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An inquiry presented this week by RTS reveals evidence of likely vote buying related to the choice of Qatar for the 2022 Football World Cup due to start on 20 November 2022.
A cloud of corruption has hung over FIFA since 2010 when Qatar was chosen by 14 votes to 8 as the place for the 2022 World Cup. The US was the front runner, however, tiny Qatar, a nation with little in the way of football culture and infrastructure, was chosen. Suspicion has abounded ever since, something FIFA has brushed off by claiming there is no proof of wrong doing.
Sepp Blatter, the head of FIFA at the time, said publicly this week that choosing Qatar was a mistake. Blatter told Swiss newspaper Tages Anzeiger that “Qatar is a mistake,” and “the choice was bad.” “It is too small of a country. Football and the World Cup are too big for it.”
In line with suspicions of vote buying, RTS, Switzerland’s broadcaster said this week that it had found concrete evidence supporting vote buying. The evidence presented by RTS points to Ricardo Teixeira, former president of the Brazilian Football Confederation and a former member of FIFA’s Executive Committee. Teixeira’s name appears on a New York court document where he’s accused of taking a bribe of at least US$ 1 million in exchange for his vote. Teixeira claims the US is attacking him because he voted against having the 2022 World Cup hosted there.
At the same time Switzerland’s federal public prosecutor is looking at the case and is looking at money flows related to a friendly match played between Brazil and Argentina in Qatar. US$8.6 million was paid by Qatar to FIFA to host the match which was played in November 2010 in Doha just ahead of the World Cup vote. The oversized sum aroused suspicion that much of the money may have been used for bribes to sway votes. Investigators continue to work with the evidence and no conclusions have been revealed. Ricardo Teixeira’s lawyer told RTS that Teixeira rejects the claims.
Switzerland’s Federal Office of Police said that it does not comment on active cases. However, it did tell RTS that requests made to Qatar for legal cooperation have received no response despite several reminders. Qatar denies all accusations of corruption.

domain: sports


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domain: artistic


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Winter can be SNOW much fun! Enjoy read aloud stories featuring sledding, skating and some special snow people. Activities, videos and coloring sheets add to your winter fun.
READ ALOUD: Snowmen at Night by Caralyn Buehner. Also, check out Hoopla and Tumble Book Library on the Library's website for other books to enjoy.
VIDEO: The Snowy Day. Ezra Jack Keats's classic story, with animation by Jay Boucher and narration and sound by Napoleon Maddox.
ACTIVITY: Build a snowman or take it a step further and have a snow sculpture competition!
COLORING SHEET: Print the attachment and decorate with crayons, paint, stickers or whatever inspires you!
Visit the library website calendar for more activities this week.


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The list of updated apps for iPhone 6 and iPhone 6 Plus is still somewhat small since developers only learned of the new iPhone display resolutions earlier this month. The Kindle iPhone app from Amazon is joining that short list today, though, with a new version optimized for the iPhone 6.
That means that like iBooks, text you read in Kindle’s iPhone app won’t be fuzzy or scaled up. If you prefer the zoomed up version, however, iPhone 6 users do have that option to make every app larger using the Display Zoom feature found in the accessibilities section of the Settings app on iOS.
Facebook Messenger has also been updated for the new iPhone models. Notably, the chat app has beat the primary app for the social network in updating for the new iPhones.

domain: news


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Minister Naftali Bennett was the first cabinet minister to say that there is a need for a change in the Nationality Law in the context of the Druse community’s protests. In a special letter released on Wednesday, 20 Menachem Av to members of the community, he calls for the drafting of a special law that will permanently determine the status of the Druse community in Israel.
He points out that “the Druse community does not have to prove its loyalty to the State of Israel to anyone, nor the strength of the alliance that exists … The 70 years of the state prove this beyond any doubt.”
However, Bennet claimed that “every decent person who reads the Nationality Law will agree that there is no violation of the individual rights of any Israeli citizen, certainly not members of the wonderful Druse community, despite the crisis and protest surrounding the Nationality Law.
“On the contrary,” the minister added, “it is a vital law, but for a variety of reasons, the Druse community is hurt and cries due to its cumulative pain.”
Bennett later noted two dangers: that the community might emerge from the Israeli consensus and become a subject of political controversy. The second is the distancing of the certain Druse population from a connection to the State of Israel. Both of them said they were “serious dangers, and everyone should now refrain from actions and statements that will hurt us all for years to come.”
Surrounding the protests of the media and those opposed to the law, Bennet adds, “There are certain players who are not pure of heart, opting to exploit the distress of the Druse community in order to sabotage the Nationality Law and to create a chasm between the Druse community and the State while this does not interest the Druse community”.
Bennet explains the considerations for the community should have been included, but stresses, the law as it stands today is “essential and important”, advising all to read the law and familiarize themselves with it before drawing conclusions.
(YWN Israel Desk – Jerusalem)

domain: sociology


James Harden will be meeting with the Philadelphia 76ers this Saturday, according to a report.
Earlier this week, Harden declined his $47.3 million player option with the team. He's reportedly willing to work with the Eastern Conference franchise to get a team-friendly deal.
Harden and the Sixers will begin negotiations for that deal this Saturday afternoon in the Hamptons.
"Free agent star James Harden is meeting with the Philadelphia 76ers today in the Hamptons to begin negotiating his new multiyear deal, league sources tell @YahooSports," said NBA insider Chris Haynes.
Harden re-negotiating his deal will allow Daryl Morey and the Philadelphia 76ers much more flexibility.
"Lowering Harden's salary from $47.4 million allows 76ers president Daryl Morey to offer free agents the $10.5 million non-taxpayer midlevel exception without any other moves, flexibility Morey would have had difficulty creating by trading players already on guaranteed contracts," said Shams Charania of The Athletic.
Harden was a pretty big disappointment in Philly last season. He scored 21 points per game to go along with 10.5 assists and 7.1 rebounds.
The Sixers star was mostly ineffective in the playoffs as Joel Embiid and Tyrese Maxey carried the load.


Through the years, there are Ford Components that came out that not only strengthen the functionality of the automobile but at the identical time keep it ?green?. Ford Motors applied a variety of automobile technologies to further retain its autos ?sensitive? sufficient to care for the environment. The catalytic converter, for example, is made use of by the American automaker in its automobiles, sport utility vehicles, and trucks to hold the noxious emissions on protected levels. With this auto portion intact in the method, system exhaust fumes made by during the internal engine combustion is treated prior to released into the air. In this way, damaging gases are lessened for the reason that of the catalytic converter.
Various new items of Vorsprung Durch Technik which means, ?Advancement By means of Technologies? which tends to make the Audi S4 deal with like no Audi saloon has before. The second optional extra which impressed was Audi Drive Choose, which enables the settings for the active steering, seven-speed S Tronic gearbox (if fitted), active sport differential and adjustable suspension to be tweaked through buttons on the dashboard.
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Ford Motor Company, which debuted in the industry far more than a century ago, is 1 of the top automobile businesses worldwide. This American automaker requires pride in its competent sales across the globe that tends to make this brand a household name specially in the United States. Aside from guaranteeing that its models can carry out nicely, the enterprise is also keen in improving its Ford Components to develop into effective yet environment-friendly.
Even so, the engine?s instant punch and smoothness is rather impressive.
Yet another component installed in the corporation?s cars is the oxygen sensor. This diminutive portion is strategically placed along the exhaust manifold and close to the catalytic converter as it examines exhaust fumes for the availability of air. After it detects a low oxygen presence in the engine?s mixture, it relays the data instantly to the engine manage unit. From there, important adjustments are completed for the engine to have a very good mixture of cool air and fuel. When the automobile?s energy plant is efficient enough, it will no longer emit as well substantially exhaust fumes that are harmful to the atmosphere. These are just some of the a lot of Ford Parts that make the automobiles of the corporation gentler to the environment.
The new technologies has been introduced to S4 which pulls power. Audi claims the new 3-litre supercharged engine is a whopping 37 per cent a lot more economical than its predecessor. The engine possibilities offered are two-litre direct injection turbocharged generating 200bhp and 3.two litre V6 making 255bhp. Added to these, the normal ones are 1.six litre producing 102 bhp, two litre producing 130bhp and 1.8 litre turbo-charged producing 163 bhp.
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The Audi S4 is a breathtaking car to be in and covers ground at an awesome price but its is still not an excellent driver?s favourite. Other than the engine revision Audi has not created any substantial adjustments to the older version. However, the engine?s instant punch and smoothness is really impressive. The special extras added to the S4 are a slightly more aggressive front bumper, extended side skirts, brushed aluminium door mirrors modest spoilers and 4 chrome exhaust pipes enhance the stealthy character.
By means of the years, there are Ford Components that came out that not only strengthen the performance of the automobile but at the same time keep it ?green?. Ford Motors applied various automobile technologies to additional hold its automobiles ?sensitive? adequate to care for the environment. The catalytic converter, for instance, is made use of by the American automaker in its cars, sport utility automobiles, and trucks to hold the noxious emissions on protected levels. With this auto component intact in the technique, program exhaust fumes created by throughout the internal engine combustion is treated before released into the air. In this way, damaging gases are lessened because of the catalytic converter.
Sell Auto Parts Online Free – The S4?s superior torque thrashes the M3 on in-gear instances. Audi has hinted BMW with S4 that it is capable of giving an equivalent sportier automobile in this horsepower battle.


