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Publications (21)67.6 Total impact
Article: Exercise Improves Quality of Life in Bariatric Surgery Candidates: Results from the Bari-Active Trial[Show abstract] [Hide abstract]
ABSTRACT: Objective To examine the impact of a pre-bariatric surgery physical activity intervention (PAI), designed to increase bout-related (≥10 min) moderate to vigorous PA (MVPA), on health-related quality of life (HRQoL).Methods Analyses included 75 adult participants (86.7% female; BMI = 45.0 ± 6.5 kg m−2) who were randomly assigned to 6 weeks of PAI (n = 40) or standard pre-surgical care (SC; n = 35). PAI received 6 individual weekly counseling sessions to increase walking exercise. Participants wore an objective PA monitor for 7 days and completed the SF-36 Health Survey at baseline and post-intervention to evaluate bout-related MVPA and HRQoL changes, respectively.ResultsPAI increased bout-related MVPA from baseline to post-intervention (4.4 ± 5.5 to 21.0 ± 21.4 min day−1) versus no change (7.9 ± 16.6 to 7.6 ± 11.5 min day−1) for SC (P = 0.001). PAI reported greater improvements than SC on all SF-36 physical and mental scales (P < 0.05), except role-emotional. In PAI, better baseline scores on the physical function and general health scales predicted greater bout-related MVPA increases (P < 0.05), and greater bout-related MVPA increases were associated with greater post-intervention improvements on the physical function, bodily pain, and general health scales (P < 0.05).Conclusions Increasing PA preoperatively improves physical and mental HRQoL in bariatric surgery candidates. Future studies should examine whether this effect improves surgical safety, weight loss outcomes, and postoperative HRQoL.
Article: Bari-Active: A Randomized Controlled Trial of a Preoperative Intervention to Increase Physical Activity in Bariatric Surgery Patients[Show abstract] [Hide abstract]
ABSTRACT: Background: Habitual physical activity (PA) may help to optimize bariatric surgery outcomes; however, objective PA measures show that most patients have low PA preoperatively and make only modest PA changes postoperatively. Patients require additional support to adopt habitual PA. The objective of this study was to test the efficacy of a preoperative PA intervention (PAI) versus standard presurgical care (SC) for increasing daily moderate-to-vigorous PA (MVPA) in bariatric surgery patients. Methods: Outcomes analysis included 75 participants (86.7% women; 46.0±8.9 years; body mass index [BMI]=45.0±6.5 kg/m2) who were randomly assigned preoperatively to 6 weeks of PAI (n=40) or SC (n=35). PAI received weekly individual face-to-face sessions with tailored instruction in behavioral strategies (e.g., self-monitoring, goal-setting) to increase home-based walking exercise. The primary outcome, pre- to postintervention change in daily bout-related (≥10 min bouts) and total (≥1 min bouts) MVPA minutes, was assessed objectively via a multisensor monitor worn for 7 days at baseline- and postintervention. Results: Retention was 84% at the postintervention primary endpoint. In intent-to-treat analyses with baseline value carried forward for missing data and adjusted for baseline MVPA, PAI achieved a mean increase of 16.6±20.6 min/d in bout-related MVPA (baseline: 4.4±5.5 to postintervention: 21.0±21.4 min/d) compared to no change (-0.3±12.7 min/d; baseline: 7.9±16.6 to postintervention: 7.6±11.5 min/d) for SC (P=.001). Similarly, PAI achieved a mean increase of 21.0±26.9 min/d in total MVPA (baseline: 30.9±21.2 to postintervention: 51.9±30.0 min/d), whereas SC demonstrated no change (-0.1±16.3 min/d; baseline: 33.7±33.2 to postintervention: 33.6±28.5 minutes/d) (P=.001). Conclusion: With behavioral intervention, patients can significantly increase MVPA before bariatric surgery compared to SC. Future studies should determine whether preoperative increases in PA can be maintained postoperatively and contribute to improved surgical outcomes.
Article: Subjective sleepiness and daytime functioning in bariatric patients with obstructive sleep apnea[Show abstract] [Hide abstract]
ABSTRACT: Purpose The purpose of this study was to evaluate associations between obstructive sleep apnea (OSA) severity and self-reported sleepiness and daytime functioning in patients considering bariatric surgery for treatment of obesity. Methods Using a retrospective cohort design, we identified 342 patients who had sleep evaluations prior to bariatric surgery. Our final sample included 269 patients (78.6 % of the original cohort, 239 females; mean age = 42.0 ± 9.5 years; body mass index = 50.2 ± 7.7 kg/m2) who had overnight polysomnography and completed the Epworth Sleepiness Scale (ESS) and the Functional Outcomes of Sleep Questionnaire (FOSQ). Patients' OSA was classified as none/mild (apnea–hypopnea index (AHI) < 15, n = 112), moderate (15 ≤ AHI < 30, n = 77), or severe (AHI ≥ 30, n = 80). We calculated the proportion of unique variance (PUV) for the five FOSQ subscales. ANOVA was used to determine if ESS and FOSQ were associated with OSA severity. Unpaired t tests compared ESS and FOSQ scores in our sample with published data. Results The average AHI was 29.5 ± 31.5 events per hour (range = 0–175.8). The mean ESS score was 6.3 ± 4.8, and the mean global FOSQ score was 100.3 ± 18.2. PUVs for FOSQ subscales showed moderate-to-high unique contributions to FOSQ variance. ESS and global FOSQ score did not differ by AHI group. Only the FOSQ vigilance subscale differed by OSA severity with the severe group reporting more impairment than the moderate and none/mild groups. Our sample reported less sleepiness and daytime impairment than previously reported means in patients and controls. Conclusions Subjective sleepiness and functional impairment were not associated significantly with OSA severity in our sample of patients considering surgery for obesity. Further research is needed to understand individual differences in sleepiness in patients with OSA. If bariatric patients underreport symptoms, self-report measures are not an adequate substitute for objective assessment and clinical judgment when evaluating bariatric patients for OSA. Patients with severe obesity need evaluation for OSA even in the absence of subjective complaints.
Article: Comparison of Two Objective Monitors for Assessing Physical Activity and Sedentary Behaviors in Bariatric Surgery Patients[Show abstract] [Hide abstract]
ABSTRACT: Objective quantification of physical activity (PA) is needed to understand PA and sedentary behaviors in bariatric surgery patients, yet it is unclear whether PA estimates produced by different monitors are comparable and can be interpreted similarly across studies. We compared PA estimates from the Stayhealthy RT3 triaxial accelerometer (RT3) and the Sensewear Pro(2) Armband (SWA) at both the group and individual participant level. Bariatric surgery candidates were instructed to wear the RT3 and SWA during waking hours for 7 days. Participants meeting valid wear time requirements (≥4 days of ≥8 h/day) for both monitors were included in the analyses. Time spent in sedentary (<1.5 METs), light (1.5-2.9 METs), moderate-to-vigorous (MVPA; ≥3.0 METs), and total PA (TPA; ≥1.5 METs) according to each monitor was compared. Fifty-five participants (BMI 48.4 ± 8.2 kg/m(2)) met wear time requirements. Daily time spent in sedentary (RT3 582.9 ± 94.3; SWA 602.3 ± 128.6 min), light (RT3 131.9 ± 60.0; SWA 120.6 ± 65.7 min), MVPA (RT3 25.9 ± 20.9; SWA 29.9 ± 19.5 min), and TPA (RT3 157.8 ± 74.5; SWA 150.6 ± 80.7 min) was similar between monitors (p > 0.05). While the average difference in TPA between the two monitors at the group level was 7.2 ± 64.2 min; the average difference between the two monitors for each participant was 45.6 ± 45.4 min. At the group level, the RT3 and SWA provide similar estimates of PA and sedentary behaviors; however, concordance between monitors may be compromised at the individual level. Findings related to PA and sedentary behaviors at the group level can be interpreted similarly across studies when either monitor is used.
Article: Stress-only or stress/rest myocardial perfusion imaging in patients undergoing evaluation for bariatric surgery[Show abstract] [Hide abstract]
ABSTRACT: Bariatric surgery for management of obesity is being used with increasing frequency. Stress testing with myocardial perfusion imaging is often employed as part of the workup prior to anticipated bariatric surgery. The incidence of clinically significant abnormalities on stress MPI performed for this indication, however, has not been established. We retrospectively reviewed a series of 383 consecutive stress MPI studies performed on patients undergoing workup prior to planned bariatric surgery. The study population had a mean age 42 ± 10 years, and was 83% female, with a body mass index of 49 ± 8. The majority of patients (81%) were able to exercise using either the Bruce or Modified Bruce protocol, and 67% underwent stress-only imaging. Overall SPECT MPI findings were normal in 89% and equivocal in 6% of patients. The incidence of abnormal findings on MPI was 5% (3% mild and 2% moderate-to-severe abnormalities). At 1 year, overall survival was 99.5%, with no difference between those with and without MPI abnormalities. Similarly, the incidence of post-operative cardiac events was very low (2%), and mostly due to atrial arrhythmias or borderline elevations of troponin. In a typical pre-bariatric surgery population, the incidence of abnormal stress MPI is low. The majority of patients were able to use a stress-only strategy for assessment of perfusion. At 1 year the incidence of adverse cardiovascular outcomes is very low. Additional studies should be focused on determining whether any subgroup of such patients may benefit more from pre-operative stress testing.
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ABSTRACT: Bariatric surgery candidates spend very little time in moderate-to-vigorous intensity physical activity (≥ 3 metabolic equivalents [METs]). This study examined (1) how much of their remaining time is spent in sedentary behaviors (SB < 1.5 METs) compared to light-intensity activities (1.5–2.9 METs) and (2) whether sedentary time varies by BMI. Daily time (hours, %) spent in SB was examined in 42 surgery candidates (BMI = 49.5 ± 7.9 kg/m2) using the SenseWear Pro2 Armband. Participants were stratified by BMI to assess the relationship between degree of obesity and SB. Participants wore the armband for 5.4 ± 0.7 days and 13.3 ± 1.7 h/day. On average, 81.4% (10.9 ± 2.1 h/day)of this time was spent in SB. Participants with BMI ≥ 50 spent nearly an hour more per day in SB than those with BMI 35–49.9 (p = 0.01). Bariatric surgery candidates spend over 80%of their time in SB. Reducing SB may help to increase physical activity in these patients.
Article: P-73 Does parental weight loss after gastric bypass affect the weight of children in the household?
Article: Significant resolution of female sexual dysfunction after bariatric surgery. Surg Obes Relat Dis[Show abstract] [Hide abstract]
