text:
The Adjunctive Use of the Erbium, Chromium: Yttrium Scandium Gallium Garnet Laser in Closed Flap Periodontal Therapy. A Retrospective Cohort Study
Rana Al-Falaki*, ‡, Mark Cronshaw†, Steven Parker†
Identifiers and Pagination:Year: 2016
First Page: 298
Last Page: 307
Publisher ID: TODENTJ-10-298
Article History:Received Date: 20/12/2015
Revision Received Date: 03/05/2016
Acceptance Date: 09/05/2016
Electronic publication date: 13/06/2016
Collection year: 2016
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
The current periodontal literature has been inconsistent in finding an added advantage to using lasers in periodontal therapy. The aim of this study was to compare treatment outcomes following root surface instrumentation alone (NL group), or with adjunctive use of Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser (L group).
Material and Methods:
Patients diagnosed with generalized chronic periodontitis, having a minimum of 1 year follow up were selected by a blinded party for inclusion in a retrospective analysis from patients treated prior to and after integration of laser in a single clinic setting. Probing depths (PD) of all sites ≥5 mm and full mouth bleeding scores were analyzed. Further analysis was carried out on the treatment outcomes of only the molar teeth and of pockets >6mm.
53 patients were included (25 NL,28 L). There was no significant difference between baseline PDs (NL=6.19mm, L=6.27mm, range 5-11mm). The mean PD after one year was 2.83mm (NL) 2.45mm (L), with the mean PD reductions being 3.35mm (NL) and 3.82mm (L) (p<0.002). The mean PD reduction for the molars were 3.32mm (NL) and 3.86mm (L) (p< 0.007), and for ≥7mm group were 4.75mm (NL) compared to 5.14mm (L) (p< 0.009). There was significantly less bleeding on probing in the laser group after one year (p<0.001)
Both treatment modalities were effective in treating chronic periodontitis, but the added use of laser may have advantages, particularly in molar tooth sites and deeper pockets. Further research with RCTs is needed to test this hypothesis further.
Chronic periodontal disease results from inflammation of the supporting structures of the teeth in response to chronic infections caused by various periodontopathic bacteria . Bacterial biofilm plays a key role in the etiology of periodontitis . Specifically, the challenge of periodontopathogens and their virulence factors may induce the release of pro-inflammatory cytokines, which elicit an inflammatory response and drive alveolar bone loss . There is a variation in host susceptibility and chronic periodontitis which may be considered as a genetically determined, inflammation-induced dysregulation of bone metabolism.
Periodontitis is the leading cause of adult tooth loss worldwide . As an example, a recent nationwide survey found that periodontitis affects more than 50 % of Americans above the age of 30 years . Given its relatively high prevalence and the concerns at the potential systemic effects of living with a chronic infection, there is a recognition that technological advances and the development of new protocols may improve patient related outcomes and additionally address therapy cost effectiveness [6, 7].
The multiple species of periodontopathic bacteria present in periodontal disease co-exist and form symbiotic mutually supportive communities leading to pathogenesis . Once formed the biofilm provides a mechanism for microorganisms to survive extreme temperature changes, radiation or mechanical trauma. Due to the structure and composition of the biofilm, the bacteria become very much more resistant to topical and systemic chemotherapy and biofilm formation is a highly successful and important microbial survival strategy .
One of the most active areas of research in periodontal therapy in the recent years has been the therapeutic use of lasers. To date, however the consensus views in the multiple systematic reviews and meta-analyses published over the past decade are that there is insufficient evidence to show a significant improvement in efficacy when compared with conventional scaling and root planing (SRP) alone [10-24]. Current advice is centered on root surface debridement with the option of surgical access in non-responsive disease sites.
The study reported here is a retrospective analysis of patients treated within a specialist periodontal practice comparing treatment with and without the adjunctive usage of an erbium, chromium: yttrium scandium gallium garnet (Er,Cr:YSGG) laser (λ 2780nm) in the management of pocket depths in both single and multi rooted teeth in the range of 6-11mm pre-treatment, with up to one year follow up.
To compare treatment outcomes following root surface instrumentation alone (NL group), or with adjunctive use of Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser (L group).
MATERIALS AND METHOD
The study was carried out to evaluate periodontal treatment modalities within a specialized private clinic setting. Statistically-sound conclusions drawn from the study would provide prospective strategy for future treatment protocols.
Patients with a diagnosis of generalized moderate to advanced chronic periodontitis, who had been treated with up to a minimum of one year follow-up were eligible for inclusion in the study. The non laser group consisted of patients treated with SRP prior to adoption of the laser in the specialist clinic and the laser group from other patients treated with the adjunctive use of the laser to SRP. These patients were selected in consecutive order based on if they met the criteria and were selected by a third party, other than the operator. Exclusion criteria consisted of any patients who had taken antibiotics any time between 3 months prior to initial consultation and the follow-up of one year and systemic diseases affecting immune response, such as poorly controlled diabetics.
53 patients were included in the analysis (25 NL, 28 L). In the no-laser group, the age range was 38 to 72 (mean 55 years), while in the laser group the range was 40-72 (mean 55 years). There were 3 smokers in the no-laser group and 5 in the laser group. There were 1092 sites ≥ 5mm in the no-laser group vs. 994 sites ≥ 5mm in the laser treated group. The mean PD at baseline for NL was 6.19mm (range 5-10mm), and for L 6.27mm (range 5-11mm). No statistical significance was found between the groups in the baseline data.
Patients were treated over two visits, with treatment on half the mouth (right or left) on each visit. Local anesthetic was administered, followed by supra and sub-gingival root surface debridement using ultrasonic scalers (Cavitron inserts SLI, SL-R and SL-L, Dentsply). For those patients receiving laser adjunct therapy, ultrasonic scaling was first carried out, followed by the use of the Er,Cr:YSGG laser (Biolase, Irvine, California) in each pocket. A radial firing periodontal tip of 500um diameter and 14mm length (RFPT5) was used with settings of 1.5W, 50%: 40% water: air ratio, 30Hz, fast pulse mode (60µs, H mode). The laser tip was inserted to the depth of the pocket parallel to the root surface and then moved in an apico-coronal and bucco-lingual direction to allow the laser energy to contact the entire root surface. In the case of root furcations, an attempt was made to insert the tip into each furcation area as far as possible. The tip was then directed away from the root surface towards the pocket lining and moved in a similar fashion to remove diseased pocket epithelium and diseased connective tissue. 30 seconds were spent in a pocket of 5mm, and 10 seconds were added for each mm as shown in Table 1. The tip was then used outside the pocket to disrupt outer epithelium to a surrounding distance of 5mm from the pocket entrance. The disruption and superficial denaturation of the outer epithelium took approximately 10 seconds/tooth. This technique is essentially similar to the erbium yttrium aluminium garnet laser assisted periodontal therapy as described by Aoki et al. .
Time spent in each pocket being treated with laser, dependent on pocket depth.
|Pocket Depth (mm)||5||6||7||8||9||10||11|
|Time Spent in Pocket (s)||30||40||50||60||70||80||90|
Patients were reassessed after 2 months, measuring probing depths (using a UNC 14mm probe, PDT, USA) and bleeding index. This was repeated at 6 and 12 months as part of a periodontal maintenance protocol. The same operator carried out all assessments and treatments.
Probing depths (PD) of all sites ≥5mm and full mouth bleeding scores (BI) were analyzed for each group – laser (L) and non-laser (NL). Pocket depth reduction and number and percentage of residual sites ≥5mm were calculated at each stage (2, 6, 12 months). In addition, two further subsets of each group were analyzed, consisting of all sites ≥7mm and all molar teeth.
Statistical analysis was carried out on all the data using a variety of statistical tests (Independent Samples t-test, Paired t-test, and Chi-Squared) using SPSS software.
The mean PD at baseline for NL was 6.19mm (range 5-10mm), and for L 6.27mm (range 5-11mm). No statistical significance was found between the groups in the baseline data. The mean probing depths at one year were 2.83mm (no-laser) and 2.45mm (laser). The mean probing depth reductions for each group are shown in Fig. (1).
Mean probing depth reduction (mm) after one year for the whole group (initial PD ≥5mm), subset of molars (initial PD ≥5mm), and subset all teeth (initial PD ≥7mm).
There was no significant difference between the baseline bleeding scores, and both groups showed a significant reduction in bleeding index after 2 months (p<0.001), but the Laser group had a significantly less bleeding on probing after 1 year (p<0.001), as shown in Fig. (5).
Percentage of pockets remaining after 2 months, 6 months and one year for all laser and no-laser treated sites.
Percentage of sites ≥5mm remaining after one year in the whole group (1) and a sub-group of patients initial pockets ≥7mm (2). Percentage of sites ≥5mm remaining after one year laser or no-laser.
Percentage of sites ≥5mm remaining around molar teeth after 2 months, 6 months and one year, in laser and non-laser treated groups.
Bleeding Index (%)in each group after 2 months, 6 months and one year.
There was a consistent trend in the pattern of stability demonstrated in the whole group as well as the subsets. After two months, there was a significant reduction in probing depths, number of pockets ≥5mm, and also percentage bleeding on probing. However, longer term follow up demonstrated a greater tendency for relapse in the group not treated with laser at the outset (NL), which seemed to start after 6 months and this was seen in all parameters and sub-groups as shown in Table 2 and Figs. (1-5).
