Part 2: What makes a tackle risky?
On January 1st 2017 World Rugby announced some law clarifications and changes related to the high tackle laws. They are part of a zero-tolerance attitude to head contact during the sport, aimed at reducing the risk of concussion. These changes were not 'guesswork', but rather the result of an 8-month research project, the largest yet undertaken in the sport, to understand exactly how head injuries happen in professional rugby.
They have, of course, caused a spike in the number of high tackle penalties, yellow cards and red cards in the game, something I reviewed recently here on this site. The most recent, and perhaps highest profile of them all, is shown in the clip below. This is the story of how those laws were changed, and why.
Academic journals are often not accessible to many, and so I want to use this site to translate and explain the research a bit more engagingly.
Below is a brief explanation of the process and the findings that led to the changes. This is Part 1 of what will be a three-part series. Part 2 will describe the characteristics of the tackle that increase the risk of head injury and Part 3 wraps it up with the recommendations of the expert group based on these findings.
In the sports injury field, there is a well-known model called "The Sequence of Prevention model" (van Mechelen) which describes how scientific research should be applied to reduce the risk of injury. The model works in other situations too – it's been applied to reducing gun violence, for instance. You could apply it to figuring out why you get the flu every winter, or why you develop anterior knee pain on the bike every March, if you felt that way inclined.
The process must begin by understanding how often the event in question happens. This is called the incidence, and in our case, the event is concussion. An example of incidence would be to say "Employees miss six days of work per year due to illness", or "Concussion happens once every two matches". There's always a number of the event, plus a 'denominator' or time, making it a unit of frequency.
We know from various injury surveillance research studies that concussion incidence has been on the rise, and is now the most common injury in rugby.
That establishes the need to intervene to reduce the incidence. In the last five years, rugby has introduced a number of initiatives to help identify, treat and then manage players who experience concussions, and these fall under the umbrella "secondary prevention strategies" – they detect and treat, rather than prevent ("primary prevention).
These initiatives include the HIA protocol, which gave teams access to a temporary substitution so that a player suspected of being concussed could be assessed for 10min away from the field. The HIA Protocol also identified a number of criteria that would cause a player to be immediately and permanently removed from play, the result being that players who suffered serious head knocks would not play on.
This HIA protocol has been part of successfully reducing the number of times a concussed player stays on the field. There was a time when more than half of the players who would later be diagnosed as concussed kept playing on. That figure is now down in the single digits. Obviously, it needs to be zero, but it's come down enormously, and a big part of it is the tool created to allow doctors to evaluate players away from the noise and pressure of the field.
Then there is also the Graduated Return to Play protocol, adopted to ensure that a player is not rushed back to match play too soon after concussion.
These initiatives are themselves works in progress, and are constantly being researched to look for improvements and changes that can be made in order to further protect players after concussions.
However, what we were really interested with this project in is whether the risk can be reduced. That is, prevention, rather than cure or management. And that's where the mechanism of Head injury becomes really important.
This is the second step of that sequence of prevention model, because until you understand exactly how the undesired event happens, how can you target your response to prevent it? That was the fundamental question addressed in this research study.
The mechanism of head injury – who, what and how?
You might think it overkill to study in detail how head injuries happen. That they're obviously the result of impact, and so the solution should be obvious.
At a very superficial level, that's true, but if you want to be really effective in your action to reduce the risk of concussion, then you have to be very detailed in your understanding of the mechanism of the injury.
Unintended consequences. Sometimes a change is intended to produce a positive outcome X, and it might, but it might also achieve outcome Y, which is negative. The only way to anticipate this is to fully understand all the risks, and to avoid basing decisions on 'gut instinct' or intuition.
This is why the mechanism matters. World Rugby had the capacity to do this study because of the HIA protocols that have been in place since 2013, allied to video footage of every single HIA event logged over this period.
What is the highest risk activity in rugby?
Who is likely to experience a head injury?
How, specifically, does the head injury happen during tackles?
World Rugby also employs a team of full-time video analysts, one of whom was devoted to this project. He was the man who did a huge amount of the work in actually "coding" those 611 events.
Which activity caused the injury – tackle, kick contest, ruck, maul, lineout, open play etc.
Once that was done, we moved on to the tackle specifically. We did this because we knew from experience and previous research that tackles are the highest risk activity in rugby. We would confirm this in Part 1 of this study too.
Our analyst, Ben Hester, got through a mountain of work, because not only did he label every one of the 611 Head injury events this way, he also analysed tackles in 20 "control" matches, where there was no head injury. That meant another 3,160 tackles that did not cause a head injury were also labelled in this way.
Why was this necessary? Because once we know how many head injuries happen in a certain way, we need to contextualize this by comparing it to how many tackles happen that same way. It's the denominator I spoke of earlier, and you can think of it as exposure – how many of a given situation is a player exposed to, and then how often does that thing cause an injury?
For example, imagine you found that half of all head injuries happen during high speed tackles, but that high speed tackles make up 80% of all tackles in rugby.
That would mean a completely different thing compared to if high speed tackles make up only 10% of all tackles, but still caused half of the head injuries. We are seeking to identify whether certain situations are disproportionately more likely to cause a head injury, because that's where we'd put our efforts into reducing the risk.
So it's important to have this "denominator" or a measure of exposure to a risk factor, because only then can you work out the true risk of that factor.
Ultimately, what we were aiming to do was to work out which aspects of tackles are more likely to cause a head injury. In the field, this is called "propensity", and it's the likelihood or risk of head injury for a given event.
Our approach would be to identify the aspects of tackles that have the highest propensity or risk to cause a head injury, and then put that set of situations before a group of rugby experts – players, coaches, referees, and ask them to help reduce the risk by making suggestions ranging from law change to education.
We knew this when we started. We knew that solving the problem was not the domain of scientists, even though most fancy themselves to do that. Our role was to describe the problem, understand it, and then explain it to people who knew more than we did and who could suggest ways to solve it.
So, our destination was some point in the future, when a group of expert coaches, players and officials would be brought together, to discover exactly which aspects of the sport posed the greatest risk of head injury. They would discuss what the best strategies might be to reduce that risk.
Eliminate the risky behaviour completely.
Substitute the risky behaviour for something that is less risky.
As the figure below shows, we are trying to move behaviour from right to left along this spectrum of risk. Our job as researchers was to create the spectrum with research. The expert group's job would be to use tools like law change, education, training and equipment to make the leftward shift.
The first set of questions we asked produced some expected, and one very surprising answer.
In the figure below, you'll see a breakdown of the 611 HIAs resulting from each match activity, and on the right is the propensity, which is the number of head injuries for every 1000 of that match event.
So for tackles, the propensity was 1.94 Head injuries per 1000 tackles. If you want to think about this differently, it means that a head injury happens once every 516 tackles.
Kick contests also had a relatively high propensity – 1.57 head injuries per 1000 kick contests, or once every 637 kick contests. Then comes quite a large drop-off to the next activities – mauls, scrums, rucks and lineouts.
What is important to take into account here is not only how risky a given activity is, but also how often it happens during a match? That's because practically, the interventions we would consider must address both aspects, and it would be inefficient to put a lot of effort into changing something that happens very rarely.
Tackles, of course, are far more common than kick contests. In fact, our analysis showed that are 26 tackles for every kick contest, and so even though a tackle and a kick contest have a relatively similar propensity, the tackle is the area of greatest concern because it is so much more frequent.
The combination of high propensity and high frequency makes the tackle responsible for a very large majority of the head injuries – 464 out of 611 head injuries, or 76%. It's clearly the area of focus moving forward.
What's really interesting, and is our first unusual finding with implications for our actions later, is that the tackler is the one who is most at risk – see on the left of that figure that 335 out of those 464 tackle-induced head injuries happen to the tackler? That's 72%, and it means that making a tackle is 2.6 times more likely to cause a head injury than being tackled. Other research studies looking at all injuries find either that the ball carrier is more likely to be injured, or that the risk is similar.
But for head injuries, the player who is most at risk is the one MAKING THE TACKLE. Think about the implication of this for law change, because it's very important. The law almost exclusively protects the ball carrier – high tackles, tip tackles, no arms tackle – all written with the ball carrier as the object. Meanwhile, the player more at risk is the 'perpetrator' of the tackle (legal or not). We will come back to this one, because it's central to understanding actions later.
In any event, the findings you see in the figure above tell a pretty clear story – the tackle is the most frequent and the highest risk activity, and so it is fully deserving of the more detailed analysis we did next.
And that is where we will pick it up early next week, for Part 2, which will look at the 464 tackles, and describe which are more likely to cause a head injury. So do check in then to understand why the high tackle laws were changed.


text:
Der Bezirksverband Fußball Dresden e.V. (BVFD) war eine Vereinigung von Fußballkreisverbänden im Regierungsbezirk Dresden. Er wurde 1952 als Bezirksfachausschuss Sektion Fußball im Bezirk Dresden (später BFA Fußball Dresden) gegründet und 1990 in den jetzigen Namen umbenannt. Der BVFD war ein Unterverband des Sächsischen Fußball-Verbandes. Im Zuge der Strukturreform des sächsischen Fußballs wurde der Verband am 30. Juni 2010 aufgelöst. Der letzte Präsident war Jörg Freund.

