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GOP senators threaten to block NDAA over COVID-19 vaccine mandate
A Marine with 3rd Battalion, 1st Marines receives a COVID-19 vaccine shot in Kuwait on March 16, 2021. (Lance Cpl. Jacob Yost/Marine Corps)
Nearly half of the Senate Republican caucus is threatening to block the annual defense authorization bill unless Congress agrees to abolish the military's coronavirus vaccine mandate for troops and reinstate all those dismissed under the policy.
"The vaccination mandate has forced our nation's young patriotic men and women to choose between their faith, their medical autonomy and their careers," said Sen. Rand Paul, R-Ky., at a press conference Wednesday afternoon. "At a time when the military is struggling to meet targets for recruitment, the administration is firing soldiers we invested in and trained."
Whether the senators opposing the vaccine mandates have enough numbers to block the authorization bill in the Senate remains unclear. So far, no senior Senate Republican leaders have signed onto the plan. If no Democrats back the effort, the group will need 41 GOP votes to halt consideration of the NDAA.
VA study finds Paxlovid may help prevent long COVID-19 problems
The medication helped reduce the chance of long-term health complications by 25%.
Officials from each of the military services have required all troops to receive a Covid-19 vaccination or risk dismissal from the armed forces, but the courts intervened when religious objectors to the vaccine argued their requests for waivers have not been dealt with fairly. The program has been in limbo since, although new service members must still be vaccinated.
According to the latest data released by the Defense Department, about 3,300 Marines, 1,800 soldiers, 1,800 sailors and 900 airmen have been booted from the ranks for refusing to get vaccinated.
The group of 20 GOP senators is demanding a full chamber vote on their proposal to dump the vaccine mandate, reinstate those dismissed troops and award them back pay. The lawmakers did not have any estimates on how many individuals would return to their jobs and how much the provisions would cost.
"Our recruiting goals are way short," said Sen. Lindsey Graham, R-S.C. ""We need more people in the military, not less. And this mandate is going to result in thousands, tens of thousands of able bodied Americans who are well-trained leaving the military because they chose not to get vaccinated."
The lawmakers involved in the anti-vaccine effort argued that because most troops are young and healthy, the vaccine provides little to no value to their long-term fitness.
Air Force's unvaccinated instructor pilots allowed to resume flying
Defense Department officials have said because of the quick-spreading nature of coronavirus, the vaccine is needed to limit the number of individuals in the Defense Department — both military and civilian — who will face serious health consequences from COVID-19 illnesses.
They have also framed the vaccine requirement as a readiness issue since the rapid spread of the illness could incapacitate a military unit.
More than 98 million cases of COVID-19 infection have been recorded in America since the start of the pandemic in spring 2020. At least 1,075,000 have died from complications related to the virus, according to the Centers for Disease Control and Prevention.
Federal officials have worked in recent months to convince the public that the vaccine is safe and needed to stop the spread of coronavirus. Military officials have also argued that troops are required to receive a host of other vaccines in order to stay in the ranks, and the Covid-19 one should not be treated differently.
But senators opposing the mandate said the military is not considering a host of religious exemptions to the coronavirus vaccines, thereby infringing on troops' personal freedoms.
The national defense authorization bill is seen as a must-pass measure for Congress each year. It sets a host of spending policies and priorities for the military, including the annual military pay raise and a host of new program starts, and has passed annually for more than five decades.
Both Senate and House leaders have said they are close to a final compromise on this year's bill. The House is expected to bring a draft to the full chamber floor next week.
military covidcovid 19rand paullindsey grahammilitary vaccinescovid deathsNDAAFY23NDAA


Geographically, every market is different. Cities and their surrounding areas vary by population, demographics and transportation. Higher education marketers need to consider such differences to optimize marketing campaigns.
An effective geo-targeting approach for one location cannot always be replicated to a second location with equal success. To achieve maximum return on investment, higher education marketing initiatives must be tailored specifically to the market of each campus location. A custom geo-targeting approach can optimize conversions, conversion rate and cost per conversion.
An analysis of eight United States markets reveals patterns of decreasing inquiry volume, conversion volume and conversion rates at increasing distances from campus locations. Markets with relatively large populations, such as Philadelphia and Chicago, tend to have a higher concentration of inquiries and conversions in close proximity to campus locations than smaller markets, such as Columbia, SC, and Birmingham, AL. However, exceptions to these patterns are common. Individual analyses of each market reveal geographic areas to include or exclude for optimal conversion-based results.
Custom geo-targeting strategies help schools enhance conversion performance and optimize marketing spend by eliminating poor converting areas from campaigns. Some schools may be hesitant to reduce a marketing geography in fear of losing any conversions. However, a school that regularly hits caps or can draw from new sources will likely be able to replace volume lost in geo-cuts with better performing inquiries from higher converting areas. If a school is able to compensate for some or most of lost volume when employing strategic geo-targeting, it can not only raise conversion rate and decrease cost per conversion, but increase conversions as well.
Geographic evaluation is a simple way to boost performance in higher education enrollment marketing campaigns. The Marketing Analytics team at DMS uses a cutting edge geographic information system (GIS) to analyze marketing performance and generate custom geo-targeting initiatives. Our ability to leverage the powerful Sparkroom database and its expertise in strategic geographic marketing can help schools surpass enrollment goals and efficiently spend marketing dollars.


Specialized Home Decor and Tabletop Design Components.
At Main Dish, we work with you to create the perfect design presentation in your home that reflects your unique style, taste, and personality.
Receive inspiration for your next home design scheme by visiting our showroom. There you will experience the Main Dish atmosphere, see how our presentation pieces come together, and get expert design tips from our team of artistic professionals.
Seeing is believing - and when it comes to your own home presentation, you need the right inspiration. Check out our online gallery and experience the beauty the Main Dish designers and products can create.


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Discover Abruzzo
Summer mountain
Winter mountain
Active tourism & Wellness
Arts, Faith & Culture
Archaeological Museum - Atri (Te)
The Museum is located in a complex of eighteenth-century buildings and consists of three rooms: the first is a tribute to the figure and work of Ing. Vincenzo Rosati, director of the ancient School of Arts and Crafts of the Orphanage of Atri and houses numerous archaeological finds recovered by the eminent scholar atriano. The second, instead, is dedicated to the Prehistory of the Abruzzo territory. The last room is certainly the most charming thanks to the exhibition of two intact burials dug in the early '900. The outfits, mostly women and children, are dated to the first three quarters of the sixth century and come from 22 burials dug in the necropolis of Atri, Colle della Giustizia and Pretara.
Via dei Musei ATRI
www.comune.atri.te.it
per saperne di più http://www.comune.atri.te.gov.it/pagina2259_museo-archeologico-civico-capitolar…
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Has Shopping Online Rendered the Brick-and-Mortar Store Irrelevant?
Shopping online started out as just an option. It was a nice option to be be able to find that item you'd been searching for for a long time at a decent price. eBay was always a great place for locating that hard-to-find treasure, and Amazon was the place to go to buy books, and now it's the place to go for …. just about everything. But in the years since, has the popularity of shopping online now rendered the brick-and-mortar store irrelevant?
We can look all around us and see the evidence of what has happened to the brick-and-mortar store. Blockbuster seemed to have been dying a slow death and recently finally admitted defeat, closing its remaining locations in the U.S. Best Buy is hanging in there, but probably only because it's in the Tech industry. It also helps that they are partnering with others by offering stores-within-a-store and holding some great deals. But the question remains if this will keep them profitable enough to stay alive as shopping online continues to become the preferred shopping option.
Will Best Buy and other stores be able to stay alive despite the onslaught of shopping online? Or will the likes of eBay, Amazon, and the multitude of other online stores eventually put all brick-and-mortar stores out of business?
While online shopping for electronics seems to offer convenience, I prefer B&M stores because they offer the opportunity to check out the item(s) before purchase. How convenient is it to buy something online, then, when it is delivered, find out it is not exactly what you want/need, or it does not perform as advertised, and then have to return it? The one advantage that online retailers do have is their lower prices (most of the time).
Research online. Go to the stores. Check websites. But what you need from where you think is best. I often buy from B&M stores as they let me get a real feel for the product and ask questions of the people who know about the product without the wait. There is also a better sense of instant gratification when you buy in store, and if you have an emergency and need a replacement part and you need it quickly, there is no beating a B&M store, especially when you know exactly what you need.
Apologies if this seems in any way confusing.
Online shopping is the updated version of catalogue shopping. It's extremely convenient, available 24/7, but the main drawback is delivery time and charges, and for many items, a picture cannot replace the act of actually seeing and touching the product.


