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Absent or impaired rectoanal inhibitory reflex as a diagnostic factor for high-grade (grade III–V) rectal prolapse: a retrospective study
BMC Gastroenterology volume 21, Article number: 157 (2021)
Clinically diagnosing high-grade (III–V) rectal prolapse might be difficult, and the prolapse can often be overlooked. Even though defecography is the significant diagnostic tool for rectal prolapse, it is noticed that rectoanal inhibitory reflex (RAIR) can be associated with rectal prolapse. This study investigated whether RAIR can be used as a diagnostic factor for rectal prolapse.
In this retrospective study, we evaluated 107 patients who underwent both anorectal manometry and defecography between July 2012 and December 2019. Rectal prolapse was classified in accordance with the Oxford Rectal Prolapse Grading System. Patients in the high-grade (III–V) rectal prolapse (high-grade group, n = 30), and patients with no rectal prolapse or low-grade (I, II) rectal prolapse (low-grade group, n = 77) were analyzed. Clinical variables, including symptoms such as fecal incontinence, feeling of prolapse, and history were collected. Symptoms were assessed using yes/no surveys answered by the patients. The manometric results were also evaluated.
Frequencies of fecal incontinence (p = 0.002) and feeling of prolapse (p < 0.001) were significantly higher in the high-grade group. The maximum resting (77.5 vs. 96 mmHg, p = 0.011) and squeezing (128.7 vs. 165 mmHg, p = 0.010) anal pressures were significantly lower in the high-grade group. The frequency of absent or impaired RAIR was significantly higher in the high-grade group (19 cases, 63% vs. 20 cases, 26%, p < 0.001). In a multivariate analysis, the feeling of prolapse (odds ratio [OR], 23.88; 95% confidence interval [CI], 4.43–128.78; p < 0.001) and absent or impaired RAIR (OR, 5.36; 95% CI, 1.91–15.04, p = 0.001) were independent factors of high-grade (III–V) rectal prolapse. In addition, the percentage of the absent or impaired RAIR significantly increased with grading increase of rectal prolapse (p < 0.001). The sensitivity of absent or impaired RAIR as a predictor of high-grade prolapse was 63.3% and specificity 74.0%.
Absent or impaired RAIR was a meaningful diagnostic factor of high-grade (III–V) rectal prolapse. Furthermore, the absent or impaired reflex had a positive linear trend according to the increase of rectal prolapse grading.
Rectal prolapse is a disease in which a part of the rectum or the entire rectum slides out through the anus . Rectal prolapse consists of external rectal prolapse (ERP) and internal rectal prolapse (IRP) . Rectal prolapse is diagnosed when the rectum has protruded through the anal sphincter as observed by physical examination. Another way of diagnosing rectal prolapse, especially IRP, is by radiologic defecography. Recently defecography is commonly used as a diagnostic tool for rectal prolapse grading. ERP and high-grade (III–IV) IRP are indications for surgical treatment once the conservative treatment fails .
However, patients with rectal prolapse, particularly IRP, sometimes visit outpatient clinics with symptoms such as fecal incontinence or chronic constipation without feeling the prolapse [3, 4]. If a patient does not present with a feeling of prolapse, it is difficult to suspect rectal prolapse, because the symptoms are vague. A physical examination inducing rectal protrusion does not usually work in this situation. Therefore, the clinical diagnosis of rectal prolapse is difficult, and the prolapse can be often overlooked [5, 6]. In addition, defecography, one of the radiologic tests, is considered an unpleasant test for patients . Therefore, it would be clinically useful to have other diagnostic tools or clinical variables to detect rectal prolapse. Among the manometry tests, there are reports that rectoanal inhibitory reflex (RAIR) is associated with rectal prolapse [8, 9]. If RAIR can be a diagnostic factor for rectal prolapse, it may have important clinical significance.
Therefore, we aimed to identify the clinical factors that could detect rectal prolapse, and to investigate whether RAIR can be used as a diagnostic factor for rectal prolapse.
Patients who underwent both anorectal manometry and defecography for fecal incontinence, constipation, or anorectal discomforts at Pusan National University Yangsan Hospital between July 2012 and December 2019 were included. All data were taken from a prospectively maintained database. Patients younger than 18 years were excluded. The study design was approved by the Institutional Review Board of the Pusan National University Yangsan Hospital (No. 05-2020-106) and was conducted in accordance with the Declaration of Helsinki.
In this study, rectal prolapse was classified in accordance with the Oxford Rectal Prolapse Grading System , which defines high-grade (III–V) rectal prolapse as clinically significant rectal prolapse because it requires surgical treatment when it affects quality of life or does not improve with conservative treatment . Thus, patients with high-grade (III–V) rectal prolapse were designated for the high-grade group (n = 30), and patients without rectal prolapse and those with low-grade (I, II) rectal prolapse were designated for the low-grade group (n = 77) (Fig. 1). The Oxford Rectal Prolapse Grading System details are delineated with the description of defecography later in this article.
Clinical data selection
Clinical variables, including age, sex, symptoms at presentation, and surgical or radiotherapy history were collected. Symptoms at presentation included fecal incontinence, incomplete evacuation, straining, feeling of prolapse, and anorectal pain, which are thought to be associated with rectal prolapse . Symptoms were evaluated using yes/no surveys, answered by the patients. According to Rome IV criteria  fecal incontinence was defined as recurrent uncontrolled passage of liquid or solid stool; anorectal pain included levator ani syndrome, unspecified functional anorectal pain, and proctalgia fugax. Incomplete evacuation, straining at defecation and feeling of prolapse were adopted as symptoms related to rectal prolapse . Surgical history included anal surgery, rectal surgery, and hysterectomy.
Manometry was performed in the left lateral decubitus position. A flexible water-perfused eight-channel catheter with an external diameter of 5.5 mm was inserted into the rectum up to 6 cm from the anal verge. The catheter was connected to a computerized gastrointestinal tract motility recording system (Polygraf ID®, Sierra Scientific Instruments, Los Angeles, CA, USA) and the microcapillary infusion system (MUI Scientific, Mississauga, ON, Canada). The capillaries were perfused with distilled water at a rate of 0.5 ml/min per channel using a constant pressure of 96 kPa. A continuous pull-through technique was performed at a rate of 1 cm/s. All patients had an enema 1 h before the testing to prevent fecal content in the rectum from impairing adequate positioning of the catheter.
Maximum resting pressure, mean resting pressure, maximum squeezing pressure and high-pressure zone (HPZ) were evaluated. The maximum resting pressure was defined as the highest resting pressure recorded . The mean resting pressure was considered as the mean of the resting pressures recorded within the HPZ. Moreover, the maximum squeezing pressure was defined as the highest pressure recorded of the anal canal during a maximum squeezing effort by the patient. HPZ was defined as the anal area with a pressure exceeding 50% of the average maximum pressure measured .
To measure rectal sensitivity, the catheter with a latex balloon in the tip was inserted into the rectum. Then, the catheter balloon was insufflated with an increment of 10 ml. The first-sensation volume was defined as the volume at which balloon expansion was first felt, and the urge-sensation volume was defined as the volume at which the patient felt a desire to defecate [11, 12]. The maximal tolerated volume was defined as the volume at which the patient felt discomfort and an intense urge to defecate.
The RAIR was assessed by checking the relaxation of the internal anal sphincter by rapid inflation of the balloon at the catheter tip in the distal rectum. The eight-channel catheter with a latex balloon was reinserted into the anal canal and the balloon was positioned in the distal rectum. After attaining steady pressure, the balloon was rapidly inflated using air with incremental steps of 10 ml, starting from 10 to 60 ml. If the reflex was not elicited with 60 ml, the catheter was repositioned and the procedure was repeated in 60 ml. RAIR was considered to be normally present when the amplitude of resting anal pressure was reduced by 25% or more in response to the rapid inflation of the rectal balloon (Fig. 2a) . Cases in which RAIR was not present or less elicited, even after inflating the balloon to 60 ml were considered to be absent or impaired RAIR, respectively (Fig. 2b). Normal RAIR and abnormality of RAIR were automatically reported by the software installed in the anorectal manometry system. The results were finalized by one gastroenterologist and one colorectal surgeon after blinded verification without noticing any other results including defecography.
The vector volume and asymmetry of the anal sphincter were evaluated by withdrawing the catheter gradually at a rate of 1 cm/s. The two parameters were automatically calculated using the software installed in the computerized anorectal manometry system. Due to the parameters being very sensitive to the catheter position, the anal sphincter pressure was evaluated three times before the catheter position was decided. The asymmetry of the anal sphincter was defined as the degree of deviation of the integrated cross-section from a perfect circle . It was calculated at the HPZ and presented as a percentage (0%, perfect symmetry; 100%, total asymmetry). A higher percentage meant a greater degree of asymmetry. The vector volume of the whole anal sphincter was defined in terms of a 3D shape generated a volume of the overall anal canal .
In the fluoroscopy room, the patient’s rectum was filled with 200–250 ml of barium sulfate suspension (70%) introduced by a soft diagnostic enema probe. The patient was then seated on a radiolucent commode placed on the fluoroscopic X-ray table. Lateral video radiographs were taken and recorded at rest, during squeezing, and expulsion of barium enema.
The stored defecography videos were analyzed to confirm the presence of rectal prolapse. Rectal prolapse was graded according to the Oxford Rectal Prolapse Grading System (Fig. 3) : grade I, descends no lower than the upper level of a concurrent rectocele; grade II, descends lower than the upper level of a rectocele but not onto the anal canal; grade III, descends and impinges on the anal canal; grade IV, enters the anal canal; grade V, the rectal wall protrudes from the anus beyond the anal verge.
Grade I and grade II prolapse were considered as low-grade IRP, grade III and IV prolapse as high-grade IRP, and grade V prolapse as ERP.
The results were verified by one radiologist and one colorectal surgeon after being blinded without noticing any other results including anorectal manometry.
Statistical analyses were performed using the IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA). The means of continuous variables were compared using independent t-tests, and non-normally distributed data were analyzed with the Mann–Whitney test. A normal distribution was assessed using the Shapiro–Wilk test. The associations of categorical variables were analyzed with the chi-square test and Fisher’s exact test. Factors that were significant in the univariate analysis were entered in the multivariate logistic regression using a forward likelihood ratio approach. The Cochran-Armitage test for trend was used to check if the change in percentage of the dependent variable had a significant trend according to the changes in the independent variables. Results with p < 0.05 were deemed significant.
Comparison of clinical characteristics according to the rectal prolapse grading
The percentage of patients with fecal incontinence (18 cases, 60% vs. 21 cases, 27%, p = 0.002) and feeling of prolapse (11 cases, 37% vs. 2 cases, 3%, p < 0.001) was significantly higher in the high-grade group than in the low-grade group (Table 1). In addition, the proportion of patients with a history of hysterectomy was higher in the high-grade group (p = 0.028). There were no significant differences in age, sex, and symptoms such as incomplete evacuation, straining, and anorectal pain. Moreover, there were no significant differences in the history of anal surgery, rectal surgery, and radiotherapy.
Analysis of manometric results between the high-grade group and the low-grade group
The maximum resting pressure, mean resting pressure and maximum squeezing pressure were significantly lower in the high-grade group than in the low-grade group (p = 0.011, p = 0.009, and p = 0.010, respectively) (Table 2). The percentage of patients with absent or impaired RAIR was significantly higher in the high-grade group than in the low-grade group (19 cases, 63% vs. 20 cases, 26%, p < 0.001). The vector volumes of the total anal sphincter at rest and squeeze were significantly lower in the high-grade group (p = 0.002 and p = 0.006, respectively), whereas there were no significant differences in length of HPZ, rectal sensation volume, and asymmetry of the anal sphincter.
Multivariate analysis of the relative factors for high-grade (III–V) rectal prolapse
A multivariate analysis identified feeling of prolapse (odds ratio [OR], 23.88; 95% confidence interval [CI], 4.43–128.78; p < 0.001) and absent or impaired RAIR (OR, 5.36; 95% CI, 1.91–15.04; p = 0.001) as independent factors of high-grade (III–V) rectal prolapse (Table 3).
A trend of absent or impaired RAIR according to the changes in rectal prolapse grading
RAIR was absent or impaired in 23% (11/48) of patients without rectal prolapse and 18% (2/11) of patients with grade I, 39% (7/18) of patients with grade II, 40% (4/10) of patients with grade III, 70% (7/10) of patients with grade IV, and 80% (8/10) of patients with grade V rectal prolapse (Fig. 4). The Cochran-Armitage test for trend confirmed that the percentage of the absent or impaired RAIR significantly increased with increasing grading of rectal prolapse (p < 0.001). A sensitivity of absent or impaired RAIR as a predictor of high-grade prolapse was 63.3% and specificity 74.0%.
Our study showed we could use absent or impaired RAIR as a meaningful diagnostic factor of clinically significant high-grade (III–V) rectal prolapse. Furthermore, absent or impaired RAIR had a significant linear tendency to increase rectal prolapse grade. These results may help recognise high-grade rectal prolapse that can be overlooked. RAIR can contribute to enhancing quality of life for patients with the rectal prolapse. Another predictor identified in the present study was the feeling of prolapse.
Our primary focus was whether RAIR was strongly related to rectal prolapse. In the present study, absent or impaired RAIR was the useful diagnostic factor of the high-grade (III–V) rectal prolapse. There have been several studies which showed an association between RAIR and rectal prolapse similar to our study. Spencer reported that all 12 patients with rectal prolapse had absent or impaired RAIR . Similarly, Farouk et al. performed a study of 22 patients with ERP and fecal incontinence . They showed that 16 (73%) patients did not elicit RAIR. In contrast, several reports had results different from those of our study. A study on 27 patients with rectal prolapse reported that 70% of the patients had normal RAIR . Sainio et al.  reported that patients with ERP could elicit normal RAIR in 79% (22/28), which was higher than that of our study.
As shown above, the relationship between RAIR and rectal prolapse remains unexplained. Most previous studies limited the study population to patients with ERP, and did not include IRP. Furthermore, most studies had been published before the introduction of the Oxford Rectal Prolapse Grading System which is currently widely utilized in clinical settings . This study classified the patients according to the existence of high-grade (III–V) rectal prolapse for which surgical treatment can be helpful. Therefore, the results could increase the clinical application. Also, this study performed a multivariate logistic regression analysis, which could minimize the influence of confounding variables such as sphincter tone. Finally, it can raise the value on the identified predictors. The linear trend of a positive linear correlation between RAIR and increasing rectal prolapse grading is also a new finding. To the best of our knowledge, this result has never been published to date. This suggests that RAIR might be impaired due to accumulated impact as rectal prolapse progresses.
There are several hypotheses regarding the mechanism behind absent or impaired RAIR in patients with rectal prolapse. One of the suggested mechanisms is that a prolapsed rectum causes persistent RAIR by substantial rectal distention produced by a prolapsed rectum . Therefore, the internal anal sphincter might be relaxed constantly, and RAIR might not be elicited. Many authors have agreed to this hypothesis [9, 17,18,19]. The hypothesis must be feasible in the case of ERP and was supported by an ambulatory assessment of combined electromyography and anorectal manometry . However, there seems to be a little difference in the case of IRP. In high-grade (III, IV) IRP included in this study, the prolapse usually occurred during the pushing state of defecography. Defecography often shows no specific changes at resting and squeezing state than usual. Therefore, we cannot deduce that a prolapsed rectum elicits constant RAIR without straining in patients with IRP and that it makes absent or impaired RAIR. Furthermore, in the left lateral position for manometry, prolapse or pelvic descent usually does not occur even in ERP. Therefore, the hypothesis might be not definite and may need to be verified by well-designed studies.
Another possible mechanism is direct damage to the internal anal sphincter by chronic stretching of the pelvic floor from rectal prolapse [14, 21, 22]. Dvorkin et al.  found that anal sphincter distortion significantly occurred frequently in the rectal prolapse. They concluded that it may be a response to mechanical stress from rectal prolapse although the course was unknown. Woods et al.  showed that anatomical defects in both internal and external anal sphincters are common in patients with ERP. Also, the dysfunctional sphincter might be caused by increased collagen fibril in the anal sphincter probably because of continuous stimulation [23, 25]. This study showed both of the resting anal pressure and the squeezing anal pressure decreased in high-grade rectal prolapse. This indicated that the functions of both anal sphincters decreased in rectal prolapse. The results supported that RAIR might not be elicited because of a dysfunctional internal anal sphincter.
The stretching effect from rectal descent can possibly damage the nervous system of the pelvic floor, including the enteric nervous plexus . Park et al.  founded histologic evidence of denervation in the anal sphincter in patients with rectal prolapse. They suggested that the denervation could be due to entrapment or stretching injury of the nerve as a result of rectal descent. A study exploring the mechanism of RAIR showed that nitric oxide appeared to be a neurotransmitter to mediate RAIR and the nerve fiber within the internal anal sphincter contained nitric oxide synthase . Therefore, if the nerve fiber is damaged by rectal prolapse, nitric oxide insufficiency may also affect RAIR. In summary, the mechanisms discussed above might influence the reflex simultaneously.
Several factors can influence the occurrence of RAIR and confound the results of our study. The well-known influencing factors are megarectum and extremely low anal resting pressure . This study assessed rectal sensation volume to check for the presence of megarectum. The volumes were not different between the two groups. In addition, if a patient had very low anal resting pressure, manometry was not likely to show RAIR. Detecting RAIR might be difficult when base pressure amplitude is very low. Another probable reason is that the internal anal sphincter might be already inhibited fully by the prolapsed rectum. Sainio et al.  reported the absence of RAIR in six patients with rectal prolapse, which might be because of very low anal resting pressure. Therefore, we compared the incidence of very low mean resting pressure (< 20 mmHg) between the two groups. We found that only one patient in the high-grade rectal prolapse group had very low resting pressure and confirmed there was no significant difference in the pressure.
Another significant factor for rectal prolapse in the present study was anal sphincter pressure. Our results showed that both decreased resting and squeezing anal pressure were associated with rectal prolapse in the univariate analysis. However, they were not drawn as independent predictive factors in the multivariate analysis. There have been several reports that anal pressure was related to the rectal prolapse. Harmston et al.  reported that the maximum resting and squeezing pressure significantly decreased in ERP, and maximum resting pressure significantly decreased in IRP than the squeezing anal pressure would. Moreover, Zbar et al.  showed that maximum resting and squeezing pressure was significantly lower in patients with pelvic organ prolapse. Hawkins et al.  reported that increasing rectal prolapse grade was related to an increase in the proportion of patients with decreased sphincter pressures. In contrast, there was a report stating that the maximum resting and squeezing pressure were not associated with the IRP grade . The univariate analysis in our study identified the variable with significant relevance and they may be associated with each other. The relationship may be caused by the common point with structural abnormalities. However, we cannot determine definitely whether decreased anal sphincter tone was the etiology of the rectal prolapse or the consequence of prolonged rectal prolapse [24, 32]. The characteristics of rectal prolapse can be different depending upon the mechanisms which cause the prolapse , and future studies must analyze these issues.
Several efforts have been devoted to predicting the existence of rectal prolapse. Karlbom et al.  reported that clinical examination such as digital rectal examination and rectoscopy can help diagnose IRP. Prichard et al.  concluded that rectoanal pressure patterns on high-resolution rectoanal manometry might identify rectal prolapse. Another study using high-resolution anorectal manometry showed that an anterior high-pressure area with an excessive perineal descent was associated with IRP . The investigators suggested that it could help diagnose prolapse. Although the study results are encouraging, they had a limitation regarding patients’ position. It is usually difficult to induce prolapse of the rectum in the left lateral or supine position [6, 35]. Furthermore, it is more difficult when a probe is located in the rectum during high-resolution anorectal manometry. Moreover, an empty rectum can make producing prolapse more difficult . Another study by Grande et al.  using vectography suggested that in cases of incontinent patients with anal asymmetry > 20%, a defecography may be helpful to diagnose rectal prolapse.
Patients with rectal prolapse present to the hospital because of various symptoms . The patient management strategy is determined after obtaining a patient’s history and performing a physical examination. If the patient has a feeling of prolapse or obstructive defecation, rectal prolapse could be easily suspected and visually confirmed by inducing prolapse. However, if the patient complains of other anorectal symptoms such as fecal incontinence or chronic constipation without a feeling of prolapse, other diseases might be considered. Several guidelines suggested that anorectal manometry can be considered more primarily than defecography in the case of fecal incontinence or chronic constipation [37, 38]. Therefore, anorectal manometry is sometimes performed without defecography based on the symptoms and examination findings at presentation. In such cases, we suggest if manometry shows absent or impaired RAIR, clinicians should consider a possibility of rectal prolapse and perform defecography to confirm rectal prolapse. This diagnostic flow could detect the rectal prolapse earlier and ultimately may enhance the quality of life of patients with rectal prolapse.
Of course, the defecography might reveal no or low-grade rectal prolapse. Therefore, if RAIR is absent or impaired, posibilities other than rectal prolapse should be considered simultaneously. Other conditions that impair RAIR include megarectum, post-proctectomy and colo-anal anastomosis, severely reduced internal anal sphincter pressure, chronic constipation, fecal incontinence, rectal ischemia, systemic sclerosis, diabetic neuropathy, myelomeningocele, and Chagas disease [39,40,41,42]. However, the aforementioned diseases such as systemic sclerosis and Chagas disease are very rare. In addition, megarectum, postoperative change, and severely reduced anal sphincter were just results that originated from other problems. Although there are many possible causes of impaired RAIR, suspecting rectal prolapse with absent or impaired RAIR on anorectal manometry can have significant clinical implications because prolapse is not very infrequent and active management such as surgical treatment is of great benefit to the patient.
This study has several limitations. First, this was a retrospective study; hence, there is the possibility of selection bias. Prospective studies may be able to obtain more meaningful results. Second, the sample size was small. Therefore, a type II error may have occurred and a larger sample size may have shown statistical significance. Third, this study was conducted in a tertiary hospital; thus, the patients had higher severity than patients in primary and secondary healthcare facilities, which can be another factor contributing to the selection bias.
Absent or impaired RAIR was a meaningful diagnostic factor of high-grade (III–V) rectal prolapse. Furthermore, the absent or impaired reflex had a positive linear trend according to the increase of rectal prolapse grading.
Availability of data and materials
The datasets generated and analyzed during the current study are not publicly available due to health privacy concerns, but are available from the corresponding author on reasonable request.
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The authors gratefully acknowledge the statistical advice and suggestions given by Prof. Mi Sook Yun (Ph.D), Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital.
This study received no funding.
Ethics approval and consent to participate
This study was approved by the Institutional review board of the Pusan National University Yangsan Hospital (No. 05-2020-106), which also waived the requirement for informed consent due to the retrospective nature of the study. The study was conducted in accordance with the Declaration of Helsinki.
The authors declare that they have no competing interests.
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Park, BS., Cho, S.H., Son, G.M. et al. Absent or impaired rectoanal inhibitory reflex as a diagnostic factor for high-grade (grade III–V) rectal prolapse: a retrospective study. BMC Gastroenterol 21, 157 (2021). https://doi.org/10.1186/s12876-021-01729-1
- Rectal prolapse
- Rectoanal inhibitory reflex


