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No, unlike bodybuilders, who train in a more isolated, specific way, we train using functional movements. That is, movements that your body was designed to do. CrossFit is the most effective way to build strength, burn fat, and increase cardio capacity.
Will it be hard?
Every workout is designed to be challenging whilst also being scalable to your own personal ability. You will be challenged everyday you come to a class but this will get you exceptional results.
What are the classes like?
Each session includes an extended warm up, skills practice, coaching of technique, the main WOD (Workout Of the Day) and cool down and stretch.
What should I expect at my first CrossFit workout?
Each session is a fun and challenging experience. Classes start with a dynamic warm-up to get you loosened up and ready to train. After the warm up you will be taken through skill training and instruction on movement standards to improve your technique and ensure that you can safely perform the movements for the WOD (workout of the day). Once you are ready with your scaling options and you have ran through the movements the entire class will tackle the WOD together. At the end it's high fives and fist bumps all round before we hit a cool down and stretch together.
Do I need prior experience to take classes?
No. New members participate in our Beginners program and then transition into general classes. The beauty of CrossFit is that all exercises are based on movements that you already do in everyday life such as squatting, pushing and pulling. Exercises are scaled to improve both beginner elite athletes depending where they are at in their fitness journey.
Do I have to be in shape to take CrossFit classes?
No. Really. There is a common misconception that CrossFit is for elite athletes. The truth is that it is for everyone. You can start the journey where you are today and, if you continue to follow our program, it's likely that you will get in to the best physical and emotional shape of your life.
Our community is comprised of competitive athletes, former athletes, working professionals, people that had never stepped foot into a gym and people with physical ailments. Our program is designed in such a way that it will get results for any committed individual.
Should I warm up and stretch before class?
We always have a warm up session before the WOD (Workout of the Day). If you find yourself with a little extra time before or after class, feel free to start warming up on your own, practice skills, or just socialize. All we ask is that you come in ready to do some work!
Do you recommend training daily?
No. Maximum benefits are derived from intensity and recovery. We offer a complete health and fitness program, and so we recommend that you take time to recover so that you perform your best at every session. This will prevent injury and backsliding from overtraining. On the other hand it is important that your training is consistent. Generally, we recommend our members train 3 days on and 1 day off.
What makes CrossFit different than other gyms?
CrossFit is about variance and adaptation. We "program" our workouts for General Physical Preparedness. That means we don't have leg days, back-and-bi days, or cardio days. We believe the body is a whole system and that the best form of training is that which strengthens the body as a whole unit. We do this by performing functional movements that the body was designed to do naturally.
When you come and train at Superhuman CrossFit you won't find machines to train on. Instead you will find free weights, pull up bars, jump boxes, skipping ropes and other functional equipment. When you come to class you will train with people who know your name, motivate you and help you get through those tough workouts.
At Superhuman CrossFit you will be trained to be ready for any fitness challenge. This means you'll be a better runner than the best weightlifter, a better lifter than the best marathoner, and generally physically prepared for anything in your everyday life. Plus you'll live in a healthy body with a strong, lean physique.
The best part is that every workout is lead by a qualified coach. There are no additional fees for the one on one service you will receive every single class. So what are you waiting for? Come in for a free trial and see how Superhuman CrossFit can help you to be the fittest and healthiest that you have ever been!
What can I expect after my first CrossFit workout?
It's our goal that you will feel a part of our amazing community of athletes. You will have certainly learned a ton of new skills and met some great people. It is important to note that you will likely feel a bit sore as well. Particularly if this is the first time you have done physical exercise in this way or if it has been a long time since you have trained. It is important that you move through this soreness and come back in to do a WOD as soon as possible. The less you move through it by coming back in to train and stretch the sorer you will be. So make sure you are aware of this before your first class, make sure you you are intelligent about the intensity you train with on your first session, and then make sure you come back in as soon as possible to continue your training. Consistency is key!


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This article might change your life or make you rich. It's time to save the world. There's a lot of bad news out there. Rising unemployment, soldiers being replaced in their jobs by drones that kill babies, a new housing crisis that will end all housing crisises, who is the real father of Kim Kardashian's child, and on and on.
Meanwhile, many futurists are at work on "what's new for 2013?" Will Lindsay Lohan play Princess Leia's daughter in the new Star Wars movies? Will Tiger Woods make a comeback? Will the Middle East "have tension"?
Forget about 2013 and Princess Leia. While the futurists do their thing let's actually get down to exercising our idea muscles.
The idea muscle atrophies, just like any other muscle. I need to exercise mine every day or it starts to not work. It doesn't matter if you come up with bad ideas or good ideas. There's no such thing as a a bad exercise session.
Let's come up with some real ideas that can save the world. The only criteria – they have to help a million people. Or, if they don't work, can be turned into a science fiction novel that one million people would enjoy. Don't be afraid to come up with bad ideas. Here are mine. Feel free to have idea sex between your ideas and mine so we can come up with even better ideas. This is just practice. Practice makes perfect.
A) I wrote down an idea here but I deleted it. I'm not afraid to admit when ideas are bad. More on this later.
B) Klout as currency. Think about it. It makes sense. If I give $5 to a donut shop that means a lot less than if Barack Obama gives $5 to a donut shop. Then that donut shop is "The Presidential Donut Shop". B's $5 was a lot more valuable than my $5. The $5 is just paper after all. It doesn't matter who holds it.
Klout + currrency = value in today's world. So it makes complete sense that people with higher Klout should be able to buy more things. Because their currency is more valuable than mine. And when they buy things, that infers Klout on the seller, who can now buy more things. The world is heading in this direction anyway. Look at Oprah. Oprah has an infinite Klout score. When Oprah reads a book, that book's author suddenly gets wealthier. If Oprah bought a pencil from me my Klout score would go up 80%, give or take. The middle class is disappearing. The temp staffers pay for goods with scrip and rich people buy twitter followers. We're moving towards a Klout-currency world anyway. Now make it happen.
(In all respect to Josh Gosfeld, author of "The Art of Doing", I just stole the idea you told me you were going to do a science fiction novel about. Sorry.)
C) Use Global Warming to Solve Global Warming. I don't know why nobody has thought of this yet. Just look at the words "Global. Warming." i.e. The surface of the planet is getting hotter. That means it's giving off energy. Use photovoltaic strips to harness the energy coming off the planet to reduce our need for carbon-based energy. BAM! Problem solved.
The beauty of this is that if there is no global warming then the technique won't work. No problem! Go back to carbon then until the planet starts heating again. I am already to meet Al Gore now.
D) 3D Printing of Humans. "3D Printing" seems to be the latest tech fad. But whatever. I don't even know what it is. But here's what "3D Human Printing" is. Let's say I can't make a meeting tomorrow that's in India, 8000 miles away. But I really want to go. I get in my virtual reality suit at home and turn it on. In the conference room in Bangalore, another suit opens up. It opens its eyes. On the video screen in my suit I see what those eyes see. I move my arms and that suit moves its arms. I talk and that suit talks with my voice. My entire awareness feels like it's in the room in Bangalore.
Video conferencing can never replace face to face. And even though this is sort of like advanced video conferencing, the minds of the other people in the room are basically psychologically fooled into thinking I am right there with them. It's just like if you take a robot and give it a human body, many people think it's almost like an actual human even though it's just a computer. This is one idea I can invent personally. And I have motivation. I don't like to travel. I like to sit at home and do nothing. With this invention I can travel all over the world. I can even go to Easter Island. This is sort of like Teleportation 101.
E) Advertising in Houses. This sounds ugly at first. An ad on a wall in your house? Maybe in a frame like a picture. Or a mirror. But here's the deal: I get the price of my house reduced if I agree to allow advertising all over the house. Like if I'm sitting in the bathroom and I see "daily deals" projected onto the shower curtain. The ad agencies agree to subsidize part of the price of my house. It gets better. As part of this, they have software that listens to all my phone calls. Forget "social media". Let's see what I'm interested in when I'm ACTUALLY being social, i.e. talking to people on the phone. If I say on the phone, "I'd really love to go skiing this year but I can't afford it" I start getting offers for skiing trips at a discount on my shower curtain. It's win-win-win. I make money while talking to my friends. My house is cheaper. And companies sell more, improving the economy, hiring more people, and life goes from "bad" to "good".
F) Happiness Hotspots. For ten years I've been getting business proposals like "with our product you will get alerted when your friends are close by". I actually think now is the time this will actually work because of the rise of phablets like the Galaxy Note II. But forget that. When I want to see my friends, I'm not an idiot. I just call my friends and say, "hey, let's meet for coffee."
But let's make this localization thing really life improving. "Studies show" that it's better to be around positive people than negative people. Positive people uplift you, negative people bring you down. So let's do this. Everyone wears an earplug that takes constant scans of your brain activity. The brain scans are matched against a database of 10,000 brain scans labeled "happy" or "sad" and then use standard speech recognition techniques to classify the user brain scan as either "happy" or "sad".
NOW, on my Google Maps on my phone I can see shades all over the map. The brightest colors denote areas where the happiest people seem to be. The darker colors denote areas where negative people are. So if I'm trying to decide today, "hmmm, uptown or downtown?" I can look at the Happiness Map to see where the happiest areas are and go there. Who cares if my friends are there or not? I'll make new friends in the happy hotspots!
G) 40% Unemployment. The reality is, most people should not be at work. Why? Because they are bad at it. It's rare that someone is actually good at what they do. I know maybe ten people that are good at their jobs. This is not a criticism. It's just a fact. And basically, robots are better. That's why Apple is moving production back to the US. Because too many Chinese people were killing themselves in their factories. Robots don't kill themselves and they get the job done faster.
So what society really needs is 40 or 50% unemployment. Here's how you do it. My solution starts off communist but ends up libertarian. Basically, companies get incentivized to replace all humans with robots. The excess profits you get from firing people gets taxed at only half the rate. All of those "robot taxes" get put into a government fund that is used to subsidize the people who are fired (just like farmers are often paid subsidies not to farm). The subsidies, though, run out after three years. So you have three years from the day you are fired to start a new business. Hopefully the business uses robots instead of humans else you won't be able to compete against your higher margin competitors. If you can't start a business then you end up being a temp-staffer somewhere. Don't say this is heartless. This is the way the world is going. That's why the middle class is disappearing. Robots are the new middle class. And everyone else will either be an entrepreneur or a temp staffer. Don't shoot the messenger here. It's already happening. I'm just trying to figure out a way that we can actually accept the 40% unemployment or "underemployment" (which is already at 20%) which is coming.
H) Brain Dating. This is a slight take on "G" above. No dating service works. The divorce rate is going up. Many people are not happy and end up cheating. For the first time, five star hotels like the Parker Meridien are charging by the hour because of cheating dating services like AshleyMadison.com.
So let's solve this and end a lot of misery. Take the brain scans of 1000 couples who are happily married after 40 years. You know the couples that say, "well, we've had our problems but we'v'e survived." Get rid of them. NO PROBLEMS. They are out there. Just a 1000 couples of the 2 billion couples on the planet. Now average the brain scans together.
When you sign up for the brain dating service, you have to submit your brain scan. It averages your brain scan with the brain scans of all the women in the database. Then it matches the results against the database of 1000 happily married people. Whichever combination for you results in the closest match to those 1000 brain scans, you then get set up on date with the woman (or man) behind that brain scan. Price: $10,000. Guarantee: life-long marital bliss or your money back.
I) A "Like" button in my contact lenses. I just read they are making contact lenses that can read SMS texts. That's nice. I like to be in constant communication with everyone I know all the time. But let's take it one step further. I meet you, I like you, BAM, I blink twice quickly and my contact lens registers the like. Now you go about your day and other people who meet you can immediately see, "Sharon has 158 Likes today". And I can also see which of my friends like you.
If you're having a bad day maybe you have only "5 Likes today". No problem. People will avoid you on those days and give you your space. Life is stressful and maybe you need a break. Tomorrow you might be refreshed and get more Likes again. I don't want just "social media". I want social LIFE.
Before I get to "J", I want to explain about "A". The original idea was "Wifi with protein". When nomad tribes got to a new area 15,000 years ago they would think, "Where's the food?" Now, in my nomadic wanderings (i.e. NYC Starbucks locations) I think, "where is the wifi". Wifi has clearly replaced food in our minds. So Wifi with protein would solve the problem, right? But here's the issue. For the life of me, I can't figure out how you would do it. With every idea above I can think of the next step. Ideas are a dime a dozen. It's all about EXECUTION. I just looked up everything I could about molecular biology on wikipedia and I simply cannot figure out how to make Wifi with protein. So I deleted that idea. No good. By the way, if you are Ridley Scott please call me about licensing any of these ideas for a science fiction movie.
J) I don't have a "J". My brain is hurting. If you can come up with a good "J" to help me round this out into 10 ideas I'd be really grateful and if I ever make a company out of it that makes a few billion dollars I'll give you a small piece of the company and part of my Klout score. Please follow me on Twitter so my Klout score goes up. I love you.

