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A novel, multi-level approach to assess allograft incorporation in revision total hip arthroplasty
Tim Rolvien1,
Christian Friesecke2,
Sebastian Butscheidt1,
Thorsten Gehrke3,
Michael Hahn4 &
Klaus Püschel5
The successful use of allografts in reconstructive orthopedic surgery, including revision total hip arthroplasty (THA), has been outlined repeatedly. Nonetheless, as previous studies were primarily based on clinical follow-ups, we aimed to create an algorithm that accurately determines the extent of allograft incorporation in the acetabulum and femur using a suite of high-resolution imaging techniques. This study is based on a large patient database including > 4,500 patient data with previous revision THA and simultaneous use of allografts. While the database was continuously matched with the deceased individuals at the local forensic medicine department, complete hips were retrieved in case of a positive match. A positive match was achieved for n = 46 hips at a mean follow-up of 11.8 ± 5.1 years. Comprehensive imaging included contact radiography, high-resolution computed tomography (HR-pQCT), undecalcified histology of ground sections and quantitative backscattered electron imaging (qBEI). We here define a histomorphometric toolkit of parameters to precisely characterize the incorporation of structural (bulk) and morselized (chip) allografts in the acetabulum (n = 38) and femur (n = 8), including the defect area and interface length, microstructural and cellular bone turnover parameters as well as overlap and fibrosis thickness. This collection of samples, through its unique study design and precise definition of incorporation parameters, will provide the scientific community with a valuable source for further in-depth investigation of allograft incorporation and, beyond that, the regenerative potential of this osteoconductive scaffold.
Total hip arthroplasty (THA) represents a commonly performed surgical procedure to restore the joint function of the hip in patients with osteoarthritis (OA) and other joint diseases1. Only in Germany, THA is carried out over 250,000 times annually2,3. While overall excellent results regarding pain reduction and mobility are achieved, one of the major long-term complications is aseptic loosening of the components of the joint prosthesis (i.e., the acetabular cup and the femoral stem)4. Aseptic loosening is usually associated with bone loss around the prosthesis. During revision surgery, the removal of the implants can be accompanied by additional bone loss, which can be a major challenge for the fixation of the new prosthesis.
Allografts are commonly used to restore the host bone stock and to provide sufficient stability for the new prosthesis. Different techniques and types such as morselized ("chips") and structural ("bulk") bone allografts can be used depending on the defect size and configuration5,6. Although good to excellent short- to long-term clinical and radiological outcomes and survival rates of acetabular and femoral revisions using allografts have been documented in the literature7,8,9,10,11,12,13,14, the underlying factors for the success of allograft incorporation are not completely understood. It is likely that the defect size, the surgical technique, the type of allograft, the use of bone cement and host-related factors influence graft incorporation15.
In the current article, we present a unique approach to histologically assess the total incorporation potential of allografts used in revision THA. We have managed to include complete hip explants of 46 individuals (83% acetabulum, 17% femur) to precisely characterize the host bone–allograft bone interface. This recruitment procedure with post-mortem explantation allowed us to depict the complete interface region. Thus, we are able to assess different factors that may contribute to allograft incorporation and to compare the histological incorporation of structural allografts and allograft chips.
We included all patients who underwent cemented revision THA (acetabulum, femur) in combination with the use of allografts (chips, structural) at the ENDO-Klinik, Hamburg, Germany, one of the largest European centers for joint arthroplasty, between 1987 and 2009. These patients were included in a central database containing of > 4,500 patient data. From 2009 until today, this database has been continuously matched with the deceased individuals who have been examined by the university forensic medicine. In the case of a positive match and after informed consents and approval of the relatives, the hip (pelvis and femur) was explanted and transferred to our research facilities for further analyses. Exclusion criteria were documented loosening of the prosthetic components as well as evidence of a systemic disorder affecting bone turnover (e.g., hyperparathyroidism or an inflammatory or renal disorder) and local changes within the pelvis (e.g., malignant tumor and Paget disease). Furthermore, death was unrelated to the surgical procedure and included primarily traumatic causes or vascular events (e.g., acute stroke or myocardial infarction). While clinical data including surgical reports and perioperative radiographs were available for all patients, we were able to collect 46 hips of 42 individuals. In four cases, allografts had been used in different surgeries and at different locations. The detailed results of the initial study in 13 structural allografts is published elsewhere16. This study was approved by the ethics committee of the "Ärztekammer Hamburg, Germany" (WF-005/09) and complied with the Declaration of Helsinki.
