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1Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts, MA 02118-2526, USA
2Boston University Schools of Medicine and Public Health, 715 Albany Street, Boston, Massachusetts, MA 02118-2526, USA
Correspondence to: A Moreno, Boston University School of Public Health, 715 Albany Street, Talbot Bldg. T3W, Boston, Massachusetts, MA 02118-2526, USA
Background: Refugees and asylum seekers continue to enter the United States and the European Union in record numbers. Some have estimated that between 5-35% of all refugees have suffered torture in their countries of origin. Although general practitioners and specialized physicians are likely to encounter victims of torture as patients, few providers are familiar with the health problems that may affect this patient population.
Purpose: To provide neurologists, neurosurgeons, and rehabilitation medicine physicians with basic knowledge about survivors of torture that can help in the diagnosis, treatment, and referral of such patients.
Methods: A MEDLINE (1966-October 2001) search using keywords torture and sequelae (nervous system diseases and brain injuries) was conducted. Other data sources included books, reference lists, online resources and expert opinion.
Findings: Forms of torture that may affect the nervous system include beatings, gunshot wounds, stab wounds, asphyxiation, prolonged suspension and electrocution. Victims of torture commonly experience neurological symptoms such as headaches, vertigo, loss of consciousness and dizziness during and after torture. A successful and meaningful clinical interaction with a survivor of torture includes avoiding retraumatization, building trust, spelling out any limits on confidentiality, and above anything else, establishing empathy with the patient.
Conclusions: Neurological sequelae of torture can be devastating physically and psychologically. The treatment of these neurological conditions does not differ from other patient populations. However, the clinical approach is unique and must focus on avoiding retraumatization and helping the victim reintegrate into society as quickly as possible.
Spinal Cord (2002) 40, 213-223 DOI: 10.1038/sj/sc/3101284
torture; refugee; human rights; neurological sequelae
Torture, `the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason,'1 continues to be practiced systematically in more than 120 countries.2
In this article, we review the epidemiology and classification of torture, its forms and neurological sequelae. The article also addresses the clinical approach to survivors of torture with permanent neurological sequelae. The goal of the article is to provide neurologists, neurosurgeons and rehabilitation medicine physicians with some basic knowledge about survivors of torture that can help in the diagnosis, treatment and referral of such patients.
Over the past 30 years, the number of refugees (Defined by the United Nations Conference of Plenipotentiaries on the Status of Refugees and Stateless Persons as `any person who, owing to a well founded fear of being persecuted for reasons of race, religion, nationality, or membership of a particular social group or political opinion, is outside the country of his nationality and is unable, or owing to such fear, is unwilling to avail himself to the protection of that country.') and asylum seekers (A person who asks for a refugee status after entering a host country) has increased rapidly. The United Nations (UN) estimates that there are some 13 million refugees and asylum seekers, although the number may be as high as 50 million if we consider all those who were forcefully displaced from their places of residence.3
Despite an increasing anti-immigrant sentiment in the United States and in the European Union, refugees and asylum seekers continue to enter these countries in record numbers.4 For instance, the United States and the United Kingdom received during the 1990s over 1.5 million refugees and asylum seekers, most of whom came from the former Yugoslavia, the former Soviet Union, the Middle East, and the Sub-Saharan region of Africa.5 In 2000 alone, the United States received 72 000 refugees and 91 000 asylum seekers.6 Once inside a host country, this population tends to resettle in large coastal urban centers with few exceptions, such as Chicago and the Twin Cities area in the United States.7
Certain subgroups of refugees and asylum seekers have a higher risk of suffering torture and its psychological sequelae. Barker estimates that between 5-35% of all refugees have suffered torture in their countries of origin.8 Although women and minors compromise more than two-thirds of the refugee population, the likelihood of becoming a victim of torture is similar for both women and men.6,9,10 Women, nonetheless, are more likely to suffer sexual torture than men.11 Table 1 summarizes the risk factors for torture and its psychological sequelae.12,13
Compared to other immigrant groups, refugees and asylum seekers have higher morbidity and mortality rates. Prevalent illnesses include conditions such as hepatitis B, tuberculosis, intestinal parasites, posttraumatic stress disorder (PTSD), depression, and anxiety.14,15,16 The prevalence of some of these conditions is even higher in tortured refugees than in non-tortured refugees. For instance, the prevalence of PTSD in the general population is around 1%, in non-tortured refugees who experienced battlefield conditions is 20% and in tortured refugees is as high as 67%.17,18 Leading causes of death include malnutrition and infectious diseases, such as gastroenteritis.14,15,16
General practitioners and specialized physicians are likely to encounter refugees and asylum seekers as patients. Two different surveys found that 5-10% of all foreign-born patients seen in general medical settings had suffered torture in their country of origin. Unfortunately, few providers are familiar with the health problems refugees and survivors of torture may suffer.19,20,21,22 Lack of awareness and training are likely to affect such patients in a direct way. Physicians may misdiagnose certain conditions, particularly those with culture-related symptoms, thus failing to treat properly. More important is the fact that physicians who lack training or awareness may re-traumatize a survivor of torture during a clinical encounter.23
Classification and forms of torture
For a perpetrator, torture serves two goals. The first objective is to break down an individual physically and mentally. The second objective is to spread fear throughout the community in which the individual resides.24 An implicit aim of those who carry out such acts is to avoid leaving permanent physical marks or to make them as subtle as possible.25 Several techniques exist to minimize the appearance of permanent physical sequelae, for instance, using blunt instruments or protecting the skin with clothing during beatings.24 Perpetrators also inflict the physical torture during the initial stages of the detention, allowing time for ecchymosis, soft tissue edema and other transient physical findings to fade away.
Torture can be classified as physical, mental and sexual. However, it is important to highlight that such classification is an artificial one and only serves the purpose of explaining the nature and extent of torture. In most cases, victims experience all three forms of torture during a single event. Table 2 summarizes some of the most common forms of torture.26,27,28,29,30,31,32,33,34
Torture affects both central and peripheral nervous systems. Blunt trauma, in particular beatings, is the most common form of physical torture.27,29,30,35,36,37 Beatings and crushing injuries may produce intracranial bleeding, spinal cord hematomas, intracranial edema, cerebrospinal fluid fistulas and seizures. Reports of adult shaken syndrome from violent shaking exist in the literature, allegedly causing retinal and subdural hemorrhages and diffuse axonal injury.38,39 Bone fractures caused by blunt trauma may affect some peripheral nerves, such as the axillary and the radial nerves with humeral fractures. Figure 1 shows a spinal cord injury with syrinx formation at the level of T12-L1 after a wedged compression fracture of L1 vertebral body caused narrowing of the spinal canal. The patient was thrown out of a moving car after being chased by a rival ethnic militia. The neurological exam of the lower limbs revealed asymmetric motor weakness, affecting primarily the hip flexors and the ankle plantar flexors, and an increased Achilles tendon reflex.
Although less common than blunt trauma, penetrating injuries are particularly serious, as they tend to produce more permanent neurological damage. Gun shot wounds to the head or to the spinal cord may produce massive destruction of nerve tissue, leaving patients with a multiple array of conditions such as motor and sensory deficits, as well as cognitive and visual impairments.40 Stab wounds may sever peripheral nerves or the spinal cord. Figures 2 and 3 show a lateral view and an anteroposterior view of a skull film and a head CT scan of a political activist who received several gunshots to the head. The neurological exam revealed a mild right arm weakness, particularly on wrist extension, difficulties on fine finger movement, and a bitemporal hemianopia. Figure 4 shows a spinal cord injury at the level of T12-L1. The patient, an opposition activist, received two gunshot wounds in the abdomen, and after falling down he received a third gunshot to the back that severed his spinal cord. On physical exam, complete motor and sensory deficits were present below T11, as well as muscle atrophy and sphincter dysfunction. Figure 5 shows a right humeral fracture caused by a gunshot wound. The patient, a member of an ethnic minority, received the wound during a failed execution attempt, after which he has been experiencing a discrete right wrist extension weakness suggesting a radial nerve injury.
Of the different forms of torture, asphyxiation has the potential for always ending with the death of the victim. Regardless if it is carried out by preventing the victim from breathing by covering his or her face with a plastic bag, by submerging the victim's face in fluid, or by hanging the victim, perpetrators can easily go beyond the physical limits that a victim can tolerate without air. When suffocation is not fatal but the extent of the cerebral anoxia is severe, the victim may suffer loss of consciousness, seizures and incontinence. Chronically, victims may suffer from memory and cognitive impairments, or they may be left in a permanent vegetative state.41 Figure 6 shows a prisoner of war in a Nazi concentration camp during World War II who was asphyxiated during a high altitude experiment.
Several different devices may be used to deliver electric shocks during torture, including stunt guns, cattle prods, generators, and wires plugged directly to power outlets.39,42 In addition to burns, electric shocks may cause radiculopathies as a result of vertebral compression fractures that arise from violent muscle contractions, lethal cardiac arrhythmias from the disruption of the heart's electrical impulse, incontinence and tonic-clonic seizures.29,39,42
