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The Never Ending Threat of the Carbon Tax
Despite the brutal bipartisan legislative defeat in 2009 of the Waxman-Markey cap-and-trade bill, there continue to be policymakers who want to impose a carbon tax. This time, the failures of current tax incentives and proposed regulations that attempt to lower our carbon dioxide emissions and encourage renewable energy are the impetus for the imposition of a carbon tax. But as we have explained many times, carbon taxes are economically harmful, not matter how they are dressed up.
Dissatisfaction with the Tax Credit Incentive Structure
Everyone acknowledges that the tax code is too complex. This provides an opportunity for those interested in pushing a carbon tax to present it as the solution to everyone's problems. A recent Senate Finance Committee hearing about the energy tax extenders gave some clues that carbon tax advocates are laying the groundwork for another carbon tax push.
In his opening speech, Senator Hatch bashed the Obama administration's energy policy and immediately brought up the threat of a carbon tax. He stated, "Proponents of a cap-and-trade approach have, for the most part, acknowledged that this proposal is dead. However, instead of admitting failure and moving on, they are repackaging cap-and-trade by calling it a carbon tax."[1]
Pro-Carbon Tax Testimony
Gilbert Metcalf, a witness at the hearing, testified in favor of a carbon tax. Metcalf was the Deputy Assistant Secretary for Environment and Energy at the U.S. Department of Treasury in the Obama administration and is currently an economics professor at Tufts University. First he laid out the long-term plan for his ideal energy tax policy: "Current energy tax policy can perhaps be best viewed as a transitional policy until policies such as carbon pricing are put in place. A carbon tax would provide the correct signal to the economy about the social cost of energy production and consumption and so improve economic efficiency."[2]
Metcalf's justification for the carbon tax will sound familiar to anyone who has taken an entry-level microeconomics course. He argues that a carbon tax "'internalizes' the externality' by forcing firms to take into account the social costs of pollution by raising their private costs by the value of the social damages that are generated by the pollutant."[3] He does not however specify how to calculate the amount needed to "internalize the externality". In fact Metcalf admits, "Estimating the social marginal damages from greenhouse gas emissions is an immensely complex task and all integrated assessment models that undertake that challenging task make clear that considerable uncertainty exists with respect to estimates."[4]
Metcalf also admits that a domestic carbon tax by itself will have no discernable impact on global emissions, but says if the United States does not act first that "will mean other major countries will not take action." If the United States does take action they could punish countries who do not act through "border tax adjustments on imports from countries not pricing emissions or carbon tax credits for energy intensive and trade exposed sectors competing with those countries."[5] Metcalf's analysis neglects the dubious legality of these types of tariffs.
Overall, Metcalf's testimony in favor of a carbon tax seems to be a non-solution to a stipulated problem.
Anti-Carbon Tax Testimony
To counter that narrative, economist David Kreutzer testified against carbon taxes and argued that carbon taxes do serious damage to the economy. Using the same modeling techniques employed by the government, Kreutzer outlined some of the effects of the carbon tax proposed by Senators Barbara Boxer and Bernie Sanders. His analysis found a family of four would lose more than $1,000 of income per year, a loss of over 400,000 jobs by 2016, a rise in gas prices by $0.20 by 2016, and a 20 percent rise in electricity prices by 2017.[6] In addition to these findings he noted that a $25/ton carbon tax would only result in a 0.05 degree centigrade change in temperature.
EPA's Coal Rule
The Environmental Protection Agency's (EPA) proposed power plant rule regulating carbon dioxide emissions, if implemented, may provide carbon tax advocates another reason to justify a carbon-pricing scheme.
EPA promotes the alleged "flexibility" states have to determine how to achieve their emissions reductions. However, this state-based "flexibility" ignores the interconnected regional nature of the electric grid and the power sector. Andy Weissman, senior energy policy advisor for Haynes and Boone LLP, explains, "It doesn't make sense to talk about power plants in any one state if you can't talk about the utilization of plants across the region."[7]
The state-based nature of the rule is already causing confusion for utilities and states as they try to come up of compliance plans. David Thornton, the assistant commissioner at Minnesota's Pollution Control Agency, commented on problems such as: how states will get credit for renewables, nuclear energy, and energy efficiency. He said, "And we're still sorting through a lot of these details, because quite frankly, EPA's proposal isn't clear on how it treats a lot of things."[8]
A regulatory legal expert summed up the extent of compliance problem upon reviewing the proposed rule:
"The rule, the way it's crafted, does make cap-and-trade appear as sort of an elegant solution to the problem of how to incentivize reductions in demand and increased renewable generation from the affected sources, which are only fossil fuel generating units."[9]
EPA's Onerous Carbon Dioxide Regulations are an Excuse for a Carbon Tax
Groups that support the carbon tax are already using the weaknesses of EPA's carbon dioxide restrictions to present the carbon tax as the superior alternative. For example Michael Wara, an attorney at green group, Resources for the Future, wrote:
To me, this whole thing is reminiscent of California- lots of shadow carbon prices that are higher and lower than the visible power sector price that's driving the cost-effective abatement strategy- redispatch. And it makes a fantastic argument for legislative action to implement a simpler and more cost-effective policy. Why can't we just have a carbon tax and cut my FICA withholding already?[10]
Here the author is showing that poorly designed regulations, essentially act as a surrogate (or "shadow") carbon tax by making carbon-intensive activities more expensive. One problem with Wara's argument is that he ignores an important element in the economic literature of carbon taxes. As IER's Robert Murphy has explained many times, the so-called "tax interaction effect" (the way new carbon taxes interact with pre-existing taxes on labor and capital) means that we don't get a win-win or a cost-effective policy from just reducing FICA and imposing a carbon tax. Wara and others who write in praise of a carbon "tax swap" often lead their readers to believe that using carbon tax receipts to offset pre-existing tax rates is a "no brainer" to promote conventional economic growth, but actually the peer-reviewed literature says the exact opposite. Carbon taxes are so destructive to the conventional economy that they magnify the damage that labor taxes cause, even if the labor tax rate is reduced with carbon tax receipts.
Even with the bipartisan defeat of cap-and-tax, the threat for similar legislation in the future continues to be real. Dissatisfaction with the patchwork of energy incentives in the tax code, coupled with increasingly onerous regulations such as EPA's coal rule will help carbon tax proponents continue to bring up the idea of a carbon tax. It is important not to lose sight of the fact that a carbon tax is essentially the same as cap-and-trade, which the American people loudly rejected. Now Washington is attempting to dress the wolf in sheep's clothing in order to get what they want.
This post was authored by IER Policy Associate John Glennon.
[1] Hatch Statement at Finance Hearing on Energy Taxation, 9/17/14, http://www.finance.senate.gov/imo/media/doc/9.17.2014%20Hatch%20Statement%20at%20Finance%20Hearing%20on%20Energy%20Taxation.pdf
[2] Dr. Gilbert Metcalf, Testimony for Reforming America's Outdated Energy Tax Code, 9/17/14, http://www.finance.senate.gov/imo/media/doc/Testimony%20-%20Gilbert%20Metcalf.pdf.
[6] Dr. David Kreutzer, The Impacts of Carbon Taxes on the U.S. Economy: Testimony before the Committee on Finance, United States Senate, 9/16/14, http://www.finance.senate.gov/imo/media/doc/Testimony%20-%20David%20Kreutzer.pdf.
[7] Keith Goldberg, EPA Carbon Rule Points States Toward Cap-And-Trade, Law360, 6/1/14, http://www.law360.com/articles/543619/epa-carbon-rule-points-states-toward-cap-and-trade
[8] Erica Martinson, States, utilities break out ouiji board for EPA carbon plans, POLITICOPro, 9/26/14, http://www.politico.com/morningenergy/0914/morningenergy15453.html.
[10] Michael Wara, What's in the BSER: EPA's Process for Setting State Goals in the Clean Power Plan, Common Resources, 6/10/14, http://common-resources.org/2014/whats-in-the-bser-epas-process-for-setting-state-goals-in-the-clean-power-plan/.
Emissions Standards
carbon taxcoalEPApower plant ruletax credit


