text:
Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. It has been extensively used in various clinical settings. Based upon recent discoveries related to the systemic effects of voluntary breathing and intrinsic physiological interactions among systems during voluntary breathing, a new EStim protocol, Breathing-controlled Electrical Stimulation (BreEStim), has been developed to augment the effects of electrical stimulation. In BreEStim, a single-pulse electrical stimulus is triggered and delivered to the target area when the airflow rate of an isolated voluntary inspiration reaches the threshold. BreEStim integrates intrinsic physiological interactions that are activated during voluntary breathing and has demonstrated excellent clinical efficacy. Two representative applications of BreEStim are reported with detailed protocols: management of post-stroke finger flexor spasticity and neuropathic pain in spinal cord injury.
20 Related JoVE Articles!
Determining heat and mechanical pain threshold in inflamed skin of human subjects
Institutions: Stanford University School of Medicine.
In a previous article in the Journal of Visualized Experiments we have demonstrated skin microdialysis techniques for the collection of tissue-specific nociceptive and inflammatory biochemicals in humans. In this article we will show pain-testing paradigms that are often used in tandem with microdialysis procedures. Combining pain tests with microdialysis provides the critical link between behavioral and biochemical data that allows identifying key biochemicals responsible for generating and propagating pain.
Two models of evoking pain in inflamed skin of human study participants are shown. The first model evokes pain with aid of heat stimuli. Heat evoked pain as described here is predominantly mediated by small, non-myelinated peripheral nociceptive nerve fibers (C-fibers). The second model evokes pain via punctuated pressure stimuli. Punctuated pressure evoked pain is predominantly mediated by small, myelinated peripheral nociceptive nerve fibers (A-delta fibers). The two models are mechanistically distinct and independently examine nociceptive processing by the two major peripheral nerve fiber populations involved in pain signaling.
Heat pain is evoked with aid of the TSA II, a commercially available thermo-sensory analyzer (Medoc Advanced Medical Systems, Durham, NC). Stimulus configuration and delivery is handled with aid of specific software. Thermodes vary in size and shape but in principle consist of a metal plate that can be heated or cooled at various rates and for different periods of time. Algorithms assessing heat-evoked pain are manifold. In the experiments shown here, study participants are asked to indicate at what point they start experiencing pain while the thermode in contact with skin is heated at a predetermined rate starting at a temperature that does not evoke pain. The thermode temperature at which a subject starts experiencing pain constitutes the heat pain threshold.
Mechanical pain is evoked with punctuated probes. Such probes are commercially available from several manufacturers (von Frey hairs). However, the accuracy of von Frey hairs has been criticized and many investigators use custom made punctuated pressure probes. In the experiments shown here eight custom-made punctuated probes of different weights are applied in consecutive order, a procedure called up-down algorithm, to identify perceptional deflection points, i.e., a change from feeling no pain to feeling pain or vice versa. The average weight causing a perceptional deflection constitutes the mechanical pain threshold.
Medicine, Issue 23, Experimental pain, experimental inflammation, human, skin, heat stimuli, mechanical stimuli, pain threshold, psychophysics, non-myelinated nociceptive nerve fiber, small myelinated nociceptive nerve fiber
Technique and Considerations in the Use of 4x1 Ring High-definition Transcranial Direct Current Stimulation (HD-tDCS)
Institutions: Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Pontifical Catholic University of Ecuador, Charité University Medicine Berlin, The City College of The City University of New York, University of Michigan.
High-definition transcranial direct current stimulation (HD-tDCS) has recently been developed as a noninvasive brain stimulation approach that increases the accuracy of current delivery to the brain by using arrays of smaller "high-definition" electrodes, instead of the larger pad-electrodes of conventional tDCS. Targeting is achieved by energizing electrodes placed in predetermined configurations. One of these is the 4x1-ring configuration. In this approach, a center ring electrode (anode or cathode) overlying the target cortical region is surrounded by four return electrodes, which help circumscribe the area of stimulation. Delivery of 4x1-ring HD-tDCS is capable of inducing significant neurophysiological and clinical effects in both healthy subjects and patients. Furthermore, its tolerability is supported by studies using intensities as high as 2.0 milliamperes for up to twenty minutes.
Even though 4x1 HD-tDCS is simple to perform, correct electrode positioning is important in order to accurately stimulate target cortical regions and exert its neuromodulatory effects. The use of electrodes and hardware that have specifically been tested for HD-tDCS is critical for safety and tolerability. Given that most published studies on 4x1 HD-tDCS have targeted the primary motor cortex (M1), particularly for pain-related outcomes, the purpose of this article is to systematically describe its use for M1 stimulation, as well as the considerations to be taken for safe and effective stimulation. However, the methods outlined here can be adapted for other HD-tDCS configurations and cortical targets.
Medicine, Issue 77, Neurobiology, Neuroscience, Physiology, Anatomy, Biomedical Engineering, Biophysics, Neurophysiology, Nervous System Diseases, Diagnosis, Therapeutics, Anesthesia and Analgesia, Investigative Techniques, Equipment and Supplies, Mental Disorders, Transcranial direct current stimulation, tDCS, High-definition transcranial direct current stimulation, HD-tDCS, Electrical brain stimulation, Transcranial electrical stimulation (tES), Noninvasive Brain Stimulation, Neuromodulation, non-invasive, brain, stimulation, clinical techniques
Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia
Institutions: New York Institute of Technology College of Osteopathic Medicine.
Pneumonia, the inflammatory state of lung tissue primarily due to microbial infection, claimed 52,306 lives in the United States in 20071
and resulted in the hospitalization of 1.1 million patients2
. With an average length of in-patient hospital stay of five days2
, pneumonia and influenza comprise significant financial burden costing the United States $40.2 billion in 20053
. Under the current Infectious Disease Society of America/American Thoracic Society guidelines, standard-of-care recommendations include the rapid administration of an appropriate antibiotic regiment, fluid replacement, and ventilation (if necessary). Non-standard therapies include the use of corticosteroids and statins; however, these therapies lack conclusive supporting evidence4
. (Figure 1)
Osteopathic Manipulative Treatment (OMT) is a cost-effective adjunctive treatment of pneumonia that has been shown to reduce patients’ length of hospital stay, duration of intravenous antibiotics, and incidence of respiratory failure or death when compared to subjects who received conventional care alone5
. The use of manual manipulation techniques for pneumonia was first recorded as early as the Spanish influenza pandemic of 1918, when patients treated with standard medical care had an estimated mortality rate of 33%, compared to a 10% mortality rate in patients treated by osteopathic physicians6
. When applied to the management of pneumonia, manual manipulation techniques bolster lymphatic flow, respiratory function, and immunological defense by targeting anatomical structures involved in the these systems7,8, 9, 10
The objective of this review video-article is three-fold: a) summarize the findings of randomized controlled studies on the efficacy of OMT in adult patients with diagnosed pneumonia, b) demonstrate established protocols utilized by osteopathic physicians treating pneumonia, c) elucidate the physiological mechanisms behind manual manipulation of the respiratory and lymphatic systems. Specifically, we will discuss and demonstrate four routine techniques that address autonomics, lymph drainage, and rib cage mobility: 1) Rib Raising, 2) Thoracic Pump, 3) Doming of the Thoracic Diaphragm, and 4) Muscle Energy for Rib 1.5,11
Medicine, Issue 87, Pneumonia, osteopathic manipulative medicine (OMM) and techniques (OMT), lymphatic, rib raising, thoracic pump, muscle energy, doming diaphragm, alternative treatment
Meal Duration as a Measure of Orofacial Nociceptive Responses in Rodents
Institutions: Texas A&M University Baylor College of Dentistry.
A lengthening in meal duration can be used to measure an increase in orofacial mechanical hyperalgesia having similarities to the guarding behavior of humans with orofacial pain. To measure meal duration unrestrained rats are continuously kept in sound attenuated, computerized feeding modules for days to weeks to record feeding behavior. These sound-attenuated chambers are equipped with chow pellet dispensers. The dispenser has a pellet trough with a photobeam placed at the bottom of the trough and when a rodent removes a pellet from the feeder trough this beam is no longer blocked, signaling the computer to drop another pellet. The computer records the date and time when the pellets were taken from the trough and from this data the experimenter can calculate the meal parameters. When calculating meal parameters a meal was defined based on previous work and was set at 10 min (in other words when the animal does not eat for 10 min that would be the end of the animal's meal) also the minimum meal size was set at 3 pellets. The meal duration, meal number, food intake, meal size and inter-meal interval can then be calculated by the software for any time period that the operator desires. Of the feeding parameters that can be calculated meal duration has been shown to be a continuous noninvasive biological marker of orofacial nociception in male rats and mice and female rats. Meal duration measurements are quantitative, require no training or animal manipulation, require cortical participation, and do not compete with other experimentally induced behaviors. These factors distinguish this assay from other operant or reflex methods for recording orofacial nociception.
Behavior, Issue 83, Pain, rat, nociception, myofacial, orofacial, tooth, temporomandibular joint (TMJ)
Assessment of Morphine-induced Hyperalgesia and Analgesic Tolerance in Mice Using Thermal and Mechanical Nociceptive Modalities
Institutions: Université de Strasbourg.
Opioid-induced hyperalgesia and tolerance severely impact the clinical efficacy of opiates as pain relievers in animals and humans. The molecular mechanisms underlying both phenomena are not well understood and their elucidation should benefit from the study of animal models and from the design of appropriate experimental protocols.
We describe here a methodological approach for inducing, recording and quantifying morphine-induced hyperalgesia as well as for evidencing analgesic tolerance, using the tail-immersion and tail pressure tests in wild-type mice. As shown in the video, the protocol is divided into five sequential steps. Handling and habituation phases allow a safe determination of the basal nociceptive response of the animals. Chronic morphine administration induces significant hyperalgesia as shown by an increase in both thermal and mechanical sensitivity, whereas the comparison of analgesia time-courses after acute or repeated morphine treatment clearly indicates the development of tolerance manifested by a decline in analgesic response amplitude. This protocol may be similarly adapted to genetically modified mice in order to evaluate the role of individual genes in the modulation of nociception and morphine analgesia. It also provides a model system to investigate the effectiveness of potential therapeutic agents to improve opiate analgesic efficacy.
Neuroscience, Issue 89, mice, nociception, tail immersion test, tail pressure test, morphine, analgesia, opioid-induced hyperalgesia, tolerance
Development of a Virtual Reality Assessment of Everyday Living Skills
Institutions: NeuroCog Trials, Inc., Duke-NUS Graduate Medical Center, Duke University Medical Center, Fox Evaluation and Consulting, PLLC, University of Miami Miller School of Medicine.
Cognitive impairments affect the majority of patients with schizophrenia and these impairments predict poor long term psychosocial outcomes. Treatment studies aimed at cognitive impairment in patients with schizophrenia not only require demonstration of improvements on cognitive tests, but also evidence that any cognitive changes lead to clinically meaningful improvements. Measures of “functional capacity” index the extent to which individuals have the potential to perform skills required for real world functioning. Current data do not support the recommendation of any single instrument for measurement of functional capacity. The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is a novel, interactive gaming based measure of functional capacity that uses a realistic simulated environment to recreate routine activities of daily living. Studies are currently underway to evaluate and establish the VRFCAT’s sensitivity, reliability, validity, and practicality. This new measure of functional capacity is practical, relevant, easy to use, and has several features that improve validity and sensitivity of measurement of function in clinical trials of patients with CNS disorders.
Behavior, Issue 86, Virtual Reality, Cognitive Assessment, Functional Capacity, Computer Based Assessment, Schizophrenia, Neuropsychology, Aging, Dementia
Urinary Bladder Distention Evoked Visceromotor Responses as a Model for Bladder Pain in Mice
Institutions: Duquesne University.
Approximately 3-8 million people in the United States suffer from interstitial cystitis/bladder pain syndrome (IC/BPS), a debilitating condition characterized by increased urgency and frequency of urination, as well as nocturia and general pelvic pain, especially upon bladder filling or voiding. Despite years of research, the cause of IC/BPS remains elusive and treatment strategies are unable to provide complete relief to patients. In order to study nervous system contributions to the condition, many animal models have been developed to mimic the pain and symptoms associated with IC/BPS. One such murine model is urinary bladder distension (UBD). In this model, compressed air of a specific pressure is delivered to the bladder of a lightly anesthetized animal over a set period of time. Throughout the procedure, wires in the superior oblique abdominal muscles record electrical activity from the muscle. This activity is known as the visceromotor response (VMR) and is a reliable and reproducible measure of nociception. Here, we describe the steps necessary to perform this technique in mice including surgical manipulations, physiological recording, and data analysis. With the use of this model, the coordination between primary sensory neurons, spinal cord secondary afferents, and higher central nervous system areas involved in bladder pain can be unraveled. This basic science knowledge can then be clinically translated to treat patients suffering from IC/BPS.
