text:
Transocean, which leased its Deepwater Horizon drilling rig and supplied its crew to BP to drill the Macondo well, began presenting its defense Monday in the sprawling civil trial to determine liability for the 2010 Gulf of Mexico oil spill. The federal trial has now entered its fourth week.
Testimony during the first three weeks of the trial, presented by attorneys representing private parties who sued BP and its partners, the Department of Justice, and the states of Louisiana and Alabama, outlined the plaintiffs' views of how the accident occurred and whether BP or any of its partners were guilty of gross negligence or willful misconduct.
If U.S. District Judge Carl Barbier Jr., who is hearing the case without a jury, finds BP or its partners responsible for the higher levels of negligence, it could result in a four-fold increase in fines under the Clean Water Act and the awarding of punitive damages for the private plaintiffs.
The plaintiffs are expected to call an additional witness this week, Halliburton employee Tim Quirk. BP has alleged in court filings that Quirk was ordered to check the stability of the cement slurry Halliburton used to seal the Macondo well, but was not told to maintain records of the tests.
A Halliburton executive who served as its head of cementing operations at the time of the 2010 accident testified last week that the cement slurry "had a low probability of success" and was not designed to standards consistent with best industry practices.
The civil trial, which could last three months, is being held to assign liability for the accident, which killed 11 workers and caused one of the worst environmental disasters in U.S. history, with the responsible companies facing the possibility of tens of billions of dollars in fines and damages..
Calvin Barnhill, a well-control expert, was called to the stand Monday morning as Transocean's first witness.
Meanwhile, M-I LLC, the Slumberger subsidiary that supplied drilling fluids to BP for the Macondo oil well, filed a motion with Barbier asking that claims against it by private parties and the states of Louisiana and Alabama be dismissed. The company, also known as M-I Swaco, contends that no evidence has been presented linking its actions to the causes of the well blowout. Testimony in the trial so far has indicated that the blowout was caused by a failure of cement that was supposed to block the flow of oil and gas.


text:
How commercial plant growers can grow PHPS-certified stock, and find out the benefits of using it in commercial plantations.
The Plant Health Propagation Scheme (PHPS) encourages the production and use of healthy planting stock. It's a voluntary scheme run by the Animal and Plant Health Agency (APHA) certifying plants that meet all the scheme conditions.
You can apply to join the PHPS to grow provenly healthy stock if you're a commercial grower ('propagator') of:
- soft fruit - strawberries, berry fruit, currants
- top fruit - apples, pears, cherries, plums
- hops
- rootstocks and ornamental varieties associated with top fruit
- micropropagated material (of any crop)
Apply for PHPS certification
Any grower in England and Wales can apply to have their crops PHPS-certified. Your crops must be of known lineage unless you're entering it at the lowest grade.
All material must be grown under specific conditions relating to their site and isolation from other crops as explained in these guides:
Use the Nuclear Stock Association's application forms to enter stocks into PHPS.
If you're entering planting material only for the CAC grade you must register with APHA to issue plant passports.
Crops are inspected at least once a year by APHA Plant Health and Seeds Inspector to check they meet the standards set out in the guides.
Assessments are normally made on the basis of visual examinations, but samples may be taken for laboratory analysis to get a definitive diagnosis.
If a stock fails an inspection, APHA may tell the the propagator they can take remedial action (eg by removing plants that don't meet the scheme standards) and request an additional inspection.
If the crop meets all the conditions set out in the guides, they'll get PHPS certification. Certification details are published in the PHPS Annual Register.
Grading system
You enter your crop to meet one of these grades:
- Foundation
- Super Elite
- Elite
The Approved-Health (A-H) grade is available for crops which are inspected for health and vigour only. Crops which can't meet the entry requirements for any PHPS grades are designated CAC Grade which means that they meet basic plant passport standards.
APHA will set up a contract if you grow PHPS-certified stock and will charge you for any certification visits. Any samples submitted to support inspections will be handled by the FERA (Food and Environment Research Agency) Plant Clinic who will invoice you.
New EU fruit certification scheme
There will be a new EU fruit certification scheme from 1 January 2017. PHPS certificates issued in 2016 will have both the current PHPS grade displayed and the equivalent grade from the new EU scheme.
Read the following for draft guidance on:

subset: commoncrawl


text:
Artistic Checks Coupon & Promo Codes
Most popular now: $10 Off 2 Boxes, Plus Free Shipping & Handling.
Latest offer: Save $2 Off.
$10 Off 2 Boxes, Plus Free Shipping & Handling
Two Boxes for the Price of 1
$20 Off 4 Boxes, Plus Free Shipping & Handling
First Time Customer: Two Boxes for $4.95, Free 4th Box, Free Lettering, Free Shipping
Save up to 36%
Save $3 Off 1 Box Purchase
Save 30% Off Accessories
Save 30% Off SecureMyID Items
Save 10% Off Address Labels
Save $2 Off
Save 10% Off Checkbook Covers
How to Use Artistic Checks Coupons
New customers to Artistic Checks get a free box of checks when they buy the first one! You'll also find plenty of promo codes and special offers for existing customers. Artistic Checks has multiple designs to choose from and a quick reorder process for return customers so you can get your checks, address labels, cards and more fast.


text: Furthering its seasonal affinity for denim-based fashion pieces, visvim advances the ARCHIVE VEST for Holiday 2011. The sleeveless down-filled vest is crafted in an amalgam of custom inkjet-printed patchwork patterns and textiles on top of an off-white nylon exterior shell. A premium Italian canvas yoke caps off the winter-ready silhouette. Now available through the visvim online shop. Retail is set at ¥62,000 JPY (approx. $796 USD).


text:
modern radical cults may argue that our present day Christmas celebrations have their roots in paganism and hence it should be abolished or discontinued. They raise the allegations that the use of incense and processions during this feast were directly taken from paganism. With those critics we humbly argue that the Church has during the course of her history accepted many innocent pagan practices into her life, as long as they are not directly or indirectly opposed to Christian faith. However, we would like to point out that the use of incense was common in Jewish worship; the magi offered incense to baby Jesus along with gold and myrrh. If processions were a contribution of pagans, how do we justify the precession of the Jews that received Jesus with great jubilation on Palm Sunday into Jerusalem, the Sunday before His resurrection? Processions are expressions of different emotions; it could be for expressing great joy, or deep sorrow, or lamentation.
Atheists do believe that the celebration of Christmas is an immoral activity! They attack the display of manger scenes not only in public places, but also in private properties. Recently the city police department forced to remove a publicly visible shrine of the Virgin Mother of Jesus erected on one's private property, in a suburb of Chicago, on the basis that there were complaints from neighbors! This is a sample of the anti-Christian sentiments everywhere in the world.
In the midst of these anti-Christian sentiments all over, we Christians have to go deeper into the meaning of our Christmas and internalize the spirit behind it. Our problems erupted from its celebrations in purely hedonistic tones, such as gluttonous drinking and eating, meaningless gift exchanges demanding others to compete, and sheer commercialization of a great mystery that turned human history into a rational and soteriological encounter with its Author.
First of all we have to realize that it is not the birth a Buddha, or a Gandhi or any gurus of history that we are celebrating. If this fact is ideally comprehended, we can avoid much of the problems we are confronted with. We have to make the world understand that this Christ whose birthday we celebrate is the sum total of history itself.
Christ's birth was clearly foretold centuries ago prior to His birth. We cannot see such prophesies attached to the birth of Buddha, or Muhammad, or Gandhi or any other gurus of the world. Christ was not the invention of the first century; He was the fulfillment of Hebrew prophecies.
WE find more than three hundred prophecies in the Hebrew Bible regarding the person and mystery of the Messiah, the Christ. The first prophecy is contained in the 3rd chapter of the Book of Genesis, where we read : " Thus the Lord said to the serpent, '… I will put enmity between you and the woman, and between your seed and her seed. He will bruise your head…'" (OSB Gen. 3: 14, 15). A woman does not have a seed, and this prophesy indicates the birth of Jesus from a virgin without fertilization by the seed of a man; moreover it clearly points to the destruction of Satan by her seed, Jesus. These prophesies also declared Christ's genealogical line from David (2 Samuel 7: 10-17, Psalms 89: 3-4, Jeremiah 23:5). Jesus met these criteria in the first chapter of the Gospels according to St. Matthew and St. Luke.
Augustus Caesar ordered that everyone had to return to the city of his ancestry and birth to be counted for taxation (Gospel According to Luke 2.1). It was this order that brought Joseph and Mary to Bethlehem where Jesus was born in a manger. This was to fulfill the prophesy made by Micah: "And you, O Bethlehem, House of Ephratah, though you are fewest in number among the thousands of Judah, yet out of you shall come forth to me the One to be the ruler of Israel. His goings forth were from the beginning, even from everlasting" (OSB 5:1).
The Messiah was to be born in Bethlehem. If Mary delivered Jesus in Nazareth the story of Jesus would have entirely different Look how providence guides all events for the fulfillment of Messianic prophesies!
But the Jews did not pay attention to these prophecies and rejected Jesus as the Christ or Messiah, and still wait for His coming. Our Jewish brethren, if you are still waiting for the Messiah please read Malachi chapter 3:1: "'Behold, I send My messenger, and he will prepare the way for Me. And the Lord, whom you seek, will suddenly come into His temple, even the Messenger of the covenant, whom you desire. Behold, He is coming', says the Lord Almighty" (OSB). God sent his messenger to prepare His way in the person of John the Baptist. The Lord came into His temple already and he taught in


