Terminal elements shall have at least the equivalent net free area of the duct work. When the fan is located directly above a shower or bathtub, it needs to be connected to a GFCI-protected circuit. (The electrical box and connections for this device are accessible from an attic over this area. The size of a bathroom fan. But when you rent, usually the landlord is not legally bound to improve your bath venting. Bathroom code does address the issue of moving odor- and moisture-laden air from the bathroom to the outside. In no case shall the net free area of the This article series describes how to install bathroom ventilation systems, fans, ducts, terminations. Above-ground duct systems shall conform to the following: Source: IRC SECTION M1601 DUCT CONSTRUCTION (2015) [PDF] Utah state code, retrieved 2019/10/03 original source: https://up.codes/viewer/utah/irc-2015/chapter/16/duct-systems#16 codes as adopted by the state of Utah. are following the manufacturer's guidelines. ), Here is an NY City company familiar with ventilation codes - you could call to see what they charge and what they will do (and let me know what you're told). Read on to find out more. www.fantech.ca; firstname.lastname@example.org, - [Table 403.3, Minimum Ventilation Rates], - [Table 401.5, Opening Sizes in Louvers, Grilles and Screens Protecting Outdoor Exhaust and Air Intake Openings]. If your bathroom has a toilet or shower area enclosed by a door, it's a good idea to install a separate exhaust fan for that area. in number. You Save: 49 (3%) More Buying Choices 1,170 offer (5 offers) Rs.2000 off with Amex Cards; 5000 off on ICICI AMEX Credit Card EMI ; 1500 off on HSBC Credit Card EMI; 10% off with AU Bank Debit Cards; See Details. Section R303 of the International Residential Code discusses light and ventilation regulations in general. Obviously it passed inspection 20 years ago. Duct systems serving heating, cooling and ventilation equipment shall be installed in accordance with the provisions of this section and ACCA Manual D, the appliance manufacturer's installation instructions or other approved methods. Lighting as well as mechanical ventilation are both required where there is not an adequate operable window. In this installation the duct is improperly installed, spilling directly into the attic space of the building. I'm preparing to build a home and need to specify exhaust fans for two bathrooms. The higher rate shall be provided where the exhaust system is designed to operate intermittently. How to install a bathroom vent fan. And there is one other invisible place where you will find water in the bathroom: in the air. Bath vent fan codes, installation, diagnosis & repair: How to install, specify or improve bathroom venting, reduce indoor condensation, avoid bathroom mold. On 2020-09-15 by (mod) - My bathroom vent is vented to my attic. Bathroom extractor fans are mandatory in any bathroom without a window and still highly recommended in bathroom with windows. Leave a Reply Cancel … A 3- or 4-inch duct connects to the outlet on the fan housing and runs to a side wall or to the roof and connects to a vent cap that allows the exhaust to disperse outdoors. +31 522 46 99 44 Details about how to determine the necessary vent fan capacity in cubic feet per minute and about bath vent fan noise control options are, at BATHROOM VENT FAN SIZING & NOISE RATINGS. Prev Hidden Ceiling Extractor Fan. Especially in bathrooms where a shower is used, large amounts of moisture are added to room air and are concentrated in this area. A bathroom fan is an essential piece of hardware in any indoor bathroom, without a window. Where exhaust duct construction is not specified in this chapter, construction shall comply with Chapter 16. The formula to calculate bathroom exhaust fan size reads as follows: Cubic Volume/7.5= CFM Necessary. What Size Bathroom Fan Best Supports Your Space Has it been a while since you've shopped for a new bathroom ventilation fan? ", Luminaires located where subject to shower spray shall be marked suitable for wet locations. Sketch above was provided courtesy Carson Dunlop Associates a Toronto home inspection, education, and report-writing firm. These are larger size fans and generally would have two or more ducts from the bath into the unit. Instead we vented this fan out through the soffit in the roof eaves. I'd have preferred using a fire-resistant foam, but if the above conditions are met you should be ok. Take a look at the bathroom vent fan duct installation in the photographs above and you'll see a successful bath vent installation in a foam-insulated cathedral ceiling. Bathroom Exhaust Fan Venting Code Summary, Section R303.3: Bathrooms Must Have Windows, Section R303.4: Bathrooms Require Exhaust Venting Fans, Section M1507.2: Exhausted Air Terminal Point, Why Your Bathroom Should Have an Exhausting Vent Fan, Choosing the Right CFM Size for a Bathroom Exhaust Fan, Electrical Code Requirements for Bathrooms, National Electrical Code Requirements for Bathrooms. RockNorth Carolina's 2012 mechanical code gives lots of detail on exhaust ventilation but I don't see a specification of the exhaust duct material itself. I am adding two bathrooms exhaust fans in new construction. But it is impossible to translate the thin tissue of that observation to an objective measure of air flow rates nor to a reliable statement about the adequacy of a vent system since even the most slight air flow will move a light tissue against the intake grille of the vent. It isn’t crucial to the functionality of a device but will influence its look in your bathroom. On 2020-09-12 by (mod) - bathroom ceiling fan vents into concrete ceiling space. The size of the bathroom (measured in m3) is the most important factor when determining which bathroom exhaust fan you should pick. Bathrooms and toilet rooms shall be ventilated as follows: (a) When ventilated by natural means, the natural Take Longer to Install – A 6-inch duct needs more work to install compared to smaller ducts. This section notes that air exhausted from the bathroom must be sent outdoors, not indoors to the same residence or indoors to any other dwelling unit. We explain how to install bathroom exhaust fans or vents, the vent ducting, the vent termination at the wall, soffit or roof, vent fan wiring, bath vent duct insulation, bath vent lengths, clearances, routing, and we answer just about any other bathroom ventilation design or installation question you may have. It can be an ugly sight to crawl above a poorly ventilated bathroom's ceiling. SAILFLO 4 Inch Wall-Mounted Exhaust Fan, 12W 130m³/h Ventilation Extractor with Anti-backflow Check Valve Chain Switch for Window Duct Glass Grow Tent Bathroom Vents - 6"×6" Grid Panel - Small Size 4.2 out of 5 stars 115 They connect to an exhaust duct that runs through the attic or between floors. TerryThanks for a question that bothers lots of people.Bathroom exhaust vent clearance above ground:The words "above ground" do not appear in the Chapter 15 - Exhaust Systems of the IRC. If you take a look in the ductwork and see an accumulation of grease in a kitchen exhaust I'd consider that a potential fire worry that might get action. Bathroom code does address the issue of moving odor- and moisture-laden air from the bathroom to the outside. Thanks in advance, James. I hope that the cost of that fix is trivial compared with the value of the home being sold; in my OPINION, if I were selling my home and the only issue were the one you cite, I'd leap to get it fixed and close the deal. CarynWe give venting specs above on this page and in this article series. The model building codes adopted by most jurisdictions typically require bathroom ventilation to be provided either by an operable window (3 sq.
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text:
George William Mote (1832-1909)
|Artist Name||George William Mote (1832-1909)|
|Title||Landscape with Cattle - Surrey|
|Description||This charming Victorian landscape oil painting is by noted prolific exhibited British artist George William Mote. Mote was very fond of painting landscapes in Surrey and this is a particularly fine example of his work with cattle and chickens in a rustic farmyard landscape and which was painted circa 1880. The colouring and brushwork are superb.
Signed lower right.
|Medium||Oil on Canvas|
|Size||36 x 24 inches|
|Frame||Housed in a period Victorian gilt frame, 43 inches by 31 inches and in good condition.|
|Biography||George William Mote (1832-1909) was a self-taught artist, who worked as gardener and caretaker to Sir Thomas Phillipps, the great manuscript collector at Middle Hill, near Broadway Worcester. His early paintings, mostly of the house and gardens at Middle Hill, are painted in an evocative primitive style, which faithfully reproduces the scene. Later he became a fulltime artist and enjoyed success in exhibiting at the Royal Academy 1857- 1873, the British Institution and in the Provinces.|

domain: history


text:
There are many forms of earth science, and therefore many names
for those who study aspects of earth--geologists, geophysics
scientists, ecologists, hydrologists, sedimentologists, and
Geology is the study of rocks, minerals, ores and earth processes.
Geologists, geophysicists and geochemists are among the scientists who study the Earth.
Types of rocks are inside the Earth, so scientists study them.
When scientists study plants, it is called Botany.
Scientists who study caves are called speleologists
Antarctica is where scientists can study the health of planet earth.
Geophysicists, Geologists The study of the Earth's surface is called geology, and people who study it are called geologists. A geophysicist studies the processes that change and shape the earth.
Scientists pursue the study of the health of planet earth in Antarctica. Scientists working in Antarctica, collect data to study the health of planet earth.
Scientists who study earth's oceans are called oceanographers.
Scientists that study fungi are called mycologists.
Why do scientists study Earth's tidal patterns?
The study of meteorites help scientists study the interior of the earth because it is believed that the meteorites are made up of the same material as earth.
The study of rocks is called Petrology, and the scientists that study them are called petrologists. Petrology is a sub branch of geology.
Scientists in Antarctica study the health of planet earth.
Scientists in the Antarctic study the health of planet earth.

