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fic title: neck deep
summary: neverland plotline. emma takes an accidental dive in the mermaid lagoon, has a catfight with a topless female sea-monster and hook worries himself sick.
It's not that she doesn't like Neverland. Neverland is pretty, full of wonder and breathtaking sights. It's more beautiful than the Enchanted Forest, at least after it was hit by Regina's curse; its magic is untamed and wild, fickle and capricious. The landscape is like a moving watercolour painting, the colours spreading out of the frame in hypnotic and meandering streams. It fucking figures that a world so gorgeous is actually a deathtrap.
Oh, who's she kidding, she freaking loathes Neverland.
She's only spent, what, two days in this land? In this time she's come to understand that the more beautiful something looks, the deadlier it probably is. Everything around her is a disaster waiting to happen, which makes the fact that Henry is all by himself all the more terrifying.
Hook has assured her time and time again that the world protects the children, so Henry should be safe from all of the 'did you see this pretty flowe- oh, OH, IT SPITS ACID, OH CRAP' situations David, Snow and her have encountered so far. Still, the anxiety gnaws away at her resolve and makes her stupid. Very stupid.
And, on top of that, she has to admit that Hook's help has been invaluable so far. The number of times her family could've been hurt by the environment if not for Hook's knowledge is actually staggering, and they're not exactly what you'd call a sheltered royal family. They're the kind of people that should be able to thrive in this kind of world; Snow lived a long time as an outlaw, her father is famous for dragon-slaying and she's not that far behind in terms of badassery. She's put plenty of criminals behind bars. And she's killed a dragon. And she's defeated a giant. No big deal. However, it's like the world is aware of the fact that they should not be there and is letting them know in no uncertain terms that they're not welcome. By having pretty flowers spit acid in their face.
Yeah, that had been fun.
Hook is, of course, another matter entirely. He breathes Neverland. Knows which flowers will try to bite your face off, knows the winds and the seas and and the animals and the trees and the motherfucking pixies (ugh, she hates those). He has everything under control.
He's also been a smug, irritating prick about it. Charming, from whom Emma has discovered she's gotten her anger-management issues, has developed more than one nervous tic from holding himself back, because even a hothead like him can tell that an unconscious Hook is a useless Hook and that they need the pirate at his best to find Henry.
Anyway. Neverland. Terrible place. Tell your friends.
Still, it has taken a dive into the mermaid lagoon that has nearly killed her for Emma to finally get into her head that this world is fucked and pretty unkind to outsiders and shit, she's so cold her teeth are clattering together.
Right. Mermaid lagoon.
She's soaked to the bone and with the sun coming down, that's not a good way to be. The cold waters have done a number on her: her hair is dirty and muddy, her jacket has been torn and she's slowly freezing to death.
And she doesn't mean to sound mysoginistic but those fucking bitches.
"Well, I did tell you not to stray close to the water, love. That's pretty much their territory you stepped in."
And now she's thinking out loud. Great.
Emma coughs a few more times, still shaking slightly, and glares at Hook, sitting near her on the damp grass, trying unsuccessfully to get all the sea water out of his boots. He's also soaked, and looks tired under the weight of his wet leather clothes.
And yep, he still looks insultingly pretty under all the mud. So unfair.
"I thought they only attacked men," she bites back, defensively.
He looks up, surprised for a moment, and then scoffs.
"Where did you hear that nonsense?"
Hook had warned her, before they went scouting while Snow and David kept an eye on the Jolly Roger. He had seemed reluctant to ask the mermaids about Henry but, after Emma insisted they could not let possible information slip past, he had agreed to accompany her. Only after assuring her, time and time again, that the mermaids were not to be trifled with. That they were selfish and unbalanced and incredibly aggressive, and she should be careful and not approach themunder any circumstance.
So it was her own damn fault that she had thrown caution to the wind when one of the mermaids, who looked like a prettier version of Ariel, a redhead with soft features and startlingly blue eyes, had told her she knew where Henry was, and couldn't you come a little closer because I don't want big bad Captain Hook to hear.
Damn it, but she was an idiot.
"I don't know. It's common knowledge. Mermaids," she says, spitting the word like poison, "beautiful creatures that lure sailors to their death but leave women the hell alone. The sisterhood and all that."
It had taken a very wet, very irritated Captain Hook, a screwdriver she didn't even know she had and Emma using a lifetime of experience in vicious hairpulling to get the damn mermaid to stop trying to drown her. The jerk even had the gall to look affronted by her resistance to be, well,killed.
Yes, Emma hates Neverland. With all of her fucking heart.
"They actually abhor women. Specially the leggy ones" he tells her, making a show of checking her out up and down. "Unfair competition, you see."
"Yeah, whatever. At least now you have an image to keep you warm during cold nights," she says grimly, still frustrated and angry with herself, cold and shaken, because he had said something to that effect the first time she'd shed the jacket under the unforgiving Neverland sun. "Me wrestling vicious, horrible, uncomfortably topless female sea-monsters."
Hook makes a non-committal noise and turns to look at her, completely silent, which is not exactly what she had expected when she thought about flinging a slightly sexual joke back at him. His eyes are weirdly intense, and for a moment Emma thinks it's because her wet shirt is now see-through or something, but before she can debate whether to cover herself or not, he speaks;
"Well, while the catfight might have been enjoyable under other circumstances," he begins, a teasing tilt in his voice that fades abruptly, "you should have paid heed to my advice and stayed away from the killer mermaids!"
His voice has turned into a growl. Not a sexy one. Well, that could be debated.
Anyway, Emma startles. Badly. Because oh, shit. Is he actually angry?
"Look, pal-" she starts because excuse her, Emma was the one getting drowned by a bare-chested, murderous fish-chick, not him.
Hook, however, is having none of it.
"Don't look pal me, lass! I gave you a clear instruction!" He points at her, angry as the day she left him on the top of the beanstalk. "Stick. to. the. shore. What part of that did you not understand?"
Emma knows he's right, and she's so angry with herself she finds it more comforting to be mad at him right back.
"I had it under control!"
"Are we talking before or after you tried to bite off the mermaid's arm?" he says as he sheds the long coat, which hits the ground with a damp thud. "Because let me tell you, love, that was the least alluring thing I've ever seen you do."
Yeah, that might have been a tad stupid. Okay, more like a lot. Her mouth still tastes like seafood and that's by far the grossest thing she's ever thought. Eugh.
"I told you that mermaids were liars and monsters and you decided to get cozy with the first one you laid eyes on-"
"And she wasn't even the most attractive or busty one!"
"What are you even-"
"You just ran into her arms like an ignorant, stupid landlubber. You can spot lies! How did you not-"
"Well, I'm sorry, I just thought her distrust of you was warranted!" she shouts back and she's freezing and exhausted and sleep-deprived and so, so terrified, that she adds "I also wouldn't trust you with a child!"
Even as she says it, she knows that she's crossed a line. Hook expression goes blank for a moment, then turns stormy and dark.
"Oh, you mean the child I'm risking my neck to save? The child that would have no hope of returning to his family had I not agreed to be your bloody guide?"
He's full on shouting now, voice filled with anger, looking down at her with a cold fury that looks a lot like hurt. Emma's feeling small, way too small, frustration and guilt and the fear that's been choking her since she saw Henry falling down the portal, so she stands, trying to be at eye level with him. That doesn't deter him in the least.
"Tell me, Emma, tell me how you don't trust me with him and I will leave you fools to - "
And Hooks sees her grimace of pain when she stands up, sees the claw marks on her naked ankle that not even Emma had noticed until now because adrenaline leaves her cold and numb and painless, and his rant stops abruptly. He's left breathing hard, his body tense, staring at her like he wants nothing to do with her anymore and she-
Sighing, he grabs his coat and pulls out a tattered handkerchief from one of its pockets.
"Sit back down."
Emma grits her teeth, wants to say it's nothing, but now that she's stood up the wound, although superficial, has started to bleed profusely.
She doesn't want to know what kind of Neverland creatures are drawn to the smell of blood, so this time she does what she's told.
Hook pulls out a small vial from his satchel and grabs her ankle with his hook, inspecting it. Then drops the vial's contents (not rum this time, because she had got rid of all the bottles the first night – which had prompted a very Jack Sparrow-esque whine fest) on her ankle.
It stings like a motherfucker. Emma stares at him, grimacing.
"That was uncalled for."
"It's to disinfect the wound."
Oh, he's going to make this difficult, isn't he.
"I meant my comment. Earlier."
Hook says nothing for a moment, still inspecting the wound with a pointed fascination. Then reaches for the cloth.
"Just don't chain me to anything and I won't demand satisfaction." he replies, voice neutral, but he doesn't meet her gaze while bandaging her ankle.
Emma feels like a damn jerk.
"I'm sorry," she says, and she hopes Hook understands how much that apology is costing her.
"Don't worry, love. Mermaids have good ideas from time to time. Trouble is, they celebrate by drowning people. That makes them very poor advisors" he replies, nonchalant. "I wouldn't trust myself with children either. Pirates make for bad caretakers."
Emma can spot lies and knows Hook has been nothing but honest here.
She feels like such a jerk.
"Henry would probably adore you."
Hook lifts his gaze, naked surprise plain in his face. He catches the sincerity, the absence of double meanings or hidden jabs and, after a brief hesitation, he grins. It's a small, slightly embarrassed, sheepish smile that takes Emma's breath away.
Oh, no. That was all the water she's swallowed. She coughs one more time, hiding the stutter in her breath, and he looks at her with a raised eyebrow.
"I bet he would. Just like his mother."
Emma rolls her eyes, but she's glad for the shift in his demeanor; this is safer ground.
"Come on, now you're just fishing for compliments."
Hook shrugs, smirk in place, still pressing the cloth to her ankle. The potion is strong, and the bleeding has almost stopped.
"I was serious though, love. Don't ignore my advice again." he says with gravity, looking at her in the eye with a focus that makes her feel uncomfortable.
Oh, fuck.
Emma finds that train of thought, puts dynamite in the tracks, blows them up and waits for the trainwreck only for the thought-train to grow wings and this metaphor has gotten away from her so she will stop.
"I don't react well to being shouted at," she confesses, because she thinks she should explain the reason she spoke to him that way after he dove into a mermaid infested lagoon to pull her out.
Hook glances at her, then turns to his task.
"I don't react well to mutiny," he says under his breath.
Emma scoffs.
"Don't be such a drama queen. Also, I can't mutiny against you. You're not my captain."
"Yes, I am. For the duration of this journey you're on my ship under my captaincy, and that makes you and your royal parents members of my crew, whether you like it or not."
"You didn't have to overreact!"
"I was worried about you!"
Emma stops at that, stares at him. Hook looks like he wants nothing more than to crawl into a hole and die.
Emma means to say she doesn't need him worrying about her, she doesn't need anybody; she's managed without family or friends for 28 years, what's one day more. Instead, what comes out of her mouth is
"You were?"
in that stupid little voice she's only ever used with Neal, or Graham, or Henry, or Snow or David.
Hook coughs to clear his throat, avoiding eye contact.
"Well, your charming father would have me beheaded should something happen to the little princess," he answers, voice filled with fake cheer.
Emma sighs, drops her gaze to the ground, lets him work. Hook's shoulders sag, in resignation or defeat.
"And I would probably let him."
They don't say anything else after that.
you can find me on tumblr and prompt stuff, shipmates! my url is yunuen


