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Using Yoga for a Healthy Heart
Practicing yoga has already been shown to have a positive effect on the overall health of patients with a variety of illnesses including anxiety, depression, cancer and heart failure. Now, a new study by Dr. Dhanunjaya Lakkireddy that was presented at the annual scientific sessions of the American College of Cardiology shows yoga can reduce episodes of irregular heart beats in patients with atrial fibrillation. Dr. Lakkireddy was prompted to study this when he witnessed the improvement in a patient who practiced yoga regularly. Patients in the study participated in a yoga program (which included breathing exercises, yoga postures, meditation and relaxation) three times a week and decreased their irregular heart beat episodes from 2.6 to 1.4. More importantly, they reported an improved quality of life, decreased anxiety and depression.
Here's another example of how clearing your mind of stress can lead to a healthier body. It's amazing to me how our physical body is so directly impacted by our mental health. Yoga is just one way to work on improving your mental health. Find what works for you and stick with it…your body will appreciate i
In the March 23rd issue of JAMA, air pollution is highlighted as am emerging global risk factor for strokes.
Air pollution exposure is already considered to have an important association with mortality world-wide. In fact, in high income countries, 2.5% of all deaths are associated with air pollution. It's important to note that air pollution has an association with strokes and is not a direct cause based on the information we have now. Although, the American Heart Association has updated their statement on air pollution and it's relationship with cardiovascular disease and deaths (like heart attacks) saying "The overall evidence is consistent with Particulate Matter playing a causal role in cardiovascular morbidity and mortality."
The role of air pollution in strokes has not yet been studied thoroughly. It will probably be a while before we have further scientific evidence regarding air pollutions impact on strokes. But, it's important to remember that it's not just individual risk factors like obesity and high cholesterol that have increased the incidence in strokes. Our environmental risk factors are also changing and may be having more of an impact on our health that we realize.
How often have you been to your doctor only to leave frustrated that you have not had the main reasons you were there addressed? It's a problem, and one that is getting worse given the pressure on physicians to see more patients in a shorter amount of time. Whether you are seeing your primary care doctor, a doctor in the ER, or a specialist for the first time, here are a few tips on how to get the most out of every visit.
1) Bring a list of all medications that you take, the doses and how often you take them each day.
2) Bring a list of all your medical problems (like Diabetes, High Blood Pressure, High Cholesterol) and surgeries.
3) Bring a list of what medicines you are allergic to, if any.
4) Tell your doctor at the beginning of your visit what you would like to discuss with them.
5) Communicate with your doctor what is the one most important thing to you to be addressed at this visit.
If you bring this information with you, your doctor will not need to spend most of the visit gathering this from you or your medical records and will have more time to discuss with you why you are actually there. Taking responsibility for this information as the patient allows your doctor to more easily address your health concerns. And, communication is important too. A regular office visit usually allows for a doctor to address about 2-3 things with a patient. Any more than that will require a second visit. This is why you must prioritize your most important concerns and communicate that to your doctor.
One of the most common complaints I hear from patients is "I'm not sleeping well." While there are several different medications that can be used to treat insomnia, I find many people have very poor "sleep hygiene" which can cause or exacerbate sleep problems. Here are a few tips to improve your sleep hygiene.
– Do not watch TV, play video games or use your computer 2-3 hours before bedtime. These types of activities stimulate your brain and make it more difficult to wind down for bedtime.
– Establish a regular sleep schedule.
– Avoid caffeine after lunch.
– Avoid alcohol near bedtime. (While alcohol does make you sleepy, it disrupts your sleep cycles later in the night making it difficult to stay asleep.)
– Stop smoking, especially just before bedtime.
– Exercise regularly (just not right before bedtime!)
– And lastly, if you can't sleep, get up! Read until you feel sleepy and try again but don't just lay there getting frustrated that you can't fall asleep.
While all of these will help, just simply avoiding TV, video games, computers and caffeine prior to bedtime can have a dramatic impact on your ability to fall asleep quickly at night.
In 1999, the American Academy of Pediatrics recommended that children under 2 years old should not have any TV/screen time. None. Despite this, 43% of kids under 2 years old watch TV every day! Not only should 2 year olds not be exposed to adult TV that may be on in the home, but also should avoid exposure to programs that are specifically marketed to parents with children under 2 years old. "Learning videos" like Baby Einstein and cartoons like Blue's Clues have NO scientific evidence that they will help your child become developmentally advanced. And, there are more and more concerns that these videos may be actually harming your child's brain development!
A study done at The Child Health Institute at the University of Washington has found a concerning correlation between the amount of TV that 1-3 year olds watch and their later ability to pay attention. For every 1 hour of TV/day before age three, a child is 10% more likely to show ADHD symptoms at age 7.
I have thought the main influence on the rise of ADHD we are seeing in our country is mostly due to the lack of consistent parenting and discipline. But, perhaps another huge factor is that we are actually rewiring our children's brains from the very beginning to be "ADD." We already know the best way to help babies develop connections in their brain is with social interaction. Most babies favorite thing to look at is a human face- they can stare at their mom's face for a long time learning to mimic expressions, see shapes, colors, even emotions. When we substitute that human interaction for screen time (even "learning" screen time), it's as if we're telling that brain, go ahead and short circuit all those connections you are trying to develop, you won't need them. But then that child gets to first grade and we expect them to have the wiring in place to be able to sit still and listen to a story when we haven't given them what they needed early on to develop it.
Of course every mom needs a few minutes to take a shower or have some "me time." But, next time you're about to pop in an educational video for your child under 2, remember you may actually be doing harm and they would rather learn from you anyway!
For more information, I highly recommend Bright from the Start by Jill Stamm, Ph.D.
The Work of Byron Katie: "I'm Not Living Up to My Fully Potential." Is it True?
Have you ever stressed out about something you think other people want you to do? Watch as this man questions the thought, "I'm not living up to my full potential." Funny how we let our minds convince us our thoughts are true that may not be true at all. And then, those thoughts become beliefs we act on or at least stress and worry about so much it can begin to affect our health and well-being.
I just did a search on PubMed for "artificial sweeteners" and came up with 162,789 resulted published articles. Wow, it's no wonder there are so many questions out there about which artificial sweeteners are safe and how much is too much. I haven't even sorted all that out yet myself- except to say that moderation is the key with sugar and artificial sweeteners alike.
However, I have come across a natural plant fiber used as a sweetener called inulin or oligofructose. The main sources of this are Jerusalem artichoke and chicory. It's a sugar free sweetener with a glycemic index of approximately zero! This means, it does not cause any surges in your insulin levels after eating making it very different from sugar or complex carbohydrates. Studies have shown it to be helpful in stimulating the immune system, decreasing the bad bacteria in the intestine, alleviating constipation, lowering the risk of osteoporosis (by increasing the absorption of calcium in the gut), reducing the risk of plaques building up in your arteries and lowering the risk of colon cancer. In fact it seems to act very similar to dietary fiber in our bodies and some have even proposed classifying it as dietary fiber instead of it's current classification as a carbohydrate.
If you'd like to try it out for yourselves, check out these ChocoPerfection bars. They are sweetened with oligofructose. That is definitely the best "sugar-free" chocolate I have ever tried with none of the side effects of sugar alcohols. If you're looking for a way to satisfy your sweet tooth without the sugar rush followed by the inevitable crash, try these. Absolutely delicious!!
The Magic Number: 10,000
Have you ever wondered if it is really necessary for doctors to go through a minimum of 11 years of training to be able to practice their field of medicine? I'm not going to lie- I have. After reading Malcolm Gladwell's, Outliers, I realize again the value in the length of our training.
He states, "The idea that excellence at performing a complex task requires a critical minimum level of practice surfaces again and again in studies of expertise. In fact, researchers have settled on what they believe is the magic number for true expertise: ten thousand hours. ' The emerging picture from such studies is that ten thousand hours of practice is required to achieve the level of mastery associated with being a world-class expert- in anything' writes the neurologist Daniel Levitin."
Becoming an expert in medicine appears to be the same. A doctor training in primary care has already spent 4 years in undergraduate school then 4 years in medical school learning the basic sciences required to practice clinical medicine. Except for the last 2 years of medical school, these 8 years are not spent actually practicing medicine though. That begins in residency. A family medicine or internal medicine physician will spend 3 years in residency working on average 60 hours a week (seldom <40 hours and by law not more than 80 hours). Working about 49 weeks out of the year at 60 hours a week adds up to 8, 820 hours practicing medicine. Add in 1000 hours from the clinical years in medical school and what do you know- about 10,000 hours. No matter how intelligent someone is upon graduating from medical school they still need the 10,000 hours "practicing" medicine to become an expert.
Interestingly, for specialists the numbers work out too- for example a cardiothoracic surgeon spends the same 8 years in school prior to residency then spends 5 years in a general surgery residency then 2-3 years in cardiothoracic surgery residency. The 8 years of school plus 5 years of general surgery are prerequisites in preparation for the more specialized skill. Then spending 70-80 hours a week (more typical in surgery residencies) over 3 years is just over 10,000 hours.
So, if you're seeing a young physician or an older, more experienced one, at least you can be assured they have all met their 10,000 hours in their field required to be an expert.
Preventive Medicine
Preventive Medicine refers to preventing medical illness and disease instead of treating a disease after it exists. I continue to be amazed at how many patients I see a day who are physically suffering from diseases that can be prevented (referred to as primary prevention) or at least managed better to have fewer complications (referred to as tertiary prevention). For a doctor this is an important and sometimes overlooked area of practicing good medicine. It's becoming a more and more recognized part of quality medical care as people are searching for ways to provide good care at a more economical cost. There is even a new field of medical training referred to as preventive medicine. As a patient, I invite you to become more proactive in taking part in your own preventive medicine. YOU are the one that lives your life everyday! You know what you eat and what bad habits you have. Being honest with yourself and your doctor about the effect those habits can have on your health is the first step in looking for ways to stay as healthy as you can.
