text:
Temozolomide, Cixutumumab, and Combination Chemotherapy in Treating Patients With Metastatic Rhabdomyosarcoma
A Pilot Study to Evaluate Novel Agents (Temozolomide and Cixutumumab [IMC-A12, Anti-IGF-IR Monoclonal Antibody, IND #100947, NSC #742460]) in Combination With Intensive Multi-Agent Interval Compressed Therapy for Patients With High-Risk Rhabdomyosarcoma
This clinical trial is studying the side effects and how well giving temozolomide and
cixutumumab together with combination chemotherapy works in treating patients with
metastatic rhabdomyosarcoma. Drugs used in chemotherapy, such as temozolomide, work in
different ways to stop the growth of tumor cells, either by killing the cells or by stopping
them from dividing. Monoclonal antibodies, such as cixutumumab, can block tumor growth in
different ways. Some block the ability of tumor cells to grow and spread. Others find tumor
cells and help kill them or carry tumor-killing substances to them. Giving temozolomide and
cixutumumab together with combination chemotherapy may kill more tumor cells.
I. To determine the feasibility of administering cixutumumab in combination with an
intensive multi-agent interval compressed chemotherapy regimen for the treatment of
high-risk metastatic rhabdomyosarcoma (RMS).
II. To determine the feasibility of adding temozolomide to vincristine and irinotecan in
these patients.
III. To assess immediate and short-term side effects of concurrent temozolomide,
vincristine, and irinotecan with radiotherapy in these patients.
I. To gain a preliminary estimate of the response rate to cixutumumab or temozolomide,
vincristine, and irinotecan in these patients.
II. To obtain preliminary efficacy data for cixutumumab or temozolomide in combination with
an intensive multi-agent interval compressed chemotherapy regimen in these patients.
III. To determine the effectiveness of detecting metastatic disease with fludeoxyglucose F
18 positron emission tomography (FDG PET) and to compare assessment of response using
standard imaging techniques with response assessed by FDG PET.
IV. To assess changes in serum levels of insulin-like growth factor (IGF)-I, IGF-II, IGF-BP3
as biomarkers of IGF-IR inhibition.
OUTLINE: This is a dose-escalation study of cixutumumab. Patients are assigned to 1 of 2
treatment groups according to the timing of their enrollment onto the study.
GROUP 1: Patients receive vincristine sulfate intravenously (IV) on day 1 of weeks 1-5, 7,
8, 11, 12, 15, 16, 20-24, 28, 29, 32, 33, 35, 38, 41-44, 47, 48, 50, and 51; irinotecan
hydrochloride IV over 90 minutes on days 1-5 of weeks 1, 4, 20, 23, 47, and 50; ifosfamide
IV over 1 hour and etoposide IV over 1-2 hours on days 1-5 of weeks 9, 13, 17, 26, and 30;
doxorubicin hydrochloride IV on days 1 and 2 of weeks 7, 11, 15, 28, and 32;
cyclophosphamide IV over 30-60 minutes on day 1 of weeks 7, 11, 15, 28, 32, 35, 38, 41, and
44; dactinomycin IV on day 1 of weeks 35, 38, 41, and 44; and cixutumumab IV over 1 hour on
day 1 of weeks 1-51. Patients also undergo radiotherapy* on days 1-5 of weeks 20-24.
GROUP 2: Patients receive vincristine sulfate, irinotecan hydrochloride, ifosfamide,
etoposide, doxorubicin hydrochloride, cyclophosphamide, and dactinomycin and undergo
radiotherapy* as in group 1. Patients also receive temozolomide orally (PO) on days 1-5 of
weeks 1, 4, 20, 23, 47, and 50.
etoposide, doxorubicin hydrochloride, cyclophosphamide, dactinomycin, and cixutumumab and
undergo radiotherapy* as in group 1. Patients also receive temozolomide as in group 2.
(Discontinued as of January 2013)
NOTE: *Patients with parameningeal tumors and evidence of intracranial extension or those
requiring emergency radiotherapy may receive radiotherapy starting in week 1; cixutumumab
should be withheld during radiotherapy.
After completion of study therapy, patients are followed up periodically for up to 10 years.
- Newly diagnosed, biopsy-confirmed metastatic rhabdomyosarcoma (RMS) or
ectomesenchymoma
- Stage IV, Clinical Group IV
- RMS with parameningeal and paraspinal primary tumors, including those with
intracranial extension by contrast magnetic resonance imaging (MRI) showing that the
primary tumor touches, displaces, invades, distorts, or otherwise causes signal
abnormality of the dura in brain or spinal cord in contiguity to the primary site,
are allowed; ICE is also presumed to exist if the cerebrospinal fluid (CSF)
cytopathology is positive for tumor at diagnosis
- Has undergone initial surgery (including biopsy) that provided the definitive
diagnosis within the past 42 days
- Enrollment on COG-D9902 required
- Patients must have a performance status corresponding to Eastern Cooperative Oncology
Group (ECOG) scores of 0, 1, or 2; use Karnofsky for patients > 16 years of age and
Lansky for patients =< 16 years of age
- Absolute neutrophil count (ANC) >= 750/μL
- Abnormal blood counts are permissible if there is bone marrow biopsy or aspirate
proven bone marrow involvement by RMS
- Platelet count >= 75,000/μL
- Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min OR
maximum serum creatinine based on age/gender as follows:
- 0.4 mg/dL (for patients 1 to 5 months of age)
- 0.5 mg/dL (for patients 6 to 11 months of age)
- 0.6 mg/dL (for patients 1 year of age)
- 0.8 mg/dL (for patients 2 to 5 years of age)
- 1.2 mg/dL (for patients 10 to 12 years of age)
- 1.5 mg/dL (males) or 1.4 mg/dL (females) (for patients 13 to 15 years of age)
- 1.7 mg/dL (males) or 1.4 mg/dL (females) (for patients >= 16 years of age)
- Patients with urinary tract obstruction by tumor must meet the renal function
criteria listed above AND must have unimpeded urinary flow established via
decompression of the obstructed portion of the urinary tract
- Total bilirubin =< 1.5 times upper limit of normal (ULN) for age (unless there is
evidence of biliary obstruction by the tumor)
- Shortening fraction >=≥ 27% by echocardiogram (ECHO) OR ejection fraction >= 50% by
radionuclide angiogram
- Not pregnant or nursing
- Negative pregnancy test
- Sexually active patients of childbearing potential must agree to use effective
contraception during therapy (groups1 and 2) and for at least 3 months after the last
dose of cixutumumab (group 1)
- No uncontrolled infection
- No known type I or type II diabetes mellitus (for patients enrolled in group 1)
- No prior chemotherapy or radiotherapy except corticosteroids or emergent radiotherapy
- Patients requiring emergency radiation are eligible
- No concurrent growth hormone therapy
- All patients and/or their parents or legal guardians must sign a written informed
Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
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The GBP/USD finally made a breakout but the news around the Brexit process currently is and remains the main driver of price action. Price managed to push through the support zone which means that price could be in a downtrend as part of a wave 3 (blue).
The GBP/USD could be in a wave 3 but for this wave pattern to be confirmed, price needs to keep pushing lower towards deeper Fibonacci levels of wave 3 vs 1. The minimum expected target of a wave 3 is the 161.8% Fib target.
The GBP/USD made a retracement and bearish bounce at the 50% Fibonacci retracement level of wave 4 vs 3 (green) before price made a new low. For the moment it seems likely that price will either make a bearish continuation lower (orange arrow) or make a consolidation zone (grey arrows).