Number and percentage of pockets at baseline and after one year in laser and no-laser treated groups for the whole group (≥5mm) and subsets of molars and deep pockets ≥7mm.
|Whole group||Laser Group||No Laser Group|
|No. of sites ≥5mm at baseline||924||1092|
|No. of sites ≥5mm after 1 year||15||157|
|% of sites ≥5mm after 1 year||1.6||14.3|
|No. of sites ≥5mm at baseline||503||537|
|No. of sites ≥5mm after 1 year||14||119|
|% of sites ≥5mm after 1 year||2.8||22.1|
|No. of sites at baseline||334||347|
|No of sites ≥5mm after 1 year||11||75|
|% of sites ≥5mm after 1 year||3.3||21.5|
In the study presented here, there was a consistent trend in the pattern of response and stability demonstrated in the whole group, as well as the subsets. After two months there were significant reductions in probing depths, number of pockets ≥5mm and also percentage bleeding on probing in both groups of patients. The greater probing depth reduction seen in the laser-treated group (and all the subsets of molars and ≥7mm) of 0.4-0.5mm greater reduction was highly statistically significant, but one would perhaps question the clinical significance. However, longer term follow up demonstrates a greater tendency for relapse in the group not treated with laser at the outset, which seems to start after 6 months and this is seen in all parameters and sub-groups. These results are consistent with those reported by Kelbauskienne [25, 26] and Dyer & Sung .
There have been numerous studies reporting on the efficacy or otherwise of the application of the Erbium family of lasers (Er:YAG λ 2940nm & Er,Cr:YSGG λ 2780nm) in the management of chronic periodontitis. Some of these studies have looked at the use of the Erbium laser as an alternative to standard SRP and others have investigated combination therapies of SRP with the Erbium laser. There are conflicts and disagreements between the studies as there are some that report no clinical benefits compared to SRP alone, and on the other hand, there are studies that appear to show significant improvements in Erbium plus SRP treated patients. Kelbauskienne [25, 26], for instance, reports significant reductions of the indices measured of PPD & CAL plus significantly reduced bleeding on probing compared to groups treated with SRP alone at 12 months. The clinical approach adopted involved debridement of the pocket by ultrasonic and hand instrumentation along with removal of the inner epithelium and surface denaturation of the outer epithelium using laser. In addition, diseased connective tissue was removed and the root surfaces subject to modification by application of the Erbium laser (Er,Cr:YSGG). This treatment approach is essentially similar to that described by Aoki [22, 28] and is not a non-surgical approach and ought to be considered as minimally invasive flapless surgery. Dyer & Sung  described an excellent treatment outcome following minimally invasive surgery to treat persistent pockets using the Er,Cr:YSGG following SRP. Initial pocket depths of 7-9mm in the treatment group and CAL levels of 7.6mm +/- 0.6mm improved to an average of 3.7mm +/- 1.2mm & 3.6 +/- 1.2mm, respectively. This significant clinical improvement was found to be maintained for a period of at least two years post-treatment. Dederich  presented a case report showing apparent bone infill into an intra-osseous defect following a minimally invasive approach adopting the Er,Cr:YSGG as an adjunct to pocket debridement and root surface preparation.
Gutknecht et al.  reported a case series of 12 patients with initial pocket depths in the range 2-8mm in a split mouth type study design. Following repeat laser applications using a radial firing 500 micron tip and the Er,Cr:YSGG it was found that at six months there was only a very small difference in pocket depth reduction between quadrants treated adjunctively with the laser and those treated solely by scaling and root planing. There was however a highly significant reduction in the periodontal pathogen counts favoring the laser treated pockets at three and six months compared to the control quadrants. This study concluded that this may lead to better long-term healing and stability compared to SRP alone.
Lasers generically have many intrinsic interesting and useful properties. For instance, there is the potential for producing different results depending on dose . Laser tissue interaction can range in product from biochemical and biophysical promotion of healing and the selective suppression of the inflammatory cytokine cascade through to surgical ablation of diseased tissues and the photo-thermal destruction of pathogens [32-37]. There are major differences in laser target interaction and depth of tissue penetration between the various wavelengths of laser. However, all lasers have the potential to positively influence healing, repair and also the regeneration of tissues.
In vitro studies have demonstrated that the Er,Cr:YSGG laser can assist in calculus removal without thermal damage [38, 39]. Also, it can be useful in the removal of smear layer. This in turn may be beneficial in enabling cell attachment in the regeneration of new attachment [40-43].
The potential benefits to be gained by the application of an Erbium laser in root surface bio-modification has been the subject of a recent review by Lavu et al. . This interesting review states that the Erbium laser can be used safely for root surface modification, a proven anti-bacterial action, predictable calculus removal, and minimal root surface damage. Finally, that lased root surfaces appear to favor attachment of fibroblasts and blood components. The conclusion of this review is that Erbium lasers are a useful tool in the periodontists’ armamentarium. To date, however the superiority of Erbium lasers over conventional treatment has not yet been clearly demonstrated.
Issues related to the prognosis post SRP have been analyzed by Cobb  in a review on non-surgical pocket therapy. Only a few sites within a small percentage of patients (8-12%) do not respond to routine treatment. The majority of teeth (19-57%) lost over a 15 year period are those initially diagnosed with furcation lesions compared to just 5-10% of those without furcation involvement.
The acknowledged evidence based approach to the management of chronic periodontal disease is pocket debridement by means of scaling and root planing. In deeper pockets (≥7mm) the likelihood of a surgical approach is increased due to difficulties of access to deeper areas to ensure adequate debridement, particularly in multi rooted teeth .
In the present study it was found that 75/347 (21.5%) of sites treated with scaling alone with initial pockets ≥7mm had pockets ≥5mm at one year. By contrast in the laser group at 1 year only 11/334 (3.3%) of sites had pockets ≥5mm. Also, at one year bleeding indices were significantly lower in the laser group (2.5%) compared to the non-laser group (6%).
Gupta et al.  compared open flap reduction (OFD) to a minimally invasive approach using the Er,Cr:YSGG. Gupta et al. concluded that the two approaches resulted in similar gains in CAL. Of particular note was that there was a significant reduction in gingival recession in the laser group compared to the open flap debridement group at six months (0.6mm laser vs. 1.87mm OFD). The PPD differed in favor of open flap debridement by around 1mm at six months (4.47 ± 0.92 laser vs. 3.33 ± 0.62 OFD). In addition, there was a small but statistically significant outcome in relation to the reduction in gingival index at six months in favor of open flap debridement (0.52 laser vs. 0.95 OFD). Also, the reduction in the sulcular bleeding index at six months was again in favor of open flap debridement (0.53 laser vs. 0.85 OFD).
The parameters and clinical technique adopted by Gupta et al. are different in some regards to the approach described in this paper, which may have influenced the measured treatment outcome. Gupta et al. conclude that laser assisted pocket therapy offers a number of benefits including less mechanical trauma, less post-operative complications (swelling and pain), no need for antibiotics and analgesics post-operatively, a minimally invasive procedure with greater patient compliance and less time consuming with minimal bleeding. The clinical consequence in the study presented here of the consistently observed pocket reduction with apparent stability at 12 months and beyond has been to greatly reduce the need for open flap surgery. The less traumatic minimally invasive surgical approach is in accordance with the current trend within the non laser specialist periodontal community [48, 49].
In respect of the literature on lasers and PD therapy, there are conflicting opinions and confusion concerning the interpretation of treatment outcomes and their relevance to clinical practice. Also there are issues related to study design and the selection criteria for inclusion into meta-analyses and systematic reviews.
The challenge of treating chronic periodontitis is to balance local and systemic etiologies, rationalize the available therapy options and address the complex architecture that may present as infra-bony pocketing.
The outcome of the study presented here must be viewed with caution as the measured clinical parameters were not blinded and this is not a controlled case study but rather a retrospective analysis and audit of patient data within a single clinic setting. The results are however sustained at a year and in view of the positive outcome of this study and the current evidence base, there is value in continued efforts to further evolve current attempts to integrate Erbium laser therapies as an adjunct to more conventional scaling and root planing periodontal treatment.
Both treatment modalities were effective in treating chronic periodontitis, but the added use of laser may have advantages, particularly in deeper pockets and molar teeth. Further research with RCTs are needed to test this hypothesis further.
CONFLICT OF INTEREST
The authors confirm that this article content has no conflicts of interests.
Dr. Rana Al-Falaki receives lecturing fees and occasional discounted equipment from Biolase, Statistical analysis was carried out by Dr Swatee Patel; head of biomedical statistics; University of Greenwich, UK.


