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SYMPOSIUM - HINDFOOT AND ANKLE TRAUMA
|Year : 2018 | Volume
| Issue : 3 | Page : 315-321
|A modified broström repair with transosseous fixation for chronic ankle instability: A midterm followup study in soldiers
Pei-Wei Weng1, Chih-Yu Chen1, Yang-Hwei Tsuang2, Jui-Sheng Sun3, Chian-Her Lee4, Cheng-Kung Cheng5
1 Department of Biomedical Engineering, National Yang-Ming University; Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University; Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, Taiwan
2 Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University; Department of Orthopaedics, Shuang Ho Hospital, Taiwan
3 Department of Orthopedic Surgery, School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
4 Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
5 Department of Biomedical Engineering, National Yang-Ming University, Taiwan
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|Date of Web Publication||7-May-2018|
| Abstract|| |
Background: Various surgical techniques are available to reduce chronic instability of the lateral ankle ligament complex. The most effective method for these procedures remains controversial. This report presents a surgical technique that is similar to the Broström procedure and uses a modified, nonaugmented repair technique. Materials and Methods: 38 soldiers with a history of chronic lateral ankle instability and poor ankle function underwent plication of the anterior talofibular ligament-lateral capsule complex with transosseous fixation of the calcaneofibular ligament through a fibular bone tunnel between 2004 and 2007. This study included 33 men and 5 women with a mean age of 25.6 years (range 18–36 years) at the time of surgery. Each patient was confirmed to have a history of chronic lateral ankle instability after an inversion injury, and symptoms had been noted for at least 1 year. The patients were followed up with stress radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score, and the Sefton assessment system. The mean followup period was 77.6 months (range 66-89 months). Results: At the last evaluation, the talar tilt reduced from an average of 13.9° ± 2.4° before surgery to 3.8° ± 1.8° after surgery, and anterior drawer displacement reduced from 9.6 ± 2.9 mm to 2.3 ± 1.6 mm. The mean AOFAS ankle-hindfoot scale score for functional stability increased from 71.6 ± 4.0 points preoperatively to 95.6 ± 4.0 points postoperatively. As evaluated by the Sefton assessment system, 36 patients (95%) reported an excellent or good functional outcome. All patients resumed normal daily activities and active military duty after the surgery. Conclusion: The procedure described here could be considered a viable alternative option to anatomic reconstruction such as the modified Broström procedure and might be appropriate for the general population.
Keywords: Chronic lateral ankle instability, modified Broström procedure, nonaugmented repair
MeSH terms: Ankle injuries; ankle lateral ligaments; calcaneofibular ligament; chronic ankle instability
|How to cite this article:|
Weng PW, Chen CY, Tsuang YH, Sun JS, Lee CH, Cheng CK. A modified broström repair with transosseous fixation for chronic ankle instability: A midterm followup study in soldiers. Indian J Orthop 2018;52:315-21
|How to cite this URL:|
Weng PW, Chen CY, Tsuang YH, Sun JS, Lee CH, Cheng CK. A modified broström repair with transosseous fixation for chronic ankle instability: A midterm followup study in soldiers. Indian J Orthop [serial online] 2018 [cited 2019 Oct 17];52:315-21. Available from: http://www.ijoonline.com/text.asp?2018/52/3/315/231950
Chian-Her Lee and Cheng-Kung Cheng contributed equally to this study
| Introduction|| |
Ankle sprain with lateral ankle ligament injury is the most common injury in sports. Usually, application of excessive inversion force when the foot is plantar flexed, affects the anterolateral capsule first, followed by the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL), depending on the increasing stress. The primary antagonist to inversion and translation of ankle plantar in flexion is the ATFL, while the major contributor to subtalar joint stability is the CFL., The ATFL and CFL act synergistically: The ATFL is stretched in the plantar flexed ankle and the CFL and PTFL are stretched in the dorsiflexed ankle. Lateral ankle stability chiefly depends on the ATFL and CFL.
Management of acute injuries includes rest, icing, compression, elevation, and protection, followed by rehabilitation with peroneal muscle strengthening and proprioceptive training. Although conservative management protocols are often the first choice of treatment and are effective, recurrent sprains may lead to ligament attenuation or complete tearing. These patients are likely to develop an instability pattern. Symptoms such as recurrent ankle sprains, difficulty in ambulation on uneven ground, and pain during an activity of instability, may significantly affect daily activities, work, or exercise. Furthermore, osteochondral lesions of the talar dome and subsequent ankle osteoarthritis have been reported as long term complications of chronic lateral instability.,
Operative reconstruction not only maintains the stability of the ankle, but may also prevent these complications. Since the reconstruction procedure of nonaugmented, direct repair of the torn ends of the ATFL and CFL by midsubstance suturing was first described by Broström in 1966, that and several subsequent modifications have all resulted in satisfactory outcomes. Multiple studies have reported that nearly 90% of patients exhibit good to excellent outcomes.,,,,,, The common advantages of these procedures include its simplicity and reliability with few complications, as it is performed with the original ligament tissue and does not require the normal tendon to be sacrificed. Furthermore, this procedure restores the native ankle anatomy, joint kinematics, and stability, while preserving subtalar motion and ankle function. Therefore, the Broström technique or its modifications are believed to be the first choice of treatment when surgical intervention is necessary. Our modification of this popular technique makes use of plication of the ATFL-lateral capsule complex with transosseous fixation of an advanced CFL through a fibular bone tunnel. The ATFL-lateral capsule complex plication is technically simpler and easier to perform. Meanwhile there is less fracture risk for the distal fibula during the transosseous fixation of the CFL due to the creation of only a single bone tunnel. We believe that this hybrid technique can accomplish the goal of anatomic reconstruction, which is sufficiently stable and easily reproducible.
| Materials and Methods|| |
38 soldiers who underwent unilateral reconstruction of the lateral ligaments of the ankle by a single experienced orthopedic surgeon between 2004 and 2007 constitute this retrospective study. This study included 33 men and 5 women with a mean age of 25.6 years (range 18–36 years) at the time of surgery. Each patient was confirmed to have a history of chronic lateral ankle instability after an inversion injury, to have undergone a program of nonoperative management consisting of physiotherapy and home exercise, and experienced limitations in sports and daily life activities. All patients had recurrent symptoms, such as give-way weakness or a sensation of instability during daily activities and in sports that resulted in pain, swelling, and interference with their normal activities. In all patients, symptoms had been noted for at least 1 year, but for not more than 10 years. Physical examination with both the anterior drawer and inversion stress tests of the index ankles showed laxity in comparison with that of the contralateral ankle. All patients were skeletally mature and had not undergone a prior ankle surgery. Patients were included in this study if they had no prior surgery or advanced osteoarthritic change in the affected ankle, no previous fractures, an uninjured contralateral ankle, a properly aligned foot, and no neuromuscular disorder. Standing radiographs of the ankle, preoperative and followup stress radiographs in two planes were obtained for all patients using a Telos GA-II/E stress radiography device with standardized measurement of anterior talar translation and talar tilt with 150 N of applied force, as described in Karlsson et al.
The anesthetized patient was asked to lie in a supine position and a large sandbag was placed underneath the buttock on the side where the surgery was being performed, and a thigh tourniquet control was placed. Thereafter, a 3 cm slightly curved incision was made from the distal fibula tip toward the 5th metatarsal base to expose the anterolateral ankle joint. Next, full-thickness skin flaps were made and a dissection was performed to expose the anterolateral capsule, distal fibula, and peroneal tendons. The lateral capsule ligament complex (anterolateral capsule and ATFL) was transected at its midpoint and redundant or scar tissue was excised. The joint was inspected for loose bodies or osteochondral lesions, and hypertrophic synovium or fibrous tissue was removed by arthroscopy before the repair procedures.
Thereafter, the peroneal tendons were retracted posteriorly to expose the CFL, which allowed for subsequent identification of the CFL insertion site [Figure 1]. The CFL was often attenuated or even avulsed from its insertion in the fibula. The CFL was then cut from the insertion point and advanced with 2-0 Ethibond sutures using the Bunnell technique. A short bony tunnel along the original CFL axis was created from the distal to the proximal direction in the distal fibular by removing some cancellous bone from the fibular attachment of the CFL using a 2.0-mm drill bit. Then, the bony tunnel was dilated using a 3.0-mm drill bit followed by a 4.0-mm drill bit [Figure 2]. Care was taken to not damage the cortex of the proximal end of the bony tunnel of the fibula by creating an approximately 2-cm cannulated structure through the fibular attachment of the CFL. Under tension with the ankle in slight dorsiflexion and the foot slightly everted, the CFL was advanced and inserted into the bony tunnel with transosseous suture fixation. Some of the cancellous bone that was removed before drilling was then grafted into the bony tunnel. After CFL reconstruction, the incised ATFL-lateral capsule complex was imbricated in a pants-over-vest fashion with 2-0 Ethibond sutures [Figure 3]. The wound was then irrigated and hemostasis was obtained. The closure was performed in layers and the tourniquet was released. Thereafter, the ankle was immobilized using a posterior molded splint with the ankle and foot in a neutral position.
|Figure 1: Diagramatic representation of the lateral capsule-ligament complex was transected in its mid-portion and the redundant or scar tissue was excised. The calcaneofibular ligament insertion points were divided and the calcaneofibular ligament was cut from the insertion point|
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|Figure 2: Peroperative photograph showing calcaneofibular ligament was advanced with the Bunnell suture technique. A short bony tunnel along the original calcaneofibular ligament axis was created from the fibular attachment of the calcaneofibular ligament using the 2.0-mm, 3.0-mm, and 4.0-mm drill bits|
Click here to view
|Figure 3: Diagramatic representation (a), peroperative photograph (b) showing that after the advanced calcaneofibular ligament was inserted into the bony tunnel with transosseous suture fixation, the incised anterior talofibular ligament-lateral capsule complex was imbricated in a pants-over-vest suture|
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The ankle was immobilized with the posterior splint for 2 weeks and maintained in a nonweight bearing position. After removal of the wound dressing and sutures, a short leg-walking splint was applied, and active range of motion exercises were performed for the treated ankle for another 4 weeks. At 6 weeks postoperatively, the walking splint was removed and the ankle was protected by a soft orthosis. Physiotherapy, including proprioceptive training, progressive strengthening, and flexibility exercises were then initiated. Three months postoperatively, patients were allowed to practice straight line running and gentle jogging with a soft brace. Patients were allowed to participate in a full range of sports activities by 6 months postoperatively; however, the use of an ankle support during heavy exercise, such as while playing basketball or tennis, was advised for an additional 6 months.
Patients were assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS score) as the functional score, the scoring system developed by Sefton et al. for the evaluation of subjective satisfaction [Table 1], and stress radiographs of the talar tilt and anterior talar displacement.,, Results of the Sefton assessment identify patients with “excellent” results as those who are capable of full activity, including strenuous sports and do not experience pain, swelling, or ankle instability. Patients with “good” results were those who had pain only after strenuous exercise; however, with no instability or feelings of apprehension. Patients with “fair” results were those who felt some residual instability and exhibited apprehension while walking, although it was comparatively reduced after surgery. Patients with “poor” results were those who experienced recurrent instability and give-way weakness during normal activities with episodes of pain and swelling. Such patients may require surgery again. Postoperative AOFAS score evaluation, Sefton assessment, and stress radiography were performed at an average followup period of 77.6 months (range 66–89 months).
Statistical analysis of the data was performed with using a paired t-test. A P ≤ 0.05 was assumed to indicate statistical significance.
| Results|| |
Between 2004 and 2007, the procedure was performed on 42 ankles, of which 38 ankles completed followup. The mean surgical time measured from the placement to removal of the tourniquet was 45 min (range 38–56). The average followup period was 77.6 months (range 66–89 months).
