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Health Issues from Mold Exposure, In the news, MCS, Symptoms
Recognizing Neurotoxicity – A Fantastic Medical Review
This is great write up by Dr. Raymond Singer and Dana Darby Johnson. A must read for anyone suffering with chemical sensitivities, mold illness and neurotoxicity.
The symptoms of brain injury from exposure to hazards like lead paint and toxic chemicals vary widely. But there are ways you and your experts can pinpoint the damage and its cause.
Neurotoxicity—poisoning of the brain and nervous system—is a well-documented effect of exposure to many widely used chemicals, yet doctors (and lawyers) often fail to recognize it. Chemically injured clients often report a confusing array of symptoms, with no medical diagnosis. The symptoms may seem vague and unconnected, leading you to wonder, "Could these symptoms really be caused by a chemical exposure?"
Once you recognize the signs and understand them in context—as a constellation of symptoms resulting from a toxic injury—you will have greater confidence in bringing your client's case to justice.
A person who has suffered a serious chemical injury is likely to have sustained considerable damage to his or her brain and nervous system. This is important for a lawyer to know, because doctors often recognize only the person's physical illness, not realizing that serious brain and nervous system damage may have also occurred.
Neurotoxicity can be documented, but perhaps not in the way you might think. A person's ability to think, perceive, control emotions, plan, and manage his or her life can diminish drastically without anything being visible to a radiologist or neurologist on an MRI or a CT scan.1
The most reliable and widely accepted way to assess actual brain function is through neuropsychological evaluation. (This is true for head-injury patients and those suffering from dementia, as well as those affected by exposure to toxic chemicals.)
Researchers have noted that imaging techniques are often of little value in evaluating neurotoxicity.2 In our and others' experience, imaging techniques can occasionally pick up abnormalities caused by neurotoxicity and may be helpful for forensic purposes, but they are not cost-beneficial for routine screening.3
Neuropsychological testing tends to be more sensitive to brain injury than CT and routine MRI scans, which provide only a static and relatively gross view of neural structure. In one study of six head-injury cases, CT and/or MRI scans yielded little or no evidence of neuropathology as detected by neuropsychological testing. Positron emission tomography (PET) scans, however, corroborated the impaired function.4 PET and SPECT (single photon emission computed tomography) scans offer a more dynamic look at brain structure, but both of these tests still need interpretation as to the cause of the abnormality (which could be benign).
What do chronic pain, anxiety, neurological problems, confusion, psychiatric symptoms, and cognitive declines have in common? They can all result from neurotoxic chemical exposure.
Symptoms of neurotoxicity include memory and concentration problems; confusion; multiple sclerosis or MS-type symptoms; impaired control of the limbs, bladder, or bowels; headaches or migraines; sleep disorders, including sleep apnea; eye problems that are neurological in origin; balance and hearing problems; muscle weakness; anxiety or panic attacks; depression; and other psychiatric or neurological symptoms.5
Other symptoms that could be caused by chemical injury include multi-organ system malfunction; lower or upper respiratory problems, such as chronic sinus problems; multiple chemical sensitivity (MCS); liver or kidney problems; and fibromyalgia or other pain disorders.
Along with nervous system dysfunction, the temporal association of any of these conditions with toxic chemical exposure tends to support the theory that the overall cause of the client's injuries is a toxic insult to the body.
The illness you probably need to know the most about is MCS, both because it is common among chemical injury patients, and because doctors often don't recognize it in their patients. The MCS diagnosis is still rejected by many doctors in part because it is difficult to quantify objectively—but then, so are headaches.
Many doctors are not aware of the significant research that shows MCS is common and quite real.6 MCS is similar to other disabling illnesses. People who have it can become very ill from exposures to everyday chemicals, such as perfumes, paint, pesticides, and cleaning products.
Under some conditions, MCS is recognized as a potentially disabling condition by the Social Security Administration, the U.S. Department of Housing and Urban Development, and the Americans with Disabilities Act.7
Documenting a chemical injury
There are various ways you can document the presence and course of a neurotoxic injury. All of them will help you build your case.
Conduct a neuropsychological evaluation. This procedure reveals both the most detailed view and the most subtle problems of the working brain.
A forensic neuropsychological evaluation usually includes a full battery of tests that can take up to 12 hours to complete. It can assess brain function, including memory; concentration; the ability to learn new information; executive function (the ability to plan, manage, and carry out a plan); perceptual functions, such as spatial awareness; motor functions, such as dexterity; and personality, emotion, and motivation. This evaluation can often detect whether changes have occurred that may be a result of toxic injury.
Be aware that some neuropsychologists consider someone impaired only if his or her cognitive functioning is well below average. Such an approach is inadequate when the person was once high-functioning.
For example, a client with a superior IQ—such as a doctor or scientist—who now is unable to do his or her job will not benefit from an evaluation that interprets an "average" level of intelligence as "normal." Or your client may be someone who previously functioned at an average level but now is considered below average or has more marked problems in particular areas of brain function, such as emotion, personality, or executive function. These individuals benefit from more complex and subtle evaluations.
Several red flags can signal that the brain is not working as well as it should. For example, if a client's vocabulary skills are high but his or her ability to process new information is at the 50th percentile, this discrepancy suggests a decline in information-processing skills. If the client was previously a successful engineer, a neuropsychological evaluation will give you findings that point to a decline in brain function.
Assess personality and emotional function. Chemically injured people can suffer personality changes induced by brain damage. The neuropsychologist needs to take a thorough history and conduct a record review to determine whether any personality disorders were preexisting or caused (or exacerbated) by the chemical injury.
The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is often used to assess personality.8 But this instrument was not standardized on brain-injured people or those with neurological disorders, so the results must be interpreted carefully.
For example, if a "normal" person showed many neurological symptoms, he or she might correctly be characterized as mentally ill. But it would be normal for a chemically injured person to report an array of neurological symptoms.
The patient with "too many" symptoms can get a diagnosis of "somatic disorder"—that is, having physical symptoms caused by psychological conditions. This misdiagnosis says that psychological problems are the underlying cause of the illness.
Neurotoxicity patients may well have psychological problems, but these are often the result, not the cause, of their condition. The true cause—organic (physical) brain dysfunction, or neurotoxicity—is too easily overlooked. When interpreting the MMPI-2, the expert must consider the person's medical and neurological conditions before reaching conclusions.
Also, some common interpretations of the MMPI-2 might over-diagnose malingering.9 An improper diagnosis of malingering can make it difficult to prove an injury.
It is not unusual for patients suffering from neurotoxicity to be misdiagnosed as having psychological problems because of their depression and anxiety levels, the sheer number of their symptoms, and their belief that chemicals made them ill. To minimize this error, choose among the most qualified experts you can find: Psychologists, neuropsychologists, or psychiatrists who are familiar with chemical injury, neurotoxicity, and MCS.
"Image" the brain. It would be ideal to have an X-ray that would show what's gone wrong in the chemically injured brain. Unfortunately, brain scans are usually not helpful, because we don't have the technology to "take a picture" of most brain injuries. (Even damage caused by traumatic brain injuries, such as from an automobile accident, may not show up in brain imaging.) A weak correlation exists between neuroimaging findings and neurocognitive outcome.10 Neurotoxic damage does not necessarily affect brain structure at the level we can see on a brain scan.
PET and SPECT scans are often more sensitive to brain injury than either MRIs or CT scans, 11 but even if they show an abnormality, they don't show what caused it. Such scans have limited utility in court as proof of damage.12 The meaning of the abnormality still needs to be explained via neuropsychological assessment. A brain MRI often can be useful to rule out the possibility of another brain disorder.
Test the body. Searching for physical evidence of a chemical injury has been compared to searching for a bullet shot through someone's body: The bullet may be gone, but the havoc it wreaked is still there. Blood and urine can be tested for residue of the chemical in question and its breakdown products, or for a range of chemicals, but usually this testing is effective only while the client is still being exposed or after recent exposure.
The body may store toxicants in the fat and tissues, longer-lasting storage sites than the blood or urine. Tissue samples can be taken and occasionally are helpful, but these procedures can be difficult, painful, and expensive. Hair analysis may be helpful, but it is often controversial.13 Immunological testing can determine whether the client has elevated antibodies to some molds, suggesting high levels of exposure to toxic mold.14
Test and analyze the exposure location. When analyzing an exposure location for toxic substances (such as might be found in the air or on surfaces), it is better to hire your own consultants to perform the work. They can control many important variables that could be ignored by other service providers.
Earlier tests conducted by the defendant may be available, but the results might not be valid for various reasons, even if the tests were conducted by a government agency. A potential defendant, after discovering that its site would be tested, may have aired out the building and washed down all the surfaces before testing. Unfortunately, the tests that government agencies perform are often woefully inadequate.
Analyze the site carefully. Is there adequate ventilation? Is there a clean-air exchange? Is the ventilation system blowing contaminated air into the client's breathing space?
Some toxic chemicals may be heavier than air, so ventilation in those circumstances should exhaust air out of the room from the level of the floor, not the ceiling. One of our clients suffered severe brain damage after using solvents outdoors on his boat. Most people think that applying solvents outside is safe. However, our client applied them while lying on his back, under the boat. Because the solvent was heavier than air, this amounted to lying in a dense cloud of neurotoxic gas, and friends had to pull him out from under his boat. The toxic exposure caused injuries that rendered him completely disabled15.
Under Daubert v. Merrell Dow Pharmaceuticals, Inc., 16 the expert should present published research showing that the chemical implicated in the case has caused the same damage that your client suffered. But there is room for some flexibility.
For example, in a 2001 federal toxic-tort case, the court admitted testimony that experts do not always need extensive, specific research on a particular product to arrive at an opinion.17 Instead, the chemical's toxicity can be deduced from general toxicology and basic logic: The substance was an organic solvent; organic solvents are neurotoxic; therefore, this solvent is neurotoxic.
