Iconic North American wildlife
Discover America and Canada's best-known fauna
The vast continent of North America is home to over 455 species of mammals and more than 910 birds, 660 reptiles, 300 amphibians, and 4,000 known arachnids. Numbering among this impressive list of fauna are iconic wildlife like bison, mountain lions, and the bald eagle. So, is your favorite creature listed?
Click through and admire the marvel that is North American wildlife.
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- Make sure this fits by entering your model number.
- Excellent value
- Handmade Quality
- Unique design
For over 20 years Judith Edwards Designs has been a manufacturer and importer of unique lighting and home decor products. They are continually researching current market trends to always offer exceptional and exciting designs at today’s affordable prices. Their resources in markets throughout the world provide us with the opportunity to offer original designs in a wide variety of distinctive materials. So whether your style, is coastal, contemporary, cottage or cabin they’re sure to have something fashionable you’re going to fall in love with. From traditional to juvenile they have products representing a wide variety of today’s most popular styles.

domain: design


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Walgreens Boots Alliance is due to report quarterly results Wednesday, and investors will be looking for updates on a pending merger, the pharmacy chain's cost-saving efforts and any early read on the currency fallout from the Brexit.
Analysts expect the Deerfield, Ill.- based company to deliver earnings of $1.14 per share on revenue of $29.7 billion in its third quarter, as it continues to cut costs and focus on acquisitions to drive growth in a sluggish pharmacy retail environment. It reported $1.02 EPS and $28.8 billion in revenue in the corresponding quarter last year.
Investors will be watching for any news on
Walgreens' progress on its $1.5 billion cost-cutting effort also bears watching. The company said it would shut 200 U.S. stores by the end of fiscal 2017. By the end of Q2 the firm had already closed half of those stores and it has achieved more than 50% of its savings goal.
Some of that savings came from new agreements with primary drug distributor AmerisourceBergen. Management has "aggressively attacked Walgreen’s historical cost structure,” says FBR Capital Markets analyst Steven Halper. "A lot of it came from procurement side—the drug purchasing,” he added.
The progress on the cost plan prompted management to raise the lower end of guidance by a nickel last quarter, putting the company's full-year forecast at $4.35-$4.55 EPS.
Walgreens' third quarter may also show some effects from currency headwinds, though those are more likely to surface in the following quarter, Halper warns. After the U.K. voted to leave the European Union in late June, the pound crashed to 31-year lows, while the euro also faces pressure.
Its 2014 merger with Boots expanded Walgreen's European reach, and though the company gets a modest 12% of revenue from its international retail segment, Boots' 2,500 U.K. stores could dent the company's top line.
As for the stores themselves, Walgreen has been adding beauty offerings, but Halper is skeptical that it will boost sales. “We don’t know for sure if that’s working for them,” he says.
Walgreen stock is down nearly 2% this year.

domain: finance


text: Sometimes when people annoy us it is best to try and find a humorous approach in dealing with our frustration. This how Mr. Llama came to me. I wrote about him several years ago when I was obviously annoyed by someone and really wanted to let them know and it occurred to me – wouldn’t it be cool to have our own personal Llama who would take care of such things for us. 😉 I would encourage you to check out my poem Mr. Llama. I hope you enjoy reading it as much as I enjoyed writing it.

domain: literature


Last week I introduce you to the acapella group, Straight No Chaser. This is entirely my older sister's fault. Several years ago she showed me the YouTube video of their "Christmas Can-Can" and I've been hooked ever since . . .
So today, the song that started it for me:


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Dusty pink oversized shirt
This laidback casual shirt is made from pure breathable cotton that is lightweight and airy. Designed for an oversized fit, this shirt features relaxed long sleeves with cuffs, a curved hem, a patch pocket on the chest, and a pointed collar neck.
One size runs up
Oversized dolman sleeves with cuffs
Shirt length: 30 inches
Sleeve length: 17.5 inches
Model is? tall and wearing a size S
Made with love in India
Styling tips: Tuck into your fitted pair of jeans or high-waisted trousers for a casual day out or office wear
ABOUT OUR HANDLOOM FABRICS
We are proud to use organic cotton, handwoven and artisanal, that is skin-friendly and made using azo-free dye. Grown in India, it is produced responsibly with the environment in mind to reduce the carbon footprint. Read more.
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Quanta Launches Record Number of Laptops in June
Chances are you have never heard of Quanta before. If you use a laptop sold by HP, Dell, or Sony, then you are using a Quanta built laptop. Quanta has set a record high for shipments and revenue in June. The reason is contributed to smaller component shortages, like the new Intel Arrandale chips, and that customers placed orders in early June so that the laptops would ship out before July hit. The company expects things to slow down in July, but exactly how much did Quanta sell this past month? 4.8 million laptops that generated $3.1 billion in revenue. Staggering numbers really and it is the main reason Quanta is the number one laptop manufacturer in the world. The previous high was 4.3 million laptops sold which Quanta hit this past April. So long as Intel can keep up demand of its chips, I think Quanta will break yet another record before long.

domain: news


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As we reported yesterday, the new Dream Theater album is set for a September release through Roadrunner Records. Now, Dream Theater have officially announced the title of their new album: A Dramatic Turn of Events. It will be released Sept. 13. The band will support the album with a world tour.
Of the new album, vocalist James LaBrie said, "In the grand scheme of Dream Theater's career, the last several months have been such an incredibly positive, fulfilling and rewarding experience. The new songs and sound has never been so spirited or rejuvenating. I cannot wait for every one of our fans to sink their audio senses into this batch of tunes."
This will be Dream Theater's first album without original drummer and founding member, Mike Portnoy, who parted ways with the band last year.
The recent announcement that drummer Mike Mangini would be replacing Portnoy caused such fanfare that Mangini was a trending topic on Twitter, second only to England's royal wedding.
Track Listing for A Dramatic Turn of Events:
- 1. On the Backs of Angels
- 2. Build Me Up, Break Me Down
- 3. Lost Not Forgotten
- 4. This is the Life
- 5. The Shaman’s Trance
- 6. Outcry
- 7. Far From Heaven
- 8. Breaking All Illusions
- 9. Beneath The Surface


