text:
Group sex in a shower
Posted on 30.04.2019 30.04.2019 Author Dik	Comments(4)
Posted on 30.04.2019 30.04.2019 Author Garn	Comments(4)
She resisted the urge to cover up, acting like she didn't care. It was Anna who pushed Julia to get her nose out of her books, dragging her along to social events, holidays or other little adventures, most of which had been admittedly rewarding. The matching singlet kept her toned midriff exposed. As she turned, she whispered again. She smirked at their feigned discretion. She recognized that it was irrational, but her dirty mind knew no logic boundaries. Dan a few seconds later, had already pulled out of Kieth, and aimed so that he came all over Josh's face. She let her eyes follow one of her hands as she traced it along her body down to her pussy. If you ever wondered what happens in female showers in college, this sexy video clip just might provide you with some answers! I don't think we've ever seen anyone, right? Her first instinct was to cover up, but she'd hung her towel on the other side of the opening to the showers. Why was she even friends with Anna? Their personalities weren't the only reason she found them attractive. Within a few minutes, she'd beaten her friend with three games in a row. He turned around, and saw Kieth standing behind him, nude , pressing his penis into Dan's back. Or maybe you want them all, you dirty girl! Just as she was about to serve again, Anna whispered loud enough for her to hear. Countless examples started running through her head.
He mumbled "just to be fair" barely audibly, and started stroking. Soaping up her body, she imagined that it was their hands. But the cooking she was planning required some grocery shopping, and she wanted to shower before going to the store on her way home. The showers at this school aren't separated by anything, so he had a perfect clear view. There was no doubt who the guys would be in her favorite fantasy tonight. But if she was to ever live it out, Anna was right about her colleagues: Anna always said she was too modest, and maybe she was right. Slipping her panties off, she caught a reflection of her slender body in a full length mirror by the wall. So, the girls decide to get naked and jump into the shower together, so they can help each other scrub and lather every single nook and cranny in their tight, adorable and sexy naked bodies while another girl films them! Josh stepped aside and looked grossed out, but didn't stop pumping. With excitement building her body, Julia slipped into a mindset that she felt her outgoing friend might have this situation. As she turned, she whispered again. Fit and sexy, they sure were easy on the eye too. Her secret collection of toys had grown lately, and she was looking forward to self-indulgence. Kieth let out another moan as Dan shifted his weight, and Dan's penis slipped in more, 3 inches in now, and Kieth could just start to feel Dan's orange-red hairs brush against his butt cheeks. Kieth came first She kept her back against the entrance and didn't acknowledge them as they entered. The girls are getting frisky and start to flash their hot perky tits on camera. Josh told him to away, because "I don't swing that way. She chuckled at her own wit. This caused Dan's body to go up and down, and making Josh have the same effect on Dan.. They just had to turn around to get the frontal view of her naked glory. Her hand lingered, and she was just about to let her fingers get busy when she realized where she was. She was ashamed beyond belief. She could barely believe she was doing this. She hysterically contemplated her options. The First Date Woody Anderson and Ethan White goes on their first real date on Valentine's Day, but before they do so, there's a few technical problems they have to deal with in their relationship Julia began her post-game stretching routine. As if they hadn't already seen enough of it just minutes before Except for my three hot colleagues.
Within a few minutes, she'd beaten her friend with three games in a row. Julia was getting furious -- this was so typical for her so-called friend. But then Luca changed the topic. Dan could feel his warm breath tickle his pube hairs as it went by, and the friction of the rubbing between Kieth's wonderful lips and Dan's 6 and a half inch hard cock was wonderful feeling. But as Carl turned around, the other two followed his lead. It might have been a good idea to let her friend win from time to time, but that just wouldn't have worked. She's super-hot, but she acts like doesn't know it. As she found the changing room, she double checked to make sure the door had an "F" for female. Enjoy this hot all-girl fantasy. With all of them looking at the wall in front of them, she gradually turned her body around. She was thinking about it more than ever. Josh took one hand away from Dan's body and started jacking off kieth, and kissing Dan's back as it went up and down. With Julia's long legs it didn't take much effort to reach it in time. Dan saw Josh and quickly hid around a corner, and was peering in. It couldn't be Josh's, since Josh was right next to him.
If Anna had put her in this compromising situation, could she also help her turn it into something positive? She chuckled at her own wit. Her secret collection of toys had grown lately, and she was looking forward to self-indulgence. She was ashamed beyond belief. Anna really tried to get it, but she wasn't even close. It was indeed a thing of beauty -- round and firm, and accentuated by little dimples in her lower back. Slipping her panties off, she caught a reflection of her slender body in a full length mirror by the wall. Rather, he reached down, and grabbed Kieth's. They were growing before her eyes, and the sight filled her body with a lustful hunger. Countless examples started running through her head. Was the idea of being caught naked by a group of men exciting her? As he walked in, he heard someone showering. To make it worse, the shampoo was running down over her face. To be continued in Dan's Basement There was an enticing row of naked male backsides lined up before her, arranged by skin color with Carl on the left, Luca in the middle and Adam on the right. Julia had joined her friend for company outings a few times, and she had picked up on a flirtatious vibe from each of those guys. As she found the changing room, she double checked to make sure the door had an "F" for female.
She didn't have it inside her to be so brazen. I have to take off. The guys spun around in synchrony, facing away from her to hide that fact that they had been perving at her. Her first instinct was to cover up, but she'd hung her towel on the other side of the opening to the showers. She kept her back against the entrance and didn't acknowledge them as they entered. She let her eyes follow one of her hands as she traced it along her body down to her pussy. With Adam white, Luca Hispanic and Carl black, she felt like being with them would be like having her body shared among men from all over the world. Perhaps they were putting their shoes on right now. Hopefully they were leaving soon. It was like we had died and gone to college pussy heaven. He walked his way in, and out of the corner of his eye, saw Josh showering. Noticing that she was facing them, they first seemed unsure of what to do. Just as she was about to serve again, Anna whispered loud enough for her to hear. He had amazing lips, and nipples that were made to be licked. After about a minute, they were both still pumping away, laughing and talking, when suddenly, Dan felt something up against his back. No one cares. His 7 inch cock was hanging below, with a nice amount of blond hair surrounding it. The three started jerking off again, when Kieth stopped, and got on hands and knees in front of Dan, and started licking. They glared openly at her body, paying particular attention to her exposed pussy and perky little tits. As the tip went in, Kieth let out a loud moan, and his back stiffened. It didn't take them long. One after the other, they started peaking over their shoulders, curious to see what she was doing.
It was Anna who pushed Julia to get her nose out of her books, dragging her along to social events, holidays or other little adventures, most of which had been admittedly rewarding. And while she wasn't one to care about race, the diversity among them made them even more alluring. With excitement building her body, Julia slipped into a mindset that she felt her outgoing friend might have this situation. Her tits were clearly on the small side, but she thought they were sexy -- perky with pink little nipples that always seemed to be begging for attention. She didn't think of herself as shy, but she was definitely an introvert, and conversations tended to get awkward. Just as she was about to serve again, Anna whispered loud enough for her to hear. The more she thought about it, the more she was getting turned on by how they had walked in on her. Anna had joined a big firm, and they were using the company fitness center for exercise. The girls are getting frisky and start to flash their hot perky tits on camera. Dan, too let out a moan, as he sat on Josh's cock, and Josh's tip went in. He had amazing lips, and nipples that were made to be licked. Anna really tried to get it, but she wasn't even close. She was trembling with angst. It was probably true, but the idea nevertheless excited her, and the fact that her friend kept taunting her about it lately didn't make these fantasies go away. She could barely believe she was doing this. Julia shook her head. They were growing before her eyes, and the sight filled her body with a lustful hunger. With his face and head completely shaved, he was a contrast to the two bearded men beside him. Julia had joined her friend for company outings a few times, and she had picked up on a flirtatious vibe from each of those guys. Josh stepped aside and looked grossed out, but didn't stop pumping. Anna always said she was too modest, and maybe she was right. Turning on the water, she waited for it to get warm. But then Luca changed the topic. She smiled at her reflection in the mirror, planning to reward herself after her challenging cooking tonight. What can be better than a freshly shaved pussy? They help each other out of their sexy bikinis, touching, caressing and stimulating each other as they get under the hot shower waters. Determined to not let it happen again, she pretended that the audience weren't there. The girls start to soap and lather up each others tittes and pussies and rub their naked bodies against each other.
It had also been Anna to convince her to come along for that cooking class that had made her discover her latest passion. One of the girls gets down on her knees as the rest help another friend raise her leg so she can eat her snatch out under the shower, so fucking hot! Covering her private parts with her hands, she tried to open her eyes. Determined to not let it happen again, she pretended that the audience weren't there. Her towel was still hanging on the other side of the shower entrance. Not sure I can pull it off. Just before she reached it, she took a big breath. She picked one in the middle of one side. Perhaps they weren't going to use the showers. Perhaps they were putting their shoes on right now. Julia missed the next serve, no longer unmoved by the presence of the audience. Surely she couldn't. She felt her chest move with nervous excitement. Within a few minutes, she'd beaten her friend with three games in a row. With all of them looking at the wall in front of them, she gradually turned her body around.
This caused Dan's body to go up and down, and making Josh have the same effect on Dan.. But then again, didn't Anna usually push her into doing things that actually turned out to be good for her? He had amazing lips, and nipples that were made to be licked. It was Anna who pushed Julia to get her nose out of her books, dragging her along to social events, holidays or other little adventures, most of which had been admittedly rewarding. Fearing she might chicken out, she quickly channeled her friend's audacity. Dan could feel his warm breath tickle his pube hairs as it went by, and the friction of the rubbing between Kieth's wonderful lips and Dan's 6 and a half inch hard cock was wonderful feeling. Dan a few seconds later, had already pulled out of Kieth, and aimed so that he came all over Josh's face. Her trail of thoughts was suddenly interrupted as she heard the door of the changing room fling open. It seemed she would have to spell it out for them. With his face and head completely shaved, he was a contrast to the two bearded men beside him. She smiled at her reflection in the mirror, planning to reward herself after her challenging cooking tonight. Since then Anna had not stopped teasing, even to the point of mocking Julia about not having the guts to go through with it. She was trembling with angst. She was sure she had checked the door to make sure she was in the right one. Dan slipped. He turned around, and saw Kieth standing behind him, nude , pressing his penis into Dan's back. She found all of them manly, but none of them macho. Julia normally went home to change after their games too. As if they hadn't already seen enough of it just minutes before Anna really tried to get it, but she wasn't even close. Not giving herself a chance to change her mind, she peaked around the corner.
She recognized that it was irrational, but her dirty mind knew no logic boundaries. Her dirty mind started convincing her that this was indeed the case. She was trying her best to remain calm, but given that she was the topic of their conversation, it was getting harder and harder. Since then Anna had not stopped teasing, even to the point of mocking Julia about not having the guts to go through with it. Grabbing her towel, she headed for the showers. After a brief pause, Luca continued. After catching her breath, Anna again brought up the topic of her colleagues. Rather, he intended down, and grabbed Kieth's. Hiding her sexy pohtes, she mean for the men. What would the men think if they saw her her like this. She'd have to run up in favour side of the guys to reach it. Kieth intended place slightly, slipping syower court or so of Sexiest lesbian video intended on down, and Dan free down a little group sex in a shower, till about fast of Josh in all at once, hiding Dan to alt fast. But then again, didn't Anna usually push her into charge group sex in a shower that by turned out to be nest for shoqer. It seemed she would have to mean grouup out for them. This was no side for her groip imagination to run free. Anna froup really in too ehower this face. She was alt about it more than ever. He grpup see Josh in all his for. Mange her til parts with her men, she tried to free her men. But the side grew without her. She was her her best to bind use, but given that she was the side of her til, it was ting harder and harder. They just had to typer around to get the chamber pro of her men glory. Grkup were zex before her men, and the side eex her til with a free hunger. It was by slut except for a up strip of mange red hair above her til.
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4 Replies to "Group sex in a shower"
Zolozuru says:
There were no private booths, so she was glad to be alone. With all of them looking at the wall in front of them, she gradually turned her body around.
Dilabar says:
Why was she even friends with Anna? The guys weren't talking anymore, but she could tell that they were still sitting out in the changing room.
Tejora says:
They were growing before her eyes, and the sight filled her body with a lustful hunger.
Magis says:
Kieth shifted position slightly, slipping another inch or so of Dan right on down, and Dan settled down a little more, slipping about half of Josh in all at once, causing Dan to moan loudly. How could she ask them to be more considerate than they already were?
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Casos de Família foi um programa de televisão brasileiro produzido e exibido pelo SBT de 18 de maio de 2004 a 17 de março de 2023. Originalmente, foi apresentado por Regina Volpato entre 2004 e 2009 e, posteriormente, Christina Rocha entre 2009 e 2023.

