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Monday, February 10, 2014
…death is not a fearful thing: HAAST’S EAGLED – ‘Haast’s Eagled’
Released toward the end of 2013, Haast’s Eagled’s self-titled debut is one of the most refreshing and somber albums in recent memory to come down the pike. Aided by an impenetrably thick, yet crystalline production job ‘Haast’s Eagled’ is a sweeping, atmospheric journey that is epic in scope due to the band’s success in combining loud and quiet dynamics to optimal effect. With only four tracks and a runtime reaching toward the forty minute mark the band has plenty of time, within each individual tune, to engage the listener by intertwining subtle instrumental nuances—most notably delicate, acoustic passages—amongst a barrage of heavy and hypnotic riffs. Add to this formula the occasional use of growled vocals, incidentally some of the most tasteful and successful to grace a doom album in the traditional vein, resulting in an extremely well-crafted and mature debut.
Opening strongly with “The Viking”, Haast’s Eagled immediately displays an aptitude for establishing a subdued, melancholy mood by utilizing a progressive, slow-build burn consisting of crackling needle on vinyl, distant rolls of thunder, and gentle piano and bass. Though the song’s intro is brief, it effectively sets the tone for the duration of the album. At the minute-and-a-half mark the bottom falls out and the guitars, drums, and bass come crashing in and immediately settle into a mid-paced groove. Both growled and clean vocals are used to establish a dichotomy within the song wavering between primitive barbarism and an emotive placidity.
The second track, “The Eye of God”, arises from the ashes of “The Viking’s” fading feedback. Beginning with Celtic influenced classical guitar, “The Eye God” eases into a brief, yet dreamy soundscape. Where “The Viking” hinted at loud and quiet dynamics, “The Eye of God” perfects it. Gentle, downhearted acoustic passages—held aloft with fluid basslines and prodding drums—are knotted with heavier, cavernous blasts of crushing distortion and, again, a mix of clean and growled vocals. “The Eye of God” is a killer track that invokes moments of The Flight of Sleipnir and even, at times, Pink Floyd.
The final tracks, “Tracking the Footsteps of Goliath” and “Cruithne Tide”, are instrumental tunes totaling seventeen minutes—half the album’s runtime. “Tracking the Footsteps of Goliath”, the shorter of the two, is an unsettling, lumbering tune punctuated by sound bites from the Jonestown “death tape”. “Cruithne Tide”, the twelve-and-a-half minute album-closer, fluctuates between sobering passages of soft instrumentation that eventually collapse beneath the weight of heavier riffs and, eventually, changes in tempo and trippy, psychedelic leads.
Haast’s Eagled seemingly came out of nowhere with their excellent, self-titled debut. The four tracks of ‘Haast’s Eagled’ are undeniably rooted in traditional doom, but the band has also created a unique and cohesive atmosphere through their use of varied instrumentation and dynamic song structures. The band has also announced that ‘Haast’s Eagled’ will see a physical release through Senseless Life Records, as will their follow-up release. Based on the strength of their debut—here’s looking forward to the band’s continued evolution and next release…
Haast's Eagled Facebook
Haast's Eagled Bandcamp
Senseless Life Records Homepage
Senseless Life Records Facebook


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The vaccine, made right here in West Michigan, is the first of the three approved vaccines to move beyond the emergency use stage for those 16 and older. The vaccine will now be known as Comirnaty and will remain available for those aged 12-15 under its current authorizations.
Reinvention is an amazing thing. I grew up in Chicago, and my one son lives about six blocks from an amazing reinvention/repurposing. Walgreen's, trying to fit into a gentrified neighborhood, took over a former bank building, and rather than tear down some classic architecture, fit their pharmacy into the existing structure. And it's quite amazing.