Dr. Mahrukh Subhani, MD is an internal medicine specialist in Bloomingdale, IL. She specializes in internal medicine.
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Jeunesse is a proud member of the Direct Selling Association (DSA). The DSA is an organization committed to the highest ethical business standards for the direct selling channel and to the customers their member companies serve every day. Their Code of Ethics is a robust series of policies that every DSA member agrees to follow as condition of membership.
Being a member of the DSA ensures accountability to policies that protect independent salespeople and consumers and encourages the entire marketplace for direct selling to meet these high standards.
Please do not hesitate to contact us if you have any questions regarding the DSA Code of Ethics.
If you feel that Jeunesse, or an Independent Distributor of Jeunesse, has failed to meet these requirements, please send your concerns to [email protected] and you will be contacted shortly by our appointed DSA Code Responsibility Officer.
If you are unsatisfied with the resolution provided, you may file your complaint with the DSA.
Visit the DSA web site to file a code complaint.
No member company or independent salesperson for a member company shall engage in any deceptive, false, unethical or unlawful consumer or recruiting practice. Member companies shall ensure that no statements, promises or testimonials are made that are likely to mislead consumers or prospective independent salespeople.
Member companies and their independent salespeople must comply with all requirements of law. While this Code does not restate all legal obligations, compliance with all pertinent laws by member companies and their independent salespeople is a condition of acceptance by and continuing membership in DSA.
Member companies shall conduct their activities toward other member companies in compliance with this Code and all pertinent laws.
Information provided by member companies and their independent salespeople to prospective or current independent salespeople concerning the opportunity and related rights and obligations shall be accurate and complete. Member companies and their independent salespeople shall not make any factual representation to prospective independent salespeople that cannot be verified or make any promise that cannot be fulfilled. Member companies and their independent salespeople shall not present any selling opportunity to any prospective independent salesperson in a false, deceptive or misleading manner.
Member companies and their independent salespeople shall not induce a person to purchase products or services based upon the representation that a consumer can recover all or part of the purchase price by referring other consumers, if such reductions or recovery are violative of applicable referral sales laws.
Member companies shall provide to their independent salespeople either a written agreement to be signed by both the member company and the independent salesperson, or a written statement containing the essential details of the relationship between the independent salesperson and the member company. Member companies shall inform their independent salespeople of their legal obligations, including their responsibility to handle any applicable licenses, registrations and taxes.
Member companies shall provide their independent salespeople with periodic accounts including, as applicable, sales, purchases, details of earnings, commissions, bonuses, discounts, deliveries, cancellations and other relevant data, in accordance with the member company's arrangement with the independent salesperson. All monies due shall be paid and any withholdings made in a commercially reasonable manner.
Independent salespeople shall respect any lack of commercial experience of consumers. Independent salespeople shall not abuse the trust of individual consumers, or exploit a consumer's age, illness, handicap, lack of understanding or unfamiliarity with a language.
The offer of products or services for sale by member companies and their independent salespeople shall be accurate and truthful as to price, grade, quality, make, value, performance, quantity, currency of model and availability. All product claims made by member companies and their independent salespeople must be substantiated by competent and reliable evidence and must not be misleading. A consumer's order for products and services shall be fulfilled in a timely manner.
Neither member companies nor their independent salespeople shall make misleading comparisons of another company's direct selling opportunity, products or services. Any comparison must be based on facts that can be objectively and adequately substantiated by competent and reliable evidence. Neither member companies nor their independent salespeople shall denigrate any other member company, business, product or service – directly or by implication – in a false or misleading manner and shall not take unfair advantage of the goodwill attached to the trade name and symbol of any company, business, product or service.
Promotional literature, advertisements and mailings shall not contain product descriptions, claims, photos or illustrations that are false, deceptive or misleading. (Promotional literature shall contain the name and address or telephone number of the member company and may include the telephone number of the individual independent salesperson).
Independent salespeople shall offer consumers accurate information regarding: price, credit terms; terms of payment; a cooling-off period, including return policies; terms of guarantee; after-sales service; and delivery dates. Independent salespeople shall give understandable and accurate answers to questions from consumers. To the extent claims are made with respect to products, independent salespeople shall make only those product claims authorized by the member company.
Member companies and their salespeople shall offer a written, clearly stated cooling off period permitting the consumer to withdraw from a purchase order within a minimum of three business days from the date of the purchase transaction and receive a full refund of the purchase price.
Member companies and their independent salespeople offering a right of return, whether or not conditioned upon certain events, shall provide it in writing.
At the beginning of sales presentations independent salespeople shall truthfully and clearly identify themselves, their company, the nature of their company's products or services, and the reason for the solicitation. Contact with the consumer shall be made in a polite manner and during reasonable hours. A demonstration or sales presentation shall stop upon the consumer's request.
Member companies and independent salespeople shall take appropriate steps to safeguard the protection of all private information provided by a consumer, independent salesperson or prospective independent salesperson.
Any member company with a marketing plan that involves selling products directly or indirectly to independent salespeople shall adopt and communicate a policy, in its recruiting literature, sales manual, or contract with an independent salesperson, that the company will repurchase on reasonable commercial terms currently marketable inventory, in the possession of that salesperson and purchased by that salesperson for resale prior to the date of termination of the independent salesperson's business relationship with the company. For purposes of this Code, "reasonable commercial terms" shall include the repurchase of marketable inventory within twelve (12) months from the salesperson's date of purchase at not less than 90 percent of the salesperson's original net cost less appropriate set offs and legal claims, if any. For purposes of this Code, products shall not be considered "currently marketable" if returned for repurchase after the products' commercially reasonable usable or shelf life period has passed; nor shall products be considered "currently marketable" if the company clearly discloses to salespeople prior to purchase that the products are seasonal, discontinued, or special promotion products and are not subject to the repurchase obligation.
Any member company with a marketing plan that requires independent salespeople to purchase company-produced promotional materials, sales aids or kits shall adopt and communicate a policy in its recruiting literature, sales manual or contract with the independent salespeople that the member company will repurchase these items on reasonable commercial terms. Any member company with a marketing plan that provides its independent salespeople with any financial benefit related to the sales of company-produced promotional materials, sales aids or kits shall prominently state and communicate in its recruiting literature, sales manual or contract with the independent salespeople that the member company will repurchase, on reasonable commercial terms, currently marketable company-produced promotional materials, sales aids or kits. A member company shall clearly state in its recruiting literature, sales manual or contract with the independent salespeople if any items not otherwise covered by this Section are ineligible for repurchase by the member company.
The DSA Code Administrator appointed pursuant to Section C.1, upon finding a member company has engaged in false, misleading or deceptive recruiting practices, may employ any appropriate remedy to ensure any complainant shall not incur significant financial loss as a result of such prohibited behavior, including but not limited to requiring such member company to repurchase any and all inventory, promotional materials, sales aids and/or kits which a complainant has purchased.
7a. The purpose of the buyback is to eliminate the potential harm of "inventory loading;" i.e., the practice of loading up salespeople with inventory they are unable or unlikely to be able to sell or use within a reasonable time period. Inventory loading has historically been accomplished by giving sellers financial incentives for sales without regard to ultimate sales to or use by actual consumers. The repurchase provisions of the Code are meant to deter inventory loading and to protect distributors from financial harm that might result from inventory loading.
Changes in marketplace demand, product formulation, or labeling are not sufficient grounds for a claim by the company that a product is no longer "marketable." Nor does the ingestible nature of certain products limit the current marketability of those products. Government regulation that may arguably restrict or limit the ultimate resalability of a product does not limit its "current marketability" for purposes of the Code.
State statutes mandate that certain buyback provisions required by law must be described in an independent salesperson's contract. While acknowledging that the contract is probably the most effective place for such information, the DSA Code allows for placement of the provision in either "its recruiting literature, sales manual or contract." Regardless, the disclosure must be in writing and be clearly stated. Wherever disclosed, the buyback requirement shall be construed as a contractual obligation of the company.
A member company shall not place any unreasonable or procedural impediments in the way of salespeople seeking to sell back products to the member company.
The buyback process should be as efficient as possible and designed to facilitate buyback of products. The buyback provisions apply to all terminating independent salespeople who otherwise qualify for such repurchase, including independent salespeople who are not new to a particular company, or those who have left a company to sell for another company.
The buyback policy should be published in multiple locations and formats, and stated in a manner understood easily by a typical independent salesperson. It should be the goal of each member company to ensure that the typical independent salesperson is aware of the company's buyback policy. Therefore, each member company should undertake its best efforts to ensure the effective communication of the policy.
With respect to the final paragraph of Section 7b., disclosure of an item's eligibility or ineligibility for the buyback is key. Provided that repurchase is not required by this Code provision, for those items a member company chooses not to repurchase, the member company should clearly and conspicuously disclose to the independent salesperson or prospective independent salesperson that the items are not subject to the repurchase requirement. Under such disclosure, a refusal to take an item back will not constitute a violation providing the member is acting in good faith and not attempting to evade the repurchase requirement.
This Code provision is not intended to endorse marketing plans that provide financial benefits to independent salespeople for the sale of company-produced promotional materials, sales aids or kits ("tools"). While these materials can be important to individual sellers, the Code requires that member companies remunerate independent salespeople primarily on the basis of sales of products, including services, purchased by any person for actual use and consumption (See Code Section 6 and accompanying explanatory provision) and not on the sale of tools. In instances when some financial benefit is provided to an individual independent salesperson based on the sale of company-produced promotional materials, sales aids or kits, and is not otherwise in violation of the Code, this Section requires that the tools be repurchased under commercially reasonable terms.
Gross or net income or profits, including but not limited to representations that either explicitly or implicitly suggest that lifestyle purchases – including homes, vehicles, vacations and the like – are related to income earned.
Any award or announcement of compensation describing the earnings of any current or past salesperson. A company's sales incentive awards, trips or meetings, and/or commissions, overrides, bonuses or other compensation, shall not be considered earnings representations unless they are accompanied by express indication of their value.
Earnings representations and sales figures must be truthful, accurate, and presented in a manner that is not false, deceptive or misleading.
Such amounts are before expenses, if any.
Current and prospective independent salespeople must be provided with sufficient information to enable a reasonable evaluation of the opportunity to earn income.
If a specific independent salesperson's commission or bonus payments are included in an earnings representation, any distributions made for those payments to others in the sales organization must be disclosed or deducted from the figure(s) used.
Any sales and earnings representations must be documented and substantiated. Member companies and their independent salespeople must maintain such documentation and substantiation, making it available to the Administrator upon written request.
Industry-wide – including DSA-produced – financial, earnings or performance information cannot be used as the primary source in documenting or substantiating a member company's or independent salesperson's representations. Such information can, however, be used in a general manner.
In assessing whether an earnings representation violates this section of the Code, the Administrator shall consider all relevant facts and information, including but not limited to the factors outlined in this section.
8. There is ample legal precedent in the form of FTC decisions to afford guidance on the subject of earnings representations. While not controlling, these precedents should be used by the Administrator in making determinations as to the substantiation of a member company's earnings claims.
The Code's simple prohibition of misrepresentations was intended, in part, to avoid unduly encumbering start-up member companies that have little or no actual earnings history with their compensation plan or established member companies that are testing or launching new compensation plans. The prohibition approach is meant to require that member companies in these circumstances need only ensure that their promotional literature and public statements clearly indicate that the compensation plan is new and that any charts, illustrations and stated examples of income under the plan are potential in nature and not based upon the actual performance of any individual(s).
A member company shall not require or encourage an independent salesperson to purchase inventory in an amount which unreasonably exceeds that which can be expected to be resold and/or consumed by the independent salesperson within a reasonable period of time.
Member companies shall take clear and reasonable steps to ensure that independent salespeople are consuming, using or reselling the products and services purchased.
It shall be considered an unfair and deceptive recruiting practice for a member company or independent salesperson to require or encourage an independent salesperson to purchase unreasonable amounts of inventory or sales aids. The Administrator may employ any appropriate remedy to ensure any individual salesperson shall not incur significant financial loss as a result of such prohibited behavior.
9. See, Code Explanatory Section 7a. regarding inventory loading.
This provision should be construed in light of the regulatory admonition that commissions be generated by purchases that are not simply incidental to the purchase of the right to participate in the program (see Federal Trade Commission 2004 Advisory Opinion Letter to DSA.) Member companies that implement procedures demonstrating that salespeople are purchasing the product for resale, for their own use/ consumption (i.e., "self-consumption," "personal consumption" or internal consumption") or for other legitimate purposes will be better able to meet the requirements of Section 9. The Code recognizes this as a long-standing and accepted practice in direct selling and does not prohibit compensation based on the purchases of salespeople for personal use.
Member companies shall provide adequate training to enable independent salespeople to operate ethically.
Member companies shall prohibit their independent salespeople from marketing or requiring the purchase by others of any materials that are inconsistent with the member company's policies and procedures.
Member companies shall take diligent, reasonable steps to ensure that promotional or training materials produced by their independent salespeople comply with the provisions of this Code and are not false, misleading or deceptive.
Member companies shall establish, publicize and implement complaint handling procedures to ensure prompt resolution of all complaints.
In the event any consumer shall complain that the independent salesperson offering for sale the products or services of a member company has engaged in any improper course of conduct pertaining to the sales presentation of its goods or services, the member company shall promptly investigate the complaint and shall take such steps as it may find appropriate and necessary under the circumstances to cause the redress of any wrongs that its investigation discloses to have been committed.
Member companies will be considered responsible for Code violations by their independent salespeople where the Administrator finds, after considering all the facts, that a violation of the Code has occurred. For the purposes of this Code, in the interest of fostering consumer protection, member companies shall voluntarily not raise the independent contractor status of salespersons distributing their products or services under its trademark or trade name as a defense against Code violation allegations, provided, however, that such action shall not be construed to be a waiver of the member companies' right to raise such defense under any other circumstance.
Member companies should be diligent in creating awareness among their employees and/or the independent salespeople marketing the member company's products or services about the member company's obligations under the Code. No member company shall in any way attempt to persuade, induce or coerce another company to breach this Code, and an attempt to induce a breach of this Code is considered a violation of the Code.
Independent salespeople are not bound directly by this Code, but as a condition of participation in a member company's distribution system, shall be required by the member company with whom they are affiliated to adhere to rules of conduct meeting the standards of this Code.
This Code is not law but its obligations require a level of ethical behavior from member companies and independent salespeople that is consistent with applicable legal requirements. Failure to comply with this Code does not create any civil law responsibility or liability. When a company leaves the DSA membership, a company is no longer bound by this Code. However, the provisions of this Code remain applicable to events or transactions that occurred during the time a company was a member of DSA.
All member companies are required to publicize the DSA Code of Ethics and the process for filing a Code complaint to their independent salespeople and consumers. At a minimum, member companies must have one of the following: 1. an inclusion on the member company's web site of the DSA Code of Ethics with a step-by-step explanation as to how to file a complaint; or 2. a prominent link from the member company's web site to the DSA Code of Ethics web page, with a separate mention of, or separate link to, the Code complaint filing process; or 3. an inclusion of the member company's Code of Ethics and its complaint process on its website with an explanation of how a complainant may appeal to the Administrator in the event the complainant is not satisfied with the resolution under the member company's Code of Ethics or complaint process, with a reference to the DSA Code of Ethics web page.
All member companies, after submission of their program, are required to state annually, along with paying their dues, that the program remains effective or indicate any change.
2a. The links should be clear and conspicuous. The location of the link on the member company's website should be prominent so as to be accessible and visible to sales people and the consumer; member companies should place the link on a web page that is commonly accessed by salespeople and consumers. Inclusion of statements, such as, "We are proud members of the DSA. To view the Code of Ethics by which we abide please click here," and "To file a complaint, please contact us at [company email and/or phone number]. If you are unsatisfied with the resolution, you may escalate your complaint to the DSA by clicking here," are also ideal. Member companies should specifically link to either www.dsa.org/consumerprotection/Code and www.dsa.org/consumerprotection/filing-a-code-complaint.
The Board of Directors of the DSA shall appoint a Code Administrator ("Administrator") to serve for a fixed term to be set by the Board prior to appointment. The Board shall have the authority to discharge the Administrator for cause only. The Board shall provide sufficient authority to enable the Administrator to properly discharge the responsibilities entrusted to the Administrator under this Code. The Administrator will be responsible directly and solely to the Board.
The Administrator shall be a person of recognized integrity, knowledgeable about the industry, and of a stature that will command respect by the industry and from the public. He or she shall appoint a staff adequate and competent to assist in the discharge of the Administrator's duties. During the term of office, neither the Administrator nor any member of the staff shall be an officer, director, employee, or substantial stockholder in any member of the DSA. The Administrator shall disclose all holdings of stock in any member company prior to appointment and shall also disclose any subsequent purchases of such stock to the Board of Directors. The Administrator shall have the same rights of indemnification as the Directors and Officers have under the bylaws of the DSA.
The Administrator shall establish, publish and implement transparent complaint handling procedures to ensure prompt resolution of all complaints.
The Administrator shall review and determine all charges against member companies, affording those companies an opportunity to be heard fully. The Administrator shall have the power to originate any proceedings and shall at all times have the full cooperation of all member companies.
The Administrator shall have the sole authority to determine whether a violation of the Code has occurred. The Administrator shall answer as promptly as possible all queries relating to the Code and its application, and, when appropriate, may suggest, for consideration by the Board of Directors, Code amendments, or other implementation procedures to make the Code more effective.
If, in the judgment of the Administrator, a complaint is beyond the Administrator's scope of expertise or resources, the Administrator may decline to exercise jurisdiction over the complaint and may recommend to the complainant another forum in which the complaint can be addressed.
The Administrator shall undertake to maintain and improve all relations with better business bureaus and other organizations, both private and public, with a view toward improving the industry's relations with the public and receiving information from such organizations relating to the industry's sales activities.
The Administrator shall conduct a preliminary investigation, making such investigative contacts as are necessary to reach an informed decision as to the alleged Code violation. If the Administrator determines, after the informal investigation, that there is no need for further action or that the Code violation allegation lacks merit, the investigation and administrative action shall terminate and the complaining party shall be so notified.
The Administrator may, at his discretion, remedy an alleged Code violation through informal, oral and written communication with the accused member company.
If the Administrator determines that there are violations of such a nature, scope or frequency that the best interests of consumers, the DSA, and/or the direct selling industry require remedial action, the member company shall be notified. The reasoning and facts that resulted in the decision as well as the nature of the remedy under Section E.1. shall be included in the Administrator's notice. The notice shall also offer the member company an opportunity to consent to the suggested without the necessity of a Section D.4. appeal. If the member company desires to dispose of the matter in this manner, it will within 20 calendar days advise the Administrator, in writing. The letter to the Administrator may state that the member company's willingness to consent does not constitute an admission or belief that the Code has been violated.
If a member company has submitted a request for review pursuant to Section D.2. or an appeal of the Administrator's remedial action pursuant to Section D.3., an Appeals Review Panel consisting of three representatives from active member companies shall be selected by the Executive Committee of DSA's Board of Directors within 20 calendar days. The three member companies shall be selected in a manner that represents a cross-section of the industry. When possible, none of the three shall sell a product that specifically competes with the member company that is seeking the Appeals Review Panel (hereinafter "the Appellant"), and every effort shall be made to avoid conflicts in selecting the Panel. If for any reason, a member of the Panel cannot fulfill his or her duties, the Chairman of the Board of DSA can replace that person with a new appointment. The representatives serving on the Appeals Review Panel shall during their time on the Panel have the same rights of indemnification the Directors and Officers have under the bylaws of the DSA.
A member company must make a request to convene an Appeals Review Panel in writing to the Administrator within 20 calendar days of the Administrator's notice of the member company's failure to comply or the Administrator's recommended remedial action. Within 10 calendar days of receiving such a request, the Administrator shall notify the Chairman of the Board of DSA. The Executive Committee then shall select the three-person Panel as set forth in Section D.4.
As soon as the Panel has been selected, the Administrator shall inform the Appellant of the names of the panelists. Within 14 calendar days of that notification, the Administrator shall send a copy of the Complaint and all relevant documents, including an explanation of the basis of the decision to impose remedial action, to the panelists with copies to the Appellant. Upon receipt of such information, the Appellant shall have 14 calendar days to file with the Panel its reasons for arguing that remedial action should not be imposed along with any additional documents that are relevant. Copies of that information shall be provided to the Administrator, who can provide additional information as the Administrator decides is necessary or useful to the Panel and the Appellant.
Once the information has been received by the panelists from both the Administrator and the Appellant, the Panel will complete its review within 30 calendar days or as soon thereafter as practicable. If the review pertains to whether the Appellant's membership in the DSA should be terminated, the Panel shall decide whether the member company's failure to work with the Administrator justifies suspending or terminating the Appellant's membership in the DSA. If the review pertains to the Administrator's suggested remedial action, the Panel shall decide whether the Administrator's decision to impose remedial action was reasonable under all of the facts and circumstances involved and shall either confirm the Administrator's decision, overrule it, or impose a lesser sanction under Section E. The Panel shall be free to contact the Administrator, the Appellant, and any other persons who may be relevant, in writing as deemed appropriate. A decision by the Panel shall be final and shall be promptly communicated both to the Administrator and the Appellant. The costs involved in the appeal such as costs of photocopying, telephone, fax, and mailing, shall be borne by the Appellant.
Cancellation of orders, return of products purchased, cancellation or termination of the contractual relationship with the independent salesperson or other remedies.


