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Saturday, March 31, 2012

[OOC] A river of tears

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Please post all "Players Wanted" threads in the Roleplayers Wanted forum!

This topic is an Out Of Character part of the roleplay, ?A river of tears?. Anything posted here will also show up there.

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Hi.Can I play the boy? And the charac. skeleton?

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Heat win finals rematch, top Dallas 106-85

Miami Heat shooting guard Dwyane Wade (3) prepares to shoot over Dallas Mavericks small forward Shawn Marion (0) during the first half of an NBA basketball game in Miami, Thursday, March 29, 2012. (AP Photo/Alan Diaz)

Miami Heat small forward LeBron James (6) goes to the basket against the Dallas Mavericks during the first half of an NBA basketball game in Miami, Thursday, March 29, 2012. (AP Photo/Alan Diaz)

Dallas Mavericks forward Dirk Nowitzki (41) prepares to shoot over Miami Heat forward Udonis Haslem (40) during the first half of an NBA basketball game in Miami, Thursday, March 29, 2012. (AP Photo/Alan Diaz)

Dallas Mavericks shooting guard Jason Terry (31) prepares to pass as \mMiami Heat shooting guard Dwyane Wade (3) defends and Chris Bosh, left, watches the play during the first half of an NBA basketball game in Miami, Thursday, March 29, 2012. (AP Photo/Alan Diaz)

Miami Heat power forward Chris Bosh (1) prepares to shoot against the Dallas Mavericks during the first half of an NBA basketball game in Miami, Thursday, March 29, 2012. (AP Photo/Alan Diaz)

MIAMI (AP) ? No fourth-quarter collapse this time against Dallas. These days, everything seems to be going right at home for the Miami Heat.

LeBron James and Chris Bosh each finished with 19 points and nine rebounds, Dwyane Wade and Udonis Haslem scored 16 apiece and the Heat extended the league's longest home winning streak this season to 15 games with a 106-85 win over the Mavericks in an NBA finals rematch on Thursday night.

Mario Chalmers scored 12 points and Norris Cole added 10 for Miami, which swept its two games with Dallas this season and snapped a two-game losing streak.

"We just worked our habits," James said. "The best thing about tonight, we didn't take another step backwards like we did the last two games. And it was good to see."

Dirk Nowitzki scored 25 for Dallas, but was held to 1-for-9 shooting in the second half. Lamar Odom had 12 for the Mavericks, who were outrebounded 44-29 and were held to only two fast-break points.

Miami outscored Dallas 26-13 in the fourth quarter to cap the win.

"You have to give them credit," Nowitzki said. "They stepped up their pressure on both ends of the floor. In the first half everything came a little too easy for us. We got some good looks, got some rolls, had everything going. Then they really picked up their pressure and we didn't have many good looks."

It was Dallas' first time playing at Miami since winning Game 6 of the NBA finals last June, a series that turned after an epic late Game 2 comeback by the Mavs in Miami and eventually became the ultimate payback ? hoisting a championship trophy in Miami, five years after Wade and the Heat celebrated winning their title in Dallas.

Still, Dallas insisted this trip wasn't about revisiting memories.

"Just another day at the office," Mavs owner Mark Cuban said.

Well, not an altogether friendly day at the office ? particularly late.

In the fourth quarter alone, Nowitzki had the bridge of his nose bloodied, James got hit in the mouth and Wade spent a few minutes grabbing at his right index finger in obvious discomfort. Adding to Miami's discomfort: Dallas being within 90-83 with 4:37 left after Nowitzki made four free throws in a 27-second span.

Any angst existing at that point dissipated quickly.

"I felt like we were in control," Wade said. "They got a couple things to go their way. It was just about settling down and running offense."

Simple as that. A 9-0 run sealed it for Miami, with Wade quarterbacking the charge.

His two-handed dunk pushed the Heat lead back to double figures, then he found Bosh to set up a three-point play and set up James for a slam that pushed the lead to 99-83 with 3:03 left. The Mavs called time out, took Nowitzki and three others off the floor for the night, and the Heat slide was soon over.

Vince Carter and Brandan Wright each scored 11 for Dallas.

"It's tough," Carter said of facing the Heat. "When they're rolling, they're rolling."

Miami's offense has sputtered for nearly a month, but the Heat scored 60 points by halftime for the first time in 11 games. James, Bosh and Wade shot 12 for 21 by halftime, and Miami's bench ? Haslem and Cole, mostly ? connected on 10 of 13 shots before intermission. Haslem made all four of his shots in the half and Cole was 4 for 6 after making four shots in his last seven games.

Even with all that, the lead was only 60-53 at the break, in large part because Nowitzki was 8 for 10 from the field.

Miami's offense cooled big-time in the third, the Heat shooting an abysmal 5 for 23. And the lead actually grew by a point in the period, thanks to what went on at the other end.

