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Valeant Risks Dilution as Debt Threatens Rating: Canada Credit
Valeant Pharmaceuticals International Inc. (VRX), Canada's most acquisitive and indebted junk-rated company, will probably turn to the equity market to fund further purchases as it seeks to avoid a credit-rating cut.
"We're not going to issue bonds and make our leverage worse," Chief Executive Officer Mike Pearson, said in a March 19 interview at Bloomberg's Toronto office. "We have a commitment to our lenders."
Moody's Investors Service Inc. has said Pearson's strategy of growth by acquisition -- which the rating company estimates has left Valeant carrying about 4.5 times more debt than pre-tax earnings -- could lead to a downgrade if that ratio is not brought below four.
Pearson said he can do another deal this year that's comparable in size to his debt-fueled $8.7 billion purchase of the eye-care company Bausch & Lomb Inc. in 2013 without raising the leverage ratio, and maybe even reducing it.
"We can use equity," he said, adding that "in all likelihood" he will do a deal without selling bonds. "Depending on how much equity we could de-lever. The deal could get us under" the four times ratio highlighted by Moody's.
He said in the interview he's committed to reaching that target by year-end.
Most Acquisitive
Valeant shares fell $3.22, or 2.3 percent, to $137.19 at 10:14 a.m., the third straight day of losses.
Pearson has added $17.3 billion in long- and short-term debt to the Laval, Quebec-based company's books since taking over in 2008. Valeant has been the most acquisitive company on Canada's benchmark S&P/TSX Index in the past three years, data compiled by Bloomberg show. It has spent at least $19 billion since 2008 to buy 35 different firms. On absolute terms, it's the most indebted junk-rated firm in Canada, data compiled by Bloomberg show.
The strategy has paid off for shareholders, sending the stock on a nearly 10-fold increase since 2008. It's also rewarded bondholders. Valeant debt has returned 7.3 percent in the past year through yesterday, more than the 5.2 percent return on the Bank of America Merrill Lynch U.S. & Canada BB-B High Yield Index.
"We care about our equity investors, and we care about our bond investors," Pearson said. "Our bondholders have made a lot of money."
The Bausch & Lomb acquisition in August was Pearson's biggest deal to date, and he reiterated he's aiming to do a similar-sized transaction this year. He declined to name any companies. Teva Pharmaceutical Industries Ltd., the Israeli manufacturer of generic drugs, has been mentioned as a possible target by analysts including Raghuram Selvaraju of Aegis Capital in New York.
Possible Debt
While Valeant remains much smaller than world's biggest drugmakers -- Sanofi, the fifth-largest, has a market value of about $134 billion -- Pearson isn't daunted by his goal of becoming one of the top five by the end of 2016. The acquisition of closely held Bausch & Lomb helped vault Valeant from a market value of about $27 billion to $46.6 billion.
While a transaction may involve some new debt, it wouldn't come at the expense of the overall leverage ratio, Pearson said.
"We're committed to working on our leverage," he said. "If we had an acquisition that was large enough we could use enough equity to get our leverage down, but we could still do more bonds."
There's precedent for pharmaceutical companies bringing down their leverage ratios by issuing equity to fuel acquisitions, according to Michael Levesque, the analyst at Moody's who covers the company.
Cash Flow
The key metric the ratings company looks at is not how much total debt the company has in determining whether to downgrade from its Ba3 rating, Levesque said; it's debt compared to earnings before interest taxes, depreciation and amortization, or Ebitda.
"If they use 100 percent equity, then their earnings would benefit from the Ebitda that they would acquire," he said in a telephone interview from New York. "Their Ebitda would instantly go up, but their debt would stay the same."
In the long term, rising interest rates mean Valeant's deal-making may slow down. The yield on the benchmark U.S. Treasury 10-year note climbed 10 basis points on March 19, or 0.10 percentage point, the most in four months, after Federal Reserve Chair Janet Yellen suggested interest rates may rise by the middle of next year. The key rate has been held at zero to 0.25 percent since 2008.
Raise Threshold
Higher borrowing costs raise the threshold for what makes an appropriate deal, Pearson said. With the cost of capital where it is, an acquisition must guarantee a 20 percent return, he said. If those costs go up, a 25 percent return may become the minimum.
"If interest rates go up a percentage point, we don't like that, but it's not going to stop us from doing our strategy because interest rates are still pretty low," Pearson said. "They've been historically low. Has it helped us over the last six years to be in a low-interest environment? Absolutely. The strategy will still work."
To contact the reporter on this story: Ari Altstedter in Toronto at firstname.lastname@example.com
To contact the editors responsible for this story: Dave Liedtka at firstname.lastname@example.com Greg Storey


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this man told me yesterday to dye
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Join Date: May 2005
Posts: 119
Saturday, March 3, 2007 at 10:00PM
I've never met this man, and it wasn't instant messaging. He was responding to my online ad and emailed me. I blocked him so he wouldn't get a hold of me. But I guess the blocking didn't work.
he actually wrote back and said he was kidding you look cute just as you are.
Thanks Brio, I like the avatar too. It's a t-shirt? How cute.
three a.
I have always been a curly girl who always wanted straight hair till my old hairdresser convinced me to go curly. I have been styling my hair for about three years and my hair keeps getting better and better. I have a variety of routines but have cut down on experimenting products and found a good stylist who cuts my hair (although he cuts it wet, its hard to find one where I live, but I am happy with him).

subset: commoncrawl


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The set's relatively small size and low price haven't precluded it from enjoying two of Samsung's picture processing elements: the Digital Natural Image engine (DNIe) and something called Movie Plus. DNIe is really just Samsung's name for the sort of multitasking picture processing common in some form or other to practically every TV these days, and as usual its focus is on improving colour saturation/tone, sharpness, motion handling and video noise reduction.
Movie Plus is rather more unusual but potentially no less welcome, as it calculates and interpolates extra image frames in a bid to reduce the resolution loss that can occur with LCD technology when showing motion.
Also of interest to videogame obsessives like ourselves is the 26R87BD's Game mode, which mysteriously claims to optimise pictures for HD console gaming. This includes reducing the screen's response time so that you don't end up 'pwned' by some shotgun wielding maniac on Halo 3 before your screen has even told you he's there.
Other more general bits and bobs include a black level booster, manual gamma adjustment, the facility to adjust the backlight output, Samsung's Wide Colour Gamut technology for a more expansive colour palette, and finally edge enhancement circuitry for sharpening up the extremities of objects in the picture.
All in all the 26R87BD's features count and flexibility is very impressive indeed for such an affordable telly. And we're happy to say it all translates nicely into an equally impressive picture performance.
Or at least it does after a bit of tinkering. For it's a simple fact that the Dynamic picture mode the TV is set to when you get it out of its box is really quite scarily bad: a horror show of overcooked colours, forced black level response, and video noise. Quite why Samsung should think that anyone would want such a mess as their default picture settings is anyone's guess?
Thankfully, switching to the TV's Standard mode and ramping down the contrast, brightness and colour levels improves things immeasurably. For instance, colours that previously looked garish and unreal suddenly become vibrant and believable with pretty much every type of source, from a colour-rich game like Halo 3 to the drab palette of your average episode of EastEnders.
More information -
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Product Info
Assymmetrical draped dress with 3D rosette on shoulder and fixed braid belt, slight flare, giving a very feminine look. Above Knee length/Side zip. Dress can be made to order and can take up to 4-6 weeks to be delivered. Colours and sizes can be semi-customised.
Shipping and Return
Goods can be returned if damaged or defective only - items must be posted within 1 week from date of receipt unworn, with tags and with original packaging - even if opened. Please contact us for returns and we will assist you as far as possible.


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This property has been removed by the agent. It may be sold or temporarily removed from the market
7 bedroom end of terrace house for saleAshley Down Road, BRISTOL, BS7 9JT
Property Description
Key features
- Currently rented for approx £2400 pcm
- Self contained two bedroom garden flat
- Five bedroom student let
- Garage
Full description
Currently rented for approx £2400 pcm. This unusual and versatile property is currently rented as two separate dwellings comprises a two bedroom self contained flat and a five bedroom student let but offers flexible accommodation over 3 floors including 3 bathrooms, two living rooms, two kitchens a garage and courtyard garden. This property is being sold with no onward chain.
Listing History
Floorplan 1
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Floorplan 4
Map & Street View
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Market Info
Disclaimer - Property reference 53919. The information displayed about this property comprises a property advertisement. Rightmove.co.uk makes no warranty as to the accuracy or completeness of the advertisement or any linked or associated information, and Rightmove has no control over the content. This property advertisement does not constitute property particulars. The information is provided and maintained by Andrews Estate Agents, Bishopston. Please contact the selling agent or developer directly to obtain any information which may be available under the terms of The Energy Performance of Buildings (Certificates and Inspections) (England and Wales) Regulations 2007 or the Home Report if in relation to a residential property in Scotland.
Map data ©OpenStreetMap contributors.