ABSTRACT: We have previously reported that most women seeking bariatric surgery have had female sexual dysfunction (FSD) as defined by the validated Female Sexual Function Index (FSFI). The present study examined whether FSD resolves after bariatric surgery. A total of 54 reportedly sexually active women (43.3 ± 9.5 years) completed the FSFI preoperatively and 6 months postoperatively after a mean percentage of excess weight loss of 42.3% (laparoscopic adjustable gastric banding [n = 38], percentage of excess weight loss, 34.6% ± 15.7%; Roux-en-Y gastric bypass [n = 16], percentage of excess weight loss 60.0% ± 21.2%). The FSFI assesses sexual function across 6 domains, with higher scores indicating better sexual function. The summing of these scores yields a FSFI total score (range 2-36, with a score of ≤ 26.55 indicating FSD). Before surgery, 34 women (63%) had scores indicative of FSD. By 6 months postoperatively, the FSD had resolved in 23 (68%) of these 34 women, and only 1 woman had developed FSD postoperatively. In the entire sample, significant (P < .05) improvements occurred from before to after surgery on all FSFI domains. The FSFI total scores improved after laparoscopic adjustable gastric banding (from 24.2 ± 5.9 to 29.1 ± 4.1, P < .001) and Roux-en-Y gastric bypass (from 23.7 ± 7.7 to 30.0 ± 4.7, P < .001). In regression analyses, being married, younger age, and worse preoperative sexual function were related to greater sexual function improvements. Postoperatively, the participants' FSFI total scores were indistinguishable from those of published normative controls (29.4 ± 4.3 versus 30.5 ± 5.3, P = .18). FSD resolved in a large percentage of women after bariatric surgery. Sexual functioning in the entire sample improved to levels consistent with those of normative controls. This improvement in sexual function did not depend on surgery type or weight loss amount and appears to be an additional benefit for women undergoing bariatric surgery.
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ABSTRACT: Successful weight loss after bariatric surgery depends on the patient's adherence to prescribed eating and physical activity behaviors. However, few studies have assessed patients' adherence to the behavioral recommendations and most have used retrospective self-report measures. The present study is the first to use ecological momentary assessment (EMA) via a palmtop computer to assess bariatric surgery patients' eating and activity behaviors in real-time in the natural environment. The study was conducted at Miriam Hospital (Providence, RI). A total of 21 patients (14 laparoscopic adjustable gastric banding and 7 Roux-en-Y; 81% women; mean age 48.5 yr) were studied 6.1 ± 2.1 months postoperatively. The participants used a palmtop computer for 6 days to report on all eating and physical activity episodes as they occurred in the natural environment. All participants demonstrated good compliance with the EMA, using the device on ≥5 full days. Most participants (94.8%) adhered to the recommendation to not drink while eating, and most took their vitamin supplements and medication as prescribed (85.7% and 90.5%, respectively). Few (4.8%) participants ate the recommended ≥5 meals daily, most participants exceeded the recommended portion sizes during meals and snacks (100% and 72.0% of the participants, respectively), and 47.6% of the participants consumed ≥5 servings of fruit and vegetables daily. Only 15.8% regularly consumed adequate liquids. Only 23.8% of participants engaged in moderate to vigorous physical activity for ≥30 minutes daily, as recommended. The EMA results suggested that adherence to the recommended behaviors varied considerably, depending on the behavior, with greater adherence to simple versus complex behaviors. EMA might eventually be a useful tool to help optimize the outcomes of bariatric surgery by identifying behavioral targets for additional monitoring and intervention.
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ABSTRACT: More women than men pursue bariatric surgery for treatment of obesity. Untreated obstructive sleep apnea (OSA) in bariatric patients increases perioperative morbidity and mortality, and, therefore, most bariatric surgeons screen for OSA with polysomnography (PSG). We sought to develop a model for predicting OSA in women seeking bariatric surgery in order to use this diagnostic resource most efficiently. We identified 296 women who had PSG in preparation for bariatric surgery. Regression and logistic regression analyses were used to assess the relationship between history and physical examination findings and OSA severity. After developing best statistical models, we constructed a summary index to identify patients exceeding clinical thresholds for mild (apnea-hypopnea index [AHI] ≥ 5) and moderate to severe disease (AHI ≥ 15). In our sample, most women (86%) had OSA, and more than half (53%) had moderate to severe disease. Multiple logistic regression showed that age, body mass index (BMI), neck circumference, hypertension, witnessed apneas, and snoring predicted AHI. Diabetes mellitus and daytime sleepiness measured with the Epworth Sleepiness Scale (ESS) were not significant predictors of OSA. Prediction models were statistically significant but had poor specificity for predicting OSA severity. OSA is highly prevalent in symptomatic and asymptomatic women planning bariatric surgery for obesity. Best prediction models based on clinical characteristics did not predict disease severity under conditions superior to those in which they might be applied. In light of the perioperative risks associated with OSA in bariatric patients, all women considering bariatric surgery for obesity should be evaluated for OSA with PSG.
Article: Pre- to Postoperative Physical Activity Changes in Bariatric Surgery Patients: Self Report vs. Objective Measures[Show abstract] [Hide abstract]
ABSTRACT: Bariatric surgery patients report significant pre- to postoperative increases in physical activity (PA). However, it is unclear whether objective measures would corroborate these changes. The present study compared self-reported and accelerometer-based estimates of changes in moderate-to-vigorous intensity PA (MVPA) from pre- (pre-op) to 6 months postsurgery (post-op). Twenty bariatric surgery (65% laparoscopic-adjustable gastric banding, 35% gastric bypass) patients (46.2 ± 9.8 years, 88% female, pre-op BMI = 50.8 ± 9.7 kg/m(2)) wore RT3 accelerometers as an objective measure of MVPA and completed the Paffenbarger Physical Activity Questionnaire (PPAQ) as a subjective measure before and 6 months after bariatric surgery. Time (min/week) spent in MVPA was calculated for the PPAQ and RT3 (≥ 1-min and ≥ 10-min bouts) at pre-op and post-op. Self-reported MVPA increased fivefold from pre-op to post-op (44.6 ± 80.8 to 212.3 ± 212.4 min/week; P < 0.005). By contrast, the RT3 showed nonsignificant decreases in MVPA for both ≥ 1-min (186.0 ± 169.0 to 151.2 ± 118.3 min/week) and ≥ 10-min (41.3 ± 109.3 to 39.8 ± 71.3 min/week) bouts. At pre-op, the percentage of participants who accumulated ≥ 150-min/week of MVPA in bouts ≥ 10-min according to the PPAQ and RT3 was identical (10%). However, at post-op, 55% of participants reported compliance with the recommendation compared to 5% based on RT3 measurement (P = 0.002). Objectively-measured changes in MVPA from pre-op to 6 months post-op appear to be much smaller than self-reported changes. Further research involving larger samples is needed to confirm these findings and to determine whether self-report and objective PA measures are differentially associated with surgical weight loss outcomes.
Article: Objective quantification of physical activity in bariatric surgery candidates and normal-weight controls[Show abstract] [Hide abstract]
ABSTRACT: Physical activity (PA) is an important component of weight loss programs and should be encouraged for severely obese patients undergoing bariatric surgery. However, few studies have determined the amount and intensity of activities undertaken preoperatively by bariatric surgery patients using objective measures. Using RT3 tri-axial accelerometers, the present study compared 38 bariatric surgery candidates and 20 normal weight controls on activity counts/hr; the number of minutes daily spent in moderate-to-vigorous intensity PA (MVPA) and vigorous intensity PA; and the level of compliance with national recommendations to accumulate 150 min/wk of MVPA in bouts of > or = 10 minutes. Surgery candidates, compared with controls, recorded significantly (P <.01) fewer activity counts/hr (13,799 +/- 3758 counts/hr versus 19,462 +/- 4259 counts/hr) and spent fewer minutes per day engaged in MVPA (26.4 +/- 23.0 min/d versus 52.4 +/- 24.7 min/d) and vigorous PA (1.2 +/- 3.4 min/d vs 11.8 +/- 9.0 min/d). More than two thirds (68%) of the surgery candidates versus 13% of the normal weight controls did not accumulate any MVPA in bouts of > or = 10 minutes and only 4.5% of obese patients met the weekly MVPA recommendation versus 40% of the controls. The results of our study have shown that bariatric surgery candidates have low PA levels and rarely engage in PA bouts of sufficient duration and intensity to maintain and improve health. Additional research is needed to determine how best to increase PA in bariatric surgery candidates.
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ABSTRACT: Sexual functioning has been shown to be impaired in women who are obese, particularly those seeking bariatric surgery. However, most previous studies evaluating sexual function in these populations have not used validated measures. We used the validated Female Sexual Function Index (FSFI) to assess the prevalence of female sexual dysfunction (FSD) in a sample of >100 women evaluated for bariatric surgery. The FSFI was administered to reportedly sexually active women during their preoperative evaluation. The scores for the individual FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) ranging from 0 (or 1.2) to 6 were summed to produce a FSFI total score (range 2-36). A FSFI total cutoff score of <or=26.55 was used to identify participants with FSD. The participants' FSFI total and domain scores were compared with previously published norms available for women diagnosed with female sexual arousal disorder and healthy controls. Of the 102 women, 61 (59.8%) had FSFI total scores of <or=26.55, indicative of FSD. Older age and menopause were associated with FSD. Compared with published norms, bariatric surgery candidates had FSFI domain scores that were lower than those of the control group (all P values < 0.0001) but greater than those of the female sexual arousal disorder group (all P values < 0.0001), except for desire, for which the scores were similar. Women seeking bariatric surgery are clearly a population with substantial sexual function impairment, with 60% of participants reporting FSD. These findings highlight the need to initiate routine assessment of sexual functioning in this population and examine whether the weight loss after bariatric surgery contributes to a reversal of FSD.
Article: Differences in Salivary Habituation to a Taste Stimulus in Bariatric Surgery Candidates and Normal-Weight Controls[Show abstract] [Hide abstract]
ABSTRACT: Previous studies show that slower habituation to taste stimuli is associated with reduced rates of satiation and greater energy intake. This study compared rates of salivary habituation to gustatory presentations of lemon juice in 34 severely obese bariatric surgery candidates [48.8 +/- 7.9 years, 85% female, body mass index (BMI) = 47.4 +/- 7.5 kg/m(2)] and 18 normal-weight controls (48.4 +/- 9.5 years, 88.9% female, BMI = 22.7 +/- 1.2 kg/m(2)). Parotid saliva was collected from cotton rolls positioned in the oral cavity during two baseline water trials and ten lemon juice trials. Data were condensed into trial blocks, representing mean values for the two baseline water trials and each of five pairs of lemon juice trials (i.e., blocks 1-5). Salivary change across lemon juice trials was calculated by subtracting values for blocks 1 through 5 from baseline. A significant interaction of group (bariatric surgery candidates/normal-weight controls) by blocked trials [F (4, 200) = 3.0; p < 0.05] indicated that the groups differed in their pattern of salivary responding, with bariatric surgery candidates' salivation (grams) failing to decrease significantly over the five blocked trials (-0.47 +/- 0.18, p = 0.12), unlike that of the normal-weight controls (-1.30 +/- 0.25, p < 0.001). These findings suggest that severely obese participants' rate of salivary habituation to a taste stimulus is delayed compared to normal-weight controls. This provides support that satiation in bariatric surgery candidates is impaired, possibly leading to increased energy intake and positive energy balance.
