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HomeSports & RecreationOutdoor & Indoor SportsTrekking-poles help reducing muscle soreness after trekking
Trekking-poles help reducing muscle soreness after trekking
Most adventure lovers would be familiar with the thrills of trekking. Experts at Northumbria University claim to have found that hikers could make use of trekking-poles as it would help them control muscle function. It would also reduce soreness in the days after a hike. This would ease the trekking experience of many adventure lovers. They also observed the effectiveness of trekking poles in the environments for which they were designed.
A study was conducted on 37 physically active men and women. They were split into two groups depending on their similar fitness levels. They were asked to go up and down Snowdon, the highest mountain in England and Wales. One group was asked to hike with the help of trekking poles and the other group was asked to hike unaided. Both the groups were put in similar situations like they carried similar weight in day packs, took similar scheduled rests during both ascent and descent. They also consumed the same evening meal on the night before and ate the same breakfast.
Heart rates and their personal perceived exertion ratings were tracked as the participants were hiking. At the end of the hike, and after 24-, 48- and 72-hour intervals, muscle damage and function were examined through varying tests. The analysis revealed that there was notably less muscle soreness in the group using trekking poles. It also revealed that this group exhibited reduced strength loss and a quicker recovery as soon as the group completed their trek as compared to the control group.
It was also observed that self-rated soreness was at its highest at 24 hours but it significantly reduced in the trekking pole group both at the 24 hour point and at the 48 hour point. Further it was identified that levels of the enzyme creatine kinase, which indicates muscle damage were greater at the 24 hour point in the non-pole group and on the other hand it was close to the pre-taking levels in the trekking poles group. This signified that the muscle damage they experienced was negligible.
"The results present strong evidence that trekking poles reduce, almost to the point of complete disappearance, the extent of muscle damage during a day's mountain trek," says Dr Glyn Howatson, who conducted the study. "Preventing muscle damage and soreness is likely to improve motivation and so keep people enjoying the benefits of exercise for longer. Perhaps even more advantageously, the combined benefits of using trekking poles in reducing load to the lower limbs, increasing stability and reducing muscle damage could also help avoid injury on subsequent days trekking. It is often the reduced reaction time and position sense, associated with damaged muscles that cause the falls and trips that can lead to further injury in mountainous or uneven terrain."
He further said that these findings have a strong impact on exercisers who wish to engage in consecutive day's activity in mountainous terrain. Trekking poles are anticipated to reduce pressure on the lower-limb joints as much as 25 percent inform pole manufacturers. Despite this the latest study is bound to laboratory or to non-mountainous outdoor settings namely running tracks. The study has particularly focused on biomechanical investigations about the stress on the ankle, knee and hip.
These findings indicate that muscle damage and soreness may be reduced. Hence we hope that trekking poles may help have a delightful trekking experience.
SOURCE: healthjockey
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Are you giving birth soon? Do you want to make sure you and your home are ready for the arrival of your baby? Here is a list of essentials to assist you in your daily routine with your new baby.
Are you wondering what you should buy to bathe your baby comfortably? Here is a list of all the things you'll need for bath time!
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Being pregnant also means you can't have that cocktail you usually indulge in. Here are some recipes and non-alcoholic beverages you can enjoy instead!
The Holidays are often synonymous with excesses of all kinds. But can we actually reduce our impact on the environment at Christmas? Here are some tips to help you out... keep these in mind for the next holiday season!


Fluffy Gluten Free Waffles | Great gluten free recipes for every occasion.
The perfect fluffy gluten free waffles made with yogurt and just a touch of sugar, with a lightly crisp outside.
Is it pancakes all the way for you, or are waffles more your style? In my family, when I make pancakes I'm kind of a hero. But when I make waffles, my kids practically throw me a ticker tape parade. I'm thinking it's the built-in syrup cups in waffles?
The main difference between waffles and pancakes is in the method. When making gluten free waffles (or any waffles, for that matter), the eggs are separated and the whites are beaten separately before being folded into the rest of the batter.
I've been making a variation of this recipe for years, and I always take the extra few minutes to treat the eggs just right.Although the yolks beat best at room temperature, it's easiest to separate eggs that are still cold. I recommend separating the eggs when they're cold, then letting the yolks sit for a bit if possible.
But do beat the whites. Even dense waffles will have those lovely syrup pockets, but they won't be crips on the outside, soft and fluffy inside. If you're breaking out the waffle iron, let's go all the way.
There aren't too many ingredients in this recipe, but the plain yogurt is really important. Oh, and in my experience waffles work best with oil instead of butter, as oil is nearly pure fat and butter has a fair amount of water in it. It makes for much neater waffle-iron-cooking.
If you're a perfectionist, you'll want each and every waffle to be a perfect shape. For Belgian waffles, that means the whole circle, and not a 'cup' missing. For square waffles, that means no rough edges.
Made with the flour blend as directed, you can spread the batter all the way to the edges of the mold without worrying that it will pour out during cooking. If you use one of my all purpose gluten free flour blends instead of the gum-free blend as specified, the batter will be much, much thicker and will expand quite a bit more during cooking.
Leave a 1/4-inch clean border around the edge of the iron. I really do recommend using the blend specified in the recipe, though. The batter is much simpler to work with, and the waffles are even fluffier.
For the fluffiest waffles, be sure to blend the oil and egg yolks first until creamy before adding the other ingredients, and then folding in the whipped egg whites.
I've tried many, many waffle makers over the years, and I've finally settled on two favorites.
For Belgian waffles, I'm partial to the Presto Flipside Waffle Maker (aff. link). It cooks very evenly and as long as there's a light coating of oil, the waffles never stick. And the price is very fair.
For traditional square waffles, I absolutely love the waffle maker I bought years ago at Kohl's, but I'm sorry to say that they don't sell it any longer! It's The Food Network brand, and I've loved everything I've ever bought under that label. There are recommendations in the links below. And if you have a favorite square waffle maker, please tell us about it in the comments!
Preheat and prepare your waffle iron according to the manufacturer's directions.
In a large bowl, place the flour blend, xanthan gum, sugar, baking powder, baking soda and salt, and whisk to combine well. In a separate bowl, whip the egg whites with a hand mixer (or in a stand mixer fitted with the whisk attachment) until stiff (but not dry) peaks form. Place the egg yolks and oil in a separate large bowl and blend with a hand mixer (or in a stand mixer fitted with the paddle attachment) until creamy. Add the yogurt and milk, and blend until well combined. Add the dry ingredients, and blend again. The mixture will be smooth and thickly pourable. Fold the beaten egg whites gently into the large bowl of batter until only a few white streaks remain.
Pour or scoop about 3/4 to 1 cup of batter into your prepared waffle iron (more or less depending upon the size and shape of your iron), and spread the batter into an even layer. Close the lid and cook until steam stop escaping from the waffle iron, between 4 and 5 minutes, depending again upon the capacity of your waffle iron. Remove the waffle from the iron and serve immediately. Repeat with the remaining batter.
If you do not serve each waffle as soon as it is made, refresh the waffles by placing them in a toaster oven at 400°F for about 3 minutes. Waffles can also be cooled completely, wrapped tightly and frozen, then defrosted and refreshed in a similar manner before serving.
First published on the blog in 2013. Recipe updated slightly (recommended flour blend modified), photos replaced, video added 2017.
I have a square Von Shef waffle maker. It makes great waffles using your recipes. Even the churros waffles. I have even made Potato waffles in it.
I'm so bummed, I just made them and they were very heavy and didn't cook well (spotty brown, and dough like inside).
Just can't think of what happened if everyone else did well.
DCP, did you measure your ingredients by weight, and use the flour blend I specify? Most likely, one or both of those is your issue. You can't use just any flour blend. They are not created equal!
Wow! The Fluffy Gluten Free Waffle recipe is THE BEST gluten free waffle recipe I have tried. The waffles are delicious. I used fat free plain Greek yogurt. I appreciate you providing the specific weight of the ingredients for the gluten free flour blend so I could mix my own for the recipe. Thanks Nicole.
Hey Nicole! I'm allergic to any and all dairy, and I miss waffles terribly. Could I use a coconut milk yogurt for these? And would ghee be all right instead of oil? It has all the water boiled out of it and is basically pure fat, just with much more flavor than the oil has.
Super yummy! Like the updates. Made them for breakfast and they disappeared.
Hi, Fazzy, I don't provide nutrition information. Feel free to use any of the online nutrition calculators. That's all I would do, too!
I am also a newbie of the gluten free diets. I cannot have tapioca, is it possible to substitute the tapioca for arrowroot flour in the flour mixture? Thanks!
Hi, Julie, I'm afraid not, generally. Tapioca is a very particular starch, and it's very hard to replace. You can try superfine sweet white rice flour, but I'm afraid I can't promise results!
Newbie question here – what is accomplished by getting ingredients to room temperature before mixing? Or put another way, if one were to decide to whip this together at the last minute one morning without letting the ingredients come to room temp first, what would be the result?
p.s. thanks for this site and your books – I've found them to be one of the best for quick, simple, and *affordable* GF recipes!
I'm thinking my family will be demanding a taste-off between the two versions. They do love that other recipe!
In the first part of the directions you mention to beat the egg yolks until stiff peaks form, I'm assuming that's a typo? Also (sorry) is the fat content of the yogurt important in this recipe? I ask as we eat lots of fat free greek yogurt, so I happen to have it on hand.
Personal note. I've become a HUUUUUGE fan of your site, your recipes and your cookbooks. They've made switching to a GF diet a "piece of cake".
PS–Cannot WAIT for your bread book!!!
Yes! That's a typo! Thank you for catching that so early on, so no one is confused. Fixed it!
I'm so glad my recipes have been helpful (and I love a good (or even bad) pun, so thanks for that). Thank you so much for your support of the books. It means so much. About the yogurt, the reason I specify whole milk yogurt is because the recipe has very little oil and lack of fat can make them rubbery. And Greek yogurt is too thick. You'll either need to experiment by adding more milk, or use regular yogurt!
Gracias! Regular yogurt it is! I'm going to make these for weekend brunch! Thanks again!
Could you substitute rice milk for both milks and egg replacer for the eggs?
Egg replacer will not work for the eggs, Sandra, as the egg whites must be beaten. I haven't tested the recipe with a nondairy milk sub, so you'll have to experiment.