The average preoperative AOFAS ankle-hindfoot scale score was 71.6 ± 4.0 points (range 63–79 points). The average 77.6-month followup period score was 95.6 ± 4.0 points (range 84–100 points), and the difference was statistically significant (P< 0.001). Results of the Sefton assessment showed that 27 patients had excellent results, 9 had good results, and 2 had fair results. After surgery, all patients not only resumed daily activities, but also participated in their organized physical fitness training programs and could meet the standards of the physical fitness, such as the 3000 m run for men and the 1500 m run for women. No patient complained of lasting pain in the lateral aspect of the operated ankle.
Telos GA-II/E stress radiographs indicated that talar tilt reduced from an average of 13.9 ± 2.4° (range 10°–22°) before surgery to 3.8° ±1.8° (range 2°–9°) after surgery, and the anterior drawer displacement improved from an average of 9.6 ± 2.9 mm (range 6–15 mm) before surgery to 2.3 ± 1.6 mm (range 1–7 mm) after surgery. Both differences were statistically significant (P< 0.001). No patient showed evidence of degenerative arthritis at the time of final followup.
Postoperative physical examination at followup showed that the range of motion for dorsiflexion and plantar flexion was unrestricted for relative measurements compared to the uninjured side. Injured ankles had a mean minimal loss of range of motion (<5°) for dorsiflexion and plantar flexion compared with healthy ankles. One ankle was found to have tenosynovitis of the peroneal longus tendon intraoperatively, therefore, the pulley was thickened with a partial fissure for the peroneal longus, and the tendon was debrided and tabularized using a running, braided suture. This patient complained of retrocalcaneal pain and soreness while playing basketball at 18 months after surgery though the pain was reduced by 33 months after surgery. He was still pleased with the result and changed his sports to swimming and jogging. A grade 1°–2° anterior drawer test without excessive lateral inversion was noted in two patients postoperatively. However, both exhibited generalized ligamentous laxity, as evidenced by a positive thumb to forearm test and elbow hyperextension, and were inclined to have a lower postoperative AOFAS ankle-hindfoot scale scores (85 and 86 points). These two patients had fair results postoperatively according to the Sefton criteria. No complications of wound healing, infection, fibular fracture during surgery, or nerve injury occurred in any patient.
| Discussion|| |
An ideal ankle ligament reconstruction restores the normal anatomy and function of the ligaments and corrects both talar tilt and anterior drawer instability without resulting in a loss of a talocrural and subtalar range of motion. The key to achieving these goals is the maintenance of the ligament insertion points and fiber structure. These goals are achieved in the procedure described in this report. Compared with anatomical reconstruction procedures, the tenodesis procedure results in abnormal subtalar and talocrural joint kinematics and increases the risk of ankle stiffness, which induces long term complications of chronic pain or further subtalar arthrosis and increases the difficulty of walking in rough terrain., Imbrication of the anterolateral capsule-ATFL complex and preservation of the original CFL and normal peroneal function results in near-normal proprioception. This also helps achieve better functional stability. The CFL in chronic lateral ankle instability generally healed in continuity and was most often attenuated in midsubstance and lengthened. We advanced the originally scarred CFL and overcame the lengthening problem to create an anatomical reconstruction by use of the bone tunnel technique by letting the nonfunctional ligaments restore their tensile strength and regain their functions.
Surgical techniques for attaching tendon grafts or original ligaments to ankle bones that have been described previously include fixation of bone suture anchors and the use of interference screws.,,, Several key factors affect the mechanical stability of a suture-anchor threaded with a defined suture, such as the pullout strength of the anchor, the tensile strength of the suture, and the interaction of the anchor and suture at the suture-anchor interface. The biomechanical tests of Giza et al. and Li et al. have reported that there is no statistical difference in strength and stiffness for a suture-anchor compared with that of a bone tunnel construct for an anatomic repair of the lateral ligaments of the ankle. We know that transosseous tunnel fixation has the advantages of a larger contact area of the tendon with bone that can advance tendon healing in the bone tunnel and is less expensive than other implantation procedures.,, We performed surgery on two ankles in which the CFL was avulsed from the calcaneus insertion during the period of data collection. The procedure was performed similarly; however, the fixation was performed with the interference screw at the calcaneus. Due to the fewer number of cases that exhibited this condition and the different fixation methods of CFL, these two patients were excluded from the current study. For tendon grafts that use interference screws, graft fibers may be directly damaged by the sharp edges of the screws and the acute angle at the tunnel entrance. In addition, interference screws may block the growth of the tendon graft-bone tunnel interface. Our current procedure uses a transosseous tunnel technique that enhances tissue healing and is simple to perform. Lower costs and a lack of residual hardware are additional advantages.
In studies of modified Broström repair techniques by Karlsson et al. and Girard et al.,, poor outcomes were more commonly associated with patients who were overweight, had a long standing ligamentous insufficiency (10 years), exhibited generalized hypermobility, and underwent revision surgery. Since the concept of the procedure discussed herein is similar to that of the direct repair of ligaments that is used in the modified Broström procedure by the aforementioned authors, we did not perform our procedure on patients who had a prior failed lateral ankle ligament surgery, a history of chronic lateral ankle instability that was >10 years, or body weight >100 kg. Although we only found two patients in the current study that had a relatively lower postoperative AOFAS ankle-hindfoot scale scores, both exhibited generalized ligamentous laxity. However, they were still pleased with the results and returned to their preinjury levels of activity. As for patients with generalized hypermobility, our procedure not only directly repaired or advanced the ATFL and CFL, but also imbricated the anterolateral capsule and shortened the CFL to an adequate length. Thus, this procedure can be an alternative surgery for chronic lateral ankle insufficiency.
In our study, the diagnosis of chronic lateral ankle instability was primarily made by complete history taking, detailed physical examination, and plain radiography. Although some problems are encountered with stress radiographs such as different techniques of stress application, inadequate muscle relaxation, and the coexistence of subtalar instability and generalized hypermobility. Previous studies reported that stress radiographs of the ankle and the calcaneocuboid joint can be read reliably if the proposed measurement techniques are applied., Moreover, stress radiography was able to quantify the talar tilt and anterior drawer displacement for the index ankles. Thus, it supplied simple, useful, and more objective measurements of mechanical laxity.
One patient with peroneal tenosynovitis at the time of surgery had a relatively lower postoperative AOFAS ankle-hindfoot scale score (84 points). For ankles with chronic lateral instability, DIGiovanni et al. reported that peroneal tenosynovitis was the most common associated injury (77%, 47 of 61 patients), while Strauss et al. reported peroneal tendon injuries occurred with the highest frequency (28%, 51 of 180 patients) in association with extra-articular injuries. Both authors emphasized the poor postoperative results of ligament reconstruction in the presence of associated injuries and the importance of preoperative screening for associated injuries. As posteromedial or medial pathologic lesions of the ankle may be missed during the inspection at anterolateral arthrotomy, we now routinely examine the ankle with arthroscopy at the time of open ligament reconstruction in recent years.
The present inside-out technique with transosseous suture fixation of the advanced CFL enabled the surgery to be performed with a limited incision of around 3 cm in length. It also has a rapid and short learning curve. The total tourniquet time, including wound closure, was 45 min (range 38–56 min), and this is a relatively lower surgical time than that of other procedures, such as 67 min (range 36–96 min) of total tourniquet time for the modified Broström procedure and 93 min (range 67–114 min) for the Chrisman–Snook procedure, as reported by Hennrikus et al.
There are some limitations of the current study. Further long term or controlled comparative studies are needed to predict long term success, especially for patients with generalized hypermobility. It is unclear, based on the current study, whether the strength and stiffness of the advanced CFL and at the ligament graft-bone tunnel junction will continue to develop over time. We do not know whether the ankle or subtalar arthrosis wound occurs over the long term with over tightening of the anterolateral capsule-ATFL complex or CFL in the procedure; however, patients did not exhibit restriction motion of the ankle or subtalar joint in our series. Future in vitro biomechanical studies with cadaveric specimens would be an interesting avenue of exploration.
The procedure reported herein is another modified, surgical option for the repair of chronic lateral ankle instability that has limited invasiveness. It provides satisfactory functional outcomes and mechanical stability, a shorter tourniquet time, and low morbidity, and retains the technical simplicity of the original Broström procedure.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Prof. Chian-Her Lee
No. 250, Wuxing St., Xinyi Dist., Taipei City 110, Taiwan
Source of Support: None, Conflict of Interest: None
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Back to top. Before you take Naltrexone GH Naltrexone GH is not suitable for everyone. When you must not take it. Do not take Naltrexone GH if you have had an allergic reaction to Naltrexone GH or any of the ingredients.
Use the pill identifier tool on RxList. Back to Medications Index.It also decreases the desire to take is medication is also used to treat alcohol abuse. It can help people drink less alcohol or stop drinking altogether. It also decreases the desire to drink alcohol.
It was removed surgically. She started a melanoma vaccine trial in April 1999 but developed two new skin lesions on the low back over the next six months. In February 2000 a bone scan showed a lesion in the left sixth thoracic rib, with growth.
Click to read on or to watch the linked video. What is low-dose naltrexone and why is it important? Low-dose naltrexone holds great promise for the millions of people worldwide with autoimmune diseases or central nervous system disorders or who face a deadly cancer.Are there.
Covers chronic Lyme disease pain and headaches. Symptoms and treatment covered.An analgesic or painkiller is any member of the group of drugs used to achieve analgesia, relief from pain. Analgesic drugs act in various ways on the peripheral and.
Hardman, Ph. D. and Lee E. Limbird, Ph. D. New York: McGraw-Hill, 2001. Jack Raber, Pharm. D.If no problems occur after this test dose, another 25 mg test dose is administered. Getting a person to comply with treatment for opiate addiction is the single most.
Naltrexone treatment is started after you are no longer dependent on narcotics. The length of time this takes may depend on which narcotic you took, the amount you took, and how long you took it. There are no data that demonstrate an unequivocally beneficial effect of Naltrexone hydrochloride on rates of recidivism among detoxified, formerly opioid-dependent individuals who self-administer the drug. The failure of the drug in this setting appears to be due to poor medication compliance.
41 less alcohol craving, and fewer drinking days compared with patients who received placebo, but these results depended on the specific analysis used. The clinical use of Naltrexone hydrochloride as adjunctive pharmacotherapy for the treatment of alcoholism was also evaluated in a multicenter safety study.
This makes the blockade produced potentially surmountable, but overcoming full Naltrexone blockade by administration of very high doses of opiates has resulted in excessive symptoms of histamine release in experimental subjects.
Drug information provided by: Micromedex US Brand Name Revia Descriptions Naltrexone is used to help narcotic dependents who have stopped taking narcotics to stay drug-free. It is also used to help alcoholics stay alcohol-free.
Contraindications Naltrexone hydrochloride is contraindicated in: 1. Patients receiving opioid analgesics. 2. Patients currently dependent on opioids, including those currently maintained on opiate agonists (e.g., methadone) or partial agonists (e.g., buprenorphine).
Naltrexone is not a narcotic. It works by blocking the effects of narcotics, especially the "high' feeling that makes you want to use them. It also may block the "high' feeling that may make you want to use alcohol.
Naltrexone Hydrochloride Tablets USP are also related to the potent opioid antagonist, naloxone, or n-allylnoroxymorphone. The chemical name for. Naltrexone hydrochloride is Morphinan-6-one, 17-(cyclopropylmethyl)-4,5-epoxy-3,14-dihydroxy-, hydrochloride, (5)-. C20H23NO4HCl M.W. 377.86 Naltrexone Hydrochloride Tablets USP are a white, crystalline compound.
Adequate studies of Naltrexone in patients with severe hepatic or renal impairment have not been conducted (see PRECAUTIONS, Special Risk Patients ). Clinical Trials Alcoholism The efficacy of Naltrexone hydrochloride as an aid to the treatment of alcoholism was tested in placebo-controlled, outpatient, double blind.
Naltrexone hydrochloride, unlike methadone or LAAM (levo-alpha-acetylmethadol does not reinforce medication compliance and is expected to have a therapeutic effect only when given under external conditions that support continued use of the medication.