subset: commoncrawl


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FRAME ARMS GIRL GOURAI-KAI Ver.2 SAMURAI Form
FRAME ARMS GIRL GOURAI-KAI Ver.2 SAMURAI Form
Down payment: ₱400
Pre Order Deadline: Nov-16 2021
ETA: May-2022
Remaining amount after down payment: ₱2300
Product size: 205mm tall. Material PS, PE, ABS, POM, PVC.
Pre-order process:
1. Choose your preferred product
2. Process the down payment on our Website
3. Once done, please send us a private message on our Facebook page: ShaJo Toy Store (https://bit.ly/37kmvsJ) or send an email to firstname.lastname@example.com
4. Someone from our team will get back to you and will provide the next step
1. Down payment will be deducted to the pre-order price
2. Please expect a private message from FB, text message or email prior to the arrival and/or release date of the product
3. For pre-order on our website, we can only process refund within 24 hours. If you believe there's a mistake with your order and would like to edit/cancel it, please make sure to send us a private message on our Facebook page https://bit.ly/37kmvsJ or send an email to firstname.lastname@example.com. Any cancellation/request to edit after 24 hours will not be accepted.
4. Cancellation of pre-order on our website after 24 hours are not allowed since we're forwarding the down payment to distributor or manufacturer. Furthermore 24 hours rule won't be applicable if you process downpayment 2 days prior to the pre-order deadline/due date.
Reminders: Pre-order process
Reminders: Pre-order process
1. Send us the order number or the screenshot of your payment confirmation to our Facebook page for documentation purposes
2. Minimum down payment will be deducted from the actual pre-order price
3. Please expect a private message from FB, text message, or email before the arrival and/or release date of the product
The shipping fee will be based on the actual shipping rate of each courier:
- Flash Express
- Lalamove
- Grab
Returned customers on the other hand has still option to opt with the Flat rate shipping. PHP 140 shipping fee will be available for a total pre-order down payment amount under PHP 4,000, while PHP 4,001 and above will be automatically considered as free shipping on the same order
For Shopee checkout for the remaining balance and other concerns, please send us a private message on Facebook
Cancel/Edit order
Cancel/Edit order
1. We can only refund the down payment within 24 hours. If you believe that there's a mistake with your order and would like to edit/cancel it, please send a private message to our FB page.
2. Take note that the request for pre-order cancellation is subject to approval.
3. The 24-hour rule won't be applicable if you process the down payment 2 days before the pre-order deadline.
Need support?
Need support?
Contact us at https://www.facebook.com/ShaJoToyStore


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Justin Bieber's Alleged Baby Mama Mariah Yeater -- My Baby Will Take The DNA Test
Justin Bieber Alleged Baby Mama My Baby Will Take the DNA Test
Mariah Yeater -- Justin Bieber's alleged baby mama -- will submit her baby for DNA testing ... this according to her legal team.
Attorney Jeffrey Leving tells TMZ ... his client is NOT avoiding the DNA test, and can't wait to compare baby Tristyn's DNA with Justin Bieber's.
But Leving says he DOES have a big problem with the DNA test Justin has already taken, because a member of Yeater's team was not present while it was administered and he has no idea if the test was done using proper controls.
Although members of Justin's team have told TMZ Yeater and her team had gone radio silent since Justin took the test on Friday, Leving says his co-counsel has been in touch with Justin's lawyer, Howard Weitzman, Monday and Tuesday. Leving says he hopes both sides will reach an agreement on a DNA protocol.
Weitzman could not be reached for comment.


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Natural Solutions to
Chronic Pain
Dr. Frank Painter
The Nutritional Management of Chronic Pain
Chronic pain causes UNBELIEVABLE suffering, disrupts careers and lifestyle, and brings about unimaginable financial drains on our society. It's now estimated that 24 percent of Americans (or approx. 48 million people) suffer from chronic pain. More than one-third of them regularly take pain medicine to manage their suffering. Those statistics are very frightening.
Pain is caused by tissue injury, surgical procedures, and a variety of illnesses. The common pain we experience from a cut or bruise is very well understood. It is referred to as acute pain, and is accompanied by the inflammatory response, which involves local swelling, increased temperature, redness, and loss of function.
Damage to cell membranes during an injury releases two substances that initiate the inflammatory response. They are called prostaglandins and bradykinins. These molecules cause nearby nerve cells to transmit pain information to the brain. Following the formation of a stable clot, fibroblasts migrate to the site of injury to repair the damaged tissues. That is when acute pain is normally extinguished.
Chronic pain is different, because Chronic pain persists.
Our talk tonight is devoted to discussing the Shaklee supplements that can help to reduce or extinguish chronic pain. Supplementation is a safe and effective alternative to using pain medication. We'll discuss this later in our talk. We will also explore how the modern American diet unknowingly contributes to chronic pain syndromes.


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Shake Up Your Clothing Collection with Vans Apparel
You can shake up your clothing collection with Vans apparel that offers vibrant block colour designs and bold logos to give you the edge on the street when it comes to skateboarding style.
Vans apparel came onto the market in 1997 to stand alongside their popular footwear collection. Having made a name for themselves in the skateboarding community; Vans apparel was designed to appeal to those with a similar passion for street sports. Attempting to become the dominant supplier of skateboarding apparel in the US, Vans apparel was created with skaters in mind. Working together with Pacific Sunwear, Vans apparel soon stood out from the crowd when it came to providing durable and stylish skateboarding clothes; competing with established brands such as Rusty and Quicksilver.
Vans Apparel: Tailored to the SkaterDesigned with the skateboard community in mind, Vans apparel has been tailored to stand up to the everyday rough and tumble that professional and amateur skaters get into. As a result, Vans apparel is made from durable, tough materials that can be put through their paces and still look great. Warm and protective; Vans apparel is versatile enough to wear every day. Form large thermal hoodies to stay-cool t-shirts; Vans apparel comes in a range of garments to suit the everyday needs of the skater. Clothing can be layered and stripped to suit the level of activity and weather conditions; ensuring comfortable skating and optimum performance throughout the day.
Classic Fashions with a Twist: Vans ApparelKnown for their stand-out shoe designs; Vans took their apparel to another level. With innovative designs and large logos; Vans apparel offers statement style that doesn't compromise on quality. Their latest t-shirts, hoodies and accessories have seen a revival of their original branding with a modern twist. Classic trends have been fused with modern retro-inspired styling for a fresh new streetwear look. From day to evening; Vans apparel can be dressed up or down to suit any occasion.
Vans Apparel from FootasylumIf you are looking for trendy and functional Vans apparel to shake up your skater clothing collection; you can find an array of the latest styles and designs at Footasylum. Our online selection of Vans apparel has something to suit every individual style. Browse our range of Vans apparel online today.