An 11-2 run gave the Heat their first double-digit lead, after holding Dallas without a field goal for more than 6 minutes. Miami led by as many as 13 in the third, before Odom scored Dallas' final seven points of the period to get the Mavs within 80-72 going into the final quarter.

"It was disappointing," Mavs coach Rick Carlisle said. "Our start to the third quarter was strong and then they answered back."

And now, Miami hits the road for games in Toronto on Friday and Boston on Sunday. The Heat have lost six of their last eight away from home.

"It's time for a response on the road," Heat coach Erik Spoelstra said. "We will take this win. This is a great team win against a very good team. But we have to move on and now let's take care of business on the road."

NOTES: Bosh returns to Toronto on Friday, the city where he played his first seven seasons. ... Dan Marino was among those in attendance. ... Miami held a 36-24 scoring edge in the second quarter, the first time the Heat outscored an opponent in their last 12 quarters. ... Mavs point guard Jason Kidd played in his 1,308th regular-season game, passing Buck Williams for 10th place on the NBA career list. ... Mavs guard Delonte West (broken right ring finger) played for the first time in 22 games. Center Brendan Haywood (sprained right knee) was active, but indicated he was more likely to return at Orlando on Friday. ... It marked the third time in Heat history that the team swept a season series with a reigning NBA champion.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/347875155d53465d95cec892aeb06419/Article_2012-03-30-BKN-Mavericks-Heat/id-eb21d8a31631439bbbcfdce165637e01

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No Joke: 'American Idol' Loses Heejun Han

Resident jokester joined by Hollie Cavanagh and Skylar Laine in bottom three.
By Adam Graham

Heejun Han on "American Idol" Thursday
Photo: Fox

The laughs are over for Heejun Han, as this season's court jester was voted off "American Idol" on Thursday (March 29).

Han, who with his goofball demeanor and off-center sense of humor was criticized heavily for not taking the competition seriously enough, ended up at the bottom of America's votes following Wednesday's performance episode, despite earning a standing ovation from the judges for his performance of Donny Hathaway's "A Song for You." He reprised the song for the judges in an effort to get them to use their one save for the season on him, but the judges let him go.

"Let the record show that you knew this was coming yourself, you saw it come this week," Steven Tyler told him. "Unfortunately after talking, we're gonna have to let you go, man."

Just 24 hours earlier, Tyler had praised Han for turning himself around in the competition, and Jennifer Lopez reaffirmed his talents, telling him, "You didn't make it this far by mistake." Randy Jackson welcomed him back to the competition, telling him, "Finally, the Heejun that we selected came back to us tonight!"

But the 22-year-old from Flushing, New York's fate may have been sealed following his performance of Billy Joel's "My Life" the week prior, which was met by a stinging critique from "Idol" mentor Jimmy Iovine. "He came out and disrespected the entire process. His performance was more like four minutes of a bad Adam Sandler movie that goes straight to DVD," Iovine said, referring to it as a "stunt gone wrong." "At the end of the day, Interscope has to spend a lot of money on somebody who wins this show, and that's not it."

At the time, Han — who landed in second to last place following the performance — defended himself by saying, "I'm not trying to be a star, I'm just really happy where I am."

Han was in the bottom three Thursday with Hollie Cavanagh and Skylar Laine. Laine was sent back to safety first, and was followed by Cavanagh. It was the first time in the bottom three for both Laine and Cavanagh.

Also on the show, Eric Benet came out to surprise DeAndre Brackensick, who performed his song "Sometimes I Cry" on Wednesday's show.

Meanwhile, last year's "Idol" champ Scotty McCreery performed his latest single, "Water Tower Town," and was presented with a platinum sales plaque by Iovine, signifying 1 million sales of his debut album, Clear as Day.

Nicki Minaj appeared and performed "Starships" and made a pitch to do a guest-judging bid on the show. "J. Lo, can you scoot over a little bit?" she asked, to which Lopez replied, "I don't know if there's enough room for both of us up here!"

What did you think of Thursday's "Idol"? Did Heejun Han go home too soon? Let us know in the comments!

Source: http://www.mtv.com/news/articles/1682098/american-idol-heejun-han.jhtml

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Friday, March 30, 2012

Food & Drink | How in order to Make Medicinal Chicken Soup by ...

Everybody knows that soup is the entire remedy for as soon as you are generally down. Creating soup with bone marrow stock is much more than a mood cure. it improves a immune system plus delivers us alongside effortless to be able to assimilate minerals. The actual marrow inside the particular bones contains vitamins that feed your bone tissue marrow. When a bone tissue marrow is actually nourished, anyone create healthier immune cells not to mention may better fight off colds and even flu.

