text:
Current issues with prediction rules for syncope
Steve W. Parry
CMAJ October 18, 2011 183 (15) 1694-1695; DOI: https://doi.org/10.1503/cmaj.111529
For correspondence: swparry@hotmail.com steve.parry@nuth.nhs.uk
See related research article by Saccilotto and colleagues at www.cmaj.ca/lookup/doi/10.1503/cmaj.101326 and synopsis on page 1721.
Syncope (transient loss of consciousness with loss of postural tone, collapse and spontaneous recovery) is a serious public health issue, accounting for 1%–6% of visits to emergency departments1,2 and up to 6% of admissions to acute care hospitals.3 The front-line clinician assessing a person with syncope often faces a difficult choice: Can the patient be safely discharged, or should he or she be admitted for in-patient monitoring and investigation? Traditionally such choices have remained the province of clinical judgment, but in recent years, interest has grown in the development of prediction rules aimed at the efficient management and discharge planning for patients presenting to emergency departments with syncope. In a related research article, Saccilotto and colleagues bring some much needed objectivity to this issue through their systematic review and meta-analysis of one such prediction rule.4
Syncope prediction rules were developed to evaluate the likelihood of short-term serious outcomes or death using simple scoring systems that depend on electrocardiogram (ECG) findings, the presence of heart disease and other relevant variables. The rules currently available are difficult to evaluate, in part because different studies have placed different weights on the number and type of variables contributing to the scoring systems, and in part because application strategies and patient populations have varied widely. Meta-analyses and systematic reviews are of course powerful evaluation tools, but because of heterogeneity of study design and outcome assessment in syncope, authors need to justify completely their inclusions and exclusions; otherwise the effect of "comparing apples and oranges" becomes a powerful limiting factor.
To a large extent, Saccilotto and colleagues succeed in presenting a cogent view of the available literature, although the underrepresentation of older patients in the studies is of concern. This is not simply an academic exercise: although the lifetime prevalence of syncope has been estimated to be 42% of the general population,2 there is a threefold rise in incidence with advancing age, from an overall incidence of 6.2 per 1000 person-years to 18 per 1000 person-years among people 80 years and older.5
Cardiac causes of syncope are disproportionately represented among patients over 60. Observational data have shown that up to 30% of such individuals have an underlying cardiac arrhythmic or structural cause, compared with less than 5% of younger patients.2 Cardiac and other serious outcomes (adjusted for comorbidity) are also much more common among older patients with syncope (adjusted odds ratio 3.8, 95% confidence interval 1.2–12, for patients over 60 years compared with patients 18–39).6
This increased risk among older patients is particularly important given the main finding reported by Saccilotto and colleagues,4 namely that the San Francisco Syncope Rule (Box 1) is the most adequately validated across various populations,8 a finding echoed in a recent, similar meta-analysis.9 As the authors point out, although the San Francisco Syncope Rule can aid decision-making at triage in emergency departments, it should be used only in tandem with a detailed clinical assessment, particularly in older individuals. Several studies have shown that this rule may miss arrhythmias and other serious outcomes in older patients. In a retrospective study involving 517 patients 65 years and older who presented to the emergency department with syncope, 23 of the 98 who experienced a serious outcome had a negative score with the rule; 17 of these 23 had arrhythmia despite having presented with normal ECG findings.10 A prospective validation study of the San Francisco rule similarly showed that 26% of patients who subsequently had a poor outcome were initially misclassified as being at low risk.11
Box 1:
The San Francisco Syncope Rule7
The San Francisco Syncope Rule is a simple rule for evaluating the risk of a serious short-term (within 30 days) outcome in a patient who presents to the emergency department with syncope. The mnemonic for features of the rule is CHESS:
C – History of congestive heart failure
H – Hematocrit < 30%
E – Abnormal findings on ECG or cardiac monitoring (new changes or nonsinus rhythm)
S – Shortness of breath
S – Systolic blood pressure < 90 mm Hg at triage
The presence of any of the above risk factors mandates hospital admission and further monitoring and investigation.
Note: ECG = electrocardiogram.
Comparisons of outcomes using syncope prediction rules and careful clinical assessment sound a further note of caution. In two prospective studies, clinician judgment was found to perform as well as the San Francisco Syncope Rule12,13 and the OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) risk score13 in determining whether a patient would have an adverse outcome. Another study, however, showed that application of the San Francisco Syncope Rule would have increased the rate of hospital admission by 9% in a cohort of older patients with syncope compared with usual clinical care.14
So where does this leave busy clinicians trying to best serve their patients with syncope? Risk stratification tools, with guidance on determining need for hospital admission, associated length of stay and which tests to perform, are at best imperfect for the management of patients with syncope. Educated clinician judgment based on evidence-based guidelines (e.g., those published by the European Society for Cardiology,2 algorithms published by our group3 and guidelines from the United Kingdom's National Institute for Clinical Excellence15) seem to be the best strategy for management. Patients first need to be carefully assessed to see if their history suggests true syncope, as defined in the opening paragraph. A basic evaluation is then needed to find features of their history, examination results and ECG findings that are suggestive of cardiac versus noncardiac causes of the syncope. Further triage, referrals and investigation may be required from this initial review.
Syncope prediction rules can certainly aid this process, but they are not yet fit for use alone for risk stratification in any population, particularly older patients, in whom cardiac syncope (with its associated excess morbidity and mortality) is more likely.
Much of the evidence presented by Saccilotto and colleagues is difficult to assess because of the heterogeneity of study design and the use of short-term mortality and serious outcomes (e.g., myocardial infarction and stroke) as proxies for the sensitivity and specificity of the prediction rules being evaluated. The risk of subsequent syncopal events, the potential for injury, the need for immediate treatment in hospital (e.g., thrombolysis for pulmonary embolism, and implantable cardiac defibrillators) as well as what happens to patients following discharge are ignored by prediction rules. Arguably these issues are also important in terms of patient management.
Rules to predict serious outcomes following syncope have recently been developed to aid the management and discharge planning for patients presenting to emergency departments with syncope.
A new systematic review and meta-analysis suggests that the San Francisco Syncope Rule is the best validated rule to date.
The San Francisco Syncope Rule, however, has important limitations and should be used only in association with appropriate clinical judgment to rule out serious cardiac-related causes, particularly in older patients.
Competing interests: Steve Parry was involved as a contributor to the 2009 guidelines on the diagnosis and management of syncope issued by the European Society of Cardiology.
This article was solicited and has not been peer reviewed.
Day SC,
Cook EF,
Funkenstein H,
. Evaluation and outcome of emergency room patients with transient loss of consciousness. Am J Med 1982;73:15–23.
Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009;30:2631–71.
Parry SW,
Frearson R,
Steen N,
. Evidence-based algorithms and the management of falls and syncope in the acute medical setting. Clin Med 2008;8:157–62.
Saccilotto RT,
Nickel CH,
Bucher HC,
. San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review. CMAJ 2011;183:E1116–26.
Soteriades ES,
Evans JC,
Larson MG,
. Incidence and prognosis of syncope. N Engl J Med 2002;347:878–85.
Sun BC,
Hoffman JR,
Mangione CM,
. Older age predicts short-term, serious events after syncope. J Am Geriatr Soc 2007; 55:907–12.
Quinn JV,
Stiell IG,
McDermott DA,
. Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes. Ann Emerg Med 2004;43:224–32.
Quinn J,
McDermott D,
Stiell I,
. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med 2006;47:448–54.
Serrano LA,
Hess EP,
Bellolio MF,
. Accuracy and quality of clinical decision rules for syncope in the emergency department: a systematic review and meta-analysis. Ann Emerg Med 2010;56:362–73.e1.
Schladenhaufen R,
Feilinger S,
Pollack M,
. Application of San Francisco Syncope Rule in elderly ED patients. Am J Emerg Med 2008;26:773–8.
Birnbaum A,
Esses D,
Bijur P,
. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med 2008;52:151–9.
. The San Francisco Syncope Rule vs physician judgment and decision making. Am J Emerg Med 2005;23:782–6.
Dipaola F,
Costantino G,
Perego F,
.; STePS Investigators. San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio risk score, and clinical judgment in the assessment of short-term outcome of syncope. Am J Emerg Med 2010;28:432–9.
Cosgriff TM,
Kelly AM,
Kerr D
. External validation of the San Francisco Syncope Rule in the Australian context. CJEM 2007; 9:157–61.
National Institute of Clinical Excellence. Transient loss of consciousness (TLoC) management in adults. NICE guideline. London (UK): The Institute; 2010.
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text:
UNGA Jerusalem Vote Prompts US to Threaten With Sanctions Almost Entire World
Peter Korzun
On December 21, the UN General Assembly (UNGA) overwhelmingly voted in favor of a resolution calling on the US to reverse its decision to recognize Jerusalem as the capital of Israel. A total of 128 countries voted for the resolution, with nine countries voting against and 35 abstaining. 21 nations did not turn up for the vote. Major allies like the UK, France, Germany and Japan voted for the resolution, though some allies, like Australia and Canada, abstained.
The US was the only global power to oppose the resolution. The list of naysayers included only Israel itself, four states of Oceania, which depend on the US, and several Latin American countries, such as Guatemala. David Harris, the chief executive officer of the American Jewish Committee, said he was "dismayed by the overwhelming support of U.N. Member States for the General Assembly resolution condemning US recognition of Jerusalem as Israel's capital."
For comparison, the UN General Assembly voted on December 19 in support of a resolution on the human rights situation in Crimea. 70 countries voted in favor (compared to 128 in case of the Jerusalem vote), 26 voted against, and 76 abstained. Unlike the Jerusalem vote, this outcome is evidently unconvincing. The majority of UN 193 members did not support the resolution condemning Russia.
Nikki Haley, the US Ambassador to the UN, had warned that she would take names of the countries voting to criticize the United States. According to her, the UNGA vote will not influence Washington's decision on Jerusalem. She reminded UN member states of the US' generous contributions to the organization and said that the United States expects its will to be respected in return. She also noted that the vote will be "remembered" by the US and "make a difference on how the Americans look at the UN."
Before the vote, President Trump had threatened to cut off financial aid to countries that voted in favor. "Let them vote against us," he said. "We'll save a lot. We don't care. But this isn't like it used to be where they could vote against you and then you pay them hundreds of millions of dollars… We're not going to be taken advantage of any longer."
So, here is the gist of Washington's position on the issue – it does not care about what the overwhelming majority of nations think. If the US does something that contradicts international law, then so be it. But international law is remembered when other nations do something the US does not approve.
When the UNGA voted against Moscow, Washington emphasized the need to comply and respect the opinion of "international community". The State Department cites the UN resolutions in its statements to condemn Moscow. Former President Barack Obama referred to the 2014 UNGA resolution on Crimea to call for "isolation" of Russia on international stage. Now, when the US has suffered a crushing defeat at the UNGA, it insists on its right to do whatever it deems right and not to care about what the world says. This is a perfect example of double standards.
The threat to cut aid to other countries is a part of bigger trend. Financial and economic punitive measures have become a foreign policy tool to target Russia, Iran, North Korea and many more countries. Hard-power diplomacy is given a priority over soft power diplomacy. This policy has come under harsh criticism in the UN recently.
The Trump administration has announced its intent to cut foreign aid anyway. The president has significant legal latitude to do so. The question is, will close strategic partners, such as Egypt, Jordan, Saudi Arabia, the UAE, who voted for the resolution, be included into the list of the nations to be punished? This year, Congress rejected aid cuts proposed in the State Department budget request. Aid levels for Jordan, Egypt, Tunisia and Morocco should remain "at or above current levels". The preponderance of American aid to the Middle East and North Africa is earmarked for buying US-made military equipment.
Washington praises the UN when it serves its interests but it's an open secret that the organization is largely viewed in the US as anti-American, inefficient, and known for its corruption and waste. This sentiment has been brewing for some time. The voices calling for leaving the UN have been heard loud enough. Donald Trump himself once likened the UN to a "club for people to get together, talk and have a good time."
Washington has already announced its withdrawal from UNESCO and the Human Rights Council. The bill, proposed by Rep. Mike Rogers (R-AL), entitled American Sovereignty Restoration Act of 2017, seeks a complete US withdrawal from the UN. It says the international body should remove its headquarters from New York. Rogers and other prominent Republicans, such as Rand Paul (R-KY), believe that US taxpayer money should not go to an organization that does not promote US interests. As Senator Paul put it, "I dislike paying for something that two-bit Third World countries with no freedom attack us and complain about the United States… There are a lot of reasons why I don't like the UN, and I think I'd be happy to dissolve it." With Donald Trump now in power, many Republicans seem to be attacking the idea of UN membership or cutting funding with renewed vigor.
The US reaction to the Jerusalem vote illustrates its contempt for international public opinion. Almost isolated, Washington resorts to threats against almost the entire world. That's something really new in the world politics.
Jerusalem UN
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text:
What's Left?
The neo-liberal discourse dominant in the last three decades has collapsed. But what is the state of the European Left?
Tibor Dessewffy
Commentary 6 April 2009 11 minute read
Horror vacui:
Nature abhors a vacuum. Written some 2,300 years ago, the thesis of Aristotle is
also true for the world of social political ideas. And it seems that it is the
most precise possible description of our situation today, early 2009. The
preeminent neo-liberal discourse that was dominant in the last three decades
has collapsed by today. Framed by nationalized banks, community cash injections
to market players, direct intervention on the stock exchanges, the history of
the global economic crisis shows clearly that a completely new set of rules
based on very different theoretical principles will operate from now (and this
process is far from over yet).
While practice is
progressing towards a very clear direction that brings the role of the state
into the forefront once again, theory can only trail behind all that. It would
be a serious theoretical challenge to define how the world will look like after
the crisis. The attitude of left-wing economists is well reflected by the joy
of Will Hutton who called the collapse of Lehman Brothers the sweetest day of social
democracy. Others point out that, compared to previous periods of state
expansion (the 1930's or the 1960's), there is a professional consensus that
this is a temporary expansion of the state only. However, I believe that
it is too early to herald the ideological renaissance of proactive social
