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Living in a Violent Neighborhood Is as Likely to Give You PTSD as Going to War

Mother Jones

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This story originally appeared on ProPublica.

Chicago’s Cook County Hospital has one of the busiest trauma centers in the nation, treating about 2,000 patients a year for gunshots, stabbings and other violent injuries.

So when researchers started screening patients there for post-traumatic stress disorder in 2011, they assumed they would find cases.

Is PTSD Contagious?
Read Mac McClelland’s feature story on the epidemic in military families.

They just didn’t know how many: Fully 43 percent of the patients they examined–and more than half of gunshot-wound victims–had signs of PTSD.

“We knew these people were going to have PTSD symptoms,” said Kimberly Joseph, a trauma surgeon at the hospital. “We didn’t know it was going to be as extensive.”

What the work showed, Joseph said, is, “This is a much more urgent problem than you think.”

Joseph proposed spending about $200,000 a year to add staffers to screen all at-risk patients for PTSD and connect them with treatment. The taxpayer-subsidized hospital has an annual budget of roughly $450 million. But Joseph said hospital administrators turned her down and suggested she look for outside funding.

“Right now, we don’t have institutional support,” said Joseph, who is now applying for outside grants.

A hospital spokeswoman would not comment on why the hospital decided not to pay for regular screening. The hospital is part of a pilot program with other area hospitals to help “pediatrics patients identified with PTSD,” said the spokeswoman, Marisa Kollias.”The Cook County Health and Hospitals System is committed to treating all patients with high quality care.”

Right now, social workers try to identify patients with the most severe PTSD symptoms, said Carol Reese, the trauma center’s violence prevention coordinator and an Episcopal priest.

“I’m not going to tell you we have everything we need in place right now, because we don’t,” Reese said. “We have a chaplain and a social worker and a couple of social work interns trying to see 5,000 people. We’re not staffed to do it.”

A growing body of research shows that Americans with traumatic injuries develop PTSD at rates comparable to veterans of war. Just like veterans, civilians can suffer flashbacks, nightmares, paranoia, and social withdrawal. While the United States has been slow to provide adequate treatment to troops affected by post-traumatic stress, the military has made substantial progress in recent years. It now regularly screens for PTSD, works to fight the stigma associated with mental health treatment and educates military families about potential symptoms.

Few similar efforts exist for civilian trauma victims. Americans wounded in their own neighborhoods are not getting treatment for PTSD. They’re not even getting diagnosed.

Studies show that, overall, about 8 percent of Americans suffer from PTSD at some point in their lives. But the rates appear to be much higher in communities–such as poor, largely African-American pockets of Detroit, Atlanta, Chicago and Philadelphia–where high rates of violent crime have persisted despite a national decline.

Researchers in Atlanta interviewed more than 8,000 inner-city residents and found that about two-thirds said they had been violently attacked and that half knew someone who had been murdered. At least 1 in 3 of those interviewed experienced symptoms consistent with PTSD at some point in their lives–and that’s a “conservative estimate,” said Dr. Kerry Ressler, the lead investigator on the project.

“The rates of PTSD we see are as high or higher than Iraq, Afghanistan or Vietnam veterans,” Ressler said. “We have a whole population who is traumatized.”

Post-traumatic stress can be a serious burden: It can take a toll on relationships and parenting, lead to family conflict and interfere with jobs. A national study of patients with traumatic injuries found that those who developed post-traumatic stress were less likely to have returned to work a year after their injuries.

It may also have a broader social cost. “Neglect of civilian PTSD as a public health concern may be compromising public safety,” Ressler and his co-authors concluded in a 2012 paper.

For most people, untreated PTSD will not lead to violence. But “there’s a subgroup of people who are at risk, in the wrong place, at the wrong time, of reacting in a violent way or an aggressive way, that they might not have if they had had their PTSD treated,” Ressler said.

Research on military veterans has found that the symptom of “chronic hyperarousal”–the distorted sense of always being under extreme threat–can lead to increased aggression and violent behavior.

“Very minor threats can be experienced, by what the signals in your body tell you, as, ‘You’re in acute danger,'” said Sandra Bloom, a psychiatrist and former president of the International Society for Traumatic Stress Studies.