The entire bones in the soup as well contain quite a few really good minerals which support regeneration and in addition optimum health. As soon as you add an acidic component to the stock it helps in order to leech the actual minerals from the bones. That is actually why a large number of bone tissue marrow soup dishes currently have wine, vinegar or lemon fruit juice added with them.

The following recipe typically is for a medicinal chicken bone tissue marrow soup filled with natural herbs. Whenever creating the soup stock, I suggest making a double batch to freeze a few of it that would come with on hand for the entire next soup buyers make.

Soup Stock
1 whole natural chicken carcass (right after you currently have cooked the chicken and additionally consumed almost all of the entire meat) with a few of the meat left about it and then the legs cut upwards Or simply Cut upwards 3 raw poultry legs then thighs
12 cups drinking water
1 entire bulb of garlic (certainly not really individual pieces, yet the entire bulb)
5 sticks astragalus
3 medium slices of fresh ginger
3 tablespoons fresh chopped rosemary
2 tablespoons fresh or perhaps dried thyme Fruit juice of 2 lemons

1) Should you are using raw poultry bones rather than the particular carcass, cut the particular poultry leg bones back into 3 pieces. Create many of these cuts through the entire bones; the idea is that would expose the particular marrow inside the particular leg bones.

2) Put the particular cut upwards leg pieces then or even the chicken carcass back into the particular water. Add almost all elements, bring this particular on to a boil then turn down as well as permit simmer for four to 8 hours.

3) Permit cool a little bit, skim off certain of the hardened fat

4) Strain everything from the liquid by means of a strainer except for large bones in the event you are getting to make a fresh soup now. If perhaps you are really going to freeze the particular stock, remove everything, such as the particular big bones. The actual liquid typically is the bone marrow soup stock.

Final soup
4 tablespoons olive oil
5 cloves garlic
3 slices of fresh ginger
2 teaspoons salt
4 tablespoons of savory natural herbs (rosemary, thyme or perhaps basil)
1 bay leaf
1 tablespoon paprika
2 onions or alternatively leeks
2 carrots
2 celery stocks
1 turnip
? cup rice or simply 2 potatoes Strained soup stock

1) Sautee the herbs and in addition veggies with regard to a pot. Whenever veggies are generally a little bit soft, add the actual rice as well as soup stock. At this particular point you can as well add a very few fresh pieces of chicken, cut upwards breasts are informative. Allow everything simmer on low for 1 hour immediately after which enjoy! Right prior to eating add fresh greens including chopped chard, beet greens parsley or perhaps kale. Kami McBride has assisted thousands of people learn how to make use of natural herbs inside their daily lives with regard to techniques which are healthy, safe and additionally fun not to mention she teaches classes throughout natural medicine and women's health A great intuitive then inspiring teacher, she works in order to revive the actual cultural art of residence organic care not to mention teaches herbology because a relationship with the Earth and a means of life. Kami is actually the particular creator of 105 Techniques to Enjoy Menstruation.

Article Source:?http://www.bharatbhasha.net
Article Url: http://www.bharatbhasha.net/food-and-drink.php/362749

Article Added on Friday, March 30, 2012
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Police torture in Russia causes public outrage

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[ [ [['matter what you do in this case', 5]], '28759848', '0' ], [ [['presume laws are constitutional', 7]], '28747556', '0' ], [ [['has destroyed 15 to 25 houses', 7]], '28744868', '0' ], [ [['short answer is yes', 7]], '28746030', '0' ], [ [['opportunity to tell the real story', 7]], '28731764', '0' ], [ [['entirely respectable way to put off the searing constitutional controversy', 7]], '28723797', '0' ], [ [['point of my campaign is that big ideas matter', 9]], '28712293', '0' ], [ [['As the standoff dragged into a second day', 7]], '28687424', '0' ], [ [['French police stepped up the search', 17]], '28667224', '0' ], [ [['Seeking to elevate his candidacy back to a general', 8]], '28660934', '0' ], [ [['The tragic story of Trayvon Martin', 4]], '28647343', '0' ], [ [['Karzai will get a chance soon to express', 8]], '28630306', '0' ], [ [['powerful storms stretching', 8]], '28493546', '0' ], [ [['basic norm that death is private', 6]], '28413590', '0' ], [ [['songwriter also saw a surge in sales for her debut album', 6]], '28413590', '1', 'Watch music videos from Whitney Houston ', 'on Yahoo! Music', 'http://music.yahoo.com' ], [ [['keyword', 99999999999999999999999]], 'videoID', '1', 'overwrite-pre-description', 'overwrite-link-string', 'overwrite-link-url' ] ]

Source: http://news.yahoo.com/police-torture-russia-causes-public-outrage-132624189.html

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Today in History

Source: http://news.yahoo.com/today-history-050206767.html

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Sales Training ? The Future - Business and Finance

The outdated challenges of gross sales training will remain as we come out of recession, to develop in trainees a excessive degree of communication expertise, self-group and a key understanding of the particular market(s) related to the salesperson and guaranteeing they implement the actions necessary to succeed. ?

