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The Future Matrix
The Future Matrix
A practical approach to planning for uncertain futures
About the Book
This book or set of instructions was initially developed as a quick-use tool for my clients who wanted to do some planning for projects and operational situations where there were many unpredictable or unknown outcomes. Scenario planning seemed the obvious choice for these clients but as this required a fair amount of effort, on behalf of the client, to get through, I found that before any decent plans were made the situation was often already over.
The lack of speed led me to shortening and adapting the scenario planning methodologies into 7 phases to very quickly help someone understand a situation and plan for 4 possible outcomes of that situation. I use this shortened method myself on projects when I just want to check what other resources we might need or what possible outcomes there could be that are not in my control but that I need to be prepared for. It is also useful for defining all the indicators that I need to measure as the project unfolds. I hope that you too will be able to learn to use this tool as comfortably and quickly as it was intended.
This is a very short book with actionable steps - there are no theoretical meanderings or ponderings - from the very first step YOU are required to take action within your organisation. It is practical, easy to understand and the outcomes can be profound.
- Forward 3
- Background 4
- The Future Matrix 6
- Identify 7
- Classify 9
- Articulate 13
- Numbers 16
- Systems 17
- Engage 18
- Evaluate 19
- Your Next Steps 21
- Appendices 22
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Production HaskellMatt Parsons
Are you excited about Haskell, but don't know where to begin? Are you thrilled by the technical advantages, but worried about the unknown pitfalls? This book has you covered.
Functional Design and ArchitectureAlexander Granin
Software Design in Functional Programming, Design Patterns and Practices, Methodologies and Application Architectures. How to build real software in Haskell with less efforts and low risks. The first complete source of knowledge.
Ansible for KubernetesJeff Geerling
Ansible is a powerful infrastructure automation tool. Kubernetes is a powerful application deployment platform. Learn how to use these tools to automate massively-scalable, highly-available infrastructure.
Ansible for DevOpsJeff Geerling
Ansible is a simple, but powerful, server and configuration management tool. Learn to use Ansible effectively, whether you manage one server—or thousands.
Composing SoftwareEric Elliott
All software design is composition: the act of breaking complex problems down into smaller problems and composing those solutions. Most developers have a limited understanding of compositional techniques. It's time for that to change.
Practical FP in Scala: A hands-on approachGabriel Volpe
A practical book aimed for those familiar with functional programming in Scala who are yet not confident about architecting an application from scratch.
Together, we will develop a purely functional application using the best libraries in the Cats ecosystem, while learning about design patterns and best practices.
Tame your Work FlowSteve Tendon and Daniel Doiron
Do you need a high performance enterprise governance approach improving management, execution and delivery while dealing with multiple projects/products, events, stakeholders and teams? Giving you better bottom line results, faster time to market, less work, better predictability, happier employees, and delighted clients? Then learn about TameFlow!
Invest In Digital Health - The Medical Futurist's GuideDr. Bertalan Mesko
Artificial Intelligence and Digital Health are booming. In this book, we explain why now it's a good time to invest in Digital Health and give recommendations on where to invest by looking at the top 24 technological trends we find the most promising.
The Hundred-Page Machine Learning BookAndriy Burkov
Everything you really need to know in Machine Learning in a hundred pages.
Windows 10 System Programming, Part 1Pavel Yosifovich
Growing Agile: The Complete Coach's Guide
7 BooksGrowing Agile: Coach's Guide Series This bundle provides a collection of training and workshop plans for a variety of agile topics. The series is aimed at agile coaches, trainers and ScrumMasters who often find themselves needing to help teams understand agile concepts. Each book in the series provides the plans, slides, handouts and activity...
The Tester's Library
8 BooksThe Tester's Library consists of eight five-star books that every software tester should read and re-read. As bound books, this collection would cost over $200. Even as e-books, their price would exceed $80, but in this bundle, their cost is only $49.99. Here are the books, and why they should be in your library: Perfect Software and Other...
11 BooksIn this bundle, you will find 10 different agile books. They are about different aspects of being agile. - finding a job - doing coding dojo's - Retrospectives - Personal kanban - a non-typical coaching book and even a book that gives you an insight in the lives of some agile people.
WTFlop 6M + HU - Beta Bundle
Growing Agile: Coach's Guide Series
4 BooksThis bundle provides a collection of training and workshop plans for a variety of agile topics. The series is aimed at agile coaches, trainers and ScrumMasters who often find themselves needing to help teams understand agile concepts. Each book in the series provides the plans, slides, handouts and activity instructions to run a number of...
Marionette.js A to Z
Build A Better Backbone App
3 BooksThe best way to learn new development skills is through experience, but that takes time you don't have.Get the best of both worlds with this bundle: you'll learn how to produce modern web applications by learning from experienced developers like Derick Bailey and David Sulc. BackboneJS is one of the favorite tools on the web today, but it...
General Systems Thinker Bundle
5 BooksThe General Systems Thinker Bundle is just that: a bundle of five books to advance the reader one giant step toward improved thinking, based on General Systems principles. Four of the books are the complete General Systems Series. The fifth is fictional piece which shows some general systems thinkers in action. It's a mystery in which a group of...
Experiential Learning Bundle
4 BooksThis bundle provides all four volumes of the popular Experiential Learning Series at a savings of $20 over the price if purchased separately.
2 BooksAfter getting up and running with Ansible in Jeff Geerling's Ansible for DevOps, strengthen your skills managing tens to thousands of instances and services in Amazon's AWS cloud with Yan Kurniawan's Ansible for AWS.


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Wellstar Douglas Hospital
Wellstar Douglas Hospital, a constituent member of WellStar Health System - the largest not-for-profit hospital system in Georgia, has been catering to the healthcare needs of the residents of Douglas County since 1954. Its specialties and services cover cardiac care, wellness clinic, women’s center, diabetes education, rehabilitation service, wound care, pain clinic and bariatric/weight control services.
Wellstar Douglas Hospital is accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).
Wellstar Douglas Hospital accepts both Medicare and Medicaid patients.Address: 8954 Hospital Drive , Douglasville
Number of Beds: 98
Total Staff : 0
Click here to see the complete state rankings.

domain: medical


This article describes how to make REST calls to Azure Resource Manager (ARM) from Python. In particular, how to authenticate. Once you have an authentication token you just add it to your REST call headers when calling the Azure REST API.
Note: If you’re looking for the official Azure SDK for Python, go here: https://github.com/Azure/azure-sdk-for-python.
Creating an Azure Resource Manager app requires some one-time setup steps:
- Create an Azure Active Directory App
- Create a Service Principal (an Active Directory “user” which represents an automated application) and grant it permissions
- Create a credential object and get the tenant ID.
These steps are well documented here: Authenticating a Service Principal with Azure Resource Manager, and are covered (using PowerShell) in steps 1-4 of my C# Azure REST write-up here: How to call the Azure Resource Manager REST API from C#.
If you follow these steps you will have the…
View original post 185 more words


Pune: The city police on Wednesday sealed two flats being run as brothels at Budhwar Peth for employing minor girls in the flesh trade. This is the first time that the police have taken such action against such properties.
The two flats located on the third floor of Maachis Apartments were sealed under section 18 of the Prevention of Immoral Trafficking Act (PITA) for three years, said deputy commissioner of police Anil Kumbhare (crime). He said permission to seal the flats was taken from the additional collector.
Kumbhare said the city crime branch had submitted a proposal to the collector to seal the two flats after the police rescued seven women and seven minors from there. Three persons, including brothel-keeper Pooja Bahadur Sharma, were arrested in the raid conducted on April 3 this year. Four cases have been registered against Sharma under PITA and the Indian Penal Code.
The flats were sealed by the police on Wednesday afternoon in the presence of two panch' witnesses. Shashikala Palkar, Shakuntala Dixit, Annapurna Karnekar and Sumitra Kamble jointly owned the flats, Kumbhare said.
"The sealing of such properties should serve as a deterrent to property-owners who rent out their premises to brothel-keepers for huge sums," Kumbhare said.
Additional collector Chintamani Joshi directed the crime branch to seal the properties after giving a hearing to both the police and the brothel-keeper on Tuesday. The collector is empowered to seal the properties for two years when an adult woman is rescued from a brothel and for three years if a minor girl is rescued.
Kumbhare said a proposal for sealing another property at Budhwar Peth has been submitted at the collector's office.
The city crime branch has registered 36 cases and arrested 68 women and 21 men under PITA this year. Kumbhare said 19 minor girls and 49 women have been rescued from brothels in Budhwar Peth and other places. These women and girls were lured to Pune from other states under the pretext of providing them employment, he added.