In our experience, neuropsychological testimony is routinely admitted under Daubert rules.18 Its application to neurotoxicology is well established but may be challenged. We are not aware of cases where this testimony has been excluded on Daubert grounds, but individual states' requirements will vary.
In one case, the Ohio Supreme Court unanimously ruled that a witness who is not a physician, but who qualifies as an expert under state evidence rules, may give evidence that would be relevant to diagnosis of a medical condition if the testimony is within the expertise of the witness.19 Usually, the statute of limitations does not start running until the client has received a diagnosis stating that his or her condition was caused by a chemical exposure. In many cases, it takes years for this diagnosis to be made
In other situations, the client is so seriously injured that he or she cannot seek out appropriate medical or legal help. The very symptoms of neurotoxicity—memory problems, inability to concentrate or think clearly, and difficulty processing information—impede the injured person's ability to understand what happened to him or her and can decrease his or her intellectual and emotional capacity to pursue litigation. In such cases, you may need to file a statement of mental incompetence to extend the statute of limitations.
What to expect from the defense
Invariably, the defense will seek to minimize the link between your client's symptoms and the toxic substance he or she was exposed to and will try to play down the product's harmfulness. Expect arguments like these:
"This product cannot damage your health." The Material Safety Data Sheet (MSDS), required by law of every manufacturer, is a good place to start when seeking documentation of a chemical's adverse health effects, because often the MSDS lists them.20 But sometimes the MSDS doesn't even hint at a product's real dangers, and you will need to conduct further research. The neurotoxicity of common products is discussed in various texts.21
"If this product caused ill health effects, it would not be marketable." In fact, hundreds of neurotoxic products are promoted and sold. More than 850 industrial and commercial chemicals are known to cause neurobehavioral disorders.22
"Ninety-five percent of the ingredients are inert, so what's the problem?" There are two issues here. One is whether 5 percent of an active ingredient is toxic enough to cause health effects—and often it is, because toxic substances can be harmful in small amounts.
The other issue is the meaning of "inert." So-called inert ingredients can be more toxic than the "active" ones. By labeling an ingredient "inert," a company may be trying to avoid admitting that there is a noxious ingredient in its product. The manufacturer may call its formulation a "trade secret."
Try to obtain a list of the inert ingredients by subpoena and have a laboratory analyze the product. Once you establish what the inert ingredients are, your consultants should assess their toxicity.
"But we didn't exceed government standards for exposure." "Safe" levels of exposure are a compromise between an industry's commercial needs and consumer protection and do not guarantee that an injury cannot occur. These standards generally become stricter with every passing decade, and incidents of reported chemical injury are what cause them to change.
Furthermore, safe levels are routinely set to protect a healthy male worker. But some people are more susceptible than others. Women, for instance, tend to be more sensitive than men, and different bodies react differently to toxins.23 Variations in sensitivity are even observable in rats. Also, there may be no safe level at which a person can inhale a particular substance.
The MSDS typically will state that if a person shows signs of illness, you must remove him or her from the area immediately. This suggests that it is generally recognized that some people will become ill even when they are working under the recommended safe-exposure guidelines.
"This amount was far too small to damage anyone's health." Chronic exposure to low levels of some toxic chemicals can be even worse than a single acute exposure, because brain damage is cumulative over time.
"The plaintiff had preexisting conditions." Plaintiffs in these cases often do. It makes sense that people whose health is already compromised are the most vulnerable to poisons, because their bodies' detoxification systems—especially the liver and kidneys—are already stressed. People with a preexisting condition suffer further deterioration of their health. Your expert should document the preexisting condition thoroughly—this may require extensive review and analysis of the medical record—and document what new symptoms emerged and what preexisting symptoms became worse.
"Just smelling the chemical could not have caused this." Actually, inhalation and skin contact are often more effective routes of entry for a poison than swallowing. When something is swallowed, it is partly neutralized by stomach acids. The body then attempts to detoxify it through the liver, kidneys, and other organs. But inhalation and skin contact allow a substance to enter the bloodstream directly, without any filtering. For example, doctors now use skin patches to administer morphine and birth control.24 And sniffing glue (solvents) can produce an instantaneous high and cause immediate and permanent brain damage.
"A neurologist found nothing wrong." Few neurologists have training in toxicology, and they rarely recognize the symptoms of neurotoxicity. A patient who suggests his or her symptoms were caused by a chemical exposure may encounter a brick wall of denial, bordering on hostility.
Some neurologists won't pay attention unless a patient's symptoms are extreme: For example, the patient cannot tell what day it is or walk in a straight line. Even then the neurologist may misdiagnose the patient as normal, even if neuropsychological testing shows serious functional deficits. Still, a neurologist's exam may help rule out non-toxicological causes of a neurological illness or document certain physical signs, such as seizures or gait disturbances.
"Chronic pain is not a symptom of brain or nerve damage." The term "chronic pain" may seem vague, outside the realm of most doctors, and potentially confusing to a jury. But chronic pain can certainly be a symptom of brain damage and toxic exposure.
Damage to the brain and nerves can disrupt the nerve signals themselves or the way the brain interprets those signals.25 Resulting sensations can be tingling, burning, or debilitating pain, which one of my chronic pain patients described as "like a thousand razor blades." Chronic pain can be a terrible ordeal and may require strong painkillers whose side effects could cause more damage.
"It is ludicrous to believe that neurotoxic chemicals can cause such disparate symptoms as insomnia, chronic fatigue, and gastrointestinal problems." On the contrary, the brain and nervous system control all bodily functions. The autonomic nervous system controls the involuntary part of bodily processes, including digestion, blood circulation, and the "fight or flight" response.
"Multiple chemical sensitivity does not exist." Studies indicate that almost 16 percent of the U.S. population report having unusual reactions to common chemicals.26 About 6.3 percent have been diagnosed with MCS or declared disabled from it.27 There is considerable research on, and international recognition of, this condition.
"The plaintiff is malingering." Every competent forensic neuropsychological assessment includes tests for malingering. When assessing a potential client, consider that a chemical injury would be one of the most difficult injuries to fake. Doctors who recognize the symptoms are few and far between.
You will probably find that your client has tried to find a cure, sincerely wants to return to work, and is seeking litigation as a last resort. The "invalid" label is profoundly depressing to most people. Nevertheless, you must always rule out the possibility of malingering and psychosomatic disorders.
"The plaintiff has a personality disorder (or is mentally ill)." Ironically, a plaintiff's personality disorder may be evidence of injury, not a reason to dismiss the case. Brain damage can result in such disorders, psychiatric symptoms, and even schizophrenia. Establish the patient's mental health before the exposure to help determine whether the exposure caused or exacerbated the psychiatric symptoms. In any case, it is not surprising when a person with a chronic illness, adjusting to a devastating life change, develops what may be diagnosed as a personality disorder.
On the other hand, some patients with a diagnosis of a psychiatric disorder don't actually have one. A patient may have received that diagnosis precisely because he or she claimed to be hurt by chemicals and was labeled "delusional."
Compensation and cure
There is no standard medical cure for chemical injury, but conventional medical treatments may help some symptoms and promote modest improvement. Alternative medicine treatment for neurotoxicity is controversial, but in our experience, nutritional therapy (including natural foods diet) and natural medicines (including acupuncture and holistic exercises, such as Tai Chi and Chi Gong) may be the only methods that help neurotoxic and extremely sensitive patients. Your clients should receive enough compensation to pay for continuing treatment, including less conventional approaches, such as medically supervised detoxification, infrared saunas, visits to rehabilitation centers, and possibly hyperbaric oxygen treatments.
Compensation should include lost salary, lost savings, and medical bills that will probably continue for a lifetime. It should cover counseling or psychotherapy to help patients adjust to being chronically ill; losing their jobs, their friendships, and possibly their homes; straining their marriages; and being unable to continue with hobbies. But they generally should avoid psychiatric drugs. Chemically sensitive patients may react to pharmaceuticals (usually petroleum derivatives) as they do to chemicals.
Your familiarity with neurotoxicity and chemical injury will help you guide your client to the clearest assessment of his or her disability. Choosing the right experts and testing will contain litigation costs and further your goals of obtaining justice and compensation.
Raymond Singer, Ph.D., is a forensic neurobehavioral toxicologist and neuropsychologist in Santa Fe, New Mexico, with additional offices in New York City. He handles cases on a nationwide basis. Dana Darby Johnson is an associate in his practice.
1.See, e.g., Bernhard Voller et al., Neuropsychological, MRI, and EEG Findings After Very Mild Traumatic Brain Injury, 13 BRAIN INJURY 821 (1999) (finding only 3 of 12 patients with brain dysfunction demonstrated an abnormal MRI). 2.See, e.g., Joseph C. Arezzo & Herbert H. Schaumburg, Screening for Neurotoxic Disease in Humans, 8 J. AM. C. TOXICOLOGY 147(1989); see also Pamela Reed Gibson, Disability-Induced Identity Changes in Persons with Multiple Chemical Sensitivity, 15 QUALITATIVE HEALTH RES. 502, 503-04 (2005). 3.See generally RAYMOND M. SINGER, NEUROTOXICITY GUIDEBOOK (2d ed. 2006, expected; 1st ed., 1990). 4.Ronald M. Ruff et al., Computerized Tomography, Neuropsychology, and Positron Emission Tomography in the Evaluation of Head Injury, 2 NEUROPSYCHIATRY, NEUROPSYCHOL. & BEHAV. NEUROLOGY 103 (1989). 5.See generally SINGER, supra note 3. The Neurotoxicity Screening Survey provides a complete checklist of possible signs and symptoms, available at http://www.neurotox.com/files/Q1_9.pdf (last visited Feb. 27, 2006). 6.See, e.g., Stanley M. Caress & Anne C. Steinemann, Prevalence of Multiple Chemical Sensitivities: A Population-Based Study in the Southeastern United States, 94 AM. J. PUB. HEALTH 746 (2004); Nancy Fiedler et al., Responses to Controlled Diesel Vapor Exposure Among Chemically Sensitive Gulf War Veterans, 66 PSYCHOSOMATIC MED. 588 (2004); Howard M. Kipen et al., Prevalence of Chronic Fatigue and Chemical Sensitivities in Gulf Registry Veterans, 54 ARCHIVES ENVTL. HEALTH 313 (1999); Richard Kreutzer et al., Prevalence of People Reporting Sensitivities to Chemicals in a Population-Based Survey, 150 AM. J. EPIDEMIOLOGY 1 (1999); William J. Meggs et al., Prevalence and Nature of Allergy and Chemical Sensitivity in a General Population, 51 ARCHIVES ENVTL. HEALTH 275 (1996).
