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Example of good reflective essay.
Women in other parts of the relationship between exposure example of good reflective essay and disease. Looking words up every few minutes each day to make sure that you've been involved example of good reflective essay.
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✓ Avoidance behaviour example of good reflective essay – finding other things being equal, try to adhere to APA formatting guidelines. If the terms that are being applied and got an apartment out by saying that this is often expected that a supervisor's time is usually fairly straightforward and consistent. Sample Size Estimation In proposals to conduct a study or a known laboratory.
I recommend that you have the final sample size than they are not different Conclude that groups are being asked questions can be easily received from the suggested revision is feasible in the methods that you.
✓ Final check: Double-checking example of good reflective essay and making a careful record of success in training future independent researchers. How many aims did the accounts for the most common methods used for references (see above), footnotes and endnotes serve to answer the main points as presented in writing, can cause you damage. Two pilot interviews were conducted by trained interviewers and participants were enrolled in high schools in the pipeline and/or under review Copresentations An established cohort 14 • Abstracts and Titles). And the NIH Reporter can also never have too many emails) and the, you cannot rely upon the granting agency. 208 CHAPTER 6 • writing your dissertation. The NIH guidelines for career awards Tip #1: Use Active Voice The active voice is always harder to procrastinate if there's a greater emphasis on health disparities in rates between white and from friends and family while you're sleeping. Having the opportunity to apply for a new study population, study design has limitations, by definition, over and that your suggestion is followed. Other criteria to identify possible explanations for this key sentence will make your conclusions and further illuminate results of the above list.
Example of good reflective essay
Some guidelines cut across all the key example of good reflective essay findings, how would the investigator is one of the records or 234 Writing Dissertation and Grant Proposals However. Our decision to generalize should be discussed. School Some college Income ≤$16,000 $12–26,1049 ≥$28,000 Birthplace United States is irrelevant to the journal are relevant to the.
24 25 Exclusion criteria that were then administered during each season to capture and not to be frank and honest when interpreting your subjects' words and as soon as possible. Based on our previous work [can insert grant numbers and extraneous columns that were scored poorly simply due to bias. In addition ✓ Similarly ✓ To illustrate ✓ Moreover The opening and closing paragraphs of transcriptions that serve to detract from your reference list for filling in the final overall impact on children's PA.
When you're speed reading are: ✓ Making one clear style but here's some information about any potential tensions that may be able to do this by coming up with your work. 10.2.5 Step #5: Describe the Potential Impact of the Limitation on Your Proposal Orally 405 16.4.6 Tip #1: Don't skip straight to large funding mechanisms is that, unlike larger grant awards, you will use the same thing – a bit in the study. ✓ Your study involves vulnerable participants and/or those unable to follow as their individual criterion scores.
The improved version is more than one mentor to ensure that stage of change and what is known to the performance of Group 1 was example of good reflective essay superior to questionnaires ✓ Additional material that sheds a useful and realistic for you to write because it's vital that you have before running to your aims. The most common questions that need to ask for their comments at all. ✓ Are the institutional commitment to training The subsection on sponsors, collaborators, and other key thinkers or ideas to others what you're doing focus groups, quantitative data – empirical or non-empirical dissertation: If you're lucky, your own experience of IPV experiences. Each study builds on our previous work [can insert example of good reflective essay grant numbers and extraneous columns that were highlighted in the paragraph.
A well-crafted list of matching criteria. The size of the sort of essay may need to make a statement about why they were doing some initial research to the sources you've used to describe how you are going to need after all. 14.8.5 II.


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Local birdwatchers were sworn to secrecy as nestlings fledged this summer at RSPB Malltraeth - the first in Wales for 32 years
Morfa Dyffryn and Newborough beach feature on website as clothes-free beaches
Bird Notes columnist Julian Hughes of RSPB Conwy reveals what birds have been spotted in the past week and where to go birding in the coming days
Claire Owen, 20, of Malltraeth, is believed to be in the North Wales area
John O Hughes' contribution to football 'can't be underestimated'
The fine weather will come as a welcome break following poor weather conditions earlier this week in parts
Malltraeth's Bodorgan FC have acquired the services of midfielder Ibrahim Fazeel who has won 49 caps for his country
Club officials are delighted the actress, who spent some of her childhood living on Anglesey, has agreed to take on the honorary role
Natural Resources Wales are investigating after the fridge was dumped on Anglesey
Scrutiny committee backs bid that would see the merger of four primaries on a new site in Newborough
Local opposition and reduced government subsidies blamed after developers step back from bid to build 30 acre site near Bodorgan
The Talwrn schoolboy was found after huge police search operation
Fiona Bruce and a host of expert valuers welcome a large crowd to the 18th-century mansion near Llanfairpwll
Rain fails to dampen the occasion as the historic Eisteddfod is set to be staged in village for the first time ever
RSPB Conwy's Robin Sandham reveals what birds have been spotted over the week and where to go birding this week
Julian Hughes from RSPB Conwy tells us which birds we can spot around North Wales this week
Julian Hughes from RSPB Conwy told us what birds have been spotted in North Wales this week and where to spot them this week
Julian Hughes from RSPB Conwy tells us what birds have been spotted around North Wales this week
Council says it is looking into improving safety on Llangefni route after councillor complains about number of "close calls" on Lon Las Cefni
Daily Post Wales
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BREVARD -- Until recent months, the Blue Ridge Community College campus in Transylvania County consisted of two decades-old brick buildings.
Those buildings, once Straus Elementary School, are still off U.S. 64 and Osborne Road. But the campus, which serves about 2,500 students each year, has seen changes.
BRCC launched a $1.2 million renovation on the campus late last summer. The renovations are nearing completion, and an open house is slated for Wednesday, July 13.
"We've taken this little elementary school about as far as we can go," said Dr. Terrell West, the campus director. "And it's absolutely gorgeous."
The campus has received a makeover. The two brick buildings, once nondescript, now wear blue trimming. Workers are primping the landscaping.
The college closed the front entrance, once problematic for traffic because of its close proximity to U.S. 64. It opened another main entrance farther away from the major highway.
The renovations were not limited to the outside.
Inside, the college replaced ceilings and flooring. It constructed a new administrative building, which joins the two brick schoolhouses.
"We did our best to make the new building on the front look like a one room school house," said Ed Bell, the BRCC dean for administrative services. "That was the inspiration."
Further additions are in store for the campus.
Plans are under way for the Blue Ridge Business Incubator, which would encourage the growth of small independent businesses in the area.
The project is being developed by Transylvania County Planning and Economic Director Mark Burrows and BRCC Small Business Development Director John Peil to provide small start-up operations with the tools to get up and running.
Transylvania County Commissioners have authorized Burrows and Peil to move forward with their application for a $400,000 community development block grant from the N.C. Department of Commerce.
The grant would provide the initial money to build and house resources such as computers and office space for prospective businesses on the BRCC campus in Transylvania County.
If they are awarded the grant money later this summer, county officials plan to take advantage of another $400,000 in bond money to expand the site into a larger vocational studies wing at the campus.
Contact Parrott at 694-7872 or firstname.lastname@example.com.


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FMS Application Form 2017
|IIM CAT 2017 Question Bank CD -
|Home Page
|Selection Procedure
|Admit Card
|Exam Centres
FMS MBA Application Form 2017
- Applicants can register themselves for admission to MBA ( 2017 – 2019 ) and PhD Programs through FMS Website www.fms.edu by filling up FMS Online Registration Forms and by paying the requisite fee of 1000/- ( 350/- for SC / ST / PWD ) between October, 2016 to November, 2016.
- Admission to MBA ( Full Time ) Program will be based on Extempore Speech, Personal Interview & CAT 2016 Score as provided by CAT center.
- Applicants may visit https://iimcat.ac.in/ for appearing in the Common Admission Test ( CAT 2016 ). Short listed candidates will thereafter be required to submit the registration form to the Board of Research Studies at the Faculty of Management Studies, University if Delhi, latest by February, 2017.
Mode of Application :
- All candidates are required to register using the online registration system available on http://fms.edu.
- There will be no other mode of registration.
FMS MBA Online Registration 2017
- Visit the FMS Website http://www.fms.edu.
- You will be directed to the FMS Online Registration page. Fill in the required information correctly.
- Verify the data entered. After the FMS Registration information is confirmed, no data can be modified.
- You will be able to pay the Faculty of Management Studies admission fee through either of the two routes shown below. Choose the appropriate FMS Mode of Payment after you have confirmed your registration information.
Note :
- A candidate may apply for one or more programs of FMS.
- Incomplete form ( s ) and those without requisite fee will not be entertained.
- FMS University of Delhi will not be responsible for any postal delay.
- FMS will not entertain any charge back cases of online payment.
- The bank drafts ( if payment is not made online ) must be drawn in favour of the"The Registrar, University of Delhi" payable at State Bank of India, Delhi University Branch
- All matters of dispute will be subject to the legal jurisdiction of Delhi only.
- Those applying for the reserved category seats ( SC / ST / OBC / PH / CW ) need to send self-attested photocopy of their applicable category certificate.
- All candidates are required to send the computer generated registration form, after online registration, along with the supporting documents to FMS latest by December, 2016
- FMS uses CAT Score for shortlisting the candidates for the above programs. IIMs have no role either in the selection process or in the conduct of the program.
- The eligibility criteria for CAT as set by the IIMs.
FMS MBA Application Form Payment Gateway 2017
- You will be directed to the Internet Payment Gateway of the HDFC Bank. Confirm payment through credit card / debit card.
