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Did anyone say 'war fatigue' about Ukraine?
By Mathieu Droin
Members of Ukraine's 95th Air Assault Brigade defend an area near the front line of fighting on Jan. 12, 2023, outside Kreminna, Ukraine. Kreminna, located on the western edge of the Luhansk region, has seen fierce fighting between Ukraine and the Russian forces who occupy it. (Photo by Spencer Platt/Getty Images)
This has not been the winter Vladimir Putin wished for. The Russian president expected temperatures to plummet, and with them Ukrainian resolve as well as Western resilience. None of this has happened.
France's recent decision to deliver tank-killing armored combat vehicles to Ukraine softened reservations among allies about sending heavier, Western-made equipment for fears that such a move would represent escalation against Russia.
The day after the French announcement, the U.S. committed 50 Bradley infantry fighting vehicles as part of a further tranche of military support worth $3 billion. Germany finally agreed to deliver Marder armored vehicles and Patriot anti-missile systems. The United Kingdom and the Netherlands are among many countries that may follow suit.
Polish President Andrzej Duda has expressed his readiness to cross yet another threshold, that of main battle tanks, by offering to deliver Leopard 2 as part of a larger European coalition. He thus adds pressure on Chancellor Olaf Scholz since the German-made tanks require Berlin's approval to be sent anywhere.
The weapons would be a big boost for Ukraine's military, but Germany since the beginning of the war has constantly refused to create precedents in military support, relenting only when under pressure. The current level of pressure might not yet be untenable, but it is very high and might deepen cracks in the country's governing coalition.
These new deliveries are pivotal for several reasons.
For one, they meet Ukrainian demands and needs to fight off Russian forces. At this stage, Ukraine's most critical needs rest on two types of capabilities: air defense systems for shooting down missiles and drones, and armored combat vehicles for breaking through enemy lines and liberate territories. The latter might indeed prove more challenging as Russia has fallen back to more defensive positions, recruited fresh troops through mass conscription, returned to frenetic industrial production (40 to 50 heavy armored vehicles per month) and is crowding its best tanks, the T-90, in eastern Ukraine.
The messaging of Ukraine's allies is also instrumental to defeat Moscow in the "battle of resolves" on which Putin bet for an easy win against an allegedly divided, fragmented West. This is yet another delusion for Putin, after expectations that Ukrainians would welcome Russians, that the country's armed forces would be defeated within days, and that the passing of time would skew in Russia's favor. It is also important for the morale of the Ukrainian forces, as they are fighting tough battles in the Donetsk region.
Finally, the European step-up bodes well for the future of Western support to Ukraine. It is encouraging for transatlantic relations, as the United States was rightfully expecting a more even burden sharing, especially at a moment where its new Congress might complicate Washington's support. It is also positive for intra-European relations, as western continental Europe has taken a lot of flak from Eastern allies for not living up to the challenge. It shows that Europeans can take bold decisions, which could lead to further decisions on even heavier equipment without having to wait for the United States.
Yet this new wave does not come without risks. The reluctance to give Ukraine domestically designed heavy armored fighting vehicles was grounded in fears that this could be used by Russia as an excuse to escalate. In the present case, escalation could entail increased use of largely untapped tactical weapons and, ultimately, a potential nuclear option.
The reality is that qualitative upgrades in military aid to Ukraine are likely to change the tactical landscape for Russia but not its strategic equation.
There is at least one thing on which Russia and NATO agree: Neither want the alliance directly dragged into the war. The rules to prevent such an event were set early on and they still hold. They are that NATO nations shall not find themselves as co-belligerents in Ukraine and that Russia shall not attack NATO territory. It implies that the weapons delivered from abroad are in Ukrainian hands, and that their ammunitions do not fall on Russian territory. In this regard, the new military aid does not change the rules of the game as long as Ukrainians respect these rules of engagement.
In any event, it is up to the Ukrainians to say if they are willing to bear the risks of escalation rather than for the West to decide for them. And Ukrainian calls in this regard could not be more clear: Heavier, more sophisticated equipment is not a fear-enhancer, but a fear-eraser.
On the nuclear equation, the only escalation that the new deliveries might incur would be related to Moscow's rhetoric. Russia is all too aware that nuclear threats have no impact on Ukrainian resolve. The main objective of Moscow's nuclear saber-rattling is therefore to scare the West so that it restrains its support to Ukraine. This, too, seems to have failed.
This new wave of military support to Ukraine can be a watershed moment. It might have the ability to decisively reverse the tide, if it is swiftly implemented, sustained, and ideally enhanced.
Mathieu Droin is a visiting fellow at the Europe, Russia, and Eurasia Program of the Washington-based Center for Strategic and International Studies. A career diplomat with the French Foreign Service, he most recently served as deputy head of the Strategic Affairs Division at the French Ministry for Europe and Foreign Affairs.
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From ordering supplies to connecting with customers, you depend on technology to bring your small business dream to life.
These simple steps can help you build a computer security strategy ─ so you can protect your business and stay focused on the things you love, instead!
Set some rules. Socialize safe and unsafe online practices, internet research guidelines and a policy on the use of social media sites with your employees.
Up your password strength. Protect all computer accounts with strong passwords and remember to change them often. As an extra security measure, try to limit the employees with administrative privileges to only those who absolutely need them.
Fight against viruses. Install and regularly update antivirus and antispyware software on every computer. It's worth the upfront cost to avoid major damage to your bottom line (and your reputation) in the long run.
Lock it down. Invest in locking devices for monitors and laptops, and safes for mobile devices such as tablets to avoid physical theft of your technology goods – still the most common cause of data breaches.
Secure your Wi-Fi. Make sure that whatever Wi-Fi network you're using – both at work and at home – is secure and accessed only by a private password. For added safety, you can also configure your wireless access point or router so your network name does not show up to outside users.
Keep business separate. Though it may be tempting to use your work computer at home for games or email, it puts your business data at risk. Consider having a separate computer for personal use and make sure that your employees do the same.
Provide firewall security. Firewall security for your internet connection is a great idea. And, if your employees work from home, ensure that their home systems are also protected by a firewall.
Choose a secure bank. Protect your funds by making sure your bank has the most trusted and validated tools in anti-fraud services.
Invest in IT. If you don't have an IT person on staff, enlist an IT consultant or business advisor to help you create a more solid computer security policy. Your business will thank you!
No matter how your business uses technology, getting a security policy in place quickly is a smart item to bring to the top of your to-do list. Take these simple steps and get the peace of mind you need as you pursue your growing business dream!


Neil Gorsuch is about the best we could expect to see for a Supreme Court appointment. Gorsuch advocates inching away from one of the worst doctrines infecting courts: "judicial deference"--the subordination of the courts to Congress.
Conservatives' opposition to "activist" courts represents the same mistake. The notion that the courts should be passive means that courts should assume that laws passed by the legislature are Constitutional, not meddle, not "make law."
But the courts are the defenders of the Constitution, and the Supreme Court is the Constitution's ultimate defender. A deferential court, a passive court, is not holding the legislature to the limits on its power set by the Constitution.
In our system of checks and balances, the Supreme Court's role is to be a check on the power of Congress, to look upon every act with suspicion.
Far from bowing to Congress, the Court's job is to make Congress to bow to the Constitution.
When Constitutional challenges are brought before the court, the burden of proof is on the government. The government has to show authorization for their (so often destructive) acts.
It is not the citizen who has to show that an Act of Congress is wrong, it is the government that has to show it is right--i.e., that the Constitution gives it the authority to make such a law.
Remember: a law is a rule enforced by the police. A law is not a recommendation, but a command, backed up by physical force.
The use of force by the government is justifiable--when and only when it is used to counter the force initiated by a criminal or foreign aggressor. Laws against theft, extortion, murder are proper: in such cases, the government is using force in retaliation, to defend rights, not to violate them. (See Ayn Rand, "Man's Rights," and "The Nature of Government,").
The Framers of the Constitution understood what "deference" to governmental power means in actual practice. They had lived under the rule of His Highness, His Majesty, George III and the various Your Lordships and Your Ladyships under him. They had just fought a long and painful war to release themselves from having to give deference to arbitrary authority. They understood that government exists "to secure these rights."
"The Congress shall have Power ... To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers." That limits Congress to what's necessary and proper to the severely limited Powers (not rights) granted to the state. It places the burden of proof on Congress to show that its enactments are in fact necessary and are in fact proper.
Deference to the legislature is deference to power. Deference makes the default assumption be: might is right.
Judicial activism? An inactive judiciary means one that does not defend our rights. "Judges shouldn't make law?" Judges should stop Congress from making laws that violate individual rights.
It wasn't by declaring acts of Congress null and void that the leftist Courts imposed the regulatory state on this nation. It was precisely by upholding the constitutionality of acts that were actually unconstitutional. The upholding of Obamacare was the latest in this ugly, century-old record.
Consider the argument offered in defense of deference to the legislature: the legislature is composed of elected representatives of the people; Congress is enacting the will of the electorate.
This objection comes from a collectivized approach to the issue. "The people," and "the electorate" do not exist as such. Only individuals exist. The legislature represents the will not of some mystical Collective but of the majority. But what about the minority? Do they not have rights?
Once foggy group-talk about "the people" is cleared away, we see what judicial inactivism and deference to the legislature come down to: letting the majority victimize the minority.
If two people gang up on a third, beat him, and take his property, that is understood as criminal. When two hundred million people do the same, through their Congressional representatives, to one hundred million people, the increase in the numbers doesn't sanctify the crime. Is this what the judiciary should give deference to?
Hitler was elected, and he certainly embodied the will of the German majority. Should the German judiciary have shown deference to Hitler's orders?
The Supreme Court's members are not elected and they serve for life. This set-up is designed to insulate them from the passions of the mob. The Justices are the defenders of the minority against "The Will of the People." And, as Ayn Rand observed, "the smallest minority on earth is the individual." The Supreme Court is charged with protecting your rights from the power-grabs of Congress.
When courts give deference to the legislature, it is your rights that aren't being protected. It is you they are making kneel in submission.
Harry Binswanger is an Objectivist philosopher, and was a close associate of Ayn Rand. He blogs at www.hbletter.com.