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Advanced Search
Founder extends goodwill gesture in hopes of promoting use of genuine versions of Windows software.
Founder Technology President Qi Dongfeng said the company would buy $250 million worth of licenses for a Chinese version of Windows over the next three years, to be used on computers sold in China. The two companies also agreed to work together to promote the use of genuine versions of Windows.
The agreement, which company officials signed at Microsoft's Redmond headquarters, follows high-level talks Tuesday between U.S. and Chinese officials in which China pledged to crack down on piracy and require computers to use legal software. Piracy is thought to be extremely widespread in China, hampering Microsoft's efforts to make money in the vast and growing market.
The signing ceremony also comes ahead of a visit next week by Chinese President Hu Jintao, who will visit Microsoft headquarters and dine at the home of Microsoft Chairman Bill Gates.
Other computer manufactures also have already begun efforts to increase the number of computers running legitimate Windows versions.
Last week, Chinese PC manufacturer Tsinghua Tongfang Co. Ltd. signed an agreement to purchase $120 million worth of Windows licenses over the next three years for the Chinese market.
And in November, computer maker Lenovo Group Ltd. pledged to start loading most of the computers it manufactures for China with the Windows operating system. Lenovo is based in Purchase, N.Y., but manufactures its computers in China.
More TechLibrary
More Webcasts


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CISPA's proponents bent over backward to respond to reasonable complaints, but the extremists are still complaining. Anonymous and Mozilla (much of which is foreign, no?) are whining, but nobody ever points to any specific, offending verbiage of the bill. Am I the only one who reads tech bills before complaining about them?
Even Democrats are having to start acknowledging Republican expertise in tech leadership, though. Darrell Issa is the leader of quite a gang in DC.
FCC on the other hand…
FCC is still going to totally nuts. We're now regulating channel numbers. Seriously. This is out of control.
We're also arbitrarily delaying decisions because we're not meeting our own deadlines, allegedly over a minor complaint that has been addressed. But no, there must be complaints and delays anyway. The rules must move to suit the extremists.
Extremists who now wish to silence critics of the administration ahead of the election. Funny, that.
A more interesting question the FCC is tackling: Should police be able to jam cellular phone signals in riot situations?


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CHARLOTTE, N.C. — Authorities have filed criminal charges against a mother accused of driving around barricades during a hurricane, resulting in the drowning death of her 1-year-old son.
Union County Sheriff's detectives say that Dazia Ideah Lee, 20, of Charlotte, drove around highway barricades and kept going east until her vehicle encountered rushing water flowing across the road during Hurricane Florence.
Her car left the roadway and came to a rest among a group of trees where she managed to free herself and her 1-year-old son Kaiden Lee-Welch. However, she lost her grip on Kaiden in the rushing water.
Related: 1-year-old dies after being swept away by floodwaters from Florence
"The tragic death of this child and the circumstances surrounding this case are heartbreaking. We continue to pray for all those suffering as a result of this child's death," Sheriff Eddie Cathey stated. "However, after a very thorough investigation and taking all facts into consideration and applying the law, we feel that these charges are appropriate."
Lee faces a charge of involuntary manslaughter and a misdemeanor charge of driving on a closed/unopened highway in connection with the death of her son.
She is due in court on November 20, 2018.