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Laffey leads Chiefs past Bisons in opener
Southpaw's seven strong frames lead Chiefs to 6-3 win
By Syracuse Chiefs | June 7, 2014 9:09 PM ET
The Syracuse Chiefs, the Triple-A affiliate of the Washington Nationals, used a sterling pitching performance from Aaron Laffey in a 6-3 win over the Buffalo Bisons on Saturday night from Coca-Cola Field. The left-hander tossed seven innings of two-run ball, and the Chiefs picked up 11 hits to begin their four-game series with a win. The victory moved first-place Syracuse to 10 games over .500 for the first time since 2010.
Syracuse (36-26) picked up the game's opening runs in the first inning against right-hander Kyle Drabek. With two outs and nobody on, Steven Souza, Jr. doubled to right field, before Tyler Moore followed with a walk. Left fielder Zach Walters then bashed a two-run triple into the right-center field gap to score both runners, giving the Chiefs a 2-0 lead.
The heart of Syracuse's order added to the total again in the fifth. Souza smashed another two-out double to right field, and Moore followed with an RBI double to the left-center field gap.
In the sixth inning, the Chiefs added a fourth run against reliever Esmil Rogers - again with a two-out, none-on rally. Brandon Laird was hit by a pitch and advanced to second on a wild pitch, and catcher Sandy Leon followed with a line-drive single to right field. Laird slid in with his left hand ahead of the tag to score and give Syracuse a 4-0 lead.
Buffalo (29-30) finally struck in the bottom of the inning. Shortstop Jonathan Diaz led off the frame with a double, advanced to third on a wild pitch and scored on an RBI groundout by A.J. Jimenez.
In the seventh, the Bisons grabbed another run. First baseman Dan Johnson started the inning with a solo home run to right field, cutting the lead to 4-2. Laffey, however, retired the next three batters on groundouts to conclude his night. In seven innings, he allowed just five hits and two runs, striking out four batters to no walks.
The Chiefs would pad their lead in the ninth against left-hander Mike Zagurski. Leon started the inning with a double, bringing up leadoff batter Josh Johnson. The Syracuse shortstop laid down a sacrifice bunt, advancing Leon to third base, with Zagurski throwing wide of first for an error to allow Johnson to reach. Will Rhymes followed with a walk to load the bases. Two batters later, Moore walked to force in a run, driving in Leon for a 5-2 lead and knocking Zagurski out of the game. Southpaw Ryan Rowland-Smith entered, and Walters greeted him with a first-pitch single to left field, scoring Rhymes for a 6-2 Chiefs lead.
Buffalo tacked on a run in the ninth when Dan Johnson drove in Jimenez with a sacrifice fly against Mike Gonzalez. The left-hander, however, would retire the next two batters he faced to close out the win.
Syracuse and Buffalo will resume their series on Sunday afternoon at 1:05 in a matchup of the league's two best starting pitchers by ERA. Chiefs right-hander Taylor Hill (8-1, 1.57 ERA) and Bisons right-hander Liam Hendriks (5-0, 1.91 ERA) are the scheduled starters.
This story was not subject to the approval of the National Association of Professional Baseball Leagues or its clubs.View More


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Topeka Rugby Club hosts international match
The Topeka Rugby Club welcomed in the British Royal Defense Academy for an international friendly on Wednesday night.
The Topeka Rugby Club welcomed in the British Royal Defense Academy for an international friendly on Wednesday night.
The Dodge Magnum was found unoccupied and abandoned.
Topeka, Kan. (KSNT) – The Topeka Zoo has high hopes for a major makeover. A multi-million dollar revision to its master plan hinges on voter…
Senators worry youngsters being targeted.
The Kansas Department of Agriculture opened for business in the new facility earlier this week.
All those at risk for the disease are being contacted and the investigation is ongoing.
A man interrupted a burglar from breaking into his truck Tuesday night.
Schodorf's campaign said Wednesday that the commission had informed it of the decision after the panel's regular monthly meeting.
The ruling doesn't directly force the team to abandon the name.
A 43 year old warned motorists with a sign Friday night in that said: "Check point ahead! Turn now!"
White House officials said Obama had made no decisions about how to respond to the crumbling security situation in Iraq.
The defective switches are blamed by GM for at least 54 crashes and more than 13 deaths.
Barra made her second appearance before the committee since GM recalled 2.6 million small cars in February.
The Kansas City Royals held off Detroit once again to claim their 10th victory in a row.
The new Fire phone also adds such features as the ability to render images in 3-D.
The court's recent decision follows a Shawnee County court ruling.
The board approved proposals Wednesday from the six state universities and the University of Kansas Medical Center in Kansas City.
City council gives protesting home owner who turned house into giant flag 90 days to make repairs; group steps forward to help.


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Throw Pillow
Inner Spaceby Terry Fan
20% Off + Free Worldwide Shipping - Ends Tonight at Midnight PT!
Throw Pillow made from 100% spun polyester poplin fabric, a stylish statement that will liven up any room. Individually cut and sewn by hand, each pillow features a double-sided print and is finished with a concealed zipper for ease of care. Sold with or without faux down pillow insert.
A reference to the memoir (and later film by the same name) The Diving Bell and the Butterfly. This design contemplates the immensity of the inner self. In the memoir, a successful French Elle magazine editor suffers a stroke and locked-in disorder, but he still manages to write a book about the experiences. It's heartbreaking and uplifting at the same time.
vintage, nautical, diving-bell, butterflies, sky, clouds, surrealism


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Martha Stewart Reveals Her Hollywood Crush - Watch Here!
Love is in the air, and Martha Stewart appeared on TODAY's new "Orange Crush" web series, just in time for Valentine's Day!
Having joined Match.com, interest has risen about the reality homemaker's love life, and on the "Orange Crush " episode, she admitted to having the hots for Christian Bale, saying that she is most enamored with his performance as the eccentric Patrick Bateman in "American Psycho."
Of the British-born stud, Martha said, "He got fat for 'American Hustle,' so that would've been a good time for him to eat at my house, but he might be on a diet now," she said with a smile, before suggesting that she might have a little more in mind.
Concluding her dream, the 72-year-old smiled, saying, "I don't think eating is exactly what I want to do with Christian Bale." Watch the video below!
Photo Credit: NBC


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little hip hoppish loop with some vinyl noise on it part one of 4
Used this in my track "Now". www.myspace.com/longwaveradio2 - would be good to know what you think!
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text: Hey all, just registered on this site. I've been on NASIOC for a few years and have had enough of the BS and drama on there and decided to start posting on another site I have a SRR 2006 WRX TR that I've had since she was new. She's my pride and joy! I don't know any members on this site, but hope I can learn a few things and make a few friends along the way. Haha, I feel silly introducing myself. Time to start seeing what's it's all about here!


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Download: Ayurvedic Approaches to Self-Care Through Cancer
Sangeeta Agarawal, MS, RN, CAS, discusses the basic principles of Ayurveda, including the 3 Pillars of Health and causative factors for imbalance; how to bring balance into your life using the five senses; mindful eating; and the importance of daily routine. Recorded July 21, 2014. 1 hr, 3 min.