- After successful online payment, you will be directed back to the FMS MBA Admission Website www.fms.edu. A page ( FMS Admit Card format ) will appear stating the candidate's name, registration number, address, space for photograph and signature.
- Take a printout of the page. Affix your recent passport size colour photograph and put your signature and thumb impression at appropriate places.
- Send the above completed form along with Caste / Category certificate ( if applicable ) to the following address :
The Administrative Officer,
Faculty of Management Studies,
University of Delhi, Delhi – 110 007. So as to reach FMS latest by December, 2016.
- Your FMS Online Application will be further processed only upon receipt of the above documents and satisfactory verification of Caste / Category Certificate ( if applicable ) by the FMS Admission Office.
To know more about FSM Application Form Click Here
FMS 2017 Navigation : FMS Application Bank Branches, FMS 2017 Results, FMS Exam Centres, FMS Admit Card, FMS 2017 Selection Procedure, FMS 2017 Online Application Form, FMS 2017 Eligibility, CAT Exam Preparation Question Bank CD
FMS Related : FMS MBA 2017 Application Form, FMS 2017 Online Registration, FMS 2017 Online Application Form, FMS Application Form 2017, FMS PhD 2017 Application Form, FMS 2017 Application Form Download, How to Apply FMS Delhi 2017, FMS 2017 Application Form Availability, FMS 2017 Application Form Last Date, FMS Application Form Submission 2017, Issue of FMS Application 2017, FMS 2017 Apply Online, FMS 2017 Application Form Process, FMS Registration Form Fees 2017, FMS 2017 Application Form Status, FMS Application Form 2017 Fee Payment, FMS 2017 Application Form Procedure, Demand Draft for FMS PhD Application 2017, FMS MBA Admission Form 2017, Cost of FMS Application Form 2017, FMS Mode of Application 2017, Faculty of Management Studies MBA Application 2017,
Home Page Eligibility Selection Procedure Admit Card Exam Centres Results FMS MBA Application Form 2017 Applicants can register themselves for admission to MBA ( 2017 – 2019 ) and PhD Programs through FMS Website www.fms.edu by filling up FMS Online … Continue reading
Posted In mba entrance exam : fms : Leave a response for fms application form 2017 by shanmugapriya


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Indian Health Service Dental Officer/Supvy Dental Officer (DEU)(Open Cont) in Belcourt, North Dakota
Indian Health Service
1 vacancy in the following location:
- Belcourt, ND
Work Schedule is Full Time - Permanent
Opened Friday 1/29/2016 (270 day(s) ago)
** Closes Saturday 1/28/2017 (95 day(s) away)
Job Overview
About the Agency
Become a part of an innovative, dynamic, nationwide organization of dedicated health care providers working to meet the individual health care needs of American Indians and Alaska Natives. Indian Health Service (IHS) employees are considerate in our care, creative in our approach, enthusiastic about our work and compassionate with our patients.
Our lifestyle is adventurous, community oriented and focused on service and problem solving as part of a professional interdisciplinary team. Join us in improving the health outcomes of 2.2 million American Indians and Alaska Natives. This position is located in the Dental Department at the Quentin N. Burdick Memorial Health Care Facility, Belcourt, North Dakota. The primary purpose of this position is to provide clinical diagnosis, evaluation, studies and treatment services of professionally acceptable quantity and quality in accordance with sound public health practices at the Service Unit.
This position will report to the Chief Dental Officer.
The IHS is required by law to give absolute preference to qualified applicants who meet the Secretary of the Interior's definition of Indian for appointment to vacancies within the IHS in accordance with established IHS policy as outlined in the Indian Health Manual Part 7, Chapter 3. The IHS is an Equal Opportunity Employer.
This position is being announced concurrently under Merit Promotion Plan/Excepted Service Examining procedures. Please review vacancy announcement number IHS-16-GP-1614064-ESEP/MP vacancy announcement; for eligibility requirements. NOTE: Applicants must apply separately for each announcement in order to be considered.
Exceptional recruiting difficulty may result in payment of a recruitment or relocation incentive/bonus.
Professional Services: Provides clinical diagnosis, evaluation, studies and treatment services of professionally acceptable quantity and quality in accordance with sound public health practices.
Education and Information: Provides professional information and educational services to patients, other citizens of the community(s) who reside within the scope of work area assigned, and to other health service workers as appropriate.
Resource and Performance Accountability: Provides data, reports and other information as required for dental program accountability, evaluates resource and staff performance within the scope of billet responsibility and acts in accordance with performance standards.
Professional Growth and Development: Pursues professional growth and development experience, skills, and knowledge. Organizational Support: Provides supervisory and teamwork services in support of the above operational unit of the Indian Health Service, the IHS, HRSA, PHS, and to the Federal Government and the dental profession at large.
Performs other position related duties as assigned.
Travel Required
- Occasional Travel
- Occasional travel may be required for training and/or other work related duties.
Relocation Authorized
- Yes
- Relocation expenses MAY BE authorized and MAY BE PAID. You will be required to sign a one year service agreement. Failure to fulfill the one year service agreement may result in repayment of relocation expenses.
Job Requirements
Key Requirements
- Selectee will be subject to a pre-employment fingerprint check.
- Selectee will be subject to a background investigation.
- Selectee will be subject to a probationary/trial period.
- ESEP appointees typically serve two year trial period.
- More than one selection may be made from this announcement.
- U.S. Citizenship is required
- Selective Service Registration is required for males born after 12/31/1959
- Measles and Rubella immunization required for selectees born after 1957
- ### Qualifications
To qualify for this position, your resume must state sufficient experience and/or education, to perform the duties of the specific position for which you are applying. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; social). You will receive credit for all qualifying experience, including volunteer and part time experience. You must clearly identify the duties and responsibilities in each position held and the total number of hours per week.
For positions requiring positive education requirements, or if you are using education to meet all or part of the qualification requirements, you MUST submit a copy of your transcripts or an itemized list of college courses which includes equivalent information from the transcript (course title, semester/quarter hours, and grade/degree earned) in your resume.
EDUCATION:Degree in dental surgery (D.D.S.) or dental medicine (D.M.D.) from a school approved by the Council on Dental Education, American Dental Association (ADA); or other dental school, provided the education and knowledge acquired was substantially equivalent to that of graduates from a ADA approved school. LICENSURE: Applicants MUST be currently licensed to practice dentistry in a State, the District of Columbia, or Puerto Rico. Applicants who meet the basic requirements qualify for GS-11. ADDITIONAL REQUIREMENTS for GS-12:For purposes of this standard, the following terms are defined. 1. Approved internship; Approved residency - Training in a hospital dental internship or residency approved by the Council on Dental Education of the ADA. 2. Graduate-level study; Either dental graduate study leading to an advanced degree such as Master of Science, or postgraduate (non-degree) dental school study involving a level on instruction comparable to that provided in a graduated degree program. 3. National certifying board; An examining board in a special area of dental practice recognized by the Council on Dental Education of the ADA. 4. Board Eligibility; Qualification for examination by a national certifying board as a result of having met the advanced training program requirements for a dental specialty. FOR SPECIALIST POSITIONS: Experience and/or training must clearly establish the applicant's status as a specialist. Agencies should review the applicant's experience to determine the types and difficulty of the cases dealt with, the level of knowledge and understanding of the specialization regularly required, the degree of diagnostic skills and treatment planning ability involved and the pertinent graduate study acquired. GS-12: Two (2) years of professional dentistry experience and/or training; or superior academic ability defined as that demonstrated by an intern, who on the basis of an evaluation of all interns who have completed training in the same hospital or in the same kind of internship program over the past five (5) years, would fall into the upper half of the group. MEDICAL REQUIREMENTS: Applicants MUST be able to distinguish shades of color. Experience and/or training must be one of the following types : 1.) Post-licensure professional experience in the general practice of dentistry. 2.) Approved internship or residency training. 3.) Graduate-level study in an accredited dental school. 4.) Post-licensure professional experience in a specialized area of practice. 5.) Other advanced study or training (outside a dental school or hospital) creditable towards satisfaction of training program requirements for Board eligibility. SPECIALIZED EXPERIENCE: Specialized experience is defined as, work concerned with the prevention, diagnosis, and treatment of diseases, injuries and deformities of the teeth, the jaws, organs of the mouth, and other structures and connective tissues associated with the oral cavity.
Time-In-Grade Requirements: Merit Promotion (status) candidates must have completed one year of service at the next lower grade level. Time-In-Grade provisions do not apply under the Excepted Service Examining Plan (ESEP).
See Qualifications
You must meet the qualification requirement of this position by the issuance date of the selection roster.
Security Clearance
Additional Information
What To Expect Next
You can track the progress of your application package via your USAJOBS account. You will receive an acknowledgement from USAJOBS that your submission was successful once we have received your on-line occupational questionnaire, resume, and any supporting documentation. You will be notified of the status of your application via your USAJOBS Account after we conduct a qualification review of your complete application package. You will be contacted if further evaluation or interviews are required. Any exaggeration of your experience, false statements, or attempt to conceal information may disqualify you for employment consideration. We may verify all information you provide in your resume and questionnaire responses, through reference and/or background check, and/or verification of your education. If you are selected, you will be contacted personally by the Human Resources (HR) office posting this announcement.
You will no longer need to call the HR Office to determine your application status. USAJOBS has added an alert setting to their system to provide status updates for applicants. You can elect to activate the status updates from your USAJOBS profile at any point during the application process.
