text:
Current details for ABN 47 711 038 464Version: 9.8.22

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Entity name: CHAN, JOSH
ABN status: Active from 01 Nov 1999
Entity type: Individual/Sole Trader
Goods & Services Tax (GST): Registered from 01 Jul 2000
Main business location:
NSW 2007
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Trading name From

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Current details for ABN 47 712 128 157Version: 9.8.22

ABN details help
Entity name: The Trustee for KRD Group Trading Trust
ABN status: Cancelled from 31 Dec 2015
Entity type: Discretionary Trading Trust
Goods & Services Tax (GST): Not currently registered for GST
Main business location:
QLD 4556
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From 1 November 2023, ABN Lookup will not display trading names and will only display registered business names. For more information, click help.
Trading name From
KRD Building And Developments Pty Ltd 23 Jun 2010
Deductible gift recipient status help
Not entitled to receive tax deductible gifts

The Registrar makes every reasonable effort to maintain current and accurate information on this site. The Commissioner of Taxation advises that if you use ABN Lookup for information about another entity for taxation purposes and that information turns out to be incorrect, in certain circumstances you will be protected from liability. For more information see disclaimer.

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text:
Current details for ABN 47 712 308 139Version: 9.8.22

ABN details help
Entity name: COOLEY, KAREN ANN
ABN status: Cancelled from 12 Feb 2015
Entity type: Individual/Sole Trader
Goods & Services Tax (GST): Not currently registered for GST
Main business location:
QLD 4121
Trading name(s) help
From 1 November 2023, ABN Lookup will not display trading names and will only display registered business names. For more information, click help.
Trading name From
KAREN COOLEY 05 Jun 2012

The Registrar makes every reasonable effort to maintain current and accurate information on this site. The Commissioner of Taxation advises that if you use ABN Lookup for information about another entity for taxation purposes and that information turns out to be incorrect, in certain circumstances you will be protected from liability. For more information see disclaimer.


text:
Ormond A. MacDougald

University of Michigan, Ann Arbor, Ann Arbor, MI
Molecular Biology, Cell Biology, Animal Physiology Biology
"Ormond MacDougald"

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Donald B. Jump research scientist Michigan State (Chemistry Tree)
M. Daniel Lane research scientist Johns Hopkins (Chemistry Tree)
BETA: Related publications

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Scheller EL, Cawthorn WP, Burr AA, et al. (2016) Marrow Adipose Tissue: Trimming the Fat. Trends in Endocrinology and Metabolism: Tem
Ge C, Cawthorn WP, Li Y, et al. (2016) Reciprocal Control of Osteogenic and Adipogenic Differentiation by ERK/MAP Kinase Phosphorylation of Runx2 and PPARγ Transcription Factors Journal of Cellular Physiology. 231: 587-596
Cawthorn WP, Scheller EL, Parlee SD, et al. (2015) Expansion of bone marrow adipose tissue during caloric restriction is associated with increased circulating glucocorticoids and not with hypoleptinemia. Endocrinology. en20151477
Alexander CM, Kasza I, Yen CL, et al. (2015) Dermal white adipose tissue: a new component of the thermogenic response. Journal of Lipid Research. 56: 2061-9
Scheller EL, Doucette CR, Learman BS, et al. (2015) Region-specific variation in the properties of skeletal adipocytes reveals regulated and constitutive marrow adipose tissues. Nature Communications. 6: 7808
Zhang J, Motyl KJ, Irwin R, et al. (2015) Loss of bone and Wnt10b expression in male type 1 diabetic mice is blocked by the probiotic L. reuteri. Endocrinology. EN20151308
Doucette CR, Horowitz MC, Berry R, et al. (2015) A High Fat Diet Increases Bone Marrow Adipose Tissue (MAT) But Does Not Alter Trabecular or Cortical Bone Mass in C57BL/6J Mice. Journal of Cellular Physiology. 230: 2032-7
Kasza I, Suh Y, Wollny D, et al. (2014) Syndecan-1 is required to maintain intradermal fat and prevent cold stress. Plos Genetics. 10: e1004514
Mandrup S, MacDougald OA, Moss J, et al. (2014) In memoriam: M. Daniel Lane, 1930-2014. Trends in Endocrinology and Metabolism: Tem. 25: 437-9
Cawthorn WP, Scheller EL, Learman BS, et al. (2014) Bone marrow adipose tissue is an endocrine organ that contributes to increased circulating adiponectin during caloric restriction. Cell Metabolism. 20: 368-75
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Jahia Cloud best practices

  Written by The Jahia Team
   Estimated reading time:

There is not much difference between best practices for on-premise and cloud platforms, but with the right level of automation, following a few rules makes the development, testing and content production much more powerful and secure.

This page presents the best practices to manage the environment. You can find development best practices for Jahia here.

Always plan your operations to avoid downtime

Jahia Cloud is built to avoid downtime at all cost: whether you need to deploy code, restart your servers or upgrade the whole environment. We always have straightforward documented procedures to help you answer every visitor requests in a fast and reliable way.

Understanding technical limitations and using mitigation workarounds is a very good way to avoid shutting down the service, or having to perform a complicated deployment at midnight on a Sunday.

  • Deploying code on Jahia is very fast and reliable but can generate a few seconds of downtime per node. Performing deployment one node at a time is a great way to perform zero-downtime code deployment.
  • Server restarts are performed dynamically by our load balancers and there is no action needed on your side to avoid any downtime. Incoming traffic is directed to the remaining nodes of the environment during a restart.
  • Environment upgrades require an environment shutdown and take approximately 10 minutes. However, you can avoid downtime by creating a copy of your production environment, upgrading it, and redirecting traffic to the new environment. All it takes is a quick contribution freeze, and you even enjoy the luxury of testing your new updated environment before redirecting visitor traffic to it.

Always test your operation before applying it to production

There are a few sensitive operations in the life of an application: changing configuration, upgrading, and deploying modules. Always populate test environments with fresh production data to validate these operations before applying them to mission-critical environments.

Assuming everything will fail is the best way to make sure nothing will

That's how we built Jahia Cloud: several data centers per regions, each service is redundant, and data is always available in multiple copies to make sure we meet the highest standards.

When you design your applications, remember:

  • Never assume that a server will remain available
    • Auto-scaling will summon and remove nodes dynamically for you.
    • Clusters will provide you with service and data redundancy
  • Capacity planning is key, if you do not use auto-scaling, never run your service at near full-capacity
    • When auto-scaling is turned off, always make sure that one browsing node can be removed without impacting your overall performance and stability. Being able to restart one node is recommended for deploying configuration changes and code without downtime. (This is also known as node-per-node deployment)
    • Auto-scaling will always reserve the room to absorb an instant traffic surge and will always add new nodes to your infrastructure when its capacity reaches 80%.

Running performance tests before opening the platform to production is a must

Running performance tests that simulate target visitor traffic is the only way to understand how the platform will behave at high visitor throughput. Performance tests are also a great way to understand the weaknesses of your applications and for discovering your application’s breakpoint. Knowing your breakpoint gives valuable insights about code optimization, and behaviors to look for to predict a platform at near-full capacity.

We are always happy to help you design and implement performance tests that are relevant to your use cases. Don't hesitate to get in touch with your Success Manager to get you started.

Check monitoring console periodically

Jahia and Datadog partnered to provide a customized monitoring experience, tailored for our products and for your use. Custom Jahia dashboards provide insights about the health of the application and optimization requirements.

Even though the monitoring platform will send alerts when a website needs immediate attention, it is also a good practice to check the dashboards periodically to understand how the application behaves.

We put a lot of effort to design these dashboards and avoid any irrelevant data and will keep improving it in the future. Any suggestion that might make your life easier is also greatly appreciated.


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Tag Archives: advertising

Now that I don’t have to spend my Christmases without a significant other I really enjoy them. I loved them when I was a child too – there were just a few awkward years in between when they were depressing, irritating, and on occasion, dull.

The inescapable family

One thing that never changes for me, and as a festive theme, is the presence of family. Last year an advert for John Lewis started a trend for strongly emotive seasonal selling which has now spread to other big brands like Boots.

The Christmas themes aren’t new – there’s togetherness, a focus on giving being better than receiving, the idea that gifts are worth more than their monetary value, and so on. The general idea is to make us appreciate the old-fashioned values of Christmas so it becomes about spending quality time with your family and being thoughtful, rather than being a mad whirlwind of consumerism and gluttony.

This is all very admirable, although, since these messages are coming to us from shops hoping to sell us things, it’s a little hard to stomach at times.

The truth can be colder

Away from this cosy, log-fire vision of Christmas there’s also the stark reality that many families are not like the ones in the TV adverts.

Some families don’t care about each other, and some people do not have any family. Some families have problems, and may find Christmas very stressful and even upsetting. I am not a Grinch, but I know that Christmas isn’t wonderful for everyone.

Even for me, who has some wonderful people to share the day with, it’s a double-edged sword. I like seeing my family, or my in-laws, swapping presents, and eating roast parsnips and mince pies. I dislike the large amount of noise and the inability to spend any time alone. I also don’t like spending so much time in a house that isn’t my own. I can’t wander about or do the things I normally do. I can’t make myself a cup of coffee without feeling displaced and asking permission.

If I had the space to let all my relatives come to my home this would also be irritating. It would feel crowded and I’d be running around like a headless chicken trying to keep on top of the drinks and food, and keeping the place in some semblance of order.