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The chief executive of Bumi, the Indonesian coal group created by banking scion Nat Rothschild, has vowed to clean up the scandal-ridden group within four weeks.
Bumi's heavily delayed annual results came out today, showing there was a $201 million (£133 million) hole in one of its business units.
After announcing a $2.4 billion pre-tax loss, Nick von Schirnding told the Evening Standard that "the mess is bigger than I thought" when he took over Bumi at the end of last year.
The shares have been suspended, but von Schirnding is confident he will be able to ask the listing authorities to resume trading ahead of the annual meeting on 26 June.
Bumi said in April it could not verify some of its expenditure at its PT Berau business and called in Ernst & Young and PricewaterhouseCoopers.
Von Schirnding said: "Some of the transactions relate to companies that we haven't heard of, [there is correspondence] that has suspiciously similar letterheads.
"Clearly, we didn't have the right people doing the right jobs and we've removed a number of key people from a number of positions."
- More about:
- Evening Standard
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Designing Your Course
Large Lectures
Labs, Studios & Discussions
Building Inclusive Classrooms
Assessing Student Learning
Engaging Students
Teaching with Technology
Two-Minute Teaching Tips
Follow Us
Setting Learning Outcomes
Places to Go Next
What are learning outcomes?
Why set learning outcomes?
How can you develop learning outcomes?
Next steps
What are learning outcomes?
Learning outcomes are measurable statements that articulate what students should know, be able to do, or value as a result of taking a course or completing a program. Learning outcomes often take this form:
As a result of participating in (program/course name), you (students) will be able to (Action verb) (Learning statement).
Some examples:
Students will be able to describe the key characteristics of the different classes of planets.
Students will be able to explain economic institutions, such as the Federal Reserve and stock markets.
Looking at the previous sample learning outcomes, imagine what course lectures might entail, what learning activities might be effective, and how student learning might be measured. Use learning outcomes as a tool; let them inform your choice of teaching strategies, course activities and assessments.
Why set learning outcomes?
Setting learning outcomes will make it easier for instructors to:
- Make hard decisions about selecting course content.
- Design assessments that allow students to demonstrate their knowledge and skills.
- Design teaching strategies or learning activities that will help students develop their knowledge and skills.
- Measure student learning accurately and effectively.
Having access to articulated learning outcomes (in a syllabus, for example) helps students:
- Decide if the course is a good fit for their academic trajectory.
- Identify what they need to do to be successful in the course.
- Take ownership of their progress.
- Be mindful of what they are learning.
How can you develop learning outcomes?
- Ask yourself: what are the most important things a student should know (cognitive), be able to do (skills), or value (affective) after completing the course/program?
- Consult a list of action verbs, which are verbs that result in overt behavior or products that can be observed and measured. Bloom's Taxonomy of Educational Objectives provides some useful verbs to write objectives for different levels of learning. See An Introduction to Bloom's Taxonomy from the University of West Florida.
- Avoid verbs that are unclear and cannot be observed and measured easily, for example: appreciate, become aware of, become familiar with, know, learn, and understand.
- Draft a list of possible learning outcomes. Be realistic in considering what is possible for students to accomplish in your course. Only keep the most essential learning outcomes.
- Edit and review the outcomes using the Learning Outcome Review Checklist .
Next Steps
Setting learning outcomes is the first step in a five-part process (Walvoord, 2010):
- Outcomes: What do we want students to be able to do after the course?
- Identify: Where in the curriculum are the outcomes addressed?
- Measures: How well are students achieving the outcomes?
- Revision: What changes can be made to the course to improve student achievement?
- Re-measure: Did the revision to the curriculum work?
CTE Setting Learning Outcomes (CU NetID required to access. Link redirects to login page.)
Learning Outcomes Checklist
Working Session on Learning Outcomes and Assessments
Assessment Resources
Past CTE Presentation Materials
- AEM Learning Goals & Assessment
Ed McLaughlin, Professor of Applied Economics & Management
- Student Learning Outcomes
Barbara J. Millis, Director, The Teaching & Learning Center, The University of Texas at San Antonio
Bloom, B. S. (1956). Taxonomy of educational objectives: The classification of educational goals. New York: Longmans, Green.
Walvoord, B. E. (2010). Assessment clear and simple: A practical guide for institutions, departments and general education. San Francisco: Jossey-Bass.


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It's early yet, but so far the biggest laugh I've had today. On another note, it's sad and scary all at the same time.
This is a discussion on Good arguement for background checks within the Law Enforcement, Military & Homeland Security Discussion forums, part of the Related Topics category; Well, on second thought......
Heaven goes by favor. If it went by merit, you would stay out and your dog would go in.- Mark Twain
It's early yet, but so far the biggest laugh I've had today. On another note, it's sad and scary all at the same time.
Helpful hints on pushing back and strengthening the 2A:
...from the reports:
FBI Investigated Boston Terror Suspect 2 Years Ago | Boston Bombers | Fox Nation
...the FBI did their job thoroughly...even interviewing the mother of the older of the two...and interviewing him...and found nothing...
...the younger was around 17...they had no cause to investigate him, and didn't
...it was about two years ago when the older went overseas for 6 months, wasn't it???it was before the investigation...the Russians are the ones who requested the investigation...his trip was primarily to Russia...
As I have told everyone who argues for more back ground checks, they argue that it will keep arms from criminals, I keep telling them over and over again, law abiding gun owners already go through back ground checks, criminals won't bother, instead they go to back alleys to buy their arms.
I wouldn't be so quick as to say the FBI did their job thorougly. How much intel did they recieve from Russia? Did they request more? Did they truly do an investigation or did they simply cover their asses? Inerviewing the def. and mom, to me, does not constitute an investigation. I am not blaming the FBI because they get their orders from the white house, but thorough is a very subjective word.
went to the CIA with concerns about those two, too.
IMO most folks who migrate to the US have little interest in returning to the old country. They want out, and away, and
have little desire to return. These folks apparently felt persecuted in Russia, got asylum here, and then they WENT BACK?????
Geez, you couldn't have paid my grandparents or my dad enough money to go back to Russia.
Yikes. If that return isn't a red flag that something is really wrong I can't imagine what is.
If the Union is once severed, the line of separation will grow wider and wider, and the controversies which are now debated and settled in the halls of legislation will then be tried in fields of battle and determined by the sword.
Andrew Jackson
YiIts only a "red flag" if you notice it.kes. If that return isn't a red flag that something is really wrong I can't imagine what is.
With things being upside down these days,if they did happen to notice, they may have let it slide so that they wouldn't be accused of "profiling" them.
Stranger things have happened.
Universal Background Checks...the next step towards registration and confiscation.
AR. CHL Instr. 07/02 FFL
Like custom guns and stuff? Check this out...
The only valid argument I can see for the utility of background checks (beyond questions of its constitutionality) is: if it could be shown if a significant majority of violent felons and adjudicated "mentals" on the NICS list actually never again ended up with weaponry. Until that can be shown, it's utility is merely a pipe dream.
Irrespective of that, it still remains an unconstitutional infringement upon the RKBA, IMO, as it essentially denies the right of citizens to own or carry arms.
Your best weapon is your brain. Don't leave home without it.
Thoughts: Justifiable self defense (A.O.J.).
Explain: How does disarming victims reduce the number of victims?
Reason over Force: Why the Gun is Civilization (Marko Kloos).
They already have laws and rules that simply don't work. Our government has FAR too much bureaucracy to EVER be efficient. Expanded background checks are nothing more than an illusion to hide the ever tightening stranglehold on our rights by a government that increasingly becomes despotic in its attempts to feed itself money and power.
You do know they were getting WELFARE. (imagine that on a terrorist watch list & getting public assistance...GREAT COUNTRY AMERICA !


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Players' hair turns heads at World Cup
By Helen Popper
JOHANNESBURG (Reuters Life!) - The shaggy manes and bushy moustaches of soccer days past have been replaced by bleached beards, "city boy" crops and headbands at the World Cup in South Africa.
Players; hairdos are a perennial talking point at soccer's biggest spectacle and players face razor-sharp scrutiny -- right down to their shaving routines.
Brazil's Robinho has been sporting a new-look beard at the tournament and bloggers back home have launched an online campaign urging the baby-faced forward to visit the barber's.
"Ugly face, beautiful game -- God willing," Robinho, 26, told reporters last week, laughing off suggestions he grew the beard in a bid to frighten opponents. "I just forgot to shave," he said.
Meanwhile, at the camp of South American rivals Argentina, the new greying beard worn by Diego Maradona is being seen as a symbol of a more serene, mature air in the squad that seems to be bearing fruit on the pitch.
Maradona, nicknamed El Pelusa (Fuzzy) for the voluminous hairdo of his 1980s playing heyday, grew the beard because he could not shave after his pet dog bit him in the face, but it looks like becoming a permanent fixture.
As far as footballers' haircuts go, award-winning British hairdresser Mark Woolley said they have got more conservative and sophisticated of late.
The famously clean-cut Cristiano Ronaldo has become one of the sport's leading style icons and Spain's Fernando Torres recently chopped off his highlighted locks, opting for a discreet crop. Continued...