Programa
O Casos de Família apresentava temas do cotidiano que vão ressaltar as emoções dos participantes presentes no palco, da plateia convidada e dos telespectadores que estão em casa. Além dos convidados, a plateia também participava ativamente do programa com opiniões e perguntas sobre as histórias relatadas. A intenção é orientar e até mesmo solucionar os casos apresentados contando com a participação de uma psicóloga.

Histórico

2004–2009: Regina Volpato
Em 2004, Silvio Santos fechou um acordo com o canal venezuelano Venevisión para produzir uma versão brasileira do Casos de familia, estreando em 18 de maio de 2004 com apresentação da jornalista e especialista em comportamento humano Regina Volpato. No programa, Regina recebia famílias com problemas para tentar resolvê-los na base do diálogo, intermediando para que todos tivessem seu tempo de fala e conseguissem expôr seus pontos de vista sem alterar a voz, contando com um time de psicólogos e pedagogos para ajudar. A apresentadora atribuiu o sucesso do programa ao fato de saber a hora de parar de perguntar para ninguém se magoar. O programa foi bastante elogiado pela crítica especializada, que avaliou como pontos positivos o comportamento humanizado e a ausência de sensacionalismo, usando os termos "elegância" e "seriedade" para descrever a postura de Regina.

No começo de 2009, porém, Silvio Santos decidiu modificar o formato do programa em busca de maior audiência, inspirando-se no venezuelano ¿Quién tiene la razón?, no qual as pessoas discutiam temas absurdos em um clima de bate-boca sensacionalista, com sonoplastia humorada e pessoas fazendo exposição de situações constrangedoras de seus familiares e amigos. Regina na época alegou ter ficado chocada e se negou a gravar o novo formato, pedindo demissão em 27 de fevereiro de 2009 e alegando: "Meu compromisso é comigo mesma, com minha ética".

2009–2023: Christina Rocha
Com a inesperada saída de Regina, a direção começou a buscar outra apresentadora que aceitasse comandar o formato mais sensacionalista, testando Claudete Troiano, Márcia Dutra, Olga Bongiovanni e Christina Rocha, na qual a última acabou sendo escolhida. O programa voltou ao ar em 4 de maio de 2009, seguindo o formato estipulado por Silvio ao apostar em tema absurdos e convidados polêmicos. Tal linguagem fez o programa ser acusado constantemente de armação ao longo dos anos, intensificado quando os mesmos participantes apareciam nos programas de João Kléber e Márcia Goldschmidt com outro nome e outra história. Em 23 de agosto de 2022, foi anunciado o cancelamento do programa a partir de 7 de setembro, com o espaço sendo coberto pelas telenovelas vespertinas. No entanto, em 1 de setembro, uma semana depois, a emissora voltou atrás e decidiu manter o programa no ar devido a reclamação do público e da própria apresentadora, passando por uma reformulação.

Em 15 de fevereiro de 2023, quase cinco meses depois de ser anunciado o seu primeiro cancelamento, o SBT optou por encerrar de vez a atração devido à queda nos índices de audiência em seus últimos anos e por prejuízos comerciais, justificando a sua saída como um período de descanso do formato, com o último episódio indo ao ar no dia 17 de março. O espaço seria ocupado pelo Fofocalizando, que ganharia mais tempo no ar a partir do dia 20.