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Ischemic colitis (IC) remains a great threat after cardiac surgery with use of extracorporeal circulation. We aimed to identify predictive risk factors and influence of early catecholamine therapy for this disease.
We prospectively collected and analyzed data of 224 patients, who underwent laparotomy due to IC after initial cardiac surgery with use of extracorporeal circulation during 2002 and 2014. For further comparability 58 patients were identified, who underwent bypass surgery, aortic valve replacement or combination of both. Age ±5 years, sex, BMI ± 5, left ventricular function, peripheral arterial disease, diabetes and urgency status were used for match-pair analysis (1:1) to compare outcome and detect predictive risk factors. Highest catecholamine doses during 1 POD were compared for possible predictive potential.
Patients’ baseline characteristics showed no significant differences. In-hospital mortality of the IC group with a mean age of 71 years (14% female) was significantly higher than the control group with a mean age of 70 (14% female) (67% vs. 16%, p<0.001). Despite significantly longer bypass time in the IC group (133 ± 68 vs. 101 ± 42, p = 0.003), cross-clamp time remained comparable (64 ± 33 vs. 56 ± 25 p = 0.150). The majority of the IC group suffered low-output syndrome (71% vs. 14%, p<0.001) leading to significant higher lactate values within first 24h after operation (55 ± 46 mg/dl vs. 31 ± 30 mg/dl, p = 0.002). Logistic regression revealed elevated lactate values to be significant predictor for colectomy during the postoperative course (HR 1.008, CI 95% 1.003–1.014, p = 0.003). However, Receiver Operating Characteristic Curve calculates a cut-off value for lactate of 22.5 mg/dl (sensitivity 73% and specificity 57%). Furthermore, multivariate analysis showed low-output syndrome (HR 4.301, CI 95% 2.108–8.776, p<0.001) and vasopressin therapy (HR 1.108, CI 95% 1.012–1.213, p = 0.027) significantly influencing necessity of laparotomy.
Patients who undergo laparotomy for IC after initial cardiac surgery have a substantial in-hospital mortality risk. Early postoperative catecholamine levels do not influence the development of an IC except vasopressin. Elevated lactate remains merely a vague predictive risk factor.
Vaginal intraepithelial neoplasia (VAIN) is a pre-malignant lesion, potentially leading to vaginal cancer. It is a rare disease, representing less than 1% of all intraepithelial neoplasia of the female genital tract. Similar to cervical intraepithelial neoplasia (CIN), there are three different grades of VAIN. VAIN 1 is also known as a low-grade squamous intraepithelial lesion (LSIL), whereas VAIN 2 and VAIN 3 both represent high-grade squamous intraepithelial lesions (HSIL). Risk factors for the development of VAIN are similar to those for cervical neoplasia, i.e. promiscuity, starting sexual activity at an early age, tobacco consumption and infection with human papillomavirus (HPV). However, compared to other intraepithelial neoplasia such as CIN or VIN (vulvar intraepithelial neoplasia), there still is little understanding about the natural course of VAIN and its capacity for pro- or regression. Furthermore, there is controversial data about the HPV detection rate in VAIN lesions.
Patients and Methods
67 patients with histologically confirmed VAIN, who were diagnosed between 2003 and 2011 at the University Women´s Hospital of Heidelberg Germany, were included in this study. The biopsies of all participating patients were subjected to HPV genotyping. GP-E6/E7 Nested Multiplex PCR (NMPCR) was used to identify and genotype HPV. Eighteen pairs of type-specific nested PCR primers were assessed to detect the following "high-risk" HPV genotypes: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68, as well as the "low-risk" genotypes 6/11, 42, 43 and 44. The data was analyzed with the software SAS (Statistical Analysis System).
All 67 cases were eligible for DNA analysis. The median age was 53 years. The largest group with 53% (n = 36) was formed by women, who were first diagnosed with VAIN between the age of 41 to 60 years. 50% (n = 37) of the patients presented a VAIN in the upper 1/3 of the vagina. 58 (87%) were diagnosed with HSIL (VAIN). The median age in patients with LSIL (VAIN) was 53 years and in patients with HSIL (VAIN) 53.5 years. 12 women (18%) had an immunosuppression. HPV positivity was confirmed in 37 patients (55%). Except for a single patient, who had a triple infection with HPV types 6/11, 16 and 68, only infections with one single HPV genotype were detected. An infection with the HPV genotypes 31, 39, 45, 51, 58, 59, 66, 42, 43 and 44 couldn’t be found in any of the patients. In 28 patients with diagnosed VAIN, an infection with HPV 16 could be shown, 24 (86%) of them were diagnosed with a HSIL (VAIN). 16 (24%) women presented condylomata and 13 of them (81%) had a positive HPV status. However, only 47% of the women without condylomata presented a positive HPV status, resulting in a significant correlation (p = 0.0164) between condylomata and HPV infection. In 28 of all 67 patients (42%), recurrence of the neoplasia occurred.
HPV 16 is the main virus-type to be associated with the development of a VAIN. Also, HPV 16 infection, VIN or condylomata acuminata in the past medical history seemed to be significant factors for early relapse.
To compare the effects of resistance training versus passive physical therapy on bone survival in the metastatic bone during radiation therapy (RT) as combined treatment in patients with spinal bone metastases. Secondly, to evaluate overall survival and progression-free-survival (PFS) as well as to quantify prognostic factors of bone survival after combined treatment.
In this randomized trial 60 patients were allocated from September 2011 until March 2013 into one of the two groups: resistance training (group A) or passive physical therapy (group B) with thirty patients in each group during RT. We estimated patient survival using Kaplan-Meier survival method. The Wald-test was used to evaluate the prognostic importance of pathological fracture, primary site, Karnofsky performance status, localization of metastases, number of metastases, and cerebral metastases.
Median follow-up was 10 months (range 2–35). Bone survival showed no significant difference between groups (p = .303). Additionally no difference between groups could be detected in overall survival (p = .688) and PFS (p = .295). Local bone progression was detected in 16.7 % in group B, no irradiated bone in group A showed a local progression over the course (p = 0.019). In univariate analysis breast cancer, prostate cancer, and the presence of cerebral metastases had a significant impact on bone survival in group B, while no impact could be demonstrated in group A.
In this group of patients with spinal bone metastases we were able to show that guided resistance training of the paravertebral muscles had no essential impact on survival concomitant to RT. Importantly, no local bone progression in group A was detected, nevertheless no prognostic factor for combined treatment could be evaluated.
Clinical trial identifier NCT 01409720. Registered 8 February 2011.
Bone metastases; Spine; Resistance training; Survival; Palliative radiotherapy
Sedation prior to esophagogastroduodenoscopy is widespread and increases patient comfort. However, it demands additional trained personnel, accounts for up to 40 % of total endoscopy costs and impedes rapid hospital discharge. Most patients lose at least one day of work. 98 % of all serious adverse events occurring during esophagogastroduodenoscopy are ascribed to sedation. Acupuncture is reported to be effective as a supportive intervention for gastrointestinal endoscopy, similar to conventional premedication. We investigated whether acupuncture during elective diagnostic esophagogastroduodenoscopy could increase the comfort of patients refusing systemic sedation.
We performed a single-center, double-blinded, placebo-controlled superiority trial to compare the success rates of elective diagnostic esophagogastroduodenoscopies using real and placebo acupuncture. All patients aged 18 years or older scheduled for elective, diagnostic esophagogastroduodenoscopy who refused systemic sedation were eligible; 354 patients were randomized. The primary endpoint measure was the rate of successful esophagogastroduodenoscopies. The intervention was real or placebo acupuncture before and during esophagogastroduodenoscopy. Successful esophagogastroduodenoscopy was based on a composite score of patient satisfaction with the procedure on a Likert scale as well as quality of examination, as assessed by the examiner.
From February 2010 to July 2012, 678 patients were screened; 354 were included in the study. Baseline characteristics of the two groups showed a similar distribution in all but one parameter: more current smokers were allocated to the placebo group. The intention-to-treat analysis included 177 randomized patients in each group. Endoscopy could successfully be performed in 130 patients (73.5 %) in the real acupuncture group and 129 patients (72.9 %) in the placebo group. Willingness to repeat the procedure under the same conditions was 86.9 % in the real acupuncture group and 87.6 % in the placebo acupuncture group.
Esophagogastroduodenoscopy without sedation is safe and can successfully be performed in two-thirds of patients. Patients planned for elective esophagogastroduodenoscopy without sedation do not benefit from acupuncture of the Sinarteria respondens (Rs) 24 Chengjiang middle line, Pericard (Pc) 6 Neiguan bilateral, or Dickdarm (IC) 4 Hegu bilateral, according to traditional Chinese medicine meridian theory.
DRKS00000164. Registered on 10 December 2009.
Acupuncture; endoscopy; esophagogastroduodenoscopy; sedation
Adequate prediction of survival plays an important role in treatment decisions for patients with spinal bone metastases (SBM). Several prognostic factors are already used in daily clinical practice, but factors related to stability of SBM are still unknown. Therefore, we designed this study to identify these prognostic factors.
We retrospectively assessed 915 patients from solid tumors with commonly metastased into the bone treated at our department between January 2000 and January 2012. Lung cancer (NSCLC), breast and renal cancer listed in Table 1 are the most common solid tumors with bone metastasis in this study. Prostate carcinoma was excluded due to osteoblastic SBM with no influence for stability. We calculated overall survival (OS) and bone survival (BS; time between first diagnosis of bone metastases until death) with the Kaplan-Meier method and assessed prognostic factors for BS with the log-rank test and a Cox regression model separately for patients with stable and unstable SBM.
Median follow-up was 9.3 months. OS after 6 months, 1, 2, and 5 years was 81, 62, 42, and 25 % in patients with stable SBM and 78, 57, 38, and 22 % in patients with unstable SBM (p = 0.851). BS was 57, 38, 22, and 5 % in the group of stable SBM after 6 months, 1, 2, and 5 years. For patients with unstable SBM BS after 6 months, 1, 2, and 5 years was 59, 39, 19, and 8 % (p = 0.755). In multivariate analysis we found male gender (HR = 1.27 [95 % CI 1.01–1.60], p = 0.04), Karnofsky performance status (KPS) <80 % (HR = 1.27 [95%CI 1.04–1.55], p = 0.02) and non-small cell lung cancer (NSCLC; HR = 2.77 [95%CI 1.99–3.86], p < 0.0001) to be independent prognostic factors for shortened survival in patients with stable SBM. Independent prognostic factors for unstable SBM were age per year (HR = 1.01 [95 % CI 1.0–1.02], p = 0.025), multiple SBM (HR = 1.35 [95 % CI 1.1–1.65], p = 0.003), and NSCLC (HR = 2.0 [95 % CI 1.43–2.80], p < 0.0001). Additionally, not wearing an orthopedic corset (HR = 0.77 [95 % CI 0.62–0.96], p = 0.02) was associated with prolonged BS in patients with unstable SBM and in both groups BS was significantly longer in patients without liver metastases (stable SBM: HR = 0.72 [95 % CI 0.56–0.92], p = 0.008; unstable SBM: HR = 0.71 [95 % CI 0.54–0.92], p = 0.01).
Survival was equal for patients with stable and unstable SBM. However, prognostic factors differed in both groups and stability should therefore be considered in treatment decision-making.
Prognostic factors; Stability; Survival; Spinal bone metastases