Ligen
 Männer (Herren, A-, B-, C-, D-, E-Junioren)
 SZ-Bezirksliga
 SZ-Bezirksklasse Staffel 1
 SZ-Bezirksklasse Staffel 2
 SZ-Bezirksklasse Staffel 3
 SZ-Bezirksklasse Staffel 4 (nur bei Herren)

+ Ligen der untergeordneten Verbände

 Frauen (Frauen, B-, C-, D-Juniorinnen)
 SZ-Bezirksliga

+ Ligen der untergeordneten Verbände

Pokale (Bezirkspokal Dresden)
 Männer
 ENSO-Pokal der Herren
 ENSO-Pokal der A-Junioren
 ENSO-Pokal der B-Junioren
 ENSO-Pokal der C-Junioren

 Frauen
 ENSO-Pokal der Frauen
 Pokal der B-Juniorinnen
 Pokal der C-Juniorinnen
 Pokal der D-Juniorinnen

Übergeordnete Verbände
 Fédération Internationale de Football Association (FIFA)
 Union of European Football Associations (UEFA)
 Deutscher Fußball-Bund (DFB)
 Nordostdeutscher Fußballverband (NOFV)
 Sächsischer Fußball-Verband (SFV)

Untergeordnete Verbände
 Kreisverband Fußball Bautzen
 Stadtverband Fußball Dresden
 Fußballverband Görlitz
 Stadtverband Fußball Hoyerswerda
 Kreisverband Fußball Meißen
 Oberlausitzer Fußballverband
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Deutscher Fußball-Bund
Fußball (Sachsen)
Verein (Dresden)
Fußball (Dresden)
Gegründet 1952

