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Addressing the Interface Between Pediatrics and Psychiatry
John V. Campo, MD
Psychiatric Times, Psychiatric Times Vol 21 No 10, Volume 21, Issue 10
There has been much thought and discussion about the relationship between pediatrics and psychiatry, but research on the integration of the two leaves much to the imagination.
Shortly after completing my training in both pediatrics and psychiatry, I spoke with a retired child and adolescent psychiatrist who had invested his career in improving the relationship between pediatrics and psychiatry. As I excitedly told him about plans to focus my own career on the interface between the disciplines, he wistfully stared off into the distance, then respectfully observed, "Hope springs eternal now, doesn't it?" It is no accident that I continue to think of him often. A quick MEDLINE search gives reason for despair--collaboration between pediatrics and psychiatry has been a topic of interest, discussion and annoyance for half a century, not only in the United States, but also in a host of different countries and cultures. Parallel systems of care for pediatric physical and mental health problems persist despite recommendations to better integrate existing research-based knowledge into routine clinical practice (e.g., U.S. Public Health Service, 2000). Yet despite several "botched beginnings" between the disciplines and the imperfect nature of existing knowledge and practice, there truly is reason for hope. Psychiatry and its affiliated disciplines now offer a better product that is increasingly relevant to the pediatricians and family physicians who are being called on to manage youths with mental disorders in traditional medical settings.
Reason for Hope
This is an exciting time to be a mental health care professional. Tremendous progress has been made with the nosology and the clinical epidemiology of pediatric mental disorders, and treatments for attention-deficit/hyperactivity disorder (Jensen et al., 2001), anxiety disorders (Birmaher et al., 2003; Kendall et al., 1997; Walkup et al., 2001) and depressive disorders (Brent et al., 1997; Emslie et al., 1997) have demonstrated efficacy, calling attention to gaps between the evidence base and routine clinical practice (Institute of Medicine Committee on Quality of Health Care in America, 2001) and creating a need to expand the scientific basis of usual practice (Ringeisen et al., 2002). The future of child and adolescent psychiatry will likely depend on collaborative efforts with pediatricians, family physicians and affiliated mental health care professionals such as nurses, psychologists and social workers to fill in the gaps by improving the scope and quality of pediatric mental health services.
A Shared Challenge
Most youths with psychosocial problems do not receive mental health care services (Rushton et al., 2002), despite as many as one in four suffering from a clinically significant mental disorder (Costello et al., 1988a). The primary care setting is increasingly recognized as being relevant to the management of common pediatric mental disorders, but the role of primary care clinicians in service delivery remains poorly defined on a societal level (Costello and Pantino, 1987; Pincus, 2003). Low rates of primary care clinician recognition and referral of youths with mental disorders are the rule rather than the exception (Costello et al., 1988b; Horwitz et al., 1992; Kelleher et al., 1997), and primary care clinicians report inadequate training in the management of pediatric mental health problems (Kelleher et al., 1997; Rushton et al., 2002). Barriers to pediatric mental health care include stigma, insufficient access to specialty services, a shortage of child and adolescent psychiatrists, imbalances in the geographic distribution of available mental health care professionals, prolonged delays in scheduling appointments, administrative practices that restrict access, and reimbursement problems. Even when a credible referral is offered and available, family compliance with referrals is quite low (Rushton et al., 2002). In addition, primary care clinician management of disorders such as ADHD often fails to meet recommended standards for treatment intensity and follow-up (Jensen et al., 2001), and primary care clinicians are especially uneasy caring for mental health disorders other than ADHD, such as depression (Rushton et al., 2000). Finally, while it is almost certainly true that primary care clinicians and mental health care professionals are dedicated to improving services for pediatric mental disorders, guild issues, differences in experience and training, classification and reimbursement problems, the wish for primacy, and stigma all can interfere with mutually respectful collaboration.
A Bridge to Collaboration?
Despite the challenges outlined above, primary care clinicians remain important resources for families addressing pediatric psychosocial problems (Horwitz et al., 1992). Advantages of the primary care setting include familiarity, proximity and relative acceptability for youths and their families, allowing mental health services to be delivered in the context of an established relationship with the primary care clinician. Most youths with recognized mental disorders are managed by primary care physicians (Rushton et al., 2002), who write the majority of their psychoactive medication prescriptions (Kelleher et al., 1989; Ringeisen et al., 2002). Delivering mental health care services in primary care communicates that physical and mental health are inseparable and may aid in efforts to overcome stigma and the sometimes strained relationships between and among mental health service providers and primary care clinicians (Kelleher et al., 1997).
There is a growing appreciation that mental disorders are most often chronic conditions with a broad range of severity, analogous to asthma, and that high-quality mental health care services are multidisciplinary and collaborative (Pincus, 2003). Consequently, it is unreasonable to expect primary care clinicians to consistently deliver quality mental health care without changes in the organization of primary care health services (Rothman and Wagner, 2003). Successful strategies in adult primary care include using mental health care professionals as educators, consultants, supervisors and/or direct service providers, but specialist involvement alone is less potent than changes in care system design (Katon et al., 2001; Von Korff et al., 1997; Wagner, 2000).
The Chronic Care Model
The chronic care model suggests that optimal care is achieved when informed and motivated patients and families interact with a well-prepared and proactive collaborative care team--a multidisciplinary group of clinicians who communicate regularly about the care of a defined group of patients and participate in that care (Rothman and Wagner 2003; Wagner, 2000). The chronic care model has been applied to mental disorders in primary care in order to improve the quality of service delivery by integrating mental health care professionals into primary care as educators, consultants and clinicians for the more severely ill, and taking advantage of multidisciplinary collaborative care teams that include non-physicians, such as highly skilled nurses and other allied health professionals, as care managers (Katon et al., 2001; Von Korff et al., 1997). The chronic care model shifts the focus of care from the acute to the longitudinal perspective. Goals include ensuring that a mutually understood and agreed-upon care plan is in place; patients and families have the skills and confidence necessary to manage the condition; the most appropriate treatments are available for optimal illness control and prevention of complications; and follow-up care is available (Rothman and Wagner, 2003; Von Korff et al., 1997). The six core elements of the chronic care model are listed in the Table.
Child and adolescent psychiatrists are well positioned to participate in the leadership of collaborative efforts guided by the chronic care model and contribute to care system design; education of primary care clinicians and care managers; and development of decision-support systems, management guidelines and self-management materials. Just as primary care clinicians may play multiple roles (e.g., sources of treatment, gatekeepers determining access to specialty mental health services), child and adolescent psychiatrists can similarly improve mental health services in primary care by educating primary care clinicians and their affiliates, supervising and having their input mediated by non-physician care managers, and providing direct assessment and treatment services for selected patients and families.
A stepped-care approach emphasizes different levels of care depending on the type of specific disorder; its severity, complexity and/or persistence in the face of intervention. This approach acknowledges the need for specialty mental health care and/or referral for selected or treatment-refractory patients (Katon et al., 2001, 1999). The chronic care model has demonstrated the effectiveness of primary care-based intervention for adults with depressive disorders, with landmark quality improvement trials that integrate mental health care professionals into primary care settings, producing remission rates comparable to those observed in specialty care efficacy studies (e.g., Katon et al., 1999). There has been little comparable intervention research in pediatric primary care settings (Bower et al., 2001).
A Working Model
We have applied a stepped-care approach to the management of pediatric mental disorders in a large, rural, primary care practice in western Pennsylvania. Our collaborative care team consists of primary care clinicians, a nurse-clinician/care manager, a psychiatric social worker and a pediatric psychiatrist (Campo et al., 2003). The model affirms the primary care clinician as the physician of record, with responsibilities including initial case identification, targeted medical and psychiatric assessment, presumptive diagnosis, treatment initiation (generally for straightforward cases) or specialty referral, and ensuring the overall continuity of care. Central to the model is a full-time nurse-clinician/care manager with considerable mental health training and experience who mediates specialty input and serves as the primary liaison between primary care clinicians and the psychiatrist, who is on site less than once per week. When a youth with a suspected psychiatric disorder is identified, the nurse-clinician works with the primary care clinician to complete an initial assessment and triage the patient. Options include: collaborative management with the primary care clinician in primary care (relatively straightforward, uncomplicated patients or those on a stable treatment regimen), on-site mental health co-management with the specialty mental health team (treatment failures with the primary care clinician or patients of intermediate complexity or severity) and off-site specialty mental health care referral (patients with more complicated and/or severe disorders and psychosocial circumstances judged unlikely to be successfully managed in primary care).
