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Nestled in the pristine coastline of Algiers, the Gulfside City Park Beach beckons visitors to a haven of serene landscapes and untouched natural beauty. As a hidden gem in the region, it offers a tranquil escape, inviting you to immerse yourself in its golden sands, crystalline waters, and an array of vibrant ecosystems. Whether you’re a nature enthusiast looking to explore the rich flora and fauna or a traveler seeking a tranquil retreat, Gulfside City Park Beach stands as an emblem of tranquility and picturesque settings. Venture into this coastal paradise and discover a remarkable blend of relaxation and adventure, promising an unforgettable experience with every visit.
A Tranquil Escape at Gulfside City Park Beach Algiers
As I step onto the soft, white sands of Gulfside City Park Beach Algiers, I am immediately struck by the serene atmosphere surrounding me. The gentle sound of the waves lapping against the shore and the warm sun on my skin create a sense of calm and relaxation.
Unlike other bustling beaches crowded with visitors, Gulfside City Park Beach Algiers offers a tranquil escape. The clean, crystal-clear waters and natural beauty of the beach make it a perfect spot for unwinding and rejuvenation. Anyone looking to take a break from the chaos of everyday life will appreciate the peacefulness this beach offers.
Exploring the Amenities at Gulfside City Park Beach Algiers
One of the best things about Gulfside City Park Beach Algiers is its abundance of family-friendly amenities. Whether you’re looking to enjoy a picnic, take a stroll, or let the kids burn off some energy, there’s something for everyone here.
For those looking to enjoy a meal or snack while taking in the stunning scenery, there are several picnic areas scattered throughout the park. These areas are equipped with tables, charcoal grills, and trash cans for your convenience. Additionally, the park has several public bathrooms and outdoor showers.
There are also plenty of activities available for children to enjoy. In addition to the beach and playgrounds, the park has several walking paths and nature trails that are perfect for exploring with the little ones. For those interested in history, there are also several historical landmarks nearby that are worth checking out.
For those looking for a more active experience, there are a variety of sports facilities available as well. The park has basketball and volleyball courts, as well as a baseball diamond, soccer field, and tennis court. There’s even a fitness trail for those looking to get in a workout while enjoying the beautiful Gulfside scenery.
Overall, Gulfside City Park Beach Algiers is a wonderful destination for families looking to spend a day at the beach. With its abundance of activities and amenities, it’s easy to see why so many visitors return year after year.
Enjoying Nature at Gulfside City Park Beach Algiers
As I explored Gulfside City Park Beach Algiers, I couldn’t help but appreciate the natural wonder and wildlife that encompasses this beautiful beach. The park offers visitors a unique ecological experience, complete with diverse flora and fauna.
One of the most remarkable features of Gulfside City Park Beach Algiers is the protected dune system that lines the shore. The dunes, covered in sea oats and other vegetation, serve as a vital habitat for various wildlife species. Visitors can enjoy watching the birds that inhabit the area or take a stroll along the designated boardwalks that wind through the dunes.
|The park is home to several bird species, including the American oystercatcher, black skimmer, and least tern.||The dune system is filled with sea oats, beach grasses, and other vegetation that serve as an essential habitat for various wildlife species.|
|Visitors can also spot the occasional sea turtle or dolphin swimming in the waters offshore.||The park also boasts other plant life, such as the American beachgrass, which helps to stabilize the dunes.|
Aside from the wildlife and dunes, visitors to Gulfside City Park Beach Algiers can also enjoy the nearby nature reserve. The reserve spans over 200 acres and offers hiking and biking trails, as well as opportunities for birdwatching and fishing.
If you’re looking for an escape into nature, Gulfside City Park Beach Algiers is a must-visit destination. With its diverse flora and fauna and beautiful natural surroundings, this beach park is a nature lover’s paradise.
Activities and Recreation at Gulfside City Park Beach Algiers.
Gulfside City Park Beach Algiers offers a diverse range of activities and recreational opportunities for visitors. Whether you’re looking for a thrilling water sport or a peaceful hike, this beach park has something for everyone.
One of the main draws of Gulfside City Park Beach Algiers is the range of water sports available to visitors. You can take a refreshing swim in the crystal-clear waters, or rent a kayak or paddleboard to explore the coastline. Thrill-seekers can also try their hand at surfing or windsurfing.
Hiking and Biking Trails
If you prefer to stay on land, Gulfside City Park Beach Algiers also offers a selection of hiking and biking trails. Visitors can explore the natural beauty of the surrounding area while staying active. The trails range from beginner to advanced, offering options for all skill levels.
Gulfside City Park Beach Algiers is known for its steady breeze, making it the perfect spot for kite flying. Visitors can bring their own kites or purchase one on-site. It’s a fun and relaxing way to enjoy the beach and take in the stunning views.
Picnic Areas and Playgrounds
If you’re visiting Gulfside City Park Beach Algiers with family, there are plenty of family-friendly amenities available. The beach park features several picnic areas, complete with grills, where you can enjoy a beachside meal. Additionally, there are playgrounds for kids to play on and burn off some energy.
Overall, Gulfside City Park Beach Algiers offers a wide range of recreational activities for visitors. From water sports to hiking to kite flying, there’s something for everyone. Plan your visit and experience the unique charm of this Gulfside paradise.
Overall, Gulfside City Park Beach Algiers is an absolute must-visit destination for anyone looking to relax, unwind, and enjoy the natural beauty of the Gulfside. With its pristine sands, crystal-clear waters, and family-friendly amenities, this beach park has something for everyone.
Whether you’re looking for a tranquil escape or an adventure-packed day of outdoor recreation, Gulfside City Park Beach Algiers has you covered. From water sports to hiking trails, there’s no shortage of activities to keep you entertained.
As someone who has visited Gulfside City Park Beach Algiers multiple times, I can confidently say that it’s one of the best beach parks in the country. So, if you’re planning your next vacation or just looking for a weekend getaway, be sure to include Gulfside City Park Beach Algiers on your itinerary. You won’t be disappointed!


Cold Steel Knives - Trail Master San Mai III
A Bowie knife that requires minimum maintenance and ispractically immune to water,salt,air,or humidity of a jungle. Made of San Mai III steel (3 laminated layers). Codura sheath. 9-1/2" blade. 14-1/2" OA
|Blade Length||9.5 inches|
|Blade Material||Stainless Steel (San Mai III)|
|Total Length||14.5 inches|
|Pocket Clip Included||No|
|Knife Type||Fixed Blade|
|Knife Weight||17.5 ounces|
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Perhaps the best production knife ever made, Through jungles, mountains,prospecting,jungle villages, the beaches fishing salt and fresh water, and camping in the usa, This knife is a partner and is perfect for any adventure you can dream up, cut your palm leaves for thatch, clean it and carve a pig up, if you take nothing else take this.
I had read an article in Outdoor Life called Big Ass Knives. In the article this knife was considered the best looking knife. It is that and more. It feels good in your hand and is well balanced. I showed it to several ladies in my office and they liked the grip and feel of the knife. It lives up to the Cold Steel name.
I have wanted this knife for many years. It is everything I expected it to be.
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MULTAN: Pakistan Tehreek Insaaf’s Vice Chairman Shah Mehmood Qureshi on Friday said the party’s review board constituted by Imran Khan would work independently and he was not a hurdle in awarding tickets.
Speaking at a press conference at his residence here on Friday, Qureshi said that he was ready to make any sacrifice on the tickets issue.
He disclosed that former federal minister Sikandar Bosan was aspirant for the party ticket from NA-154, adding that the party had welcomed him when he joined it in past.
Qureshi, however, explained that if Bosan wanted to leave the PTI, it would purely his own decision.
Decisions of awarding ticket for elections was not an easy job and none other than PTI chairman Imran Khan had to decide about party tickets, said Qureshi.
Shah Mehmood categorically said that he had no differences with Jehangir Tareen, adding that the latter was out of politics and he saw no reason to have differences with him.
Brushing aside allegations of awarding party tickets through nepotism, Qursehi said that he always preferred ideology over any relation for awarding tickets.—APP


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Carbon dioxide (CO2) is a colourless, odourless gas produced by burning carbon and organic compounds, and by respiration. It is naturally present in air (about 400 parts per million1) and is absorbed by plants during photosynthesis.
The Linde Group supplies CO2 into many countries. A significant amount of the product is re-captured from industrial processes. This re-captured CO2 is then condensed and purified, allowing it to be sold in cylinders or in bulk to a range of specifications, from food grade to industrial or agricultural grade.
CO2 is a versatile molecule, supporting growth in plant life whilst also serving as a useful pest control tool. It is considered an organic treatment in many countries which means that the addition of CO2 into the greenhouse or as a post-harvest treatment for produce will not impact the organic status of your produce. Consequently, with the growth in demand for organic produce increasing steadily internationally, CO2 is part of the solution for many farmers and storage facilities worldwide.
CO2 may be regulated for use as a fumigant or for use in greenhouse applications in your country and CO2 safety monitoring should be conducted during applications. For more information, please contact your local Linde representative.
Ideal for bakeries
Carbon dioxide (CO2) and nitrogen (N2) are natural products and incredibly effective in preventing pest and insect infestation in dry ingredients such as flour. If your bakery has already been infested by insects, we also have a special range of fumigants engineered to deal with that problem.
Safety Data Sheets
Safety data sheets provide key material characteristics for each product we supply. These data sheets include how to safely handle, use and respond to an emergency for each product.
References:1National Oceanic & Atmospheric Administration (NOAA) - Earth System Research Laboratory (ESRL). Trends in Carbon Dioxide Values. Values given are dry air mold fractions expressed in parts per million (ppm). For an ideal gas mixture, this is equivalent to parts per million by volume (ppmv).

domain: chemistry


There are many canals in Charpata Union, which are irrigated during the dry season in this region. However, there has been a mother river in this union. This is the Dakatiya river. This river is on the verge of extinction in the evolution of time.
সাইটটি শেষ হাল-নাগাদ করা হয়েছে: ২০২০-০৫-০৭ ১২:৫৮:২৭


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Sri Lanka’s first 3D animation movie ” Gajaman(ගජමෑන්) 3D ” using motion capture technology released in theatres from January 20. Movie premiere was held in PVR Cinemas One Galle Face Colombo. The trailer of the movie was released in 2018.
Movie was directed by Chanaka Perera and co-produced by John Fonseka and Chamika Jinadasa for Studio 101 and it is based on the popular “Gajaman” cartoon by veteran Sri Lankan cartoonist Camillus Perera.
Gajaman film’s theme song is ‘Bombe Motai’ and now it has crosses Million Youtube views.