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WASHINGTON — Top lawmakers proposed a stopgap funding package on Monday night that would avert a government shutdown at the end of the week and set aside a major new round of emergency aid to Ukraine to defend itself against Russia.
With funding set to run out when a new fiscal year begins on Saturday, lawmakers are aiming to quickly move the legislation through both chambers in the coming days to keep the government funded through Dec. 16. But even as the final details of the package came together, it faced an increasing likelihood that it could not pass in its current form.
Most of the measures in the package, which would punt difficult negotiations over the dozen annual spending bills to after the November midterm elections,appeared to generate little opposition.It would provide just over $12 billion in military and economic aid to Ukraine, and ensure the federal government could quickly spend money on natural disaster recovery efforts, according to a summary from the Senate Appropriations Committee. It also notably sidestepped the Biden administration’s request for emergency funds to combat the coronavirus pandemic and monkeypox, given Republican opposition.
But the regular autumn scramble to avoid a shutdown has been complicated by the inclusion of a plan that would make it easier to build energy infrastructure across the country. The legislation is the product of a Democratic deal that helped secure the vote of Senator Joe Manchin III of West Virginia, a centrist Democrat, for the tax, health and climate law known as the Inflation Reduction Act, but lawmakers in both parties have objected to tying it to the must-pass spending bill.
“I am disappointed that unrelated permitting reform was attached to this bill,” Senator Patrick J. Leahy, the Vermont Democrat who is the chairman of the Senate Appropriations Committee, said in a statement. “However, with four days left in the fiscal year, we cannot risk a government shutdown; we must work to advance this bill,” he added.
The sentiment was echoed in a separate statement by his House counterpart, Representative Rosa DeLauro, Democrat of Connecticut, who noted that “while the bill provides a bridge to the omnibus, it is not perfect.”
The Senate is set to take a first procedural vote on Tuesday, and it appears increasingly unlikely that the stopgap bill will advance with the permitting overhaul bill in tow. Should the package fail to secure enough support, lawmakers may strip out the permitting proposal and pass the government funding bill on its own to avoid a shutdown.
Several Republicans, whose votes are essential in order to clear the 60-vote filibuster threshold in the evenly divided Senate, have said they have little interest in helping to deliver on a promise that prompted Mr. Manchin to drop his opposition to the broader health, climate and tax plan and allow it to pass over their party’s unanimous opposition.
In a statement, Senator Richard C. Shelby of Alabama, the top Republican on the Senate Appropriations Committee, acknowledged the “significant progress” made toward a short-term bill that “is as clean as possible.” But, he warned, “if the Democrats insist on including permitting reform, I will oppose it.”
Lawmakers in both parties have expressed opposition to the details of the permitting legislation, which Mr. Manchin released last week. Republicans have said the legislation does not go far enough to ensure projects are approved more quickly, while liberal Democrats are alarmed at provisions that would make it easier to build fossil fuel infrastructure and guarantee completion of the Mountain Valley Pipeline, a natural gas project that passes through West Virginia.
In an effort to speed up the permitting process, the legislation would instruct agencies to complete required environmental reviews within about two years for major projects and limit the window for court challenges.
Some Democrats, including climate hawks, have signaled they will support the permitting package because they say it will help speed up the construction of transmission lines and other infrastructure needed to combat climate change and help deliver on President Biden’s pledge to cut United States emissions roughly in half by 2030.
“To meet our climate goals, and as renewable energy projects continue to become more economically viable, we must enact reasonable permitting reform — which includes expedited review processes that also maintain fundamental environmental protections,” said Representative Sean Casten, Democrat of Illinois, in a statement. “Anything less is failing to do what is scientifically necessary to preserve our planet.”
But at least one member of the Democratic caucus, Senator Bernie Sanders of Vermont, has confirmed that he will vote against the stopgap spending bill because of the permitting reform legislation, meaning 11 Republicans will need to back the measure to avoid a filibuster if all 49 remaining senators in the Democratic caucus vote for it. In the House, dozens of liberal Democrats have called for a separate vote on the permitting measure.
“Congress has a fundamental choice to make,” Mr. Sanders wrote in a letter urging his colleagues to reject the measure. “We can listen to the fossil fuel industry and climate deniers who are spending huge amounts of money on lobbying and campaign contributions to pass this side deal. Or we can listen to the scientists and the environmental community who are telling us loudly and clearly to reject it.”
Mr. Manchin has begun a persuasion campaign centered on his Republican colleagues, including an opinion piece in The Wall Street Journal and an appearance on Fox News.
“It would be basically a lost moment in history if we don’t do this,” Mr. Manchin declared in an interview on “Fox News Sunday.” Referring to President Vladimir V. Putin of Russia, he added: “I’m hoping that they will look at what we have in front of us — the energy independence, security, stopping Putin dead in his tracks, being able to do what we need to do to reduce the price of energy and helping people in their homes as far as energy cost there. We have a golden opportunity.”
Ukraine’s recent military success, including reclaiming territory from Russia this month, has rallied lawmakers, who have already approved roughly $54 billion in military, economic and humanitarian aid this year, behind the prospect of pouring more money into the effort.
The new package would set aside $3 billion for training, equipment, weapons and intelligence support for Ukrainian forces, as well as $4.5 billion for the Economic Support Fund, which is intended to help the Ukrainian government continue to function. It also would allow Mr. Biden to authorize the transfer of up to $3.7 billion of American equipment and weapons to the country.
The legislation also aims to address a few domestic needs. In addition to providing $20 million to help address the water crisis in Jackson, Miss., and $2 billion for a block grant program to help communities rebuild after natural disasters in 2021 and 2022, it would give the federal government more flexibility to spend existing disaster aid quickly.
The package also includes language that would ensure the Food and Drug Administration maintains the ability to collect industry fees that make up much of its budget.
Catie Edmondson contributed reporting.


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The Santoku is the Japanese brother of the Western Demi Chef. The meaning of "Santoku Bocho" means "three virtues" or "three possible uses" and of course refers to the three cutting tasks in which the Santoku excels: cutting slices, dicing and chopping.
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domain: design


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Diagnosis and classification of diabetes mellitus”. Preventive Services Task Force recommendation statement.
Of the women with GDM Anthropometric measurements and some biochemical parameters were also obtained. Preventive Services Task Force. Diabetes Care ; BMJ Clinical research ed. English Turkish English Login.
Diabetes trends among delivery hospitalizations in the U. Placental passage of metformin in women with polycystic ovary syndrome.
Exercise and disease management 2nd bas. Some features of this site may not work without it. Cochrane Database Syst Rev1s.
European journal of clinical investigation. Nutrition recommendations and interventions for diabetes: Glycemic control and maternal prognosis[Cited September 12],available from: Preventive Services Task Force. International association of diabetes and pregnancy study diyanet recommendations on the diagnosis and classification of hyperglycemia in pregnancy.
In the second visit their adherence to medical nutrition therapy and 3 days food records were evaluated. Tip 2 diabetes mellitus Universal blue circle symbol for diabetes.
Universal blue circle symbol for diabetes. The Journal of nutrition.
Haemoglobin A1c levels in normal and diabetic pregnancies. The roles of placental growth hormone and placental lactogen in the regulation of human fetal growth and development. However, it may be important to educate women with GDM about the risks of low carbohydrate and excessive fat intake —especially SFA intake- during pregnancy and postpartum period in order to prevent later onset of Type 2 DM and CVD.
Hyperglycemia and adverse pregnancy outcomes. Fuel metabolism during pregnancy. At the end of the pregnancy, information about weight in which the pregnancy was completed, birth weight, height, sex of baby and type of delivery was obtained. N Engl J Med ; Type 2 diabetes mellitus: Standards of medical care in diabetes Am J Clin Nutr ;

domain: health


Four inches of rain has already fallen in these areas and several more inches of rain possible.
The rain has ended for most areas around Williamsburg.
We'll get a chance to dry out for at least a few hours, but more showers and storms are possible overnight and tomorrow morning.
A tornado warning for York County expired at 7:45pm and a flood warning for urban areas and small streams in Williamsburg, James City Co. and York Co. until 8:30 PM.
The Colonial Parkway has flooded and is impassable at the Williamsburg Visitors Center.