Allison Childs Wells is Senior Director of Public Affairs at the Natural Resources Council of Maine. She is a widely published natural history writer and contributor of many bird family accounts to Scholastic's New Book of Knowledge. She is coauthor with Jeffrey V. Wells ofMaine's Favorite Birds and Birds of Sapsucker Woods.


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Josh Gasser Crucial To Wisconsin's Success
After spending all of last year injured, Josh Gasser has provided offensive stability to the undefeated Wisconsin Badgers. How can his presence help the Badgers make a tournament run?
By Kevin Dlugos Jan 7, 2014, 3:00pm CST
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Geoff Burke-USA TODAY Sports
When Josh Gasser tore his ACL last season, it was unclear how badly it would effect the Badgers' backcourt. After a rough start to the season, Traevon Jackson emerged as a legitimate point guard and a level-headed leader of the Wisconsin offense. This season, Gasser triumphantly returned from injury, and found himself in a remarkably deep Wisconsin backcourt. While Gasser won't light up the stat sheet, his calming offensive presence gives Wisconsin the best chance they've had in a while to make a tournament run.
Gasser's first two years in Madison were wildly successful. In his freshman year, he started 30 games and averaged 28.1 minutes a game. If that doesn't seem significant to you, consider this: in Sam Dekker's freshman year, he started 3 games. And Dekker was a 5-star recruit! The 13th best player in the country! If you're a freshman, you have to earn a starting job in Bo Ryan's system. Gasser did just that, and played with the maturity of an upperclassman. He was second on the team with an assist-to-turnover ratio of 2.5, and only turned the ball over 13 times in all of conference play. While his 5.9 points per game don't jump out at you, the computers loved his offensive contributions. As a freshman, he was 28th in the country in offensive rating, coming in at 124.6. This means that the Wisconsin offense ran much more efficiently when Gasser was on the floor. But that doesn't mean Gasser was afraid to knock down the big shot. He made sure we all knew he was clutch with his buzzer-beater over Michigan.
Wisconsin's Josh Gasser tops Michigan basketball team with a buzzer-beater (via iDetroitOnline)
The one constant in Josh Gasser's game throughout the years is his knowledge of when to shoot the ball. This became extra clear in his sophomore year, and is still clear today. In 2011-12, Gasser played 84.6% of the team's minutes. In that time (34.1 minutes a game), he put up a True Shooting Percentage of 62.4%, good for 68th in the country. What's amazing is that he was used in only 12.9% of possessions, and took only 11.4% of the team's shots. There aren't a lot of guys in the country who are so effective in such small doses. In fact, one of KenPom's closest comparisons to Gasser that year is Wisconsin guard Jason Bohannon from 2008. Both were used in limited roles, but were reliable offensive threats when the opportunity came. Last season, Wisconsin lacked that type of offensive awareness, and it hurt them in the long run.
But this season, all is right in the world. Josh Gasser is back, and Wisconsin is 15-0. The best thing? Gasser hasn't changed a bit offensively. His offensive rating is again through the roof, at 129.3, and he's doing it in short, yet effective bursts. Gasser is a part of 13.3% of the team's possessions, and takes 11.6% of the shots this year. But as expected, he's got a sky-high True Shooting Percentage of 64.5%.
So far, his most valuable contribution to the 2013-14 Badgers has been allowing Bo Ryan to rest Traevon Jackson without bringing the offense to a halt. As Wisconsin fans know, Jackson can occasionally get a little wild with the ball. In his first full year as a point guard last season, Jackson did an admirable job, but still had a turnover rate of 25.2%. That's because Bo Ryan didn't have any other options; he had to let Trae figure it out on the court. This year, Jackson's turnover rate has gone down significantly to 19.0%, and Gasser's presence has played a major role in Jackson's development.
This was most evident in Wisconsin's win over Iowa on Sunday. Jackson struggled the whole game, logging 7 turnovers and making consistently poor decisions. Because of this, Bo Ryan let Gasser run the point for stretches in the second half. That's not Gasser's natural position, and by no means is Gasser athletically able to play point guard for long stretches, but Bo knew his sharp decision making would help calm the offense down. He did just that. Gasser only turned the ball over once against Iowa, and played a major role in the second half comeback. Gasser also came up huge from the foul line, hitting 6-7, including 4 from intentional fouls as the seconds dwindled away. Last season, without Gasser, I think Wisconsin loses that game. Gasser's offensive poise kept the team's winning streak alive.
When the dog days of conference play come, Wisconsin will be tested each night, with games similar to the victory over Iowa. These games will only get harder in the NCAA Tournament. As long as Josh Gasser is in the lineup, Wisconsin's offense will run smoothly. This team is built to make a deep run in March, and will do so on the back of Josh Gasser.