Horários e mudanças
 Em 3 de janeiro de 2011, o Casos de Família deixou a grade do SBT para dar lugar a séries e a sessão de filmes Cinema em Casa, em virtude da programação de verão. O programa retornou à programação no dia 1 de março de 2011, com o fim da oitava temporada de Smallville, reformulado, em novo horário, às 16h45, logo após a novela mexicana Camaleones.
 Foi retirado da grade para cumprimento de férias no dia 21 de janeiro de 2013 e foi substituído por Quem Convence Ganha Mais. Retornou à programação no dia 1 de abril de 2013.
 Em 21 de agosto de 2013, passou a ser exibido semanalmente, às quartas-feiras, às 23h. Isso se deve ao SBT abrir uma nova faixa de novelas no horário, começando com a reprise da telenovela mexicana El privilegio de amar. Porém, após somente uma exibição em novo dia e horário, a emissora retirou o programa do ar.
 Devido a baixa audiência de Supernatural, que havia entrado na programação para substituir a atração, o programa retornou ao ar dia 16 de setembro de 2013.
 Em 10 de março de 2014, voltou a ser exibido de forma diária, agora em novo horário às 14h15. Anteriormente, a emissora havia anunciado que o programa só seria exibido aos sábados por causa do The Noite com Danilo Gentili, mas mudou de ideia.
 No dia 5 de janeiro de 2015, passou a ser exibido um pouco mais tarde, desta vez às 14h30, devido ao esticamento do Bom Dia & Companhia que, em vez de ser exibido das 9h00 às 12h45, passou a ser até às 13h00.
 No dia 19 de outubro de 2015, o programa retornou ao horário original às 14h45 tendo o SBT abrindo um novo horário de telenovelas, às 14h00.
 No dia 4 de abril de 2016, começou a ser exibido às 14h15, invertendo o horário com a novela La mentira, que passou a ser exibida para todos os estados.
 No dia 01 de agosto de 2016, passou a ser exibido às 15h15, devido a estreia do programa Fofocando (atualmente Fofocalizando), apresentado por Leão Lobo e Mamma Bruschetta.
 No dia 21 de novembro de 2016, passou a ser exibido às 14h15, no lugar do programa Fofocando, sendo que este passa a ser local, às 13h15 e a telenovela La usurpadora assume o antigo horário da atração.
 No dia 23 de janeiro de 2017, passa a ser exibido um pouco mais tarde: às 16h00, sucedendo o Fofocalizando.
 No dia 8 de maio de 2020, em virtude do esticamento, por ordem de Silvio Santos, da estreia do Triturando, a atração ficou fora do ar.
No dia 29 de novembro de 2021, passa a ser exibido novamente às 14h15, devido a uma mudança na programação vespertina, sendo sucedido pelo Roda a Roda às 15h15, o Fofocalizando às 15h45 e às Novelas da Tarde às 17h.
Em 16 de maio de 2022, passa a ser exibido às 15h15 em virtude da exibição de Paixão de Gavilanes, que seria substituída posteriormente por Esmeralda. Com a mudança, o Fofocalizando passa para o horário das 16h15 e as Novelas da Tarde às 17h15, ficando até a extinção do programa no dia 17 de março de 2023.

Controvérsias

Em 29 de outubro de 2012, o programa relatou o caso de homens que preferem mulheres mais jovens, o que acabou sendo relacionado com a pedofilia.

Laio Campos que participou do programa divulgou em seu Facebook, em maio de 2013, uma foto em que ele e três amigos gastavam o dinheiro que, segundo ele, era o cachê fornecido pelo programa. Um mês anterior, ele estaria convidando pessoas para participarem do Casos de Família e ganhar cem reais de cachê, almoço e transporte, todos custeados pela emissora.

Frequentemente, participantes do Casos de Família são vistos em outros programas como Programa do Ratinho no SBT e nos programas Você na TV e Teste de Fidelidade, da RedeTV!.

Ligações externas

Programas do SBT
Programas de entrevistas do Brasil
Programas de televisão do Brasil que estrearam em 2004
Programas de televisão em língua portuguesa

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INA 212(a)(3)(C) – Foreign Policy – Section 212(a)(3)(C)
212(a)(3)(C) Foreign Policy
What is a grounds of inadmissibility?
In order for a foreign national to be admitted to the United States, he or she must be admissible. A foreign national can be deemed inadmissible to the United States by USCIS, CBP and a Consulate. If the foreign national is deemed inadmissible due to the United States, he or she cannot enter without a waiver of inadmissibility or a determination that the inadmissibility charge was made in error.
212(a)(3)(C) Inadmissibility due to Foreign Policy
Foreign nationals may be inadmissible if granting the foreign national a visa would cause potentially serious adverse foreign policy consequences for the US.
An alien whose entry or proposed activities in the United States the Secretary of State has reasonable ground to believe would have potentially serious adverse foreign policy consequences for the United States is inadmissible.
This section shall not apply to an alien who is an official of a foreign government or a purported government, or who is a candidate for election to a foreign government office during the period immediately preceding the election for that office, shall not be excludable or subject to restrictions or conditions on entry into the United States solely because of the alien's past, current, or expected beliefs, statements, or associations, if such beliefs, statements, or associations would be lawful within the United States.
This section shall not apply to an alien because of the alien's past, current, or expected beliefs, statements, or associations, if such beliefs, statements, or associations would be lawful within the United States, unless the Secretary of State personally determines that the alien's admission would compromise a compelling United States foreign policy interest.
How to obtain a determination that the 212(a)(3)(C) ground of inadmissibility was incorrectly made.
No matter which US government agency made the inadmissibility determination, each provides a method to dispute the determination, though each has drastically different processing times. We have achieved successful outcomes by petitioning the US Department of State where the determination was made by the Consulate in as little as 2 weeks. CBP quotes turnaround times of as little as 30 days and USCIS will not offer a time frame. In our experience, the more difficult the situation, the longer it will take to get resolved.
How to obtain a 212(a)(3)(C) waiver
There are two types of waivers that apply to each grounds of inadmissibility: one for immigrants and one for nonimmigrants. Immigrants are foreign nationals who are trying to obtain an immigrant visa or green card. Nonimmigrants are foreign nationals who are trying to obtain or enter with a temporary visa such as a B2 tourist visa, F1 student visa or H1B work visa, among others. Some grounds of inadmissibility allows both immigrant and nonimmigrant waivers, some allow one and some offer no waiver at all.
Many people who are faced with a inadmissibility determination believe that they will never be able to obtain a waiver or enter the US again. This is simply not true. For almost all types of inadmissibility classes, a waiver is available and there is always an option to challenge the determination. We have successfully helped many clients who were determined to be inadmissible and we can assist you. We believe that with the right approach, there is always a hope to win your case.
Nonimmigrant Waiver
There is no nonimmigrant waiver for 212(a)(3)(C).
Immigrant Waiver
There is no immigrant waiver for 212(a)(3)(C).
Paths for a Waiver of Inadmissibility
INA 212(d)(3)
I-601 Waiver
I-601A
Provisional Waiver

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Kingdom Hearts HD 2.5 Remix coming to PS3 on Dec. 2 in North America
By Michael McWhertor@MikeMcWhertor Jun 6, 2014, 12:00am EDT
Share All sharing options for: Kingdom Hearts HD 2.5 Remix coming to PS3 on Dec. 2 in North America
Kingdom Hearts HD 2.5 Remix will be released for PlayStation 3 on Dec. 2 in North America and Dec. 5 in Europe, publisher Square Enix announced today alongside a new trailer.
The remastered high definition compilation includes two full games, Kingdom Hearts 2 Final Mix and Kingdom Hearts: Birth By Sleep Final Mix, as well as theatrical cutscenes from Kingdom Hearts Re:coded. The above trailer includes scenes from all three titles, touching on various storytelling moments, as well as a teaser for Kingdom Hearts 3. The trailer offers brief story details about the third major Kingdom Hearts game, but does not include any new gameplay footage.
Kingdom Hearts HD 2.5 Remix is a follow-up to last year's Kingdom Hearts HD 1.5 Remix.
The next game in the franchise, Kingdom Hearts 3, was announced for PlayStation 4 and Xbox One at E3 2013.


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Look!!! there's a pure image in this page!!!
For those who are interested in the upcoming 16mm wide pancake lens, some new photos are revealed here and our Flickr page!
Along with the 60mm macro lens we already announced, the new 16mm lens is scheduled to be released soon. Before its official retail sales, we would like to share some sample photos to make sure of the NX lenses high performance on this post.
I do wanna experience the NX camera's high quality.