This is the challenge of Christmas for those with Asperger’s who also have families who want to see them. The day will always be irritating as well as fun. It will never be truly relaxing. Nonetheless it is better than offending everyone and annoying your (non-Aspie) partner.

Outdated sexism

For me the worst Christmas advert is by Morrisons as it features a woman being stressed out and miserable as she runs around single-handedly preparing dinner for an enormous family. Her consolation? When she sits down (she is last to do so) at the table and sees her family digging in with a level of gusto that suggests they have been starving. This presumably is meant to show their appreciation but I imagine they’re all thinking ‘what the Hell took her so long?’

Are we meant to believe that women don’t, or shouldn’t ask for help at Christmas? Are we meant to believe that nobody in the entire family offered to help with any of it? If I had such an uncaring and ungrateful family I would refuse to invite them over for a cup of tea, much less a full Christmas dinner. And yet this advert assumes this is normal. It seems to say ‘this is how things are and there’s nothing wrong with that, because look – she’s happy at the end’.

It’s this kind of pessimistic sexist view of Christmas that really irritates me. I’m happy for adverts to espouse traditional family values like caring and thoughtfulness, but don’t turn Christmas into some awful challenge that people just have to put up with because it’s expected of them!

You can read a funnier article about UK Christmas adverts here.


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Biography of Henry Louis Dausman A.M., Ph.D., M.D.

Dr. Henry Louis Dausman, a physician and surgeon of St. Louis, his native city, was born January 18, 1855. His father, the late Henry Dausman, was a native of Germany but was brought by his parents to America when only two years of age, the family home being established on a farm near Evansville, Indiana. There Henry Dausman was reared, pursuing his education in nearby schools and after reaching a working age learned the tobacco business, thoroughly acquainting himself with that task. In 1850 he became associated in tobacco manufacturing in connection with John E. Liggett under the firm style of Liggett & Dausman. This connection was maintained until 1873, when the partnership was dissolved and Mr. Dausman became a partner of John T. Drummond, organizing the Dausman & Drummond Tobacco Company. This partnership was continued for a number of years, at the end of which time the business was sold to the tobacco trust. At the time of the sale the firm was among the largest conducting business independently in the United States. The death of Henry Dausman occurred in St. Louis in 1891, when he had reached the age of seventy-seven years. His wife, who bore the maiden name of Nancy Jones, was a native of Virginia and a representative of one of the old families of that state of English lineage. Her grandfather was an officer in the Revolutionary war under Washington. Mrs. Dausman passed away in 1906 at the advanced age of eighty years. By her marriage she became the mother of four children, three daughters and a son, all of whom have now passed away, with the exception of Dr. Dausman of this review.

Educated in the public schools of St. Louis until he had mastered the branches of learning therein taught, Dr. Dausman afterward attended the Washington University and subsequently spent eight years as a student in Germany, being graduated from the University of Heidelberg with the degree of Ph. D. and with the degree of M. D. from the University of Wuertzberg, Germany. He afterward pursued postgraduate work in the hospitals of Vienna and came under the instruction and acquainted himself with the methods of the most eminent physicians and surgeons of Europe. With his return to America he entered upon private practice in San Francisco, California, where he remained for two years and later spent ten years in Boise, Idaho. He then again came to St. Louis and for a quarter of a century has continuously engaged in practice 1n this city. He belongs to the St. Louis, Missouri State and American Medical Associations.

In St. Louis, in 1900, Dr. Dausman was married to Miss Emma Louise Koelling. a native of St. Louis and a daughter of Fred Koelling, one of the old settlers of this city who has now reached the venerable age of ninety-one years. Dr. and Mrs. Dausman have one son, Harry L., who was born in St. Louis in 1901.

In his political views Dr. Dausman has always been a democrat since age conferred upon him the right of franchise. Fraternally he is connected with the various bodies of Masonry and is a loyal follower of the teachings and purposes of the craft.

Search Military Records - Fold3

Stevens, Walter B. Centennial History of Missouri (The Center State) One Hundred Years In The Union 1820-1921 Vol 2. St. Louis-Chicago: The S.J. Clarke Publishing Company. 1921.

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Saturday, July 04, 2009

Speaking of the NDP Convention...

For those looking for the latest unofficial news on the NDP's convention in Halifax this summer, keep an eye on Devin's blog for details about the Tweet Up planned for the Saturday night, as well as a Twitter feed about the convention.

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Mansfield, Ohio Commercial Recycling Services

AccuShred offers commercial recycling services, in addition to document destruction service. AccuShred is a member of the National Association for Information Destruction (NAID). The NAID Certification Program is voluntary but establishes the standards for a secure destruction process. AccuShred is NAID certified and the first company in the area to achieve AAA Certification status, which is the highest level currently attainable.

AccuShred offers pickup services for secure data destruction, documentation of the destruction, on-site shredding, mobile shredding services, and shredding events in Mansfield, Ohio.

AccuShred works with State Paper and Metal, our parent company, to meet the needs of commercial recycling in the community. Some of the industries we serve include hospitals, banks, schools, universities, non-profits, and corporations.

Between AccuShred and State Paper and Metal, we are able to meet the needs of both data destruction and commercial recycling needs.


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Select a community to browse its collections.

Bölüm&Birim&Merkez [198]
Eğitim Fakültesi / Faculty of Education [171]
Fen Edebiyat Fakültesi / Faculty of Letters and Sciences [1225]
Hukuk Fakültesi / Faculty of Law [315]
İktisadi İdari Bilimler Fakültesi / Faculty of Economics and Administrative Sciences [394]
İKÜ Dergiler / IKU Journals [1118]
İKÜ Tezler / IKU Theses [850]
Meslek Yüksekokulları / Vocational Schools [53]
Mimarlık Fakültesi / Faculty of Architecture [523]
Mühendislik Fakültesi / Faculty of Engineering [548]
Sağlık Bilimleri Fakültesi / Faculty of Health Sciences [73]
Sanat ve Tasarım Fakültesi / Faculty of Art and Design [180]
Uluslararası İndeksli Yayınlar [1126]

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PUCTPublic Utility Commission of Texas
Copyright 1988-2018 AcronymFinder.com, All rights reserved.
References in periodicals archive ?
The PUCT rules require the fixed fuel charge on customer's bills to be changed bi-annually each September and March.
InfraREIT Inc (NYSE:HIFR) on Thursday declared that the Public Utility Commission of Texas (PUCT) has approved the company's acquisition by Oncor Electric Delivery Company LLC.
PUCT approval was the final regulatory approval needed to complete the transactions.
The PUCT sets rates on a cost-of-service basis with the opportunity for capital recovery outside of base rate proceedings through annual or semi-annual clause mechanisms.
We can resolve this paradox by introducing revenue sources that are excluded from the PUCT's calculation but are relevant for profitability.
Centrica has asked the PUCT for authority to market electric services to residential and small commercial customers in all deregulated areas of Texas, including the previous service territories of Reliant, TXU Electric, Central Power & Light, West Texas Utilities and Texas-New Mexico Power.
The sale is subject to customary closing conditions, including approvals from the Federal Energy Regulatory Commission, the Public Utility Commission of Texas (PUCT) and the Committee on Foreign Investment in the United States (CFIUS).
LCRA TSC is a regulated utility, subject to Public Utility Commission of Texas' (PUCT) rate approval.
Oncor Electric Delivery Company and Sempra Energy announced that the Public Utility Commission of Texas, or PUCT, approved an order authorizing the joint Change-in-Control application filed by Oncor and Sempra Energy, representing the last regulatory approval necessary for Sempra Energy to complete its pending acquisition of Energy Future Holdings, including EFH's indirect, approximate 80% ownership of Oncor.
Anderson said he could not comment on the lawsuit, but added that if the allegations were credible, "it's outside the purview of the PUCT."
The contracts are being signed for transmission and infrastructure services associated with the Competitive Renewable Energy Zone (CREZ) projects assigned to ETT by the Public Utility Commission of Texas (PUCT).


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text: TY - JOUR AU - Zahra Razavi AU - Elham Kaviani AU - Javad Fredmal PY - 2018/11/26 Y2 - 2021/05/07 TI - Glycosylated Hemoglobin and Related Factors in Children With Type 1 Diabetes Mellitus Under 20 Years of Age JF - Acta Medica Iranica JA - Acta Med Iran VL - 56 IS - 8 SE - Articles DO - UR - https://acta.tums.ac.ir/index.php/acta/article/view/7066 AB - The number of child and adolescence with type 1 diabetes mellitus (T1DM) is increasing. This study was conducted to assess glycemic control in child and adolescence with type 1 diabetes mellitus and its associated factors in Hamadan (Iran). This was a prospective observational study, dealing with 110 child and adolescence with type 1 diabetes mellitus, who referred to a pediatric diabetes clinic, affiliated to Hamadan University of Medical Sciences in 2012-2014. All blood tests were performed in a single laboratory. In this study, HbA1c levels of 6-7.9%, 8-9.9 and >10% were considered as good, moderate, and poor control. All collected data were recorded in the questionnaire. The number of male and female was equal. HbA1c level was equal to 6-7.9 in 48 patients (43.6%), 8-9.9 in 38 patients (34.5%), and more than 10 in 24 individuals (21.8%). Poor glycemic control was associated with: older age, duration of disease more than 5 years, less glucose monitoring, greater insulin dose, illiterate mothers, and more number of children, and residency in rural regions. Moreover, intensive insulin regimen and more times of insulin injection increased HbA1c level, though the difference was not significant. We concluded that in T1DM child and adolescence, the age, long duration of disease, number of glycemic control, insulin dose and living in urban regions are effective factors on the better control of the HbA1c levels. To improve glycemic control, we suggest more education and social support especially for mothers and rural patients and more blood glucose monitoring. ER -


text:
Busy Labor Day Weekend

Real Estate Agent with Helix Properties, LLC

Wow – what a busy weekend it was for us.  I helped two people find a home to rent (yes, we do work with tenants looking to rent homes) on Saturday, held one open house in Paradise Valley on Sunday and wrote an offer on a home for another buyer.  Long, stressful but enjoyable weekend.