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Our Mexican friend the sheriff Amigo Pancho knows how to fly using 2 hot-air balloons. It's up to you to help him to navigate through the hazardous levels. In this great sequel our friend gets an invitation to China, so he is traveling across the world!
CategorizationPuzzle » Escape » Amigo Pancho 4
More Information About Amigo Pancho 4
This is a fabulous escape game that you can enjoy on this page in your browser. The game is built with Flash technology to run in all modern browsers. It has been played by 26,720 people and has received a rating of 8.6 / 10 with 312 votes. Did you like playing this puzzle game? Then take a look at our other escape or Area51 Stormers and Creepy Granny Scream: Scary Freddy.SHOW LESS
Use your mouse to play.

domain: game


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..Especially for my Kawerau card class ladies….Theres one more project (and maybe another quick one if you twist my arm (or if you get it all done quickly!)
And for my card classes next week we are working with acetate and a tricky looking fold card (but its not!) …I have a very cool acetate card Im working on for this.. so look out for this next week!
I was surfing the net a few days ago and came across Alana Galaghers post using my LO as inspiration that she had seen on Splitcoaststampers!! …. So thanks for getting inspiration from me Alana I get lots of inspiration from yours constantly!
Ive decided to set up my ‘Cocktail group’…ask me about this when you book your next workshop with me!
Dont forget that for the next two months you can get extra benefits …dont leave it to the last minute though as I might be booked up!
1 commentAdd Yours

domain: artistic


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Fazer and Dappy suit it up in tailored suits, while Tulisa flaunts her curvy body in tight mini dress.
N-Dubz have just debuted a new music video. The British Hip-Hop group film the clip in support of their latest single "Morning Star". Beside promoting their music, they also make use of this newly-premiered video to debut their "sharper" new looks.
Fazer suits it up in formal outfit, Dappy also rocks tuxedo but he wears it casually, and Tulisa is dressed in a figure-hugging mini dress. "Fazer and I have been inspired to wear more tailored suits and smart jackets. You have to evolve," Dappy told The Sun.
"Morning Star" is lifted from N-Dubz's third studio album "Love Live Life" which has been in stores since November 2010 in the U.K. They reportedly have flown to New York to meet Def Jam record label bosses to discuss plans for releasing a single Stateside, and they hope "Morning Star" could be their first hit in the country.
N-Dubz's "Morning Star" music video

domain: news


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The manager of Arsenal football club, Mikel Arteta believes his team could finish in the top four despite losing control of the race to Tottenham Hotspur when they lost 2-0 at the hands of Newcastle United on May 16.
Ahead of the club’s last Premier League game of the season which is against Everton, the coach of the 5th placed club noted that the Premier League game between Crystal Palace and Everton has made him believe that anything is possible on the last day of the Premier League campaign.
Recall that Everton fought from behind to defeat in-form Crystal Palace 3-2 at Goodison Park on Thursday. Even though the game was inconsequential to Crystal Palace, Patrick Vieira’s team played the game as if their survival in the league depended on it. Despite that, Everton used Villa to escape relegation.
Mikel Arteta is drawing inspiration from the game in respect to the Premier League game between Arsenal’s rival Tottenham Hotspur and relegated Norwich City. The Spanish tactician noted that the relegated side could play as if they have something at stake when they face Tottenham on May 22 and probably defeat the Champions League-bound team.
Mikel Arteta said: “[The Everton game] gives me more encouragement about what can happen on the last day at Norwich. This only happens in this league, it’s what makes this league so incredible. In many other countries, with nothing to play for you don’t see performances like this [from Crystal Palace] – it makes us hopeful something can happen.
“It’s very possible. Looking back, I’ve been back a few years and seen a few examples of things like this happening at the end of the season. The longer the game is close, the more I am hopeful.
“We are back in Europe, we don’t know where, hopefully, it will be in the Champions League – we’ll do what we have to do and we will be cheering for Norwich.”
💬 "We're going to be cheering for Norwich and after that, we're going to take this club to the next level."— Arsenal (@Arsenal) May 20, 2022
A few words from the boss ahead of our final pre-match press conference of the season 👇 #ARSEVE | @M8Arteta pic.twitter.com/dH3ZTI1ps9
Can Mikel Arteta help Arsenal qualify for the Champions League in the 2021-2022 season?
Mikel Arteta can still help Arsenal to qualify for the 2022-2023 UEFA Champions League by ensuring that his team defeat Everton on May 22.
However, Arsenal’s qualification is 99 percent in the hands of Tottenham Hotspur because if Spurs defeat the relegated Norwich City with any scoreline, the outcome of the Arsenal vs Everton match would be inconsequential.
Note that Tottenham Hotspur are currently occupying the 4th spot with 68 points in 37 games. While Arsenal are sitting on the 5th spot with 66 points in 37 games, two points away from Spurs.
Based on the caliber of the team (bottom-placed Norwich City) Tottenham Hotspur are playing against on Sunday at 16:00, it will be a great miracle if Tottenham draw or lose the league game. Hence, the UEFA Champions League dream is more or less over for Arsenal.
Arteta read out his scorecard at Arsenal for the 2021-2022 season:
Before coach Mikel Arteta began his press conference ahead of Sunday’s clash with Everton, the Spanish coach decided to read out the progress his team has made so far.
In his speech, Arteta who has been the coach of Arsenal since 2019, said the fact that Arsenal which finished 8th in the last two seasons respectively, would finish 4th or 5th this season is a sign that his team is making progress.
“It has been a long journey and a very challenging one this season, but I think we have come a long way as a club”, Mikel Arteta said. “As a team, I think we have transformed the energy, vibe, and expectation of this club again and we have done it together.
“I have hope and expectation to move this club to the place it deserves. We have done it the way we predicted with the project we set a year ago, with a lot of young players, with senior players, and with our crowd in our stadium with a real sense of connection around the place.
“After [the weekend] we will take the club to the next level and that is the ambition. To do that we have to have a very clear plan again about how we want to do it and execute it.
“It is no secret we need resources and we need to increase the quality and depth of the squad, as long as we maintain at the same time who we are as a club and the people we have next to us. That will be the challenge the following season, but hopefully, in front of our people, we have a great day.
“We are going to have certain resources, not unlimited. With those, we have to do what we have to do in the best possible way. We don’t know what the rest of the teams will, obviously it will be challenging, it’s not a top-three but a top eight or 10, but we have to find a way to do again what we did last summer.”


Printed blue swim shorts with tropical leafs
If you are looking for a swimsuit that is practical, comfortable and in line with the latest trends, these swim shorts are made for you! Designed in an innovative fabric, with the Wateractive Print technology, it looks plain when dry and reveals a tropical print on contact with water. Lightweight and short, with an adjustable elasticated waist, it ensures you a flawless comfort and a feeling of freshness every day.
- 34cm length
- Leafs pattern
- Elastic waistband
- Pocket on the back
Machine wash cold, 30° maximum / Do not tumble dry / Do not bleach / Do not iron / Do not dryclean