redpajama_set_name: RedPajamaCommonCrawl


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Walter Bethke, Editor in Chief
Published 26 April 2019
The Questionable Cataract: Who Decides?
Surgeons share tips to help you navigate the sometimes murky waters of preop evaluations.
Surgeons say that the success of modern cataract surgery, both with premium lenses and high-quality monofocal IOLs, can push some patients to visit their ophthalmologist to try to get cataract surgery—medically justified or not—in an effort to "get what my neighbor got." Some of these patients are even savvy enough to work the system by claiming visual difficulties.
To avoid committing insurance fraud and exposing these individuals to unnecessary risks, surgeons say there are certain measures you can take. They're quick to add, however, that just because a patient's attempt at insurance- or Medicare-paid surgery is rebuffed doesn't mean he won't want to spring for it himself in the form of refractive lens-based procedure, and they offer further advice on making sure the right patient gets the right procedure—or none at all.
"I Think I Have a Cataract"
Boulder, Colorado, ophthalmologist Mark Packer says that though malingering in most of medicine is usually done to qualify for some sort of disability payment, it can take on a new form in ophthalmology.
"There aren't a lot of examples in other fields where someone is malingering in order to get an operation, other than Munchausen's syndrome," he says. "But in ophthalmology, I've definitely seen this. I guess it arose even before the Medicare ruling in 2005 regarding presbyopic IOLs. Before that, patients were aware that their friends went to see the ophthalmologist for cataract surgery, and that they used to wear bifocals but now they don't. This would lead them to my office, saying something to the effect, 'I don't have cataracts but I want that.' But then they find out it will cost $10,000 because they don't have cataracts. 'But my neighbor didn't pay anything—the insurance paid for it!' You reply that that's because the neighbor had cataracts. 'So,' he thinks, 'what does it take to have a cataract? Maybe I can find one.'"
It turns out, however, that if a patient really wants to say he has poor vision, this can be difficult to disprove just by using visual acuity charts. "They can see the size of the letters," Dr. Packer says. "They might know what 20/40 looks like or, if you're using an older chart, it might say '20/40' right on the chart. While today we have randomized, digital charts that no one can memorize, if someone's motivated to lie to get the surgery paid for by Medicare or insurance, it can still be hard to prove that someone is malingering, just by using visual acuity."
At this point, if you simply don't believe what a patient is saying for some reason, it would be easy enough to smack the patient down as dissembling and refuse to do the surgery. However, surgeons say the effect of this is to alienate a member of your community, as well as all of that person's family members and friends. "It's helpful to have some other workarounds that maybe patients aren't as familiar with, but which can provide evidence that they're not really a candidate for medically-reimbursed cataract surgery," Dr. Packer says. "I've got a few of those up my sleeve."
Scheimpflug imaging can provide an objective grading of a cataract that can help in borderline cases, surgeons say.
Since physicians say visual acuity can be "squishy" and easy to manipulate, one of the first ways to weed out a less-than-truthful patient is with the VF-14 visual function questionnaire. "It has such questions as, 'Do you drive?' and 'If you drive, is it difficult?'" says Dr. Packer. "A patient doesn't know what the score on that is supposed to be, or what a realistic score would be for someone with the degree of visual disability that he's claiming to have—but I do. So, if the vision is 20/50, for instance, in general that correlates with a VF-14 in the range of 60 to 75. If it's better than that, such as an 88, then there's no reason to have cataract surgery, because that's the average score for individuals who've had the surgery. In that case, there'd be no room for improvement."
Contrast sensitivity is another test about which patients have little understanding, so they can't easily manipulate its results. "They don't know how it's graded, what a result is supposed to look like or anything else about it," avers Dr. Packer. "They don't know how hard to try on it or how poorly they're supposed to do on it, yet they can't say 'I don't see anything,' because that's not plausible. It's a subjective test, however, so a very sophisticated patient might be able to fake it, but most aren't that sophisticated and won't know how; they'll get a score that's either too good or too bad. Then, they're caught. This is the general method for spotting a malingerer: Give him a test where a certain response would be physiologically impossible."
Surgeons say that the advent of certain instruments, such as the Pentacam, allows them to objectively evaluate a cataract's density, which can help in cases such as this. "We do tests like the iTrace or HD Analyzer to look at the quality of the optical system," says Jeffersonville, Indiana, surgeon Asim Piracha. "We use these to see if we can objectively confirm their complaints and say, 'Yes, your vision is poor.' If, however, these tests show a perfect optical system, I wouldn't recommend surgery, because I don't think the surgery would help them. We then get into why they're not seeing well. Is it amblyopia? A retinal issue? An optic nerve problem? Often, we do a Pentacam exam and end up doing more testing than we'd normally do; we perform topography and an OCT of the optic nerve and retina to make sure it's not something I'm missing on exam. If there aren't any findings, however, they can complain but I can't do cataract surgery because I'm not seeing any findings on exam that would justify it."
Determining that a patient is feigning worse vision is only half the battle, however. The final challenge is informing him that you're not going to perform surgery in such a way that you don't incite anger or resentment. "When you return to the exam room with the patient, and have such things as his questionnaire, contrast sensitivity and the objective measurement of the cataract's densitometry," says Dr. Packer, "you can say, 'Look, even though your visual acuity is in line with Medicare or your insurance carrier's definition of a cataract, based on this additional testing you're functioning pretty well. I don't believe that cataract surgery's benefits will outweigh the risks for you. Please come back and see me in a year." He says framing it in this way gives you an argument to fall back on, rather than just pointing your finger at him and saying that he's faking it.
Dr. Piracha says he's seen patients seeking cataract surgery not because of malingering, but because of the effects of past corneal refractive surgery. "Some older patients come in and think, 'I can't see well, it must be a cataract,' " he says. "When I perform iTrace on these patients such as, for example, the post-RK patient who's now hyperopic—+4 D and seeing maybe 20/30 best-corrected—and it shows the cornea isn't right but the lens is pretty good, I tell them that cataract surgery probably won't improve their quality of vision, it'll just help reduce the hyperopia. Also, with the post-RK eye, cataract surgery's not as predictable. I get patients referred in also, such as post-LASIK and post-RK, and they say they want cataract surgery. This testing helps me tell them that I don't see a value in cataract surgery for them, since it's not going to address their irregular astigmatism. If you perform cataract surgery on these patients, they can be difficult to deal with postop, because they expected cataract surgery to fix them but they still won't see well."
For surgeons who don't have an iTrace, Dr. Piracha says the time-honored RGP over-refraction will tell you if the irregular vision is from the cornea or not. "If it's an RK patient, or a patient with ectasia, and you do the RGP over-refraction and they go from 20/40 to 20/20," Dr. Piracha says, "you know the problem is the cornea. If we do it, however, and they're still 20/40, then we know the problem isn't the cornea, because the RGP covers up the irregular astigmatism."
When the Talk Turns Elective
Surgeons say that a few of these patients who are exaggerating their poor vision will actually be open to having an elective lens procedure when they're eventually told that an insurance-paid cataract surgery isn't advisable. Though this development may cause the surgeon to heave a sigh of relief—the patient isn't going away mad and possibly embarrassed—experts remind that just because the patient is ready and willing to pay for the procedure doesn't automatically mean that it should happen.
"We have to consider a few major things," says Arturo Chayet, MD, of Tijuana, Mexico's, Codet Vision Institute. "The first is the refractive error. In other words, myopes vs. hyperopes. There's very strong data from the past 20 years that's made it well-known that if a patient has an axial length of over 25 mm, and undergoes uneventful cat-aract surgery or refractive lens exchange, he's in the highest incidence group for retinal detachment.
Legal Lookouts
Denver, Colorado, attorney C. Gregory Tiemeier has represented ophthalmologists in a number of malpractice cases, from lasers to lenses. Here are his tips for covering yourself, whichever way the surgical discussion goes.
• Get it in writing. Mr. Tiemeier says if you go ahead with an insurance-covered procedure in which you have some objective proof of a cataract—it doesn't need to be 3+—but the main complaints are subjective, make sure to have a record of it. "If you're going to perform the procedure and want to cover yourself, make sure the patient signs something to the effect of, 'I have problems with reading, low-light vision, driving at night, driving during the day, etc.,' " he says. "Though brightness acuity testing can be a gamble, the critical question is how it's affecting the patient subjectively, though some objective findings need to be there. If you don't want to perform the surgery, such as a case where you've done BAT and you think the patient is faking it, make a note to the effect that the patient's subjective complaints and the BAT aren't consistent with the degree of cataract that's observed objectively."
• RLE is less common. "If you're going to perform an elective clear lens extraction on someone and he doesn't have a cataract, be aware that you're increasing your risk slightly in terms of legal exposure," Mr. Tiemeier says. "When compared to more 'mainstream' procedures like PRK and LASIK, this is less common. This is important to note because there are conservative doctors out there who won't remove a lens unless it has a cataract. Postoperatively,
the patient could go to one of these doctors and the doctor will say, "I can't believe they did a clear lens extraction on you."
• Focus on the informed consent. Mr. Tiemeier says that any time a patient is paying out of pocket for a procedure, the patient's expectations go up dramatically. "You need to adjust your informed consent process accordingly," he warns. "I know most doctors tend to view informed consent as a kind of 'necessary evil,' but I remind them that if the patient is unhappy for some reason and you get sued, it's going to take more time to deal with that lawsuit than the five minutes it would have taken to sit down with the patient and explain that this surgery is different from LASIK or PRK; you're going inside the eye, so the risks go up, especially the risk of endophthalmitis. You also have to have something in the document that says, 'You may need to wear glasses after the surgery.' " Though Mr. Tiemeier hasn't been involved with any CLE lawsuits, he has had suits involving multifocal IOLs. Based on that experience, he says surgeons should also advise patients in the informed consent for multifocal lenses that it might take up to six months to adjust to the multifocality effects.
• Check your malpractice coverage. This could be a hidden trap. "Though I'm not aware of any insurance companies that exclude clear lens extraction," Mr. Tiemeier says, "it would probably be a good idea to make sure that it's not excluded from your malpractice coverage before you do it."
— WB
"And, there's the knowledge that high myopes are also at a higher risk for spontaneous bag dislocation 10 years after IOL implantation," Dr. Chayet continues. "So these two issues, in my opinion, are definite exclusion criteria for RLE in high myopes."
If a patient isn't a candidate, Los Angeles ophthalmologist Sam Masket says the best thing is to be upfront and honest about it. "I always say that if it's good for the patient, it's good for the doctor—and the industry," Dr. Masket says. "The patient's interests must always be front and center."
Dr. Chayet says that the patient's age also plays a large role—especially which side of age 60 they're on. "I've found that there's a big difference between someone younger than 60, and someone older," he says. "The crystalline lens becomes very dysfunctional after age 60. In my practice, most of the patients who request RLE start doing so at about age 52, right around the time they began wearing progressive lenses or using bifocals." Dr. Chayet isn't saying everyone should universally accept "dysfunctional lens syndrome" as a diagnostic term, but he is saying he thinks presbyopia is a precursor to cataracts. "I personally don't do RLE on someone who's younger than 60 and has 20/30 or better distance vision," Dr. Chayet says. "I've found that the expectations of those patients are very high, and their satisfaction rate after RLE isn't that good. Most of the very unsatisfied patients I've seen after RLE are these patients. Surgeons who perform RLE on them are pushing the envelope.
"Now, if the patient is older than 60, his distance vision is 20/40 or worse and the axial length is shorter than
25 mm, then I think the RLE conversation becomes more appropriate," Dr. Chayet continues. "At that point, you have to explain to the patient what to expect and the side effects of our current IOLs, even if you go with monovision with monofocal IOLs. If the patient accepts the possibility of these side effects, then I feel comfortable doing the procedure."
Dr. Chayet says categorizing patients based on their vision also helps ensure a positive outcome. "If the distance vision is good, I wouldn't recommend doing any RLE," he says. "On the other hand, if the patient is +4 D with 20/200 uncorrected distance vision with an anterior chamber depth of 2 mm or less, I think that patient might benefit from surgery. That's because not only will he be able to see well, but the surgery will increase the depth of the anterior chamber, and will increase the angle, which will reduce the risk of glaucoma in the future. These types of patients, however, are the least frequently encountered ones seeking RLE these days." He says the only refractive procedure he'd perform on a high myope would be a phakic intraocular lens in the form of the Visian ICL. "Even if I know cataract is a risk for them," he says, "I'd rather implant an ICL [than perform RLE.]"
There are also the patients who aren't malingering, but have visual issues that don't reach the level of an insurance-covered cataract. Dr. Piracha offers as an example the patient who has a best-corrected vision of 20/25 or 20/30, and inquires about a refractive option. "This happens a good bit," he says. "We rule out all the causes for decreased night vision, all the issues associated with glare and halo, and examine the ocular surface and topography to make sure nothing else is going on, and if they say they'd like to have refractive surgery, we'll discuss it with them. If they don't meet the definition of cataract per insurance—which here in Indiana is 20/50 or worse with either best-corrected vision testing or testing with glare—we tell them, 'You have a mild cataract that doesn't meet the official criteria yet, so you have two choices: Do an elective surgery now in order to get better vision without glasses, as well as improve your visual quality, or wait until you meet the criteria for insurance coverage, in which case we can see you back here in a year for another evaluation.' I inform them that if they decide to wait, insurance will cover part of the procedure, but not the refractive-cataract surgery part—i.e., if they have astigmatism or want to see both near and far, then they'll still need to pay for the laser AK, or a toric or multifocal lens." He then follows this with a discussion of the risks outlined by Dr. Chayet, especially with regard to high myopes.
In the end, if a patient is trying to get surgery paid for but doesn't really have a cataract, Dr. Packer says it often comes down to your estimate of his character, "as much as you can do that in the three minutes that you're with him in the exam room," he says. "Ask yourself, 'Is this someone who's primary motivation is refractive but he's trying to frame it as a medical procedure?' That's the main distinction." REVIEW
Dr. Piracha has spoken for iTrace in the past. The other surgeons have no financial interest in the products they discuss.
Managing Surgical Complications
Combined Procedures: Know Your Options
Point/Counterpoint: Intracameral Vancomycin and Cataract Surgery
Phaco: New Tech, New Techniques
Stop the Sneeze to Fight the Haze


