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Thanks Mike,

I did the google search but regret to say I cannot understand any of it. To many unknown terms for me.

I need it all plain and simple.

I didn’t even understand your statement “FYI – Sub-lingual is more effective than any pill you swallow. And all “methyl B12″ are not the same.”

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Graham, B12 comes in 3 forms – pills you swallow, pills you let dissolve under your tongue (sub-lingual), and injections. The pills you swallow are absorbed at a very low rate – around 1% for anything over 10 ug. Sub-lingual types are absorbed around 10%, if you keep them in place 30-60 minutes. Injectable B12 is 100% absorbed, but it requires a prescription.

Methyl-B12 (methylcobalamin) and dibencozide (adenosylcobalamin) are the active forms. M-B12 is generally the most useful for to take as supplement, but you may also benefit from taking dibencozide.

M-B12, and probably also dibencozide, degrades to hydroxocobalamin on exposure to light. So it’s important to keep your supplies in a cool, dark place. Hydroxocobalamin is an inactive form of B12, but it may not benefit you as much as the active form. Cyanocobalamin is B12 with a cyanide atom attached. The kidneys are very efficient at getting rid of cyanocobalamin, so it may not stick around long enough for your body to split it into the usable form.

M-B12 is a very complex molecule, and it’s hard to test for variations. The general belief is that some sources of M-B12 are chemically similar, but not as active as other forms. There are other people who are much more sensitive than I am to this difference (such as freddd), and they recommend only certain brands because they produce better results. The current recommendation is Enzymatic Therapy brand for M-B12. I take ET M-B12 and Country Life brand dibencozide, although it’s no longer a recommended brand.

There are a lot of supporting supplements that can help a person with B12 deficiency. Potassium is important. If you develop a muscle twitch or cramps, you need to boost potassium intake, but it’s best to take extra and keep that from happening. Magnesium is important for absorption and use of potassium. Some of the other recommendations are for methylfolate (the active form of folate or folic acid), zinc, calcium, D, E, C, chromium, selenium, TMG, and the other B vitamins.

I took methylfolate for about a year, but had to stop because it made me feel woozy for about an hour afterward. Not everyone needs it or benefits from it.


Hi Chris, I wanted to see if you have any information on what might cause high b-12 results. My 8 y/o dd came back with a result over 1500. Ped office is not concerned, said they only worry if it is low. My dd has IBS with frusctose malabsorption and she does tend to eat more meat because fruit and veggies are not her favorite. She was also supplementing prior to the test with Re-New life Ultra Flora probiotics (25 billion cells) the week prior to the test. All of her other lab tests have come back normal – CBC and Chemistry panel.


Clinical Evaluation and DNA Extraction

Informed written consent was obtained from study participants under a protocol approved by the Institutional Review Board of the Mayo Clinic. Family members were evaluated by electrocardiography and echocardiography, with normal values based on body surface area and age. Medical records were acquired for the proband’s deceased siblings, as well as a detailed medical history for the extended family. Genomic DNA was extracted from either whole blood samples or paraffin-embedded cardiac tissue from biopsy (QIAamp DNA Mini Kit, QIAGEN, Inc).

Genotyping and Haplotype Analyses

We selected 3 polymorphic dinucleotide repeat markers spanning each of the 8 gene loci for autosomal dominant HCM: , and . Markers were identified from online genetic databases and maps (Map Viewer and GeneMap’ 99 [National Center for Biotechnology Information] and The Genome Database ) and amplified by the polymerase chain reaction (PCR), as previously described. Taita Hat Maison Michel q9yrBt
Genotypes were scored and haplotypes were constructed with the goal of identifying the inheritance of an identical paternal and maternal haplotype among the siblings with cardiomyopathy.

Mutational Analyses

Once the haplotype analyses implicated the () as a candidate gene for autosomal recessive cardiomyopathy, mutational analyses of the gene were performed. Genomic structure was first determined by performing an online Human Genome Basic Local Alignment Search Tool (BLAST) search Mens Banstead Np Derbys Kurt Geiger tCyCZ
with mRNA sequence (GenBank accession number Hilfiger Denim Mens Slim Tapered Steve Belb Jeans Tommy Jeans YmleX
), identifying a single genomic contig harboring (GenBank accession number NT_029949 ). Oligonucleotide primer pairs were designed for PCR amplification of coding and splice junction regions for the 6 translated exons of , by use of OLIGO 6.51 Primer Analysis Software (National Biosciences). PCR amplification and single-strand polymorphism (SSCP) analyses were performed as previously described. DNA cycle sequencing of exon 4 was performed with the use of a Thermo Sequenase kit (Amersham Life Sciences, Inc). Sequence homology between human essential light chain of myosin and homologous proteins was determined with the MaxHom multiple sequence alignment program on the PredictProtein server.