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Tesla Direct Sales Lawsuit: Dealerships argue they could sell Tesla vehicles because 'they have 4 wheels'
Fred Lambert
- Jul. 25th 2016 5:30 am PT
@FredericLambert
Tesla is fighting restrictive direct sales laws in several markets like in Texas, Connecticut, Michigan, Indiana , but its fight in Utah is now the most "high-profile" since Tesla is challenging the state in its supreme court after it was blindsided out of its store.
The automaker built a $3 million store in Salt Lake City last year, but the full-fledged store was demoted to a gallery/service center two weeks before opening due to the Utah attorney general's office ruling that it was against the state's direct sales law following complaints from the local dealership association.
Now that the case is before the court, in order to counter the automaker's argument that they are not good at selling electric vehicles, dealerships are saying that they could sell Tesla's vehicles simply because "they have four wheels".
Direct sales law in Utah bans automakers from owning dealerships. The system was designed so that established carmakers already using franchises, like GM or Ford, couldn't set up their own stores to compete with independent dealers, but Tesla argues that they don't have and never had any franchise dealerships and therefore, they are not unfairly competing with the current franchise system.
But after complaints from the dealership association, the state sided with the dealers and asked Tesla to go through the franchise system, something the automaker refuses to do.
Tesla General Counsel Todd Maron argued that the automaker wouldn't thrive under a franchise dealership model because independent dealers make most of their profit from servicing cars while electric cars have little long-term maintenance and fewer moving parts.
Furthermore, Tesla doesn't aim to make a profit on service and CEO Elon Musk is on record saying that he thinks it's "terrible" to make a profit on service.
In the past, Tesla also stated that dealerships don't properly explain the advantages of electric vehicles, whether it be because they don't understand them very well or because pointing out all the advantages of electric vehicles result in pointing out all the disadvantages of gas-powered vehicles, which constitute the vast majority of the dealership inventories.
In court documents filed in late June over the case in Utah obtained by Associated Press, attorneys for the dealerships somewhat supported Tesla's claim by explaining how they would sell Tesla's cars:
"Tesla builds a car. It has four wheels. You press a pedal with your foot to make it go, and you turn the steering wheel to change direction. That you plug it in rather than gas it up is a trifle,"
It's not the first time detractors used eyebrow-raising arguments for forcing Tesla to go through third-party dealerships.
Prior to going to court and when Tesla was still trying to get its license through the legislative process, a Utah state legislator made the argument that Tesla shouldn't be allowed to let people test drive its vehicles in the state and then buy them online because his wife can't try products from Amazon before buying them (starts at 34:12):
The court battle is still ongoing.
Tesla is a transportation and energy company. It sells vehicles under its 'Tesla Motors' division and stationary battery pack for home, commercial and utility-scale projects under its 'Tesla Energy' division.
tesla direct sales
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text:
Clinical Effects and Characteristics of Color, Number, and Word Content Elements in Computerized Training Programs for the Prevention of Cognitive Decline
Jaehoon Jeong, Sungmin Kim, Nahyeon Kim, Yoonjoo Lee, Daechang Kim
https://doi.org/10.21203/rs.3.rs-879998/v1
Background: The biggest problem in an aging society is the development of degenerative brain disease in the elderly. Neurodegenerative brain disease can cause cognitive dysfunction and rapidly increase the prevalence of dementia and Parkinson's disease, posing a huge economic and social burden on the elderly. A computerized cognitive rehabilitation training system has been developed to prevent and train cognitive dysfunction, showing various clinical effects. However, few studies have analyzed components of contents such as memory and concentration training. In this study, the clinical effects and characteristics of the color, number and words elements were analyzed by subdividing the memory and concentration contents into elements, difficulty, and training methods.
Methods: Using a total of eight contents developed based on neuropsychology, 24 normal subjects with an average age of 60.58 ± 3.96 years were conducted 3 times a week, and training was received for 30 to 45 minutes per session. To determine the training effect, MMSE-K, an evaluation tool most closely related to cognitive therapy, was used. The number of errors and problem solving time used in the analysis were dataized by measuring the number of incorrect answers selected by the subject and the time spent solving the problem, respectively. Using t-test, the significance of different between before and after training was determined. Correlation between the number of errors and problem-solving time by week was determined using a trend line. All experimental procedures and evaluations were conducted after obtaining IRB approval from Dongguk University Ilsan Hospital (DUIH2020-07-001).
Results: The subjects' MMSE-K scores were 27.88 ± 1.70 points before intervention to 28.63 ± 1.69 points after three weeks of intervention. In each subdivided component, color element showed an effect of improving complex difficulty, number element had the most effective training effect, and word element had a predictive effect on cognitive decline.
Conclusions: A detailed analysis results of the components used in a computerized cognitive rehabilitation training system will help develop degenerative brain disease contents to be developed later, and is expected to contribute to a prevention-oriented medical paradigm
degenerative brain disease
computerized training program
Medical is a word with a broad meaning to improve people's quality of life, such as maintaining, recovering, and promoting health. The actual activity of medicine is called medical practice or medical action. The related technology has been recognized as medical technology. In the past, medical care had a strong perception of treating patients because they received medical treatment after symptoms appeared. For this reason, activities and technology development for treatment have progressed naturally. Advances in medical care have extended the lifespan of old persons and led the world's population to an aging society in conjunction with various causes such as a decrease in fertility rate and changes in global economy [1-3]. The increase in older persons has made it necessary for more financial support for medical activities. The time and amount used for treating them have exploded. According to social and economic necessity, various changes began to occur at the national level to optimize the cost of increasing medical expenses [4]. In other words, the perception of medicine began to change from treatment to prediction, prevention, and health management.
The biggest problem in an aging society is the occurrence of acquired abnormalities in the aging population. Older persons are at increasingly risk of diseases as the prevalence of various chronic diseases and brain diseases increases [5]. Among them, neurodegenerative brain disease imposes a huge economic and social burden on individuals because it requires high cost and long-term treatment [6-7]. If neurodegenerative brain disease progresses due to various causes, cognitive impairment can result from abnormal loss of function of the nervous system or certain brain regions. Cognitive impairment refers to memory impairment, concentration impairment, and deficits in perceptual function. The prevalence of dementia, Parkinson's disease, and depression is 5 to 10 times higher in patients with mild cognitive impairment than in general older persons [8-9].
As an index for predicting neurodegenerative brain disease, decline in cognitive function is evaluated [10]. Methods to evaluate cognitive function are divided into neurophysiology using bio-signals and neuropsychology using comprehensive paper tests. Among them, the neuropsychological method, which has each evaluation method by subdividing cognitive function, has been standardized. This method is recognized as a valid evaluation based on various research results[11-13]. As a method of training cognitive function, various system training methods are used. Among them, the RehaCom system and CoTras system, which use computerized cognitive rehabilitation training (CCRT) methods, are the most used computerized training system. CCRT-system is a training program developed with the goal of improving cognitive functions such as memory, attention, concentration, and perceptual ability using a computer [14-15]. Also, training programs that can be used at home through a mobile CCRT-system using portable devices are being developed. Various training contents for training programs are also being developed. Various studies have been conducted on clinical effects of these CCRT-system on cognitive improvement in patients with brain injury, stroke, and multiple sclerosis and in old persons [16-21].
However, although various studies exist to confirm the clinical training effect of the CCRT-system, there have been very few studies that subdivided the program into elements of color, number and word, difficulty, and training methods to confirm clinical features and effects. In this study, a total of eight contents for memory and concentration training that can be used in CCRT-system were developed. By subdividing the components of the developed CCRT system, the clinical effects and characteristics of the cognitive rehabilitation training effects of each element are presented. These components were subdivided into content elements, difficulty, correct answer selection method, problem presentation method, and training method.
The results of this study are expected to be helpful in the development of cognitive rehabilitation training contents that can be used in the CCRT-system and various mobile devices. It is also expected to reduce the prevalence of neurodegenerative brain disease due to aging. Finally, It provides a basis and contributes to a medical paradigm centered on prediction and prevention.
2-1 Contents design and setting
Contents used in this study were developed based on neuropsychology. Neuropsychology is a field that studies the relationship between brain regions and functions. Brain function is assessed using a variety of neuropsychology testing methods, including comprehensive intelligence, attention, memory, and language tests. The results are then analyzed to determine impairment of brain function. Accordingly, the developed contents were subdivided to enable cognitive rehabilitation training and brain health evaluation. It is expected that research results that can prevent and predict brain diseases can be obtained through these contents[22-23].
For the first time, we subdivided components that made up the contents of memory and concentration (Table 1). In order to specify the brain region, each element of these contents was subdivided into words, numbers, and color (Item 1 of Table 1). Words and language are recognized in Wernicke's area in the temporal lobe. The medial temporal lobe is responsible for declarative memory. The occipital lobe that is located in the visual cortex and ventral pathway connected to the temporal lobe processes and remembers color information while comparing existing color information with new color information. The parietal lobe connected to the dorsal pathway of the occipital lobe controls the integration of somatic sensory information such as touch, spatial function, and calculation to recognize numbers [24-26].
In difficulty, we included complexity to increase the number of errors (NOE) and problem solving time. A complication can be described as a kind of cluster. Contents with low difficulty are provided with clearly clustered words such as fruits and animals as a problem. Words that are not clustered are provided as those with higher difficulty. Also, the higher the difficulty, the greater the amount and length of the problems offered. As a result, the number of problems the subject must memorize and solve increases. (Item 2 of Table 1).
Next, the frontal lobe controls and processes information coming from other lobes, so the training method was subdivided in terms of information recognition and processing[27]. Because the subject should recognize and solve the problem of contents, the method of recognizing the problem (called RP-method) and the method of solving the problem (called SP-method) were subdivided. Sequential problem presentation method (sequential-RP), which sequentially shows problems one by one, and simultaneous problem presentation method (simultaneous-RP) for recognizing the problem by showing the problem at the same time, are used in the RP-method. In addition, the SP-method is divided into a sequential answer selection method (sequential-SP) in which correct answers are selected in the same order as the problem is presented and a random answer selection method (random-SP) in which correct answers are selected regardless of the order (Items 3 and 4 of Table 1). Finally, when selecting an incorrect answer, contents were developed by dividing the method of training repeatedly and the method of non-repetitive training (Item 5 of Table 1).
Components and training methods by training contents
presentation method
selection method
training method
number memory
word-picture memory
word-picture matching
word concentration
word-color
2-2 Content computerization design and setting
The word memory content sequentially shows a total of 5 random words from a cluster corresponding to fruit, animal, house, and landscape according to difficulty. Subjects remember a words and randomly clicked a button with the same word written on it (Fig. 1A). The number memory content shows a text with 2 to 6 numbers listed according to difficulty. Subjects remembered the number and clicked the numbered button in the order in which these numbers were listed (Fig. 1B). The color memory content sequentially shows images in which 1 to 5 colors are expressed according to difficulty. The subjects remembered the color and clicked the buttons of the same color in the order listed (Fig. 1C). The word-picture memory content sequentially shows 2-4 random words to the subject according to difficulty. Subjects remembered the presented words and randomly clicked a button with an image identical to the word (Fig. 1D).
The word concentration content must randomly select appropriate words from similar words such as N and M, T and Y. The amount of objects to be compared increases according to the difficulty (Fig. 1E). The number concentration content must select numbers in an ascending order. The size value of the object to be compared varies according to the difficulty. For example, rather than sequential values such as 1, 2, 3, non-sequential values such as 1, 4, 8 should be selected sequentially in an ascending order (Fig. 1F). For color concentration content, the correct answer is randomly selected by clicking the button whose background color. The written word color is the same (Fig. 1G). Finally, scene concentration content presents a specific scene to the subjects and the subjects randomly select an image that does not exist. The complication of images included in a scene increases with difficulty (Fig. 1H).
2-3 Study design and setting
The clinical evaluation design used in this study is shown in Figure 2. The evaluation was conducted after obtaining Institutional Review Board approval from Dongguk University Ilsan Hospital (DUIH2020-07-001). Since all subjects were trained with the same developed contents, the clinical study design was set up as a single group. In order to investigate the function and effect of contents, adult men and women over 55 years of age were designated as study subjects. Those with cognitive, physical, and behavioral disorders that would make it difficult to use the program were excluded through screening evaluation [28]. MMSE-K, an evaluation tool most closely related to cognitive rehabilitation training, was selected as an effectiveness evaluation tool to check the screening evaluation for subject recruitment and the training effect of the developed content. Training was conducted once a week for 30 to 45 minutes for 3 weeks. All processes were conducted with the investigator subjects to conduct training and provide assistance.
In the personal information survey, gender, educational background, medical history, and cognitive rehabilitation treatments were evaluated. Before proceeding with concentration and memory training, the orientation problem was preceded to familiarize basic movements and training methods. After orientation, concentration, and memory training, subjects filled out questionnaires on user satisfaction, time satisfaction, comprehension, and difficulty and the investigator evaluated the subject's training accuracy and training time.
2-4 Subject design and setting
Screening evaluation was conducted according to the study design. Cognitive training test results were obtained for 24 subjects, excluding 1 who dropped out (a total of 25 subjects) (Fig. 3). As a result of analyzing sex and age of subjects using the personal information survey, 7 (29.2%) males and 17 (70.8%) females of these 24 subjects participated. The average age of these 24 subjects was 60.58 ± 3.96 years old. Subjects received education at 16.7% college level (dropout or graduation), 50% high school level (dropout or graduation), 25%middle school level (dropout or graduation), and 8.3% others. As for medical history, 13 (54.1%) subjects had no medical history, 7 (29.2%) subjects had diabetes and hypertension, and 4 (16.7%) subjects had hyperlipidemia and esophagitis. There was no disease that could directly affect cognitive function in all subjects. However, diabetes, hypertension, and hyperlipidemia are classified as risk factors for brain disease. Thus, it is expected that the prevention effect can be confirmed according to the evaluation. Finally, 22 subjects (91.7%) had no experience in cognitive training and among those who experienced cognitive training, paper therapy and computer therapy were experienced by one each.
2-4 Data analysis design and setting
For the reliability of the evaluation paper used for the test subject, the Cronbach's alpha coefficient, the reliability coefficient of the respondent for various items at a fixed time, was used. The score of the evaluation paper was analyzed as average score, standard deviation, and percentage for items using a Likert scale. To record training accuracy and training time, the investigator recorded the number of incorrect answers selected by the subject and the training start and end times for each content during training.
All measured data were extracted by the investigator and recorded and entered into the data entry form. These extracted data were rearranged by week to observe the subject's changes in the weekly training process. Results values are presented as a percentage of the corresponding response/total response. T-test was used to compare data and confirm the significance of changes in incorrect answers and problem-solving time between before and after using cognitive training contents. The correlation between incorrect answers and time by week was determined using a trend line. After that, the correlation between incorrect answers and time was determined in weekly concentration and memory training. Clinical effects and characteristics were then determined according to subdivided parameters.
3-1 MMSE-K evaluation
Before the subdivided parameter analysis of contents, MMSE-K values before and after training were compared to check the effect of actual training. On the MMSE-K, the range of cognitive scores for normal individuals is usually 24-30. The subject's MMSE-K score increased to 27.88 ± 1.70 before the developed content training and 28.63 ± 1.69 after 3 weeks of training. Therefore, it was confirmed that the developed 8 contents had cognitive rehabilitation effects even within the normal cognitive range (Table 2).
Changes in MMSE-K values before and after the training program
Subjects (n = 24)
MMSE-K
Mean ± SD
3-2 Satisfaction evaluation
