This paper describes several methods that considerably speed up calculations of the travel times and amplitude of body waves by the ray method.
KeywordsSeismic Wave Focal Depth Body Wave Layer Parameter Deep Point
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Unable to display preview. Download preview PDF.
- 1.Gerver, M. L., and V. M. Markushevich, “Determining seismic-wave velocity from travel-time curves,” this volume, p. 123.Google Scholar
- 2.Azbel’, I. Ya., and T. B. Yanovskaya, “Approximation of velocity distributions for calculation of P-wave times and amplitudes,” this volume, p. 62.Google Scholar
- 3.Yanovskaya, T. B. (1966), “Algorithm for calculating reflection and refraction coefficients of head waves,” Computational Seismology, No. 1, Moscow, Nauka, pp. 107–111.Google Scholar
- 4.Yanovskaya, T. B., “Program for calculating travel-time and amplitude curves of body waves in a layered medium,” Problems of the Dynamic Theory of Seismic Wave Propagation, No. 6, pp. 87–93.Google Scholar
- 5.Alekseev, A. S., and B. Ya. Gel’chinskii (1959), “Ray method for calculating wave fields for inhomogeneous media with curvilinear interfaces,” Problems of the Dynamic Theory of Seismic Wave Propagation, No. 3, pp. 107–160.Google Scholar
© Consultants Bureau, New York 1972


TO THE THIRD POWER – One Voice Records Latin pop artist Freddie Colloca recently wrapped up hosting duties for the taping of his third season as host of One Cubed. The CBN International Latin show is seen by 25 million households in the United States, Argentina, Colombia, Mexico, El Salvador, Nicaragua, Uruguay, and Puerto Rico. The new shows begin airing this May. Olé!
TIME FOR SOME SALT & LIGHT – "Pillar is not selling out or doing this to get rich," stresses the band's lead singer Rob Beckley of the newly inked deal between Flicker Records and MCA Records. The Flicker/MCA ball starts rolling with a remix of the rock quartet's Fireproof (released to the CBA marketplace last May) and a subsequent release to mainstream retailers later this year. The single "Fireproof" will hit mainstream radio next month and the accompanying music video will be serviced to MTV and other video outlets. Back to Beckley…who sez the band has "been praying over [the record deal] for many months making sure we took the steps God would clearly have us take." Label prez Bob Herdman further clarifies that "[the band] never pursued it. The mainstream heavyweights sought after them." The fastest selling album yet for indie Flicker Records, Fireproof has scanned over 125,000 units and snagged two No. 1 singles—one being "Fireproof" which tied with P.O.D. as having the longest held No. 1 song on Rock R&R chart.
A LITTLE BIT O' ESPANOL, BRIT STYLE – The Spanish-language speaking public-at-large needs their Delirious, too, si? Perhaps that's why the band o' Brits are readying their first Spanish-language CD, Libertad, to be released by Furious Records on May 6. "A week was spent with a vocal coach from Mexico," reveals lead singer Martin Smith, "painstakingly singing line by line in an attempt to sound like Enrique Iglesias, and then amazingly, Libertad was born." Right-y-o. Well, moving right along…Libertad, meaning "freedom", features 12 fan favorites from the early "Cutting Edge" years of Delirious. Tracks were taken from the band's first four mini-albums and include "I Could Sing of Your Love Forever", "Find Me in the River", "The Happy Song", "Obsession", and others.


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General Page Media
Welcome to the Small Horticultural Farm Resources Website. This site is maintained by the Department of Horticultural Science and the College of Food, Agricultural and Natural Resources at the University of Minnesota.
This site is intended to provide information and resources for commercial growers of horticultural (primarily fruit and vegetable) crops in the Upper Midwest.
For further information about this site, contact the webmaster for this page (see below).

domain: biology


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BBIKE enters into the European Market
This year marks BBIKE'S first official participation in Eurobike as we celebrate the launch of our latest models in the European market. The BBIKE brand is thrilled at the opportunity to become part of Europe’s rich cycling culture, building on our impressive growth over the past few years. At Eurobike 2023, visitors will get the chance to discover BBIKE’s long history that reaches back over a century, see our latest models up close, and learn about what’s in store for the future.
BBIKE is the most recent chapter in the story of the renowned Italian brand Benelli. A shortening of Benelli Bike, BBIKE was formed in 2018 on the heels of Benelli Motorcycles becoming part of the Chinese manufacturing consortium Qianjiang. The original Benelli company was established in 1911 in the small Italian village of Pesaro where the brand still maintains its design headquarters. Over a century of motorcycle design and manufacturing expertise inspired the creation of BBIKE as a natural diversification into two-wheeled mobility.
BBIKE is a refreshing new player in the bicycle industry, embracing a unique global sales model and the production of high-quality bikes at a competitive price. Customers can take advantage of our growing network and purchase directly from BBIKE either online or in-store, saving them money. Quality and impeccable Italian design are the hallmarks of Benelli Bike products, including complete bicycles, cycling apparel, and helmets.
We first launched our bikes in Argentina and Ecuador in 2020 and now have operations across North and South America. This year, we are kicking off the start of our participation in the European and Asian markets here at Eurobike 2023. We have brought along several of the most exciting new additions to our fleet. Our extensive lineup includes electric bikes, urban commuters, road, and mountain bikes. By 2025, BBIKE plans to be present in more than 100 countries.
Our brand embraces its current role as a pioneer in the mobility industry and continues to develop its two-wheeled expertise that reaches back decades. At BBIKE, we source inspiration from our rich history and work toward the future of bicycle design.
Enjoy Eurobike 2023 and swing by our booth A13, Hall 12.1 to see our bikes in action and chat with us! If you have any additional questions, feel free to send a message online or email us at email@example.com

domain: geography


Russell Hamley–Mayor’s Newsletter
(My understanding is this is from a Newsletter by Mayor Russell Hamley in August 2008.)
In serving as an elected official, the most important function is approving the budget. This process started back in May with the Council retreat and will end at the September Council meeting with the approval of the budget and setting the tax rate for next year. As a part of that process, City Council recently completed a review of the 2008-2009 budget analysis and made recommendations about the needs and desires of the Village.
The budget is made of fifteen different funds; by law, some enterprise funds are required to be separated and other funds are created to simplify the accounting. The good news is that the City has excess reserves in the general fund this year of over $1.5 million. We have a healthy reserve and a great credit rating. Both of these things were important earlier this year when we purchased bonds for the street and drainage projects.
This is a good thing, however, since the City has a few outstanding projects needed in the near future. The Police Department is severely cramped, having run out of space several years ago. Having studied various options to alleviate the problem, Council has determined that the best option is to expand the police building as soon as possible.
Council is also considering the purchase of a fire truck to replace the 1978 truck that needs constant repair and does not meet the minimum codes. Who would think that one truck could cost a half million dollars? Another major project is the replacement of our City Hall buildings, which are fifty years old and deteriorating rapidly
Citizens who have visited City Hall recently will agree that the buildings are in bad condition and do not represent a positive image of Jersey Village. Council envisions a new, modern facility that will be a source of pride in our community, but that project will be expensive so the City should start setting money aside.
The plan is to build the City’s reserve to a significant level in order to pay for this replacement without having to go further in debt. I recently read a biography written by a famous politician who stated that the main job of an elected official is to “establish the budget and the rest of it is just fluff.”
As I write this, I have already skimmed, read and studied the first draft of the budget, a 500 page document which I and the other Council members received about two weeks ago. There are two scheduled public meetings at which Council will discuss the intricacies of the budget and to listen to input from citizens and staff. I invite all citizens to come to these public hearings which are scheduled for August 18 and September 15.