To celebrate Labor Day Holiday, I took most of the day off and spent it with my two kiddo’s.

Memorial Day – most of us who grew up on the East Coast or Mid-west remember this as the last holiday before school starts.  It's a bitter sweet holiday – enjoying the last day of summer vacation but still filled with excitement about going back to school.  New school clothes, new shoe’s and new expectations on what school would entail.

In Arizona, our children start school mid August so the “new school” experience has already worn off.  For me, Memorial Day is more about relaxing with the family and just being grateful for having a job (ok, as a Realtor, it’s actually my small business and not a job –but, I’m still grateful for being able to sell homes) that I enjoy.  I think about the millions of American’s out there right now that want to work but can’t find any gainful employment.  It must be tough for them.  Memorial Day is just another day to wish they had a job.

I hope everyone had a chance to enjoy the holiday weekend and spend it with family.

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Pat Champion
John Roberts Realty - Eustis, FL
Call the "CHAMPION" for all your real estate needs

It is good to see you enjoyed the Labor Day weekend with your family making lasting memories is what it is all about.

Sep 09, 2011 06:02 AM

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Text: Hebrews 1:13-14

“But to which of the angels said he at any time, Sit on my right hand, until I make thine enemies thy footstool?

Are they not all ministering spirits, sent forth to minister for them who shall be heirs of salvation?”

The ministry of angels is a New Testament reality that every believer in Christ must begin to pay attention to…if we must enjoy the full benefits of our “so great salvation”.

In Psalm 91:10-11 we read,

“There shall no evil befall thee,

neither shall any plague come nigh thy dwelling.

For he shall give his angels charge over thee,

to keep thee in all thy ways.”

The ministry of angels came with the salvation package…it’s one of “the things that accompany salvation”…freely given to us from heaven (our country)…to richly enjoy…as “ambassadors of Christ” here on earth…Hebrews 6:9,

“But, beloved, we are persuaded better things of you, and things that accompany salvation…”

The Passion Translation Of Hebrews 1:14 says,

“What role then, do the angels have? The angels are spirit-messengers sent by God to serve those who are going to be saved.”

If have confessed Jesus as your personal Lord and Savior, you are now saved – Romans 10:10. So you qualify for the ministry of angels.

When Jesus was here on earth (as the exemplary man we have now become in Christ), he enjoyed the Ministry of angels.

After his 40 days and 40 nights ordeal in the wilderness, where the devil came to distract him from his mission, Matthew 4:11 says,

“Then the devil leaveth him, and, behold, angels came and ministered unto him.”

He said to Nathaniel in John 1:51,

“And he saith unto him, Verily, verily, I say unto you, Hereafter ye shall see heaven open, and the angels of God ascending and descending upon the Son of man.”

If you’re born again you are now in the likeness of Jesus, and for as long as you’re here on earth fulfilling God’s purpose for your life, you are also entitled to this same privilege that Jesus enjoyed.

He said in Matthew 26:53,

“Don’t you realize that I could ask my Father for thousands of angels to protect us, and he would send them instantly?”

So, it’s your responsibility to place a demand for them.

Apostle Peter was arrested and put in prison, awaiting the day of his execution…

“But while Peter was in prison, the church prayed very earnestly for him…

Suddenly, there was a bright light in the cell, and an angel of the Lord stood before Peter. The angel struck him on the side to awaken him and said, “Quick! Get up!” And the chains fell off his wrists…

Then the angel told him, “Get dressed and put on your sandals.” And he did. “Now put on your coat and follow me,” the angel ordered…”

That’s how Peter came out of that prison where he was “fastened with two chains between two soldiers (and) Others stood guard at the prison gate.”

You can read the full story in Acts 12: 1-12.

Even in the Old Testament, people like Daniel enjoyed the Ministry of angels for divine intervention….

Daniel was thrown into the lions’ den, and in the morning, when the king came to check on him…Daniel was still alive and well…(Remember Daniel was also a man of prayer?)…

He told the king, “My God sent his angel to shut the lions’ mouths so that they would not hurt me, for I have been found innocent in his sight. And I have not wronged you, Your Majesty.”

Read the full story in Daniel 6:1-22.

Finally, note that the words you speak (in line with God’s Word and promises) and your confessions of faith in the finished work of redemption)…can also provoke your ministering angels.

So you must be careful what you say…because satan’s angels are also at alert to work with the things you say that are contrary to the Word of God…

That’s why you are warned in Psalm 34:12-13…

“Does anyone want to live a life

    that is long and prosperous?

Then keep your tongue from speaking evil

    and your lips from telling lies!”

Speaking words contrary to the realities of the finished work of redemption (even as a joke)…is speaking evil against your destiny, it’s speaking lies…

So, you need good, accurate and exact knowledge of who you are and what you have in Christ…to enjoy the ministry of angels – Read Ephesians 1:17-22; Philemon 1:6.

From today, I see you enjoying this awesome privilege of the Ministry of angels that is yours in Christ…in Jesus name!

I would love to hear from you!

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text:
Dangers of Vaporizing Tobacco Products – WHAT EXACTLY ARE Your Options?

Dangers of Vaporizing Tobacco Products – WHAT EXACTLY ARE Your Options?

The dangers of vaping tend to be cited as outweighing the benefits of switching to this new method of smoking. This is because many research has been conducted into the negative areas of e-cigarette use, plus they include everything from lung problems to possible diseases developed in smokers if they use the device for extended periods. The primary problem lies in the fact that a lot of people who use vaporizers don’t understand that they aren’t really replacing one medium of nicotine consumption with another, they’re replacing it with something very different.

dangers of vaping

A lot of us have probably heard the term ‘torrent harm’ linked to cigarettes. This refers to the damage that smokers can suffer as a result of continuing to smoke even when they are not physically hooked on cigarettes. The effects include everything from cancer to emphysema and stroke. In the case reports that have been released there are many cases where people have died due to their smoking habits.

So, the facts about vaporizing tobacco that makes it so dangerous? The primary concern about the dangers of vaping tobacco relates to the fact that an individual isn’t actually replacing one substance that they are ingesting with another, however they are replacing one technique of delivery with another. When you smoke cigarettes, you’re literally inhaling a large number of different substances into your lungs. These substances are tar, nicotine and carbon monoxide, all of which can cause serious health issues.

So, why would anyone elect to replace these substances with something less harmful? The answer comes down to psychology. You see, in e-cigarettes there is no such thing as a chemical replacement that may make the act of smoking safer. In fact, the dangers of vaping tobacco is that the addicting nature of nicotine itself implies that there will always be a stronger way to obtain nicotine available to smokers if they need to get their fix.

Another danger of Vape Pen e-cigarette use is that the chemicals and toxins that are present in the tar and nicotine are highly resistant to being divided by human metabolism. Therefore, long term usage of any e-cigarette can expose you to more serious health effects, such as for example cancer. When you are already suffering from a serious medical condition, using the cigarettes can exacerbate the issue. For instance, smoking when pregnant or having a respiratory infection increases the threat of complications during pregnancy, and prolonged use could even lead to miscarriage. Really the only solution to completely avoid these dangers of smoking in e cigarettes isn’t to smoke at all.

Gleam danger of exposing children to the negative health threats of tobacco. Nicotine is addictive, and as time passes, smokers develop nicotine dependency. The more you smoke, the more nicotine you will get into your system. But, e cigarettes contain no tar or nicotine, and therefore they are ideal for kids to use. They won’t have the same psychological effects on them because they would the real thing, making them just as possible for kids to start smoking real cigarettes.

There is also the danger of lung injury caused by second-hand smoking. It really is now known that almost 1 / 3 of all smokers get some good type of lung injury from their cigarette smoking. This causes various short and long term health effects, with the short-term ones being easier overcome than the long term ones. But for women that are pregnant, or children or teenagers suffering from a respiratory illness, then there really isn’t any safe solution, and smoking should absolutely be avoided.

Much like most other potential health effects of tapering, there really is no real solution to completely avoid these dangers of vaporizing tobacco products. But, it is possible to significantly reduce your likelihood of getting them by not Vaporizing tobacco products at all. Or, better yet, try making your own. There are numerous recipes available on the web that explain steps to make your own e-juices. So, instead of sucking on someone else’s cigarette, or their friends’ lungs, you can enjoy an ice cold glass of your very own made e-juice.

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TIP 47-Substance Abuse-Clinical Issues in Intensive Outpatient Treatment, Contiuum of Care and Services in IOT

This course was updated 73 days ago. If you're about to take the exam, you may benefit from reviewing the exam questions listed below before starting on the actual exam.

About the Course:

This course gives an overview of the continuum of care. It includes the key aspects of IOT, including the 5 levels. It explains key aspects of outpatient treatment, core services, enhanced IOT services, and continuing community care. There are several useful appendices, and some case studies.