redpajama_set_name: RedPajamaWikipedia


text:
Pharmacotherapies for Acute and Chronic Responses to Psychological Trauma
By Negar Fani, MS
Benjamin M. Hampstead, MS
J. Douglas Bremner, MD
Psychiatric Issues in Emergency Care SettingsPsychiatric Issues in Emergency Care Settings Vol 5 No 3
The presentation of patients to the emergency department following trauma is often complicated by the behavioral reaction to the accident that brought them there. In some cases, the mental reaction to psychological trauma is the primary presenting phenomenon. ED physicians and staff often use medication to treat the acute effects of psychological trauma. However, there is little empiric evidence to support this practice.
Stress reactions can be a normal response to traumatic events. However, sometimes such a response can be complicated by brain injury, the symptoms of which can be difficult to disentangle from symptoms of posttraumatic stress disorder (PTSD). In the acute period, acute stress disorder (ASD), which is characterized by symptoms of hyperarousal and dissociation, can develop. When stress symptoms persist in the aftermath of trauma, they can lead to chronic PTSD. Here we review the presentation of PTSD symptoms and discuss various approaches to treatment.
RESPONSES TO PSYCHOLOGICAL TRAUMA
The consequences of acute psychological trauma have long been recognized. Syndromes of "traumatic neurosis" and "shell shock" were initially described during World War I. Soldiers were noted to forget their name or where they were on the battlefield; they also experienced hyperarousal and extreme fear with reminders of the trauma.
Over the course of the 20th century, diagnostic conceptualizations have changed. In earlier versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), "gross stress reaction" was conceived as a temporary response. In 1980, when PTSD was included in the third edition of the DSM, the effects of stress were thought to be long lasting in a subgroup of patients. Since the official recognition of PTSD, there has been increased awareness of the potentially debilitating effects of traumatic stress.
PTSD is characterized by specific symptoms that develop after exposure to a "threat to the life of oneself or others accompanied by intense fear, horror, or helplessness."1 PTSD can have an acute or delayed onset after a traumatic event. Symptoms must be present for at least 1 month to meet the minimum criteria for a diagnosis of PTSD.
Three symptom categories are representative of PTSD:
•Intrusion symptoms (intrusive memories, flashbacks, feeling worse with reminders of the trauma, and nightmares).
•Avoidance symptoms (avoidance of thinking about the event, avoidance of reminders, decreased concentration, amnesia, feeling cut off from others, and a sense of foreshortened future).
•Hyperarousal symptoms (increased startle response, hyperarousal, hypervigilance, and decreased sleep).
To meet the criteria for diagnosis, a patient must have 1 intrusion, 3 avoidance, and 2 hyperarousal symptoms.1 Although earlier versions of the DSM listed both acute and chronic PTSD, the latest version of the DSM only includes a general PTSD category with a symptom-duration requirement of 2 months.
About 30% of persons who survived a trauma will meet criteria for PTSD early after the trauma; chronic PTSD will develop in about half of these patients.2 There is some evidence that early interventions can prevent the development of chronic PTSD, but not all interventions are necessarily helpful in all patients. On a biologic level, early modifications while memories are being consolidated--to prevent memories from becoming strongly engraved and indelible--are thought to be most useful.
ASD can be diagnosed in the immediate aftermath of a trauma. For an ASD diagnosis, a patient must meet criterion A as in PTSD and also have 3 or more of the following dissociative symptoms during or immediately after the trauma1:
•A subjective sense of numbing, detachment, or absence of emotional responsiveness.
•A reduction in awareness of surroundings (eg, "being in a daze").
•Derealization.
•Depersonalization.
•Dissociative amnesia (ie, inability to recall an important aspect of the trauma).
In addition, persons with ASD will persistently reexperience the traumatic event through recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or experience distress on exposure to reminders of the traumatic event. They will also avoid stimuli that arouse recollections of the trauma (eg, thoughts, feelings, conversations, activities, places, people); have marked anxiety or increased arousal (eg, difficulty in sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness); and have clinically significant distress or impairment in social, occupational, or other important areas of functioning, or have impairments in ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.
ASD must last at least 2 days and at most 4 weeks, occur within 4 weeks of the traumatic event, not be caused by the direct physiologic effects of a substance (a drug of abuse or a medication) or a general medical condition, not be better accounted for by brief psychotic disorder, and not be merely an exacerbation of a preexisting axis I or axis II disorder.
Other Trauma-Related Disorders
Other psychiatric disorders associated with trauma exposure include depression, anxiety, dissociative disorders, eating disorders, alcohol abuse, and substance use disorders. There is considerable overlap or comorbidity in trauma patients with these diagnoses. It has been argued that these disorders should be considered part of a "trauma spectrum" of psychiat- ric disorders, all sharing a stress- induced alteration in brain circuits and systems.3
Both peritraumatic dissociation and trauma-related persistent dissociation have been demonstrated to be markers for long-term psychopathology.4-6 In addition, extreme feelings of panic in the aftermath of a psychological trauma, which may underlie the dissociative reaction, have been associated with poor long-term outcome.7 Persistent elevations of heart rate (at 1 week but not at 1 month) in the aftermath of trauma also have been associated with long-term psychopathology.8
PHARMACOTHERAPY FOR PTSD
Psychotherapy and medication, alone or in combination, are the current treatments of PTSD. Medication is often required if symptoms are severe and long lasting; psychiatric comorbidities are present; or the patient is suicidal, continues to experience significant amounts of stress, has great difficulties with functioning, or has not responded to psychotherapy alone. Two selective serotonin reuptake inhibitors (SSRIs), sertraline and paroxetine, have received FDA approval for PTSD. However, many other medications are also used to manage the disorder.
Side effects associated with tricyclic antidepressants (TCAs) and dietary restrictions with monoamine oxidase inhibitors (MAOIs) have led most clinicians to treat patients who have a stress disorder with more recently developed medications, such as SSRIs. Thus, SSRIs are the most widely used first-line therapy for PTSD.9 Expert consensus guidelines support this use of SSRIs, suggesting treatment of 12 months or more, and also recommend the use of exposure-type behavioral therapies.10
Efficacy of Medication
Myriad studies have tested the effectiveness of various medications for managing PTSD. The first controlled trial of medication for chronic PTSD compared the MAOI phenelzine and the TCA imipramine with placebo in persons with chronic combat-related PTSD and found that both medications were more effective than placebo.11 Phenelzine was effective primarily in PTSD for intrusion symptoms but not avoidance symptoms.
A study of patients with mixed causes of PTSD (civilian and combat) found no efficacy for phenelzine compared with placebo;12 nor did a study comparing the norepinephrine reuptake inhibitor desipramine with placebo.13 However, these results are probably influenced by the short (4-week) treatment duration. Patients taking amitriptyline showed significant improvement in combat-related PTSD symptoms, compared with patients taking placebo.14 TCAs and MAOIs are as effective as or more effective than SSRIs, but 5 weeks of treatment are necessary for efficacy.15
Compared with placebo, fluoxetine is effective in patients with PTSD related to civilian events but not combat events,16 whereas nefazodone, which has both SSRI and postsynaptic serotonin receptor antagonist properties, was effective for managing combat-related PTSD.17 The mean dosage of nefazodone was 424 mg/d, and improvement was noted in intrusion, avoidance, arousal, depression, anxiety, and sleep symptoms. In a placebo-controlled trial, brofaromine effectively managed PTSD, but the drug manufacturer did not pursue FDA approval for this indication.18 Other medications shown to be effective in the management of PTSD include valproic acid, carbamazepine, alprazolam, propranolol, clonidine, mirtazapine, fluvoxamine, and bupropion.19
The first medication to receive FDA approval in the United States for the indication of PTSD was sertraline. A multisite comparison of sertraline (50 to 200 mg/d) versus placebo in 187 outpatients with PTSD showed efficacy for PTSD symptoms in the avoidance and hyperarousal categories but not the intrusion category.20 Twelve weeks of treatment resulted in a medication response rate of 53% at study end point, compared with 32% for placebo. Sertraline was well tolerated, with insomnia as the only adverse effect reported significantly more often than with placebo. Sertraline use was associated with greater treatment response in women than in men.
Emerging data from open-label trials demonstrate efficacy in paroxetine comparable with the findings in sertraline studies.21 A recent study of paroxetine in 551 patients showed up to a 40-point drop in PTSD symptoms as measured with the Clinician Administered PTSD Scale, indicating a significant decrease in PTSD symptom severity.22 Symptom improvement was seen in all of the PTSD symptom categories, including intrusion, avoidance, and arousal.
In one of the few studies of pharmacologic treatment of acute trauma, 4 patients were treated within 1 to 3 weeks of trauma exposure with the benzodiazepine hypnotic temazepam for 5 nights followed by a 2-day taper and discontinuation.23 One week after discontinuation, patients reported improved sleep and reduced PTSD severity. The authors concluded that controlled trials are needed in this area.
Imipramine was compared with chloral hydrate for children who were acute burn victims; imipramine treatment led to a significant improvement in psychiatric symptoms compared with chloral hydrate.24 In the only controlled study comparing active medication with placebo in acute trauma survivors presenting to an ED, the benzodiazepine alprazolam actually increased the risk of long-term development of PTSD.25
Although behavioral treatments are outside the scope of this review, it is of interest in this context to note that treatments such as psychological debriefing or critical incident stress debriefing, which are offered to acute trauma survivors, have been found in several studies to actually worsen outcome relative to no treatment at all.26 There is a natural tendency for psychiatrists and other emergency physicians to want to do something for the acute trauma patient. However, these studies should give us pause before we prescribe or recommend untested treatments. Surely, more research needs to be done in this important area.
Preclinical studies, which show that stress-induced stimulation of noradrenergic function may modulate the laying down of traumatic memories, have stimulated interest in the use of agents that may block noradrenergic function for the treatment of acute trauma. Animal studies have shown that pharmacologic blockade of the b receptor in the amygdala prevents the laying down of emotionally aversive memory. With this in mind, Pitman and colleagues27 treated patients in the ED with the noradrenergic b-blocker propranolol within 6 hours of experiencing trauma and continued treatment for 10 days. Propranolol did not lead to a significant reduction in PTSD symptoms compared with placebo, but there was a decrease in conditioned responses to traumatic reminders. This study suggests that propranolol interfered with the acquisition of conditioned responses but not the development of core PTSD symptoms.
Given the absence of empiric information on the treatment of acute trauma, some guidance may be gleaned from preclinical studies of the neurobiology of stress, which have identified specific circuits and systems that should be targeted for potential pharmacologic interventions.28-35 However, these systems are plastic and their regulation continues to undergo modification in the aftermath of acute trauma extending into the period of chronicity.
Based on these preclinical studies, new classes of compounds have been recently introduced that may be applicable to the treatment of acute trauma. These include more specific serotonergic agents, corticotropin-releasing factor (CRF) antagonists, antiadrenergic compounds, agents normalizing opioid function, neuropeptide Y enhancers, drugs to down-regulate glucocorticoid receptors, substance P antagonists, N-methyl-d-aspartate facilitators, and antikindling/antisensitization anticonvulsants.36 CRF antagonists show particular promise given their role in preventing the negative behavioral consequences of stress in animal studies.
Some medications that have efficacy for sleep disturbance or other troubling symptoms may be useful for acute trauma victims, even if they are not associated with broad-based improvements in all trauma-related symptoms. Nefazodone, for example, has proved useful in sleep-related problems in PTSD.37 In addition, the a1-adrenergic antagonist prazosin was demonstrated to be effective for nightmares in patients with PTSD.38
Based on the hypothesis that the trauma-related symptom of emotional numbing is an opiate-mediated phenomenon, there has been some interest in opiate antagonist medications for PTSD. A trial of nalmefene, a non-FDA-approved oral opiate antagonist, showed a favorable response, with a marked decrease of emotional numbing and other symptoms of PTSD--including startle response, nightmares, flashbacks, intrusive thoughts, rage, and vulnerability--in half of the patient sample.39 There is some preliminary evidence that increased activity of the opioid system may contribute to dissociative symptoms, including flashbacks and other symptoms commonly seen in trauma victims, and that these symptoms may respond to opiate antagonists such as naltrexone.40
Findings of hippocampal damage in stress and PTSD have promoted interest in mood-stabilizing and antiepileptic medications for the treatment of trauma-related disorders. Theories of kindling and sensitization in the hippocampus, which have been invoked as causes of epilepsy, have also been suggested to underlie the development of chronic PTSD. Medications used for epilepsy, such as carbamazepine and valproic acid, also have effects on mood and have been shown to be efficacious in open-label trials in PTSD, while a 12-week placebo-controlled trial of lamotrigine showed improvement on both reexperiencing and avoidance/numbing symptoms.41 Phenytoin is an agent of particular interest, since it is effective in epilepsy and has been shown in animal studies to block the negative effects of stress on hippocampal morphology.42-44
Benzodiazepines might be of interest to investigate in the treatment of acute trauma. However, the one controlled study does not support this approach.25 Gabapentin, which modulates GABAergic function, may be useful in PTSD and deserves further study.45 CRF receptor antagonists may represent a novel class of antidepressants and anxiolytics; their development is still in its infancy, though they have shown promise in animal studies.46,47
Antidepressants promote neurogenesis in the hippocampus and improve memory in preclinical studies.48 The effects of stress on the hippocampus are reversible with treatment with SSRIs,49-51 tianeptine,52 and phenytoin.44 Antidepressant-induced promotion of neurogenesis may influence the behavioral effects of these medications,53 although the relationship between the hippocampus and depression and PTSD is still not clear.
Hippocampal volume loss and memory deficits were reversed in patients with PTSD following treatment with the SSRI paroxetine.48 Treatment with phenytoin resulted in improved PTSD symptoms,54 a 6% increase in right cerebral volume, and a 5% increase in right hippocampal volume.55 These findings suggested that long-term treatment with paroxetine or phenytoin is associated with changes in brain structure that may improve symptoms as well as memory problems.48
TREATING PTSD IN THE ED
Patients presenting to the ED with PTSD symptoms of intense fear and persistent elevated heart rate may benefit from treatment with propranolol. A single dose of a benzodiazepine may be needed in some situations; however, prolonged use is not known to be effective in PTSD and may interfere with memory consolidation processes that can lead to recovery.
Current recommendations for the treatment of PTSD include SSRI therapy and cognitive behavioral therapy. Patients who have sustained symptoms should be considered candidates for these treatments. Other medications mentioned in this article may be helpful, but their usefulness is dependent on the particular symptom being targeted.
Unfortunately, little is known about effective pharmacologic interventions for acute psychological trauma, with the only published controlled trial showing that benzodiazepine treatment (which has been commonly used in clinical practice in combat situations) actually makes patients worse in the long run. The use of SSRIs for chronic PTSD is well established. However, there is no evidence that SSRIs prevent the development of chronic PTSD.
Given findings that certain treatments for patients in the acute stages may make things worse, psychiatrists and other physicians need to proceed with caution when managing acute stress reactions.
Some studies show that propranolol has efficacy in PTSD prevention by blocking the encoding of negative memories, possibly through blockage of noradrenergic b receptors in the amygdala. Studies of the neurobiology of stress will continue to guide our drug development and will suggest future clinical trials that should be undertaken. New agents, such as CRF antagonists, offer particular interest for studies of the pharmacotherapy of acute trauma with applications to prevention. *
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3. Bremner JD. Does Stress Damage the Brain? Understanding Trauma-Related Disorders From a Mind-Body Perspective. New York: WW Norton; 2002.
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8. Bryant RA, Marosszeky JE, Crooks J, Gurka JA. Elevated resting heart rate as a predictor of posttraumatic stress disorder after severe traumatic brain injury. Psychosom Med. 2004;66:760-761.
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11. Frank JB, Kosten TR, Giller EL Jr, Dan E. A randomized clinical trial of phenelzine and imipramine for posttraumatic stress disorder. Am J Psychiatry. 1988;145:1289-1291.
12. Shestatzky M, Greenberg D, Lerer B. A controlled trial of phenelzine in posttraumatic stress disorder. Psychiatry Res. 1988;24:149-155.
13. Reist C, Kauffmann CD, Haier RJ, et al. A controlled trial of desipramine in 18 men with posttraumatic stress disorder. Am J Psychiatry. 1989;146: 513-516.
14. Davidson J, Kudler H, Smith R, et al. Treatment of posttraumatic stress disorder with amitriptyline and placebo. Arch Gen Psychiatry. 1990;47:259-266.
15. Cyr M, Farrar MK. Treatment for posttraumatic stress disorder. Ann Pharmacother. 2000;34:366-376.
16. van der Kolk BA, Dreyfuss D, Michaels M, et al. Fluoxetine in posttraumatic stress disorder. J Clin Psychiatry. 1994;55:517-522.
17. Zisook S, Chentsova-Dutton YE, Smith-Vaniz A, et al. Nefazodone in patients with treatment-refractory posttraumatic stress disorder. J Clin Psychiatry. 2000;61:203-208.
18. Baker DG, Diamond BI, Gillette G, et al. A double-blind, randomized, placebo-controlled, multi-center study of brofaromine in the treatment of post-traumatic stress disorder. Psychopharmacology (Berl). 1995;122:386-389.
19. Sutherland SM, Davidson JR. Pharmacotherapy for post-traumatic stress disorder. Psychiatr Clin North Am. 1994;17:409-423.
20. Brady K, Pearlstein T, Asnis GM, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA. 2000;283:1837-1844.
21. Marshall RD, Schneier FR, Fallon BA, et al. An open trial of paroxetine in patients with noncombat-related, chronic posttraumatic stress disorder. J Clin Psychopharmacol. 1998;18:10-18.
22. Marshall RD, Beebe KL, Oldham M, Zaninelli R. Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. Am J Psychiatry. 2001;158:1982-1988.
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24. Robert R, Blakeney PE, Villarreal C, et al. Imipramine treatment in pediatric burn patients with symptoms of acute stress disorder: a pilot study. J Am Acad Child Adolesc Psychiatry. 1999;38:873-882.
25. Gelpin E, Bonne O, Peri T, et al. Treatment of recent trauma survivors with benzodiazepines: a prospective study. J Clin Psychiatry. 1996;57:390-394.
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31. Diamond DM, Fleshner M, Ingersoll N, Rose GM. Psychological stress impairs spatial working memory: relevance to electrophysiological studies of hippocampal function. Behav Neurosci. 1996;110: 661-672.
32. Sapolsky RM. Why stress is bad for your brain. Science. 1996;273:749-750.
33. Smith MA, Makino S, Kvetnansky R, Post RM. Stress and glucocorticoids affect the expression of brain-derived neurotrophic factor and neurotrophin-3 mRNAs in the hippocampus. J Neurosci. 1995;15: 1768-1777.
34. McEwen BS, Angulo J, Cameron H, et al. Paradoxical effects of adrenal steroids on the brain: protection versus degeneration. Biol Psychiatry. 1992; 31:177-199.
35. Fowler CD, Liu Y, Ouimet C, Wang Z. The effects of social environment on adult neurogenesis in the female prairie vole. J Neurobiol. 2002;51:115-128.
36. Friedman MJ. What might the psychobiology of posttraumatic stress disorder teach us about future approaches to pharmacotherapy? J Clin Psychiatry. 2000;61(suppl 7):44-51.
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38. Raskind MA, Dobie DJ, Kanter ED, et al. The alpha1-adrenergic antagonist prazosin ameliorates combat trauma nightmares in veterans with posttraumatic stress disorder: a report of 4 cases. J Clin Psychiatry. 2000;61:129-133.
39. Glover H. A preliminary trial of nalmefene for the treatment of emotional numbing in combat veterans with post-traumatic stress disorder. Isr J Psychiatry Relat Sci. 1993;30:255-263.
40. Bills LF, Kreisler K. Treatment of flashbacks with naltrexone. Am J Psychiatry. 1993;150:1430.
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42. Hui Z, Guang-Yu M, Chong-Tao X, et al. Phenytoin reverses the chronic stress-induced impairment of memory consolidation for water maze training and depression of LTP in rat hippocampal CA1 region, but does not affect motor activity. Brain Res Cogn Brain Res. 2005;24:380-385.
43. Reagan LP, McKittrick CR, McEwen BS. Corticosterone and phenytoin reduce neuronal nitric oxide synthase messenger RNA expression in rat hippocampus. Neuroscience. 1999;91:211-219.
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47. Habib KE, Weld KP, Rice C, et al. Oral administration of a corticotropin-releasing hormone receptor antagonist significantly attenuates behavioral, neuroendocrine, and autonomic responses to stress in primates. Proc Natl Acad Sci U S A. 2000;97: 6079-6084.
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51. Lee HJ, Kim JW, Yim SV, et al. Fluoxetine enhances cell proliferation and prevents apoptosis in dentate gyrus of maternally separated rats. Mol Psychiatry. 2001;6:610, 725-728.
52. Czeh B, Michaelis T, Watanabe T, et al. Stress-induced changes in cerebral metabolites, hippocampal volume, and cell proliferation are prevented by antidepressant treatment with tianeptine. Proc Natl Acad Sci U S A. 2001;98:12796-12801.
53. Santarelli L, Saxe M, Gross C, et al. Requirement of hippocampal neurogenesis for the behavioral effects of antidepressants. Science. 2003;301:805-809.
54. Bremner JD, Mletzko T, Welter S, et al. Treatment of posttraumatic stress disorder with phenytoin: an open-label pilot study. J Clin Psychiatry. 2004;65:1559-1564.
55. Bremner JD, Mletzko T, Welter S, et al. Effects of phenytoin on memory, cognition and brain structure in post-traumatic stress disorder: a pilot study. J Psychopharmacol. 2005;19:159-165.
56. Foa EB, Davidson JRT, Frances A, Ross R. Expert consensus treatment guidelines for posttraumatic stress disorder: a guide for patients and families. J Clin Psychiatry. 1999;60(suppl 16):4-76.
57. Staab JP. Posttraumatic stress disorder: drug therapy. American College of Physicians, Physicians' Information and Education Resource. Available at: http://pier.acponline.org/physicians/public/d251/ drug.tx/d251-s7.html. Accessed July 5, 2006.
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A New Breath of Care for our Retired Heroes: Cancer Resource Alliance Supports the RMA
4/30/3019 Brooklyn, NY -- The RMA (Retired Member's Association of the FDNY) welcomed some of the leading patient advocates of the First Responders Cancer Resource to present its cancer awareness message to the packed room of career firefighters. Among the many topics covered were: Early Detection & Prevention, the value of a SECOND OPINION, current mortality rates and the vigilant health message of "Get Checked Now!"
It was an evening of great solidarity for the members united by the leadership of President and membership chairman Jim Hayhurst. This highly respected organization (founded in 1946) is comprised of retired firefighters of all ranks chartered to bring access to top professionals and direct supporters of this special community. Proud attendees express their appreciation for the RMA as one of the major groups that seek out valuable information and contributors to help their members stay current on safety, health, information about pensions and other vital matters to all ex-firefighters. This event in Brooklyn is one of five main events offered each year alongside their second location in New Hyde Park, NY. Mr. Hayhurst expressed significant interest in the "Get Checked Now!" message for his men with the hopes of 'saving at least one life from this or any other health program' introduced to the RMA.
The 2019 outreach calendar of FDNY presentations reflect the growing momentum of interest gained in cancer awareness from all the firefighter orgs and firehouse events. The standard speaking tour is comprised of program director Lennard Gettz and retired firefighter-turned health ambassador Sal Banchitta. Mr. Gettz usually delivers highlights of NYCRA's educational programs and details the many available healthcare innovations and advancements of the medical community for any cancer victims. Sal Banchitta carries the discussion as a retired firefighter and a 9/11 responder by underscoring the many types of toxins and cancerous events that firefighters may be exposed to in their career- all leading to staying proactive about their health and safety. Furthermore, as a patient of a battery of clinicians, Sal promotes his audience to "ask a lot of questions, do your own personal research and seek peace of mind by getting a SECOND OPINION about complex health matters".
RMA member John Signorile and 3rd VP in charge of good and welfare of the Columbia Association of FDNY gave major support to the First Responders Cancer Resource's public mission. "We were very impressed with this program and its cancer screening breakdown", says Mr. Signorile. "You don't have to have an issue to come in for a screening—that's a big plus. Most of my fellow members were impressed by that and look forward to getting tested because you don't want to find out when it's too late and you have an issue…. it's better to be proactive in these cases." John Signorile also found the benefit of the philosophy behind the Second Opinion program- "I'm friends with one of the top oncologists in the city who always tell me to get multiple tests and have more than one doctor check you out… so many things may be overlooked by one pair of eyes."
Dr. Robert Bard, one of the top medical advisors of the First Responders screening program & active cancer diagnostic specialist in NYC made a surprise appearance to speak in this venue. "He insisted on being part of this meeting and got on the mic to engage with the members. Having him at the RMA meeting was such a blessing because he added that science angle to the whole presentation", says Sal Banchitta. Dr. Bard opened with an introduction of his 45+ years of experience as a tumor analyst and a "cancer finder". He shared actual references from his own patients as well as some of the most common cases that plague first responders. Dr. Bard embraced the bevy of questions which continued long after the presentation where members sat privately with Dr. Bard one at a time-- exploring their deepest concerns that deserved the uncompromising attention that Dr. Bard is known for.
One of the major highlights of the event was delivered by Ms. Cheri Ambrose, NYCRA Communications Dir. and head of the international Male Breast Cancer Coalition. Having campaigned publicly about cancer awareness to countless individuals, she expressed that the biggest underlying challenge in reaching our society is DENIAL. She boldly takes credit for the prompted "NOW" in the group's "Get Checked Now!" mantra.
Cheri also concluded the group presentation by presenting one of NYCRA's highest honors to Jim Hayhurst for his work with the RMA. "As advocates of cancer education and safety awareness, organizers like Jim are some of our greatest champions… we appreciate community leaders (like Jim) who go above and beyond to build, maintain and expand the pillars of unity and loving support for our heroes. They give so much of themselves toward the betterment of others' lives-- especially all the members of such a worthwhile org as the RMA."
NYCRA's First Responders Cancer Resource awareness team continues to forge an unending advocacy work for all emergency responders. They are scheduled this year to present in over 35 community groups in the NYC and Long Island areas. Dr. Bard's busy NYC practice continues to tirelessly screen all newcomers, conducting Early Detection and Prevention scans- especially firefighters (both active and retired) as part of his commitment to the "Get Checked Now!" program.
1) NY Cancer Resource Alliance
2) First Responders Cancer Resource
3) Retired Members' Association of FDNY
4) The Columbia Association of FDNY
5) Bard Cancer Diagnostics
6) Male Breast Cancer Coalition
7) Integrative Medicine of NY
8) Awareness for a Cure
9) LI2DAY Walk
A New Breath of Care for our Retired Heroes: Cance...