Article: Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery[Show abstract] [Hide abstract]
ABSTRACT: To evaluate the sensitivity and specificity of eight previously reported computed tomography (CT) signs in diagnosing internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Preoperative CT images of nine patients with surgically proven internal mesenteric hernia as a complication of gastric bypass surgery and 10 matched control patients were reviewed in a blinded fashion by three radiologists. The presence of eight previously reported signs of internal mesenteric hernia was assessed: mesenteric swirl sign, hurricane eye sign, mushroom sign, small bowel obstruction, clustered small bowel loops, small bowel other than duodenum located behind the superior mesenteric artery (SMA), presence of the jejunal anastomosis to the right of the midline, and engorged mesenteric lymph nodes. The sensitivity and specificity were calculated for each sign, as well as inter-observer reliability in recognizing these signs. Mesenteric swirl was the most predictive sign of internal hernia (sensitivity 78-100%, specificity 80-90%). Other CT signs showed good specificity (70-100%), but sensitivities were low (0-44%). The presence of a small-bowel obstruction and engorged mesenteric nodes was found to be 100% specific in predicting the presence of an underlying hernia. There was substantial inter-observer agreement in detecting mesenteric swirl sign (kappa=0.48-0.79), but agreement was relatively poor for all other signs. Mesenteric swirl is an easily recognized CT sign, and is the best indicator of internal hernia following Roux-en-Y gastric bypass surgery. Other reported CT signs are diagnostically insensitive. The presence of small-bowel obstruction with engorged mesenteric nodes is highly specific in diagnosing internal mesenteric hernia.
Article: 35.28: Incidence of abnormal stress MPI in obese patients who are candidates for bariatric surgery
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ABSTRACT: Obese women who become pregnant face many health risks, including gestational diabetes, pregnancy-induced hypertension, and pre-eclampsia. These women also have a greater incidence of preterm labor, cesarean sections, and perioperative morbidity. Infants born to obese women have increased rates of macrosomia and congenital anomalies, as well as life-long complications such as obesity and its associated morbidities. With the increase in numbers of weight loss operations being performed in women of child-bearing age, physicians will have to address patient concerns regarding the safety of pregnancy after surgery. Many of the proposed health benefits of weight loss after surgery could translate to decreased rates of complications experienced by obese pregnant women. Case reports and small series have emerged documenting pregnancy courses after bariatric surgery. We reviewed the studies that reported pregnancy outcomes compiled from PubMed and Ovid databases to help draw conclusions regarding the maternal, fetal, and infant safety in women after bariatric surgery. The observations from these studies have shown that the health risks experienced by obese women during pregnancy are reduced after weight loss surgery. Additionally, there does not appear to be any increased risk regarding fetal or infant outcome.
Article: Presurgical psychiatric evaluations of candidates for bariatric surgery, part 1: Reliability and reasons for and frequency of exclusion[Show abstract] [Hide abstract]
ABSTRACT: Many bariatric surgery programs include psychiatric evaluations as part of the pre-operative screening procedure. Surveys of surgeons and mental health professionals have found variability in opinion regarding what psychosocial problems warrant denial of clearance for surgery. Few studies have reported the number of patients who are not cleared for surgery due to psychiatric reasons, and no study has reported the reliability of decision making. The goals of the present study were to examine the reliability of decisions to clear candidates for surgery, determine the percentage of candidates who were not cleared for surgery, and detail the reasons candidates were not cleared for surgery. Five hundred candidates for bariatric surgery were evaluated from July 2004 until July 2006 with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders supplemented by a module specific to this population. Reliability for determining clearance was evaluated in 73 patients. Reasons for not clearing patients were recorded on the Surgery Clearance Form. Eighteen percent (N = 92) of the patients were not cleared for surgery. The kappa coefficient of reliability of determining surgical clearance was 0.83. The most common reasons for the negative recommendation were overeating to cope with stress or emotional distress, current eating disorder, uncontrolled psychopathology, and the presence of significant life stressors. Only 1 patient was excluded for a lack of understanding of the potential risks of surgery. The decision whether to clear candidates for bariatric surgery can be made reliably. Approximately 1 in 5 surgical candidates did not pass the initial psychiatric screening, usually because of current eating pathology, other forms of uncontrolled psychopathology, or difficulty coping with current life stressors.
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ABSTRACT: Determining the success of technical skill training for surgery residents should include not only the efficacy of the training in terms of skills learned but also the cost of the facility where the training occurs and the cost of faculty participation. Traditional training occurs in the operating room, but the cost of faculty time and operating room time has not been well established. Assessing the cost of traditional training may allow us to put the cost of building and maintaining skills laboratories in perspective. To estimate the cost of traditional training we have recorded the time and interventions necessary for our senior residents to do a laparoscopic entero-enterostomy. Each senior resident (PGY3-5) was asked to perform a laparoscopic entero-enterostomy in its entirety as part of a laparoscopic gastric bypass. After cannulation of the abdomen and division of any adhesions, we timed the residents for the performance of the following group of tasks: finding the ligament of Treitz, dividing the bowel 50-60 cm downstream, and creating a 2-layer anastomosis at 125 or 200 cm distal to the ligament. We tracked total time and number of interventions, which are defined by the attending temporarily taking over the case. Twelve residents were tracked by this system. The average time to complete the task was 93.7 minutes (+/-11.9 SD). The average number of interventions per case was 1.5 (+/-1.1 SD). Nine residents completed more than 1 procedure. Seven residents reduced their operative time on the second attempt. Operative times between the first and second procedure showed a reduction of 4.4 minutes (+/-17.4 SD), although this was not statistically significant (p = 0.47). No adverse clinical sequelae developed in these small bowel anastomoses. Educational time was calculated by subtracting the resident time from the time it takes an attending or finishing laparoscopic fellow to complete this task (50 minutes). The educational time for each anastomosis was 43.7 minutes. Using the AAMC average salary for an assistant professor of surgery of $180,000 year and assuming a 60-hour work week, this is $45.52 in faculty costs per anastomosis. If the cost of an operating room is $2000 per hour, the educational cost is $1457 per anastomosis. In our program, providing our 15 senior residents an educational opportunity to perform 2 laparoscopic entero-enterostomies would cost $45,061 a year. Resident education is expensive. Knowledge of the cost of skills training in a traditional operative setting is necessary to put the costs associated with building and maintaining skills laboratories in perspective. Cost analyses and efficacy of teaching will allow us to rate the success of new educational techniques.
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ABSTRACT: Objective: Determining the success of technical skill training for surgery residents should include not only the efficacy of the training in terms of skills learned but also the cost of the facility where the training occurs and the cost of faculty participation. Traditional training occurs in the operating room, but the cost of faculty time and operating room time has not been well established. Assessing the cost of traditional training may allow us to put the cost of building and maintaining skills laboratories in perspective. To estimate the cost of traditional training we have recorded the time and interventions necessary for our senior residents to do a laparoscopic entero-enterostomy. Methods: Each senior resident (PGY3-5) was asked to perform a laparoscopic entero-enterostomy in its entirety as part of a laparoscopic gastric bypass. After cannulation of the abdomen and division of any adhesions, we timed the residents for the performance of the following group of tasks: finding the ligament of Treitz, dividing the bowel 50-60 cm downstream, and creating a 2-layer anastomosis at 125 or 200 cm distal to the ligament. We tracked total time and number of interventions, which are defined by the attending temporarily taking over the case. Results: Twelve residents were tracked by this system. The average time to complete the task was 93.7 minutes (±11.9 SD). The average number of interventions per case was 1.5 (±1.1 SD). Nine residents completed more than 1 procedure. Seven residents reduced their operative time on the second attempt. Operative times between the first and second procedure showed a reduction of 4.4 minutes (±17.4 SD), although this was not statistically significant (p = 0.47). No adverse clinical sequelae developed in these small bowel anastomoses. Educational time was calculated by subtracting the resident time from the time it takes an attending or finishing laparoscopic fellow to complete this task (50 minutes). The educational time for each anastomosis was 43.7 minutes. Using the AAMC average salary for an assistant professor of surgery of $180,000 year and assuming a 60-hour work week, this is $45.52 in faculty costs per anastomosis. If the cost of an operating room is $2000 per hour, the educational cost is $1457 per anastomosis. In our program, providing our 15 senior residents an educational opportunity to perform 2 laparoscopic entero-enterostomies would cost $45,061 a year. Conclusion: Resident education is expensive. Knowledge of the cost of skills training in a traditional operative setting is necessary to put the costs associated with building and maintaining skills laboratories in perspective. Cost analyses and efficacy of teaching will allow us to rate the success of new educational techniques.
Top Journals
Alpert Medical School - Brown University
Providence, Rhode Island, United States
- • Department of Surgery
- • Department of Psychiatry and Human Behavior
Brown University
Providence, Rhode Island, United States
- Department of Surgery
Rhode Island HospitalProvidence, Rhode Island, United States