This course is based on the reading-based online, TIP 47-Substance Abuse-Clinical Issues in Intensive Outpatient Treatment, Contiuum of Care and Services in IOT created by SAMHSA in 2017.

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Course Creator

L.A. Rankin

L.A. Rankin is a social worker with experience in many different settings with a variety of clients. She has worked with dementia and Alzheimers patients, dual diagnosis MH/MR, in a battered women’s shelter, and a rape crisis center. She also has 11 years of experience as a child protective social worker, where she earned certificates in domestic abuse/family violence and substance abuse.

Recommended For:

Counselors, marriage and family therapists, psychologists and social workers. This course is appropriate for all levels of knowledge.

Course Objectives:

  1. Acknowledge the continuum care is an effective treatment package that can be stepped up or down based on client need.

  2. Identify the 5 levels in the continuum of care.

  3. Summarize core and enhanced services in IOT.

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American Academy of Health Care Providers in the Addictive Disorders (AAHCPAD)

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American Psychological Association (APA)

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CE Learning Systems is approved by the American Psychological Association to sponsor continuing education for psychologists. CE Learning Systems maintains responsibility for this program and its content.

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CE Learning Systems, LLC, provider #1020, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. CE Learning Systems, LLC maintains responsibility for this course. ACE provider approval period: 2/23/2019 – 2/23/2022. Social workers completing this course receive 3 general continuing education credit(s).

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Course Material in PDF format

The exam questions are based on Chapter 3 and 4 only.

References begin on page 197.

Editor’s Note On TIP 47, Substance Abuse: Clinical Issues in Intensive Outpatient Treatment in PDF format

This editor’s note provides an update to the information in the original article

References begin on page 4.

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Well, I guess you are never too young to fall in the tub. I had a little mishap today. I guess I was reaching too far out of the tub and lost my footing on the slippery surface. I was able to catch myself before I did any real damage, granted my hands were on the floor. My back is a little sore but I’ll live. I am just to klutzy for my own good.

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A Feast of Flavourful Fondues at Vila Podvin

Thanks to the ever-creative team at Vila Podvin in Mošnje, now there’s no need to go all the way to the Swiss Alps to enjoy a cheese fondue! Though only recently revived, the tradition of fondues in Podvin actually dates back quite some way.

Prior to World War II, the French Duke of Polignac lived in Podvin Castle and, according to locals, the castle’s residents used to enjoy fondues on cold winter evenings, made with cheese that they brought with them from France. Vila Podvin decided to revive the tradition this winter, initially just for the month of February, but it’s been such a hit, that you will now be able to enjoy a fondue up until the end of April!

When creating and testing fondue recipes, Uroš Štefelin, co-owner of Vila Podvin and one of Slovenia’s top chefs, was keen to ensure that rather than using imported cheese, he uses the excellent-quality cheese that is produced here in Slovenia. And he knew just where to turn – the  award-winning Pustotnik dairy from Gorenja vas – with whom he set about blending a mixture of their cheeses to create the perfect fondue.

You can also try and buy Pustotnik cheese at the monthly Vila Podvin Local Market, which takes place on the first Saturday morning of each month. Read more here – https://adeleinslovenia.com/2016/09/05/shop-locally-at-radovljicas-farmers-and-craft-markets/

Vila podvin trznica

Each cheese fondue comes with a whole host of tasty and unusual bite-size delights to dip into the gooey cheese!

For a change from dining alone (sigh!), I invited fellow blogger Peter, who writes a blog in German about Slovenia, to join me for dinner – especially since the fondues are designed for two. Of course, fondues are not restricted to just cheese, oh no, lucky for me Vila Podvin does a chocolate fondue too, using 60% dark chocolate and with a range of wonderfully sinful things to dip, including chocolate brownies, fresh and dried fruit, macarons …

Another important feature of the fondues, as well as other dishes, is the recent link-up with attendees of the Radovljica Centre for Work, Training and Care (CUDV). Working together they have created unique pieces of ceramicware on which to serve up the restaurant’s tasty and creative dishes. The range of products is collectively made and sold under the name BISER, meaning ‘pearl’, and they really do make original gifts or additions to your own kitchenware.

Find out more about Vila Podvin here – http://www.vilapodvin.si/EN/ and about Taste Radol’ca here – http://www.radolca.si/en/taste-radolca/

© Adele in Slovenia

Sorica: Super Skiing and Slovenia’s Most Beautiful Mountain Village

The well-kept village of Sorica is considered to be one of most beautiful mountain villages in Slovenia. As the tourism writer Rudolf Badjura wrote ‘It would be necessary to travel some distance around the world to see such a beautiful village.’ And even though it didn’t look its best on a slightly overcast February afternoon when I visited, when nature’s hues are still somewhat subdued after the winter slumber, one can easily imagine how glorious it must be here in the warmer months when nature is at its vibrant best.

Sorica is known as Grohar’s village (Groharjeva vas) as it is the birthplace of one of Slovenia’s most esteemed impressionist painters, Ivan Grohar (1867-1911).

The best way to get acquainted with the village is by walking the theme path ‘Path through Sorica’, which begins in the centre of the village between the Gostilna Macesen restaurant with rooms and Grohar’s House (Groharjeva hiša) – Ivan Grohar’s birth house.

With views like this, it’s easy to see where Grohar got his inspiration! The 18th century Baroque parish church of St. Nicholas contains a ceiling fresco of ‘The Last Supper’ by another of Slovenia’s esteemed painters, Janez Šubic from Poljane.

Tone Logonder, the sculptor of the statue of Ivan Grohar which was placed here in 1981, received the Gorenjska Prešeren Award for his work.

Rather than just being a museum, locals wanted Grohar’s House to once again come to life and a winning formula was found in making it into a kind of one-stop cultural centre which has become particularly popular for school field trips, and visits for private groups can also be arranged. The ground floor features a gallery.

On the first floor you can indulge your creative side and take part in a workshop in the music room.

And then head up to the upper floor to the artists’ workshop to have a go at creating one of your own pictures to rival that of Grohar!

You can choose to just soak up the views of the village and its surroundings, set off on one of the many paths in the hills and mountains or, for those with a thirst for more active pursuits, head up to Soriška planina where in winter you can ski and in summer there are numerous scenic and interesting hiking trails.

Soriska planina can be reached from several directions; from Škofja Loka via Železniki, from Bohinjska Bistrica or from Most na Soči via Baška Grapa.

Facilities at the Soriška planina ski resort consist of a two-person chairlift, 3 drag lifts, a children’s drag lift, a snow park, a sledging track, cross-country ski trails and a restaurant.

I had previously hiked in this area in the summer, but prior to last week had never seen it in its winter glory. Even for non-skiers like me, there’s still snowy fun to be had! Here I am at the highest point of the ski resort looking back down over the village of Sorica.

One of the most interesting features of this area are the numerous bunkers, barracks and other fortifications remaining from the time of the Rapallo Border – a former border that existed during both world wars between Yugoslavia and Italy.

Below you can see the bunker on Lajnar, and you can also continue to others including on Možic, Slatnik and Dravh.

Find out more about the Soriška planina ski resort here – http://www.soriska-planina.si/en/hiking/ and more about other theme paths and trails along the Rapallo Border here – http://www.visitskofjaloka.si/en/experiences/theme-paths/rappalo-border

© Adele in Slovenia

Celebrating 10 Years in Slovenia in a WILDART Style!

Yesterday marked exactly 10 years to the day since I moved to Slovenia!

On the one hand I can say that the time has flown by, though, on the other, when I look back over the past 10 years I’ve packed so much in and am proud of all that I’ve achieved. Yes, there are still, and probably will always be, a few challenges of living alone in a foreign country, but the pluses far outweigh the minuses. So I decided a celebration was in order, and arranged a get-together with some of those who I’ve met along the way and have been, and I hope will continue to be, an important part of Adele in Slovenia!

I must first thank Staša and Jože from Jansa Apartments in Radovljica, for allowing me to use their breakfast room to hold my celebration, and even gave me this heart-shaped cake too. I can thoroughly recommend their apartments and hospitality if you are considering visiting Radovljica and looking for self-catering apartments. And I’m not just saying that, I have first-hand experience of the excellently-equipped apartments, since my parents stay there every time they visit Slovenia, which, as you might imagine, is quite often!  http://apartmaji-jansa.net/

I must also thank Mišo (ably assisted by Erik!) from Joštov Hram restaurant in Podnart, one of the participating Taste Radol’ca restaurants. Mišo is the go-to man for catering around here! Regular readers will recall that I also turned to him for my father’s surprise 70th birthday last year. They provide excellent home-cooked food for all kinds of private events, parties, weddings, celebrations etc.

Guests were welcomed with the (almost!) obligatory Slovenian blueberry schnapps and warm home-made pogača bread topped with minced bacon and onion, then later we tucked into bograč, cold deli platters and for dessert, one of my favourites, šmorn, with Miso’s extra little touch – a trio of sauces.

After my short speech – yes, in Slovene – we watched a short slide show of just a few of my favourite adventures from the last 10 years. Thanks Dad!

Then it was time for the ‘surprise’ and the highlight of the evening, a performance by the winners of the 2016 Slovenia’s Got Talent. These two young lads, Timotej Willewaldt and Lenart Prek – both aged 14 and collectively WILDART, have exceptional talent and surely a very bright future ahead of them.

You can see their amazing performance here.

Another one of the many highlights of the evening for me was being presented with a special gift from the Mayor of Radovljica in recognition of my efforts in promoting Radovljica through my blog. I was truly honoured.