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MBTI Type: INFJ
Charlie has full faith in her hunches, which are startlingly accurate; she has spent her day pondering when we first meet her, and musing on that their lives are dull and need to change, which makes her think of her Uncle Charlie – as she finds out, they thought of each other in the exact same moment, and he is coming to see them (the same thing she wanted him to do). She thinks they are identical, alike, that she knows him intimately without even spending much time with him. When he makes a boat out of their father’s newspaper after dinner, she accurately assumes there’s something in the paper he did not want them to see—about him! When men comes to the house to do a ‘survey,’ after spending some time with them, Charlie accurately intuits that they are detectives investigating something. She is determined to find out something “nobody else knows about” her uncle, but doesn’t like it when she does, since it implicates him as a serial killer! Her illusions about him shattered, Charlie then develops an apathetic and negative attitude toward mankind (“I don’t believe in goodness anymore”) that is a vast, sweeping generalizing judgment because someone has let her down. She thinks in terms of others and their feelings above her own, not wanting her uncle to leave because it would hurt her mother, being proud of showing off how handsome he is to all her friends, and being concerned with keeping her parents happy. Charlie is exuberant and emotional, quickly sharing all of her feelings (how glad she is to see her uncle, how sorry she is that they live such mundane lives; how much she hates her mother’s “old hat,” eager to talk to the government men who come to see her, and she even goes out on a date with one of them and quickly falls in love). But when she finds out the truth about her uncle, Charlie also struggles to conceal her suspicions and her true feelings – she becomes distant and blunt, hints that her uncle should leave, and plays an emotional game with him, where she confronts him with her upset feelings and then taunts him by wearing the evidence of his crime in front of him, as a threat to get him out of the house. She asks him how he could do such a thing, because they had such faith in him. Prior to knowing the truth, Charlie saw them as two halves of the same whole, as twins linked by telepathy. She spoke in “we” terms about their need to know things about each other, and share everything. Charlie tries to understand and figure things out for herself, including examining the stairs after she suspects her uncle tried to kill her by causing her to fall down them. She shows some Se impulsiveness and a need to do things immediately; after being unable to read her uncle’s scraps of newspaper, she rushes off to the library before it closes—darting out into traffic and almost getting hit by a car. She dumps her best friend and their plans for the evening to go out on a date instead.
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Charlie starts out as a wildly optimistic but somewhat passive girl, who has spent the day pondering all the things she doesn’t like about their boring life – but then who concludes there’s quite simply nothing she can do about it, in sort of an apathetic acceptance that nothing will ever change. She does decide to send for her uncle, in the assumption that he can shake things up for her. When he arrives, she dreamily wanders about the house, being overcome with joy at his presence, not wanting gifts or anything other than to see her mother’s happiness and feel it (Fe + 9). Charlie tries to keep everything peaceful, proactively – don’t mess with father’s paper, he won’t like it; I told Uncle Charlie no one would bother him and I intend to make sure that doesn’t happen; I need you to abide by his wishes! She trusts people easily and is naïve about their intentions, but also shows a little 6ish distrust and suspicion under stress. More often, though, she leans into her 8 wing. She becomes unable to conceal her true moods, confrontational (heedless of how dangerous this might be), and even aggressive, informing her uncle that if he doesn’t leave at once, “I may kill you myself!”
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domain: psychology


text:
What: The Crisis Centre is relocating.
When: Effective Wed June 16 for the next six to eight months.
New Location: 534 Queens Ave, London, N6B 1Y6
Are services at the Crisis Centre changing?
No, there will be no break in service and all services provided at the Crisis Centre will continue as usual. This includes the 24/7 walk-in centre as well as our Support Line (519-601-8055, 1-844-360-8055) and Reach Out, our 24/7 crisis line (519-433-2023, 1-866-933-2023, reachout247.ca). Services that have been operating virtually since the pandemic will also continuing to do so.
How can I get to the new location?
There are several ways to get to the Crisis Centre’s new location at 534 Queens Ave:
The Queens site is located on the corner of Queens Avenue and William Street. The closest major intersection is Adelaide St and Dundas St. The Queens site can be accessed via William St, with parking spots specifically for those going to the Crisis Centre available on the East side of the building, immediately off of William St.
By public transit:
Buses #2 and #20: Take to stop #623 EB / #624 WB (Dundas at William)
Bus #16: Take to stop #73 SB (Adelaide at Queens) or #27 NB (Adelaide at Dundas)
Bus #1: Take to stop #434 SB (Colborne at Dufferin) or #531 EB (Dufferin at Colborne)
Bus #7: Take to stop #2175 EB (York at William) or #2176 WB (York at William)
Updates and More Information:

domain: geography


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Whole Melt refers to the quality of hash in terms of purity, ability to melt without residue, and the richness of the cannabinoid and terpene profile contained in hash.
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When shopping for bubble hash or dryer sift, it’s important to look at the star rating to understand what you’re buying. fuses can “damage” or corrupt the quartz battery.
Some taste more like smoking a flower or a bowl of resin than the more aromatic terpenes found in live resin extracts.

