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[ASAP] Size Distribution and Morphology of Gypsum Crystals Precipitating from Hypersaline Solutions

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Crystal Growth & Design
DOI: 10.1021/acs.cgd.9b00735

          

New (and New to Us) Materials in October & November 2019

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Collection development activities have always included a mix of purchases, gifts, and rediscovered items - at least during my twenty-years on the job. Items added to the Research Room during October 2019 continue that long tradition.

A memoir is the least objective, most personal form of writing. There have been a string of memorials and memoirs about Pat Conroy since his 70th birthday and quick death from pancreatic cancer in March 2016. Earlier this year we added memoirs about him by Bernie Schein, Pat Conroy: Our Lifelong Friendship and Michael Mewshaw, The Lost Prince: A Search for Pat Conroy. The latest memoir is perhaps the most personal of all. Tell Me A Story: My Life with Pat Conroy by Cassandra King Conroy, 2019 recounts "King-Ray's" life and times as the girlfriend, wife and widow of the Lowcountry's "Prince of Tides."  
 

Sat, Nov 23, 2pm or 4pm
JAPAN HOUSE Salon, Level 5
6801 Hollywood Blvd.
Los Angeles, CA 90028
Free, Must RSVP

*Yes, really a rice tasting

Since 1971, the Japan Grain Inspection Association has conducted rice taste sensory tests on a national scale, ranking each regional variant through rigorous scientific assessment to determine the best tasting rice every year. (*) This workshop features a lecture led by the National Agricultural Research Organization of Japan (NARO) in which participants will learn about Japanese short-grain rice and its regional variants, and the best way to cook rice and how to pair side dishes to complement its flavor.
Following the lecture, participants will join in a professional-level sensory test of rice, sampling four types of cooked white rice. Participants will also receive a souvenir as a small token of appreciation to take home.


Saturday, December 7, 2019 | 10 am–4 pm
Japanese American Cultural & Community Center
244 S. San Pedro St. Los Angeles
$90 JACCC MEMBER | $100 GENERAL

LEARN TO MAKE YOUR OWN JAPANESE NEW YEAR TRADITIONAL OSECHI!
Yoko Maeda Lamn, founder of Hakko, returns to JACCC’s culinary team to create several traditional Japanese New Year dishes. Learn the craft of regional styles of soups and vegetable-based dishes with explanations of the historical basis on this traditional cuisine.
Saturday, December 7, 2019 | 10 am–12 pm
Japanese American National Museum  

244 S. San Pedro St. Los Angeles
$80

Make soba using fresh, stone-milled artisanal flour from Japan and authentic soba tools. This soba will be served in the classic way: cold with fresh soy-based dipping sauce, toppings, and spices. 
Soba is a type of noodle traditionally made from buckwheat flour, or a combination of buckwheat and wheat flours. In Japan, many people celebrate special occasions by eating soba. For example, many celebrate New Year’s Eve by eating toshikoshi soba or when moving into a new residence, people will serve their new neighbors hikkoshi soba.

Sun, Dec 8, 2019 5:30 pm–8 pm 
Smidt Welcome Plaza  |  LACMA 
$100 LACMA members, $134 LACMA members with wine-tasting; $110 general public, $144 general public with wine-tasting


Start this fun evening with a tour of the exhibition Every Living Thing: Animals in Japanese Art, which celebrates one of the most distinctive aspects of Japanese art: the depiction of animals. Underpinned by Japan's spiritual heritage of Shintō and Buddhism, the Japanese reverence for nature—and the place of animals within that realm—is expressed in a variety of artworks. You will find artistic representations of animals real and imagined, including lions, dogs, cats, fish, insects, dragons, and phoenixes. Learn about the various roles animals have played in Japanese culture.
Then move to Ray’s & Stark Bar to enjoy a creative vegan Japanese dinner specially designed by executive chef Phillip Martin, featuring seasonal ingredients. The vegan menu is inspired by the Buddhist ritual of releasing captured animals that was practiced in Japan.



          

Vol. 158 - Kung Fu Heroes

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This week, The Hyperkin Admiral is N64 BT Controller goodness, more Black Friday deals, The NES Mouse is the mouse all retrogamers didn't know they needed until now, Castlevania Season 3 drops Dec. 1st, & Jason reviews Kung Fu Heroes for the #NES. #Retrogaming

Support us on Patreon: http://www.patreon.com/nerdcaveretro

Follow us on Twitter:
Derek Diamond
Jason Robbins
Nerd Cave Retro

Email us at NerdCaveRetro@Gmail.com


          

‘Generations & Tribes’ : l’hyperciblage au coeur de la prochaine Matinale JDL.

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Et si vous commenciez l’année 2020 avec des insights inédits ? Comprendre les consommateurs du Luxe d’aujourd’hui. Après le succès de sa dernière Matinale dédiée aux Tendances Retail de 2020, le Journal du Luxe vous donne rendez-vous pour un rendez-vous exclusif sur la thématique ‘Generations & Tribes’. Quels sont les profils et les appétences de…
          

When the sewers get blocked: sanitation labour in urban India

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On World Toilet Day, we bring to light the labour of India’s sewer workers - those who do the unclean work that a Clean India relies on.
Photo credit: Sharada Prasad

November 19th is World Toilet Day. India's massive five-year all-hands-on-deck Clean India Mission to construct latrines for all has just ended. The Government reports that 100 million additional toilets have been constructed via this campaign; these are mostly not connected to waterborne sewer systems. Just over 30% of India's urban population has access to sewers, though most city plans include elaborate plans for sewerage. Sewers are supposed to be underground and unseen, and are not supposed to need manual labour to dispose of the waste. But sewers get blocked and have to be unblocked, overflow and have to be cleaned out, break and have to be repaired. Several cities have introduced mechanisation to fix major blockages and to avoid people having to jump into the sewer system when problems arise, but sewer management remains quite a challenge.

The sewers are often densely networked, the pipes are old, the streets are narrow. Water and Sewerage Boards are just overwhelmed with the number of demands and complaints they get on a daily basis, and they can't be everywhere at once. Deaths of sewer workers in India's cities continue to occur. Sewers continue to be unblocked with makeshift equipment such as bamboo poles and iron rods; accumulated silt often needs to be cleaned out by hand or shovel. And so human labour, which in this case is inevitably Dalit labour, keeps India's sewers flowing. Technically, this is not "manual scavenging". But what is it, then? On this World Toilet Day, we bring to light the labour of India's sewer workers – those who do the unclean work that a Clean India relies on. We tell their stories through the voice of Sharada Prasad, who followed the men as they worked.

Sriramulu and Narasimhulu

August 2019. The afternoon in Hyderabad has not been tempered by the rains. I'm walking around, looking for sanitation workers. Narrow streets, dense settlements and old sewer lines are a recipe for sewer blockages. I see them: four men lifting a large slab of concrete to gain access to the drain underneath. The homeowner connected to the drain is with them, too. Once the slab is pried open, all four peer into the hole.

Frontiers
Frontiers
Science External News
          

The Hyper-Realistic Pencil Drawings of Kohei Ohmori

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Japanese artist Kohei Ohmori rose to prominence over the last few years thanks to his uncanny ability to draw everyday metallic objects to perfection. Just take a look at the three-dimensional Seiko wristwatch below! Using graphite pencils is usually a dead giveaway that you’re looking at a drawing of something, but in the case of […]
          

The Mind-Boggling Optical Illusions of Marcello Barenghi

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Italian artist Marcello Barenghi has a very special skill – he can draw hyper-realistic versions of everyday objects, using commons drawing tools to make them look three-dimensional. Even as a child, Marcello Barenghi had a knack for hyper-realistic drawing, trying his hardest to imitate reality. At just 18 months he was drawing airplanes that had […]
          

ÇözümPark Haftalık Bülten – 2 Aralık 2019

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ÇözümPark Webcast Yeni Nesil Yedekleme Çözümü: Rubrik ile Canlı Demo – 17 Aralık 2019 Salı Saat 10:00 ÇözümPark Akademi Eğitimleri Azure Üzerinde Serverless Yazılım Geliştirme – 10/11 Aralık 2019 VMware vSphere: Kurulum, Yapılandırma ve Yönetim V6.7 – 21/22 Aralık 2019 Sponsor Etkinlik Data Center İstanbul – 3 Aralık Salı Güncel Teknoloji Haberleri Microsoft Gartner’da Liderler Kategorisine Yükseldi Google, Google Fotoğrafların Önemli Bir Özelliğini Yanlışlıkla Kaldırdı Yeni Exchange Yönetim Panelini Denediniz mi? MixCloud Hacklendi 20 Milyondan Fazla Kullanıcının Kişisel Verisi DarkWeb de Satıldı RIPE NCC Son IPV4 Adres Aralığını Tahsis Ettiğini Duyurdu Kali Linux 2019.4’de Yeni Mod Eklendi : ” Undercover MOD “ HP, SSD Diskler İçin Acil Güncelleme Yayınladı !! Twitter Etkin Olmayan Hesapları Silme Kararını Geri Aldı Black Friday 2019 Fırsatları:Apple,Amazon,Walmart Adobe: Magento Marketplace Portalının Hacklendiğini Açıkladı Makaleler .Net Core MVC İçerisinde Bootstrap Kullanımı Windows 10 Hyper-v VM Live Storage Migration SQL Script ile Otomatik Backup ve Restore SQL Server 2019 Kurulumu Office Customization Tool ile Ofis 365 Pro Plus, Business ve Standart Kurulum İşlemleri Windows Server 2019 Hyper-v VM Live Storage Migration ITSM İçin Yol Haritası, Kritik Başarı Faktörleri ve Zorluklar ITIL V3 ve ITIL V4 Hakkında Bilmeniz Gereken Her Şey Dell Poweredge R740 XD Üzerine Nasıl OS Kurulumu Yapılır? GFI Mail Archiver Kurulum Adımları Bloglar Microsoft Azure AD ve Office 365 Ne Kadar Güvenli? How To Get The Most Out Of Your Security Investment PFSense DHCP Loglarını ELK Stack ile Parse Etme ve Görüntüleme Azure Hybrid Servisleri Nelerdir? Azure Hybrid Services Azure Arc Nedir? Windows Server 2008 ve 2008 R2 için Uzatılmış Destek Süresi 14 Ocak 2020 Tarihinde Sonra Eriyor Active Directory Attribute Editor ASP .NET Core Blazor ve React Arasındaki Farklılıklar Centos Stream 8 (1905) Üzerinde Node.js Kurulumu ve Kullanımı Vmware Distributed Switch Nedir? Standart Switch ile Arasındaki Farklar Nelerdir? Videolar HPE – Qumulo – Verileriniz 10 Yıl Öncesi ile Aynı Değil, Depolama Teknolojiniz Neden Olsun? Microsoft Power BI : Hızlı, Kolay, Yetenekli Çalışmayan Felaket Senaryoları ve Sonuçları Veeam ile Office 365 Yedekleme Hizmeti Parola Güvenliği Ürünü PassGate’in Finans Sektöründeki Deneyimi Sekillendirilebilir Mimaride Yenilikler Synergy FixSIEM Açık Kaynak Kodlu Güvenlik Platformu ATAR Güvenlik Otomasyon Robotu

The post ÇözümPark Haftalık Bülten – 2 Aralık 2019 appeared first on ÇözümPark.


          

Hyper-converged Infrastructure

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In this episode, host Michael Bird talks to Softcat's CTO, Sam Routledge, Tim Jeans, Softcat's Datacentre and Cloud Practice Manager and Paul Petty, Laing O'Rourke's Infrastructure Team Leader about what a hyper-converged infrastructure is and how it's worked for Laing O'Rourke. They discuss the importance of forward planning when looking at your infrastructure options, as well as the practicalities of implementing a hyperconverged infrastructure and the benefits that come with it.

____

Get in Touch

https://www.softcat.com/Podcast-S1E4

https://twitter.com/softcat

https://www.linkedin.com/company/softcat/


          

Root coverage stability with acellular dermal matrix in multiple gingival recessions in esthetic zone: A clinical case report with 12-year follow-up

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Ísis De Fátima Balderrama, Rafael Ferreira, Daniel Romeu Benchimol Rezende, Ana Lúcia Raphaelli Nahás Nogueira, Sebastião Luiz Aguiar Greghi, Mariana Schutzer Ragghianti Zangrando

Journal of Indian Society of Periodontology 2019 23(6):584-588

The importance of surgical intervention for the maintenance of long-term results by root coverage of multiple gingival recessions in an esthetic area treated with a tissue substitute (acellular dermal matrix [ADM]-Alloderm®) is widely required. The present case report highlights the effectiveness of the ADM for the treatment of multiple recession defects in a female patient with Class I and II gingival recession in relation to maxillary anterior associated with esthetics and dentin hypersensitivity demands. The root coverage rate for the anterior area showed greater value with 70% of coverage; at 90 days and 2 and 12 years of follow-up, it showed 70.5%, 79%, and 77%, respectively. Conversely, for the posterior area, these rates were 68.5%, 63%, and 57% for the same follow-up periods. Results regarding gain of keratinized tissue demonstrated superior values for the anterior area, namely 3.92, 3.34 and 3.22 mm at 90 days and 2 and 12 years. These values for the posterior area were 0.54 mm, 2.41, and 1.87 mm, respectively. These findings suggest that the tissue substitute Alloderm® showed excellent long-term results for areas of multiple recessions, providing root coverage and stability of keratinized tissue gain. After this long period of evaluation, some local factors associated with recurrence of gingival recessions were detected, and a lack of proper periodontal maintenance care was observed. However, esthetic and functional outcomes achieved with surgical procedure were maintained.
          

Pannexin-1 Channels Are Essential for Mast Cell Degranulation Triggered During Type I Hypersensitivity Reactions

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Mast cells (MCs) release pro-inflammatory mediators through a process called degranulation response. The latter may be induced by several conditions, including antigen recognition through immunoglobulin E (IgE) or “cross-linking,” classically associated with Type I hypersensitivity reactions. Early in this reaction, Ca2+ influx and subsequent increase of intracellular free Ca2+ concentration are essential for MC degranulation. Several membrane channels that mediate Ca2+ influx have been proposed, but their role remains elusive. Here, we evaluated the possible contribution of pannexin-1 channels (Panx1 Chs), well-known as ATP-releasing channels, in the increase of intracellular Ca2+ triggered during cross-linking reaction of MCs. The contribution of Panx1 Chs in the degranulation response was evaluated in MCs from wild type (WT) and Panx1 knock out (Panx1−/−) mice after anti-ovalbumin (OVA) IgE sensitization. Notably, the degranulation response (toluidine blue and histamine release) was absent in Panx1−/− MCs. Moreover, WT MCs showed a rapid and transient increase in Ca2+ signal followed by a sustained increase after antigen stimulation. However, the sustained increase in Ca2+ signal triggered by OVA was absent in Panx1−/− MCs. Furthermore, OVA stimulation increased the membrane permeability assessed by dye uptake, a prevented response by Panx1 Ch but not by connexin hemichannel blockers and without effect on Panx1−/− MCs. Interestingly, the increase in membrane permeability of WT MCs was also prevented by suramin, a P2 purinergic inhibitor, suggesting that Panx1 Chs act as ATP-releasing channels impermeable to Ca2+. Accordingly, stimulation with exogenous ATP restored the degranulation response and sustained increase in Ca2+ signal of OVA stimulated Panx1−/− MCs. Moreover, opening of Panx1 Chs in Panx1 transfected HeLa cells increased dye uptake and ATP release but did not promote Ca2+ influx, confirming that Panx1 Chs permeable to ATP are not permeable to Ca2+. These data strongly suggest that during antigen recognition, Panx1 Chs contribute to the sustained Ca2+ signal increase via release of ATP that activates P2 receptors, playing a critical role in the sequential events that leads to degranulation response during Type I hypersensitivity reactions.


          

Diagnosis of Metal Hypersensitivity in Total Knee Arthroplasty: A Case Report

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Delayed type hypersensitivity (DTH) reactions are considered infrequent complications in arthroplasty, but have been recognized to be associated with devastating morbidity and substantial decrease in quality of life of affected patients. Chronic inflammation of artificial joints and associated loss of peri-implant bone often require revision surgery. Methods for the diagnosis of implant-related DTH are available but infrequently considered to the full extent. Sequential diagnostics based on exclusion of septic complications, local and systemic metal level determination, lymphocyte transformation testing (LTT), and local T cell subset analysis are required for an unequivocal DTH diagnosis. Here, we report on a patient with a history of chronic rheumatoid arthritis and an unfavorable outcome of unilateral knee arthroplasty. This case illustrates pitfalls and difficulties in the course of recurrent inflammation following joint replacement. In the early course, suspicion of low-grade bacterial infection led to three two-stage revisions. Afterwards, the joint was proven to be sterile. However, metal level quantification revealed release of especially cobalt and chromium from the joint, LTT indicated persisting cobalt and nickel sensitization and subset analysis of T cells from the synovium suggested DTH as a root cause for the inflammatory symptoms. This report aims to recommend the depicted diagnostic algorithm as an adequate tool for future DTH detection. Yet, systemic to local subset ratios for effector memory and regulatory T cells should be derived from sufficient patient numbers to establish it as a diagnostic marker. Moreover, future prospects regarding implant-related DTH diagnostics are discussed. Therapeutic options for the portrayed patient are proposed, considering pharmaceutical, cell-therapeutic and surgical aspects. Patients who experience peri-implant inflammation but do not have obvious mechanical or infectious problems remain a diagnostic challenge and are at high risk of being treated inadequately. Since potentially sensitizing materials are regularly used in arthroplasty, it is essential to detect cases of acute DTH-derived inflammation of an artificial joint at early postoperative stages. This would reduce the severity of inflammation-related long-term consequences for affected patients and may avoid unnecessary revision surgery.