democracy. It is more the fear of the vacuum that we can see, much more than a
desired ideological renewal.
balance that was: the Third Way
Since the Beatles –
and perhaps with the exception of David Beckham – the most successful British
cultural export article has been the New Labour Party of Blair and Brown
characterised by the third way. What was the reason for this international success
that is far from self-explanatory? I think the main reason was that it could
recombine the dominant liberal ideology along leftist values in such manner
that it became attractive also for the middle-class. The third way – as we know
from the books of Giddens – was looking for, and indeed found a progressive
path between traditional, orthodox social democracy and the new neo-liberal
hegemony. This led to political success through useful and efficient social projects.
The third way could
also be successful because it implemented the unity of innovative policies that
were based on coherent values and embedded in an established ideological
context. Also it could implement a comprehensive organizational and
communicational modernization in the Labour Party that was becoming too heavy
and frozen in its past. This organizational reform that domesticated and
humanized liberalism was a recipe for success that the whole of Europe was open
to. Two data that say more than any amount of words: at the turn of the millennium
when the Progressive Governance movement started there were 15 social
democratic governments in the EU-15 countries. Today, even if we count
generously, there are maximum 6 countries from the 27 members states where
social democrats are in power, and we are quite far from being able to talk
about the dominance of a coherent ideology. This restructuring did not happen like a landslide but was rather part of a
process. On the other hand, it also indicates that the troubles did not start
with the financial crisis last autumn: the crisis situation has only
strengthened the dilemmas of looking for a way out and has put them into a new,
more dramatic context.
Looking back at the
history of the left in the last decade, the work done in the framework of Progressive
Governance was the peak of the process, from where the road took us downwards –
at least in Europe. First because of terrorism, and because of the anxiety
caused by immigration and the sustainability issues of welfare and social
systems the progressive left came under increasing pressure after 2001, which
in turn led to an increased loss in the political space. The fundamental
characteristic of this new situation was highlighted by Wouter Bos when, after neo-liberalism, he identified strengthening and increasingly
isolationist populism as the main ideological competitor to the progressive
left. This duel in the headwind of the zeitgeist usually led to election
defeats of the progressives – even in places where the fundamental dilemma was
in fact confronted.
interim state
crisis halted the process of searching for a way out for an instant – short
term crisis management tasks must come to the forefront in a state of
emergency. Not that the task has become any simpler as we look ahead into the
future: the downsizing of production capacities to fit shrinking consumption,
and hesitantly and partly involuntarily reconsidered welfare benefits are
expected to strengthen the anxieties that have already appeared in the
beginning of the 2000's. The challenge facing the progressive left is at least as
big as at the end of the eighties – as the task then was to find a new
ideological path between the neo-liberal hegemony and orthodox leftist values,
one should construct the antidote to isolationist and populist ideologies that
are getting stronger on both the left and the right.
For that we have to
dig down to the fundamental values which define the social democratic model as
it is under continuous pressure to modernize. This does not at all mean that
the program of the third way should be thrown into the waste bin of history. It
does not seem that there is a viable alternative to capitalism, however
regulated, and the market economy operating in coordination with social
aspects. However enthusiastically some left-wing leaders leash out against bankers
and speculators with a rhetoric that almost reminisces of good old times,
cooperation with the business sector – an important tool and also value of the
third way – will also remain with us.
Nevertheless, we
presumably must reconsider some other core elements of our ideology. In case of
state services, securing the possibility of choice for customers will probably
be pushed into the background by the security of universal services – the approach
of the third way probably needs to be revised in this case. The risk community
will stay with us, however, the ability and readiness of the individual will
probably be smaller than envisaged by the original third way concepts. The life
career model that spans from baby bonds through student loans to bank
facilities that cover housing loan repayment instalments and to various refined
pension saving schemes is also questioned. The model of the citizen who manages
his own assets and makes investments will face substantial problems not only in
countries with an undeveloped financial culture like Hungary but also in
regions of Europe that don't carry a post-communistic legacy.
But these do not
concern the core values that I mentioned above, so our revision will also not
equal the outlining of a new, coherent concept of the world. In order to live
up to the challenge of such a greater task, if the context is so difficult to
comprehend, it makes sense to retreat to "anthropological constants"
and think about the lessons of the crisis from the aspect of group psychology.
We know from group
psychological research that when old rules suddenly lose their meaning, when
"the usual order of things changes", when earlier habits no longer
give guidance in the wilderness of life, the need to belong to the group
increases. Ethological experience shows that primates will cuddle up together
when the storm and lightning come. Experiencing togetherness is there to
mitigate the anxiety caused by the unusual and unknown.
We can draw two
consequences if we accept this metaphor as a starting point for the current
global social and economic situation. On the one hand, the pendulum that swung
towards individualism so far will swing back in the next period. On the other
hand, it is easy to see that defensive collective identities that seem to give
an "answer" to the situation for the populist right, such as
"the nation defined in contrast to aliens", the "hard working
middle-class as opposed to parasites" are almost naturally available to
the right. Once again, the progressive left faces a problem here: the
definition of such collective identities is not self-evident for it, and it
usually is not its strength.
The whole thing is
further complicated by the fact that this communal experience has a different
pattern today than in earlier structures of the public dimension. As Chris
Anderson, the editor of Wired Magazine points out in his book "Long
Tail", cultural consumption and the identities formed as a consequence
become more and more fragmented and segmented with the spreading of the
The prevailing trend gets lost in the shadow of global idols and allows the
formation of such endlessly diverse communities through digital technologies
that were unfathomable before. Ninety-eight percent of the hundreds of
thousands of songs available on iTunes are downloaded at least once a year –
exciting and unknown groups are born in the "long tail", only a few
members on an individual basis but, aggregated, they happen under that curve
that stretches practically endlessly. If this cultural pattern becomes
dominant, then we have good reason to assume that the large collective
identities mitigating these anxieties will also change. Even if they define
themselves along the traditional labels of the "nation",
"middle-class", "tough, masculine, honest people", the
reality behind these labels, the communicaitonal structure will be innovative.
This is a challenge also for the defensive, inward turning right – but it
generates no automatic advantage for the progressive side.
we can also think about the history of the near past from the aspect of anxiety
management. Maybe it is no accident that the progressive success period of the
nineties evolved in parallel to the end of the cold war and the spreading of
the connecting universal optimism of the Fukuyama kind. That zeitgeist was in
support of individualization and the relative devaluation of defensive
collective identities. However, this is not the end of history but the end of a
story today: the end of the story of free market capitalism.
Changes based on
group dynamics go against the value changes of the last 30 years. In modern
societies, according to sociologists, the increase of material wealth and a
stronger development of the middle-class nurtured the values of
individualization and growing freedom.
These trends are interrupted, maybe even broken by the crisis, and we
cannot even exclude durable movements in the opposite direction. However,
ideology is different from social scientific theories, among others, in that it
does not wish to merely interpret reality through understanding. The purpose of
interpretation is the shaping of reality through political utilisation.
Therefore in our case we cannot be satisfied with stating that the next decade
will probably prefer defensive collective identities, a situation with which
right-wing populism is assumed to find easier to get attuned to than the
progressive left as we know it today.
a new equilibrium
The situation is
difficult but far from hopeless. Namely, we can see a gradually enfolding
experiment for the seamless
coordination of the left and the communal principle in the largest and
strongest democracy of the world, the United States. Of course I mean the election
victory and governance of Barack Obama, which – even if it does not deny what I
have written so far but – it
demonstrates that it is not impossible to give an answer that can successfully
release the anxiety and fill the ideological vacuum. The rhetoric of the Obama
campaign is interesting from three aspects in this context.
On the one hand, it
not only demonstrated but also reclaimed for Democrats the collective desires
attached to the greatness of the American nation and the ability to make the
American dream come true. After eight years of Bush administration and the
disappointment in the promise of "compassionate conservatism", these
phenomena were stronger than ever, which was augmented by the historical stakes
of the election: the election of the first black or woman president (vice
president), the biggest crisis since several generations, and finally the hope
of starting over and reunifying the country.
This was primarily
attached to the consciously undertaken role of Obama as a healer, which offered
a remedy for both historical and current grievances. The new Democrat president
took a third-way position in a new sense of the word: he could overcome
traditional division lines, and was able to reach out his hand to the majority
of Americans despite his liberal-leftist background. Even if he did not do that
with a Democrat, Clintonite public policy approach, he is still, in the philosophical
sense, the worthy continuer of third-way traditions that focus on the
middle-class and the inhabitants of Main Street in the countryside in addition
to urban citizens.
Also, one of the
greatest succeses of Obama was that he could attain this national
reconciliation with the decided support of the rainbow coalition that has
traditionally been the objective of Democrats. Namely, in addition to the
middle-class the campaign could also mobilize minorities: in the sense of
races, gender, sexual identity and religion. He was able to create the
coalition of hope by fitting the tiles of the mosaic, which gave a new identity
to social layers that were apolitical or perceived politics as a dandy sport
and turned consciously against it.
This latter thought
leads us to the third concept: the contents of this coalition, collective
identity – the announcement of the "green new deal" has been an
important new element in this in comparison to the 1990's. With his public
economic stimulus and reform package optimized for the twenty-first century, he
is the first president who has given a priority to the issues of environment
protection and energy in his policies. Joint work to protect the climate of the
planet (and not least to reach the energy independence of the country) means
the integration of a discourse into the mainstream that can be the basis for a
new collective identity, which in turn can become an efficient answer to the
trends of turning inwards by overwriting former division lines.
inspiration but not a model
While reveling in
the euphoria of the beginning of an era dominated by Democrats we should not
forget that the success of Obama happened under very particular circumstances.
These circumstances (getting stuck in the war in Iraq, the dire financial
crisis, the unpopularity of George W. Bush of historical proportions) created
the proper ground for proclaiming the emphatically progressive politics of
However, it is far
from definitely decided if the election victory and governance of Obama will be
the exception or the rule in the years of the progressive left ahead. What is
certain is that the factors of the success of Obama as demonstrated above are a
source of inspiration for all of us. Having said that, it cannot be seen as an
easy-to-copy, coherent system of views and policies that can be
"copy-pasted" into any different economic and social environment. Contrary
to the third way that started its tour around the world with the Clinton
administration in the early nineties, Obama's way is not yet an (almost)
universal model.
And finally there
is something that links Clinton and Obama. The title of the famous
autobiographical campaign video of Clinton from 1992 was "The Man from
Hope" as the then hopeful candidate had indeed been born in a little town
called Hope. Obama's slogan was also hope in addition to 'change'. This is
printed on his posters turned cultural icons, and this is used by his
supporters that roam the Web 2.0 world of the internet. Of course this is no
accident: as any pre-school for campaign strategists will teach you, the
symbolic possession of hope is the key to political success. However, there is
something we forget about in late modern politics: at least on the progressive
side this hope cannot emanate from the charisma of the leader only. Two things
are necessary to form hope into a comprehensive message that reaches many
people. On the one hand it is necessary to demonstrate that we know and
understand what is going on in the world, we are able to project some sort of
order into the chaos, we know where the road forward lays. On the other hand
this solution, this plan should be made socially open; this is the way that we
are going to go down, and You can join this direction in this or that manner,
this is why it will be good or you, this is why you will feel comfortable if
you come along with us, if things work out the way we would like them to work
out. If we think through all these it becomes obvious that progressives of the
'Old Continent' face formidable challenges in both dimensions of constructing
So while relying on
it, progressives in Europe should also be prepared for the difficult decade
that lays ahead. They should find an ideology that reflects to the anxiety the
is becoming ever stronger in the society. They should carve out narratives that
can define communities in the progressive way. Collectives that can provide
protection to the people in this insecure environment. The feeling of belonging
to a group that can ascertain that, in the difficult years of reconstruction,
it is not Evil hiding in all of us but the equally omnipresent Good that can
define our deeds.
Tibor Dessewffy,
Sociologist, President of DEMOS Hungary Foundation
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Discussion in 'Military Photos & Multimedia' started by Adux, Apr 26, 2007.
Indian Army buglers look on during the marking of the 39th anniversary of 'Vijay Diwas' (Victory Day) as they stand above a plaque listing soldiers killed in different wars in Kolkata on December 16, 2010.
American Special Forces personnel under going jungle warfare training at the specialised counter-insurgency range of the Indian army's famous Counter-Insurgency and Jungle Warfare School (CIJW) in Vairengte in Mizoram.
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Operation Desert Lark - U.S. and Indian Soldiers during Yudh Abhyas - HD - YouTube!
This is the worst nightmare of every soldier. If a man can clear this, he can handle anything on earth. My brother has recounted the nightmarish training regime inside the jungle. It feels like it is the end of the world. Heck! Even many mizo cadets who join the Army don't clear it.
The basic logic is; you go in there as a boy and you come out as a man.
If anyone has a picture of RCL kindly post it.
Used to be mounted on jeeps and jongas before havent seen any lately except in one scene from Mission Army where Paras are walking in front of a Mahindra jeep which has a RCL.