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In the United States, people have the right to peacefully protest under the First Amendment’s guarantee of free speech. However, governments can limit freedom of speech, which includes requiring limitations on protesting.
In this blog, we will review the laws you need to know about protesting in Alabama.
Alabama Protest Laws: Riots
In Alabama, we have special statutes related to protesting aimed at maintaining public health and safety.
Alabama Law to Know: Alabama Code § 13A-11-4
Legal Term to Know: Riot
The Alabama law defines a riot as noisy, disorderly, and violent actions that are likely to cause a serious risk of public fear or alarm.
In the state of Alabama, a person can be found guilty of inciting a riot if he/she commands, asks for, encourages, or promotes behavior likely to lead to a riot.
What the Law Says:
- This law makes it a crime for someone to start a riot.
- If found guilty, individuals can be charged with a misdemeanor.
Alabama Protest Laws: Unlawful Assembly
Alabama Law to Know: Alabama Code § 13A-11-5
Legal Term to Know: Unlawful Assembly
Alabama law defines unlawful assembly as:
- Gathering with five or more people with the intent of starting a riot.
- Staying anywhere that a riot has started with the goal of helping the riot continue.
What the Alabama Law says:
People found committing unlawful assembly in Alabama can be charged with a Class B misdemeanor.
Alabama Protest Laws: Failure to Disperse
Alabama Law to Know: Alabama Code § 13A-11-6
Legal Term to Know: Failure to Disperse
The Alabama law defines failure to disperse as:
- Joining with five or more people in disorderly actions that are likely to cause grave injuries, serious inconvenience, annoyance or fear
- AND refuses to stop or leave after being asked by the police or other law enforcement
What the Alabama Law says:
This law makes it a Class B misdemeanor in Alabama if individuals commit failure to disperse.
Alabama Protest Laws: Guns at Protests
Alabama Law to Know: Alabama statute § 13A-11-59
What the law says:
- This law makes it illegal for people to carry a firearm while attending or joining in a public protest.
- Individuals can be charged with a misdemeanor for committing this offense.
An individual was arrested on this charge on June 1, 2020, at the protest held near the Madison County Courthouse.
Huntsville Protest Laws
City governments in Alabama also have rules and regulations related to protesting. In Huntsville, the City government requires protesting organizations to obtain a special event permit.
This permit is then reviewed by:
- Huntsville Police
- Huntsville Fire & Rescue
- Parking & Transportation
- Traffic Engineering Department
Huntsville Law to Know: Huntsville Municipal Code Chapter 23
What It Says:
This law governs demonstrations made on streets, sidewalks, and public places.
It says that Huntsville can require individuals to get a demonstration permit before holding a protest.
If a demonstration is held without gaining a permit, the government may take action to stop or limit the protest.
A proper permit also allows law enforcement to protect any protestors from counter-protestors that may try and disrupt the original protest.
How to Apply for a Permit:
You can find details and apply for a protest permit in Huntsville, Alabama on the City of Huntsville’s website.

domain: law


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You can apply peat moss in a2:1 ratio as a soil amendment,with two parts soil to one part peat moss. Mix the peat moss into the top 12 inches of the soil along with any other amendments until the mixture is evenly distributed and plant into the freshly prepared ground.
People also ask
How much peat moss do I put in my garden?
For improving the general physical condition of soils. Apply peat moss in a 2鈥?-inch layer in your vegetable garden, and incorporate it into the top 12 inches of soil. For pots, containers and raised beds, use between 1/3 and 2/3 peat moss mixed with potting soil or compost.
What does peat moss do to soil?
Peat moss will lighten up the soil in your garden, which may have become compacted over the years, resulting in inadequate drainage. But you do not want all of the water to pass quickly through your soil. An ideal soil will retain enough moisture to keep your plants irrigated.
What can I use instead of peat moss?
Sand is excellent suitable alternatives to peat moss to break down clay soil and improve the texture, aeration and drainage of soil. It too is inert, so, it will not affect your soil pH and nutrients of your soil.
Can you use peat moss to start seeds indoors?
So if you have started plants indoors from seed, then you have very likely already dealt with peat moss. A soilless potting mix is much better to use for starting seeds than regular soil, for the following reasons: Regular soil is too heavy for plants just sprouting from seed.


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If you think you have a cavity, you are probably right that something is wrong. While it may be tooth decay, it’s always possible that it’s something else entirely (or just a bit of irritation). To help you soar comfortably through the waiting period before you come in to see us (hint, hint), we offer up our suggestions. Remember that it’s always good to keep yourself out of pain but it’s also extremely important to see us for a checkup, so an untreated cavity does not remain untreated for long.
You Can Take OTC Meds
If you are dealing with what you think is tooth decay and it’s causing you some amount of discomfort, we generally suggest you do what you can to reduce that pain or soreness with over the counter (OTC) pain medication. This will help you get your tooth back to a comfortable level, so you can sleep, work, and everything else without the tooth bothering you.
You Can Avoid The Area
Don’t go overboard trying to clean the area, touching it with your tongue or anything else, or pretending nothing is wrong and using it to chew. Instead, do your best to avoid that area until we see you and can determine whether it’s tooth decay or something else, and how to proceed.
You Need To Schedule An Appointment
Yes, we just shifted from things you can do to something you need to do. If you continue doing your best to keep the cavity from bothering you but you don’t take care of the problem, you will find yourself with a more serious issue down the line. Come in for an examination, so we can then proceed with the treatment your tooth needs (likely a dental filling or dental crown).
Protect Your Teeth With Immediate Care
If you suspect you have a cavity, address any discomfort and schedule a visit with us immediately, so we can solve the problem. Learn more by scheduling a visit in Prairie Village, KS by calling Robert M Browne, DDS at (913) 901-8585.

domain: medical


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Diving deeper, we'll explore the diverse ecosystem of royalty-free
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Learning doesn't stop after graduation. We'll showcase how
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Having green grass in the desert is a year round process. As the inevitable change in temperature occurs, many of us transition. We switch from Summer Bermuda grass to rye grass for the winter. There are obvious problems with this, Especially if you want your lawn to look great. An artificial lawn install could be the answer. Here why.
The Problem with Overseeding
For starters, it is estimated watering 500 square feet of winter grass takes about 10,000 gallons of water. That number doubles if not triples for maintaining natural grass during the summer months. If you do not have a separate meter for landscape water use, you could be in trouble. Your sewer fees may go up as a result of winter Rye grass irrigation. In Scottsdale, sewer fees are based on water usage during the months of December, January, and February. However, forego the overseeding process and deal with a white colored lawn. This is especially true from November to April.
Instead, Consider an Artificial Lawn Install
Instead of overseeding there is another option. Besides, overseeding incurs the cost of labor, seed, fertilizer, and water. Instead, homeowners should consider an artificial lawn install from Paradise Greens. We have prices to match any budget. And our install teams? Well, they are the best. Plus, think of all the areas you will save money. You will have no need for:
- Lawn equipment
Charlie Ferer, President & CEO of Paradise Greens commented ”A synthetic grass lawn from Paradise Greens is environmentally responsible. It can also significantly cut costs. We eliminate natural lawn maintenance, As such, homeowners see a return on their investment in four years.” Also, the lifespan of an artificial grass lawn installed by Paradise Greens is 15 years. So you will recoup your investment over four times during its lifetime.
Now its time to kiss overseeding goodbye. Call Paradise Greens to get your artificial lawn install. We are ready to help you create the perfect green space. Imagine a permanent ever green yard. Paradise Greens can make it a reality. You have nothing to lose and a new lawn to gain. The consult is free. Call us now!

domain: agronomy


text:
Black History Month 2021
To celebrate and honour #BlackHistoryMonth this year we arranged activities across our services and are sharing stories across our organisation.
Day Opportunities Service
The Day Opps team had a full programme of activities organised by Day Opportunities Coordinator Natalia Thomas-Jikiemi.
Below you can see some of our service users amazing art work for the 3D Sensory Afro Queens Posters session!
And here you can see one of our service users Jemel’s amazing art work for the Kente Cloth Weaving and Printing session! Kente cloth is a beautiful fabric that is worn today by many people who regard it as a symbol of African pride and dignity!
Jemel’s beautiful Kente cloth was also displayed with pride at our Black History Month Museum (check it out below!)
Friday Cooking Club (Learning & Leisure)
Last Friday, at our weekly Cooking Club, we kicked off our Black History Month by celebrating Afro-Caribbean cuisine. Tariq, Jemel & Saron are seen here all taking part in preparing, cooking together and enjoying themselves whilst doing so.
Black History Month Museum (Independent Living Outreach Service and Learning & Leisure Personal Support Worker Service)
The Black History Month Museum was organised by our amazing staff Hannah Broomes and Jayde Christian, and has been planned for Wednesday 13th, 20th and 27th October 2-5pm in Room A at 404 Camden Road.
It includes various information and visual displays about Black History, including The Slave Trade, Black Hair and Black Lives Matter.
“We absolutely loved service user Jemel contribution [pictured below], and have given it inclusive pride and place amongst the museum exhibits, absolutely fabulous!” Hannah Broomes, Senior Support Worker (pictured above).
Black History Month at Leigh Road (Independent Living Service)
Leigh Road had a Black History Month event, which was hosted by our staff Olivia Marriott and Marie Barned. They celebrated with Caribbean food and music in the lounge, as well as a banner in the hallway of historical and famous black people.
Staff Heritage Stories
Here Shiloh, our Database & Admin Assistant Kickstarter, has kindly shared some fascinating facts and memories from her families Montserrat heritage. Thank you to Shiloh for sharing her story and we hope to see more stories shared from around our community, with the aim of learning about different countries and heritages and celebrating and honouring these roots.