The nurse-clinician provides relevant patient and family education, ongoing case management and coordination, school liaison, and treatment-support services such as psychopharmacology safety and outcome monitoring. The nurse-clinician may also deliver brief psychotherapeutic and supportive interventions, including training in self-management strategies. The psychiatric social worker is charged with delivering on-site specialty psychotherapeutic interventions, particularly focused cognitive-behavioral treatments, for selected patients and families. The pediatric psychiatrist provides leadership for the on-site mental health care team, regular supervison for the nurse-care manager and therapist, regular education for the primary care clinicians on the assessment and management of common pediatric mental disorders, psychiatric consultation for selected cases (e.g., diagnostic dilemmas, treatment failures), and co-management for intermediate cases.
Although challenging from a fiscal perspective, this approach incorporates pediatric mental health care specialists into primary care, appears to be feasible and compatible with the workings of the practice, and has been well received by primary care clinicians, patients and families. In a single year, primary care clinicians requested triage assistance during 789 primary care visits (2.5% of annual visits), approximately one-third being first-time mental health contacts. Of these, approximately two-thirds were triaged to routine services delivered by the primary care clinician with nurse-clinician support, 20% were managed on-site by the primary care clinician and mental health care team, and the remainder was referred to more intensive specialty services off-site. Family compliance with scheduled assessment and triage visits was quite high (91%) in comparison to findings for off-site mental health referral in other studies.
The Need for Research
The relative lack of research addressing pediatric mental disorders in the primary care medical setting is rather striking, with only a handful of studies addressing this broad area. As a beginning, we have established a functional practice-based research network in primary care dedicated to improving the care of common pediatric mental disorders that is supported by the National Institute of Mental Health (MH 66371). Formal research addressing the effectiveness and design of collaborative pediatric mental health care teams; the roles of specific professionals; and the implementation of specific management guidelines, educational efforts and treatment interventions is warranted, but is best conducted as a shared, collaborative venture involving pediatricians and other primary care clinicians as active participants.
The Task Before Us
How can child and adolescent psychiatrists and other mental health care professionals productively collaborate with each other and with other primary care clinicians to improve the quality of care available to youths with mental disorders? The chronic care model provides a template for the task before us. The issue is not simply whether pediatricians and psychiatrists can successfully collaborate, but rather whether an effective system of mental health service delivery can be crafted that fosters collaboration between the disciplines. Improving the process of specialty mental health care referral alone is unlikely to address the scope of the public health problem. Primary care clinicians, psychiatrists and other mental health care professionals must face the challenges outlined above, which will necessitate real and enduring changes in current practices. Child and adolescent psychiatrists must be open to new models of care delivery and collaboration with our medical and mental health colleagues, or face increasing isolation as a rarefied specialty. The various mental health care disciplines must develop some degree of consensus on appropriate roles for particular specialties with regard to service delivery in primary care. There is wisdom in child and adolescent psychiatrists being proactive rather than simply reactive in any such process.
It makes abundant sense that any successful system of care should be built around the primary care clinician, while taking advantage of the expertise and training of child and adolescent psychiatrists and other mental health care professionals. Child and adolescent psychiatric input can be mediated by non-physician care managers with specialized clinical and behavioral skills who communicate regularly with the specialist and the primary care clinicians (Katon et al., 2001, 1999; Rothman and Wagner, 2003; Wagner, 2000). The goal is not to provide a non-physician substitute for the primary care clinician or specialist, but rather to complement and supplement both the primary care clinician's and specialist's roles by delivering services that they do not have the skills or time necessary to provide (Von Korff et al., 1997; Wagner, 2000). The care manager can thus complement the primary care clinician's mental health care skills while mediating and expanding the impact of psychiatrists within traditional medical settings. Such a model can successfully incorporate the expertise of highly trained, doctoral-level pediatric psychologists who can serve as educators, consultants, supervisors and interventionists focused on the delivery of specialized psychotherapeutic interventions. Master's-level clinicians in disciplines such as nursing, psychology and social work find roles in direct service delivery and in care management.
Relevant professional organizations must come together to develop a credible and committed leadership team that will likely need to include representation from relevant third party payers. Efforts can then follow to develop consensus on delivery system design, decision-support and self-management materials, and information systems relevant to common pediatric mental disorders that can ultimately be tested in a collaborative research process.
Hope does spring eternal.
Dr. Campo was supported by National Institute of Mental Health grant MH 01780, and this work was facilitated by NIMH grant MH 66371 and the ACISR for Early-Onset Mood and Anxiety Disorders.
Dr. Campo is medical director of an on-site mental health program in pediatric primary care, director of the Research Network Development Core of the Advanced Center for Interventions and Services Research (ACISR) for Early-Onset Mood and Anxiety Disorders, and associate professor of psychiatry and pediatrics at Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center.
Birmaher B, Axelson DA, Monk K et al. (2003), Fluoxetine for the treatment of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 42(4):415-423.
Bower P, Garralda E, Kramer T et al. (2001), The treatment of child and adolescent mental health problems in primary care: a systematic review. Fam Pract 18(4):373-382 [see comment].
Brent DA, Holder D, Kolko D et al. (1997), A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy. Arch Gen Psychiatry 54(9):877-885.
Campo JV, Shaffer S, Lucas A et al. (2003), Pediatric mental health services in primary care: a nurse centered model. Presented at the 50th Annual Meeting of the American Academy of Child and Adolescent Psychiatry. Miami Beach, Fla.; Oct. 17.
Costello EJ, Burns BJ, Costello AJ et al. (1988a), Service utilization and psychiatric diagnosis in pediatric primary care: the role of the gatekeeper. Pediatrics 82(3 pt 2):435-441.
Costello EJ, Edelbrock C, Costello AJ et al. (1988b), Psychopathology in pediatric primary care: the new hidden morbidity. Pediatrics 82(3 pt 2):415-424.
Costello EJ, Pantino T (1987), The new morbidity: who should treat it? J Dev Behav Pediatr 8(5):288-291.
Emslie GJ, Rush AJ, Weinberg WA et al. (1997), A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry 54(11):1031-1037.
Horwitz SM, Leaf PJ, Leventhal JM et al. (1992), Identification and management of psychosocial and developmental problems in community-based, primary care pediatric practices. Pediatrics 89(3):480-485.
Institute of Medicine Committee on Quality of Health Care in America (2001), Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press.
Jensen PS, Hinshaw SP, Swanson JM et al. (2001), Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): implications and applications for primary care providers. J Dev Behav Pediatr 22(1):60-73.
Katon W, Von Korff M, Lin E, Simon G (2001), Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse. Gen Hosp Psychiatry 23(3):138-144.
Katon W, Von Korff M, Lin E et al. (1999), Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Arch Gen Psychiatry 56(12):1109-1115.
Kelleher KJ, Childs GE, Wasserman RC et al. (1997), Insurance status and recognition of psychosocial problems. A report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Networks. Arch Pediatr Adolesc Med 151(11):1109-1115.
Kelleher KJ, Hohmann AA, Larson DB (1989), Prescription of psychotropics to children in office-based practice. Am J Dis Child 143(7):855-859.
Kendall PC, Flannery-Schroeder E, Panichelli-Mindel SM et al. (1997), Therapy for youths with anxiety disorders: a second randomized clinical trial. J Consult Clin Psychol 65(3):366-380.
Pincus HA (2003), The future of behavioral health and primary care: drowning in the mainstream or left on the bank? Psychosomatics 44(1):1-11 [see comment].
Ringeisen H, Oliver KA, Menvielle E (2002), Recognition and treatment of mental disorders in children: considerations for pediatric health systems. Pediatr Drugs 4(11):697-703.
Rothman AA, Wagner EH (2003), Chronic illness management: what is the role of primary care? Ann Intern Med 138(3):256-261 [see comment].
Rushton J, Bruckman D, Kelleher K (2002), Primary care referral of children with psychosocial problems. Arch Pediatr Adolesc Med 156(6):592-598.
Rushton JL, Clark SJ, Freed GL (2000), Primary care role in the management of childhood depression: a comparison of pediatricians and family physicians. Pediatrics 105(4 pt 2):957-962 [see comment].
U.S. Public Health Service (2000), Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda. Washington, D.C.: U.S. Department of Health and Human Services.
Von Korff M, Gruman J, Schaefer J et al. (1997), Collaborative management of chronic illness. Ann Intern Med 127(12):1097-1102.
Wagner EH (2000), The role of patient care teams in chronic disease management. BMJ 320(7234):569-572 [see comment].
Walkup JT, Labellarte MJ, Riddle MA et al. (2001), Fluvoxamine for the treatment for anxiety disorders in children and adolescents. N Engl J Med 344(17):1279-1285.