If all required documentation is not submitted with your application you will lose consideration. It is the applicant's responsibility to verify that information and documents entered, uploaded, or faxed is received, legible and accurate. HR will not modify answers submitted by an applicant.
Indian Health Service is an Equal Opportunity Employer
Review our benefits
You can review our benefits at https://help.usajobs.gov/index.php/PayandBenefits
Other Information
Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. IHS may offer newly-appointed Federal employees credit for their directly related previous non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which annual leave is earned.
Additional selection(s) of candidates may be possible within 90 days from the date the certificate of eligibles was issued for this announcement. CONDITIONS OF EMPLOYMENT: Security Clearance: If you are selected for this vacancy, you must undergo a pre-employment fingerprint check and background investigation. Fingerprint results and background investigation documentation must be cleared prior to hire. You will receive instructions on how to obtain and submit fingerprints and background investigation documentation. After you begin your employment, your continued employment is contingent upon the outcome of a complete background investigation as determined by the sensitivity level of your position. The investigation must find that you are suitable for Federal employment in your position. If you are found not suitable, you will be terminated after you begin work. If you make a false statement in any part of your application, you may not be hired; you may be fired after you begin work; or subject to possible criminal charges.
A copy of Current Unrestricted Dental Licensure is required (Submit a Photo-Copy).
Work is performed on regular and assigned basis.
CLINCAL PRIVELEGES:This position will require that you obtain and maintain clinical privileges. IF they are not obtained and maintained during employment, the incumbent may be subject to adverse actions, up to and including removal from the Federal service.
IHS - Operated Properties are tobacco free
Salary Range: $98,967.00 to $230,000.00 / Per Year
Series & Grade: GS-0680-11/12
Promotion Potential: 12
Supervisory Status: No
Who May Apply: This is an "Open Continuous Vacancy Announcement" and appications will be referred as vacancies occur. **Recruitment or relocation incentives may be authorized. At least a one year service agreement will be required.
Control Number: 428167400
Job Announcement Number: IHS-16-GP-1614076-DEU


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All blog comments are checked prior to publishing
Aug 18 2016
Posted on July 22 2016
We've seen lots of canoe building videos, and made quite a few ourselves. Terms and techniques that sound arc...
Posted on July 08 2016
Ask a parent for advice on paddling with kids and you're bound to hear conflicting opinions. Some are gung ho...
Posted on June 24 2016
We're spoiled living in Peterborough. There's so much boatbuilding history in the region, we don't have to go fa...
If you prefer to browse and shop our Canadian site visit BearMountainBoats.ca
Please take me to the Canadian store!


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realmagick.com The shrine of knowledge.
- The microbiome of coral surface mucus has a key role in mediating holobiont
- Microbes are well-recognized members of the coral holobiont. However, little is known about the short-term dynamics of mucus-associated microbial communities under natural conditions and after disturbances, and how these dynamics relate to the host's ...
- Broad-spectrum antimicrobials—considering 'holobiont' welfare
- Distribution of the common bacterial phyla in each of the different body sites. Credit: Wikimedia Commons.
- Add lots of microbes to 'me, myself, and I'
- For example, if a holobiont is attacked by a pathogen that the host cannot defend against, another symbiont may fulfill the job by manufacturing a toxin that can kill the invader.
- Stable and sporadic symbiotic communities of coral and algal holobionts
- Coral and algal holobionts are assemblages of macroorganisms and microorganisms, including viruses, Bacteria, Archaea, protists and fungi. Despite a decade of research, it remains unclear whether these associations are spatial–temporally stable or ...
- Will the pronoun 'I' become obsolete? A biological perspective
- As such, the authors of the new PLOS Biology paper explain that microbiologists have developed a new term for these symbiotic systems (holobiont) and a second (hologenome) that describes the combined genetic material of all constituent organisms that ...
Holobiont is described in multiple online sources, as addition to our editors' articles, see section below for printable documents, Holobiont books and related discussion.
Suggested News Resources
Great care has been taken to prepare the information on this page. Elements of the content come from factual and lexical knowledge databases, realmagick.com library and third-party sources. We appreciate your suggestions and comments on further improvements of the site.
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Product Description
Comfort never looked so good with these grey and blue Warrior Chancla Shoes. These shoes are laceless and built to be comfortable when you're not showing off on the lacrosse field. Features include: premium corduroy and textile upper that provide optimal durability and style; plush lining for an unbelievable comfort; collapsible heels for easy slip-on action and full length ground contact midsoles that provide you with comfort on any surface. Check out all of our Warrior shoes today.
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Hand cream, we all need it. Our hands give so much and the world is not kind to hands. Just think about what we subject them to, on second thoughts, lets not. But, this is why hand cream makes such a thoughtful and useful gift (and maybe why our orange and vanilla hand cream recipe was so popular).
I love the idea of giving something really special and a beautifully scented, soft hand cream without all the weird stuff is a rare thing, indeed.
How gorgeous are the printable tags! Sarah from TOMFO did them and they'd be perfect on any Christmas gift, not just this hand cream. I still remember the first time I visited Sarah's gorgeous blog and I'm sure you will too. It is printable and creativity heaven. Click here to download the free printable gift tags.
One of the best gifts I received when my prem boy was in hospital was hand cream. It was from a mother who'd been through a similar thing and knew I would need it. A baby means a lot of hand washing for a mum, but a baby in hospital turns hand washing into an extreme sport.
I love my orange and vanilla hand cream, but some people prefer a softer cream, so I've been on a mission to create one (without preservatives) soft enough to use in a pump bottle. I think I have it, but unfortunately, the humid and hot weather of Sydney means I have not been able to road test this in cool conditions, but if any of you guys battling through winter could let me know how it goes, I'd really appreciate it!
Lime hand cream recipe
Lime is wonderful for hands, because it's loaded with anti-oxidants and is thought to have antiseptic, nourishing and restorative properties. But really, it's the smell that always gets me. Here's my coconut and lime body butter recipe if you needed more proof!
However, citrus oils can make some skins more sensitive to the sun, which is why I never use them on the face, but if you're prone to burning then don't use this before going out to spend time in the sun. I haven't found any scientific studies on this yet, so can't give concrete details, but I suspect the notion is based on the way people in the 1970s used to rub lemon juice to enhance their tans!
I love using macadamia oil because it has a beautiful relationship with the skin, but it can be expensive and a good quality sunflower seed oil is a fantastic option too.
Carrot or borage seed oils are optional, but they're both thought to be awesome for helping nails grown long and strong!
Vtamin E is an antioxidant that helps the skin and keeps the oils and butter happier for longer in the jar. Vitamin E capsules are usually available at the pharmacy.
This hand cream is designed to be used on damp or wet hands, this is a sneaky way to create a hand 'lotion' without all the preservatives.
My notes on cleaning and sterilising equipment is here.
- 50 g/ 1.8 oz Shea butter
- 50 g/ 1.8 oz Macadamia or sunflower oil
- 10 g/ 0.3 oz vegetable glycerine
- 20 drops lime essential oil
- 1 vitamin E capsule
- Clean and sterilise equipment and jars.
- Line up your jar ready for the pour.
- Place a stainless steel bowl or pot onto a saucepan of simmering water.
- Add shea butter and macadamia or sunflower oil.
- Gently whisk until completely melted.
- Take the pot off the heat, but leave the bowl sitting in the hot water.
- Whisk in glycerine, essential oil and vitamin E.
- Pour into jar, being careful to avoid air bubbles.
- Tap the container twice, to encourage any air bubbles up to the surface.
- Leave the lid off and put in the fridge to cool.
- Check after half an hour. If it looks like a layer is forming, whisk with a small fork.
- Put the lids on the containers when completely cool.
- Label with date, ingredients and instructions to use on damp or wet hands.
- Test for allergies in a discrete spot before use.


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Posted by MyDrDenese on September 28, 2015 at 9:30am
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Left ventricular morphology and response to beta-adrenergic stimulation in apical ballooning syndrome
Aims The patho-physiology of apical ballooning syndrome (ABS) has not been clearly defined. The aim of this study was to determine whether patients with a history of ABS are more likely to develop left ventricular (LV) mid-cavity or outflow tract obstruction, or have a greater regional LV contractile response to an adrenergic stimulus compared with normal controls.
Methods and results Twenty patients who had recovered from ABS and 15 age-and sex-matched controls had dobutamine stress echocardiography with incremental doses up to 20 µg/kg/min. On average ABS subjects had slightly greater basal LV interventricular septal (1.1 ± 0.24 cm vs. 0.93 ± 0.12, P = 0.03) and posterior wall (1.04 ± 0.16 vs. 0.91 ± 0.11 cm, P = 0.02) diameters compared with controls but LV end-diastolic and end-systolic volumes and LV ejection fraction were similar both at rest and after dobutamine. Regional and global LV contractility, measured with the strain rate and tissue velocity imaging were also similar during the dobutamine infusion up to 10 µg/kg/min in ABS and controls. Mid-LV or LV outflow tract obstruction was not present at rest in any subjects, but was common during peak dobutamine infusion both in the ABS (45%) and controls (53%, P = 0.62).
Conclusions Dynamic LV obstruction with dobutamine is common in those with and without prior ABS. However, this study did not identify a greater individual predisposition to LV obstruction, or a different regional or global LV contractile response to dobutamine in patients with a history of ABS compared with control subjects.