text:
New school aid formula helps some towns, hurts others
Paul Crocetti/Daily News staff
Representatives from Milford, Mendon and Hopedale met with local government officials last night at Milford Town Hall to hear state aid statistics and voice concerns or questions they have about the new formula.
For towns that have not been receiving as much as they should, such as Milford, the goal is to get to the target within five years, said state Rep. John Fernandes, D-Milford, who helped organize the meeting with state Sen. Richard Moore, D-Uxbridge.
"The idea is, over five years, hopefully all the communities will be working on the same page," Moore said to the group of about 30 officials, who included superintendents, selectmen and School Committee members.
However, the goal for communities that receive more than they should, such as Mendon and Hopedale, is "not as firm," Fernandes said.
According to the Department of Education, Milford should pay 56.6 percent of its school budget and receive the rest from Chapter 70 funding. But the town's preliminary contribution for fiscal 2008 would be about 68 percent of its school budget, or $4.3 million in excess.
Taking into account a 25 percent reduction toward the target, the town's local contribution will be decreased by about $1 million this fiscal year, down to 65 percent of the school budget, according to the formula.
"At the end of the day, I'll take it," said Al Correia, chairman of the Milford Finance Committee, after the meeting. "The formula had tilted against Milford for a number of years. We've been asking for this formula to be looked at."
The formula can still be confusing, although it is easier to explain than the old one, and meetings of this nature are a big help, Correia said.
"There are still a lot of areas that aren't easy to understand," he said. "But it has become more transparent because of (Moore and Fernandes). This is an excellent result of a lot of hard work by both of them."
With Mendon going in the opposite direction, in that it will be receiving less state aid, the town must decide how it is going to make up the difference, said Chris Felton, chairman of the Mendon Finance Committee.
"New growth is slowing," Felton said. "It's going to come down to, what are people willing to pay for? People will have to make a decision on what services they want."
The town eventually should be paying 59.23 percent of the school budget and receiving the rest in state aid, according to the new formula.
But Mendon's preliminary contribution to the schools in fiscal 2008 would be about $4.2 million, or 41.76 percent of the budget, according to the Department of Education. Taking into account the new formula, though, the town will now have to pay about $4.3 million, or 42.55 percent.
"The state feels that, given our wealth, we should be giving more," Felton said. "All kinds of factors go into it, but it forces us, on the municipal side, to level-fund the budget."
Town Meeting recently approved two operational overrides, including one that would cover salary increases for town employees.
The challenge is educating residents about the new formula and its effects on the town, Felton said.
"It's not an easy formula to understand, and we deal with the budget every day."
Paul Crocetti can be reached at 508-634-7583 or pcrocett@cnc.com.