This time of year you might notice some flies repeatedly shaking their legs. A closer look will show a tiny, pale brown thing attached to the leg. This is actually one of our native pseudoscorpion Thalassochernes tairiensis. What is is doing is hitching a ride on the fly. This is a habit known as phoresy. It's a way for the animal to get a ride somewhere else. For minute animals unable to cover a lot of ground, phoresy is quite handy.
Pseudoscorpions are an order of arachnids that are widely distributed. As an order, they are on par with spiders or scorpions or harvestmen. Despite being even more widely distributed than scorpions, most people are not aware of them. The reason is simple. These arachnids are tiny and cryptic. They dislike the light and move away from it. They're usually very small. Most are much less than 2mm long.
They have a number of appealing traits however. The female feeds nymphs a nourishing liquid. They also have small silk glands, which in some families are used to make little domes to protect the female and her nymphs. Despite their pincers and segmented body, they're not a descendant of scorpions. Their poison apparatus is on a tiny tooth, on one of the fingers of their claw. It's pretty lethal if you're a mm long and have 6 legs.
To get these pics I waited for the pseudoscorpion to detach herself. To boost the magnification (the arachnid here is about 2mm long) I attached a 24x Raynox microscope adapter. Then my macro flash (the two small heads of this are much easier to work up close than a ringflash) was attached to boost the shutter speed. I had hoped I could get some shots hand-holding the camera but this was impossible. The depth-of-field was critically narrow and for a moving subject, impossible. So it was then on to the tripod (and thankfully, the geared head).
Even with the 24x magnifier I still couldn't see the edge of the carapace so a bit of guesswork was involved. At least with the arachnid being blind, I didn't have to worry about getting the eyes in focus. They have a number of long, sensitive seta (trichobothria) on their claws that are used to locate prey.
Bear in mind with these pics, almost all the detail shown here is invisible to the naked eye.


Google adsense account can be banned for most of the users but they won't give a specific reason for banned. Most of the adsense users got banned because of they clicked their own ads by mistake. Even when you know that the click is by an accident but google won't know that. They simply banned your account by marking as a spam click. Once your account is banned then there is no ways to get that adsense account. This is a headache for most of the adsense users so that they develop a tools called google publisher toolbar. This toolbar is helpful for users who are all use adsense.
Google Publisher Toolbar is the best ways to defend your adsense account without getting blocked because of the spam clicks made by mistake. It will not let you click your ads because it will close your ads completely with shield. Even when you click your ads you only click that shield only so it will not mark as a spam.
Click on menu – setting – extensions or click here.
In the bottom of the page click get more extensions.
Now type in search bar and type Google Publisher Toolbar.
Click install google publisher toolbar.
Now it will add into your chrome browser in top right corner.
Click that icon and enable it.
It will ask you to sign in to your adsense mail account.
Now open your website or blog.
Click on the publisher icon now turn on the ads protection.
Now you website ads will be protected with green shield.
Clicking your own adsense ads without google publisher toolbar will be marked as a spam. And your account will be banned soon. most of the blogger or website owners main source of income is google adsense. If you maintain your ads properly then you won't get kicked out from the adsense. One of the best thing about this tool is you can see your adsense earning and google analytics by one click.


Hi gues, how i may get active renderer name and version if i use redshift or octane?
But "Render Engine (external renderers pass their plugin ID)".
Where to see the plugin and id mapping and is it possible to get a renderer version?
Hi Waynee, first of all, welcome in plugincafe.
As you figured it out, RDATA_RENDERENGINE store the plugin ID, the usual way to know which render engine is used, is to check this ID.
You can know such ID if you drag and drop the Render parameter into the console.
About render version, we can only offer support for Cinema 4D. And we don't have any idea, how 3rd party renders actually store this kind of data. So please directly contact them.
And finally please make sure to use [ code] [ /code] markdown when you post code on the forum.


Vastavam web: Mohun Bagan stay in hunt for the title as they scored a hard fought 2-1 win over Churchill Brothers in a penultimate round match of the I-League here today.After a barren first half, Bagan scored through Nikhil Kadam (54th minute) and Akram Moghrabi (76th). Churchill Brothers pulled one back through Osagie Moday in the 74th minute in the match played at Tilak Maidan.Churchill Brothers, meanwhile, remained on ninth place with 17 points. They play Minerva Punjab on March 8 in Panchkula in their last match.
Mohun Bagan made two changes from their side that beat Indian Arrows, bringing in Kinshuk Debnath and Gurjinder Kumar in place of Ricky Lallawmawma and Rana Gharami.Both the side's played a cautious game initially which saw play confined to midfield for most part of the first half. Mohun Bagan tried to make inroads into the Churchill goal but their moves fizzled out as they found defender Monday a tough nut to crack.
Churchill had two clear chances but Jeancy Zunapio Siyo was guilty on both the occasions. First, he first headed over the bar off a cross from Britto and in the dying minute of the first half, he directed the ball wide off the mark off a Frincis pass.Mohun Bagan broke the deadlock after the break in the 54th minute. Aser Pierrick Dipanda Dicka, who missed a clear chance after the break, played a square pass to Nikhil Kadam who unleashed a left-footer that found the far corner of the net.
The visiting side preferred to defend their citadel after taking the lead while Churchill went all out to find the equaliser.The move paid off as Churchill found the equaliser in the 74th when substitute Nicholas Fernandes sent a measured cross into the box for unmarked Monday who tapped in.
Next articleNatural Star Nani increased remuneration to 9 crores?