          

Other: Florida Wound Care Job - Boca Raton, Florida

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Pompano Beach AreaWe are working with a client in the Pompano Beach area needing long term coverage Beginning asap for a wound care practice setting.Locums, Inc. will provide your medical malpractice coverage and hourly compensation. Details below:Clinic SettingDates: Asap - ongoing assignment Outpatient clinicHours: 9a-1p or 9a-3p (Tue and Fri)Wound careComplete support staff Paper chartingHyperbaric certified or experienced in hyperbaric treatment a mustPatient ServicesWellness, wound healing, tissue repair and preventative healthcareIf you would like more information on this assignment, please contact Scot Gray at ()
          

Expedition Titan uses mixed reality to turn Saturn’s mysterious moon into a thrill ride

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It’s doubtful anyone alive today will get to ride through the ice volcanoes of Saturn’s largest moon — but you can do the next best thing at Seattle’s Pacific Science Center, thanks to a mixed-reality experience called Expedition Titan. The walk-through production is the latest showcase for Hyperspace XR, a startup-in-residence that’s pioneering the frontiers of mixed reality at the science center. That frontier is associated with other labels of immersive experiences, including virtual reality (MR), extended reality (XR) and augmented reality (AR). Hyperspace XR’s brand of mixed reality involves creating a real-world environment — complete with walls, doorways and… Read More
          

Kapadokya Turu İle Zamanı Durdurmaya Hazır Mısınız?

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Kapadokya Turu İle Zamanı Durdurmaya Hazır Mısınız? 

İç Anadolu’da doğal güzellikler içerisinde en popüler tatil yerlerinden biri olan Kapadokya, Unesco Dünya Mirası Listesi'ne alınmış bir turizm bölgesi. Binlerce yıl önce etrafında bulunan volkanların püskürmesi sonucu oluşan lavların doğa olaylarıyla Peri Bacaları’nı oluşturmasıyla bölgenin kendine özgü yapısı meydana gelmiş. Kapadokya doğa güzellikleri ile mutlaka gidilmesi gereken bölgelerden biri. Siz de bölgenin güzelliklerini keşfetmeye hazırsanız sizi şöyle alalım... ProntotourKapadokya turları ile doğa eliyle oluşmuş coğrafyada tarihi bir atmosfer içerisinde konforlu bir tatil geçirmeniz için her türlü imkanı yaratıyor. Kapadokya turu, tarihte bölgede yaşamış olan Asurlar, Hititler, Romalılar ve Bizanslıların bıraktığı izleri ziyaretçilerin görebilmesi için büyük bir fırsat. Prontotour ayrıcalığıyla doğanın dokunuşuyla bölgede oluşmuş peri bacalarında mağara evlerde lüks, zarif ve otantik otel odalarında konaklama imkanı bulabilirsiniz. Vadilerin güzelliğiyle beraber gökyüzündeki uçan balonların eşsiz gösterisi altında muhteşem manzarayı izleme fırsatını da yakalayabilirsiniz. Peki ya başka, Kapadokya turu size neler vadediyor? 



Kapadokya Turu Masallara Özgü Bir Gezi Fırsatı Sunuyor 

Kapadokya turu gün sayısına göre içerik olarak değişebiliyor. Turlar uçakla veya otobüsle 1 ya da 2 gecelik olacak şekilde düzenleniyor. Bu tur içerisinde tarihi gezi, doğa yürüyüşü, atölye gezisi ve yerel lezzetlerin tadımı gibi etkinlikler yer alıyor. Kapadokya turunda rehberler eşliğinde doğa manzaralarını izleme fırsatı yakalıyorsunuz ve tarihi mekanları gezebiliyorsunuz. Rehberlerle bölgeyi en iyi şekilde tanımanızı sağlayan turun sistemli bir içeriği bulunuyor. Bu tur için ayıracağınız gün sayısı etkinliklerin çeşitliliği açısından önemli. Kapadokya ziyareti yapacaklara Göreme Açık Hava Müzesi’ni, Ürgüp’te yer alan Asmalı Konağı, Üç Güzeller Peri Bacaları’nı, Güvercinlik Vadisi’ni, Çavuşin Kalesi’ni ve Aşk Vadisi’ni görebilme imkanı sunuluyor. 


Hareketli Bir Seyahat İçin: Balon ve ATV Turları 

Harika manzaralarıyla hem gözlere muhteşem yemeklerle hem damak tadına yönelik olan Kapadokya turu ile çevrede yapılacak gezilerle harika vakit geçirebilirsiniz. Gün doğumunu olağanüstü araçlarla izleyebilmeniz mümkün. İsterseniz Prontotour ayrıcalığıyla balon turlarına da katılabilirsiniz. Balon turları ile Ürgüp’te, Avanos’da ve Göreme’de 4-25 km. arasında bir bölgenin kuş bakışı izlenebilmesi mümkün. Sokaklar arasında yer alan taş evlerin, güzelliğiyle göz kamaştıran vadilerin, güvercinlerin yuvası olan Güvercinlik’in, eşsiz güzelliğe sahip bağ ve bahçelerin ve peri bacalarının tümünü balon turlarıyla çok farklı bir bakış açısıyla görebilme imkanı yakalıyorsunuz. Balon turları 1 saat ile 1.5 saat arası sürüyor ve sabah erken vakitte bölgenin tüm güzelliklerini farklı bir perspektifle görebilme imkanını sizlere sunuyor. Fakat bazı hava koşullarında balon turu mümkün olmayabiliyor. Balon turunu düşünenler için yaz ve bahar ayları çok uygun. Ayrıca ATV turlarıyla ve deve gezileriyle de bölgeyi keşfetme imkanı yakalıyorsunuz. Bölge karasal iklime sahip olduğu için beraberinizde uygun kıyafetleri getirirseniz çok daha keyifli bir tatil geçirebilirsiniz. Kapadokya turu ile verilen molalarda alışveriş yapılabilecek, hediyelik eşya alınabilecek yerler de bulunuyor. 

 

Kapadokya’da Gezilecek Yerler 

Prontotour Kapadokya turu ile ilk günde Ihlara Vadisi’ni, kaya kiliselerini, şarap mahzenlerini ve Hacı Bektaş Türbesi’ni gezebilirsiniz. Bu gezi içerisinde tarihi mezarlar ve taş işleme atölyelerini de ziyaret edebilirsiniz. Genellikle balon turları gezinin ikinci günü yapılıyor. İkinci günde isterseniz ATV ile tur imkanı da bulunuyor. Kapadokya’da her yerin ayrı bir öyküsü var. Çarıklı Kilisesi’ni gördüğünüzde bölgede ilk sakinlerin yaşantılarına şahit olabilirsiniz. İncil’in tümünün resmedildiği Tokalı Kilisesi’ni ziyaret edince büyük bir uygarlığın öyküsünü dinleme imkanı yakalayacaksınız. Ayrıca Ihlara Vadisi’ni gezerek muhteşem doğayı izleme imkanı bulacaksınız. Evlerin altında oyulmuş olan sığınaklar, kilerler, ibadet yerleri ve yaşam alanlarıyla meydana getirilmiş yeraltı şehirlerini göreceksiniz. Kapadokya turu için genellikle Kaymaklı ve Özkonak yeraltı yerleşimleri geziliyor. Ayrıca isteğe bağlı olarak Türk gecesine de katılabilirsiniz. Türk gecesi ile müzik ve folklor eşliğinde geleneksel etkinliklerin tadını çıkarabilirsiniz. 

Prontour ile konforlu bir tatil için avantajlı fiyatlardan faydalanabilme imkanınız bulunuyor. Ödemelerde Kapadokya turu için taksit seçenekleri de mevcut. Yılın belirli dönemlerindeki Prontotour kampanyalarını da takip ederseniz erken rezervasyon fırsatından yararlanabilirsiniz. Siz de Kapadokya’nın otantik havasını solumak ve doğa güzelliklerini keşfetmek için davetlisiniz. Prontotour’a uğrayın sizin için en iyi tarihlere göz atın Kapadokya turu için cazip fiyatlarla kolayca rezervasyon yaptırın.  


          

Re: CodeBench - memory needs on 4.1FE UAE and other questions [by Severin]

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CodeBench:: CodeBench - memory needs on 4.1FE UAE and other questions
@Sprocki

Quote:
I wonder why Hyperion does not do this on their own.


Errr... They have done what they can, FE runs on WinUAE which is after all a 3rd party program. It's nothing to do with Hyperion or Cloanto That WinUAE is limited to 128mb of ram. WinUAE was never designed to emulate NG machines, the PPC enhancement lets you run OS3.x with 603e support where 128mb of ram is more than enough for nearly everything. and very, very few systems had more.

Way back when OS4.0 first came out the minimum requirement was 256Mb, 512 Recomended, now 10 years later and considering the amount OS4 has grown over the years you're incredibly lucky that it runs at all with only 128mb.


          

THE FLASH Review “The Last Temptation of Barry Allen, Part One”

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  The Flash Review: “The Last Temptation of Barry Allen, Part 1”   By Justin Carter   The Flash wants to make sure you’re aware the Crisis, and by extension the big crossover alluded to all season, is just around the corner. The hyper-accelerated timeline of the season thus far means it’s only two days […]

The post THE FLASH Review “The Last Temptation of Barry Allen, Part One” appeared first on ScreenSpy.


          

Comment on Day #5 on JFLAP by Stratego

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<strong>Stratego</strong> [...]that will be the end of this post. Here you’ll come across some websites that we assume you will appreciate, just click the hyperlinks over[...]
          

Hyperchase Vectrex Video Game Cart

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$17.09
End Date: Thursday Dec-12-2019 18:22:19 PST
Buy It Now for only: $17.09
Buy It Now | Add to watch list

          

The benefits of hyperconverged infrastructure

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The benefits of hyperconverged infrastructureHyperconvergence isn’t something only large enterprises can benefit from — businesses of all sizes should consider this infrastructure strategy. Read on to learn more about what hyperconvergence can do for your company. What are hyperconverged infrastructures? In a traditional IT environment, networking, server, and storage hardware need to be purchased separately and configured to work […]
          

Reverse RDP攻击:Hyper-V Connection

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checkpoint研究人员发现利用Reverse RDP Attack可以对Hyper-V发起guest-to-host VM逃逸攻击。
          

Clavier Gaming mécanique HyperX Alloy FPS (HX-KB1RD1-FR) - Cherry Red

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69,99€ - Amazon
HyperX HX-KB1RD1-FR Alloy FPS - Clavier Gaming mécanique, Cherry MX Red (AZERTY)

  • Design compact, idéal pour jouer aux jeux FPS
  • Struct...
          

Other: Center Lab Supervisor (Schenectady, NY) - NY State License Required - Albany, New York

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Under the general direction of the laboratory director, this position supervises technical personnel and reporting of findings, performs tests requiring special scientific skills, and, in the absence of the director, are responsible for the proper performance of all laboratory procedures. In compliance with Standard Operating Procedures (SOPs), supervises reception area testing activities. Provide clear and consistent instructions and directions, conduct meetings and clearly communicate performance expectations. May be required to perform tasks in work areas. Advise management of employee relation issues or escalated donor issues. In conjunction with Group Leaders, facilitate donor movement throughout the center minimizing wait time and processing. Ensures the center is staffed with adequate number of personnel to provide sufficient support based on center size, structure and donor flow. Monitor time card reporting procedures, attendance, and utilization of overtime. Conduct error investigations and develop recommendations for process improvement. Participate with management in conducting performance appraisals, providing performance feedback. With management review, document verbal and written coaching level corrective actions as needed. Assist in maintaining up-to-date employee training files, checklists, and assist with performance evaluations and certification status. May assist with the recruitment and selection of center operation staff. Adhere to and promote compliance to company policies and procedures. Ensures accurate recording of donor data in the electronic donor information management system as outlined in the SOPs. Understands policies and procedures associated with hyper immune programs at the center if applicable. Maintain clean efficient work environment, and ensure sufficient operating supplies and forms are available. Comply with all Health Safety and Environmental (HSE) and Occupational Safety and Health Administration (OSHA) policies and procedures. May conduct routine internal procedures and documentation audits. Promote safety in all actions. Maintain confidentiality of personnel, donor, and center information. Will be cross-trained in all technical areas and other functions to meet the needs of the business. Bilingual skills may be required, at the discretion of the organization, to meet the needs of the business Perform other job-related duties as assigned. Provide minimum hiring requirements, specialized knowledge, and other considerations required Physician OR New York Licensed Clinical Laboratory Technologist with 6 years clinical laboratory experience subsequent to qualifying, with at least 2 years working in a clinical laboratory with a director at the doctoral level OR Masters Degree in a chemical, physical or biological science with 4 years laboratory experience, subsequent to graduation, in which not less than 2 years have been in the laboratory specialty in a clinical laboratory with a director at the doctoral level OR Doctoral Degree in chemical, physical or biological science with 2 years experience, subsequent to graduation, in one of the laboratory specialties in a clinical laboratory or blood bank having a director at the doctoral level OR Cytotechnologist with 4 years experience in cytotechnology subsequent to qualifying in a laboratory with a director at the doctoral level in cytopathology For individuals first qualifying prior to April 1, 1972, an exception to the requirements may be made if: (1) The supervisor was performing the duties of a clinical laboratory supervisor at any time between July 1, 1961 and September 1, 1971; and (2) the supervisor has had at least 15 years of pertinent clinical laboratory experience prior to September 1, 1971: provided, that a minimum of 30 semester hours of credit toward a bachelor's degree with a chemical, physical or a biological science as his major subject; or 30 semester hours in an approved school of medical technology shall reduce the required years of experience by two years, with any additional hours further reducing the required years of experience at the rate of 15 hours for one year; And (3) he has performed the duties of a supervisor for at least two years during the qualifying 15 years in: (i) A clinical laboratory having a director at the doctoral level, of a hospital, university, health department or medical research institution; or (ii) in a laboratory approved under the Medicare supplementary medical insurance program, provided also, that where qualifying years in a laboratory described in subparagraph (i) of this paragraph are obtained after January 30, 1969, the laboratory meets applicable conditions under the Medicare health insurance program, or, under title 42, Code of Federal Regulations, part 74, the latter being the regulations issued pursuant to the Federal Clinical Laboratories Improvement Act of 1967. Minimum 1 year supervisory, leadership experience responsible for overseeing the activities of others required. Clinical laboratory or blood bank experience shall be part of a hospital, university, health department, medical research institution or other institution, which provides equivalent training. If qualified, may also function as Lab Director Shares information with internal contacts with common desire to reach a solution Ability to make decisions, which have moderate impact on immediate work unit. Must be able to see and speak with customers and observe equipment operation. Occasionally perform tasks while standing and walking up to 100% of time Reach, bend, kneel and have high level of manual dexterity Occasionally be required to lift and carry up to 25 pounds Fast paced environment with frequent interruptions Frequently exposed to hazardous chemicals, extreme temperatures and to blood borne pathogens. Required to wear Personal Protective Equipment while performing specific tasks or in certain areas Required to work overtime and extended hours to support center operational needs Apply at: https://csl.wd1.myworkdayjobs.com/en-US/CSL_External/job/Americas-US-NY-Schenectady-229-CSL-Plasma/R-058266-Center-Lab-Supervisor-NY-State-License-Required_R-068016 Note: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, disability, veteran status, national origin or other legally protected classifications. ()
          

Chronique de l’opposition mondiale à la 5G en 2019: Comment les télécoms sont en train de perdre la bataille pour imposer la 5G contre la volonté de la population

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Une série de photos du photographe américain Eric Pickersgill montre des gens regardant l’endroit où se trouve normalement leur téléphone

Tous les faits consignés ici sont appuyés par des hyperliens vers les documents, articles ou vidéos d’origine, où les lecteurs


          

Executive: Associate, Financial Management (State and Local ) - Albany, New York

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Business Title: Associate, Financial Management (State and Local Govt)Requisition Number: 47474 - 61Function: AdvisoryArea of Interest:State: NYCity: AlbanyDescription:Known for being a great place to work and build a career, KPMG provides audit, tax and advisory services for organizations in today's most important industries. Our growth is driven by delivering real results for our clients. It's also enabled by our culture, which encourages individual development, embraces an inclusive environment, rewards innovative excellence and supports our communities. With qualities like those, it's no wonder we're consistently ranked among the best companies to work for by Fortune Magazine, Consulting Magazine, Working Mother Magazine, Diversity Inc. and others. If you're as passionate about your future as we are, join our team.KPMG is currently seeking an Associate in Financial Management for our Consulting practice.Responsibilities: Participate in large scale financial transformation efforts that focus on delivering operational, technical, and/or product development change, such as system and operational conversions, enhancements, process re-engineering, and new product development Utilize program level processes, controls, or tools utilized to manage a large scale banking initiative or merger and integration such as Project Management Office Manage a project lifecycle including assisting with scope definition, business case development, vendor assessment, requirements gathering, functional and technical design, testing, training, and implementation phases Develop and sustain solid relationships with client personnel and identify opportunities to provide additional services Contribute to design, preparation, and analysis of reports and findings in a clear, logical, and concise mannerQualifications: A minimum of one year of diversified experience in financial management or analysis Bachelor's degree from an accredited college/university, CPA is preferred Experience in working with state and local governments strongly preferred Moderate Project Management or Project Management Office experience in support of a large scale change initiative Excellent written and verbal communication and presentation skills with the ability to create and sustain meaningful client relationships Proficiency in Microsoft Word, Excel, PowerPoint, Microsoft Project, SAP, Cognos and/or Hyperion Travel may be up to 80-100% Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the futureKPMG LLP (the U.S. member firm of KPMG International) offers a comprehensive compensation and benefits package. KPMG is an affirmative action-equal opportunity employer. KPMG complies with all applicable federal, state and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other category protected by applicable federal, state or local laws. The attached link contains further information regarding the firm's compliance with federal, state and local recruitment and hiring laws. No phone calls or agencies please.GL: 6GF: 15292 ()
          

Molecular mechanisms in skeletal muscle underlying insulin resistance in women who are lean with polycystic ovary syndrome

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Molecular mechanisms in skeletal muscle underlying insulin resistance in women who are lean with polycystic ovary syndrome

Hansen, S. L., Svendsen, P. F., Jeppesen, J. F., Høeg, L. D., Andersen, N. R., Kristensen, J. M., Nilas, L., Lundsgaard, A-M., Wojtaszewski, J., Madsbad, S. & Kiens, B., 2019, In : Journal of Clinical Endocrinology and Metabolism. 104, 5, p. 1841-1854 14 p.