The family pedigree structure is shown in Mens Wesley Fedora Hat Brixton IMQve6dp
A. The proband (V.3) and his sister (V.4) were referred for cardiac evaluation after the death of 2 siblings. The oldest brother (V.1) developed dyspnea and peripheral edema at age 13 and died a year later after a thromboembolic event. The other brother (V.2) developed fatigue, cardiomegaly, and hepatomegaly at age 12 and died 2 years later after operation to remove an intracardiac thrombus. Intraoperative needle biopsies of both ventricles demonstrated mild-moderate myocyte hypertrophy and interstitial fibrosis. Echocardiograms were not available for either brother, but their medical records indicated they had cardiomyopathy with dilated atria, suggesting restrictive heart disease.

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Although registration with the PTO is not required for a trademark to be protected, registration does confer a number of benefits to the registering party. 15 U.S.C. § 1051 . As described above, registration gives a party the right to use the mark nationwide, subject to the limitations noted above. Womens Shoes On Sale Black Suede leather 2017 25 3 35 4 45 55 6 7 75 Hogan 2017 Womens Shoes On Sale Qgvgz73DF
. Registration constitutes nationwide constructive notice to others that the trademark is owned by the party. Registration enables a party to bring an infringement suit in federal court. 15 U.S.C. § 1121 . Registration allows a party to potentially recover treble damages, attorneys fees, and other remedies. Finally, registered trademarks can, after five years, become "incontestable," at which point the exclusive right to use the mark is conclusively established. Green Suede Pablo Espadrilles Castaner ufhKQx

Applications for registration are subject to approval by the PTO. The PTO may reject a registration on any number of grounds. 15 U.S.C. § 1052 . For example, the PTO will refuse to register generic marks or descriptive marks that have not attained secondary meaning. The PTO can also reject "immoral or scandalous" marks, certain geographic marks, marks that are primarily surnames, and marks that are likely to cause confusion with existing marks. As noted above, rejection of the mark does not necessarily mean that it is not entitled to trademark protection; it means only that the mark is not entitled to the additional benefits listed above. 15 U.S.C. § 1125.

Some states also have their own registration systems under state trademark law.

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The rights to a trademark can be lost through abandonment, improper licensing or assignment, or genericity. A trademark is abandoned when its use is discontinued with an intent not to resume its use. Such intent can be inferred from the circumstances. Moreover, non-use for three consecutive years is prima facie evidence of abandonment. The basic idea is that trademark law only protects marks that are being used, and parties are not entitled to warehouse potentially useful marks. So, for example, a recent case held that the Los Angeles Dodgers had abandoned rights to the Brooklyn Dodgers trademark Look At Me Now Stretchjersey Maternity Leggings Black Spanx OvwiOF

Trademark rights can also be lost through improper licensing or assignment. Where the use of a trademark is licensed (for example, to a franchisee) without adequate quality control or supervision by the trademark owner, that trademark will be canceled. Similarly, where the rights to a trademark are assigned to another party in gross, without the corresponding sale of any assets, the trademark will be canceled. The rationale for these rules is that, under these situations, the trademark no longer serves its purpose of identifying the goods of a particular provider. Poleo Sandal in Red size 37 also in 36383940 Castaner 39 Poleo Sandal in Red. - size 37 (also in 36 38 nofS6L

Policy Choices for the Trump Administration

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More than 30 nations already have or are developing armed drones, and at least 90 nations, as well as some non-state actors, possess unarmed drones. The continued spread of uninhabited aircraft, or drones, introduces new dynamics to international engagements that heighten uncertainty and confront well-understood behaviors, especially in the context of crisis stability, escalation dynamics, and sovereignty norms. To get ahead of these issues, the United States has begun to craft complementary unilateral and multilateral policies to respond to drone proliferation and shape their use in ways that align with U.S. interests.

Further drone proliferation is inevitable. The technology has already spread widely, with countries such as Israel and China selling drones on the global market, as well as indigenous production increasing in a number of countries. While the United States can slow the spread of sensitive military subcomponents, such as stealth, protected communications, advanced autonomy, and other features, basic drone technology is already too widespread to halt its proliferation. However, the United States can influence how other nations use drones by example and by promulgating norms of appropriate behavior.

Over the past two years, the United States has taken significant steps toward establishing policies and building international consensus to manage many of the challenges posed by drone proliferation. In February 2015, the United States issued a new export policy for military unmanned aerial systems, or drones. This policy required that recipients of U.S. drones agree to “principles of proper use.” In October 2016, the United States built upon this policy by spearheading a Joint Declaration for the Export and Subsequent Use of Armed or Strike-Enabled UAVs. This declaration, which has been signed by over 40 countries, lays out important principles for the export and use of armed drones. Combined, these two policies are first steps toward establishing a normative framework on how armed drones are used.