Assos GTO Winter Dermasensor Long Sleeve Base Layer
A truly exceptional choice for battling winter conditions, Assos' GTO Dermasensor Long Sleeve Base Layer keeps you warm and comfortable thanks to advanced material and construction. The 3D jacquard warp-knit is produced in such a way as to eliminate seams completely, enhancing fit when layering and reducing the risk of possible friction. The material is odour resistant, super soft, breathable, stretchy and highly durable and offers a second-skin fit that hugs the body without feeling restrictive.
- DermaSensor textiles are technologically advanced 3D jacquard warp-knit materials produced as single, finished garments rather than as separate panels that are then sewn together
- Exceptionally soft, breathable, stretchy, durable, and odour resistant
- Streamlined regularFit provides total comfort for long training rides and layering under thermal insulation and winter jackets
- Raw-cut DermaSensor construction eliminates hems on the sleeve and waist, reducing bulk to facilitate layering
- Seamless construction eliminates friction between the rider and other equipment layers
Assos GTO Winter Dermasensor Long Sleeve Base Layer Sizing
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£420,000 Offers over
"Wallace Lodge'' is a very attractive and beautifully appointed, impressive luxury Detached Villa with Three Double Bedrooms, offering magnificent accommodation with exceptional high specification finishing throughout, enjoying an idyllic peaceful semi-rural setting close to Linlithgow, with beautiful secluded private gardens and a large private driveway. The property offers a great opportunity, with Residents benefiting from excellent transport links to key commuter areas, as well as an impressive range of leisure, sporting and retail facilities in the close surrounding Towns. Boasting spacious and versatile accommodation with stunning contemporary interiors, lovingly upgraded by the current owners, with bespoke internal design and immaculate move-in presentation comprising - double doors entry to an open plan Reception Hallway, Lounge/Dining/breakfasting Kitchen, Double Bedroom or Home Office, Shower-Room and a Utility Room. The first floor comprises: Principal Bedroom with En-Suite, a second generously proportioned Double Bedroom and the four-piece Family Bathroom completes the accommodation. This truly impressive family home offers a welcoming open plan Reception Hallway to the Lounge/Dining and breakfasting Kitchen. A feature of the living space welcomes you with beautiful ''Porcelanosa'' ceramic tiled flooring throughout the Reception, Lounge/Dining and Kitchen areas, which also benefit from a dual aspect and enjoy an abundance of natural light. The Lounge is welcoming and spacious, with French Doors from the Dining area opening to the rear garden. The contemporary fitted breakfasting Kitchen offers an excellent range of base and wall cabinets with complimentary work surfaces, bespoke cabinet lighting and a convenient breakfasting bar. A second set of French Doors open from the Kitchen area to the rear garden. Integrated appliances include an induction hob with extractor canopy, double electric ovens, dishwasher, fridge and drinks cooler fridge. The Utility Room offers additional cabinet storage, with space for free standing appliances and a door accesses the side of the property. The ground floor also offers a Double Bedroom set to the front of the property, which could be utilised as a home office or playroom with ample space for free standing furniture. The contemporary Shower-Room comprises a double shower compartment with beautiful, “Porcelanosa” tiled surrounds, WC, wash hand basin set in vanity storage and a heated towel rail. An elegant staircase with a ''Velux'' window offers a convenient under-stair storage cupboard. The spacious Principal Bedroom offers a generous three door fitted wardrobe and impressive, full height ''Cabrio Velux'' windows with mini balcony and, integrated black out blinds, offering lovely views to the rear of the property and a second window to the side of the property. The stylish En-Suite comprises a double shower compartment with rain shower, stunning “Porcelanosa” tiled surrounds, WC, ''Villeroy & Boch'' oval wash hand basin set in a floating vanity storage cabinet and a tall, heated towel rail. The second Double Bedroom features a bespoke wood panelled wall, with ''Velux” windows and integrated black out blinds overlooking the rear of the property, with ample space for free standing furniture. Completing the accommodation on the first floor is the four-piece Family Bathroom comprising bath, WC and wash hand basin set in vanity storage with attractive tiled surrounds and a shower compartment.
Externally there is much to appreciate, with a large private mono-blocked driveway providing substantial parking for several cars to the front of the property. The secluded, enclosed rear garden offers a large, paved patio with an area for relaxing in the sun and a barbecue space ideal for entertaining and al-fresco dining. A large area laid to lawn, with borders of mature plants and shrubs and surrounded by stunning trees. The garden is completed with an enclosed hot tub and garden shed with more room available for further outdoor buildings. Further benefits include an Oil-Fired Central Heating System, Double Glazing and Solar Panels. The solar panels create a great opportunity to earn money back quarterly on extra electricity created by natural sunlight. This truly impressive family home offers a rarely available opportunity, in a beautiful setting with immaculate move-in ready presentation early viewing is essential to fully appreciate this unique opportunity.
Enjoying a stunning semi-rural setting, close to Linlithgow and Falkirk, within easy reach of the M9 lying one mile from Bowhouse Roundabout with access to the A801 towards Falkirk and the M9 connecting north and south to the main motorway network including the M8 to Glasgow and Edinburgh. Edinburgh International Airport lies approx 20 minutes' drive away. Locally, the property is situated in the middle of the central belt within easy reach of excellent local amenities and local schooling in the nearby villages of Maddiston, Avonbridge and Brightons. Further extensive shopping is also available in Falkirk, Linlithgow, Grangemouth and Livingston. Offering numerous beautiful countryside walks with stunning scenery, local attractions include Muiravonside Country Park, the River Avon and Beecraigs Country Park all within easy reach. The location boasts a choice of high-quality golf courses nearby and a wide range of local horse-riding stables for the outdoor enthusiast. An ideal location for a commuter with main train line services available at nearby Polmont, Linlithgow and Bathgate stations.
This house description is based upon information supplied by the owner, or on behalf of the owner. These property particulars are produced in good faith and do not constitute or form part of any contract. s1homes do not take any responsibility for the accuracy of the information contained in this document.
If a property value displays '0', don't worry it just means no properties have been sold in that area during that time.
Source acknowledgement: Contains data compiled by Registers of Scotland. For further information, please contact firstname.lastname@example.org.
Registers of Scotland is a government body responsible for compiling and maintaining property registers. There can be a delay of up to 3 months from when a property is sold to being recorded with Registers of Scotland. We provide house price data for your information only, we do not accept any liability for any errors.
If you have noticed any incorrect information, please contact email@example.com.

domain: design


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Liverpool's midfield star Javier Mascherano admits former Chelsea star Claude Makelele has been a major inspiration
Javier Mascherano has revealed that studying former Chelsea star Claude Makelele helped him become one of the best defensive midfielders in the game.
Liverpool star Mascherano has paid tribute to the Frenchman, who is set to retire from football this summer after a magnificent career.
And the Argentine admitted: 'I've always modeled myself on Claude Makelele, though it's hard to explain why.
In form: Javier Mascherano in action for Liverpool against Fulham on Sunday
'It's not a question of me wanting to play like him when I watch him, but I get the feeling he feels and thinks about the game the same way as I do.
'I've played against him a few times and to be honest he seems more and more of a special player every time.
One of the very best: Claude Makelele in action for Chelsea in 2007
'There are a few others too. When I started training with the national team I watched (Matias) Almeyda and (Diego) Simeone a lot, and Leonardo Astrada taught me a great deal too.'
Mascherano has been one of the genuine bright spots for Liverpool in their disappointing season.
So impressive is his form that Argentina coach Diego Maradona has insisted his selection for the World Cup would be 'Mascherano and 10 others' after installing him as captain.
Mascherano told FIFA's website: 'I feel very proud when I get recognition, especially when it comes from coaches who've worked with me.
'That means I'm a good professional who goes through ups and downs like everyone else. It makes me blush sometimes though, especially when the praise comes from someone important.
'Obviously you work hard to improve, although I'm not going to win any personal awards because of the position I play in and the way I play. I just try to do what I do well and help the team, that's all.
'Every morning when I get up I know I've got to give my all to keep on progressing.'
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domain: sports


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Bahrain’s director general of criminal investigations on Tuesday announced the arrest of 15 people for causing “chaos” during recent Ashura commemorations.
The group were financed by the Iranian Revolutionary Guards “through terrorists living as fugitives in Iran, mainly members of the February 14 group”, Bahrain News Agency reported.
They were described as “indulging in abusive activities” during the September 20-21 holiday in Malkiya, a coastal village located southwest of Bahrain.
February 14 marked the first day of Arab Spring protests that hit the island kingdom in 2011.
The name was adopted by the February 14 Youth Coalition, which was designated a terrorist organisation by Bahrain, Saudi Arabia, the UAE and Egypt in 2017, to organise further protests.
Those arrested on Tuesday included a mixture of students, workers, security guards and unemployed people.
1. Ahmed Abdulrasool Khamis, security guard
2. Adel Abdulwahid Darweesh, worker
3. Abdullah Isa Darweesh, worker
4. Ali Nabeel Mahdi, worker
5. Mahdi Ali Jaffar, worker
6. Mohammed Yousif Noah, unemployed
7. Hussain Isa Ali, worker
8. Sadiq Jaffar Abduljabar, worker
9. Ali Hassanain Hamza, student
10. Hameed Ahmed Abdulwahab, unemployed
11. Ahmed Mohammed Ali, unemployed
12. Habib Maki Ali, unemployed
13. Qassim Abdulrasool Kadhim, security guard
14. Sayed Hassan Saeed, student
15. Abdullah Juma Habib, unemployed
“The investigation had also shown the gang of vandals was being directed by a person who had been arrested in a terrorism case in February 2018,” BNA reported.
“Legal action has been taken in the case and those arrested have been referred to the Public Prosecutor.”
Authorities warned that any activities that “disturbed civil peace and harmed the social harmony” would be handled in accordance with the law.
Ashura is an important event on the Islamic calendar for Shia Muslims, which make up a significant portion of Bahrain’s population, as it marks the climax of the “Mourning of Muharram”.
The event is the anniversary of the Battle of Karbala that saw the Prophet Muhammad’s grandson and his family members martyred.