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No, hemp oil is not the same as cannabis oil. All-natural hemp oil is obtained by cold pressing of hemp seeds whereas cannabis oil is obtained by separating the resins from cannabis flowers. Their uses and chemical composition are quite different. Cannabis oil is much higher in THC (tetrahydrocannabinol) content, which has certain effects, whereas hemp oil tends to be higher in CBD (cannabidiol) levels.
Talansky says that his sleep improved almost immediately when he started taking CBD daily. Soon after, he was also less anxious about transitioning from pro cycling to his new sport, felt that he recovered more quickly from hard training, and had fewer flare-ups of his old cycling injuries. Now he encourages other athletes to try CBD, in part “to get rid of the association with smoking weed,” he says. “It’s completely different.”
Further testing found what the world now knows: This compound is the plant’s principal active ingredient, its mind-altering essence—the stuff that makes you high. Mechoulam, along with a colleague, had discovered tetrahydrocannabinol (THC). He and his team also elucidated the chemical structure of cannabidiol (CBD), another key ingredient in marijuana, one that has many potential medical uses but no psychoactive effect on humans.
Last year, the National Academies of Sciences, Engineering and Medicine released a nearly 500-page report on the health effects of cannabis and cannabinoids. A committee of 16 experts from a variety of scientific and medical fields analyzed the available evidence — more than 10,000 scientific abstracts in all. Because so few studies examine the effects of CBD on its own, the panel did not issue any findings about CBD specifically, but it did reach some conclusions about cannabis and cannabinoids more generally. The researchers determined that there is “conclusive or substantial evidence” supporting the use of cannabis or cannabinoids for chronic pain in adults, multiple sclerosis-related spasticity (a kind of stiffness and muscle spasms), and chemotherapy-induced nausea and vomiting. The committee also found “moderate” evidence that cannabis or cannabinoids can reduce sleep disturbances in people with obstructive sleep apnea, fibromyalgia, chronic pain and multiple sclerosis, as well as “limited” evidence that these substances can improve symptoms of Tourette’s syndrome, increase appetite and stem weight loss in people with HIV/AIDs, and improve symptoms of PTSD and anxiety.
Epilepsy Society believes that individuals or their parents or carers should decide whether or not to use CBD-based oils. However they should always discuss any decision with their healthcare professional and should not stop taking their epilepsy medication without the supervision of their doctor. Unlicensed CBD oils may not be produced to the same high standards as licensed products and could interact with epilepsy medication. This could increase the risk of side effects or seizures.
You can rub CBD oil on your skin or drop it under your tongue; you can eat it as a sugarcoated gummy or drink it as a Goop-approved cocktail. There's evidence (some scientific, plenty anecdotal) that it helps with epileptic seizures, opioid addiction, PTSD, arthritis, anxiety, insomnia, nausea, chronic pain, and much more. If you believe the hype, CBD can do just about anything for your physical and mental health — and it won't get you high as a kite.
As with any new nutritional supplement choice, there are several factors that will determine how quickly you see results: duration and severity of the factors in your life which are impacting your sense of wellness and well-being, concentration of the capsules or tincture, and other therapies you might be using at the same time are just some of the variables to take into account when beginning therapeutic use of whole plant hemp oil, hemp capsules, or hemp tincture. Hemp is a natural remedy that functions with your body to gradually improve its overall state of balance, and, unlike with most prescription medications, the changes you experience as a result can often be very subtle. This is a gradual process toward long lasting health and vitality, so be patient, stay consistent, and you will see results!
Cannabidiol (CBD) is a naturally-occurring constituent of industrial hemp (cannabis sativa) plants. It is the most abundant non-psychoactive cannabinoid found in cannabis and is being scientifically investigated for numerous reasons. Most people have heard of a cannabinoid called THC, which is the ingredient in cannabis that gets users high. Unlike THC, CBD (cannabidiol) is a non-psychoactive cannabinoid and does not cause a high.
The patient continued to use cannabis oil for 65 days. The family changed strains of the oil repeatedly, and some were more effective in increasing appetite and alleviating pain than others. The author of the case report suggests that cannabis oil needs to be explored further because there is potential that cannabinoids might show selectivity when attacking cancer cells, thereby reducing the widespread cytotoxic effects of conventional chemotherapeutic agents. Sadly, the young girl with ALL passed away due to gastrointestinal bleeding and a bowel perforation.
Possession or manufacture of cannabis and cannabis extracts is illegal in most jurisdictions. People caught with small amounts of extracts can face extremely harsh prison sentences. As of 2017 in some regions of the United States mandatory minimums of a year in jail still exist. However, it is widely produced in states where cannabis has been legalized.
Yet another benefit of essential fatty acids is mood health. Several studies have shown that Omega 3 supplementation can improve symptoms in bipolar disorder. Others have found improvements in. This could be because essential fatty acids are critical to maintaining brain function. Endocannabinoids are also essential for mood. The endocannabinoid system regulates the release of neurotransmitters, some of which play major roles in conditions like depression and anxiety. As mentioned previously, endocannabinoids are made from fat. Consuming extra essential fatty acids gives your body the ability to produce these lipids.
Nutiva began in 1999 as an idea in the mind of John W. Roulac, the author of four books on home composting and industrial hemp. Nutiva is the third successful business John has founded since jump-starting the modern home-composting movement in the early 1990s with his best-selling book, Backyard Composting. That book has sold more than a million copies worldwide.
Laboratory evidence indicated that cannabidiol may reduce THC clearance, increasing plasma concentrations which may raise THC availability to receptors and enhance its effect in a dose-dependent manner. In vitro, cannabidiol inhibited receptors affecting the activity of voltage-dependent sodium and potassium channels, which may affect neural activity. A small clinical trial reported that CBD partially inhibited the CYP2C-catalyzed hydroxylation of THC to 11-OH-THC.
If you just don’t have the time or inclination to take supplements every day, but you still want to experience the potential benefits of CBD, this Hemp Oil CBD Patch from Pure Ratios could be just what you’re looking for. With little fuss or need for specialist know-how or equipment, simply apply a patch to the target area and enjoy a slow-release 40-mg serving of CBD that will last for up to 96 hours.
Even as the research proceeds, thousands of people are using CBD as medicine. A British pharmaceutical company, GW Pharma, has developed two CBD drugs: Sativex, which contains a 1-to-1 ratio of CBD and THC, and Epidiolex, which is pure CBD. The former is prescribed for the painful muscle spasms that occur in multiple sclerosis, while the latter is aimed at childhood seizures. Sativex is not available in the United States, but it is approved in 29 other countries, including Canada, England and Israel.
According to the American Glaucoma Society, cannabis has demonstrated the ability to lower IOP in both normal individuals and in those with glaucoma, and therefore might be a natural glaucoma treatment. One cautionary fact about cannabis’ ability to lower IOP is that it only works for a short time, so patients would have to use cannabis about every three hours.
When I meet the Patricks in late 2014, they’ve settled into their new home on the north side of Colorado Springs. Pikes Peak looms in their living room window. Addy is thriving. Since first taking CBD oil, she hasn’t been hospitalized. She still has occasional seizures—one or two a day—but they’re less intense. Her eyes wander less. She listens more. She laughs. She’s learned how to hug and has discovered the power of her vocal cords.
Everybody has different medical needs, because of this Medix CBD hemp oil tinctures are available in different dosages ranging from 100mg – 4,500mg per bottle. The reason for such a large difference in CBD concentrations between the lowest strength bottle and the highest strength bottle is because we offer a vast and wide selection of CBD hemp oil tinctures to meet the needs of people with different medical goals.
Medical Disclaimer: Statements in any video or written content on this site have not been evaluated by the FDA. If you are pregnant, nursing, taking medications, or have a medical condition, consult your physician before using this product. Representations regarding the efficacy and safety of CBD oil have not been evaluated by the Food and Drug Administration. The FDA only evaluates foods and drugs, not supplements like these products. These products are not intended to diagnose, prevent, treat, or cure any disease. The material on this site is provided for informational purposes only and is not medical advice. Always consult your physician before beginning any supplement program.
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domain: chemistry


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Bioactive Compounds and Antioxidant Activity of Mango Peel Liqueurs (Mangifera indica L.) Produced by Different Methods of Maceration
Department of Food Technology, Instituto Federal do Sertão Pernambucano, Petrolina PE 56314-522, Brazil
Empresa Brasileira de Pesquisa Agropecuária, Semiárido, Petrolina PE 56302-970, Brazil
Author to whom correspondence should be addressed.
Antioxidants 2019, 8(4), 102; https://doi.org/10.3390/antiox8040102
Received: 28 March 2019 / Revised: 11 April 2019 / Accepted: 15 April 2019 / Published: 16 April 2019
The present work had the objective of producing liqueurs from mango peels (varieties “Haden” and “Tommy Atkins”) by processes of alcoholic maceration and maceration with pectinase, as well as to evaluate bioactive compounds by reversed-phase high-performance liquid chromatography coupled to diode array detection and fluorescence-detection (RP-HPLC/DAD/FD) and in vitro antioxidant activity (AOX), for by-product potential reuse. Alcoholic maceration in wine ethanol (65% v/v) produced liqueurs with higher phytochemical and AOX content. Maceration with pectinase resulted in liqueurs with higher quercetin-3-O-glucopyranoside content. In relation to mango varieties, Haden liqueurs presented higher bioactive content than Tommy Atkins liqueurs. The liqueurs presented high antioxidant activity. The main bioactive compounds found were flavanols (epicatechin-gallate, epigallocatechin-gallate), flavonols (quercetin-3-O-glucopyranoside and rutin), and phenolic acids (gallic acid, o-coumaric acid, and syringic acid). The present study showed that the production of liqueur enabled the recovering of an important part of the bioactive content of mango peels, suggesting an alternative for the recovery of antioxidant substances from this by-product.

domain: agronomy


- Mike Novogratz said cryptocurrencies were likely to see a "washout" in the short term.
- The billionaire investor predicted it would be a volatile week after Coinbase's direct listing.
- Yet he remains bullish, seeing bitcoin at $100,000 by the end of the year.
The cryptocurrency market is probably in store for a "washout," billionaire investor Mike Novogratz has said, after the Coinbase listing created a frenzy that drove up bitcoin and the likes of Dogecoin and XRP.
Novogratz, the founder and chief executive of crypto-focused investment company Galaxy Digital, told MarketWatch in a virtual event: "I've seen a lot of weird coins like dogecoin and even XRP have huge retail spikes, which means there's a lot of frenzy right now."
He added: "That never ends well, and so we'll probably have a washout at one point."
Novogratz also said: "In the next week, certainly we could have somebecause of the excitement around Coinbase."
Cryptocurrency exchange Coinbase went public on Wednesday, closing with a valuation of $65.4 billion, in what analysts have heralded as a coming-of-age moment for the crypto word.
Coinbase's direct listing to the Nasdaq generated a lot of excitement around cryptocurrencies. It sent bitcoin soaring to an all-time high close to $65,000 and also pushed the ether, XRP and Dogecoin cryptocurrencies to records.
But bitcoin (BTC) has fallen quite sharply since Coinbase's debut to below $62,959 on Thursday.
Despite his words of warning about the short-term outlook, Novogratz remains highly bullish on bitcoin, saying Coinbase's IPO is "monumental" for the industry.
He predicted that bitcoin could hit $100,000 by the end of the year and may even be worth $500,000 in three years' time.
Crypto entrepreneur Bobby Lee, who founded one of the first cryptocurrency exchanges, told Insider in March bitcoin investors should be more aware of the token's wild bull and bear cycles.
He predicted there will be another "winter" when the currency falls dramatically and stays low for two or three years. But Lee is also bullish over the long term, saying bitcoin could even hit $1 million in future bull runs.


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- Search results for Akshay Kumar
The audio launch of 2.0 was held on October 26 in Dubai. The grand event was held at the sprawling Burj Park, Downtown Dubai. The cast and crew were in full attendance, including Rajinikanth's family members such as Latha Rajinikanth, Soundarya, Dhanush, and Aishwarya.
Padman is the biographical drama film featuring Akshay Kumar, Radhika Apte, and Sonam Kapoor. Directed by R Balki, the film is inspired by the life of Arunachalam Muruganantham, a social activist from Tamil Nadu.
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Is clicking a celebrity's picture without their permission right?
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domain: entertainment


These vintage gay Pride photos will remind you to be proud of who your queer heritage.
MOGA and musician Zain Mitchlan team up for Pride Month.
Pop superstar Taylor Swift dedicated her performance of “Delicate” to her LGBTQ fans.
Love, violence and daily survival: inside Morocco’s LGBTIQ community.
Disney has always had queer-coded characters.
Have you ever wondered where you and your partner would retire?
Harry’s to offer one-of-a-kind rainbow razor handles to celebrate Pride season.
Gay football fans going to the 2018 World Cup have been warned that they’ll be “hunted down and stabbed”.
The number of American adults who identify as lesbian, gay, bisexual, or transgender (LGBT) is at an all-time high.
Big city gayborhoods: where they come from and why they still matter.