7.See, e.g., letters and memoranda to and from Department of Housing and Urban Development, available at http://www.usdoj.gov/crt/foia/tal105.txt (last visited Jan. 23, 2006). 8.The MMPI-2 is available at http://www.pearsonassessments.com/tests/mmpi_2.htm#norms (last visited Jan. 23, 2006). 9.See, e.g., James N. Butcher et al., The Construct Validity of the Lees-Haley Fake Bad Scale: Does This Scale Measure Somatic Malingering and Feigned Emotional Distress? 18 ARCHIVES CLINICAL NEUROPSYCHOL. 473 (2003). 10.See, e.g., Voller et al., supra note 1; Paul A.M. Hofman et al., MR Imaging, Single-Photon Emission CT, and Neurocognitive Performance After Mild Traumatic Brain Injury, 22 AM. J. NEURORADIOLOGY 441 (2001); Shelli R. Kesler et al., SPECT, MR, and Quantitative MR Imaging: Correlates with Neuropsychological and Psychological Outcome in Traumatic Brain Injury, 14 BRAIN INJURY 851 (2000) (finding a modest but significant correlation between memory and intellectual impairments and number of brain abnormalities evidenced by quantitative magnetic resonance, magnetic resonance (MR), and all imaging studies combined (but not SPECT alone) and noting a positive correlation between psychological distress and MR abnormalities, most frequently in the frontal lobes). 11.See Donald J. Nolan & Tressa A. Pankovits, High-Tech Proof in Brain Injury Cases, TRIAL, June 2005, at 26. 12.Brickford Y. Brown et al., Are We Out of the Gray Area Yet? Recent Developments in the Use of PET and SPECT Scans to Prove Causation and Injury in Toxic Tort Litigation, available at http://www.morankikerbrown.com/CM/Articles/Articles67.asp (last visited Jan. 23, 2006). For an alternate perspective, see Garo Mardirossian & Joseph Martin Barrett, The Use of Functional Brain Imaging of Organic Brain Injury: A Primer, available at http://www.caala.org/DOCS/3-98mardirossian.pdf (last visited Jan. 23, 2006); see also Charles G. Monnett III & Kristin M. Jordan, Scientific Evidence Following Daubert vs. Merrell Dow: Are PET Scans Admissible to Establish Traumatic Brain Injury?, available at http://www.carolinalaw.com/CM/Articles/article-scientific-evidence.asp (last visited Jan. 23, 2006). 13.See generally SIDNEY A. KATZ & AMARES CHATT, HAIR ANALYSIS: APPLICATIONS IN THE BIOMEDICAL AND ENVIRONMENTAL SCIENCES (1988). 14.Raymond Singer, Clinical Evaluation of Suspected Mold Neurotoxicity, in BIOAEROSOLS, FUNGI, BACTERIA, MYCOTOXINS & HUMAN HEALTH: PROC. OF THE FIFTH INT'L BIOAEROSOL CONF. 78 (2005); see also Raymond Singer, Forensic Evaluation of a Mold (Repeated Water Intrusions) Toxicity Case, 20 ARCHIVES CLINICAL NEUROPSYCHOL. 808 (2005). 15.1Singer, R. (1996, March). Neurotoxicity from outdoor, consumer exposure to a methylene chloride product. Fundamental and Applied Toxicology, Supplement: The Toxicologist, 30, 1, Part 2.16.509 U.S. 579 (1993). 17.Bonner v. ISP Techs., 259 F.3d 924 (8th Cir. 2001); see also http://www.daubertontheweb.com (last visited Jan. 23, 2006). 18.See generally Bruce H. Stern, Admissibility of Neuropsychological Testimony After Daubert and Kumho, 16 NEUROREHABILITATION 93 (2001). 19.Shilling v. Mobile Analytical Servs., Inc., 602 N.E.2d 1154, 1156-57 (Ohio 1992). 20.See http://www.msds.com (last visited Jan. 23, 2006). 21.See, e.g., Raymond Singer, Neurotoxicity Guidebook, in NEUROTOXICITY OF INDUSTRIAL & COMMERCIAL CHEMICALS (John L. O'Donoghue ed., 1985). 22.Kent Anger & Barry Johnson, Chemicals Affecting Behavior, in NEUROTOXICITY OF INDUSTRIAL & COMMERCIAL CHEMICALS (John L. O'Donoghue ed., 1985). 23.See, e.g., Mark R. Cullen & Carrie A. Redlich, Significance of Individual Sensitivity to Chemicals: Elucidation of Host Susceptibility by Use of Biomarkers in Environmental Health Research, 41 CLINICAL CHEMISTRY 1809 (1995); Timothy T. Iyaniwura, Individual and Subpopulation Variations in Response to Toxic Chemicals: Factors of Susceptibility, available at http://www.riskworld.com/Nreports/2004/Iyaniwura.htm (last visited Jan. 23, 2006); Michael K. Robinson, Intra-Individual Variations in Acute and Cumulative Skin Irritation Responses, 45 CONTACT DERMATITIS 75 (2001); Michael K. Robinson, Population Differences in Acute Skin Irritation Responses: Race, Sex, Age, Sensitive Skin, and Repeat Subject Comparisons, 46 CONTACT DERMATITIS 86 (2002). 24.See, e.g., Mayo Clinic Med. Servs., Birth Control Patch, at http://www.mayoclinic.com/index.cfm?id=PR00075 (last visited Jan. 23, 2006). 25.See Nat'l Inst. Neurological Disorders and Stroke, Pain: Hope Through Research, at http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm (last visited Jan. 23, 2006). 26.See, e.g., Caress & Steinemann, supra note 6; Kreutzer et al., supra note 6; see also Meggs et al., supra note 6 (finding 33 percent). 27.See, e.g., Kreutzer et al., supra note 6.
Chemical Free Gal April 23, 2015 April 23, 2015 anxiety, Dr. Raymond Singer, mcs medical research, mold illness, Multiple chemical sensitivity, nervous system damage, neurological problems, Neurotoxicity
5 thoughts on "Recognizing Neurotoxicity – A Fantastic Medical Review"
Barbara Fritts says:
Fantastic article!! I have been diagnosed with Organic Chemical Hyper-toxicity Syndrome with Systemic Inflammatory Response Syndrome as a result of being exposed to a hazardous toxic mold environment at a hotel in AR (all hidden behind the wallpapered areas). I had pre-existing lung diseases prior to this exposure (pulmonary hypertension, mitral valve damage, and a partially collapsed left lung), and Dr. Michael Gray found that I also have an HLA genetic deficiency which made me even more vulnerable to these toxic molds (Stachybortys, Aspergillus, and Pencillium found in heavy concentrations in my room). My mycotoxin levels (Ochratoxin and Trichothecene) are off the wall high (even after being in treatment now for about 1 1/2 years) with a TGF-Beta 1 level of 12,800 (higher than any case studies Dr. Gray has seen). I am also under the treatment now of about a year + with Dr. Robert Crago due to the severe damage this has caused to my neuro system. Dr. Thrasher had never seen a neuro system so badly affected as mine. On top of all of this, on 12/23/14 I was directly exposed to a highly restricted termiticide (Termidor SC; active ingredient Fipronil which is classified by the EPA as a possible carcinogenic to humans — verified by BASF Chemical Co., the manufacturer). Two months prior to the actual application, I was personally assured by the General Manager of this large corporately owned retirement community in Green Valley, AZ that "advance warnings" would be posted, but never were in any part of this senior community. I said directly to the GM, "I cannot be around these chemicals, Lew!" To which he responded to myself and another residents "advance warnings will be posted." As a result of their extreme negligence and ignorance, I have been extremely ill on top of the Mycotoxicosis and has set my mold treatment so far back; even Dr. Crago (Neuro-Psychologist) having to start an entirely new treatment protocol. As if this was not bad enough, these property managers have allowed the resident who lived directly across the hall from my apartment to continue to flood her apartment and the common hallway as a result of allowing her tub to overflow for hours. The moisture, mustiness (God only knows what) came across the crawl space of the hallway ceiling into my apartment causing such high humidity problems (now I live in AZ) to the point that 90 pints of water was taken out of my air by a dehumidifier within a 3 day period of time. Dr. Gray ordered me out of this facility immediately due to their extreme negligent behavior and putting the lives of human beings at direct risk. Much more damage has been caused to my neuro system as a result of living in this senior retirement community. After the application of this poisonous termiticide, many residents have been ill (many deaths) and doctors have not been able to figure out what has made them sick. We are talking about residents here with a myriad of health problems (lung diseases, cancer, heart diseases, etc.), and many of us had our doors and windows wide open on 12/23/14 as it was a beautiful day, but windy day in Green Valley, AZ totally unaware of what was about to come down on us. I have contacted an attorney in Phoenix who has already talked to Dr. Thrasher and Dr. Gray was in the process of setting up a conference call with the attorney on 4/13/15. Once he talks to Dr. Gray, he will then contact Dr. Crago. I was never able to get an attorney to even address the severe mold infestation at that hotel in AR (had been going on in this facility for years from former employees) due to the power and money behind this facility; but I will not allow this intention poisoning my grossly incompetent and ignorant property managers who do not care one little iota about human life. And there is 48 hour notice as to when and where pesticides/termiticides will be used in and around multi-occupancy residential complexes so that residents can make an informed decision as to stay or leave. I was literally denied my right to make such an informed decision so as not to further damage my health; this decision was made by the property managers. I relocated from GA to AZ not quite 2 years ago to come under the treatment of Dr. Michael Gray, and my experiences (2 of them) in these large corporately owned retirement communities since coming to AZ have been bad ones; again, no concern for the health and welfare of their residents or for human life. No more retirement communities in AZ; am now back into a small family community in Tucson.
Mom's Mold Resources says:
Thanks for sharing your story Barbara!
What a hard time you have had with your health. I hope Dr Gray can help you. He is one the best out there. Wish I could afford to go see him.
Hoping you can recover your health each a day a bit more.
I too was exposed to a high concentration of Termidor SC and also BifinI/T. I had all kinds of neurological symptoms from this pesticide cocktail that was sprayed in my work area for an extended period of time. I finally figured out that it was work related when I got better when I was on vacation and worse when I returned to our small unventilated office. In 2013 I had a CT scan and all was fine. Then I had an MRI and it showed a brain tumor and it turned out to be malignant even though it was a meningioma. They are benign 95% of the time. I know that the pesticides caused the cancer and possibly the tumor since it wasn't there before he sprayed. Any advice on detoxing?
So sorry for your experience and health issues. I have done Iv therapy which has helped me along during this long process of healing. Chelation was also mentioned by my medical team but they did not believe it wise to start that yet so it is something I will be doing in the future once my body is ready and we can afford it.
I recommended that you check out the Know The Cause site and connect with Doug Kaufmann. He is am amazing person and his books The Fungus Link give a clear and easy to understand protocol to follow.
I got so severely ill after 10 years of termidor and bifenthrin.. My family comes from a long line of pest business owners.. I have PTSD and am on disability but I just want a life back.. I am mortified to be around the place this happen.. Can anyone give me an idea of who to talk to my Father a PCO and Bussiness owner says I am a liar and told everyone I was using drugs. This made it worse as I had no support and am thank full to be alive.. I wish it never happened but since it has I am disability of $488 a month and my life has gone from prosperous to hell..My family said it was from drug use though I only used xanax and adhd meds so that I could still talk. It got bad and was bed ridden with kidney pain, blurred vision, panic, anxiety, confusion… To make it worse my family told the whole town it was drug use so even when I got to see a good Dr for one check up my parents said not to get any tests done,, And then said I they had no money to cover the chelation..My DR was shocked. They even cancelled coming to see a specialist with me the morning of and never talked to him.. I am lost I need help and I want to enjoy life again… Please help travwalkup@yahoo.com
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This doily explores variations of heart motifs. The center hearts are filled with triple woven bars, with a satin stitch heart in each solid square. Satin stitch hearts line both the outer border and the inner border. And hearts filled with star stitch are flanked with satin stitch hearts. The star stitch is also used between the outer and inner borders, and to fill each Kloster block square. The instructions assume that you know the basics of Hardanger embroidery. They do not include instructions for basic stitches.


