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Home » Pioneering new Leeds Health and Care Academy takes international stage
Pioneering new Leeds Health and Care Academy takes international stage
Around 57,000 people who work in Leeds' health and care sector are part of the pioneering new Leeds Health and Care Academy showcased in Washington DC in May.
In an unprecedented partnership approach by the UK's third largest city, the Leeds Health and Care Academy is spearheading a new and shared way of thinking, learning and working together across the sector.
It is bringing together and transforming the learning and development for all who work in health and care. In doing so, it underpins the city's aim to benefit citizens by create 'one workforce' across health and care.
The city's universities will help position the Academy at the forefront of learning, with a portfolio based on world-leading evidence, research and education.
The Academy is a groundbreaking project of Leeds Academic Health Partnership (LAHP), one of the biggest of its kind in the UK. The LAHP founding partners include three Leeds universities, the city's three NHS trusts, NHS Leeds Clinical Commissioning Group and the City Council.
The LAHP is one of only two UK members of the Association of Academic Health Centers International. LAHP representatives were invited to present the Academy ambition and vision to its prestigious Global Issues Forum in Washington DC this week. This international conference brought together senior leaders in academia, healthcare and government relations to hear how its members around the world are enhancing health and care in sustainable ways.
The LAHP presentation included a dynamic short film, narrated by Yorkshire born and bred actor and Coronation Street star Joe Duttine.
The Leeds Health and Care Academy is not about creating one big organisation, but about working better and smarter together beyond organisational boundaries to give Leeds people a more seamless experience of health and care services.
The Leeds Health and Care Academy will help the city:
tackle current workforce challenges across all sectors
provide Leeds' people with opportunities for work experience, apprenticeships and careers, with a focus on areas of highest deprivation, thereby supporting the city's inclusive growth strategy
equip the health and care workforce for the future, keep pace with changing models of health and care, such as the impact of digitalisation and new technologies
offer a transformational experience of learning and working together, with a focus on the city and its people rather than on services and organisations
be agile in responding to its population's health and care needs
implement its citywide health and care workforce strategy
attract talented people work in its health and care sector.
Ongoing advice and guidance from academic experts, those leading innovation in health and care practice, national policy and think tanks will help ensure the Academy's portfolio remains in the vanguard of learning.
Academy Director Sheree Axon said: "This is a very exciting step for Leeds and for Leeds people. We don't think any other city of our size, involving so many partners, has attempted such a comprehensive approach to transforming the culture, capacity and capability of its health and care workforce.
"As with any large scale ambition, we are starting by laying good foundations, such as improving support for people already in health and care roles and helping everyone understand the 'one workforce' approach.
"Technological developments are dramatically changing how we all work and it's vital that our staff are equipped for this, not just to embrace the change, but to lead it with confidence, knowing they're providing the very latest and best care possible.
"The issue of workforce shortages in this sector is a global one. We're addressing this in Leeds by using the Academy to inspire and support more people into the diverse careers it offers. As well as talking to young people, we're especially promoting these opportunities to those in our more deprived communities, to help reduce inequalities in our city.
"We also recognise the vital roles of volunteers, unpaid carers and those who work in care homes and that, to truly be the best city for health and wellbeing, we must transform our approach to learning, working and supporting each other."
Email LHCA@nhs.net


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Young Sheldon Star Loved by Aussies
Posted on April 8, 2018 April 9, 2018 by Sarah Mccoy
The success of the Big Bang Theory is one that not many can argue. However the success of Young Sheldon also has been well-received by Television viewers as the young bow-tie Sheldon, played by Iain Armitage, wins people over for his performance as young Sheldon Cooper.
The show debuted on Monday night in Australia and saw over one million viewers tuning in to see the young Sheldon character getting ready to start high school. Unlike the character he portrays, Armitage is nine and lives at home with his parents, one of which, his month, is a theater producer and his Dad an actor.
At the tender age of nine, he is far from entering high school and is currently in fourth grade. Beside enjoying heading off to the park with friends or watching his favourite shows on television, his life is far from others in fourth grade.
The decision to create a spin-off series on Jim Parsons character Sheldon was one that Chuck Lorre knew would come down to the actor who portrayed Sheldon as a young boy, and considering the scripts and language, this was not a small task for a child of only nine. However, when Lorre received the audition tape from the very two who suggested Parsons for the role of Sheldon, Lorre was quite surprised at his luck.
Speaking on the tape, Lorre said, "We looked at it and went 'Oh my god, we can't possibly be this lucky. He was just spectacular." Parsons, who also viewed the tape agreed and was equally excited stating, "We saw his audition on tape, and I don't know how to put this other than to say it was kind of jaw-dropping."
Premier of Young Sheldon generates 1.6 million viewers
The material sent out to those who wanted to audition for the role was difficult and included the actors having to do a William Shatner impression For Parsons, who has been given the role of mentor to Iain, he finds the actor inspiring saying that the monologue written by Lorre was incredibly long and for Ian to pull it off showed a natural ability and spirit in how he understood what was being said in that monologue.
As for Armitage on the new fame that he is experiencing, he told Ellen DeGeneres that he is truly enjoying it and loves the character finding him interesting. Previous to Young Sheldon, Armitage portrayed Ziggy in the show Big Little Lies, when asked if the Sheldon role was harder he replied,
"Well, not really. Both are hard characters to play, actually. I like both comedy and drama but I really like being funny. And I love that Sheldon is an incredibly smart kid. I'm lucky to have Jim help me get into his mindset."
Armitage got the acting bud early coming from a family that is in the business. His first job was when he was five as a critic while reviewing other theatre productions. His first television gig was in a Law & Order: Special Victims Unit episode and shortly thereafter, he won the role of Ziggy. Since his debut, he has portrayed characters in The Glass Candle that stared Robert Redford and Jane Fonda and is now, on top of his Young Sheldon responsibilities working on the second Big Little Lies season.

redpajama_set_name: RedPajamaCommonCrawl


You'll know by now there's no shortage of love for the raw and almost punked Chicago sound of Jamal Moss, the appointed flame carrier for the old skool Ron Hardy/Armando aesthetic and standard bearer for ruff, psyched and funkin effective house music. While not quite as squashed as last years 'Bathroom Sessions' on Morphine, 'So Much Noise 2 Be Heard' is defiantly Jamal Moss, and uncompromisingly covers all angles of his strong willed style. The punishing jack track opener 'Fingerprints Of The Gods' or the rudely lo-fi Euro synth and jackbeat killer 'MB Trax V' on the first plate are just appetisers for the seriously psyched gear on the second disc. 'The Pineapple Effect (Future Jazz Version)' is an instant winner, grinding looped pianos with hacked machine beats or getting ambient on 'Encounters Of A Third Kind', before dropping the stunning 'I Am That I Am (New Age House Re-Make)' sounding like you're trapped in the Music Box on some particularly strong Hoffmans with nowt but a thong on (Don't we all have that fantasy?). In his own words Jamal Moss describes his music as "encompassing an array of sounds and influences from Aboriginal Noises/Classic House/New Age/Acid/Free Jazz/Sufi Rhythms/Deep Soundscapes and Ragtime Electronics" which is far better than we can put it. The execution and purposefully lo-fi aesthetic is utterly devastating - one for the faithful! Essential Purchase.


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De gemeente Chocz is een landgemeente in het Poolse woiwodschap Groot-Polen, in powiat Pleszewski.

De zetel van de gemeente is in Chocz.

Op 30 juni 2004 telde de gemeente 4796 inwoners.

Oppervlakte gegevens
In 2002 bedroeg de totale oppervlakte van gemeente Chocz 73,41 km², waarvan:

 agrarisch gebied: 54%
 bossen: 39%

De gemeente beslaat 10,31% van de totale oppervlakte van de powiat.

Demografie
Stand op 30 juni 2004:

In 2002 bedroeg het gemiddelde inkomen per inwoner 1388,76 zł.

Administratieve plaatsen (sołectwo)
Brudzewek, Chocz, Józefów, Kwileń, Kuźnia, Niniew, Nowa Kaźmierka, Nowolipsk, Nowy Olesiec, Piła, Stara Kaźmierka, Stary Olesiec.