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The city’s Law Department is taking action against a Chicago nightclub, which was recently the scene of several shootings.
Meanwhile, some popular clubs say they’re being pressured to cancel parties in the wake of other violent outbreaks.
CBS 2’s Suzanne Le Mignot reports Hearts Night Club in Goose Island has had its liquor license revoked for seven days.
The city’s Liquor Commission said the business operation poses a threat to the welfare of the community. The city will present additional information at a hearing later this month.
Chicago club owners and promoters say they’re feeling pressure after recent shootings.
At the Near North Side club Bodi, a man was shot outside early Sunday. Another man was found dead from a gunshot wound in the alley.
On Wednesday, at Hearts Night Club, four men were shot.
In response to this, club managers like Teddy Gilmore say owners have been asked to no longer host urban parties.
“All the events were shut down yesterday. There was not one African-American event in the downtown area,” says Gilmore, manager at Nouveau.
Sources tell CBS 2 club owners have been told to be mindful of using certain promoters to book concerts or parties that can bring violent patrons — primarily gang members and drug dealers -– to their clubs.
“Following the shootings at Hearts and the shootings at Bodi, the city reacted,” Gilmore says.
Social media has been buzzing about the move. One Tweet said clubs are closing due to the violence and killing.
Anthony Lindsey, an event coordinator of nearly two decades, posted a message on Instagram, saying in part, “Everyone can’t be allowed entrance.”
“You have to be on a list to even attend a party. And being on a list means you have to know someone in order to get on that list. You can’t just show up, and that way you can actually help filter some of the people who you might not want to be there,” he says.
On Friday, Chicago police said they are not part of any crackdown on urban parties at downtown clubs.
Sources say club owners and promoters are being pressured from community leaders to take action.

domain: law


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As featured in The Country Web 2017 Annual
Fourteen finalists competed for the title of The Land Sydney Royal Showgirl 2017. These young women were a mix of medical and business students, teachers, volunteers and science graduates. Their interests covered many diverse areas including free range farms, mental health in bush communities, sustainability and community gardens. Finalists are judged on their rural knowledge, ambition and genuine interest in their local community.
Twenty-four-year-old Maisie Morrow, from Merriwa, took out the title of The Land Sydney Royal Showgirl 2017, becoming an ambassador for rural NSW and the Sydney Royal Easter Show and an important role model for young women in agricultural communities.
An Agronomist and Livestock Nutritionist for Landmark, Maisie grew up at Cassilis and studied Rural Science at the University of New England. She is the first ever Showgirl to represent Merriwa at the Sydney Royal.
Maisie is involved in the Cassilis Rural Fire Brigade, Merriwa Show Society, Merriwa Country Women’s Association, and the Scone Grasslands Society. She has ambitions to get involved in farming lobby groups and politics, to ensure Australia educates and supports the ageing farming population, and invests in technology to support the ‘green’ movement to meet world food demand.
Maisie’s interest in being a Showgirl was driven by her support of women in agriculture, emphasising their integral role in the industry both now and in the future.
What do you hope to achieve as The Land Sydney Royal Showgirl 2017?
I am passionate about recognising women’s involvement in agriculture and I am humbled and proud to be representing a movement that promotes young women in agriculture. I believe women are the key to thriving communities as we bring a different dimension to the ‘table’. I would like to use this powerful position as a rural ambassador to encourage women, especially young women, to engage in their communities and showcase the diverse opportunities that exist in rural NSW.
How has your involvement in the competition benefited you?
I have met some incredible people and made some wonderful friendships. The week spent at the Show was a very empowering experience being surrounded by such a diverse group of women, all championing agriculture in different ways.
Why do you think it is so important to raise awareness of rural and regional NSW?
Raising awareness of rural and regional NSW is essential for the economic sustainability of global primary industries. We are a key contributor in the food security discussion and we must maintain an active voice, so farmers and producers have a seat at the table.


China's drive to modernize its armed forces has routinely commanded headlines during the last two decades. Besides the J-20, the story which has attracted the most attention in the last couple of years has been the country's program to develop Anti-Ship Ballistic Missiles, which have reportedly attained operational status.
As Andrew S. Erickson and David D. Yang note in their excellent article in the Naval War College Review, the paucity of actual detail about the system, and the vagueness of the literature, have resulted in an avalanche of conflicting speculations, but little real clarity. Still, there are grounds for reasonable guesses about some things. First and foremost, China's ASBM would appear to be a relatively cheap way of achieving sea denial, compared with the country's building the kind of navy it (and just about everyone else excepting the United States) cannot and will not build any time soon. This would be consistent with China's apparent focus on the acquisition of systems for neutralizing capabilities the country may deem threatening rather than on the acquisition of the muscle for long-range actions of its own (a capability China is clearly developing at a much more careful rate).
As might be guessed, technical feasibility's a much grayer area. Still, it's clear that building a working system of the kind described is a tall order. Implicit in such claims is China's possession of surveillance and communications capabilities advanced and robust enough to, under combat conditions, reliably locate a warship and call in timely, accurate fire on it. (This kind of thing goes off without a hitch in Tom Clancy novels, but the reality is much different, though China has reportedly made great strides in this area during the last decade.) That, in turn, would be meaningless without Chinese industry's resolving the problems in making the missile capable of tracking and maneuvering in response to a moving target in the course of its flight--the larger challenge, as it would involve a new technology nothing short of revolutionary. Ballistic missiles historically have been used to hit stationary targets, not moving ones, and an aircraft carrier can move a distance measurable in miles inside the missile's likely flight time. The intrinsic difficulty of developing an effective system of this kind aside, the fact remains that new weapons systems tend to have long teething processes, as the history of combat aircraft makes clear, and it is worth noting that the system has yet to actually be "test-fired over water at maneuvering targets."
Assuming China has succeeded in overcoming all this, actual use of the ASBM entails an additional, political problem, the same one facing American plans to use conventionally-armed ballistic missiles for quick strikes--the launches may be susceptible to misinterpretation as a different kind of strike, with potentially strategic consequences. (It is worth remembering that the 1995 Black Brant scare was started by the launch of a comparatively innocent weather rocket.) That by itself may inhibit their use in a crisis situation, as might the fact that the use of ballistic missiles by one great power against another (something that has not happened since Germany's V-2 attacks against Britain in World War II, a situation not at all comparable) would be worrisomely unprecedented. At the very least, the threat to use such missiles would increase the possibility of strikes against launch sites inside the Chinese mainland, escalating any crisis situation.
These technical and political complications do not make the existence of such a system impossible, and it should be conceded that even a system that's only partly functional would be a factor in any U.S. calculations (for instance, regarding the placement of its carrier groups in a repeat of the 1996 crisis over Taiwan). Still, they also suggest a strong likelihood the weapon is too problematic for China to get much use out of it, and perhaps simply a stopgap solution to the acquisition of a more robust conventional capability. Despite the highly publicized appearance of the J-20 fighter this month, and new talk about a carrier program, it remains to be seen that this will materialize anytime soon.
New and Noteworthy (Unemployment, Supporting 9 Billion By 2050)
Keeping the Hype in Check I: The Chengdu J-20


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Known for his roles as Neil Barash, Joel Goodman, and Dr. John Morgan on the respective television series Flying Blind, Blue Skies, and Love Boat: The Next Wave, Parker is also notable for his appearances in the films Friday the 13th: A New Beginning and Biloxi Blues.
After graduating from New York City's High School of Performing Arts, he performed with the Ensemble Studio Theatre and became a member of the famed Actors Studio.
In the early years of the 21st century, he settled in Memphis, Tennessee.
After his marriage to Linda Kerridge ended in divorce in 1992, he married Angela Parker.
As a young man, he trained with the renowned acting coach Uta Hagen.


"Originally from the New Jersey based indie band Boy Things, Beth has been actively pursuing solo and group projects since age 12. Boy Things’ unique pop-punk sound went so far as to attract MTVU, who named them “a ‘boy’ band that actually rocks,” and shed the spotlight on Beth for her “dynamic vocals.” This momentum led to an introduction with producer Caleb Shreve (Stars, Ra Ra Riot, Bear Hands) and Josh Sadlier Brown, whose extensive experience in the music industry were critical in bringing C’Mere to life.
A five track EP is ready for release with the full-length album in the works as C'Mere explores exciting new collaborations. Stay on the lookout for her local shows and party performances in NYC by following @CMere_Music on Instagram, Twitter, and Soundcloud.
“Being a musician is almost all about the performance for me. Leaving everything up for the audience and taking in whatever they give you while you’re on stage,” says C’Mere."
Created: March 7, 2016, 2:39 p.m.
Last Modified: May 21, 2016, 1:36 p.m.