domain: geography


text:
"RNA Editing" is a descriptor in the National Library of Medicine's controlled vocabulary thesaurus,
MeSH (Medical Subject Headings). Descriptors are arranged in a hierarchical structure,
which enables searching at various levels of specificity.
A process that changes the nucleotide sequence of mRNA from that of the DNA template encoding it. Some major classes of RNA editing are as follows: 1, the conversion of cytosine to uracil in mRNA; 2, the addition of variable number of guanines at pre-determined sites; and 3, the addition and deletion of uracils, templated by guide-RNAs (RNA, GUIDE).
This graph shows the total number of publications written about "RNA Editing" by people in Harvard Catalyst Profiles by year, and whether "RNA Editing" was a major or minor topic of these publication.
To see the data from this visualization as text, click here.

domain: medical


Benefits of VoIP Phones
VoIP phones are coming to be more popular as individuals realize the benefits they use. A VoIP phone or digital phone makes use of voice over web procedure innovation for positioning as well as getting telephone call over a web IP network, like the Net. There are different advantages to utilizing a VoIP service. VoIP phones are utilized instead of traditional landline phones and also supply most of the very same attributes. Nevertheless, with VoIP phones, the provider have the ability to give features that would be very expensive to supply to their consumers if they made use of a conventional telephone solution. With traditional telecoms systems, the data that is sent out and also gotten by telephone lines takes a trip with countless copper cables. This information is then pressed by a series of copper wires and sent over a variety of interaction networks. This means that every telephone call requires that the customer leave numerous call that are forwarded to another office making use of the same copper cable system that was used in the initial telephone call. This above cost is one of the factors that people use voip phones. The overhanging expense of VoIP phones are removed since these telephone calls are put on the exact same network as the data, rather than being positioned on separate networks. Consequently, there is no difference in the price of making the telephone calls as there would be if the phone calls were placed on different lines. With this benefit, VoIP phones are able to provide users the capability to conserve cash. An additional advantage of VoIP Phones is that it is extremely simple to establish telephone calls using them. Unlike with traditional telephony systems, it is very easy to develop a direct link to a voice service provider. Voip phones can likewise permit an individual to establish a safe and secure cordless link with any individual in the whole country. This attribute is not readily available with numerous other sorts of telephone systems. The last significant advantage of VoIP Phones is that they have actually made international voice interaction less expensive. In the past, it has actually been difficult for somebody located in the United States to phone to an individual in Europe for an inexpensive. Nonetheless, with the intro of Voip phones, worldwide calling has ended up being an extra viable alternative. Considering that Voip phones link directly to the web, they are able to transfer messages in any global language. To make the most of these excellent functions of VoIP Phones, all that a user requires is a suitable telephone adapter and a high speed Web connection. Voip Phones can easily be contributed to an existing analog telephone adapter. Voip Phones can also be purchased as standalone gadgets. With these kinds of systems, any sort of mobile phone can be utilized as a VoIP Phones device.


text:
SHERIDAN — The University of Wyoming will offer a grafting and pruning workshop Saturday from 9 a.m. to 3 p.m.
Those planning to attend should dress for time outdoors.
Attendees will carpool to the T-T Ranch outside of Sheridan for the afternoon pruning demonstrations. Lunch will be provided.
The hands-on workshop will allow attendees to learn how to effectively graft fruit trees and to appropriately prune already established trees.
Dr. Steve Miller, founder of the Wyoming Apple Project, will teach proper grafting methods, while UW Extension Horticulture Specialist Christ Hilgert will demonstrate pruning.
To register, call (307) 673-2856.

domain: agronomy


text:
Company Overview of Engles Urso Follmer Capital Corporation
Engles Urso Follmer Capital Corporation is a private equity firm specializing in leveraged acquisitions. The firm also seeks and manages co-investments from a select group of institutional and private investors. It prefers to invest in businesses which are in a state of transition. Engles Urso Follmer Capital Corporation was founded in 1994 and is based in Dallas, Texas.
5956 Sherry Lane
Dallas, TX 75225
Founded in 1994
Key Executives for Engles Urso Follmer Capital Corporation
Similar Private Companies By Industry
|Blinkbox Ltd.||United States|
|China Fuhua New Material Holdings Inc.||United States|
|79 Capital Securities, LLC||United States|
|Accessory Specialists Inc||United States|
|University of Michigan, Research Division||United States|
Recent Private Companies Transactions
|No transactions available in the past 12 months.|
To contact Engles Urso Follmer Capital Corporation, please visit www.eufcc.com. Company data is provided by Capital IQ. Please use this form to report any data issues.

domain: finance


text:
Game Show, 30mins
Distributed by: Armoza Format
Five couples board an airport shuttle, ready for a dream vacation… but only one couple will make it to the airport! The stakes? In order to be the ONE couple to board the plane, they not only need to beat the other couples on the shuttle in trivia battles and physical challenges, but also to beat the game’s reigning trivia champs! The catch? The champs are already enjoying the luxurious resort… and they have no intention of giving up their vacation without a battle!
If the challenging couple wins, they will immediately board the plane and replace the vacationing couple. If they lose, the vacationing couple will continue to enjoy their luxurious holiday – but only until the next battle!

domain: entertainment


Named for the accomplished UConn forestry professor Albert E. Moss (and containing an abundance of moss), Moss Sanctuary serves as an intimate showcase of several native habitats. A healthy grove of hemlock and white pine provides deep green in every season, before the trail opens up to a view of Tift Pond. This fairly large pond is a shining centerpiece reflecting both the liveliness and calm of the surrounding forest. The outer loop trail continues into wetlands and further into upland forest. Look to towering old hardwoods as a testament to resilience on the steady inclines and declines of this walk.


The Thermodynamics of Chromatography - Other Thermodynamic Methods that are Used for Studying Chromatographic Systems > Optimum Operating Conditions for Chiral Separations in Liquid Chromatography > Effect of Temperature and Solvent Composition on the Optimum Velocity > Page 81
In addition, the viscosity of a binary mixture of unassociating solvents, canbe calculated using an equation developed by Moore et al. , viz,
|where (y1)||is the mole fraction of solvent (1),|
|(y2)||is the mole fraction of solvent (2),|
|(h1)||is the viscosity of solvent (1),|
|and (h1)||is the viscosity of solvent 2.|
By employing the viscosity values calculated for a range of temperatures and solvent mixtures in equation (50) the effect of temperature and solvent composition on the optimum mobile phase velocity could be calculated. A practical initial value for () was assumed to be 2.5 x 10-5 cm2s. This value was taken as the probable estimate from publishd data for similar compounds (21,22) for the diffusivity of the (R)-enantiomer at 20˚C in a solvent mixture containing 10%v/v of ethanol and consequently may not be a highly accurate value. Nevertheless, it will allow the relative effect of temperature and solvent composition on the optimum mobile phase velocity and analysis time to be demonstrated. The optimum mobile phase velocities were calculated using the above equations and experimental data, and the results obtained are shown as graphs relating optimum velocity to temperature for a range of different solvent mixtures in figure 25.


Overgrown tree leaning/about to fall on shed
Reported in the Obstruction category anonymously at 20:53, Tue 14 July 2020
Sent to Bristol City Council less than a minute later
Massive tree blocking, and breaking the wall.
A new enquiry has been raised for this issue.
Posted by Bristol City Council at 20:54, Tue 14 July 2020
This issue is currently under investigation. We'll provide updates on the outcome as soon as we can.
Posted by Bristol City Council at 10:44, Wed 15 July 2020
We've investigated this query but have been unable to trace any issue that requires action.
If you believe that the issue still exists, please review the location/description provided and let us have further details to help identify where the problem is via an update on Fix My Street
Posted by Bristol City Council at 14:12, Wed 15 July 2020
As you can see a massive tree, which use to be trimmed almost every year but the root is going through the walls and breaking the wall.
Posted anonymously at 15:44, Wed 15 July 2020
A citizen has provided a follow-up to the original enquiry.
Posted by Bristol City Council at 16:14, Wed 15 July 2020
We will shortly be in touch with an update on this issue.
Posted by Bristol City Council at 15:33, Mon 3 August 2020
This enquiry is now closed. No further action is required.
State changed to: Fixed
Posted by Bristol City Council at 10:50, Wed 16 September 2020
This report is now closed to updates. You can make a new report in the same location. Please reference 2200692 in your new report if it is an update on this one.