Another issue, wrote researchers at Drexel University, is that people with symptoms of PTSD may be more likely to carry a weapon in order to “restore feelings of safety.”

Hospital trauma centers, which work on the front lines of neighborhood violence, could help address the lack of treatment. Indeed, the American College of Surgeons, which sets standards for the care of patients with traumatic injuries, is set to recommend that trauma centers”evaluate, support and treat” patients for post-traumatic stress.

But it’s not a requirement, and few hospitals appear to be doing it.

ProPublica surveyed a top-level trauma center in each of the 22 cities with the nation’s highest homicide rates. Just one, the Spirit of Charity Trauma Center in New Orleans, currently screens all seriously injured patients for PTSD. At another, Detroit Receiving Hospital, psychologists talk with injured crime victims about PTSD.

Other hospitals have a patchwork of resources or none at all. At two hospitals, in Birmingham, Alabama and St. Louis, Missouri, trauma center staff said they hope to institute routine PTSD screening by the end of the year.

Doctors in Baltimore, Newark, Memphis, and Jackson, Miss., said they wanted to do more to address PTSD, but they do not have the money.

They said adding even small amounts to hospital budgets is a hard sell in a tough economic climate. That’s especially true at often-cash-strapped public hospitals.

In order to add a staff member to screen and follow up on PTSD, “Do I lay someone else off in another area?” asked Carnell Cooper, a trauma surgeon at Maryland Shock Trauma in Baltimore.

Many public hospitals rely on state Medicaid programs to cover treatment of low-income patients. But several surgeons across the country said they did not know of any way they could bill Medicaid for screenings.

The federal government often provides guidance to state Medicaid programs on best practices for patient care and how to fund them. But a spokeswoman for the Centers for Medicare and Medicaid Services said the agency has given states no guidance on whether or how hospitals could be reimbursed for PTSD screenings.

Hospitals are often unwilling to foot the bill themselves.

Trauma surgeons and their staffs expressed frustration that they know PTSD is having a serious impact on their patients, but they can’t find a way to pay for the help they need.

“We don’t recognize that people have PTSD. We don’t recognize that they’re not doing their job as well, that they’re not doing as well in school, that they’re getting irritable at home with their families,” said John Porter, a trauma surgeon in Jackson, Miss., which has a per-capita homicide rate higher than Chicago’s.

“When you think about it, if someone gets shot, and I save their life, and they can’t go out and function, did I technically save their life? Probably not.”

When RAND Corp. researchers began interviewing violently injured young men in Los Angeles in the late 1990s, they faced some skepticism that the men, often connected to gangs, would be susceptible to PTSD.

“We had people tell us that we’d see a lot of people who were gang-bangers, and they wouldn’t develop PTSD, because they were already hardened to that kind of life,” said Grant Marshall, a behavioral scientist who studied patients at a Los Angeles trauma center. “We didn’t find that to be the case at all. People in gangs were just as likely as anyone else to develop PTSD.”

In fact, trauma appears to have a cumulative effect. Young men with violent injuries may be more likely to develop symptoms if they have been attacked before.

The Los Angeles study found that 27 percent of the men interviewed three months after they were injured had symptoms consistent with PTSD.

“Most people still think that all the people who get shot were doing something they didn’t need to be doing,” said Porter, the trauma surgeon from Jackson, Miss. “I’m not saying it’s the racist thing, but everybody thinks it’s a young black men’s disease: They get shot, they’re out selling drugs. We’re not going to spend more time on them.”

While post-traumatic stress often does not show up until several months after an injury, experts say many trauma centers are missing the chance to evaluate patients early for risk of PTSD and to use clinical follow-ups–when patients come back to have their physical wounds examined–to check if patients are developing symptoms.

Doctors say hospitals are unlikely to make significant progress until the American College of Surgeons makes systematic PTSD screening a requirement for all top-level trauma centers.

An ACS requirement would be “a much better hammer to show the administration,” said Michael Foreman, chief of trauma surgery at Baylor University Medical Center in Dallas. Baylor, one of the few trauma centers to have a full-time psychologist on staff, surveyed 200 patients and found that roughly a quarter experienced post-traumatic stress. But Foreman said the center would not systematically screen all its patients until the ACS mandates it.

