us to explore other {Read More}
CurrClick LIVE Online Homeschool Classes {Review}
March 20, 2013 by
Need help with Frugal, Healthy Menu Planning? Try Emeals, it will change your life!


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More possible riding area in Wisconsin! Please see below and take the survey to show support for this new opportunity!
Attention OHV enthusiasts in Wisconsin, Minnesota, Michigan, Iowa and Illinois.
Ripon College is conducting a market survey to determine the feasibility of establishing a large off-road vehicle park in Forest County in northern Wisconsin. The potential park would be approximately 10,000 acres with trails and facilities for off-highway motorcycles, ATVs, ROVs (side by sides) and 4WD vehicles. The park would have areas for all skill levels of riders, including children.
The purpose of the survey is to determine the potential demand for such a facility and preferred customer amenities. The survey will take less than 3 minutes of your time and is conducted by SurveyMonkey. Your input will influence the decision to build this park.
To take the survey, go to http://www.surveymonkey.com/s/orvpark


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Schools & Colleges|
Campus Life
To be registered for one of our programs, please complete our registration form (PDF) following the instructions below:
The School of Continuing Education is located in Lorber Hall, Room 102, on the LIU Post campus, 720 Northern Boulevard, Brookville, N.Y. 11548-1300. Early registration is encouraged, as space in many classes is limited. In some instances, a student may register at the first class meeting; please call the office prior to the first class to confirm schedule and course availability.
Mailed-in registration is accepted if postmarked no later than one week prior to the beginning of class. Forward the registration form with a check or money order made payable to Long Island University, or completed credit card information to Continuing Education, LIU Post, 720 Northern Blvd., Brookville, N.Y. 11548-1300.
Call 516-299-2236 with your credit card information (VISA, MasterCard, AMEX or Discover) up to the day of the first class meeting. To ensure that you receive the course(s) of your choice, please register early.
Call 516-299-2066 and include your credit card information on your registration form. Only one person may register per form. Additional forms may be printed. Registration will not be accepted without Social Security Number (or Student ID Number) and full payment of tuition. Checks, money orders or credit cards (VISA, MasterCard, AMEX or Discover) will be accepted toward payment of tuition. Please make checks payable to Long Island University.
Email a PDF of the completed registration form to firstname.lastname@example.com.
School of Continuing Education
Lorber Hall
LIU Post
720 Northern Boulevard
Brookville, N.Y. 11548
Phone: 516-299-2236
Fax: 516-299-2066
Email: firstname.lastname@example.com
Contact Us
Visit Us
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University Policies |
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Working at LIU |
Faculty/Staff E-Mail Login
700 Northern Boulevard, Brookville, New York 11548-1327 | Telephone: 1-800-LIU-PLAN


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The Senate farm bill is likely to pass today. And while I disagree with the cuts to the food stamp program dressed up as fraud prevention, the bill does end the practice of paying farmers not to produce, which in practice was a subsidy to southern farmers who relied on the subsidies (insert your snarky quote about how Southern Republicans "hate government handouts to the undeserving" here). The subsidy payments that remain, particularly on crop insurance payments, will be limited in significant ways – adjusted gross income limits for eligibility used to be $1.5 million, and will now get cut to $750,000. Payments will be capped at $50,000 for individuals and $100,000 for couples. And "farm managers" who make money off a farm they don't really have involvement in (think Blanche Lincoln, Michele Bachmann, etc.) will be ineligible for payments.
These are relatively small changes, and advocates still believe that agribusiness will make out far too well on this bill, still taking in the majority of the subsidy payments. But it's a small step forward. Which is why it will never pass.
The House Agriculture Committee is abruptly pulling back from its planned farm bill markup next week, amid signs that Republican leaders want a pause to consider how to proceed given the progress made in the Senate on its five-year bill.
Chairman Frank Lucas (R-Okla.) told POLITICO that he will move "hell or high water" when lawmakers return after the July 4th recess. But he confirmed the change in plans, which came after discussions with Majority Leader Eric Cantor (R-Va.).
Cantor's involvement is an ominous sign for farm bill advocates, but his aides insisted that the Virginia Republican was not saying "no" to any House farm bill this summer. Instead, they said the majority leader wanted to "push the pause button" and allow time for some assessment of the political situation.
The political situation is that a farm bill might pass, and the GOP can't have that, at least not without holding the system hostage for some set of goodies.
So the excitement over a bipartisan farm bill in the Senate should be viewed in the same way as the excitement over a bipartisan Violence Against Women Act, or a bipartisan surface transportation bill, or a bipartisan Chinese currency reform bill. None of these have come close to passing into law.