domain: medical


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What it’s about: Eighth grader Nicki Ames has been best friends with Ava for five whole years, so when their gym teacher tells everyone to pair up with their best friend, Nicki knows who she’ll be next to. Only Ava doesn’t choose her. She chooses one of the popular girls instead.
Nicki isn’t sure if she’s been abandoned in front of her whole class, or if she’s just reading too much into a simple action. But as the weeks drag by and Ava barely talks to Nicki, she has to ask herself: if Ava is being a bad best friend, does that mean Nicki should just wait for her to come around? Or is this her opportunity to strike out on her own?
Why we chose it: Over the years, I’ve probably read hundreds of realistic fiction novels. Some I’ve loved. Some I’ve hated. Out of all of those, there are only a small number which really spoke to me and felt as though they accurately portrayed the lives of middle schoolers today—and among those, Bad Best Friend is a standout. Blending sensitive, accurate portrayals of tweens, conflicts, and families with a full cast of characters, each with an astonishing amount of nuance, this book feels as though it gives voice to the complexities, uncertainties, and messiness of middle school without ever being forced, preachy, or simply inaccurate. This is a book which I feel should be widely read, because it gives voice to some of the most universal feelings of tweens which are rarely explored in novels in a way that considers the layers and confusion of these events in the most authentic way possible.

