AD dementia affects over 55 million individuals worldwide and about 6.5 million Americans aged 65 and older. Approximately one-third of individuals with MCI progress to AD dementia within 5 years, while some may reverse to normal cognition. Mild cognitive impairment (MCI) is a clinical stage that falls between normal aging and dementia. A large underdiagnosis of the MCI and Alzheimer’s population still remains in clinical screening.Īlzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by a gradual and irreversible decline in cognitive function, accounting for 60% to 80% of dementia. The findings suggest that the ADAS-cog and MoCA are reliable tools for detecting AD and MCI, while the MMSE may be less sensitive in detecting these conditions. The estimated true prevalence of AD among individuals aged over 65 was 20.0%, and the estimated true prevalence of MCI due to AD was 24.8%. The ADAS-cog exhibited the highest sensitivity, closely followed by the MoCA and MMSE (0.869 vs 0.845 vs 0.757), and the ADAS-cog also had good specificity (0.835 vs 0.769 vs 0.721). For MCI detection, the ADAS-cog had the highest Youden's Index (0.704) compared to the MoCA (0.614) and MMSE (0.478). The ADAS-cog and MoCA showed similar sensitivity (0.922 vs 0.912) and specificity (0.907 vs 0.901), while the MMSE had lower sensitivity (0.874) and higher specificity (0.922). In detecting AD, the ADAS-cog had the highest Youden's Index (0.829), followed by the MoCA(0.813) and MMSE(0.796). Bayesian latent class models, accounting for conditional dependence between MoCA and MMSE, were conducted to assess the diagnostic accuracy of the three tests for detecting AD and MCI. MethodsĪ total of 1289 participants aged over 65 were included from the baseline visits of Alzheimer’s disease Neuroimaging Initiative. We aimed to accurately evaluate the discriminative ability of the three tests administrated at the same visit simultaneously in detecting AD and MCI due to AD in the absence of a gold standard. Neuropsychological testing, such as the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), is commonly used tests in identifying AD and MCI, offering convenience, affordability, non-invasiveness, and accessibility in clinical settings. In addition, the gold standard for diagnosing Mild Cognitive Impairment (MCI) remains unclear yet. ![]() These results should be viewed with some caution due to the use of the Cognistat as the gold standard.The neuropathological confirmation serves as the gold standard for diagnosing Alzheimer's disease (AD), but it is usually not available to the living individuals. ![]() The MMSE and the MoCA have relative strengths and weaknesses and neither emerged as a clearly superior tool however, the MoCA had a slightly better diagnostic accuracy than the MMSE. Intraclass correlation coefficients and kappa statistics were also calculated. ![]() ROC curves, sensitivity, specificity, positive and negative predictive values and positive likelihood ratios were analyzed. Age and side of stroke were abstracted in a chart review and patients were asked their level of education. A second Cognistat was administered by occupational therapists for the reliability sub-study. The MMSE and the MoCA were administered by occupational therapists and the Cognistat was administered by the student investigator. It was hypothesized that the MoCA is a superior screening instrument to the MMSE for the detection of cognitive impairment in stroke patients. This was a validation study of the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MoCA), using the Cognistat, as the criterion or ‘gold standard’. ![]() To identify the better of two commonly used screening tools for detecting probable cognitive impairment in stroke patients in a large regional rehabilitation hospital (ParkwoodHospital,London,Ontario).
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While the industry was down, the local economy saw an estimated loss of $900 million. From local employees on the dock to the array of locally sourced foods on the ships (including Darigold dairy products and wine from Eastern Washington) and the money passengers spend on shore before or after a cruise, Jones Stebbins said each ship visit translates into about $4.2 million for the local economy. The economic impact of the cruise industry is also an important factor in cruising’s impact on Seattle, which was made especially clear during the months-long pause. “It's actually possible and work is happening around the world right now to bring it to bear on both shipping and the cruise industry.” “I am excited to see that the technology is not science fiction any longer,” he said. And in May it announced its partnership with Juneau, Alaska the Port of Vancouver British Columbia and several cruise lines to potentially launch the world’s first green cruise corridor - a maritime route without greenhouse-gas emissions.