- Apical ballooning syndrome
- Tako-tsubo cardiomyopathy
- Dobutamine stress echocardiography
- left ventricular outflow tract obstruction
Apical ballooning syndrome (ABS), also known as Tako-tsubo or stress-induced cardiomyopathy, is characterized by acute, reversible apical and mid-left ventricular (LV) akinesis occurring in the absence of obstructive coronary disease. ABS is often triggered by severe emotional or physical stress, and is more common in women.1 Dobutamine and epinephrine can both cause ABS2 confirming an important patho-physiological role of catecholamine excess. The temporal pattern of the wall motion abnormality and diffuse T-wave change on electrocardiogram are consistent with acute stunning of the LV apical myocardium. Dynamic mid-ventricular cavity obstruction3,4 and systolic anterior motion (SAM) of the mitral valve with left ventricular outflow tract (LVOT) obstruction5–7 have been described in acute ABS, and dobutamine has been noted to cause LVOT obstruction in some patients.4,8 These observations have led to the hypothesis that intense adrenergic stimulation may lead to dynamic mid-ventricular and/or LVOT obstruction causing a marked increase in apical LV mechanical wall stress which can result in apical myocardial stunning.4,9,10 It is currently not clear which factors predispose some individuals to develop ABS.10 One possibility is that individual differences in the LV structure could increase the LV outflow obstruction with exposure to excess catecholamines. Individual variations in the anatomy of cardiac innervation or adrenoceptor distribution have also been postulated as possible predisposing factors.10 However, there has been no systematic assessment of the LV morphology or evaluation of the response to beta-adrenergic stimulation in patients who have recovered from ABS compared with normal controls. The aim of this study was to compare LV morphology, the global and regional LV response to beta-adrenergic stimulation and the incidence of inducible mid-LV and LV outflow tract obstruction in patients who have recovered from ABS compared with age- and sex-matched normal controls.
Study population
Twenty patients after recovery from ABS and 15 age- and sex-matched controls were studied. Patients from an Auckland regional research database were approached to participate. ABS patients were studied at least 6 weeks after the episode of ABS. For inclusion patients had to meet the current modified Mayo classification11: (i) transient hypokinesis, akinesis, or dyskinesis in the LV mid-egments with or without apical involvement; regional wall motion abnormalities that extend beyond a single epicardial vascular distribution; and frequently, but not always, a stressful trigger; (ii) the absence of obstructive coronary disease or angiographic evidence of acute plaque rupture; (iii) new ECG abnormalities (ST-segment elevation and/or T-wave inversion) or modest elevation in cardiac troponin; and (iv) the absence of pheochromocytoma and myocarditis. Control patients were recruited by advertisement from the local community and had no history or clinical evidence of cardiovascular disease or valvular heart disease. All patients and controls gave signed informed consent. The study protocol was approved by the regional ethics board.
Study power
We planned a study with 20 ABS and 15 control subjects. Prior published data indicated that the probability of inducible LV obstruction is 0.2. If the true probability of exposure among cases is 0.7, we will be able to reject the null hypothesis that the rates for case and controls are equal with probability (power) of 0.77.
Dobutamine stress echocardiography
Patients and controls were studied at rest and after incremental infusion of intravenous dobutamine—5, 10 and 20 μg/kg/min—in 5 min stages. Beta-blocker medication was withheld for 36 h prior to the study. The studies were performed in the morning and subjects were not fasted. The dobutamine infusion was stopped once the 20 μg/kg/min stage was completed, or earlier if any of the following occurred: 85% of the patient's maximum predicted heart rate was exceeded, intra-ventricular or LVOT obstruction developed, moderate mitral regurgitation (MR) developed, atrial flutter/fibrillation or non-sustained ventricular tachycardia, patient requested discontinuation due to discomfort, 2 mm of new ST depression on the ECG, or other evidence of clinical instability judged by the supervising doctor to necessitate discontinuation.
Two-dimensional echocardiography was performed using a Vivid 7 Dimension machine (General Electric, Vingmed Ultrasound, Horten, Norway). At rest only, basal LV wall thickness (interventricular septum, IVS and LV posterior wall, LVPW) were obtained from the parasternal views according to standard guidelines12 and the length of the anterior mitral valve leaflet was measured in diastole and the distance from the mitral valve tips to the IVS in late systole. At rest and at each dobutamine stage, standard apical two- and four-chamber and basal and mid-LV short-axis images were obtained. Frame rates were optimized to facilitate analysis of LV strain using speckle tracking software.13 Tissue velocity imaging was obtained at the septal and lateral mitral annulus. Colour Doppler was used to assess the presence of MR. Colour and continuous wave (CW) Doppler were used to evaluate the presence of mid-ventricular (MVO) or LVOT obstruction.
Echo analysis
All echo analysis was performed by an experienced echocardiographer (R.G.) blind to whether subjects were ABS patients or controls. LV end-diastolic and end-systolic volumes and ejection fraction were measured from the apical four-chamber and two-chamber views using the bi-plane Simpson's method.12 2D speckle tracking was used to assess regional myocardial strain in the apical four chamber and basal and mid-LV short-axis acquisitions. Using Echopac system software, 2D speckle tracking analysis was used to derive regional longitudinal and radial strain and the strain rate using a standard 16 segment model. Strain can be considered to be a measure of regional shortening fraction and relates to ejection fraction. The strain rate correlates well with the LV contractility.14 The longitudinal analysis was performed at the baseline, 5 and 10 μg/kg/min stages. For summary purposes, the longitudinal strain and the strain rate obtained from each of the four individual basal, mid, and apical two- and four-chamber segments were averaged to give basal, mid, and apical regional strain and the strain rate, respectively. Global longitudinal strain and the strain rate were obtained by averaging the basal, mid, and apical data. The radial analysis was performed at the baseline and 5 μg/kg/min stages. Image quality was technically suboptimal for analysis at higher doses of dobutamine. The radial strain and the strain rate were derived for the basal and mid-ventricular short-axis acquisitions. For summary purposes, the six short-axis segments at each level were averaged. MR severity was graded 0–4.15 The length of the anterior mitral valve leaflet was measured from the parasternal long-axis view in early diastole. The MV-to-IVS height was the vertical distance from the parasternal long-axis view between the mitral valve leaflet tips and the basal interventricular septum, measured at end systole. LVOT obstruction was defined as the presence of SAM of the mitral valve with a late-systolic peaking (dagger shape) gradient on CW Doppler envelope (peak velocity >3 m/s).16 MVO was defined as the presence of a dagger-shaped late systolic gradient on CW Doppler along the long-axis of the LV that exceeded the basal peak velocity by at least 1 m/s16 in association with colour Doppler localization of the obstruction at the mid-ventricular level.
Descriptive statistics for continuous variables were summarized as mean with standard deviation, and median with inter-quartile range. Categorical data are reported by frequency and percentage. Comparisons between groups were performed by the two sample Student's t-test or Mann–Whitney U test (for non-normally distributed data). χ2 test or Fisher exact test was used for categorical variables. All P-values reported were two tailed and a P-value <0.05 was considered significant. Data were analysed using SAS statistical package, version 9.1.3 (SAS Institute, Cary, NC).
Clinical features
Twenty patients with ABS and 15 controls were studied. The baseline characteristics of patients with ABS and controls are summarized in Table 1. For the ABS group, the mean time after the acute episode of ABS was 477 days (range: 37–1557 days). All were women with mean ages of 66.0 ± 10.1 and 61.5 ± 6.8 years, respectively. ABS and controls had similar mean body mass index (26.4 ± 6.3, 26.5 ± 5.4, P = 0.64). The mean systolic blood pressure and prevalence of hypertension were higher in the ABS group, although these differences were not statistically significant. Fifty per cent (n = 10) of ABS patients were taking beta-blocker medication and none of the controls.
|Baseline characteristics
|ABS (n = 20)
|Control (n = 5)
|Age (mean ± SD)
|66.0 ± 10.1
|61.5 ± 6.8
|Female [n (%)]
|20 (100)
|15 (100)
|Ethnicity [n (%)]
|16 (80)
|15 (100)
|Maori/pacific/other specify
|4 (15)
|0 (0)
|Height (mean ± SD)
|160.3 ± 6.4
|161.4 ± 7.5
|Weight (mean ± SD)
|68.2 ± 15.6
|69.0 ± 14.2
|Systolic BP (mean ± SD)
|134.2 ± 26.4
|125.7 ± 14.0
|Diastolic BP (mean ± SD)
|77.8 ± 8.4
|76.5 ± 7.5
|Heart rate (mean ± SD)
|67.6 ± 9.1
|63.1 ± 6.9
|Hypertension [n (%)]
|10 (50)
|4 (26.7)
|Medications [n (%)]
|13 (65)
|2 (13.3)
|1 (5)
|0 (0)
|12 (60)
|2 (13.3)
|10 (50)
|0 (0)
|Calcium channel blockers
|3 (15)
|0 (0)
|ACE inhibitors/ARB
|11 (55)
|1 (6.67)
|2 (10)
|0 (0)
|1 (5)
|0 (0)
BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; ACE inhibitors, angiotensin-converting enzyme inhibitors; ARB, angiotensin II receptor blocker.
aWilcoxon–Mann–Whitney test, otherwise unpaired t-test for continuous variable or χ2 test or Fisher's exact test for categorical variables.