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MQM condemns destruction of martyrs' monument in Karachi
London [UK], Dec 14 (ANI): Convener of Muttahida Quami Movement (MQM) Nadeem Ehsan and all the members of the party's Central Coordination Committee (CCC) have condemned the destruction of 'Martyrs' Monument' at the Jinnah Ground in Karachi and have termed the act as a shameful demonstration of state oppression and barbarism.
In a joint statement, MQM members said the relatives of the martyrs, workers of the MQM, and other people used to visit the Martyrs' Monument every year to offer Fatiha (religious ritual) and also to lay the floral wreath, but since the last four years, the tyrant and brutal government and the Army have put a ban on their visit.
Last night, the Paramilitary Rangers destroyed the monument. While in the past they have desecrated the place, this time they went as far as to destroy it. Nadeem Ehsan and the members of the CCC have condemned the incident and said that it is a shameful demonstration of state oppression and barbarism and eternal hate against the Mohajirs.
They further said that this condemnable act is not only against the relatives of the martyrs but is also causing grief and trauma to the whole Mohajir nation.
This brutal act is enough to open the eyes of all the Mohajirs to the fact that the state brutality has gone so far that even the monuments of their martyrs are now being demolished.
Ehsan and the members of CCC said that every religion keeps the sanctity of the graves but due to the severe hatred for the Mohajirs, "our monuments of the martyrs are also being destroyed."They said that Allah is observing this cruelty and "we have faith that Allah will bring torment to those who have desecrated and destroyed the monument." (ANI)

redpajama_set_name: RedPajamaCommonCrawl


Trimble is demonstrating its sophisticated Connected Site portfolio for heavy civil contractors, which connects assets, information, people, machines and sites. This package can meet a vast array of workflow needs of different stakeholders within the contractor's organisation and meets demand for greater efficiency, shorter completion times and higher quality.
Trimble is demonstrating how its Connected Site solutions leverage real-time wireless data flow between the office and job site. This technology allows design engineers, contractors and job site crews to tackle grading and excavation jobs by providing workflow integration from the design phase through to the finished project. According to Trimble, contractors can achieve faster project completion, while reducing costs, improve safety and reduce environmental impact.
For the Connected Controller, Trimble is giving demonstrations of real-time, two-way data flow between the office and field handheld mobile devices using GPS or total station positioning systems used for staking, grade checking, site supervision, or inspection of work. The takeoff and data preparation tasks can be carried out using the Business Center – HCE system, and design files sent wirelessly to the controller in the field. Eliminating trips back to the office to retrieve or download the latest design and work order data streamlines the process and enables field crews to have up-to-date information, reducing downtime.
Similarly for the Connected Machine, Trimble's demonstration highlights productivity improvements from real-time, two-way data for on-machine grade control systems though a live link between the machines and the office. The live link allows contractors to send up-to-date design information from Business Center – HCE to the cab, eliminating the risk of errors associated with use of incorrect or out-of-date site models. Two-way data also allows the equipment manager to connect assets remotely and use VisionLink powered by Trimble to monitor site production volumes, compaction performance, and equipment productivity and utilisation.
The Connecting People demonstration of the Connected Community uses the Internet to integrate head office, site office and field crew operations in a communication portal. This can then be accessed by construction project stakeholders to exchange project-related information. The Connected Community can provide insight into project operations, head office activities and provide a collaboration site that allows efficient sharing of information and rapid resolution of site problems and requests for information. The collaborative environment boosts efficiency, and reduces delays associated with communicating and sharing information with multiple stakeholders on the construction site.


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//
//  UTViewSwitcher
//  State View Manager
//
//  Created by Paul Taykalo on 7/18/13.
//  Copyright (c) 2012 Stanfy LLC. All rights reserved.
//
#import <Foundation/Foundation.h>
#import "UTFadeInOutViewSwitcher.h"
#import "UTViewSwitcher.h"

/*
 Simply switches view with fade animations
 */
@interface UTFadeInOutViewSwitcher : NSObject <UTViewSwitcher>

@property (nonatomic, assign) CGFloat animationDuration;

@end

redpajama_set_name: RedPajamaGithub


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The 2017 Ford Escape is the company's first vehicle to support Apple CarPlay
Posted by Evan Selleck on Mar 18, 2016 in Apple News, CarPlay
Back in January of this year, it was confirmed that, after an extended wait time, Ford would finally be adding vehicles to its lineup that support Apple CarPlay.
Ford has officially announced that the 2017 Ford Escape will be the company's first to offer Apple CarPlay in its in-dash system. Ford will be integrating the feature into its latest-generation Ford SYNC platform, which is now version 3. The vehicle goes on sale this May, but pricing wasn't disclosed in the announcement.
"New Escape – first Ford vehicle to offer Apple CarPlay and Android Auto – aims to maintain sales momentum and attributes that led it to a tie* as Highest-Ranked Compact SUV by J.D. Power in Initial Quality; Escape is the No. 2-selling Ford vehicle in the United States, second only to F-Series."
While the 2017 Escape is the first Ford vehicle to support Apple CarPlay, the company plans to offer even more vehicles with the in-car system as an option as well. More than that, Ford also plans on offering updates to some older vehicles to bring the option to even more drivers.
[via Ford (Businesswire)]


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Call Goodfellas Carpet Cleaning today and set up a free appointment. We offer residential and commercial cleaning services. We will evaluate your needs and come up with the best plan for your home or office.


$1,000 opening deposit is required. If your average daily balance falls below $1,000 for the statement period we may impose a $15 monthly service charge. Transfers from this account to another account or to third parties by preauthorized, automatic, telephone, or computer transfer or by check or similar order to third parties are limited to six per statement period. Unlimited transfers are allowed within our institution.
$2,500 minimum average daily balance for the statement period is required.
Account earns interest off of a variable interest rate.


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Malaga Airport (AGP) Informational Guide to Malaga Airport (AGP) - Non Official
Malaga Airport (AGP)
Use this website to quickly find the most important information about Malaga Airport or Costa del Sol Airport: Flights (Departures, Arrivals and Delays), Parking, Car Hire, Hotels near the airport and other information about Malaga Airport. Plan your travel to AGP Airport with the information provided in this site.
Málaga Airport (AGP) is the 4th busiest airport in Spain
The 85% of Malaga Airport traffic is international.
Malaga Airport is located 8 kilometres from Malaga city.
AGP Airport consists of a single terminal.
Costa del Sol is a unique destination in South Europe
Malaga Airport (IATA: AGP, ICAO: LEMG), officially known as Malaga-Costa del Sol Airport (Spanish: Aeropuerto de Málaga-Costa del Sol) is the fourth busiest airport in Spain after Madrid-Barajas, Barcelona and Palma de Mallorca.
It is an important Airport for Spanish tourism as it is the main international airport serving Costa Del Sol. It is located 8 km (5 miles) southwest of Malaga and 5 km (3 miles) north of Torremolinos. Malaga Airport counts with two runways.
The 85 percent of its traffic is international, offering a wide variety of international destinations. A huge part of the traffic comes from countries in the European Union and United Kingdom: Belgium, the Netherlands, Denmark.
In 2019, Malaga Airport handled 19,856,299 passengers.
Terminal + info
Malaga Airport counts with a single terminal that handles both domestic and international flights.
It is also known as New Terminal or Terminal 3.
Services + info
Malaga Airport has lots of different services available to all passengers as:
- Restaurants and cafes
- Shops
- Duty Free
- Defibrillators
- Art gallery
- Meeting rooms
- Meet and Assist services
- Fast Lane Pass
- VAT Refund
- Baggage Wrapping Machine
- Left Luggage Office
- Lost Luggage
About Malaga
Malaga- Málaga in Spanish- is a beautiful port city located in Costa del Sol, south of Spain.
It is a very touristic place to visit during summertime. There are beaches, beautiful hikes and amazing historic sites. In Malaga you will find plenty of things to do.
You should visit Malaga's port, or Castillo de Gibralfaro, a moorish palace dated back to the 10th century.
You can't miss either the opportunity to taste Malaga's seafood. Food in the area is amazing, as well as its tapas.
For sightseeing, there is Picasso Museum, the Alcazaba, Malaga beaches and really near Malaga city you will find Caminito del Rey or Ronda, top places to visit.
Transport + info
From Malaga Airport there are various methods of transportation to get around and explore the area:
Bus: There are urban, intercity and long distance buses available that run to different destinations.
Train: RENFE C1 line links Malaga Airport with the city center in about 12 minutes. It also runs to other destinations such as Benalmadena or Torremolinos.
Transfers: If you want private transportation to and from Malaga Airport to your destination, you can book a transfer.
Taxi: Vehicles are white with a blue line on the side. There are urban and interurban areas. There is available a list next to the taxi rank to know the taxi fares.
Car Rental: Renting a car is a good idea to move around Malaga and Costa del Sol. Check our search engine to find the best offer for your car.
Address: Avenida Comandante García Morato s/n . 29004 Málaga, Andalucía, SPAI
Email: infoagp@e-externas.aena.es
Telephones: 902 404 704 / (+34) 91 321 10 00
Not the official airport website. Disclaimer - Contact Copyright © 2021. airport-malaga.com
Best Prices in Car Hire!
Search in our car hire booking engine!