Ĭalkins also referenced the broader effort around hydrogen-powered cruise ships, as well as ammonia and methanol fuels for ships, saying he would like to see these used in the near future for vessels docking in Seattle. In 2020 the port committed to phasing out emissions associated with seaport activities by 2050. ![]() In 2021, for example, 53 cruise ships docked at terminal 91, but only 30 actually used shore power. And not all cruise ships are equipped to use shore power. The addition is expected by 2024.īut Calkins estimated that ships are in port, plugged in, only about 4% of the time. Oaks would like to see changes such as preferential docking for companies with better environmental practices, refusing those cruise companies that repeatedly pollute and adding fees to cruising that could help fund restoration projects.Īsked how the port is responding to the environmental impacts of cruising, Calkins highlighted the fact that the port has been working toward adding electric shore power to Pier 66 (Terminal 91 already has it) so ships can turn off their diesel engines while docked. And the next step is starting to take real bold action as much as actually can be done legally on that journey.” But the first step is admitting that there's a problem. “We also know that that's a transition that would need to happen. “We do want to see a cruise-free Salish Sea,” she said. And so I think there was a missed opportunity there.”īetween greenhouse-gas emissions from each vessel and the flights passengers take into Seattle before and after cruises, Oaks believes removing the cruise industry could eliminate as much as one-third of Seattle’s carbon emissions. “And, unfortunately, when they came back, it was full celebration mode. “We had that opportunity to really rethink, is this what we want to be doing,” she said. Stacy Oaks, founding member of Seattle Cruise Control, a group working to end cruising in the Salish Sea, said that during the pause she had hoped local officials would drastically change how the area does cruising given its negative impacts on the environment. ![]() Meanwhile, concerns and protests have been raised over whether this return to business-as-usual for the cruise industry was less an accomplishment than a wasted opportunity. Carnival Cruise Line did not respond to a request for comment. While they’re anticipating that ships will keep their passenger numbers at about three-fourths capacity to help ward off the virus, the Port of Seattle expects to see 1.26 million passengers and 296 sailings this year – thousands more passengers and dozens more sailings than in 2019.īut, as Jones Stebbins put it, “there’s new challenges every day.” And the latest involved a COVID outbreak on a cruise ship that docked in Seattle last month. Whether because the public has confidence in the safety measures or simply is eager to get back to cruising after such a long wait, the port expects more passengers and ships than the pre-COVID 2019 season. Nine months later, the Puget Sound cruise industry started its 2022 season at its traditional time in the spring, with agreements among the Port of Seattle, cruise lines and local health departments detailing COVID protocols (which included having at least 95% of vaccine-eligible passengers and crew vaccinated and isolation and disembarkation procedures following a COVID outbreak). ![]() Your doctor may also prescribe physical therapy. Maintain proper blood glucose levels, and try exercises to strengthen the hand and keep it flexible, such as tossing a ball. Your doctor may also suggest splinting, over-the-counter medications, prescription medications, yoga, physical therapy, or surgery. Take frequent breaks, avoid activities that aggravate symptoms, and apply a cool pack. Other treatments depend on the cause of the circulation issue. Participate in an exercise program recommended by your doctor. Severe dehydration is a medical emergency, and you should go to the emergency room. ![]() You can also create your own rehydration drink with 1/2 teaspoon of salt, 6 teaspoons of sugar, and 1 liter of water. To treat dehydrationįor mild dehydration, drink water as well as a rehydration drink with electrolytes, such as Gatorade. If you experience stomach upset, try magnesium chelate, which is easier to digest. Take a magnesium (or magnesium and calcium) supplement. Increase magnesium intake by eating more leafy greens, legumes, and whole grains. Treatments may also be prescribed based on the reason for your symptoms. General home remedies for hand cramps include stretching, swimming, strength building exercises, increasing your fluid intake, and taking vitamin D supplements. If you have this condition, you may also experience: They are thought to be caused by imbalances in fluid and electrolytes, or by nerve damage or blood flow problems. Kidney disease can cause cramps, due to fluid and electrolyte imbalances, blood flow issues or nerve damage.