text: Some new random text: 6898

redpajama_set_name: RedPajamaGithub


text:
Home / Media / LeBron James wants to play 5-7 more years in the NBA and retire at 45, per Dennis Schroder
LeBron James wants to play 5-7 more years in the NBA and retire at 45, per Dennis Schroder
By Zach Stevens
David Reginek-USA TODAY Sports
Los Angeles Lakers superstar LeBron James is now in his 20th NBA season, and although he has lost a bit of athleticism, he's still playing at a high level.
Many have been wondering just how his career will end and how many more years he will play, and according to teammate Dennis Schroder, James has no plans on retiring anytime soon, as he wants to play at least five more seasons.
In an interview that came out today, Dennis Schröder said LeBron told him he wants to play 5-7 more years and retire at 45. pic.twitter.com/LJwSabGKhc
— Deandre Hayton (@YCSNOW23) December 11, 2022
According to Dennis Schröder, LeBron James says he wants to play 5-7 more years in the NBA and retire at 45, h/t @YCSNOW23. 👑
Unbelievable. pic.twitter.com/yZodWuPCWp
— Legion Hoops (@LegionHoops) December 11, 2022
When James came into the NBA as an 18-year-old, there was massive hype surrounding him, and a few wondered if he would be one of a handful of players to go straight from high school to the pros who didn't quite pan out.
But he quickly became an elite player, and by the time he won his first championship in 2012, he had become the best player in the world.
These days, the four-time MVP may not be the best player in the league anymore. Some of that is because he has lost some of his otherworldly athleticism, but another reason is that he has been pacing himself in order to save his best for when it has been needed the most.
James is currently under contract through next season, with an option for the 2024-25 campaign. He has said more than once that he wants to play with his son, who will be eligible to enter the NBA two seasons from now.
The one blemish on James' resume is his 4-6 record in the NBA Finals. There is no doubt he would like to do something about improving it and playing several more seasons while playing at an All-Star level would greatly help.
On Sunday versus the Detroit Pistons, he went 14-of-24 from the field and scored 35 points. Although he got off to a rough start this season, he has picked up his shooting percentages over the past few weeks.
The way James maintains his body, it likely wouldn't be that much of a surprise if he's still a good player into his early 40s.
Dennis SchroderfeaturedLeBron JamesLos Angeles Lakersnews ticker
← Previous Story James Harden flexes on social media after 76ers' big win vs. Lakers
Next Story → Austin Reaves speaks on LeBron James being criticized his whole career for making right basketball play late in games
About Zach Stevens
Zach has always had a profound love and respect for the Lakers that has inspired him to write about the franchise. He has a great deal of admiration for LeBron James, and his overall knowledge about the NBA has made him a solid addition to the Lakers Daily staff.

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Electrical Maintenance Technician Geismar, LA, US, 70734 Jan 27, 2023
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Instrumentation & Electrical Maintenance Planner Geismar, LA, US, 70734 Jan 27, 2023
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Your rack and pinion system with power steering ensures your steering is smooth and easy. But what happens when something goes wrong?
We all develop bad driving habits over the years. And it's not just driving at high speeds or braking late.
If you're feeling a wobble or your car won't drive straight, get easy-to-read advice on wheel alignment.
Get to know the function of a steering system and its role in great handling with MOOG.
How much does it cost to fix your car suspension?
Your suspension system gives you a smooth ride and works hard to cope with uneven road surfaces.
NASCAR® racing is more intense than normal driving. And that's not just the emotional rollercoaster the audience experiences as world-class drivers speed around the track.
Want great, safe road handling? Learn how to spot bad suspension. Discover the easy way to inspect car suspension DIY with MOOG.
Ball joint failure isn't a common problem, but can be the result of years of driving along bumpy, uneven road surfaces.


RV trailer stabilizer jack pads may not be the largest and most immediately apparent of all RV supplies, but they are an important thing to ensure the quality of all the same.
As with all camping supplies, the quality of your trailer stabilizer jack pads shouldn't be something that you're forced to begin considering better options in when it's already become a problem.
The best RV trailer stabilizer jack pads should be able to do their job well enough to make you forget that they're in place; at the same time, the best motorhome stabilizer jack pads don't have to be the most expensive kind on the market at all. The following are some of the top RV Trailer Stabilizer Jack Pads available today.
Camco's 4495 stabilizer jack pads are packaged in a group of four per box. To make the pads easier to handle, they've been designed with a built-in handle. In addition to a handle for increasing the usability, these jack pads also have a convenient storage strap.
Tri-Lynx's 0015 Lynx levelers come in a pack of 10 per set. These levelers are made in a modular design, capable of supporting a significant degree of weight and compatible with practically all leveling functions.
Level-Trek's LT800 jack pads are capable of being used with a wide variety of different jacks. These jack pads come in a pack of two per set, are made of orange polypropylene, and resistant to terrestrial sinking.
There are ten of Camco's 44505 leveling blocks per package. The ten blocks are affixed in an interlocked structure with an optimal height for secure leveling. The leveling blocks are not only durable, but have been specially designed to keep steady on softer soil without sinking into it.
Camco's 44953 stabilizer jack pads come in a package of four pads per box. With the implementation of a placement handle, the jack pads have thirteen additional inches of reach. The jack pads have been designed for sink resistance and also have helpful strap for easier storage.
The BAL 20031 trailer jack base pads are sold in packages of four per set. Each of the pads are 7.25 inches in diameter, and they're specially designed for use on telescopic and T-type jacks. To lessen rattling when driving, these pads are designed with rubber bushing.
Camco's stabilizer jack pads and leveling block wheel chocks bundle contains a 4-pack of interlocked leveling blocks. The leveling blocks are made with a tough constitution and a sturdy base that prevents them from submerging in softer ground. A 2-pack of leveling block wheel chocks facilitate an easier wheel-centering and stabilization process.
Prothane's 19-1403 red jack pads have been designed for a more optimal fit with special precision fabrication. These are rigid jack pads primarily composed of premium grade polyurethane. To ensure that the jack pads operate smoothly and quietly, each of the jack pads holds super grease.
Camco's 44600 leveling block non-slip pad has been specially designed to avoid sinking into the ground when in use. They are both weatherproof and UV resistant. These pads remain consistently steady on all different kinds of terrain, from slick mud to rough gravel. When used beneath jack pads, these non-slip pads can significantly prevent the risk of cracking.
Andrersen Camper's leveler TUFF Pads come in a set of four with each pack. These pads have been made with a design that is resistant to the buildup of oil, grease and dirt after prolonged use. These American-made pads are composed of recycled material and boast a superior degree of toughness.
The above RV leveler pads are all fine examples of what to look for when it comes to making the most well-informed choice in RV trailer stabilizer jack pads to buy online. In addition to seeing to it that they're affordable, pay attention to the lengths that the manufacturers have gone to create a product with the rig owner's convenience in mind.
Aim for the RV leveler pads that are not only durable, but are also designed in a manner that keeps them from getting compromised by unsteady terrain or excessive sediment buildup. Ultimately, if they're of a high enough quality, the best RV trailer stabilizer jack pads should only have to be purchased once.