It’s not clear when that will happen. The organization’s recognition of PTSD screening as a recommended practice is a first step. Those new guidelines will be released in March 2014, according to Chris Cribari, who chairs the subcommittee that evaluates whether hospitals are meeting ACS standards. Cribari declined to say when PTSD screening might become a requirement. He said the timing will depend on what hurdles hospitals encounter–such as patient privacy–when some of them start screenings.

Cribari acknowledged that at some hospitals, “unless it’s a regulation, they’re not going to spend the money on it.”

At minimum, experts say, hospitals should provide all trauma patients with basic education about post-traumatic stress.

“The number one thing we do,” is simply “tell everybody in the trauma center about PTSD,” said John Nanney, a Department of Veterans Affairs researcher who developed a program for violently injured patients at the Spirit of Charity in New Orleans.

Without education about symptoms, patients who have flashbacks or constant nightmares may have “these catastrophic beliefs” about what is happening to them, Nanney said. “Just say, ‘This is something you might notice. If you do notice it, it doesn’t mean you’re going crazy. It doesn’t mean you’re weak. This is something that happens—don’t freak out.'”

The city of Philadelphia has begun to focus on trauma as a major public health issue. Philadelphia is working with local mental health providers to screen for PTSD more systematically–and to focus on post-traumatic stress as part of drug and alcohol treatment. The city has also paid to train local therapists in prolonged exposure, a proven treatment for PTSD– the same kind of training the US Department of Veterans Affairs has paid for its therapists to receive.

For violently injured Philadelphia residents, there’s also Drexel University’s Healing Hurt People, a program that’s become a national model for addressing trauma and PTSD.

Healing Hurt People reaches out to violently injured adults and children at two local hospitals and offers them intensive services. The program accepts a broad range of patients — from high-schoolers to siblings of young men who have been shot to former drug dealers. (One of Healing Hurt People’s clients talked about his post-traumatic stress in 2013 on This American Life.)

The program’s social workers screen all clients for PTSD symptoms and host discussions in which clients can share their experiences with one another. It’s a way of fighting stigma around mental-health symptoms. Instead of thinking that they’re going crazy, the conversations help them realize, “OK, this is normal,” as one client put it.

One of the program’s central goals is to discourage victims of crimes from retaliating against their attackers and to help them focus on staying safe and rebuilding their own lives.

The program’s therapists and social workers remind clients that the aftereffects of trauma may make them overreact and help them plan how to identify and avoid events that might trigger them. In one discussion last fall, a therapist sketched a cliff on a whiteboard, with a stick man on the top, close to the edge. The question: How do you recognize when you’re getting close to the cliff edge—and learn to walk away?

“Our thing is education,” social worker Tony Thompson said. The more clients “understand what’s going on in their body and their mind, the more prepared they are to deal with it.”

Intensive casework like this has shown good results, but it’s not cheap. Healing Hurt People is relatively small: Its programs served 129 new clients in 2013 and offered briefer education or assistance to a few hundred more. Its annual budget in 2013 was roughly $300,000, not including the cost of the office space that Drexel donates to the program.

Other researchers have been working to develop quicker, more modest interventions for PTSD, including some that use laptops and smartphones—programs that could easily be extended to more patients and still have some positive effect.

Whatever the approach, there “is untapped potential,” said Joseph, the surgeon at Chicago’s Cook County Hospital. Healing Hurt People is a model for what she wants to create. “These are kids, for the most part. When a 17-year-old kid crashes their parents’ car, and they were drinking, we don’t say, ‘Oh, that kid’s hopeless, let’s just give up on them.'”

“We’ve certainly had decades of trying to apply political solutions and social solutions to our inner cities’ financial problems and violence problem, and they haven’t been successful,” said Ressler, the Atlanta researcher. “If we could do a better job of identification, intervention and treatment, I think there would be less violence, and people would have an easier time doing well in school, getting a job.”

