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Texas Physicians Are Choosing Wisely
Quality Feature — August 2014
Tex Med. 2014;110(8):45-59.
By Amy Lynn SorrelAssociate Editor
When Fort Worth gastroenterologist Monte E. Troutman, DO, first heard about Choosing Wisely, it immediately changed his thinking.
"I've been a big advocate of colorectal cancer screening my whole career, and remarkably, over the past 10 years, we've seen a dramatic decrease in the incidence of colon cancer because of aggressive screening, most noticeably colonoscopy," he said. "But there's still about 45 percent of the population who should get screened and do not. And while a lot of people say we are doing a good job, unfortunately, we may be overdoing [screenings] for the people who are already adherent to the guidelines."
That's why Dr. Troutman chooses to focus on the American Gastroenterological Association's colorectal cancer screening guidelines not to repeat screenings for certain individuals within a certain period of time.
The goal of the national Choosing Wisely campaign is to improve quality and reduce waste by getting physicians and patients talking about medical tests and procedures that may be unnecessary and possibly harmful. Texas physicians aim to keep the conversation going.
So far, more than 60 national medical specialty societies have joined the initiative to identify and create lists of the top five tests and procedures they say are overused or inappropriate. (See "Three Steps to Start Choosing Wisely.")
Dr. Troutman's patients often ask him about when they need a colonoscopy but, more often, when they can stop the screenings. Those questions open the door for physicians to not only discuss the Choosing Wisely recommendations with their patients but to also consider them in their own practice, Dr. Troutman says.
Not all polyps are created equal, yet "a lot of times patients will come in and say, 'I had polyps.' Then you really need to get the colonoscopy and pathology reports" to find out if another test is needed, he said. "That information doesn't come to you. You and your staff have to take the time to ask, 'Where did you have it done?' and try to track it down."
Dr. Troutman acknowledges that's not always possible, and the conversation might take a few extra minutes. But he says it's in patients' best interest that physicians attempt the extra steps instead of defaulting to another test. "Sometimes the best thing to do — and the hardest thing to do — for the patient is nothing, other than offer advice. Put the pen and prescription pad away. Sometimes when we do too much, there are consequences and risks for doing procedures if they are harmful and not necessary."
Dr. Troutman also agrees that it's probably more difficult to talk patients out of unnecessary antibiotics than colonoscopies. "You would be surprised how receptive patients are when you tell them, 'You don't need to have a colonoscopy done.'" But mostly, patients just want an explanation, he finds. "Then it doesn't take much convincing."
As a medical educator, the associate professor at the University of North Texas Health Science Center also informally incorporates the Choosing Wisely resources into resident and fellow training. He refers them to videos offering scripts to help guide physicians through a patient conversation over an unnecessary test or drug. Medical education may be changing, but "one thing we [physicians] are taught from day one is to 'first do no harm.' So maybe we should change it to 'first do no harm by choosing wisely,'" he said.
At TexMed 2014 in May, the Texas Medical Association's Council on Health Care Quality led a continuing medical education track to educate physicians on the program, and Texas Medicine spoke to Dr. Troutman and some of the other physician panelists and participants about the recommendations they've chosen to focus on, how they are incorporating the guidelines into daily practice, and their experiences so far.
You, too, can get on board, starting with a suite of Choosing Wisely educational tools and videos TMA developed thanks to a grant from the program's creator, the American Board of Internal Medicine (ABIM) Foundation, through the TMA Foundation. Support for the program comes from the Robert Wood Johnson Foundation.
As the campaign gains momentum and factors into other quality improvement initiatives — including those considered by the Texas Institute of Health Care Quality and Efficiency — TMA leaders say Choosing Wisely offers physicians an opportunity to lead the charge.
Stewarding the Health Care Dollar
Regardless of physicians' medical specialty, Lubbock emergency physician Gerad Troutman, MD, says there's something for everyone among the 300 evidence-based recommendations of the Choosing Wisely program.
The medical director of University Medical Center's Emergency Medical Services (EMS) and Lubbock Fire Rescue noticed one of the American College of Emergency Physicians (ACEP) guidelines coincides with what happens to be a national shortage of saline. He emailed his staff about incorporating the guideline to "avoid instituting intravenous (IV) fluids before doing a trial of oral rehydration therapy in uncomplicated emergency department cases of mild to moderate dehydration in children."
"In staff training, we talked about the fact that in EMS, we are in the habit of starting an IV and hanging a liter of saline on everyone, when the literature does not support this habit," particularly for children, he said. "So we agreed as we move forward to stop and think about whether patients need the saline, and if they have normal vital signs, let's not waste a bag of saline on them. A simple IV with saline lock can be used instead."
Already, the vigilance paid off. Dr. Troutman compared saline usage during a recent three-month period of implementing Choosing Wisely to the same three-month period a year ago and discovered a 25-percent decrease. "If we start thinking about that nationally, and not just Lubbock, that's a huge difference. And we should be stewards of the health care dollar."
Dr. Troutman is implementing another ACEP guideline aimed at getting hospice services to certain emergency patients sooner. Sometimes those with end- or late-stage cancer, for example, have never had an end-of-life discussion with a health care professional or don't understand their options.
"A lot of people don't have that education. Sometimes when I bring up hospice to patients, they roll their eyes and think you are sending them home to die," he said.
So Dr. Troutman's team revisited with their hospice partners and tweaked certain protocols so that they now post hospice phone numbers in the emergency department for staff to use for referrals. This allows emergency patients to connect with hospice services sooner.
"It's something that's always been available, but [Choosing Wisely] brought it back up again and reminded us of it," the member of TMA's Committee on EMS & Trauma said. The initiative doesn't cost anything more than "a little doctor time or effort. But hospital time and time in the emergency department are much more costly."
Changing the Conversation
In primary care, Keller family physician Gregory M. Fuller, MD, often sees respiratory infections like sinusitis and bronchitis, mostly uncomplicated cases. He and his colleagues at North Hills Family Medicine commonly get requests for antibiotics from patients who may be used to receiving the drugs elsewhere, even though they are not warranted.
Given the prevalence of antibiotic prescriptions, Choosing Wisely guidelines from roughly a dozen medical specialty societies caution against overuse of the drugs for mildly or nonsymptomatic patients or for nonbacterial infections, for example.
For Dr. Fuller, "choosing wisely" means engaging patients in discussions over their own care and educating them about why antibiotics or other treatments aren't always the answer. By sparking that conversation, he also hopes to change it.
"I try to teach my patients what is appropriate use of an antibiotic. Not why aren't you prescribing an antibiotic, but why are you prescribing an antibiotic?" the TMA Council on Health Care Quality member said.
That education starts with what Dr. Fuller describes as a "frank" conversation with his patients about side effects and antibiotic resistance, for example. He also uses the terms "virus" or "viral" frequently in conversation when explaining why prescribing the drug won't make a difference with a viral infection and will end up wasting money.
Physicians have a responsibility to examine their own activities, which Dr. Fuller says is an important part of improving quality of care. But taking additional steps to engage and inform patients "takes quality medical care to the next level so they can have a conversation with their physician. And hopefully that conversation will be the patient asking, 'Why are you doing this?' and not, 'Why aren't you?'"
Improving Care
When the faculty and residents at Wichita Falls Family Medicine Residency Program saw an uptick in what appeared to be external ear infections, they decided to visit recently updated guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) on proper treatment for acute otitis externa (AOE). Those guidelines call for use of topical versus systemic antibiotics and analgesics in the treatment of uncomplicated AOE.
That's when faculty member Tania Khan, MD, and her fellow educators wondered whether residents were confusing the condition with other types of ear infections and unnecessarily prescribing certain medications. They also noticed the AAO-HNSF guidelines coincided with similar Choosing Wisely recommendations from the medical specialty society urging against prescribing oral antibiotics for uncomplicated AOE.
Dr. Khan said the campaign helped call the practice's attention to something "we just didn't pay attention to before. This [AOE] sometimes gets confused with middle ear infection because that's the most common diagnosis. And you mostly see it in pediatrics," versus a family medicine practice like hers.
To get a better grasp on treatment patterns within the practice, the faculty tasked residents with conducting a chart review. A key finding revealed slightly more than one-third of 23 patients seen for uncomplicated AOE between 2009 and 2014 received systemic rather than topical antibiotics.
The data prompted a research project the residents launched to improve care within the practice.
The plan includes:
Dr. Khan and her residents shared the project at TMA's second annual Quality Poster Session at TexMed 2014 in May. Past Wichita Falls Family Medicine residents conducted a similar research project with foot care for diabetic patients and saw immediate care improvements, she says.
This time, residents hope their project "will not only improve treatment of AOE but will also demonstrate the effectiveness of employing the Choosing Wisely campaign in physician education," the poster states.
One of the main reasons Choosing Wisely has attracted widespread participation is that the campaign is physician-driven, says ABIM Board Chair David H. Johnson, MD, a Dallas oncologist.
"Instead of third-party entities like insurance companies or Medicare saying, 'Doctors must do this or can't do that,' these are recommendations that physicians are saying, 'We know by virtue of our daily practice and scientific literature that these [treatments or tests] are of low value.' And because we [physicians] are experts, we ought to be able to participate in a proactive way in controlling cost and reducing harm," Dr. Johnson said.
Not only does the campaign allow physicians to have meaningful conversation with their patients, but it also adds gravitas to those discussions because it's not a single physician telling a single patient that a particular test or drug is not warranted, Dr. Johnson adds. Rather, it's practicing physicians working with their medical specialty societies, consumer organizations, and more recently nursing and other health professional groups, which all agree with the evidence-based recommendations.
Physicians have room to be creative in how they incorporate the guidelines into daily practice, he adds. Some health systems integrate them into their electronic medical record system such that an alert pops up at the point of service.
As chair of the Department of Internal Medicine at The University of Texas Southwestern Medical Center in Dallas, Dr. Johnson helped distribute the Choosing Wisely lists to each of the center's specialty department chairs to help guide physicians' decisionmaking. He also charged the school's new chief resident for quality improvement and patient safety with evaluating before-and-after outcomes in one clinic based on the recommendations for reducing testing in patients with back pain, for example.
As the campaign evolves, so do the recommendations.
When the initiative launched in 2012, the original recommendations were what Dr. Johnson called "mostly low-hanging fruit — things most physicians would know are of minimal value. For example, a preoperative EKG in a patient without a known heart problem — most doctors know that's not something you should do."
By contrast, more recent recommendations made by the American Society for Radiation Oncology took the "bold" step of advising against proton beam therapy to treat prostate cancer, says Dr. Johnson, who subspecializes in oncology. "There are only a dozen or so places in the United States that have proton beam therapy units. Now that Medicare reimburses at a high rate for [the therapy], suddenly everybody wants to build a new facility and use it. But the truth is, with the exception of certain childhood cancers, it has not proved to be any better than standard linear accelerators. And there are not enough kids with cancer in the country to treat with the ones already built."
Going forward, still other "more stringent" recommendations likely will call on physicians to consider the most cost-effective treatment among equally effective options, he says. The American Society of Clinical Oncology, for example, one of the Choosing Wisely founding partners, recently announced it will integrate cost information into its clinical guidelines.
Choosing Wisely "is really capturing an energy within the medical community to say in a more constructive way, 'We are the experts. We should help society decide what can be reasonably avoided,' versus just proscribing or prescribing," Dr. Johnson said. "After all, this is about our patients."
Amy Lynn Sorrel can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.
Three Steps to Start Choosing Wisely
The Choosing Wisely campaign is a no-cost initiative that promotes conversations among physicians and patients about the need, or lack thereof, for many commonly ordered tests or treatments.
Here's how to get started:
August 2014 Texas Medicine ContentsTexas Medicine Main Page