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The High schooler
'No candidate would miss their exams' – WAEC speaks on timetable clash with JAMB
The West African Examinations Council (WAEC) has assured that no candidate would miss their examinations as the Unified Tertiary Matriculation Examination (UTME) begins…
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UNILAG, SAF encourage students to embrace science subjects
Over 1000 primary and secondary school students have been encouraged to take science seriously and change the world with the use of science…
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redpajama_set_name: RedPajamaCommonCrawl


Little Monsters Comes To You!
What makes Little Monsters so different?
Little Monsters is a distinguished all-inclusive dog care service & training provider.
Seeing the smiles on our clients' faces and joyful wagging tails fill our hearts with joy! That's why Little Monsters is proud to present our clients with the highest quality dog care services. All of our services are tailor-made for you and your dogs. Our services include dog training, in-home care and check-ins, supply runs, vet visits, hotel dog sitting, residential poo-scooping, and everything in between. Our unique training method takes a dog-natural approach: teaching you dog psychology and how to speak and understand their language. To reduce stress and travel time, Little Monsters comes to your home to provide top quality, professional services. Gifting dog parents with more time to simply love on their fur-babies, without the added stress, is why we do what we do. We invite you and your little monsters to be a part of our pack!
Is to enrich the lives of dog parents and their fur-babies by providing top quality tailor-made services and a natural, integrative approach to dog training.
Being a dog-parent has been one of the greatest joys of my life. Working with dogs and helping dog-parents live a relaxing love-filled life alongside their fur-babies is my passion. Combining my degree in Industrial Organizational Psychology, background in business, and love for animals has allowed me to transform this passion into a reality. I started Little Monsters after adopting two of our fur-babies. My husband and I started our little fur-family with Bailey, a rescued lab mix who was severely abused. Bailey deepened my compassion and sparked the interest in learning about dog psychology and training. Bailey ended up connecting with my mom on a deeper level and became her service dog. A year later, Andrew and I adopted our second fur-baby and little monster, Chloe.
Γειά σας! Με λενε Χλόη. Hello! My name is Chloe. My mom and dad adopted me from the country of Cyprus, while they were there as missionaries. I'm what the humans call "a really cute mutt" (whatever that means). Two of my favorite things to do are cuddling with my mom and playing, especially now that I have a little (big) sister! I love to play with big dogs and little dogs, big humans and little humans! But most of all, I love my family and helping my mom out with her job whenever I can. I've also been training to become a therapy dog and I am really excited to be able to help others! My mom is always teaching me new things, encouraging me to grow, and wanting the very best for me. I hope you become a part of our pack and get to experience the love she has for others!


This campaign ended on December 31, 2017, but you can still make a gift to University of Southern Maine by clicking here!
USM has created two new School of Music scholarships* named to honor two of our legendary music professors, Dr. Peter Martin and Dr. Robert Russell.
We're working hard this fall to raise the $40,000 needed ($20,000 for each fund) to ensure both scholarships become fully endowed. But we've only got until December 31st to make this happen. That's why we need YOU! One of the ways you can support USM's music program is by donating any amount to either (or both!) of these scholarship funds before the end of December to honor these two great educators.
As the School of Music grows, one of our biggest priorities is to ensure that the quality music education we offer remains accessible to deserving students whose means are limited but whose talent and ambitions are limitless. Supporting these two funds and the legacy of these two outstanding music educators, is one way you can help USM do that.
* Your gift will provide scholarship support to USM music majors. The intent is for both scholarship funds to become permanently endowed. However, if the total raised to either fund does not reach $20,000 in gifts or pledges by December 31, 2017, the Fund will be a non-endowed fund, with the purpose stated above and expended over several years.


Nature Biotechnology. 2012 Jan 22;30(2):174-8. doi: 10.1038/nbt.2095.
Genome sequencing reveals agronomically important loci in rice using MutMap.
Abe A, Kosugi S, Yoshida K, Natsume S, Takagi H, Kanzaki H, Matsumura H, Yoshida K, Mitsuoka C, Tamiru M, Innan H, Cano L, Kamoun S, Terauchi R.
Copyright© 2014 Cift Corporation All Rights Reserved.


Abstract: An extensive empirical literature has documented that workers with high tenure suffer large and persistent earnings losses when they get displaced. We study the reasons behind these losses in a tractable search model with a life-cycle dimension, endogenous job mobility, worker- and match-heterogeneity. The model reconciles key characteristics of the U.S. labor market: large average transition rates, a large share of stable jobs, and the earnings losses from displacement. We decompose the earnings losses and find that only 50% result from skill losses. Endogenous reactions and selection account for the remainder. Our findings have important implications for the welfare costs of displacement and labor market policy.


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PlayStation 5 Release Date and Pricing Revealed
Posted on Published: September 16, 2020
Sony Interactive Entertainment (SIE) today announced the PlayStation 5 release date and price details (pre-order the PlayStation 5 at Amazon). SIE also revealed new updates to the PS5 game portfolio, including Final Fantasy XVI, Fortnite, Hogwarts Legacy, and a new God of War title.
On November 12, PS5 will launch in seven key markets: the U.S., Canada, Mexico, Australia, New Zealand, Japan and South Korea. The global rollout will continue on November 19 with launches throughout the rest of the world, including Europe, Middle East, South America, Asia and South Africa.
The PS5 Digital Edition will be available for a recommended retail price (RRP) of $399.99/¥39,980/€399.99, and the PlayStation 5 with an Ultra HD Blu-ray disc drive will be available for an RRP of $499.99/¥49,980/€499.99.
Both PS5 models use the same custom processor with integrated CPU and GPU for high-fidelity graphics up to 4K, as well as the same ultra-high speed SSD with integrated I/O that will deliver lightning-fast loading. Both PS5 models also offer a deepened sense of immersion through the DualSense wireless controller and 3D audio capabilities, so players will enjoy the same transformative gameplay experiences regardless of which PS5 they choose.
"Since we first announced our next generation console last year, we have received astounding support from developers and gaming fans all around the world, and it's truly humbling," said Jim Ryan, president and CEO of Sony Interactive Entertainment.
"Now we are just a couple of months away from launching PS5, which will offer a new generation of experiences that go beyond players' expectations of how games can look, feel, sound, and play. We can't wait for our fans to experience for themselves the incredible speed, the heightened immersion and the breathtaking games on PS5 when we launch this November."
In addition to the PlayStation 5 release date and pricing, SIE today also unveiled several new titles coming to the new console:
Devil May Cry 5 Special Edition (Capcom)
Final Fantasy XVI (Square Enix)
Five Nights at Freddy's Security Breach (Steel Wool Studios and ScottGames)
Hogwarts Legacy (Warner Bros. Games)
A new God of War title (Santa Monica Studio)
With titles such as Marvel's Spider-Man: Miles Morales, Call of Duty: Black Ops Cold War, and Demon's Souls, the breadth of unique gaming experiences coming to PS5 represent the best lineup in PlayStation history. Exclusive titles from SIE Worldwide Studios will be priced at launch from US$49.99 to US$69.99 (RRP) on PS5.
To support the PlayStation 4 community as they transition to the next generation when they're ready, SIE will launch PS4 versions of a few exclusive titles: Marvel's Spider-Man: Miles Morales, Sackboy A Big Adventure, and Horizon Forbidden West. While these three games were designed to take advantage of PS5 and its unique next-gen features like the ultra-high speed SSD and DualSense controller, PS4 owners will also be able to enjoy these experiences when they launch.
The PS4 digital versions of launch games include a free upgrade on both PS5 consoles, while the PS4 disc versions of these games include a free upgrade on the PS5 with Ultra HD Blu-Ray disc drive.
In addition, SIE today revealed the PlayStation Plus Collection, a curated lineup of PS4 games that defined the generation, which will be available to PS Plus members to download and play on PS5. The PS Plus Collection features critically acclaimed games, including Batman Arkham Knight, Bloodborne, Fallout 4, God of War, Monster Hunter: World, Persona 5 and many more.
SIE also announced the price for the following accessories that will launch alongside the PS5 console:
DualSense Wireless Controller (standalone) – US$69.99/¥6,980/€69.99 (RRP)
PULSE 3D wireless headset – with 3D audio support and dual noise-cancelling microphones US$99.99/¥9,980/€99.99 (RRP)
HD Camera – with dual 1080p lenses for gamers to broadcast themselves along with their epic gameplay moments US$59.99/¥5,980/€59.99 (RRP)
Media Remote – to navigate movies and streaming services with ease US$29.99/¥2,980/€29.99 (RRP)
DualSense Charging Station – to conveniently charge two DualSense Wireless Controllers US$29.99/¥2,980/€29.99 (RRP)
PlayStation 5 Launch Day Games from SIE Worldwide Studios;
Astro's Playroom (Japan Studio) – pre-installed on PS5
Demon's Souls (Bluepoint Games / Japan Studio) – US$69.99/¥7,900/€79.99 (RRP)
Destruction AllStars (Lucid Games / XDEV) – US$69.99/¥7,900/€79.99 (RRP)
Marvel's Spider-Man: Miles Morales (Insomniac Games) – US$49.99/¥5,900/€59.99 (RRP)
Marvel's Spider-Man: Miles Morales Ultimate Edition (Insomniac Games) – US$69.99/¥7,900/€79.99 (RRP)
Sackboy A Big Adventure (Sumo Digital / XDEV) – US$59.99/¥6,900/€69.99 (RRP)
PlayStationPlayStation 5Sony Interactive Entertainment
Final Fantasy XVI Announced for the PlayStation 5
ABC Orders Erin Brockovich-Inspired Drama Rebel