Aangrenzende gemeenten
Blizanów, Czermin, Gizałki, Grodziec, Pleszew

Gemeente in Groot-Polen

redpajama_set_name: RedPajamaWikipedia


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By Tony Booth
Thank you for reading. If you wish to read more about canine kidney failure, please take a look at My 10 Step Plan for Dogs With Kidney Failure and Tremors and Shaking in Dogs With Kidney Failure
InfoBarrel > Lifestyle > Pets & Animals > Dogs
Phosphate Binders And Canine Kidney Disease
Credit: Photographer: Erik Lam. Additional Artwork: Tony Booth. Source: Dreamstime.com. Copying prohibited without permission.
A dog's health and quality of life are severely undermined by the build-up of toxic blood phosphorus during canine kidney disease (CKD). Studies tell us that controlling how much phosphorus dogs eat becomes a priority in later stages of the condition and phosphate binders become an increasingly essential element in battling the disease. But deciding which binder to use and when to start one are not always straightforward decisions and current research is starting to question traditional advice. This article outlines the reasons for phosphate binders, explains the decision-making process and hopefully helps support conversations you will need to have with your trusted vet.
Most avid gardeners will already know that phosphorus is a key ingredient to plant life. It's added to fertilisers and plant food to enhance growth and flowering, and to boost fruit and crop production capabilities. As a mineral, phosphorus is not found freely distributed or naturally occurring on Earth. It is however found in compound form in both rock and soil. Plants extract phosphorus from the ground, and all human and animal life acquires the mineral from foods we eat.
Phosphorus is an essential ingredient of life and the second most abundant mineral in the human body. It is found mainly in the bones and dental structure of all animals and helps to support the structure of the skeleton and keep other parts of the body healthy. The kidneys regularly extract any excessive amounts of phosphorus and discharge them in urine, and this function maintains a safe phosphorus-calcium balance in the body. Unfortunately, excessive amounts of phosphorus disrupt calcium levels in the blood, and dangerous symptoms begin to develop as this process draws more and more calcium out of bones.
When damaged kidneys are unable to fulfil their role efficiently, it disrupts the essential control of phosphorus and calcium levels. These changes are responsible for some of the serious health problems seen in CKD and increase the rate of further kidney damage. If these changes remain unchecked and unstable, progressive toxaemia and devastating domino effect repercussions occur to overall health.
Why do dogs need phosphorus?
Apart from it being an essential building block for bones and teeth, phosphorus also assists in metabolising carbohydrates and fats. It also enables proteins to undertake the necessary growth and repair of cells and tissues. It is furthermore involved in a molecule being produced called ATP (adenosine triphosphate), which keeps a store of energy ready for constant use by the body. Phosphorus beneficially interacts with B vitamins, a process that assists the regulation and maintenance of heartbeats, muscle contractions, nerve signals and kidney function. In short, dogs could not survive without adequate amounts of phosphorus (see below for daily intake guidelines) – but on the other hand, excessive amounts circulating in the body without correction will lead to disastrous health consequences over time.
Are phosphate and phosphorus the same thing?
When discussing the management and treatment of canine kidney failure, owners are sometimes confused by the terms 'phosphate' and 'phosphorus'.
Phosphate is a compound that's found in its natural form in rock, but also in the ground due to intensive agriculture and the abundant application of fertilisers. Phosphate contains phosphorus. Phosphorus isn't a stable element on its own, which is why dogs acquire phosphorus from phosphate sources. This usually means from eating meat, fish, grains and other foods (including processed and natural products). Phosphate binders make chemical changes to the phosphate compounds in food, turning the phosphorus element into an insoluble compound that cannot be absorbed into the body.
How much phosphorus is safe for my dog?
Healthy dogs will typically excrete any excessive amounts of phosphorus, which means there is no need to quantify or control the amounts taken in from a varied, nutritious and good quality diet. Dogs with progressive kidney failure that cannot excrete phosphorus are prone to developing complications that will cause a rapid worsening of the condition, as well as other associated symptoms and disorders. Vets usually suggest restricting phosphorus intake from the point of diagnosis.
Dogs in advanced kidney failure should have no more than 10 mg of phosphorus in their diet per pound of body weight per day. The National Research Council recommends dogs in early stage renal failure should have no more than 30 mg per pound of body weight per day, although 7 to 18 mg per pound is an even better goal to aim for. Owners should educate themselves about the phosphorus content of foods they give to their dogs and restrict it wherever possible. Most dog food manufacturers list the amount of phosphorus in their products. As a general guide, it is worth noting that bones, dairy products, whole fish with bones, organ meats, and egg yolks are all high in phosphorus. Some meats, poultry, grains and vegetables are also moderately higher than their counterparts, so choose ingredients carefully when home cooking.
What problems does excessive phosphorus cause?
The parathyroid hormone (PTH) regulates both phosphorus and calcium levels in dogs. PTH works with Vitamin D on bones, the intestines and the kidneys to support a natural and healthy balance of phosphorus and calcium. When the kidneys start to fail, PTH concentrations rise while Vitamin D levels fall – and the rise in PTH alone causes many of the symptoms and ill-effects associated with chronic kidney failure (CKF). PTH increasingly draws both calcium and phosphorus from bone as the blood pH drops, causing a generalised weakness of the skeleton and a heightened risk of fractures. The apparent increase in calcium also further damages the kidneys and accelerates a complete failure of these organs. But the process is even more complicated than that.
The increase in blood phosphate levels attracts and binds with free ionised calcium in the blood stream. This binding of free calcium causes the body to have a relative hypocalcaemia event (too little calcium), which causes a stimulation of parathyroid hormone to correct this deficit. A fall in calcitriol reduces calcium absorption from the gut wall causing further relative hypocalcaemia, stimulating parathyroid hormone secretion and releasing calcium from the skeletal bones. The net effect is that calcium stays at the normal level but it's being depleted from the skeleton, which can lead to osteodystrophy most commonly seen as "rubber jaw" in dogs.
Rubber jaw is a symptom worth checking for, as it provides vets with a warning of abnormal PTH and calcium levels, even when blood calcium seems apparently within normal range. Typically, teeth become loose, there is a softening of the lower jaw bone and dogs find it difficult to properly close their mouths. In addition, gum sores commonly occur and these prove slow to heal.
Unfortunately, high PTH is not always discovered in CKD, because it can stay high even when phosphorus levels become normalised after using an appropriate phosphate binding treatment. One solution to the higher PTH is to give low doses of calcitriol, which is a very specific form of vitamin D. Success using this method are unpredictable, but it's certainly worth trying.
A slow but constant accumulation of phosphorus in the bloodstream commonly leads to hyperparathyroidism, resulting in a much shorter lifespan. Hyperparathyroidism (actually, in CKF it is known as Secondary Hyperparathyroidism) adds to or exacerbates the symptoms of chronic kidney failure. These symptoms include increased thirst, increased urination, lack of appetite, weakness, vomiting, sluggishness, a swelling of the parathyroid glands in the neck, extreme fatigue and occasionally coma, urinary tract stones, poor body condition and progressive malnutrition. Research shows that, in humans, each 1 mg/dL of higher serum phosphorus levels coincides with a 31% increase of a first major cardiovascular event (likely due to elevated calcium that clogs arteries and tissues). There is precious little research to suggest this is exactly the same for dogs, but the mechanisms and illness progression seem ominously like-for-like.
Will reducing phosphorus in the diet solve the problem?
Most dog health and veterinary articles suggest phosphorus restriction is a priority once blood levels show a significant increase. I have also suggested this in previous articles on canine kidney failure. However, there is now evidence that proves restricting phosphorus in the diet may have only minimal advantages unless it's started extremely early. This is a cutting-edge kidney failure management conclusion from renowned professionals in the field. It is so new, it has yet to filter down into standard practice or veterinary recommendations. Strangely, it seems some veterinary authorities are resisting this news (for reasons so far unknown) and are continuing to rely on outdated and traditional treatment protocols.
While the studies and research conclusions all relate to chronic kidney failure in human patients, it is likely that the same mechanisms and outcome occur in dogs. In the 2016 study, 'Relationship of dietary phosphate intake with risk of end-stage renal disease and mortality in chronic kidney disease stages 3-5: The Modification of Diet in Renal Disease Study', the authors concluded 'phosphate intake is not tightly linked with serum phosphate concentrations in CKD …'.
A 2015 study ('Contemporary management of phosphorus retention in chronic kidney disease: a review') concluded that higher serum phosphorus (known as Hyperphosphatemia) is the most common metabolic complication of end-stage kidney disease. It also remarked that studies have found that subtle increases in serum phosphate levels, even within the normal range, are also associated with an increased risk for death in predialysis (where there is significant kidney impairment) and the non-kidney disease population.
Having read many recent research documents, it seems clear to me that damaging changes are already present long before blood results show higher than normal phosphorus levels. In her 2016 updated study report ('Chronic Kidney Disease [CKD] in Dogs & Cats: An update 2016') Doreen M. Houston DVM, DVSc, Diplomate ACVIM, of Ontario, Canada, confirms that even as early as stage 1 CKD a phosphorus restricted diet is best started. And despite early diet intervention, a binder is best introduced within short succession if levels are not brought under good control.
What all this means is that the dietary intake of phosphorus is clearly not the main player in the damaging metabolic process, because a range of adaptive mechanisms come into play before blood levels substantially increase. These mechanisms involving parathormone (PTH), acidosis and the adverse mobilisation of calcium from bones are all involved in increasing the rate of damage.
While restriction of the mineral remains important, because it is likely to increase the potentially positive results expected from a phosphate binder, it is not going to solve the problems associated with high blood values on its own. Research has shown that vets and dog owners shouldn't wait for phosphorus blood levels to markedly rise, but instead introduce a binder as soon as the level moves into the higher range of normal or the lower range of abnormal.
But even that advice is probably not enough to prevent inevitable organ damage.
Theorists are starting to question whether serum phosphorus is as significant as many agencies involved in kidney failure treatment seem to think, as it seems there is little if any evidence that lowering phosphorus blood levels later into the disease slows the rate of deterioration or improves life expectancy. The current thinking is that it may need much earlier intervention to restrict phosphorus (which will mean much earlier renal-damage detection and CKD diagnosis), thereby enabling a longer period of serum phosphorus control. A good and effective binder will virtually eliminate phosphorus absorption … and, given what theorists and researchers in the field are saying, it is my assertion one is probably better started earlier than current convention.
What does a phosphate binder do?
There is a range of different binders and the choice of which is better depends on each dog, how the disease is progressing and what blood values are like. They all work in a similar way - some work like a sponge while others act more like a magnet drawing the phosphorus out. In essence, binders typically combine with phosphate (from ingested food) in the gastrointestinal tract to create an insoluble compound, which cannot be absorbed and is instead excreted. After starting a binder, the phosphorus-reducing process actually takes a while to reach the desired results (the average is between one and two months), so don't become disheartened at the outset. It is worth noting that binders should always be given with food – and separately (by at least an hour) from other medications and particularly antacids, as absorption efficacy is seriously undermined.
Are there any dangers in giving a phosphate binder to my dog?
There are health risks to using phosphate binders, which largely depend on the type of binder and the blood values and current symptoms of the dog. I will outline the risks of each type of binder further into this article.
It is worth noting at this stage that most binders include ingredients that are toxic. However, the rate and extent of toxicity and complications from substances such as calcium, aluminium and magnesium are relatively slow (albeit with exceptions in some dogs) and any dangers are often made redundant owing to kidney failure morbidity time-periods. In other words, a dog is far more likely to die from the kidney disease long before the phosphate binder's potential for toxicity becomes a problem.
Calcium-based binders are perhaps the exception to the rule, because if a dog's blood test shows abnormally high calcium levels, it is eminently dangerous to then introduce even more calcium by giving a calcium-based phosphate binder. Phosphorus levels must also be within normal range before prescribing this type of binder (see below), which presents a Catch-22 dilemma. Regular blood testing is an absolute necessity and offers both vets and owners the opportunity to react quickly to abnormal results and change the type of binder prescribed.
Can I use ground eggshells as a phosphate binder?
Yes, but using ground eggshells as a source of calcium carbonate is not always undertaken with enough care. There are dangers to this practice, including the potential for infection (from contaminated eggs and eggshells), hypercalcaemia (from calcium overdose) and alkalosis (an excessively alkaline condition of the body fluids or tissues).
Some owners give their kidney failure dogs' ground eggshells as a routine, without knowing the proper dosage, whether a phosphate binder is actually needed or whether calcium levels in the blood are abnormally high. Moreover, the calcium carbonate obtained from ground eggshells is not a premium calcium-based binder. Calcium acetate is better, as it has a superior phosphorus-binding ability, requiring about 40% less calcium to bind the same amount of phosphorus. This reduces the risk of hypercalcaemia occurring and avoids the potential of infection from contaminated eggs.
There is about 1 gram of elemental calcium in half a teaspoon of ground eggshells (equal to about 2,500 mg calcium carbonate), which is ordinarily a suitable daily dose for medium size dogs. I would however suggest owners do not use ground eggshells as a phosphate binder, but consult their vet about prescribing a safer and more suitable alternative.
Some owners use different sources of calcium, sometimes following veterinary advice – but not always. I have read people stating on various dog internet sites and forums they give calcium carbonate powders, regular and extra-strength Tums or similar calcium-based antacids, seaweed and other calcium supplements. While these all have their benefits and drawbacks, they are essentially carbonate forms of calcium and are best avoided when calcium blood levels are close to becoming or are abnormally high. Some of these types of supplement also contain undesired elements, such as high levels of sucrose and phosphorus.
I suppose the best advice is … know what you are giving your dog and check with your vet that it is the best there is, given current blood-test results.
When should I start my dog on a phosphate binder?
There is a lot of debate about this, but the consensus suggests a binder is best started when phosphorus blood level results climb and stay above 4.5mg/dL for more than a month despite restricting phosphorus in the diet.
In trying to prevent or at least better manage complications resulting from disease progression, it is important to restrict phosphorus in the diet once creatinine reaches 1.4 - 2.0mg/dL in blood test results. In early stage kidney disease, there is an opportunity to add calcium to the diet (at ratios of 3:1 of calcium to phosphorus) in the hope of bringing abnormal blood levels down in the short-term. Adding calcium (particularly when home-cooking for your dog) requires veterinary supervision and advice to prevent the risk of hypercalcaemia occurring.
All phosphate binders need giving with food, so they can bind with the phosphorus content of the meal ingested and work to their peak level.
Calcium to Phosphorus Ratios
While mentioning the 3:1 ratio above, it's important to emphasize that adopting such a high calcium to phosphorus ratio using food sources and supplements is not normal, should only be undertaken on a short-term basis and under the guidance and supervision of a vet. Calcium is an essential and the most abundant mineral in a dog's body, and the relationship between calcium and phosphorus is critical to overall well-being. When phosphorus increases, the canine body will take every measure possible to support a healthy ratio, even by stealing calcium from bones and teeth – and despite the adverse health consequences of such extreme action.
It is easier to regulate phosphorus than try to deal with calcium changes, so dog owners are best advised to focus on this task in the hope of achieving effective control. The typical ratio of calcium to phosphorus in a healthy dog is somewhere between 1:1 and 2:1. As a percentage in food, a healthy dog needs around 0.5% to 0.9% calcium and 0.4% to 0.8% phosphorus. But in CKD (stage 3 or 4) the suggested phosphorus intake is 0.2% to 0.5%.
It may seem logical to try to increase calcium intake after a period of test-result deficiency, but as the inability to absorb calcium is a possible cause of the shortage (or indeed a possible cause of high serum calcium), it is much wiser to concentrate on lowering phosphorus to bring calcium under better control. Calcium levels can stay apparently normal in CKD or they can go high or low – but these changes are often related to phosphorus levels, which should persist as the management priority.
Calcium-based phosphate binders
PhosLo and Ipakitine are two of the most commonly used calcium-based phosphate binders. Reports suggest they produce varied and unpredictable results, although many vets recommend PhosLo (available only by prescription) over Ipakitine because the latter is a chitosan-based product and really little more than a nutritional supplement with less than 10% calcium carbonate content.