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Philadelphia 76ers coach Doug Collins has let ownership know that he will be resigning at the end of the season, league sources told Yahoo! Sports. The move definitely doesn't come as much of a surprise to anyone. The Sixers will miss out on the playoffs as they are 33-47 and ninth in the East. The season never shaped up to what hopes were, especially in light of Andrew Bynum not even playing a minute. According to Yahoo! Sports: Collins, 62, has one year left on a four-year deal, but has told management he won't return in that job. Collins' possible return to the franchise in another role – perhaps in the front office – hasn't been ruled out, a source said. Ownership wanted him to return for the final season of a contract that would've paid him $4.5 million, one source said, but Collins informed owner Josh Harris of his decision to leave in recent days. [Woj] Article found on: Next Impulse Sports
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subset: commoncrawl


text:
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Home > Community > Health Library > Monoclonal Antibodies
Monoclonal antibodies are substances produced in a lab that attach
to certain proteins in the body (like a key in a lock). The antibodies can
boost your body's natural defenses against disease or can be used to kill
cancer cells or slow the progress of a disease.
Monoclonal antibodies are given through an intravenous (IV)
injection. The antibodies can be used alone, or they can be used to deliver
medicine or radiation directly to cancer cells to treat diseases such as
leukemia and non-Hodgkin's lymphoma. Also, monoclonal antibodies can slow the
progress of a disease by stopping biological processes such as inflammation in
rheumatoid arthritis.
Current as of:
November 20, 2015
Healthwise Staff
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David Ripplinger, Ph.D.
David Ripplinger is the bioenergy/bioproduct specialist with the North Dakota State University Extension Service. He conducts research and delivers educational programs that assist commercialization efforts and existing renewable energy industry members.
Contact David for information on: biofuel policy and markets, life cycle assessment, EPA pathway approval, new pathway commercialization (finance, marketing), industrial sugar


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Latest question:
How do you think the new GigE standards will influence the machine vision industry?
Respond or ask your question now!
By Larry Adams
The tragedy is biblical in nature. Water rising. Thousands feared dead. Lawlessness in the streets. But, could the damage been mitigated?
Not entirely, certainly. Hurricane Katrina was a force that exceeded Hurricane Andrew, Hugo and Alicia and other major hurricanes in its ferocity. Damage and death seemed unavoidable.
But that doesn't mean that the devastation couldn't have been less severe.
The post-Katrina fallout is just beginning. Like Sept. 11, 2001, more and more information is being released that showed that not only were warning signs missed, but warning signs were ignored.
I've heard the term "bathtub" in reference to New Orleans. I have seen the computer models on how it happened. Walled by earthen levees between the Mississippi River and Lake Pontchartrain, the city's basin filled like a bathtub.
On its face, it seems hard to imagine that this might occur, unless one realizes that this was a known possibility. The federal government had flooding concerns since the 1960s, funding various projects throughout the years. Recent funding dried up as money was diverted to Iraq and other ends.


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After interpretation of the statement V="A" we can see the contents of the V variable by the simple statement say V. It displays A on the screen. The value "A" is saved in one byte as a sequence bits. We display this sequence by the Rexx say X2B(C2X(V)) statement. The statement say C2X(V) will show the hexadecimal representation. And the C2D(V) function returns the value of V interpreted as a decimal number, for our example and ASCII it is 65 (16*4+1).
List of implementations of bitwise operations
The BITAND function is bitwise AND operation, it returns its operators ANDed together bit by bit.
The BITOR function is bitwise OR operation, it returns its operators ORed together bit by bit.
The BITXOR function is bitwise eXclusive OR (XOR) operation, it returns its operators XORed together bit by bit.
Bitwise left shift by B bits for N is equal
B must be nonnegative.
Bitwise rigth shift by B bits for N is equal
B must be nonnegative.
EXAMPLE 1 - Vernam's method
The BITXOR function is as well the famous Vernam's encryption and decryption method. To encrypt a message Text, using Vernam's method, proceed as follows. First, create random string of bits Key, where LENGTH(Text)=LENGTH(Key). Then encrypt the Text by
To decrypt the ciphertext perform
Then Text==Plaintext. You can try the following program.
EXAMPLE 2 - Gray code
Gray code is a function G of the integers I, that for each integer N>=0 is one-to-one for
and that has the following property: The binary representation of G(I) and G(Ip1), for Ip1=I+1, differ in exactly one bit.
The algorithm for generating this code is simply to form the bitwise exclusive-or (BITXOR) of I and I%2, where I%2 is bitwise right shift by 1 bit.
The following program GRAY displays on the screen, for the argument equals 15
00000000 00000001 00000011 00000010 00000110 00000111 00000101 00000100 00001100 00001101 00001111 00001110 00001010 00001011 00001001 00001000
We need to know the number of bits necessary to represent the codes plus the padding to align to nearest byte boundary. The number of bits of the N-th code is
The BYTES function returns the necessary number of bytes for a given number of bits.
EXAMPLE 3 - Decompression routine
The input for this routine is a compressed text C. It contains two types codewords - LITERAL X and COPY X, -Y.
means pass the next X characters directly into the uncompressed output D.
means go back Y characters in the uncompressed output and copy X characters forward to the current position.
We will use 8 bits for coding a LITERAL codeword and 16 bits for coding a COPY codeword. If the first 4 bits are 0, then the codeword is a literal; the next 4 bits encode the length X in the range 1 to 16 (0 to 15 in code) and the following X characters are literal. Otherwise, the codeword is a copy; the first 4 bits encode a length X in range 3 to 17 (1 to 16 in code) and the next 12 bits are a displacement Y in the range 1 to 4096 (0 to 4095 in code).
The input string AAAAAABBBBCCCAABBBBC with 20 characters can be compressed into the string
with 14 characters.
Fiala E.R., Greene D.H., Data Compression with Finite Windows
CACM, April 1989, Vol. 32, No. 4, pp. 490-505
Press W.H., Teukolsky S.A., Vetterling W.T., Flannery B.P., Numerical Recipes in C : the art of scientific computing
- 2nd ed. University Press, Cambridge, 1992