Ĭramps - especially leg cramps - are common for those with kidney disease. Kidney disease, or renal disease, occurs when your kidneys can’t remove waste from your body well enough or keep your fluids balanced. Joint inflammation from rheumatoid arthritis is usually symmetrical, meaning that if one hand is affected, the other usually is as well. If you have RA, you may feel the cramps not just in your hands, but also in your feet, ankles, knees, wrists, and elbows. In time, the joints can lose their mobility. This autoimmune disease attacks the joints, causing inflammation that makes the joint tissue thicken. Rheumatoid arthritis (RA) can cause hand cramps, as well as cramping in other parts of the body. thick, waxy skin on the back of the hand.the inability to bring all fingers together.stiffness in the little finger that eventually extends to the thumb.Other symptoms of stiff hand syndrome include: The increase causes the skin to increase in collagen. Researchers believe that this condition may be caused by an increase of glycosylation, in which sugar molecules attach to protein molecules. People with both type 1 and type 2 diabetes can experience hand cramps from stiff hand syndrome. Stiff hand syndrome, also known as diabetic stiff hand syndrome and diabetic cheiroarthropathy, is a complication of diabetes in which thickening and waxiness of the hands begins to limit the movements of the fingers. Other types of repetitive strain injuries can also cause hand cramps, such as writer’s or musician’s cramp and sports related injuries. burning or tingling in the palm and fingers.If you have carpal tunnel syndrome you may experience hand cramps as well as the following symptoms: The compression can be caused by thickening or swelling of tendons that have become irritated. The nerve is inside the carpal tunnel, which comprises the flexor retinaculum, tendons, and the bone just below the hand. You may also experience the following symptoms:Ĭarpal tunnel syndrome occurs when the nerve that goes from the forearm to the palm is compressed. You may feel circulation issues in your hands, arms and legs. Circulation sends blood, nutrients, and oxygen through your body. Poor circulation happens when your body lacks sufficient blood flow. While dehydration is more likely to occur in hot temperatures, you can develop dehydration without proper water intake in cold temperatures as well. Dehydration affects the functioning of the muscles and causes them to cramp. Dehydration occurs when the body lacks enough water to properly function. If you don’t drink enough water, you may become dehydrated. If you’re low on magnesium, you may also experience some of the following symptoms: This mineral can aid in preventing muscle cramps, including hand cramps, as well as restless leg syndrome and eye twitches. ![]() Magnesium helps to maintain strong bones and relax muscles. Contact your doctor for more information. The following are only a few of the possible reasons for hand cramps. If you are able to determine the cause of your hand cramps, you’re more likely to be able to keep them from occurring in the future. ![]() Our budget is based directly off of these templates and we have used them for years in order to control our spending, show us were our money is going, and to give us timely information about the state of our finances. ![]() We have two basic templates that you can use to create your own budget. Below the video we also have links to a template that you can use to create your own budget. In the quick tutorial below you will see how we created our budget in Google Sheets and learn how to create your own. To complete our budget, we use Google Sheets. Work out a proposed household budget by inputting your sources of income and projected expenses into. ![]() To begin with, we break our expenses down into two basic sections, wants and needs.ĭepending on your situation, you may need to edit your needs and wants, but we break them down into the following categories:īy keeping each of these areas in our budget, we are able to track our spending and determine if we really need something or if we want it. A good budget helps you reach your spending and savings goals. To get more specific with our budget we need to examine our costs each month. Instructions: Click the link above to download the spreadsheet tool. Some items, like our mortgage, or fixed, but others change depending on the month. Download: MoneySense monthly budget Excel template. Our expenses, costs, are what change on a month to month basis. If your income is not as predictable, we would recommend that you update your budget often to better track your income and try to find an average monthly income. We know what we are going to earn each month, and we can plan very far in advance because of this. For us, we have two general areas that we use as our starting point, income and expenses. Once you have your general areas, you can begin to get more specific with each of the areas. When you are