IT will continue to dominate providing ever sooner entry to up to date information. This may allow gross sales people to provide clients correct information and feed data quickly back to base. This in turn means we are going to need salespeople who will be workforce members, and not loners. ?

As to the place the sales training perform should sit on a company group chart this is an attention-grabbing query, which begs the question about company attitudes to training in general. Organizations on this nation have been criticized for not taking coaching significantly enough. Specifically, the buck stops at the high ? the Gross sales and Marketing Director, if there?s one, the Chief Govt if there is not. The federal government has become more and more concerned in promoting training and training at all levels. At the time of writing it?s closely promoting leadership training and there are a number of grants out there to corporations desirous to specifically improve their leadership ? and this would come with gross sales leadership. ?

Continued training remains the accountability of line management, however responsibility lies also with the individual. To encourage individual responsibility some organizations have developed a system whereby the person sets out their own coaching programme. These are the so known as ?Learning Organizations?. In some cases this has given administration the excuse to abdicate accountability for training. This pattern should be reversed. ?

It is fascinating that all model chief firms still contemplate sales training as vitally vital, despite recent challenging times. Additionally it is a truth that the majority companies that have gone into liquidation had poorly developed training, or no dedication to coaching at all. Nearly with out exception, these corporations that invest in the training and development of their gross sales staff will let you know it?s an funding, not a cost. These individuals produce more enterprise, are highly motivated ? they usually?re enjoyable to work with too. ?

To ensure that somebody to turn into a top quality sales coach they need three issues: ?

1.?? The flexibility to relate to the extent of data and understanding of the pupil. Generally the most effective gamers make the worst trainers. ?

2.?? A great understanding of the function of a coach ? helping folks to learn ? not making an attempt to show how good they?re themselves. ?

3.?? Information of the subject. So to achieve the latter if not the previous, no less than 5 years sales expertise is needed, ideally in numerous markets, dealing with different products and totally different ranges of purchasers. ?

On the saying: ?When you can?t prepare, you cannot handle a gross sales staff?. I as soon as labored for H J Heinz, the meals firm, and so they used to put could be sales managers into sales coaching first. I think it is a good concept if it can be done. The human ego is likely one of the most fragile things on earth, and must always be dealt with sensitively.? ?

Training is the best proving ground for can be gross sales managers. They?ll learn to cope with people, the right way to get one of the best from them, and an entire host of other abilities that can finally stand them in good stead as a manager. ?

What proof is there that classroom based mostly gross sales coaching truly works? Classroom, if that?s the right word, is usually a highly efficient approach of imparting information and converting data into skill. This can be proved by setting studying objectives and measuring the trainee?s capability to satisfy objectives. ?

For instance, I?m a professional pilot, and I can tell you that classroom work is crucial to gain the data a pilot needs, and a simulator is a highly effective strategy to construct up skill levels.? ?

For salespeople, imparting knowledge within the classroom is a sensible manner to help folks learn and thru simulations you may significantly improve expertise and demonstrably measure these skills. ?

No doubt, gross sales trainers should be accomplished sales professionals, you need to be accomplished and educated about the subject. All our trainers are experts in their specific field. Actually DVD?s and different coaching aids assist, however my recommendation to would-be gross sales trainers is this. If you understand nothing about the topic, hold your mouth shut! ?

As for the Web, we?ve to do not forget that computers are machines and not human beings. So I count on human beings to be involved in coaching for so long as human beings have to be trained. It is also worth stating that one of many many benefits of head to head sales training is the elevated stage of motivation that delegates show when getting back from a course. This motivation stems from quite a lot of issues, similar to sharing experiences with others, and a feeling of private growth, however a whole lot of it comes from the course leader. Good sales trainers don?t just prepare, they inspire, and that?s something you?ll be able to?t get by browsing the online simply but!

This post is written by Jason Young, he is a web enthusiast and ingenious blogger who loves to write about many different topics, such as abcmouse coupons. His educational background in journalism and family science has given him a broad base from which to approach many topics abes of maine coupon and many others. He enjoys experimenting with various techniques and topics like afgfitness coupons and has a love for creativity. He has a really strong passion for scouring the internet in search of ?inspirational topics.

Source: http://www.francescovalpa.com/sales-training-the-future/

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Thursday, March 29, 2012

How to Create Your Own Living Will

The best course of action to take sometimes isn?t clear until you?ve listed and considered your alternatives. The following paragraphs should help clue you in to what the experts think is significant.

It may not be necessary, but it would surely be wise and considerate of you to write and put up your own living will. It is a legal document that facilitates exercise of your right to make decisions about what could happen and what medical procedures to be performed on you the moment you undergo a critical or life-threatening condition. In cases wherein you would not be able to speak or decide for yourself regarding medical issues, the living will would definitely be advantageous. If you are in a coma or are unconscious, the healthcare providers could do everything to help you recover. In such a way, they could also rule out certain medical procedures that you would not want yourself to undergo.