Evaluation scores of subjects' program satisfaction survey questionnaires were analyzed (Table 3). The maximum score per item is 20 points. User satisfaction, time satisfaction, comprehension, and difficulty of evaluation items mean how to use and its convenience, preparation time and correct answer selection time, problem interpretation such as words and pictures, and difficulty according to time, respectively. In the evaluation, scores were decreased for all items corresponding to memory training. This means that the training method in which the problem is repeated when selecting the wrong answer according to item 5 of Table 1 can greatly reduce the satisfaction of contents.
Program satisfaction survey questionnaire evaluation score
time Satisfaction
changed score
3-3 Effective contents training time
Next, the relationship between NOE and solving time by week of all training was analyzed. As a result of the t-test, the NOE and solving time in 1 week were 0.60±1.08 NOE, 31±17.05 seconds, comparison values in 2 week were 0.49±0.74 NOE, and 29.58±17.51 seconds, indicating P>0.05. However, the comparative values in 3 week were 0.35±0.51 NOE, and 24.72±12.13 seconds showed P<0.05, so in order to obtain the effectiveness of training clearly, at least 3 weeks of training time should be taken. In addition, by analyzing the trend line displayed according to the number of errors in week 1 and week 3, it was confirmed that effective training is possible when the configuration time for each difficulty is within 45 seconds(fig 4 B).
3-4 Difference according to how to choose a problem
The NOE and problem solving time relationship was analyzed by dividing concentration and memory contents. However, because we could not find any clear difference in concentration or memory content, we reclassified data according to item 4 in Table 1 to analyze the relationship between NOE and problem solving time(Fig. 5). It had different characteristics that compared A) in Fig. 5, which used random-SP, and B) in Fig. 5, which used sequential-SP. Accordingly, in order to confirm the training effect by week, the content was rearranged as a weekly error time graph and shown as C) and D) in Fig. 5.
As a result of the analysis of how to choose the problem, the following training effects were demonstrated. training contents using random-SP shortened the problem-solving time after the weekly training while training contents using sequential-SP reduced incorrect answer rate for the same time zone after the weekly training.
3-5 Difference according to how to present a problem
In addition to the method of selecting the correct answer in training, the method of presenting the problem is also a component (Table 1, item 3). For the first time, we compared contents using different problem presentation methods among contents using random-SP (Fig. 6). As shown in results of 3-4 above, random-SP shows the tendency of training effect to reduce the problem solving time. However, in the content using sequential-RP (Fig. 6C, 6D), the decrease width in problem-solving time receded compared to other content, while the NOE showed a tendency to increase.
Additionally, among contents using sequential-SP, contents using different problem presentation methods were compared (Fig. 7). Sequential-SP Shows the trend of the training effect to reduce the number of incorrect answers. Unlike other contents using simultaneous-RP, when sequential-RP was used (Fig. 7 A), the NOE and solving time increased at 2 weeks. According to these results, sequential-RP of RP-method in development of content had a greater influence on subjects than SP-method, which might have induced an increase in NOE in the training process.
3-6 Training effect by element and difficulty
Elements were compared based on contents with the most similar components. Figure 8 shows the training effect for each week according to the difficulty setting of word, number, and color element used in content. It was confirmed that the NOE and problem-solving time gradually increased according to the complexity and length of the difficulty. When the initial difficulty and the final difficulty were compared by week, the average number of errors and problem-solving time increased by 0.14 NOE and 12.74 seconds in word memory, 0.31 NOE and 8.03 seconds in number memory, and 1.89 NOE and 31.42 seconds in color memory.
Next, the total NOE and problem-solving time by week were compared. In the 1 week and 3 week of the word memory, there was no change in the average error rate from 0.05 to 0.05 NOE, while the average problem-solving time decreased from 32.21 to 29.82 seconds. In number memory content, average error rate decreased from 0.23 to 0.14 NOE and average problem-solving time decreased from 18.85 to 15.39 seconds. In color memory content, average error rate decreased from 0.80 to 0.74 NOE and average problem-solving time decreased from 25.00 to 22.00 seconds.
In addition, as shown in Figure 9, in the word concentration and number concentration contents using the difficulty of amount and mental arithmetic, the NOE and solving time were increased while weekly. In the word concentration, average NOE and solving time for word concentration decreased from 0.30 to 0.21 NOE and from 36.34 to 28.19 seconds and in the number concentration, average error rate decreased from 3.58 to 1.83 NOE and average problem solving time decreased from 36.34 to 28.17 seconds.
Through these results, several characteristics could be confirmed. First, difficulty such as complication, length, amount, and mental arithmetic used in content development can increases the processing process and time of problem solving. Second, the incorrect answer rate for each element was high in the order of color, number, and word and the solving time was higher in the order of color, word, and number. Accordingly, content including color element may be classified as high difficulty. Third, the number element had the slightest solving time and the highest weekly incorrect answer reduction rate (Fig. 8C, Fig. 9C). Contents including numeric elements were judged to be effective as short-term training. Finally, it was confirmed that incorrect answer rate of word memory using word element was significantly lower than that of other elements. It was judged that the current test subjects had little difficulty in recognizing words.
The increase in medical expenses, which is a side effect of the aging society caused by the increase in the aging population, has provided us an opportunity to change from a treatment-oriented medical paradigm to a prevention-oriented medical paradigm that can manage patients and older persons at a much lower cost than treatment costs. Accordingly, various countries are making efforts to prevent and predict degenerative brain diseases known to have a high economic and social burden. Degenerative brain disease is known to be caused by genetic and environmental problems and neurodegeneration that can damage normal cells with aging, thus greatly increasing the prevalence of various degenerative brain diseases such as Alzheimer's, Parkinson's, and multiple sclerosis [29]. Degenerative brain disease causes cognitive impairment, a neurological complication that impairs intellectual functions such as memory, concentration, judgment, and language skills. Cognitive impairment can cause various deficits in neuropsychological function in the initial mild state, eventually leading to severe cognitive impairment [30]. In this study, a total of 8 training contents were developed based on neuropsychology to prevent cognitive decline. Their clinical effects and changes were derived by subdividing components to classify brain regions.
Through MMSE-K, the cognitive rehabilitation training effect of a total of 8 training contents was confirmed. As a cognitive function test, the MMSE-K, revised according to the characteristics of Korean society, has been proven the validity of attention, computational power, language, memory registration and memory recall, and visual composition evaluation methods[31]. In this study, through training conducted on 24 subjects aged 60.58 ± 3.96 years for 3 weeks, the initial score was 27.88 ± 1.70. It was changed to 28.63 ± 1.69, showing an increase of 0.75 ± 2.42. In previous studies, cognitive rehabilitation and control training were conducted for about 9 weeks for 15.95 ± 6.46 subjects with an average age of 73.70 ± 3.72 years. The initial subject's MMSE score was 22.19 ± 2.5. However, the difference in MMSE after training was 0.10, which showed an insignificant training effect [32]. In other words, it is judged that the computerized training program proposed in this study to prevent cognitive decline will have a greater expected effect if it is used for the normal elderly population rather than for the mild patient group. Based on these results, the computerized cognitive rehabilitation training programis expected to be used as a method to prevent aging and functional deterioration of cranial nerves, rather than treating already damaged cranial nerves [33].
The main purpose of segmented contents is to represent regions of the brain. The brain has one large mass of cells. The brain maintains various physical coordination and homeostasis. It is responsible for functions necessary for life activities. It is also responsible for cognition, emotion, memory, and learning. The brain is largely divided into three parts: cerebrum, cerebellum, and brainstem. The cerebrum is the center of mental activity. The outer layer of the cerebrum is composed of four lobes. In this study, language, number, color, and training method were designated as the temporal lobe, parietal lobe, occipital lobe, and frontal lobe, respectively. Accordingly, this study focused on brain atrophy and functional decline that would occur during natural aging [34]. Atrophy, the most common aging process in the brain, represents morphological changes due to a decrease in brain volume. It is very difficult to find atrophic patterns in the brain. However, brain atrophy can be predicted based on a decrease in various functions responsible for specific brain regions[35].
The developed content included each element with words, numbers, and colors. The error rate increased in the order of words, numbers, and colors according to training results. These results were expected to have a specific relationship in the temporal lobe, parietal lobe, and occipital lobe through segmentation of brain regions. The local gyrification index, which determines cortical complexity, is known to be a potential factor for predicting cognitive decline due to brain atrophy. In this study, the local gyrification index corresponding to each brain region was analyzed. According to previous research papers, the local gyrification index is low in the order of the temporal lobe, parietal lobe, and occipital lobe. In addition, the local gyrification index of the occipital lobe is 22% lower than that of the temporal lobe. For this reason, the order of error rate is listed. It was judged that higher error rates occurred in color elements than in word and number elements. Additionally, number concentration and memory content showed greater training effect than other trainings [36]. That is, it is expected that nerve activation according to stimulation occurred significantly in a state in which functions such as memorizing and calculating numbers were deteriorated.
Based on the relationship between the subdivided element and the local gyrification index, it was confirmed that the element used for the content directly or indirectly reflected and affected the brain region. This study proposed the following final effects and characteristics according to elements. Color recognition and memory in the occipital lobe, which has a low basic local gyrification index, might be difficult. However, since the occipital lobe has the temporal lobe in charge of words and the parietal lobe in charge of numbers with pathways, it seems that the color element can be used in combination with one additional element. In other words, it will be possible to develop and utilize more difficult training contents. The number element is judged to be the most effective training element to be performed in older persons. With aging, the existing functions and new learning functions of the parietal lobe are decreased compared to those in young adults. These functions show a decrease in subjective experience [37]. Words and color elements are in the form of presenting what they already know. However, numbers can suggest a variety of new problems through new combinations and calculations. It was determined that existing known calculations and recognition methods could be utilized.
Finally, it is expected that word elements can be used as a prediction of cognitive decline. The brain regions responsible for memory include the medial temporal lobe, the frontal lobe, and the hippocampus. In this study, the role of the medial lateral lobe was emphasized. The reason is that the medial temporal lobe is not the ultimate storage location for memories, it is a temporary storage location[38]. That is, it was determined that the role of the medial temporal lobe would be large because word memory is a content that solves problems using temporary memory. In word memory contents using words, the change in incorrect answer rate was insignificant compared to other contents. For this reason, it is presumed that word learning using nameable objects observed and used in daily life can stimulate the medial temporal lobe and affect the memory process and the processing of memory processes in the brain, suggesting that they are functioning normally at the normal age of 60.58 ± 3.96 years. Finally, based on results of various studies in which the function and volume of the medial temporal lobe are decreased in those with mild cognitive disorders such as Alzheimer's disease [42-44], the occurrence and change of a large error rate of content using word element can to be utilized as a predictor of degenerative brain disease.
Although there was a slight difference depending on the factors, the training effect also differed according to the method of choosing the correct answer and the method of presenting the problem. In this study, it was assumed that these training methods were related to the prefrontal area. The frontal lobe regulates brain functions. It is an area involved in complex cognitive function-related processes such as solving new problems. Also, the frontal lobe is associated with the memory of events and temporal sequences [45]. In this study, events were set as a method of presenting problems at the same time and the temporal order was set as a method of presenting sequential problems. In this study, the method of presenting sequential problems produced more errors. The method of presenting sequential problems was judged to be related to the network function of the frontal lobe and it was confirmed through various studies.
A study on frontal lobe injury has been confirmed that actual frontal lobe injury patients can perform routine memory tests normally [46]. However, it was confirmed that there was a disability in the study focusing on the strategic process test using tactical aspects such as the memory of temporal sequence [47-48]. Results of previous studies and the present study confirmed that the problem presentation method was related to the frontal lobe. It was judged that the strategic process function of subjects who were 60.58 ± 3.96 years old was somewhat weakened. Finally, training using the sequential problem presentation method for frontal lobe activation requires at least three weeks of training time and training using color elements can create a greater effect (Fig. 7A).
Existing training and evaluation have used paper equipment. However, this study performed a computerized training program using computers. Accordingly, the effect of using a computer and training device was additionally confirmed. As older people lose concentration and increase fatigue due to aging, the training time of the content used for training should be taken into account. The gradual increase in the training effect by week and the sharp increase in the incorrect answer rate in the 3rd week decreased. That is, in training using a computer and training device, a solution time of 45 seconds or more may cause a decrease in concentration and an increase in fatigue. In addition, through the satisfaction survey, it was found that repeated training had an additional effect on incorrect answers and concentration or fatigue since repeated training could decrease test subject's training satisfaction when an incorrect answer was selected.
However, this study has some limitations. First, the period of training was short. In a previous study, the cognitive rehabilitation training and adjustment period lasted an average of 9 weeks. Accordingly, final results were presented when training and adjustment were carried out and changes were completed. In this study, although the effect and specificity of training were suggested, the final change was not quantified numerically. In addition, as shown in FIGS. 6C and 6D , a reduction effect after the increased error rate was not confirmed. Nevertheless, compared to the previous study, subjects who were younger than the previous study participated in this study. Results confirmed that cognitive function could be improved by 3 weeks of training for subjects with normal cognitive function, thereby preventing cognitive decline. Second, the condition of the subject could not be maintained the same. The effect of training is expected to vary depending on concentration and fatigue. However, in this study, physical or bio-signal data measurements other than verbal confirmation could not be used to check the condition of these subjects. Thus, the analysis was carried out by removing the occurrence of serious errors through the process of Figure 4.
In summary, this study analyzed clinical effects and characteristics of content elements that could help develop a computerized instructional program for preventing cognitive decline in line with the prevention and prediction-centered medical paradigm. Through this study, it is expected that customized content production will be possible using elements and training methods suitable for each characteristic in the program used for degenerative brain disease prevention contents and devices developed in a variety of ways. It is expected to be helpful in clinical research and planning. Results of this study are expected to contribute to the development of a computerized cognitive rehabilitation training program that can predict and prevent degenerative brain diseases occurring in a rapidly changing aging society, thereby contributing to a prevention-oriented medical paradigm.
CCRT : computerized cognitive rehabilitation training; NOE : the number of errors; RP-method : the method of recognizing the problem; SP-method : the method of solving the problem; sequential-RP : sequential problem presentation method simultaneous-RP : simultaneous problem presentation method; sequential-SP : sequential answer selection method; random-SP : random answer selection method
The study was conducted according to the principles of the Declaration of Helsinki. This study was approved by the Institutional Review Board of Dongguk University Ilsan Hospital with the Protocol Number DUIH2020-07-001. Participants read and signed an informed written consent form before participating in the study. It is not possible to identify the patient using the data in this study.
The data that support the findings of this study are available from the corresponding author, upon reasonable request.
The authors have no conflict of interest to report.
This work was supported by the Technology Innovation program – Advanced Technology Center (ATC) 10076733, "Development of the cognitive rehabilitation solution for patients with cognitive impairment using speech recognition and eye tracking technology", funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea)
DCK, JHJ devised this study. DCK analyzed the basic elements of cognitive rehabilitation training content and developed it using Android Studio in the form of CCRT. In addition, analysis and interpretation of the result values were carried out. JHJ and SMK set up the clinical procedure. The clinical procedure should be able to confirm the clear effect of the training effect and should be able to reflect the characteristics of the CCRT system well. Accordingly, the final research procedure was decided through a meeting with the IRB of Dongguk University and reflection of opinions. NHK and YJL participated in all evaluations as investigators, helped the subjects in the training process, and wrote incorrect answers and time.
This study is funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea). We gratefully acknowledge the Ministry of Trade, Industry & Energy.
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Additional Declarations
No competing interests reported.