In all cases, revision THA was performed due to aseptic loosening of the acetabular cup or the femoral stem associated with bone loss (Fig. 1). In the acetabulum, the extent of bone loss varied from minimal destruction (Paprosky 1–2) to more extensive (Paprosky 3) defects17,18. Paprosky 3 defects required reconstruction with structural allografts, which were usually additionally fixed with screws. The allograft was adapted as exactly as possible to the bony defect situation. The typical indications for such structural grafts were a bone-deficient acetabular superior dome or medial wall. As large anterior and posterior defects usually cannot be adequately reconstructed with allografts, metal supporting shells were used in these cases. Remaining incongruities were additionally filled with cancellous bone chips if needed. The reconstruction of Paprosky 1–2 defects (Fig. 1A), which is technically easier from a surgical point of view, was performed by preparing cancellous bone chips from the femoral head allograft.
Radiographic appearance of aseptic loosening and surgical reconstruction with allografts. (A) Left: Clinical radiograph [left hip, anteroposterior (AP)] showing a cemented cup with circumferential signs of loosening (red arrows), clear central migration with protrusion. Right: Successful reconstruction of the medial wall with allograft chips. The polyethylene cup is sufficiently lateralized (blue arrow). (B) Radiographic course (left femur, AP) in a patient with extensive bullous lysis around the femoral stem (red arrows) after cemented THA and increasing bony consolidation after revision THA and reconstruction with impacted allograft chips (blue arrows). Pre preoperative, post postoperative, mo. months.
While initially fresh frozen allografts had been used, thermal disinfection was applied from 1994 onwards. Thermal disinfection (101–109 °C for 45 min.) was carried out using a Lobator SD-2 system (Telos, Marburg, Germany) with subsequent cryopreservation at − 80 °C. The femoral head was ensured to be free of cartilage, and larger areas of cortical bone were removed. Subsequently, cancellous allograft chips with an edge length of 3–7 mm and irregular shape and size were prepared. This is necessary to achieve an optimal interlocking with each other and with the bone defect. The mixture of cancellous chips resulted in an ideal granulate of different grain sizes, which were impacted into the bone defect according to the impaction grafting technique described by Sloof et al. 19. The allograft chips were carefully degreased before implantation of the cemented cup. By using bone cement, the complete contact surface of the prosthesis could be embedded in the reconstructed acetabulum. Of note, cementless fixation techniques usually require at least 60% contact surface with the host bone20.
In the femur, large bone defects (ENDO-Klinik classification Grade 2–421 or Paprosky 2–422,23) were reconstructed with cancellous chips and a cemented stem according to the Exeter technique 24 (Fig. 1B).
Specimen preparation & imaging
After acquisition of all required clinical data (surgical reports, clinical radiographs), complete removal of the hips and digital contact radiography (DCR, Faxitron X-ray Corp., Wheeling, IL, USA) of the explants was performed (Fig. 2A). The additionally performed three-dimensional (3D) high-resolution computed tomography (HR-pQCT, Scanco Medical, Brüttisellen, Switzerland) of the respective regions of interest (acetabulum or femur) allowed us an exact localization of the transplant. From the identified complete interface region, cut sections were carried out using a diamond band saw (EXAKT Advanced Technologies, Germany). These cut sections were again imaged by contact radiography (Fig. 2B), and ground sections of the complete cut sections were performed according to a previous protocol from our group25,26. Briefly, processing of the specimens included fixation in 3.7% formaldehyde, dehydration in an ascending series of ethanol, embedding in a PMMA based plastic medium (Technovit 7200; EXAKT/Kulzer, Germany) and grinding with an EXAKT grinding unit. Ground sections (30 µm) were stained by toluidine blue.
Imaging and processing of the hip explants in 46 cases (acetabulum and femur). (A) After explantation of the hip region, digital contact radiography (DCR) of the complete explant was performed first. Blue arrows indicate the allograft localization in accordance with available surgical reports. (B) Further processing included DCR of the cut sections, where the allograft region could already be identified (blue arrows). (C) Overview images of the ground sections (GS) reveal the bone microstructure of the host bone and the allograft. Blue arrows: allograft localization.
The complete ground sections were scanned using an Olympus BX61 microscope (Olympus, Shinjuko, Tokyo, Japan) equipped with a camera and by merging 500 to 1,000 single images (50 × magnification) to create a large image file covering an overall area of approximately 20 cm2 (Fig. 2C). The acquired images were subsequently analyzed by Olympus Stream Motion 2.1 imaging software. Another cut section was subdivided into several parts for undecalcified histology processing (4 µm) and subsequent staining with toluidine blue, von Kossa and trichrome Masson-Goldner.