Jungheinrich EKS 110 Order Picker
Low-Level Order Picker
Jungheinrich EKS 110 order picker ergonomic and technical features are utilized to make order picking easier, faster and more economical. The features on the order picker include: large storage areas on the battery cover, 3 phase AC drive system, extended operator platform width (optional), infinitely variable speed control and individually adjustable travel parameters.
Readily Available in the following counties: Kendall, Grundy, Will, Kankakee, Lake & Porter IN and all of WI. All other areas contact us today!


text:
A recent Internet marketing survey shows that 55% of respondents said they even if get more than $10,000 in revenue from the average customer from a highly-qualified lead, only 8.8% said they would be willing to pay $500 for that lead. Why are so few companies willing to pay that money for a promising lead? After all, in many cases those leads will lead to a much larger return in revenue.
Jive software just released a December 2010 customer survey ofÂ 500 individuals (from CEO to individual contributor), representing more than 300 companies worldwide, a large percentage of whom have more than 10,000 employees,Â on th... Read Post
According to this recent article over on CNNMoney.com on how emerging markets are hot, total sales are expected to rise an average 10% among S&P 500 companies that derive more than half of their revenues overseas. In comparison, we'... Read Post

domain: news


Jon Jones Calls Holly Holm G.O.A.T. And Aims To Be The Same
Jon Jones declared Holly Holm the G.O.A.T. (greatest of all time) in women’s combat sports, via Facebook following her victory over Ronda Rousey on Saturday, November 14 before a stadium crowd of 56,214 in Melbourne, Australia. Former Ultimate Fighting Championship Light Heavyweight title-holder Jones, 28, released his comment to address questions about his comeback after a hit-and-run case disqualified him in April 2015.
According to Fox Sports, Jon Jones and Holly Holm, 34, have been close teammates under coaches Greg Jackson and Mike Winkeljohn at the at Jackson-Winkeljohn MMA in Albuquerque, New Mexico. Considered Holm’s secret weapon for helping to train her, Jones had this to say on Facebook.
“She was considered the greatest female boxer to ever compete in the sport and now she has defeated the greatest female mixed martial arts fighter to date.”
Holm herself has given Jon credit for her fight-preparedness at UFC 193 where she took the belt away from Rousey, 28, with a second-round knockout. In a promotional conference call transcribed by MMA Fighting, Holm referred to Jones’ influence as she prepared for the event at Melbourne’s Etihad Stadium on November 14 (November 15 local time in Australia).
“Obviously, he’s not going to be sparring with me the way he would with the big heavyweights. But we have the same coaches, we have the same team and I love to hear his input, because he’s obviously been able to take what our coaches teach and put it together perfectly. So I love to hear his input on it and he has been very helpful and very instrumental in this fight camp.”
With his name being bandied about as an MMA icon, Jon Jones is trying live past the Albuquerque accident on April 26 in which his vehicle struck a car driven by a pregnant woman and he fled the scene, leaving her with a broken arm. According to the Vancouver Sun, a police report based on the testimony of witnesses accused Jones of running from a crash resulting in the hospitalization of the other driver, who was pregnant. Jones then reportedly doubled back to his rental car to “grab a wad of cash,” but left behind a pipe with marijuana in it and rental car documents in his name.
Jon Jones’ case was resolved with a guilty plea to a charge of leaving the scene of an accident that resulted in injury to the other driver. While he was ordered to serve up to 18 months of supervised probation, his plea deal kept a felony conviction off his record. The plea agreement led to him being officially reinstated by the UFC in October.
The light-heavyweight title Jon Jones vacated was assumed by Daniel Cormier, who won it by submitting Anthony Johnson at UFC 187 in May. Cormier then successfully defended the title by besting Alexander Gustafsson in an October five-round match at UFC 192.
According to Fox Sports, the ex-champ has not fought in the Octagon since January when he defeated Cormier by unanimous decision, before the April accident finally stripped him of his belt. Jon Jones’ aim is to be ready by April 23, 2016, the date of UFC 198, scheduled to take place at Madison Square Garden if the UFC is able to get MMA sanctioned in New York on time. However, Cormier has told the press several times that he does not want to fight in Jones’ home state of New York.MMA Fighting featured former UFC light heavyweight champion Jon Jones in the weight room, keeping social media in the loop to track his results. His Instagram post on Thursday, November 19 compared his 2013 physique to his current condition with defined musculature. He explained how his training regimen has paid off.
“Started powerlifting June 1, 2015. In just about seven months of training four days a week, my body has made a complete transformation. Off season 2013 vs off season 2015. Five more months to prepare for this win. I’ll be sure to be at my best April 23rd.”
The sweet victory enjoyed by teammate Holly Holm seems to have inspired Jon Jones to aim for a similar high when he returns to the Octagon.
[Photo by Quinn Rooney/Getty Images]


text:
Martin Usher argues that the need for increased access to rehabilitation services has never been more important as the NHS recovers from the impact of the pandemic.
Martin Usher, a member of the Major Trauma Group, argues that the need for increased access to rehabilitation services has never been more important as the NHS recovers from the impact of the pandemic. He calls for an injection of funding to address the backlog and the shortfall in investment.
As we leave an undeniably tough winter behind, it is very encouraging to have multiple vaccines at our disposal. The rapid progression of vaccine development has been nothing short of incredible, and the ongoing vaccination programme provides hope for the future of a return to some semblance of normality. While things are looking up, many people have been left behind by the pandemic, and one group that has been adversely affected over the course of the last year is major trauma victims.
Individuals that suffer major trauma injuries rely on access to rehabilitation services, but such access has been limited throughout the course of the pandemic due to the strain COVID-19 has put on the NHS. Unfortunately, there is no quick fix to the burden the NHS is facing and following the recent rise in COVID-19 infections the harmful impact on both the NHS and major trauma victims is likely to increase. It is clear that rehabilitation services need serious assistance and we cannot afford to delay this any longer
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- Election Countdown: Senate, House Dems build cash . . .
We're 111 days from the 2018 midterm elections and 839 days from the 2020 elections The battle for the House and Senate have at least one thing in common: Democrats are raising a ton of cash and
- Election Countdown: Dems raising millions in fight for . . .
We're 34 days until the 2018 midterm elections and 762 days until the 2020 elections Democratic House candidates' staggering fundraising hauls are yet another sign of the widening enthusiasm gap
- Mad dash for campaign cash: 2020 Dems race to post big . . .
The fundraising pitches from the 2020 Democratic presidential candidates are coming fast and furious Sunday is the last day candidates can bring in campaign cash in the first fundraising quarter
- The Spot: Senate Democrats attempt to regroup, the House . . .
The Spot: Senate Democrats attempt to regroup, the House takes up the state budget, and first recall petition approved Plus: More protections for seniors could be on their way, why fundraising
- Trump: If Democrats Dont Give Me The Money For The Border . . .
Senate Democrats are more willing to fork over some cash for border security, some $1 3 billion, which is not making House Democrats happy threatening to have the military build it “if
- 2020 Presidential Election Countdown Clock - 270towin. com
Grab the code for your website or blog to count down the days until the 2020 presidential election A few people have reported problems viewing certain 270toWin election maps and or polls If you have an Ad Blocker in place, please disable it Separately, you may not be able to view our maps in the
- Democrats projected to win control of House, but Senate . . .
Follow Wednesday’s updates here: Democrats flip House as GOP expands Senate majority Democrats claimed control of the House late Tuesday and flipped at least seven governorships, but Republicans
- RealClearPolitics - Election 2020
'FOX News Sunday' Panel: House Continues Investigations, Trump vs Biden, Ranking 2020 Dems Rep Tim Ryan Says "Listening To Each Other" Is The Key To Unifying The Country General Election 2020


The wait is over. The time is now. Vladimir Guerrero Jr., the top prospect in baseball per MLB Pipeline, and the most hyped Minor League player in Blue Jays franchise history, is heading to the big leagues.
Blue Jays manager Charlie Montoyo made the official announcement Wednesday evening following a 4-0 loss to the Giants. The highly anticipated move came just hours after Guerrero went 2-for-5 with a home run in his final game for Triple-A Buffalo.
The 20-year-old missed almost all of Spring Training with a strained oblique muscle. Wednesday marked the first time this year Guerrero played three consecutive days, which was believed to be the final hurdle he needed to pass before a promotion. After Guerrero cleared that obstacle, the callup for Friday's series opener vs. Oakland became a foregone conclusion.
"This is a big moment for the Toronto Blue Jays," Montoyo said. "He's the No. 1 prospect in baseball. It's coming Friday. It's a big moment for us. Hopefully, he becomes what everybody thinks he's going to become. That's going to be good for all of us. The city of Toronto, the Blue Jays, the organization."
After months of non-stop hype and speculation, Guerrero closed out his Minor League career in style. In the top of the seventh inning, during Wednesday morning's game vs. Syracuse, Guerrero stepped into the box for his second-to-last at-bat and sent the ball deep over the wall in right for an opposite-field home run.
Guerrero likely finishes his time in the Minors -- minus any potential future rehab games -- with a career .331/.413/.531 slash line and 44 homers over parts of four seasons. In eight games for Buffalo this year, Guerrero hit .367 with three home runs, a double and eight RBIs over 30 at-bats. Outside of his defense, Guerrero had nothing left to prove in the Minors and should immediately step into a prominent role with the Blue Jays as their starting third baseman.
"I think we have to be patient, but I honestly think he's going to do well," Montoyo said. "Whatever happens, we have to be patient. Defensively, offensively, because he's 20-years-old. He's comfortable. He's not going to be nervous and scared of the big leagues. ... I think he'll be fine when he comes here."
Montoyo admitted Wednesday that he has already spent a lot of time thinking about where Guerrero will hit in the lineup. Toronto's first-year skipper wasn't prepared to make any definitive statements before Guerrero's arrival, but it's safe to assume that it won't take long at all for the Dominican native to become a permanent fixture in the heart of the batting order.
The Blue Jays also have spent the past several weeks talking about the roster changes that will be made as a result of Guerrero's arrival. Montoyo confirmed that Brandon Drury will shift from third to second when Guerrero joins the team. Veteran infielder Freddy Galvis, who is currently out with a sore left hamstring, is a possible candidate for the injured list to make room.
"I got to see a little bit of him when I was down in Florida," Blue Jays starter Clay Buchholz said. "He's pretty special. It's fun to watch him in the box. I actually pitched to him a couple of times and he definitely hit a hard ball off me. I think it's going to be good.
"I told him that his dad was the first hit that I gave up in the big leagues. It's pretty cool to be around the son of a guy that got the first hit off me in the big leagues. I think everybody is looking forward to it."
Montoyo has spent the last several weeks answering an endless stream of questions from reporters about the timing of Guerrero's arrival. Even though Guerrero wasn't even in the same country as his future teammates, he dominated the pregame talk on a daily basis. The ironic part is that the player Montoyo has talked about the most this year, is someone he hasn't seen more than a handful of times.
In some ways, Montoyo is just like the fanbase: eager to get his first real look at what the hype is all about.
"The funny thing about it, I haven't seen him play," Montoyo said. "I hear everything from everybody else, which I believe what people say. But the only time I saw him was in Spring Training, the 20 at-bats or so that I saw ... I want to see what everybody is talking about. In person."