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To add functionality and livable space to the small kitchen, the Werdens converted an enclosed rear porch into a light and bright breakfast nook. Providing the light are large windows that Annie says they "found for a steal" from Second Chance, a nonprofit organization that deconstructs homes and buildings and then resells salvageable pieces. She intentionally left the windows undressed to allow every bit of natural light to stream into the space. "This room gets a ton of sunlight all day. I love how bright it is," she says.
Annie advises young families is to save on pieces you know will take a beating, such as the kitchen table (theirs came from IKEA) and chairs (which she picked up at an antiques store, painted, and covered with durable outdoor fabric).


text:
First post 2011 X5 35d (buying)
I have enjoyed trolling the community the past two months as I narrowed which 35d year to buy, so thank you for all the informative posts!
I placed a down payment on a used 35d this week. Taking delivery on Saturday at the BMW dealer. I declined all $12k of maintenance upsell from the finance manager :rofl:
I will spend $$$$ to upgrade the base sound system. The only other item I wish it had is comfort access, which I may retro-fit. And I can't drive to Tahoe with the 214's so I'll need to pickup an additional set of wheels for snow, along with adding a space saver spare w/piston mount.
Any recommendations or things to look out for or consider with the purchase?
2011 X5 35d
17,000 miles
Platinum Gray Metallic
Black Nevada Leather
Bamboo Trim
Sport Activity Pkg w/Y-Spoke (style 214)
Premium Pkg
Technology Pkg
Cold Weather Pkg
Rear Climate Pkg
Running Boards
Multi-Contour Seats
Heated Rear Seats
iPod + USB
see when all the oil changes have been done.
Yes, the services records indicate: "1ST ENG OIL SERVICE-FULL MAINTENANCE" was executed 6-28-12 @ 9,000 miles
Too bad you couldn't get them to CPO it...the 6/100 warranty is worth 3500.! Gbut the CPO inspection is worthless)
I assume you've checked for accident history if this is important to you
Considering how limited the CPO warranty is, is it worth spending another $3,000?
CarFax was clean.
Depending on the "in service" date, it may not even be a year old and 17K miles means that you have at least 3+ years left on the warranty (if you drive under 10K/year like I do) so the bottom line is that "you don't NEED the warranty UNTIL the manufacturer's warranty runs out" some 3+ years from now, right? Why pay ANYBODY $3K now when you can simply wait those 3 years and then buy whatever coverage you want at that time (for less $'s)???
What do you mean "upgrade the base sound system"? Are you saying that you are going to buy some aftermarket sound system or that you are planning on buying the bits to convert the base to a premium system? If so, you'd be the first I have heard of even considering something that extreme. If you ARE a TRUE audio-file and ambitious enough to pursue something like B&O or B&W audio, please keep us informed of what and how you do it.
PS - If you are even considering putting one of those HUGE-ARSE subs in the cargo space, you are not IMHO, an audiofile
I've done some research, but still learning about my options with the X5. Definitely not crowding my cargo area with giant subs. Need space for the baby stroller ;)
this is a good color from a detailing standpoint.
Black shows scratches too easily.
I was dead set on getting sapphire metallic until i read about the issues with black, and i've always wanted a dark platinum/titanium color in a vehicle.
I'd go back at the GM and say "bad news, I found a CPO for $x. If you can do this for $2k more I'll pick it up". See what happens.
IMO it is worth 3k, unless you are a DIYer or married to a bmw master technician. Especially living int he bay area where owners are abu$ed.
Carfax is worthless. Recent damage may not have made it to carfax yet. Even a CPO might have repaint/repairs...fyi
In the meantime, I did find this 2011 E70 basic audio upgrade. Check out Bavarian Soundwerks for their stage upgrades (supply is an issue).
Great choice and nice looking X5!
I also purchased an X5 this past week. It's 2011 X5 5.0. The car many of the packages including M Sport Package. The M Sport comes with Sport seats. The only thing I don't like about this car is the seat colors and the fact that it does not have Contour seats. Is there anyway to swap/upgrade seats from MSport seats to possibly Contour seats or Luxury seating package. I called a local BMW service center and they told me that I may run into problems with electrical as the SUV may not have the harnesses necessary to upgrade to luxury or Contour seating package.
Does anyone know of any services who may be able to upgrade the seating on the X5?
Thank you! I'll look into this.
I love mine since I drove it off the lot 2 years ago. I have put a lot of miles on it, 52K more highway than city. I just bought the maintenance plan and warranty right before the 50K deadline. Ouch. But I want to keep the car a long time, and do not think I will pile up the miles as fast now that my son is out of college (500 miles away). I have heard that a few unexpected out of pocket repairs could be so expensive, and I just like the security of knowing that I should not have unexpected repairs with the car in the future. I would not buy extended warranty and maintenance till you have to.
The car has been a dream, the only problem I have had is brakes. They were replaced under the original warranty (no cost to me) at 30K.
I love the cold weather package. The only criticism I have of the car is seat comfort. They are a little hard. I also seem to get a lot of neck pain on long trips. I wish I bought the option the salesperson was telling me about that included the seats that 'hug' you a little more. I think that must be the option you have.
p.s. i ended paying for the extended maintenance and total care warranty. i know the dealer GM, and he gave me a good deal + a write-off because this is a business car. the RFT are covered as well, so i'm happy with the option.
Good luck with it! It is a lovely vehicle.:)
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text:
Makes 1 cup
If I could use only one marinade for the rest of my life, it would be this one. Redolent with garlic, piquant with fresh lemon juice, and fragrant with extra virgin olive oil, it instantly transports you to the Mediterranean. I can't think of a single food that doesn't taste better bathed in it. You can use it as both a marinade and a basting sauce. If marinating poultry, meat, or seafood, simply set a portion aside for basting.
1/4 cup fresh lemon juice
1/2 teaspoon hot pepper flakes
1/2 teaspoon cracked black pepper
1/2 teaspoon coarse salt (kosher or sea), or to taste
4 strips of lemon zest
3 gloves garlic, crushed with the side of a cleaver or minced
1/4 cup coarsely chopped fresh parsley
1/4 cup coarsely chopped fresh basil, cilantro,
dill, oregano or a mix of all four
1/2 cup extra virgin olive oil
Combine the lemon juice, hot pepper flakes, cracked pepper, and salt in a nonreactive (glass, ceramic, or stainless steel) bowl and whisk until the salt crystals are dissolved. Add the lemon zest, garlic, parsley, and basil. Stir or whisk in the olive oil. The virtue of this marinade is its freshness; use it within 1 to 2 hours of making. Stir again before using.
Barbecue! Bible
Sauces, Rubs, and Marinades,
Bastes, Butters & Glazes
By Steven Raichlen
Workman, 2000
Paper: $12.95 (ISBN: 0-7611-1979-5)
Hardcover: $22.95 (ISBN: 0-7611-2013-0)
Illustrations throughout; two color; 320 pages
Recipe reprinted by permission.
This page created August 2000
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text:
Antarctic glacier mission seeks global climate clues
* Iceberg collision could affect global ocean circulation
* Scientists on mission to Antarctica to study aftermath
* Team studies impact of rising acidity on animals with shells
By David Fogarty, Climate Change Correspondent, Asia
SINGAPORE, Jan 31 (Reuters) - The breaking off of a Luxembourg-sized iceberg in Antarctica could affect ocean circulation patterns and be a harbinger of changes to come from global warming, scientists on a mission to the frozen continent say.
Last February, a 2,500 sq km (965 sq m) iceberg broke off from a giant floating tongue of ice from the Mertz Glacier after being rammed by an even larger iceberg.
The ice tongue, sticking out into the Southern Ocean, had acted like a dam, preventing sea ice from moving into a permanently open section of water to the west.
But now with the ice tongue gone due the collision, scientists fear it could trigger changes to the behaviour of a major part of global ocean circulation patterns that shift heat around the globe via myriad currents at the surface and along the bottom.
The area around the glacier tongue, since halved in length by the collision, and to the west are one of the few places around Antarctica where dense, salty water is formed and sinks to the depths of the ocean, said mission leader Steve Rintoul on Monday. Continued...