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Estimates and determinants of stocks of deep soil carbon in Gabon, Central Africa
© 2019 Despite the importance of tropical forest carbon to the global carbon cycle, research on carbon stocks is incomplete in major areas of the tropical world. Nowhere in the tropics is this more the case than in Africa, and especially Central Africa, where carbon stocks are known to be high but a scarcity of data limits understanding of carbon stocks and drivers. In this study, we present the first nation-wide measurements and determinants of soil carbon in Gabon, a nation in Central Africa. We estimated soil carbon to a 2-m depth using a systematic, random design of 59 plots located across Gabon. Soil carbon to a 2-m depth averaged 163 Mg ha −1 with a CV of 61%. These soil carbon stocks accounted for approximately half of the total carbon accumulated in aboveground biomass and soil pools. Nearly a third of soil carbon was stored in the second meter of soil, averaging 58 Mg ha −1 with a CV of 94%. Lithology, soil type, and terrain attributes were found to be significant predictors of cumulative SOC stocks to a 2-m depth. Current protocols of the IPCC are to sample soil carbon from the surface 30 cm, which in this study would underestimate soil carbon by 60% and underestimate ecosystem carbon by 30%. A nonlinear model using a power function predicted cumulative soil carbon stocks in the second meter with an average error of prediction of 3.2 Mg ha −1 (CV = 915%) of measured values. The magnitude and turnover of deep soil carbon in tropical forests needs to be estimated as more countries prioritize carbon accounting and monitoring in response to accelerating land-use change.
Wade, AM; Richter, DD; Medjibe, VP; Bacon, AR; Heine, PR; White, LJT; Poulsen, JR
Volume / Issue
Start / End Page
International Standard Serial Number (ISSN)
Digital Object Identifier (DOI)