text:
Harley Davidson Red White & Blue Large Iron On Back Patch
This is an excellent quality patch from our Americana collection.
Easy to apply iron-on applique.
Detailed embroidered quality iron-on patch.
Great to patch holes or just to decorate Cap, Polo, Backpack, Clothing, Jacket, Shirts, bags, towels and more.
Size – 10 inches
FREE DELIVERY These patches are not designed by Harley Davidson, they are independently designed.
Fantastic quality, please check out our other designs

domain: design


text:
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Genotype-phenotype links in frontotemporal lobar degeneration
Tijdschriftbijdrage - Tijdschriftartikel
Frontotemporal lobar degeneration (FTLD) represents a group of neurodegenerative brain diseases with highly heterogeneous clinical, neuropathological and genetic characteristics. This high degree of heterogeneity results from the presence of several different underlying molecular disease processes; consequently, it is unlikely that all patients with FTLD will benefit from a single therapy. Therapeutic strategies for FTLD are currently being explored, and tools are urgently needed that enable the selection of patients who are the most likely to benefit from a particular therapy. Definition of the phenotypic characteristics in patients with different FTLD subtypes that share the same underlying disease processes would assist in the stratification of patients into homogeneous groups. The most common subtype of FTLD is characterized by TAR DNA-binding protein 43 (TDP43) pathology (FTLD-TDP). In this group, pathogenic mutations have been identified in four genes: C9orf72, GRN, TBK1 and VCP. Here, we provide a comprehensive overview of the phenotypic characteristics of patients with FTLD-TDP, highlighting shared features and differences among groups of patients who have a pathogenic mutation in one of these four genes.
Tijdschrift: Nature Reviews. Neurology
Pagina's: 363 - 378
Jaar van publicatie:2018

domain: literature


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New Signaling Pathway Found, May Be Linked To Movement Disorders
- July 15, 2002
- Washington University School Of Medicine
- Though previous evidence points to the contrary, scientists have discovered that the protein known as fibroblast growth factor 14 (FGF14) may not actually behave like a growth factor. The research suggests that FGF14 is instead involved in transmitting signals from one nerve cell to another and may help regulate walking and other movements. The protein could, therefore, be linked to movement disorders such as Parkinson's and Huntington's diseases.
St. Louis, July 11, 2002 — Though previous evidence points to the contrary, scientists have discovered that the protein known as fibroblast growth factor 14 (FGF14) may not actually behave like a growth factor. The research suggests that FGF14 is instead involved in transmitting signals from one nerve cell to another and may help regulate walking and other movements. The protein could, therefore, be linked to movement disorders such as Parkinson's and Huntington's diseases.
"We believe we have found a new signaling pathway in the brain," says study leader David M. Ornitz, M.D., Ph.D., professor of molecular biology and pharmacology at Washington University School of Medicine in St. Louis. "Once we learn what FGF14 does at the molecular level, I believe we may uncover a new mechanism for regulating nerve cell function."
The work is published in the July 3 issue of the journal Neuron. It is the first study to examine the role of FGF14 in living animals and could provide new targets for testing future drugs designed to treat movement disorders and seizures, says Ornitz, who also leads the cancer and developmental biology program at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.
Ornitz and the team of investigators developed a strain of mice lacking the gene for FGF14. They expected these mice to have brain abnormalities and to perhaps die before birth. To their surprise, however, the mice seemed physically healthy and lived relatively normal lives, though most were about 15 percent under-weight after two weeks of age.
But the young mice did develop coordination problems and abnormal posture. Compared with normal mice, the genetically altered animals walked sluggishly and shuffled, and they had reduced muscle strength. They also were less sensitive to stimulants such as cocaine and amphetamines and were more prone to drug-induced seizures. The investigators also examined the animals' brains. When they disabled the gene for FGF14, the team had ensured that a fraction of the protein remained intact and replaced the rest with a protein that appears blue when exposed to certain chemicals.
This marker molecule revealed that FGF14 was primarily found in three regions of the mouse nervous system: the cerebellum and basal ganglia in the brain and the motor tracts of the spinal cord. All three areas are involved in regulating movement. The basal ganglia, in particular, are affected by Parkinson's disease and other movement disorders.
Also surprisingly, FGF14 fragments also showed up in the long projections—the axons—of the nerve cells.
"This tells us that FGF14 recognizes the machinery that transports material down the axon to the area of the synapse, where nerve impulses jump from one neuron to the next," says Ornitz.
What it does at the synapse is a question Ornitz plans to investigate next. He speculates that FGF14 could signal the formation or release of neurotransmitters, modulate electrical signals or mechanisms that transport electrical signals or regulate the transport of molecules down the axon.
"Any number of things are possible," he says.
One thing is certain, though. "It's pretty clear now that FGF14 is not a growth factor," he says.
Reference: Wang Q, Bardgett ME, Wong M, Wozniak DF, Lou J, McNeil BD, Chen C, Nardi A, Reid DC, Yamada K, Ornitz DM. Ataxia and Paroxysmal dyskinesia in mice lacking axonally transported FGF14. Neuron, 35, 1-20, July 3, 2002.
Funding from the National Institutes of Health and the Virginia Friedhofer Charitable Trust supported this research.
The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
Materials provided by Washington University School Of Medicine. Note: Content may be edited for style and length.
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The trade unions are showing quite pessimistic of reaching an agreement on compensation
The trade unions demand an increase of 20% in that period of time to recover purchasing power lost during crisis years
The second meeting between Government and most representative trade unions of public sector (CSIF, CCOO and UGT) led without progress in plane of compensation committee, even though it was on issues such as maintenance of employment.
The Executive do not put on table any specific proposals in matter of wage increases for public employees, and he cited trade unions to a new meeting next Tuesday. However, trade union sources claim that offer of Government could be in environment of 6% in three years. A proposal in any case very different from reinvidicaciones of trade unions, which claim a rise of 20% in that period to officials to recover purchasing power lost during crisis.
After two meetings after summer break, last Thursday with secretary of State for Public Function, Elena Collado, positions remain very far away while time is running out. The next day 22 Council of Ministers will approve draft of General State Budget (PGE) for 2018, which includes item of personnel expenses.
The Government has raised a wage increase linked to evolution of GDP. The Executive estimates that GDP will grow 2.6% in 2018, 2.5% in 2019 and 2.4% in 2020, in such a way that linking salaries of officials and to increase of economy would, at least, a loss of purchasing power, taking into account also that Government contemplates an evolution of moderate inflation in coming years.
This does not mean, as clarified by minister of Finance and Public Function, Cristóbal Montoro, on Tuesday in Senate that is moving "miméticamente" figures of growth of GDP, salaries of public employees, since se salary hikes should be compatible with compliance with deficit target.
The unions are not willing to assume increases of 1% in last few years, as y believe that with increases of GDP of close to 3% and taking into account cuts suffered by public employees during crisis, a rise in this line would not be of receipt.
CSIF warns Haciende that if you want a deal, "you should make an effort and open negotiation of journey of 35 hours in different areas of governments". Likewise, values to carry out mobilizations, "if Treasury is not sensitive to just claims of a group that has all shoulder of an exemplary way to promote recovery and ensure provision of services in toughest moments of crisis".Day of 35-hour
in Addition to remuneration, in meeting today we also talked about or working conditions of three million civil servants and public employees, as recovery of working hours of 35 hours per week in those communities where this has been agreed by administrations with union. It is case of Andalusia, Extremadura, Castilla-La Mancha, Castilla y León, Basque Country or town hall of Madrid.
"it is unacceptable that ban from central Government journey of 35 hours especially in those communities that have reached agreements with unions," explained sources of Central trade Union Independent and of Officials (CSIF).
But apart from salary increases and journey of 35 hours, unions also want to approve an offer of public employment that put an end to replacement rate and to increase templates on top of retirements in those areas where it is necessary, as a way also to rejuvenate staff of administrations. CSIF figure in approximately 231,000 number of jobs lost since 2011.
Sources of CCOO assured that at this point could result in progress. However, y noted that "re will be no global agreement without increases in compensation committee. For that reason, we urge Government to make an effort". An approach that also shares CSIF. "If Executive wants an agreement must make an effort that is demanded of public employees when began economic crisis," says union in a statement.
Until now, have only been produced informal meetings. It is expected that next week a meeting of Bureau General of Negotiation of Public Administrations, where it is fixed by wage increases of officers for next year.
In this table, in addition to unions and Administration, are also represented in autonomous communities and municipalities, through Spanish Federation of Municipalities and Provinces (FEMP), and his call is mandatory before presentation of draft of General State Budget (PGE) Government plans to approve next Friday, 22nd of September.