If our country successfully adopted healthy lifestyles and reduced the incidence of obesity, heart disease and diabetes, our cost of medical care would plummet. Education about healthy diets does not seem to be working. I notice that taking a deeper look at what is driving people to turn to unhealthy food or physical inactivity despite their knowledge about what is good for them is more important. Studying the social determinants of health (for example, those that don't believe they can afford healthier options or have transportation to get it) and the mental determinants of health (for example, poor coping skills causing a anxious person to turn to food for comfort) I believe is the answer. I invite you to take a look at your own life, what is holding you back from making the lifestyle changes you already believe you should make?
Addressing that is true preventive medicine.
How Do You Define Being Healthy?
What does it mean to you to be healthy? When so many are concerned with "being healthy," perhaps it would be beneficial to take a look at what that actually is. Is it merely being free from any disease or ailments? Is it freedom from any physical suffering? Does it mean not having to take any vitamins, supplements or medications…ever? Does it mean you never have to go see a doctor? If we are not sure what the goal is, how will we ever get there?
The World Health Organization defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."
"Physical, mental and social well-being." Physical well-being involves taking care of the body you have to live your life in: nutrition, fitness, medical care. Mental well-being involves a balance of self responsibility and self love, appropriate coping mechanisms to assist you in dealing with stress, freedom from worry, learning you can be happy no matter what circumstance you are in. And finally, social well-being involves having meaningful relationships with healthy communication. When it comes down to it, life is about relationship with yourself and others.
Physical, mental and social well-being are intertwined together. So what do you think, are you healthy? I've noticed that if you work on mental well-being first, the rest tends to fall into place.
Next post: how preventive medicine addresses physical, mental and social well-being.
A dear friend reminded me of the importance the mind has on the physical body's health. When your thinking is contaminated with stressful thoughts, that stress can come out in many different ways and manifest in your body. Your immune system may be weakened and unable to fight off infections. You may not be able to sleep with the thoughts churning in your mind. When you do not have a way to deal with those thoughts, the only alternative is to find a way to escape from them. Maybe it's with eating to numb the mind, turning to drugs or alcohol, escaping from the pain with prescription medications (narcotics, antidepressants, etc.), sex, smoking, watching TV, too much exercise or not enough exercise. These addictions, where you turn to escape from the pain, may eventually lead to obesity, heart disease, cancer, dependence on drugs and alcohol and the list goes on and on.
If you had to choose, would you rather have a healthy body or a healthy mind? As Byron Katie says, "I hope you chose mind because bodies don't make it." Heal your mind and notice if the body follows. Start by just noticing what thoughts you are having in the moments before you turn to your escape, whatever that is for you.
"I'm not good enough." "My body shouldn't be hurting." "I am alone." "I'm too fat." "I have too much to do."
If we are honest, we all have them…just notice.
Swine Flu in Birmingham, AL
I'm working at the health department this month and swine flu is certainly continuing to circulate in Jefferson County. See your doctor if you have fever > 100 with cough and/or sore throat. The only treatment are anti-virals (like Tamiflu) which do not cure swine flu but may lessen the severity of the illness or shorten the course of illness by 1-2 days. Some physicians are now even calling in these medicines for children with fever, cough and/or sore throat to avoid them having to wait in the waiting room at their office. Fortunately, thus far, most cases of swine flu have been fairly mild.
When you are swabbed for influenza at your doctor's office, most can do a rapid test in their office to tell you if you have influenza but it must be sent to the state lab to determine if it is H1N1. Since 8/1/09, of specimens testing positive for influenza in AL, 99% have been confirmed novel H1N1. As of 8/27/09, Alabama has had 1,587 confirmed cases of novel H1N1 influenza (or swine flu).
There is no vaccine available for H1N1 yet. It is encouraged for all to get the seasonal flu vaccine when available. The H1N1 vaccine (separate from the seasonal flu vaccine) is scheduled to be available by mid-October but this will be given to high-risk patients first.
So what can you do? The most important preventive measure is personal hygiene. Wash your hands frequently with soap and water!! Cover your nose and mouth when you cough or sneeze. (If you don't have a tissue to cover your mouth, cough into the crook of your elbow.) Stay home from school or work if you are sick. Get the seasonal flu vaccine when available. Remember, vaccines work best when everyone gets them.
AL Department of Public Health
1.Heart Disease
4.Chronic lung disease (like COPD)
5.Accidents (unintentional injuries)
6.Diabetes mellitus (diabetes)
7.Alzheimer's disease
8.Influenza and pneumonia
9.Nephritis, nephrotic syndrome and nephrosis (kidney disease)
10.Septicemia (infection in the blood)
Now here's a list of the top 10 things you can do to maintain your health. If you do the things on this list, you'll be reducing your risk of all of the diseases on the list above. Do your part to take care of yourself! Don't wait until you are sick to make changes in your lifestyle. Prevention is key!
1. Do not smoke. If you smoke, quitting is the single best thing you could do to improve your health. (Click here for more info.)
2. Limit your Alcohol intake to 2 drinks a day for men and 1 drink a day for women.
3. Maintain a healthy diet and lose weight if you are overweight.
4. Exercise 30-60 min 5 days a week.
5. Don't sunbathe or use tanning booths.
6. Practice safe sex.
7. Control your cholesterol and blood pressure with diet, exercise and medication if needed.
8. Keep your shots up to date, including flu and pneumonia (if over age 65).
9. Have yearly health screenings with your primary care doctor even if you don't feel sick. (You may need to be seen several times a year if you have chronic diseases like diabetes or heart disease).
10. Get help if you are suffering from psychological problems like depression, anxiety, or excess stress instead of turning to addictive habits like smoking, alcohol, drugs, overeating or other self destructive behaviors.
Vitamin B12 is an important vitamin mostly obtained from dairy products and meat. It is a critical ingredient your body needs to make red blood cells and also helps your nervous system work correctly. If you have low B12 levels, you might have anemia, depression, dementia or neuropathy (pain, burning or tingling sensation). Some people with low B12 also have high levels of homocysteine which may increase your risk of heart disease and stroke. Your doctor can run a simple blood test to see if your B12 level is low.
The most common reasons for low B12 are 1) not taking in enough in your diet or 2) a problem with your stomach or intestines that prevents you from being able to absorb the vitamin. This includes Pernicious Anemia (where you do not have the cells needed in your stomach to absorb B12) or long standing heartburn or ulcers or having had surgery on your stomach or intestines.
In the past, everyone who needed B12 supplementation was given shots- initially given several times a week for a couple weeks and then once a month. Now we know that unless you have a problem absorbing B12, it is just as effective to take a daily pill instead of getting a shot. Over the counter Vitamin B12 pills do not have enough B12 to increase your levels- you need to take at least 1000 mcg of B12 everyday. You can get a prescription for this high dose from your doctor if you levels are low.
Even if you've been getting Vitamin B12 shots for years, you can switch to the pill and it will be just as effective unless you have a problem absorbing B12 from your digestive tract.
According to a recent study by Nielson, the average American watches about 5 hours of TV per day or 153 hours per month. That's almost 160 hours per month – equivalent to another 40 hour work week. In a 65 year life, that person will have spent 9 years watching television! That doesn't even count the time spent playing video games or on the computer. Did you know the average American youth spends 900 hours in school in one year and 1500 hours watching TV in one year?
It is recommended by the American Academy of Pediatrics that children have their screen time (TV, videos, video games, computer time) limited to no more than 2 hours total per day. If yours or yours child's screen time was truly 2 hours a day, how much time would be left to participate in more stimulating and productive activities? If you only watched 2 hours of TV a day, your children would also be much less likely to watch over 2 hours a day. There would be more time to exercise or be involved in some sort of physical activity, spend more time in conversation with our children, help them with homework, prepare healthier meals and eat them with our family. Essentially, there would be more time to do a huge number of activities that are likely more valuable than watching TV. Next time you say "I don"t have time to exercise or cook my family a healthy dinner" add up the hours that week you spent glued to the TV and ask yourself if that is really true?
Here's one thing I have noticed about the grocery store. The healthiest foods are located around the periphery of the store. That's where the dairy, meats, fruits and vegetables are found. The aisles are typically filled with pre-packaged, processed carbohydrates and bad fats. Think about your trips to the grocery store- do you find most of the items on your list around the periphery in the produce and refrigerated sections or do you spend most of your time weaving your way through the aisles? More "aisle time" probably reflects the amount of unhealthy food you are stocking your pantry with which almost certainly reflects what you are eating. Except for an occasional trip to an aisle for a specific item like beans or legumes for example, try spending your next trip to the grocery store only around the periphery and notice the difference in what's in your refrigerator when you get home.
Makeover Your Kitchen
Wanting to make over your body? The best place to start is your kitchen. Good nutrition is in part about knowing which foods are good to eat but it may be more about altering lifestyle habits. Even if you know what's good to eat, if those foods are not around, you won't eat them! So how do you start establishing a lifetime of good nutrition? Well, start at home! Your dietary willpower and discipline will be frequently challenged at potluck dinners, social events, lunch meetings at work, etc. But, what matters more than an occasional non-nutritious meal is the other meals you are eating the majority of the time. Start by making your home a "safe place."
Here are some excerpts from Gourmet Nutrition by John Berardi, PhD, founder of Precision Nutrition.
"If a food is in your possession or located in your residence, you will eventually eat it. That's right, if you wish to be healthy and lean; you must remove all foods not conducive to your goals from your residence and replace them with a variety of better, healthier choices. Now, before you go thinking that this is just a suggestion- one way to improve your body- we want to make it clear. This is the only way to improve your body….We assure you that once you makeover your kitchen, your body will follow."