Shenae Grimes-Beech has been in relationships with Brendan Fellis (2011) and Ethan Rapport-Cole (2007 - 2009).
Shenae Grimes-Beech is a 29 year old Canadian Actress. Born Shenae Sonya Grimes on 24th October, 1989 in Toronto, Ontario, Canada and educated at City Academy, she is famous for Degrassi and 90210 in a career that spans 2004-2014. Her zodiac sign is Scorpio.
Shenae Grimes-Beech has been in 5 on-screen matchups, including Adam Gregory in 90210 (2008), Dustin Milligan in 90210 (2008), Jamie Johnson in Degrassi: The Next Generation (2001), Matt Lanter in 90210 (2008) and Shane Kippel in Degrassi: The Next Generation (2001).
Shenae Grimes-Beech is a member of the following lists: Actresses from Toronto, Canadian child actresses and 21st-century Canadian actresses.
Help us build our profile of Shenae Grimes-Beech! Login to add information, pictures and relationships, join in discussions and get credit for your contributions.
Distinctive Feature "Myself"-tattoo under her right chest, Has a tattoo on the right side of her ribcage which says "Myself and I"
Brand Endorsement TV commercial: Coffee Crisp (2004-present).
Shenae Grimes-Beech (/ʃəˈneɪ/; née Grimes; born October 24, 1989) is a Canadian actress. She portrayed the role of Annie Wilson on 90210, a spin-off of Beverly Hills, 90210. Prior to that she played Darcy Edwards on Degrassi: The Next Generation. She was also a recurring guest star on the series Naturally, Sadie, and had a cameo role in the horror film Scream 4.
Josh Beech and Shenae Grimes-Beech have been married for 5 years. They were dating for 5 months after getting together in Jul 2012. After 5 months of engagement they married on 10th May 2013.
Brendan Fellis and Shenae Grimes-Beech dated from May to August, 2011.
Ethan Rapport-Cole and Shenae Grimes-Beech dated from 2007 to 2009.
Umm.. Why does it say she was Rebecca Harper on The Latest Buzz?
is this an actress for real????
She is pretty and a good actress but I heard she is a diva in person.
i dont know about you guys but she looks cute with matt lanter.
You are so pretty and you are a great actress!!!
darcy u r ot very nice u cheated and ur not cheery but we can be friends can we?
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Cam Ranh Bay: Vietnam's ace in the hole against China
ATSUSHI TOMIYAMA, Nikkei staff writer May 21, 2015 00:00 JST | China
HANOI -- Vietnam is David to China's Goliath when it comes to strategic competition. China's economy is 54 times larger and its navy is 10 times bigger.
But as far as territorial disputes in the South China Sea are concerned, Vietnam has an ace up its sleeve: Cam Ranh Bay. To make the most of its leverage, Hanoi is apparently letting Russia use the natural harbor on its central coast.
Cam Ranh Bay is one of the most strategically important bays in Asia. The U.S. used it as its center for naval operations during the Vietnam War.
Now, the U.S. Navy wants to return on friendly terms. It is locked in a strategic rivalry with Russia over the use of the bay. Vietnam could tremendously alter the balance of power in Asia-Pacific waters simply by granting one or the other preferential access.
Beachfront location
On March 11, Reuters reported the U.S. government had asked Vietnam to stop letting Russia use the military base at Cam Ranh Bay. U.S. officials complained that Russian bombers circling Guam, home to an American air base, were being refueled by Russian tanker aircraft flying out of the bay, the report said.
The harbor is about 600km west of the Paracel Islands and some 800km northwest of the Spratly Islands.
Ships stationed at Cam Ranh Bay can easily enter the Indian Ocean through the Strait of Malacca. History shows its value, with naval and air bases: In the Russo-Japanese War of 1904-1905, Russia's Baltic Fleet called there, and Imperial Japan used the facility during World War II.
After the Vietnam War, the Soviet Union and then Russia leased the base from 1979 to 2002. After the end of the Cold War, the bay lost some of its strategic importance. But China's growing assertiveness aimed at establishing its presence in contested waters has changed matters.
Vietnam says it does not want anyone to have preferential rights to the bay. Vietnam has turned down repeated requests from the U.S. seeking to use its facilities. Vietnam's apparent move to give Russia access is seen as an effort to strengthen ties with Moscow, on which it has relied militarily since the Vietnam War.
As of March, the Vietnamese navy had purchased three Russian-built Kilo-class submarines, deploying them in Cam Ranh Bay, with three more expected by 2016. Regular port calls by Russian warships would make it easier for the Vietnam to get Russian advice about submarine operations and strategy.
"Vietnam is likely to have secured a Russian pledge to update its arms and weapons systems in return for allowing Russia to use Cam Ranh Bay," said a foreign diplomat in Hanoi.
The Vietnamese government has been silent about Russia's use of the bay. This is because Vietnam wants to strengthen relations with the U.S. even more than those with Russia.
Hello, Uncle Sam
This year marks the 20th anniversary of the normalization of U.S.-Vietnam relations. Vietnam's supreme leader Nguyen Phu Trong is to become the first secretary-general of the Communist Party to visit Washington, possibly as early as June.
The U.S. is Vietnam's second-largest trading partner after China, accounting for 11.7% of its total trade value.
The U.S. has partially lifted its arms embargo on Vietnam, which lasted for about 40 years. So far, the restrictions have been eased only on items related to maritime defense. Vietnam appears to be interested in buying anti-submarine aircraft and high-speed coast-guard patrol boats.
About 95% of Vietnam's arms come from Russia, and most of them are old. Vietnamese officials are well aware that American arms come with better after-sales service and training. They may be looking to gradually replace their Russian gear with American.
Japan is keenly watching these developments. In late April, Reuters reported Japan's Defense Ministry has begun considering joint patrols in the South China Sea with the U.S. Japan has a fleet of 70 P-3C surveillance planes, which gives it a strong reconnaissance capability. Should it be allowed to use Cam Ranh Bay, "Japan would be able to routinely monitor the entire South China Sea," said a diplomat in Hanoi.
On May 13, two Maritime Self-Defense Force P-3Cs flew to Danang, north of Cam Ranh Bay, in a military exchange. This was the second visit by Japanese P-3Cs. Whether the timing was deliberate or by chance, Vietnam is sending a message to its neighbors. The region's power games are growing more complex.
Vietnam enters the limelight
Moscow V-E Day highlights tensions, alliances
Vietnam to forge trade pact with Russia