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Salomon Pearl Boa Snowboard Boots Women's
Comfort is key for The Salomon Pearl Boa Snowboard Boots. With the Auto Fit and Feel Good technologies your feet will be always be comfortable regardless of your riding style. Worried that a nasty slam might loosen your laces The Boa Coiler lacing system will get you back on the mountain with a few flicks of your wrist. Salomon 's Pearl is perfect for those who want both a comfortable boot and easy to use functionality. Features: Flex Rating: Soft Feel Good Liner Autofit Ortholite C1 footbed D Light Outsole Coiler Boa Tech Specs: Ability Level: Beginner Intermediate Flex Rating: Medium Lacing System: BoaR Warranty: 1 Year Fit Tip: All Boots stretch out about 12 size. It is normal to have a smaller Boot size than your shoe size to compensate for the boots stretching and getting BIGGER from how they feel in the store. Make sure to work with a boot tech person to fit the boot to the SHAPE of your foot. Fit Shape is vital to the performance of any brand of boot. Be sure to walk around in the boots10 15min fully laced to help make sure they are the correct shape for your foot. For improved fit and comfort consider adding a CUSTOM FOOTBED like Superfeet that is properly matched to your arch shape. This will help the boot anatomically support your foot which will reduce pressure points and securely hold your foot in place. Spend some time choosing your boots. They are the most important piece of gear you'll buy.
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Celebrate the 4th of July with your little learners! This free 25-page printable is perfect for doing just that. If you're looking for more patriotic fun, check out the hands-on activities, treats, and books I've rounded up for you, as well!
4th of July Printable Pack
4th of July Printable
In this brand new 25-page printable for grades PreK-2, your little ones will enjoy the following activities:
- -ar, -at, and -ag word family practice
- handwriting practice
- American flag report/research page
- skip counting
- odd and even sorting
- and more!
To download your free printable pack, please enter your information below. You should receive your download link within the hour. If, after an hour, you have not received your link, please contact me and we'll figure it out together.
Please note that your link will expire in 72 hours, and it can only be downloaded twice. Be sure to download and save it once it arrives in your inbox.
Hands-On Activities
- Noodle Play (Sensory Bin) for 4th of July at B-Inspired Mama
- Pom-Pom American Flag Painting Craft at Crafty Morning
- Patriotic Necklace at Buggy and Buddy
- Star-Spangled Slime at I Can Teach My Child
- Straw Fireworks Painting at Crafty Morning
Snacks and Treats
- 4th of July Snack Mix at Glorious Treats
- Flag Fruit Skewers at Just Imagine
- Patriotic Puppy Chow at This Idyllic Life
- Fourth of July Rice Krispie Treats at Two Sisters Crafting
- Red, White, and Blue Jello Salad at Real Mom Kitchen


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Q: I'm terribly fond of salads, and usually dress them with homemade dressing. However, I've really run out of ideas and have been crowdsourcing them from everywhere possible ... until it occurred to me that The Kitchn's the best forum possible for crowdsourcing!
What are some of your favorite homemade salad dressings?
Sent by Ko
Editor: I'm with you, homemade dressings are the best way to finish off a salad! Here are a few recipe ideas you might enjoy:
Readers, what are your favorite homemade salad dressings?


text: Century Schoolbook is a Modern serif typeface designed by Morris Fuller Benton in 1924. It was originally designed to be an easy-to-read font for use in textbooks. Many Americans first learned to read with books set in Century Schoolbook, which can give the typeface a pleasant, nostalgic feeling. Century Schoolbook is available in two weights—regular and bold—each available with matching italics. There is also a condensed and monospaced version available.


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one of the latest crazes so it seems.
I say "craze" because before I would've thought I was absolutely crazy to do such a thing.
But now that it is all trendy and what not, I am all about it.
Because I am trendy junkie that's why.
So today I've enlisted somebody who is here to teach us how to do exactly that--paint furniture.
And really anything else your paint lovin' heart desires.
You have a dog you wish was black instead of tan?
Spray away.
Those pants you just bought that you wish were three shades lighter--
Spray away.
Now that you are all freaked out about my ideas on spray painting, I'll turn it over to Erika.
She's pretty cool
And pretty legit.
And I think she is talking about more than painting dogs & pants.
So go get to know her better.
Maybe then you'll be cool and legit?
Hi! I'm Erika!
This will ensure that the paint sticks evenly. Clean it off with a cotton cloth.
Tape the parts that you don't want to paint. Take the time to do this-- it's worth it.
You can buy a cheap primer but you should defintely buy one. A primer, like sanding, will ensure a more even coat. Do one thin coat, and if you're covering a darker surface, go over it with another light coat. Let it dry-- the longer the better.
Do light coats of spray paint from 6 inches away, shaking your can periodically. Let dry for more than the recommended time during coats. The thinner the coat, the better. Thick coats of spray paint will glob and run.
This is Erin again-
Okay so that was like crazy easy wasn't it?
Who the heck knew that's all it takes to get a dresser looking beautiful beyond beautiful.
Thank you Erika for teaching us :)
Now she is going to each us a thing or so about herself...
1. When and why did you start blogging?
I actually started blogging two years ago but it was a family blog about the adventures of the husband and I. We didn't actually go on that many adventures... and I wanted to blog about more things so I started a different blog.
2. So you have an etsy store too, do you ever feel overwhelmed with being so awesome ;)
3. One thing I must buy from you...tell me now.
4. As you know, I love food. What is one thing you could eat daily?
I could, and do, eat chips & salsa on a daily basis. Except for today-- well almost every day.
World's prefect food.
Open a blog or shop for YOU-- no one else. If you love what you write or make, chances are others will too :)
here's a discount code for free shipping in my shop: erinisfab
...Umm, yeah that discount code is the coolest one I've ever seen ;)
So anyhow-go get to know Erika more here.
You'll be happy you did.
Awkward & Awesome comin' atcha tomorrow.
Get ready for it.