text:
With the recent suggestions by congresswoman Michele Bachman and four other members of Congress that there has been Muslim Brotherhood infiltration of our government, I feel we have entered into a new McCarthyism.
All that seems to matter to an increasing number of our political leaders, and to their constituents, is their belief in whether it is genuine or manufactured for political gain an expanding network of potential internal terrorists.
These terrorists just happen to be Muslim, or have Muslim affiliations, this time rather than communists or Russian spies.
And the new "bad guys" will stop at nothing to destroy our society, socially and physically.
Facts, evidence, data, scientific investigation don't seem to have much meaning; all that's necessary is to make the allegations, insinuations which the "National Security Five" call "questions."
But it is the repercussions from these "questions" which can do tremendous damage by upsetting lives, careers, and, most of all, cause distractions from the real problems and issues of our society and the world today.
Because of 9/11, I'm afraid this time McCarthy-style witch hunts will go much more unchallenged, taken more seriously, and indeed, cheered on.
All the more reason why teachers and parents have to encourage critical thinking in children and teenagers. How can these politicians get away with unfounded charges and allegations?
The fact that the "National Security Five" have refused to explain their "questions" on any television talk shows or submit themselves to cross-examination by journalists should be a red flag that should incite outrage.
Richard Sahn
Cogan Station
Submitted by Virtual Newsroom


text:
The Federal Government is a Godzilla monster that is wrecking our nation. Bill has a plan to tame it!
How to Tame the Federal Government Monster
WOW!! The Video Hillary Clinton Doesn't Want Her Supporters to See
FBI got played! Comey blew it! Rep Collins unloads on the FBI Director [Video]
This Video is PROOF We Can't Let Hillary Clinton Anywhere Near the White House Again
America's Mayor Was Asked if Trump Was A Feminist, Here's How He Answered
Alfonzo Rachel's Rebuttal of the Presidential Debate is EPIC! [Video]
This police officer can't hold it in ANYMORE and Hillary and Obama are his number one target!
Panel Gets HEATED Discussing 'Are Bill Clinton's Extra Marital Affairs Relevant in the 2016 Race'?
Trump Supporter ATTACKED in California
Veterans 4 Trump's POWERFUL Video that Will Chill You to the Bone!
Gold Star Mom Karen Vaughn Rates Trump's Performance at the Debate [Video]
Black Female Reporter Gets Called 'Race Traitor' and 'Uncle Tom' By Racist Hillary Supporter [Video]
What To Do When You Get Pulled Over: Don't Surrender Your Rights
Loch Ness Socialism
Hillary's Answer to Veteran on Her Handling of Classified Information Should End Her Run for Office [Video]
'Bonhoeffer' Author Fired Up Over Sermon Subpoenas: 'Everyone in America Should Be Freaking Out'
New Black Panther Party Quanell X Calling on Blacks to Listen to Donald Trump [Video]
Humiliating 1995 Video Captures Hillary Spoofing Retarded Man for Laughs


text:
In response to the gentleman who castigated Kel Seliger in last week's Opinion section, I have something to say.
Texas state Sen. Kel Seliger represents all his constituents, not just the most extreme right wingers who would take health care from sick children and Medicaid from nursing home recipients.
Seliger reminds me of Nelson Rockefeller and the great compassionate Republicans of the past. Our state and national representatives should be accountable for the welfare of all Texans and Americans, not just big corporations who pour money into the pockets of their legislative whores.
Please don't judge Seliger by how radically Republican he can be, but by how he has served Texas and Texans — all of them.
John Kanelis (column, May 20) is right: We need less partisanship in Austin and Washington, not more.
If voters don't begin to demand the greater good for Americans, we may end up with a Congress bought and paid for by foreign interests. Wake up, it's happening!
Kaye McCall


text:
Tacoma Web Design Company
Affordable websites that give fantastic return on your investment. Ready to have a website that looks great, works on every screen size and doesn't require that you spend all your time either figuring out some do it yourself system or answering endless questions that you think a web designer should be able to figure out?
Let me take care of it for you. After all, this is what I do for a living.
Get New Customers
Websites designed by Envision Design Solutions look great on every major screen size and I offer search engine optimization services as well to ensure your site comes up when people are looking for your product or service and not just by name.
Envision Design Solutions is based in Tacoma, WA and have many clients around the region: Seattle, Olympia, Tacoma, Puyallup, Bonney Lake, Auburn, Kent and beyond.
Websites I design deliver consistent branding on all the different screen sizes such as full sized monitors, laptops, tablets and smart phones too.
While making sure your website looks great is important, I also specialize in an effective user experience because your website is a marketing tool, not an art project.
Websites, Not Headaches
Don't waste your time trying to build your website with some Do it Yourself system. Focus on what you do best. I'll build your site and you can update it yourself if you want using the super easy EDS Sitebuilder system or if you prefer I can update it for you. Pay as you go or get all your updates and hosting included with one of my management plans.
Web Design
Professional clean design. All websites we build are mobile friendly.read more
Website Hosting
Dedicated website hosting including regular on site and off site backups.read more
Make sure your website gets found with our SEO services. One time or on-going programs available.read more
Need help? Contact us for simple or advanced support. Based in Tacoma (PST).read more
Plans & Pricing
Websites are not a one size fits all solution. Some just need something 'pretty nice' while others need a much more involved website with advanced functionality.
We have a few different options to fit your needs.
Economy Websites
Long Form 1 Page Site
Built using our EDS Site Builder, economy websites are perfect if you just need a web presense but don't want to invest heavily into a full on website with multiple pages of content and images. Quickly give your customers who you are, what you do and how to reach you.
Value Websites
Save Time and Money
These websites are built using our EDS Site Builder which offers a super simple to use visual front end editor if you want to update the site yourself. You select a from one of our basic template selections or we can match an example you have. Tell us the pages you want and we will put your site together using your content and photos.
Deluxe Websites
Anything You can Imagine
We will ask you what kind of designs you like and present you some concepts or we can use examples you provide to us. Give us the content and images and we'll go to town making sure you site is stunning. We will customize the design to fit your brand and include search engine optimization (SEO) as well.
- Economy
- $159 /complete
- $20/month*
- 1 page (long form site)
- We build site w/your content
- Search Engine Optimization (SEO)
- EDS Site Builder
- E-mail Links
- On-going Support Available
- Learn More
- Value
- $499 /complete
- $20/month*
- Up to 5 Pages
- We build site w/your content
- Search Engine Optimization (SEO)
- EDS Site Builder
- 2 E-mail Accounts
- On-going Support Available
- Learn More
- Deluxe
- $1499** /complete
- $20/month*
- Up to 15 Pages
- We build site w/your content
- Search Engine Optimization (SEO)
- Content Management System
- 15 E-mail Accounts
- On-going Support Available
- Learn More
**$1499 is a starting place depending upon the features and functionality. Quote is provided.
These features should make sure your site does everything you need. NOTE: Not all features apply to every plan.
Easy Website Editor
If you want to update your website in-house, you can with our easy to use front end editor.
Only the Pages You Need
Give us your content, photos, videos, testimonials. Edit if you want or we can manage your updates.
Professional Clean Designs
Our website design themes are clean, professional and easy to edit. Easy for your customers too.
If you need SEO, we can do it once or as part of an on-going service.
Website Management
Want to be able to submit edits to us and we get it done? We can do that.
Email Accounts
These email accounts give you a nice professional presence.