domain: biology


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The Broke and the Bookish. This week is the top 10 books that made you cry. Here are mine in no order:
1. Suzanne's Diary for Nicholas by James Patterson: I read this when I was pregnant with my first son so it really hit me hard! I bawled like a baby.
2. The Twilight Saga: New Moon by Stephenie Meyer: I hurt so bad for Bella when Edward left that I just had to cry.
3. My Sister's Keeper by Jodi Picoult: The unfairness of life just hit me in this one.
4. Night by Elie Wiesel: The fact that this was a true story by a survivor of the Holocaust was enough. The horrendous things that were done to people was so sad and disgusting!
5. My Darling Elia by Eugenie Melnyk: This was another book about the Holocaust that was just filled with heartache (although it was fiction). The unfairness of life again got to me.
6. The Kite Runner by Khaled Hosseini: There were many times during this book that I teared up. It was just a very emotional book.
7. Sundays at Tiffany's by James Patterson: I felt for the main character as a child neglected by her mom and left to be raised by nannies. It was so sad!
8. Dear John by Nicholas Sparks: It takes a lot of love to let someone go and that is what this book was all about.
9. The Boy in the Striped Pajamas by John Boyne: As a mother I could not fathom this happening to my child!
10. The Color Purple by Alice Walker: Just a heartwrenching novel!