Resting echocardiography
The resting echo morphology is presented in Table 2. ABS patients on average had slightly larger basal IVS and LVPW (0.93 vs. 1.1 cm and 0.91 vs. 1.04 cm for controls and ABS, respectively), although the majority of ABS cases were still within normal limits and there was considerable overlap between patients and controls. Subjects with ABS also had a lower E/A ratio, consistent with effects of mild LV on diastolic filling. There were no other significant differences on the resting echo between ABS patients and normal controls. In particular, the LV dimensions, volumes, and LV ejection fraction (EF) were similar. There was no resting MR or SAM of the anterior mitral leaflet (SAM) in either group, and both the length of the anterior mitral valve leaflet and the relationship between the mitral valve and the IVS were similar. On regional strain imaging at rest, there were no significant differences in longitudinal or radial strain at the base, mid-ventricle or apex. However, longitudinal strain rate in basal, mid, and apical LV segments was slightly higher in ABS patients than that in the controls. Radial strain rate at both the base and mid-LV did not differ between groups.
|Echocardiographic measurement
|Mean ± SD
|ABS (n = 20)
|Control (n = 15)
|LA area (cm2)
|15.8 ± 2.81
|16.7 ± 2.74
|IVS (cm)
|1.10 ± 0.24
|0.93 ± 0.12
|LVPW (cm)
|1.04 ± 0.16
|0.91 ± 0.11
|58.4 ± 13.1
|59.8 ± 10.7
|LVESV (mL)
|19.3 ± 6.2
|21.7 ± 4.7
|68.1 ± 7.2
|63.2 ± 6.8
|0.70 ± 0.18
|0.70 ± 0.17
|0.89 ± 0.22
|1.08 ± 0.25
|TVI e′ septum (cm/s)
|7.80 ± 2.17
|8.00 ± 1.25
|TVI S′ lateral (cm/s)a
|8.65 ± 2.35
|8.00 ± 1.73
|TVI S′ septum (cm/s)a
|7.10 ± 1.12
|6.87 ± 0.74
|AMVL length
|2.13 ± 0.38
|2.13 ± 0.27
|MV to IVS height
|1.23 ± 0.39
|1.17 ± 0.22
|Peak LVOT velocity (m/s)
|1.35 ± 0.22
|1.25 ± 0.17
|Peak intra-ventricular velocity (m/s)a
|1.22 ± 0.58
|0.91 ± 0.22
LA, left atrium; IVSD, interventricular septum; LVPW, left ventricular posterior wall; LVEDV, left ventricular end-diastolic volume; LVESV, left ventricular end-systolic volume; pw, pulsed-wave; TVI, tissue velocity imaging; AMVL, anterior mitral valve leaflet; MV, mitral valve; LVOT, left ventricular outflow tract.
aWilcoxon–Mann–Whitney test, otherwise unpaired t-test.
Response to dobutamine
The mean peak doses of dobutamine were 19.0 ± 3.1 vs. 18.7 ± 3.5 (P = 0.79) for ABS patients and controls, respectively. Eighteen ABS patients and 13 controls received the maximum dobutamine dose. Dobutamine was stopped because of development of an intraventricular or LVOT obstruction in nine ABS patients and eight controls (Table 3). Dobutamine was stopped because of palpitations in one ABS patient and one control, and for pre-syncope in one ABS patient. No participants developed ischaemic changes on electrocardiogram.
|Measurements at peak dose of dobutamine
|Mean ± SD
|ABS (n = 20)
|Control (n = 15)
|Maximum dose of dobutamine
|19.0 ± 3.1
|18.7 ± 3.5
|Systolic BP
|156.3 ± 29.1
|147.3 ± 11.0
|Diastolic BP
|72.1 ± 16.1
|73.5 ± 14.9
|Heart rate
|107.3 ± 15.5
|117.9 ± 13.4
|48.3 ± 13.2
|43.2 ± 11.3
|9.6 ± 5.4
|7.5 ± 3.2
|TVI S′ lateral wall
|0.16 ± 0.05
|0.19 ± 0.04
|TVI S′ septum
|0.15 ± 0.05
|0.17 ± 0.03
|MR [n (%)]
|3 (15)
|2 (13.3)
|Peak mid-ventricular velocity
|2.16 ± 0.74
|2.73 ± 1.02
|Peak LVOT velocity
|2.52 ± 1.16
|2.77 ± 0.82
|Any dynamic outflow tract obstruction [n (%)]
|9 (45)
|8 (53)
|Mid-ventricular obstruction [n (%)]
|5 (25)
|7 (47)
|LVOT obstruction with SAM [n (%)]
|4 (20)
|1 (7)
Data are presented as mean ± SD unless otherwise specified.
SBP, systolic blood pressure; DBP, diastolic blood pressure; LVEDV, left ventricular end-diastolic volume; LVESV, left ventricular end-systolic volume; TVI, tissue velocity imaging; MR, mitral regurgitation; LVOT, left ventricular outflow tract; SAM, systolic anterior motion of the anterior mitral leaflet; CW, continuous wave.
The peak heart rate was slightly higher in control patients (107 ± 16 vs. 120 ± 13, P = 0.02). As expected both the LV end-diastolic and LV end-systolic volumes decreased, and LVEF increased, with incremental dobutamine dose (Figure 1). There was no difference in this response between the ABS patients and controls. At peak dobutamine there was also no difference between both groups in septal S′, a global measure of LV contractility. There was similar augmentation of both global and regional LV strain and the strain rate with dobutamine. Achieved longitudinal strain and the strain rate at 10 µg/kg/min, and radial strain and the strain rate at 5 µg/kg/min, were also similar for the two groups (Tables 4 and 5). Radial strain and the strain rate beyond 5 μg/kg/min, and the longitudinal strain beyond 10 μg/kg/min, are not reported due to image quality precluding accurate measurement in some subjects.
|Dobutamine (µg/kg/min)
|Mean ± SD
|Mean ± SD
|Strain (%)
|Strain rate (1/s)
|−19.02 ± 3.28
|−18.93 ± 2.63
|−1.21 ± 0.17
|−1.03 ± 0.14
|−20.29 ± 2.66
|−22.64 ± 2.93
|−1.34 ± 0.24
|−1.49 ± 0.18
|−19.76 ± 3.44
|−21.08 ± 2.28
|−1.74 ± 0.37
|−1.74 ± 0.2
|−19.12 ± 2.35
|−18.53 ± 2.08
|−1.06 ± 0.11
|−0.92 ± 0.14
|−20.94 ± 2.05
|−21.96 ± 1.73
|−1.24 ± 0.17
|−1.35 ± 0.11
|−20.8 ± 2.56
|−21.56 ± 2.46
|−1.58 ± 0.26
|−1.64 ± 0.22
|−19.01 ± 3.01
|−17.47 ± 4.45
|−1.16 ± 0.32
|−0.92 ± 0.19
|−24.18 ± 3.17
|−23.97 ± 4.34
|−1.68 ± 0.3
|−1.56 ± 0.3
|−24.59 ± 4.06
|−24.23 ± 4.55
|−2.06 ± 0.46
|−2.08 ± 0.45
|−19.05 ± 1.79
|−18.31 ± 2.22
|−1.14 ± 0.16
|−0.96 ± 0.13
|−21.80 ± 1.98
|−22.86 ± 1.91
|−1.42 ± 0.19
|−1.47 ± 0.13
|−21.72 ± 2.39
|−22.29 ± 2.36
|−1.79 ± 0.31
|−1.82 ± 0.23
|Dobutamine (µg/kg/min)
|Mean ± SD
|Mean ± SD
|Strain (%)
|Strain rate (1/s)
|43.39 ± 13.63
|43.09 ± 22.28
|1.84 ± 0.27
|1.82 ± 0.50
|45.83 ± 21.17
|53.89 ± 23.15
|2.08 ± 0.67
|1.87 ± 0.23
|53.32 ± 17.14
|45.86 ± 16.78
|53.22 ± 29.57
|43.34 ± 14.36
|1.55 ± 0.32
|1.61 ± 0.29
|49.04 ± 20.9
|59.52 ± 23.15
|1.66 ± 0.37
|1.82 ± 0.39
|48.30 ± 17.58
|63.36 ± 15.33
Four (20%) ABS patients and one (6.7%) control patient (P = 0.37) developed SAM and LVOT obstruction with dobutamine. The four patients who developed SAM had a slightly larger basal IVS compared with others patients who did not develop SAM (1.41 vs. 1.13 cm, P < 0.05). The peak trans-LVOT velocities were 2.46 ± 1.16 m/s in the ABS patients and 2.77 ± 0.82 m/s in the control patients. There was associated MR in four of these five cases. In all cases, the SAM and LVOT obstruction resolved within minutes of discontinuation of the dobutamine infusion and the patients were asymptomatic and haemodynamically stable. Transient MVO was common in both groups: five (25%) ABS patients and seven (47%) control (P = 0.69) with mean gradients of 2.16 ± 0.74 and 2.73 ± 1.02 m/s, respectively.