The use of low intensity pulsed ultrasound (LIPUS) in the treatment of nonunions is still controversial. The present study is concerned with whether this procedure has a clinical use and which cofactors influence its therapeutic results.
In this prospective, single institution, observational study, data from October 2010 to October 2013 from 61 nonunions in 60 patients treated with EXOGEN® LIPUS therapy were analysed. The average age was 45.4 ± 9.81 (18–63) years. Treatment was primarily done on long bones of the lower extremity (75.4 %). All 61 nonunions were examined after treatment, and the rate of healing as well as functional and subjective results were evaluated. Based on clinical and radiological findings, patients were divided into two groups: G1—successful treatment; and G2—unsuccessful treatment. Groups were compared to one another to identify possible factors influencing treatment.
Twenty (32.8 %) patients showed bone consolidation with an average time of healing of 5.3 (2–7) months. In patients without successful treatment, who underwent revision surgery instead, full weight bearing took on average 3.7 months longer, and they were able to return to work 6.8 months later. Most of the treated patients (70.5 %) reported no improvement in pain. In G2, 12 (29.3 %) patients suffered in their previous history from osteitis; in G1 there were only two patients (10 %) (p = 0.012). There were further significant differences in the age of the fracture, the type of osteosynthesis, the gap size, as well as the NUSS score.
Despite patients being chosen strictly according to EXOGEN® indications, only a small number of patients with nonunions who underwent LIPUS therapy experienced successful treatment (32.8 %). Overall, its use resulted in a clear delay in the time of treatment, so that according to our results, the use of LIPUS should be seen critically in long bone nonunions and use should be made on a case-by-case basis.
Nonunion; Delayed fracture healing; Low intensity pulsed ultrasound; LIPUS; EXOGEN®
Despite substantial improvements in surgical and anesthesiological practices leading to decreased mortality of less than 5 % at high-volume centers, pancreatic surgery is still associated with high morbidity rates of up to 50 %. Attention is increasingly directed toward the optimization of perioperative management to reduce complications and enhance postoperative recovery. Currently, two different strategies for postoperative pain management after pancreatoduodenectomy are being routinely used: patient-controlled intravenous analgesia and thoracic epidural analgesia. Evidence is lacking to assess which strategy entails fewer postoperative complications.
The PAKMAN trial is designed as an adaptive, pragmatic, randomized, controlled, multicenter, open-label, superiority trial with two parallel study groups. A total of 370 patients scheduled for elective pancreatoduodenectomy will be randomized after giving written informed consent, and 278 patients are needed for analysis. Patients with chronic pancreatitis, severe chronic obstructive pulmonary disease (COPD), American Society of Anesthesiologists (ASA) physical status classification ≥ IV, or chronic pain syndrome will be excluded. The group A intervention includes intraoperative general anesthesia and postoperative patient-controlled intravenous analgesia; the group B intervention comprises combined intraoperative general anesthesia and epidural analgesia with postoperative epidural analgesia. The primary endpoint of this trial is a composite of the gastrointestinal complications (delayed gastric emptying, pancreatic fistula, biliary leak, gastrointestinal bleeding, and postoperative ileus) up to postoperative day 30. The aim is to investigate whether the frequency of gastrointestinal complications following pancreatoduodenectomy can be reduced by 15 % using postoperative, patient-controlled intravenous analgesia compared with epidural analgesia.
Several previous studies investigating the two different strategies for postoperative pain management have mainly focused on their effectiveness in pain control. However, the PAKMAN trial is the first to compare them with regard to their impact on the surgical endpoint “postoperative gastrointestinal complications” after pancreatoduodenectomy.
German Clinical Trials Register, DRKS00007784
Electronic supplementary material
The online version of this article (doi:10.1186/s13063-016-1306-4) contains supplementary material, which is available to authorized users.
Epidural analgesia; Patient-controlled intravenous analgesia; Pancreatoduodenectomy; Postoperative pain management; Postoperative complication; Randomized controlled trial
Neoadjuvant chemotherapy is a standard of care for patients with adenocarcinoma of the esophagus and stomach in Europe, but still only 20–40 % respond to therapy and the critical issue; how to treat nonresponding patients is still unclear. So far, there is no randomized trial evaluating the impact of early termination of neoadjuvant chemotherapy and immediate tumor resection in nonresponding patients with locally advanced gastroesophageal cancer on postoperative outcome. With this exploratory pilot trial, we want to get first estimates about the effect of discontinuation of chemotherapy with the aim to plan and conduct a further definitive trial.
OPTITREAT is designed as a single-center, randomized controlled pilot trial with two parallel study groups. Four weeks after starting neoadjuvant chemotherapy in all patients, clinical response will be assessed by endoscopy and endosonographic ultrasound. Then, nonresponding patients (n = 84) will be randomized in a 1:1 ratio to intervention group with stopping chemotherapy and immediate tumor resection or control group with completion of chemotherapy before surgery. Outcome measures are overall survival, R0 resection rate, perioperative morbidity and mortality, histopathological response, and quality of life. Statistical analysis will be based on the intention-to-treat population. Due to the study design as an explorative pilot trial, no formal sample size calculation was performed. The planned total sample size of 120 patients is considered ethical and large enough to show the feasibility and safety of the concept. First data on differences between the study groups in the defined endpoints will also be generated.
Individualized therapy is of utmost interest in the treatment of locally advanced gastroesophageal adenocarcinoma as less than half of the patients show objective response to current chemotherapy regimens. The findings of the OPTITREAT trial will help to get first data about clinical response evaluation followed by immediate tumor resection in nonresponding patients after 4 weeks of neoadjuvant chemotherapy. Based on the results of this pilot study, a future confirmatory trial will be planned to prove efficacy and evaluate significance.
German Clinical Trial Register number: DRKS00004668
Esophagogastric cancer; Neoadjvuant chemotherapy; Response evaluation
To compare the effects of resistance training versus passive physical therapy on bone turnover markers (BTM) in the metastatic bone during radiation therapy (RT) in patients with spinal bone metastases. Secondly, to evaluate an association of BTM to local response, skeletal-related events (SRE), and number of metastases.
In this randomized trial, 60 patients were allocated from September 2011 to March 2013 into one of the two arms: resistance training (Arm A) or passive physical therapy (Arm B) with thirty patients in each arm during RT. Biochemical markers such as pyridinoline (PYD), desoxy-pyridinoline (DPD), bone alkaline phosphatase (BAP), total amino-terminal propeptide of type I collagen (PINP), beta-isomer of carboxy-terminal telopeptide of type I collagen (CTX-I), and cross-linked N-telopeptide of type I collagen (NTX) were analyzed at baseline, and three months after RT.
Mean change values of PYD and CTX-I were significantly lower at 3 months after RT (p = 0.035 and p = 0.043) in Arm A. Importantly, all markers decreased in both arms, except of PYD and CTX-I in arm B, although significance was not reached for some biomarkers. In arm A, the local response was significantly higher (p = 0.003) and PINP could be identified as a predictor for survivors (OR 0.968, 95%CI 0.938–0.999, p = 0.043). BAP (OR 0.974, 95%CI 0.950–0.998, p = 0.034) and PINP (OR 1.025, 95%CI 1.001–1.049, p = 0.044) were related with an avoidance of SRE.
In this group of patients with spinal bone metastases, we were able to show that patients with guided resistance training of the paravertebral muscles can influence BTM. PYD and CTX-I decreased significantly in arm A. PINP can be considered as a complementary tool for prediction of local response, and PINP as well as BAP for avoidance of SRE.
Clinical trial identifier NCT 01409720. August 2, 2011.
Bone metastases; Spine; Physical exercise; Biochemical markers; Resistance training
We compared the accuracy of US to 3 T Tesla MRI for the detection of rotator cuff and long biceps tendon pathologies before joint replacement.
45 patients were prospectively included.
For the supraspinatus tendon, the accuracy of US when using MRI as reference was 91.1%. For the infraspinatus tendon, the accuracy with MRI as reference was 84.4%. The subscapularis tendon was consistently assessed by US and MRI in 35/45 patients (accuracy 77.8%). For the long biceps tendon the accuracy was 86.7%.
US detection of rotator cuff and biceps tendon integrity is comparable to MRI and should be preferred in revision cases.
Rotator cuff; Ultrasound; MRI; Shoulder; Supraspinatus
Supplemental Digital Content is available in the text
Pancreatic ductal adenocarcinoma (PDAC) is characterized by a strong fibrotic stromal reaction and diffuse growth pattern. Peritumoral fibrosis is often evident during surgery but only distinguishable from tumor by microscopic examination. The aim of this study was to investigate the role of clearance of fibrotic stromal reaction at the mesopancreatic resection margin as a criterion for radical resection and preoperative assessment of resectability.
Mesopancreatic stromal clearance status (S-status) was defined as the presence or absence (S+/S0) of fibrotic stromal reaction at the mesopancreatic resection margin. Detailed retrospective clinicopathologic re-evaluation of margin status and preoperative cross-sectional imaging was performed in a cohort of 91 patients operated for pancreatic head PDAC from 2001 to 2011.
Conventional margin positive resection (R+, tumor cells directly at the margin) was found in 36%. However, S-status further divided the margin negative (R0) group into patients with median survival of 14 months versus 31 months (S+ versus S0, P = 0.005). Overall rate of S+ was 53%. S-status and lymph node ratio constituted the only independent predictors of survival. Stranding of the superior mesenteric artery fat sheath was the only independent radiologic predictor of S+ resection, and achieved a 71% correct prediction of S-status.
Mesopancreatic stromal clearance is a major determinant of curative resection in PDAC, and preoperative prediction by cross-sectional imaging is possible, setting the basis for a new definition of borderline resectability.
Laparoscopy training has become an integral part of surgical education. Suturing and knot tying is a basic, yet inherent part of many laparoscopic operations, and should be mastered prior to operating on patients. One common and standardized suturing technique is the C-loop technique. In the standard training setting, on a box trainer, the trainee learns the psychomotor movements of the task and the laparoscopic visuospatial orientation simultaneously. Learning the psychomotor and visuospatial skills separately and sequentially may offer a more time-efficient alternative to the current standard of training.
This is a monocentric, two-arm randomized controlled trial. The participants are medical students in their clinical years (third to sixth year) at Heidelberg University who have not previously partaken in a laparoscopic training course lasting more than 2 hours. A total of 54 students are randomized into one of two arms in a 1:1 ratio to sequential learning (group 1) or control (group 2). Both groups receive a standardized introduction to the training center, laparoscopic instruments, and C-loop technique. Group 1 learn the C-loop using a transparent shoebox, thus only learning the psychomotor skills. Once they reach proficiency, they then perform the same knot tying procedure on a box trainer with standard laparoscopic view, where they combine their psychomotor skills with the visuospatial orientation inherent to laparoscopy. Group 2 learn the C-loop using solely a box trainer with standard laparoscopic view until they reach proficiency. Trainees work in pairs and time is recorded for each attempt. The primary outcome is mean total training time for each group. Secondary endpoints include procedural and knot quality subscore differences. Tertiary endpoints include studying the influence of gender and video game experience on performance.