text:
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Dance Moms
Exclusive: Dance instructor Abby Lee Miller talks about 'Dance Moms'
By Elizabeth Kwiatkowski, 10/12/2011
Dance Moms
proved to be one of the summer's most talked about new reality series after it premiered on Lifetime this summer.
Starring Pittsburgh-area dance instructor Abby Lee Miller and a group of her dance students and their mothers, the series gave viewers a look into the behind-the-scenes drama that happens in a competitive dance studio.
On Tuesday, Abby Lee Miller --
who will host
Dance Moms
: Most Outrageous Moments, a special which will air on Lifetime tonight at 10PM ET/PT
-- talked to Reality TV World about the first season of the show, which will conclude with tonight's special but
return for a second season
next year.
Below is the first portion of our interview with Abby Lee Miller in which the outspoken dance teacher and studio owner shares her thoughts on several subjects -- including how the show came about, whether claims that she believes dance is more important than school education are really true, how she originally wasn't even supposed to be part of the show's cast, and whether
Dance Moms
' publicity has been good or bad for her studio's business.
Check back with Reality TV World later this week for more of our exclusive interview with Abby Lee Miller.
Reality TV World: How did the reality show come about and what made you want to be on a reality show with some of your dancers? What were your goals and intentions?
Abby Lee Miller:
Well, the show came about from my friend John Corella. We're personal friends and we've been friends for 20 years, and every summer I end up in LA and we talk about all these crazy mothers and how it should be a reality show.
And then I come back to my life in September and he gets back to his life, and then every night I call him saying, "I want to throw out this one and I want to throw out that one and this one's dumber than dirt and it doesn't matter how talented the kid is -- I can't stand the mother," and whatever.
So he was kind of taking notes and writing it all down and pitched it to a producer, and then the producer took it to a production company and then Lifetime came onboard and the rest is kind of history. As far as me being on the show, I wasn't really supposed to be on the show at all.
I didn't want to be on-camera at all until after the first episode when Minister Dawn wreaked havoc on my studio and interrupted my rehearsal when I have to take care of business, and then that's when they were like, "Oh my God, we need her on the show."
And as far as my goals for my students, having my dancers perform on national television every week -- I mean, come on, that's like back in the day of the Fly Girls or Solid Gold -- What dancers are on weekly? On
So You Think You Can Dance
, they're doing other people's work. They always stick to what they do best.
Reality TV World: The show has shown a lot of drama between you and your dancers' mothers and generated some controversy about your stern teaching approach. Has the publicity been good or bad for business at your studio -- do you have a lot of new students coming in or has the show scared off potential students?
Abby Lee Miller:
No, we have students -- I've been doing this for 31 years, so my studio very much a place of education. It has very high standards and I have the reputation in town of, "This is where you bring your child when they are talented and they really want to do this."
Right now, I have four kids -- they hired four people in Pittsburgh to do a movie with Michael Rooney and three were mine and one they booked directly from LA. I have 15 kids in Tokyo Disney in Japan.
I have a girl in
The Book of Mormon
on Broadway. The seriousness and the dedication and the intensity, let's say if you will, at my studio has always been here. For 30 years, it's been going on. For the TV show, it's kind of just like icing on the cake.
Reality TV World: You put a lot of stress on your pyramid of dancers for your competition team. It seems like you see it as constructive criticism and want to motivate the kids on the bottom to work harder, but do you see a negative to it at all in that it might promote jealousy or competitiveness amongst the girls, or is competitiveness actually the goal you're striving for?
Abby Lee Miller:
Well I do everything in my power not to put the kids against each other. I don't know if you know too much about competitions, but there's many different age divisions and many different categories. Here at my own studio and in the history of the Abby Lee Dance Company, I want to win as much as we can possibly win.
So, to put three girls in against each other is dumb. I'd rather put three girls in three different categories like one in lyrical and one in jazz and one in musical theater. Why put all three of them in jazz when you could win every category?
So as far as the pyramid goes, that's why sometimes all the girls don't do solos, is because they would be against each other and sometimes we don't want that. We want them to compete against themselves really, rather than others.
Reality TV World: Just to clarify, are the girls shown on the competition team [on
Dance Moms
] the only Abby Lee dancers competing at the events they attend, do you also allow other Abby Lee dancers that aren't on the competition team to compete if they want?
Abby Lee Miller:
Okay, good question. Last year when they started shooting the show, it was the middle of April. My competition season for the Abby Lee Dance Company was pretty much over. We compete in January, February and March here in Pittsburgh.
It just so happens that most of the competitions locally that we attend -- that come into Pittsburgh -- I attend really high-end things and they come into Pittsburgh in the winter. Why? I don't know, but that's when they come in.
So after Easter, we're pretty much done. We're just working on our showcase -- our dance concert. So, that's when the show started shooting. The show had to find competitions for me to go to and nothing was [here] in Pittsburgh, so that's why we would go to the extent and everything of going out of town to find different competitions for them, because my stuff is over.
Had we been going in Pittsburgh, sure, my other kids could have attended. They would have had to pay their own way and signed up separately, but sure. I try to get them to show more kids on the show. I really have some amazing teenagers.
The Mr. Dance of America and the Miss Dance of Pennsylvania are here in my studio right now. They're my students. They have been since they were three-years-old, and they're quite incredible dancers. I wish you could see all of them on the show, but there's just no time.
Reality TV World: Your intense teaching methods have sparked controversy, so would you consider or describe yourself as a role model and mentor to these young girls or would you say you're all business and are simply dedicated to being their dance coach and seeing improvement and results?
Abby Lee Miller:
No, I'm definitely their mentor. Some of them are child prodigies and the ones to achieve greatness that only I have dreamed for them, I sometimes -- I've said it before. I think my dreams are bigger than their own dreams. I raise every child in this studio as if they were my own children and that's what parents forget.
A lot of the moms on the show, like Kelly, this is her first teenager with Brooke. I've been through a thousand teenagers. Yeah, definitely, definitely. Kids have gotten sick all over me. I've held a kid's head, I've stood there while they're throwing up from something they ate that was bad -- every bruise or every bump or every broken bone, I'm the one that's there with them.
I did the "mom duty" quite often. It's just these people on the show that are there all the time -- most parents can't afford the luxury of traveling with the kids. They can't go everywhere that we go.
So, the kids often travel with me by themselves. I have a temporary guardianship of them, so yeah. It's more than that and you know, when they're at that audition or they're on their way to that big audition, usually I'm the one driving them.
Reality TV World: I don't know if the shooting schedule is why, but the show showed you on the road with your competition team for several weeks but you obviously have a lot of other students that take classes at your studio -- a few that you have mentioned -- beyond the girls on the competition team. So how much involvement do you have with the studio's non-competition team kids and are you able to teach them on a regular basis?
Abby Lee Miller:
Yes. I don't work with too many of the -- we call them rookies -- the recreation students. They come once a week for class, and I'm usually here. I write the lesson plans for their classes, but I'm not always here because I do travel. But that's not only for the show. I do a lot of master teaching all over the country prior to the show.
So, I was gone a lot anyway and you kind of need a day off to re-charge and that's what our recreation classes are, and I have great faculty here. Most of my faculty that I have were trained by me.
They started here at three-years-old, and they either left and worked professionally and then had time to come back to the area or are married and are working for me, or they've been here since they started dancing and never left. I'm here at 4:30, so I'm here. I actually teach all the time. (Laughs) My classes normally begin at 4:30. So, I'm here and ready to teach.
Reality TV World: Christi was shown [on the show] saying that you always say "dance needs to come before school" and that the girls miss school all the time for dance competitions and such. Do you really believe dance is more important than a school education and how does that work -- are the girls home-schooled while on the road?
Abby Lee Miller:
Absolutely not. I never say that. She's probably lying. I don't agree with everything in the public school system. I believe that, certainly, they need an education. I would love it.
I freak out on my girls, especially my senior company, and I always tell them if they could speak seven languages fluently, they would be able to write their own ticket and get a job anywhere because they're gorgeous girls. They know how to interview, they wear a stunning suit and they could work in any huge company internationally.
They could fly out all over the world if they could speak Mandarin or Chinese and they laugh at me. So, I definitely think -- like Maddie for example -- she's extremely intelligent, and I yell at Melissa all the time, "Let's hire a private tutor to teach her Chinese. She's not getting that in school."
But on the flip side, I do not think that my dancers need to take [physical education], and in Pennsylvania, that's a huge thing here -- the physical education requirement, like getting into the gym uniform and getting hit in the face with the dodgeball and hit in the bust over and over and over and calling it phys ed, that's really important here in Pittsburgh.
I think that my girls who are dancing 16 hours a week should be exempt from physical education and during that 45-minute period, they should be in an accounting class or another math class or another language class. So, I think Christi has that a little bit confused.
If I could eat lunch while I'm driving my car, they can eat lunch at their desks. There's a lot of time wasted of going to the cafeteria and getting in line and getting your food, and then you have to shove it down your throat and then run back to class.
They could all sit on a yoga ball during class and eat at their desk and then be out of school at 2:00. So when it comes to their education, I'm just anti-wasting time. (Laughs)
Reality TV World: How was it decided to focus on the specific young girls on the show and their mothers? Was it as simple as these were the seven girls on your competition team when the show began filming?
Abby Lee Miller:
Actually, [the production company] Collins Avenue Entertainment, they interviewed -- I believe it was 23 families, to choose those mothers. The children were never auditioned.
Reality TV World: Would you be able to elaborate on that a little more and discuss what criteria was used, if you know?
Abby Lee Miller:
I have no idea. You'd have to check with the producers on the show. I really don't know. I laugh about this all the time, but it's sad, because I have some amazing students who pay their bills on time, who follow all the rules, who say, "Yes, Ms. Abby. Thank you, Ms. Abby," give me birthday gifts and Christmas gifts and are excellent students. Excellent. And they are not on the show, sadly, because they don't make good TV. (Laughs)
'The Biggest Loser' eliminates contestant Mike "Coach" Danley
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Abby Lee Miller says she'll pretend prison is just a movie set
Abby Lee Miller sentenced to one year and one day in prison for bankruptcy fraud case
Abby Lee Miller undergoes weight-loss surgery shortly before prison sentencing
Cheryl Burke reportedly replacing Abby Lee Miller on Lifetime's 'Dance Moms'
Abby Lee Miller announces she's quitting 'Dance Moms' -- I've been "disrespected and used"
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text:
I just realized I've converted 5 TF templates to Joomla, for clients, over the last several months and really think it'd be cool if a lot of these templates can be Joomla templates.
Anyone template devs interested?
Here are some I've done recently (from static HTML to Joomla)
http://rainforestbusinessmodel.com/ http://floridajoomla.com/ http://joomextend.com/
Also working on a joomla integration for this: http://themeforest.net/item/profi-admin-administration-for-the-professionals/49058
Will be done in a bit….top secret project…