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Dear Mr. or Mrs. President,
Bullying occurs once in every 7 minutes and 1 in 3 students report being bullied. This is extremely scary. These statistics scream out that action needs to be taken on bullying in schools.
When a student reports being bullied in school, it should be dealt with right then and there. The answer should NEVER be,"Oh, we'll see what we can do." That just makes the student seem like their issue is getting thrown under a rug and is not actually being dealt with. The staff members in schools should be trained a lot better to deal with bullying, since it does happen so much. Teachers and guidance counselors should pay more attention to the world around them, and not just be focused on academics. In all reality, a student who is being bullied and tormented every day in school probably isn't as motivated to do well in school, let alone even show up. Then, there's a downward cycle of failing grades, and having to stay in school longer because of them. There should be state-wide and nationwide training for teachers in public schools. Bullying is getting out of control, and the students bullying others need some kind of consequence for their actions. Seeing bullies walk away like nothing occurred, while some victims contemplate taking their own lives is very bothersome to me. Suicide remains one of the top leading causes of death of children 14 and under. This statistic is another one that really bothers me. No child should have to suffer from suicidal thoughts.
Even though children get to go home at night, that doesn't always mean the torment stops. Cyber bullying is a very common type of bullying these days, due to the up rise of social media sites. Cyber bullying is harder for people/adults to take action to stop it from happening. In this case, I think that when cyber bullying is reported, there should be a specific protocol taken to deal with it; it would be up to parents, schools authority figures, and if necessary, police.
As president of the United States, you have the power to give funding to schools to have training for teachers and other authority figures. Bullying needs to stop, so let's start the process to stop it.