Research output: Contribution to journalJournal articleResearchpeer-review

Context: Skeletal muscle molecular mechanisms underlying insulin resistance in women with polycystic ovary syndrome (PCOS) are poorly understood.

Objective: To provide insight into mechanisms regulating skeletal muscle insulin resistance in lean women with PCOS.

Participants and Methods: A hyperinsulinemic-euglycemic clamp with skeletal muscle biopsies was performed. Thirteen lean, hyperandrogenic women with PCOS and seven age- and BMI-matched healthy control subjects were enrolled. Skeletal muscle protein expression and phosphorylation were analyzed by western blotting and intramuscular lipid content was measured by thin layer chromatography.

Results: Women with PCOS had 25% lower whole body insulin sensitivity and 40% lower plasma adiponectin concentration than control subjects. IMTG (intramuscular triacylglycerol), sn-1.3 DAG (diacylglycerol) and ceramide contents in skeletal muscle were higher (40%, 50%, and 300%, respectively) in women with PCOS than control subjects. Activation of insulin signaling did not differ between groups. In women with PCOS, the insulin-stimulated glucose oxidation was reduced and insulin-stimulated dephosphorylation of PDH (pyruvate dehydrogenase) Ser293 was absent. AMPK (AMP-activated protein kinase) α2 protein expression and basal Thr172 phosphorylation were 45% and 50% lower in women with PCOS than control subjects, respectively.

Conclusion: Whole body insulin resistance in lean, hyperandrogenic women with PCOS was not related to changes in the proximal part of the insulin signaling cascade in skeletal muscle despite lipid accumulation. Rather, reduced insulin sensitivity was potentially related to plasma adiponectin levels playing a modulating role in human skeletal muscle via AMPK. Furthermore, abnormal PDH regulation may contribute to reduced whole body metabolic flexibility and thereby insulin resistance.

Original languageEnglish
JournalJournal of Clinical Endocrinology and Metabolism
Volume104
Issue number5
Pages (from-to)1841-1854
Number of pages14
ISSN0021-972X
DOIs
Publication statusPublished - 2019

          

5 Konami Coin-Op Hits (Compilation)

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5 Konami Coin-Op Hits  (Compilation)
CONDITION:- GREAT
COMPATIBILITY:- ZX SPECTRUM 48K / 128K RANGE
FORMAT:- CASSETTE x 2
CASE/BOX TYPE:- DOUBLE CASSETTE / JEWEL

 

 Quick description

SUPERB compilation, containing FIVE absolute classic Imagine conversions of hit Konami games, including the absolute cult classics, GREEN BERET and MIKIE!:-

 

GREEN BERET

MIKIE

PING PONG

HYPER SPORTS

YIE AR KUNG-FU


          

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ADHD and Autism Share Changes in Same Genes

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Autism and attention-deficit hyperactivity disorder (ADHD) share changes in the same genes, according to researchers from iPSYCH, Denmark’s largest psychiatry research project. In Denmark, approximately one percent of schoolchildren have...
          

SPACE/The Anthology (6CD Box Set) review!

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SPACE
THE ANTHOLOGY: 
FIVE STUDIO ALBUMS, B-SIDES, AND RARITIES (6CDs)
(Edsel Records)

Available NOW!



Space was the first – and, so far, only - “Multi-Dimensional Cinematic Technicolor Pop Band”. Hailing from Liverpool, it’d be easy to compare them to The Beatles, OMD, The La’s, The Icicle Works, Deaf School, Echo & The Bunnymen, Yachts, and any other great band that came from that small but influential part of the world.  However, Space sounds nothing like any of those artists... or anyone else for that matter. To be honest, their uniqueness bas been both a blessing and a curse. Ask Space fans what the band means to them and most of the time, each answer will be different. However, a band that always challenges itself - and musically evolves with each album release - may not be as appealing to a mass commercial audience. Space is a band ten steps ahead of the charts and it doesn’t seem that anyone has quite caught up with them yet.

Some artists are content to focus on one genre at a time but not Space. In any given song, you will find guitarist/bassist/vocalist Tommy Scott crooning a melody inspired by the ‘60s, keyboardist FrannyGriffiths exploring different eras of Electronica, guitarist/vocalist Jamie Murphy bashing out some power chords and classic Rock ‘n’ Roll-influenced riffs/licks, and solid rhythms from bassist Yorkie Palmer, and drummers Andy Parle and Leon Caffrey providing simple yet sophisticated rhythms. Surprisingly, they all remain on the same musical page and everything fits together perfectly. On the surface, Space is a slightly odd but undeniably melodic Pop band but peel away the layers and you’ll discover a band like no other. Oh, and did I mention that they have a very wicked sense of humor? Space most certainly threw out the Pop and Rock rule books and just did whatever the hell they wanted.


Space’s career is now being celebrated with a six CD box set from Edsel entitled THE ANTHOLOGYwhich contains their first five studio albums – including their previously unreleased third album LOVE YOU MORE THN FOOTBALL - as well as a slew of non-album tracks. While the band has a seemingly endless supply of remixes and single edits, this box set's bonus material wisely overlooks them and focuses on the more desirable non-album songs.  For collectors and Space novices alike, this box set is a brilliant introduction to a musical career that continues to surprise fans this very day.


SPIDERS (1996) is the band’s debut album and the only full-length released in the States. The band’s enormously popular “Female Of The Species” is their best-known track in the U.S. but the album includes plenty of gems that are just as adventurous as that fantabulous single. “Dark Clouds” is a sweeping Dance/Rock tune with Disco influences and flourishes of Flamenco added into the mix. “No One Understands” sounds like a Prog Rock tune recorded on a carousel. “Neighborhood” explores the darker side of life with such musical glee. And that is just a tip of the iceberg. One of the most engagingly eclectic albums to ever spawn some equally delightful UK hit singles.  (Disc One contains the album plus six bonus tracks)


TIN PLANET(1998) is even better. Slightly moving away from their tendency to experiment, the band turns up the melodic hook quota and offers a more refined – but still unique – approach to their music. “Avenging Angels” sounds like it could have been a James Bond theme and remains one of their finest moments. “The Ballad Of Tom Jones” is a twisted love song featuring a duet between Tommy and Cerys Matthewsfrom Catatonia. “Be There” has quirky verses but a chorus that could fit onto a ‘60s Easy Listening compilation. “The Unluckiest Man In The World” has a Madness swagger and swings like a Sinatra classic. “Bad Day’s” is quite beautiful, influenced by classic Glen Campbell but turned completely on its head with some twanging guitar and quirky lyrics. “Disco Dolly” is Punk Rock Electronica. TIN PLANET is a big step forward for the band and is a classic Pop album on almost every level. (Disc Two contains the full album plus six bonus tracks including their classic cover of “We Gotta Get Out Of This Place”)


LOVE YOU MORE THAN FOOTBALL (2000) is their legendary unreleased third album. Due to problems with the label, the album was shelved. Although a few tracks have surfaced on various ‘hits’ collections, this is the first time the full album has been released physically. Sounding like a kinder, gentler TIN PLANET,it is a shame that the album was never released because it surely would have given the band a few more hits. Mostly produced by Edwyn Collins, the album offers up a buffet of great tracks. While Franny is certainly providing plenty of atmosphere, the album is far less electronic and even more focused on classic songwriting than ever before. The previously-released “Diary Of A Wimp” is an absolute Pop classic and should have been a massive hit.  “Good Times” is yet another melodic gem, an optimistic anthem with some Hawaiian sweetener added to the mix. “Gravity” is a moody anthem with a soaring chorus. “Raymond” finds the band exploring Rockabilly. “Supersonic Jetplane” and “Despise” are delightfully delicious. “Juno 54” is a Disco-influenced instrumental with some vocals floating in and out of the mix. The only misstep is opening the album with “Everybody In The Madhouse”, a fine Techno-driven rocker that seems wildly out of place on the album. LOVE YOU MORE THAN FOOTBALL is their most accessible and rewarding album and the fact that it remained unreleased for 19 years is a travesty. A truly magnificent album that deserves to be heard. (Disc Three features the original album with no bonus tracks.)


SUBURBAN ROCK ‘N ROLL(2004) finds the band bloodied and bruised from the experience with their previous label, yet not even close to being broken. The first release after the departure of Jamie Murphy, this is an album that is a little darker than their previous releases yet they rebound with a great batch of songs. Still traveling down many musical paths at the same time, the album was produced by Stephen Lironi,who twiddled the knobs for SPIDERS. SUBURBAN ROCK ‘N ROLL isn’t SPIDERS, Part 2, though. The album is melodic, clever, and created by a band that still has plenty to say. More personal than their previous releases, this is an album that should have been heard by more people. However, working within the limitations of an independent label, the album didn’t reach as wide of an audience as their first two albums. With that being said, there are plenty of Space nuggets to be found here including “Zombies”, “Paranoid 6Teen”, “Punk Rock Funeral”, “20 Million Miles From Earth”, and the title track. Space survived the record industry and more than proved their worth on this platter. Sadly, they disappeared shortly after the album’s release. (Disc Four includes the entire album plus four bonus tracks including “Play The Songs”, one of those songs that are so good, you wonder why it didn’t make the album.)


ATTACK OF THE MUTANT 50FT KEBOB (2014) sees the return of Tommy and Franny with a new Space line-up and another set of cracking tunes. Ten years is a long time between albums but this release sounds like the natural follow-up to SUBURBAN ROCK ‘N ROLL. However, the lyrics make it seem like there may have been a few LSD trips into the world of ‘50s monster movies during their decade away. Song titles like “She’s In Love With The Boy In A Bodybag”, “Guest List To Hell”, “Day Of The Dead”, and “Attack Of The Mutant 50ft Kebab” seem to take the songs into previously uncharted territories. In reality, the band has already played with these types of lyrical images in the past but they seem to more prominent on the album. With Rock, Indie Rock, Ska, and Pop on display, this is just as wonderfully strange as their previous albums and a marvelous return for a band that still deserves your love and affection. (Disc Five contains the full album – in slightly different order than the original release – plus two bonus tracks.)


Disc Six in this box set contains additional non album tracks including cuts taken from their pre-Franny debut EP as well as songs from their online MUSIC FOR ALIENSseries. And yes, all of the tracks are must-have additions to your Space collection.
  
The Space story didn’t end there. There is a 2017 album entitled GIVE ME YOUR FUTURE that is not included in this box but has proven to be difficult to track down (I’m STILL looking for it - Spaz). Hopefully, we can look forward to more music from a band that has been overlooked here in the States. This box set should change things. Stop what you are doing and spin some Space!

Your pal,
Stephen SPAZ Schnee





          

Arkona - Age of Capricorn (2019)

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cover

Just when you think that 2019 can’t get any better in terms of Black Metal release, Polish Arkona decides to drop their triumphant release “Age of Capricorn”. Delivering one of the most savage and yet melodic and refined BM releases of the last decade, we are treated to over 46 minutes of vicious music. If you are a fan of the genre that wants both relentless aggression and high-octane atmospherics, this is the best album you can get in 2019.

After a creepy intro with some eerie samples, “Stella Inferno” quickly unleashes grim riffs and bestial drums. This track is both atmospheric and in your face, blowing past your eardrums and rattling your brain as Khorzon and company spew their madness. The playful synths perfectly combine with the blistering pace of the demonical “Alone Among Wolves”. As if the BM aural assault wasn’t enough, some super creepy wolf samples add and insane amount of depth and vigor to this track.

The band’s musical savagery reaches new levels with the demoralizing album title track. Perfectly blending atmosphere with inhuman screams, layered guitars and hyper fast drums, this track is what hellish dreams are made of. Coming off such a high from the previous song, tracks like “Deathskull Mystherium” and “Towards the Dark” do not give the listener any room to breath with even more powerful waves of riffs, haunting atmospherics, and a furious pace.

As this release dawns to a close with the bestial “Grand Manifest of Death”, we can’t really recover from such a precisely crafted savage onslaught of both brutality and atmosphere. While most bands focus their energy on a limited aspect of their sound, Arkona has truly mastered all their influences together in one massive and cohesive sound. If you are not afraid of aural savagery, move forward and check out this magnificent release.

Band: Arkona Album: Age of Capricorn

Label: Debemur Morti Productions

Release: December 13th, 2019

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Genre: Black Metal

Country: Poland

Rating: 97/100
Year: 
Genre: 

          

Hypervolt: Essential Techno Electro Mix (2019)

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Hypervolt: Essential Techno Electro Mix (2019)

Для любителей Техно Электроники , а так же музыкальных гурманов новая подборка фантастических треков последнего месяца. Модное звучание и необходимый минимум инструментов – этого достаточно, чтобы народ на танцполе не сбился с ритма и продолжал активно двигаться в такт приятной и лёгкой музыке!

Исполнитель: Various Artist
Название: Hypervolt: Essential Techno Electro Mix
Жанр музыки: Techno, Electro
Дата релиза: 2019
Количество композиций: 130
Формат | Качество: MP3 | 320 kbps
Продолжительность: 13 :38 :46
Размер: 1760 mb (+3% )
          

Fernando Alonso y la extraña vía de regreso a McLaren

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El asturiano estudia "la Indy" para 2020 y "la F1 o los 'hypercar' en 2021" y Zak Brown tiene un sitio para él en dos de esas tres opciones.
          

Arthrofibrosis of the knee

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                                   Arthrofibrosis of the knee



                                          Dr KS Dhillon


What is arthrofibrosis of the knee?

Spraque et al [1] were the first to describe knee arthrofibrosis in 1982. Arthrofibrosis refers to the development of excessive fibrotic tissue or adhesions within and around a joint which leads to limitation of movements of the joint. In the knee, the adhesions occur anteriorly in the infrapatellar fat pad, the pretibial recess, the suprapatellar pouch, medial and lateral gutters, posteromedial and posterolateral capsule. The clinical spectrum of this varies widely, ranging from localized to diffuse involvement of all compartments of the knee and of the extra-articular soft tissues around the knee.

Etiology of knee arthrofibrosis

There are several causes of knee arthrofibrosis and these include:

1.Soft-tissue Injury

The severity of soft-tissue injury, multi-ligamentous injury, severity of bony injury and dislocations of the knee, all play a role in the pathogenesis of arthrofibrosis.

2.Infection

Knee infections lead to the production of intraarticular inflammatory mediators which in turn produce synovitis and toxic degeneration of the articular surface. Local cytokine activation leads to fibrous scar formation.

3.Knee joint immobilization

Knee immobilization for ligament and bony injury as well as immobilization following knee surgery is a well-established risk factor for arthrofibrosis.

4.Timing of Surgery

Acute knee injuries need to be treated on admission to the hospital. Reconstructive surgery should be delayed until recovery from the acute injury has occurred. Timing of reconstructive surgery of the knee remains controversial. Majority of the authors recommend a delayed reconstruction of knee ligaments at 3 weeks. This delayed allows time for soft-tissue healing, resumption of full ROM, and improved strength. Reconstruction of knee ligament in the acute phase is associated with an increased incidence of arthrofibrosis [2,3,4].

5.Extra-articular and intraarticular procedures

Open arthrotomy and periarticular operative procedures such as collateral ligament repair as well as capsular surgery are known to cause arthrofibrosis. Multiple ligament reconstruction of the knee is also a known risk factor for arthrofibrosis. Graft malposition during ligament reconstruction can also lead to arthrofibrosis.

6.Genetic risk factors

Some patients develop arthrofibrosis despite efforts to reduce or eliminate the aforementioned risk factors. This has led some researchers to believe that there may be some genetic predisposition to arthrofibrosis after injury.

7.Complex regional pain syndrome

Complex regional pain syndrome also known as reflex sympathetic dystrophy inhibits effective patient participation in proper postoperative rehabilitation. As a result of the pain, quadriceps inhibition occurs leading to muscle atrophy and reduced joint mobility which in turn leads to arthrofibrosis.

Pathophysiology of arthrofibrosis

Locally acting growth factors and cytokines signals, control tissue organization and homeostasis in the human body. The cytokines coordinate cell growth, differentiation, and programmed cell death. This is done through constant signals which are sent between local cells (paracrine) and among themselves (autocrine). Platelets release transforming growth factor-β (TGF-β) and this growth factor plays an important role in tissue repair [5]. At the site of injury, the growth factor
initiates a series of events that result in the production of extracellular matrix proteins and protease inhibitors. Proteolytic enzyme production is also inhibited. An increase in the concentration of extracellular matrix at the site of injury results in TGF-β feedback inhibition. Excessive expression of TGF-β results in progressive deposition of matrix and tissue fibrosis [6].

Clinical presentation

Patients with arthrofibrosis of the knee can present with knee stiffness, pain, limping, warmth, swelling, crepitus, and/or weakness [7]. Loss of motion is the main symptom of knee arthrofibrosis. There can be a loss of flexion, loss of extension or loss of both flexion and extension.
Shelbourne et al [8] described a classification system based on the pattern of knee stiffness.