After yesterday's Summit Meeting in Newark on a new trans-Hudson Tunnel, Christie, Sens. Cory Booker and Bob Menendez and U. S. Transportation Secretary Foxx said in a joint statement that they had a "substantive and productive meeting" and "all of us are committed to working together on a path forward on this critical project." In other words they told us nothing.
Christie's office followed up with a statement on the Governor's press release site. In an unusual move, instead of a Christie press release, there appeared a reprint of NJ Transit Executive Director Veronique Hakim's letter to The Record of August 13 in which she says, "Governor Christie and his administration support building a new tunnel." She goes on to enumerate the same conditions that Christie has mentioned before. In effect our governor, trying to thread his way through a campaign in which he now ranks 11th, is not speaking forthrightly and "telling it like it is," but rather letting someone else provide a vague and unsatisfactory statement.
A NY Times editorial says clearly and simply, Build a New Hudson River Tunnel. In this editorial its second photo of the tunnel is scary: decrepit, crumbling concrete, and exposed wiring.
Another rush hour in Hell: An NJ Transit train broke down on the Amtrak line under the Hudson River Monday at 7 a.m.
How to make the tunnel a reality: Elect a majority Democratic Congress next year. (Some NJ incumbent Republican Representatives would not be missed.) But first some agreement on the estimated total cost and a reasonable buy-in from those affected. That includes NY whose governor did not attend the summit.
As if his position on Cuba is not bad enough, Sen. Menendez yesterday "went on offense savaging the Iran nuclear deal backed by President Barack Obama." Sen.Booker appears undecided so far. Rep. Donald Payne (D-10th) endorses it, and Rep. Albio Sires (D-8th) opposes it. The opposition at this point is substantial, but less likely to be sufficient to over-ride a presidential veto.
More about 14 year old Radazz Hearns, voter expansion, a Christie paradox, Moody's credit rating, and what would you pay for this meal?
Cami Anderson, hand-picked thy Gov. Christie to run dismantle Newark's public education is a classic example of, When everybody tells you you're drunk, it's time to sit down.
Keystone XL Pipeline Act passed 266-153. Democrats Norcross and Sires voted Yes as did all NJ Republicans. All other NJ D's voted No.
Promoting Job Creation and Reducing Small Business Burdens (weakens Dodd Franks legislation) passed 271-154. Democrat Sires and All NJ R's voted Yes, and all other NJ D's voted No.
Natural Gas Pipeline Permitting Reform Act passed 253-169. Norcross (D) and all NJ R's voted Yes. Other NJ D's voted No.
Prohibit taxpayer abortions passed 242-179. All NJ R's voted Yes; all D's voted No.
Appropriations for the Department of Homeland Security (Limits the President's authority to to spare classes of deserving immigrants per his Executive Order.) passed 236-191. All NJ R's voted Yes. All NJ D's voted No.
For committee assignments and power ratings, go below the fold.
Not so long ago the NJ legislature used to have an annual Christmas tree bill which was sprung upon the membership and laden with all sorts of holiday goodies inserted by individual legislators. This week in the House of Representatives with little more than two days to review the bill, leadership sprung their $1.1 trillion Christmas tree bill to fund the government next year and avert a federal shutdown.
The bill narrowly passed 219 votes to 206. Many Republicans did not like the bill for the generic reason that it calls for "too much government spending," and because the act does not explicitly block President Barack Obama from implementing his Executive Order on immigration. Republicans voted 162 in favor and 67 against. Many Democrats did not like the bill because it weakens Dodd-Frank consumer legislation and because it increases substantially the amount donors can contribute to political parties. Democrats voted 57 in favor and 139 against.
The House Speaker Republican John Boehner never had enough Republican votes to pass the bill, so he relied on support from Democrats. The White House vigorously lobbied Democrats for passage as did Steny Hoyer, Democratic Whip. Minority Leader Nancy Pelosi spoke out and voted against it. Five of our NJ Democrats refused to "hold their nose" and vote for it and instead voted against it.
The saga of the Keystone Kops like the Keystone Pipeline is one of unsuccessful, seemingly incompetent people repeatedly failing in a venture which in this case increases carbon emissions, could cause significant environmental damage and is still under study. For the ninth time the House voted on Friday to approve the Keystone XL Pipeline – 252 to 161.The roll call for our New Jersey Representatives was not what you might expect.
Republicans in the NJ delegation all voted YES to approve Keystone including Rep. Jon Runyan (R) who continues in office until January when his successor Tom MacArthur (R) is sworn in. Among the Democratic delegation the newly minted Don Norcross (replacing the already departed Rob Andrews) and Albio Sires also both voted YES. Donald Payne did not vote. The three remaining Democrats voted NO including Rush Holt who in January will be succeeded by Bonnie Watson Coleman (D).
Norcross said "I am proud to stand with members of both parties to support this project that can transform the American economy and put our nation back on the path of lasting growth." As a candidate his platform supported "Job creation and Economic Development," but did not mention energy policy. He calls himself an "Advocate for South Jersey," but while the pipeline has national consequences its impact on South Jersey is considerably less significant. When he was sworn in he said he would "specifically like to serve on the House Committee of Energy and Commerce." He might be welcomed by the Republican majority on the committee but his vote seems out of sync with his Democratic colleagues.
As Roll Call points out, "the bill would still need 60-votes in the Democratic Senate before heading to President Barack Obama's desk – a tall, but perhaps achievable order." The House vote did not reach the veto-proof level. President Obama has never expressed support for the pipeline, but he has not said definitively that he will veto it.
In the U. S. elections last week Republicans took control of the U. S. Senate with 7 new seats and as of now have a lead of 52 to 46 with two undecided. In the House of Representatives Republicans, already in the majority, have gained 12 seats to lead 244 to 184 with 7 undecided. In gubernatorial races, where Christie spent so much time, Republicans gained net 3 seats with 2 still undecided.
In New Jersey we note in congressional races low Democratic turn out, an exciting victory in CD 12, heartbreak in CD 3 and 5, the winners all being those who raised the most money, independent funders spending big in CD 3 but not so much elsewhere, the departure of a highly respected congressman in CD 12, mixed quality of public polls, all incumbents winning, and the congressional delegation balance remaining unchanged at six R's and six D's. Both Public Questions passed. Voting by mail has increased from 10,000 in 2003 to 139,000 in the most recent report for 2013.
Also worth noting is the resurgence of county Democrats in Bergen, which has the state's largest number of registered voters and whose Dem. Party Chair Lou Stellato is being wooed by potential gubernatorial candidates. Jim Tedesco (D) defeated long-time politician Kathe Donovan (R) to become the B. C. Executive. Current Freeholder Board Chair David Ganz (D) was re-elected as was Joan Voss (D), allowing the Board to remain in control of Democrats.
For brief comments on the 12 congressional races go below the fold.


