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Post operative clinical scenarios are very high-yield in Surgery on USMLE Step 2CK and USMLE Step 3. Also, useful for COMLEX and Family medicinine boards.
Here, we will discuss several scenarios in post-operative setting, diagnosis and management. This discussion will be followed by self – assessment questions to reinforce your knowledge and to test your analytical skills in complex scenarios.
One important clue in the diagnosis of certain post operative complications is the timing – the day after which the symptom appeared can offer a big clue towards the underlying complication.
General post-operative complications include post-operative fever, atelectasis, wound infection, embolism and deep vein thrombosis.
The highest incidence of post-operative complications is between 1 and 3 days after the surgery. However, specific complications occur in the following distinct temporal patterns: early post-operative, several days after the operation, throughout the post-operative period, and in the late post-operative period. Let us discuss common scenarios in post-operative period.
1) Post-operative fever : A common problem seen after surgery
Etiology of post-op fever can be identified depending on : a) Time since operation b) Type of surgery c) associated clinical features. The following time scales can help you in arriving at most likely etiology of post-op fever.
First 24 hours : systemic response to surgical trauma and pre-existing infection should be considered.
24 to 72 hours : Pulmonary atelectasis is very important etiology in this time frame. Other cause is pneumonia.
3 to 7 days : Pneumonia, Wound infection, UTI, Intraperitoneal sepsis, Sepsis and Anastomotic leak are common causes
7 to 10 days : Deep vein thrombosis ( can start as soon as 5 days post-op) and Pulmonary embolism
Do a full clinical examination, inspect the wound for infection signs, obtain chest x-ray to rule out atelectasis or pneumonia and check for calf tenderness while evaluating post-operative fever to identify the etiology.
2. Hemorrhage:
Primary hemorrhage: either starting during surgery or following post-operative increase in blood pressure – replace blood loss and may require return to OR to re-explore wound.
If large volumes of blood have been transfused during surgery, you must remember an entities such as "dilutional thrombocytopenia", "dilutional coagulopathy" and "consumption coagulopathy" . Large volume blood transfusions more than 5 units can lead to fall in the clotting factors due to dilution and consumption from bleeding/ clotting. Hemorrhage may be exacerbated by consumption coagulopathy. Check CBC, PT, PTT. Transfuse platelets and Fresh frozen plasma with large volume blood transfusions.
If large volumes of blood have been transfused during surgery, you must also remember electrolyte imbalances can occur such as hypocalcemia which can eventually lead to cardiac arrest if severe. Transfused blood contains anticoagulants such as potassium citrate which when given in excess can chelate the calcium in the body causing a drop in free calcium. Look for signs of hypocalcemia. Check calcium level always after massive blood transfusion and replete calcium if low.
Late post-operative haemorrhage occurs several days after surgery and is usually due to infection damaging vessels at the operation site. Treat infection and consider exploratory surgery.
3) Infection : Infectious complications are the main causes of post-operative morbidity in abdominal surgery.
Wound infection: most common form is superficial wound infection occurring within the first week presenting as localised pain, redness and slight discharge usually caused by skin staphylococci.
Cellulitis and abscesses: present in the first week but can occur as late as third post-operative week. Presents with fever and local signs of infection. Cellulitis is treated with antibiotics. In case of abscess, sutures must be removed and wound must be probed. If there is a depper abscess, surgical re-exploration must be performed.Wound must be left open to heal by secondary intention.
Wound sinus : a late infectious complication from a deep chronic abscess that can occur after apparently normal healing. Usually needs re-exploration to remove non-absorbable suture or mesh, which is often the underlying cause.
4) Disordered wound healing : includes Wound dehiscence and Incisional Hernia
Wound dehiscence : A serious complication with mortality up to 30% and occurs at about 7 to 10 days in the post-operative period. Affects about 2% of mid-line laparotomy wounds. Wound dehischence is often heralded by serosanguinous discharge from wound. – if the question mentions a serosanguinous dischargefrom surgical wound in 7-10days post-op always keep this entity in mind. A defect can be palpated in the wound area. Initial management includes opiate analgesia, sterile dressing to wound, fluid resuscitation and early return to theatre for resuture under general anesthesia.
Incisional hernia :Occurs in 10-15% of abdominal wounds usually appearing within first year but can be delayed by up to 15 years after surgery. Risk factors include obesity, distension and poor muscle tone, wound infection and multiple use of same incision site. Presents as bulge in abdominal wall close to previous wound. Usually asymptomatic but there may be pain, especially if strangulation occurs. Management includes abdominal binders in uncomplicated hernia but surgical repair is needed when where there is pain or strangulation.
5) Urinary Problems :
Urinary retention: common immediate post-operative complication – often tested on the exam. Usually, this is because of post-operative pain and can be treated conservatively with adequate analgesia. If this fails, catheterization is the next step.
UTI: very common, especially in women, and may not present with typical symptoms. Treat with antibiotics and adequate fluid intake. Also, indwelling catheters left for long duration increases the risk of UTI. If catheter required for more than 2 weeks 90% patients will develop bacteriuria.