domain: sociology


text:
Presentation on theme: "INVESTOR RELATIONS BANCA CR FIRENZE GROUP March 2002 - U.S.A."— Presentation transcript:
INVESTOR RELATIONS BANCA CR FIRENZE GROUP March 2002 - U.S.A.
INVESTOR RELATIONS 2 REGIONAL PRESENCE & MARKET SHARE Strong regional presence (416 branches at 31.12.01) High market share Tuscany market share* by deposit 15.6% by loans 12.7% 900,000 customers Over 60,000 on-line customers Euro 24.8 bln total deposits Euro 11.2 bln customer loans Net NPL ratio 1.7% 2001E ROE 11% *As at Sept. 30, 2001
INVESTOR RELATIONS 3 C. R. FIRENZE Spa - Shareholders structure CR Firenze Foundation Market Others BNP Paribas Sanpaolo IMI No. of shares1,086,236,393 No. of floating shares 290,000,000 Shareholders agreement CR Firenze Foundation22% Sanpaolo IMI 15% BNP Paribas 7% 44%
INVESTOR RELATIONS 4 Network C. R. FIRENZE C. R. PISTOIA e PESCIA C. R. ORVIETO C. R. CIVITAVECCHIA C. R. MIRANDOLA 271 63 33 25 24 Total number of branches416 * As at 30 September 2001 Full range product portfolio Infogroup Data Centro Centro Telemarkenting Citylife Perseo Finance Pro. Du. Ser. CFT Finanziaria RETAIL BANKING PRODUCT COMPANIESSERVICE COMPANIES LIBERAMENTE NETWORK 6 FINDOMESTIC BANCA 96 Centro Leasing Centro Factoring Centrovita CR Firenze Gestion Intl. Eptaconsors Arval Italia CERIT
INVESTOR RELATIONS 5 CREATION of SHAREHOLDER VALUE B. Lombarda B. Pop. Bergamo BPCI B. Pop. Em. Romagna B. Pop. Milano MPS B. Pop. Verona Banca Carige C.R. Firenze B. Pop. Sondrio B. Pop. Lodi 2001E ROE 2001E Cost of Capital B. Pop. Novara Source : Prometeia Calcolo Oct.30, 2001 - C.R. Firenze ROE : Internal forecast Banca CR Firenze creates value : ROE 2001E : 11% Cost of Capital 2001E = 7% ROE = Cost of Capital
INVESTOR RELATIONS 6 STOCK TRADING AT DISCOUNT *BVS & ROE : Prometeia Calcolo - C.R. Firenze 2001E ROE : Internal forecast - Prices : 1 Aug. 01 / 31 Jan. 02 average Data average as axis origination C.R. Firenze B. Pop. Bergamo B. Pop. Verona MPS B. Lombarda B. Pop. Novara B. Pop. Milano BPCI B. Pop. Lodi Banca Carige B. Pop. Em. Romagna B. Pop. Sondrio 2001E ROE* P/BVS* High ROE Low P/BVS Low ROE High P/BVS High ROE High P/BVS Low ROE Low P/BVS UNDERVALUED
INVESTOR RELATIONS 7 RELATIVE SHARE PRICE PERFORMANCE * See back-up slides As at Feb.16, 2002 - Source : Datastream Since its IPO CR Firenze has been one of the best performers amongst the Italian Financial Institutions Banca CR Firenze Comparables Index* Italian Banking Index JASONDJFMAMJJASONDJF 50 60 70 80 90 100 110 120 20012002
INVESTOR RELATIONS 8 VALUE CREATION K = DPS/EPS DPS EPS Eur Public status strengthened the commitment to improve profitability (EPS) and increase the DPS ratio. Higher pay-out ratio (DPS grew more than EPS). Group
INVESTOR RELATIONS 9 ~ 12 CUSTOMER LOANS EFFICIENCY Steady growth coupled with improving quality Euro bn Customer loans Net NPL ratioCoverage ratio With mortgage lienWithout mortgage lien
INVESTOR RELATIONS 10 INTERNAL RATING SYSTEM Euro bln 5 – 4 – 3 rating2 – 1 - NPL rating 5 – 4 – 3 rating as % of total loans 5 – Excellent34.25% Loans by rating 4 – Good 20.05% 3 – Acceptable19.20 % 2 – Risky22.60% 1 – Critical 2.20% NP Loans 1.70% The Internal Rating System proved to be effective and reliable *CRF Group, Findomestic excluded
INVESTOR RELATIONS 11 COST / INCOME Strong commitment to reduce this level although Group consolidation makes this possible on a medium term basis only 9.5 C / I ratio, exceptionals excluded Personnel expenses Exceptionals Other expenses C / I ratio, recovered expenses excluded Cost / Income ratio
INVESTOR RELATIONS 12 CUSTOMER BASE Segmentation & specialized distribution Integrated Multichannel Bank with a personal approach reserved for customers with a high-net worth. ACTION PLAN Product s streamlining Centralized marketing Innovation One 2 One marketing Dedicated channels Innovation Packaging Multichanneling Offer development Advisory services Multichanneling CHANNELS & TOOLS Corporate Retail Affluent / Private Bkg. Small Business 81% 19% 83% 17% 89% 11%
INVESTOR RELATIONS 13 AUM - High quality proprietary funds & Multibranding Total AUM* > Euro 7 bn GP + GPF 34.% Mutual Fund 46.% Insurance Prod. 20% Portfolio Managers nr. 1,150 *FY 2001E GP + GPF (Discretional accs./Mutual Funds discretional accs.) MUTUAL FUNDS INSURANCE PRODUCTS 1 Manager / 1,250 customers 1 Manager / 200 customers 1 Manager / 65 customers Retail Affluent Small. Buss. Corporate.
INVESTOR RELATIONS 14 The proprietary mutual fund factory C.R. FIRENZE GESTION INTERNATIONALE S.A. Source : Assogestioni GIOTTO LUX FUND Since April 2001 Luxembourg based Umbrella Fund 35 sub-funds Euro mn Net inflows 2001 Progressive shift of funds to Giotto Lux:
INVESTOR RELATIONS 15 AUM NET INFLOWS Net inflows were on track at 30 June. Slightly below the target at 31 December. TARGET 2001 + 22 % NET INFLOWS + 20 % Euro mn 7,770 8,420 8,160 MKT VALUE + 16.6 % Increasing the Business Mix will be a solid starting point when the equity market recovers. Market deterioration keeps the total stock value under pressure
INVESTOR RELATIONS 16 Arval Service LeaseItalia - Vehicle leasing CentrovitaAssicurazioni - Insurance FindomesticBanca - Consumer credit Centro Factoring - Factoring Centro Leasing - Leasing Eptaconsors - Asset management STRATEGIC INVESTMENTS *Group as at Sept. 30, 2001 Shareholdings book value Shareholdings profit Return on main shareholdings Shareholdings at book value *...… and their return 198.5 38.8
INVESTOR RELATIONS 18 FINDOMESTIC BANCA - Shareholders structure C.R. Firenze Group Cetelem BNP Paribas Group Banco Sardegna Sept. 1984 - The beginning of the JV with Cetelem S.A. and Banco di Sardegna June 2001 - Shareholders agreement between C.R. Firenze and Cetelem S.A. in order to exercise joint control over the Company Sept. 2001 - B. di Sardegna resolved to accept the offer from C. R. Firenze and Cetelem.
INVESTOR RELATIONS A shareholding of CR Firenze Group 19 Widespread distribution High market penetration * Market share: by transactions 27.8% by volume 12.2% 2000 ROE : >18% 3,600,000 customer database 96 Customer Service Centers Over 65,000 affiliated stores 1,500 employees S & P rating : ST A2 LT A- Trentino Alto Adige Friuli V. Giulia Veneto Emilia Romagna Marche Umbria Abruzzo Molise Puglia Basilicata Calabria Sicilia Sardegna Campania Lazio Toscana Liguria Piemonte Valle dAosta Lombardia FINDOMESTIC Banca INVESTOR RELATIONS FINDOMESTIC Banca * As at Dec. 31, 2000
INVESTOR RELATIONS 20 FINDOMESTIC EURO ZONE Consolidation in the core area and investments in unserviced markets