Medicine, Issue 86, Bladder pain, electromyogram (EMG), interstitial cystitis/bladder pain syndrome (IC/BPS), urinary bladder distension (UBD), visceromotor response (VMR)
The Use of Magnetic Resonance Spectroscopy as a Tool for the Measurement of Bi-hemispheric Transcranial Electric Stimulation Effects on Primary Motor Cortex Metabolism
Institutions: University of Montréal, McGill University, University of Minnesota.
Transcranial direct current stimulation (tDCS) is a neuromodulation technique that has been increasingly used over the past decade in the treatment of neurological and psychiatric disorders such as stroke and depression. Yet, the mechanisms underlying its ability to modulate brain excitability to improve clinical symptoms remains poorly understood 33
. To help improve this understanding, proton magnetic resonance spectroscopy (1
H-MRS) can be used as it allows the in vivo
quantification of brain metabolites such as γ-aminobutyric acid (GABA) and glutamate in a region-specific manner 41
. In fact, a recent study demonstrated that 1
H-MRS is indeed a powerful means to better understand the effects of tDCS on neurotransmitter concentration 34
. This article aims to describe the complete protocol for combining tDCS (NeuroConn MR compatible stimulator) with 1
H-MRS at 3 T using a MEGA-PRESS sequence. We will describe the impact of a protocol that has shown great promise for the treatment of motor dysfunctions after stroke, which consists of bilateral stimulation of primary motor cortices 27,30,31
. Methodological factors to consider and possible modifications to the protocol are also discussed.
Neuroscience, Issue 93, proton magnetic resonance spectroscopy, transcranial direct current stimulation, primary motor cortex, GABA, glutamate, stroke
Analysis of Nephron Composition and Function in the Adult Zebrafish Kidney
Institutions: University of Notre Dame.
The zebrafish model has emerged as a relevant system to study kidney development, regeneration and disease. Both the embryonic and adult zebrafish kidneys are composed of functional units known as nephrons, which are highly conserved with other vertebrates, including mammals. Research in zebrafish has recently demonstrated that two distinctive phenomena transpire after adult nephrons incur damage: first, there is robust regeneration within existing nephrons that replaces the destroyed tubule epithelial cells; second, entirely new nephrons are produced from renal progenitors in a process known as neonephrogenesis. In contrast, humans and other mammals seem to have only a limited ability for nephron epithelial regeneration. To date, the mechanisms responsible for these kidney regeneration phenomena remain poorly understood. Since adult zebrafish kidneys undergo both nephron epithelial regeneration and neonephrogenesis, they provide an outstanding experimental paradigm to study these events. Further, there is a wide range of genetic and pharmacological tools available in the zebrafish model that can be used to delineate the cellular and molecular mechanisms that regulate renal regeneration. One essential aspect of such research is the evaluation of nephron structure and function. This protocol describes a set of labeling techniques that can be used to gauge renal composition and test nephron functionality in the adult zebrafish kidney. Thus, these methods are widely applicable to the future phenotypic characterization of adult zebrafish kidney injury paradigms, which include but are not limited to, nephrotoxicant exposure regimes or genetic methods of targeted cell death such as the nitroreductase mediated cell ablation technique. Further, these methods could be used to study genetic perturbations in adult kidney formation and could also be applied to assess renal status during chronic disease modeling.
Cellular Biology, Issue 90,
zebrafish; kidney; nephron; nephrology; renal; regeneration; proximal tubule; distal tubule; segment; mesonephros; physiology; acute kidney injury (AKI)
Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation
Institutions: Piedmont Heart Institute, Medtronic Inc..
Cryoballoon ablation (CBA) is an established therapy for atrial fibrillation (AF). Pulmonary vein (PV) occlusion is essential for achieving antral contact and PV isolation and is typically assessed by contrast injection. We present a novel method of direct pressure monitoring for assessment of PV occlusion.
Transcatheter pressure is monitored during balloon advancement to the PV antrum. Pressure is recorded via a single pressure transducer connected to the inner lumen of the cryoballoon. Pressure curve characteristics are used to assess occlusion in conjunction with fluoroscopic or intracardiac echocardiography (ICE) guidance. PV occlusion is confirmed when loss of typical left atrial (LA) pressure waveform is observed with recordings of PA pressure characteristics (no A wave and rapid V wave upstroke). Complete pulmonary vein occlusion as assessed with this technique has been confirmed with concurrent contrast utilization during the initial testing of the technique and has been shown to be highly accurate and readily reproducible.
We evaluated the efficacy of this novel technique in 35 patients. A total of 128 veins were assessed for occlusion with the cryoballoon utilizing the pressure monitoring technique; occlusive pressure was demonstrated in 113 veins with resultant successful pulmonary vein isolation in 111 veins (98.2%). Occlusion was confirmed with subsequent contrast injection during the initial ten procedures, after which contrast utilization was rapidly reduced or eliminated given the highly accurate identification of occlusive pressure waveform with limited initial training.
Verification of PV occlusive pressure during CBA is a novel approach to assessing effective PV occlusion and it accurately predicts electrical isolation. Utilization of this method results in significant decrease in fluoroscopy time and volume of contrast.
Medicine, Issue 72, Anatomy, Physiology, Cardiology, Biomedical Engineering, Surgery, Cardiovascular System, Cardiovascular Diseases, Surgical Procedures, Operative, Investigative Techniques, Atrial fibrillation, Cryoballoon Ablation, Pulmonary Vein Occlusion, Pulmonary Vein Isolation, electrophysiology, catheterizatoin, heart, vein, clinical, surgical device, surgical techniques
A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Institutions: University of Nevada, Reno, St. Joseph's Medical Center, University of Rochester Medical Center .
Each year, an estimated 785,000 Americans will have a new coronary attack, or acute coronary syndrome (ACS). The pathophysiology of ACS involves rupture of an atherosclerotic plaque; hence, treatment is aimed at plaque stabilization in order to prevent cellular death. However, there is considerable debate among clinicians, about which treatment pathway is best: early invasive using percutaneous coronary intervention (PCI/stent) when indicated or a conservative approach (i.e.
, medication only with PCI/stent if recurrent symptoms occur).
There are three types of ACS: ST elevation myocardial infarction (STEMI), non-ST elevation MI (NSTEMI), and unstable angina (UA). Among the three types, NSTEMI/UA is nearly four times as common as STEMI. Treatment decisions for NSTEMI/UA are based largely on symptoms and resting or exercise electrocardiograms (ECG). However, because of the dynamic and unpredictable nature of the atherosclerotic plaque, these methods often under detect myocardial ischemia because symptoms are unreliable, and/or continuous ECG monitoring was not utilized.
Continuous 12-lead ECG monitoring, which is both inexpensive and non-invasive, can identify transient episodes of myocardial ischemia, a precursor to MI, even when asymptomatic. However, continuous 12-lead ECG monitoring is not usual hospital practice; rather, only two leads are typically monitored. Information obtained with 12-lead ECG monitoring might provide useful information for deciding the best ACS treatment.
Therefore, using 12-lead ECG monitoring, the COMPARE Study (electroC
n of ischeM
sive to phaR
atment) was designed to assess the frequency and clinical consequences of transient myocardial ischemia, in patients with NSTEMI/UA treated with either early invasive PCI/stent or those managed conservatively (medications or PCI/stent following recurrent symptoms). The purpose of this manuscript is to describe the methodology used in the COMPARE Study.
Permission to proceed with this study was obtained from the Institutional Review Board of the hospital and the university. Research nurses identify hospitalized patients from the emergency department and telemetry unit with suspected ACS. Once consented, a 12-lead ECG Holter monitor is applied, and remains in place during the patient's entire hospital stay. Patients are also maintained on the routine bedside ECG monitoring system per hospital protocol. Off-line ECG analysis is done using sophisticated software and careful human oversight.
Medicine, Issue 70, Anatomy, Physiology, Cardiology, Myocardial Ischemia, Cardiovascular Diseases, Health Occupations, Health Care, transient myocardial ischemia, Acute Coronary Syndrome, electrocardiogram, ST-segment monitoring, Holter monitoring, research methodology
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Institutions: University of Washington School of Medicine.
Many women undergo cesarean delivery without problems, however some experience significant pain after cesarean section. Pain is associated with negative short-term and long-term effects on the mother. Prior to women undergoing surgery, can we predict who is at risk for developing significant postoperative pain and potentially prevent or minimize its negative consequences? These are the fundamental questions that a team from the University of Washington, Stanford University, the Catholic University in Brussels, Belgium, Santa Joana Women's Hospital in São Paulo, Brazil, and Rambam Medical Center in Israel is currently evaluating in an international research collaboration. The ultimate goal of this project is to provide optimal pain relief during and after cesarean section by offering individualized anesthetic care to women who appear to be more 'susceptible' to pain after surgery.
A significant number of women experience moderate or severe acute post-partum pain after vaginal and cesarean deliveries. 1
Furthermore, 10-15% of women suffer chronic persistent pain after cesarean section. 2
With constant increase in cesarean rates in the US 3
and the already high rate in Brazil, this is bound to create a significant public health problem. When questioning women's fears and expectations from cesarean section, pain during and after it is their greatest concern. 4
Individual variability in severity of pain after vaginal or operative delivery is influenced by multiple factors including sensitivity to pain, psychological factors, age, and genetics. The unique birth experience leads to unpredictable requirements for analgesics, from 'none at all' to 'very high' doses of pain medication. Pain after cesarean section is an excellent model to study post-operative pain because it is performed on otherwise young and healthy women. Therefore, it is recommended to attenuate the pain during the acute phase because this may lead to chronic pain disorders. The impact of developing persistent pain is immense, since it may impair not only the ability of women to care for their child in the immediate postpartum period, but also their own well being for a long period of time.
In a series of projects, an international research network is currently investigating the effect of pregnancy on pain modulation and ways to predict who will suffer acute severe pain and potentially chronic pain, by using simple pain tests and questionnaires in combination with genetic analysis. A relatively recent approach to investigate pain modulation is via the psychophysical measure of Diffuse Noxious Inhibitory Control (DNIC). This pain-modulating process is the neurophysiological basis for the well-known phenomenon of 'pain inhibits pain' from remote areas of the body. The DNIC paradigm has evolved recently into a clinical tool and simple test and has been shown to be a predictor of post-operative pain.5
Since pregnancy is associated with decreased pain sensitivity and/or enhanced processes of pain modulation, using tests that investigate pain modulation should provide a better understanding of the pathways involved with pregnancy-induced analgesia and may help predict pain outcomes during labor and delivery. For those women delivering by cesarean section, a DNIC test performed prior to surgery along with psychosocial questionnaires and genetic tests should enable one to identify women prone to suffer severe post-cesarean pain and persistent pain. These clinical tests should allow anesthesiologists to offer not only personalized medicine to women with the promise to improve well-being and satisfaction, but also a reduction in the overall cost of perioperative and long term care due to pain and suffering. On a larger scale, these tests that explore pain modulation may become bedside screening tests to predict the development of pain disorders following surgery.
JoVE Medicine, Issue 35, diffuse noxious inhibitory control, DNIC, temporal summation, TS, psychophysical testing, endogenous analgesia, pain modulation, pregnancy-induced analgesia, cesarean section, post-operative pain, prediction
Reverse Total Shoulder Arthroplasty
Institutions: Case Western Reserve University.
Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in patients who were not appropriate for tendon transfer reconstructions. Traditional surgical options for these patients were limited and functional results were sub-optimal and at times catastrophic. The use of reverse shoulder arthroplasty has been found to effectively restore these patients function and relieve symptoms associated with their disease. The procedure can be done through two approaches, the deltopectoral or the superolateral. Complication rates associated with the use of the prosthesis have ranged from 8-60% with more recent reports trending lower as experienced is gained. Salvage options for a failed reverse shoulder prosthesis are limited and often have significant associated disability. Indications for the use of this prosthesis continue to be evaluated including its use for revision arthroplasty, proximal humeral fracture and tumor. Careful patient selection is essential because of the significant risks associated with the procedure.
Medicine, Issue 53, Reverse, Total, Shoulder, Arthroplasty, Rotator Cuff, Arthropathy, Arthritis, Glenoid, Humerus, Fracture
Community-based Adapted Tango Dancing for Individuals with Parkinson's Disease and Older Adults
Institutions: Emory University School of Medicine, Brigham and Woman‘s Hospital and Massachusetts General Hospital.