Libya is a country in North Africa and the fourth largest in Africa. To the north, it borders the Mediterranean Sea. In the west, you will find its largest city and capital, Tripoli. Other large cities include Benghazi and Misrata. While the 679,363 square mile (1,759,541 square kilometer) region has a relatively small population, 90 percent of its residents inhabit just ten percent of the land, mostly along the Mediterranean.
Libya acquired its independence in 1951. Formerly a poor nation, it has become one of the continent's wealthiest countries since the discovery of its oil reserves in 1959. Thanks to petroleum sales, the World Bank considers Libya as an "upper middle income economy." For this reason, accommodations and goods can be expensive in this country.
Hotels and hostels are sparse in Libya. Hostels are most likely to be found near tourist attractions such as the ruins of the ancient city Sabratha along the coast. While the country does not attract large crowds of tourists, many individuals visit in order to see the ancient Tripoli region, the Mediterranean, as well as the beautiful architectures of each region.
For the most part, Libya's accommodations are made up of luxury hotels. There are also a few family-run hotels and B&B's which provide a more informal, traditional as well as organic experience of this unique country. The budget-minded traveler should look into staying in a family-owned hotel and sharing a room with fellow tourists. Most of the hotels are located in Tripoli, Al Bayda, Benghazi, Al Khums, Ghadamis, and Sabha.
There are numerous airports, including international options, in Libya. Once you have landed, you can get around via bus or car. There are no railways. Once you find a hostel or hotel to your liking, you easily can take day-trips to sightsee other locations by using buses to get from city to city and taxis to get around towns.
An interesting quality about Libya is the Greek, Italian, and many other influences it has acquired from invasions of ancient as well as modern times. Subsequently, there are traces of these foreign influences to be found in the country's ruins, architecture and foods. For the most well-rounded experience of this exotic locale, be sure to spend a few days in various cities in order to experience all of the different facets of Libya.
Travelers come to see places such as the temple of Zeus, built in the ancient Greek-Roman city of Cyrene, a UNESCO World Heritage Site since 1982, located close to today's city of Shahhat.
Tourists also enjoy another UNESCO World Heritage Site of an ancient Roman city, Leptis Magna in the current city of Al Khums. Here you can see some of the world's most ornate ruins such as The Arch of Septimius Severus.
If you decide to stay in a hostel or hotel in Benghazi, you can admire the Al Manar Royal Palace in the center of the city. This beautiful structure served as the first campus of the University of Libya.
No itinerary within Libya is complete without a stop in the capital. Here you can admire the architectural beauty of Tripoli Cathedral, a Roman Catholic creation turned into a present-day mosque. There is also the extraordinarily beautiful Tripoli Palace, former residence of King Idris. Today, this magnificent building houses the public library. Another point of interest within the city is the Red Castle Museum, or Assaraya Alhamra Museum. Located in the Red Castle Fortress, it presents Libya's past, from prehistoric times to its independence revolution.
Libya is a country of many flavors due to the many invasions from different peoples, as evidenced by the varying architectures. Not only do the buildings reflect the various influences, but also the cuisine combines the varying flavors of the former invaders. Libya's main foods are olives, dates, grains and milk. Dishes include a lot of pastas, proof of the Italian influence. Teas, nuts and pastries make up the desserts. A favorite of the people is Khubs Bitun, a kind of tuna sandwich. Be sure to get a taste of this unique cuisine, either by dining in authentic eateries or by indulging in the home-cooked food in a B&B.
Hi, I'm Jakob Lombardi, the Hostelz.com local expert for Libya hostels. Welcome.