domain: artistic


text:
Medulloblastoma with Extensive Nodularity Undergoing Post-Therapeutic Maturation to a Gangliocytoma: A Case Report and Literature ReviewChelliah D. · Mensah Sarfo-Poku C. · Stea B.D. · Gardetto J. · Zumwalt J.
aSchool of Medicine and bSchool of Public Health, Loma Linda University, Loma Linda, Calif., and Departments of cRadiation Oncology and dPathology, University of Arizona, Tuscon, Ariz., USA
We present a report of a 12-year-old boy diagnosed with medulloblastoma at 22 months of age. A gross total resection was performed followed by adjuvant systemic chemotherapy due to his young age; however, the tumor recurred locally in the posterior fossa 7 months later. The recurrent tumor was excised and he received craniospinal radiation with a boost given to the posterior fossa followed by high-dose chemotherapy. He remained disease free for approximately 10 years without major neurologic deficit and only mild cognitive impairment. A routine follow-up MRI of the brain revealed an enhancing mass. The patient underwent surgical debulking and pathological examination revealed no residual immature medulloblastoma cells but instead mature ganglion cells, consistent with a gangliocytoma. The apparent maturation of primitive medulloblastoma cells is a rare phenomenon, which may have ensued from the long-term effects of adjuvant therapies inducing advanced cellular maturation.
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Tom Brosseau and Andru Bemis played a lovely show at the Foundry Hall last Tuesday and this song, which Andru found in an 80 year old hymnal, was really special. They both played spirituals and soulful songs. It was a great show guys!
Tom Brosseau (& Andru Bemis) played a lovely show for us last November at Foundry Hall. They played a number of folk spirituals, together and separately, and also original songs. This song, Cradle Your Device, is off Tom’s new CD – Grass Punks. Pretty song, especially since Tom has such a beautiful voice. If you get a chance, listen to this song from the CD too. It has another instrument in it, a high end sound, that is not in the live performance. Listen to it here >>>
Here is a long story of who Liberty Hyde Bailey was plus a song about the man by Pam Chappell. Also playing on this song is Andru Bemis and Jim Hughey. I added some images to the story to help Pam along.
This song, Cane Fishin’ Pole, is part of the 6th annual, South Haven in Stories and Song HASH presentation. It was recorded live at Foundry Hall in front of a huge audience. Hundreds of people came out to enjoy Pam Chappell, Andru Bemis, and Jim Hughey, with stories by Roger Horton. It was a great night.
Lipbone Redding – WOW – played an incredible show at Foundry Hall last night. Really engaging performer, and I use that term performer completely. He tells stories that set the scene for each song, and the songs from this singer/songwriter are so real it is obvious that he’s lived them, felt the content of them himself, in his soul. He’s most noted for his ability to imitate accurately brass instruments, and he does that with amazing style, but what I loved was the content of the songs. He took us to Chili in this song about the dogs of Santiago. I felt as if I went there with him, seeing the place from his mind’s eye, feeling it through his music.
This is a story about Paul Hogan, told by Joe Foster at Open Mic.
Paul Hogan plays ‘Imagine That’ at Foundry Hall’s monthly (4th Wednesdays) Open Mic, which Paul hosts each month and also brings some amazing treats for everybody made by his great wife, Mary Hogan. This particular night we had her always tasty chocolate chip cookies and also pound cake and strawberries on a stick slathered in chocolate… really good. So come to open mic and share your talents – music, poetry, storytelling, juggling… – in front of a friendly audience that loves to applaud. It’s a really warm, friendly environment for everyone involved, including the audience.
Deborrah Wyndham is a wonderful performer and proved that again at Foundry Hall, her fourth time there, Friday night. Lovely performance, this is an original song – The Atmosphere.
Izzy and the Catastrophics put on a crazy-wild show for us at Foundry Hall. Wow, those guys rock and roll and a whole lot more. A bunch of really nice and fun people. Purchase their CDs here >>>
Link to it, embed it, tell your friends. I used a piece of Andru’s tune Kibbie to advertise this site. Take a look at the video, it’s really short.


The Perfinity Workstation is a multi-column apparatus that automates protein separations and mass spec sample preparation. Automated integration of affinity selection, buffer exchange, proteolysis and desalting steps enables users to start with serum and in 10 minutes have peptides ready for LC/MS analysis. In addition to the dramatic reduction in time required to have peptides ready for LC-MS analysis, it enables researchers to obtain consistent, high-quality results (CVs < 10%) and achieve a significant reduction in cost per sample.
The Perfinity Workstation combines the selectivity of antibodies with the resolving power of chromatography. Buffer exchange and desalting are performed on-line. The reduction in sample-processing time enables users to screen a variety of conditions rapidly.
The major advantage of the Perfinity Workstation’s sample-preparation approach is that users are not required to immobilize antibodies. Instead, scientists can add antibodies directly to the sample. By removing the immobilization process, users have eliminated a potential source of error, making LC/MS analysis with Perfinity Workstation more accurate and reliable.


Nvidia is serious about getting its ARM-based processors inside Windows 8 systems. The company is working with Microsoft to supply developers and device makers with Windows 8 systems based the Tegra 3 SoC. It's unclear whether the "test PCs" are notebooks, tablets, or stripped-down development platforms like the Tegra 2-based Trim-Slice desktop released last year. Given Win8's focus on touch, I wouldn't be surprised touchscreen displays were involved.
The Tegra 3 is already out in the wild, of course, most notably in the Asus Transformer Prime.
Nvidia also has an interest in getting developers more familiar with coding for the ARM architecture in general. At the Consumer Electronics Show last year, Nvidia revealed Project Denver, a plan to produce ARM-compatible CPUs for desktops and servers. We haven't heard much about the initiative since, but if Nvidia intends to compete with the likes of AMD and Intel, it's going to need applications that run on its CPUs—and systems built around them.
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|Asus' ROG Swift PG278Q G-Sync monitor reviewed||88|


We need a massive carbon removal industry. What will it take to scale it up?
The infrastructure bill is going to put billions into growing the carbon-removal industry
Put climate reparations at the top of every wealthy country’s agenda
How the Inflation Reduction Act will supercharge climate tech startups
‘The bill is just a monumental accelerator for a whole host of technologies that serve to decarbonize one sector or another.’
How does direct air capture work? An inventor of the carbon-scrubbing tech explains
Carbon-removal technology is still in its nascent stages, but it could be crucial to avoiding the worst effects of climate change.
5 technologies that should give us some hope for the planet’s future
From offshore wind power to e-bikes, there are at least a few reasons for (cautious) optimism.
2021 is the year the carbon-removal industry went mainstream
Big investment, new government funding, and a growing acceptance that any climate solution will need to involve more than just emissions cuts all fueled explosive growth in giant fans—and more bizarre solutions—in 2021.