Be sure to make your own living will not liable for any misinterpretation. You should hire the legal assistance of a professional (an attorney). Be clear to set out goals before you begin writing the living will. What do you intend? Are you just not into certain medical procedures or are you just considering the hefty costs the processes might incur? Here are some guidelines that could help you create your living will appropriately and in a breeze.

Carefully look at all the options as you write your living will. As mentioned, you could consider the possible costs. You should also take a look at the survival rate. If an event could not be possibly overcome, why prolong your agony? You would have to consider all your existing medical conditions and history. It would be advisable if you would seek the assistance and guidance of a doctor or medical professional as you write the document.

I trust that what you?ve read so far has been informative. The following section should go a long way toward clearing up any uncertainty that may remain.

Ask someone permission if you want to name him or her as a person who would make decisions on your own behalf. Some people might not be comfortable with the idea. You could ask any member of your family or even your legal counsel to do so. It is always important to attain the full consent of that person before he is included as a decision maker in your living will. You might need to appoint other proxy in case that person is unable to perform the duties you assign him or her.

Have a witness when writing and legalizing your living will. This is similar to the process when you make a living trust or last will. Legal issues need to be settled and taken care of for the living will to be effective. This is more helpful if you are consenting to donate your organs upon your death.

Strive to write your living will in a straightforward and clear manner. You certainly would not want it to be subject to too much misinterpretation. You should also check for typographical, spelling, or grammatical errors as such could possibly interfere with correct interpretation of the document.

Keep a copy of the living will. You could also distribute other copies particularly to your lawyer, doctor, healthcare provider, family members, and several trusted friends. This is to make sure your living will would take effect when the time comes.

About the Author
At Nayxa we program our own applications and we have continuously opened several lines of R & D, allowing us to place ourselves at the forefront of Wind Engineering. Visit us to discuss your next wind energy project

Source: http://www.minolta-3d.com/living-will/how-to-create-your-own-living-will.htm

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Video: Did Jack Welch Deflate the Market?

The markets end lower for the second trading day in a row, but was Jack Welch's comments on natural gas the reason for the pullback? Doug Cote, ING chief market strategist, and Michael Norman, John Thomas Financial chief economist, weigh in.

Regency at The Glen | Pulte VIP Realtor Event | Chicagoland Real ...

There is a new community coming to the Glen, and Chicago real estate agents can be the first to learn all the details.

Regency at The Glen is a new development slated for Glenview, and Pulte Homes is hosting a VIP Realtor Preview Event to discuss the details with local agents before they are released to the public.

The event, set for Wednesday, April 18 at The Glen Club, will unveil final pricing, option selections, the community plat map and homesite release to participating agents, who can enjoy wine and hors d?oeurves as they learn about the new homes.

Agents will also have a chance to pre-register clients after the presentation.

Doors open at 5:30 p.m. and the presentation will take place at 6 p.m. Interested agents should RSVP by Monday, April 8.

Not a local agent? Stay tuned to Chicagoland Real Estate Forum for the exciting details on this Chicago new home community.

What: Pulte Homes VIP Realtor Preview Event of Regency at The Glen

When: Wednesday, April 18 at 5:30 p.m.

Where: The Glen Club, 2901 W. Lake Ave., Glenview

RSVP: By Monday, April 8 to 877-335-9324 or john.hudson@pulte.com

Source: http://www.chicagolandrealestateforum.com/2012/03/28/chicago-realtor-preview-event-set-at-the-glen/

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Wednesday, March 28, 2012

DJ Jaffe: Department of Justice Finds New Program Reduces Violence by Mentally Ill

Monday, the Department of Justice (DOJ) Office of Justice Programs certified Assisted Outpatient Treatment (AOT) as an Effective Crime Prevention Program. This comes on top of previous recognition by the DOJ Office of Community Oriented Policing Initiatives.

AOT allows courts to order mental health departments to provide treatment to certain people with mental illness who are likely to become dangerous or gravely disabled without treatment and who have a history of violence and refusing treatment.

Historically, many mental health departments like California and New York elected to require psychotic individuals who don't recognize they are ill to become "danger to self or others" or "gravely disabled" before offering treatment. Because of this "no-treatment" policy, seriously mentally ill individuals who refuse treatment deteriorate and the police are forced to intervene. Too often, this is after the individual becomes a "psychotic killer on rampage" headline and has resulted in three times as many people being incarcerated for mental illness as hospitalized. AOT laws allow courts to require departments to provide treatment before that happens. In California, Laura's Law reduced hospitalization 46 percent, reduced incarceration 65 percent, reduced homelessness 61 percent and reduced emergency contacts 44 percent. Results in New York on Kendra's Law were equally impressive.