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More lyricists, bands represented at iconic award show
When I first saw the announcement of the 2013 Grammy Award nominees, my faith in popular music was restored. For about five years, I haven't actually watched the Grammys because I felt like the judges were choosing what was popular, number-wise, as opposed to what was good, quality-wise. But this year, I am pleasantly surprised to see some actual substance, rather than flashiness, in the nominees.
The exciting category to me is the Album of the Year. This category has been usually reserved for the chart-toppers. Last year's nominees included Lady Gaga, Bruno Mars, Adele, Rihanna and Foo Fighters. I could understand Adele and Foo Fighters being there, seeing as they are what I consider "artists." I'd even make an exception for Bruno Mars seeing as he is a modern-day crooner. But I though Lady Gaga and Rihanna made the list on radio play and chart topping alone, not really on songwriting talent. Are their live shows exciting and flashy? Of course. Are they Grammy-award-winning songwriters and lyricists? Not really.
Somehow, this year changed the status quo for this category. The 2013 nominees for the Album of the Year were announced, and all five were songwriters. I was pleasantly surprised with the change-up.
My favorite to win is The Black Keys. I have a special place in my heart for them, seeing as they were one of the first alternative bands I discovered. The Black Keys went under the radar for a number of years, having started in 2001 and not earning a Grammy nod until the release of Brothers in 2010.
With the critical and commercial success of El Camino, it was no surprise to see them on the list. The band Fun. and the Mumfords also were not huge surprises. Both of them had critically acclaimed and well produced albums. Fun. also showed the ability to cross over between pop and alternative radio, something that rarely happens. Jack White kept his place as an alternative powerhouse with his nomination for his album, Blunderbuss.
Frank Ocean's nomination was the most exciting for me. The last time a hip-hop artist was nominated was 2011 when both Eminem and Jay-Z were nominated.
Ocean's first major album, Channel Orange, is something of a new concept for hip-hop itself. Ocean uses electronica-type beats and then uses a mixture of singing and speaking over the sounds. It's a whole album of experimentation. For a work of that artistic openness to impress music critics is something to be celebrated.
Ocean is nominated in three other categories for his work on Channel Orange and is also nominated for Best Rap/Sung Collaboration and Best Longform video for his work with Kanye West and Jay-Z on "No Church in the Wild" off of Watch the Throne.
I assume that Carly Rae Jepsen will take Song of the Year, but she has some competition from Ed Sheeran. Best Dance Album will most likely be a battle royale between deadmau5 and Skrillex. Some other categories I'm excited about are Best New Artist, Best Pop Duo/Group Performance and Best Rap Performance, mainly for the diversity of the artists nominated in them. Pop, indie and rock are all being recognized for contributions to the music world. My favorite pair-up has to go to Pop Duo, which features English indie band Florence and The Machine alongside the sexy-and-they-know-it group LMFAO. Are we sorry for party rocking? Not at all.
You can tune into the 55th Annual Grammy Awards on CBS at 7 p.m.


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Thanks, Mavs. We Needed This Offseason
As fans of the Dallas Mavericks, we needed this.
Undoubtedly, it's greedy in the wake of a championship only three years removed, but after the perception of striking out on LeBron James (twice), Deron Williams, Dwight Howard and Carmelo Anthony, beside a pair of first-round exits sandwiched around missing the playoffs entirely for the first time in twelve years; we all needed something to fall in the column on the left. We needed an offseason win.
We needed the Mavs to "win" Chandler Parsons … as well as the return of Tyson Chandler.
We've turned to tales of hope more than a few times in this space. At its heart, sports' fandom can be broken down to three basic rivers of emotion, each fed by a wealth of tributaries, and each constantly fighting for dominion over our hearts.
There's hope. Elation or happiness. And, there's the widest and deepest of them all, a current of white caps and hidden hands so often given avenue to drown us all: dejection, doubt, and anxiety, all close cousins feeding on or to the pain of loss.
Across all of them -- hope, joy and hurt – everything flows through the prism of expectation, for better or worse.
Is this an oversimplification? Yes. There are shades of gray everywhere. There's anxiety and tension, surprise and inspiration, and a wealth of emotion too vast to ever envelope completely in words, but most feed in one way or another to hope, joy or hurt.
With the championship fading into a horizon that simultaneously feels so close and so very far, we've tripped forward three years and an eternity in the same number of steps. We needed to have our hope given fresh blood, we needed to believe Dirk Nowitzki wasn't merely wondering the broken final miles of a sports' life meandering to a quiet conclusion in relative, discounted irrelevance.
Even if we haven't truly reached that, we needed to find our head above water, to see that the sun could climb once more without being filtered through the churning waters of a disheartening ending that was becoming all too easy to envision, we needed to be granted a respite, a clean breath.
At no time do hope and fear wander such murky boundaries as the offseason, justifications are thrown and swallowed relying on only little more than unsubstantiated inklings. Like trying to place a book on a fog bank, we rationalize the fall or the magic that will lift the story once more to the cradle of NBA history, to personal mythology ("you see, the season was hatched with the false-disappointment of getting 'only' Tyson Chandler …" we'll tell grandchild we'll trick ourselves into believing are enthralled with the "Tale of 2011" ...and the above photo by Brandon Colston.).
It's in this time of sweetly-haunted uncertainty we needed something positive, after what feels like too much of the opposite (the fact that we are venturing into ridiculousness given the success so recently tasted is irrelevant to a fan's heart). Even Monta Ellis, the biggest triumph of the post-championship summers, came riding a bag of mixed feelings, on the reputation of a me-first, shot-hunter who fired indiscriminately with minimal efficiency … and blatantly obvious talent.
Sure, there's the whisper of Parsons' admittedly bloated contract, but there's also the rejuvenation fed to an ember that's fought to stay alive beneath waves, the protective bubble solidified three years ago quickly fading, leaking, allowing the drowning waters in. In a dichotomy of spirit, hope is both hard to kill, as the fans of the Bucks or 76ers, and frighteningly fragile.
Houston deciding not to match the Mavs offer sheet has reinvigorated us, or at least, many of us. It's granted us a reprieve from the bargain bin, from settling for the "best available" or the "best of what's left" after missing on previous swings. True, this isn't Chris Paul or Dwight, and comes after pitches to Melo and LeBron's agent, but it is something we cast our hearts to, whispering that our attempts were in vain as we longed for them not to be.
This was a love letter sent to Cindy Crawford (don't hate me because I'm old) … that was answered, somehow, and reciprocated.
We can hear national or Houston-based writers say the Rockets got a better "shooter" in Trevor Ariza, apparently ignoring the fact that Parsons worst 3-point percentage, which came in his rookie year (33.7), is better than Ariza's percentages in eight of his ten seasons. We can bemoan the "untradeable" contract, or note that a 25-year-old was treated as an asset to this team rather than the trade market. We can fear the team's depth, almost across the board, but give us a moment to gather around what was gained. We can harbor anxiety over the health of Tyson and Devin, but let us dream for a moment of what could be.
It's not perfect. No one is pretending it is. However, perhaps it is better than the expectations fostered by the blueprints laid out after the returns of the last three summers. We, fans, doubted a trade for Tyson was possible. We were sure the Rockets would match, logic screamed that they would. Both are now on the Mavs roster.
What could this mean on the court?
For one, we may see the corner 3-pointer become more of a factor in the offense. Dallas excelled in converting corner threes last season, shooting the second highest percentage (42.2), but attempted only the 23rd most in the league. Given the drive and kick abilities of Monta Ellis, Devin Harris and now Raymond Felton and Parsons, as well as Dirk Nowitzki's own passing skills when a defense collapses, this would seem to be a prime attack point.
Looking at four players that have moved on in comparison to those likely replacing them in the roster's totem pole, we can see an obvious advantage in the new faces … outside of Jose Calderon's brilliance:
Of those who have moved on, Vince Carter was the second most efficient from the corner over the course of the regular season (thus, not including a certain playoff game-winner). Parsons, Jefferson and Felton (surprisingly) each converted at a higher rate, with Lewis coming in just below. All four are well above Shawn Marion or Wayne Ellington.
Marion led the Mavs in corner-three attempts with 85, followed by Calderon (77), Crowder (63) and Carter (61). It's not hard to envision those shots now falling to the four new names listed above.
Some may also be surprised to see that Jefferson falls so closely to Calderon. Unfortunately, this isn't the sole similarity they share, more on that below.
There also stands some chance of a small defensive renaissance, though this may be completely dependent on the health of Tyson Chandler, as well as Devin Harris, the commitment of Raymond Felton, and the will to improve on that end of the court by Parsons.
Heading into the All-Star break last season, Dallas ranked 22nd with a defensive rating of 105.2. After the break, they slipped to a rating of 107.4, though that was good enough to also rank 22nd. So, while consistently bad in relation to the league, the defense slipped considerably after the break. Nagging Injuries may have been a part of this, and likely, so was age.
Outside of Parsons (25) it's hard to say the age issue has been corrected when Carter (37), Marion (36) Calderon (32) and Samuel Dalembert (33) were replaced by Tyson (31), Jefferson (34), Felton (30) … and Lewis (34). (Though we should tap the breaks on Rashard now, Fish reporting last night that he signed his Merry Minimum contract with a knee problem the Mavs knew nothing about. Oh-oh.)
However, the shift of minutes from Marion to Parsons could prove to be significant as Marion's decline over the course of the season on the defensive end played a role in the team's slip, per MySynergySports Marion allowed 0.86 points per possession at the break (on par with the majority of his previous time in Dallas), but rose to 0.92 by the end of the season.
Marion saw a similar decline in isolation points-per-play allowed, from 0.86 at the break to 0.91 by the end of the season, easily his lowest as a member of the Mavs (previous worst was 0.85 in 2010-11).
Here's a look at a few of the outgoing and incoming players' defensive numbers allowed (per MySynergySports.com) for the 2013-14 season:
We're not claiming these to the be-all-end-all of defensive measurements, far from it, but they do capture a glimpse that somewhat reflects our eye-test observations. Crowder was included as he's likely to see an increase in minutes with the shift in roster.
This shows that Ellington was the worst of the group, though he also played the fewest minutes and never got a shot to set his feet and find a rhythm. It's not surprising to find Richard Jefferson with the next worst showing, measuring as nothing short of a defensive sieve by these statistics (remember that other similarity to Calderon we mentioned above, here it is).
Parsons had the safety net of Dwight Howard behind him, but his struggles become a little clearer on the "isolation" side of the chart above, but he's young enough to improve, and the hope is that Chandler can return to being a "safety net" here.
From these nine players, by far the most surprising find was Raymond Felton's isolation defense, ranking better than everyone included but Crowder … though we're not putting too much stock in this, we thought it was an interesting find.
For the sake of fairness, when comparing this group the context of Marion's role differs greatly from the rest. He alone was asked to regularly defend the opposition's most significant offensive threat, and did so from power forward to point guard, embracing the mismatches from Chris Paul or LaMarcus Aldridge. While he cannot be fairly compared with the other eight players shown here, the decline in comparison to his own returns over the course of his time in Dallas cannot be dismissed, particularly as the minutes collected.
As previously stated, the Mavs defense will likely come down to the health of Tyson Chandler, and the hope that he'll shed the disappointment of last season to again show the form that anchored the Mavs in 2011, earned him a Defensive Player of the Year award in 2012 and an all-star nomination in 2013 … but there's hope, even a logical justification, for improvement at both ends of the floor.
For the moment, that's all we really have, all we've been given: hope … for Ellis to take another step forward, for health, for Dirk to keep being Dirk just a little while longer. But, that's what's so great about this time, about the infusion of energy that "winning" a pair of Chandler's has delivered. For the moment, anything is possible as we float on our backs down a river and dream of where it may take us … whether it's ultimately to hope, doubt, elation or hurt.
Take a minute and anything seems possible, but in this respite from the truth of on-court results, it was with joy that I updated the Mavs roster on NBA 2K14, I may have bitched about the fact that Parsons had only a 76 rating, but did so through a smile.
It feels like it's been a long time since I did this with such unbridled enthusiasm, even as the doubts have caught up and crept in, they've done so mingled with the sweet intoxication of that little ghost: hope.
We needed this. It doesn't matter how greedy it defines us … we needed this.
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text:
Ghost Whispers
0518hrs Washington DC - Survivor House
Jacen woke up grogally. He didn't know where he was or what was going on. He did know that the light that was illuminating the room, was bright... too bright. He began to sit up... or tried to. The pain was just a bit too much for him to handle and he slammed back down on the bed that he barely noticed he was on.
"Hey, you're awake." Someone said. Jacen slowly looked around and found the source of the voice and it was a pretty one.
She walked towards his bed with an easy grace. Her hair shone brightly even in the small ammount of light that was entering the room. And even though her face was a bit covered with a light coat of dirt and dust, it still showed her beautiful complexion.
"How are you feeling?" She asked him. Even though he was still a bit grogry, he still was able to answer.
"Like... um.... hell." he responded slowly. His head hurt and something else hurt worse.
"Yeah, well, that would happen after most of your house falls one ya." She told him. So that's what happened.
"How did I show up here?" He asked. He raised his head a bit and surveyed the room. It was actually a basement, but had multiple rooms. The windows were barricaded, mostly, but there were enough other lights to suffice. He seemed to be the only one in the room minus the girl, even thought there were other beds.
"One of my friends found you out in the street. You were screaming your head off for help." She said, "We were lucky we got to ya, the riders almost got to ya."
"A bike gang that roams around now and tries to kill, steal and other wise antagonize the public, or what's left of it. We got you just in time. We heard their motors in the distance, but like I said, we got to you."
Jacen sat there for a moment, the smiled, "So you were the ghost?"
"What?" The girl asked, perplexed.
"The person who covered my eyes and mouth."
"Oh yeah, that was me. The Riders were using flares, you didn't have sunglasses and your eyes were probably hurt already."
"So you are the ghost."
"Yes, yes I am." She started to slowly dissapear behind Jacen's heavy eyelids.
"Who... who are you?" he asked weakly
Before he passed out, the girl leaned in and whispered, "Just a ghost, that's all."