Why women cannot become priests? Is the Church sexist?
All Apostolic churches, namely all Orthodox and Catholic churches have been only ordaining males to the Priesthood since the birth of the Church in the first century. Is this simply due to the Patriarchal societies of the time? In other words, is it about historical cultural customs that need to be adjusted for our modern needs? Or is there more to it than that? Before tackling this question, it has to be made absolutely clear that males and females are equal in Christianity. Both genders are created in the image of God, are asked to love and respect the other, and are essential to the survival of the other. As St. Paul puts it: "For as many of you as were baptized into Christ have put on Christ. There is neither Jew nor Greek, there is neither slave nor free, there is neither male nor female; for you are all one in Christ Jesus." This verse emphasizes the equality of the members of the body of Christ regardless of their gender, nationality or social status. However, this verse does not cancel the gender. The female remains a female and the male, a male. It rather puts everyone on the same pedestal.
We are created in the image of the One Trinitarian God and as the Father, the Son and the Holy Spirit are equal and diverse so we, males and females, are also equal and diverse. And, just as the Persons of the Trinity have different roles, so do males and females within humanity. Now, what characterizes gender? Is it merely a sexual organ or a question of hormones? As we have previously seen, gender affects us at the very core of our personality—of our soul. Gender dictates how we think, how we pray, how we love, how we relate to others, how we work, how we raise children, etc. Each gender is as talented as the other, but women and men are given by God necessary gender-specific characteristics to perform certain tasks. God appoints the task of the priesthood to males. Nevertheless, it is not only about a personality-specific role. There is much more to it than that.
We first need to understand the sacrament of the priesthood itself. Let us rewind back in time to the Eucharistic supper that took place about 2,000 years ago. As Christ was sitting at the table with His disciples, He took the bread in His hands and said "take eat, this is My Body." And then He said: "do this in remembrance of Me." The Son of God is therefore sitting at the table, and He is also holding Himself in His hands. We thus have the Son of God holding the Son of God. It is truly a great mystery. This mystery is commemorated or re-enacted every single liturgy. This is the meaning of "do this in remembrance of Me." How is the re-enacted? Well, we have the Son of God in the Eucharistic Bread on the altar or table, and we also have the Son of God in the priest in front of the altar. So what is the sacrament of the Priesthood? It is the Presence of Christ. The Priesthood is not a representation of Christ. The priest is neither the actual Person of Christ. By God's grace, the priest makes Christ present through Christ's Priesthood in him. Again, Christ's Priesthood exists to make Christ present in the priest. Christ is there. It is for this reason that the priest is the one that performs all the Church sacraments. Because Christ is the One performing them through him.
Second, there is another mystery that we need to understand: the mystery between Christ and the Church. In Ephesians 5, St. Paul is instructing husbands and wives within marriage and then he quotes Genesis 2, at the time of Adam and Eve. He says: "'For this reason a man shall leave his father and mother and be joined to his wife, and the two shall become one flesh.' This is a great mystery, but I speak concerning Christ and the church." The emphasis, here, is that there is a mystery between Christ and the Church. And this mystery is parallel to the union between a husband and a wife. In other words, as a husband and wife mystically become one, there is a similar mystery between Christ and the Church. That is why we refer to the Church as the Bride and Christ is the Bridegroom. Now, as we have mentioned it earlier, the priest is the presence of Christ, and Christ is a male. Therefore, as the priest shares in the Priesthood of Christ, he also shares in being the bridegroom of the bride who is the Church. Tertullian draws a nice parallel on this subject, he says: "Adam was a figure of Christ, Adam's sleep provided a shadow of the death of Christ, who was to sleep a mortal slumber [so Adam sleeping in Genesis 2 is a shadow of Christ's death on the cross]; that from the womb inflicted on his side, might be figured the true mother of living, the Church." Hence, it is as Christ who was struck with the spear on His side and brought forth blood and water, which is a symbol of the Eucharist that gives life to the Church. He explains that this hole in Christ's Body is the Church. This is a direct link to Eve being taken out of the side of Adam. Therefore, as Christ, the male, is the Bridegroom, the priests are also participating with Christ in being the bridegroom to the Church. It is a relationship between a bridegroom and a bride, not between a bride and another bride. The priests need therefore to be males.
Why was Christ born as a male? As explained earlier, each gender contains certain characteristics of the Divine image. Each gender is as important as the other, but they have different roles. Now, for each gender, we find a correlation between the transgression of Adam and Eve, the salvific actions of Christ and St. Mary and today's role for each respective gender. As a matter of fact, Eve disobeyed the commandment. St. Mary participated in the salvation of all of humanity by obeying the words of Archangel Gabriel to bring forth the Son of God. And although both men and women need to submit to each other, the role of women today is emphasized in her obedience. Through this obedience, women freely choose to die to their selves and truly love as God loves. Men, on the other hand, are also asked to die to their selves, but in a different way: Adam was asked to leave his father and mother and be joined to his wife, which implies sacrificing his life. He needs to leave what is his, to please his wife. But when God asked him if he ate from the tree, he did not take the responsibility of his actions, but pointed to Eve and said, "the woman gave me to eat." He failed to love Eve. He failed to give himself as a sacrifice for her. Now the second Adam did the opposite: He was incarnate as a male and became the true Adam, the One who literarily sacrifices Himself for all of humanity. Similarly, all males today are asked to love their wives as Christ loved the Church and died for her. The husband and father's role is to offer his life as a sacrifice for others. In other words, both men and women sacrifice themselves to each other, yet in different ways. The man's way is to take responsibility and ownership and to sacrifice himself for the woman and the kids. This is precisely what Christ did.
It is important to note here that the principal role for each gender has nothing to do with authority! That is the understanding of Christian love: sacrifice and obedience! Not authority. Unfortunately, many men and women desire the priesthood for the sake of authority. Such people are missing the entire meaning of Christian love and misunderstand the meaning of the Priesthood. Priesthood is not about lust for power or authority. Priesthood is about serving others: it is about carrying the cross and being crucified with Christ for the sake of the Church. It is a very difficult path to salvation. Usually, the ones that are truly worthy of the Priesthood are the ones that flee from it. We have so many examples of those people in the Coptic Church. One of them was HH Pope Shenouda III who was ordained a bishop by force. I am sure many can also remember the tears of HH Pope Tawadros II when he was being enthroned on the See of St. Mark. Those who run after the priesthood are usually unsuitable for it regardless if they are males or females. Let us therefore approach this subject with a humble spirit. Remember know your faith, live your faith and teach your faith and glory be to God forever, Amen.
How do I live a life of resurrection?
How important is the Ascension of Christ?


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Under The Waves By Bella Rios Premiere
by Rockshot | Sound/Vision
Bella Rios is a multi-instrumentalist Singer-Songwriter residing in Chicago, Illinois, playing guitar, piano, bass and saxophone and guess what she is fifteen years old.
Her newest single, Under The Waves, premiered her, shows her lyrical and vocal prowess. Her songwriting shows an understanding of the world beyond her age, if we were throwing comparisons to other songsters at this age then perhaps think a female Jackson Browne.
We asked Bella what spark ignited the song and how did she find the inspiration to complete the songwriting process. She told us "A few years ago, people were spreading rumours about me at school and I lost some of my closest friends because of it. Under The Waves was written for a true friend who stuck with me through everything."
"I've been working on really trying to find and further develop my own sound over the past few months. Under The Waves is a song that was influenced a lot by my acoustic/rock inspirations. I'm really excited for the upcoming releases. My style has progressed, yet remained true to my roots."
Keep an ear out for future songs by chickening her Facebook page and Instagram stream.
Facebook: https://www.facebook.com/pg/bellariosmusic/
Instagram: https://www.instagram.com/_bellarios
Check the lyric video here:
and covering all the bases go to Spotify here:


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As a proud member of the BeadSmith Inspiration Squad, I made this beautiful bracelet with 2-hole Half Moon Beads and super interesting Czech glass fire-polished 4mm snakeskin beads.
Media Luna bracelet is an easy and quick beading project.
If you have enough beads you can make a gorgeous necklace.
Free Beading Tutorial for Media Luna Bracelet is very detailed, easy to follow, step by step, with clear beading instructions and with color photos of each step.