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President Trump is the gift that gives on giving – a gift of red pills that is.
President Trump, at his recent Florida, post-election rally, mentioned that he saw” last night on the TV” that there was “problems” in Sweden; then, the Cathedral, and the rest of the bobo Brahmins erupted into spasms of outrage accusing him of lying once again.
Firstly, watch the video of what President Trump actually said:
Below is the Fox News report that Trump was probably referring to. It refers to a documentary by Ami Horowitz, who spent time in Sweden reporting on migrant crime and the inability of the socially elite progressive (Brahmin) Swedes to overcome their cognitive dissonance with reality.
Trump has trumped the Cathedral once again; proving himself, again, to be an adroit ringmaster in getting all the clowns in the circus to run around in endless circles of confusion.
Trump is getting the Cathedral to unintentionally “Red Pill” everyone. The first level is the the various problems itself; the second is the fact that the Cathedral (its mainstream media arm) is dishonest and untrustworthy.
President Trump’s game is a simple two step procedure. First, he says something, then his enemies in the media accuse him of lying; then (usually via twitter) he goes on to prove that they were either lying or confused or stupid. For example, after the media’s attack, he tweeted that he was referring to a Fox new report (see above video).
President Trump achieves two things here: he is getting the media to cover what is actually happening in Sweden, even if they only downplay or deny the problems, the problems nevertheless get mentioned. And of course, this all speaks to his immigration stance for America, which is his ultimate goal. President Trump, as I pointed out here, is using strategic ambiguity in his language to achieve this.
What seems to have happened is that either the journalists, or the rest of the progressives have either intentionally lied, or they have actually hallucinated that President Trump was referring to a terror attack when actually he was referring to “problems.”
Scott Adams, the canniest observer of Trump there is, has pointed out this phenomenon here. He also went on to make a telling prediction:
And that brings us to our current situation. As Trump continues to defy all predictions from his critics, the critics need to maintain their self-images as the smart ones who saw this new Hitler coming. And that means you will see hallucinations like you have never seen. It will be epic.
The reason this will be so fun to watch is that we rarely get to see a situation in which the facts so vigorously violate a hallucination. Before Trump won the presidency everyone was free to imagine the future they expected. But as Trump continues to do one reasonable thing after another, his critics have a tough choice. They can either…
1. Reinterpret their self-images from wise to clueless.
2. Generate an even stronger hallucination. (Cognitive dissonance.)
If Trump’s critics take the second option – and most of them will – it means you will see a lot of pretzel-logic of the type that is necessary hold onto the illusion that Trump is still a monster despite continuing evidence to the contrary.
And its happening.
The Guardian’s byline reads:
“After Trump suggests a non-existent terrorist attack took place in Sweden, supporters claim the media is covering up migrant crimes.”
He suggested no such thing. Ironically, the fact that there was “cover-ups” was covered, months ago, in the Guardian itself!
Andrew Brown, from the Guardian, on the covering up of sex crimes in Sweden concludes:
“This policy was fuelled partly by wishful thinking, partly by principle and partly by self-righteousness. It ended disastrously.”
“So teenage girls were systematically assaulted and robbed by gangs of young foreign men because too many powerful people found their suffering was inconvenient. The result of this cover-up will be far more damaging than the truth could have been.”
The editors of the Guardian are incompetent, as well as dishonest.
Not that the English are any better than the Swedes on the subject of sex crime cover-ups.
Back to President Trump, The Guardian reports:
“….the Swedes are still scratching their heads over Trump’s comments, and the former prime minister Carl Bildt wonders on Twitter what the president had been smoking, some Trump supporters believe the media is “intent on covering up what migrants have done to Sweden”.
The Guardian then uses the “no evidence that” canard:
“However, there is little evidence that the nation is suffering under a migrant-led crime wave. In fact, the most pressing issue in Sweden at the moment is apparently who will become the nation’s Eurovision entrant.”
I think everyone should watch this video:
So what is actually happening in Sweden? Let’s take a look:
“Sweden is a peaceful democratic state that has long been a safe haven for those fleeing conflict. Yet many young people whose families took refuge there are now turning their back on the country. More than 300 people have gone to fight in Syria and Iraq, making Sweden per capita one of the biggest exporters of jihadists in Europe.”
According to a report by Radio Sweden, for example:
“Around 140 Swedes have so far returned after having joined the violent groups in Syria and Iraq. Now several municipalities are preparing to work with those who want to defect. This could include offering practical support to defectors.”
The municipality of Lund has dealt with this issue, and Malmö, Borlänge and Örebro have similar views. As Radio Sweden reports:
“Lund’s conclusion is that defectors from violent extremist groups should be handled like defectors from other environments, such as organized crime. After an investigation of the person’s needs, the municipality can help with housing, employment or livelihood.”
According to Sweden’s “national coordinator against violent extremism,” Christoffer Carlsson:
“…You need to be able to reintegrate into the job market, you may need a driver’s license, debt settlement and shelter. When people leave, they want to leave for something else, but they do not have the resources for it, so it is difficult for them to realize their plan. If they do not receive support, the risk is great that they will be unable to leave the extremist environment, but instead fall back into it.”
Anna Sjöstrand, Lund’s municipal coordinator against violent extremism, says that people who have served their penalty should all have support. Last year, the Municipality of Örebro received criticism for offering an internship to a young man who returned after having been in Syria.
“There may be such criticism, but for me it is difficult to think along those lines. They get the same help as others who seek help from us. We cannot say that because you made a wrong choice, you have no right to come back and live in our society,” says Anna Sjöstrand.
According to Sweden Radio, several of the municipalities stress that people who commit crimes should be sentenced and serve their penalties before they can receive support. According to Amir Rostami, who works with the national coordinator against violent extremism:
“If you are suspected of a crime, the investigation of the crime always comes first. But as long as there is no suspicion of a crime, then it is in our own interest to help those that come out of this extremist environment. The consequences for society are quite large if you do not.”
Sweden, meanwhile, also has a new rape culture like Germany:
“Outrage and shock are spreading across Sweden over a case against three men of foreign origin arrested on suspicion of raping a woman and broadcasting it live on Facebook.”
Sex (crimes) lies and progressive pathology:
Not long after, he and the other two suspects entered the young woman’s apartment in the city of Uppsala. They raped her for a full three hours. The entire crime was broadcast live on Facebook. Yesterday, footage was released of Khodagholi bullying his victim when she was calling someone for help. The poor girl was barely conscious, but her rapist couldn’t control himself. “You got raped. There, we have the answers. You’ve been raped,” he shouted gleefully at her. He then laughed like a psychopath and continued to make fun of her.
Like his friend Khodagholi, the second suspect is an immigrant and an acquaintance of the Swedish authorities. His name is Maisam Afshar. The identity of the third suspect has not been released yet.
It goes without saying that this horrendous gang rape has caused a major controversy in Sweden and in the rest of Europe. What angers people even more, aside from the nature of the crime itself, is the response of the Swedish mainstream media, which refuses to admit that the rapists are immigrants. Economist Tino Sanandaji explains:
Hundreds of people have watched the video and know therefore that the perpetrators have a foreign background. That’s a fact, but the media won’t mention it. The majority of perpetrators of gang rapes have an immigrant background. This is a well-known fact.
The government has the duty to share all relevant information when a crime is committed. The government denies that there’s a relationship between this sort of crime and immigration, but refuses to even look at the statistics.
A Swedish police officer who spoke out about the fact that immigrants commit more crime than the Swedes is now being investigated for blasphemy.
Correction, “hate” speech
The police, meanwhile, are quitting in disgust.
There is a consistent pattern, across the Western world, of the ruling class behaving in ways that are fundamentally dishonest, incompetent, contrary and lethal to their “own” people’s lives and liberty.
The crimes are one thing, the lies, the cover-ups and the disinformation quite another.It is two pillars of the system (security and information) that are undermined, not one. And therefore the system is much more vulnerable to collapse or capture by its rivals and enemies.
( In Richard Fernandez’s formulation, the Modern Structure has three pillars (security, economics and information); Moldbug, meanwhile, has four.)
The modern crisis is the Western world’s collapsing, interlinked system of security, economic prosperity, and people’s trust in the political and information systems and authorities; which will result in hostility against the social class (Brahmins) that manage them.
“It’s almost impossible to over-estimate how important this is (and the trend matters more than the current level). Regime legitimacy is sunk in radical crisis.”
Land, however, is only referring to the American Press; but, as we have just seen, the crisis extends throughout the entire West.
Trump, meanwhile, is more trusted than the media.
Finally, a commentator going by the handle “Rhetocrates” at my Social Matter piece has something interesting and important to say; I will copy the entire comment without comment, because in my next post, that’s coming shortly, I will talk about the very thing that Rhetocrates is describing:
I am in a somewhat unique positions culturally with regard to the Red and Blue empires.
On the one hand, I am attending college at the graduate level, which means I get intimate contact with the faculty, administration, and other thought-shapers of the next generation. True, it’s a consolation university, so they’re not setting any trends.
On the other, I’m strongly allied with the Red government because my wife is middle management in the Navy (plus a whole lot of familial history – I was raised believing I would also join the Navy, for example).
Anyway, with my bona fides out of the way, I think the greatest and most dangerous service Trump is performing for reaction is the disillusionment of the military.
Our military is the source of modern conservatism, and specifically, its hang-ups about getting anything done. This was a masterful stroke by FDR: in creating the Pentagon structure he instilled the philosophy of absolute obedience to civil authority. Our military considers it a virtue to die on its sword defending the Republic, whether or not it agrees with the philosophical or political tenets of the fight. The civil religion of America – starting with taking the Constitution as a sort of sacred scripture, and moving down through, “I may not agree with you, but I will defend to the death your right to speak,” runs strong through our military. (The only thing missing from previous installments is that the saints – Washington, Paine, Henry, etc. – have withered away. This is par for the course with Protestantism.)
One of the strongest but most subtle effects of this is a lack of what I’ll call generalism or general-worship. Throughout history, armies have been loyal to their generals, not to the State. Thus, generals have always been something of a threat to the civil power. (Medieval feudalism partially got around this with the ingenious method of making the head of state also the head of the army, though it still had problems with the aristocracy, who could command the personal loyalty of their retainers, King be damned.)
General-worship was intentionally stamped out by FDR’s reinvention of the Republic, though it may have been on the decline beforehand. (I’m not sure. Washington definitely commanded personal loyalty from his troops, Teddy Roosevelt may have done the same.) To replace it, the civil religion was installed. In practice, this was done by coopting the generals into the scheme of the religion – Patton was still idolized, but Patton himself would never countenance marching on Washington.
Over time, even that level of general-worship was extirpated, to the point these days where the strongest example resides in Petraeus. When his character was assassinated, there was wide-spread, low-level grumbling from the military, but only because he was ‘one of us’ and was used unfairly. Not because he was anyone’s general, and damn the State, because the general needs his men.
Back to Trump. Trump’s greatest and most dangerous triumph so far has been to rock the military’s faith in the civil religion. There has been a sea change because of him (and, in the negative, because of men like SecNav Mabus, who under Obama tried to destroy Navy tradition as much as possible). Men are starting to identify primarily with their commands and their commanders, because the ‘legitimate authority’ of the State has shown itself to be a fraud. Men in uniform are under attack, and they know it.
We’re coming around to days when (for example) Mattis using the personal loyalty of his troops to occupy Washington and ‘restore order’ with an ‘interim’ government that completely ignores the screeching of the judiciary and civil service are, if not close, at least thinkable.
Proceed to Part 9d.