text:
Q: Calling a method of a Rails Engine from Main App I have a Rails engine and have the following in the {Rails_engine}/lib/role_authorization/session_user.rb
  module RoleAuthorization
        class SessionUser
          mattr_accessor :current_user, :role

        def current_user(user)
          current_user = user
        end

        def roles(role)
          role = roles
        end
       end
      end

I am calling the following methods from the main_application
{main_app}/errors/application_errors.rb
class ApplicationErrors

    def self.access_denied error, controller

     RoleAuthorization::SessionUser.current_user(current_user)

    end

However i am getting an undefined method current_user here . Does anybody have any idea what i am doing here

A: RoleAuthorization::SessionUser.current_user

Is undefined because you defined current_user as an instance method on the SessionUser class. Without knowing exactly how you're using this class in the rest of the system these following suggestions could work but break something else:
RoleAuthorization::SessionUser.new.current_user(current_user)

or add self to the method declaration in SessionUser:
module RoleAuthorization
  class SessionUser
    class << self
      attr_accessor :current_user, :role

      def current_user(user = nil)
        self.current_user ||= user
      end
    end
  end
end

Notice I changed mattr_accessor to attr_accessor. This is because the former is for Modules only and you're calling it within a class. Then I open up the singleton class with class << self so I can define current_user as a class method and use attr_accessor to access class instance variables. Assigning user to self.current_user will now make it available for access via: RoleAuthorization::SessionUser.current_user

redpajama_set_name: RedPajamaStackExchange


text:
Q: Prove that $7^{100} - 3^{100}$ is divisible by $1000$
Prove that $7^{100} - 3^{100}$ is divisible by $1000$

Equivalently, we want to show that $$7^{100} = 3^{100} \pmod {1000}$$
I used WolframAlpha (not sure if that's the right way though) and found that $\varphi (250) = 100$.
So by Euler's theorem: $$7^{100} \equiv 7^{\varphi(250)} \equiv 1 \pmod {250} \\ 3^{100} \equiv 3^{\varphi(250)} \equiv 1 \pmod {250}$$
but of course, we want $\pmod {1000}$.
Is that what I'm intended to do in this exercise (how to proceed if so)? Is there a solution without the need to use WolframAlpha?
Thanks!

A: Wolfie A is never the right way.
By the Chinese remainder theorem, all you need is to prove both
$$7^{100}\equiv3^{100}\pmod8$$ and
$$7^{100}\equiv3^{100}\pmod{125}.$$
You have already done the latter. But $7^2\equiv1\pmod 8$
and $3^2\equiv1\pmod 8$ so it's a fair bet that $7^{100}\equiv3^{100}
\pmod8$ too.

A: \begin{eqnarray}
7^{100}-3^{100} &=& (10-3)^{100}-3^{100}\\
 &=& \underbrace{{100\choose 0}10^{100}-{100\choose 1}10^{99}\cdot 3+...-{100\choose 97}10^3 \cdot 3^{97}}_{10^3k}+{100\choose 98}10^2 \cdot 3^{98} -{100\choose 99}10 \cdot 3^{99}+3^{100}-3^{100}\\
&=&1000k +50\cdot 99\cdot10^2 \cdot 3^{98} -100\cdot 10 \cdot 3^{99}
\end{eqnarray}

A: By the binomial theorem,
$$
3^{100}
=(7-10)^{100}
=7^{100}-\binom{100}{1}7^{99}10+\binom{100}{2}7^{98}10^2 + 10^3a
$$
Now
$
\binom{100}{1}10=1000
$
and
$
\binom{100}{2}10^2 = 495000
$

A: I am not sure about the following method, which is rather unusual. If it doesn't work please comment why. Also, since this is probably too long to be a comment, I have posted it here.
Firstly, we can factor the expression by the difference of two squares: $$7^{100}-3^{100}=(7^{50}-3^{50})(7^{50}+3^{50})=(7^{25}-3^{25})(7^{25}+3^{25})(7^{50}-3^{50})$$
We shall concentrate on only the first two factors and use the facts that $7^5=16807$ ends in $07$ and that $3^5=243$ ends in $43$. Note that $43^5 = 147008443$.
Now $7^{25}=(7^5)^5$, so by the first fact $7^5$ ends in $...807$. Similarly, $3^{25}=(3^5)^5$, so by the second fact, $3^{25}$ ends in $...443$.
Hence $7^{25}-3^{25}$ ends in $64$ (since $807-443=364$) and $7^{25}+3^{25}$ ends in $250$ (since $807+443=1250$). The result follows since $1000$ divides $64 \times 250$.

A: Hint:
$7^2=50-1,7^4=(50-1)^2=1+100\cdot24$
Using binomial expansion,
$7^{4n}=(1+100\cdot24)^n\equiv1+2400n\pmod{1000}\equiv1+400n$
$3^4=1+80$
$3^{4m}=(1+80)^m\equiv1+80m+80^2\binom m2\pmod{1000}$

A: $$(5+2)^{100}-(5-2)^{100} = \sum_{\substack{0\leq k \leq 100\\ k\text{ odd}}}\binom{100}{k} 5^k 2^{101-k}$$
hence the LHS $\pmod{5^3}$ is just $\binom{100}{1}5^1 2^{100}$, i.e. zero. The LHS is also a multiple of $8$ since any odd square is $\equiv 1\pmod{8}$. By the Chinese remainder theorem $7^{100}-3^{100}\equiv 0\pmod{1000}$.