domain: library


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Like the work of fellow Swede Gustav Ejstes (of Dungen fame), Matthias Danielsson’s instrumental post-prog experiment, Makajodama, is rife with psychedelia. But while records like Ejstes’s Ta Det Lugnt explore the pop influence of the flower generation, Danielsson and his quartet prefer a stylistic ambiguity allowing for copious amounts of improvisation and experimentation, making this self-titled debut an adventurous production.
Makajodama set out to explore the fusion of written and improvised music from a progressive rock perspective (Danielsson regularly plays guitar for the prog band Gösta Berlings Saga). As a result, these eight tracks often involve elaborations upon a general theme, typically with prolonged sections of improvisation that at times owe allegiance to jazz or classical structures while at other times harken back to oddball, Zappa schizo-funk. As can often be the case with such ambition, Makajodama tend to overstay their welcome where many of the songs would benefit from a more concise treatment. For example, the latter six minutes of “Buddha and the camel” are purely superfluous, whereas the succeeding “Wolof” ties things up nicely in brass and birdsong in nearly a third of the time. But what really stands out about these songs is their instrumentation. The strings (violin and cello) deserve most of the credit for the focus and warmth they imbue, but bassoon, saxophone, sitar, flute, and pedal steel—among many others—all contribute to a sound that defies, even transcends, genre pigeonholing. For the patient listener that makes for rewarding repeat listens.
As much as this record owes to art music, it hardly lacks soul. “Reodor Felgen blues” is steeped in psychedelia laid over a groove that eventually crescendoes in a careening 60s revival blitz. “Vallingby revisited,” named after a suburb of Stockholm, is a bass-fueled jazz shamble, featuring saxophone and violin interplay that eventually disperses for the eerie single-note whine introducing “The girls at the marches.” This track seems to breathe, stretch, and even yawn as though rising from a long, Nordic nap.
It’s Makajodama’s final entry, “Autumn suite,” that singularly attests to this group’s ambition and artistry. From string quartet beauty, to English folk-rock groove, to near-comic fractured experimentalism, to psychedelic (think Dark Side of the Moon) ambience, “Autumn suite” tastefully blends a bevy of distinct styles into a single statement that not only rounds out a challenging and adventurous album but defines the reach and the harmony this group can achieve.
Stephen B. Griggs
December 22, 2009

domain: artistic


© David Kostner
our preview of Bayerische Staatsoper’s 2016-17 season
Munich is one of the top European destinations for opera tourists. It’s not difficult to see why. The Staatsoper's season is built around six new opera productions at the Nationaltheater, ranging from Rossini to Schreker.
Upcoming eventsSee more...
Strauss R.: Ariadne auf Naxos
Oksana Lyniv; Robert Carsen; Bavarian State Opera; Peter Pabst; Falk Bauer; Karita Mattila; Jane Archibald
Various: The Little Prince
Maged Mohamed; Bavarian State Ballet
Bach, Vivaldi, Debussy, Beethoven
Maximilian Randlinger; Andreas Skouras
Mozart: Die Entführung aus dem Serail (The Abduction from the Harem)
Constantin Trinks; Martin Duncan; Bavarian State Opera; Ultz; Lisette Oropesa; Sofia Fomina; Daniel Behle
Latest reviewsSee more...
The Rossini masterpiece is brought to life by an inspired conductor and four first-class singers in a new, modern production by David Alden.
Robert Dean Smith replacing an ailing tenor as Lohengrin was merely adequate but the rest of the cast and the superb orchestra made the modern production of Lohengrin in Munich memorable.
After Martinů's Memorial to Lidice Mariss Jansons and the BRSO left the listener speechless with Shostakovich's Seventh.
Despite the starriest of casts the première of Miroslav Srnka's double opera South Pole falls behind the expectations created by the media hype, but is celebrated by the audience.


On Saturday, House Minority Leader Nancy Pelosi announced she planned to file a Freedom of Information Act (FOIA) request to obtain documents related to the FBI’s supplemental probe of Supreme Court Justice Brett Kavanaugh, which senators said showed no corroboration of the decades-old sexual misconduct allegations against him.
FBI background checks on judicial nominees have traditionally been kept confidential so that only senators, White House officials, and certain aides can view them.
“In purposefully limited the FBI investigation, it is clear the Republicans were not seeking the truth,” California Democrat Pelosi wrote in a statement. “They were seeking cover to do what they wanted to do anyway. To add insult injury they blocked the public’s access to the report.”
Pelosi also requested any communications from Senate Republicans to the FBI concerning the scope of the investigation.


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Salema Beach, located in Vila do Bispo, Costa Vicentina, is a village with strong ties to fishing and with brightly colored boats and traditional white houses.
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Color Blue Indigo
Made in Portugal with love.


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Discuss books from a variety of genres at 7 pm, the first Monday of each month. Authors DO NOT attend.
Monday, December 2, 7:00pm
How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence by Michael Pollan
A unique and elegant blend of science, memoir, travel writing, history, and medicine, How to Change Your Mind is a triumph of participatory journalism. By turns dazzling and edifying, it is the gripping account of a journey to an exciting and unexpected new frontier in our understanding of the mind, the self, and our place in the world. The true subject of Pollan's "mental travelogue" is not just psychedelic drugs but also the eternal puzzle of human consciousness and how, in a world that offers us both suffering and joy, we can do our best to be fully present and find meaning in our lives.

domain: literature


The UC Davis women’s tennis team played three dual matches over the weekend, winning two and dropping the other.
On Wednesday, the Aggies were swept 7-0 to the top team in the nation, Stanford.
No match went longer than two sets as the Cardinal boast four players in the top 100 nationally.
On Saturday, UC Davis took a 6-1 victory over Portland on the road. All but one of the seven matches were decided in more than two sets. Dahra Zamudio, Megan Heneghan and Kelly Chui each picked up key victories over the hosting Pilots.
On Sunday, UC Davis won again 6-1, this time over Portland State. The pairs of Ellie Edles/Lauren Curry and Chui/Melissa Kobayakawa each picked up doubles victories to open up the event.
After the weekend matches, the Aggies moved to 3-2 on the season. UC Davis will be back in action next week, when they travel to face San Francisco on Saturday, Feb. 5 at 12 p.m.
Track and Field
The women’s track and field team traveled to the University of Washington to take part in the UW invitational at Dempey Indoor.
The event was highlighted by Chidinma Onyewuenyi’s school record performance in the shot put. Onyewuenyi had a mark of 48 feet, 1.75 inches in the event, breaking her previous mark of 45-8.50 from last season.
Leslie Reed also performed well, posting a pair of top-five all-time UC Davis marks in the sprints competitions. Reed finished 12th in the 200 with a time of 25.50.
The Aggies will return to Seattle in two weeks for the Husky Indoor Invitational.
– Jason Alpert


