LAX99LA248LAX99LA248 On July 10, 1999, at 1230 hours Pacific daylight time, a Piper PA-24-180, N6597P, collided with ground obstructions during a forced landing following a loss of power during the takeoff initial climb at San Luis Obispo, California. The aircraft, owned and operated by the student pilot, sustained substantial damage. The student pilot and his instructor were not injured. The cross-country instructional flight was conducted under 14 CFR Part 91 and a VFR flight plan was filed. The dual cross-country flight originated at Whiteman Airport in Pacoima, California at 1030. Visual meteorological conditions prevailed at the time of the accident. The flight instructor told Safety Board investigators that he met the student pilot at the airplane and watched him preflight the airplane. The airplane was being fueled at the time. He stated he verified the fuel quantity (full left and right main tanks), and fuel cap security after the fueling. The student sumped both tanks with no reported discrepancies. The flight instructor reported that they took off and flew the entire flight to San Luis Obispo on the left tank. They taxied to the ramp area and did not shutdown the engine. He said he had the student change the fuel selector to the right tank at that time, closed their flight plan, and reviewed the return flight. He estimated they were on the ground about 10 minutes, asked for their taxi clearance, and were given taxi instructions to runway 29. The instructor reported that the power came up smoothly on the takeoff roll. He reported that the engine quit approximately 600 feet above ground level (agl). He reported that there was no roughness or surging, and that it just suddenly quit. The flight instructor said he took the controls at that point and lined up on Highway 101. He said he verified that the fuel selector was on the right tank, mixture rich, and the carburetor heat and boost pump was on. He said he had to maneuver the airplane to miss an overpass and proceeded to touchdown in the northbound lanes of the highway. The flight instructor said that the right wing struck a bush, which spun the airplane off the highway and down the embankment next to the highway. At the request of Safety Board investigators, the airplane was removed from the side of the road and taken to an aircraft recovery facility near Pleasant Grove, California. A follow-up examination of the aircraft and engine took place on July 23, 1999, at the recovery facility. The engine had been removed from the airframe and placed on a stand to facilitate the engine examination. Federal Aviation Administration (FAA) inspectors from the Sacramento, California, Flight Standards District Office and a technical representative from Textron Lycoming conducted the subsequent engine examination. According to a report received from the Textron Lycoming investigator, the two bladed constant speed propeller remained attached at the crankshaft flange. The engine data plate identified the subject engine as an O-320-A1A. The top spark plugs were removed and examined. The spark plug electrodes remained undamaged, and, according to the Textron investigator, their coloration was consistent with normal operation. The cylinders were examined at the combustion chamber utilizing a lighted borescope. In the written report, the Textron investigator stated there was no evidence of internal mechanical malfunction or foreign object ingestion. The propeller was turned and piston movement was observed at each cylinder. The Textron investigator noted that during the turning of the propeller, the vacuum pump drive did not turn. The accessory gearbox cover was removed for further examination of the accessory gears. During the removal of the accessory case, the Textron investigator noted that the crankshaft idler gear (left magneto) was detached from the mounting pad at the back of the crankcase. Additionally, he noted that the crankshaft gear was not secure to the crankshaft, and the locating dowel pin was fractured and separated. He did not notice any other damage or mechanical malfunctions. The full flow oil filter was removed and cut open to gain access to the filter media for examination. The filter media contained a large amount of bright silver colored material. Further examination of the idler gear shaft and attaching parts revealed severe wear signatures on the attachment bolts and locking plate. The non-threaded or shank portions of the two 1/4-inch diameter attachment bolts were worn away to approximately 50 percent of their original diameter. The hex head end of the bolts displayed signatures consistent with prolonged contact with the rotating idler gear. Additionally, according Textron's written report, the threaded bolt holes located on the engine case were severely worn and elongated. The bore at the idler gear shaft-mounting pad was "severely worn, elongated and had displaced aluminum material around the circumference." The Textron investigator stated that the wear patterns and material loss were consistent with a condition that "had existed for an extended period of time." He concluded that the two bolt holes of the metal locking plate were elongated and missing a significant amount of material. Further examination of the crankshaft counterbore and corresponding gear revealed fretting and corrosion signatures at the mating surfaces. The dowel pin was separated in line with the parting surfaces of the gear and counterbore. The dowel pin fracture surface displayed visually obvious beach markings. The attachment bolt and locking plate remained intact and undamaged. The locking plate appeared to have been bent against the head of the bolt. The FAA and Textron investigator reviewed the aircraft logbook and located an invoice documenting a field overhaul of the engine in March 1987. The engine had accumulated approximately 1,200 hours of operation since the overhaul. No evidence of a propeller strike or sudden stoppage of the engine was noted during examination of the engine, airframe, and propeller logbooks. It was noted that the current logbooks were begun on August 3, 1988, when the engine had accumulated 400 hours of operation. According to the logbook entries, the original logbooks had been lost. An examination of the propeller logbook revealed that a propeller overhaul had been completed on April 16, 1999, approximately 20 hours prior to the malfunction of the engine. The propeller overhaul facility was subsequently contacted by the FAA inspectors, and it was determined that the propeller was undamaged when the propeller was received. A dynamic propeller balance had been performed after the installation of the propeller. The Chadwick-Helmuth balance card attached to the logbook indicates that 33.6 grams of weight were added to balance the propeller. Safety Board investigators reviewed the standard practices manual section pertaining to static and dynamic balance of the Hartzell propeller. Section C of the manual addresses modification of the spinner bulkhead to accommodate dynamic balance weights. The section states that the placement of balance weights should be outboard of the deice slip ring, or bulkhead doubler, and inboard of the bend at the point the bulkhead creates a flange to attach the spinner dome. Additionally the manual states, "Do not exceed a maximum weight per location of 0.9 oz (25.51 grams) . . . this is approximately equal to six AN970 style washers." The bulkhead on the accident airplane was examined. The FAA and Textron investigator noted that the weights were placed on the outside of the bend at the point the bulkhead created a flange to attach to the spinner dome. Additionally, it was noted that there were seven washers placed in the one location, with a total weight of 36 grams. Textron Lycoming issued Service Instruction SI 1310 in February, 1977, that offered the availability of an improved idler gear shaft and attaching hardware that utilized slotted shear nuts, bolt, and locking wire. Although not required, the examination revealed that the subject installation did not employ the referenced components.
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In a recession we all take steps to cut our spending both at home and in business but is this really always the best strategy?
With so many companies falling by the wayside, the desire to hold on to what money we have is understandable but not necessarily pragmatic. However, there are ways to maximise on potential client opportunities without breaking the bank.
Let’s explore a few affordable options.


Effective Informed Consent: Fostering a Dialogue Hippocrates once promoted the beneficence model of medicine, which encouraged minimal communication with patients about their condition. Like Hippocrates, those days are long gone, and guidance now supports the idea that patients need to understand planned medical procedures adequately so they can make informed decisions about their treatment. Effective informed consent requires a dialogue with the patient wherein he or she feels comfortable fully participating by asking clarifying questions and offering personal concerns.
Requirements for informed consent have not changed in modern healthcare, but the delivery has seen strong consumer momentum to encourage a better exchange of information. Traditionally, informed consent was limited to operative procedures, but, in recognition of the high-tech nature of medicine and the potent medications that have been developed, it must now encompass a broader range of medical care, including:
surgical procedures significant medical treatments prescriptions with severe side-effects Physicians are bound, in advance of this medical care, to provide the patient with detailed information on the risks, benefits, and alternatives, including the option to not perform the procedure or treatment regimen and the effect that doing nothing would have on that patient’s health status. They are also required to inform the patient about any potential clinically significant adverse drug reactions or other concerns when a new medication is ordered.
Patients can be overwhelmed by medical jargon and may be medically naïve, so it is imperative for the physician to foster an open dialogue with the patient and allow adequate time for discussion, translating key terms to common language and providing commonly asked questions that may put the patient at ease and stimulate further questions. It is important to base information not only on personal experience, but on broader sources as well. Verify understanding by asking patients to restate or recall key elements so the patient has an accurate understanding and does not develop unrealistic expectations, which often result in unfair complaints about the practitioner’s care.
An area often minimized prior to medical care is the recovery period. Prior to treatment, the physician should discuss any limitations or unwelcome surprises that may arise. Often the focus is on early medical issues (e.g., pain, possible infection, drainage), but it is valuable for the patient to also understand what life will be like for a longer period of time. Perhaps they will require readily accessible restrooms or will not be able to perform household activities. Finally, physicians will strengthen understanding and reduce potential complaints by including family members or friends in the discussions.


Professor Warns of Death by Pooch Smooching? 01/26/2011 A veterinary professor has written an article for a scientific journal showing that people who allow their pets to lick them, give them "kisses" or sleep with them are at risk for a variety of diseases known as zoonoses. Zoonoses ? What the heck? Is this what what happens when you have zoonose?
According to a University of California, Davis professor and his fellow researchers, the risks associated with smooching your dog or cat, or even letting them sleep on your bed, can range from the mundane to the life-threatening, particularly among infants and people whose immune systems have been weakened by disease, chemotherapy or other medicines.
Okay, okay - we get that, but conversely, I'm thinking that the health benefits of smooching our pets or allowing them to share our beds with us far outweigh the risk of zoonose...right? Given that recent studies indicate that 50% of all dog owners and up to 75% of all cat owners sleep with their pets, it sounds like most of us pet lovers are willing to take the risk!What do you think?
As a animal lover, I'm all for an occasional lick from my pooch on the cheek or forehead, but I must draw the line at those who literally make-out with their dogs, essentially allowing their pet to conduct a tooth enamel cleaning..that's what a toothbrush is for. (See Exhibit A). What do you think ?