text:
A Systematic Review of Early versus Late Closure of Loop Ileostomy
Introduction. A Loop ileostomy is one of the most common techniques used in colorectal surgery to establish a reversible faecal diversion and bypass the large bowels, in order to protect either a downstream colorectal anastomosis or a coloanal anastomosis. However, it is a procedure that can cause a plethora of complications including long term ones such as the psychological effects. Currently, there is no consensus regarding the optimal time to perform closure of a loop ileostomy. Some studies suggested the early reversal of ileostomy procedure as a solution to reduce these complications. This study aims to review the available literature in order to ascertain the benefits behind early closure of loop ileostomy. Methods. The literature was searched for all studies that included a comparison between the outcomes of early and late closure of loop ileostomy in terms of morbidity, mortality, or quality of life, where available. Early closure of loop ileostomy is defined as closure less than three months and late as more than three months, in accordance with conventional literature. The resultant articles were filtered using our inclusion and exclusion criteria. Finally, the remaining articles were assessed for quality and their results were compared to one another in order to draw our conclusions. Results and Discussion. The results were slightly inclined toward early closure of loop ileostomy. However, there were limitations of the studies reviewed, including the heterogenicity of studies, selection bias, lack of clear definition of measured outcomes, and small sample size. Taking that into consideration, the results of early closure of loop ileostomies in the selected patients were promising and require further investigation.
A loop ileostomy is one of the most common techniques used in colorectal surgery to establish a reversible faecal diversion and bypass the large bowels, in order to protect either a downstream colorectal anastomosis or a coloanal anastomosis [1, 2]. However, in spite of its potential benefits, it is worth noting that the incidence of complications, in general, is very variable and some studies estimated it between 14% and 79% . Complications that arise from stoma formation can be divided into early and late. To better understand how these complications may arise, it is essential to discuss the steps involved in the procedures of a loop ileostomy’s formation.
Loop ileostomy procedure is as follows :(i)The procedure starts by mobilizing a well-vascularized segment of the small bowel.(ii)This is followed by a creation of a circular incision of 2 to 4 cm in a predetermined site.(iii)While protecting the rest of the abdominal contents, the skin disc is resected and monopolar diathermy is used to deepen the incision to the anterior rectus sheath with the help of blunt retractors.(iv)At that level, the fascia is divided and the muscle is separated using blunt dissection.(v)This will lead to the posterior sheath, which should be divided using diathermy until we are through the peritoneum.(vi)These steps have to be done while keeping in mind that the size of the internal incision should be enough to deliver the bowel without resulting in a parastomal hernia thereafter.(vii)The next step involves passing a finger through the defect to preserve the tract and to guide a babcock to clamp the bowel segment of interest.(viii)This is followed by pushing the clamped segment gently through the created defect via the guidance of the babcock clamp.(ix)Once this step is done, the main laparotomy incision can be closed and covered to minimize contamination of the wound.(x)The next stage of the procedure involves maturing the stoma, in other words creating a spout by everting the edges of the stoma. This technique serves to protect the skin surrounding the stoma and to prevent distal strictures formation.(xi)It is worth noting that, in the case of loop ileostomies, a bridge is placed under the posterior wall of the stoma to prevent it from retracting .
Early complications, by definition, are those occurring within three months of the stoma creation. These include abscess formation, wound infection, bleeding, stomal necrosis, stomal retraction, mucocutaneous separation, and peristomal skin breakdown .
Late complications that develop after three months include stomal stenosis, peristomal skin breakdown, stomal prolapse, parastomal herniation, fistula formation, and negative psychological effects [3, 4]. Parastomal hernia is one of the common late complications affecting about 6.2% of patients with loop ileostomies. It is a type of incisional hernia resulting in the protrusion of abdominal content through the created defect. It presents with an abdominal swelling around the site of the hernia with or without pain, or as an acute strangulated or incarcerated hernia. .
Temporary stomas have negative effects on the quality of life (QoL). This is attributed to the fact that affected patients do not adapt well to a life with a stoma . Some studies showed that patients who underwent low anterior resection with ileostomy had significant reductions in physical activity and role functioning . Furthermore, it has negative effects on the body image. A pilot study showed that loop ileostomy patients had many concerns including feeling embarrassed about body image, feeling sexually unattractive, and limited choice of clothes, among other concerns. However, anxiety about pouch filling and loosening was among the biggest concerns. All these concerns were accredited to the lack of knowledge, lack of self-confidence about handling the stoma, fear of stoma getting injured, and the social taboo of having an “unusual thing on the body.”.
The reversal of loop ileostomies has an overall morbidity and mortality estimated at 17.3% and 0.4%, respectively . To better understand how these complications may arise, it is beneficial to understand the steps involved in the reversal of a loop ileostomy.
Loop ileostomy reversal is as follows :(i)Prior to reversal of a diverting loop ileostomy, a water-soluble contrast enema is performed to demonstrate absence of any anastomotic leaks or other abnormalities in the downstream anastomosis.(ii)In the majority of cases, the reversal of the ileostomy is done through a local circumferential incision, encompassing 1-2 mm of skin surrounding the diverting loop ileostomy, at the level of the stoma itself, whereas a laparotomy is reserved only in the most extreme cases of tenacious adhesions.(iii)Then, each of the proximal and distal limbs is dismembered off the surrounding tissues all the way down into the peritoneal cavity.(iv)In order to avoid injury to the intestine, the rim of excised skin may be grasped with clamps to provide traction.(v)The tip of the proximal limb is reinverted after a complete bowel mobilization, and the lumen of each of the limbs is injected under pressure with diluted Betadine solution or similarly coloured liquids mixed with air to check for occult leaks from inadvertent enterotomies.(vi)Then, the edges of the stoma are chipped to excise any residual skin and subcutaneous fat.(vii)The ileostomy is then closed, either by suturing the resulting in antimesenteric defect in one or two layers and by performing a side-to-side stapled enteroenteric anastomosis, among other techniques. The technique of ileostomy closure therefore mainly depends on the individual surgeon’s preference.(viii)Following fascial closure, one technique is to partially reapproximate the skin using a subcuticular purse-string suture, which leaves a portion of subcutaneous tissue exposed to heal by secondary intention .
The morbidities associated with loop ileostomy reversal include small bowel obstruction (7.2%), anastomotic leak at the stoma closure site (1.4%), intraoperative bowel perforation and peritonitis (1.2%), and postoperative enterocutaneous fistula (1.3%). Other common morbidities include wound infection (5%) and incisional hernia in the stoma site (1.8%) . These complications increase medical costs, prolong hospitalization time, and increase the need for outpatient care as well as the risk of late complications such as incisional hernia. Significant risk factors for complications after ileostomy reversal are male gender, surgical site infection, longer time from creation to closure, operation for diverticular disease with significant peritoneal contamination, age, type of ileostomy, the general condition of the patient, and small bowel resection .
Fortunately, some studies suggested that earlier closure is not only feasible but might reduce stoma-related morbidity, improve quality of life, and still effectively protect the distal anastomosis [11–14]. An improvement in the overall QoL is possible after ileostomy reversal, as Camilleri-Brennan and Steele illustrated. Their research showed that the reversal of the defunctioning ileostomy resulted in significant improvements in global QoL, physical function, social function, and role‐physical and energy‐vitality scores . Gooszen et al. also demonstrated that there is a relation between the number of stoma care problems and the degree of social restriction, which significantly impacts the QoL .
Unfortunately, there are no established guidelines to indicate the optimal timing to reverse a loop ileostomy [17, 18]. Loop ileostomies reversal is generally recommended within 8–12 weeks after the primary surgery, in order to obtain adequate healing while avoiding an extended presence of a loop ileostomy with subsequent burden for the patient and the risk of developing stoma-related complications . Nevertheless, because studies in population-based setting are rarely described in the surgical literature, it is uncertain how often loop ileostomies are reversed after 8–12 weeks in routine clinical practice .
In practice, temporary stomas may not be closed for months or even years. It may even become permanent. Hence, preoperative counselling and planning is just as important as it is for a permanent stoma . The National Bowel Cancer Audit Project (NBOCAAP) 2013 report found that almost 30% of temporary ileostomies following anterior resection are still not closed after 18 months with the median time of closure being 7 months . Other studies reported a risk of nonclosure between 3 and 25% . Delayed reversal has various reasons including postoperative adjuvant chemotherapy, nonsurgical complications, symptomatic anastomotic leakage, and small bowel obstruction as well as administrative obstacles. This is explained by the fact that reversal operation is considered an elective low-priority operation that has to compete with more complex and urgent operations [17, 18].
Thus, the aim of this article is to review the relevant literature attempting to determine whether early closure of loop ileostomy is more beneficial compared to late closure (defined as closure >12 weeks after stoma creation) in terms of morbidity, mortality, and quality of life.
2. Materials and Methods
2.1. Study Selection
The relevant literature was selected through a multistep process. PubMed, Cochrane library, Google Scholar, and EBSCOhost search engines were searched using the terms “loop ileostomy,” “early closure,” and “late closure” and other possible phrasings including “delayed closure,” “early reversal,” and “delayed reversal” on their own or as a combination. The search yielded 2790 studies (161 results in Google scholar, 0 results in Cochrane library, and 2629 in EBSCOhost search engine). Then, the results were searched using our inclusion and exclusion criteria. Finally, the resultant articles included were collated and analysed in light of their results and quality.
Inclusion criteria were as follows:(i)Adult subjects: 18 years old and older.(ii)English language.(iii)Full-text articles.(iv)Human subjects only.(v)Studies that compared early versus late closure stoma-related outcomes, in terms of morbidity, mortality, and quality of life where available.(vi)Publications since 2008.
Exclusion criteria were as follows:(i)Paediatric articles.(ii)Systematic reviews and meta-analysis.(iii)Studies that included only early or late closure stoma-related outcomes.(iv)Study protocols that did not include any results.(v)Studies that did not meet with our selected definition of early and late closure timing.(vi)Studies that did not clearly link the rate of complications to the timing of closure.(vii)Abstract-only available.
There was no restriction placed on the type of research included in this review as long as it had a comparison of the outcomes of early and late closure of loop ileostomy (in accordance to our definition), in terms of morbidity, mortality, or QoL, which is our primary objective in this systemic review. The decision to review all types of literature with an obtainable comparison between the outcomes of early and delayed closure of loop ileostomy offered an opportunity to assess the quality of the different types of research on this topic. However, considering the nature of loop ileostomies, it was within our expectations that randomized controlled trials would be few.
Because loop ileostomies are done primarily to protect a downstream anastomosis, which is common among low rectal cancer patients, the decision has been made to include adults only as they are the primary affected population with low rectal cancer.
There is no available consensus regarding the definition of early and late closure of loop ileostomy. As such, it was decided to define late closure of loop ileostomy as any closure beyond three months of the stoma creation, in accordance with conventional literature . This time interval would allow recovery after primary surgery, softening of intra-abdominal adhesion, and resolution of inflammation and edema of the stoma border . The inclusion of only studies that included a comparison of early versus late closure of loop ileostomy outcomes was intended to provide more homogenous and comparable results.
2.2. Statistical Analysis
Microsoft excel was used for all data processing and representation.
The search yielded 2790 studies (161 results in Google scholar, 0 results in Cochrane library, and 2629 in EBSCOhost search engine). The results were reduced to 147 after limiting them to full-text English publications since 2008 with human only subjects. Then, the results were searched using our inclusion and exclusion criteria (listed above), thus eliminating 143 nonrelevant studies. Finally, the four resultant articles included were collated and analysed in light of their results and quality.
A comparison between patient baseline demographics from these studies is shown in (Table 1), while some studies have demonstrated that early closure of loop ileostomy is feasible and beneficial [11, 20, 21]. Other studies did not report time to closure as a predictor of morbidity .
The postoperative complications overserved in each study were variable, and it is summarized as shown in Table 2.
Among the studies our search yielded, only two were multicentre randomized controlled studies including one that solely focused on comparing the outcomes of early and late closure of loop ileostomy with regard to the quality of life. The first randomized controlled study primarily compared the number of complications in early and late closure groups using computer-generated randomization by Danielsen et al. . It included a total of 112 patients divided into early closure group (defined as closure 8–13 days after formation) and late closure group (defined as closure after >12 weeks). The study’s primary endpoint was to compare both groups by examining the mean number of complications after total mesorectal excision (TME) for low rectal cancer. Secondary endpoints measured were the proportion of patients with at least one severe complication, in accordance with the Clavien–Dindo Classification, and the mean number of stoma-related complications after TME and up to 12 months, from the period of February 2011 to November 2015. The blinding of the intervention was not possible. The study noted that the patient baseline demographics, perioperative details of loop ileostomy closure, and its complications were comparable in both groups. It also noted that the mean number of complications after TME up to the 12 months of follow-up was significantly lower in the early closure group (mean number of complications was 1.24 in the early closure group compared with 2.88 in the late closure group) with a ratio for early to late closure of 0.42 (95% CI 0.32–0.57), . As for more severe complications (Clavien–Dindo Grade IIIa or higher), there was no significant difference between the two groups (proportion of patients with at least one complication Clavien–Dindo Grade IIIa or higher; 0.22 for the early closure group and 0.29 for the late closure group, ). The mean number of stoma-related complications was significantly higher in the late closure group (early closure group 0.30 and late closure group 1.25) with a ratio for early versus late closure of 0.25 (95% CI 0.15–0.42), .