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Written and medically reviewed by Dorcas Morak, Pharm.DIn the United States, about half of adults regularly take dietary supplements like vitamins, fish oil, and minerals. Unfortunately, a lot of people choose their vitamins and supplements without following any guidelines, and many decide to start using dietary supplements after reading only general information about their positive effects. However, taking dietary supplements excessively might cause imbalances; some may even be harmful to those with medical conditions. Here is your guide to using vitamins and supplements safely.
Do you need a supplement?
While many healthy individuals don't require supplements or vitamins, many people do. The best source of vitamins and minerals is always food. However, some people find it extremely challenging to consume enough fresh produce, healthy grains, and fruits that will give them the vitamins and minerals that they need. These people could benefit from a supplement:
Older people: When you turn 50, your body starts to absorb less vitamin D and vitamin B12. Adding an extra dose of these vitamins via a supplement may help you get what you need.
Those with certain diseases: Certain disease conditions can make it difficult for you to absorb some vital nutrients so a supplement may be needed. Some of these conditions are inflammatory bowel disease, celiac disease, cystic fibrosis, liver disease, cancer, pernicious anemia, alcohol dependence, and certain gene mutations. Additionally, if you take a medication, ask your doctor about any potential interactions with vitamins or supplements.
Pregnant women: You won't get enough iron and folic acid from meals if you are or intend to get pregnant. Prenatal vitamins give you an extra cushion of safety. If you have any worries about taking vitamins and supplements while pregnant, talk to your doctor.
Young children: Infants and children may benefit from additional vitamin D and iron.
Individuals on restricted diets: If you are on a restricted diet, it may be harder for you to get some nutrients such as vitamin B12 or calcium. People on restricted diets, including vegans and people with dairy allergies, benefit more from vitamins and minerals supplements.
Those with lower access to healthy foods: Those who, due to their financial situation or where they live, don't have easy access to healthy meals might consider vitamins or supplements to help support health.
Do I have vitamin or mineral deficiencies?
If you are concerned about whether you have vitamin or mineral deficiencies, your doctor may recommend a blood test to confirm it. For instance, if you have been a vegan for an extended period of time, you might want to confirm your vitamin B12, calcium, and vitamin D levels. If you experience any of the following symptoms, your doctor may advise getting tested:
- extreme hair loss
- bone or joint pain
- extreme exhaustion
- irregular heartbeat
- vision changes
- wounds that heal slowly
How common are nutritional deficiencies in the United States?
Nutritional deficiencies are fairly rare among Americans. However, there is a growing concern with some nutrients, such as:
Are vitamin and mineral supplements safe?
Vitamins and minerals supplements are generally safe and do not pose any harm when you are within the tolerable limit. However, if you take a multivitamin every day and simultaneously eat fortified foods and drinks, the level of some nutrients in your body may exceed the tolerable upper limit. The implication of this may be mild like nausea, or serious like bleeding.
Do I need to tell my healthcare provider if I take any supplements?
Yes, talk to your healthcare provider if you are taking any supplements. Some supplements can interfere with how your medications work. For example, taking warfarin (Coumarin) with supplements such as ginkgo biloba and vitamin E can increase your risk of internal bleeding or stroke.
When should I use caution when taking supplements?
Some vitamins and minerals require extra caution when taken by those with certain conditions. For example:
- High doses of beta-carotene and vitamin A can increase your risk of lung cancer if you smoke.
- Vitamin A in retinol form increases the risk of birth defects in pregnancy.
- [Calcium](https://www.rxless.com/savings/calcium-acetate and vitamin D should be avoided in cases of hypercalcemia due to the increased risk of kidney stones.
- Retinol, magnesium, and potassium should be avoided by patients with renal impairment.
- Fish oil supplements should be avoided by patients with type 2 diabetes.
What should I be aware of before taking supplements and vitamins?
Before taking vitamins and supplements, you should do the following:
- Always check with your healthcare provider to confirm you need it and how much to take.
- Never exceed the recommended daily value unless your doctor prescribes it.
- Buy brands with USP, NSF, or another third-party “seal of approval.”
When your doctor provides you with a prescription for the vitamins and supplements you need, use an rxless discount coupon to save up to 88% off the retail price. Follow this guide on how to use your prescription coupon at pharmacies nationwide including CVS, Rite Aid, and Walgreens.

domain: health


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Luxury streetwear label Stussy recently collaborated with highly acclaimed American artist Lucien Smith on a three-piece apparel capsule featuring clothing designs crafted with the painter's popular Tigris motifs.
The freshly crafted Lucien Smith x Stussy clothing pieces were officially launched on September 16 and 17, in North America and Japan, respectively. These designs range in price from $160 to $280, according to the streetwear label's official website. Readers who are interested in buying these can choose from a variety of sizes.
Lucien Smith x Stussy collaborated for apparel pieces as a part of brand’s Fall 2022 collection
Stussy is a California-based company that has wowed footwear fans with its numerous collaborations with Converse and Nike. It recently released a collaborative collection with Denim Tears and Our Legacy, and is now gaining traction with the introduction of a collaboration apparel line with Lucien Smith.
For this project, Stussy has chosen to highlight the LA artist's work from his "Tigris" paint exhibition in NYC in 2014. The works, which were inspired by Hokusai's The Great Wave off Kanagawa, employ abstractions to evoke impressions of nature.
Items offered under Lucien Smith’s artwork laden range
A distinctive camouflage pattern from the exhibition is used in the motley of silhouettes. The offerings include a Tigris Bomber jacket, crewneck sweater, and straight-fit pants.
1) The Tigris Canvas Bomber jacket
The Tigris Canvas Bomber jacket will cost you $280. The popular tigris artwork by the artist accents the outerwear in purple and orange tones. The rib collar, cuffs, and hem are highlighted with black elements and have YKK metal zip closures on the chest.
These jackets are made with functionality in mind, as they have slanted welt pockets and MA-1 sleeve pockets. The satin quilt lining provides insulation and includes an interior welt snap pocket. Finally, a large Stussy flag label at the side seam completes the outerwear, which is available in sizes XS to XXL.
2) The Tigris Print Sweater
The Tigris Print Sweater costs $170 per piece. This pullover is made of a nylon, spandex, mohair, wool, and acrylic blend. The sweater is decorated with Lucien's artwork and has heavy rib collars, hems, and cuffs. It is available in sizes ranging from S to XXL.
3) The Tigris Canvas Big Ol’ Jean
The Tigris Canvas Big Ol' Jean is richly decorated with the artist's original artwork. The fashion label's swirly 'S' logo appears on the coin pocket of this five pocket style. These comfortable pants feature nickel shank buttons and rivets.
Finally, a suede logo patch on the back of the waistband completes the look. These denims cost $160 and are available in sizes ranging from 28 to 38.
More about Lucien Smith
Lucien Smith is a well-known contemporary American artist known for his process-based abstract art, in which he uses improvised and spontaneous strokes to create flowing all-over compositions. His Rain Paintings series, which he created with paint-filled fire extinguishers, is regarded as the best example of the early 2010s Zombie Formalism trend.


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Compte rendu publié dans Acta Fabula (Décembre 2020, vol. 21, n° 11) : "Déchiffrer les corps, inscrire l’identité : les signes cutanés à l’époque moderne" par Jeanne Barnicaud
Signing the Body: Marks on Skin in Early Modern France,
EAN13 : 9780754657729.
Date de parution : 4 décembre 2019
Nb. de pages : 318 p.
The first major scholarly investigation into the rich history of the marked body in the early modern period, this interdisciplinary study examines multiple forms, uses, and meanings of corporeal inscription and impression in France and the French Atlantic from the late sixteenth through early eighteenth centuries. Placing into dialogue a broad range of textual and visual sources drawn from areas as diverse as demonology, jurisprudence, mysticism, medicine, pilgrimage, commerce, travel, and colonial conquest that have formerly been examined largely in isolation, Katherine Dauge-Roth demonstrates that emerging theories and practices of signing the body must be understood in relationship to each other and to the development of other material marking practices that rose to prominence in the early modern period.
While each chapter brings to light the particular histories and meanings of a distinct set of cutaneous marks—devil’s marks on witches, demon’s marks upon the possessed, devotional wounds, Amerindian and Holy Land pilgrim tattoos, and criminal brands—each also reveals connections between these various types of stigmata, links that were obvious to the early modern thinkers who theorized and deployed them. Moreover, the five chapters bring to the fore ways in which corporeal marking of all kinds interacted dynamically with practices of writing on, imprinting, and engraving paper, parchment, fabric, and metal that flourished in the period, together signaling important changes taking place in early modern society.
Examining the marked body as a material object replete with varied meanings and uses, Signing the Body: Marks on Skin in Early Modern France shows how the skin itself became the register of the profound cultural and social transformations that characterized this era.
Introduction: The Impressionable Body
1 Seals of Satan: Demonologists and the Devil’s Mark
2 Demonic Marks, Divine Stigmata: The Female Body Inscribed
3 The Amerindian Tattoo: Signs of Identity in New France
4 Jerusalem Arms: The European Pilgrim Tattoo
5 Stigma and State Control: Branding the Deviant Body
Conclusion: Lasting Impressions
Available through Routledge https://bit.ly/37NqUT9 and through other major booksellers.