text:
Camel Pride
NKY.com: Campbell County rallies past Bourbon County, 7-4
Posted On: May 29, 2013	Posted By: David Shepard
When the lights came back on following a power outage at Scott High School in the top of the fifth inning of Tuesday's 10th Region semifinal baseball game between Campbell County and Bourbon County, the lights came back on as well for the Campbell County bats.
Campbell County scored three runs in the top of the fifth, including a two-run double by sophomore first baseman John Eblin after play resumed following the power outage, and rallied from a 4-2 deficit for a 7-4 victory that advanced the Camels to the regional title game for the first time since 2005.
Campbell County (19-16), which is 16-6 since a 3-10 start to the season, will face perennial 10th Region power Harrison County at 6 tonight in the regional championship game.
Harrison County (23-7) advanced to the championship game for the 23rd time since 1984 with an 8-1 semifinal win over host Scott in Tuesday's first semifinal game. The Thorobreds, who lost in last year's regional championship game to Bishop Brossart and haven't won the title since 2010, are seeking their 21st regional title since 1984.
Bourbon County (24-13), which was seeking its third regional championship game appearance in the last four seasons, had rallied from a 2-1 deficit to its 4-2 lead by scoring three runs in the bottom the fourth, including two runs that scored on a throwing error at home.
Campbell County senior shortstop Tyler Walsh, who went 3 for 4 and missed the cycle only by not hitting a homer, led off the top of the fifth with a triple and scored on a single by senior center fielder Paul Griffis to cut the deficit to 4-3. After Bourbon County sophomore starter Kaven Brown, who entered the game with a 10-1 record, recorded a strikeout, the lights went out and caused about a 30-minute delay.
When play resumed junior third baseman Joe Kremer lashed a single against Brown, senior pitcher Rob Franzen was hit by a pitch to load the bases and Eblin then followed with a two-run double to put the Camels up 5-4.
"That was one of the oddest things I've seen in baseball," said Campbell County coach Scott Schweitzer, who is in his fourth season. "Our guys stayed focused and stayed in it and came right back out and hit the first pitch and bam, bam, bam we're off and running again. It's a group that stays loose and they do struggle at times with focus, but when the lights come on for them and it's a big game that means something they've played incredibly well."
Campbell County added two runs in the top of the sixth when No.9 batter Mitch Kramer walked, Walsh doubled him home, and after Griffis singled, a pinch-runner for Walsh scored on a double-play ground out.
Walsh didn't run, because he was warming up to relieve, but Schweitzer stuck with Franzen, who allowed a leadoff single in the sixth, proceeded to pick off that runner, got the final two batters in the inning, and after allowing a leadoff walk in the seventh, struck out the next two batters and got a fly out to center field to end the game. Franzen, who was clocked at 86 mph in the game, allowed just six hits, one earned run, walked one and struck out 10.
"Robby came off the mound in the sixth and patted his chest and said I want it," said Schweitzer. "He's worked his butt off all winter long and paced himself out to get there. He threw more pitches than I'd like him to throw, but he's a senior and he gutted it out."
Campbell County took a 1-0 lead in the top of the first when Franzen hit a sacrifice fly to center with the bases loaded to score Griffis.
Bourbon County tied it at 1-1 when Nick Wheeler doubled home David Baker in the bottom of the second.
The Camels went back up 2-1 in the top of the fourth when Franzen hit a one-out bad-hop single and scored on an error.
Bourbon County then went up 4-2 in the bottom of fourth when junior third baseman Tyler Bretz singled, Allen double to put runners at second and third and both scored on an infield error. Cody Miles, who reached on the error, scored on a double by Cameron Whitaker.
Schweitzer said Walsh will likely start tonight's championship game against Harrison County senior standout Jordan Martin, who pitched a complete-game , five-hitter in a 2-1 win over Louisville Butler in the 2010 state championship game.
Campbell County 7, Bourbon County 4
WP-Franzen (12 Ks). LP-Brown. Hitting Leaders: CC-Walsh 3-4, 2B, 3B; Griffis 2-3; Eblin 2-4, 2B, 2 RBI. BC-Whitaker 2B; Baker 2B; Wheeler 2B.
Records: Campbell County 19-16, Bourbon County 24-13.
http://nky.cincinnati.com/apps/pbcs.dll/article?AID=/AB/20130528/SPT0302/305280091/&nclick_check=1
David Shepard
Connect with David at david.shepard@fmr.com
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One tiny gland in your body that weighs under one ounce can put you into a world of hurt if it is not working correctly. That would be the thyroid gland. The Mayo Clinic notes that your thyroid "is located at the base of your neck, just below the Adam's apple." The gland contains hormones that regulate multiple functions in your body, including your metabolism, heart rate, and body temperature. So if it malfunctions, you can have a variety of health issues.
There are two basic ways your thyroid gland can go awry, according to EndocrineWeb.com: hyperthyroidism, in which the gland produces too much thyroid hormone, and hypothyroidism, in which it produces too little. These disorders can be caused by a variety of issues and are more common in women than in men, according to the U.S. Department of Health and Human Services.
Here are the symptoms you should watch out for that can show that the gland is overactive or underactive.
This is one of the most frustrating things about not being diagnosed with a thyroid issue. You may be depressed, have memory issues, or be annoyed or panicky all the time, and you think it's psychological instead of physical. Dr. Romy Block, a Chicago-area endocrinologist, told me that "mood changes (anxiety or depression)" can indicate that your thyroid is out of whack. The Mayo Clinic cites depression as a symptom of hypothyroidism, but it can also manifest in hyperthyroidism, as one counselor wrote in Psychology Today, and as a patient case study on the National Center for Biotechnology Information's website shows.
Other things to look out for include "nervousness, anxiety and irritability," which the Mayo Clinic says may be a sign of hyperthyroidism. And Dr. Block told me that "a common symptom of hypothyroidism is memory loss," so if you feel like you're being too forgetful these days, there might be a reason.
One of the reasons people don't always know that they should ask to get their thyroid checked is the fact that so many of the symptoms can also indicate some other issue besides too-high or too-low thyroid hormonal levels. You don't think of a high cholesterol level as indicative of a thyroid problem, but it can be. The Mayo Clinic says to watch out for an "elevated blood cholesterol level" as a symptom of hypothyroidism. The American Thyroid Association explains why this is. "When thyroid hormone levels are low and TSH levels are increased (hypothyroidism), cholesterol levels are increased," the organization says. So treatment for the condition may also help to lower cholesterol levels.
Dr. Block told me that "most people recognize weight changes as the primary symptom of thyroid problems," although the endocrinologist said "it is often not the first sign to appear." That's because the thyroid regulates our metabolism, so if that goes awry, so can our weight.
The Mayo Clinic lists "sudden weight loss, even when your appetite and the amount and type of food you eat remain the same or even increase" as a primary symptom of hyperthyroidism. And weight gain that people might attribute to other factors, such as getting older, may possibly be hypothyroidism.
If you have such issues, it may be assumed that something is wrong with your digestive system. But the thyroid may also cause gastrointestinal problems. Dr. Block told me that bowel changes are one of the symptoms of a malfunctioning thyroid. Specifically, the Mayo Clinic describes one of the symptoms of hyperthyroidism as "changes in bowel patterns, especially more frequent bowel movements," while constipation can be a symptom of hypothyroidism.
Women's health expert Carolyn Dean, MD, ND told me, "Slow metabolism leads to slow bowel movement."
Insomnia can have many causes. But if you're having a hard time sleeping, it could be hyperthyroidism, according to the Mayo Clinic. In addition, Dr. Block said, "I also find racing thoughts before bedtime often accompany hyperthyroidism." That is something that we might think is psychological, but it can have a physical cause.
Another symptom to watch out for is fatigue, which can be a symptom of both hyperthyroidism and hypothyroidism. Dr. Ehsan Ali, the physician known as the Beverly Hills Concierge Doctor, told me that fatigue is a big sign you should get your thyroid checked.
Muscle weakness is another sign that could show that your thyroid is not working correctly. It can be a symptom of both hypothyroidism and hyperthyroidism. The Mayo Clinic also says that "muscle aches, tenderness, and stiffness" and "pain, stiffness, or swelling in your joints" may be signs of hypothyroidism.
If your muscles feel sluggish, Melanie Goldfarb, MD, MS, FACS, a California-based endocrine surgeon, told me that this could be a sign of hypothyroidism. She explained that "sluggishness (mental and physical)" could be a sign that "your thyroid isn't producing enough hormone."
Since one of the things the thyroid does is regulate body temperature, if it is malfunctioning, you may notice it with how you feel when it comes to the cold and heat. The Mayo Clinic cites both "sweating" and "increased sensitivity to heat" as symptoms of hyperthyroidism, while "increased sensitivity to cold" can be a sign of hypothyroidism.
Dr. Jason Cohen, a Los Angeles-based surgeon and expert in thyroid cancer treatment, told me that because "the thyroid maintains our homeostasis and keeps the body's energy levels in check," when it malfunctions, people may notice a difference in body temperature. When the "thyroid levels are low," he said, "people typically feel cold all the time," and when the levels are high, people may be "feeling hot or sweating." So what women of a certain age may think of as menopausal hot flashes may have another cause.
If you are having problems with your period, you may assume that you have issues with your reproductive system. But it could be your thyroid causing those issues, rather than your uterus, ovaries, or fallopian tubes. The Mayo Clinic lists "heavier than normal or irregular menstrual periods" as symptoms of hypothyroidism and "changes in menstrual patterns" as possibly indicating hyperthyroidism.
Dr. Ali told me you may want to get your thyroid checked if you are experiencing menstrual cycle changes, and Dr. Block said that "irregular periods can often represent a thyroid problem, either overactive or underactive."
Most of the doctors I spoke with mentioned to pay attention to the state of your hair, as it can provide a clue as to the health of the rest of your body. The Mayo Clinic says that "fine, brittle hair" can be a symptom of hyperthyroidism, and "thinning hair" can indicate hypothyroidism. Dr. Goldfarb explained that "when your thyroid isn't producing enough hormone," you may experience hair loss. Dr. Dean said that you may have dry hair as well with hypothyroidism. "Your hair doesn't grow as fast and your circulation is slowed down and doesn't nourish your hair," she explained.
A puffy face could be a sign of hypothyroidism, according to the Mayo Clinic. and thinning skin can be a sign not just of aging, but of hyperthyroidism. Dr. Ali also said that acne can be a sign that your thyroid is out of sync, specifically if your hormonal levels are low.
People think of trembling hands as a sign of Parkinson's disease, as well as simple nervousness, but it can also be a sign of hyperthyroidism. The Mayo Clinic describes the hand tremors as "usually a fine trembling in your hands and fingers." When you have a tremor, you may literally find that your hands are shaking. And if the case of trembling is severe, the National Institute of Neurological Disorders and Stroke says that you might have "difficulty writing or drawing" as well as "problems holding and controlling utensils." You might also find that the trembling gets worse during times of stress.
If you are feeling weird sensations around your chest, neck, or throat, it could be heart palpitations, and they may be caused by your thyroid, not your heart itself. The Mayo Clinic describes a number of things connected with your heart rate that can really indicate hyperthyroidism, including "rapid heartbeat (tachycardia) — commonly more than 100 beats a minute," as well as "irregular heartbeat (arrhythmia) or pounding of your heart (palpitations)." Dr. Goldfarb explained: "When your thyroid is making too much hormone (hyperthyroid), you can experience racing heart" as well as "palpitations." On the other hand, a slower heart rate can indicate hypothyroidism, according to the Mayo Clinic.
Dr. Cohen said that "when thyroid levels are low, we are low" and "our hearts might beat slower." He added, "If thyroid levels are high, a person will show signs of overactivity," including a "racing heart."
If your voice feels very hoarse, it can indicate that you've been talking too much, have a cold, or have an issue with your thyroid. The Mayo Clinic says it can be a sign of hypothyroidism. It can also indicate, according to EndocrineWeb, that a thyroid nodule is physically pressing on your throat, causing your voice to become hoarse.
If the front of your neck looks and feels swollen, as if you literally have a lump in your throat, it could be hyperthyroidism. The Mayo Clinic describes it as "an enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck." This is why if you go to the doctor for thyroid issues, he/she will physically feel and examine your thyroid to see if it is too big. Dr. Ali said to pay attention to any "neck swelling" you may experience.
Since the thyroid regulates so much of our body, it is important to have it working correctly to have optimum health. Dr. Goldfarb told me that when it comes to your thyroid, some "mild thyroid conditions that are not treated for many years can affect your heart, bones, and other organ systems," but that there are also "very mild abnormalities" that "may go unnoticed and don't necessarily need to be treated." She stressed that "symptoms that are caused by very abnormal thyroid hormones can also affect things like your energy level and productivity, which impacts your general health."
In addition, "for women trying to get pregnant, having your thyroid hormones in normal range is important," the physician said.
If you go to your physician about a thyroid issue, chances are they will physically examine your thyroid. But you will also need to get blood tests that break down your thyroid levels. Dr. Block explained to me the the TSH (Thyroid-Stimulating Hormone) Test is what is used to diagnose thyroid issues. It measures these "signals from your pituitary to your thyroid," but she explained that the TSH levels are "the opposite of what people think." A high TSH level indicates hypothyroidism and a low level indicated hyperthyroidism.
She said that a "high TSH is seen in hypothyroidism because your brain is yelling at your thyroid to speed up," while a "low TSH is seen in hyperthyroidism because your pituitary is telling your thyroid to slow down or stop making thyroid hormone."
There are other thyroid tests that can be given to further determine what is going on with your thyroid. The Free T4 Test measures "one of the circulating blood levels of thyroid hormone," and Dr. Block said "it is helpful in both hyper and hypothyroidism." The Free T4 Test "is really only helpful in hyperthyroidism," Dr. Block said. "It can often be high when the free T4 is normal in Graves' [Disease]. It is another circulating hormone in the bloodstream." Then there are tests to measure thyroid antibodies. "Thyroids stimulating Immunoglobulin (TSI) is often seen in Graves' Disease," she said. "Thyroid peroxidase antibody (TPO) is often seen in hypothyroidism," she added, specifically with Hashimoto's disease. "We can see it in hyperthyroidism too," she said. "I think of it like a key that can turn your thyroid off or on." The thyroglobulin antibody "is mostly seen in hypothyroidism," she said.
In early 2007, I found that I was tired all the time and felt very weak. My muscles seemed to get tired quickly; even just walking down the street from my car to my house seemed to wear me out. I also had tremors in my hands, I was hot all the time, even in winter, and my eyesight seemed to be fading.
I chalked some of it up to stress at work but I began to get really scared when even on days off from work, I was still so exhausted. So I went to my primary care physician to see what was going on. He ran a battery of tests, including blood work, on me, and discovered my thyroid numbers were way off, indicating an overactive thyroid.
My physician referred me to an endocrinologist, a doctor who is a specialist in thyroid issues. All it took was him taking literally one look at me, as well as feeling my thyroid nodules in my neck, to figure out that I appeared to have Graves' Disease, an autoimmune disease that causes hyperthyroidism. He also asked me about how I was feeling. I didn't have all of the symptoms of hyperthyroidism. For example, my hair didn't change, and my skin stayed the same. But I had enough of the symptoms to indicate that there was an issue.
The doctor ran more specialized blood work (TSI, T3 and T4 tests) that confirmed the diagnosis. The reason he could tell so quickly? My "stare," as he called it, that he noticed as soon as he met me. Without me even realizing it, my eyes were starting to get a protruded, heavy-lidded look to them, which is what is known as Graves' Ophthalmopathy. Remember how actor Marty Feldman and former First Lady Barbara Bush had that bug-eyed look? Both of them suffered from Graves' Disease as well, and the disease was causing my eyesight to get blurry. I worried my eyes would get even worse. And I worried that I would never get my energy back. It was a frightening time for me.
Even though I had a disorder that was supposed to speed up my metabolism, I had actually gained weight because I was too fatigued to do much of anything outside of going to work. It took about six frustrating months of my endocrinologist trying different thyroid medications to get me back to normal. I was at the point where I was considering radiation to "zap" the thyroid just to get some relief. Finally, we found a medication that worked. After several years of regularly monitoring my thyroid, I was able to get off the medication for good, and my Graves' Disease went into remission.
I consider myself one of the lucky ones, as other people have had to get their thyroid removed, and/or be on medication for the rest of their lives to get back to normal, while my time of suffering was fairly short.
I asked Dr. Block for this article about why I gained weight, and she confirmed she had "Graves' patients that gain weight (instead of losing weight)," and said that some of them were also "exhausted," the way I was. I'm glad to finally learn that I wasn't alone here.
If you have some of the symptoms listed, and you just don't feel right, you might want to talk to your physician about it and have your thyroid checked. If your thyroid is the issue, there are a variety of treatments out there that can potentially improve your health and quality of life. It does get better.