domain: sociology


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Suburethral Sling Procedures
Vincent R. Lucente and Marisa A. Mastropietro
Table Of Contents
|Vincent R. Lucente, MD, MBA
Interim Chairman, Department of Obstetrics and Gynecology; Chief, Division of Gynecology; Chief, Section of Urognyecology and Reconstructive Pelvic Surgery, Lehigh Valley Hospital, Allentown, Pennsylovania; Associate Professor of Clinical Obstetrics and Gynecology, Pennsylvania State Univeristy College of Medicine/Hershey Medical Center (Vol 1, Chap 94)
Marisa A. Mastropietro, MD
Associate Chief, Section of Urogynecology and Reconstructive Pelvic Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania (Vol 1, Chap 94)
INTRINSIC SPHINCTER DEFICIENCY
In treating any patient with urinary incontinence, the goal is to provide the patient with a cure from her symptoms and improve her quality of life. To obtain this goal consistently, considering the variability among patients and the multiple factors contributing to the development of incontinence, physicians must be well aware of the various treatment options and their indications. Suburethral sling procedures have long been a mainstay in the surgical treatment for female stress urinary incontinence.
Traditionally, suburethral sling procedures were reserved for patients with recurrent stress urinary incontinence. During the past century, indications have been expanded to include not only those patients with the severe form of stress urinary incontinence, namely intrinsic sphincter deficiency (ISD), but also patients with routine stress incontinence in conjunction with comorbid conditions.
With hopes of improving the treatment of stress incontinence symptoms, interest in primary and secondary slings has increased. The sling procedure is now often considered in any patient with stress urinary incontinence. The suburethral sling procedure requires careful attention to patient selection, workup, surgical technique, and avoidance of complications. The history of the sling procedure, patient evaluation and indications, surgical techniques, and complications of the sling procedure will be discussed here.
Since the first reported case in the early 1900s, the suburethral sling procedure has seen many changes. All aspects of the sling, including its indications, materials, and techniques used, have undergone a generation of change. With each change, there was improvement on the previous modification.
The earliest described sling procedure was in 1907 by Giordano, who used the gracilis muscle. In 1926, Giordano's technique was applied to a case of epispadias by Denning. In 1910, Goebell first described the use of freed pyramidalis muscle suburethrally. This was followed in 1914 by Fragenheim's modification of Goebell's technique, which employed fascial attachments of the pyramidalis muscles and the recommendation for use of the rectus abdominis muscles when the pyramidalis muscles were inadequate. The final modification to this technique in 1917 was by Stoeckel, who combined a vaginal plastic operation with muscular plication at the vesical neck. This is known as the Goebell-Fragenheim-Stoeckel technique.
Further modifications of the sling procedure were reported in 1923 by Thompson, using rectus muscle and fascia, and later in 1929 by Martius, using bulbocavernosus muscle and its surrounding fatty tissue transplanted suburethrally.1
In the early 20th century, sling procedures were described that included the use of a number of autologous grafts. Muscle sling grafts were later abandoned secondary to difficulty in maintaining an adequate vascular and neural supply and therefore a viable graft. In 1942, Aldridge described yet another modification of the sling procedure using the aponeurosis of the external oblique muscles, which most resembles the modern fascial sling. In his procedure, Aldridge harvested two strips of fascia, maintaining medial attachment, and passed the lateral arms inferiorly to be sutured suburethrally at the level of the urethrovesical junction. In the same report, Aldridge discussed the advantages of autologous fascia lata over abdominal wall fascia.1
A more recent modification was described by Raz and colleagues2 in 1989. In this report, an in situ vaginal wall patch was used suburethrally in conjunction with suture arms. Cure of stress incontinence was reported in 94% of patients with ISD.
Difficulties with autologous grafts include inadequate length or poor quality of the tissue and the complications of a harvesting technique (i.e., additional incision, risk of incisional hernia at harvesting site). Surgeons continued to search for the ideal graft material and switched to inorganic from organic graft materials. First reported was a nylon sling by Bracht in 1956.3 Later use of inorganic grafts included Silastic sheets (silicone), Mersilene, Marlex, and Gore-tex slings. In 1962, Williams and TeLinde4 reported the use of a Mersilene sling in 12 patients. Complications included abscess formation with a persistent sinus tract and urethral trauma. At the time the authors did not believe the Mersilene to be the etiology of the infection, but rather believed it to be the vaginal surgical route and therefore equal to a fascial sling. In 1985, Stanton and colleagues5 reported on 30 Silastic sling procedures with an 83% subjective and objective short-term cure rate. Silastic sheets were chosen because of the consistent strength, lack of incorporation into surrounding tissues, local fibrous sheath response, and therefore ease of removal, if necessary. In 1988, Horbach and associates6 reported on the use of Gore-tex slings with a short-term 85% subjective and objective cure rate. The tension-free vaginal tape sling procedure (TVT), first described in Sweden by Ulmsten and Petros7 in 1995, incorporated several different materials in the original series. Since 1996, however, the TVT procedure has used a unique prolene mesh sling.8,8a Complications of inorganic graft materials have included urinary retention requiring surgical revision, urethral irritation, necrosis, and graft infection and erosion.
A return to the use of organic materials has occurred with the use of allografts such as cadaveric fascia lata, dermis, pericardium, and dura, and heterologous grafts such as porcine small intestine submucosa and dermis.
As surgeons continue to search for the ideal graft material, organic (homologous and heterologous) and inorganic graft materials continue to be employed. No study has compared organic with inorganic grafts. As yet, the ideal material has not been identified, and the selection continues to be the surgeon's choice.
As recommended by the Agency for Health Care Policy and Research (AHCPR), all patients with complaints of urinary incontinence should undergo a basic evaluation that includes a medical history, physical examination, measurement of postvoid residual volume, and urinalysis. Particularly important in the history is a detailed exploration of the incontinence symptoms, including duration, frequency, precipitating factors, other lower urinary tract symptoms, and possible risk factors, including prior treatments. During the physical examination, a focus on the pelvic examination, with emphasis on site-specific support defects, will identify concurrent prolapse conditions while assessing the integrity of the urogenital tissue. Patients with a complicated history in terms of severity of disease, recurrence of symptoms, or presence of comorbid conditions should undergo further evaluation with urodynamic testing, endoscopy, and/or imaging studies.9
Genuine stress incontinence (GSI) is defined as the involuntary loss of urine occurring when, in the absence of a detrusor contraction, the intravesical pressure exceeds maximum urethral pressure.10 Patients with GSI are often categorized according to the presence or absence of urethral hypermobility. Early definitions of GSI classified patients as types I, II, and III. Type I is defined as straightening of the posterior urethrovesical angle to 180° or greater with straining. Type II consisted of the changes seen in type I, together with an increase of greater than 45° in the urethral axis in the vertical plane. Type III is associated with a fixed, “lead-pipe”, urethra.11
The term “intrinsic urethral sphincter deficiency” was first described by the AHCPR in 1992 as a cause of GSI.12 This condition is considered a more severe form of GSI and is defined as a subset of patients with GSI whose urethral sphincteric mechanisms fail to maintain sufficient resistance for urinary continence either at rest or in the presence of minimal physical exertion. The AHCPR guidelines recommend preoperative identification of patients with ISD, suggesting the use of various tests. However, despite these guidelines, a specific definition of ISD is not provided. Additional terms such as low-pressure urethra and type III incontinence have been used, but these entities are not interchangeable. Recommended management of the patient with ISD includes sling procedures, periurethral bulking agents, and artificial urethral sphincter.
Traditionally, as recommended by the AHCPR, sling procedures have been indicated in patients with either GSI caused by ISD or recurrent GSI. Expanded indications include patients with GSI with comorbid conditions that increase the risk of surgical failure. The high risk of surgical failure is associated with a tendency for repetitive increased abdominal pressure. High-risk conditions include chronic bronchitis/asthma, severe obesity, chronic steroid use, congenital tissue weakness, and a history of recreational or occupational heavy lifting or high impact.13
|INTRINSIC SPHINCTER DEFICIENCY|
Much clinical research has been done in an attempt to identify and define the patient with ISD. McGuire14 described a subset of patients whose symptoms had failed to respond to multiple operations for the treatment of stress incontinence. In this report, 75% of patients who failed to respond to multiple operations were defined as having type III incontinence (urinary loss associated with stress, with variable urethral mobility from none to marked, and urethral closure pressures less than 20 cm H2O). However, the finding of type III incontinence is not clearly noted as a cause of the surgical failure or an effect.
The association of multiple prior procedures with lower urethral closure pressure on urodynamic testing was confirmed in 1983 by Hilton and Stanton.15 In this report, continent and stress incontinent women were compared by urodynamic testing, specifically urethral pressure profilometry. Women with three or more prior anti-incontinence operations, age older than 60 years, and more severe symptoms of stress incontinence, as demonstrated objectively, were found to have lower mean maximum urethral closure pressures.