The author asserts that her parents' divorce, which occurred when she was 11 years old, encouraged her to be more self-sufficient. She further states that it also made her appreciate the relationships she still had in her life, and ultimately helped her to choose a stable partner in marriage. Finally, the author claims that having worked through family issues in her childhood helped her to avoid repeating those same mistakes as a parent.
The author's story may be reflective of a larger societal shift in attitudes about families and children. Specifically, national survey data collected by the Centers for Disease Control and Prevention indicates that a majority of men and women approve of single female parenting, regardless of the woman's former or intended future marital status. Over two-thirds of the approximately 10,000 Americans surveyed also approved of the right of gay and lesbian couples to adopt. Finally, it seems that Americans are taking the parenting step only when ready: over 90 percent of the survey participants believe that children are not necessary to find life happiness.
Has the law changed regarding child custody and support determinations? Just as societal opinions are shifting, so might interpretations of the best interest of the child standard be evolving. Our law firm, which focuses on divorce and other family law issues, has seen a greater willingness of courts to consider joint custody arrangements and a flexible approach to visitation arrangements.


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The year 1613 A.D.
in the Iranian History
1613 A.D. / April, 16 : The Isfahan Treaty With Ottomans
1613 A.D. / October, 17 : Safavid Venture In Georgia
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April, 16, 1613 A.D.:
The Isfahan Treaty With Ottomans
After 3 consequent years of several battles with Ottomans in which Iranians were victorious, the Ottoman envoy reaches Isfahan to sign a peace treaty according to which the Ottoman Empire accepted waiver of all rights and claims regarding Kafkas region. Erivan, Ghares and Van were battlegrounds in... Read Full Article:
October, 17, 1613 A.D.:
Safavid Venture In Georgia
Shah Abbas marched from Isfahan towards Ardebil on Oct, 17, 1613. His next stop was Karabagh in a campaign to take control of the Iranian side of Georgia, especially Kartli, Kakheti and Meskheti where revolts had broken out. It seemed crucial for Shah Abbas to take control of the Iranian share of Ge... Read Full Article:
More About The Iranian History
Complete Iranian History Chronicle arranged by year
Complete Iranian History Illustrated
Periods of the Iranian/Persian History by Dynasties
Elamite Dynasties (2800 - 550) BC
Median Empire (728 - 550) BC
Achaemenid Empire (550 - 331) BC
Seleucid Empire (330 - 150) BC
Parthian Empire (247 BC - 226 AD)
Sassanid Empire (226 - 651) AD
Omavi Caliphates (661 - 750) AD
Abbasi Caliphates (750 - 1258) AD
Taherian Dynasty (821 - 873) AD
Alavid Dynasty (864 - 928) AD
Samanid Dynasty (875 - 999) AD
Ziyarid Dynasty (928 - 1043) AD
Buyid Dynasty (934 - 1062) AD
Ghaznavid Dynasty (977 - 1186) AD
Seljuk Empire (1037 - 1194) AD
Kharazm Dynasty (1077 - 1231) AD
Mongol Ilkhanates (1256 - 1353) AD
Timurid Empire (1370 - 1506) AD
Kara Koyunlu (1407 - 1468) AD
Safavid Dynasty (1502 - 1736) AD
Hotaki Dynasty (1722 - 1729) AD
Afshar Dynasty (1736 - 1750) AD
Zand Dynasty (1750 - 1794) AD
Qajar Dynasty (1794 - 1925) AD
Pahlavi Dynasty (1926 - 1979) AD
Islamic Republic (1979 - ?) AD

redpajama_set_name: RedPajamaCommonCrawl


20 For his invisible attributes, that is, his eternal power and divine nature, have been clearly seen since the creation of the world, being understood through what he has made. As a result, people are without excuse. 21 For though they knew God, they did not glorify him as God or show gratitude. Instead, their thinking became worthless, and their senseless hearts were darkened.


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It is a song by one of your favourite artists covering a song that you haven't heard before.
Another mix of covers follows. You will notice a change in the music player. Problems, problems… Click away and you will figure out what to do.
I am particularly fond of the Juliana Hatfield cover of the Olivier Newton John song. She has turned it into a real banger.
The Bennie & The Jets cover is also fab.
Looking forward to seeing Teenage Fanclub when they play next year.


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City lawyer arrested over Magara murder
Late Susan Magara's gruesome murder raised eyebrows (FILE PHOTO)
The joint security team investigating the murder of Susan Magara has arrested Muzamil Bikanga, a city lawyer, in connection with the crime, PML Daily has learnt.
Highly placed security sources told this website that Bikanga was arrested on Thursday after his name was mentioned by suspects arrested during the raid on Usafi Mosque in Kisenyi, a Kampala suburb, on Friday.
Sources added that the investigations team had been tracking him after he had reportedly made a telephone contact to Magara's family shortly before the kidnap.
Bikanga, who is also an official of Bunyoro Kingdom, is also believed to be a relative of Yakubu Byensi, who is said to have escaped during the Usafi Mosque raid. Bikanga was also reportedly known to the Magara family and had contacted Mr John FitzGerald Magara for a business deal shortly before Susan's kidnap.
When contacted, Police spokesperson Emilian Kayima refused to comment on the arrest of the lawyer and his connection to the murder. "We shall give a report on the investigation when the time is right," Mr Kayima said.
Since the Usafi Mosque raid, the investigating team has made several strides, arresting 9 suspects in the process.
The suspects have led the security agencies to a house in Konge, Buziga, where they said Magara was being held before she was murdered.
In the process, a video clip showing kidnappers cutting off her fingers to demand ransom from her parents was recovered
The joint security team investigating the murder has also since recovered several phone handsets and SIM cards that it believes were used by her kidnappers in the three-week ordeal.
The suspect also led to detectives the vehicle which was used to transport Magara's body, eventually leading to the arrest of the owner, who sources say is a woman.
Security sources said the investigations also retrieved several land titles and car sale agreements, which the investigators believe were bought using the Shs700m ransom money.
Among the recovered items is a title of a chunk of land measuring 35 acres that the suspects bought in Buikwe District at Shs140 million.
The suspect also took the investigations team to the various scenes of crime.
They are said to have gone to Buziga first, then to Kabaka Anjagala Road in Rubaga Division, Kampala, where Magara was kidnapped from on February 7 and then Kitiko, between Kigo and Kajjansi near the Entebbe Expressway, where her body was found.
Security agencies have also arrested the owner of the house in Buziga over allegations that he knew of the Magara murder plot.
So far, security has arrested more than 20 suspects over the murder, among them Agaba, and Ronald Asiimwe, aka, Kanyankole.
Suspects have also told investigators that Patrick Agaba, aka, Pato, was part of the group that plotted the kidnap and murder of Susan Magara, PML Daily can exclusively reveal.
Security agencies have for long believed that Agaba, who is Magara's distant cousin, is the key suspect in the murder and have since March been trying to have him extradited from South Africa to face trial.
Sources close to the investigation on Thursday told this website that the suspects, who have admitted to participating in the murder, have implicated Agaba in the murder.
Pato was arrested in March following a tip off (FILE PHOTO)
Pato was arrested on March 7 by South African police in collaboration with Ugandan security agencies ISO, ESO and CMI.
However, the court in Randburg asked the Ugandan security agencies to present enough evidence that Pato committed crimes that would call for his extradition to face trial here.
As part of the evidence presented in the court in Randburg, Johannesburg, the government team states that the voice recording of the person who was demanding for the $1 million (about Shs3.6 billion) ransom, which was later reduced to Shs700m, from Magara's parents was Agaba.
Related Items:Bikanga, City Lawyer, news, susan magara, top, USAFI
Extradited Magara murder suspect being quizzed, says police
Magara murder suspect Pato extradited from South Africa