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He may appear a little annoying at first, but Dobby the House Elf turns out to be a loyal and important friend to Harry Potter. If you're thinking of dressing up as the kooky little elf, don't forget your Harry Potter Dobby Mask to complete your costume!
TM & © Warner Bros. Entertainment Inc. Harry Potter Publishing Right © JKR.
Not recomended for children under 10 years old.

subset: commoncrawl


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- With a fun and friendly international crew?
- With PADI professionals who REALLY care about your development and success?
Your IDC should be all about fun and success. During your 3 week program you will have moments of doubt followed by major breakthroughs and we will be there to share them with you. You'll make friends that last a lifetime and share in some unforgettable moments. This is a life changing course which will ensure that you achieve your dream of becoming a PADI Instructor. You will be able to live and teach anywhere in the world, share your passion with all ages and races and be an inspiration to your students. Live the dream, take the challenge and get ready for an extraordinary life. Choose an IDC centre that offers professionalism, a fun learning experience, lifelong friendships and guarantees your success.
What Does The Bali Scuba IDC Package Include?
- $500 worth of free ocean dives
- Unlimited class & pool sessions before your IDC
- IDC preparation course – an additional 3 day theory and skills workshop before your IDC
- IDC – complete course
- Lunch & free-flow tea, coffee & drinking water
- Emergency First Response Instructor Course (EFRI)
- Nitrox Instructor Specialty course
- Introduction to tec diving
- Business of Diving Workshop
- Duty of Care Workshop
- Tanks, weights, belts
- Free rental BCD, wetsuit, regulator
- Free Wi-Fi at our dive centre…….
…….AND a cast-iron pass GUARANTEE
Why choose Bali Scuba for your IDC?
In this great value 15 day program you'll cover everything you need to pass the Instructor exam and become a capable and confident PADI Instructor. You will have a great team on hand ready to make you feel welcome and to encourage you every step of the way. You will learn from true professions with years of IDC experience. As the only dive center in Indonesia to have three Course Directors on staff (who can teach in English, Chinese and 5 other languages) your dreams of becoming an Instructor can become a reality. You will be training with the current (and former) holders of the PADI award for "Outstanding Contribution to Instructor Development". An award presented annually to just one dive centre in Indonesia as recognition for providing the highest quality Instructor courses. You can assume success and with a cast-iron pass guarantee included you can be absolutely sure: if you somehow fail your Instructor exam you can come back and take another IDC completely free-of-charge. Check out these special offers you might be able to take advantage of:
10% Early Bird discount if you book your IDC at least 60 days in advance
10% Buddy discount if you book another candidate on the same IDC as yourself
10% Friend of Bali Scuba discount if you took your Divemaster program with Bali Scuba
And that's not all – As an IDC Candidate you become part of the family so if you choose to spend your time and money here you won't be forgotten – you are not "just another candidate". You can pop back any time in the future and jump on any trips with spaces available and pay our special price of currently $20 per dive. Plus you'll be entitled to never-ending Coffee, Wi-Fi and divers chit-chat. There's hardly a week goes by where former Divemaster or IDC candidates call in – hopefully that'll include you too next time!
When can I start my IDC?
IDC courses are carefully scheduled to marry in with the dates of the PADI Instructor exams here in Bali. These are the dates for our upcoming 2016 IDCs:
2016 IDC dates
Optional dive skills & dive theory workshops: February 16 – 18
IDC program: February 19 – March 4
PADI Instructor Exam: March 5 – 6
Optional dive skills & dive theory workshops: March 22 – 24
IDC program: March 25 – April 8
PADI Instructor Exam: April 9 – 10
Optional dive skills & dive theory workshops: April 26 – 28
IDC program: April 29 – May 13
PADI Instructor Exam: May 14 – 15
Optional dive skills & dive theory workshops: May 31 – June 2
IDC program: June 3 – 17
PADI Instructor Exam: June 18 – 19
Optional dive skills & dive theory workshops: July 5 – 7
IDC program: July 8 – 22
PADI Instructor Exam: July 23 – 24
Optional dive skills & dive theory workshops: August 9 – 11
IDC program: August 12 – 26
PADI Instructor Exam: August 27 – 28
Optional dive skills & dive theory workshops: September 13 – 15
IDC program: September 16 – 30
PADI Instructor Exam: October 1 – 2
Optional dive skills & dive theory workshops: October 18 – 20
IDC program: October 21 – November 4
PADI Instructor Exam: November 5 – 6
Optional dive skills & dive theory workshops: November 22 – 24
IDC program: November 25 – December 9
PADI Instructor Exam: December 10 – 11
You'll need to pay US$819 for IDC & EFRI required materials and AU$1321 for PADI fees.
Will I Be Able to Dive Bali's Best Dive Sites?
Yes!! We want you to experience and enjoy the diving here too so once you arrive in Bali we'll give you $500 worth of dive trip vouchers. You'll be able to use these vouchers within the 15 days before the start of your IDC and/or in the 15 days after your Instructor Exam. You can use them to dive the famous World War Two shipwreck at Tulamben, Manta Point at Nusa Penida, and any other trips we have scheduled at the time. Take a look at the world-class diving you'll be doing in our 2-minute
If you want to add Master Scuba Diver Trainer preparation course of 5 Instructor Specialty Courses to your package you can take advantage of the special offer price of just US$599 – usual price is US$799. This takes place in the 4 days after the Instructor Exam.
What Other Facilities Are There For Me?
You will enjoy dive trips on our two powerful purpose-built diving speedboats, your free Intro to Tek will introduce you to a complete working Technical Diving facility, you will study in fully air-conditioned classrooms & travel in air conditioned vehicles (no battered local buses!). You will train in an on-site 4m deep dive pool so you can practice and improve your dive skills any time. You will have constant access to your Course Director and all of our staff – You can be part of the best IDC pass rates in Bali!
Do you need help finding somewhere to stay?
There are lots of accommodation options near our dive center, some within walking distance. Prices start from US$15/night or US$300/month for a private fan cooled room. We'll be happy to book somewhere on your behalf. You'll be glad to know that living costs are very low here, and you can easily survive on US$10-15 per day.
What do I do now?
Now that you have made the decision to take your IDC the process couldn't be simpler! Use the enquiry form below to send us your details and any questions and we promise you a fast response with everything you need. We can take care of booking your accommodation, we prepare all of your manuals and equipment, we make a schedule for your time with us and all you need to do is some packing! If you are ready to change your life, achieve your dreams and become part of the elite team of PADI Instructors we are waiting for you to contact us!
Still not sure?
- The IDC was fantastic! All the staff at Bali Scuba were very friendly and helpful. The facilities are top shelf and the Course Director and assistants were amazing!Andre, December 18th
- I cannot speak highly enough of Knut's outstanding teaching skills and I say this as a professional teacher myself … nothing short of inspiring.Carl Davies, March 19th
- Knut and Ketut were super friendly, patient and helpful with us during the IDC. Had a great time with Bali Scuba.Ali, Oct 28th
- I really enjoyed my experience in the IDC. Chong has a wealth of knowledge and experience and I learned a great deal from him although I myself have quite a bit of experience already. Please extend my gratitude to Chong and all the staff in Bali Scuba for making it such a memorable and valuable experience.Toru Hayama, May 8th
Fill out the form opposite
Let us know which IDC you want to join and we'll block your space on the course right now. If you need more information first just send us a message and we'll get right back to you.


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Skip to content, or skip to search.
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Critics' Pick
137 Sullivan St.,
New York, NY 10012
Daily, noon-8pm
C, E at Spring St.; 1 at Houston St.
American Express, MasterCard, Visa
Sartorial junkies can get their fill of superior craftsmanship and classic styles at this cozy Soho shop that specializes in American-made menswear and a variety of vintage ephemera. Opened in November 2010 by obsessive curators and co-owners Willy Chavarria and David Ramirez, the space is homey, but certainly not kitschy. The low-lit boutique gives off a retro living room vibe, complete with antique globes, rotary telephones, wall clocks, and deep leather chairs, all of which are available for purchase. Deer antler lamps and JFK prints provide a hearty taste of American nostalgia, complemented by timeless accessories like vintage Rolexes and horn-rimmed eyeglasses. The vintage goods are seamlessly integrated into the store's selection of new clothes and accessories: Vibram-soled footwear from Oak Street Bootmakers; denim, collared worker shirts from Klaxon Howl; and made-to-order leather moccasins from Pelkey, to name a few. Chavarria and Ramirez design and manufacture the store's namesake brand, which includes handmade leather belts, wallets, chambray bowties, and their hot-selling leather and canvas messenger bags.


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Pictures Of God.
Pictures Of God
John Kosmas Skinas
Conciliar Press
PO Box 76, Ben Lomond, CA 95005-0076
9781888212587, $10.95, www.amazon.com
Icons are religious pictures most closely associated with the traditions, theology, and customs of Orthodox Christianity. A premier publisher of books of interest to Orthodox communities, Conciliar Press offers "Pictures Of God: A Child's Guide To Understanding Icons". This informative introduction designed specifically for use with children, explains what icons are, what they mean, and how they portray holy stories taken from scripture and other sources for the benefit of the faithful. The full color reproductions of representative examples of icons is simply flawless. "Pictures Of God" is a highly recommended means by which parents can provide their children with a true understanding of the value icons have within the Orthodox community and the believing hearts of the faithful.
Reader Opinion
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GOOD RATING: Sidemoor Pre-School has received a good Ofsted inspection. Pictured are Jean Taylor, deputy manager, with Ethan Greaves, three, and Mia Griffiths, three. Buy this photo BMM0614029 at bromsgroveadvertiser.co.uk/pictures or call 01527 889027.
Sam Greenway / / Local
A BROMSGROVE pre-school has been rated as good by inspectors.
Ofsted inspectors visited Sidemoor Pre-School, based at Peartree Children's Centre in Broad Street, last November.
In inspector Catherine Sharkey's report, which has now been published, the pre-school was overall judged a two, which is a rating of good in Ofsted's criteria.
This is an improvement from three, which the pre-school received in its previous inspection last July.
Among the areas rated as good in the latest report were how well the early years provision meets the needs of the range of children who attend, the contribution of the early years provision to the well-being of children and the effectiveness of the leadership and management of the early years provision.
Teaching and the wide range of resources was praised as very effective, enabling children to made good progress.
Inspectors said children's health and well-being is given a high priority, with healthy eating and lifestyles being promoted.
The report said: "Staff are well motivated and work very well as a team to meet the needs of all children.
"Staff plan very exciting activities based on individual children's needs and interests."
Toni Cooke, pre-school's manager, said it was down to the hardwork and dedication of the staff team that the pre-school continues to achieve high standards.
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Apr 07, 2007 - Springfield, Illinois view event >>
Aug 26, 2006 - Lincoln, Illinois view event >>
Apr 14, 2006 - Illinois view event >>
Shootfighting Challenge view organization >>
STOCKHOLM -- Swedish promotion Superior Challenge made significant changes for their sixth event, "Lion´s Den," the biggest being the move from a ring to a cage. However, the card also boasted a line read news >>
Four elite lightweight fighters and finalists of M-1 Selection welterweight tournament will open the new season of M-1 Challenge tournaments in Orenburg, Russia on February 27. read news >>
This Saturday at UFC 178, the fans will get a chance to see probably the biggest UFC card of 2014 so far. Dominick Cruz will step foot in the Octagon after being out almost three years. Cat Zingano w read news >>
ONE Championship welterweight titleholder Ben Askren needs top competition to maintain his current world ranking, but is he getting more of a challenge than he can handle on Friday?Filed under: Featu read news >>
UFC women's bantamweight champion Ronda Rousey faces perhaps her toughest challenge to date when she defends her title against Holly Holm at UFC 193. read news >>
M-1 Challenge Fedor Emelianenko vs Shinya Aoki (PREVIEW) watch video >>
M1 Challenge 2009 Semifinals Promo Trailer watch video >>
As we recap UFC 136 on Inside MMA, we have Bas Rutten and Anderson Silva's manager respond to the rather outlandish challenges posted by Chale Sonnen. Also on the show we have Carlos Condit, Mark Mu watch video >>
Five of the best mixed martial artists in the Philippines will rise to the challenge on May 31 to face some of the world's best fighters in the ONE FC cage. Get ready to support homegrown champions l watch video >>
Ronda Rousey and Miesha Tate battle it out in the coaches challenge before Anthony Gutierrez and David Grant fight for a spot in the finale. watch video >>
Ultimate Challenge are back December 1st with an epic line up to end 2012 with a Bang, former Cage Rage and UFC star Neil 'Goliath' Grove will grace the UCMMA Cage fighting for the Heavyweight title, watch video >>