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Fucoxanthin is an antioxidant compound (concretely, a carotenoid) found in brown seaweed. It is claimed to help combat a variety of health issues including obesity, diabetes, and inflammation, although clinical trials are lacking. Read below to discover the potential benefits and side effects of fucoxanthin.
What Is Fucoxanthin?
Fucoxanthin belongs to a class of plant compounds called carotenoids, which confer yellow, orange, or red color. The structure of fucoxanthin makes it different from other plant carotenoids (it has an unusual allenic bond, a 5,6-monoepoxide, and 9 conjugated double bonds).
This unique structure contributes to its instability, which makes fucoxanthin difficult to study. However, this same structure is exactly what confers its potential to help with health issues such as obesity, diabetes, and inflammation .
Fucoxanthin’s anti-obesity effects are thought to be mediated through its ability to influence gene expression of the following genes related to fat metabolism, as seen in rat studies :
- Acetyl-CoA carboxylase (ACC)
- Fatty acid synthase (FAS)
- Glucose-6-phosphate dehydrogenase (G6PDH)
- Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA)
- Acyl-CoA cholesterol acyltransferase (ACAT)
- Brown algae
- Only one clinical trial carried out
- Never evaluated alone
- Unknown safe profile
The following purported benefits are only supported by limited, low-quality clinical studies and animal and cell-based research. There is insufficient evidence to support the use of fucoxanthin for any of the below-listed purposes. Remember to speak with a doctor before taking fucoxanthin supplements and never use it as a replacement for approved medical therapies.
In a clinical trial on 151 obese, non-diabetic women with non-alcoholic fatty liver disease, fucoxanthin (0.8-4.0 mg) and pomegranate seed oil increased weight loss and reduced body and liver fat .
A single clinical trial (testing fucoxanthin in combination with pomegranate seed oil) and some animal research cannot be considered sufficient evidence to claim that fucoxanthin helps with weight loss. Further clinical trials are needed to validate these preliminary findings.
A single study is insufficient to attest to the effectiveness of fucoxanthin in reducing depression. Most importantly, the study was associational, meaning a cause-effect relationship couldn’t be established. Other dietary, environmental, and genetic factors could have contributed to the effects observed.
No clinical evidence supports the use of fucoxanthin for any of the conditions listed in this section. Below is a summary of the existing animal and cell-based research, which should guide further investigational efforts. However, the studies should not be interpreted as supportive of any health benefit.
In mice exposed to ultraviolet radiation, fucoxanthin applied to the skin blocked the premature aging of the skin and protected skin cells from sunburn .
In mice with traumatic brain injury, fucoxanthin reduced brain cell death .
However, high doses of fucoxanthin increased blood cholesterol in mice .
In menopausal mice, fucoxanthin prevented bone loss. In cells, it blocked the development of the cells that promote bone breakdown (osteoclasts) .
Fucoxanthin inhibited the parasite that causes malaria (Plasmodium falciparum) in test tubes .
Only one clinical trial and one observational study have been conducted, and most potential health effects have only been tested in animals and cells. Because the trial used fucoxanthin combined with pomegranate oil and the observational study evaluated the intake of seaweed instead of purified fucoxanthin, the specific contribution of this carotenoid to the effects observed is difficult to estimate.
Keep in mind that the safety profile of fucoxanthin is relatively unknown, given the lack of well-designed clinical studies. The list of side effects below is not a definite one and you should consult your doctor about other potential side effects based on your health condition and possible drug or supplement interactions.
No adverse effects were observed in the only clinical trial conducted .
In mice, fucoxanthin didn’t increase the rate of mutations and wasn’t toxic to the kidney, liver, spleen, and gonads. The only adverse effect observed at high doses was increased blood cholesterol [18, 24].
Supplement/Herb/Nutrient-drug interactions can be dangerous and, in rare cases, even life-threatening. Always consult your doctor before supplementing and let them know about all drugs and supplements you are using or considering.
Fucoxanthin can inhibit the enzyme CYP3A4, which is responsible for the metabolism of approximately 45-60% of prescribed drugs. This may enhance the effects of the drugs by increasing their blood levels, but also reduce their activation if the drugs are administered as a pro-drug that needs to be broken down into its active form [25, 26, 27, 28, 29].
The following drugs are metabolized by CYP3A4, meaning fucoxanthin may affect their effectiveness:
- Opioids such as sufentanil and methadone [28, 29]
- Immunosuppressants such as cyclosporine, tacrolimus, and sirolimus [30, 31, 32]
- Antihypertensive drugs such as felodipine and nifedipine [30, 33]
- Anticancer drugs such as endoxifen, tamoxifen, and sunitinib [33, 34]
- Sedatives such as midazolam
- Cholesterol-lowering drugs (statins) such as simvastatin, atorvastatin, and lovastatin [35, 33]
- Antibiotics such as erythromycin
- Corticosteroids such as fluticasone propionate
Because fucoxanthin is not approved by the FDA for any condition, there is no official dose. Users and supplement manufacturers have established unofficial doses based on trial and error. Discuss with your doctor if fucoxanthin may be useful as a complementary approach in your case and which dose you should take.
The only human trial carried out tested a dose of 0.8-4.0 mg fucoxanthin combined with pomegranate seed oil .
The opinions expressed in this section are solely those of fucoxanthin users, who may or may not have medical or scientific training. Their reviews do not represent the opinions of SelfHacked. SelfHacked does not endorse any specific product, service, or treatment.
Do not consider user experiences as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare providers because of something you have read on SelfHacked. We understand that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.
Weight loss was by far the most common use of fucoxanthin. Fucoxanthin pill users were often satisfied and reported weight reduction without needing to increase physical exercise.
Similarly, several users of fucoxanthin patches claimed that they worked well to increase weight loss and energy. However, some of them complained that the effect was slow and the patches didn’t help decrease appetite.


The Federal Financial Supervisory Authority or BaFin, Germany’s financial regulator, is reminding firms that want to issue electronic securities of its registration guidelines as provided in the Electronic Securities Act that came into force in June 2021.
In a new leaflet BaFin published, the regulator stated that the deadline for application for licenses would end on June 10, 2022. BaFin also reiterated the application requirements for both new registrants and companies who want to transition their existing services to offering securities with blockchain technology.
The process involves submitting a permit application that contains certain required details. One of these details is information on the firm’s IT security systems. BaFin expects this to be well spelled out with a risk assessment attached.
The application should also contain the number and details of the firm’s directors and managers who will be screened based on how “reliable and technically suitable” they are. Additionally, the application should spell out money laundering and terrorist financing prevention measure the firm has in place.
A fee of 6,336 euros ($6,745) is also required, and the application must be signed by authorized personnel of the company. Once these are provided, the BaFin reserves the right to approve or reject the application and ask questions for more information.
The Electronic Securities Act was first introduced in 2020 before coming into force in 2021. In particular, the law allows for the use of blockchain technology to issue securities in place of paper certificates.
Germany still broadening scope of digital currency regulations
The Electronic Securities Act is only one example of German laws that have fostered the adoption of blockchain technology and digital currencies. This year, the European country issued a nationwide digital currency tax regulation legislation that clarified taxation of the assets.
The law allows for capital gains tax to be waived for digital currencies held or staked for more than a year. Before the tax law, the country had also implemented a licensing regime for digital currency and blockchain companies.
It has also encouraged more institutional investment in digital assets with the passage of a law that allows funds to allocate up to 20% of their portfolio to digital assets. These regulations have made Germany the most digital currency-friendly jurisdiction in Q1 of 2022, according to a study by Coincub.
Watch: The BSV Global Blockchain Convention presentation, BSV On-chain Ecosystem Development in Europe
New to Bitcoin? Check out CoinGeek’s Bitcoin for Beginners section, the ultimate resource guide to learn more about Bitcoin—as originally envisioned by Satoshi Nakamoto—and blockchain.