Presentation coaching is critical for any executive wanting to deliver impactful presentations that influence audiences to act. Great ideas and charismatic personality alone won't move people to action. You need the confidence in your message and the ability to engage with your audience to get the results you want.
Each presentation coaching initiative is developed to compliment the communication coaching program. You'll learn and put to practice active listening and other communication techniques on audience and group dynamics, and to adapt to any situation to influence more people more frequently. Coaching is tailored to each presenter's strengths so you'll be able to successfully engage with the audience in your own words.
Connie's proven method takes you beyond experience alone, and helps you grow your presentation skills through evaluated experience. This approach will greatly improve your confidence, helping you adapt to any situation and ensure your messages stick.
When you're presentations connect with, convey to, and convince your audience, you'll influence people to positive action and get the results you want.
Every engagement is customized to your specific style and abilities. We'll bring out and enhance your inherent strength.
As you watched the London Olympics, you may have wondered, "Why does one athlete reach her golden goal while another with equal talent falters?" Sports psychologists tell us the athlete who hauls in the hardware has learned to manage her anxiety. Same with influential leaders and presenters. After a decade of coaching executives, I've learned the key is to manage your anxiety, not try to control it. Managing and controlling are two different mindsets. If you manage your anxiety, you'll stay focused, which radically reduces your stress and improves the outcome. If you try to control it, you give the anxiety too much power. Trying to control your nerves while delivering a presentation makes you vulnerable because...
It was the silence heard around the world: Rick Perry's brain freeze. Perry's mental cramp during the GOP presidential debate stole the show and was quickly hailed as one of the worst memory meltdowns in history. It was a cringe-inducing 53 seconds as Perry scrambled to recall the name of the third federal agency he'd shut down, to no avail.


All equipment used for the production and transportation of Roundup Ready alfalfa must be cleaned before it's used for conventional alfalfa, and the transgenic hay or silage must be segregated and clearly labeled. Those are among the Roundup Ready alfalfa production requirements outlined in a July 12 administrative order issued by USDA's Animal and Plant Health Inspection Service (APHIS). The order was mandated in the May 3 permanent injunction that outlawed the planting of Roundup Ready alfalfa until USDA completes an environmental impact statement. The judge in the case ruled that existing Roundup Ready alfalfa fields can continue to be grown, harvested and sold, provided safeguards are implemented to minimize commingling of Roundup Ready and conventional alfalfa.
Before moving mowing, raking, merging, baling or stacking equipment from a Roundup Ready to a non-Roundup Ready field, growers and custom harvesters must "sweep, blow with forced air, or wash exterior parts clean," the order says. The same procedure is sufficient for choppers; no internal cleaning is needed. For square balers, the first three bales made in a non-Roundup Ready field must be removed and stored with Roundup Ready alfalfa from the previous field. Wagons and trucks used to haul the crop must be swept clean after they're unloaded, and buyers must be notified if the hay or silage they're buying contains Roundup Ready alfalfa. To read the order, which includes detailed instructions for cleaning Roundup Ready alfalfa seed-handling equipment, click: www.aphis.usda.gov/biotechnology/alfalfa.shtml. Then scroll down to "View the July 12, 2007 APHIS Administrative Order."


Truckers/users of lime must comply with DEQ/MI Department of Agriculture regulations.
A brief outline of the applicable regulations are as follows:
Truckers: the same regulations for hauling quarry lime apply. You may need to take steps to prevent blowing of dust from the truck.
Users: the nutrient loading should be accounted for in your fertilizing program. The sugarbeet lime contains: Nitrogen 5.5 pounds per ton, Phosphorus 1.0 pound per ton, Potassium 0.36 pounds per ton, Calcium 570 pounds per ton (80% as CaCO3 or limestone), Organic content 8%, Moisture content 10%-15%, and Micro nutrients typical background levels.


Corpora Space is about collaboratively curating and exploring large-scale corpora. By curation we mean "the activity of managing and promoting the use of data from its point of creation, to ensure it is fit for contemporary purpose, and available for discovery and re-use." (Lord 2004) This involves both the enrichment and maintenance of content and metadata. By exploration we mean discovery, analysis, visualization, and ways of generating new results and provoking new research questions. Curation is doing things to texts; exploration is doing things with texts.


User Login: A group of Irish economists have an interesting joint article in today’s Irish Times. It is available here. It usefully goes beyond the rather sterile austerity/no austerity debate to focus mainly on the mix of adjustments.
Drawing on the available evidence, the article notes that fiscal consolidation measures lead to slower growth and job losses.
The evidence is clear: contractionary fiscal policy does indeed restrict economic activity and employment.
The austerity-focused policies being pursued in Europe and in Ireland will continue to drive down employment and living standards, while embedding high levels of long-term unemployment in the economy.
However, the article does not claim that consolidation is unnecessary (though it does not offer a preferred time path for bringing the deficit down), but rather focuses on the mix of consolidation and financing measures. The authors argue for a mix that involves higher capital spending and higher taxation aimed primarily at higher income individuals. (For the medium term, they also argue for higher social expenditures financed partly by increased PRSI contributions.)
Such an investment programme must be accompanied by “smart” fiscal consolidation, focusing on the least contractionary forms of fiscal adjustment. This requires progressive and equality-proofed taxation targeting high-income groups, property assets, unproductive activity and passive income, as well as environmental measures.
In the medium term, we should explore the potential of social insurance and local taxation to broaden the tax base while providing real benefits in return. PRSI can be expanded and combined with general taxation to provide free universal healthcare and earnings-related pensions. Stronger local taxation has the potential to be more accountable while providing investment in services responsive to local needs.
The mix of adjustments is also receiving recent attention in the international debate. For differing perspectives on the most effective mix from a macroeconomic perspective see Alberto Alesina and Francesco Giavazzi here and Simon Wren-Lewis here.


This concentration explores the processes of tradition that move through multiple expressive forms, such as folktales, folk beliefs, folk medicine, folk art, folksong, and literature. A discipline based on ethnographic fieldwork, folklore offers students a chance to work in communities and collect living traditional materials that are critical to human identity and values. Interdisciplinary by nature, folklore thrives on local particularities and compelling global connections. Internships in the many Washington, D.C., metropolitan area folklore organizations are central to students’ experiences.
This course of study prepares students for careers in cultural agencies, governmental organizations, and teaching institutions, and advanced study in the humanities.