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In my experience, there are two types of “albino” characters: the simpleton and the villain. The simpleton is generally a weak-willed lackey, either an obedient sidekick to a main character or a pawn in the grand scheme of a nefarious plot. The latter is a ruthless brute, a man bent on destroying society as we know it for the sake of extremely misguided ideals. Thus, it was refreshing for me to read Akata Witch by Nnedi Okorafor, a novel that treats albinism—and disabilities in general—not like impurities that ruin the gem that is a human being, but rather as defining aspects of their character. Okorafor argues that we must embrace rather than hide our imperfections in order to truly understand who we are.
Akata Witch follows the story of Sunny, a twelve-year-old African-American albino whose family recently moved back to their native Nigeria. Because of her odd looks and African American heritage, Sunny is ostracized by her peers to an extent typical of any book featuring an albino character. Nonetheless, with the help of some friends, Sunny discovers that she is capable of much more than she realized. She is a “leopard person,” a secret race of peoples in Nigerian folklore who walk between the human and spirit worlds and are capable of practicing “juju.” Soon she is whisked into a world of magic, masquerade, and monsters as she slowly assumes her role as a leopard person. Here Okorafor uses her expertise with Nigerian folklore to paint a truly marvelous world outside anything any Western reader could imagine. Each scene brims with foreign words, ideas, and languages in a way that draws the reader into the page.
As I mentioned, albinism is a characteristic most commonly applied to either the weakest or most malevolent characters. Their shocking appearance either provides an air of sickly paleness accompanied by either a physical or emotional weakness, or a frighteningly brutal ghost-like appearance which elicits revulsion from the reader and character alike. Akata Witch is one of the few novels I’ve read that breaks this particular mold. While Sunny’s albinism draws the ridicule of her classmates, Okorafor ensures that Sunny’s character is not tarnished by her physical disabilities or the stigma of her peers. In fact, Sunny’s albinism affects her character in a positive way, as dealing with the physical and social aspects of her albinism help build her confidence. She refuses to allow taunts and abuse to compromise her integrity and is never afraid to defend herself from those who see her as inferior.
Unlike many authors, Okorafor pulled no punches in regards to society’s treatment of those with albinism. As a person of color growing up with albinism, Sunny’s character particularly resonated with me. Her interactions with her classmates and countrymen strongly resembled my own. The odd looks and comments that Sunny deals with from her Nigerian counterparts are familiar to any “albino of color” as we see the confusion in the faces around us—as if we’re pieces in a puzzle that don’t fit correctly. Between the devices we use to protect ourselves from the sun, the blond or white hair, and the pale skin, we’re seen as misfits even among our own societies. Nevertheless, Okorafor does not allow Sunny to succumb to this atmosphere. Unlike most characters with albinism who are meek, easily manipulated characters, Sunny is an athletic, adventurous, and confident preteen who is not held back by her albinism and is quick to challenge those who question her looks or sun-shield umbrella. In fact, in the Leopard society her condition is seen as an indication of her power and abilities rather than a reason to ostracize her.
However, Sunny’s ready acceptance into Leopard society also plays into the “magical albino” myth that permeates fantasy movies and novels. While Okorafor attempts to distance Sunny’s albinism from the novel’s mysticism, in Leopard society a Leopard person’s abilities are very much influenced by their most striking physical features and/or maladies; the more striking or severe the disability, the more powerful the associated magic. Thus, while in principle Sunny’s albinism is not meant to contribute to the “magical albino” myth, Okorafor’s use of Leopard society ideology and mythology invokes an element of the aforementioned trope which mars what otherwise is an unprecedentedly mundane depiction of albinism.
While Sunny’s character is strongly affected by her albinism, Okorafor ignores or marginalizes some aspects of the condition. Because of our lack of melanin, people with albinism tend to have varying degrees of low vision. But Sunny didn’t suffer from any type of visual impairment; she didn’t even suffer from photophobia, the most common visual impairment associated with albinism. Okorafor’s mysterious “cure” for Sunny’s susceptibility to sunburn was an even more blatant affront to the integrity of her albinism. Soon after Sunny’s magical awakening, she discovers that she is no longer affected by sunlight—that she no longer has to worry about using an umbrella or long clothes to protect herself in the sun. As photophobia (in my opinion) is the most cumbersome physical symptom associated with albinism, Okorafor’s cure does the novel a disservice as she frees Sunny from a burden that every other albino must consciously shoulder or risk the consequences.
From the perspective of its portrayal of albinism I must confess to being underwhelmed by Akata Witch. While I loved Sunny’s character, Okorafor seemed to pick and choose from the physical and social aspects of albinism to craft a character that suited her needs rather than creating a truly realistic character with albinism, and—perhaps unintentionally—strayed back into the “magical albino” trope that mars so many novels with characters with albinism. However, from a literary standpoint Akata Witch is a great novel that features the first strong, sympathetic lead with albinism I’ve seen in quite a few years. With a wonderful setting that provides a breath of fresh air to an otherwise tired premise, accurate, life-like characters, and a great message, Akata Witch is a book I would recommend to readers of all ages.
My son has albinism and as a result he has low vision. I am looking for books that we might read together. Any suggestions?
Sorry I didn’t see this sooner. It really depends on what age your son is and what kind of stuff he’s interested in. Most of the books I’m familiar with are targeted towards preteens and teens, but you may find something interesting. For reference I started reading most of the following books and series between the ages of 10 and 15.
Books featuring characters with Albinism, Blindness, and/or Visual Impairment
– Akata Witch
– Golden Boy by Sullivan Tara: This book follows the story of a young boy with albinism growing up in Tanzania. As you may know people with albinism are treated very poorly in some African nations and this book describes a young boy’s attempts to live in such a society. it’s written as a children’s book, but is a bit heavy.
– Midnight for Charlie Bone This is the first book in a YA fantasy series with a major character with albinism.
– Things Not Seen: This book is targeted more to teens. The protagonist’s friend (a major character) is blind.
– All the Light We Cannot See: Probably one of my favorite YA books. It follows two children growing up in world war 2, a german boy with an uncanny gift for engineering and a blind girl in possession of a “cursed” stone. As it is set in WW2 this book can be quite heavy, but definitely worth a read.
YA Books I’ve enjoyed in general:
– Artemis Fowl by Eoin Colfer (series)
– The Wish LIst by Eoin Colfer
– Harry Potter by JK Rowling (series)
– Percy Jackson by Rick Riordon (series)
– The Thief by Megan Whallen Turner
– Eragon (series) by Cristopher Paolini
– Ender’s Game by Orson Scott Card (series) – One of the best SciFi books of all time. While the main characters are children, the series is targeted to teens and adults.
– Ender’s Shadow by Orson Scott Card (series): Parallel series to Ender’s Game
– Stormbreaker by Anthony Horwitz (series): YA spy series
– The Hobbit by JRR Tolkein: Probably the only Lord of the Rings book targeted to children.
– Star Wars – The pre-Disney Star Wars expanded universe (now they call it “legends”) has books and series targeted to people of all ages. I read a lot of these when i was younger.
– Gregor the Overlander by Suzane Collins (series): Suzane Collins before the Hunger Games. Contains a very similar anti-violence and war message, but is targeted to younger boys.
– Chasing the Falconers by Gordan Korman (series)
– The Wee Free Men by Terry Pratchet: A children series within Prachet’s Discworld series.
A lot of the author’s names were probably misspelled. Sorry about that.
Feel free to get in touch with me if you have any questions.
Oh I also forgot to mention – I was recommended the book If You Could See What I Hear by Tom Sullivan. It looks pretty good and inspirational so it may be worth looking into.
Pingback: Review for Akata Witch by Nnedi Okorafor | READING (AS)(I)AN (AM)ERICA
I’m an albino myself and thought the writing was weak. Everything was cardboard thick. In the end she treated albinism like something that is literally skin deep. Just because she didn’t stray to the usual tropes, doesn’t mean she represented albinism well at all. It’s like she didn’t even bother reading a simple Wikipedia article.

domain: entertainment


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Texas becomes first US state to ban warrantless email SNOOPING!
Texas has become the first US state to ban email snooping without a warrant. Governor Rick Perry signed the new privacy bill – HB 2268 – into law on Friday. It went into effect immediately. The bill enacts a law that sets Texas residents apart from the other 49 states by protecting them from state and local law enforcement surveillance carried out without a warrant.
-Well it’s a start, but I’m not sure on how much I trust them, but I will give them the benefit of the doubt for now! Trust has to start somewhere!

domain: law


Linux Debugger configuration
The debugging of Miosix on Linux can be done through OpenOCD, that creates a bridge between GDB and the JTAG device.
Setting up OpenOCD
sudo apt-get install openocd # Install OpenOCD for Ubuntu/Debian
The OpenOCD configuration is included in the official Miosix distribution under the path 'miosix/arch'. You must choose the proper config file for the device in use. For example for the stm32f429zi_stm32f4discovery board:
openocd -f miosix/arch/cortexM4_stm32f4/stm32f429zi_stm32f4discovery/stm32f4discovery.cfg
OpenOCD provides built-in configuration files for many boards, chips and debugging adapters. You can see the entire range of files in the directory
/usr/share/openocd/scripts. If Miosix does not provide a configuration file for you, in most cases there will be appropriate scripts available together with OpenOCD.
If breakpoints don't work on your board you can try adding the option
-c 'gdb_breakpoint_override hard' to the OpenOCD invocation. This option disables GDB software breakpoints and always forces the use of hardware breakpoints, which might be needed if OpenOCD provides an incomplete memory map to GDB.
Debugging with GDB
The GDB used is provided by the official Miosix Toolchain. If you haven't already installed it's time to do it. The debugger must be launched on the ELF binary file.
OpenOCD provide a network interface for connect the debugger, the follow command is necessary for establish the connection:
(gdb) target remote <ip>:<port>
The default socket is listening on port 3333 in the loopback interface of your computer. So you can use the default command:
(gdb) target remote :3333
Reset the board
After the connection (and after each change of configuration) you must reset the board in a safe state:
(gdb) monitor reset halt
Flash a new firmware
If you want to upload to the board a new firmware version you can made it through gdb and OpenOCD, you must indicate the binary file and the address of the flash memory of your board:
(gdb) monitor flash write_image erase main.bin 0x08000000
It's often necessary to perform a reset of the board before and after the firmware upload.


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City Election Early Voting To Be Held At Greenwood City Hall
Early voting for the Nov. 10 City Election will be held at Greenwood City Hall, according to a news release from Sebastian County Clerk/Recorder Sharon Brooks.
The release states that this was decided by the Sebastian County Board of Elections. Because Greenwood City Hall is so close to the Greenwood Courthouse, early voting for south Sebastian County will not be held at the Greenwood Courthouse location.
According to the release, voters will receive updated Voter ID cards reflecting the change in polling locations from the Office of the Sebastian County Clerk.