text:
Brain and Body
Animal Testing on Chimps is Over For Good in the US, N.I.H Declares
November 25, 2015 | Kelly Tatera
Photo credit: pixabay.com
Now there's only one country left in the entire world where it's legal to perform invasive tests on chimpanzees.
In the recent years, the only two countries in the world who legally used great apes for invasive scientific research were the United States and Gabon, a country in Central Africa. But thanks to some wonderful news announced by the National Institutes for Health (NIH) last Wednesday (November 18), invasive research on chimpanzees will no longer be permitted in the United States.
(Invasive research includes any type of biomedical testing where the chimp is injected or cut into. However, the recent decision shouldn't affect behavioral and cognitive research on chimps.)
In 2013, the NIH made a controversial decision to retire all but 50 of its research chimpanzees to animal sanctuaries. However, in the two and a half years following that decision, there has barely even been any interest in using the chimps for research, and no proposals have moved forward, according to Dr. Francis S. Collins, the director of the NIH, during a news briefing with reporters. Consequently, the institute decided to retire the remaining 50 animals, effectively putting an end to biomedical chimp research.
ALSO SEE: Judge Denies Chimps Legal Rights
In an interview with Science, Collins said, "I think it is the natural next step in what has been a process over the last 5 years, really, of deep thinking about the appropriateness of research on our closest relatives, the chimpanzees."
An announcement in June thickened the plot. The U.S. Fish and Wildlife Service (FWS) listed research chimpanzees as "endangered," matching their status to that of the other chimps living in the wild. Scientists would thus be required to obtain a permit in order to use any of the captive chimps for invasive research. Additionally, the researchers would have to show that their studies would benefit chimpanzees in the wild in some way.
Due to the CHIMP Act of 2000, all federally-owned chimps must be retired in a chimpanzee sanctuary in Louisiana called Chimp Haven. The NIH plans to send over 300 more chimps there, including the 50 who have finally been given their freedom back. However, the process could take years, and the chimps will be kept in three federal facilities in the meantime.
A lot of care and effort will be put into the process to ensure the chimps live happily for the remainder of their lives. In fact, the NIH plans to move chimps together based on their family and social groups, also taking age and health into consideration.
"When in 2013 they announced they would release the majority of chimps, some people focused on the 50 that would be left behind," Kathleen Conlee, the vice president for animal research at the Humane Society of the United States, told the New York Times. "And I said, 'Don't worry, someday we will get them protected.' And today, we did."
While most people are elated that endangered lab chimps will be free from invasive research, Peter Walsh and his team of researchers at the University of Cambridge aren't as thrilled. He says it will be difficult for his team to test an Ebola vaccine for wild chimps, and his group had planned to do further trials before deploying the vaccine in Africa. Most people associate the Ebola virus with humans, but tragically, conservationists report that Ebola has wiped out a third of the world's chimpanzee and gorilla populations since the 1990s.
However, Dr. Collins is confident that biomedical research is moving past the point where invasive research on chimps is necessary to yield results. "We find no evidence that there is a need to continue to do research of an invasive sort on chimpanzees, not now and not going into the future," he said.
Now, it's time to let the research chimps enjoy the rest of their days in peace.
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House of the Dragon: HBO Max Crashes as Millions of Game of Thrones Fans Tune in for Series Premiere
The show's debut was plagued with technical issues.
Posted Aug. 22, 2022, 11:11 a.m.
Game of Thrones prequel House of the Dragon has crashed HBO Max. Millions of subscribers flocked to the app on Sunday for the series premiere, but many were unable to view it due to technical issues that affected at least 3,500 users.
As reported by The Hollywood Reporter, it seems that certain Amazon devices couldn't keep up with the influx of viewers. Meanwhile, HBO Max users turned to Twitter to vent their frustrations.
"House of the Dragon is being successfully viewed by millions of HBO Max subscribers this evening," HBO said in a statement. "We're aware of a small portion of users attempting to connect via Fire TV devices that are having issues and are in the process of resolving for those impacted users."
The only thing that could tear down the House of the Dragon was itself. #HOTD
— HBO Max (@hbomax) August 22, 2022
Right now, it looks as though those issues have largely been resolved. Game of Thrones fans were left stranded and frustrated last night, however, when the debut episode was officially released, only to find that they simply couldn't watch it.
HBO Max support advised users that: "To help with the crashing issues you're experiencing, please go to any other show/movie on HBO Max, turn off subtitles/captions, and then try streaming House of the Dragon again." This reportedly worked for some users, but others remained unable to watch. Of course, it also didn't help those who need closed captioning to view the episode at all.
This isn't the first time Game of Thrones has caused Amazon Fire crashes as similar issues were reported during the final episodes of the original show.
House of the Dragons keeps crashing the HBO MAX app on Fire TV. Other shows don't crash the app. What is going on? I cleared cache, restarted, deleted/reloaded the app. Nothing works.
— lgbeddow (@lgbeddow) August 22, 2022
House of the Dragon is the long-awaited Game of Thrones prequel that's had fans on the edge of their seats since it was first announced.
IGN's review of the debut episode called it "a strong, well-cast start to the Game of Thrones spin-off. This feels very close to its predecessor in tone and content, but immediately establishes a struggle for power around an amiable, weak-willed king, and vivid new characters to fight those battles. We also have dragons, inbreeding, and resentment. It's good to be back in backstabbing Westeros."
Want to read more about House of the Dragon? Check out everything we know about House of the Dragon so far, and find out what we know about the Gold Cloaks.


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Home > Health News > New USDA Rules Ramp Up Oversight of Organic Food
New USDA Rules Ramp Up Oversight of Organic Food
By LadyLively on January 20, 2023
FRIDAY, Jan. 20, 2023 (HealthDay News) – Organic food will soon have to comply with stricter labeling rules under new requirements announced Thursday by the U.S. Department of Agriculture (USDA).
In what the Organic Trade Organization (OTA) called the biggest change since the USDA's organic program was first founded in 1990, the new requirements include that all imported organic food be certified by the USDA National Organic Program.
The rule increases certification of more supply chain businesses, and boosts authority for inspections, record-keeping, traceability and fraud prevention.
The rule also builds on the USDA's definitions for organic food, which must use "natural substances and physical, mechanical or biologically based farming methods to the fullest extent possible."
The new program will start in March, and companies must comply within a year.
The OTA had lobbied for the changes and said in a statement the regulation "will do much to deter and detect organic fraud and protect organic integrity throughout the supply chain."
Organic food does big business in the United States, where customers spent $63 billion in 2021 for food free of pesticides and contaminants, the Associated Press reported.
Working to ensure customers were getting what they paid for, the U.S. Department of Justice recently indicted those alleged to have been involved in a multimillion-dollar fraud operation to export non-organic grain to the United States with the intent of selling it as a certified organic product, the AP reported.
The U.S. Environmental Protection Agency has more on organic farming.