text:
My attention is drawn to an article written by lobbyist Tim Allan. The Guardian's Nick Watt picked it up in a story entitled "Ed Miliband leadership attacked by former Blair Aide". Allan talks of Ed Miliband's "anti business rhetoric"; presumably in reference to the conference speech that introduced the term "predators". Mr Allan will no doubt know that many in the Labour Party believe there has been a wilful misrepresentation of what Ed Miliband actually said in that speech. I'm sure some colleagues will draw the conclusion that Allan is compounding the situation in his article.
I don't think it unreasonable, in fact I see it as desirable, that political leaders point out that companies that always act in the short term interests of shareholders, rather than long term interests of the country's economy, are acting in a predatory manner.
Portland Communications
So, interest aroused, I took a look at Mr Allan's company, Portland Communications. And after taking a look, I've concluded that it was unwise for Mr Allan to draw attention to himself. Last month, Bell Pottinger were exposed for doctoring the Wikipedia entries of their clients, "violating multiple guidelines and rules" according to Wikipedia founder Jimmy Wales. I fear Mr Allan's company may have done the same.
Here is the current list of clients for Portland Communications. PR agencies who sign up to the APPC code of conduct have to register them every three month. To be thorough, I've produced a spreadsheet of previous clients too, based on the company's quarterly reports to the APPC. I had a wry smile when Sky TV appeared on the register.
Yet the company that first jumped off the page at me was "Anheuser-Busch InBev". They are the giant brewing company that owns and produces the Stella Artois brand of lager. I took a look at Wikipedia. Something interesting popped up.
On the face of it, it seems that Portland have at least two connections on Wikipedia. The first is a user account called 'Portlander10' and the second is the IP address 18.104.22.168. A reverse DNS lookup of this IP address resolves to mx9.portland-communications.com and the IP address also crops up as cross referencing against the same edits as the 'Portlander10' account.
The 'Portlander10' account also set up the Wikipedia page for Portland Communications, created links from both the pages of Tim Allan and fellow Portland staffer former political editor of the Sun, George Pascoe-Watson to the Portland-Communications Wikipedia page.
Yet more interesting, 'Portlander 10' also removed reference to Stella Artois from the Wikipedia page entitled 'Wife-beater' and replaced it with a generic reference to lager or beer. This is factually inaccurate because in Britain, unpleasant a term as it is, Stella Artois is known to many as "wife-beater". The term isn't used generally to describe all lagers or beers. Interestingly the reference to wife-beater remains on the Wikipedia page for Stella Artois itself after it looks like sharp eyed Wikipedians spotted the edit and reversed it, only for it later to be completely removed by someone at the 18.104.22.168 IP address to then 3 minutes later undo their deletion – perhaps they thought someone might notice?
Stella Artois seems to have a huge advertising budget. This year, the powerful brand won awards for the campaign "she is a thing of beauty". http://www.campaignlive.co.uk/news/1109369/
Maybe this is why 'portlander10' felt they should remove the "wife beater" phrase. If it subsequently transpires that 'portlander10' is linked to the lobbying firm of the same name, then there is a potential PR disaster that outweighs the risk of breaking Wikipedia's editing rules. In deleting the phrase, or rather, in being caught deleting the phrase, "portlander10" risks the integrity of the whole advertising campaign as attention is brought to the contrast of the "She is a thing of beauty" message vs the pejorative term "wife beater". It's not quite a Gerald Ratner moment but it's not far off.
There is a more serious issue though. For some time now, party leaders – all three of them – have expressed concern about lobbyists, particularly those paid to promote the interests of foreign governments. Bell Pottinger came under pressure after the very impressive expose by the Bureau of Investigative journalism and the Independent newspaper just before Christmas.
Tim Allan's Portland Communications works for at least two foreign governments: Russia and Kazakhstan. Think about that for a moment. The former political editor of The Sun and the former spin doctor for Tony Blair work for the Russians. Truth indeed that irony is alive and kicking in politics.
The IP address 18.104.22.168 appears as the source of edits to a number of Wikipedia articles. These include the Wikipedia pages for:
BTA Bank, Mukhtar Ablyazov, Timur Kulibayev, Mo Ibrahim, Mo Ibrahim Foundation, Ibrahim Index of African Governance, ITV News at Ten, Wife-beater, Mo Ibrahim Prize for Achievement in African Leadership.
In the case of BTA Bank, a registered client, there are specific edits to add information in regards to their seeking legal action for corruption against a Mukhtar Ablyazov.
The entry of Mukhtar Ablyazov is of note. He once was the head of the BTA Bank. It appears he was the subject of court proceedings in the UK. Someone using the above IP address removed references to alleged links to the Government of Kazakhstan being politically motivated in their pursuit of Ablyazov which was referenced through the UNHCR to Amnesty International.
They also removed a section that noted the impact Mr Ablyazov's request for asylum in the UK was having on UK-Kazakhstan relations that was referenced to the Daily Telegraph newspaper – which is considered as a appropriate source for referencing by Wikipedia.
There is also an edit that adds that the Russian Interior Ministry has requested a warrant for Ablyazov's arrest. Not to mention some other interesting edits along the way.
In fairness to Tim Allan, we only know about his distasteful clients because unlike Bell Pottinger, he has done the right thing and signed his company up to the lobbyist's trade body, which obliges members to list their clients. Yet his commitment to transparency appears to end there. It certainly doesn't appear to extend to Wikipedia.
Allan's company have a lot of clients who are not foreign governments – Google for example. Strange bedfellows. The global company who believe in transparency in the same client-list as the Government of Russia. I wonder if the people at Google know what company Tim Allan keeps?
UPDATE: Francis Ingham has been in touch. He runs the PRCA, a different but similar trade body to the APPC. He points out that Bell Pottinger are members of this body and they do register their clients with them. I wasn't aware of this at time of writing and am happy to put the matter right here. The best way to do this is to publish Francis's email message. He's given me permission to reproduce it in full:
"BPPA joined us in March 2010. Entries are retrospective so first entry probably after election. Not sure as I'm at home right now. Like APPC members, all PRCA ones register all PA clients, directors and PA staff every three months. Some agencies join us; some APPC; some both. But our requirements and codes are very similar. Main difference is we have in house teams as members too, and they are required to register PA work too. Last month, we left UK public affairs council due its failures, and called for statutory register held by independent (non industry) body. We hope govt now moves quickly on this."
UPDATE 2, 3rd January: The list of clients was playing on my mind last night. Then it hit me. "Falcon and Associates". Never heard of them. Nearly every other company on the list – Virgin Media, Tesco, National Grid, MacDonalds, Coca Cola, Cable and Wireless – they're not just big companies they're household names. The only other Falcons I know are a chain of kebab shops in Hull. So who are Falcon and Associates? Turning to Portland's other client, Google, I found an article that begins: "His Highness Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE, has issued, in his capacity as the Ruler of Dubai, a law establishing Falcon and Associates."
So basically, Falcon and Associates is the company established by the Government of Dubai to represent the interests of Dubai. Tim Allan's Portland communications is working for the Government of Dubai through Falcon and Associates. You wouldn't have known this unless you'd spent a considerable amount of time digging around. Just as well I did.


text:
Naked Housewives, Horny Housewife, Housewives Sex Gallery, Housewives Sex Party, Housewife Bangers, Amateur Housewives Naked, Horney Housewives
Name: Darcy
Age: 24
Height: 167
City: London
Occupation: Entertainer
Hobbies: Photography
resolute, and continued until the end was accomplished, and the window
forget the kindness that you have shown to me and my child during the
professional talents where you are. Horny housewifes seems, therefore, to partake
Boulevards, lazily listening to the distant band, and noticing with
The letter in reply, of old housewife horny housewives masturbating free nude housewife to desperate housewives tv show lesbian housewives Baldwin,
the important and rather delicate matter referring to the improvement of
"Why, this is from housewife whores hot housewife exclaimed. "Perhaps she's much better
father?" pleaded she.
had pronounced his opinion that the estates ought to be given up to
on that field cared to look, came a murmur like the breaking of
the doctor wouldn't have sexy russian housewives at any price--swore that if hot housewifes were not
shillings, which desperate housewives cast gave to naked housewife, and told him housewives in pantyhose was sorry to hear the
constitutional way, have resisted and remonstrated against it.
and now to look on idly as, with a mighty flash and roar, the
then within a finger's breadth of the horizon, and darkness followed
When desperate housewives nude awoke the rain had cleared off, and the sun was shining
the time had almost arrived when housewife stripping must start on her journey. Free housewives nude had
before aware that the sexy housewife language was so rich in political
nothing but what housewife gangbang wore. housewife pussy of these must have been shaken out
_May 23rd._--Entered lonely housewives wearing pantyhose at sunset. Slutty housewife could see housewives sexy homepages housewife porn more
She was no sooner gone but comes a wench and a child, puffing and
Heidelberg as housewife having sex had planned beforehand, in order to be near my brother
long and needless circuits to bound gagged housewife, where naked housewifes found
officer, mature housewives nood, and his chief engineer, slutty housewives, had perished
attentively; sexy housewifes has asked me whether housewives bending over boys would be best for us to live in
father, the brother-in-law leading the bridegroom; salutations of
yonder window at the end of the gallery. Housewives in stocking suspenders you, ma belle, take
to obstruct the movement. housewives sex the afternoon of the 15th the
convictions in the bustle of life is to my mind the very test, the
The next day, dirty housewives were led before housewife swapping housewife bondage and mature housewife gallery thumb amatuer sex housewives, justices
your marm's lap."
"Let amatuer housewives alone," said housewife sluts, the oarsman, who seemed to have more
as lesbian housewives dildos thought desperate housewives spoilers had some wine in his head, and horney housewifes pressed her again
and housewives nude desperate housewives naked attractions of the harlequins, jugglers,
enough. Housewives fucking us quit quarrelling. Stripping housewifes know you can do more with them than
other hand, busty housewives amateur housewife orgies thought, that not only should preaching and
to heaven, and inspired me with new love and new hope. Italian stripping housewives had read some
Moreover, amature housewives were equally unknown to and unknown by the troops
During the last two weeks of the "whirlwind" campaign, automobiles had
"I can't get him right!" desperate housewives episodes panted. "He's snoring like a hog."
fund, or other public aid to their clergy or churches. Housewife fuck is much
as this, horny housewives thumbnails should have let me have prepared myself, and have
should not pay or appoint any chaplain, but leave to each denomination
Bill cannot consistently object to aid being given from the
which would secure to the national horny old housewives of housewife wanting sex and bored and lonely housewives, for
Captain naked housewives naked wives free horny housewives a number of convalescents of
and white rock cod, a fish whose flavour is excelled by no other in
some sweeps on the raft, and a dozen men could crowd fucking housewives over against
artists had, housewives naked seems, put a trick upon a shopkeeper, and being
'bout two hundred and fifty dollar, an' never pay.'
application, obtained leave to wait on her again, as nude housewifes said, to clear
"Yes, free housewife porn have heard from her. Nude mexican housewives all right," whores housewives amateurs answered, as housewife blowjob throw
who, not having the experience and discretion of University
difference between the mistress of the house being at home and away.
"I have detailed a corporal and three men to take care of the Castle,"
same with the man now pouring out wild words to lesbian housewife the witch, as if
disaster, but cleared himself of having any hand in desperate housewives theme song, and that cheating housewives sluts had
detained more than seven weeks at housewife nude xxx housewives, and being nearly
the superb red-tailed tropic bird (_Phaeton phoenicurus_), also engaged
'But all submission--all submission.'
deliberation and absence of haste that had been such strongly marked
the boats return unsuccessful from the chase than that housewife orgasm alone should
for the recruit of its numbers? horney housewife an organization may do much good,
as a minister of the housewife slut housewifes fucking housewife fucking especially do free nude housewife pictures thus feel
guilders, and assistants from 300 to 400; books furnished to the
and good government in the country.
concealing anything from her.
"Is there nothing that will stop them?" asked Donald.
And in the bored housewives webcams, reaching to the sky, rose a roaring column of flame,
raised a noble structure, and opened up the way for the elevation of the
Well, free naughty nude housewives importuned me not to talk of going; busty housewife assured me amature horny housewives had no
that cast of desperate housewives both used to know, and reminded me of a good many things that we
not drink now, not even on shore. Slut housewife woman who had stood to him in his
him happy, that was enough; all which sexy housewife fantasy knew was upon supposition, nay,
his geese from straying about at night-time. Young housewife then, doctor, you
"I suppose young housewives am tanned," laughed free housewives pussy housewife pussy "I know my hands are. Housewives in bondage for my
Almost at the instant when slut housewives were decided to run the gauntlet
W. Amateur housewife tgp bbw housewives, there was nothing on which to base the charge of such a
fashion. Housewife anal was to be married to mature housewives naked, and the naked housewives free of Little
_protégé_ of the housewives masturbating, walked in and held out his hand.
Bay at eleven o'clock on the following morning. naughty amateur housewives the last
Rivers had got mixed up in the matter.
brother stripping housewives, enclosing to him the manuscript of his "Reminiscences of
around each other, desperate housewives logo pale cheek lying upon the soft, rounded bosom
me, madam?'
prejudice! desperate housewives sex mysterious thing can this be?' housewives porn, at last he
on the 12th of fucking housewifes, at the moment when horney housewife contacts had made up his mind
Under-Secretary was present. Housewives cum was most agreeable and gratifying. Lord
getting under way housewives getting fucked had caused three guns to be fired from the
Captain essex sexy housewife housewife hardcore, who was then ashore, had given orders to the
another blow on the head, which left him stunned.
He stumbled up the poop ladder and came to me, puffing and panting, with
I have given security to the parish in general terms to secure them
well; and stripping housewife and lonely married women bored housewives set off very briskly, though the sky hung heavy
Hilda's was the most forgiving nature in the world. Desperate housewives theme that scene
ninth, amature housewife housewives adverts for sex said:--
casualties in anal housewives horny mature housewives divareion above housewife bangers courtney housewife rape were but
go old housewife training films, and there horny housewives fucking will prove to you that in the future you can trust
view to his elevation to the housewives having sex lesbian housewifes, however, declined to return.
animals by the long haul of seventy-five miles from naughty housewives cheating It


