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Becoming a private investigator isn't as simple as walking down the street and applying for the job. That certainly might be involved, but the process is a complicated one, involving a great deal by way of background checks, licensing by the state in which you intend to operate, and qualifications required in accordance with strictly-defined sets of standards. A private investigator has access to sources of personal information which are unavailable to the general population – and their trustworthiness is of great concern to each licensing body. Thus, certain experience is expected, and a variety of background checks are conducted. Someone looking to become a licensed private investigator can expect to have those who know them, or who have known them in the past, interviewed; this is something of which it is considered polite to inform those who might fall under this category, though ultimately the decision to pursue the career should be your own.
Many private investigators are willing to take promising individuals who are interested in pursuing the career with them for a day or two, to help them see what exactly the job is like, what work is involved, and how they go about discharging the duties for which their clients pay them. If you think that this is a field in which you might be interested, you should try to get in touch with private investigators in the state in which you would be looking to practice, and ask them for suggestions and advice. There will always be plenty of work to go around, and many private investigators have a deep and profound feeling for the function they fill within the wheels of the American civil and criminal justice systems. You will doubtless receive a great deal of feedback, as well as a lot of information on what steps to take next, and possibly more than a few offers to go on a ride-along.
Requisite Experience
Before you consider filing an application to become a private investigator, you need to examine your state's licensing requirements. Many states have requirements that a licensed private investigator have a certain amount of law enforcement experience before they can receive their license. This requirement varies from state to state, and isn't present in all of them, but where it is present it tends to consist of a requisite of several years' experience: by way of an example, the state of Massachusetts requires 3 years' experience in law enforcement, while the state of Connecticut to its immediate south requires 5.
In some cases, however, it is possible to gain that experience – not through law enforcement, or at least not only through law enforcement – but through employment under a licensed private investigator. Many private investigators employ administrative assistants or other personnel; being a private investigator involves the handling of a great deal of paperwork, including sensitive information, contracts, and large financial transactions. A person can pick up the nuances of working as a private investigator while working in the employ of one.
In addition… there is one more possibility whereby someone can gain the requisite experience to apply for a private investigator's license. In some states – though certainly not in all – it is possible to work in the employ of a private investigative agency which is itself the holder of a license, whereupon it is the responsibility of that agency to selected suitable individuals for employ depending upon their qualifications. While, in many cases, they are likely looking for the same traits as the state government would be – and while their hiring policies may themselves be strictly monitored, more so in some states than in others – this remains a possibility. At the very least, you could make inquiries, and deal directly with the individuals who would be making the hiring decision.
Background Checks and Criminal History
In most cases of employment in the modern day, background checks are a fact of life, but when pursuing employment as a private investigator it's a matter of state requirement… and it goes a bit further than what the local grocery store or construction contractor is likely to demand, if only because these kinds of background checks are extremely expensive for civilian agencies to perform. They include not only a credit check and a criminal background check, but also involve the conducting of interviews with friends, family members, and associates of the applicant. Strength of character, behavioral history, and an individuals demonstrated past tendencies when it comes to such qualities as personal responsibility and reliability – along with many other, similar factors – are taken into consideration when deciding whether or not to issue a candidate with a private investigator's license.
Not only is the background check thorough with regards to an applicant's criminal background – if there is one to be found, that is – but the existence of any current or past charges is taken strongly into account when the decision is made as to whether or not a candidate may be eligible for a license. Different states may have different requirements here, but there are certain features which are common enough to be considered more or less universal. A person cannot become a private investigator if they have any felony convictions in their past, or if they are currently facing charges which have yet to be officially resolved. There are certain misdemeanor offenses which will likewise present a more or less universal barrier to employment as a private investigator, regardless of where you are looking to practice; these vary slightly more than other requirements do, but consistently present among them are charges involving the knowing mishandling or theft of money or personal information. Private investigators have access to a wide variety of databases regarding personal information that is not available to the general public, and those with a history of obtaining such information illicitly – or using it inappropriately – are not granted licenses which would allow for more ready access to any such official government databases.


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Discussion in 'Pistons and NBA' started by indiefan23, Apr 10, 2009.
Nicely said! Question is: Where are we going to get a defensive anchor? Marcus Camby via trade?
Iverson didn't complain about being hurt, he said he came back without being fully healed and it affected his game. For 11 points and 2 assists in 5 minutes ya know. The team didn't force him but they made him feel crappy enough that he'd rather not play then be a team's scapegoat for their own decline. I get what he's saying.
The Tropicana.
Click red button
Indiefan...Your last response to me was exceptional...Thanks.
Hey, thanks! I'm gonna turn it into an article on my blog actually. Ironically the last one I wrote defended the Wizards. Full Court Pest: Is The Wizards Ceiling Higher Then The Basement? I just set up e-mail subscriptions if you're interested. I only put something out once or twice a week so no spam. This one is probably not going to be as nice to them though. I'm not the biggest Flip fan. But I suppose to their credit: the Wizards are much more suited to running/offense then the Pistons ever were and so is Flip, so maybe its a good match.
Allen Iverson will be on Pistons' playoff roster, won't play - ESPN Nothing we didn't already know. It just sucks b/c against the Cavs, he would help. I'm far from an AI fan, but I am a make the Cavs series less painful fan.
Man, screw him. Who was the last all-star athlete to just quit on his team like this? It's as unprofessional as it gets.
AI has reached Starbury status among NBA owners. Who will get the better contract in the off season?
Who was the last all-star athlete who got played 18 minutes a game, was told he could have the bench player's minutes and got pulled from games he single handedly got the team back into to have the people put back in lose?
Starbury? I don't think so. AI is way above that guy. He's going to come back and have a great season in comparison. Quite sure of that after this debacle. Iverson is at the end of his prime, not finished.
Well, I know Iverson wasn't the last, because he averaged 36.5 minutes per game this year, which was 2nd on the team, and only 48 seconds less than Tay, our most played player. This is surprising since AI was terrible and we had 2 other solid players at his position vs. at the SF, where we had nobody behind Tay. AI single handedly got us back into games? The team was +9 this year while he wasn't doing us that favor and -49 when he was. I agree that whatever he was doing could be categorized as single-handedly though as he chucked up 17.5 shots every 36 minutes with an eFG so bad that is was only higher than 2 guys who never played, Alex Acker and Walter Shape. You really don't want to brand yourself as a quitter when you are in a contract year.
The point is, by the end the team didn't want him, and he didn't want to be on the team. Why not just accept this? Giving AI and lots of other players 18 mpg and saying its going to stay that way is equivalant to telling him you don't want him, we all know that. AI wasn't going to come out and refuse to play, so they obviously didn't want him around that much or he'd still be playing, simple really. Its both sides not just one.
I don't think he cares about how he gets branded....He came out and publically said he wasn't a team player when he wouldn't play off the bench! Needs to go back to clubbing since that's what he was doing before being rushed to play 18 minutes off the bench. I don't think the Iverson/Pistons problem is solvable since he was banned from the the Detroit Casinos...
MGM and Greektown spokesmen: Allen Iverson isn't banned from our casinos | Freep.com | Detroit Free Press
I was reading this article on NBC Sports which stated that he was banned...Iverson reportedly banned from Detroit casinos - NBA- nbcsports.msnbc.com But I do know that one of his thugs (I don't consider his crew body guards because professional executive protection personnel try to avoid problems when the client is around as it poses danger to the client) broke a bottle over a guys head at the South Beach Pizza Bar in Detroit after they exchanged some words last Sunday... Man Says Iverson's Bodyguard Hit Him - Detroit Local News Story - WDIV Detroit
Why didn't the team want him? I mean we gave up our best player to get him. Joe has been trying to get AI for years (so it wasn't purely an expiring contract play). And even if the team didn't want him after getting to know him better, I would expect AI to follow through and give the best effort anyways. All I'm asking is this. Find me another example that meets these condition:All-star playerQuits on his team right before they enter the playoffs.And I'm not talking about guys like Manny Ramirez, cause at least he showed up to the facility. I want an example of a guy who just took his punchcard home with him. To make matters worse, AI was our ONLY all-star. And he wasn't just an all-star, he was a starting guard for the Eastern Conference. He was our highest paid player. He was supposedly hungry for a Championship and was attractive because our team had become complacent. We benched an all-star from last season and 5-time team leading scorer to accomodate him. After all of that, one sacrifice was asked of him for the good of the team, and he pouted for a few weeks and then he que-you-eye-tee.
I wasn't talking about the players, I was talking about the management inculding Curry. At the end they didn't want him. It was a mutual decision IMO. If it was AI, it isn't hard to place the blame on him, I mean they could blame him and even if he denied it, it would probably still stick. And again it wasn't the bench, it was the minutes which show they didn't want him. Rip would have gone mad with those minutes as well AND I WOULDN'T BLAME HIM EITHER. P.S. Did AI seem to be dogging it in any of the games he played off the bench, I saw the first one and I saw effort, second one, I didn't see but the play that allowed him to be taken out was apparently an effort play, what about the third game? AFAIK, he moaned but gave full effort while on court.
A great season for IIIIIIverson is points scored ...not games won. I mean, if GEORGE KARL cant deal with u?......................
Separate names with a comma.