Calcium-based binders are losing some credibility among vets, not least because of the risks of hypercalcaemia and the demand for regular and more frequent blood testing. There are often higher cost implications to owners that choose calcium-based binders – and greater stress for dogs unhappy about visiting the vet to have blood drawn.
There is also a dilemma faced by many vets that prefer to use calcium-based binders, because unless serum phosphorus levels are already within the normal range in blood tests, there is a danger the calcium and phosphorus will combine and precipitate in tissues. If this happens, it is likely to generate urinary tract and kidney stones and exacerbate kidney failure.
Aluminium-based phosphate binders
Aluminium hydroxide is probably the most widely prescribed phosphate binder presently available. It is generally more effective and efficient than calcium carbonate, but it is also advantageously inexpensive in comparison to other binders with lower health risks. The problem with aluminium is it accumulates in the dog's body and becomes toxic. Healthy dogs excrete 95% of aluminium salts ingested through food, water and other everyday matter (being bound to transferrin and albumin intravascularly and then eliminated through the kidneys). Excess aluminium cannot be easily eliminated by impaired kidneys. Consequently, it slowly starts to accumulate in the dog's body. On the plus side of things, many studies and experts in the field suggest the levels of aluminium toxicity in dogs suffering from renal failure (and receiving aluminium-hydroxide), is probably over-stated.
In their 2008 case study, "Aluminum Toxicity Following Administration of Aluminum-Based Phosphate Binders in 2 Dogs with Renal Failure." (G. Segev, C. Bandt, T. Francey, and L.D. Cowgill) the authors concluded '… aluminium toxicity can occur in dogs with CKD that are supplemented with aluminum-based phosphate binders at dosage required to normalize serum phosphorus concentration.' They advised any progressive decreases in MCV (red blood cell volume count) and microcytosis should be monitored in dogs treated with aluminum-based phosphate binders, as these are early indicators of aluminium overdose. At the time of the study, the authors helpfully mentioned that Deferoxamine combined with hemodialysis can effectively treat aluminum overload in dogs with CKD.
Toxicity concerns aside, there are also three other health worries over the use of aluminium-based phosphate binders.
Some routine vaccinations (the rabies vaccine, for example) use aluminium because it triggers or increases an immune response (known as an immune modulator). There has been significant research undertaken into the potential link between the vaccination sites on cats and dogs and the seemingly increased risk of sarcoma around those sites ('Origins of Injection-Site Sarcomas in Cats: The Possible Role of Chronic Inflammation—A Review' by Kevin Woodward. 2011). Whether aluminium hydroxide acts like a foreign body carcinogen remains uncertain and unconfirmed, although some believe there's reliable evidence to the theory and several CKD dog owners have expressed concern over it. To help allay fears, it's worth noting that the World Health Organisation classifies aluminium as non-carcinogenic and it is more likely the very small risk of sarcoma at vaccination sites is not actually associated with aluminium hydroxide at all, but more associated with chronic inflammation and a genetic predisposition to this type of cancer.
The second health concern involves a dog's neurological system. The lungs, bones and central nervous system are the primary targets of aluminium. Significantly, it targets the brain and endocrine system and triggers a cascade of events leading to inflammation, neurotoxicity and disease. It's thought likely that the inflammation causes memory and learning issues in humans (possibly symptoms of slow-onset dementia), although there is very limited study facts to help confirm or deny the same process occurs in dogs.
The third health concern is constipation. Dogs taking aluminium hydroxide commonly suffer from this side-effect, which then needs treating carefully so as not to cause even more mineral and electrolyte imbalance problems.
It is interesting to note that calcium blocks some aluminium absorption, which suggests there is an advantage to using calcium-based and aluminium-based binders in combination. Very few vets attempt this remedy because it involves more intensive monitoring of blood levels to support a healthy balance of minerals and electrolytes.
Magnesium-based phosphate binders
Owing to the long-known toxicity and other health concerns of using calcium and aluminium, phosphate-binding experimentation started to look at the use of alternative magnesium compounds and lanthanum salts. Initial studies concentrated on magnesium hydroxide as a suitable compound, but these provided poor results with widespread side-effects. Research then moved to magnesium carbonate. In 1986, 'The Lancet' published 'Substitution of Aluminium Salts by Magnesium Salts in Control of Dialysis Hyperphosphataemia' by Richard O'Donovan et al, which proved the value of magnesium carbonate. In its day, this was ground-breaking research that seemingly addressed one of the biggest stumbling blocks involved in treating renal disease.
The passage of time has shown that magnesium carbonate often needs giving with calcium-carbonate to have even a moderate phosphate-binding effect, but there are also enormous and debilitating side-effect trade-offs to this approach. Reports of constant and profuse diarrhoea became common – and further studies also showed dogs had a very limited ability to excrete magnesium, causing a higher risk of toxicity likely in a shorter time-period than aluminium. Moreover, despite promising early study data, magnesium is not as good at binding with phosphorus as aluminium. As a result, magnesium compounds are very rarely used by vets as a phosphate binder today.
In the search for a phosphate-binder that doesn't include either aluminium or calcium and therefore wouldn't cause the same issues of bone toxicity and encephalopathy (brain disorder), scientists developed a medicinal form of sevelamer hydrochloride. It's suggested this cross-linked polymeric resin binds phosphorus in a completely different way by adhering to the mucous membrane of the intestines. In turn, this slows the transit time of the compound and improves its phosphate-binding ability. During the process, it releases chloride, which means vets need to check serum chloride levels closely during treatment to prevent adverse heart, nervous system, blood oxygen and fluid imbalance effects occurring. Renagel is the leading phosphate binder containing sevelamer hydrochloride on the market.
In 'Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice', which is widely respected as an authoritative guide, the author Stephen P. DiBartola suggests that while sevelamer hydrochloride is a useful and promising development, there are studies that show calcium acetate is actually superior to it in controlling high serum phosphorus (hyperphosphatemia). There are also known common side effects including sometimes severe gastrointestinal issues. Another problem is it's able to bind to other bodily substances such as bile acids, vitamins (D, E, K, and folic acid) and cholesterol as well as phosphorus, which are then all excreted at the same time. This effect is often contrary to what's actually needed and can lead to other complications.
In a 2014 review of all established phosphate binders ('A comparative study of phosphate binders in patients with end-stage kidney disease undergoing hemodialysis' by Prajapati, Galani and Shah), the authors considered sevelamer hydrochloride is as good as the others at lowering phosphorus levels but better at lowering incidences of hypercalcemia and reducing parathyroid hormone levels.
Perhaps the biggest drawback of sevelamer hydrochloride for many owners is the cost. It is a very expensive drug and often prohibitive due to that fact alone.
Lanthanum carbonate
The use of lanthanum carbonate (also free of calcium and aluminium) to bind phosphorus is a very recent development. In his work 'Lanthanum carbonate as a first-line phosphate binder', the specialist in nephrology Tilman Bernhard Drueke says: 'Lanthanum is a rare-earth trace metal with industrial and agricultural applications. As a therapeutic, this metal-based binder appears effective in reducing serum phosphorus, yet concerns remain about lanthanum accumulation in tissues during long-term oral administration. Similar to the metal aluminium, lanthanum is absorbed in the intestine and accumulates in body tissues, especially in the liver, bone, muscle, kidney, and brain. Moreover, the rate of intestinal absorption of lanthanum is enhanced in chronic renal failure.'
In theory, lanthanum should not accumulate excessively in renal failure dogs because it's excreted in bile, but Drueke's contrary concerns about absorption rates are noteworthy and the long-term implications and health risks are as yet untested and unknown. In comparison to aluminium (excreted largely by the kidneys), lanthanum is advantageously removed more through the hepatic system. Renalzin and Fosrenol are prescription drugs used for the delivery of lanthanum carbonate in animals, although these products are mostly targeted towards cats than dogs.
Myalgia (muscle pain), muscular cramping, and peripheral oedema (swelling caused by fluid accumulation) are known short-term concerns and side-effects. Just like sevelamer hydrochloride, this is also a very expensive phosphate binder and its application in the veterinary treatment of canine kidney failure is uncommon and sporadic.
Dosages of phosphate binders:
Calcium Acetate: The dose of calcium acetate is dependent on blood values. A suitable starting dose per day is 15 mg per pound of body weight when phosphorus levels in the blood are below 6.0mg/dL. The dose needs apportioning and feeding with each meal. The dose can rise to 27 mg per pound of body weight to reach phosphorus control in late stage kidney failure, and is on top of up to 1,000 mg of calcium per pound of food (needs careful calculation), contained in the food and/or given in supplements. If these doses fail to have the desired effect or if calcium blood levels rise to abnormal levels, talk to your vet about switching to another binder.
Calcium Carbonate: Like calcium acetate, the dose of calcium carbonate is dependent on blood values. A suitable starting dose per day is 15 mg per pound of body weight when phosphorus levels in the blood are below 6.0mg/dL. The dose needs apportioning and feeding with each meal. The dose can rise to 45 mg per pound of body weight to reach phosphorus control in late stage kidney failure, and is on top of up to 1,000 mg of calcium per pound of food (needs careful calculation), contained in the food and/or given in supplements. If these doses fail to have the desired effect or if calcium blood levels rise to abnormal levels, talk to your vet about switching to another binder.
Aluminium Hydroxide: Use aluminium hydroxide gel powder and mix it into food, to get the best results. The starting dose is 15 mg daily per pound of body weight when phosphorus levels in the blood are below 6.0mg/dL. If phosphorus levels rise to 8.0mg/dL, the amount of aluminium hydroxide should progressively but cautiously increase to an upper-limit of 100 mg per pound of body weight (Larry Nagode DVM Ph.D. of The Ohio State University Veterinary College). As all phosphate binders take some time to have an effect, dosages are best reassessed and increased when necessary at monthly intervals. Aluminium hydroxide is known to start reducing serum phosphorus after about 10 to 14 days, so the first post-binder blood check is best undertaken at this stage.
Magnesium Carbonate: When given as Pronefra the dosage is 1 ml per 5 kg of a dog's weight given twice daily with meals. This particular binder product entered the market in 2014 and combines magnesium carbonate with calcium carbonate. Studies report moderate success in reducing phosphorus and creatinine in cats with kidney disease, but similar studies in dogs have not been conducted, so the success of its use in canine kidney disease is uncertain.
Sevelamer hydrochloride: Recommendations on dosing for dogs could not be found at the time of writing.Vets prescribing it need to calculate a therapeutic dose from human recommendations (as outlined below). Renagel is a pharmaceutical product for delivering sevelamer hydrochloride into the human body.
The recommended starting dose of sevelamer hydrochloride is 2.4 g, 3.6 g or 4.8 g per day based on clinical needs and serum phosphorus level. Renagel requires administering three times per day with meals. Serum phosphate levels need monitoring closely and the dose of sevelamer hydrochloride titrated by 0.4 g or 0.8 g three times per day (1.2 g/day or 2.4 g/day) increments with the goal of lowering serum phosphate to 1.76 mmol/L (5.5mg/dl) or less. Serum phosphate requires testing every two to three weeks until it becomes stable and regularly after that.
Lanthanum carbonate: In a study review of canine toxicology using lanthanum carbonate hydrate (Fosrenol) conducted in 2002, the proposed starting dose of 750 mg per day taken proportionately with meals proved safe and effective. The same study suggests cautious upward titration of the dose to an upper limit of 3,000 mg per day or until serum phosphorus levels fall. The researchers found notable tissue accumulation of lanthanum occurred at 2,000 mg per day at the end of a 52-week trial, and I would interpret that to mean that less than 2,000 mg a day is a better and slightly safer upper limit. There were no specific or common toxic symptoms identified in the study – and after stopping treatment using the drug, serum lanthanum levels slowly reduced.
New research into alternative phosphate binders
There is a huge amount of scientific research happening all over the world trying to find and develop new phosphate-binding alternatives. While this research is generally all human-centred, there are usually consequential applications in the veterinary treatment of kidney failure.
One of the most promising avenues explored in recent years was the PEACH pivotal study of PT20 by scientists in Cambridge in the United Kingdom. Exclusively licensed by Phosphate Therapeutics, this is a novel phosphate binder based on proprietary 'Interstitial Mineral Hydroxide' technology using adipate-doped iron oxide at the core of the product, thereby allowing PT20 to act as a very high-capacity 'phosphate sponge'.
Dr Geoffrey Block, MD, the study's lead Investigator commented in 2015: 'The highly positive results of this first pivotal study of PT20 provide a very encouraging start to the clinical pathway of this exciting product. The management of end stage renal disease inherently carries a large treatment burden for the patient and having an iron-based phosphate binder with such an apparently positive safety and efficacy profile at this stage of development suggests the product could be of high clinical value to both doctors and patients in the future.'
The March 2016 edition of Kidney News reported that the first absorbable iron-based phosphate binder, Auryxia (ferric citrate), is now available for humans as a result of this exciting research. Whether it has any positive canine applications depends on further veterinary developments, clinical trials and testing in the future.
There is another and completely different avenue of research being conducted into the role that saliva might play in phosphorus absorption. This began because it was found that phosphorus levels in saliva were ominously higher in human kidney failure patients – and, significantly, it was higher in saliva even before an abnormal rise occurred in blood phosphorus. Early Italian studies (2009) suggested a chitosan-loaded chewing-gum was successful in reducing blood levels, but the results of this study were found to have flaws and could not be replicated by other researchers.
In 2016, scientists discovered that using the chewing-gum approach combined with a traditional phosphate binder accentuates the effects of the binder and efficiently contributes to lower phosphatemia in human CKD patients ('Phosphate binders for the treatment of chronic kidney disease: role of iron oxyhydroxide' by Cernaro V, Santoro D, Lacquaniti A, Costantino G, Visconti L, Buemi A, Buemi M). While the chewing-gum approach may not directly benefit dogs with the disease, it could lead to new and more suitable veterinary products being introduced in due course.
Although not connected to phosphate binders, there is another fascinating study looking into the extraordinary rejuvenating quality of American black bear kidneys, which on the face of it seems a fairly unique physiological occurrence in the mammalian world.
"Black bears go into hibernation in the fall with healthy kidneys," says Ron Korstanje, PhD, a researcher at the Jackson Laboratory in Maine, in an article on the Jackson Laboratory website. "They don't urinate during hibernation, and by the time spring arrives, their kidneys are damaged and have lost most of their function." At that point, the bears' kidneys seem to regenerate themselves, returning to normal function during the spring and summer. "How does that happen?" Korstanje asks. "And if we figure that out, can we come up with treatments that can prevent or reverse kidney damage?"
While these and many more studies and research programs are occurring all over the world, we are perhaps sometimes frustrated that we often seem to take two steps forward and one backward in developing new and creative treatments for canine kidney disease. And while that is perhaps true, at least we are moving slowly forward in the search for effective treatments.
While trying to work out the best phosphate binder to treat a dog with chronic kidney failure, I have found there are far too many variables to give a definitive response. My choice would probably be sevelamer hydrochloride, despite it being extremely expensive and having unknown long-term consequences. The biggest hurdle to overcome in using sevelamer hydrochloride is there are no dosing recommendations available for dogs, which means vets need to calculate safe and effective quantities from reports into human treatment.
The next best choice is probably aluminium hydroxide combined with a low dose of calcium acetate, bearing in mind this dual treatment approach involves frequent and costly blood-testing to make sure mineral and electrolyte balances and other associated blood values remain stable.
If cutting-edge theoretical conclusions prove correct, it is clearly important to start a phosphate binder as early as possible despite the potential toxicology and mineral/electrolyte complication risks of longer term treatment.
It is important to mention that I am not a vet. Owners should discuss the options available with their own vet who, armed with a comprehensive set of urine and blood test results, will recommend the best and most appropriate phosphate binder based on a case-for-case basis and taking into consideration any pertinent other health issues a dog might have.
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10 Amazingly Fun Games to Play with Your Dog
6 Huge Lies About Dogs That We All Still Believe
The 'Monkey Terrier'
Protection and Care for Your Cat or Dogs Teeth
Whats The Beef About Raw Diets for Dogs
Stinky Dog Ears - How To Clean Smelly Dog Ears Fast and at Home
Dandie Dinmont, a Once Popular Dog Breed on Extinction's Edge
How to Find My Runaway Dog - Lost Pets
13 Unusual Things You Didn't Know Your Dog Really Enjoys