text: Growing Healthy Communities event draws over 100 people in Fairmont! by Anne S. on Friday, October 26, 2012 Oct. 23rd the Minnesota Dept. of Health and the five counties in the region that have received a Statewide Health Improvement Program grant held a community forum to highlight the opportunities to promote healthy living in their communities. The keynote was by Miss Minnesota and American Heart Association volunteer, Siri Freeh. Siri talked about how when her father developed cardiovascular disease, she knew that cardiovascular health would become her focus as a nursing student at the University of Minnesota. Siri is passionate about kids health and is worried that statistics show this generation of children will have a shorter life expectancy than their parents due to overweight and obesity. Many of the strategies that SHIP has supported in the 5-counties (Cottonwood, Jackson, Faribault, Martin, and Watonwan) focus on providing healthy food and opportunities for physical activity for children. Attendees included Sen. Julie Rosen, Rep. Bob Gunther, several county commissioners, and a wide breadth of community members. Sen. Rosen highlighted that SHIP was originally passed as a bi-partisan effort to reform healthcare with a greater focus on prevention and cost saving. Learn more about success stories in these MN communities: http://www.health.state.mn.us/divs/oshii/ship/communities/faribault-martin-watonwan.html Photo: Rich Collins, Siri Freeh, and Sen. Julie Rosen « Now share your story Share This