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Released RT media fixer shifts focus to his retrial, uniting with exiled family
15 December 2020 4:32 PM
Khy Sovuthy
Media fixer Rath Rott Mony speaks about his time in a Phnom Penh prison on Saturday, after serving a two-year conviction for incitement. Panha Chhorpoan
Rath Rott Mony sits at a Phnom Penh café over the weekend, dressed in a blue shirt and grey trousers – gone are the orange prison overalls. The media fixer and translator was released from prison on Friday.
The 49-year-old man was arrested and convicted by a Phnom Penh court last year for helping produce a documentary for Russia's RT news service on sex trafficking in Cambodia. He was charged with incitement and sentenced to two years in prison.
He is pleased to have left prison but is still concerned about being targeted if he continues with his previous line of work.
"I regret that I was imprisoned for two years because I was a fixer," said Rott Mony. "I am concerned about my safety because my safety is unsure while the court does not hold a retrial yet," Rott Mony.
This year the Supreme Court directed a retrial in his case, disagreeing with an Appeal Court ruling that the municipal court's conviction was legally sound. Even as Rott Mony was released, he is still awaiting a retrial in the case – he can only get a lesser prison sentence after the retrial because the conviction was appealed by the defendant and not the prosecution.
Reentry into Cambodian society brings Rott Mony face-to-face with another test for the family. After the government expressed its anger at the RT documentary, the media fixer fled to Thailand seeking asylum, but was deported in December 2018 by Thai authorities.
Shortly after Rott Mony's conviction, his wife Long Kimheang also left for Thailand with their child and has been in hiding since.
"It makes me very concerned about my wife and my son," Rott Mony said. "I miss my wife and my son because I haven't seen them for a long time."
He said that his wife wants to come back to Cambodia – she has not been publicly charged of any crimes – but he does not know whether local authorities will allow her to return. He is worried Cambodian authorities would not be happy Kimheang petitioned for his release and protested on multiple occasions outside the Russian Embassy in Phnom Penh from late 2018 to early 2019.
Rott Mony said his wife was under surveillance by Thai authorities and had rarely left the room she was staying in.
Rath Rott Mony waves as he arrives at the Supreme Court on July 15. Panha Chhorpoan
Ny Sokha, the head of monitoring for local rights group ADHOC, said the courts were moving very slow in processing Rott Mony's case, given that he had already served his term before he could contest his conviction.
"It is a regret that the court's procedures are progressing slowly which has made the defendant to lose his rights," Sokha said, questioning if the Appeal Court will give Rott Mony any compensation if it was found out he was not guilty of the charges.
He said the court should enforce corrective measures to ensure that defendants don't finish their sentences before they can complete the entire judicial and appeals process.
Sokha said Rott Mony's conviction was a blow to press freedoms in Cambodia, revealing that journalists and fixers could get into legal trouble for doing their work.
"I think that it affects the journalists' spirit," said Sokha.
Touch Tharith, the spokesperson at the Appeal Court, could not be reached for comment.
Chin Malin, a Justice Ministry spokesperson, did not agree with Rott Mony's accusations of a wrongful conviction or delays in the process. He said the court always followed the procedures written in law and based judgments on evidence, pointing out that Rott Mony's release from prison on completion of his prison sentence was also an application of judicial procedures.
"The court processes the procedures normally and when he completed his jail term, he was let out," said Malin.
Nop Vy, executive director at Cambodian Journalists Alliance, said the conviction was unjust for Rott Mony because he was just a fixer and was only assisting foreign journalists on the project.
He said it would have an effect on other fixers who would be reluctant to work with journalists.
"The court should drop all charges on him because it will make fixers and journalists afraid of doing their work," said Vy.
The Cambodian government never said anything publicly about RT nor is there any suggestion that the issue was taken up with the Russian Embassy in Phnom Penh. The documentary remains online and can be viewed by anyone.
The state-owned publication even sent a letter to the Cambodian Embassy in Moscow clarifying that Rott Mony was only a "fixer and translator" for the documentary crew and had obtained consent forms from the women featured in the video. The two main characters in the documentary denied claims made in the video and said they were paid to speak on camera.
The Cambodian government has been particularly sensitive to stories about sex trafficking in the country. In 2017, it threatened to shut down anti-trafficking NGO Agape International Missions for allegedly misidentifying three girls sold into sexual slavery as Cambodians, when they were ethnic Vietnamese.
Similar to the RT documentary, international broadcaster CNN had featured the three girls' stories in the "CNN Freedom Project," an international news campaign by the U.S.-based television channel to end modern-day slavery.
Government officials, all the way up to Prime Minister Hun Sen, attacked CNN for its coverage of the story; anger that RT, formerly known as Russia Today, was spared in 2018.
Back at the café, Rott Mony is not shy to speak about his time in prison. He said he was first placed in a crowded cell block with people convicted for various crimes, but was later moved to one which housed more jailed human rights defenders and prisoners of "conscience."
He said he would have to spend at least $175 to $200 a month to buy edible food and other items he needed while in prison. Rott Mony soon got the moniker "teacher" after he started helping a few inmates learn English.
"And while I taught English to some inmates, I also learned Thai and Vietnamese from other inmates and now I can speak Thai and Vietnamese," he said.
Even though it's been days since his release, Rott Mony is not necessarily shying away from returning to journalism. He said he had been granted a media license for an online publication he had founded called "Samleng Baksey." While the publication was ready to publish news in 2018, Rott Mony's arrest meant he never had a chance to use it.
"If I have ability, I want to be a journalist in the future," said Rott Mony.
RT Media
Provincial journalist convicted for reporting military-linked land dispute
Journalist alleges threats from Kratie Military Police official over illegal logging story
Government alleges misconduct among journalists, greenlights legal action
Three Kratie journalists charged with extortion in suspicious land clearing case
Dutchman convicted of child pornography finally pays compensation to families
Case against Cambodia Daily reporters withdrawn but press freedom attacks persist


Heather T. Pane Seifert, Ph.D., M.P.P.
Heather T. Pane Seifert, Ph.D., M.P.P., is a licensed clinical psychologist in North Carolina and works as a Clinical Implementation Specialist for the North Carolina Child Treatment Program, Center for Child and Family Health, which has multiple partners including the UCLA-Duke National Center for Child Traumatic Stress. Here, she collaborates on projects to support the effectiveness and implementation of evidence-based treatments for children across the state. Dr. Seifert also spends part of her time providing trauma-focused treatment for youth and parent-management training for families.
Dr. Seifert has more than seven years of experience conducting evidence-based assessments and group and individual psychotherapy with youth, families, and adults from diverse backgrounds. These experiences have spanned a variety of mental health difficulties across inpatient, residential treatment, outpatient, school, and private practice settings.
Dr. Seifert's research and interests focus on youth in or at-risk for out-of-home placements, such as group homes and juvenile detention centers, who have been exposed to trauma or chronic stress. She studies risk and protective factors for psychiatric disorders and functional outcomes, and effectiveness and implementation of evidence-based treatments for children and families. Dr. Seifert's goal is to support positive youth development through integrating evidence-based, trauma-informed interventions in school and other community settings.


text:
Q: Docker - Running Container but can't view app in browser Following the getting started docs outlined here I have decided to run the same environment but with the new Docker for Mac app. The docs say that after running the commands I should be able to go to 192.168.99.100/admin to login but I am not able to pull anything up. I think this is because the app was configured with docker tool box which used a VM ip of the one mentioned above. Doing localhost:80 I get the apps error and favicon, please what am I doing wrong I am new to docker and developing with these new tools.

A: your questions leaves a lot of room for errors - I will try to answer it as simple as possible.
How to identify you docker IP on a mac - depending on the method you are using:

*

*boot2docker boot2docker ip

*docker-machine docker-machine ip default

*If you were using kitematic - check the tool

In case this does not work, check your docker container (docker ps for the ID) by using docker inspectwhich will reveal the information you need if you find the Keyword IPAdress.
In case it still feels it should run but does not - check with a default docker container like nginx ( docker run --name docker-nginx -p 80:80 nginx )

redpajama_set_name: RedPajamaStackExchange


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Have you Been Charged with Embracery in Georgia?
The Sixth Amendment to the United States Constitution guarantees the rights of criminal defendants. One such guarantee is the right to an impartial jury. Embracery violates a defendant's right to an impartial jury because it seeks to influence jurors. If you have been charged with embracery, you need a Georgia Embracery Attorney. We have unparalleled defense experience and are prepared to help with your case today.
What is Embracery in Georgia?
This statute applies to traverse jurors as well as grand jurors. Traverse jurors are those that listen to evidence and determine the facts in a particular case. They generally serve for a week or less.
A person convicted of embracery will be guilty of a felony. The coinciding penalty will be a fine of no more than $1,000 and between one and five years in prison, or both.
However, a person convicted of embracery may also be subject to civil damages by the person injured.
Lack of intent: The statute requires that the accused intentionally interfere with the juror to influence their action. If there is no evidence of intent to influence their action, that would be an acceptable argument.
No matter the crime, our Georgia Attorneys can help. If you have been charged with embracery in Georgia, we are here to assist with your case. Contact us today to start building your defense.