The second multicentre randomized controlled study focused on comparing early closure (days 8–13 after stoma creation) with late closure (more than 12 weeks after stoma creation) of loop ileostomy with regard to QoL, by Park et al. . The study evaluated health-related quality of life HRQOL at 3, 6, and 12 months after the index operation using the European Organization for Research and Treatment of Cancer (EORTC) questionnaires: QLQ-C30 and QLQ-CR29 and Short Form 36 (SF-36). These questionnaires aimed to measure physical, cognitive, emotional, and social functions. They also measured other items including financial difficulties, global health status, several symptoms, body image, sexual function, and interest, among others.
The study included 112 patients randomized to early or late closure group using computer-generated blocks of six, from February 2011 with the last follow-up in November 2015. The early closure group included 55 patients compared to 57 in the late closure group. The study noted the patient baseline demographics.
The response rates of the questionnaires were 82–95%, except for EORTC QLQ‐C30 at 12 months, to which only 54–55% of the patients responded due to an error in questionnaire distribution. The SF‐36 scores, overall, were similar between the two groups, with no differences in the physical component score or the mental component score. However, there were significant score differences in physical role at 3 months, bodily pain at 12 months, and mental health at 12 months. All dimensions in SF‐36 improved over time. The majority of patients in both groups scored values below mean levels in the reference population at 3 months, especially regarding physical role. At 12 months, 52–85% of the patients scored higher than the reference group, with physical functioning scoring the highest among the dimensions.
As for the EORTC QLQ‐C30 and QLQ‐CR29 questionnaires, the scores were comparable between early and late closure groups. Emotional functioning scores were lower in the early closure group at 3 and 6 months, but similar to the late closure group at 12 months. No statistically significant differences were seen in the dimensions of the QLQ‐CR29 questionnaire. In summary, there were no statistically significant differences in any questionnaire scores between the groups at 3, 6, or 12 months.
The only retrospective study in our data was carried in a single-centre, by Figueiredo et al. . It included 259 rectal adenocarcinoma patients who underwent laparoscopic total or subtotal mesorectal excision (TME) with temporary ileostomy. These patients were divided into three groups, based on the time of stoma closure: group A included sixty-five patient who underwent stoma closure before day 61 after TME; group B included 115 patients who underwent stoma closure between day 61 and day 90; and group C included 79 patients who underwent closure after day 90. Both groups A and B patients fit into our definition of early closure of loop ileostomy but were dealt with separately in this article as grouping them was not possible without recalculating values for the study. However, data needed for the process was not available. Patient baseline demographics were comparable in all groups and findings showed only 1 patient (1.5%) in group A and 2 patients (2%) from group B with anastomotic leakage compared to 44 patients (56%) in group C () post primary procedure. There were no significant differences between groups with regard to operative time, overall morbidity rate, and medical morbidity rates. However, one patient from group A and none from group B had anastomotic leakage at the site of stoma closure compared to four patients from group C (). No patient from group A had stoma-related complications, whereas two cases of dehydration occurred in group B (2%) and two cases of acute renal failure occurred in group C (2.5%). Furthermore, one patient from group B had stoma prolapse and one patient from group C had peristomal evisceration, requiring surgery. At the time of stoma closure, 4 patients (6%) from group A and 14 patients (12%) from group B had a peristomal hernia compared with 21 patients (27%) in group C ( group C versus group A and group C versus group B). Furthermore, group C had six patients with major morbidity (Clavien–Dindo III–IV) compared to zero patients in group B ().
Median length of hospital stay after stoma closure in group C was 6 days [4–20] compared to 5 days [4–15] in group A (). After a median follow-up of 17 [0–66] months, no significant difference between groups was observed for rehospitalization (3% in group A versus 3% in group B versus 8% in group C), bowel obstruction (0% versus 1% versus 1%), late anastomotic leakage (1% versus 3% versus 1%), or hernia at the stoma closure site (3% versus 11% versus 8%).
Finally, the last study in our data was a case matched study performed in a single-centre focusing on ileostomy closure before and after 3 months, by Li and Ozuner . The study had a total of 358 patients and each group included 179 patients. As this was a case matched study, the characteristics of patient were similar in both groups; this includes the primary diagnosis, ASA, primary procedure, surgical technique used in primary and secondary procedure, and suspected complication from index procedure. The median time for ileostomy reversal in the early closure group was 64.5 ± 13.1 days, while closure in the late reversal group was 126.8 ± 44.2 days.
Postreversal outcome in both groups was similar and no statistical significance was demonstrated, including the rate of complications (see Table 1). For example, wound infection affected only 4 patients (2.2%) of the early group and 3 patients (1.7%) of the late group with a value >0.99. This trend was observed in all complication rates including anastomotic leak, intra-abdominal abscesses, postoperative ileus, and small bowel obstruction.
Loop ileostomies are created to protect distal anastomoses and reduce the impact of anastomotic complications. These are temporary stomas and their reversal is performed regularly. However, the length of time over which the stoma should persist is still debated. This study reviewed the literature to determine the effectiveness and safety of early closure of a defunctioning loop ileostomy compared to late closure, defined as closure of loop ileostomy after 12 weeks from the stoma creation, in terms of stoma-related morbidity, mortality, and quality of life.
The data in Danielsen et al. showed that early closure of a loop ileostomy is feasible, safe, and more effective in certain selected patients with rectal cancer compared to late closure. The study had a randomized design that included patients after ascertaining lack of asymptomatic anastomotic leakage. Due to the strict inclusion criteria of the study, not all patients were screened for participation. The study analysed the data of 112 patients out of 418 patients screened for participation. Thus, a selection bias may have occurred. Furthermore, the coding of complications during the study was done on twofolds. However, because it was not possible to blind the researchers who coded the actual complication, an observer bias may have also been undertaken. The baseline patient characteristics were comparable, thus excluding impact of age, gender, BMI, comorbidity, or neoadjuvant radiotherapy. Patients in the early closure group had fewer complications than patients in the late closure group, even during the follow-up of up to 12 months, with a ratio for late versus early of 0.42 (95% CI 0.32–0.57, ). Furthermore, there was no significant difference in the rate of severe complications (Clavien–Dindo Classification > IIIa) between the two groups (0.22 versus 0.29 for the early versus late closure groups, respectively; ). However, the severity of complications seemed higher in the late closure group.
Figueiredo et al. carried a retrospective single-centre study to include temporary stoma patients who had been radiologically screened within 5 weeks of stoma creation to exclude anastomotic leakage. The study included patients with adjuvant chemotherapy where the stoma closure took place 2-3 weeks after the last administration of chemotherapy. The study divided patients into three groups: A, B, and C, according to the time of closure. Both groups A and B patients fit into our definition of early closure of loop ileostomy. However, we were unable to group them together without recalculating the values, which was not possible due to missing data. Due to the design of the study, it should be noted that a selection bias may have occurred. The patients baseline characteristics were comparable, thus excluding impact of age, gender, BMI, comorbidity, or neoadjuvant radiotherapy. The results of the study were in support of early closure of loop ileostomy. There was no significant difference in overall morbidity rate between the groups. However, significantly less patients from early closure groups (1 patient in group A and 0 patients in group B) had anastomotic leakage, at the site of stoma closure, compared with 4 patients from late closure group (). Furthermore, late closure group had 6 patients with major morbidity (Clavien–Dindo III–IV) compared to none in early closure group (). Even with ongoing adjuvant chemotherapy, stoma closure is safe, contrary to the conventional belief. This is demonstrated considering that the rate of surgical complications was higher in the late closure group despite a lower rate of ongoing chemotherapy (30% in group C versus 37% in group B). For example, it was observed that the parastomal hernia, at the time of stoma closure, was significantly more frequent in the late group (27%) than in the early closure groups (6 and 12% for groups A and B, respectively, versus group A, and versus group B). There were some issues regarding the lack of clear expanded definitions of the outcomes measured. For instance, the study included “late anastomotic leakage” as a measured outcome without clearly defining it.
Park et al. conducted a randomized study on the same population as Danielsen et al. discussed previously, as part of the EASY trial. However, this paper was focused on measuring the outcomes in terms of quality of life. The study clearly defined what clinically significant results were. However, the data showed no significant difference between early and late closure groups in terms of quality of life. All aspects of quality of life were similar between both groups and improved over time. The study failed to specify possible predictor factors affecting the quality of life such as the number of complications. It also neglected to account for the improvement of quality of life as time went by. These findings are contrary to other studies that clearly linked low anterior resection and stoma-related care problems to the quality of life, suggesting that early closure would be more beneficial [8, 17]. A significant limitation was that there were no baseline data for preoperative assessment due to the inclusion of patients only after rectal resection. Furthermore, this similarity between the groups may be explained by the fact that rectal cancer surgery requires a lengthy recovery, which would require a longer follow-up than 12 months for the significant differences to appear.
Wanglin Li et al. is a case matched study that included 358 patients. By definition, these studies have a retrospective aspect involved. In addition, due to the design, it is prone to be affected by selection and observer bias. It appears that the authors’ logic from using such a design is to eliminate variables that could introduce bias between the study subjects. In other words, dividing the population into 2 equivalent groups in numbers and characteristics was intended to reduce the effect of variables on the final results. These included age, sex, pathology, comorbidities, primary surgery, and the same technique for stoma reversal. However, a strong factor that could influence the occurrence of complication is the surgeons technique which will always be variable.
It is worth noting that even though the authors were partially in favour of early reversal of loop ileostomies, their results are statistically inconclusive. In fact, the number of patients affected by each complication observed during the study was similar in the early and late closure groups. In addition, the study sample is small and the values obtained were indicating statistical insignificance. Furthermore, the study did not take into consideration the social and psychological complications. This review is limited by the heterogenicity of the studies included. Another limitation was the small number of studies that met our criteria. This is due to our own selection of how to define late closure which was based on convention as there is no consensus on how to define late closure of loop ileostomy . As a result, various studies with different definitions of late closure were overlooked in this review [12, 21, 26, 27]. Furthermore, all the studies in this review shared significant limitations due to the small sample size, selection bias, and the lack of clear definitions of the measured outcomes.
In conclusion, current available data were inclined toward early closure of loop ileostomies, especially in patients with uneventful postoperative course, but not sufficient to draw firm conclusions on the matter. As such, further studies are required to establish the optimal time of reversal for specific groups of patients, what factors may indicate a delay of the reversal, and to what extent.
Conflicts of Interest
The authors declare that there are no conflicts of interest regarding the publication of this paper.
T. D. Francone, Overview of surgical ostomy for fecal diversion, M. Weiser, W. Chen, editors, UpToDate, 2018, https://www.uptodate.com/contents/overview-of-surgical-ostomy-for-fecal-diversion?search=loopileostomy&source=search_result&selectedTitle=1~13&usage_type=default&display_rank=1#H21063116“result&selectedTitle=1∼13&usage_type=default&display_rank=1&H21063116.
H. Chen, Illustrative Handbook of General Surgery, Springer, London, UK, 2010.
R. G. Landmann, Routine care of patients with an ileostomy or colostomy and management of ostomy complications, M. Weiser, W. Chen, editors, 2017, https://www.uptodate.com/contents/routine-care-of-patients-with-an-ileostomy-or-colostomy-and-management-of-ostomy-complications?topicRef=15026&source=see_link#H60238543.
R. H. Bell Jr. and D. B. Kaufman, Northwestern Handbook of Surgical Procedures, Landes Bioscience, Georgetown, TX, USA, 2005.
R. R. Cima, Parastomal hernia, M. Rosen and W. Chen, editors, UpToDate, 2018, https://www.uptodate.com/contents/parastomalhernia?topicRef=15026&source=see_link%20.
V. Fazio, J. Church, and J. Wu, Atlas of Intestinal Stomas, Springer, Berlin, Germany, 1st edition, 2012.
A. Chow, H. S. Tilney, P. Paraskeva, S. Jeyarajah, E. Zacharakis, and S. Purkayastha, “The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases,” International Journal of Colorectal Disease, vol. 24, no. 6, p. 711, 2009.View at: Publisher Site | Google Scholar
P. Waterland, K. Goonetilleke, D. N. Naumann, M. Sutcliff, and F. Soliman, “Defunctioning ileostomy reversal rates and reasons for delayed reversal: does delay impact on complications of ileostomy reversal? A study of 170 defunctioning ileostomies,” Journal of Clinical Medicine Research, vol. 7, no. 9, p. 685, 2015.View at: Publisher Site | Google Scholar
S. K. Perdawid and O. B. Andersen, “Acceptable results of early closure of loop ileostomy to protect low rectal anastomosis,” Danish Medical Bulletin, vol. 58, no. 6, p. A4280, 2011.View at: Google Scholar
M. N. Figueiredo, D. Mège, L. Maggiori, M. Ferron, and Y. Panis, “When is the best time for temporary stoma closure in laparoscopic sphincter-saving surgery for rectal cancer? A study of 259 consecutive patients,” Techniques in Coloproctology, vol. 19, no. 8, pp. 469–474, 2015.View at: Publisher Site | Google Scholar
T. Nelson, A. R. Pranavi, S. Sureshkumar, G. S. Sreenath, and V. Kate, “Early versus conventional stoma closure following bowel surgery: a randomized controlled trial,” Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association, vol. 24, no. 1, p. 52, 2018.View at: Google Scholar
P. Jordi-Galais, N. Turrin, C. Tresallet, Q. Nguyen-Thanh, J. P. Chigot, and F. Menegaux, “Early closure of temporary stoma of the small bowel,” Gastroenterologie clinique et biologique, vol. 27, no. 8-9, pp. 697–699, 2003.View at: Google Scholar