Victims of torture frequently report being restrained with handcuffs, shackles, wires or ropes. A significant number of them also reports being secluded inside small box-type cells that completely limit any physical mobility.35 Tight ropes, handcuffs and shackles may cause peripheral nerve damage with symptoms ranging from transient sensory deficits to permanent motor damage.37 Nerves that are particularly susceptible to compression include, but are not limited to, the median, the ulnar nerves and the tibial nerve. Radial nerve compression may also result from prolonged immobilization, as when victims of torture are forced to lay down on their side inside small box-type cells while having their hands tied on the back. Figure 7 shows the left ankle of a patient who was imprisoned and restrained with a shackle for months because of her ethnic background. The patient reported having dysesthesias on her left sole for some time. During her medical evaluation, the patient was symptom free and her neurological exam was negative.
Suspension causes nerve damage by one of two mechanisms. The first mechanism is direct mechanical compression of the nerve, which may occur when a victim is suspended by the wrists or by the ankles causing damage to either the median, the ulnar or the tibial nerve.39 The second mechanism of injury is axonal damage from forced traction.39 This mechanism occurs quite often when victims are suspended in a `Palestinian fashion', as shown in Figure 8, causing damage to the brachial plexus. Figure 9 shows a victim of torture with brachial plexus damage as demonstrated by the finding of a wing scapula.
Neurological sequelae of torture
The presence of neurological symptoms, physical findings, and diagnoses varies from study to study. There are three reasons that explain this discrepancy. Some studies look at the presence of acute neurological symptoms, findings, and diagnoses while others look at presence of the chronic ones.43,44 Studies analyze different subgroups of torture victims, a rather heterogeneous population because of its diverse geographical origins, cultural backgrounds and circumstances related to the torture trauma.29,44,45,46 Finally, overlapping symptoms such as headaches, dizziness, numbness and memory impairment are found in both neurological and psychological conditions, making difficult the diagnosis of conditions such as organic brain syndrome.30,47
Neurological symptoms are experienced frequently among survivors of torture. Tables 3 and 4 summarize the neurological symptoms and conditions torture survivors may experience. One study that looked retrospectively at the presence of neurological symptoms found 75% of the patients reported having at least one symptom during torture.29 The same study found that 64% of the patients continued experiencing at least one neurological symptom chronically. In another study, 86% of the patients complained of neurological symptoms during the medical evaluation.48
Headache is the most common neurological symptom reported by survivors of torture. In one survey conducted on detained political prisoners, 86% of the patients reported the presence of headaches.43 In another study, 54% of the patients recalled experiencing headaches during torture, and 64% of them complained about this symptom at the time of the interview.29 Mollica et al45 found in a study on functional health status of Cambodians living in refugee camps that 74% of study subjects reported having frequent headaches.
Other common neurological symptoms include vertigo, loss of consciousness and dizziness. The presence of vertigo ranges from 20% during torture to 3% during the medical evaluation.29,49 Loss of consciousness due to head trauma occurred in 19% of the cases and was due to reasons other than head trauma in 31%.29 Two other studies reported loss of consciousness due to beatings in 34% and 90% of the patients.50,51 Dizziness is found in up to 68% of torture victims.45
Most of the above neurological symptoms are present in victims who suffered head trauma. Overall, the incidence of head trauma during torture is high.30,39 Rasmussen reported that 73% of the study subjects endured beatings to the head. Another study conducted on prisoners of war in Croatia found 67% of the patients recalled experiencing blows to the head.52 A significant clinical correlation exists between closed head trauma and headaches, as well as between loss of consciousness due to head trauma and changes in visual evoked potentials.29,53
Less frequent neurological symptoms include paresthesias, paralysis of a limb, and seizures. Patients describe paresthesias more often in the upper limbs than in the lower. Overall, about 10% of torture victims reported such symptom.29 Paralysis of a limb was reported in less than 2% of the patients.45 The presence of seizures in torture victims, which is strongly related to electric shocks, ranges from 2.5% to 8%.29,43,45
Data about the presence or absence of neurological finding on physical examination is limited. A United States Navy study found that former prisoners of war were eight times more likely than non-prisoners of war to have clinical and/or laboratory findings consistent with peripheral nervous system disorders that fell within the International Classification of Diseases (ICD) codes 350 to 359, such as mononeuritis of the upper limb and mononeuritis multiplex.44 Rasmussen found that around 16% of the torture victims had abnormal neurological findings, of which decreased sensation was the most common one.29 In another study, 22% of the torture victims were found to have abnormal neurological findings on physical examination.48 In our experience at the Boston Center for Refugee Health and Human Rights, around 8% of the patients presented neurological findings on physical examination (Moreno A, Piwowarczyk L, and Grodin MA. unpublished data). Similar to Rasmussen's study, the most frequent neurological finding at the Boston Center for Refugee Health and Human Rights is sensory deficits.
Clinical approach to the survivor of torture with neurological sequelae
The basic steps towards a successful and meaningful clinical interaction with a survivor of torture include avoiding retraumatization, building trust, spelling out any limits on confidentiality, and above any other, establishing empathy with the patient. For most victims, torture is a shameful event that patients believe needs to be kept away from relatives and friends. Physicians often become the first person to whom the survivor confides his or her story. Physicians are in a key position to reopen bridges of trust between the patient and the community, which are essential for successful social reintegration.
Physicians should pay special attention to retraumatization, which may happen inadvertently, may affect relatives of the patient if they are present during the interview and the examination, or may affect the providers themselves, including the physicians.54,55 To avoid victim retraumatization, it is important to consider the following guidelines.12,31,55 Before seeing a survivor of torture, a physician should, if possible, learn about the patient's country conditions. Such preparation helps the physician not only to better understand the patient's problem, particularly the trauma history, and to avoid cultural misunderstandings, but also to show a genuine interest for the patient. The exam room where the medical interview takes place should not resemble a prison cell, should be free of curtains or folding screens and should have a comfortable room temperature.12,31,55
The physician should introduce him or herself and explain the purpose of the visit, whether it is for consultation, to establish regular care, or to conduct an asylum evaluation.12,31,55 The physician should give the patient a sense of control.12 For instance, the physician should allow the patient to terminate the interview or to stop the examination at any time. Rushing the patient or asking serial questions must be avoided since it resembles an interrogatory.
One of the most common mistakes physicians make with survivors of torture, thus a source for retraumatization, is failing to explain the interview, the examination or any diagnostic test that would be performed.12,55 For instance, pulling out a reflex hammer and tapping the victim without fully explaining the purpose of this action may trigger a flashback of past beatings. Similarly, an MRI scanner may resemble a box-type cell because of its tight space. The electrodes of an electroencephalogram machine may resemble the devices used to deliver electric shocks.
Not all survivors of torture are ready to reveal their trauma history during the first visit; nor it is necessary to do so. Physicians should remember that, in addition to building trust, patients sometimes need to come to terms with personal conflicts before being able to tell their story. Sometimes such conflicts include an inherent fear to physicians either because they are seen as government agents or because they were active or passive participants of the torture.43,56,57 Meanwhile, the most important thing a physician can do is to continue to show to the patient his or her support.
When interpreters are present, physicians should remember possible drawbacks.12,31,55,58 If the interpreter is a relative, the patient may not fully disclose the trauma for fear of hurting his or her relative, or the relative may not provide an accurate translation because he or she is ashamed of the actual trauma history. When the interpreter is a fellow national, issues of confidentiality become a problem. In addition, the patient may not fully trust the interpreter fearing he or she may be a government agent. Professional interpreters can be costly, may not always be available, or may fail to provide an accurate cultural translation. At no time, should children be used as interpreters for their parents or relatives. Even when the child is the patient and he or she speaks the language, physicians must request the presence of an interpreter for the parents.
Providers planning to conduct a written affidavit or consultation report as part of an asylum claim are encouraged to read the Instanbul Protocol in its entirety, which can be found at the website Physicians for Human Rights (www.phrusa.org/esearch/istanbul_protocol/index.html).
Teamwork is important not only for the success of the victim's treatment, but also to avoid vicarious traumatization. Team members may include nurses, physical therapists, social workers, psychotherapists, vocational therapists, as well as non-health professionals such as attorneys and schoolteachers. Because most victims of torture link with medical care only after a window of opportunity to prevent the appearance of permanent torture sequelae has passed, team efforts should be geared towards making the patient as functional as possible both at a physical and a psychological level. Permanent physical sequelae are a constant reminder of the trauma and a source for psychological distress.25