Mondeo bed frame will soothe your eyes with its modern and tidy look. Its design does not have much button tufting or floral finish which will be perfectly fit to a mature personality. Its medium high headboard provides backrest which will allow you to lean back against the bed headboard and read your favourite books.


text:
Suburban Combat: Syrian Army Fights Islamists in Greater Damascus
© Sputnik / Dmitriy Vinogradov
Syrian forces, supported by the county's air force, have reportedly destroyed more militants' strongholds in the eastern and western areas of Ghouta in Damascus province.
© AP Photo / Alexander Kots
Senior General: Syrian Army Begins Operation to Cut Off Daesh Supply Routes
More strongholds of the militant groups have been obliterated by the Syrian Army and the country's air force in eastern and western Ghouta to the east of the capital, according to the Iranian news agency FARS.
"Gathering centers of the militant groups in Jobar in eastern Ghouta were massively attacked by the Syrian troops. Several militants were killed or wounded in the attacks," FARS quoted the sources as saying on Saturday.
© Sputnik / Michael Alaeddin
A radar station in the Marj al-Sultan district in southeastern Damascus that has been retaken by the Syrian Arab Army
The sources added that "the Syrian fighter jets, for their part, bombed the militant groups bases and gatherings in Jobar," which also claimed the lives of several militants. Jobar is an inner suburb of Damascus located between the city and a key thoroughfare, Almotahalik Aljanobi Street, which connects with the M5 highway leading north to Homs.
Earlier this week, it was reported that the Syrian Army and the country's National Defense Forces (NDF), managed to drive Islamist militants out of more areas in Damascus Province, where the army regained control over several sites during fighting near the Qalamoun Mountains.
#SYRIA During 10 days of 2016, Rus aircraft performed 311 sorties on 1097 terrorist objects https://t.co/xBs2DBvFQm pic.twitter.com/RPhNxQrnd8
— Минобороны России (@mod_russia) 11 января 2016
Army sources said that on Friday night, the army and the NDF "surprised Daesh terrorists in the Eastern Qalamoun with a powerful assault on the Damascus Train Tracks, the Petrol Pumping Station, the al-Thaniyah Walls, and the village of al-Azzam in rural West Damascus." Scores of militants were killed and many more wounded in this large-scale attack, according to sources.
#SYRIA Supported by Rus aircraft, units of Syrian Democratic Army #SDA continue their offensive on #Raqqah, #ISIS capital
© Sputnik / Valery Melnikov
Run for the Hills: Syrian Army Gains More Ground in Aleppo
In another development, the governor of the Syrian province of Deir ez-Zor said that Syrian troops had liberated the al-Bagilya settlement, where Daesh militants had earlier killed 280 people.
Adding to the Syrian Army's anti-Daesh effort is Russia's air campaign, which was launched on September 30, when more than fifty Russian warplanes, including Su-24M, Su-25 and Su-34 jets, commenced precision airstrikes on Islamic State targets in Syria at the behest of Syrian President Bashar Assad.
Final Countdown? Syrian Army Advances on All Fronts
Syrian Army Gains Control Over Strategic Heights in Latakia Province
Restless Warriors: Night Footage Shows Syrian Army's Advance in Latakia
Flushed Out: Syrian Army Reclaims Key Damascus Area Villages From Daesh
strongholds, terrorists, province, militants, army, air force, Daesh, Syria


text:
Behaghel oder Behagel ist der Familienname folgender Personen:

 Daniel Behagel (1625–1698), deutscher Kaufmann und Fabrikant
 Ernst Behaghel (1825–1903), deutscher Architekt, großherzoglich badischer Baubeamter (Sohn von Johann Georg)
 Felix Behaghel (1822–1888), badischer Verwaltungsbeamter
 Fritz Behaghel (1891–1973), deutscher Exportkaufmann, Kommunalbeamter, NSDAP-Mitglied, Stadtrat und Beigeordneter in Berlin (Sohn von Georg Behaghel)
 Georg Behaghel (1870–1942), Prof. Dr.-Ing., deutscher Bergingenieur, Geologe und Hochschullehrer (Sohn von Hermann Behaghel)
 Georg Christian Andreas Behaghel (1800–1871), deutscher Handelsmann und Abgeordneter
 Johann David Behaghel (1804–1850), deutscher Arzt und Abgeordneter
 Johann Georg Behaghel (1797–1861), Professor am Lyzeum in Heidelberg (Bruder von Johann Peter)
 Johann Peter Behaghel (1805–1871), Professor am Lyzeum in Mannheim (Bruder von Johann Georg)
 Hermann Behaghel (1839–1921), deutscher Architekt, großherzoglich badischer Baubeamter (Sohn von Johann Peter)
 Otto Behaghel (1854–1936), deutscher Germanist (Sohn von Felix)
 Otto Behaghel (Chemiker) (1895–1961), deutscher Chemiker
 Wilhelm Jakob Behaghel (1824–1896), deutscher Jurist und Hochschullehrer (Sohn von Johann Georg)
Siehe auch:
 Behaghelsche Gesetze beschreiben Grundprinzipien der Stellung von Wörtern und Satzgliedern im Satz, formuliert von dem Germanisten Otto Behagel (1854–1936)

redpajama_set_name: RedPajamaWikipedia


text:
Q: casperjs persistent Login I am running Phantomjs, Casperjs with php-casperjs
I want that the login persist on a website, I don't want to have to login every time I start casper.
Now I tried with many sites, I enabled cookies and tested, they works and are the same with different session.
But still the login doesn't persist.
I tried do use disk-cache true. Nothing change.
The Casper UserAgents, viewPortWidth/height doesn't change. The IP is the same. So a fingerprint authentication should still work...
What it is missing?
Edit: some code:
// Casper constructor and setting:
    private $_userAgent = 'Mozilla/5.0 (Windows NT 6.1; WOW64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/52.0.2743.116 Safari/537.36';
    private $_viewPortWidth = 1345;
    private $_viewPortHeight = 749;
    private $_temp_dir = '/tmp';
    private $_path2casper = '/usr/local/bin/'; //path to CasperJS

//
    $this->casper->setOptions(array(
        'ignore-ssl-errors' => 'yes',
        'ssl-protocol' => 'any',
        'cookies-file' => sys_get_temp_dir().'/JScookies.txt',
        'load-images' => 'true',
        'disk-cache' => 'true'
    ));

// Login
    $this->casper->start($this->LINK_LOGIN);

    $this->casper->waitForSelector('input#btnLogin', 3000);
    $this->casper->fillForm(
        'form[action="/accedi"]',
        array(
            'Username' => $this->Account,
            'Password' => $this->Password
        ), true);
    $this->casper->wait(1000);

    $this->casper->run();
    if($this->CheckLogin($this->casper->getCurrentPageContent()))
        echo "
 Login Success";
    else
        echo "
 Error Login";

// test after login
    $this->casper->start($this->LINK_MAIN_PAGE);

    $this->casper->wait(2000);
    $this->casper->run();

    if($this->CheckLogin($this->casper->getCurrentPageContent()))
        echo "
 Login Success";
    else
        echo "
 Error Login";

A: You need to keep cookies on your side:
$casper->setOptions(array(
    'ignore-ssl-errors' => 'yes',
    'cookies-file' => 'cookies.txt'
));

redpajama_set_name: RedPajamaStackExchange


text:
Dinoplay Bluetooth Headset
by Anders Yao on December 28, 2021
Lately, we're going to release a series of products that are designed only for children and we named this series Dinoplay. The biggest joy is playing, as our slogan for Dinoplay, is our best wish to bring joy to all kids.
DP10, a Bluetooth headset, is the first product of this series. It contains two different colors: teddy pink and teddy blue. The two kinds of headsets have teddy bears imprinted on headsets' two sides with green color embellishing the headphones, which make their overall design more harmonious and pretty. Our headset is one of circumaural earphones. Therefore, we use a soft sponge material with leather covering as earmuff to make kids feel comfortable while enjoying the music. As for the headband designed with a telescopic structure, kids can adjust the length of the band to fit their heads.
There are three modes that kids can choose: Bluetooth mode, FM mode and TF mode. Bluetooth mode allows kids to play the music transferred from the phone, FM mode allows kids to search the FM signal to listen to the radio show, and TF mode allows kids to play the music that is saved on the TF card with the precondition that the TF card is inserted in the headset.
After the headset is turned on, it will automatically enter into the Bluetooth mood. The Bluetooth version of our headset is Version 5.0 and its working distance range is 10 meters. Kids can go anywhere within a range of 10 meters from the Bluetooth device without being limited by wire. And if kids want to connect to some devices that do not contain the Bluetooth function, like a computer, they can also use the Aux-in cable to connect. And the Aux-in cable is one of the complimentary accessories included in the package.
To change into the FM mode, kids need to short press the M button. After switching into this mode, kids can short press the on/off button for one time to search the FM signal and it will save the available FM broadcast channel automatically. Once the kids switch into the FM mode again, it will play from the first saved channel.
If the headset did not insert a TF card, kids can only switch the mode from Bluetooth mode to FM mode. Only with the headset inserting a TF card, the TF mode is available. Under this mode, the headphone will play the music stored in the TF card in sequence.
"The beautiful thing is, music can be like a time machine. One song- the lyrics, the melody, the mood- can take you back to a moment in time like nothing else can." We hope children can make an unparalleled and precious journey with our Bluetooth headset and revoke this greatness once they wear it on their head.


text:
Q: What is the highest sampling frequency the iWatch can use to measure heart rate? I'm building an app which requires frequent readings from the heart rate sensor on the watch. I know that throughout the day the watch will sample heart rate at ~10 minutes intervals and during an exercise session it can be as frequent as ~5 seconds using HKWorkoutActivityTypeRunning with HKWorkoutSessionLocationTypeIndoor.
Is this the highest frequency at which the watch can measure heart rate with?