This study addresses whether the learning of the psychomotor and visuospatial aspects of laparoscopic suturing and knot tying is optimal sequentially or simultaneously, by assessing total training time, procedural, and knot quality differences between the two groups. It will improve the efficiency of future laparoscopic suturing courses and may serve as an indicator for laparoscopic training in a broader context, i.e., not only for suturing and knot tying.
This trial was registered on 12 August 2015 with the trial registration number DRKS00008668.
Laparoscopy; Training; Education; Minimally invasive surgery; Suturing; Knot tying
Carcinogenic exocyclic-DNA adducts like 1,N6-etheno-2'-deoxyadenosine (εdA) are formed through reactive intermediates of 4-hydroxynonenal (4-HNE) or other lipid peroxidation (LPO) products with the DNA bases A, C, methyl-C and G. High levels of hepatic etheno-DNA adducts have been detected in cancer prone liver diseases including alcoholic liver disease (ALD). In ALD εdA levels correlated significantly with cytochrome P-450 2E1 (CYP2E1) expression which is also induced in non-alcoholic steatohepatitis (NASH). We investigated the occurrence of εdA adducts in children with NASH as a DNA damage marker.
Liver biopsies from 21 children/adolescents with histologically proven NASH were analysed for hepatic fat content, inflammation, and fibrosis. εdA levels in DNA, CYP2E1-expression and protein bound 4-hydroxynonenal (HNE) were semi-quantitatively evaluated by immunohistochemistry.
Among 21 NASH children, εdA levels in the liver were high in 3, moderate in 5, weak in 9 and not elevated in 4 patients. There was a positive correlation between CYP2E1 and protein-bound 4-HNE (r=0.60; P=0.008) and a trend for a positive relationship for CYP2E1 vs. staining intensity of εdA (r=0.45; P=0.06). Inflammatory activity and fibrosis correlated significantly (r=0.49, P=0.023).
Our results demonstrate for the first time the presence of elevated carcinogenic etheno-DNA lesions (εdA) in the majority (17/21) of liver biopsies from young NASH patients. Our data suggest that LPO-derived etheno-adducts are implicated in NASH. Whether these adducts may serve as predictive risk markers in NASH children to develop hepatocellular cancer later in life remains to be investigated.
Cytochrome P-450 2E; etheno-DNA adducts; hepatocellular cancer; lipidperoxidation-induced DNA damage; non-alcoholic steatohepatitis in children (NASH in children)
The influence of patients’ preoperative nutritional status on their clinical outcome has already been proven. Therefore, patients with malnutrition are in need of additional therapeutic efforts. However, for pancreatic surgery, evidence suggesting the adequacy of existing nutritional assessment scores to estimate malnutrition associated with postoperative outcome is limited.
The aim of the observational trial “Nutritional Risk in Major Abdominal Surgery (NURIMAS) Pancreas” is to prospectively assess and analyze different nutritional assessment scores for their prognostic value on postoperative complications in patients undergoing pancreatic surgery.
All patients scheduled to receive elective pancreatic surgery at the University Hospital of Heidelberg will be screened for eligibility. Preoperatively, 12 nutritional assessment scores will be collected and patients will be assigned either at risk or not at risk for malnutrition. The postoperative course will be followed prospectively and complications according to the Clavien-Dindo classification will be recorded. The prognostic value for complications will be evaluated for every score in a univariable and multivariable analysis corrected for known risk factors in pancreatic surgery.
Final data analysis is expected to be available during Spring 2016.
The NURIMAS Pancreas trial is a monocentric, prospective, observational trial aiming to find the most predictive clinical nutritional assessment score for postoperative complications. Using the results of this protocol as a knowledge base, it is possible to conduct nutritional risk-guided intervention trials to prevent postoperative complications in the pancreatic surgical population.
germanctr.de: DRKS00006340; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006340 (Archived by WebCite at http://www.webcitation.org/6bzXWSRYZ)
Diagnosis Related Group system; malnutrition; nutritional assessment; nutritional score; pancreatic surgery
Clinical care of unstable spinal bone metastases in many centers often includes patient immobilization by means of an orthopedic corset in order to prevent pathological fractures. The aim of this retrospective analysis was to evaluate the incidence of pathological fractures after radiotherapy (RT) in patients with and without orthopedic corsets and to assess prognostic factors for pathological fractures in patients with spinal bone metastases.
The incidence of pathological fractures in 915 patients with 2.195 osteolytic metastases in the thoracic and lumbar spine was evaluated retrospectively on the basis of computed tomography (CT) scans between January 2000 and January 2012 depending on prescription and wearing of patient—customized orthopedic corsets.
In the corset group, 6.8 and 8.0 % in no-corset group showed pathological fractures prior to RT, no significant difference between groups was detected (p = 0.473). After 6 months, patients in the corset group showed pathological fractures in 8.6 % and in no-corset group in 9.3 % (p = 0.709). The univariate and bivariate analyses demonstrated no significant prognostic factor for incidence of pathological fractures in both groups.
In this analysis, we could show for the first time in more than 900 patients, that abandoning a general corset supply in patients with spinal metastases does not significantly cause increased rates of pathological fractures. Importantly, the incidence of pathological fracture after RT was small.
The optimal type of bearing for hip arthroplasty remains a matter of debate. Ceramic-on-polyethylene (CoP) bearings are frequently used in younger and more active patients to reduce wear and increase biocompatibility compared to Metal-on-Polyethylene (MoP) bearings. However, in comparison to metal heads, the fracture risk of ceramic heads is higher. In addition, ceramic head fractures pose a serious complication which often necessitates major revision surgery. To date, there are no long-term data (>20 years of follow-up) reporting fracture rates of the ceramic femoral heads in CoP bearings. The purpose of this research was to investigate long-term CoP fracture rate.
We evaluated the clinical and radiographic results of 348 cementless THAs treated with 2nd generation Biolox® Al2O3 Ceramic-on-Polyethylene (CoP) bearings consecutively implanted between January 1985 and December 1989. The mean age at implantation was 57 years. The patients were followed for a minimum of 20 years. At the final 111 had died, and 5 were lost to follow-up. The cumulative incidence of ceramic head fractures in the long-term was estimated using a competing risk analysis.
The cumulative incidence of ceramic head fracture after 22-years was estimated with a competing risk analysis at 0.29 % after 22-years (SE = 2.09 %; 95 % - CI: 0.03-1.5 %). The radiographic analysis revealed no impending failures at final follow-up.
The fracture rate of second-generation ceramic heads using a CoP articulation remains very low into the third decade after cementless THA.
Bearings; Ceramic; Polyethylene; Hip Arthroplasty; THA; Hip Replacement; THR
Roux-en-Ygastric bypass (RYGB) and sleeve gastrectomy (SG) rank among the most frequently applied bariatric procedures worldwide due to their positive risk/benefit correlation. A systematic review revealed a similar excess weight loss (EWL) 2 years postoperatively between SG and RYGB. However, there is a lack of randomized controlled multi-centre trials comparing SG and RYGB, not only concerning EWL, but also in terms of remission of obesity-related co-morbidities, gastroesophageal reflux disease (GERD) and quality of life (QoL) in the mid- and long-term.
The BariSurg trial was designed as a multi-centre, randomized controlled patient and observer blind trial. The trial protocol was approved by the corresponding ethics committees of the centres. To demonstrate EWL non-inferiority of SG compared to RYGB, power calculation was performed according to a non-inferiority study design. Morbidity, mortality, remission of obesity-related co-morbidities, GERD course and QoL are major secondary endpoints. 248 patients between 18 and 70 years, with a body mass index (BMI) between 35–60 kg/m2 and indication for bariatric surgery according to the most recent German S3-guidelines will be randomized. The primary and secondary endpoints will be assessed prior to surgery and afterwards at discharge and at the time points 3–6, 12, 24, 36, 48 and 60 months postoperatively.
With its five year follow-up, the BariSurg-trial will provide further evidence based data concerning the impact of SG and RYGB on EWL, remission of obesity-related co-morbidities, the course of GERD and QoL.
The trial protocol has been registered in the German Clinical Trials Register DRKS00004766.
Sleeve gastrectomy; Roux-en-Ygastric bypass; Randomized controlled trial; Patient and observer blind trial; Long-term excess weight loss; Obesity related co-morbidity; Gastroesophageal reflux disease; Quality of life; Morbidity; Mortality
Bone metastases are an important clinical issue in women with breast cancer. Particularly, unstable spinal bone metastases (SBM) are a major cause of severe morbidity and reduced quality of life (QoL) due to frequent immobilization. Radiotherapy (RT) is the major treatment modality and is capable of promoting re-ossification and improving stability. Since local therapy response is excellent, survival of these patients with unstable SBM is of high clinical importance. We therefore conducted this analysis to assess survival and to determine prognostic factors for bone survival (BS) in women with breast cancer and unstable SBM.
A total population of 92 women with unstable SBM from breast cancer who were treated with RT at our department between January 2000 and January 2012 was retrospectively investigated. We calculated overall survival (OS) and BS (time between first diagnosis of bone metastases until death) with the Kaplan-Meier method and assessed prognostic factors for BS with a Cox regression model.
Mean age at first diagnosis of breast cancer was 60.8 years ± SD 12.4 years. OS after 1, 2 and 5 years was 84.8, 66.3 and 50 %, respectively. BS after 1, 2 and 5 years was 62.0, 33.7 and 12 %, respectively. An age > 50 years (p < .001; HR 1.036 [CI 1.015–1.057]), the presence of a single bone metastasis (p = .002; HR 0.469 [CI 0.292–0.753]) and triple negative phenotype (p < .001; HR 1.068 [CI 0.933–1.125]) were identified as independent prognostic factors for BS.
Our analysis demonstrated a short survival of women with breast cancer and unstable SBM. Age, presence of a solitary SBM and triple-negative phenotype correlated with survival. Our results may have an impact on therapeutic decisions in the future and offer a rationale for future prospective investigations.
Bone metastases; Breast cancer; Radiotherapy; Survival; Stability
Stereotactic body radiation therapy (SBRT)using intensity-modulated radiotherapy (IMRT) can be a safe modality for treating spinal bone metastasis with enhanced targeting accuracy and an effective method for achieving good tumor control and a rigorous pain response.
This is a single-center, prospective randomized controlled trial to evaluate pain relief after RT and consists of two treatment groups with 30 patients in each group. One group will receive single-fraction intensity-modulated RT with 1×24 Gy, and the other will receive fractionated RT with 10×3 Gy. The target parameters will be measured at baseline and at 3 and 6 months after RT.