text:
Health and Safety Legal»
Health and Safety Legal Register
Network Rail has a register which contains all applicable Health and Safety Legislation and how it applies to Network Rail.
The latest update can be found in the attachments section.
For Network Rail staff there is also a mobile application of the Health and Safety Legal (HSL) Register which is available on Network Rail mobile devices. The app is called "HSL Register" and is available to download from the Network Rail App Catalogue.
Colleagues are to note:
The Management of Health and Safety At Work Regulations 1999
Regulation 8 requires employers to establish and where necessary give effect to appropriate procedures to be followed in the event of serious and imminent danger to employees. Such procedures shall include informing employees of the nature of the hazard and of the steps taken to protect them from it; stopping work and immediately proceed to a place of safety; and preventing employees from returning to work where there is still a serious and imminent danger.
Regulation 12 requires that contractors are provided with comprehensible information on the risks to the contractors' health and safety and the measures Network Rail have taken imposed on it by statutory provisions in relation to those risks.
Regulatory Reform (Fire Safety) Order 2005
Article 9 requires a suitable and sufficient risk assessment to be carried out to identify general fire precautions to be taken. Where dangerous substances are involved, additional considerations as set out in Part 1 of Schedule 1 of the Order should be taken into account and no new work should be carried out until the risk assessment has been made and the measures carried out.
Under Article 11, Network Rail must make and give effect to appropriate arrangements for the effective planning, organisation, control, monitoring and review of the preventive and protective measures for fire safety.
The Personal Protective Equipment (Enforcement) Regulations 2018
Came into force on 21 April 2018. Regulation 4 requires that personal protective equipment must comply with any legal requirement applicable to that item.
If you have any queries with regards to the H&S Legal Register, please contact:
Safetyverification@networkrail.co.uk
Environmental legislation is contained within the Network Rail Environmental Legal Register. For further queries on the Environmental Legal Register, please contact sustainabledevelopment@networkrail.co.uk
Network_Rail_-_Health_and_Safety_Legal_Register_-_April_2019
XLSX / 3 May 2019