text:
New state retirement regulations established
Local | December 6, 2007
Appeal Capitol Bureau
The Public Employee Benefits Program adopted regulations Thursday to put in place rules for which retirees can be in the plan and which ones can't.
Effective Sept. 1, 2008, only those public employee groups which have their active members in the state plan can send their retirees to the state. At present, any public retiree can join the state plan whether his government or school district is in the plan.
In addition, lawmakers ruled the local governments where those retirees worked must subsidize those retiree premiums to at least the same degree the state subsidizes its retirees.
Lawmakers who created the new rules did so, saying local governments and school districts were reducing or eliminating coverage for retirees and dumping them on the state.
That cuts the per-person cost for local governments and schools because younger active workers are healthier and it costs less to provide benefits. But state officials said it raises costs to the state plan, which is becoming disproportionately retirees.
Lawmakers said effective next year, the rule is "all in or all out."
The new law is pushing large numbers of experienced public workers at local governments and school districts to consider early retirement so they can get in the state plan before that deadline, further increasing the strain on entities like the Clark and Washoe county school districts, which are concerned they will lose a large number of experienced teachers.
One issue created by the new rules is still unresolved. The Las Vegas Metropolitan Police has refused to pay the subsidy for its state plan retirees, saying their benefits are provided through a collectively bargained trust which puts them outside the statute requiring the subsidy.
A Las Vegas judge agreed, but the plan appealed. PEBP Director Leslie Johnson said if Metro loses, it will have to make back payments to the state totaling over $1 million. If the benefits program loses, Johnstone said PEBP will have to absorb that cost.
But she said it has another ramification. If Metro wins, its estimated 100 state retirees will have to leave PEBP because only public workers covered by that statute, NRS287, can be in the program.
That would apply to an estimated 3,500 other retirees in PEBP as well, more than 2,000 of them retired Clark County teachers, since the district plan is also provided through a collectively bargained trust.
That case is scheduled for argument before the Nevada Supreme Court on Jan. 24.
• Contact reporter Geoff Dornan at gdornan@nevadaappeal.com or 687-8750.