The aim of this study is to evaluate pain relief after RT in patients with spinal bone metastases by means of two different techniques: stereotactic body radiation therapy and fractionated RT. The primary endpoint is pain relief at the 3-month time-point after RT. Secondly, quality of life, fatigue, overall and bone survival, and local control will be assessed.
ClinicalTrials.gov identifier NCT02358720 (June 2, 2015).
Bone metastases; Spine; SBRT; IMRT; Palliative radiotherapy
Cardiovascular diseases are the current leading causes of death and disability
To assess the effects of a basic educational program for cardiovascular prevention
in an unselected outpatient population.
All participants received an educational program to change to a healthy lifestyle.
Assessments were conducted at study enrollment and during follow-up. Symptoms,
habits, ATP III parameters for metabolic syndrome, and American Heart
Association’s 2020 parameters of cardiovascular health were assessed.
A total of 15,073 participants aged ≥ 18 years entered the study. Data
analysis was conducted in 3,009 patients who completed a second assessment. An
improvement in weight (from 76.6 ± 15.3 to 76.4 ± 15.3 kg, p =
0.002), dyspnea on exertion NYHA grade II (from 23.4% to 21.0%) and grade III
(from 15.8% to 14.0%) and a decrease in the proportion of current active smokers
(from 3.6% to 2.9%, p = 0.002) could be documented. The proportion of patients
with levels of triglycerides > 150 mg/dL (from 46.3% to 42.4%, p < 0.001)
and LDL cholesterol > 100 mg/dL (from 69.3% to 65.5%, p < 0.001) improved. A
≥ 20% improvement of AHA 2020 metrics at the level graded as poor was found
for smoking (-21.1%), diet (-29.8%), and cholesterol level (-23.6%). A large
dropout as a surrogate indicator for low patient adherence was documented
throughout the first 5 visits, 80% between the first and second assessments, 55.6%
between the second and third assessments, 43.6% between the third and fourth
assessments, and 38% between the fourth and fifth assessments.
A simple, basic educational program may improve symptoms and modifiable
cardiovascular risk factors, but shows low patient adherence.
Health Behavior; Life Style; Prevention; Obesity; Risk Factors; Health Education
Pro- and anti-inflammatory cytokines might have a large impact on the secondary phase and on the neurological outcome of patients with acute spinal cord injury (SCI). We measured the serum levels of different cytokines (Interferon-γ, Tumor Necrosis Factor-α, Interleukin-1β, IL-6, IL-8, IL-10, and Vascular Endothelial Growth Factor) over a 12-week period in 40 acute traumatic SCI patients: at admission on average one hour after initial trauma; at four, nine, 12, and 24 h; Three, and seven days after admission; and two, four, eight, and twelve weeks after admission. This was done using a Luminex Performance Human High Sensitivity Cytokine Panel. SCI was classified using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at time of admission and after 12 weeks. TNFα, IL-1β, IL-6, IL-8, and IL-10 concentrations were significantly higher in patients without neurological remission and in patients with an initial AIS A (p < 0.05). This study shows significant differences in cytokine concentrations shown in traumatic SCI patients with different neurological impairments and within a 12-week period. IL-8 and IL-10 are potential peripheral markers for neurological remission and rehabilitation after traumatic SCI. Furthermore our cytokine expression pattern of the acute, subacute, and intermediate phase of SCI establishes a possible basis for future studies to develop standardized monitoring, prognostic, and tracking techniques.
spinal cord injury; neuroregeneration; cytokines; inflammation; trauma
Despite multimodal therapy esophageal cancer often presents with poor prognosis. To improve outcome, tumor angiogenesis and anti-angiogenic therapeutic agents have recently gained importance. However, patient subgroups who benefit from anti-angiogenic therapy are not yet defined. In this retrospective exploratory study we investigated 9 angiogenic factors in patients’ serum and tissue samples with regard to their association with clinicopathological parameters, prognosis and response in patients with locally advanced preoperatively treated esophageal cancer.
From 2007 to 2012 preoperative serum and corresponding tumor tissue (n = 54), only serum (n = 20) or only tumor tissue (n = 4) were collected from esophageal squamous cell carcinoma (SCC) (n = 34) and adenocarcinoma of the esophagogastric junction (AEG) (n = 44) staged cT3/4NanyM0/x after preoperative chemo(radio)therapy. Angiogenic cytokine levels in both tissue and serum were measured by multiplex immunoassay.
Median survival in all patients was 28.49 months. No significant difference was found in survival between SCC and AEG (p = 0.90). 26 patients were histopathological responders. Histopathological response was associated with prognosis (p = 0.05).
Angiogenic factors were associated with the following clinicopathological factors: tumor tissue expression of Angiopoietin-2 and Follistatin was higher in SCC compared to AEG (p = 0.022 and p = 0.001).
High HGF and Follistatin expression in the tumor tissue was associated with poor prognosis in all patients (p = 0.037 and p = 0.036). No association with prognosis was found in the patients’ serum. Neither patients’ serum nor tumor tissue showed an association between angiogenic factors and response to neoadjuvant therapy.
Two angiogenic factors (HGF and Follistatin) in posttherapeutic tumor tissue are associated with prognosis in esophageal cancer patients. Biological differences of AEG and SCC with respect to angiogenesis were evident by the different expression of 2 angiogenic factors. Results are promising and should be pursued prospectively, optimally sequentially pre- and posttherapeutically.
Electronic supplementary material
The online version of this article (doi:10.1186/s12885-015-1120-5) contains supplementary material, which is available to authorized users.
Esophageal cancer; Prognosis; Angiogenic factors; Response
We designed this study to quantify the effects of radiotherapy (RT) on bone density as a local response in spinal bone metastases of women with breast cancer and, secondly, to establish bone density as an accurate and reproducible marker for assessment of local response to RT in spinal bone metastases.
We retrospectively assessed 135 osteolytic spinal metastases in 115 women with metastatic breast cancer treated at our department between January 2000 and January 2012. Primary endpoint was to compare bone density in the bone metastases before, 3 months after and 6 months after RT. Bone density was measured in Hounsfield units (HU) in computed tomography scans. We calculated mean values in HU and the standard deviation (SD) as a measurement of bone density before, 3 months and 6 months after RT. T-test was used for statistical analysis of difference in bone density as well as for univariate analysis of prognostic factors for difference in bone density 3 and 6 months after RT.
Mean bone density was 194.8 HU ± SD 123.0 at baseline. Bone density increased significantly by a mean of 145.8 HU ± SD 139.4 after 3 months (p = .0001) and by 250.3 HU ± SD 147.1 after 6 months (p < .0001). Women receiving bisphosphonates showed a tendency towards higher increase in bone density in the metastases after 3 months (152.6 HU ± SD 141.9 vs. 76.0 HU ± SD 86.1; p = .069) and pathological fractures before RT were associated with a significantly higher increase in bone density after 3 months (202.3 HU ± SD 161.9 vs. 130.3 HU ± SD 129.2; p = .013). Concomitant chemotherapy (ChT) or endocrine therapy (ET), hormone receptor status, performance score, applied overall RT dose and prescription of a surgical corset did not correlate with a difference in bone density after RT.
Bone density measurement in HU is a practicable and reproducible method for assessment of local RT response in osteolytic metastases in breast cancer. Our analysis demonstrated an excellent local response within metastases after palliative RT.
Bone density; Bone metastases; Breast cancer; Radiotherapy; Local response
The role of reactive carbonyl species, such as methylglyoxal (MG), has been overlooked within the context of the sepsis syndrome. The aims of this study were to assess the impact of MG formation in different inflammatory settings and to evaluate its use for early diagnosis as well as prognosis of the sepsis syndrome.
In total, 120 patients in three groups were enrolled in this observational clinical pilot study. The three groups included patients with septic shock (n = 60), postoperative controls (n = 30), and healthy volunteers (n = 30). Plasma samples from patients with septic shock were collected at sepsis onset and after 24 hours and 4, 7, 14, and 28 days. Plasma samples from postoperative controls were collected prior to surgery, immediately following the end of the surgical procedure as well as 24 hours later and from healthy volunteers once. Plasma levels of MG were determined by high-performance liquid chromatography. Additionally, plasma levels of procalcitonin, C-reactive protein, soluble CD14 subtype, and interleukin-6 were determined.
Patients with septic shock showed significantly higher plasma levels of MG at all measured times, compared with postoperative controls. MG was found to identify patients with septic shock more effectively—area under the curve (AUC): 0.993—than procalcitonin (AUC: 0.844), C-reactive protein (AUC: 0.791), soluble CD14 subtype (AUC: 0.832), and interleukin-6 (AUC: 0.898) as assessed by receiver operating characteristic (ROC) analysis. Moreover, plasma levels of MG in non-survivors were significantly higher than in survivors (sepsis onset: *P = 0.018 for 90-day survival; **P = 0.008 for 28-day survival). Plasma levels of MG proved to be an early predictor for survival in patients with septic shock (sepsis onset: ROC-AUC 0.710 for 28-day survival; ROC-AUC 0.686 for 90-day survival).
MG was identified as a marker for monitoring the onset, development, and remission of sepsis and was found to be more useful than routine diagnostic markers. Further studies are required to determine the extent of MG modification in sepsis and whether targeting this pathway could be therapeutically beneficial to the patient.
German Clinical Trials Register DRKS00000505. Registered 8 November 2010.
Electronic supplementary material
The online version of this article (doi:10.1186/s13054-014-0683-x) contains supplementary material, which is available to authorized users.
Uncemented femoral components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the third decade.
We evaluated (1) survivorship using femoral revision for any reason as the end point; (2) survivorship using femoral revision for aseptic loosening as the end point; and (3) patient-related and surgical risk factors for aseptic stem loosening at a minimum 20-year followup with an uncemented tapered titanium stem.
We reviewed the clinical and radiographic results of 354 THAs in 326 patients performed between January 1985 and December 1989 using an uncemented grit-blasted, tapered titanium femoral stem. Mean age at surgery was 57 years (range, 13–81 years). Kaplan-Meier survivorship analysis was used to estimate long-term survival. Minimum followup evaluation was 20 years (mean, 22 years; range, 20–25 years); at that time, 120 patients (127 hips) had died, and four patients (five hips) were lost to followup. Multivariate survival analysis using a Cox regression model was performed.
Survivorship at 22 years with revision of the femoral component for any reason as the end point was 86% (95% confidence interval [CI], 81%–90%). Survivorship for femoral revision for aseptic loosening as the end point was 93% at 22 years (95% CI, 90%–96%). Undersized stems (canal fill index ≤ 80%) and stems in hips with cup revision were at higher risk for aseptic loosening (hazard ratio, 4.2 and 4.3, respectively). There was a high rate of acetabular revision in this series (38%), mostly related to smooth-threaded, cementless sockets.
Uncemented femoral fixation was reliable into the third decade. Age, male sex, and diagnosis were not associated with a higher risk of aseptic loosening.
Level of Evidence
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