The relationship between low urethral closure pressure and outcome with a specific anti-incontinence procedure was later described.16 Subjects were grouped according to preoperative maximum urethral closure pressure (group 1, 20 cm H2O or less; group 2, more than 20 cm H2O), and all patients underwent Burch colposuspension (Tanagho modification). A 54% failure rate was seen in the low-pressure group. No significant difference was identified between the groups except for age. The low-pressure group was statistically older (mean age 53.3 years).
Further research evaluated 13 clinical characteristics as possible predictors of ISD, as defined by a maximum urethral closure pressure of 20 cm H2O or less.17 Clinical characteristics including age, gravidity, parity, estrogen status, prior hysterectomy, number and type of prior incontinence surgeries, associated presenting symptoms of urgency, frequency, or urge incontinence, maximum straining Q-tip angle, postvoid residual volume, and uroflow pattern were evaluated retrospectively. The only identifiable statistical predictor of ISD was an age older than 50 years.
Maximum urethral closure pressure evaluates the urethral sphincter mechanism at rest and therefore refers to the passive continence mechanism. An active test of the continence mechanism is the stress leak point pressure, either during a Valsalva maneuver or a cough. Comparison of maximum urethral closure pressure to stress leak point pressure in patients with GSI revealed a significant positive correlation. With stress leak point pressure as a diagnostic tool to define low-pressure urethra, a critical value of 45 cm H2O results in a sensitivity of 80% and a specificity of 90%. However, if stress leak point pressure is to be used as a screening tool, a critical value of 60 cm H2O shows an improved sensitivity of 90% with a reduced specificity of 64%.18
McLennan and Bent19 reported a comparison of stress leak point pressure and maximum urethral closure pressure with the supine empty stress test (postvoid residual volume less than 100 cc). The supine empty stress test was found to be a screening tool for low (60 cm H2O or less) stress leak point pressure but not for low (20 cm H2O or less) maximum urethral closure pressure. Similarly, Hsu and coworkers20 showed a sensitivity and specificity of at least 90% for the supine stress test (bladder volume = 200 cc) in comparison to low (100 cm H2O or less) stress leak point pressure.
Prior attempts to define the spectrum of GSI and its subset of patients with ISD by clinical and urodynamic evaluation emphasized age, prior surgical history, severity of incontinence history, extent of urethral mobility, maximum urethral closure pressure, and stress leak point pressure testing. In 1997, Bump and colleagues21 reported on the comparison of the latter three parameters. Low stress leak point pressure was consistently strongly associated with worse symptomatic incontinence. Sensitivities, specificities, and positive and negative predictive values among the three parameters were low, ranging from 40% to 85%. Subjects with all three parameters present had the worst incontinence. As previous work suggests, subjects with positive parameters were found to be significantly older and more likely to have had a prior hysterectomy or anti-incontinence or prolapse surgery, and averaged a higher number of prior procedures.
In summary, recommendations for the diagnosis of ISD included a composite of historic, urodynamic, anatomic, and clinical severity criteria.21
Once the incontinence workup is completed and the decision to proceed with a sling procedure has been made, options remain. First is the choice of graft material. Organic grafts require a harvesting procedure or can be obtained from a tissue bank. Autologous grafts include vaginal epithelium, rectus fascia, or fascia lata. Allografts include cadaveric dermis, fascia lata, dura, and pericardium. Heterologous grafts include porcine dermis and small intestine submucosa. Multiple inorganic grafts are readily available. Second is the choice of surgical approach. The various sling procedures performed today are technically somewhat similar. Most sling procedures are performed using a combined abdominal and vaginal approach, with most of the dissection performed vaginally. As reported in the early 1900s, a complete abdominal approach is possible but may be associated with increased urethral injury. Early avoidance of a combined procedure was common because of concern about vaginal contamination and increased postoperative infection. With today's improved surgical techniques and antibiotic coverage, combined abdominal and vaginal procedures are safe. Sling variations include a full-length sling, a patch sling, or a TVT sling.
As part of the preoperative preparation, the risks and benefits of the procedure, along with postoperative restrictions, are reviewed with the patient. Many surgeons teach all patients clean intermittent self-catheterization before surgery. On the day of surgery, the patient should receive appropriate antibiotic prophylaxis, according to patient allergy and medical history, 60 minutes before surgery. The patient is positioned in the dorsal lithotomy position and prepared and draped in a sterile fashion for abdominal and vaginal surgery. A Foley catheter is placed transurethrally.
If a full-length sling is planned, the graft of choice is prepared and soaked in antibiotic solution. If an autologous fascial graft is planned, a harvesting procedure for either fascia lata or rectus fascia is completed using a Wilson fascial stripper or a vein stripper. Similarly, if an allograft is used, this too should be hydrated in an antibiotic solution. Generally, the graft should measure approximately 2 ×12 to 18 cm for a full-length sling, according to patient habitus. A transverse suprapubic incision is made 2 fingerbreadths superior to the symphysis pubis, measuring approximately 4 cm. The underlying rectus fascia should be exposed with either sharp or blunt dissection. The anterior vaginal epithelium is then infiltrated with either sterile saline or dilute anesthetic/epinephrine solution. A midline anterior vaginal incision is made, measuring about 3 cm, at the level of the urethrovesical junction. The vaginal epithelium is sharply dissected away from the periurethral and perivesical tissue. The dissection should be completed laterally to the inferior pubic rami. Gentle traction is applied to the Foley catheter to allow identification and palpation of the balloon, indicating the urethrovesical junction. The bladder is decompressed. With the surgeon protecting the urethra with the nondominant hand, the perineal membrane is perforated bilaterally, allowing entrance into the space of Retzius, using either Metzenbaum or curved Mayo scissors at a 45° angle, always lateral to the urethra and directly behind the symphysis pubis (Fig. 1). The midportion of the sling is secured using delayed, absorbable suture along the proximal urethra, with the most proximal edge at the bladder base to prevent folding or kinking of the graft material. As is done with a needle urethropexy, packing forceps are passed with guidance from a vaginal finger, from the abdominal incision through the space of Retzius to the vaginal incision. The graft arm is grasped and carried back through to the abdominal incision. This is repeated on the opposite side (Fig. 2). When passing through the space of Retzius, the surgeon takes care to start medial to the pubic tubercle to avoid ilioinguinal nerve injury. Once both sling arms are passed, urethrocystoscopy is performed to rule out urethral or vesical injury. Ureteral function is also confirmed by intravenous indigo carmine injection. A suprapubic catheter is placed under cystoscopic guidance for postoperative bladder drainage and voiding trials. The sling arms are then sutured to the rectus fascia using permanent suture to allow a urethrovesical junction angle of 0° with the horizontal plane. The incisions are irrigated with antibiotic solution. The vaginal and abdominal incisions are reapproximated using delayed, absorbable suture (Fig. 3).
A variation of the full-length sling is the patch sling. This procedure can be performed with either a patch of in situ vagina, as described by Raz and associates in 1989,2 or other organic or inorganic grafts. The patch sling has been described as a variation of a Pereyra or Raz procedure.22 The patch should measure approximately 2 × 5 cm. Surgical preparation, the abdominal and vaginal incisions, and dissections are completed as described for the full-length sling. Entrance into the space of Retzius may or may not be accomplished, according to the surgeon's preference. As in the full-length sling procedure, the midportion of the patch graft is secured suburethrally using delayed, absorbable suture to prevent folding or kinking of the graft. In a helical fashion, permanent suture is passed along the long axis of the patch graft. A Stamey ligature carrier is passed with guidance from a vaginal finger, from the abdominal incision through the space of Retzius to the vaginal incision on each side for suture transfer. Once both suture arms have been transferred, urethrocystoscopy is performed after intravenous indigo carmine administration to rule out urethral, vesical, or ureteral injury. A suprapubic catheter is placed under cystoscopic guidance for postoperative bladder drainage and voiding trials. The suture arms are tied down to a urethrovesical junction angle of 0° with the horizontal plane. The incisions are irrigated with antibiotic solution. The vaginal and abdominal incisions are reapproximated using delayed, absorbable suture (see Fig. 3).
The full-length and patch sling procedures are most often performed under general anesthesia; however, if medically indicated, they may be completed under regional anesthesia.
Tension-Free Vaginal Tape Sling
The TVT system consists of a reusable stainless-steel introducer handle, a reusable rigid catheter guide, and the single-use device. The TVT device consists of a 1 × 40-cm ribbon of polypropylene mesh covered by a plastic sheath attached onto two curved stainless-steel needles (Fig. 4).