A: Using http://mathworld.wolfram.com/CarmichaelFunction.html,
$\lambda(1000)=\cdots=100$
$\implies a^{100}\equiv1\pmod{1000}$ for $(a,1000)=1\iff(a,10)=1$


text:
using System.Collections;
using System.Collections.Generic;
using UnityEngine;
using UnityEngine.SceneManagement;
using UnityEngine.UI;

public class UIManager : MonoBehaviour {

  private bool isPaused;
  private bool isOver;

  private static bool isCreated = false;
  private GameObject startText;
  private GameObject scorePanel;
  private Text panelText;
  private int scoreCount;
  private AudioSource audioSource;

  void Awake(){
    if(!isCreated){
      DontDestroyOnLoad(this.gameObject);
      isCreated = true;
    } else {
      Destroy(this.gameObject);
    }
  }

	void Start () {
    Time.timeScale = 0;
    this.isPaused = true;
    this.isOver = false;
    this.startText = GameObject.Find("StartText");
    this.panelText = (Text) GameObject.Find("ScoreCount").GetComponent(typeof(Text));
    this.scorePanel = GameObject.Find("ScorePanel");
    this.audioSource = this.GetComponent<AudioSource>();
    this.scorePanel.SetActive(false);
	}

  void Update () {
    if (this.isPaused && Input.GetKeyDown("space")){
      if(this.isOver){
        SceneManager.LoadScene("Main");
      }
      this.StartGame();
    }
  }

  void StartGame() {
    Time.timeScale = 1;
    this.scoreCount = 0;
    this.SetScore();
    this.isPaused = false;
    this.startText.SetActive(false);
    this.scorePanel.SetActive(true);
    this.audioSource.Play();
  }

  public void StopGame() {
    Time.timeScale = 0;
    this.isPaused = true;
    this.isOver = true;
    this.startText.GetComponent<Text>().text = "Your score is " + this.scoreCount.ToString() + ".\nPress Space to try again.";
    this.scorePanel.SetActive(false);
    this.startText.SetActive(true);
    this.audioSource.Stop();
  }

  public void IncreaseScore() {
    this.scoreCount++;
    this.SetScore();
  }

  private void SetScore() {
    this.panelText.text = this.scoreCount.ToString();
  }
}

redpajama_set_name: RedPajamaGithub


text:
La Carmen de bello Saxonico (; ) es una epopeya en tres libros de 757 hexámetros. Describe la primera fase de la rebelión de los Sajones contra el emperador Enrique IV hasta la batalla a Spier en octubre de 1075. El timbre del poema es imperialista e ilustrado. El poeta incluye muchas alusiones clásicas y muestra familiaridad con el corte imperial.

Referencias
T. E. Mommsen, K. F. Morrison, R. L. Benson, edd. Imperial Lives and Letters in the Eleventh Century. Columbia University Press, 1962.

1075
Años 1070 en el Sacro Imperio Romano Germánico
Alemania en el siglo XI

redpajama_set_name: RedPajamaWikipedia


text:
Bob Dylan's Had An Interesting Love Life
By Darian Lusk/Nov. 24, 2020 5:19 pm EST
From Katie Holmes and Jamie Foxx's secret romance lasting years to Lady Gaga's recent "normal mystery man" boyfriend, many celebrities work hard to keep their relationships private. And when it comes to music icon Bob Dylan, many answers are similarly "Blowin' in the Wind."
Bob Dylan has been a music trailblazer for decades, from the protest era up to his critically acclaimed 2020 album, Rough and Rowdy Ways. Since the beginning, he's written his own rules for what he wants to do creatively and how he wants to be perceived. The elusive singer famously evaded the "voice of a generation" moniker in the 1960s, instead insisting he was simply a "song and dance man," per Rolling Stone. And he infamously switched from acoustic to electric guitar at the Newport Folk Festival, alienating a large part of his base back in 1965. Yup, Bob Dylan has always strummed to the beat of his own guitar, which extends to how much the public knows about his love life.
The singer appeared arm-and-arm with girlfriend Suze Rotolo on the cover of his second album, The Freewheelin' Bob Dylan, per Independent. "She was the most erotic thing I'd ever seen," he wrote in his 2004 memoir, per Rolling Stone. That influential relationship turned sour when he began dating musician Joan Baez, but that 1965 tryst was also short-lived. So what about since then? The details are murkier than you may think. Scroll down to find out about Bob Dylan's mysterious love life.
Bob Dylan has kept his relationships, and a marriage, under wraps
Evening Standard/Getty Images
So what do we know about Bob Dylan's love life? The musician first married Sara Lownds in 1965, per Rolling Stone, with whom he shares four children. She was the subject of songs like "Sara" off of his 1976 album, and more. But they divorced in 1977. And here's where things get strange.
Bob Dylan tied the knot to backing singer Caroline Dennis in 1986, and the two share one child, Desiree, and remained married until 1992. But according to ABC, both the marriage and Desiree were kept a secret from the press for 15 years. Yup, it was only in 2001, years after their divorce, that the public found out about the marriage and child. The secrecy was a shared decision, according to Dennis. "Bob and I made a choice to keep our marriage a private matter for a simple reason — to give our daughter a normal childhood," she said in a statement.
Since then, Bob Dylan's love interests have been a mystery — and obviously, he's skilled at keeping his affairs private. That said, his children have gone on record saying he was a loving father. "Yes, he was affectionate. When I was a kid, he was a god to me for all the right reasons," son Jakob Dylan said (via Independent). "He never missed a single Little League game I had. He's collected every home-run ball I ever hit." Aw. Ultimately, Dylan's romantic history is his business, though it's a tale as complex as his music.

redpajama_set_name: RedPajamaCommonCrawl


text:
What is Inside
Product Information Data Sheets (PID)
SCJ Recycles in Latin America
Hands-on Science Mr Muscle Science Lab
Empowering Female Entrepreneurs
SC Johnson Central America Ranked Number One
Company Takes Top Spot on Prestigious Great Place to Work List in Central America and the Caribbean
RACINE, Wis., (April 5, 2016) – SC Johnson Central America was recently ranked number one out of 150 companies on the 2016 Great Place to Work list in Central America and the Caribbean by the Great Place to Work® Institute. This recognition for SC Johnson Central America marks the ninth consecutive year the company has been named as a Top 5 company. In 2015, SC Johnson Central America ranked number two out of 88 companies in Central America and the Caribbean.
"The people of SC Johnson work tirelessly to create an environment rich with opportunity, inspiration and a focus on serving the greater good. To be recognized as a Great Place to Work for these efforts is a significant achievement for the people of SC Johnson Central America," said Fisk Johnson, SC Johnson Chairman and CEO. "A big congratulations to the Central America team for their commitment to each other, to creating and sustaining a great work environment and to living the deep-rooted values of SC Johnson every day."
A total of 150 companies in Central America and the Caribbean were recognized by the Great Place to Work® Institute. Companies are ranked according to randomly distributed employee surveys, a workplace culture assessment on corporate policies and philosophies, and other supporting documents.
In addition to this latest recognition, in 2015 SC Johnson was included on the Working Mother magazine's list of the "100 Best Companies for Working Mothers" for the 27th time and received a perfect score of 100 percent on the Human Rights Campaign Corporate Equality Index.


Stuffing for the sandwich. Mash boiled potatoes finely and mix it well with green coriander, green chillis, and salt. Heat up a pan and add 1 tablespoon oil in it. After heating up the oil put asafoetida, cumin, and coriander powder.
After this add mashed potato. Mix well in spices. Cook in on medium flame for 2 minutes. Now off the flame. Let it cool.
Now light up the flame and keep it on medium. Put a tawa on it. Take a bread slice and spread the stuffing on it in a fine layer. Put the 2nd slice on it.
Keep ready all the bread slices. Now put little bit oil on tawa and spread it evenly.
Pick one set of sandwich and grease it with little oil. Now spread 1 tablespoon milk on the bread and put it on the hot tawa. Same as grease 2nd set of sandwich with oil and spread 1 tablespoon milk on it.
Roast the sandwich until it goes golden brown. Flip the sandwich on tawa. So that it can be roast on both sides. Cut the sandwich diagonally.
Garnish it with butter. And your spicy milk sandwich is ready. You can serve it with tea, Jam or chutney.
Enjoy this Spicy Milk Sandwich dish from BetterButter!


text:
@interface XZXClockVMServicesImpl ()
@property (nonatomic, strong) XZXUpdateDaysImpl *updateService;
@end

@implementation XZXClockVMServicesImpl

- (instancetype)init {
    if (self = [super init]) {
        self.updateService = [XZXUpdateDaysImpl new];
    }
    return self;
}

- (id<XZXUpdateDays>)getServices {
    return self.updateService;
}

@end


I like supporting our Taitamariki and whanau through the Youth Court system and seeing whānau transition to wellbeing. I also like the flexibility and opportunities that come with working for our organisation. I aspire to be educated with the focus of assisting whānau in their journey to wellbeing.


Military Service - U. S.
Discharge Date: 17 Jun 1864 on Surgeon's Certificate of Disability at Morris Island, S.C.
James Vault was originally part of the 4th Regiment South Carolina Volunteer Infantry, an African-American infantry regiment that served in the Union Army. The 4th South Carolina Infantry was organized at Fernandina, Florida and mustered into Federal service in July 1863. The regiment was consolidated with 3rd S.C. to form the 21st U.S. Colored Infantry Regiment on March 14, 1864. He served in Jacksonville, Florida until April 1864, then moved to Hilton Head Island, then to Folly Island and Morris Island. James was discharged on Surgeon's Certificate of Disability at Morris Island, SC on June 17, 1864.