The Rio Conventions Pavilion (RCP) continued on Thursday, 14 June 2012, convening for Africa Day, and Indigenous Peoples and Local Communities Day. Three sessions were held addressing: economic valuation of land (EVL) - an approach to advance sustainable development in the context of a green economy; facilitating green growth in Africa - perspectives from the African Development Bank (AfDB); and the contribution of traditional knowledge to climate mitigation and adaptation.
ECONOMIC VALUATION OF LAND: AN APPROACH TO ADVANCE SUSTAINABLE DEVELOPMENT IN THE CONTEXT OF A GREEN ECONOMY
Co-chaired by Aly Abou-Sabaa, AfDB, and Simone Quatrini, Global Mechanism, the session was moderated by John Soussan, Offering Sustainable Land-Use Options (OSLO) Consortium.
Quatrini noted increases in foreign direct investment (FDI) in land acquisition as “a potential catalyst for the African green revolution,” highlighting the concern about hidden costs for society and environment from unsustainable land use. Quatrini explained the OSLO Consortium seeks to unlock responsible investment by providing incentives and safeguards to investors while emphasizing: costs of inaction; net economic benefits from internal rates of return; and social, environmental and future values.
Soussan highlighted the economic case for investing in sustainable land management (SLM). He emphasized the need for policymakers to incorporate the full value of land resources and the wide range of ecosystem values that they generate into national accounting systems.
Abou-Sabaa noted that Africa has no choice but to manage its natural resources sustainably and build resilience to the increased incidence of droughts and floods, and desertification. Underlining that the notion of valuing ecosystem services is relatively new, he called for a gradual approach in introducing the concept in order to ensure buy-in from key stakeholders.
Elijah Phiri, University of Zambia, presented a case study on the economic land valuation in Zambia. He highlighted the contribution of land use to the economy including, agriculture, forestry, fisheries and wetlands, reflected by the distribution of Zambia’s resources into these sectors. He also observed the highest economic value is carbon sequestration in forestry and wetlands. Noting the economic value of these ecosystem services is estimated at US$ 240 million, Phiri emphasized that failure to address rapid land degradation can have negative economic affects.
William Ehlers, the Global Environment Facility (GEF), described GEF’s investments over the last two decades through the Land Degradation Focal Area as a major catalyst of innovation in SLM, leveraging an additional US$ 2 billion in co-financing. He highlighted this strategy includes explicit links between SLM and human well-being, establishing a foundation for improving the livelihoods of millions of rural people who rely on agriculture and livestock management. He emphasized the focus on agriculture, rangelands and forest landscapes where the potential for maximizing global environment and development are greatest, and the value-added of land-based investments will show the greatest returns in a Green Economy.
Andrew Seidl, IUCN, spoke on IUCN’s recent experience in economic valuation and development. Noting that this involves “recognizing value, demonstrating value and capturing value,” he highlighted a global-level assessment linked to the Convention on Biological Diversity (CBD) Target 15 that found US$ 84 billion global annual net benefit of forest landscape restoration. Seidl highlighted challenges including: inadequate local technical and human capacity; methodological issues such as “answering the right questions,” transferability and scaling, and dealing with communal tenure systems; and political considerations such as the misuse of information, and ensuring distribution and equity are taken into account.
Timo Busch, ETH Zurich, presented on the private sector perspective. He observed that the growing interest in ecosystem services among large institutional investors and a rising number of socially-responsible investors provide important opportunities for investing in sustainability. Noting, however, that the short-term focus of financial markets presents a greater challenge, he suggested that it might be necessary for valuation processes to explore appropriate policy incentives for longer-term investments, modeled for instance on feed-in tariffs within the renewable energy sector. In conclusion, he highlighted government involvement in securing sustainable investments and negative externalities in the value chain as critical issues for investors.
During discussions, panelists responded to questions on environment and gender equity inter-linkages, with Soussan observing “women are principle users but not controllers of land resources” and Abou-Sabaa acknowledging the need to increase inclusiveness in development and to distribute economic growth in a more equitable manner, including through better shares of land use. Seidl noted the incorporation of women and vulnerable populations is still in the early awareness raising stages with a long way to go.
FACILITATING GREEN GROWTH IN AFRICA: PERSPECTIVES FROM THE AFRICAN DEVELOPMENT BANK
Daniel Makokera, CEO, Pamuzinda Productions, South Africa, introduced the panel. Kate Raworth, Oxfam, presented a vision for inclusive and sustainable economic development as a safe and just space for humanity. Raworth noted scientists’ emphasis on global climate change, soil degradation and biodiversity loss where environmental boundaries have already been over stepped. She stressed the need to focus beyond green limits and that national level analysis must also include assessment of the social foundations, including meeting human rights to resources such as food, water and jobs. She stated all countries are developing nations, because no country yet lives in the safe green economic space.
Frank Sperling, AfDB, provided perspectives on facilitating green growth in Africa, which he defined as a transformative and iterative process towards more sustainable pathways. He pointed out that Africa’s bountiful natural resources and low ecological footprint at present offer real opportunities for this transition, noting that the priorities for the continent include: addressing the infrastructure deficit; sustainable management of natural resources; enhancing resilience to natural disasters; and food security. He noted that meeting these needs requires strong political leadership, an enabling regulatory environment, multi-stakeholder engagement and a focus on the quality of growth. Stressing that African countries run the risk of lock-in to unsustainable pathways, he called for adequate financing of the upfront investments required in this transition.
During the panel discussion, Anthony Okon Nyong, AfDB, stressed that green growth should be a priority for all countries. Highlighting initiatives by Japan, Junya Nakano, Ministry of Foreign Affairs, Japan, remarked that green growth offers additional opportunities for leapfrogging Africa’s development challenges while avoiding the negative social and environmental impacts of economic growth. Noting that some of the misconceptions around the concept arise from a narrow interpretation of the green economy as an “anti-growth” development trajectory, Sperling emphasized the need for each country to map its own green growth path.
Responding to a question about reducing emissions from deforestation and forest degradation’s (REDD) role in African green growth during discussions, Sperling stressed carbon as an asset and huge opportunity for Africa to benefit from global interest in carbon mitigation. He emphasized the need for capacity building to up-scale African project proposals to meet performance-based criteria to attract investments in REDD at a comparable level to Brazil and Indonesia. Abou-Sabaa explained how the AfDB serves as catalyst, covering upfront costs and providing technical and design support for project proposals. Okon Nyong emphasized that AfDB also finances public goods and development projects that may not recover all costs as required by private sector investments.
Raworth noted that besides finance, “we need an injection of creativity” and stressed that leadership on green growth should be taken by developed countries whose traditional economic growth model has neither solved poverty nor been sustainable. She explained an inclusive and sustainable development course would allow low-income countries to focus on poverty alleviation while avoiding being locked into unsustainable pathways, learning from emerging economies that have the highest potential to transform resource use while increasing well-being. Noting the need for political will at all levels of governance for such a transition, Okon Nyong lauded the Brazilian government for its leadership and engagement in South-South Cooperation with the AfDB.
THE CONTRIBUTION OF TRADITIONAL KNOWLEDGE TO CLIMATE MITIGATION AND ADAPTATION
Moderator Johnson Cerda, Conservation International, noted the importance of respecting the rights of indigenous peoples, underscoring that indigenous peoples have valuable traditional knowledge that could be contributed to international processes. He said Conservation International has started a fellowship programme to encourage the study of traditional knowledge in specific indigenous communities and how it could contribute to multilateral negotiations. Cerda said the panel would also address work on indigenous peoples by UN Educational, Scientific and Cultural Organization (UNESCO) and a case study on Central America.
Diana Nacimiento, Conservation International Fellow, said her project supports the recovery and restoration of indigenous lands in the Kaingang territory in Brazil. She highlighted that Kaingang territory has a complicated background due to colonization, noting that in 1949 17000 hectares were taken from the indigenous peoples and turned into a state park. She stressed that the indigenous population relied on this land for their livelihoods, but said that in 1989 the state park was abandoned by the government and reverted to indigenous management. She noted the resulting challenges, including illegal logging and exploitation, are harming the Kaingang area, which she characterized as “an island of biodiversity floating in a sea of monocultures.” She said the objective of her study was to develop appropriate methodologies in consultation with local communities, noting that external agencies with proposals of recovery and restoration do not consider what local communities desire or local and indigenous knowledge. She highlighted the role of intergenerational transfer of knowledge, in particular as outside cultural influences creep in, and noted the goal of “rescuing” traditional stories and knowledge to preserve them for future generations. She said a next step is to engage indigenous school children in planting native species to restore degraded areas.
Jennifer Rubis, UNESCO, announced the book launch of “Weathering Uncertainty: Climate Change Assessment and Adaptation” and explained that Climate Frontlines supports the voices of indigenous peoples and promotes traditional knowledge in climate adaptation working at the science and policy level. She noted that after having claimed “full participation in issues that affect us” indigenous peoples’ knowledge has been recognized in several texts including the UN Framework Convention on Climate Change and the CBD. Rubis reported that while their communities can be targets of interventions, indigenous people “do not see themselves as passive victims but actively engage: they have negotiated; resisted; and adapted.” She highlighted the need for flexibility in programming and climate financing. She explained that moving beyond recognition towards respect for indigenous traditional knowledge that challenges reductionism would require a conceptualization of traditional knowledge on the same footing as science, giving them equal inputs and looking at complementary areas that can benefit communities.
Jadder Lewis, Center for the Indigenous Peoples Autonomy and Development, Nicaragua, lamented the many misconceptions at the heart of mainstream approaches to supporting traditional knowledge. He noted that ignorance of how indigenous social institutions work and the assumption that they want to “conserve nature for the sake of it” has resulted in an overemphasis of the protected area approach, which often exacerbates the marginalization of indigenous communities and increases poverty. He stressed the need for support programmes to strengthen local governance capacities by enhancing equitable access to the benefits of ecosystem services and involving them more meaningfully in global value chains. He also highlighted the role of education and exchanges among indigenous communities in protecting local institutions and enabling indigenous peoples to consolidate their territories as viable economic, social and political systems.
In the ensuing discussion, panelists emphasized the need to strengthen learning alliances between indigenous and academic communities and noted the opportunities that South-South cooperation offers for scaling up good practices.


OLDWICK, N.J., Dec 13, 2012 (BUSINESS WIRE) -- A.M. Best Co. has affirmed the financial strength ratings (FSR) and issuer credit ratings (ICR) of the insurance subsidiaries of UnitedHealth Group Incorporated (UnitedHealth) (Minnetonka, MN) [NYSE: UNH]. Additionally, A.M. Best has upgraded the FSRs to A (Excellent) from A- (Excellent) and the ICRs to "a" from "a-" for the following subsidiaries of UnitedHealth: Health Plan of Nevada Inc. (Las Vegas, NV) and Sierra Health and Life Insurance Company Inc. (Los Angeles, CA). Concurrently, A.M. Best has affirmed the ICR of "bbb+" and debt ratings of UnitedHealth. The outlook for these ratings is stable.
A.M. Best also has assigned debt ratings of "bbb+" to $625 million 0.85% senior unsecured notes, $625 million 1.4% senior unsecured notes, $625 million 2.75% senior unsecured notes and $625 million 3.95% senior unsecured notes all issued on October 17, 2012 by UnitedHealth. The outlook assigned to these debt ratings is stable.
Additionally, A.M. Best has withdrawn the FSR of A (Excellent) and ICR of "a" of PacifiCare Life Assurance Company (Denver, CO), as the company is inactive.
The rating affirmations for the organization reflect its premium growth, strong earnings, highly liquid assets, ability to adjust to market changes and high degree of technological innovations. These strengths are further supported by the significant market presence, diverse non-insurance operations and financial strength of UnitedHealth. The organization has a wide geographic reach and a diversified portfolio, which includes commercial, Medicare and Medicaid managed care products. UnitedHealth also continues to expand its profitable non-regulated businesses and its share of non-regulated earnings remains significantly higher compared to its peers. Furthermore, UnitedHealth's non-regulated subsidiaries are well positioned for continuous revenue growth. Non-regulated earnings enhance UnitedHealth's financial flexibility by contributing to its already strong interest coverage as well as reducing its reliance on dividends from its regulated subsidiaries.
Partially offsetting these positive rating factors are A.M. Best's concerns, which arise from UnitedHealth managing to a lower level of risk-based capitalization at its regulated entities. Following consistently high dividends to UnitedHealth, the level of risk-based capitalization at the leading regulated subsidiary, UnitedHealthcare Insurance Company (UHIC) (Hartford, CT), though improved in 2011 remains low compared to its peers and A.M. Best's expectations. However, this is offset by the parent's ability to support the legal entities through capital infusions.
A.M. Best does acknowledge that UHIC is a significant source of dividends and consistently produces strong operating results. In addition, UHIC's improved ability to predict claims trends and better fund transfer mechanisms within UnitedHealth enhances the entire organization's ability to support each subsidiary and mitigate lower capitalization concerns. Although A.M. Best expects earnings to remain strong, operating margins at UnitedHealth, in line with the industry trend, have declined compared to its historical levels and are likely to moderate further. The earnings deterioration is due to competitive pressure, implementation of minimum loss ratio requirements related to the Patient Protection and Affordable Care Act and the changing business mix within the organization's growing share of Medicare and Medicaid products where the margins are lower. In the near term, A.M. Best notes that UnitedHealth's financial flexibility is reduced because of the expected increase in its financial leverage as well as the increase of the level of goodwill in its related acquisition of Amil Participacoes SA (Brazil). However, both UnitedHealth's financial leverage and goodwill are in line with peers. Furthermore, UnitedHealth has proven its ability to quickly reduce financial leverage.
The upgrading of the ratings for Health Plan of Nevada Inc. and Sierra Health and Life Insurance Company Inc. acknowledges their strong earnings, improved capitalization and integration into UnitedHealth.
Key rating drivers that may lead to positive rating actions for UnitedHealth and its subsidiaries include substantial earnings growth, improvement in risk-adjusted capital at regulated entities and reduction in financial leverage. Key rating drivers that may lead to negative rating actions include a sizeable decline in risk-adjusted capital at UnitedHealth's lead operating entity, UHIC, significant weakening of operating performance across the enterprise, an increase in financial leverage beyond A.M. Best's expectations or substantial deterioration in interest coverage.
For a complete list of UnitedHealth Group Incorporated and its subsidiaries' FSRs, ICRs and debt ratings, please see www.ambest.com/press/121311unitedhealth.pdf.
The methodology used in determining these ratings is Best's Credit Rating Methodology, which provides a comprehensive explanation of A.M. Best's rating process and contains the different rating criteria employed in the rating process. Key criteria utilized include: "Understanding BCAR for Life/Health Insurers"; "Insurance Holding Company and Debt Ratings"; "Rating Members of Insurance Groups"; "Risk Management and the Rating Process for Insurance Companies"; "Rating Commercial Paper"; and "Evaluating Country Risk." Best's Credit Rating Methodology can be found at www.ambest.com/ratings/methodology.
Founded in 1899, A.M. Best Company is the world's oldest and most authoritative insurance rating and information source. For more information, visit www.ambest.com.
Copyright (C) 2012 by A.M. Best Company, Inc. ALL RIGHTS RESERVED.
SOURCE: A.M. Best Company, Inc.
A.M. Best Co. Doniella Pliss, 908-439-2200, ext. 5104 Senior Financial Analyst doniella.pliss@ambest.com or Kenneth Frino, 908-439-2200, ext. 5012 Group Vice President kenneth.frino@ambest.com or Rachelle Morrow, 908-439-2200, ext. 5378 Senior Manager, Public Relations rachelle.morrow@ambest.com or Jim Peavy, 908-439-2200, ext. 5644 Assistant Vice President, Public Relations james.peavy@ambest.com Copyright Business Wire 2012