Beat The Lock Escape Room in Santa Clara, CA, is located at 1171 Homestead Road, Suite 280, at the corner of Jackson & Homestead. Walk toward the tower and take the elevator to the second floor to Suite #280. The Parking Lot is located behind the University Plaza building. Entrance/Exit accessible from either Jackson or Homestead. Street parking also available.


Our mission is to inspire and equip the local church, community, and families to a deeper relationship with Jesus Christ through biblical teaching and excellent programming and service.
The following principles guide our everyday decisions, actions, and expectations. Like a thread in a canvas, these values weave and hold together the very core of who we are that ultimately creates the "Welcome Home" feeling many experience when they are here. They are not ideas we merely post on a wall to inspire; they are concepts we live by in both speech and action. It's one reason why we have been around for over 50 years serving the Church and community in New England.
We are Gospel-Centered. (Titus 2:14) Jesus Christ is at the heart of Monadnock Ministries. We want people to know Jesus personally by the teaching and preaching they hear, but also through the way we serve and love.
We are Grace-Expressed. (Galatians 6:2) We want people to feel welcomed, accepted, and loved here regardless of situation or belief. We care that your story will encounter His story of redemption and grace (His unmerited favor). Forgiveness and mercy are purposeful in its expression towards others.
We are Discipleship-Focused. (1 Thessalonians 5:14) Our goal is to encourage and equip believers to grow into full maturity in Christ.
Community Building – The MCM community is one that is founded on trust, honesty, and authenticity. We accept you right where you are. We love celebrating the uniqueness that each individual brings to MCM with them but we also realize the similarities we have are for the edification of the community.
Shared Learning/Discipleship – The process of working collectively to achieve a common objective is central to the community here at MCM. Shared learning is foundational to a culture of discipleship where continuous learning, cooperative problem solving, and the shared experiences we have together is a discovery of who we are in relationship to others and most importantly to Christ.
Authentic Relationships – Relationships can deepen in ways at MCM that no one else can offer because of the authentic and shared experiences that is created in our community. Devotions, room assignments, activities, teaching sessions, short term mission trips, volunteer opportunities and so much more can lend itself to amazing relationships. At the heart of this approach is relational wisdom which is best defined as our ability to discern emotions, interests and abilities in ourselves and others, to interpret this information in the light of God's Word, and to use these insights to manage our responses and relationships successfully.
Excellent Service – Service isn't something we take lightly. We strive in providing a world-class experience here at MCM. Our standards are high when it comes to our facilities (despite their old age), safety, and hiring practices. We look for the best in staff and volunteers. These high standards bring a great deal of knowledge, expertise, and commitment to your experience here at MCM.
Families (Deuteronomy 6): God has designed the family to pass faith on to the next generation. He has given MCM the mission to inspire and equip families. Families are strengthened through specific retreats geared for families, teens, couples, men, and women.
Churches (Ephesians 4:15-16): We believe thatMCM is a hub of ministry. We absolutely believe that families and individuals need to be connected to a local church to grow in their faith and service. Our role as a ministry is to see where the needs are in the local church and partner with them to meet those needs.
Community (Jeremiah 29:7) We come alongside the needs of our local community to serve and meet their needs where it aligns with our charter. We will work for the peace and prosperity of New England where it makes sense to draw those we serve to a deeper relationship with Jesus Christ.
We believe in the Scripture of the Old and New Testaments as verbally inspired by God, inerrant in the original writings, and that they are of supreme and final authority in faith and life.
We believe that man was created in the image of God; that he sinned, and thereby incurred, not only physical death, but also spiritual death which is separation from God; and all human beings are born with a sinful nature and in the case of those who reach moral responsibility, they become sinners in thought, word, and deed.
We believe that the Lord Jesus Christ died for our sins according to the Scriptures, as a representative and substitute sacrifice; and that all who believe in Him are justified on the grounds of His shed blood.
We believe in "that blessed hope" the personal, pre-millennial and imminent return of our Lord and Savior Jesus Christ.