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Last updated: January 20, 2010
Promoting Safe and Effective Genetic Testing in the United States - Chapter 5
Promoting Safe and Effective Genetic Testing in the United States
Chapter 5
Genetic Testing for Rare Inherited Disorders
The vast majority of single-gene (Mendelian) disorders are rare, occurring less often than 1 in 10,000 live births. Exceptions are sickle cell anemia, cystic fibrosis, thalassemia, and Tay-Sachs disease in some populations, and heterozygous familial hypercholesterolemia, Duchenne muscular dystrophy, and the hemophilias more generally. Phenylketonuria, for which newborns are routinely screened, occurs in slightly less than 1 in 10,000 births. Most of the several thousand other known inherited diseases occur much less frequently, but their combined incidence is by no means rare. Between 10 and 20 million Americans may suffer from one of the several thousand known rare diseases over their lifetimes.1(p. xiii) With the discovery of the role of inherited mutations in common diseases, such as breast and colon cancer and Alzheimer disease (albeit in a small proportion of affected people), the Task Force is concerned that research might shift away from the multitude of rare diseases. Commercial genetic test developers, for instance, expend a greater effort on the common, complex disorders than on rare ones (see table 3, Appendix 3). The development and maintenance of tests for rare genetic diseases must continue to be encouraged.
Congress recognized the need to provide incentives for the development of drugs for rare diseases when it passed the Orphan Disease Act in 1983.2 To stimulate research and development, it granted a 7-year period of market exclusivity for unpatented drugs, a tax credit to offset the cost of drug development (the tax credit expired in 1994), and government grants and contracts to help defray costs of clinical studies. Over 300 grants have been awarded, primarily to support the development of drugs and biologics. (Personal communication, Dr. John V. Kelsey, Office of Orphan Products Development, FDA, February 22, 1996) In 1988, Congress added medical devices, authorizing government grants and contracts for "defraying the costs of developing medical devices for rare diseases or conditions."3 Devices now account for about 10 percent of all orphan products receiving assistance under the Act.
As part of the Safe Medical Devices Act of 1990, Congress enacted the Humanitarian Device Exemption "to encourage the discovery and use of devices intended to benefit patients in the treatment and diagnosis of diseases or conditions that affect fewer than 4,000 individuals in the United States."4 The incentive to device manufacturers is temporary authorization to market the device without meeting the effectiveness requirements of FDA. The exemption lasts for 18 months, although it can be renewed for up to five years. During the period of the exemption, the manufacturer cannot obtain a profit on device sales; the device must receive pre-market approval before a profit mark-up can be included in the price. In addition to the special incentives under these Acts, approximately 20 percent of the National Institutes of Health (NIH) budget funds research that is related to rare diseases, of which about 90-95 percent are inherited. (Personal communication, Steven Groft, Director Office of Rare Diseases, NIH, October-November 1996)
There is no uniform definition of a rare disease. The Orphan Drug Act (ODA) defines orphan disease as one affecting less than 200,000 persons in the U.S., or approximately 1 in 1,250 Americans. For devices (which include genetic tests), the 1988 ODA Amendments define rare disease as "any disease or condition that occurs so infrequently in the United States that there is no reasonable expectation that a medical device...will be developed without [financial] assistance."a As already noted, the Humanitarian Device Exemption of the Safe Medical Devices Act of 1990 applies to diseases or conditions that affect fewer than 4,000 persons in the United States (1 in 62,500 Americans). It is silent on what constitutes a disease or condition (e.g., whether rare variants of a common genetic disease constitute a separate disease, or whether carriers are excluded). The carrier (heterozygote) frequency for autosomal recessive disorders with an incidence of 1 in 10,000 is 1 in 50.
Of great concern to the Task Force is the dissemination of information related to the diagnosis and management of rare diseases, the continuing availability of tests for their diagnosis and for predicting risk of future disease, and, finally, the quality of laboratories performing genetic tests for rare diseases. We consider these topics in turn in the remainder of this chapter.
Research Activity
The NIH Office of Rare Diseases (ORD), founded in 1994, maintains a database of clinical studies involving rare diseases that are funded by NIH. At the end of 1996, approximately 300 studies were contained in the database. ORD plans to expand the database to include clinical research supported by private organizations, including the biotechnology and pharmaceutical industries. When fully operational, the database will contain abstracts of studies, enrollment criteria, and the names of principal investigators and how to contact them. The database is available to patients, providers, and other researchers on the World Wide Web as part of the National Institutes of Health's clinicaltrials.gov site. In the future, people may be able to contact principal investigators of clinical studies through the databases. ORD would also like to coordinate rare disease research by the establishment of an information center, which would also respond to inquiries about rare genetic disorders. Funds have been authorized but not appropriated.
The Metabolic Information Network (MIN) (Dallas, Texas) is a registry containing medical information on approximately 10,000 living and deceased patients with any one of 86 metabolic disorders. Funded originally by the National Institute of Child Health and Human Development, MIN currently receives most of its support from pharmaceutical companies. Through MIN, an investigator doing research on a particular disease can locate other investigators doing related research. Names of patients are not included in the registry and requests for investigator-to-investigator contact are reviewed by a scientific advisory board.
A major concern of the Task Force is that as tests to diagnose and, in many cases, to predict, rare diseases are developed, data will not be systematically compiled on their clinical, as well as analytical validity. A comprehensive system to collect data on rare diseases must be established. As discussed in Chapter 2, the Center for Disease Control and Prevention (CDC) can and should play a role in coordinating data collection from multiple sources to facilitate the review of new genetic tests, particularly for rare diseases. Multiple sources will almost always be needed to validate tests for rare diseases. CDC and ORD should work closely to develop the appropriate data-gathering and monitoring systems to assess the validity of genetic tests for rare diseases.
Finding Information on the Interpretation of Clinical Findings
Some rare genetic diseases present with unusual symptoms or signs, making diagnosis relatively easy for knowledgeable physicians. Many rare inherited metabolic disorders present with commonly encountered problems for which the usual explanation is not a rare disease.5 When the clinical problem persists or recurs despite treatment, health care providers must be aware that a rare disease could be the explanation. Prompt recognition can often save the patient's life by leading to initiation of effective therapy before irreversible damage occurs. Many of these metabolic disorders appear in infants and children; early diagnosis can alert the parents to their risk of having another affected child. Several tests can be used predictively for prenatal diagnosis. Carrier testing in collateral relatives is often possible.
Unfortunately, the diagnosis of rare diseases is often delayed. One reason for the delay is inaccessibility of information. Physicians who encounter patients with symptoms and signs of rare genetic diseases should have access to accurate information that will enable them to include such diseases in their differential diagnosis, to know where to turn for assistance in clinical and laboratory diagnosis, and to locate laboratories that test for rare diseases. The commonly encountered symptoms and signs with which rare diseases present and the process of evaluating them should be taught to medical students and residents. It would be too much to expect health care providers to retain information on all the unusual presentations, but they should be taught where to seek information. Although textbooks and medical journals are the classical starting points, and referrals to specialists may help, computerized databases in which a user could search by the patient's presenting finding would be more expeditious and effective. Most available information is organized by disease, not by presenting findings. The National Organization of Rare Diseases, Inc. (NORD) publishes The Physician's Guide to Rare Diseases, which includes an atlas of visual diagnostic signs. NORD also maintains the rare disease database [rarediseases.org] containing entries on over 1,100 rare diseases. The database is logically organized by a description of the disorder, symptoms, causes, affected population, related disorders, diagnostic procedures, status of treatment (investigational or standard of care), resource referral for further information and support, and references from peer-reviewed medical literature.
Although primarily providing information to researchers, the Metabolic Information Network can provide information to physicians on over 200 metabolic disorders.
Once diagnoses are made, patients and/or their families often want written information about the diseases. In a survey of 270 physicians conducted about 10 years ago, 42 percent were unable to find printed information to distribute to their patients with rare diseases.1 NORD's database on rare diseases has since been made available to consumers. NORD also maintains a Patient Services Department, one of whose functions is to help affected individuals and families in need of accessing services. The Department also maintains a confidential patient registry.
Information about individual disorders, particularly for consumers, is also available through individual genetic support organizations, which can be located through NORD (Washington, DC) or the Alliance of Genetic Support Groups (Chevy Chase, Maryland).
Finding Clinical Diagnostic Laboratories
Because of the rarity of many diseases, only one or a few laboratories in the United States, or the world, accurately perform tests for them. This raises the problem of how physicians caring for patients will be able to identify these laboratories in time to benefit patients who present with acute illness.
The Helix Directory of Medical Genetics Laboratories, supported by the National Library of Medicine, lists approximately 300 laboratories that perform tests on over 480 genetic diseases. Helix began by listing laboratories performing DNA-based tests including fluorescent in situ hybridization (FISH), but will extend to biochemical tests in the future. As of July 1997, Helix has 4,500 registered users and receives 150 requests per day. (Personal communication, Maxine L. Covington, Helix Directory Manager, July 23, 1997) Helix provides information by phone and fax, but it is encouraging inquiries via the World Wide Web (note: Helix is now part of Geneclinics) [geneclinics.org]. As many of the laboratories entered in the database do not want to be contacted directly by patients, passwords for entry to the database are available only to health care providers. Consequently, Helix is not listed in NORD's databases.
Through ORD's database on clinical research studies, physicians can get help in the diagnosis of patients in whom they suspect particular rare diseases. To maintain and expand its database, ORD should identify laboratories worldwide that perform tests for rare genetic diseases, the methodology employed, and whether the tests they provide are in the investigational stage, or are being used for clinical diagnosis and decision making.
Need for Coordination
The Task Force is concerned that there might be some unnecessary duplication of effort in compiling databases while, at the same time, some diseases or laboratories offering tests will not be included. In addition to the databases mentioned so far, several other organizations, including the Alliance of Genetic Support Groups, some of its member organizations, and other independent genetic disease interest groups maintain databases and, in some cases, patient registries. The American Academy of Pediatrics provides information periodically on newborn screening and other disorders. The Society for Inherited Metabolic Disorders is compiling information for providers about diagnostic evaluations of rare disorders, and ACMG is developing databases on tests that should be used to diagnose specific disorders. In order to avoid redundancy and to use the expertise of these organizations more efficiently, NIH should assign its Office of Rare Diseases (ORD) the task of coordinating these efforts and provide ORD with sufficient funds to fulfill the Task Force's recommendations on rare diseases. ORD should periodically report to the proposed Secretary's Advisory Committee on the status of these activities. With CDC playing a greater role in genetics, it should be closely involved in activities in this area.
The clinical diagnostic tests for some rare diseases are available only from laboratories that are primarily engaged in research. Some of these laboratories perform clinical tests at no cost to the patient and with the primary purpose of furthering their own research. This raises two questions: First, what happens to the availability of the test for clinical diagnostic purposes when the laboratory (or laboratories) performing the assay ceases to do so because it switches to other research projects or for other reasons? Second, as discussed in the concluding section, how can the quality of clinical test performance be assured in laboratories engaged primarily in research?
Research laboratories that were offering genetic tests for rare diseases will cease performing them as they complete their investigations and move on to other areas of interest. This is particularly a problem for the continued availability of clinical tests when only one research laboratory performed the test. It is not unlikely, however, that as progress on a given rare diseases is made, all of the research laboratories offering tests will move on to solve other problems.
The Task Force considered the transitioning problem at great length. It rejected the possibility of creating central or regional laboratories that could perform a wide range of tests for rare diseases because assembling the necessary expertise for performing and interpreting all of the tests under one roof would be difficult or impossible. For the same reason, it rejected transfer of these tests to large mega-test commercial laboratories that might be willing to add on tests for rare diseases if they could cover costs. The Task Force also considered whether agencies funding research that included the development and offering of tests for rare diseases should be asked to allocate a small part of the grant or contract they awarded to enable the investigator to transfer the test to a service laboratory just before funding for the research terminated. This might discourage investigators from applying for grants if they were reluctant to take on this responsibility. Agencies funding research might also be reluctant to use funds to establish service activities. They might also have concerns about the quality of the tests being offered as a service.
The Task Force is not convinced that the transitioning problem is insurmountable. One possibility is that a laboratory that was offering genetic tests as part of its research, but on which clinical decisions were being made, procure CLIA certification (see below) and serve as a service laboratory, recovering its costs for the test by instituting charges for it. Another possibility is for the research laboratory to transfer the testing capabilities to the clinical diagnostic laboratory in its institution. The proximity of the expert investigator could facilitate a smooth transition and ensure the test would be performed and interpreted properly. A third possibility is that the test be transferred to a research laboratory elsewhere that is willing to perform the test as a service. In this case, mechanisms are needed to ensure that providers know where to obtain the test. Whichever alternative is adopted, the test should undergo some form of external review before transition to a service.
The NIH Office of Rare Diseases should have the lead responsibility in ensuring the continued availability of safe and effective tests for rare diseases when it learns that a test will cease being offered. Funds to enable it to accomplish this task should be available. Laboratories should notify ORD about impending cessation of their testing so that provisions for a transition to other laboratories can be made. ORD should, in turn, notify other laboratories when a demonstrably safe and effective genetic test ceases to be available and make every effort to get another laboratory to perform it. If this fails, ORD should notify the other organizations with whom it coordinates, as well as the proposed Secretary's Advisory Committee.
Neither the clinical nor the laboratory diagnosis of rare inherited diseases is easy. If clinicians do not mention the possibility of a rare disorder when they order clinical laboratory tests, the laboratory might not test for them. Clinical laboratories, too, might misinterpret abnormal findings, often neglecting rare disorders in favor of more common situations, such as poisoning. Some clinical laboratories do not have the equipment or expertise to diagnose a rare disorder, but clinicians might not realize it. (That is one reason why directories of qualified laboratories, as will be discussed further, are so important.) Many rare disorders will be diagnosed only by special laboratories accustomed to looking for rare diseases and having the equipment and expertise to do so.
Some genetic tests for rare diseases have been developed in research laboratories under grants. In accordance with current law, the Task Force recommends that any laboratory performing any genetic test on which clinical diagnostic and/or management decisions are made should be certified under CLIA. Research laboratories that are not currently providing genetic test results to providers or patients but that plan to do so in the future must register under CLIA. Once a laboratory registers, it does not have to wait for a survey (see Chapter 3) before performing clinical tests.
Some research laboratories have complained of the difficulty and expense of obtaining CLIA approval for tests that constitute a small part of their activity and will only be performed occasionally. A laboratory performing 2,000 or fewer tests a year can register for $100 and obtain certification for $300 (including onsite inspection for its first two years.)b
The Task Force recognizes the important contribution that research laboratories make to clinical testing, particularly for rare diseases. The type of skills that are needed for research, including a willingness to modify experimental conditions, are not necessarily the skills for maintaining the quality of a service laboratory, in which consistency of performance ensures reliability. Research laboratories that provide physicians with results of genetic tests, which may be used for clinical decision making, must validate their tests and be subject to the same internal and external review as other clinical laboratories. Nevertheless, the proposed genetics subcommittee of CLIAC should consider developing regulatory language under the proposed genetics specialty that is less stringent, but does not sacrifice quality for laboratories that only occasionally and in small volume perform tests whose results are made available to health care providers or patients.c
Of great concern to the Task Force, discussed at length in Chapter 3, is whether certification under CLIA will ensure the quality of genetic tests, particularly those for rare genetic diseases. The creation of a subspecialty of genetics under CLIA will greatly improve the situation. Many tests for rare disorders are biochemical. The quality of performance of these tests would be ensured if they were included under a genetics specialty.
Directories of laboratories that perform tests for rare genetic diseases should indicate whether or not the laboratory is CLIA-certified and whether it has satisfied other quality assessment and proficiency assessments, such as those provided by CAP and ACMG. Directors of these laboratories are encouraged to participate in these programs or other programs of at least comparable quality that may be established.
The Task Force is concerned that third-party payers, including managed care organizations will not recognize that tests for rare diseases can only be performed in certain highly-specialized laboratories. Patients will be misdiagnosed and harmed unless these laboratories are used. The Society of Inherited Metabolic Diseases is preparing a list of laboratories qualified to perform tests for several rare diseases. The Helix database should also indicate whether the laboratories listed in it are CLIA-registered and/or certified. When the proposed genetics specialty is established, the directories should indicate whether the laboratory performing genetic tests is certified in that specialty or the appropriate subspecialty.
- National Commission on Orphan Diseases: Report of the National Commission on Orphan Diseases. 1989;(Abstract)
- Public Law 97-414: 1995;U.S.C. Sec 360aa et:(Abstract)
- Public Law 100-290: Orphan Drug Amendments of 1988. 1995;U.S.C. Sec 360cc(a):(Abstract)
- Public Law: Safe Medical Devices Act of 1990. 1995;U.S.C. Sec 360j(m):(Abstract)
- Holtzman NA: Rare diseases, common problems: Recognition and management. Pediatrics 1978;62:1056-1060.
- Shoemaker JD, Lynch RE, Hoffmann JW, Sly WS: Misidentification of propionic acid as ethylene glycol in a patient with methylmalonic acidemia. Journal of Pediatrics 1992;120:417-421.
- Woolf AD, Wynshaw-Boris A, Rinaldo P, Levy HL: Intentional infantile ethylene glycol poisoning presenting as an inherited metabolic disorder. Journal of Pediatrics 1992;120:421-424.