Acute Renal Failure : If there is no urinary output or oliguria after surgery, urinary retention should first be considered and a foley catheter must be inserted. After foley insertion, if there is still no urinary output – cosider, acute renal failure as the reason for oliguria or anuria. Acute renal failure can be pre-renal ( hypoperfusion secondary to shock) or renal ( interstitial nephritis secondary to antibitics used or Acute tubular necrosis secondary to rhabdomyolysis or drugs) or post renal secondary to bladder flow obstruction. It is important to identify the etiology so that it can be adequately treated as soon as possible. Follow the guidelines for investigating ARF that are mentioned under our renal lectures.
6) Post-operative delirium : very common and must be differentiated from other causes of delirium such as dehydration, hypoxia, electrolyte imbalance and sepsis. Treat the underlying cause and treat symptoms with haloperidol.
7) Bowel function issues:
Delayed return of bowel function: post-op ileus is a common problem. Patient may complain of nausea, anorexia and vomiting. Management is conservative – electrolyte repletion, hydration. More prolonged and severe form of post-op ileus is calledadynamic obstruction . Patient may have vomiting and intolerance to oral intake. It must be distinguished from mechanical obstruction. An obstructive series x-rays can help in differentiating it from mechanical obstruction. A CT scan with oral contrast is very useful if there is suspicion of mechanical obstruction. If it involves large bowel – usually described as " colonic pseudo-obstruction". Diagnosed by instant barium enema
Early mechanical obstruction: may be caused by twisted or trapped loop of bowel or adhesions occurring approximately 1 week after surgery. Treat with nasogastric aspiration plus IV fluids. If progresses despite conservative measures, requires surgery.
Late mechanical obstruction: adhesions can organise and persist, commonly causing episodes of small bowel obstruction months or years after initial surgery. Treatment is same as for early mechanical obstruction.
Respiratory complications
Occur in up to 15% of general anaesthetic and major surgery and include:
a) Atelectasis (alveolar collapse):Caused when airways become obstructed, usually by bronchial secretions. Common cause post-operative fever from day 0 to day 2. Symptoms are slow recovery from operations, poor colour, mild tachypnoea, tachycardia and low-grade fever. Prevention is by pre-and post-operative physiotherapy. In severe cases, positive pressure ventilation may be required
b) Pneumonia: requires antibiotics, physiotherapy. CXR will reveal infiltrate with out volume loss. In atelectasis, the infiltrate is usually accompanied by volume loss in the lung.
c) Aspiration pneumonitis: Sterile inflammation of the lungs due to inhalation of gastric contents. There is a preceding history of vomiting or regurgitation which is a clue and such symptoms are followed by rapid onset of breathlessness and wheezing. Mortality is nearly 50% and requires urgent treatment with bronchial suction, positive pressure ventilation, prophylactic antibiotics and IV steroids. Antibiotics in aspiration pneumonitis/ suspected aspiration pneumonia should cover both anerobes and gram negatives eg: piperacillin/ tazobactam. Clindamycin alone may be insufficient since it does not have gram negative coverage.
d) Acute Respiratory Distress Syndrome: ( ARDS): presents with rapid, shallow breathing, severe hypoxaemia with scattered crepitations but no cough, chest pains or haemoptysis, appearing 24-48 hours after surgery. Occurs in many conditions where there is direct or systemic insult to the lung, e.g. multiple trauma with shock. CXR reveals bilateral diffuse infiltrates in the absence of congestive heart failure. A swan ganz catheter reveals normal PCWP (pulmonary capillary wedge pressure) ( remember that increased PCWP will favor CHF or fluid overload as the cause of acute diffuse CXR infiltrates rather than ARDS) Requires intensive care with mechanical ventilation with positive-end pressure ( HIGH PEEP / LOW TIDAL VOLUME Strategy – refer to our pulmonology lectures for ventilation strategies and strategies for ARDS)


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When Old Buildings Go High Tech
Originally published in the San Diego Business Journal March edition of "Sustainable San Diego"
Built in 1946 in a grand old Hollywood style, San Diego's Lafayette Hotel was once a retreat for Southern California's rich and famous from Bob Hope and Ava Gardner to Tarzan actor Johnny Weissmuller. By 2010, the historic landmark was in need of extensive remodeling and a creative approach was necessary in order to comply with historic preservation guidelines and incorporate sustainability.
"A big part of the renovation was looking at how we could incorporate sustainable business practices as that was a key component to the overall project financing," said Jay Wentz, managing partner of Hampstead Lafayette LLC, owners of the hotel. "We wanted to combine the Hollywood history embodied in this hotel from the forties and fifties with a present day urban chic, boutique feel."
When Hampstead Lafayette decided to incorporate sustainable energy into the hotel's $6 million 2011 renovation, they chose an innovative fuel cell technology for reducing energy costs and lessening the facility's environmental impact. Housed in the hotel's basement, the energy system does not affect the building's exterior appearance and complies with historic preservation guidelines.
Savings at the Lafayette today
The 40-kilowatt stationary fuel cell system manufactured by ClearEdge Power generates much of the hotel's electrical needs and supplies heat for its large outdoor swimming pool. This simultaneous production of electrical and thermal energy from a single source is known as combined heat and power (CHP). CHP can be configured with fuel cells or alternative on-site generation technologies such as a microturbine or internal combustion engine. The dual benefit of generating both heat and power makes CHP systems more cost effective, with a better return on investment and a more efficient use of natural resources.