a1 School of Social Sciences, University of Queensland, Australiaa2 Institute of Social Studies, Erasmus University Rotterdam, the Netherlandsa3 Department of Geography, Environmental Management & Energy Studies, University of Johannesburg, South Africaa4 Center for the Study of Institutional Diversity, Arizona State University, USAa5 Institute for Development Management and Policy, University of Manchester, Manchester, UKa6 Institute for Public Service, Seattle University, Seattle, WA, USAa7 School of Geography and Environmental Science, Monash University, Melbourne, Australiaa8 Department of Geography, Pennsylvania State University, USAa9 Faculty of Architecture, Design and Planning, University of Sydney, Sydney, AustraliaSUMMARY
Community-based natural resource management (CBNRM) has been on the ascendancy for several decades and plays a leading role in conservation strategies worldwide. Arriving out of a desire to rectify the human costs associated with coercive conservation, CBNRM sought to return the stewardship of biodiversity and natural resources to local communities through participation, empowerment and decentralization. Today, however, scholars and practitioners suggest that CBNRM is experiencing a crisis of identity and purpose, with even the most positive examples experiencing only fleeting success due to major deficiencies. Six case studies from around the world offer a history of how and why the global CBNRM narrative has unfolded over time and space. While CBNRM emerged with promise and hope, it often ended in less than ideal outcomes when institutionalized and reconfigured in design and practice. Nevertheless, despite the current crisis, there is scope for refocusing on the original ideals of CBNRM: ensuring social justice, material well-being and environmental integrity.
(Received September 02 2009)
(Accepted December 18 2009)
(Online publication June 14 2010)


This article provides a broad theoretical and clinical overview of thethree regional prefrontal syndromes. An understanding of the extendedneural connectivity of the prefrontal cortex provides the template fordescribing the three distinct prefrontal syndromes (dysexecutive,disinhibited, and apathetic types), each associated with dysfunction in oneof the three prefrontal regions. This clinical approach should aid theclinician in determining the etiology of the specific regional prefrontalsyndrome and developing effective treatment strategies.


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Portland cement concrete (PCC) structures deteriorate with age and need to be maintained or replaced. Early detection of deterioration in PCC (e.g., alkali-silica reaction, freeze/thaw damage, or chloride presence) can lead to significant reductions in maintenance costs. However, it is often too late to perform low-cost preventative maintenance by the time deterioration becomes evident. Non-destructive evaluation (NDE) methods are potentially among the most useful techniques developed for assessing constructed facilities. They are noninvasive and can be performed rapidly. Portland cement concrete can be nondestructively evaluated by electrically characterizing its complex dielectric constant. The real part of the dielectric constant depicts the velocity of electromagnetic waves in PCC. The imaginary part describes the conductivity of PCC and the attenuation of electromagnetic waves, and hence the losses within the PCC media. Dielectric properties of PCC have been investigated in a laboratory setting using a parallel plate capacitor operating in the frequency range of 0.1MHz to about 40MHz. This capacitor set-up consists of two horizontal-parallel plates with an adjustable separation for insertion of a dielectric specimen (PCC). While useful in research, this approach is not practical for field implementation In this research, a capacitance probe has been developed for field application. The probe consists of two planar conducting plates and is made of flexible materials for placement on exposed surfaces of the specimens to be tested. The calibration method of both capacitive systems has been extensively studied to minimize systematic errors in the measurement process. These two measurement systems will be discussed and compared to one another on the basis of sensitivity and measurement repeatability.


Internal combustion engines generate globe-warming CO2 and create air pollution in cities. They're inefficient, too, as a large slice of the energy stored in their fuel is wasted as heat during combustion and braking. Alternative cars driven by electric motors, which can be powered by batteries or fuel cells, will unquestionably play a central role in reducing transport emissions.
In Manchester, the case for alternative vehicles was made by Hugo Spowers of Riversimple, a company that has produced a prototype two-seater city car running on hydrogen gas. Even if the hydrogen is produced using natural gas, the emissions of the car are many times lower than those of a petrol-hybrid model.
The panel members believe that electric rather than hydrogen cars will dominate the future, but they were impressed with many elements of the Riversimple project. These include the use of lightweight composite materials rather than steel in the chassis, and the company's plan to lease rather then sell their cars, something that removes a major financial barrier for the consumer.


This paper uses factor models to identify and estimate distributions of counterfactuals. We extend LISREL frameworks to a dynamic treatment effect setting, extending matching to account for unobserved conditioning variables. Using these models, we can identify all pairwise and joint treatment effects. We apply these methods to a model of schooling and determine the intrinsic uncertainty facing agents at the time they make their decisions about enrollment in school. Reducing uncertainty in returns raises college enrollment. We go beyond the “Veil of Ignorance” in evaluating educational policies and determine who benefits and loses from commonly proposed educational reforms.
JEL Code: C 31


For large-scale, multi-tenant cloud service providers, balancing the performance and capacity expectations poses a unique challenge in the storage arena.
While modern hypervisors have advanced to the point where that performance/capacity balance can be achieved in compute, storage has lagged behind, according to SolidFire, a three-year-old startup based in Boulder, Colo., that offers a high-performance storage architecture catering to cloud service providers with massive, multi-tenant deployments.
For SolidFire's customers, the "objective is not about delivering massive amounts of performance to [a] single application at any cost. Instead, these providers are focused on profitably delivering consistent performance to thousands of applications [and] tenants at the same time," explained Dave Wright, the company's founder and CEO.
"Conversations with service providers throughout the past year have only reinforced our belief that this customer segment is unique in its scale, business model and the solutions that it requires," Wright said.
SolidFire's SSD storage systems are meant to address a number of pain points common to large cloud service providers, including distinct challenges associated with multi-tenancy architectures deployed at a massive scale. Wright noted recently that "scale is not a checkbox feature," but rather a set of challenges that span across all facets of a system, highlighted by capacity and performance, which SolidFire notes are often at odds with one another. Flash systems, for example, offer robust performance but can fall short in their ability to scale capacity across a deployment. Hard-disk systems, in contrast, offer abundant capacity scale but are generally weaker on performance.
Then, too, service providers are challenged by the expectation of delivering predictable performance while retaining a measure of visibility at the application level.
"Individually, each of these factors impose unique pressures on the IT environment," Wright said. "Taken together, they demand an entirely new approach."
For SolidFire, that approach comes in the form of a performance virtualization technology that facilitates what the company describes as a more granular level of provisioning, enabling service providers to efficiently allocate storage resources to the unique demands of a given application.
SolidFire systems run the company's Element operating system, which offers a standard feature set that includes data protection, real-time compression and real-time deduplication.
Additionally, SolidFire offers a guaranteed quality-of-service (QoS) that enables customers to configure minimum, maximum and burst IOPS. Once set, those configurations can be adjusted through SolidFire's API to modify the system's performance, with the changes taking effect instantly.
"Armed with [a] previously unavailable level of performance control, service providers can now confidently offer hard SLAs around storage performance," Wright said.
SolidFire's clusters are designed to scale incrementally, so that as additional nodes are incorporated, each brings an equal balance of capacity and performance without requiring an elaborate reconfiguration.
Wright, whose former firm JungleDisk was acquired by Rackspace, believes that his latest venture is well positioned as cloud computing continues its march into the mainstream and the use cases and business value of the technology grow more apparent.
"We are charging hard toward general availability later this year," Wright said. "This has us mostly focused on product development and servicing key early access customers."
Additionally, the firm is working to achieve certifications from an array of cloud computing components, continuing in the vein of SolidFire's recent announcement that it had completed an initial integration with the open source cloud operating system OpenStack.
Kenneth Corbin is a freelance writer based in Washington, D.C. He has written on politics, technology and other subjects for more than four years, most recently as the Washington correspondent for InternetNews.com, covering Congress, the White House, the FCC and other regulatory affairs. He can be found on LinkedIn here


Tribenzor well-tolerated among older patients in study PARSIPPANY, N.J. — A drug made by Daiichi-Sankyo was safe and effective in maintaining reductions in blood pressure in older patients, according to a new study presented at the American Society of Hypertension’s 26th annual meeting in New York.
The “TRINITY” study of Tribenzor (olmesartan medoxomil, amlodipine besylate and hydrochlorothiazide) showed the drug was well-tolerated and effective in patients ranging in age from younger than 65 years to older than 65 years, after a year.
“Older patients generally have a more difficult time achieving recommended blood pressure levels and as a result, their hypertension often remains uncontrolled,” University of Alabama medical professor Suzanne Oparil said. “However, this analysis shows that long-term blood-pressure control can be achieved safely and effectively across all studied dosing strengths with a triple combination therapy regardless of age.”