subset: commoncrawl


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The Great American Tap Extravaganza Kick Off Party!!!
Theatre on Tap
Saturday, May 24, 2014 from 7:00 PM to 10:00 PM (CDT)
Who's Going
San Francisco, California
London, United Kingdom
Florence, Italy
Event Details
The Great American Tap Extravaganza Kick Off Party will launch our National Tap Dance Day Celebration Weekend! Join the dancers, singers, and musicians of Gulf Coast Theatre on Tap for a one-night only evening of live performances by company members, guest artists, and our live jazz ensemble. Your ticket for the evening entitles you to complimentary beer, wine, specialty cocktails created by The 12-Mile Limit, and a delicious spread of barbecue catered by Shortall's BBQ! If you enjoyed our Preview Party in January, you won't want to miss this exciting summer event!
The Great American Tap Extravaganza Kick Off Party is only the beginning of the exciting events we are hosting over the weekend! Visit www.theatreontap.com to register for National Tap Dance Day Master Classes, Workshops, Tap Jam, and Pedagogy Workshop/ Teacher Training!
When & Where
NOLA Spaces
1719 Toledano Street
New Orleans,
Saturday, May 24, 2014 from 7:00 PM to 10:00 PM (CDT)
Add to my calendar
Theatre on Tap
Theatre on Tap is New Orleans' Premier Rhythm Tap Dance Company whose mission is to celebrate, promote, and preserve America's indigenous dance form in the birthplace of jazz, and to share with the community the amazing experience that blending the two American art forms can illuminate.
Emmy Award and three-time Big Easy Award Winning Artistic Director and principal choreographer, Heidi Malnar, directs the three divisions of the company: Professional, Pre-Professional, and Junior in training, choreography, and performance. In addition to our diverse group of dancers, Theatre on Tap is proud to share the stage with our Live Jazz Ensemble.
We believe that rhythm is universal, and that tap dancing is accessible to people of all ages and levels of experience; and we offer first-hand opportunities through classes, workshops, master classes, company memberships, and live performances with the hopes of uniting diverse individuals through the power of shared rhythm.


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|"Hey, y"all!"
My friend Alison had a spectacular Mardi Gras party a couple of years ago to celebrate her birthday. Here are a few fun photos from that night...
|Birthday girl Alison is in the center
|these boys also play at Disneyland in New Orleans Square
|the tables and the food were spectacular, and
the chef was flown in from the Big Easy
|me and Suzy Q
ciao! fabiana


text:
Want to Break the Glass Ceiling? Give Young Women a Running Start
USA Today had a troubling piece this week reporting that the outcome of the 2010 midterms could lead to the biggest reduction of female representation in Congress in over three decades.
And it's not like female representation in Congress is great right now. Women make up 17 percent of the members of Congress, ranking the United States 68th internationally in women's political representation.
If the midterms prove to be a setback for Democratic women in Congress, it may give progressives an opportunity. We can surpass the abysmal 17 percent and break the glass ceiling once and for all by encouraging women to run earlier in their careers. According to the White House Project, in the 20th century, twelve of the nineteen presidents were thirty-five years or younger when they were elected to their first office.
To do this we must find, recruit and groom progressive young women. We will need to build recruiting organizations that cultivate aspiring female leaders when they are in high school and college. We will have to nurture and mentor young female candidates who lose their first local, state or federal race and empower them not to get discouraged and to continue to strive for elected office.
What progressives cannot do is let Sarah Palin's Mama Grizzlies define what the female politician looks and sounds like in the 21st century. This country is hungry for female leadership, and as women continue to be the majority of voters, we must take the opportunity to paint our nation pink.
Reshma Saujani ran an unsuccessful campaign in the Democratic primary against Rep. Carolyn Maloney in New York's 14th district, which covers Manhattan and Western Queens. A community activist and a legal scholar, she is a graduate of the University of Illinois, received her Masters in Public Policy from the Kennedy School of Government at Harvard University and her JD from Yale Law School.


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Loras Boulevard
Dubuque, Iowa, 52001
Commute to Downtown Dubuque
Some errands can be accomplished on foot.
About your score
Loras Boulevard has a Walk Score of 66 out of 100. This location is Somewhat Walkable so some errands can be accomplished on foot.
This location is in Dubuque. Nearby parks include Jackson Park, Madison Park and Bluff Side Park.
Explore how far you can travel by car, bus, bike and foot from Loras Boulevard.
View all Dubuque apartments on a map.
This location is in the city of Dubuque, IA. Dubuque has an average Walk Score of 39 and has 57,637 residents.Learn More About Dubuque


text: Two Skinny Black Guys Present: / / . T h e . C h a l l e n g e : . S m a c k d o w n . B o a r d . v s . . P r o . W r e s t l i n g . B o a r d . \ \ *Thanks to RHS and Juicebox, who collaborated and brought us this very sexy banner. The rosters are finally set, and thus the two boards are ready to wage war. The Challenge will see 14 pro wrestling board competitors face off against 14 Smackdown board competitors in a battle to determine which of these two boards is superior. The format for the contest can be found here. The Smackdown! Board Roster *Even more thanks to Juice for providing the team's roster cards. The Rules The rules are simple, and easy to follow: 1) First and foremost, if you are banned at any point of the Challenge, you will be eliminated from the contest 2) Discussion in the team threads is encouraged among participating users, but we ask that users uninvolved in the contest do not post in them. 3) Eliminated users, and those not involved in the contest are not to assist their board. If a team is caught getting outside help in a competition they will be disqualified from the current Match (some exceptions will be made, and will be noted when the Match is announced). 4) All votes are to be PM'd to your team's captain (SD Board - jpmegami, Pro Wrestling Board - Generation.Now) The game shall start with the first Squared Circle nomination. Both teams are to PM their votes to the team hosts immediately so that the first challenge can begin. @AliRock @DeathToAllMarks @ZweihanderDaBest @Ksquall1 @JuiceBox96 @HellfireUndeadjokerz


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Electric Rates Hit Another High
The price for electricity hit another record in October, up 42-percent in a decade. Good news for Texans is that we continue to pay well below the national average due to the state's reliance on natural gas.
"What we have right now is an environment of low natural gas prices, says Centerpoint's Shane McLaughlin. "So, the more natural gas you get your electricity from, the lower your costs are going to be."
And rates in Texas should remain roughly 25-percent below the national average.
"There's a lot of supply, people know where it is, and if there needs to be more, people can drill it fairly quickly," says McLaughlin.
If you want to keep your bills low this winter, McLaughlin says keep those holiday lights to a minimum, and always shop around.
"The rates we're quoting are available to customers that select them," he says. "So if you're not renewing your electricity contract every year, odds are you're over paying."


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Despicable! Mia Love's Wikipedia Page Hijacked By Racist Left-Wing Trolls
posted at 4:05 pm on August 29, 2012 by Matt Vespa
I couldn't agree more with Howard Portnoy's post on Mia Love's speech at the RNC last night. She is living proof that the America Dream is still alive. However, it always amazes me how the left can't stand people of color having conservative principles. Mia Love embodies hope and change, which isn't bolstered by a bed of hot air. She worked for the American Dream, whereas Barack Obama and the Democratic Party want to destroy it under the thumb of a hyper-regulatory progressive state. It's because Mia Love is black, conservative, and successful that the political left needs to smear and destroy her. She's an aberration concerning their narrative that government is here to take care of you–ALL of you.
As Portnoy posted in his piece, Love said in her speech:
Let me tell you about the America I know. My parents immigrated to this country with $10 in their pockets and the hope that the America they heard about really did exist.
The America I now is grounded in the determination found in patriots and pioneers. It's found in the Olympic athletes and every child who looks at the impossible and says, 'I can do that.' That's the America I know.
That drives liberals crazy. As a result, the left's hate began to flow. As reported by Twitchy today, the left-wing hate was apparent on Twitter with some of these classy folks tweeting the following:
Even more egregious was her Wikipedia page being hijacked and loaded with despicable edits that Gateway Pundit and others reported on earlier today.
Pundit posted this about the edits.
However, what's even more revolting was the edit calling Ms. Love a "house n*gger" for being a conservative Republican. Warning: some language may be inappropriate for younger viewers and it's definitely Not To Be Viewed at Work.
In Andrew Breitbart's last address to CPAC back in February, he quickly touched upon why he retweeted the hate that was sent to him via Twitter. He said it was to expose the left's "false narrative of their innate tolerance." I guess this awful incident is just another chapter in the annals of American liberalism. Stay classy left-wingers.
(H/T Tabitha Hale)
(H/T The Blaze)
(H/T Legal Insurrection)


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New Releases: July 18
"Sex Tape" Starring Jason Segel and Cameron Diaz
"Planes: Fire and Rescue" Starring Dane Cook
"The Purge: Anarchy"
"Wish I Was Here"
"Boyhood"...Richard Linklater wrote and directed this unusual movie about a young boy becoming an adult. It was filmed off and on over a period of 12 years, using the same cast..so you see everybody age in real life. Ellar Coltrane is the boy..the director's daughter, Lorelei Linklater, plays his older sister..and their parents are played by Patricia Arquette and Ethan Hawke.