The bucket bag, with a clean minimalist design and signature gold hardware is the newest style to be introduced to the Strathberry designer handbag collection.
Versatile luxury bucket bags, designed in Scotland with practicality in mind, and crafted in Spain from the finest calf leather.
The Bucket Bag collection: The Lana Bucket Bag and The Lana Midi Bucket Bag.


Even lifelong consumers of animal protein can find cooking it to be daunting. I include myself in that category. I knew my way around every vegetable, pasta sauce, and hummus-like spread before I even considered roasting a chicken or pan-frying a salmon steak.
Maybe you're apprehensive about handling raw meat. Maybe you don't want your house to smell like fish for five days. Maybe you don't have the time to commit to a low-and-slow braise.
Shrimp is the gateway protein. Unassuming as it may seem, shrimp actually has a ton going for it: not too scary to handle, only mildly fishy-smelling, and ready in a flash. Tonight, expand your cooking horizons with this garlicky-lemony shrimp, perfect with a salad and a baguette, and ready—really—in 20 minutes.
We're assuming you already have a lemon, 4 cloves of garlic, olive oil, and butter. If not, add those to your list!
About 20 minutes before dinner, clean and devein your shrimp in cold water. Chop your garlic and sauté in olive oil in a large pan over medium-low heat. Add in the shrimp, arranging them so they're evenly spaced, and season with salt, pepper, and the zest of your lemon.
Flip after a minute or two, cooking for a minute or so more, then shower with chopped parsley, the juice of the lemon, and three tablespoons of butter.
Click here to see the full version of this recipe.
What was your gateway protein? Tell us in the comments!
Unfortunately, our local grocery store does not EVER have fresh seafood. I'd love to have a recipe like this, but using frozen shrimp.
I think you could buy frozen uncooked shrimp and defrost them first. then proceed with recipe.


text:
Q: displaying results in a table using mysqli so my friend just changed my php so I'm using mysqli and after slight modifications to my code I still receive:
Fatal error: Call to undefined method mysqli::fetch_object() in C:\wamp\www\web2\database.php on line 44
   <?php
class Database
{
 public $server = "localhost";
 public $database = "database";
 public $user = "root";
 public $password = "";
 public $row;
 public $result;
 public $sqlExtra = " ORDER BY firstname ASC";
 public $dbLocalHost;

 //call connection method upon constructing
 public function __construct(){
  $this->createConnection();
 }

 //connection to the database
 public function createConnection()
    {
     $this->dbLocalhost = new mysqli($this->server, $this->user, $this->password, $this->database)
                or die("could not connect:");

      //mysql_select_db($this->database)
       //
       //  or die("Could not find the database: ".mysql_error());

 }

 //execute query string
 public function query($queryString)
    {

        $result = $this->dbLocalhost->query($queryString);

        while($row = $this->dbLocalhost->fetch_object($result))
        {
            echo "
".$row[0]."	".$row[1]."	".$row[2]."
";
        }

    }

    public function newRecord($fname, $lname)
    {
        $firstname = $fname;
        $lastname = $lname;

        $this->emptyCheck($firstname, $lastname);
        $this->insert($firstname, $lastname);
    }

    function insert($fname, $lname)
    {
        $insert = "INSERT INTO table (firstname, lastname)
            VALUES ('$fname','$lname')";
        mysql_query($insert)
        or die("could not insert:".mysql_error());
        header('Location: blah.php');

    }

    function emptyCheck($fname, $lname)
    {
        if ($fname == "" || $lname == "")
        {
            echo "Please fill in all the fields.";
        }
    }

}

?>

and this page displays it:
  <?php

include('database.php');
$db = new Database();
$sql = "SELECT *
    FROM tables";

if ($_GET['sort'] == 'id')
{
    $sql .= " ORDER BY id";
}
elseif ($_GET['sort'] == 'fn')
{
    $sql .= " ORDER BY firstname";
}
elseif ($_GET['sort'] == 'ln')
{
    $sql .= " ORDER BY lastname";
}

?>

        ID
        First Name
        Last Name
        Edit
        Delete

<?php
$db->query($sql);
?>

    Add new Record

Sorry if this is really obvious, I'm terrible at webdev and new to mysqli.
Thanks.

A: You should use fetch_object on the result of the query and not on your database connection:
$result = $this->dbLocalhost->query($queryString);

while($row = $result->fetch_object())    // here

A: This line while($row = $this->dbLocalhost->fetch_object($result)) needs to be
 $result = $this->dbLocalhost->query($queryString);
 while($row = $result->fetch_object())

Also, the insert function uses mysql, instead of mysqli.

redpajama_set_name: RedPajamaStackExchange


3 Agreements excluded from definition of "supply contract"
1. These Regulations may be cited as the Building and Construction Industry Security of Payment Regulations.
"sub-contract", in relation to a construction site, means a contract for the carrying out of construction work at or on, or for the supply of goods or services in relation to, the construction site, other than the main contract.
3. The definition of "supply contract" in section 2 of the Act does not include agreements which do not contain any provision specifying or identifying the construction site or the construction project in relation to which goods are to be supplied.
(c) the main contract is made before 1st April 2005.
5.—(1) Where a contract does not contain any provision specifying the time at which a payment claim shall be served or by which such time may be determined, then a payment claim made under the contract shall be served by the last day of each month following the month in which the contract is made.
(iv) the calculations which show how the claimed amount is derived.
(ii) contain any amount that is being withheld, the reason for doing so and the calculations which show how the amount being withheld is derived.
(d) the variation shall conform with paragraph (1)(c) and (d) as appropriate.
(f) a brief description of the payment claim dispute.
(e) be accompanied by a copy of the relevant notice of intention to apply for adjudication, a copy of the relevant payment claim and a copy of the payment response (if any) thereto.
(2A) The adjudicator appointed under section 14 of the Act may, at any time before the making of the determination and on such terms as to costs or otherwise as he thinks just, allow such amendments to be made to an adjudication application as he thinks fit.
(f) a brief description of the payment claim dispute as contained in the adjudication application.
(4) In this regulation, "notice of intention to apply for adjudication" means a notice by which a claimant is required under section 13(2) of the Act to notify a respondent of his intention to apply for adjudication of a payment claim dispute.
(d) where the respondent intends to supplement the relevant payment response, contain the additional computations and justifications.
(1A) The adjudicator appointed under section 14 of the Act may, at any time before the making of the determination and on such terms as to costs or otherwise as he thinks just, allow such amendments to be made to an adjudication response as he thinks fit.
(d) where the contract that is the subject of the payment claim dispute is a sub-contract, the date the main contract is made.
(g) the date on which the adjudicated amount is payable.
(d) the particulars of the amendments made to the adjudication determination.
10.—(1) A respondent who is a party to an adjudication shall be entitled to lodge an application for the review of the determination of the adjudicator under section 18 of the Act if the adjudicated amount exceeds the relevant response amount by $100,000 or more.
(b) be accompanied by a copy of the adjudication determination that is the subject of the application.
(b) appoint a panel of 3 review adjudicators if the adjudicated amount exceeds the relevant response amount by $1 million or more.
(b) the person has working experience of at least 10 years in, or relating to, the building and construction industry in Singapore, and has successfully completed the pre-qualification assessment and training course conducted by the authorised nominating body.
(d) the person has assisted the party to prepare any document for, or has provided any advice to, the party in relation to the contract.
"sibling" means a brother or sister, and includes a step-brother or step-sister or an adopted brother or sister.
(ii) in any other case, $2,400.
13.—(1) An authorised nominating body may require the claimant to pay an initial deposit in respect of the fees payable to the adjudicator for the adjudication proceedings, and such initial deposit shall be paid at the time of lodgment of the adjudication application.
and the authorised nominating body may require the claimant to pay the additional deposit (if any) within 3 days after being required to do so.
(b) where the claimed amount exceeds $24,000, 10% of the claimed amount or $33,600, whichever is the lower.
(b) where the claimed amount exceeds $24,000, 10% of the claimed amount.
(5) In the event the additional deposit is not fully paid within the time limit referred to in paragraph (2), the claimant is deemed to have withdrawn his agreement to the longer period for making a determination and the adjudicator shall determine the application forthwith.
14.—(1) An authorised nominating body may require the respondent to pay an initial deposit in respect of the fees payable to the review adjudicator or panel of review adjudicators, as the case may be, for the adjudication review proceedings, and such initial deposit shall be paid at the time of lodgment of the adjudication review application.
and the authorised nominating body may require the respondent to pay the additional deposit (if any) within 3 days after being required to do so.
(5) In the event the additional deposit is not fully paid within the time limit referred to in paragraph (2), the respondent is deemed to have withdrawn his agreement to the longer period for making a determination, and the review adjudicator or panel of review adjudicators, as the case may be, shall determine the application forthwith.