Neurological sequelae of torture can be devastating physically and psychologically. Victims of torture can be left with painful and permanent disabilities, such as chronic pain syndromes, organic brain syndrome, paraplegia, just to mention few of them. The treatment of these neurological conditions does not differ from other patient populations. However, the clinical approach is unique in order to avoid retraumatization and to help the victim reintegrate into society as quickly as possible.
As the number of survivors of torture continue to increase, physicians are more likely to encounter such patients in their clinical practices. Therefore, physicians should be alert when they care for foreign-born patients. Asking about torture should be part of the interview when caring for such patients and fears of addressing this subject should be set aside. If the physician fears not knowing what to do after asking the question of torture, several non-governmental organizations are ready to help. At Global Lawyers and Physicians (www.glphr.org), a worldwide directory of such organizations is available to anyone.
1 World Medical Association. Tokyo Declaration. Tokyo, Japan, 1975.
2 Amnesty International. 2001 Annual Report. Available at www.amnesty.org/ailib/aireport/index.html Accessed 12/01/01.
3 United Nations High Commissioner or Refugees. People in need of protection. In The State of the World's Refugees 1997-1998 - A Humanitarian Agenda Oxford, UK: Oxford University Press, 1998, pp 1-9.
4 United Nations High Commissioner for Refugees. Asylum in the Industrialized World. In The State of the World's Refugees-50 Years of Humanitarian Action Oxford, UK: Oxford University Press, 2000, pp 157-183.
5 United Nationals High Commissioner for Refugees. Annexes. In The State of the World's Refugees-50 Years of Humanitarian Action Oxford, UK: Oxford University Press, 2000, pp 301-307, 301-327.
6 United Nations High Commissioner for Refugees. Refugees by Numbers. 2001.
7 Limon L. Office of Refugee Resettlement, Department of Health and Human Services. 1997; Report to Congress. Available at www.acf.dhhs.gov/programs/orr/97arc-index.htm Accessed 12/01/01.
8 Baker R. Psychological consequences for tortured refugees seeking asylum and refugee status in Europe. In: Basoglu, M (ed) Torture and Its Consequences-Current Treatment Approaches Cambridge, UK: Cambridge University Press, 1992, pp 83-106.
9 Allotey P. Travelling with `excess baggage': Health problems of refugee women in Western Australia. Women Health 1998; 28: 63-81. MEDLINE
10 Fornazzari X, Freier M. Women as victims of torture. Acta Psychiatr Scand 1990; 82: 258-260.
11 Allodi F, Stiasny S. Women as torture victims. Can J Psych 1990; 35: 144-148.
12 Weinstein H, Dansky L, Iacopino V. Torture and war trauma survivors in primary care. Western J Med 1996; 165: 112-118.
13 Paker M, Paker O, Yuksel S. Psychological effects of torture: An empirical study of tortured and non-tortured non-political prisoners. In: Basoglu M (ed) Torture and Its Consequences-Current Treatment Approaches Cambridge, UK: Cambridge University Press, 1992, pp 72-82.
14 Ackerman L. Health problems of refugees. J Am Board Fam Prac 1997; 10: 337-348.
15 Gavagan T, Brodyaga L. Medical care for immigrants and refugees. Am Fam Phys. Available at www.aafp.org/afp/980301ap/gavagan.html Accessed 12/01/01.
16 Walker P, Jaranson J. Refugee and immigrant health care. Med Clin N Am 1999; 83: 1103-1119. MEDLINE
17 Westermeyer J, Williams M. Three categories of victimization among refugees in a psychiatric clinic. In: Jarason J, Popkin M (eds) Caring for Victims of Torture Washington, DC: American Psychiatric Press, 1998.
18 McNally R. Psychopathology of post-traumatic stress disorder: Boundaries of the syndrome. In: Basoglu M (ed) Torture and Its Consequences-Current Treatment Approaches Cambridge, UK: Cambridge University Press, 1992, pp 229-252.
19 Brenner J. Human rights education in public health graduate schools: 1996 survey. Health Hum Rights 1996; 2: 129-139. MEDLINE
20 Eisenmann D, Keller A, Kim G. Survivors of torture in a general medical setting. West J Med 2000; 172: 301-304. MEDLINE
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22 Rafuse J. `Dealing with a population you weren't quite prepared for'. J Can Med Assoc 1993; 148: 282-285.
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24 Piwowarczyk L, Moreno A, Grodin M. Health care of torture survivors. J Am Med Assoc 2000; 284: 539-541.
25 Moreno A, Grodin M. The not-so-silent marks of torture. J Am Med Assoc 2000; 284: 538-.
26 McIvor R, Turner S. Assessment and treatment approaches for survivors of torture. Br J Psych 1995; 166: 705-711.
27 Forrest D. The physical after-effects of torture. Foren Sci Intl 1995; 76: 77-84.
28 Petersen H, Rasmussen O. Medical appraisal of allegations of torture and the involvement of doctors in torture. Foren Sci Int 1992; 53: 97-116.
29 Rasmussen O. Medical aspects of torture. Danish Med Bull 1990; 37: (Supplement 1) 1-88. MEDLINE
30 Goldfeld A, Mollica R, Pesavento B, Stephen V. The physical and psychological sequelae of torture - symptomatology and diagnosis. J Am Med Assoc 1988; 259: 2725-2729.
31 Iacopino V, Ozkalipci O, Schlar C. Manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment-the Istanbul Protocol. 1999; Available at www.phrusa.org/research/istanbul_protocol/index.html Accessed 12/01/01.
32 Sommier FVP, Kastup M, Genefke IK. Psychological consequences of torture: current knowledge and evidence. In: Basoglu M (ed) Torture and its Consequences: Current Treatment Approaches Cambridge, UK: Cambridge University Press, 1992, pp 56-68.
33 Lunde I, Ortmann J. Prevalence and sequelae of sexual torture. Lancet 1990; 336: 289-291. MEDLINE
34 Swiss S et al. Violence against women during the Liberian civil conflict. J Am Med Assoc 1998; 279: 625-629.
35 Physicians for Human Rights Scope of torture and coercion of physicians to conceal evidence. In Torture in Turkey and its Unwilling Accomplices Boston, USA: Physicians for Human Rights, 1996, pp 53-152.
36 Petersen H, Wandall J. Evidence of physical torture in a series of children. Foren Sci Intl 1995; 75: 45-55.
37 Skylv G. Physical sequelae of torture. In: Basoglu M (ed) Torture and Its Consequences-Current Treatment Approaches Cambridge, UK: Cambridge University Press, 1992, pp 39-53.
38 Derrick P. Shaken adult syndrome. Am J Foren Med Pathol 1997; 18: 321-324.
39 Physicians for Human Rights: Physical evidence of torture-a health professional's guide to medical and psychological evaluations of torture. In Examining Asylum Seekers-A Health Professional's Guide to Medical and Psychological Evaluations of Torture Boston, USA: Physicians for Human Rights, 2001.
40 Petersen H, Vedel O. Assessment of evidence of human rights violations in Kashmir. Foren Sci Intl 1994; 68: 103-115.
41 Taylor T. Opening statement of the prosecution-December 9, 1946. In Annas GJ, Grodin M (eds) The Nazi Doctors and the Nuremberg Code Oxford, UK: Oxford University Press, 1992, pp 67-93.
42 Amnesty International-Fighting torture: an agenda for action. In Torture Worldwide-An Affront to Human Dignity New York, USA: Amnesty International, 2000, pp 87-115.
43 Riquelme H. The Practice of Medicine Under a Totalitarian Regime (Spanish). In Between Obedience and Opposition Caracas, Venezuela: Nueva Sociedad, 1995, pp 43-142.
44 Nice S et al. Long-term health outcomes and medical effects of torture among US Navy prisoners of war in Vietnam. J Am Med Assoc 1996; 276: 375-381.
45 Mollica R et al. The effect of trauma and confinement on functional health and mental health status of Cambodians in Thailand-Cambodia border camps. J Am Med Assoc 1993; 270: 581-586.
46 Thomsen A, Eriksen J, Smidt-Nielsen K. Chronic pain in torture survivors. Foren Sci Intl 2000; 108: 155-163.
47 MacDonald B, Mummery C, Heaney D. Health needs of asylum seekers and refugees: Head injury needs to be taken into consideration in survivors of torture. Br Med J 2001; 323: 230-.
48 Genefke I, Vesti P. Diagnosis of governmental torture. In: Jaranson J, Popkin M (eds) Caring for Victims of Torture Washington, DC: American Psychiatric Press, 1998, pp 43-60.
49 Randall G et al. Long-term physical and psychological sequelae of torture on 44 victims examined in the United States. In: Stover E, Nightingale E (eds) The Breaking of Bodies and Minds-Torture, Psychiatric Abuse and the Health Professionals New York, USA: WH Freeman and Company, 1985, pp 58-66.
50 Forrest D. Patterns of abuse in Sikh asylum-seekers. Lancet 1995; 345: 225-226. MEDLINE
51 Peel M. Effects on asylum seekers of ill treatment in Zaire. Br Med J 1996; 312: 293-294.
52 Begovac J et al. Health status of 1458 Croatian prisoners of war, 1991-1992. J Am Med Assoc 1993; 270: 574-575.
53 Vrca A et al. Visual evoked potentials in relation to factors of imprisonment in detention camps. Intl J Legal Med 1996; 109: 114-117.
54 Moreno A, Grodin M, Schadt R, Isasi R. Caring for survivors of torture and refugee trauma-An introductory internet-based course. Available at www.dcc2.bumc.bu.edu/refugees Accessed 12/01/01.
55 Physicians for Human Rights: General interview considerations. In Examining Asylum Seekers-A Health Professional's Guide to Medical and Psychological Evaluations of Torture Boston, USA: Physicians for Human Rights, 2001, pp 19-35.
56 Physicians for Human Rights: Coercion of physicians to falsify autopsy reports. In Torture in Turkey and Its Unwilling Accomplices Boston, USA: Physicians for Human Rights, 1996, pp 153-161.
57 Mozes-Kor E. The Mengele twins and human experimentation-A personal account. In: Annas G, Grodin M (eds) The Nazi Doctor and the Nuremberg Code-Human Rights in Human Experimentation Oxford, UK: Oxford University Press, 1992, pp 53-60.
58 Randall G, Lutz E. Approach to the patient. In Serving Survivors of Torture Washington, DC: American Association for the Advancement of Science, 1991, pp 55-70.
Figure 1 Spinal cord injury at the L1 level, arrows pointing to the syrinx formation and to the L1 wedged compression fracture
Figure 2 Lateral and anteroposterior views of a skull film showing multiple radiopaque objects consistent with bullets
Figure 3 Head CT scan showing a skull fracture and metallic artifact from a bullet
Figure 4 Lumbar spine MRI at T11 level, arrows pointing to the path left by a projectile and to an empty spinal canal
Figure 5 Diaphyseal fracture of the right humerus due to a gunshot wound
Figure 6 Prisoner of war in a Nazi concentration camp asphyxiated during a high altitude experiment (Courtesy of the US Holocaust Museum)
Figure 7 Shackle marks above the left ankle
Figure 8 `Palestinian' suspension and wires to deliver electric shocks (Courtesy of Physicians for Human Rights)
Figure 9 Wing scapula on a patient with brachial plexus injury (Courtesy of Physicians for Human Rights)
Table 1
Table 2 Common forms of torture
Table 3 Clinical symptoms
Table 4 Neurological conditions