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Living in a Violent Neighborhood Is as Likely to Give You PTSD as Going to War

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Train in India Hits Elephants Crossing Track

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Codex: Inquisition (eBook Edition) – Games Workshop

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Train in India Hits Elephants Crossing Track

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Anthony Kennedy Denounces Anthony Kennedy’s Supreme Court Jurisprudence

Mother Jones

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Justice Anthony Kennedy thinks our political system should solve more problems on its own, instead of turning to the courts to solve them. Jonathan Adler is unimpressed:

In most cases, the Supreme Court intervenes not to help the democratic process to function, but rather to alter the way in which these questions have been resolved. Moreover, Justice Kennedy is more prone to support such intervention than most of his colleagues, having voted to invalidate DOMA, Section 4 of the Voting Rights Act, McCain-Feingold, the PPACA, the Stolen Valor Act, and so on. The only sense in which these questions were not “solved” before they came to the Court is in that the resolution was not that which Justice Kennedy would have preferred (or which Justice Kennedy believed is constitutionally compelled).

The Supreme Court, if it chose, could informally agree to overturn only those laws that are definitively unconstitutional. It has, needless to say, chosen nothing of the sort, with justices at both ends of the political spectrum routinely voting to overturn statutes based on wholly novel and often tortuous lines of reasoning. In recent years, this has been far more common among Anthony and his fellow conservatives than among the liberal justices.

However, if Kennedy is serious, perhaps he should propose a constitutional amendment that would require a two-thirds majority to overturn an act of Congress. More prosaically, since Kennedy is so often a swing vote, he could personally decide never to overturn a law unless there were at least five other votes already in favor. But he pretty obviously hasn’t the slightest intention of doing so.

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Anthony Kennedy Denounces Anthony Kennedy’s Supreme Court Jurisprudence

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Court tells Transocean to stop obstructing Deepwater Horizon investigation

Court tells Transocean to stop obstructing Deepwater Horizon investigation

Sky Truth

Transocean doesn’t want federal investigators getting to the bottom of this.

Yes, owner of the Deepwater Horizon oil rig, you do have to cooperate with the federal government’s investigation into the 2010 explosion and oil spill. The rest of us would like to see how such disasters could be avoided in the future.

That was the message sent by a U.S. Court of Appeals to Transocean, the world’s largest offshore drilling company, ordering it to finally turn over long-sought documents to the Chemical Safety and Hazard Investigation Board (CSB).

Transocean has been appealing some of CSB’s subpoenas, arguing that the board lacks the authority to probe the disaster. CSB investigates industrial accidents, but Transocean says the rig explosion is outside the board’s purview partly because the rig was not a “stationary source.”

But the company was sharply rebuked by a three-judge panel for that reckless intransigence. From The Louisiana Record:

Transocean is currently appealing the CSB’s authority to investigate the matter.

The appeals court denied Transocean’s request for a stay under its claim that the CSB had abused its discretion and it ordered Transocean to turn over the subpoenaed information.

“Transocean has identified no particular interest in the subpoenaed documents,” the appeals court ruling states. “If this is true, then we find it remarkable that Transocean has resisted the CSB’s subpoenas for approximately thirty-one months, and continues to resist them on appeal.”

The court’s decision also made the point that the appeal concerning the CSB’s authority may take years to decide, whereas the information required by the CSB is needed immediately to prevent another hazardous situation from occurring.

To spend three years obstructing a federal probe into the Deepwater Horizon accident may seem unconscionable, but, then, this is the oil-drilling industry that we’re talking about.

John Upton is a science fan and green news boffin who tweets, posts articles to Facebook, and blogs about ecology. He welcomes reader questions, tips, and incoherent rants: johnupton@gmail.com.

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Court tells Transocean to stop obstructing Deepwater Horizon investigation

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Is It Time to Ban Banks Completely From Commodities Trading?

Mother Jones

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Last night the New York Times put up a story about the purchase of an aluminum warehousing business by Goldman Sachs. Today, Matt Yglesias points out that the whole thing really doesn’t make sense. Here is Goldman’s apparent business strategy:

  1. Buy Metro International, a leading aluminum warehousing firm.
  2. Deliberately slow down customer service so that it take 16 months to ship orders instead of six weeks.
  3. Charge customers extra for storage because their aluminum is lying around longer.
  4. Game the regulations requiring that at least 3,000 tons be moved out of storage each day by simply shuffling it between warehouses.