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Your Account
Go under the hood with new (and old) features in Apple Mail in Leopard!
Are you using Apple Mail in Leopard effectively? In this book, completely updated from its previous Panther and Tiger editions, author Joe Kissell provides comprehensive guidance, with a focus on new and updated features.
You'll learn how to use and customize the Mail window, control the size and styling of incoming messages, and make rules to move messages into different mailboxes automatically. The book covers outgoing mail, showing you smart ways to address messages, send attachments, and send HTML-based messages. But, that's not all! You'll also find advice about setting up accounts, solving account connection problems and other bug-a-boos, handling spam, managing attachments, making backups, searching, signatures, notes and to-do items, Data Detectors, and more.You'll find answers to questions such as:
Joe Kissell has written numerous books about the Macintosh, including many popular Take Control ebooks. He's also Senior Editor of TidBITS, contributes frequently to Macworld, and previously spent ten years in the Mac software industry. Joe Kissell joined the TidBITS staff in 2006 as Senior Editor and currently lives in Paris. He has written more than a dozen Take Control ebooks, including the best- selling Take Control of Mac OS X Backups. He's also the author of numerous print books about Mac OS X and a frequent contributor to Macworld magazine. Joe runs a business called alt concepts, which publishes such Web sites as Interesting Thing of the Day and Truffles for Breakfast.
View Joe Kissell's full profile page.
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Return to SwingLifeStyle.com The Swingers Home Page
There are a total of 1454 Elk Creek swingers, within 100 miles.
The list below is a subset of the swingers in the Elk Creek area.
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Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems
- First Online:
- Received:
- Accepted:
DOI: 10.1007/s00134-011-2459-y
- Cite this article as:
- Reintam Blaser, A., Malbrain, M.L.N.G., Starkopf, J. et al. Intensive Care Med (2012) 38: 384. doi:10.1007/s00134-011-2459-y
- Citations
- 5k Downloads
Acute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. The variety of definitions proposed in the past has led to confusion and difficulty in comparing one study to another. An international working group convened to standardize the definitions for acute GI failure and GI symptoms and to review the therapeutic options.
The Working Group on Abdominal Problems (WGAP) of the European Society of Intensive Care Medicine (ESICM) developed the definitions for GI dysfunction in intensive care patients on the basis of the available evidence and current understanding of the pathophysiology.
Definitions for acute gastrointestinal injury (AGI) with its four grades of severity, as well as for feeding intolerance syndrome and GI symptoms (e.g. vomiting, diarrhoea, paralysis, high gastric residual volumes) are proposed. AGI is a malfunctioning of the GI tract in intensive care patients due to their acute illness. AGI grade I = increased risk of developing GI dysfunction or failure (a self-limiting condition); AGI grade II = GI dysfunction (a condition that requires interventions); AGI grade III = GI failure (GI function cannot be restored with interventions); AGI grade IV = dramatically manifesting GI failure (a condition that is immediately life-threatening). Current evidence and expert opinions regarding treatment of acute GI dysfunction are provided.
State-of-the-art definitions for GI dysfunction with gradation as well as management recommendations are proposed on the basis of current medical evidence and expert opinion. The WGAP recommends using these definitions for clinical and research purposes.
KeywordsGastrointestinal function Failure Symptoms Feeding intolerance Intensive care Definitions Classification
More than 10 years ago a round-table conference on gut dysfunction in critical illness concluded that intestinal function is an important determinant in the outcome of patients admitted to the intensive care unit (ICU), but that there is no objective and clinically relevant definition of gastrointestinal (GI) dysfunction in critical illness. In addition, it was stated that the definition developed in the future should grade the severity of dysfunction [1].
The problems in defining GI dysfunction start with defining GI function. Next to the digestive tract, the GI tract also carries out endocrine, immune and barrier functions. The clinical assessment of the impairment of these functions today is more intuitive than objective. Therefore, endocrine, immune and barrier dysfunctions will not be addressed in detail in the present paper.
Several studies have confirmed that GI symptoms are frequent in the ICU with up to 62% of patients exhibiting at least one GI symptom for at least 1 day [2, 3, 4]. There is also increasing evidence that development of GI problems is related to worse outcome in critically ill patients [2, 5, 6, 7].
Different definitions for separate GI symptoms have been used. The lack of markers for the measurement of GI function has suppressed studies in this field as well as the assessment of GI dysfunction as an organ failure. Although plasma citrulline and intestinal fatty acid binding protein have been proposed as possible markers for small bowel function [8], their clinical use in diagnosis and management of GI dysfunction is still unclear.
At least partly due to the lack of a formal definition and classification, treatment strategies for GI problems have been difficult to develop and are currently based on experience, rather than evidence.
There is increasing evidence that early protocolized and goal-oriented care can improve organ function and the patients' outcome during critical illness [9, 10, 11, 12]. Improving the definition of GI dysfunction as a part of the multiple organ dysfunction syndrome (MODS) and its derived sequential organ failure assessment score (SOFA) [13] will establish the base for setting up the bundle of preventive and therapeutic measures and support the development of novel treatment strategies.
For these reasons, the Working Group on Abdominal Problems (WGAP) as part of the Perioperative Intensive Care (POIC) section of the European Society of Intensive Care Medicine (ESICM) proposes a set of definitions and grading system of GI dysfunction in critical illness that are applicable both for clinical and research purposes.
Several key elements were used as a starting point for defining acute GI organ failure. An organ failure was considered as a dichotomous event that is either present or absent, whereas organ dysfunction is a continuum of physiologic derangement [14]. The expression "GI dysfunction" is used to describe the large variety of GI symptoms (diarrhoea, vomiting) and diagnoses (gastroenteritis) outside of the ICU setting; therefore, the expression "acute GI injury" was introduced.
Current definitions and management recommendations (according to Table 1; [15]) were developed on the basis of the available evidence and current understanding of the pathophysiology. Definitions serve as expert opinion, with their reasoning given in each "rationale" subsection.
The working method is described in detail in the electronic supplementary file.
Grading of the quality of evidence and strength of recommendations
Quality of evidence
RCT or meta-analyses
Downgraded RCTs or upgraded observational studies
Well-done observational studies
Very low
Case series or expert opinion
Strength of recommendation
Grade 1
We recommend
Grade 2
We suggest
- 1.
Gastrointestinal function
The human GI tract has many functions including facilitating digestion to absorb nutrients and water, barrier control to modulate absorption of intraluminal microbes (and their products), endocrine and immune functions. Perfusion, secretion, motility and a coordinated gut–microbiome interaction are prerequisites for an adequate function [16].
It needs to be underlined that because we currently lack the tool or marker to measure GI function we cannot reliably decide about normal GI function in the acute setting.
- 2.
Acute gastrointestinal injury (AGI) and its different grades
Acute GI injury (AGI) is malfunctioning of the GI tract in critically ill patients due to their acute illness.According to severity the following grades of AGI can be distinguished:
- 2.1
AGI grade I (risk of developing GI dysfunction or failure)—the function of the GI tract is partially impaired, expressed as GI symptoms related to a known cause and perceived as transient.
Rationale Condition is clinically seen as occurrence of GI symptoms after an insult, which expectedly has temporary and self-limiting nature.
Examples Postoperative nausea and/or vomiting during the first days after abdominal surgery, postoperative absence of bowel sounds, diminished bowel motility in the early phase of shock.
Management The general condition is usually improving and specific interventions for GI symptoms are not needed, except the replacement of fluid requirements by intravenous infusions. Early enteral feeding, started within 24–48 h after the injury, is recommended [17, 18] (grade 1B). The use of drugs impairing GI motility (e.g. catecholamines, opioids) has to be limited whenever possible [19, 20, 21, 22] (grade 1C).
- 2.2
AGI grade II (gastrointestinal dysfunction)—the GI tract is not able to perform digestion and absorption adequately to satisfy the nutrient and fluid requirements of the body. There are no changes in general condition of the patient related to GI problems.
Rationale The condition is characterized by acute occurrence of GI symptoms requiring therapeutic interventions for achievement of nutrient and fluid requirements. This condition occurs without previous GI interventions or is more severe than might be expected in relation to the course of preceding abdominal procedures.
Examples Gastroparesis with high gastric residuals or reflux, paralysis of the lower GI tract, diarrhoea, intra-abdominal hypertension (IAH) grade I (intra-abdominal pressure (IAP) 12–15 mmHg), visible blood in gastric content or stool. Feeding intolerance is present if at least 20 kcal/kg BW/day via enteral route cannot be reached within 72 h of feeding attempt.
Management Measures to treat the condition and to prevent the progression to GI failure need to be undertaken (e.g. treatment of intra-abdominal hypertension [23], grade 1D; or measures to restore the motility function of GI tract, such as prokinetic therapy [24, 25, 26], grade 1C). Enteral feeding should be started or continued; in cases of high gastric residuals/reflux or feeding intolerance regular challenges with small amounts of enteral nutrition (EN) should be regularly considered (grade 2D). In patients with gastroparesis, initiation of postpyloric feeding should be considered in this state, when prokinetic therapy is not effective (grade 2D).
- 2.3
AGI grade III (gastrointestinal failure)—loss of GI function, where restoration of GI function is not achieved despite interventions and the general condition is not improving.
Rationale Clinically seen as sustained intolerance to enteral feeding without improvement after treatment (e.g. erythromycin, postpyloric tube placement), leading to persistence or worsening of MODS.
Examples Despite treatment, feeding intolerance is persisting—high gastric residuals, persisting GI paralysis, occurrence or worsening of bowel dilatation, progression of IAH to grade II (IAP 15–20 mmHg), low abdominal perfusion pressure (APP) (below 60 mmHg). Feeding intolerance is present and possibly associated with persistence or worsening of MODS.
Management Measures to prevent worsening of GI failure are warranted (e.g. monitoring and targeted treatment of IAH [23], grade 1D). Presence of undiagnosed abdominal problem (cholecystitis, peritonitis, bowel ischaemia) should be excluded. The medications promoting GI paralysis have to be discontinued as far as possible [19, 20, 21, 22] (grade 1C). Early parenteral feeding (within the first 7 days of ICU stay) supplementary to insufficient enteral nutrition is associated with higher incidence of hospital infections and should be avoided [27] (grade 2B). Challenges with small amounts of EN should be regularly considered (grade 2D).
- 2.4
AGI grade IV (gastrointestinal failure with severe impact on distant organ function)—AGI has progressed to become directly and immediately life-threatening, with worsening of MODS and shock.
Rationale Situation when AGI has led to an acute critical deterioration of the general condition of the patient with distant organ dysfunction(s).
Examples Bowel ischaemia with necrosis, GI bleeding leading to haemorrhagic shock, Ogilvie's syndrome, abdominal compartment syndrome (ACS) requiring decompression.
Management Condition requires laparotomy or other emergency interventions (e.g., colonoscopy for colonic decompression) for life-saving indications [28, 29, 30] (grade 1D). There is no proven conservative approach to resolve this situation.
As differentiation of the acute GI problem from previously existing chronic condition might be very difficult, we suggest using the same definitions also in cases where the condition (e.g. GI bleeding, diarrhoea, etc.) might be due to a chronic GI disease (e.g. Crohn's disease). In patients on chronic parenteral feeding, GI failure (equal to AGI III) should be considered chronically present, and no new acute interventions to restore function are indicated. However, monitoring of IAH and exclusion of the new acute abdominal problems should be performed similarly as in AGI grade III management.
- 2.5Primary and secondary AGI
- 2.5.1
Primary AGI is associated with primary disease or direct injury to organs of the GI system (first hit).
Rationale Condition may usually be observed early (during the first day) after the insult to the GI system.
Examples Peritonitis, pancreatic or hepatic pathology, abdominal surgery, abdominal trauma, etc.
- 2.5.2
Secondary AGI develops as the consequence of a host response in critical illness without primary pathology in the GI system (second hit).
Rationale Condition develops without direct insult to the GI tract.
Examples GI malfunction in a patient with pneumonia, cardiac pathology, non-abdominal surgery or trauma, postresuscitation state.
- 2.5.1
- 2.1
- 3.
Feeding intolerance syndrome (FI)
FI is a general term indicating intolerance of enteral feeding for whatever clinical reason (vomiting, high gastric residuals, diarrhoea, GI bleeding, presence of entero-cutaneous fistulas, etc.).
Rationale Diagnosis is based on complex clinical evaluation. There is no single clear-cut symptom or value that defines FI [31]. Several symptoms are commonly present.
FI should be considered present if at least 20 kcal/kg BW/day via enteral route cannot be reached within 72 h of feeding attempt or if enteral feeding has to be stopped for whatever clinical reason. FI should not be considered as present if enteral feeding is electively not prescribed or is withheld/interrupted due to procedures.
FI in special conditions: in a patient with postpyloric feeding, FI is defined similarly to gastric feeding. If a patient is not fed enterally due to the presence of entero-atmospheric fistulas, FI should be considered present. If the patient undergoes a surgical intervention for ACS or for changing of surgical dressings of an open abdomen, FI should be considered present immediately after surgery unless enteral feeding can be administered.