Adapted tango dancing improves mobility and balance in older adults and additional populations with balance impairments. It is composed of very simple step elements. Adapted tango involves movement initiation and cessation, multi-directional perturbations, varied speeds and rhythms. Focus on foot placement, whole body coordination, and attention to partner, path of movement, and aesthetics likely underlie adapted tango’s demonstrated efficacy for improving mobility and balance. In this paper, we describe the methodology to disseminate the adapted tango teaching methods to dance instructor trainees and to implement the adapted tango by the trainees in the community for older adults and individuals with Parkinson’s Disease (PD). Efficacy in improving mobility (measured with the Timed Up and Go, Tandem stance, Berg Balance Scale, Gait Speed and 30 sec chair stand), safety and fidelity of the program is maximized through targeted instructor and volunteer training and a structured detailed syllabus outlining class practices and progression.
Behavior, Issue 94, Dance, tango, balance, pedagogy, dissemination, exercise, older adults, Parkinson's Disease, mobility impairments, falls
The Spared Nerve Injury (SNI) Model of Induced Mechanical Allodynia in Mice
Institutions: Aarhus University, University of Copenhagen.
Peripheral neuropathic pain is a severe chronic pain condition which may result from trauma to sensory nerves in the peripheral nervous system. The spared nerve injury (SNI) model induces symptoms of neuropathic pain such as mechanical allodynia i.e. pain due to tactile stimuli that do not normally provoke a painful response .
The SNI mouse model involves ligation of two of the three branches of the sciatic nerve (the tibial nerve and the common peroneal nerve), while the sural nerve is left intact . The lesion results in marked hypersensitivity in the lateral area of the paw, which is innervated by the spared sural nerve. The non-operated side of the mouse can be used as a control. The advantages of the SNI model are the robustness of the response and that it doesn’t require expert microsurgical skills.
The threshold for mechanical pain response is determined by testing with von Frey filaments of increasing bending force, which are repetitively pressed against the lateral area of the paw , . A positive pain reaction is defined as sudden paw withdrawal, flinching and/or paw licking induced by the filament. A positive response in three out of five repetitive stimuli is defined as the pain threshold.
As demonstrated in the video protocol, C57BL/6 mice experience profound allodynia as early as the day following surgery and maintain this for several weeks.
Neuroscience, Issue 54, Sciatic, Injury, PNS, Mechanical allodynia, Neuropathic pain, von Frey
Acute and Chronic Tactile Sensory Testing after Spinal Cord Injury in Rats
Institutions: School of Allied Medical Professions, The Ohio State University, Drexel University College of Medicine.
Spinal cord injury (SCI) impairs sensory systems causing allodynia1-8
. To identify cellular and molecular causes of allodynia, sensitive and valid sensory testing in rat SCI models is needed. However, until recently, no single testing approach had been validated for SCI so that standardized methods have not been implemented across labs. Additionally, available testing methods could not be implemented acutely or when severe motor impairments existed, preventing studies of the development of SCI-induced allodynia3
. Here we present two validated sensory testing methods using von Frey Hair (VFH) monofilaments which quantify changes in tactile sensory thresholds after SCI4-5
. One test is the well-established Up-Down test which demonstrates high sensitivity and specificity across different SCI severities when tested chronically5
. The other test is a newly-developed dorsal VFH test that can be applied acutely after SCI when allodynia develops, prior to motor recovery4-5
. Each VFH monofilament applies a calibrated force when touched to the skin of the hind paw until it bends. In the up-down method, alternating VFHs of higher or lower forces are used on the plantar L5 dermatome to delineate flexor withdrawal thresholds. Successively higher forces are applied until withdrawal occurs then lower force VFHs are used until withdrawal ceases. The tactile threshold reflects the force required to elicit withdrawal in 50% of the stimuli. For the new test, each VFH is applied to the dorsal L5 dermatome of the paw while the rat is supported by the examiner. The VFH stimulation occurs in ascending order of force until at least 2 of 3 applications at a given force produces paw withdrawal. Tactile sensory threshold is the lowest force to elicit withdrawal 66% of the time. Acclimation, testing and scoring procedures are described. Aberrant trials that require a retest and typical trials are defined. Animal use was approved by Ohio State University Animal Care and Use Committee.
Medicine, Issue 62, Rat, neuropathic pain, allodynia, tactile sensation, spinal cord injury, SCI, von Frey monofilaments
Chronic Constriction of the Sciatic Nerve and Pain Hypersensitivity Testing in Rats
Institutions: University of New South Wales .
Chronic neuropathic pain, resulting from damage to the central or peripheral nervous system, is a prevalent and debilitating condition, affecting 7-18% of the population1,2
. Symptoms include spontaneous (tingling, burning, electric-shock like) pain, dysaesthesia, paraesthesia, allodynia (pain resulting from normally non-painful stimuli) and hyperalgesia (an increased response to painful stimuli). The sensory symptoms are co-morbid with behavioural disabilities, such as insomnia and depression. To study chronic neuropathic pain several animal models mimicking peripheral nerve injury have been developed, one of the most widely used is Bennett and Xie's (1988) unilateral sciatic nerve chronic constriction injury (CCI)3
). Here we present a method for performing CCI and testing pain hypersensitivity.
CCI is performed under anaesthesia, with the sciatic nerve on one side exposed by making a skin incision, and cutting through the connective tissue between the gluteus superficialis and biceps femoris muscles. Four chromic gut ligatures are tied loosely around the sciatic nerve at 1 mm intervals, to just occlude but not arrest epineural blood flow. The wound is closed with sutures in the muscle and staples in the skin. The animal is then allowed to recover from surgery for 24 hrs before pain hypersensitivity testing begins.
For behavioural testing, rats are placed into the testing apparatus and are allowed to habituate to the testing procedure. The area tested is the mid-plantar surface of the hindpaw (Figure 2
), which falls within the sciatic nerve distribution. Mechanical withdrawal threshold is assessed by mechanically stimulating both injured and uninjured hindpaws using an electronic dynamic plantar von Frey aesthesiometer or manual von Frey hairs4
. The mechanical withdrawal threshold is the maximum pressure exerted (in grams) that triggers paw withdrawal. For measurement of thermal withdrawal latency, first described by Hargreaves et al
(1988), the hindpaw is exposed to a beam of radiant heat through a transparent glass surface using a plantar analgesia meter5,6
. The withdrawal latency to the heat stimulus is recorded as the time for paw withdrawal in both injured and uninjured hindpaws. Following CCI, mechanical withdrawal threshold, as well as thermal withdrawal latency in the injured paw are both significantly reduced, compared to baseline measurements and the uninjured paw (Figure 3
). The CCI model of peripheral nerve injury combined with pain hypersensitivity testing provides a model system to investigate the effectiveness of potential therapeutic agents to modify chronic neuropathic pain. In our laboratory, we utilise CCI alongside thermal and mechanical sensitivity of the hindpaws to investigate the role of neuro-immune interactions in the pathogenesis and treatment of neuropathic pain.
Medicine, Issue 61, Neuropathic pain, sciatic nerve, chronic constriction injury, pain hypersensitivity
Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity
Institutions: Greenville Hospital System, Duke University Health System, Duke University .
Endometriosis is a common disease affecting 40 to 70% of reproductive-aged women with chronic pelvic pain (CPP) and/or infertility. The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surfaces during laparoscopy (L/S) to detect the loss of peritoneal integrity in patients with pelvic pain and suspected endometriosis. Forty women with CPP and 5 women without pain were evaluated in this pilot study. During L/S, concentrated dye was sprayed onto peritoneal surfaces, then aspirated and rinsed with Lactated Ringers solution. Areas of localized dye uptake were evaluated for the presence of visible endometriotic lesions. Areas of intense peritoneal staining were resected and some fixed in 2.5% buffered gluteraldehyde and examined by scanning (SEM) electron microscopy. Blue dye uptake was more common in women with endometriosis and chronic pelvic pain than controls (85% vs. 40%). Resection of the blue stained areas revealed endometriosis by SEM and loss of peritoneal cell-cell contact compared to normal, non-staining peritoneum. Affected peritoneum was associated with visible endometriotic implants in most but not all patients. Subjective pain relief was reported in 80% of subjects. Based on scanning electron microscopy, we conclude that endometrial cells extend well beyond visible implants of endometriosis and appear to disrupt the underlying mesothelium. Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity, allowing menstrual or ovulatory blood and associated pain factors access to underlying sensory nerves. Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP. This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at L/S and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy.
Medicine, Issue 70, Anatomy, Physiology, Endocrinology, Obstetrics, Gynecology, Surgery, endometriosis, pelvic pain, dysmenorrhea, diagnostics, laparoscopy, peritoneum, scanning electron microscopy, SEM
Demonstration of Cutaneous Allodynia in Association with Chronic Pelvic Pain
Institutions: University of Calgary.
Pelvic pain is a common condition that is associated with dysmenorrhea and endometriosis. In some women the severe episodes of cyclic pain change and the resultant pain becomes continuous and this condition becomes known as Chronic Pelvic Pain. This state can be present even after the appropriate medical or surgical therapy has been instituted. It can be associated with pain and tenderness in the muscles of the abdomen wall and intra-pelvic muscles leading to severe dyspareunia. Additional symptoms of irritable bowel and interstitial cystitis are common. A common sign of the development of this state is the emergence of cutaneous allodynia
which emerges from the so-called viscero-somatic reflex. A simple bedside test for the presence of cutaneous allodynia
is presented that does not require excessive time or special equipment. This test builds on previous work associated with changes in sensation related to gall bladder function and the viscera-somatic reflex(1;2).
The test is undertaken with the subject s permission after an explanation of how the test will be performed. Allodynia
refers to a condition in which a stimulus that is not normally painful is interpreted by the subject as painful. In this instance the light touch associated with a cotton-tipped applicator would not be expected to be painful. A positive test is however noted by the woman as suddenly painful or suddenly sharp. The patterns of this sensation are usually in a discrete pattern of a dermatome of the nerves that innervate the pelvis.
The underlying pathology is now interpreted as evidence of neuroplasticity as a consequence of severe and repeating pain with changes in the functions of the dorsal horns of the spinal cord that results in altered function of visceral tissues and resultant somatic symptoms(3).
The importance of recognizing the condition lies in an awareness that this process may present coincidentally with the initiating condition or after it has been treated. It also permits the clinician to evaluate the situation from the perspective that alternative explanations for the pain may be present that may not require additional surgery.
Medicine, Issue 28, Chronic pelvic pain, cutaneous allodynia, trigger points, dysmenorrhea, endometriosis, dyspareunia
Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Institutions: Brandeis University, Brandeis University.
The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is respect for patient's values, preferences, and expressed needs. Yet specific approaches to gaining this understanding and translating it to quality care in the clinical setting are lacking. From a patient perspective quality is not a simple concept but is best understood in terms of five dimensions: technical outcomes; decision-making efficiency; amenities and convenience; information and emotional support; and overall patient satisfaction. Failure to consider quality from this five-pronged perspective results in a focus on medical outcomes, without considering the processes central to quality from the patient's perspective and vital to achieving good outcomes. In this paper, we argue for applying the concept of fair process in clinical settings. Fair process involves using a collaborative approach to exploring diagnostic issues and treatments with patients, explaining the rationale for decisions, setting expectations about roles and responsibilities, and implementing a core plan and ongoing evaluation. Fair process opens the door to bringing patient expertise into the clinical setting and the work of developing health care goals and strategies. This paper provides a step by step illustration of an innovative visual approach, called photovoice or photo-elicitation, to achieve fair process in clinical work with acquired brain injury survivors and others living with chronic health conditions. Applying this visual tool and methodology in the clinical setting will enhance patient-provider communication; engage patients as partners in identifying challenges, strengths, goals, and strategies; and support evaluation of progress over time. Asking patients to bring visuals of their lives into the clinical interaction can help to illuminate gaps in clinical knowledge, forge better therapeutic relationships with patients living with chronic conditions such as brain injury, and identify patient-centered goals and possibilities for healing. The process illustrated here can be used by clinicians, (primary care physicians, rehabilitation therapists, neurologists, neuropsychologists, psychologists, and others) working with people living with chronic conditions such as acquired brain injury, mental illness, physical disabilities, HIV/AIDS, substance abuse, or post-traumatic stress, and by leaders of support groups for the types of patients described above and their family members or caregivers.
Medicine, Issue 48, person-centered care, participatory visual methods, photovoice, photo-elicitation, narrative medicine, acquired brain injury, disability, rehabilitation, palliative care