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Two Australians are reportedly among a group of Norwegian Dawn passengers stuck in Africa after failing to return to port in time to catch their ship.
WMBF News in South Carolina reported the Australians were among eight guests who went on a private short excursion in a port call on a 21-day cruise from South Africa. They claim the tour operator failed to return them to the port in time after a trip to São Tomé Island.
Despite the frantic efforts of the local coast guard to get them back on board, the ship sailed without them and they remained stuck in Africa.
The report quoted South Carolina couple Jill and Jay Campbell who said the group were “stranded on a small island off the coast of Africa”.
“We were waiting for the tender boats to come back and get us because our boat was anchored off the harbour, but they didn’t come back to get us. So, we’re stranded here,” Jay Campbell told the local TV station.
Stuck just one week into cruise
The Campbells were eight days into the three-week cruise.
“We were on a tour of the island, but we had an issue on the tour, and they didn’t get us back in time,” Jay Campbell said.
The report maintains local coast guards tried to help but the cruise ship “reportedly refused to let them and several others back on board”.
Some were now without medicine, money and paperwork. Several passengers are elderly, one has a heart condition, one is a paraplegic and another is a pregnant woman.
The group still hope to resume the cruise and get permission to board at another African port.
Jay Campbell said: “We paid a lot for this trip to Africa, so we hope to make it through the rest of this trip and end in Spain.”
“On the afternoon of March 27, 2024, while the ship was in Sao Tome and Principe, an African island nation, eight guests who were on the island on their own or with a private tour missed the last tender back to the vessel, therefore not meeting the all aboard time of 3 p.m. local time.
“While this is a very unfortunate situation, guests are responsible for ensuring they return to the ship at the published time, which is communicated broadly over the ship’s intercom, in the daily communication and posted just before exiting the vessel.
“Guests are responsible for any necessary travel costs to rejoin the ship at the next available port of call. When the guests did not return to the vessel at the all-aboard time, their passports were delivered to the local port agents to retrieve when they returned to the port.
“Our team has been working closely with the local authorities to understand the requirements and necessary visas needed if the guests were to rejoin the ship at the next available port of call. We are in communication with the guests and providing additional information as it becomes available.”
Cruise Passenger has reached out to Norwegian Cruise Lines and is awaiting comment and more details about any Australians on board.
- Do you know more? Have you ever missed a ship? Leave a comment below.