Management FI requires efforts to maintain/restore GI function: limiting the use of drugs impairing motility, application of prokinetics and/or laxatives [32, 33, 34] (grade 1C), and controlling IAP. Challenges with small amounts of EN should be regularly considered. In patients not tolerating enteral feeding, supplemental parenteral nutrition should be considered [35, 36] (grade 2D). Recent data suggest that delay for 1 week with parenteral nutrition enhances recovery when compared to early intravenous feeding [27] (grade 2B).
- 4.Intra-abdominal hypertension (IAH)
- 4.1
IAH is present if IAP is found to be 12 mmHg or higher, confirmed by at least two measurements, 1–6 h apart [37].
Rationale Normal IAP is around 5–7 mmHg [38]. There are inherent variations and fluctuations in the IAP. IAH should also be considered present if the mean of the IAP measurements of the day is 12 mmHg or higher provided that at least four measurements were performed [39].
Management Monitoring of fluid resuscitation is necessary to avoid over-resuscitation [23] (grade 1C). Continuous thoracic epidural analgesia may decrease IAP in postoperative patients with primary IAH [40] (grade 2B). Nasogastric/colonic decompression is suggested for evacuation of intraluminal contents [23] (grade 2D). In patients with intraperitoneal fluids, percutaneous catheter decompression is recommended [23] (grade 1C). Elevation of head of bed above 20° should be considered as an additional risk for development of IAH [23] (grade 2C). Neuromuscular blockade decreases the IAP [41], but due to many undesirable effects it should be considered only in selected patients (grade 2C).
- 4.2
Abdominal compartment syndrome (ACS) is defined as a sustained (minimally two standardized measurements, performed 1–6 h apart) increase in IAP above 20 mmHg with new onset organ failure [37].
Management Although decompression remains the only definite management for ACS, the exact indications and timing of this procedure still remain controversial [42]. Currently it is recommended (1) to perform surgical decompression as a life-saving intervention in patients with ACS that is refractory to other treatment options [28, 43] (grade 1D), and (2) to consider pre-emptive decompression at the time of laparotomy in patients who demonstrate multiple risk factors for IAH/ACS [23] (grade 1D). In most severe cases of ruptured abdominal aortic aneurysm or abdominal trauma the initial use of mesh closure avoids development of ACS [44, 45] (grade 1C).
- 4.1
- 5.Gastrointestinal symptoms
- 5.1
Vomiting (emesis) is the occurrence of any visible regurgitation of gastric content irrespective of the amount.
Rationale Vomiting is commonly defined as the oral expulsion of GI contents resulting from contractions of gut and thoracoabdominal wall musculature [46]. Vomiting is contrasted with regurgitation, which is the effortless passage of gastric contents into the mouth [46]. In ICU patients the forcefulness of the act is often not detectable; therefore, regurgitation and vomiting should be assessed together.
Management Several guidelines for prevention and management of postoperative nausea and vomiting are available [47, 48, 49, 50, 51]. However, no studies have addressed management of vomiting in mechanically ventilated ICU patients; therefore, no specific recommendation can be given.
- 5.2
Gastric residual volume could be considered high if a single volume exceeds 200 ml [52, 53, 54].
Rationale There is no sufficient scientific evidence or physiological ground to define precise values for high gastric residuals [53, 55]. Measurement of gastric residuals is neither standardized nor validated [56]. It has been suggested that gastric residual volume greater than 200 ml should prompt careful bedside evaluation, but automatic cessation of enteral nutrition solely on the basis on residual volumes of 200–500 ml should be avoided [53, 56, 57]. Despite the lack of scientific evidence, the members of the WGAP arbitrarily use total volumes of gastric residuals above 1,000 ml/24 h as a sign of abnormal gastric emptying, which requires specific attention.
Management Intravenous administration of metoclopramide and/or erythromycin is recommended for management of high gastric residuals, whereas cisapride is no longer approved [58] (grade 1B). Routine use of motility agents is not recommended [58] (grade 1A). Acupuncture stimulation may facilitate gastric empting in neurosurgical ICU patients [59] (grade 2B). Use of opioids and deep sedation should be avoided/reduced if possible. Cessation of gastric feeding is suggested if residual volumes exceed 500 ml per single measurement [57]. Here, postpyloric feeding should be considered [58] (grade 2D). Routine application of postpyloric feeding is not advocated [58] (grade 2D). Postpyloric feeding may cause severe small bowel dilatation and perforation in rare cases.
- 5.3
Diarrhoea is defined as having three or more loose or liquid stools per day with a stool weight greater than 200–250 g/day (or greater then 250 ml/day) [60, 61].
Rationale Normal bowel frequency ranges from three times a week to three times a day. Secretory, osmotic, motor and exudative diarrhoea may be distinguished [61], but in the ICU it is often better to distinguish between disease-, food/feeding- and drug-related diarrhoea [61, 62].
Management Symptomatic therapy—replacement of fluids and electrolytes, haemodynamic stabilization and organ protection (e.g. correction of hypovolaemia to prevent impairment of renal function) forms the basic management [61, 63, 64] (grade 1D). At the same time, trigger mechanisms need to be discovered and when possible stopped (e.g. laxatives, sorbitol, lactulose, antibiotics) or treated (e.g. malabsorption, inflammatory bowel disease). Feeding-related diarrhoea in critically ill patients may require reduction of infusion rate, repositioning of feeding tube, or dilution of nutrition formula. Changing formula by adding soluble fibre prolongs transit time [61, 64, 65, 66] (grade1C). Only in cases of severe or recurrent Clostridium difficile-associated diarrhoea is oral vancomycin superior to metronidazole [67, 68, 69] (grade 2C).
- 5.4
GI bleeding is any bleeding into the GI tract lumen, confirmed by macroscopic presence of blood in vomited fluids, gastric aspirate or stool.
Rationale Asymptomatic, endoscopically evident mucosal damage occurs in the majority of ICU patients [2]. Clinically evident GI bleeding reflecting considerable damage to GI mucosa may be seen in 5–25% of ICU patients [2]. Clinically important bleeding, defined as overt bleeding in association with haemodynamic compromise or the need for blood transfusions [70], occurs in 1.5–4% of mechanically ventilated patients [2, 70, 71].
Management In cases of clinically evident GI bleeding, the haemodynamic status dictates the approach. In cases of bleeding with haemodynamic instability endoscopy is the diagnostic tool of choice [72], but when bleeding is ongoing and massive, precluding adequate endoscopic assessment, angiography is appropriate (grade 2C). Early upper GI endoscopy (less than 24 h) is recommended [72, 73] (grade 1A), except for patients with acute variceal bleeding in whom a more expedite procedure (less than 12 h) should be considered [74] (grade 2C). Epinephrine injection can be used in combination with another method, such as clips, thermocoagulation or sclerosant injection [72] (grade 1A). Routine second endoscopy is not recommended, but in cases of rebleeding, a second attempt for endoscopic therapy is recommended [72] (grade 1A). In cases of a negative upper endoscopy with evidence of GI bleeding, colonoscopy should be performed, followed by small bowel exploration using push enteroscopy if colonoscopy is negative [75] (grade 2C). In cases of ongoing bleeding with negative endoscopies, abdominal surgery with intraoperative endoscopy or interventional radiology should be considered [76, 77] (grade 2C).
- 5.5
Paralysis of lower GI tract (paralytic ileus) is the inability of the bowel to pass stool due to impaired peristalsis. Clinical signs include absence of stool for three or more consecutive days without mechanical obstruction. Bowel sounds may or may not be present.
Rationale Outside of the ICU, the terms constipation and obstipation include uncomfortable or infrequent bowel movements, hard stool and painful defecation. Because these symptoms may not be expressed in ICU patients, it is suggested to use the term paralysis of lower GI tract. A cut-off level of 3 days has been used in most of the epidemiological ICU studies [78, 79].
Management Inhibitory drugs for GI motility (e.g. catecholamines, sedatives, opioids) must be withdrawn if possible and conditions impairing motility (e.g. hyperglycemia, hypokalaemia) corrected [19, 20, 21] (grade 1C). Because of their delayed onset of action, laxative drugs must be started early or given prophylactically [24, 25] (grade 1D).
Because of unknown long-term efficacy and safety the routine use of opioid antagonists cannot be recommended [80, 81] (grade 2B).
Prokinetics like domperidone, metoclopramide and erythromycin are used to stimulate the upper GI tract (stomach and small bowel), whereas neostigmine stimulates small bowel and colonic motility [25, 30]. Despite the lack of well-controlled studies and sufficient evidence, we recommend a standardised approach in using prokinetics for management of motility disorders [24, 25] (grade 1D).
- 5.6
Abnormal bowel soundsRationale Normal frequency of bowel sounds may range between 5 and 35 sounds/min [82]; the clinical significance of abnormal bowel sounds is not clear. No technique of auscultation has been proven to be superior [83]. The authors suggest auscultation for at least 1 min in two quadrants, repeated at least once within a tight time frame. Palpation of the abdomen before the auscultation may stimulate peristalsis causing subsequent bowel sounds that may not have been there otherwise [82].
- 5.6.1
Absent peristalsis—no bowel sounds are heard at cautious auscultation.
Rationale Complete lack of bowel sounds is abnormal [83]. However, it should be recognized that presence of bowel sounds does not confirm normal motility, and that reoccurrence of bowel sounds does not correlate with improvement of paralysis.
- 5.6.2
Hyperperistalsis is present if excessive bowel sounds are heard on auscultation.
Rationale Hyperperistalsis is a state of excessive motility of the digestive tract. It can be present during bowel obstruction occurring in parts of the bowel as attempts to overcome obstruction [84].
Management There are no special management suggestions for absent/abnormal bowel sounds.
- 5.6.1
- 5.7
Bowel dilatation is present if colonic diameter exceeds 6 cm (greater than 9 cm for caecum) or small bowel diameter exceeds 3 cm, diagnosed either on plain abdominal X-ray or CT scan [85, 86].
Rationale Bowel dilatation is a common sign in obstruction at any level of the GI tract. Bowel dilatation may also appear without an obstruction; the terms toxic megacolon following colitis and acute colonic pseudo-obstruction or Ogilvie's syndrome, are used to describe acute severe colonic dilatation.
Management Next to the correction of fluid and electrolyte imbalance, nasogastric decompression may be helpful [29, 87] (grade 1D), although routine usage of nasogastric tubes after elective laparotomy is not recommended [88] (grade 1A). After exclusion of mechanical obstruction, intravenous neostigmine could be considered in patients with a caecal diameter >10 cm and without improvement within 24 h [29, 89] (grade 2B). Colonoscopy is recommended for non-surgical decompression in patients with a caecal diameter >10 cm and no improvement after 24–48 h of conservative treatment [29, 87, 90] (grade 1C). Colonoscopic decompression is effective in up to 80%, but carries a certain morbidity/mortality risk [30]. Conservative treatment together with colonoscopy may be continued for 48–72 h unless the caecum is >12 cm wide [30, 91] (grade 2C). In cases of unresponsiveness to conservative treatment, surgery is indicated due to the threatening risk of perforation [29, 30] (grade 1D). Usage of a laparoscopic technique with thoracic epidural anaesthesia where appropriate enhances bowel function after abdominal surgery [92, 93, 94] (grade 1B), and may therefore prevent bowel dilatation.
- 5.1
- 6.
Feeding protocols
Decreased food intake and resulting malnutrition are independent risk factors for in-hospital mortality [95]. European Society for Parenteral and Enteral Nutrition (ESPEN) guidelines are available with recommendations for nutrition in intensive care [58]. Feeding protocols based on these guidelines should be implemented in every institution. Periods of interruption of enteral feeding due to various interventions in the hospital (surgery, diagnostic or therapeutic interventions, extubation) should be remembered and minimized [96, 97]. Daily assessment of adequacy of enteral nutrition is required.
- 7.A schematic guideline for the management of patients with AGI is presented in Fig. 1.
Terminology and definitions provided in the present paper were developed with the aim of providing clinical definitions which may be used in different ICUs and clinical situations.
Our working methods were similar to those commonly used for the consensus definitions and grading of evidence for the treatment recommendations. The main limitation of the current document is the lack of objective measures for GI function/dysfunction. As the evidence in this field is scarce, the definitions are largely based on expert opinion. Therefore, in case new established measures to assess GI function/dysfunction become available, proposed definitions need to be revised. The complete description of diagnostic procedures for conditions underlying AGI is not provided in the current manuscript, common clinical approach is presumed.
Our grading system is not based on a certain numeric variable and is not validated. With no doubt further research is needed to establish the measures of GI function that could be used in a reproducible manner for grading GI function. At present, the descriptions of the grades of AGI are complicated and the same grade of AGI may have different clinical expressions. It is likely that the score will in some extent be dependent on the treatment applied. In fact, other organ dysfunction scores (e.g. SOFA score) have also been developed first, and only validated afterwards. Moreover, the cardiovascular sub-score of SOFA [13], known to be the most performing among all the sub-scores, is defined as a mean arterial pressure and the usage/dosage of vasoactive/inotropic agents, where the last part is clearly dependent on the local treatment traditions.
Despite the many well-known limitations which have been restraining the development in this area for so long, we need to move forward, and we suggest to start with the definitions proposed in this paper.
The terminology and definitions provided herein should allow better clinical communication as well as comparison between future studies. Defining the specific variables is the first step in a process towards better knowledge in this area. We propose a definition of acute gastrointestinal injury (AGI) with four grades of severity. AGI grade I stands for a self-limiting condition with increased risk of developing GI dysfunction or failure; AGI grade II (GI dysfunction) is a condition requiring interventions to restore GI function; AGI grade III (GI failure) is a condition when GI function cannot be restored with interventions; and AGI grade IV is dramatically manifesting GI failure, which is immediately life-threatening.
The WGAP of ESICM suggests using the proposed definitions until the results of a broader consensus are available. We encourage research to define explicit characteristics of GI function in critically ill patients.
We thank Luigi Camporota for his contribution.
Conflicts of interest
Open Access
This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.