Next to histology and histomorphometry of the ground and histological sections, our study protocol also involves other micro-morphological techniques to further characterize the host bone–allograft bone interface. Quantitative backscattered electron imaging (qBEI, LEO 435 VP; LEO Electron Microscopy Ltd., Cambridge, England) is operated at 20 kV and 680 pA with a constant working distance. While the beam current is controlled using a Faraday cup, all parameters are kept stable and the grey values are controlled using calibration standards with carbon and aluminum (MAC Consultants Ltd., England). As the generated grey values of each pixel represent the mean calcium content (mean Ca-Wt%), the technique is used to measure the bone mineral density distribution (BMDD) as described previously27. Acid etching and subsequent scanning electron microscopy (SEM) will be performed to image the lacuna-canalicular network of the host bone and allograft bone as described28,29.
For all individuals, we have additionally prepared histological sections of obtained iliac crest biopsies to assess the overall skeletal status belonging to the respective specimens, which includes bone microstructure and turnover.
Prism software version 7 (GraphPad Software Inc., La Jolla, USA) was used for statistical analysis. Normal distribution of the data was tested with the D'Agostino & Pearson normality test. Datasets were analyzed by one-way ANOVA with Tukey's post hoc analysis for multiple comparisons in the case of normally distributed data. For non-normally distributed data, the Kruskal–Wallis test with Dunn's post hoc test for multiple comparisons was performed. All data are reported as individual values (scatter plots) and mean ± standard deviation (SD). Where appropriate, differences between groups were also reported with corresponding 95% confidence intervals (CI). A p-value ≤ 0.05 was considered as statistically significant.
Clinical characteristics
Of the 46 specimens included, 32/46 (69.6%) were female and 14/46 (30.4%) were male (Fig. 3A). Thirty-eight of 46 (82.6%) allograft specimens were obtained from the acetabulum, while the remaining 8/46 (17.4%) were allografts in the femur (Fig. 3B). Of the 38 acetabular allografts, 15/38 (39.5%) were structural (bulk) allografts and 23/38 (60.5%) were allograft chips (Fig. 3C). In most cases, polyethylene acetabular revision cups were implanted. Metal supporting shells (e.g., Burch-Schneider rings) were only used in 4 cases (2/23 chips, 2/15 structural). Additional synthetic grafts (hydroxyapatite, tantalum or glass ionomer) were used in 4/23 (17.4%) chips, 2/15 (13.3%) structural and 2/8 (25.0%) femoral allografts. The defect area determined in the ground sections was significantly larger in the specimens with previous use of acetabular structural allografts compared to acetabular chip allografts (p = 0.012) and femoral allografts (p = 0.0007), while no differences between acetabular chip allografts and femoral allografts were observed (Fig. 3D).
Demographic and disease-specific characteristics. (A) Sex distribution. (B) Skeletal region in which the allograft was implanted (acetabulum vs. femur). (C) Distribution of structural allografts (Str.) and allograft chips (Ch.) among the acetabular specimens. (D) Quantification of defect sizes in structural (Str.), chip (Ch.) and femoral (Fem.) allografts determined in the ground sections. Kruskal–Wallis test with Dunn correction for multiple comparisons. (E) Timeline demonstrating the mean age at primary total hip arthroplasty (THA), allograft use during the revision arthroplasty and analysis of the specimens at the time of death. (F) Comparison of the time in situ between structural (Str.), chip (Ch.) and femoral (Fem.) allografts. ANOVA with Tukey correction for multiple comparisons. (G) Summary of the conducted methods. HR-pQCT: High-resolution peripheral quantitative computed tomography, DCR: digital contact radiography, qBEI: quantitative backscattered electron imaging. (H) Three-dimensional HR-pQCT served for more detailed allograft localization, surface colors indicate virtual cut planes. (I) Differences in the success of graft detection (via HR-pQCT and histology). *p < 0.05, **p < 0.001.