The backup wizard in Partition Assistant, before using PA, there’s an article about the definition of Backup
In information technology, a backup, or the process of backing up, refers to the copying and archiving of computer data so it may be used to restore the original after a data loss event. The verb form is to back up in two words, whereas the noun is backup.
Backups have two distinct purposes. The primary purpose is to recover data after its loss, be it by data deletion or corruption. Data loss can be a common experience of computer users. The secondary purpose of backups is to recover data from an earlier time, according to a user-defined data retention policy, typically configured within a backup application for how long copies of data are required. Though backups popularly represent a simple form of disaster recovery, and should be part of a disaster recovery plan, by themselves, backups should not alone be considered disaster recovery. One reason for this is that not all backup systems or backup applications are able to reconstitute a computer system or other complex configurations such as a computer cluster, active directory servers, or a database server, by restoring only data from a backup.
Since a backup system contains at least one copy of all data worth saving, the data storage requirements can be significant. Organizing this storage space and managing the backup process can be complicated undertaking. A data repository model can be used to provide structure to the storage. Nowadays, there are many different types of data storage devices that are useful for making backups. There are also many different ways in which these devices can be arranged to provide geographic redundancy, data security, and portability.
Before data is sent to its storage location, it is selected, extracted, and manipulated. Many different techniques have been developed to optimize the backup procedure. These include optimizations for dealing with open files and live data sources as well as compression, encryption, and de-duplication, among others. Every backup scheme should include dry runs that validate the reliability of the data being backed up. It is important to recognize the limitations and human factors involved in any backup scheme.


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The Lyme disease spirochete controls production of its OspC and Erp outer surface proteins, repressing protein synthesis during colonization of vector ticks but increasing expression when those ticks feed on vertebrate hosts. Early studies found that the synthesis of OspC and Erps can be stimulated in culture by shifting the temperature from 23°C to34°C, leading to a hypothesis that Borrelia burgdorferi senses environmental temperature to determine its location in the tick-mammal infectious cycle. However, borreliae cultured at 34°C divide several times faster than do those cultured at 23°C. We developed methods that disassociate bacterial growth rate and temperature, allowing a separate evaluation of each factor's impacts on B. burgdorferi gene and protein expression. Altogether, the data support a new paradigm that B. burgdorferi actually responds to changes in its own replication rate, not temperature per se, as the impetus to increase the expression of the OspC and Erp infection-associated proteins.
|Number of pages||8|
|Journal||Journal of Bacteriology|
|State||Published - Feb 2013|
ASJC Scopus subject areas
- Molecular Biology


Taking antibiotics unnecessarily for viral illnesses might improve the chance of micro organism creating resistance. Later, you would get or spread an infection that these antibiotics can not cure. In some instances, they gave themselves or native elected politicians the authority to stop the unfold of infectious disease. Wayne Fawbush – stated a few of right now’s politicians might come to remorse these legal guidelines. Losing the power to order quarantines has left Karen Sullivan, health officer for Montana’s Butte-Silver Bow division, terrified about what’s to return – not solely in the course of the covid pandemic but for future measles and whooping cough outbreaks. They recognized 88 Covid instances amongst those that acquired the two shots more recently, in contrast with 162 cases among these vaccinated final year. Another county in Indiana has already seen its health division’s mask mandate overridden by the local commissioners, Welsh said. A minimum of nine states have new legal guidelines banning or limiting mask mandates.
In a minimum of 16 states, legislators have restricted the ability of public health officials to order mask mandates, or quarantines or isolation. In three additional states, an govt order, ballot initiative or state Supreme Court ruling restricted long-held public health powers. A KHN assessment of a whole bunch of items of laws discovered that, in all 50 states, legislators have proposed bills to curb such public health powers for the reason that covid-19 pandemic began. When North Dakota’s legislative session began in January, an extended slate of bills sought to rein in public health powers, together with one with language much like ALEC’s. Then, abruptly, the supply of vaccine doses started outstripping demand. April eleven – that day, 3.48 million doses were administered within the nation. If schools are closed, they should accept that they’ve failed their youngsters and the youngsters of the country and are preventing them from being educated. We need to elevate all lockdown restrictions as soon as potential to place the nation on a path to greater employment and economic recovery, which will only be attainable by means of widespread vaccination.
Gray says it pains her to see this happening in her native West Virginia, which she’s at all times thought of as a tight-knit place where folks cared about one another. We’re heading with warp pace in the direction of a spot the place these who are throwing their right of alternative on the desk, will see those same rights severely impacted and even taken away by social unrest, weakening economies, death and destruction. Choice comes with responsibility and consequences. It comes after Minaj says her cousin’s friend is keen to be interviewed “for the best value” – days after she made the baseless claim about his testicles. That blowback comes as no surprise to health workers. 28 to contemplate whether the pause for health care employees needs to be prolonged. In his three interventions made through the meeting, Mr Ong spoke about Singapore’s COVID-19 expertise as a city-state, emphasising the significance of strengthening health emergency preparedness in an city setting.
Weishaar, chief medical officer at Frederick Health hospital. In close by Frederick, Md., Kathy Weishaar stated the intensive-care unit was filling up final week at her hospital. A Trump advisor advised The Solar this week that he believes Minaj’s anti-vax tweet could be treated in another way if it got here from a MAGA supporter. In a brick constructing off a semi-rural highway in West Virginia, Terrence Reidy says he was distributing 3,000 vaccine doses per week in March. The man berated her and levelled what passes for an insult in a lot of West Virginia, the place Republicans dominate state politics: She have to be a liberal. Now, West Virginia has the bottom proportion of vaccinated adults in the U.S. With vaccination rates lagging across the country, U.S. Vaccination rates tapered off across the U.S. The analysis released on Wednesday, nonetheless, confirmed a chink within the Moderna shot’s armour over time, with larger charges of infection among folks vaccinated roughly 13 months ago compared with these vaccinated roughly eight months in the past. The final 18 months have forced the system. Yes, it’s now 18 months since the primary lockdown, and we are still in uncharted and, perhaps, much more stormy waters. In the brand new evaluation, Moderna compared the vaccine’s efficiency in greater than 14,000 volunteers vaccinated between July and October of 2020 to some 11,000 volunteers initially in the placebo group who had been offered the shot between December 2020 and March 2022 following its US emergency use authorization.


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Home Tags J-Scrilla
That's a really inviting album cover. But at least it is to present a good message. DOWNLOAD: MarQ Spekt – Cut It Out (prod. J-Scrilla)
Back from his release with Cunninlynguist, Kno, here's the first single off his upcoming solo project entitled, Persona No Gratta. Do it to the death,ss...
DOWNLOAD: Sketch – The Connect f. K-Beta, Uptown XO & Nickelus F (prod. J-Scrilla)
DOWNLOAD: J-Scrilla - Capital Punishment


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Study session 14 in the Level III CFA Program curriculum begins the readings on Risk Management with two readings (34-35). The Level 3 exam puts a lot of emphasis on the topic area and it is extremely testable. There is typically a question in the morning essay section, in fact last year was the first time since 2007 that there was no risk management essay. REVIEW THOSE PAST ESSAY QUESTIONS.
The reading starts of with some basic concepts and is important but secondary to the later material. Understand the advantages and disadvantages of both a centralized risk management system versus a decentralized system. A centralized system is led by a senior management employee within its own department and benefits from economies of scale and can provide an integrated picture of the company’s risks. In a decentralized system, each department handles their own risks and allows people closer to the actual risk to directly manage it.
Understand the different categories of risk: financial, non-financial, and sovereign and the risks within each category:
Financial risks: market, credit, and liquidity
Non-financial risks: operational, model, regulatory and settlement
The measures of market risk are the more important material. You must understand standard deviation and value at risk, and the three methods of calculating value at risk.
Analytical– VAR = E® – z value (StDev)
Remember, you may need to adjust the standard deviation and expected return depending on the data provided and the question. Daily StDev =Annual StDev/(square root of 250)
Historical Method– uses actual historical returns ranking in decending order and picks out corresponding return for the % probability. For example, if there are 100 observations and we want a 5% probability, then we would select the fifth worst return (or the average of the two closest).
Monte Carlo Simulation – generates random outcomes according to assumed probability distribution and a set of parameters to estimate the VAR.
Understand the extensions/supplements to VAR like stress testing and scenario analysis, as well as the performance measures like the Sharpe and Sortino ratios.
Currency Risk Management
The reading can get pretty detailed and quantitatively intense but you need to be able to work through all the hedging exercises. Pay attention to whether the question asks for the return in the local or domestic currency and whether the expected future value is hedged or only the principal.
Understand the differences between hedging with futures and using options. Futures are less expensive and appropriate when the investor risks volatility in rates but has a clear view of the direction of change. Options may be more expensive but provide more precision and are appropriate when exposures are uncertain with respect to timing and magnitude of exchange rate changes.
Understand the concepts behind strategic and tactical currency risk management. The three types of approaches are strategic management with a balanced mandate, currency overlay (tactical management), and treating the currency as a separate asset class.
Study session 15 in the Level III CFA Program curriculum concludes the readings on risk management with three readings on applications of derivatives.
‘til next time, happy studyin’
Joseph Hogue, CFA

domain: finance


The Centers for Disease Control and Prevention (CDC) is the nation’s health protection agency, working 24/7 to protect America from health and safety threats, both foreign and domestic to increase the health security of our nation. Visit their website for the latest information about COVID-19 and other health and safety threats.
Come paint with your child. You & Me St. Patrick's Day Painting March 2nd! This is a youth program, and you must bring a minor child to attend. https://mljlibrary.org/you-me-painting
Please visit https://mljlibrary.org/person-paint-classes for Adult painting.