  • Type I. Patients have normal flexion and less than 10-degree extension loss.
  • Type II. Patients have normal flexion and more than10-degree extension loss.
  • Type III. Patients have more than a 10-degree extension loss and a more than a 25-degree flexion loss with patella tightness.
  • Type IV. Patients have an extension loss of more than 10 degrees and 30 degrees or more loss of flexion with patella infera with marked patella tightness.


Del Pizzo et al [9] classified knee arthrofibrosis based on deviation from full extension and amount of flexion present:

  • Mild: less than 5° loss of extension, flexion more than 110° 
  • Moderate: 5°–10° loss of extension, flexion between 90°–100° 
  • Severe: More than 10° loss of extension, flexion less than 90° 


Paulos et al [10] were the first to describe infrapatellar contraction syndrome (IPCS). In patients with IPCS, there is a significant reduction of both flexion (>25°) and extension (>10°) with a decrease in patellar mobility which is characterized as patellar entrapment. IPCS is caused either by an exaggerated pathologic fibrous hyperplasia of the anterior soft tissues of the knee or certain risk factors associated with knee surgery such as poor graft isometry, joint immobilization, and muscle weakness.

Paulos et al [10] divided patients with IPCS into three stages namely the prodromal, active, and residual stages.

In the prodromal stage, there is periarticular inflammation, oedema, weakness of the quadriceps, extension lag, painful movements and tenderness over the patellar tendon with decreased patellar excursion.

In the active stage, there is a marked decrease in patellar mobility, severe quadriceps atrophy, worsening knee motion, and induration of the fat pad with a rigid patellar tendon.

In the residual stage, the peripatellar and retinacular tissues are more
supple than in the active stage and there is marked quadriceps atrophy with loss of knee flexion and extension.

The diagnosis of joint arthrofibrosis is clinical. It is made after excluding other causes of knee stiffness. There are no radiological investigations which can confirm the diagnosis. Arthroscopy can confirm the diagnosis but it is not warranted for diagnosis. Tissue biopsy is also not required to make the diagnosis.

The average genu recurvatum is 5 degrees for males and 6 degrees for females, and the average knee flexion is 140 degrees for males and 143 degrees for females [11]. Studies have shown that 67 degrees of knee flexion is required in the swing phase of walking, 83 degrees to ascend stairs, 90 degrees to descend stairs, and 93 degrees to rise from a standard chair [12]. Loss of knee flexion is usually better tolerated than the loss of knee extension. Even small discrepancies in extension are associated with increased energy consumption during gait and extension loss can cause undue strain on the quadriceps musculature and the patellofemoral joint [13].

Ligament reconstruction is probably the most common cause of arthrofibrosis. The incidence of knee stiffness after ligament reconstruction varies between 4% to 35% [14]. Shapiro and Freedman [15] reported a 57% incidence of knee motion loss in patients undergoing combined anterior cruciate ligament and posterior cruciate ligament reconstructions.

IPCS is the most serious form of arthrofibrosis which can complicate ligament reconstructions. The natural history of an anterior cruciate ligament-deficient knee is much more benign than the natural history of a knee that develops IPCS [10].

Treatment of knee arthrofibrosis


1.Immediate Postoperative Motion

Following knee ligament injury and knee surgery, all efforts must be directed at prevention arthrofibrosis and consequent loss of motion. Prolonged immobilization should be avoided and immediate active and passive range of motion exercises should be started.

Noyes et al [16] was able to show a good outcome with postoperative immediate knee motion and early intervention in patients who had ACL reconstruction. In a prospective study, 93% (413 of 443) of their patients regained full ROM (0º to 135º) with the use of active and passive knee exercises in the immediate postoperative period. Of the 30 patients who did not regain full range of movements, 23 were subjected to a postoperative treatment regime which included hyperflexion and hyperextension exercises and serial extension casting. Eight patients who did not respond to cryotherapy, NSAIDs, elevation, and compression were given oral steroids. In refractory cases, manipulation under anesthesia, physical therapy, and arthroscopic débridement were performed. At the end of treatment, 98% of their patients regained full knee motion, 2% had minor extension limitations, less than 1% required arthroscopic release of adhesions, and no patient developed permanent arthrofibrosis.


2.Postoperative Knee Bracing

A rehabilitation brace is commonly used after ACL reconstruction although its use is controversial. Majority of the surgeons use a brace for about 4 weeks after ACL reconstruction [17].

Melegati et al [18] carried out a prospective study to assess the role of the rehabilitation brace in restoring knee extension after anterior cruciate ligament reconstruction. They compared the outcome in two groups of patients. In one group the knee was braced from 0° to 90° and in the other group the knee was locked in full extension during the first week after ACL reconstruction. They found that patients who were braced in full extension for the first week postoperatively had a lower heel-height
differences at 4 and 8-week followup as compared to patients whose brace was unlocked twice daily for physiotherapy.

Mikkelsen et al [19] in a randomized prospective study showed that patients braced in 5 degrees hyperextension had less extension deficits as compared to patients whose knee was immobilized in full extension (0°) after ACL reconstruction. The outcome was measured 3 months after the surgery. The authors concluded that the use of a knee brace in hyperextension for at least 3 weeks after ACL reconstruction is an effective way of preventing postoperative extension loss.

3.Manipulation of knee under anesthesia

Dodds et al [20] reported the results of knee manipulations in 42 knees which had persistent flexion or extension deficits after ACL reconstruction. The manipulation was done at an average of 7 months (range, 3 to 14 months) following the reconstruction and the average follow up was 26 months (range, 6 to 56 months). After manipulation, the average flexion was increased from 95 degrees to 136 degrees and average extension from 11 degrees to 3 degrees. The outcome after manipulation was proportional to the severity of extension loss before manipulation. Patients with greater extension deficits achieved less overall final extension. They were able to achieve improvement in both flexion and extension in 86% of the knees. The authors of this study recommended manipulation within 12 weeks of ACL reconstruction. There are other authors who recommend manipulation within 4 to 12 weeks of reconstruction. Overaggressive and significant delay in manipulation can result in complications such as chondral damage, distal femur or patella fracture, patellar tendon rupture, quadriceps myositis ossificans and ossification of the MCL.

Consensus has been reached that MUA should be carried out between three and six months post-operatively and MUA is not indicated after 6 months [21].

4. Surgical treatment


A.Arthroscopic treatment

Arthroscopic debridement or arthrolysis is often successful in treating arthrofibrosis. The procedure can be carried out on an outpatient basis. A careful and thorough inspection of all compartments is carried out.

First, the suprapatellar pouch is cleared of adhesions followed with the medial and lateral gutters. The infrapatellar fat pad is then debrided and the recess between the patellar tendon and anterior tibia be reestablished.

In patients with excessive scarring and patellar entrapment, the medial and lateral retinacula are released.

In patients with limitation of extension clearance of the notch and notchplasty will be necessary. In some patients with limitation of extension, posteromedial and posterolateral capsular release may be necessary.

Aglietti et al [22] carried out a prospective study of 31 knee arthrolysis which were performed for loss of motion after anterior cruciate ligament reconstruction. The arthrolysis was carried out at an average of 10.6 months after the reconstruction (range 4-25 months). Twenty-one knees had arthroscopic and 10 had open surgery. In most knees suprapatellar, medial, and lateral gutter adhesions were removed and in 7 knees posteromedial and/or posterolateral capsulotomy was necessary. The ACL graft was nonfunctional and malpositioned in 19 knees.

The average follow up after arthrolysis was 3.5 years (range 1.5-7). Satisfactory outcome was obtained in only 37% of the knees. The authors found that arthrolysis performed within 8 months from index operation had a better outcome.

Cosgarea et al [23] carried out a retrospective analysis of 43 knees in 37 patients who had previous ligament surgery and developed postoperative arthrofibrosis. The average follow up was 3.6 years. Arthrolysis was carried out when there was flexion or extension deficits of equal to or more than 10 degrees or when motion failed to improve despite 2 months of intense therapy. Though flexion improved from 83% to 97% of the contralateral side and extension deficits improved from 14 degrees to 3 degrees, only 62% achieved satisfactory functional results. They found that lysis carried out sooner then 6 months had a better outcome.

Fisher et al [24] reported good outcome of arthroscopic excision of abundant tissue in the anterior tibiofemoral joint which caused an extension block after open ACL reconstruction. They had forty-two patients in their series and all patients had marked improvements in function and symptoms especially in activity-related anterior knee pain, crepitus at terminal extension, and knee stiffness.
Klein et al [25] reported the outcome of arthroscopic management of postoperative arthrofibrosis in 46 knees. The gain in range of motion was excellent in 54.5%, good in 21.7%, and fair and poor in 23.8%. Reduction of pain occurred in 80.4% of the patients. Patient satisfaction was excellent or good in 56.5%, fair in 39.1% and poor in 4.3%of the patients.

B.Open Debridement and Soft Tissue Release

Open debridement and soft tissue release is sometimes required in patients with severe scarring and in patients who have failed less-invasive approaches. Open surgery is usually required in patients with chronic motion problems who have long-standing extension deficits and generalized arthrofibrosis. In such patients, open surgery is usually a salvage procedure [26].

When extensive extra-articular calcification is present, open excision has to be carried out to restore knee motion. When extensive intra-articular fibrosis is present an anteromedial approach is used to completely debride all fibrous scar tissue anteriorly and posteriorly in the joint. Sometimes lateral retinacular release is needed to mobilize the patella. Following the surgery meticulous hemostasis has to be achieved to prevent a postoperative hematoma, which can lead to arthrofibrosis.

Millett et al [26] carried out a retrospective review of eight knees in 8 patients who had open debridement soft tissue release for extensive intraarticular and periarticular fibrosis of the knee. The average preoperative range of motion was 62.5° (flexion 81°, loss of extension 18.8°). The motion improved to an average of 124° after surgery. The average flexion improved from 81° to 125° and the loss of extension improved from 18.8° to 1.25°. Functional outcome was good and patient satisfaction was high.

Lobenhoffer et al [27] carried out a prospective study of 24 patients who were treated with arthroscopic arthrolysis and open posterior capsulotomy for flexion contractures of the knee. Twenty-one patients were available for review with a mean follow-up of 18 months (range 6–38 months). The mean preoperative extension deficit was 17° (range 10–30°). The postoperative extension improved to a mean value of 2°. None of the patients had more than 5° of extension deficit at follow-up. The knee function improved significantly with a Lysholm Score 62 preoperatively and 88 postoperatively 88 and the Tegner Scale 2.2 preoperatively and 4.0 postoperatively.

Tardy et al [28] carried out a retrospective study to assess the outcome arthroscopic anterior debridement and open posterior medial and lateral capsular release in twelve patients who presented with a chronic flexion contracture of 10° or more after ACL reconstruction. The average follow-up period was 38months (range 6 to 90 months). All patients except one (93%) achieved complete extension. Only one patient (7%) had a residual postoperative flexion deformity of five degrees. The range of motion improved significantly after arthrolysis. There were no postoperative complications. The post-operative objective IKDC scores, subjective IKDC scores, Knee injury and Osteoarthritis Outcome Score (KOOS), pain score, symptoms scores, ADL scores, sports activities scores and quality of life scores all improved. The mean patients' satisfaction was 9.25±0.6 (SD) out of 10 after arthrolysis.

The authors concluded that open posterior release with both posteromedial and posterolateral approaches is a safe and efficient procedure in patients with persistent flexion contracture.
Wierer et al [29] carried out a study to evaluate the efficiency of an arthroscopic posterior capsule release for the treatment of persistent knee extension deficits following ACL reconstruction. The study included 10 patients with knee flexion contracture who had arthroscopic debridement and arthroscopic posterior capsular release.

The median follow-up period was 25months (range: 14 to 69months). The median preoperative extension deficit was 15° (range: 10 to 20°) and the median postoperative extension deficit was one degree (range: 0 to five degrees). The median Lysholm score improved from 52 (range: 32 to 67) to 92 (range: 84 to 100) postoperatively. The median Tegner Activity Level improved from three to six postoperatively. The median VAS status for pain decreased from five to one. There were no postoperative complications.

The authors concluded that arthroscopic posterior capsulotomy is a safe and effective procedure for treatment of knee flexion contractures.

Conclusion

Arthrofibrosis, the formation of extra and intra-articular excessive fibrotic tissue can result from knee injury, infection, extra and intra-articular surgical procedures, and joint immobilization.
Arthrofibrosis can present with knee stiffness, pain, limping, warmth, swelling, crepitus, and/or weakness. Loss of motion remains the main symptom of knee arthrofibrosis. Several classification systems for arthrofibrosis based on the pattern of knee stiffness are available.
Every effort should be taken to prevent arthrofibrosis because loss of knee movements especially extension can be very disabling. Several treatment options are available including knee mobilization exercises, bracing and manipulation of the joint under anesthesia. Failure of noninvasive treatment will warrant surgical treatment which includes arthroscopic or open arthrolysis and soft tissue release. The outcome of treatment is variable. Some of the older studies reported outcome of treatment which was not so good but some newer studies show a much better outcome of treatment.





References


  1. Spraque NF, O’Connor RL, Fox JM. Arthroscopic treatment of postoperative knee arthrofibrosis. Clin Orthop. 1982;166:165-172.
  2. Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M: Arthrofibrosis in acute anterior cruciate ligament reconstruction: The effect of timing of reconstruction and rehabilitation. Am J Sports Med 1991;19:332-336.
  3. Wasilewski SA, Covall DJ, Cohen S: Effect of surgical timing on recovery and associated injuries after anterior cruciate ligament reconstruction. Am J Sports Med 1993;21:338-342.
  4. Harner CD, Irrgang JJ, Paul J, Dearwater S, Fu FH: Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med 1992;20:499-506.
  5. Border WA, Noble NA: Transforming growth factor-beta in tissue fibrosis. N Engl J Med 1994;331:1286-1292.
  6. Magit D; Wolff A; Sutton K; Medvecky M. Arthrofibrosis of the Knee. J Am Acad Orthop Surg 2007;15:682-694.
  7. Fisher SE, Shelbourne KD (1993). "Arthroscopic treatment of symptomatic extension block complicating anterior cruciate ligament reconstruction". The American Journal of Sports Medicine. 1993; 21 (4): 558–64.
  8. Shelbourne KD, Patel DV, Martini DJ. Classification and management of arthrofibrosis of the knee after anterior cruciate ligament reconstruction. Am J Sports Med. 1996 Nov-Dec;24(6):857-62.
  9. Del Pizzo W, Fox JM, Friedman MJ, et al. Operative arthroscopy for the treatment of arthrofibrosis of the knee. Contemporary Orthopaedics 1985;10:67-72. 
  10. Paulos LE, Wnorowski DC, Greenwald AE: Infrapatellar contracture syndrome: Diagnosis, treatment, and long term followup. Am J Sports Med 1994;22:440-449.
  11. DeHaven KE, Cosgarea AJ, Sebastianelli WJ. Arthrofibrosis of the knee following ligament surgery. Instr Course Lect. 2003;52:369–381.
  12. Laubenthal KN, Smidt GL, Kettelkamp DB. A quantitative analysis of knee motion during activities of daily living. Phys Ther. 1972;52: 34–43.
  13. Perry J, Antonelli D, Ford W. Analysis of knee-joint forces during flexed-knee stance. J Bone Joint Surg Am. 1975;57: 961–967.
  14. Cosgarea AJ, Sebastianelli WJ, DeHaven KE. Prevention of arthrofibrosis after anterior cruciate ligament reconstruction using the central third patellar tendon autograft. Am J Sports Med. 1995; 23:87–92.
  15. Shapiro MS, Freedman EL. Allograft reconstruction of the anterior cruciate and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med. 1995;23:580–587.
  16. Noyes FR, Berrios-Torres S, BarberWestin SD, Heckmann TP: Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: A prospective study in 443 knees. Knee Surg Sports Traumatol Arthrosc 2000;8:196-206.
  17. Delay BS, Smolinski RJ, Wind WM, Bowman DS: Current practices and opinions in ACL reconstruction and rehabilitation: Results of a survey of the American Orthopaedic Society for Sports Medicine. Am J Knee Surg. 2001;14:85-91.
  18. Melegati G, Tornese D, Bandi M, Volpi P, Schonhuber H, Denti M: The role of the rehabilitation brace in restoring knee extension after anterior cruciate ligament reconstruction: A prospective controlled study. Knee Surg Sports Traumatol Arthrosc 2003;11: 322-326.
  19. Mikkelsen C, Cerulli G, Lorenzini M,Bergstrand G, Werner S: Can a postoperative brace in slight hyperextension prevent extension deficit after anterior cruciate ligament reconstruction? A prospective randomised study. Knee Surg Sports Traumatol Arthrosc 2003;11:318-321.
  20. Dodds JA, Keene JS, Graf BK, Lange RH: Results of knee manipulations after anterior cruciate ligament reconstructions. Am J Sports Med 1991;19:283-287.
  21. Kalson NS, Borthwick LA, Mann DA, Deehan DJ, Lewis P, Mann C, Mont MA, Morgan-Jones R, Oussedik S, Williams FM, Toms A, Argenson JN, Bellemans J, Bhave A, Furnes O, Gollwitzer H, Haddad FS, Hofmann S, Krenn V. International consensus on the definition and classification of fibrosis of the knee joint. Bone Joint J. 2016 Nov;98-B(11):1479-1488.
  22. Aglietti P, Buzzi R, De Felice R, Paolini G, Zaccherotti G. Results of surgical treatment of arthrofibrosis after ACL reconstruction. Knee Surg, Sports Traumatol, Arthroscopy. 1995; 3:83-88.
  23. Cosgarea AJ, DeHaven KE, Lovelock JE. The surgical treatment of arthrofibrosis of the knee. Am J Sports Med. 1994 Mar-Apr; 22(2):184-91.
  24. Fisher SE, Shelbourne KD. Arthroscopic treatment of symptomatic extension block complicating anterior cruciate ligament reconstruction. Am J Sports Med. 1993 Jul-Aug;21(4):558-64.
  25. Klein W, Shah N, Gassen A. Arthroscopic management of postoperative arthrofibrosis of the knee joint: indication, technique, and results. Arthroscopy. 1994 Dec;10(6):591-7.
  26. Millett PJ, Williams RJ III, Wickiewicz TL: Open debridement and soft tissue release as a salvage procedure for the severely arthrofibrotic knee. Am J Sports Med. 1999; 27: 552–561.
  27. Lobenhoffer HP, Bosch U, Gerich TG: Role of posterior capsulotomy for the treatment of extension deficits of the knee. Knee Surg Sports Traumatol Arthrosc. 1996; 4: 237–241.
  28. Tardy N, Thaunat M, Sonnery-Cottet B, Murphy C, Chambat P, Fayard JM. Extension deficit after ACL reconstruction: Is open posterior release a safe and efficient procedure? Knee. 2016 Jun;23(3):465-71.
  29. Wierer G, Runer A, Gföller P, Fink C, Hoser C. Extension deficit after anterior cruciate ligament reconstruction: Is arthroscopic posterior release a safe and effective procedure? Knee. 2017 Jan; 24(1):49-54 



          

Losing Sight of Jefferson and Falling into Plato

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The Death of Socrates, by Jacques-Louis David (1787)

 

Many professors at higher-level academic institutions profess to be practitioners of a Socratic method of teaching, which is a method of students arriving at understanding by a teacher “pestering” them with probing questions that lead to self-searching. Many, if not most, of such practitioners presume that the method facilitates true learning. Socratic teaching and learning are not reducible, in John Dewey’s words, to pouring information into the heads of students, but they are a matter of drawing out what is, in some sense, already there.