Whether passengers on a sinking ship decide to let women and children escape first depends on the speed at which the ship is sinking, a recent study suggests.
On April 15, 1912, the world learned that the Titanic had sunk on its maiden voyage across the Atlantic Ocean, killing 1,500 people. The ship collided with an iceberg and sank into the ocean's icy depths over the course of 2 hours and 40 minutes in the middle of the night.
In 1915, the Lusitania was torpedoed off the coast of Ireland by a German U-boat, and sank in 18 minutes. The attack killed more than 1,000 civilians, including 128 Americans, and prompted the United States' entry into World War I.
The majority of the survivors of the Titanic disaster "were women, children and people with young children," Thomas H. Maugh II wrote for the Los Angeles Times, compared to the Lusitania, where they were primarily "young men and women who responded immediately to their powerful survival instincts," according to the Associated Press.
The two tragedies offered researchers a valuable "natural experiment," being comparable in the size and demographic makeup of their passenger populations. The main difference between the two disasters was the time it took for each ship to sink. Also notable in the findings were that more passengers from steerage survived the Lusitania's sinking, implying that social class considerations came into effect during the Titanic's evacuation.
In 2009, a behavioral economist said that British men were too polite to fight for spots in lifeboats on the sinking Titanic.
British women who survived the Titanic's sinking testified that their husbands calmly put them on lifeboats and did not fight for their own lives. Researcher David Savage of Queensland University of Technology, who was also part of the recent study of the Lusitania and Titanic, told the BBC that the behavior of British men on the Titanic reflected the Edwardian tenet of behaving like a gentleman.
In contrast, Americans of that time followed a more individualistic code of behavior. Savage found that while Americans were 8.5 percent more likely to survive than passengers from other countries, the British were 7 percent more likely to die. Savage suggests that two factors may have boosted Americans' survival: They were less likely to politely line up for lifeboats, and most of them were in first-class compartments, which were closer to the lifeboat deck. But he admits that he has no evidence that Americans behaved rudely in their effort to leave the Titanic.
Savage, a behavioral economist, made these observations about the Titanic as part of a larger study of human responses to maritime disasters. His theory is that altruism and social conventions, not desire to survive, have the strongest influence on human behavior in crisis situations. Savage witnessed the same behavioral pattern in the January 2009 US Airways plane crash on the Hudson River; women and children were rescued first.


TMG by Magellan Health is recruiting IRIS Consultants in Columbia County, Wisconsin. We will be continuously recruiting candidates who are interested in furthering TMG's role with full self-direction with the IRIS program. We will continue to interview candidates who meet the qualifications that are needed and will develop a pool of candidates and contact candidates when a position is available for hire.
Explore a broad view of the participant's life, including goals, important relationships, connections with the local community, interest in employment, awareness of the Self-Directed Personal Care option, and back-up support plans.
Assist participants in identifying personal outcomes and ensure those outcomes are being met on an ongoing basis, all while staying within the participant's IRIS budget and within the requirements of the IRIS program determined by the Department of Health Services (DHS).
Work collaboratively with other IRIS Consultant Agency staff in order to ensure a successful implementation of participants' plans.
Must possess a valid driver's license and maintain adequate auto insurance for job-related travel to home visits and attending meetings and conferences as requested.


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Tuesday, February 01, 2022, 12:00 PM until 1:00 PM
"The Psychology of Color in Design" by Helen Houston Creamer.
Helen was born and raised in Price, Utah, considered the melting pot of the State. She is proud of her Scottish heritage and the opportunity growing up in a small town, rich in cultural diversity.
Throughout her school years, Helen enjoyed the entire experience. Leadership, sports and scholastic opportunities were presented to her throughout high school and university. These opportunities provided Helen with the early experiences she parlayed into her professional business skills.
Immediately after graduating from Utah State University with a degree in Consumer Studies and a minor in Business Administration, Helen began her successful 27-year career with a multi-billion-dollar oil and gas company headquartered in Salt Lake City. Sales and marketing of natural gas remained Helen's focus throughout her career.
Leadership opportunities resulted in advancement, broader experience and recognition within a mostly male-dominated industry. Helen was the first woman chairperson of the American Gas Association's Residential Marketing Committee. She was inducted into the AGA Residential Hall of Honor and received the Gas Research Institute's Pacesetter Award. From its inception, Helen served as the Managing Director of the Utah Chapter of the Rocky Mountain Gas Association.
Community involvement has and always will be a top priority for Helen. Helen was one of the first women members of the Salt Lake Area Chamber of Commerce Goodwill Ambassadors. She volunteered for the Utah Food Bank, Ronald McDonald House, Salt Lake Library System and March of Dimes.
Helen came to Mesquite on a part-time basis in 1997 and full time in 2004. She became a member of the Mesquite Chamber of Commerce, the Sunrise Rotary Club, the Greater Mesquite Arts Foundation and the Salvation Army Advisory Board where she held the Chairperson position for two years and actively participated in all its programs including the Kettle program and Angel Tree.
Transitioning from a corporate business leader into an interior "redesigner" was easy for Helen. By unleashing her passion for color and textiles, her talent for design, and good deal of business savvy and a willingness to take a risk, she began her solopreneur business in window fashions, fabricating exquisite, one-of-a-kind window treatments for Mesquite residents and businesses. Further educating herself in the industry coming from hours and hours of technical classwork, certifications, trade events and trade networking has taken the businesses products and services to a truly professional level.
The natural flow into color consulting and interior redesign expanded her business over the next 13 years. Helen is now the owner of Staging Spaces and Redesign which encompasses real estate staging and interior redesign.
Helen believes building relationships is the core of her business and is also the major component to the many friends and associates developed since arriving in Mesquite.
Helen's design topics can be read in each issue of the View On Magazine where she has been a contributing writer for 12 years.