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Locosxelcine
Baskin Robbins Menu Prices 2019 – List All The Benefits..
Baskin-Robbins is developing a frenzy of excitement this summer with its new tubular Surf's Up inspired flavors, Penguin Swirl and Splish Splash(TM). Ice cream lovers will go wild for the flavors' unique colors, since the black soft ice cream and blue sherbet turns tongues penguin black and ocean blue within the first lick. Additionally, consumers can cool-off using one of Baskin Robbins refreshing new Fruit Blast Smoothies, a combination of real fruit and non-fat frozen yogurt, available in a variety of new and exotic fruit flavors like Berry Pomegranate Banana.
"Baskin-Robbins is going back to its California roots to take summer fun to its customers," said Scott Colwell, Baskin-Robbins' v . p . of advertising. "We are excited to kick-off our mobile tour and help soft ice cream enthusiasts sweeten their day with our refreshing new treats."
The Baskin-Robbins USA Co. Was formed around 1945. It was produced by Irv Robbins and Burt Baskin. Irv Robbins utilized to manage an soft ice cream shop when he had been a teenager. It absolutely was during that time that Robbins grew bored with the normal frozen treats flavors of vanilla and chocolate. He began to experiment with fruits and candies introducing new flavors of ice cream. Robbins bought an soft ice cream parlor, after returning from the Second World War. 36 months later, his brother in law Burt Baskin joined in the business. From both their names the brand name "Baskin and Robbins' was born. The "Baskin-Robbins USA Co." Has its head quarter inside the Canton, Massachusetts.
The "Baskin-Robbins USA Co." As Well As Their Franchisees – The "Baskin-Robbins USA Co." Includes a presence in than fifty countries worldwide. They may have started franchising through the year 1948. In accordance with the 2009 reports "Baskin-Robbins USA Co." has 2000 six hundred and one franchisee at the United States only. The quantity of Canadian franchises is just one hundred and seventeen, the quantity of foreign franchises is at whooping three thousand three hundred and eighty two. Each of the franchise serves the famous 31 flavors of soft ice cream and frozen yogurt, drinks, cakes and sherbet, also. The Baskin Robbins delivery is area of the Dunkin Brands Inc. The Dunkin Brands Inc is belonging to Bain Capital, The Carlyle Group and Thomas H. Lee Partners. The Baskin Robbins group is seeking franchisees for the domestic, and also the international market.
The Fee And Fees To Become Baskin Robbins Franchise – The complete investment to turn into a full fledged Baskin Robbins franchise ranges between $ 41,450 to $ 3,73,595. The "Baskin-Robbins USA Co" charges franchise fee and ongoing royalty fee off their franchisees. The franchise fee charged by "Baskin-Robbins USA Co" is $ 5,000 to $ 35,000. The ongoing royalty fee is 5.9 percent. The phrase of agreement is not renewable with the "Baskin-Robbins USA Co". The "Baskin-Robbins USA Co" offers the choice of express shop or kiosk for their franchisees. The "Baskin-Robbins USA Co" doesn't offer any financing selection for franchise fee, startup costs, Inventory cost, receivable accounts costs and payroll costs. They simply provide finance for the 3rd party equipment cost.
The Desired Qualification To Become A Franchise – The "Baskin-Robbins USA Co" mentions the person ready to take up the franchise must have a value of $ 1,200,000 and liquid cash of $ 600,000. The "Baskin-Robbins USA Co" prefers the franchise owner to possess industry or general business experience. The individual obtaining the franchise should have the necessary marketing skills to operate the company profitably as well as raise the sales volume.
The Superb Training And Support – The education is generally provided at the "Baskin-Robbins USA Co" head quarter only. The ongoing support is provided through news letter, meetings, toll-free phone line, internet, safety procedure, field tczxmz and grand openings. The extensive marketing support is supplied towards the franchise as regional advertising. This is accomplished to popularize and boost the business of the franchise.
The Baskin Robbins is a hugely popular brand name and quite a heavy weight in the frozen treats industry. They also provide good support for your franchisees to develop business. Taking on the franchise of Baskin Robbins hours is a good idea.
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Never Leave Office Comic Strips - Page 1
1000 Results for Never Leave Office
View 1 - 10 results for never leave office comic strips. Discover the best "Never Leave Office" comics from Dilbert.com.
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Tags #Advice, #office workers, #presentation
Dilbert stands in front of the dresser mirror tying his tie and Dogbert sits on the bed watching him. Dilbert says to Dogbert, "I'm really nervous about this presentation for the Big Boss. Got any tips for me?" Dogbert replies, "Remember to bring a bunch of coins to jangle self-consciously in your pockets." Dogbert continues, ". . . Avoid eye contact and don't pause to explain your acronyms." Dilbert says, "I wish I could tell when you're kidding."
Saturday April 29, 1989
Tags #dog, #sarcasm, #wise, #wisdom, #animals
Dilbert says, "You know what I just realized, Dogbert?" Dilbert continues, "The little hairs on the back of my hand - they never get any longer." Dogbert says, "Before I respond, just give me a moment to bask in the radiance of your wisdom."
Tags #invention, #lawyers, #money
Dilbert and Dogbert stand on either side of a device. Dogbert says, "I think you should see a lawyer before unleashing this new invention on mankind." Later, Dilbert sits in an attorney's office. Dilbert says, ". . . I'm afraid my new invention will expose me to lots of lawsuits." Dilbert asks, "Will you advise me?" The lawyer replies, "No. Sounds like I can make more money by suing you."
Tags #book, #office workers, #writing
Dogbert stands on a desk chair typing. He says to Dilbert, "I'm writing my first business management book, 'Managing in a Bureaucracy.'" Dilbert reads a draft, "You know you're in a bureaucracy when a hundred people who think 'A' get together and compromise on 'B.'" Dilbert asks, "Think anybody will read it?" Dogbert replies, "It doesn't matter. The real money is on the lecture circuit."
Sunday May 14, 1989
Tags #nose, #office workers, #presentation, #itch
Dilbert stands at the front of a room giving a presentation. He points to a diagram and says, ". . . And as you can see . . ." Dilbert wiggles his nose and thinks, "Uh oh . . . I got an itch in my nose." Dilbert thinks, ". . . Can't scratch it now without looking unprofessional." Dilbert thinks, "Maybe I can casually scratch it with one smooth gesture toward the easel." Back at home, Dilbert sits in his chair with a bandage on his nose. Dilbert says, "There's a good chance they thought it was part of the presentation." Dogbert asks, "Did the paramedics remove the pointer or just tape over it?"
Tags #compliment, #office workers, #reaction
Dilbert sits in his chair and Dogbert stands on the hassock. Dilbert says, "Alice brought her new baby to the office today." Dilbert asks, "What are you supposed to say when somebody shows you a baby?" Dogbert replies, "'Precious' usually works." Dilbert says, "Judging from the reaction, 'bug-ugly' wasn't what she was looking for."
Tags #furniture, #office workers, #phone call
Dogbert says into the telephone, "I'm sorry to bother you at work, Dilbert, but apparently the furniture has become possessed by mischievous spirits." The chair and the hassock have faces and clawed feet. Dogbert says to the chair and hassock, "He wants to know who you guys are." The chair responds, "Upholsterygeist."
Tags #learning, #mailman, #observe
Dogbert holds the telephone and yells, "Dogbert! The post office is complaining that you attacked a mail carrier." Dogbert replies, "Tell them that I love mail carriers and would NEVER try to hurt one." Dilbert says, "Apparently they object to the tranquilizer darts and homing transmitters." Dogbert asks, "But how else can we learn their migration patterns?"
Tags #money, #choke, #tie
Dilbert says to Dogbert, "Admit it: you don't think I'm manly enough to take sky diving lessons, do you?" Dogbert replies, "That never crossed my mind." Dilbert says, "Good." Dogbert says, "However, it did occur to me that you could be the first sky diver to grab his necktie instead of the ripcord and choke himself to death on the way down."
Tags #crimes, #letter, #mail, #illegal
Dilbert says to Dogbert, "I got a chain letter." Dogbert says, "Those are illegal." Dilbert says, "I've never broken a law in my whole life, but I'm tempted to try this." Dogbert says, "One suggestion." Dogbert continues, "Maybe for your first crime you shouldn't put your name and address on it and distribute it to ten thousand strangers."