domain: entertainment


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FAKKU is a name that has become synonymous with adult entertainment in the world of hentai. This pioneering website has been at the forefront of creating and publishing some of the most riveting and engaging erotic content in English adapted from Japanese art.With years of experience under their belt, FAKKU has established itself as a trusted source for hundreds of thousands of people around the world. The platform boasts an incredible library of premium content, featuring top-rated comics, manga, doujinshi, and even full collections that can only be found on FAKKU.
As the largest English-language hentai publisher in the world, FAKKU draws its attention to bringing Western users enticing material while staying true to the original Japanese culture. This allows fans to indulge in their love for fantasy-based erotica without compromising on quality or authenticity.
One noteworthy aspect about FAKKU is its community culture—a space where fans can come together and share their thoughts on various topics related to hentai, such as characters development, suggested works analysis, and even niche preferences discussion. Besides discussing their passions with like-minded individuals, users also get access to exclusive social events and discounts.
Another factor that sets this site apart is its dynamic approach to content curation. While other adult websites may focus on quantity over quality, FAKKU takes a different approach by ensuring all comics are edited and translated professionally before they are published. This ensures that every single work uploaded to the website matches—and even exceed—the industry’s highest standards.
When it comes to navigating through their extensive collection of works safely without any fear or foul play guaranteed safe browsing will be provided Throughout its years of operation., FAKKU has consistently managed to maintain an impeccable reputation for privacy protection; hence members can feel at ease during each visit knowing they remain protected from cyber threats.
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To sum it up, FAKKU is an unmatched platform that pushes the boundaries in creating stimulating adult content while maintaining a friendly environment for their community members to discuss and share opinions safely. The website’s vast library of top-rated content, coupled with its unwavering commitment to quality, has made it a go-to destination for people around the world who are seeking an indulgent and satisfying experience within the hentai community.

domain: literature


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We have been married since 2006, and best friends since we were teenagers. We live with our children in Thailand, where we love the slower-paced life, and incredible beauty around us. We have been on quite a wild journey of healing ourselves, and it is our immense honor to help you learn how to listen to the wisdom of your body as you find your way back to yourself.
In Healing and Wholeness,
Lauren + Luke
This shield was for your protection, but once the actual threat has passed, it becomes a hindrance to your flourishing. (The memory of the threat stays alive and active in the body long after the acute threat has passed, until it experiences resolution). Not only are the hard emotions like grief, shame, regret, heartache, (sometimes […]
Become the primary caretaker of your own parts, so that your partner is freed up to become the secondary caretaker. Richard Schwartz So much of the pain caused in relationships is because you want your partner to do what only you can do for yourself. YOU are the one who you can venture inside and […]
Humans need 4 things from an attachment standpoint, according to Dr. Dan Siegel, founder of the remarkable field of interpersonal neurobiology (also known as relational neuroscience). To be: 1.) Safe2.) Seen3.) Soothed4.) Secure These needs are present from the very beginning and depending on how they are responded to and how consistently they are met, […]

domain: psychology


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1. Summary: Harvest Fund Management’s Hong Kong subsidiary has submitted an application for a Bitcoin spot ETF to the Securities and Futures Commission, marking the first of its kind in Hong Kong. The launch is expected to take place after Chinese New Year and the SFC is expediting its approval. Additionally, Hong Kong is also preparing to accept applications for virtual asset spot ETFs, as the SFC and the Hong Kong Monetary Authority have outlined the standard of conduct for distributing these funds.
2. Brief Article Summary: Harvest Fund Management’s Hong Kong subsidiary has submitted an application for a Bitcoin spot ETF, the first of its kind in Hong Kong, with plans for a post-Chinese New Year launch. The Securities and Futures Commission is expediting approval and Hong Kong is preparing to accept applications for virtual asset spot ETFs. Despite this openness to digital assets, Hong Kong has strict regulations and has enforced stricter measures after a scandal involving a crypto exchange last year.
3. Thought-Provoking Questions/Insights:
– Regulatory Environment: How will the approval of a Bitcoin spot ETF in Hong Kong impact the regulatory environment for digital assets in the region?
– Investor Behavior: What impact will the availability of a Bitcoin spot ETF have on investor behavior and interest in digital assets in Hong Kong?
– Risk Management: How can regulators and financial institutions ensure effective risk management and consumer protection in the context of digital asset ETFs in Hong Kong?
This is sponsored by: Learn Bitcoin Option