In three years, Those Girls are Wild (TGAW) has gained over 50,000 loyal subscribers who've watched and shared their videos more than seven million times spawning a growing number of TGAW-themed products and events.
And with countless TGAW fan submissions for themes like "Shameless Mondays" and videos that discuss topics such as friendship, relationships, and natural hair, Andrea and Shannon are driving the discussion that is inspiring a new generation of 'wild girls' to celebrate the ups and downs of life while living out loud on their own turns.
Here, Andrea and Shannon talk about their biggest regrets and inspirations, growing a business with a partner who lives in a different city, and the origin of their 'shameless' promotion.
Madame Noire (MN): What was the inspiration and purpose behind TGAW? What made you want to join forces?
Shannon Boodram (SB): Essentially blogs were all the rage during that time in our city of Toronto and we wanted a piece of the shine too. We both felt like we were in a place in our lives both professionally and personally where we felt comfortable sharing our lives and we believed others could benefit from that kind of honesty.
Andrea Lewis (AL): I always feel like the best way to get people to support you is for people to feel like they know you. Especially for myself coming from the acting world. Often people just assume you're exactly like whatever character you were playing on TV. At the time before we started TGAW we didn't have anything where people could get to know who we really were. [With TGAW] we truly got a chance to just be ourselves!
MN: You have an active digital audience of more than 50,000 people. Was it hard to grow your audience or did you find that people knew you from previous work?
SB: Andrea being famous has and continues to help, but at the same time there is SO MUCH to pay attention to online. So it is hard to get attention. Unless you are doing things in the formulaic way — beauty, DIY stunts, cats, tag videos — it can take a long time before one of your videos sees 1,000 hits! We had to be very persistent and innovative from [day one]. And living up to that standard has been tough because now that we are both busier it is a lot easier to do the standard videos than the risky ones.


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The Sage-Grouse is the largest grouse in North America. Its range is sagebrush country in the western United States and southern Canada. Their current population is less than 10 percent of historical numbers.
Found only in Colorado, the Gunnison Sage-Grouse was recently (2001) recognized to be a new species separate from the greater sage-grouse. They are about one-third smaller than the greater, and males have more distinct white tail feathers and hair feathers (filoplume).
The Greater Sage-Grouse is the largest grouse in North America. Its range is sagebrush country in the western United States and southern Canada. Their current population is less than 10 percent of historical numbers.
The sage-grouse's unique, dramatic, and impressive courtship dance is one of the most flamboyant mating displays in nature. This bizarre, yet spectacular display, easily captures the heart of people who are fortunate enough to witness it.
The Gunnison Sage-Grouse, found only in Colorado, was recently (in 2000) realized to be a species separate from the Greater Sage-Grouse.
They are about one-third smaller than the typical sage grouse, and males have more distinct white tail feathers and hair feathers (filoplume). Females are about one-third smaller than other sage-grouse. Just like the greater sage-Grouse, the Gunnison sage-grouse depend on sagebrush.
Male Gunnison sage-grouse perform an elaborate display to attract females. They will strut, flap their wings against their white pouches and utter a distinctive series of sounds by vocalizing and popping two air sacs within their pouches.