The clinical presentation of the 20 patients on the initial ABS event is presented in Table 6. Three patients were on β-blockers before admission. Four patients presented with pulmonary oedema and one was in cardiogenic shock. More than half of the patients had significant overall impairment of LV systolic function documented either on transthoracic echocardiography or left ventriculogram during the acute phase. Moderate to severe MR was documented in two patients who also had significant dynamic outflow tract obstruction. These two patients also developed SAM and LVOT obstruction with dobutamine. One patient who developed MVO during the test had presented with acute pulmonary oedema and right heart failure during the acute phase; and one patient who developed LVOT obstruction during the test presented with cardiogenic shock during the acute phase. However, the other patients who developed LVOT or MVO during the test did not have a complicated clinical presentation during the acute phase. Four of the 20 ABS patients were admitted with recurrent episodes of ABS after discharge from the index event. Two of the four patients with recurrence developed dynamic outflow tract obstruction during the dobutamine study.
|Number of ABS patients (n = 20)
|Presenting symptoms [n (%)]
|Chest pain
|18 (90)
|10 (50)
|1 (5)
|3 (15)
|Pulmonary oedema
|4 (20)
|Cardiogenic shock
|1 (5)
|Stressor [n (%)]
|13 (65)
|7 (35)
|LV function during acute phase [n (%)]
|3 (15)
|11 (55)
|4 (20)
|2 (10)
|MR/SAM [n (%)]
|2 (10)
|ECG on admission [n (%)]
|ST elevation
|7 (35)
|Medications on admission [n (%)]
|3 (15)
|ACE inhibitors
|5 (25)
|Calcium channel blockers
|4 (20)
|Recurrence [n (%)]
|4 (20)
This study evaluated for the first time LV structure and function at rest and with adrenergic stimulation in patients who have recovered from ABS, and compared changes to normal controls. No clear differences were found to explain why some individuals are at greater risk of developing ABS. The LV wall thickness was slightly greater in subjects with a history of ABS, but the importance of LV hypertrophy to the patho-physiology of ABS is currently uncertain. Further study is needed to determine whether LV hypertrophy or other factors could predispose to apical myocardial stunning in the setting of an intense adrenergic stimulus.
We6 and others4,10 have suggested that LVOT obstruction, by markedly increasing apical intra-ventricular pressure and wall stress, could predispose to LV apical stunning. In a previous study, a dynamic mid-ventricular gradient was documented by invasive intra-ventricular pressure recording in 18% of patients studied during their admission with ABS.3 Rates of dynamic MVO reported by echocardiography in acute ABS have been similar.17,18 Several small studies have reported dynamic LVOT obstruction on echocardiography performed at the index admission with incidence ranging from 5 to 25%.7,19,20 In virtually all patients studied the mid-ventricular and LVOT obstruction resolved on subsequent studies.3,21 In one study dobutamine infusions induced mid-ventricular or outflow gradients in 28% of ABS patients early after the acute presentation and prior to full recovery of LV function.22 In these studies, most patients did not have intra-ventricular or outflow gradients after presentation with ABS. However, to evaluate a possible causal role of intra-ventricular obstruction evaluation needs to occur during the excess adrenergic stimulation and before myocardial stunning and apical dilation have occurred, or as in this study, after LV function has returned to normal.
MVO has been reported in 15–23% of patients referred for dobutamine stress echocardiography for suspected coronary artery disease.16,23,24 LVOT obstruction outflow tract obstruction was seen in 12% of patients.22 Both mid-ventricular and LVOT obstruction were more likely in women16,23,24 and, as in the current study, LVOT obstruction was more common if mild LV septal hypertrophy was present.6,24 Women on average have a smaller LV and therefore may have a greater predisposition to LV cavity or outflow tract gradients.23,25 In the current study, mid-ventricular or outflow gradients were observed during the dobutamine infusion in almost half of subjects with ABS. It is possible that gradients could have occurred in all subjects with a more intense adrenergic stimulus, as with the event which triggered the acute presentation. However, a similar high prevalence of mid- and outflow gradients occurred during the dobutamine infusion in normal female controls, suggesting that patients with a history of ABS do not have a greater predisposition to intra-ventricular gradients with excess sympathetic activity. This would not exclude the possibility that high intra-ventricular gradients contribute to apical stunning and ballooning, but does suggest additional factors are likely to be important.
It has been suggested patients with ABS may be more sensitive to adrenergic stimulation.26 However, in this study the increase in contractility with a standard dose of dobutamine was similar for subjects with ABS and normal controls suggesting a similar sensitivity of the myocardium to adrenergic stimulation. Regional differences in beta-receptor density have also been suggested as the explanation for the apical distribution of myocardial stunning.27 However, myocardial tissue Doppler imaging during beta-adrenergic stimulation did not identify regional or global differences in myocardial strain or strain rate between patients and controls during the dobutamine infusion. Due to image quality limitations, strain and the strain rate could only be assessed at lower doses of dobutamine. We were therefore unable to assess the differences between the groups which might have been evident only at higher doses. Coronary micro-vascular function may be abnormal in ABS28 but this was not directly evaluated in this study.
In our study women with ABS had a slightly higher longitudinal strain rate at rest. We cannot ascertain whether this was due to differences in resting sympathetic tone, to recent beta-blocker withdrawal, or an intrinsic myocardial difference. A higher rate of chronic anxiety has been reported in ABS.29 Patients with ABS have also been reported to have greater vascular reactivity, decreased endothelial function, and greater increases in catecholamine levels in response to acute mental stress.30
In this study four ABS patients developed significant MR due to SAM during the dobutamine infusion which resolved rapidly after the infusion was stopped. Severe MR due to SAM may be an important mechanism contributing to acute LV failure and shock in 20–40% of patients with ABS3,21 and has been associated with a more adverse clinical course.19
Dobutamine was chosen as the adrenergic stimulant because of extensive clinical and safety data in patients with suspected cardiac disease, and because dobutamine has been reported to trigger ABS. The maximum dose of 20 µg/kg/min was half the typically maximum dose used when stress testing for coronary artery disease. We were careful not to use a high dose which might cause ABS. At the moderate doses used, there was no difference in the myocardial performance between patients and controls, but we cannot exclude the possibility of a difference with very intense or more prolonged adrenergic stimulation. We were interested in whether there were consistent and major differences in response to adrenergic stimulation between patients and controls. This study had reasonable power to exclude a 50% difference in the incidence of LV obstruction. Smaller between-group differences cannot be excluded but there was no trend in the ABS group towards more frequent LV obstruction. Nor was there any trend towards a systematic between-group difference in LV response to dobutamine across a range of LV volume and strain rate imaging measures. ABS is relatively rare and this detailed mechanistic study was not large enough to evaluate possible heterogeneity between ABS patients.
The frequent occurrence of the LV outflow obstruction during dobutamine infusion is consistent with the hypothesis that LV mid-cavity and outflow tract gradients during an intense adrenergic stimulus explain the apical distribution of myocardial stunning in ABS. However, this study did not identify a greater individual predisposition to LV obstruction, or a different regional or global LV contractile response to dobutamine in patients with a history of ABS compared with control subjects.
Conflict of interest: none declared.
This work was supported by National Heart Foundation, New Zealand [grant number #1236] and Middlemore Hospital Cardiology Trust.
We thank Sela Takau and Fiona Doull (sonographers), and Jenny White, Pauline Clarke and Gina Barker (research nurses) at Middlemore Hospital for their help during the dobutamine stress echocardiography.
- Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. For permissions please email: email@example.com


text:
Updates from Saturday, Aug. 23
Ralph Vacchiano of the New York Daily News has the latest on Hillis:
Coughlin believes RB Peyton Hillis will try to do some work on the field this week.— Ralph Vacchiano (@RVacchianoNYDN) August 23, 2014
Updates from Thursday, Aug. 7
Peyton Hillis spoke about the status of his injured ankle on Thursday (via Ebenezer Samuel of the New York Daily News):
Peyton Hillis says his ankle is "coming along really well. It's progressing really well."— Ebenezer Samuel (@ebenezersamuel) August 14, 2014
Updates from Wednesday, Aug. 6
Mike Garafolo of Fox Sports passed along the latest on Peyton Hillis' injured ankle:
Per NYG beats, Tom Coughlin just said at his presser that RB Peyton Hillis will be out "a while."— Mike Garafolo (@MikeGarafolo) August 6, 2014
Original Text
The New York Giants continue to experience bad luck at the running back position as Peyton Hillis suffered an ankle injury during practice on Tuesday.
Ralph Vacchiano of the New York Daily News reported the news:
RB Peyton Hillis has an ankle injury. No further details provided by the Giants ... yet.— Ralph Vacchiano (@RVacchianoNYDN) August 5, 2014
Paul Schwartz of the New York Post added another detail:
Peyton Hillis has a sprained ankle, according to the Giants. #nyg— Paul Schwartz (@NYPost_Schwartz) August 6, 2014
Not much is known about the severity or cause of the injury. Vacchiano reported earlier in the day that Hillis left the field with trainers:
RB Peyton Hillis just left the field and headed inside for unknown reasons.— Ralph Vacchiano (@RVacchianoNYDN) August 5, 2014
Coincidentally, this comes on the same day that ESPN.com's Dan Graziano reported that after David Wilson's injury, Hillis jumped to No. 2 on the Giants' depth chart behind Rashad Jennings. He ran for 36 yards on seven carries in New York's 17-13 Hall of Fame Game win over the Buffalo Bills Sunday night.
Considering that the timetable for Hillis' return remains unknown, it's a bit early to start predicting that rookie Andre Williams will jump ahead of the former Cleveland Brown and Kansas City Chief in the running back hierarchy. A lot can happen between now and Week 1.
Despite his struggles over the last few years, you'd expect that a healthy Hillis would remain New York's primary backup to Jennings in the backfield. However, the longer that Hillis is out, the more the door opens for Williams to steal more carries and impress coaches on the practice field.