text:
Arkansas Symbols & Icons
State Cooking Vessel
State Creed
State Dinosaur
State Folk Dance
State Fruit & Vegetable
State Gem
State Grain
State Grape
State Insect
State Language
State Mammal
State Musical Instrument
State Nut
State Poet Laureate
State Quarter
State Rock
State Song (Anthem)
State Song (Historical)
Arkansas State Gem
diamondsDiamond.jpg
Diamonds; photo by Paul Hocksenar on Flickr (noncommercial use permitted with attribution / share alike).
Arkansas designated diamond as the official state gem in 1967 (the same legislation, Act 128, recognizes quartz crystal as the state mineral and bauxite as the state rock). Arkansas is one of the few places in North America where diamonds are present and the only place where tourists may hunt for them. The importance of diamonds in Arkansas history is also acknowledged on the state flag and Arkansas state commemorative quarter.
Diamonds are the hardest known substance on earth. Composed of densely packed carbon, a diamond has unique physical and chemical properties (in addition to its brilliance and "fire" when faceted into a gemstone) which make it important to industry. Industrial-grade diamond powders are used to cut and polish gem-grade stones. Other uses include surgical blades, glass cutting and engraving tools, metal cutting tools, and drill bits.
Diamonds were discovered in Arkansas in 1906 near the mouth of Prairie Creek southeast of Murfreesboro, and later diamonds were reported from two small areas two miles northeast of the Prairie Creek pipe. Although these discoveries created a modest local sensation, attempts to mine Arkansas diamonds commercially during the first half of the twentieth century were without sustained success. in the 1950s man-made diamonds suitable for industrial purposes were developed and sealed the fate on Arkansas' diamond mining prospects.
The failed commercial mining operations became a tourist attraction after World War II. The state of Arkansas bought the volcanic pipe property and some surrounding acreage for $750,000, which became Crater of Diamonds State Park in 1972. The lure of finding gem-quality stones has drawn a steady flow of visitors to this unique attraction: nearly 2.3 million guests visited the park from 1972 to 2005. The diamond is also memorialized in the 2003 Arkansas commemorative quarter, which bears a cut gem.
Arkansas became the 25th state in 1836. The Arkansas quarter features a diamond (state gem), rice stalks, a lake bordered by pines (state tree), and a mallard duck flying above (public domain image on Wikipedia).
Flag of Arkansas (public domain image on Wikipedia).
Edit Diamond Page
Add Media for Diamond


text:
Kid Cudi Brings 'Cud Life Tour' & A$AP Rocky to Brooklyn: Live Review
It's not a term used often, but it applies: Kid Cudi is a kook. Last night (March 22) the alt-hip-hop singer/rapper extended his fall "Cud Life Tour" for a set in Brooklyn's Barclays Center.
By Brad Wete
Brad Wete
More Stories by Brad
Jimetta Rose and More Bring Soul to The Broad Museum's Black Fire Sessions Finale
The Search for Good Vibes: How Theophilus London Lost, Then Found His Glow
Blood Orange's Negro Swan Tour Brings an Outcast's Pain to a City Near You
Kid Cudi Courtesy of Republic Records
It's not a term often used, but it applies: Kid Cudi, strange and offbeat, is a kook. Last night (March 22) the alt-hip-hop singer/rapper extended his fall "Cud Life Tour" for a set in Brooklyn's Barclays Center. A few shows from the tour were cancelled and rescheduled due to illness.
"I missed you motherfuckers something terrible," Cudi said upon arrival, clad in what he's dubbed his "Satellite Academy Space Suit." The matte grey neck-to-toe 'fit is something of a variant to Iron Man's uniform. The stage, though, was set up like Superman's Fortress of Solitude, a frigid prickly cave for a lost man with a lot on his mind to fully plunge into his thoughts.
It was fitting, considering Cudi is an underdog turned unlikely hero. In 2008 he released his "A Kid Named Cudi" mixtape, one that ushered in hip-hop's melodic heart on sleeve, fears on forehead era —before Kanye West blew it wide open with "808s & Heartbreak" and Drake crafted his career around it. Still, Cudi has remained a bit of a sub-pop star. He keeps a core fan base strong enough to pack all but the upper bowl in Barclays, but not strong enough to make him a mainstay on the Billboard Hot 100 chart.
To be fair, it appears he's just fine with where he's at on the pop spectrum—off in space, crooning the lonely off their respective ledges.
The top of his set included "A Kid Named Cudi's" "Down and Out." "I be like me, Mr. K-i-d S-o-l-o D-o-l-o," he sang. "Down and out, so I'm out and down and looking for a substance to drown in." It's an odd gift Cudi has: The ability to corral and uplift loners with his words.
"I've got some issues that nobody can see/ And all of these emotions are pouring out of me/ I bring them to the light for you," he groaned when performing "Soundtrack 2 My Life." Cudi closed the song with a brief story about his addiction to cocaine.
"I used to do so much coke I couldn't feel my face," Cudi shared with Brooklyn. The period Cudi was referring to was around 2010. He was trying to hit high notes on the title track on his "Man on the Moon II: The Legend of Mr. Rager" album. But he couldn't. So he quit and tried the song again months later. "Mr. Raaaaaager," he wailed to the crowd. "Say no to coke!" he said emphatically, with a hint of humor.
The mood of the concert switched from dark to uplifting just then, first with the seductive "Balmain Jeans," from his latest release "Satellite Flight: The Journey to Mother Moon." It's a prelude to 2015's "Man On The Moon" trilogy capper. "I don't know how sexy I can be in this space suit," Cudi joked.
The crowd was then treated to an appearance from Harlem-native A$AP Rocky for his verse on "Brothers." "I'm so happy to be alive," Cudi said, before belting out that he's "feelin' alright" on "Cudi Zone."
"Pursuit of Happiness" came next. It was followed by the David Guetta-produced cut "Memories," which featured Cudi cheerfully doing robot dances. The show was a 90-minute trip, one that ended awkwardly. When Cudi left the stage, the audience expected an encore. He hadn't performed a proper version of his lone hit, "Day N' Nite," opting instead for a few moments of its clubby Crookers remix.
"We want Cudi," they chanted. The stage lights flickered, teasing his return. After five minutes, a voice rang throughout the arena. However, it was that of a Barclays staff member, requesting that everyone go home. The party was done. The odd man was out.


text:
The Zeilendorf (plural: Zeilendörfer)  is one of the historical types of village that emerged in Central Europe and consists of a single row of houses () or farmsteads arranged in a regular and linear fashion. Zeilendörfer tend to occur as a result of the terrain and often lie on the edge of broad valleys. The individual house plots are arranged along a village street and have strips of farmland adjacent to the dwelling. It is a type of linear village.

The farmsteads of these rural settlement types are strictly linear, because they run alongside a track or a small or larger watercourse. They can be viewed as one half of an Angerdorf or small Straßendorf that has been bisected longitudinally.

The Zeilendorf differs from the Reihendorf or Hufendörfer mainly because of its regularity and the close proximity of adjacent dwellings as well as its generally small size.

Whether front gardens are laid in front of the row of houses in a Zeilendorf, depends on regional tradition. Many narrow Zeilendörfer could develop into an Angerdorf through further building (e. g. Jetzles near Vitis) or into a larger Reihendorf (e. g. Kirchschlag near Linz). If the single line of settlement at the heart of the settlement was extended on the other side of the river or stream, the strips of land belonging to the farms would face one another on either side of the village street.

If the elongated arable fields behind a single- or two-row village had a width of less than about 10 metres (which often used to happen as a result of inheritance division), they are known in the Upper German language area as Streifenparzellen ("strip plots") or Riemenparzellen ("belt plots"). Through combining plots and land amelioration more economically viable plots of land could be formed.