Friends – welcome to my new website. I'm happy you're here.
Since 2008, I've semi-regularly maintained zachleary.com primarily as a blog. It was a space for me to share my thoughts and points of view on things that I found interesting in the world. The majority of posts had to do with yoga/spirituality but also with politics, music and the overall broad landscape of the expansion of consciousness. Lofty topics all. While I didn't update it as often as I probably should have I did manage to build up a small but loyal following that felt supportive and encouraging.
Just over a year ago I launched the It's All Happening podcast on a separate URL thinking that I'd build that brand as something separate. While we did succeed in doing that it became apparent that there really was no reason to have two separate websites going on simultaneously. Traffic was split, opportunities were lost. One hand didn't know what the other was doing, all that sorta stuff.
Thank you so much for being a part of this journey and I look forward to sharing it together as we figure out the future as one collective community.
Many of you have the previous It's All Happening URL bookmarked as your place to listen to the podcast. You can still do that however, I recommend updating your bookmark to www.zachleary.com. The old URL will redirect to the new one but sometimes those things fall apart.
One of my favorite combinations within the multi-verse is to take visionary work and combine it with the urban realities that make up real life for most people. It's a necessary exercise to, now and then, step away from the elevated way nature of visionary experience and come back to the inclusionary bond that is all life. Tony Moss stops by the kitchen table to beautifully articulate how his 22 years of entheogenic work has led to profound realizations on the systemic problems of our culture and how to address them with grace. He's not coming to the table with dogmatic firm answers but rather with wonderfully poetic points of view that will open your heart up to asking the right questions. Tony is a wonderful ambassador for the shamanic arts, musicians and entheogen advocates.
"I am a artist, recording artist, and event producer influenced by 20 years of entheogenic study. My work is a synthesis of my interests in art, spirituality, and science, with passionate emphasis & interest in the evolution of human consciousness and greater under-standing and reverance for nature.
I've been called a mystic and a rationalist.
Whatever you think reality is. That's not it. That's why these practices are so important. They are methods which can pierce the veil which then allows us to view things as they really are. Yoga, meditation, kirtan, psychedelics, making art, whatever..they all reveal the same a-ha moment. It's just that those moments are short and fleeting. That's why we do them regularly.The true value in any practice is the remembering, the taking it with you in everything you do. The Gita defines it "as remembering Krishna in every action you perform." When you do that, this thing we call reality has more meaning and can certainly be a lot more fun to play around in.
Two of the great ambassadors and talents from the mantra music world stop by the kitchen table to discuss the origins of the universe and the very meaning of life! Not really but it sure seemed like that. But we did talk about the Chant4Change project going on in Washington DC on 10/08, the practice of Bhakti Yoga in the west, the power of sound, the essence of mantras and how to find a deeper connection no matter what faith you do or do not belong to.
Gaura Vani is a multi-disciplinary artist – fluent in music, film and visual arts. He is most known for his Mantra Music performances (an emerging genre based on ancient Indian mantras or chants). Gaura Vani's events are unifying and transporting – a mix of participatory rhythm and song, story and dance. He travels often to Africa, the Americas, Europe, Asia and Australia performing both as a solo artist and with his sacred music ensembles Sita & the Hanumen and As Kindred Spirits. Gaura Vani performs regularly at eclectic venues like private homes, theatres, temples, yoga studios as well as festivals like Lollapalooza, Bhakti Fest and Wanderlust.
Benjy Wertheimer is award-winning musician, composer, vocalist and multi-instrumentalist equally accomplished on tabla, congas, percussion, esraj, guitar, and keyboards, Benjy Wertheimer has performed and recorded with such artists as Krishna Das, Deva Premal and Miten, Jai Uttal, Walter Becker of Steely Dan, virtuoso guitarist Michael Mandrell, tabla master Zakir Hussain, and renowned bamboo flute master G. S. Sachdev. He has also opened for such well-known artists as Carlos Santana, Paul Winter, and Narada Michael Walden. Benjy is a founding member of the internationally acclaimed world fusion ensemble Ancient Future.
The Book of the Month selection is "The Journey Within" by Radhanath Swami. There really is no equal for this book in that there's nothing else like it out.
It's a step by step breakdown of the practice of bhakti yoga with as little dogma as possible. If you're new to the path of yoga or an old time practitioner, this book gives new light to the origins and depths of these practices. Highly recommended reading.
As I travel through the urban sprawl and colorful cultural montage that is mid-city LA I come to a huge Victorian style house where Charles Shaw, the king of the new generation of gonzo-journalism is staying. This is where we do our podcast. Charles and I sit in a sweaty musty corner of this amazing artist complex maze and discuss a wide array of conspiracy theories, reality theories, political contradictions, personal roadblocks, the global security threat and how our own personal relationship got off on the wrong foot. I don't agree with everything Charles says but he is wonderfully intelligent, seductively articulate and exhaustingly well researched. I can't wait for the next one!
Charles Shaw is the author of the critically-acclaimed memoir, "Exile Nation: Drugs, Prisons, Politics & Spirituality" (2012, Counterpoint/Soft Skull Press) and the Director of the documentary films, "The Exile Nation Project: An Oral History of the War on Drugs & The American Criminal Justice System" (2011), "Visurreality" (2013), "WHITE PANTHER: The Legacy of John Sinclair" (2013) and "Exile Nation: The Plastic People" (2014 Cinedigm Films: Executive Produced & Narrated by Edward James Olmos). He is currently in post-production on SOLDIERS OF THE VINE, a documentary series about healing war trauma with plant medicine.
His work has appeared in Alternet, Grist, Guardian UK, Huffington Post, openDemocracy & The New York Times. He was a contributing author to Planetizen's Contemporary Debates in Urban Planning (2007, Island Press). In 2009 he was recognized by the San Diego Press Club for excellence in journalism.
He is the former Editorial Director of Conscious Enlightenment Publishing (Conscious Choice, Common Ground, Whole Life Times, and Seattle's Conscious Choice), and the founder and publisher of Newtopia, former head writer for the nationally syndicated radio show Reality Checks.
He holds a BA in English and Creative Writing from Boston University. A native of Chicago, he lives on the West Coast.


More than 100 people came out on a cold Tuesday night to the Durham County Human Services building downtown. City and county leaders gave a brief overview of government services before small groups discussed what they want for Durham's housing, health and transit future.
Better customer service on buses.
Light rail sooner rather than later.
Safety for bikes and pedestrians.
Safety for children riding buses.
Expand the Bull City Connector.
Multiple bus hubs with rides at 20-minute intervals.
City-supported co-housing, elderly housing and aging in place.
Raise tax for affordable housing.
Funds to renovate properties for affordable housing units.
Help people pay for home repairs and stay in their houses.
Streamline process for accepting Section 8 vouchers.
Understand what affordable housing means to different groups of people.
More attractive upkeep of affordable housing.
Help people stay in their homes.
Include public housing and low income housing when talking about affordable housing.
The phone tree prompt for "Spanish" to be in Spanish.
Weekend hours for social services.
More mental health providers in schools.
Expand access not just on the internet.
Access to home delivery of nutritious food.
Each table was led by a government official, from Durham County Commissioner Brenda Howerton to Durham Ciy Council member DeDreana Freeman. City and county staff were spread throughout. After more than an hour of table talk, the groups shared their lists of what they want the city and county to make priorities about each topic.
Mayor Steve Schewel said they would take the comments really seriously and use it for their budget and strategic plan.
The third and final "Community Conversation" is about education and jobs. It will be held at 7 p.m. Feb. 6 at Brogden Middle School.


text:
Q: Interviewing Process (using blank paper etc)
Possible Duplicate:
What are the pros and cons for the employer of code questions during an interview?

I am curious to know why do companies hand you a blank paper and ask you to write code? This confuses me, because these days intellisense, google, stackoverflow etc are common sources to look up syntax and / or IDE gives you a colored indicator if your syntax is wrong.
I usually get stressed out during these situations. I am curious to know opinions of other developers. I am posting this on this forum, hoping to get helpful feedback from other experienced developers.

A: I think they are not so interested in checking your syntax but the logic that are trying to put. They need problem solvers and it is important to know what approach you are trying to implement to solve a problem. Correct syntax would be a plus but not necessarily what they are looking for.

A: Speaking from experience on having been on the interviewee and interviewer side of things: Problems where you're asked to use a piece of paper or white board is done because your potential employer essentially wants to know two (2) things about you:

*

*Are you a problem solver? It might sound elitist and harsh but if you can't solve my problems then why should I hire you?

*Are you able to communicate well about how you solve a problem? You will be working together with a team, the management and sales. Failure to communicate is problematic in a team environment, there are a lot of times during software crafting/development where making one solution may wreak havoc on another. I can't stress enough how important a simple chat would've saved you and your team from dealing with the havoc and come up with an even better solution.

When the problem you're given is done right by the interviewer then you should be able to answer some questions and solve problems without the need of IDE's or other tools. Usually the problems you're given should be answerable regardless of intellisense/autocomplete knowledge as they won't help you anyway on software and algorithm design anyway, so it is a bogus statement if anyone tells you otherwise as those tools only aid your productivity. I wouldn't be surprised if candidates that complain about the lack of IDE are red flagged as copy-and-paste/wizard users rather than "real" coders/programmers.
So if you're in a situation where you have to write code then do the following:

*

*Take a deep breath. Get that blood circulating in your head.

*Focus on the problem at hand. Everything else is irrelevant.

*And whatever you do: Don't panic! Always assume good intentions. Just so you know: freaking out is a bad sign.

Usually you won't be gauged on syntax correctness anyway. As long as you know what variables, arrays, loops and conditionals are, you should be able to solve problems on paper. Bonus points if you can remember some computer structures and algorithms. Sometimes the interviewer might probe you on typos and it would help to recognize your own mistakes; in such situations just apologize, correct and move on.
And if you want practice, there is Project Euler... or you could just work on real problems writing real applications.

A: Few companies I know of are too particular about syntax. They don't expect you to write pseudo code, but they don't expect you to write syntactically flawless code either. Its to see you know what how to proceed.
If a company expects you to write compilable code on paper, its probably not a company you want to work for.

A: It shows how much you actually know.
Auto-completing intellisense / google / other sites - are just tools.
Although i must admit that knowing what to look for, and doing it fast is also a skill, it's a different one than what is required in that type of test.
A person who can write a program without looking it up first will usually be more productive because he's not wasting time looking for it.

A: Why?
Because too many people with nice looking resumes can't code their way out of a paper bag.
Also, there are people who maybe can code, but can't communicate what or why they are doing it that way, which is a big detriment in team coding situations.
And don't worry about punctuation coloring and the other stuff that the IDE can fix; because if it's someone you want to work for, that's not the part of the answer in which they're really interested.

A: Because I want to know if you can go up to the board during one of our brainstorming sessions and convey your ideas to the rest of the team.
I don't even care if you know how to spell your name, as long as you can get up in front of the team and convey your ideas to the rest of us.

A: This could be percieved as a good way of identifying the candidates true understanding and experience of a language.
Im not a fan however, programmers today use IDE's and tools because they improve productivity. If a candidate can do great things using just Notepad i wouldn't value them over someone who can do great things using intelisense, why would i?.
You may be the greatest digger in the world with a shovel in your hand, but i would hire the guy whos great with the excavator if i wanted to dig a big hole.
From personal experience though, im astonished at how many times ive tried to jot down solutions to simple problems and been stuck trying to remember basic syntax. It can be really good way of solidifying your understanding by trying "think in code".

redpajama_set_name: RedPajamaStackExchange


text:
Q: Possessive Noun Apostrophes I'm struggling a bit with an apostrophe question - I have the clause, "Using the example of the singer Michael Jackson's death", which I'm pretty sure isn't right as there should probably be a comma after "singer", but the apostrophe doesn't look right there either and I'm not sure how to handle this. Thanks in advance.