New Affordable Housing website for Lower Columbia Region
According to the Greater Trail Skills Centre Executive Director, there's never enough affordable housing around the region, but they're trying to help with a new website.
Morag Carter says the community developed a plan in the past couple of years called Thriving for All, with 5 pillars, one of them being housing.
So housing providers around the community came together to work on a project thanks to some CBT funding, and came up with a website.
The directory provides details of the non-profit affordable housing options available in the region, as well as other services available.
She says there's still a significant need, and stakeholders are also helping to develop and bring on stream more affordable housing for the community.
According to Morag, a recent survey by the LCCDT found that there has been a 10 to 15 percent increase in the cost of rental housing this year.
The new website is www.findaffordablehousing.ca


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Möchten Sie als Ihre Standardwährung festlegen oder nur für diese Sitzung behalten?
Friendly staff, comfortable rooms, rustic decor, pool, dry sauna, fitness room and breakfast all worked for me! Easy location to main street and park. Value price for end of season. I enjoyed my stay and would recommend.
Comfortable spacious lodging well situated to the dining and pub opportunities in the small town center. The gracious lobby had multiple great game trophies to admire and inspect. Staff was welcoming. Great self serve breakfast in a large dining area. Our room with the king size bed had an excellent mattress, much appreciated after a day of exploring the Park.
Close to Yellowstone park entrance and the Rendezvous ski trails. Exceptional value. Very comfortable room. Breakfast included, and involves the use of paper plates and bowls instead of the usual styrofoam, which was appreciated.
The room was clean, spacious, and comfortable. Beds were comfortable. Bathroom was very clean. Bathroom was small, but not uncomfortably so. AC worked well and maintained a consistent room temperature. Internet connected quickly, and was reasonably fast. Big selection of TV channels. Very friendly and helpful staff. Very good value. Convenient location, easy walk to restaurants, bars, and shopping. If you recognize that this is an older, classic style (with real room keys) travel-motel, and have reasonable expectations, you will love this place! Tight parking.
This was one of the best hotels we've stayed in. We got one of the king rooms with hot tub and loved it. We will be staying there many more times.
Room was clean and property was nice. Prices for meals in resturant were very high, but everything in West Yellowstone, MT was overpriced. Holiday Inn is very convenient for visting Yellowstone National Park.
Expensive, out dated rooms in needs of renovation. Noisy, with thin walls. You can hear all conversations from your neighbors. Had to get up twice to report a noisy neighbor above me. The staff finally did something on the second request. In fairness, the hotel management refunded one nights stay as compensation. Will not stay there again.
The bed was comfy and soft and the rim was clean. The breakfast was very mediocre for the price of the hotel.
Staff were very helpful even when the cattle bus arrived with 60 people standing in the lobby and we could not even get in to go to our room! The TV is much too limited with no direct TV or good channels and no guide for the channel list!


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Minecraft: Pocket Edition for iOS (Minecraft for iOS 1.12 for short) is a building survival game created by Mojang and is now available to download on iOS devices.
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domain: game


A “Christmas truce” for landlords and tenants in England and Wales
By John Arnold, Partner and Head of Commercial Law
The UK Government has provided a further update on its eviction legislation for the private rental sector in England and Wales.
An initial ban on evictions, which was introduced at the start of the pandemic and subsequently extended three times, now also requires that landlords give tenants a six-month notice period, meaning that no tenant will find themselves evicted over the winter.
The Government measures also feature a “Christmas truce”, with no evictions permitted in the run-up to, or during the Christmas period, however, this will not apply in serious cases such as; domestic abuse, antisocial behaviour or where tenants have committed fraud.
In addition, if an area goes into a local lockdown that includes a restriction on gathering in homes, evictions will not be enforced by bailiffs.
The return of court proceedings
Court proceedings for evictions are due to resume from 21 September, however if a case does proceed to court, landlords will be required to provide information about how their tenants have been affected by the pandemic. If this information is not provided, a judge will be able to adjourn proceedings.
Housing Secretary Robert Jenrick has said: “We have protected renters during the pandemic by banning evictions for six months – the longest eviction ban in the UK.
“To further support renters we have increased notice periods to six months, an unprecedented measure to help keep people in their homes over the winter months.
“It’s right that we strike a balance between protecting vulnerable renters and ensuring landlords whose tenants have behaved in illegal or anti-social ways have access to justice.”
If you would like any support or advice regarding a landlord or tenant related issue, please contact us on 01244 356 789 or email firstname.lastname@example.org to arrange a free half hour consultation with a member of our Commercial Law team.
Please note: This is not legal advice; it is intended to provide information of general interest about current legal issues.


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Home » Games » Puzzles » Knf Escape With Boat From Villa
Knf Escape With Boat From Villa by Knfgame
Knf Escape With Boat From Villa is the 185th escape game from knfgame.
Knf Bank Robbery Escape is the 120th escape game from KnfGame. The Story of the game is to rob the gold and cash from the bank. Assume that you are a thief, and you have planned to rob a private bank located in your city. Click on the objects to interact with them and solve simple puzzles to open bank secret Locker. Good luck and have fun playing Knf escape games, free online and point and click games.
Knf Immoral House Escape is the 54th game from knfgame. Assume that while you’re in a deep sleep you was disturbed by some evil thoughts, when you open your eyes you found that your locked inside a Immoral house, Now you need to escape from the house. For that you have use solve some puzzles by clicking the object. Find the key soon and escape from the immoral house. Good luck and have fun!
Knf Escape with Helicopter is the 181th escape game from knfgame. Imagine a situation that you are alone in a private village guest house, Only a way you can escape from guest house to give a signal to the helicopter by on or off the swiches. Click on the objects around the guest house and use them to solve some puzzles. Good luck and have fun playing Knf escape games, free online escape and point and click games.
Knf Gold Box Rescue From Stone Forest is the 115th escape game from KnfGame. The Story of the game is you have to rescue a Golden treasure Box from the stone forest. Use the objects around the forest and by solving some puzzles find the Golden treasure box. Good luck and have fun playing Knf escape games, free online and point and click games.
Goat Escape is new escape game from KNFGAME. A goat is tied up to a Stick and it need a food to eat. As player cut the rope and help the goat to escape and get his food.click on objects and solve some puzzles. Good luck and have fun.
More Puzzles Games
Skerry is an intriguing escape game crafted by ENA game studio, this place very secure island and belongs to an entrepreneur . He has habit of collection of different object .Gravity stone can be found in his island house that holds many surprises . Explore this authentic place for clues and decipher interesting puzzles, break through the hurdles to succeed in your attempt..
THE LIGHTING TOWER is a interesting point and click type new escape game developed by ENA Game Studio. Drean up a situation that you went to trip with your father.The place you visited looks amazing world.Unfortunately you missed the way and left your father.Now you have to find the object that help you to escape from that place.keep playing ENA games.
Bakugan coloring page game
25 Piece Jigsaw of the Cartoon Networks Ben 10 Alien Force. Try to complete the puzzle as quickly as you can with or without the background picture to help.
The mystical time crystal part 2 is a point and click adventurous escape game developed by ENA game studios. you have successfully crossed the previous level and got a step closer to the medium, find the medium and know the actual truth and solve the mystery. in this level you will have to deal with deadly traps, cunning puzzles and hidden objects to find clues leading to your missing girlfriend, time to put the foot ahead.


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Four of DeLand's most interesting houses will be open to the public today and Sunday from 1 to 5 p.m.
A tour of homes and gardens sponsored by the Garden Club of DeLand will include Varan and Buddy Sheats' plantation farmhouse, 2665 Stately Oaks Lane; the contemporary home of Edna and Dave Robinson on Orange Camp Road; the French country house of Nancy and Sheldon Hayes, 103 Country Club Drive; and the traditional ranch house of Betty and William Churm at 615 Orange Camp Road.
-- The Sheats' 6,000-square-foot home is patterned after the farmhouses in the Low Country of South Carolina. It was built of pine grown and aged for several years on the Sheats' 91-acre plot.
The farmhouse features wide porches and such antique decorative elements as bathroom fixtures, a Tiffany chandelier in the entrance hall, a mantel from an old Sanford hotel, doors and bathroom fixtures. Also included is a rose garden.
-- The home of builder David Robinson is an Oriental flavored contemporary with pool, pool house, workout room and sauna. Windows and doors areof stained and clear beveled glass and the home is decorated in earthtones and burgundies.
-- The Churms house on Orange Camp Road is known for lovely and extensive gardens planned by Mrs. Churms and planted with dogwoods and azaleas, jasmines and annual beds. The house's decor is traditional and furnishings are antiques and reproductions of antiques.
-- Nancy and Sheldon Hayes' French manor house was built on the foundation of the Hayeses' 1920s Mediterranean that burned several years ago.
Portions of the house, including a wing that is now a guest house, remained and were renovated. The extensive Mediterranean gardens were also untouched and have been restored to their '20s beauty. The Hayes house contains collections of paintings and antiques.
Floral arrangements fashioned by garden club members will decorate each of the homes.
Refreshments will be served at the Robinson house where plants will also be on sale.
Tickets, $10, are available at each tour house. Take Lake Helen exit, No. 55. Follow signs.