text:
Today the National Bank of Hungary (the country's central bank) abandoned the currency's ERM-style trading band (15 percentage points fluctuation margins in either direction from a central parity of 282.36 forints to the euro). At the end of the trading day, the market rate was 263,57; the abandonment of the band was from the 'strong' side of the band. It was meant to give the forint greater scope for appreciation than would have been possible with the band in place (the band would have 'capped' the forint at 240 to the euro).
The NBH was right to can the band. An exchange rate target zone or exchange rate band is the worst exchange rate regime designed by man or dog. It combines the major weaknesses of any fixed or managed exchange rate regime – lack of flexibility combined with, ultimately, lack of commitment – with those of a market-determined exchange rate regime – the exposure of producers, consumers and portfolio holders to large and sudden swings in the nominal and real exchange rate, often caused by nothing more fundamental than one of the many manifestations of foreign exchange market psychosis.
For reasons understood only by the authors of the Treaty of Maastricht (and quite possibly not even by them), membership of the ERM for a period of 2 years preceding the examination date for full (stage 3) membership in the EMU, is a prerequisite for becoming a member of the Euroclub. So for countries willing to join and with some hope of meeting all the other criteria as well (inflation, interest rate, public debt, public deficit, central bank independence, good table manners etc.) entering the ERM makes instrumental sense. The 2-year ERM purgatory remains at best, an exercise in futility and an investment without any prospect of a positive return; at worst it exposes a candidate Euroclubber to unnecessary risk of financial and macroeconomic instability.
Clearly, the Hungarian authorities have given up on joining the eurozone for the time being. Quite wisely too. They have serious economic problems on their hands; not meeting the criteria for eurozone membership is the least of these. Growth is the lowest of any CEE country (1.3% for real GDP in 2007; maybe around 1.5 in 2008 – with a global economy that is slowing down and an effective real exchange rate that may be appreciating in the short term). Inflation is high, starting off January 2008 at 7.1% (on a year earlier). Private sector unit labour costs rose by 8.0 percent in 2007. It will have to be a lot less than that if domestically generated inflation is going to be anywhere near the Bank's target.
Public debt (probably near 70 percent of GDP at the beginning of 2008 and rising fast) and public sector deficits (around 6.5% of GDP in 2007) are high and will turn out to be unsustainable unless there is a major change in the political equilibrium – one that permits non-interest public spending to be cut by at least 10 percentage points of GDP from its Swedish-French level of 53% of GDP (in 2006). The country is in a deep fiscal mess. Gross external debt (private and public) stands at around 100 percent of GDP. The band was irrelevant.
Abandoning the band will not materially affect the policy choices open to the authorities, however. To the extent that the public debt is forint-denominated, fixed-rate nominal debt, its real value can be eroded by creating unexpectedly high rates of inflation. This will not help with debt (both private and public) that is denominated in euro, Swiss franc and other foreign currencies. In Hungary, as in most of the CEE, many private sector players (households, non-financial corporates and banks) have funded themselves increasingly abroad and in currencies other than the forint. Hungary is, of course, very open to trade (exports are around 80 percent of GDP), so a number of firms, and even some households, will have natural hedges for their financial foreign currency exposure, but many will not. Of those that don't have natural hedges, a few may have taken out synthetic hedges, but many will not have done so. Hungarian banks and other financial institutions will discover that they have little foreign exchange risk on their balance sheets (or off it) but rather a lot of credit risk.
The monetary authorities (who did not raise the official policy rate from its excessively low 7.5 percent level) may hope that the appreciation of the forint will give them some anti-inflationary freebies without the need to raise interest rates. They are right only if the forint is undervalued in real terms and if this disequilibrium is corrected more swiftly with the band removed than with the band in place. Even if they are right in their belief that the forint is undervalued as likely to appreciate in real terms, their apparent faith that underlying inflation can be brought down to its official target of 3 percent from an actual level of over seven percent with short real interest rates barely positive, beggars belief.
Marcus Miller and I showed back in the middle ages[1] that the sacrifice ratio (the cumulative additional unemployment incurred or output lost to achieve a given sustained reduction in inflation) is not lowered by a sharp up-front real appreciation of the currency if the transitional dynamics of the economy are rather old-Keynesian. When forward-looking expectations effects dominate, it may be possible to lower the sacrifice ratio through a sharp up-front appreciation, but policy sequences that make use of this feature are not time-consistent, that is, they involve a commitment by the policy maker to future actions that are not credible: when the day comes that the future commitment has to be honoured, the incentives facing the policy maker will have changed as a result of the earlier actions.[2]
So in all likelihood, there will either be a de-facto or de-jure abandonment of/increase in the operational inflation target, or the policy rate will have to be raised quite sharply, possibly to double digits. I expect that the underlying Balassa-Samuelson pressure for gradual real exchange rate appreciation will for several years be swamped by the contractionary fiscal measures required to achieve fiscal and external sustainability. The real value of the forint should, once the need for drastic belt-tightening is recognised, fall quite significantly. The immediate appreciation that followed the death of the band should not be taken as a reliable guide to the medium term behaviour of the real exchange rate.
Will the government do enough to avoid a default on the public debt? Hungary is unique among the countries of central and eastern Europe, in that it has never received (or indeed asked for) forgiveness or rescheduling of its public debt. So its record as regards debt servicing willingness and ability is unequalled. Since the country has never had its debt rescheduled, restructured or written down, it is key to look beyond the level of the debt-to-GDP ratio (which is at about the French and German level and well below those of Italy, Greece or Belgium) and beyond the level of the general government deficit, which includes interest on the outstanding stock of debt. Instead we should look at the trend in the debt-to-GDP ratio (rising) and at the behaviour of the primary (non-interest) general government balance, which should be in or headed for a surplus (it is not). Most important, we should look at the elephant lurking behind the financial account bushes: the level of (non-interest) public spending on goods and services. At around fifty percent of GDP, this is not financeable for a country with Hungary's level of per capita income unless Hungary discovers an, as yet unknown, much less distortionary and much less growth-discouraging way of taxing away half of every Hungarian's income.
I fear Hungary's economic prospects for the next few years are very challenging even if the authorities take the plunge and slash public spending drastically. Things will be even worse if sustainable and sustained spending cuts are not implemented. In that case, only the most immediate pain will be postponed, to be served up again later, mightily compounded. A default on the public sector debt then becomes a distinct possibility, despite the country's stellar past record of meeting its public debt obligations. It would be a sad end to a remarkable story of economic and political success. I hope that the country wakes in time from its stupor and enters rehab.
[1] Buiter, W. H. and M.H. Miller (1983), "Real exchange rate overshooting and the output cost of bringing down inflation: Some further results", in J. Frenkel (ed.) Exchange rates and international macroeconomics, University of Chicago Press.[2] See Buiter, W. H. (1986), "Policy evaluation and design for continuous time rational expectations models: some recent developments", in M. H. Peston and R. E. Quandt (eds.) Prices, Competition and Equilibrium, Essays in honor of William Baumol, Barnes and Noble Books, pp. 84-108, reprinted in Willem H. Buiter, Macroeconomic Theory and Stabilization Policy, Manchester University Press, 1989; and Buiter, W. H. (1985), "International Monetary Policy to Promote Economic Recovery", in C. van Ewijk and J.J. Klant (eds.), Monetary Conditions for Economic Recovery, Martinus Nijhoff, Amsterdam, reprinted in W. H. Buiter, International Macroeconomics, Clarendon Press, Oxford, 1990.