Take a look in your fridge and pantry- is it filled with soft drinks, fruit juices, processed foods wrapped in colorful wrappers, boxes and containers? If so, it may be time for a kitchen makeover.
Since stress is an activation of our "fight or flight" or sympathetic activity, it is important to balance that with our "rest and digest" or parasympathetic activity. I've heard many people say they exercise for stress relief. While consistent exercise is a critical component to overall health and improving your body's capability of coping with stress, it is yet another activiation of your sympathetic system. In fact, competitive athletes consider recovery a valuable part of their training. They understand the need for rest and relaxation to allow their body to recover from the stress it is put under during exercise and intense training.
So while we are unlikely to find a way to live in our world and eliminate all the sources of stress in our life, we can learn to increase our parasympathetic activity to balance that. Here is the key: take 30 minutes a day to engage in some activity that allows your mind to go into a state of relaxation. Choose activities that help you get quiet, restful and worry-free parasympathetic activiation. Every person's activity might be different. One person could achieve that state by taking a bath each evening to relax but another might take a bath and allow their mind to spin with worries the whole time- that doesn't count! The key is to do what allows your mind and body to relax for 30 minutes each and every day.
Here's a list of activities that might work for you:
Yoga or Pilates
Massage Therapy
Reading in a quiet spot
"Zoning out"
Listening to soothing music
Taking a bath
When you do this and have actually relaxed, you may notice tension in your neck, shoulder and back release. You might experience a decrease in your heart rate and blood pressure and a sense of calmness. If you do your activity before bed, you will probably be able to fall asleep faster and achieve a better night's sleep.
Does it sound too simple? It's obviously not that easy to do because how many of us get 30 minutes a day of a truly relaxed state of mind. But remember all those effects of stress on your body and health- it's important to allow your body to recover! This is the best way to get control of stress- start today, make it a habit!
A study done in 2003 showed that 80% of Americans reported feeling stressed out. Are you one of them? Take a look at what being stressed can do to your body. Chronic stress can alter our biochemical state and have major effects on our health.
Being stressed puts our bodies in the "fight or flight" state which leads to high levels of cortisol and adrenaline. When we are under chronic stress, the secretion of these hormones takes precedence over other functions like digestion, cellular repair, immune function, reproduction and liver function and detoxification. So we end up with poor blood sugar control, sleep disruption, carbohydrate cravings (which worsens the poor blood sugar control), reduced metabolism, reduced thyroid function, alterered sex hormone activity, infertility, depression, alcohol and drug abuse. Your immune system doesn't work as well to fight off infections. Stress has even been linked to heart disease.
Basically our bodies are in a state of hormonal imbalance and we simply are not able to function like we want to. Not only that, but stress is also known to decrease the brains functionality causing difficulty thinking and solving problems or a loss of memory. And, after a long time of your body pumping out so much cortisol and adrenaline eventually it wears out and chronic fatigue sets in.
So as you can see, stress is not something to just blow off by saying "things will calm down when the kids are back in school" or "as soon as I get this project done at work my stress level will be a lot less." You are just continuing the cycle and setting yourself up for problems that are becoming more and more common in America- obesity, heart disease, infertility, irritable bowel syndrome, depression, alcohol and drug abuse.
The best time to slow down and relax is when you don't have time for it!
Stay tuned for some tips on decreasing your stress level.
Have you ever been concerned that your doctor makes a quick assumption about what you have without really thinking it through? Or, concerned that he/she has been telling you the same diagnosis over and over but your symptoms persist despite treatments? Well, as advised in Dr. Groopman's book "How Doctor's Think," here is one question you can ask to help prevent your doctor from missing something- "Doctor, what else could this be?"
Our goal as physicians is to arrive at the correct diagnosis, give the appropriate treatment and make the patient better. But, sometimes a misdiagnosis can set you on the wrong path and delay the correct treatment. No single remedy can prevent all mis-diagnoses. But, asking that one simple question, "what else could this be?" can help your physician broaden the number of possibilities to consider with a simple reminder of "the reality of uncertainty in medicine." It could help your doctor take a step back and think of a cause of your symptom that he might not have previously considered and make the correct diagnosis.
Vitamin D Part 2
Driving from Birmingham to Huntsville, AL this weekend, I saw this billboard for "Sunset Tanz" encouraging you to tan to get Vitamin D naturally. In the upper right corner, it says "Tanning – look good, feel great." And, "More Vitamin D than milk" referring to tanning. It was a good example of what I was referring to in "Tanning to get more Vitamin D?" so I thought I'd post it here. Don't believe the tanning industry's justification of putting yourself at a much higher risk of skin cancer when you could just take a Vitamin D supplement instead.
Here are some interesting numbers comparing the swine flu (H1N1 influenza) to past influenza outbreaks:
Seasonal influenza has about 3-5 million severe cases each year with 250,000-500,000 fatalities annually. In the 1918 pandemic influenza there were 1-1.5 million fatalities. In the 1968 pandemic influenza there were 1 million fatalities. In the 2009 H1N1 influenza or Swine flu , there have been 40,617 confirmed and probable cases and 263 fatalities (as of July 17th). Alabama has had 477 confirmed and probable cases of swine flu and no deaths.
A brief review of the timeline of the swine flu outbreak:
The first H1N1 patient in the US was confirmed on April 15, 2009. The second patient was confirmed on April 17th. On April 26th, the US Government declared a public health emergency. On June 11th, the World Health Organization activated Phase 6 of their pandemic alert scale meaning that they officially recognized the virus is at the pandemic phase. At that time, more than 70 countries had reported cases of H1N1 infection. By June 29th, all 50 states in the US, District of Colubia, US Virgin Islands and Puerto Rico had reported H1N1 infection.
Nationwise US influenza surveillance systems seem to indicate that overall influenza activity is decreasing in the US. Although the 2009 H1N1 influenza has relatively low infection and death rates, the CDC continues to monitor the situation carefully. They have already begun work on creating a vaccine that will be effective against the Swine flu in preparation for the flu season this fall.
Interestingly, spread of the swine flu through water is not likely this summer because the amount of chlorine used in swimming pools and even tap water is adequate to inactive the virus. Human to human spread is still possible so protect yourself with handwashing and covering your mouth when coughing or sneezing!
Tanning to Get More Vitamin D???
You may have heard in the news or from your doctor that there have been studies done that associate a low blood level of Vitamin D with some types of cancers, neurologic disease, autoimmune disease and cardiovascular disease. Let me emphasize- the studies show an association, not that a low level of Vitamin D causes these diseases. However, based on these studies there was an emphasis placed on educating patients to have their Vitamin D levels checked or talk with their doctor about getting more Vitamin D.
The two sources of Vitamin D are through the sun's UV rays or through our diet by either food or supplements. Some doctors had recommended that people spend more time in the sun without sunscreen to increase their levels of Vitamin D. The American Academy of Dermatology has recently ammended their position on Vitamin D. It is NOT recommended that people increase their unprotected UV exposure from the sun or tanning beds in order to increase Vitamin D. Sun exposure and tanning are known causes of skin cancer. Since there is another method of increasing Vitamin D in our systems through our diet, this is clearly the better choice.
There are currently ongong studies to determine if the current recommended adequate intake levels should be revised but for now we are using the levels shown in Table 2 of this link from The National Academy of Sciences Institute of Medicine (IOM) guidelines for vitamin D.
Some people with higher risk of having Vitamin D insufficiency are "dark skin individuals, elderly persons, photosensitive individuals, people with limited sun exposure, obese individuals or those with fat malabsorption."
See the official statement here for further details: American Academy of Dermatology Position Statement on Vitamin D.
Sun and tanning beds cause skin cancer and premature aging (wrinkles). In fact, many skin products that are advertised as "anti-aging" actually have nothing extra but sunscreen added in. In the midst of the summer time sun, here are a few reminders on keeping your skin protected from the sun's rays.
2. Regardless of skin type or SPF, sunscreen needs to be re-applied about every 2 hours and after swimming, drying off or sweating.
Sunscreens are just lotions, gels, sprays, etc that will eventually wear off- especially when you get wet or are just wiping it right back off when you dry off after a dip in the pool. If you don't reapply you are most likely loosing the effectiveness of wearing the sunscreen in the first place after the first 2 hours in the sun. Some dermatologists say the higher the SPF the better, but regardless of the SPF you still need to reapply frequently. (Don't do the math and decide you can stay out in the sun for 12 hours without putting on more sunscreen!)
3. Sunscreens should be applied 30 minutes to 1 hour before sun exposure. Give it time to be absorbed into your skin before you jump in the pool and wash it all off.
4. Spend some time in the shade- especially between the hours of 10 am to 4 pm when the sun's rays are the strongest.
It's no surprise we are at a loss for primary care physicians in our nation. Primary care includes the specialties of Internal Medicine, Pediatrics and Family Medicine. Did you know that 98% of residents completing an internal medicine residency subspecialize to become cardiologists, gastroenterologists, pulmonologists, endocrinologists, etc? 85% of pediatric residents subspecialize. On the other hand, 98.9% of family medicine residents stay in family medicine.
This July 284 residents started their training in Alabama. Out of those 146 entered residencies in primary care. 74 in Internal Medicine,25 in Pediatrics, 42 in Family Medicine and 5 in a combined Medicine/Pediatrics program. Given the percentages above that means that in 3 years when these physicians are beginning their practices we'll have 41.5 family medicine docs entering practice, 1.5 internal medicine docs and 3.75 pediatricians. The rest will be starting fellowships to further narrow their area of expertise.
So when I hear discussions from the powers that be about how to recruit more medical students into the field of primary care and specifically family medicine I am all for it. Not everyone needs a cardiologist or rheumatologist but everyone does need their own doctor that knows their medical problems and medications, can see them when they get sick and also treat their diabetes, congestive heart failure and other chronic diseases. Everyone needs a doctor that they see for routine check ups to order the tests and procedures needed to prevent further disease down the road, and knows when they need to tap into the expert opinion of the specialists. That's what family medicine doctors provide, we call it a medical home for our patients.
Brooke Uptagrafft, MD
Dr. Brooke is a family medicine doctor.
July 2017