text: Get in while you can! Registration is now open, and will remain open until August 5th, 2011. We have a new setup this year, and it will allow you to update and correct your information all through the website. Remember to check your SPAM folders / filters as we will be send out registrations in a few weeks.


text:
In his new book Bicycle Diaries (Viking, $26), David Byrne, the former Talking Heads singer, reflects on the cities he has toured, appraising their bikeability ("In Berlin, there are little stoplights just for bikers!"), quirks ("In Manila's funky old city center, karaoke machines are everywhere"), and their essence ("Buenos Aires is not a place for vegetarians"). Part travelogue, part journal, part urbanism textbook, it is, in its delightful idiosyncrasy, 100 percent David Byrne.
David Byrne's Bike Book
More from T+L


text:
S- Editor Liu Y L- Editor Wang XL E- Editor Liu WF
Published online Jan 28, 2007. doi: 10.3748/wjg.v13.i4.594
Revised: December 3, 2006
Accepted: December 21, 2006
Published online: January 28, 2007
AIM: To investigate some possible etiologies of achalasia by screening patients with achalasia for some autoimmune diseases such as thyroid disease.
METHODS: We examined 30 known cases of achalasia (20 females, 10 males). Their age ranged 15-70 years. All of them were referred to our institute for treatment. Their sera were evaluated to detect some possible associations with rheumatoid disease, thyroid disease, inflammatory process, anemia, etc.
RESULTS: Seven out of 30 patients (23%) had thyroid disease including four patients with hypothyroidism (13.3%), two patients with hyperthyroidism (6.6%), and one had only thyroid nodule but was in euthyroid state (3.3%). Two of these hypothyroid patients had no related clinical symptoms (subclinical) and two had clinical manifestations of hypothyroidism. There were no correlations between the intensity of thyroid diseases and the severity of achalasia symptoms.
CONCLUSION: The etiology of achalasia is unknown although autoimmunity has been implicated and is supported by several studies. Thyroid disease presents concomitantly with achalasia in about one fourth of our patients who may have a common etiology.
Citation: Emami MH, Raisi M, Amini J, Daghaghzadeh H. Achalasia and thyroid disease. World J Gastroenterol 2007; 13(4): 594-599
Achalasia is a common and well characterized primary motility disorder of the esophageal body and lower esophageal sphincter (LES), causing impaired progressive peristalsis in the esophageal body, incomplete relaxation of LES during swallowing, and sometimes increased abnormal relaxation of the LES pressure. Previous studies evaluating esophagomyotomy and esophageal resection specimens have shown that the presence of myenteric inflammation is a consistent and early pathologic change in patients with achalasia[1,2]. The disorder is observed in both genders primarily in the fifth and sixth decades of life, although achalasia can present at any age[3,4]. The cause of the degeneration of neurons in achalasia is not known. The observations that achalasia is associated with HLA-DQw1 and that affected patients often have circulating antibodies to enteric neurons suggest that achalasia may be an autoimmune disorder[5-7]. Nonspecific degeneration of smooth muscle cells and a loss of small nerve fibers have been reported[8-10]. Another controversial issue is the role of inflammatory infiltrates in the pathogenesis of the disease. A study has suggested that complement activation is involved in the autoimmune pathogenesis of achalasia[11]. Achalasia is associated with extra esophageal autonomic nervous dysfunction that involves cardiovascular and papillary function as well as regulation of mesenteric arterial blood flow[12]. Some investigators have proposed that achalasia may result from chronic infections with herpes zoster or measles viruses, but modern studies have not confirmed an association between achalasia and any recognized viral disease[13,14]. However, a recent study also showed that there is no association between the most common viruses and achalasia[14]. As myenteric neurons synthesizing nitric oxide are responsible for the inhibitory component of esophageal peristalsis and LES relaxation, it is considered likely that these neurons are involved in this disease[15,16].
Since there is no consistent single abnormality in achalasia, this study was designed to evaluate the relationship between achalasia and some of the commonest autoimmune diseases.
All 42 newly diagnosed patients referred between 2001 and 2005 to our research center (Poursina Hakim Research Institution, Gastroenterology Division, Isfahan, Iran) were examined prospectively and enrolled in the study. Poursina Hakim Institution is a reference tertiary care center that services a population of about 4 000 000 individuals in the central area of Iran. Of the 42 enrolled cases in the study based on clinical and radiological findings, 6 patients with pseudoachalasia but without endoscopic features of achalasia were excluded due to non-compliance (one case) or some other reasons such as loss of follow-up due to changing their address or phone number, immigration to other provinces and admission by other physicians far from our institution. Finally 30 cases were included. Their symptoms, laboratory results, and historical and functional data were recorded. Achalasia was defined by clinical criteria, namely prolonged (more than 1 year) intermittent or progressive dysphagia to liquids and solids in addition to some other minor symptoms such as regurgitation, chest pain and nocturnal cough plus barium swallow with a typical beak like appearance. We obtained posterior-anterior chest x ray radiographies at 1, 5, and 20 min after a single barium meal to assess barium column and measure its heights and widths as well as the delay time of esophageal clearance (timed barium swallow). Upper gastrointestinal endoscopy was done to confirm the diagnosis and to rule out secondary achalasia (such as esophageal tumors of cardia and fundus, submucosal tumor of distal esophagus, peptic stricture and other mucosal or infiltrative lesions of the esophagus or gastric cardia). Endoscopic findings suggestive of achalasia may be seen and are very helpful if endoscopy is done carefully by experts in this field. Some of the suggestive criteria for achalasia are as following: esophageal dilation, esophageal dysmotility or aperistalsis in response to air insufflations, abnormal LES opening and high pressure LES during scope passage. Manometery although very helpful especially in early stages of the disease, was not available in our province at the time of the study, so it was not done for most of them.
Exclusion criteria included those found to have an underlying malignancy during the study, any types of generalized neuropathies, diabetes mellitus, non-compliance or unwillingness of patients to continue the study, and finally those lost to follow up by any reason.
The patients' history was taken using a structured questionnaire. We interviewed, examined and completed a questionnaire designed to detect possibility of connective tissue and autoimmune diseases, other gastrointestinal motility disorders, diabetes mellitus, use of immunosuppressive medications, chronic viral illnesses, thyroid problems, usage of a regular immunosuppressive medication and also habits and addictions for all patients. Informed consent was obtained from all patients. None of the patients underwent surgical therapy.
After diagnosis of achalasia, all patients were screened for a set of selected autoimmune disease and other markers as shown in Table 1. Serum factors were evaluated by biochemical techniques. A double check of laboratory tests was conducted by a second laboratory to assure validity of abnormal results. Equivocal laboratory results were rechecked by a reference laboratory.
|Test title
|Anti nuclear anti body (ANA)
|Antineutrophil cytoplasm antibody (c-ANCA)
|Binding site
|Alkaline phosphatase
|Thyroid stimulating hormone(TSH)
|Isfahan pharmacology faculty
|T3 Resin uptake
|Isfahan pharmacology faculty
|Rapid plasmin reagin (RPR)
|Urine analysis
|Complete blood count
Clinical data regarding symptoms of dysphagia, regurgitation, and chest pain, nocturnal cough and pyrosis were collected by means of a validated questionnaire. Dysphagia was described as difficulty in swallowing, and regurgitation as the sensation of stomach contents going up the esophagus. The frequency of each symptom was graded on a scale ranging from 0 to 5 (0 = none, 1 = once per month or less, 2 = once per week up to three to four times a month, 3 = two to four times per week, 4 = once per day, 5 = several times per day). This scoring system is similar, but with some modifications, to that used by Eckardt et al[17] and modified by Vaezi et al[18].
For comparison between patients with achalasia and normal population, Student's t-test assuming equal variance was used. In addition, we analyzed the symptoms using the non-parametric Mann-Whitney test, because the data were not normally distributed.
Of the 42 newly suspected achalasia patients referred to our institution, 36 (11 men and 25 women) fulfilled the participating criteria in the study, but only 30 (20 females, 10 males) finished the study. The remaining six patients were statistically similar by age and gender to the 30 cases and they had no unusual reason for their loss of follow-up.
Of the 30 patients, 7 had thyroid disease (23.7%), 4 had hypothyroidism (13.3%), 2 had hyperthyroidism (6.7%) and one (3.3%) had only a thyroid nodule in euthyroid state. Two of these hypothyroidism patients had no related clinical symptoms (subclinical) and two had clinical manifestations of hypothyroidism. Both patients with subclinical hypothyroidism were diagnosed in our screening. One patient experienced hypothyroid shock after balloon dilation therapy (cool skin, hypothermia, hypotension and bradicardia not responsive to volume expansion and intravenous atropine injection). She had clinical symptoms of hypothyroidism which was not detected before balloon dilation therapy. The results of laboratory tests are listed in Table 2.
|Patients withhypothyroidism
|Patients with benignthyroid diseases1
|Patients withoutthyroid problems
|Mean score ofall patients
|39.5 ± 14.3 a
|35.8b± 11.9b
|38.5 ± 18.1
|37.9 ± 16.7
|4.5 ± 1.1d
|4.8 ± 0.45
|4.8 ± 0.66
|4.7 ± 0.75f
|3.5 ± 1.9
|3.8 ± 1.8
|Nocturnal cough
|2.5 ± 2.8 g
|2.5 ± 2.5h
|2.5 ± 2.2
|2.5 ± 2.2
|Chest discomfort
|3.75 ± 1.5 i
|2.2 ± 2.1 j
|1.86 ± 2.7
|1.96 ± 2
|Weight loss
|0.5 ± 0.5k
|0.4 ± 0.5l
|0.65 ± 4.08
|0.6 ± 0.49
There were 21 (70%) Fars (the major Persian ethnicity), 7 Bakhtiari, an Iranian tribe, living in west of Isfahan Province) (23%), one Gilaki (another group of Iranians originating from northern Iran) (3.3%), and one patient was Turkish inhabitant in the central area of Iran (3.3. 0%).
The median age of onset of symptoms was 37 years (range 15-80 years). The mean age of patients with thyroid disease and other patients with achalasia was 35.8 and 38.5 years (P: 0.9). All patients complained of dysphagia to both liquids and solids. Regurgitation, weight loss, chest discomfort and heartburn were reported in 28 (93.3%), 18 (60%), 15 (50%) and 8 (26.6%) patients, respectively.
