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Chiropractors and osteopaths have long tried to convince us that spinal manipulation and mobilisation are the best we can do when suffering from neck pain. But is this claim based on good evidence?
This recent update of a Cochrane review was aimed at assessing the effects of manipulation or mobilisation alone compared with those of an inactive control or another active treatment on pain, function, disability, patient satisfaction, quality of life and global perceived effect in adults experiencing neck pain with or without radicular symptoms and cervicogenic headache (CGH) at immediate- to long-term follow-up, and when appropriate, to assess the influence of treatment characteristics (i.e. technique, dosage), methodological quality, symptom duration and subtypes of neck disorder on treatment outcomes.
Review authors searched the following computerised databases to November 2014 to identify additional studies: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). They also searched ClinicalTrials.gov, checked references, searched citations and contacted study authors to find relevant studies.
Randomised controlled trials (RCTs) undertaken to assess whether manipulation or mobilisation improves clinical outcomes for adults with acute/subacute/chronic neck pain were included in this assessment.
Two review authors independently selected studies, abstracted data, assessed risk of bias and applied Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods (very low, low, moderate, high quality). The authors calculated pooled risk ratios (RRs) and standardised mean differences (SMDs).
Fifty-one trials with a total of 2920 participants could be included. The findings are diverse. Cervical manipulation versus inactive control: For subacute and chronic neck pain, a single manipulation (three trials, no meta-analysis, 154 participants, ranged from very low to low quality) relieved pain at immediate- but not short-term follow-up. Cervical manipulation versus another active treatment: For acute and chronic neck pain, multiple sessions of cervical manipulation (two trials, 446 participants, ranged from moderate to high quality) produced similar changes in pain, function, quality of life (QoL), global perceived effect (GPE) and patient satisfaction when compared with multiple sessions of cervical mobilisation at immediate-, short- and intermediate-term follow-up. For acute and subacute neck pain, multiple sessions of cervical manipulation were more effective than certain medications in improving pain and function at immediate- (one trial, 182 participants, moderate quality) and long-term follow-up (one trial, 181 participants, moderate quality). These findings are consistent for function at intermediate-term follow-up (one trial, 182 participants, moderate quality). For chronic CGH, multiple sessions of cervical manipulation (two trials, 125 participants, low quality) may be more effective than massage in improving pain and function at short/intermediate-term follow-up. Multiple sessions of cervical manipulation (one trial, 65 participants, very low quality) may be favoured over transcutaneous electrical nerve stimulation (TENS) for pain reduction at short-term follow-up. For acute neck pain, multiple sessions of cervical manipulation (one trial, 20 participants, very low quality) may be more effective than thoracic manipulation in improving pain and function at short/intermediate-term follow-up. Thoracic manipulation versus inactive control: Three trials (150 participants) using a single session were assessed at immediate-, short- and intermediate-term follow-up. At short-term follow-up, manipulation improved pain in participants with acute and subacute neck pain (five trials, 346 participants, moderate quality, pooled SMD -1.26, 95% confidence interval (CI) -1.86 to -0.66) and improved function (four trials, 258 participants, moderate quality, pooled SMD -1.40, 95% CI -2.24 to -0.55) in participants with acute and chronic neck pain. A funnel plot of these data suggests publication bias. These findings were consistent at intermediate follow-up for pain/function/quality of life (one trial, 111 participants, low quality). Thoracic manipulation versus another active treatment: No studies provided sufficient data for statistical analyses. A single session of thoracic manipulation (one trial, 100 participants, moderate quality) was comparable with thoracic mobilisation for pain relief at immediate-term follow-up for chronic neck pain. Mobilisation versus inactive control: Mobilisation as a stand-alone intervention (two trials, 57 participants, ranged from very low to low quality) may not reduce pain more than an inactive control. Mobilisation versus another active treatment: For acute and subacute neck pain, anterior-posterior mobilisation (one trial, 95 participants, very low quality) may favour pain reduction over rotatory or transverse mobilisations at immediate-term follow-up. For chronic CGH with temporomandibular joint (TMJ) dysfunction, multiple sessions of TMJ manual therapy (one trial, 38 participants, very low quality) may be more effective than cervical mobilisation in improving pain/function at immediate- and intermediate-term follow-up. For subacute and chronic neck pain, cervical mobilisation alone (four trials, 165 participants, ranged from low to very low quality) may not be different from ultrasound, TENS, acupuncture and massage in improving pain, function, QoL and participant satisfaction at immediate- and intermediate-term follow-up. Additionally, combining laser with manipulation may be superior to using manipulation or laser alone (one trial, 56 participants, very low quality).
Confused? So am I!
In my view, these analyses show that the quality of most studies is wanting and the evidence is weak – much weaker than chiropractors and osteopaths try to make us believe. It seems to me that no truly effective treatments for neck pain have been discovered and that therefore manipulation/mobilisation techniques are as good or as bad as most other options.
In such a situation, it might be prudent to first investigate the causes of neck pain in greater detail and subsequently determine the optimal therapies for each of them. Neck pain is a SYMPTOM, not a disease! And it is always best to treat the cause of a symptom rather than pretending we know the cause as chiropractors and osteopaths often do.
The authors of the Cochrane review seem to agree with this view at least to some extent. They conclude that although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed. Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.
The call for further research is, of course, of no help for patients who are suffering from neck pain today. What would I recommend to them?
My advice is to be cautious:
- Consult your doctor and try to get a detailed diagnosis.
- See a physiotherapist and ask to be shown exercises aimed at reducing the pain and preventing future episodes.
- Do these exercises regularly, even when you have no pain.
- Make sure you do whatever else might be needed in terms of life-style changes (ergonomic work place, correct sleeping arrangements, etc.).
- If you are keen on seeing an alternative practitioner for manual therapy, consult a osteopath rather than a chiropractor; the former tend to employ techniques which are less risky than the latter.
- Avoid both chiropractors and long-term medication for neck pain.
The aim of this study was to evaluate clinical effectiveness of Alexander Technique lessons or acupuncture versus usual care for persons with chronic, nonspecific neck pain.
Patients with neck pain lasting at least 3 months, a score of at least 28% on the Northwick Park Questionnaire (NPQ) for neck pain and associated disability, and no serious underlying pathology were randomised to receive 12 acupuncture sessions or 20 one-to-one Alexander lessons (both 600 minutes total) plus usual care versus usual care alone. The NPQ score at 0, 3, 6, and 12 months (primary end point) and Chronic Pain Self-Efficacy Scale score, quality of life, and adverse events (secondary outcomes) served as outcome measures. 517 patients were recruited. Their median duration of neck pain was 6 years. Mean attendance was 10 acupuncture sessions and 14 Alexander lessons. Between-group reductions in NPQ score at 12 months versus usual care were 3.92 percentage points for acupuncture (95% CI, 0.97 to 6.87 percentage points) (P = 0.009) and 3.79 percentage points for Alexander lessons (CI, 0.91 to 6.66 percentage points) (P = 0.010). The 12-month reductions in NPQ score from baseline were 32% for acupuncture and 31% for Alexander lessons. Participant self-efficacy improved for both interventions versus usual care at 6 months (P < 0.001) and was significantly associated (P < 0.001) with 12-month NPQ score reductions (acupuncture, 3.34 percentage points [CI, 2.31 to 4.38 percentage points]; Alexander lessons, 3.33 percentage points [CI, 2.22 to 4.44 percentage points]). No reported serious adverse events were considered probably or definitely related to either intervention.
The authors drew the following conclusions: acupuncture sessions and Alexander Technique lessons both led to significant reductions in neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained.
Where to begin? There is much to be criticised about this study!
For starters, the conclusions are factually wrong. They should read "acupuncture sessions plus usual care and Alexander Technique lessons plus usual care both led to significant reductions in neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained.
On this blog, we have repeatedly discussed the 'A+B versus B' study design and the fact that it cannot provide information about cause and effect because it fails to control for placebo effects and the extra attention, time and empathy (for instance here and here). I suspect that this is the reason why it is so very popular in alternative medicine. It can make ineffective therapies appear to be effective.
Another point is a more clinical concern. Neck pain is not a disease, it is a symptom. In medicine we should, whenever possible, try to treat the cause of the underlying condition and not the symptom. Acupuncture is at best a symptomatic treatment. Usual care is often not very effective because we normally fail to see the cause of neck pain. In my view, alternative treatments should either be tested against placebo or sham interventions or against optimal care.
What is optimal care for nonspecific neck pain? As its causes are often unclear and usually multifactorial, the optimal treatment needs to be multifactorial (one could also call it holistic) as well. The causes often range from poor ergometric conditions at work to muscular tension, stress, psychological problems etc. Thus optimal care would be a team work tailor-made for each patient possibly including physiotherapists, pain specialists, clinical psychologists, orthopaedic surgeons etc.
My points here are:
- neither acupuncture nor Alexander technique take account of this complexity,
- they claim to be holistic but, in fact, this turns out to be merely a good sales-slogan,
- usual care is usually no good,
- if pragmatic trials using the 'A+B versus B' design make any sense at all, they should employ not usual care but optimal care for the control group.
In the end, we are left with a study that looks fairly rigorous at first sight, but that really tells us next to nothing (except that dedicating 600 minutes to patients in pain is not without effect). I am truly surprised that a top journal like the Annals of Internal Medicine decided to publish it.
Alternative medicine encompasses many bizarre treatments, but one of the weirdest must be craniosacral therapy (CST). The assumptions underlying CTS are:
- light manual touch of the head moves the joints of the cranium;
- this movement stimulates the flow of the cerebrospinal fluid;
- the enhanced flow has profound and positive effects on human health.
None of these assumptions are supported by evidence. In fact, they are as implausible as assumptions in alternative medicine get.
CST was developed by the osteopath John Upledger, D.O. in the 1970s, as an offshoot osteopathy in the cranial field, or cranial osteopathy, which was developed in the 1930s by William Garner Sutherland. Apart from this confusing terminology, we are also confronted with a confusing array of therapeutic claims; CST seems to be recommended for most conditions.
And the evidence? As good as none!
This is why any new trial is worth a mention. A recent study tested CST in comparison to sham treatment in chronic non-specific neck pain patients. 54 blinded patients were randomized to either 8 weekly units of CST or light touch sham treatment. Outcomes were assessed before and after treatment (week 8) and a further 3 months later (week 20). The primary outcome was pain intensity on a visual analogue scale; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients' global impression of improvement and safety.
In comparison to sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 as well as at week 20. Minimal clinically important differences in pain intensity at week 20 were reported by 78% of the CST patients, while 48% even had substantial clinical benefit. Significant differences at week 8 and 20 were also found for pain on movement, functional disability, physical quality of life and patients' global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8; anxiety only at week 20. No serious adverse events were reported.
The authors from the Department of Internal and Integrative Medicine, University of Duisburg-Essen and the Institute of Integrative Medicine, University of Witten/Herdecke, Germany, concluded that CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and quality of life up to 3 months post intervention.
Oddly, this is not even close to the conclusion I am going to draw: inadequate control for placebo and other non-specific effects generated a false-positive result.
Who is correct?
I suggest we wait for an independent replication to decide.
Some people seem to believe that the field of alternative medicine resembles a quaint little cottage industry where money hardly matters. A new analysis shows how far from the truth this impression is.
In the 2007 US National Health Interview Survey, use of complementary health approaches, reasons for this use, and associated out of pocket (OOP) costs were captured in a nationally representative sample of 5,467 US adults. Ordinary least square regression models that controlled for co-morbid conditions were used to estimate aggregate and per person OOP costs associated with 14 painful health conditions.
The analyses suggest that individuals using complementary approaches spent a total of $14.9 billion OOP on these approaches to manage three painful conditions: arthritis, back pain and fibromyalgia. Around 7.5 billion of that total was spent on consulting practitioners such as chiropractors and acupuncturists. Total OOP expenditures seen in those using complementary approaches for their back pain ($8.7 billion) far outstripped that of any other condition, with the majority of these costs ($4.7 billion) resulting from visits to complementary providers. Annual condition-specific per-person OOP costs varied from a low of $568 for regular headaches, to a high of $895 for fibromyalgia. The total expenditure on complementary medicine was comparable to that on conventional care.
The authors concluded that adults in the United States spent $14.9 billion OOP on complementary health approaches (e.g., acupuncture, chiropractic, herbal medicines) to manage painful conditions including back pain ($8.7 billion). This back pain estimate is almost 1/3rd of total conventional healthcare expenditures for back pain ($30.4 billion) and 2/3rds higher than conventional OOP expenditures ($5.1 billion).
These are truly eye-watering sums. The obvious question is: IS THIS MONEY WELL-SPENT?
The short answer, I fear, is NO!
The alternative therapies in question are not based on compelling evidence in the management of these painful conditions. Some are clearly not better than placebo, and others are apparently supported by some research but its quality is hardly good enough to rely upon.
This level expenditure is both impressive and worrying. It highlights an enormous waste of resources, alerts us to an urgent need for truly rigorous research, and demonstrates how high the stakes really are.
Nonspecific neck pain is extremely common, often disabling, and very costly for us all. If we believe those who earn their money with them, effective treatments for the condition abound. One of these therapies is osteopathy. But does osteopathic manipulation/mobilisation really work?
The objective of a recent review (the link I originally put in here does not work, I will supply a new one as soon as the article becomes available on Medline) was to find out. Specifically, the authors wanted to assess the effectiveness of osteopathic manipulative treatment (OMT) in the management of chronic nonspecific neck pain regarding pain, functional status, and adverse events.
Electronic literature searches unrestricted by language were performed in March 2014. A manual search of reference lists and personal communication with experts identified additional studies. Only randomized clinical trials (RCTs) were included, and studies of specific neck pain or single treatment techniques were excluded. Primary outcomes were pain and functional status, and secondary outcome was adverse events.
Studies were independently reviewed using a standardized data extraction form. Mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated for primary outcomes. GRADE was used to assess quality of the evidence.
Of 299 identified articles, 18 were evaluated and 15 excluded. The three included RCTs had low risk of bias. The results show that moderate-quality evidence suggested OMT had a significant and clinically relevant effect on pain relief (MD: -13.04, 95% CI: -20.64 to -5.44) in chronic nonspecific neck pain, and moderate-quality evidence suggested a non-significant difference in favour of OMT for functional status (SMD: -0.38, 95% CI: -0.88 to -0.11). No serious adverse events were reported.
The authors concluded that, based on the three included studies, the review suggested clinically relevant effects of OMT for reducing pain in patients with chronic nonspecific neck pain. Given the small sample sizes, different comparison groups, and lack of long-term measurements in the few available studies, larger, high-quality randomized controlled trials with robust comparison groups are recommended.
Yet again I am taken aback by several things simultaneously:
- the extreme paucity of RCTs, particularly considering that neck pain is one of the main indication for osteopaths,
- the rather uncritical text by the authors,
- the nonsensical conclusions.
Let me offer my own conclusions which are, I hope, a little more realistic:
GIVEN THE PAUCITY OF THE RCTs AND THEIR SMALL SAMPLE SIZES, IT IS NOT POSSIBLE TO CLAIM THAT OMT FOR NONSPECIFIC NECK PAIN IS AN EVIDENCE-BASED APPROACH
On this blog, we have discussed the Alexander Technique before; it is an educational method promoted for all sorts of conditions, including neck pain. The very first website I found when googling it stated the following: "Back and neck pain can be caused by poor posture. Alexander Technique lessons help you to understand how to improve your posture throughout your daily activities. Many people, even those with herniated disc or pinched nerve, experience relief after one lesson, often permanent relief after five or ten lessons."
Sounds too good to be true? Is there any good evidence?
The aim of this study, a randomized controlled trial with 3 parallel groups, was to test the efficacy of the Alexander Technique, local heat and guided imagery on pain and quality of life in patients with chronic non-specific neck pain. A total of 72 patients (65 females, 40.7±7.9 years) with chronic, non-specific neck pain were recruited. They received 5 sessions of the Alexander Technique, while the control groups were treated with local heat application or guided imagery. All interventions were conducted once a week for 45 minutes each.
The primary outcome measure at week 5 was neck pain intensity quantified on a 100-mm visual analogue scale; secondary outcomes included neck disability, quality of life, satisfaction and safety. The results show no group differences for pain intensity for the Alexander Technique compared to local heat. An exploratory analysis revealed the superiority of the Alexander Technique over guided imagery. Significant group differences in favor of the Alexander Technique were also found for physical quality of life. Adverse events were mild and mainly included slightly increased pain and muscle soreness.
The authors concluded that Alexander Technique was not superior to local heat application in treating chronic non-specific neck pain. It cannot be recommended as routine intervention at this time. Further trials are warranted for conclusive judgment.
I am impressed with these conclusions: this is how results should be interpreted. The primary outcome measure failed to yield a significant effect, and therefore such a negative conclusion is the only one that can be justified. Yet such clear words are an extreme rarity in the realm of alternative medicine. Most researchers in this area would, in my experience, have highlighted the little glimpses of the possibility of a positive effect and concluded that this therapeutic approach may be well worth a try.
In my view, this article is a fine example for demonstrating the difference between true scientists (who aim at testing the effectiveness of interventions) and pseudo-scientists (who aim at promoting their pet therapy). I applaud the authors of this paper!
Neck pain is a common problem which often causes significant disability. Chiropractic manipulation has become one of the most popular forms of alternative treatment for such symptoms. This seems surprising considering that neck manipulations are neither convincingly effective nor free of adverse effects.
The current Cochrane review on this subject could not be clearer: "Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior." In the absence of compelling evidence for efficacy, any risk of neck manipulation would tilt the risk/benefit balance into the negative.
Adverse effects of neck manipulations range from mild symptoms, such as local neck tenderness or stiffness, to more severe injuries involving the spinal cord, peripheral nerve roots, and arteries within the neck. A recent paper reminds us that another serious complication has to be added to this already long list: phrenic nerve injury.
The phrenic nerve is responsible for controlling the contractions of the diaphragm, which allows the lungs to take in and release air and make us breathe properly. The phrenic nerve is formed from C3, C4, and C5 nerve fibres and descends along the anterior surface of the scalenus anterior muscle before entering the thorax to supply motor and sensory input to the diaphragm. Its anatomic location in the neck leaves it vulnerable to traumatic injury. Phrenic nerve injury can result in paralysis of the diaphragm and often leads to deteriorating function of the diaphragm, which can lead to partial or complete paralysis of the muscle and, as a result, serious breathing problems.
Patients who experience such problems may require emergency medical treatment or surgery. Sudden, severe damage to the phrenic nerve can make it impossible for the diaphragm to contract on its own. In order to make sure that the patient can breathe, a breathing tube needs to be inserted, a process called intubation. Artificial respiration would then be required.
American neurologists published a case report of a healthy man who consulted a chiropractor for his neck pain. Predictably, the chiropractor employed cervical manipulation to treat this condition. The result was bilateral diaphragmatic paralysis.
Similar cases have been reported previously, for instance, here and here and here and here. Damage to other nerves has also been documented to be a possible complication of spinal manipulation, for instance, here and here.
The authors of this new case report conclude that physicians must be aware of this complication and should be cautious when recommending spinal manipulation for the treatment of neck pain, especially in the presence of preexisting degenerative disease of the cervical spine.
I know what my chiropractic friends will respond to this post:
- I am alarmist,
- I cherry-pick articles that are negative for their profession,
- these cases are extreme rarities,
- conventional medicine is much more dangerous.
To this I reply: Imagine a conventional therapy about which the current Cochrane review says that it has no proven effect for the condition in question. Imagine further that this therapy causes mild to moderate adverse effects in about 50% of all patients in addition to very dramatic complications which are probably rare but, as no monitoring system exists, of unknown frequency. Imagine now that the professionals using this treatment more regularly than any other clinicians steadfastly deny that the risk/benefit balance is way out of kilter.
Would you call someone who repeatedly tries to warn the public of this situation 'alarmist'?
Would you not consider the professionals who continue to practice the therapy in question to be irresponsible?
Iyengar Yoga, named after and developed by B. K. S. Iyengar, is a form of Hatha Yoga that has an emphasis on detail, precision and alignment in the performance of posture (asana) and breath control (pranayama). The development of strength, mobility and stability is gained through the asanas.
B.K.S. Iyengar has systematised over 200 classical yoga poses and 14 different types of Pranayama (with variations of many of them) ranging from the basic to advanced. This helps ensure that students progress gradually by moving from simple poses to more complex ones and develop their mind, body and spirit step by step.
Iyengar Yoga often makes use of props, such as belts, blocks, and blankets, as aids in performing asanas (postures). The props enable students to perform the asanas correctly, minimising the risk of injury or strain, and making the postures accessible to both young and old.
Sounds interesting? But does it work?
The objective of this recent systematic review was to conduct a systematic review of the existing research on Iyengar yoga for relieving back and neck pain. The authors conducted extensive literature searches and found 6 RCTs that met the inclusion criteria.
The difference between the groups on the post-intervention pain or functional disability intensity assessment was, in all 6 studies, favouring the yoga group, which projected a decrease in back and neck pain.
The authors concluded that Iyengar yoga is an effective means for both back and neck pain in comparison to control groups. This systematic review found strong evidence for short-term effectiveness, but little evidence for long-term effectiveness of yoga for chronic spine pain in the patient-centered outcomes.
So, if we can trust this evidence (I would not call the evidence 'strong), we have yet another treatment that might be effective for acute back and neck pain. The trouble, I fear, is not that we have too few such treatments, the trouble seems to be that we have too many of them. They all seem similarly effective, and I cannot help but wonder whether, in fact, they are all similarly ineffective.
Regardless of the answer to this troubling question, I feel the need to re-state what I have written many times before: FOR A CONDITION WITH A MULTITUDE OF ALLEGEDLY EFFECTIVE THERAPIES, IT MIGHT BE BEST TO CHOSE THE ONE THAT IS SAFEST AND CHEAPEST.
The very first article on a subject related to alternative medicine with a 2015 date that I came across is a case-report. I am afraid it will not delight our chiropractic friends who tend to deny that their main therapy can cause serious problems.
In this paper, US doctors tell the story of a young woman who developed headache, vomiting, diplopia, dizziness, and ataxia following a neck manipulation by her chiropractor. A computed tomography scan of the head was ordered and it revealed an infarct in the inferior half of the left cerebellar hemisphere and compression of the fourth ventricle causing moderately severe, acute obstructive hydrocephalus. Magnetic resonance angiography showed severe narrowing and low flow in the intracranial segment of the left distal vertebral artery. The patient was treated with mannitol and a ventriculostomy. Following these interventions, she made an excellent functional recovery.
The authors of the case-report draw the following conclusions: This report illustrates the potential hazards associated with neck trauma, including chiropractic manipulation. The vertebral arteries are at risk for aneurysm formation and/or dissection, which can cause acute stroke.
I can already hear the counter-arguments: this is not evidence, it's an anecdote; the evidence from the Cassidy study shows there is no such risk!
Indeed the Cassidy study concluded that vertebral artery accident (VBA) stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and primary care physician visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care. That, of course, was what chiropractors longed to hear (and it is the main basis for their denial of risk) – so much so that Cassidy et al published the same results a second time (most experts feel that this is a violation of publication ethics).
But repeating arguments does not make them more true. What we should not forget is that the Cassidy study was but one of several case-control studies investigating this subject. And the totality of all such studies does not deny an association between neck manipulation and stroke.
Much more important is the fact that a re-analysis of the Cassidy data found that prior studies grossly misclassified cases of cervical dissection and mistakenly dismissed a causal association with manipulation. The authors of this new paper found a classification error of cases by Cassidy et al and they re-analysed the Cassidy data, which reported no association between spinal manipulation and cervical artery dissection (odds ratio [OR] 5 1.12, 95% CI .77-1.63). These re-calculated results reveal an odds ratio of 2.15 (95% CI.98-4.69). For patients less than 45 years of age, the OR was 6.91 (95% CI 2.59-13.74). The authors of the re-analysis conclude as follows: If our estimates of case misclassification are applicable outside the VA population, ORs for the association between SMT exposure and CAD are likely to be higher than those reported using the Rothwell/Cassidy strategy, particularly among younger populations. Future epidemiologic studies of this association should prioritize the accurate classification of cases and SMT exposure.
I think they are correct; but my conclusion of all this would be more pragmatic and much simpler: UNTIL WE HAVE CONVINCING EVIDENCE TO THE CONTRARY, WE HAVE TO ASSUME THAT CHIROPRACTIC NECK MANIPULATION CAN CAUSE A STROKE.
Some chiropractors claim that their main intervention, spinal manipulation, works for nonspecific neck pain by improving inter-vertebral range of motion (IV-RoM). But IV-RoM is difficult to measure, and whether it is related to clinical outcomes seems uncertain. Researchers from the Institute of Musculoskeletal Research & Clinical Implementation and the Anglo-European College of Chiropractic have just published a study that might throw some light on this issue. According to its authors, it was aimed at answering the following research questions:
- Does cervical spine flexion and extension IV-RoM increase after a course of spinal manipulation?
- Is there a relationships between any IV-RoM increases and clinical outcomes?
- How does palpation compare with objective measurement in the detection of hypo-mobile segments?
Thirty patients with nonspecific neck pain and 30 healthy controls matched for age and gender received quantitative fluoroscopy (QF) screenings to measure flexion and extension IV-RoM (C1-C6) at baseline and 4-week follow-up. Patients received up to 12 neck manipulations and completed NRS, NDI and Euroqol 5D-5L at baseline, plus PGIC and satisfaction questionnaires at follow-up. IV-RoM accuracy, repeatability and hypo-mobility cut-offs were determined. Minimal detectable changes (MDC) over 4 weeks were calculated from controls. Patients and control IV-RoMs were compared at baseline as well as changes in patients over 4 weeks. Correlations between outcomes and the number of manipulations received and the agreement (Kappa) between palpated and QF-detected of hypo-mobile segments were calculated.
QF had high accuracy (worst RMS error 0.5σ) and repeatability (highest SEM 1.1σ, lowest ICC 0.9σ) for IV-RoM measurement. Hypo-mobility cut offs ranged from 0.8σ to 3.5σ. No outcome was significantly correlated with increased IV-RoM above MDC and there was no significant difference between the number of hypo-mobile segments in patients and controls at baseline or significant increases in IV-RoMs in patients. However, there was a modest and significant correlation between the number of manipulations received and the number of levels and directions whose IV-RoM increased beyond MDC (Rho=0.39, p=0.043). There was also no agreement between palpation and QF in identifying hypo-mobile segments (Kappa 0.04-0.06).
The authors concluded that this study found no differences in cervical sagittal IV-RoM between patients with non-specific neck pain and matched controls. There was a modest dose-response relationship between the number of manipulations given and number of levels increasing IV-RoM – providing evidence that neck manipulation has a mechanical effect at segmental levels. However, patient-reported outcomes were not related to this.
This conclusion seems a little odd to me. In my view the study suggests a clearly negative answer to all the three research questions formulated above. An interesting paragraph from the authors' discussion section provides further insight: The lack of a relationship between symptomatic improvement and increased IV-RoM is also of interest. Clearly other mechanisms that improved the comfort and functional capacity of the patients in this study were in play, including spontaneous recovery. Other important biological factors may have included chemical factors in joint and muscle and activation patterns in the latter. However, this study seemed to rule out central pain hypersensitivity as a factor, as this was not detected at baseline in any of the patients. Psychological and social factors and their influence on functional behavior may also have had a role and may have been influenced by the interventions received.
So, spinal manipulation does not seem to work by improving IV-RoM. Could this be because spinal manipulation does not work at all?