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Time has tapped White House correspondent Michael Scherer to be Washington bureau chief, one of several hires and promotions unveiled yesterday at the sole surviving news weekly.
Scherer is the first to hold the position since Jay Carney, the current press secretary for President Obama, left to go to work for Joe Biden after the 2008 election.
Ben Goldberger will become Nation editor, covering national news outside of DC.
Since 2008, Executive Editor Michael Duffy has been doing all three jobs. He keeps his executive editor title.
In other moves, Time hired Jack Dickey as a reporter covering sports and culture. As a writer for Gawker Media's Deadspin site, he helped break the story about Notre Dame linebacker Manti Te'o and the hoax surrounding his girlfriend.
The moves point to a major redesign of Time.com ahead of the planned spinoff of Time Warner's magazine division later this year.
"This is allowing us both to innovate in our journalism and bring in new talent to create it," Managing Editor Rick Stengel said.

subset: commoncrawl


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* Alipay bigger threat to UnionPay than Visa, Mastercard
* Rivals growing faster than UnionPay in online market
* China to open up its credit card market to foreigners
* China credit card market to be global No.1 by 2020
By Engen Tham
SHANGHAI, Nov 13 (Reuters) - Chinese bank card operator UnionPay, which may soon have to defend its near monopoly against Visa and MasterCard, faces a much bigger threat from online payment providers such as Alipay, and is upgrading its systems to meet the danger.
Shored up by a raft of protectionist measures, the state-backed company has grown in just over a decade from an unknown name to a true heavyweight, commanding 50.6 percent of all the global cards in circulation in 2013, according to the Nilson Report statistics newsletter.
China said last month it would open its credit card market to foreign players following a World Trade Organization ruling in 2012 that it discriminated against U.S. card firms.
The prize for the foreign companies would be access to what is projected to become the biggest card market in the world by 2020. Transactions were already around 32 trillion yuan ($5.22 trillion) in China in 2013, according to data from the People's Bank of China.
But analysts say the obstacles to a successful foreign invasion of UnionPay's dominant card position are considerable, as UnionPay charges merchants much lower rates than the Western card companies - as low as 0.04 percent, compared with MasterCard's 0.60-1.85 percent in Britain for certain cards.
"The low rates in China will make entry by foreign players extremely difficult as business cases will not stack up, based on the lower rates," said James McKeogh, a partner in consulting at KPMG China.
A more immediate and perilous threat comes from online payment firms like Alipay, a unit of giant e-commerce company Alibaba, which already dominates a parallel and growing payment universe that rivals the traditional card set-up.
In less than three years, Alipay has grown to control nearly half of China's online third-party payment market, tapping the hundreds of millions of Chinese still without a credit card. That market commanded gross merchandise volume of 17.2 trillion yuan ($2.8 trillion) in 2013, according to estimates from iResearch.
UnionPay, on the other hand, commands a mere 11.9 percent of that market and faces competition from over 250 new online providers that have been awarded licences from Beijing as it aims to stimulate consumer demand.
Alibaba told Bloomberg on Wednesday it was open to working with eBay Inc's PayPal to expand its payment options, a plan that could magnify Alipay's reach and put further pressure on UnionPay.
With the opening of the market, Li Ye, an analyst at Analysys International, believes that with government support, Alipay could even challenge UnionPay's offline payment dominance.
"Alipay is well placed to become the next UnionPay," said Li.
UnionPay is nevertheless putting up a fight. Last month it started working with airlines Lufthansa, Emirates , Etihad and Air Holland to provide payment services for online airline tickets through its cards for the first time.
In September, it teamed up with Samsung in near-field-communication payment (NFC), which lets users pay by tapping their phones on a device available at local shops.
UnionPay's company spokesman said it plans to "deepen its transformation into a market-orientated firm. And embrace market competition."
But Alipay is also trying to clinch a deal with Apple on its own NFC payment system, a senior executive from Alibaba told the Wall Street Journal on Tuesday.
Alipay also has the advantage of being at the heart of the freewheeling, profitable and fast-growing Alibaba empire, which just eight weeks ago pulled off the world's biggest-ever IPO in New York.
UnionPay comes from a much more restrictive lineage, a product of government policy, so there are a lot of zero commission transactions that keep a lid on profit. ($1 dollar = 6.1257 Chinese yuan) (Additional reporting by Denny Thomas in Hong Kong and Shanghai Newsroom; Editing by Lisa Jucca, Kazunori Takada and Will Waterman)


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Alternative spring break volunteer trips
Whether you're looking for a volunteering adventure under the Costa Rican sun, an alternative break in India, or some time in Guatemala to do good, here are 5 reasons why your next spring break should be an alternative spring break with Cross-Cultural Solutions:
1) You can share the story with mom and dad. So maybe you haven't always behaved like the perfect angel your parents know you to be on spring break trips in the past. It happens. But when you volunteer internationally on an alternative spring break program with CCS, we guarantee that you'll return home with tons of inspiring stories to share with the folks.
2) Everyone else is going to Mexico. Let's put that Economics 101 knowledge to the test. What happens when everyone wants to purchase a flight to the same place during the same short window of time? Airfare gets sky high! Popular spring break destinations like Cancun and Panama City Beach are in peak season right around spring break. That means accommodation, transportation, flights, and even meals could be pricier than usual. When you enroll to volunteer on a CCS alternative spring break, meals, in-country transportation, accommodation, cultural activities, and 24-hour support are all included. Plus, travel with a group of six or more volunteers, and you can score an awesome discount!
3) Start a tradition. Some schools have got some pretty out there traditions. Naked quad runs in the dead of winter, mud volleyball fundraisers, organized howling — yup, it's a thing. But maybe it's time to start a tradition of your own. Organize some friends from your club, sports team, sorority, or fraternity to volunteer this spring break, and then challenge future generations to keep your alternative spring break tradition alive. Make it "a thing."
4) Give back. Take a moment to reflect on all of the amazing things that you've gotten as a college student. You've made lifelong friends, laughed until you cried, explored your independence, and had tons of opportunities to be taught by some of the brightest minds in the field. Pretty incredible. Now it's time to give back. Spread the love and share all of the good vibes that you've enjoyed with somebody whose culture is different from your own. Somebody who can seriously benefit from your perspective, enthusiasm, and passion. And somebody who has so much to share with you as well.
5) Feel awesome. This one is self-explanatory. Volunteering on an alternative spring break abroad will make you feel awesome. It's a fact.
Go ahead and pick your alternative spring break destination, or contact a Program Advisor for some advice.


text: ¡HICA! is a nonprofit organization dedicated to the social, civic and economic integration of Hispanic families and individuals in Alabama. www.hispanicinterest.org . Founded in 1999, ¡HICA! engages and empowers Alabama's Hispanic community and its numerous cultures as an economic and civic integrator, social-resource connect...or, and statewide educator. ¡HICA! works towards its mission of social, civic, and economic integration through its four programs: Strong Families - Asset Building and Economic Development - Immigration and Access to Justice - Community Engagement and Education


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Social Responsibility
Social Responsibility Fund
You want to support organizations that make a lasting difference. So do we.
Concern for community is a co-operative principal. That's why we embody this principal through our Corporate Social Responsibility Fund. North Peace Savings and Credit Union provides financial support to socially responsible organizations that increase community sustainability within the communities we serve. We donate to organizations whose essential work makes a life-changing difference for Fort St. John's, Hudson's Hope, Taylor, Dawson Creek and Fort Nelson.
The organization and project that we support must be:
- locally based and supported
- have broad community support, appeal and impact.
We want to get to know you, your organization, and the difference you're making. That's why we'd rather meet with you than have you fill out another application form. To get more information on how your organization can meet our criteria, or how they can benefit from this initiative, please contact the Marketing and Community Investment Department, Lisa Stewart, at 250-794-3753 or email email@example.com.
Learn more about who we have sponsored in your communinty by visiting Credit Unions are Helping Here or click here for a list of 2018 recipients.