Socrates (469–399 B.C.) was one of Ancient Athens’ most unusual citizens. He professed a profound love of Athens insofar as he claimed he could never offer a return to Athens (or its citizens) as valuable as what he had, throughout his life, gained from the cosmopolitan polis.

 

What was unique about Socrates was his zetetic (seeking) manner of living. He renounced all pleasures other than the pleasure he experienced in searching for knowledge, which he said he never possessed. He claimed to be wise only inasmuch as he recognized that he, unlike other prominent Athenians, understood that he knew nothing, and thus, that human wisdom counted for nothing next to divine wisdom.

 

Never claiming to have any (real) knowledge—that is, knowledge of things substantive such as of the virtues piety, wisdom, justice, self-control, and courage—he spent his days throughout his life in pursuit of knowledge. His daily zetetic activity showed that he did not consider that activity fatuous. That demonstrates that he, at least, thought that acquisition of knowledge was humanly possible. Otherwise, his life would have been as pointless as searching to find great-tailed grackles, birds endemic to hot places like Texas, in Anchorage, Alaska.

 

Socrates’ method of pursuit was elenchus—a method of dialectic exchange in which the one chiefly in pursuit of knowledge, usually Socrates, asked an interlocutor a number of questions, pointedly articulated to get at the nature of a particular virtue, or even virtue in general.  After expostulation of an initial definition from an initial question—e.g., “What is virtue?”—questions would be crafted to expose insufficiencies in the proposed definition—e.g., “Whatever is just is virtuous” (Meno)—with the expectation of either refinement of the proposed definition or proposal of a different definition, in keeping with flaws in the definition, exposed by later questions.

 

The end of all such elenctic Socratic dialogs was aporia—a state of puzzlement or confusion which characterizes an interlocutor who came to recognize that he did not or might not know what he had thought he knew. In Plato’s Socratic dialogs, interlocutors in aporia often walk away in anger from Socrates, but sometimes walk away accepting that they must now seek the knowledge they hitherto thought that they had.

 

Socrates, Plato tells us in Apology, made few friends through his practice as he showed prominent Athenian politicians, poets, and craftsmen that they did not know the things they thought that they knew (things such as justice, piety, and beauty). He doubly irritated many, as the youth often imitated his methods. Hence, he was ultimately sentenced to death because of numerous charges, each reducible to corruption of the young.

 

Socrates was not supposed to be sentenced to death, for Athenian democracy was in the main largely tolerant of differences of opinion—even somewhat disruptive differences of opinion (consider Epicurus’ philosophical Garden, which placed just outside Athens, preached a minimalist sort of hedonism, through freedom from mental disquiet, ataraxia, and social withdrawal). Socrates merely could not promise to stop doing what was considered by many to be so disruptive of daily Athenian affairs—his daily dialectic.

 

There are too few genuine Socrateses in today’s higher education and even fewer students, willing to be challenged dialectically. Anyone who has taught in higher education for more than two decades has doubtless come to recognize that the “New Millennials” and even the generation beyond them, the students born in or after 2000, are difficult, if not impossible to teach. They are, in the words of Professor Elayne Clift, “devoid of originality, analytical ability, [and] intellectual curiosity.” She continues, “Having passed through a deeply flawed education system in which no one is paying attention to critical thinking and writing skills, they just want to know what they have to do to make their teachers tick the box that says ‘pass.’” All the other teachers do that.

 

Why? Students have an effective tool, rage, through a sense of academic entitlement, which many utilize as a security blanket. When they perform poorly, as they often tend to do, they blame their poor performance on poor teaching. Teachers, due to pressure aligned with need of strong evaluations, seldom challenge inculpation. They are too afraid of poor evaluations and direct complaints, which may readily result in loss of adjunct work or failure to attain tenureship. Many teachers, I believe, now sheepishly accept the notion that they, not the students, are the problem. Moreover, students are also in a position of power because they are viewed as consumers, and institutions are in the market to attract as many students each year as they can attract. Education is increasingly following the pattern of successful businesses, which follow the mantras: The more customers, the more money, and the customer is always right.

 

Socratic teaching in such a milieu is impossible, because it is designed principally to expose ignorance. Today’s students are entitled to a passing grade without working because they already know everything they really need to know. Each is a sun of his own solar system—no binary stellar systems here!—and the orbiting bodies orbit for the sake of that sun. Says Daniel Mendelson, “Perhaps because they have received more attention than any generation in the history of Homo sapiens, millennials seem to be convinced that every aspect of their existence, from their love lives to their struggles with reverse peristalsis, is of interest not just to their parents but to everyone else as well.”

 

Plato millennia ago saw the problem as one of pure democracy (demokratia). In a democracy, according to Plato in Republic, each person thinks of himself as the equal of all others in all ways. The city is full of freedom and free speech and everyone is free to do what he wants to do when he wishes to do it. Democracy, constitutionally, is a “supermarket of constitutions,” as it embraces all persons and all rules. “[A democrat], always surrendering himself to whichever desire comes along, lives as if it were chosen by lot” (557a–561b). 

 

Thomas Jefferson, of course, was aware of the pitfalls of democracy. There can be no such thing as a pure democracy over a large expanse of land, he avers, but only in a small parcel, such as a ward, where smallness of political space enables all to have an equal share in political matters. Hence, Jefferson, while in France, speaks to James Madison (30 Jan. 1787) of the need of representative government, where “the will of every one has a just [and not a direct] influence,” for affairs of state and country. Even with representative government, he continues to Madison, “the mass of mankind … enjoys a precious degree of liberty & happiness.” Nonetheless, “it has it’s evils too: the principal of which is the turbulence to which it is subject,” because of its embrace of freedom of expression.

 

Yet the pitfall of turbulence is often massively misconstrued or hyperbolized by scholars—e.g., Conor Cruise O’Brien. Jefferson writes thus in a letter to Madison (20 Dec. 1787) of Shays’ Rebellion, an event which horrified many, especially New Englanders. “The late rebellion in Massachusetts had given more alarm than I think it should have done. Calculate that one rebellion in 13 states in the course of 11 years, is but one for each state in a century & an half. No country should be so long without one.” Earlier in the same year (Jan. 30), he writes to Madison, “A little rebellion now and then is a good thing & as necessary in the political world as storms in the physical.” Some six years later (3 Jan. 1793), he writes to William Short of the sanguinary effects of the French Revolution: “My own affections have been deeply wounded by some of the martyrs to this cause, but rather than it should have failed, I would have seen half the earth desolated. Were there but an Adam and an Eve left in every country, and left free, it would be better than as it now is.” The bloodshed of a rebellion is, of course, abominable in the short term, but “this evil is productive of good. It prevents the degeneracy of government, and nourishes a general attention to the public affairs.” In sum, what appears as a pitfall of democracy on a large scale is really its great strength.

 

Jefferson did have an antidote—a means of preventing too many rebellions. That was periodic constitutional reform, effected through robust discussions by the people themselves. John Stuart Mill agrees. The strength of a vital democracy, Mill notes, is not only its tolerance of difference of opinions, but also the vitality with which it aims to iron out those differences through respectful, progressive debate. Robert Healey agrees: “Democracy is a means of determining courses of action through use of open and admitted conflict of opinion. Its ideal is not the achievement of a homogeneous society, but true cooperation, the working together of different people and groups who have deliberated with each other.” Thus, the aim of democratic thriving is citizens’ engagement with the institution through collisions of ideas. Those collisions are not purposeless, but aim at truth or at least heightened understanding of problems or issues in a solemn effort toward resolution.

 

Robust discussion is what is missing in the educative climate of the twenty-first century which worships a new, radical liberalism—toleration of diversity of opinion as an end, not as a means. The teaching milieu in the twenty-first century embraces tolerance of differences, but not progress with the aim of ironing out those differences through respectful debate—the Jeffersonian ideal behind periodic constitutional renewal. Thus, with disavowal of the Jeffersonian ideal, there is avowal of Plato’s concept of democracy in which freedom has become an end, and a deteriorative end, and not a means to an end—human flourishing.

 

We ought to strive today to recognize and aim at the Jeffersonian democratic ideal, not the Platonic degenerative conception. Within the ideal of Jeffersonian republicanism, there not only is room for Socratic methods of teaching, there also is need for Socratic methods of teaching. Why? It is, as Jefferson noted, better to have turbulent liberty than quiet servitude.


          

More Than You Know

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Enjoy the fun challenge of party trivia combined with the excitement of secretly wagering on the strengths and weaknesses of others!

More Than You Know


          

Zwuits Versatile Leather Bag

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Hazardous-chemical Free Versatile Leather Bag that can be Carried as a Messenger, Briefcase, and Backpack.

Zwuits Versatile Leather Bag


          

Ελληνική αγγελία για Ferrari La Ferrari που κοστίζει 3 εκατ. ευρώ (με ελληνικές πινακίδες)

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Η Ferrari La Ferrari είναι ένα σπάνιο αυτοκίνητο συλλεκτικής αξίας, το οποίο βρίσκεται στα χέρια συγκεκριμένων πελατών της Scuderia. To ιταλικό Hyper car εφοδιάζεται...
          

Dzień otwarty_05.12.2019 r.

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W czwartek, 05.12.2019 r. zapraszamy rodziców i opiekunów na spotkania z wychowawcami i nauczycielami.

godz. 16.00 klasa "0"C

godz. 17.00 klasy IV - VIII oraz "0"B
godz. 18.00 klasy I - III

Na stołówce w godz. 16.45 – 18.45 będzie dyżur firmy PrimaSort. Chętne osoby zapraszamy do rozmów z przedstawicielami ajenta.

Na parterze swe miejsce będzie miało stoisko kiermaszu świątecznego zorganizowane we współpracy z Radą Rodziców. Przypominamy, że całkowity dochód rozpocznie zdobywanie środków na rzecz WOŚP. Czekamy na Was !

Na parterze znajdzie się też punkt Rady Rodziców - prezydium zaprasza do współpracy, przypomina o dobrowolnych składkach i podkreśla , że zebrane fundusze służą tylko i wyłącznie dla naszych dzieci.

Przydział sal na spotkania z wychowawcami


          

Office Space for sale in Noida-Greater Noida Expressway, Noida

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www.propertywala.com
OFFICE SPACE SALE FOR IN GRANDTHUM
Bhutani Grandthum Highlights Retail & office spaces, hypermarket and food & beverage stores Sustainable green building design Situated in Noida Extension- the commercial hub of Noida Available in three tentative sizes- 500 sq. ft, 750 sq. ft, 1,000 sq. ft. Ample car parking ...
more details..
          

Bugaboo hyperpersonaliserar med ny Salesforce Commerce Cloud, Service Cloud och Sales Cloud kombination

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Under Dreamforce 2019 var ledande barnvagnsföretaget Bugaboo en av de nya referenscasen ...
          

Razing Storm: An Arcade Light Gun Game Built With PS3 Hardware

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Namco Bandai is no stranger to System 357. The PlayStation 3 based arcade hardware was chosen for Tekken 6. In spring 2009 it’s going to be used to power Razing Storm too. The newly announced light gun game is set in 2030 where your mission is to shoot terrorists in South America. A hyper vibrating machine gun controller is your weapon.   So what does the power of the System 357 board add to the game? It’s supposed to produce beautiful graphics on a 62 inch monitor. The screenshots are far from jaw dropping, but it looks like the environments […]

The post Razing Storm: An Arcade Light Gun Game Built With PS3 Hardware appeared first on Siliconera.


          

Empreinte Digitale - Reconnaissance faciale en Chine- iMAL en fête- Keypad et souris hyperspeed - 20/11/2019

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Reconnaissance faciale en Chine : La « techno-surveillance » est omniprésente. Témoignage du journaliste Gilles Quoistiaux : généralisation des caméras dans les rues, reconnaissance faciale pour faire des paiements, pour ouvrir sa porte d’entrée, censure de l’Internet etc. iMAL en fête : Depuis 20 ans, iMAL développe des activités à la croisée des arts, des sciences et de l’industrie. En février, iMAL va emménager dans ses nouveaux locaux à Molenbeel pour accueillir un plus large public. Fête de pré-ouverture du 21 au 24 novembre avec expo, performances internationales, workshops. imal.org Keypad et souris hyperspeed : Pour un gamer, une souris à 20 000 dpi et 11 boutins programmables c’est pratiquement le Nirvana. Mais que dire alors d’un keypad, 32 touches programmables ET équipé de switches optiques analogiques de dernière génération? Une merveille…peut-être pas si facile à maîtriser !
          

Vaqueros de corte slim cómodos y superelásticos en azul descolorido Hyperflex Anbass de Replay Ropa Hombres Azul Denim elástico GCRH4F78

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Vaqueros de corte slim cómodos y superelásticos en azul descolorido Hyperflex Anbass de Replay Ropa Hombres Azul Denim elástico GCRH4F78

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Al ver parpadear en pantalla la palabra \'re-play\' durante la Copa del Mundo de Argentina de 1978, Claudio Buziol, el fundador italiano de esta marca decidió que sería el nombre perfecto para una línea de ropa. Aludiendo al mundo vintage a través de la reinterpretación de la ropa del pasado con una manera contemporánea, Replay crea una línea de vaqueros hechos a mano, camisetas, camisas y jerséis, todo bajo el estilo de la firma de la casa Replay.

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Modelo: Altura de 6\'1\'/185,5 cm Modelo: An. 32\' Regular

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Percutaneous coronary intervention assisted by invasive mechanical ventilation and intra-aortic balloon pump for acute myocardial infarction with cardiogenic shock: Retrospective cohort study and meta-analysis

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The aim of this study was to compare the mortality outcome in patients with acute myocardial infarction and cardiogenic shock who were treated with percutaneous coronary intervention (PCI) assisted by intra-aortic balloon pump (IABP) + invasive mechanical ventilation (IMV) with historical controls. From January 1, 2016 to June 1, 2017, 60 patients were retrospectively enrolled at Tianjin Chest Hospital. Out of these, 88.3% of patients achieved thrombolysis in myocardial infarction flow 3 after PCI. The all-cause mortality rate in-hospital and at 1 year was 25% (95% CI: 0.14–0.36) and 33.9% (0.22–0.46), respectively. A systematic review followed by meta-analysis was performed with 4 historical studies of patients treated by PCI + IMV with partial IABP, which found an in-hospital mortality rate of 66.0% (95% CI: 0.62–0.71). Recently, a meta-analysis of patients receiving PCI + IABP with partial IMV showed that the 1 year mortality rate was 52.2% (95% CI: 0.47–0.58). In Cox regression analysis of patient data from the current study, lactic acid level ≥4.5 mmol/L, hyperuricemia, and thrombolysis in myocardial infarction flow <3 were independent predictors of death at 1 year. All-cause mortality, in-hospital and at 1 year, in patients with acute myocardial infarction and cardiogenic shock treated with PCI + IABP and IMV was lower than in those treated with PCI + partial IABP or IMV. Larger, longer-term direct comparisons are warranted.


          

Vernon #MPM5-0348, CNC pipe profiler, 60″ capacity, 5-Axis, Hypertherm Max 200, #11471 PROFILERS, CNC CNC MACHINERY & EQUIPMENT

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PROFILERS, CNCCNC MACHINERY & EQUIPMENT
Yoder Brothers Machinery, Holland, OH 419-269-2000 (Email: yoder@yoderbrothersmachinery.com) Ryan Yoder
          

Black Friday : la résistance s'organise

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Cette journee de promotions importee des Etats-Unis est desormais bien installee en France. Mais de nombreux mouvements denoncent l'hyperconsommation.
          