text:
Susan Krauss Whitbourne Ph.D.
Fulfillment at Any Age
A New Way of Looking at the Personality of the Bragger
If you think that all braggers are narcissists, new study shows why they're not.
Find an expert on Personality
Source: Antonio Guillem/Shutterstock
Everyone is familiar with, and tired of, people who brag. There is the clear annoyance you feel about the "humble bragger," whose social media posts might include "complaining" about having to take a business trip to an exotic location because someone wants to meet with them. That post is intended to make humble braggers seem important by showing that they are so much in demand that the company is willing to pay for a weekend in Waikiki. The complaints are there, we may presume, to neutralize the act of bragging. You'd feel much better if these people would just say something like "looking forward to" x, y, or z, instead of putting on the pretense of being so inconvenienced by the trip that they have to broadcast it to the world. The other kind of braggers take a different approach to the art of trying to impress. They will pretend not that they're unhappy about something great, but that they're doing something much greater than is actually the case. Part of the pretense of this type of bragger involves claiming to be something they're not. Why do people do this? Are they driven by the narcissistic need for admiration?
A new study by Humboldt Universität zu Berlin's Doreen Bensch and colleagues (2019) zeroes in on the overclaiming form of bragging to find out who is the most likely to engage in this particular impression management strategy. The study was motivated by an interest that researchers in personality measurement have in identifying people who try to look better than they are in psychological tests. If participants try to make themselves look good, they will put a positive spin on every question that they believe can show them in a favorable light. One form of self-enhancing fabrication is social desirability, in which test-takers choose not to admit to behaviors that could put them in an unflattering light. They may claim, for example, that "my table manners at home are as good when I eat out in a restaurant," or that "I never resent being asked to return a favor." If you answer "true" to a number of these items, the researcher can infer that you are also trying to make yourself look good in the actual tests of interest.
The related behavior of overclaiming takes a different form of response distortion. As defined by Bensch et al.'s summary of research on the topic, "Overclaiming is the tendency to claim knowledge about nonexistent items" (p. 353). In everyday life, people use overclaiming to make it sound like they know about areas in which they have no actual knowledge. Here's where you can probably dip into your storehouse of bragging scenarios with people trying to impress you. Perhaps you work with someone who feels it's important to appear knowledgeable about important media phenomena. The series finale of Game of Thrones was fodder for water cooler conversations that lasted for days. Not wanting to appear out of it, he never admits to not having watched it, but instead laughs and agrees with what everyone else is saying. He might even quote from media coverage of the episode. Similarly, you might have a relative who likes showing off her mastery of sports trivia. Her overclaiming takes the form of rattling off supposed statistics regarding her team's best players, as she feels confident no one will realize she made up those numbers.
A final type of positivity bias involves a simpler process of just saying you are better than you are, in the type of bragging the German authors refer to as overconfidence. You may be playing a video game that is now at a very high level of difficulty. You know that it's taken you an inordinate amount of time to complete the level. Therefore, when talking to a friend who plays the same game, it surprises you to hear her say how easy it was. There's very little chance that she was able to whiz through the level unless she was extremely lucky. In her own estimation, she did a great job, but the reality was almost certainly far less gratifying. In actual psychological testing, overconfidence would be measured by seeing how well participants performed on a memory quiz in comparison to how well the participant felt they had done. The comparison between estimation and performance provides a nice way to quantify this type of bragging.
The three components of personality test bragging, then, include social desirability, overclaiming, and overconfidence, which, as noted by the authors, form a "nomological network" reflecting a general positivity bias. The bane of the personality researcher, these qualities should also correlate with traits such as grandiose narcissism and, in some way, with the five personality traits included in the Five-Factor Model (neuroticism, extraversion, agreeableness, openness to experience, and conscientiousness). You might immediately suspect, as did the authors, that the bragger's true personality fits the profile of the grandiose narcissist. To test whether this hypothesis is valid, the German authors administered a set of online questionnaires to German university students whose average age was 25 (58 percent female). Included in these questionnaires was a measure of so-called crystallized intelligence, or knowledge about culture, vocabulary, and other areas of general information.
The overclaiming measure, that assessment of bragging which taps saying you know about something that you don't, was tested with questionnaires that gave them items from popular culture that have never happened. The three categories included in the overclaiming scale were physical sciences, civics, and humanities. Participants indicated how well they knew each item, from "never heard of it" to "know it very well." One such example was the item "prosa," a fake term. If they said they were familiar with this non-existent term, the response added to their overclaiming score. These lures were enough to draw out the overclaimers, which, when added to social desirability and overconfidence, provided the researchers with an overall picture of how much the participant was trying to make a good online impression.
Much to the surprise of the researchers, overclaiming stood out on its own as an index of the positivity bias by failing to relate to personality at all, including grandiose narcissism. As the authors note: "overclaiming has its own nomological network not including relationships with socially desirable responding (SDR) scales, personality, nor intelligence" (p. 360). Overclaiming still may be an index of a person's need for self-enhancement, though, and in fact may be a more purified form of the process. It's not just that overclaimers want to look more honest, socially skilled, or more able than they are, but that they feel it's important to appear to be familiar with a wide range of topics about which they have no knowledge. An overclaimer, in other words, can't stop from "faking." Narcissism doesn't even enter into the equation, because such a person simply enjoys being a show-off.
To sum up, don't assume that overclaimers are narcissists or even out for personal gain. Their need to impress doesn't come from anything more than needing to look smart. If you're the occasional overclaimer yourself, think about what's leading you to feel this particular need. Admitting honestly your strengths and your weaknesses might be just the way to feeling fulfilled with who you are.
Bensch, D., Paulhus, D. L., Stankov, L., & Ziegler, M. (2019). Teasing apart overclaiming, overconfidence, and socially desirable responding. Assessment, 26(3), 351–363 doi:10.1177/1073191117700268
Braggers and economic insecurity
Submitted by B on May 13, 2019 - 3:58am
We brag partly because we are explicitly told to as soon as we are old enough to submit job applications and resumes.
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Quote B
Submitted by Leia M. on May 13, 2019 - 12:32pm
Don't bother with braggers, liars, fools, and other related sub humans. Truth need not always be earned but it's expected. The highest point in my life is when I'm dealing with intelligent, honest, caring people as opposed to dam fools who waste my time lying. Lastly, are you as concerned with braggers who tell the truth? Often you will not know who's telling the truth. I was blessed with caring parents and thankful to the Lord, two brilliant kids. I rarely tell anyone. Would hate to cause envy or sadness in a so fucked up chaotic world. Would you think better of truthful braggers? I usually don't. Kindness is contagious. Why lie if you can uplift.
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Susan Krauss Whitbourne, Ph.D., is a Professor Emerita of Psychological and Brain Sciences at the University of Massachusetts Amherst. Her latest book is The Search for Fulfillment.
Abnormal Psychology: Clinical Perspectives on Psychological Disorders
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Vyne Education is combining efforts with PESI Rehab to provide you with the same great education in one collective library. You have been redirected to PESI Rehab to offer you a single website experience featuring the training you need and want from today's leading experts. If you have already created a PESI Account, you are all set and all of your previously purchased VYNE content will be linked in your PESI Account. If not, you can login with your VYNE Account credentials as this has been transferred over to create a PESI Account for you.
This is the best seminar on challenging geriatric behaviors that you will ever attend - GUARANTEED! Join Steven Atkinson, nationally-known expert, author and speaker on geriatrics, for a high-energy, dynamic seminar filled with interesting case studies, insightful discussions and interactive learning. You will leave this seminar with practical techniques that you can apply the next day!
If older adults are routinely under your care, minimize your risk of escalating the problems associated with troublesome, often irrational behavior by attending this program. Gain valuable insights into the causes of challenging geriatric behaviors and learn innovative and practical intervention strategies to improve the care you provide.
Develop strategies to manage difficult behaviors in seniors who have an altered perception of reality.
Identify the signs and symptoms of Alzheimer's Disease and other dementias.
Discuss current research on the prevention of Alzheimer's disease, as well as lifestyle factors to slow the disease progression.
Summarize the safety issues associated with geriatric patients who drive and identify individuals who pose a safety threat.
Explain why wandering occurs in individuals with cognitive impairment and develop strategies to minimize or redirect this behavior.
Describe the environmental and behavioral causes of agitation.
Differentiate between appropriate and inappropriate sexual behaviors in individuals with dementia.
Distinguish between normal sleeping patterns and bedtime issues which could lead to increased health problems.
Analyze the physical and psychological changes that affect an elder's desire and ability to eat including the changes in nutritional requirements.
Identify the signs of caregiver stress and develop intervention strategies to prevent burnout.
Is wandering a bad thing?
Steven Atkinson, PA-C, MS, is a Board-Certified Physician Assistant specializing in Geriatric Internal Medicine. He practices medicine in the greater Minneapolis area. In addition to his private practice, he has been on the faculty at the University of Utah since 1994 and has been involved in medicine for over 30 years.
Steven is the co-founder of Twin Cities Physicians, which serves older adults in nearly all levels of their care. He has presented nationally for over 15 years, primarily speaking bout geriatric-related syndromes. Steven is a published author and also sits on several boards whose purpose is to elevate the level of care in medicine for the patients they serve. Steven has been described as a "dynamic" educator and one of the most engaging presenters around. Don't miss him!
Financial: Steven Atkinson is the founder and co-owner of Twin Cities Physicians; and owner of Mindful Geriatrics, LLC. He is an Adjunct Faculty at the University of Utah. Mr. Atkinson receives royalties as an author for PESI Publishing and Media. He receives a speaking honorarium from PESI, Inc.
Nonfinancial: Steven Atkinson has no relevant nonfinancial relationship to disclose.
PESI, Inc. PE001, is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR) from July 1, 2018 through June 30, 2019. Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 6.0 continuing professional education units (CPEUs) for completion of this program/materials. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials. This program/material is designated as LEVEL 2.
IOWA NURSES: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Full attendance at this activity qualifies for 6.3 contact hours. Full attendance in the activity is required; no partial contact hours will be issued for partial attendance. These contact hours are used for your license renewal. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.
This program offers 60 instructional minutes of pharmacology content which is designed to qualify for 1.0 contact hours toward your pharmacology requirement to receive credit. It is your responsibility to submit your certificate of successful completion and a copy of the seminar brochure to your licensing board.
This educational offering has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 6.25 clock hours and 6.25 participant hours. Full attendance is required; no partial credits will be offered for partial attendance.
This activity consists of 6.25 clock hours of instruction that is applicable for physical therapists. CE requirements for physical therapists vary per state/jurisdiction. Please retain the certificate of completion that you receive and use as proof of completion when required.