text:
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Actual physical and occupational therapy normally Participate in essential roles in this type of care, and and speech-language pathology and psychiatric rehabilitation. Rehabilitation may possibly take place in an inpatient or outpatient ecosystem.
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Our target with this particular program is that may help you raise an exceedingly assured and obedient puppy from an exceptionally young age. You're going to be mentored by us with the full approach! For this program, we hugely advise house owners to send us video clips of them practising so we might help!
Maryanne graduated with significant distinction as being a Qualified Dog Actions Advisor, then accomplished her internship by participating in the rehabilitation of fearful and aggressive dogs from the Canine Dimensions shelter outreach program.
The best type of Doggy training for both equally you and your Canine depends upon the outcomes you hope to obtain. If you need your Puppy to find out agility training, visit someone who focuses primarily on People methods. Regardless of whether you would like your Doggy to know simple behavior or aggressive-degree tricks, many Puppy training is actually about training the operator the best way to communicate with their Doggy. Most Specialist Canine trainers concur that a product of training depending on good reinforcement breeds a contented, healthier, nicely-altered Pet. The alternative to positive reinforcement training is working with force or aggression approaches like Bodily punishment or shock-collar training to obtain the dog to carry out (or not do) a conduct.
In 2011, she was appointed Animal Control Officer for the townships of Montgomery and Berkshire, VT exactly where she functions with nearby and state authorities to aid enforce animal cruelty Aggressive dog training in New Hampshire regulations and investigate instances of abuse and neglect.
This is where you drop off your dog, and a couple of-weeks later you decide up a Puppy that is flawless outside the house, off-leash, with interruptions! See our youtube channel for various board and train prior to/just after movies!
Training effectively opens strains of interaction between both you and your Doggy. A pet which responds to your instruction and instructions offers a way more worthwhile Best dog trainer in New Hampshire marriage
Some parks embrace off-leash guidelines while some have independent sections for scaled-down dogs. Anywhere that you are inside the point out, make certain to take a look at Aggressive dog training in New Hampshire any of your best Puppy parks in New Hampshire.

domain: pet


text:
The Cincinnati Bengals will likely be making several roster moves this week in light of Andy Dalton's injury, but this one is unexpected.
The team announced Tuesday that linebacker/defensive end Chris Carter has been waived; no corresponding move has yet to be made. That means the Bengals' roster now stands at 52 players with the freed-up spot likely to be filled by a quarterback in the coming hours.
Carter, a fifth-year player, was in his first full season with the Bengals after being signed in December of last season. He went on to appear in three games, mostly in special teams roles. Carter originally entered the NFL in 2011 as a fifth-round draft pick by the Pittsburgh Steelers. He spent his first three seasons with the Steelers before joining the Indianapolis Colts for one game in 2014 before being waived.
This season, Carter was faced with a tough task of earning a roster spot with both outside linebacker and defensive end being deep with capable players. Carter spent most of his NFL career playing as an outside linebacker in 3-4 defenses, and finding a role for him in Cincinnati was no easy task.
Carter ended up becoming essentially a nickel pass-rusher who was getting almost all of his snaps in obvious passing situations. He got a little over 100 defensive snaps this season while also appearing on special teams. He accounted for only 10 tackles and no sacks after finishing with 3.5 sacks and one forced fumble in the preseason.
Still, Carter was as expendable of a player as could be found on the roster, and it didn't help that other players were starting to get more snaps. Most notably, Margus Hunt has seen an increase in playing time as the season has wore on. This past Sunday against the Steelers, Carter played only two defensive snaps, whereas Hunt played in 11 snaps. In the Week 13 win over the Cleveland Browns, Hunt played 15 snaps vs Carter's 12.
At this point, the Bengals will likely be signing a quarterback to fill Carter's spot on the roster with a variety of candidates already known. Keith Wenning is sitting on the practice squad and has for the entire regular season. He knows the offense as well as any player the Bengals will find on the free agent market, so it would make the most sense to have Wenning as the backup this week.
However, the Bengals will almost certainly want a veteran quarterback also on the roster, if for nothing else than to help new starter AJ McCarron get adjusted to life as a starting NFL quarterback. Free agent Christian Ponder is among the confirmed names the Bengals have worked out.
With Carter now gone, the Bengals are down to Hunt, Carlos Dunlap, Wallace Gilberry, Michael Johnson, and Will Clarke at defensive end in addition to Emmanuel Lamur, Vincent Rey, Vontaze Burfict, P.J. Dawson and A.J. Hawk at outside linebacker.


Sweat Shirt - Two Colors
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|Place Of Origin||TURKEY|
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text:
If you’re considering transferring to a place far out of your native country, then it’s essential to take into consideration many particulars from housing to schooling. Learn concerning the College of Public Health, curriculum, admissions necessities, the appliance process, and potential public health careers. Tobacco as a Health Hazard: Smoking is the main reason behind preventable illness in the U.S. Recognition of tobacco use as a health hazard has resulted in restrictions on cigarette advertising, shopper education campaigns and initiatives aimed toward lowering the inhabitants’s publicity to environmental tobacco smoke.
Generally a social work bachelor’s diploma is a requirement for well being jobs, sometimes however sociology or psychology degrees are thought-about instead. These professionals are liable for policy growth, health promotion, and the surveillance of oral health and upkeep of dental safety. Regardless of background, these specialists analyze, evaluate and design behavioral methods, spearhead public interventions and talk and promote health packages. The public health nurses usually undertake a systematic strategy to discovering a repair for the well being care wants of a society.
Most governments acknowledge the importance of public well being programs in lowering the incidence of disease, incapacity, and the results of ageing and different bodily and mental well being situations, although public health usually receives considerably much less authorities funding in contrast with medicine. Public well being nurses do treat ailments, but their essential objective is to stop illnesses and issues from occurring. This is only one motive why completing a public health degree in Australia is a superb idea.
Since 1950, age-adjusted dying charges from heart problems (CVD) have declined 60 percent, representing some of the important public well being achievements of the twentieth century. Natural born leaders with a strong interest in oral health might need to pursue a career as a public well being dentist. Transfers from well being centers to hospitals present inconveniences to both affected person and family, but additionally places stress on the system of healthcare in Malaysia. This job includes maximizing the restoration of medical health insurance benefits by a claimant. The formal definition of diabetes has been tightened because prior standards had been too imprecise.
There are available public well being on-line levels and this can actually put together you in becoming a entrance-liner in public health. Also, in its Healthy 2020 initiative, the federal authorities called for an increase in public health experts throughout the nation to forestall and deal with diseases, identify potential threats, and facilitate collaboration each within and across communities.

domain: health


text:
Our Facilities - Perth's First Purpose Built Vet Rehab Centre & Animal Gym!
Our State of the Art Facility is the first Purpose Built Vet Rehab Centre in Perth!
We have a specialized animal gym which is fully equipped with all the rehab equipment required to assist animals in building strength and balance.
In addition to the gym, we have a specialized wellness room which is a quiet, peaceful and non clinical area designed to have a home-like feel, ensuring that your pets are relaxed and as comfortable as possible for their therapy. This spacious room is reserved solely for physio and acupuncture sessions, so that your pets don't feel like they are in a veterinary environment and will leave feeling so relaxed that they will look forward to their next session!
Our underwater treadmill is designed specifically with weak, injured and anxious animals in mind. It is so low to the ground that no ramps for entry and exit are required, and it has a dual entrance/exit system meaning that your pet can walk in and then straight out without having to turn around. This reduces their anxiety, making their hydro sessions a positive experience for them.