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Type of Article: Original Research
Year: 2016 | Volume 4 | Issue 3 | Page No. 2692-2697
Date of Publication: 31-08-2016
Anandhi. V *1, Rajeswari. K 2, Christilda Felicia Jebakani
Anandhi. V * 1, Rajeswari. K 2, Christilda Felicia Jebakani 3.
*1 Associate Professor, K.A.P.V Government Medical College, Tiruchirapalli, Tamilnadu, India.
2 Associate Professor, Coimbatore Medical College, Coimbatore, Tamilnadu, India.
3 Professor, SRM Medical College and Research Centre, Tamilnadu, India.
Address: Dr. V. Anandhi, M.S. (Anatomy), Associate Professor of Anatomy, KAPV Government Medical College, Tiruchirappalli-620 001,Tamilnadu, India. Mobile No: Mobile No: +9194442 48184.
Background: The versatility of the inferior epigastric artery as a vascular graft in various areas and the recognition of its growing importance in the anterior abdominal wall and retropubic region surgical disasters have all prompted me to study the inferior epigastric artery, with particular reference to the distance of the inferior epigastric artery from the important landmarks of the abdomen and pelvis. The results will prove to be a vital guide for the surgeons to select sites for trocar insertion to prevent fatal complications arising from injury to the inferior epigastric artery.
Materials and method: Study material consisted of 50 adult specimens from 16 male and 9 female cadavers studied by direct dissection method and predissectional dye injection method.
Results: Measurements were taken from the midline to the inferior epigastric artery at different levels of the anterior abdominal wall. The danger zones were delineated from the distances measured. Incisions and trocar insertions are to be avoided between 3cm and 8cm from the linea alba.
Conclusion: The distance of the inferior epigastric artery from the midline at various levels will provide a safe field to steer clear of the inferior epigastric artery while performing laparoscopic surgeries.
KEY WORDS: Inferior Epigastric Artery, Origin, Distance, Rectus Abdominis.
- Henry Gray (1858)Gray’s Anatomy– 39’th edition P –1101
- Last R.J (1954) Last’s Anatomy – Ninth edition P -300
- Sir Henry Morris (1893) Human Anatomy – Eleventh edition P –725
- John E Skandalakis (2004) Skandalakis’Surgical Anatomy P-408- 438
- Buchanan A. M (1906) Manual of Anatomy –Eighth edition P -729,730
- Thomas Dwght (1907) Human Anatomy –Eighth edition P -820, 821.
- Sir John Bruce, Robert Walmsley, James A Ross (1964) Manual of Surgical Anatomy P – 294
- Giovanni Teodori, Philippe-PrimoCatmmi, Thomas Toscano and Massimo Bernardi. Use of inferior epigastric artery for CABG. Plastic Reconstructive Surgery 1984;73(1):1-16.
- Donald Serafin (1996)Atlas of microsurgical composite tissue transplantation P-227 -247
- Michael S Baggish, Mickey M.Karram (2001) Atlas of Pelvic Anatomy and Gynaecologic Sugery Second edition P 71-75
- Levent Sarikcioglu, Muzaffer Sindel,Feyyaz Akyildiz,Semih Gur. Anastomotic vessels in the retropubic region:Corona mortis Folia Morphol. 2003;62(3):179-182.
- TeLinde Richard W (1894) TeLinde’s Operative Gynaecology –Ninth edition P –99
- Alan A Saber, Ali M Meslemani, Robert Davis, Ronald Pimentis. Safety zones for Anterior Abdominal wall Entry during Laparoscopy-A CT scan Mapping of Epigastric vessels. Annals of Surgery. 2004;239(2):182-185.
- Boileau Grant J.C (1937) A Method of Anatomy - Sixth edition P211,212,357
- Hurd William W,Bude ,Ronald O,De Lancey, John O L;Newman, Joel S(1994) The location of Abdominal wall blood vessels in relationship to abdominal landmarks apparent at laparoscopy. American J of Obstetrics and Gynaec. 1994;171:642-6.
- Braithwaite JL. Variations in origin of the parietal branches of the internal iliac artery. Journal of anatomy. 1952 Oct;86(Pt 4):423.
Anandhi. V, Rajeswari. K, Christilda Felicia Jebakani. A STUDY OF THE ORIGIN AND COURSE OF THE INFERIOR EPIGASTRIC ARTERY AND ITS SIGNIFICANCE IN LAPAROSCOPIC SURGERY. Int J Anat Res 2016;4(3):2692-2697. DOI: 10.16965/ijar.2016.308


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Arthroscopy is a minimally invasive surgical procedure that uses an arthroscope (thin, flexible tube) to access your affected joints and project an image of them on large screen. This image guides your orthopaedic surgeon as he used specialized instruments through the arthroscope to repair any damage.
Recovery from arthroscopic surgery generally includes wearing a splint for a short time, followed by physical therapy. Your orthopaedic surgeon will discuss the specific details of your recovery with you prior to your procedure.
At MedStar Health, our specialists work with each patient to establish a treatment plan—including the techniques used in supervised and independent therapy sessions—based on their individual situation and needs.
Additionally, our therapists teach and guide each patient to maximize the use of the dysfunctional extremity while preventing re-injury or worsening of condition. Therapists may educate the patient on the disease process, the healing process, and rationale for the prescribed therapy techniques.
An assortment of services are offered, including
- Management of acute or chronic pain
- Protective splinting for immobilization and controlled motion post-operatively or post-injury
- Exercise programs to restore motion, strength, and fine and gross motor coordination
- Home exercise programs
- Sensory re-education programs after nerve injury
- Thermal and electrical modalities to minimize pain and swelling, facilitate restoration of joint motion and tendon gliding, and decrease hypersensitivity
- Whirlpools to assist with wound healing
- Social work consultations
Minimally Invasive Nerve Surgery
Minimally invasive surgeries use smaller incisions than traditional open surgical techniques. This advanced procedure also causes less pain and allows you to recover faster and more easily.
We can use minimally invasive surgery to treat conditions including:


text:
1. When Adam fell, he quickly lost
God’s image, which he once possessed:
See all our nature since could boast
In Cain, his first-born son, expressed!
2. The sacrifice the Lord ordained
In type of the Redeemer’s blood,
Self-righteous reasoning Cain disdained,
And thought his own first-fruits as good.
3. Yet rage and envy filled his mind,
When, with a fallen, downcast look,
He saw his brother favor find,
Who God’s appointed method took.
4. By Cain’s own hand, good Abel died,
Because the Lord approved his faith;
And, when his blood for vengeance cried,
He vainly thought to hide his death.
5. Such was the wicked murderer Cain,
And such by nature still are we,
Until by grace we’re born again,
Malicious, blind and proud, as he.
6. Like him the way of grace we slight,
And in our own devices trust;
Call evil good, and darkness light,
And hate and persecute the just.
7. The saints, in every age and place,
Have found this history fulfilled;
The numbers all our thoughts surpass
Of Abels, whom the Cains have killed!
8. Thus Jesus fell—but O! His blood
Far better things than Abel’s cries:
Obtains His murderers peace with God,
And gains them mansions in the skies.
|First Line:||When Adam fell, he quickly lost|
|Title:||When Adam Fell|
|Author:||John Newton (1779)|
|Source:||Olney Hymns (London: W. Oliver, 1779)|
|Incipit:||13456 71515 43214|
|Source:||Psalmodia Evangelica, by Thomas Williams, 1789|
|Adobe Acrobat image:||Adobe Acrobat image|
|MIDI file:||MIDI File|
|Noteworthy Composer score:||Noteworthy Composer score|
|XML score:||XML score|
|Thine the Glory - Organ Music for Lent and Easter||Easter Triumph||LIFT UP YOUR HEADS, YE MIGHTY GATES! (Trinity Hymnal 198)|
PowerPoint Presentation for Projection
|CHOIR HYMNAL, THE|