Relatively elongated Zeilendörfer often develop along rivers, whose frequently flooding required the construction of the village street immediately on the edge of the river terrace, where agriculture was in any case restricted to one side. Such an example is Spillern on the Danube (see 2nd external link), where the single row of houses was not expanded into two rows until recent decades when it became a Straßendorf. A saying from earlier times is that in Spillern "the geese are only fried on one side."
Through the construction of the railway embankment in 1841, the side facing the river was made flood-proof and the former back doors (Hintauswege) now face the country road built soon after the construction of the railway, whilst on the river side, a branch of the Danube silted up.

External links
 Linear forms of settlement in Thuringia

Rural geography
Settlement geography
Types of village

redpajama_set_name: RedPajamaWikipedia


foods low in arginine/high in lysine...I'm confused!
By nikkinyc, January 2, 2008 in Just signed up? Say hello here!
Does anyone know where I can get a comprehensive list of foods to avoid when following the high lysine/low arginine protocol? I've looked at several websites but with some of the foods they all have conflicting lists. I'm considering going to a nutritionist as I want to make sure I'm not depriving my body of any essential vitamins and minerals but, thought I'd ask here first.
Just remember that arginine is still an important amino acid - you don't want to completely eliminate it, just find the right balance of lysine:arginine.
Thanks for the replies and the info. I have already seen these lists but again, they don't cover all the food groups and other web sites have conflicting info......who's correct? Does that mean that what isn't on these lists doesn't contain arginine???
Just trying to find a regime that could perhaps lessen my ob's (I seem to have them all the time). I did the DMSO & BOL for 2 years and that didn't work, tried the H-Balm and I'm STILL looking for something that actually works. Just started the Dynamiclear so will see how that goes, seems to dry up the lesions in an amazingly short period of time.
No, the lists generally show foods rich in arginine or lysine. There may be foods that are less known as contributors of either amino acid. If you have specific foods that you are interested in, there are probably nutrition information available if you ask around.


text:
Wife of actor says most marriages fail because women like to snoop
A popular actress from Ghana has said the easiest way for a woman to preserve her marriage is through keeping away from her husband's phone.
Apparently, constantly peeking through a man's phone is a ticket to destruction and divorce.
Mansurah Issah, who is married to fellow actor, Sani Danja, told DailyTrust she sometimes has to act deaf, dumb and blind.
To her, this is the best way to insure there is peace between a man and his wife.
For the actress, this is an ultimate sign of submission and one of the best ways a lady can save her union.
Mansurah added that her husband, who is rich and handsome, is allowed to marry more than one wife.
"Being married to Sani Danja is not a day's job and it is not easy at all. Sometimes, I have to be blind, deaf and dumb to survive in this marriage. He is a star, and apart from that he is handsome and rich. These are the qualities a lot of women want in a man. A lot of girls beg to date him," she said.
The beauty then said snooping through a man's phone might unearth painful secrets that are in turn bound to break a woman's spirit.
READ ALSO: Cassper Nyovest reaches out and offers assistance to aspiring rapper
"When a woman checks her husband's phone and sees something she is not supposed to see, it will really affect her, and by extension the marriage. But when you stay away from your husband's phone, his laptop and some personal stuff, you will have a very peaceful marriage. I think those are the kind of things that have made our marriage last," the actress added.
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Times of Mass, Confessions and other services are given here. Very occasionally, times may be altered due to events in the Cathedral. Check the newsletter or the Cathedral diary for full details. Click on the links to get a brief explanation of each service. The Cathedral is open for prayer every day, 8:30am-6pm.
Everyone is welcome to attend the celebration of the Mass.


Best of all, I work with clients across the US via in-person, phone and Skype, which means we can work together from anywhere.
I'm excited to work with professionals or stay at home moms who are ready to lose the weight, lose the sugar cravings, and live more authentically.
I anticipate hearing from you!


Functionality and technology are increasingly dominating the way we style domestic and commercial spaces.
Accessorising the work place and home is now simpler than ever, with a wide range of accessories and smart product design delivering the opportunity to bring in personality or mood to the environment.
There are many exciting options available that will complement an existing space while also enhancing function, style and design. The CBOX pedestal from Dieffebi is a perfect example of function meeting form adding value to a workspace. The stylish little ped variety of colours and finishes, and simply by adding the optional cushion allows it to double as a spare mobile seat for informal meetings.
Technology advancements also offer enhanced environments. In a world where people are constantly connected to digital devices such as mobile phones and tablets, the launch of wireless charging solutions to the market opens up a wealth of new product adaptions. Aircharge, wireless charging experts have produced just such a range. Their flagship Z-Bar ergonomic desk light now incorporates Qi charging technology. This desirable accessory is up for grabs in an array of funky colours – an ideal way to add personality to your workspace.
Great things come in small packages, and the Carry On stool is no exception. This portable seating solution combines traditional materials and craftsmanship with contemporary design and function, and is ideal for flexible working and domestic spaces where occasional seating is required. Produced in a variety of colours and fabrics, this designer stool is a superb accessory to add a punch of colour and designer presence without breaking the bank.


WALK RIGHT IN! 1600 sq. ft., 12 year old stick built ranch home on 2 acres near Gotham. 2 main floor bedrooms with 3rd on lower level. Two full baths, main floor laundry, large living room, combination kitchen/dining area. Open floor plan and so well maintained. New furnace and hot water heater in 2011. 2 car attached garage and storage building.
You are here: Home Search Our Listings Sold WALK RIGHT IN!


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I ordered this set in green as another reviewer stated that their green set was just fine. I carefully inspected the set when I first opened it, and did not see any holes, rips, or unfinished seams. Washed and dried according to directions, and they still look fine. The cotton is soft and feels very nice to the touch, and the color is pretty. I can't address the depth issue, as I bought this set for using on an air mattress (for occasional guest use) which is not as thick as a standard mattress.
Seems to be fine all the way around. If issues develop I will update the review.
This is my ALL time favorite lip balm. The scent is a wonderful lime-citrus and it keeps my lips moisturized for hours.
It fits the baby bjorn travel crib perfectly. It's so soft and my child loves sleeping on it. Yes, it's a little thin but it's still great for this price.


In this report, CONCORD examines the impact assessments that accompanied proposals issued by Directorates-General of the European Commission in 2016, singling out four cases in which there was an adequate, an inadequate or no impact assessment, exploring them in greater depth in an attempt to learn the strengths and weaknesses of the Commission's current approach to impact assessments and propose recommendations for the future.
At the start of his term in office, President Juncker asked First-Vice President Timmermans to help him ensure the Commission abides by the highest professional and ethical standards and leads the way as a modern, efficient and transparent public administration, open to all input that helps deliver work of a consistently high quality, in full independence and impartiality. Charged with the Better Regulation agenda, he needed to ensure the quality of impact assessments underpinning Commission activities. By addressing negative and promoting positive impacts of non-development policies on developing countries, the EU lives up to its Treaty obligation. It would also make proposals more coherent with the principles of sustainable development, another responsibility of Vice-President Timmermans. Three years later, did he manage to meet these expectations?
Well, we are not there yet. In 2016, 24% of the proposals relevant to developing countries were accompanied by an impact assessment that looked in sufficient depth into the impacts on those countries. This score is better than in previous years, but is still far too low. The Regulatory Scrutiny Board afterwards should systematically examine whether or not impact assessments have adequately taken impacts on developing countries into account. But they only considered this in 10% of the cases where they could have done so. Our qualitative assessment shows that impact assessments can be improved by better balancing the economic, social, environmental and governance impacts of proposals, by taking into account the impacts on developing countries from the outset, by ensuring that they are underpinned by high-quality research, by weighing the different policy options carefully and by looking at power imbalances when considering the different interests at play.
The below Special edition of the Snakes and Ladders game reveals which strengths and weaknesses determine the successful completion of the impact assessment path.


Decide the types of vegetables to grow in the garden. If you live in a cool region, you can try radishes, spinach and lettuce. If you live in a warm region, tomatoes and eggplants are the perfect vegetables to grow. If you grow the plants based on the climate or weather in the region, you will get amazing quality and fast growing rate.
Decide the proper site for growing the vegetables. They will need at least 6 to 8 hours of sunlight every single day. You have to avoid planting them in northern garden area due to the least amount of sunlight. The buildings and trees will give them shade and make them receive less amount of sunlight. It is recommended for you to have the vegetables planted in southern facing garden areas.
Make sure that the vegetables are planted in open area. Don't grow these plants closer to the trees, hedges, shrubs or bushes. You need to have them in an open space to get sufficient amount of light. Check guides on how to arrange vegetable garden in pots here.
The germination can occur in the vegetable garden if you can have the warm ground temperature. You can put the seeds inside a cup and keep it in a warm area. Then you can plant it on the ground and cover it using fabric, landscape sheet or plastic to make the soil warm.
Choose the fertilizer which can improve the fertility of soil in the garden. There are three important elements that the soil needs. Those are phosphorus, potassium and nitrogen. To find out the less amount of nutrient on the soil, you have to do a test. Get ideas on how to start a vegetable garden on your balcony here.
What do you think about the ideas on how to make your vegetable garden grown faster?