domain: finance


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We aimed to investigate clinical parameters that affected the results of navigated repetitive transcranial magnetic stimulation (nrTMS) language mapping by comparing the results of preoperative nrTMS language mapping with those of direct cortical stimulation (DCS) mapping. In the prospective, non-randomized study, patients had to meet all of the following inclusion criteria: the presence of left- or right-side brain tumors in the vicinity of or inside the areas anatomically associated with language functions; awake brain surgery scheduled; and age >18 years. Sixty one patients were enrolled, and this study included 42 low-grade gliomas and 19 high-grade gliomas (39 men, 22 women; mean age, 41.1 years, range 18–72 years). The tumor was located in the left and right hemisphere in 50 (82.0%) and 11 (18.0%) patients, respectively. In the 50 patients with left-side gliomas, nrTMS language mapping showed 81.6% sensitivity, 59.6% specificity, 78.5% positive predictive value, and 64.1% negative predictive value when compared with the respective DCS values for detecting language sites in all regions. We then investigated how some parameters, including age, tumor type, tumor volume, and the involvement of anatomical language-related regions, affected different subpopulations. Based on the receiver operating curve statistics, subgroup analysis showed that the non-involvement of language-related regions afforded significantly better the area under the curve (AUC) values (AUC = 0.81, 95% confidence interval (CI): 0.74–0.88) than the involvement of language-related regions (AUC = 0.58, 95% CI: 0.50–0.67; p < 0.0001). Our findings suggest that nrTMS language mapping could be a reliable method, particularly in obtaining responses for cases without tumor-involvement of classical perisylvian language areas.
The first-line treatment for low- and high-grade gliomas is extensive surgical resection1,2,3. Numerous clinical studies have demonstrated that gross total resection or maximum extent of resection (EOR), such as maximum resection, significantly increase progression-free survival (PFS) and overall survival (OS) in patients with gliomas1,3,4,5,6,7,8. However, gliomas often occur near or within functionally eloquent regions9,10, which means that tumor removal in such areas carries a potentially high risk for neurological function deficits, including motor dysfunction, language disturbance, and neurocognitive impairments. Intraoperative awake language mapping with direct cortical stimulation (DCS) is therefore advocated for the preservation of language function11,12,13.
While intraoperative language mapping is highly reliable, preoperative language evaluation can be of great value because the investigation of cortical language functions preoperatively makes brain tumor surgery safe, practical, and effective. Furthermore, the risk of postoperative language deficits significantly increases when brain tumor surgery involves the language dominant hemisphere; it is therefore crucial to determine language dominance for surgical planning14,15. Language task-based functional magnetic resonance imaging (fMRI) allows preoperative non-invasive identification of language areas. This technique has been widely used in preoperative risk assessment and planning to reduce the rate of post-surgical functional impairments16,17. Because a fMRI activation also represents excitatory activation, which is the result of having been recruited by an upstream or downstream area, there is a fundamental problem with fMRI to predict speech localization for presurgical planning. Although one surgical study has shown fMRI for neurosurgical planning was a useful, comparing with intraoperative DCS during awake surgery18, most studies have not clarified the reliability of language fMRI in preoperative neurosurgical planning for patients with tumors in language-eloquent brain regions17,19,20,21.
Navigated repetitive transcranial magnetic stimulation (nrTMS) has been increasingly used for preoperative language mapping in patients with tumors in left-side perisylvian brain regions22,23,24,25. These studies compared preoperative nrTMS and intraoperative DCS language mapping. nrTMS in combination with picture-naming tasks has enabled the mapping of the cerebral cortex for language-eloquent regions22,23,24,25,26,27. However, the accuracy of preoperative language nrTMS mapping varies across cortical language regions, protocol types, and some clinical parameters22,23,24,27. Picht et al. reported that pre-surgical nrTMS language maps showed high sensitivity and negative predictive values, while specificity and positive predictive values were low when compared with DCS22. In contrast, Tarapore et al. found that nrTMS language mapping had high sensitivity and specificity (90% and 98%, respectively) when compared with DCS27. These studies reported high numbers of false-positive findings and varying degrees of specificity and positive predictive values. We suspect that the discrepancies between these studies were caused by the influence of several pathological brain conditions, such as high-grade gliomas with broad peritumoral edemas. Krieg et al. compared two different picture-to-trigger intervals (PTI) (0 ms and 300 ms) and concluded that nrTMS stimulation onset coincident with picture presentation onset showed more language-involved regions than intraoperative DCS, thereby demonstrating the influence of stimulation onset on picture-naming tasks24. A PTI with 0 ms delay led to 90% sensitivity, 79% specificity, a 53% positive predictive value, and a 97% negative predictive value across regions. Although some groups intend to identify the optimal timing of pulse onset and new nrTMS protocols to improve the specificity of nrTMS language mapping24,27, it still remains unclear whether the clinical features of patients with brain tumors influence language mapping results. Clinical factors underlying the inter-individual variability of the resting motor threshold (RMT) regarding nrTMS motor mapping have been previously shown28; therefore, clinical factors that potentially affect the accuracy and reliability of nrTMS for language mapping should be explored.
Low-grade gliomas of World Health Organization (WHO) grade I or II are slow-growing primary brain tumors, while high-grade gliomas, such as WHO grade III or IV, show aggressiveness and rapid infiltration in the brain. Fast-growing high-grade gliomas may cause more profound language dysfunction than slower-growing low-grade gliomas, since in the former case cerebral reorganization may not occur to a great degree when neuronal damage happens at a high rate. Tumor growth could increase the extent of language impairments due to displacement or infiltration of language-eloquent brain regions. Previous studies reported the results of preoperative nrTMS language mapping performed in a comparatively large cohort of patients with high-grade gliomas22,24,27. However, in a study by Krieg et al., which showed optimal timing of pulse onset for language mapping with nrTMS, 25 out of 32 patients (78.1%) had high-grade gliomas such as glioblastoma, anaplastic astrocytoma, and anaplastic oligodendroglioma24. Picht et al. had a majority of high-grade gliomas (16/20; 80%), in a study that compared the safety and effectiveness of preoperative nrTMS with DCS mapping during awake surgery22. Furthermore, Tarapore et al. reported nine out of 12 patients (75.0%) with high-grade gliomas in a study on language mapping with nrTMS27. To the best of our knowledge, there is no clinical study with a majority of low-grade gliomas comparing nrTMS language mapping to intraoperative DCS during awake surgery. As the present study included mostly low-grade gliomas (68.9%), we hypothesized that such tumor effects can affect nrTMS language mapping results, with differences in tumor grade potentially altering the accuracy of preoperative language nrTMS mapping.
Regarding nrTMS language mapping, most previous studies were conducted in patients with tumors in or close to left-sided language-eloquent regions only, not right-sided regions. There is one study using nrTMS that confirmed that the right hemisphere is involved in language reorganization in patients with left hemispheric tumors29. Another study using nrTMS demonstrated that lesions within the language-eloquent brain can induce plasticity as a shift of language function to the non-dominant hemisphere (right hemisphere)30. However, the role of the right hemisphere for language in patients with right-sided tumors has not yet been determined.
In the present study, we performed preoperative language mapping using nrTMS and awake brain surgery using DCS in patients with tumors in left- and right-side brain regions that are associated with language functions. We aimed to identify the clinical parameters that affect the results of nrTMS language mapping by prospectively comparing the results of preoperative nrTMS language mapping with DCS mapping. Furthermore, we analyzed the nrTMS language mapping data of those patients with right-sided gliomas that were not located within or adjacent to anatomically defined language-eloquent brain regions.
Patient demographic information
Between August 2013 and February 2019, 63 patients with glial tumors associated with functionally eloquent brain areas were assessed for the eligibility criteria listed above, and 61 patients (96.8%) were enrolled (Fig. 1). Clinical characteristics of all patients are summarized in Table 1. The study group consisted of 39 men and 22 women aged 18–72 years (mean age 41.1 years, median age 39 years). Sixty patients were right-handed (98.4%), and one patient was left-handed (1.6%). Histologically, this study included 42 low-grade gliomas and 19 high-grade gliomas. The tumor was located in the left and right hemisphere in 50 (82.0%) and 11 (18.0%) cases, respectively. Most of the tumors were located in the frontal lobe (n = 29, 47.5%), followed by those in the insular lobe (n = 17, 27.9%), the temporal lobe (n = 9, 14.8%), and the parietal lobe (n = 6, 9.8%). Median tumor volume, measured on MRI at preoperative diagnosis, was 43.2 cm3 (range, 0.6–177.3 cm3). The median EOR was 94.1%. A final EOR = 100% (gross total resection) was achieved in 25 patients (41.0%), an EOR ≥ 90% <100% (subtotal resection) in 16 (26.2%) patients, and an EOR < 90% in 20 (32.8%) patients.
Preoperative nrTMS language mapping in patients with left-side brain tumors
Preoperative nrTMS language mapping was performed in the 50 patients with left-side brain tumors over the whole left cerebral hemisphere. While five of the 50 patients (10.0%) asked us to reduce the stimulation intensity due to discomfort, pain, or muscle tetanization related to transient temporal muscle activation, no other adverse events were observed.
The left hemisphere was stimulated at 145–522 sites (median, 422 sites). Median RMTs, as a percentage of the stimulator output, were 46% (range, 32–57%). nrTMS intensity mapping (between 60% and 100%) of each participant’s own RMT was carried out in all 50 patients. Each nrTMS train consisted of 10 pulses given at rates between 5 and 10 Hz (Table 2). Trains with 5-Hz frequency were well tolerated and used most often.
Twenty-two patients (44.0%) showed involvement of anatomical language regions inside the brain tumors. During the preoperative course, three patients (6.0%) had already exhibited mild language disturbances. After tumor resection with awake brain mapping, 21 of all 50 patients with left-side brain tumors (42.0%) developed transient speech disorders and four (8.0%) exhibited permanent language disorders.
Accuracy of nrTMS language mapping in patients with left-side gliomas
Awake brain surgery was successfully performed with intraoperative functional mapping using DCS in all 50 patients with left gliomas. The minimum DCS intensities used in positive language site are shown in Table 2. In these patients, we compared the results of nrTMS and DCS language mapping in 278 regions according to Corina’s cortical parcellation system (CPS). Responses of intraoperative DCS mapping were positive for 1–8 areas (median, 3 areas), whereas responses of nrTMS were positive for 0–8 regions (median, 4 regions). There was no significant difference in the mean DCS intensities between the regions negative with nrTMS and positive with DCS (3.36 mA) and the regions negative with nrTMS and negative with DCS (3.31 mA).The overall accuracy values (sensitivity, specificity, positive and negative predictive values) for all regions in the 50 patients with left-side gliomas are shown in Table 3. Sensitivity was 81.6%, specificity was 59.6%, the positive predictive value was 78.5%, and the negative predictive value was 64.1%, for detecting language sites across all regions. Sensitivity (89.5%) and the positive predictive value (82.8%) were higher in the anterior compared with the posterior language-related CPS regions, while specificity (73.5%) and the negative predictive value (71.4%) were higher in the posterior compared with the anterior language-related CPS regions.
Effect of tumor involvement of language-related regions on nrTMS language mapping results
Next, we sought to determine how subpopulations were affected differently by different parameters, including age, tumor type, tumor volume, and the involvement of anatomical language-related regions. A subgroup analysis showed that involvement of language-related regions compared to non-involvement of language-related regions was associated with lower sensitivity (70% vs. 90.9%, respectively), specificity (46.9% vs. 72.0%, respectively), a lower positive predictive value (68.3% vs. 86.5%, respectively), and a lower negative predictive value (48.9% vs. 80.0%, respectively) (Table 4, Figs. 2 and 3). We obtained similar results for accuracy across groups for age (≥40 or <40 years), tumor type (high- or low-grade), and tumor volume (≥40 or <40 cm3).
Furthermore, we calculated receiver operating characteristic (ROC) curve statistics for the sensitivity, specificity, positive predictive values, and negative predictive values (Fig. 4). Notably, our results show that the non-involvement of language-related regions led to significantly better AUC values (AUC = 0.81, 95% CI: 0.74–0.88) than the involvement of language-related regions (AUC = 0.58, 95% CI: 0.50–0.67; p < 0.0001; Figs. 2–4).
Determination of hemispheric language dominance using nrTMS language mapping
In the 11 patients with right-side brain tumors, we performed preoperative nrTMS language mapping of both the left and right cerebral cortex. As shown in Table 5, all 10 right-handed patients showed language errors in the left hemisphere and no language errors in the right hemisphere. One left-handed patient’s language area was located in the right cerebral cortex (Table 5). These findings suggest that nrTMS language mapping enables the determination of hemispheric language dominance in patients with brain tumors.
Clinical parameters associated with results of nrTMS language mapping