AOT laws were proposed by families of people with mental illness. The Department of Justice researched implementation of AOT programs like Laura's Law in California and Kendra's Law in New York. DOJ noted:

The goal of AOT is to improve access and adherence to intensive behavioral health services in order to avert relapse, repeated hospitalizations, arrest, incarceration, suicide, property destruction, and violent behavior.

Police Chief Michael Biasotti recently released a major survey of senior law enforcement officers that found police and sheriffs are being overwhelmed "dealing with the unintended consequences of a policy change that in effect removed the daily care of our nation's severely mentally ill population from the medical community and placed it with the criminal justice system."

A sheriff in Summit County, Ohio recently took action to prevent seriously mentally ill people from entering his jail arguing they need treatment instead. A Sheriff in Illinois is threatening to sue the mental health department to get them to treat people with mental illness. States are closing psychiatric hospitals in record numbers, further shifting the burden of care from the mental health system to the criminal justice system.

AOT programs exist in many states but are rarely used. The Department of Justice lists resources for states that want to implement AOT or expand existing programs, including Mental Illness Policy Org.

Follow DJ Jaffe on Twitter: www.twitter.com/MentalIllPolicy

Source: http://www.huffingtonpost.com/dj-jaffe/assisted-outpatient-treatment_b_1380308.html

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Sleep apnea puts patients at risk for delirium after surgery

Public release date: 27-Mar-2012
[ | E-mail |

Share ]

Contact: Mary Jane Gore
mary.gore@duke.edu
919-660-1309
Duke University Medical Center

DURHAM, N.C. An anecdotal observation of a possible link between sleep apnea and post-surgical delirium has been measured and confirmed by a team of researchers at the Duke University Medical Center.

"The association between sleep apnea and postoperative delirium is big news because it may offer us a way to control postoperative delirium which can be devastating," said senior author Madan Kwatra, Ph.D., who is associate professor of anesthesiology at Duke.

The study appears in the April 2012 issue of Anesthesiology.

Delirium is not a minor consequence. The condition involves an acute and fluctuating consciousness and ability to understand, and is associated with health problems and higher risk of death right after surgery. Delirium is a strong predictor of mortality even 10 years after surgery.

There is hope for prevention, Kwatra said. "If the association between pre-existing sleep apnea and postoperative delirium discovered in this study is confirmed by a larger study, we may be able to prevent postoperative delirium by treating sleep apnea before and immediately after surgery."

The prospective study investigated patients who were having a total knee replacement, a routine procedure for older patients that restores function and reduces pain.

Out of 106 patients in the study, 27 developed delirium after surgery. Eight out of the 15 patients in the study who had been diagnosed with obstructive sleep apnea experienced post-operative delirium, or 53 percent. By comparison, 20 percent of the patients without apnea (19 out of 91) experienced delirium.

In the analysis, apnea was the only statistically significant factor that predicted delirium out of many medical conditions that were analyzed.

The study provides early evidence that doctors might do better presurgical screening for sleep apnea and introduce effective therapy for obstructive sleep apnea as a way to reduce the risk of delirium, Kwatra said. The causes of postsurgical delirium are still unknown, but lack of oxygen before or after surgery or possibly immune factors that lead to inflammation may play a role, he said.

The study findings support recent recommendations to screen for and treat obstructive sleep apnea in an effort to reduce respiratory and cardiovascular problems associated with obstructive sleep apnea.

###
Authors include lead author Benjamin J. Flink, a student in the Duke School of Medicine, Sarah K. Rivelli of the Duke Department of Psychiatry and Behavioral Sciences; Elizabeth A. Cox, a Duke resident physician; William D. White of the Duke Department of Biostatistics and Bioinformatics; Grace Falcone and Andrew D. Krystal of the Duke Department of Psychiatry and Behavioral Sciences; Thomas P. Vail, Department of Orthopedic Surgery, University of California San Francisco; Christopher C. Young, Duke Department of Anesthesiology; Michael P. Bolognesi, Duke Department of Surgery; Paula T. Trzepacz, Lilly Research Laboratories, Indianapolis, Indiana; and Richard E. Moon of Duke Anesthesiology and the Duke Department of Medicine.

The study was supported by a National Institutes of Health/National Institute of Aging grant.

[ | E-mail | Share ]
?

AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Sleep apnea puts patients at risk for delirium after surgery Public release date: 27-Mar-2012
[ | E-mail | Share ]
Contact: Mary Jane Gore
mary.gore@duke.edu
919-660-1309
Duke University Medical Center

DURHAM, N.C. An anecdotal observation of a possible link between sleep apnea and post-surgical delirium has been measured and confirmed by a team of researchers at the Duke University Medical Center.