Nearly three years later, the Lafayette Hotel is saving more than 45 percent on its annual electrical bills with a 40 percent reduction in its carbon footprint. The cost of the fuel cell CHP system was offset by $100,000 through the California Self-Generation Incentive Program (SGIP), administered by CSE in the SDG&E territory, and was eligible for a 30% federal tax credit, allowing for an anticipated payback of only 5.8 years for the CHP investment. "The SGIP rebate was essential in allowing our hotel to implement fuel cell technology," Wentz said.
What is stationary fuel cell technology?
A fuel cell is an electrochemical energy conversion device that captures the power of hydrogen to produce clean electricity and heat. The hydrogen used to power the fuel cell may come from a variety of sources, including natural gas, waste gas or biogas. The term stationary fuel cell differentiates them from portable fuel cells used in cars, forklifts and other applications.
Individual fuel cells produce relatively small amounts of electricity so they are stacked, or placed in series, to increase output. For properties such as the Lafayette Hotel where aesthetic considerations and spatial constraints played a large role in determining the appropriate energy generation technology, fuel cells can be an excellent choice due to their relatively small footprint and scalability.
According to Jeremy Del Real, CSE senior energy engineer, CHP works well with coincident and continuous thermal and electric loads, both of which are inherent to hospitality facilities. "CHP offers the hospitality industry a method to enhance power reliability, reduce electric and thermal operating costs, and promote a green image," he said.
California leading the way
Nationwide, fuel cell use is growing for industrial applications and university microgrids and as a reliable power source for businesses that cannot afford to experience power outages, such as telecommunication firms, medical facilities and grocery stores. Fuel cells are capable of generating power 24/7, even when the power grid goes down.
Self-generating fuel cell systems are operating in the San Diego region at companies such as Cox Communications, Albertsons and Sheraton San Diego Hotel & Marina and at much larger facilities such as UC San Diego and Camp Pendleton. At the Sheraton, Fuel Cell Energy has installed two fuel cell systems that generate 1.5 megawatts on-site. The fuel cells are quiet enough to be located next to the hotel's guest facilities and supply electricity for the 1,044-room hotel and heat to warm the hotel's pool.
California continues to lead the way in supporting both fuel cell and CHP technologies by providing financial and regulatory support. In San Diego, CSE has provided nearly $44 million in SGIP funding for eligible CHP projects since the program's inception in 2001, with $7 million devoted specifically to fuel cell CHP projects like those at the Lafayette Hotel and Sheraton San Diego.
CSE also represents the U.S. Department of Energy (DOE) as the Pacific Combined Heat and Power Technical Assistance Partnership (Pacific CHP TAP) that offers a number of federally funded engineering services for potential CHP projects in California including hotels, hospitals and critical infrastructure facilities.
Which technology is right for you?
"The first step in determining if CHP technologies are a good fit for a facility is to perform a qualification screening" said Del Real. "The results of this first-cut analysis determine if a more detailed analysis should be pursued and the evaluation of a CHP system at a customer's facility should be continued."
There is a wide range of self-generation technologies, and the one that is right for a business depends on the unique load profile and energy objectives.
CSE provides technical and financial assistance to San Diego area businesses interested in wind, waste energy recovery, pressure reduction turbines, advanced energy storage and combined heat and power systems. Through the SGIP, CSE offers substantial cash incentives that can range up to hundreds of thousands of dollars or more. In addition, CSE assists business and facilities determine if CHP is right for them through the Pacific CHP TAP.
For more information
To discover which technology is right for your facility, you can take an online clean energy assessment and check out details about the DOE Pacific CHP TAP. For further information, contact CSE project managers Gene Kogan (CHP) at (858) 633-8561 or Rebecca Feuerlicht (SGIP) at (858) 634-4737.

subset: commoncrawl


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Detailed plot synopsis reviews of The Secret Life Of Bees
Script Analysis of The Secret Life Of Bees
Click on a plot link to find similar books!
Plot & ThemesTime/era of movie: - 1960's-1970's Kids growing up/acting up? - Yes Kids: - runaways! Parent(s) gone? - Momma gone Age group - trouble in grade school
Main CharacterIdentity: - Female Profession/status: - unemployed Age: - a kid Ethnicity/Nationality - White American
SettingUnited States - Yes The US: - Deep South Farm/Ranch? - Yes Farm/Ranch: - farm
Writing StyleAccounts of torture and death? - moderately detailed references to deaths Any profanity? - Occasional swearing Is this movie based on a - book
Movies with storylines, themes & endings like The Secret Life Of Bees
|Moonrise Kingdom starring Edward Norton, Bruce Willis, Bill Murray, Frances McDormand
|Digging to China starring Evan Rachel Wood, Kevin Bacon, Mary Stuart Masterson
|The Adventures of Huck Finn starring Elijah Wood, Courtney B. Vance
|Heaven Help Us starring Donald Sutherland, Andrew McCarthey
|The Tree of Life starring Brad Pitt, Sean Penn, Jessica Chastain


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Fall 2019 courses now available!
Top 5 Benefits of Our Program
1. Enhanced Literacy
Fun Creative Writing boosts students' reading and writing skills. By identifying key components of a story and essay, children are able to comprehend text with higher lexile levels. Children who write read more and vice versa.
2. Grammar Improvement
We broaden our students' vocabulary by introducing power and genre specific words. Students are encouraged to evaluate word choice. In addition, the role of an editor is discussed. We teach students about the editing stage by introducing standard editing markings used in higher level education and publishing houses across the country.