domain: design


text:
Last night when i finally slowed down and sat down, I started to crash pretty hard. Just a big wave of *the tired* hit. Slept pretty well and woke up feeling good, so I hit the gym for Chest/Back/Abs day...which felt great! I had a fantastic workout...but on my way home ... the tired wave crashed over me again. Ate, felt a little better..and then there was work. Not really gonna go there, here, but...will leave it at "a trying day" - it just sort of pulled anything/everything I had left, ugh :P
Right about now I'm FREEZING, and plonked out on the sofa with a big fuzzy warm cuddly blanket (thanks Bran :) and watching bad American Idol. Tomorrow is planned as cardio only, plus Softball tomorrow night after work. Can't bail on softball, so a really long day ahead, need to listen to me *carefully* in the morning...
On THAT note...tomorrow is a NEW day and I can look forward to starting it out that way and feeling rested and GOOD. That's how we roll 'round these here parts ;)
Here's how we were rollin' through the workout this morning...
Bench warmups then Week 3 of 5-3-1...
5 x 75
3 x 85
1+ x 95 ... 11 :)
I tried the sort of 'compromise grip,' identified as a possible winner last week :) Mid-palm on rings. I think this is a pretty good spot...a little wobbly at first but I settled into it and felt stable and strong as I worked through the set. Happy with the results, and absolutely a PR with that weight...former PR was for 9.
Also tried the new Rogues with Bench...I wore them for the first 2 short little sets but was NOT digging it, so changed back to sneakers for the long set. I'll try them out a few more times, may just be a matter of getting used to it, but today I wasn't feeling it there at all.
BB Rows: 15 x 65, 12 x 75, 10 x 85, 8 x 95
BB Incline Press: 65 x 12, 12, 10, 10
Supine Pullups: 3 x 6
Freemotion Standing Cable Flys: 15 x 15, 9 x 20
DB Pullovers: 35 x 12, 11 30 x 12, 12
Push-ups SS w/ Back Extensions x 3
12 / 15 @ 25
9 / 15 @ 10
- / 15 @ BW
Hanging Knee Raises (w/4lb ball) SS w/ Cable Crunches (110lbs) x 2
12 / 12
12 / 12
V-Sit Med Ball Twists (w/10lb ball) SS w/ Wtd Crunches (25lb plate) x 2
30 / 30
30 / 30
FB Roll-ins 2 x 12
Bicycle Maneuver 1 x 60 (30/side)
Plank 1 x 75 secs
20 mins SS Cardio (no HIIT today)

domain: hobby


When the opportunity arose to travel to New Zealand as a family to visit the source of our wool we couldn't pass it up. Sourcing the highest quality Merino wool fibre for our garments has been our mission since we launched Wee Woollies more than 5 years ago. It was important for us to know we were using fabric of the highest quality, and that the processes involved in producing it were both safe for the sheep and the environment.
On our quest to source the most ethical, sustainable fibre we discovered ZQ Merino, launched by The New Zealand Merino Company: "to help people understand that their textile choices could be a reflection of their beliefs – you are what you wear – and that Merino, done the right way, was a smart and sustainable choice." Growers show their commitment to the ZQ Merino ethos by meeting the highest standards in the areas of animal welfare, environmental care, and social sustainability, along with delivering premium quality “fit for purpose” fibre.
It's easy to feel good about what you do when you know the foundation for your business reflects your values, but we needed to see it for ourselves! So we set off on a woolly adventure. After two glorious weeks of sailing with my parents in the Bay Of Islands, we headed to the South Island to Merino country.
Boat life in the Bay of Islands, NZ.
Urupukapuka Island. A sheep's paradise!
Our first stop: The New Zealand Merino Co. headquarters in Christchurch to learn more about the innovation and dedication behind New Zealand's Merino wool industry. In true Kiwi style we were greeted with open arms and tremendous enthusiasm for our brand. With the backing and support from such a forward-thinking, environmentally responsible company, who partners with the world's leading brands, we left our meeting recharged and inspired wondering where this journey will take us next. It was absolute validation of what we do and why we do it.
At the New Zealand Merino Company Headquarters in Christchurch, NZ
After a long journey south though the pouring rain and the remnants of a tropical cyclone we finally made it to New Zealand's Southern high country to the town of Middlemarch in the stunning Central Otago region, famous for its Merino sheep. We could only see a a few feet in front of us the rain was so heavy and had no idea what our surroundings looked like, "worst summer on record" our hosts told us - lucky us! Needless to say, when the sky cleared the scenery was breathtaking. Our first day we toured the farm with our fabulous hosts Lynnore and Andrew. They own and operate 7000 acres of land and at various times throughout the year manage 6000 Merino and cross breed sheep for the wool market.
Lynnore and one of her Huntaway dogs working the flock, no matter what the weather. Middlemarch, NZ.
These NZ Heading Dogs are truly brilliant. Animal and human synergy at work.
Flourishing crops in a stress - free environment nourish healthy, happy Merino Sheep who in turn produce high quality fleece - it's complex science at work and truly incredible to see, especially for us city folk. The Merinos graze the higher, dry land and seek shade and shelter under the giant rocks and boulders. The ewes birth their lambs under these rocks; the perfect natural habitat for Merinos - with extreme ranges in temperature and weather conditions and an abundance of grass varieties for them to feed on year round producing the best wool fibre perfected by nature.
Where the Merinos roam. Central Otago, NZ
Watching the process at work was awe-inspiring as Lynnore and Andrew worked together with their dogs to move the sheep from paddock to enclosed pens for "drenching" (to control internal parasites) and then out to another paddock. Their experience as farmers and wool experts runs deep, with a lifetime of farming and accreditations in dog training and wool classing and much more. Visiting the wool shed and feeling and analyzing the wool up close was, to me, like coming full circle. Here we were with our three little inspirations putting our hands in the very raw fibre which will eventually become our garments.
Bringing the sheep in for "drenching" to control internal parasites.
Filip and the kids helping get the job done.
In the wool shed. Lynnore explaining micron count and fibre strength.
Every part of our "on farm" experience blew us away... the kids actually cried when we left, so did we(almost). It could have been the farewell to the litter of puppies, or Ellie and her pony. And for us, home to the world's best Pinot Noir. Well that, and the sheep of course ;)
A final (teary) farewell to Ellie(the farmers' daughter) and Comet in a paradise like no other. Outside our cottage, Middlemarch. NZ
If you have any questions about our adventures in Merino country, please get in touch! email@example.com


2627 Hwy 281 South
Jamestown, ND 58401
Phone: (701) 952-9800
Fax: (701) 952-9803
The Jamestown Country Club offers an 18-hole par 72 championship golf course, a driving range, full-service restaurant and bar, heated swimming pool, and much more.
This 18-hole municipal grass course is operated by the Jamestown Parks and Recreation.
The Jamestown Parks & Recreation Department operates and maintains this Olympic-size pool that includes a separate diving bay and two wading pools.


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Junior Developers, did they teach you debugging in school?
Python is a hot technology that is popping up everywhere. But what do you do when it stops working?
Adventures In Python Debugging is a new ebook that presents strategies and tips whether you are a new developer or just new to Python. Save time by getting a head start on knowing what to do first, and what tools work best.
Here’s a peek at some of the things you will learn about:
- The basic steps of debugging (are you missing the most important step?)
- Using Python’s built in debugger: How to use it and how to make it more awesome
- Tools and techniques for unusual situations
- Preventing bugs from reaching production
- Stories of unusual problems
- Tips for working with APIs
Included in the zip file:
- PDF and EPUB versions of the book
- A quick resources guide to help you get straight to the good stuff and get up and running with best tools available (many are open source and free!).
- Size1.78 MB

domain: library


text:
Read More about Gay Couple Travel: Our City Weekend Nijmegen | The Netherlands
A Gay Couple City Weekend Nijmegen – It is time for Nijmegen, the oldest Dutch city is the fifth destination of our Dutch Gay City Tour in a warming late winter sun. We spent a long weekend in the history-charged charming city in Gelderland close to the German border. While wandering and biking around the unique mixture of a traditional Dutch city with a modern touch in architecture, art, hip and cozy places and along the Waal river, we felt home for some days in our gay-friendly hotel Sleep in Box5. An early warm spring sun, a busy shopping crowd in the city center and abounded spots along the river: Nijmegen has it all. Don’t forget to look up the old Dutch houses, check historical Roman archaeological finds at Valkhof Museum, enjoy a beer and dinner at the Honig Factory and discover the world like blind people do. Follow us on our Gay Couple City Weekend Nijmegen on the scout of history in the summer capital of the Netherlands by the Waal river and see Nijmegen through a couple of men’s eyes.