The TVT procedure is most often performed under local anesthesia with intravenous sedation. The procedure is performed with the patient in the dorsal lithotomy position with her lower extremities supported in Allen-type stirrups. An 18F Foley catheter is inserted to the urethra and the bladder is emptied. Local anesthetic is applied suprapubically at two points, 1 to 2 cm above the pubic symphysis and 2 to 3 cm lateral to the midline. The abdominal skin, underlying rectus muscle, and fascia as well as the posterior aspect of the pubic bone is infiltrated bilaterally. Two small abdominal skin incisions (0.5 to 1.0 cm) are then made at these points. No further abdominal dissection is necessary.
A Sims speculum is then inserted into the vagina to allow visualization of the anterior vaginal wall. The indwelling Foley bulb is used to identify the location of the internal urethral egress, while the external meatus is easily visualized. Using these two points as landmarks, the region of the midurethra is identified. The local anesthetic solution is injected into the vaginal submucosa in the midline and slightly lateral on each side of the urethra. Allis clamps are placed bilaterally for countertraction as a small sagittal incision (1.5 cm) is made in the midline at the level of midurethra. The incision should begin approximately 1 cm from the external urethral meatus. The Metzenbaum scissors are then used to minimally dissect the vaginal wall, freeing it from the underlying periurethral tissue and developing a small tunnel bilaterally. This dissection should be limited to a depth of 1 to 1.5 cm. Care should be taken not to puncture the pubocervical fascia or injure the urethra (Fig. 5). Additional local anesthetic solution should be injected bilaterally using a long spinal needle, placing the solution along the inferior and posterior aspects of the pubic symphysis.
The rigid catheter guide is then inserted into the Foley catheter. The handle of the rigid guide is then moved to the ipsilateral side of the anticipated passage of the forthcoming TVT needle. With the aid of the introducer handle, the surgeon places the tip of the needle into the previously developed periurethral tunnel (Fig. 6). Two hands are required to pass the needle safely. The needle is directed slightly laterally, most often in direct alignment with the patient's ipsilateral axilla. The TVT needle is gradually advanced by applying gentle pressure with the palm of the vaginal hand, with continued vaginal finger guidance and slight pressure from the second hand on the introducer handle. As the needle tip passes through the endopelvic fascia, a distinct drop in resistance is appreciated. At that point, with downward deflexion of the introducer handle, the surgeon guides the needle superiorly through the space of Retzius, with the needle being immediately opposed to the back side of the pubic symphysis (Fig. 7). As the needle opposes the underside of the rectus muscle and fascial sheath, resistance is again appreciated. At this point, the introducer handle is used solely to direct pressure anteriorly, advancing the needle tip through the previously made small abdominal incisions. The surgeon's nondominant hand is used suprapubically to help guide the needle tip (Fig. 8).
The rigid catheter guide and Foley catheter are removed and diagnostic urethrocystoscopy is performed to evaluate for any unintentional injury of the urethra or bladder. Once correct needle placement is confirmed, the needles pass completely through the abdominal incision. The steps of the procedure are then repeated on the opposite side. Care should be taken to ensure the tape is not twisted under the urethra (Fig. 9).
After correct placement of the TVT device and before removal of the protective plastic sheath, a cough test is performed to identify the correct positioning of the tape. The cough test is conducted with a full bladder (250 to 300 mL saline) (Fig. 10). Once the proper positioning of the tape is obtained, the plastic sheath is removed and the prolene mesh is left in place without tension under the midurethra. The abdominal ends of the tape are cut just below the skin surface. The procedure is completed with closure of the abdominal and vaginal incisions (Fig. 11).
All of the above sling procedures have been successfully reported in patients with recurrent stress incontinence as well as patients with ISD. Cure rates for sling procedures vary from 70% to 100%.23,24 Comparison of various sling case series is difficult, given the variation in surgical technique. No direct comparison study has been reported.
The use of inorganic graft materials in gynecologic and urologic surgery has developed from the use of these materials in general surgical techniques such as herniorrhaphy and orthopedic repairs. Inorganic materials can be compared by their mechanical and biologic properties.
Chemical components of inorganic grafts include monofilament and multifilament types. Monofilaments include polypropylene (Marlex, Prolene, and Atrium). Multifilaments include polytetrafluoroethylene (Teflon), expanded polytetrafluoroethylene (Gore-tex), polyethylene terephthalate (Mersilene), polyglycolic acid (Dexon), and polyglactin 910 (Vicryl). Of the multifilaments, only two are absorbable (Dexon and Vicryl). One theoretical disadvantage of multifilament mesh is that its interstices may allow penetration by small bacteria (less than 1 μm), but not larger macrophages and polymorphonuclear leukocytes. The porosity of the mesh also contributes to the development of fibrous tissue. The number, size, and shape of the pores appear to be related to tissue bonding. Mersilene is the most porous compared with Teflon and Marlex. Mesh flexibility is another property related to clinical outcome in that complications such as mesh extrusion may relate to the rigidity of the mesh.25
Organic grafts can be autologous or heterologous. Autologous grafts require a separate harvesting procedure. Allografts and heterologous grafts can be purchased from various tissue banks. It is recommended that grafts be purchased from accredited tissue banks. The American Association of Tissue Banks inspects the bank to ensure high- quality tissue production. Autologous grafts used include various muscles, rectus fascia, and fascia lata. Allografts include dermis, dura, pericardium, and fascia lata. Heterologous grafts include porcine small intestine submucosa (SIS) and porcine dermal collagen (Pelvicol). Alloderm is an acellular, freeze-dried, human dermal graft. Fascia lata grafts are available as either solvent-dehydrated, gamma-irradiated (Tutoplast) or freeze-dried (FasLata). Pericardium is available as a solvent-dehydrated, gamma-irradiated graft (Tutoplast).
Graft materials vary in mechanical and biologic properties. These properties are associated with a variety of success and complication rates when used in anti-incontinence surgery. Without randomized comparison studies, the decision remains with the surgeon. It is therefore of utmost importance that the surgeon be familiar with these graft materials and their properties.
The complications associated with sling procedures can be categorized as those common to anti-incontinence surgery (transvaginal or retropubic) and those specific to the sling technique.
Complications common to anti-incontinence surgery include injury to the bladder, urethra, or ureter, retropubic or vaginal hematoma, wound infection, cystitis, nerve damage, and recurrent or persistent urinary incontinence. The use of urethrocystoscopy at the time of sling procedures can aid in identifying intraoperative lower urinary tract injury, therefore allowing immediate attention and repair of the injury. Intraoperative hemorrhage and hematoma formation should be prevented by meticulous surgical technique. Knowledge and attention to surgical anatomy, as well as experience with the technique, are essential to avoidance and management of vascular injury. Nerve damage may occur secondary to positioning for abdominal or vaginal surgery. Injury is commonly due to compression or stretch of the nerve fibers but may also be secondary to direct transection. Attention to intraoperative positioning and surgical technique, along with early recognition and evaluation of any postoperative complaints, is recommended to avoid injury. Persistent or recurrent urinary incontinence can occur due to surgical failure, de novo or persistent detrusor instability,overflow incontinence, or fistula formation. This complication should be addressed with a thorough workup and appropriate treatment.
Complications specific to the sling procedure include voiding dysfunction and urinary retention, detrusor instability, and graft erosion and infection. Voiding dysfunction and urinary retention are associated with the level of tension of the sling and resultant outlet obstruction. Many techniques are used during surgery for sling adjustment, but no one method is recommended, and the selection remains a matter of the surgeon's experience. Rates of persistent urinary retention have been reported to be 2% to 10%.13,23,26 Symptomatic de novo postoperative detrusor instability is thought to be related to the degree of outflow obstruction. Reported rates vary from 2% to 22%.13 Graft erosion and infection have been reported with an increased incidence associated with inorganic materials. Due to the increased incidence of graft erosion and infection with inorganic materials, there has been a trend toward the use of organic grafts. Organic grafts, however, are not free of similar complications.
Few randomized controlled trials exist comparing sling procedures with colposuspensions.27 No randomized controlled trials exist comparing the various techniques of the suburethral sling procedure.
Variation exists with regard to surgical technique, graft material, and success and complication rates for the suburethral sling procedure. Despite this variation, the suburethral sling procedure is an effective, safe technique for the treatment of GSI and ISD.
6. Horbach NS, Blanco JS, Ostergard DR et al: A suburethral sling with polytetrafluoroethylene for the treatment of genuine stress incontinence in patients with low closure pressure. Obstet Gynecol 71: 648, 1988
8. Dietz HP, Vancaillie P, Svehla M et al: Mechanical properties of implant materials used in incontinence surgery [abstract 98]. 31st Annual Meeting of the International Continence Society, Seoul, Korea, 2001
9. Urinary Incontinence in Adults Guideline Update Panel. Urinary Incontinence in Adults: Acute and Chronic Management, Clinical Practice Guideline. AHCPR Pub No. 96-0682. Agency for Health Care Policy and Research, Public Health Service, U.S. Dept. of Health and Human Services, March 1996
21. Bump RC, Coates KW, Cundiff GW et al: Diagnosing intrinsic sphincteric deficiency: comparing urethral closure pressure, urethral axis, and Valsalva leak point pressures. Am J Obstet Gynecol 177: 303, 1997