A: Yes, Apple Watch records heart rates most frequently when the user is recording a workout.


Watermelon is a summer staple, but there are more ways to enjoy it beyond slicing and serving. In fact, there are a variety of unique ways to serve watermelon that satisfy both your sweet and savory tooth. The following 3 watermelon recipes are simple, fun and absolutely refreshing ways to nosh on a summertime favorite. Squeeze the last of watermelon into your life before summer comes to an end!
Directions: Toss together the watermelon and cucumber in a large bowl. In a small bowl, whisk together the olive oil, lime juice, sea salt and black pepper. Pour the sauce over the watermelon and cucumber and add the mint leaves. Toss. Next add the feta cheese and toss lightly before serving.
Directions: Add all ingredients to a blender and blend until smooth.
Directions: Slice watermelon into 16 bite-sized square pieces. Slice the halloumi into 8 bite-sized square pieces the same size as the watermelon pieces. Place all the watermelon and halloumi pieces on a grill that has been greased with the olive oil. Grill for 2 minutes on each side for the watermelon and 1 minute on each side for the halloumi. Remove both from grill and get ready to assemble. Drizzle the watermelon with the balsamic vinegar. Place 8 pieces of the watermelon on a paper-towel lined plate. Top each with 1 slice of grilled halloumi and a leaf or two of basil. Season with salt and pepper and top with another slice of the watermelon to top it off. Enjoy!


text:
Storybook time …
A winter afternoon in Amish country has a storybook feel despite the traffic. One doesn't have to venture more than 30 miles west of Philadelphia to be surrounded by picturesque hillsides blanketed with snow and punctuated with farm silos. Every home, it seems, has a long pulley-operated clothesline angling from the house to the top of a barn or tall pole, so that frozen sheets and shirts hang 20 feet off the ground.
Off the beaten path of tourist stops and quilt shops, horse-drawn buggies are about as common as cars, and the snowy farms seem an idyllic place to live, until you remember that milking cows in the frozen dawn and shoveling manure into a mule-drawn spreader come with the territory.
Despite their staid reputation, the Amish have a deep sense of humor, though I'm not sure it's always intended the way visitors take it. Driving along Route 30, you pass through a town called Paradise, where there's a big sign pointing to "Christ's Home Office." I know (thanks to Google) that it's a residential children's home, but still — finding Christ's home office in Paradise was fun.
In Lancaster, at the Mennonite Information Center, you can see a life-sized replica of the tabernacle as described in the book of Exodus, with the exception that it has real walls and a roof rather than the four layers of woven cloth and skins called for in the Old Testament. It has a really cheesy feel (to me), but the guides take it very seriously. When I asked why the Mennonites have such an interest in the tabernacle, it turns out that the replica was built by a Baptist preacher in Florida about 40 years ago. He later sold it to a Mennonite evangelist, who operated it in Florida for a while before bringing it north.
Stopping at Katie's Kitchen, you can sample pepper cabbage and creamed celery while falling in love with their homemade peanut butter. Then, looping back along Route 340, you can visit communities with names like Bird-in-Hand, Intercourse (really), and White Horse. Running low on fuel, I wondered why there seemed to be so few gas stations, until I remembered that buggies run on one horsepower.
The Prius did make it down Octorara Trail to a WaWa station in Sadsbury, and I was glad: hitching a buggy ride into town would not be much of a storybook ending.
Jim Clark	on March 6, 2014 at 7:21 pm
Strange folks. Some men of their ilk went to jail in western Kentucky for not attaching a phosphorescent triangle to the back wall of their buggies. They didn't mind the safety device but a religious hangup made the triangle unacceptable. The legislature passed a law that they must use the material but okayed a form other than a triangle. The men apparently meant to stay jailed until that well-known place froze over.


If you're new to a daily mediation practice, the idea of doing something every day may seem daunting. But I encourage my students to do a little bit often rather than feel they have to take on a lot all at once. I've always believed that we get the best results when we work at a pace that feels right for us personally.
The best time to practice is anytime you can commit to it regularly. Personally, I like to practice first thing in the morning, as it sets the tone for my day and ensures that I don't get sidetracked by responsibilities and distractions.
What is important is regularity. Find a 10- to 30-minute slot in your day that you can dedicate to your practice. If you can stretch out one to three longer practices (20 to 60 minutes) during the week, add those in to your weekly schedule. Remember, a little + often = a lot.
The more comfortable and happy you are in your practice space, the more you will want to show up there. Think of this as a special space where you feel cared for and at ease. Choose a spot that is private, warm, and quiet. It's helpful if there are no phones or distracting devices. You should have enough space to stand on your yoga mat and reach in all directions.
It's lovely to add some personal heart-warming objects to your space, such as photos of loved ones, a special rock from a hike, maybe flowers. I recommend keeping a journal near your mat. I find that after practice my mind and heart are open, and writing comes more easily. Sometimes I get a flow of insight as I am practicing, and I pause to make a note in my journal while these thoughts are fresh.
You can find yoga props online, at your local yoga studio, or at a sporting goods store. However, you can also use items from around the house.
Bed pillows are great replacements for blankets in many poses, too. Usually, a king- or queen- size pillow will work best. However, ensure that the pillow offers consistent support and that its fill is not lumpy or uneven.
Open your yoga blanket fully.
Fold the blanket in half widthwise, bringing the fringed sides together. Line up the blanket corners precisely. Turn the blanket so that the fringe hangs toward the floor.
Fold the blanket in half lengthwise, with the fringe continuing to hang toward the floor.
Fold the blanket in half lengthwise again, the fringe still toward the floor.
Fold the blanket according to the long rectangle instructions, above.
Then fold the blanket in half, down toward the fringe. The fringe still hangs toward the floor as you create a shorter rectangle.
Roll the blanket lengthwise, so that the fringe is at one short end of the roll.
Fold the blanket in half widthwise, bringing the fringed sides together. Line up the corners precisely. Turn the blanket so that the fringe hangs toward the floor.
Roll it like a yoga mat, toward the fringe.
Your short roll will have fringe along the full length of the roll.
Set up your meditation seat.
Stack three folded blankets and place them against a wall.
Sit cross-legged with one block under each knee for support.
Place blocks or pillows on top of your thighs to rest your forearms on. This will take strain off the shoulders and neck.
Learn more about the practice and the secrets to meditation in my book, Deep Listening.
The article How to Prepare for Your Deep Listening Practice originally appeared on Rodale Wellness.


text:
/*
** NOTE: This file is generated by Gulp and should not be edited directly!
** Any changes made directly to this file will be overwritten next time its asset group is processed by Gulp.
*/

/* http://keith-wood.name/calendars.html
   Montenegrin localisation for calendars datepicker for jQuery.
   Written by Miloš Milošević - fleka d.o.o. */
(function ($) {
    $.calendarsPicker.regionalOptions['me-ME'] = {
        renderer: $.calendarsPicker.defaultRenderer,
        prevText: '<', prevStatus: 'Prikaži prethodni mjesec',
        prevJumpText: '<<', prevJumpStatus: 'Prikaži prethodnu godinu',
        nextText: '>', nextStatus: 'Prikaži sljedeći mjesec',
        nextJumpText: '>>', nextJumpStatus: 'Prikaži sljedeću godinu',
        currentText: 'Danas', currentStatus: 'Tekući mjesec',
        todayText: 'Danas', todayStatus: 'Tekući mjesec',
        clearText: 'Obriši', clearStatus: 'Obriši trenutni datum',
        closeText: 'Zatvori', closeStatus: 'Zatvori kalendar',
        yearStatus: 'Prikaži godine', monthStatus: 'Prikaži mjesece',
        weekText: 'Sed', weekStatus: 'Sedmica',
        dayStatus: '\'Datum\' DD, M d', defaultStatus: 'Odaberi datum',
        isRTL: false
    };
    $.calendarsPicker.setDefaults($.calendarsPicker.regionalOptions['me-ME']);
})(jQuery);