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This piece can be a way of wishing good luck to someone who is following a new path in life, is recovering from an illness or someone who is always looking to be a better person.
In case of stock out of Willow Tree we accept orders by email.
Warning: Last items in stock!
Willow Tree is an intimate line of figurative sculptures that represent feelings of love, closeness, healing, courage, hope...all the emotions we encounter in life. This iconic figure is a tangible reminder of those emotions. - Susan Lordi.
The item is made of resin and handpainted with lead-free paint. Supplied in a branded gift box and a gift tag with sentiment. It is not a toy or product for children. Intended for adults only.
PORTO DE MAGIA - Willow Tree - Ideal Gift - Raises the spirit - Collection - Family - Friends - Boyfriends.
|Dimensions cm - Height||13.5 cm|
|Dimensions cm - Width||4|
|Dimensions cm - Depth||7|
|Autoria||Willow Tree - Susan Lordi|
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CamelBak M.U.L.E. Hydration Pack Electric Blue
Out of stock
- The iconic M.U.L.E is the perfect balance of cargo and hydration in a feature-rich, narrow-gauge design
- Antidote reservoir features Quick Link system, easy open/close cap, lightweight fill port, Dryer arms, center baffling and low-profile design
- Key pack features: xv back panel, magnetic tube trap, bike tool organizer pocket, four-point compression, helmet hooks
- Designed to carry helmet, Multi-tool, pump, Spare tube, extra layer, lunch, phone, keys
- Camelbak Got your Bak guarantee: if we build it, we'll Bak it with our lifetime guarantee
- Three interior slip pockets. Three exterior pockets.
All of our Octane series packs are made from ultra-light materials so they're good for adventure racing, trail running or XC bike riding - anything where you need to move fast and minimize weight. The Octane XCT takes this approach to extremes by stripping the pack down to the basics. Inside you'll find our 3 liter Antidote Reservoir, which drops in behind the back panel. Outside we've added a single vertical zip storage pocket on the front and two stash pockets on the waist belt and harness so you can keep essentials close at hand. For safety we've added reflectivity front and back and a whistle on the harness.
Write Your Own Review

domain: sports


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It’s now week 8 of our EUKANUBA Ambassador feeding trial! Eddie still continues to thrive, loves his meals and eats all his kibble in one sitting!
One physical change that we’ve really noticed in the past couple of weeks is his coat becoming a lot shinier, this is something that I really wanted to see improve in Eddie! His coat now looks glossy - and we’ve even had a few compliments on how lovely his coat is!
Since starting the Eukanuba ambassador programme Eddie has turned into a local celebrity and he now bumps into his followers on walks and around town - we always make sure to give them his pawtograph as well as a sample of Eukanuba for their furry friends

domain: pet


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When James Gibbons (1834–1921), Bishop of Richmond, Virginia, and Administrator Apostolic of North Carolina, published The Faith of Our Fathers in December 1876, he stated the book’s purpose forthrightly in its sub-title: “Being a Plain Exposition and Vindication of the Church Founded by Our Lord Jesus Christ.” This relatively short book has been a much-read standard of Catholic apologetics from that time to this day. Yet its publication that year also made a notable contribution to a general shift in the broader history of the Bible in American culture. This article explores the nature of that change set within the context of broader American developments during the 1870s.
Gibbons would later become the ninth Archbishop of Baltimore (1877–1921) and in 1886 the second American to be named a cardinal of the Catholic Church. For the last decades of his life he was the most visible American Catholic and one of the most influential voices representing American interests to the Holy See. Attention to the circumstances surrounding the appearance of The Faith of Our Fathers suggests that he began to exert a broad influence early in his career. Besides his explicit religious intentions, Gibbons was also making three large and contentious claims about the place of Catholics in the United States: first, the Bible belonged to Catholics every bit as much as to Protestants; second, Catholicism should be regarded as the normative expression of Christian faith because, among other important reasons, God sanctioned its understanding and use of Scripture; and third, Catholicism should be regarded as a fully American religion.
An introduction to the book and its enduring popularity begins this study, but then it is necessary to consider at some length the surrounding contexts in which The Faith of Our Fathers appeared, before returning to examine its exposition. Such an examination of what the bishop wrote in the context of when he wrote it will explain the unusual significance of his effort for the history of the Bible in America. [End Page 77]
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The Bishop and His Book
The Faith of Our Fathers arose from Gibbons’ responsibilities as a young bishop in Wilmington, North Carolina, and then Richmond, Virginia. In the course of his duties in these overwhelmingly Protestant regions of the United States, he was often called upon to explain the character of Catholic Christianity. To indicate the dimensions of that challenging assignment, it is useful to remember that when Gibbons in 1868 began his service as the missionary vicar apostolic of North Carolina, the state had more congregations of both Methodists and Baptists than individual Catholics; Virginia enjoyed a larger Catholic population, but when in 1872 he was promoted to the residential see of Richmond, while still maintaining his North Carolina charge, that population represented at most two percent of Virginia’s total.1 For some years Gibbons had been recommending several books to [End Page 78] correspondents and interlocutors who asked for such introductions. These included John Milner’s The End of Religious Controversy in Friendly Correspondence Between a Religious Society of Protestants and a Catholic Divine, first published in England in 1819; The Catholic Christian Instructed in the Sacraments, Sacrifice, Ceremonies, and Observances of the Church which appeared in 1738 from Bishop Richard Challoner, the best known English Catholic of his generation who also revised the Douay-Rheims Bible translation; and a printed series of lectures by Gibbons’ own mentor, Archbishop Martin Spalding of Baltimore, entitled The Evidences of Catholicity.2 During these same years Gibbons’ own speaking before what he called “mixed audiences” had multiplied the opportunities where such resources were useful, “especially on the occasion of a mission in the rural districts” when such talks could be “supplemented by books or tracts circulated among the people, and which could be read and pondered at leisure.”3 The Faith of Our Fathers was the product of those occasions.
Before publication Gibbons asked a young man, John B. Tabb, whom he had shepherded into...