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- Bacon. I especially love it cold and crunchy.
- I love to peel dried glue from my hands.
- That I believe any mistake or flaw in my art just adds character.
- The swish swish sound of my thighs rubbing together when I wear courdiroy pants.
- Going potty by myself.
- Listening to Dyllan crack him self up
- People watching.
I will pass the love for weirdness on to: Michelle Geller

domain: hobby


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A couple of weeks ago there was special on TV that celebrated the arrival of the Beatles in America, and their landmark appearance on the Ed Sullivan Show in February, 1964. Several contemporary artists played classic Beatles songs, while surviving Beatles Paul and Ringo, their spouses, and other family members including Yoko Ono and Sean Lennon rocked out in the audience. The big finale saw both ex-Beatles taking the stage to perform some of their greatest hits. Ringo went on first. He looked very fit and energetic as he sang songs such as “Boys”, “Matchbox”, and “Yellow Submarine.” Then Paul joined him on stage for a performance of “Sgt. Pepper’s Lonely Hearts Club Band”, and “With a Little Help from My Friends.” From time to time the camera would scan the audience, where celebrities such as Tom Hanks and Dave Grohl were enjoying the show. There was also a lot of twenty-something women dancing and singing along like it was a Taylor Swift concert.
It’s always nice to see young people that appreciate the Beatles’ music, or any of the music my generation grew up with. Not that today’s music is all that bad. It just doesn’t have the same quality that music from the definitive years of rock and pop had. Another let down is that today’s music, and movies, and just about every other form of arts and entertainment, is way too digitalized. The pounding, pulsating sound of electronic dance, house, club, disco, or what-have-you is such a mind-numbing experience, who cares what the song is about. Then there’s the American idol, MTV, or YouTube path to stardom. In my day we used to stay up till midnight on weekends to see our favorite bands on shows such as “In Concert,” or “Don Kirschner’s Rock Concert”. There is an aura of mystique that surrounds a band that you only see in magazines or a couple of times a year on late night TV.
Getting back to the Beatles (Get Back Jojo!), I have read comments from some individuals on the internet that don’t like the Beatles, and can’t understand why Sgt. Pepper is considered by many to be the greatest rock album of all time. Some of them are just internet trolls, or right-wingers that think the Beatles were a “liberal” band, and their music appealed mainly to left-wing hippies. But there are some that just don’t like their music; and that’s okay. I didn’t like the music my parents listened to when I was young (even if I did, I wouldn’t have told nobody!). Let’s face it: The Beatles started out with only 3 guitars and drums. No backup keyboards, synthesizers, or orchestras (until later in their career). The Fender amps they relied on to power their sound was no match for today’s sound systems. If you have ever seen the video of the lads playing Shea Stadium in 1965, you know what I’m getting at. They couldn’t even hear themselves sing because girls in the audience were screaming so loudly. These days’ musicians have cordless microphones and headsets. A lot of the music seems to be piped in so the artists can focus on their dance routines. All this along with Dolby Surround Sound systems would make anyone sound better.
What it comes down to is, you had to have been around back then. I was 7 when the Beatles performed on Ed Sullivan in 1964. Soon after, I got “Meet the Beatles”. When “A Hard Day’s Night” premiered at the movie theaters, I went to see it. Likewise for “Help”. I think I had every album up to “Rubber Soul” when “the Monkees” TV show premiered in 1966. At that point, the Beatles, and their music had matured, and so had their audience. I was only 9, and the Monkees were on every week. So I concentrated less on the Beatles and more on the show that was created after two producers saw “A Hard Day’s Night”, particularly the scene where John, Paul, George and Ringo danced and goofed around in fast motion while “Can’t Buy Me Love” played in the background (essentially the first music video).
My older brother bought “Revolver”, which is still one of their best albums in my opinion, and I would listen to it from time-to-time. But for the most part my interest in the Beatles had waned somewhat.
Then Sgt. Pepper came out….wait, no, 2 singles with accompanying videos came out first: “Strawberry Fields Forever” and “Penny Lane”. The songs and videos were radically different than anything I had ever seen before. Time magazine called SFF “the latest example of the Beatles’ astonishing inventiveness”. It was dark and moody, and the imagery was haunting. It almost gave me nightmares. Penny Lane was more cheery, but still radically different from anything I had seen before.
When we got Sgt. Pepper (by this time my whole family was Beatles fans), I played it about 10 times a day. It wasn’t one particular song, but the way each song transitioned into the next one that compelled one to listen to it in its entirety. Now the band used new instruments, explored different genres, and experimented with recording techniques that were revolutionary.
After Sgt. Pepper, I mostly bought 45 RPM singles (remember those?) instead of whole albums, and I began to listen to the radio a lot. So I had singles like “All You Need is Love”, “Hello Goodbye”, “Rain”, “Come Together”, “I am the Walrus”, “Back in the USSR”, “Get Back” “Revolution” and a few more that were big hits back then. I don’t think I ever owned another Beatles album after Sgt. Pepper, but obviously I was still a fan, and I paid attention to the latest Beatle news, from their trip to India, the death of their manager Brian Epstein, the Yoko Ono buzz, the Manson family connection, and finally, their breakup in December 1970. I had just turned 13.
About 7 years ago, I rediscovered the Beatles when I bought a laptop and an iPad, and began downloading music. My brother-in-law has a subscription to a website where you can download files of all kinds, and I downloaded about 4,000 songs, including about 280 Beatles songs. I found that I like their music more than ever. I also downloaded songs by the Stones, Led Zeppelin, Elvis (Costello and Presley), CCR, and many others. With a 16GB iPod that holds about 1300 songs, I would put it on shuffle, and go for a 10 mile run. Whenever a Beatles song came on, I always savored it. The Beatles really were the greatest rock band ever, and I’m so glad that I literally grew up with them.