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Just starting your Walla Walla self storage search? There are a few things you should know. The pricing and availability of storage units in Walla Walla will depend on several factors such as the real estate climate, the number of people moving into or throughout the area, housing conditions in the city, and the general wealth and prosperity of the area. In order to give you a better idea of these factors in Walla Walla, we pulled in data from the US Census.
Many people use storage as part of their move, so if there are many people moving to Walla Walla, you might expect storage prices to be higher and unit availability to be lower. We can get a good idea of whether or not many people are moving to or from Walla Walla by looking at the change in population. The US Census tells us that the metro area population of Walla Walla grew from 31,793 in 2010 to 31,910 in 2014, which is a rate of 0.37% growth over four years.
Vacancy and occupancy rates in the Walla Walla housing market can help us gauge the demand for living space and thus self-storage space in Walla Walla, and may hint at storage availability and pricing. Low rates of vacancy in Walla Walla housing could indicate that real estate is in short supply. Self storage units in Walla Walla may then also be in short supply, which means Walla Walla storage unit prices may be higher. Walla Walla is estimated to have a 92.2% housing occupancy rate, while the vacancy rate is at 7.8%. The average occupancy rate in US cities is 89%, so it's likely the case that storage facilities in Walla Walla also have higher than average occupancy rates. High occupancy rates in Walla Walla will make it more difficult to find a good deal on a storage unit.
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subset: commoncrawl