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This eBulletin is produced by NHS Diabetes and Kidney Care in conjunction with the Department of Health to support the NHS Health Check Learning Network. This is a useful tool for anyone working in health or social care with an interest in the prevention of vascular disease and vascular risk assessment and management. To subscribe or unsubscribe, please contact Eleanor Kent-Dyson.
In response to demand from NHS Health Check commissioners, we have put together a further assessment of the Cochrane review published on 17th October 2012.
The Cochrane review is a systematic review of the published literature on randomised trials of general health checks. The principal end point reviewed was mortality, for which nine trials provided evidence. A meta-analysis of these trials showed no difference in deaths overall, or from cardiovascular disease or cancer, between intervention and control groups.
The review also comments on comparisons of morbidity between intervention and control groups, although this was not the primary intention of the review and no meta-analysis was possible. Some trials showed differences, but the review authors did not consider these useful, partly as a result of the poor quality of the evidence in many individual trials.
There are some major difficulties in interpreting the results of this review:
(a) There was no specification of what constitutes a 'general health check', its content or its objectives. It is clear that there was significant heterogeneity between different trials. Some interventions included relevant measures such as blood pressure and cholesterol, but not all. In keeping with the 'general health check' terminology, most were not well focused on specific enquiries and tests but included non-specific searches for any abnormal finding including those suggestive of cancer.
(b) Nor was there any specification of what follow up action would be invoked in response to any identified abnormality, and the trials considered differed. It is notable that in most the action triggered by an identified lifestyle risk was merely brief lifestyle advice.
(c) Most of the trials considered are old, dating from as long ago as the 1960s when understanding of health risks and particularly how they may be modified was at an early stage of development. Most of the risk reduction measures now used post-date these trials.
(d) These older trials contribute disproportionately to the overall mortality results, because by definition all of the trials with longer follow up and thus more deaths are older. The newer trials that are more likely to reflect current practice have such brief follow up periods that it is unlikely that they would have much prospect of showing a significant effect.
(e) Few of the trials appear to have looked at the effect of a sustained programme of either checks or risk reduction. The effect of a single piece of lifestyle advice on mortality many years later is likely to be so diluted by other factors as to be undetectable.
A few trials were based on vascular risk factors and reasonably recent, although still not based on protocols that would match current NICE guidance. The OxCheck trial reported significant improvements in risk in the study group compared with controls. This study was not designed to look at mortality and none of the referenced publications report on it; the review authors say that they contacted the authors of the study to enquire about death rates and were able to include them in their analysis despite them never having been published. This unusual approach is unlikely to be considered appropriate in other circumstances.
The other relevant and recent trial that looked at cardiovascular risk is the ongoing Inter99 trial, which has already reported significantly improved mental health and physical health amongst the study group compared with controls, with no detectable mental distress resulting from the intervention. Self-reported health was significantly better in the study group, which is known to correlate with mortality. This trial has not reported on mortality to date as sufficient follow up has not yet accrued.
The NHS Health Check Programme was designed as a specified set of questions and investigations focused strictly on a set of related ('vascular') conditions, followed by a range of risk reduction measures known to be effective. The basis for both aspects has been firmly grounded in NICE guidance. None of the trials reviewed by Krogsbøll et al would match this protocol, even the Inter99 study that most closely resembles it. The Cochrane review authors conclude that their "…results do not support the use of general health checks…"; the key point is that NHS Health Checks are not 'general health checks.'
Overall, the review conclusions can have little if any relevance to NHS Health Checks. What the review does, however, is underline very clearly the need to evaluate the effectiveness of the programme at national level, including outcomes.
It should be noted that assessments and tests were included in the NHS Health Check only if there was cost effectiveness evidence to support their inclusion. The economic modelling also only included interventions for which there is good evidence of their cost effectiveness (see page 9 of the Economic Modelling Report). The relevant NICE guidance is shown in table 1 below (page 10 of the report).
Table 1:
Intervention offered
Existing Guidance
Brief exercise intervention
NICE Guidance PHI002 "Four commonly used methods to increase physical activity", March 2006
Multi-component weight loss programmes
NICE clinical guideline CG43 "Obesity", December 2006
IGR intensive lifestyle management
NICE clinical guideline CG43 "Obesity", December 2006 and Health Technology Assessment 2004; Vol 8: No. 21
Stop Smoking Services
NICE guidance PHI001 "Brief interventions and referral for smoking cessation in primary care and other settings", March 2006
Anti-hypertensives for those with hypertension
NICE clinical guideline 34 "Management of hypertension in adults in primary care: partial update", June 2006
Statins for primary prevention
NICE technology appraisal 94 "Statins for the prevention of cardiovascular events", January 2006
In addition, the following NICE Guidance have been released since the economic analysis was carried out:
Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease - Clinical guidelines, CG67 - Issued: May 2008
Preventing type 2 diabetes: population and community-level interventions in high-risk groups and the general population - Public health guidance, PH35 - Issued: May 2011
Alcohol-use disorders - preventing the development of hazardous and harmful drinking - Public health guidance, PH24 - Issued: June 2010
All operational queries about the NHS Health Check programme, or questions about the Learning Network should be directed to Eleanor Kent-Dyson. Policy queries should continue to be directed to the NHS Health Check team at the Department of Health using their dedicated mailbox .
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Your wedding is one of the biggest events of your life and is probably the most memorable. It's also the event that requires the greatest amount of preparation, which can lead to quite a lot of tears as you approach your big day. Much of the frustration comes from the awkwardness that often surrounds gift-giving; after all, you know what you want, but you can't seem to find a way around getting something that you know you'll never use. Luckily, with a cash wedding registry the stress of asking for and receiving gifts doesn't have to be a problem.
Tell Them Your Story: Most couples these days create wedding websites, which offer plenty of opportunities for personalization. Your guests were invited for a reason; they care and want to wish you well on your big day. They want to know all about how it happened. How did you meet, what happened on the first date, who popped the question? Throw in some fun anecdotes from your relationship for good measure. Let your well-wishers experience your love story and get to know how the two people standing at the altar got to where they are.
Make a Registry: A cash wedding registry is the perfect opportunity not only to get what you want, but also to get what a couple embarking on a new life together needs. So don't forget to include things like money for down payments and kitchen appliances for your new home, along with that evening gown and cruise tickets you'd like for your honeymoon.
Keep In Touch: Stay in touch even after you send the thank you cards! Make sure to send frequent updates with pictures of what you and your partner are getting up to. When you start your life together, keep all the people that helped make it possible in the loop. There's nothing more satisfying than knowing that you helped a couple start out on a long and happy life together!
If you're looking for some inspiration, check out the registry that Ben and Daniela made, or this one by Rachel and Adam.


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Emerald Ash Borer Now in 28 PA Counties
Posted: August 13, 2012
The small insect, an Asian invasive that was first detected in Michigan in 2002, kills ash trees. As it moved through Detroit, the streets became lined with dead or dying trees, and municipalities were strapped for funds as they realized they had to cut the trees down to avoid a public safety problem.
The insect spread quickly, and in 2002 it was first detected in Pennsylvania's Butler County -- not far from the turnpike. Because the insect seems to follow highways, often being found at or near rest stops, officials theorize the transport of firewood is a major route of expansion.
And then earlier this year, when it was found in Bucks County -- no where near any other spotting -- officials figured the only way it could have gotten there was by firewood transport.
They found the dreaded insect in one place -- at a Warrington apartment complex -- but they figure it won't be long before it spreads, or evidence it has already spread becomes apparent.
Meanwhile, look at the map: You can see how the insect spread from west to east, and then made that huge leap to Bucks. It's now in 28 Pennsylvania Counties.
Other places it has recently spread to (note the highway and campground spots, indicating probable firewood transport):
• Along I-76 close to Willow Hill, Franklin County;
• Near Brookville, Jefferson County;
• At a campground near Liverpool, Perry County;
• Near the state hospital in Selinsgrove in Snyder County;
• At a campground close to Emlenton, Venango County.
As part of a national survey, crews from the Pennsylvania Department of Agriculture began hanging more than 750 triangular purple traps from ash trees in eastern Pennsylvania in May. The idea isn't to trap the insects to control them, but to detect them. The hope is that you put out the traps and catch nothing. Crews will continue to monitor the traps and sites through August, officials said.
Posted by Sandy Bauers