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Academic Senate
The Academic Senate has oversight of all academic programs at Swinburne on behalf of Swinburne Council.
Its responsibilities reach across all courses offered by the university, including vocational education, higher education and research, and includes:
- Academic policies, procedures and regulations
- Accreditation and reaccreditation of courses
- Requirements for the awarding of degrees, diplomas and certificates
- Maintenance of courses
- Course evaluation.
The Academic Senate Chair is Professor Bernadine Van Gramberg, Pro Vice-Chancellor (Graduate Research and Research Training).
See Section 5 of the Governance Framework for more information about the Academic Senate.
See the Academic Senate Regulations 2014 for information about the powers, functions, schedule, membership, committees and transitional provisions of the Academic Senate.


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In partnership with the China Copyright and Media blog, "Propaganda Past" is now featured in our Censorship Vault series. All translations in this series are by Rogier Creemers.
New series: Propaganda Past
One of my ongoing projects is a book on the history of Chinese media regulation. When working on this, I recently came across a collection of CCP propaganda departments, dating from the early beginnings of the CCP until the mid-Nineties. Some of the documents in this collection are public, but a good number of them were for internal circulation and are, so far, not available in the public sphere. I have decided to translate the most interesting of the documents and publish them here with comments. I expect that new posts will be added to this series on a biweekly basis.
To kick off the series, I translated two speeches from around this time, 24 years ago. The first one was given by Peng Zhen, the retired head of the Central Political-Legal Committee, and addressed the question of how to bring unity through abiding by the Constitution and the law. On the student protest, he found that
The motivations for these student demonstrations are good, pure, kind and constructive, the objective is to overcome flaws and mistakes in work, and to run State affairs and the Socialist system even better, this is consistent with our requirements. But the methods and means that they have adopted is not very appropriate. This is not the fault of the children. First, they do not know the law or don't know it well. Second, they lack political experience, and are insufficiently on guard against the treacherous intentions of an extremely, extremely small number of conspirators and evildoers who seize the opportunity to cause turmoil.
His subsequent analysis about how the Constitution and the law did not allow for such protests, is interesting in the light of the ongoing debate about constitutionalism at the moment. Much of the language used is very similar.
Article 1 of the Constitution provides that the People's Republic of China is led by the working class, not that it is led by the bourgeoisie, and not that the working class and the bourgeoisie jointly lead and divide all under heaven between them; that it is based on the alliance between workers and peasants, not on the basis of any other class or stratum; that it is a people's democratic dictatorship, not a bourgeois dictatorship, and certainly not a landlord class dictatorship; that it is a Socialist country, and isn't a capitalist country. The movement to do bourgeois liberalization in our country violates the Constitution, and violates the fundamental interests of the people of all ethnicities in the entire country and the standpoints of the Party.
Read the complete speech here: Use the Constitution and the Law to Unify Thoughts.
The second speech was made by Deng Xiaoping, on 9 June. This speech takes stock of the events in Beijing, and much attention is paid to the harm suffered by the armed forces.
During the suppression of this riot, so many of our comrades have been wounded, and even sacrificed themselves, their arms have also been stolen, why is this? It is also because good people and bad people have become confused, resulting in the fact that it was difficult to take on some drastic measures that should have been adopted. Dealing with this incident was a grim political trial for our Army, practice proves that our Liberation Army has passed the examination, if tanks had been used to press their way through, it might have created an ignorance of right and wrong around the entire country. Therefore, I must thank the PLA officers and men that they used this attitude to deal with the riots and incidents. Even though the losses makes one feel heartbroken, they may win the people, and make people not clearly knowing right and wrong change their viewpoint. Let everyone see, what kind of people the PLA actually are.
It is interesting as it outlines the primary building blocks for the political and economic consensus in the Nineties. It does so by re-establishing the necessity the basic policy of "One Centre, Two Basic Points". The one centre here refers to the central position of economic development, the two basic points consist of the Four Cardinal Principles on the one hand and reform and opening up on the other. Deng also reiterates his objective of becoming a "middle-level developed country" by the 2040s. The mistakes that were made, according to Deng, were in the field of education.
Since founding the nation, we have always put the emphasis on arduous creation, in later days, when matters became a bit better, we advocated high consumption, consequently, the phenomenon of waste spread in all areas, adding to this a weakening in ideological and political work, the fact that the legal system is not complete, the phenomena of violation of law and discipline, corruption, etc., they all came out. I said to foreigners that the biggest mistake of the decade was education, here, I mainly talk about ideological and political education, I don't purely talk about schools and young students, we also lack education for the people. There is little education concerning arduous creation, concerning what kind of country China is, and what kind of country we must change it into. This is a very big mistake of ours.
Lastly, Deng warns against the influence of the West, indicating that
in the area of political structural reform, there is one point that can be confirmed, which is that we must persist in implementing the People's Congress system, and we cannot adopt a US-style tripartite separation of power structure. In fact, Western countries also not all implement the system of a tripartite separation of powers. The US scold us for suppressing the students, but in their dealing with domestic campus uprisings and riots, did they also not send the police and the military, did they also not arrest people and shed blood? They suppress students and the people, and we have suppressed a counterrevolutionary riot. Which qualifications do they have to criticize us!
Read the complete speech here: Speech when Receiving the Capital Martial Law Army Troop-Level or Higher Cadres
The next post in Propaganda Past will go back forty years, from 1989 to 1949. [Source]


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There is nothing like a trip to the Theatre to make you feel like every nerve in your body is on fire as your body become alive with excitement and exhilaration.
The chilling vocals and mesmerising storylines draw you in time and time again, with a feeling of breathlessness once the final curtain falls.
So here are New Narrative's top picks for what you should be going to see on stage this summer.
The Lion King
As the summer rolls in and the excitement for the movie remake builds, why wait for the star-studded cast (believe me, we can't quite wait for a Beyoncé and Donald Glover collab either)? Head down to the Lyceum Theatre in London and see one of London's most popular shows, and while you're at it – subscribe to our e-magazine for an exclusive interview with a cast member of the stage show!
Whitney Queen of the Night
A night full of classic Whitney Houston songs? Hun where do I sign up! Heading on a tour across the UK this summer, make sure to check the website to see if it's coming to a stage near you.
Sticking to the theme of legendary singers, Tina the musical tells the story of the iconic Tina Turner. With legs for days and vocals to match, this show is the feel-good musical of the summer.
White Pearl
One of the few on our list that isn't a musical, White Peal is a play about a Singapore-based cosmetics company, Clearday, who go into panic mode after a leaked advert for skin-lightening cream is released. The summer satire is at the Royal Court Theatre until mid-June, so don't miss out!
Everybody's Talking About Jamie
With inspiration taken from a BBC documentary, Everybody's Talking About Jamie arrived on stage in 2017. Layton Williams stars as Jamie, a high school student from Sheffield who dreams about being a drag queen. It's electric numbers and thrilling dance numbers follow Jamie as he struggles with the prejudice and judgement from people around him.
A celebration of women, Emilia is about the untold story of published poet, Emilia Bassano, the woman rumoured to be Shakespeare's muse – The Dark Lady. With an all-female cast, this is Shakespeare, as you've never known it before.