text:
Category: Sports Medicine
Photograph by Hillary Swift (NYT)
The stress of competition or even less stress can trigger eating disorders (energy intake imbalance), depression and other emotional disturbances. These need to be recognized, referred and treated as rapidly as possible.
Sports psychologists and teams that are prepared to handle all of the ramifications of these issues are critical.
NY Times Magazine Article on Gracie Gold
Biomechanics Sports Medicine Tendinopathy Tips
Kevin Kirby, DPM has posted a biomechanical description of the orthotic modifications he uses when treating chronic peroneal tendinopathy. They mesh well with what we've presented here and Kevin provides an excellent diagram along with his description. Be sure to read his post.
See his tweet with a link to Facebook: Off To Twitter
Sports Medicine Tendinopathy
Peroneal Tendon Complex: Injury and Rehabilitation
By Stephen M. Pribut, DPM
While ankle sprains are the most common musculoskeletal athletic injury,(1) the peroneal tendon complex (PTC) is often injured concurrently. Injury to the PTC has become widely recognized as an acute injury and a significant source of lingering pain and disability. These injuries are frequently correlated with inversion ankle sprains and chronic ankle instability (CAI).
The peroneal tendon complex (PTC) includes the peroneus longus and brevis tendons, the os peroneum, and their restraining components (Figure 1). We will discuss the anatomy, clinical significance and conservative treatment of injury to the PTC.
Peroneal Muscles and Tendons
(Image courtesy 3d4Medical Ltd. "Essential Anatomy 5")
The peroneus longus and brevis muscles are located within the lateral compartment of the leg. The vascular supply is primarily from the posterior peroneal artery. Innervation of the peroneals is from the superficial peroneal nerve. The well positioned constraints which serve to maintain proper anatomical position of the PTC include the superior peroneal retinaculum, the retromalleolar groove, the shared tendon sheath, the individual tendon sheaths, the peroneal tubercle, the inferior peroneal retinaculum, and the peroneal groove below the cuboid (Table 1).
Peroneus Longus
The origin of the peroneus longus muscle is from the head and upper two-thirds of the lateral surface of the fibular body and from the intermuscular septa adjacent to the muscles of the anterior and posterior leg. The musculotendinous junction occurs proximal to the lateral malleolus. The peroneus longus along with the peroneus brevis enters the fibular fibro-osseous tunnel behind the fibular malleolus and shares a common synovial sheath. The peroneus longus tendon changes direction three times in the foot: at the lateral malleolus, the peroneal tubercle, and at the cuboid notch. A hypertrophied tubercle may be a cause of injury of the PLT.(2)
An ossified os peroneum is found in approximately 20% of individuals at the cuboid notch (Figure 2).(3). The tendon runs below the cuboid and crosses obliquely to insert into the base of the first and second metatarsal and the lateral facet of the medial cuneiform bone.
Peroneus Brevis
The peroneus brevis muscle originates at the distal two thirds of the lateral
aspect of the body of the fibular and the adjacent intermuscular septa. It passesbehind the fibula where it lies adjacent to the fibula and deep to the peroneus longus while passing through the fibro-osseous tunnel. The insertion is at the tuberosity of the base of the fifth metatarsal bone. An os vesalianum is found near the insertion in less than 1% of people.(4)
The peroneus tertius muscle is found in approximately 90% of people and begins at the distal third of the anterior fibula. The muscle is usually confluent with the extensor digitorum muscle and ends before the inferior extensor retinaculum. The peroneus quartus is an anomalous muscle found in 6.6% to 22% of individuals. It begins at the peroneus brevis and inserts into the peroneal tubercle after travelling through the shared peroneal tendon sheath. (5)
Biomechanics and Injury
Peroneal tendon injures are a direct result of their anatomy and biomechanics. (5) The peroneal muscles are multi-joint muscles. Early in stance, the PTC is subject to passive stretch as the gastrosoleus acts proximally as a tibial decelerator. Late in stance phase, the PTC acts as a weak plantar flexor at the ankle joint.
At the subtalar joint (STJ), the peroneals act as pronators and are antagonists to the tibialis anterior and tibialis posterior muscles. Additionally, the peroneus longus muscle (PLM) plantarflexes the first ray and is a pronator at the midtarsal joint. The peroneals are most active in mid- and terminal stance, functioning to stabilize the foot. (6,7) Recent studies have demonstrated weakness of functional evertor strength in CAI. (8)
The PTC is subject to strain forces when the foot is inverted or supinated about the STJ. A sudden inversion force or chronic overuse may injure the PTC or the lateral ankle. The most frequent injuries to the PTC are traumatic tendinopathy, a tear, or a subluxation of the peroneal tendons. (9) Tendon subluxation is believed to occur with the foot in a dorsiflexed position and the peroneal tendons contracting strongly. (10)
Risk factors associated with peroneal tendon injuries may be seen in Table 2. (11, 12) Multi-directional sports, such as soccer, tennis, and basketball, are associated with these injuries. While peroneus brevis injuries are frequently suspected at the level of the lateral malleolus, injury to the distal peroneus longus is often undetected. Additional associated injuries include injury to the cuboid, the os peroneum, or fifth metatarsal. (3, 13) Differential diagnoses are listed in Table 3.
Peroneal tendon complex injury is considered a risk factor and contributor to CAI. (14, 9) A recent study showed that a brief bout of pain posterior to the lateral malleolus preceding an inversion ankle injury was associated with MRI evidence of peroneal tendinosis in 95% of cases. (13) Up to 75% of those suffering inversion ankle injuries may have a recurrence of injury or are subject to ongoing symptoms related to chronic ankle instability (CAI). (15, 16) Examination at the time of surgery for recalcitrant CAI often demonstrates injury. A retrospective review of 136 patients who underwent a Broström-Gould ankle reconstruction found that 53.3% required operative intervention for peroneal tendon pathology. (14)
Examination of sixty-four consecutive acute ankle inversion injuries by MRI revealed that 30% of the subjects suffered an associated tendon injury. (17) These injuries, when unrecognized, may contribute to ongoing symptoms. Estimates range from 30% to 70% of inversion ankle injuries may recur or have lasting symptoms. These ongoing symptoms diminish sensorimotor functioning and lead to decreased physical activity and concomitantly a diminished quality of life (18). It has been reported that 32% of ankle inversion injuries are still symptomatic seven years after the injury. (19)
Painful Os Peroneum Syndrome (POPS)
The os peroneum (OP) is a sesamoid bone found within the peroneus longus tendon (PLT) of most people. It is usually located just proximal to the cuboid tunnel. The OP is frequently fibrocartilaginous, often bipartite, and is only visible on x-ray 6–20% of the time (Figure 3).
The OP is subject to both fracture and contusion. Bone callus formation during healing can lead to tendinopathy of the peroneus longus tendon and it may also play a role in tears of the tendon. When the OP is injured, the MRI may show fluid around the PLT and bone marrow edema of the cuboid. (20)
A history and physical examination will reveal the cause of many injuries. While the inversion movement which causes the injury occurs rapidly, the full effects may not be obvious for several hours. The lag between injury and effect will lead many patients to forget the inversion event. The history may reveal previous ankle sprain, fracture, or other lateral foot injury. Peroneal subluxation may be associated with a sensation of painful clicking.
A methodical physical examination follows the principles of look, touch, and move. Examine for swelling, color, general alignment, structure, and symmetry. Thoroughly palpate the lateral foot and ankle and explore the peroneal tendons through their entire course. Peroneus brevis tears often occur behind the fibula, while peroneus longus injury may occur at the cuboid groove or more distally. Note the strength of the peroneal tendons and pain during resisted ankle eversion. Also note pain in response to dorsiflexion of the first ray or an inability to resist the dorsiflexion. (5) Be sure to check the ankle for ligamentous disruption.
Peroneal subluxation may be tested by flexing the knee and asking the patient to actively dorsiflex the ankle with resisted eversion. The test is positive if the peroneal tendons are seen to subluxate anterior to the fibular malleolus. Intra-sheath subluxation is suspected if their position translates relative to each other. (5) The peroneal compression test suggests peroneus brevis tendinopathy. To perform this test, evert and dorsiflex the foot while compressing the fibular groove.(20)
The Ottawa protocol outlined in Table 4 should only be used for acute ankle injuries and not for late injury evaluation. On x-ray, carefully evaluate all the lateral boney structures. Figure 4 shows a hairline Jones fracture that went undetected the previous night at an urgent care center (Figure 4). A visible fleck of bone at the fibula indicates possible subluxation of the peroneal tendons from the fibular groove. A Harris view assists in assessing the peroneal tubercle and the retromalleolar groove. (21, 22) Be on guard for a fracture of the os peroneum or distraction of multipartite fragments (Figure 5). Fractures of the os peroneum may best be assessed using a CT scan which better reveals the border of the ossicle.
Ultrasound can be useful to detect peritendinous fluid, or partial or complete rupture, but it requires an experienced examiner.
Magnetic resonance imaging (MRI) shows the anatomy in best detail. Fluid surrounding the tendons are best seen on T2-weighted or short tau inversion recovery (STIR) images. These images are useful to assess subtle injury to the cuboid and base of the fifth metatarsal. The MRI finds more pathology than is clinically relevant in some cases while it may miss other pathology. (23) MRI has a positive predictive value of less than 50%. (24, 25)
Outline of Treatment
High level evidence-based medicine is the goal we seek to attain. However, there are times when the evidence is weak, contrary, wrong, or lacking. There is only scant material written on rehabilitation for PTC injury. Researching the rehabilitation of ankle injuries is a reasonable place to begin crafting a program for the PTC. (26) Most recent overviews have come to realize the flaw of not using adequate protection during the earliest stage of therapy. (16, 27)
The most consistently recommended therapy for rehabilitation of an acute ankle sprain, CAI, and for prevention to reduce the risk of future re-injury is balance training. (27, 28, 29, 30)
Proposed Functional Rehabilitation of PTC Injury
Phase I: Protection, rest, ice, compression, and elevation.
Initial therapy requires protection of the injured area. A removable pneumatic cast boot serves as both protection and compression and may be removed for exercise and evaluation. (21) An ankle brace alone is not effective since the stabilization achieved is inadequate. The tendons must be protected from forces that place them under stretch, including dorsiflexion moments applied to the foot. It is helpful to protect the mid-foot, mid-tarsal joint, and first ray from forces which translate into strain forces on the peroneal tendons. The removable cast boot is used for one to four weeks depending upon the severity of the injury.
Ice may be applied for 20 minutes on/40 minutes off for three to six times per day for the first 48 hours. Ibuprofen or another NSAID may be helpful.
Phase II: Motion
Do not rush the patient into vigorous muscle and strength exercises. This has been part of chronically failing regimens previously used for the ankle. Gentle range of motion exercises may be performed.
Phase III: Neuromotor
Proprioception, balance, and muscle strength are keys to successful recovery. The most efficacious tool to accomplish these goals is the 20" wobble board. This appears to reach optimal angular relationships at maximum excursion to train the neuro-facilitative responses needed in gait.
Other proprioception and balance exercises may also be used. The most popular are Romberg one leg balance exercises and the simplified STAR excursion exercises. (31, 32)