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Create a Website Account - Manage notification subscriptions, save form progress and more.
The Rockdale City Council adopted guidelines to make Rockdale "film friendly". The guidelines require anyone wanting to film a movie, television episode, commercial or training film to submit an application to the city manager. The guidelines give the city manager the authority to close streets or restrict, if necessary, the use of any public property during the filming. The guidelines do not restrict or give the city manager any authority over the filming of private property--those matters would be between the filming company and the property owner. There are no fees for submitting an application or filming in the city of Rockdale. For more information, download a complete copy of the guidelines (PDF).


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Practically lost in the brouhaha concerning the effects of the imminent changes in lease accounting has been the impact they could have on lessees' relationships with their banks.
Bankers are warning that altering lease accounting could significantly change a borrower's balance-sheet profile, possibly making it look more leveraged than it actually is. The changes could also worsen the financial ratios that govern a loan's covenants, to the point where the borrower is in violation of its agreement with the bank.
With a final vote by the Financial Accounting Standards Board and the International Accounting Standards Board on lease accounting rules possible as soon as mid-March, the focus has been on their advantages for investors and the difficulty corporate finance and accounting departments might have in complying with the rules.
Following vociferous objections by senior corporate finance executives and others to the most recent plan delivered last May, the boards are now mulling new ways to proceed on lessee accounting. Whatever changes the boards do make, however, one thing is nearly certain: the assets and liabilities of what are now operating leases will henceforth be recorded on corporate balance sheets.
No matter how the boards decide to make that happen, the current apple cart of the relations between companies and their lenders is bound to be upset, experts say. That's because the calculations of many of the key ratios governing bank covenants, such as earnings before interest, taxes, depreciation, and amortization (EBITDA), debt-to-equity (D/E) and return on assets (ROA), are bound to come out a whole lot differently for many companies.
Especially affected by a new system would be companies that retain the right to use equipment or real estate via operating leases. The assets and liabilities of such leases, which are tantamount to rentals, aren't currently reported on corporate balance sheets. (Lessees are required to put capital leases, in which the lessee essentially agrees to buy the asset with financing help from the lessor, on their balance sheets.)
But under the boards' lease accounting exposure draft, however, banks would likely see a whole lot more debt and assets on the loan applications of corporations bound by operating leases.
Oddly, the changes are likely to be favorable for many corporations when it comes to EBITDA. That's because a large amount of what's currently operating expense on lessee income statements would be reported on balance sheets as debt and amortization. "If we required minimum EBITDA of $25 million … the customer's financial performance could deteriorate[,] yet it could meet the covenant," Roger May, president and board chairman of CBI Equipment Finance, a subsidiary of Commerce Bank, wrote FASB Chairman Russell Golden in September 2013.
Precisely because of the appearance of all that debt, however, bankers could be looking at a raft of borrowers with much gloomier D/E ratios. Thus, "even though the customer's financial performance has remained the same," its higher leverage ratio under the proposed lease accounting standard could violate its debt covenant with the bank, wrote May. That would require the borrower to obtain a waiver for breaking the covenant and to re-document the loan request, and both actions would involve fees.
Besides friction with their clients, bankers have other reasons to be touchy regarding changes to lease accounting rules that might make their clients look more indebted. "Changes to financial statements of banks and their borrower customers would be vast," Dennis E. Dixon, the president of International Bancshares Corp. wrote Golden in October. "The final impact of these changes will probably result in a de facto increase in the regulatory capital requirements of financial institutions. This is especially troublesome because financial institutions are already subject to increased capital levels due to Dodd-Frank and the Basel III capital requirements."
The current situation in lease accounting is a difficult one for CFOs, because without final guidance from FASB and IASB, it's hard to know how to approach bankers. However, "what we are suggesting to our client base is, 'Don't start doing the accounting yet, because it might very well change. But start talking to your lenders and the people who hold your covenants, because you might be able to reach some accommodation with them,'" advises Richard Stuart, a partner in the national accounting standards group at McGladrey.
One possibility is for finance chiefs to try to persuade their lenders to allow current lease accounting to apply to their covenants, even if new standards are needed to satisfy generally accepted accounting principles, he says.
But when it comes to lease accounting, every silver lining may have its cloud. "That could be beneficial to you, but you still have the cost of having to keep up another set of books," Stuart adds.
Image: martymadrid, via Flickr


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Barnabas Project
- Type:
- Education
- City:
- Santo Antão do Tojal
- Ministry Type:
- Children and YouthTeaching (Language)
The vision is to provide 2 year traineeships for third year or Masters level university students and/or graduates. This "Programa Barnabé" already functions in other cities of Portugal under the local direction of GBU (Grupo Biblico Universitaria) and involves the trainee in an intensive training programme for effective ministry amongst university students in local church settings, through combining theological and cultural studies, practical ministry experience and mentorship. God has graciously provided an apartment which can accommodate up to 5 students, and currently we have two postgraduates in the programme, Marta and Denise.


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Brander Matthews (1852–1929). The Short-Story. 1907.
By Ludovic HalévyXVII The Insurgent
"Yes, Colonel," answered the prisoner. "You assigned me a little lawyer who has defended me in his fashion. I want to defend myself in my own.
"My name is Martin,—Louis Joseph. I'm fifty-five. My father was a locksmith. He had a little shop up in the St. Martin quarter, and he had only a little business. We were able to live. I learned to read in the National, which was, I believe, Monsieur Thiers's newspaper.
"The 27th of July, 1830, my father went out early in the morning. That evening, at ten o'clock, they brought him back to us, dying on a litter; he had received a bullet in the chest. By his side, on the litter, was his gun.
"'Take it,' he said to me; 'I give it to you,—and whenever there shall be an insurrection against the government,—always, always, always!'
"An hour after he was dead. I went out into the night. At the first barricade, I stopped and offered myself. A man examined me by the light of a lantern. 'A child,' he cried. I was not yet fifteen. I was very small, very undersized. I answered, 'A child, that's possible; but my father was killed two hours ago. He gave me his gun. Teach me how to use it.'
"From that moment I became what I have always been for forty years—an insurgent! If I fought under the Commune, it was not because I was forced for the thirty cents. It was from liking, for pleasure, by habit, by routine.
"In 1830, I behaved myself bravely enough in the attack on the Louvre. That boy who first climbed the iron fence under the fire of the Swiss, that was I. I received the Medal of July; but the shopkeepers gave us a king. We had all our work to do over again. I joined a secret society; I learned how to cast bullets, to make powder. In a word, I completed my education,—and I waited.
"I had to wait nearly two years. June 5, 1832, at noon, before the Madeleine, I was the first to unhitch one of the horses from the hearse of General Lamarque. I spent the day crying, 'Hurrah for La Fayette!' and the night making barricades. The next morning we were attacked by the regulars. That afternoon, about four o'clock, we were shut in, bombarded, swept with grapeshot, crushed in the church of St. Méry. I had a ball in my body and three bayonet wounds when the regulars picked me up, on the steps of a little chapel on the right,—St. John's chapel. I used to go back often to that little chapel,—not to pray, for I hadn't been brought up in those ideas,—but to see the stains of my blood which still mark those stones.
"On account of my youth I had only ten years of prison. I was sent to Mont-St.-Michel. That's why I didn't have a hand in the risings of 1834. If I had been out, I should have been fighting in the rue Transnonain, as I had fought in the rue St. Méry, against the government,—always, always, always. That was my father's last word, my evangel, my religion. I called that my catechism in six words. I got out of prison in 1842, and I began again to wait.
"The Revolution of 1848 made itself. The shopkeepers were stupid and cowardly. They didn't go with us, nor against us. Only the city guards defended themselves. We had a little trouble in capturing the post of the Chateau-d'Eau. The night of the 24th of February, I stayed three or four hours on the Place de la Hôtel de Ville. The members of the provisional government, one after another, made speeches to us; they told us we were heroes, great citizens, the foremost people in the world,—that we had thrown off the yoke of tyranny. After having fed us on these fine words, they gave us a Republic which wasn't any better than the Monarchy we had upset.
"In June, I took up my gun again, but this time it didn't succeed. I was arrested, condemned, sent to Cayenne. It seems that I behaved myself out there. One day, I saved a captain of marines who was drowning. They thought that was very fine. Remember that I'd have shot that captain, if he'd been on one side of a barricade and I on the other, but a man who is drowning, who is going to die—well, I was pardoned. I got back to France in 1852, after the Coup d'État; I had missed the insurrection of 1851.
"At Cayenne, I had made a friend, a tailor named Bernard. Six months after I left for France, Bernard was dead. I went to see his widow. She was in dire poverty. I married her. We had a son in 1854. You will understand soon why I speak of my wife and my son. Only you ought to doubt already whether an insurgent who marries the widow of an insurgent has royalist children.
"Under the Empire there was nothing doing. The police had a hard hand. We were dispersed, disarmed. I worked, I brought up my son in the ideas that my father had given me. It was a long time waiting. Rochefort, Gambetta, the public meetings, all that started us up again.
"At the first serious chance I showed myself. I was one of the little group that assaulted the barracks of the firemen of La Villette. Only there there was a fool thing done. They killed a fireman without necessity. I was taken, thrown in prison; but the government of the 4th of September let us out, from which I concluded that we had done right in attacking the barracks and killing the fireman, even without necessity.
"The siege began. From the start I was against the government, for the Commune. I marched against the Hôtel de Ville the 31st of October and the 22d of January. I loved revolt for the revolt itself. An insurgent, I told you at the start; I am an insurgent. I can't see a political club without going in, an insurrection without running to it, a barricade without taking my stone to it. That has passed with my blood.
"And then, besides, I wasn't altogether ignorant; and I said to myself, 'We've only got to succeed one day, down to the bottom, and then in our town, we shall be the government; and things will go a little better than with all the lawyers who get behind us during the fight and go ahead of us after the victory.'
"The 18th of March came, and naturally I took part. I cried 'Hurrah for the regulars!' I fraternized with them. I went to the Hôtel de Ville. I found there a government at work—absolutely, as on the 24th of February.
"Now you tell me that this insurrection was not lawful. That's possible, but I don't know quite why. I begin to get muddled between these insurrections which are a duty and these insurrections which are a crime. I don't see any great difference.
"I fired on the Versailles troops in 1871 as I had fired on the Royal Guard in 1830 and on the City Guard in 1848. After 1830 I had the Medal of July. After 1848 I had the compliments of Monsieur de Lamertine. This time, I'm going to have transportation or death.
"Some insurrections seem to please you. You put up columns to them, you name streets after them; and you give yourselves the places, the offices, the big salaries; and we others, who made the revolution, you call us 'great citizens,' 'heroes,' 'brave people,' etc., etc. It is with that sort of small change that you pay us.
"And then, some other insurrections don't seem to please you. After those, you distribute exile, transportation, death. Well, now, if you had not paid us so many compliments after the first lot, perhaps we might not have made the second. If you had not put up the Column of July in our quarter, perhaps we might not have gone to your quarters to pull down the Vendôme Column. Those twopenny trumpets didn't agree. One had to upset the other; and that's what happened.
"Now, why I threw in a corner of the street my captain's uniform on the 26th of May, why I was in my blouse when I was taken, I'll tell you. When I learned that those fellows of the Commune, instead of standing up to the fire with us on the barricades, were distributing thousand-franc notes to themselves at the Hôtel de Ville, shaving their beards, dyeing their hair, and going to hide themselves in cellars, I wasn't willing to keep the epaulets they had given me.
"Besides, these epaulets annoyed me. 'Captain Martin' was all foolishness. The 'insurgent Martin,' if you like. I wanted to end as I had begun, to die as my father had died, like an insurrectionist in an insurrection, a barricader in a barricade.
"I wasn't able to get myself killed. I was taken. I belong to you. Only I'd like to ask one favor. I've a son, a boy of seventeen; he's at Cherbourg, on the hulks. He's been fighting, that's true, and he won't deny it; but it was I who put the gun in his hand: it was I who told him that his duty was there. He listened to me. He obeyed me. That's all his crime. Don't condemn him too harshly.
"As for me, you've got me; don't let me go,—that's the advice I give you. I'm too old to change, and besides, what would you have? Nothing can alter what is; I was born on the wrong side of the barricade."