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Contact Info / Websites
All 3 audio Reviews
Korn Here To Stay Instrumental
Rated 3 / 5 stars
Nicely done
Here to Stay is one hell of a song and I don't think anyone in the audio portal can do it justice, but your attempt was not half bad.
Harry Potter - Magical Moment
Rated 4.5 / 5 stars
A good piece! Perhaps I shall use it in a Leatherclothes Hagrid film. :)
Harry Potter Techno Remix
Rated 4.5 / 5 stars
Woah o.O
Besides the large file size, this is a fine remix!

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TJ Callaway / Onward Reserve
TJ Callaway is CEO of Onward Reserve. He is from Thomasville, GA, and attended the University of GA. TJ graduated in 2007 with a degree in Finance from the Terry College of Business.
Virginia Johnson / Onward Reserve
Creative Director
Virginia Johnson is the Creative Director at Onward Reserve. She graduated from North Georgia College in 2011 with a degree in Marketing and began working for Onward Reserve in 2012.


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Tips on Handling a Testate Westchester Estate
New York has a number of procedures in place that need to be followed when someone dies in order to settle their estate. The law is somewhat different depending on a number of circumstances, such as whether or not the person died with or without a will or what the size of the estate is. Whenever you have to deal with an estate, it is best to hire a Westchester estate attorney to make sure that you properly follow all necessary procedures in order to avoid problems in the future.
If there is a will, the will needs to be filed along with other paperwork to be given letters testamentary with the Surrogate's Court located in White Plains. This would normally be filed by the executor named in the will (unlike if there was no will left, where a person would apply to be made Administrator of the estate and be given Letters of Administration). Whether someone is applying for letters testamentary with or without a will, they will have to provide a death certificate to the court.
Once the letters are issued, the estate debts need to be paid off. There is a seven month period after the letters are issued for the specific purpose of allowing any debtors to come forward. The letters would allow the executor or the administrator to dispose of estate proceeds and to pay these bills. While it would be allowed to have the executor or administrator to release funds to beneficiaries during these seven months, those funds would have to be returned to the estate if a debtor should materialize during that time and there are no other funds in the estate to pay the debt. If the money cannot be recovered from the beneficiary, this can lead to significant problems for the executor, who may be personally liable for the estate's debts in that scenario.
After seven months have passed and the debtors have been paid, the estate is distributed to the named beneficiaries in the case of a will or to those allowed to collect under intestacy laws, usually close family members. After all assets have been distributed, the estate can be closed.
To learn more, read How Long Does It Take to Close an Estate in Westchester County.
If you are interested in hiring an attorney, call Westchester County, New York estate attorney Albert Gurevich, Esq. at (914) 293-2043.


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With their parents out of town, Victoria feels neglected and clings to Ellen, who urges her to enjoy her independence. The advice backfires when Victoria throws a wild party that ends with a burglary.
Add this episode to your queue to receive more information about
Home Alone and we will let you know when it becomes available.


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Monthly Archives: November 2016
30 November 2016
New Year, New You! 2017 Health Marketing for PT Practices
Once the holidays are over, our hearts and bellies are full with the past couple months of festivities. Mainstream media capitalizes on New Year's...
30 November 2016
4 Ways to Simplify Your Private Practice Marketing
Running your own business is more than a full time job. You are the owner, CEO, PT, admin, and marketing manager (just to name...
26 November 2016
The Best Tax Deduction For Your PT Practice
Have you planned out your PT practice's tax reduction strategy? Now is the time to start thinking about reducing your tax liability for this...
4 November 2016
What Does a Physical Therapist Do? How to Explain PT to Patients
One of the core components of any PT marketing strategy should be to educate prospective patients and referrers on what physical therapy is and...


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Deal: Nexus 6 32GB White Unlocked For $299.99
When the Nexus 6 was officially launched, it was quite different from most other Nexus devices before in the price factor, coming in at a full cost of at least $599 for the smaller storage size model. Now that the next Nexus phones are rumored to be launching soon, the Nexus 6 can be found at some pretty great prices. This deal on eBay for instance has the 32GB unlocked Cloud White model going for a full cost of $299. This is for a brand-new model nonetheless and not a refurbished model, making it that much better and since it's unlocked it can be used on virtually any GSM network.
The Nexus 6 sports a 5.96-inch AMOLED Quad-HD display, carries 32GB of internal storage, and it's powered by a 3220mAh battery and a Qualcomm Snapdragon 805 CPU with 3GB of RAM inside. It's got a 13MP rear facing camera while there's a 2MP camera up front for selfies and video chat, and it's currently running the latest version of Android which is 5.1 Lollipop, and it should swiftly be updated to Android 6.0 Marshmallow aft Google releases it in the near future. It also supports Qi wireless charging and Quick Charge 2.0 so you can charge it fast and without cables if you need to.
Nexus 6 32GB Unlocked-Cloud White For $299.99


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Wow, only a couple of days away from a new year, and a new decade.
Well, 2010 is one of my favorite sci-fi movies, and I think highly underrated. Released by MGM in 1984 (the first year of the Copper Age of . . . → Read More: 2010
Copyright © 2017 Very Fine / Near Mint - All Rights Reserved