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Whisk together the mayonnaise, mustard, Worcestershire and lemon zest in a medium bowl. Set aside half of the mustard sauce in a small bowl for topping the cocktail.
Gently toss the crab, 1/2 cup of the tomatoes and the avocado with the remaining sauce. Season with salt.
Arrange the lettuce leaves in 4 to 6 martini glasses. Spoon the crab salad on top. Garnish with a dollop of the reserved sauce, the remaining tomatoes and lemon wedges.


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Retail Spotlights
Licensing Spotlights
E-Commerce Spotlights
Tradeshow Coverage
Foot Locker stores are designed to engage consumers in finding shoes that make their statement.
By Tim O'Connor
Dick Johnson enjoys standing at the top of the escalator at the entrance to Foot Locker's new flagship store on 34th Street in New York City. From that vantage point, he can soak in the comments from shoppers as they walk around the 10,000-square-foot retail space and marvel at how the modern design tells the story of each brand's shoes.
"You can tell they love the space," the CEO of Foot Locker says. "You see it with the amount of product they are buying."
Customer engagement was a core tenet of the company even before Johnson arrived at Foot Locker. In 1997, Johnson was working for catalog athletic footwear company Eastbay when Foot Locker – then known as Woolworth's – purchased the Wisconsin-based company.
Foot Locker has changed dramatically in the nearly 20 years since, Johnson says. After being absorbed into the company, Johnson at first stuck with the catalog side of the business and had little interaction with the brick-and-mortar stores. That changed in 2007 when he took over the European operations, which were firmly rooted in physical locations.
As CEO, Johnson now is responsible for all of Foot Locker's nearly 3,400 stores. The company operates locations in North America and 19 countries in Western Europe, Australia and New Zealand. It also franchises stores in the Middle East and South Korea. In addition to the Foot Locker name, the company's brands include Champs Sports, Footaction, Lady Foot Locker, SIX:02, Kid's Foot Locker, Runners Point, Sidestep, and Eastbay.
Europe is one of Foot Locker's strategic growth pillars. The company purchased Runners Point Group in 2013, giving it control over 212 stores in Germany, Holland, Switzerland and Austria and expanding its footprint in Europe to over 850 stores. Johnson sees opportunities to expand the Foot Locker and Kid's Foot Locker brands throughout Europe.
In addition to its physical retail locations, Foot Locker sells shoes through its brands' websites. Foot Locker has always been forward-thinking when it comes to online. The Eastbay acquisition prepared the company's infrastructure for e-commerce and the first Foot Locker websites appeared in the early 2000s.
The move to online shopping has forced some retailers to close brick-and-mortar stores, but Foot Locker believes each shopping avenue has value for its customers. "The channel is irrelevant," Johnson says. "We want to have a great connectivity with our consumer wherever they choose to interact."
Passion for the Game
How customers perceive a brand is instrumental in its success. Foot Locker has long been seen as the expert on athletic shoes. The referee jerseys worn by sales associates – in use since the brand launched in 1974 – are an integral part of the company's athletic culture and give it a sense of authority when it comes to sneakers. Beginning in 2009, Foot Locker began conceptualizing its stores to create an even stronger environment for the consumer based around the shoe brands it sells.
Consumers embraced those changes because they see the company's passion for sneakers and its willingness to cater to different customer groups, Johnson says. "Each of our banners stand for something different, [and] the consumers who shop there have different buying habits and different buying occasions," he explains.
Foot Locker is perceived as the all-around sneaker store, while Champs has a more high school athlete bent. Meanwhile, SIX:02, one of the company's newer concepts, is designed as a premium women's retail destination where fashionable athletic wear is given equal presence to the shoes.
The company's engagement with its customers begins outside the store with focus groups, social media contact and even home visits. Those personal interactions lend some of the best insights. Johnson says Foot Locker can better grasp what motivates its customers when it sees what posters they have on their bedroom walls and hear what music they listen to. "It's that one-on-one relationship with them that allows you – a year later, 18 months later – to circle back to them and see if the same influencers are impacting their life, if the same artist is impacting their life, who are they following on their twitter account," he explains.
The intersection of sport and culture has never been closer than it is today, so understanding consumers beyond their buying habits enables Foot Locker to create content that reaches customers in a way that is relevant to them. That impacts everything from how Foot Locker markets itself to how it designs its stores.
The company's brick-and-mortar stores still feature plenty of shoes, but it also understands that people no longer want an overwhelming shopping experience. Customers buy into a lifestyle and Foot Locker's stores are a critical component in helping its shoe brands tell their stories. Walls are no longer stacked floor to ceiling with sneakers on display. Instead, locations have in-store sections that appeal to those lifestyles, such as House of Hoops, a basketball-focused concept that pairs premium court sneakers with t-shirts and other athletic wear.
The key is to find appropriate apparel and accessories that set the tone and connect to the shoes. After all, most consumers don't drop $200 on a new pair of Jordans and then buy a $5 tee shirt. "It's all designed to be complementary to the business of selling sneakers," Johnson says.
Telling Stories
Buying decisions also involve a lot more voices today. Consumers don't come in, try on a few pairs and make a decision. Sometimes, they'll pick out two finalists, slip one shoe on the left foot and its competitor on the right, then Tweet out of photo and ask their followers to decide. Johnson says stores must be participants in those interactions, and sales associations are trained to engage with customers on that level. "We want to be part of the conversation with our consumers," he says.
The company has been rolling out these storytelling concepts to its stores for several years, but its new flagship store in Manhattan is the culmination of those ideals. In August, Foot Locker celebrated the reopening of its location in New York's Herald Square following a massive redesign that granted individual spaces to several brands, including Nike, adidas, Under Armour and Puma. "It is a combination of brand space which really allows the great stories our vendor partners have to tell to come alive under one roof," Johnson says.
Foot Locker worked with shoemakers to create the in-store concepts and develop the cross-category product offerings. "The build-out and connectivity with the brands and their co-investment with us in the flagship spaces has really created an environment that fits our core consumer," Johnson adds.
Bucking a Trend
By creating retail environments that connect to consumers, Foot Locker has fought off the declines experienced by other mall retailers. Real-estate research firm Green Street Advisors released a report last spring that determined department stores needed to close about 800 stores across the country to return to the same sales per square foot productivity they had in 2006. The potential loss of a fifth of the country's mall anchor store space has concerned the industry – especially since major retailers like Sears and Macy's have already dropped locations.
However, Johnson says traffic at Foot Locker stores is actually up and credits that success to the company's ability to excite consumers. "We make people happy," he says. "They leave our stores with a bag, they have a fresh pair of kicks that they get to wear at school and show it off."
Tags: retail,	sports
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I am close to finishing Christopher McDougall's Born to Run. I want to learn how to write proper book review but I don't know how. I read books in a way that makes it impossible to process that afterward. Is it a good thing to consume media in such a fashion? I consume media for entertainment purposes. I don't want overhead of taking notes and following up on it. I think it is a quality of a write to make up words around nonsensical things. I had been watching Game of Thrones and I wasn't satisfied with an hour. So after watching episodes I usually read some reviews. Some of the reviews, especially on Forbes, are very passionately written which is very enjoyable to read.
From time to time I have thought how will it change me if I were to write 500 words everyday on the blog. 500 might be a big number. 100 would be a good target. Just to talk about what I have done. And difficulty in getting it done. Maybe I will do it.
In order to do anything one has to make time. If you have work stacked one after another, it is very hard to do any creative work. You want to finish something and move on to next one. There is a hurry. Hurry kills the cat.


What is a Welcome Table?
First thing's first. What exactly is a welcome table? It's one of the first things a wedding guest sees when she walks into the wedding. It's a strategically placed table that allows a guest to leave a gift, find the seating arrangements and more (we'll get to that in a minute). The fun part about these is that they can display whatever you want. Make one for both the ceremony and reception, and the more personalization the better!
These are just some things to think about. Of course, you don't have to have any of them. You many not even want programs for your ceremony, and that is totally fine. Another idea is to make it completely personalized. Add photos of loved ones who are no longer with you. Display a "Welcome" sign on a decorated easel (we can later move this sign to the entrance of the reception as well!).
We can also create a welcome table for the reception. So what should go on this one?
Just to name a few! Again, these are completely optional, but a good place to start if you're considering having a welcome table.
This is just another way that you can let your personalities as a couple shine bright! Get creative, and most importantly, have fun!