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Poetry Makers - Michael J. Rosen
Michael J. Rosen came to my attention with the publication of his book Our Farm: Four Seasons with Five Kids on One Family's Farm. It's not poetry, but considering he's published more than 75 books, I was pretty darned discouraged that it took me so long to find him.
There was poetry in Michael's publishing past, all books for adults, but that changed last year with the publication of The Cuckoo's Haiku: and Other Birding Poems.
Before we read some of Michael's poetry, let's learn a bit about him.
How did you get started writing poetry? What got you hooked on children's poetry?
Michael: If you'll indulge me in a long anecdote, I think I can get at the core impulse.
Several years ago, working as author-in-residence at an all-boys middle school, I finished lunch with the students while a teacher made announcements. He concluded by asking how the students wanted to spend their day between exams and Thanksgiving break. "Let's do something special," he urged, knowing the students would already be focused on vacation. "Want to come dressed as your favorite sports team?" he offered. The room exploded into cheers. Boys around me clapped each other on the back and slapped high-fives, shouting approval, calling the names of teams as though victory were suddenly at hand.
Amid that crowd of pre-teens, some thirty years more mature, accomplished, and confident, I was thinking: I don't have a favorite sports team. I never did—not when I was their age, not in college, not now. I felt a shudder of exclusion and embarrassment as though the teacher had called on me particularly—particularly because I was known to be unprepared. I'll just miss school on Favorite Sports Team Day, I thought to myself with an involuntary, but practiced, rationale.
I was considered popular, funny, smart, and plenty of other consoling adjectives in junior high school, but dread and anxiousness still plagued my adolescence. (Every kid finds some sort of dread and anxiousness, right? How else can adolescence do its job?) In gym class, team sports and cocky, loud-mouthed jocks made me feel marginal and mediocre. On the school grounds, kids we called, at the time, "hoods," tormented me and the other obvious targets, which isn't to suggest I didn't construe it all personally. "Just ignore them," adults would always advise, which really did ameliorate the situation: Instead of feeling like a chicken-shit loser I felt like a slightly more mature and aloof chicken-shit loser.
Indeed, I began to feel a precocious maturity, since most of what preoccupied the boys my age seemed to me ridiculous and crude. (And it was. As was the very expectation to go along with everyone else.) Yet this may be the point from which I began to dream of a world where the things I wanted to do, and could do well, would be the popular and enviable goals and attributes. I couldn't entirely believe in a world that didn't value and feature the traits and qualities that I identified as my own: being Jewish, for instance; being preoccupied with drawing pens and honors biology rather than RBIs and MVPs; being thought of as responsible and caring and empathic. Where was the world—and where were its occupants?—that held what I held dear?
Dreaming of alternatives, of course, is the root of making poetry and fiction. (Blessedly, libraries now brim with books—unlike when I was growing up—that lend commonality and credence to so many more experiences and backgrounds, to the broadest range of family groupings and cultures.) Being, or at least, feeling excluded often provokes introspection and self-consciousness; as well, it often provides an outsider's ability to observe and assess.
All I needed to find was to find a form for such anxious and dreamy thoughts to fill.
What are the things you enjoy most about writing poetry for children/young adults?
Michael: The emphasis and need for form—rhyme and meter—are always welcome challenges. And the chance to create something I would have liked to have read as that kid I still imagine myself to be. I also relish the chance to use humor, which can be a serious way to understand ourselves in the world.
Who/what made you want to write?
Michael: I've had the gifts of working with several mentors in my life. That "being identified" is crucial. Someone to help you see the self that you haven't yet the imagination to see yourself being. In high school, two of my English teachers offered both encouragement and opportunities. And, for almost 40 years, I've shared every inking, every inkling of work that I do with Mimi Chenfeld—by happy coincidence, one of the great early childhood educators in the nation was my neighbor growing up. Likewise, at writers' conferences, I've met colleagues who value the same back-and-forth commiserating that I find indispensable to my own poetry.
Have you had any formal poetry training? If not, how did you learn to write what you do?
Michael: Along with the mentors, the general support of teachers in high school, I took one class in poetry in college (while I was studying pre-med). And I worked at Bread Loaf Writers' Conference three years in a row before abandoning medical school to attend Columbia, where I received my MFA in poetry. But it was really though sharing poems with a few respected and indulgent friends, and through imitating writers I loved, that I came to share my own writing.
Can describe your poetry writing process?
Michael: I've always cherish one of W. H. Auden's definitions of poetry: clear thinking about mixed feelings. Mixed, muddled feelings compose so much of my life—and I surmise, others', too. Art can be clear thinking that returns us to those clouded sensations and emotions in hopes of some better comprehension, some small reparation.
Writing poetry for kids, I often have lighter motives! But the verse is always to cause a thickening of perception, as if to say, Not so fast there! Look again. Look harder…and while you're at it, listen harder, think harder. I'm all for making poetry something very rich. If life is milk, then prose makes a luscious, thick cream of it—or a pudding, maybe, while poetry makes butter…or yogurt…or ice cream! (In other words, it's that further attention and time that creates the unctuousness, the extra tartness, the over-the-top pleasure. I know I'm going to regret that metaphor!)
So the process? When I served as Literary Director at The Thurber House, we brought about 120 great writers to the center for workshops and readings. And I'd say nearly everyone answered that question in a different way. I think the object is to learn what makes writing both difficult and possible for you. Not just difficult. And not just possible. But that friction that makes for the best work.
This is a vague answer since I write in so many different ways, in different genres, for different ages. But in every case, I can say, I begin with something impressionistic or inchoate, and go through a very liberal, inclusive, gathering process that is mining (a term from Ruskin), and then a prolonged period of molding (also from Ruskin) in which form helps me undergo the compression and shaping that creates—it doesn't simply carry—the very subject of the work. It's the process of writing that reveals actual theme or subject matter. Said another way: I don't look to writing to document my thoughts, but to help me conceive of those very cloudy thoughts—to help me present them in a clear, crystalline form.
Do you have a favorite among all the poems/poetry books you have written?
Michael: When kids ask me, "What's your favorite book?" I can only reply, jokingly, "No, what YOUR favorite book of mine? My job is just to write them." Maybe if all I wrote were narrative picture books, I'd have a means of comparing. But considering the range of work I'm drawn to do, I can't chose one favorite among my apples and oranges, my pies and my cakes, and all the rest that's in the cupboards, fridge, pantry…
Would you like to share the details of any new poetry project(s) that you're working on?
Michael: I'm fortunate enough (or that ambitious, self-indulgent, or unfocused) to work on many things at once. Some people write from a passion for a given subject—say, nature, historical figures, or animals—and I do have a passion for some subjects, bug my governing, motivating passion is for writing itself: the pleasure of puzzling and piecing together than is the actual creating of poetry and stories.
At the moment, I'm writing poems about baseball, creatures that co-own the vegetable garden (with me), and odd body parts. How about that for a mixture?
Pop Quiz!
Your favorite dead poet?
Michael: I always love when I'm being introduced to a kindergarten class or an elementary school group by a well-meaning librarian or principal who says something such as, "Guess what boys and girls: Do you know who Michael J. Rosen is? That's right! He's a real, live poet…" I mean, talk about scary? Talk about a minimal qualification: at least I'm not unreal and dead? Yikes! Anyway, considering the fact that the entire canon of literature consists of dead folks, there are a lot of choices. And, to me, there's no comparing what I love about, say, Elizabeth Bishop or Randall Jarrell, with Emily Dickinson or Homer. But just to suggest other dead folks I continue to reread, I'd say Robert Frost, Pablo Neruda, William Meredith, Marianne Moore, James Merrill…. Oh, and then there are those LIVE poets I love…!
Your favorite place to write?
Michael: With a portable computer, the sense of "favorite place" has changed into everywhere. I mean, it used to be that my writing life was anchored to one desk and chair. But now, even though I do spend a great deal of time in my home office/library, I like to write wherever I am. I think of it as a way of grounding myself wherever I am…motel room, friend's house, vacation, outside on the deck.
Favorite quote on writing/poetry?
Michael: Poetry is the one means I have of slowing down the speed of life in hopes of understanding, not life, but my own reaction to it. A poem is my attempt at a prism that reveals the identifying colors of some unknown subject.
Your nominee for the next Children's Poet Laureate?
Michael: Let's see, since we can't name ourselves (LOL), why not the prolifically energetic, irrepressible J. Patrick Lewis?
Why birds and haiku? Here's what Michael had to say to Holly Richards, Zanesville Times Recorder journalist in the article Author opens haiku collection about feathered friends.
"Birding and writing poetry have been a part of my life for decades," he said by e-mail. "When I began writing haiku, rather than other forms that are more familiar, they sort of take over. So many observations suddenly had an opportunity to try to become a poem. My head percolated with alternative versions of poems. Haiku is a way of culling things from the stream of things that rush past the senses."
Looking much like a field journal, this beautifully written and constructed volume introduces readers to more than 20 common American birds. Grouped by season, each bird is afforded a double-page spread with a stunning watercolor illustration to accompany the haiku. Here are my favorite poems, one from each season. (Please note that the poems in the book are not titled. I have highlighted them this way only as a means of organization.)
Spring - American Crow
blooming apple tree
round and white as one peeled fruit
crow-seeds at its core
Summer - Pileated Woodpecker
woodpecker knock-knocks . . .
riddled with the same question
trees yawn, answering
Fall - Black-billed Cuckoo
the cuckoo's haiku
hidden like the chance of rain
its name, repeating
Winter - Dark-eyed Junco
phased like titled moons
half shadow, half reflection
juncos cross the snow
The book concludes with "Notes for Birdwatchers and Haiku Lovers," informational bits about each of the birds identified in the book. Here are the notes for the American Crow.
A roost of crows can number two million individuals. Since they're omnivores (eating most everything), they do no small amount of damage to orchards, fields, and crops--yet they also help farmers by eating destructive beetles and grasshoppers. Among the most clever, inquisitive, adaptive, easily trained, and aggressive birds, crows create complex family units, which may include fifteen family members with young from five different years.
The Cuckoo's Haiku was so well-received that it was nominated for both the 2010 Ohioana Book Award for Best Juvenile Book and the 2009 Cybils award for poetry. To see some of the illustrations and read more about the book, check out the review at Seven Impossible Things Before Breakfast.
I don't know about you, but I'm certainly hoping that Michael has more poetry for young people up his sleeve.
To learn more about Michael, check out these sites.
Michael's web site
Author info at Orange Fraser Press
A hearty thanks to Michael for participating in the Poetry Makers series.
All poems ©Michael J. Rosen. All rights reserved.
Labels: poetry makers
I am not familiar with this prolific poet, but the bird haiku are simply beautiful. Wow.
I want to know if he skipped Sports Team Day! I know that there were some other boys who were thinking, "Oh, no!" in that crowd. I hope he came in something creative.
Bridget R. Wilson 4/23/2010 10:23 AM
Loved "The Cuckoo's Haiku"...I'll be reviewing it on my blog early in May. I look forward to Michael's future collections for children especially the garden critters. I live on a farm so I can relate. :) Thanks for interviewing, Tricia!
Hooray for the hometown boy!
Excuse Me While I Step Out For a Bit
In Praise of Poets
Poetry Makers - X.J. Kennedy
Poetry Friday - A Psalm of Life
Poetry Stretch Results - Eggs
Poetry Potluck, My Grandmother, and Me
What's In YOUR Pocket?
Poetry Makers - Bruce Lansky
Poetry Makers - Kalli Dakos
Poetry Makers - Brod Bagert
Monday Poetry Stretch - Eggs
Nonfiction Monday - Smart-Opedia Junior
Poetry Makers - Jenny Whitehead
Copyright Infringement and a Teachable Moment
Poetry Makers - Carmen Bernier-Grand
Your Chance to Win a Manuscript Critique
Poetry Makers - Hope Anita Smith
Poetry Friday - Tire Swing
Poetry Stretch Results - Shoes
Poetry Makers - April Halprin Wayland
For Earth Day - A Thematic Book List on Trees
Poetry Makers - Ron Koertge
Poetry Makers - Allan Wolf
Poetry Makers - Heidi Mordhorst
Monday Poetry Stretch - Shoes
Poetry Makers - Kathi Appelt
Poetry Makers - Charles R. Smith, Jr.
Poetry Makers - Eileen Spinelli
Poetry Friday - A Mathematical Mash-Up
Poetry Makers -Stephen Swinburne
Poetry Makers - Marjorie Maddox
Poetry Stretch Results - Lipogram
Poetry Makers - Deborah Ruddell
Poems Set to Music - Are They Still Poetry?
Poetry Makers - Juanita Havill
Poetry Makers - David Harrison
Monday Poetry Stretch - Lipogram
Poetry Makers - Kurt Cyrus
Some Things Worth Sharing
Poetry Makers - Patricia Hubbell
Poetry Makers - JonArno Lawson
Poetry Makers - Charles Ghigna (Father Goose)
Poetry Stretch Results - Reverso
Poetry Makers - Nikki Giovanni
Poetry Makers - Alice Schertle
Poetry Makers - Anna Grossnickle Hines
Monday Poetry Stretch - Reverso
Poetry Makers - Sharon Creech
Poetry Makers - Gene Fehler
Poetry Makers - Francisco X. Alarcón
Poetry Makers - Nikki Grimes
Poetry Makers Schedule
Ready to Rock National Poetry Month? YOU BET!
Kicking Off National Poetry Month With the Big Kah...