The symptoms of patients were compared (Table 2). Correlations between the intensity of thyroid disease and the severity of achalasia symptoms were statistically insignificant by Mann-Whitney test.
In 2002 -2005, 42 cases of suspected achalasia were identified in or referred to our center. Of these, 19 were residents of Isfahan during the period of the study. The population of Isfahan was about 4 million in 2006. The overall ethnic- and gender-specific incidences of achalasia in our cases are shown in Table 3. No strong history of rheumatic disease or neuropathy in patients and their family was detected in our study.
All serum samples were evaluated with sensitive tests for autoimmune diseases but we did not find any positive test except for 2 positive anti nuclear antibody tests (6.6%). Evaluation for vasculitis, some electrolyte disturbances, and anemia did not show any important finding (Table 4).
|Normal (%)
|Abnormal (%)
|Thyroid function tests
|Calcium and phosphorus
|Alkaline phosphatase
|Complete Blood Count
|Urine analysis
Although achalasia is a historically recognized clinical entity, its fundamental pathophysiology remains poorly understood. Primary achalasia accounts for the majority of cases. The etiology of primary achalasia is not entirely clear and probably multidimensional[19] including genetic predisposition (supported by the concordance for the disease in monozygotic twins[20] and associations with some HLA loci[7]), inflammation (myopathy of the smooth muscle cells[21], neuropathy[22,23] and inflammatory changes in esophageal specimens[24]), infections (virus[14], Chagas' disease, poliomyelitis[25,26], varicella zoster virus[27] and Helicobacter[28]), ischemia, toxicity and autoimmune disease[19]. Some other diseases postulate these etiologies such as concomitant appearance of achalasia and Guillain-Barré syndrome [29], Parkinson's disease[30], triple A syndrome[31], etc.
There are some reports about thyroid and esophageal problems in animals[32] but we have not found any reports about such problems in humans in English articles. Although it has been reported that there is a correlation between achalasia and autoimmune diseases, this is the first cross sectional study evaluating the relative prevalence of these problems (rheumatic disease, thyroid disease, inflammatory disease, etc) in a consecutive series of patients affected by achalasia which led us to a few interesting points. First, the results of serological tests obtained from this study confirmed some literature data that predict a potential autoimmune etiology of achalasia. Second, an association was found between thyroid problems and achalasia. Third, the frequency of thyroid disease was higher in patients with achalasia than in normal population.
It was reported that the prevalence of hypothyroidism is 4.6% (0.3% clinical and 4.3% subclinical) in the United States of America[33]. Whickham showed that the prevalence of spontaneous hypothyroidism in community is 1.5% in females and less than 0.1% in males [34]. These prevalence rates are similar to those reported in Finland[35], Japan[36], and in another US survey[37-39]. Heydarian and Azizi reported that the prevalence of hyperthyroidism, overt and subclinical hypothyroidism is 0.45%, 0.35% and 2.2% in Iran, respectively[40]. The prevalence of hypothyroidism and benign thyroid diseases (hypothyroidism, hyperthyroidism and thyroid nodules) in our patients was significantly higher than that reported in latter study (P value and confidence interval for each group were 0.025 and 0.000, 1.3-43.4 and 2.9-76.5 respectively).
The mean age of our patients is one -two decades lower than reported in other studies[3,4]. It may have a role in these findings. We found about a 5-fold rise in the prevalence of thyroid dysfunction in this study. Since our center is the only center offering balloon dilation therapy in Isfahan, we can assume that the overall population with achalasia in this area is very similar to that registered in our center and therefore these data are repeatable in our future study, but they may not be generalized in all cases of achalasia in other societies. Hence we suggest a similar study in all centers working in this subject. We should direct our future studies to find the possible genetic and environmental risk factors for earlier disease in this geographic area.
The reason why there is such a relatively strong association between these diseases can be explained by the literature describing most thyroid problems as probable autoimmune diseases[41-44]. Autoimmune etiology of achalasia is also supported by the presence of circulating autoantibodies against the myenteric plexus and inflammatory T-cell infiltrates in the myenteric plexus, as well as the increased prevalence of HLA class II antigens. Possibly the initiating event may be an unknown environmental insult due to a viral infection resulting in inflammation of the myenteric plexus in susceptible patients. Not all affected individuals develop achalasia[45]. However, autommunity at least has a concomitant or susceptible role in pathogenesis.
Is there a symptomatic mimicry between achalasia and thyroid diseases? There is some evidence in animal model that a mega esophagus may occur in hypothyroidism which is a criterion of achalasia[32]. We had one clinical hypothyroid patient and one clinical hyperthyroid patient detected before balloon dilation therapy. We treated these two patients with levothyroxine and methimazole respectively for 6 mo after achievement of euthyroid state. No clinical or radiological improvements were obtained in symptomatology and radiological findings of achalasia after treatment, suggesting that what we found is actually a true association rather than a symptomatic mimicry or a transient neurological dysfunction. We also found a 6% positive ANA in this series which is similar to that in general population[46]. These findings may give some stronger evidence for certain autoimmune bases of achalasia. However, more and larger groups are necessary and a larger spectrum of autoimmune markers must be tested to make it possible to establish the utility of the issue in the early diagnosis of achalasia and identification of different etiologic mechanisms, which would allow us to think about novel outline of management since the existing treatments are only partially palliative.
We also found a hypothyroid shock after balloon dilation therapy which was fortunately well managed because we were alert to the problem. Therefore we recommend clinical evaluation of thyroid disease for all patients and thyroid function test for suspicious cases to control thyroid function before any invasive therapy. Clinical severity was statistically similar in both groups of patients with normal and abnormal thyroid function tests. Therefore we cannot predict the possibility of thyroid disease on the basis of severity indexes.
In conclusion, achalasia may be associated with thyroid diseases (hypothyroidism, hyperthyroidism and thyroid nodules), and this association should be kept in mind when a new case of achalasia is diagnosed. More accurate and extensive immunopathological studies should be performed to assess the possibility of a common immunopathogenesis or a cause and effect relationship in these diseases.
The authors thank Ziba Farajzadegan MD, Hamid Tavakoli MD, Mehran Haghighi MD, Abbas Esmaeili MD, Peyman Adibi MD, Ali Akbar Vosughi MD, Mandana Soleymani MS, and other Poursina Hakim colleagues for their superb assistance in executing, coordinating and analyzing this project.
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|Paterson WG. Etiology and pathogenesis of achalasia. Gastrointest Endosc Clin N Am. 2001;11:249-266, vi. [PubMed]
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|Storch WB, Eckardt VF, Junginger T. Complement components and terminal complement complex in oesophageal smooth muscle of patients with achalasia. Cell Mol Biol (Noisy-le-grand). 2002;48:247-252. [PubMed]
|von Herbay A, Heyer T, Olk W, Kiesewalter B, Auer P, Enck P, Häussinger D, Frieling T. Autonomic dysfunction in patients with achalasia of the oesophagus. Neurogastroenterol Motil. 1998;10:387-393. [PubMed] [DOI]
|Niwamoto H, Okamoto E, Fujimoto J, Takeuchi M, Furuyama J, Yamamoto Y. Are human herpes viruses or measles virus associated with esophageal achalasia? Dig Dis Sci. 1995;40:859-864. [PubMed] [DOI]
|Birgisson S, Galinski MS, Goldblum JR, Rice TW, Richter JE. Achalasia is not associated with measles or known herpes and human papilloma viruses. Dig Dis Sci. 1997;42:300-306. [PubMed] [DOI]
|De Giorgio R, Di Simone MP, Stanghellini V, Barbara G, Tonini M, Salvioli B, Mattioli S, Corinaldesi R. Esophageal and gastric nitric oxide synthesizing innervation in primary achalasia. Am J Gastroenterol. 1999;94:2357-2362. [PubMed] [DOI]
|Mearin F, Mourelle M, Guarner F, Salas A, Riveros-Moreno V, Moncada S, Malagelada JR. Patients with achalasia lack nitric oxide synthase in the gastro-oesophageal junction. Eur J Clin Invest. 1993;23:724-728. [PubMed] [DOI]
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|Vaezi MF, Richter JE, Wilcox CM, Schroeder PL, Birgisson S, Slaughter RL, Koehler RE, Baker ME. Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut. 1999;44:231-239. [PubMed] [DOI]
|Podas T, Eaden J, Mayberry M, Mayberry J. Achalasia: a critical review of epidemiological studies. Am J Gastroenterol. 1998;93:2345-2347. [PubMed] [DOI]
|Zilberstein B, de Cleva R, Gabriel AG, Neto SG, Gama-Rodrigues JJ. Congenital achalasia: facts and fantasies. Dis Esophagus. 2005;18:335-337. [PubMed] [DOI]
|Gockel I, Bohl JR, Junginger T. Achalasia: new insights in pathogenesis. Am J Gastroenterol. 2006;101:202-203. [PubMed] [DOI]
|Csendes A, Smok G, Braghetto I, González P, Henríquez A, Csendes P, Pizurno D. Histological studies of Auerbach's plexuses of the oesophagus, stomach, jejunum, and colon in patients with achalasia of the oesophagus: correlation with gastric acid secretion, presence of parietal cells and gastric emptying of solids. Gut. 1992;33:150-154. [PubMed] [DOI]
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|Benini L, Sembenini C, Bulighin GM, Polo A, Ederle A, Zambito A, Vantini I. Achalasia. A possible late cause of postpolio dysphagia. Dig Dis Sci. 1996;41:516-518. [PubMed] [DOI]
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|Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87:489-499. [PubMed] [DOI]
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Tag Archives: creativity
38 Things to do when you Quit your Job (or Any Damn Time)
Go to the ocean Get a room with a view Eat fish and chips, mac and cheese, or whatever your favourite comfort food is for breakfast. Drink vodka, whiskey, red wine. Wear "too much" or "too little" make-up. Read Big … Continue reading
Posted in Creating, Culture, Introverting, Moments, self love, Travel, Uncategorized, well being Tagged big magic, creativity, freedom, hotels, quitting, sadness, Travel, truth, UK Leave a comment