2009 Fortune 500 rank: 143In the past year, Kathy Soenderby has become a more visible presence for the 300 workers at Union Pacific's West Colton, Calif., shop.
As the location's occupational health nurse, her contact with employees has increased 30% in the last six to eight months. Her scope has also broadened, expanding beyond nurse to life counselor, as more employees report stress-related symptoms such as high blood pressure and sleepless nights. They tell her they're worried about job security and the economy.
"This is a complication that's not just unique to Union Pacific but is a sign of the times," says Soenderby. "Our focus is to be a little bit more like social workers."
At the railroad company, which has furloughed 4,000 of its 48,000 employees through mid-April, reducing stress and distractions are essential to safety on the job. Along with tackling anxiety-related health issues, Soenderby has created a space where workers can vent their fears. She helps run a peer-support network and regularly screens videos about such topics as resiliency and depression. She collaborates with managers, helping them become aware of the workers' concerns so they can be addressed and quash rumors.
"So many times I feel like the employees are keeping a lot of things to themselves," she says. NEXT: Dan Bickett - CarMax


On January 2, President Barack Obama signed a bill designed to avert the fiscal cliff. At the same time, to slightly less fanfare, he averted the “milk cliff.” By extending the 2008 farm bill another nine months, he prevented the automatic revival of a 1949 law requiring the federal government to buy dairy products under certain circumstances, effectively setting a floor for the price of milk. While the actual fate of milk prices was far from clear, the milk cliff provided cover to continue the practices of subsidizing wealthy farmers, to the detriment of just about everyone else. The time has come, writes Veronique de Rugy, to end farm subsidies once and for all.
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Oklahoma State University Center for Health Sciences - College of Osteopathic Medicine City: Tulsa State: OK Links:Commentary:This institution participated for the first time this year in the AMSA PharmFree Scorecard. They supplied AMSA with a previously approved policy conflict of interest policy after the submission deadline had passed. This policy is currently being evaluated and the final grade increased from an F to a D.
This institution did not provide any new or additional for the 2012-13 AMSA PharmFree Scorecard.
Gifts & Meals Policy does not adequately address small gifts and does not explicitly discuss on-site meals. Consulting relationships Policy does cover consulting in its disclosure policy and all consulting relationships are subject to University review. However, there are not specific provisions or frameworks related to creating formal consulting contracts or language to ensure payment is appropriate for tasks. Instead, these issues would be reviewed on an individual basis. Industry-funded speaking relationships Institutional review is required for all potential conflicts of interest, which would include speaking engagements. No explicit discussion of "speaker's bureaus" is included. Disclosure The policy includes an extensive discussion of disclosure policies. However, disclosures are not publically reported and instead are considered confidential. Pharmaceutical samples Samples are not explicitly discussed in this policy. Purchasing & Formularies Employees are required to disclose potential conflicts of interest in purchasing decisions. However, the policy does not explicitly state that committee members with financial conflicts of interest will be forbidden from participating in purchasing decisions. Instead, this would be done on a case-by-case basis. Industry Sales Representatives Policy does not address the presence of industry sales representatives at the school/medical center. On-campus Education This policy does not explicitly address on-site education and industry influence. Attendance at Industry-Sponsored Lectures & Meetings Off-Campus Industry support for travel/off site education would be covered under the disclosure policy, however this type of support is not banned outright. Industry Support for Scholarships & Funds for Trainees The disclosure policy covers scholarships/trainee funds, however there should be more regulation of these funds written into the policy. Medical school curriculum This policy does not include any details on the school's conflict of interest curriculum. Do the policies specify an oversight mechanism? The Appropriate Administrator for each employee unit provides oversight. Are there explicit sanctions for noncompliance? Potential consequences are delineated in the policy under the "Consequences of Policy Violations" section.
Model policy Good progress toward model policy No policy, or policy unlikely to have a substantial effect on behavior Did not report Policy not relevant to this institution (e.g., does not make purchasing decisions)


Perceptible changes in regional precipitation in a future climate Geophys. Res. Lett. , Vol. 39, No. 5. (1 March 2012), pp. n/a-n/a, doi:10.1029/2011gl050738 Key: citeulike:12057074Formatted Citation Show HTML Likes (beta) Abstract Evidence is strong that the changes observed in the Earth's globally averaged temperature over the past half-century are caused to a large degree by human activities. Efforts to document accompanying precipitation changes in observations have met with limited success, and have been primarily focussed on large-scale regions in order to reduce the relative impact of the natural variability of precipitation as compared to any potential forced change. Studies have not been able to identify statistically significant changes in observed precipitation on small spatial scales. General circulation climate models offer the possibility to extend the analysis of precipitation changes into the future, to determine when simulated changes may emerge from the simulated variability locally as well as regionally. Here we estimate the global temperature increase needed for the precipitation “signal” to emerge from the “noise” of interannual variability within various climatic regions during their wet season. The climatic regions are defined based on cluster analysis. The dry season is not included due to poor model performance as compared to measurements during the observational period. We find that at least a 1.4°C warmer climate compared with the early 20th century is needed for precipitation changes to become statistically significant in any of the analysed climate regions. By the end of this century, it is likely that many land regions will experience statistically significant mean precipitation changes during wet season relative to the early 20th century based on an A1B scenario.


Taylor Farms Retail, Inc. has issued what is considered a voluntary recall of spinach products due to possible E. coli contamination.
The spinach that might be contaminated with E. coli was reported to be in 39 states, which include the following: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Illinois, Iowa, Kentucky, Kansas, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, New York, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.
The recalled products from Taylor Farms Retail Inc. are sold under names such as Central Market Organics, Full Circle Organics, Marketside Organics, Simple Truth Organics and Taylor Farms Organic. These recalled packages are all marked with the best by date of February 24, 2013.
As with any recalled food item, customers may return the recalled spinach to the place of purchase for a complete refund. The recalled spinach should not be eaten in any manner. If someone has eaten the recalled spinach and feels this has caused a health issue, they should seek medical attention.
Ingesting a food contaminated with E. coli may cause symptoms such as stomach cramps and diarrhea. Some experience vomiting and may have a fever. Those wishing to contact Taylor Farms Retail, Inc. with questions about the recalled spinach may call 855-293-9811.


Foreclosure rates in the greater Miami area remain astonishingly high, but they’re headed in the right direction. In March, 13....
A debate is stirring in Michigan over legislation that aims to shorten the redemption period for homeowners in foreclosure, The...
The Obama administration’s latest housing scorecard reflects an improving market, with the number of underwater borrowers falling 5.8% in the first quarter to 11.4 million from 12.1 million the previous quarter.
The administration, citing data from Corelogic ($26.70 -0.48%), reported that a year earlier, 11.5 million borrowers were underwater.
However, the housing market remains on fragile ground.
Foreclosure starts and completions declined in May, though officials expect activity to increase in the coming months as firms lift delays in foreclosure processing. Also, the inventory of houses for sale remained low. At the current pace, it would take 6.6 months to sell the supply of existing homes on the market and 4.9 months to clear the new homes on the market.
Experts consider a six-month supply of homes to be a balanced market.
The inventory of existing homes for sale slid to 2.39 million in June from 2.47 million in May, according to data from the Department of Housing and Urban Development and the Treasury .
Home prices grew to $139,000 on average for June, compared to $135,900 in the previous month, according to Standard & Poor's /Case-Shiller data cited in the scorecard.
New home sales totaled 29,200 in June, up from 25,300 a year earlier. And existing home sales hit 364,200, up from 348,300 in the year-ago period. First-time homebuyer numbers grew to 145,500 from 138,300 in June 2011, according to the scorecard.
Foreclosure starts rose slightly to 64,100 in June from 63,900 the year before, according to the scorecard. Foreclosure completions, in contrast, fell during the same period to 54,300 from 68,900. (Click on graph to expand.)
Mortgage originations for the purchase of new homes declined to 493,000 in the second quarter from 541,800 in the year-ago period. Refinance originations rose to 1.23 million from 869,100 in that period.
Mortgage delinquency rates rose to 4.1% from 3.9% the previous month, but are below last year’s rate of 4.4%.
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Macroeconomic Forecast Puerto Rico June 2012 | Macroeconomic ForecastsPuerto Rico's debt load continues to rise. As of end-2011, we estimate total government debt of US$66.3bn, representing just over 100% of GDP. Moreover, in the first four months of 2012, the island sold US$4.8bn worth of bonds, as investors were attracted by a full exemption from federal, state and local income taxes. However, we believe this level of debt may become difficult to sustain in the long run, noting substantial imbalances in the economy. These include weak growth, with real GNP averaging just 1.8% over the next decade, a high unemployment rate (at around 15% as of April 2012) and a weak fiscal position.
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[show abstract] [hide abstract]ABSTRACT: The health system must develop effective solutions to the growing challenges it faces with respect to individuals who suffer with mental health disorders and addictions. The purpose of this study was to evaluate the usability and potential impact on outcomes of a knowledge translation system aimed at improving client-centered, evidence-based care for hospitalized individuals with schizophrenia.A pre-posttest design was used. The e-Volution-TREAT system was implemented on two inpatient units at a large mental health facility. Thirty-seven nurses, allied health workers, and physicians participated from two units. Data collection involved questionnaires, semistructured interviews, and observations. Thirty-eight consenting clients' outcome data were collected from organizational records.Overall, staff participants were very satisfied with the functions of the e-Volution-TREAT system. Barriers to using the system were identified by participants related to the work environment, to understaffing, equipment problems, discomfort with technology, and a focus on short-term rather than long-term goals. There was moderate uptake of guidelines related to social issues, and low uptake of guidelines related to family support and addictions. There were significant improvements in four client outcomes over time, specifically aggressive behavior, depression, withdrawal, and psychosis.In conclusion, users were overall satisfied with the e-Volution-TREAT system, although expressed challenges related to workload that interfered with time to utilize the system. It would be premature to conclude the change in client outcomes was related to the e-Volution-TREAT system without a randomized controlled trial with outcomes compared to a control group. Future research needs to incorporate strategies for modifying the context and engage clinicians who are in a position of influence to model change. Worldviews on Evidence-Based Nursing 03/2010; 7(3):174-84. · 1.24 Impact Factor