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Love Island first look teases tension as Ekin-Su dates bombshell
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New arrival Reece is wasting no time in causing some drama.
Patrick Cremona
Published: Thursday, 21st July 2022 at 4:17 pm
It looks like things are going to get tense on tonight's episode of Love Island – with a first look teasing that Ekin-Su Cülcüloğlu will go on a date with new bombshell Reece Ford.
Reece was one of four new arrivals at the villa in last night's episode – along with Jamie Allen, Nathalia Campos and Lacey Edwards – and it appears he's wasting no time in causing a bit of drama.
While Davide Sanclimenti is still busy giving new girl Nathalia a tour of the villa, he seizes his moment to speak to Ekin-Su, telling her: "You intrigue me, that's why I wanted to speak to you first."
And he later chooses to go on a date with her, promoting Deji Adeniyi to declare: "You've got balls, my boy."
Davide, however, doesn't seem too concerned, simply saying: "I am calm and chill... I don't see competition."
But will he still be saying that when Ekin-Su returns from the date? Love Island viewers will have to tune into tonight's episode to find out.
Meanwhile, the other new bombshells will also be going on their first dates in the episode, with Jamie choosing Danica Taylor, Nathalia going for Adam Collard and Lacey picking Deji.
Love Island airs at 9pm nightly on ITV2 and ITV Hub. Episodes are available the following morning on BritBox – you can sign up for a 7-day free trial. If you're looking for more to watch, check out our TV Guide. Visit our Entertainment hub for all the latest news.
The latest issue of Radio Times magazine is on sale now – subscribe now and get the next 12 issues for only £1. For more from the biggest stars in TV, listen to the Radio Times podcast with Jane Garvey.


1) Deconvoluting the α1D-adrenergic receptor (ADRA1D) PDZ-protein macromolecular complex. Tandem-affinity purification/mass spectrometry identified novel PDZ-protein interactors syntrophin and scribble for the ADRA1D in human cells. DMR assays subsequently revealed syntrophin and scribble differentially enhance agonist efficacy. 2) Investigating the importance of PDZ-ligands for GPCR agonist pharmacodynamics. DMR screens were used to assess the importance of PDZ-protein interactions for agonist pharmacodynamics of 24 human GPCRs containing PDZ-ligands in their distal C-termini. DMR agonist concentration response-curves were generated for full length and PDZ-ligand truncated GPCRs expressed in human cells. 3) Structure-function analysis of GPCR structural domains. SNAP-technology revealed the ADRA1D undergoes constitutive N-terminal domain proteolytic cleavage in human cells. DMR assays indicate this N-terminal cleavage event enhances ADRA1D signaling properties. 4) Identification and pharmacological characterization of endogenous adrenergic receptors in human cancer cell lines. DMR assays examining subtype-selective adrenergic receptor drugs revealed previously undetectable adrenergic receptors in SW480 human colon carcinoma cells. Schild plot analysis with adrenergic receptor subtype-selective antagonists permitted pharmacological characterization of functional adrenergic receptors expressed in SW480 cells. DMR data facilitated subsequent examination of adrenergic receptor stimulation on SW480 cell fate. To conclude, label-free DMR technology is a diverse, powerful tool that can be used to study both transfected and endogenous GPCRs in cultured cells; to deconvolute functional modules of GPCR macromolecular complexes; to address the importance of specific structural domains for GPCR function; and can be combined with traditional analytical methods to facilitate pharmacological characterization of ligand-receptor interactions.
Dr. Hague's research focuses on the molecular pharmacology of G protein-coupled receptors (GPCRs). The Hague lab currently focuses on proteomic identification of GPCR macromolecular complexes in human cells, and molecular deconvolution of functional roles of de novo interacting proteins. The long-term goal of the Hague lab is to identify novel GPCR protein-protein interaction interfaces that have the potential to be targeted by novel small molecules to modulate GPCR function. Dr. Hague received his B.Sc from McMaster University (Hamilton, ON, Canada) in Pharmacology, his Ph.D. from Creighton University (Omaha, NE) in Pharmacology, and performed his post-doctoral fellowship in the Department of Pharmacology at Emory University (Atlanta, GA). Dr. Hague has been a faculty member in the Department of Pharmacology at the University of Washington since 2005.


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"x" marks the spot / 2010
"x" marks the spot" seeks to leave the mark of the childhood playground (physically gone) on the memory map (of memories almost gone). In that spot, No.12-14 Teodosie Rudeanu Street, which is now an urban void, was the only factory in Romania that produced watermeters - before 1989. Opened back in 1977, the mechanically-profiled factory named "Precizia" (eng. precision, accuracy) used to fabricate casted parts from non-ferrous materials, equipment for industrial washhouses, machines meant for processing wood, light industry equipment and other devices.
It managed to survive for a few years in the 90s, finally freezing in the financial Balkanic cold.
This was the favorite playground of the kids that grew up near the Town Hall of Bucharest's 1st Sector (right next to the factory). We used to steal carbide from "Precizia" in order to make bombs. We used to perforate coffee cans (Amigo coffee cans), after which we put the carbide in with a burning match. One of the favourite activities of the '90s kids was crafting weapons. We made weapons and fighting devices, inspired from ninja movies and martial arts movies (such as "Mortal Kombat", "Street fighter", Bruce Lee movies, and so on). Cross bows were crafted from branches and metal parts, we stole PVC pipes in order to make dart guns, so that we can hunt pigeons. Instead of darts we used screws of paper with a needle at the tip – and we would sometimes harm each other with these outstanding weapons. Also, we used to play hide and seek back there. The building was fully demolished in 2008. The "X" is the epilogue.
working method: making an "X" using two toilet paper rolls (each of 15 meters)
Daniel Djamo - Before x marked a spot from djamo on Vimeo.
Daniel Djamo - before "x" marked a spot / 2010


Following the IGF awards, the main Game Developers Choice Awards event got underway and it was another good night for CD Projekt as The Witcher 3 picked up Game of the Year.
Her Story managed to scoop two more awards for "Inovation" and "Best Narrative" following wins in the IGF awards earlier in the evening. Individual awards went to Todd Howard, Tracy Fullerton and Markus Perrson for their contributions to the industry. The Audience Award went the Life is Strange.
It can't have been easy top pick winners because there has been so many great games in the past year. Here's all the Game Developers Choice Awards winners, nominees and honourable mentions.