Thanks also to my neighbour and photographer Tomaž Sedej for all the photos. On this occasion I decided it would be nice for me to be able to enjoy socialising without having to worry about taking photos too, so I turned to Tomaž, safe in the knowledge that he would do a good job. His website sums it up – ‘Photography has a powerful message. It ensures that we remember the stories and the people that would otherwise be forgotten.’ Find out more here – http://www.sedejtomaz.com/

And thanks to all of those of you that came for being part of my celebration and for the wonderful array of thoughtful and imaginative gifts. Too numerous are they to show them all, but here are a few! 10 cheers for Adele says Anja!

According to Tanja I’m now a ‘čista prava Radolčanka’!

Jure and Denis – thanks for coming so far to be here and, amazingly, on time!!!!!!

A book and CD of Slovene songs which I now have a duty to learn according to Marcela from Vila Podvin!

Flowers and gifts galore! It was all a bit overwhelming.

And these two came all the way from the UK, well, they do have a house here too, so not exactly, but ….!

Thank you to everyone for making it such a memorable evening and here’s to many, many more years of Adele in Slovenia!

© Adele in Slovenia

Like Beekeeping? Love Radovljica!

Those interested in beekeeping should definitely make a beeline for Radovljica!

The Radovljica area has a wealth of beekeeping-related sights of interest, all within close proximity, thus making it ideal place to visit for beekeepers or those with an interest in beekeeping.

One such example is the group of 38 beekeepers from Estonia who I helped with their plans to visit Radovljica.

Whilst the main purpose of their trip was beekeeping-related activities, they also managed to find time to do some sightseeing in Ljubljana, took a traditional pletna boat to the island on Lake Bled, and visited Vintgar Gorge.

The main beekeeping day began with a visit to Kralov med in the hamlet of Selo near Bled, where owner Blaž Ambrožič told them everything, and more, that they could possibly want to know about beekeeping in Slovenia. I wrote more extensively about my visit to Kralov med in a previous blog, also about World Bee Day, which you can read here – https://adeleinslovenia.com/2016/05/17/world-bee-day-the-anton-jansa-honey-route/

The undoubted highlight, whether a beekeeper or not, is the chance to see and experience up close the hive found on a nearby tree trunk and transported to its current home. The fact you can get so close is testament to the calm nature of Slovenia’s Carniolan grey bee.

Next the group came to Radovljica, beginning at the Tourist Information Centre where they tasted local honey and chocolate, and had the chance to buy some gifts to take home. They even brought us some of their own Estonian honey, which, as you can see, the staff enjoyed tasting!

We then took a stroll through the medieval old town to see the main sights of interest – the Šivec House Gallery, the Radovljica Mansion, St. Peter’s Church, and the other wonderful frescoed buildings.

Then it was on to the viewpoint for wonderful views of the Julian Alps, the Jelovica plateau and the Sava river.

The next stop was to Lectar Inn to watch the process of making and decorating the traditional ‘lectar’ gingerbread’ hearts, made with honey, of course!

And a chance to buy souvenirs and/or gifts for loved ones.

Having seen Radovljica, it was then time to Taste Radol’ca, with a traditional Slovene lunch, also at Lectar Inn, one of the participating Taste Radol’ca restaurants. During lunch, the owner Jože entertained us with a few of his favourite songs played on the harmonica – never something to be missed!

The final stop in Radovljica was to the Museum of Apiculture, housed in the Radovljica Mansion, where visitors can learn all about the history of beekeeping in Slovenia, watch a video (narrated in English by me!), and in summer watch the bees hard work diligently in the hive.

The group’s very last stop on the jam-packed, or should I say honey-packed, day, was to the Gorenjska Beekeeping Development and Education Centre in Lesce. You can read more about the centre and its wide-ranging activities here – http://www.radolca.si/en/gorenjska-region-beekeeping-development-and-education-centre/

So, as you can see, the Radovljica area really is a beekeeper’s paradise!

If you’d like any more information about Slovenian beekeeping, or are interested in taking a tour of the town and/or visiting some of the above-mentioned sights, feel free to get in touch or contact Tourism Radol’ca – http://www.radolca.si/en/

© Adele in Slovenia

Sunny Skiing, Stunning Views and Romance on Stari Vrh!

The Stari Vrh ski resort is located in the middle of the Selca and Poljane valleys, just a ten minute drive from Škofja Loka. It’s proximity to Ljubljana makes it a popular destination; in winter for skiing, snowboarding and other winter sports, and in summer for hiking and cycling.

Stari Vrh offers 10kms of slopes (1km difficult, 5kms medium, 4kms easy), together with a snowboard park, night skiing, a toboggan run and a children’s snow playground.

Even for a non-skier like myself, it’s well worth donning your winter gear and taking the chairlift up to the top for the stunning panoramic views.

Once at the top, you will be blown away (hopefully not literally!) by the views over the Škofja Loka hills and further to the Kamnik-Savinja Alps.

The peak of Stari Vrh is at an altitude of 1217m.

At the top you can visit the cosy Stari Vrh Restaurant and Guest House, where you can enjoy a drink and/or snack, indulge in one of the Slovene specialities – all the while gazing at the stunning views – or stay overnight in one of the inn’s comfortable rooms and warm up in the sauna!

And since February is the month of romance, you might be interested to know that one of the ski pistes at Stari Vrh is named Valentine’s piste, after the nearby St. Valentines church in Jarčje Brdo. Additionally, the very scenic Valentine’s Path (Valentinova pot) begins at the lower station of the Stari Vrh chairlift. Note, however, that you will need to wait until at least spring before setting out to walk this path, as it runs on part of the ski piste, so can’t be walked when the ski centre is open.

The circular path is marked with green circles with a yellow inner and runs along old cart tracks and forest paths. It takes about 2 hours to complete, has a total height difference of 280 metres, and leads past the Žgajnar Tourist Farm, a 200-year old farmhouse in the hamlet of Zapreval, where in 1970 the Stari Vrh Tourist Association was founded. During winter there is a marked detour to reach Zapreval, since the ski pistes run almost literally past the front door, hence making it an excellent base for those on multi-day trips.

Today the tourist farm offers accommodation and delicious home-produced and home-cooked food year-round. You can read more about the tourist farm here – http://zgajnar.starivrh.si/presentation/Presentation.html

The path begins at the lower station of the chairlift at the Stari vrh ski resort and continues beside the Valentine ski piste to reach the exact boundary of the municipalities of Gorenja vas-Poljane and Škofja Loka, before rising up to the Stari vrh Restaurant and Guest House. It continues through the village of Mlaka past the Jejlar homestead (Jejlarjeva domačija), the famous house where the film Cvetje v jeseni (Blossoms in Autumn) was filmed. On reaching the village of Jarčje Brdo you will catch sight of the imposing St. Valentine’s parish church and return to the start of the walk.

Photo: TD Stari Vrh

Photo: TD Stari Vrh

Every year on 31st October there is an organised hike on Valentine’s Path, arranged by the Stari Vrh Tourist Association, beginning at 9am from the car park of the lower station of the 6-person chairlift at the Stari vrh ski resort.

The Association also arranges other events, including the popular Charcoal Makers Day, which has been held annually on the first Sunday in August since 1972.

Photo: TD Stari Vrh

Having seen how beautiful Stari Vrh is in winter, and the numerous opportunities the area offers for hiking and cycling in summer, I now can’t wait to go back and explore more of the area on foot or by bike. And when I do, you will be sure to read about it here!

You can find out more about all the above on the Visit Skofja Loka website here – http://www.visitskofjaloka.si/en/about-us/tourism-board-skofja-loka

© Adele in Slovenia


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Biking and Hiking in Koroška – Through and On Mount Peca!

For lovers of the great outdoors, particularly hiking and cycling, Slovenia’s Koroška region offers a wealth of opportunities and exciting, unique experiences and was somewhere I had long had on my list of places to get round to visiting.

This is not a place of mass-tourism, and is all the better for it. Instead it’s crammed with unspoilt nature, picturesque alpine valleys, peaceful hamlets, remote and hidden delights, farmsteads and tourist farms with hospitable locals. In fact, Koroška is among the most mountainous of Slovenia’s regions – hence it has my name written all over it!

I stayed at the family-run Bike and Eko Hotel Koroš, in Jamnica, near Mežica – the Alpine and mining centre of the Mežiska valley. As you can see below, the views I woke up to of the surrounding countryside and mountains were pretty breathtaking!

The hotel stands at an altitude of 900m, and is the first dedicated bike hotel in Slovenia.

As well as offering 10 simple rooms and excellent home-grown and home-cooked food, it boasts the Jamnica Single Trail Bike Park – a paradise for fans of adrenaline-filled mountain biking. Making the most of the idyllic surroundings, and with the agreement and co-operation of the local community, the hotel’s owners have prepared a network of 30km of single trails which you can tackle alone or with a guide. More information about the hotel and bike park here –

Photo: Rupert Fowler

Lead, zinc and iron ore mining was once the region’s key industry and there was, or rather still is, a labyrinth of tunnels under Mount Peca stretching for around 800 kilometres. At the peak of its production, around 2,000 people worked in the mine’s various units, which operated for three centuries, with production finally ceasing in 1994.

Nowadays, just a small part of the mine is open for tourists who can choose from 3 ways of experiencing it. The more sedentary option is to take a tour of the 3.5km Glančnik tunnel on board an original mining train. You also get to don some miners’ gear, to make the experience even more authentic! However, it’s not entirely sedentary, as the experience also includes a 1.5km walk through part of the mine.