domain: hobby


How do you keep fabric paint from washing off? The best way to seal acrylic paint onto fabric is to use heat. Using heat will ensure the paint is permanently stuck to the material. This will make the clothing able to withstand the rigors of constant washing and wearing. Iron is the easiest method of applying heat.
How soon can you wash fabric paint? Though you may be ready to finish the piece as soon as you’re done painting, it’s best to hold off on ironing for a bit. At a minimum, wait 24 hours just to be sure the paint is dry. After you’ve set the paint in, give it at least four days (according to Golden Paints) before washing the fabric.
Does fabric paint rub off on clothes? Will Simply Spray Upholstery Paint rub off onto clothing? The paint should adhere into the fabric and after 72 hours it should not rub off. Test by running your hand over the material, if any paint rubs off, it is because there is excess paint between the fibers that did not absorb into the material.
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To review the current practice of retreatment with Ozurdex injections in patients with macular edema (ME) secondary to retinal vein occlusion (RVO), and to recommend simple guidelines for Ozurdex reinjection in management of RVO.
This was a multicenter retrospective study of patients who received more than 2 Ozurdex injections for the treatment of ME in RVO. Recorded parameters included percent of patients with a 15-letter gain, visual acuity (VA) improvement from baseline, change in central macular thickness (CMT), time to reinjection, and occurrence of any complications.
A total of 128 patients were included, 58 (45.3%) with central RVO (CRVO) and 70 (54.7%) with branch RVO (BRVO). Mean interval for Ozurdex reinjection was 5.9 months following the first injection and 8.7 months following the second. A >15-letter gain in VA was observed in 34 (48.8%) patients with CRVO and 16 (28%) patients with BRVO. Mean overall VA improvement at month 6 did not show significance (p>0.05); however, a significantly better mean VA improvement was seen in treatment-naïve eyes (p<0.03). The CMT was significantly reduced compared to baseline. The mean CMT decreased by 214.6 µm in eyes with BRVO (n = 53) and by 355.1 µm in eyes with CRVO (n = 63) (p = 0.002). Complication rates were very low.
Repeated injections of Ozurdex are effective and have a favorable safety profile. In current practice, the retreatment interval with Ozurdex injections might be too long, precluding the full therapeutic potential of this treatment modality. A strategy for managing RVO patients treated with Ozurdex on an as-needed basis is provided.
Eur J Ophthalmol 2014; 24(1): 1 - 9
Article Type: ORIGINAL RESEARCH ARTICLE
Article Subject: Retina MED
AuthorsGabriel Coscas, Albert Augustin, Francesco Bandello, Marc D. de Smet, Paolo Lanzetta, Giovanni Staurenghi, Maria Cristina Parravano, Patricia Udaondo, Elad Moisseiev, Gisele Soubrane, Yossi Yatziv, Anat Loewenstein
- • Accepted on 19/09/2013
- • Available online on 14/10/2013
- • Published in print on 20/11/2013
This article is available as full text PDF.
Retinal vein occlusion (RVO) is a sight-threatening retinal vascular disorder associated with macular edema (ME) and neovascularization (1-2-3-4-5-6). The overall goal of RVO management is improvement of patients’ vision, which translates into improved quality of life. This is achieved by identifying modifiable risk factors and means of managing them, and by recognizing and managing sight-threatening complications. Close monitoring and early intervention has been shown to effectively reduce retinal complications and the rate of vision loss (3, 4, 6).
Until recently, the standard of care for branch RVO (BRVO)–associated ME was grid laser photocoagulation, and observation was suggested for central retinal vein occlusion (CRVO)–associated ME. Central RVO with neovascularization was treated with scatter laser photocoagulation (3-4-5-6).
Over the past decade, advances in retinal imaging technology and drug development have radically changed the standard of care (7-8-9-10-11-12-13-14-15-16). Two classes of drugs have emerged as alternative treatments for ME in RVO: corticosteroids and anti–vascular endothelial growth factor (VEGF) agents. Superiority of these treatments over the previous standard of care has been demonstrated in a number of randomized, controlled multicenter studies. Intravitreal injection of triamcinolone acetate was the first treatment shown to improve the visual prognosis in ME secondary to CRVO, and observation of these patients in no longer an acceptable option. It was also found to be approximately equal to laser treatment in ME secondary to BRVO (11, 12).
In 2009, a sustained-release intravitreal 0.7 mg dexamethasone delivery system, Ozurdex® (Allergan Inc., Irvine, California, USA), was approved for the treatment of ME secondary to RVO (9, 10). Ozurdex, which contains the corticosteroid dexamethasone, has demonstrated efficacy and safety for the treatment of BRVO and CRVO when delivered to the vitreous cavity by a sustained-release intravitreal implant (DEX implant; Ozurdex, Allergan, Inc.).
A single intravitreal treatment of 0.7 mg DEX implant was shown to produce improvements in visual acuity (VA) already at 30 days post-treatment, which persisted over 90 days, and in many eyes for as long as 6 months; good tolerance was also observed for a 12-month period, with significantly less adverse effects compared to triamcinolone (9, 10).
Studies of anti-VEGF agents for management of RVO have specifically used ranibizumab (Lucentis, Genentech Inc., South San Francisco, California, USA), which has been demonstrated to be a safe and effective therapy for ME associated with both BRVO and CRVO (14-15-16-17), and was subsequently approved for use in RVO in 2012 in Europe. Efficacy of bevacizumab (Avastin, Genentech Inc.) in the treatment of ME in RVO was also reported in several uncontrolled studies (18-19-20), but this anti-VEGF agent is currently not licensed for use in any ophthalmologic indications. Also, recent studies have shown positive results for aflibercept (VEGF Trap-Eye, Eylea, Regeneron, New York, USA) for the treatment of CRVO (21).
In light of the wide variety of treatment options available for the treatment of RVO associated with ME, the standard of care that was used until a few years ago is no longer valid. The new therapeutics have all been compared to the now obsolete standard of care that included laser treatment in BRVO patients with ME and observation alone in CRVO patients with ME.
However, direct comparisons between the new drugs are not yet available, and controversy exists regarding the current optimal long-term treatment scheme for ME in RVO. A guideline for first-line therapy of RVO has been proposed in a consensus paper published in 2011 (8) but did not address retreatment.
Today, studies and experience from clinical practice have shown that both corticosteroids and anti-VEGF agents usually require long-term repeated treatments in order to control the ME, prevent vision loss, and increase the chance of visual improvement.
Criteria for the retreatment of ME in RVO have yet to be defined, and there are currently no established protocols for long-term management of these patients.
Ozurdex is a promising treatment option for ME in RVO. Being a slow-release implant, its pharmacokinetics enable high concentrations of dexamethasone to be sustained in the retina and vitreous during the first 2-3 months after Ozurdex injection, and lower concentrations are sustained up to 6 months (22). Therefore, long-term therapy with Ozurdex will require significantly fewer injections compared with anti-VEGF agents, which need to be administered as frequently as once a month for an optimal VA outcome (14-15-16-17).
Existing Ozurdex studies have not directly addressed the question of the optimum retreatment interval for the Ozurdex® implant 0.7 mg or safety after long-term repeated injections. The time course and magnitude of the response to Ozurdex treatment suggests that some eyes are undertreated and that physicians may want to evaluate their patients for retreatment earlier (before 180 days) than the current pivotal studies indicate. Today, in clinical practice, many patients are being treated before month 6, at their physician’s discretion.
The purpose of this study was to demonstrate real-life data on repeated use of Ozurdex in patients with RVO, i.e., 2 or more injections during at least 1 year of follow-up, and evaluate its efficacy and safety. In addition, we suggest a simple algorithm for its repeated use. Efficacy outcomes were BCVA and central macular thickness (CMT), and safety outcomes were intraocular pressure (IOP) and cataract development.
Patient data were collected from 9 participating retina clinics all over Europe. The study was approved by the institutional review boards of all institutions. Included patients had received at least 2 Ozurdex injections for the treatment of ME secondary to RVO between August 1, 2010, and July 31, 2012. All patients had at least 6 months of follow-up after the last injection. A minimal VA of 20/200 at baseline was required for inclusion in the study.
Eyes with documentation of severe macular ischemia on fluorescein angiography were excluded. Patients with additional ophthalmic comorbidity, which could have had a considerable influence on VA, were excluded from this analysis. Specifically, patients with any history of advanced age-related macular degeneration (AMD), diabetic macular edema (DME), proliferative diabetic retinopathy (PDR), advanced glaucoma, optic neuropathy, or corneal opacity were not included. Also, patients with previous ocular trauma or vitrectomy were excluded. Patients who participated in other therapeutic studies during the time period of this study were also excluded.
Data were retrieved by retrospective review of the patients’ medical charts. Collected parameters included demographic information, previous ocular history, type of RVO, number and dates of Ozurdex injections, additional treatments for RVO-associated ME (before and after Ozurdex administration), VA and IOP throughout the study period, and the occurrence of any complications. Data regarding CMT and presence of intraretinal fluid from OCT scans were also included when available.
Primary outcome measures were VA improvement from baseline, the percentage of patients with a 15-letter gain, and change in CMT following at least 2 Ozurdex injections.
Secondary outcome measures included IOP measured 5-7 months after the last injection, the time to reinjection, and the incidence of any adverse effects following repeated injections. Recorded adverse events included IOP elevation, cataract progression, retinal detachment (RD), vitreous hemorrhage (VH), and endophthalmitis.
For statistical analysis, all visual acuity values were converted to the logMAR scale. According to Holladay (23) and the University of Freiburg study group results (24), blindness was set at 0.00125/2.9 (decimal/logMAR), light perception al 0.0025/2.6, hand movements at 0.005/2.3, and counting fingers at 0.014/1.85.
Included in the study were 128 eyes of 128 patients who fulfilled the inclusion criteria. Of the 128 eyes, 58 (45.3%) had ME secondary to BRVO and 70 (54.7%) had ME secondary to CRVO. Patients included 75 (58.6%) men and 53 (41.4%) women, with a mean age of 65.8 ± 12.9 years (range 27-101 years). The duration of ME was under 6 months in 62 (48.4%) patients. Previous treatment had been administered for 68 (53.1%) eyes. These included 39 (30.2%) eyes that were previously treated with anti-VEGF injections, 9 (7%) eyes with laser treatment, 8 (6.2%) eyes with both anti-VEGF and laser, and 10 (7.8%) eyes with other steroid treatment (
Distribution of previous treatments for macular edema administered to the patients in this study. VEGF = vascular endothelial growth factor.
Effect of repeated injections on visual acuity
At baseline, mean VA of all patients was 0.42 ± 0.32. An improvement of 15 letters or more after the first 2 injections of Ozurdex was achieved in 50 (39%) patients. These included 34 (48.8%) patients with CRVO and 16 (28%) patients with BRVO. A loss of 15 letters or more was observed in 13 (10%) patients, which included 8 (12.2%) of the patients with CRVO and 5 (8%) of those with BRVO (
Patients who gained or lost >15 letters in visual acuity following 2 Ozurdex injections. BRVO = branch retinal vein occlusion; CRVO = central retinal vein occlusion.
Mean final VA, measured at the last follow-up visit between 5 and 7 months after the last injection, was 0.48 ± 0.38, with no significant difference (p = 0.13). In patients with BRVO, mean baseline VA was 0.44 ± 0.27 and final VA was 0.48 ± 0.27. In patients with CRVO, mean baseline VA was 0.41 ± 0.36 and final VA was 0.489 ± 0.46. The differences were not statistically significant (p = 0.24 and p = 0.14, respectively).
Repeated Ozurdex injections achieved a better mean final VA improvement in treatment-naive eyes when compared to eyes that were previously treated for ME. A trend towards better final VA in these eyes was noted (p = 0.06) (
COMPARISON OF VISUAL ACUITY BETWEEN TREATMENT-NAIVE AND PREVIOUSLY TREATED EYES AT 5-7 MONTHS AFTER LAST INJECTION
|Parameter||Treatment-naive eyes||Previously treated eyes||p Value|
|VA = visual acuity.|
|Final VA||0.38 ± 0.28||0.54 ± 0.35||0.06|
|VA change||0.26 ± 0.36||0.04 ± 0.26||0.03|
Effect of repeated injections on retinal thickness
Following repeated Ozurdex injections, CMT continued to decline significantly after the second injection, showing a positive response to retreatment.
At the final follow-up, for CRVO patients with a baseline CMT of 629.4 ± 191.2 µm, the mean change in CMT was −355.1 μm. For BRVO patients with a baseline CMT of 507.5 ± 158.0 µm, the mean change in CMT was −214.6 μm (p<0.002) (