Jungian psychology expert Gary S. Bobroff (hours 2 & 4) and systems and management consultant Cynthia Cavalli (hours 3 & 4) spoke about the role of synchronicity, and how it relates to such things as consciousness, crop circles, and the work of Carl Jung and Rupert Sheldrake. Jung wrote much about the image of the circle and its symbolism, and Bobroff related the intriguing and mysterious crop circle patterns to Jung's archetypal psychology. Sheldrake's work on crop circles, the extended mind, and synchronicities shows the positive side of the world's mysteries revealing themselves, Bobroff added.
Crop circle messages speak through symbols and art, and are examples of the return of the archetypal feminine-- phenomena grounded in mystery and wonder that we can't quite pin down, Bobroff continued. Cavalli, who has extensively studied synchronicity, defined the experience as when you have an inner event such as a dream, thought, premonition, or image that is matched in outer reality by some event, and there's no causal connection between the two.
One such example of synchronicity was relayed to Cavalli by her therapist friend, who had a client who could never seem to grasp how much trouble his marriage was in. The therapist in exasperation threw up his hands and said 'your marriage is like a car wreck.' And just as he said the words 'car wreck,' there was a car accident right outside the office. It really shook up the client, and the message finally got through, she recounted. Synchronicities seem to occur more frequently to people who are going through major times of change in their lives, Cavalli added. Bobroff shared stories of musical synchronicities such as when he was outside with a group watching a meteor shower, and the song "Pennies From Heaven" came up on a random iPod shuffle. For more, check out videos from the two guests.
First hour guest, privacy expert Lauren Weinstein talked about issues related to technology and the Internet. There's been an increase of "scam support calls" in which callers claim to be computer technicians with well-known companies, he reported. They say they've detected viruses or malware on the person's computer in order to try and control their computer or get them to pay for software they don't need. Weinstein also talked about the launch of Microsoft Windows' new system 10 software, and Google's overhaul of its corporate structure, with its new parent company Alphabet.


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You are in for a treat when you purchase one of Hepzibah's Sweet Shoppe's award-winning truffles! Our beautiful and delicious truffles will not only satisfy but will have you floating in chocolate heaven. We use imported chocolate to craft these gorgeous treats, and we are sure you will love them. Come by Hepzibah's Sweet Shoppe today and try one of our delightful award-winning truffles!


This thesis focuses on the current higher education export issues in Finland and especially on the Finnish Universities of Applied Sciences. The thesis work describes the problems related to degree programs for international students in English after the introducing of tuition fees for education in Finland.
As a case study is chosen Centria UAS, a University of Applied sciences situated in the region of Central Ostrobothnia in Western Finland. Centria is one of the 24 Universities of Applied Sciences in Finland.
The work describes also some features of export of Finnish higher education to Russia and the current position of Centria UAS related to export of higher education to Russia.
The aim of the research is to reveal perspectives of Finnish higher education export to Russia for a Finnish regional higher education institution. Some other aspects of further competitiveness and development of Centria on domestic and international higher education market are considered in thesis.
A general SWOT analyze for Finnish education export gives the picture of strengths, weaknesses, opportunities and threats of this field of export for Finland. There is also a SWOT analyze for Centria UAS.
The research of the empirical part of the thesis was done in Russia among potential students for degree programs conducted in English. The research was conducted in Moscow and Saint-Petersburg during the Study in Finland education fair organized by CIMO Center for International mobility in September 2015.
The research has an observing character, considering needs, interests and possibilities of potential degree students from Russia. The conclusions and the recommendations will serve as help for those who are going to work on educational fairs in Russia.
According to research results, potential students from Russia have much interest in degree programs of HEI in Finland. This shows that Finland definitely has opportunities in exporting higher education to Russia.
Interviews with specialists in education of Centria UAS provided a view on the perspectives of education export for a regional UAS internationally and for Russia.


Click the button below to add the Craps and Roulette Table Felt Layout - 2 Sided to your wish list.
The layout is 72" by 36" and can be easily used on almost any table or playing surface. The layout travels well and is water resistant.
The Craps side of the felt features the traditional Las Vegas-style craps board. The Roulette side of the felt features the traditional red and black roulette board.
Easily folded and stored when not in use, this layout makes a great gift idea for the avid gamer in your life.
CROWN & DICE 14gm Clay Poker Chip Sample Set - 9 Different Chips!
COWBOYS HAND PAINTED COIN CARD COVER - NEW!


text:
Q: Problems with javascript to add Class to Tabs I have problems with buttons in article example "Home" div
i main i add a button in div id "Home" see this:

Home

TEXT

<button class="tablink" onclick="openPage('About', this)">Go to About</button>

TEXT

And i want when user click on that button "Go to About" open page (section) "About"
And problem i see that when user click that button the page was open awesome but the button is not dark gray, i try to add JavaScript when is click that button "Go to About" open page and the section "About" button need to be dark gray but not working for me.
I try this:
<button class="tablink" onclick="openPage('About', this); myscript()">Go to About</button>

Now when User click to that button "Go to About" the button "About" is not black gray.
See full code:

function openPage(pageName, elmnt) {
  document.querySelector('.tablink.selected').classList.remove('selected');
  elmnt.classList.add('selected');

  document.querySelector('.tabcontent.visible').classList.remove('visible');
  document.getElementById(pageName).classList.add('visible');
}
tablink {
  display: inline-block;
  min-width: 128px;
  font-size: 16px;
  padding: 8px;
  color: #6D6E70;
  font-weight: 500;
  text-decoration: none;
  background-color: #F2F2F2;
}

.tablink.selected {
  color: #fff;
  background-color: #6D6E70;
}

.tablink:hover {
  background-color: #777;
  color: #fff;
}

/* Style the tab content (and add height:100% for full page content) */

.tabcontent {
  color: black;
  display: none;
  padding: 100px 20px;
  height: 100%;
}

.tabcontent.visible {
  display: block;
}
<button class="tablink selected" onclick="openPage('Home', this)">1 Button</button>
<button class="tablink" onclick="openPage('News', this)">2 Button</button>
<button class="tablink" onclick="openPage('About', this)">3 Button</button>

Home

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula

eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, pellentesque eu, pretium quis,

sem. Nulla consequat massa quis enim. Donec pede justo, fringilla vel, aliquet nec,

vulputate eget, arcu. In enim justo, rhoncus ut, imperdiet a, venenatis vitae, justo. Nullam dictum felis eu pede mollis pretium. Integer tincidunt.

  <button class="tablink" onclick="openPage('About', this)">Go to About</button>

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula

eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, pellentesque eu, pretium quis,

sem. Nulla consequat massa quis enim. Donec pede justo, fringilla vel, aliquet nec,

vulputate eget, arcu. In enim justo, rhoncus ut, imperdiet a, venenatis vitae, justo. Nullam dictum felis eu pede mollis pretium. Integer tincidunt.

News

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula

eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, pellentesque eu, pretium quis,

sem. Nulla consequat massa quis enim. Donec pede justo, fringilla vel, aliquet nec,

vulputate eget, arcu. In enim justo, rhoncus ut, imperdiet a, venenatis vitae, justo. Nullam dictum felis eu pede mollis pretium. Integer tincidunt.

About

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula

eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, pellentesque eu, pretium quis,

sem. Nulla consequat massa quis enim. Donec pede justo, fringilla vel, aliquet nec,

vulputate eget, arcu. In enim justo, rhoncus ut, imperdiet a, venenatis vitae, justo. Nullam dictum felis eu pede mollis pretium. Integer tincidunt.

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula

eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, pellentesque eu, pretium quis,

vulputate eget, arcu. In enim justo, rhoncus ut, imperdiet a, venenatis vitae, justo. Nullam dictum felis eu pede mollis pretium. Integer tincidunt.