redpajama_set_name: RedPajamaGithub


text:
Personalized treatment of hepatitis B
Anna S. Lok
DOI : https://doi.org/10.3350/cmh.2015.21.1.1
Lok: Personalized treatment of hepatitis B
Clinical and Molecular Hepatology 2015; 21(1): 1-6.
DOI: https://doi.org/10.3350/cmh.2015.21.1.1
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
Corresponding author: Anna S. Lok. Division of Gastroenterology and Hepatology, University of Michigan, 3912 Taubman Center, SPC 5362, 1500 East Medical Center Drive, Ann Arbor, MI, USA.
Tel: +1-734-936-7511, Fax: +1-734-936-7392, aslok@umich.edu
Received November 15, 2014 Accepted January 09, 2015
(open-access, http://creativecommons.org/licenses/by-nc/3.0/):
There are seven approved drugs for treatment of hepatitis B. Professional guidelines provide a framework for managing patients but these guidelines should be interpreted in the context of the individual patient's clinical and social circumstances. Personalized management of hepatitis B can be applied based on prediction of the individual patient's risk of cirrhosis and hepatocellular carcinoma to guide the frequency and intensity of monitoring and urgency of treatment. It can also be applied to decisions regarding when to start treatment, which drug to use, and when to stop based on the individual patient's disease characteristics, preference, comorbidities and other mitigating circumstances.
Keywords: Hepatitis B virus; Chronic hepatitis B; Management; Personalized medicine
Personalized medicine has gained a lot of attention in recent years with improved understanding of the contribution of genetic factors to benign and malignant diseases and responses to pharmacological interventions, and the availability of a wide spectrum of genetic tests at low costs. Although the term "personalized medicine" is often used to refer to individualizing care according to the genetic make-up of the patient, this term can be interpreted more broadly to mean "tailoring care to the individual patient characteristics". In other words, personalized medicine can be interpreted as an approach to classify individuals into subpopulations that differ in their susceptibility to a particular disease, rate of disease progression, and response to specific treatments such that preventative or therapeutic interventions can be concentrated on those who will benefit, sparing expense and side effects for those who will not. Simply put, the goal of personalized medicine is to provide optimal care according to the individual patient's disease characteristics, personal preference, comorbidities, and social circumstances such that maximum benefit can be derived while minimizing costs and adverse reactions.
Substantial progress has been made in the treatment of hepatitis B in the last 15 years. There are currently seven approved drugs for the treatment of hepatitis B: two formulations of interferon (IFN) - conventional and pegylated IFN (PEG-IFN), and five nucleos(t)ide analogues - lamivudine, telbivudine, adefovir, entecavir, and tenofovir. These drugs can suppress hepatitis B virus (HBV) replication, decrease hepatic inflammation and fibrosis and even reverse cirrhosis, prevent complications of cirrhosis, and reduce the incidence of hepatocellular carcinoma (HCC).1,2,3 However, currently approved drugs do not eradicate HBV and have low rates of clearance of hepatitis B e antigen (HBeAg) and hepatitis B surface antigen (HBsAg) and HCC continues to occur albeit at a lower rate. Because currently available treatment has little or no effect on covalently closed circular DNA, the template for transcription of HBV pregenomic RNA and messenger RNA and translation of viral proteins or on restoration of host immune response to HBV, viral relapse occurs in most patients when treatment is stopped. Thus, most patients require many years and often lifelong treatment to derive continued benefit. Long durations of treatment are associated with increasing risks of adverse reactions, antiviral drug resistance, costs, and nonadherence to medications. Thus, a major dilemma in hepatitis B treatment is when to initiate therapy. While all patients with chronic HBV infection are at risk of cirrhosis, liver failure and HCC, not all patients will experience these outcomes. Immune control of HBV with spontaneous loss of HBeAg and HBsAg can occur and patients can remain in remission for many years.
Professional society guidelines provide frameworks for managing patients with hepatitis B but these guidelines have to be interpreted in the context of the individual patient's clinical and social circumstances. Personalized management of hepatitis B can be applied based on prediction of the individual patient's risk of cirrhosis and HCC to guide the frequency and intensity of monitoring including HCC surveillance and urgency of treatment. It can also be applied to decisions on when to start treatment, which drug to use, and when to stop based on the individual patient's disease characteristics, preference, comorbidities and other mitigating circumstances.
Prediction of risk of cirrhosis and HCC
Host, viral and environmental factors contribute to an HBsAg-positive person's risk of cirrhosis and HCC (Table 1). Although several studies have identified genetic markers associated with increased risk of HBV-related HCC, these markers have not been validated in broad patient populations of diverse racial/ethnic origins infected with all HBV genotypes. Therefore, genetic markers have not yet been incorporated into prediction models for cirrhosis or HCC.
During the past decade, many models have been developed to predict the risk of cirrhosis or HCC in persons with chronic HBV infection. Some models incorporate many variables including blood test results such as HBV genotype, precore and core promoter variants that are not routinely available or clinical information such as alcohol and tobacco use that are unreliable unless the information is collected using standardized questionnaire. Table 2 summarizes three prediction models for HCC based on routinely available clinical and laboratory information: REACH-B, CU-HCC, and GAG-HCC.4,5,6,7,8 These models can be used to predict 5- and 10- year risk of HCC to guide the frequency of monitoring, the need for HCC surveillance, and the urgency of antiviral treatment. However, there are limitations to these models. These models were derived from cohorts of patients with chronic hepatitis B in Asia, who were predominantly infected with HBV genotypes B and C and who did not receive antiviral treatment. Thus, these models may not be applicable in other parts of the world where the prevalent HBV genotypes are different and where HBV infection is mostly acquired in adult life and not early childhood or in patients receiving antiviral treatment. Indeed, two studies of patients receiving antiviral treatment in Europe found that performance of these scores, particularly the REACH-B score was poor.9,10 By contrast, one study in Hong Kong showed that all three models accurately predicted which patients with chronic hepatitis B treated with entecavir will develop HCC.11
When to initiate antiviral treatment?
The American, Asian-Pacific and European Liver Association (AASLD, APASL and EASL) Guidelines recommend that treatment decision should be made based on clinical status, serum HBV DNA and alanine aminotransferase (ALT) levels, HBeAg status, and liver histology if available.12,13,14 All guidelines recommend starting treatment as soon as possible in patients with life-threatening liver disease: acute liver failure, decompensated cirrhosis or severe acute exacerbation of chronic hepatitis B regardless of HBV DNA and ALT levels. These guidelines also recommend antiviral treatment for patients with compensated cirrhosis regardless of ALT levels but there are minor differences in threshold HBV DNA levels for initiating treatment. All guidelines agree that treatment should be initiated in noncirrhotic patients with serum HBV DNA levels greater than 20,000 IU/mL and persistently elevated ALT levels and/or histologic evidence of moderate or severe inflammation or fibrosis. However, cutoff values of HBV DNA and ALT and the need for liver biopsy or non-invasive assessment of liver fibrosis in determining treatment indications vary slightly among the guide-lines. Because HBV DNA and ALT levels fluctuate during the course of chronic HBV infection, all guidelines agree that serial HBV DNA and ALT levels are more important than values at a single time point in making treatment decisions. Furthermore, all guidelines recommend that patients who are not started on treatment should be monitored such that treatment may be initiated at a later time when HBV replication or liver disease becomes more active.
The AASLD, APASL and EASL guidelines are based on a combination of scientific evidence and expert opinion and experience. These guidelines have not incorporated prediction models for cirrhosis or HCC into recommendations when or which patient should start treatment but incorporation of risk scores for HCC may be appropriate for Asian patients particularly those in the gray zone. The guidelines emphasize that patient age, family history of HCC, occupational requirements, plans to start a family (for women), and patient preference should also be considered in making treatment decisions. There are many settings when a patient's medical or social circumstances warrant a personalized approach that may be "at odds" with the guidelines but appropriate for that patient. For example, a 48 year old man who is HBeAg-positive with serial ALT 19-28 U/L and HBV DNA 3,000,000-400,000,000 IU/mL with no evidence of cirrhosis would be considered to be in the immune tolerant phase and "not meet" criteria for treatment but starting this patient on treatment is appropriate because there is ample data showing that patients who remain HBeAg-positive after age 40 and those who have serum HBV DNA levels higher than 2,000 IU/mL after more than four decades of infection are at increased risk of cirrhosis and HCC.15,16 Treatment would also be appropriate in a 32 year old surgeon who has the same disease characteristics if suppression of viremia is a prerequisite for permission to continue his profession as a surgeon and to perform surgical operations (exposure-prone procedures). Treatment might also be appropriate in a 45 year old man who is HBeAg negative with ALT 25-35 U/L and HBV DNA 1,800-9,500 IU/mL if he has several family members with HCC. Other examples of personalized approach being "at odds" with guidelines may involve a decision to defer treatment when guidelines would recommend treatment. For example, a 35 year old woman who is HBeAg-negative with ALT 55-65 U/L and HBV DNA 28,000-75,000 IU/mL with no evidence of cirrhosis may choose to defer treatment if she wishes to start a family and is concerned about the safety of anti-HBV medications on fetal development. Another patient with the same disease characteristics may choose to defer treatment if she does not have insurance coverage for medications, or has contraindications to using interferon and is unwilling to commit to many years of nucleos(t)ide analogue therapy. Guidelines do cite these examples as situations where individualized decisions are appropriate.
Which anti-HBV drug to use?
Selection of the first-line anti-HBV drug should be based on the safety and efficacy of the drug, risk of drug resistance, cost of the drug, and patient preference. The main advantages of IFN include a finite duration of treatment and a higher rate of HBeAg and HBsAg loss but IFN has to be administered parenterally and is associated with a wide range of adverse reactions some of which can be serious. Nucleos(t)ide analogues are well tolerated but most patients require many years or lifelong treatment. Entecavir, telbivudine and tenofovir have more potent antiviral activity, and entecavir and tenofovir have higher barriers to antiviral drug resistance.
All guidelines recommend initial treatment with PEG-IFN, entecavir or tenofovir as monotherapy.12,13,14 Because of cost concerns and the lack of access to tenofovir in some Asian countries when the most recent version of the APASL guidelines were released, lamivudine, adefovir or telbivudine were also recommended as first-line drugs in treatment-naïve patients.13 IFN is not recommended in patients with acute liver failure, decompensated cirrhosis or severe exacerbations of chronic hepatitis B but it may be used with caution in patients with compensated cirrhosis.
While guidelines consider PEG-IFN, entecavir and tenofovir as equivalent first-line anti-HBV drugs, in clinical practice, entecavir and tenofovir are used much more often than PEG-IFN even in patients with no contraindications to the use of IFN. The decision to choose a nucleos(t)ide analogue over PEG-IFN may be based on the patient's preference for an oral drug with minimal adverse reactions over an injectable drug with many potential side effects but it may also be based on the physician's beliefs and bias. Drug cost is certainly an important factor in medical decisions in any society. Although cost-effectiveness studies have been performed, these analyses rely on many assumptions and decision on PEG-IFN versus nucleos(t)ide analogues is complicated because the efficacy, tolerability, and duration of these two classes of drugs are very different and the costs of these medications vary widely from one country to another.