3. Expanded Imagination
The National Endowment for the Arts issued a report entitled "How Creativity Works in the Brain". The report underscored how vitally important it is to nurture the imagination, because it leads to innovation. To appeal to all types of learners, Fun Creative Writing incorporates three types of learning styles:
✓ Visual ✓ Auditory ✓ Kinesthetic
We challenge the status quo and teach students to think outside the box, encouraging them to ask "What if?" and "What now?"
4. Persuasiveness
The ability to sway others' thinking toward your point of view is a tremendously valuable skill in educational and professional instances. Fun Creative Writing teaches the three modes of persuasion. We also touch on the following:
✓ Identifying audience ✓ Creating tone
✓ Developing empathy ✓ Using power words
5. Creative Writing as a Form of Therapy
Creative writing offers our students and outlet to share their thoughts and beliefs on paper. Whether through the eyes of a fictional character or personal narratives, children who express themselves through writing are more confident, creating a sense of assurance, and in some instances, resolution to issues that concern them.
Help your child become a better writer.
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Emerging Writers - 2nd & 3rd grade
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**COMING THIS FALL Digital Media for a digital worldOur children are the biggest consumers of media. So why not teach them to produce it? Our after-school writing programs include:
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A fun and interactive class, perfect for beginner writers or creative students who want to strengthen their writing skills. Important milestone writing curriculum is taught to supplement classroom learning.
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Students who struggle with completing writing assignments benefit tremendously from this fun engaging course. Creative students will love learning more about story development and essay writing while developing stronger writing skills. Important milestone writing curriculum is taught to supplement classroom learning.
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We offer writing instruction and homework help for groups of 3 or more. Consistent lessons give students the confidence needed to excel in essay and creative writing. We come to your location (no private homes).
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The beautiful and historic Duffryn Gardens in South Wales will soon be passing into the hands of The National Trust. I think this is a good thing, I've visited the garden several times and it would have been a tragedy were it to have closed. I just hope The Trust allow it to remain true to itself in its quirkiness. At Duffryn you have it all: a rockery, formal beds near the house, a newly restored kitchen garden and glasshouses, long borders, and a series of garden rooms contained by beautiful old stonework. The mish-mash of styles is what makes me want to visit Duffryn again and again - hopefully The National Trust won't try to 'pull it all together' with homogenous planting schemes. I look forward to seeing how the garden will continue to develop over the coming years. Meanwhile, here's how it looked in August when I last visited.
|Formal beds, but not your standard planting
|Part of the new glasshouse has been devoted to cacti
The long borders were looking ravishing, so here's quite a few pics of them:
|Finally, waterlilies were at their best in the rill.


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Primary Update: Nebraska Gov. Wins Tough Primary
Nebraska Gov. Dave Heineman pulled off a stunning come-from-behind victory over Rep. Tom Osborne to claim the Republican Party nomination.
Shortly after midnight East Coast time, AP called the race for Heineman, who won about 50 percent of the vote, compared with 44 percent for the legendary former coach of the University of Nebraska football team. Businessman Dave Nabity had around 5 percent. The Lincoln Journal Star reported around 12:15 a.m. ET that Osborne has conceded.
Heineman's victory was unimaginable when Osborne announced last year that he would leave his western Nebraska House seat to run for governor. Polling showed Heineman trailing by huge margins. But Heineman, who took over as governor in January 2005 when Mike Johanns (R) was named Secretary of Agriculture in President Bush's Cabinet, resisted entreaties to enter the Senate race and instead focused on racking up accomplishments with the belief that Nebraska voters would opt to stay the course rather than make a change if he showed he was up to the job. That prediction proved prescient Tuesday night.
Democrat David Hahn won his party's gubernatorial primary easily after his opponent was ruled inelgiible due to a prior felony conviction on drug charges. Hahn has little chance in the general election against Heineman given the state's strong Republican nature.
Elsewhere in the Cornhusker State, former Ameritrade executive Pete Ricketts secured the Republican Senate nomination, beating back former state Attorney General Don Stenberg and former party chairman David Kramer. Ricketts, who's running in his first political campaign, emerged from the pack thanks to nearly $5 million in personal donations. He will face Sen. Ben Nelson (D) in the fall in what could be one of Republicans' few takeover chances this year.
In the 3rd District, which Osborne vacated to run for governor, state Sen. Adrian Smith bested Osborne aide John Hanson and Grand Island Mayor Jay Vavricek to win the Republican nomination. Smith, who is in his mid 30s, cast himself as someone who could be in Washington for decades, accruing seniority to benefit the state. He also benefitted from strong financial support from the D.C.-based Club for Growth, which helped Smith raise and spend the most money of the three main candidates.
West Virginia
Republicans breathed a sigh of relief in West Virginia as 1984 Senate nominee John Raese defeated 2004 state Attorney General nominee Hiram Lewis to claim the party's nomination. Party insiders at the national level had made clear that Raese, who is independently wealthy, was their preferred candidate to challenge Sen. Robert Byrd (D) in November.
"Senator Byrd's voting record and principles are no longer in touch with mainstream West Virginians, and with a challenger as strong as John Raese, Senator Byrd's liberal record puts him in serious electoral danger," said National Republican Senatorial Committee Chairwoman Elizabeth Dole (N.C.). Raese begins the contest as a decided underdog, however.