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Highly Sensitive Noninvasive Cardiac Transplant Rejection Monitoring Using Targeted Quantification of Donor-Specific Cell-Free Deoxyribonucleic Acid
Author + information
- Published online April 1, 2014.
Author Information
- Mats Hidestrand, PhD,
- Aoy Tomita-Mitchell, PhD,
- Pip M. Hidestrand, MD,
- Arnold Oliphant, PhD,
- Mary Goetsch, MS,
- Karl Stamm, MS,
- Huan-Ling Liang, MD,
- Chesney Castleberry, MD,
- D. Woodrow Benson, MD, PhD,
- Gail Stendahl, DNP,
- Pippa M. Simpson, PhD,
- Stuart Berger, MD,
- James S. Tweddell, MD,
- Steven Zangwill, MD and
- Michael E. Mitchell, MD∗ (mmitchell{at}chw.org)
- ↵∗Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, MS B730, Milwaukee, Wisconsin 53226
To the Editor:
Approximately 20,000 cardiac transplant recipients currently reside in the United States. Rejection remains a major cause of graft failure and requires lifelong surveillance. The current gold standard for monitoring rejection is catheter-based endomyocardial biopsy (EMB), which is associated with risk and expense (1). Donor-specific cell-free deoxyribonucleic acid (DScf-DNA) has been proposed as a marker for cellular injury caused by rejection (2). Shotgun whole-genome sequencing (WGS) has been used to detect DScf-DNA (3). The complexity and cost of the analysis required by WGS limits its application as a surveillance tool. We have employed targeted quantitative genotyping to determine the %DScf-DNA. The targeted approach relies on selected highly-informative genomic regions and potentially provides a rapid (24 to 48 h) cost-efficient (significantly less than whole genome sequencing) method suitable for clinical surveillance. We applied this method to detect DScf-DNA in pediatric cardiac transplant recipients in a prospective blinded study.
Cardiac transplant recipients followed at the Herma Heart Center at the Children's Hospital of Wisconsin were invited to participate. Blood samples (5 ml) were collected in 3 clinical scenarios:
1. Scheduled surveillance EMB from asymptomatic heart transplant recipients in the catheterization laboratory immediately before scheduled surveillance EMB.
2. Unscheduled diagnostic EMB from symptomatic heart transplant recipients before unscheduled diagnostic EMB.
3. Rejection from heart transplant recipients with biopsy- proven rejection (> The International Society for Heart and Lung Transplantation grade 2R or antibody mediated rejection 1) before initiation of treatment, during treatment, and at 1 week.
Clinical, laboratory, cardiac catheterization, and echocardiographic data were recorded. Anticoagulated blood was collected to measure cell-free deoxyribonucleic acid (cf-DNA) levels. Plasma separation, cf-DNA extraction, and quantification of total cf-DNA were carried out as previously described (4). Genomic DNA for genotyping was prepared from 1 buffy coat of each recipient, and donor DNA was obtained from the Blood Center of Wisconsin. Determination of the %DScf-DNA in recipient plasma was performed using Digital Analysis of Selected Regions (DANSR, Ariosa Diagnostics, San Jose, California) (5). Genotyping of donor and recipient genomic DNA was carried out by the same assay. Loci are informative when recipient genotypes are homozygous and donor genotypes are either heterozygous or homozygous for the other allele. The minor allele frequency for informative loci was modeled as a binomial distribution. The %DScf-DNA was defined as the peak from this modeling. Summary statistics included median and range. Unpaired samples (i.e., rejection group vs. surveillance group) were compared using a Mann-Whitney U test. Rejection samples were compared with a Friedman analysis of variance. A Pearson correlation summarized correlations. A p value <0.05 was considered significant.
Fifty-three samples from 32 patients were analyzed.
Scenario 1
The cf-DNA levels were obtained from 26 patients undergoing 38 scheduled surveillance EMBs (Fig. 1A). Thirty-two (84%) samples contained <1% DScf-DNA. No patient with DScf-DNA <1% had pathological rejection. DScf-DNA levels exceeded 1% in 6 samples, and the highest percentage of DScf-DNA was associated with asymptomatic biopsy-proven rejection. The remaining 5 samples had negative biopsies.
Scenario 2
Seven samples were obtained from 6 patients before unscheduled diagnostic EMB to rule out rejection based on clinical criteria (Figs. 1B and 1D). Six samples had DScf-DNA levels >1%, and 1 sample contained DScf-DNA <1%. Four of the 6 were associated with biopsy-proven rejection; the other 2 patients had significant coronary artery vasculopathy on angiography. The single symptomatic patient with a low percentage of DScf-DNA had high levels of total cf-DNA (Fig. 1D), implying that the dominant pathology was global rather than confined to the donor organ. This patient was diagnosed with culture-positive sepsis, the accompanying EMB was negative for rejection, and coronary angiography was normal.
Scenario 3
Four patients with biopsy-proven rejection were analyzed. All pre-treatment samples collected at diagnosis contained DScf-DNA >1% (sensitivity 100%). Following intravenous immunosuppressive therapy, all patients demonstrated significantly decreased %DScf-DNA. Interestingly, 3 to 4 days after discontinuing augmented immunosuppression, the %DScf-DNA rebounded in 3 of 4 patients (Fig. 1C). The DScf-DNA was compared with other candidate noninvasive laboratory variables (B-natriuretic peptide, troponin, and C-reactive protein) as well as echocardiographically determined left ventricular ejection fraction in predicting rejection on biopsy; DScf-DNA had the highest sensitivity and specificity (100% and 84%, respectively).
DScf-DNA may be sufficiently sensitive to detect rejection and injury to the donor organ earlier than currently available methods. Levels of DScf-DNA fall consistently by 1 week post-transplant, which may allow for noninvasive detection of rejection in the vulnerable early post-transplant period (data not shown). A sensitive noninvasive rejection monitoring method could decrease the number of biopsies needed over a lifespan, thereby considerably decreasing complications, discomfort, and cost. We were able to detect all rejection episodes, including both cellular and antibody-mediated rejection, at the earliest onset and even before clinical indicators of disease. However, these results are based on a limited sample size. A larger validation study is needed.
In summary, targeted quantitative genotyping was employed to determine circulating levels of DScf-DNA in pediatric heart transplant recipients. The percentage of DScf-DNA was elevated in all patients diagnosed with rejection. Further, all patients with DScf-DNA levels <1% were shown by biopsy and clinical parameters to be negative for rejection (negative predictive value 100%). Targeted quantitative genotyping of circulating DScf-DNA constitutes a sensitive, rapid, and cost-effective noninvasive tool potentially suitable for rejection surveillance as an alternative to EMB.
Please note: This study was funded by the Department of Surgery, New Faculty Pilot Grant Program at the Medical College of Wisconsin and the Clinical and Translational Science Institute (CTSI) pilot grant program, Milwaukee, Wisconsin. Digital Analysis of Selected Regions (DANSR) was run free of charge by Ariosa Diagnostics. Drs. Mats Hidestrand, Pip Hidestrand, and Goetsch own stock in Ariosa Diagnostics. Dr. Oliphant is an employee of Ariosa Diagnostics. Dr. Simpson has served as a paid consultant to Roche. Drs. Tomita-Mitchell and Mitchell own stock in and are cofounders of Ariosa Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2014 American College of Cardiology Foundation
- ↵
- Pophal S.G.,
- Sigfusson G.,
- Booth K.L.,
- et al.
- ↵
- ↵
- Snyder T.M.,
- Khush K.K.,
- Valantine H.A.,
- Quake S.R.
- ↵
- ↵


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I love carbs. I love bread, pasta, and crackers. I would love to eat Wonder white bread at every meal. Instead, I've filled our house with whole grains. Now however, we have some other things to consider.
There is a lot of research on the effects of gluten on the body. It makes me cringe very time I hear it because, if I didn't already make it clear, I love gluten. Here's the thing. I have a child struggling with an illness that could be greatly improved by eliminating gluten from her diet. That changes the stakes. Now "mom mode" kicks in. I have told her from the beginning I am willing to do anything to help her and apparently that includes giving up some of my favorite foods.
So this is the start of our family's journey away from gluten. We are going at it as a whole family and will commit to 30 days. The first (huge) hurdle, getting my teenager on board, has been met so now I need to figure out what we are going to eat! I have two loaves of bread baking right now and we are exploring new foods every day!
If anyone has any suggestions, please share and don't be surprised if you see a future post titled "I miss bread".


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Senda thrives on stunning yet delicate fabrics. Tulles, pearls, transparencies and elegant shades with embroidered flowers in colour are assume the leading role of the new designs. Fringes, frills, puff sleves and daring silhouettes bring movement and strength to a collection designed for authentic brides.
Brides who value personalisation and exclusivity offered by Immaclé, accentuating their own personality and each bride's innate nature.
Colección Senda
2018 © Immaclé


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Your Astor, Florida Professional Real Estate Agent
North Central Florida Real Estate (Includes E. Lake Co. & W. Volusia Co.)
Featured Listings
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"A Passion for The Water and The Land"
Welcome to the premier resource for all real estate information and services in the area. I hope you enjoy your visit and explore everything my realty website has to offer, including Astor real estate listings, information for homebuyers and sellers, and more About Me, your professional Astor Realtor.
I have over 30 years in Real Estate servicing Seminole, East Lake and West Volusia Counties. Specializing in Waterfront, Unique Properties, Acreage or just that special New Place to call Home!!
I am a Full time realtor in the Astor, Florida and the surrounding areas with MLS exposure in the Mid-Florida, Lake and West Volusia Boards.
Central Florida has something for everyone – Come discover "The Florida Life Style"! Nancy looks forward to assisting you in both residential & commercial properties.
For more information on Astor, Seminole, West Volusia & East Lake Cities, Florida: Click on the "Property Search" link on the site!
I look forward to assisting you in waterfront, acreage, residential, commercial and unique properties. – The Nancy Brand Team Cares!!


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What is retrograde motion and why does a planet like Mars appear to change directions in the night sky? Is it playfully looping about in its orbit around the sun or is something less strange going on? From episode 2 of Wonders of the Solar System, Professor Brian Cox explains why Mars Loops The Loop.
Though it baffled ancient astronomers, we know now that retrograde planets are an illusion caused by the motion of Earth… You can test this the next time you pass a car on the highway. As you approach the slower car, it is clearly moving in the same direction you are. Right as you pull along side and pass it, however, the car appears to move backwards for just a moment. As you continue pulling away, the car resumes its forward motion.
The same thing happens as Earth passes the slower moving outer planets. When we pass Jupiter, for example, the gas giant appears to reverse course in the sky for a couple of months.
Related watching: more with Brian Cox, more orbiting, more illusions, and more tricks of perception, including The Moon Illusion.
Thanks, @kvetchup.