The purpose of our study was to investigate the impact of clinical parameters on the results of nrTMS language mapping and their reliability in relation to DCS. The effects of clinical parameters on the results of nrTMS language mapping were investigated by determining accuracy and calculating ROC curves in each subgroup; the parameters included age, tumor type, tumor volume, and the involvement of language-related regions (Table 4, Fig. 4). We detected a significant difference regarding the involvement of language- and non-language-related regions between groups (Fig. 4). These findings were considerably affected by the presence of brain lesions (Figs. 2 and 3).
A previous study has yielded controversial results on nrTMS language mapping. Ille et al. reported that nrTMS language mapping in 27 patients with left-side perisylvian lesions was not affected by the presence of brain lesions when comparing with intraoperative DCS language mapping23. There are, however, some critical differences in clinical features and methodology between our study and the aforementioned one. First, the number of low-grade gliomas in our group was larger than that of the study by Ille et al.23. Unlike high-grade gliomas, low-grade gliomas often contain several brain functions, such as motor, language, and cognitive functions, inside the tumor. Furthermore, low-grade infiltrating gliomas are characterized by progressive functional reshaping because of their slow growth even before treatment. Such functional modifications can occur during the natural history of disease. The location of lesions within language-function areas had several patterns in each patient with low-grade gliomas. We assume that functional language reorganization occurs when a tumor with low-grade glioma invades the language-related regions. Therefore, it may be difficult for nrTMS language mapping to detect scattered localized language areas inside the tumor. On the other hand, cerebral reorganization of high-grade gliomas may not be possible; thus, brain functional modification may not be induced by fast-growing lesions. Therefore, language functions may remain associated with the language-related regions regardless of tumor invasion. These differences in tumor types may explain the different results of nrTMS language mapping between the two studies. In addition, there is a difference in the picture-to-trigger interval between the two studies. The nrTMS language mapping procedure in Ille et al.’s study used a picture-to-trigger interval time of 300 ms for 81% of patients and 0 ms for 19% of patients. In contrast, in the current study, synchronization of the nrTMS stimulation started at 300 ms after image presentation for all patients. Since Ille et al.’s study included patients for whom nrTMS stimulation onset coincided with picture presentation onset, the accuracy of their study’s nrTMS language mapping procedure might have been more accurate compared with the results of the present study. This methodological difference may also account for the difference regarding tumor involvement of language-related regions during nrTMS language mapping between the two studies.
Accuracy of nrTMS language mapping for all brain regions
nrTMS has increasingly been used as a preoperative evaluation procedure at a number of institutions, because it allows for language mapping before awake surgery with DCS27,31. The combination with neuro-navigation and electric fields has dramatically improved the clinical value of the TMS technique32,33. Some studies assessing the relationship between nrTMS and DCS reported that nrTMS is superior to other preoperative modalities, such as fMRI, electrocorticography, and magnetoencephalography22,25,26,27. Further, nrTMS yields higher overall sensitivity (>90%) and negative predictive values (>80%), compared with DCS language mapping22,23,24,27,34. One group reported high specificity (98%) and positive predictive values (69%)27, while other studies have shown low specificity (<25%) and positive predictive values (<40%)22,23,24,34. The former group started nrTMS language mapping at 110% of RMT using a pulse train of 10 pulses at 5 Hz27. In the latter groups, Picht et al. used three patterns: (a) 5 Hz, 5 pulses, 100% RMT; (b) 7 Hz, 7 pulses, 100% RMT; (c) 10 Hz, 7 pulses, 100% RMT22. In addition, the train of TMS pulses started 300 ms after the picture presentation onset. On the other hand, IIIe et al. reported the following stimulation parameters: three setups of nrTMS bursts (5 Hz, 5 pulses; 7 Hz, 5 pulses; 7 Hz, 7 pulses) with an intensity of 100% RMT23. Krieg et al. applied a 5-Hz pulse train starting at either 0 ms or 300 ms post picture presentation onset24. Median RMT was 90% at 0 ms stimulation onset and 100% at 300 ms post picture presentation onset. Compared to these studies, the current study used slightly different parameters: a rTMS train of 10 pulses at 5–10 Hz, with an RMT of 60–80% (Table 2). In addition, we employed a 300-ms delay between object presentation and nrTMS stimulation (Table 2). Regarding the tumor location, the previous studies included the frontal, temporal and parietal lobes. All previous groups had approximately 30–60% of tumors in the temporal lobe. In contrast to these groups, there were only few temporal tumors in our study (an approximate 15%) (Table 1). One possible reason for these differences is that different intervals between picture presentation and nrTMS stimulation onset were adopted between study groups. In the former study, nrTMS stimulation onset was simultaneous with picture presentation, while other groups employed a 300-ms delay between object presentation and nrTMS stimulation. Additionally, differences in results might be expected, because the language system is complex regarding cortical and subcortical language networks. nrTMS motor mapping has revealed that TMS activates motor neurons via indirect intracortical neuro-pathways, whereas DCS directly activates motor cortical fibers35. The unspecific activation and inhibition of intracortical neuronal pathways might render TMS stimulation spots positive that have no crucial language functions. In the current study, we obtained high positive predictive values compared to other reports, which suggests preoperative nrTMS mapping as a reliable technique for neurosurgeons (Table 3). Furthermore, our nrTMS language mapping results yielded low overall sensitivity and negative predictive values compared with prior studies (Table 3)22,23,24,27. Considering that the group with non-involvement of language-related regions showed high sensitivity and negative predictive values, it seems that the presence of brain lesions played a role in these diverging results. Moreover, it has been reported that a 5-Hz pulse train starting at 0 ms post picture presentation onset leads to high accuracy in preoperative language maps24. Thus, a nrTMS protocol with a picture-to-trigger interval of 0 ms might have improved the accuracy of our nrTMS language mapping results36.
Another reason for the differences in the accuracy of nrTMS language mapping was the use of a different nrTMS system among research groups. We have applied an image-guided rTMS using the commercial neuronavigation system Visor2 (ANT Neuro, Enschede, the Netherlands) and real-time visualization of the Figure 8 coil (Magstim, UK). On the other hand, most of the nrTMS system in previous studies adopted a different nrTMS system, the eXimia NBS version 3.2.2 and Nexstim NBS 4.3. with a NEXSPEECH module (Nexstim Oy, Helsinki, Finland). Using a different nrTMS system may account for the differences between previous and current results.
nrTMS language mapping and determination of language dominance
Although some groups have sought to determine language dominance with nrTMS, results remain inconclusive. In the present study, we did not perform the intracarotid amobarbital procedure or the Wada test, which are gold standards for the lateralization of language dominance37. The Wada test is an invasive examination with a significant risk of neurological impairment and patient discomfort; therefore, there has been great interest in replacing it with a non-invasive procedure. Compared with intraoperative DCS during awake surgery, preoperative fMRI for language function is insufficiently accurate to serve as a basis for the decision-making of brain surgery19,20,21. However, some studies have shown that preoperative lower-frequency nrTMS predictions are well correlated with the results of DCS language mapping during awake brain surgery22,34. In this study, we demonstrated an excellent correlation between nrTMS-derived language laterality and the DCS procedure during awake surgery (Table 5). In addition, we were able to determine hemispheric language dominance in patients with tumors in right-side brain regions using nrTMS language mapping in the cerebral cortex.
Our results are somewhat limited compared to those of randomized clinical trials, because non-randomized studies may be influenced by unrecognized biases. Furthermore, the present study was based on a small number of cases. Therefore, a large randomized study is required to further establish the role of nrTMS in preoperative language mapping in patients with gliomas. Additional evidence from nrTMS language mapping studies is crucial for our understanding of preoperative language assessments before awake surgery.
Furthermore, one of the limitations of our study is the inclusion of hesitation errors in the analysis. In cases of delayed answers during stimulation, we had difficulty in differentiating “difficulty of word recall” from “hesitations” objectively. Despite the fact that the analysis was performed by experienced examiners, subjectivity cannot be ruled out. In fact, hesitations are commonly regarded as a comparatively untrustworthy error category, and, thus, they were mostly excluded. The interpretation of hesitation errors might be a cause of increased false-positive results when comparing with DCS.
To investigate the clinical parameters that affect the results of nrTMS language mapping, we prospectively compared the results of preoperative nrTMS and DCS language mapping. Tumor involvement of anatomical language-related regions significantly affected the results of the nrTMS mapping. Furthermore, nrTMS language mapping enabled the determination of hemispheric language dominance in a preoperative assessment of patients with gliomas. Our findings suggest that nrTMS language mapping could be a reliable method, particularly in obtaining responses for cases without tumor-involvement of classical perisylvian language areas. Further studies are required to validate nrTMS language mapping as a preoperative mapping tool of cortical language function.
Materials and Methods
This clinical trial was designed as a single-center, prospective, non-randomized study to assess the clinical factors that affect the results of nrTMS language mapping when preoperative nrTMS language mapping is prospectively compared with DCS mapping. All patients were scheduled for awake brain surgery at our neurosurgical department and underwent preoperative language mapping with nrTMS while performing a picture-naming task the day before the surgery. The study protocol was approved by the Ethics Committee of Nagoya University Hospital (approval number: 2013-0094) and carried out in accordance with the Declaration of Helsinki38. Written informed consent was obtained from all participants included in the study.
The process of enrollment and exclusion of participants is presented in Fig. 1. For inclusion in this study, patients had to meet all of the following criteria: the presence of left- or right-side brain tumors in the vicinity of or inside the areas anatomically associated with language functions; awake brain surgery scheduled; and age >18 years. The exclusion criteria were as follows: severe cognitive disorders; severe aphasia; psychiatric disorders and higher brain dysfunctions identified during preoperative neuropsychological testing; patients who were not able to execute one or more of three tests, including the Standard Language Test of Aphasia (SLTA)39, the third edition of the Wechsler Adult Intelligence Scale (WAIS-III)40, or the Wechsler Memory Scale-revised (WMS-R)41; a heart pacemaker or drug infusion pump; severe heart disease; currently undergoing deep brain or spinal cord stimulation; and pregnancy or intention to get pregnant.
Sixty-one patients who underwent preoperative language mapping using nrTMS and awake surgery with intraoperative direct electric mapping for gliomas associated with language functions were enrolled in the current study. All patients were treated at Nagoya University Hospital (Nagoya, Japan) between August 2013 and February 2019.
Pre- and post-operative neuroradiological evaluation
Preoperative navigational MRI, including three-dimensional contrast T1-weighted imaging, conventional MRI (two-dimensional T1- and T2-weighted imaging), and diffusion-weighted imaging data were acquired for this study using a 3.0-Tesla scanner (Siemens MAGNETOM Verio; Siemens Healthcare, Erlangen, Germany) with a 32-channel head coil.
Our MRI protocol consisted of the following imaging parameters: whole-brain; high-resolution; T1-weighted; phase encoding direction, anterior to posterior; matrix size, 256 × 256; repetition time (TR), 2.5 s; echo time (TE), 2.48 ms; 192 slices; slice thickness, 1 mm with no gaps; flip angle, 15°; voxel size, 1 × 1 × 1 mm3; field of view (FOV), 256 mm. We performed the volumetric analysis to define tumor volume using the iPlan cranial planning software included in the BrainLAB iPlan Cranial version 2.6 and 3.042 (German HealthCare Export Group, Bonn, Germany).
The pre- and post-operative tumor volumes were measured to estimate EOR using contrast T1-weighted when the tumor mass was enhancing, while T2-weighted MRI was used for non-enhancing tumor before and after tumor resection. The EOR was calculated by two independent experienced neurosurgeons (L.C, K.I) using the following formula (preoperative tumor volume – postoperative tumor volume)/preoperative tumor volume.
Preoperative nrTMS language mapping
Cortical nrTMS language mapping was performed using the Magstim Rapid2 biphasic stimulator to generate repetitive magnetic pulses (Magstim Co. Ltd., Whitland, UK). The pulses were delivered with a standard 70-mm figure-8 coil. We co-registered three-dimensional T1-weighted MRI as an anatomic reference and the patient’s brain to observe the cortical areas during nrTMS. The nrTMS neuro-navigation system displayed the electric field induced by the stimulating coil, which is directly visualized over the three-dimensional reconstruction of the patient’s brain43. We used electric-field-navigated TMS, which is clinically accurate and effective in cortical mapping. The hotspot can be defined as the accurate location of the calculated strongest electric field that the navigator visualizes on the individual MRI of the cortex. This system can be used to visualize the real-time position of the coil with respect to the head and the estimated induced electric field distribution at the cortical level.