Here's the Associated Press write-up of the Nebraska and West Virginia results.
Chris Cillizza
May 10, 2006; 12:23 AM ET
Categories: Governors , House , Senate
Save & Share: Previous: Feingold Says It's Time For Dems to Talk Tough
Next: Parsing the Polls on Congress and Corruption
Talk about an astute politician! Nebraska Governor Heineman was a master at kissing babies and working the media.
With the Cornhusker State a pool of Presidential Candidates, I think Heineman might be a guy to watch for U.S. President sometime in the future.
And I am a big time liberal.
Ricky From Omaha
Posted by: Ricky | May 10, 2006 7:47 AM | Report abuse
Ben Nelson is awesome! He is my kind of Democrat. He voted for Roberts and Alito and he is pro-life. He is a common-senss, middle-of-the-road Democrat who supports the President when he is right and opposes him when he is wrong. I like his independence.
Posted by: Natalee H. | May 10, 2006 12:49 AM | Report abuse
Not so fast, the same commentators who claimed Heineman had no chance, now say that Hahn has no chance. Heineman ran to the far right, leaving the silent moderate majority to Hahn. Heineman said he would support and sign the "South Dakota" bill on Abortion. Nebraska under seven years of Johanns/ Heinemann and a Republican Unicameral was 49th in economic development in 2004 while Iowa with a democratic governor and legislature was first.
Not so fast, the governor's race will be very competitive.
Posted by: vince powers | May 10, 2006 12:49 AM | Report abuse
Seeing as how Nelson won in 2000(a fairly "even" year with no major tilt towards either party ) and now it is 2006,(a year with a democratic tilt) I think Ben Nelson will prevail in the Nebraska Senate race. His performance in the Senate has made him the most popular Senator in the country with an approval rating of 73%. It will be interesting to see how much $$ Ricketts burns on this race, though.
Posted by: Ohio guy | May 10, 2006 12:34 AM | Report abuse
heineman pulled it offff, did he?
Posted by: edit | May 9, 2006 11:57 PM | Report abuse
The comments to this entry are closed.


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By Allison Kraft, MS
It's a common misconception that it is difficult to build muscle on a vegetarian diet. After all, a chicken breast or steak provides much more protein per ounce than beans or whole grains. But building muscle as a vegetarian is not as difficult as you may think.
Why Should Vegetarians Care About Muscle?
Before we discuss the how, you might be wondering why it is important to build muscle. Increasing your muscle mass is a worthwhile goal for several reasons:
- Muscle burns more calories than fat, so increases in lean body mass can speed up your metabolism.
- Gaining muscle mass can decrease your overall body fat percentage.
- Strength training helps you build stronger bones AND stronger muscles.
- Having strong muscles can make it easier to perform daily activities, such as carrying multiple grocery bags or opening a stubborn jar of pickles.
How To Build Muscle
Obviously, protein is essential for increasing muscle. As a vegetarian, the sources of protein in your diet will differ from the average person consuming meat. Plant-based proteins may include beans, lentils, whole grains (like quinoa, brown rice and farro), nuts, seeds, soy products, and dairy. Plant-based protein powders can also be a source of protein for the busy athlete but are certainly not needed to meet protein needs as a vegetarian.
Tips for Building Muscle
While protein sources may differ between meat-eaters and vegetarians, other recommendations for building lean body mass are the same for both groups. These tips will help you increase your muscle in no time.
- Eat protein throughout the day. For optimal muscle growth, aim to eat 20-30 grams of protein at each main meal. Vegetarian foods that pack a protein punch include:
- Beans & Lentils – Versatile and nutritious, beans and lentils provide 15 grams of protein per cup when cooked.
- Dairy products – Dairy is an easy source of protein when you are on the go. A cup of milk provides 8 grams of protein, while the protein in ½ cup of Greek yogurt or cottage cheese is closer to 12-15 grams.
- Soy products – Soy milk packs just as much protein as dairy milk, and other soy foods such as tofu and tempeh are also great sources, packing 10-12 grams of protein per cup.
- Whole grains – Along with many other nutrients, whole grains add a surprising source of protein to the diet. Among grains with the highest protein levels are quinoa and whole wheat pasta (8 grams per cup), old-fashioned or steel cut oats (5 grams per ½ cup), and whole wheat bread (5 grams per slice).
- Nuts & Seeds – Making a great addition to salads, smoothies, and yogurt, nuts and seeds also provide a good amount of protein. Examples include hemp seeds (10 grams per 3 Tablespoons), almonds (6 grams per ounce), and peanut butter (4 grams per Tablespoon).
2. Variety is key. Consuming protein from a variety of sources leads to a greater variety of nutrients in your diet and can keep eating fun!
For example, you might consume a bowl of oatmeal with walnuts and a glass of milk at breakfast, a black bean quesadilla for lunch, and a salad with hemp seeds, tofu, and a hard-boiled egg for dinner. These meals alone provide over 60 grams of protein. If you throw in snacks such as Greek yogurt and a peanut butter sandwich, that number jumps up to nearly 100 grams – an amount of protein that would easily meet the needs of a 150-pound person working to build lean body mass!
3. Don't be afraid of carbohydrates. Carbohydrates are essential and provide energy for all sorts of activities. If you limit your carbohydrates, you will not be able to perform your best or build lean body mass efficiently.