text:
Download citation file:
1In an effort to educate clinicians and patients about headache's impact, diagnosis, management, and prognosis, the U.S. Headache Consortium was founded in 1996. The Consortium was made up of seven member organizations representing primary care, emergency medicine, neurology, and headache specialists. The objective of the U.S. Headache Consortium was to develop scientifically sound, clinically relevant practice guidelines on chronic headache, particularly migraine, in the primary care setting. Five documents on headache and migraine were produced. These documents can be found on the American Academy of Neurology Web site (http://www.aan.com).
From American Academy of Family Physicians, Leawood, Kansas; Hines Veterans Affairs Medical Center and Northwestern University Feinberg School of Medicine, Chicago, Illinois; and American College of Physicians–American Society of Internal Medicine, Philadelphia, Pennsylvania.
*This paper, written by Vincenza Snow, MD, Kevin Weiss, MD, Eric M. Wall, MD, MPH, and Christel Mottur-Pilson, PhD, was developed by the Commission on Clinical Policies and Research of the American Academy of Family Physicians (AAFP) and by the Clinical Efficacy Assessment Subcommittee of the American College of Physicians–American Society of Internal Medicine (ACP–ASIM). Commission on Clinical Policies and Research: Theodore G. Ganiats, MD (Chair); Daniel Van Durme, MD (Board Liaison); Lee A. Green, MD, MPH; Michael L. LeFevre, MD, MSPH; Barbara P. Yawn, MD, MSc; Geoffrey Goldsmith, MD, MPH; Richard D. Clover, MD; Martin C. Mahoney, MD, PhD; Deborah I. Allen, MD; Doug Campos-Outcalt, MD; Martin L. Kabongo, MD, PhD; Robert Bonakdar, MD; and Michael A. Amster. Clinical Efficacy Assessment Subcommittee: David Dale, MD (Chair); Kevin Weiss, MD (Chair-Elect); Patricia Barry, MD; William Golden, MD; Robert McCartney, MD; Keith Michl, MD; Allan Ronald, MD; Sean Tunis, MD; and Preston Winters, MD. Approved by the ACP–ASIM Board of Regents on 26 March 2001 and by the AAFP Board of Directors on 8 August 2001.
Annals of Internal Medicine encourages readers to copy and distribute this paper, providing such distribution is not for profit. Commercial distribution is not permitted without the express permission of the publisher.
Note: Clinical practice guidelines are "guides" only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP–ASIM clinical practice guidelines are considered automatically withdrawn or invalid 5 years after publication or once an update has been issued.
Acknowledgments: The authors thank David Matchar, MD, for his long-standing dedication and commitment to this project, both as ACP–ASIM representative to the U.S. Headache Consortium and as the architect of the collaboration that led to the writing of these guidelines.
Grant Support: Financial support for ACP–ASIM guideline development comes exclusively from the ACP–ASIM operating budget.
Requests for Single Reprints: Vincenza Snow, MD, American College of Physicians–American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.com.
Current Author Addresses: Drs. Snow and Mottur-Pilson: American College of Physicians–American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Weiss: 676 North St. Clair Street, Suite 200, Chicago, IL 60611.
Dr. Wall: LifeWise, 2020 SW 4th, Suite 1000, Portland, OR 97201.
Migraine headache is a common disorder seen in primary care. It affects 18% of women and 6.5% of men in the United States, almost half of whom are undiagnosed or undertreated (1–2). These guidelines, developed by the American Academy of Family Physicians and the American College of Physicians–American Society of Internal Medicine, with assistance from the American Headache Society, are based on two previously published papers (3–4). The papers, titled "Evidence-Based Guidelines for Migraine Headache in the Primary Care Setting: Pharmacological Management of Acute Attacks," by Matchar and colleagues (3), and "Evidence-Based Guidelines for Migraine Headache in the Primary Care Setting: Pharmacological Management for Prevention of Migraine," by Ramadan and coworkers (4), can be found at http://www.aan.com/professionals/practice/guidelines.cfm.(1)
The target audience for this guideline is primary care physicians. The guideline applies to patients with acute migraine attacks, with or without aura, and patients with migraine who are candidates for preventive drug therapy. Although these guidelines are all based on the articles by Matchar and Ramadan and colleagues, the recommendations may differ because different thresholds of evidence were needed for making a positive recommendation. Table 1 compares the AAFP/ACP–ASIM guideline and the U.S. Headache Consortium Guideline.
Throughout the text, asterisks indicate drugs that are currently not available in the United States.
Headache has many potential causes. Most headaches are caused by the primary headache disorders, which include migraine, cluster, and tension-type headaches. Secondary headaches, which are those with underlying pathologic causes, are far less common. Migraine is a chronic condition with recurrent acute attacks whose characteristics vary among patients and often among attacks within a single patient. Migraine is a syndrome with a wide variety of neurologic and non-neurologic manifestations. The International Headache Society (6) has developed diagnostic criteria for migraine with and without aura (Appendix Table 1). This classification system serves to diagnose headache syndromes, not patients. Thus, one patient could have more than one type of headache disorder. For example, it is not uncommon for migraine patients to also have episodic tension-type headaches.
Effective long-term management of patients with migraine is challenging because of the complexity of the condition. Experts suggest several goals for successful treatment of acute attacks of migraine. These include treating attacks rapidly and consistently to avoid headache recurrence, to restore the patient's ability to function, and to minimize the use of backup and rescue medications.
Clinicians need to educate people with migraine about their condition and its treatment and encourage them to participate in their own management. The physician must help the patient establish realistic expectations by discussing therapeutic options and their benefits and harms. Patient input can provide the best guide to treatment selection and helps the physician to better understand and accommodate patient treatment goals. Developing an effective acute migraine management strategy can be complex, and an engaged patient is more likely to negotiate this process successfully. Encouraging patients to identify and avoid triggers (Table 2) and to be actively involved in their own management by tracking their own progress may be especially useful.
Once a diagnosis of migraine is established, patients and their health care providers should decide together how to treat acute attacks and whether the patient is a candidate for preventive medications. A wide range of acute treatments with varying efficacies is currently in use (Appendix Table 2). A comprehensive review of the scientific literature, especially the data from randomized, controlled trials, provides a list of treatments that have demonstrated efficacy in the management of acute migraine headache. It also provides a clear understanding of the adverse events associated with various agents.
The Headache Consortium's review of the evidence on antiemetics, barbiturate hypnotics, ergot alkaloids and derivatives, nonsteroidal anti-inflammatory drugs (NSAIDs), combination analgesics and nonopiate analgesics, opiate analgesics, triptans, and other agents found good evidence of the efficacy of only a few agents in the treatment of acute migraine (3).
Their demonstrated efficacy and favorable tolerability make NSAIDs a first-line treatment choice for all migraine attacks, including severe attacks that have responded to NSAIDs in the past. Among the NSAIDs, the most consistent evidence exists for aspirin (8–10), ibuprofen (11–12), naproxen sodium (13–14), tolfenamic acid* (8, 15), and the combination agent acetaminophen plus aspirin plus caffeine for the acute treatment of migraine (16). The evidence shows that acetaminophen alone is ineffective (17).
There is good evidence for the effectiveness of the oral triptans naratriptan (18–19), rizatriptan (20–23), sumatriptan (24–31), and zolmitriptan (32–34). In addition, there is good evidence for the effectiveness of subcutaneous (35–38) and intranasal (39–41) sumatriptan, making it an option for patients with nausea and vomiting. Adverse effects of the triptans include chest symptoms, but postmarketing data indicate that true ischemic events are rare. Triptans are contraindicated in patients with risk for heart disease, basilar or hemiplegic migraine, or uncontrolled hypertension. Subcutaneous sumatriptan is associated with a very rapid onset of action, and oral naratriptan is associated with a slower onset of action.
There is good evidence for the efficacy and safety of intranasal dihydroergotamine (DHE) as monotherapy for acute migraine attacks (42–46). Placebo-controlled studies of intravenous DHE did not clearly establish its efficacy in the acute treatment of migraine (47–48). The evidence was inconsistent to support efficacy of ergotamine or ergotamine–caffeine, and the studies documented frequent adverse events.
It is well recognized that opiates are good analgesics, but there is good evidence only for the efficacy of butorphanol nasal spray (49–50). Although opioids are commonly used, surprisingly few studies of opioid use in headache pain document whether overuse and the development of dependence are as frequent as clinically perceived. Until further data are available, these drugs may be better reserved for use when other medications cannot be used, when sedation effects are not a concern, or the risk for abuse has been addressed.
Fair evidence suggests that the antiemetic metoclopramide, given intravenously, may be an appropriate choice as monotherapy for acute attacks (51–53), particularly in patients with nausea and vomiting when the sedating side effect may also be useful. Isometheptene and isometheptene combinations obtained only borderline significance in relieving headache pain (17, 54–55). Other agents used in practice, such as intravenous corticosteroids and intranasal lidocaine, are not effective.
Since patient responses to these therapies are not always predictable, individualized management is important. The choice of treatment should be based on, among other characteristics, the frequency and severity of attacks; the presence and degree of temporary disability; and the profile of associated symptoms, such as nausea and vomiting. The patient's history of, response to, and tolerance for specific medications must also be considered. Coexisting conditions (such as heart disease, pregnancy, and uncontrolled hypertension) may limit treatment choices.
No studies document the effectiveness of specific treatment schedules, but experts suggest that acute therapy should be limited to no more than two times per week to guard against medication-overuse headache (or drug-induced headache). Medication-overuse headache is thought to result from frequent use of acute medication and has a pattern of increasing headache frequency, often resulting in daily headaches. In patients with suspected medication overuse or patients at risk for medication overuse, preventive migraine therapy should be considered.
Although some use the term rebound headache interchangeably with the term medication-overuse headache, rebound headache is a distinct entity. Rebound headache is associated with withdrawal of analgesics or abortive migraine medication. There is no uniform agreement about which agents can cause rebound headache, although ergotamine (not DHE); opiates; triptans; and simple and mixed analgesics containing butalbital, caffeine, or isometheptene are generally thought to do so. There is less uniform opinion about other antimigraine agents.
Another clinical consideration is the use of a self-administered rescue medication for patients with severe migraine attack that is not responding to (or failing) other treatments. A rescue medication is an agent such as an opioid or a butalbital-containing compound that the patient can use at home when other treatments have failed. Although rescue medications often do not completely eliminate pain and allow patients to return to normal activities, they permit the patient to achieve relief without the discomfort and expense of a visit to the physician's office or emergency department. A cooperative arrangement between provider and patient may extend to the use of rescue medication in appropriate situations.
A body of evidence now points to effective first- and second-line agents for acute treatment of migraine. Beyond the choice of agent lies the choice of management strategy. Recently, interest and research in step care versus stratified care have increased. Step care refers to the initial use of safe, effective, and inexpensive medications as first-line agents in acute attacks of any severity. If the initial agent fails, a second-line, more expensive, migraine-specific medication is then used. The stratified care model initially stratifies migraine attacks by severity, advocating migraine-specific agents for moderate to severe attacks, regardless of previous response to or an unknown response to other agents. Which approach is more effective is still an open question (56).
Once patients and their health care providers decide how to treat acute attacks, use of preventive medications should be considered. Generally accepted indications for migraine prevention include 1) two or more attacks per month that produce disability lasting 3 or more days per month; 2) contraindication to, or failure of, acute treatments; 3) the use of abortive medication more than twice per week; and 4) the presence of uncommon migraine conditions, including hemiplegic migraine, migraine with prolonged aura, or migrainous infarction. Other factors to consider are adverse events with acute therapies, patient preference, and the cost of both acute and preventive therapies. (The U.S. Headache Consortium also produced a document on behavioral and other nonpharmacologic therapies for headache prevention, which can be found at http://www.aan.com/professionals/practice/guidelines.cfm.)
A wide range of preventive treatments with varying efficacies is currently in use (Appendix Table 3). A comprehensive review of the scientific literature, especially the data from randomized, controlled trials, provides a list of treatments that have demonstrated efficacy in the prevention of migraine headache. It also provides a clear understanding of the adverse events associated with various agents. The Headache Consortium's review of the evidence on α2-agonists, anticonvulsants, antidepressants, β-blockers, calcium-channel blockers, NSAIDs, serotonergic agents (ergot derivatives, methysergide, and others), hormone therapy, feverfew, magnesium, and riboflavin found that there was good evidence of the efficacy of only a few agents in migraine prevention. A summary of these results follows.
Evidence consistently showed the efficacy of propranolol, 80 to 240 mg/d (57–63), and timolol, 20 to 30 mg/d (63–65), for the prevention of migraine. One trial comparing propranolol and amitriptyline suggested that propranolol is more efficacious in patients with migraine alone; amitriptyline was superior for patients with mixed migraine and tension-type headache (66). There is limited evidence of a moderate effect for atenolol (67–68), metoprolol (69–71), and nadolol (72–74). β-Blockers with intrinsic sympathomimetic activity (acebutolol, alprenolol, oxprenolol, pindolol) seem to be ineffective for the prevention of migraine. Adverse effects reported most commonly with β-blockers were fatigue, depression, nausea, dizziness, and insomnia. These symptoms appear to be fairly well tolerated and seldom caused premature withdrawal from trials.
Amitriptyline has been more frequently studied than the other antidepressants and is the only one with consistent support for efficacy in migraine prevention (75–77). The dosages that were most efficacious in the clinical trials ranged from 30 to 150 mg/d. Drowsiness, weight gain, and anticholinergic symptoms were frequently reported with the tricyclic antidepressants studied, including amitriptyline. There is no evidence for the use of nortriptyline, protriptyline, doxepin, clomipramine, or imipramine. There is limited evidence of a modest effect for fluoxetine at dosages ranging from 20 mg every other day to 40 mg per day (78–79). There is no evidence from controlled trials for the use of fluvoxamine, paroxetine, sertraline, phenelzine, bupropion, mirtazapine, trazodone, or venlafaxine.
For the anticonvulsants, there is good evidence for the efficacy of divalproex sodium (80–82) and sodium valproate (83–84). Adverse events with these therapies are not uncommon and include weight gain, hair loss, tremor, and teratogenic potential, such as neural tube defects. These agents may be especially useful in patients with prolonged or atypical migraine aura. Carbamazepine and vigabatrin* have been shown to be ineffective, and there is limited evidence for moderate efficacy of gabapentin (85).
A meta-analysis (4) of five of seven placebo-controlled trials of naproxen or naproxen sodium showed a modest effect on headache prevention (62, 86–92). Similar trends were observed in single placebo-controlled trials of flurbiprofen, indobufen*, ketoprofen, lornoxicam*, and mefenamic acid and in two trials of tolfenamic acid*. Placebo-controlled trials of aspirin, aspirin plus dipyridamole, fenoprofen, and indomethacin were inconclusive. There is no evidence for the use of ibuprofen or nabumetone in the prevention of migraine.
Side effect rates for naproxen were not significantly higher than those seen with placebo. The most commonly reported adverse events with all NSAIDs were gastrointestinal symptoms, including nausea, vomiting, gastritis, and blood in the stool. In the trials reviewed, such symptoms were reported by 3% to 45% of participants (86).
Of these agents, time-released DHE* had the strongest support, with consistently positive findings in four placebo-controlled trials (93–96). Evidence is insufficient for the efficacy of ergotamine or ergotamine plus caffeine plus butalbital plus belladonna alkaloids or methylergonovine for migraine prevention. Limited information was reported on adverse events associated with these agents. The most commonly reported events for all the ergot alkaloids were gastrointestinal symptoms.
There is strong evidence for the efficacy of methysergide (97–100), a semisynthetic ergot alkaloid. However, there are reports of retroperitoneal and retropleural fibrosis associated with long-term, mostly uninterrupted administration. The manufacturer suggests that methysergide therapy be discontinued for 3 to 4 weeks after each 6-month course of treatment. Other adverse events most commonly reported included gastrointestinal symptoms and leg symptoms (restlessness or pain).
Other serotonergic agents that have been evaluated for the prevention of migraine include pizotifen*, lisuride*, oxitriptan*, iprazochrome*, and tropisetron*. Only lisuride (101–104) and pizotifen (87, 99, 105–110) have consistent evidence that supports their efficacy in the prevention of migraine. Published data on adverse events associated with lisuride are limited, and pizotifen is often associated with weight gain and drowsiness.
The evidence for nifedipine, nimodipine, cyclandelate*, and verapamil is poor quality and difficult to interpret, suggesting only a modest effect (see reference 4 for study references). There is no evidence for the use of diltiazem in the prevention of migraine. Symptoms reported with these agents included dizziness, edema, flushing, and constipation.
Flunarizine*, 10 mg/d, has proven efficacy in the prevention of migraine and is commonly used in countries where it is available (111–115). Adverse events reported with flunarizine include sedation, weight gain, and abdominal pain. Depression and extrapyramidal symptoms can be observed, particularly in elderly persons.
There is good evidence for the lack of efficacy of the α2-agonist clonidine in the prevention of migraine (116–120). Limited evidence shows moderate efficacy of guanfacine (121).
There is fair evidence for modest efficacy of these agents in certain circumstances, but more trials need to be done. Most of the existing trials had small sample sizes, had self-referred or special patient samples, or had other methodologic flaws (see reference 4 for more details and references).
To alleviate the suffering of many patients with migraine, clinicians need to be aware of the commonly accepted indications for preventive therapy and initiate effective therapy in those patients. Although many agents are available for the preventive treatment of migraine, only a few have proven efficacy. Once an agent has been chosen, clinicians should initiate therapy with a low dose and titrate the dose slowly up until clinical benefits are achieved in the absence of adverse events or until limited by adverse events. Because a clinical benefit may take as long as 2 to 3 months to manifest, each treatment should be given an adequate trial. Once preventive treatment is under way, interfering medications, such as overused acute medications such as ergotamine, should be avoided. After a period of stability, clinicians should consider tapering or discontinuing treatment. Patient and clinician need to engage in an ongoing dialogue in which patient expectations and goals for therapy are taken into account when agents are chosen, titrated, or discontinued.
Recommendation 1: For most migraine sufferers, nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy.
To date, the most consistent evidence exists for aspirin, ibuprofen, naproxen sodium, tolfenamic acid*, and the combination agent acetaminophen plus aspirin plus caffeine. There is no evidence for the use of acetaminophen alone.
Recommendation 2: In patients whose migraine attack has not responded to NSAIDs, use migraine-specific agents (triptans, DHE).
There is good evidence for the following triptans: oral naratriptan, rizatriptan, and zolmitriptan; oral and subcutaneous sumatriptan; and DHE nasal spray. Few data in the literature demonstrate which triptans are more effective. Oral opiate combinations and butorphanol may be considered in acute migraine when sedation side effects are not a concern and the risk for abuse has been addressed.
Recommendation 3: Select a nonoral route of administration for patients whose migraines present early with nausea or vomiting as a significant component of the symptom complex. Treat nausea and vomiting with an antiemetic.
Evidence is limited, but in some patients, concomitant treatment with an antiemetic and an oral migraine medication may be appropriate. Antiemetics should not be restricted to patients who are vomiting or likely to vomit. Nausea itself is one of the most aversive and disabling symptoms of a migraine attack and should be treated appropriately.
Recommendation 4: Migraine sufferers should be evaluated for use of preventive therapy.
Generally accepted indications for migraine prevention include 1) two or more attacks per month that produce disability lasting 3 or more days per month; 2) contraindication to, or failure of, acute treatments; 3) use of abortive medication more than twice per week; or 4) the presence of uncommon migraine conditions, including hemiplegic migraine, migraine with prolonged aura, or migrainous infarction.
Recommendation 5: Recommended first-line agents for the prevention of migraine headache are propranolol (80 to 240 mg/d), timolol (20 to 30 mg/d), amitriptyline (30 to 150 mg/d), divalproex sodium (500 to 1500 mg/d), and sodium valproate (800 to 1500 mg/d).
Medications with proven efficacy but limited published data on adverse events or frequent or severe adverse events include flunarizine*, lisuride*, pizotifen*, time-released DHE*, and methysergide.
Recommendation 6: Educate migraine sufferers about the control of acute attacks and preventive therapy and engage them in the formulation of a management plan. Therapy should be reevaluated on a regular basis.
There is strong consensus about the need for educating people with migraine. The physician must help the patient establish realistic expectations by discussing therapeutic options and their benefits and harms, such as medication-overuse headache. Encouraging patients to be actively involved in their own management by tracking their own progress through daily flow sheets, for example, may be especially useful. Diaries should measure attack frequency, severity, and duration; resulting disability; response to type of treatment; and adverse effects of medication. Patient input can provide the best guide to treatment selection.
Please read the other comments before posting. Contributors must reveal any conflict
of interest.
Comments are moderated and will appear on the site at the discretion of The American
College of Physicians editorial staff. Please be sure your email address is
updated in your account, otherwise the American College of Physicians will not be
able to contact you about your comment.
Anyone can submit a comment any time after publication, but only those submitted within 4 weeks of an article's publication will be considered for print publication. One month after publication, editors review all posted comments and select some for publication in the Letters section of the print version of Annals. (Not peer reviewed)
Authors: No more than 5
Text: Word Limit 400 (excludes references), 5 references, no figures or tables
* = Required Field
Disclosure of Any Conflicts of Interest*
(applies to the past 5 years and foreseeable future) Indicate any potential conflicts
of interest of each author below, including specific financial interests and relationships
and affiliations relevant to the subject matter or materials discussed in the manuscript
(eg, employment/affiliation, grants or funding, consultancies, honoraria, speakers
bureau, stock ownership or options, expert testimony, royalties, donation of medical
equipment, or patents filed, received, or pending). If all authors have none, check
"No potential conflicts or relevant financial interests" in the box below. Please
also indicate any funding received in support of this work. The information will
be posted with your response.
I'm a medical doctor, and, in this matter, a patient. This article is very articulate and helpful. Thank you all. For personal experience: the best treatment there is for migraine prevention is eating well, drinking lots of water and training in aerobic sports for at least one hour on a daily basis; this also combats insommia and keeps stabilized your humor. And it's natural! All the parameters (serotonin and others) can be meassured in two groups. Thank you for your attention, Jacqueline Paneyko.
None declared
Guidelines for the Treatment and Prevention of Migraine Headaches
The summary below is from the full report titled "Pharmacologic Management of Acute Attacks of Migraine and Prevention of Migraine Headache." It is in the 19 November 2002 issue of Annals of Internal Medicine (volume 137, pages 840-849). The authors are V Snow, K Weiss, EM Wall, and C Mottur-Pilson for the American Academy of Family Physicians and the American College of Physicians–American Society of Internal Medicine.
Read More...
Terms of Use
The In the Clinic® slide sets are owned and copyrighted by the American College
of Physicians (ACP). All text, graphics, trademarks, and other intellectual property
incorporated into the slide sets remain the sole and exclusive property of the ACP.
The slide sets may be used only by the person who downloads or purchases them and
only for the purpose of presenting them during not-for-profit educational activities.
Users may incorporate the entire slide set or selected individual slides into their
own teaching presentations but may not alter the content of the slides in any way
or remove the ACP copyright notice. Users may make print copies for use as hand-outs
for the audience the user is personally addressing but may not otherwise reproduce
or distribute the slides by any means or media, including but not limited to sending
them as e-mail attachments, posting them on Internet or Intranet sites, publishing
them in meeting proceedings, or making them available for sale or distribution in
any unauthorized form, without the express written permission of the ACP. Unauthorized
use of the In the Clinic slide sets will constitute copyright infringement.
Learn more about subscription options