Another option, and for a unique and thrilling experience, is to explore the tunnels on a guided mountain bike trip – which was my choice!

The mountain bike experience lasts around 3 hours and begins with a short van ride to the entrance at Igrčevo, in Črna na Koroškem. Each participant is provided with a helmet and headlamp. Do make sure to have extra layers of clothing as it is a constant 10˚C inside the mines. It was around 30˚C outside on the day of my visit, so warm clothes were not at the forefront of my mind, though, I sure wish I had taken warm gloves!

It feels slightly disconcerting at first, but you soon adjust to cycling through the narrow low tunnels. Along the way the guide gives information about the working conditions in the mine and you can see some remains of equipment used and names scribbled on the mine’s walls. The total ride itself is only around 6km, with a negligible incline.

All the experiences begin at the cross-border Karavanke Geopark in Mežica, which in itself is worth a visit, and in 2013 it became a member of the European and global network of geoparks under the auspices of UNESCO.

The centre offers a glimpse into the more than 400 million-year-old history of the area of today’s eastern Karavanke and comprises an exhibition area with exhibits including a fully-preserved smithy, an information area with a café and gift shop, and it also hosts workshops and other events.

In an adjacent building there is museum, which gives a further insight into the lives of those working in, or connected to, the mines, and a collection of ores, minerals and fossils.

Note: for bike and kayak tours, prior reservations are required; the minimum age is 10. More information about the Geopark can be found here –

Having spent the afternoon going through Mount Peca, next morning it was time to go ON Mount Peca – this time on foot! Peca is part of the Karavanke chain, which has a total length of around 120km and forms a natural border between Slovenia and Austria.

The Peca massif forms part of the Eastern Karavanke and can be approached from either Slovenia or Austria. I chose to begin my hike from the serene and stunning Topla Valley, which is surrounded on all sides by lush forest and contains just a handful of farmsteads – each with a traditional shingle roof. This protected valley really is like something out of a fairytale and is about as unspoilt as it gets.

At the far-end of the valley, near the entrance to the Topla mine, a path leads steeply up through the forest taking about 2 hours to reach the Dom na Peci mountain hut (1665m), where you can enjoy delicious home-cooked stews, štruklji, strudel and other types of food, which always seem to somehow taste even better when you have earnt them after a long hike!I

However, knowing it was still a way to go to reach the top of Peca, Kordeževa glava (2125m), and not wishing to do so with a full stomach, I resisted the temptation and continued onwards and upwards! At first across a meadow, then the terrain becomes more rocky, but still relatively easy, though for those who like more challenging climbing routes (that doesn’t include me, I hasten to add!), there is also an alternative path to the top, which is classified as ‘demanding’.

The higher you go, the better and more far-reaching are the views, and the more the effort pays off!

Despite it being a searingly-hot mid-August weekend, I still had the place to myself! Well, not exactly, but in fact there were just about the right number of people for my liking. Enough that one could pass the time of day and exchange a few words with fellow hikers here and there, and find some friendly folk to take the odd snap for me, but not so many that it felt crowded – just perfect!

Koroška tends to get somewhat overlooked in terms of tourism, at least in terms of those visiting from outside of Slovenia, however, I recommend that for lovers of the outdoors, it definitely deserves to be included in your holiday plans.

This gives just a brief snapshot of the area; more information about what else to see and do can be found here –

© Adele in Slovenia


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Docs on Pharma Payroll Have Blemished Records, Limited Credentials

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This story first appeared on the ProPublica website.

The Ohio medical board concluded that pain physician William D. Leak had performed “unnecessary” nerve tests on 20 patients and subjected some to “an excessive number of invasive procedures,” including injections of agents that destroy nerve tissue.

Yet the finding, posted on the board’s public website, didn’t prevent Eli Lilly and Co. from using him as a promotional speaker and adviser. The company has paid him $85,450 since 2009.

In 2001, the US Food and Drug Administration ordered Pennsylvania doctor James I. McMillen to stop “false or misleading” promotions of the painkiller Celebrex, saying he minimized risks and touted it for unapproved uses.

Still, three other leading drug makers paid the rheumatologist $224,163 over 18 months to deliver talks to other physicians about their drugs.

And in Georgia, a state appeals court in 2004 upheld a hospital’s decision to kick Dr. Donald Ray Taylor off its staff. The anesthesiologist had admitted giving young female patients rectal and vaginal exams without documenting why. He’d also been accused of exposing women’s breasts during medical procedures. When confronted by a hospital official, Taylor said, “Maybe I am a pervert, I honestly don’t know,” according to the appellate court ruling.

Last year, Taylor was Cephalon’s third-highest-paid speaker out of more than 900. He received $142,050 in 2009 and another $52,400 through June.

Leak, McMillen and Taylor are part of the pharmaceutical industry’s white-coat sales force, doctors paid to promote brand-name drugs to their peers—and if they’re convincing enough, get more physicians to prescribe them.

Drug companies say they hire the most-respected doctors in their fields for the critical task of teaching about the benefits and risks of their drugs.

But an investigation by ProPublica uncovered hundreds of doctors on company payrolls who had been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.

This story is the first of several planned by ProPublica examining the high-stakes pursuit of the nation’s physicians and their prescription pads. The implications are great for patients, who in the past have been exposed to such heavily marketed drugs as the painkiller Bextra and the diabetes drug Avandia—billion-dollar blockbusters until dangerous side effects emerged.

“Without question the public should care,” said Dr. Joseph Ross, an assistant professor of medicine at Yale School of Medicine who has written about the industry’s influence on physicians. “You would never want your kid learning from a bad teacher. Why would you want your doctor learning from a bad doctor, someone who hasn’t displayed good judgment in the past?”

To vet the industry’s handpicked speakers, ProPublica created a comprehensive database that represents the most accessible accounting yet of payments to doctors. Compiled from disclosures by seven companies, the database covers $257.8million in payouts since 2009 for speaking, consulting and other duties. In addition to Lilly and Cephalon, the companies include AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer.

Although these companies have posted payments on their websites—some as a result of legal settlements—they make it difficult to spot trends or even learn who has earned the most. ProPublica combined the data and identified the highest-paid doctors, then checked their credentials and disciplinary records.

That is something not all companies do.

A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses.

More than 40 have received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes. And at least 20 more have had two or more malpractice judgments or settlements. This accounting is by no means complete; many state regulators don’t post these actions on their web sites.

In interviews and written statements, five of the seven companies acknowledged that they don’t routinely check state board websites for discipline against doctors. Instead, they rely on self-reporting and checks of federal databases. Only Johnson & Johnson and Cephalon said they review the state sites.

ProPublica found 88 Lilly speakers who have been sanctioned and four more who had received FDA warnings. Reporters asked Lilly about several of those, including Leak and McMillen. A spokesman said the company was unaware of the cases and is now investigating them.

“They are representatives of the company,” said Dr. Jack Harris, vice president of Lilly’s US medical division. “It would be very concerning that one of our speakers was someone who had these other things going on.”

Leak, the pain doctor, and his attorney did not respond to multiple messages. The Ohio medical board voted to revoke Leak’s license in 2008. It remains active as he appeals in court, arguing that the evidence against him was old, the witnesses unreliable and the sentence too harsh.

In an interview, McMillen denied nearly all of the allegations in the FDA letter and blamed his troubles on a rival firm whose drug he had criticized in his presentations.

“I’m more cautious now than I ever was,” said McMillen, who said he also does research. “That’s why I think a lot of the companies use me. I’m not taking any risks.”

Taylor said that the allegations against him were “old news” from the 1990s and that regulators had not sanctioned him. “It had nothing to do with my skills as a physician,” said Taylor, noting that he speaks every other week around the country and sometimes abroad. “Even my biggest detractors in that situation lauded my skills as a physician. That’s what’s most important.”

Disclosures are just the start

Payments to doctors for promotional work are not illegal and can be beneficial. Strong relationships between pharmaceutical companies and physicians are critical to developing new and better treatments.

There is much debate, however, about whether paying doctors to market drugs can inappropriately influence what they prescribe. Studies have shown that even small gifts and payments affect physician attitudes. Such issues have become flashpoints in recent years both in courtrooms and in Congress.

All told, 384 of the approximately 17,700 individuals in ProPublica’s database earned more than $100,000 for their promotional and consulting work on behalf of one or more of the seven companies in 2009 and 2010. Nearly all were physicians, but a handful of pharmacists, nurse practitioners and dietitians also made the list. Forty-three physicians made more than $200,000—including two who topped $300,000.

Physicians also received money from some of the 70-plus drug companies that have not disclosed their payments. Some of those interviewed could not recall all the companies that paid them, and certainly not how much they made. By 2013, the health care reform law requires all drug companies to report this information to the federal government, which will post it on the Web.

The busiest—and best compensated—doctors gave dozens of speeches a year, according to the data and interviews. The work can mean a significant salary boost—enough for the kids’ college tuition, a nicer home, a better vacation.

Among the top-paid speakers, some had impressive resumes, clearly demonstrating their expertise as researchers or specialists. But others did not –contrary to the standards the companies say they follow.

Forty five who earned in excess of $100,000 did not have board certification in any specialty, suggesting they had not completed advanced training and passed a comprehensive exam. Some of those doctors and others also lacked published research, academic appointments or leadership roles in professional societies.