text:
For football fans, the offseason sometimes feels interminable. The last regular-season game was played six months ago, the Super Bowl was decided in February, and the draft in April was little more than a short-term fix for the truly addicted.
But the long wait is almost over. The Cleveland Browns open training camp Friday in Berea, and by Aug. 1, all 32 teams will be sweating somewhere under summer's heat.
So why wait any longer? Here are five questions we're anxious to see answered when camps open:
1. Where will T.O. go? Let's start with the teams that have no interest in Terrell Owens: the Redskins, Chargers, Seahawks, Vikings and Patriots, plus a few others. Although his agent, Drew Rosenhaus, insists there's still a market for the 36-year-old wide receiver, don't expect a contract offer for a few weeks – or until an injury creates a need for a wideout. Owens, whose numbers have tapered off in each of the past three seasons, will have to accept a supporting role and an incentive-laden deal, and he'll have to tone down his usual over-the-top histrionics. But is that really a bad thing?
2. Will Albert Haynesworth be a happy camper? No one knows for sure, but if the Redskins defensive lineman has really dropped 32 pounds, as his personal trainer claimed last week, it can't be view as anything but a good sign. Still, you can't get away from the fact Haynesworth has been absent from the team's offseason activities and has yet to agree to jump on board Washington's switch to a 3-4 defense. Until that happens – and until he makes amends with disgruntled teammates who were unhappy over his no-shows – there's no reason for new coach Mike Shanahan to feel optimistic.
3. Will Michael Vick be wearing an Eagles uniform when camp breaks? Right now, the smart money says yes. Vick should feel happy to have a job, but he hasn't hidden his desire or intention to still be a starting quarterback somewhere. Even so, it's difficult to understand why he's doing things to sabotage his career since gaining reinstatement last season. Vick has already been paid a $1.5-million roster bonus, so unless a team approaches the Eagles about a trade (not likely), he'll probably serve as Kevin Kolb's backup and as a gimmick player again.
4. Can Jason Campbell turn the Raiders into contenders? Probably not, but if there's such a thing as addition by subtraction, Oakland will certainly be better than last season's 5-11 team. The release of JaMarcus Russell can only be viewed as a good thing, but there's just so much Campbell can do. Given the fact the Raiders last season scored fewer points than every team but the St. Louis Rams and totaled just 17 touchdowns, their offense will need to improve in several areas to finish ahead of the San Diego Chargers and Denver Broncos in the AFC West.
5. Will Brett Favre return for one more season? Puh-leez. The only question is when Favre will come back, not if (that's why Vikings coach Brad Childress was in Mississippi on Monday to visit with the QB). OK, so Favre still sounds undecided because his left ankle isn't fully healed since undergoing surgery two months ago. The fact is, he wants to come back and was throwing the ball to some kids in Hattiesburg last week. Anyway, how much time does Favre really need in training camp? Sure, he turns 41 in October, but he played in just three preseason games last season and still took the Vikings to the NFC Championship game. Best guess: He suits up around mid-August.