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domain: health


text: FS98 Sukhoi Su-26. The most famous Russian aerobatic airplane. It has the M-14P radial engine (360 hp) which gives the plane 280 mph max speed and 3500 feet/minute climb rate. Type has been very successful in competitions all over the world. Designed by Mikko Maliniemi. Added sounds and FD by George Csillag.

domain: hobby


text:
Montana Divided: An Examination Of Cultural And Political Contrariety Between Eastern And Western Montana
The question of whether or not political lines of demarcation have been historically consistent with natural boundaries between distinct geographical regions inspires an eternal debate. For, in some cases, planned political divisions have closely paralleled natural boundaries, while in others, artificial lines of partition have been agreed upon with more concern for legality and national interest than the "lay of the land.” The boundary between Texas and Mexico would seem to exemplify the first case: politicians and surveyors considerate of southwest topography were naturally inclined to designate the Rio Grande river as both an inherent and politically convenient point of separation between the desert regions. Yet, more often, lines of demarcation have been the result of completely political consideration, excluding the presence of dramatic variation in topography. If the Texas-Mexican border serves as a classic example of both natural and political considerations in boundary drawing, conversely, the act of determining borders surrounding the state of Montana would appear to have been a completely political exercise. Montana's eastern borders defy the course of no less than three major river systems (the Yellowstone, Missouri, and Powder rivers) and in the west, Montana intricately cuts across the twisting labyrinth peaks of the Rocky Mountains. No geographical rationale is apparent when one observes a three-dimensional, topographical map display of the region. Montana is also a very large state. Specifically it is the fourth largest political subdivision in America, stretching five hundred and fifty miles at its largest east to west dimension directly below the Canadian border, and three hundred and twenty five miles at its greatest north to south distance along the Idaho border. Montana's surface area covers an incredible 147,138 square miles. At the outset of our examination of cultural and political distinctions between eastern and western Montana, both the politically determined boundaries and immense magnitude of the state deserve important consideration as related determining variables. For within political boundaries so distant, dramatic, measurable diversities in resource—wealth, belief, culture, and political persuasion are to be expected. Still, as an influencing variable, "size" is perhaps too abstract to account for dynamics of diversity in Montana. Magnitude cannot truthfully be considered a causal variable. Rather, the dimension of the state should be considered a "given," or more technically an "independent" variable, for it is within Montana's dimension that the real, concrete agents creating cultural and political variations are to be found. After a more thorough consideration of these concrete, causal variables, we may then be justified in concluding that although Montana is legally considered one unified political state, it is actually home to two distinct, contrasting and often conflicting regions, and two distinct political philosophies resultant from a further divergence in culture within the two distinct regions.

domain: geography


Nashville opens office for immigrant ‘new Americans’
Immigrants in Nashville have found a vocal ally in Mayor Karl Dean in recent years, and on Monday he announced the creation of a new Metro office focused exclusively on helping them.
By executive order, Dean created the Mayor’s Office of New Americans, or MONA, a city office tasked with involving immigrants in local government, expanding economic and educational opportunities and creating partnerships between Metro and community organizations.
Dean has backed a series of initiatives to make the city more welcoming to the international newcomers who have accounted for more than half of the city’s population growth in the past decade.
The city’s foreign-born population has grown from 2 percent to almost 12 percent in two decades, and some 21,000 immigrants here are legal permanent residents and eligible to seek citizenship.
Praise for Dean’s latest move came quickly from immigrant advocacy groups.
“We hope that the [office] will ensure that the initiatives of the mayor’s office are inclusive of the unique experiences of immigrant communities, and that cities throughout Tennessee will learn from Nashville’s example,” Stephanie Teatro, interim co-director of the Tennessee Immigrant and Refugee Rights Coalition, said in a statement.
Teatro is one of several speakers scheduled for the office’s first public event, a roundtable talk at noon on Oct. 2 at the Sonny West Conference Center at 700 Second Ave. S. The public is invited to bring ideas about the needs of immigrants.
In making the move, Dean named a senior adviser, Shanna Hughey, to the director’s role. She’ll work with existing funding, a spokeswoman said.
Hughey has worked on immigration projects for several years and has a personal connection, as well: her father was a refugee from Pakistan to India in 1947 before moving to the United States in the 1970s.
The new office isn’t meant to be a destination for immigrants seeking services, but will play a role in coordinating new and ongoing efforts, including several announced this year.
Earlier this month, Dean and Metro Schools created a Parent Ambassadors program to connect immigrant families based on their shared languages so that newcomers have guidance navigating the school system. One out of every five Nashville students is Latino now, and more than 140 languages are spoken through city schools, officials said.
In August, Dean signed an agreement with U.S. Citizenship and Immigration Services to turn five libraries and four community centers in Nashville into information hubs for legal permanent residents interested in gaining citizenship. Nashville became just the third city in that program, the Pathway for New Americans, along with Chicago and Los Angeles.
The new office will also take its cues from the mayor’s New Americans Advisory Council, formed in 2009 to involve refugees and immigrants in city decisions. That council helped create the MyCity Academy in 2012, putting new citizens through a seven-month program about Metro government.
For more information, visit www.newamericans.nashville.gov.
Reach Tony Gonzalez at 615-259-8089 and on Twitter @tgonzalez.
New data on Nashville immigrants
The Partnership for a New American Economy published data about immigrants in Nashville on Monday showing how new international arrivals are responsible for 60 percent of the city’s population growth in the past decade. Among other findings:
• Some 8 percent of immigrants are self-employed, compared with 3.8 percent of native-born residents.
• Nearly one in three Nashville children live in bilingual or non-English-speaking households.
• Nashville’s foreign-born population grew by more than 86 percent from 2000 to 2012.
Contribute to ‘new Americans’ office
The Mayor’s Office of New Americans will host a free panel discussion at noon on Oct. 2 about how to serve immigrants. The free event will take place at the Sonny West Conference Center at 700 Second Ave. S.


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On Thursday, May 29, 2008, the Arts Club Theatre Company will host BUZZ ’08, their 7th annual corporate appreciation event.
May 12th, 2008


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Objectives: There is continuing demand for non-implant prosthodontic treatment and yet there is a paucity of high quality Randomised Controlled Trial (RCT) evidence for best practice. The aim of this research was to provide evidence for best practice in prosthodontic impressions by comparing two impression materials in a double-blind, randomised, crossover, controlled, clinical trial.
Methods: Eighty-five patients were recruited, using published eligibility criteria, to the trial at Leeds Dental Institute, UK. Each patient received two sets of dentures; made using either alginate or silicone impressions. Randomisations determined the order of assessment and order of impressions. The primary outcome was patient blinded preference for unadjusted dentures. Secondary outcomes were patient preference for the adjusted dentures, rating of comfort, stability and chewing efficiency, experience of each impression, and an OHIP-EDENT questionnaire.
Results: Seventy-eight (91.8%) patients completed the primary assessment. 53(67.9%) patients preferred dentures made from silicone impressions while 14(17.9%) preferred alginate impressions. 4(5.1%) patients found both dentures equally satisfactory and 7 (9.0%) found both equally unsatisfactory. There was a 50% difference in preference rates (in favour of silicone) (95%CI 32.7-67.3%, p <0.0001).
Conclusion: There is significant evidence that dentures made from silicone impressions were preferred by patients.
Clinical significance: Given the strength of the clinical findings within this paper, dentists should consider choosing silicone rather than alginate as their material of choice for secondary impressions for complete dentures. (C) 2014 The Authors. Published by Elsevier Ltd.
|Number of pages||7|
|Journal||Journal of Dentistry|
|Early online date||1 Jul 2014|
|Publication status||Published - Aug 2014|
- quality-of life
- patient outcomes
- impression materials
- removable prosthodontics


text:
By Ed Frankl
Hannover Re shares fell on Wednesday after it published new guidance for 2023 that lagged expectations.
Shares at 0830 GMT were down 3.8% to EUR179.05.
The German reinsurer said net profit would increase in 2023 to at least 1.7 billion euros ($1.85 billion), based on what it said was a continued favorable market.
But the guidance is around 11% below consensus, according to analysts at Jefferies in a note, although that could be down to the company’s customary prudence, they wrote.
Hannover Re said it would also beef up its major-loss budget for 2023 to EUR1.725 billion from EUR1.4 billion in 2022, on the expectation of higher loss expectations from natural catastrophes.
The DAX-listed company also said Wednesday that its net profit in 2022 was EUR1.41 billion, in line with prior guidance to be at the lower end of a EUR1.4 billion-EUR1.5 billion range.
It came as its property-and-casualty business was hampered by high claims, although its life-and-health operations came in above expectations, Hannover Re said.
The 2022 and 2023 results aren’t directly comparable, the company cautioned, as insurers switch to new IFRS regulations this year.
Despite the share-price fall in Wednesday trading, the stock is up almost 30% in the past six months.
Reinsurance peers Munich Re, Swiss Re and Scor also fell in Wednesday trading, down 2.1%, 1.3% and 1.8% respectively.
Write to Ed Frankl at firstname.lastname@example.org


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Poppy – F – Maltese/Poodle Mix – 7 yrs
Look who came to visit! Poppy and her new mom came by to visit us at Petco! Just look how happy everyone is! Thank you for bringing her by to say hi and giving Poppy such a loving home<3
This is why we do what we do…
Poppy has been adopted! We could not be happier for Poppy and her new family! <3
This is our little Poppy, a 7 year old Maltese/Poodle mix. She was rescued by a quick thinking good samaritan at a Circle K gas station. He rescued her from a canal just behind the Circle K or she probably would have drowned. They contacted Pammy and the rest is history. Poppy needed some medical attention and dental work. With the generous support and donations received…. Poppy is ready for her new home. To read more about Poppy’s story, click here
Now she is ready to find her ‘forever home’. She would love a nice yard to run and play in, but her biggest wish is for a loving family who will spend time with her. She seems to get along with most dogs so a sibling would probably be OK –just do a ‘meet and greet’ first. Poppy is pretty outgoing and likes most people, she would love some older ‘dog friendly’ children who would play with her and take her for a daily walk.
Poppy is a non-shedding dog so she will need regular grooming to keep her coat mat-free. She has had some house training but will need to learn the rules of her new home. She would also love some obedience training to become the best dog she can be. Poppy is hoping for a special forever family – could yours be just the one she is dreaming of?

domain: pet