domain: history


text:
An artfully designed and restored historic residence, immersed in a venerable landscape of the Valle d'Itria, among centuries-old oaks and
thousand-year-old hills, dry-stone walls and the suggestive trulli typical of this strip of Apulian territory. Once you arrive at Trulli Zaccano for Rent with Private Pool, you may never want to
leave. The great advantage of this property is its proximity to a small village in the Valle d'Itria within walking distance, where it is possible to stock up on all basic necessities or enjoy tasty
dinners in small typical restaurants.
The structure is
spread over different levels and has independent rooms with access from the outside. The visitor arrives in the large and bright main courtyard, which leads immediately to the first 4 double
bedrooms, all independent and with en-suite bathrooms, not communicating from the inside with each other. One of these rooms has an alcove with sofa/double bed and is an ideal suite for a family of
4. Furthermore, always accessing it from the outside there is a first equipped kitchen.
From a masonry
hallway, you reach an oasis of peace with a view of the valley and the swimming pool. This area has an independent cottage on two levels consisting of a small garden equipped with seating and a view
of the valley; entering the ground floor, there is an armchair/single bed for a child, bathroom with shower and an iron staircase leads to the loft with double bed.
In total Trulli Zaccano can accommodate 10 adults + 3 children. Simplicity and rurality are the keywords of this residence: all the rooms open onto
a furnished outdoor patio. The turquoise swimming pool is the nerve center and has numerous seats and a stone farmyard with an outdoor lounge to fully enjoy the wonderful sunsets that this property
The garden has been
left in a semi-natural state, with fragrant herbs, wild flowers, dry stone walls, thus blending in with the surrounding countryside. Most of life in Trulli Zaccano takes place outdoors, under the
gazebo equipped for outdoor lunches and dinners and the eat-in kitchen.
Trulli Zaccano is the ideal property for all those who prefer to stay away from crowded tourist destinations and wish to savor the slow, rural life of the
beautiful Valle d'Itria.
INTERNET WI FI, AIR CONDITIONING, BBQ, PRIVATE PARKING, ALARM SYSTEM.
Location: Cisternino (Br)
- 10 in queen beds;
- 2 in sofa double bed
- 1 in sofa bed
- 4 bathrooms with shower;
- 1 bathroom with hot tub
- 1 Lounge Area
- 1 sitting room
- 2 kitchends
- 5 bathrooms
- Square Meters: 250
- Garden 20.000 sqm
- Pool 12x6mt
- 1 parking area
Address: Contrada Zaccano snc
- 7 habitable rooms;
- 5 car parking internal space;
- 1 patio gazebo
- Heating/Air Conditioning;
- Alarm System
- Internet wi fi
Linen and Towels; 5 Electric Cookers; Stoves; Hoven, mixer, coffee machine, Dishwasher, Satellite tv, Frindge; Garden Furniture, pool, heating, air
conditioning; INTERNET WI FI.
Bari Apt 60km, Brindisi Apt 50km, Pub/Restaurants 4km, Shop 4km, Banks 4km, Hospital 4km, Station 4km, Brindisi Port 50km, Beaches 5km (Savelletri, Torre Canne), Golf 2km (Fasano -
Coccaro Golf), Alberobello 20km, Ostuni 10km, Martina Franca 14km, Polignano 20km, Lecce 80km, Taranto 70km.


text: This spice is fabulous. I made the gingerbread cookies and added it to my fruit cake. I also put it in a buttercream icing for some Christmas muffins. I think it’s my favourite of all the spices I have purchased from you. So much so I just ordered 4 more so I have plenty on hand.

domain: food


Dahntay Jones should be kicked out of the NBA indefinitely.
When he applies for readmission, after this season is over, he should be required to explain his rationale behind his cowardly, and dangerous, move of sliding under Kobe Bryant as the Los Angeles Lakers star was attempting a would-be game-tying jumper against the Atlanta Hawks Wednesday night.
The shot missed, Bryant rolled on the floor after landing on Jones’ foot and now Bryant is out indefinitely with a sprained ankle. In fact, Bryant called it the worst sprained ankle of his 17 NBA seasons.
Not only was Jones not disciplined, he wasn’t even called for a foul on the play. At least the NBA acknowledged that Jones should have been called for a foul and Bryant should have been awarded free throws.
That’s not enough, though.
I’m pretty confident that there is an unwritten code of conduct in the NBA. Fouling someone hard to try to prevent him from making a layup - as long as it is not a flagrant foul - does not violate the code. Sliding under a shooter tramples all over it.
The NFL meted out discipline in the New Orleans Saints “bounty scandal,” case. Why no discipline here?
NBA players, as some of the most overpaid people on the planet, should expect tough, even merciless, criticism when they are not performing up to expectations.
They also have the right to expect basic protection when they play. “Protect the shooter,” is a code officials supposedly use from pee wee basketball on up.
Bryant has let his displeasure about the entire situation be known. According to the Associated Press, he tweeted about it and included a hash-tag: “cleanupthegame.”
Kobe has his many fans and his many detractors, but no one can say that the sure first-ballot Hall of Famer is not a tough-minded player. It takes a lot for him to yell “Foul!,” after he has been, well, fouled.
The late great coach Vince Lombardi once said, “The name of the game is to win. Honorably, within the rules, but to win.”
Too many people are ignoring the “Honorably, within the rules,” admonition. They just want to win.
In this case of dishonor, Jones caused Bryant the worst sprained ankle of his career.
I have never been a huge fan of Kobe’s, even when he’s led the Lakers, my favorite NBA team, to championships. I’m with him on this one, though.


Boasting a space-friendly build and a formidable set of hardware, the Acer DQ.VNDAA.002 Desktop PC is everything you need rolled in a singular device. The Veriton Z4820G_Wtub All-in-one PC is a jack of all trades type computing device that brings a lot of function to the table.
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While its singular design is of much help in space optimization, the Acer DQ.VNDAA.002 does its damage in providing you solid internals that lift your efficiency against any workload. Avail this all-in-one PC here at TigerDirect.com!
Acer Veriton Z4820G_Wtub AIO Desktop PC - Intel Core i5-6500 Quad-Core Processor, 3.2GHz, 8GB DDR4, 1TB HDD, Win 7 Pro 64-bit, Win 10 Pro 64-Bit, 23.8" 1920x1080 Full HD - DQ.VNDAA.002Item#: 40100338 | Model#: DQ.VNDAA.002
- In Stock. Usually ships next business day. (Details)
Acer Veriton Z4820G_Wtub AIO Desktop-DQ.VNDAA.002 Product Details
Acer Veriton Z4820G_Wtub AIO Desktop PC
Maximize your productivity in a faster, easier and space-saving manner with the Acer Veriton Z4820G_Wtub AIO Desktop PC. This outstanding all-in-one PC is powered by Intel® Core™ i5-6500 Quad-Core Processor with 3.2GHz speed that assures high productivity and high level multitasking abilities. The 8GB DDR4 RAM maintains a good system speed, prevents lags and slowdowns during intense work or entertainment sessions. The 1TB HDD gives enormous space for storing as well as retrieving important files, documents, downloads, multimedia, digital data etc. You are assured to experience outstanding connectivity with 5x USB 3.0 & 2x USB 2.0 ports. The large 23.8" display screen with full HD (1920x1080) resolution and multi-touch touchscreen makes sure you get to see outstanding and high quality images. Plus, with Windows 7 Pro & Windows 10 Pro operating system you are assured to experience a user friendly interface. Buy your Acer Veriton Z4820G_Wtub AIO Desktop PC now!
What It Is And Why You Need It:
- Intel® Core™ i5-6500 Quad-Core Processor with 3.2GHz speed that assures high productivity
- 8GB DDR4 RAM maintains a good system speed
- 1TB HDD gives enormous space for storing important files
- USB 2.0 & USB 3.0 ports; ensue great connectivity
- 23.8" Full HD Display Screen; assures you get to see high quality images
Additional Resources: Product Manuals
Manufactured by: Acer
Warranty provided by: Acer
UPC No: 4713392461576
Mfg Part No: DQ.VNDAA.002
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The Average Net Worth Of Millennials By Age
Let’s not sugar coat it - we’re all a bit voyeuristic when it comes to other people’s money. How much do you think they make? How much do you think they have? How did they afford that car? Can you believe that so and so is buying a house? So let’s focus on one metric - net worth. And let’s talk about millennials - which is likely you, and is me too.

domain: economics