text:
Raw yellowfin tuna recalled in salmonella outbreak
A California company is voluntarily recalling 58,828 pounds of a frozen raw yellowfin tuna product linked to a multistate salmonella outbreak, including 14 cases in southeastern Wisconsin.
Moon Marine USA Corp. (also known as MMI) of Cupertino, Calif., is voluntarily recalling the product labeled as Nakaochi Scrape AA or AAA.
The product has been linked to an ongoing investigation of Salmonella Bareilly infections that have sickened 116 people in 20 states and the District of Columbia.
Nakaochi Scrape is tuna backmeat, which is specifically scraped off from the bones, and looks like a ground product. The product is not available for sale to individual consumers but may have been used to make sushi, sashimi, ceviche and similar dishes available in restaurants and grocery stores.
The raw yellowfin tuna product may have passed through several distributors before reaching the restaurant and grocery market, and may not be marked with lot information. Distributors and end users should consult their suppliers to determine the origin of any Nakaochi Scrape AA or AAA in their possession.
Consumers should not eat the recalled product, and retailers should not serve the recalled raw Nakaochi Scrape tuna product from Moon Marine USA Corp.
Because raw seafood is not fully cooked to assure that pathogens are destroyed, it is not considered as "safe" as cooked seafood.
Consumers should take precautions when choosing to eat raw seafood and be sure that the Nakaochi Scrape is not from the implicated lots. When in doubt, don't eat it. Consumers who think they might have become ill from eating possibly contaminated raw Nakaochi Scrape should consult their health care providers.
Many of the people who became ill reported eating "spicy tuna."
State health officials and local health department officials in Milwaukee, Waukesha, Washington and Fond du Lac counties have been collaborating with the federal Centers for Disease Control and Prevention and Food and Drug Administration to investigate the outbreak and identify the source of the salmonella.
Since February, 14 Wisconsin residents have had laboratory-confirmed Salmonella Bareilly infections that match the DNA fingerprint of the national outbreak strain. Three of the 14 patients were hospitalized and all of the patients have recovered from the infection. Six of the cases were in Milwaukee County; seven in Waukesha County; and one in Washington County.
State health officials advise consumers to contact their doctors if they believe they became ill from eating potentially contaminated food.
Consumption of food contaminated with salmonella can cause salmonellosis, which typically lasts four to seven days. Most people infected with salmonella develop diarrhea, fever, and abdominal cramps within eight to 72 hours and some individuals may experience vomiting. Bloodstream infections are infrequent, but can be serious, particularly in the very young or elderly.
Since the organism is passed in the feces, and person-to-person spread of the bacteria is possible, people should follow proper hand-washing methods. People should always carefully wash their hands with plenty of soap and water after bowel movements, and before and after food preparation. Parents should stress proper hand-washing habits to their children. If soap and water are not available, use an alcohol hand sanitizer.
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- Treatment Advocacy Center