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MAJT Volume 1.2
Preparing the City-Bride for Her Lord: An Exegetical Exposition of Isaiah 62:1-12 by Mark D. Vander Hart
Christian Ascetics in the Tehological Curriculum: an Apologia by Nelson D. Kloosterman
The Image of God and the Law of God by Henry Vander Kam
Comments on Catechetical Preaching by Peter Y. De Jong
Scripture and Faith: A Response to Nelson Kloosterman by Henry Vander Goot
Reviews of Books
David L. Edwards. Christian England (Volume Three): From the Eighteenth Century to the First World War. Jerome M. Julien
Richard S. Armstrong. The Pastor as Evangelist. C. Eric Fennema
C. Samuel Storms. The Grandeur of God: A Theological and Doctrinal Study of the Divine Attributes. C. Eric Fennema
James D. Stuart. The Cultural Subversion of the Biblical Faith: Life in the Twentieth Century Under the Sign of the Cross. C. Eric Fennema
John E. Burkhart. Worship: a Searching Examination of the Liturgical Experience. Peter Y. De Jong
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Saam Daam Dand Bhed 5th April 2018 Written Episode, Written Update on TellyUpdates.com
Bulbul disguised as Sardarji electrician walks into Ananth's house. Malkayin says electrician came so soon. Ananth says Mandira's fast service. He throws flashlight on Bulbul, but she hides face. Mandira takes Bulbul to fuse room and throws flashlight on her. She gets afraid thinking if Mandira identifies her, asks to show light on board. Mandira walks away asking to work properly and call her when she fixes problem. Bulbul walks into home and searches proof of Vijay's innocence and thinks where Ananth must have kept it. She drops something in dark. Tejaswini gets alert.
Keshav meets Vijay and self-praises himself. Vijay says if he is done, let us talk about case, they have to find evidence in Ananth's office Keshav says they should search house first.
Vijay asks where is Bulbul. Keshav stammers nervously. Vijay thinks something is wrong and says he does not know his wife, she is very intelligent and daring and can do anything to save him. Excited Keshav reveals that Bulbul has gone to Ananth's house to find proof.
Bulbul continues searching Ananth's room. Ananth walks in and asks what is he doing here. He says due to extra load, he has to check wire here. Mandira walks in and says she allowed him to enter as he wants to check wiring. Ananth scolds how can she let a stranger man inside their room and asks if his work is done, he can go out. Bulbul walks out. Ananth then gives swiss watch gift to Baba. Baba praises him and says Vijay's story is finished and his wife will live a widow life hereon. Bulbul cries. Vase falls. Ananth asks what is he doing here. He says doing his job and asks to pay him. Ananth says unbelievable and asks to do his work soon.
Mandira walks to sardarji and holds his hand. Bulbul says she should not hold stranger man's hand. Mandira warns to stop her acting and says she can help her as she also loves Vijay and wants him freed, how can she help her. She hears someone coming and asks her to go. Bulbul runs out and seeing Keshav asks what is he doing her. He says Vijay called her. She reaches Vijay's jail cell and asks if he called her. He says why will he call him. She removes fake beard.
Precap: Real electrician reaches Ananth's house, Ananth is shocked.
Bulbul tells Vasu that con artist's number must be in Sadhna's phone, she should check it.
Update Credit to: MA


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Energy Savings Tips for Small Businesses: Home‐Based Businesses
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Use this six-page document to find specific advice on how home-based businesses can become more energy efficient. This resource is intended to complement and build upon the guidance provided in the ENERGY STAR® Small Business Action Workbook, with a focus on the home-based business facility type.
Home-based businesses face unique energy considerations including the impact business energy usage on personal finances. In addition to energy saving tips, Energy Savings Tips for Small Businesses: Home‐Based Businesses provides guidance on how to profile your energy use and links to additional resources.
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Obit: Kleckner, John L. (1864 - 1943)
Contact: Crystal Wendt
Email: firstname.lastname@example.com
Surnames: Kleckner, Longenecker, Skippins
----Source: The Clark County Press (Neillsville, Clark County, Wis.) 23 Dec. 1943
Kleckner, John L. (14 Feb. 1864 - 21 Dec. 1943)
John L. Kleckner, 79, prominent business man of Neillsville, passed away at his home at 6 p.m. Tuesday, December 21, 1943. Although he had been in poor health for several years, his death was sudden and unexpected, as his health had been better of late.
Funeral services will be held at the residence, 171 West Fifth Street, on Friday, December 24, at 2 p.m. The Rev. George W. Longenecker, pastor of the Congregational Church, will have charge of the services.
Mr. Kleckner was born at Mifflinburg, Pa., February 14, 1864, the son of William and Matilda Zellers Kleckner. When he was fourteen years of age, the family moved to a farm near Schoolcraft, Mich., where he grew to manhood. On September 4, 1888, he was married to Miss Olive Skippins, who passed away August 24, 1943.
As a young man, he taught school, was a bank cashier, and engaged in the grain business in and near Schoolcraft. Later he moved to Chicago, where he engaged in the grain and real estate business for fourteen years. Owing to ill health, he retired from that business and moved to a farm south of Neillsville. As his health improved, he became active in the grain business, moving to Neillsville. He purchased the home on West Fifth Street, where the family has since resided.
In 1916, Mr. Kleckner was elected mayor of Neillsville, and served the city well in this capacity. For several years much of the management of the grain business has been turned over to his son Alfred, but Mr. Kleckner has always retained an interest in the business, and has always been actively interested in civic and public affairs.
Surviving are two sons, Everett and Alfred, four grandchildren, and two great-grandchildren. Three sisters and one brother also survive. Two sisters reside in Schoolcraft, Mich., and one sister, in Kalamazoo, Mich. His surviving brother lives in Highland Park, Mich.
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This post is sponsored by Zeeberry.com and may contain affiliate links.
Summer is totally my favorite so it only seemed right to share with you what summery things I'm crushing on right now.
Beach umbrellas are a total necessity here in Florida. Honestly, I've never had one before but here the sun is so intense you need a little more protection than just sunscreen. I love this one – it totally reminds me of a cabana somewhere tropical.
Then of course, my favorite anchor print – perfect to add a little summer into your home!
The Gorjana Greer V neck necklace is my jam right now. I love how light it is and you can totally dress it up or down. I wear shopping but I also wore it on a date last weekend. Top notch.
Turkish Towels – okay so these probably aren't just a "summer" trend but I think they look pretty darn beachy. Love this one with the aqua stripes.
Alex and Ani Bangles – I'm totally late to the party with these but I fell in love with the the birthstone bangles. I grabbed one with P's birthstone (emerald) and plan on getting another with the new baby's birthstone as well. Super cute.
Kendra Scott Alex Earrings – I got these specifically to wear to a blog conference I'm going to later this month. I love all of Kendra Scott's jewelry and I'm really attracted to the bright colors that are offered but these slate gray earrings are gorg!
Star shaped popsicle molds – because SUMMER! My kiddo loves popsicles of any kind and making our own is so fun with these super cute star shaped molds!
Popsicle Tote – again… because SUMMER! The cutest tote for heading to the pool or the library – love it.
To celebrate summer the wonderful folks at Zeeberry.com sent me a few pieces to try and I'm obsessed with all of it 🙂


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The four-day Thanksgiving holiday is a great time to spend time with your family and friends. That's what I've always heard. Nonetheless, not necessarily everyone enjoys socializing a lot or even have the desire to do so. Each individual has the innate need to communicate with others, but introvert people can be happy individuals as they interact with others a few minutes at a time.
No Unpleasant Feelings
I am one of many people who's happy to be alone doing important tasks. It was not until I read a great article not too long ago that explains how to enjoy time when you're away from others. That's when I fully realized it's acceptable that I enjoy spending time alone. There's no reason at all for me to feel guilty, or odd, because I am content with myself.
Credit: http://en.wikipedia.org/wiki/File:Paul_Gauguin_072.jpgCredit: http://en.wikipedia.org/wiki/File:Paul_Gauguin_072.jpg
Schoolwork on Thanksgiving Holiday
Thanksgiving is a great time for students to catch up on their schoolwork. There are plenty of college students who need to work to pay for college expenses. Therefore, they could use a break to study. Children taking challenging classes and have extracurricular activities could feel fortunate for having four days to do schoolwork. I don't think it's never too early for children to work hard in attempt to get admitted into exceptional colleges. Introvert students could be happy studying alone and just socialize with others when they are taking breaks.
Credit: http://en.wikipedia.org/wiki/File:Salomon_Koninck_001.jpgCredit: http://en.wikipedia.org/wiki/File:Salomon_Koninck_001.jpg
Entertainment from Different Media
Not every working person gets a day off on Black Friday. That is the day after Thanksgiving. Therefore, some people only have one weekday to relax. Introvert individuals only have one day to enjoy time alone. What if they work at a retail store that is expected to have increase traffic on Friday? I believe they would go to sleep not too late and prefer to spend most of the daytime alone. They may have interest in watching something on TV. There are the annual Macy's Day Parade or NFL games to watch. Perhaps watching a movie at a theatre during a matinee showtime would be a better fit for some introvert people. It gives them a chance to interact with theatre employees before they experience quiet time alone in a dark area.
Credit: http://en.wikipedia.org/wiki/File:Georges_Seurat_066.jpgCredit: http://en.wikipedia.org/wiki/File:Georges_Seurat_066.jpg
Fun Activities for Introverts
During the whole time I that I set my mind to write this article, I wanted to let readers know that writing, reading, drawing, and painting are perfect activities for introvert persons to do during Thanksgiving. We enjoy pondering. We become insightful as we spent plenty of time figuring out and explaining our beliefs to ourselves. Yet, we could publicize our thoughts and write articles for Info Barrel on Thanksgiving Day. Researching over the Internet would also be embraced by introverts as another task to enjoy. Another online activity to do is to upload artworks to certain websites and discuss them whenever someone comments on it. Christmas could be astonishing just by having artwork praised and ruminated by other people living somewhere around the world.
Credit: http://en.wikipedia.org/wiki/File:Paul_Sandby_by_Francis_Cotes_N01943_9.jpgCredit: http://en.wikipedia.org/wiki/File:Paul_Sandby_by_Francis_Cotes_N01943_9.jpg
There are other merry activities for introvert individuals to do without having the obligation to socialize with other people during Thanksgiving that I didn't mention.