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Zadar Celadon linen cushion 50x50cm
Feather insert NOT included
Zadar is a striking block print inspired by the motifs found in antique Uzbek ikat coats. This fabric has been hand block printed by artisans on 100% linen.
- 50cm x 50cm
- Pipe edge finish
- 100% linen
CARE INSTRUCTIONS: Cold machine wash separately, delicate cycle, mild detergent. Do not tumble dry, soak or bleach. Iron at medium setting if necessary. Due to the nature of hand printed fabrics, variation in colour and pattern may occur.


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Warning: This is an opinion piece, and may not reflect the opinions of my co-bloggers, The LEGO Company, or custom-accessory producers (whose products appear here for illustration purposes only). This post may also include external links to opinions and facts you may not agree with, so read the whole post and share your own thoughts in a comment.
We feature so many LEGO military creations here on The Brothers Brick that all those fighters, battle dioramas, and tanks have their own category. There's also a lively discussion going on among commenters in the LEGO City 2010 post. Between Independence Day last Friday here in the United States, my own pacifist upbringing, and this recent discussion, I've been giving some serious thought to the convergence of LEGO bricks and the military, and the differences between realistic and fantasy violence.
I myself have built plenty of LEGO military creations, most frequently to illustrate the most accurate historical use for custom accessories I'm reviewing. I'll also admit that like many males, I have a strong fascination with things that go "Boom!"
In responses to questions from Gizmodo readers, here's what a LEGO Company representative said recently:
Q: Are there any chances that Lego will ever start producing modern day warfare Lego, with tanks and helicopters and what not?
A: We have a strict policy regarding military models, and therefore, we do not produce tanks, helicopters, etc. While we always support the men and women who serve their country, we prefer to keep the play experiences we provide for children in the realm of fantasy.
Some LEGO fans argue that LEGO has, in fact, released military-themed sets in the past:
- 7477 T-1 Typhoon vs. T-Rex: The helicopter looks remarkably like a Russian Mi-24 "Hind".
- 7475: Fire Hammer vs. Mutant Lizards: The off-road vehicle looks a lot like a Humvee.
- 4953 Fast Flyers: The main jet model resembles an F-14 Tomcat.
And of course, there have been elements of conflict throughout many of LEGO's themes, going all the way back to the earliest police and castle sets of the 1970s. More recently, LEGO has even included realistic-looking guns in Wild West, Star Wars, Batman, Indiana Jones, and other themes.
This leads to the obvious question from another Gizmodo reader:
Q: Why did they changed the founders rule to never make gun like elements?
A: The company still has a no gun policy when it comes to realistic or military play scenarios. However, in order to stay true to the strong licensed properties we incorporate to the Lego portfolio, we need to stay true to those properties and sometimes that involves including weapons. In our own play themes, some element of good vs. bad conflict is typically considered to provide for role play opportunities. In those instances, the setting is very clearly a fantasy world.
The distinction makes sense to me. Most 10-year-olds aren't going to mistake a set that includes dinosaurs and a four-wheeler with a lightly-armored Humvee avoiding improvised explosive devices. Similarly, dwarves fighting goblins, the undead, or even each other are unlikely to evoke images of coalition forces putting down the insurgency in Fallujah.
If LEGO were to create sets based on the military, that begs the question, "Which military?" LEGO is a global company. If they were to design military sets, which countries should be represented? Royal Danish Jægerkorpset (special forces) or HDMS Absalon? American A-10 Thunderbolt (with depleted uranium flick-fire action!) and M1 Abrams tank? Russian R-36 ICBM (with pop-out MIRV warhead action!) and Sukhoi Su-27?
Or perhaps LEGO could take its inspiration from the military history of the past 100 years. Would you buy an Allied flamethrower set, with Okinawan civilian minifigs in caves ($29.99), or a Dresden Firebombing playset with limited-edition Kurt Vonnegut minifig ($49.99)? Modular Hanoi Hilton and Ho Chi Minh's bunker? Something from the War on Terror, perhaps: An Al-Quada training camp set with Osama bin Laden minifig, camouflaged Navy SEAL, and inbound cruise missile ($19.99) or extraordinary rendition set with unmarked CIA jet, compliant third-world diplomat, and abducted French-Algerian shopkeeper ($39.99)?
How about a LEGO Third Reich theme, with an impulse-purchase Adolph Hitler for $2.99 and a LEGO Auschwitz for $89.99?
"An Osama bin Laden minifig?! LEGO Auschwitz?! That's going too far. Andrew, that's patently offensive!" Exactly. War is not fun. War is not play.
Ultimately, the job of every military is to conduct war (whether defensive or offensive), and I believe that war is wrong. There are those in every government who would have its citizens believe that the lives of people who don't look like us, live somewhere outside our borders, or don't believe the same things we do are somehow less valuable than our own. And therefore, it's okay to kill our fellow human beings to achieve the political goals of these leaders.
Applying this philosophy to my LEGO hobby, I don't believe LEGO sets that depict realistic or modern military themes — including soldiers, military vehicles, and historical conflicts — are appropriate for children ages 5 to 12. Other toy companies certainly don't agree, taking advantage of patriotic fervor and every boy's fascination with guns. And yet, this is one of the very reasons I respect LEGO and their no-military policy. They stand apart from the rest.
On a more practical level, LEGO's largest market is Germany, a country whose 20th-century history has left many modern Germans without much of a taste for war. LEGO is also a global company. As my somewhat outlandish list of potential military sets illustrated, how could LEGO possibly choose which countries to represent?
I'm probably not going to convince many of you that pacifism or nonviolence is always the most appropriate political response, but I hope that I've made you think, and that perhaps some of you can understand why I personally hope that The LEGO Company never changes its no-military policy.
Thanks for reading. Without further ado, sound off in the comments and vote your conscience in the new poll.
[poll id="9″]