text:
Blood Drops and Roses
HI HI! I know I haven't updated anything in a while! I am so sorry bout that! but how about a new story for you all?
I know I know "get back to work on the other stories!" but my brain is dead _ thus, you will have to put up with this until it revives ^_^
Thank you all for your support and care!
This is another Naruto fic but the pairing is of course, the wonderful Naru-chan! And O_O whats this! The demonic demon fox known to us as Kyuubi? I MUST be insane!
But yep, that's the pairing ^_^ hope you all like it!
So here is the prolog for my newest story!
Rating: M for boy/boy smex
Pain...all he felt was pain and anger.
He didn't know what he had done, all he did was protect the village as was his duty. He had chosen to protect this village for it housed a little girl whom he had rescued and promised her mother to protect. He had been comfortable in his woods, away from humanity and safe from all dangers not that many could take on a demon boy. Yes, he was a child born and blessed to house the spirit of the nine tailed fox. His flame red hair and crimson slitted eyes marking hims as such.
One day, a dying woman holding a small bundle had wandered into his woods. Curious, he had gone to her when she begged him to protect the small child...a little girl with black hair and purple eyes. Feeling compassion for the dying mother and her young babe, he transformed to his human form and picked her up, promising to protect her. From there, he went to a village on the edge of his woods and entrusted her to the village elder, an older man with a young son who had a blinding smile and bright blue eyes.
All there feared him and said they wanted no child brought by a demon in their town. The elder and his son though said that they would allow her to stay in the village if the demon boy became the protective deity and kept them from harm.
Feeling they were well within their rights to ask, the demon readily agreed and, leaving the child with a single red stone of crystallized fox fire, he locked himself within the shrine, sealing his own power to the land and never letting any harm come to the village. As the girl grew, she became closer with the village elders son causing strife between the village. Many tried to harm the girl but each time, a shield of fire came up to protect her.
One day though, when she and the older boy whom turned out to be named Minato were out for they had become close over the years, a boy attacked them with a knife and no fire shield came up. Instead, Minato disarmed the boy and took her hand, dragging the girl to the market where he yelled out for all to hear, including the fox.
"You don't have to protect her anymore! I will save her from all who hurt her! So let me do it, let me take her!"
The towns people stared in both horror and joy. Those who stared in horror suddenly raised their voices in protest, many taking to throwing rocks at the young couple when suddenly, amid the rage and happiness, flame appeared out of no where, a ring surrounding the couple and protecting them from the rocks. Outside the circle, a male, head down one hand to the side and flame colored hair blowing behind him appeared.
Raising his head slowly, crimson eyes narrows and face grim, he looked out over the crowed. Some cowered in fear while others stood fear in their hatred. The demon called out, not in rage but with a sense of determination and righteousness.
"Why do you attack them? They are nothing more then two lovers hoping to move forward in their love with the blessing of their home. So why would you attack them?"
A man spoke up with conviction.
"Because the girl is cursed! A demon child that must die!" Many raised their voices to agree and the fox only shook his head.
"Then I will extend my protection to both. I, who have protected you all for 17 years now will protect and bless their union so that none can tear it apart."
Minato stepped through the protective ring at that moment, placing a hand on the fox's shoulder.
"Kyuubi...nine tailed fox boy...you have protected us for so long and even when you could have let us die in retaliation for how we have acted, you never let harm befall us. I thank you for saving us for all this time and now, I ask you as a friend, will you continue to do so no matter what?"
Kyuubi turned to the boy before looking at his ward. Sighing softly he held a hand out to her which she took quickly, also stepping through the blaze.
"Shira...beautiful Shira. I never knew why I saved you and I never knew why I chose to stay in this village...maybe one day I shall find a love like yours. You and Minato are bless here and will be loved forever by me. I will never let harm befall you or yours no matter what."
Shira nodded and took her loves hand before walking through the crowd and away from those that would hate while those that were happy for them followed them.
Kyuubi stayed where he was, his eyes becoming cold as he took in the ones left. His red and black robe melted into his skin, becoming fur as he turned into a large red fox, his fangs snapping out as he growled.
"You will all learn to accept them or you will die by my claws." With that, he vanished into the earth, returning to his shrine.
It was that night though...that night that they betrayed him...allowed him to be locked inside of the shrine walls and experience the pain of never seeing or touching the world of the living. They killed him for lack of better word...he was frozen there.
They came at night, five priests, five people with the power to seal him...and one that should not have been there. Minato...he was there but he wasn't there to save Kyuubi...no...his father would only bless them if the Kyuubi was destroyed...only then would he be allowed to marry the girl.
Minato cried for the creature who screamed and fought, asking over and over WHY WHY WHY WHY WHY WHY WHY WHY WHY! A voice that would haunt the blondes for centuries that screamed out for help, to make the pain stop...to just kill him and not make him suffer. Minato could give no mercy though...only a prayer that someone would undo the evil he had done to the creature they owed their lives too.
Kyuubi lifted his broken body a final time, blood streaming down his face like red tears. "Minato..." He growled. "You have betrayed me..." a grunt of pain as another wave of agony hit him "If it was not for her...I would curse you...instead...I pray that for her sake you never hurt her for if you do...you will feel more agony then I have felt here today...I promise you a lifetime of hardships and tortures from this day on...good bye Minato...I will see you in death."
With a final roar of pain, Kyuubi dissolved and lay dormant within the walls while the rest of the shrine was burnt to the ground.
None would be allowed back into the shrine for 50 years while the beast within it stewed and burned in agony and hate.
50 years before one person would come...but would they be the end of the village or the end of the fox...will you be waiting to find out?
Weeeeeeeeeeeeeeee I did it! A prolog! woooooooooot!
Please oh pleasey review! I need reviews to keep my mind working while I get back to work on the Love Is Blood Deep! thankies thankies thakies! I love you all so much thank you for reading the chapie!
Tata for now!


text:
by Rocks Off
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text: SEATTLE, Nov. 5, 2012 /PRNewswire/ -- Omeros Corporation (NASDAQ: OMER) today reported positive data from the second of its two pivotal Phase 3 clinical trials evaluating OMS302 in patients undergoing intraocular lens replacement surgery. In this second Phase 3 clinical trial comparing OMS302 to placebo, OMS302 met its co-primary endpoints by demonstrating statistically significant (p<0.00001) maintenance of intraoperative mydriasis (pupil dilation) and statistically significant (p=0.0002) reduction of pain in the early postoperative period. OMS302, added to standard irrigation solution used during ophthalmological procedures, is Omeros' proprietary PharmacoSurgery™ product designed to maintain intraoperative mydriasis and reduce postoperative pain and irritation resulting from cataract and other lens replacement surgery. Now with positive data from both trials in the OMS302 Phase 3 clinical program, Omeros plans to submit a New Drug Application (NDA) with the U.S. Food and Drug Administration in the first half of 2013 and a Marketing Authorization Application (MAA) with the European Medicines Agency in mid-2013, potentially allowing sales in 2014. This multicenter, double-blind, Phase 3 clinical trial enrolled 416 patients randomized 1:1 to receive either OMS302 or placebo. The co-primary endpoints were maintenance of intraoperative mydriasis (pupil dilation) and reduction of pain in the early postoperative period. Mydriasis is critical to the safety and surgical ease of lens replacement surgery as intraoperative pupil constriction increases the risk of injury to intraocular structures and can substantially prolong surgical time. OMS302 also achieved statistical significance in other clinically relevant measures. The results from this trial are consistent with those from Omeros' first OMS302 Phase 3 and earlier Phase 2b clinical trials. In this study, as with the earlier clinical trials, OMS302 was well tolerated. The final review of all safety data will occur following the last safety assessment in January 2013. To date, no safety concerns have been identified. Results from this study are expected to be presented at an upcoming major ophthalmology meeting. Omeros also plans to publish the results in a leading peer-reviewed ophthalmology journal. "The data from this second Phase 3 trial are as compelling as those from the first Phase 3 and earlier Phase 2b trials," stated Alan S. Crandall, M.D., director of glaucoma and cataract, senior vice chairman of ophthalmology and visual sciences at the Moran Eye Center, University of Utah, and past president of the American Society of Cataract and Refractive Surgery. "Collectively, these data consistently and convincingly demonstrate that OMS302 addresses two universal needs in lens replacement surgery – maintenance of intraoperative mydriasis and management of postoperative pain. I expect that OMS302 will represent a significant and widely used advance in the practice of ophthalmologic surgeons who perform intraocular lens replacement, improving both surgical ease and patient outcomes." "As a clinical investigator in both OMS302 Phase 3 trials, I was impressed by the substantial benefits observed in a large cohort of my patients who participated in the studies," stated Steven H. Dunn, M.D., Fellow of the American Academy of Ophthalmology, Houston Eye Associates. "A good number of patients generally had better postoperative courses and greater overall satisfaction with the entire surgical experience – both critically important to ophthalmologic surgeons and their practices. The maintenance of pupil diameter throughout the lens replacement surgery facilitates the technical aspects of the procedure and, I believe, could reduce the potential for surgical and postoperative complications." "This successful trial marks another major milestone for Omeros, our employees and our shareholders," said Gregory A. Demopulos, M.D., chairman and chief executive officer of Omeros. "We are on track to submit an NDA in the first half of 2013 and an MAA shortly thereafter, and we are continuing to build out our commercialization plan in anticipation of a 2014 market launch. With the anticipated arrival later this year of Phase 3 results from our OMS103HP meniscectomy trial as well as Phase 1 data from our PDE10 program, together with additional programs advancing into the clinic in 2013, we expect that OMS302 will be the first of many Omeros products to improve the lives of patients." About Omeros' OMS302 ProgramOMS302 is Omeros' product being developed for use during intraocular lens replacement (ILR) surgery, including cataract surgery and refractive lens exchange. OMS302 is a proprietary combination of ketorolac, an anti-inflammatory agent, and phenylephrine, a mydriatic (pupil dilating) agent. FDA-approved drugs containing each of these agents have been used in ophthalmological clinical practice for more than 15 years, and both are contained in generic, FDA-approved drugs. ILR surgery involves replacement of the original lens of the eye with an artificial intraocular lens. These procedures are typically performed to replace a lens opacified by a cataract or to correct a refractive error of the lens (i.e., refractive lens exchange). OMS302 is added to standard irrigation solution used in ILR surgery and delivered intracamerally to maintain intraoperative mydriasis (pupil dilation), to prevent surgically induced miosis (pupil constriction), and to reduce postoperative pain and irritation. Maintenance of mydriasis is critical to the safety and surgical ease of the procedure. Intraoperative pupil constriction increases the risk of injury to intraocular structures and can substantially prolong surgical time.


text:
Lady Gaga's secrets are about to be exposed
All the secrets of Lady Gaga are about to be exposed.
Her former personal assistant, Jennifer O'Neill, just landed a book deal with Simon & Schuster. It's believed she could be paid $1 million for spilling dark secret and revealing embarrassing events.
O'Neill left Gaga three years ago, and immediately sued her for unpaid overtime work. She claimed Gaga never compensated her for more than 7,000 hours to the tune of nearly $400,000. They settled out of court to undisclosed terms.
In the lawsuit, O'Neill alleged that she was forced to share the bed with Lady Gaga, who was afraid to sleep alone. Also, there was a daily dispensing of Gaga's "medicine." Her assistant bolted shortly after the Monster Ball tour abruptly ended because of Gaga's damaged hips.