Muscular strength exercises may be augmented using exercise band therapy. Recent evidence has shown more proximal muscle training may also assist in recovery.
Limitation of dorsiflexion and equinus may be addressed by posterior muscle group stretching and active exercises such as the heel roll-up. Toe crunches strengthening the intrinsic muscles are also helpful to stabilize the mid-tarsal joint and decrease PTC forces needed for this stabilization.
Gentle foam rolling of the calf muscles may help mobilize the ankle.
Phase IV: Return to Activity
The balance and proprioceptive exercises from Phase III should all be continued for at least three months. Specific training for a return to activity may begin.
Preparation for return to full activity includes beginning with walking, progressing to running, cutting, and sideways movements needed for sport. It generally requires four to six weeks to return to most sports but occasionally twelve weeks may be needed.
Evidence has pointed to orthotics as being helpful in treating CAI. Orthotics are also helpful in treating PTC injuries. Orthotic modifications to reduce the strain on the peroneal tendons and lateral foot structures are important components of treatment. Research also indicates that orthotics produce proprioceptive and balance improvements. (33)
Feet that suffer these injuries often have a lateral shift of the STJ location, which increases the supinatory moment of ground reaction forces. The orthotic modifications I use are designed to alter these moments and allow the peroneals to function optimally. These modifications include a 0/0 rearfoot post with "no lateral bevel" (Figure 6). This makes the orthotic less prone to cause excessive supination. You may use a low level of cast inversion and medial skive depending upon the foot type. In addition, you may use about 3 degrees of lateral forefoot valgus wedging to the sulcus, especially for patients who do not contact with the rear foot. Additional modifications seen in Table 6 are based on Richard Blake's suggestions for excessive supination. (34)
We have briefly reviewed the anatomy, injuries, and rehabilitation for injuries to the PTC (Table 7). There is much to research and write about this topic. Don't stop learning. Your patients benefit from your knowledge.
Outline of Therapeutic Treatment for Peroneal Tendon Injuries
Acute Care:
PRICE: Protection, Rest, Ice, Compression, Elevation
Pneumatic walking boot
ROM exercises
Wean from cast boot
Proprioception exercises
Wobble Board Training
STAR with imbalance platform
Custom Orthotic:
No rear foot post bevel
Minimal Cast correction
Possible FF Valgus Posting
Additional corrections as needed
PDF Version with Medical CME
More images coming:
Figure 1. Know your anatomy. Tablet-based apps help demonstrate the anatomy to your patients. (Image courtesy 3d4Medical Ltd. "Essential Anatomy 5")
Figure 2. Normal os peroneum.
Figure 4. Hairline Jones fracture. Tender to touch and visible on x-ray.
Figure 5. Fragmented os peroneum. Healing bone callus visible.
1. Waterman, B.R., et al., The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am, 2010. 92(13): p. 2279–84.
2. Palmanovich, E., et al., Peroneus longus tear and its relation to the peroneal tubercle: A review of the literature. MLTJ Muscles, Ligaments and Tendons Journal, 2011. 1(4): p. 153–160.
3. Brandes, C.B. and R.W. Smith, Characterization of patients with primary peroneus longus tendinopathy: a review of twenty-two cases. Foot Ankle Int, 2000. 21(6): p. 462–8.
4. Vasiljevi?, V., L. Markovi?, and J. Vasi?-Vili?, Accessory bones of the feet: Radiological analysis of frequency. Vojnosanitetski …, 2010.
5. Roster, B., P. Michelier, and E. Giza, Peroneal Tendon Disorders. Clin Sports Med, 2015. 34(4): p. 625–41.
6. Perry, J., Gait Analysis: Normal and Pathological Function. 1992, SLACK, Inc.: Thorofare, NJ. p. 165–167.
7. Santilli, V., et al., Peroneus longus muscle activation pattern during gait cycle in athletes affected by functional ankle instability: a surface electromyographic study. Am J Sports Med, 2005. 33(8): p. 1183–7.
8. Terrier, R., et al., Assessment of evertor weakness in patients with chronic ankle instability: Functional versus isokinetic testing. Clin Biomech (Bristol, Avon), 2017. 41: p. 54–59.
9. DiGiovanni, B.F., et al., Associated injuries found in chronic lateral ankle instability. Foot Ankle Int, 2000. 21(10): p. 809–15.
10. Cerrato, R.A. and M.S. Myerson, Peroneal tendon tears, surgical management and its complications. Foot Ankle Clin, 2009. 14(2): p. 299–312.
11. Hyer, C.F., et al., The peroneal tubercle: description, classification, and relevance to peroneus longus tendon pathology. Foot & ankle international, 2005. 26(11): p. 947–950.
12. Mook, W.R., S.G. Parekh, and J.A. Nunley, Allograft Reconstruction of Peroneal Tendons. Foot & Ankle International, 2013. 34(9): p. 1212–1220.
13. Ziai, P., et al., Peroneal tendinosis as a predisposing factor for the acute lateral ankle sprain in runners. Knee Surg Sports Traumatol Arthrosc, 2016. 24(4): p. 1175–9.
14. Burrus, M.T., et al., Predictors of peroneal pathology in Brostrom-Gould ankle ligament reconstruction for lateral ankle instability. Foot Ankle Int, 2015. 36(3): p. 268–76.
15. Gerber, J.P., et al., Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int, 1998. 19(10): p. 653–60.
16. Richie, D.H. and F.E. Izadi, Return to play after an ankle sprain: guidelines for the podiatric physician. Clin Podiatr Med Surg, 2015. 32(2): p. 195–215.
17. Khor, Y.P. and K.J. Tan, The Anatomic Pattern of Injuries in Acute Inversion Ankle Sprains A Magnetic Resonance Imaging Study. Orthopaedic journal of sports medicine, 2013.
18. Gribble, P.A., et al., 2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med, 2016. 50(24): p. 1493–1495.
19. Konradsen, L., et al., Seven years follow-up after ankle inversion trauma. Scand J Med Sci Sports, 2002. 12(3): p. 129–35.
20. Sobel, M., H. Pavlov, and M.J. Geppert, Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Foot & ankle …, 1994.
21. Heckman, D.S., G.S. Gluck, and S.G. Parekh, Tendon disorders of the foot and ankle, part 1: peroneal tendon disorders. Am J Sports Med, 2009. 37(3): p. 614–25.
22. Bruce, D.W., et al., Stenosing Tenosynovitis and Impingement of the Peroneal Tendons Associated with Hypertrophy of the Peroneal Tubercle. Foot & Ankle International, 1999.
23. Major, N.M., C.A. Helms, and R.C. Fritz, The MR imaging appearance of longitudinal split tears of the peroneus brevis tendon. Foot & ankle …, 2000.
24. Giza, E., et al., A clinical and radiological study of peroneal tendon pathology. Foot & ankle …, 2013.
25. Park, H.J., et al., Reliability of MRI findings of peroneal tendinopathy in patients with lateral chronic ankle instability. Clin Orthop Surg, 2010. 2(4): p. 237–43.
26. Kosik, K.B., et al., Therapeutic interventions for improving self-reported function in patients with chronic ankle instability: a systematic review. Br J Sports Med, 2017. 51(2): p. 105–112.
27. Kaminski, T.W., et al., National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train, 2013. 48(4): p. 528–45.
28. De Ridder, R., et al., Effect of a Home-based Balance Training Protocol on Dynamic Postural Control in Subjects with Chronic Ankle Instability. Int J Sports Med, 2015. 36(7): p. 596–602.
29. Hupperets, M.D., E.A. Verhagen, and W. van Mechelen, The 2BFit study: is an unsupervised proprioceptive balance board training programme, given in addition to usual care, effective in preventing ankle sprain recurrences? Design of a randomized controlled trial. BMC Musculoskelet Disord, 2008. 9: p. 71.
30. Hupperets, M.D., E.A. Verhagen, and W. van Mechelen, Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ, 2009. 339(jul09 1): p. b2684.
31. Herb, C.C. and J. Hertel, Current concepts on the pathophysiology and management of recurrent ankle sprains and chronic ankle instability. Current Physical Medicine and Rehabilitation Reports, 2014. 2(1): p. 25–34.
32. Gribble, P.A., J. Hertel, and P. Plisky, Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train, 2012. 47(3): p. 339–57.
33. Sesma, A.R., et al., Effect of foot orthotics on single- and double-limb dynamic balance tasks in patients with chronic ankle instability. Foot Ankle Spec, 2008. 1(6): p. 330–7.
34. Blake, R. Orthotic Design for Excessive Supination. 2013 (cited 2017 05/05/2017); Available from: https://www.youtube.com/watch?v=hMhrTmWXfDA.
Bio: Dr. Pribut is a Clinical Assistant Professor of Surgery at George Washington University Medical School. He serves on the Runner's World Board of Advisors. He is a past president of the American Academy of Podiatric Sports Medicine. Dr. Pribut is in private practice in Washington, DC.
Tags Tendinopathy
Biology Sports Medicine Tendinopathy
NSAID treatment and tendinopathic tissue
A new study – online at the J Applied Physiology (August 31, 2017) – was performed to measure beneficial impact on collagen production in chronic tendinopathy. The study evaluated mRNA (and ribosomal RNA) and more along with determining the impact on gene activity.
The study showed that one week of 1800 mg per day of Ibuprofen seemed to not have a measurable impact. The authors propose that the impact in vivo and in vitro may be dramatically different for one of several reasons. The tendon cells may not be sensitive to ibuprofen or they may not be exposed to a high level of ibuprofen in the body
The study did demonstrate that there was a decrease in pain compared to placebo and suggested that the pain reduction pathway may work in ways not yet well described.
The best news was that although it may not have a dramatic impact on chronic Achilles tendinopathy (which we suspected and perhaps knew all along), it did not destroy tendon cells.
Online: J Appl Physiol (August 31, 2017). doi:10.1152/japplphysiol.00281.2017
Biomechanics Running Sports Medicine Tendinopathy
Hot off the presses – a new article at Podiatry Management Magazine with CME credits available.
Just added: peroneal tendon complex injury and rehabilitation.
And for the pdf file for the article just published: Peroneal Tendon Complex: Injury and Rehabilitation.
Biomechanics Sports Medicine
Orthotic Modifications for High Arched Feet (Pes Cavus)
Special Topic: Orthotic Modifications for Over Supinated Feet
In most cases I am not designing a foot to correct a "foot type" but to provide a solution for a specific clinical problem. While having a high arched, over supinated, under pronated foot may predispose to certain problems other "foot types" can have many of the same problems.
Some problems that can occur and are related to supination movements (or even "moments") include:
chronic and repeated ankle sprains
peroneus brevis tendinopathy
peroneus longus tendinopathy
cuboid stress fractures
4th and 5th metatarsal stress fractures
5th metatarsal base or midshaft fractures
lateral leg pain (peroneal muscle group)
In many instances with problems like these, immobilization may be necessary for a time. Wobble board training should be incorporated into rehabilitative programs. The purpose of the wobble board training is to have the neuromuscular system adapt the peroneal muscles to performing repetitive firing for stabilization. The angles that the wobble board makes with the ground and the motion and angular relationships that it engenders in your ankle and leg are ideal to training the peroneals to fire appropriately.
The wobble board assists in training muscle strength, balance, and improving joint position sense. There is nothing that beats this 3 in 1 training.
For patients who do not have a dramatic Pes Cavus foot there are a few specific corrections I include in the orthotic:
Accurate cast of the foot.
I do not want a 2D pressure scan. I want to hold the foot in neutral subtalar joint position. And I want to plantar flex the first ray by either light dorsal pressure over the first metatarsal or by slight dorsiflexion of the great toe during the casting.
Minimal cast correction.
I want the cast to reflect the shape of the foot to mirror it so that when I want to alter forces, they will be altered by the shape and adjustments to the orthotic. I want the forces distributed through a large surface area and need conformity between the shape of the foot and the shape of the orthotic.
No lateral bevel.
This resists over supination directly. It is like an outrigger on a boat. It also changes moments of force going into the foot.
3 degree lateral forefoot wedge.
This is often used to prevent over supination of the foot after the heel as left the ground or as weight is transferred towards the forefoot.
These are often my starting steps to deal with the problems listed above when they are resistent to treatment.