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The debut grown-up novel from Caitlin Moran, bestselling author of How To Be a Woman…
What do you do in your teenage years when you realise what your parents taught you wasn't enough? You must go out and find books and poetry and pop songs and bad heroes - and build yourself. It's 1990. Johanna Morrigan, 14, has shamed herself so badly on local TV that she decides that there's no point in being Johanna anymore and reinvents herself as Dolly Wilde - fast-talking, hard-drinking Gothic hero and full-time Lady Sex Adventurer! She will save her poverty stricken Bohemian family by becoming a writer - like Jo in Little Women, or the Brontes - but without the dying young bit. By 16, she's smoking cigarettes, getting drunk and working for a music paper.
She's writing pornographic letters to rock-stars, having all the kinds of sex with all the kinds of men, and eviscerating bands in reviews of 600 words or less. But what happens when Johanna realises she's built Dolly with a fatal flaw? Is a box full of records, a wall full of posters and a head full of paperbacks, enough to build a girl after all? Imagine The Bell Jar written by Rizzo from Grease, with a soundtrack by My Bloody Valentine and Happy Mondays. As beautiful as it is funny, How To Build a Girl is a brilliant coming-of-age novel in DMs and ripped tights, that captures perfectly the terror and joy of trying to discover exactly who it is you are going to be.
Read Caroline Baum's Review
I've been a fan of Moran's ever since I read her hilarious story in the British press about trying to learn Beyonce's All the Single Ladies dance routine. She is a one-of-a-kind talent, untamed by success, outspoken, mouthy, with a wild and brilliant voice on just about everything. And now she's tackled fiction. Despite an author's note at the front of the book it does seem that she is using her own life story as material: she is, like her heroine Johanna, a girl raised on a housing estate in Wolverhampton with ambitions to write about music and go to London. In the novel, Johanna leaves behind a sarcastically sharp-tongued mother and a hopeless father who is just a demo tape away from success and fails to recognise her brother is gay. She also has sex with a man with an overly large member and makes inept attempts at self-harm. It's a roller coaster ride of chaos, insecurity, longing and drugs in I'm-with-the- band land. This is rock 'n' roll meets Jeanette Winterson. Julie Burchill without the vitriol. Or as Moran herself puts it, The Bell Jar written by Adrian Mole. Raw, rude, irresistible and very funny.
About the Author
Caitlin Moran was brought up on a council estate in Wolverhampton where she was home-educated, wore a poncho and had boys throw stones at her whilst calling her 'a bummer'. She published a children's novel, The Chronicles of Narmo, at the age of 16, then became a columnist at The Times at the age of 18 which, yeah, looking back now is kind of weird. At one point she was Columnist, Interviewer and Critic of the Year - so in your face, 'bummer' boys. Her multi-award-winning bestseller How To Be a Woman was published in 25 countries, was a New York Times bestseller and won the British Book Awards Book of the Year. Her second book, Moranthology, was a Sunday Times bestseller. With her sister, she co-writes the Channel 4 sitcom Raised by Wolves.Caitlin lives on Twitter with her husband and two children, where she spends her time tweeting either about civil rights issues, or that picture of Bruce Springsteen when he was 25 and has his top off. She would like to be remembered as 'a very sexual humanitarian'.
"Brilliantly observed, thrillingly rude and laugh-out-loud funny" -- Helen Fielding "I have so much love for Caitlin Moran" -- Lena Dunham "Binge-read all of #HowToBuildAGirl in one sitting. Even missed supper. A first" -- Nigella Lawson "spirited coming of age novel romps from strength to strength.I'm a Moran fan" -- Lionel Shriver The Times "She writes with breathtaking brio.Moran shows her shining soul - which is even more remarkable than her wit - when she writes about being young, looking for love and the utter vileness of the class system ...almost every page has something on it which makes you smile, makes you sad or makes you think - often all three at once, in one sentence" -- Julie Burchill The Spectator
For Ages: 15+ years old
Number Of Pages: 352
Published: 1st July 2014
Dimensions (cm): 22.5 x 13.7 x 2.7
Weight (kg): 0.38


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The ESO Console Enhanced upgrade is launching soon. In todays article we are going to take a look at everything we know so far about the ESO Enhanced upgrade for PS5 and Xbox Series X. Read more
By Alcast at 11 Jun 2021 10:23
(2 items) Adds 129 Weapon Damage (3 items) Adds 1096 Maximum Stamina (4 items) Adds 657 Weapon Critical (5 items) When you deal damage with a weapon, you deal an additional 600 Flame damage. This effect can occur once every 2 seconds and scales off the higher of your Weapon or Spell Damage.

domain: game


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Earlier this week, the Forbes list of wealthiest American celebrities featured Oprah Winfrey and a young woman who’s on her way to becoming a self-made billionaire, Kylie Jenner. But in Forbes’ analysis of the year’s highest paid comedians, not one woman landed on their list, as Kathy Griffin was very quick to point out.
Griffin tweeted out an image of the Forbes list with the simple caption “No women.” It’s a frustrating lack of diversity, especially as Forbes notes that Amy Schumer, for one, cracked the $15 million threshold last year on the back of a tour and Netflix special.
Ellen DeGeneres also was not eligible for the list as she’s a talk show host, but it’s worth noting that she just made her return to stand-up comedy in the first time in over a decade with her recent Netflix special “Relatable.” If she was, she might easily give Jerry Seinfeld a run for his money, who topped the list by making $57.5 million.
Seinfeld has topped the list every year Forbes has run it since 2006, with the exception of 2016, when Kevin Hart edged out Seinfeld. And Hart, who recently stepped down from hosting the 2019 Oscars over backlash about old homophobic tweets and comments, boasted the biggest comedy tour of the year in 2018, his “Irresponsible” tour that sold over 1 million tickets and netted $30 million for Hart, according to Forbes.
Louis C.K. previously made the list in 2017, but is now absent as a result of his sexual misconduct scandal.
In order, the list is Seinfeld, Hart, Dave Chappelle, Chris Rock, Ricky Gervais, Gabriel Iglesias, Terry Fator, Jim Gaffigan, Jeff Dunham and Sebastian Maniscalco. See the full list via Forbes, and see Griffin’s tweet below:
No Women pic.twitter.com/njywQqFTXY
— Kathy Griffin (@kathygriffin) December 21, 2018

domain: news


Rocket Lab Selected to Launch NASA Tropics Mission
By Stephen Nakrosis
Rocket Lab USA Inc. said Wednesday it was chosen by the National
Aeronautics and Space Administration to launch several cubesats in
support of a new weather observation program.
The launches will support NASA's Time-Resolved Observations of
Precipitation Structure and Storm Intensity with a Constellation of
Smallsats, or Tropics, mission, Rocket Lab said. The constellation
of satellites will be used to target the formation and evolution of
tropical cyclones, including hurricanes, the company said.
Rocket Lab said two dedicated missions will launch on Electron
rockets from Virginia's Mid-Atlantic Regional Spaceport at NASA
Wallops Flight Facility. The launches are scheduled to take place
no earlier than May 1, the company said.
Write to Stephen Nakrosis at email@example.com
(END) Dow Jones Newswires
November 23, 2022 16:50 ET (21:50 GMT)
Copyright (c) 2022 Dow Jones & Company, Inc.


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Here's a healthy drink that's good for breakfast or snack! You can prepare this delicious Easy Berry Smoothie with fresh or frozen berries, so feel free to make it the whole year-round!
Don't know about you, but on weekday mornings, a smoothie and a cup of coffee is my go-to breakfast -- before rushing out of the door.
Oh! If you like your smoothie on the sweet side, add a bit more honey in this recipe. I prefer mine slightly tart. 🙂
- Berries - a mix of your favorite berries, fresh or frozen. If you're using frozen berries, you don't even need to thaw them. Just add them directly to your blender and mix.
- Honey - mildly-flavored honey would be excellent.
- Almond milk - you can use sweetened or unsweetened; that's up to you.
- Yogurt - I generally use plain yogurt, but if you already have a berry-flavored yogurt that you like, go ahead and use that.
Just be aware that any other flavors might not go well with the berries.
Start by rinsing and draining all the berries, if using fresh ones.
Add everything on a blender (photo 1).
Add yogurt, honey, and almond milk (photo 2).
Blend until you get a smooth consistency (photo 3).
Pour smoothie into mugs (photo 4).
Garnish your mixed berry smoothie with fresh mint leaves, if desired.
- You can use any combination of berries that you like. Just remember that you might need to adjust the amount of honey, depending on the tanginess or sweetness of the fruits.
- You can replace the almond milk with any other type of milk. I usually use hazelnut milk interchangeably with almond milk for this smoothie.
- You can store this berry smoothie in the refrigerator for no more than 24 hours -- and make sure you place it in a container (or mug) with a tight, sealed cover.
IF YOU WANT MORE REFRESHING BEVERAGE, TRY CUCUMBER MINT LEMONADE!
IF YOU ARE LOOKING FOR OTHER BREAKFAST IDEAS, THEN YOU MIGHT LIKE THESE POSTS:
OR IF YOU ARE LOOKING FOR MORE SUMMER TREATS, HEAD STRAIGHT TO MY SUMMER COLLECTION!
Mixed Berry Smoothie
- 1 cup blueberries
- 1 cup strawberries
- 1 cup raspberrries
- 1/2 cup blackberries
- 1 & 1/2 cups almond milk
- 3/4 cup plain yogurt
- 3 to 4 tbsp honey
- fresh mint leaves, optional
- Rinse all the berries and drain them, if using fresh ones.
- Place all berries in a blender pitcher.
- Add yogurt, honey, and almond milk.
- Blend until you no longer see chunks and bits of the berries.
- Pour into a tall glass or mug.
- Garnish with fresh mint leaves, if preferred.
- Feel free to use fresh or frozen berries, either kind will turn out well for this smoothie.
- You can mix the berries as you prefer but bear in mind that you might need to adjust the amount of honey depending on the sweetness of each type that you use.
- Hazelnut milk or even regular whole milk are excellent substitutes for almond milk.
- 24-hours is the maximum length of time that you keep your mixed berry smoothie in the refrigerator. Make sure you place it in a tight, sealed glass.

domain: food