Volumes 1, 2, &3 have been updated. The same files will be updated on scriptures.info very soon.
20 Neither pray I for these alone, but for them also whom shall believe on me through their word, that they all may be agreed as one, as you, Father, are in me, and I in you, that they also may be agreed as one in us, that the world may believe that you have sent me. And the glory which you gave me I have given them, that they may be agreed as one even as we are one: I in them, and you in me, that they may be made perfect in agreement as one, and that the world may know that you have sent me, and have loved them as you have loved me.
1 John 1:22 - ...And it is the Spirit that bears witness, because the Spirit is truth; for there are three that bear record in heaven: the Father, the Word, and the Holy Ghost, and these three are agreed as one. And there are three that bear witness in earth: the spirit, and the water, and the blood; and these three agree in one. If we receive the witness of men, the witness of God is greater, for this is the witness of God which he has testified of his Son.
Where is Skousen Coming From?
As more people take a critical look at the scriptures, some understanding is needed. Royal Skousen did a marvelous job of analyzing the variations in the different editions of the Book of Mormon and trying to understand how they came about. But he also had a particular agenda - to get to the most accurate copy of the Original Manuscript (OM). This is a different goal than ours - the most Joseph-accurate copy of the Book of Mormon.
Whenever Joseph made a change to the text that is found in the OM, Skousen set it aside. If it doesn't match the OM, he felt it shouldn't be there. Skousen has published his own version of the Book of Mormon that matches as closely as possible the OM.
The problem for us is that this ignores 2 things happening through Joseph. First, he recognized that a lot of mistakes were made, both in recording the OM, and then in the transcribing of the OM to the Printer's Manuscript, and then to subsequent published editions. Joseph spent time throughout his life seeking to correct those errors. As late as 1842 he noted in his journal that he was working to fix the errors. Second, Joseph was ever learning. And as his knowledge increased, so did his understanding of the meaning of scripture. For example, Denver has given a good explanation of how Joseph's perception of the First Vision evolved over time.
A more recent example that we can likely relate to is found in Nephi's discussion of his father's vision with an angel. At one point the angel says, "And he said unto me, Behold, the virgin whom thou seest is the mother of the Son of God, after the manner of the flesh." For most of us, we understand that the angel is referring to Mary, Christ's mother in the flesh. But read in the context of the talk Our Divine Parents that Denver gave in Phoenix in March, a second meaning appears - that Christ's Heavenly Mother may have condescended to be His mother in the flesh as well.
So not all of Skousen's recommendations were adopted. Please recognize that though we might find a few things that got missed, overall we won't be changing a lot. At times we had to make some tough decisions and many, many were discussed by all of the committee and decided by mutual agreement.
Now that we have a working set of scriptures, the final goal is to have the reasonably best set we can have by cleaning up the problems we run across. Some of them have been created by software, some by human error, some intentionally by well-meaning volunteers who decided to make their own changes. We're just now seeing these as people submit what they consider problems with the text.
We will take as long as is necessary to make the reasonable updates in preparation for the fancy set of scriptures, at which point we expect updating will end (except for new material). The timeframe rests with all of us: as fixes keep coming in, we have to expect that there may be more. But you need to reference the TYPOS AND ISSUES doc to see if they have already been submitted. Once we have a few months where few, if any, fixes are submitted, we will feel confident that we've made it to a publication point.
"Reasonable" was intentionally stated because some submitted fixes are very subjective and hard to justify. So please give solid evidence that a fix really does need to be made - do the research first. Links have been provided to all the material we've used.
When he was a member of the Church of Christ, a brother in my local fellowship made the email acquaintance of a Nigerian man named Adefelu David Adebowale. David teaches at a little church school in IIe ife, Osun State, Nigeria, a day or two out past the middle of nowhere. There are 100 souls in their little fellowship of believers in Christ. Here's David with some of his students, dressed as they are, like wee angels.
One day David asked my friend, Tony, if Joseph Smith has light brown hair. David described having seen Joseph Smith in dreams since he was five. His testimony to Tony: "Joseph is a very sacred prophet like Moses and Abraham". Years ago David came by a few photo-copied pages from 1 Nephi. The LDS missionaries that shared this with him never returned but he has taught what he had at his school. Eventually he got in touch with the Church of Christ and the Temple Lot group and requested a copy of the Book of Mormon from them. Six years on and still no Book of Mormon.
David's faith and persistence found a friend in Tony. They email back and forth on a daily basis. Tony mentioned the request for scriptures on our fellowship forum, I requested a set of scriptures and we shipped them to Nigeria via UPS. Today was a box full of light and truth for David! Here he is with his own copy of one of the most profound books in print on this planet. Some joyful day we will meet David and his family and embrace one another as brothers and sisters in Christ.