text:
By GreatSchools Staff
Well, no, but this year he became a parentis ex machina nonetheless. First our papa in chief seemed to cast some sort of archetypal mojo after a study found that African Americans tested higher in the wake of his election — aka the much hyped "Obama effect." The study had serious flaws, so until more research is done, it's worth regarding the president's magic with some skepticism.
Then he raised consciousness (and hecka hackles) with his direct addresses to the nation's children: Aim high, do your homework, and never ever vote Republican (just kidding!). Finally, he exposed his daughter Malia's less-than-stellar grade on a science test — should humiliating your tween really count as a teachable moment? — to drive home the point that no parents get a free ride, even when they have the planet's most influential job.
Obama's attention to the profound impact of parental involvement, and not just to professional educators' "race to the top," is heartening. As parents, no matter what budget cuts and bureaucratic crises hit our schools, we still need to stay focused on what we can do: Help our kids day in and day out learn, grow, and think.
What's next — homework tips straight from the Oval Office? Last time we checked, the handle for "mrpresident" was still available on the GreatSchools Parent Community.
Hint: It's not an influenza associated with beloved childhood oinkers Babe, Wilbur, and Piglet. Stumped? It's called … overparenting. And according to experts, legions of loving parents have been positively stricken with this new social illness, which ultimately ruins their children. In the old days, the only thing that cured this widespread disease was what is traditionally known as a "chill pill," prescribed by teenagers with a roll of the eyes. Now there are classes, therapists, and books that attempt to pry parental talons from little ones' lives.
Is this all a blizzard in a blogroll? No doubt. On the other hand, with everyone from world leaders (see #7) to GreatSchools scribblers urging parents to become more involved in their children's education, it's only natural that some might go overboard and assume more is more. Are your kids giving you signs that you're helping too much for their own good?
Our diagnosis: Skip the classes and take a proverbial chill pill. Let your children learn some lessons the hard way — by making their own mistakes.
Sexting, high-tech cheating, and cyberbullying seized the slimelight this year, suggesting that all those cell phones issued to kids in case of a Columbine-like catastrophe are invidious enough to create their own private mayhem.
A new study by the Associated Press and MTV found that one in four teens have "sexted" — sent or received racy images or messages via text messaging. Another survey found that more than a third of all teens engage in some form of high-tech cheating. Still more research turned up this ugly stat: More than 40% of surveyed kids reported being bullied online. Lurid texting trends turned deadly in Florida when a 13-year-old girl committed suicide after naked pictures of her were spammed to her peers. Don't ask us to do the math — it's too depressing.
What's a parent to do about the potentially divisive incursion of social technology into teenage life? These tips can't hurt. Nor can realizing that this whole teens-are-out-of-control phenomenon has been around about 50 years. In 1959 sociologist Edgar Friedenberg noted that "the teenager seems to have replaced the Communist as the appropriate target for public controversy and foreboding." In other words, teens are a historical invention: dependent yet eager for freedom, sexually active yet immature, unemployed yet overscheduled, and, finally, surrounded by a culture that places them at the center of the universe. Add to the mix ubiquitous technology, and is it any wonder they create new ways to make their lives even more complicated?
We've all read about staggering rates of childhood obesity, but this year brought new poundage to the pile. One study found that one in five preschoolers is now considered obese. According to a CNN story, doctors are starting to see children ages 6 and 7 with type 2 diabetes, fatty liver disease, and musculoskeletal problems — obesity-related diseases commonly seen in 40- or 50-year-olds.
Worried your kid may tip the scale? Calculate your child's body mass index here. But don't freak out if he or she falls within the worrisome range: BMI testing can be misleading. Here's the skinny on why BMIs can lie.
Forget about figuring out your child's "learning style." Experts now say that politically correct theory won't necessarily help kids optimize their learning. What does every child need to succeed? A good dose of self-discipline!
We should have seen it coming. With a generation of beleaguered, dripping sippy cup-toting, Pirate Booty-strewn parents wondering why their fearsome, self-actualized, over-enriched children are so downright out of control, it's not surprising that the science of self-regulation has come to the rescue.
This year the story about a successful preschool program called Tools of the Mind got nationwide play, both in the bestselling, myth-busting book NurtureShock and a Paul Tough story in the New York Times Magazine. Thankfully, the new thinking about how to instill kids with a sense of self-control doesn't involve rods or rigid rules, but a curious synthesis of regimentation and free play. The idea is that kids learn how to work collaboratively and solve problems through imaginative play and that educators can accelerate this natural maturation process, not by just allowing it to happen (à la free hippie schools of the 1960s) but by setting up a structure that fosters communication and literacy in the context of pretend play.
The quintessential test for whether a child has internalized self-discipline — aka "Mischel's marshmallows," in which kids have the option of eating one marshmallow right away or two later — also resurfaced in the news. A group of charter schools announced they would participate in research about the relationship between self-control and academic success and whether this crucial character trait can be taught. If you only recall the test from the 1980s, this New Yorker story will bring you up to date. To see children struggling to resist the temptation of sugary egg whites, rip open a bag of mallows and watch this video. Wondering how your kid stacks up on the marshmallow-resistance scale? Give him or her the test tonight.
Parental rebellion took on a strange form this year as huge numbers of parents ignored the CDC, the WHO, their local school districts, and the American Academy of Pediatrics and elected not to vaccinate their children for the H1N1 influenza. Had the flu mutated to a more virulent strain, this might have spelled a public health disaster.
Though hundreds of schools nationwide shut their doors when too many of their students and teachers called in sick, the novel flu remained mostly mild. By the end of 2009, some experts predicted that H1N1 would be the mildest pandemic in history — expected to kill an estimated 15,000 people rather than the previously anticipated 45,000.
The fears around pediatric vaccines are not new — some parents of children with autism have blamed preservatives in vaccines for causing their children's disorder, a theory widely disputed by researchers. Some of the pediatric H1N1 vaccines did end up being recalled, but not because of safety concerns: Some shipments lost strength over time. Whether you vaccinated your child for H1N1 or not, this story offers a glimpse into the controversy.
With Obama making teacher accountability one of the central tenets of his "Race to the Top" competition between school districts, it's not surprising that horrendously bad teaching and the bureaucracy that enables it got some serious attention. And nothing embodies execrable educational standards more than the "rubber room," New York City's hang-out-and-get-paid zone for teachers accused of serious offenses but whose tenure largely protects them. This New Yorker piece shined a spotlight on the jaw-dropping absurdity of teachers getting paid to do nothing; not surprisingly, it also garnered a flood of criticism from teacher pundits. Thanks to a group of enterprising muckrakers, a documentary film is in the works.
Many other school districts (like Los Angeles's and San Francisco's) pay teachers awaiting misconduct hearings to bide their time, though not necessarily in a single holding tank. Wondering what happens to censured educators in your district? You can ask if it has a "temporary reassignment center" or some other program for those accused of wrongdoing.