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From the eye-popping adventure drama "Gravity" on the big screen to the addictively tragic end to "Breaking Bad" on the small screen, 2013 dished out some delicious TV and movie fare for those who love a good story.
On Tuesday at 12:15 p.m., Salt Lake Tribune movie critic Sean P. Means and television critic Scott Pierce join Jennifer Napier-Pearce to talk about their top picks for 2013.
You can join the discussion by sending questions and comments to the hashtag #TribTalk on Twitter and Google+, or submit comments in the comment section below this story. > sltrib.com


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Have Cat Questions? Ask a Cat Vet Online.
Hi Diana,
Thanks so much for requesting me!
I am sorry Harvey has been so ill.
Can you tell me some more information?Is he still at the vets?is he able to pass urine?do you see any yellowing of his eyes or gums?
has he been eating normally?
what foods?
After your reply, please give me a few minutes to type detailed answer.
He's still at the vet. They are monitoring him until Thursday because of the blockage issue. He still has a catheter in and has been passing urine that way.
They told me he was showing no symptoms of the elevated billirubin so I'm assuming that means no jaundice symptoms.
They told me that he did eat last night after the procedure, but very little. But I'm assuming that would be normal after coming out of anesthesia. I don't know what kind of food they're giving him.
Dear Diana,
Thanks so much for your helpful reply.
They are monitoring Harvey because a cat that blocked once can develop strictures (narrowing) from the catheter.
read about blockage here:
The most common cause of urinary tract disease is a dry food diet.
Read more here:
I suspect they want to do the ultrasound to check for stones.
Here is info on the different kinds.
Elevated bilrubin can indicate a liver issue or it could be caused by the blockage or even stress.They will be able to see the liver via the test.
Liver disease can be due to a cat not eating for a few days:http://www.fabcats.org/owners/liver/info.html
It is a very good sign that Harvey is not jaundiced. He may be put on a special renal diet if he has stones or urinary tract disease.
Most cats do quite well on this food.
I tried to cover everything you asked but if you still have questions just press reply and I will be here for you.
I hope Harvey feels better and can come home very soon.
Best wishes for him,'
Elevated bilirubin can be caused by stress? I couldn't find anything online that said that. Harvey has definitely been stressed the last few days with him not feeling well.
Yes, you can read about stress induced elevated bilirubin here:
Fortunately, Harvey is not jaundiced which could point to liver disease.
If you still have questions please do not hesitate to ask. I want you to be 100 satisfied with my help.
I hope the poor baby feels better very soon.