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Taipana (friülà Taipane, eslovè Tipána) és un municipi italià, dins de la província d'Udine. Forma part de l'Eslàvia friülana. L'any 2007 tenia 715 habitants. Limita amb els municipis d'Attimis, Kobarid (Eslovènia), Faedis, Lusevera i Nimis. Segons el cens de 1971, el 74,4% de la població són eslovens.

Administració

Municipis d'Udine


I want to see the U.S. Men's Team win the World Cup.
I would have dinner with Robert Car.
I started my political journey with a Masters of Public Affairs and State Legislative experience in Austin. I later headed to D.C., serving as a legislative aide in the House of Representatives and a capital markets analyst before joining AALU in 2014.
I drive AALU's regulatory policy efforts and focus on improving the value of our content for members and partners.


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Kibbeh Balls (Kibbeh Iras)
By Quench Staff / Food / August 31st, 2022 / 4
By Chef Barbara Massaad
1 small onion, quartered
8 oz (225 g) lean ground lamb leg or beef sirloin
½ teaspoon ground allspice
¼ teaspoon ground cinnamon (optional)
¼ teaspoon freshly ground black pepper
2½ cups (400 g) fine brown bulgur
Vegetable oil, for deep-frying
1 tablespoon clarified butter or butter
¼ cup (35 g) pine nuts
1 small onion, finely chopped
9 oz (250 g) coarsely ground lamb or beef with 20% fat
¼ teaspoon ground allspice
¼ teaspoon ground cumin (optional)
½ tablespoon pomegranate molasses (optional)
To make the kibbeh shell mixture, very finely chop the onion in a food processor. Add the ground meat, along with the spices and salt and a couple of ice cubes. Blend until you have a smooth, creamy paste. Wash and drain the bulgur well, then add it to the meat mixture. Pulse for 1 minute to combine. Transfer to a mixing bowl.
Prepare a small bowl of ice water. Dipping your hands into the ice water periodically to prevent sticking, knead the mixture for a few minutes until smooth and uniform.
To make the stuffing, melt ½ tablespoon of the clarified butter in a frying pan. Sauté the pine nuts until golden brown, watching carefully so they don't burn. Remove with a slotted spoon and set aside on paper towels to drain. Add the rest of the clarified butter to the pan and sauté the onion until translucent. Stir in the ground meat, salt, and spices and cook, breaking up the meat with a wooden spoon, until well browned, 8 to 10 minutes. Once cooked, stir in the fried pine nuts and set aside.
Again moistening your hands with the cold water, divide the shell mixture into even balls each about the size of a walnut. Place one ball in your hand. Poke a hole in the ball using the index finger of your other hand, and rotate your finger to make a hollow. The walls of the shell should be an even ½ in (1 cm) thick and the length about 3 in (8 cm). Be careful not to pierce the bottom or sides of the shell. Spoon about 2 teaspoons of the stuffing into the hollow and pinch the opening together with moistened fingers to seal the opening, forming the kibbeh into a football shape. Repeat with the remaining shell mixture and stuffing.
At this stage, you can freeze them (first spaced out on a tray, then
in sealed containers or bags; fry them from frozen), use them in recipes calling for kibbeh balls, or proceed to frying.
Pour vegetable oil into a large pot or deep-fryer to a depth of 2 in (5 cm). Heat until the oil reaches a temperature of 350°F (180°C), or until small bubbles gather around a small piece of bread dropped into the oil. Working in batches, deep-fry the kibbeh for 3–4 minutes until golden brown on all sides. Using a slotted spoon, transfer to a colander to drain excess oil. Serve warm or at room temperature.
Barbara Abdeni Massaad is a food writer, TV host, cookbook author, and a regular contributor to international cooking magazines. She is the author of Interlink's bestselling cookbook Man'oushe: Inside the Street Corner Lebanese Bakery. She won the the Gourmand Cookbook Award and the International Academy of Gastronomy Award forMouneh: Preserving Foods for the Lebanese Pantry.
Born in Beirut, Lebanon, she moved to Florida at a young age. She gained her real culinary experience while helping her father in their family-owned Lebanese restaurant, Kebabs and Things. After moving back to Lebanon in 1988, and completing university there, she decided to pursue her passion for cooking. Determined to gain proper experience within the culinary world, Barbara trained with several renowned chefs at Lebanese, Italian, and French restaurants. She is also a founding member of Slow Food Beirut and an active participant in the International Slow Food movement. She lives in Beirut with her husband and three children.
Excerpted from Forever Beirut by Barbara Massaad Copyright © 2022. Published by Interlink Publishing.