looking to start a budget you really want to break down your areas of concern as simply as possible. You will also find links to our budget and downloads if you prefer a different version. Below you will find resources to help you start your own budget along with a tutorial on how we setup our budget. weekly budget template 01 (87.22 KB) weekly budget template 02 (50.80 KB) weekly budget template 03 (53.80 KB) weekly budget template 04 (16.46 KB) weekly budget template 05 (72.00 KB) weekly budget template 06 (32.00 KB) weekly budget template 07 (51. With insert function you can easily manage calculations and find out the loopholes in your budget, if any. We use Google Sheets to help us keep our budget in order and with us at all times. Budget Templates on Excel sheets are easier to manage as the addition and deletion of categories like income, housing, living costs, bills, outings all and everything can be listed easily. Our budget is fluid, flexible, and works for us. ![]() Tencent was founded by Pony Ma, Zhang Zhidong, Xu Chenye, Charles Chen and Zeng Liqing in November 1998 as Tencent Inc, in the Cayman Islands. Please try to keep recent events in historical perspective and add more content related to non-recent events. This article appears to be slanted towards recent events. Tencent's valuation approached US$1 trillion in January 2021 before it plummeted. TechCrunch characterized Tencent's investment strategy as letting its portfolio startups operate autonomously. Tencent has stakes in over 600 companies, and began focusing on tech start-ups in Asia in 2017. In 2015, 2018, and 2020, the company was ranked by the Boston Consulting Group and Fast Company among the 50 most innovative companies worldwide. It has since then emerged as the most valuable publicly traded company in China, and is the world's tenth most valuable company by market value as of February 2022. The company surpassed a market value of US$500 billion in 2018, becoming the first Asian technology company to cross this valuation mark. It operates the instant messengers Tencent QQ and WeChat, and QQ.com. Its services include social networks, music, web portals, e-commerce, mobile games, internet services, payment systems, smartphones, and multiplayer online games. It is among the largest social media, venture capital, and investment corporations. Tencent is the world's largest video game vendor, as well as one of the most financially valuable companies. Its twin-skyscraper headquarters, Tencent Seafront Towers (also known as Tencent Binhai Mansion) are based in the Nanshan District of Shenzhen. įounded in 1998, its subsidiaries globally market various Internet-related services and products, including in entertainment, artificial intelligence, and other technology. It is also the world's largest company in the video game industry based on its equity investments, with Tencent Games being the subdivision of Tencent Interactive Entertainment Group (IEG) focused on publishing of games. It is one of the highest grossing multimedia companies in the world based on revenue. ![]() ( Chinese: 腾讯 pinyin: Téngxùn) is a Chinese multinational technology conglomerate and holding company headquartered in Shenzhen. ![]() Tang4 Seon3 Hung3 Gu2 Jau5 Haan6 Gung1 Si1 "Tencent" in Simplified (top) and Traditional (bottom) Chinese characters ![]() Hats, Glasses, Backpacks and Shoes that you bought don't appear in your toon if you didn't buy the Trunk first (even that it doesn't appear in you house). Golfing crashes the game when you use speedchat phrases during the game.įurniture Trunk arrives but doesn't appear in house. Kart Racing crashes the game when you use speedchat phrases during a race. Trolley Games crash the game when you use speedchat phrases during a game. Kart Racing Blizzard Bouvelard Practice/Toon Battle (also rev) freezes the game for 30 secconds. Kart Racing City Circuit Practice/Toon Battle (also rev) crashes the game. Thanks for this Super Update team loved it so much! Just reporting some issues here to help you identify the bugs and fix them on future releases! :)Ĭlothing Shop crashes the game when you start selecting the clothes. Having said that, we hope you all enjoy the Prologue update let us know what you think, and let us know of any issues you notice in-game! No guarantees it will work on Mac.