Un vendredi noir pour la planète et les droits humains

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Ce vendredi, c'est le Black Friday, ce vendredi noir des super promotions venu des Etats-Unis. Autant vous dire que la surproduction et l'hyperconsommation entraînées ce jour-là, ça ne fait pas les affaires de la planète ni des petites mains qui fabriquent tous ces produits dont, souvent, on n'a même pas besoin. En revanche le géant Amazon, lui, a tout à y gagner. Des associations (dont Greenpeace) et des personnalités se mobilisent "contre Amazon et son monde", et son désastre écologique et social. Rejoignez-nous.

Cet article Un vendredi noir pour la planète et les droits humains est apparu en premier sur Greenpeace France.


          

Koike Aronson #FM620, plasma cutting, 6′ x 20′, Hypertherm EdgePro Ti control, ′07, #8816XJVP PLASMA CUTTING SYSTEMS (FLAME CUTTERS), CNC CNC MACHINERY & EQUIPMENT

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PLASMA CUTTING SYSTEMS (FLAME CUTTERS), CNCCNC MACHINERY & EQUIPMENT
Industrial Assets Machinery, Painesville, OH 323-587-1887 (Email: rick@iamachinery.com) Rick Kruger
          

Toulouse: démissions en série à l’hôpital des enfants

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Depuis des mois, les professionnels de santé réclament davantage de moyens. Jeudi 14 novembre, une grande journée de mobilisation nationale est prévue. À Toulouse (Haute-Garonne), tous les responsables de services de l’hôpital des enfants ont décidé de frapper fort en démissionnant administrativement. Hôpital: “J’ai démissionné des urgences” Mulhouse: tous les internes des urgences en arrêt maladie Source: francetvinfo A l’attention des lecteurs du site BusinessBourse Nous sommes à la veille d’un tournant majeur dans l’économie mondiale. Le moment est venu d’acheter de l’Or avant qu’il ne soit trop tard. Pour les très rares personnes qui ont des actifs à protéger, il devient urgent de sortir des bulles d’actifs(marché boursier, obligataire, immobilier, etc…), comme je le recommande depuis longtemps. Il est également temps de détenir de l’or et de l’argent physique comme assurance pour son patrimoine. Les métaux précieux atteindront des niveaux sans précédents, voire non envisageables aujourd’hui avec l’hyperinflation. Pour ceux qui pensent que c’est le moment d’investir dans l’or ou l’argent, nous vous recommandons de contacter le site “l’once d’or”. Leurs prix, le service et le conseil vous aideront à prendre votre décision. Livraison gratuite dans toute la France métropolitaine, et territoires d’outre-mer. Pour d’importants achats, si vous venez de la part du [...]

The post Toulouse: démissions en série à l’hôpital des enfants appeared first on BusinessBourse.


          

Les chinois ont tiré les leçons de l’hyperinflation des années 1930

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Le peuple chinois a appris à ses dépens l’importance de l’or. La Chine a été le premier pays à introduire une monnaie fiduciaire sous la dynastie Tang 740 av. La valeur de la monnaie fiduciaire chinoise est restée stable jusqu’à la dynastie des Yuan aux XIIIe et XIVe siècles. Il s’agit de la première période d’hyperinflation de la Chine, qui imprimait alors d’énormes quantités d’argent pour financer ses guerres.Plus tard, dans les années 1930 et 1940, la monnaie chinoise a totalement perdu sa valeur alors que le règne de Chiang Kaï-Shek touchait à sa fin. Chiang a été président de la Chine continentale de 1928 à 1949. En 1929, les prêts représentaient déjà 49% des recettes publiques. Les finances se sont encore détériorées après l’invasion japonaise de 1932. Au cours des dernières années du régime de Chiang, l’économie chinoise s’effondrait et l’impression monétaire était effrénée. Un dollar américain valait 3,4 yuans en 1937, puis 23 millions de yuans en 1949. L’euro, une réussite ? Non… un véritable désastre ! Déjà -75% face à l’Or depuis l’an 2000 !! Daniel Gerino: “Depuis 1999, l’euro s’est déprécié pratiquement des 2/3 par rapport à l’Or… C’est catastrophique !” La Chine a commencé à comprendre l’or au cours [...]

The post Les chinois ont tiré les leçons de l’hyperinflation des années 1930 appeared first on BusinessBourse.


          

La menace d’une récession et d’une crise financière se précise !

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Les signaux indiquant le retour d’une récession et d’une possible crise financière se multiplient depuis plusieurs mois, et singulièrement depuis la mi-septembre 2019. Crise Financière 2020: Tout Savoir sur le Crash à Venir ! Jean-Michel Naulot: “La prochaine Crise Financière fera passer celle 2008 pour une plaisanterie !” Source: ouest-france A l’attention des lecteurs du site BusinessBourse Nous sommes à la veille d’un tournant majeur dans l’économie mondiale. Le moment est venu d’acheter de l’Or avant qu’il ne soit trop tard. Pour les très rares personnes qui ont des actifs à protéger, il devient urgent de sortir des bulles d’actifs(marché boursier, obligataire, immobilier, etc…), comme je le recommande depuis longtemps. Il est également temps de détenir de l’or et de l’argent physique comme assurance pour son patrimoine. Les métaux précieux atteindront des niveaux sans précédents, voire non envisageables aujourd’hui avec l’hyperinflation. Pour ceux qui pensent que c’est le moment d’investir dans l’or ou l’argent, nous vous recommandons de contacter le site “l’once d’or”. Leurs prix, le service et le conseil vous aideront à prendre votre décision. Livraison gratuite dans toute la France métropolitaine, et territoires d’outre-mer. Pour d’importants achats, si vous venez de la part du site BusinessBourse, vous aurez de meilleures conditions en [...]

The post La menace d’une récession et d’une crise financière se précise ! appeared first on BusinessBourse.


          

Japon: Chute de la production manufacturière de -7,4% au mois d’octobre 2019 en 1 an. Pire déclin depuis février 2013 !!

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La production manufacturière japonaise a chuté de -4,2% en octobre par rapport au mois précédent (Plus fort déclin depuis 2011). Mais ce n’est pas tout, cette production manufacturière a surtout plongé de -7,4% par rapport au même mois de l’année précédente, ce qui représente la plus forte chute depuis le mois de Février 2013. Nicolas Chéron: “Les risques récessifs augmentent à leur tour au Japon !” Japon: Les exportations ont chuté de -5,2% au mois de septembre 2019 sur 1 an. Un déclin pour le 10ème mois consécutif Source: jeroen blokland Source: or.fr – Voir les précédentes interventions de Charles Gave A l’attention des lecteurs du site BusinessBourse Nous sommes à la veille d’un tournant majeur dans l’économie mondiale. Le moment est venu d’acheter de l’Or avant qu’il ne soit trop tard. Pour les très rares personnes qui ont des actifs à protéger, il devient urgent de sortir des bulles d’actifs(marché boursier, obligataire, immobilier, etc…), comme je le recommande depuis longtemps. Il est également temps de détenir de l’or et de l’argent physique comme assurance pour son patrimoine. Les métaux précieux atteindront des niveaux sans précédents, voire non envisageables aujourd’hui avec l’hyperinflation. Pour ceux qui pensent que c’est le moment d’investir dans l’or ou [...]

The post Japon: Chute de la production manufacturière de -7,4% au mois d’octobre 2019 en 1 an. Pire déclin depuis février 2013 !! appeared first on BusinessBourse.


          

Body Mass Chart - Weight Chart - Bmi Chart

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This is actually untrue. Accepting that experience control as well as that's nature has supplied you with most of the tools were required to be healthy is empowering and begins to automatically increase health.The link between our food, our behavior, life style, our thinking and our wellbeing became obscure as the responsibility for our well being was wrongly diagnosed. How do we claim back ideas presented ours all along? In the age of the internet we've got no more legitimate excuse for not searching the answers, and retrieving right information that educate and guide us back to physical, mental, emotional and spiritual wellbeing. Even when you are diagnosed and a solution or prescription medication is prescribed by your health practitioner, your responsibility is to search for alternatives, side effects, and a second opinion.This medicine act well on obese patients with skin difficulty.Breath smells like urine.Rotten odor with salivation and blisters in the mouth.Sour eructations with gastric complaints.Skin complaints with sticky discharges.Gastric pain ameliorated to eat.This questions clearly questions your motivation so answer accordingly. Discuss how you're excited in regard to a project or a health examination to help provide the interviewer using you find satisfying within a job.Fiber is fine! Fiber is quite important to hypertension patients. Fiber cleanses or flushes your system of celebrations and will also normalize your score. Find foods which contain high fiber such as whole whole. I highly recommend the water-soluble fiber foods to my customers.Second, here are some who thinks that it's dangerous take into consideration chiropractic. The medical industry already acknowledges the employment of chiropractic along with the treatments the player provide. Many individuals is an indication that considering chiropractic treatment solution is not dangerous at more or less all. It is a form of alternative medicine that concentrates on the diagnosis, treatment and prevention in the disorders in musculoskeletal podium.Ask for discounts. A person have shopped around and located your product for a lower life expectancy price, ask your current supplier to go with the price level. Most medical suppliers will match a price cut in order to keep the business.You might or might not have noticed, another days lots of are also rating their doctors located on the quality of care they receive. Yup, doctors, hospitals, and nursing homes all have report cards now. For instance, the Golden, CO based company, Healthgrades, provides grades determined its survey of Medicare and other records. A person don't are confronted with and require to to access the report on a specific physician or hospital, you've got pay atiny low fee. For instance, I checked in my family physician and We can buy the report for $12.95.You think you might away with eating rubbish. You can't. Possess a cheat day, don't make it a action. You are not really a huge special genetic phenomenon. What makes others fat will do the same you r in time. The fast food restaurants and heavily junk foods (food in the box) simply make you fat there isn't an nice strategy to say this task.V. A practice can be of huge boost for sharing new developments in health care. Blogs are a superb way for patients to acquire a sneak peek into function ethics, could be often useful in determining throughout of physician they are seeking.The bills I pay every month include rent, electricity and then any other utilities, internet, the company that transmits our bills over the internet, insurance for my staff, salaries for the staff, taxes on staff salaries, unemployment, workman's compensation, advertising, equipment and supplies, maintenance on any equipment that is part of me, postage, paper, ink, printing, extra taxes because I possess a medical practice, as well as the list continues. There are fees to belong to professional suppliers. I have to admit my partner and i have limited those for the few which usually very vital that me. When I'm finished office stuff, I start paying the bills at home.Most people would contend that acids can't go through the kidneys because of the body's filter, the poorly liver. However, it has been learned that your liver plays no role in acid base regulation with the body. Which happens to be why you possibly can use an acidic remedy to treat kidney stones and even urinary tract infections.If you're skeptical, doesn't. A regarding people continue to be. However, let's have a look in a very few regarding just how powerful the human brain can continually be. One of probably the most obvious is scientific, and actually occurs in medical career. This particular subconscious mind effect is documented time and time again.While it is a great idea to want to do something you love, it's though not always possible. For instance, the medical industry is booming at the moment and nurses are used so if you want to be a nurse, desires to give great tv news. The mortgage industry is suffering tremendously right now as may be the real estate market do you want to avoid to be a real estate agent perhaps a mortgage forex broker. You should still find something your good at and in the event you do a person are love, no less keep it as a diversion!If you liked this information and you wish to be given more info relating to physicians data Base generously stop by the page.

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Researchers train AI to map a person’s facial movements to any target headshot

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What if you could manipulate the facial features of a historical figure, a politician, or a CEO realistically and convincingly using nothing but a webcam and an illustrated or photographic still image? A tool called MarioNETte that was recently developed by researchers at Seoul-based Hyperconnect accomplishes this, thanks in part to cutting-edge machine learning techniques. The researchers claim it […]
          

Professions: CDL A Delivery Truck Driver - Norman, Oklahoma

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Job Description: Company: Sysco Oklahoma Location: US-OK-Norman Zip Code: 73069 Minimum Level of Education: Not Applicable Minimum Years of Experience: 0-1 Position Type: Non-Exempt Travel Percentage: 0 More information about this job: This position is located at 1350 W Tecumseh Rd, Norman, OK, 73069 OVERVIEW: We offer our associates the opportunity to grow personally and professionally, to contribute to the success of a dynamic organization, and to serve others in a manner that exceeds their expectations. We're looking for talented, hard-working individuals to join our team. Come grow with us and let us show you why we're at the heart of food and service. POSITION SUMMARY: Sysco is the global leader in foodservice distribution. With over 67,000 associates and a fleet of over 13,000 vehicles, Sysco operates approximately 330 distribution facilities worldwide and serves more than 600,000 customer locations. We are looking for talented, hard-working individuals to join our team and experience The Heart of Food and Service. Sysco has immediate job openings for dependable CDL A Delivery Truck Drivers to safely and efficiently operate a tractor trailer and manually unload/deliver various products (meats, produce, frozen foods, groceries, dry goods, supplies, etc.) to customer locations on an assigned route schedule. Using a positive, friendly attitude, our drivers build relationships with each customer and become familiar with their operations to meet needs and expectations. Most CDL A Delivery Truck Drivers have daily routes and are home nightly Excellent pay, including productivity incentives Paid vacation and holidays Comprehensive healthcare benefits Generous retirement benefits Employee discount programs Discounts on Sysco stock (SYY) Ongoing training and career growth opportunities Uniforms, More benefits, too many to nameRequirements: 21+ years of age License to drive - valid Class A Commercial Driver License (CDL) with a clean driving record Must pass pre-employment drug screen Touch freight - may need to lift, push or move product weighing an average of 40-60 pounds and as much as 100 pounds Ability to read, write and communicate in English Winning attitude and approachable personality Flexibility - overtime as required, occasional weekends and holiday Sysco is more than just a place to work. Our passion for food and our customers has made us the industry leader. To remain on top, we will continue to think bigger, work harder and never give up. It takes a special kind of CDL A Delivery Truck Driver to work for Sysco. Are you ready to drive success? Click on the hyperlink to watch A Day in the Life of a Sysco Driver . Applicants must be currently authorized to work in the United States. Sysco Oklahoma is proud to be an Equal Opportunity and Affirmative Action employer, and considers qualified applicants without regard to race, color, creed, religion, ancestry, national origin, sex, sexual orientation, gender identity, age, disability, veteran status or any other protected factor under federal, state or local law. This opportunity is available through Sysco Corporation, its subsidiaries and affiliates. Employment Type: Full Time ()
          

String "feel" question?

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Jeps ^Micro truss rod adjustment is a crucial factor in getting the action/set-up hyper right. It shouldn't be feared or avoided - nor overdone.
          

National data with high validity and completeness showed that only 0.04% of Danish children had been registered with diagnosed hypertension.

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National data with high validity and completeness showed that only 0.04% of Danish children had been registered with diagnosed hypertension.

Acta Paediatr. 2019 Nov 30;:

Authors: Langhoff AF, Børresen ML, Wason MP, Andersson M, Jeppesen DL, Schmidt IM, Cortes D

Abstract
AIM: Hypertension has been reported in up to 4.0% of American children, but no national data exist in Europe. We studied the frequency of registered hypertension in Danish children and evaluated the data.
METHODS: This 2014-2015 study focused on patients under the age of 16 registered with hypertension in the Danish National Patient Register and 10 paediatric departments in central and eastern Denmark. The diagnoses were coded according to the International Classification of Diseases, 10th revision. All the subjects' medical records were reviewed, including any confirmed diagnoses.
RESULTS: There were 553,784 children under 16 in the study regions at 30 April 2014. By May 2015, 222 of those had been registered with hypertension: 200 in the Danish National Patient Register and 191 in the 10 paediatric departments. Their medical records confirmed hypertension in 187 and 185 cases, respectively. The prevalence of registered and confirmed hypertension was 222/553,784 (0.04%). The positive predictive values of hypertension were 187/200 (94%) and 185/191 (97%) and the completeness of diagnosed hypertension were 187/222 (84%) and 185/222 (83%).
CONCLUSION: The registers had high-quality positive predictive values and completeness, but only 0.04% of the Danish children were registered with a verified diagnosis of hypertension.

PMID: 31785102 [PubMed - as supplied by publisher]


          

We still need to know more about adolescents with attention deficit hyperactivity disorder who undergo surgery for severe obesity.

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We still need to know more about adolescents with attention deficit hyperactivity disorder who undergo surgery for severe obesity.

Acta Paediatr. 2019 Nov 28;:

Authors: Järvholm K

PMID: 31782173 [PubMed - as supplied by publisher]


          

Post-discharge neonatal hyperbilirubinemia surveillance.

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Post-discharge neonatal hyperbilirubinemia surveillance.

Acta Paediatr. 2019 Nov 19;:

Authors: Kaplan M, Zimmerman D, Shoob H, Stein-Zamir C

Abstract
AIM: To assess implementation of the Israel Neonatal Society's 2008 guidelines for universal community assessment of jaundice within 72 hours of discharge from birth hospitalization.
METHODS: Mothers of newborns were interviewed at Maternal Child Health Clinics in the Jerusalem District, Israel, and asked whether their newborn had been evaluated for jaundice within the recommended timeframe. Newborn discharge letters from Israeli hospitals were assessed for appropriate inclusion of instructions for early follow-up for jaundice.
RESULTS: 217/659 (32.9%) mothers whose newborns were at low risk for neonatal hyperbilirubinemia reported an examination within 72 hours of discharge. 18 (8.3%) were referred for a bilirubin test. In contrast, 99.1% (109/110) of high-risk newborns who were specifically invited for a bilirubin test the day following discharge complied. 12/26 (46.2%) hospital discharge letters specified both a time limit of 72 hours post discharge and jaundice as a reason for early follow-up.
CONCLUSION: The early community surveillance rate for jaundice was low, contrasting with near universal compliance in those who received a specific instruction for a post-discharge bilirubin blood test. Inclusion of specific written instructions in hospital discharge summaries was also low and may contribute to poor implementation of guidelines.