domain: medical


text:
Learn how to manage lower back pain with effective techniques and exercises. Learn the right exercises to strengthen your back muscles and relieve pain. Get tips for maintaining good posture and preventing back problems.
Back pain is one of the most common problems faced by people of different age groups. This can happen for a variety of reasons, including a sedentary lifestyle, poor posture, injury, or age-related changes. Pain can be acute or chronic and in any case causes discomfort and limitations in daily life.
However, there are some effective ways to help you get rid of lower back pain and strengthen your back. This includes exercise, stretching, and changes in daily life. In addition, it is important to pay attention to the features of sitting and standing, sleeping place and pillows, as well as adjusting the correct position when lifting and carrying heavy objects.
In this article, we will discuss some effective exercises and methods that will help you get rid of lower back pain. Remember, it's important to start small and build up gradually, and consult with a professional before starting a new exercise program.
Correct posture and spine support
Correct posture and spinal support play an important role in preventing and eliminating back pain. Poor posture and misalignment of the spine can cause back muscle strain, slipped discs and pain.
To maintain proper posture and back support, the following are recommended:
- Sit and stand straight. Try to keep your shoulders down, your back straight and your stomach slightly tense. Avoid slouching and stand up straight when you feel your posture getting worse.
- Use a medium height pillow. Choose a pillow that supports your neck and head without arching up or down. The pillow should be soft enough to provide comfort, but not so soft that the neck collapses.
- Avoid long periods of sitting. If you spend a lot of time at the computer or behind the wheel, take regular breaks to warm up and stretch your back.
- Strengthen the back muscles. Regular exercises to strengthen your back and correct your posture can help prevent and eliminate lower back pain. It is recommended to include exercises to strengthen core muscles (strength training, yoga, pilates) in your exercise program.
Correct posture and spinal support are important factors for spinal health. Following good posture and back strengthening guidelines can help prevent and eliminate lower back pain and improve overall fitness and well-being.
Exercises to strengthen back muscles
To strengthen the back muscles, it is recommended to regularly perform exercises that will help improve their strength and flexibility. It is important to remember that you should consult your doctor before starting any new physical activity to avoid possible injury or worsening of the condition.
- Pelvic lift
Lie on your back, bend your knees and place them shoulder-width apart on the floor. Lift the pelvis up, create a straight line from the knees to the shoulders, stay at the top point for a few seconds, and then slowly lower to the starting position. Repeat the exercise 10-15 times.
Lie down on your stomach. Raise your upper body, stretch your arms and fingers. Hold this position, stretching the muscles of the back, abdomen and buttocks for 30-60 seconds. Repeat the exercise 3-5 times.
- Raise your arms and legs
Get on all fours with support on your hands and knees. Slowly lift one arm forward and to the side, and the opposite leg back and up. Hold at the top for a few seconds and then slowly lower back to the starting position. Repeat the exercise on the other side. Perform 10-15 approaches on each side.
Get on all fours with support on your elbows and knees. Slowly lift one leg back and up, aiming for a straight line from head to heel. Hold at the top for a few seconds and then slowly lower back to the starting position. Repeat the exercise on the other leg. Perform 10-15 approaches on each leg.
In addition to these exercises, it is recommended to do swimming, yoga or pilates, because these types of physical activities also help to strengthen the back muscles.
It is important to remember that in order to achieve the best results, you must perform the exercises regularly and follow the correct technique. If you have any pain or limited movement, see your doctor or physical rehabilitation specialist.
Stretching and flexibility
Stretching and flexibility exercises are an important part of treating and preventing back pain. They help to strengthen and stretch the back muscles, improve blood circulation and increase the flexibility of the spine.
Here are some effective stretching and flexibility exercises for the lower back:
- cat-cowGet on all fours, bend your spine up (like a cat) and then down (like a cow). Repeat the exercise 10-15 times.
- leans forward. Sit on the floor with your legs straight. Bend one leg at the knee and hold it to the chest. Gradually bend forward, trying to reach the outstretched leg with your hand. Hold the position for 30 seconds, then repeat on the other side. Do 3 repetitions on each leg.
- body rotations. Sit on a chair or on the floor with your feet together. Turn to the right, try to rotate your torso as much as possible and hold the position for 30 seconds. Then repeat on the other side. Do 3 repetitions on each side.
- Breast stretching. Stand next to the door frame and place your hands on the frame at shoulder level. Enjoy the stretch in your chest muscles and hold the position for 30 seconds. Repeat 3 times.
Remember to do regular stretching and flexibility exercises to keep your back healthy and prevent lower back pain. Remember to consult your doctor or rehabilitation specialist before starting any exercise.
A set of exercises to relieve tension
Low back pain can be caused by a variety of reasons, including a sedentary lifestyle, poor posture, lack of physical activity, and injury. One way to relieve tension and reduce lower back pain is to regularly perform exercises aimed at strengthening the back muscles and stretching the body.
It is important to remember that you should consult your doctor or physical rehabilitation specialist before starting any exercise.
Stretching the back muscles:
- Stand straight on your legs, slowly bend forward, trying to touch the floor with your toes. Stay in this position for 10-15 seconds, then slowly return to the starting position. Repeat the exercise 5-10 times.
- Lie on your back, bend your knees and place your hands on your chest. Slowly lift your head and shoulders off the floor while extending your arms forward. Hold this pose for 10-15 seconds, then slowly lower to the floor. Repeat the exercise 5-10 times.
Strengthening the back muscles:
- Get on all fours, bend your left arm at the elbow and raise it parallel to the floor. As you exhale, slowly raise your right leg back and parallel to the floor. Hold this pose for 10-15 seconds, then slowly lower your arm and leg to the floor. Repeat the exercise 5-10 times for each side.
- Get on all fours, straighten your right arm and left leg parallel to the floor. As you exhale, slowly raise your right arm forward and left leg back until they are parallel to the floor. Hold this pose for 10-15 seconds, then slowly lower your arm and leg to the floor. Repeat the exercise 5-10 times for each side.
Stretching the lateral muscles:
- Stand straight and spread your legs shoulder width apart. Raise your left hand up and lean on the right, try to touch the floor with your fingertips. Stay in this position for 10-15 seconds, then slowly return to the starting position. Repeat the exercise on the other side. Do 5-10 repetitions on each side.
- Stand straight and spread your legs shoulder width apart. Raise your left arm up and lower your right arm along your body. Bend to the left, try to touch the floor with your fingertips. Stay in this position for 10-15 seconds, then slowly return to the starting position. Repeat the exercise on the other side. Do 5-10 repetitions on each side.
These exercises will help relieve tension and strengthen the back muscles, which will help reduce lower back pain. Regular exercise combined with good posture and an active lifestyle can help reduce the risk of back pain and maintain a healthy back.
Relaxation and massage
One of the effective ways to get rid of back pain is relaxation and massage. These methods help to relieve muscle tension, improve blood circulation and reduce pain.
Relaxation can include various techniques such as deep breathing, meditation, yoga and progressive muscle relaxation. This technique will help you relax, improve your posture and relieve stress.
Massage is also effective in relieving back pain. Back and lumbar massage helps to relieve muscle tension, improve blood circulation and reduce pain. You can do the massage yourself or contact a professional massage therapist.
For self-massage, you can use various massage devices, for example, rollers, balls or special devices. You can also use massage oils or creams for better gliding.
During the massage, you should pay attention to the points that cause pain or discomfort. It is necessary to massage, rub and stretch the muscles around these points to increase their flexibility and elasticity.
In addition to relaxation and massage, it is also useful to engage in physical exercises to strengthen the back muscles and correct posture. Regular exercise, swimming, yoga, pilates and special back exercises can help strengthen your muscles and reduce the likelihood of lower back pain.
It is important to remember that before starting any exercise or massage, you should consult a doctor or a physical rehabilitation specialist to choose the most suitable methods and avoid possible complications.
Avoid heavy lifting
Weight liftingIt is one of the main causes of back pain. Increased stress on the spine when lifting heavy objects can lead to injury and development of pain symptoms. To avoid this, follow some guidelines:
- Use proper lifting technique. When lifting heavy objects, especially from the floor, bend your knees without arching your back. Keep your back straight and hold heavy objects close to your body. Do not twist your body while lifting.
- Optimizing your workspace. Whenever possible, lift weights at or below waist level to reduce stress on your back. Use stands or carts to move objects, especially if they are very heavy or bulky.
- Spread the load. If a heavy object needs to be moved a long distance, break it into lighter parts and move them one by one. This will distribute the load evenly and reduce the risk of back fatigue.
- Use specialized machinery or equipment. In some cases, lifting very heavy or bulky objects may require the use of special equipment such as lifting straps or mechanical devices.
Avoiding heavy lifting or using proper lifting techniques can greatly reduce the risk of developing low back pain and help maintain a healthy spine.
Correct sitting and sleeping position
Correct sitting and sleeping position plays an important role in preventing back pain. Incorrect alignment can strain the spine and muscles, causing discomfort and pain. The following tips can help you improve your posture and reduce your risk of back pain.
correct sitting position
- Take a correct and stable position. Sit in a chair, press your back against the backrest, straighten your shoulders and maintain an even posture. Do not lean forward or backward.
- Distribute body weight equally on both legs. Do not sit on one buttock or cross your legs, as this can cause an uneven load on the spine.
- Bend your knees at right angles and keep them parallel to the floor. Feet should be firmly pressed on the floor.
- Use a pillow or lumbar support to support the natural curves of your spine.
Correct sleeping position
- Choose a mattress and pillow that matches your firmness. The mattress should be firm enough to support the spine, but not too hard to be comfortable to sleep on. The neck and head should be in a natural position on the pillow.
- Lie on your side or back. Avoid sleeping on your stomach as this can damage the cervical vertebrae and cause lower back pain.
- When you sleep on your back, place a small rolled pillow or rolled blanket under your knees to relieve excess strain on your back.
- When sleeping on your side, place a pillow between your knees to maintain proper spine alignment.
Maintaining correct sitting and sleeping postures will help reduce stress on the lumbar spine and reduce the risk of pain. Remember that taking regular breaks while sitting and choosing the right mattress and pillow also play an important role in maintaining a healthy spine.
Read the answer:
What exercises can help you get rid of lower back pain?
There are several exercises that can help relieve lower back pain. One of them is the "cat-camel" exercise. To perform it, you need to get on all fours with your hands under your shoulders and your knees under your pelvis. While inhaling, you need to slowly lift your back up, tense your abdominal muscles, and while exhaling, slowly lower your back down. This exercise stretches and strengthens your back, helping to relieve lower back pain. Stretching exercises such as side bends or forward bends can also be helpful in stretching your back muscles.
How can you relieve back pain at work?
There are a few things you can do to ease back pain at work. First of all, you should pay attention to your work chair: it should be comfortable and support the correct posture. If this is not the case, you can use special pillows or supports to correct your body position. It is also important not to forget to take a break and warm up: get up, stretch your back muscles and do some simple exercises. In addition, it is useful to perform exercises to warm up the back before starting the working day.
Can physical activity relieve back pain?
Yes, physical activity can help relieve back pain. Regular exercise such as swimming, yoga, pilates or playing sports strengthens the back muscles and improves flexibility. This helps reduce stress on the lower back and prevents straining. However, before you start exercising, you should consult your doctor to choose the right exercise routine for your condition.
The need for specialist consultation
Back pain can be caused by various reasons: osteochondrosis, scoliosis, muscle tension and others. To determine the exact cause of the pain and prescribe the right treatment, you need to consult a specialist.
A qualified doctor will conduct an examination, ask questions about the nature of the pain, the circumstances of its origin and, if necessary, conduct additional research. As a result of the consultation, the doctor will be able to determine which treatment methods will be most effective in each specific case.
Uncontrolled treatment without consulting a specialist can lead to deterioration of the condition of the spine and complication of the recovery process. The doctor will be able to select an individual set of exercises, massage, physiotherapy or prescribe medication.
It is also important to consult a specialist to rule out the possibility of a serious spinal disease that requires specific treatment or surgery. The doctor will be able to conduct all the necessary examinations to determine the presence or absence of pathologies.
It should be remembered that each organism is individual and what is suitable for one patient may be ineffective or even harmful for another. Therefore, it is recommended to contact a specialist for advice and individual treatment.

domain: health


text:
BREAKING NEWS: We will be closing up for the summer, but we will occasionally be checking email at our email@example.com address and you can call our Board Chair, Karen Augustin at (705) 772-0015 In the mean time, we are still accepting new candidates for our 2015 Autumn Auditions on Saturday, September 12th. Click here to find out more.
Note: we have moved out of the PSO offices on George St. and are currently searching for a new ‘home’. If you have a great idea or an offer for the KYO, contact us at firstname.lastname@example.org or (705) 772-0015.
Under the direction of Music Director Michael Newnham and professional instrumental coaches, the KYO offers young musicians an advanced level of instruction and a quality orchestral experience in the Kawartha region while enjoying the camaraderie of other young people.

domain: artistic


text: Beautiful setting in a heritage environment. Friendly owners and caretakers add to the ambience of the place. Not crowded ! Selected by only nature lovers. Horses and olives add to the attractiveness of the place. Ideal place for farm lovers and walkers. Away from the city noise and yet not that far. A Must stay.