The mean age at primary THA was 54.4 ± 10.4 years. While the allografts were used during the 1st to 3rd revision THA at an age of 71.2 ± 8.2 years, the mean age of death was 83.0 ± 7.5 years (Fig. 3E). The resulting time that the allografts remained in the individuals' body (i.e., the time in situ) varied from 1.2 to 27.1 years (11.8 ± 5.1 years). No differences in the time in situ between structural allografts, allograft chips and femoral allografts could be determined (mean difference structural vs. chips 3.4 years (95% CI − 0.6 to 7.4 years) p = 0.11; mean difference structural vs. femoral 1.8 years (95% CI − 3.5 to 7.1 years) p = 0.69; mean difference chips vs. femoral − 1.6 years (95% CI − 6.5 to 3.3 years) p = 0.11) (Fig. 3F). The individual data of the included 46 cases for structural and chip allografts (both acetabular) as well as femoral allografts is displayed in Supplementary Table 1.
Graft detection & definition of incorporation parameters
We have applied several methods for optimal graft detection (Fig. 3G). After initial localization of the grafts from the surgical reports and clinical radiographs, allografts were imaged in 3D by HR-pQCT (Fig. 3H). This enabled us to determine cut sections with the largest possible interface for further histomorphometric analyses. Graft detection was achieved in 13/15 (86.7%) of the structural allografts and in 16/23 (69.6%) of the allograft chips in the acetabulum as well as in 7/8 (87.5%) of the allograft chips in the femur (Fig. 3I).
A representative ground section overview image of an acetabulum with structural allograft and the definition of the respective histomorphometric incorporation parameters is provided in Fig. 4. From the high-resolution images of the complete ground sections (Fig. 4A), histology and qBEI images, the following quantitative parameters are defined and measured through digital image analysis (Fig. 4B):
Interface characterization: Several measurements can be obtained from the ground section images: Defect area & depth (mm2, mm), interface length (mm), direct contact of host bone and allograft bone (% of the interface length), overlap or remodeling width (mm) indicating the distance between the most distant avital remnants from the allograft bone body and the maximum ingrowth of the vital host bone penetrating the allograft bone.
Microstructure: The structural integrity of the host bone and allograft bone are characterized by the following parameters: Bone volume per tissue volume (BV/TV, %), trabecular number (Tb.N, 1/mm), trabecular thickness (Tb.Th, µm), trabecular separation (Tb.Sp, µm).
Cells/bone quality: The interface region, including the allograft and the host bone part, can be furthermore assessed on a cellular and bone quality level by cellular histomorphometry and qBEI. This includes: Osteoblast surface per bone surface (Ob.S/BS, %), osteoclast surface per bone surface (Oc.S/BS, %), number of osteocytes per bone area (N.Ot/B.Ar, 1/mm2), number of osteocyte canaliculi per osteocyte lacuna (N.Canaliculi/Ot.Lc, #), BMDD characteristics including the mean mineralization (CaMean, wt%) and mineralization heterogeneity (CaWidth, wt%).
Toolkit of parameters for the detailed analysis of allograft incorporation. (A) Overview of a ground section with a large, well-incorporated structural allograft (STRUCTURAL) with a schematic illustration of the incorporation analysis. The direct contact as well as the overlap between the host bone and allograft can be quantified from large high-resolution imaging files. The images also enable to visualize and quantify the cement to allograft bone interface, the implant as well as the microstructure of the different regions. Ob. osteoblast, Oc. osteoclast. (B) Along the different dimensions (mm to µm), several parameters to characterize the interface (length and width measurements), the microstructure and the cellular characteristics are defined. These parameters can be obtained using the respective different methods (right column). BV/TV bone volume per tissue volume, Tb.N trabecular number, Tb.Th trabecular thickness, Tb.Sp trabecular separation, Ob.S/BS osteoblast surface per bone surface, Oc.S/BS osteoclast surface per bone surface, N.Ot/B.Ar number of osteocytes per bone area, N.Canaliculi/Ot.Lc number of osteocyte canaliculi per osteocyte lacuna, CaMean mean mineralization, CaWidth mineralization heterogeneity.
Interface analysis, cement, fibrosis and graft stability
Our study algorithm enables a precise determination of the histological allograft incorporation through digital image analysis of large overview image files of the ground sections. This is achieved by an unmissable appearance of the implant, bone cement, fibrosis as well as dead allograft bone and viable host bone (Fig. 5A). Additional qBEI studies complement the algorithm, since allograft bone has a unique imaging appearance compared to host bone including hypermineralized osteocyte lacunae and significantly higher matrix mineralization of structural and chip allografts compared to the host bone (both p < 0.001) (Fig. 5B, C). In the case of impacted allograft chips, the bone cement can theoretically penetrate deeper into the allograft, while the chips may have a segmented appearance (Fig. 5D). The defined parameters adequately represent the defect size, host-related factors such as bone remodeling capacities, surgical impaction and cement penetration as well as the integrity of the graft, which can all be quantified in relation to the occurrence of fibrosis (Fig. 5E).