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Natural Society, Feb. 4, 2012
Will hundreds of more websites soon be popping up telling the tragic tales of young men whose life was riddled with adverse effects after receiving the Gardasil vaccine? Based on the devastating history of the HPV shot Gardasil, the answer is most likely an unfortunate 'yes'. Following the advice of an advisory panel who failed to examine the high number of adverse reactions and deaths associated with Gardasil use, the Centers for Disease Control (CDC) is now recommending that all boys between the ages of 11 and 12-years-old receive the Gardasil shot.
The advisory panel and the CDC both fail to mention that Gardasil was linked to 3,589 harmful reactions and 16 deaths between May 2009 and September 2010 alone, which could be of major concern to parents considering injecting their children with the shot. Permanent disability was the result of 213 cases; 25 resulted in the diagnosis of Guillain-Barre Syndrome; and there were 789 other "serious" reports according to FDA documents.
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As temperatures rise and the days last a little longer, it's only natural to want to break out of a dreary all-black winter wardrobe. Adding a bright pop to your outfit is simple with a color as fun as emerald green. The color experts at Pantone, who named emerald green as the Color of the Year for 2013, say the hue is "lively, radiant, renewing, and positive." I styled a few outfits to prove how easy it is to wear emerald this spring.
If you want to start out slowly, wear pieces with green accents. My friend (and fellow Marist student) Meg Flannery plays around with emerald details, like the leaves on her skirt, to brighten up an otherwise neutral ensemble. I love wearing one bright green piece at a time, like my emerald skirt from Francesca's Collection (find them at the Poughkeepsie Galleria). If you focus on one key piece, keep the rest of the outfit simple with neutrals or other jewel-toned shades, like navy blue. Stick to cool tones if you're hesitant to mix colors. You can also incorporate metallic gold accents for a more sophisticated look.
Don't be afraid to make a major statement with a green dress. I bought the emerald dress in the gallery below at Kohl's last year, and I'm always surprised by its versatility. To prevent the color from overwhelming you, wear pieces with simple silhouettes. I also like to wear black accessories with my green dress for balance.
For all the fearless fashionistas out there, I dare you to try your hand at wearing green in a wild pattern. Meg's tribal-printed shorts mix green with red, yellow, and purple — colors you're traditionally warned against mixing. The thin stripes aren't overpowering when worn with a plain black top. Her yellow shoes, which pull from the yellow in the print, complete the outfit.
Have fun experimenting with green attire this spring! See more of our favorite looks in the gallery below.
» More from blogger Tori Huntsinger
» More from The Couture Report
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Homer Wilderness Leaders (HoWL) has organized the Reel Rock 7 Tour Saturday at the Alaska Island and Oceans Center from 6-9 p.m., with a silent auction of items donated from more than 50 local businesses.
The evening will begin showcasing three short films made by and starring HoWL students this summer: "How to Build a Backcounty Hot Tub," "Awesome Sauce Montage" and "How HoWL Rocks It."
The evening will end with the full-length feature film "Reel Rocks 7," directed by Josh Lowell and Peter Mortimer. The film follows the world's best alpine and rock climbers tackling Catalunya, Spain, Mount Meru in India, and Yosemite.
Homer is one of 280 international stops on the Reel Rocks 7 Tour, and the final stop in Alaska.
HoWL director Libby Veasey describes the annual event as "a celebration of the youth in the community and a look at what they are up to."
As a celebration, 2012 HoWL participants will be honored at the event for their dedication to the program. HoWL student and volunteer Sarah Wolf has been in the HoWL program for two years and describes a HoWL trip as different than what she was used to.
"There was all this stuff I hadn't learned yet. HoWL introduced me to all these new ideas and skills like how to build a fire and edible plants," said Wolf.
The math-loving 12-year-old has received firstplace two years in a row at the DiRtBaG trash cleanup event, and her favorite HoWL trip is the Kachemak Crack-Paddle Surf trip, combining land and water sports.
"Because of that trip, rock climbing and paddle boarding are now my favorite sports. It was crazy learning how to paddle board. I remember falling off a lot," said Wolf.
Third year in the making, the annual HoWL film event is the largest fundraiser for the Homer-based program, and this year HoWL is expecting to raise $6,000 from tickets sales and silent auction.
"Our DiRtBaG clean up week in the spring is the biggest fundraiser in terms of scholarship funding for HoWL students, whereas the film night fundraiser goes directly into the programs that we offer to the local community through the winter," said Veasey.
HoWL's winter program will start in January with day trips teaching winter skills and camping. HoWL also continues its rock climbing classes at the Bay Club throughout the school year.
Kids rock climbing classes are offered Sundays from 2-4 p.m. and Wednesdays from 3:30-5:30 p.m. Teen classes are offered Wednesdays from 6-7:30 p.m. All rock climbing classes will break for usual school holidays.
The Reel Rock Film Tour is $12 per person or $22 for appetizers made by Two Sisters Bakery and the film. For more information on the Reel Rock 7 Tour and HoWL's programs, go to www.howlalaska.org.


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It was a quiet funeral home in a respectable part of Manhattan, but on August 24, 1926, it was the improbable scene of a near riot. The turmoil broke out among thousands of women, mourning the death of actor Rudolph Valentino, as they attempted to rush the doors at Campbell's Funeral Church. After several women broke through a large plate-glass window, police were called to the scene.
For the next few days, as contributor Beverly Smith Jr. noted in his Post article "Farewell, Great Lover" (January 20, 1962), the police had their hands full controlling the line of women—estimates vary between 30,000 and 100,000—who waited to file past Valentino's mortal remains. In a time of mass excitements, he wrote, the Valentino craze lasted longer than most among "the nation's more susceptible womenfolk, from flappers to grandmothers."
The surging crowds at Campbell's gave America its first glimpse at the modern celebrity cult. Until then, America had known actors and musicians who could draw large crowds, but no one had been able to draw so many fans for so many days.
The Valentino craze began 91 years ago this month, with the premier of The Sheik. Today, it seems like a prehistoric, overacted piece of melodrama. Yet it still offers a vivid reflection of American society as it entered the modern age.
It was remarkably successful, earning $1 million in its first year—five times more than what it cost to produce.
Just as reflective of the year 1921, though, is how the movie became so profitable. The Sheik didn't work the same old melodramatic formula, offering women another charming hero in another predictable romance. Instead it gave them Hollywood's first male sex symbol.
Rudolph Valentino (i.e., Rodolfo Alfonzo Raffaello Pierre Filibert Guglielmi Di Valentina d'Antonguolla) was an Italian immigrant who'd worked his way across the country with odd jobs, eventually winding up as a ballroom dancer in California. His tango skills helped him land a role in The Four Horsemen of Apocalypse in 1920. The film was a hit, principally due to Valentino's success in portraying an impulsive, fiery, headstrong "Latin lover." Later that year, he was chosen to play another exotic lover: Sheik Ahmed Ben Hassan.
Three minutes into the movie, as Valentino appeared before his tent, happily supervising the sale of wives to his tribesmen, many American women began to reconsider their choice of daydreams. Suddenly the old romantic heroes—the rugged lawman, sensitive poet, laughing cavalier, or wealthy sophisticate—were demoted by Valentino's ability to smolder, pose, look imperious, and break into a boyish grin.
Years later, actress Bette Davis recalled, "A whole generation of females wanted to ride off into a sandy paradise with him." But the Sheik's paradise wasn't about sharing poetry and soulful looks while holding hands. It was about sex.
The novel, on which the movie was based, concerned a willful aristocrat, Lady Diana Mayo, who sets out to explore the Algerian desert with no company but an Arab guide. Sheik Ahmed Ben Hassan spies her and, within a chapter, abducts her and rapes her. But apparently it's all right because Lady Mayo falls in love with him by the end of the book.
The novel is not explicit about the rape, but it leaves the reader in little doubt. ("Her whole body was one agonized ache from the brutal hands that forced her to compliance," chapter three, The Sheik, Edith Hull, 1919.) The movie is even more careful to avoid direct reference to sexual assault, but the implications are as subtle as a billboard:
"Why have you brought me here?" Lady Mayo demands of the Sheik in his tent.
He replies. "Are you not woman enough to know?" (See accompanying leer at right.)
The movie played to the liberated spirit of the 1920s. It was the perfect entertainment for a carefree, reckless age. It appealed to women who were celebrating the modern freedoms, the new fashions of the Flapper, bootleg liquor, hot jazz, and the permissiveness to "pet" in the boyfriend's roadster far in a dark lane, far from parents' supervision.
The movie also reflected a changing attitude among American men. For the most part, they hated the new male sex symbol, having already committed themselves to the styles of Douglas Fairbanks or Tom Mix. But other men saw the future of American romance in Valentino's polished, sensual manner and hurried to climb onto the bandwagon. They copied Valentino's world-weary languor, his smooth manners, his passionate lovemaking, and his thoroughly oiled hair.
Lastly, but unfortunately, the Sheik represents the ambient racism that Americans had come to expect from popular entertainment of the 1920s.
In the book and movie, much is made about the forbidden love between an Arab and a "white woman." Even love could not be allowed to overcome the social divide of Arab and European. But any plot that worked so hard to unite the lovers could find a convenient solution. The Sheik, it was revealed at last, was not "Arab" but as "white" as Lady Mayo. He had been adopted by the Ben Hassan tribe as a youngster, but was nonetheless the child of an English father and Spanish mother. The happy ending could now proceed. While some women could forgive abduction and assault in 1921, no one felt comfortable with interracial romance.
It might have been the modern age, but American society hadn't come that far.