Baseline and final central macular thickness (CMT) values of patients with central retinal vein occlusion branch (CRVO) and branch retinal vein occlusion branch (BRVO). A significant reduction was noted in both groups (p<0.002).
No significant difference in CMT reduction was noted between treatment-naive eyes and those that had undergone previous treatments.
Timing of reinjection
The mean time between the first and second Ozurdex injections was 175.7 days (approximately 5.9 months, range 3-23 months), and between the second and third injections, 261.7 days (approximately 8.7 months, range 3-16 months) (
Mean intervals (in months) between the first and second Ozurdex injections and between the second and third Ozurdex injections.
Safety of repeated injections
No safety issues were observed following more than 2 injections of Ozurdex. The IOP increases were transient and easily handled with medications. Intraocular pressure increases of >10 mm Hg or >25 mm Hg were seen in 9 (7%) patients, and 21 patients (16.4%) required medical treatment during the study period. Cataract progression occurred in 3.9% of patients. No cases of RD, VH, or endophthalmitis were encountered in any of these patients.
The GENEVA study has demonstrated the safety of retreatment with Ozurdex for both BRVO and CRVO. Following 2 DEX implants, the incidence of adverse events was similar to that of those who received a single DEX implant, except for a greater number of patients with cataract progression, 29.8% compared to 10.5%, and IOP elevation of more than 10 mm Hg, 15.4% compared to 12.6% (9, 10). Cataract extraction was performed in only 1.3% of the patients who received 2 DEX implants; IOP increases were usually transient and controlled with medication or observation. Acute treatment-related serious adverse events, including VH, endophthalmitis, and RD, were extremely rare following both initial and second injections (9, 10).
Regarding efficacy, the beneficial effects of treatment on VA and macular thickening were similar after the first and second injections of DEX implants. However, the decline in benefit observed in some eyes before the 6-month assessment led the investigators to conclude that some eyes were undertreated and that evaluation for retreatment should occur earlier than 6 months (10).
A number of small, single-center retrospective series have recently documented the efficacy and safety of repeated treatments with Ozurdex on an as-needed basis (25-26-27-28-29-30). Improvements in VA measured at the time of peaking efficacy following the second implant were similar to those following the first implant, with no increase in serious adverse effects (25-26-27-28-29-30). It has also been shown that 1 or 2 injections of Ozurdex are not associated with any complications in the long term, and may have a beneficial effect on long-term visual prognosis (31).
Our study was designed to evaluate the results of current practice with repeated Ozurdex injections and analyze the long-term outcome of efficacy and safety after at least 2 or more injections. Based on these study results, evaluating patient data from clinical practice, Ozurdex is shown to be both effective and well-tolerated after multiple re-treatments.
A marked improvement of 15 letters or more was recorded after the first 2 injections of Ozurdex in 39% of patients. These included 34 (48.8%) patients with CRVO and 16 (28%) patients with BRVO. Mean initial VA was not significantly different between CRVO and BRVO patients, and a higher rate of VA improvement of 15 letters or more in CRVO patients repeatedly treated with Ozurdex has also been reported in another study (29).
Another finding of our study is that Ozurdex retreatment achieved a greater improvement in VA in treatment-naive eyes 5-7 months after last injection, compared to previously treated eyes (
Interestingly, the time to retreatment was approximately 5.5 months, which is a longer treatment interval than reported in previous studies, which ranged from 3.2 to 5.5 months (25-26-27-28-29-30). As mentioned, it has previously been suggested that the optimal interval for repeated Ozurdex injection can be less than 6 months. Our results of VA gain in general population of patients with ME due to RVO at 5-7 months after the last injection support this notion, as the long intervals achieved no significant change in mean VA at this time. The collected data in this retrospective multicenter study demonstrate that the absence of standardized criteria for retreatment with Ozurdex has a significant impact on the timing of the repeated injections, which is highly variable.
Following repeated Ozurdex injections, CMT showed a good response to treatment and continued to decline significantly after the second Ozurdex injection.
Overall, CMT was significantly reduced from a baseline mean of 568.45 ± 186.4 µm to 284.85 ± 174.6 µm, which represents a mean reduction of 50.1% (p<0.002), a clinically significant reduction of retinal thickness well within what has been shown in previous studies.
Our study also demonstrated that long-term treatment with multiple injections of Ozurdex is safe and well-tolerated. Complication rates were comparable with previously published data on Ozurdex retreatment (10, 25, 29). The positive safety profile observed in this study, with more than 2 injections of Ozurdex and a mean follow-up of over 6 months following last injection, suggests that retreatment is not associated with an increase in any adverse effects. The common side effects, mainly cataract progression and a transient increase in IOP, were not a major problem during the follow-up in our study. This has also been demonstrated in long-term follow-up in patients who were treated with Ozurdex for RVO (31).
These side effects should not cause a barrier to repeated Ozurdex use in RVO patients. The IOP elevation is usually mild and transient, easy to manage, and has not been shown to cause significant glaucomatous optic nerve damage or visual field loss. No surgery for uncontrolled IOP was needed.
Cataract progression was documented in 3.9% of patients, which is lower than reported in other studies. In the GENEVA study, cataract progression was demonstrated in approximately 30% of patients after 1 year with 2 Ozurdex injections, but cataract extraction was needed in only 1.3% of eyes (10). Although cataract progression may adversely affect VA, it should be noted that cataract extraction is a simple and safe procedure.
Macular edema in RVO is a condition that persists for a considerable time, and its treatment is also prolonged. Close monitoring for a long time is required in these patients, and as-needed in regimens enable tailoring of treatment to individual patients. In the continuing efforts to improve vision and quality of life, cataract progression and eventual extraction should be considered part of the treatment process in phakic patients, much like is commonly the case in patients who undergo vitrectomy for any indication.
Studies have yet to compare the long-term effectiveness and safety of repeated corticosteroid and anti-VEGF regimens for treatment of RVO. In patients with CRVO, monthly dosages during a second year of treatment with intravitreal ranibizumab were associated with sustained VA, as well as regained VA in patients who were on a quarterly regimen during the previous year, with no serious adverse events (32).
In another trial of patients with CRVO, improvements in VA and CMT were sustained for up to 2 years, during which time intravitreal ranibizumab was administered according to signs of macular edema, averaging 6.6 injections during the second year (33). However, rescue treatment was allowed in the treated arm, which might reflect the treatment outcome. In a second year extension of the BRAVO and CRUISE trials, patients were examined at least once in 3 months and were administered intraocular injections of ranibizumab on an as-needed basis. The resultant reductions in examinations and treatments, compared to the first year, were associated with a decline in vision in CRVO eyes, yet stable vision in BRVO eyes (34). In these studies, response to treatment varied considerably among patients with RVO. It appears that after the first year with monthly injections, one anti-VEGF injection every 3 months may be adequate to treat many patients with BRVO, but most patients with CRVO seem to require more frequent monitoring and treatment.
The continuous release of medication by the DEX implant maintains a consistent level of drug within the eye, precluding the need for multiple repeated injections of other medications. This is a significant advantage of Ozurdex over anti-VEGF agents, since as-needed treatment with Ozurdex would result in 2 or 3 injections per year, much less than that required with anti-VEGF injections (32-33-34).
Our study includes the largest series of patients treated with at least 2 Ozurdex injections. The information provided reflects the current practice patterns of retreatment with Ozurdex injections in Europe. It seems that repeated Ozurdex injection is a valid treatment option of ME in RVO, accepted by both clinicians and patients. However, indications and protocols for reinjections have not been clarified and marked variation exists in the timing of repeated injections. Although it is generally accepted that due to its pharmacokinetic and clinical profiles, Ozurdex should be reinjected within less than 6 months after the previous injection, our results indicate that in many cases it is reinjected after 6 months or more. The retreatment intervals in current practice may be too long, and a shorter treatment interval may allow Ozurdex to reach its full potential efficacy after multiple injections. As a general rule, the decision to retreat, with any drug, should be based on both functional (VA) and morphologic (OCT) criteria. As such, retreatment should be considered when VA deteriorates or if persistent ME is documented by OCT (and fluorescein angiography in case of doubt).
Therefore, we have established the following recommendations for the treatment of ME in RVO with Ozurdex. The suggested retreatment algorithm is based on the joint clinical experience of the authors, as well as on data from this and other recent studies on this issue. After baseline VA, complete examination, and imaging have been performed, an Ozurdex injection is administered. In patients with BRVO, but not CRVO, laser treatment can be considered in combination with the injections, at the physician’s discretion.
Following an Ozurdex injection, IOP should be monitored between 4 to 8 weeks, and this monitoring can be done by the local physician or a nurse at the closest clinic. If an IOP rise >10 mm Hg or ≤30 mm Hg occurs, treatment should be initiated with IOP-lowering agents and the patient followed monthly until IOP returns to normal. If a patient experiences blurred vision or pain, he or she should contact the clinic immediately.
A complete examination including VA and OCT imaging should be performed 3 months after an Ozurdex injection. According to the findings in the examination, a repeated Ozurdex injection should be performed if ME is still present or if VA has decreased. With this strategy (
Ozurdex retreatment strategy. IOP = intraocular pressure; ME = macular edema; VA = visual acuity.
If there is ME and VA has improved 6 months after the injection, monitoring should be continued without reinjection. This protocol may allow for adequate monitoring of such patients, early recognition of sight-threatening complications, and timely reinjections tailored to each patient’s needs. If ME is present even without VA decrease, reinjection may be considered in order to achieve greater VA improvement.
Based on available data from this and other studies (25-26-27-28-29), reinjections generally will be performed after 4 to 5 months, with a mean of approximately 2-3 injections per year. We recommend applying this suggested protocol until large-scale, randomized, controlled trials addressing this issue are conducted.
11. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular edema secondary to branch retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study report 6. Arch Ophthalmol 2009; 127: 1115-28 Google Scholar
12. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with observation to treat vision loss associated with macular edema secondary to central retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study report 5. Arch Ophthalmol 2009; 127: 1101-14 Google Scholar
- Coscas, Gabriel [PubMed] [Google Scholar] 1, * Corresponding Author (email@example.com)
- Augustin, Albert [PubMed] [Google Scholar] 2
- Bandello, Francesco [PubMed] [Google Scholar] 3
- de Smet, Marc D. [PubMed] [Google Scholar] 4
- Lanzetta, Paolo [PubMed] [Google Scholar] 5
- Staurenghi, Giovanni [PubMed] [Google Scholar] 6
- Parravano, Maria Cristina [PubMed] [Google Scholar] 7
- Udaondo, Patricia [PubMed] [Google Scholar] 8
- Moisseiev, Elad [PubMed] [Google Scholar] 9
- Soubrane, Gisele [PubMed] [Google Scholar] 10
- Yatziv, Yossi [PubMed] [Google Scholar] 9
- Loewenstein, Anat [PubMed] [Google Scholar] 9
Centre Hospitalier Intercommunal de Créteil - France
Augenklinik, Städtisches Klinikum Karlsruhe - Germany
Eye Clinic, University Vita-Salute, Scientific Institute San Rafaele, Milan - Italy
Retina and Inflammation Unit, Clinique De Montchoisi, Lausanne - Switzerland
Department of Ophthalmology, University of Udine, and Istituto Europeo di Microchirurgia Oculare–IEMO, Udine - Italy
Department of Biomedical and Clinical Science “Luigi Sacco,” Sacco Hospital, University of Milan, Milan - Italy
Fondazione G.B. Bietti–IRCCS, Rome - Italy
Department of Ophthalmology, Nuevo Hospital Universitario y Politecnico La Fe, Valencia - Spain
Department of Ophthalmology, Tel Aviv Medical Centre, and the Sackler School of Medicine, Tel Aviv University - Israel
Department of Ophthalmology, Hotel Dieu, University Paris Centre, Paris - France