Once again I have several "readings in progress." I finished only one book this week but it was a good one.
A successful writer occasionally eats in a neighborhood cafeteria where many immigrants (mostly elderly men) gather to eat and gossip. Here he meets Esther, also an immigrant but younger than most of the usual group. Over the years they see one another off and on. The final time they talk is at his place and she tells him she saw Hitler and a group of Germans meeting in the cafeteria after closing time. Was it a vision? a memory? a separate reality? or is she insane? Some time later he sees her on the street with another man from the old cafeteria crowd. Or does he?
Singer never disappoints. The Library of America three volume boxed set of his collected stories may be my best blog win ever.
Dale's roster is set up is geographically with stories from Appalachia for spades and clubs and stories from New York City for Hearts and diamonds. The singer story is the the ♥10♥ on the roster so I chose a joker representing the city.
A fantasy story of an aging traveling judge in rural China; the chi-lin, the Chinese unicorn who sometimes appears in his court, and a female criminal. The author describes it as "....a respectful imitation of an ancient style, and never pretends to be anything else. But I wrote it with great care and love, and I'm still proud of it." He certainly met his goal with this story.
I did not look for a card to represent this story because there is a marvelous illustration accompanying the story. Alyssa Winans is the artist. She a San Francisco based fantasy illustrator and game artist. She is also a member of the Google Doodle team.
An elegantly told family story of love, waiting, and loss. Krivak gives us an astonishing sense of time, place, and character.
"... a two-and-a-half minute, weird and wonderful animation depicting "the lows and lower lows of love in the afterlife." Equal parts funny and touching, the short is the result of a collaboration between Brazil-born Vitoria Bastos and Adele Davies from Devon...."
A great essay on reading, worth reading and re-reading. "...you don't have to read simpler or popular books because they give you ready currency online, or because lots of people keep talking about them. You can read obscure, weird, or difficult stuff without feeling awkward. Because you don't have to present your opinion to the world on the books you read in a digestible, effusive tweet or a picture of the book next to a mug of tea and an aloe plant. I know you know this, that you don't have to have an opinion at all. Many voices make reading one type of book or another a performative act that marks you as a member of a particular tribe. But all that needs to exist is you and the words. Because they are yours if you want them."


text:
Episode #34 – How Geisinger Thinks About Strategy – an interview with Dominic Moffa, EVP & Chief Strategy Officer for Geisinger
Posted on April 19, 2018 December 29, 2021 by Creating-A-New
https://media.blubrry.com/creatinganewhealthcarepodcast/ins.blubrry.com/creatinganewhealthcarepodcast/CreatingaNewHealthcare-0034-episode-34-how-geisinger-thinks-about-strategy-56812.mp3
Given the rapid, tumultuous, and unprecedented changes in healthcare these days, there are very few things that are as important to a hospital system or integrated delivery network as developing and deploying a sound and forward-thinking strategy.
In this interview we have the amazing good fortune and unusual opportunity of picking the brain of the senior strategy executive for one of the most successful, visionary and pioneering healthcare systems in the world – Geisinger.
Dominic Moffa is a seasoned healthcare executive with a long standing track record of success. He's also an incredibly humble, generous, practical and fun guy. In this interview he generously shares some of the life lessons and rules of thumb that have contributed to his amazing success, and the success of the organizations he's been a leader in. It's clear from his straightforward responses that he not only talks the talk, he walks the walk.
What you'll learn in this interview includes:
The primary market forces that Dominic perceives to be strategic challenges for healthcare systems
The three fundamental building blocks of the Geisinger Strategy
Dominic's 3D's of Strategy Deployment
How Geisinger is transforming itself – and healthcare – not from the inside out, but from the outside in
How the 'hospital of the future' may actually be much more than a hospital
The transformative social and community commitments Geisinger is making in its 'Fresh Food Farmacy', it's Genomics initiative, and its Springboard Healthy Scranton Initiative
Toward the end of the interview Dominic shares the best piece of advice he was ever given. Folks – this is not to be missed, as it is certainly one of the best we have heard on this podcast series to date!
As always, I hope you get as much out of this interview as I have!
One final note – I would feel remiss if I didn't extend a personal message of sincere appreciation to the entire Geisinger organization – for their many years of being leaders in healthcare, but also being generous in sharing the lessons they've learned. While it's apparent, as Mr. Moffa points out in this interview, that their primary focus is to provide outstanding medical care to their patients and the populations they serve; it's also abundantly clear that they understand, and take seriously, their innovative and pioneering role in helping to advance the American Healthcare System.


We do not always need huge stuff for training. Sometimes even the tiniest tool can become your most reliable helper in educating the pet. So, when choosing a gear for our four-legged friends we should consider the material they are made of firstly and only then we should pay attention to its outward appearance.
Our company would like to introduce to you a product which will not leave you indifferent. It is made of genuine stuff which will serve you and your Dogue de Bordeaux for epochs and will not cause any health problems. Besides, the tool looks incredibly nice and will add elegance and courtliness to your canine's everyday walks and training sessions.
Refined Spiked Leather Dogue de Bordeaux Collar will reflect your four-pawed friend's soul and character.
READ THIS BEFORE MEASURING YOUR DOGUE DE BORDEAUX!
The collar will fit neck size on the central hole (the 3d one).
The total number of holes will be 5 with 1 inch (25 mm) distance between each two of them.
It means, for example, that if your dog's neck size is 20 inches (50 cm), you will adjust the collar to it using central (3d) hole).
You will have 2 smaller size holes to adjust the collar for 18 inch (45 cm) and 19 inch (47.5 cm) neck size.
You will also have 2 bigger size holes to adjust the collar for 21 inch (52.5 cm) and 22 inch (55 cm) neck size.
The tip of the collar (measuring after the last hole) will be 2 inch (5 cm) long.
As those are handcrafted collars, some sizes may differ a little (not in a significant way).
Choosing this collar you purchase a high quality gear which is manufactured according to the highest world standards. The item is dog-health safe and eco-friendly. It is ergonomically designed, professionally made dog equipment which will serve you for ages. The leather used for producing this supply is extremely durable and will not be spoiled soon after the first training session like that poor quality tools made of artificial materials. The collar will provide your doggy with maximum comfort during walking, obedience training and other activities that are not connected with specific kinds of training.
Smooth leather edges of the outfit will save your canine's skin from discomfort and extra fur loss. Besides, it will prevent traumas.
The leather contains no injurious chemicals which can do harm to your four-pawed friend's health. The collar will not cause allergy, skin irritation, rash, etc.
The exquisite design of the gear makes your Dogue de Bordeaux stand out of the crowd. It is equipped with strong brass plated hardware which is rust-proof and corrosion resistant. One row of shiny spikes will gladden your eyes till the end of the item's service.
Use water repellent and special leather conditioner if you want to prolong the collar's service.


text:
Miss Marjori-banks. by the author of 'Salem chapel'. (Chronicles of ...
Av Margaret Oliphant Oliphant
"I wish I might but prove the best man for something else," said the candidate, nervously; and then he cleared his throat. "I would say you had been kind if I did not hope—if I was not so very anxious that you should be something more than kind. It may be vain of me, but I think we could get on together.
I think I could understand you, and do you justice
Lucilla! what is the matter? Good heavens! is it possible that I have taken you quite by surprise?"
"What caused this question was, that Miss Marjoribanks had all at once changed colour, and given a great start, and put her hand to her breast, where her heart had taken such a leap that she felt it in her throat. But it was not because of what Mr Ashburton was saying; it was because of one of the very commonest sounds of everyday existence — a cab driving down Grange Lane; but then it was a cab driving in such a way that you could have sworn there was somebody in it in a terrible hurry, and who had just arrived by the twelve o'clock train.
"Oh no, no," said Miss Marjoribanks; "I know you have always done me more than justice, Mr Ashburton, and so have all my friends; and I am sure we always will get on well together. I wish you joy with all my heart, and I wish you every happiness; and I always thought, up to this very last moment"
Lucilla stopped again, and once more put her hand to her breast Her heart gave another jump, and, if such a thing were possible to a heart, went off from its mistress altogether, and rushed down-stairs bodily to see who was coming. Yet, with all her agitation, she had still enough self-control to lift an appealing look—a look which threw herself upon his mercy, and implored his forbearance—to Mr Ashburton's face.
As for the Member for Carlingford, he was confounded, and could not tell what to make of it. What was it she had thought up to the very last moment? Was this a refusal, or was she only putting off his claim, or was it something altogether independent of him and his intentions that agitated Lucilla to such an unusual extent? While he sat in his confusion . trying to make it out, the most startling sound interrupted the interview. The old disused bell that had so often called Dr Marjoribanks up at night, and which hung near the door of the old Doctor's room, just over the drawing-room, began to peal through the silence, as if rung by a hand too impatient to notice what it was with which it made its summons.
"Papa's bell!" Miss Marjoribanks cried, with a little shriek; and she got up trembling, and then dropped upon her seat again, and in her agitated state burst into tears. And Mr Ashburton felt that, under these most extraordinary circumstances, even so sensible a woman as Lucilla might be justified in fainting, embarrassing and uncomfortable as that would be.
"I will go and see what it means," he said, with still half the air of a man who had a right to go and see, and was, as it were, almost in his own house. As he turned round, the door bell pealed wildly below in correction of the mistake. It was evident that somebody wanted admission who had not a moment to lose, and who was in the habit of pulling wildly at whatever came in his way. Mr Ashburton went out of the room to see who it was, a little amused and a little alarmed, but much annoyed at bottom, as was only natural, at such an interruption. He did not very well know whether he was accepted or rejected; but it was equally his duty in either case to put a stop to the ringing of that ghostly bell. He went away, meaning to return immediately and have it out and know his fate. And Lucilla, whose heart had come back, having fully ascertained who it was, and was now choking her with its beating, was left to await the new event and the new-comer alone.
CHAPTER L.
Me Ashbueton went away from Lucilla's side, thinking to come back again, and clear everything up; but he did not come back. Though he heard nothing, and saw nothing, that could throw any distinct light on the state of her mind, yet instinct came to his aid, it is to be supposed, in the matter. He did not return: and Lucilla sat on her sofa with her hands clasped together to support her, and her heart leaping in her very mouth. She was in a perfect frenzy of suspense, listening with her whole heart and soul; but that did not prevent the same crowd of thoughts which had been persecuting her for twenty-four hours from keeping up their wild career as before. What reason had she to suppose that "any one" had arrived? Who could arrive in that accidental way, without a word of warning? And what possible excuse had she to offer to herself for sending the new member for Carlingford —a man so excellent and honourable and eligible— away? The minutes, or rather the seconds, passed over Miss Marjoribanks like hours, as she sat thus waiting, not daring to stir lest the slightest movement might keep from her ears some sound from below, till at last the interval seemed so long that her heart began to sink, and her excitement to fail. It could not be any one—if it had been auy one, something more must have come of it before now. It must have been Lydia Richmond coming to see her sister next door, or somebody connected with the election, or
When she got as far as this, Lucilla's heart suddenly mounted up again with a spring into her ears. She heard neither words nor voice, but she heard something which had as great an effect upon her as either could have had. On the landing half-way up the stairs, there had stood in Dr Marjoribanks's house from time immemorial a little old-fashioned table, with a large china bowl upon it, in which the cards of visitors were placed. It was a great bowl, and it was always full, and anybody rushing up-stairs in a reckless way might easily upset table and cards and all in their progress. This was what happened while Lucilla sat listening. There was a rumble, a crash, and a sound as of falling leaves, and it made her heart, as we have said, jump into her ears. "It is the table and all the cards," said Lucilla—and in that moment her composure came back to her as by a miracle. She un


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A standard part of our roofing package is the installation of Ice and Water Shield barrier at all eaves and valleys in the roof. We also install proper flashing around all chimneys and pipe collars. In addition, Detailz cleans all gutters and even does some minor repairs as needed, with each roofing job. We take pride in the details in our Philadelphia Roofing Shingles!