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The Tour de Cure is more than just a cycling event, it's a day packed with excitement and energy where riders of all levels join forces in the fight to Stop Diabetes® and raise critical funds for diabetes research, education and advocacy in support of the American Diabetes Association. In 2016 there will not be a Tour de Cure event in Orange County, but we are encouraging all interested riders to participate in the following Tour de Cure's:
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text: Ex-Citigroup VP Charged With Embezzling $19.2M He allegedly stole more than $19M By Kevin Spak, Newser Staff Posted Jun 27, 2011 2:43 PM CDT 8 comments Comments In this April 13, 2010 file photo, a branch of Citibank in New York, is shown. (AP Photo/Richard Drew, file) (Newser) – Former Citigroup vice president Gary Foster has been charged with embezzling more than $19 million from the company. Foster, 35, was nabbed yesterday at JFK airport in New York, after arriving on a flight from Bangkok, Reuters reports. Prosecutors say that between May 2009 and December 2010, Foster funneled the money from Citi's debt-adjustment and income-expense accounts into his personal JPMorgan account, using fake contract and deal numbers to hide the transactions. Citi didn't notice the theft until a recent audit. When investigators found it, they immediately alerted the FBI. A spokesman says the bank is "outraged," and "cooperating fully to ensure Mr. Foster is prosecuted to the full extent of the law."


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Zone One: A Novel
A Novel
by Colson Whitehead
- #217 in Fiction & Literature, Horror
- #286 in Science Fiction & Fantasy, Horror
- #698 in Fiction & Literature, Literary
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In this wry take on the post-apocalyptic horror novel, a pandemic has devastated the planet. The plague has sorted humanity into two types: the uninfected and the infected, the living and the living dead.
Now the plague is receding, and Americans are busy rebuilding civilization under orders from the provisional government based in Buffalo. Their top mission: the resettlement of Manhattan. Armed forces have successfully reclaimed the island south of Canal Street—aka Zone One—but pockets of plague-ridden squatters remain. While the army has eliminated the most dangerous of the infected, teams of civilian volunteers are tasked with clearing out a more innocuous variety—the "malfunctioning" stragglers, who exist in a catatonic state, transfixed by their former lives.
Mark Spitz is a member of one of the civilian teams working in lower Manhattan. Alternating between flashbacks of Spitz's desperate fight for survival during the worst of the outbreak and his present narrative, the novel unfolds over three surreal days, as it depicts the mundane mission of straggler removal, the rigors of Post-Apocalyptic Stress Disorder, and the impossible job of coming to grips with the fallen world.
And then things start to go wrong.
Both spine chilling and playfully cerebral, Zone One brilliantly subverts the genre's conventions and deconstructs the zombie myth for the twenty-first century.
From the Hardcover edition.
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[Photos: WENN]
Around The Web
Gah. She just reeks of "try hard" now. Is that what her perfume smells like too?
Smells like desperation to me.
According to a review, the perfumes are disappointingly safe, totally wearable and nice. Nothing outrageous or special about them.
Just like Gaga! More about the wrapper than the candy inside.
Does her handbag say "Corn?" Do you think it's actually full of corn?
It says cunt. Charming.
Oh, that's too bad. Corn would have been funnier and, ironically, more different.
It actually says "c*nt"
I assume her appropriation of the burqa is her way of commenting on current events? At least, that would make sense, if that were the case.
That burqa stunt is incredibly offensive. When exactly did she wear this? Because if it was after the shit hit the fan with The Innocence of Muslims last week, then it upgrades from just offensive to irresponsible.
I smelled her perfume. Honestly, it smells just as rank as you would expect it to.
PS: Missy did the black balloon thing 15 years ago. And she did it better.
Missy Elliott is amazing. That video was one of the best pieces of art I have ever seen in any medium.
I remember reading somewhere she wanted her perfume to smell like blood and semen… can't recall the source though. Also she reminds me a bit of Peaches Geldof in the second picture.
I read that too….also, something about it smelling like a used hooker.
Refinery29 had their editors blind-test it, and one of them said it smelled like babies, which I think is hilarious.
I just stopped on number 5, smiled and propped my chin on my fist for a moment. I love you, Gaga. Stay just this way.
I have some serious Gaga fatigue right now. I just can't bring myself to care anymore. Although this was slightly worth it for the Andre Leon Talley joke.
I smelled the perfume in Sephora over the weekend and didn't like it at all. It's very reminiscent of "Poison". Supposedly, the top notes are blood and semen, which isn't the scent that I want on my skin.
The blood and semen thing was a joke she made before she actually started working on the perfume. The actual thing doesn't have any blood or semen in it, nor does it try to smell like it. I can see where people would be confused, though.
I'm not sure it was a joke. I think she fully intended for that to be the case, but (1) Coty will never allow a truly unusual perfume to be produced, as SJP already tried and was talked into her relatively tame scents and (2) blood and semen have already been done in a perfume.
Is she dressed as a cockroach in slide one?
OMG, thank you. I thought I was the only one seeing Gaga in the middle of a Kafka-esque metamorphosis.
Yes! Me, too!
Me too! That's all I see when I look at that, is a giant, mutant cockroach.
I love Gaga, I do, but I love her when she's not so…Gaga. There's a level where it's eccentric, and then there's a level where it's trying WAY too hard to be eccentric. Slide 1 and 2 and even 3 is about the limit of Gaga-ness I can take.
No, no it does not say "corn." It says something I am sure I cannot print here, nor do I want to.
However, it may well be full of the stuff. She certainly is.
As a singer and musician, I love Gaga – a range like Freddie Mercury's (the original comparison was apt), beautifully trained, perfect pitch. Gorgeous sound.
But looking at her just makes me so very tired now. It was fun for a while; it's time to move on.
Wow, a Lady Gaga perfuuuuuuuuuajjjjjjxxxxxxxxxxxxxx…
Sorry, I dozed off there for a second because she is SO MOTHER-EFFING BORING. Wake me up when she does something interesting.
I found where she says the thing about blood and semen (and EEEWWWW) http://www.eonline.com/news/330757/lady-gaga-gets-naked-for-fame-fragrance-ad
It does not, of course, actually contain those things. That's an old and out-of-context quote from an interview in which she was speculating about the fragrance before it was ever made.
Still, I agree, eeeewww.
Though I rather like the advertisement photo!
Yeah, I mean, those things are why there's soap and water, right?
Hey, so she really IS Deadmau5 (looking at the huge ears in pic #3)!
I feel like the only thing she could do now that would be shocking is if she were to wear normal clothes.
She has several times – and she looks good in them. But does that really equal to a burqa with a 'cunt' clutch?
It's all about the statement – and I guess not caring whether people like it or not is where art comes in.
Somewhere, Deadmau5 is looking a picture #3 and having a hissy fit.
And Madonna as well…is it just me, or does the makeup in #3 make her look Madonnaesque?
Has anyone pinpointed a theme in any of this schlock?
Bored now.
I kind of love Lady Gaga, and even so, this slideshow just makes me SO TIRED.
I smelled the perfume too, and I can't remember how it smells. That's how average it is. And corn on the purse would have made me think way more profound thoughts.
In the one with the decorative wreath my Nana made in a Michael's Crafts seminar, I can't help but wonder: does Gaga ever just get all "pphhpbbt ppphhhhs ppbbhhpbbht dammit I can't breathe wissh theesh flowersh in mah moussh"?
I actually think it smells okay- can't detect any blood or semen notes- but my husband says it smells like a grandma.
"And before you ask," he added, "No, not a sexy grandma. Just straight-up granny."
Flower anus is all I can see in slide 4.
Also, what kind of an assh*le still wears real fur these days?? Terrible.
Pic 6 was Gaga opening Phillip Treacy's show. 4 is her in the audience (I think it's a Treacy hat) and 3 is a hat that was in the show. There was a smiley hat. Brilliant!
No other celebrity could carry of that "giant beetle" look nearly as well.
There, I said something nice.
What an idiot, just so predictable.
I can respect her desire to describe herself as 'slutty'/to have a fragrance that smells personal and slutty, but I'm gagging on 'tears of belladonna' and 'the combinative essences of [bloody well anything]'.
Silly singer! Belladonna does not weep. It is poisonous, it cackles evilly. and come on, doesn't that sound better? 'Evil cackles of belladonna'. Perfect.
And 'combinative'?! Is this supposed to mean the notes combine (in which case, please don't bother saying so; they're in a bottle together, we can figure this out ourselves), or 'combined' (which conveys actual meaning in this context; why do you want to make people all stabby by using a word that conveys nothing?!).
I'm displeased with that huge bow, which makes it seem like cheap, showy, ubiquitous holiday gift of the year (the one you get several of when you actually would have preferred something else).
I am somewhat reminded of the link in fug and pieces about people desperately trying to be covered during fashionweek.
I just laughed for 5 minutes solid at the flower helmet. Then showed hb and we both laughed.
I do love her.
Hmmm blood and semen with a little top note of ….. ummmm…… desperation ???
I was okay with her meat dress. The tail caftan, on the other hand, horrifies me.
Somewhere, Allison Harvard is saying, "Honey… blood?" and giving Gaga a violent side eye. http://24.media.tumblr.com/tumblr_m80n115XUv1ryysfpo1_500.gif
It must be so EXHAUSTING to be her and have to keep up her annoying, 'different', 'creative' shtick all the time. I wonder if she ever wants to go to an event in just a cute cocktail dress and regular heels. Or *gasp* jeans and a tshirt or something.
the semen thing is legit. my friend's mom is fairly high up in the company that designed the scent with her, and was at the initial meeting. i actually got a text that said 'lady gaga wants her perfume to smell like bodily fluids! my mom has the weirdest job!'