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Writing A Screenplay Treatment
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Writing a screenplay treatment is telling a story step by step, a short version of the screenplay. A treatment that flows smoothly and is engaging to read holds great potentialities for the author. It can place him on a higher pedestal that he could only dream about. Treatments make good selling tools too, for, not only are the screenplays sale-able commodities but today even an idea for a movie can fetch a high price.
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Beginning September 4th crews will be working to replace the curb, gutter and sidewalk along 10th Street, between Sheridan Avenue and Beck Avenue. Work will begin on the west side of the street, abutting City Park and will then move to the east side of the street, abutting the Park County Courthouse. Work is estimated to take approximately two weeks on each side. During this time parking will be limited to one side of the street.


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Social media was recently under fire, a continued streak for major companies, as their accountability for managing disinformation and hate speech was put to the test. Jasmine Razeghi writes on how the enforcement of social media policies remains inconsistent.
Yesterday, Facebook took down a Trump re-election campaign advertisement that featured a Nazi symbol, fueling the fire between social media companies and the President. The advertisement featured an upside-down red triangle, a symbol used by Nazis in order to classify concentration camp prisoners, as a part of its description of “dangerous MOBS of far-left groups.”
Facebook’s spokesperson said that the move was in response to their policy that “prohibits using a banned hate group’s symbol to identify political prisoners without the context that condemns or discusses the symbol.” Trump defended the triangle as a part of Antifa.
Facebook joined Twitter in monitoring the President’s social media posts. On Thursday, Twitter flagged a tweet from Trump and labeled it as “manipulated media”. The video was edited, as the headline and music did not match its original video.
CNN replied to the President’s tweet with the original report. They then stated, “CNN did cover this story – exactly as it happened. Just as we reported your positions on race (and poll numbers). We’ll continue working with facts rather than tweeting fake videos that exploit innocent children. We invite you to do the same. Be better.”
Facebook Remains Inconsistent
Facebook CEO Mark Zuckerberg was recently under fire for his refusal to remove a post by Donald Trump that threatened to shoot looters during the George Floyd protests. Facebook employees, congress members, and the American public all slammed Zuckerberg and his neglect of managing hate speech on the popular social media platform.
Even though there was a large amount of backlash, Facebook cited its refusal to remove the President’s post as the preservation of “free expression”. Zuckerberg also noted that the post had the potential to warn civilians of the possibility of government violence during the ongoing protests.
Holding Social Media Accountable
On June 18th, Republican Rep. Michael McCaul, leader of the House Foreign Affairs Committee, released a report card for top social media sites, a follow up from his initial request for Twitter, Facebook, and YouTube (Google) to address the Chinese Communist Party (CCP) and other propaganda outlets that give a platform for disinformation.
McCaul initially contacted these three major social media companies in March of this year. “The Chinese Communist Party has weaponized American social media platforms to push their disinformation and promote their propaganda. The solution is simple – de-platform CCP officials and propagandists who consistently spread lies,” stated Rep. McCaul. After months of contact, the congressman noted that there has been minor progress, but these social media companies still have a lot of work to do.
Report Card: Twitter
With the lowest grade of a D- among the three companies, Twitter made no progress in de-platforming CCP or other propaganda sources. McCaul noted that Twitter is the “most heavily abused by the CCP,” in his summary statement released by the GOP Foreign Affairs Committee.
While the company was recognized for its effort in fact-checking policies for truthfulness, the social media outlet failed to label propaganda and state-funded outlets, block CCP officials, and state-funded propaganda outlets from having verified accounts and remove CCP propaganda and disinformation.
Report Card: YouTube (Google)
With the second-worst grade of C-, YouTube has labeled propaganda and state-funded outlets. However, it was inconsistent. An example of the inconsistency was while there have been labels on videos that are viewed through a desktop or laptop, the label does not appear on videos viewed through a mobile device.
The Foreign Affairs Committee recognized the company for its fact-checking and labeling but recognized that YouTube (Google) still fails to block these CCP accounts from verification. There is also a lack of comprehensive removal of false information. The inconsistencies of YouTube have made its performance “insufficient” to the GOP House Committee.
Report Card: Facebook
The social media company faced no competition compared to YouTube or Twitter with a C+ grade from the House Foreign Affairs Committee. The Committee recognized that Facebook, like YouTube, labeled CCP propaganda and state-funded outlets in addition to their fact-checking policies.
However, since Facebook has not taken down any of the accounts that spread disinformation, the committee feels that the social media company’s actions did not meet standards. McCaul said that Facebook, like YouTube and Twitter, did little to maintain the spread of disinformation.
Congress Slams Facebook
Just last week, Congress members including Emmanuel Cleaver, Barbara Lee, Jahana Hayes, Katie Porter, and Ayanna Pressley among others wrote to the CEO of Facebook Mark Zuckerberg and demanded he addresses the company’s inability to address hate-speech and paid political disinformation on the social media platform.
Rep. Cleaver, who led the letter, slammed Facebook yesterday on Twitter. “Facebook’s new policy doesn’t go nearly far enough in addressing the disinformation & political manipulation occurring on their platform,” he tweeted. He made it clear that without combating disinformation, threats to democracy will continue around the world. “Congress cannot stand for any half-hearted attempts to address these serious flaws,” he wrote.