The first step in deciding which drug to use for treating hepatitis B is to choose between PEG-IFN versus nucleos(t)ide analogue. Patients' preference for route of administration (injection versus oral), duration of treatment (1 year versus many years), and presence of medical/psychiatric comorbidities that contraindicate use of or decrease tolerance to IFN are the most important deciding factors. A personalized decision on anti-HBV drug should also consider the likelihood of response. In this regard, the predictors of response to PEG-IFN and nucleos(t)ide analogues are similar: high ALT and low HBV DNA levels are the most reliable predictors of response to both PEG-IFN and nucleos(t)ide analogues. Thus, patients who are more likely to respond to PEG-IFN are also more likely to respond to nucleos(t)ide analogues. One predictor of response that is unique to PEG-IFN is HBV genotype although this applies mainly to HBeAg-positive patients. HBeAg-positive patients with genotype A HBV have significantly higher rates of HBeAg and HBsAg loss compared to patients with genotypes B, C or D.17 Thus, HBeAg-positive patients with genotype A HBV and no contraindications to use of IFN should be encouraged to receive PEG-IFN. Interleukin-28B (IL28B) polymorphism was shown to be a strong predictor of response to IFN-based therapy for hepatitis C but the association between IL28B polymorphism and PEG-IFN treatment of hepatitis B is inconsistent.
Other factors may play a role in personalized decisions regarding choice of anti-HBV drugs. For example, young patients may prefer a finite course of PEG-IFN versus many years of nucleos(t)ide analogue treatment. This is particularly true for young women contemplating to start a family in the next few years. Once a decision is made to treat with nucleos(t)ide analogues, the main considerations are cost and risk of antiviral drug resistance. If cost is not a concern, tenofovir and entecavir are preferred as these drugs have markedly lower rates of drug resistance (0-1% after 5-6 years of continuous therapy)18,19 compared to lamivudine, adefovir or telbivudine. Tenofovir and entecavir have similary potency and barrier to antiviral resistance, and either drug may be used as first-line treatment in nucleoside-naïve patients. Because of a low risk of nephrotoxicity, entecavir is preferred in older patients, patients with baseline impaired renal function and those with other medical conditions such as hypertension or diabetes that would increase the risk of renal insufficiency. Although telbivudine had been reported to improve renal function,20 the high risk of antiviral drug resistance and the potential for other adverse reactions such as myopathy and polyneuropathy make this a poor choice as first-line treatment.21 Tenofovir is effective in suppressing not only wild type HBV but also lamivudine, telbivudine or entecavir resistant HBV and to a slightly lesser extent adefovir resistant HBV; therefore, it is a better choice for patients who had been previously treated with other nucleos(t)ide analogues. Tenofovir is also a preferred choice for women of reproductive age because of its safety record in pregnancy.22
When to stop treatment?
AASLD, APASL and EASL guidelines recommend administration of PEG-IFN for 48-52 weeks in both HBeAg-positive and HBeAg-negative patients.12,13,14 There is some variation in recommendations when nucleos(t)ide analogues can be stopped. All guidelines recommend that in HBeAg-positive patients, nucleos(t)ide analogues can be stopped when the patient has completed 6-12 months consolidation therapy after HBeAg seroconversion. The EASL guidelines recommend continuing treatment until HBsAg loss in patients with advanced fibrosis or cirrhosis to avoid flares associated with viral relapse. The AASLD and EASL guidelines recommend that in HBeAg-negative patients, nucleos(t)ide analogues should be continued until HBsAg loss but the APASL guidelines stated that treatment may be withdrawn after completing at least two years treatment with undetectable HBV DNA documented on three occasions six months apart. All three guidelines recommend lifelong nucleos(t)ide analogue treatment in patients with cirrhosis before treatment unless they had compensated cirrhosis and had cleared HBsAg.
Not all patients respond to PEG-IFN. In addition to pre-treatment factors, several studies have found decrease in HBsAg level after 12 or 24 weeks of PEG-IFN treatment to be better predictors of response. Specifically, a lack of or a small decline in HBsAg level after week 12 or 24 of PEG-IFN is associated with 85-95% negative predictive value of a response.23 These data suggest that a response-guided stop-rule may be used making PEG-IFN therapy more attractive because patients who are unlikely to benefit can be spared from further side effects and costs. A recent cost-effective study showed that response-guided PEG-IFN therapy is the most cost-effective approach for HBeAg-positive but not HBeAg-negative patients.24 Thus, HBeAg-positive patients with no contraindications, particularly those with genotype A HBV, high ALT and low HBV DNA levels before treatment who are already predicted to have a high likelihood of response to PEG-IFN may be further encouraged to have a trial of PEG-IFN, treatment can be stopped after 12 weeks if decline in HBsAg is inadequate. A caveat to this approach is that it has not been validated prospectively and different stop rules have been proposed by different authors and for different HBV genotypes.
For patients receiving nucleos(t)ide analogue therapy, the likelihood of achieving HBeAg seroconversion is 40-50% and the likelihood of achieving HBsAg loss is 0-10% after 5 years of continuous treatment.3 Thus, more than half of the HBeAg-positive patients and ≥95% of HBeAg-negative patients will require more than 5 years of treatment. A few studies found that while viral relapse (redetection of HBV DNA in serum) occurs in all HBeAg-negative patients who completed 2-5 years treatment and who stopped treatment before HBsAg loss, clinical relapse with elevated ALT and HBV DNA levels >2,000 IU/mL occurred in only 50% of patients.25,26 These data suggest that HBeAg-negative patients who have completed >2 years treatment may consider stopping treatment if they are unwilling to continue or unable to afford continued treatment. However, this personalized approach must be accompanied by a plan for close monitoring for at least 6 months after discontinuation of treatment such that treatment can be promptly resumed if necessary.
Personalized approach to treatment of hepatitis B should adapt practice guidelines to individual patient's disease characteristics, personal preferences, medical comorbidities and social circumstances to determine when treatment should be started, which drug to use, and when to stop treatment, such that maximum benefit can be derived while minimizing costs and adverse reactions (Table 3).
Conflicts of Interest: The author has no conflicts to disclose.
AASLD
American Association for the Study of Liver Diseases
alanine aminotransferase
APASL
Asian Pacific Association for the Study of the Liver
European Association for the Study of the Liver
hepatitis B e antigen
hepatitis B surface antigen
HBV
PEG-IFN
pegylated interferon
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2. Marcellin P, Gane E, Buti M, Afdhal N, Sievert W, Jacobson IM, et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet 2013;381:468-475. 23234725.
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4. Lee MH, Yang HI, Liu J, Batrla-Utermann R, Jen CL, Iloeje UH, et al. Prediction models of long-term cirrhosis and hepatocellular carcinoma risk in chronic hepatitis B patients: risk scores integrating host and virus profiles. Hepatology 2013;58:546-554. 23504622.
5. Wong VW, Chan SL, Mo F, Chan TC, Loong HH, Wong GL, et al. Clinical scoring system to predict hepatocellular carcinoma in chronic hepatitis B carriers. J Clin Oncol 2010;28:1660-1665. 20194845.
6. Yang HI, Sherman M, Su J, Chen PJ, Liaw YF, Iloeje UH, et al. Nomograms for risk of hepatocellular carcinoma in patients with chronic hepatitis B virus infection. J Clin Oncol 2010;28:2437-2344. 20368541.
7. Yang HI, Yuen MF, Chan HL, Han KH, Chen PJ, Kim DY, et al. Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): development and validation of a predictive score. Lancet Oncol 2011;12:568-574. 21497551.
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9. Arends P, Sonneveld MJ, Zoutendijk R, Carey I, Brown A, Fasano M, et al. Entecavir treatment does not eliminate the risk of hepatocellular carcinoma in chronic hepatitis B: limited role for risk scores in Caucasians. Gut 2014;doi: 10.1136/gutjnl-2014-307023.
10. Vlachogiannakos J, Papatheodoridis GV. Optimal therapy of chronic hepatitis B: how do I treat HBeAg-positive patients? Liver Int 2015;35(Suppl 1):100-106. 25529094.
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12. EASL . EASL Clinical Practice Guidelines: Management of chronic hepatitis B virus infection. J Hepatol 2012;57:167-185. 22436845.
13. Liaw YF, Kao JH, Piratvisuth T, Chan H, Chien RN, Liu CJ, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update. Hepatol Int 2012;6:531-561.
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15. Chu CM, Liaw YF. Chronic hepatitis B virus infection acquired in childhood: special emphasis on prognostic and therapeutic implication of delayed HBeAg seroconversion. J Viral Hepat 2007;14:147-152. 17305879.
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17. Buster EH, Hansen BE, Lau GK, Piratvisuth T, Zeuzem S, Steyerberg EW, et al. Factors that predict response of patients with hepatitis B e antigen-positive chronic hepatitis B to peginterferon-alfa. Gastroenterology 2009;137:2002-2009. 19737568.
18. Kitrinos KM, Corsa A, Liu Y, Flaherty J, Snow-Lampart A, Marcellin P, et al. No detectable resistance to tenofovir disoproxil fumarate after 6 years of therapy in patients with chronic hepatitis B. Hepatology 2014;59:434-442. 23939953.
19. Tenney DJ, Rose RE, Baldick CJ, Pokornowski KA, Eggers BJ, Fang J, et al. Long-term monitoring shows hepatitis B virus resistance to entecavir in nucleoside-naive patients is rare through 5 years of therapy. Hepatology 2009;49:1503-1514. 19280622.
20. Gane EJ, Deray G, Liaw YF, Lim SG, Lai CL, Rasenack J, et al. Telbivudine improves renal function in patients with chronic hepatitis B. Gastroenterology 2014;146:138-146. 24067879.
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22. Antiretoviral pregnancy registry, interim report, 1/1/1989-7/31/2014. Accessed 3/9/15]. Available from: http://www.apregistry.com/forms/interim_report.pdf.
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Factors associated with risks of hepatocellular carcinoma
1. Virus: HBV DNA level, HBV genotype, molecular variants (pre‐S, basal core promoter, precore)
2. Host: sex, age, race/ethnicity, genetics, diabetes, cirrhosis
3. Environment: alcohol, cigarettes, coinfection with hepatitis C or D virus, aflatoxins
Risk scores for predicting hepatocellular carcinoma
GAG-HCC [8]
CUHK-HCC [5]
REVEAL Nomogram Original [6]
REVEAL Nomogram Updated [4]
REVEAL Nomogram REACH-B: abbreviated [7]
Derivation Cohort
Geographical area Hong Kong Hong Kong Taiwan Taiwan Taiwan
Origin of subjects Hospital based Hospital based Community based Community based Community based
No. of subjects 820 1005 2435 2435 3584
Risk predictors Gender Age Gender Gender Gender
Age Albumin Age Age Age
HBV DNA level Bilirubin HBeAg status HBeAg status HBeAg status
Core promoter HBV DNA level HBV DNA level HBV DNA level HBV DNA level
mutations Cirrhosis ALT level ALT level ALT level
Cirrhosis HBV genotype HBV genotype
Alcohol consumption HBsAg level
Family history of HCC Family history of HCC
• When to start treatment
◦ Predicted risk of disease progression, cirrhosis and HCC
◦ Assessment of HBV replication status and activity / stage of liver disease
◦ Other considerations: age, medical comorbidities, plans to start a family (for women), occupational requirements (for health care workers engaged in exposure prone procedures), health insurance coverage, willingness to commit to injection therapy or long durations of oral therapy, perception of seriousness of liver disease and benefits/risks of treatment
• Which drug to use
◦ Liver disease: any cirrhosis, portal hypertension, severe hepatitis flare or liver failure
◦ Medical or psychiatric contraindications to use of IFN
◦ Likelihood of response: ALT and HBV DNA level, HBV genotype (for IFN)
◦ Patient preference: acceptance of injection versus oral therapy, adverse reactions, duration of treatment
• When to stop treatment
◦ IFN: finite duration or response‐guided therapy for HBeAg‐positive patients
◦ Nucleos(t)ide analogues: indefinite treatment vs. trial of stopping treatment
- HBeAg‐positive: after HBeAg seroconversion and 12 months consolidation therapy
- HBeAg‐negative: after 3‐5 years treatment with persistently undetectable HBV DNA
Radioembolization for the treatment of hepatocellular carcinoma 2017 June;23(2)
Mycophenolate mofetil as an alternative treatment for autoimmune hepatitis 2016 June;22(2)
Recent trends in the treatment of chronic hepatitis C 2012 March;18(1)
Epidemiology and prevention of hepatitis B virus infection 2011 June;17(2)
New treatments for chronic hepatitis C 2010 September;16(3)