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Obituary of Martin Steven Yoho | Ducro Funeral Services, Inc.
FARGO, ND –Martin Steven "Marty" Yoho, 54, died unexpectedly on Tuesday, February 5, 2019.
The son of Ralph and Marie (Brown) Yoho, Marty was born on June 2, 1954 in Houston, Texas.
Marty was a veteran of the United States Navy and was stationed Pearl Harbor, Hawaii.
Marty could make you smile with his unique sense of humor; he could repair anything and enjoyed watching television. Above all; Marty was a kind and gentle soul. He will be remembered with genuine love and happiness by his sister and her husband, Barbara and Randy Lewis, brother and wife, Rob and Pame Yoho and his mom, Marie Allen.
He was preceded in death by his dad, Ralph Yoho.
If desired, contributions may be made to Ducro Services.
DUCRO FUNERAL HOME AND CREMATORY, 4524 Elm Avenue, Ashtabula, Ohio, 44004, is assisting the family.


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Experimental Technique Coaxes Muscles Destroyed By War To Regrow : Shots - Health News By surgically transplanting material from pig bladders into the injured legs of several men, doctors prompted muscles to heal by growing and nurturing fresh, healthy cells.
Health News From NPR
Treatments & Tests
Health Inc.
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Experimental Technique Coaxes Muscles Destroyed By War To Regrow
Experimental Technique Coaxes Muscles Destroyed By War To Regrow 4:00
< Experimental Technique Coaxes Muscles Destroyed By War To Regrow
April 30, 20149:13 PM ET
This next story offers hope to people wounded in disasters, or for that matter maimed in war. It's a medical advance reported in the journal Science Translational Medicine. Scientists say they have found a way to grow new muscle for trauma victims. Here's NPR's Rob Stein.
ROB STEIN, BYLINE: One day, while on patrol in Afghanistan, Ron Strang stepped on a homemade land mine.
RON STRANG: When it went off, it came across the front of my body. My left leg was forward since I had just begun to walk again so the outside of the blast struck my left leg.
STEIN: Strang survived but was never the same. He'd lost most of the muscle on his left thigh. He used to swim, hike and run, but those days were gone.
STRANG: It was impossible for me to run. It was hard for me to walk. I'd use a cane a lot. That knee would give out and I'd fall over all the time. So that was huge and hard to get used to at first.
STEIN: Then Strang heard about some doctors who were trying to help patients like him, Stephen Badylak and his colleagues at the University of Pittsburgh. They knew that thousands of lives are devastated every year when people's muscles are destroyed.
STEPHAN BADYLAK: Present methods for trying to correct that involve rather heroic attempts at moving a muscle from somewhere else in the body to that location. That doesn't work very often and now you've created a deficit somewhere else.
STEIN: But Badylak and his colleagues had an idea. What if they replaced the decimated muscle with something that would help the body grow new muscle? Something Badylak calls the matrix.
BADYLAK: The matrix can be thought of simply as the glue that holds all of the cells and different tissues together. However, in addition there's all these hidden signals in the matrix that actually instruct the cells on what to do.
STEIN: Like grow new muscle. Badylak decided to try transplanting matrix from pig bladders into patients whose muscles had been destroyed. He started with five patients, Strang and four other men who remain disabled despite the best physical therapy and the best medicine had to offer.
BADYLAK: Some of them could not get out of a chair without help. Some of them walked with a cane. Some of them could not take steps, you know. This was not just a mild loss of strength. They had real problems.
STEIN: Strang was curious, but also skeptical.
STRANG: At first, when I first heard about it, I wasn't sure. It kind of seemed far-fetched.
STEIN: But Strang decided to give it a try. And just as Badylak had hoped, the pig matrix triggered immature muscle cells that were dormant in the men's bodies to grow and make new muscles.
BADYLAK: A patient who was in Iraq and they were ambushed, and he'd been about three years of trying to recover from this with, I think, over 30 surgeries and nothing worked - he was actually considering amputation of his leg because he felt like he was just dragging it around. He now mountain bikes and does jumping jacks.
STEIN: Strang's recovery hasn't been quite that dramatic and two patients only got slightly better. But Strang's limp is gone and he can walk without a cane, and in short spurts he can even do something he never thought he'd do again.
STRANG: I'm able to run now, which is a great feeling after almost two and a half to three years of not being able to do that. It's been amazing and definitely life-changing for me.
STEIN: Other experts say the work is exciting. Arnold Caplan studies muscle regeneration at Case Western Reserve University.
ARNOLD CAPLAN: This is a very big deal. This study is a proof of concept that there's a good chance that not only can you save some of the muscle using this technique, but you can actually get a real regeneration.
STEIN: Badylak has already treated about a dozen patients and plans to try this on dozens more with the hopes that lots of doctors around the country will someday be able to use the same approach to help many patients whose muscles have been destroyed. Rob Stein, NPR News.
INSKEEP: And we're hearing news right here on MORNING EDITION from NPR News.


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Ask Tom: What are the details about the iceberg that broke away from Antarctica?
Jul 14, 2017 | 8:18 PM
What are the details about the iceberg that recently broke away from Antarctica?
— Jordan Chris, Chicago
A massive portion of the Larsen C ice shelf broke off the main floating ice pack Wednesday and is drifting into the ocean.
Antarctica is surrounded by ice shelves, floating extensions of glaciers that exist over land. Large portions of the extensions on occasion break away. It's a natural process. The Wednesday event produced a massive iceberg 2,200 square miles in extent, nearly the size of Delaware. An even larger portion of Larsen C broke off in 1986.
"I think we're all scratching our heads as to just what combination of changes in the ice, air and ocean caused this," said Ted Scambos, senior research scientist at the National Snow and Ice Data Center. There is a debate as to whether this event can be attributed to global climate change.


BOSTON, October 16, 2013 – The systems design and integration experts at Clearwing Productions last year overhauled the Phoenix Zoo's annual seasonal spectacular "ZooLights," transforming a linear roadside display into an immersive, 360-degree audio and lighting experience that encircled the zoo's central water lagoon. The advanced audio system from Technomad performed so well that zoo officials opted to use the system year round, delivering multi-zone background and event music to visitors across the lagoon area.
The Phoenix Zoo initially hired Clearwing Productions to increase the production value of the annual lighting show, though the two teams quickly determined that the audio system was underperforming – not to mention falling apart.
Technomad delivered an advanced outdoor audio solution comprising 24 loudspeakers, 12 subwoofers and multiple wired power amplifiers, all fully weatherproof to protect against UV rays and other outdoor elements. The Clearwing design included 12 speaker poles surrounding the lagoon, each with two Paris weatherproof loudspeakers pointing in opposite directions from a height of 16 feet. One Technomad Chicago subwoofer and two PowerChiton amplifiers were added to the base of the pole.
The PowerChiton amplifier modules simplified the installation for the Clearwing team and ultimately reduced project costs for the Phoenix Zoo, eliminating lengthy complex underwater wiring jobs to connect traditional indoor amplifiers to outdoor loudspeakers.
The end-to-end distributed audio architecture includes Harman or BSS equipment to route, zone and delay signals for everyday use or special events as required. Network protocol signals are converted back to balanced audio en route to the PowerChitons. From there, the Paris loudspeakers deliver full-range musical reproduction with broad dispersion across the entire lagoon, with the Chicago subwoofers filling in the low end with additional bass output.