US, 30 Jun 2009 - Hoffman La Roche is severing its ties to Big Pharma. The venerable drug maker this week plans to drop its membership in the Pharmaceutical Research and Manufacturers Association.
PhRMA, as it is known informally, is the leading trade group for the U.S. pharmaceutical industry.


the hard way this morning because Ashley started to have problems, real problems…so I ran in the kitchen and gave him a triple dose of lactulose!! (it is what they did at the Intensive Care Unit when he was in coma, they gave him intensive doses of lactulose through his nose so I knew it was safe)…I know Ashley is very intelligent and that's why I was letting him managing the drugs but I realized even if you are a genius, (Ash had a IQ of 169) if you are weak then you can not manage that….The ammonia was hitting the brain again…you need to recover first…and then you can manage your drugs…Ashley is sooooooo tired because he was having nausea for three hours (from about 7:00 a.m. to 10:00 a.m. and I JUST realized to have nausea in his case means his ammonia level is high….
In fact, the Albany VA hospital did another mistake – Ashley was on absolutely NO SALT DIET and now one of his drugs IS SALT BASED because his system lacked it too much…(so don't ask me what to understand from what the Albany VA medical center is doing…they sure don't know themselves, so…) by the way, I am sooooo glad and happy I don't have to beg a nurse to give him lactulose anymore…I knew it is what he needed this morning and if I would go to the hospital, I WOULD MOST LIKELY HAVE TO BEG FOR LACTULOSE UNTIL ASHLEY WOULD BE AT LEAST IN COMA OR MAYBE DEAD…all I have to do is to give him…THANK GOD !!!!
I would have to beg for lactulose until he would be in coma like it happened before at the Albany VA Hospital – I had to beg Diane M Ehmann and he had to go coma at the Intensive Care Unit to get his lactulose like I was requesting.
Ash was released on November 24th and turned yellow on November 27th and his arms and legs were shacking, which was a sign his liver was shutting down 3 days after being released from the Albany VA Medical Center. Even though I did not trust the hospitals anymore, I had to call the ambulance because it was very hard for me to see Ashley in this state, I could not take it anymore to see him that weak and he could not eat and his kidneys were on their way to shut down and the dialysis was not even offered by Dr. Nimesh Desai like I already explained previously.
So I was the third woman becoming a widow even though I was sad for Mrs. Abrahamsen because he died simply because they did not bring the oxygen tank on time so he had time to end up at the ICU in coma and die there but it turned out that I was becoming a widow myself.
Mrs. "Hocus-Pocus" told me indirectly that I didn't care for my husband and that's why I don't want him to have another surgery at the Albany VA Medical Center. She needs to go walk on the yellow line (this is not said literally, it is said metaphorically) is what I should have told her for attacking me somehow in a way I couldn't sue her. All was in the manner that it was said and in the tone of the voice. The main reason why I don't want my husband to have another surgery is because he would be in this VA hospital on this blip blip blip 8th floor where they ALMOST KILLED HIM 5 TIMES IN A ROW.
because we almost all blew up one time because they did not mind to have this addicted to cigarettes near the tank of oxygen, I told this stupid social worker (Lori Bobersky) that this addicted to cigarettes was around the oxygen tank asking for cigarettes and he had lighters with him and she did not do anything. WTF – sorry but there are limits to my tolerance to absolute stupidity.
to put what Ashley wasn't able to eat on the way of everybody (in the doorway) so somebody inquired very quickly "what was that?" and I said what was going on. One of the aids (a nurse assistant) advised me to scream, to yell but I thought that wasn't a good idea because I was/am aware that I was/am in a hospital and I didn't want to disturb the other patients, including Ashley. (I am not like folks who are visiting someone and acting like they would be in a bar) By the way, I didn't want somebody to stumble on it (what I put in the doorway) and I was watching for making sure that would not happen simply from the corner of my eye because that was not my goal to harm somebody because Ash was in acute pain for many hours.
My experience with 2 VA Hospitals is: it is a sample of hell. I am just sick of it. DID I NOT MENTION THAT THE 8TH FLOOR OF THE ALBANY VA MEDICAL CENTER WAS UNDER INVESTIGATION WHILE WE WERE THERE? MY HUSBAND TOLD ME THIS AT THE MIDST OF NOVEMBER 2006.
BNA is continuing its investigative report about the criminal investigation of the Stratton VA Medical Center, Albany. The investigation has uncovered multiple crimes and systemic violations that have put patients' lives at risk.
We waited between 5:00 p.m. and 9:00 p.m. for Ashley to get his painkiller. I am sick to death of this VA hospital. I would have understood if his blood pressure would be low and/or if his ammonia level wouldn't be tested but we got the results about 6:30 p.m. and it was only at 26 and anyway they were giving him his lactulose in case his ammonia level would increase because generally after a TIPS procedure that is the case. Like it wouldn't be enough, I already said to the nurses and the doctor he is able to take FENTANYL like he received at the ICU and guess why he waited for 4 hours to get his painkiller? It's because it was FENTANYL that was to be prescribed again meaning that they had to get a prescription first in order to get it. I thought we were at a hospital where everything is supposed to be handy in order to intervene effectively but I guess not. Ash had to wait 4 hours with an acute chest pain for no other reasons that the folks working there aren't caring enough… If the VA Hospitals aren't better than this office in this Village and the Albany Stratton VA Medical Center, I wish us to find another way for my husband to have health care.
They were supposed to provide an ambulance to transfer Ashley from the Albany VA Hospital to the nearest hospital (it was a DAV Van instead) and they provided a wheel chair with dried human excrement on it.
Like this wouldn't be enough, they didn't provide all the papers Ashley needed to get his TIPS procedure to this other hospital in Albany so his surgery was delayed 1 hour. Instead of having it at 9:00 a.m. he got it at 10:00 a.m….
I made sure they will check Ashley's ammonia level after the TIPS procedure and I made sure they won't give him Morphine.
I realized this morning when they entered (inserted) a ¾ inch tube in Ashley's body to first his belly, second his lungs, they could use FENTANYL as a painkiller. (the one that at first Ashley felt he was about to vomit – read part 28. Why I know that?!? Because yesterday night, Ashley had a very big pain and I told them to NOT use Morphine even though it is what the nurse and the doctor available at the Intensive Care Unit wanted to use. They finally figured something out about 30 minutes later my husband asked for a painkiller and they found FENTANYL.
Since they didn't try to find another painkiller when they inserted this ¾ inch tube (I wasn't able to be at the Albany medical center at that time because US Immigration was "handling" my green card so I was not able to get a learner permit from the DMV and I was at hundreds of miles away from the Hospital) simply because they could find FENTANYL, I consider what they did to my husband is called: TORTURE. Ashley had what the "doctor called": "panic attack" this morning. What he had was acid reflux chest pain or the gastroesophageal reflux.


If these memes still don't make you laugh I will post some more.
Entity uncovers thirteen of the funniest memes about Hillary Clinton's email scandal.
4. Where is my knife?
Star Wars Funny Memes and Hilarious Jokes - May the fun be with you!
Anakin and Obi Wan fight in this funny meme over whether certain foods are sandwiches.
For instance, anyone who has ever dieted might enjoy a pop-culture meme that pairs helpful "Sesame Street" advice with an image of Homer Simpson.
46. Truly, no earthly idea what that's like.


T-Kea Blackman provides support to the Maryland Employment Network as the peer career advancement specialist and serves as one of the leads for the Intensive Peer Support and Benefits Planning Pilot Program. The program is in collaboration with Cornerstone Montgomery, a non-profit that provides resources to individuals with mental illness, and will examine the effects of enhanced peer support services and benefits on career advancement to demonstrate the importance of peer support and benefits planning in increasing Social Security beneficiaries' earnings and self-sufficiency.
T-Kea is also the creator and host of the Fireflies Unite Podcast, a weekly podcast dedicated to bringing light into darkness (just like the fireflies) by sharing the stories of individuals thriving with mental illness within communities of color despite the disadvantages and racism that negatively impact their mental health. Her articles have been published on The Mighty, Urban Faith, Blavity, and 21 Ninety, and garnered over 50,000 views and encouraged individuals to seek treatment.
Additionally, T-Kea has been a guest on Good Morning Washington, That Anita Live Show, The Blessed & Bossed Up and Minding My Black Business podcasts to discuss topics such as wellness and recovery, faith, suicide among children of color and her personal story of surviving suicide. She served as a cast member and producer for This Is My Brave, a non-profit that gives those with mental illness the opportunity to share their story through creative expression live on stage.
T-Kea is currently pursuing her peer recovery specialist/recovery coach certification through the Maryland and Behavioral Health Professional Certification Board. She earned a master's degree in public relations and corporate communications from Georgetown University, and a bachelor's degree in radio, television and film production from Howard University.
Check back frequently for more updates from T-Kea and our Peer Counseling Project!


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Portrait of the Queen of England and all the heirs to the throne
Portrait of the Queen of England and all the heirs to the throne; Princes Charles, William and George
The Queen is celebrating the new decade with a royal portrait.
Moreover, the photo is taken by Ranald Mackechnie in the Throne Room at Buckingham Palace on December 18
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In addition, Her royal Majesty, 93, was pictured alongside the Prince of Wales, Duke of Cambridge and six-year-old Prince George.
All direct heirs to the throne of England.
The photograph is only the second time that a portrait of Her Majesty and her three heirs has been issued.
Download: Prince Kaybee says Uwrongo visuals is his last feature
The first was released in April 2016 to mark the Queen's 90th birthday.
previousKano – Hoodies All Summer ALBUM ZIP DOWNLOAD
nextActress Anita Joseph stuns in birthday photos as she clocks 35 today


Aphrodite is the Goddess of love, beauty, and war. How better to do spells for beauty and love than to use this Aphrodite spell candle. Hand-crafted with soy wax and coconut oil. Colored pink for love and beauty, infused with red and pink rose petals, scented with rose essential oil and a touch of apple. Crystal charged with rose quartz.
Roses are used for love and beauty, but also protect from the evil eye. Use this beautiful candle in spell work for love, beauty, and romance. Crystal and magickally charged for love and beauty. Remove rosebud before lighting and remove crystal before or shortly after lighting.
Made to order there may be some variance in color of wax, rose bud or rose quartz stone. In an 8 oz. tin.