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Monthly Archive for July, 2012
NY judge lets Chevron's Ecuador claim move forward
A judge who once tried to stop collection worldwide of an $18 billion environmental judgment in Ecuador against energy company Chevron continued his criticisms of the award on Tuesday in litigation that seeks a declaration that the judgment was the product of fraud.
Potter becomes president of FMC Technologies
Robert L. Potter has been appointed president of FMC Technologies. John T. Gremp will keep his roles as chairman and chief executive officer.
Sports star set to be new face of coal
Just in time for the election cycle, a newly released commercial by American Coalition for Clean Coal Electricity will tout the importance of coal. See who is the star of the new advertisement campaign.
Electricity grids fail across half of India
Electric crematoria were snuffed out with bodies inside, New Delhi's Metro shut down and hundreds of coal miners were trapped underground after three Indian electric grids collapsed in a cascade Tuesday, cutting power to 620 million people in the world's biggest blackout.
Anadarko leaders tout second-quarter bright spots
Anadarko saw sales volumes double in several U.S. fields during over the past year and marked major natural gas discoveries in Africa, leaders said.
Feds expand online mapping to Arctic
As Shell inches closer to launching exploratory drilling in the Chukchi and Beaufort seas, the federal government today announced it is expanding an online mapping tool for responding to offshore oil spills so it includes Arctic waters.
Are Texas oil and gas jobs on the rise? Find out here
Texas oil and gas employment rose last year, but what did the Texas Petroleum Index find out this year? Follow live as Fuel Fix reporter Zain Shauk hears the presentation.
More college grads want to work for energy firms
Energy companies are becoming more popular among college students, the latest in an annual survey shows.
Venezuela officially joins Mercosur trade bloc
Venezuela was officially welcomed into the Mercosur trade bloc Tuesday, giving that nation's leader Hugo Chavez a long-awaited political prize and strengthening links among the region's agricultural and energy powerhouses.
Valero may split off retail operations
Valero Energy may split its retail business from the rest of the company. It is reviewing several ways to separate its retail operations, including a distribution to shareholders, the company said.
Show More


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Speaker David Raskino, Jim Lewallen, and Lili Cheng
Duration 00:04:56
Date recorded 7 March 2011
FUSE Labs delivers two new projects that give users new ways to create, connect and collaborate with the people, information and ideas that matter to them.
©2011 Microsoft Corporation. All rights reserved.
By the same speakers
Microsoft Research Gender Diversity Lecture Series 4: Diversity Driving Innovation Moving from Research to Action


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8 Super Nutrients for Weight Loss
You already know that nutrients like fiber, protein, and monounsaturated fats are necessary to sustain long-term health. Now, our Diet Doctor, Mike Roussell, phD, outlines the best ways to add 8 of these super nutrients to your diet so that you can optimize your weight-loss progress.
4. Docosahexaenoic acid (DHA): Docosahexaenoic acid or DHA is one of the two omega-3 fats found in oily fish like salmon. DHA can stop growth of young fat cells and actually causes them to die, says... more
4. Docosahexaenoic acid (DHA): Docosahexaenoic acid or DHA is one of the two omega-3 fats found in oily fish like salmon. DHA can stop growth of young fat cells and actually causes them to die, says research published in the Journal of Nutrition.
Where to get it: To get more DHA in your diet, you can eat more oily fish or just take a fish oil supplement. If you are a vegetarian, pick up an algae-based DHA supplement to reap the same benefits.less
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Liverpool have all the form going into this Sunday's clash at Old Trafford, but our friends at Squawka believe Manchester United can get the points.
1. Liverpool's Defence Is Far From Perfect
In attack the Reds have been excellent and with 73 goals they are the Premier League's top scorers but they have needed to score a large amount of goals due to the fact they only have the joint sixth best defence.
With 35 goals conceded, the same amount as Southampton, West Ham United and Hull City, Liverpool have a worse defensive record than Manchester United, who have conceded 31 goals.
This is in part due to poor overall performances in tackles and headed duels. Over the course of the season Liverpool have won just 48% of the 974 tackles attempted and 49% of the 841 headers challenged for.
Jose Enrique is definitely out of the clash and if Lucas Leiva and Mamadou Sakho do not recover in time it will hamper an already suspect back line.
2. Luis Suarez Is Having a Slight Dip in Form
The Uruguay international is having a great season with 24 goals in 23 Premier League matches and averaging just over a goal per game as well as assisting a further 10 goals. This means he has been directly involved with just under half of all Liverpool's league goals in 2013/14.
However, in the last seven games the goals have dried up. Since the 5-3 win over Stoke City, Suarez has scored just twice, once against Everton in the Merseyside derby and a well taken goal against Southampton.
His shot accuracy is also low with just 41% of his 29 efforts in those seven games hitting the target compared to a season average of 55%.
Suarez is still a danger though and has created 20 chances and assisted five goals in his poor run in front of goal.
While Moyes has got much wrong since taking over from Sir Alex Ferguson in the summer he has got a few things right, one of those being the acquisition of Spain playmaker Juan Mata from Chelsea during the January transfer window.
He has played six games for the Old Trafford club and has been key in an upturn in form that has seen United lose just one game in the league since his debut.
Mata has made 17 key passes, almost three per match, and has assisted three goals, or 30% of his team's goals in those six matches. Mata has also completed 90% of passes and is capable of pulling the strings against the very best.
- Soccer
- Sports & Recreation
- Manchester United
- West Ham United
- Premier League


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Future Students & Parents
CCAD Request for Information
Join our mailing list and receive more information about CCAD and your program of interest.
- Interested in our Masters of Fine Arts (graduate program)? Sign up here.
- Interested in our Bachelor of Fine Arts (undergraduate program) and want to start in the Fall 2016 or after? Sign up here.


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|Benjamin Powell is a Senior Fellow at the Independent Institute, Director of the Free Market Institute at Texas Tech University. He Independent Institute books include The Economics of Immigration: Market-Based Approaches, Social Science, and Public Policy, Housing America: Building out of Crisis, and Making Poor Nations Rich.
|Matt Ryan is a Research Fellow with the Independent Institute and Assistant Professor of Economics at Duquesne University.


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Edmonton Meeting Space
The Westin Edmonton, the City's premier business and conference hotel, is ideally situated in the heart of downtown adjacent to the city's scenic river valley. We are conveniently connected to the Shaw Conference Centre and a 10 minute drive to Edmonton's newest conference facility, the Edmonton Expo Centre.Our hotel offers a total of 15 meeting rooms with over 24,000 square feet of sophisticated meeting accommodations. Our meeting space is anchored by the 9,400 square foot Grand Ballroom, downtown Edmonton's largest hotel ballroom. Our Clutter-free approach to meeting set up, helps planners and guests stay organized and productive. Open room design, socially conscious amenities and delicious SuperFoodsRx™ menu choices keep minds sharp.
Explore all our Edmonton business hotel features as well as hot dates we have available for planning your Edmonton meeting, event or wedding.
For more information email Irina Dimitrova-Stancheva or submit an RFP here.
Year Opened: 1974
Learn more about our Edmonton accommodation.
Goods and Services Tax: 5%
Tourism Marketing Levy: 4%
Destination Marketing Fee: 3%
Edmonton Meeting Space
Floor Plans & Capacity Chart | Virtual Tour
Business: Let us take care of your every need from an array of services like our 24 hour Business Centre, wired and wireless internet throughout the hotel. Tangent, our newest addition, is a state-of-the-art room, equipped with the lasted smart technology is available by the hour for up to four people allowing you to stay connected to colleagues across the globe or for small meetings and interviews locally. Our Executive Meeting Specialist, dedicated to your event will be your personal liaison between you and our staff to ensure your event is perfectly executed.
Recreation: To help keep you moving, our WestinWORKOUT® Fitness Studio and heated indoor pool are available 24-hours a day. Take advantage of our New Balance® gear lending program allowing you to pack light and stay fit.
Nearby: City Center Mall, Art Gallery of Alberta, Winspear Centre, Citadel Theatre.
See more things to do in Edmonton.
Dining and Food & Beverage Averages
Recharge your body and mind with our delicious SuperFoodsRx™ inspired emenus. Packed with healthy nutrients, they give you the focused energy you need to work at your best.
Edmonton Restaurants
Whether you're looking for a dining experience to tempt your taste buds or restore your energy levels, you'll find cuisine that's both nourishing and irresistible at our Share restaurant and Lobby lounge.
Airport Proximity
The Edmonton International Airport is 30.8 km / 19 miles / Apx. 35 minutes away
On-Site Specialty Events
Choose from a variety of offerings which provide both cost effective and highly engaging events on-site, at our hotel. Our on-site events are turnkey, keep attendees engaged, cut out extra planning time and effort on the part of the meeting planner, and are cost effective for your over-all budget. Most importantly attendees will have a memorable experience. The Westin Edmonton offers the following on-site event options:
Ask your Westin Edmonton sales associate for more on-site event details.
Our team is ready to ensure that you experience so much more by redefining efficient service with an effortless style that ensures a truly unforgettable experience for you and your guests.