Full Article Birthmark Shape and Location Meanings Birthmarks, which are simply colored spots on skin, have long been suspected of having a meaning. Different cultures have different beliefs based on folklore and superstition.
Common Folklore Folklore suggests that what a woman was experiencing during pregnancy is imprinted on the child in the form of a birthmark. For instance, many believe that gazing upon an unattractive individual during pregnancy would result in either an unattractive baby or a baby with an unattractive birth mark, often a port wine stain. Others believe a birthmark is the result of something a pregnant mother wanted and did not receive.
Birthmark Location Has Meaning to Some
Common birthmark locations intertwined with folklore:
Abdomen: A greedy and selfish person Left breast: This person will enjoy success Right breast: This person will enjoy fortune Center of chest: This person will NOT enjoy fortune Chin:This person will enjoy success Left cheek: This person will have financial difficulties Right cheek: Indicative of someone who will enjoy a happy marriage Near mouth: This person will enjoy great wealth and happiness Right side of forehead: This person has great mental power Left side of forehead: This person likes to spend money Center of forehead: This individual is attractive to the opposite sex and has many love affairs. Birthmarks can have real meaning and can be indicative of serious medical conditions, particularly in they change in size, shape or color.
Congenital Nevus: This dark mole can indicate that individuals have a higher risk of skin cancer. Port-Wine Stain: This pinky colored birthmark often grows darker, and could indicate Klippel-Trenaunay syndrome or Sturge-Weber syndrome, both of which require medical attention. Strawberry birthmarks: When located near the eye, these can make it difficult to see and can be linked to glaucoma.


English 258. Introduction to Film Studies Current trends stemming from the globalization of the media and its accompanying media synergies make it untenable to view the cinema as a discrete, unitary phenomenon. This course addresses this phenomenon in a parallel manner by bridging the disciplinary divides between film theory, media and cultural studies. Conjoining theoretical and historical approaches to cinematic texts, institutions and audiences, this course explores the multidimensional nature of the cinema and its place in society: (1) as representational spaces with textual properties and reading protocols enabling the creation of “meaning,” (2) as a unique industry driven by political and economic agendas; and (3) as a social practice that audiences “do,” involving relations of subjectivity and power.
As such, we shall survey various approaches to the study of the cinema, and work through crucial questions regarding film analysis (e.g., what is the relationship between film and literature?), the political economy of the media (e.g., is the cinema a democratic institution?) and audience reception (e.g., what is a fan? Why do we adore “stars”?). By engaging these issues, this course will teach you not only how to engage critically with media texts, but also how to “talk” to the powerful media institutions that touch our lives.


Ask your MEPs to support the accurate labelling of ritually slaughtered produce
In the UK, up to two-thirds of kosher and halal meat is sold on into the general market but it is not labelled as such. In June 2010 the European Parliament agreed that meat and meat products derived from animals that have not been stunned prior to slaughter should be labelled as 'Meat from slaughter without stunning'. Unfortunately this was rejected by the European Council. The issue has now returned to the European Parliament, where amendments 353 and 359 to the EU 'Proposal for the Provision of Food Information to Consumers' calls again for meat derived from non pre-stunned animals to be labelled 'Meat from slaughter without stunning' Please write to your MEPs to urge them to support the amendments due to be debated on 11th April 2011.


Consumer math Consumer math comprises practical mathematical techniques used in commerce and everyday life. In schools, these techniques are often taught to students who are not planning a university education. In the United States, consumer math is typically offered in high schools, some elementary schools, or in some colleges which grant associate's degrees.A U.S. consumer math course might include a review of elementary arithmetic, including fractions, decimals, and percentages. Elementary algebra is often included as well, in the context of solving practical business problems. The practical applications typically include: changing money, checking accounts, budgeting, price discounts, markups and markdowns, payroll calculations, investing (simple and compound interest),[1] [2] taxes, consumer and business credit, and mortgages.
The emphasis in these courses is on computational skills and their practical application, with practical application being predominant. For instance, while computational formulas are covered in the material on interest and mortgages, the use of prepared tables based on those formulas is also presented and emphasized.
See also [edit] References [edit] Bibliography [edit] Brechner, Robert. (2006). Contemporary Mathematics for Business and Consumers, Thomson South-Western. ISBN 0-324-30455-2 T. R. Ittelson, (2009), "Financial Statements", Career Press, 2009.


In a significant jump, the U.S. oil market recorded significantly high profits, accompanied with significantly high net income, in the second quarter of the year 2010. The rise is directly attributed to the increase in the prices of petroleum and natural gas, for, during this fiscal quarter, oil prices reached $71 a barrel.
On Friday, Chevron Corporation scored profits of $2.70 a share, exceeding the $2.44 a share profits expected by Thomsen Reuters analysts. This rise tripled the Company’s profit, reporting net income of $5.41 billion. The oil giant recorded 2010 sales of $51 billion, soaring up from the $40 billion sales noted in 2009. These series of victories dashed last year’s poor performance, which resulted in Chevron discharging a big lot of its employees.
In addition, profits of Exxon Mobil Corporation showed a massive rise from 2009’s $4 billion profits, scoring $7.6 billion profits in 2010. Occidental Petroleum, as well, increased its earnings by 61% and its sales by 30%, during this lucrative second quarter of 2010. ConocoPhillips reported a rise in its share value from 57 cents to $2.77 a share.
Despite this marathon of growth, Fadel Gheit, a Senior Energy Analyst for Oppenheimer & Co. warned the investors that this climb will not last for long due to the slow pace of the economic recovery.
One particular Company remained out of the race, which is British Petroleum, recording net loss of around $15 billion, as a result of the oil spill in the Gulf of Mexico.
UK News Inquest into Death of Dylan Crean, 3, Finds Communication Failings between Agencies Denise Welch Shares Her Experience during Fight against Depression Toy Car Helps 16-Year-Old Girl Recover of Paralysis Lack of Support Makes Carers in Scotland Fail in Relationships Vodafone pays no corporation tax in UK for second consecutive year, despite earning over £5bn


This study is a qualitative enquiry into the experiences of grade 12 Business Studieseducators in the process of compiling school-based assessment portfolios for learners in2009. It answers the question: “What are the primary challenges in the process of compilingSchool Based Assessment (SBA) portfolios for FET Business Studies?The literature review covers the strengths and limitations of portfolio-based assessment as astrategy for combining formative and summative assessment purposes, the complexities ofcurriculum change and implementation, and bureaucratic and professional forms ofaccountability. In order to understand what is involved in the portfolio assessmentimplementation processes, I analyzed six assessment policy documents, two circulars and twoChief Moderators’ reports. I also interviewed four teachers and four principals, two eachfrom more and less advantaged schools in Johannesburg.Findings from the document analysis illustrate the incomplete and at times contradictorynature of the assessment policies and circulars, while the interviews highlighted a lack ofcommunication and mutual adaption between stake holders in the compilation of SBAportfolios. The key recommendation is that the concept of mutual adaptation may be usefulto overcoming the challenges encountered in SBA portfolio compilation.


A new report by two Delhi pediatricians suggests that the sharp rise in childhood paralysis in India is due to the increased usage of the oral polio vaccine, a drug that was banned in the U.S. over a decade ago.
Dr. Neetu Vashisht and Dr. Jacob Puliyel of St. Stephens Hospital created the report after analyzing data from India’s 10-year-old National Polio Surveillance Project, which is available online.
Their findings, which were published in the Indian Journal of medical Ethics, revealed that rates of non-polio acute flaccid paralysis (NPAFP) have increased 1200% since the oral polio vaccine was introduced to India a decade ago.
The oral polio vaccine contains a live polio virus and has been linked to polio-like paralysis. Polio vaccines used in other countries do not include the live virus, but polio vaccines used in India do.
Read more: polio vaccine


The volume of distressed property in Portugal is expected to increase over the first quarter of 2012, compared to the final three months of 2011.
In the Royal Institution of Chartered Surveyors (Rics) new Global Distressed Property Monitor report, respondents are anticipating that demand for such assets will be significantly lower than supply.
However, professionals in the nation did record a substantial increase in the level of interest in distressed real estate from specialist property funds during the final quarter of 2011, compared to the previous three-month period.
Simon Rubinsohn, Rics chief economist, explained these problems are not solely limited to eurozone countries.
"The economic news flow remains mixed at best and sentiment in the real estate sector is still fragile in much of the world as a consequence," he asserted.
Investors with property in Portugal may have been encouraged by comments made by Rics senior economist Josh Miller last month.
According to the expert, a lack of available mortgage finance has forced many homeowners into the rental sector, presenting opportunities for those who can find an alternative way to fund real estate purchases.