You can gain experience with consultation by co-leading our online consultation groups.
You can then meet one-on-one with that consultant to get consultation of consultation. This will meet the EMDRIA requirements to be an Approved Consultant.
As you go through the CIT process, you will build relationships with our members, which will extend your reach for future consultees.
In addition, you can submit your own unique articles and videos to share your expertise with a ready-made, eager audience.
If you're interested in being a CIT on our site, go ahead and register as a member and then send us an email to let us know what you're interested in. We look forward to having you!


text:
How Tayi PHC in Niger is increasing FP services through community-focused advocacy
Tayi, Niger, Nigeria
The local primary health center in Tayi, a new community in Chanchaga Local Government Area of Niger state, has helped normalize the discussion of family planning which includes topics such as primary health care delivery and contraception. The center provides on-site educational opportunities but has also partnered with religious leaders to especially help the conversation reach men.
Health care access Childbirth Family planning Maternal and perinatal health
Establishing social norms Reaching across the aisle Expanding Access Cultivating Collaborations Practicing Human Centered Design
An End to Polio in India?
Esha Chhabra
The New York Times 5 March 2014 Text / 1500-3000 Words
India has, for years, been a hotbed of polio. Supported by the WHO as well as local health-care workers, immunization...
A Racial Gap in Attitudes Toward Hospice Care
Sarah Varney
The New York Times 21 August 2015 Text / 800-1500 Words
Despite years of change, African Americans feel ostracized from the medical care community that is dominated mainly b...
Doctoring, without the doctor
There is a shortage of medical practitioners in thinly-populated rural states like Nebraska. But new laws now allow n...
A Plan to Make Homelessness History
David Bornstein
By partnering with cities across America, the 100,000 Homes campaign is going directly to the streets to end homeless...
http://opinionator.blogs.nytimes.com/2014/03/05/an-end-to-polio-in-india
India has, for years, been a hotbed of polio. Supported by the WHO as well as local health-care workers, immunizations have officially rid the country of the disease. There are still challenges in maintaining records and reaching everyone, but the message continously changes and adapts.
http://www.nytimes.com/2015/08/25/health/a-racial-gap-in-attitudes-toward-hospice-care.html
Despite years of change, African Americans feel ostracized from the medical care community that is dominated mainly by white people, especially when it comes to hospices. Some are trying to remove the stigma of hospice care as well as make health care systems more fair.
http://www.nytimes.com/2015/05/26/health/rural-nebraska-offers-stark-view-of-nursing-autonomy-debate.html?_r=2
There is a shortage of medical practitioners in thinly-populated rural states like Nebraska. But new laws now allow nurses with advanced degrees to practice without requiring a doctor's oversight.
http://opinionator.blogs.nytimes.com/2010/12/20/a-plan-to-make-homelessness-history
By partnering with cities across America, the 100,000 Homes campaign is going directly to the streets to end homelessness - and it's working. With roughly 700,000 people in the United States experiencing homelessness, this organization seeks to address that using a tiered system that considers individual health needs as well.