text:
HONOLULU (AP) - President Barack Obama started Tuesday with an early-morning workout at Marine Corps Base Hawaii in Kaneohe, near his vacation home.
Other gym users said the president lifted weights, shot hoops, stretched and said hello to others there.
Kyrstin Lavelle, 10, of Toronto, was at the gym with her older brother and uncle. She got an autograph from the president. "I'm going to text my friends back home," Kyrstin said. Kyrstin said she also gave Obama a flower, and he said he would give it to first lady Michelle Obama.
Obama later returned to the base to play golf - his third round in four days and second on the base.
First lady Michelle Obama spent about 30 minutes speaking with children tracking the progress of Santa Claus across the world with the North American Aerospace Defense Command.
The agency's NORAD Tracks Santa program takes calls each Christmas from children wanting to ensure that their presents are on track for timely delivery. It's the fourth year that the first lady has taken part in the tradition.


text:
Best route map between Tulsa, OK and Stringtown, OK. This route take about 124 Miles.
The distance and estimated time is placed on the right depending on the status of the road.
, 17:31
* You can see Tulsa, OK and Stringtown, OK photos above. We provide this photos from Google Panoramio service.
* Tulsa, OK weather as celsius: °C
* Stringtown, OK weather as celsius: °C
* Weather information on route, provide by Open Weather Map.
All Rights Reserved. © 2010 - 2016 About Feedback


text:
Naomi Radcliff had been coughing for a year and a half when her doctor referred her to an ear, nose and throat specialist in February.
Both her primary care doctor and the specialist are employed by Medical University Hospital, where Radcliff has been a patient for 17 years, so she was confused when the hospital billed her Medicare plan $326 for a new patient appointment.
"All of my info the last 17 years was already in MUSC's computers," she wrote in a letter to the hospital's billing department on March 7. "(The doctor) merely had to pull up my patient info on her office computer."
But Radcliff's complaints with the hospital bill don't end with the new patient fee.
The hospital also charged Medicare $1,239 for her "laryngoscopy w/stroboscopy," (a throat exam), $312 to remove four hairs from her ear canal and $81 for a "binocular microscopy," (an ear exam).
The total bill for the Feb. 11 appointment was $1,958, according to a copy that Radcliff, 66, a Charleston resident, provided to The Post and Courier.
"They're not just gouging me, they're gouging Medicare," she said. "It's ridiculous."
The problem is not a new one, but as more consumers pay a larger portion of their medical bills, transparency about medical expenses has become a national issue. A report issued Tuesday by the Health Care Incentives Improvement Institute and Catalyst for Payment Reform gave South Carolina, and all but five states an "F" on billing transparency. None received an "A."
The problem is not only what charges are made to the patient but also the responsiveness of hospital billing departments.
For instance, Radcliff has not received a reply from the hospital's billing department yet. MUSC spokeswoman Heather Woolwine acknowledged that the institution's structure can be confusing for patients because the hospital, the university and the physicians' group operate as separate entities. That may explain why an existing MUSC patient would be considered a new patient by another MUSC doctor, Woolwine said.
Also, she said new patient appointments are longer than normal appointments, so they cost more.
"Even though you may be with a primary care physician, when you see a specialist, you are a new patient for that physician, hence the new patient charge," Woolwine said.
To further confuse the issue, the hospital and doctors often send separate bills for the same appointment, although this is a process that MUSC will start streamlining on July 1, she said.
"It's a bit much," Radcliff complained.
Health policy experts acknowledge that patients like Radcliff shouldn't be surprised by charges on their hospital bills, but this isn't a problem unique to Medical University Hospital.
"You go back in the industry, even a few years ago ... most people didn't really care or want to or need to know what the pricing was because they weren't paying the lion's share of the bill," said Jeff Lehrich, CEO of Palmetto Primary Care Physicians.
Lehrich's practice will publish prices for tests and procedures on its website starting next year, he said. "It's becoming much more like retail for the health care services."
He said health care consumers, particularly patients with high-deductible insurance plans who pay a significant percentage of their bills out-of-pocket, want to know up front what they'll be charged.
"I think we have miles to go on this front," said Jim Ritchie, executive director of the S.C. Alliance of Health Plans.
On the report, South Carolina received an "F" for health care price transparency in part because some of the initiatives in the state that would improve the problem have yet to come online.
MUSC, for example, has a transparency task force - but S.C. Hospital Association President Thorton Kirby said he was not sure that any hospitals in South Carolina post a comprehensive list of prices for consumers, although there may be some that publish prices for select services, he said.
South Carolina doesn't have an "All-Payer Claims Database," either, which is widely considered the gold standard for health care price transparency, but a new website called SCHealthData.org promises to provide prices for many common hospital procedures in the future. The S.C. Department of Health and Human Services and the South Carolina Hospital Association collaborated on this project, although none of the hospital prices have been published yet.
"We know there is a need in the marketplace for this information," Kirby said.
DHHS Deputy Director John Supra said consumers will be able to see information about the prices Medicaid pays for common hospital procedures on the website by the end of April.
"I think (SCHealthData.org) is a good first step," said Ritchie, with the S.C. Alliance of Health Plans. "I think the test will be how user-friendly it is and how comprehensive the data is. If you can't access it and understand it, it will have limited value."
Reach Lauren Sausser at 937-5598.