A: Give the buttons IDs. Then use document.getElementById() to provide that button as the second argument to openPage().

function openPage(pageName, elmnt) {
  document.querySelector('.tablink.selected').classList.remove('selected');
  elmnt.classList.add('selected');

  document.querySelector('.tabcontent.visible').classList.remove('visible');
  document.getElementById(pageName).classList.add('visible');
}
tablink {
  display: inline-block;
  min-width: 128px;
  font-size: 16px;
  padding: 8px;
  color: #6D6E70;
  font-weight: 500;
  text-decoration: none;
  background-color: #F2F2F2;
}

.tablink.selected {
  color: #fff;
  background-color: #6D6E70;
}

.tablink:hover {
  background-color: #777;
  color: #fff;
}

/* Style the tab content (and add height:100% for full page content) */

.tabcontent {
  color: black;
  display: none;
  padding: 100px 20px;
  height: 100%;
}

.tabcontent.visible {
  display: block;
}
<button id="homebutton" class="tablink selected" onclick="openPage('Home', this)">1 Button</button>
<button id="newsbutton" class="tablink" onclick="openPage('News', this)">2 Button</button>
<button id="aboutbutton" class="tablink" onclick="openPage('About', this)">3 Button</button>

Home

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula

eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, pellentesque eu, pretium quis,

sem. Nulla consequat massa quis enim. Donec pede justo, fringilla vel, aliquet nec,

vulputate eget, arcu. In enim justo, rhoncus ut, imperdiet a, venenatis vitae, justo. Nullam dictum felis eu pede mollis pretium. Integer tincidunt.

  <button class="tablink" onclick="openPage('About', document.getElementById('aboutbutton'))">Go to About</button>

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula

eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, pellentesque eu, pretium quis,

sem. Nulla consequat massa quis enim. Donec pede justo, fringilla vel, aliquet nec,

vulputate eget, arcu. In enim justo, rhoncus ut, imperdiet a, venenatis vitae, justo. Nullam dictum felis eu pede mollis pretium. Integer tincidunt.

News

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula

eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, pellentesque eu, pretium quis,

sem. Nulla consequat massa quis enim. Donec pede justo, fringilla vel, aliquet nec,

vulputate eget, arcu. In enim justo, rhoncus ut, imperdiet a, venenatis vitae, justo. Nullam dictum felis eu pede mollis pretium. Integer tincidunt.

About

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula

eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, pellentesque eu, pretium quis,

sem. Nulla consequat massa quis enim. Donec pede justo, fringilla vel, aliquet nec,

vulputate eget, arcu. In enim justo, rhoncus ut, imperdiet a, venenatis vitae, justo. Nullam dictum felis eu pede mollis pretium. Integer tincidunt.

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula

eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Donec quam felis, ultricies nec, pellentesque eu, pretium quis,

vulputate eget, arcu. In enim justo, rhoncus ut, imperdiet a, venenatis vitae, justo. Nullam dictum felis eu pede mollis pretium. Integer tincidunt.

redpajama_set_name: RedPajamaStackExchange


text:
Comic Reviews, Comics, Reviews
Marvel Masterworks The Avengers Volume 4 Review
June 10, 2015 dreager1
The Avengers are known as Earth's Mightiest Heroes and considering that the Justice League don't exist in Marvel, I must agree. The Avengers have always been a team of powerhouses who could tackle any threat. That being said, this volume occurs when the team is actually not looking too powerful so they must use their quips and wit to outsmart the foes who stand in their way. It is an interesting concept, but the volume isn't quite up to taking on the average Avenger collection thanks to its high standards. Still makes for a fun read of course.
There were around 10 issues in this collection, which is a reasonable amount. The first few issues deal with the Sons of Serpent organization. While they may appear to be extremely weak on the surface, they are powerful when in great numbers. They manage to capture Captain America so the rest of the Avengers are pressured into supporting the political views of the enemies. It's always intriguing to see politics addressed in comics, but they made sure to not get too involved with those issues. I'm sure that the Avengers won't underestimate the group again after this!
The next two issues featured The Living Laser! This guy was typically an Iron Man villain, but this time he decided to take on the Avengers because of his feelings for the Wasp. Little did he know that Heart, not feelings, wins battles. He was outmatched from the start even though he nearly finished off the Avengers for good. After that was a two part adventure featuring the Ultroids. They weren't exactly Ultron, but these androids were still decently powerful and they could copy the abilities of the foes that they defeated through their technology. They managed to cream the Avengers for a while, but they overestimated themselves, which doomed the villains.
Finally, a three part epic involving the famous Hercules arrived. He was tricked by the Enchantress into attacking the Avengers and then he helped them out against Namor. That was a decently fun trilogy although it is always sad to see the heroes mind controlled so easily. Their strength of will should suffice to keep them safe from danger and harm. Ah well, at least Hercules realized what was up with some help and then stuck around to help the team when they were in a jam. I still consider him to be a watered down Thor who is not quite as impressive physically or mentally, but Hercules is still stronger than the rest of the cast at the moment so that's always a plus.
We start to see why Hank Pym isn't one of the greatest heroes in this collection. While he has some good moments like talking back to Hawkeye and taking charge, he's definitely not very nice to the Wasp. When she's in danger he gets riled up of course, but he basically tells her to leave when she was trying to help him with an experiment. He certainly doesn't have a whole lot of tact and I can see why they drifted apart. The Wasp is a decent character here, but she's still not close to how she was in later years as she can still be a bit of a flirt.
The Scarlet Witch and Quicksilver are good heroes here and they are finally confident in the fact that they are Avengers. They had some iffy moments down the line, but they now know their place on the team. With two of the stronger team members back with the Avengers, they helped to give the heroes some much needed muscle. Hawkeye does a lot of trash talking for the team and he's always got an arrow at the ready. It's scary to think that he's actually one of the tougher members on board, but that's simply what the Avengers had been reduced too in this era. He's always a fun character to have around.
Captain America is the best Avenger so I was sad to see him go. I know that he eventually comes back, but it must have been tough for fans of the team to see the final member of the big three leave. With only the B list heroes on board, The Avengers really needed him to stick around. As far as the villains go, The Living Laser was one of the only ones that I recognized. He looked pretty bad here as he was just attacking people to get the Wasp to like him. He had some good dialogue, but such a petty reason for being a villain definitely ensures that I wouldn't care for him as a villain. That's just very shallow.
Namor was a neat guest star and he looked fairly impressive as he held his own against Hercules. Hercules is certainly stronger of course, but Namor found the Cosmic Cube and that helped him out a lot. I didn't expect to see such a powerful cosmic item come into play either so the final issue really raised the stakes on the adventure. Namor's still antagonistic here, but you can't blame him for being fed up with the humans since they constantly attack his home. So long as Atlantis is under the sea, humans will never leave it alone so it is an endless fight.
The Black Widow has a subplot where she tries to join the Avengers once more, but Giant Man doesn't trust her and she doesn't give the heroes much reason too. She ultimately takes on a mission from S.H.I.E.L.D. which puts a damper on her plans and I guess that her plot will likely continue more in future issues. I don't remember her really appearing in volume 5, but she may have been around briefly. This old version of her was certainly very different from her modern incarnation.
If I had one critique for the collection, it would just be that the stakes are typically very low. It's hard to get very excited about some of the issues and some more well known characters would have been nice to have. The plot in X-Men was more interesting for me and the characters may have actually been slightly better although the writing here beats that of the X-Men's. It's still a fun comic that you will be able to coast through, but you won't be as invested as you typically would be in one of these classic Marvel issues.
As always, the art is quite good for the Avengers collection. The classic designs for the characters are always fun to look at and the fight scenes are engaging. Quicksilver's speed here looks more impressive than it did in other instants and we are finally starting to get to the point where his speed is at in the modern days. He'll never be quite as fast as someone like the Flash, but this is still a nice start. The writing is also quite good as the heroes trade good one liners with the villains. We really don't see dialogue like this anymore, which is too bad. It's one of the reasons why comics were so awesome in the first place after all. The burns were certainly real.
Overall, This was a good collection of the Avengers, but it just wasn't as exciting as it could have been with Captain America missing some issues and Iron Man/Thor not being around. I always miss the big three when they're not together as they are The Avengers for me. I recently reviewed volume 5 so I'm already okay on that front. I've still got another Marvel Masterworks coming up, but after that one, it could be gone for a while. The series has been a fun way to read up on the old series though so I won't be forgetting about it anytime soon. If you're a fan of the classic Marvel stories, this is definitely the comic for you. It's still a solid action title that makes for a good read.
Tagged Ant Man, Captain America, Comic Review, Hank Pym, Hawkeye, Hercules, Marvel, Marvel comics, Quicksilver, Review, Scarlet Witch, Ultroids, Wasp
Published by dreager1
Ultimate Battles is what this site is all about! Always wanted to see a battle? Request it and see who would win!	View all posts by dreager1
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Michael on Ghost Review


11:11, May 6, 2018 in ZAMBETUL ZILEI.
09:40, May 2, 2018 in ZAMBETUL ZILEI.
08:33, April 28, 2018 in ZAMBETUL ZILEI.
08:22, April 26, 2018 in ZAMBETUL ZILEI.
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07:50, April 22, 2018 in ZAMBETUL ZILEI.