4. Lift weights. Regardless of how much protein you consume, you will struggle to build muscle without lifting weights or doing some other form of strength training. If you are new to strength training, you can try out a circuit class, find a personal trainer, or watch YouTube videos to get started.
Allison recently graduated from the Coordinated Master's Program in Nutrition and Dietetics at the University of Utah. With a concentration in sports nutrition, she has a passion for teaching others to take charge of their nutrition to lead healthy, active lives that they love.


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The Doc Next Media Collection | Doc Next on Vimeo | Doc Next on ResourceSpace | Curated Playlists
We use Vimeo to showcase our videos and curate playlists. It is not an archive, but most of our archive's categories, as well as curated subcollections, are presented in Vimeo as channels.
Media Collection categories
Films made by, with and for young people
Kidsploitation Films about young people in cities – often with time on their hands
Young Eyes Life viewed through young people's eyes
Teen Soapbox Teens share their opinions
Teen Drama Homemade dramas mostly made by teens and young people
Films made of personal and collective memories
Memory Prompts Using objects and buildings to explore the past
Remembering Communism Remembering the legacy of the Soviet Union in today's Europe
Remembering War Films looking at the legacy of conflict, fighting and borders.
Watching Places
Films documenting places and the people who live in them
Watching the city Little glimpses of life in the city by day and night.
Watching the countryside Living in the European countryside
Watching small towns Portraits of places and people who live there
Social Struggles
The frontlines and faultlines of politics and power
Urban Change How cities are changed, what is lost and gained. Top down, bottom up
Chomsky's Filters Revealing and subverting agendas in everyday media
The European Crisis Experiences of Europe's Economic Crisis
Authoritarianism Films about oppression, exclusion and exploitation.
Civic Complaints Films providing a way to complain about urban life
Poverty People living on the margins.
Protests Films documenting European protests since 2011
Identities & Interests
Experiences of individuals and groups with whom they identify
Ageing Society Europe's aging populations
Migrant Experiences Films about their feelings, struggles and dilemmas.
The Roma Windows on the Roma in Europe.
Disablism Films that touch on being significantly physically and mentally different to the norm
Liberating Women Talking about women, their rights, perceptions and representations
Labels for people Films about created and imposed identities.
Hybrid Identity People and places reconciling two established identities
Everyday Life
Documenting people at work, at play and in love
Transgressions Films about skating, rebellion and breaking conventions
Love Love, intimacy and its price with people, places and animals.
Pleasure People finding pleasure in hobbies, music and gardens.
Work Snapshots of people at work
Community Films about volunteering and communities supporting themselves
Videos to feel more than read
Vibes Videos that don't seem to be about much specifically but create a strong 'mood'
Dreamstates Dreamy films and surreal stories.
Other channels
DNN projects
About Doc Next Network Project trailers, making of, interviews and other promo materials.
Radical Democracy Video Challenge. Showcase of the 30 finalists.
Remapping Europe: a Remix Project. 46 videos
Guest curators
María Yáñez curates: The Ones That Stay. 10 videos
Necati Sonmez curates: Resist to Exist. 10 videos
Edwin Bendyk curates: Respect, appreciation, solidarity. 10 videos
Videos to #ReclaimTheCommons
Poland: Opening the heart of the city 15 videos
Turkey: Making the city liveable 21 videos
UK: Finding a home in the city 21 videos
Spain: Taking back the city 16 videos
We also follow some of the hubs' channels, like Gezi MODE, that appears in our Channels list.
DNN has also used groups to gather content related to different projects, such as Remapping Europe and Radical Democracy Video Contest or even the whole DNN Media Collection. These groups are open to external members and are moderated by DNN.


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The Cardinals waited a long time for quarterback Kevin Kolb's ribs to heal enough for him to return to the lineup, but their patience has reached its end.
Arizona placed Kolb on injured reserve Wednesday, ending his season and ending the hopes that the best of their three quarterbacks might return to help them end a losing streak that stands at nine games after last Sunday's humiliating 58-0 loss to the Seahawks.
Kolb said last week that the ribs were still not completely healed from the initial injury and the pace of the recovery process obviously hasn't picked up since them. That means John Skelton, Ryan Lindley and Brian Hoyer will have to figure out a way to pick up a win in the final three weeks, which might be a tall order given the way Skelton and Lindley have played so far this season.
Kolb is set to make $9 million in salary next season and he's due to receive a $2 million roster bonus in March. Even though Kolb did show them more command of the offense in his six games this season than he did in 2011, it's hard to see the Cardinals bringing him back at that price regardless of who is making the decisions after the Cardinals sift through the detritus of this season.
The Cardinals added offensive lineman Mike Gibson to the roster in the spot vacated by Kolb.


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Stop-Motion Addams Family Movie Still Moving Forward with Tim Burton in Mind to Direct
Posted on Sunday, June 27th, 2010 by Russ Fischer
In March, a story came out of Deadline that a stop-motion animated Addams Family film is being developed with Tim Burton as likely director. Burton's reps quickly issued a denial, saying that he "has not lined up any of his upcoming projects." When Brendon reported on the story and the denial, he surmised that Deadline's report wasn't incorrect, but that this project might just be a long ways off.