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Requested page does not exist.The possible reasons can be:
Join the AtmosRx family to receive discounts, updates on new product, and much more!
Contact customer support at (855) 633-3244 or click here to chat live with one of our online representatives.
We are now implementing a 5 year warranty program. Please retain your receipt after purchasing your vaporizer. To be a part of the program, you must register your AtmosRX® Vaporizer online.


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After being banned to play in 50 matches, Ryan Braun launched an attack over the system saying that he the system of flawed.
In October, Ryan Braun was tested for drugs which turned out to be positive. The player was alleged of consuming drugs and thus was banned to play the coming 50 matches. However, Thursday, the aggrieved player at Maryvale Park launched an attack over the system and defended himself saying that the system which alleged him of using drug is flawed.
While commenting upon the horrifying incident taking place in his career life, Braun said, "I've tried to handle the entire situation with honor, with integrity, with class, with dignity and with professionalism…If I had done this…I'd be the first one to step up and say I did it".
Braun said that when the tests were being conducted something went out on a limb with the samples collected by the authorities concerned. However, when asked as to why his blood samples showed a testosterone-to-epitestosterone ratio of 20-to-1, he didn't have any answer to it.
The points raised by the Braun have put the authorities in to the tight position. Braun didn't allege anyone directly. He simply said that something went wrong with his samples. The remarks made by Braun has raised several questions related to as to what made him say so, is there anyone who might have played game with Braun and are the tests right.
It has been reported that further tests would be conducted to make sure that Braun is being punished for the violation. If his tests reveal that he has not been using drugs then he would be saved from the penalties of
50 matches. Further tests over him would be conducted soon.
Product Launch
- Samsung signs deal with Amazon.in to sell Galaxy K Zoom handset in India
- GE unveils smart LED light bulb – 'Link'
- Report: iPhone 6 likely to be launched one month earlier than expected
- Huawei officially unveils its new high-end Ascend P7 smartphone
- Samsung launches its 'Galaxy K zoom' camera specialized-smartphone


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Monticello Girls Lacrosse Fights Off Charlottesville
Monticello girls lacrosse fights off Charlottesville
It's tough to win in girls lacrosse when you don't have an advantage on draw controls, particularly when the other holds a nearly 2 to 1 advantage on the draw.
But Monticello proved Tuesday night that if you pick up a ton of ground balls, you can get the job done, edging Charlottesville 12-11 despite the Black Knights holding a 16-9 advantage on the draw.
"It was a wonder we were still in the game after that first half," said Monticello coach Karen Redd. "These injuries (including Ari Slate and Caroline McDonald) are still hurting us. I'll give it to Charlottesville though, they brought it."
The Mustangs held a 30-14 ground ball advantage with Georgia Proutt's seven pickups and Jessica Worsham's five leading the way. Those groundballs created second chance points and the Mustangs took advantage, with Schuyler Thornton notching four goals and three other players — Sydney Larese, Ari Slate and Alex Johnson — finishing with two goals and an assist each.
The game was dead even at the half at 6-6, because Charlottesville's Jayme Kusyk kept taking the attack to the Mustangs with a six goal, six draw control night. Kendall Ballard and Ellie Barber finished with two goals each while Barber also dished out an assist. The Black Knights outshot Monticello 24-21, but Monticello keeper Anna Brown was solid and finished with 10 saves on the night.
Charlottesville's squad will travel to Fluvanna Thursday while the Mustangs host Western Albemarle Saturday.