Since the day eBay was born, it's been a big hit, and no surprise – not only can you grab a bargain from the comfort of your own sofa, you can also make money out of selling your own belongings.
This original Mickey Mouse lunchbox and thermos flask sold for a whopping $1,326.77 in April 2014. It's an extremely rare 'original' lunchbox with matching thermos pair features Mickey Mouse on the front and Donald Duck on the back. Now whilst this is not as costly as the other items on this list, we liked it and, for a lunch box, it's definitely not cheap…!


Caspari Entertaining Le Jardin De Mysore Cocktail Napkins, Box of 40 - Napkins are made of triple-ply tissue printed with non-toxic, water-soluble dyes biodegradable and compostable. Caspari le jardin de mysore cocktail napkins, box of 40. Each individually folded cocktail napkin measures 5-inch square and opens to 10-inch square, pack comes wrapped in cellophane. Biodegradable and compostable made using environmentally-conscious raw materials. Add beauty to every part of your life with coordinating gift cards, gift wrap/bags and top quality candles from caspari.
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Cholesterol – a problem solved?
November 2017Br J Cardiol 2017;24:136	Leave a comment
Authors: Jaqui Walker
Jaqui Walker
General Practice Nurse and Medical Writer
The 31st HEART UK Annual Medical and Scientific Conference took place at the University of Warwick from 5th – 7th July 2017. This year's conference focused on cholesterol management in the future and reflected the current period of change in health care delivery and expectation. Jaqui Walker reports the meeting's highlights.
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The benefits of child-parent screening for familial hypercholesterolaemia (FH), were explored by Professor David Wald (Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London). Detection rates are highest if FH is screened for in children between one to two years of age – a heel prick test, for example, is quick to carry out at routine immunisation appointments and uptake rates of 84% have been achieved. Screening is effective – a rate of four children and four parents are identified for every 1,000 children screened. The child benefits twice: their own FH is detected and the premature death of their parent is prevented.
This type of population screening is inexpensive when combined with routine immunisation and is helping to achieve the ultimate goal of identifying all or nearly all of those children with FH in the general population.
The signs, symptoms and management of inborn errors of lipoprotein metabolism in children was discussed by Dr Uma Ramaswami (Royal Free London NHS Foundation Trust). She explained how some children present over and over again with symptoms before being diagnosed. A lipid profile for children that present with non-specific abdominal pain to paediatric clinics should be considered. With the exception of heterozygous FH, these conditions are mostly rare, but they can cause significant morbidity and mortality. They require specialist input from paediatric dietitians and clinicians. Several therapies are emerging to treat these conditions and early diagnosis is important.
Professor Steve Humphries (University College London) explored polygenic FH and explained the low-density lipoprotein (LDL) cholesterol single nucleotide polymorphism (SNP) score to delegates. Overall, in FH, a monogenic molecular cause is found in only 35%–47% of patients. SNP scores can be used to help stratify the remaining patients. A score using the top six SNPs appeared to work best.
Once mutation in the LDLR/APOB/PCSK9 gene is ruled out, the most likely cause of the FH phenotype is a polygenic inheritance, and this type of FH would be better called polygenic hypercholesterolaemia. In fact, in subjects in the top three quartiles of a 6-SNP score, there is more than a 95% probability of a polygenic aetiology for their LDL cholesterol being over 4.9 mmol/L. Studies have shown the 6-SNP score discriminates well in European FH patients but data is needed in other ethnic groups. The number of patients that carry an unidentified FH-causing mutation is likely to be a very rare event.
Polygenic patients have been shown to have less severe disease, which means they could be more easily managed in general practice with a statin, for example. The focus of attention in tertiary centres should be on those with a monogenic cause who are more at risk and are likely to require the prescription of novel more expensive agents.
New therapies
Practical advice on the use of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors was shared by Professor Elizabeth Hughes (Sandwell General Hospital, West Bromwich). This new class of drugs are monoclonal antibodies, which have a powerful LDL-cholesterol lowering effect and recent outcome data showing a reduction in cardiovascular events in high-risk patients. The National Institute of Health and Care Excellence (NICE) has approved the use of these agents for high-risk patients including those with FH. With increasing numbers of people now using these drugs for life-long therapy, shared care pathways with primary care are important.
Processes to gain access to these agents vary between CCGs – secondary care may need time to fill out approval paperwork, for example, in addition to arranging education for the patient on how to self- administer the subcutaneous injection and confirming home delivery arrangements. A 12-week assessment of the drug efficacy in individual patients is often required and this needs to be factored into the patient pathway. Side effects are usually mild but should be reported using the yellow card system as these are new treatments. Should side effects occur, switching agents, reducing the dose, or missing one or two doses to identify whether the side effect is associated with the new therapy may help.
Helping patients achieve goals
Dr Tim Chadborn (Public Health England) explored the psychology behind decision-making processes and explained how using this psychology can help plan lifestyle interventions. Dr Chadborn showed the audience some successful examples, such as a social contract that could be signed and witnessed by someone other than the patient could significantly increase the ability of an intervention group sticking to their planned behavioural goals.
Our psychology is such that we feel loss twice as much as we feel gain. This can be applied to the design of interventions to change behaviour. In one study looking at weight loss, those in the intervention group paid $3 into an account each day and this was matched by the researcher resulting in $6 a day. This money was lost if the goal was not achieved. At the end of the study, the intervention group had lost 6.4 kg compared to a weight loss of 1.8 kg in the control group.
Loss aversion can be used to effectively structure financial incentives for goal adherence. Public Health England are developing and evaluating some apps to help behaviour change. Guidance is also available to help commissioners, clinicians and researchers use behavioural insights in the interventions they plan.
Dr Stephen Lawrence (University of Warwick Medical School) discussed the current concern surrounding type 2 diabetes, which is highly prevalent and carries a 75% increased risk of dying from cardiovascular disease (CVD). He identified primary as being well placed to have an impact on this burden of CVD morbidity and mortality. Preventing diabetes occurring in the first place is vital and studies have shown that simple lifestyle changes can reduce the incidence of developing diabetes by up to 50% in those identified with impaired fasting glucose. In those with diabetes, taking a multifactorial interventional approach to controlling blood pressure, cholesterol, and Hba1c, lifestyle changes have been shown to translate into a 53% relative risk reduction in CVD and a 60% reduction in microvascular complications.
This year's Myant Lecture was given by Professor Tom Sanders
A historical overview of the research surrounding our understanding of the role of diet in cholesterol management was the subject of this year's Myant Lecture, given by Professor Tom Sanders (King's College London). He emphasised the importance of decreasing the intake of dietary trans and saturated fatty acids and maintaining a healthy weight. While death rates from CVD have declined substantially, the prevalence of obesity is increasing and having adverse effects on lipid metabolism.
Although, the effects of modification of dietary fat intake on blood cholesterol are modest, much greater effects are seen when the overall diet is changed particularly when a vegan diet is adopted. The Portfolio diet, which is a largely vegetarian diet with added plant sterols, nuts, soya and wholegrains, brings about substantial reduction in LDL-cholesterol but for many people it is difficult to follow. Current UK dietary guidelines have been shown to lower LDL-cholesterol by 10% and also decrease the risk of CVD by mechanisms such as lowering blood pressure.
Professor Jane Ogden (University of Surrey) led the audience through the evidence and reasons for food choice being largely a modifiable psychological factor rather than just a biological one. The scheme in our heads (which develops from our childhood and culture), as well as environmental triggers, act as the key drivers for weight gain and this differs from the current public perception of weight gain being something to do with biological factors, such as genetics, metabolism or gut hormones. Migration data and social network studies show body weight to be contagious. Research in Professor Ogden's own department indicates the way food is presented, with factors such as what the food is called (e.g. snack versus meal), where and how it is eaten, all influencing the total number of calories we consume. Current habits of grabbing and eating food on the go encourage a higher overall consumption.
Professor Gary Frost (Imperial College London) described the "devastating change" in the UK and other wealthy countries on body weight and how this is a massive public health problem with no current solution. Three generations ago, in the 1900s when people were living in an era when malnutrition was rife, they benefitted from the body's adaptive mechanisms that today make it hard to lose weight. For example, the brain has an ability to override a sensation of satiety and enable a person to eat pudding after a big meal. In the past, this ability to eat food to excess when it was available was important for survival.
In looking for solutions, Professor Frost described obesity as a chronic disease requiring structured clinical pathways with options and long-term support to manage it. He recommended the 2015 Scottish Intercollegiate Guideline Network (SIGN) Management of Obesity guidelines for useful pathways. Successful lifestyle interventions show that simple messages with frequent face-to-face contact for support help the most.
Although short-term weight loss is relatively easy, maintaining weight stability after this is more difficult. Managing hunger is an important issue and high protein, low glycaemic index (GI) diets can help. Professor Frost's group are working on developing a functional fibre, which can manipulate anorectic peptides in the colon to reduce appetite, thus helping people use their natural body systems to manage their appetite. It is hoped that this inulin-propionate ester will be added to the food people normally eat, such as smoothies or bread. Although obesity is conceptually simple, it is a complex condition from both a physiological and behavioural point of view. Professor Frost believes government intervention will be required to exert influence over the food chain and to make a difference to the population's health.
Professor Jane Ogden (left) with Dr Hilary Jones
TV personality, Dr Hilary Jones (General Practitioner, Medical Broadcaster and Author) explained that whilst the media can create confusion and distress, with its sensational and conflicting attention-grabbing headlines, it also presents a useful opportunity. Trusted clinicians should get involved and ensure balanced accurate messages are put across to large audiences in an authoritative way with confidence, consensus and perspective. Dr Jones called for more healthcare professionals to get involved with the media to help educate the public. Researchers should be encouraged to work with colleagues to share important news before it breaks. Basic media training, such as handling difficult questions and having concise, pithy, rehearsed, statements for interviews is very useful.
Dr Jones recommends being proactive and using current technology to keep up-to-date with current news stories and the balance of opinion. There are apps that can be used for this and the NHS Choices website provides an unbiased, evidence-based analysis of news stories.
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New test hopes to boost med school recruitment
New series on insights from the Bradford Healthy Hearts project
familial hypercholesterolaemia
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lipoprotein metabolism
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proprotein convertase subtilisin-kexin type 9
proprotein convertase subtilisin-kexin type 9 inhibitors
Myant Lecture
trans and saturated fatty acids
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Anticoagulation: insights from pivotal studies and sub-analyses
Advances in treatment of chronic HFrEF in real world settings
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New research @portsmouthuni suggests that temperature scanners are of limited value in detecting COVID-19 as skin temp is a poor surrogate for deep body values. Differences between eye and finger measures is more reliable says Prof Mike Tipton et al.
https://physoc.onlinelibrary.wiley.com/doi/abs/10.1113/EP089260
We are delighted, Prof Adrian Brady @PAdrianbrady Cons cardiologist, Glasgow Royal Infirmary, past President @BIHSoc_Events is joining BJC editorial board. He brings a wealth of experience in hypertension/lipids and in promoting preventive cardiology @ScotCardio @SHARPScotland
Great information on LVADs.
ImmaR | January 12, 2021
On article Heart failure module 6: surgical management
v interesting overview
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On article Heart failure module 1: background, epidemiology and pathophysiology
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Video: Aladdin star shows love for Egyptians
Mira Maged
Egyptian-Canadian actor Mena Massoud, who played the leading role in the highly anticipated film Aladdin along with Co-stars Will Smith and Naomi Scott, dedicated several videos to greeting the Egyptian people.
Directed by Guy Ritchie, the film is a re-adaptation of the much-loved 1992 animated film Aladdin that is based on the fairytale story. It was remade with special effects and magical, attractive colors, inspiring audience anticipation across the world.
Massoud was selected to star in the Aladdin remake amongst hundreds who auditioned to pinch the role.
The Egyptian-Canadian Aladdin filmed a behind-the-scenes video for his Egyptian fans, showing a band playing authentic Arabic Egyptian music by the legendary Abdel Halim Hafez and Massoud interacting in Arabic as he sang and danced with the crew.
He also filmed another video saying, "Egypt, this one's for you!
"I am excited for you to see the film Aladdin that is produced by Disney. I am proud to be part of this film and I hope you love it as much as I do and you enjoy it as I much as I did filming it," he added.
He also cheered "Tahya Masr" (long live Egypt), showing love and respect for Egypt and the whole Arab community, whom he greeted during the holy month, saying, "Ramadan Kareem" during a press conference in Jordan.
To facilitate an authentic and magical feel for the film, the footage was shot in Jordan's Wadi Rum.
"You could feel the history in the sand," Will Smith, who will play the genie, commented on the sensational shooting journey.
In a previous interview with ET, Massoud described the overwhelming feelings he had when he first met with Smith, who described Massoud as a bold dancer while talking to ET, affirming that they both loved their duo.
Massoud was previously featured in eight movies including What Happens Next, Ordinary Days, Final Exam, Let's Rap and more. He was born in Cairo to Egyptian Coptic Christian parents, then immigrated to Canada. He moved to Los Angeles two years ago.
"LEMME OUT!! Can't wait for y'all to see Me BLUE!" Will Smith said on Instagram, showing his great enthusiasm to introduce the blue genie to the world.
The film hit Jordan's cinemas last week and was released on May 23 in Egyptian cinemas.
Egypt ?? this one's for you! #Aladdin
A post shared by Mena Massoud (@menamassoud) on May 19, 2019 at 1:58pm PDT
Tags "Tahya Masr" Abdel Halim Hafez Aladdin ET Guy Ritchie Mena Massoud Naomi Scott Wadi Rum Will Smith
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Welcome to Opa-locka, a lil bit of Ali Baba in America