Now there is support for that idea, which comes from one of the film's producers, Christopher Meledandri. He says the film is indeed being developed, but that it is in the early stages. And yes, Tim Burton is the director he has in mind. Read More »


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Andhra pradesh
ANDHRA PRADESH Video News
Here on this page, you can See A Collection of Andhra pradesh Videos. The list contains Important Videos and Video News related to Andhra pradesh. You can watch the videos of Andhra pradesh with a brief description written in English. Here all the Videos related to Andhra pradesh are quality checked and listed date wise.
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Please click on "Show all content" to view videos.
Incredible Edible Microchips! - How Science Changed Our World - BBC One
Prof. Robert Winston visits the London Centre for Nanotechnology where they can manufacture electronic components smaller than a virus! They have even created completely edible microchips, the use for which is demonstrated in this clip.
The next generation of HIV monitors
Dr Rachel McKendry from the London Centre for Nanotechnology is heading a world-leading consortium of scientists, who are engineering the next generation of HIV monitoring devices. These new types of devices will rapidly diagnose and monitor HIV in resource-limited environments such as district hospitals, GP surgeries and developing countries.
Professor Steve Bramwell on 'magnetricity'
The London Centre of Nanotechnology's Professor Steve Bramwell explains the discovery of 'magnetricity' - magnetic charges that behave and interact just like electric charges in some materials. The groundbreaking research could lead to a reassessment of current theories of magnetism as well as significant technological advances.
One to Watch
Professor Neal Skipper and Dr Chris Howard of the LCN discuss their research into developing commercially-viable methods to produce carbon nanotubes
Simon Gane of the LCN discusses SnapScope, a revolutionary device that makes medical instruments such as an optical endoscope, compatible with gadgets like the iPhone so that doctors can share data with medical professionals and patients.
SEE THE LIGHT: Why lasers are the future for the silicon chip
As silicon chips keep getting faster, the copper connections used to transmit electrical
signals between them are finding it hard to keep up. Optical signals are the obvious next step, but integrating them with silicon systems is difficult -- and we've spent so long learning how to work with silicon, we're reluctant to give it up.
Researchers in UCL's Electronic and Electrical Engineering Department and the
London Centre for Nanotechnology successfully produced "the Holy Grail of silicon photonics" - an efficient laser for telecommunications, grown on a silicon base. This could be a stepping stone to a single chip capable of electronic processing and photonic transmission.
Coffee with qubits
Dr Gavin Morley explains new experiments demonstrating fast control of quantum bits in silicon.
London Centre for Nanotechnology Video for In-cosmetics tradeshow
The LCN is at the forefront of research for the benefit of every one. It is also heavily involved in biology including healthcare and cosmetology. This film is a teaser made for the In-cosmetics tradeshow showing how research at the LCN could benefit public health and wellfare.
The LCN and the Engineer
The Engineer paid a visit to the London Centre for Nanotechnology to uncover how tiny structures are making a big difference across a range of disciplines.
Source and copyright: The Engineer http://www.theengineer.co.uk
Light-based CPUs could break the Terahertz barrier
The beauty of technology is that when you come to buy a new phone, laptop or camera, you can always bag a significantly better model for the same price you paid for the outdated hunk of junk you wish to dispose of. In this video, Jerome Evans visits the London Centre for Nanotechnology and discovers how nanotechnology makes this possible and what it might mean for the future of computing.
George's 1970 salt dissolving lecture
In this original footage from 1970 George shows that even then it was possible to dissolve salt in water and study the process on the nanoscale. 40 years on George junior (otherwise known as Jiri) is a PhD student studying the same process at the London Centre for Nanotechnology at University College London.
Quantum Computing
This video discusses some of the science demonstrated by the LCN ath the exhibit 'Schrödinger's cat in a silicon chip' that was part of the Royal Society Summer Science Exhibition 2011.
3D imaging: nanotechnology and the quest for better medical sensors
Professor Ian Robinson (UCL London Centre for Nanotechnology)
The smaller the scales we want to look at, the bigger the tools we need to use, and with complex equipment of this magnitude, it is becoming more and more common for research groups to share central user facilities. Focusing on UCL's use of central user synchrotron radiation facilities (sub-atomic particle accelerators), this lecture highlights developments in the 3D imaging of nanomaterials in the ultimate quest for creating better medical sensors.
Diamond as a Gemstone, what a waste!
Professor Richard Jackman's Inaugural Lecture.
Scientific highlights - Plasmonics, Professor Stefan Maier
The London centre for nanotechnology 5th anniversary celebrations. Professor Stefan Maier from Imperial gives a talk on Plasmonics
TV Globo feature
TV Globo recorded a news feature on nanotechnological developments in medical research at the LCN, for broadcast in South America. Note: the audio track is in Portuguese.
Interview with Prof. Gabriel Aeppli and Dr Sandrine Heutz of the LCN
Prof. Angelos Michaelides on the Nature Podcast
LCN Researcher, Professor Angelos Michaelides, appears on the weekly Nature podcast discussing the "Cold Hard Facts" - a short feature on why ice is interesting and some of the things we still don't know about it!
Science Weekly podcast: The next generation supercomputer
LCN PhD student, Robert Thompson, appeared as an expert in the weekly science podcast for the Guardian. The podcast focused on what the next generation of supercomputers could be built with, from new materials to changing the fundamentals of how they process information, and Robert offered his insight on organic electronics.