text:
Listening Library: Beaver County
EVERYONE HAS A STORY. EVERY STORY MATTERS
LISTENING LIBRARY: BEAVER COUNTY
The Listening Library: Beaver County is a collaboratively produced multimedia archive of stories, conversations, and photographs that explore, share and reveal Beaver County’s historic heritage, social diversity, creativity, environmental richness, and community spirit.
LLBC tells stories that challenge community stereotypes of people and places; celebrate the dignity and value of individuals by raising up Beaver County voices and visions; support communities’ efforts to achieve justice and equity and solve their own problems in their own ways, and raise up voices that are unheard or overlooked.
Your Voice Matters
The Listening Library: Beaver County appreciates that history is happening now, in the work we do, the causes we support, the setbacks and struggles we endure, and the relationships we build that uplift our communities. You are an important part of the full picture that future generations need to see to understand our part of the world, their place in it, and their power to shape it. We invite you to share your experiences.
Connect with LLBC
The LLBC Podcast is a special audio project produced by The Social Voice Project for the Listening Library: Beaver County, a multimedia collaborative and developing archive of recorded stories, conversations, and photographs that explore, share, and reveal Beaver County’s historic heritage, social diversity, creativity, environmental richness, and community spirit.
Community Conversations Series
We created our Community Conversations to bring together Beaver Countians around meaningful discussions about home life, family, friends, work, and spirituality. Adapting to the times, we are connecting with each other via internet conferencing, recording our gatherings, and then sharing our conversations with short videos and the LLBC Podcast on our website and social media.
MORE BEAVER COUNTY VOICES, STORIES, STORYTELLERS & CREATIVE MEDIA INITIATIVES

domain: sociology


Source: Dr. Jean-Paul Rodrigue, 2010.
The Maher Terminal Overlooking the Bayonne Bridge
The Bayonne Bridge was built in 1931 and crosses the Kill Van Kull
Channel, which is the only access to the Newark Bay where the bulk of
the container terminals in the Port of New York and New Jersey are located.
With a clearance of about 155 feet (47.2 meters), it can accommodate
containerships up to a range of 7,000 to 8,000 TEU, depending on their
load configuration, but not those above 10,000 TEU. It is thus underlined
that future growth prospects of the port of New York and New Jersey
could be compromised by a lack of clearance.
On the above photo, the portainers of the Maher Terminal at the forefront
and the APM Terminal (in blue) in the background underline the contradiction
between modern terminal equipment and a bridge built close to 80 years
ago. The indication, which is conveyed by the port community, is that
the bridge "needs a lift".


text:
And Tiger Shroff has decided to make an extreme change for his second film.
Tiger Shroff who will be seen in Sajid Nadiadwala‘s Baaghi seems to have decided to go extremely experimental with his looks.
The actor who made a smashing debut last year will be seen in various looks for his next.
As the title goes, Tiger will be seen as a rebel in the film and for each stage in the film Sabir Khan has shortlisted different looks for Tiger.
One of which is said to be a bald look. The actor has always been seen in long hair onscreen, he has never even sported short hair.
Tiger’s character in the film is very intense and each look which has been decided will give an edge to his character.
The makers have been tight lipped about Tiger’s look in the film, and even the actor has been with all means hiding his look.
When the makers decided to go through this change, Tiger had willingly agreed. Tiger made a debut with Sajid and Sabir and he is sure of their vision.
It will be an interesting sight to see when the young actor will shave all of his hair off.
Sajid gave Tiger Shroff a huge launch pad with Heropanti which went on to become a huge success.
It will be very interesting to see a new and fresh pairing of Tiger and Shraddha in the film.
Baaghi will be directed by Sabir Khan. The film will be packed with action and drama. We’ll get to see Tiger in some high-end action martial arts fight scenes.
The storyline of the movie has not been declared yet but the title of the movie says it all. The movie seems to be on a beautiful love story. Sabbir Khan made his directorial debut with Kambakkht Ishq. Baaghi– Rebel for Love is set to release in April 2016.
Also Watch: Tiger Shroff Reveals Why He Will Never Work With Salman Khan And Shah Rukh Khan

domain: entertainment


text:
Camphill Communities California is a residential care community for adults with developmental disabilities near Monterey Bay. We support each person's potential. We are a part of the international Camphill movement.
Our Ideal Customer
We are open to individuals who are interested in volunteering in our garden.


Reason TV and The Moving Picture Institute recently came out with a new video called “The Machine.” ”The Machine” highlights the correlation between the taxpayers, politicians, and the education unions. It works like this: Taxpayers send money to the government, which then uses it to pay for government education employees. Teachers are forced to pay a portion of their paychecks to pay union dues. The union uses those dues to make campaign contributions, and the politicians vote in favor of the unions. As the video puts it, it is a “political perpetual motion machine.” This machine has consequences, though. It is corrupting our education system, and most importantly, failing our children. It’s time to break the machine.
It's Time to Break 'The Machine'
Big Government Is NOT the Answer
Your tax dollars are being spent on programs that we really don't need.
Get Heritage In Your Inbox — FREE!
Heritage Foundation e-mails keep you updated on the ongoing policy battles in Washington and around the country.×


- 450 round high capacity magazine
- Compatible with Olympic Arms, ICS guns
- This magazine is not recommended for use with the KWA AEGs
Easy to fill, just pour in 450 rounds through the top hatch. Easy winding spring dial on the bottom keeps tension on the ammo for smooth feeding.
Item Code: SDERICSMA04 [PY-A-3132]