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Henderson Castle Bed & Breakfast and Winery
Welcome to The Henderson Castle, the most popular bed and breakfast in Kalamazoo. Whether you're local or coming from Grand Rapids, Detroit, Lansing, South Bend or Chicago, you'll find us to be the best destination for your anniversary, birthday, wedding, graduation or romantic getaway. Situated in the historic West Main Hill neighborhood, you’re minutes away from the theatres, shopping and vibrant night life of downtown Kalamazoo. Get a massage, facial or manicure in our day spa. Soak in our rooftop hot tub while taking in the best view of downtown Kalamazoo that’s available. Stay for dinner at our restaurant and indulge in the finest French food southwest Michigan has to offer. Why settle for a hotel - instead experience luxury fit for a King or Queen. In addition to the bed and breakfast, restaurant and spa, we offer a banquet hall and ball room. Our daily tours, princess tea parties, murder mystery dinner party and high tea are fun things to do in Kalamazoo. In the pure French tradition of a wine maker in Bordeaux, the Henderson Castle is proud to announce the completion of our wine cave: a beautiful underground room cut into the hill near the castle connecting to the remains of the old tunnel. The wine cave is complemented by a large patio and sky deck with a view of the orchard and vineyard where we grow the organic fruit used in our wine and jams. We currently feature six varieties of wine.
|Season(s) of Operation||