First, the resting motor threshold (RMT) was defined by measuring the motor threshold of the contralateral abductor pollicis brevis (APB) muscle stimulating the primary motor cortex using a coil positioned tangentially to the skull before nrTMS language mapping. RMT was determined for muscles as the minimum stimulation intensity (%) that evoked a clearly distinguishable motor evoked potential (MEP). Each MEP was verified using customized MATLAB software allowing semi-automatic rejection for pre-activation. The ground electrode was placed over the contralateral hand area (abductor pollicis brevis muscle)24,44,45. A rough mapping was then started with MEPs between 100 and 500 μV. The RMT was defined as the lowest stimulus intensity sufficient to elicit five MEPs of ≧50 μV in a series of 10 stimuli46,47. Motor hotspots were identified with the aid of the anatomical MRI template-guided hardware and software Visor 2 (ANT Neuro, Enschede, the Netherlands). The obtained RMT was used to choose the appropriate intensity for subsequent language mapping while assuring compliance with the risk and safety guidelines48,49,50.
For the language mapping, a picture-naming task was presented on a monitor to identify the cortical language sites using nrTMS. We have used the same picture-naming task for the nrTMS and the DCS language mapping. This task allowed us to check whether patients were able to say aloud the first phrase “this is a …”, to distinguish between speech arrest and anomia51. We performed the picture-naming task using a customized LabVIEW program (National Instruments, Austin, TX, USA). Picture presentation on the screen was 700 ms, with an interpicture interval of 2500 ms. To define the appropriate mapping frequency and nrTMS intensity for each patient, a train of 10 TMS bursts was used with 5, 7, or 10 Hz, 10 pulses, and 60–100% RMT. We started nrTMS language mapping at a pulse train of 10 pulses at 5 Hz and were generally able to obtain positive responses. If we could not induce language disruption, we changed the frequency to 5, 7, or 10 Hz. The conditions that were most effective in evoking language errors were then used for language mapping over whole cortical regions. The intensity was increased to 110–120% RMT if there was no apparent effect on picture naming and decreased to 60–90% RMT if patients complained of muscle-related pain or discomfort interfering with the consecutive response evaluation by nrTMS. We sometimes experienced language errors related to muscle stimulation when patients complained of pain or discomfort at the stimulation site. In these cases, we examined all regions of the brain with decreased stimulation intensity. The electric fields induced by the nrTMS parameters ranged between 45 and 80 V/m at the cortical brain surface (the rise time from 0 to peak waveform was between 25.4 and 45.2 A/µs). To ensure the detection of speech arrest and language deficits, the TMS pulse train automatically triggered 300 ms after the picture onset22,23,52.
We selected a picture-naming task with black-and-white photographs as the most appropriate cortical stimulation paradigm. A total of 40 photographs of common objects were displayed on a monitor. Before the nrTMS language mapping, the picture-naming task was performed without stimulation to familiarize the patient with the procedure and images. Misnamed pictures were excluded from the stimulation sequence. With the remaining object images, the actual diagnostic naming task was subsequently presented together with a train of nrTMS pulses. The program triggered the onset of every nrTMS pulse train. During the interpicture interval, the stimulation coil was moved to the next cortical stimulation site that was randomly selected. In total, 80–120 sites of the frontal, temporal, and parietal cortex were stimulated three times with nrTMS. In patients with left-side brain tumors, preoperative nrTMS language mapping was only performed on the left side. In contrast, in patients with right-side brain tumors, we mapped both the left and right cerebral cortex. Tumor areas and their proximity were examined in detail.
Intraoperative DCS language mapping
We performed tumor removal in all 61 patients during awake craniotomy with direct brain stimulation using an asleep-awake-asleep technique, as previously described11,53,54,55,56. Briefly, the patient underwent craniotomy under general anesthesia. The tumor margins were identified using the neuronavigational system in relation to sulcal and gyral brain surface anatomy, and letter tags were initially placed along the cortical tumor boundaries before the brain shifts.
DCS was applied using a biphasic current (pulse frequency, 60 Hz; single pulse phase duration, 0.5 ms) using a bipolar stimulator with a 2-mm diameter and 5-mm interelectrode distance (Unique Medical, Osaka, Japan). The mapping began at 1 mA, in 0.5-mA increments, until a reproducible functional response was obtained. Thus, the optimal threshold for stimulation was determined and used for the remainder of the cortical and subcortical mapping. Maximum individual current intensities ranged from 2–8 mA. After tumor resection, intraoperative MRI was routinely performed using a 0.4-Tesla vertical field MR scanner (Aperto Inspire; Hitachi, Tokyo, Japan) installed in the operating room of the Brain Theater at Nagoya University Hospital to confirm the EOR of the tumor in all patients55.
For the language mapping, a picture-naming task was presented on a monitor to identify the cortical and subcortical language sites using direct electrical stimulation56,57. Disruption of object-naming abilities can lead to several types of language deficits, including speech arrest, anomia, dysarthria, anarthria, speech slowness, initiation trouble, perseveration, and paraphasia. This task was performed by asking patients to first test the phrase “this is a …” in order to distinguish speech arrest from anomia51. All positive mapping sites were marked with number tags to indicate the specific event that was evoked (speech disorders/arrest, motor dysfunctions, and after discharge). Therefore, recordings of positive responses were transferred to the neuro-navigation system with the navigation pointer. Furthermore, tumor resection was accompanied by subcortical stimulation through the resection cavity, based on the information of the fiber tractography for delineation of white matter anatomy during awake surgery. Thus, intraoperative awake functional mapping for the evaluation of brain functions can define functional boundaries in patients with brain tumors.
Data analysis of nrTMS and DCS language mapping
If we detected nrTMS-induced language errors such as no-response errors, performance errors, hesitations or the difficulty of word recall, neologisms, semantic paraphasias, phonologic paraphasias, and circumlocutions in at least two out of three trials, the stimulation site was judged as language-positive. In cases of other types of language errors induced by the nrTMS mapping, a site was also considered language-positive. Two experienced speech therapists (H.Y, K.K) analyzed these data independently. The cortical stimulation sites were hidden from these two examiners.
To correlate the findings of both nrTMS and intraoperative DCS language mapping at the anatomic level, we assigned them to the language deficits according to CPS58 (Fig. 5, Supplementary Table 1). In this method, the cortex is parcellated into 37 individual anatomic brain regions for assessing the anatomic site of the stimulation. Furthermore, we selected anterior language-related CPS regions (trIFG, opIFG, and vPrG), as well as posterior language-related CPS regions (aSMG, pSMG, anG, mSTG, and pSTG; Fig. 5, Supplementary Table 1)22,24. Subsequently, the error rate (number of errors per number of stimulations) was calculated for each brain region of the CPS. Two experienced speech therapists (H.Y, K.K) evaluated the language errors for DCS language mapping. Moreover, two independent experienced neurosurgeons (K.M, H.T) assessed the involvement of language areas in the parcellation analysis.
Language positivity or negativity of a CPS region defined with nrTMS was compared with the results of the DCS language mapping22,23,24. When a CPS region was defined as language-positive by both DCS and nrTMS, the region was labeled as a “true positive”. If both DCS and nrTMS indicated a CPS region to be language-negative, the region was regarded as a “true negative”. When nrTMS defined a CPS region as language-positive, but DCS did not, the region was labeled as a “false positive”. Furthermore, a CPS region was documented as a “false negative” when nrTMS did not induce a language error in this region, but DCS determined the region to be language-positive. This procedure was performed separately for each method and for each patient.
ROC curves were used to graphically represent the relationship between sensitivity and specificity for the comparison of nrTMS and DCS language mapping data with respect to language error categories and language-positive or language-negative CPS regions (Fig. 5). Graphs were generated using the R package pROC59, which is included in the statistical software R version 3.5.2 (URL: https://www.r-project.org/). AUC values were used to compare TMS performance to DCS data using the method described by DeLong et al.60, and the 95% confidence intervals (CI) were computed with bootstrap resampling.
We assessed the following subgroups: language-related CPS regions (anterior or posterior), age (≥40 or <40 years), tumor type (high- or low-grade), and tumor volume (≥40 or <40 cm3), and the anatomical language-related regions (involvement or non-involvement). Language-related CPS regions: according to CPS, the language mapping area was divided into anterior language-related CPS regions (trIFG, opIFG, and vPrG) or posterior language-related CPS regions (aSMG, pSMG, anG, mSTG, and pSTG; Fig. 5, Supplementary Table 1). Age: median age was 39 years. The age subgroup was divided into big (≥40 years) and small (<40 years). Tumor type: our study included two types of gliomas: 68.9% of low-grade glioma (WHO grade I or II), 31.1% of high-grade glioma (WHO grade III or IV). Median tumor volume was 43.2 cm3. Lesions were therefore divided into large (≥40 cm3) and small (<40 cm3) tumors. Anatomical language-related regions: this subgroup was divided based on whether tumors were located within or without anatomically defined language-eloquent brain regions (anterior or posterior language-related CPS regions).
Duffau, H. & Taillandier, L. New concepts in the management of diffuse low-grade glioma: Proposal of a multistage and individualized therapeutic approach. Neuro Oncol 17, 332–342, https://doi.org/10.1093/neuonc/nou153 (2015).
Jakola, A. S. et al. Surgical resection versus watchful waiting in low-grade gliomas. Ann Oncol 28, 1942–1948, https://doi.org/10.1093/annonc/mdx230 (2017).
Sanai, N., Polley, M. Y., McDermott, M. W., Parsa, A. T. & Berger, M. S. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 115, 3–8, https://doi.org/10.3171/2011.2.JNS10998 (2011).
Smith, J. S. et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26, 1338–1345, https://doi.org/10.1200/JCO.2007.13.9337 (2008).
Schomas, D. A. et al. Intracranial low-grade gliomas in adults: 30-year experience with long-term follow-up at Mayo Clinic. Neuro Oncol 11, 437–445, https://doi.org/10.1215/15228517-2008-102 (2009).
Jakola, A. S. et al. Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA 308, 1881–1888, https://doi.org/10.1001/jama.2012.12807 (2012).
Berger, M. S., Deliganis, A. V., Dobbins, J. & Keles, G. E. The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 74, 1784–1791 (1994).
Duffau, H. Long-term outcomes after supratotal resection of diffuse low-grade gliomas: a consecutive series with 11-year follow-up. Acta Neurochir (Wien) 158, 51–58, https://doi.org/10.1007/s00701-015-2621-3 (2016).
Sawaya, R. et al. Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42, 1044-1055; discussion 1055-1046 (1998).
Duffau, H. & Capelle, L. Preferential brain locations of low-grade gliomas. Cancer 100, 2622–2626, https://doi.org/10.1002/cncr.20297 (2004).
Duffau, H., Peggy Gatignol, S. T., Mandonnet, E., Capelle, L. & Taillandier, L. Intraoperative subcortical stimulation mapping of language pathways in a consecutive series of 115 patients with Grade II glioma in the left dominant hemisphere. J Neurosurg 109, 461–471, https://doi.org/10.3171/JNS/2008/109/9/0461 (2008).
Duffau, H. Stimulation mapping of white matter tracts to study brain functional connectivity. Nat Rev Neurol 11, 255–265, https://doi.org/10.1038/nrneurol.2015.51 (2015).
Gil-Robles, S. & Duffau, H. Surgical management of World Health Organization Grade II gliomas in eloquent areas: the necessity of preserving a margin around functional structures. Neurosurg Focus 28, E8, https://doi.org/10.3171/2009.12.FOCUS09236 (2010).
Knecht, S. et al. Handedness and hemispheric language dominance in healthy humans. Brain 123(Pt 12), 2512–2518 (2000).
Bonelli, S. B. et al. Imaging language networks before and after anterior temporal lobe resection: results of a longitudinal fMRI study. Epilepsia 53, 639–650, https://doi.org/10.1111/j.1528-1167.2012.03433.x (2012).
Kundu, B. et al. Association of functional magnetic resonance imaging indices with postoperative language outcomes in patients with primary brain tumors. Neurosurg Focus 34, E6, https://doi.org/10.3171/2013.2.FOCUS12413 (2013).
FitzGerald, D. B. et al. Location of language in the cortex: a comparison between functional MR imaging and electrocortical stimulation. AJNR Am J Neuroradiol 18, 1529–1539 (1997).
Brennan, N. P., Peck, K. K. & Holodny, A. Language Mapping Using fMRI and Direct Cortical Stimulation for Brain Tumor Surgery: The Good, the Bad, and the Questionable. Top Magn Reson Imaging 25, 1–10, https://doi.org/10.1097/RMR.0000000000000074 (2016).
Roux, F. E. et al. Language functional magnetic resonance imaging in preoperative assessment of language areas: correlation with direct cortical stimulation. Neurosurgery 52, 1335-1345; discussion 1345-1337 (2003).
Giussani, C. et al. Is preoperative functional magnetic resonance imaging reliable for language areas mapping in brain tumor surgery? Review of language functional magnetic resonance imaging and direct cortical stimulation correlation studies. Neurosurgery 66, 113–120, https://doi.org/10.1227/01.NEU.0000360392.15450.C9 (2010).
Voss, J. et al. The role of secondary motor and language cortices in morbidity and mortality: a retrospective functional MRI study of surgical planning for patients with intracranial tumors. Neurosurg Focus 34, E7, https://doi.org/10.3171/2013.2.FOCUS12410 (2013).
Picht, T. et al. A comparison of language mapping by preoperative navigated transcranial magnetic stimulation and direct cortical stimulation during awake surgery. Neurosurgery 72, 808–819, https://doi.org/10.1227/NEU.0b013e3182889e01 (2013).