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Get the best cuts of meat at King of Meats in Northern Beaches Central. This butcher shop supplies a wide range of meat products to food businesses and residents in Mackay. From beef wellingtons to chicken mignons, you'll find what you need at King of Meats. The butchers create sausages in store, so you know they're made by experts! King of Meats also creates preservative-free sausages — just ask the butchers to make these for you. Drop by King of Meats to sample their own wood smoked bacon. It's fit for royalty!
King of Meats butchers wanted a simple, traditional butcher shop design with a more polished interior finish. Stockwell's $250 million Shopping Centre expansion at Mackay Northern Beaches hasn't been completed yet, so Food Strategy created the design off the master architect's building plans. Our foodservice designers did this while the shopping centre was under construction.
The advantages of working off the master plan are cost savings. Site visits are not required, and the butcher's services can be installed in the base building during its construction to save fitout costs.
Open your own butcher shop or food business with Food Strategy. Contact us for a streamlined foodservice design.


A superbly crafted watch fitted with a genuine leather strap and made from 100% natural wood. This beautiful time piece features elegant flowers around the watch face and silver watch hands to give it a classy feel. The Black Betty is perfect for any occasion and would be a great gift.


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The Pragmatic Aspie
Practical Solutions
This post is aimed at anyone that thinks our current economic system is doing more damage than help to people. By people, I mean the majority of people. I concede that perhaps 8% or so of people in the world may honestly benefit from capitalism. They are the ones that have broken past a certain barrier, so that instead of being behind the wave, they are ahead of it. Effectively, 8% of humanity is swimming downstream and the other 92% are swimming upstream.
I can already see the knee-jerk reaction to this: "But that just means that those 8% were more hard-working and just took all opportunities available to them, the other 92% are just lazy/ineffective/inefficient!"
In fact, inherent in capitalism's design, 92% of the world's people MUST support the other 8%. It is the effort of swimming upstream for the 92% that provides the slipstream for the other 8% to swim downstream. Therefore, if you are lucky enough to be born into the elite, you will, barring seriously terrible life events, remain there. And if you are unlucky enough to be born poor, again the economic system dictates that one should remain there.
And of course there are exceptions. Occasionally, someone DOES slip through the cracks. It happens. What doesn't happen is a person making that alone. It takes the effort and sacrifice of several people to push just one through the cracks. And then all too often, the person that has made it to the 'top' or at least improved his or her social status, forgets everything and everyone that helped him or her there in the first place. Those of us that are not necessarily rich, nor poor (the 'middle' class, perhaps the people that belong in between the 90th and the 97th percentile) are a very insecure bunch. We are constantly reminded that all the poverty we see around us, could just as easily BE us. And for this, we are conditioned to dissociate ourselves as much as we can from anything that may 'bring us down'. We are taught to hate the poor and see them as responsible for their situation.
And that is why class mobility is not the answer. It is too slow, and only an absolute minority of people can ever achieve it. The rest of us are left to drive the economic engine. The fuel of the engine is your labour, your happiness, your success. Can you see it burned away in front of you, all in the service of someone else?
So all of this begs the question: What are we going to do about it? Those of us who are well-enough educated to see that a crisis is looming, but not well-resourced enough (at least alone) to fix it? Those of us who are morally opposed to the way capitalism dehumanises the majority of people, but don't see any clear solution?
What we have to understand is that those of us who are in this small band of people are a minority. The reason, of course is that the authorities (who are in service of the elite, as always) have tried their utmost to prevent anyone from graduating into this class of people. They have done this by only making career options available to people who follow the capitalist system. Sure, there's an education out there for you, as long as you want to be an accountant, an advertiser, an investor, a doctor or an engineer. As long as you're the kind of person who they're sure will become corrupted by money and not become a problem to them (because what you think of as 'looking out for yourself' is actually looking out for them), then they will offer you a career.
Those of us who can see that it is only getting worse in capitalism-land and have the skills to do something about it, must therefore serve as the early adopters of a new system. Early adopters are often ostracised by society as a whole, because they are seen as attempting to fix something that, in the minds of society at large, isn't broken. We are so conditioned from a young age that capitalism is the ONLY economic system that could ever work - because hey, look how badly the Russians, Chinese and Koreans fucked up communism? That happened, according to the propagandists, because any opposition to capitalism is doomed to failure. What they have done is create a strawman (dirty commie! hippie! anarchist! terrorist!) and played word association games with it, and introduced a false dichotomy, as though there were only TWO possibilities of economic system in the world - capitalism, and whatever those weird people did.
What we need to do, as the early adopters, is start a new system. My suggestion for this is to do some research into what exactly it takes to run a functional, self-sustaining eco-village. How many people, how long our project is expected to take before we break even, and what outside help we need. We need to break the association between rural villages with backward-thinking and conservative people. We need to redesign 'rural' life into one that embraces change, forward-thinking attitudes, dynamism (see my earlier post on this) and most importantly, TECHNOLOGY. Technology is, in my opinion, what will improve our lives to the point that there no longer needs to be physical labour and the unhappiness that comes from doing that. Technology drives us forward, towards progress.
Once we've worked out how many people we need, we must then recruit multi-talented people who can help us realise our goal. We can buy farmland by putting our assets together, and use the farm as a place to start our new society. It is time to get out of the overcrowded, polluted city. It isn't doing our health any favours to sit for long periods in traffic and constantly experience all the frustration that comes with having not enough space. The city is a fundamentally inefficient place, because it has been stretched to its logical limit and beyond. The frustration of this will set us back so much that we should no longer tolerate such conditions.
Some of us in South Africa may have seen films such as Zeitgeist and wondered whether the only sort of support for these claims stems from an international base. In fact, I recently came across a book called The Human Alliance, written by Michael Ruppert (who is from Midrand) that deconstructs how a far more humanitarian society could be established, how it may function and what flaws may arise. I would recommend having a look. The book is updated and reprinted frequently, which represents the commitment to an ideal of dynamism in the sort of way that is helpful to understand it. If you can find a copy, read it. (The books are still in the process of distribution).
In closing, I would like to say why this is all so important to me: I am of the opinion that once humanity evolves past the need for money, we will be a species of more tolerant, helpful and happier people that will continue to improve and excel, no longer at the expense of any other species or members of its own. It is therefore something of a personal goal, a goal that is forever evolving, to becoming as unreliant on the capitalist system as possible while maintaining a healthy and happy standard of living. Or stated another way: Having the sort of life that I would truly be happy to bring children into, to the point that I would intentionally aid the process of creation of life that the collective consciousness has given rise to.
Posted by David at 6:35 PM
My absence of late, the myth of the lone innovator...
Teacher, aspiring EcoVillager and market gardener, occasional writer and storyteller.


This documents sets out frequently-asked 'questions and answers' regarding the new guidelines on Good Distribution Practice of medicinal products for human applicable as of 8 September 2013 2 , and their revision of November 2013 3 .... Sampling distributions multiple choice questions and answers pdf: sampling distributions, population parameters and sample statistic, stratified sampling, cluster sampling, sampling distribution in statistics for online college statistics courses distance learning.
7 Kevin uses Ills mobile phone for X minutes each day. X is a random variable which may be modelled by a normal distribution with mean 28 minutes and standard deviation 8 minutes. military athlete training program pdf Also an online normal distribution probability calculator may be useful to check your answers. Problems X is a normally normally distributed variable with mean μ = 30 and standard deviation σ = 4.
Whenever using the t distribution in estimation, we must assume that a. the sample size is at least 30 b. the sampling distribution is approximately normal c. the population is approximately normal d. the finite population correction factor is necessary II. PROBLEMS (20%) 1. In a random sample of UTC students 50% indicated they are business majors, 40% engineering majors, and 10% other majors drug handbook pdf free download questions and clear and concise answers are provided in step-by-step detail. There are several good books on these subjects and perhaps there is no need to bring a new one to the market.
If the problem is that a command or program described doesn't exist in a given distribution, it is generally possible to download a copy of that program from a Web site, if needed.