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Up until just a few months ago I was stuck in a "we aren't living here forever" decorating rut in my home. We were not planning on making this our forever home because we had already started the process of building another. We had a contract to build in a neighborhood we loved contingent on the sale of our current home. After months of our home being on the market, money spent, switching realtors and many showings with our best efforts to sale our home, we decided we would rather stay and find Read More... {Read More...}
Disney on Ice Let's Celebrate Phoenix Review
I am a Feld Family ambassador and have received complimentary tickets in exchange for sharing information and my opinion about this event. My family attended the opening night of Disney On Ice Let's Celebrate in Phoenix. As expected, the show was fantastic and my daughter loved every minute seeing her favorite Disney characters perform! The show includes many iconic characters and scenes from classic Disney movies. The dancing brooms were one of my favorite performances of the Read More... {Read More...}
Turn holiday cash gifts into a college savings plan
Being a parent gives you the opportunity to watch your child grow and be proud of their accomplishments. That opportunity also comes with a great responsibility to provide. My husband and I have already taken steps to start a savings plan for our daughter but with a second baby on the way, the significance of starting early has increased. As part of a sponsored campaign by Find Your Influence and AZ529, I'm sharing how we've turned holiday cash gifts into a college savings Read More... {Read More...}
Fun with friends #PHXMomcation
Every mom deserves a break. Whether you are working outside of your home, from home, or just being mom, motherhood is not easy. Last weekend I went on a little mommy break with close friends. I was home less than 24 hours later and felt completely refreshed. Our #PHXMomcation is just what I needed. We dined at the True Food Kitchen, stayed over at a Pointe Hilton Squaw Peak resort casita, then had breakfast at the resort's Rico's restaurant. Our casita at the Pointe Hilton Squaw Peak Read More... {Read More...}
Get your kids active with a LeapFrog LeapBand virtual pet
I received free products in order to host the LeapFrog and CLIF Kid sponsored MommyParty. All opinions and ideas are my own. We celebrated Fit Made Fun Day September 6th by getting active with the new LeapFrog LeapBand and sharing healthy snacks, CLIF Kids Zbar Protein. The Fit Made Fun celebration was to inspire kids everywhere to get up and active. The new LeapBand is an excellent way to encourage active play while making fitness fun. The new LeapFrog Read More... {Read More...}
Disney movie themed after school snack ideas
Check out Disney movie themed after school snack recipes by Brie Brie Blooms at Foodie.com My daughter has always been a picky eater but she will never turn down a fun Disney movie themed snack. I've seen so many cute Disney desserts lately but I was on a mission to find some healthier after school snack ideas. With recipes featuring characters from FROZEN, Muppets Most Wanted, The Pirate Fairy, and more I created a great Foodie collection of Disney movie themed after school Read More... {Read More...}