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March 14, 2007
Mr. Chairman and members of the Subcommittee, thank you for the opportunity to appear before you today to discuss the Department of Veterans Affairs (VA) medical and prosthetic research program's fiscal year ( FY) 2008 budget request. I appreciate this invitation to discuss the important work of VA research. With me are Dr. Timothy O'Leary, Director of Biomedical Laboratory and Clinical Science Research and Development, and Dr. Robert Ruff, Acting Director of Rehabilitation Research and Development. I would like to take this opportunity to give an overview of VA's research program.
Let me first say that the future of medicine is determined by research. The advances in medicine that we have all grown to expect will not occur without research, just as many of the medical advances of the past 50 years brought about by VA would certainly not have occurred without research. I am sure that you are familiar with the many awards won by VA investigators - 3 Nobel prizes, 6 Lasker awards, and others. But what is more important is the large number of treatments and procedures that have been developed and proven by VA investigators. VA research has been a highly valuable investment with very substantial returns for veterans first and the Nation as a whole.
VA's research program was developed as part of the post-World War II effort to discover knowledge and create innovations that advance health and healthcare for veterans and the Nation. VA research has taken special advantage of its connection to clinical care and is replete with examples of how VA investigators have improved care, including:
But past success is not enough. Research must always be future-oriented. We must look at how we practice healthcare today and ask: how can we do better? VA's research program builds on its past by identifying and confronting the important questions and challenges of today and conducting the hard work to find solutions for the future.
VA Research as a Unique Laboratory
A particular advantage of VA research is that it is an intramural program where clinical care and research are under one roof. For this reason, it has the capacity to bring scientific discovery from the patient's bedside to the laboratory bench and then back to the care of patients, making this program one of VA's most effective tools to continue improving the care of veterans. Embedding research within an integrated healthcare system with a state-of-the-art electronic health record creates a national laboratory for the discovery of new medical knowledge and the translation of that knowledge into improved health. Furthermore, the opportunity to conduct research assists VA in recruiting outstanding clinicians and creates a culture of continuous learning and innovation that helps VA maintain its position of leadership.
Additionally, VA research has a unique program, the Quality Enhancement Research Initiative (QUERI), which creates durable partnerships between VA researchers, policy-makers, and clinicians to accelerate the implementation of research evidence into routine practice. Allow me to give you one example of this fine program - administration of influenza and pneumococcal vaccine to individuals with spinal cord injury. It had been found that the rate of vaccination in these individuals was unacceptably low. To address this, QUERI investigators formed a partnership with VA's spinal cord injury leaders and were able to increase the vaccination rate from 28% and 40% to 61% and 79% for influenza and pneumococcal vaccine, respectively. After three years, this QUERI initiative was stopped. As all of you are aware, some research efforts create only temporary improvements that are lost once the project terminates. However, in this case, the vaccination rates did not decline after termination of the initiative, and in fact increased even further to 65% and 82%, respectively. This occurred because VA researchers worked within VA's health delivery system to make lasting changes in the process of care. I think this exemplifies the value of having research and clinical care under one roof, working together to improve the delivery of care.
Information Technology (IT) Security and Privacy
It is important to note our efforts in IT security and privacy protections. The following are among the steps VA research has taken, in close collaboration with the Office of Information and Technology, to strengthen IT security and privacy:
In addition, VA has implemented rigorous technical and administrative controls to protect the security and privacy of patient information used in the course of approved research projects. Every researcher seeking access to protected information must receive specific approval to access that information from a VHA Privacy Officer. The Privacy Officer works closely with the Office of Research and Development to ensure that access is granted or denied in accordance with federal law - including the Privacy Act, the Federal Information Security Management Act (FISMA), and the Health Insurance Portability and Accountability Act (HIPAA) - and further, that access is restricted to the minimum information necessary to support the approved research protocol.
Funding Priorities of VA Research
VA research focuses on the special healthcare needs of veterans. To accomplish the VA research mission, the President's 2008 budget request includes $411 million to support VA's medical and prosthetic research program. This amount will fund nearly 2,100 high-priority research projects to expand knowledge in areas critical to veterans' healthcare needs. The VA medical care appropriations also include an additional $411 million for research activities. In addition to VA appropriations, VA researchers compete for and receive funds from other federal and non-federal sources. Through a combination of VA resources and funds from outside sources, the total research budget in 2008 will be almost $1.8 billion.
The following highlights some of the current funding priorities for VA research.
Research Related to Returning Operation Iraqi Freedom and Operation Enduring Freedom ( OIF/ OEF) Veterans and Deployment Health. VA has implemented a comprehensive research agenda to develop new treatments and tools for clinicians to ease physical and psychological pain, improve access to VA healthcare services, and address the particular health issues of OIF/ OEF veterans. This research also has direct relevance for veterans of other conflicts, as well as for civilians suffering from disability due to injury or disease.
It is important to note that last week the President created an Interagency Task Force on Returning Global War on Terror Heroes (Heroes Task Force), chaired by the Secretary of Veterans Affairs, to respond to the immediate needs of returning Global War on Terror service members. The Heroes Task Force, which had its first meeting last week, will work to identify and resolve any gaps in service for service members. As Secretary Nicholson said, no task is more important to VA than ensuring our heroes receive the best possible care and services. VA research is helping to ensure that our heroes do receive the best possible care.
Specific areas of focus in OIF/ OEF and deployment health related research include:
Neurotrauma (including traumatic brain injury and spinal cord injury). Although Kevlar helmets and improved body armor save lives, they do not protect the head, face, and cervical spinal cord from blast and impact injuries. Accordingly, traumatic brain injury (TBI) and spinal cord injury (SCI) account for a significant number of the combat casualties sustained by our soldiers in OIF/OEF.
In 2005, VA issued a solicitation for research in combat casualty neurotrauma. This research initiative seeks to advance treatment and rehabilitation for veterans who suffer traumas from improvised explosive devices and other blasts. The solicitation is still active and applicants are asked to pay special attention to cooperative projects in TBI with the Department of Defense ( DoD), co-morbid conditions with TBI such as PTSD and trauma to extremities, screening and diagnostic tools related to mild TBI, especially field-based, and continuity of care between DoD and VA. Neurotrauma studies underway span the full spectrum of VA supported research and include those in neurobiology, protection and prevention of injury, drug treatments, and treatments to enhance attention and cognition.
Mental Health and PTSD Research. VA's combat-related mental health research portfolio includes studies about addictive disorders (including nicotine dependence), the behavioral consequences of TBI, PTSD, and depression. In addition, VA health system studies are focusing on how to integrate mental health services into primary care, thereby improving access to needed care as well as reducing the stigma associated with mental illness.
VA investigators are working to understand the course of the readjustment experience and to identify PTSD risk factors and treatment response for veterans returning from OIF/ OEF as well as from other conflicts.
In one study, VA researchers collaborating with DoD are collecting risk factor and health information from military personnel prior to their deployments to Iraq. These soldiers will be reassessed upon their return and several times after that to identify possible changes that occurred in emotions or thinking as a result of their combat exposures and to identify predisposing factors to PTSD as well as other health conditions.
In addition, in 2006, VA initiated a new center-based program of research to examine biological mechanisms and potential treatments for PTSD complicated by secondary drug abuse. Such dual-diagnosis patients have proven difficult to treat in the past.
VA investigators are also examining new treatments of PTSD, including the very promising prolonged exposure therapy and various kinds of drug treatments in refractory cases.
VA supports a broad research portfolio on depression, including investigations of cognitive behavioral therapy and new types of drug treatments. VA is unique in its ability to use research to design and test new ways of delivering care to veterans, such as collaborative care models in which professional mental healthcare is integrated into VA primary care practices, thereby increasing the effectiveness of mental healthcare, and tele-health, which uses Internet-based technologies to bring state-of-the-art care into veterans' homes and communities.
Prosthetic Devices and Amputation Healthcare Research. VA research continues to expand its support of multidisciplinary research and examination of enabling technologies to ease the physical and psychological impacts of limb loss. A primary goal is to generate rigorous data that can drive policy and shape clinical care guidelines.
While traditional prosthetic and amputation healthcare research has focused on mechanical limb prostheses, VA is expanding its focus to include novel approaches such as tissue engineering and surgical treatment for residual limb lengthening, joint replacement and attachment of prostheses, as well as incorporating advanced materials, microelectro-mechanics, and nanotechnologies into current prosthetic designs. One innovative approach has involved investigating the control of prostheses through direct brain activity. The overarching goal of all these initiatives is to maximize the functional recovery and well-being of veterans who have compromised limb function as a result of combat injury.
VA is also partnering with DoD to compare prosthetic designs, define standards of function, evaluate psychological issues faced by returning service personnel, determine psychosocial issues that challenge successful reintegration, and conduct longitudinal outcome studies.
Polytrauma. Improvements in body armor and battlefield medicine have resulted in higher survival among wounded soldiers, but also, in some cases, new combinations of multiple injuries, including head injuries, sensory loss, nerve damage, infections, emotional problems, amputation, and/or SCI. This is a new challenge for VA and VA research is working to develop the knowledge base to manage these conditions over the lifetime of the veteran.
In 2006, VA established a Polytrauma and Blast-Related Injury Quality Enhancement Research Initiative (PT/BRI QUERI) coordinating center to use the results of research to promote the successful rehabilitation, psychological adjustment, and community reintegration of these veterans. The PT/BRI QUERI links VA investigators with VA's Polytrauma system of care, including the four lead centers located in Minneapolis, Richmond, Tampa, and Palo Alto. The Polytrauma QUERI has two particular emphases: to accelerate the diffusion and use of new knowledge generated by VA research in the areas of neurotrauma, sensory loss, prosthetics, and amputation, and to identify and address the needs of informal caregivers such as spouses or parents in order to allow veterans to remain in home and community-based settings.
Gulf War Veterans' Illnesses. Many individuals returned from the 1990-1991 Persian Gulf War with unexplained medical symptoms and illnesses. Nonspecific symptoms such as fatigue, weakness, gastrointestinal difficulties, cognitive dysfunction, sleep disturbances, headaches, skin rashes, respiratory problems, and mood changes that often occur together in a constellation have been termed Gulf War veterans' illnesses (GWVI). Despite a large number of studies and considerable funding over the past decade, the etiology and successful treatment of GWVI remains elusive. VA research continues to expand its efforts to understand and improve the treatment for Persian Gulf War Veterans.
Several studies have shown that Persian Gulf War veterans have up to a two-fold greater risk of developing amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, than those not deployed to the Gulf. ALS is a tragic condition characterized by progressive muscle wasting and weakness. The diagnosis of ALS is based on the patient's history and clinical findings. There is currently no single test that is specific for ALS, so it may take up to two years to confirm the diagnosis.
VA investigators recently identified three proteins that were significantly lower in concentration in the cerebrospinal fluid from patients with ALS than in normal subjects. The combination of these three proteins correctly identified patients with ALS with 95% accuracy from normal subjects. The change in content of these three proteins may help identify patients with ALS early in the course of the disease.
Beyond OIF/ OEF and deployment health related research, VA's research funding priorities include several areas affecting the larger veteran population, including:
Mental Health Research. Mental health research is spread throughout many parts of the VA's research portfolio. The scope of VA's mental health research includes studies about:
Examples of VA mental health research projects currently underway include multi-site cooperative studies such as "Improving Outcomes among Patients with Co-Occurring Depression and Diabetes," studies about TBI and its behavioral consequences, and research centers in the areas of addictive disorders and serious mental illness.
Genomic Medicine. Genomic medicine is the direction for healthcare in the twenty-first century. Genomic medicine could allow VA to provide care that is tailored specifically to the genetic makeup of individual veterans, increasing the effectiveness and safety of healthcare and disease prevention efforts, while protecting privacy. VA is uniquely situated to combine the research and clinical application of genomics because of VA's large patient population that is stable, diverse, and treated in a variety of settings; healthcare system with outstanding investigators and an integrated research network; and, unrivaled electronic health record. Taking advantage of these factors inherent in VA, VA intends to develop a genomic medicine program that could considerably improve the care of veterans.
In March 2006, VA research took the first step toward establishing a genomic medicine program by impaneling a Genomic Medicine Program Advisory Committee of internationally recognized scientists and veterans' advocates to help lay the groundwork for future development of a comprehensive genomic medicine program in VA.
Specifically, the genomic medicine program will help VA:
Chronic Diseases. Promoting good health and managing chronic conditions remain high priorities for VA healthcare and VA research. The following are examples of efforts by VA investigators to discover how to prevent and treat chronic disease.
Diabetes. Nearly a quarter of the veterans receiving care from VA have diabetes, and an even greater number (73%) are at risk due to overweight or obesity. VA investigators have completed the first study to compare the quality of diabetes care among patients in VA and commercial managed care organizations. Quality of care measures were compared for seven diabetes processes of care, three diabetes intermediate outcomes, and four dimensions of satisfaction. Results from this study showed that VA patients had better scores than commercial managed care patients on all assessed quality of care measures. VA patients also had better lipid control and were slightly more satisfied with the overall quality of diabetes care at VA. All of this is considerably enhanced by the electronic health record that enables precise evaluation and follow-up of diabetic patients.
Obesity. The VA patient population, like that of the U.S. in general, is experiencing an epidemic of overweight and obesity. Obesity contributes to increased heart disease, diabetes and sleep apnea, and other health conditions. Examples of VA obesity research include studies about traditional and new approaches to prevent and treat obesity such as comparing lower extremity functional electrical stimulation (FES) on obesity and associated co-morbidities to upper extremity aerobic exercise for persons with paraplegia; assessing the impact of walking aids on quality of life and physical activity in overweight and obese veterans with osteoarthritis; and exploring drug therapies.
HIV/AIDS. AIDS (acquired immunodeficiency syndrome) is caused by HIV (human immunodeficiency virus). VA is the largest single provider of HIV care in the U.S., with nearly 20,000 patients seen annually with the disorder. Accordingly, VA research funds a full range of studies from bench research aimed at elucidating the underlying mechanisms of HIV to implementation projects that improve VA's effectiveness in caring for this population.
A recent study by VA researchers found that routine HIV screening is cost-effective even in low prevalence populations, because early treatment with highly active antiretroviral therapy can reduce the degree of infectivity and transmission of the HIV virus, improve quality of life and increase life expectancy for the patient, and reduce healthcare costs for the system. Such research has helped shape VA policy for HIV care (e.g., implementation of rapid HIV testing) and also influenced the Centers for Disease Control and Prevention to recommend that HIV testing be offered to all adults.
Alzheimer's Disease. Alzheimer's disease is the most common form of dementia (loss of mental abilities) among older people. Alzheimer's disease involves the parts of the brain that control thought, memory, and language, and people with Alzheimer's disease have memory problems, may become lost in familiar places, and get disoriented about time and places. VA related studies include discovery of new links between diabetes and Alzheimer's disease, examination of dietary treatments, and many others.
Substance Abuse. Alcoholism and dependence on other drugs are a major problem in the VA patient population. While environmental stressors contribute to the development of alcoholism, a substantial part of an individual's risk for becoming an alcoholic is inherited.
A group of more than a dozen scientists at VA's Alcohol Research Center has been studying alcoholism for over 20 years. This group is recognized as one of the world leaders for behavioral genomics studies of alcoholism and substance abuse. The scientists have discovered a gene, the Mpdz gene, related to alcoholism and the methods they introduced for gene mapping have been widely adopted.
Women's Health. In response to the increasing number of women veterans, documented expansion of the number of women in the military, and special healthcare needs of female veterans, VA has focused additional attention on women's health research. VA has developed a comprehensive women's health research agenda including a new priority research solicitation on women's health. Examples of VA research studies relevant to women veterans' health include further understanding the cellular mechanisms underlying breast and cervical cancers, the role of hormones in stroke and aging, further characterizing basic neurobiological changes in women who have undergone severe trauma, and specific prosthetic designs for women. Together with a strong mental health research program, VA research is well positioned to continue to enhance healthcare for women veterans.
In 2006, VA investigators served as guest editors and prominent contributors to a special supplement of the Journal of General Internal Medicine that focused on VA women's health research. Articles describe research on the health and healthcare delivery of female veterans, including diabetes care, PTSD, and obesity, and highlight issues related to access to care, the quality of VA women's healthcare, and VA organization and policy.
Long-term Care. Meeting the long-term care needs of veterans is growing in importance as the number of veterans most in need of these services - those 85 years old and older - is expected to increase to 1.3 million by 2012. In addition, a new younger population of veterans with different long-term and care coordination needs is emerging as a result of the OIF/ OEF conflicts.
Many veterans prefer to receive long-term care in non-institutional settings, so they can stay connected with their community and loved ones. However, the success of such long-term care is critically dependent on the ability of veterans' family and friends to assist in their care. Caregiver burden is common and frequently limits the ability of family and friends to provide that assistance. Caregiving also can have significant negative consequences on the health and well-being of caregivers, yet little is known about how to ameliorate the impact of the burden of care. VA research has initiated several efforts aimed at understanding and supporting the needs of caregivers, including special efforts targeted through the QUERI program to survey the needs of caregivers of blast injury and TBI patients, and a new research initiative focused on developing new approaches to community-based long-term care.
Because over 70 percent of VA researchers are also clinicians who take care of patients, VA is uniquely positioned to move scientific discovery from investigators' laboratories directly to patient care. In turn, VA clinician investigators can identify new research questions for the laboratory at the patient's bedside, making research one of VA's most effective tools to continue improving the care of veterans. The fundamental goal is to address the concerns of the entire veteran population from the aging veteran to the young recruit who returns with injuries from recent conflicts. VA takes great pride in the research that keeps it at the forefront of modern medicine and healthcare and expects to see further remarkable discoveries in the coming decades. VA research has been a wonderful investment with remarkable returns.
Mr. Chairman, that concludes my statement. I am pleased to respond to any questions you or the Subcommittee members may have.
Thank you.
House Committees | Senate Committees | Find my Representative | Find my Senator
Veterans and their family members who wish to contact the Department regarding a claim, benefits, or services, may call VA Toll-Free at 1 (800) 827-1000 or 1 (800) 829-4833 [TDD], or Contact the VA via the web.
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U.S. Department of Veterans Affairs - 810 Vermont Avenue, NW - Washington, DC 20420
Reviewed/Updated Date: November 10, 2009