Upgrading from older versions of WordPress is designed to go without a hitch, but depending on the setup and the two versions involved, you may encounter some hangups along the way. For example, if you are upgrading from a version of WordPress older than 3.0, eventually you may encounter the dreaded "Warning! WordPress Encrypts User Cookies" error. This quick DigWP tutorial explains what it is, why it happens, and how to fix the problem asap.
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News: Quick Takes
State Ag Department spent $22k on hotels for officials to stay near N.C. State Fair
N.C. Agriculture Commissioner Steve Troxler speaks at an annual forum at the State Fairgrounds in Raleigh. (CJ photo)
in Quick Takes
Agriculture Commissioner Steve Troxler and department leaders wrongly spent $22,000 in travel expenses during the N.C. State Fair, a new audit report says.
The report from the Office of State Auditor found the Department of Agriculture and Consumer Services used the money on hotel stays for the commissioner, chief of staff, and State Fair manager.
The Agriculture Department failed to comply with State Budget Manual regulations regarding overnight travel, State Auditor Beth Wood says in the report, released Wednesday, Sept. 25.
State policy restricts overnight travel to equal to or more than 35 miles from an employee's home or duty station, whichever is closer. Troxler, Chief of Staff Zane Hedgecock, and G. Kent Yelverton, the fair manager, all live more than 35 miles from the State Fairgrounds. The distance from Troxler's and Hedgecock's duty station to the State Fairgrounds is about five miles.
The N.C. State Fair runs for 11 days in October. Doors open as early as 8 a.m. and close as late as midnight. Business demands justified the overnight stays, as Troxler, Hedgecock, and Yelverton would need to rapidly respond to any safety or security issues, Agriculture management claim in the report.
"In the case of the Commissioner of Agriculture, Chief Deputy Commissioner, Chief of Staff, and State Fair manager, work days are long and they need to be available 24 hours a day, 7 days a week to address any issues that may occur during the event," the Agriculture Department said in a statement in response to the audit. "These staff members are considered 'mission critical' to the operations of the State Fair."
While the Agriculture Department argued hotel rates in Raleigh were expensive, the audit shows the department was able to secure lodging for Yelverton for $70 a night. Troxler and Hedgecock received lodging for $199 a night.
Since 2014, the Agriculture Department paid more than $22,000 in travel expenses for the N.C. State Fair with money from the State Fair receipts. The fair generates its own operating funds and isn't supported by tax dollars, the Agriculture Department said in its statement.
Auditors say the Agriculture Department needs to follow the rules.
"No state agency, nor its leadership, has the authority to override existing state policies and regulations," the report reads. "In fact, Department management's decision to override these regulations sets a precedent for other state agencies to also ignore whichever policy or regulation they choose, which could cause a great cost to the taxpayers."
The audit calls for the Agriculture Department to comply with State Budget Manual regulations or obtain a waiver from the Office of State Budgement and Management. The waiver could then allow them to seek hotel rooms in accordance with the approved state rates.
The audit also recommends the Commissioner, Chief of Staff, and State Fair Manager consider reimbursing the Agriculture Department for all costs not in compliance with State Budget Manual regulations.
OSA informed the Agriculture Department about the option for a waiver early in its investigation. But, the report says, the Agriculture Department waited until a few days before the response deadline to seek the waiver. The Agriculture Department requested a waiver from OSBM Aug. 19 and received an approval two days later.
categories: CJ Quick Take, History, Law & Regulation, North Carolina, State Government
tags: N.C. Agriculture Department, N.C. State Fair, Office of State Auditor Beth Wood, Steve Troxler


A root sample prepared for scanning. Photo: IDPAN.
About the facility: Laboratory equipped with WinRhizo software for root image analysis.
The root analysis laboratory provides analyses of root samples. Root analysis offers insight into the root structure and morphology, and is an essential component of tree growth analysis. This technique provides valuable information on tree growth and phenology, especially in the context of variation within a population. Root analysis has been typically used to study e.g. biomass allocation or root morphology in response to environment. It can be used i.a. for study of age-related patterns of fine root development, and to estimate fine root biomass and morphology along a chronosequence of forest stands. The facility allows the following fine root traits to be studied: biomass, length, surface area, volume, tip numbers, fine root tip density, specific fine root area, specific fine root length, and fine root tissue density.
What does the TA programme offer? The access to the laboratory is supported by an experienced team at the site available to train the user in sample preparation, data acquisition, data interpretation, and periodic quality control, sample preparation, etc. Users will be given the needed training for the technique and use of the equipment, as well as safety training.
An estimated length of stay is 10 days, but this depends on the number of samples to be analysed. It is estimated that approximately three samples per day can be analysed. Expected output/deliverables for users: analysis of root area, length, and specified morphological parameters, e.g. diameter, number of root tips, forks, etc.
Example image of fine roots sample acquired by scanning and ready for analysis. Photo: IDPAN.