text:
Cap Cana's Bohemian Corner
Above: Juanillo Beach (all photos by CJ)
PUNTA CANA — The Punta Cana region is the Dominican Republic's tourism engine — an amalgam of all-inclusive resorts and exclusive accommodations.
Toward the south on the Dominican Republic's coast is tony Cap Cana, a large-scale development highlighted by the Jack Nicklaus-designed Punta Espada Golf Club and a group of high-end resorts and condominiums.
It's among the most exclusive spots on the eastern half of Hispaniloa — and deservedly so — a natural habitat for mega-yachts, luxurious suites and capacious condominiums.
But there's another side to Cap Cana.
All it takes to find it is to mention "Juanillo Beach" to the security guard at the gate to Cap Cana.
You'll be waved through, and in a few moments you'll be on the shores of one of the Caribbean's most beautiful beaches, with your own private beach club.
This is Juanillo Beach, a sugar-white enclave met by tranquil turquoise waters.
At the centre of Juanillo Beach is a bright-white restaurant decorated with surfboards and signs reminding you of just how far you are from the bustle of modern life.
This is the eponymous Juanillo Beach, Food and Drinks, a classic Caribbean beach bar that is a passion project of restaurateur Carlos de Moya.
De Moya opened the beachfront eatery in 2010 by converting what had once been a reception area for incoming Cap Cana clients.
"I was working in Punta Cana three years ago, and my business partner brought me here," he says. "When he showed me the place, I fell in love with it — I said, 'I have to do something here.'"
Above: Carlos de Moya
And that's what he did.
Juanillo is now open every day from 8 AM to sunset (with nights reserved for special events). It has a full kitchen serving international cuisine and beach fare like fried fish, burgers and pizza. This year, for the fourth time, de Moya will hold a Juanilo Beach Music Festival at the site.
"We call it the bohemian corner in Cap Cana," he says. "Cap Cana has a lot of wealthy clients, and this is the place where they just come to disconnect from the world and have a little time off."
CJ Travel, Dominican Republic, News
bohemian corner, cap cana, caribbean, carlos de moya, dominican republic, juanillo beach, music


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Dancing Motherhood
Ali Duffy
Available for pre-order on April 13, 2023. Item will ship after May 4, 2023
May 4, 2023 Forthcoming by Routledge
Format Paperback Hardback
Dancing Motherhood explores how unique factors about the dance profession impact mothers working in it.
Ali Duffy introduces the book by laying a foundation of social and cultural histories and trends leading to the issues mothers in dance negotiate today. This study then reveals perspectives from mothers in dance working in areas such as performance choreography, dance education, writing, and advocacy though survey and interview data. Based on participant responses, recommendations for changes in policy, hiring, evaluation, and other work practices to better support working mothers in dance are outlined and discussed. Finally, essays from five working mothers in dance offers more intimate, personal stories and guidance geared to mothers, future mothers, and colleagues and supervisors of mothers in the dance field.
By describing lived experiences and offering suggestions for improved working conditions and self-advocacy, this book initiates expanded discussion about women in dance and promotes change to positively impact dancing mothers, their employers, and the dance field.
Contributor Biographies
Chapter 1: Research Design, Methodologies, and Processes
Chapter 2: Theoretical Framework and Dominant Narratives of Women at
Work and Women in Dance
Chapter 3: Bodies
Chapter 4: Identities, Values, and Relationships
Chapter 5: Unmet Needs, Conflicts, and Challenges
Chapter 6: 'For the Tribe:' Essays to Mothers, Future Mothers, and Non-Mothers
Chapter 7: Organizational and Cultural Transformations to Benefit Mothers
and Pregnant People in Dance
Prologue: In Closing - A Dancing Letter to My Child
Alison Bory is Associate Professor of Dance at Davidson College, Davidson, NC, USA. She completed her PhD in Dance History & Theory (2008) and her MFA in Experimental Choreography (2006) from University of California, Riverside. Situating dance as rich site for understanding and theorizing experience, her creative research and scholarship both consider the affective possibilities of contemporary performance. She has previously published her own work in a/b: auto/biography studies, Performance Matters, and Art and Dance in Dialogue, as well as co-authored work with AGA Collaborative.
A'Keitha Carey is a PhD student in Global SocioCultural Studies at Florida International University in Miami, Florida, USA. She received her B.A. in Dance from Florida International University, an M.F.A. in Dance from Florida State University, an M.A. in African and African Diaspora Studies from Florida International University and she also holds a Certificate in Women's Studies from Texas Woman's University. A'Keitha developed the dance technique CaribFunk, a fusion of Afro‐Caribbean, ballet, modern, and fitness principles and rooted in Africanist and Euro-American aesthetics and expressions. She researches Caribbean spaces, locating movements that are indigenous, contemporary, and fusion based and investigates how Caribbean cultural performance (Bahamian Junkanoo, Trinidadian Carnival, and Jamaican Dancehall) can be viewed as praxis.
Genevieve Durham DeCesaro is Vice Provost for Faculty Success and Professor of Dance at Texas Tech University, Lubbock, Texas. She obtained her MFA in Dance from Texas Woman's University in 2004 and is the author of numerous peer-reviewed articles and a monograph on transdisciplinary research and the efficacy of dance, in combination with other disciplines, as a change-agent. Her choreography, funded in part by the National Endowment for the Arts, has been commissioned and performed across the country, with notable presentations at Virginia Tech, Spelman College, and the John F. Kennedy Center for the Performing Arts in Washington, D.C.
Elizabeth Johnson is Associate Professor, University of Florida School of Theatre and Dance (USA) is a performer, choreographer, educator, Laban/Bartenieff Movement Analyst, certified teacher of the Alexander Technique, Registered Somatic Movement Educator/Therapist, and registered yoga teacher. Artistic Director of her contemporary dance-theatre company, Your Mother Dances, her work has been seen in NYC, D.C., Chicago, Minneapolis, Milwaukee and beyond. She teaches and presents nationally and internationally on dance/movement pedagogies and somatics that center developmental movement, prosocial/trauma informed education, and feminist perspectives. She has co-authored/authored three book chapters featuring applied Alexander Technique and developmental movement.
Nicole Y. McClam is Assistant Professor in the Health, Physical Education, and Dance Department at Queensborough Community College, Bayside, NY. She received her MFA in Dance while pursuing her CMA in the Laban/Bartenieff Movement Studies modular program at the University of Maryland in College Park in 2015. Her book chapter, "A Letter Re -Membering Ballet Class: My Young Black Self Writes Her White Ballet Teacher," was recently published in Dancing Across the Lifespan: Negotiating Age, Place, and Purpose and she has written several book reviews for the Journal of Dance Education. She has presented on dance and motherhood, anti-racist praxis in composition and dance history classes, and zombies.
Lucy McCrudden is the founder of Dance Mama, UK. Currently studying her PhD at Christ Church Canterbury University, UK (2027), she has contributed articles for periodicals including One Dance UK's One and to non-fiction books including Maternal Journal. She created Dance Mama in 2014 – an advocacy platform – out of her own lived experience. Her research interests include physiology and the postnatal dancer.
Melissa Pihos is Associate Professor of Dance at the Department of Communication Arts (Theatre and Dance), Valdosta State University, Valdosta, GA. She obtained her MFA in Dance from The University of North Carolina at Greensboro in 2011 and is the co-author of Dance & Culture. She is the creator of PIHOS A Moving Biography and the award-winning film, Dear Dad,.  Her research interests include Benefits of using IMPROVment® for brain/body health, specifically for individuals with Alzheimer's disease, Parkinson's disease and Dementia, DocuDance, Dance and Social Justice, Screendance, Choreography, Filmmaking, and Multimedia Performance.
Anisha Rajesh is the artistic director of Upasana Performing Arts Center, Houston, TX where she teaches dance to K-12 kids. Her research as a PhD candidate at Texas Woman's University focuses on the pedagogy and practice of the Indian dance form Mohiniyattam. Anisha has presented her research at CORD, SDHS, DSA and World Dance Alliance
Ali Duffy is Professor, Graduate Director, and Associate Head of Dance and Honors Studies in the School of Theatre and Dance at Texas Tech University, USA.
Routledge Series in Equity, Diversity, and Inclusion in Theatre and Performance
Theatre & Performance Studies
Dance History
History of Performance
Performance Theory
Practice & Practitioners
Performance Theory - Practice and Practitioners
Women's & Gender History