Wine Maestro presents "Rose' in the Rose Garden"
3 Suppliers for 3 hours tasting your favorite Spring wines.
Celebrating Mom and Spring with your favorite light wines to carry you both trough summer.
Three Distributors will be on site for this Wine Tasting Event; Andrea Nordin, Fine Wine Trading, Ron Montonera, Tryon Distributing, & Thomas Shook, Freedom Beverage. Come see what they have to offer and make your selections for the season.


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ARE YOU MAKING THE MOST OF THE HYPE AROUND THESE DESIGN TRENDS?
Fall is in full force here in Cincinnati, Ohio, and 2019 is creeping up on the horizon. The past year has brought some innovative design trends to the forefront, and we're reviewing some of our favorites while assessing why these trends are so impactful to consumers.
First up on the docket: Responsive logos.
Given the many ways mobile has revolutionized how consumers access brands, responsive logos have become a must. Implementing differentiations of your logo ensures you're not compromising the identity of your brand, and it's a strategic way to reinforce your brand across different mediums. Think of the different ways you see Nike use their name interchangeably with the iconic Nike swoosh. The reality is, where you put your logo has a lot to do with where you're putting it, so you want to have options for how you can put your best food ahead of you. Maintaining that sense of relevance to your audience should be of high priority, so be sure to condense your logo in an intentional way.
Photo by Joe Harrison; Select examples from "Responsive Logos"
Remember when gradients indicated the "cool" themes on PowerPoint in the mid-2000s? Gradients, or "color transitions", bowed out for awhile, but now they're back and just as popular as they were before. Brands like Instagram have already adopted the once sidelined tactic, and it's trending. We're seeing more and more principles from the flat design space evolving, and gradients are now being utilized as a way to enhance UI design in an engaging way. We're seeing this principle finds its space in the modern world of design—meshing colors of the same palette to create a smooth, rich appearance that aligns with today's aesthetiacs.
The gradient comeback comes with an emerging focus on shadows and depth. Initially used as a tool for establishing visual hierarchy, depth became a way for designers to guide the eye of the viewer in an intuitive yet subtle way. Now, designers are using shadows to create depth in UI design executions. This addition often brings simplicity to the overall feel of the design, and translates as an asset for optimizing usability.
On the note of colors, we're seeing everything from the notoriously coined "millennial pink" to vibrant, electric hues that bring you back to the rock bands of the 80s and 90s. As designers engage more and more with flat design, color plays a critical role in maintaining appeal and engagement. In addition to color variations we're arguably more used to seeing, abstract palettes, geometric designs, and detailed patterns are becoming increasingly normalized. In addition to adding a dose of pizazz to your designs, it also commonly adds a touch of nostalgia.
Flat design isn't the only aspect of the umbrella in the midst of a field day. Movement is redefining the way consumers engage with digital content thanks to new innovations like gifs. A design principle that's largely brought on by UX, these micro-interactions are a ground-breaking way to modify your engagement strategy. In fact, the introduction of this practice has been so paramount that it translates as one of the most popular UX trends to date. These details make ordinary actions and standard CTAs feel more profound, and give users a sense of ownership and accountability for simply utilizing an interface in the way it was designed. We'll likely see more of this in 2019.
Bold typography, authentic lifestyle photography, and highly-curated vintage styling are other trends we're seeing claim their power in the design space. How do you think these trends will evolve moving forward? Which ones will flourish and which will flop? Tell us what you think in the comments below.
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