domain: artistic


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Lewis Black Comes to Penn State York April 22
"America's Foremost Commentator on Everything," Lewis Black, will visit Penn State York’s Pullo Family Performing Arts Center (Pullo Center) on Sunday, April 22 at 7:30 p.m. to share his special form of humor. Penn State York students, faculty, and staff can purchase tickets now with tickets on sale to the general public Monday, March 26.
Listen to a short clip from Lewis Black [1.84M mp3]
Black is a weekly political commentator on, COMEDY Central’s "The Daily Show with Jon Stewart" and has starred in comedy specials for the network. As a stand-up comedian, he has performed at the U.S. Comedy Arts Festival in Aspen, The Montreal International Comedy Festival, The Irish Comedy Festival in Kilkenny, Ireland; and Carnegie Hall in New York City.
Born and raised in Silver Spring, Maryland, Black has found a home on the stage as an actor, playwright, and stand-up comedian. He has performed his caustic, cranky, bile-spewing, dead-on social and political comedy throughout Europe, Australia, New Zealand, Canada, and the United States.
Black is a graduate of the Yale School of Drama. As a playwright he has authored more than 40 plays that have been produced in theatres across the country, including "Czar of Rock and Roll" (Alley Theatre) and "Crossing the Crab Nebula" (The Alliance Theater), which was later produced in New York at the Ensemble Theatre starring Terri Garr. In addition, Black co-wrote and performed, "The Laundry Hour" with Mark Linn Baker (Joseph Papp's Public Theatre). His theatre credits include "Indians" (McCarter Theatre), "Self-Defense" (Long Wharf Theatre), "Our Father" (Edinburgh Fringe Festival) and "Dead End" and "Johnny-on-the-Spot" (Williamstown Theatre Festival). Lewis has spent many a summer acting and teaching stand-up as an artist in residence at the legendary Williamstown Theatre Festival. He lends his teaching and playwriting talents to the Tampa University Arts Festival, and he is developing a comedy festival at his alma mater, North Carolina University at Chapel Hill. In 2005 Garry Marshall's Falcon Theatre in Los Angeles produced Black’s play, "One Slight Hitch."
As an actor, Black has appeared in such films as "Jacob's Ladder," "The Hard Way," "The Night We Never Met," and Woody Allen's "Hannah and Her Sisters." Currently Lewis stars In "Accepted" (Universal, summer 2006). He co-stars with Wilmer Valderrama ("That 70's Show") in "Unaccompanied Minors" (Warner Brothers, Christmas 2006), and co-stars with Robin Williams in "Man of the Year" (Christmas 2006) directed by Barry Levinson.
His television acting credits include, "The Days and Nights of Molly Dodd," "Homicide," "Mad About You" and "Law and Order." Lewis has been featured on CBS Sports' "NFL Today" and the Final Four coverage. He is also a regular guest on "Late Night with Conan O'Brien."
Black received the award for "Best Male Stand Up" by The American Comedy Awards in 2001. In 2004 he was recognized by The Pollstar Awards for his blockbuster comedy tour, "Rules of Enragement." In 2006 he received a Grammy nomination for his comedy CD of the same name.
A milestone for Black was starring in a one-hour stand-up special for HBO, "Black on Broadway," which was also a successful DVD release. His second HBO special from the Warner Theater, in Washington DC, "Red, White and Screwed" aired June, 2006. He authored his first book, Nothing's Sacred (April 2005 Simon and Schuster) which debuted on the New York Times Bestseller List.
Black works as a professional mentor with the 52nd Street Project teaching inner city youth. He also raises money for several scholarship programs including The William Foeller Scholarship at Williamstown Theatre Festival where he also teaches. He is also active in the Cystic Fibrosis Foundation.
Tickets, which are $49 to the general public, can be purchased by calling (717) 505-8900 or (866) 468-7619 or at ticketweb.com beginning March 26. Penn State York students can purchase one ticket at a special price of $29 for the first 250 students and $39 for the next 200 students and these tickets are available only in the box office at the Pullo Center. Faculty and staff may also purchase tickets now through the box office at $49. Box office hours are Monday – Friday, 10 a.m. – 4 p.m.
Mark your calendar now for Friday, April 6 at 8 p.m. when Cirque Dreams, Jungle Fantasy comes to the Pullo Center. Tickets are on sale now. Check out other performances at Penn State York's Pullo Family Performing Arts Center by visiting http://www.pullocenter.yk.psu.edu/. The Pullo Center has seating for more than 1,000 and offers full theater capabilities.


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DUBLIN, May 17, 2023 /PRNewswire/ — The “Mobile Phone Insurance Market by Phone Type, Sales Channel, Coverage, and End User: Global Opportunity Analysis and Industry Forecast 2023-2030” report has been added to ResearchAndMarkets.com’s offering.
Mobile Phone Insurance market size was valued at USD 31.55 billion in 2022, and is predicted to reach USD 75.13 billion by 2030, with a CAGR of 11.7% during the forecast period, 2023 to 2030.
Growth in incidents of damages involving unintentional handling damage and loss protection, along with surge in cases of phone thefts across the globe propel growth of the mobile phone insurance market.
However, high cost of premium packages restrains growth of the market. On the contrary, growing advancements in technologies in mobile insurance such as artificial intelligence, machine learning, and deep learning technology creates an ample growth opportunity for the market.
- The global mobile phone insurance market is segmented on the basis of phone type, sales channel, coverage, end user, and region.
- By phone type, the market is classified into budget phones, mid & high-end phones, and premium smartphones.
- By sales channel, the market is segmented into mobile operators, device OEMs and retailers, and others.
- By coverage, the market is categorized into physical damage, internal component failure, theft & loss protection, virus & data protection, and others.
- By end user, the market is divided into business and individuals.
- Region wise, the market is segmented into North America, Europe, Asia-Pacific, and RoW.
Asia-Pacific is expected to hold a dominant share of the market by 2030
Increase in use of high premium smartphones, owing to rise in disposable income of people and presence of local mobile phone manufactures including Realme, Vivo, and Oppo in China that provide insurance while buying cell phones boost growth of the market.
In addition, increase in partnerships between mobile phone companies and service providers of MPI to deliver protection against all forms of damages including accidental damage, mobile theft, and virus and data protection drives the market growth.
For instance, in October 2020, Bolttech announced its partnership with Samsung in Thailand. Through this partnership boltech provides mobile device repair services to owners of Samsung Galaxy smartphones and tablets through the Samsung Care+ programme
Key Market Players
Emerging and efficient key players in mobile phone insurance research include companies such as:
- Apple Inc.
- American International Group Inc
- Assurant Inc
- Asurion Group Inc
- Amtrust Financial Services
- Securranty Assurance for TomorrowS
- Square Trade Inc
Apple Inc launched AppleCare+ that provides warranty of one year and 90 days of technical support with the option to purchase plans for longer service periods
Assurant Inc launched a multiyear extension of its long-standing partnership with T-Mobile to continue providing comprehensive mobile device protection solutions.
- The report provides quantitative analysis and estimations of the mobile phone insurance market from 2023 to 2030, which assists in identifying the prevailing market opportunities.
- The study comprises a deep dive analysis of the mobile phone insurance market including the current and future trends to depict prevalent investment pockets in the market.
- Information related to key drivers, restraints, and opportunities and their impact on the mobile phone insurance market is provided in the report.
- Competitive analysis of the players, along with their market share is provided in the report.
- SWOT analysis and Porters Five Forces model is elaborated in the study.
- Value chain analysis in the market study provides a clear picture of roles of stakeholders.
Key Topics Covered:
2. Mobile Phone Insurance Market- Executive Summary
3. Market Overview
3.1. Market Definition and Scope
3.2. Market Dynamics
22.214.171.124 Surge in Adoption of High-Quality Smartphones Across the Globe
126.96.36.199 Rising Incidents of Accidental Damage and Phone Thefts Across the World
188.8.131.52 Rising Initiatives by Various Mobile Insurance Companies
184.108.40.206 High Premium Packages
220.127.116.11 Introduction of Artificial Intelligence (Ai) in Insurance Companies
4. Market Share Analysis
4.1. Market Share Analysis of Top Mobile Phone Insurance, 2021
5. Global Mobile Phone Insurance Market, by Phone Type
5.2. Budget Phones
5.2.1 Budget Phones Market, by Region
5.3. Mid & High-End Phones
5.3.1 Mid & High-End Phones Market, by Region
5.4. Premium Smartphones
5.4.1 Premium Smartphones Market, by Region
6. Global Mobile Phone Insurance Market, by Sales Channel
6.2. Mobile Operators
6.2.1 Mobile Operators Market, by Region
6.3. Device Oems
6.3.1 Device Oems Market, by Region
6.4. Retailers & Others
6.4.1 Retailers & Others Market, by Region
7. Global Mobile Phone Insurance Market, by Coverage Type
7.2. Physical Damage
7.2.1 Physical Damage Market, by Region
7.3. Internal Component Failure
7.3.1 Internal Component Failure Market, by Region
7.4. Theft & Loss Protection
7.4.1 Theft & Loss Protection Market, by Region
7.5. Virus & Data Protection
7.5.1 Virus & Data Protection Market, by Region
7.6.1 Others Market, by Region
8. Global Mobile Phone Insurance Market, by End-User
8.2.1 Businesses Market, by Region
8.3.1 Individuals Market, by Region
9. Global Mobile Phone Insurance Market, by Region
10. Company Profiles
For more information about this report visit https://www.researchandmarkets.com/r/12pcdd
ResearchAndMarkets.com is the world’s leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.
Research and Markets
Laura Wood, Senior Manager
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SOURCE Research and Markets