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Story Details
Governor Herbert Appoints Campbell to State Board of Regents
May. 06, 2010
SALT LAKE CITY - Governor Gary R. Herbert has appointed Daniel W. Campbell to the State Board of Regents.
"In addition to having an extensive background of management and governance expertise, Dan has been an active supporter of public and higher education in the State of Utah," Governor Herbert said. "I look forward to his contribution to the State Board of Regents."
Mr. Campbell is a managing general partner at EsNet Group, a privately held investment company. Prior to his current position, he was the senior vice president and chief financial officer of WordPerfect Corp.
Mr. Campbell has a bachelor's degree in accounting from Brigham Young University. He currently serves as a member of Utah Valley University's Board of Trustees, and is a former chairman of that same board. He also serves on the Board of Governors for the Provo School District Foundation and is a national advisory council member for Brigham Young University's Marriott School of Management.
Mr. Campbell has been appointed to fill the vacancy created by resignation of Anthony Morgan. The Governor's appointment is subject to confirmation by the Utah State Senate.


text: Am 18.05.2012 13:53, schrieb Ken Moore:> > I just fixed this typo in our source code. Thanks for reporting it! > > If you come across an other English typo's, just let us know here on the > translation list and we will try to get that fixed as soon as possible. Hi, there is another english typo: http://pootle.pcbsd.org/de/pcbsd/EasyPBI.po/translate/?unit=403288 "Select Digital Signiture File" elwood


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Masters top 15
1. Adam Scott- no one has gone back to back since Tiger in 2001 and 2002- great in Masters and playing very well…One of three players to make the cut in each of the last 8 majors and only one to post a below par aggregate score. (-4) Tiger is +21 and Dufner is +12.
2. Matt Kuchar- most consistent player in the world but can he win? 8 top 10's no wins…8th and 3rd last 2 years
3. Dustin Johnson- Along with Rory the most talented player in the world but what the heck happened in Houston? 80 and a Withdraw?
4. Bubba Watson- kind of a forgotton guy over the last few weeks but 4 top 3s this year- Came into Masters rolling in 2012 and won it..best golf of his career then and now
5. Zach Johnson- Former champ but hasn't been as hot lately as he was in the winter- 5 top 10's
6. Jason Day- he would be my favorite without question but I'm concerned about the thumb- Killed it in majors last year
7. Keegan Bradley- Consistently good all year and due a win…had 1 bad round each of the last 2 years at Augusta
8. Rory McElroy- Monumental collapse in 2011 with an 80 in 4th round- 1 bad 79 round last year- maybe most talented golfer in world- not great in masters (more rounds over 76 than he does in the 60's.
9. Jason Dufner- How can you not root for Duf? He isn't just a characture, he can play
10. Phil Mickelson- 3 time winner -9 top 5s in last 12 years- mediocre lately until last week
11. Sergio Garcia-hot all year- Top 11 in every match play tourney and sweet 16 in match play
12. Hunter Mahan- Either top 12 or cut in last 6 years- withdrew from last tourney before this week
13. Charl Schwartzel- Former champ playing pretty well right now
14. Lee Westwood- When he's playing really well he's really good at the Masters, he isn't really good right now
15. Justin Rose- 11th and 8th last 2 years


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"It was five in the afternoon – precisely five in the afternoon". Thus begins the saddest and most beautiful poem in the Spanish language, "Lament for Ignacio Sánchez Mejías".
Five o'clock, for Spaniards, used to mean only one thing: it was the hour at which bullfights began. The verse is an elegy to a popular matador, gored to death in 1934. The author, Federico García Lorca, was his friend.
Like all aficionados, Lorca was keenly interested in death, and the morbidity of his verse was perhaps its most Spanish attribute. In one of his poems, he eerily foretold his own demise:
"Then I realised I had been murdered. They looked for me in cafes, in cemeteries, in churches, but they didn't find me. They never found me? No. They never found me."
Shortly after the outbreak of the Spanish Civil War, when he was exactly my age [38], Lorca was shot by Nationalist sympathisers in Granada, and his body thrown into a mass grave. The reasons for his assassination have never been fully explained. It may have been his Leftist sympathies, or his homosexuality, or it may simply have been a grudge. Until recently, no one much wanted to raise the subject.
Now, though, Lorca's body is to be unearthed, and the story of its exhumation is the story of Spain's recent past. For a long time, the first rule of Spanish society was "Don't mention the war".
Lorca's skeleton speaks of a new Spain - communal graves of Civil War victims finally being excavated
Current Status: Blessed (1)
Seeded on Mon Aug 31, 2009 3:25 AM
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A commercial induction cooktop is perfect for food trucks, buffets, and catered events because they can be easily moved around to accommodate small spaces and display cooking purposes. We carry models in a wide variety of styles and sizes, so you're sure to find one to fit your establishment. Many options are even NSF Listed, so you don't have to worry about hard-to-reach sauce splashes or crumbs. For products to use with your countertop induction cooker, be sure to check out our induction-ready fry pans, induction-ready display cookware, turners. If you're wondering where to buy countertop induction ranges and induction cookers, we have a large selection of countertop induction ranges and induction cookers for sale at the lowest prices.


