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The diagnosis of gout is confirmed by the identification of MSU crystals under polarizing microscopy in synovial fluid aspirated from a joint or bursa or in material aspirated from a tophus. While not intended for use in making diagnoses, the 2015 American College of Rheumatology (ACR) - European League Against Rheumatism classification criteria for gout highlight some of the key factors to consider when evaluating an individual for the possibility of gout. 16, 17 Classification criteria are intended for use in research to identify individuals for enrollment into clinical studies, and therefore do not necessarily cover the full spectrum of the disease. MANAGEMENT OF GOUT IN CKD The management of gout follows the same four principles regardless of the presence of CKD: 1) lower SUA (i. . manage the hyperuricemia); 2) provide prophylaxis while initiating ULT; 3) treat gout flares; and 4) optimize dietary and lifestyle factors as appropriate. Over a prolonged period of time with adequate management of hyperuricemia, defined as maintenance of a SUA level Management of Hyperuricemia Hyperuricemia is a necessary, though not sufficient, cause of gout since there are many more individuals with hyperuricemia than with clinically evident gout. Nonetheless, the mainstay and primary focus of gout therapy is to lower elevated SUA to achieve the clinical outcomes that matter to patients: cessation and prevention of flares, resolution and prevention of tophi, and control of inflammatory arthritis for those with chronic gouty arthritis. In 2012, the ACR published guidelines for the management of gout. 18, 19 New in these guidelines was the recommendation to initiate ULT with the first flare of gout in patients with CKD stage 2 and worse. 18 The rationale for this new ULT indication is that these patients often have limited options for gout flare management. By initiating ULT earlier, the aim is to avoid the need to treat subsequent gout flares with potentially nephrotoxic or contraindicated agents. In addition imaging evidence of tophi is a new indication for ULT. Non-pharmacological approaches can be recommended to all gout patients as adjunctive measures; these include weight loss and avoiding excess intake of purine-rich foods, alcoholic beverages and fructose-rich beverages. At lower GFR levels, uricosuric agents may not be efficacious; accordingly agents with other mechanisms of action need to be used.

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The artifice of the film is, in part, an homage to the film to which it acts as a sequel, as the original The Cabinet of Dr. Caligari was also made up largely of painted flats and odd camera angles. The plot doesn’t really matter; just watch it for the weirdness. TRIGGER ALERT: If your idea of an odd movie is Edward Scissorhands, you should probably avoid Dr. Caligari. 44. Frankenstein Must Be Destroyed (1969) (Blu-ray) - The fifth in Hammer’s Frankenstein series is probably my favorite of the bunch. Peter Cushing as Baron Frankenstein is up to his old tricks again, except that he seems to be getting more and more ruthless in trying to achieve his goals. This time around, he’s working on brain transplants, which is a logical progression from the previous film, Frankenstein Created Woman. At least this time he’s not creating gender dysphoria with his experiments. The film's first sequence is a stand-out, as is the one involving a burst water main. 45. Frankenstein's Daughter (1958) (DVD) - Okay, let’s get this out of the way: even though one character calls another character “Frankenstein’s daughter,” the Frankenstein character in the film is actually the original Dr. Frankenstein’s grandson, and he has no actual daughter. Instead, we get a lower-budgeted take on I Was a Teenage Frankenstein and I Was a Teenage Werewolf, combining aspects of both into a totally forgettable film.