With iOS 17.1 now out there, Apple stopped signing iOS 17.0.3. With that, you may now not downgrade to older iOS 17 construct variations – however if you’re experiencing any bug or unreliability, an iOS 16 model continues to be out there — iOS 16.7.2 — for gadgets which are suitable with iOS 16.
With iOS 17.1, launched final month, Apple introduced a number of delayed options from the unique iOS 17 launch, akin to AirDrop with Mobile Information, NameDrop for Apple Watch, and several other Apple Music tweaks, together with the power to favourite songs, artists, and albums. This replace additionally fastened some points with Display Time, keyboard responsiveness, and even a burn-in-like software program bug.
iOS 17.0.3, for instance, centered on bettering iPhone 15 efficiency, as Apple had confirmed these telephones had been overheating. As well as, the corporate stated at the moment that Instagram, Uber, and Asphalt 9 had been a number of apps that additionally brought about the brand new iPhones to overheat.
One of many the reason why Apple stops signing older variations of iOS, akin to iOS 17.0.3, is to stop individuals from jailbreaking their iPhones and iPads. Though there’s no signal of any jailbreak instruments for iOS 17 being developed for the brand new iPhones, it’s additionally a approach to push customers to remain up-to-date with Apple’s working programs. That stated, you may nonetheless downgrade to iOS 16 in order for you.
Right here’s the right way to downgrade from iOS 17.0.3 to iOS 16
Since Apple just isn’t providing iOS 17 to a number of iPhone fashions, such because the iPhone 8 and iPhone X, the corporate continues to be releasing minor software program updates to those older smartphones. At the moment, iPhones that may run iOS 16 can help as much as model 16.7.2, which you should use to downgrade from a tool operating iOS 16.
To do this, you should use a Mac or PC. It’s essential to notice that this isn’t the primary time Apple has provided an older model for customers to downgrade. Final yr, when the corporate launched iOS 16, customers may keep a little bit longer in iOS 15 by getting bug fixes and safety patches.
It’s essential to notice that should you’re experiencing any unreliability or subject, you may at all times attempt the general public or developer beta as nicely. Apple is presently testing iOS 17.2.


text:
The regular feature Limestone Block pattern of limestone render is normally used outside on your Brisbane house or even as a feature wall. The regular pattern mimics the look of large limestone quarry blocks. Using a limestone render allows the walls to evapourate any water that penetrates into them.
Brisbane Stone Render can also render over your existing old limestone retaining walls to freshen them up. You can have featured limestone blocks with pagét joints, rolled joints or striked joints.