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Historic Chagrin Falls listed by the National Park Service
Historic Districts Chagrin Falls West Side Historic DistrictBounded by Franklin, Maple, Church, and East Washington Streets, this district was established October 9, 1974. Chagrin Falls Triangle Park Commercial District Chagrin Falls Triangle Park Commercial District Main, Franklin, & Washington Sts. also at the junction of N. Main and E. Orange Sts. extending East & South. This district was established Oct. 1, 1974. Chagrin Falls East Side Historic District East Washington and Philomethian Sts. This district was established June 14, 2013 … Read More
Early Churches in Chagrin Falls
There were five early churches in Chagrin Falls, the planners envisioned all churches tobe located around a projected public square. As was the case with all the early churches, they first met in private homes. The First Congregational Society The First Congregational Society was formed in 1835, just two years after the settlement of Chagrin Falls was formed. By 1844 they were raising money to build a church house. The Congregational Church was located on the north side of the … Read More
The History of Chagrin Falls Schools
Chagrin Falls has always been known for the excellence of its teachers and schools. The quality of our schools is often given as the top reason people desire to move to this wonderful community. You can visit the official Chagrin Falls school website at: http://www.chagrin-falls.k12.oh.us/ Listed below is a short history of the different school buildings that have been in Chagrin Falls. Tom Mattern has written an excellent history of the Chagrin Falls School area and his book can be … Read More
Explore Historic Chagrin Falls!
The Village of Chagrin Falls possesses two historic cemeteries, Grove Hill Cemetery and Evergreen Hill Cemetery. These two cemeteries serve as the burial grounds for a variety of prominent Chagrin residents and war veterans. The first burial was made in Grove Hill during the year Chagrin Falls was founded, in 1833. The Village of Chagrin Falls went on to establish the Evergreen cemetery in 1863 for residents of the village and township. Today, both cemeteries continue to serve as an … Read More
Century Home Plaque Program
Mission:• To create community pride in our historic homes• To plaque qualified century homes• To promote and contribute accurate research to the Historical Society's archive of century plaqued homes. Welcome:We welcome you to unravel the mysteries of your historic home by investigating its origins, structural history and chain of ownership. We encourage you to do your own research. If you wish, you may hire an accredited researcher, from those listed on the Ohio Historic Preservation Office website, to help you. … Read More
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Drive to Sangla through the thick woods of Kufri, Fagu and Narkanda and along side the River Sutlej to arrive in the evening and check in to Luxury Camp. Enjoy the evening in beautiful surroundings in the river valley of Baspa at a height of 9000ft. This is one of the most beautiful valleys in the Himalayas and is often compared to the famous valley of Kashmir. Known for its rich Kinnauri culture and apple orchards, this valley was opened for tourists only in 1993 for its close proximity to the Tibetien border. O/N Hotel.
After B/F, check-out from the Hotel & drive to Kalpa – District Headquarter of Kinnar & once a favorite haunt of Lord Dalhousie. Arrive Kalpa & Check-in to your Hotel. Kalpa was known as Chini back in the days when it was the Regional Capital. Kalpa has changed little in the last 500 years. It is said that as & when Lord Dalhousie wanted to take a break from his hectic schedule in Shimla, he would come here on his Horseback. Each & every corner of Kalpa facing Jorkanden & the Kinner Kailash Peaks, considered as one of the mythical homes of Lord Shiva & by its side is a 79 foot rock formation that resembles a Shivlinga that changes the colour as the day passes & is visible to the naked eye on a clear day. Post Lunch rest in Hotel & in evening visit to Buddhist Gompa – Hu Bu Lan Kar. Dinner & O/N stay.
After breakfast checkout from hotel and drive to Chandighar O/N Hotel.


Language Arts/Fine Arts: Choose an onomatopoeia design.
Math: All - create a list of at least 5 ways that we use fractions in every day living. Hint - look around your house, ask your parents, google it. Give examples: e.g. You might eat 3/12 of a pizza.
Technology: Upload all of your Art photos to your website, and give each one a title.
Socials: Use the 'map' icon on the left to create a map. Go to your own website. Drag the 'map' icon onto the page. Click on it, put in the address of an interesting place, NOT your own address. (I used the school's address for my map: 18599 65 Ave, Cloverdale, Surrey, British Columbia). Voila! You have a map. Leave a message about the map you created.
the map was cool i did osoyoosand it only takes couple of mins and its was really easy so you all tomorrow!
I couldn't find were to click but I know what I am going t do for art.
Yah I can not find the side icon thing.
Same I don't know how to do it but i'll keep working on it.
Dolphin man click the google sign in the corner. I have no idea if I did it right though.. I will be there tomorrow at school!
I did Cancun Mexico because it was the first thing that came in my head. See you all tomorrow bye!
Hey I just got home. I'm going to do the map soon. I hope that I don't get the same problem that others got. I think that I'm going to do Phoenix, Arizona because my Dad has been there before. See you all tomorrow.
I could not also find the icon on the left to make my own map. Oh well I guess I have to keep on trying, or come in early.
The map isnt working for me,because the map icon wont take me anywere.Anyways today was fun,but I was so tired because it was an inn day both at recess and lunch.
Im going to do Disneyland for my map though.
I can find the map icon so I can do it now.
Ok I did the map but I don't know how to get it onto my website....I'm doing Las Vegas!!
Ok I FINALLY got it!!?!
The map isn't working for me either:( I will keep working on it though. Well see you guys tomorrow!
I know what im doing for my onomatopoeia design! Im just about to try the map on my website now so hopefully it works. See everyone tomorrow, bye!
the map is not working for me either!
It worked yay!!! I did Disneyland as well because it is my favourite place on earth!
The map isn't working  why not?
I got the map! I did Diagon Alley, London from Harry Potter :D So exciting! A lot of people said that the map didn't work. We might have to do it in the class tomorrow. I FINALLY decided on my onomatopoeia drawing but it will remain a secret until tomorrow. I also plan on making dog treats for Heidi on the weekend.
My map was my grandpas house, he is dead now but you got to live in the present not the past. I do have an onomatopoeia design, it is on a piece of paper as a list so I do not forget what I am doing.