Experts say the fact that some companies are disclosing their payments is merely a start. The disclosures do not fully explain what the doctors do for the money—and what the companies get in return.

In a raft of federal whistleblower lawsuits, former employees and the government contend that the firms have used fees as rewards for high-prescribing physicians. The companies have each paid hundreds of millions or more to settle the suits.

The disclosures also leave unanswered what impact these payments have on patients or the health care system as a whole. Are dinner talks prompting doctors to prescribe risky drugs when there are safer alternatives? Or are effective generics overlooked in favor of pricey brand-name drugs?

“The pressure is enormous. The investment in these drugs is massive,” said Dr. David A. Kessler, who formerly served as both FDA commissioner and dean of the University of California, San Francisco School of Medicine. “Are any of us surprised they’re trying to maximize their markets in almost any way they can?”

From drug reps to doc reps

For years, drug companies bombarded doctors with pens, rulers, sticky notes, even stuffed animals emblazoned with the names of the latest remedies for acid reflux, hypertension or erectile dysfunction. They wooed physicians with fancy dinners, resort vacations and personalized stethoscopes.

Concerns that this pharma-funded bounty amounted to bribery led the industry to ban most gifts voluntarily. Some hospitals and physicians also banned the gift-givers: the legions of drug sales reps who once freely roamed their halls.

So the industry has relied more heavily on the people trusted most by doctors—their peers. Today, tens of thousands of US physicians are paid to spread the word about pharma’s favored pills and to advise the companies about research and marketing.

Recruited and trained by the drug companies, the physicians—accompanied by drug reps—give talks to doctors over small dinners, lecture during hospital teaching sessions and chat over the Internet. They typically must adhere to company slides and talking points.

These presentations fill an educational gap, especially for geographically isolated primary care doctors charged with treating everything from lung conditions to migraines. For these doctors, poring over a stack of journal articles on the latest treatments may be unrealistic. A pharma-sponsored dinner may be their only exposure to new drugs that are safer and more effective.

Oklahoma pulmonologist James Seebass, for example, earned $218,800 from Glaxo in 2009 and 2010 for lecturing about respiratory diseases “in the boonies,” he said. On a recent trip, he said, he drove to “a little bar 40 miles from Odessa,” Texas, where physicians and nurse practitioners had come 50 to 60 miles to hear him.

Seebass, the former chair of internal medicine at Oklahoma State University College of Osteopathic Medicine, said such talks are “a calling,” and he is booking them for 2011.

The fees paid to speakers are fair compensation for their time away from their practices, and for travel and preparation as well as lecturing, the companies say.

Dr. Samuel Dagogo-Jack has a resume that would burnish any company’s sales force: He is chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center. Dagogo-Jack conducts research funded by the National Institutes of Health, has edited medical journals and continues to see patients.

While most people are going home to dinner with their families, he said, he is leaving to hop on a plane to bring news of fresh diabetes treatments to non-specialist physicians “in the trenches” who see the vast majority of cases.

Since 2009, Dagogo-Jack has been paid at least $257,000 by Glaxo, Lilly and Merck.

“If you actually prorate that by the hours put in, it is barely more than minimum wage,” he said. (A person earning the federal minimum wage of $7.25 would have to work 24 hours a day, seven days a week for more than four years to earn Dagogo-Jack’s fees.)

For the pharmaceutical companies, one effective speaker may not only teach dozens of physicians how to better recognize a condition, but sell them on a drug to treat it. The success of one drug can mean hundreds of millions in profits, or more. Last year, prescription drugs sales in the United States topped $300 billion, according to IMS Health, a healthcare information and consulting company.

Glaxo’s drug to treat enlarged prostates, Avodart—locked in a battle with a more popular competitor—is the topic of more lectures than any of the firm’s other drugs, a company spokeswoman said. Glaxo’s promotional push has helped quadruple Avodart’s revenue to $559 million in five years and double its market share, according to IMS.

Favored speakers like St. Louis pain doctor Anthony Guarino earn $1,500 to $2,000 for a local dinner talk to a group of physicians.

Guarino, who made $243,457 from Cephalon, Lilly and Johnson & Johnson since 2009, considers himself a valued communicator. A big part of his job, he said, is educating the generalists, family practitioners and internists about diseases like fibromyalgia, which causes chronic, widespread pain—and to let them know that Lilly has a drug to treat it.

“Somebody like myself may be able to give a better understanding of how to recognize it,” Guarino said. Then, he offers them a solution: “And by the way, there is a product that has an on-label indication for treating it.”

Guarino said he is worth the fees pharma pays him on top of his salary as director of a pain clinic affiliated with Washington University. Guarino likened his standing in the pharma industry to that of St. Louis Cardinals first baseman Albert Pujols, named baseball player of the decade last year by Sports Illustrated. Both earn what the market will bear, he said: “I know I get paid really well.”

Is anyone checking out there?

Simple searches of government websites turned up disciplinary actions against many pharma speakers in ProPublica’s database.

The Medical Board of California filed a public accusation against psychiatrist Karin Hastik in 2008 and placed her on five years’ probation in May for gross negligence in her care of a patient. A monitor must observe her practice.

Kentucky’s medical board placed Dr. Van Breeding on probation from 2005 to 2008. In a stipulation filed with the board, Breeding admits unethical and unprofessional conduct. Reviewing 23 patient records, a consultant found Breeding often that gave addictive pain killers without clear justification. He also voluntarily relinquished his Florida license.

New York’s medical board put Dr. Tulio Ortega on two years’ probation in 2008 after he pleaded no contest to falsifying records to show he had treated four patients when he had not. Louisiana’s medical board, acting on the New York discipline, also put him on probation this year.

Yet during 2009 and 2010, Hastik made $168,658 from Lilly, Glaxo and AstraZeneca. Ortega was paid $110,928 from Lilly and AstraZeneca. Breeding took in $37,497 from four of the firms. Hastik declined to comment, and Breeding and Ortega did not respond to messages.

Their disciplinary records raise questions about the companies’ vigilance.

“Did they not do background checks on these people? Why did they pick them?” said Lisa Bero, a pharmacy professor at University of California, San Francisco who has extensively studied conflicts of interest in medicine and research.

Disciplinary actions, Bero said, reflect on a physician’s credibility and willingness to cross ethical boundaries.

“If they did things in their background that are questionable, what about the information they’re giving me now?” she said.

ProPublica found sanctions ranging from relatively minor misdeeds such as failing to complete medical education courses to the negligent treatment of multiple patients. Some happened long ago; some are ongoing. The sanctioned doctors were paid anywhere from $100 to more than $140,000.

Several doctors were disciplined for misconduct involving drugs made by the companies that paid them to speak. In 2009, Michigan regulators accused one rheumatologist of forging a colleague’s name to get prescriptions for Viagra and Cialis. Last year, the doctor was paid $17,721 as a speaker for Pfizer, Viagra’s maker.

A California doctor who was paid $950 this year to speak for AstraZeneca was placed on five years’ probation by regulators in 2009 after having a breakdown, threatening suicide and spending time in a psychiatric hospital after police used a Taser on him. He said he’d been self-treating with samples of AstraZeneca’s anti-psychotic drug Seroquel, medical board records show.

Other paid speakers had been disciplined by their employers or warned by the federal government. At least 15 doctors lost staff privileges at various hospitals, including one New Jersey doctor who had been suspended twice for patient care lapses and inappropriate behavior. Other doctors received FDA warning letters for research misconduct such as failing to get informed consent from patients.

Pharma companies say they rely primarily on a federal database listing those whose behavior in some way disqualifies them from participating in Medicare. This database, however, is notoriously incomplete.

The industry’s primary trade group says its voluntary code of conduct is silent about what, if any, behavior should disqualify physician speakers.

“We look at it from the affirmative—things that would qualify physicians,” said Diane Bieri, general counsel and executive vice president of the Pharmaceutical Research and Manufacturers of America.

Some physicians with disciplinary records say their past misdeeds do not reflect on their ability to educate their peers.

Family medicine physician Jeffrey Unger was put on probation by California’s medical board in 1999 after he misdiagnosed a woman’s breast cancer for 2½ years. She received treatment too late to save her life. In 2000, the Nevada medical board revoked Unger’s license for not disclosing California’s action.

As a result, Unger said, he decided to slow down and start listening to his patients. Since then, he said, he has written more than 130 peer-reviewed articles and book chapters on diabetes, mental illness and pain management.

“I think I’ve more than accomplished what I’ve needed to make this all right,” he said. During 2009 and the first quarter of 2010, Lilly paid Unger $87,830. He said he also is a paid speaker for Novo Nordisk and Roche, two companies that have not disclosed payments.

The drug firms, Unger said, “apparently looked beyond the record.”

Companies make their own experts

Last summer, as drug giant Glaxo battled efforts to yank its blockbuster diabetes drug Avandia from the market, Nashville cardiologist Hal Roseman worked the front lines.

At an FDA hearing, he borrowed David Letterman’s shtick to deliver a “Top Five” list of reasons to keep the drug on the market despite evidence it caused heart problems. He faced off against a renowned Yale cardiologist and Avandia critic on the PBS NewsHour, arguing that the drug’s risks had been overblown.

“I still feel very convinced in the drug,” Roseman said with relaxed confidence. The FDA severely restricted access to the drug last month citing its risks.

Roseman is not a researcher with published peer-reviewed studies to his name. Nor is he on the staff of a top academic medical center or in a leadership role among his colleagues.