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In discussing the cognitive inadequacies by which ideology is defined for them, Sutton et al. The ideological picture uses sharp lines and contrasti ng blacks and whites. The ideologist ex aggerates and caricatures in the fashion of the cartoonist. In contrast, a sci entific description of social phenomena is likely to be fuzzy and i nd istinct. But mi,- ed verd icts are not the stu ff of ideology. Ideology must categori ze the Act as a whole with a symbol to rally workers. More exactly, it appears to be a metaphor or at least an attempted metaphor. When it works, a metaphor transforms a false iden tifi cation (for example, of the labor policies of the Republican Party and of those of the Bolshev iks) into an apt analogy; when it misfires, it is a mere extravagance. The semantic tension between the image of a conservative Congress outlawing the closed shop and of the prison camps of Siberia was-apparently-too great to be resolved into a single conception, at least by means of so rudimentary a stylistic device as the slogan. Except (perhaps) for a few enthusiasts, the analogy did not appear; the false identification remained false. But fail ure is not inevitable, even on such an elementary level. More important, however, than any assessment of the adequacy of the two tropes as such is the fact that, as the mean ings they attempt to spark against one another are after all socially rooted, the success or failure of the attempt is relative not only to the power of the stylistic mechanisms employed but also to precisely those sorts of factors upon which strain theory concentrates its attention. It is thus not truth that varies with social, psychological, and cultural contexts but the symbols we construct in our unequally effective atte mpts to grasp it. War is hell and not the mother of culture, as the Japanese eventually discovered -although no doubt they express the fact in a grander idiom. The sociology of knowledge ought to be called the sociology of mean ing, for what is socially determined is not the nature of conception but the vehicles of conception.

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Hell, Janos didn't get punished at all for hiding with Gilly, and that was worse. Jon later killed him simply for disobeying an order even with him changing his mind and saying he'd do it. She judged Tyrion guilty without any real evidence. Tyrion saved her life when he could have taken off on a horse, but she was still determined to have him killed. Cat killed a girl simply because she was married to Walder Frey. Cat betrays Robb and releases Jaime, which weakens their position in the war, but she gets a light slap on the wrist. Yeah, what Rickard did was worse, but he got the the full punishment while Cat got a light slap on the wrist. In our world Jaime looks bad, but he doesn't look as bad in the GoT world. If you want to look at him in a harsh light, then shine that same harsh light on everyone, and not conveniently pick and choose. A serial killer killing innocents and a person killing attackers of his family can all be called equal if we strip away context. The Night's Watchmen Ned murdered wasn't attacking his family, Janos wasn't attacking anyone, Walder's wife wasn't attacking anyone, and Tyrion wasn't attacking anyone and even saved Cat's life. Ned and Jamie have no business being compared due to outcome of actions stripped of context. Jon may seem to be a little naive at times but it's often because he is put in the situation where he has no choice but to trust people. He threw his weight around,but in the end they just fucked him up,and never did anything he told them to do anymore. Cersei didnt marry Loras,and Tyrion didnt consummate his marriage to Sansa.

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Today's show features author and entrepreneur Jenn Aubert. Her first book Women Entrepreneur Revolution: Ready. Launch! (Balboa Press, 2014) explores the mindset, motivation and behaviors of successful female entrepreneurs and the role models in their lives who have influenced them. She is also the Co-founder and CEO of LearnSavvy, an online education marketplace and community for women business owners. Personally, she adores inspirational quotes, all things French (yes, that does include wine), Deepak Chopra and a comfy pair of ballet flats. She has recently relocated to Portland, OR with her husband and adorable son and is spending her free time exploring everything this new city has to offer. As I was painting this afternoon, I was listening to your latest podcast and I would love to see some mini video offerings Kimberly. I always look forward to watching your videos and come back to them too. Great guest also and very timely as I'm reading Sweet Poison currently. Take care. I remember coming to your first retreat at the cabin after telling you I wanted to meet Louis and he was one of the reasons I came. I had my car door open as I was talking to you and didn’t notice Louis had jumped in and shut the door. You started looking for him and the next thing we see is his sweet face looking out the driver’s side window at us. Recorded live at Mississippi Studios, in Portland, OR.