domain: economics


text:
Former Rangers star Kal Naismith has paid tribute to his girlfriend after she died on Thursday aged just 22.
It's believed Ashley Dickson, from Glasgow, passed away following a long-term illness.
22-year-old midfielder Kal, who now plays for Accrington Stanley in League Two, posted on Twitter about his partner.
He wrote: "Ashley I miss you like crazy I would give anything in the world to be able to cuddle you. You'll always be mine and I'll always be yours."
Hundreds of tributes have been posted on social media as grieving friends and family learned of her death.
It's understood Ashley worked in Cruise in Glasgow.
Naismith has had previous loan spells at Cowdenbeath and Partick Thistle and also represented Scotland at under-16 and under-17 level.
Football fans last night took to Twitter to express their condolences to Ashley’s loved ones.
Davie Shanks tweeted: “My thoughts are with Kal Naismith and all the family at this sad time”
Ewan McQueen posted: “Awful news about former Rangers player Kal Naismith’s girlfriend passing away. Thoughts with him right now.
Adam Shaw tweeted: “horrible news to hear about Kal Naismith’s girlfriend. thoughts are with him and Ashley’s family!”
Jade wrote: “Feel so so sorry for Kal Naismith such tragic news about his girlfriend.”
And Gurdep posted: “My Thoughts & prayers are with Kal Naismith and the family of his girlfriend, RIP Ashley”
Naismith and fellow Rangers starlet Kyle Hutton hit the headlines in 2010 after a thug abducted and threatened to kill them.
Paul Hislen and his accomplice Ryan Moore bundled the two players into the back of Hutton's Audi A3 in Edinburgh city centre.
Moore then drove the footballers through the city before dumping them in the Niddrie area.

domain: celebrity


The problem of parking is very common these days, whether it is parking area of the mall , offices , railway or airport, the need for parking becomes a battle sometimes. Colleges and schools are no different especially during the early morning hours of school and the time when the school gets over, the problem of parking is at peak at these two times. The fleet of buses , vans, and other vehicles that shuttle in during these hours has given rise to the maximum traffic problem.
Problem of school traffic:
Traffic congestion in and around schools is an everyday occurrence. School traffic congestion is associated with the overcrowding of street, blocking off the street by buses and that overcrowd the street. The majority of traffic congestion problems related to school traffic congestion occur in middle and elementary schools. School traffic problem and parking problem is just one aspect of the issue however, there is various other problem that arises because of this traffic congestion, some of which include the following:
- Speeding is one of the common problems.
- Reckless driving
- Poor parking or overcrowding of the street
- Loud car stereos and volume from vehicles causing disturbance to the people living in the vicinity of school
- Overcrowding of street by school vehicles and other vehicles used by parents.
- Parents parking on foot ways and many others.
These are some of the common issues which create a problem for both the parents who come to pick and drop their children as well as for the commuters. A lot of problems has been reported by the people residing in the residential; area near the school, sound, and air pollution is some indirect impact of traffic congestion and overcrowding.
Well, many schools have introduced new methods of providing a parking space, an intelligent parking solution allowing only the vehicles with a permit to place their vehicles near schools.
What is the way out?
There are many way schools can employ to control the traffic congestion, here are a few methods that can help reduce the parking issue by parking management solution:
- Placing of clear no parking area signboard
- Spreading the awareness amongst the parents not to stop in the middle of the road.
- Installing of speed signs and radar speed sign which indicate both speed limit near school areas .
- Encourage car pooling
- Encouraging students to walk or bike to school
A major problem that traffic near the school is the over speeding vehicles. The school area is the most sensitive area when it comes traffic movement, there are children and parents walking down the school and many time the incidents of accidents come up; the school area should have a sign board indicating the speed limit of the vehicle or any of the traffic calming device . Radar speed sign have proven to be very useful in areas near school primarily because firstly they don’t occupy the space of the road, secondly they can be placed at roadside, thirdly they indicated the speed limit as well as the speed of the approaching vehicle, Also a digital sign board indicating the status of traffic or children moving can prove to be very helpful to control the traffic and problems arising because of the speeding vehicles.
Our Role: Houston System is a company establishing its prowess in manufacturing some of the most advanced traffic control devices. This system and devices are based on modern technology and work efficiently with minimum error. We highly recommend usage of one of the traffic devices near the school to avoid any problems. These devices no only help in traffic management but also streamline the traffic flow and reduce the major bottlenecks of traffic. You can email us or call us to know more about our products.


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Leica D-LUX 2 review
Has any one heard about Leica providing an update to the firmware for the D-Lux2 to handle HDSC feature?
Anyway, Casio Exilim has done it. Read in DPreview: Casio has released updated firmware for its Exilim EX-Z70 and EX-Z700 digital camera to support SDHC.
Danke schoen Leica.
|Child and seal by APenza|
from Kids world
|Calatrava in Reggio Emilia by NCV|
from Your City - Telelens in the City
|Aurora's, Science and the Milky Way by man4mopar|
from My Best Photo of the Week

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Meg Graham's earlier studies focused on Graphic Design and Illustration. She attended The Rhode Island School of Design for drawing and Graphic Design summer of 1979 and the foundations year at The School of Visual Arts 1979-1980. In the late '80's she began painting and her work shifted towards fine art. Her first exhibit was a one woman show in her loft in 1987 of her oil paintings. Meg has been involved with different art organizations and in steering committees though the years. Exhibiting her work with these organizations from 1991-2001. From 2007-2009 she explored working with film and animation. Playing with Photoshop and found images she did a series of videos titled; Art as Meditation. In 2009 she began an art journal to get back into her painting from doing film. This transformed into the Mixed Media work and now the paintings she does today.
Meg Graham’s paintings have been exhibited in solo and group shows in art galleries, art foundations, cultural centers and corporations in the eastern coast to coast in the United States.Meg is currently a member of The International Women Arstists Salon and Openings NY a artist collective. She lived and worked in Chelsea in New York City from 1985-2014. And now lives in Staten Island, NY.
Latest animations post: I'ts Like Flying

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Photo by Trip Burns
October 3, 2014
Southern Co. said Thursday that it will cost at least another $59 million to finish the power plant it's building in eastern Mississippi's Kemper County, pushing the total cost above $5.6 billion.
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On July 7, the Israeli Civil Administration – the arm of the Israeli army which administers the occupation of the West Bank – accompanied by military troops, demolished 27 residential shelters, animal structures and water tanks, and confiscated the community’s belongings.
According to reports, 11 households – comprising around 70 people, including 35 children – were displaced. Among the sequestered possessions were food, water and clothing, leaving the community without shelter and sustenance in the summer heat of the Jordan Valley.
The community appears to be at a high risk of forcible transfer, Lynk said. Prior to the demolition, the Israeli Civil Administration had proposed to transfer the community to a different location.
“This demolition is both unlawful and heartless,” said the human rights expert. “As the occupying power, Israel is strictly forbidden from destroying Palestinian property unless it is absolutely required by military necessity during active armed operations.
“The forcible transfer of the inhabitants of Humsa al-Bqai’a is also strictly prohibited as a grave breach and a potential war crime under the Fourth Geneva Convention.”
Israeli forces demolished 55 structures in Humsa al-Bqai’a in February 2021. Eleven of the structures demolished this week were provided to the community as an international humanitarian response following the February 2021 demolitions. Humsa had also been razed by the Israeli military in November 2020.
“Humsa al-Bqai’a is one of a number of Palestinian herding communities in the Jordan Valley,” said the expert. “These communities are extremely vulnerable, both because they have limited access to water, sanitation, education and electrical power, and because the Israeli military has seized large swaths of their traditional lands for military firing zones.
“In contrast, the illegal Israeli settlements in the Jordan Valley are left undisturbed by the military. This progressive seizure of Palestinian lands, together with the protection of the settlements, is a further consolidation of Israel’s de facto annexation of the West Bank.”
So far in 2021, the Israeli authorities have demolished, seized or forced people to demolish at least 421 Palestinian-owned structures, including 130 donor-funded, displacing 592 people, including some 320 children across the West Bank, the UN Office of the Coordinator for Humanitarian Affairs says.
“The discriminatory Israeli planning regime in the occupied Palestinian territory results in a coercive atmosphere, where property demolitions, or the threat of demolitions, drives Palestinians away from their homes, lands and livelihoods,” Lynk said.
“We again call on Israel to immediately halt its property demolitions in the occupied territory, to ensure that its actions are strictly compliant with its international humanitarian and human rights obligations and to provide protection for, rather than displacement of, the protected population.”
The Special Rapporteur implored the international community to take meaningful accountability measures to ensure that Israel complies with its legal obligations.
“Criticism without consequences has rarely reversed illegal Israeli conduct in the past,” he said. “Accountability has to rise to the top of the international community’s agenda. Only by imposing an escalating cost to Israel’s illegal occupation will there be the prospect that these injustices will end.”