Ille, S. et al. Impairment of preoperative language mapping by lesion location: a functional magnetic resonance imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation study. J Neurosurg 123, 314–324, https://doi.org/10.3171/2014.10.JNS141582 (2015).
Krieg, S. M. et al. Optimal timing of pulse onset for language mapping with navigated repetitive transcranial magnetic stimulation. Neuroimage 100, 219–236, https://doi.org/10.1016/j.neuroimage.2014.06.016 (2014).
Ille, S. et al. Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation. J Neurosurg 123, 212–225, https://doi.org/10.3171/2014.9.JNS14929 (2015).
Babajani-Feremi, A. et al. Language mapping using high gamma electrocorticography, fMRI, and TMS versus electrocortical stimulation. Clin Neurophysiol 127, 1822–1836, https://doi.org/10.1016/j.clinph.2015.11.017 (2016).
Tarapore, P. E. et al. Language mapping with navigated repetitive TMS: proof of technique and validation. Neuroimage 82, 260–272, https://doi.org/10.1016/j.neuroimage.2013.05.018 (2013).
Sollmann, N. et al. Clinical Factors Underlying the Inter-individual Variability of the Resting Motor Threshold in Navigated Transcranial Magnetic Stimulation Motor Mapping. Brain Topogr 30, 98–121, https://doi.org/10.1007/s10548-016-0536-9 (2017).
Rosler, J. et al. Language mapping in healthy volunteers and brain tumor patients with a novel navigated TMS system: evidence of tumor-induced plasticity. Clin Neurophysiol 125, 526–536, https://doi.org/10.1016/j.clinph.2013.08.015 (2014).
Krieg, S. M. et al. Functional language shift to the right hemisphere in patients with language-eloquent brain tumors. PLoS One 8, e75403, https://doi.org/10.1371/journal.pone.0075403 (2013).
Picht, T. Current and potential utility of transcranial magnetic stimulation in the diagnostics before brain tumor surgery. CNS Oncol 3, 299–310, https://doi.org/10.2217/cns.14.25 (2014).
Ruohonen, J. & Karhu, J. Navigated transcranial magnetic stimulation. Neurophysiol Clin 40, 7–17, https://doi.org/10.1016/j.neucli.2010.01.006 (2010).
Sollmann, N. et al. Comparison between electric-field-navigated and line-navigated TMS for cortical motor mapping in patients with brain tumors. Acta Neurochir (Wien) 158, 2277–2289, https://doi.org/10.1007/s00701-016-2970-6 (2016).
Sollmann, N. et al. Preoperative language mapping by repetitive navigated transcranial magnetic stimulation and diffusion tensor imaging fiber tracking and their comparison to intraoperative stimulation. Neuroradiology 58, 807–818, https://doi.org/10.1007/s00234-016-1685-y (2016).
Kombos, T., Picht, T., Derdilopoulos, A. & Suess, O. Impact of intraoperative neurophysiological monitoring on surgery of high-grade gliomas. J Clin Neurophysiol 26, 422–425, https://doi.org/10.1097/WNP.0b013e3181c2c0dc (2009).
Krieg, S. M. et al. Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report. Acta Neurochir (Wien) 159, 1187–1195, https://doi.org/10.1007/s00701-017-3187-z (2017).
Aghi, M. K. et al. The role of surgery in the management of patients with diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline. J Neurooncol 125, 503–530, https://doi.org/10.1007/s11060-015-1867-1 (2015).
World Medical, A. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310, 2191–2194, https://doi.org/10.1001/jama.2013.281053 (2013).
Tamura, A., Shichijo, F. & Matsumoto, K. A study on simplification of the Standard Language Test of Aphasia (SLTA). Tokushima J Exp Med 43, 39–46 (1996).
Wechsler, D. (The Psychological Corporation, San Antonio, 1997).
Wechsler, D. (Psychological Corporation, San Antonio, 1987).
Nimsky, C., Ganslandt, O. & Fahlbusch, R. Implementation of fiber tract navigation. Neurosurgery 61, 306-317; discussion 317-308, https://doi.org/10.1227/01.neu.0000279224.83998.7d (2007).
Modolo, J., Thomas, A. W. & Legros, A. Mechanisms and applications of transcranial magnetic stimulation: an overview. 2014 Xxxith Ursi General Assembly and Scientific Symposium (Ursi Gass) (2014).
Krieg, S. M. et al. Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. J Neurosurg 116, 994–1001, https://doi.org/10.3171/2011.12.JNS111524 (2012).
Picht, T. et al. Preoperative functional mapping for rolandic brain tumor surgery: comparison of navigated transcranial magnetic stimulation to direct cortical stimulation. Neurosurgery 69, 581-588; discussion 588, https://doi.org/10.1227/NEU.0b013e3182181b89 (2011).
Rossini, P. M. et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol 91, 79–92 (1994).
Rossini, P. M. et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol 126, 1071–1107, https://doi.org/10.1016/j.clinph.2015.02.001 (2015).
Rossi, S., Hallett, M., Rossini, P. M. & Pascual-Leone, A. & Safety of, T. M. S. C. G. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 120, 2008–2039, https://doi.org/10.1016/j.clinph.2009.08.016 (2009).
Chen, R. et al. Safety of different inter-train intervals for repetitive transcranial magnetic stimulation and recommendations for safe ranges of stimulation parameters. Electroencephalogr Clin Neurophysiol 105, 415–421 (1997).
Wassermann, E. M. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalogr Clin Neurophysiol 108, 1–16 (1998).
Mandonnet, E., Sarubbo, S. & Duffau, H. Proposal of an optimized strategy for intraoperative testing of speech and language during awake mapping. Neurosurg Rev 40, 29–35, https://doi.org/10.1007/s10143-016-0723-x (2017).
Lioumis, P. et al. A novel approach for documenting naming errors induced by navigated transcranial magnetic stimulation. J Neurosci Methods 204, 349–354, https://doi.org/10.1016/j.jneumeth.2011.11.003 (2012).
Motomura, K. et al. Association of dorsal inferior frontooccipital fasciculus fibers in the deep parietal lobe with both reading and writing processes: a brain mapping study. J Neurosurg 121, 142–148, https://doi.org/10.3171/2014.2.JNS131234 (2014).
Iijima, K. et al. Efficacy of the transtemporal approach with awake brain mapping to reach the dominant posteromedial temporal lesions. Acta Neurochir (Wien) 159, 177–184, https://doi.org/10.1007/s00701-016-3035-6 (2017).
Motomura, K. et al. Surgical benefits of combined awake craniotomy and intraoperative magnetic resonance imaging for gliomas associated with eloquent areas. J Neurosurg 127, 790–797, https://doi.org/10.3171/2016.9.JNS16152 (2017).
Motomura, K. et al. Supratotal Resection of Diffuse Frontal Lower Grade Gliomas with Awake Brain Mapping, Preserving Motor, Language, and Neurocognitive Functions. World Neurosurg 119, 30–39, https://doi.org/10.1016/j.wneu.2018.07.193 (2018).
Motomura, K. et al. Neurocognitive and functional outcomes in patients with diffuse frontal lower-grade gliomas undergoing intraoperative awake brain mapping. J Neurosurg, 1–9, https://doi.org/10.3171/2019.3.JNS19211 (2019).
Corina, D. P. et al. Dissociation of action and object naming: evidence from cortical stimulation mapping. Hum Brain Mapp 24, 1–10, https://doi.org/10.1002/hbm.20063 (2005).
Robin, X. et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics 12, 77, https://doi.org/10.1186/1471-2105-12-77 (2011).
DeLong, E. R., DeLong, D. M. & Clarke-Pearson, D. L. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44, 837–845 (1988).
The authors thank Mr. Hiroyasu Yamamoto, Mr. Kyohei Koyama, Mr. Daisuke Hara, and Mr. Yasuyuki Matsui (Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan) for their superb technical assistance. This work was supported by a Grant-in-Aid for Scientific Research (C) to K.M. (No. 17K10862) from the Japanese Society for the Promotion of Science (JSPS), and a research grant from Takeda Science Foundation. The authors have no financial disclosures or conflicts of interest to declare.
The authors declare no competing interests.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Cite this article
Motomura, K., Takeuchi, H., Nojima, I. et al. Navigated repetitive transcranial magnetic stimulation as preoperative assessment in patients with brain tumors. Sci Rep 10, 9044 (2020). https://doi.org/10.1038/s41598-020-65944-8
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About Currency Exchange in Vietnam.
Following up on the previous article about where to exchange money in Vietnam, this time, I’ll go into detail about how much you should exchange when you visit Vietnam.
As introduced in the article about Vietnamese currency and exchange in Vietnam, it is recommended to withdraw only as much money as needed from an ATM while in Vietnam.
If you’re visiting Vietnam, it’s best only to exchange a minimum amount of dollars before your visit. The amount of currency you need for an initial exchange in Vietnam that I will introduce here is based on the essential amount needed.
The more cash you have, the greater your loss will be if you are pickpocketed or robbed, and having a large amount of money can be worrisome.
Violent crimes targeting tourists are rare in Vietnam, but minor crimes like pickpocketing happen frequently.
Even if you stay at a five-star hotel in Vietnam, it’s common for thieves to use various tools to steal cash through small gaps in your luggage during an exchange process in Vietnam.
The process of exchanging money in Vietnam
You probably won’t be able to walk into any bank in many countries and exchange money directly into Vietnamese dong, so most visitors to Vietnam will follow the process below.
- Exchange US dollars.
- Exchanging essentials (like taxi fares) for Vietnamese Dong at the airport.
- Visit banks and private currency exchanges after arriving in the city.
- Compare exchange rates and convert US dollars to Vietnamese dong.
- Repeat when you run out of money.
However, it’s generally safer and more convenient to withdraw the amount you need from a local ATM in Vietnam.
- Local banks’ ATMs in Vietnam allow you to withdraw up to VND3 million (about $130) at a time.
- Foreign banks’ ATMs in Vietnam (like Citi, Standard Chartered, Kookmin, Woori, etc.) let you take out up to VND8 million ($350) per transaction.
In perspective, VND8 million per withdrawal is roughly the average monthly salary of a university graduate in Vietnam.
This isn’t an insignificant sum of money; even with just one withdrawal of VND8 million, you can afford many things in Vietnam.
Withdrawal fees usually range from 2 to 30,000 dong (about $1 to $1.50). Despite the differences in exchange rates and fees, carrying large amounts of cash presents significant risk due to the prevalence of pickpockets and thieves in Vietnam.
Hence we strongly recommend bringing along an internationally accepted credit or debit card like Visa or Mastercard and only withdrawing as needed.
How much money should I exchange when visiting Vietnam?
The amount of money you need to exchange will depend on your location in Vietnam and the purpose of your travel.
For instance, in major cities like Ho Chi Minh City and Hanoi, there’s no need to exchange a large sum of money because you can easily withdraw and exchange currency anywhere within the city.
However, if you’re traveling to a city like Phu Quoc, where cash withdrawals are only available in certain parts of the city, you’ll need to exchange more money.
For the sake of this article, we’ll assume you’ve already booked your hotel. Therefore, exchanging around $200 should suffice. More details on why $200 is sufficient will follow below.
USIM purchase and service registration fees – approximately US$10 to US$20
Upon arriving at an airport in Vietnam, one of the first things you’ll likely want to do is purchase a USIM and register for wireless internet service.
Having an internet connection can be a huge relief. It opens up numerous possibilities and solves many potential problems.
You can buy a USIM in advance or use roaming if available, but if you’re looking to save some money, you can purchase a USIM at the local airport upon arrival.
The price of a USIM may vary slightly depending on the number of digits in your phone number, but this isn’t significant.
The cost primarily depends on which wireless internet service you opt for. We’ve covered more about using USIMs in Vietnam in our comprehensive guide to mobile phones!
Transport from the airport to the city (hotel) – approximately $10 to $50
After purchasing a USIM, the following expense you’ll need to account for is the travel cost to your hotel.
Like any other country, the distance between the airport and the city center varies in Vietnam.
Some cities are nearby, such as Da Nang, while others, like Hanoi, are about an hour away.
Regardless of the city in Vietnam, you can reach your hotel in the city center from the airport for under $50 if you take a taxi.
It’s really not necessary to recklessly travel long distances by taxi.
In our Vietnam Guide, we’ve detailed various transportation methods from airports to city centers for each major city, including buses and taxis.
An even better alternative to taxis is to install and sign up for the Grab app in advance, register your credit card, and hail a Grab to your hotel.
Grab is a must-have app for traveling in Vietnam, and we’ve got you covered with our complete guide to Grab in Vietnam.
Assuming you’re using Grab, you can minimize the amount of currency exchange as the cost is automatically taken out of your registered card.
Moving from the hotel to a nearby downtown area – about $10 ~ $20
You can withdraw money directly if there’s an ATM near your hotel.
However, if not, you’ll need to go downtown to use an ATM. Since taxi fares in Vietnam are not very expensive, in any major city, you should be able to reach a bustling area for about $10 ~ $20.
Eating at a convenience store or restaurant – approximately $10
As soon as you step out of the airport in Vietnam, the sweltering heat might tempt you to buy a bottle of water.
It’s wise to factor in some expenses for convenience store purchases.
Bottled water and food are relatively cheap in Vietnam, so you can easily get a quick bite for around $10.
Conclusion: Exchanging about $200 should be sufficient.
First, exchange only $200 (about 4.8 million VND), then use it in Vietnam and withdraw the necessary amount from an ATM afterward.
In your country, there will surely be banks or card companies that do not charge fees for overseas withdrawals.
Moreover, in Vietnam, there are even banks with no ATM fees. So, exchange the minimum amount and withdraw the rest locally in Vietnam.
What currency should I exchange?
Although we’ve explained in detail in our previous post, “Introduction to Vietnamese Money and Precautions for Use,” Vietnam does not have coins and only uses 12 banknotes.
Typically, when you exchange dollars or euros for Vietnamese dong at the airport or locally, they give you 500,000 VND notes, depending on the amount.
Ask to have your money exchanged mainly into 200,000 and 100,000 VND notes. Since 500,000 VND (about $20) is quite a lot of money locally in Vietnam, there are very frequent cases where small shops or taxis don’t have change when you pay with a 500k note.
If you only use 100k notes, your wallet will become very thick. Therefore, the best method is to get 500k notes and exchange the rest into denominations of 200k -100k.