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text:
Helen Sanders
Published 12 October 2016 8 MIN READ
Great Expectations or Pride & Prejudice?
What do treasurers really want from their banks?
by Helen Sanders, Editor
"If you want to go fast, go alone. If you want to go far, go together" (African proverb) quoted Phil John, EMEA Treasury Director for Mars, concluding the corporate panel at Sibos, and encapsulating many of the key themes discussed during the session. The four panellists, Phil John, Tobias Thiessen (The Global Fund), Betsy Clark (Alliance Data) and Shahrul Azman Mohd Moktar (Felda Global Ventures Capital) emphasised the value of long-term partnerships with their banks. However, they expressed a number of frustrations and areas where they recognised the benefits of greater collaboration and standardisation both within banking organisations, across banks and across the wider financial and regulatory community.
Bank-agnostic channels and formats
Connectivity and visibility was the opening theme of the panel. While banks are often keen to promote proprietary systems, this is unhelpful for multi-banked corporations, who are then forced to maintain multiple systems, interfaces, security tokens and user rights. Instead, panellists emphasised the importance of SWIFT as a bank-agnostic channel. However, adoption amongst banks is still patchy, with far fewer banks in regions such as Latin America, Africa and Asia supporting corporate access to SWIFT than international banks. Furthermore, companies cannot necessarily rely on being able to access all branches of these international banks or use all message types, such as trade finance instruments. Onboarding processes can also be complex, costly and inconsistent across banks.


text:
Q: Check value in datatable with Linq I am creating a Word Cloud and so I am splitting my sentences in Linq using Regex and grouping the words and taking the count of them. However, I don't want some blacklist words to appear in my cloud, so I get those words in a datatable (dtBlackList) and check with Linq as shown in the code below
var result = (Regex.Split(StringsForWordCloud, @"\W+")
                   .GroupBy(s => s, StringComparer.InvariantCultureIgnoreCase)
                   .Where(q => q.Key.Trim() != "")
                   .Where(q => (dtBlackList.Select("blacklistword = '" + q.Key.Trim() + "'").Count() == 0))
                   .OrderByDescending(g => g.Count())
                   .Select(p => new { Word = p.Key, Count = p.Count() })
              ).Take(200);

Will this query affect my performance badly? Is this the right way to check against a datatable?

A: A LINQ query as this one will execute a query for each word found with the Regex.Split operation. I'm referring to this line of code:
.Where(q => (dtBlackList.Select("blacklistword = '" + q.Key.Trim() + "'").Count() == 0))

I've had to deal with a lot of performance problems on the project I'm working right now, caused by situations similar to this one.
In general, performing a query to check or complete the data extracted in your database is not a good practice.
In your case, I think it's much better to write a single query that will extract the blacklist words and then exclude that list from the dataset you have just extracted. As follows:
var words = Regex.Split(StringsForWordCloud, @"\W+")
    .GroupBy(s => s, StringComparer.InvariantCultureIgnoreCase)
    .Where(q => q.Key.Trim() != "")
    .OrderByDescending(g => g.Count())
    .Select(p => new { Word = p.Key, Count = p.Count() });

// Now extract all the word in the blacklist
IEnumerable<string> blackList = dtBlackList...

// Now exclude them from the set of words all in once
var result = words.Where(w => !blackList.Contains(w.Word)
    .OrderByDescending(g => g.Count())
    .Take(200);

redpajama_set_name: RedPajamaStackExchange


Turn a small PIC18 micro and an OLED display into a miniature handheld classic game console.
The video game industry is massive, bringing in an estimated $108 billion a year. But have you ever thought of making your own video game? In this DIY Hacking project, we will turn a small PIC18 micro and an OLED display into a miniature handheld classic game console.
How Does the Digital Table Tennis Game Work?
The system has two sides: the hardware side and the software side. The hardware side is incredibly simple, with just a few external components. These ensure that the PIC can run properly and accept user input and power control in the form of a single AMS1117 3.3V regulator. The power supply uses 3.3V, as the OLED is a 3.3V device.
The main loop (void main) is an infinite loop that runs the game and calls all the needed functions in the correct order. First, the loop calls all the important game functions such as player movement and collision detection, then sits in a delay loop. This delay loop prevents the game from running too fast and is a crude way to slow the game down. A better system would take advantage of timers, and on a timer overflow, the game would iterate once. Doing that would free up CPU time to do other tasks. But for now, a delay loop is used.
PlayerMove() is a function that handles all player and CPU-based movements. If the player is pressing one of the direction buttons, it will advance the player in said direction. The CPU simply tries to stay in line with the ball, so if the ball goes too far in any direction, the paddle will move in that direction until the ball is in line with the paddle. Such logic would be unbeatable if the ball's Y speed were equal to the computer's paddle Y speed. So, to get around this, the ball's Y speed has randomness introduced such that the Y speed of the ball can be greater than the Y speed of the CPU's paddle.
CollisionEngine() is a function that handles all the collision-related code to the ball. If the ball hits the top or bottom of the game area, it is simply deflected on the Y axis. If the ball hits one of the paddles, it will be deflected, but the angle and speed of this deflection is completely random. This is to add a level of difficulty to the game and to help remove predictability. The collision engine also restarts the game if the ball hits one of the sides that the player/CPU has to guard. While no point system has been introduced in this game, adding such a feature should be very easy.
The draw_game() function is responsible for displaying the ball and paddles on the screen. Its first job is to clear the screen by writing 0x00 to every block in the display, however, this is not the most efficient method for clearing a screen thats maximum operating frequency is rather limited. A more efficient method for screen clearing is to only clear areas that have been written to, which is very difficult, or store a buffer internally in the PIC of the screen and only stream it out once. However, that would require 1024 bytes of RAM, and with C18 being limited on maximum buffer sizes, such a feat is rather implausible. The next task of the draw game function is to draw the ball and paddles. The last function that draw game completes is the drawing of the lines.
This project can be made using most circuit construction techniques, thanks to the use of all through-hole parts (including the microcontroller). Some of these circuit construction techniques include stripboard, matrix board, veroboard, solderless breadboard, and even DIY PCBs. Unfortunately, the author's CNC machine was broken at the time of this project, so no PCB files were produced. However, considering the simplicity and few components needed to make this project work, the circuit could easily be routed on a single-sided PCB.


With a stay at The Lakes Apartments in Lakes Entrance, you'll be a 3-minute walk from Lakes Entrance Bowls Club and 7 minutes by foot from Cunningham Foot Bridge. The front desk is staffed during limited hours. Free self parking is available onsite.
With a stay at Cottages at Monreale in Sassafras, you'll be within a 10-minute drive of Dandenong Ranges National Park and Puffing Billy Steam Train. Free self parking is available onsite.
When you stay at Motel Margeurita in Queanbeyan, you'll be near the airport and 8 minutes by car from Superkarts Go Karts. Free self parking is available onsite.