|Numéro de publication||US6160240 A|
|Type de publication||Octroi|
|Numéro de demande||US 09/172,134|
|Date de publication||12 déc. 2000|
|Date de dépôt||14 oct. 1998|
|Date de priorité||14 oct. 1997|
|État de paiement des frais||Payé|
|Autre référence de publication||DE19745294A1, EP0909553A1, EP0909553B1|
|Numéro de publication||09172134, 172134, US 6160240 A, US 6160240A, US-A-6160240, US6160240 A, US6160240A|
|Inventeurs||Carslen Momma, Siefan Nolte, Ferdinand von Alvensleben, Armin Bolz|
|Cessionnaire d'origine||Biotronik Mess-und Therapiegerate GmbH & Co Ingenieurburo Berlin|
|Exporter la citation||BiBTeX, EndNote, RefMan|
|Citations de brevets (13), Référencé par (101), Classifications (28), Événements juridiques (4)|
|Liens externes: USPTO, Cession USPTO, Espacenet|
1. Field of the Invention
The invention relates to a method of producing microstructural medical implants by laser material processing and in particular by the laser cutting of bioresorbable vessel wall supports.
2. Background Art
As for the background of the invention, numerous implants are known in medical technology, which consist of medical technological materials such as metal alloys or polymers and are structured by cutting processes. Vessel wall supports for use in the human heart are to be mentioned by way of example; they are denoted as "stents" in technical language. So as to avoid unnecessary irritation of the implant contacting tissue, for instance the inside wall of a blood vessel of the heart in the case of an intravascular stent, the edges of the implant structure are to be as smooth and flash-free as possible.
The prior art teaches to manufacture microstructural medical implants by laser cutting processes that originate from conventional material processing technology. Fundamentally, the use of lasers permits the production of microstructures at a high precision and a high working speed.
As a rule, the conventional laser cutting processes mentioned make use of continuous-wave lasers or possibly tunable lasers of pulse lengths in an order of magnitude ranging from nanoseconds to milliseconds. Consequently, the time of action of the laser on the material at the respective spot of machining is so long that in addition to the job of material cutting, considerable heat build-up is produced in the microenvironment of the edge of cut. Minimal quantities of the material are melted, which rigidify irregularly after the time of action of the laser beam or in between the individual pulses of long duration. This causes disadvantageous flashing of the edges of cut.
The flashing mentioned above requires aftertreatment jobs for deflashing. A customary method therefor is electropolishing, which is however very complicated regularly and produces only minor improvements. Further, electropolishing cannot be used because of the low electrical conductivity of many materials, in particular polymers.
So as to avoid the mentioned drawbacks, use may be made of an alternative cutting method such as electrical discharge machining. This is accompanied with an increase in the time consumed for material working as well as a reduction of precision. Owing to the low electrical conductivity of polymers, the use of electrical discharge machining is not possible with these materials.
Finally attention is drawn to the fact that a process for laser material processing is known from WO 95/27586 A, using very short laser pulses in the range of femtoseconds. Various samples such as a gold assay, a sheet of glass and a sample of body tissue (cornea) are exposed to short laser pulses in the range of femtoseconds, microscopical holes and ablation spots being created thereby.
Proceeding from these problems, it is an object of the invention to specify a method of producing microstructural medical implants by laser material processing, by means of which to produce as flash-free as possible edges of cut without any complicated aftertreatment.
This object is attained by a method wherein the treatment by a tunable laser beam of a pulse length in the range of 10 to 10000 femtoseconds and an adjusted combination of the parameters of frequency of pulse repetition, pulse energy and of velocity of displacement of the workpiece relative to the laser beam is effected for gentle material treatment "without melting" to take place. The term "without melting" means that uncontrolled melting processes no longer occur in the material to be worked, any flashing of edges of machining and in particular of edges of cut being precluded. The parameters of frequency of pulse repetition and/or laser capacity and/or the velocity of displacement of the workpiece relative to the laser beam must be adapted and combined correspondingly. The preclusion of uncontrolled melting processes becomes generally feasible by the laser pulse length being reduced as far as to the range specified, which leads to a decrease in the need of laser pulse energy and reduces the heat build-up so strongly that undesirable and uncontrolled melting processes are suppressed. In the cutting of medical technological materials, this helps avoid the flashing of the edges of cut and any thermal or photochemical impairment of the workpiece material. The latter explanations are to be subsumed under the terms "gentle treatment of material".
As regards the background of the technique, according to the invention, of femtosecond lasering, it can be said in short that so far short pulse lengths of this type have been used to some extent only in data and information technology where high data transfer rates have been attained because of the short pulse lengths. However, this kind of application requires only low laser capacities.
Preferred embodiments of the method according to the invention as well as further features, details and advantages of the invention will become apparent from the ensuing description of an exemplary embodiment of the subject matter of the invention, taken in conjunction with the annexed drawings.
FIG. 1 is a developed view of the structure of a "stent"; and
FIG. 2 is a diagrammatic illustration of an apparatus for tunable laser cutting by ultra-short pulse lengths of the "stent" according to FIG. 1.
As seen in FIG. 1, a "stent" 1 which is known per se consists of a microstructural network of lengthwise ribs 2 and crosswise ribs 3 connecting the latter. The lengthwise ribs 2 branch into parallel strands 4 which are joined by twos at their ends by way of an arc 5. By their branching strands 4, the lengthwise ribs 2 continue to the left and to the right of FIG. 1 as far as to the end of the tubular "stent". In the direction of the crosswise ribs 3, the structure is bent cylindrically so that the crosswise ribs 3 ending at the top of FIG. 1 pass into the crosswise ribs 3 ending at the bottom. As regards the order of magnitude, the widths b of the ribs 2, 3 are in the range of submillimeters.
The "stent" seen in FIG. 1 is bioresorbable. It consists of the material of poly-hydroxybutyrate (PHB).
The apparatus seen in FIG. 2 serves to produce the "stent" 1 with its structure of lengthwise and crosswise ribs 2, 3 as well as strands 4 and arcs 5. A cylindrical PHB stent blank 6 is fixed on a manipulator 7 which provides for a displacement of the blank 6 relative to laser beam 9 which is stationary in its axis 8.
The laser beam 9 is produced by a tunable titanium sapphire laser 10, having a variable wavelength of 760 to 810 mm. The pulse energy is approximately 1 mJ, it may however be selected to be as low as 10 μJ or less. The pulse length is variable, amounting at least to 120 fs. The laser works at a frequency of pulse repetition in the range from 0.1 to 10 kHz at maximum. Corresponding completions of the commercially available titanium sapphire laser have allowed for the laser system to be further adapted to the method according to the invention. For instance a so-called half-wave plate is integrated for energy variation and a rapid mechanical shutter for computer controlled triggering of the laser.
As regards the path of the laser beam 9, FIG. 2 roughly outlines that the laser beam 9 is led through a diaphragm 11 and projected on the "stent" blank 6 by means of the lens 13 with a tilted mirror 12 being interconnected.
The mentioned manipulator 17 is lodged in a vacuum chamber 14. Laser processing takes place at a pressure of less than 10-4 mbar. Working under a processing gas or in the air is also possible.
The manipulator 7 possesses two axes relative to the workpiece 6, namely a linear axis 15 in the form of a correspondingly adjustable support 16. A turning gear 17 is disposed on the support, having the axis of rotation 18, relative to which the "stent" blank 6 is held concentrically in a chuck (not shown). By means of overlapped motion of the blank 6 along the linear axis 15 and by rotation about the axis of rotation 18 combined with simultaneous exposure of the blank to ultra-short high performance laser pulses, a "stent" of the structure seen in FIG. 1 can be cut from the blank 6 accurately and without flashing on the edges. In doing so, also thermal or photochemical impairment of the PHB material is avoided owing to the conditions of exposure, as a result of which the material properties such as resorbability and mechanical elasticity remain unchanged.
Attention is drawn to the fact that the laser beam, instead of being projected by the diaphragm 11, may also be focused on the workpiece. Another possibility resides in directing the laser beam on to the workpiece by means of a diffractive optic, which is frequently called a "hologram" in technical language. Furthermore, use can be made not only of a stationary axis 8 of the laser beam 9, but the laser beam 9--possibly by the overlapping of workpiece motion--can be passed over the workpiece by means of a laser scanner. The respective mode of working will depend on the structure to be attained an on the material of the workpiece.
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|WO2007041478A2 *||29 sept. 2006||12 avr. 2007||Boston Scientific Scimed, Inc.||Method of manufacturing a medical device from a workpiece using a pulsed beam of radiation or particles having an adjustable pulse frequency|
|WO2007041478A3 *||29 sept. 2006||28 juin 2007||Boston Scient Scimed Inc||Method of manufacturing a medical device from a workpiece using a pulsed beam of radiation or particles having an adjustable pulse frequency|
|WO2007062130A1 *||22 nov. 2006||31 mai 2007||J.P. Sercel Associates Inc.||System and method for laser machining of three-dimensional structures|
|WO2007114994A1 *||13 mars 2007||11 oct. 2007||Abbott Cardiovascular Systems Inc.||Pulsed synchronized laser cutting of stents|
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Owner name: BIOTRONIK MESS-UND THERAPIEGERATE GMBH & CO. INGEN
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:MOMMA, CARSTEN;NOLTE, STEFAN;VON ALVENSLEBEN, FERNINAND;AND OTHERS;REEL/FRAME:009571/0582;SIGNING DATES FROM 19981006 TO 19981012
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text:
Watch the new CBSN Originals documentary, "Zika: Children of the Outbreak," in the video player above.
Three years after Zika virus first made headlines, and the photos of babies born with disturbingly small heads instilled fear in expectant parents around the world, doctors have learned a great deal about the disease. But while some of Zika's mysteries have been solved, other questions linger.
Between 2015 and 2016, thousands of babies whose mothers were infected with Zika during pregnancy were born with severe birth defects and a range of disabilities. Recife, Brazil was ground zero. There, Zika spread explosively in densely populated neighborhoods whose poor living conditions were a perfect breeding ground for the mosquitoes that .
Then, as mysteriously as it arrived, the outbreak mostly subsided — from over 20,000 cases a week to just a few hundred.
Now, three years later, the children of the epidemic — they've been dubbed "Generation Zika"— are toddlers. Their families' lives have been turned upside down trying to secure the care and services these children need. Doctors struggle to provide treatment while at the same time keeping close watch on pregnant women for any sign of another outbreak.
"Every day that we talk to a mother planning a pregnancy, we can sense a concern. And this is a haunting menace," said Dr. Esper Kallas, an infectious disease specialist at the University of São Paulo.
Here's a look at what we know — and what we still don't fully understand — about Zika.
Where has Zika virus spread?
Zika emerged as a serious health concern in northeast Brazil in 2015. By 2016, 61 countries had experienced mosquito-borne Zika infections, according to the World Health Organization. Forty-seven of these countries had never seen the virus before. It spread through Latin America, the Caribbean, and as far north as South Florida and Texas.
Over 200 people contracted it in the United States, and even more Americans got infected while traveling abroad. The Centers for Disease Control and Prevention says there were no locally-transmitted cases in the U.S. in 2018 or so far in 2019.
Is it safe to travel?
Check the CDC's travel information page for up-to-date information about areas with a risk of Zika transmission. Health officials recommend pregnant women not travel to places where outbreaks are happening, and carefully consider whether travel is necessary to areas with possible risk.
"The large outbreak in the Americas is over, but Zika is and will continue to be a potential risk in many countries," the CDC says.
How does Zika spread?
Zika is primarily transmitted by Aedus aegypti mosquitoes. When one of these mosquitoes bites an infected person, it can pick up the virus and then spread it others when it bites them. The mosquitoes can bite four or five people in one blood meal, meaning it has the potential to spread the virus rapidly.
The insect thrives in warm climates and standing water. Recife's poorer communities were hit hardest by Zika because mosquitoes multiplied around homes without proper plumbing and moved freely through open windows with no screens.
Less commonly, Zika can be sexually transmitted by both men and women to their partners. Research is underway to better understand how long the virus stays in the semen and vaginal fluids of people who have Zika, and how long it can be passed to sex partners. It is known that Zika remains in semen longer than any other bodily fluids. The CDC recommends avoiding sex or using condoms for three months after possible Zika infection.
Even rarer, it's been documented that Zika can spread through blood transfusions, organ transplants, exposure in a laboratory setting, and from mother to baby during pregnancy, delivery, or breast-feeding.
What are the symptoms of Zika?
About four out of five people who are infected with Zika do not experience any symptoms at all and probably don't even know they have it. Ifdo arise, they normally occur within about 14 days of exposure, and may include:
- Mild fever
- Skin rash
- Muscle or joint pain
In rare cases, people may develop an immune system complication called Guillain-Barré syndrome, which can .
Most people fully recover from Zika. The greatest concern is for women infected early in pregnancy, because of the risks to the fetus.
What are the risks for pregnant women (or those who may want kids in the future)?
Even when a pregnant woman shows no symptoms of illness from the Zika virus, it can be passed to her fetus. Infection during pregnancy can lead to an array of health problems for the baby, including a serious birth defect called microcephaly (more on that below).
Not every pregnant woman with Zika will have a baby who's affected. Doctors aren't certain how likely that outcome is, but one study found that of 250 pregnant women in the U.S. with a confirmed Zika infection,had a baby with virus-related birth defects.
The CDC reports the risk of birth defects appears to be greatest if Zika infection occurs during the first trimester.
The CDC recommends women avoid pregnancy for two months after possible exposure to Zika or after traveling to areas where it's spreading; they should wait three months if their male partner was exposed. But based on available evidence, researchers believe that a Zika infection in a woman who is not pregnant would not pose risks for her future pregnancies. And once someone has been infected with Zika, he or she is likely protected from a future infection with the same virus.
What is microcephaly?
In simple terms,is a condition where a baby's head is much smaller than expected — less than the 3rd percentile, or smaller than 97 out of 100 people. The smaller the head and the earlier the brain was impacted during fetal development, the more serious the condition is.
Microcephaly can lead to seizures, developmental delay, intellectual disability, problems with movement and balance, feeding problems, hearing loss, and vision problems.
The Zika epidemic was the first time in history that a virus transmitted by a mosquito bite has been found to cause birth defects.
Though rare, microcephaly can also be caused by other viruses, alcohol, drugs or toxic chemicals during pregnancy, or if there's a disruption of the blood supply to the baby's brain during development.
What is congenital Zika syndrome?
Congenital Zika syndrome, or CZS, is the name that's been given to the pattern of birth defects found among children whose mothers were infected with Zika virus during pregnancy. These problems include microcephaly as well as issues affecting the baby's brain development, skull, eyes joints, and muscles.
Babies with CZS also experience challenges with sitting and standing on their own, feeding, and sleeping. Seizures and hearing and vision problems are also common.
Children born at the height of the Zika epidemic are now 3 years old and struggling with multiple health issues. Many, like Gleyse da Silva's daughter Gigi, still cannot walk or talk, and it's unclear if they ever will.
"There are still many uncertainties," da Silva said. "They don't have many answers. Even today there are a lot of questions."
Is there a treatment or cure for microcephaly or CZS?
There is no cure for microcephaly. Because symptoms range from mild to severe, a child's treatment options vary widely and depend on their individual case.
In Brazil, after the surge in cases, physical therapist Dr. Pepita Duran developed a personalized approach to treatment with exercises to help children improve motor function, a zero-gravity suit to improve posture, and aqua therapy to ease restricted muscles.
"In these three years, we have started to understand how each child is different," Duran told CBS News. "We find a unique approach for each child. The way we touch them, or engage them with a song or a cuddle, is different for each one."
But of the hundreds of children diagnosed in the state, she can only offer free services to nine patients at a time. Other families have to rely on overcrowded public hospitals where wait times for appointments can take hours.
Is there a vaccine for Zika virus?
There is currently no vaccine for Zika, though scientists around the world are working hard to develop one.
Is there a treatment for Zika virus?
There is no specific treatment for Zika. Doctors recommend getting plenty of rest, drinking fluids to prevent dehydration, and taking acetaminophen to reduce fever. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) should not be taken until dengue can be ruled out to reduce the risk of bleeding.
People who are infected with Zika should take steps to protect others, including wearing insect repellent and using condoms during sex.
Will there be another Zika outbreak?
After Zika flared up in Recife, Brazil three years ago, the number of cases in the region just as quickly plummeted back down to very low levels. Dr. Carlos Reinaldo believes there is a simple explanation.
"There was no immunity against Zika" back in 2015, said Reinaldo, who is an obstetrician. "And practically the entire population was contaminated." Because of this, it created a herd immunity, and the outbreak then dwindled.
But while fears may have subsided, there are still some new cases in the region, a sign that not everyone is immune. In other densely populated areas of Brazil, less than 5 percent of people were infected with Zika, leaving millions more people potentially vulnerable to the virus in the future.
Infectious disease specialist Dr. Esper Kallas says it's a matter of when, not if, Zika will spread to other areas of Brazil like São Paulo.
"One day this virus is going to knock on our door," he said. "And it's going be transmitted."
Kallas is one of the doctors currently working on a vaccine in an effort to be prepared.
"If this happens again, we're not going to have time," he said. "We need to get it ready. We need preparedness."
for more features.