|Publication number||US7547327 B2|
|Application number||US 10/678,352|
|Publication date||Jun 16, 2009|
|Filing date||Oct 3, 2003|
|Priority date||Oct 3, 2003|
|Also published as||US20050075736|
|Publication number||10678352, 678352, US 7547327 B2, US 7547327B2, US-B2-7547327, US7547327 B2, US7547327B2|
|Inventors||Carlos E. Collazo|
|Original Assignee||Howmedica Osteonics Corp.|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (57), Referenced by (18), Classifications (10), Legal Events (3)|
|External Links: USPTO, USPTO Assignment, Espacenet|
The invention relates to trial augments used with femoral trials during knee surgery.
Failure of a knee arthroplasty can be caused by a variety of factors, and such failure requires knee revision surgery. When a distal condylar defect is present during total knee replacement, the surgeon corrects this condition by preparing the defective bone to accept a femoral component implant that includes an augment. Typically, the distal end of the femur is resected to remove diseased or unhealthy bone to ensure sufficient anchoring and proper fit of the femoral component implant. Augments are used with the femoral component to increase the thickness of the inferior portion of the femoral component to compensate for lack of sufficient bone tissue. Thus, an augment is a spacer to fill a gap between the femoral component and the resected femur.
Trial components are used in knee replacement surgery to assist the surgeon in determining the appropriate size and type of femoral implant to use on a particular patient. A femoral trial is placed on a resected femoral surface and a tibial trial is placed on a prepared tibial surface. With the trials in place, the knee is checked for flexion and extension. Thus, during the trialing phase of the surgical procedure, the surgeon makes a final check of the reconstructed joint by temporarily inserting the trials, which mimic the final implants prior to permanent placement of the implant. Similar to the final implants, augments are used, particularly for the femoral trial, so that the surgeon can fill any voids and deficiencies between the inner surface of the trial and the resected femur.
Presently, trial augments having thicknesses between 2 mm and 20 mm are used with femoral trials. Typically, a set of trial augments are provided in a surgical tray having thicknesses of 5 mm and 10 mm, and in some cases, 5 mm, 10 mm, and 15 mm. In addition, the trial augments generally are provided in 8 different standard sizes that vary in length in the anterior-posterior direction and width in the medial-lateral direction to be used with various sized femoral trials. The distal femoral trial augments that are currently in use are specific to the size of the femoral trial component to be used. Since the final implant size selection is not made until the time of surgery, a large number of different sized trial augments have to be stored and available for use in a sterilized tray. It would be desirable to reduce the number of trial augments required for knee surgery.
In accordance with one or more embodiments of the present invention, an orthopaedic trial augment is provided comprising a first block and an expansion member. According to these embodiments, the expansion member is slidably associated with the first block so that the trial is expandable in at least one direction. The expansion member may include a second block. In one or more preferred embodiments, the first and second blocks are biased such that the blocks expand in at least one direction. Biasing may be accomplished by providing a spring associated with at least one of the blocks, and the spring configured to permit sliding movement between the blocks and expansion of the augment.
According to certain embodiments, one of the first or second blocks includes at least one channel and the other of the first or second blocks includes at least one complementary surface configured to provide sliding movement between the first and second blocks. According to some embodiments, one of the first or second blocks is keyed to fit inside the other of the first or second blocks to permit sliding movement between the two blocks in at least one direction. The keyed fitting structure may be provided wherein one of the first or second blocks includes at least a pair of grooves adapted to receive complementary surfaces on the other of the first or second blocks. In certain preferred embodiments, the trial expands in an anterior-posterior direction with respect to an orthopaedic trial.
According to some embodiments, the trial augment includes engagement surfaces configured to cooperate with at least one groove in an orthopaedic trial to secure the trial augment within the orthopaedic trial. The trial augment may further include a stop member to prevent the blocks from sliding apart. The stop member may include a pin or other suitable device to prevent the blocks from sliding apart. Other embodiments relate to a surgical tray including an orthopaedic trial augment of one of the embodiments described herein.
Another embodiment of the invention relates to an orthopaedic trial implant. The trial implant comprises a main trial implant body having at least one surface configured to be in contact with a bone surface and a recess in the main trial implant body adapted to receive a trial augment. The recess has at least one engagement surface for securing an augment in the recess. According to one embodiment, the engagement surface includes a groove. The trial implant further includes an expandable augment biased to expand in at least one direction and configured to be received in the recess. The expandable trial augment includes at least one edge surface configured to cooperate with the at least one engagement surface.
Still another embodiment of the invention relates to a method of augmenting an orthopaedic trial implant. The method comprises providing a trial implant having at least one recess and an engagement surface for a trial augment and inserting a trial augment in the recess, the trial augment being expandable in at least one direction. According to certain embodiments, the trial augment is compressed in at least one direction prior inserting the trial augment in the recess. In these embodiments, the trial augment is released after insertion in the recess, such that that the trial augment expands and is secured in the recess between the engagement surfaces. Preferably, the spring provides sufficient force to secure the block between the engagement surfaces.
A more complete appreciation of the subject matter of the present invention and the various advantages thereof can be realized by reference to the following detailed description in which reference is made to the accompanying drawings in which:
Before describing several exemplary embodiments of the invention, it is to be understood that the invention is not limited to the details of construction or process steps set forth in the following description. The invention is capable of other embodiments and of being practiced or carried out in various ways.
In overview, one or more embodiments of the invention relates to an expandable trial augment. Other embodiments relate to an orthopaedic trial implant using an expandable augment and a method of using an expandable augment trial. According to one or more embodiments of the invention, the number of trial augments needed during surgery is greatly reduced. As discussed above in the background section, there are generally at least eight different sized augments for the different sized trials, and in particular femoral trials, used in knee surgery. For each different size trial augment, at least two different thicknesses are usually provided in the surgical tray used by the surgeon performing the knee surgery. The present invention reduces the number of parts required in the surgical tray and simplifies the trialing procedure during knee revision surgery.
Referring to the drawings and first to
The augment 30 is preferably an expandable augment that is biased to expand in at least one direction and configured to be received in the recess 22, as will be described in more detail below. In preferred embodiments, the expandable trial augment 30 comprises a pair of slidingly engaged blocks having a spring disposed between the blocks so that the augment expands in at least one direction. According to certain preferred embodiments, the blocks include keyed mating surfaces permitting sliding movement between the two blocks. These features will be described in more detail below. Preferably, the augment 30 is made from a material that can be autoclaved and reused. Such autoclavable materials are known in the art. However, the present invention is not limited to a particular material to construct the augment 30.
Referring now to
According to preferred embodiments, one of the first or second blocks includes at least one channel and the other of the first or second blocks includes at least one complementary surface configured to provide sliding movement between the first and second blocks. As shown in
It will be understood that the above described configuration is just one example of a configuration that permits sliding movement between the first block 34 and the expansion member 36. Other designs can be used. For example, instead of a pair of channels 40 on the first block, a single channel or groove can be provided in either of the first or second blocks, and a single complementary rail can be provided to permit sliding movement between the blocks.
The trial augment 30 includes edge surfaces 32 configured to cooperate with at least one of the engagement surfaces or grooves 24, 26 in the orthopaedic trial implant 10 to secure the trial augment within the orthopaedic trial. The edge surfaces 32 may be beveled or pointed so that they fit securely in the engagement surfaces or grooves 24, 26. In certain embodiments, the trial augment 30 includes a stop member to prevent the blocks from sliding completely apart and prevent disassembly of the augment 30. The stop member may include a pin 41 or other suitable structure for preventing the blocks from sliding apart and disassembling. The pin 41 may cooperate with a track 43 in one of the blocks. As best shown in
In a fully assembled configuration, the spring 38 is seated between the channels 40 in the first block 34, and the second block 36 slides along the rails 42 in the channels 40. In preferred embodiments, the first block may include side channels 37 and the second block 36 may include side rails 39 to facilitate relative sliding movement between the two blocks 34, 36 and expansion of the trial augment 30. It will be understood, that in certain embodiments, either the side channels 37 and side rails 39 may be eliminated, or the channels 40 and rails 42 may be eliminated. In other words, only one set of channels and rails may be required to hold the blocks together and provide relative sliding movement between the blocks.
The trial augments described above are preferably used with femoral trial implants. The trial augments can be included as part of a kit or surgical tray used by a surgeon during knee revision surgery. Such a tray may include an orthopaedic implant trial and other components and tools needed for a knee revision surgery.
Another embodiment of the invention relates to a method of augmenting an orthopaedic trial implant. According to one or more embodiments, the method comprises providing a trial implant 10 of the type described above. The trial implant preferably has at least one recess 22 and an engagement surface for a trial augment 30. A trial augment 30 that is expandable in at least one direction, preferably the anterior posterior direction with respect to the trial implant, is then inserted in the recess of the trial implant. According to some embodiments, the trial augment 30 is compressed in at least one direction, as shown in
During a knee revision surgery, the surgeon would prepare the femoral and tibial surfaces by making the appropriate cuts to the bone surfaces using known surgical protocols, and then the femoral and tibial trials would be put in place to check for proper flexion and extension of the joint as is known in the art. Depending on the amount of bone cut from the distal end of the femur, augments having thicknesses between about 2 mm and 20 mm are used to fill any voids between the distal end of the femur and the femoral trial to determine the thickness of the augment to be used in the permanent femoral implant.
When the surgeon checks for flexion and extension with the trials in place, if the augment is too thin, during the check of flexion and extension, the joint will feel unstable or wobbly to the surgeon. In such instances, the femoral trial will be removed, and the trial augment will be compressed to remove the trial augment from the femoral trial implant. A thicker trial augment will then be inserted in the femoral trial implant, and the femoral trial implant will be assembled to the knee again. Flexion and extension is again checked by the surgeon. If the trial augment is too thick, the surgeon will not be able to move the knee joint from a flexed position to the extended position. If the leg cannot be straightened, the femoral trial is removed, the trial augment is removed, and a thinner trial augment is inserted in the femoral trial implant. This process is repeated until the surgeon determines that a proper fit has been achieved with the trial implants. Once a proper fit is achieved, the trial implants are removed, and the permanent implants are implanted in the femur and tibia.
Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. For example, the positioning of the channels and rails on the respective first and second blocks can be reversed. In addition, other stop structures can be used to prevent the augment from sliding completely apart. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims and their equivalents.
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|U.S. Classification||623/20.16, 623/20.35|
|International Classification||A61F2/30, A61F2/38, A61F2/46|
|Cooperative Classification||A61F2002/30736, A61F2/3886, A61F2/3859, A61F2/4684|
|Oct 3, 2003||AS||Assignment|
Owner name: HOWMEDICA OSTEONICS CORP., NEW JERSEY
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:COLLAZO, CARLOS E.;REEL/FRAME:014583/0782
Effective date: 20030923
|Dec 12, 2012||FPAY||Fee payment|
Year of fee payment: 4
|Dec 1, 2016||FPAY||Fee payment|
Year of fee payment: 8


text:
Ooni of Ife, Oba Adeyeye Ogunwusi, has decried the poor state of roads in the ancient city, saying “the town has never had it this bad”.
“I really do not know our offence in Ife to deserve the poor road network that surrounds us.
“It is not enough to call Ife the source, this city deserves to be treated as the true source of humanity that it is.
“It is so bad that the same government that has refused to fix our roads is the one denying us access to do what we can ourselves. All we hear is that it is a government road so we have to keep waiting.
“We are aware that the government cannot do it alone so we want them to put up a scheme, like a form of concession on all major roads in Ife. We would look for able personalities within the community, they will fix the road and they will give them task credit. It is the same.
“Let government give us that opportunity and see whether we will perform, we can now replicate it in other communities across the country.
“We are willing and able to do that on all major roads in Ife, all we need is a form of concessioning that regard,” the Ooni added.