High-resolution imaging enables allograft detection and characterization. (A) In higher magnification, the individual areas (implant, cement, fibrosis, allograft, overlap, host bone) are well defined. (B) Assessment of bone mineral content by qBEI. Representative images demonstrate the differences in microstructure and mineralization distribution between host bone, structural and allograft chips. (C) Quantification of the mean mineralization (CaMean, % change compared to host bone (HB)). Both structural (Str.) and chip (Ch.) allografts show higher CaMean values. ANOVA with Tukey correction for multiple comparisons. ***p < 0.0001. (D) Characterization of the host bone–allograft interface in a case with previous implantation of allograft chips (CHIPS) (ground section, toluidine blue staining). In this case, large areas of fibrosis are visible, right image: orange markings illustrate the fibrous areas. (E) Outline of possible factors influencing the formation of fibrosis and thus the potential stability.
It is widely accepted in the orthopedic community that allografts represent a suitable option to address small to large acetabular or femoral bone defects, which represent a common problem in revision procedures (especially revision THA). This notion is primarily based on clinical and radiological evidence with good to excellent outcomes for structural and chip allografts in both the acetabulum9,19,30,31,32,33 and the femur14,19,34,35,36. On a histological level, previous studies in the acetabulum were limited to small n-numbers and indicated remained integrity of structural allografts with minimal remodeling37. While other histological studies have analyzed the incorporation of allograft chips in the acetabulum and the femur, they were all based on small core biopsies. These studies demonstrated new trabecular formation within the grafted area accompanied by fibrous ingrowth at mid- to long-term follow-up8,38,39. In the femur, a previous case report indicated that the implanted allografts chips had been largely replaced by viable cortical bone40.
We here present a novel, multi-level approach to assess the total incorporation of both structural allografts and allograft chips previously implanted in the acetabulum as well as allograft chips implanted in the femur. Since this approach is based on the combination of clinical data and high-resolution histological analyses in the context of a post-mortem cadaveric study that included complete removal of the respective hips, we are able to assess the complete interface region. To this end, the aim of the present study was to define several incorporation parameters that fully define the complete interface, microstructure and cellular processes. The aim of future studies on these specimens is to compare the allograft incorporation (i.e., the osteoconductive capacity) of structural allografts with allograft chips and of acetabular with femoral allografts. While we have already applied a selection of these parameters in an initial study on structural allografts in which we demonstrated successful incorporation with avital remnants of allograft bone in the center16, several clinical questions remain that can be answered with this unique collection of samples.
First, we aim to apply this approach in more detail to the collection of allograft chips (n = 23) as well as to the obtained femoral allografts (n = 8) in order to determine precise similarities and differences regarding the allograft incorporation. For example, although load has been found to have only minor influences on graft incorporation41, this study was based on a goat model with only short-term follow-up. It is generally known that mechanical loads have a remarkable impact on skeletal remodeling and overall integrity42. Especially the comparison between the acetabular and the femoral specimens could help to answer this question.
Second, as allograft particle size has been found to influence allograft incorporation43, the comparison between structural and chip allografts is of major interest. The definition of quantitative and reproducible parameters such as the host bone-allograft bone overlap, the fibrosis thickness as well as cellular parameters of bone turnover (i.e., osteoblasts, osteoclasts) is highly important to detect differences regarding incorporation and osteoconductive capacities. Specifically, it is important to find out whether critical size defects exist, in which structural allografts could be superior to allograft chips in terms of minimal fibrous areas and successful remodeling of the graft. The primary defect area is indeed larger in the specimens with previous use of structural allografts compared to allograft chips, however, the range of defect sizes is sufficient to perform inter-group comparisons. One of the main aims of future studies on the acquired sections is to determine factors that contribute to fibrous ingrowth, which most likely affects graft stability/instability. Furthermore, as there have been conflicting statements regarding the negative effects of cement on allograft incorporation, the cement-allograft bone interface could also be assessed in the present collection of samples.
Third, the time-dependency of both allograft incorporation and potential loosening/failure is not yet completely understood. It has been demonstrated that allograft incorporation may occur early (i.e., in the first weeks) with progressive loosening at long-term follow-up44. As this observation was based on a goat model and a maximum follow-up of 4 years, our collection of samples should provide information regarding this issue. Importantly, according to the initial findings of the current study, none of the implants showed a higher degree of loosening or collapse of the graft. Clinically, while low revision rates due to cup loosening have been detected in the midterm around 5 years31, in long-term follow-up there was a relevant rate of re-revision and loosening45,46.