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Official Website of the Fannin County Chamber of Commerce and
Welcome Center
Phone - (706) 632-5680
Toll-free (800) 899-MTNS (6867)
Fannin County Chamber of Commerce
Business Directory
Community & Southern Bank (CSB)
150 Orvin Lance Connector
Blue Ridge, GA, 30513
706-258-4000; Fax: 706-258-4001
Ruth Jordan
Contact by e-mail
Visit their website
CSB is an innovative, community bank offering an array of products and services for a diverse banking audience.
We create products and services based upon the ever-growing banking needs of our clients. We are committed to delivering unparalleled service.


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Fidelity keeps its options open
Fidelity Investments is set to open a state-of-the-art data center in Nebraska based on a design it has been working on for five years. Fidelity aims to use as much open source code and standardized Open Compute hardware as possible in its data center, along with its own proprietary "Click to Compute" server orchestration and management system.
As an early member of Facebook's Open Compute Project, Fidelity is hoping to see competing suppliers produce servers for a networked, rack-based hardware platform that encourages rapid cycles of innovation. As part of a highly regulated industry, it also wants a data center that it owns and manages and in which it retains company data.
The data center, slated to open in September, implements the Centercore design Fidelity has been working on since 2009, as it settled on the right blend of elements for a leading financial services company. Its intention is to capture the elasticity of "hyperscale" data centers built by the likes of Google and Amazon, says Eric Wells, Fidelity's VP of data center services. "It's a very open design that can evolve as we decide to add capacity in the future."
What's different
In the previous generation of Fidelity data centers, Wells says, "We found a lot of stranded power and IT capacity, where the infrastructure couldn't take full advantage of the resources available to it because of a crowding together of the wrong mix of elements." Fidelity adds units to its Centercore design in 500-kilowatt or 1-megawatt units, with all the power capable of being consumed by the equipment in the unit. A 500-kilowatt CoreUnit might typically represent 2,200 square feet of data center space.
CoreUnits are steel-frame, one-story rooms that can be assembled together like Lego pieces coming together at the site, Wells says. CoreUnits have sliding panels in the walls that allow a new unit added to the data center to open up and provide contiguous space to another CoreUnit. The units are built off-site to Fidelity's specs by an independent fabricator, Environmental Air Systems, and then trucked to Fidelity's data center construction site. The units, unlike earlier modular designs based on shipping containers, may be stacked into a multistory building, which can be particularly useful in an urban location.
Within days of arrival, they've been equipped with the power connections and cabling they need to take up their station. An entire data center can be constructed in this way in six months, and expanded as needed. Fidelity calls it "just-in-time data center construction" and builds no more than it needs at any one time.
Each CoreUnit has its own cooling system and power distribution system. They're designed to run at a warm 90 degrees, collecting hot air off the equipment and either cooling it or venting it to the outside. CoreUnits can withstand F3-force winds, which can occur in the large tornadoes that strike the Midwest.
Fidelity's Nebraska data center is expected to use 40% less energy than the company's previous data centers.
It will contain thousands of x86 servers, but unlike Google's and Amazon's facilities, it will also contain some RISC/Unix servers, Wells says. The servers and switches are based on Open Compute standards.


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Delanie Ella Reeves - November 17, 2010
To Darrin and Ashley Reeves of Gothenburg on Tuesday, Oct. 12, 2010, at North Platte, a daughter, Delanie Ella, weighing eight pounds, 10 ounces. She was welcomed home by a sister, Macie.
Paternal grandparents include Ralph Reeves of Chadron and Wendy Fairchild of Grand Island. Maternal grandparents are Greta and Darrell Mueller of Maxwell.
Great-grandparent is Robert Roeder of North Platte.
Latest Headlines
- Training for emergency preparedness
- Gothenburg FFA members compete at state fair
- Learning to adapt to change
- City Council sets tax request and levy for 2016-17
- Cornhusking contest returns to Harvest Festival after 17 year absence
- Summer evening bike ride goes wrong
- New hospital safety ratings now available to the public
- Mentees, others share value of TeamMates


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Classic Darracq cars for sale
- Petrol
- Manual
A magnificent & imposing large engined Edwardian. This car received its current body in 1954 Having been discovered in Wales. The first owner on the buff log book is Lord Swansea who was the original owner of the car. The body is an exact copy ...


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Conveniently located across the street from Fenway Park in the heart of Boston, Bradley's Fine Wine & Spirits has been servicing local residents and business providing free local delivery for over 30 years.
Known for it's large selection of Wine, Spirits, & Craft Style Beers, the store has been a stomping ground for alcohol enthusiasts for generations.
The store is known for it's diverse clients from around the world as they come visit our beloved Boston Red Sox. It's very common to see both opposing teams and local teams frequent Bradley's for an after game celebration or drown their sorrows!


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Investigators say they caught Stanton, his son 18-year-old Adrian Stanton, stepsons 23-year-old Bruce Johnson and 19-year-old Blake Johnson, along with 27-year-old Ryan Tarrer and 20-year-old Joseph Adkins were caught loading up a trailer full of stolen sewer parts a couple weeks ago. Police say it took time for them to figure out who owned the stolen goods. Stanton and the five other men turned themselves in to police over the weekend. Authorities say the operation was huge and the stolen items are worth $500,000. That's the largest amount in DCP history.
Detectives say the men would recycle the equipment and had only received about $10,000 for the items.


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Some Sangaree residents are advised to boil water before drinking it.
Berkeley County Water & Sanitation issued a boil water advisory Monday for its customers in the Highland Avenue and Tabby Creek area of Sangaree.
The advisory only affects houses in that area and not any nearby schools, according to spokespersons for both the school district and the water service.
An advisory means the water could be contaminated and is issued as a precaution. Test results won't be known until late Tuesday, so the advisory will be in effect until further notice, according to the water department.
Drinking water should be brought to a vigorous, rolling boil, and then boiled for an additional minute.
Residents can call 843-572-4400 if they have additional questions or concerns.
Reach Dave Munday at 937-5553.


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I looked for months online and in stores to find a bedspread that would come down to the floor on my bed. Most of them are so short they need to be used with a dusk ruffle and I just didn't want that. This one is perfect. Just a perfect weight - not too heavy to handle comfortably and not so light that it feels cheap. Surprise!!! I didn't see anywhere in the description that it's reversible to a striped bedspread, but it is. What a great option when I want a fresh look for the bedroom. I also ordered the layered valances which will go with either side of the bedspread. Couldn't be happier with this purchase. Thanks Touch of Class!
It's just like the pictures. Bought the king grande bedspread, 3 pillows, and the layered valances. Love it all! The only negative is the valances should have had more body. Had to use a lot of starch.


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Bonding Tunes
By Vital Acts Inc.
Open iTunes to buy and download apps.
Strengthen your Bond of relationship.. For Lovers, Couples, In relationship.. SHARE the moments, EXPRESS the feelings, CONNECT with each other while you LISTEN to the BONDING Tunes of 1st Date, 1st KISS, 1st HUG, 1st ILoveU, 1st Proposal, 1st RING, 1st Gift, 1st Hope, 1st Dance, 1st Acceptance, 1st Dinner, 1st NIGHT, 1st Passion, 1st Longing, 1st Rain, 1st Walk, 1st Roses, 1st Sorry & LOT MORE 1st Memories in Bonding Tunes - A PERFECT GIFT that comes with TUNES and IMAGES that will bring back your memories! Play these Tunes and Go with it!
Ability to also CREATE YOUR OWN COMPOSITIONS! Bonding Tunes is a perfect gift for everyone - comes with LOTS of features along with 50+ various music collections.
We have listed some of the key features below:
* 50+ Music in areas of Memories of Bonding and more!
* Ability for you to MIX & Match Music
* Compose your own Music
* Save your own Music
* Create Play List
* Wake up Timer
* Night Timer
Bonding Tunes is very easy to use and we encourage you to take few minutes to go through our quick guide on how to use. Bonding Tunes is one of the best app that will help you with enhance your Love and Romance Memories!
Please use your discrete judgement in trying the points out as per tips and description. We are here to help and are NOT responsible for you getting impacted at any level due to this app.
- Category: Music
- Released: 18 February 2012
- Version: 1.0
- Size: 53.7 MB
- Language: English
- Seller: Vital Acts Inc.
- © 2012 RRV Apps
Compatibility: Requires iOS 3.2 or later. Compatible with iPhone, iPad, and iPod touch.