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- Reel Reviews: 'Blade Runner' and 'Blade Runner 2049'
- Wool Frolic Sept. 16 at Landis Valley
- Bluetrain will kick off shindig season
- AJ's pop up mini golf fundraiser returns
- Another round! Ephrata Brewfest back for second year
- This summer, at the movies…
- Easter Egg Hunt List
- Irish dance showcase at Warwick High School
- Roots and Blues 2017
- Reel Reviews: 2017 Oscar picks
Savor Spring at Gus's Keystone Restaurant
At Gus's Keystone Family Restaurant in Ephrata, it's a springtime celebration of fresh flavors.
You'll love the light, refreshing salads, club sandwiches, luscious fruit pies and seasonal fresh filet of shad and shad roe. It's all here for you, at Gus's Keystone Family Restaurant in Ephrata.
Easter Sunday at Gus's promises to be quite the feast for the whole family. The Easter selections include baked sugarcured ham with pineapple raisin sauce, roast leg of lamb with mint, fresh roast turkey over filling, fresh roast beef over filling, prime rib au jus, baked stuffed chicken breast, filet mignon, surf and turf, and an ocean full of seafood dishes, from barramundi to salmon to scallops.
"There will also select items from the regular menu. Be sure to save room for dessert like mile-high coconut cream pie, carrot cake, cheesecake and fresh strawberry pie with whipped cream.
Hours for Easter dinner are 9 a.m. to 5 p.m., with breakfast served until 11 a.m. Reservations for dinner are a good idea, especially if you have a larger group.
Refreshing salads like grilled chicken berry salad bowl, strawberry salad with mixed greens and pecans, Greek salad with feta and olives, and California chicken Cobb salad are always popular. Sandwiches range from gourmet chicken salad on a croissant to seafood salad sandwiches to the turkey club panini. Entrees at Gus's include chicken Marsala, grilled ham steak with pineapple raisin sauce, chicken and biscuits, breaded veal cutlet with tomatoes and fettuccine Alfredo.
Gus's has a devoted following of customers who show up nearly every day for full breakfasts like multigrain pancakes, eggs Benedict, Belgian waffles with fruit topping and the Keystone omelet with ham, sausage, bacon, onions, mushrooms, green peppers and cheese. You can even have breakfast all day. Lunch specials change daily with five soups each day, such as chili, baked onion or corn chowder.
When you and your family come to Gus's Keystone Family Restaurant, you always feel welcomed by Gus's family, which includes Gus Kourgelis, his wife Eleni, daughters Lemonia (Lem) and Evangelia (Lia), and son-in-law Dino Papazekos. The Kourgelis family also has its original Gus's in Mount Joy.
"We always have a member of the family here," says Gus. That might be Gus, Eleni, Dino, Lem or Lia, or maybe everyone!
Located right across from K-Mart, at 3687 Rothsville Road, people come in for great breakfasts, tasty lunch and dinners, and the warm friendly greeting they always receive.
Hours at Gus's Keystone Family Restaurant are 6 a.m. to 8:30 p.m. daily. To find out more, call 738-7381 or check the website at www.guskeystone.com.
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Dittrick Museum of Medical History Begins New 'Conversations' Series
Eric Sandy
September 23, 2015 at 7:51 AM
Courtesy of Brandy Schillace
I'm looking at this massive cloth womb encased in glass, and it's sort of terrifying. It's a "woman machine," Brandy Schillace tells me, and it's based on a device William Smellie used in the 18th century to demonstrate birthing methods. Smellie's machine is something of a grail for those in the early obstetrics collection game.
"I spent two years, three continents and not a few scary basements looking for the damn thing," Schillace says. "I felt like Indiana Jones, except I came back with sand and that was it."
Smellie's original machine featured lifelike skin, muscle and tissue — all long before the advent of plastics. It even wore stockings. Petrus Camper, an 18th-century surgeon, famously insisted that he couldn't tell the difference between Smellie's machine and a real woman, despite the machine having no head.
That's the brand of off-kilter historical anecdote that Schillace specializes in. She's the public engagement fellow at the Dittrick Museum of Medical History, and she's been illuminating these lesser-known niches of our past for curious Northeast Ohio residents.
Schillace never found Smellie's machine, but she did track down the one on display at the museum now. This one belonged to a female midwife, who wrote a book about the birthing process, although most of her students couldn't read — hence the machine.
It's but one of the museum's 150,000 articles from all corners of the history of medicine. Large exhibits and wooden display cases bring the trial-and-error trajectory of surgical procedures to the average person, most of whom, like myself, have never stopped for a moment to ponder early 19th-century bloodletting protocol.
"You didn't really want to be sick in 1810," Schillace says, elaborating on photos of physicians draining copious amounts of blood from their patients. "They had a real misunderstanding of how much blood was in the human body."
A $400,000 endowment is supporting the museum's development of "How Medicine Became Modern: A Humanities Perspective," an interactive digital history exhibit that tracks how we got from there (using leeches as medical tools) to here (sterilized operating rooms). Everything on display at the museum reminds visitors of how far we've come and how medical practices, even today, are always a matter of refining the process.
The Dittrick Museum is a house of oddities — and an oddity in itself. Located in a nondescript building on the edge of Case Western Reserve University's campus (11000 Euclid Ave.), the museum functions as an study center of sorts. An ornate reading room has space for students to work quietly in the looming presence of primitive microscopes.
Still, it's almost too quiet around these parts. Sitting in the eastside shadow of the Cleveland Museum of Art, Dittrick pulls in only a trickle of visitors most days (outside of school field trips and the like). Schillace wants to change that.
Beginning this week, Schillace is hosting a series of conversations about science and history. She's inviting the public to get an even closer look at what the museum has to offer. The first talk — "Hard Labor: Birth in the 19th Century and Today" — takes place at 6 p.m. Sept. 24 on the museum's third floor. Register at
The series, as planned, runs every other month through August 2016 and features topics like vaccinations, PTSD and the evolution of medicine technology. If the public isn't already coming to the museum in droves, Schillace's idea is to take the museum to the public. (Future talks will take place elsewhere, like the Cleveland Museum of Natural History or MOCA.) She'll speak on a topic for 15 minutes or so before opening the room to general conversation — distinctly not a straight Q&A session, though there will be various experts on hand to keep the convo deep and broad.
"We're really inviting the public to come in and talk with us," Schillace says, distinguishing these events from more typical TED-style lectures.
There's plenty of fertile ground for conversations here; not only has the museum amassed an incredible collection of artifacts and exhibits, but Cleveland as a city is tied to 20th-century medical innovations. The defibrillator, for instance, was invented here. ("The only trick was, your chest had to actually be open for it to work," Schillace says.)
Through these event and the museum itself, Schillace is finding light-hearted ways to frame grand topics — like the evolution of contraception — in engaging and even humorous ways and connect Clevelanders more closely to the city's legacy and to the arc of human health.
To keep visitors on their toes, she often begins tours of the museum by asking: "What do crocodile dung, pomegranate and weasel testicles have in common?"
Turns out they're all ancient forms of contraception. (How anyone first discovered this sort of stuff is unclear.)
"The crocodile dung works — they would make suppositories of that and put it in the vagina as a contraception device," she explains. "I don't imagine it did much for your love life, though."
Such is the daily chit-chat at the Dittrick Museum, one place in Cleveland where it's impossible not to learn something new.
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Detectives investigating historical sex crimes should not be ordered to believe alleged victims "unconditionally", Britain's top police officer has said.
Sir Bernard Hogan-Howe said officers should investigate allegations with an "open mind" rather than follow the current policy of presuming claims to be true.
Suspects should also be offered anonymity before they are charged because "reputations may be tarnished" even before officers decide whether an allegation has merit, he added.
His comments came after he announced a judge-led review of Scotland Yard's controversial handling of claims of a VIP paedophile ring in Westminster amid mounting pressure over Operation Midland.
Writing in the Guardian, the Metropolitan Police commissioner said "public confidence has been affected" by the Met's handling of investigations into Lord Bramall and other high-profile figures.
The way officers investigate historical sex claims involving public figures would be part of the review, Sir Bernard added, suggesting a shake-up of policy to make it "more neutral".
He said a review of the Met's approach to rape cases showed the force's policy moved from, in 2002, accepting an allegation as "truthful" in the first instance to being in line with guidance from the HM Inspectorate of Constabulary in 2014 which stipulated the victim should always be believed.
Sir Bernard said: "The public should be clear that officers do not believe unconditionally what anyone tells them. They are listened to, sometimes at length, before the decision is made to begin an investigation.
"A good investigator would test the accuracy of the allegations and the evidence with an open mind, supporting the complainant through the process. This is a more neutral way to begin than saying we should believe victims, and better describes our impartial mindset.
"Emotionally, though, it may not be enough to give victims confidence in our approach."
But he admitted the change in approach created a tension that was "hard to reconcile".
The embattled Scotland Yard boss again refused on Wednesday to bow to calls to apologise to Lord Bramall, 93, amid fierce criticism over the conduct of Operation Midland, which saw police raid the home of the former D-Day veteran.
The case against Lord Bramall was later dropped.
The findings of the review, to be led by former High Court judge Sir Richard Henriques, will be published later in the year, although the full report will remain confidential.
But it has been dismissed as a "PR campaign" by former Conservative MP Harvey Proctor, who was questioned under the controversial inquiry before facing no further action.
Operation Midland, which had cost £1.8 million as of November last year, centred on allegations by a man known as "Nick", which were described by a detective at the time as "credible and true".


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NYFW | Street Style Recap
Hey Guys! I'm so excited you loved the last post about NYFW & my workout routine. I'm really focused on health these days and judging by the feedback it makes me really happy you are as well. I will continue to post more about this topic since it's one of the questions I get asked the most….Read more
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Lacoste | Made For Her Campaign
"No One is You and That is Your Power." -Dave Grohl
Hey Guys! The quote above is by the famous musician and producer Dave Grohl, and is one I personally love. I've always believed that your true power comes from the fact that there is only ONE you….Read more
NYFW SS18 Day 1 & The Secret To My Abs
Hey Guys! NYFW is officially over and what a week it has been. Adrian and I literally got home on Tuesday night (9/5) from Greece and I went straight into NYFW stuff on Wednesday. The jet lag was real. I lost my voice from speaking so much as well..LOL!…Read more
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What to See, Eat and Do in Ibiza, Spain
"Sometimes you find yourself in the middle of nowhere, and sometimes in the middle of nowhere you find yourself."
Hey Guys! This summer has been so amazing and even though we typically travel every summer to Europe, we don't typically visit 3 different countries….Read more
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Pop Of Yellow | How to Wear This Season's IT Color
Hey Guys! Hope you are having a great week. Yellow is the season's IT color and will still remain a strong color into the Fall. You've probably seen me wearing pops of yellow (here and here) and in St….Read more


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Day #15: Who are your book blogging mentors?
Any blog that I read, I keep an eye out for what I like and don't like – and if I like something, I see how I can implement that aspect on my own blog. However, I will say that I love Chuck Wendig's advice on blogging and writing in general.
And this concludes the 15 Day Book Blogger Challenge!
This almost makes me want to create my own blogging challenge. Would you sign up for it?