domain: hobby


Photo via Slam Magazine
Everybody has seen it, LeBron James positioned twenty feet from the basket on a wing isolation performing a series of feigned pump fakes and jab-steps as he evaluates the help-side defense.
Lebron has become incomparably adept at surveying and timing the help defense’s obligation to get in and out of the paint as he prepares to attack the basket, swing the ball cross court in a manner that only he can, or rise up for the jump shot. The defense has formed a human barrier around LeBron in a zone formation where there are two players “guarding” a post player on the block.
One player is defending LeBron, another player is legitimately guarding the post player, yet another is circumventing the defensive three-second rule by touching the same post player while standing in the paint, while the remaining two defenders are pinched in waiting to react to the King’s looming decision.
This scenario is one that Michael Jordan and his contemporaries never had to confront during their NBA heyday. Before the 2000-2001 NBA season, the NBA did not allow zone defense. NCAA basketball primarily features the 2-3 zone, 3-2 zone and the 1-3-1 zone; while this game-altering rule change would allow these types of zones to be played, the aforementioned zones have not been consistently implemented by NBA defenses.
So how exactly did the installment of zone manifest itself within the defenses of the NBA?
On the NBA’s official website the rules changes for the 2000-2001 season regarding zone defense read:
- on the strongside, any defense is legal
- on the weakside, defenders must remain on the weakside outside the paint unless they are double-teaming the ball, picking up a free cutter or closely guarding an offensive player
Before the rule change, defending players were required to guard their respective men at all times. Granted, if a player who was not a proficient long-distance shooter encroached upon the perimeter, the defender did not have to hug them completely, but they were not allowed to drop below foul-line extended. This made stopping star players increasingly difficult.
The only way to attempt to neutralize a star player in the 90’s was to launch hard double-teams that placed the remainder of the defense in precarious situations which is certainly not a reliable tactic to consistently defend professional players.
[irp posts=”10101″ name=”LeBron James’ ‘The Decision’ costing him the 2017 NBA Finals”]
While the rule change stated that a team can only double team a player with the ball, the NBA rules treat every player in the paint as a cutter, and thus a simple touch to the nearest post player resets a single player’s defense three-second clock, potentially granting a player unlimited time in the paint.
Below are a couple of examples of how zone defenses were prohibited before the 2000-2001 rule change:
Here, Michael Jordan is isolated on the left mid-post and as he is getting into his move a Knicks player guarding the player at the top of the key comes down to offer help. This was illegal, called a technical foul, and Jordan was rewarded with a free throw and the ball:
In this next clip, Jordan is in the right corner preparing to use a ball screen that would send him to the middle of the court. In preparation for a shot or a drive, two Portland Trailblazers are “guarding” a post player who does not have the ball as they anticipate Jordan’s next move. This defensive alignment was illegal and was always called, take a look at a hysterical Scottie Pippen pleading with the refs to make the illegal defense call:
During this possession, lilliputian Mugsy Bogues finds himself matched up with the much larger Jordan on the perimeter. Anticipating the imminent doom, 7-foot-2 Robert Parish abandons his man and prepares to come to Bogues’ aid. Parish ends up staying in the paint for around three seconds, which would be illegal by today’s NBA rules, but by the 90’s rules, he was illegal the very moment he elected not to guard a player in the paint.
As definitively illustrated by the video clips above, 90’s rules made defending superstar players extremely difficult. A simple isolation call could strand a defender on an “island,” and with rules that prohibited pre-rotation or pre-help defense, it was often too late to stop a slashing player that beat his initial defender.
[irp posts=”9255″ name=”Shooting Myths, One-Motion Shooting And The WNBA”]
Not surprisingly, many star players were not too fond of the rule changes that occurred in the 2000-2001 season. In an interview with KICKS Magazine shortly after the rule change, superstars Tim Duncan, Kevin Garnett and Tracy Mcgrady offered their opinions on zone defense:
KICKS: “If you guys could change one rule in the League, what would it be?”
Kevin Garnett: “No zone.”
Tim Duncan: “Yeah, the zone.”
Tracy Mcgrady: “That shit is stupid.”
KICKS: “Because it didn’t do what they (The NBA) thought it would do?”
Kevin Garnett: “I think it puts players that are really good at a disadvantage… I remember Phoenix sat somebody literally right there (in the lane).”
Tracy Mcgrady: “It makes it hard for a guy like me-
Kevin Garnett: “Who penetrates.”
Tim Duncan: “It makes it hard for all of us.”
Tracy Mcgrady: ” It’s tough on all of us, it really is. When you’re trying to make a move, and you got another guy sittin’ right there on the same side just waitin.”
Kevin Garnett: “He ain’t even playin’ his man.”
Tracy Mcgrady: “Nah, not at all. “
Kevin Garnett: “That’s where teammates are really, really important. Not only is there pressure on you to get them the ball, but the pressure’s on them to be productive and draw the defense.”
Each of these players played before and after the implementation of zone defenses in the NBA, establishing their experience both before and after the change.
Even Jordan, arguably the greatest NBA player ever, was troubled by the zone defense. In a postgame interview in 2001 after a loss to the Charlotte Hornets, Jordan is quoted as saying, ” I never liked zones, I felt like that’s a lazy way to play defense and with them, you can eliminate a lot of the stars making things happen,” via USA Today’s Jenna Fryer.
As these three superstar players explained, the rule change had a profound impact on the way the game was played as it put a premium on shooting and demanded that star players trust their teammates if they wanted to succeed.
Below are a few NBA clips after the implementation of zone defenses:
In this clip, James catches the ball in the left corner and prepares to use a Dwyane Wade ball-screen that will send him to the middle of the court. As this unfolds, Tiago Splitter, Danny Green, Tim Duncan and Manu Ginobili are below foul-line extended, and thus would have been considered illegal before 2001. All four players pinch in and shrink the floor forcing James into a low percentage, contested mid-range pull-up:
In this next example, Wade has the ball at the top of the key as the clock is winding down in the fourth quarter. This clip illustrates one of the biggest differences in the NBA post-rule-change.
In years prior, a superstar player could get an isolation play whenever he wanted and he could be sure that it was a “true” ISO. However, after the rule change, situations like those in the video above became possible.
[irp posts=”10023″ name=”Raiders’ Marquette King tabs jab at Rihanna, LeBron James”]
In the clip, Shaquille O’Neal, who is on the right block, is being “covered” by two Sixers players. One player is legitimately guarding Shaq while standing outside of the paint, and another Sixers player sets up shop in the paint for six seconds, touching Shaq every three seconds to reset the count. Wade, seeing a defender literally sitting in the middle of the paint, is forced to take a tough outside shot:
Lastly, this clip illustrates exactly what McGrady was alluding to in his interview with KICKS when he referenced the defending team being allowed to station players behind their man, lying in wait.
Here, James catches the ball on the right wing and prepares his move on Jimmy Butler. As LeBron is getting into his move the Bulls defense shifts its position. Before LeBron can even put the ball on the floor, Taj Gibson maneuvers right behind Butler, frantically jumping up and down. While this is happening, Joakim Noah drops down to take Gibson’s man and Nate Robinson drops below foul-line extended to provide additional support, forcing LeBron into a poor shot.
After providing all of this evidence to the nostalgic NBA fan who believes that the 90’s were the more challenging era in which to play hoops, the desperate fan will condescendingly point to hand-checking. For those who are not aware, hand-checking has been one of the most frequent talking points for fans who passionately argue that the 90’s was the more difficult epoch for top-flight players to truly strut their stuff.
Unfortunately for this line of thinking, hand-checking was abolished in 1979:
- “Clarification added to prohibit hand-checking through “rigid enforcement” of rule allowing a defensive player to retain contact with his opponent so long as he does not impede his opponent’s progress”- NBA.com- NBA Rules History.
The myth that hand checking was refereed any differently than it is in 2017 is simply that: a myth.
Below are videos from the 1980’s and 1990’s where hand checking is clearly called as a foul:
In this first video in 1988, Vinnie “The Microwave” Johnson performs a left-to-right crossover on the Sixers player, and the defender uses his hand to stop him from going to the basket. The referee calls the foul and gestures with his arms that it is a hand checking foul. The ignorant crowd boos in response, but none of the players argue or gesticulate in any way because it is a routine call:
This next video is a collection of three separate instances that Jordan’s defender puts minimal hand contact on Jordan and a foul is called immediately as Jordan dribbles the ball:
Lastly, hand-checking still occurs in today’s NBA. Yes, they call it today, as they called it in the 1990’s as well. That being said, here is a collection of some plays where hand-checking is not called in the contemporary NBA:
So, what does all of this mean?
Well, it’s fairly blatant that the two different eras of basketball cannot be compared because of the differences in rules. When was it more difficult to play NBA basketball, the 1990’s? Or the 2000’s? “Harder for whom?” are the questions that demand to be asked and answered.
There is overwhelming evidence pointing towards the 1990’s being a significantly easier era in which to battle as a superstar player because zone defenses were not allowed. Having said that, I believe that role players, especially shooters and off the ball players, are currently experiencing their most exciting moment to date. The zone defenses allow teams to load up on superstars, which in turn puts a premium on players that can space the floor.
[irp posts=”9871″ name=”Durant’s basketball shouldn’t surprise us, his unselfishness should”]
Overall, this rule change in the 2000-2001 NBA season has had a positive impact on basketball. In the 1990’s, children grew up watching stagnant “ISO ball” that only existed in the NBA.
At every other level, teams were allowed to play zone and I believe that this made young athletes who idolized certain players develop bad habits. Without zone defenses in the league, the NBA was able to more efficiently market the premier players as stars, making it easier for them to score. It has now been close to two decades since zone has been allowed in the NBA and star players still shine, the only difference is that defenses can be more complex and unpredictable which forces the stars to get others involved.
–Videos courtesy of Ron M. at the Youtube Channel ‘TheRiggedBA’.


text:
(Abt 1826-Bef 1863)
McARTHUR, Mary 1
Mary married Arthur STEWART, son of Samuel STEWART and Frances UNKNOWN, about 1840 in Prob. Ontario, Canada. (Arthur STEWART was born on 14 Oct 1823 in Ireland and died on 21 Jan 1908 in Logan, Perth County, Ontario, Canada 2.)
1 1851 Census of Canada West, New Brunswick and Nova Scotia (Logan, Perth County, Ontario, Canada). Repository: Ancestry. Surety: 4. Lists Arthur Stuart [spelled Stewart] (age 27, b. Ireland), wife Mary (age 30, b. Ireland) and children Fanny (age 6, b. Ontario) and Mary Jane (age 3, b. Ontario), living in Logan, Ontario. Arthur is listed as a "farmer." The family's religion is listed as Presbyterian.
Ontario Canada Deaths, 1869-1932 (Logan, Perth County, Ontario; 1908). Surety: 4. Stewart, Arthur
Date of Death: 21 Jan 1908
Age: 84 yrs
Marital Status: married
Place of Birth: Ireland
Cause of Death: old age, three days
Physician: W.J.M. Armstrong, M.D.
Informant: W.J.M. Armsrong, M.D.

domain: history


text:
Boy,do those Fightin' Irish alumni have a sense of humor! A group...well a guy named Tom Reynolds who claims to be spokesman for a group...has bought space on a billboard near the campus of Notre Dame. The billboard reads "Best wishes to Charlie Weiss in the 5th year of his college coaching internship - Linebacker Alumni."
Reynolds, who allegedly played for the Irish back in the day when they were too good for things like bowl games, claims to represent fifty former Irish players from the same highfalutin' era. He/they are threatening to wear shirts with the same message as the billboard to the Notre Dame opener against Nevada, which he is allegedly selling to defray the cost for the billboard. There's no evidence yet if these shirts (or the group) actually exist, or where the public can buy them.
As for Charlie Weiss' reaction? “I’m the head coach at Notre Dame — I mean, welcome to my world...Tell ‘em thanks a lot for wishing me best wishes. I heard about it, I haven’t seen it and we’ll just leave it at that.” Translation: He wants to take that billboard, polish it up, turn it sideways, and ...well, you get the drill.