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Brain Game: It's a Date!
I remember when I got my first "desk" job... My desk had a funky calendar that was really nothing but two cubes and a little stand to place the two cubes side-by-side for the date. I also used a manual typewriter, but that's just showing my age.
Anyway, this two-cube calendar didn't indicate the month or the day of the week; just the date. Each of the six sides on the two cubes depicted a single digit. By placing some combination of the two cubes in the slots on the stand, you could indicate any date from 01 to 31. (You had to keep a cube in each slot... you wouldn't want to hide one of them and lose it.)
Today's question (and it's probably a bit trickier than it seems at first glance):
What were the digits on the sides
of the two 'date' cubes that allowed
every possible date to appear
using both cubes?
Here's one SOLUTION.
ONE POSSIBLE SOLUTION:
One of the cubes had the digits: 0, 1, 2, 3, 4, and 5.
The other cube had the digits 0, 1, 2, 6, 7, and 8.
By using some combination of the two cubes -- and placing the '6' cube upside down for the '9' when necessary -- you could use these two cubes to indicate any date from 01 to 31.


Islamic wall artcomes in a wide variety of materials, colours and sizes, and is often made to order according to the demands of a customer.One of the reasons for the several modern innovations in Islamic wall art is the constantly evolving online marketplace. At the click of a button, one can buy Islamic art onlinefrom anywhere in the world, in any size or colour or material they want.
We scanned Islamic wall art for sale across ecommerce platforms and found the following options to be the most sought-after for someone looking to buy Islamic art online.
These economical decals that are made of vinyl are the most visible variety of Islamic wall art for salein theonlinemarketplace. This kind of Islamic wall arthas no requirement of framing or drilling a hole into the wall. The vinyl sticker, as its name implies, just has to be "stuck" to the wall.
Thevinlydecals are sticky on the side that is to be pasted on the wall. On the other side is a Quranic ayatwritten in calligraphic font. Those looking to buyIslamic art online will be spoilt for choice when it comes to decals as these are abundantly available and are often easy on the pocket, besides the fact that they come in large sizes.
One must properly scrub the wall before sticking the self-adhesive, water-resistant decal, otherwise it would stick to the dirt or oil on the surface.
If you are a stickler for bright, colourful paintings but find them too expensive, then you have the option of coloured prints. You can either go for giclée prints of original Islamic paintings, orprints of black-and-white handwritten calligraphy that has been digitally coloured. This is how the latter is done: A calligrapher writes the ayatswith a traditional bamboonpen in black ink on a white sheet. This sheet is then scannedafter which the image is digitally coloured. It is also embellished with geometric patterns, stars, crescents, borders and other decorative motifs.
This digital image can then be printed to any size on canvas or paper. A canvas print, like a painting, is stretched over a wooden frame, but needs no protective glass cover. A paper print does not have to be stretched over a wooden mount, but needs a protective glass cover.
If you are a 3D enthusiast, then you would probably appreciate stainless steel frames, the latest innovation in Islamic wall art for sale.A stainless steelframe, cut to the shape of the text with the aid of a machine, has a grand, imposing appearance, especially if it is back-lit. This is still not easily available and is slightly expensive than other options.
Most certainly, as more and more people log on to the ecommerce marketplace to buy Islamic art online, the field of Islamic wall art is set to grow, expand and perhaps see even more exciting innovations in the time to come.


A Skillet sports bar, wha?
Across Occidental from us, in the Nolo. In addition to the burgeoning mercantiles and incoming Taylor Shellfish. WOOHOO!
Josh Henderson, the busy chef-owner behind Skillet, Westward and other Seattle-area projects, is planning to open a restaurant in Stadium Place, the large mixed-use development just north of CenturyLink Field.
"It'll be fine food and drink … Similar to Westward. A little whimsical," he said, adding that he hopes it will capture a nontraditional sports crowd, one not entirely wrapped up in sports.


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Legislative Bulletin January 14, 2016
Marijuana/Cannabis Legalization Under Consideration in the Senate
Two bills are being reviewed in the Senate Judiciary committee that would effectively legalize marijuana/cannabis for Vermonters 21 and over.
NOTICE: THE SENATE JUDICIARY COMMITTEE WILL BE HOLDING A SERIES OF PUBLIC FORUMS NEXT WEEK. FOR DATES AND LOCATIONS, CLICK HERE.
With minor variations in the bill language, S.95 would create an excise tax and distribute funds generated by marijuana taxes to initiatives focusing on public education about the safety risks of alcohol, tobacco, and marijuana, evidence-based criminal justice programs and substance-abuse treatment services, law enforcement, municipalities that have marijuana establishments in their jurisdictions, the Youth Substance Abuse Safety Program, and academic and medical research on marijuana. The bills propose to:
Permit a person who is 21 years of age or older to possess and cultivate limited amounts of marijuana/cannabis for personal use; establish civil penalties for possession and cultivation above the limits; and criminal penalties for unauthorized dispensing or sale of marijuana/cannabis.
Provide civil penalties for a person who is under 21 years of age who possesses marijuana/cannabis or attempts to procure marijuana/cannabis from a registered marijuana/cannabis establishment and criminal penalties for a person who furnishes or sells marijuana/cannabis to a person who is under 21 years of age.
Establish a Marijuana/Cannabis Control Board within the Department of Public Safety. The Board would be responsible for rulemaking, administration, and enforcement concerning registered commercial cannabis establishments.
Establish a regulatory structure for commercial cannabis, including six types of marijuana/cannabis establishments that may be registered to operate in this State: marijuana/cannabis cultivator; marijuana/cannabis transporter; marijuana/cannabis-infused product manufacturer; marijuana/cannabis testing laboratory; marijuana/cannabis retailer; and cannabis lounge.
Permit commercial manufacture and sale of marijuana/cannabis-infused products that are intended for topical use only and that are nonedible, while directing further study of commercial production and sale of edible marijuana/cannabis products.
Permit municipalities to regulate or prohibit marijuana/cannabis establishments, but not personal possession and cultivation.
Prohibit consumption of marijuana/cannabis in a public place and any other location in which smoking a tobacco product is prohibited.
Establish a fund for depositing all monies collected by the State related to commercial marijuana/cannabis establishments and allocate monies first toward implementation, administration, and enforcement of the act and youth access prevention and education.
Establish the temporary Marijuana/Cannabis Program Review Commission for the purpose of facilitating efficient and lawful implementation of this act and making recommendations to the General Assembly and the Governor concerning issues such as drugged driving and advisability of permitting the manufacture and sale of edible marijuana/cannabis products.
The Vermont Medical Society will review its current policy on legalization of marijuana/cannabis at the January 23rd Council Meeting.
To read to entire bills, click on S.95 or S.241.
Senate Committee Deletes New Private Right of Action and Punitive Damages for HIPAA Non-Compliance
On January 7th, the Senate Judiciary Committee voted unanimously to delete from S. 155 the section creating a new private right of action for inappropriate HIPAA disclosures. This important vote was greatly facilitated by VMS members contacting their Senators over the holidays and the thoughtful testimony provided by VMS President James Hebert, MD.
Dr. Hebert, a general surgeon at the University of Vermont Medical Center, described being in crowded rooms with patients and their relatives and opening up a computer to review medical records. "It is hard to find a nook where only you can see it," he told the Senate Judiciary Committee. "One of the unintended consequences of electronic medical records is that it makes privacy very difficult," Hebert said.
VMS testified several times in opposition to Section 1 of S.155. The provision would have created a new state-based private right of action against physicians and other covered entities for HIPAA violations. This would enable patients who believe that their health information was disclosed inappropriately to file a lawsuit in Vermont Superior Court.
The bill provided for damages - including automatic damages and punitive damages - and for costs and attorney's fees for inappropriate disclosures. It authorized the court to award actual damages to patients or automatic damages of $500.00 for the first violation, and $1000.00 for any subsequent violation, whichever is greater. With attorney's fees, punitive damages, and automatic damages, this bill created incentives for patients and lawyers to take cases for HIPAA violations to court, regardless of whether the violation is small or large, or caused harm to the patient.
HIPAA is a federal law and the Office of Civil Rights (OCR) within HHS enforces it. Federal law includes very significant penalties, which increase dramatically when inappropriate disclosures are willful, intentional or made with the intent to sell the health care information. Also, State Attorneys General have the authority to enforce HIPAA rules by bringing civil actions on behalf of state residents in federal district court. Vermont Attorney General Sorrell has been quoted as saying: "[W]e're not at all reluctant to bring an enforcement."
In its testimony, VMS stated the current joint federal and state enforcement structure is sufficient and it believes working to obtain voluntary compliance before moving to penalties is the best way to enforce a highly complex and detailed law like HIPAA.
VMS also indicated that creating a new private right of action against physicians and other covered entities for HIPAA violations would add to an already stressful practice environment for physicians in Vermont and send exactly the wrong message as the state seeks to recruit and retain physicians to care for an aging population.
Vermont, unlike its neighbors, does not have any meaningful tort reform, a factor seriously considered by physicians who are deciding whether to come to Vermont or whether to leave Vermont. Maine, New Hampshire and Massachusetts all have malpractice screening panels that reduce the time needed to resolve cases.
In addition, passing the section could create great inconvenience for Vermont patients. As one family physician wrote: "[O]ne of the consequences will be patient care issues cannot be discussed over the phone. Patients would be informed this is no longer possible as information could be overheard by others. Patients will have to come to the office to discuss any issues in a room, face-to-face, only with the exam door closed."
If you have the opportunity, please thank Senators Dick Sears, Alice Nitka, Jeanette White, Tim Ashe and Joe Benning for their vote to delete the section in S.155 establishing a private right of action for HIPAA violations.
VMS feels it is possible that the proposed private right of action may resurface when the bill moves to the House of Representatives and will continue to strongly oppose its adoption.
VMS to Establish Task Force to Review Governor Shumlin Proposals: Two Opioid Prescribing Bills Introduced
In his State of the State message, Governor Shumlin described new initiatives to address prescribing controlled substances. First he proposed limiting opioid prescriptions for minor procedures to a maximum of 10 pills and said that his administration is also looking at "reasonable limits for more major procedures that provide pain relief without filling up our medicine cabinets with unused opiates."
Two opioid prescribing bills have been introduced in the Senate so far – S. 201 and S. 243. VMS will establish a task force of interested physicians to review these bills and any other related proposals with respect to prescribing controlled substances and develop a position for VMS.
Please let Madeleine or Paul know if you have comments on these two bills, or are interested in participating on this task force.
S. 201 – Limitations on Opioid Prescriptions
Section 1 – Limitations of Opioid Prescriptions
S. 201 would limit opioid prescriptions for acute pain to no more than a 72-hour supply, unless an opioid is required to stabilize the patient's emergency medical condition. The bill would also prohibit physicians from prescribing more than a 30-day supply of an opioid for patients with chronic pain. It prohibits refills and future fill dates for any opioid prescriptions and requires prescribers to check the Vermont Prescription Monitoring System (VPMS) prior to prescribing a subsequent 30-day prescription.
Section 2 – Amendments to VPMS
This section requires prescribers to check the VMPS when they start a patient on a controlled substance for non-palliative long-term pain therapy of 90 days or more for a non-opioid, or long-term pain therapy of 30 days or more for an opioid. Also, as noted above, the bill would require physicians to check the VPMS once every 30 days, prior to prescribing a refill.
S. 243 – Regulation of Controlled Substances
Vermont Prescription Monitoring System
S. 243 would require physicians to check the VPMS every time they issue a new prescription or renew a prescription for an opioid on Schedule II, III, of IV to a patient. Physicians would also be required to check the VPMS when starting a patient on a non-opioid schedule II, III, or IV controlled substance for non-palliative pain therapy of 90 days or more. The bill classifies failure to register for the VPMS and failure to check the VPMS as required by law or the Department of Health rules as unprofessional conduct.
Drug Disposal Program
The bill would require the Commissioners of Health and of Public Safety to move forward on a requirement created in 2013 that they establish a statewide prescription drug disposal program. The bill notes that the commissioners have identified options for drug disposal in a 2014 report, but have not implemented any of the options. The bill requires the drug disposal program to be fully operational statewide on or before January 2, 2017.
Sections 3 and 4 – Treatment of Opioid Addiction
To improve care for patients receiving buprenorphine, the bill encourages care coordination among primary care providers, addiction medicine physicians or nurse practitioners, and other medication-assisted treatment team members and asks the Director of the Blueprint (currently Dr. Craig Jones) to consider increasing payments for primary care clinicians prescribing buprenorphine who engage in care coordination for patients. The bill also asks the Green Mountain Care Board and the Department of Health Access to develop a pilot program that would enable a patient taking buprenorphine to receive treatment from an addiction medicine specialist through telemedicine.
Section 5 – Pill Counts
The bill requires health insurers to reimburse pharmacists for conducting opioid pill counts that are ordered by the prescribing physician. Pharmacists must report the results of the pill count to the ordering physician promptly.
Section 6. – Continuing Medical Education
H. 243 would also increase the amount of continuing medical education that physicians "who prescribe or are likely to prescribe opioid controlled substances" must complete by requiring them to have one additional hour on "the appropriate use of opioids, including the use of complementary and alternative therapies instead of opioid controlled substances to treat chronic pain." This requirement would start with the 2016 license renewal and would be reported at the time of the 2018 license renewal.
Pharmacists Plan to Seek "Provider Status" in Order to be Reimbursed for Services
The independent pharmacists' association contacted VMS to discuss their proposal to request "provider status," so that services within their scope of practice can be reimbursed by Medicaid and insurers.
Currently in Vermont, pharmacists' scope of practice includes providing immunizations to adults, dispensing emergency contraception under a collaborative agreement and performing medication therapy management. Pharmacists also serve on community health teams for the Blueprint for Health. They believe having provider status would help them participate in payment reform initiatives and health care reform initiatives, such as accountable care organizations (ACOs). The pharmacy association said they do not intend to try to expand their scope of practice at this time.
As a model, the pharmacists are looking at a law enacted in Oregon last year that defines the "practice of clinical pharmacy," and permits, but does not require, the Oregon Medicaid agency and insurers to reimburse a pharmacist for these health services. The practice of clinical pharmacy described in the Oregon law, includes "providing patient care to optimize medication therapy and to promote disease prevention" in conjunction with the patient's other practitioners. It also includes "post-diagnostic disease state management service and the practice of pharmacy by a pharmacist pursuant to a clinical pharmacy agreement."
Please let VMS know your thoughts about this proposal.
View the Oregon law here.