text:
I have to give Nicole, Kelly and their friend Andrea full credit for this amazing appetizer. Not too long ago, they got together with some friends and Andrea made this. As they were explaining it to me, I kept asking what else was in it and they kept saying nothing. It's just brie, apples and crescent rolls. It's almost not a recipe.
So as the three of us were planning a party, they told me that we had to make these turnovers. OK….I still was having a hard time believing there was only three ingredients in it….but we'll make them.
Well they were SO amazingly good and amazingly simple to make! You just wrap a couple of thin slices of apple along with a slice of brie in a crescent roll and bake it. THAT'S IT. The combination of the apple and the warm brie all wrapped up in the crescent roll was wonderful. There was not a single one left!
- 1 granny smith apple
- brie cheese
- 2 cans crescent rolls
Shared at Miz Helen's Country Cottage on 1/12/12.


text:
Society for Human Resource Management (SHRM) Student Chapter - Online Application
Benefits of Student Membership
- Students should go online and complete an application for the Delaware Chapter.
Payment of $10.00 is required.
- Meeting and sharing with your fellow students your knowledge and experience
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The Wilmington University Society of Human Resource Management Student chapter will help you move into the business world. The Chapter will allow you to supplement your classroom education with real-world knowledge hands-on experience. ELIGIBILITY FOR ENROLLMENT IN THE WILMINGTON UNIVERSITY FOR HUMAN HUMAN RESOURCE MANAGEMENT IS LIMITED TO THOSE STUDENTS ENROLLED EITHER IN HUMAN RESOURCE MANAGEMENT OR BUSINESS MANAGEMENT DEGREE SEEKING PROGRAMS.


text:
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text:
Rating: 3.0/5 (Total votes: 99)
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text:
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Say What? (feat. Steve Cole)
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text:
How to Style a Pixie Cut - Battle of the Styling Creams
I spray on some Color Vibrancy Dual Protect Spray by L'Oreal ($8.99, I think I got mine at CVS and it was around $5), which basically shields color from fade-out. After that I spray in some John Masters Organics Deep Scalp Follicle Treatment and Volumizer for Thinning Hair ($23) because after bleaching my hair I have scalp issues. The 17 organic herbs and oils help improve scalp health.
My ultimate favorite hair "stuff" was Garnier Fructis Pure Clean Finishing Paste ($4.99), it did everything I wanted it to, wasn't goopy or stiff, had strong hold and it's 99% naturally-derived. I used up a whole container and went to buy a new one and couldn't find it!
I saw the Garnier Fructis Style Deconstructed Pixie Play Craft Cream ($4.99), hoping it would do the same thing. WRONG. It claims to give high definition and control without clumping. There was hardly any definition or control. FAIL.
The next day I bought the Not Your Mother's Short Order Fiber Glaze Cream ($5.99), which smells like fresh oranges. I put it in my hair while it was damp and once my hair was dry it looked the same as it would without anything in it at all. I tried to use it on dry hair but still results were less than good.
I finally found my treasured Pure Clean Finishing Paste and will never use anything else.


text:
Bankruptcy Law
Bankruptcy Law Questions? Ask a Bankruptcy Lawyer.
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text: About One-of-a-kind action puzzle game inspired by the classic tale of Alice in Wonderland. In this abstract bomb-based game, apply real physics in an imaginative environment. Juggle bombs and blow out burning fuses in familiar character scenes – from the harried White Rabbit and the elusive Cheshire Cat, to the hookah-smoking Caterpillar and the tea-drinking Mad Hatter, and more! Game … Read More


text:
I guess ''regularly'' is a variable ..... but more times than not apart from EDC 226 - I have my NAA .22mag mini in one or another pocket.
It is of course a minimalist BUG but - it's still something to fall back on.
The ultimate is maybe the guy who carries two of same - and thus all ready for the famous ''New York Reload'' if need be


text:
Reese Witherspoon has lined up another romantic comedy.
The actress is set to star in and co-produce "The Beard," based on a script by Becca Greene (MTV's "Good Vibes,"), according to The Hollywood Reporter.
PLAY IT NOW: Reese Witherspoon Gets Sexy For 'This Means War'
No plot details were available on the project - from Chernin Entertainment - but beard, when applied to a woman, usually refers to a gal who poses as the lady love of a secretly gay man.
Reese, 36, most recently appeared in the rom com, "This Means War," alongside Chris Pine and Tom Hardy.
VIEW THE PHOTOS: Blonde or Brunette! Which Celebs Are Hitting The Bottle?
Next up for the actress is "Mud," a drama in which she co-stars with Matthew McConaughey.
A U.S. release date for the film, about a group of young men who help a fugitive avoid capture, has not been announced.
Copyright 2012 by NBC Universal, Inc. All rights reserved.
This material may not be published, broadcast, rewritten or redistributed.
VIEW THE PHOTOS: (Legally) Blonde & Beautiful Reese Witherspoon!


text: Today is the 2nd anniversary of my Dad's death. He passed young (63) and very suddenly, no warning. I really can't think of a day that has passed that I don't think about him. It's just a dreary gloomy day outside, thats kinda how I'm feeling. Thanks for letting me share a little everyone.