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The Old Guys - Series 1 DVD
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The Old Guys - Series 1 DVD Product Description
All six episodes of the BBC sitcom starring Clive Swift and Roger Lloyd-Pack. Elderly divorced man Roy (Swift) shares his suburban home with his housemate, Tom (Lloyd-Pack). The two men spend their days growing old disgracefully and lusting after their neighbour Sally (Jane Asher). Episodes are: 'Sally's Party', 'The Therapist', 'Marriage', 'The Old Flame', 'The Croft' and 'Courtesan'.
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Challenge Four...Mature
Ozil Mir was deep in thought as he stood near the window overlooking the Palace gardens. The lushness of the grass and the clarity of the sky were enhanced by the majestic sun, which blazed in all its glory on this summer's morning. The larks had settled into whistling their familiar tunes and the oaks stood majestically at the perimeter of the gardens. The forest appeared to be a haven for anyone travelling during this sweltry day with its dense foliage and cool, shady shelters. Sounds of children playing nearby echoed back to Ozil's ears and transmitted an ache in his heart so intense that he nearly buckled under it.
It was the start of yet another day that promised a better end than yesterday, but one that always failed to live up to that expectation. A frown marred the distinguished features of the Overlord of Parzenia, and a grimace of pain overshadowed his eyes. It was as if he was looking out at a different landscape; one in which the sun was an obscure spectator in the dull, uninviting sky, and where the luxuriance of Parzenia had been replaced with the barren and parched land of Dahroob.
Time passes, but does it really heal?, Ozil thought to himself. As the Overlord, he had had to make only one singularly tough decision during his extended reign over the people, but as a grieving and aging patriarch, that one decision had cost him his relationship with the only person he ever truly saw as a reflection of himself. Oh! Shehzaad, why won't you understand my dilemma? Why don't you come and ask for an explanation? For how long will you freeze me out of your life?
Ozil asked himself these questions every morning. Facing the plentiful lands of his country, he would lament the shortage of love between him and his dear Shehzaad. He would try to recall the memories of their time together, but with his rapidly increasing age it had become a lot more difficult. He barely remembered the magic lessons, the berry plucking, or fishing from the Lodha river. All these incidents had been marred by his grief and he only had one wish on his lips now. If only Shehzaad would return to him.
Since the day Ozil had used his conjuring prowess to devastating effect, Shehzaad had refused to face him. He had not come to the Palace and neither had he allowed his grandfather to visit him at his cottage. Ozil had felt a flicker of hope in his aching heart when he had fallen grievously ill, but even that had been extinguished when there had been no sign of Shehzaad at his bedside. It was Peeran, Shehzaad's younger brother, who kept him sane by feeding him snippets of information about Shehzaad.
But even these reports of Shehzaad were unhelpful. The only thing Shehzaad seemed to do these days was brood over the past. Ozil had thought that with the passage of time, these wounds would heal but it appeared not to have aided his grandson in the least. Ozil still remembered the red-rimmed eyes, the begging lips and the broken spirit of his grandchild. And there wasn't a single day that passed when he did not curse the day he lost control, or when he prayed for his child to return to him. But all his hopes shattered by the time the gloomy night befell the enchanted lands of Parzenia.
This morning, everything was unfolding in the same manner as it had for nearly four and five decades. The beautiful morning, the broken heart, the burning sun and the dark cloud of Ozil's hopelessness were all familiar eventualities.
Peeran softly rapped his knuckles against the oak paneling of the doors of the spectacular library, waiting for permission from his grandfather to enter. Receiving no acknowledgement that his knock had been heard, he stepped into the cavernous room. He moved to stand behind Ozil and cleared his throat, trying to garner his attention.
"Grandfather, I bid you Good Morrow. I know you have been awaiting news from Shehzaaad, and I am pleased to bring you good tidings."
Hearing these words, Ozil turned around sharply and grabbed his grandson by his shoulders and exclaimed, "What did you just say, Peeran? Did I hear you correctly? Oh! Are my ears betraying me, or is it you?"
Seeing a ghost of a smile beginning to stake its rightful claim on Ozil's lips, Peeran could not stop himself from smiling and the words just came cascading out from his mouth. "Grandfather, I would not dare to taunt or tease you. What I say is absolutely true. Shehzaad is on his way to greet you and should be arriving any moment now."
"But....But how did this come to be? Is he well? "
"Yes, Grandfather. There is nothing wrong with him. I do not know why he is coming here but he told the Palace guards that he wished for an audience with you. I was passing through when I overheard him speaking to the guards and immediately thought to come to you and relay the wonderful news."
"Boy, you do not know what joy you have brought me. I only hope that my Shehzaad is returned to me today after all these years. My heart aches at the mere possibility." So saying, a beautiful smile bloomed on Ozil's face. A smile which hadn't been seen in a long, long time.


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How to Look Fashionable: Calle Ocho Cool
You don't need to speak Spanish to look Calle Ocho cool. In fact, it's all about mixing up traditional accessories and apparel with a modern twist. Here are the top 6 trends you'll be spotting on denizens and where to get them no matter your budget.
Salsa Dancing Shoes
Yellow is the "it" color for Spring and these Cole Haan oxfords for the guys will keep them in rhythm and breaking lots of corazones. The leather shoe is also concealed with NIKE AIR Technology. $189; ColeHaan.
Fancy Fan
Miami is known for being muy caliente and a Spanish fan is a must to stay cool especially when strolling down Eighth Street to watch locals at Domino Park playing a game of dominoes. $29; Esty.com
Bling Bling Every Cuban girl gets a stack of 15 gold bangles for her Quinces and women keep piling on the pulsos through the years. Local label Citrine by the Stones' Large Wire Bangle has an antique vibe. $265, Citrine byTheStones.com
Traditional Top
When it comes to tops, nothing says Calle Ocho like a guayabera. Whether you are getting a mamey shake at El Palacio de Los Jugos or having a sit down dinner with the family at Versailles, these tops are versatile to don at anytime. Check out the modern line Cubavera; $60, Macys.com
Sexy Senorita
Lots of Latinas turn to body hugging dresses to show off their curves. Others resort to breezy tropical frocks. Whatever your choice, a dress is a must. This BCBG's dress combines the color blocking and pleated trend and makes the perfect get up to dance the conga or hit up a fiesta with a caja china; $288, Nordstrom.
Patriotic and Proud
If there is one thing Cubans are proud of, it's their heritage. Tops, bottoms, hats and jewelry baring the Cuban flag are common to see. Keep it hipster with a Cuban themed Adidas track jacket; $79, Ebay.