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A post after a very long time… These days have been trying my hand at making sculptures. This is the bust of a tribal leader of the Karo tribe in Africa. The bust is about 12cms tall
Category Archives: tangy thoughts
A beautiful home
What would your house look like if you had an unlimited budget to set it up? Here is a peek to how I would love it to be
Fly you fools
The fall of Gandalf in the mines of Moria
my contribution to The Lord of the Rings 😀
Piano man
its sad and its sweet and he knew it complete!
Leather Tote Bag
I love myself a tote, they are spacious and look very chic. So I tried to go out of my realm and sew my own.
Bohemian Summer Sandals
Tassels to me scream summer and everything fun! Bring on you A game this summer with these vibrant bohemian sandals that will liven up any outfit!
Globe clay cow
If getting your hands dirty does not scare you one single bit, then try making this groovy little cow. This little thing is so groovy that you can jive with it later.
Just follow the instructions to make your own globe cow. I used red terracotta clay to make it, but you can use any clay to make the same. I have also given specific instructions if you are planing to use terracotta. Lets start!
Thrift home shopping in Delhi
Delhi is a shoppers haven, there are enough choice here to suit everyones pocket. A walk along the streets and flea markets of Delhi can give you many home decor options even within a tight budget. From the streets of Old Delhi to refurbished vintage furniture in Amar Colony be ready to be blow away by the options Delhi can offer. Here is my list of places to visit in Delhi for home decor shopping
Vintage furniture shopping in Amar colony
Hidden away within the alleyways of Amar Colony this quaint market place is full of vendors selling refurbished, colonial vintage wooden furniture. This market is a visual treat and here you can find beautifully carved wooden trays, glass and tile inlayed dressers or polished/painted side racks. From bookshelves, cabinets, chairs, dining tables, lampshades, stools to rocking chairs they have everything to offer.
Pro tip: Do not forget your bargaining skills while here, as discounts are based on your haggling powers.
Hand Dyed Rainbow Tassel Scarf
Who would not like a nice funky rainbow scarf with a pastel dress on a hot summer day. I have created one of my one and shared the procedure with you.
Cement Vase
I feel extremely joyful when I create things on my own. This time I wanted to experiment with cement. I created a vase with it using an old plastic bottle. Though I did go wrong at places, the end result came out beautifully. Here is a DIY explaining my process, and the places where I went wrong.


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Graphicool1 15:52 11 Aug 2010
I've never used Windows Washer but most of those sort of software programmes list all your drives. Asking you to tick or untick the ones you want it to clean or not. Make sure your external drive is switched on before you open Windows Washer. If it's switched off it won't be able to see it.


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Both will be appearing with Generation Gallery from 12-3pm on stand A245. Getting There The Ideal Home Show 2017 will take place at Olympia London for the third year since moving back to its original home! Plan your journey […]Read More
This Saturday 25th March, 12-3pm Kealey Farmer will be with Generation Gallery on stand A425! There will be a selection of new limited edition prints from 'Universal Language of Love' to be exhibited at the show. Please follow and like […]Read More
The Iconic British Home Show will be returning to Olympia London from 18th March- 3rd April this year.10am-6pm Daily. (Thursdays until 9pm) 'Bursting with inspiration' the show returns with everything you need to create the perfect home. JJ Adams will […]Read More


text: I know there are a few Battle Beast figure fans here (i've PM'ed back and forth with some) so i'm passing along the word.. Last month we were discussing the early teaser image release of this line in the Battle Beasts thread on Hisstank ( a GI JOE forum) and now it looks to be a full blown line! Rise of the Beasts - Series 1 by Jon Karis — Kickstarter An exclusive gold armored lion figure has been added as a free bonus for pledges above a certain level! : Rise of the Beasts - Series 1 by Jon Karis » Updates — Kickstarter As a fan of M.U.S.C.L.E.S. and Battle Beasts (not to mention owning Masters of The Universe product both vintage and MOTUC) this is everything i love wrapped in one package I'm all over these so i figured some of the old school fans of MUSCLES and Battle Beast would want to know ! Plastic !magination company Facebook Page: http://www.facebook.com/pages/Plastic-magination/308160545907228


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Allow US to introduce you to OUR community..
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We can sell you any property for sale in the Southeast Texas area, regardless of who the listing agent is. Use this website to search all listed Homes and Properties for sale in the Southeast Texas area.
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If you are a seller, we can help price and put your Southeast Texas home or property on the market for a quick sale. If you'd like to find out the value of your Southeast Texas home or property, go to my "Your Home Value" page and submit a CMA request. We will research the value of your home or property for you. This is a free service provided by The Autumn Morrell Team of RE/MAX ONE.
This site is designed to help you make the important decisions needed to purchase or sell real estate, homes, or property in Southeast Texas. Bookmark it for future reference and feel free to call or e-mail us for all of your real estate needs.
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- green eco solutions gutter magican fraud allentown, Pennsylvania
- Green Eco Solutions They use the hard-sell because if you found out how much you were being ripped off, you would go crazy Allentown PA
- ECO PEST SOLUTIONS Misrepresentation of Services Allen, Texas
- Eco Plus Solutions Sent a container of toner that was not ordered. Mercier Quebec
- Green Culture Eco-Furniture, Lake Forest, CA **BUYER BEWARE** Green Culture Managment, Sales Practice and Product Delivery Lake Forest, California
- MGR Solutions Scammers, Liars, and a bunch of THIEVES! Houston, Texas
- Green Eco Solutions Allentown Window Pro's * hazardous * mold due to poor window installation Allentown, Pennsylvania
- Consumer Funding Solutions or Diverse Payment Solutions ARE SCAMMERS!!! BEWARE OF FRAUD AND BEING RIPPED OFF Suitland Maryland
- AES Modules Automotive Electronic Solutions National Parts Scammers and Liars. Beware of this company...... Jacksonville, Florida
- Eco Green DryCleaners Harvey Kleinman Refusal to refund deposit of $5000.00 as per contract BOCA RATON, Florida
- Beware fraud - Sunny Grace Human Hair -Scammers sunny grace human hair sunny sun natural human hairsunny grace wigs sunny hair review Do not deal with this company they are robbers and thieves of hair factory in china Qingdao Qingdao
- Report: #1053672
Green Eco Solutions
Green Eco Solutions1740 Lynnwood Rd,Allentown, PA 18103 Whitehaven, Pennsylvania USA
Green Eco Solutions beware of this scammers and thieves Whitehaven Pennsylvania
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All business will get complaints. How those businesses take care of those complaints is what separates good businesses from the rest.
Consumers love to do business with someone that can admit mistakes and state how they made improvements.
Corporate Advocacy Business Remediation and Customer Satisfaction Program.
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This report was posted on Ripoff Report on 05/24/2013 03:55 PM and is a permanent record located here: http://www.ripoffreport.com/reports/green-eco-solutions/whitehaven-pennsylvania-18661/green-eco-solutions-beware-of-this-scammers-and-thieves-whitehaven-pennsylvania-1053672. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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Hidalgo Falls Festival
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Casual Watches for Women in Philippines
It is very stylish to look at a lady who can pull off a simple dress, or shirt and jeans and still look modest and elegant with just a piece of ladies' accessories like a simple watch. No matter how simple your clothes are, it is very easy to look classy with trendy casual watches to put an accent to the laid-back style of your clothes. There are lots of simple yet fashionable timepiece available in the Philippine market, and picking your own can be based on the material, brand, and style of your choice.
Quality Watches for Women
Picking a watch depending on the movement, whether Japan or Quartz can be a major factor, but is definitely not a problem, as there are different brands which offer these units. The face, whether analog or digital will be a lot easy as the preference will only depend on the use. The water and shock resistance is also a big factor in selecting the perfect unit which will fit the lifestyle and fashion sense.
Watches are very versatile accessories and you can definitely alternate them from day to day, so you can opt to have one for your casual look and another one for formal gatherings. So what are you waiting for? Avail of the best casual timepiece from the product listing of the leading online shop and have the items delivered right at your doorstep.
- Strap Materials: The casual watches are available in different straps like silicon, leather, stainless steel, and rubber
- Type: These watches are available in digital, analog, or combination
- Uses: This kind of watch is easy to match with whatever type of get-up you have.
- Brands: There are several brands that offer casual watches for women namely Casio, Bluelans, Geneva, and Seiko
Casual Watches
- Strap Materials: The ladies' fashion watches are available in different straps like leather, and stainless steel
- Type: These units are usually analog type of ladies watches
- Uses: This kind of watch is easy to match with smart casual dress or casual shirt and pants
- Brands: There are several brands that offer fashionable watches for women: Michael Kors, Geneva, Guess, and Marc Jacobs


text: Dr. Samy obtained her medical and doctor's degree from the University of Munich in Germany. Since 1995, she held several positions of increasing responsibility in the pharmaceutical and biotech industry, particularly in the field of vaccines and cancer immunotherapy. Starting her career at SmithKline Beecham, she later worked at Bavarian Nordic, Berna Biotech and Micromet before joining Bavarian Nordic again in 2007, where she is now responsible for clinical development of the Company's infectious disease programs. Dr. Samy has long-standing experience in building up and leading clinical departments, and in the strategic planning and worldwide execution of clinical development programs, ranging from Phase I to licensure.