text:
Do not take moexipril if you are pregnant. If you become pregnant while taking moexipril, call your doctor immediately.
Why is this medication prescribed?
Moexipril is used to treat high blood pressure. Moexipril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It decreases certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.
High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
How should this medicine be used?
Moexipril comes as a tablet to take by mouth. It is usually taken once or twice a day and should be taken on an empty stomach 1 hour before or 2 hours after a meal. To help you remember to take moexipril, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take moexipril exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Moexipril controls high blood pressure but does not cure it. Continue to take moexipril even if you feel well. Do not stop taking moexipril without talking to your doctor.
Other uses for this medicine
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before taking moexipril,
- tell your doctor and pharmacist if you are allergic to moexipril or any other medications, or any ingredients in moexipril tablets. Ask your pharmacist for a list of the ingredients.
- tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT). Your doctor will probably tell you not to take moexipril if you have diabetes and you are also taking aliskiren.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: diuretics ('water pills'), lithium (Lithobid), other medications for high blood pressure, and potassium supplements.
- tell your doctor if you have diabetes, or heart or kidney disease.
- tell your doctor if you are breastfeeding.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking moexipril.
- you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.
What special dietary instructions should I follow?
Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.
What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
Moexipril may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- cough
- dizziness or lightheadedness
- sore throat
- hoarseness
- excessive tiredness
- headache
- diarrhea
- vomiting
- fever
- muscle aches
- fast heartbeat
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
- swelling of the face, eyes, lips, tongue, arms, or legs
- difficulty breathing or swallowing
- fainting
- rash
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to moexipril.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Brand names
- Univasc®
Brand names of combination products
- Uniretic® (containing Moexipril Hydrochloride and Hydrochlorothiazide)


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Hurry over to HeroBuilders.com to pick up your very own Tanorexic action figure. For $30, you can have your very own miniature version of the woman who was arrested for child endangerment after allegedly taking her toddler tanning. Unfortunately, the doll doesn't call you fat and jealous if you pull a string. The creation of this action figure, clearly, is definitive proof that the apocalypse is closing in. The Earth's crust will surely split and open our existence to demons and hellfire in a matter of days. Plan accordingly. [NJ.com]
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Let us know when your receive great advice so we can thank our lawyers and point others with similar questions in the right direction.Got it!
I got rear-ended in a car accident three days ago, but don't feel like I'm injured. I'd rather not go to the doctor, but what if I should anyways. Is it always smart to go after an accident?
Always get evaluated by a doctor after any kind of car accident as a health safety precaution.
Licensed in PA & NJ. 29% Contingency Fee. Phone: 215-510-6755 www.InjuryLawyerPhiladelphia.comAsk a similar question
Good question! I usually recommend my clients go to a doctor immediately after a collision to get checked out when they aren't sure they are injured. Better safe than sorry. You would be surprised how many times they are diagnosed with serious injuries, including one young man who was rushed in for emergency surgery to stabilize his spine after precautionary x-rays at an urgent care clinic. However, if after 3 days you don't think you are injured, and you are experiencing no pain, discomfort, or other symptoms, you most likely are not. If you develop any symptoms, go get checked out immediately.Ask a similar question
Yes, you should always get checked out by a doctor as soon as you can. Some injuries do not show up for some days, and pain and suffering is a sign of injury. I have had cases where a small pain that would not go away turned out to be a much more serious injury that first thought. Some types of soft tissue injury to the back and neck do not show up for several days to a week or more.Ask a similar question
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LibraryThing Author:
Member: DerekGilletteCo
CollectionsYour library (1)
Reviews1 review
TagsFatherhood (1), Parenting (1) — see all tags
About meDerek Gillette is an author who writes with candor and honesty. His willingness to self-disclose is so revealing, it will make you cringe at times. He is a writer without shame, not lacking in boldness for the message he feels called to broadcast through paper and pen.
Also onTwitter
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LocationSeattle, WA
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High Power Bob,
My PT-145 shoots low and to the right just like yours. Do you know what the height of the Williams front sight is?
Since you really do shoot a lot---do you find very much metal filings in your PT-145 when you clean it? Mine has a lot!


text:
Health Level Seven International has strengthened its ties with the Denmark-based International Health Terminology Standards Development Organisation.
IHTSDO has provided HL7 with a free "public good" license to the SNOMED CT terminology codes and descriptions. This will aid HL7 in producing SNOMED-enabled international products or specifications to advance interoperability across nations.
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[Date Index]
[Thread Index]
[Author Index]
RuleDelayed plot options and Show
Dear Group,
evaluate code to see error message:
SetOptions[Plot, AxesLabel :> {"X", y[[i]]}];
y = {"Y1", "Y2"};
Plot[Sin[x], {x, -1, 1}]
, {i, 2}]
The problem is Show does not know what iterator 'i' means. The
individual plots have the correct y axis labels, but Show failes to
print them in the array (since in Show the y labels are re-evaluated -
due to RuleDelayed).
The layout of this code I do not want to change (ie. the SetOptions as
initialization, and the delayed rule for the y label).
Any suggestion?
thanks in forward
Istvan Zachar


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No pics?
This is a discussion on Range And Carry (RAC) Holster Review within the Defensive Carry Holsters & Carry Options forums, part of the Defensive Carry Discussions category; DISCLAIMER: I am not employed by or affiliated with I.C.E. Training, Rob Pincus, or Psy-Op Tactical Holsters. The following review is based on my personal ...
DISCLAIMER: I am not employed by or affiliated with I.C.E. Training, Rob Pincus, or Psy-Op Tactical Holsters. The following review is based on my personal experience and is intended for informational purposes only.
I don't post often but regularly read this sites many forums. I recently posted this review on my FB page and thought the members here might enjoy it as we'll...
Range And Carry (RAC) Holster Review
Earlier this year I made the decision to switch to kydex holsters/gear. I now work in a construction type job and needed something more durable and sweat resistant than leather. I was all set to purchase another brand when I learned Rob Pincus had designed a kydex holster.
Rob Pincus has a solid reputation for not advocating or promoting products just simply to sell gadgets. So I figured if he designed a holster for "Range & Carry", this is something I should look into.
I've been using this holster daily for about two weeks. I primarily carry a G26 but occasionally switch to a G19, the holsters open bottom design allows for carrying all sizes of a specific "family" of guns (Glock, M&P, XD, etc.)
The holster holds the pistol tight agains the body while hugging the curve of the hip making for a very comfortable carry. With the belt properly tightened I found no movement of the holster along the belt, leather or synthetic.
Retention was superb. The holster holds the pistol firmly even when turned upside down and gently shaken; however, drawing is smooth and no "hard pull" is needed.
The "lip" molded into the face of the holster was designed for easier re-holstering and one handed manipulations. While this feature aided both, I find that it helps with the latter the most.
The holster conceals very well under a sweatshirt, button down shirt, or heavy polo, not so well under a t-shirt or "performance" polo. Of course this is with MY wardrobe and MY body, your experience may be different.
My only dislike for this holster is that it is a straight drop design. I prefer about 15 degrees of cant; however, to call it a dislike is unfair as it was well and honestly described and I knew this before I purchased.
My holster won't see much range use as sadly the range I shoot at doesn't allow drawing from the holster. For my body type, wearing my style of clothing, participating in the activities of my lifestyle I probably won't cary this much in Ohio's summer months; however, I see this holster as being my permanent cool/cold weather carry holster.
This holster is definitely well thought out and we'll made. It is honestly advertised and priced conservatively. I'm very happy with my purchase and look forward to other products in this line.
To purchase: I.C.E. RAC (Range and Carry) Kydex Holster
No pics?
Black Arch Holsters
SHTF Gear is now Black Arch Holsters
I guess that would help...
And to show how different guns protrude from the open bottom...
Glock 19
Glock 26


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Almost all leading brands made sure to include capes in their collections. These comfortable yet effortlessly stylish pieces are the perfect choice to wear when you want to stand out without going over the top. Scarves are the one item which can never go out of fashion. Whether you choose a silk paisley printed or a woolen patterned one, a scarf is sure to function as the perfect accessory to dress an outfit up or down according to the occasion and the way you carry it.
When it comes to jeans, skinnies are still the way to go. Pair them with a leather jacket and ballet flats, and you are good to meet up with the girls for lunch! If having a night out, pair them with a drapey top, some chunky accessories and pointy-toe heels. The trend might have started last year, but it was this year that the animal prints fever caught up with fashionistas. From scarves to footwear, from shrugs to trench coats…animal prints are everywhere. Paris, London, New York…they were spotted on nearly all major international fashion weeks and our local designers couldn't keep away either.
To make the shopping experience more exciting for their valued customers, Daraz.pk has now started its winter sale. With over 2500 products, and discounts going up to 50%, you are sure to find the perfect additions to your wardrobe at a way lesser price! Browse the sale items and filter them according to your requirements, eliminating the pain of going through hundreds of products till you find the one you like. Besides clothes, the sale is also extended to accessories and bags. Stay warm yet fashionable this season by getting tips from Daraz.pk's online fashion e-Mag or checking out their 'New and Top Pick' section.
Daraz.pk also offers a Rs. 500 discount for all first-time visitors, who can claim the discount by simply signing up for the official newsletter on the site. Some of the top brands available on daraz.pk are Arsalan Iqbal, Deepak Perwani, Lark & Finch, Edge, Pink Bling, Taneesha, Shahzeb Saeed, Umar Sayeed, Feeha Jamshed, Ego, Yellow and Daaman, including many other of the best Pakistani fashion brands, making sure there is something that will fit everyone's pocket!
So log on to daraz.pk today to start shopping and receive your purchases at your doorstep!