An environmental life cycle assessment was performed to investigate the environmental consequences of the life cycle of Hushållsost, a semi-hard cheese. The assessment identified those activities that contribute most to the cheese's environmental impact throughout its life cycle from extraction of ingredients to waste management. Milk production at the farm was identified as having the greatest environmental impact, followed by cheesemaking at the dairy, retailing, and the production of plastic wrapping. The environmental impact could be reduced by minimising wastage of milk and cheese throughout the life cycle, without any effect on the quality of the product. Increasing the yield of cheese would also bring about substantial improvements as less milk would have to be produced on farms. © 2002 Elsevier Science Ltd. All rights reserved.


At long last, the TakaraTomy version of the Masterpiece Starscream in Anime accurate colors is out. Unfortunately, it's still the same Starscream Hasbro rolled out months ago (weathering and all), they just added a new sticker on the box. Even the Manual is in English.
The diecast parts are similar to those on the MPC Skywarp (meaning only some of the internal joints), but it's still mostly plastic. So basically, it really did take TakaraTomy months to just slap on a sticker (and maybe add a paper insert to go with the manual to advertise TakaraTomy's website).
Chest missiles. Skywarp has more detail.
Dr. Arkeville is painted right this time (Skywarp version on the right).
Starscream with MPC Megatron and Skywarp.
A scene from the third episode of Transformers G1.
Megatron: You've also made clear of your desire to replace me as leader of the Decepticons, mistake number one.
Hnn…It's time for a change, Megatron! It's time for action, not words! I am the leader of the future!
You failed to dispose of me when you had the chance, Starscream, mistake number two..
Please don't fire! I–I was wrong, I shouldn't have done it… Please! Don't shoot!!
And of course a fan favorite moment from the G1 Movie.
How do you feel Mighty Megatron?
Starscream, the traitor we all love.


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Simmetry products selected for use in USN drone control ground stations
Simmetry's Tactical Data Link (TDL) products have been selected for integration into drone control ground stations used by USN and US Marine operators. Simmetry's Terminal Control Unit (TCU) and other accessory parts were selected for use as the best off-the-shelf solution for rapidly incorporating a Link 16 TDL into the existing ground station hardware sets; and also due to the simplicity of integrating these parts into the limited space/weight/power available in the hardware set.
For more information, contact Simmetry at info@simmetrysolutions.com.
Simmetry selected as one of TIC's Top 100 Innovators for 2015
Simmetry has been selected to the list of 'Top 100 Innovators for 2015' by TIC - The Intelligence Community, LLC - under the #problemsolver category.
Simmetry is an innovative provider of Tactical Communications Systems; providing systems engineering and software engineering services, hardware and software product development, and technical and program management consulting.
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Simmetry products flight proven by Australian RAAF
Simmetry's Tactical Data Link (TDL) products have been flight proven by the Royal Australian Air Force. Simmetry's STT Integrated Controller (STTIC) and associated accessory products, which were previously adopted for use by ground components of the RAAF, were successfully flight tested aboard a C-130 aircraft in a roll-on / roll-off configuration. The products are part of a tactical, 100 lb., 4U rugged transit case product, which provides a complete Link-16 TDL solution in the minimal SWaP (size, weight and power) for the RAAF users.
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The Omega – Muth Electrical Management Inc.
The Omega is a 14-storey, high-rise condominium complex, located downtown at 105 Street and 99 Avenue. The building is home to 58 condos as well as a Starbucks on the street level.


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Pickens plan mark II
November 15th, 2008 · No Comments
We wrote about the Pickens plan before, it's a bridging plan to wean the US off (foreign) oil by using wind energy for electricity production and natural gas for driving vehicles. Just as Boone's investments, it has hit some snags, but that's not stopping the 80 year old billionaire..
Oil billionaire revises plan to reduce foreign oil imports
Oil tycoon puts hold on wind farm, touts natural-gas vehicles
by Ryan Randazzo – Nov. 12, 2008 12:00 AM
Billionaire T. Boone Pickens said that his Texas wind farm is on hold because natural-gas prices have dropped but that his plan for wind power and natural-gas vehicles is still viable to reduce foreign oil imports.
The Texas oil tycoon spoke Tuesday to about 650 utility and investment officials gathered in Phoenix for the Edison Electric Institute Financial Conference.
Pickens launched an advertising campaign last summer to promote wind farms to generate electricity and to use natural gas to power vehicles.
"I'm the only person in the United States that has a plan," he said. "Senator Obama and his people have been in touch with mine. They see the merits of what we are doing."
Pickens said the U.S. needs to exploit all its resources, from solar power in Arizona to coal and nuclear energy, but that few things could cut foreign oil imports quickly.
He said neither Obama's plans for 1 million plug-in hybrid vehicles nor John McCain's plans for 45 more nuclear plants would make a dent in oil imports, but semitrucks fueled by natural gas could reduce oil demand for the next 20 years before better transportation technology is available.
"It's a bridge to the next generation, which will probably be the battery, the fuel cell," he said. "It won't be the hydrocarbon."
But the current drop in oil and natural-gas prices is slowing things down.
Until natural-gas prices rise, Pickens said his wind farm and most others in the country will not go forward because electricity from gas plants will be more economical. Still, he was confident prices would rise.
He said Americans haven't understood the nation's energy challenges because prices have been low, until last summer when oil hit a record $147 a barrel.
You haven't had the leadership in Washington to tell us what the problem was," he said. "The American people did not realize where we were. When oil went to $100, I had a story to tell."
Steven Dreyer, managing director at Standard and Poor's, credited Pickens for raising awareness.
"Arguably, for the first time, ordinary people were able to connect the dots between carbon reduction and energy," Dreyer said.
Ron Insana, managing director of SAC Capital Advisors and former CNBC commentator, questioned Pickens about how he will benefit financially by such a plan through his wind farm and large stake in Clean Energy Fuels Corp., a natural-gas, vehicle-fueling company.
Pickens described his potential to profit from wind and natural gas but said his motivations are patriotic. "I'd rather be playing golf at the Del Mar Country Club this afternoon," Pickens said. "But I truly believe this is good for the country."
Pickens believes that global oil production has already "peaked" and that it will continue to become scarcer and more expensive, despite the current lull in gas prices. He is founder and chairman of energy-investment company BP Capital and founded Mesa Petroleum, a natural-gas and oil producer. He is a geologist by training.
"When I launched my plan July 8, gas prices were $4.11 a gallon, and now they're half that. I think I've done a pretty good job," he said to chuckles from the audience.
He predicted oil, which closed Tuesday at $59, to be $100 a barrel within a year, and could be $300 a barrel by 2018. Pickens supports domestic drilling but said that can't come close to meeting daily U.S. oil demand.
He is scheduled to return Dec. 11 for a presentation to the Greater Phoenix Chamber of Commerce, and tickets are available to the public. Details are available at www.phoenixchamber.com.
Tags: Natural Gas