PMID: 31742751 [PubMed - as supplied by publisher]


          

Using clinical and genetic data to predict pulmonary hypertension in bronchopulmonary dysplasia.

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Using clinical and genetic data to predict pulmonary hypertension in bronchopulmonary dysplasia.

Acta Paediatr. 2018 12;107(12):2158-2164

Authors: Trittmann JK, Bartenschlag A, Zmuda EJ, Frick J, Stewart WCL, Nelin LD

Abstract
AIM: Pulmonary hypertension significantly increases morbidity and mortality in infants with bronchopulmonary dysplasia. The frequency of single nucleotide polymorphisms in arginase-1 (ARG1 rs2781666) and dimethylarginine dimethylaminohydrolase-1 (DDAH1 rs480414) genes has been found to differ in a cohort of bronchopulmonary dysplasia patients with pulmonary hypertension (cases) and without pulmonary hypertension (controls). Therefore, we tested the hypothesis that combining these genotypes with phenotypic data would better predict pulmonary hypertension in bronchopulmonary dysplasia patients.
METHODS: Bronchopulmonary dysplasia patients (n = 79) born at <35 weeks gestation were studied. Pulmonary hypertension was diagnosed by echocardiographic criteria (n = 20). ROC curves to predict pulmonary hypertension in bronchopulmonary dysplasia were generated from genotype and/or clinical data.
RESULTS: Cases were born at an earlier gestation and weighed less at birth than did controls. ROC curves for rs2781666 had an AUC of 0.61, while rs480414 had an AUC of 0.66. Together, the AUC was 0.70. When clinical data were added to the genetic model, AUC was 0.73.
CONCLUSION: These findings demonstrate that ROC predictive modelling of pulmonary hypertension in bronchopulmonary dysplasia improves with inclusion of both genotypic and phenotypic data. Further refinement of these types of models could facilitate the implementation of precision medicine approaches to pulmonary hypertension in bronchopulmonary dysplasia.

PMID: 30267614 [PubMed - indexed for MEDLINE]


          

Healthcare: Nursing,Med-surg abult - Scranton, Pennsylvania

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Catapult Healthcare is a comprehensive national staffing agency and placement firm specializing in both travel nursing and allied clinical service professionals. We offer both short and long-term contract and permanent placement assignments nationwide.We are currently seeking a full time Nursing,Med-surg Adult for a 13-week contract position in Scranton,Pennsylvania. Please see below for additional information:Job Details:13 week Med/Surg/tele traveler. Care on D6 includes general medical/surgical patients as well as oncological and remote telemetry from the age of 18 to geriatrics.Diagnosiss include but are not limited to pulmonary disease, diabetes, gastrointestinal disorders, infections and oncology and remote telemetry according to criteria. Procedures performed by the staff include medication administration, wound care, IV therapy, hyper-alimentation, blood administration and pain management. Nurses are educated in the administration and safe handling of chemotherapy during orientation and annually. In collaboration with the Pharmacy, chemotherapy is administered by specially trained RNs. Patient education needs are assessed on admission and throughout their stay. Social services, along with Care Management and other healthcare professionals, assure that the patient is cared for on a continuum. They assure the patient and/or family has appropriate resources for discharge, placement or are supported through end of life decisions.Average nurse to patient ratio 1:5 and 1:6.Shift: Three twelve hour Days E/O weekend, E/O holiday, must be willing to float to units of similar acuity or where otherwise competent. ()
          

Premiere für GT EVO-R

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Auf der Essen Motorshow zeigt die Gewe Reifengroßhandel GmbH erstmals die neue Felge GT EVO-R.

Auf der Essen Motorshow zeigt die Gewe Reifengroßhandel GmbH erstmals die neue Felge GT EVO-R. Das klassische fünf Speichen Rad der TEC SPEEDWHEELS wird in den Startgrößen 8.0x18"-9.0x20" in Schwarz-Glanz- Hornpoliert und Hyper-Silber-Hornpoliert zum Frühling 2020 verfügbar sein.

Rubrik: 


          

Children with mucopolysaccharidosis risk progressive visual dysfunction despite haematopoietic stem cell transplants.

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Children with mucopolysaccharidosis risk progressive visual dysfunction despite haematopoietic stem cell transplants.

Acta Paediatr. 2018 11;107(11):1995-2003

Authors: Teär Fahnehjelm K, Olsson M, Chen E, Hengstler J, Naess K, Winiarski J

Abstract
AIM: This prospective study assessed the long-term ocular and visual outcomes of children with mucopolysaccharidoses type I Hurler syndrome (MPS IH) who were treated with haematopoietic stem cell transplants (HSCT).
METHODS: Clinical ophthalmological assessments were performed on eight patients at the St Erik Eye Hospital, Huddinge, Stockholm, Sweden, from 2001-2018: The median age at diagnosis and HSCT were 12.2 (range 5.0-16.4) and 16.7 (8.0-20.4) months. The last eye examination was at a median of 13.4 (6.3-19.0) years and follow-up lasted a median of 12.0 (5.0-17.4) years.
RESULTS: Poor visual acuity, poor night vision and, or, photophobia were reported by six children. The best corrected visual acuity at the last visit was a median of 0.4 and 0.5 in the right and left eye and had declined significantly in two patients. Corneal opacities had increased despite HSCT in five patients. High hyperopia, at a median of +6 Dioptres, occurred in all patients and stiff corneas in all four patients that were measured. The patients' corrected intraocular pressures were normal. Retinal degeneration was identified in two patients.
CONCLUSION: Despite HSCT, the long-term follow-up of patients with MPS IH showed reduced visual acuity due to corneal opacities or retinal degeneration.

PMID: 29683519 [PubMed - indexed for MEDLINE]


          

1/48 McDonnell Douglas F-4 Phantom Canopy Detail Set for Academy kits

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1/48 McDonnell Douglas F-4 Phantom Canopy Detail Set for Academy kitsDetail parts for the inner canopies on F-4 Phantoms. The set comprises of resin and PE parts for windscreen, forward-, centre- and rear canopies and includes canopy actuator jacks, safety uplocks (optional installation), detailed downlocks, forward and rear compasses and various detail parts for the centre canopy section. Parts are included for all major variants: F-4B/N, F-4C/D, F-4J/S, F-4E/EJ, F-4F and FG.1/FGR.2. Also included are parts for the VTAS system in the fron canopy on late F-4J's, F-4N and F-4S as well as two lengths of different diameter copper wire for cable detail. Note that clear parts are not included!

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The benefits of hyperconverged infrastructure

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The benefits of hyperconverged infrastructureHyperconvergence isn’t something only large enterprises can benefit from — businesses of all sizes should consider this infrastructure strategy. Read on to learn more about what hyperconvergence can do for your company. What are hyperconverged infrastructures? In a traditional IT environment, networking, server, and storage hardware need to be purchased separately and configured to work […]
          

Land Use Technician

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JOB OPENING

TOWN OF CLINTON

The Town of Clinton is seeking applicants for a full time Land Use Technician. The salary for this position is $17.26 per hour with an excellent benefits package.  Position overview: The Land Use Technician performs office administration and regulatory technical work in assisting the Land Use Professional Staff and Commissions and Boards.

The job application and a copy of the job description is available on the town’s website at www.clintonct.org.  Please submit your application and resume electronically on the town website at www.clintonct.org no later than December 13, 2019.  Click here to apply.


EOE



          

Comment on Labs Walkthrough by Internet Marketing

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I will right away snatch your rss as I can not to find your e-mail subscription hyperlink or e-newsletter service. Do you have any? Kindly permit me recognise so that I could subscribe. Thanks.
          

The Importance of Sleep Phenotypes in Bipolar Disorders

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Sleep disturbance plays several key roles in bipolar disorder (BD). From a diagnostic perspective, insomnia and hypersomnia are criteria for a depressive episode, while decreased need for sleep is a highly specific symptom for a manic episode. Sleep disturbance is the most common prodromal symptom preceding mania, and the duration of sleep observed early in the course of psychiatric hospitalization may predict the speed of recovery from a manic episode. Even during euthymic periods, patients with BD frequently struggle with sleep difficulties, which may affect quality of life and the choice of pharmacotherapy and increase the likelihood of major mood episode recurrence.
          

Kingston hyper x pendrive 256gb brutális :) - Jelenlegi ára: 18 000 Ft

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Nagyon újszerű állapotban lévő keveset használt kihasználatlanság miatt eladó féláron ez a brutál dög. De tényleg nagyon gyors : )
Kingston hyper x pendrive 256gb brutális :)
Jelenlegi ára: 18 000 Ft
Az aukció vége: 2019-12-02 08:41
          

Why Traditional Approaches to Governing Customer-facing Content Fail

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The standard ways of governing customer-facing content have been around for ages. The problem? They weren’t designed for today’s hyper content world. Nowadays, traditional content governance methods just don’t cut it. 

Learn:

  • Why traditional approaches to content governance fail
  • A better solution called Active Content Governance
  • How to get started on the road to greater content oversight
  • Make sure your content delivers the right value with our short guide.

GET THE GUIDE



Request Free!

          

Selective Neurectomy of the Masseteric Nerve in Masseter Hypertrophy

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imageAsian women prefer to have more delicate and feminine features rather than prominent squared mandibular angles. It was proposed that a selective neurectomy of the masseteric nerve might result in muscular atrophy and subsequent reduction of the hypertrophic mass of the masseter muscle. This study is aimed at an elucidation of the precise course of the masseteric nerve and the impact of a neurectomy in case of masseter hypertrophy. Eleven heads of Korean cadavers were halved and dissected. The masseteric nerve and artery in the mandibular notch were clearly located. A selective neurectomy of the masseteric nerve was performed in four cases of masseter hypertrophy. The masseteric nerve and artery behind the temporalis muscle at the mandibular notch cross over to the masseter. The masseteric nerve was found 11.3 ± 2.6 mm horizontally from the anterior border of the ramus and 11.3 ± 2.6 mm above the mandibular notch and the superior masseteric artery, 25.6 ± 3.7 mm from the ramus, and 7.8 ± 2.6 mm above the notch. A neurectomy of the masseteric nerve can be used to reduce the hypertrophied masseter and as an ancillary procedure of mandibular angle ostectomy. One procedure can accompany another in the reduction of a prominent mandibular angle.
          

How to speed funding processes

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A hyper-connected society has come to expect near-instantaneous business transactions. Whether it’s an Amazon purchase, concert tickets or a flight to London, consumers expect a quick, efficient experience. Although auto lending is more complicated than those purchases, lenders can leverage the latest technologies to deliver similar efficiency. Many lenders have optimized loan application and underwriting […]
          

Ducati Hypermotard / Hyperstrada 821 - 6 800

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Predám Ducati Hypermotard / Hyperstrada 821, 77kW, (105PS), rok výroby 07/2014, najazdené kilometre 43906km, farba červená, maximálne zachovalý stav (bez škrabancov), pravidelný servis v Ducati Frankfurt overiteľný na základe VIN čísla, nové pneu, vý ...
          

Hyper REV - Suzuki Jimny No.5 Vol 235

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Hyper REV - Suzuki Jimny No.5 Vol 235

The fifth dedicated edition for Hyper REV book for the Suzuki Jimny features the largest listing of parts from all of Japans tuners.


          

Hyper REV - Suzuki Swift No.10 Vol 234

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Hyper REV - Suzuki Swift No.10 Vol 234

The 10thdedicated edition for Hyper REV book for the Suzuki Swift features the largest listing of parts from all of Japans tuners.


          

Hyper REV - Nissan GTR No.3 Vol 237

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Hyper REV - Nissan GTR No.3 Vol 237

The 3rd dedicated edition for Hyper REV book for the Nissan GT-R features the largest listing of parts from all of Japans tuners.


          

Hyper REV - Honda S2000 No.9 Vol 239

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Hyper REV - Honda S2000 No.9 Vol 239

The 9th dedicated edition for Hyper REV book for the Honda S2000 features the largest listing of parts from all of Japans tuners.


          

Hyper REV - Honda CR-Z No.2 Vol 160

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Hyper REV - Honda CR-Z No.2 Vol 160

The second dedicated edition for Hyper REV book for the Honda CR-Z features the largest listing of parts from all of Japans tuners.


          

Hypersphere Mini Vibrating Massage Ball

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Identification of Lower Extremity Ulcers, Evaluation and Treatment

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The purpose of this paper is not to make primary care physician assistant’s experts in the evaluation and treatment of lower extremity ulcers but to help guide you in the initial evaluation and work up of ulcers. Identifying the type of ulcer is important to ensure proper treatment for example mixed arteriovenous leg ulcers were associated with lower health related quality of life, greater mobility impairments, and more deficits in self-care and usual activities. 1

Lower extremity ulcerations are seen commonly in patients with peripheral arterial and venous disease in cardiovascular practice. The recognized risk factors include tobacco use, hypertension, hyperlipidemia and diabetes for peripheral arterial disease and venous insufficiency and deep vein thrombosis in venous disease. The need to properly identify and diagnose the ulcers placing them in the correct category is imperative as the proper treatment can mean the difference between a healing ulcer or possible amputation of the affected limb. This review will cover the diagnosis and treatment of various lower extremity ulcers. Even with the best available care, at least 25% of leg ulcers and foot ulcers are not fully healed after 6 months of treatment.2


          

In Adults with Type 2 Diabetes Mellitus, Does the Risk of Statin-Induced Insulin Resistance Outweigh its Cardiovascular Benefits?

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An increase in the incidence of type 2 diabetes mellitus (T2DM) worldwide finds us amid a global diabetes epidemic. Epidemiologic data suggest a link between hyperglycemia and increased cardiovascular risk, with the presence of diabetes increasing one's risk for developing cardiovascular disease (CVD) by two-to-fourfold. Consequently, almost all patients with T2DM are placed prophylactically on statin-therapy to decrease adverse CVD outcomes. A surplus of evidence-based research has shown an association between the use of statin therapy and the overall risk of developing diabetes mellitus. In addition, statin therapy has been shown to further increase hyperglycemia in patients who were already diagnosed with T2DM. This study reviews the current literature to address whether the risk of statin-induced insulin resistance in patients with T2DM outweigh its cardiovascular benefits.


          

Topical Capsaicin for Treatment of Cannabinoid Induced Hyperemesis

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Cannabis use is on the rise across the United States. Cannabinoid hyperemesis syndrome is an emerging condition that has recently gained recognition and creates several diagnostic and therapeutic challenges. The only definitive treatment for this condition is the complete cessation of cannabis use. Topical capsaicin cream shows promise as a non-invasive and inexpensive option to provide symptomatic relief for this condition in the emergency department setting.


          

A Review of Benign Prostatic Hyperplasia and Current and Future Treatment Options

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Benign Prostatic Hyperplasia (BPH) is a common condition in male patients. Symptoms

include urinary frequency, slow stream, urgency, and incomplete bladder emptying. This

condition can have a significant impact on quality of life. There are several treatment modalities

available for the management of BPH including watchful waiting, medications, minimally

invasive surgical interventions, and transurethral resection of the prostate (TURP). This paper

will review the pathophysiology, symptoms, medications, and surgical interventions available.


          

Busting the Myths: A Closer Look at ADHD Diagnosis and Treatment Algorithms

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An estimated 15 million individuals in America have Attention Deficit Hyperactivity Disorder, ADHD. Without identification and proper treatment, ADHD may have serious consequences, including school failure, family stress and disruption, depression, relationship problems, substance abuse, delinquency, accidental injuries, and job failure. Early identification and treatment are extremely important. With identification, proper treatment and management, individuals with ADHD can lead successful lives and even thrive. Therefore, ADHD is diagnosed and treated at any age when it begins to negatively impact the patient at home, work or social settings.1


          

In African Americans with uncontrolled Hypertension, would the addition of ACE Inhibitors combination therapy be more effective than Calcium Channel Blocker monotherapy to control blood pressure?

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ABSTRACT

Background

African-Americans have a greater burden of hypertension and target end organ damage in the United States. Lifestyle and dietary modification are important but effective and aggressive therapeutic management of hypertension in African Americans should be initiated early. There are multiple ways of initiating antihypertensives and the selection of antihypertensives are traditionally base on race and to some extent age. However, it is unclear which approach offers the best blood pressure control. The main goal of this article is to review and explore therapeutic interventions in the management of uncontrol hypertension in African-Americans utilizing ACE inhibitors and calcium channel blocker combination therapy.

Methods

A PubMed literature search was conducted with search terms hypertension,

uncontrol hypertension, African-Americans, hypertension management, ACE inhibitors, calcium

channel blockers, hypertension therapeutics, risk factors of hypertension. An additional search

was conducted in the American Journal of Hypertension and Cleveland Clinic Journal of

Medicine. Seven relevant articles were retrieved from PubMed, five from the American Journal

of Hypertension and four from the Cleveland Clinic Journal of Medicine and served as the basis

for the clinical review for this article. Additionally, data from the Pharmacogenomic

Antihypertensives agents in African Americans with Uncontrolled Hypertension

Evaluation of Antihypertensive Responses study to determine the effectiveness of

antihypertensives control rates in Africans Americans was utilized.1,2

Results

The prevalence of hypertension is greater in African Americans with a higher incidence

of cardiovascular, cerebrovascular, end-stage kidney diseases and heart failures and associated

morbidities and mortalities. Traditionally, the initiation of antihypertensives is based on race and

age and recently discovered plasma renin activity.1 Conventional monotherapy and combination

therapy with calcium channel blocker and or diuretics may not be effective in African Americans

with uncontrolled blood pressure. Initiation of ACE inhibitors and calcium channel blockers

could potentially control blood pressure in African Americans. More evidence base study is

needed in the future to explore treatment modalities.