Grace and peace to you from God our Father and our Lord and Savior Jesus Christ. Amen. The word from God through which the Holy Spirit draws us to Jesus is Matthew 2.
The visit of the Magi, or wise men, is so familiar. We might breeze by it figuring we've already know it well enough. Or we become sidetrack with unanswerable questions: How many wise men were there? Where did they come from? How did they know what the star meant? What exactly was the star?
Today, though let's revisit the story. And although you know it well, how much wisdom we can still gain as we contemplate these familiar events and apply them to our lives, putting them into practice! We're not going to speculate on those unanswerable questions; rather, we want to learn wisdom from the wise men. That's the theme today: Learn wisdom from the wise men. This wisdom confronts us, comforts us, and compels us.
Those wise men were certainly people of means. Look at the gifts they brought: gold, incense, myrrh--not stuff that you'd pick up at the Dollar Store. They were no ordinary travelers. Look at the stir their arrival in Jerusalem caused. They were prominent enough to have an audience with King Herod himself. I think it's safe to say that whatever this world had to offer--wealth, wisdom, influence, power, fame, prestige--all was in the reach of these wise men.
But none of that could satisfy what they needed most. How could they be right with God? No amount of wealth could buy him off. No amount of wisdom could persuade him to excuse our sinfulness. No amount of fame could attract his kindness toward us. How could they be right with God?
Even before they set out on that journey, they knew that their own desire, effort, or skill could not bring them to God. Rather he would come to us. He would come through the Jewish people, through King David's family line. He would come to bring us into his kingdom. He would come, and that star announced his arrival. So on seeing the star they pursued their relationship with God to honor their newborn King. They left the comforts of their homes. They made the arduous and dangerous journey. Even with all their wealth, traveling in those days was no luxury cruise. They spared no cost in this pursuit to honor this King. And when the clear word of God, recorded through the prophet Micah, directed them to the small town of Bethlehem, they did not turn up their nose or try to find a more "reasonable" interpretation. They took God at his word and were not put off by the smallness of Bethlehem or the humbleness of the house that Mary and Joseph were staying in.
But what did they do? They left behind the comfortable and pursued their relationship with this new-born King. How that confronts you and me with our spiritual laziness and lack of zeal for the Lord! This spiritual laziness deprives us of more fully enjoying the true comfort Jesus brings. It deprives of that joy that overflowed from the wise men when the saw the star again after leaving Herod. Yes, dear friends, the wisdom that exposes our spiritually laziness confronts us, so that we see all the more how much we need the wisdom that comforts us, truly comforts us.
"Where is the one who has been born King of the Jews?" (Matthew 2:2 NIV84) the Magi asked. But take careful note, the Magi were not Jews. The Lord had chosen the forefathers of the Jews--Abraham, Isaac, and Jacob--to carry the promise of the Savior. He had rescued the Jews out of Egypt and gave them his law at Mt. Sinai. He had established the Jews and given them David's family as their kings. He had sent his prophets to the Jews and the Scriptures were written down in their language. No wonder the Magi referred to him as the King of Jews.
But remember the Magi were not Jews, yet they came to worship the Jews. Jesus was certainly born a Jew from David's family. He came according to the prophecies given by God to the Jews. Yet he came not only for the Jews. He came for those Magi. He came for you and for me as well, dear sinners.
Here's the wisdom that comforts: When my heart accuses me for the failure I am, when the guilt of my spiritual laziness exposes how weak and helpless I am, when the futility of my earthly pursuits brings home my own worthlessness, and the hopelessness of hell envelops me, then what comfort to know, to truly know, that Jesus came not only for the Jews, not only for the Magi, but even for me! And he came for you, dear sinner. He came for you. What wisdom that is--the only wisdom that truly comforts!
Linger with the wise men as you kneel in that Bethlehem house. Here is your Savior. Here is your God who came to rescue you. Here is Love incarnate. Here is your Hope, your Salvation. For just as the wise men beheld Jesus in the flesh, so also he brings you his body and blood in the Lord's Supper for you to eat and to drink. For you see, he wants you personally to know and believe with all sureness that he came for you, dear sinner, for you. What wisdom!
What comfort this wisdom brings! This good news moves us, you could even say compels us, to honor our King.
Please, don't misunderstand that word "compel." I'm not using it in the sense of forcing us against our will, coercing us, driving us like slaves, making us do it under compulsion. It's not that in any way at all. Rather I'm using it like St. Paul did when he wrote, "Christ's love compels us, because we are convinced that one died for all, and therefore all died. And he died for all, that those who live should no longer live for themselves but for him who died for them and was raised again" (2 Corinthians 5:14, 15 NIV84). What wisdom! Christ's love compels, moves, motivates, empowers us. His love transforms our will so that we willing, gladly, eagerly want to. His love strengthens us, moving us to act, propelling us forward. It's compelling in the best sense of the word.
Look at the reaction of the wise men to his love. They gave their treasures to him and then followed the Lord's command when he told them to go home another route and not return to Herod. That's how they honored their King because of his great love that came to save them. So also, dear Christians, that wisdom which comforts us with the good news that this baby is our God and Savior, that same wisdom powerfully moves us, compels us, to eagerly, gladly, willingly give him our best and dearest gifts and to follow the Lord's direction, obeying his commands revealed in the Scriptures. That's how we honor our King. Even as we pursue the earthly things the Lord gives us to do, we want to do it in a way that gives our King the best and follows his direction. We want him honored in all that we do whether at church, at work, at home, at school, out shopping, out fishing, dining out, playing sports, playing music, playing games, exercising, watching TV, and everything else. We want to honor him in all our pursuits, because of his love for us.
You see, the wise men were not driven by the threat of punishment or by the promise of reward. All the motivating techniques of this world fall into one of those two categories: punishment or reward, the stick or the carrot. Other religions use those as well to motivate their followers. Many even view Christianity as motivating people with the threat of hell for bad behavior and the promise of heaven for good behavior. But that's not what the Bible teaches. That's not the wisdom that compelled the wise men or you and me.
Rather our Savior acted first. He first loved us. He first came for us. He first laid down is life in our place. He first comes to us through his word and sacraments. And his great love that came for us changes us so that we willingly, gladly, eagerly give him our best and follow his ways, just as the wise men did. We do so not compelled by any sort of punishment or reward, but because of his love for us. That's true wisdom.
So dear friends, marvel with the wise men at the King who loved you so dearly that he came to redeem you with his blood so that now he reigns in your heart. That never grows old, no matter how often we hear it. Learn wisdom from the wise men. This wisdom knows that our sin confronts us, but Jesus' love, which is so much greater love than our sin, comforts us and compels us. What wisdom that rejoices in his love in all that we do, gladly giving him our best as we eagerly obey his commands. Amen.


Let's say you invent and launch a product. This must mean you have faith in it, right? In theory, you will be the first one using your product to show others that it will enhance your life or make it easier.
Take Mark Zuckerberg for example. Founder of Facebook, blah blah blah, but he is a great example of this because he actively uses his own product, thus promoting continual growth. I mean really, who else gets 476,806 "likes" to their newest Facebook status? Who even has that many friends anyway?
In contrast, while Google+ emerged to compete with the Facebook way of social networking, their growth may have already passed that "honeymoon" phase as far back as late July. This could be caused by several factors, including a confusing user interface or simple apathy toward another social networking site. Or, users could be asking themselves this question: If the Google management doesn't even use Google+, why should I?
This question becomes even more relevant given Michael DeGusta's recent correlational study of Google management and the activity on their Google accounts. The graphic below demonstrates the lack of use by everyone in Google management f rom the CEO to the Board Members to a Co-Founder—what's more is that the Executive Director of Google doesn't even have a Google+ account!
After all, Yegges did post his original rant on his Google+ account.


With age, comes experience, wisdom, and a long list of health complications. When age takes its toll on our health, it is impossible to dispel most illnesses. As our bones weaken and the probability of accidents increase, back problems such as spinal stenosis turn into a reality for many.
Affecting primarily the lumbar and cervical areas of the spine, spinal stenosis occurs when the spinal canal (which is composed of nerves and the spinal cord itself), begins to compress. While the narrowing itself does not cause extreme pain, the pressed nerve endings inflict discomfort. For those who suffer from lumbar spinal stenosis, they tend to experience pain and/or numbness in their back and legs. With cervical spinal stenosis cases, the symptoms are generally more severe. This pain can occur in their arms, legs and even cause imbalance.
Spinal stenosis targets many older victims, as it is a medical condition that derives from weak bones or illnesses such as osteoarthritis. When we age, our bones begin to calcify and lose some of its cushion that protects the area. As a result, it becomes more difficult to move quickly and walk great distances. While some are born with it, women who are over 50 tend to be primary targets. If you are suffering from painful spinal stenosis, it is recommended that you look at all of your options. Surgery is usually not a popular method, especially with older patients. Nonetheless, there are many beneficial treatments which are non-invasive in nature that could reduce some of the pain.
Spinal decompression therapy is one of the pain-free treatments available. It requires the patient to lay on a table hooked up to a harness and receive pressure to their spine. This pressure actually creates a vacuum effect, tugging the discs apart, allowing them to gain flexibility and stretch out. By decompressing this area, vital nutrients and blood supply re-enter, which allows the spine to heal. As a result, the pain and muscle spasms are reduced, and it becomes easier to move again. In terms of recovery, those with spinal stenosis may only experience partial recovery which means pain is somehow alleviated, unlike those with herniated discs wherein full recovery is achievable. Nevertheless, this makes a lot of difference. Most patients have to receive 4-5 sessions per week for a minimum of twenty sessions.
In addition to spinal decompression therapy, those with spinal stenosis can also benefit from exercise. Your flexibility determines the treatment available to you — many would advise Pilates, Yoga or a physical therapy-centered treatment. Exercise routine that works up your back pain is vital to the healing process. If you are still struggling, you may also want to ask your physician about medications. Cortisone shots give temporary relief in muscle spasms. Regardless of what you choose, there are many methods to tackle spinal stenosis. If we could reduce just some of the pain in our lives, living into our 100 s would certainly be a walk in the park.
OsteoArthritis or OA – what is it?