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When it comes to holidays in the United States, Los Angeles is one of the crown jewels: who could turn down a trip to Hollywood? A definite plus point is that the city has no shortage of motorhomebookers.com rental partners from which to pick up your RV rental.
Once you have chosen which of the camper rentals best suits your needs, you are free to plan your exploration of Los Angeles. This article aims to help you get started on your way.
It is hard to say exactly where to begin when listing the sites available to anyone with a Los Angeles RV rental. Many visitors will start their journey with a trip to Hollywood, where you can stroll down the legendary Walk of Fame and hike up the Mt. Hollywood Trail.
But Los Angeles is more than just a tinsel town. Griffith Observatory is the ideal place to get close to stars of a very different sort. Other informative destinations include the museums dotted along Miracle Mile: the Los Angeles County Museum of Art, the Peterson Automotive Museum and the Academy Museum of Motion Pictures.
For motorhome rentals with families, Disneyland is a must-see destination. Older visitors might lean towards the Getty Center, known for its many works of art. If you feel like a Los Angeles shopping spree, then Rodeo Drive might be worth a look. Finally, you can relax on Venice Beach when you have exhausted yourself after a day of touring Los Angeles.
People who start their road trips with Los Angeles RV rentals will find that the city and its surrounding area have various RV-friendly accommodations. For example, to the northwest of the city are the Valencia Travel Village, Hasley Canyon Mobile Estates and the Castaic Lake TV Park, all of which accept visitors with campervans.
The above RV sites allow access to such nearby destinations as Castaic Lagoon, Pico Canyon Park and Six Flags Magic Mountain. There are also historical landmarks like Pico Number 4: the first oil well in California. East of the city, there are RV parks like Desert Shadows and Cathedral Palms near the Californian desert.
Since Los Angeles is a coastal city, you will not even have to drive into the country to enjoy a scenic RV rental in Los Angeles. Visitors who park their motorhomes at destinations like the Huntington Beach RV Campground or the Seabreeze RV Park can take in rolling ocean views and experience beach activities from watersports to sunbathing.
Once you have arrived for your RV rental in Los Angeles, you will find yourself in one of the city's airports. As you would expect from a city of this size and importance, Los Angeles has multiple airports; the Los Angeles International Airport is the most prominent, followed by the John Wayne Airport. Other airports in LA are primarily domestic.
Los Angeles offers various benefits as a starting point for a long-haul journey by RV rental. Since it is a coastal town, Los Angeles makes a great destination for those who enjoy beach activities. Also, its sheer size and significance make it a major hub for travel.
If you are interested in motorhome rentals for short trips, you will find more than enough to experience within the confines of Los Angeles. However, if you are interested in a longer journey, then you can travel north to San Francisco, south to San Diego, or east across state lines to Phoenix, Arizona.
Having read this article, you should know some of the destinations and activities Los Angeles offers for visitors with RV rentals. While on your road trip, you can sample the glitz and glamour of Hollywood or retreat into nature. Whether your ideal backdrop is a big city, a desert, woodland or a sunny beach, Los Angeles has it all!
If you are eager to start planning your journey in Los Angeles and would like to find the best RV rentals in the city, then get in touch with motorhomebookers.com to find your vehicle. The team will help give you all the information you need to begin your tinsel-town journey of a lifetime!


|Publication number||US4056268 A|
|Application number||US 05/677,578|
|Publication date||Nov 1, 1977|
|Filing date||Apr 16, 1976|
|Priority date||Jun 9, 1975|
|Publication number||05677578, 677578, US 4056268 A, US 4056268A, US-A-4056268, US4056268 A, US4056268A|
|Inventors||Thomas R. Connor, Shirley A. Connor|
|Original Assignee||Connor Thomas R, Connor Shirley A|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (5), Non-Patent Citations (1), Referenced by (10), Classifications (11)|
|External Links: USPTO, USPTO Assignment, Espacenet|
1. Field of the Invention.
This is a continuation-in-part of my original application for patent, Ser. No. 577,305 filed June 9, 1975 now co-pending and which is to be abandoned upon the filing of this specification.
The invention relates generally to the game of polo, and more particularly to apparatus for motorcycle polo game.
2. Description of the Prior Art.
Polo does not seem to have been played on motorcycles heretofore, but has been played on bicycles with no modification of the bicycle or field.
It is an object of the invention to provide steering apparatus that will not interfere with hitting a ball with a mallet from a motorcycle.
Another object of the invention is to provide foot control for all motor controls and braking.
Another object of the invention is to increase traction and decrease wear and tear on a playing field.
A further object of the invention is to provide apparatus for stabilizing a rider on a moving motorcycle as he rises from his seat and tries to hit a ball on the ground.
A last object of the invention is to provide side boards and goals on the field that are compatible with the use of motorcycles.
FIG. 1 is a three dimensional view of a motorcycle modified for playing polo;
FIG. 2 is a plan view of steering apparatus of the invention with interior channels and engaging projection shown by dotted lines;
FIG. 3 is a side view of the steering apparatus illustrated in FIG. 2;
FIG. 4 is a partial three dimensional view of a motorcycle showing position and installation of stabilizing apparatus;
FIG. 5 is a three dimensional view from above of a playing field according to the invention;
FIG. 6 is a side elevation of a field side board;
FIG. 7 is a three dimensional view of a net staple;
FIG. 8 is a partial view of netting and fastening;
FIG. 9 is a plan view of the throttle and brake foot pedal;
FIG. 10 is a side view of FIG. 9;
FIG. 11 is a plan view of clutch and gear shift pedal controls; and
FIG. 12 is a side view of FIG. 11.
Referring to FIG. 1, the invention comprises a motorcycle 10 of any convenient make and size which is modified by installing wide anti-skid tires 12 on disc wheels 14 and removing the conventional handlebars (not shown) and replacing them with steering control 16 that is rigidly connected to a central steering post 18. Resilient knee rolls 20 are adjustably mounted to a circumferential strap 22 for securing around a top mounted gas tank 24, the rolls being adjusted adjacent the knees of a rider or player to permit him to lean forward and backward without fear of loosing his knee grip on motorcycle 10. A hand strap 26 secured to center steering post 18 at one of said strap ends and to strap 22 at the other of said ends defines a hand loop 30 at the strap 22 end for engaging with a steering hand gripping operably steering control 16 for preventing inadvertently changing direction of motorcycle 10 when leaning outward to strike a ball. See FIG. 4.
Conventional foot controls are modified by adding foot-cups 32 to pedal controls 34 and 36 of motorcycle 10. A foot-cup 32 is fixed to pedal control 34 to which brake cables 38 and 40 are operably connected for brake application when pedal control 34 is depressed, and throttle cable 42 is connected for increasing speed when pedal control 34 is raised. A second foot-cup 32 is slidably mounted on pedal control 36 and biased by spring 44 rearward. Second foot-cup 32 is connected with clutch cable 46 for disengaging the clutch when slid forward and engaging said clutch (not shown) when biased rearward. Raising and depressing pedal control 36 shifts gears. See FIGS. 9-12.
A polo playing field is modified by covering with a neoprene covered netting 48 that is secured to the field on three foot centers by staples 50. Side boards 52 running along the sides of the field are pivoted to anchoring extensions 54 and biased upright for deflecting a ball back in the field but allowing a motorcycle 10 to flatten it in either direction of pivoting when running into it. Goal posts 56 are made of an elastic material for yielding to impact with a motorcycle 10. The field modifications thus permit fast stops, starts and turns without destroying the turf and with increased traction between wide non-skid tires and the field, allows collisions with side boards without damage to motorcycle and rider, and the same with respect to goal posts. See FIGS. 5-8.
Referring to FIGS. 2 and 3, steering control 16 comprises clamps 58 rigidly clamping it to center steering post 18. Miniature handlebars 60 with hand knobs 62 are connected by transverse rod 64 serving as a pivot support for a rearwardly extending steering lever 68 on the end of which handgrip 70 is fixed. Handlebars 60 are provided to meet the minimum requirements for road use to get motorcycle 10 to and from a playing field under its own power.
Steering lever 68 comprises a deformable middle sleeve 72 pivoted at one end to transverse rod 64 equi-distant from said hand knobs 62. Interior "I" channel 74 is defined in the top of middle sleeve 72 with the parallel end channel parts 76 defining semi-circles adjacent the oppositely disposed ends of middle sleeve 72. An inner member 78 having an upwardly projecting lug or cam 80 adapted to engage in "I" channel 74 is forced into middle sleeve 72 by deforming it sufficiently to admit lug or cam 80 past the free end of middle sleeve 72 and slidably engage said inner member 78 in said middle sleeve 72 with lug 80 engaged in "I" channel 74. A non-deformable outer sleeve 82 is fixed around deformable middle sleeve 72 to prevent any deformation that would allow the disengagement of lug 80 from channel 74. Handgrip 70 is mounted normal to inner member 78 and on its free end to extend upwardly.
|Cited Patent||Filing date||Publication date||Applicant||Title|
|US583809 *||May 29, 1896||Jun 1, 1897||Steam-bicycle|
|US616153 *||Feb 18, 1896||Dec 20, 1898||Motor-vehicle|
|US2330341 *||Jul 23, 1942||Sep 28, 1943||Indian Motocycle Company||Motorcycle saddle|
|US2613722 *||Jul 1, 1949||Oct 14, 1952||Eli W Gaffield||Saddle cover|
|US3820790 *||Sep 27, 1972||Jun 28, 1974||Peterson G||Vehicle for playing a ball game|
|Citing Patent||Filing date||Publication date||Applicant||Title|
|US4630703 *||Dec 12, 1985||Dec 23, 1986||Fletcher James D||Two-wheeled motor vehicle assembly|
|US4708357 *||Mar 31, 1986||Nov 24, 1987||Gerard Berkowitz||Adaptor handle|
|US4872697 *||Nov 1, 1988||Oct 10, 1989||Gerard Berkowitz||Adaptor handle|
|US4964648 *||Aug 16, 1989||Oct 23, 1990||Gerald Berkowitz||Adaptor handle with adjusting mechanism|
|US6945376||Aug 4, 2003||Sep 20, 2005||Hunter Robert M||Foot operated motorcycle clutch|
|US7143662||May 18, 2005||Dec 5, 2006||Hobson Jr Claud||Motorcycle cruiser bars|
|US7258357||Jan 21, 2005||Aug 21, 2007||Berezny Thomas J||Motorcycle safety saddle|
|US8409035||Oct 5, 2009||Apr 2, 2013||Winsor Fun, LLC||Method of playing a field game|
|US8640808||Aug 7, 2007||Feb 4, 2014||Edwin Dennis Kissick||Motor-driven cycle having a foot-operated throttle control|
|US20050257641 *||May 18, 2005||Nov 24, 2005||Hobson Claud Jr||Motorcycle cruiser bars|
|U.S. Classification||273/118.00R, 180/219, 180/332, 180/292, 280/263|
|International Classification||A63B67/00, B62K21/00|
|Cooperative Classification||B62K21/00, A63B67/002|
|European Classification||A63B67/00B, B62K21/00|