domain: travel


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Welcome to Round 3 of Battle of the Culottes !
The competition is hotting up in the Culottes Off with one win each to Rachel and Nikki.
Going into Round 3 our next two contenders are arguably some of the most hotly anticipated!! Both big hitters, the Flint Pants by Megan Nielsen are seasoned professionals BUT can the plucky new Ultimate Culottes from Sew Over It put up a good fight and take the crown?? Let’s find out….
Ding Ding! Round 3!
In this battle we decided to look at slightly more structured culottes with a few extra design elements, although both patterns are still pretty simple and suitable for beginners.
What patterns did we choose and why?
Rachel chose to make the Flint Pants by Megan Nielsen as they were featured on her Make Nine list for the year. Released in March 2017 there have been over 1000 posts using #mnflint on Instagram alone and so many beautiful variations made. Rachel was drawn to the simplicity of the original light blue denim version and so wanted to recreate something similar. (We were very kindly gifted the Flint pattern to do this review, but we promise it has in no way biased our opinions and the review is open and honest.)
Nikki bought the Ultimate Culottes pattern by Sew Over It they very day it was released! As a big fan of their Ultimate Trousers, she knew the fit would be good for her and that it would be a quick and simple pattern she could try out in lots of different fabrics.
What type of culottes are they?
The Flints are reminiscent of the cropped wide leg pants that have been seen a lot on the high street this past year, probably more accurately called a “gaucho pant”. However the Ultimates have a fuller hem and are probably a truer example of a traditional “culotte”.
There are a few other patterns available with a similar shape and style. Here are some of our favourites:
And, as we keep saying, keep your eyes peeled for vintage patterns too as a retro flared trouser like these beauties could easily be shortened into a culotte. (Those purple ones are giving us serious heart eyes!!)
So, let’s get into Flint vs Ultimate!
Megan Nielsen Flint Pants
The Flints are described as a “wide leg cropped pant or shorts with unique crossover details at the side seam”. They have a hidden closure in the left pocket with tucks/pleats at the front, darts in the back and you can choose between a waist tie (which Rachel used) or a button closure. To be honest, the pocket closure takes a little getting used to as it means that your pocket is partially open. But don’t worry, you won’t be flashing anyone!! It’s all very well covered and so no-one else knows it’s there. On the first wear though, Rachel kept thinking she’d found a hole every time she put her hand in her pocket – doh!!
The pattern comes in sizes 0-20 although this wider size range is a recent addition. Rachel had an older version where the sizing is XS-XL making the largest size a 16. This was fine for her as she blended between a 14 (L) at the waist and a 16 (XL) at the hips. But if you already have an older version of the pattern and need a larger size, you are entitled to a free download with the new sizing. (You should have been sent an email to that effect, but if you don’t have one, just drop the peeps at MN a message and they can sort it out for you.)
For the fabric, Rachel used a 4oz light blue denim she bought from Doughty’s Online. It is just a little bit heavier than a chambray but still light and airy. It does crease a lot but, to be honest, most fabrics used on a wide leg trouser will crease as there is so much fabric to sit on!
The instructions were simple to follow, very well illustrated and as long as you read them properly will steer you well.
At one stage, Rachel went on auto pilot and nearly constructed both of her pockets before remembering that the hidden closure would have specific instructions. Luckily she’d only pinned it, so no unpickers were needed! In total, they took about 3 hours to sew.
The trousers have a nice wide waistband and a deep hem. They look fab in a plain fabric but would also look amazing in a bold print. The visible details are minimal and so a print would really sing. Rachel opted for the standard length, which is slightly longer than your average culotte, but it could easily be shortened to whatever length you prefer.
Overall, this pattern is bit hit and Rachel was really happy with the finished product – going so far as to say they are her favourites yet!!
Sew Over It Ultimate Culottes
The Ultimate Culottes are described as a “a simple pair of flattering, oh-so-easy-to-sew wide-legged cropped trousers”. Described as an Advanced Beginner pattern they have a two darts in the front, four at the back and a invisible zipper at the side. They are finished with a choice of facing (which Nikki chose) or waistband with belt loops.
The pattern comes in sizes 8-20 and Nikki made a size 14 but they did come up a little roomy and she thinks she might go down a size on the next pair.
For the fabric, Nikki used an upholstery weight cotton ticking that she also bought from Doughty’s Online (she just loves a bit of upholstery fabric for dressmaking!). It handles like a mid-weight denim so it is very stable and easy to sew. Plus it has lots of structure so really emphasises the wide leg!
The instructions were very simple to follow. It comes with a separate booklet with colour photos and a list of Top Tips. They took her just over 2 hours to sew.
The simple design looks amazing in Nikki’s bold print but would work just as well in a plain fabric or something with a smaller print. We’ve seen lots of version in a more drapey fabric too, so you could always opt for that if you want a softer look.
Overall, Nikki loved the pattern and is over the moon with her “deck chair culottes”! Just don’t sit on her!!
And who is the winner of this round?
So, without wanting to be overly critical, Rachel thought that the design of the Ultimate Culottes was just too simple to compete with the arguably more stylish Flint pants. She is already a big fan of the Butterick B6178 which is a very similar design to the Ultimates, but includes more variations, so she does not think she would make the Ultimates herself.
Nikki on the other hand loves the look of the Flints and is sure she wants to make a pair for herself. So by that reckoning, it would appear that the Flints are the clear winner!!
If you want to watch the battle and see lots more pictures, why not head over and check out the YouTube video!
Whats coming in Battle of the Culottes Round 4 ?
In the final battle we will be ramping things up a level with the most tailored culottes we could find. Nikki will be pitting the Tanner Culottes by Designer Stitch against Rachel’s Classix Nouveau Camera Ready Culottes by Hot Patterns.
Who will be the overall winner? Tune in to find out next week when we’ll also be looking at how to style culottes for different body shapes!
Are you enjoying this series? We’d love to hear from you! Please comment below and let us know what you think.
Thanks for stopping by!
Nikki & Rachel x