Although the ride is still not open, today Knoebel's fans and coaster fanatics got a glimpse of the Flying Turns roller coaster. The park released a POV video of a GoPro camera mounted on one of the coaster's chasis going down the track. From first glance, I have to say I am very impressed with the speed and pacing of the ride.
Flying Turns, which is now approaching it's 4th year in delay, is custom designed and built by the Knoebel's theme park. Inspired by the "flying turns" style coasters of the early-mid 1900's. The ride which was constructed in 2006 with a planned opening of 2007, obviously, missed that planned opening date. Knoebels, who is constructing the ride themselves, has gone through a fully of changes, at one point radically changing the layout and also burning through a seemingly endless list of chasis mock ups.
This latest update does however seem optimistic. The track appears to be no problem with the park now only having to tweak the ride's trains before opening. When will the ride open? "When it's done." The park has said that it is very unlikely that the ride will open this season, but you never know. Leave a comment with your Park Thoughts below.
I have gone to Knoebels almost every year since they started construction, and I'm glad that they FINALLY plan to open this thing. I was surprised by the speed of this thing, it looks like it wants to flip going around some of those turns!
They never planned not to open it. But when you are building a ride from scratch with no outside help, obviously you are going to run into some bumps. And I do believe the speed is the problem. The video was recorded by a camera mounted directly onto the chasis. Imagine if the seats and riders were added. The added weight may cause the ride to go even faster!
Wow, I didn't even think of that 😀 This thing could be seriously intense! unless they had dummies in the trains when they filmed this thing.
It was cool seeing this built though, because this is the only ride I've really followed throughout its entire construction, I even got to walk the track once!


A comparison of laboratory measures of escape and avoidance behavior.
Escape and avoidance of the onset of pain and exacerbations of pain can be difficult to distinguish in certain circumstances. This investigation compared measures of participants' (N = 61, 50.8% women) escape and avoidance behavior during an ischemic pain task. Instructions for the ischemic task were manipulated so that one group stopped the task whenever they wanted (eg, before the onset of pain) and another group endured the ischemic pain to tolerance. Delay time before beginning the task and willingness to complete the task were not related to self-reported escape/avoidance (r = -.21, P = .10; r = -.14, P = .30). Also, they were not predicted by fear, anxiety, or catastrophizing. Task duration with the unrestricted stop rule was not related to self-reported escape/avoidance (r = -.13, P = .50) and was not predicted by fear, anxiety, or catastrophizing. However, task duration with the tolerance stop rule was associated with self-reported escape/avoidance (r = -.40, P = .02) and was predicted by catastrophizing (t(29) = -2.92, P < .01). Thus, evidence for the validity of task duration with a tolerance stop rule as a measure of escape from pain or avoidance of pain exacerbation was found.Measures of avoidance of pain onset were not supported. However, task duration was a valid measure of escape from pain or avoidance of pain exacerbation with tolerance stop rules. Other measures of escape/avoidance behavior and participants' perceptions of stable or increasing pain level throughout a pain task should be examined.