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Living room is probably the most frequently used place so it is worth attention. The designs, shapes, sizes and colours of the furniture that has been presented below, differ from each other but they all fulfill their functions well. Do you think you could choose one of these or do you still need something else?
It is a very comfortable and casual reclining sofa that has got a two tone thick chenille fabric upholstery. It is a perfect addition for your living room and family room area.
Dixon Chenille Living Room Collection
Traditional and elegant set of living room furniture with decorative carvings and rounding on the frame. It is upholstered in nice touch material and has extra pillows for comfort. Neutral solution for any living room, and more.
A chic western style set with wooden frames and brown turned legs. An armchair has a thick removable seat, a tall arched wingback, rolled arms, a square ottoman - a 2-tier seat. Covers are of cotton fabric with geometric patterns in prevalent browns.
It is a beautiful arm chair that has got a Chenille fabric upholstery, very elegant design and comfortable seat. Everyone will tell you how amazing it looks in your living room, family room and other.
This contemporary sofa features thick seat cushions, slightly angled arms, and coil springs wrapped in thick density foam. The sofa is generously padded and very comfy, upholstered in a smoke-colored plush fabric and resting on espresso-finished tapered legs.
Clayton Chenille Living Room Collection
Transitional lounge set in brick red. Classic look is easy to blend with any decor style, and the color provides a warm feel in the indoor area. The sofa accommodates three people, so it's spacious and comfy.
Living Room Collection
Amazing living room set containing loveseat, sofa, and chaise lounge. Each item is made of solid hardwood, features highest quality upholstery and comfortable cushions, gorgeously carved details and stylish design.
It is a living room set that includes traditional sofa and loveseat. If you want to refresh your living room area, you need to choose this set. Everyone will tell you how beautiful and comfortable these sofa and loveseat are.
small+living+room+arrangements+for+sectional | Sofa Living Room Furniture | Brookstone | Sofa Sectional Living Room ...
This sofa is an original, attractive and high quality product created for people who love comfort and style in their living rooms. This piece of furniture stands on solid wooden legs that increase the level of support and stability.
Embracing the neutral palettes and minimalist approach of this popular style, our Garner Sectional is swathed in a soft chenille fabric accented by a rich Hickory stained wood frame for an irresistible presentation
It is a 2-pieces living room set that includes sofa and chaise with accentuated pillows. They have got a traditional design and cushioned seat, for enhanced comfort of use. This set is perfect to refresh your living room area.
Superb wide seat and carved frame offering a wide range of visually pleasing accents provide a merge of decorous traditional style with desirable comfort. The arm chair that is presented here is padded with gold and brick red chenille fabric.
Inland Empire Furniture Marsala Light Tan Soft Chenille Sofa & Love Seat
A very comfortable and decorative element used in living rooms. This is a loveseat chair that features a durable wooden frame with attractive curves. The soft seat assures comfort and support thanks to its solid backrest.
This very luxurious, astonishing set in European style features a large sofa and love seat. Both piece of this set was crafted from a highest quality wood and fabrics, all keep in few shades of old gold.
Homelegance Lambeth Ii 2 Piece Living Room Set In Textured Chenille
Homelegance Lambeth Ii Loveseat In Textured Chenille
Genova 2 Pieces Classic Brown Fabric Leather Collection Sofa and Love Seat Set with Luxury Accent Pillows
It is a 3-piece living room set that is very elegant and has got green gold and grey pillow accents, comfortable seats, solid wood construction and rich tones. This set is perfect to refresh your living room area.
It is a sofa furniture protector that keeps your sofa clean. It is available in three color options to choose: blue, chocolate and natural. It is very easy to care for and machine washable.
It is a product that looks perfectly in the living room and bedroom. This is an armchair that is supported on a solid frame and durable legs. It features extra soft seat and backrest. Its size is 26.5"w x 26"d x 32.3"h.
Elizabeth Living Room Collection
A whole living room collection that includes one sofa and one ottoman that use only hardwood frames. Its contemporary style perfectly blends with other modern furniture. It features removable seat cushions.
This collection includes traditional-styled pieces of furniture designed for use in living rooms. The sofa, loveseat and chair are very comfortable products equipped with soft seat cushions. Their frames are very solid and resistant to wear.
This kind of sofa is a piece of furniture that has got a functional and decorative character. It is made of durable wood and its sitting space includes three seat cushions and five pillows for a superior comfort.
It is an elegant sofa that has got a chocolate and raisin finish, decorative accent pillows, rolled arms and very comfortable seats. Everyone will tell you how amazing it looks in your living room.
Casual sofa in federal blue ( blue denim chenille upholstery) coming with two accent pillows (modern pattern with geometric leaves in dark brown, beige and light blue). It stands in line with ecologically friendly surroundings thanks to manufacturing process.
It is a sectional sofa that has got a brown beige chenille upholstery and traditional design that fits to classic style and decor in your living room. You will be impressed how comfortable this sofa is.
It is a fantastic shag pouf ottoman that has got a red color, large size and soft cotton upholstery. This product can be used as a seat, footstool, ottoman and other. You will be impressed how cool this pouf is.
It is a fantastic shag pouf ottoman that has got a yellow color, large size and soft cotton upholstery. This product can be used as a seat, footstool, ottoman and other. You will be impressed how cool this pouf is.
It is a contemporary adjustable futon sofa bed that is a perfect addition for your living room and guest room. It has got a zebra pattern with black and white colors. It is a great choice.
A very solid, comfortable and decorative sofa designed for a living room use. It features a durable frame and three soft seat cushions with backrest supports. This sofa includes stable and attractive wooden legs.
Flash Furniture WM-8700-210-GG Rocker Recliner Chenille Tahoe Bark (WM-8700-210-GG)
Raymour & Flanigan The Dorian Collection in olive tones. #RaymourandFlanigan
Inland Empire Furniture Camila Tanish Grey White Wash Chenille Solid Wood Sofa & Loveseat
... Paint Colors For Living Room With Brown Furniture Picture » Part 76
Inland Empire Furniture Marta Soft Beige Chenille Sofa & Love Seat
chenille classic sofa set features traditional living room furniture ...
14 Mid Century Modern Living Room Design Ideas. The windows, the fireplace :)
Room Furniture Sets, THE FURNITURE :: Traditional Chenille Living Room ...
Trafalgar Square
poundex 2 pc Dark grey chenille microfiber fabric upholstered small sectional sofa with reversible chaise at
Chenille Fabric w/Gold Piping Contemporary Living Room
This is a sofa that provides a touch of a classic style into the living room. It has got a neutral colour that matches any decor. This piece of furniture stands on solid wooden legs and it has got a hand-built frame.
lantern hanging on hook
Morgan Living Room Collection Morgan's honey colored chenille and brightly colored accent pillows are the perfect place to start for transitional space. Roll arms are typically seen on traditional sofas, but the pillows' patterns are more contempor
American Signature Furniture - Monarch II Upholstery Collection-3 Pc. Sectional $899.99
... - 3pcs TAN CHENILLE SOFA COUCH SECTIONAL SET LIVING ROOM FURNITURE
... Contemporary Tan Chenille Sofa Couch Loveseat Living Room Furniture
Molly Chenille Chair