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The Nissan Z, Four Decades On
The aggressive Nissan 370Z, here in Magma Red, offers 43 years of sports-car heritage.
Some of us still fixate on the splendid heritage of certain sports cars while pooh-poohing those from the Orient as newcomers whose "soul-less reliability" is no substitute for DNA forged in the heat of wheel-to-wheel combat.
Yes, a Porsche or a Ferrari brings with it the burnt-Castrol haze of hundreds of wins in decades of racing at the world's storied tracks. Yes, most Japanese cars are pretty vanilla. (That's what most people want.) But the exceptions are, well, exceptional. A couple of months ago, we brought you Nissan's ultimate road-and-track monster, the ferocious $110,000 GT-R. Now here is the GT-R's stablemate, the 370Z: Two-thirds of the performance for one-third the cost.
The original Z-car, the Datsun 240Z, was a revolutionary coupe that rode out of the Far East way back in 1970 to challenge the world's top two-seaters. It's still around. By now it has a more than adequate heritage of its own and its price, performance, looks and quality still make it a winner. Fortunately, it is not offered here under its home-market name of "Fairlady."
Over the decades the Z put on weight and got slower, but then it went to the gym, slimmed down and became the athletic 350Z and then the 370Z. (Meanwhile, Datsun somehow became Nissan and, of the original Z's peers, Porsches and Corvettes can now cost six figures and the Mazda RX-7, Jaguar E-Type and Toyota Supra are extinct.)
For 2013, Z prices start at $33K; the top hardcore model, from Nissan's Nismo performance garage, costs ten grand more. There is also a convertible. Changes for the new model year include LED daytime running lights in the front, a red reflector panel at the rear, different wheels and a few options such as red brake calipers, "Euro-tuned" shock absorbers and two new colors. The doors panels, hood and hatchback are still aluminum; the cockpit is still a fine place in which to do business; the aerodynamics still cancel all lift, front and rear, at speed.
The high-winding 3.7-liter V6 hasn't changed either; it's rated for 332 horsepower and 270 lb-ft of torque (the Nismo's numbers are a bit higher) and is attached to a 6-speed manual gearbox or a 7-speed autobox with paddle shifters. The SynchroRev transmission feature that blips the throttle on downshifts to match gear RPM is very cool, if you never learned to double-clutch. Satnav as well as Bluetooth and all the FaceTube-USB gear is available, if you feel lost without it. There are two option packages: Navigation ($2,150) and Sport ($3,030).
The basic Z is pared down to sports-car essentials. Punch the starter button and the motor whirrs and whines, then awakens with a bark. The clutch grabs like steel Velcro; backing out of the driveway, the wide Yokohamas stutter on fallen leaves. The brakes bite hard. In town the suspension has all the give of sun-warmed granite. The Z is mechanical and growly and it constantly asks, "Are you paying attention?" But the driver's seat adjusts eight ways and is snug and supportive, and the steering tells us exactly what's going on.
Slip out of town and when there's an opening in traffic, tug the nose to the right, downshift and go. With a baritone howl the car shoots ahead. Hard corners, emergency maneuvers, full-bore stops—the Z stays planted, never discomposed. On the interstate it can clear the left-lane slugs simply by showing up hungry in their mirrors. At speed it's noisy enough to discourage cellphone use, which is all to the good, but long runs are exhilarating, involving and not uncomfortable.
So here we have many of the characteristics of a supercar—poor visibility aft, a stiff ride, a steering wheel that hunts back and forth over rough pavement, the decibel output of farm machinery, room for one passenger and barely a weekend's worth of clothing, and an exciting driving experience—but at the price and the drip-dry reliability of a humdrum family sedan. How great is that?


text:
Analyst Sees Grim Future For California High-Speed Rail Project
Filed Under:Analyst, Assembly Transportation Committee, California, High Speed Rail, High-Speed Rail Authority, Matt Bigler, Public transit, Train, Trains, Transportation
California high speed rail animation still. (California High Speed Rail Authority)California high speed rail animation still. (California High Speed Rail Authority)
SAN FRANCISCO (CBS/AP) – California's plan for a $98 billion high-speed rail system to connect Northern and Southern California does not comply with some parts of the 2008 ballot measure voters approved to provide the seed money, providing the latest obstacle for the embattled project, according to the state's legislative analyst.
Proposition 1A required rail officials to identify all sources of committed funds for a usable segment of the line and to clear all environmental requirements before the $9 billion in bonds could be sold.
The latest plan from the California High-Speed Rail Authority proposes to start with a 130-mile stretch of track from Merced to Bakersfield that would serve as a test track for 220 mph trains and could be used by existing Amtrak routes until the next segment of high-speed rail is finished.
KCBS' Matt Bigler Reports:
The report by the Legislative Analyst's Office, issued Tuesday to a legislative transportation committee, said that stretch would not be a stand-alone operating segment of the high-speed rail line, as required by Proposition 1A.
With federal funding for high-speed rail drying up and speculative financing for many of the rail authority's plans, the analyst's office said it is increasingly likely that the stand-alone, 130-mile stretch planned for the Central Valley "may be all that is ever built."
"It is highly uncertain if funding to complete the high-speed rail system will ever materialize," the report said.
The report's co-author, Farra Bracht, told the Assembly Transportation Committee that the High-Speed Rail Authority is relying too much on continuous federal support for the project.
"As noted previously, it appears doubtful that there will be any additional federal support any time soon," said Bracht. "This makes it increasingly likely that the ICS is all that will ever be built."
ICS stands for "initial construction segment," which is in the Central Valley.
The rail authority plan released earlier this month boosted the estimated price tag for the entire system, linking Anaheim to San Francisco, from $43 billion to $98 billion and moved final completion to 2034 from 2020. The authority needs legislative approval to begin its plan to start building a stretch of track in the Central Valley, which it hopes to do next year.
High-speed rail authority officials have conceded that much of the funding for future segments remains speculative, but they hope to attract private investors after initial segments are built.
"My fear is that with (an uncertain) price tag and no dedicated revenue stream, any money we do get will go to that project, to the detriment of the state's existing transportation systems," said Assemblywoman Bonnie Lowenthal, D-Long Beach.
Still, she said high-speed rail promises "extraordinary benefits such as jobs, private investment and economic growth that has to be considered," according to comments reported by the San Jose Mercury News. She is chairwoman of the Assembly Transportation Committee, which held a hearing on the rail project Tuesday.
Dan Richard, who was appointed to the high-speed rail board by Gov. Jerry Brown, acknowledged during the hearing that the project faces greater hurdles if it does not have a dedicated revenue source.
Even so, board members believe the draft business plan and funding proposal are consistent with Proposition 1A and have promised to work with the nonpartisan legislative analyst to address concerns, rail authority spokeswoman Rachel Wall said.
The high-speed rail commission had said in its report that while the $98 billion price tag is high, the state otherwise would need to spend more than $170 billion in upgrades to the state's transportation infrastructure to accommodate future population growth. That would include wider freeways, more airport gates and upgrades to commuter trains and tracks.
The analyst's report does not go into details but calls that comparison "very problematic." It notes that the state will still need to maintain its existing infrastructure, fund urban transit and increase capacity on freeways to address higher demand.
"In light of this, the Legislature should consider where to invest limited state resources," the report said.
In a statement, the High Speed Rail Authority said it welcomes the critique, and vows to meet with the analyst's office to discuss the report. The state is planning to begin construction on the rail system next year, spending $2.7 billion in state bonds, unless the project is altered by state lawmakers.
(Copyright 2011 by CBS San Francisco. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.)
Tours Martel says:
Astonishing, you mean that the state with the worst credit rating in the United States may be overreaching again?
Bay Area Guy says:
With all the opposition and reports showing this is a high speed rail system to no where, The High Speed Rail Authority said it welcomes the critique, and vows to meet with the analyst's office to discuss the report. The state is planning to begin construction on the rail system next year, spending $2.7 billion in state bonds, unless the project is altered by state lawmakers."
I think we need to fire the High Speed Rail Authority. Why the huge push to move this thing through at all cost? I smell payola.. Who are the biggest benefactors of this project?
AUDIT- AUDIT AUDIT
I voted for the train. I want the train. Why no train. Why doesn't my vote matter.
JaneQPublic says:
@ Kyle – so do you have the MONEY to build it?
I could vote for pie-in-the-sky too – that doesn't mean I'm going to get it!
This project was poorly conceived, poorly funded & probably dangerous. Kill the thing now.