domain: medical


text:
Vietnam’s shrimp exports are forecast to reach $3.7 billion this year, posting an year-on-year increase of 9.8 percent, according to Vietnam Association of Seafood Exporters and Producers.
The agro product trade value between Vietnam and China reached over $9.8 billion in the first nine months of 2020, said the Agro Processing and Market Development Authority .
Vietnam’s largest city received $4 billion remittances during the first nine months of the year, up two percent despite the severe impacts from the global public health crisis.
Exxon Mobil and Japan's biggest power generator, JERA, have agreed to build a power station and import facilities for LNG to fuel it in Haiphong, the companies said on Wednesday.
- Vietnam-China agro product trade hits over $9.8 billion in nine months 1
- Nine-month remittances to Ho Chi Minh City rises 2% to $4bln despite pandemic 2
- Exxon, Japan's JERA to build LNG-to-power project in Vietnam 3
- US Secretary of State Mike Pompeo to visit Vietnam this week 4
- Natural disasters cost Vietnam $11bln annually, World Bank says 5
- German firm hopes to build $1.5 bln offshore wind farm in central Vietnam 6
US Secretary of State Michael Richard Pompeo will pay an official visit to Vietnam from October 29-30 at the invitation of Vietnamese Deputy Prime Minister, Foreign Minister Pham Binh Minh.
Natural disasters cost Vietnam an estimated annual losses at around $11 billion in purchasing power parity terms, World Bank said in a recent report.
Binh Dinh Province has given approval to a German company to study the possibility of building the country’s second offshore wind power plant.
Vietnam’s e-commerce growth reached 32 percent last year and averaged about 30 percent annually since 2016, according to a report by the Vietnam e-Commerce Association.
The US Customs and Border Protection has confirmed that Mseafood, a unit of Vietnam’s shrimp producer Minh Phu export Indian-origin frozen shrimp to avoid anti-dumping duties.
The General Department of Taxation has asked streaming giant Netflix to furnish details about its revenues in Vietnam since its entry in 2016 to assess its taxes.
Prime Minister Nguyen Xuan Phuc has encouraged Samsung Electronics to build a semiconductor plant in Vietnam.
Gunma Bank, one of biggest banks in Japan plans to open a representative office in Ho Chi Minh City, as part of its strategy to enter the Southeast Asian market, Nikkei reported.
As of 4:00 pm on Monday, floods caused by heavy rains claimed 102 lives and 26 others were missing in central localities, official data showed.
Japanese Prime Minister Yoshihide Suga and his Vietnamese counterpart, Nguyen Xuan Phuc, have agreed to resume regular flights between two countries.
Death toll from the recent severe flooding in the central region reached 84 while 38 others were missing as of 6pm of October 18.
Samsung's Vice Chairman Jay Y. Lee will visit Vietnam this week, where he is expected to meet Prime Minister Nguyen Xuan Phuc to seek support to expand in the country, Yonhap reported.


text:
This volume serves up all the dreadful details of horrible history you'll ever need to know.
Bezahlung bei Abholung
This is a Horrible Book of Foul Facts
Fantastic Beasts and Where to Find Them. The Original Screenplay
Joanne K. Rowling

domain: literature


text:
Pictured are All Ireland Scholarships 2015 recipients, Aine Collier, Gorey Co. Wexford, Anna Kern, Limerick City, Eoin Corcoran, Co. Longford and Owen McKeown, Belfast Co. Antrim with Champion Jockey AP McCoy and JP McManus. Picture: Alan Place/Fusionshooters.
Champion Jockey AP McCoy commended winners of the All Ireland Scholarships 2015 at an awards ceremony on Saturday, November 21, at the University of Limerick. Minister for Education & Skills, Jan O’Sullivan TD and the Minister for Employment and Learning, Northern Ireland, Dr Stephen Farry presented the students from the North and South with a third-level scholarship award.
Sponsored by JP McManus, the All Ireland Scholarships 2015 is an educational scheme set to provide financial assistance to many high achieving students who completed their Leaving Certificate/A Level examinations in 2015. Among the winning students was 19 year old Limerick asylum seeker, Anna Kerns who is studying in Physiotherapy at the Royal College of Surgeons.
Congratulating this year’s recipients, Special Guest at the All Ireland Scholarships 2015 awards, AP McCoy said; “It’s a great honour to be here today with all these students who have worked so hard in making their dreams come true. Each and every one of you should be incredibly proud of your achievements and are proof that if you are willing to be dedicated to something and apply yourself, great things can happen. I wish you all continued success in your lives.”
Welcoming guests at the All Ireland Scholarships 2015 awards ceremony, JP McManus said; “It is wonderful to be joined by so many parents, principals, friends and other invited guests from all over Ireland as we celebrate the success of these young men and women, who today are being recognised for their outstanding academic achievements.”
He added: “To our special guest and great friend AP McCoy, we are honoured to have you present at the awards event. In you illustrious career you have shown the value of hard work, determination and bravery matched by undoubted ability. Your qualities certainly stand out as an example to others of how to succeed in life and also how to carry one’s success lightly.”
The scholarships have been set at €6,750 per annum in Ireland and stg£5,500 in Northern Ireland and will continue for the duration of the undergraduate programme chosen by the scholarship winners.
JP McManus has contributed a total of €32 million in support of third-level educational initiatives in recognition of the 32 counties of Ireland. The All Ireland Scholarship Trust has received €30 million to fund the provision of these bursaries each year and it is estimated that over 1,200 students throughout the country will benefit from the scheme over its duration. The remaining €2 million has been contributed to the Paddy Harrington Golf Scholarships at NUI Maynooth. The scholarships scheme is administered by the Department of Education & Skills, the Department for Employment & Learning with support from the Department of Education, Northern Ireland.
Visit the All Ireland Scholarship website here
Read more about the All Ireland Scholarships here


text:
Great short romance
I received a free copy of this book from the author and voluntarily chose to review. This was a great short romance story between two amazing characters. I cried a lot while reading this book, but it was worth it. I can’t wait for the next book in the series.


Lincoln University Students Practice Debate Skills at Public Forum
- Posted in All University
- Category: Campus News
LINCOLN UNIVERSITY, Pa. – On a Wednesday night after most classes ended for the day, students, faculty, and staff came together to witness students debate students in a moderated forum outside the Thurgood Marshall Living Learning Center.
Realizing the importance of having an open outlet for students to discuss pertinent public policy topics that affect their everyday lives, residence hall coordinator Curtis Reed reached out to various on campus student organizations to organize a public debate on two topics: gun control and the legalization of marijuana.
“In light of what’s happening in the country, I wanted to give students the opportunity to discuss their ideas in a structured and constructive environment,” said Reed.
Before the October 25 debate, participants such as members of the Thurgood Marshall Law Society were instructed to conduct research to support their stance on the issues so that they would be ready to discuss the intricacies of the topics in front of the approximately 80 attendees. Many of the attendees said afterward that the public debate concept was well received.
“I believe these debates allowed students to enhance their knowledge on subjects that affect their everyday lives,” said Burnell Barnes, a law society student who participated in the debate.
The debates were structured in a mildly modified form of the Lincoln-Douglas style where each debate lasted 30 minutes with 10 minutes allotted for questioning.
“It was well organized, and the turnout exceeded everyone’s expectations,” said Jordyn Adams, vice president of the Thurgood Marshall Law Society, “Students were able to get their ideas across in a productive and cooperative environment.”
Debate organizer Curtis Reed said he hopes to use the Thurgood Marshall Living Learning Center for more academic venues in the future.
Article by Devin Bonner, Office of Communications and Public Relations.


text:
Dow plunges nearly 300 points on concern about Lehman Brothers
The Dow Jones industrial average ended the day with a loss of nearly 300 points on fresh concerns about the stability of Lehman Brothers. Investors worry that Lehman is having trouble finding new sources of capital.
Shares of most local companies, including Entergy Corp., IberiaBank Corp., Pool Corp. and Whitney Holding Corp., ended the day lower.
The Dow ended the day at 11,230.73, down 280.01. The pullback comes a day after the Dow's biggest single-session rally in a month.