Īlso, here's a quick video from earlier today going into more detail on the Prologue update, as well as the future of Toontown Offline: It's POSSIBLE it may work through Wine, but NOT tested. I haven't had access to a Mac to be able to get it working on Mac. Quick reminder: Windows only release at the moment. Inside the zip is a README explaining how to run the game once downloaded, please refer to said README, and let me know of any issues you may have otherwise. Toontown Rewritten - Storyline and base game source code.Forkrave - 3D modeling and music composition.Odie - 3D modeling and music composition.Rocky - Lead Creative Design and Developer.Retro Mode improvements, as well as a new "stretched screen" option (similar to TTO).Experimental "tank drive mode" (Use Ctrl+Tab to try it out).Began work on calendar page (again, not complete).Significant code cleanup and bug fixes.You can now obtain the Resistance Salute by visiting "Talking In Your Sleep Voice Training" in DDL!.Miniservers have been disabled for the time-being they will be returning soon!.DNA system overhaul we are now using libpandadna! This will make loading the game quicker, and also reduces the amount of TTR code being used.Prologue event use the Prologue button on your Pick-A-Toon screen!.Began implementation of Magic Word page still incomplete!.Implemented remaining party activities, and cleaned up party code.Implemented gardening (Leaking fountain, anybody?).Toontown Offline Prologue (cv.prologue) Release Notes: This not only brings some new content into the picture, but it also brings some enhancements, bug fixes, and even some more TTO content! So let's get right into the release notes: So yes, after over a year of no official Toontown Offline updates, we are back with a rather big update overall. Today, the Toontown Offline Team is proud to present the release of the Toontown Offline Prologue Update! Pinkermash, or JawhnL5, whatever you want to call me. Howdy there, toons! It is Sparky, or B.D. Just remember to update and clean them often to avoid cluttering the grid with unnecessary information. Do not feel self-conscious about it using them. In fact, the harder the Sudoku the more valuable and indispensable they become to find the final solution. On the contrary, it is an essential part of the puzzle to keep track of all the candidates and help with the process of elimination. Our Sudoku books are available in PDF format, ready for you to print and play off-screen. Taking notes is not considered cheating in Sudoku and it is not even a beginner’s trait. Explore our collection of free printable Sudoku puzzles and solutions in various difficulty levels (easy, hard, evil), formats (2, 4 or 6 per page), and themes (kids, large). Find out the missing numbers in it and then check your possibilities block by block by testing the missing digit against the information of the row and column where it is inserted. Since the easy level is the one where more hints are given right from the beginning, the best way to start is by focusing on the columns, row or group with the most digits allocated and find out which ones are missing.įor the next step, you can focus your attention on a specific group at a time. The object of Sudoku is to fill in the empty spaces of a 9x9 grid with numbers 1-9 in such a manner that every row, every column and every 3x3 box contains all numbers 1 through 9. The basic rule of Sudoku is that numbers can only appear once per row, column, and group. Printable Sudoku Puzzles (Deluxe Version) Generate unlimited free Sudoku puzzles with varying degrees of difficulty Sudoku is a great activity to sharpen the mind. Finding the solution for an easy puzzle requires only attention, logic and basic knowledge of the mechanics of the game. Based on these, you must fill the remaining blank cells on the grid with numbers from 1 to 9, paying attention not to repeat the same digit in each column, row or group. The easy level is the variety that starts with the most allocated digits. The levels of difficulty in Sudoku depend on the number of filled cells allocated at the beginning of each game. ![]() Seasoned players looking for a quick and straightforward challenge to clean their minds or just pass time will also be able to enjoy this mode. Easy Sudoku puzzles are perfect for beginners and kids to get acquainted with the rules and the principles of the game. Requiring receipts for all listed expenses on a report is essential to minimize errors and facilitate tax filing and audits for businesses. Maintaining these reports is crucial for budgeting and tax purposes. This report includes details about each expense and acts as an organized record for reimbursement or accounting purposes.Īn expense report can be used in various scenarios, such as tracking mileage and gas expenses during work-related travel, documenting client meetings that involve meals or entertainment, or recording office supply purchases made by employees. Getting started with the Smartsheet APIĪn expense report is a document used to track business-related expenses, such as transportation, food, lodging, and conference fees.ENGAGE Smartsheet ENGAGE brings together our global customers, experts, and partners to share their experiences, ideas, and best practices.Smartsheet events Your hub for Smartsheet events, webinars, Q&As, and user groups.Partners Learn about the Smartsheet partner program and access our partner directory.Community Explore user-generated content and stay updated on our latest product features.Help and Learning A comprehensive knowledge