text:
- Research article
- Open Access
- Open Peer Review
Urine IL-18, NGAL, IL-8 and serum IL-8 are biomarkers of acute kidney injury following liver transplantation
- Jeffrey C Sirota†1,
- Angela Walcher†1,
- Sarah Faubel1,
- Alkesh Jani1,
- Kim McFann1,
- Prasad Devarajan2,
- Connie L Davis3 and
- Charles L Edelstein1Email author
© Sirota et al.; licensee BioMed Central Ltd. 2013
- Received: 29 June 2012
- Accepted: 11 January 2013
- Published: 17 January 2013
AKI is common following liver transplantation and is associated with significant morbidity and mortality. Biomarkers of AKI have not been well established in this setting but are needed to help guide patient care and facilitate development of novel therapeutics.
Serum creatinine, cystatin C, IL-6, and IL-8 and urine IL-18, NGAL, IL-6, and IL-8 were measured before and within 24 hours after liver transplantation in 40 patients. AKI was defined as a ≥50% sustained increase in creatinine above pre-operative values occurring within 24 hours of transplantation and persisting for at least 24 hours.
Seven patients met criteria for AKI (17.5%), with mean creatinines of 0.81 mg/dL pre-operatively and 1.75 mg/dL post-operatively. While pre-operative biomarker levels in patients with AKI were similar to those in patients without AKI, differences were seen between the groups with regard to median post-operative serum IL-8 (pg/mL) (242.48 vs. 82.37, p = 0.0463) and urine NGAL (ng/mL) (386.86 vs. 24.31, p = 0.0039), IL-6 (pg/mL) (52 vs. 7.29, p=0.0532), IL-8 (pg/mL) (14.3 vs. 0, p = 0.0224), and IL-18 (pg/mL) (883.09 vs. 0, p = 0.0449). The areas under receiver operating characteristic (ROC) curves were 0.749 for urine IL-18, 0.833 for urine NGAL, 0.745 for urine IL-6, 0.682 for serum IL-6, 0.773 for urine IL-8, and 0.742 for serum IL-8. Post-operative cystatin C was not significantly different between AKI and no AKI groups.
Serum IL-8 and urine IL-18, NGAL, IL-6, and IL-8 are elevated in AKI within the first 24 hours following liver transplantation.
- Acute kidney injury
- Liver transplantation
Orthotopic liver transplantation (OLT) is the definitive treatment for end-stage liver disease (ESLD), but the procedure has a significant morbidity and mortality. One of the most significant complications of OLT is AKI, which has been reported in 17 to 95% of OLT patients depending on the definition of AKI . The incidence of AKI was 78% when defined as an increase in serum creatinine of greater than 0.5 mg/dL, 46% when defined as an increase in serum creatinine of greater than 1.0 mg/dL and 14% when defined as an increase in serum creatinine of greater than 50% above 2.0 mg/dL . A variety of etiologies can underlie the renal dysfunction in this setting, including pre-operative hepatorenal physiology, intra-operative vascular clamping that interferes with renal blood flow, peri-operative hypotension and vasopressor requirement, and post-operative use of nephrotoxic medications such as calcineurin inhibitors . These myriad of factors contribute to a high incidence of AKI immediately after liver transplantation, and the development of AKI has been associated with increased length of hospital stay, morbidity, and mortality [1, 3–6].
Given the unfavorable outcomes associated with AKI (in the setting of OLT and otherwise), there has been considerable interest in developing therapies to improve renal dysfunction. However, interventional approaches have been limited by the shortcomings of the conventional approach to the diagnosis of AKI. Measurement of serum creatinine remains the commonest diagnostic tool for assessment of renal function, but this long-used marker suffers from its insensitivity to small changes in renal function, its lack of specificity for renal function given the influence exerted by a variety of non-renal factors (such as muscle mass and diet), and its long lag-time in response respond to kidney injury. These problems can be particularly pronounced in the setting of ESLD, where creatinine has been shown to be an especially unreliable marker of renal function . The inadequacies of creatinine-based estimates of renal function have probably limited the success of AKI therapeutic trials and the opportunity to change the therapeutic strategy accordingly (e.g., delaying the initiation of nephrotoxic immunosuppression after transplant in patients with AKI). A new class of molecular biomarkers has shown significant promise in other clinical settings. These biomarkers include serum cystatin C, urine IL-6, serum IL-6, urine IL-18, and urinary neutrophil gelatinase-associated lipocalin (NGAL). These molecules have been shown to be early detectors of AKI in a variety of clinical settings such as critical illness, [8–10] after cardiopulmonary bypass surgery, [11, 12] in heart failure,  and with contrast-induced kidney injury.
However, the role of biomarkers for detection of AKI in patients undergoing OLT has been explored in only a few prior studies that were limited to urinary and serum NGAL levels [15–18]. Urinary NGAL and L-FABP have recently been described as biomarkers of early AKI after liver transplantation . Besides NGAL and L-FABP, there have been no reports of using other established AKI biomarkers in OLT patients, in whom the levels of these molecules could be altered by factors unrelated to kidney function. Therefore, in this study, we examined a wider panel of biomarkers of AKI in patients undergoing OLT, with the hypothesis that post-operative biomarkers would be higher in patients who develop AKI than in those who do not.
All patients aged 18 to 90 years old who underwent a first-time OLT at the University of Colorado (N=11) and University of Washington (N=29) were eligible for the study. Patients were excluded if they were pregnant, incarcerated, unable to provide consent, received dialysis before or during OLT, or received a kidney transplant simultaneously with their liver, had pre-renal AKI (a more than 50% rise in serum creatinine that was not sustained for 24 hours). All the patients received either tacrolimus or cyclosporine as immunosuppressive therapy. All study enrollment procedures and subsequent data collection and acquisition was approved by the Colorado Multiple Institutional Review Board. All eligible patients who were consented according to proper procedures in a consecutive fashion over an 18 month period were enrolled at the 2 hospitals.
Sample collection and processing
Pre-operative blood and urine samples (four and ten milliliters, respectively) were collected from each patient within 24 hours of OLT. Additional samples of the same volumes were collected within 24 hours after OLT (measured from the time of surgical incision, blood samples were collected an average of 21 hours and 41 minutes later and urine samples were collected an average of 21 hours and 38 minutes later. Average time point between surgical incision and time to first blood sample was 21 hours and 21 minutes in the AKI group. Collected urine was centrifuged at 5000G for two minutes, and the supernatant liquid was stored at −80°C. Blood samples were centrifuged at 3500 RPM for ten minutes, and serum was stored at −80°C.
Biomarkers were measured on single, not pooled samples. Serum cystatin C levels were measured using an immunonephelometric method (Dade Behring, Marburg, Germany), and a standard calibration formula was used to estimate glomerular filtration rate from the result . Urine IL-18 levels were measured with a specific enzyme-linked immunosorbent assay (ELISA) kit (Medical and Biological Laboratories, Nagoya, Japan) that specifically detects the mature form of IL-18 as previously described . All measurements were made in a blinded fashion. The inter- and intra-assay coefficient variations were 5–10%, corresponding to that reported by the kit manufacturer. Urine NGAL levels were measured using a commercially available ELISA (Bioporto, Gentofte, Denmark) as published previously . Briefly, microtiter plates pre-coated with a mouse monoclonal antibody raised against human NGAL (HYB211–05, AntibodyShop, Gentofte, Denmark) were blocked with buffer containing 1% BSA, coated with 100 μL of samples (urine) or standards (NGAL concentrations ranging from 1–1000 ng/mL), and incubated with a biotinylated monoclonal antibody against human NGAL (HYB211–01B, AntibodyShop) followed by avidin-conjugated HRP (Dako, Carpinteria, CA, USA). TMB substrate (BD Biosciences, San Jose, CA, USA) was added for color development, which was read after 30 min at 450 nm with a microplate reader (Benchmark Plus, BioRad, Hercules, CA, USA). The intra- and inter-assay coefficients of variability (CVs) were 5.6% and 6.4%, respectively. Serum and urine IL-6 and IL-8 levels were measured using an ELISA kit (R&D Systems, Minneapolis, MN). Briefly, the IL-6 and IL-8 assays employ the quantitative sandwich enzyme immunoassay technique. A monoclonal antibody specific for IL-6 or IL-8 has been pre-coated onto a microplate. Standards and samples are pipetted into the wells and any IL-6 or IL-8 present is bound by the immobilized antibody. After washing away any unbound substances, an enzyme-linked polyclonal antibody specific for IL-6 or IL-8 is added to the wells. Following a wash to remove any unbound antibody-enzyme reagent, a substrate solution is added to the wells and color develops in proportion to the amount of IL-6 bound in the initial step. The color development is stopped and the intensity of the color is measured.
Serum creatinine levels were measured daily by the hospital’s central laboratory as part of routine peri-operative care, and these values were recorded. A combination of retrospective and prospective chart reviews was performed to collect demographic and pertinent clinical data. AKI was defined as an increase in serum creatinine by 50% or greater compared to pre-operative values that occurred within 24 hours of OLT and that was sustained for at least 24 hours. Patients who developed a 50% rise in serum creatinine that was not sustained for 24 hours were removed from analysis as their kidney injury was thought to be pre-renal in nature. The definition of AKI was based on the Risk, Injury, Failure; Loss, End-Stage Renal Disease (RIFLE) classification and Acute Kidney Injury Network (AKIN) classification where Risk or AKIN stage 1 represents an increase of serum creatinine to 1.5 times baseline . In a separate analysis, biomarkers were compared in patients with or without AKI as defined by a >50% increase in serum cystatin C level at 24 hours.
Demographic data was compared between patients who developed AKI and those who did not using either the Fisher’s exact test or the unpaired t test. Two-tailed p-values are presented. Mean and standard deviation calculations were performed for the measured levels of serum creatinine and serum cystatin C. Mean pre-operative values were compared to mean post-operative values among patients who developed AKI and separately among patients who did not develop AKI using two-tailed paired t tests. At each of the two timepoints (pre-operative and post-operative), mean creatinine and cystatin C values among patients who developed AKI were compared to those in patients who did not develop AKI using two-tailed unpaired t tests. For serum and urinary biomarkers, medians and interquartile ranges were calculated, and median values of the AKI group were compared to those of the no AKI group using the Mann–Whitney test with two-tailed p-values. We defined statistical significance as a p-value of <0.05. InStat software was used for statistical analysis.
Demographic information in patients undergoing liver transplantation
baseline serum creatinine (mg/dL)*
duration of ESLD (months)*
etiology of ESLD
% with a viral component
% with an alcoholic component
pre-operative MELD score*
history of hypertension (%)
history of diabetes (%)
Duration of surgery (hours)
Creatinine and cystatin C measurements (means)
Mean serum creatinine in mg/dL (SD)
Mean serum cystatin C in mg/L (SD)
To determine whether low albumin or systemic inflammation contributed to the lower pre-operative creatinine in the AKI group, serum albumin and serum IL-6 was compared between the AKI and no AKI groups. There was no difference in serum albumin or serum IL-6 pre-op between the AKI and no AKI groups suggesting that malnutrition or systemic inflammation is not the cause of the lower serum creatinine in the AKI group: Serum albumin (g/dL) pre-op was 3.15 in the AKI group and 3.08 in the non-AKI group (P=NS). Serum IL-6 (pg/mL) pre-op was 20.2 in the AKI group and 15.0 in the non-AKI group (P=NS).
Table 2 also shows the mean serum cystatin C values for the two groups before and after liver transplantation. Patients who developed AKI had a mean pre-operative cystatin C value of 0.94 mg/L, compared to the no AKI group’s mean value of 1.16 mg/L (p = 0.1674). These two groups did not have a statistically significant difference in their post-operative mean cystatin C values (1.33 for the AKI group vs. 1.19 mg/dL for the no AKI group, p = 0.4236). While the AKI group did have a substantial increase in serum cystatin C value (0.94 mg/L pre-operatively, 1.33 mg/L post-operatively), the increase failed to reach statistical significance (p = 0.0812). The change in serum cystatin C level amongst the no AKI patient group was small and not statistically significant (1.16 mg/L pre-operatively, 1.19 mg/L post-operatively; p = 0.6325). Median values for pre-operative cystatin C were 0.94 mg/L for the AKI group and 1.19 mg/L for the no AKI group; median post-operative values were 1.36 mg/L and 1.16 mg/L, respectively.
Median biomarker levels [25-75% IQR], (range) when AKI is defined as a >50% increase in serum creatinine
Urine IL-18 (pg/mL)
Urine NGAL (ng/mL)
Urine IL-6 (pg/mL)
Serum IL-6 (pg/mL)
Urine IL-8 (pg/mL)
Serum IL-8 (pg/mL)
Absolute change in serum creatinine (mg/dl) from pre-operative to 24, 48, 72, 96 and 120 hrs post-operative in AKI patients
Median biomarker levels (range) when AKI is defined as a >50% increase in cystatin C
Urine IL-18 (pg/mL)
Urine NGAL (ng/mL)
Urine IL-6 (pg/mL)
Serum IL-6 (pg/mL)
Urine IL-8 (pg/mL)
Serum IL-8 (pg/mL)
In this study, we sought to evaluate the performance of a variety of biomarkers of AKI in the setting of OLT when examined within 24 hours of surgery. We used serum creatinine in our definition of AKI because of its prominence in standard AKI definitions and because data on the superiority of cystatin C in the setting of OLT is conflicting. Some studies have shown that cystatin C may be a better assay for GFR estimation in the setting of cirrhosis  and a 2006 study showed that serum cystatin C correlated better with iohexol-based GFR estimates than serum creatinine did . However, a subsequent study in 2009 did not demonstrate improved diagnostic accuracy of cystatin C over serum creatinine in the setting of liver transplantation . Serum cystatin C has been shown to be superior to creatinine as a marker of kidney function in chronic kidney disease . Therefore, we chose to use serum creatinine in our AKI definition despite its limitations.
As established by our definition, post-operative serum creatinine levels were higher in the AKI group than in the non-AKI group. Interestingly, however, we found that pre-operative serum creatinine levels were significantly lower in the AKI group than in the non-AKI group. A similar pattern was seen with respect to cystatin C (although the difference in pre-operative cystatin C levels failed to achieve statistical significance). While these differences were not expected, they supported the notion that AKI patients did not harbor any manifest renal dysfunction prior to transplantation, and the similarities seen in the pre-operative biomarker levels between the groups further supports this hypothesis.
Using serum creatinine elevations to define AKI, we found statistically significant elevations in post-operative urine IL-18, urine NGAL, urine IL-8, and serum IL-8 in patients with AKI compared to those without AKI, and both serum and urine IL-6 levels were higher in AKI patients despite failing to achieve statistical significance. ROC curve analysis showed that urine NGAL had the best diagnostic performance and that the IL-6 measures performed the worst amongst those we tested. We also examined the biomarkers using an alternative, cystatin C-based definition of AKI. With AKI defined as a >50% increase in serum cystatin C levels at 24 hours, we found that post-operative urine NGAL, IL-6, and IL-8 levels were all significantly elevated above non-AKI controls. We did not normalize urinary biomarker concentrations to contemporaneous urine creatinine concentration because urinary creatinine excretion in the setting of AKI is dynamic and its inclusion in the assessment of urinary biomarkers has been challenged .
While a few previous reports have documented elevations in NGAL levels in post-liver transplant patients who develop AKI, the utility of other biomarkers that have been proven indicators of AKI has not yet been established in the setting of OLT. In 2009, Niemann et al. evaluated plasma NGAL levels in 59 patients undergoing OLT and found that elevations in NGAL levels measured two hours after reperfusion was predictive of AKI . Among those patients with pre-operative serum creatinine levels of <1.5 mg/dL, plasma NGAL level at two hours post-perfusion was associated with the subsequent development of AKI. The following year, Portal et al. evaluated both urinary and serum NGAL levels in 95 patients undergoing OLT and found that post-operative serum NGAL (but not urinary NGAL) was a predictor of severe AKI in multiple logistic regression analysis . In 2011, Wagener et al. examined urinary NGAL/creatinine ratios in 92 patients undergoing OLT . Elevations in urinary NGAL/creatinine ratios were detected three hours after reperfusion and were more pronounced in patients who developed AKI. Urinary NGAL/creatinine ratios were evaluated again in a recent study by Jeong et al. . Elevated urinary NGAL/creatinine ratios were seen two hours after reperfusion in 11 patients who developed AKI after living-related liver transplantation, and peak elevation preceded the rise in serum creatinine in these patients by 19 hours.
Despite this data on NGAL’s role as a predictor of AKI, other biomarkers have not been evaluated in the setting of OLT. The need for studying other biomarkers in AKI is underscored by a closer examination of the previous studies on urinary NGAL that reveals some limitations of its diagnostic ability. When ROC curves were constructed in these prior studies, the AUC’s did not indicate superior diagnostic capabilities (AUC’s for urinary NGAL ranged from 0.693 to 0.800). Thus, urinary NGAL may be an imperfect tool in the early detection of AKI, and defining the diagnostic characteristics for other biomarkers may prove useful in designing future studies to determine whether multiple biomarkers are early predictors of AKI .
Our goal was to expand the current panel of biomarkers that has been studied in the setting of OLT from NGAL alone to include urine IL-18, serum and urine IL-6, and serum and urine IL-8. These various biomarkers have been established in other settings. IL-18, a proinflammatory cytokine, has been identified as a mediator of ischemic injury in the kidney and has been demonstrated to be a reliable marker of and contributor to AKI through animal studies [28–30]. Further studies have demonstrated its diagnostic utility in patients with AKI in the setting of critical illness [10,31] following cardiopulmonary bypass surgery [12, 32–34] and after toxin exposure [14, 35] IL-6 is another pro-inflammatory cytokine that has been shown to be elevated in animal models of AKI  and in humans with AKI after cardiac surgery [37, 38] or with severe sepsis . IL-8 is an endothelial-derived chemokine involved in recruiting neutrophils to the site of injury and stimulating their response. IL-8 levels have been shown to be elevated in the setting of renal allograft dysfunction  and in AKI associated with cardiopulmonary bypass surgery .
It has been reported that worst pre-orthotopic liver transplant hepatic function is associated with an increased incidence of post- orthotopic liver transplant AKI [42, 43]. In the present study, there was no difference in MELD score between AKI and non AKI patients. Also, there was no difference in pre-operative AST, ALT, alkaline phosphatase, albumin or bilirubin between AKI and non AKI patients.
Our study has limitations. First, the overall sample size was small and the incidence of post-operative AKI was significantly lower than that reported in the literature, resulting in a small pool of patients for analysis. This shortcoming may have diminished our statistical power and precluded a more robust calculation of our biomarkers’ predictive abilities. Second, it is likely that some of these biomarkers would have been elevated earlier than 24 hours post-operatively. Thus biomarkers that rise quickly in response to AKI may have already peaked and began normalizing by the time we measured them at 24 hours post-operatively. The degree of elevation may have underestimated the peak degree of elevation and thereby diminished our diagnostic power. Additionally, we may have missed transient elevations that had fully resolved by the time we collected our samples. In the present study, biomarkers were measured at the same time as serum creatinine and were elevated at the same time as serum creatinine in AKI patients. Our previous studies in AKI patients post cardiac surgery demonstrate that urine IL-18 and NGAL peak at 6 hrs post op . Thus it is possible that urine IL-18 and NGAL may peak earlier than serum creatinine and serve as an early biomarker of AKI post liver transplant. Future studies will determine whether these biomarkers increase before serum creatinine in liver transplant patients.
In conclusion, the present study establishes the utility of measuring a wider selection of cytokines and chemokines (urine IL-18, urine NGAL, urine IL-8, serum IL-8 and urine IL-6) as biomarkers of AKI post liver transplantation. The present study should prompt further research into using these biomarkers with urine NGAL to detect AKI prior to randomization to therapeutic strategies in clinical studies. Given the prevalence of AKI associated with OLT and its associated morbidity and mortality, therapeutic studies based on the diagnosis of AKI using a panel of biomarkers including kidney injury molecule-1 (KIM-1), may be possible in the future. The development of novel therapies for AKI may lead to better outcomes.
Work at the University of Washington was funded in part by a grant from Astellas Pharma, Inc. A.W. was funded by a Fellowship Grant from the American Heart Association. K.M. was supported by NIH/NCRR Colorado CTSI Grant Number UL1 RR025780. There are no other disclosures or conflicts of interest to declare.
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Symptoms to look for include: swelling, numbness, weakness, bruising.
Sometimes dislocation may tear ligaments or tendons in the shoulder or damage nerves. The shoulder joint can dislocate forward, backward, or downward. A common type of shoulder dislocation is when the shoulder slips forward (anterior instability). This means the upper arm bone moved forward and down out of its joint. It may happen when the arm is put in a throwing position.