domain: design


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Articles about Matthew McConaughey
09 Mar 2022Entertainment
Relationships in Hollywood are more often than not messy affairs with little hope for forever afters.
27 Dec 2021Entertainment
Jean-Marc Vallée, director of films like Dallas Buyers Club, Wild, and acclaimed shows like Big Little Lies, and Sharp Objects, breathed his last on Sunday.
21 Mar 2021Entertainment
Hollywood actor Matthew McConaughey has said that he's seriously considering a run at becoming the Governor of Texas.
15 Nov 2020Entertainment
The chemistry between Matthew McConaughey and Kate Hudson is too scintillating to miss in How to Lose a Guy in 10 Days.
19 Sep 2020Entertainment
Reliving a comedy to raise funds for COVID-19 is a great idea. And when it brings together several top stars, it just doubles the fun!
16 Apr 2020Entertainment
If you have ever dreamt of working with Hollywood greats like Martin Scorsese, Robert De Niro, and Leonardo DiCaprio, now is the time to make it happen.
24 Mar 2020Entertainment
From heart-warming, mildly weird to downright outrageous, celebrity reactions to the ongoing coronavirus pandemic have been pretty varied so far.

domain: artistic


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182G Tall Peak - A favorite image to go above your horizons. Brings a sense of
majesty/grandeur to a scene. Stamp it above a water scene and do it again only
upside down in the water itself to act as a reflection. I like stamping it out and
toning it in so I can pull out highlights on the peaks with white gel pens. It gives
the appearance of light hitting certain areas or acting as snow capped peaks.
Another favorite thing to do is to stamp clouds below the summit to really give the
appearance of great height and scale.

domain: hobby


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I got a box of comics in from the folks at Discount Comic Book Service in yesterday evening. Some of the highlights so far are:
Spider-Man Human Torch #1 - Dan Slott somehow manages to tell a hilarious story, despite the fact that the two leads are enormous jerks. Thus remaining true to the original stories, but with a modern sensibility that keeps things fun.
She-Hulk #11 - I like how they explain away what seems to be some very stupid sounding continuity from Avengers quickly. With Doc Samson having the quote :
It's called life, Jen. You don't always get to pick and choose what happens. Sometimes things are out of your control.
Which makes a good point about life, but also about what a creator who chooses to work on franchise characters in a shared universe must deal with. Where others may do something to your character, and you have no say in the matter.
The rest of the issue is a good fight between Jen and a suped up Titania that manages to be interesting if for nothing else but its treatment of the two as just hero and villain. No silly reasoning like jealousy over a boyfriend or looks, as too often happens when women in comics fight.
Love Fights Volume 2 - Haven't read the book yet, but Johanna Draper Carlson's afterword covers two things we are of like mind about. The need to be careful of following characters or creators blindly, and our mutual love for Andi Watson's work.
Stuff I haven't read yet:
Superman: Strength #1 - Interior art reminds me a bit of Jon Bogdanove's work on the Superman titles of the early 90s. I mainly got it for Scott McCloud story, which I'm sure will be strong.
I don't like the binding on the book though, it looks... ugly is all I can think of.
Blade of Kumori #3
Samurai Heaven & Earth #2 - Both titles look interesting, but I'm surprised at how much blood is on both covers.
Hero Squared #1 - I have high hopes for this series from the same creative team behind the classic loony Justice League era of the 1980s.
Anyone know if these are out yet?
Legend of Grimjack TPB 1, FOUR LETTER WORLDS GN, Bizarro World HC and American Flagg Vol 1 & 2 TPBs.

domain: literature


Sunera returned to the scene of her SA Fillies Sprint win, only this time for the country's oldest existing sponsored event, the Gr1 Gilbey Stakes, which is a handicap. This 1200m race also carries the country's top sprint stake.
With stable jockey Felix Coetzee content to ease her back just off the pace after an electrifying break, Sunera tracked the speedy Military Song, Power and Glory and District Attorney early on. Without undue effort form her rider, she made a move on the leaders little more than 300m from the line. From then on it was a case of how far, as she drew away from her rivals for a clear-cut 2½ length victory, with Military Song staying on for second. The filly had started even money favourite, making the race anything but a real handicap.
Carrying 54kg, which was 2.5 kg more than Rotterdam did in establishing his track and race record in '80, Sunera was only .37 seconds off that mark, covering the distance in 1:08,21.
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Chanyeol (22,451 chanyeol fanfics)
“Who are you?”, Baekhyun asked, not reacting to the information the stranger gave him. He put his bag on a chair near the door. “I am Chanyeol guardian of fire and I’m here to protect you Byun Baekhyun.”, he smiled nonchalantly and took a step forward to the smaller who ogled Chanyeol as when he’d found a psychotic who run out of his mental hospital. It wasn’t new to him that students he’d never seen before knew his name but Chanyeol was the first to sound like a freak while talking..
This is the story of Oh Sehun, a young man with a head full of unknown places; where a white "rabbit" frantically worries about the time on his gold chained pocket watch. Where a royal rivalry stirs within a realm named Underland and where he is some sort of savior within this land. Sehun is faced with the harsh reality when his family forces him into a marriage that he would rather wither and disappear from but his world is turned
When Baekhyun wakes to find a very tall strager looming over him after a drunken night out, he finds that everything may not be as it seems. With the help of Chanyeol and his slightly weird group of friends, Baekhyun must figure out how to get back to his own timeline. “Baekhyun I hate to break it to you but time travel is impossible, even in the advanced world of 1995”
What happens when a group of eight college friends living together find three hybrids drenched in the rain sitting on their doorstep?
After brutally messing up one of their company’s biggest sales, Chanyeol and Baekhyun are forced to clean up after the annual Halloween party instead of attending it. The two come to work the day after the party happier than ever, leaving their coworkers to, obviously, suspect that the two have suddenly been possessed. What other reason would two rivals have for them to be this randomly close?
in which chanyeol and baekhyun haven't really seen each other lately , because of chanyeol's work, so what would happen when they finally meet but chanyeol never gave him the attention he needed ...
Park Chanyeol hides his biggest secret behind his long coat, and has been spending an awful lot of time in a coffee shop. Meanwhile, Baekhyun is worried sick because Chanyeol hasn't come home in a month.
a vampire oneshot that is short with chanyeol in mind but you can imagine anyone you like but has to be tall :D


A group of 3rd and 5th year students left Le Havre on Friday 1st May and arrived at destination on Saturday 2nd May. The planning included conferences, visits of museums, factories, research consultancy offices and shipyards.
KONSBERG Maritime : discovery of the K-Bridge and K-Nav systems, of the technology for the DP and bridge simulators, of the assembly and test beds for bridge systems (“black team”), as well as the quality department for manufactured products.
ROLLS-ROYCE: visit of Rolls-Royce’s training centre, presentation of the Rolls-Royce technologies.
ULSTEIN: conference, presentation of the technologies and certificates Ulstein X-Bow and X-stern as well as the projects for the integrated bridge. Visit of the shipyard, assembly of two half hulls and presentation of the technical solutions for the hull developed by Ulstein’s engineers.
KLEVEN: visit of Kleven’s shipyards and three seismic and Offshore vessels at different building stages.
For the students,” the trip was extremely interesting as it allowed us to gain more knowledge especially in simulation, DP, Offshore, LNG propulsion, Bridge Programmes, automation and to have an overview of the technologies which aren’t, yet, well-known on the French market”.