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A New Way to Get Places
Do you have trouble getting from point a to point b on a regular basis? Are you unable to move around like you once could? If you have even thought about answering yes to either of these questions, then you might need another way to get around. For years, the same technology has been around for wheelchairs, and no real improvement has been made. In a world where transportation is key, you might be better off finding an easy way for you or a loved one to get out and about. But now there is a new way to move around, and it starts with Buffalo Wheelchair.
Even if you aren't in the market for a mobility device, you can find a multitude of various medical equipment to be used at home. Since the professionals are there to help you make a positive purchase, you should be satisfied by the way they conduct themselves. The goal of any medical store is to help you pick out the right purchase while also having other items that you might need later. If you need any medical device to help you at home, then you have come to the perfect place.
Signs You May Need Hearing Aids
Our hearing is precious but most of us take it for granted until we lose it. Slight hearing loss can be a normal part of aging, but for many people, it can become severe enough to affect their quality of life. If you find yourself having to constantly ask people to repeat themselves, have trouble following conversations in groups, or family members are always yelling at you for having the TV up too loud, you may be suffering from serious hearing loss. Only your doctor and certified audiologist can determine your exact level of hearing loss and whether you need hearing aids. Today's hearing aids are discreet, comfortable and work extremely well. If you think your hearing is becoming a problem, contact your doctor and arrange a hearing test.
Of course it goes without saying that prevention is the best cure. The generations that grew up attached to their Walkmans, CD players and iPods will likely find themselves dealing with hearing loss and tinnitus in their later years. Wearing headphones on high volume can be tremendously damaging to your hearing. If you cannot hear what is going on around you, the volume is too high. You should invest in high quality hearing protection if you work with noisy machinery and even when you mow your lawn or use a leaf blower. Enjoy going to rock concerts? Bring ear plugs to protect your ears. You'll be glad you did years from now!
Restore Your Vision With This Simple Procedure
Few things in life are more frustrating than vision problems. We interact with the world primarily with our eyes, and if your vision is blurry or distorted from common eye problems, everyday tasks can become ordeals. Luckily, you don't have to suffer through the pain of impaired vision forever. With advancements in laser surgery, vision problems can be solved permanently with just a few simple procedures.
How Can LASIK Help?
LASIK surgery is a procedure that uses lasers to reshape the cornea in order to fix common vision issues. Lasik eye surgery doctors are some of the best in the world, and the procedure is nothing short of a modern medical miracle. It's a remarkably quick and simple procedure, and the precision of modern lasers mean that it's perfectly safe as well. The procedure allows for incredibly fast healing, with the vast majority of patients able to return to their everyday routines by the following morning.
If you suffer from nearsightedness, farsightedness, or an astigmatism, LASIK can dramatically improve the underlying physical problem in your eyes, allowing you to reclaim your vision and improve your quality of life. Check with your doctor to see if LASIK procedures can help reduce your visual problems.
When Do You Need an Ophthalmologist?
In the eye care world, there are both optometrist and ophthalmologists. So when do you need the latter?
Generally, if you have healthy eyes without any problems, which one you select is really up to you. If you are more comfortable with your eye doctor being a real MD with the extensive training and residency that goes along with that, then you may want to use a good ophthalmologist.
Optometrists and ophthalmologists each can do basic eye exams, and both are well trained to find eye diseases that may need either medical and/or non medical treatment.
If you already know that you have some type of eye condition, which includes glaucoma or cataracts, you will most likely want to see an eye care professional with more extensive training. In most cases, this would mean that you should seek ophthalmology care.
The majority of optometrists are very good for treating the most common eye issues, which as eye infections, scratched corneas and dry eyes. They also can do a very good job of working with someone with glaucoma. However, a fully trained MD eye doctor will better know all of the various treatment options for your disease, which could include eye surgery.
What Are Some Misconceptions About LASIK?
LASIK eye surgery is a great fit for many people, but you may have heard plenty of misinformation about the procedure. For example,
- Anyone can have LASIK. No, LASIK is not a good option if you have a thin or abnormal cornea, or any kind of eye disease or virus. If you have poor health of any kind, you could have a poor result.
- LASIK hurts. It is totally without pain. You will have anesthetic drops put in your eye to make it numb. After it is done, some patients say it briefly feels like they have sand in their eye for a couple hours. However, most people have little to no pain at all.
- LASIK can make you blind. There are no confirmed cases of such a thing, but you should know that serious complications can and do result on occasion. Your doctor can go over all the risks and benefits during consultation with various eye surgeons specializing in Lasik eye surgery.
- Lasers burn your eyes. LASIK uses a cold laser so it cannot burn anything.
- You never need glasses again. Your vision can still change with time, so you could still need reading glasses at some point.
- We don't know the long term side effects. LASIK has been done for over 30 years, and it has been found to be very safe.
Natural Medicine Can Help
Throughout your daily life, have you ever just felt a little off? Do you work in a factory where the conditions are rough? Or maybe you are in the food industry and all that food has finally gotten to you. For some Americans, everyday they feel as if something is missing, when indeed nothing is medically wrong with them. When you are feeling a little under the weather, and you want to try a different kind doctor, look for specialists of naturopathic medicine.
While for many Americans, going to the doctor can be scary, especially if it is a new doctor, you shouldn't have to worry about that when you are trying to stay healthy. When it comes to our doctors, you don't have to worry because their main priority is making you feel comfortable wherever you are. After that, their job is to use successful, natural medicinal ways to cure your ailments. The staff cares so much about the experience you have, and if they can't help you, then they will do as much as they can to help find someone who will be able to. Don't settle for the rest, but try the most natural instead.
Vision Problems? Signs You Need to See an Eye Doctor
Yearly trips to an eye doctor for a comprehensive eye exam usually aren't necessary. In fact, the typical period of time you should have an eye exam is every 2 years. Having your eyes assessed with a full examination every 2 years will ensure that your vision is on-point and that your eyes stay healthy. However, if you have a medical condition, such as diabetes, glaucoma, a lazy eye, macular degeneration or any family history of these eye problems, more frequent eye care and vision care will likely be necessary.
How do you know if you do, in fact, need to have your vision checked and your eyes assessed? Here's a look at some of the signs and symptoms that you should be aware of that indicate you need to have your eyes checked.
When To Call An Eye Doctor
There are several signs and symptoms that can indicate there is a problem with the health of your eyes or your vision. If you are experiencing any of the following, it is recommended you make an appointment with an optometrist or ophthalmologist as soon as possible.
Blurry vision and difficulty focusing. If your vision suddenly becomes blurry, or you are having difficulty with focusing, you could potentially be experiencing a larger health problem. You should make an appointment with your eye doctor as soon as possible so that he or she can assess the situation and determine what the cause of the issue is.
The appearance of visual disturbances. If you suddenly experience floaters, flashes of light or you notice that there is some type of obstruction of vision, you should contact your optometrist or ophthalmologist immediately. It is recommended that you seek care within 24 hours of the appearance of these disturbances. These signs could indicate a serious issue that could potentially have a permanent effect on your vision. A retinol detachment, or a hole or tear in the retina are serious issues and these visual disturbances are signs of such a problem.
Sensitivity to light. If you are suddenly sensitive to light, you should have an eye exam as soon as possible. This may be a sign of a variety of issues, such as a disorder or a disease of the eyes, or even an infection.
Eye pain or strain. It isn't unusual to experience pain in the eyes. There are a lot of factors that can cause your eyes to ache and make them feel tired. The amount of sleep you have had, allergies and illness will greatly impact how your eyes feel. However, if your eyes have been hurting for more than a few days, or if your eyes have been hurting for a few days when you move them, you should make an appointment with your doctor.


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|Aug 6
|Johann Andreas Schmeller a German philologist who initially studied the Bavarian dialect. From 1828 until his death he taught in the University of Munich. He is considered the founder of modern dialect research in Germany. His lasting contribution is the four-volume Bayerisches Wörterbuch , which is currently in the process of revision by the Bavarian Academy of Sciences and Humanities
|Aug 15
|Thomas De Quincey an English essayist, best known for his Confessions of an English Opium-Eater. Many scholars suggest that in publishing this work De Quincey inaugurated the tradition of addiction literature in the West
|Aug 18
|Friedrich Wieck a noted German piano teacher, voice teacher, owner of a piano store, and music reviewer. He is remembered as the teacher of his daughter, Clara, a child prodigy who was undertaking international concert tours by age eleven and who later married her father's pupil Robert Schumann, in defiance of her father's extreme objections. As Clara Schumann, she became one of the most famous pianists of her time. Another of Wieck's daughters, Marie Wieck, also had a career in music, although not nearly so illustrious as Clara's. Other pupils included Hans von Bülow
|Aug 21
|George Bishop (astronomer) a noted English astronomer of the nineteenth century.
|Aug 23
|Oliver Hazard Perry an American naval commander. Born in South Kingstown, Rhode Island, he was the son of USN Captain Christopher Raymond Perry and Sarah Wallace Alexander, and the older brother of Commodore Matthew Calbraith Perry, who compelled the opening of Japan
|Aug 27
|Agustín Gamarra a Peruvian soldier and politician, becoming twice President of Peru from 1829 to 1833 and from 1839 to 1841.
|Aug 30
|Lin Zexu a Chinese scholar and official of the Qing dynasty.
|Aug 17
|Jonathan Trumbull one of the few Americans who served as governor in both a pre-Revolutionary colony and a post-Revolutionary state. He was the only colonial governor at the start of the Revolution to take up the rebel cause
|Aug 20
|Jean-Baptiste Pigalle a French sculptor.
|Aug 26
|George Germain 1st Viscount Sackville a British soldier and politician who was Secretary of State for America in Lord North's cabinet during the American War of Independence.
|Aug 31
|Pietro Chiari an Italian playwright, novelist and librettist.


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1 Store
Dietary Supplement. No Loading. Works Fast. Created for experienced athletes, whose know that power and performance must be balanced with health and safety. This product contains the world's only, authentic Creatine Serum, Creatine Phosphaate Complex. Pure. Soluble. Unique. Created using our advanced liquid technology. Formulated from the purest, natural ingredients.IngredientsDistilled Water, Glycerin, Disodium EDTA (Preservative), Sodium Benzoate (Preservative), Natural Flavors, FD &C Red Color No. 40.DirectionsBefore you exercise, use the dropper to take 5 (1 mL) servings under the tongue.


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President Hotel
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TripAdvisor Reviews President Hotel Caracas
Travel Blogs from Caracas
Caracas, Round 2... :)
... some sangria. A nice, relaxed evening and then I passed out for a good night's sleep.
Not a whole lot, I know, but that's how I roll when I'm moving from one city to another. I've noticed I've slowed down a bit over the years in travelling, but I'm perfectly OK with it and enjoying just enjoying each location better without rushing the heck out of eveything...
A funny thing about a paddle!
... mention it, I think my husband brought home a paddle only the other night. But where did he get it, asks Kaitlin, eyes rekindled with with possibility of salvation? Well, says the cleaner, I think he said he saw it in a pile of rubbish! I can ask him if he still has it......which he did! And, retrieved from the loft of the cleaner's husband, Paddle find his way back to us. So, here we are! Paddle in hand at the airport attempting to persuade Kim, one of our young ...
In and out of Caracas
... bridge to cross over traffic and then follow the well designed walk way that led right to the airport. There were plenty of airline employees heading to work as well, so it was absolutely no problem determining our bus stop and how to find the airport afterwards. Best of all, instead of paying 150 bolivars, we each paid 2 bolivars (about 25 cents!)
We had to check in for our flight, where both our check-in luggage and carry-ons were weighed. The limit per person ...
Once more into the breach
... br>
Carla then explains the the 300 bolivares I got back are for the taxi driver for my part of the ride. Fine by me!
So just now calculating this all out I somehow ended up not actually losing any money
80 US dollars is about 53 pounds
15 US dollars I got back is 10 pounds
300 Bolivares on the official exchange rate of 1 pound = almost 6 Bolivares is 50 pounds
So I gave 53 but somehow ended up ...
... with �officials� but manged to meet my lovely taxi driver (thanks for arranging Joanna you are a saint!) who could only speak spanish but we managed to change some money up on the �black market� for me and get me safely to the hotel, I attemped to speak spanish the whole way which was quite amusing, definaely need to learn quickly if i�m going to stay here long.
Anyway, hotel fine (not fantastic but a good way to ...