text:
Originally published 1/24/2017
When four years had gone by since the blog below was posted, it was time to explore whether subsequent related studies had been published. It was slim pickings, but the following journal articles had relevant content on prostate cancer followed by acute myeloid leukemia:
- A population-based analysis using a cohort of 168,612 men newly diagnosed with prostate cancer (PCa) tracked those who were treated with surgery alone, external beam radiation therapy alone, brachytherapy alone, and no treatment. The authors’ conclusion supports the Wang study cited below: “Patients treated with EBRT had a higher adjusted relative risk of developing acute myeloid leukemia than patients treated with brachytherapy or surgery…” when each group was compared with those who received no treatment.[i]
- A case study of a man who was exposed to radiation during the 1986 Chernobyl Nuclear Plant accident, and whose clinical follow-up lasted until his death. Needless to say, during those 31 years he had a complicated clinical history that included blood disorders related to chronic hepatitis C (a liver disease), and a history of ongoing genomic mutations due to the radiation exposure. In 2014, he was diagnosed PCa, underwent surgery and a course of radiation. In 2016 he was diagnosed with acute myeloid leukemia (AML), a blood cancer as reported in the original blog, and treated with chemotherapy. He died from pneumonia in March 2017.[ii] While the AML he developed after PCa radiation is consistent with the original blog, it is impossible to rule out his 1986 accident as an additional factor.
- A Japanese case study of two PCa patients on hormone therapy reported that they developed AML within 8 and 10 months of starting therapy. Unfortunately, the article abstract did not indicate their clinical history prior to hormone therapy (the full article in Japanese was not available in English translation) so it’s not possible to know if they underwent prior radiation therapy. In any event, the authors concluded that AML after PCa treatment is rare.[iii]
Based on limited findings, it appears that AML following beam radiation for PCa is not common, but there is more risk for it post-EBRT than with other radical treatments.
Americans are living longer. In 2014, USA Today reported a new record high for life expectancy.[iv] Today, according to the Centers for Disease Control and Prevention, the average person will live to be 78.8 years old (for women, 81.2 years; for men, 76.4 years). Heart disease remains the number one cause of death, and cancer is number two.
Increased life expectancy has many implications. A big one for prostate cancer patients who seek treatment is the need to consider the likelihood of late-onset side effects (those that may not show up for years) as well as long term side effects that can lessen quality of life. For treatments that either remove the prostate (radical prostatectomy) or immediately destroy the cancer inside the gland (thermal ablation using extreme heat or cold) side effects – if they occur – usually happen immediately but may improve over time. For example, a study of very low risk prostate cancer patients who had robotic surgery found that by 12 months after surgery, 84% of the men were continent (< 1 pad every 24 hours) and 44% were capable of erectile function. “The proportion of men achieving the trifecta, defined as preoperative potent and continent men who remained potent and continent with no BCR [biochemical recurrence], was 38%…at 12 months.”[v] These numbers represent improvement/recovery of function experienced over the year after treatment.
A 60-year old patient who can reasonably expect to live for another 16.4 years must consider his probable quality of life following treatment. While side effects can be embarrassing or annoying, knowing they will probably improve can make them bearable. This is encouraging for those who lean toward prostatectomy, whether open, laparoscopic, or robotic.
On the other hand, a more discouraging possibility accompanies radiation treatment for prostate cancer. Many men are drawn to noninvasive radiation, despite weeks of daily treatment or permanent radioactive seed implants, because there are so few risks of immediate side effects. However, radiation does not kill cancer instantly, as thermal ablation does, but rather interferes with the cancer cells’ ability to reproduce themselves. This requires continuous exposure to radiation over time. At the same time, the scatter effect of radiation begins to damage nearby healthy tissues, and this is the source of late-onset side effects like urinary, sexual and bowel problems.
Radiation poses a darker late-onset threat to a patient’s health: the development of secondary cancers. It is well established that the risk of bladder, rectal and colon cancers increases following prostate cancer radiation. Now leukemia must be added to the list. A new study points to a type of cancer of the blood and bone marrow in which immature white blood cells proliferate. It is called acute myeloid leukemia (AML), and the accumulation of excess white blood cells in the bone marrow interferes with the production of normal blood cells. According to www.cancer.gov, exposure to radiation is one of the causes of adult AML. A new prostate cancer study by Wang et al. (Nov. 2016) reported, “Compared with elderly patients with prostate cancer (PCa) receiving surgery only, those receiving radiotherapy (RT), especially intensity-modulated radiotherapy (IMRT), had an increased risk of … acute myeloid leukemia (AML).” [vi] While the overall incidence for radiation therapy patients is low (1.2%) it is nearly twice the incidence of those who had surgery only (0.7%). Also, patients who had IMRT (intensity modulated radiation therapy) developed AML earlier (median 2.28 years) than those who had brachytherapy (median 3.78 years) or conventional external beam radiation (4.17 years). AML is difficult to treat once it has progressed, so it is important that it be diagnosed early when it may still be curable.
As we look forward to longer lifespans, men who develop prostate cancer – or any cancer – are urged to thoroughly consult with their doctors about the side effects of the treatments for which they are qualified. In addition, second opinions are always advisable, and thanks to the abundance of information on the internet, web-based research can shed additional light. It would be a cruel irony to undergo a treatment that succeeded in controlling one cancer, only to have it associated with the risk of another that might be more deadly.
For patients who qualify for a focal treatment, Focal Laser Ablation (FLA) is a safe, highly effective MRI-guided treatment that targets just the tumor, but spares urinary and sexual function. It is repeatable if necessary, and it leaves all future treatment options open if cancer comes back. The Sperling Prostate Center offers advanced 3T multiparametric MRI and MRI-guided targeted biopsy, the most sophisticated technology for diagnosing prostate cancer, and determining if a patient qualified for FLA. Our diagnostics also help men match their cancer with the most strategic treatment options, including Active Surveillance. For more information, visit www.sperlingprostatecenter.com.
[i] Ojha RP, Fischbach LA, Zhou Y, Felini MJ et al. Acute myeloid leukemia incidence following radiation therapy for localized or locally advanced prostate adenocarcinoma. Cancer Epidemiol. 2010 Jun;34(3):274-8.
[ii] Samoylov AS, Bushmanov AY, Udalov Y, Galstyan IA et al. Acute myeloid leukemia, prostate and skin cancer in acute radiation syndrome survivor after the 1986 Cherobyl Nuclear accident: case report. Radiat Prot Dosimetry. 2018 Dec 1;182(1):85-89.
[iii] Matsuura H, Sakurai M, Arima K. [Two cases of prostate cancer associated with acute myeloid leukemia presenting as thrombocytopenia during endocrine therapy]. Hinyokika Kiyo. 2003 Feb;49(2):87-90.
[iv] Copeland, L. “Life expectancy in the USA hits a record high.” USA Today, Oct. 9, 2014.
[v] Carlsson S, Jäderling F, Wallerstedt A, Nyberg T et al. Oncological and functional outcomes 1 year after radical prostatectomy for very-low-risk prostate cancer: results from the prospective LAPPRO trial. BJU Int. 2016 Aug;118(2):205-12.
[vi]Wang R, Zeidan AM, Yu JB, Soulos et al. Myelodysplastic syndromes and acute myeloid leukemia after radiotherapy for prostate cancer: a population-based study. Prostate. 2016 Nov 21 [Epub ahead of print].

domain: biology