Needless to say, this is ridiculous. If you could make money in the warehousing business by deliberately slowing things down, a whole bunch of textbooks would have to be thoroughly rewritten. And yet, the Times seems to have the goods here. Goldman really is doing this.

But why is Goldman doing this? They can’t possibly be interested in the aluminum warehousing business per se. And they can’t possibly be interested in the small pittance they might earn in the short term by deliberately sabotaging their own company. So what’s the deal?

The Times very carefully doesn’t say. What they do say is that, thanks to the arcane rules of the aluminum spot market, the price of aluminum goes up when average storage times increase. They suggest that Goldman’s warehousing strategy is a “major reason” that the spot price of aluminum has increased dramatically since 2010.

This is obvously bad news for beer companies, but why is it good news for Goldman Sachs? The obvious answer is that, somehow, Goldman is making money by betting on the spot price of aluminum. This would be a great strategy: buy up the infrastructure for a commodity, manipulate the infrastructure to affect the spot price, and then make bets on the direction of the price. It would be a money spinning machine.

But even though this seems obvious, we don’t know that Goldman is actually doing this. Presumably Times reporter David Kocieniewski did his best to find out, but just couldn’t find a source to tell him what was going on. Nonetheless, the idiocy of allowing an investment bank to own the infrastructure of markets that it trades in should be pretty obvious, and Reuters reports this weekend that maybe the Fed is starting to understand that:

The Federal Reserve is “reviewing” a landmark 2003 decision that first allowed regulated banks to trade in physical commodity markets, it said on Friday, a move that may send new shockwaves through Wall Street.

The one-sentence statement suggests the Fed is taking a much deeper, wide-ranging look at how banks operate in commodity markets than previously believed, amid intensifying scrutiny of everything from electricity trading to metals warehouses.

While the Fed has been debating for years whether to allow banks including Morgan Stanley and JPMorgan to continue owning assets like oil storage tanks or power plants, Friday’s surprise statement suggests it is also reconsidering whether all bank holding firms should be able to trade raw materials such as gasoline tankers and coffee beans.

Between Goldman’s shady aluminum business and JPMorgan’s shady energy business, it’s about time the Fed took a fresh look at this. If they went even further, and banned big banks from trading in commodities markets at all, it would be OK with me. Rumors of commodity manipulation—and sometimes more than rumors—have been rife for years in the oil market, the water market, the energy market, and others. This is worth keeping an eye on.

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Is It Time to Ban Banks Completely From Commodities Trading?

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The Supreme Court’s Next Big Abortion Decision

Mother Jones

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Roe v. Wade, watch out. The Supreme Court will venture into the abortion debate later this year when it considers the constitutionality of an Oklahoma law restricting the use of oral medications for abortions. The case could have major implications for the 16 states that have passed laws limiting the use of drugs that induce abortions.

Oklahoma’s governor signed the state’s medicine abortion law in May 2011, putting in place new restrictions on the use of RU-486 (also known as mifepristone or Mifeprex) and any other “abortion-inducing drug.” The law mandates that doctors follow the exact protocols for the drugs that are described on the Food and Drug Administration-approved label. Off-label use of drugs is legal and fairly common, and in the years since the drug was first approved for use in 2000, doctors have found that RU-486 and other drugs can be effective at lower doses and can be done with fewer visits to the doctor’s office than outlined on the FDA label. Doctors have also found that RU-486 is effective up to nine weeks into a pregnancy, not the seven weeks for which it was originally approved. Oklahoma’s law bans doctors from using that new knowledge to help their patients.

After Oklahoma’s governor signed the law, the Oklahoma Coalition for Reproductive Justice and the Center for Reproductive Rights sued—and won. A trial judge struck down the law in May 2012. When Oklahoma appealed to the state Supreme Court, it lost again. The state then appealed to the US Supreme Court, which indicated in June that it would consider the case. Reproductive rights groups say Oklahoma’s law—and similar ones in other states—are a transparent attempt to limit access to medication abortions. The groups argue that the new laws would make medicine-induced abortions virtually inaccessible, since the drugs are so frequently used off-label. “What this law will do is deny women the benefits of nonsurgical options for terminating a pregnancy,” says Julie Rikelman, the director of litigation at the Center for Reproductive Rights. “We think it’s an extreme law.”