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Step 1: Materials
A switch
A 9v battery
A 9v battery clip (thanks to the instructable on how to recycle 9vs i made my own)
Step 2: The wiring
First strip the wires so they dont have the computer connect thingy
The red and the black wires are the ones you need.
If you dont have red and black wires i guess your going to have to figure out which ones are negative and positive.
Wire the positive (red) to the red of the battery clip and wire the negative (black) to the black of the 9v clip
Step 3: Switch design
It fits nicely where the screw holes were so i decided to put it there.
For this step you will need a dremel to cut the plastic so the switch will fit.
You will also need a drill to make the switch fit in the hole.
You will want to drill a small hole somewhere to put a wire tie in
The picture should show were i cut.
Step 4: Wiring the Switch
Cut the positive wire and solder both ends to the switch.
If you run the 9V in series it is fine, use two 9V and run them in series rather than parralel. So esentially U get 18v rather 9v wich will give you enough Volts to cover the 12 needed for the fan.
My cooler fan has three wires black, yellow and green . Black is confirm but wt bout other two >>>> Which one should i use GREEN OR YELLOW?????
How did u attach the switch? Just cut half way between the red wire (which is connected to the fan and the battery) and just insert the switch in the middle?
Also, what kind of switch is the one in the picture? What kinds of switches are the smallest?
Thanks for the great guide!
im lost . im doing a thing for a solar project and needed 2 fans one to bring air in and the other for pushing the air out . i picked up a fan it has a double fans, it comes with black , red, blue and brown.
my questions is how to i find out what is the (-) and (+) . clearly there is 2 (-) and 2 (+) but can i hook it all to one battery or should i get two batterys one for each fan?also if its a 12 v dc what size battery should i use to get more then just a couple of hours ?
+:Red, -:Black
or something like that(im looking at a computer fan for a windows XP here :P
Three cables = Power + speed sensing
Four Cables = Power +speed sensing + PWM control


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Updated: 08/28/2014 6:04 PM
Created: 08/28/2014 8:56 AM WHEC.com
By: Brett Davidsen
News10NBC continues to follow new developments in the case of a man accused of raping a 14-year-old girl downtown.
Police say 23-year-old Michael Caruthers attacked the girl Saturday morning on Liberty Pole Way just one day after being released from prison.
Today, Caruthers made a brief appearance in court. He was supposed to face a hearing but it was adjourned because a grand jury has now acted on the case, meaning an indictment is likely to come down in the coming days.
Family and friends of Michael Caruthers shielded themselves from our camera as they left court this morning, unwilling to publicly speak up on behalf of the 23-year-old who now stands accused of a vicious attack.
Police say Caruthers raped a 14-year-old girl in broad daylight downtown, threatening to kill her if she didn't comply.
Prosecutor Sara VanStrydonck, who works in the child abuse unit, says they are focused on getting justice for the victim. "I would say in this case, anytime you have an allegation of a violent rape during daylight hours and the victim is a child, 14 years old, it's obviously an incredibly serious situation and the allegations are incredibly serious."
Caruthers had just been released from prison a day before the rape, after serving two-thirds of a five year sentence for a robbery conviction. That a two-time convicted felon was walking the streets instead of behind bars has touched off public outcry.
Yesterday, District Attorney Sandra Doorley expressed her frustration with the state's sentencing guidelines. This time around, if convicted of the charges he currently faces, Caruthers could be sentenced to 25 years in prison.
We asked VanStrydonck how the victim is holding up. She says as well as can be expected. "I would say she's a survivor. Obviously she survived this and she continues to cope with what happened to her."
Police and prosecutors are still not shedding any more light on the circumstances leading up to the attack. They won't tell us where the girl was coming from or heading to or if the victim and Caruthers had had any prior contact.
News10NBC/WHEC-TV welcomes your opinion and interaction on our website, but please remember to keep it clean. If you're advertising for another business, being profane, vulgar or slanderous your post will be deleted. By commenting on this website, you agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Use. Comments are not pre-screened before they posted.