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Roundelay, a poem with a refrain that recurs frequently or at fixed intervals, as in a rondel. The term is also loosely used to refer to any of the fixed forms of poetry (such as the rondeau, the rondel, and the roundel) that use refrains extensively.
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Rondel, a fixed poetic form that runs on two rhymes. It is a variant of the rondeau. The rondel often consists of 14 lines of 8 or 10 syllables divided into three stanzas (two quatrains and a sextet), with the first two lines of the first stanza serving…
Rondeau, one of several formes fixes(“fixed forms”) in French lyric poetry and song of the 14th and 15th centuries. The full form of a rondeau consists of four stanzas. The first and last are identical; the second half of the second stanza is a short refrain, which…
Greek AnthologyGreek Anthology, collection of about 3,700 Greek epigrams, songs, epitaphs, and rhetorical exercises, mostly in elegiac couplets, that can be dated from as early as the 7th century bce to as late as 1000 ce. The nucleus of the Anthology is a collection made early in the 1st century bce by Meleager,…

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CAY HILL–As the Emergency Operations Centre (EOC) has been activated by government in connection with two confirmed cases of COVID-19 (coronavirus) in French St. Martin, management of St. Maarten Medical Center (SMMC) has activated its Outbreak Management Team (OMT) to monitor the situation on a daily basis and has informed the general public as follows:
“While there are no suspected or confirmed cases of COVID-19 in St. Maarten (Dutch side), SMMC would like to reiterate the steps to take if you or a family member show any of the signs of COVID-19, which include fever, cough, and shortness of breath,” SMMC Medical Director and OMT Chairman Dr. Felix Holiday said in a press release on Tuesday.
“In case you develop these symptoms, it is of utmost importance that you first call your family doctor instead of going there or coming to SMMC in person. You should also call your family doctor if you have been in close contact with a person known to have COVID-19 or if you have travelled from an area with widespread or ongoing community spread of COVID-19.”
SMMC alluded to preventative guidelines as issued by the United States Centers for Disease Control and Prevention (www.CDC.gov) for COVID-19, which state that currently a vaccine is not available for COVID-19. Until a vaccine is developed, community-based interventions such as school dismissals, event cancellations, social distancing, and creating employee plans to work remotely can help slow the spread of COVID-19.
Individuals can practise everyday prevention measures like frequent hand-washing, staying home when sick, and covering coughs and sneezes.
“Practise everyday preventive actions now. Remind everyone in your household of the importance of practising everyday preventive actions that can help prevent the spread of respiratory illnesses: Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use a hand sanitiser that contains at least 60 per cent alcohol.
“Always wash your hands with soap and water if your hands are visibly dirty. Avoid close contact with people who are sick. Stay home when you are sick, except to get medical care; however, always call your family doctor or the emergency number first before showing up in person,” SMMC advised.
“Cover your coughs and sneezes in the crook of your arm (elbow). Clean frequently-touched surfaces and objects daily (e.g., tables, countertops, light switches, doorknobs, and cabinet handles) using a regular household detergent and water. If surfaces are dirty, they should be cleaned using a detergent and water prior to disinfection.
“For disinfection, a list of products with Environmental Protection Agency (EPA)-approved emerging viral pathogens claims, maintained by the American Chemistry Council Center for Biocide Chemistries (CBC), is available at Novel Coronavirus (COVID-19) Fighting Productspdf iconexternal icon. Always follow the manufacturer’s instructions for all cleaning and disinfection products.”
In the interest of public health and in an effort to be proactive in minimising the transmission of the virus, SMMC is asking visitors of patients currently admitted to SMMC to refrain from visiting the hospital if they are experiencing any symptoms which include fever, cough, and shortness of breath. Persons visiting the hospital who do not have these symptoms are urged to follow all instructions on proper hand hygiene and cough etiquette.
SMMC also urges the public to call the Collective Prevention Services (CPS) hotline 914, if they have any questions or require additional information regarding COVID-19. SMMC’s Outbreak Management Team said it will share information in subsequent press releases.
Source: The Daily Herald https://www.thedailyherald.sx/islands/smmc-on-high-alert-due-to-coronavirus


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Report: One Direction to perform at Olympics closing ceremony
One Direction will be keeping Aussie fans Up All Night on August 12, with reports the swoon-worthy boyband will feature in the London Olympics closing ceremony.
According to The Mirror, Niall, Liam, Harry, Zayn and Louis will take to the stage with pal Ed Sheeran, who wrote track 'Moments' on their debut album as part of the star-studded finale.
Also rumoured to perform in the ceremony are The Who, Take That, Queen and the Spice Girls (reunited, again).
"Don't know if it's just me, but the excitement in London is unbelievable! It's gonna be a great games," Niall tweeted, but there's still no official word on whether he and the other 1D boys will perform.
A spokesperson for the band refused to comment on their involvement in the closing ceremony. We'll just have to wait and see...
One Direction - 'One Thing'

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