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Humphrey is “plunged into a Jim Crow society for the first time in his life, sees American racism in action, and is deservedly appalled by it,” said Samuel Freedman, a Columbia Journalism School professor.
At the same time, Humphrey makes his first Jewish friend, who tells of five uncles trying to escape Nazi Germany – all of whom are later murdered in the Holocaust. Humphrey also studies with Rudolf Heberle, a German professor who researched how Germany went from democracy to dictatorship within a few years by eroding civil rights.
“Heberle is drawing the parallel between what the Jews suffered at the hands of the Nazis, and what Blacks are suffering under the Jim Crow system in the United States,” Freedman said.
For Humphrey, it’s a lesson that launches him into the Black-Jewish civil rights alliance of Minneapolis in the 1940s, which propels him from activist to mayor, and then to national prominence as a senator and vice-president who helps get the landmark Civil Rights Act of 1964 passed.
That journey is revisited in a new book from Freedman titled “Into the Bright Sunshine: Young Hubert Humphrey and the Fight for Civil Rights.” Freedman writes how Humphrey’s time in Minneapolis set the stage for the Democratic Party’s embrace of civil rights.
“The time has arrived in America for the Democratic Party to get out of the shadow of states’ rights and to walk forthrightly into the bright sunshine of human rights,” Humphrey famously declared at the 1948 Democratic National Convention in a speech credited with getting President Harry Truman re-elected. Shortly after the speech, Truman desegregated the U.S. armed forces.
For Freedman, the book is an opportunity to reevaluate Humphrey’s legacy, marred in his later years by support for the Vietnam War and ill-fated campaigns for president.
“Depending on your age, people either barely know who he was, or tend to remember the later disparaged and defeated Humphrey,” Freedman said. “Not this valiant, idealistic man of the early part of his career.”
An overlooked era
A prolific author and award-winning New York Times columnist (who also lives part-time in the Twin Cities), Freedman had wanted for years to write a book about the period from the mid-1940s through the early ‘50s.
“There was this kind of complacent view that [WWII] ended, and next thing you know, it’s the mid-50s, and everyone’s mowing their lawn in suburbia,” Freedman said. That view overlooks important civil rights activity that laid the foundation for later victories.
But Freedman didn’t know what specific story to write until a 2015 talk by Julian Zelizer about his book, “The Fierce Urgency of Now: Lyndon Johnson, Congress, and the Battle for the Great Society.”
During the Q&A, Freedman’s wife – being a “good Minnesotan” – asked about Hubert Humphrey’s role as Johnson’s vice-president. As soon as Zelizer mentioned the influence of Humphrey’s 1948 speech, “the proverbial light bulb went off,” Freedman said.
“When my wife and I went to dinner after the book event, I said to her, in those words, ‘that’s the book I’ve been looking for.’”
At first, Freedman thought he was writing “Into the Bright Sunshine” just as a book revisiting Humphrey’s legacy. But as the election of President Donald Trump in 2016 dug up a new wave of white supremacy, Humphrey’s early days in Minneapolis felt increasingly – and eerily – relevant.
Humphrey “was in a battle of inclusive democracy against forms of white supremacy, Christian nationalism, and America First-ism,” Freedman said. “Those were the exact terms used, then and now. So it’s important, when we’re in this battle for the sake of our democracy, to realize that it’s a battle that recurs. That we have to be ready, in every generation or two, to fight it again.”
In 2020, Freedman saw another example of Humphrey’s unfinished work left to a new generation: The murder of George Floyd by Minneapolis Police Department officers.
MPD had been notorious for their racism, antisemitism, and brutality even in the 1930s and 40s, with several stories of police violence featured in Freedman’s book. At the behest of Black and Jewish communities, Humphrey took on the police once elected as mayor of Minneapolis in 1945.
Humphrey, and his chosen police chief Ed Ryan, “were in the process of meaningfully reforming the Minneapolis Police force, not only getting rid of the corrupt cops, but sending police officers for human relations training,” Freedman said.
“Humphrey would personally intercede into cases of police brutality. [But] unfortunately for the cause of police reform, Humphrey’s upward mobility into the U.S. Senate, and Ryan’s upward mobility to become Hennepin County Sheriff, meant that they never got to follow [the reforms] through.”
Black-Jewish partnership key to Humphrey
After his time in Louisiana, Humphrey, “instead of coming back [to Minneapolis] and thinking, ‘I’m glad I’m out of the Jim Crow South, the North is so much more enlightened,’ he can see what’s present here in Minneapolis in terms of bigotry,” Freedman said.
Black and Jewish Americans faced housing and job discrimination; a bigoted police force; racism and antisemitism from political figures and university administrators alike; and a variety of white supremacist and Nazi groups.
But, as Freedman puts it, Humphrey still needed more tutelage to understand how to fight discrimination. To that end, he connected with Cecil Newman, founder of the Black newspaper the Minnesota Spokesman-Recorder, and Sam Scheiner, a lawyer and jazz pianist who led what became the Jewish Community Relations Council of Minnesota and the Dakotas.
Newman and Scheiner “knew each other very well and collaborated,” Freedman said. “They both understood the interplay between antisemitism and racism, and that they had a lot of enemies in common.”
Still, they didn’t have the political capital to pursue meaningful change in Minneapolis – until Humphrey came along. The three were a perfect match.
“They have something [Humphrey] needs, which is knowledge, and he has something they need, which is the combination of idealism and political power,” Freedman said. “It’s the confluence of these three people that really makes what Humphrey does as mayor possible.”
To Freedman, there are many takeaways from Humphrey’s early years, from the potency of the Black-Jewish civil rights alliance to the recurring threat from white American reactionaries.
But maybe most important is that Humphrey’s accomplishments show how young people can make a huge difference in local and national politics, even when the odds seem stacked against them.
“If you think of Humphrey as this old warhorse, you miss something important – if you are a young person now – that … he made major positive change in this city, in this country, when he was in his 30s,” Freedman said.
Humphrey “was less than 10 years out of a bachelor’s degree when he was at the ‘48 convention” and changed the course of the Democratic Party, Freedman said.

domain: sociology


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Nottingham Trent University celebrates 170 years of art and design education in the heart of the UK, and offers a study abroad programme that includes:- Architectural History, Heritage and Model Making Today- Experimental Surfaces for Fashion, Tex...
I was enrolled a truly global university with over 160 nations represented on campus. I was exposed to people, ideas, and cultures I never imagined interacting with and I am a better person from it. I no longer tell my friends I WANT to apply to grad school in France, rather I tell them that I AM applying to grad school in Fran...
- San Jose State University
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Nottingham Trent University celebrates 170 years of art and design education in the heart of the UK, and offers a study abroad programme that includes: - Architectural History, Heritage and Model Making Today - Experimental Surfaces for Fashion, Textiles and Body Adornment - Marketing and Communication for International Fashion Designers - Photography, Alchemy and the Artists' Book
We offer a full-time programme for 14 weeks (just shy of the full 15 week semester), with study trips to London and Paris included in the fee. Our programme will meet the expectations of the most inquisitive and adventurous student.
Relevant Study Subject(s):
Architecture History, Architectural Criticism
Public Relations, Advertising, Applied Communication


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Posted: Structure a Land Contract? The owner of a property has offered ME a land contract. He told me to send him the terms.
It's a $72,000 Cabin that I would Air BnB... More for ski country and hunting season. Fully rehabbed. Top to bottom.
This is the ideal OPM deal. I just need one to look at. Anyone have one? Less
We also buy, sale, or trade Bulk REO tapes.
We work with investors that buy discounted... More and distressed assets in bulk.
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716-332-7566 (ex. #5)
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Posted: Bulk REO and NPNs Opportunities Nationwide
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Alternate Property Solutions Inc.
Posted: #Cash buyers needed
Posted: Hi I’m a realtor in buffalo ny. And I would like all investors who are interested to email your details because I have some properties that may interest you. Thank... More you ! Less
My goal is to purchase one undervalued investment property a year in Erie County. My current holdings include condos, single family homes, and one duplex. These properties are located in the City of Buffalo Elmwood Village, the Town of Amherst, and the Town of Cheektowaga. I happy to connect, chat, or meet up with any like minded investors in Erie County. Less
In: Buffalo NY, Dallas TX, Philadelphia PA, Orchard Park NY, Cheektowaga NY
In: Buffalo NY
My goal is to be able to start at wholesaling. I would love to be able to progress to Buy and hold , commercial , and anywhere else this could lead to. Please feel free to email me or message me on CI. My email address is Less
In: Buffalo NY
Posted: Investors join my buyers list where you'll get quality investment properties ALL the time. Right now I have homes in:
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from my Father who is a 30 year+ veteran of the business. At the age of... More I acquired
my first portfolio, which I grew to 30 units and managed them all myself. I've done
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once again so I'm in acquisition mode. Less
Posted: Buffalo, NY is a very hot market right now. I'm constantly having deals come across my desk and I can't act on all of them solo. Single family for fix and flips,... More and multi unit properties to buy and hold. Right now I'm looking for serious partners or lenders who want a good return on their investment.
Loan secured by the property or partner up and JV and split the profits.
I'm open to discussion. Message me if you want to make money with a true hustler. Less
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domain: finance