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July 16, 2014
BIRMINGHAM, Ala. ---- UAB fans have made their choice for the official Be Seen In Green t-shirt design.
Shirts will be available Aug.1 at Barnes & Nobles and Snoozy's for $10 with a portion of each purchase going toward student-athlete scholarships.
UAB Athletics will launch the Be Seen In Green campaign on Friday, Aug. 29, leading up to the Blazers' football season-opener against Troy at Legion Field.
UAB fans are encouraged to show their Blazer pride by wearing green on Fridays throughout the fall. Fans can post their photos on Facebook, Twitter and Instagram with #UABSeenInGreen. Blazer cheerleaders, along with UAB mascot Blaze, will be on campus throughout the fall rewarding Blazer fans who are seen in green.
For more on Blazer athletics, follow UAB on Twitter @UABAthletics.


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This service is offered to members of the VisitKorea website and Facebook through account log-in.
VisitKorea does not guarantee the quality of products or services introduced on its site and is not responsible for any direct or indirect losses resulting from use of said products or services.
Region : Yeongdong-gun Chungcheongbuk-do
Type : Auditoriums
Opened in 1987, Nangye Hall of Korean Classical Music is located in Yeongdong-eup, Yeongdong-gun with two above ground levels and one basement level. It is comp...
Region : Yeongdong-gun Chungcheongbuk-do
Type : Waterfalls/ Valleys/ Mineral Springs
The waters that carved Mulhan Valley (물한계곡) in Yeongdong, Chungcheongbuk-do originate in the upper reaches of the Hancheon Village stream. In summer, many touri...


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A decline of the monarch butterfly population has entomologists worried about their fate. Numbers are at the lowest level since monitoring began in 1993, reports The Dispatch on January 30. The annual monarch migration begins in the fall when millions of monarch butterflies wing their way from the United States to their winter home in Mexico.
According to the Monarch Butterfly Website, these black-and-orange butterflies travel 2,500 miles to reach their winter home in Mexico where they cluster together on oyamel fir trees.
Upon arrival in Mexico, these brightly colored butterflies blanket trees as thousands create a cluster of fluttering wings, bringing the area alive with color. Because of this practice, the migrating population is counted by the area it covers. At their peak in 1996, monarch butterflies covered 44.5 acres. This year the monarch butterflies are confined to a mere 1.65 acres.
When the time arrives for the monarch to continue breeding, it wings its way north where it finds host plants for the developing caterpillars.
The common milkweed plant (Asclepias syriaca) is the primary host plant for monarch butterflies. Scientists think that part of the problem causing the decrease in numbers of monarch butterflies lies in the destruction of milkweed plants throughout the United States. Weather may also play an important role in the declining numbers of migrating monarch butterflies.
Some homeowners and gardeners along the Gulf Coast have begun planting milkweed in an attempt to provide the monarch butterfly with host plants.


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Jean Paul Gaultier pour Gibo Vintage Jacket
- Sold for: Start Free Trial or Sign In to see what it's worth.
- Item Category: -
- Source: eBay
- Sold Date: Jul 13, 2009
- Channel: Auction House
This was quite a find! Unfortunately, it doesn't fit me! This Jean Paul Gaultier jacket is in fine Italian wool. The jacket is in perfect condition. The lining is a bit faded, but no one can tell.
The buttons have an unusual pattern....embossed flowers in a pot.
The sleeves can be worn straight or cuffed, as the lining is in wool at the cuffs.
The jacket has one breast pocket and one wool "tag" on the back as a decoration.
This jacket is a prize for someone who appreciates fine fashion.


text:
- Course Number:
- Course Title:
- Exhibit Construction, Maintenance, and Repair
- Credit Hours:
- 2
- Lecture Hours:
- 0
- Lecture/Lab Hours:
- 40
- Lab Hours:
- 0
- Special Fee:
- $12.00
Course DescriptionProvides an overview of the basic concepts used in animal exhibit construction, maintenance and repair. Emphasizes safety, identification, selection, usage and care of hand and power tools to complete projects in a team environment. Introduces the use of construction materials, concrete and related hardscapes, reading blueprints, and communication regarding mechanical, electrical, and plumbing services. Department permission required. Prerequisites: BMZA 101. Audit available.
Intended Outcomes for the course
Upon successful completion, student should be able to:
- Use appropriate safety principles and procedures when operating in a zoo construction, maintenance, and repair environment.
- Identify and select appropriate tools to complete animal exhibit construction, maintenance, and repair projects.
- Use tools and a variety of materials to complete animal exhibitry projects in a team environment.
- Identify and communicate appropriately regarding problems with mechanical, electrical, and plumbing systems.
Course Activities and Design
The format for this course is a combination of lecture, demonstration, and laboratory experience to provide necessary skills in techniques used in exhibit construction, maintenance, and repairs. Laboratory instruction will be based at the Rock Creek campus building construction technology area.
Outcome Assessment Strategies
- Attendance, punctuality, and participation
- Exams
- Concrete article review
- Successful completion of class projects
- Quality of field projects
Course Content (Themes, Concepts, Issues and Skills)
Themes, Concepts and Issues
- Tools and Safety
- Power Tools
- Hand Tools
- Fasteners
- Reading Blueprints
- Basic Wood Construction
- Electrical
- Plumbing
- Basic Concrete
- Construction Math
Process Skills
- Lay out and measure using tape measure
- Develop hand-eye coordination using hand and power tools
- Operate power tools and use hand tools safely and effectively
- Identify hand tools, power tools and fasteners
- Read blueprints
- Develop an understanding of basic electrical wiring.
- Develop a basic understanding of plumbing and the different types of pipe involved (Copper, PEX, PVC, CPVC)
- Develop a basic understanding of the composition, strengths/weaknesses and admixtures of concrete.
- Familiarity with pouring and forming concrete.
- Use critical thinking to determine the best tool for the task at hand.
- Work collaboratively with team member(s) to construct projects using hand and power tools.
- Recognize safe work practices.


text: MAUMEE, Ohio, April 11, 2013 /PRNewswire/ -- Dana Holding Corporation (NYSE: DAN) announced today that its Spicer India Ltd. facility in Jodalli, India, earned the D.L. Shah Quality Award for excellence in manufacturing. The Shah Quality Awards recognize successful projects of an organization that have resulted in continuous improvement in delivery of products or services and demonstrate efficient and effective operations, as well as increased stakeholder satisfaction. It is awarded in five sectors: manufacturing; general service; information technology; health care; and finance. "Dana continuously pursues improvements in the quality of our manufactured parts, which is essential to maintaining our technology leadership," said Mark Wallace, president of Dana Light Vehicle Driveline Technologies. "We are honored to be recognized for this achievement, because it demonstrates the commitment of our people to deliver the highest quality parts to our customers across the globe." The Jodalli facility's case study was selected first among 75 entries and was assessed on financial benefits, impact, diagnosis of a problem, methodology, sustainability, innovation in approach, application, and technique. The case study highlighted a team of 16 Dana employees from across business functions working on five projects simultaneously using the Dana Operating System – a standard problem-solving methodology to improve quality and ensure manufacturing excellence – to achieve a Cost of Poor Quality (COPQ) of zero. The Quality Council of India, comprised of industry and Indian government officials, honored Dana with the award during the 8th National Quality Conclave in New Delhi. About Dana Holding CorporationDana is a world-leading supplier of driveline, sealing, and thermal-management technologies that improve the efficiency and performance of passenger, commercial, and off-highway vehicles with both conventional and alternative-energy powertrains. The company's global network of engineering, manufacturing, and distribution facilities provides original-equipment and aftermarket customers with local product and service support. Based in Maumee, Ohio, Dana employs more than 23,000 people in 26 countries and reported 2012 sales of $7.2 billion. For more information, please visit www.dana.com. SOURCE Dana Holding Corporation


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From Fizzy's Dogster Photos[ View profile page ]
|"Momma says I have the best schnauzer stinkeye!"
Leave A Comment | 7 people already have
BOL! Is it time fur your medicine?? BOL!
Why yes you do! ;)
You looks pissed! Are it cause the dogtors gave you a 'peg' leg? BOL! Sorry, don't mean to Bol at you's 'espense.
You give a great stinkeye! I would love to learn how to give one! Could you teach me?
You're almost as good as me! BOL!
Yep, it are pawsome!
Gud gwief, Fizzy! Yur stinkeye r so gud, yu maded my Momma cwy an' den hur cookded up a side ob beef, jus' fur me :D Fanks, dood!!