text: Civitanova Marche to Udine trains might be a good value for money solution; travelling in Italy by train is often rather cheap and faster than taking a bus indeed. You can count on 17 daily rides to get from Civitanova Marche to Udine. Trains leave from Civitanova Marche-Montegranaro and arrive at Udine every 60 minutes on average. If travelling with Trenitalia, you need to know the Civitanova Marche to Udine train schedule: the first train leaves at 05:30, while the last ride is at 17:38. A Civitanova Marche to Udine train cost about 47.0 €. But how long is the train ride from Civitanova Marche to Udine? Your journey takes about 7 hours on average. Thanks to Trenitalia offers, you can save on your trip from Civitanova Marche to Udine and find prices starting from 45 €!


text: biosimulation definition October 15, 2017 AZ Dictionary Link to this page noun: The computer simulation of a biological system Related Sources Definition for "biosimulation" The computer simulation of a biological system View More Sentence for "biosimulation" "Our biosimulation platforms and insightful 'what… View More How would you define biosimulation? All the definitions on AZdictionary were written by people just like you. Now's your chance to add your own! Your Full Name Your definition Post Definition


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Howard Beach, New York
$749,0003 Beds2 BathsActive
$749,0003 Beds2 BathsActive
Howard Beach, New York 11414 - This Lovely Dwelling Is Triple Mint Condition! 2 Story Home Features 3 Beds/2 Baths, Located In Rockwood Park! All In Excellent Condition, Modern Kitchen, Ss Appliances, New Windows, Electric And Pluming. Lg Semi Ground Pool 18X24, Powerful Central Heat And Ac. Lg Pvt, Spacious Private Yard.
Listing Courtesy of Winzone Realty Inc


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fry(redirected from frying)
Also found in: Dictionary, Thesaurus, Medical, Encyclopedia, Wikipedia.
Related to frying: Deep frying, Stir frying
have other fish to fry
To have more important or more interesting things to do or attend to. I hope the boss keeps this meeting short—we all have other fish to fry.
bigger fish to fry
More important matters to deal with. I can't worry about that now, I've got bigger fish to fry! I want Chris to help me with this project, but he claims he has bigger fish to fry right now.
fish to fry
Matters to deal with. Often used in the phrases "bigger fish to fry" or "other fish to fry." I can't deal with this right now, I've got other fish to fry! Susie did bring me the latest report, but I've got bigger fish to fry at the moment.
fry the fat out of
To get money out of someone through violence and/or extortion. If you don't pay up, I'll have my men fry the fat out of you, don't you worry. It's time to fry the fat out of you, Stan, because I always get my money, one way or another.
have bigger fish to fry
To have more important or more interesting things to do or attend to. It's really not worth my time; I've got bigger fish to fry! I want Chris to help me with this project, but he claims he has bigger fish to fry right now.
fry something up
to cook something by frying. Let's fry some chicken up for dinner. We fried up some chicken.
Go chase yourself!and Go climb a tree!; Go fly a kite!; Go jump in the lake!
Inf. Go away and stop bothering me! Bob: Get out of here. Bill! You're driving mecrazy! Go chase yourself'. Bill: What did I do to you? Bob: You're just in the way. Bill: Dad, can I have ten bucks? Father: Go climb a tree! Fred: Stop pestering me, John. Go jump in the lake! John: What did I do? Bob: Well, Bill, don't you owe me some money? Bill: Go fly a kite!
See also: chase
Go fry an egg!
Go away and stop bothering me! Go away and stop bothering me. Go fry an egg! Get out of my way! Go fry an egg!
See also: fry
have bigger fish to fryand have other fish to fry; have more important fish to fry
Fig. to have other things to do; to have more important things to do. I can't take time for your problem. I have other fish to fry. I won't waste time on your question. I have bigger fish to fry.
language that would fry bacon
Rur. profanity; swearing; curse words. ("Hot" language.) He carried on in language that would fry bacon. I was shocked when I heard that sweet little girl use language that would fry bacon.
*out of the frying pan (and) into the fire
Fig. from a bad situation to a worse situation. (*Typically: get ~; go ~; jump ~.) When I tried to argue about my fine for a traffic violation, the judge charged me with contempt of court. I really went out of the frying pan into the fire. I got deeply in debt. Then I really got out of the frying pan into the fire when I lost my job.
small fry
1. Lit. newly hatched fish; small, juvenile fish. The catch was bad today. Nothing but small fry.
2. Fig. unimportant people. The police have only caught the small fry. The leader of the gang is still free. You people are just small fry! I want to talk to the boss.
3. Fig. children. Peter's taking the small fry to the zoo. We should take the small fry to the pantomime.
other fish to fry
Also, better or bigger fish to fry . More important matters to attend to, as in They asked me to help with the decorations, but I have other fish to fry. [Mid-1500s]
out of the frying pan into the fire
From a bad situation to one that is much worse. For example, After Karen quit the first law firm she went to one with even longer hours-out of the frying pan into the fire . This expression, a proverb in many languages, was first recorded in English in 1528.
small fry
1. Young children, as in This show is not suitable for small fry.
2. Persons of little importance or influence, as in She wasn't about to invite the Washington small fry to the reception. Both usages allude to fry in the sense of "young or small fish." [Late 1800s]
stew in one's own juice
Suffer the consequences of one's actions, as in He's run into debt again, but this time we're leaving him to stew in his own juice. This metaphoric term alludes to cooking something in its own liquid. Versions of it, such as fry in one's own grease, date from Chaucer's time, but the present term dates from the second half of the 1800s.
have other fish to fryor
have bigger fish to fry
If you have other fish to fry or have bigger fish to fry, you have something more important, interesting, or profitable to do. I didn't pursue it in detail because I'm afraid I had other fish to fry at the time. She tried to avoid wasting time on bureaucratic squabbling. She had bigger fish to fry. Note: This phrase is often varied. For example, if someone has their own fish to fry, they are not interested in doing something because they have business of their own to deal with. Tony comes and goes. He's got his own fish to fry, as they say.
out of the frying pan into the fireor
from the frying pan into the fire
If someone has gone out of the frying pan into the fire or from the frying pan into the fire, they have moved from a bad situation to an even worse one. I was hoping to get my career back on track after a bad time at Villa. But as it turned out, I'd gone out of the frying pan into the fire. Having finally left one bad relationship, she jumped from the frying pan into the fire.
fry up
To prepare or make something by frying: I'll fry up some pancakes for breakfast. They fried some bacon up for the sandwiches.
1. in. to die in the electric chair. (Underworld.) The DA is determined that you will fry.
2. tv. to execute someone in the electric chair. (Underworld.) They're gonna fry you for this.
Go chase yourself!and Go chase your tail! and Go climb a tree! and Go fly a kite! and Go fry an egg! and Go jump in the lake! and Go soak your head! and Go soak yourself!
exclam. Beat it!; Go away! Oh, go chase yourself! Go soak your head! You're a pain in the neck.
See also: chase
Go fry an egg!verb
See also: fry
small fry
1. n. anything or anyone small or unimportant. (Fry are juvenile fish.) Don't worry about the small fry. You have to please the fat-cats.
2. n. small children. The small fries have eaten and are getting ready for bed.
other fish to fryInformal
Other matters to attend to: He declined to come along to the movie, saying he had other fish to fry.
better fish to fry
More important things to do. This way of saying that you don't want to waste your time with something (or someone) goes back to 17th-century England. Its French equivalent is "other dogs to whip." Variations are "other fish to fry" and "better fish to fry."


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Mobile Expert Interviews: SAP's Brent Cohler
SAP's mobile security strategy has continued to evolve and today they are focusing on a cloud based mobile security solution that has been extended by partner products and capabilities. In this interview SAP's mobile security expert Brent Cohler updates us on their latest strategies from CTIA. Enjoy!