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Alienware M15 R6 AWM15R6-7287BLK-PUS Review | Superb!!
Sturdy and futuristic design
Ultrafast 360 Hz IPS screen
Powerful 11th-Gen Intel Core i7 processor
Windows 11 Home out of the box
No SD card reader
Short battery life (like most gaming laptops)
Designed to bring smooth high-speed gaming action to hardcore gamers, Alienware M15 R6 laptops are the solution you always wanted as they boast everything you need to get the job done and play the most anticipated AAA games smoothly.
And in this review of the Alienware M15 R6 AWM15R6-7287BLK-PUS, we're going to uncover the best attributes of a highly praised 15-inch gaming laptop that offers you the best bang for your buck.
Check it out: How To Choose The Best Gaming Chair with Speakers and Vibration
Amongst other features, this gaming laptop stands out as it comes with an extremely high refresh rate display of 360 Hz, a comfortable backlit keyboard, a vast 32 GB DDR4 RAM, and high-end hardware components such as an 11th-Gen Intel Core i7 processor and an NVIDIA GeForce RTX 30 graphics card. Overall, this Alienware laptop features a killer combo of specs that will have you drooling by the time we wrap up this review.
Check Pricing and Availability!
Design, Display, and Keyboard
Connectivity and Extras
Tech Specs of Alienware M15 R6 AWM15R6-7287BLK-PUS
Brand/Model Alienware M15 R6 AWM15R6-7287BLK-PUS
Dimensions 14.02 x 10.73 x 0.89 inches
Display WVA | Anti-glare | 15.6'' | 360 Hz | 1 ms
Resolution Full HD (1920 x 1080 pixels)
Processor 11th-Gen Octa-Core Intel Core i7-11800H
RAM 32 GB (DDR4)
GPU NVIDIA GeForce RTX 3070 | 8 GB (GDDR6)
Storage 1 TB (SSD)
Battery 4-Cell | Li-Ion
Connectivity Wi-Fi 6
3x USB-A 3.2
1x USB-C 3.2 | Thunderbolt 4 | DisplayPort 1.4 | Power Delivery
1x 3.5 mm audio jack
HD Webcam
Built with a combination of aluminum, magnesium alloy, and plastic, the Alienware M15 R6 AWM15R6-7287BLK-PUS presents itself with a sturdy and futuristic black chassis boasting a good-looking customizable LED both on the lid and the rear ring whose honeycomb venting system will benefit heat dissipation when working on demanding tasks.
Although it isn't the lightest laptop when compared to others in its category, at 0.89 inches in thickness and 5.93 pounds in weight, it can be carried without it being too much of a hassle. However, if weight is a dealbreaker for you, then you might want to look into the Asus TUF Gaming F17 FX706HM-ES74 we reviewed earlier this week. A top-notch gaming laptop that stands out thanks to its 5.06 pounds.
As for the display of the AWM15R6-7287BLK-PUS, it features a thin-bezel 15.6-inch WVA Full HD screen with respectable viewing angles and strong color reproduction, so you'll be able to work on productivity tasks and stream multimedia content with excellent quality pictures and with no reflections.
Regarding the technology behind the display, while most laptops come with an IPS display, the WVA display at hand isn't too shabby. WVA is a type of display that uses twisted nematic crystals to align the pixels, which results in faster pixel response time. This type of display arrives as a solution to your standard VA or TN display offering better viewing angles while maintaining speedier response times.
Once in the battleground, you'll benefit from its spectacular 360 Hz refresh rate and ultralow 1 ms response time while playing fast-paced AAA games such as e-Sports, battle royale, shooters, racing, simulators, and real-time strategy titles.
Currently, the most common refresh rates amongst gaming laptops tend to hover along 140-160 Hz. However, a higher refresh rate means that your games will look smoother as the image will be updated more frequently.
To be perfectly honest, a 360 Hz refresh rate is overkill for most people, but if you're a professional gamer or if you're aiming to become one, then you'll definitely want to take advantage of this feature.
Moving onto the keyboard, although it doesn't have a numeric keypad, the keyboard is very responsive and fast enough to play and work smoothly while allowing you to customize the key lighting in four zones and even choose between animation effects via the Alienware Command Centre app.
Performance of Alienware M15 R6 AWM15R6-7287BLK-PUS
Like the already reviewed ASUS ROG Strix Scar 15 G533ZW-AS94, this laptop boasts an 11th-Gen Intel Core i7-11800H processor powered by 8 cores, 16 threads, 24 MB of SmartCache, and a TDP of 45W. Its clock frequency fluctuates from a base of 2.30 GHz to a maximum of 4.60 GHz.
The formula is completed with a doubled 32 GB DDR4 RAM (upgradeable up to 64 GB). This is quite an impressive amount of RAM when compared to most gaming solutions.
Moving towards the GPU, this is one of the laptop's most appealing features, as stated by those who have bought it, is the fact that the dedicated 8 GB NVIDIA GeForce RTX 3070 graphics card will allow you to play most AAA games with Ultra settings and Ray Tracing enabled when available.
Amongst others, we would be remiss if we didn't highlight titles such as Ghostwire Tokyo (61 fps), Battlefield 2042 (69.3 fps), and Guardians of the Galaxy (75 fps).
When it comes to storage, there's a spacious 1 TB M.2 NVMe SSD unit reaching up to 3200 Mb/s of reading/writing speed, so it'll substantially reduce loading times in just about anything you do when compared to a traditional SSD drive.
Overall, with this set of specs, you can expect this laptop to handle any task you throw at it with ease. Whether you're looking to do some professional-grade video editing, 3D rendering, or full-stack programming, there's basically no scenario we can think of where this laptop would fall short in the performance department.
Regarding its connectivity solutions, it comes with an Ethernet port, three USB-A 3.2 inputs, and a single USB-C 3.2 port that supports Thunderbolt 4, DisplayPort 1.4, and Power Delivery interfaces to allow you to transfer data faster, connect monitors, and charge the laptop's battery, respectively.
The AWM15R6-7287BLK-PUS also features an HDMI 2.1 output for 4K monitors at 120 Hz as well as a headphone jack and an HD webcam for video calls and live streaming.
As for its wireless connections, we've got Bluetooth 5.2 and Wi-Fi 6 technologies, so you'll be able to browse the web up to three times faster when compared to Wi-Fi 5 standard.
However, if this suite of connectivity isn't enough and you're looking for a gaming laptop with even more connectivity options, then you should check out the Acer Predator Triton 500 SE PT516-52s-99EL which features two Thunderbolt 4 ports, an SD card reader, and a fingerprint reader.
Having said that, we're quite happy with this laptop's connectivity suite.
Like other gaming laptops, the battery life of the Alienware M15 R6 AWM15R6-7287BLK-PUS isn't its best attribute as it lasts roughly 3 hours of multimedia streaming, so you can expect even less battery life when playing AAA games.
However, it should be noted that if you adjust the refresh rate to 60 Hz and set the integrated GPU as the primary GPU, you can get double up on the battery life, reaching nearly 7 hours of video streaming.
And while it's undoubtedly true that most gaming laptops will offer anywhere between 3 to 5 hours worth of battery, there are some notable exceptions to this.
Case and point; the Asus TUF Dash 15 FX517ZM-AS73, a high-end gaming laptop that brings you down to 16 GB of RAM and offers an Nvidia GeForce 3060 as a graphics card, yet manages to deliver roughly 7 hours of battery life. All of this while keeping a lighter design - 4.41 pounds - and a tighter price point.
Verdict: Is the Alienware M15 R6 AWM15R6-7287BLK-PUS worth the money?
Overall, the Alienware M15 R6 AWM15R6-7287BLK-PUS is a bad-ass gaming laptop you won't go wrong with since it performs very well while playing most popular AAA games at max settings and running demanding software.
The laptop at hand boasts a futuristic and sturdy design accompanied by a 360 Hz Full HD display that provides stunning visuals - thanks to its WVA technology - and a backlit keyboard that is ergonomic enough to work and play smoothly while offering a generous connectivity suite.
Couple all of that with a top-of-the-line CPU and GPU, as well as an extremely generous 32 GB of RAM, and you've got yourself a powerhouse that's more than ready to be a gaming desktop replacement.
Labels: alienware , gaming laptop


sorry i am a noob in progaramming xD. there were something that i dont understand. can you tell me what mean of attributes and handle for a file? or show me some detail example. Thanks.
what do readonly, archive, hidden and etc means?
Readonly = you can read the file but you are unable to write to the file.
Archive = The state of on or off is read by backup software as to whether the file has already been backed up or not.
Hidden = Not visible in explorer as to human sight.


Sorry we didn't get much of a chance to talk at the check-in tonight. I couldn't get out the window I usually use, so I had to find an alternate route.
I ended up zipping out through the dryer vent.
The dryer was running at the time and you know I'm not used to that amount of heat. I had to hop into the freezer in the garage to recover.
The cold did wonders and made me feel like I was in the North Pole. I was so comfortable lying on a bag of frozen peas that I fell sound asleep.
When I came to, I only had time to drop off my report and get back to set up for the morning. I even missed the snack! What did Mrs. Clause bake? I hope it wasn't the Strawberry Creams. Those are my favorite!
I was so lightheaded from hunger that I almost fell out of the sky, so I searched the house for sugary snacks to help clear my head for mischief.
I found a jackpot of sugary snacks: powdered sugar donuts, chocolate M&Ms, peppermint M&Ms, caramel corn, Oreos, hot chocolate, red and green icing, dark chocolate peppermint squares and for dessert, a few giant Hershey's Kisses.
I even found a bottle of sparkling grape juice to wash it all down. I wanted to drizzle maple syrup all over the donuts, but we used it all yesterday at the pancake party.
I had a blast making a Christmas tree out of the Oreos and throwing popcorn everywhere. It's messy, but I think their mom will forgive me this once for setting out such an awesome breakfast.
I ate my fill and set the rest out for the boys with a note about the good behavior I have seen over the past few days.
What a great breakfast for them! They'll have enough energy to play for the rest of the day!


I recently found some "Happy New Year's" cards I bought last winter during a bout of optimism about my ability to send them out during the busy holiday season. After kicking myself for not using them, I realized that New Year's really doesn't have that much significance in my world. Sure you put on awesome hats and enjoy some bubbly, but the time of year that really gets me reflecting and planning for the future is the new school year.
So in celebration of that, I'm planning (and we'll see if I get it done this time) to send out my forgotten cards with the word "school" added to them in celebration of one of my favorite holidays "Happy New School Year." Sure there's less countdowns and parties, but there's more getting a brand new set of chart paper markers and even a fresh planner!
If you want to start running each morning, it's essential that you choose a simple cue (like always lacing up your sneakers before breakfast or leaving running clothes next your bed) and a clear reward (such a midday treat, a sense of accomplishment from recording your miles, or the endorphin rush you get from a jog). But countless studies have show that a cue and a reward, on their own, aren't enough for a new habit to last. Only when your brain starts expecting the reward – craving the endorphins or sense of accomplishment – will it become automatic to lace up your jogging shoes each morning. The cue, in addition to triggering a routine, must also trigger a craving for the reward to come.
Got it? Remember to start with a cue and a reward. Overtime these will build to create craving. Once you have craving, you have habit! (That explains why I'm always looking for chocolate in the afternoon).
What's my new habit for the new school year? Exactly the example Duhigg gives – running every morning. Day 1 down. 65 more to go! (It takes an average of 66 days to create a new habit). Wish me luck. What will yours be?
Previous postHow should we train teachers?
My sixth graders are going to write a 6th grade survival guide next week. As a follow-up, I am going to have them write New Year Resolutions for the start of the new school year. Thanks for the idea.


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Flachbunker steht für:

 Einstöckige Bauform eines Schutzgebäudes, siehe Hochbunker#Flachbunker
 Flach ausgeführte Bauform eines Lagers für Material, Schüttgut oder Abfall:
 im Bergwesen, siehe Bunker (Bergbau)
 in der industriellen Fertigung, siehe Bunker (Fertigung)

redpajama_set_name: RedPajamaWikipedia