Most people experience water retention or bloating at some point or another. Eating certain foods or health conditions can increase it. It leads to increase water storage in your body, leading to increased weight, bloated feeling and overall feeling heavy.Wonder how you can avoid it or reduce it. We have tips for you, on how you can reduce your bloating belly.
Note, that these won’t reduce the fat! For that, you need to get on a proper weight loss plan. Read below for tips to reduce the bloating


This tool is provided to help estimate potential estate taxes and should not be relied upon without the assistance of a qualified estate tax professional. Unless specifically stated, this calculator does not estimate separate estate or inheritance taxes which are levied in many states. A properly crafted estate plan may significantly reduce potential estate tax liabilities.
Assumptions
Annual growth rate of your estate
Estimated Date of Death
Assets in Your Name
Real Estate
$
(ex., market value of primary residence, vacation home)
Bank Account
$
(ex., checking, savings, CDs)
Retirement Investments
$
(ex. IRAs, 401(k)s, 403(b)s, Keoghs, current value of deferred annuities)
Non-Retirement Investments
$
(ex., stocks, bonds, mutual funds)
Personal Property
$
(ex., autos, boats, art, jewelry)
Business Ownership Interests
$
(ex., closely held business interests)
Other Assets
$
(ex. potential inheritance)
Your Liabilities
Life Insurance on Your Life
Charitable Bequests from Your Estate
The Elder and Special Needs Law Center - Murfreesboro, Tennessee, is a service of attorney John H. Baker III, of counsel with the law firm of Bullock, Fly, Hornsby & Evans. Offices are located at 307 Hickerson Drive, Murfreesboro (Rutherford County), TN 37129. Surrounding communities include Smyrna and LaVergne (Rutherford County), Franklin and Brentwood (Williamson County), Woodbury (Cannon County), Manchester and Tullahoma (Coffee County), Lebanon (Wilson County) and Shelbyville (Bedford County).


A reaction I'm going to be running to determine the efficacy of a catalyst uses benzaldehyde and butyl acrylate. The butyl acrylate is polymerization inhibited with hydroquinone monomethyl ether (MEHQ). The MEHQ requires a 5-21% O2 by volume concentration to remain effective and avoid explosive polymerization. However, the benzaldehyde undergoes oxidation with O2 to yield benzoic acid. I'm unsure of the rate at which the benzaldehyde is oxidized, but the reaction duration will be 2+ days, and I have reason to believe from past experiments that there would be a significant amount of oxidation taking place in that time. The problem is not that the benzoic acid would hurt the reaction - it would most likely serve to expedite it. However, the if we're seeking to determine the efficacy of a proposed catalyst, the benzoic acid would be an x factor - we wouldn't be able to determine whether the benzoic acid was necessary for the reaction to proceed or not. The reaction would be performed small-scale (~5g total) and neat - benzaldehyde, butyl acrylate, catalyst. Any ideas on potential ways to run this? Or any comments in general?


Measurement-While-Drilling (MWD)
Halliburton utilizes measurement-while-drilling (MWD) surveying technology to determine the well path and its position in three-dimensional space. MWD is a valuable tool that can establish true vertical depth, bottom-hole location, and orientation of directional drilling systems.
A range of measurements of the drillstring, BHA and wellbore properties are available to ensure the drilling is occurring according to plan and to identify conditions that could lead to equipment damage or other non-productive time events. These measurements provide information on:
The forces acting on the drillstring and BHA including dynamic behavior and the occurrence of vibration The static and dynamic pressures internally within the drillstring and the annulus The size and shape of the wellbore itself Sperry Drilling services leads the industry with the largest and most robust high pressure, high temperature offering, and invests in significant research and development in HP/HT technology. In HP or HT wells, equipment is required to withstand temperatures higher than 300°F/149°C and pressures above 18,000 psi/124 MPas. Today, the majority of Sperry Drilling's measurement/logging-while-drilling (M/LWD) tools are rated to 347°F/175° C and 25,000 psi/172 MPas.
Sperry now offers ExtremeHT-200™ M/LWD sensors (392°F/200°C and 20,000 psi/138 MPas) and UltraHT-230™ M/LWD sensors (446°F/230°C and 30,000 psi/207 MPas), making it possible to operate reliably at higher temperatures than ever before and gaining access to reservoirs that were previously uneconomical.


Violence permeates all parts of the West Bank and Gaza Strip. Since the onset of the Al-Aqsa Intifada on the September, 28, 2000, through October 31, 2003, more than 51,000 Palestinians have been injured and 2700 have been killed. Palestinian children suffer from various physical aliments due to their disadvantaged situation, including 10% who suffer from moderate to severe malnutrition. The children also suffer from significant mental health disorders, including 33% with acute levels of posttraumatic stress disorder, 49% with moderate levels and 15.6% low levels. In "hot" areas, 55% of the children have acute levels of posttraumatic stress disorder, 35% moderate levels, and 9% low levels.


Forward Exchange Internal Revenue Code Section 1031 encourages reinvestment in qualifying business and investment assets by enabling companies and individuals (exchangers) to reallocate their capital into new assets more suitable to their current business or investment objectives, without the imposition of income taxes.
Under Section 1031, a Forward Exchange allows exchangers to achieve substantial tax deferral on gains from the sale of property, when they also acquire like-kind property. A Forward Exchange may also defer the tax on depreciation “recapture,” which is taxed as ordinary income, rather than capital gains.
Section 1031 offers a “safe harbor” to exchangers that use a Qualified Intermediary (QI), such as NES Financial. A QI is an independent third-party that serves as the exchanger’s exchange counterparty and holds the exchanger’s funds during the period between the sale of the relinquished property and the purchase of the replacement property, so that the exchanger does not receive those funds and trigger taxable gains from the sale of the relinquished property.
NES Financial services NES Financial offers an unsurpassed level of expertise and experience in conducting smooth and secure Forward Exchanges and works closely with clients and their advisers through every stage of the exchange. NES Financial’s comprehensive services include:
Opening a new exchange account and working closely with clients and their advisers through every stage of the exchange Establishing a Qualified Escrow or Qualified Trust account to hold and protect the proceeds from the sale of the relinquished property Assisting with timely notifications of deadlines Persistent digital archive of executed exchange documentation Click on the link below for more in-depth information about NES Financial’s Forward Exchange Solution: Forward Exchange Sheet > Download


Seizures are the basic indicator of epilepsy. They vary widely:
Staring straight ahead, repetitive swallowing, and lapsing into complete immobility for a few seconds characterize absence (petit mal) seizures, which can recur many times in a day.
Tonic/clonic (grand mal) seizures, which usually last several minutes, typically begin with a loss of consciousness and a fall, followed by rigidity, then jerking motions and incontinence of urine. After the seizure ends, there is usually a period of confusion and deep sleep.
Repetitive lip smacking, aimless fiddling movements, and a sense of detachment from surroundings may indicate temporal lobe seizures. They may be preceded by a vague feeling of abdominal discomfort, visual/sensory hallucination, and distorted perceptions such as deja-vu.
Motor or Jacksonian seizures start with localized rhythmic twitching of muscles in a hand, a foot, or the face, which may spread to the whole body. Such seizures are often followed by a period of weakness or paralysis.


A fellow mom recently asked us about babysitting rates. It's a good question. When my first child was a newborn, I paid a local teen $5 an hour to watch him sleep while I spent 90 minutes or so running errands. Now I pay a teacher from my kids' daycare $12 an hour to feed two boys dinner, entertain them for the evening and then put them to bed.
Whether you hire your neighbor's 16-year-old daughter or an experienced adult, your sitter should have your phone numbers and be trained in first aid and CPR. If a teen has completed the American Red Cross Babysitter's Training course, all the better.


Dennis C Bolton Payment Breakdown Subsidy Program Total Payments 1995-2012 Total USDA - Subsidies$716,717 Subtotal, Farming Subsidies $497,414 Subtotal, Conservation Programs $13,685 Subtotal, Disaster Payments $205,618
Commodity subsidy breakdown Subsidy Program Total Payments 1995-2012 Subtotal, Farming Subsidies$497,414 Total Direct Payments $158,414 Direct Program Payments - 2008 Farm Bill $52,433 Direct Payment - Barley $49 Direct Payment - Corn $105,913 Direct Payment - Oats $19 Total Counter Cyclical Payments $52,330 Counter Cyclical Payment - Barley $9 Counter Cyclical Payment - Corn $52,321 Production Flexibility Contracts $123,409 Production Flexibility - Barley $10,924 Production Flexibility - Corn $108,413 Production Flexibility - Oats $651 Production Flexibility - Wheat $3,421 Mkt. Loss Asst. - Commodity Crops $65,849 Market Loss Assistance - Barley $6,517 Market Loss Assistance - Corn $57,062 Market Loss Assistance - Oats $372 Market Loss Assistance - Wheat $1,898 Deficiency Payments $14,016 Advance Deficiency - Barley $604 Deficiency - Barley $-588 Advance Deficiency - Corn $6,562 Deficiency - Corn $7,428 Advance Deficiency - Oats $146 Deficiency - Oats $-136 Advance Deficiency - Wheat $228 Deficiency - Wheat $-228 Loan Deficiency Payments $61,332 Loan Deficiency - Corn $61,332 Total Commodity Certificates $14 Commodity Certificates - Corn $14 Marketing Loan Gains $22,050 Market Gains Farm - Corn $22,050
Conservation subsidy breakdown Subsidy Program Total Payments 1995-2012 Subtotal, Conservation Programs$13,685 Conservation Reserve Program $319 CRP - Annual Land Rental $319 Env. Quality Incentive Program $13,366 EQIP - Regular $4,145 EQIP - Ground And Surface Water $9,221
Disaster subsidy breakdown Subsidy Program Total Payments 1995-2012 Subtotal, Disaster Payments$205,618 Misc. Disaster Payments $205,618 Crop Disaster - Program $205,618
Note: The information on conservation spending for 2011and 2012 are incomplete due to missing data from USDA's Natural Resource Conservation Service. In addition some payments made in 2010 were not assigned to recipients in the data received from NRCS. Those payments are also not included.
The information provided for the Wetland Reserve Program (WRP) provides an inaccurate picture of how WRP payments are distributed. USDA's Natural Resource Conservation Service uses title companies as intermediaries to finalize wetlands easements under the Wetlands Reserve Program. As a result, the data provided to us shows large sums of money going to these title companies. In reality, the payments are ultimately distributed to landowners participating in the WRP.
Unfortunately, NRCS has not provided the data to show where these farms and wetlands are located or which farmers or landowners are enrolling in the program, so EWG is unable to allocate these large sums of money to individuals beyond the title companies. Therefore, these companies skew the conservation rankings and payment concentration, which EWG cannot avoid unless and until NRCS makes available the additional farm attribution data. Therefore, we have not included WRP payments in the 2011 or 2012 data update.
We have separated data on farm commodity, disaster and conservation payments in order to provide a more accurate picture of top recipients and concentration of payments among the three main categories of USDA programs.
Finally, EWG works hard to ensure the accuracy of the information it provides through its products and services, but obtains data for the Farm Subsidy Database from the U.S. Department of Agriculture pursuant to the Freedom of Information Act. Therefore, EWG cannot guarantee the accuracy of the information USDA provides or any analysis based thereon. If you find an error or discrepancy on the site, please contact your local USDA Farm Service Agency office to check its records before contacting EWG.