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Just wanted to take a minute and let everyone know that we have a majority of the merchandise in. We are waiting on pint glasses and koozies to ship everything... Read more
Wow everyone what a ride that was, thank you again for all of your contributions!!! We are looking forward to getting the incentives out to you on schedule sometime in... Read more
Successfully raised $12,716 with 116 backers
Project launched


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CintaNotes is a simple and free portable note manager that can be used to store all kinds of text based information. Key features include the ability to capture text from almost any application, auto URL population for webpage captures, Ctrl+F12 quick capture hot key, note retreival simply by typing a word or phrase, exporting to Unicode Text and XML.
- Notes list: Highlight the link icon when search term appears in the Link field
- Improved performance of notes list painting and scrolling
- Logging: don't include user data to log by default
- dded "debug.log.userdata" parameter to cintanotes.settings
- Regression: Window-related items in system menu were not working
- Notes list: wrong search hilites in attachments when file name gets shortened
- File attachments: scroll file list in note preview to highlight appropriate search result
- Unnecessary log files were generated
- Section bar: double clicking on scrolling arrow shouldn't select all sections
- Import: tags were not displayed correctly after second import
- Links with percent sign (%) not recognized correctly
- Fixed duplicate menu mnemonics
- Simplenote sync: unable to upload big file (> 40MB)
- Editor: password was required to display tag suggestions
- Fixed possible "column num not unqiue" error upon deleting a section
Reviewing 2.9.3 (Sep 11, 2015)
I absolutely love this software. It meets all my tagging needs and more.
It's clean and simple. I feel the designer is very in tune with the customers and their requests and suggestions. The other popular note apps are too bulky for my personal needs.
I also love that you can get a 10 day free trial to try it out and see if your needs are met. You should at least try out the 10 day trial. You may be very surprised at what you find.
Reviewing 2.9.3 (Jul 28, 2015)
Works great for my needs. Author of this app just gets it. I have come to really rely on it for my day-to-day workflow.
Reviewing 2.9.2 (Jul 16, 2015)
Picked the full license version up for free from GiveawayOfTheDay a while ago. I wanted to use it with Simplenote syncing. Sure, it synced, but then it completely broke and duplicated my notes in SN about a hundred times each. Uninstalled completely. Useless for my purpose, maybe it's good as standalone but if I wanted that I'd just use a regular text editor and Dropbox.
Reviewing 2.8.3 (Dec 16, 2014)
using CintaNotes for taking notes is comfortable.It is versatile , has understandable interface , easy to use.
Try CintaNotes to see the difference.
Reviewing 2.8.1 (Nov 1, 2014)
-Great user interface.
-Low memory usage.
-Helpful support
This goes way beyond those simple post-it notes on your desktop, managing a huge amount of information, that is easily accessible through its main interface, and using a tags system.
Just great, try it!
No comments yet


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Action, not another 'safety study,' is needed to make Highway 50 safer
As a Mound House resident, I wanted to thank Cathy Rigby for expressing my opinion regarding placing the blame for the deaths on Highway 50 on "bad drivers." Slowing drivers down or asking them to pay more attention isn't the only fix.
I personally have attended many public meetings in Mound House and at NDOT regarding the Highway 50 Corridor project. NDOT promised work would begin in 2012 to improve safety. Recently I was informed this project is dead, mostly because the person who was spearheading this has retired. Further, NDOT is getting ready to start a new "safety study," yet if you go on their website you can see that a safety study was conducted in 2007. Guess what? Same old problems needing the same old solutions. Now it will be at least 2015 before any work will begin. I was assured that this new safety study will be better than the last. Really? Sounds like a waste of taxpayer dollars and a away to postpone taking care of the problem.
Highway dividers similar to those on Dayton Hill would help save lives on Dump Hill. NHP and the Carson City and Lyon County sheriff's offices are to be praised for stepping up their controls. But NDOT needs to get something done to improve the safety in this area. At least build a bypass road for when the road is closed due to another fatality. It's time to quit the studies and talking and start taking action.
Melinda Cash
Mound House
Why can't 150th anniversary plate be made at Nevada State Prison?
No Nevada State Museum at Nevada State Prison. Why? License plates department — made by inmates!
But our beautiful 150th year of statehood license plates can't be made there?
Judy Migan


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Open Lab - Bb Learn Grade Center and More
This workshop is open
@ Online -- Bb Learn
Category: Blackboard Learn Seats Available: 599
Format: Mixed Delivery Method: Self-paced Delivery System: Online
Instructors: Debbie Shepard, Keegan Labanz, Larry MacPhee
Open Labs are designed for people who have attended training but need some extra help working in their course. Open Labs are scheduled windows of time when you can meet with our support staff and work one-on-one to meet your particular needs. It's ok to come late or leave early.
This particular open lab will focus on how you can manage your full grade center and how to report grades to LOUIE. However, you may also bring other Blackboard Learn questions.


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Archive by Date | Archive by Article Title
Bilingual Children with Down Syndrome
Bilingual families whose child with Down syndrome or other developmental disability has also learned a second or third language have demonstrated the importance of giving every child the opportunity to grow up bilingual or multilingual
Before the First Week of School
Children with special needs can be especially anxious and confused about how their lives will change before the first week of school in a new grade, including how they will get to school and back, and where they will spend their days.
Pain, Childhood Blood Draws, Injections, IV Lines
Children deserve to be offered pain relief for childhood blood draws, injections, bone marrow aspiration, laser treatment and other medical procedures that may create more fear and anxiety than the injury or illness being treated. Some are: EMLA disks, Ametop gel, Numby Stuff, and vapocoolant sprays
Pain Management for Children with Disabilities
Pain management for children with chronic medical conditions and others who need blood draws, bone marrow aspiration, central or PICC lines, IV sticks, or port access may experience less pain, fear and trauma using numbing agents and techniques to avoid or relieve anxiety and distress
Dolls for Children with Disabilities
Beautiful dolls and toys that demonstrate the diversity of the children in our communities have been available for many years, and should be found and enjoyed in classrooms, daycare and our children´s toy collections. Some parents have found dolls with disabilities to be offensive representations.
Accessible Designs in Playgrounds and Play Areas
Children with physical disabilities should have accessible playgrounds in their communities and schools. We find great designs in accessible playgrounds and play areas in communities of all sizes, and we can also learn from the shortcomings we find in our own neighborhoods and local schools
Accessible Playgrounds & Inclusive Play Areas
Every child deserves accessible playgrounds and naturally integrated play areas in their classrooms or schools. Families of children with disabilities find that local playgrounds and school play areas can be made accessible with a bit of community effort, at reasonable cost, with benefits for all.
Grandfathers and Great Uncles
Grandfathers and great uncles can make a world of difference in the lives of children with special needs, whether they are supporting dads, or taking on some of the responsibilities of fathers who are away from home
A Brand New Baby with Down Syndrome
When a newborn is diagnosed with Down syndrome, parents may be told about the challenges the baby and family may encounter months or years later, when they deserve more than anyone just to bask in the glow of their baby´s first days and weeks.
Printing, Cursive Writing, Childhood Disabilities
Children with special needs have shown great success in learning to print and write in cursive when given the support, encouragement and tools that should be readily available to them as well as their mainstream classmates
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2 brothers plead guilty in Vt. heroin caseThe Associated Press | November 21,2013BURLINGTON - Two brothers in Vermont have pleaded guilty in federal court in Burlington to felony heroin trafficking charges.
In return for their pleas, prosecutors have agreed to drop a conspiracy charge against Louis Prue II of Newport and Matthew Prue of Barton.
The Caledonian Record reported that the two men face potential 20-year prison terms and are scheduled to be sentenced March 10.
A police affidavit says an informant purchased an ounce of heroin from Louis Prue at a park-and-ride lot in Orleans on July 10 after buying a gram of heroin from Matthew Prue a day earlier. Both transactions were arranged via telephone calls monitored by police.
The Prues said in an affidavit they had been selling heroin in the area.MORE IN This Just InMONTPELIER After sitting on the Vermont Supreme Court for nearly 30 years, Justice John Dooley... Full StoryBRATTLEBORO Entergy Nuclear says it has found a potential source of water infiltration into... Full StoryMANCHESTER A little more than a week after it was shut down, the website for the town of... Full Story
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LONDON -- Taylor Townsend can hardly help herself.
The 17-year-old Chicago native and Boca Raton resident has a chance to become the first American to win Wimbledon's junior girls' title since Chanda Rubin in 1992. She has taken more than a peek around the various Grand Slam junior tournaments in which she has played and imagines what it might feel like to be in the main draw one day.
"That's one of the reasons why it's so nice to play the junior Slams because it gives you a little taste of the environment and it really gives you something to look forward to later down the road, especially if you really want it," Townsend said.
"It's great incentive for me personally to say, 'OK, yeah, you're here in the juniors but you could be in the big locker room' or 'You could one day get the royal treatment. You could actually get a car wherever you want.' It's the little perks of being in the pros, but also playing on Centre Court and all the things that go along with it."
Townsend showed Friday that she may not be far off, defeating No. 2 seed Ana Konjuh of Croatia 2-6, 7-6(4), 7-5 to become the first American in the Wimbledon junior girls' final since Brie Rippner in 1997. Townsend will face top-seeded Belinda Bencic from Switzerland on Saturday.
Bencic defeated Townsend 2-6, 6-2, 9-7 in the French Open junior quarterfinals in June.
"She's a tough opponent and she's playing very well," Townsend said. "We had a grind, 9-7 in the third in the quarterfinals of the French, so I'm looking forward to playing her on the grass."
Friday's 2-hour, 20-minute match was a grind as well.
"I think one of my strengths is how I compete and how I fight on the court," she said. "I try to work on it every match and try to get better and better at it. … She made some mistakes and I pretty much just took advantage of it. It was very tight and it was a matter of points here and there and I was able to execute or just stay in the points, so I'm really glad.
"I look forward to playing her on the tour. I think she'll make it."
Raymond and Soares move on to mixed finals
Lisa Raymond and Bruno Soares, in only their second tournament together since pairing at the French Open, advanced to Wimbledon's mixed doubles final with their workmanlike 6-4, 6-4 semifinal victory Friday over John Peers and Ashleigh Barty.
"The thing with mixed doubles, you can never truly feel you're in command," Raymond said. "You can be up a set and a break and it can change on a dime. Momentum can definitely change. But Bruno and I have been playing well the whole tournament, so it felt good when he stepped up to the line to serve it up."
Raymond won the 2012 Wimbledon mixed doubles title with Mike Bryan, but Bryan wanted to conserve his energy for doubles, where he and brother Bob are now one one victory away from becoming the first team in Open era tennis to simultaneously hold all four Grand Slam titles.
Raymond, winner of a combined 11 Grand Slam titles in women's doubles and mixed, said teaming up on the fly with Soares has not been that big an adjustment.
"That's the nature of mixed doubles," she said. "It's not like doubles where you go out there and practice with your partner and you get to know each other and your patterns. You just kind of get thrown out there and its ready, set, go."
Raymond and Soares will meet French Open runners-up Daniel Nestor and Kristina Mladenovic in Sunday's final.