"The association between sleep apnea and postoperative delirium is big news because it may offer us a way to control postoperative delirium which can be devastating," said senior author Madan Kwatra, Ph.D., who is associate professor of anesthesiology at Duke.

The study appears in the April 2012 issue of Anesthesiology.

Delirium is not a minor consequence. The condition involves an acute and fluctuating consciousness and ability to understand, and is associated with health problems and higher risk of death right after surgery. Delirium is a strong predictor of mortality even 10 years after surgery.

There is hope for prevention, Kwatra said. "If the association between pre-existing sleep apnea and postoperative delirium discovered in this study is confirmed by a larger study, we may be able to prevent postoperative delirium by treating sleep apnea before and immediately after surgery."

The prospective study investigated patients who were having a total knee replacement, a routine procedure for older patients that restores function and reduces pain.

Out of 106 patients in the study, 27 developed delirium after surgery. Eight out of the 15 patients in the study who had been diagnosed with obstructive sleep apnea experienced post-operative delirium, or 53 percent. By comparison, 20 percent of the patients without apnea (19 out of 91) experienced delirium.

In the analysis, apnea was the only statistically significant factor that predicted delirium out of many medical conditions that were analyzed.

The study provides early evidence that doctors might do better presurgical screening for sleep apnea and introduce effective therapy for obstructive sleep apnea as a way to reduce the risk of delirium, Kwatra said. The causes of postsurgical delirium are still unknown, but lack of oxygen before or after surgery or possibly immune factors that lead to inflammation may play a role, he said.

The study findings support recent recommendations to screen for and treat obstructive sleep apnea in an effort to reduce respiratory and cardiovascular problems associated with obstructive sleep apnea.

###
Authors include lead author Benjamin J. Flink, a student in the Duke School of Medicine, Sarah K. Rivelli of the Duke Department of Psychiatry and Behavioral Sciences; Elizabeth A. Cox, a Duke resident physician; William D. White of the Duke Department of Biostatistics and Bioinformatics; Grace Falcone and Andrew D. Krystal of the Duke Department of Psychiatry and Behavioral Sciences; Thomas P. Vail, Department of Orthopedic Surgery, University of California San Francisco; Christopher C. Young, Duke Department of Anesthesiology; Michael P. Bolognesi, Duke Department of Surgery; Paula T. Trzepacz, Lilly Research Laboratories, Indianapolis, Indiana; and Richard E. Moon of Duke Anesthesiology and the Duke Department of Medicine.

The study was supported by a National Institutes of Health/National Institute of Aging grant.

[ | E-mail | Share ]
?

AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Source: http://www.eurekalert.org/pub_releases/2012-03/dumc-sap032712.php
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Tuesday, March 27, 2012

Time to Change The Carrot and the Stick Motivation to Increase Sales

The carrot and the stick motivation is one of the oldest behavior modification strategies and still used by many small businesses and sales management to increase sales. Yet this sales management tactic has been proven ineffective each year when sales goals or sales quotas are not achieved or just barely achieved.

Paul McCord in his recent blog stated about how human beings are strange in that they keep doing what they have always done.? Dan Waldschmidtsaid it a different way ?Sales quotas are for stupid people. ?

In the book Drive by Daniel Pink provides solid research about why it is time to change the carrot and the stick motivation be it to increase sales or to reach any other desired result. Rewards as evidence through the carrot and the stick approach are addictive and create a negative self fulfilling prophecy where the ante for the reward will require more and more carrots. In a time of economic uncertainty where businesses are attempting to manage their limited resources, this sales motivation strategy truly does not make sense.

The best motivation is ?intrinsic? meaning it comes from within. When sales people want to achieve, this belief will generate far more increase sales than being forced to achieve.? Possibly this is why SMART goals are no longer as effective and why the WAY criteria of Written, Aligned to passion, purpose and plans and Yours may be needed in the future.

One very interesting concept for those in sales management, small business owners to even C suite leadership may wish to consider is the Self Determination Theory (SDT) as advocated by Edward Deci and Richard Ryan. This theory is different from many others is that it begins with the idea of universal human (psychological) needs that are separated into three categories:

Competence
Autonomy
Relatedness

Human beings have an innate drive, that inner desire to achieve while still being autonomous, self determined and connected to one another.? When this drive is realized by being free from constraints, individuals achieve more and are happier in living their lives.

To raise the BAR of sales performance, organizational performance or even individual performance begins not with new sales skills or sales knowledge, but with the Beliefs (attitudes) that drive the Actions generating the Results. Those beliefs are internal to each individual and so logically to change those beliefs requires understanding how to motivate from within or in a more common term, WIIFM (What?s in it for me).

This century is so incredibly exciting in that we are learning more and more about how our brains work and how those workings can produced incredibly results driven, emotionally satisfied working individuals as well as just the opposite. Now is the time to change the carrot and the stick motivation to increase sales and recognize the innate need within individuals to be the best they can be.