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Thursday, April 07, 2011
Behold, Senator Lembke The Great Emancipator…
5 comments:
- Jaelithe said...
Another ridiculous thing that irks me about this argument that Missouri Republicans are somehow emancipating taxpayers by refusing federal funds for things like education, health care and unemployment benefits:
They talk like that money they are refusing is going to go straight back to taxpayers -- like the refund check from their efforts might be showing up in your mailbox next week. Um, no. What will almost certainly happen to that federal money that has already been allocated to go to the states is that it will GO TO ANOTHER STATE where the legislature suffers less from proud stupidity.
They aren't saving any Missourians any money. They're just screwing Missouri over to make a political point. - 9:08 AM
- LisaMJ said...
I feel like I've somehow moved to Bizzaro world hearing the ish these jackals on the far-right keep making up. I mean it is just beyond belief.
- AR said...
Missourians should force him to produce a list of actual jobs that exist that are a living wage. They get away with this stuff because they speak in vague theory. If they are so convinced of these jobs then they should be able to point directly to them. And they should be available to people. e thing is everyone knows these jobs do not exist but they don't force the politicians to prove their point. They have a burden of proof. They should also have to produce evidence that people are being held hostage by the unemployed. Of course people eventually give up looking when you apply for a huge number of jobs and don't even get an interview.
Demand proof Missouri. Once they have to produce evidence they will stop speaking in these generalities. - 3:56 PM
This bullshit is happening to us in Virginia,too. It's insane how businesses demand we lower corporate taxes so they can 'hire new workers' yet they offshore everything as soon as possible.
According to Sen. Lembke's thinking, I guess I should feel liberated because my extended unemployment benefits ran out in mid-January.
Sorry, but this white, 61-yr. old NW County woman isn't buying it. As the law requires, I was looking for jobs while I had benefits (and trying to pick up temp work to stretch the money) ... and I'm still looking. In today's job market, ageism (in addition to racism, sizeism, etc.) is rampant. Employers are scared $#!tless that if they hire someone with my experience (executive secretary/asst.), they might have to actually pay them a living wage of $15/hr. instead of $9 - 10/hr. And don't forget the health insurance costs for us 61-year-old geezers.
Hubby is still working full-time & pays for health insurance for both of us. But he's 18 mo. older than me, so when he retires @ 66 (another 3 yrs.), I still have to have coverage somehow until I turn 65.
Lord willing and I get a job pretty soon, I will most likely be working fulltime for only another 5 - 6 years. When I can collect SSI (G*d willing it's still there!), I'll have Medicare & supplemental insurance.
Sorry I rambled. I'm so happy this %#@#&* is term-limited, and even happier he's not my state senator (but I feel sorry for his SoCo constituents). - 3:14 PM
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Microsoft offered some security tips today for individuals and organizations that plan to continue to use Windows XP after April 8.
Mostly, company officials have promoted upgrading to Windows 7 or Windows 8.1 before Windows XP loses "extended support" on April 8. After that date, systems running Windows XP are considered "unsupported" and won't get monthly security updates from Microsoft, although organizations willing to pay for Microsoft's "custom support" services can get security fixes on an ad hoc basis.
Windows XP continues to be widely used, despite the potential security implications of losing product support. Data from Net Applications showed global Windows XP use in February at 29.53 percent, although StatCounter's data indicated about half that amount at 17.15 percent. Windows XP use tends to vary by country. For instance, China had 48.02 percent of Windows XP use, while the United States had 10.73 percent per February StatCounter measurements.
Some organizations apparently won't relinquish Windows XP, except from their cold dead hands. Tim Rains, director of the Trustworthy Computing Group at Microsoft, said that he has "talked to some small businesses and individuals that don't plan to replace their Windows XP systems even after support for these systems ends in April." He offered tips for those planning to go ahead with such plans, although he suggested they were temporary measures.
Five Scenarios To Address Rains said that Windows XP users will face five risk scenarios after April 8. In response, he suggested that such Windows XP users should limit using the OS to access the Internet. They should avoid using the OS for opening attachments to e-mail or instant messaging services. They should avoid attaching removable drives to Windows XP machines. In addition, the firewall should just permit exceptions for essential programs and services. Lastly, Windows XP users after April 8 will face an increased threat of "ransomware," which can encrypt user data, holding it for ransom. He suggested setting up frequent system backups to address that possible threat scenario.
As a temporary solution for continued Web access using Windows XP, Organizations could restrict Internet access to specific Web sites, Rains suggested. However, building such a whitelist could prove tedious. Rains added that "Changing browsers won't mitigate this risk as most of the exploits used in such attacks aren't related to browsers."
Rains also suggested blocking access to USB ports on Windows XP systems as a way to fend off "Autorun attacks."
Of course, Rains' advice might make continued Windows XP use impractical for many organizations and individuals. The impracticality might be the tacit point behind his tips.
Microsoft will continue to issue antimalware signatures for its Microsoft Security Essentials antivirus solution, although that program won't be available for download after April 8, according to a Microsoft announcement. Microsoft will continue to deliver those antimalware signatures through July 14, 2015, although Microsoft describes the protections afforded to an unsupported OS as "limited."
Other antimalware software vendors have pledged to provide antimalware signatures for Windows XP for longer periods of time and AV-Test has list of those vendors compiled at this page. One of those vendors, Avast, has complained about Microsoft's expiring support for Windows XP, suggesting that the unsupported OS could serve as a future infection point for non-Windows XP systems.
F-Secure's Windows XP Checklist Security solution vendor F-Secure has provided its own checklist for Windows XP users after April 8. In a "Threat Report" for the latter half of 2013, F-Secure offered a more relaxed view on Windows XP's coming loss of product support, at least for home users.
"Folks that continue to use XP at home can do so with some reasonable amount of safety, for a while still, but they absolutely need to review their Internet (particularly web browsing) and computing habits," the report states (p. 13).
F-Secure offered eight tips. First, Windows XP users should avoid using Internet Explorer after April 8, according to F-Secure. That advice is also repeated by AV-Test. Rains had dismissed such suggestions in his tips, saying that using a different browser wouldn't necessarily address the vulnerabilities that are associated more with the risks of continuing to use an unpatched OS. Both Mozilla and Google have promised extended support for Windows XP with their browsers, but Microsoft's Internet Explorer 8 (the last supported Microsoft browser on that OS) will lose product support on April 8.
F-Secure recommended tightening up the security of Microsoft Office if it's used with Windows XP after April 8. Old software should be cleared off a system, including any browser plug-ins. PDF file handling should include dialog boxes for end users as a precaution. Java can be removed from a system if not needed. Home systems should be connected to a network address translation server, "which will act as a hardware firewall," according to F-Secure. Lastly, F-Secure advises upgrading the OS to Windows 7 or Windows 8.
Final Notice Windows XP users will get a popup notice on April 8, telling them that the OS is no longer supported. Organizations using Microsoft's Windows Server Update Services (WSUS), Configuration Manager or Windows Intune software likely won't see this update, according to a Microsoft blog post. However, if the popups do appear, a registry change can make them go away, Microsoft explained.
Migrations from Windows XP to Windows 7 or Windows 8 require so-called "clean installs" of the OS, which does not permit the transfer of settings and programs to the new OS. However, the old PC's data can be archived and transferred over to the new machine using the free tool for consumers that's offered by Microsoft and Laplink.
Some other Windows XP components will be affected by the end-of-support date. Windows XP Mode for Windows 7, which allows Windows XP to run in a virtual machine atop Windows 7 systems, also loses support on April 8. Similarly, Microsoft Enterprise Desktop Virtualization (MED-V) solution used with Windows XP won't be supported after April 8.
A bunch of other Micrsosoft products lose extended support on the April 8 date, too, including Outlook 2003, Exchange 2003, Exchange 2010 Service Pack 2 and Office 2003. Windows XP Embedded products have an additional two-year shelf life, though.
Microsoft offers more end-of-product-lifecycle details for Windows XP users at this page.
About the Author
Kurt Mackie is senior news producer for 1105 Media's Converge360 group.
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Overview of Physical Medicine and Rehabilitation (PM&R)
What is PM&R?
Physical Medicine and Rehabilitation (PM&R), also known as physiatry, is a medical specialty that involves restoring function for a person who has been disabled as a result of a disease, disorder, or injury.
Physiatry provides integrated, multidisciplinary care aimed at recovery of the whole person by addressing the individual's physical, emotional, medical, vocational, and social needs. A doctor who specializes in physical medicine and rehabilitation is called a physiatrist.
What is rehabilitation?
Rehabilitation is the process of helping a person achieve the highest level of function, independence, and quality of life possible. Rehab does not reverse or undo the damage caused by disease or injury, but rather helps restore the person to optimal health, functioning, and well-being. Rehabilitate means to make able.
The rehabilitation program
Rehabilitation medicine is designed to meet each person's specific needs; therefore, each program is different. Some general treatment components for rehab programs include:
Treating the basic disease and preventing complications
Treating the disability and improving function
Providing adaptive tools and altering the environment
Teaching the patient and family and helping them adapt to lifestyle changes
The success of rehab depends on many variables, including:
The nature and severity of the disease, disorder, or injury
The type and degree of any resulting impairments and disabilities
The overall health of the patient
Family support
Areas covered in rehabilitation programs may include the following:
Patient need | Example |
Self-care skills, including activities of daily living (ADLs) | Feeding, grooming, bathing, dressing, toileting, and sexual function |
Physical care | Nutritional needs, medicine, and skin care |
Mobility skills | Walking, transfers, and self-propelling a wheelchair |
Respiratory care | Ventilator care, if needed; breathing treatments and exercises to promote lung function |
Communication skills | Speech, writing, and alternative methods of communication |
Cognitive skills | Memory, concentration, judgment, problem-solving, and organizational skills |
Socialization skills | Interacting with others at home and within the community |
Vocational training | Work-related skills |
Pain management | Medicine and alternative methods of managing pain |
Psychological counseling | Identifying problems and solutions with thinking, behavioral, and emotional issues |
Family support | Assistance with adapting to lifestyle changes, financial concerns, and discharge planning |
Education | Patient and family education and training about the condition, medical care, and adaptive techniques |
Understanding rehabilitation terminology
Rehabilitation is needed when a disease and injury causes an impairment. Consider the following:
An impairment is a loss of normal function of part of the body, such as paralysis of a leg.
Disability occurs when a person is not able to perform an activity in a normal way as a result of an impairment, such as not being able to walk.
A handicap occurs when there are limits that prevent a person with a disability from performing a role that is normal for that person, such as not being able to work. A handicap refers to a barrier that may be imposed by society, the environment, or by one's own attitude.
Most people with disabilities are not considered handicapped. They go to school, work, perform family duties, and interact with society fully and capably.