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A Community For People Who Buy, Sell or Collect Antiques, Collectibles and Art
122 members
90 members
82 members
80 members
58 members
Some nautical items.. Clock/ Barometer/ Flags.. Not sure if this interests you..?? This link will show you some pics. Thanks, Amy
Posted on March 9, 2011 at 8:36am
Posted on March 5, 2011 at 2:38pm
© 2016 Created by C. Dianne Zweig Powered by


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Burn Notice Winter Season PromoMatt Richenthal at . Comments
What is worse than being a burned spy? We'll find out November, according to this teaser of a Burn Notice promo.
This video is no longer available. Please check below for related videos.
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Footprint Aboyne
Independent shoe retailer
The Shop
We are an independent shoe retailer in Aboyne on Deeside in the heart of Aberdeenshire. Recently under new ownership we aim to continue the high quality service. Footprint has built a reputation for providing customers a first rate service for every footwear requirement.
Leading suppliers of quality footwear in Scotland's North East. Footprint boasts an extensive range from major brands such as:
- Rieker
- Josef Seibel
- Romika
- Padders
- Remonte
- Lotus
- Skechers (Here Now)
- and more
We not only look after your feet we also hold a stock of
- Innersoles
- laces
- Polish
- Shoe cleaning products
- Socks
We have an arrangement with a local Aberdeenshire based trader to provide the following services.
- Shoe Repairs
- Engraving
- Watch strap replacement
- Watch battery replacement


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We see a future where every pet finds a lifelong, loving home. We are a nonprofit that saves the lives of homeless pets.
By partnering, donating and volunteering, we support organizations dedicated to improving their communities.
We can connect you with the right pet. Save a life today.
|Store Name
|City, State, Zip/Postal
|Phone Number
|1050 N Main St Ste A
|Logan, UT 84341
|(435) 755-0244
|Store Details


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MEN'S JACKET AND PANTS: Fitted, unlined jacket has collar, collar band, shoulder pads, front extending to side back, no side seams, welt pockets (in and out side), in side right button tab, back vent, and interfaced, lined, two-piece sleeves with button vent. B: flaps. Fitted, slightly tapered pants have button waistband, carriers, side front/change pockets, back-button welt pockets, inside button tab, crotch shield, and fly zipper. Self bias binding finishes crotch seam and left fly. A, B and C: French seams.
FABRICS: Linen Blends, Seersucker, Men's Suiting. Interfacing: Nylon Fusible Knit.
Buy Vogue Patterns 8988 for $30.00
Class Details
by: Retro Grac...
by: annie1129
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Copyright © 2016 PatternReview.com® , OSATech, Inc. All rights reserved.


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Launch Weekend Feb 18-19 | Festival Weekend Feb 24-26
Join the Theatre Company at the 12th annual Colorado New Play Summit, a premier showcase and celebration of new plays. Over the past decade, we've introduced 44 new plays at the Summit, more than half of which returned to our stages as full Theatre Company productions. Recent Summit premieres include Theresa Rebeck's The Nest, Tanya Saracho's FADE, Matthew Lopez's The Legend of Georgia McBride, and Samuel D. Hunter's The Whale.
Starting in 2015, we expanded the Summit to provide participating playwrights two full weeks to workshop their groundbreaking new plays with directors, actors, and dramaturgs. Their work culminates in two unforgettable weekends of new play readings, world premiere productions, first-class meals, insider opportunities, and networking events.
2017 World Premieres: The Book of Will by Lauren Gunderson* Two Degrees by Tira Palmquist
2017 readings will be announced and packages will go on sale in fall 2016.
Watch 3 events from the 2016 Summit on HowlRound
Tomorrow's Theatre Today at the Colorado New Play Summit
by John Moore, feature for American Theatre, Feb, 2016
Each year we ask leading playwrights to develop ideas for new plays. Many of these commissions will be read at our Colorado New Play Summit, receive full productions on our stage and go on to other theatres across the nation. By commissioning plays, we underwrite the important work required of playwrights, invest in the future of the American theatre and keep our finger on the pulse of contemporary writing.
Special thanks to the Harold & Mimi Steinberg Charitable Trust for its continued support of new play development at the Denver Center for the Performing Arts.
FESTIVAL WEEKEND Fri Feb, 24 - Sun, Feb 26, 2017
For theatre professionals, artists, students, and theatre lovers who want to experience the full scope of the Summit
2017 artists, events, and partners to be announced
Sat, Feb 18 & Sun, Feb 19, 2017
We've added another weekend to give more Denver audiences than ever the opportunity to say "I saw it first." Hundreds of local audience members will experience the first public readings and meet their next favorite Colorado playwright at our Local Playwrights' Slam.
2017 events, artists and partners to be announced.
Questions? Please contact Artistic Coordinator Grady Soapes at 303.446.4841
American Mariachi by José Cruz González
Lucha and Bolie are ready to start their own all-female mariachi band. The only things standing in their way are a male-dominated music scene, patriarchical pressure from inside their families and finding the right women to fill out their sound. Watch them strive to earn the respect and admiration of their community as they make their way from practice to performance. González writes a passionate story about families, friendships and the music that ties them together.
José Cruz González's plays include The San Patricios, Sunsets and Margaritas, The Heart's Desire, September Shoes. A collection of his plays, Nine Plays by José Cruz González – Magical Realism & Mature Themes in Theatre for Young Audiences was published by the University of Texas Press in 2009. He teaches theatre at California State University at Los Angeles. He is a member of The Dramatists Guild of America. He is a Playwright in Residence at Childsplay.
The Book of Will by Lauren Gunderson
Without William Shakespeare, we wouldn't have literary masterpieces like Romeo and Juliet. But without the duo of Henry Condell and John Heminges, we wouldn't have Shakespeare. After the death of the prolific playwright, the two actors set out to find and reassemble his scripts to create the first Folio while facing challenges from rival poets, competing publishers, and old flames (literal and figurative). The impact of their resourcefulness, dedication and friendship continue to shape the literary world even today. Shakespeare lover and Steinberg/ATCA Award-winner Lauren Gunderson weaves a hilarious and heartfelt play about the story behind the stories we know so well.
Lauren Gunderson is one of the most produced playwrights in America for 2015/16. She is the winner of the 2014 Steinberg/ATCA Award for I and You, also a finalist for the Susan Smith Blackburn Prize. Her plays have been commissioned and premiered by companies across the country including South Coast Rep, TheatreWorks, San Francisco Playhouse, Crowded Fire, Marin Theatre, Cincinnati Playhouse in the Park, and more. Her work is published by Playscripts, Samuel French, and Dramatists. LaurenGunderson.com
Two Degrees by Tira Palmquist
What does it take to change the world? For the Earth, a two degree rise in temperature is enough to change the environment. For Emma Phelps, a scientist studying ice core samples in Greenland, grief over her husband's death seems unmoving, harder with each passing month. Now, at the request of an old college classmate, she's been asked to come to Washington, D.C. to testify in a Senate Committee regarding climate change legislation. In this intersection of science, politics and the personal, she struggles with life's most difficult lesson: change.
Tira Palmquist's plays include Two Degrees, Ten Mile Lake (Serenbe Playhouse), And Then They Fell and Age of Bees (MadLab Theater, Tesseract). Two Degrees has been featured in numerous festivals, most recently the New American Voices festival in the UK. And Then They Fell (finalist for the Global Age Project) will premiere in Los Angeles in 2016. Development: Seven Devils, Inkwell, EST-LA, Workhouse Theater. Publications: Age of Bees (Original Works Publishing). More info at tirapalmquist.com.
Midwinter by Mat Smart
Nothing is simple about romance at McMurdo Station, Antarctica — a small community made even smaller during the shut-in winter months. Helen loves Dmitri, Dmitri loves Hillary, and Hillary loves Tamara (who just might love her back). In this funny and complicated companion piece to the 2015 Jeff Award winner for Best New Work, The Royal Society of Antarctica, Mat Smart weaves a web of love and laughter on the edge of the world, taken from his own experiences living in Antarctica for three months.
Mat Smart (Playwright) is currently a member of the Dorothy Strelsin New American Writers Group at Primary Stages. Plays include: The Royal Society of Antarctica (Gift Theatre, 2015 Jeff Award for Best New Work in Chicago), Naperville (Slant Theatre Project), Tinker to Evers to Chance (Geva, upcoming at Merrimack Rep), The Steadfast (Slant, published by DPS), Samuel J. and K. (Williamstown Theatre Festival, Steppenwolf), The Hopper Collection (Magic Theatre, Huntington) and The 13th of Paris (City Theatre, Seattle Public Theatre). MFA: UCSD.
Hailed as one of the foremost companies creating site-specific, immersive and experiential dance-theater in the United States, Third Rail Projects, led by Artistic Directors Zach Morris, Tom Pearson, and Jennine Willett, is dedicated to re-envisioning ways in which audiences can engage with contemporary performance. They have made work in New York, internationally, and abroad for over 15 years, and their long-running, award-winning work, Then She Fell, was named as one of the "Top Ten Shows of the 2012" by Ben Brantley of The New York Times. Learn more at thirdrailprojects.com
Update on recent Summit readings and productions:
The Legend of Georgia McBride: Off-Broadway Production, MCC Theatre, New York, NY – Aug 20-Sep 27, 2015
The Most Deserving: Off-Broadway Production, Women's Theatre Project, New York, NY — March 2014
Sense & Sensibility The Musical: Reading, New York, NY — June 2014
The Comparables: Full Production, Seattle Repertory Theatre, Seattle, WA — March 2015
We're proud to list the plays we have commissioned, premiered or otherwise developed here since the beginning of the Colorado New Play Summit.
Title in bold = Commissioned by Theatre Company
WP = World premiere
D = Other development
* = Subsequent productions
We accept unproduced original, full-length plays and musicals, which must be submitted by a literary agent. (Playwrights residing in Colorado, Wyoming, Montana, Idaho, Arizona, New Mexico or Utah may send plays directly without an agent.) We have a special interest in plays written by and for African-Americans and Latinos, by women playwrights and we are also interested in plays written for young audiences. Adaptations will be considered if you have secured underlying rights.
Scripts may be sent by email or mail without prior synopsis or dialogue sample. Plays can be submitted year-round.
Plays should be sent digitally to: firstname.lastname@example.com.
Plays may also be mailed to:
Attn: New Play Development
DCPA Theatre Company
1101 13th St.
Denver, CO 80204-5319
Due to the number of submissions we receive, we will only respond if we are interested in a particular script or playwright.
In its 35 seasons, the Theatre Company has produced more than 135 world premieres, read 160 new works and commissioned 24 playwrights. Learn more about how you can support our exciting commitment to new play development.