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Have you had a reading and you just didn't feel it resonated with you? Did you feel like it didn't make sense to you? Did you feel like it didn't answer the question that you wanted to be answered? If so, there are a few reasons why this may have happened. Knowing some of the reasons below, will help you to understand the message that was given, so that you can resonate with it.
- Expectations- You might be expecting to hear what "you want to hear." This happens when the information is different than what you think it is and what is revealed doesn't connect with your thinking.
- Lessons- An answer may not be giving or revealed during a reading because it is a lesson that you need to uncover yourself. Also, sometimes the information is not meant to be revealed, due to timing of the lesson or divine timing.
- Futuristic Information– Many times, I give clients information that will happen in the future and this information does not make sense at that point in their lives.
- Not Being Open to the Message– Sometimes a person is not open to the message that is being given. This happens when they are closed or blocked to the information that is provided. The person listens to the information, but does not "hear" the information.
- Information that You Need to Hear– The Universe gives you information that you need to hear and not what you want to hear. When this happens, the Universe steps in to help guide you in other areas that might help you now. Remember, they can see a bird's eye view of what is up ahead and helping you on that path.
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Terri is a lifelong learner of the metaphysical arts and has earned certificates from Centre of Excellence for Life Coaching, Crystal Healing Therapy, and Numerology. The Psychic Senses and The Voice of Spirit in Evidential Mediumship. As well as, the Morris Pratt Institute that include Mediumship, Healing, and Ministry. In addition, she is an Ordained Minister. She continues to grow and develop her intuition, as well as, her clairaudient, clairsentient, and automatic writing skills. Terri enjoys sharing what she has learned with others, so they too, can forge their own spiritual path.
Latest posts by Terri (see all)
- Support of Friends - October 20, 2017
- Manifesting with Feeling - October 14, 2017
- Cleaning Clutter - October 6, 2017


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Update: mug shot of second murder suspect, Artavius Underwood.
Artavius Underwood, 16, of Birmingham, Alabama. Five Capital Murder warrants with no bond have been obtained against the suspect. A Robbery 1st degree warrant with a $250,000.00 bond on an unrelated case has been obtained against the suspect.
Suspect is being held at the Jefferson County Jail.


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Pros and Cons of Swimming Pools For a Custom Homeby Kuhrich on Monday, July 15, 2013
If you're thinking of building a custom house, one thing you're probably considering is whether to add in a swimming pool. You dream of hot summer days spent lounging by the pool, swimming with friends and family and all the fun you can have with a swimming pool. But, is a swimming pool really a great idea for your custom home?
Here are some pros and cons of having a swimming pool:
– Expense: On the pro side, having a swimming pool built does add to the value of the finished property. On the con side, however, it rarely adds enough value to justify the cost of construction and there are additional expenses such as water filtration systems, chemicals and other expenses associated with a pool.
– Maintenance: On the pro side, a well-maintained pool is fun, especially if you enjoy swimming and live in an area that is consistently hot such as Florida or the West. On the con side, you do have continuing expenses such as chemicals and having someone clean it if you don't take the time and effort to do it yourself.
– Accessories: Part of the fun factor for a pool is the stuff you use around it and in it. From lounge chairs to pool toys, all adds to the fun you can have with friends and family with a pool. The pros are the fun, the cons are the expenses.
– Liability: One aspect of pool ownership deals with responsibility. If you have a family, especially small kids, you have to be well aware of the liability factors of owning a pool. Also, if you have a diving board, this adds to the liability factor as well. Injuries do happen, but these are factors that also add immense levels of enjoyment to owning and using a pool as well.
Essentially what it comes down to is carefully balancing the fun and enjoyment you can have with a pool versus the expenses and liabilities that having a swimming pool added to your custom home will imply. Owning a pool can be a hassle, but it can add levels of enjoyment to your life that you've always wanted.


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Become a certified data scientist and learn various data analytics techniques using platforms like R, SAS and Excel. Certified Data Scientist Certification offers the in-depth knowledge on the data visualization, data exploration, descriptive analytics techniques and predictive analytics. The data scientist certification is recommended for experienced professionals as well as beginners looking to use R, SAS and Excel for data analytics.
To know more about the features of this training, please visit https://www.msystraining.com/big-data-and-analytics/certified-data-scientist-certification-r-sas-exc...
For further queries, call us on: +1-408 878 3096.
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Terms of Use, including your
rights to materials on this website, the rights you grant to your submissions to this website, and your responsibilities regarding your conduct on this website.
The Privacy Policy and Terms of Use for this Teradata website changed effective September 8, 2016.


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Mixed Media Artist
Graham is a professional artist who works in a variety of media to create his own unique take on landscape, narrative, and portrait painting. He loves experimenting with styles and techniques and has developed some stunning three-dimensional layered effects in his work. His background in 3-D computer graphics has influenced a strong graphic element in some of his work, but as well as embracing the effects of modern technology he also draws on a range of very traditional artistic techniques.
Graham's wide-ranging repertoire includes large narrative oil paintings and smaller more intimate still-life scenes, inspired by the techniques and themes of the great renaissance painters. He has developed his own bold and stylised version of water-colour landscape scenes and a range of local town scenes in the same media. Graham is also an accomplished portrait painter, working in oils, water-colour, pastel or pencil to create images that both the sitter and others can really relate to.
Inspired by the rural location of his workshop, surrounded by woodland and the rolling Cotswold fields, he has created a number of striking paintings in mixed media, featuring woodland scenes with a narrative twist . In these pieces forest creatures, falling leaves, a drifting feather, or children playing hop-scotch, appear between the trees - adding a reflective dynamic to the woodland scenes. The idea of a 'story embedded in a painting' runs strongly through much of Graham's art and is a theme which he continues to develop in his work.
Modern Art Gallery showing the Best of British Art and Craft


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Elle France has seemingly dropped their annual February 'Special Rondes' issue in favour of simply putting a popular model on the cover because she belongs there. Refreshing!
The ultimate of all art/fashion calendar bookings for any female model, the Pirelli Calendar is a typically nude item that has been distributed for free to very special customers by the car tire company since its first issue in 1964. It's perhaps the world's most exclusive fashion product – only 20,000 are printed, and you can't buy them […]
And just like that, UK designer Jenny Packham sets a new benchmark for high fashion bridal showings by including models of different sizes in her Spring/Summer 2015 event held on April 12, 2014 at Industria Superstudios in New York.
Given the number of editorial staff that this model has in her corner at the magazine, it was only a matter of time before Cosmopolitan Australia offered her a cover, looking pretty in pastels on the March 2014 issue.
Wait, 2013 is over already?? It's been hard to keep up with everything so I thought I would offer a recap some of the main happenings/hot topics for 2013. Comments are open for this post. I've been really busy with my day job working exceptionally long hours, therefore haven't had the time to keep the […]
It's great to see that the fashion pack can appoint more than one woman to 'supermodel' status at a time! Fronting Elle magazine for the fourth time via the November 2013 Spanish edition (that's Elle France x two issues, and one for Elle Norway), this cover girl is shining bright since her move to international powerhouse agency IMG […]
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I live in Pinecraft which is in Sarasota, but I also travel elsewhere, where ever that is. So my photos and updates are mostly from Pinecraft, until I travel...
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- AnonymousMay 7, 2013 at 10:09 PM
Do plain people visit Pinecraft even in summer ? Van ShteffyReplyDeleteReplies
Yes, they do. Not like it is during the winter but the girl with the dog is a school teacher who used to live here and so she waited to return for a vacation until school was out. Today a group of girls from Indiana were on the bus who are also on vacation.Delete
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travel advice travel domain identifies the owner as a travel-related organisation or business. This allows for shorter URLs and helps travel companies with more obscure names to be recognised as part of the travel industry.ReplyDelete
I am traveler from India and loves travelling. When anyone visit to India, they must choose Chardham Tour Packages for pilgrimage tour.ReplyDelete
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Residential Accessory Structures
Obtaining a Building Permit
Accessory structures are small utility buildings and structures associated with a residential parcel. They include but are not limited to:
Accessory structures exempt from building permits:
If the accessory structure, with the exception of the guest house, is single story, detached, less than 120 square feet of floor area as measured from outside face of framing, has no electrical or plumbing installed, and used as a tool or storage shed, playhouse, and similar uses, it is exempt from a required permit. California Building Code §R105.2
If a deck does not exceed 30 inches above grade at any point, is not attached to a dwelling, less than 200 square feet in area, and does not serve the exit door required by Section R311.4 of the residential code, it is exempt from requiring a permit.
Accessory structures located in the Tahoe Basin:
If the accessory structure is located within the Tahoe Basin, a permit will be required to facilitate the review of
Tahoe Regional Planning Agency (TRPA) requirements for the proposed structure.
Other structures exempt from permits include:
Exemption from the permit requirement of the codes does not grant authorization for any work to be done in any manner in violation of the provisions of the codes or county ordinances.