text:
Gas seal uses fluorine rubber O-ring, anti-wear, chemical corrosion resistance, low temperature and high temperature resistance, -20~250 °C can be used normally. 1x Adaptor. - The valve core is designed with double O-rings, one for sealing air, one for preventing air leakage and ensuring your safety.
Chemical resistance: Atmospheric corrosion protection with very good light and weather resistance various Colour (RAL) and gloss levels are available. Max. service temperature: 140° C dry Appliions / Miscellaneous: Particularly suitable for harbour facilities and crane installations, constructional steelwork, piping and off-shore installations.
1,1,1-Trichloroethane (Methyl Chloroform) 1,1-dichlorethylene (vinylidene chloride) 1,2,3-Trichlorobenzene 1,2,3-Trichloropropane 1,2-diaminoethane (ethylenediamine) Step 2: Results For more detailed information on the performance of the different material grades
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and anti-static copper wire Cover: Flat corrugated EPDM Temp: -40 C to +80 C, (-40 F to +176 F) Pressure: 10,5 bar / 150 psi EHC001 - Chemical S & D Hose Tube: PE blend Reinforcement: High-tensile synthetic textile, dual steel helical wire and anti-static
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domain: chemistry


text:
Both you and your pet cat are vulnerable to many of the same health concerns, including dental difficulties. Though you may struggle with cavities in your teeth due to decay, cats have distinct tooth deterioration. This condition, known as feline tooth resorption, leads to painful, cavity-like lesions that compromise the teeth’s strength. Feline tooth resorption is typical as cats age, affecting up to 60% of the adult cat population and 75% of senior cats. As a concerned pet owner, you’ll want to educate yourself about this tooth issue.
Types and Stages of Tooth Resorption
Tooth resorption is classified into two different types: Type 1 and Type 2. Type 1 tooth resorption protects most tooth structures but leaves dental flaws inside the crown or root. The only treatment alternative for teeth suffering from Type 1 resorption is surgical extraction. On the other hand, type 2 resorption occurs when the tooth’s root is removed and replaced by bone.
Coronectomy, also known as crown amputation, is a common treatment for Type 2 tooth resorption. The moment tooth resorption is diagnosed in a cat, regular oral cleanings under anesthesia every 6-9 months are necessary. If you would like to discuss your cat’s dental health, you can ask your vet or visit their wellness page online for further details.
Although recorded cases have increased in recent years, nobody knows why feline tooth resorption occurs. Genetic factors may influence which felines have this condition. Periodontal disease, characterized by persistent inflammation of the dental ligaments and gum tissue, might have a role in Type 1 resorption. The probable reason or contributor to feline tooth resorption is dietary issues such as high acid levels or nutritional deficiencies.
An early stage of feline tooth resorption may only exhibit gingivitis, with blood in your cat’s water or food dish. As the complication advances, you may see cavities or fractures in the affected teeth. Cats naturally mask discomfort to avoid possible risks. However, you can determine whether your cat is in pain from tooth resorption or other oral disorders.
Keep an eye out for drooling, mood swings, and avoidance of favorite persons or things. If your cat shows indications of a sudden change in eating habits, you need to contact your veterinarian and schedule an appointment at this vet clinic to examine their condition.
Diagnosis and Treatment
Your veterinarian can identify feline tooth resorption by giving your cat general anesthesia and obtaining dental X-rays. A crown and root checkup may help establish the condition’s development while ruling out other potential dental issues. The extent of your cat’s tooth resorption will determine the medical treatment. If your cat’s teeth are slightly damaged, a vet specializing in veterinary dentistry may recommend filling the holes. However, resorptive lesions may occur even after filling.
Therefore this approach should only be used as a temporary solution. Resorption-affected teeth will eventually need to be extracted. In Type 1 tooth resorption, your veterinarian will normally remove the entire tooth, reducing pain and gum irritation. When a cat has Type 2 tooth resorption, the doctor removes just the crown, leaving the roots intact.
Because the reasons for feline tooth resorption are unknown, veterinarians can not advise prevention treatments. The possible connection between this illness and periodontal disease should encourage you to clean your cat’s teeth at home and professionally. Dietary adjustments may reduce your cat’s risk of tooth resorption. Ask your vet whether your cat needs a different special diet or supplements.

domain: pet


text:
Measurement of antibodies to avian influenza virus A(H7N7) in humans by hemagglutination inhibition test.
ABSTRACT During the epizootic of highly pathogenic avian influenza A(H7N7) in 2003 in The Netherlands, RT-PCR and culture confirmed infection was detected in 89 persons who were ill. A modified hemagglutination inhibition (HI) test using horse erythrocytes and 2 hemagglutinating units of virus was applied to assess retrospectively the extent of human (subclinical) infection. Validation of the HI-test with sera from 34 RT-PCR and culture confirmed A(H7) infected persons and sera from 100 persons from a human influenza vaccine trial in autumn 2002 showed that this HI-test had a sensitivity of 85% and a specificity of 100% when using a cut-off titer of > or =10. Using this cut-off value, A(H7) specific antibodies were detected in 49% of 508 persons exposed to poultry and in 64% of 63 persons exposed to A(H7) infected persons. Correlation of seropositivity with the occurrence of eye symptoms in exposed persons who had not received antiviral prophylaxis and of reduced seropositivity with taking antiviral prophylaxis provided further evidence that the A(H7) HI antibody titers were real. In conclusion, by applying an HI-test using horse erythrocytes human antibodies against the avian A(H7N7) virus were detected with high sensitivity and specificity in an unexpectedly high proportion of exposed persons.
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ABSTRACT: Arboviral infections have repeatedly been reported in the republic of Djibouti, consistent with the fact that essential vectors for arboviral diseases are endemic in the region. However, there is a limited recent information regarding arbovirus circulation, and the associated risk predictors to human exposure are largely unknown. We performed, from November 2010 to February 2011 in the Djibouti city general population, a cross-sectional ELISA and sero-neutralisation-based sero-epidemiological analysis nested in a household cohort, which investigated the arboviral infection prevalence and risk factors, stratified by their vectors of transmission. Antibodies to dengue virus (21.8%) were the most frequent. Determinants of infection identified by multivariate analysis pointed to sociological and environmental exposure to the bite of Aedes mosquitoes. The population was broadly naïve against Chikungunya (2.6%) with risk factors mostly shared with dengue. The detection of limited virus circulation was followed by a significant Chikungunya outbreak a few months after our study. Antibodies to West Nile virus were infrequent (0.6%), but the distribution of cases faithfully followed previous mapping of infected Culex mosquitoes. The seroprevalence of Rift valley fever virus was 2.2%, and non-arboviral transmission was suggested. Finally, the study indicated the circulation of Toscana-related viruses (3.7%), and a limited number of cases suggested infection by tick-borne encephalitis or Alkhumra related viruses, which deserve further investigations to identify the viruses and vectors implicated. Overall, most of the arboviral cases' predictors were statistically best described by the individuals' housing space and neighborhood environmental characteristics, which correlated with the ecological actors of their respective transmission vectors' survival in the local niche. This study has demonstrated autochthonous arboviral circulations in the republic of Djibouti, and provides an epidemiological inventory, with useful findings for risk mapping and future prevention and control programs.PLoS neglected tropical diseases. 12/2014; 8(12):e3299.
- Pakistan Veterinary Journal 01/2013; 33(1):107-112. · 1.39 Impact Factor
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ABSTRACT: A novel avian H7N9 virus with a high case fatality rate in humans emerged in China in 2013. We evaluated the immunogenicity and protective efficacy of a candidate Vero cell culture-derived whole-virus H7N9 vaccine in small animal models. Antibody responses induced in immunized DBA/2J mice and guinea pigs were evaluated by hemagglutination inhibition (HI), microneutralization (MN), and neuraminidase inhibition (NAi) assays. T-helper cell responses and IgG subclass responses in mice were analyzed by ELISPOT and ELISA, respectively. Vaccine efficacy against lethal challenge with wild-type H7N9 virus was evaluated in immunized mice. H7N9-specific antibody responses induced in mice and guinea pigs were compared to those induced by a licensed whole-virus pandemic H1N1 (H1N1pdm09) vaccine. The whole-virus H7N9 vaccine induced dose-dependent H7N9-specific HI, MN and NAi antibodies in mice and guinea pigs. Evaluation of T-helper cell responses and IgG subclasses indicated the induction of a balanced Th1/Th2 response. Immunized mice were protected against lethal H7N9 challenge in a dose-dependent manner. H7N9 and H1N1pdm09 vaccines were similarly immunogenic. The induction of H7N9-specific antibody and T cell responses and protection against lethal challenge suggest that the Vero cell culture-derived whole-virus vaccine would provide an effective intervention against the H7N9 virus.PLoS ONE 01/2015; 10(2):e0113963. · 3.53 Impact Factor

domain: health