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Old Courthouse
Welcome to the Old Courthouse!
The majestic Old Courthouse has remained over the past 150 years as one of St. Louis' most prominent architectural landmarks and is now the visitors' center for the Gateway Arch. Visit the Old Courhouse to purchase your timed tickets to enter the Arch, ride to the top and see the film Monument to the Dream. You can also learn the current state of construction on the grounds and get directions for walking to the Arch while avoiding the latest construciton closures.
The Old Courthouse was the site of the first two trials of the pivotal Dred Scott case in 1847 and 1850. It was also where Virginia Minor's case for a woman's right to vote came to trial in the 1870s. You may tour this historic structure, and visit the restored courtrooms to learn more about our 19th century judicial system.
Due to construction, the capacity of the entire Gateway Arch facility will be limited. Beginning Monday, March 2, each guest planning to enter the Gateway Arch is required to have either a Journey to the Top ticket or an Arch Entry-Only ticket to be allowed access to the facility. Purchase tickets in advance at http://ticketsforthearch.com, or
in person at the Old Courthouse, or by calling 877-982-1410.


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Neoseeker.com Forum Thread: iPod Models - Complete Comparison Chart - page 2
reprinted from
original thread:
Author: Master of the VG
Date: Jan 3, 06 at 5:02pm (PST)
Subject: re: iPod Models - Complete Comparison Chart
How about this?
Sorry if it's too big, when I shrank it it became difficult to read.
Author: aceripod
Date: Jan 5, 06 at 10:31pm (PST)
Subject: FREE IPOD NO KIDDING
I actually haven't got my ipod but I'm hoping to get one for free.
[Link Removed]
This is actually a site that works.
Two of my friends got it.
And if u complete this referral i will get one too.
[Link Removed]
Thanks to anyone who does this.
I promise u this will work.
This message was edited by Master of the VG(moderator) on Jan 06 2006.
Author: Master of the VG
Date: Jan 6, 06 at 4:36pm (PST)
Subject: re: iPod Models - Complete Comparison Chart
Free iPod links with referrals codes are not allowed on this forum. Please do not post any more of those links.
Copyright Neo Era Media, Inc. 1999-2016.
All Rights Reserved.


text:
Montgomery's Scientists
Operational Research in Northwest Europe
This groundbreaking collection of documents details the technological and scientific research behind the victory campaign. Dozens of documents empirically examine the effectiveness and employment of the various weapons and tools of war. A must have for any serious student of the Second World War.
Terry Copp is Professor Emeritus of History at Wilfrid Laurier University and Director of the Laurier Centre for Military Strategic and Disarmament Studies. Copp is an influential advocate for military history in both military and civilian post-secondary education. Copp's interest in the battlefields of Europe led to the creation of memorials and study tours for teacher and students, and the publication of invaluable battlefield guides to Canadian participation in both world wars. He is also the founder of Canadian Military History, Canada's leading journal of military history.
Related interest
By the same editor
The Canadian Battlefields in Normandy: A Visitor's Guide, 3rd Edition, Terry Copp and Michael Bechthold
The Canadian Battlefields in Belgium, the Netherlands and Germany: A Visitor's Guide, Terry Copp and Mike Bechthold
The Canadian Battlefields in Northern France: Dieppe and the Channel Ports, Terry Copp and Mike Bechthold
A Nation at War, 1939–1945: Essays from Legion Magazine, Terry Copp
Canadian Battlefields of the First World War: A Visitor's Guide, Terry Copp, Mark Humphries, Nick Lachance, Caitlin McWilliams, and Matt Symes


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SIZE 0.5 oz
We are no longer offering ABSOLUTE FINISH Foundation SPF 15 by ERNO LASZLO. Discover a new favorite or contact our beauty concierge for further assistance.
Get full, flawless skin coverage with a protective barrier.
Erno Laszlo's Air Whipped Mousse Make Up delivers a natural looking finish, plus antioxidant and broad-spectrum UV protection.
• Eases hyper-pigmentation and age spots
• Softens and replenishes skin's moisture level
• Three sunscreens protect overexposed skin and reduce future damage
If you experience oily or acne-prone skin and would like more information on how to treat your skin type, please click on the links below:
To learn more about acne and its causes, click here
For more information on makeup for acne prone skin, click here
Apply immediately after moisturizing, or on top of Erno Laszlo Shake-It Tinted Treatment. Smooth evenly over the face with fingertips, blending in upward strokes and moving outward toward hairline.
Where does b-glowing ship?
b-glowing ships anywhere in the world! Please view our international shipping policy for orders shipped outside the U.S
APO/FBO Addresses: b-glowing proudly ships to our military.
What shipping methods are offered by b-glowing?
Standard Shipping: $5.95 (COMPLIMENTARY standard shipping on orders $75+) within the contiguous U.S. (2-7 business days), Hawaii and Alaska (12-18 business days)
2-3 Business Day Shipping (for orders placed before 12pm Central time): + $11.00
1-2 Business Day Shipping (for orders placed before 12pm Central time): + $20.00
Any package containing hazardous material, such as nail polish, hair spray, or perfume, is restricted by the U.S. Department of Transportation to ground-only shipping methods.
When will my order ship?
Most orders are shipped 24-48 hours within receipt of order. We ship Monday through Friday. Orders placed on Saturday and Sunday will be shipped the following Monday or Tuesday. We do not ship on major holidays; orders placed on major holidays will be shipped the next business day. Please note that due to the speed of our ordering system, order cancellations and changes are not always possible.
All orders shipped complete, when all merchandise is in-stock; no partial orders shipped. You will not be charged until your order is shipped.
How can I track my order?
You can confirm delivery of a package at www.usps.com using the tracking number emailed to you at the time of shipping. UPS provides tracking for your orders at www.ups.com. Packages shipped via FedEx can be tracked at fedex.com. Please allow 24 hours after your order ships for your tracking updates to be made available.
We are not responsible for orders damaged or missing in transit via a mail forwarder. Please call (866)525-4933 for further assistance.