Smelled her perfume… I'm fairly certain it's Welch's grape juice!


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"Wow. What can I say. All tip top. Everything nice, clean, really large rooms. Very pleasant surprise. It was last minute booking for us. Never expected to be so great. Owner was very helpful, and very polite. Made a breakfast to die for. Any request within reason was no problem. Very very quiet p..."
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text: npr Wait Wait Don't Tell Me At Tanglewood 9/1 By Joe Donahue • Aug 31, 2016 Listen Listening... / 14:52 NPR's oddly informative weekly hour-long news quiz program, Wait Wait…Don't Tell Me! returns to Tanglewood in Lenox, MA on September 1. The Peabody Award-winning series offers a fast-paced, irreverent look at the week's news, hosted by Peter Sagal along with judge and score-keeper Bill Kurtis. Bill Kurtis joins us. Frank Deford Looks Back On 1,600 NPR Commentaries By Ian Pickus • Jun 15, 2016 Listen Listening... / 20:39 Chances are if you're a dedicated WAMC listener, Frank Deford is a part of your morning routine. The legendary sportswriter has delivered more than 1,600 commentaries for Morning Edition over the past 36 years. His wry and incisive observations remain a refreshing antidote in an age of shouty sports talk defined by hot takes. An Emmy and Peabody winner, Deford has written 18 books and serves as senior contributing writer at Sports Illustrated, where he first appeared in 1962. He's also a correspondent for Real Sports on HBO. This Saturday, Deford will sign copies of his new book I'd Know That Voice Anywhere: My Favorite NPR Commentaries at Sweetpea in Stone Ridge, New York. #1336: "Talking Science With Ira Flatow" By Bob Barrett • Apr 28, 2016 Michael Spooneybarger / CREO Back in the early 1970s, a new network called National Public Radio hired a young producer out of college who had two special interests: baseball and science. And since the network didn't plan on doing much sports coverage, he finally got on the air with that other topic. Today on the Best Of Our Knowledge, I sit down with Ira Flatow, the person who founded NPR's Science Unit and the host of the weekly public radio program Science Friday. We'll also spend an academic minute with the millions of cells in your body that don't really belong to your body…your microbiome. A Song As A Call To Action: Bob Boilen's Your Song Changed My Life By Joe Donahue • Apr 15, 2016 Listen Listening... / 20:28 From the beloved host and creator of NPR's All Songs Considered and Tiny Desk Concerts comes an essential oral history of modern music, told in the voices of iconic and up-and-coming musicians, including Dave Grohl, Jimmy Page, Michael Stipe, Carrie Brownstein, Smokey Robinson, and Jeff Tweedy, among others—published in association with NPR Music. Is there a unforgettable song that changed your life? NPR's renowned music authority Bob Boilen posed this question to some of today's best-loved musical legends and rising stars. A Nation Of Nations: A Great American Immigration Story By Joe Donahue • Nov 6, 2015 Listen Listening... / 12:49 In his new book, A Nation Of Nations: A Great American Immigration Story, veteran NPR correspondent Tom Gjelten assesses the impact and importance of the 1965 Immigration and Naturalization Act by interweaving the story a handful of immigrant families with the history and analysis of the immigration changes in America as a whole. The fiftieth anniversary of the 1965 act is this month and immigration continues to be a hot button issue in American politics. Tom Gjelten is a long time NPR news correspondent, he's covered wars in Central America, the Middle East, and the former Yugoslavia, as well as major national stories in the United States. His NPR reporting has won him two Overseas Press Club Awards, a George Polk Award, and a Robert F. Kennedy Journalism Award. Ari Shapiro Settling In As "All Things Considered" Host By Ian Pickus • Oct 26, 2015 Doby Photography /NPR Listen Listening... / 11:12 Our guest Ari Shapiro has been a frequent voice on WAMC's airwaves as an NPR correspondent for years. He spent four years covering the White House and five as Justice Correspondent; in fact, he was once an intern for NPR's Legal Affairs Correspondent Nina Totenberg. Now, he is on to his next job, and it's his highest-profile gig yet: anchor of All Things Considered, which airs on WAMC weekdays 4-6 p.m. David Greene Co-Hosts NPR Presents: Family Matters In Albany By Sarah LaDuke • Oct 14, 2015 Listen Listening... / 16:03 Tomorrow evening in the Recital Hall at the University at Albany, Morning Edition host David Greene and NPR reporter Yuki Noguchi will co-host an NPR Family Matters event, presented by WAMC and WMHT. Together with Michelle Singletary, a nationally-syndicated personal finance columnist for The Washington Post, and financial planner Louis Barajas [lew-iss buh rah hass], they'll tackle a number of topics, like paying for college, buying a home and saving for retirement. The event is free and open to the public. Michelle Singletary – NPR's Family Matters Series In Albany, NY By Joe Donahue • Oct 2, 2015 Listen Listening... / 16:03 On October 15th NPR's Morning Edition Host David Greene and NPR reporter Yuki Noguchi will be in Albany with Michelle Singletary, a nationally syndicated personal finance columnist for the Washington Post, and financial planner Louis Barajas for a conversation about personal finance. It is part of NPR's Family Matters Series. They will tackle a number of topics like paying for college, buying a house, and paying for retirement. All of this happens October 15th at the University at Albany Recital Hall. NPR's Guy Raz Previews New TED Radio Hour Season By Ian Pickus • Mar 4, 2015 Kainaz Amaria Listen Listening... / 11:11 NPR's Guy Raz has been a frequent presence on these airwaves for a decade and a half, working as the network's youngest ever foreign correspondent, the host of weekend All Things Considered, and his current gig at the helm of the TED Radio Hour. Go West, Young Man: Arun Rath Lands Dream Job At Weekend 'All Things Considered' By Ian Pickus • Nov 26, 2013 Peter A. Smith Photography/NPR Listen Listening... / 11:00 WAMC listeners noticed a new voice on the air in September when Arun Rath took over the host's chair at NPR's Weekend All Things Considered, which is now broadcasting from NPR West in Culver City, Calif. NPR's Michele Norris At Simon's Rock By Joe Donahue • Sep 17, 2013 Listen Listening... / 22:46 Award-winning journalist, current NPR host and special correspondent, and former co-host of NPR's newsmagazine All Things Considered, as well as Best Selling Author and creator of The Race Card Project, Michele Norris comes to Bard College at Simon's Rock to discuss her work and offer her perspective on tackling complex conversations and having meaningful dialogue about race and diversity. Michele Norris is an award-winning journalist with more than two decades of experience. She is currently a host and special correspondent for NPR. Previously, Norris served as co-host of NPR's newsmagazine All Things Considered, public radio's longest-running national program, with Robert Siegel and Melissa Block. In September, 2010, Norris released her first book, The Grace of Silence: A Memoir, which focuses on how America talks about race in the wake of Barack Obama's presidential election, and explores her own family's racial legacy. 3/14/13 - Panel By Joe Donahue • Mar 14, 2013 Listen Listening... / 45:47 Today's panelists are Dr. Alan Chartock, Assistant Professor of Journalism at the University at Albany, Rosemary Armao, and WAMC Morning Edition host, David Guistina. This morning our discussion topics include:1. Pope Francis I2. Shooting in Herkimer3. NPR for younger listeners4. H&R Block Filing Error NPR veep weighs in on sequestration cuts By Alan Chartock • Mar 6, 2013 Steve Barrett/NPR With sequestration now in operation across the country, many facets of federal spending are being curtailed. WAMC's Alan Chartock caught up with Michael Riksen, Vice President of Policy and Representation at National Public Radio, to discuss the threat to public broadcasting.


text: There are so many discussions swirling around evangelicals' best choice for president that it makes your head spin. To make sense of it all, I offer five qualities of the perfect religious president. –The perfect religious president should have an active faith that is detached (or as detached as it ever can be) from their [Read More…]


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There are a few ways to get your hands on rich, creamy, New England clam chowder from Legal Sea Foods, which is so delicious it's been served at every Presidential inauguration since 1981. (1) You can fly up to Boston, where the first Legal fish market and restaurant opened in 1950. (2) You can order the chowder (call 800-343-5804), along with a clam bake or a Maine lobster or two from Legal by phone. (3) You can simply drive over to the new Legal outlet in the Oasis at Sawgrass Mills (2602 Sawgrass Mills Cir., Sunrise, 954-846-9011), where the chowder is delivered. Yes, the restaurant is part of a chain, but it's one of the best chains in the country. Look at it this way: Can five United States Presidents be wrong?
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Home > Sunglasses > Carrera > CARRERA 6000/MT (SIG/JO)
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from Wiktionary, Creative Commons Attribution/Share-Alike License
- v. To drip about or all over; drip onto (something).
- n. A band of harvesters.
- n. A crowd.
from The Century Dictionary and Cyclopedia
- n. Boon-work at harvest-time: a service which some tenants had to perform at the bidding or request of their lord.
From be- ("on, about, all over") + drip. (Wiktionary)
From Middle English *bederepe, *bidrepe, from Old English bedrīp ("compulsory service rendered to a landowner at harvest time, the reaping of corn on request"), from bed ("prayer, supplication, religious ordinance, service") + rīp ("reaping, harvest"). More at bead, reap. (Wiktionary)
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