text:
Steve Stiles
theheart.org|Medscape Cardiology
Darbe Rotach
Medscape Senior Photo Editor
Patrice Wendling
Senior Journalist
Deborah Brauser
Marlene Busko
Megan Brooks
Weston, Connecticut
John Gress
Freelance Photographer
Jeff Haynes
< More coverage from ACC 2016
Close<< Medscape
Top News From ACC 2016: Slideshow
Steve Stiles; Darbe Rotach; Patrice Wendling; Deborah Brauser; Marlene Busko; Megan Brooks; John Gress; Jeff Haynes | April 28, 2016
Swipe to advance
The windy city of Chicago hosted the American College of Cardiology (ACC) 2016 Scientific Sessions, held April 2 to 4, which featured more than 2400 original research presentations. Population health, with emphasis on lifestyle and prevention, was a theme the college showcased this year.
Among the key studies presented:
HOPE-3: Statins cut CV events in intermediate-CHD-risk patients
GAUSS-3: Evolocumab cuts LDL-C in statin-intolerant patients
Rhythm vs rate control: A toss-up for postoperative AF
Selective valve repair at CABG in moderate ischemic MR
Simple shared decision-making tool helpful in low-risk chest pain patients
Cryoablation on par with radiofrequency ablation in paroxysmal AF
Stem-cell therapy improves clinical outcomes in heart failure
HOPE-3: Statins Lower CV Events in Intermediate-CHD-Risk Patients
Cholesterol-lowering therapy alone and with blood-pressure (BP)–lowering treatment may prevent CV events in patients considered at "intermediate risk" for CHD—but BP lowering alone doesn't do the trick unless BP was high to begin with, hint primary results from the Heart Outcomes Prevention Evaluation-3 (HOPE-3) trial, which included almost 13,000 participants without CVD. "It's interesting that statins are not a new antihypertensive. It very clearly showed that it had no effect on blood pressure—but it stopped the events in the hypertensive people," said ACC president Dr Kim Alan Williams (Rush University Medical Center, Chicago, IL). "To see that half of the benefit was in that group with the statin and half in antihypertensive treatment, that's not something people thought of before," said Williams. "We don't need to give dyslipidemic people an antihypertensive. But we may need to give antihypertensive therapy and statins to those who are hypertensive."
Taking the PCSK9 inhibitor evolocumab (Repatha, Amgen) for 6 months dramatically reduced LDL cholesterol in patients with both uncontrolled LDL-C levels and statin intolerance in the Goal Achievement After Utilizing an Anti-PCSK9 Antibody in Statin Intolerant Subjects 3 (GAUSS-3) trial. "This is important because it means we have established that you can use PCSK9 inhibitors successfully in people with well-documented statin intolerance," said lead investigator Dr Steven E Nissen (Cleveland Clinic, OH). The coauthors of an editorial, published with the study in JAMA to coincide with presentation here, said balancing the symptoms of muscle aches with the proven benefits of statins for reducing CV events "can be a difficult clinical challenge." While several questions remain, someone at high risk for a CV event and intolerable muscle ache even with a low-dose statin "should be considered a candidate for this treatment." However, "less than 1% of all 'statin-intolerant' patients might belong in this group," the editorialists wrote.
Atrial fibrillation developing after heart surgery responds similarly to either rate-control or rhythm-control measures, according to a randomized trial of >500 patients assigned to one or the other strategy in conjunction with CABG, valve surgery, or both. The two groups each experienced an average of about 5 days of hospitalization, including emergency-department visits, during the 60 days after the index surgery, which was the primary end point of the study exploring a common postoperative problem for which there is little consensus on therapy. Rates of persistent AF and of complications were also similar at 60 days. "There's no clear advantage of one treatment strategy over the other in terms of hospital days or complications," said lead author Dr A Marc Gillinov (Cleveland Clinic Foundation, OH). "Most of the time, more than 90% of the time, most of the atrial fibrillation is going to be gone by 60 days no matter what we do." But, he said, "I personally would favor rate control."
For patients with moderate ischemic mitral regurgitation (MR) who are candidates for surgery, adding mitral-valve repair to CABG won't improve survival, cardiac structure, or function, nor will it boost quality-of-life scores over 2 years compared with CABG alone, according to an extended follow-up of 301 such patients that mostly confirms results seen at 1 year. But the results deserved a more nuanced interpretation and support an individualized approach, the investigators said. Strictly speaking, overall in the cohort there was "no meaningful advantage" to the addition of mitral repair, whether in terms of the study's primary end point of change in left ventricular end-systolic volume index, reflecting reverse ventricular remodeling, or in secondary clinical end points. The latter included mortality, major adverse cardiac events, and hospitalization over 2 years, reported Dr Robert E Michler (Montefiore Medical Center–Albert Einstein College of Medicine, New York).
Shared Decision Making in Low-Risk Chest Pain: Safe, Fewer Tests
A single-page shared decision-making tool helps low-risk chest-pain patients who present to the emergency department better understand their health status and options and may reduce the use of stress tests and imaging, possibly cutting costs, all without increasing risk, a study suggests. The four-part decision aid was developed at the Mayo Clinic using patient-friendly language and graphics to educate and facilitate discussion on how heart attack is ruled out, explain stress testing and coronary CT angiography, provide personal risk evaluation, and detail options for follow-up testing. Videotaping revealed use of the Chest Pain Choice (CPC) aid added just 1.3 minutes to the patient encounter, reported study author Dr Erik Hess (Mayo Clinic, Rochester, MN). The Chest Pain Choice Trial was conducted at six emergency departments in five states and involved >900 adults presenting with chest pain and under consideration for further testing who were randomized to treatment using the CPC or standard care.
Cryoablation Matches RF Ablation in Paroxysmal Atrial Fibrillation
Cryoballoon ablation efficacy and safety was on par with radiofrequency catheter (RFC) ablation for the treatment of paroxysmal atrial fibrillation (PAF) in the FIRE and ICE trial. "I think they are great results from a practical point of view, from a physician's point of view, and, in particular, from the patient's point of view, because it will allow more patients to get access to catheter ablation; that's what we really need," said lead author Dr Karl-Heinz Kuck (Asklepios Klinik St Georg, Hamburg, Germany). Altogether, 762 PAF patients were randomized to pulmonary-vein isolation by cryoballoon ablation with phrenic-nerve pacing or RFC ablation with 3D electroanatomical mapping. The primary efficacy end point of time to first recurrence of AF >30 s, atrial flutter, or atrial tachycardia, use of antiarrhythmic drugs, or reablation occurred in 34.6% of the cryoablation group and 35.9% of RFC patients. Kuck is working on the third update to the Heart Rhythm Society consensus statement and said he expects the FIRE and ICE trial to become a part of the new guidelines.
Stem-cell therapy injected into the myocardium significantly reduced clinical cardiac events in patients with ischemic heart failure. At 1 year, patients treated with ixmyelocel-T had a 37% relative reduction in the risk of all-cause mortality, CV-related hospital admissions, and unplanned clinic visits to treat acute decompensated heart failure. But the multicellular therapy had no effect on the secondary end points of LVEF or LV volumes, said Dr Timothy D Henry (Cedars Sinai Heart Institute, Los Angeles, CA). Henry said the greater effect on clinical events than LVEF is actually consistent with other cell-therapy trials. "Ixmyelocel-T appears to be an attractive option for NYHA class 3/4 patients with ischemic heart failure who have exhausted optimal medical and device therapy," he said. Ixmyelocel-T involves extracting bone-marrow cells and expanding them over 2 weeks to increase two key types of mononuclear cells: CD90+ mesenchymal stem cells and CD45+ and CD14+ macrophages, Henry explained.
Very High LDL Seldom Caused by FH Gene Variants
Only a small fraction of those with very high LDL-C levels carry one of the known genes that cause familial hypercholesterolemia (FH), a new study finds. However, for any two individuals with the same LDL level, those with these gene variants have a significantly increased risk for coronary artery disease. Gene sequencing in more than 26,000 individuals with LDL-C 190 mg/dL or higher revealed that only 1.7% had a known FH mutation, a low diagnostic yield. "However, with respect to clinical importance, for any given LDL, we demonstrate largely for the first time, that the risk of coronary disease is substantially higher in those who have an FH mutation, and we think this is likely related to cumulative exposure to LDL," said study presenter Dr Amit V Khera (Massachusetts General Hospital, Boston). From his perspective, "one of the most interesting results" was a substantial increase in coronary risk even at normal LDL-cholesterol levels, less than 130 or the 130–160 range. "So I think this cumulative exposure issue is real, and it's relevant, even at normal levels of observed LDL," Khera said.
Empowered Pharmacists Lower Patients' Cardiac Risk in RxEACH
A community-based pharmacist intervention in Alberta, Canada—where authorized pharmacists can prescribe and adjust medications and doses—reduced the estimated risk for CV events by 21% in 3 months. These benefits were seen in the RxEACH study of 700 high-risk patients who had at least one uncontrolled risk factor (hypertension, hyperglycemia, hyperlipidemia, smoking) and were randomized to usual pharmacist care or a targeted intervention designed to lower CVD risk. "We think [this] represents a new paradigm of community-based cardiovascular risk reduction," said study presenter Dr Ross T Tsuyuki (University of Alberta, Edmonton). "Engaging pharmacists could bring another 450,000 'helping hands' in the US and Canada to help reduce the burden of cardiovascular disease," according to Tsuyuki and colleagues. "We would encourage policy makers to consider broadening the scope of practice of pharmacists (as in Alberta) and for pharmacists and pharmacy professional organizations to seize these opportunities for the betterment of patient care," they conclude.
Patients Often Unaware of ICD Issues Near End of Life
Many patients with ICDs across the world don't realize that device shocks are common in the final hours of life and that deactivation is an option, suggests a new study, with the researchers saying cardiologists need to do a better job of explaining these issues. Dr Dilek Yilmaz (Leiden University Medical Center, the Netherlands) and colleagues assessed 328 ICD patients who attended an educational symposium in the Netherlands. They found that 27% didn't know their ICDs could be deactivated, 36% didn't know about shock risks near end of life, and 50% hadn't thought about end-of-life ICD therapy at all. And only 12% of the participants had discussed any of this with their caregivers. The investigators say while the findings show that patient awareness of the issues is somewhat "reasonable" overall, there's definitely room for improvement—and that frank talks between patients and cardiologists and/or ICD nurses "remain limited."
Calls for Higher Heparin-Dosing Caps in Obese With ACS
A small, single-center analysis suggests that it may be time to increase the recommended maximum, weight-based unfractionated-heparin bolus and infusion doses for patients with ACS so as to extend optimal anticoagulation to the growing number of these patients who are obese. In this study of 197 patients who mostly had NSTEMI or unstable angina, in which more than half weighed over 80 kg (176 lbs), patients treated with a more aggressive IV heparin-dosing protocol (that allowed for higher-than-guideline-recommended maximal weight-based heparin doses) were more likely to quickly reach a therapeutic INR range than patients who were treated with a guideline-based protocol—without any increased bleeding risk. "We need to readjust our current strategy and dosing for heparin because it doesn't take into account the [more overweight and obese] population that we're treating . . . in the United States now," said lead author Dr Barbara S Wiggins (Medical University of South Carolina, Charleston).
Image from iStock
Morphine at Acute MI May Blunt Short-Term Antiplatelet Response
Among patients who presented with an acute STEMI who were about to undergo PCI, those who had received morphine to ease severe chest pain had a weakened response to antiplatelet agents compared with other patients, in a small study. Blood tests showed that the patients who had received morphine in the ambulance en route to the hospital had worse measures of platelet activity within an hour of receiving a loading dose of aspirin plus ticagrelor or clopidogrel, but this difference disappeared within 48 hours. "Morphine has been widely used to alleviate chest pain and anxiety of patients suffering from an acute MI, but it is also known that this drug can delay gastric emptying and reduce the absorption of other oral medications," said Dr Nikolaos Spinthakis (East and North Hertfordshire NHS Trust, UK). This study showed that "opioid treatments can reduce the antiplatelet effect of ADP-receptor antagonists." Until large clinical trials confirm this finding, "caution should be exercised in the use of IV morphine and consideration given to other intravenous medication if morphine treatment is to be used," Spinthakis said.
News coverage of the American College of Cardiology 2016 Scientific Sessions.
Medscape Cardiology
American College of Cardiology