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Behind the buzz and beyond the hype:
Our Nanowerk-exclusive feature articles
Subscribe to our Nanotechnology Spotlight feed
One of the most neglected aspects in the nanoelectronics field is the problem of wiring. How do we wire individual nanoelectronic devices within a nanointegrated circuit together? Furthermore, how do we extract and input information from such a circuit - i.e. how do we let it communicate with the outside world? Researchers at Caltech present a method for multiplexing the electrical signals from potentially tens of thousands of nanoscale sensors onto a single optical output, using piezoelectric nanoscale mechanical resonators. This work is a step closer to building miniscule, highly integrated sensor arrays that are untethered from the external environment.Posted: Apr 30th, 2010
Even though traditional, digital computers have consistently increased in speed and complexity, they are limited by their reliance on sequential processing of instructions; i.e. no matter haw fast they are, they still process only one bit at a time. By contrast, individual neurons in our brain are very slow: they fire at only about 1000 times per second; however, since they are operating in a massively parallel way, with millions of neurons working collectively, they are able to complete certain tasks more efficiently than even the fastest super-computer. Another important distinction of our brain is that, during computing, information processing circuits evolve continuously to solve complex problems. An international research team from Japan and Michigan Technological University has now created a similar process of circuit evolution in an organic molecular layer, which also solves complex problems. This brain-like 'evolutionary' circuit has been realized for the first time in the world.Posted: Apr 26th, 2010
If you think that building an artificial human brain is science fiction, you are probably right - for now. But don't think for a moment that researchers are not working hard on laying the foundations for what is called neuromorphic engineering - a new interdisciplinary discipline that includes nanotechnologies and whose goal is to design artificial neural systems with physical architectures similar to biological nervous systems. One of the key components of any neuromorphic effort is the design of artificial synapses. The human brain contains vastly more synapses than neurons - by a factor of about 10,000 - and therefore it is necessary to develop a nanoscale, low power, synapse-like device if scientists want to scale neuromorphic circuits towards the human brain level. New research now suggests that memristor devices are capable to emulate the biological synapses with properly designed CMOS neuron components.Posted: Apr 23rd, 2010
Researchers have been exploring boron nitride (BN) nanomaterials - from nanotubes to nanosheets and nanoribbons - and found similarities, but also differences to the the properties of the corresponding carbon nanomaterials. Motivated by the outstanding properties of graphene, the boron nitride single layer - a structural analogy of graphene - has been extensively studied both theoretically and experimentally, and has been experimentally realized. However, BN nanomaterials are wide-band-gap semiconductors, and their band structures are rather robust, and difficult to modulate, which is a substantial obstacle for their applications in nanoelectronic devices. Researchers have now shown that hydrogenation might be a simple approach to tune the band structure of graphene-like boron nitride structures.Posted: Apr 6th, 2010
Continuing miniaturization has moved the semiconductor industry well into the nano realm with leading chip manufacturers on their way to CMOS using 22nm process technology. With transistors the size of tens of nanometers, researchers have begun to explore the interface of biology and electronics by integrating nanoelectronic components and living cells. While researchers have already experimented with integrating living cells into semiconductor materials other research is exploring the opposite way, i.e. integrating nanoelectronics into living cells. Researchers in Spain have demonstrated that silicon chips smaller than cells can be produced, collected, and internalized inside living cells by different techniques (lipofection, phagocytosis or microinjection) and, most significantly, they can be used as intracellular sensors.Posted: Mar 15th, 2010
All existing transistors are based on junctions - obtained by changing the polarity of silicon from positive to negative. Researchers have now demonstrated a new type of transistor in which there are no junctions and no doping concentration gradients. The key to fabricating a junctionless gated resistor is the formation of a semiconductor layer that is thin and narrow enough to allow for full depletion of carriers when the device is turned off - something that was achieved by fabricating silicon nanowires with a diameter of a few dozens of atomic planes. The electrical current flows in this silicon nanowire, and the flow of current is perfectly controlled by a ring structure that electrically squeezes the silicon wire in the same way that you might stop the flow of water in a hose by squeezing it.Posted: Mar 1st, 2010
Materials that can produce electricity are at the core of piezoelectric research and the vision of self-powering machines and devices. Nanotechnology researchers are even pursuing nanopiezotronics devices that have the potential of converting biological mechanical energy, acoustic/ultrasonic vibration energy, and biofluid hydraulic energy into electricity, demonstrating a new pathway for self-powering of wireless nanodevices and nanosystems. In addition to miniaturizing piezoelectric devices down to the nanoscale, nanotechnology is also contributing to making next-generation devices more effective. Piezoelectric ceramics for instance generate electrical charge or voltage when they experience stress/strain, and thus are highly efficient at converting mechanical energy into electrical energy. However, ceramics are rigid, which greatly limits the applicability of the energy harvesting. Researchers have now demonstrated that high performance piezoelectric ceramics can be transferred in a scalable process onto rubber or plastic, rendering them flexible without any sacrifice in energy conversion efficiency.Posted: Feb 3rd, 2010
Scientists have great expectations that nanotechnologies will bring them closer to the goal of creating computer systems that can simulate and emulate the brain's abilities for sensation, perception, action, interaction and cognition while rivaling its low power consumption and compact size. DARPA for instance has a program called SyNAPSE that is trying to develop electronic neuromorphic machine technology that scales to biological levels. Started in late 2008 and funded with $4.9 million, the goal of the initial phase of the SyNAPSE project is to 'develop nanometer scale electronic synaptic components capable of adapting the connection strength between two neurons in a manner analogous to that seen in biological systems, as well as, simulate the utility of these synaptic components in core microcircuits that support the overall system architecture.' Independent from this military-inspired research, nanotechnology researchers in France have developed a hybrid nanoparticle-organic transistor that can mimic the main functionalities of a synapse. This organic transistor, based on pentacene and gold nanoparticles and termed NOMFET (Nanoparticle Organic Memory Field-Effect Transistor), has opened the way to new generations of neuro-inspired computers, capable of responding in a manner similar to the nervous system.Posted: Jan 25th, 2010


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Not only is American tennis player Bethanie Mattek-Sands ahead of Venus Williams in the WTA rankings, she's also managed to surpass the elder Williams sister in terms of outrageous outfits. The 31st-ranked Mattek-Sands turned heads at Thursday night's Wimbledon player's party in a dress designed by Lady Gaga's designer, Alex Noble.
Mattek-Sands is seeded at Wimbledon and dressed like Lady Gaga
From YahooSports.com
Use your ← → (arrow) keys to browse more stories
Gareth Cattermole/Getty Images


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John's Arm
John, the world's only city morgue night watchman with a superhero for a right arm!
It's like a party in your mouth!
The Grim Reaper Show
Death finally gets his own show and a chance to speak his mind.
the drawing style wuz a lil funky and well the story is kinda erie and creepy but still interesting i liked it i guess it wasnt bad i mean the whole legendary frog shit and ye like i unno i couldnt say that was great buh i wud want you to make something else like this though with the weird music and the crazy story like i thought it was dark u know good job
that was great LF is a fucking fagget
kick ass
really trippy, make some more
You get a 10 for interactivity....
0 for style because legendary frog is cool. you're name is Oliver. Dude, that's weird. You got oliver or olive legendary frog.
The Classic Coming of Age Story
Only in Amerika, yes...Well America, and the Netherlands, and England, and Aruba, and selective parts of Mexico. But yes.


text:
OSHA News Release - (Archived) Table of Contents
OSHA Trade Release
U.S. Department of Labor
Occupational Safety and Health Administration
Office of Communications
Washington, D.C.
For Immediate Release
News Release
Wednesday, September 30, 1998
Contact: Jeff Ezell (202) 219-8151
The Occupational Safety and Health Administration (OSHA) will hold a meeting of the Metalworking Fluids Standards Advisory Committee on Oct. 19-21 in Detroit.
The committee advises the secretary of labor on issues concerning the protection of workers from occupational exposure to metalworking fluids. Millions of workers engaged in the manufacture of automobiles, farm equipment, aircraft, heavy machinery, and other hardware are exposed to these machining fluids. There is substantial evidence of serious health effects, such as respiratory cancer and occupational asthma, that can result from this exposure.
The public meetings will focus on non-cancer respiratory effects associated with exposure to metalworking fluids and ways of estimating risk of non-malignant respiratory diseases. Other items to be discussed include the ventilation and design of enclosures, and occupational dermatitis related to metalworking fluids.
Written data, views or comments for consideration by the committee may be submitted to Dr. Peter Infante, U.S. Department of Labor, OSHA, Directorate of Health Standards Programs, Metalworking Fluids Standards Advisory Committee, Room N-3718, 200 Constitution Avenue, N.W., Washington, D.C. 20210. Twenty-five copies are needed.
All interested persons are invited to attend. Anyone wishing to make an oral presentation to the committee on any of the agenda items also should notify Dr. Infante in writing. The request should specify the amount of time desired, the capacity that the person will appear and a brief outline of the presentation.
Individuals with disabilities wishing to attend should contact Theresa Berry at (202) 219-8615 ext. 106, no later than Oct. 5 to obtain appropriate accommodations.
The meeting will be held in the Westin Hotel at the Renaissance Center, located at East Jefferson Avenue and Brush Street. The hotel's phone number is (313) 568-8000.
The committee will meet from 10 a.m. to 5 p.m. Oct. 19; 9 a.m. to 6 p.m. Oct. 20; and 9 a.m. to noon Oct 21.
Notice of this meeting appeared in the September 23, 1998, Federal Register.
|OSHA News Release - (Archived) Table of Contents


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Express replacing Coldwater Creek at Bayshore
Women's clothing retailer Coldwater Creek is closing its store at Bayshore Town Center, in Glendale, at the end of business on Sunday, and will be replaced by an Express store.
Express, which sells both men's and women's apparel, will open by late spring or early summer, said David Moss, Bayshore general manager. He said Express has been the most heavily requested store by Bayshore shoppers. »Read Full Blog Post(5)
Wisconsin retirees could see 13% cut in payments
Madison - Retired public employees in Wisconsin could see their monthly pension payments decrease by as much as 13% starting in May, the last in a series of reductions caused by the most recent recession, the Department of Employee Trust Funds warned Friday.
Pension payments are based on the performance of funds managed by the State of Wisconsin Investment Board, as well as other actuarial factors like the number of retirees entering and leaving the system. »Read Full Article(240)
Two $1 million Wisconsin lottery winners claim prizes
Madison - Two $1 million lottery winners in Wisconsin have claimed their prizes.
The winners were in central Wisconsin and southeastern Wisconsin. »Read Full Article
Agencies that help kids, fight homelessness get $230,000 in grants
Seven Wisconsin agencies will be able to provide more food for infants, housing and activities for homeless people, after receiving $230,000 in grants from the Assurant Foundation.
The Guest House received $50,000 to help get homeless people into long-term housing. »Read Full Article(3)
DOT warns buyers to watch for cars damaged in Sandy
Madison - Wisconsin transportation officials are warning car buyers to watch out for vehicles damaged in superstorm Sandy.
The Department of Transportation warns the storm caused water damage to tens of thousands of vehicles, making their electrical systems suspect. Agency officials say it's likely the vehicles will start showing up on used-car lots across the country as their owners complete insurance settlements. »Read Full Article