Roseman’s public profile comes from his work as one of Glaxo’s highest-paid speakers. In 2009 and 2010, he earned $223,250 from the firm—in addition to payouts from other companies.

Pharma companies often say their physician salesmen are chosen for their expertise. Glaxo, for example, said it selects “highly qualified experts in their field, well-respected by their peers and, in the case of speakers, good presenters.”

ProPublica found that some top speakers are experts mainly because the companies have deemed them such. Several acknowledge that they are regularly called upon because they are willing to speak when, where and how the companies need them to.

“It’s sort of like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.

“Nobody will have necessarily heard of you before—but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think, ‘This guy is important.’ It creates an opinion leader who wasn’t necessarily an expert before.”

To check the qualifications of top-paid doctors, reporters searched for medical research, academic appointments and professional society involvement. They also interviewed national leaders in the physicians’ specialties.

In numerous cases, little information turned up.

Las Vegas endocrinologist Firhaad Ismail, for example, is the top earner in the database, making $303,558, yet only his schooling and mostly 20-year-old research articles could be found. An online brochure for a presentation he gave earlier this month listed him as chief of endocrinology at a local hospital, but an official there said he hasn’t held that title since 2008.

And several leading pain experts said they’d never heard of Santa Monica pain doctor Gerald Sacks, who was paid $249,822 since 2009.

Neither physician returned multiple calls and letters.

A recently unsealed whistleblower lawsuit against Novartis, the nation’s sixth-largest drug maker by sales, alleges that many speakers were chosen “on their prescription potential rather than their true credentials.”

Speakers were used and paid as long as they kept their prescription levels up, even though “several speakers had difficulty with English,” according to the amended complaint filed this year in federal court in Philadelphia.

Some physicians were paid for speaking to one another, the lawsuit alleged. Several family practice doctors in Peoria, Ill., “had two programs every week at the same restaurant with the same group of physicians as the audience attendees.”

In September, Novartis agreed to pay the government $422.5 million to resolve civil and criminal allegations in this case and others. The company has said it fixed its practices and now complies with government rules.

Roseman, who has been a pharma speaker for about a decade, acknowledged that his expertise comes by way of the training provided by the companies that pay him. But he says that makes him the best prepared to speak about their products, which he prescribes for his own patients. Asked about Roseman’s credentials, a Glaxo spokeswoman said he is an “appropriate” speaker.

Getting paid to speak “doesn’t mean that your views have necessarily been tainted,” he said.

Plus pharma needs talent, Roseman said. Top-tier universities such as Harvard have begun banning their staffs from accepting pharma money for speaking, he said. “It irritates me that the debate over bias comes down to a litmus test of money,” Roseman said. “The amount of knowledge that I have is in some regards to be valued.”

ProPublica Director of Research Lisa Schwartz and researcher Nicholas Kusnetz contributed to this report.

Reclaiming power from those who abuse it often starts with telling the truth. And in "This Is How Authoritarians Get Defeated," MoJo's Monika Bauerlein unpacks six truths to remember during the homestretch of an election where democracy, truth, and decency are on the line.

Truth #1: The chaos is the point.

Truth #2: Team Reality is bigger than it seems.

Truth #3: Facebook owns this.

Truth #4: When we go to work, we're in the fight.

Truth #5: It's about minority rule.

Truth #6: The only thing that can save us is…us.

Please take a moment to see how all these truths add up, because what happens in the weeks and months ahead will reverberate for at least a generation and we better be prepared.

And if you think journalism like Mother Jones'—that calls it like it is, that will never acquiesce to power, that looks where others don't—can help guide us through this historic, high-stakes moment, and you're able to right now, please help us reach our $350,000 goal by October 31 with a donation today. It's all hands on deck for democracy.

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Reclaiming power from those who abuse it often starts with telling the truth. And in "This Is How Authoritarians Get Defeated," MoJo's Monika Bauerlein unpacks six truths to remember during the homestretch of an election where democracy, truth, and decency are on the line.

Truth #1: The chaos is the point.

Truth #2: Team Reality is bigger than it seems.

Truth #3: Facebook owns this.

Truth #4: When we go to work, we're in the fight.

Truth #5: It's about minority rule.

Truth #6: The only thing that can save us is…us.

Please take a moment to see how all these truths add up, because what happens in the weeks and months ahead will reverberate for at least a generation and we better be prepared.

And if you think journalism like Mother Jones'—that calls it like it is, that will never acquiesce to power, that looks where others don't—can help guide us through this historic, high-stakes moment, and you're able to right now, please help us reach our $350,000 goal by October 31 with a donation today. It's all hands on deck for democracy.

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Meet our New AmeriCorps Member, Katharine Burns

americorpslogo My name is Katharine Burns and I am an AmeriCorps State member serving at Elder Law in the 2013-2014 program year as the Foreclosure Prevention Manager.  In addition, I am also part of the Michigan  Foreclosure Prevention Corps (MFPC), which is comprised of 20 AmeriCorps members serving in 16 different sites around the state.  Our mission is to prevent  foreclosure through activities such as intake and follow-up with clients, outreach and education classes, and volunteer recruitment.  Last year alone, members of the  MFPC served 10,627 homeowners statewide through intake and triage, along with an additional 13,153 homeowners reached through outreach, mailings and presentations.

In my capacity as Foreclosure Prevention Manager, I will serve clients by attending and planning outreach events, coordinating mailings to homeowners, and educating clients on foreclosure prevention.  As an attorney, I will also be able to offer them legal information on foreclosure and other housing-related issues.  Overall I look forward to building relationships within Elder Law and other agencies, with the larger goal of keeping homeowners out of foreclosure whenever possible.

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(Mid-America Pension Rights Project): Stop ‘Dollar-Cost Ravaging’ Your Portfolio in Retirement

Via Kiplinger

By Jason Lambert

It’s been more than seven years since Wade Pfau, one of the top experts in retirement research, wrote a column for MarketWatch urging readers to “Say Goodbye to the 4% Rule.”

In it, Pfau suggests that the “rule” — which is more of a theory, really — made too many assumptions based on old numbers that didn’t necessarily translate to modern markets — or modern investors. A few months later, in 2013, Pfau and fellow retirement specialists Michael Finke and David Blanchett published their study, “The 4 Percent Rule is Not Safe in a Low-Yield World,” further demonstrating why advisers who base their clients’ withdrawal plans on historical data could be doing them a disservice.

Read the full article.


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Chapter 13: Carpal Tunnel Syndrome

Chapter 13: Carpal Tunnel Syndrome

Moving right along to carpal tunnel syndrome! Most people can say they’ve heard of carpal tunnel somehow at one point in their lives. I’m here to explain the anatomy, the causes, and the ways that OTs can help an individual with carpal tunnel.

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is an upper extremity disorder caused by compression to the median nerve (Walsh & Chee, 2018). The median nerve provides sensory information along the volar aspect (palm side) of the thumb, pointer, and middle fingers, in addition to the medial aspect of the ring finger. The median nerve runs through the carpal tunnel along with multiple tendons that are responsible for flexing the fingers.

CTS is caused when the median nerve becomes compressed due to swelling or a smaller carpal tunnel (Walsh & Chee, 2018). Repetitive or sustained activities in which the wrist is flexed, extended, or ulnar deviated (positioned toward the pinky side of the hand) for long periods of time may cause the compression. Activities or work that involves repetitive forceful gripping or pinching may also cause compression. Lastly, prolonged exposure to vibration, cold, or constriction over the wrists could contribute to the existence of CTS. Pregnancy, rheumatoid arthritis, and congestive heart failure may also be contributing conditions to CTS as increased inflammation exists throughout the body (Walsh & Chee, 2018).

What does carpal tunnel syndrome “look like”?

Individuals with CTS will often report pain/tingling upon waking at night within the median nerve distribution (volar aspect of thumb, pointer, and middle fingers, medial aspect of the ring finger) (Walsh & Chee, 2018). An individual may also report that they frequently drop items. Pain/tingly during repetitive activities that require wrist flexion, extension, or ulnar deviation may also be a sign of CTS.

There are two tests to quickly assess for CTS. Tinel’s test involves tapping along the pathway of the median nerve. If paresthesia (tingling) is felt during the test, there is a possibility that CTS is present. Phalen’s test involves placing the dorsum (top) of both hands together in an upside downish position (very scientific description right?) so that the fingers are pointing towards the floor. The wrists should be flexed in this position. The individual stays in this position for up to 60 seconds. The individual is asked to report if/when tingling is felt within that time frame. If paresthesia (tingling) is felt during the test, there is a possibility that CTS is present.

How do OTs help individuals with CTS?*

There are a few ways that OTs can help individuals with carpal tunnel. Depending on its severity and potential interference with successful completion of daily tasks, an orthosis could be fabricated to help position the wrist in a less stressful way. Nerve glides could be taught to the individual which is a way of giving the nerve space to move. Education regarding safe and stress-free positioning would also be emphasized to relieve symptoms.

If conservative treatment is ineffective, a carpal tunnel release could be performed by a surgeon. The OT would then have a significant role post-surgery to ensure optimal scar healing and to prevent further or repetitive complications. If the release was done in the right wrist, it would be highly beneficial for the individual to learn ways to prevent carpal tunnel from occurring in the left wrist.

I hope you learned something from today’s post! Stay tuned for more!

*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.

Walsh J.M. & Chee, N. (2018). Hand and upper extremity injuries. In H. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy practice skills for physical dysfunction (8th ed., pp. 972-1003). St. Louis, MO: Elsevier.

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