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In this image released by the Texas Military Forces, Joint Task Force-71 leaders go over their 2011 Annual Training plan at Bee Caves Armory, Austin, Texas, Wednesday, July 6, 2011. With close to 500 individuals participating in this event, planning will be the key to success. (Photo/Joint Task Force 71, Army National Guard Staff Sgt. Melissa Bright)
In this image released by the Texas Military Forces, key leaders with Joint Task Force 71 participated in an annual training plan review in Austin, Texas July 9, 2011. Representatives were on hand from the 836th Engineers, 436th Chemical Company 236th Military Police and the medical group from the Air National Guard to review their daily plan for completing their upcoming training. Annual Training normally consists of two weeks worth of Soldier Skills training. However, JTF-71 is also using their time on Camp Swift preparing for their external evaluation as a Homeland Response Force in October. (Photo/Joint Task Force 71, Army National Guard Staff Sgt. Melissa Bright)
Joint Task Force 71JTF 71JTF71the Minuteman BrigademinutemanTX.usNational GuardTexas GuardTexas Military ForcesArmy National GuardAir National GuardPAOPIOPublic InformationPublic Affairs100th Mobile Public Affairs Detachment100th MPADalways readyDSCAdefense support to civilian authoritiespublic safetySJIATFStanding Joint Interagency Task ForceTroopers readyabel parkerannual trainingStaff Sgt. Melissa BrightCol. Bill Hall836th Engineers436th Chemical6th Civil Support Team236th Military PoliceBee Cave ArmoryAustinTexas


text: For decades, philanthropy has been understood as a fairly simple transaction. Actually, it hasn't exactly been understood as a transaction at all. Philanthropy until now has always been seen as a one-way conduit, allowing individuals and businesses to solve problems large and small by throwing money, time or resources at them–with no expectation of return.


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Links Sort by: Hits | Alphabetical
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|Vintage Test Gear and Workshop Equipment For discussions about vintage test gear and workshop equipment such as coil winders.
|Thread Tools
|2nd Dec 2017, 8:15 pm
Join Date: Sep 2008
Location: Londonderry, Northern Ireland, UK.
Posts: 58
Can the voltage at the PF terminals of an Avo Model 7 Mk2 be used as a diagnostic?
A while back I had either an Avo7 or an Avo40 with dicky AC side, it's fixed and I don't remember the cause but during the investigation/repair I had the thought that a DMM across the PF terminals would surely see virtually the full working output voltage of the transformer.
Am I up a gum tree?
I have just got a Model 7 that reads low on AC V. I have had a play, first with 1 and then 2 Avo M200x's across the PF terminals.
I didn't take note of the actual indicated voltage on the 1st DMM but it was over 0.5V, adding the 2nd caused a 3mV drop in the reading given by the 1st and there was no discernible change in the reading given by the Model 7.
Putting 100V across the the Model 7 on the 100V range gave a reading on the Model 7 in the high 80's and the DMM's across the PF terminals showed around 1.149V ( one is TRMS and the other average? responding).
I am curious if measuring the voltage across the PF terminals has any diagnostic value?
|2nd Dec 2017, 8:40 pm
Join Date: Aug 2016
Location: Colchester, Essex, UK.
Posts: 1,685
Re: Can the voltage at the PF terminals of an Avo Model 7 Mk2 be used as a diagnostic
I am very interested in people's opinions of this.
On occasions when i have had a avometer reading ACV too low, if it's an under-read to the tune of 60% it has been a switching problem (current going through DC parts of the meter that it should not be??) and if it's an under-read of the order of 10 to 25% it has been down to a lazy rectifier. Often when the rectifier is clapped out it can be seen to be quite corroded on the outside.
Last edited by The Philpott; 2nd Dec 2017 at 8:55 pm.
|2nd Dec 2017, 11:39 pm
Join Date: Apr 2005
Location: Bewdley, Worcestershire, UK.
Posts: 4,166
Re: Can the voltage at the PF terminals of an Avo Model 7 Mk2 be used as a diagnostic
I think I'm correct in saying that the current transformer only operates on the AC current ranges plus the 10 volt AC range. Looking at the circuit diagram, the P.F. terminals are indeed directly across the CT secondary (with a total of 40 kilohms resistance in series) but the CT secondary is shunted by the instrument rectifier and the movement. The rectifier will present a non-linear load, and hence measuring the actual voltage at the P.F. terminals may not be particularly informative.
I'd add to Dave Philpott's suggestions that low readings on AC ranges can be due to the single diode S.A.1 across the moving coil being leaky - I've encountered this on at least one occasion. This protection diode is only there to cause the movement to move and trip the cut-out in the event of AC inadvertently being applied to the meter whilst set to DC, so you can cut it out completely and it won't affect the accuracy of the instrument.
The place where optimism most flourishes is the lunatic asylum - Havelock Ellis
Last edited by Phil G4SPZ; 2nd Dec 2017 at 11:45 pm. Reason: Correction & clarification
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The Location of CHIME
From March 4th 2014, our postal address is:
CHIME, University College London
The Farr Institute of Health Informatics Research London
222 Euston Road
United Kingdom
The fax is 020 7679 8002.
Other telephone numbers have not changed since CHIME moved from Archway to Bloomsbury in 2013 - see CHIME People for further details.
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The nearest Underground stations are:
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The map below shows the location of 222 Euston Road, just a few minutes' walk from UCL's main campus in Bloomsbury.


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