text:
Benjamin Cawthra
History, Images, Music
Blue Notes in Black and White
Tag Archives: Francis Wolff
Barack Obama on Blue Note
The 2012 U.S. election has mercifully ended, and Barack Obama will continue in his job. If, as the New York Times' Maureen Dowd seems to believe, Obama is a most reluctant leader, he at least did what he had to do to keep on leading. His victory, while not a landslide, was decisive. This has not prevented citizens from various states, especially those of the former Confederacy, from circulating secession petitions.
Maybe it is the sesquicentennial of the Civil War that has prompted calls for self-removal. The arguments are couched in economic terms and in the fear of the federal government overstepping its bounds, but these were used in 1860 and 1861 as well. Various reenactments of secession events over the past few years—a "secession ball" in Charleston, a recreation of Jefferson Davis's swearing in as Confederate president in Montgomery—along with Texas governor Rick Perry's brief presidential candidacy, perhaps prompted [white] southerners to think about leaving the Union again.
Or perhaps, as it certainly did then, it has something to do with blackness.
One of the things Barack Obama is not allowed to talk about is blackness. Sure, he is president of everyone, but he clearly is not everyone's president. No president in my memory has ever had his legitimacy questioned to the degree that Obama has. Even Bill Clinton, denigrated as "Slick Willie" and condemned, investigated, and nearly impeached for his interactions—to put it kindly—with women, never had to deal with his own citizenship as a major issue Trump-eted across the land even as he served his terms. Clinton's status as a stand-in for the rural white Southern impoverished class seemed to rankle his social betters. Novelist Toni Morrison caught the connection Clinton had with black voters when she facetiously dubbed him America's first black president. But the actual first black president, black because of his half-black parentage and his own cultural identification according to his memoir, can never afford to register as "too black" in the public mind. Cornell West condemns him for not being an authentic advocate for people of color and the poor (in his press conference this week Obama briefly inserted "those aspiring to the middle class" as part of the constituency for economic growth, but it hasn't been his habit). Obama can't be black because it is trouble enough just looking black. Surely no previous president has prompted a "Put the White Back in the White House" t-shirt of the kind seen at a Romney campaign event just prior to the election.
Obama is not able to trade on his blackness except for lengthily interspaced cultural cues—soulfully crooning a line of Al Green for the Reverend himself at the Apollo, beating Clark Kellogg in a backyard game of P-O-T-U-S, expressing muted support for Trayvon Martin—because he understands there is very little to be gained politically by doing so. But his supporters have tried to find ways to make blackness work for Obama. Shepard Fairey's Hope poster in 2008 reconstituted Obama's blackness in the image of the nation's colors. This powerful recasting is perhaps part of what prompted the backlash against Obama and the questioning of his legitimacy. Color scheme aside, the poster reminded some of the political art associated with leftist revolutionaries such as Che Guevera, a short step to the Black Panthers and the Weather Underground and Bill Ayers and so on.
Which brings me to jazz album cover art, of all things. How to cast Obama as authentically black but distinct from a revolutionary or black nationalist tradition? What would signify Obama's status as culturally black but also unequivocally legitimate as leader of the country? J.C. Pagán, a graphic designer from San Antonio, found a way.
Pagán used the template of Blue Note Records album covers from the 1950s and 1960s through various stages of Obama's re-election campaign, and in so doing reached back to the redemptive program the Blue Note imagery had performed for black jazz artists during the civil rights movement. As I discuss in Blue Notes in Black and White and in this interview, the photography of Blue Note co-owner Francis Wolff and the designs of Reid Miles depicted jazz musicians as dignified, serious, and creative artists rather than mere entertainers. The advent of the long-playing vinyl record in 1948 and advances in photographic reproduction technology made images of musicians standard on records by the mid-1950s. It had been possible prior to this to buy records and listen to music on the radio without the attending visual associations of race. Just at the moment that the modern civil rights movement gained national exposure, black musicians appeared on their album covers. To listen to the jazz of Horace Silver, Dexter Gordon, or Art Blakey now meant having their photographs in 12 x 12 inch glory in one's home. The Amazing Bud Powell, Thelonious Monk's Genius of Modern Music, The Eminent Jay Jay Johnson—the very titles strove to lend prestige to the music and its makers. At larger labels such as Columbia, Miles Davis had such clout through his sales that he could influence who and what would be depicted on his covers. He had no problem choosing himself.
The photographs of Blue Note artists (and many of those on other labels such as Riverside and Prestige), visually contradicted just about every stereotype of the black male that had poisoned American culture since slavery itself. Blue Note projected a casual elegance and prompted a run on Oxford cloth shirts among certain jazz fans. Pagán's rendering of Obama as jazz leader comport with the president's famed and sometimes criticized sense of cool (killing the fly in the midst of a sit-down interview, delivering a speech as the Bin Laden operation went down, burying the winner vs. Kellogg while the cameras rolled). Throughout Obama's ascent, Dowd has consistently referred to him by his old nickname, Barry, a verbal stripping down that seems intended to puncture the president's "self-regard." J.C. Pagán's Blue Note images celebrate that which most seems to irritate Dowd and other Obama detractors. Whether capturing Obama's "cool struttin'" toward Air Force One, his self-confidence while being photographed playing with Bo the dog, or showing the appropriate preacherly fire as "The President," Pagán's images reach back to a visual past to burnish Obama's public image. The irony is that the originals were an ancillary part of a campaign—the civil rights movement—to make it less necessary to defend the abilities and accomplishments of a black man in America. Who knew that in 2012 they would be more necessary than ever as a counterweight to attacks on Obama's very personhood and legitimacy in office?
The original Blue Note covers marketed the music to a particular audience: jazz fans, the white members of whom (see Norman Mailer) liked to consider themselves cultural outsiders. The designs stand in for a place those in the know can always go: a visually constructed world of cool that is just so much richer than the humdrum world we inhabit. Despite this insularity and the fact that Blue Note's operation was so small that a hit record nearly bankrupted the company, the artwork has had an influence well beyond actual sales figures and has come to signify a classic era of jazz, one still mourned by those who remember. What they portray—a self-confident yet down-home sophistication (what Ralph Ellison liked to call "elegance"), an easy mix of creativity and gravitas—suits Obama rather well. They may not salve the dislike of the president among Americans whose jazz collections may be minimal or nonexistent, but as images to rally the president's supporters, these curiously retro mock album covers express high hopes for Obama as he prepares for what has often for his predecessors been a perilous second term. (The complete Obama Blue Note collection is here.)
Tagged Al Green, Barack Obama, Bill Clinton, Blue Note Records, Bud Powell, Clark Kellogg, Dexter Gordon, Francis Wolff, J. J. Johnson, J.C. Pagan, Maureen Dowd, Reid Miles, Shepard Fairey, Thelonious Monk
Douglas Mitchell: Great Conversations
Miles Davis Documentary in Theaters
Scoring Jack Johnson
Outspoken 14: Public History in Long Beach
Selma Revisited
Miles Davis at Sundance
Outspoken 13: Election Wrap
Posters from the Great Depression
On Fleetwood Mac and Lindsey Buckingham
Remembering the Great War
A Quiet Place in Paris
Latin American Music in Los Angeles
Outspoken No. 9: Sam Stephenson
Sam Stephenson's Wide-Angle View
Dunkirk, Charlottesville, and Appeasement
Jump for Joy: Duke Ellington in Wartime Los Angeles
Holidays in Cleveland
His Beauty Was a Rare Thing: Ornette Coleman
Night at the Dream Factory: Lady Gaga and Selma
Portrait of a Jazz Club
Restoring a Renaissance Gem: The Pazzi Chapel
Jazz St. Louis in Bloom
On Ferguson
Listening to Charlie Haden
Live Jazz: Past and Present
In a Dry Season: Revisiting Chinatown
Whirlaway: An Evening with Allen Toussaint
Music for a Mardi Gras Day
John Cassavetes: Too Late Blues
Remembering Lee Tanner
Blue Notes in Paperback
Tivoli and the End of Arcadia
Bella Napoli
Harlan County Histories
Donald Fagen: Sunken Condos
Italian Campaign: Not-so-soft Underbelly
Battlefields: T. Geronimo Johnson's Hold It 'Til It Hurts
Hawthorne in Florence
Blue Notes in Black and White by Benjamin Cawthra
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© Copyright 2014 by Benjamin Cawthra