A: Everything you have there is correct.
Not sure why it doesn't look right to you, but it is right.


text:
Portuguese mine starts exports of iron ore to China
| China | Portugal
Aethel Mining Ltd has begun exporting to China high-density iron ore from its mine in Torre de Moncorvo in northeastern Portugal, the first order being for 50,000 tonnes, Lusa reports, citing Aethel President Ricardo Santos Silva.
The report quotes Mr Santos Silva as saying last week that the deal struck by Aethel and its Chinese customer is very attractive, owing to the market price for iron ore having risen to about US$170 a tonne.
Mr Santos Silva said Aethel had hired 50 trucks to carry to the northwestern port of Leixões each day for six weeks 50 to 60 loads of between 24 tonnes and 28 tonnes of ore.
The company expects to begin within six months sending iron ore to Leixões by train or barge, Lusa quotes Mr Santos Silva as saying.
(Source) Permanent Secretariat to the Forum for Economic and Trade Co-operation between China and Portuguese-speaking Countries (Macao):
https://www.forumchinaplp.org.mo/portuguese-mine-starts-exports-of-iron-ore-to-china/
Non-oil sector receives funding of US$200 million from Banco de Desenvolvimento de Angola
Odebrecht Angola awarded US$268.2 million project
China-Brazil trade rises 54 percent in August and exceeds US$2 billion
Most of Angola's leading companies will be privatised by 2020
Angolan central bank may reduce benchmark interest rate again in 2019


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text:
Congratulations Jaimie Fox, named a Top 50 Technical Visionary by Intercon
by Contributed | Jun 22, 2021 | Technology | 0 comments
Claire Bonaci
You're watching the Microsoft US health and life sciences, confessions of health geeks podcast, a show that offers Industry Insight from the health geeks and data freaks of the US health and life sciences industry team. I'm your host, Claire Bonaci. Hi, Jamie, and welcome to the podcast.
Jaimie Fox
Oh, thank you. Thank you for having me today. Claire, I'm very excited to speak with you here today.
I'm really excited to hear a little bit more about your journey. So you were named a top 50 technical visionary by Intercon. Talk to me just a little bit more about how you have been so influential as that technical visionary.
So I'm very proud of winning this award of the tech, top 50 technical visionary by intercon. I'll be headed to Las Vegas the week of June 21. To pick up this award. I've been doing a lot of interesting, cool meaningful work over the last few years. But primarily I've been the ATS for a large EMR company and we've been helping them leverage the Microsoft clouds. I've been doing this since the end of 2014. And currently, we're helping them build their mission of building a connected community of health. Over the years, we've helped them modernize their offerings and bring new cloud born solutions to market and for their clinical applications as well as their payer Life Sciences application. Currently, we're helping them build a broad next generation platform of health that we're very excited about myself and the account team. However, in addition to working on this one customer as an ATS, which is my day job, I take on a few extracurricular projects I get very excited about and very proud of. For one, I co founded and co lead the SQL Server user group in New Jersey since 2012. with Linda Zhang who is a CSA on our national team, we do this together where we feel that we provide free technical education to our local community, leveraging resources that Wendy and I have access through through Microsoft. So it's a little bit of sharing with a broader public community where we have access. So we've been doing that for almost 10 years or almost nine years, I should say. Additionally, I also help provide guidance to several advisory boards, including a few Microsoft partners, which is a startup out of Israel that doesthat that cybersecurity and plugs onto our EMF E5 really nicely and another firm called divergent which is a systems integrator on Microsoft systems integrator focused on healthcare. Last year or the year before, I was also on the Rutgers University's disruptive innovation program advisory board. And it was always a lifelong ambition of mine to teach at the college level. And through this, I was able to be a guest lecturer through my involvement at Rutgers. So I was able to check the box and say, Yes, I have taught at a college and in one way man or fashion did additionally I'm also very active in our local hinze and hfma chapters, and been on the board of New Jersey and for the past year. And that's been great, because I've met very interesting people, I've had the opportunity to amplify education and the local healthcare community evangelize Microsoft, and especially hosting a few industry events at our New York office. At the end of the day, I really enjoyed making an impact across the industry and seeing how someone like me, just kind of that suburban kid from New Jersey, can positively influence others. This is developed as a passion and a calling that is very fulfilling, because I really do enjoy helping others with their development and as such a large scale.
Well, Jamie, it does seem like you really deserve this award. I don't know how you have, you know, so much time in the day to get everything done, I can't believe you're doing so much. And you know, you've you've always described yourself as that very shy, kind of suburban humble kid from New Jersey. So what has really enabled you to do all of this, to put yourself out there, and to get this award and do so much with your time.
But time management is always a challenge. I have a family. And you know, Microsoft keeps me busy with my day job. But I just enjoy this so much it's developed into a hobby. So with most things that are hobbies, you make time for them outside of your normal working hours or even family time. The way I was able to just do this and find it inside of me, just pushing myself and knowing there's more to life by watching others in the world. You know, it's better than just working a nine to five job raising a family, which is great. You know, a lot of us do that. And that's kind of like the table stakes that you have to first achieve. But after that I was like how else can I make a huge or a very large impact in the world even though I'm shy and I'm quiet. I've never really had any special upbringing for this. I just continue to push myself. And by gaining a lot of experience in my adult life, meeting many people and traveling I just thought there was more to life happiness and passion than what I previously expected and thought and said, you know, why can't I do that? You know, I see other people doing this. What's it gonna take for me to do that and when it was interesting to my journey was, every time I did something, I was so happy and proud and satisfied. And that led me to say, so what's next and what's next. And over the course of time, you know, like I said, I'm very motivated by making an impact in the world, the impacts have gotten larger. And here's a few examples of what I did. As an example, like before I worked at Microsoft, I enjoyed intending attending the SQL Server user groups, and never thought I could speak at one. But you know, with the help of Microsoft and pushing myself and really having a lot of self reflection, not only I speak at a user group, and then at Tech ready, but now I'm co leading user group with Linda, and I help others run their own user groups and events. And I've turned into a mentor for user group leaders. Nevermind just barely speaking at one. Another great story, I think this is kind of almost funny. When I first spoke at Tech ready in 2009, I did so horribly, I had no energy as a presenter. And the feedback was rough. You know, how we had tech ready and ready and all these events that you have to fill out the feedback. The feedback on me swear to god was Jamie probably shouldn't speak again, a tech ready, that was 2009. And you know, it's kind of devastating to see, like, while you're kind of really that bad, right? But then we fast forward to 2016 2017, I spoke at Tech ready again. And I had the highest rated BI chalk talk at Tech ready in 2016, the summer of 2016. And then I also did a promo video for convolve. So this is just a great example of not giving off and persisting in my evolution and wanting to make an impact and grow, right. So you have a small setback, you just have some self reflection, what can you do better next time and you keep keep swinging the bat and go for another at bat?
Well, that's so true. And I love that you're so motivated, you know, you keep you keep yourself going. And the motivation. It really it's contagious when talking to you, Jamie. So as you said, you know, what are what are your plans? What are you going to do next? What are you thinking about for the for the future?
So one thing is, I think one thing that really motivates me is that I get bored easily, like if there's nothing to do, and on a Saturday afternoon, I hate just sitting around the house watching TV, I always have to have something to do. So I think that's what really motivates me. Like he said, Oh, I'm always busy doing something. But yeah, I'm going to continue to find new things to contribute to scale, my influence in healthcare and other professional passions. I'm a big data guy grew up at Microsoft as a data data consultant in MCS, I was a data platform TSP. So I really enjoy data. I enjoy healthcare, I love seeing how I brother can help others across the industry. I recently I invested in an AI sports startup called artistics, that I'm helping grow, which combines my passions for tech for data and ice hockey, which I love. I played as a kid and now I coach my son, I'm a certified USA hockey coach. Go Islanders, they're doing really well on the playoffs this year. This year, I continue to look for more organizations to contribute to such as the hims is in the hfma is now trying to be more active and shine. I want to take on some small extracurricular projects that I have had a large impact in such as helping my friend organize a simple Saturday event for the country of Haiti. That was conducted in three languages back in March. I personally have no ties to Haiti, I had a friend who a kind of mentor through the user group, and said, You know, I'm Haitian, I'd love to give back to my community in Haiti, can you help me just figure this out. And I kind of mentored him through this, and we had a very successful sequel Saturday. I just love working on complex large scale ideas and keep my eyes open to create more opportunities to keep doing this.
That's great. I mean, you're doing so much, and it sounds like you're gonna continue doing more and more. So I'm really excited to follow up with you in a few months and see what else you've accomplished. So I guess you know, what, last few minutes, what advice would you share with others.
Just keep your passion. Just use your passion, keep your passion, keep pushing yourself forward. My father was very influential on me, he always would push me to, he would push me to put myself out there more. To do more with my life. I was the first in my family to graduate college. My mom's an immigrant. I grew up from a very insular family. So I think my parents a little bit pushed me to just do more, whatever that meant. And then once I got out in the world, I just saw that, hey, there's things that everyone's passionate about, and just continue following your passion. You know, my advice for people is to search inside themselves for their passions and ambitions, and determine how to express them for the betterment of themselves and others. The other thing that I think is important is just self reflection. Took me a good, good amount of time to do self reflection. And it changes over time. It's a progression. What I was thinking about five years ago about myself 10 years ago, 20 years ago has changed. So I think putting some time in to really reflect on yourself is very important. It's an evolution that took time to get to where I am today, and there's no doubt I will continue to evolve through my life.
Great. Well, thank you so much Jaimie. I think that is great advice for anyone listening and I definitely I think I'll be implementing that myself as well. So thank you again for being part of the podcast and I'd love to follow up with you in the future.
Great. Thanks, Claire. Thanks for having me.
Thank you all for watching. Please feel free to leave us questions or comments below and check back soon for more content from the HLS industry team.