domain: economics


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Payday Loan Las Vegas 89163 No Credit Check
Payday Loans in Las Vegas Nevada. Cash Loans from $100.00 to $15,000 by tomorrow. Bad Credit OK
Loan lenders are providing no credit check payday loans even if you have outstanding debts. Their customer service is always top notch and they truly care about their customers situations and well-being. If you do need a loan, you are not on the right path in life. Simply nominate a date and the lender will take the repayment amount and interest automatically out of your bank account.
Payday loans in general are usually fairly easy to obtain. Loans in Las Vegas Nevada Payday advance are extremely practical and can give you the cash you require in hours. Payday loans, or cash advance loans, are short-term loans that use a personal check to be held for future deposit in exchange for immediate cash. So with these loans, one can get instant cash immediately. State availability: California, Delaware, Illinois, Mississippi, Missouri, New Mexico, Ohio, South Carolina, Texas, Wisconsin Lines of Credit.
Are you not an active military member or a dependent of someone who is an active military member? The FDCPA requires that, within 5 days of the initial phone call, a debt collector must send a letter to the alleged debtor containing following things: 1. Payday Loan Las Vegas 89163 No Credit Check Today, some payday loans lenders are able to offer a faxless option because they verify the borrower’s information on their application through their payroll officer. 3 Main Myths about Payday Loan Brokers In case you hesitate, whose services to choose, you may ask those who have already used the services of brokers and left their reviews at the lender’s website. But these relatively small efforts haven’t dented the payday industry. A personal loan or credit card may offer better long term rates.
The only sure sign is if you know that your current situation is going to harm your financial future or that of your children. First, you should generally only take out a payday loan in emergency situations because this type of loan is typically a short-term, one-time solution. If you have never had a payday loan before, then here is another incentive for you to get yours quickly. This kind of loan could be a savior but also a burden if not paid on time. They will also follow your progress and benefit updates and completing reports of the performance if that's area of the criteria. Then there are refund anticipation loans where the firm gives you a check for the percentage of your refund when you file your income taxes. You rush for a payday loan but find that some documents are not available that very time to show or fax them to the lender.
Highest Rated Payday Loans Near Current Location
The breakeven APR will be smaller for a longer loan, but much higher for a shorter term loan. Not to mention that you can take advantage of applying for it at perfectly any time you would want to. So, if you don’t have any cash on hand, and that you urgently need money that it cannot wait up until your next payday, then you may want to try getting payday loans. Payday Loans in Las Vegas Payday loans are loans which are offered to the UK Public to meet out their financial problems. The multimillionaire Villanova resident and Wharton grad betrayed little emotion over the fact that he now faces a sentence that could effectively send him to prison for the rest of his life and criminal forfeiture proceedings next month that could strip him of property and assets worth millions. If you are an adult, with a regular job for the past six months and have a bank credit account, then chances are that you are almost guaranteed to get a payday loan. After you have the details from a lender, compare the different offers that you have and pick the loan where in the rates are the lowest.
Check out and see where you stand and what if any bad debt is on there as well. Payday Loans North Las Vegas Clark County Once you answer these questions, you can now assess whether you're qualified to apply for the loan or not. This is especially important if you are doing an online advance. On the other hand, online payday loan companies offer total privacy. IC3.gov.” UPDATE (11/19/14): Some of these scammers have been caught.
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domain: finance


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Croatia will play Canada in the 2nd round of the group stage of the World Cup. The match will take place on November 27, starting at 19:00 Moscow time. Croatia – Canada: predictionbet, odds, statistics.
In the opening round of the group stage of the 2022 World Cup in Qatar, the Croatian national team failed to beat Morocco – 0: 0.
In the previous match, the team beat Saudi Arabia away with a minimum score of 1:0.
Croatia vs Canada odds
In any combination of personnel, the current vice-world champion is strong. “Chess” is able to beat anyone, which has already been proven more than once.
Croatia he has won five of his last six games. Among them, formidable rivals were beaten: twice – Denmark, once – Austria and France.
The last defeat of the Balkans for today is dated June 6 this year, when they were defeated at home by Austria (0:3) in the League of Nations.
In the first round, the Canadian team almost caused a sensation, losing to the main favorite – the Belgian team with a minimum score of 0:1.
The team has only played in the World Cup once in its history. It happened back in 1986. And then he took the last place in the group, without scoring a single goal or scoring a single point.
In the qualifying round of the next world forum Canada took first place. He played 14 games, had eight wins, four draws and two losses.
The Maple Leaves have played four friendly matches since qualifying for the World Cup, including a 0-2 loss to Uruguay in September and a recent 2-1 win over Japan.
The latest success, as well as the resistance shown by the Belgians, allows the North Americans to at least count on a draw against Croatia: why are they worse than Morocco?
Forecasts and rates
Bookmaker logically he considers the Croatians the favourites: the odds for their victory are 2.10. The Canadians’ hit is estimated at 3.50, a tie at 3.40.
The Balkans need a bloody victory, and whatever North American resistance, Croatia will surely win after an hour of play.
Thus, ours prediction And Rate it – Croatia will win after 60 minutes of the match for 2.30.
Another betting option is that Croatia will win and two or more goals will be scored in the match for 2.70. However, if the Balkans score before the 60th minute, then they have every chance to score the second goal by acting on the counterattack.

domain: game


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Show times are Feb. 21 at 8 PM, Feb. 22 at 3 and 8 PM and Feb. 23 at 2 and 8 PM. Ticket prices range $50-$60, and $25 tickets for those under the age of 35 are available for Saturday and Sunday evening shows. The 92nd Street Y is also offering a special promotion for the Feb. 22 and 23 shows: those who bring a Playbill or a theatre ticket stub (for Broadway, Off-Broadway shows) can get 50 percent off the ticket price at the box office.
Zippel, who is artistic director, also hosts the evenings, which feature musical direction by Christopher Marlowe. The starry list of vocalists includes Broadway actors Kate Baldwin, Kevin Earley, Tony winner Debbie Gravitte, Danny Gurwin and Tony winner Lillias White.
In the concerts, press notes state, "Tony Award-winning, Oscar-nominated lyricist of City of Angels and Disney's animated 'Hercules' and 'Mulan,' presents highlights from his own scores and shares his inspirations and personal favorites from the American Songbook."
The first half of the evening will feature such Zippel songs as "All Girl Band," "Camel's Blues," "Cold Hard Cash," "Gotta Go West," "Double Talk," "With Every Breath I Take," "You're Nothing Without Me" and "My Rules"/"You're Living on an Elliot Garfield Grant." The second half will feature Zippel favorites "The Best Is Yet to Come," "Dear Friend," "A Wonderful Guy," "A Case of You," "Not a Day Goes By," "Some Other Time," "This Is the Time" and two versions of "New York, New York," among others.
To purchase tickets visit www.92y.org. *
The Lyrics & Lyricists series will continue with the following shows:
Sunny Side Up: Roaring Through the Twenties with DeSylva, Brown and Henderson, April 4-6
Robert Kimball, artistic director
Joseph Thalken, Vince Giordano, co-music directors
Randy Skinner, stage director and choreographer
Featuring Vince Giordano & The Nighthawks, with Nancy Anderson, vocals; Jeffry Denman, vocals and dancer; Jason Graae, vocals; Randy Graff, vocals; Meredith Patterson, vocals & dancer
The Man That Got Away: Ira After George, May 9-11
Rex Reed, artistic director, host
Tedd Firth, music director
Caitlin Carter, stage director
Lucie Arnaz, vocals; Polly Bergen, vocals; Kurt Reichenbach, vocals; Tom Wopat, vocals