domain: travel


Kasper Schmeichel has signed a one-year deal with Anderlecht just days after terminating his contract with Nice, the Belgian club announced.
The 36-year-old Denmark goalkeeper had been told by the French Ligue 1 club that they were no longer counting on him for the 2023-24 season.
“The arrival of Kasper is part of our desire to create competition in all positions,” Anderlecht sporting director Jesper Fredberg said.
“He can teach us a lot thanks to his experience.”
Schmeichel is best known for his time at Leicester, where he was part of the 2015-16 Premier League title-winning team and also lifted the FA Cup in 2021.
Anderlecht struggled with financial difficulties last season and finished 11th in the Belgian top flight, but have started better this term and sit second after four wins in their first six matches.
World Cup News
Spanish Prime Minister Pedro Sanchez on Tuesday blasted as “insufficient” the apology given by...
Spain’s Women’s World Cup hero Olga Carmona paid tribute to her father on Monday...
Spain midfielder Jenni Hermoso defended Spanish football federation president Luis Rubiales after he came...
Sunday’s World Cup final between England and Spain is the final act of a...


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👜 Purse Sewing Hardware and Supplies Galore
🎃 Halloween Witch Cat Patchwork Treat Tote - Free Pattern
🆓 FREE Big Bag Pattern Download
A free sewing tutorial for a reversible cross-body sling or shoulder bag by Char from “Crap I’ve Made”. A casual everyday bag to sew.
- 1 yard of exterior fabric
- 1 yard of interior fabric
- printed pattern pieces & one sheet of 8.5 X 11 paper
- scissors, pins,
- sewing machine,
- coordinating thread
More reversible bags to sew:
We hope these projects inspire you to create something fabulous today!

domain: hobby


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I've had 16x8's with 225/50/16's on my '66 since about 1989. You will need an
aftermarket upper control arm to accomplish this feat. In general, they swing
in a more preferable arc and miss the fender opening when at ride height,
unlike the stock upper arm which swings CLOSER to the opening at ride
height and moving dynamically. You can cheat by using stupidly high ride
heights and/or different rim sizes but that is basically where it's at..... the
right way or the not quite right way.
The 65/66 is a unique deal because there isn't much fender leeway on that car.
Fenders on my GT are also un-flared fiberglass units, pretty unforgiving as far
as tire contact is concerned.
fast65ford- I just noticed you were talking 55 series...... that would
be even a tighter fit on 65/66. Very tall tire.
I had them on my '68 at one time. Almost too much on that car,
even with the trick UCAs.
They were one of the first sets Maier ever made. and a royal PITA to
install. Had to make templates for all the emblems and letters.
I think I had 17 hours per side to fit them out of the box.
Maybe an additional 5-7 hours went into them prior to the paint booth
but I don't know for sure, I don't paint cars......
I have my mains all tightened down and oil pan back on. Do I need thread sealant on my flywheel bolts? The holes are open ended on the engine side and I can't tell if oil might migrate back out the bolt threads. Motor is a '66, 289 4v, not HyPo and all stock.
I got a 302 with a c4 tranny ....ive changed the trans module and filter....my question is at what rpms is the tranny supposed to shift...mine only shifts once around 30mph...im not a mechanic but this dosent seem right...plz let me know what y'all think...
In 2005 I bought a complete Crane ignition system for $650.00, control box, coil, billet distributer.
A couple of weeks ago I thought I'd order a new cap and rotor.
I called Crane and was told no stock,they sold the complete ignition line to F.A.S.T.
Called F.A.S.T. and was told no...


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Copenhagen has Copenhagen Solutions Lab, Danish Outdoor Lightning Lab (DOLL), Copenhagen Climate Resilient Neighborhood and Energy Lab Nordhavn. Now, New York City has Neighborhood Innovation Labs. Community labs are a new way of creating new tech solutions and social development at the same time.
Danish Cleantech Hub, a joint initiative by Confederation of Danish Industry and State of Green in New York, is hosting an event on Net-Zero Energy Districts Thursday, June 22 to wrap up the 2017 New York Energy Week.
In recent years, numerous communities have shifted their focus from net-zero buildings to net-zero energy districts. In order to achieve the renewable integration and energy efficiency goals of New York’s comprehensive energy strategy, Reforming the Energy Vision (REV), district thinking could very well become instrumental.
The event offers a unique chance to learn about the advantages and possibilities of approaching energy at a larger scale through two panel discussions featuring industry experts.
Apart from several local stakeholders such as the Office of the Governor (State of NY) and New York State Energy Research and Development Authority (NYSERDA), Danish cleantech leaders such as Rockwool, Grundfos and Ramboll are to give their insights on how the concept of Net-Zero Energy Districts should be considered a promising piece of New York’s Energy puzzle.
“Danish Cleantech Hub is proud to once again be part of the New York Energy Week, where we’ll get an opportunity to present some of the forward thinking ideas that our Danish partners have successfully been able to implement in an urban context,” says Andreas Brunsgaard, US General Manager of the Confederation of Danish Industry.”
Learn more via Eventbrite
Read more about Danish Cleantech Hub here.
TEXT: Klaus Lehn Christensen, Danish Cleantech Hub New York