However, U.S. policies have gaps and inconsistencies that harm the United States’ ability to shape patterns of proliferation and protect U.S. advantage. If the United States fails to capitalize on the momentum surrounding new drone policy, others may take the lead in establishing a normative framework contradictory to U.S. national security interests as drones continue to proliferate. The Trump administration has an opportunity to take a new look at U.S. policy with respect to drone proliferation and use, building on existing policies in some areas and changing course in others.

U.S. Policy Objectives

CNAS’ Proliferated Drones project identified five key objectives that drive the U.S. policy response to drone proliferation:

Some of these objectives are in tension, and current U.S. policies do not adequately resolve those tensions. In two significant policy areas – drone exports and transparency on U.S. drone strikes – the United States has yet to fully adjust its policies to a world where many actors have access to and use drones.

U.S. drone export policy has overly prioritized limiting proliferation at the expense of other U.S. interests, including maintaining a technological advantage over competitors, improving the capabilities of key partners, and shaping the behavior of how others use drones. To date, the United States has sought to slow drone proliferation by restricting U.S. drone exports, particularly armed drones and larger drones that fall under Category I of the MTCR. This has not significantly slowed drone proliferation, however. Other nations can still purchase drones on the global market from countries such as China or Israel.

This reluctance to transfer U.S. drones harms U.S. interests in tangible ways. Close allies and partners who otherwise have access to advanced U.S. military equipment, such as fighter aircraft, often find there are steep hurdles to acquiring U.S. drones, particularly armed drones. This runs counter to U.S. interests, since it deprives the United States of an opportunity to bolster partners’ capabilities. When U.S. partners eventually acquire drones from other countries, the United States loses an important opportunity to deepen defense relationships, improve interoperability, and influence how other countries use drones.

The current U.S. approach of restricting exports also harms the U.S. military’s long-term technological advantage over potential competitors. Non-U.S. drones of comparable sophistication already are available on the global market. Restricting exports does not stop the spread of drone technology, but it does hinder U.S. companies’ ability to compete and stay ahead in a fast-moving market. Loosening restrictions to allow targeted exports to close partners and allies could help ensure that U.S. companies continue to stay at the cutting edge of drone technology development. The U.S. military’s future technological edge hinges on having a healthy, innovative defense industrial base with the most cutting-edge technologies, and allowing U.S. drone manufacturers to compete in the global marketplace is essential to maintaining the U.S. lead in this emerging technology area.

Finally, restricting U.S. drone exports limits opportunities to shape emerging norms for drone use. Targeted, conditional exports can be a useful tool to influence how others use drones. Under the new drone export policy established in February 2015, any recipients of U.S. drones must agree to certain principles for use, such as only using drones in accordance with international law. The United States also can pair exports with training on tactics, techniques, and procedures for reducing civilian casualties. These steps can help spread norms and practices for drone use that are consistent with U.S. values and the rule of law.

Similarly, the United States has failed to adapt its transparency on its use of drones to a world where many actors have access to drones, including armed drones. The Bush, Obama, and Trump administrations all have used armed drones to strike terrorists abroad, and while they have openly acknowledged broad patterns of use, so-called “drone strikes” outside of hot battlefields have occurred under a veil of secrecy. In a world where the United States was the only actor with armed, militarily-capable drones, this secrecy may have made sense. As drones proliferate to others, however, this secrecy sets a dangerous precedent. The lack of transparency surrounding drone strikes that is intended to preserve U.S. freedom of action has perpetuated the perception that U.S. actions are illegitimate or, even worse, illegal. The perception that normal rules of international law do not apply to actions with drones could incentivize malign behavior by others. If other nations begin using drones in ways that are widely seen as illegitimate or illegal, it could undermine the legitimacy of U.S. actions. The United States should actively work to promulgate the norm that, like all weapons, drones must be used in accordance with applicable international law. While this will not constrain actors who do not respect the rule of law, it will help differentiate U.S. drone use from others. U.S. actions must reinforce that message, and the first step in doing so is greater transparency regarding U.S. use of drones.

U.S. policies must continue to adapt to a world where many actors will have access to drones. The Trump administration has an opportunity to change course and engage in targeted, conditional exports to key partners and increase transparency about U.S. drone use. These steps can help the United States advance and defend its interests in an increasingly drone-saturated world.

U.S. drone export policy has overly prioritized limiting proliferation at the expense of other U.S. interests.

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