Obama to Russia: More flexibility after elections

SEOUL, South Korea (AP) ? President Barack Obama told Russia's leader Monday that he would have more flexibility after the November election to deal with the contentious issue of missile defense, a candid assessment of political reality that was picked up by a microphone without either leader apparently knowing.

Obama's Republican opponents pounced on the comment, saying the president has a hidden agenda that could include concessions to the Russians if he is re-elected this fall.

"This is my last election," Obama is heard telling outgoing Russian President Dmitry Medvedev. "After my election, I have more flexibility."

Medvedev replied in English, according to ABC News: "I understand. I will transmit this information to Vladimir," an apparent reference to incoming President Vladmir Putin.

Obama and Medvedev did not intend for their comments, made during a meeting in Seoul, South Korea, to be made public.

Once they were, the White House said Obama's words reflected the reality that domestic political concerns in both the U.S. and Russia this year would make it difficult to fully address their long-standing differences over the contentious issue of missile defense. Obama, should he win re-election, would not have to face voters again.

"Since 2012 is an election year in both countries, with an election and leadership transition in Russia and an election in the United States, it is clearly not a year in which we are going to achieve a breakthrough," White House deputy national security adviser Ben Rhodes said.

Obama made light of the flap at his next public meeting with Medvedev. Opening the nuclear security summit that brought both leaders to South Korea, Obama jokingly moved to cover his microphone as he and Medvedev took their seats. "Wait, wait!" Obama said, grinning.

Obama's candid remarks Monday illustrated the political constraints that hem in any president who is running for re-election and dealing with a congressional chamber ? in this case, the House ? controlled by the rival party. Republicans have fought Obama fiercely on health care, taxes and other issues. They are eager to deny him any political victories in a season in which they feel the White House is within reach, although Obama's remarks suggested he feels good about his re-election prospects.

Even if Obama was confiding a political reality in a supposedly private moment, the comments gave the GOP new openings to question his sincerity and long-range plans.

Mitt Romney, the leading Republican contender to face Obama this fall, told a San Diego audience the unguarded comments were "an alarming and troubling development."

"This is no time for our president to be pulling his punches with the American people, and not telling us what he's intending to do with regards to our missile defense system, with regards to our military might and with regards to our commitment to Israel," Romney said.

Romney, a former Massachusetts governor who often faces charges of having been flexible on his own policies over the years, also issued a statement saying Obama "needs to level with the American public about his real agenda."

Obama campaign spokesman Ben LaBolt said Romney "is undermining his credibility by distorting the president's words."

Republican presidential candidate Newt Gingrich also questioned Obama's motives.

"I'm curious, how many other countries has the president promised that he'd have a lot more flexibility the morning he doesn't have to answer to the American people?" Gingrich said on CNN.

Rep. Mike Turner of Ohio, Republican chairman of the House Armed Services Subcommittee on Strategic Forces, wrote to the president requesting an "urgent explanation of (his) comments." Turner said Congress "has made exquisitely clear to your administration and to other nations that it will block all attempts to weaken U.S. missile defenses."

The Republicans' sharp remarks underscore increased willingness of politicians to criticize a president on a foreign trip. The old adage "politics ends at the water's edge" is a casualty of the nation's heightened partisanship in recent decades.

Tensions over missile defense have threatened to upend the overall thawing of relations between the U.S. and Russia in recent years.

Both leaders acknowledged as much in their public statements to reporters following their meeting. Obama said there was "more work to do" to bridge their differences. Medvedev said each country had its own position on missile defense but there was still time to find a solution.

Congress, as part of the fiscal 2012 defense authorization act, constrained Obama's ability to share classified U.S. missile defense information with Russia. Obama signed that legislation into law.

Russia has strongly criticized plans for a U.S.-led NATO missile defense in Europe. Russian officials believe the planned missile shield would target Russia's nuclear deterrent and undermine global stability. The U.S. says the planned missile shield is intended to counter threats from Iran.

Putin said earlier this month that Washington's refusal to offer Moscow written guarantees that its missile defense system would not be aimed against Russia deepened its concerns. Putin won elections earlier this year and will return to the presidency later this spring. He is expected to name Medvedev prime minister.

The United States and Russia have also clashed recently over their approach to dealing with violence in Syria. The U.S. has sharply criticized Russia for opposing U.N. Security Council action calling on Syria's president to leave power.

Obama said Monday that despite past differences on Syria, he and Medvedev agreed they both support U.N. envoy Kofi Annan's efforts to end the violence in Syria and move the country toward a "legitimate" government.

___

Associated Press writers Kasie Hunt in San Diego and Donna Cassata in Washington contributed to this report. Babington reported from Washington.

Source: http://news.yahoo.com/obama-russia-more-flexibility-elections-125849688.html

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