text:
The synthesis of a number of β‐northiadiaza steroid analogs has been described. Suitable o‐aminonitriles were acylated with γ‐chlorobutyryl chloride. These amidonitriles were cyclized to substituted γ‐lactams and subsequently to the tetracyclic products. To functionalize the “17‐position” in these steroids, the intermediate γ‐lactams were converted to arylidene derivatives before cyclization to the tetracyclic derivatives.
All Science Journal Classification (ASJC) codes
- Organic Chemistry

domain: chemistry


text:
Where “soft Islam” is on the march
A broader report on the politics of Indonesia suggesting that there are some regions where there is still hope for moderation.
1/10/2008 Indonesia (Economist) In late December a mob attacked and burned a prayer house in West Java belonging to Ahmadiyah, a sect deemed heretical by some mainstream Islamic scholars. Earlier in the month the country’s Christian leaders complained that Muslim radicals, helped by local officials, had carried out a string of attacks on churches. Ten Muslim militants were jailed for attacks on Christians on Sulawesi island, including the beheading of three schoolgirls. In late November the religious-affairs ministry barred a liberal Egyptian scholar, Nasr Hamid Abu Zayd (who calls the Koran a cultural product), from public speaking in Indonesia.
Behind many recent incidents is a vigilante group, the Islam Defenders’ Front (FPI), which in September assaulted bars, cafés and hotels in Bogor, near Jakarta, accusing them of violating Ramadan. Another rising radical force is the Indonesian chapter of Hizb-ut-Tahrir, which wants a caliphate to rule the whole Muslim world. Last August it gathered perhaps 90,000 supporters in a Jakarta stadium. Its leaders condemned democracy on the basis that sovereignty lies in God’s hands, not the people’s. A not dissimilar attack on pluralism was made in a hardline fatwa issued in 2005 by the Indonesian Ulemas Council (MUI). This same semi-official body recently demanded the banning of the liberal Egyptian scholar.
This all sounds worrying. But Indonesia is a huge, varied and complex place, and the radicalseven though some have a semi-official platformare a small and not very influential minority. Contrary evidence abounds: liberals as well as radicals are making inroads. They have won a big battle over a pornography law that Islamists proposed in 2006. It would have banned bikinis and short skirts, for non-Muslim women too, and prohibited the Hindu minority’s traditional dances. But a public outcry forced lawmakers to strike out all the controversial bitsand it still has not passed in parliament.
The formerly separatist region of Aceh was allowed, under a peace pact with the rebels, to introduce strict sharia. The move was popular at first, says Sidney Jones of the International Crisis Group, a think-tank, but there was widespread revulsion when the authorities started publicly whipping miscreants. As a result the religious police were drastically reined in. Overall, Indonesians seem to prefer the idea of living under God’s law to the practice of it.
Indonesia is, overall, edging away from radical Islamism. But the trend is not irreversible, and the authorities must avoid fostering fundamentalists by pandering to them. The MUI (the council of mullahs) and the FPI (the vigilantes) provide a lesson: both were created, for temporary reasons of expediency, by the Suharto regime but both have lingered to haunt its democratic successors. Mr Yudhoyono now seems to be trying to channel the MUI’s radical enthusiasm into issuing fatwas against deviant Islamic sects like Ahmadiyah. But this only encourages the FPI to take up its cudgels.


text:
This is a book that I picked up at BEA and got signed by the author 🙂 I love this cover!!
The Premise: In this young adult novel, the focus is on Damien Locke, a supervillian-in-training – or so he thought, until his 16th birthday when he discovers that he’s really half-superhero and his dad is one of the most moralistic Do Gooders out there. Disgusted and betrayed, Damien can’t believe that things can get worse – but they do. His father insists that Damien stay with him for six weeks so that Damien can learn about life among the Good Guys. His mom, a supervillian, agrees to the arrangement so that Damien can know the enemy and to get him out of the house while she works on her latest diabolical plan. There’s no way he would become a superhero, right? Except that Damien slowly begins to acclimatize to life with superheroes and when he finds out about a plan that could put his father and his step-family in danger, he’s strangely torn. Damien’s always wanted to be a villian, but he also wants to protect his friends and family.
Read Chapter 1 of The Rise of Renegade X
My Thoughts: The story is told in the first person viewpoint of Damien and the setting is a fictional city – Golden City, where tourists flock hoping to run into a superhero or a supervillain. It is ultimately about the choices that people make in order to become who they are. In Damien’s case, his choices determine whether he will become a superhero or a supervillain. He has the genes for both, and the “X” that appeared on his thumb as a result can turn into an “H” (for hero) or a “V” (for villain) based on what he does.
This book made me laugh. Damien has a quick wit which he actively uses in surprising ways. He’s never got the lower hand for long, and when he’s annoyed at someone, he uses his smarts to get them. It was pretty funny how he kept needling his parents about their embarrassing hook-up at inopportune moments, or how he dealt with school bullies. I found myself looking forward to reading this book when I had to put it down because of the humor, especially in the first part of the book – Damien’s disbelief and how he handled the change in his life tickled me. Once he was more settled, the shenanigans Damien gets himself into with his sidekick (more about her later), were funny as well but didn’t entertain me as much as the first part of the book.
The humor is irreverent and not exactly a kid’s humor. Damien is less innocent than I was at sixteen (which I suppose isn’t hard). He’s comfortable with sexual situations and there’s a sort of love triangle in this book between Damien and two very different girls. The first is his ex-girlfriend, Kat, who is a supervillain who has the power to shapeshift. They broke up on his last birthday when he found her with another guy, but she seems sorry for that and they both have feelings for each other (they’ve gotten closer over the past year), although Damien can’t bring himself to forgive her. The second girl is Sarah – a strange girl in Damien’s new school who is a master inventor and wants to be his superhero sidekick. One girl assumes he is a supervillain, one assumes he’s a superhero, and Damien plays the part each expects because he doesn’t want either to know about his half-hero, half-villain status.
These complex relationships with Damien and these girls, along with the relationship he develops with his father’s family (not an easy path), adds depth to the story that I wasn’t expecting but really liked. The sibling rivalry and fights that Damien has with his half-sibling closest to his age (Amelia, who is 15), was particularly endearing. They dislike each other at first sight but work their way through their differences. I thought the “teenage boy versus his younger sister” dynamics were cute and very much like how siblings work. I also liked Damien’s commentary on how people have preconceptions of villians and heroes and how that influences how people respond to him.
Overall: An enjoyable read that blends humor, comic book tropes, and a teenage boy’s coming of age to produce a story with subtle depths. I liked it.
Buy: Amazon | Powell’s | The Book Depository
The Book Smugglers – 7 (leaning towards an 8) – [I agreed with Ana’s review]
Steph Su Reads – 4 out of 5 (“The gem of this novel is Damien’s voice. A perfect balance of snark, sincerity, and your typical adolescent male stupidity”)
SciFi Chick – “pure fun from beginning to end.”
I agree that this was for older students. Interesting book, but maybe not for middle school.
Yes, Damien’s language and the sexual situations are probably more appropriate for slightly older readers.
Pingback: The Rise of Renegade X | One More Page

domain: entertainment


Download Dream Night Pro Live Wallpaper v 1.5.0 Apk
Download Dream Night Pro Live Wallpaper Full edition Free | URAPKBaru.NET -Dream night pro is usually an application which is usually useful for creating personalized screen display the homescreen of your android phone so which feels more alive.
application has the style of the beautiful night scene of beauty along with also also filled with sparkling light of the evening star along with also also the vague trees a little wind on the various other.
in addition, the application Dream Night Pro Live Wallpapers which also features effect derived, so when you shift your smartphone screen, the image shifts with the effects derived.
However, if you do not like the effects derived which, you can disable which by opening the Menu Settings = > Camera (Parallax) Speed = > Select Stay still (no parallax) option (unfortunately which functionality in PRO edition only).
for how its usage is usually very easy, just press menu = > select wallpaper = > select live wallpaper = > select dream night pro live wallpaper through the list.
brand new in v 1.5.0:
- Added various other types of winter trees to Pro edition.
- Added interactive windmills to Pro edition.
- Added a DayDream with Time display (for Android 2.2 +) to an all-in-One edition.
- Various bug fixes for all versions.
Make you want to try using cool applications dream night pro live wallpaper apk latest , you can download the application via the link below, free!!!
System required: Android OS 2.2 along with also also above
Download Link Dream Night Pro v 1.5.0 APK :
* Ori Source: http://www.apkbaru.net/2015/05/dream-night-pro-live-wallpaper-v1.4.0-apk.html translated by AndroidIndo.net


text:
The Qlucore Omics Explorer NGS module makes it is possible for biological researchers, who may not be data analysis experts to explore NGS and data, find new answers and generate new hypotheses
Qlucore Omics Explorer is a next-generation bioinformatics software program for broad usage, well known for its friendly user interface and advanced visualisation capabilities.
RNA-seq studies are one of the most used techniques in modern genetics and cancer research, and the next-generation sequencing (NGS) module enables a comprehensive and synchronised view of both expression levels and genomic locations.
One of the main components in the NGS Module is the genome browser which, in combination with the dynamic filters, ensures the user is able to visualise the most interesting regions of the genome, minimising the need to zoom and scroll.
Qlucore is a bioinformatics visualisation software specialist. Qlucore Omics Explorer software makes it possible to interactively explore and analyse multivariate data sets, from small to very large and data generated with NGS technologies.
The new NGS Module is an add on to Qlucore Omics Explorer, consisting of an interactive genome browser and flexible and interactive filter options. One of the key features is to enable synchronisation between the expression analysis of RNA-seq data and genomic information, making researchers even more productive.

domain: biology