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Season 6 is over and we had a great time over the last year; this reasonably rambly and emotive mini-episode is all about what has been going on in the last year with me, the show, and other TCG related business. I talk about being burned out at the start of the year; the crazy recording schedule over the summer; moving out of our home; and the future including TCGTV stuff. Its a bit long but it says everything I need to say and answers a Lot of the questions you have been asking. I have an amazing life because of you and I don't say that enough. I can wait to make more amazing thing with these awesome people and share it with you! On this episode of Those Conspiracy Guys we talk about a olde timey disappearance of a diplomat deep in the countryside of Austria; who by all accounts vanished into thin air. Benjamin Bathurst, the son of a Bishop and Diplomat, was sent on a mysterious envoy to Austria during the Napoleonic war and while leaving a pub, maybe a bit worse for wear, he spontaneously popped out of existence. Some say it was murder, some say espionage; well Im joined by comedian Peter Flanagan to discuss the evidence and see if we can't solve this thing. On this episode of Those Conspiracy Guys we head down south to the land of the pines, to where the seemingly inarguable facets of human decency don't seem to exist and where an historically hated, morally outdated and powerfully overrated set of white guys wilfully discriminate against anyone who isn't them, we are talking about the Ku Klux Klan. From the mis 19th Century the Klan have been active and after the emancipation proclamation freed the black slaves in the US, these post civil war contrarians have fought to keep America white and keep other races, ethnicities and religions subjugated either by intimidation or by infiltrating the houses of politics and law. With new cinema being used as a Propaganda tool in the early 20th century, a second resurgance of The Klan emerged after the first wave was destroyed by political unification and social reform. This second wave were more emboldened and took actions and made an impact so much so that this is the typical image we think of today when we say KKK. With WW2 unifying the US further and African Americans fighting not only for their country but for their rights as citizens; The KKK made their third and most violent resurgence. It was created in antithesis to the Civil rights movement and powerful figures, predominantly in the South, used it to take advantage of localised prejudice. Coming from the millions of members in the 20s to just the hundreds of thousands in the 50s and 60s the Klan influence on modern culture has shone a light on the still existing bigotry in the US social structure.

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Hense’s brightly-colored mural is going up on a building that is currently empty but was occupied by the Lewis H. Cottongim Seed Company from the 1930s to the 1980s. Hammond hopes Elevate brings people to the area who may not have visited before, showing them a piece of Atlanta that could someday soon become a new and exciting arts district. If you are Three Quarter Ale, you throw a convention and festival for musicians, performers and fans of history-inspired musical theater and performance art. The three-day AleCon is this weekend (Aug 10-12) at Fabrefaction Theatre Company in Midtown and features performances not just by Three Quarter Ale but a host of other Ren bands and performance artists presenting magic to bellydancing. Other activities include panels on a variety of theatre, music and even film topics from stage combat and Irish dance to prop-building and financing art projects, as well as Killer Karaoke and daily costume contests. How did you guys get the idea for AleCon and what inspired you to go all out. We are all three actors and dancers as well as musicians, so paying tribute to all the various crafts in which we participate seemed like the thing to do. We are so much more than just a band, and we are THRILLED to be able to do something huge to celebrate out 10th anniversary. Was it challenging or more a matter of ask and they will come. Then we got on the horn and started talking to the many talented people we know. But being so talented, many of them were already booked. WONDERFUL for them, but it meant another round of “who would we like to hear speak or perform? and more phone calls. On the other hand, we did have some folks who heard about what we were planning and approached us to ask if there was a way they could get in on it.

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Clearly, inconsistencies in design theory accompany those of industry commitment to the rooms themselves. You need specs There are two obvious reasons for this state of affairs -and a third less obvious reason which casts its shadow over the concept of acoustic specifications in general. The first reason is that the overwhelming majority of people who watch television listen on equipment with poor sound reproduction. And while it is true that a growing number of people now own 'hi -ff video systems, the percentage is still small. The second reason is that the human visual sense is so dominant that when hearing and seeing at the same time, sensory emphasis is on visual material. The third and last reason has held back television sound for some time. Most people consider high quality TV sound worthwhile, however, few enough consumers buy hi -fi TV systems to make the financiers of the TV manufacturing industry consider improving the system as a matter of urgency. It is this which leads to the third point: who of these is in control. There are TV visionaries (no pun intended) who look to a future of 'more hi -fi television', and commit themselves now to the installation of sound studios of the first order. Their companies will be the first to be able to take advantage of the new boom. Acousticians, technicians and musicians may also consider them visionaries come what OUT OF CONTROL. Philip Newell's design for the control room at Front Row Studios in London may, but if the boom does not materialise, then their accountants, chairpersons, bank managers and lawyers may not be so enthusiastic. This third important point is that the power in the television world often lies quite apart from pro -audio people. TV studios cost a truly enormous amount of money to set up, and when such projects are undertaken, no one person usually has the cash in their pockets. Almost without exception there is an involvement with banks, institutions or shareholders who are considering the venture in purely financial terms.

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