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I've been cutting - no, worse than that, tearing - into NBUS Graphic 45 papers again. I know, I'm getting reckless!
These papers are from a 6 x 6 Cityscapes backgrounds pad and I've kept to turquoise and teal, matching them with a stamped Paris Skyline stamp from the Tim Holtz Cityscapes set and a Paris collage image and postcards from a lovely un-named set I got in a bargain box at a craft show.
I am sharing this with
Sweet Stampin' - travel
Crafty Calendar - dots and/or stripes
House of Cards - where I have chosen the "Use patterned paper" option.


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Sand and Tanned on the Surf Turf.
“Summer is coming”, said no one ever.
In the last few bearable weeks that could be spent outdoors, Sarah and I greedily seized the opportunity to join a surfing trip to Udupi, Karnataka. Latching onto a half-assed invite, we were the odd balls in an engineer’s-only group. An overnight train ride and several rounds of cards later, we arrived at Udupi - the Miami of the south.
The village of Thonse has quaint, narrow lanes lined on both sides by houses no smaller than mansions. Life here is languid. Time stands still. Our holiday in this tranquil place included camping outdoors, meals, massages, surfing and yoga lessons. Let’s get one thing straight, our `health centre’ was a hospital for the nearly-but-not-really healthy. It served nutritious meals prescribed by a dietician and scheduled to the T, low decibels through the day, lights out and gates shut by 10pm. Catch-22 was that it had a beautiful property, with a panoramic view of a river bound by clusters of coconut palms, and ACs. I’m from Mumbai. One of the few times we experience winter is when the airconditioner is at 24 degrees C. So yes, this vacay had us tip-toeing about; a group of carnivorous youngsters with more bustle in our breaths than an enclosed space could handle.
The view from a room
Everyone from surfers, yogis, slack liners to locals, lost travellers and stray animals find a home and a family here. Together they can be seen in splits on yoga mats and jokes, laying out the table or washing plates and riding waves or bathing their boards. Campers are housed in sand-pitched tents and sway in leisure on colourful hammocks. These suspended cradles and a slack-line are firmly perched between tall, bendy coconut trees. A yellow kayak laps gently at the riverside while a green jungle gym is secured on the rocky seashore. A makeshift mini skate-park cum open-air yoga space completes the campsite.
The surfing gang
The first day was the only one on which we walked to the beach. Thereafter, we couldn’t be asked anymore and hitched rides in goods carriers, buses or tuk-tuks to and from the surf school.
Our first lesson was theory and on-ground practical stuff. Soon we were popping up on the disfigured boards that we etched into the sand. Unaware that it was only on land where we would perform the technique correctly, we waited impatiently to dash into the water. Fastening our leashes like we weren’t going to let go of the dogs that our boards were, we entered the sea.
The lessons involved:
1. Learning to identify a wave at the far horizon.
2. Paddling towards its peak.
3. And in our instructor's words, “Paddle! Paddle! Paddle! JUUUUMP!”
First lesson discussion
In movies and ‘epic surfing’ videos, we learned that waves are ridden diagonally or horizontally, from their peak up to the point where they break into foam. And that’s precisely what we saw the experts manoeuvre. However, as beginners we were taught to paddle towards the peak of the breaking wave and take it perpendicularly to the coastline. If luck permits, even ride it in the foam up to the shore.
The lessons helped us get our basics clear - on and off shore. Staring out into infinity we could soon gauge the areas where the water surface rose and softened. We learned that like mean girls, the swell often comes in groups of three. So we need not lose hope if we failed the first time because the next can still be the one. Conversely, if we’re rejected and thrown off on the first attempt, oh boy, the other two are going to turn us down.
One evening, using our unsupervised, extra surf sessions, we hit the shore running. As luck would have it, this was the day when there was a strong current moving southwards. Grabbing onto the 6 ft long foam boards, we dumped our slippers and t-shirts in the sand right across the surf school. An hour later, we got out of the water puzzled at how we had ended up more than a kilometre away from our starting point.
Takeaway: Most battles are fought away from your home turf.
The powerful force of the current harnessed at our waists was equivalent to a heavy workout with hundred resistance bands pulling diagonally as we tried to beat it forward. We managed to advance only a few metres inwards where the water reached waist high. There are specific regions in the surface of the ocean, where the waves form massive crests. These areas lie directly above depressions in the sea bed. Often enough we walked into them, which led to an immediate neck-deep immersion. It was amusing to watch each other descend into such pits, but not so funny when we were left with no choice but to leap over the waves that hit us head-on like aggressive bulls.
Takeaway: You can’t emerge to the highest high, without stepping into the lowest low.
Surfing that evening can be described in one word - disastrous. There was no surfing. If I recall correctly, none of us even got the opportunity to get onto our boards. The whole scene can be picturised as an attempt to walk against an oncoming truck. The only difference was that we didn’t get crushed, we got flung off. The long board capsized, jarring into someone else’s thigh.
The next evening, the opportunist inside urged us to go back to the beach, capitalizing on our 'unlimited' surf sessions. Why did we want to get beaten up by the waves again?
Takeaway: There are no takeaways since there are no free lunches.
The body-surfing progressed to knee-surfing and even sitting-surfing. In the midst of the turnovers, bumps and topples we got back up and in. Over the four day trip, our performance went from haphazard and unpoised to fair and mediocre. The panic in our endeavours to paddle and pop-up gradually wore off, morphing into a fixed pattern, a routine drill. Hard falls were taken lightly, and we continued to hit and miss, hit and miss, hit and miss.
And soon we rose as often as we fell and jumped up as often as we plunged down. We stopped fighting the ferocity, instead we let it engulf us. Learning to let go of the anxiety, we gave in and relaxed on our way down under. As the waves stormed into us, we enjoyed the somersault, the summer and the salt.
Takeaway: Lose the battle, win the war.
Side-note: Watching us from the shore, our instructor said we could easily be mistaken for a dolphin-sighting on our long boards. Turns out, he meant not as graceful. Just as fleetingly spotted above the surface of the water.
Enjoying the somersault, summer and the salt
1. Fly to Mangalore and drive down to Bengre, or take a train directly to Udupi in Karnataka.
2. Post-surfing, yoga sessions are to die for.
3.For those who are reasonably fit, you’ll be up on your board in one session.
4.Four / five sessions are most suitable to get an idea and develop an interest in surfing.
Disclaimer: The views expressed in this article are independent views solely of the author(s) expressed in their private capacity and do not in any way represent or reflect the views of 101India.com.
By Nidah Kaiser
Photographs by: Sarah Vora and Arundhati Karanth.