Discussion Paper Abstract There is a growing evidence that political corruption is often closely associated with the rent seeking activities of special interest groups. This paper examines the nature of the interaction between the lobbying activities of special interest groups and the incidence of political corruption and determines whether electoral competition can eliminate political corruption. We obtain some striking results. Greater electoral competition serves to lessen policy distortions. However, this in turn stimulates more intense lobbying which increases the scope of corrupt behavior. It is shown that electoral competition merely serves to alter the type of corruption that eventuates, but cannot eliminate it.


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B-Complex Quick Guide: B-Complex
The vitamin B-complex refers to all of the known essential water-soluble vitamins except for vitamin C. These include thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6), biotin, folic acid and the cobalamins (vitamin B12). Each member of the B-complex has a unique structure and performs unique functions in the human body. Vitamins B1, B2, B3, and biotin participate in different aspects of energy production, vitamin B6 is essential for amino acid metabolism, and vitamin B12 and folic acid facilitate steps required for cell division.


Knowledge and Understanding
Depending on the choice of modules, students will acquire detailed knowledge and understanding, across a range of Geography topics:
- Past Environments and their reconstruction
- Freshwater and Marine environments and processes
- Glacial environments and processes
- Solid Earth environments and processes
- Geographical Information Systems and Remote Sensing
- Political economy, geo-politics, inequality and justice
- Globalisation, urbanisation and culture
- Geographies of science, technology and nature
- Environment and society
- Health, development and migration
- Students will be given guidance on an appropriate choice of modules. Students will also have developed an understanding of physical and human geography in the context of N American society and environment, and have acquire knowledge and understanding specific to topics available at the N American university they attend in their 2nd year
Intellectual skills
- Synthesising and critically evaluating information from a variety of sources
- Interpreting textual, cartographic, and numerical data
- Assessing the merits of contrasting theories, explanations and policies in geography
- Analysing, problem-solving and decision making
- Developing a reasoned argument and intellectual integrity
Practical skills
- Plan, execute and report on fieldwork and geographical research in the human and physical realms, and an ability to use the technical skills needed for this
- Carry out risk assessments and list appropriate safety precautions associated with practical or project work
- Appreciate the ethical issues in geographical debates, as a citizen and researcher
Transferable skills
- Adapted to life and study in a foreign country
- Work independently or as part of a team
- Use relevant Information Technology
- Demonstrate effective written and oral communication skills
- Design and prepare project proposals
- An ability to learn new, diverse and complex material
- Take responsibility for, and reflect on one's learning, at university and later in life


Any fine-grained sedimentary rock that contains solid organic matter (kerogen) and yields significant quantities of oil when heated. This shale oil is a potentially valuable fossil fuel, but the present methods of mining and refining it are expensive, damage the land, pollute the water, and produce carcinogenic wastes. Thus, oil shale will probably not be exploited on a wide scale until other petroleum resources have been nearly depleted. Estonia, China, and Brazil have facilities for producing relatively limited quantities, and the U.S. government operates an experimental plant in Colorado.


Antisocial behavior by young adults is more likely for those who had a diagnosis of conduct disorder as children, particularly if they also had attention deficit hyperactivity disorder (ADHD). Biologically, antisocial behavior is predicted by blunted physiological responses to stimuli. Are these two predictors directly related? Herpertz et al. (p. 1100) measured the change in electrical skin conductance in response to pleasant, neutral, and unpleasant pictures in 8–13-year-old boys with conduct disorder, boys with ADHD, boys with both conditions, and healthy boys. Both groups of boys with conduct disorder showed less physiological response than the ADHD-only and healthy boys, regardless of the type of picture. This hyporesponsiveness suggests a problem in cognitive-emotional associations among children with conduct disorder. The boys’ own assessments of their emotional responses were misleading, since these measures showed differences for the conduct disorder groups only on the unpleasant pictures.


For the study, 35,016 women (ages 50 to 76) were surveyed about their use of supplements. Results revealed that those who used fish oil supplements had a reduced risk for breast cancer. However, use of the following supplements was not linked to a lower risk of breast cancer: black cohosh, dong quai, soy, and St. John's wort. It's possible that fish oil supplements may protect against breast cancer by curbing inflammation, according to the study's authors.
Rich in anti-inflammatory substances known as omega-3 fatty acids, fish oil has been found to fight against several other inflammation-related conditions in previously published studies. For instance, upping your fish oil intake may help treat asthma, inflammatory bowel disease, diabetes, and rheumatoid arthritis.


Two years ago a 32 year old female was admitted to the hospital for atypical pneumonia- pulmonary infiltrates and a high fever. Her illness was preceded by a rash on her legs, fever, cough and severe diffuse joint pains. In the hospital she was treated with two weeks of IV Rocephin and Zithromax, to "cover" her for various causes of pneumonia. When I saw her in the office for a follow up visit I noted a significant circular red rash on both lower limbs. Labs at that time showed an elevated CRP of 12, a borderline ANA antibody and a single 41 IgG WB Lyme band out of the standard 13 bands. I continued oral antibiotics. The rash improved within a couple of weeks. She complained only of fatigue and nausea. The physicians who saw her initially could not explain her findings. It was suggested that she had an autoimmune disease. The rash was biopsied. The findings were: non-specific lymphocytic dermatitis. She continued antibiotics for several months and generally did well. Additional symptoms included: persistent fatigue, strange visual changes and bouts of numbness and tingling. She developed right upper quadrant abdominal pain, suggesting gall bladder disease; this improved without intervention. After 6 months of antibiotics, she stopped them without consulting with me. I saw her about 2 months later. She had been hospitalized again. She had experienced acute weakness of her extremities and a loss of sensation in both legs. She also experienced transient double vision. The neurologists who evaluated her listed various differential causes: MS, stroke, Guillain-Barre syndrome and vasculitis. Her work up was negative. She was sent home without a diagnosis. In the medical history provided by the neurologist,"Lyme disease" was mentioned parenthetically. The verbiage in the consultation notes essentially mocked the diagnosis, treatment and physician. Repeat lab testing showed that a C6 peptide antibody test sero-converted from 0.29 to 1.2. This information was not considered relevant. The patient improved and her symptoms were stable when she came to see me after this adventure in the local hospital. I explained to the patient that I felt her symptoms and findings were consistent with chronic Lyme infection. My exam revealed numerous neurological abnormalities- not noted by the neurologists. I don't think she fully believed me. She works in a doctor's office and was hearing many conflicting points of view. Despite this, she continued antibiotics for an additional 4 months. Two months after stopping antibiotics (again!) she came into my office. She had marked numbness and weakness of the left side, upper and lower extremity. She had nearly absent pinprick and vibratory sensations of both legs. This time she was really sick. Her presentation was typical of MS or an acute stroke. I thought it was all Lyme related. She decided to follow my recommendations. An MRI of brain and spine were normal. She was immediately started on IV Rocephin along with a short course of IV steroids. She experienced a brief episode of confusion. Within 4 days the weakness was improving. Withing a month she was 80% better. Within 8 weeks she was almost normal. She has stayed on antibiotics and done well since this episode. She continues to have only minor symptoms. Her markers of inflammation have improved. Her CRP is less than one. Her ANA is negative. She continues to have abnormal physical findings which are slowly improving. Needless to say, she is no longer anxious to stop antibiotics. I think she agrees with my approach and has become a reader of this blog. She came to me by accident. I was/am her primary care physician. I can imagine how things might have turned out if she had been treated by standard paradigms. Her primary care physician would have said: "I don't know what it is." A rheumatologist would have diagnosed a non-specific autoimmune disorder and treated her with immune modulating therapy. A neurologist would have diagnosed an atypical form of MS and suggested other therapy. She might be disabled with paralysis on one side of her body. She would likely suffer with profound cognitive deficits and diffuse pains. Perhaps fibromyalgia would be added to the list of symptoms. It seems unlikely that she would be working full time and taking care of her young child. But she is. These other physicians who encountered my patient on this journey are unaware of her story. She was a consult, an undiagnosed case- lost to follow up. They are busy- seeing new patients and are not looking back.