In ruling that the law was unconstitutional, the trial court judge stated that it was “so completely at odds with the standard that governs the practice of medicine that it can serve no purpose other than to prevent women from obtaining abortions and to punish and discriminate against those women who do.” Now reproductive rights groups are hoping the Supreme Court will agree with the lower court’s ruling. There’s a problem, though: Most reproductive rights advocates believed that the justices would not take up the Oklahoma case at all, since the state Supreme Court had already agreed with the lower court.

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The Supreme Court’s Next Big Abortion Decision

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Gang of 7 Planning to Offer New Immigration Compromise

Mother Jones

Greg Sargent has some details on a new bipartisan House plan that—maybe—has a chance of saving immigration reform. The key points appear to be:

Redefining the initial “provisional” legal status granted to undocumented immigrants as “probation.”
Lengthening the path to citizenship from 13 years to 15 years.
Setting a hard trigger that would revoke everyone’s probational status unless E-Verify is “fully operational” within five years.

That last one is the key, of course, and Sargent says he was “unable to determine who gets to say whether E-Verify is fully operational.” Nonetheless, getting E-Verify operational is a reasonably achievable goal, so this might be acceptable to liberals. Overall, though, this compromise is mostly aimed at conservatives:

Ultimately, what this is all about is finding a way for House Republicans to get to conference negotiations with a bill that includes a path to citizenship. There is no telling whether a majority of House Republicans can bring themselves to embrace the above outline. But the thinking among Dems on the gang of seven is that even if this framework is much more onerous than the Senate bill, it provides at least a chance that Republicans will end up supporting something with citizenship in it. And getting to conference with a package that includes citizenship is preferable to the alternative, because it increases the chances of a good bill at the end.

Stay tuned.

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Gang of 7 Planning to Offer New Immigration Compromise

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Advertising: New Smokey Bear Gives Hugs, Not Just Warnings

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The Art of Raising a Puppy (Revised Edition) – Monks of New Skete

For more than thirty years the Monks of New Skete have been among America’s most trusted authorities on dog training, canine behavior, and the animal/human bond. In their two now-classic bestsellers, How to be Your Dog’s Best Friend and The Art of Raising a Puppy, the Monks draw on their experience as long-time breeders of German shepherds and as t […]

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Apocalypse (Digital Collection) – Games Workshop

The greatest heroes of the age lead battalions of troops and tanks against the foe. Super-heavy war machines dominate the conflict like gods of battle as bombardments rain from the skies. This is war on a whole new level. Apocalypse is a new way of playing games of Warhammer 40,000. Allowing you to field as many miniatures as you like, in any combinati […]

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How to Be Your Dog’s Best Friend – Monks of New Skete

For nearly a quarter century, How to Be Your Dog’s Best Friend has been the standard against which all other dog-training books have been measured. This new, expanded edition, with a fresh new design and new photographs throughout, preserves the best features of the original classic while bringing the book fully up-to-date. The result: the ultimate trai […]

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Apocalypse – Games Workshop

The greatest heroes of the age lead battalions of troops and tanks against the foe. Super-heavy war machines dominate the conflict like gods of battle as bombardments rain from the skies. This is war on a whole new level. Apocalypse is a new way of playing games of Warhammer 40,000. Allowing you to field as many miniatures as you like, in any combinati […]

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Warlords of the Dark Millennium: Ezekiel – Games Workshop

Ezekiel is the chief Librarian of the Dark Angels Space Marines; keeper of their most closely guarded secrets and ancient lore. As bearer of the Book of Salvation Ezekiel is an inspiration to his battle-brothers in combat, the powerful Librarian and sacred relic steadying them before the foe. About this Series: The galaxy burns with the fires of countless wa […]

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Advertising: New Smokey Bear Gives Hugs, Not Just Warnings

Posted in eco-friendly, FF, G & F, GE, Monterey, ONA, solar, solar power, Uncategorized | Tagged , , , , , , , , , | Comments Off on Advertising: New Smokey Bear Gives Hugs, Not Just Warnings