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Article Summary
Researchers from a national security laboratory in the U.S. have announced a technology which can detect the presence of thousands of microorganisms in just 24 hours. Hundreds of thousands of probes on a 1 x 3 inch glass slide can look for the entire range of known viruses and bacteria in a single test, which could prove invaluable in product safety testing, medical diagnosis and bioterrorism detection and prevention.
Read the full article: New detection technology identifies thousands of bacteria and viruses within 24 hours
Related Articles


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Sports & Fitness
Best play by Henrik Zetterberg
Best play by Henrik Zetterberg
Winner makes it to the final 8
Backhand against Ducks
Top shelf backhand goal against Kings
Shootout Goal against Raycroft
Bats puck out of mid-air
Sasha and Pasha play catch
Between the legs pass to Datsyuk
Goal with .3 seconds left in OT
Amazing goal against Avs
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In This Section
AES News
- Call for Board of Governors Nominations
- Deadline is February 15th
- The AES Celebrates Its E-Library Publications and Collections in September with FREE Offer for Members
- All members receive 25 free downloads in September 2015
- AES 2015 Election Results
- The results are in!
- Time to Vote: 2015 AES Elections
- Deadline was Friday, July 10th
AES News
AES Names Bob Moses Executive Director
Bob Moses, longtime AES member and officer, accomplished product designer, technologist, and pro audio industry advocate, has been named Executive Director of the Audio Engineering Society. Announced today, by AES President Jan Abildgaard Pedersen, Moses will assume his new role January 1, 2012.
"An exhaustive search was undertaken for the best possible candidate for this pivotal AES position," Jan Pedersen remarked. "Bob Moses is eminently qualified to address the multi-faceted demands of our 14,000 plus member organization. He brings enthusiasm, technical acumen, leadership and communications skills to this critical position. During his 23 years as an AES member, he has established invaluable relationships throughout our international membership. He is committed to implementing the Board of Governors' goals of ensuring the Society's fiscal health into the future, growing membership, and increasing value to our members and supporters. His deep appreciation for our 63-year history coupled with his eagerness to address the challenges of the future make him an ideal choice for Executive Director."
Posted: Tuesday, December 20, 2011
« Call for Engineering Briefs | Main | Call for Board of Governors Nominations »


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iHerb Customer Reviews
1 person found the following review helpful
Posted by Reviewer1020056 on May 21, 2012
Not the best tasting in the world but does feel much lighter on the stomach
i expected more
1 person found the following review helpful
Posted by vaggos on Oct 07, 2012
it does not dissolves easily, even with blender. i like my protein mixed with milk and this one needed a blender to mix nicely.
I like this product
Posted by 5452705871094330514 on Aug 16, 2012
Healthy and taste great
Good for the old man....
Posted by Reviewer2864264 on Feb 05, 2012
The best protein supplement I've found, esp. if you favor goat milk products which are more acceptable for many. Very good for emotional well being also; packed with amino acids which build neorotransmitters like serotonin. Highly recommended!
Goat Protein
Posted by Reviewer1084557 on Feb 11, 2012
This stuff is awesome. Goat dairy trumps cows dairy in so many ways. Tastes great too, just wish they had vanilla. The price is fair seeing how other brands cost significantly more.


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Bravely Default is a JRPG released for the 3DS that draws inspiration from the Final Fantasy and Dragon Quest game series. The game features party and job systems similar to earlier Final Fantasy games. The game features an original fantasy story, cutscenes, and voice acting. The title is derived from a gameplay mechanic that lets players choose to Default, and save up battle points, or Brave, which lets characters use those saved points in multiple attacks on a single turn.
The game's story follows four heroes who come together and explore the world as certain terrible events are happening. Crystals in the world of Luxendarc are tainted and causing these events and the massive destruction they leave. Can our heroes cleanse the crystals? The game also features multiple endings and turn-based combat.


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With a stay at Hotel Lucerna Tijuana in Tijuana, you'll be in the business district and convenient to Plaza Rio Commercial Center and Club Campestre Golf Course. This 4-star hotel is within close proximity of Hidalgo Market and Centro Cultural Tijuana.
Make yourself at home in one of the 168 air-conditioned guestrooms. Rooms have private balconies or patios. Complimentary wired and wireless Internet access keeps you connected, and satellite programming provides entertainment. Private bathrooms with bathtubs feature complimentary toiletries and hair dryers.
Rec, Spa, Premium Amenities
Don't miss out on recreational opportunities including an outdoor pool and a fitness center. This hotel also features complimentary wireless Internet access, babysitting/childcare (surcharge), and wedding services.
Grab a bite at one of the hotel's 2 restaurants, or stay in and take advantage of 24-hour room service. Quench your thirst with your favorite drink at a bar/lounge.
Business, Other Amenities
Featured amenities include complimentary high-speed (wired) Internet access, a 24-hour business center, and a computer station. Free self parking is available onsite.


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E.L.F. Eyeliner Brush
90 reviews
45% would repurchase
Package Quality: 3.4
Price: $
Package Quality: 3.4
Price: $
Age: 25-29
Skin: Oily, Fair-Medium, Not Sure
Hair: Black, Straight, Other
Eyes: Brown
way too rough to use on the eyes. it hurts! I'm not giving this a 1 because i can still use it to line my bottom lash line, which hurts slightly less than using it on the upper lash line. Also, the brush head/metal part already came off of the wooden handle! very poor construction. This is the only elf brush that i don't like.
Age: 36-43
Skin: Sensitive, Fair, Neutral
Hair: Brunette, Curly, Coarse
Eyes: Hazel
disappointed...no way to get a thin line out of this brush. the bristles stay separated and makes the line thick. I'll stick with my angled brush from Maybelline.
Age: 19-24
Skin: Normal, Fair-Medium, Not Sure
Hair: Black, Other, Other
Eyes: Brown
its a good brush like all of elf's other brushes
however, i would recommend you NOT get this brush if you have or are planning to buy : concealer brush, angled brush, lip brush or future tiny brushes in their collection as it would mimic the same function.
this brush can be used for lining, or in my case, dipping it into concealer and lining the outside of my lip when i make mistakes with lipstick or if ive accidentally smeared lining with liquid etc.
Age: 19-24
Skin: Combination, Medium, Warm
Hair: Black, Straight, Fine
Eyes: Black
I prefer my eyeliner brushes to have a bit of a slant or atleast be tinier. This kept randomly poking my eye...not cool.
Age: 25-29
Skin: Acne-prone, Tan, Not Sure
Hair: Black, Other, Other
Eyes: Brown
I read the reviews on this brush and I guess you either love it or you don't. I, personally, love it. I've tried other angled brushes and couldn't get the line I wanted...I decided to try this one on a whim and my liner went on beautifully. If you find angled brushes hard to use, give this one a shot...and if it doesn't work for you, hey, you just spent $1 on a concealor brush:)
Age: 19-24
Skin: Combination, Fair-Medium, Neutral
Hair: Brunette, Straight, Medium
Eyes: Brown
I hate this brush for applying cream or gel eyeliner because it's impossible to get a precise line with it (I prefer an angled eyeliner brush, like the one from Ecotools), but I like using it to put eyeshadow over it to set it (using dabbing motions rather than making small strokes). It's not particularly comfortable to use because the bristles are stiff and not of very good quality, but for $1, I can't complain. That being said, I wouldn't buy it again--I'm going to stick to angled eyeliner brushes that are of better quality in the future.
Age: 19-24
Skin: Dry, Olive, Warm
Hair: Brown, Wavy, Fine
Eyes: Green
Eh. This isn't great for thin eyeliner application, and I personally like an angled brush easier to use. (Ie- ecotools eyeliner brush). For a buck, though, you know, not bad.
Age: 18 & Under
Skin: Dry, Tan, Warm
Hair: Blond, Straight, Fine
Eyes: Blue
It's an okay brush for quick application of eyeliner, but if you want a more precise line I wouldn't recommend it for *that* purpose. But, like many have suggested below, it can be used for your eyebrows.
I, personally, don't feel as though the bristles are too stiff. They're dense but not painfully so.
Overall: I would repurchase. It's a great eyebrow brush and can be used for many other purposes as suggested in some reviews below. :)
Age: 19-24
Skin: Acne-prone, Tan, Not Sure
Hair: Black, Other, Other
Eyes: Brown
I can't possibly use this as an eyeliner brush. It's so thick so it's impossible to follow the shape of my eyes. I'm doing eyeliner quite ok with other brushes so I don't think it's my technique. And I usually do a medium eyeliner thickness-wise (not a fan of too thin eyeliner) so it's not that I'm too picky, either. It's ok to use for concealer and cream eye shadow, though. But definitely NOT for eyeliner!
Age: 25-29
Skin: Very Oily, Tan, Warm
Hair: Brown, Other, Other
Eyes: Brown
This is a very thick eyeliner brush. I bought it because I knew i could not work it with a line so thick, so I use it to apply my eyeprimer. Its flat enough to run the product across my lids evenly. I really love this brush for this reason. Its only a $1 at target makes it even more spectacular steal.
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text:
A sweet set of soulful numbers from Nancy Wilson – tracks that offer up a perfect fusion of her jazzy roots and soul-based styles of later years – wrapped up in lush arrangements from Japanese jazzman Masahiko Satoh! The record follows a similar approach to Wilson's Keep You Satisfied session – which Satoh also handled – and offers up a great format for the maturing Nancy to keep on burning with the mature, sophisticated sound she first brought to music during her 60s years at Capitol – yet with a definite 80s twist here. Titles include "Forbidden Lover", "Deeper", "Putting My Trust", "I Was Telling Him About You", "Too Good To Be True", "I Never Held Your Heart", and "A Song For You". © 1996-2016, Dusty Groove, Inc.
We realize that there are many different interpretations of the standard grades used for pre-owned vinyl record albums & CD, so we thought we'd offer you the ones that we are working with, so you have an idea what we mean when we give the grade for a non-new item on our pages.
Below are stated conditions for a used vinyl records at Dusty Groove. Grading for the cover should be assumed to be near (within a "+" or "-") the grading for the vinyl. If there is significant divergence from the condition of the vinyl, or specific flaws, these will be noted in the comments section of the item. However, please be aware that since the emphasis of this site is towards the music listener, our main concern is with the vinyl of any used item we sell. Additionally, please note that all of our records are graded visually; considering the volume of used vinyl we handle, it is impossible for us to listen to each record. If we spot any significant flaws, we make every attempt to listen through them and note how they play.
The following grading conditions apply to the vinyl component of an album or single:
If something is noteworthy, we try to note it in the comments — especially if it is an oddity that is the only wrong thing about the record. This might include, but isn't limited to, warped records, tracks that skip, cover damage or wear as noted above, or strictly cosmetic flaws.