The PS1000 charger represents the very latest in switch mode technology providing a versatile 100-300vac input to allow use virtually anywhere in the world. The 12 DC output is a robust 16A which is designed to fully charge the LiFeP04 batteries in the TDR1000 series repeaters. The unit is fitted with a professional series Amphenol connector to ensure solid connection and proper charging rates at all times.


Scope and Contents: Administrative documents for the Coalition of Hmong Students [CHS] student organization. Includes membership/alumni lists, budgets, promotional materials, meeting notes, meeting agendas, event budgets, correspondence, presentation materials, event planning documents. Photographs originally in these records filed separatly with Collection 03 - Photographs General by Year.
Page Generated in: 0.1 seconds (using 138 queries).


A Farmer's Caesar Salad – Olive For Greens.
Salads are my favorite go-to lunch and appetizer. I am constantly thinking of new ways to revamp salads to make them less boring. Growing up salads were not meals and usually consisted of iceberg lettuce, tomato and cucumber with Italian, French or Thousand Island dressing. Today, none of those dressings ever rest in my refrigerator and neither does iceberg lettuce!
When I was younger the last dressing I chose to eat was Caesar. However as an adult, I grew to like the taste of it but stopped eating it again because most recipes (especially at restaurants) include anchovies. Caesar dressing also has cheese in it, which I do love but I try to set limits on my dairy intake.
Let's talk about a traditional Caesar salad for a second. There is Romaine lettuce, Caesar dressing, Parmesan cheese and croutons- that's it! In this version I call it A Farmer's Caesar Salad because I add veggies to it and replaced the croutons with red potatoes. I hope you enjoy this!
*Note: Don't have time to bake the potatoes? Slice the potatoes then boil until soft.
Sauté the onions and potato slices in a small pan for about 5 mins. If you prefer raw onion, skip this step!
Meanwhile, in a large salad bowl add the chopped romaine, broccoli and tomatoes.
Now, add the potato and onion mixture to the salad bowl.
Pour in the dressing and toss all together, adding more dressing, if you prefer.


text:
Amaroni es un municipio sito en el territorio de la provincia de Catanzaro, en Calabria, (Italia).

Demografía

Enlaces externos
 Página web oficial de Amaroni .

Localidades de la provincia de Catanzaro


text:
Q: How to get the text of an element( by nature) using xPath() in Mocha with Selenium environment?

      saswat@matrixnmedia.com

       Log out

The first  tag contains an email id which varies based on the login session.
I want to get the text of the  tag using xPath() in Mocha.
I am writing this code snippet, but I think I am doing it wrong.
driver.findElements(By.xpath("//a[@class='user-name m-r-sm text-muted welcome-message']")).then(function(elements_arr1)
{
   if(elements_arr1.length > 0)
   {
      console.log(elements_arr1);
   }
});

I am getting the details like this.
[ { driver_:
     { session_: [Object],
       executor_: [Object],
       flow_: [Object],
       fileDetector_: null,
       quit: [Function] },
    id_:
     { closure_uid_36922274: 489,
       flow_: [Object],
       stack_: null,
       parent_: null,
       callbacks_: null,
       state_: 'fulfilled',
       handled_: false,
       pendingNotifications_: false,
       value_: [Object] } } ]

But I need the text, i.e. saswat@matrixnmedia.com

A: I don't know Mocha but I can point you in the right direction...
.findElements returns some kind of collection. You are doing the equivalent of logging an array, not an element of the array, but the array itself. That's why you are getting weird results.
You can do a couple things...
1) Access the element in the collection that you care about. In Java you would do
List<WebElement> stuff = driver.findElements(By.cssSelector("input"));
String text = stuff.get(0).getText(); // gets the innerText of the first (0th) element of the List.

2) If you always want the first element, just use .findElement() (not Elements())
OK... now you have the right element and you want to get the text from it... use .getText() on the element
String text = driver.findElement(By.cssSelector("input")).getText(); // returns the text of the first INPUT element

If it were me, I would avoid XPath like the plague... it's slow and prone to breaking (and confusing, at least to me). I think this should work for you
String email = driver.findElement(By.cssSelector("a.user-name")).getText();

The CSS Selector a.user-name means find an A tag with the class (.) user-name
CSS Selector reference

redpajama_set_name: RedPajamaStackExchange


You are the best monitoring device for your blood pressure. Blood pressure challenges is a continuous process with those who have either genetic tendencies or behavioral patterns that contribute to hypertension.
Blood pressure monitors are effective in letting you know what aspects of your life increases and decreases your blood pressure. But they cannot replace your abilities to monitor and change your actions especially during physical activities such as cardiovascular endurance exercises.
Since blood pressure is an aspect of daily life, you need to find ways to monitor it continuously in addition to your regular physical exams.
Changing lifestyles could be difficult especially when the changes are based on guesswork. Monitoring your blood pressure takes the guesswork out of the process and help you focus on the changes that help.
Remember that remedies for blood pressure, improved blood flow and vasodilation, especially those that are considered natural, may take several weeks to show the effect, and many of them could have adverse side effects. Always discuss what you do or plan to do with your physician.
If you lean toward natural remedies, remember that sometimes you might need to add medication. Either way, monitoring blood pressure includes a written record that in part is the numbers and in part is the activities prior to the monitoring.
to help you connect the dot between actions and their consequences.
It is very rewarding to find out how many steps you can take to lower your blood pressure without medication.
As far as equipment, you have many choices. I like the technology that allows me to record my data on my iPad or iPhone. Withings Wireless blood pressure monitor is what I use at home.
I also have a simple blood pressure monitor I purchased from CVS pharmacy in my office that I used for a quick check to see how my work and tension contributes to hypertension.
One feature of blood pressure monitors many do not think about is the cuff size. Make sure it fits you. A wrong cuff size may interfere with accurate reading.
And of course you need to make sure you place the cuff correctly on your arm. It is not rocket science but you may want to ask your doctor o your nurse show you where to position your cuff as well as your body arm position that should be at the same level as your heart.
Some postures crossing your knee or ankle may interfere with accurate reading as does clothing that restrict blood flow. Check your clothing for restrictions that you may be so used to that you no longer notice.


No Fines Concrete can be supplied. It is mixed to comply with the SANS 878 specification and Eastern Readymix is a producer member of SARMA- South African Readymix Association.
Concrete can be designed and supplied to the client's/ engineer's specifications.
Our sister company – ERM Pumping Services offers a concrete pumping service to place concrete on those hard to reach places.


The rustic HALINA kitchen in soft yellow tones with plenty of popular elements, such as discreet mouldings, round doors, hanging shelves and stained glass. The opulence of this kitchen becomes apparent in open interiors with a view into the garden.
inner lighting, which allows the glass and crockery used at festive events to be admired.
perfectly match the style of the kitchen. Spice jars placed in hanging shelves near the gas stove are kept within easy reach.