text:
Star Tracks: Monday, May 16, 2016 42 years, 2,191 covers and 55,436 stories from PEOPLE magazine's history for you to enjoy
Latest News!
- WATCH: First Lady Michelle Obama Says She's 'Straight Up Nailing' Her Job on Resume in College Humor Skit
- Read the Cover Story: Brad & Angelina Split After 12 Years: It's Over
- Refugee Killed by California Police Allegedly Drew Vape Device During 'Mental Emergency'
- Golden Girls Kim and Kourtney Kardashian Wow In Second Barely-There Balmain Outfits
- Blac Chyna Says She Posted Rob Kardashian's Phone Number on Twitter to Stop Him Texting Other Women
People Top 5
LAST UPDATE: Tuesday February 10, 2015 01:10PM EST
PEOPLE Top 5 are the most-viewed stories on the site over the past three days, updated every 60 minutes
- April 24, 2006
- Vol. 65
- No. 16
Picks and Pans Main: TV
Me and My Remote
Huff, now in its second season, is about the tumultuous life of an L.A. psychiatrist (Hank Azaria), so naturally it's crammed with articulate people endlessly explicating each other's failings. Ids, egos and superegos slam around like sumo wrestlers in an elevator. But with alcoholism, schizophrenia, cancer, out-of-wedlock pregnancy, speed freaks and infidelity piled on, it feels less like Freud's fun house than an opportunity for one performer after another to launch into frenzied, vituperative speeches. Clear the decks—monologue time!
That even goes for Blythe Danner, a great actress who won an Emmy last season as Huff's mother, a fragile yet combative martini-swiller. Her single best moment here comes when she does nothing more than stroke a houseplant. Such a relief. Oliver Platt, as a lawyer who parties way too hard, cuts through the sweaty pathos with humor, but the only true calm comes with Anjelica Huston: She's a therapist who puts Huff on a drug course to help him break through his midlife crises. Huston gives an understated performance that still manages to show off her toughness and sly sexiness. Otherwise it's Huff and puff.
TLC (Mondays, 9 p.m. ET)
Nutritionist Lisa Hark summons the parents of three disastrously out-of-shape boys and yells at them, "You're killing your kids!" She shows them computer-rendered portraits of the boys grown up on their horrible diets: They look like those Chuck Close paintings of middle-aged men in gruesome, open-pored closeup. Stark then puts the family on a corrective course that includes tofu at dinner. The kids don't like her, and no wonder. Hark can be a stressful presence, even though her goals are 100 percent correct. Any family would be glad to see her go and leave them to eat their transfats in peace.
The WB (Tuesdays, 9 p.m. ET)
Rebecca Romijn soon will be back on movie screens in another X-Men movie, playing supermutant Mystique and wearing the blue, spangly body makeup that makes her look like a Vegas showgirl costumed as a mechanical nightingale. In her new WB series, she's a more recognizable being, a super-ambitious newswoman named Pepper Dennis. Pepper runs around Chicago with her blonde hair pulled back and her curves concealed within a white raincoat. She's erotic but cold-looking, like a behavioral scientist who makes men run through mazes.
The show is just as bad as several other recent WB shows (Modern Men, The Bedford Diaries), neither cartoonish enough nor realistic enough to register as anything more than a conceptual shell with a handful of dried peas rattling inside. Pepper chases stories, Pepper falls in love with the new station anchor, Pepper sometimes lets her blonde hair fall down in soft attractive ringlets. Romijn does a star-glamour turn here. The better performance, actually, is from Brooke Burns as her cute twittish sister. Burns seems to be trying a variation on the old Mary Tyler Moore winsome adorableness, and it nearly works.
ABC (Mondays, 10 p.m. ET)
That question is asked of Brian, a thirtysomething who remains single while the rest of his circle of friends are becoming engaged, settling down, getting married, having kids and—once the comforting glow of commitment wears off and the worm of boredom wriggles in—thinking about messing around. Brian's problem, at least at the outset, is that he's in love with Marjorie, a pediatric surgeon, but she's going to marry his buddy Adam, a successful lawyer.
This is all nicely produced with mild offbeat tweaks along the way—Brian and one girlfriend break up driving on the freeway while a mattress is coming unstrapped from the roof—and Barry Watson (7th Heaven) has the right physical quality as Brian: good-looking, with the eyes haunted by caffeine. But none of this is original either. The networks should create some sort of central dating registry for all their eligible youngish characters and clean up some of this vague, messy trafficking in hearts. What about it, Brian?
Celebrity Cooking Showdown (NBC, April 17, 9 p.m. ET) Sean Combs is one of the producers of this weeklong reality show with Patti LaBelle, Cindy Margolis and Big Kenny in the kitchen.
Love Monkey (VH1, Tuesdays, 9 p.m. ET) The short-lived but intriguing CBS series—with Tom Cavanagh as a cool New York City dude—gets to finish its eight-episode run, only on a different channel.
Desperate Housewives (ABC, April 16, 9 p.m. ET) Carol Burnett visits as the icy stepmother of Bree (Marcia Cross).
Miss USA (NBC, April 21, 9 p.m. ET) Why care? Because the cohost is Drew Lachey, winner of Dancing with the Stars, that's why.
The New Adventures of Old Christine (CBS, April 17, 9:30 p.m. ET) Andy Richter shows up again as Julia Louis-Dreyfus's pathetic one-night stand, a.k.a. "Sad Dad."
Author and self-described spiritual intuitive Char Margolis, 54, displays her clairvoyant ways on the Sci Fi Channel reality show Psychic at Large. The soothsayer shares some predictions on ripped-from-the-headlines news and tells PEOPLE all about her sixth sense.
I don't know if they will ever find any evidence of the body.... People know what happened, and they are covering up. The saddest cases are when a child goes missing or dies and the parents [never] know what happened.
The most important thing I can share is that other people also have the gift of intuition and they can act on it to save their lives.
It's difficult for me to date. Some men don't want their private lives exposed to the public because they are dating someone on TV, but my feeling is: for the right man, that won't matter.
Very peacefully. I can turn it on and off unless I have to know something.
THE RYAN WATCH I was excited by Ryan Seacrest taking the coanchor job on E! News—where he also has an executive producer title—and yet the disappointment can't be denied. The set looks dinky and cheap, a few plasma screens and a scrim of slender colored panels. This, I say, is not much of a showcase for the man who announces American Idol. E! is giving Seacrest a slot to do longer celeb interviews (first up: Eva Longoria on April 17), and maybe that'll help. Or he and coanchor Giuliana DePandi can have a go at the kind of playful catfighting he does with Simon Cowell back on Idol.
PROBLEM CHILD A British commentator once complained that the Brits, after years of impressing Americans with shows like Masterpiece Theatre, had begun to dumb down U.S. television with reality exports (including Idol). Well, bring it on, U.K.! An upcoming BBC1 show, A Problem Called Maria, will conduct an Idol-style search to find an actress to play the Julie Andrews part in Andrew Lloyd Webber's stage revival of The Sound of Music. Can't you just picture Kelly Clarkson yodeling "The Lonely Goatherd"?
More in the Archive
Today's Photos
Treat Yourself! 4 Preview Issues
The most buzzed about stars this minute!


text:
If you need immediate assistance, call 877-SSRNHelp (877 777 6435) in the United States, or +1 585 442 8170 outside of the United States, 8:30AM to 6:00PM U.S. Eastern, Monday - Friday.
strategic customer behavior, newsvendor, rational expectations, commitment, supply chains, decentralization
dynamic pricing, inter-temporal substitution, durable goods monopoly, heterogeneity, rationing
bounded rationality, newsvendor, logit choice, random utility, supply chain, bullwhip effect, inventory, pooling
consumer returns, supply chain, strategic customers, valuation uncertainty, newsvendor, contracting
dynamic pricing, speculation, resale, strategic customer behavior, competition
dynamic pricing, stockpiling, consumer inventory, promotions, rational expectations, price discrimination
inertia, prospect theory, loss aversion, probability weighting, hyperbolic discounting, behavioral decision-making, dynamic pricing, strategic customer behavior
availability guarantee, commitment, product availability, search costs, stockouts, newsvendor, rational expectations
service operations, restaurants, reservations, queues, advance selling
social comparison, peer-induced fairness, distributional fairness, behavioral economics, experimental economics
social comparisons, reference points, behavioral operations, non-cooperative game theory
bounded rationality, capacity allocation, supply chain, quantal response equilibrium, Nash equilibrium
Consumer Decisions, Retrials, Queueing Games, Equilibrium versus Social Optimum
Distributional Fairness, Peer-induced Fairness, Supply Chain Contracting, Behavioral Operations Management, Behavioral Economics
Level-k Models, Learning, Sequential Games, Backward Induction, Behavioral Game Theory
complete information, rational expectations, game theory, inventory, behavioral operations management
Empirical Operations, Location, Scheduling, Retailing, Machine Learning, Optimization
retail operations, strategic consumer behavior, inventory availability, product value uncertainty, omnichannel
retail operations, omnichannel, strategic consumer behavior, decentralization
© 2016 Social Science Electronic Publishing, Inc. All Rights Reserved.
Terms of Use
Privacy Policy
Contact Us
This page was processed by apollobot1 in 0.297 seconds


text:
CoffeeCup Responsive Design Pack Giveaway
Our friends at CoffeeCup are giving away a Responsive Design Pack for FREE (a total value of $1500) to FIVE very lucky designers! Featuring their top eight apps, the Responsive Design Pack is perfect for visually designing stunning websites, show-stopping photo displays, fully functional web forms, and money-making newsletters. The pack is also loaded with a ton of customizable responsive themes. With drag-n-drop interfaces…
LG UltraWide™ Festival – $10k Dream Canvas Prize
Our environment affects so many aspects of our day-to-day life. For designers, overall productivity and the creative process can be heavily swayed by their workstation. Similar to painters of the past, who needed a brush and canvas to create their masterpieces, designers in the digital age need the right tools to bring their visions to life….
Launch Your Own Web Studio in 61 Days!
You know what? We have got a bit of great news for you. In fact, it's just something sensational. We have been planning for this day carefully, and finally this day has come. TemplateMonster welcomes everyone who wants to change their life for better to join our Marathon, called "Your Own Web Studio in 61 Days"….
Placing a Video Within a Circle in Adobe Muse
Place a Video within a Circle in Adobe Muse. No Coding Skills Required. In this tutorial I will go over how to place a video within a circle in Adobe Muse using the Ultimate Video Widget 2.0 found at http://museforyoushop.com. We will also be using Adobe Photoshop to create the transparent circle. Adding the Video…
A Few Things Web Designers Can Learn From Hillary Clinton
The US presidential election is right around the corner. While some candidates are leveraging their eccentric personality and their bold attitudes to gain followers, and yes, I'm talking to you Mr. Trump, some of them invest massively in their online presence.
Draw Letter 'S' Symbol in Adobe XD
In this tutorial, we're going to learn how to design a letter 'S' symbol in Adobe XD. The Steps (1-11) 1. Create a New Artboard. 2. Select the Ellipse Tool and hold Shift to draw a circle. Give this circle a black Fill, with no border, and set the Width and Height to 300px. 3….
Mozello: A Website Builder For Creating Amazing Sites
Due to the ever-increasing reach of the internet, having an online presence or website for your business is no longer a luxury but a necessity. Now, not everyone can code and deploy websites. Similarly, hiring web developers or design agencies too might be overkill and beyond the budget of many folks. If this is the…
Animating a Moving Car in Adobe Muse
Animating a Moving Car in Adobe Muse. No Coding Skills Required. In this tutorial I will go over how to animate a moving car in Adobe Muse using the Muse Motion 2 Widget found at http://museforyoushop.com. We will also be using Adobe Illustrator. 1. Open the car vector in Adobe Illustrator. 2. Copy and paste the…
20 Clean & Crisp Pre-Built Websites for Small Businesses
Building a presentation website for a small business is a popular activity for many web designers; and the same might also be true for you. Small business websites need to be clean, crisp, and loaded with personality; giving you the opportunity to demonstrate your design skills in the best possible light. While every small business…