text: Cat writes, "The Lord of the Rings is serious business, so it's about time it took itself a little less seriously - we do enough of that. That the game looks more like a Saturday morning cartoon than anything Peter Jackson made is a small shock to the system, but not unwelcome, and it's appropriate that these rose colored glasses are worn by Sam Gamgee. The game follows Aragorn through the three books in flashbacks narrated by Sam, and is even voiced by Sean Astin of the Jackson films. The game is geared towards a young audience, and so the narration is constructed like Sam is telling his kids the story."


text:
Hostellerie De La Bouriane3 Self rated
Place du Foirail Gourdon en Quercy, Sarlat, 46300
Price FromView Rooms
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About the hotel
THE HOSTELLERIE DE LA BOURIANE is a large old Quercy home. The hotel has been run by the same family since 1898, and is very much in the image of the region: Welcoming, Friendly, Comfortable, Warm-hearted and Authentic. But travellers will also find the rigour of a great hotel that remains faithful to high standards of Hotel management and Cuisine, with a well-known Gourmet Restaurant offering hearty, refined food , specialities that are recognised and appreciated by everyone.
100% NO SMOKING Hotel and restaurant The Restaurant is CLOSED every MONDAY. FREE INTERNET ADSL WIFI (including in the rooms)
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Showing Monday 8 February 2016 to Tuesday 9 February 2016Change Search
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- Wi-Fi Available , Wi-Fi Available In Public Areas , Wi-Fi Available In Rooms
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- TV , Satellite TV , [Channels] News , [Channels] Movies (Free) , [Channels] Foreign (European) , [Channels] Foreign (Other)
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- Safety Deposit Box , Hairdryer in each room , Telephone In Each Room
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- Limited Hours Room Service , Wake Up Call Available
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- Pets are not allowed
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text:
The Medical Device Quality Management (MDQM) program seeks to train and develop individuals who are currently employed in, or wish to enter the medical device industry or related industries.
BONEZONE is the premier journal for orthopaedic device company professionals at all levels of the supply chain. Enhance your performance with content focused on the industry's biggest challenges and opportunities, and editorial coverage of product design and development, supply chain optimization, regulatory processes and insights into the state of industry and cutting edge technologies.
Julie Vetalice is available by phone, 440.543.2101 or email.


text:
Can my baby #2 delevop milk protein allergy as my #1? should I be prepared?
Comments (8)
My DD can't have milk either, which I was initially suspicious of because I'm also allergic to milk.
When I had to give DD formula I gave her soy. She couldn't handle that either because it is very binding and constipated her to the point of blood in her stools. We eventually found that Enfamil GentleEase was the best fit for her... even better than the Nuramigen.
If this new LO ever needs formula, I'll start with the GentleEase just to make a smooth transition and then potentially will try a milk based formula to see if the baby could handle it. If I saw even the slightest reaction, I'd ratchet back immediately.
Things are beautiful if you love them. ~ Jean Anouilh
My 2nd son got very sick around 5 months. He ended up being hospitalized and diagnosed with Failure to thrive. We found out this was all due to a severe milk allergy. After the diagnosis our pediatrician asked if ODS (my 09 baby) had any symptoms. We had been battling severe eczema around his mouth for a year. The first 7 months he screamed non-stop! No one ever suggested allergies, and I didn't know anything.
We bought almond milk so I could try to breastfeed still and I iddn't like it, so we started giving it to ODS who immediately got better. So, at 2.5 we found out he was allergic to dairy, too.
I think it's a good probability but give it a try first.
Alimentum is super expensive, hopefully you dont have to give it to baby. We spend about 120 on formula a month.
Mother to two boys with Severe Milk Allergies and super blessed Curly Girl
It took about two weeks for the proteins to clear my body and another 2-3 weeks for the proteins to clear his before we saw real results (plus I lost all the baby weight giving up cheese!).
According to Kellymom.com and La Leche League, there is a family link with food allergies and sensitivities. So, by cutting them out now before you deliver and staying dairy free until you feel comfortable doing a food trial, you could possibly save your breast feeding relationship with your new squishy baby. This is my plan with #2 (I'm only 6 weeks along).
Here is a great link from LLL.
Wife to III & momma to my gentle and sweet yogi, Asher 9/18/09 and my rainbow, Jude 1/11/13.
Missing my babe 02/12.
My first was allergic but my second is only sensitive to it.
Mommy of... Aubrey Grace 5lbs14oz 4:17pm 9/4/09
and Carter Robert 6lbs10oz 9:52am 11/16/11
my first is severly allergic to milk but my second does not have a problem with it. so just because the oldest is doesn't mean the second one will.
My first born had no sensitivities. My second had severe milk protein and soy protein allergies up until about 14-15 months old. I was told by our pediatrician (when I asked) that once you have a child with an allergy/sensitivity, the chance of a later child having one increases. So I'm planning on this LO having issues, even though I really hope that she doesn't. At the first sign of any issues, I'll be switching her to an elemental formula and then wean from there so we don't have all the issues/tests/hospital stay that my son had to have.
SAHM to DD-14 (Nuss procedure 05/14), DS-5, DD-2, & twin nieces-2yrs
How I'm earning $925 in Amazon gift cards so far in 2014


text:
Why heliski with us?
We're high, really high.
3 Run Powder Package
Starting at $720 per person
Powder Private
Starting at $5896.75 /group
Meet our Team
staff & air crew
Scenic Flights & Fondue
From basic to exclusive
Please pass on our deepest well wishes for the staff, guides, and pilots at RK Heliski.
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The day was awesome!!!! and indescribable!!!
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Journey to Heli-skiing. Lee's story.
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For the past 46 winters, rk heliski has been sharing the magic of the Purcell Backcountry with skiers and snowboarders from far and wide. The rk Heliplex, home base of operations, is perfectly situated at Panorama Mountain Village, a short 20 minute drive west of Invermere British Columbia. This location allows for easy helicopter access to the seamlessly unending glaciers and perfectly spaced treed runs... and all that glorious powder, Classic Canadian Heliskiing.
When the heliskiing and heliboarding is over for the day, all the comforts of Panorama Mountain Village can be exploited. Hot tubs, spas, fine restaurants and a great night life are yours to explore.
The Purcell Mountains have the powder adventure you are looking for and rk heliski will show you how to find it!
Call today and heliski or heliboard tomorrow!
Tag & follow on instagram @rkheliski


text:
My approach in therapy is to walk with you in your healing journey. I understand the courage it takes to face the past and put it behind you once and for all. You will be heard and you will not be alone.
My name is Kim Snyder and I am a Christian family counselor. The Power in Parenting isn't just about being a parent, and learning skills and techniques to become more confident, but also "how" we were parented as a child can have a lasting impact on our lives as adults
Craine Mediation provides the following services: divorce and family mediation, elder mediation, parenting coordination, parenting coaching and therapy and is a safe, compassionate place to resolve conflicts and help you discover a path towards restoration and growth.
I provide a safe and comfortable environment where individuals feel free to share personal information to attain insight, increase happiness and manage stress. I also perform neuropsychological assessments to help improve academic and/or work performance.
I am a psychotherapist who understands life can feel like a daily struggle. I offer a counseling relationship that provides opportunities for clients to emotionally move forward and bring a healthy balance back into their lives.
John specializes in helping individuals/couples work through personal/relational challenges including unhealthy sexual behaviors. John is certified to work with both addict and partner in their recovery. As with any life challenge, strength is in getting help!
Living Life Counseling was founded on the desire to help people live the life they truly desire. Our counselors are here to encourage and help you understand the deepest issues holding you back from truly living life. Would you like a new, fresh start?
Franklin Sollars, PhD has been providing counseling and psychotherapy for 30+ years and is director of practices in Birmingham, Troy, West Bloomfield, Commerce and Plymouth. As a practice, we offer individual, couple, family and group therapy for all ages.
I provide a safe, empathic, and collaborative environment to help those who are experiencing life challenges such as depression, anxiety, stress, trauma, substance abuse, chronic pain, and other concerns, through exploration of thought and behavior patterns.
Thriveworks offers premium, compassionate, and confidential counseling and coaching to individuals, couples, and families. Ph.D and master level clinicians work with children, teens & adults. Appointments within 24 hours. Insurances accepted.
Our purpose is to help people everywhere find great counselors and psychologists. Everyone can have a new start in life.
Theravive does not provide medical advice, diagnosis, or treatment.
Read here for more info.


text:
AXN: Foot
You have to be really strange to enter in "Ripley's Believe it or Not" show.
Advertising Agency: 1861 United Milan, Italy
Art Director: Peppe Cirillo
Copywriter: Vincenzo Celli
Photographer: Andrea Melcangi
Published: 2007
7 comments
hdizzleOct 04, 2007 - 20:10
Well if it isn't my good friend Mr McGreg, with a leg for an arm and an arm for a leg!
Could only find it in Spanish http://www.youtube.com/watch?v=2g8RxYQt5XU
ArtAndIndustryOct 05, 2007 - 16:26
If the leg for an arm doesn't get him in that bushy uni-brow sure will
Frane RectalOct 06, 2007 - 23:13
this guy looks creepy... and it's not his foot-hand thing...