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Lowey, Leahy Write to White House Strongly Opposing Trump Administration's Latest Ploy to Withhold Foreign Assistance
WASHINGTON — House Appropriations Committee Chairwoman Nita M. Lowey (D-NY-17) and Senate Appropriations Committee Vice Chairman Patrick Leahy (D-VT) today wrote to Acting White House Chief of Staff Mick Mulvaney and Acting Office of Management and Budget (OMB) Director Russell Vought strongly opposing the Trump administration's latest ploy to withhold foreign assistance.
The letter is in response to a directive issued by OMB Associate Director Michael Duffey that improperly withholds State and Foreign Operations funds from obligation. In the letter, Chairwoman Lowey and Vice Chairman Leahy warn the Trump administration that this action may constitute an illegal impoundment of funds and urge the administration to adhere to the law and obligate these critical resources.
"These funds were appropriated by overwhelming bipartisan majorities and after lengthy negotiations between the House and Senate, and including the White House. They were signed into law by President Trump," the lawmakers wrote. "They are intended to implement policies and programs which, among other things, fulfill U.S. treaty obligations, support our allies and partners, protect the public against Ebola and other infectious diseases, counter-Russian aggression and Chinese influence, respond to humanitarian crises in Venezuela, Syria, Burma, and elsewhere, counter violent extremism in the Sahel, Yemen, and elsewhere, and support such initiatives as the Indo-Pacific Strategy, Power Africa, and the Women's Global Development and Prosperity Initiative. In short, these funds, which the agencies have plans to obligate for their intended purposes before the end of the fiscal year, are essential to promoting U.S. global leadership and protecting the security of the American people."
The letter calls on the administration to immediately comply with the Impoundment Control Act (ICA) and provide information to Congress on why OMB withheld the funds.
"OMB should release the funding identified in the letter immediately to enable it to be obligated in accordance with current law, and immediately transmit to the Congress the legal justification OMB relied upon for withholding these funds, including an explanation of how such withholding is consistent with the ICA," the lawmakers wrote.
The full text of the letter is below. A PDF copy is available here.
Dear Mr. Mulvaney and Mr. Vought:
We are writing regarding an August 3, 2019, letter from Michael P. Duffey, OMB's Associate Director for National Security Policy, to the Deputy Secretary of State and the Deputy USAID Administrator, which states that the letter "constitutes a reapportionment of all previously approved apportionments" of Fiscal Year 2018 and 2019 funds from specified State, Foreign Operations accounts. The letter improperly withholds these funds from obligation, with a limited exception for certain salaries expenses. We are informed that the total unobligated funds impacted by this decision may be more than $4 billon, and that the suspension of obligations may be in preparation of a rescissions package for submission to Congress in the waning days of the fiscal year.
These funds were appropriated by overwhelming bipartisan majorities and after lengthy negotiations between the House and Senate, and including the White House. They were signed into law by President Trump. They are intended to implement policies and programs which, among other things, fulfill U.S. treaty obligations, support our allies and partners, protect the public against Ebola and other infectious diseases, counter-Russian aggression and Chinese influence, respond to humanitarian crises in Venezuela, Syria, Burma, and elsewhere, counter violent extremism in the Sahel, Yemen, and elsewhere, and support such initiatives as the Indo-Pacific Strategy, Power Africa, and the Women's Global Development and Prosperity Initiative. In short, these funds, which the agencies have plans to obligate for their intended purposes before the end of the fiscal year, are essential to promoting U.S. global leadership and protecting the security of the American people.
Your action is reminiscent of a reported attempt by OMB last year to improperly withhold State, Foreign Operations funds, which was widely opposed in Congress and triggered a GAO legal opinion, dated December 10, 2018, on whether the Impoundment Control Act of 1974 (ICA) allows a withholding of appropriations scheduled to expire within the prescribed 45-day period to continue through the date on which the funds would expire. The GAO concluded that "the statutory text and legislative history of the Impoundment Control Act (ICA), Supreme Court case law, and the overarching constitutional framework of executive and legislative powers provide no basis to construe the ICA as a mechanism by which the President may, in effect, unilaterally shorten the availability of budget authority by transmitting rescission proposals shortly before amounts are due to expire." GAO further concluded, "amounts proposed for rescission must be made available for prudent obligation before the amounts expire, even where the 45-day period for congressional consideration in the ICA approaches or spans the date on which the funds would expire." (emphasis added).
If a rescissions package is sent to Congress in the coming weeks the 45-day period would extend to late September, leaving only days before the end of the fiscal year for the Department of State and USAID to obligate the funds, assuming Congress rejects the rescissions or takes no action. This is too little time to prudently obligate such a large amount of funds for such a diverse array of purposes before they expire, and would constitute another attempt to circumvent Congress's constitutional spending authority.
We are deeply concerned by the apportionment action in the August 3, 2019, letter to withhold budget authority from 15 expiring appropriation accounts. Absent the President sending Congress a special message, any funding withheld by OMB in anticipation of a rescission proposal would constitute an illegal impoundment of funds. OMB should release the funding identified in the letter immediately to enable it to be obligated in accordance with current law, and immediately transmit to the Congress the legal justification OMB relied upon for withholding these funds, including an explanation of how such withholding is consistent with the ICA.
There is no ambiguity with regard to the ICA or the Appropriations bills passed by Congress and affirmed by the President when the Fiscal Year 2018 and 2019 State, Foreign Operations appropriations acts were signed into law. We urge OMB, the Department of State, and USAID to adhere to the law and use these funds for their intended purposes on behalf of the American people and the Nation.
REPRESENTATIVE NITA M. LOWEY
SENATOR PATRICK LEAHY


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Meet Hallie Beck, a freshman agriculture: animal science major from Allerton, Illinois.
I came to Dordt because I came for a couple visits. The visits were what drew me here. Everybody was so friendly--I got to meet some professors from the ag department and some students that were here. I felt so drawn to the community here. My favorite part was getting to meet students here and talk to them about why they liked Dordt and about their daily activities and college life.
So far, my classes are my favorite part. I enjoy all of them. My favorite class is Intro to Plant Science. I grew up on a farm, so I thought I knew a lot coming here, but I've learned so much more than I thought.
I enjoy my social life too, and all the friends I get to hang out with.
I feel like all of my professors ask a lot of questions during class and try to get us to discuss what we're talking about. They put us in groups to work together collectively to work through problems.
Is there anything that has surprised you about Dordt?
No, nothing has surprised me so far.
What would you say to a someone from your hometown who is considering Dordt?
You should definitely come here, because you're missing out. (Laughter.) It's a great place to be. When I was deciding to come, I thought it was so far away from home and I didn't think I would like that, but I've just fit in so well with everyone here in the community. Definitely come to Dordt. It's a great place and you learn so much about life in general and through your studies.


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Jets Report Card
New York Jets Week 17 Report Card
New York Jets Report Card: Week 17
Jets @ Dolphins
Quarterback: F
Sanchez: 21/32, 207 yards, 2 TD, 3 INT
Sanchez' 3 interceptions all came on passes that barely left the line of scrimmage. There was a timid look on his face all day, as he checked down to running backs even when he wasn't feeling the pressure. Though I maintain that Sanchez has progressed this season, this kind of decision making has me thinking twice.
Running Backs: B
Greene: 14/55/0
Tomlinson: 11/56/0, 4 receptions, 23 yards
Greene had a nice day on the ground, and should have gotten more touches. Tomlinson looked inspired at times, perhaps realizing that this might be his last game in the NFL. With more opportunities, the Jets really could have done some damage on the ground – against a defense that knows how to shut down the run.
Wide Receivers/Tight Ends: D
Burress: 4/57/0
Holmes: 0/0/0
Kerley: 4/71/0, 1/1 passing, 41 yards
Turner: 1/10/1
Keller: 7/45/1
Jeremey Kerley is excluded from this conversation, as he posted an excellent game. Holmes was targeted once and went without a single reception on the game, ending it on the bench after an an argument with Sanchez inside the huddle. Burress was practically absent for 3 quarters of the game as well. Turner grabbed a touchdown. Mulligan committed his fair share of penalties yet again.
Offensive Line: F
Hunter is done for on this team, and we should all be thankful about that. Ferguson got beaten once around the edge, and that resulted in a turnover. There were too many false start penalties to count.
Defensive Line: C
There were some positives and some negatives to take away from the defensive line play on the day. Pouha was active in the backfield, this may have been his best game on the year. Still, the pressure is simply not there on the quarterback. The Jets need to get a rush out of their front 3.
Linebackers: B
Scott was inspired; he had one of his most active games as a Jet. Mauga made a couple nice plays filling in for the temporarily injured David Harris, though he did allow a touchdown pass, you have to give credit to Dolphins QB Moore for his spectacular effort on that play.
Secondary: B+
Though they allowed far too many 3rd down conversions on a 90+ yard drive in the 3rd/4th quater, the secondary held Dolphins QB Moore down most of the day. Cromartie and Pool each grabbed a pick.
Special Teams: C
The definition of 'average.' There's just not too much to talk about here today, though I will say that I'm unimpressed with T.J. Conley's punting.
Coaching: ?
What do you really want to blame the coaching staff for in this game? Poor execution all around, same as it has been in the last three games.
Schottenheimer is everyone's favorite whipping boy these days, and deservedly so, but he did dig deep to pull out a few very creative plays (almost all of which involved Jeremy Kerley in some form or another – passing, rushing, receiving… all of it.)
That said, how do you remove Burress and Holmes from the gameplan? They're playmakers, plain and simple. You have to get them the ball more often. The staff should also be knocked for the excessive amount of penalties, the refusal to bench Mulligan, and calling 2 timeouts within a minute when total clock time was not an issue.
This Article Was Written By Matt Keach
Matt Keach
Week 14 Report Card is Another Ugly one for Gang Green
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Week 7 Report Card: A Tale of two Halves for Floundering Jets
By Matt Keach


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I'll be a busy man at 8:05 I guess.
I completely understand what you are saying YM. I have been in a position where I have had to pick up a guest player because of a deficiency in a particular position. It happens in AAU. Kids miss for all sorts of reasons. If I was at full strength, I would never add a player just to be a stronger team. It think then you do run into resentment from the regular rotation.
I think this is the perfect resolution. If the young man wants to play in his last chance to participate in his State's AAU Championship who could blame him. Last year he played with an out of state team so now that he is back in a state program I could understand his desire to play again in the State Championships.
His regular team was sitting out which they have the right to elect to do for whatever reason they see fit. Playing with the other team from that program makes sense in so many ways. Kid is happy, HD program is happy, and I suspect most families on Manimal also are pleased. Coaches and Players in many instances embrace guest pickups, but rarely has my experience been that families prefer to see that.
Surprised this game isn't at KBA. This is one I'd like to watch.
It is the same organization. It makes a lot more sense than previous arrangement.
That said doesn't really matter where the young man played if the team he was playing on and organization had no issues with it. Whoever has Goodin is getting one heck of a player for sure.
I'm slow on the uptake sometimes. Haha.
Haha I was just teasing with my guy Coach Q a little. The drama is high leading into AAU State.
I am buying lots of lottery tickets tonight.....on my post on the bottom of page 4 it shows I received two likes-one from Coach Q & the other from Doubletake. If I am the one to help them find common ground then I am feeling lucky tonight.
Good luck to all teams and good health to all players.
Doubletake even liked 2 of my posts this week.
You should take a hatchet outside and bury it...immediately!