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This is a scam and a dumb person too nice job posting for yourself so you can scam others try making comments on different days!!
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Posts Tagged multiplayer games
Suggest your favorite multiplayer PC game!
Posted by Alex Ziebart in PC Gaming on March 23, 2011
After spending many hours last night playing Nutsy Bolts with a number of friends and readers, I was prompted to do something a little differently here on the blog today. I want to ask a question of all of you What do you think are good multiplayer online games?
Free games like Nutsy Bolts and Transformice are ideal, but paid games like Left 4 Dead and Magicka are very much acceptable! I find it strangely difficult to find pick-up-and-go multiplayer games that aren't MMOs or first person shooters. That doesn't mean they don't exist — I simply don't know what they are.
There are plenty of console party games like the Mario Kart, Mario Party, and all sorts of fighting games, but I find it much harder to find that experience on the PC. There is no PC Mario Party. You play an MMO or you play a first person shooter. It feels like a very limited set of options. StarCraft (or similar titles) is certainly an option, but it feels like a significant undertaking for what it is — party games generally have a very fast turnover round to round. In my experience, StarCraft … doesn't.
Please, suggest your favorite multiplayer games! Any genre is acceptable. FPS, RPG,whatever you want, as long as it's fun!


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When we found Le Parlement Bordeaux Blanc, we were blown away by this delicate, layered white wine with generous flavors of zesty citrus, fresh grass, gooseberry and honeysuckle. White Bordeaux is not on most people's wine radar, but we love this sophisticated wine that has a Sauvignon Blanc's appeal, with an added complexity that appeals to true enthusiasts. Do not miss this limited wine, which won the Gold for Best Bordeaux Blend in the 2016 Winemaker Challenge International Wine Competition.
Best of Class, 93-point Gold Medal - 2016 Winemaker Challenge International Wine Competition
89-point Silver Medal - 2016 Monterey Wine Competition


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The Best of PopSugarTV September 23-30, 2011
Metallic Eye Makeup, Fringe at Milan Fashion Week, and Tips From Jennifer Aniston's Yoga Guru: The Best of PopSugarTV This Week!
This week in PopSugarTV, Bella showed us how to wear metallic eye makeup, one of the biggest runway beauty trends for Fall, while Fab interviewed Alexa Chung about her new Madewell collection and broke down all the fringed looks at Milan Fashion Week. Fit got instructions on Warrior Pose 3 from Jennifer Aniston's yoga teacher, Mandy Ingber, and Yum showed us the right way to cut an onion. Check out all the videos at the links above, and be sure to visit PopSugarTV for even more!


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Sprint (Overland Park, Kan.) on Tuesday announced the launch of Sprint Command Center, a centralized, self-service portal that controls M2M devices and services, as well as allows businesses to control provisioning, billing, management and application development of their own M2M devices.
Sprint Command Center allows businesses to manage services via Web portal or direct API access, while also leveraging existing enterprise applications to control devices and services. According to Sprint, users can manufacture customizable devices, test connectivity and deploy to the field before generating monthly recurring charges via automatic activation triggers. Companies can add, remove, suspend and un-suspend devices, view detailed and summary usage records and billing information, and create custom user notifications based on usage thresholds.
Additional key features and benefits include:
- Secure platform and connectivity for protected access
- Remote control of key management tasks
- Add, remove, suspend or un-suspend devices
- Automated pre-provisioning, activations and un-suspensions
- Pre-planned (by date/time, usage, etc.) or on-the-fly management
- Development tools, including kits, modules, hardware and service plans


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Submit News
Zombie Worms Discovered in Mediterranean Whale Bone
Tiffany Kaiser
November 3, 2011 12:16 PM
Recipient E-mail
Sender E-mail
The Osedax worm
(Source: University of Leeds)
Researchers believe the Osedax genus may be responsible for dissolving bone before they became fossils, which may have affected the fossil record
Researchers from the University of Leeds have discovered a type of zombie-like
in the Mediterranean, which may be a clue as to how this bone-eating worm affects fossil records.
The zombie worm, which is of the Osedax genus, does not have a mouth or gut, but consumes bone by growing root-like tissues. These tissues dissolve the bone as they grow. The Osedax were first discovered alive in Monterey Bay, California in 2002, where they were feeding on the bones of a gray whale. Ever since, researchers have wondered how these creatures may have affected fossil records.
But this is no easy task. Learning when and where the Osedax evolved has been a challenge because they are soft-bodied and do not preserve as fossils. Yet understanding the Osedax could provide more insight into lost parts of the fossil record due to these worms eating the bones before they could
become fossils
The Osedax may not leave fossils behind, but they do leave their bulb-shaped cavities that they form in a bone. This has allowed Nicholas Higgs, study leader and University of Leeds researcher, to trace their beginnings. Last year, Higgs traveled to the Mediterranean and used micro-CT scanning technology to find traces of the Osedax.
Now, the bulb-shaped cavities have been found in a 3-million-year-old fossil whale bone from Tuscany, Italy. This is the first time the Osedax have been found in this region, and leads researchers to believe that the Osedax were widespread throughout the world's oceans millions of years ago.
According to Higgs, the Mediterranean dried up nearly six million years ago, and about half a million years later, it re-flooded from the Atlantic.
"So finding out that Osedax were feeding on this whale bone three million years ago tell us that their ancestors must have also been living in the Atlantic as well, because the Mediterranean was re-colonized 5.5 million years ago from the Atlantic. There are 20 different species in Monterey, California alone, so it's almost certain there are many more out there. If Osedax were living in the Mediterranean three million years ago, there's no reason why they aren't living there now."
This study
was published in
Historical Biology
University of Leeds
Science Daily
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Toolbox for IT
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Chris Brown Is In Jail, After Being Kicked Out Of Rehab
Chris Brown went to jail yesterday because he violated a judge's orders. Breezy has been living in a rehab facility for 4 months for anger management therapy. 90 days were for anger anger the remainder was until a verdict was reached in the Washington D.C. assault case. The judge told him, if he left rehab his next stop was jail.
Well the singer didn't leave at his own will, he was actually kicked out for violating "internal rules." There is no concrete on what he did exactly BUT we do know that it had nothing to do with violence or drugs. Chris was previously thrown out of a different facility for throwing a rock at his mom's car window.
Earlier this month Chris allegedly had an innapropriate relationship with one of the workers, but that isn't the reason he got kicked out of the facility. But it could be the reason why Karrueche kicked him to the curb hmmmm Story develoing.....


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text: Cast Pikachu as Amy Kirby as Cream or Cosmo Jigglypuff as Sonic or Knuckles Zero Suit Samus as Tails Samus as Knuckles or Sonic and more Retrieved from "http://scratchpad.wikia.com/wiki/Super_Smash_Bros._Brawl/Amy_Rose?oldid=2106260" Ad blocker interference detected! Wikia is a free-to-use site that makes money from advertising. We have a modified experience for viewers using ad blockers Wikia is not accessible if you've made further modifications. Remove the custom ad blocker rule(s) and the page will load as expected. Categories: Super Smash Bros. Brawl Super Smash Bros. Brawl Parodies Amy Rose Amy Rose Parodies