text:
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Concrete contractors in Lancaster work for outdoor projects including stamped and colored concrete patios, pool decks and driveways, walkways, concrete slabs and foundations, concrete pavers, and foundation repair. They also work for interior projects such as stained concrete floors, custom concrete countertops and elements, interior concrete floor, finished basements, garage floor coatings, sinks and vessels, and concrete furniture. The main applications are stained concrete, stamped concrete, resurfacing concrete, polishing concrete, colored concrete, engraving concrete and cleaning concrete. Whether one is contemplating a new project or simply wants to rejuvenate or enhance an existing surface, these contractors are there to provide their valuable services in Lancaster.
Recent News from the Green Blog
Biofuel: Food In, Fuel Out, But Is It The Answer We're looking For?
(Long Island, NY) In today's environmentally-conscious worldview that is being shared by more and more people, alternative fuel sources are the Holy Grail of the "green" movement. There are many new ways to eschew hydrocarbon-laden gasoline when it comes to filling up your vehicle's tank at the pump, and one of the most oft-talked about are biofuels- mainly ethanol and..


text:
Originally posted by Russian soldier
Russia Russia Russia! Go Russia!
+1 for Russia and -1 for the Netherlands ONLY because they have the most points
Russia 7
France 2
Japan 9
Canada 15
Netherlands 17
Brazil 13
China 5
[edit on 9-9-2006 by Russian soldier]
Originally posted by Mouth
One quick set of rules...
1. please post (as you all have done) the scoring every time you give/take a point.
2. I like the idea of adding a few more countries, lets keep the max at 10 to make everything nice and even.
3. If people post at the same time, a correction must be made. I'll try to keep my eye on that as much as possible, but I am sure it is not that big of an issue.
Originally posted by djohnsto77
What happened to the United States? It seems to have disappeared from you tallys without explanation...
Originally posted by AGENT_T
France +1 coz they make alcohol taste yummy
France -1 coz they smell funny
Russia 4
France 3
Japan 9
Canada 16
Netherlands 19
Brazil 14
China 4
Israel 8
pakistan 10


text:
Animal Consciousness
- Uploaded by Dmtshaman on Apr 24, 2010
- Views: 146
We have much to learn, if only we could see it. This is in all of us, all living beings, but i fear not all of us can see, or understand it. Live your life from the heart, and stop thinking for a change.


text:
(877) 668-6872
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Pete (Las Vegas )
Basically skiing boot. To hot for anything but cold cold weather. Fit is great, boot is tall and will have to adjust clutch lever. Can be dangerous if not used to it.
Bill (delray beach )
Great gloves, and high quality. I used the sizing chart, and think it's accurate. However, they are snug. If you like your gloves to be a little looser, I'd go up one size. Appear to be great product for the money, so have to see how they hold up. Would definitely recommend.
Harris (Tampa )
I really love this helmet... once i take 5 mins to get it on my head! I ordered the biggest size possible and this helmet still doesn't fit properly. Once its on it is pretty comfortable but there is a few pressure points that become uncomfortable after an hour or so. This is a great choice for anyone with a narrow head.
John (Eugene )
High quality at a fair price. Just a note on sizing. I'm 6' 245lbs. 2XL was just too tight around the waist. 3XL works, but they jumbo sized the arms, so it's like weight lifter popeye wide in the arms. For you super athletic muscle builder guys, the 3XL is awesome.... For reference, I can squeeze into a Cortech 2XL, so I would say the Icon Hypersport sizing runs just a bit small. Only big complaint, in the arms, they do need to come up with some smaller patterns for the 3XL jacket arms. I suspect they just went overboard on the leather portion, especially elbow. On the 2XL jacket, I think the arms were just fine, so this is probably just on the 3XL pattern. Really like that they have the drop seat hang on the back. The 3XL fits like a 3XT. I have a long torso, so that part is great. But I may end up tailoring the arms if they end up flapping at speed....
Mean (Monmouth )
Fit is snug but comfortable. Not overly noisy but fogs up a little. Overall a superior helmet for the price and I've gotten lots of compliments on the looks of it. Highly recommend.
Cody (Houston )
This helmet looks awesome! I got a medium size and it fits great, I was afraid it was going to be a bit tight, but it's good. It's tight in the ears, but once you start riding there is no movement and you forget all about it. You want this helmet a little tight because you do get some Wind drag. I highly recommend it to anyone.


text: Harald Hanche-Olsen wrote: > Somewhere at the Unicode web site there is a file UnicodeData.txt > which contains lines like this one: > > 2232;CLOCKWISE CONTOUR INTEGRAL;Sm;0;ON;;;;;Y;;;;; Oops, thanks :) > As to whether 600 K is bloat, I wonder how hard it would be to put the > conversion tables in a fasl that is automagically loaded on demand? > (My guess is it shouldn't be hard at all.) Maybe not load fasl on demand, but with parser load UnicodeData.txt on demand? -- WBR, Yaroslav Kavenchuk.


text:
Latin American Theatre Review
Volume 46, Number 2, Spring 2013
pp. 61-76 | 10.1353/ltr.2013.0007
This essay explores the intertextual relations between the Puerto Rican writer's oneact play Gení y el Zepelín and Chico Buarque de Hollanda's Ópera do Malandro. This process uncovers not only Ramos's borrowing of a Buarque ballad for his title, his protagonist, and his plot, but also the way he shares Brecht's theatre poetics with his Brazilian counterpart. The study also reveals a complex textual web that includes Brecht's Die Dreigroschenoper, Maupassant's "Boule de Suif," Queiroz's "Tangerine Girl," and García Márquez's El otoño del patriarca. The interrelated works' shared theme of the despoiling of women and the environment is analyzed through the lens of Gayle Rubin's "The Traffic in Women."
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text:
The Deep Roads by AzimedesWatch
©2013-2016 Azimedes
No Dragon Age costume is complete without one Deep Roads picture! Costume and edits by yours truly, photograph by Mike Bentley (photosbybentley.com/ ).
Woah! This is probably the most realistic cosplay I've seen. Nice work!!!
Nice work!
No matter how often I see this cosplay, it keeps frightening me. ... and making me feel like starting Dragon Age again e.e
Wow, well done !


text:
Einstein–Maxwell–Dirac equations
Einstein–Maxwell–Dirac equations (EMD) are related to quantum field theory. The current Big Bang Model is a quantum field theory in a curved spacetime. Unfortunately, no such theory is mathematically well-defined; in spite of this, theoreticians claim to extract information from this hypothetical theory. On the other hand, the super-classical limit of the not mathematically well-defined QED in a curved spacetime is the mathematically well-defined Einstein–Maxwell–Dirac system. (One could get a similar system for the Standard Model.) As a super theory, EMD violates the positivity condition in the Penrose–Hawking singularity theorems. Thus, it is possible that there would be complete solutions without any singularities – Yau has in fact constructed some. Furthermore, it is known that the Einstein–Maxwell–Dirac system admits of solitonic solutions, i.e., classical electrons and photons. This is the kind of theory Einstein was hoping for. In fact, in 1929 Weyl wrote Einstein that any unified theory would need to include the metric tensor, a gauge field, and a matter field. Einstein considered the Einstein–Maxwell–Dirac system by 1930. He probably didn't develop it because he was unable to geometricize it. It can now be geometricized as a non-commutative geometry; here, the charge e and the mass m of the electron are geometric invariants of the non-commutative geometry analogous to pi.
The Einstein–Yang–Mills–Dirac Equations provide an alternative approach to a Cyclic Universe which Penrose has recently been advocating. They also imply that the massive compact objects now classified as Black Holes are actually Quark Stars, possibly with event horizons, but without singularities.
One way of trying to construct a rigorous QED and beyond is to attempt to apply the deformation quantization program to MD, and more generally, EMD. This would involve the following.
Program for SCESM[edit]
The Super-Classical Einstein-Standard Model:
- Extend Asymptotic Completeness, Global Existence and the Infrared Problem for the Maxwell–Dirac Equations to SCESM (Memoirs of the American Mathematical Society), by M. Flato, Jacques C. H. Simon, Erik Taflin.
- Show that the positivity condition in the Penrose–Hawking singularity theorem is violated for the SCESM. Construct smooth solutions to SCESM having Dark Stars. See here: The Large Scale Structure of Space-Time by Stephen W. Hawking, G. F. R. Ellis
- Follow three substeps:
- Derive approximate history of the universe from SCESM – both analytically and via computer simulation.
- Compare with ESM (the QSM in a curved space-time).
- Compare with observation. See: Cosmology by Steven Weinberg
- Show that the solution space to SCESM, F, is a reasonable infinite dimensional super-sympletic manifold. See: Supersymmetry for Mathematicians: An Introduction
- The space of fields F needs to be quotiented by a big group. One hopefully gets a reasonable sympletic noncommutative geometry, which we now need to deformation quantize to obtain a mathematically rigorous definition of SQESM (quantum version of SCESM). See: Deformation Theory and Symplectic Geometry by Daniel Sternheimer, John Rawnsley
- Derive history of the universe from SQESM and compare with observation.
See also[edit]
- http://arxiv.org/pdf/1002.0958v1.pdf
- http://arxiv.org/PS_cache/arxiv/pdf/1101/1101.1872v1.pdf
- http://arxiv.org/PS_cache/gr-qc/pdf/9801/9801079v3.pdf
- http://arxiv.org/PS_cache/gr-qc/pdf/9810/9810048v4.pdf
- http://arxiv.org/PS_cache/gr-qc/pdf/0005/0005028v3.pdf
- http://deepblue.lib.umich.edu/bitstream/2027.42/49217/2/cqg6_13_009.pdf
- http://arxiv.org/PS_cache/gr-qc/pdf/9910/9910047v2.pdf
- http://arxiv.org/PS_cache/gr-qc/pdf/9810/9810048v4.pdf
- http://arxiv.org/PS_cache/hep-th/pdf/0608/0608221v2.pdf
- http://arxiv.org/PS_cache/hep-th/pdf/0608/0608226v2.pdf
- Varadarajan, V. S. (2004). Supersymmetry for Mathematicians: An Introduction. Courant Lecture Notes in Mathematics 11. American Mathematical Society. ISBN 0-8218-3574-2.
- Deligne, Pierre (1999). Quantum Fields and Strings: A Course for Mathematicians 1. American Mathematical Society. ISBN 0-8218-2012-5.
- Deligne, Pierre (1999). Quantum Fields and Strings: A Course for Mathematicians 2. American Mathematical Society. ISBN 0-8218-2012-5.
- van Dongen, Jeroen (2010). Einstein's Unification. Cambridge University Press. ISBN 0521883466.