domain: sports


text:
The Justice Office is warning Missouri officials that the state can’t overlook federal regulation, soon after the governor signed a monthly bill last 7 days that bans police from implementing federal gun procedures
WASHINGTON — The Justice Department is warning Missouri officers that the state cannot ignore federal regulation, following the governor signed a bill very last week that bans law enforcement from implementing federal gun procedures.
In a letter sent Wednesday night time and attained by The Associated Push, Justice officers claimed the U.S. Constitution’s Supremacy Clause outweighs the measure that Gov. Mike Parson signed into legislation Saturday. The new rules penalize local law enforcement departments if their officers enforce federal gun laws.
Performing Assistant Lawyer Basic Brian Boynton claimed the legislation threatens to disrupt the functioning romantic relationship between federal and local authorities, they said in the letter, noting that Missouri receives federal grants and complex help.
“The community protection of the persons of the United States and citizens of Missouri is paramount,” Boynton wrote in the letter.
Missouri’s regulation would topic legislation enforcement businesses with officers who knowingly enforce any federal laws to a wonderful of about $50,000 per violating officer.
Republican lawmakers who labored to go the invoice have stated they had been enthusiastic by the likely of a lot more restrictive gun legal guidelines in the Biden administration. But state Democrats have argued the regulation is unconstitutional and have predicted it would not pass a problem in the courts.
The Justice Office argued in the letter that the point out lacks the authority to defend any Missouri enterprises or citizens from federal law or to avoid federal legislation enforcement officers from carrying out their duties.
Boynton mentioned the monthly bill “conflicts with federal firearms legislation and regulation” and federal legislation would supersede the state’s new statute. He stated federal agents and the U.S. attorney’s places of work in the point out would continue on to enforce all federal firearms regulations and regulations. He questioned that Parson and Eric Schmitt, the state’s lawyer standard, explain the law and how it would do the job in a response by Friday.
Six states have handed laws eradicating or weakening hid-carry permit needs this 12 months, most lately Texas, wherever Republican Gov. Greg Abbott signed a invoice Wednesday. About 20 states now allow individuals to have concealed weapons without the need of a license. At minimum 3 other states have passed laws banning law enforcement from enforcing federal gun legislation, a preemptive shot at any new steps passed by Democrats.

domain: sociology


text:
Developed by Dubai Municipality, Al Karama Park is a hidden gem situated in the heart of one of Dubai’s most populated and lively districts. With lush-green landscapes and playgrounds, the park offers a much-needed escape from the hustle and bustle of the city. We’ve compiled everything you need to know about this tranquil retreat.
Nestled amidst the vibrant streets of Karama, Karama Park is a leafy green sanctuary in Dubai that represents a perfect place to relax or hang out with friends and family. The park is also home to a recycling center – a sustainability initiative that collects recyclable materials and utilises them for a greater good – be it environmentally or for reusability.
Al Karama Park is a somewhat surprisingly peaceful retreat amidst one of Dubai’s most vibrant districts. With its beautifully-designed, classic clock and abundance of greenery, the park has a welcoming feel that ensures its enduring popularity with local residents. Visitors to the park will enjoy all that it has to offer, including:
Plenty of benches to take the weight off your feet.
Badminton and cricket playing facilities.
Running and biking trails.
Numerous grassy areas that are perfect for a picnics.

domain: travel


text:
Check out the concerts in your area and never miss a show.
Saturday, October 28th, 2017
A very special Halloween Spooktacular show ft. Halloween costume contest, a bunch of great New Brunswick bands and us. And we become The BOO Radley Project for the evening. How cool is that?

domain: entertainment


text:
This guide will help you learn to use the U.S. Major Dailies database. To access the database, use the link below!
From the library homepage, look below the main search box and select Databases.
It is listed alphabetically as US Major Dailies, or under the Database Type selection "News/Magazine."
Off-campus Access requires your LancerPoint username and password.
US Major Dailies includes the following publications:
Chicago Tribune (1985 to present)
Los Angeles Times (1985 to present)
New York Times (1980 to present)
Wall Street Journal (1984 to present)
The Washington Post (1987 to present)

domain: library


MIAMI (CBSLA.com/AP) — Shaquille O’Neal once brought in someone to set up a makeshift jewelry store in the Miami Heat players’ lounge, and often could be found surprising team executives and employees while naked.
Sometimes, he also played basketball.
For all those reasons, and many others, Thursday was a night to celebrate O’Neal at the arena he called home for parts of four seasons. The Heat raised O’Neal’s No. 32 to the rafters during halftime against the Los Angeles Lakers, a distinction the team has only previously awarded to Alonzo Mourning and Tim Hardaway.
“This is an inside joke for all the Miami people,” O’Neal said. “It’s definitely unexpected.”
Not from the Heat perspective, it wasn’t. Although it wasn’t a well-kept secret that O’Neal’s departure from the Heat did not come with either side particularly happy with and fond of the other — O’Neal thought he was being pranked when a team official called months ago to say this event was planned — it was always Miami’s intention to pay homage to his tenure with the franchise.
“He’s a once-in-a-lifetime player,” Heat President Pat Riley said. “There are a lot of them in the history of the NBA, but he’s a once-in-a-lifetime acquisition for us and meant so much to us.”
The retirement ceremony came one day after the Lakers announced that a bronze statue of O’Neal would be unveiled March 24 outside Staples Center. The nine-foot-tall, 1,200-pound statue will be suspended 10 feet above the ground in Star Plaza and connected to Staples Center.
The statue was created by the same artists — Julie Rotblatt Amrany and Omri Amrany — who also created the statues of Kareem Abdul-Jabbar, Chick Hearn, Earvin “Magic” Johnson, Luc Robitaille and Jerry West in Star Plaza.
Alex Rodriguez was there sitting courtside for the big night, and so was rapper DJ Khaled. Heat coach Erik Spoelstra emerged from the locker room for the halftime ceremony, as did former O’Neal teammate Udonis Haslem. There were a slew of gifts, including a framed version of the jersey banner that was raised, and a miniature 18-wheeler — like the one he arrived on in 2004 — driven out onto the court by O’Neal’s mother, Lucille.
“We would not have won the championship in 2006 without the efforts of Shaquille O’Neal,” Riley said.
O’Neal had about a dozen relatives and friends with him for the halftime celebration of Miami’s game against the Los Angeles Lakers, taking a break from his game-analyst duties on television for the festivities. The Heat gave commemorative T-shirts to all fans in attendance, and presented O’Neal with a $50,000 check for his foundation.
And it ended with O’Neal offering his favorite line: “Can you dig it?” he bellowed twice, as the crowd screamed.
(TM and © Copyright 2016 CBS Local Media, a division of CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2016 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.)


text:
Rom: Spaceknight, published by Marvel Comics, 32 pages.
As an 11-year-old child, discovering Rom: Spaceknight was just more icing on the cake that was the world of comics. The exciting concept of a heroic alien, stationed on our planet to wipe out an evil alien race living right under our noses? C’mon! You expect any red- blooded boy to pass that up?
True, what then seemed so amazingly original was not; at least not completely. And, the wonderfully dramatic and angst-ridden dialogue of a man who had traded his (alien) humanity to become a living weapon against evil now seems quite over the top, at times. Despite all of that, however, Rom, a production of Marvel Comics, which began at the tail-end of 1979, and ran through 1986, still appeals. It’s the same appeal I have for those habit-forming, goofy episodes of the original Star Trek series. Or any of the grade “B” sci-fi flicks I can’t seem to resist. (Mystery Science Theater 3000, anyone?)
There is some solid characterization there, however, thanks to Bill Mantlo, who wrote the entire series, Annuals included. Though a bit black and white, there is still room for heroes that are true-blue, and villains that are..., well, truly villainous. That was Rom and the evil “Dire Wraiths”, respectively.
Nearly every issue of Rom was an action-filled page turner, with little time for readers to catch their breath. And, with the premise that practically anyone could be a Wraith, there were ample twists and turns along the way.
Add to Mantlo’s work that of two legendary comics artists, Sal Buscema, whose ability to portray breakneck comics action is surpassed by no one in the industry to this day, and Steve Ditko, co- creator of Spider-Man and Dr. Strange, who took over with issue 59, and you have a series that begs the question, “Why are there no Rom trade paperbacks?”
Rom: Spaceknight is recommended for all ages. Find it at comics shops and online retailers and auctions. Prices vary.


, pistol holster Purdy Applegate copy Detective Wond.jpg
Here's the Applegate, which is expertly handcrafted by Karla Van Horne of Purdy Gear, is a superb recreation of the Detective Wonder Holster originally produced by SD Myres of El Paso,TX circa 1930.
Designed to be worn on the belt, the pistol carried with the butt positioned at a downward angle against a thick piece of steel-reinforced leather. The pistol in question, my Colt Detective Special, sporting a unique “Fitz” conversion from the same era, fits (no pun intended) snugly between two pockets, one cradling the barrel, and the other cupping the butt. Drawing the pistol simply involves pulling the butt forward.
Part belt holster, part shoulder holster, in spite of the Detective Wonder Holster’s unique design, I’ve yet to stumble across an original Myres-made variant, and I suspect not many were made. Regardless, classic gunleather buffs like myself point to one particular event in history where the cement the holster Myres Detective Wonder Holster was called into action when one of the original members of the Office of Strategic Services (OSS) during World War II, Col. Rex Applegate was involved in a gunfight while in Mexico shortly after the war ended.
According to legend, Applegate and a friend were accosted by a man waving a machete after dinner one evening. For whatever reason, that evening Applegate, who normally carried a 2-inch Colt Fitz Special chambered in .45 ACP was carrying a 2-inch Smith & Wesson Safety Hammerless revolver —commonly referred to as a “lemon squeezer”—chambered in .38 S&W. He carried it muzzle up in an S.D. Myres Detective Wonder Holster. http://dailycaller.com/2015/01/06/the-applegate-purdy-indeed/