For a Pes Cavus, high arched, over supinated foot podiatrist Richard Blake, DPM has put a great video on line. It details his 8 steps to deal with this foot type using specially customized orthotics. The modifications made for this problem are not found in over the counter orthotics. And many specialists do not see enough patients with high arches to be adept at treating the problems associated with this foot type. It is important to find a physician that has experience with sports medicine, high arch feet, and biomechanics.
The Blake 8 Steps (only slightly modified) follow:
First an accurate cast is required as described above.
A) Rounding of the lateral border of the cast or via CAD/CAM to have the orthotic better grip the foot.
B) Lateral Kirby Skive. Often 2 to 4 mm.
C) Deep Heel Cup – up to 25 mm.
D) Extended lateral heel cup or "lateral flange"
E) Eliminate "medial heel grind off" and/or add No Lateral Bevel in rearfoot posting instructions.
F) Lateral arch fill to add more surface contact area
G) Narrower orthotic (sometimes) to limit any antipronatory forces. (note: some will go for wide or nomal width for increased stability and contact)
H) Forefoot modifications such as lateral wedge
Dr. Blake reviews these modifications in a 9 minute video on YouTube: https://www.youtube.com/watch?v=hMhrTmWXfDA
This video is well worth watching for anyone who needs the modifications or anyone who is planning to incorporate them into a patient's orthotics.
Note: Images Courtesy of ProLab Orthotics
High Arches can make you feel like you are heading for your own personal apocalypse. Turn it down and listen to Arch Enemy with some heavy metal:
Or if you feel like stepping out, you can go retro with John Mayall's Bluesbreakers:
PRP is Not for Routine Office Use
Those two recommended set of injections at $6,000 per series for your Achilles tendinitis hasn't sounded very good for the past few years. Ever since a controlled, prospective comparison study demonstrated there was absolutely no difference in the efficacy of PRP over saline injected in the same manner, there has been doubt about the use of PRP in the office. But instead of falling by the wayside, like a bad political candidate, it has spread by meme and scheme far and wide and even infiltrated some of the best offices in the country and world.
The British Medical Journal has recently posted an article strongly recommending against the in office use of PRP (platelet rich plasma) outside of established studies.
The article was titled: "How effective are platelet rich plasma injections in treating musculoskeletal soft tissue injuries?" The answer, at this time, seems to lie somewhere between "we have no clue" and "not very". This study mentions a previous review by the Cochrane review (2014) which examined 19 studies and found insufficient evidence of the usefulness of PRP. This study reviews 10 additional studies and reaches the same conclusion.
The article is readily available and worth a read:
PRP review at BMJ
How effective are platelet rich plasma injections in treating musculoskeletal soft tissue injuries? Keene,DJ, Alsousou,J, Willett,K BMJ 2016;352:i517
BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i517 (Published 17 February 2016)
Autologous platelets have no effect on the healing of human achilles tendon ruptures: a randomized single-blind study. Schepull T1, Kvist J, Norrman H, Trinks M, Berlin G, Aspenberg P. Am J Sports Med. 2011 Jan;39(1):38-47. doi: 10.1177/0363546510383515. Epub 2010 Nov 3.
Culture Running Sports Medicine
Interview/Podcast With Runners Connect
I've found what I am sure is the best podcast on running. The podcast is put on by Runnersconnect and hosted by excellent and ever improving, elite marathoner Tina Muir.
Tina is knowledgeable, ever prepared, sounds great, and conducts a wonderful interview each week. Runners Connect has interviewed many fascinating people from the running community. Among those I've listened to are Dan Lieberman, Chris McDougall, Tim Noakes, and Jack Daniels. Each week there is another interview with someone who has a special take on running and from which you can learn.
This week a podcast in which I was interviewed has gone online. The interview covered a lot of ground. We did not review the questions in advance. Instead we did wing it. Free range always sounds best to me. Tina was well prepared and asked questions that led to many different areas.
I hope you find the podcast interesting. It is likely to contain information you haven't heard before and likely not quite what you'd expect. If what you wanted wasn't included, there are so many other great podcasts, I have no doubt you'll discover a good number that you'll enjoy.
http://runnersconnect.net/running-interviews/steve-pribut-injuries/
Running Sports Medicine
Hyped Plantar Fasciitis Treatment Study is Significantly Flawed
Is There Really A New Exercise Which Will Cure Plantar Fasciitis?
This study showed no benefit at 1 month, 6 months and one year. There was only a benefit noted at the 3 month datapoint, which then disappeared.
Highly touted High-Load Strength Training Shows No Benefit In Long Term
Last fall, you may have read in the New York Times that an article had been published in the Scandinavian Journal of Medicine & Science in Sport (August 2014) discussing the benefit of high load strength training for plantar fasciitis. The NY Times then described the wonders of this "one simple exercise" in alleviating the pain of plantar fasciitis. The implication was that this particular exercise was the only thing that was going to work. The exercise is done while standing on one foot on a box with the toes dorsiflexed on a rolled up towel. Although if you use a section of the New York Times rather than using the entire paper for your bird cage that may have equivalent effects.
If you take enough data points you might very well be able to prove anything. You may even believe what you see with that limited subset of data. (See the body of work saying there is no human contribution to climate change using limited data sets and cherry picked sources.)
How Large, Precise and Lasting Was the Treatment Effect?
This question is a basic question asked in the American Medical Association's Guide to the Medical Literature, subtitled "A Manual for Evidence-Based Clinical Practice". We don't find the component parts of this question impressively demonstrated in this study.
The main problem is that the article (Rathleff 2014) found a significant improvement ONLY at 3 months (between the group performing the one leg calf raise and those performing a stretch that I'm not fond of). Both groups used "shoe inserts". Another problem is that was called the control group was a comparison and not a control group. We'll continue to use their term.
At 1 month, 6 months and 12 months, there were no significant differences or benefits of this exercise over the control group which just used one stretch and shoe inserts. If we found an exercise (like flossing) that made us feel better only at age 30 and gave us fewer cavities and better gums but only at age 30, there would be no benefit over other exercises that worked equally well for age 20, 40, 50, and 60. There would be no study or media attention given. But with the dearth of truly useful evidence based sports medicine the insignificant gains significance.
Most would like to use a treatment that enables them feel better in 4-6 weeks and at 4 to 6 months. The 3 month data point as a single marker is not useful.
And what is the relevance of this to runners? The study group and control group were both overweight with a BMI averaging 26.4 in the study group and 27.1 in the control. (Less than 25 is considered normal weight. See CDC Healthy Weight – http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/)
There were not many people in this study. Only 24 in the study group and 24 in the control. Using statistical methodology to determine the minimum number to detect a difference in the functional index which they used they required 23 patients in each group. (While the use of "intention to treat" analysis is laudable, can you imagine an approach to cancer treatment being based on a study such as this with only n=24, several dropouts and improvement over a comparative treatment only present at the 3 month mark? Impossible!)
From Ratliff et. al. (2015): "Based on a previous trial, we used a common standard deviation of 18, which showed that 23 patients were needed in each group to detect a statistical difference (power 0.80, alpha 0.05) (DiGiovanni et al., 2003)."
They began the study with 24 in each group. There was a higher drop out number on the study group. Looking at the high-load strength training group there were n=22 measured at 1 month, n=18 at 3 months, n=17 at 6 months and n=18 at 12 months. At the 3 month and beyond time points they were below the levels pre-determined for measuring a detectable difference between groups.
So here we have a study of a few people who were improved in comparison with another control group for "one brief shining moment" which quickly passed. Both groups were ultimately better after 1 year but did not demonstrate a superiority of one treatment over the other. The study design is impeccable. The statistical analysis is elegant. But, the subject number is quite low and the results are clearly open to a different interpretation.
Will this exercise be helpful to some people? Yes it will. Will it be helpful to all and is there a unique benefit demonstrated by this research. No, it is not and there is no unique benefit to this exercise. There is only evidence for a briefly lasting one in this extremely small study which was seen only at the 3 month mark. Not before and not after.
So the hype on this study is just that – media hype with no basis in the evidence contained in the study.
DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, Baumhauer JF. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am 2003: 85-A: 1270–1277.
Digiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, Baumhauer JF. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am 2006: 88: 1775–1781.
Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation.
J Am Podiatr Med Assoc 2003: 93: 234–237.
Pribut SM, "Current Approaches to the Management of Plantar Heel Pain Syndrome" J Am Podiatr Med Assoc, January 1, 2007; 97(1): 68 – 74.
Pribut SM, "Plantar Fasciitis and Heel Spurs: Plantar heel pain syndrome in runners and athletes" http://www.drpribut.com/sports/heelhtm.htm (accessed August, 2015)
Pribut SM, "The Top 5 Running Injuries: Part 2" Podiatry Management, June/July 2013, 181-192
Pribut SM, "Challenging Running Injuries: Be Knowledgeable" Podiatry Management January 2010, 157-166.
Rathleff MS et. al., "High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up." Scand J Med Sci Sports. 2015 Jun;25(3):e292-300.
Thomas JL et. al., "Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline-Revision 2010", J Foot & Ankle Surgery 49(2010) S1-S19.
Statistician's Blues
Running Sport Shoes Sports Medicine
Quick Tips on Running Shoe Lacing
Shoe Lacing Systems
What are laces good for?
Laces help keep your shoes securely on your foot. They should apply pressure evenly and appropriately. Not too tight, not too loose. Just the way the story Goldilocks and the Three Bears would have described it.
Once you have found the perfect lacing system you are sure to discover it changes before very long. Running shoe manufacturers often change the position, orientation and spacing of the eyelets and the lacing system. One would like to believe it is an evolution to greater comfort, efficiency and fit. But appearance and marketability plays at some role.
Over the past few years though, the lacing system that many manufacturers have been adopting returns to a long established standard and is much easier to modify.
Selected Lacing Systems:
Conventional diagonal (Chevron)
Conventional Parallel
Reduced Pressure Parallel
Skip Lacing Pattern
Loop Lock Lacing
Double Lacing (for wide forefoot and narrow heel)
What Problems Can Laces Cause?
Too loose overall:
Foot slips around in the shoe
Posterior Tibialis tendinopathy
Flexor Digitorum Longus tendinopathy
Too Tight overall
Parallel lacing can help
Anterior ankle pain
Tendon compression
Cure : lower lace by an eyelet
Midfoot compression or hot spot
Pain in midfoot
Compresses nerves and tendons
Cure : skip lace pattern
Make sure you remove the laces from any "tongue guide" loop
Tight toe box
Bunion pain
Aggravate incurvated toenails
Band elastic laces
Often too loose
Uneven compression
Barrel clips or locks
Can feel like big lugs banging up against your foot
They can be irritating, aggravating, and annoying
Slipping heel
Use a lock loop at the top
Wide Forefoot, Narrow Heel
Double lacing (2 sets of laces) for each foot
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