domain: news


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I write regularly about disability and churches, and other disability issues. Here are some of my recent publications and events, with links to videos and writing where available. You can find more of my academic writing on my academia.edu page.
(Still) Calling from the Edge: Conference Review 2021 (text)
A review of this year’s disability and church conference, a partnership between St Martin-in-the-Fields Church and Inclusive Church. I regularly present research at this annual disabled-led conference on disability and churches, which celebrated its tenth year in 2021.
Disability and Power in the Church of England (video), Michael Ramsey Centre for Anglican Studies, November 2021
Panel discussion with Kt Tupling, for the ‘Power in the Church of England’ webinar series.
Disability and Sexuality: Queer Encounters with Diverse Bodies and Minds (PDF)
Talk for Open Table London, September 2021
Shut In, Shut Out, Shut Up: Ableism, Faith and Church (video), HeartEdge, May 2021
For a third series of Fiona MacMillan’s discussions on disability and church, I joined autistic advocate Ann Memmott to discuss ableism in church and society.
Tizard Centre Autism Online Journal Club: A discussion on autistic people in churches, theology of autism and including autistic people in communities (video), Tizard Centre, April 2021
Panel discussion of Krysia Waldock‘s paper ‘Attitudes toward Autism Amongst Church Going Christians’, with Krysia Waldock and Damian Milton. Written summary by Krysia Waldock for the Participatory Autism Research Collective.
Shut In, Shut Out, Shut Up: Disability, Church and Coronavirus (video), September 2020
Panel discussion with neurodivergent priest Rachel Noel on access and participation in a post-coronavirus church. In this groundbreaking video series, Fiona MacMillan brings together theologians, activists and researchers from the disabled Christian movement to shape disabled-led theology and commentary.
Disabled People are Worthy of Love (text), Lacuna, June 2020.
Written in response to an advice columnist’s recommendation to a non-disabled person to leave their partner with a chronic illness. “Life is about risk, and this is one of the risks you take when you begin a relationship with any human being.”
Disabled People Say Welcome to Our World (text), Church Times, May 2020
As churches have moved online during the pandemic, they have opened up the virtual church doors for some disabled people, after years of exclusion. Here I write about what churches can learn about how to better include disabled people from their lockdown move online. I’ve also written a simple language version of this article.
The Upside-Down Kingdom of God: Stories of Disabled and Neurodivergent People in Churches.
A downloadable booklet in plain English, sharing the findings of my research on disability, churches and Christianity. Thanks to Krysia Waldock for reviewing the booklet for the Inclusive Church blog.
PhD Thesis: The Upside-Down Kingdom of God: A Disability Studies Perspective on Disabled People’s Experiences in Churches and Theologies of Disability, SOAS, University of London, 2019.
My thesis, on disabled people’s experiences in churches, can be downloaded from the SOAS research website.
‘The Cult of Health and Wholeness: Normalcy and the Charismatic Christian Healing Movement.’ Book chapter in Theorising Normalcy and the Mundane: Precarious Positions, University of Chester Press, 2016.
Reflections, Torch Trust, Premier Christian Radio, 10 June 2016. Interview about my research with Marilyn Baker, for Premier Christian Radio’s show on disability and faith.
Questions of Faith: Faith and Disability, Share Radio, 26 June 2016. Interview with Mark Shoffman, with Rev Bill Braviner and other disability theologians, on the barriers faced by many disabled people in faith communities.
Passing for Normal: The Austerity Politics of Visibility and Invisibility for Disabled People. Paper presented at the ‘Disrupting Visibility: The Politics of Passing’ conference, Goldsmiths, University of London, June 2015.
“Many disabled people desperately need the safety that is found in [the] invisibility that allows for passing.”
‘Imagine: Outside.’ The Still Point (1), 2015. Creative reflections on doing disability research as a disabled researcher. Performed at the Still Point journal launch. “I wonder if we have become too accustomed to waiting.”

domain: sociology


The Schneider Optics line of Macro Imaging Lenses is ideal for a wide range of machine vision and macro imaging applications. The ability to produce image circles ranging from 30 to 108mm allows these lenses to integrate easily with larger array sizes and high-resolution line scan sensors. Optically designed for shorter working distances, the macro lenses have the ability to produce better contrast at desired resolutions than other lenses with similar specifications. Additionally, each lens is designed to be reversible in order to increase its usable range of magnification while maintaining the highest levels of image quality.
Each lens system consists of 3 main components. First, a lens of desired focal length to meet the specific application is needed. Second, one of three different helical focusing mounts, which allows for fine focusing adjustment of the system needs to be chosen based on sensor size. Next, there are a variety of extension tubes that allow the proper image and object distance to be obtained. The extension tube selection depends on the selected helical focusing mount as well as the desired length. Extension tubes can be combined for custom lengths. Additionally, a specific camera mounting option may be required in order to correctly connect to the desired camera.
The lens options are all fitted with a special V-mount on both sides of the lens that allows adaptation to all 3 sets of focus tubes.
The UniFoc-12 and extension tubes for the Unifoc 12 focusing tube offer this same V-mount. Using these components, the UniFoc-12 system will need to be adapted to the camera with one of the lens adapters listed below.
The UniFoc-58 and UniFoc-76 are threaded focus tubes and require an adapter to mount a V-mount lens. The UniFoc-58 offers an M42x0.75 thread, while the UniFoc-76 offers an M58x0.75 thread. The UniFoc-76 can be used with an adapter for M72x0.75 threads, and increase the tube diameter for large sensors to avoid vignetting. With this adapter, the M72 extension tubes must be used.
Note: Please contact our Applications Engineering Department if you wish to discuss extension tube lengths and working distance requirements for these lenses
|Amount Required||Description||Stock No.|
|1||Componon f/2.8, 28mm Focal Length||#63-049|
|Componon f/2.8, 35mm Focal Length||#63-050|
|Componon f/2.8, 50mm Focal Length||#63-051|
|Componon f/4.0, 80mm Focal Length||#63-052|
|Componon f/5.6, 100mm Focal Length||#63-053|
|Apo-Componon f/2.8, 40mm Focal Length||#63-054|
|Apo-Componon f/4.0, 45mm Focal Length||#63-055|
|Apo-Componon f/4.0, 60mm Focal Length||#63-056|
|Apo-Componon f/4.5, 90mm Focal Length||#63-057|
|1||UniFoc-12 for sensors smaller than 30mm, V-Mount||#63-436|
|UniFoc-58 for sensors b/w 30mm and 43.3mm, M42||#63-059|
|UniFoc-76 for sensors larger than 43.3mm, M58||#63-060|
|1 (Possibly Required)||Extension Tubes for UniFoc-12: V-mount|
|8mm Extension Tube||#63-061|
|10mm Extension Tube||#63-062|
|25mm Extension Tube||#63-063|
|Extension Tubes for UniFoc-58: M42 x 0.75 Mount|
|10mm Extention Tube||#63-064|
|25mm Extention Tube||#63-065|
|Extension Tubes for UniFoc-76: M58 Mount|
|10mm Extension Tube||#63-066|
|25mm Extension Tube||#63-067|
|M58 to M72 Adapter||#63-437|
|M72 10 Extension Tube||#63-438|
|M72 25 Extension Tube||#63-439|
|1 (Optional for Unifoc-58 and Unifoc-76)||V Mount to C-mount Camera Mount||#63-068|
|V Mount to T2 Camera Mount (M42 x 0.75)||#63-069|
|V Mount to Pentax Camera Mount (M42 x 1.0)||#63-070|
|V Mount to Leica Adapter (M39 x 26 TPI)||#63-071|
|V Mount to Nikon F-Mount Camera Mount||#63-072|


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Creamy Chicken Pasta is a great weeknight meal. Made with tomatoes, cream, cooked chicken, and pasta baked with cheese it is the best one-pot meal!
Whether you’re cooking for your family or for a crowd, this one-pot entrée will be on your menu rotation for a long time to come!
How to Make Chicken Pasta Skillet
This one-pot meal is as easy as can be and just one pot needed!
- Add uncooked pasta, canned tomatoes, and water to a pot.
- Simmer until pasta is tender (al dente).
- Stir in chicken, seasonings, and cream.
- Mix and bake until the cheese is melted and the pasta is tender.
Serve immediately with a slice of garlic toast to soak up every last cheesy bite.
Even though this creamy tomato chicken pasta skillet could be a meal in itself, it’s great paired with with favorite sides.
This chicken pasta skillet recipe reheats well!
- To Store: Keep in an airtight container in the refrigerator.
- To Reheat: Pop a portion in the microwave or on the stovetop! Add a splash of cream (or milk) if needed.
One-Pot Pasta Dishes
Creamy Tomato Chicken Pasta (one pot)
- 1 tablespoon olive oil
- 2 cloves garlic minced
- 8 ounces medium pasta penne, shells or rotini
- 14 ounces diced tomatoes with juices (1 can)
- 2 ½ - 3 cups water
- 2 tablespoons tomato paste
- 2 cups chicken chopped and cooked
- ½ teaspoon basil
- ½ teaspoon oregano
- ½ cup heavy cream or evaporated milk for a lighter version
- 1 cup mozzarella shredded
- 1 cup parmesan cheese shredded
- Preheat oven to 450°F.
- Heat oil in a large oven-proof skillet. Add garlic and cook until fragrant.
- Stir in pasta, diced tomatoes with juices, water, and tomato paste. Let simmer about 2 minutes less than package calls for so pasta is VERY al dente.
- Remove from heat and stir in chicken, seasonings, and cream. Top with shredded cheese.
- Bake 10-12 minutes or until bubbly and cheese is browned.
Nutrition information provided is an estimate and will vary based on cooking methods and brands of ingredients used.
© SpendWithPennies.com. Content and photographs are copyright protected. Sharing of this recipe is both encouraged and appreciated. Copying and/or pasting full recipes to any social media is strictly prohibited. Please view my photo use policy here.
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domain: food


Development of a Free Surface Method Utilizing an Incompressible Multi-Phase Algorithm to Study the Flow about Surface Ships and Underwater Vehicles
Whitfield, David L.
Marcum, David L.
Briley, W. Roger
Taylor, Lafayette K.
Date of Degree
Dissertation - Open Access
Of the surface capturing schemes, the levelset and multi-phase models are implemented and extensively examined. First, the levelset method is shown, and its weaknesses are identified; a mis- appropriation of changes in momentum, a strong dependence on the density by the eigenvalues of the inviscid flux Jacobian, and a prescribed density transition. These weaknesses are specifically addressed and overcome by the formulation of the multi-phase model. Consequently, the multi-phase model is chosen for this work. Previous surface fitting techniques simply absorb the gravitational source term into the pressure. It must be noted that this absorbtion is valid only for single density flows; since the surface fitting approach is solving only one side of the interface, there is no significant change in the density througout the domain. Consequently, absorbing the gravitational source into the pressure term is not possible in a surface capturing scheme in which both sides of the interface are solved. Thus, a new treatment of the gravitational source term is required and is presented in this work. A multi-phase model is implemented into a parallel, three-dimensional, unsteady, incompressible Navier-Stokes flow solver for the purpose of examining free surface flows on unstructured meshes. The reasons for choosing this model above others are presented, and the multi-phase model is discussed. The base algorithm is briefly examined with emphasis given to the areas which require additional care. The construction of the gravity source term which drives the formation of the waves is explained in detail, and its effects on the rest of the algorithm are identified. Finally, the method is carefully compared with available data on a submerged NACA 0012 airfoil, the Wigley Hull, the Series 60 Cb=0.6 ship, and the DTMB 5415 ship.
Nichols, Dudley Stephen, "Development of a Free Surface Method Utilizing an Incompressible Multi-Phase Algorithm to Study the Flow about Surface Ships and Underwater Vehicles" (2002). Theses and Dissertations MSU. 1406.