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"Sir Alex has been fantastic, incredibly supportive, he's only there to help me. I have a conversation with him when I need it. I tend to see him for a minute or two after the games, we'll have a chat
and I've found him great. I've got no problem at all with it [Ferguson attending games]." -- Struggling Manchester United coach David Moyes says he's OK with his
predecessor Alex Ferguson, who remains with the club as director and club ambassador, looking over his shoulder. (MUTV) ...More
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Like thousands of other teams across the country, the Little League team on which my son plays — and which I coach — was engaged in a season-ending tournament this weekend. We won our first game yesterday on a soupy field, and the boys were flying high. In our second game, against the best team in our division, we played as well as we have all season. It was a back-and-forth game, as we exchanged the lead with the other team. But, alas, as the time limit came up and other teams waited anxiously to take the field, we were behind.
And so our season ended, not really as a baseball game should, decided by a clock. But the boys held their heads high, and there was nary a tear. I think that's because they knew that they had played their hearts out and that they were poised to defeat a superior team.
I've been a youth pastor, directed camps and retreats, coached teams, and led a Cub Scout den, but never have I experienced such a wonderful, unified, joyous group of kids. Plus, I coached with two other dads with whom I got along famously.
It was an honor to be their coach, and I will miss them.


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Last week, AlMaghrib Institute released one of the most anticipated course topics yet! The IlmSummit topic release went down as a treat ma sha Allah, with many eager students ready & excited to attend!
This week, Shaykh Abdul Nasir Jangda has recorded a quick message, explaining why Surah Fussilat is one of the Quran's most powerful Surahs and how the Surah enables us to deal with the many challenges we come across when giving Dawah as a minority.
Shaykh Abdul Nasir Jangda (Qalam Institute) has completed his B.A & M.A in the Arabic language and has taught Arabic at the University of Texas.
One his most unique teaching quality is his ability to breakdown the complexities of the Arabic language into a simpler form, enabling his students to pick up the true meaning behind the words.
"Jazak Allahu Khair ya Shaykh Abdul Nasir for helping us to strengthen our salaat and khushoo. It really opened my eyes to the beauty and majesty of the Quran and the language it was written in….There were some words or phrases that I thought I was already familiar with, but the Shaykh always delved into its deeper meaning, making it even more significant." ~ Anonymous Student
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Disclaimer: These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease.
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Floor prep for tile
Wondering what needs to be done in order to lay ceramic or porcelain tile on a floor?
The floor is; 2x10's on 12" center, no vibration
3/4" sheathing on floor joists
3/8" plywood on sheathing
plywood is screwed down with heads countersunk
Thank You
I am NOT a pro tile man, but you need a layer of cement board screwed to the flooring to lay tile on. Do not put it directly on wood of any kind.
I would go with ceramic. Porcelain cracks and scratches much more easily.
As for the tile, Porcelain IS ceramic and the toughest and most durable flooring tile there is, would love to know who told you the info above, Porcelain cracks and scratches more easily??:whistling2:, I doubt that, use any ceramic with a PEI rateing of 4 or 5, 5 being the better one.:thumbup:
ok, thanks for help guys..
few more questions->
this is not in a room that will be bath or shower, kinda a den.
what is ditra, and will it be needed if no moisture?
DITRA - link below:
Although there are lots of tiles installed over plywood, it is never a good idea. If you want it to last you need a tile backer board or a product such as Ditra. Otherwise something like this could happen to you. http://www.ontariotile.com/cgi-bin/u...c;f=1;t=001341
What you just read happens all the time.
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