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And is a bit of a surprise. Since Chrysler/Fiat was widely expected to show a production EV version of the new Pacifica Minivan.
Instead, we are getting a really good looking concept.
Which doesn't' really bring anything crazy to the table. Since it's range is about 250 miles.
Nothing futuristic.
But the basic shape would make a great design for something smaller and cheaper than the Pacifica.
But... I am afraid this is only a cheap trick form Sergio Marchionne to pretend Chrysler is still a vital brand. It is not.
It's only products are the new (And not that popular) Pacifica. And the "aging very fast" 300 sedan.
Since Sergio has killed the good looking 200 sedan, blaming the designers for slow sales. (What a great guy)
Chrysler used to come up with great concept cars a few years ago. Every year.
Let's hope this is not the last one ever...


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Written by S&T Media Service
THE leaders of Marikina City on Thursday praised the government project on disaster prevention and mitigation, and the weather bureau for the zero fatality and efficient rescue-and-relief operations in the city in the midst of Typhoon Maring.
Mayor Del de Guzman and Rep. Miro Quimbo attributed the timely, accurate and effective response of the local government unit (LGU) to the onslaught of Typhoon Maring to the precise warnings, substantial information and ample lead time provided by Project Nationwide Operational Assessment of Hazards (Noah) and the Philippine Atmospheric, Geophysical and Astronomical Services Administration (Pagasa) of the Department of Science and Technology (DOST).
Project Noah is a program of the national government as a response to the strict orders of President Aquino to put in place a responsive program for disaster risk reduction and mitigation that will provide lead-time warning to vulnerable communities against impending floods.
The project harnesses technologies and management services offered by the DOST through its agencies such as Pagasa, the Philippine Institute of Volcanology and Seismology, and Advanced Science and Technology Institute, in partnership with the University of the Philippines (UP) National Institute of Geological Sciences and the UP College of Engineering.
"Marikina receives the brunt of rains and floodwaters from San Mateo, Antipolo and Montalban, which inundate us in such a speed that often result in fatalities and massive economic losses. In times of typhoons, the people and local officials essentially operate blindly in the absence of information on the amount of rainfall and estimated time of impact. We are either caught off-guard, which results in deaths and destruction of property like what happened with Typhoon Ondoy; or we overreact and conduct massive evacuation, which unnecessarily depletes the city's resources and economically dislocates people," Quimbo said.
But the Marikina solon said this has changed when the national government provided the LGUs with a potent tool to adjust and cope with typhoons through Project Noah and Pagasa.
Through Project Noah, relocation of families in flood-prone areas has also become more efficient and systematic. It gives the officials and residents between three to six hours lead time to carry out an orderly evacuation.
De Guzman said, "There are no recorded casualties as of now in Marikina. We are not yet claiming victory, but we are hopeful that with this new tool given by the national government through Pagasa, we will survive this calamity without casualties."
The city was able to accomplish its target of zero casualty in the face of the habagat (monsoon rains) in August 2012, which the city government credit to Project Noah.
The Marikina leaders also highlighted the benefits of a dynamic synergy between the national government and the LGUs. De Guzman and Quimbo said the national government and the LGUs had a shared vision of disaster prevention and mitigation, and this was realized when the President gave the local officials a potent tool through Project Noah.
"Disaster risk-reduction management will only be effective if you have proper tools and programs like Project Noah. Projects like these are worthy investments, as they give us the informations that are required in order to properly address the immediate needs of people during typhoons. In effect, the government can act more efficiently," Quimbo said.
Project Noah was launched by the President last year in Balubad, Nangka, the most vulnerable area in Marikina.
This article was originally published in the Business Mirror on August 24, 2013


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text: Thanks to the latest mobile revolution and the ongoing smart phone craze, you can move around anywhere completely cashless. Whatever the reason is, paying bills in a restaurant, paying the cab or recharging your phone, anything is possible with the latest smart phone application, Momoe. Gone are the days when you had to run the risk of carrying cash or cards everywhere.


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"Transformers" roll through Chicago as Bay blows up Windy City
By Sean O'Connell
Hollywoodnews.com: The Windy City became The Demolished City as Michael Bay brought his production crew to Chicago to shoot scenes for "Transformers 3."
Specific details about the plot are being kept under wraps. Screenwriter Ehren Kruger, who penned part of "Transformers: Revenge of the Fallen," returns to the franchise, as does lead actor Shia LaBeouf. Of course, most of you know Megan Fox will not be returning as Shia's love interest. She has been replaced by Rosie Huntington-Whiteley. What I didn't realize is that Huntington-Whiteley will be playing Fox's character, Mikaela Banes. (At least, according to IMDB she is.) I just assumed Bay would cast her as a different girl for LaBeouf's Sam character. Maybe he fears "Transformers" fans wouldn't be able to follow just an elaborate switch? 🙂
None of the actors appear in photos posted to various Web sites this morning, however. Click on ChicagoNow for shots of Optimus Prime rolling down a devastated LaSalle Street in Chicago. And the always excellent Film Drunk ran photos sent by Drunk readers, which have a NASCAR theme. Sounds about right.
"Transformers 3" will film in Chicago through August. It's scheduled to hit theaters July 1, 2011.
Award News, Breaking News, Entertainment News, Movie News, Music News, Hollywood News


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Recipe submitted by: Amy Pickett
Recipe courtesy of: http://www.imperialsugar.com/recipes/desserts/cakes/carrot_cake
What's in it
4 large eggs
1 cup oil (grape seed, olive-not extra virgin or canola oil)
1 teaspoon vanilla extract
2 cups Imperial Sugar Extra Fine Granulated Sugar
2 cups all-purpose flour (spoon and sweep method*)
1 tablespoon cinnamon
2 teaspoons baking soda
4 cups grated carrots
2/3 cup pecan pieces or walnuts
1 cup raisins, dark or golden
Cream Cheese Frosting
Dried carrot strips
1 cup Imperial Sugar Extra Fine Granulated Sugar
1 cup water
2 medium sized carrots
Optional: 1 1/3 cups pecan pieces for sides
How to cook it
- Preheat oven to 350°F.
- Butter and flour or use baking spray, prepare two 9 inch baking pans. Set aside.
- In a bowl beat eggs for 5 minutes. Gradually add oil in a thin stream. Add vanilla.
- Sift together sugar, flour, cinnamon and baking soda and add to above and mix well. Add carrots, nuts and raisins and mix until combined.
- Evenly divide batter into prepared pan and place in oven. Bake until center of cake bounces back when lightly pressed with a finger or a toothpick comes out clean. About 45 - 55 minutes. Let sit in pan for 10 minutes before removing.
- Turn cake out pan. Let cool completely before frosting.
- Prepare Cream Cheese Frosting and frost cool cake.
- For carrot strips, peel carrots using a vegetable peeler. Continuing with vegetable peeler, make long carrot strips from top to bottom. Set aside. Bring to a boil sugar and water. Add carrot strips and simmer for 5 minutes and then drain.
- Lay carrot strips in a curvy fashion on a silicone baking mat or wax paper. Place on a cookie sheet and place in a 200°F oven until crisp, about 90 minutes.
- Optional: Coat sides of carrot cake with 1 1/3 cups of finely chopped pecans.
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Once again Thrasher magazine supply the goods in the form of this simply fantastic section from Skate Mafia and Bones Wheels' Jimmy Cao.
Set to Primal Scream's classic ode to "having fun" 'Loaded' and filmed everywhere from China to Southern California ATV Jimmy has put out a section that is sure to get you pumped regardless of you preferred skateboarding persuasion.
Bowls, mannys, tech and gnar all get a serious seeing to and his last two tricks are definite hammers that'll leave you wanting more. We know we say it a lot but if you set yourself a few minutes aside and click play we're sure you'll come out the side psyched and desperate to go straight out for a shred.