base, including articles, tutorials, videos, and other resources that cover a range of topics related to using Smartsheet. ![]() ![]() ![]() Content Center Articles and guides about project management, collaboration, automation, and other topics to help you make the most of the Smartsheet platform. ![]() Sometimes having clarity about your emotions allows you to accept them for what they are and is sufficient enough for you to move forward. Read about a study using the EMOTIONS COLOR WHEEL to improve emotion recognition deficits and social functioning levels in inpatients with paranoid schizophrenia. The circle is divided into colors to show some basic emotions. This can mean changing your routine, doing activities that boost your mood, talking to a friend about what’s been going on, or writing in your journal about it. The Emotion Color Wheel can help visually group feelings. And how you experience specific emotions depends on your. Secondary emotions may: Follow a primary emotion. Or, you may experience secondary emotions. You may experience a combination of emotions at the same time. Take action: Once you’ve identified the reasons for how you’re feeling, you can take action to manage your reaction to them and deal with the triggers. Emotions charts can help you untangle more complex feelings. ![]() You may be feeling lonely and isolated and craving some social interaction. However, it’s been months since you’ve seen your friends. For instance, maybe you’re feeling sad but nothing sad happened that day. ![]() The inner circle is solid white with a grey title that reads Emotion Color Wheel. Spend some time reflecting on your day, past week, month, or even year. The Emotion Color Wheel consists of two layers of rings. When people are emotionally heightened, it’s often not due to a single event but a series of experiences. Reflect on why you’re feeling this way: The next step is to dig a little deeper to discover potential causes for these feelings.Giving words to those feelings can help you feel more in control of them. Look at the wheel and go through the list of emotions to find one or more that describes that feeling. Name your emotion: Maybe you had a bad day at work. There was no due process, no warning, nothing. ![]() ![]() Jotform is a legit site, not even close to dubious like some others where you can actually argue that they might have been knowingly violating copyright and such. They shot first and asked questions later. What the real issue here is, is that law enforcement pretty much busted in and took down a domain name without warning. I doubt many if any registrars would refuse the government like that. GoDaddy sucking is besides the point here. Just imagine if this had been a takedown of Google, Microsoft, Apple or Facebook site, all of which easily meet or have met the conditions for alleged infringements of US IP or other laws at some point, if for no other reason than hosting user-generated content. In particular, to be able to shutdown or ruin the reputation of a business at the drop of a hat due to alleged breaking of the law - not even by the business itself - before it has even been processed by the justice system! The blame obviously lies squarely with the US federal agencies - you do not see this happen in other developed countries, for example (UK does not count since its a US colony in all but name). I wouldn't even say you are beating a dead horse with that dependency. How can anyone who has ever used the Internet or has even a basic understanding of the Domain Name System believe that it is a registrar's right or responsibility to take down a domain, especially without notice, and that does nothing to contravene the conditions of owning that domain name? Ha! How about destroying them? That's what it looks like to me.īenologist please stop trying to make it sound as if there is any dependency between your 1 and 2. Then the politicians want to go around talking about creating jobs. It's so sickening that the government probably just hurt not one but maybe thousands of companies in one fell swoop and everyone's pissed at the wrong guy. If they only knew how totally arbitrary this stuff is I think they'd be mad at the Feds like they should be. SOPA's supporters have done a really great job of training regular folks to think like some of these angry users making them think that somehow it was Jotform that did wrong. Instead of being mad at Jotform they should be mad at the government.Ī while back I was advocating that we reach out to such people and explain this SOPA censorship stuff in a way they understand and this is precisely why. ![]() I really feel for the users but at the same time I'm angry at them for placing the blame where it doesn't belong. What really struck me was that they seemed to be angry at Jorform! These angry users are talking about security too as if they were attacked or something. |
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