Conclusion

African-Americans have a greater burden of uncontrolled hypertension with higher prevalence,

morbidity, and mortality. Dietary and lifestyle modifications are essential in the initial

management. However, initiating ACE inhibitors and calcium channel blocker combination

therapy in African Americans with uncontrol hypertension are promising than conventional

calcium channel blocker monotherapy. ACE inhibitor and calcium channel blocker combination

therapy may be more effective than calcium channel blocker and diuretic combination therapy.

Further studies are needed to substantiate this study.


          

The Significance of Metal Sensitivity Testing in Instrumented Orthopedic Surgery

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  • Orthopedic procedures involving metallic implants are increasingly common with projection in future growth.
  • There remains some debate regarding the local and systemic impact of metal induced allergic reactions following implantation of orthopedic instrumentation.
  • To date, there is no accepted universal standard for a valid, cost-effective diagnostic approach to detect metal hypersensitivity in patients scheduled to undergo implantation of a prosthetic device orwho have already undergone such a procedure.
  • Inpatients who are scheduled for a surgery involving a metallic implant who are known to have allergic reactions to worn or implanted metal, research supports a role for skin patch testing with possible follow up lymphocyte transformation testing as a safe and cost-effective way to improve patient outcomes and possibly reduce the need for future revision surgery.
  • A review of the literature regarding the incidence and clinical significance of metal hypersensitivity and to help understand the role for testing in the prevention of allergic reactions to orthopedic implants.


          

Prevention of Recurrent Esophageal Variceal Bleeding in Patients with Cirrhosis

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Abstract

Purpose: The purpose of this clinical review article is to demonstrate the benefits of prophylactic treatment with beta-blockers for the prevention of recurrent esophageal variceal bleeding in patients with cirrhosis.

Method: A PubMed literature search of English-language articles was conducted with search key terms “esophageal varices/variceal,” “varix hemorrhage,” “variceal bleeding”, “prophylaxis with beta blockers,” “complications of cirrhosis,” “treatment of varices,” “endoscopic variceal ligation (EVL), “hepatic cirrhosis,” “portal hypertension,” “NSBB,” “burden of variceal bleeding.” The author identified twenty-three pertinent articles/publications for inclusion in this clinical review with use of retrieved article reference lists. Selections were based on relevance to the focused topic and served as the basis for this clinical review; many were excluded either due to irrelevance or a date of publish over 10 years ago.

Results: Multiple evidence based research studies include, peer review articles, systematic reviews, observational studies, and meta-analysis studies. Overall, concurring results demonstrate superior therapeutic management in the prevention of recurrent esophageal variceal bleeding with beta blockers.

Conclusion: Nonselective Beta Blockers (NSBB) have been the cornerstone of treatment for esophageal variceal bleeding for several decades. The goal of treatment is not only to control acute hemorrhaging with primary prophylaxis, but more importantly to prevent re-bleeding necessitating secondary prophylaxis to prevent patient decompensation and death. Therefore, prevention of variceal hemorrhaging begins with proper screening of all patients with cirrhosis. Over one-third of patients will have esophageal varices and up to 50% are likely to experience variceal hemorrhage with up to 75% likely to have future variceal bleeding episodes without proper management. The effects of daily NSBB with propranolol dosed between 40mg and 80mg has proven to increase survival rates with a 45% reduction in mortality.


          

Glycemic Control in Critically Ill Patients

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The issue of appropriate management hyperglycemia in critically ill patients is neither new or uncommon. However, this has evolved over the past 10 years and the data often appears conflicting. The purpose of this review paper is to evaluate the effect of tight glucose control on clinical outcome in critically ill patients. Tight glycemic control (80-120 mg/dl +/- 10) is also referred to in the literature as Intensive Insulin Therapy (IIT). By evaluating both older and more recent literature, it is expected that the review will demonstrate that there is a direct link between blood glucose (BG) levels and prognosis (morbidity and mortality) in the critically ill patient.


          

Sleep – An Epidemic of Insufficiency

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Sleep is one of the most important aspects of daily life and has many benefits to our minds and bodies. Inadequate sleep can increase the risk of making personal, professional, and even life-threatening errors on a daily basis. Aside from cognition, sleep promotes healing, with prolonged sleep loss resulting in detrimental effects on immune function. Many providers, as well as patients, are working more demanding hours and sleeping less while the pace of their lives is accelerating. Numerous studies have found links between insufficient sleep and an increased risk of weight gain and obesity, diabetes, hypertension, heart disease and stroke, depression, anxiety, Alzheimer’s, neurocognitive dysfunction, accidents and injuries, and even death.1-3 Inadequate sleep has even been linked to seven of the 15 leading causes of death in the United States.11 While many may be willing to trade sleep for a few more hours of wakefulness, people often overlook the potential short- and long-term health consequences that insufficient sleep has on one’s body as well as one’s mind.

While it is common practice for medical providers to encourage their patients to “get enough sleep at night”, many are unsure exactly how much is enough. In addition to this, many patients do not fully understand nor are they aware of the potentially harmful effects that prolonged sleep deprivation can have on their mental and physical health.


          

HTML - Tvorba webstránok (PREDAJ) - 2

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S touto knihou - HTML začíname programovať - sa naučíš vytvoriť vlastnú webstránku za pomoci HTML 4. NAUČÍŠ SA : Ako si vytvoriť svoju prvú web-stránku a ako do nej vložiť nadpisy, odstavce, tabuľky, zoznamy, obrázky, hypertextové odkazy a iné. ...
          

Weight Counseling and Exercise Prescription in Prenatal Care for the Maternal Obese to Manage Weight Gain and Reduce Adverse Perinatal Outcomes

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In pregnant patients with a Body Mass Index (BMI) greater than 30, does providing ten-minute obesity counseling with an exercise prescription versus no exercise prescription at the initial obstetrics visit help to manage maternal weight gain and decrease adverse perinatal risks? Most patients who present for obstetric (OB) care are overweight and obese, which can lead to adverse maternal and fetal outcomes. Discussing the issue of being obese during pregnancy can be a very sensitive conversation for both patients and clinical providers. Providing ten minutes of counseling on weight gain management and an exercise prescription at the initial prenatal visit and at subsequent antenatal visits could help motivate the maternal obese patients to engage in some physical activity and help to manage their weight gain during pregnancy. Antenatal counseling for weight management can benefit patients even after delivery. Reducing perinatal risks such as hypertension, gestational diabetes, pre-eclampsia, and large fetal birth weight can be safer for maternal obese patients, the fetus and for obstetric providers.


          

Ep 243: How to Efficiently Build Muscle, Transition to Sumo Deadlift, and be Coachable [Q&A]

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In this episode, I answer questions from my Instagram [@HuntFitness]. 

Questions on the show:

Q1: What helped you most when you switched from conventional to sumo deadlifting?

Q2: Why did you stop doing CrossFit?

Q3: Should you count incomplete protein sources toward your daily protein intake?

Q4: What are your thoughts on normalizing your metabolism after spending a long period of time in a caloric deficit?

Q5: What’s your opinion of plant-based diets for athletes?

Q6: What are your best tips for efficient bulking?

Q7: How do you manage your clients, do you have a cap on how many you work with at a given time?

Q8: Should you deadlift if you don’t compete in powerlifting?

Q9: How important is it for a client to be “coachable”?

Q10: What are some of the best ways to determine quality training volume for hypertrophy?

Q11: What is the best piece of business advice you ever received?

Q12: What is one interesting thing no one knows about you?

 

Hire Kyle as your coach: http://www.kylehuntfitness.com/services/

 

Connect with Kyle: 

http://www.kylehuntfitness.com/

Instagram: @huntfitness

YouTube: @HuntFitnessTV

 

Get my new Book, Bodybuilding For Beginners on Amazon:

https://amzn.to/33vYpHJ

Get Strong Now with the Absolute Strength Powerlifting Program: 

https://www.kylehuntfitness.com/absolutestrength2/

Build Muscle and Gain Strength with my Absolute Progress Powerbuilding Program:

https://www.kylehuntfitness.com/absoluteprogress/

Improve Your Bench Press with my 6-Week Bench Press Program:

http://kylehuntfitness.com/benchprogram

Get 10% OFF PR Breaker Materia Pre Workout and Hitpoint Protein:

DISCOUNT CODE: “HUNT10” at https://www.prbreaker.com/

Get 15% OFF Kimera Koffee by using the code “HUNT15”  

Website: http://bit.ly/2qzDapV

Get 2 FREE Months of Skillshare by using the link below:  

https://skl.sh/huntfitness

 


          

Front Office Supervisor Wound Care FT/ 40HRS | CHRISTUS Health

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Santa Fe, New Mexico, Description C oordinates activities of clerical personnel in the organization which encompasses all Wound Care, Hyperbaric and Diabetes Services on and off campus. This includes, but is not limited t
          

IRA Tattoos: Professional Tattoos Studio In Marathahalli

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IRA Tattoos Marathahalli Bangalore Best Professional Artist Studio in Various Design like 3d Tattoos, Animal Tattoos, Cute Tattoos, Demonic Tattoos, Water Colored Tattoos, Dot Work Tattoos, Double Exposure Tattoos, Fine Art Tattoos, Finger Tattoos, Geometrical Tattoos • Hyper-Realistic Tattoos, Maori Tattoos, Modern Tribal Tattoos, Religious Tattoos, Script Tattoos

View and Vote


          

Hundreds Enjoy Thanksgiving Feast Courtesy of Generous Community

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More than 350 Sussex County families will be able to enjoy a Thanksgiving turkey with all the trimmings this year, thanks to the generosity of local businesses, churches and individuals who donated voluminous amounts of food for Project Self-Sufficiency participants this November.  Agency staff and volunteers recently bagged hundreds of frozen turkeys, along with fresh produce, cans of cranberry sauce, vegetables, stuffing mix, dinner rolls, and freshly baked pies and distributed them to local families. 
 
Al & Alessandra Kash, Kate & Michael McNamara, and John Mathews


This year, 2,000 pounds of fresh vegetables were provided by longtime Project Self-Sufficiency volunteer Michael McNamara and his family in recognition of McNamara’s recent birthday.  “My whole family is involved,” noted McNamara, who has supported the organization for more than 30 years.  “Not only is it my birthday, not only is it my wedding anniversary, but Thanksgiving is my favorite holiday.   All you have to do is be grateful and share what you have.  I have been fortunate in my life, so I am sharing this with my whole family.   We’re all in it together.”
 
Colleen Duffy, First Presbyterian Church of Newton

The First Presbyterian Church of Newton Youth Group, along with help from the congregation, donated 200 freshly baked apple and pumpkin pies.  The supplies for the pie baking were donated by the congregation and the apples were donated by Race’s Farm in Blairstown.  “This is our twelfth year baking pies for Project Self-Sufficiency,” noted Colleen Duffy, Associate for Family Nurture at the First Presbyterian Church.  “It has become a beloved tradition and teaches the kids the importance of sharing God’s love with those in need in our community.”
 
Al & Alessandra Kash, John Mathews

Fresh fruit was supplied by John Mathews, Hinkley Auto Sales, and retired Project Self-Sufficiency staff member and current volunteer, Stephanie Sumpman.  Frozen turkeys were donated by the ad hoc group of approximately 20 men and women known loosely as the College of Knowledge; the donation was spearheaded by Project Self-Sufficiency Leadership Council member Roy Knutsen.  The group meets at Kathy’s restaurant in Fredon and has supported everything from baseball teams to the local fire department. 
 
Volunteers from Mars and Selective Insurance

“The generosity of our friends and neighbors towards Project Self-Sufficiency participants is deeply appreciated during the holiday season,” commented Deborah Berry-Toon, Executive Director of Project Self-Sufficiency.  “We have a lot to be thankful for this year.”

Project Self-Sufficiency has provided services to families in the New Jersey counties of Sussex, Warren and Hunterdon for more than 30 years.  Programs include career guidance, computer training, help with obtaining a high school diploma, parenting skills classes, legal assistance and education, financial workshops, health education, childcare and family activities.  The agency offers help around the holidays, formal dresses during prom season, and assistance with emergency basic needs, such as food and clothing to its participants.  Most services are free, and many are open to the public. 

To donate, or to find out more about the programs and services available at Project Self-Sufficiency, call 973-940-3500 or 844-807-3500, or visit www.projectselfsufficiency.org.

          

Part-time Transport Officer

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The Jasper County Sheriff's Office is accepting applications to fill a part-time position of Transport Officer.  Applicants must be able to perform responsible law enforcement work in ensuring the protection, welfare, safety, security and control of inmates.  Candidates must adhere to the Code of Iowa, United States Constitution and Iowa Jail Standards in reference to legal rights.  Qualified applicants will be required to have a valid Iowa driver's license and a good driving record, high school diploma or equivalent, CPR and First Aid certified a plus.

Starting rate of pay is $13.28 with scheduled increases.  This position is PRN (Per Required Need) and the work schedule will vary.  Selected candidate may work days, evenings overnights or some weekends.  The position will average 28 hours per week and is not eligible for County paid benefits.

Brief job summary: Responsible for prisoners, psychiatric patients, court committed individuals while being transported and escorted between courtrooms, prisons or medical facilities, must adhere to delivery of individuals within scheduled times and taking proactive steps to remain within scheduled deadlines, may require the use of handcuffs and/or leg irons for safe and secure operations as addressed in departmental work rules, safe operation of County owned motor vehicles and use of two-way radio, all other tasks assigned by supervisor.  Qualified applicants must have a valid Iowa driver's license with a good driving record.  To view the complete job description, "Click Here".

Applications are available by clicking on the following link "Employment Application" or can be picked up at the Jasper County Sheriff's Office located at 2300 Law Center Drive in Newton or at the Jasper County Human Resources Office located in the lower level of the Jasper County Annex Building at 115 N 2nd Ave in Newton.

All applications must be completed and returned to the Jasper County Human Resources Office no later than 4:30 PM on Friday December 13, 2019 to be eligible for the selection process.  Applications can be delivered in-person the the Human Resources's address above or mailed, emailed, faxed to one of the following:

Jasper County Human Resources Email: hr@co.jasper.ia.us
Attn: Dennis Simon Fax #: (641) 787-1101
101 1st Street North
Newton, Iowa 50208

Drug testing and extensive background checks will be conducted

Jasper County is an equal opportunity employer

          

Новые возможности Veeam Availability Suite v10 - что там интересного?

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Как некоторые из вас знают, новый пакет продуктов для обеспечения доступности датацентра Veeam Availability Suite v10 был анонсирован еще в 2017 году. С тех пор лидер в сфере резервного копирования виртуальных машин, компания Veeam, выпускала обновления Veeam Availability Suite 9.5 (например, вот последний Update 4) и параллельно рассказывала о новых возможностях десятой версии.

Недавно мы анонсировали лайв-форум VeeamON Virtual 2019, который прошел 20 ноября. На форуме, собравшем 7 тысяч человек онлайн, компания Veeam сделала несколько интересных анонсов, где главным был рассказ о новых возможностях Veeam Availability Suite v10.

Вот эти возможности:

1. Масштабируемый репозиторий резервных копий.

Благодаря этой возможности будет доступна немедленная резервная копия в объектное хранилище. Ранее Veeam Cloud Tier перемещал резервные копии в объектное хранилище в соответствии с политикой хранения (через заданное число дней), теперь вы можете отправлять их туда сразу после их создания.

Copy Mode — это дополнительная политика, которую можно задать для объектных хранилищ в составе масштабируемого репозитория ("Copy all backups to object storage as they are created"). Любые выбранные файлы резервных копий, созданные в рамках обычных заданий резервного копирования или заданий автоматического переноса, будут скопированы в Capacity Tier. Это позволит в любой момент полностью соответствовать правилу резервного копирования "3-2-1", согласно которому один экземпляр данных должен храниться на удаленной площадке.

2. Блокировка объектов S3 (защита от удаления).

Функция Immutability в Veeam Backup and Replication 10 позволяет организовать блокировку файлов резервных копий, отправленных в объектное хранилище для предотвращения их удаления программами-вымогателями (Ransomware). Например, вы ставите такую блокировку (immutability flag) на 3 дня, чтобы защитить бэкапы не только от Ransomware, но и от потенциальных вредоносных действий собственных администраторов. В течение этого времени никто, включая администраторов, не сможет удалить эти резервные копии из облака S3.

Реализуется это с помощью стандартной функции "object lock", которая есть в сервисах Amazon AWS (к сожалению, ее пока нет на платформе Azure).

3. Резервное копирование NAS-хранилищ.

Теперь Veeam Backup and Replication сможет делать резервное копирование файлов SMB (CIFS) и NFS. Вы можете восстанавливать хранилище целиком, отдельные файлы или делать откат к предыдущим версиям файлов на заданный момент времени.

Функция появилась как ответ на запрос Enterprise-пользователей Veeam, которые хранят в 10 раз больше неструктурированных данных в файловых помойках, чем структурированных данных в виртуальных машинах.

Бэкап можно делать как с файловой шары напрямую, так и из нативного снапшота на хранилище (Native Storage Snapshot):

При восстановлении можно выбрать откат к точке во времени (Rollback to a point in time):

4. Прямое восстановление в VMware.

Работает это аналогично прямому восстановлению в Hyper-V. Поддерживает данная функция резервные копии как виртуальных, так и физических машин. С помощью Direct Restore to VMware можно, например, восстановить свой физический ноутбук в виртуальную машину на платформе vSphere.

5. Интерфейсы Data Integration API.

С помощью интер