We are aware that the defined parameters can only provide information regarding cellular and structural incorporation as well as other bone quality aspects but not clinical information such as re-loosening or re-revision rates. THA was not causal for death in any of the cases and only cases without clinical documentation of implant or transplant failure were included, which limits potential investigation into the factors contributing to failure. Nonetheless, it is conceivable that future experimental and biomechanical methods could also be applied on our specimens in order to test the stability of the interface region including the remodeled compared to the non-remodeled allograft as well as to areas that are limited to bone cement without graft material. Other limitations of the present multi-level approach include the fact that allograft bone could not be detected in a number of specimens, although its use had been documented in the corresponding surgical reports. The reasons for this could be either complete graft resorption/remodeling or inaccurate localization of the allograft. Nonetheless, the current algorithm including radiographic studies combined with three-dimensional HR-pQCT and ground sections is most likely the best possible way to achieve the highest possible percentage of allograft detection.
Taken together, this study provides a detailed overview and definition of histological incorporation parameters in a large cohort of patients with allograft use in revision THA. The collection of samples will serve the scientific community as a valuable source for further investigation including in-depth analysis of allograft incorporation in the acetabulum and femur. As the results will be analyzed as a function of different factors such as defect size or the use of structural allografts vs. allograft chips, important clinical implications can be derived in the future. This procedure primarily also provides the first sufficient quality control for the successful use of allografts in revision THA.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Lee, S. H., Ahn, Y. J., Chung, S. J., Kim, B. K. & Hwang, J. H. The use of allograft prosthesis composite for extensive proximal femoral bone deficiencies: a 2-to 9.8-year follow-up study. J. Arthroplasty 24, 1241–1248 (2009).
Hooten, J. P., Jr., Engh, C. A., Heekin, R. D. & Vinh, T. N. Structural bulk allografts in acetabular reconstruction. Analysis of two grafts retrieved at post-mortem. J. Bone Joint Surg. Br. 78, 270–275 (1996).
van der Donk, S., Buma, P., Slooff, T. J., Gardeniers, J. W. & Schreurs, B. W. Incorporation of morselized bone grafts: A study of 24 acetabular biopsy specimens. Clin. Orthop. Relat. Res. 131–141 (2002).
Buma, P. et al. Impacted graft incorporation after cemented acetabular revision. Histological evaluation in 8 patients. Acta Orthop. Scand. 67, 536–540 (1996).
Ling, R. S., Timperley, A. J. & Linder, L. Histology of cancellous impaction grafting in the femur. A case report. J. Bone Joint Surg. Br. 75, 693–696 (1993).
van der Donk, S., Buma, P., Verdonschot, N. & Schreurs, B. W. Effect of load on the early incorporation of impacted morsellized allografts. Biomaterials 23, 297–303 (2002).
Rolvien, T. et al. Long-term immobilization in elderly females causes a specific pattern of cortical bone and osteocyte deterioration different from postmenopausal osteoporosis. J. Bone Miner. Res. 35, 1343–1351 (2020).
Malinin, T. I., Carpenter, E. M. & Temple, H. T. Particulate bone allograft incorporation in regeneration of osseous defects; importance of particle sizes. Open Orthop. J. 1, 19–24 (2007).
Schimmel, J. W., Buma, P., Versleyen, D., Huiskes, R. & Slooff, T. J. Acetabular reconstruction with impacted morselized cancellous allografts in cemented hip arthroplasty: A histological and biomechanical study on the goat. J. Arthroplasty 13, 438–448 (1998).
Shinar, A. A. & Harris, W. H. Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty. Sixteen-year-average follow-up. J. Bone Joint Surg. Am. 79, 159–168 (1997).
Makita, H. et al. Revision total hip arthroplasty using the Kerboull acetabular reinforcement device and structural allograft for severe defects of the acetabulum. J. Arthroplasty 32, 3502–3509 (2017).
This study was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) under Grant No. RO 5925/1-1 (TR) and Stiftung Endoprothetik, Hamburg (MH and KP). The authors thank E. Leicht and A. Thieke for technical assistance in preparing the histological sections.
Open Access funding provided by Projekt DEAL.
Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
Tim Rolvien & Sebastian Butscheidt
Department of Orthopedics, Tabea Hospital, Kösterbergstr. 32, 22587, Hamburg, Germany
Christian Friesecke
Helios Endo Clinic Hamburg, Holstenstraße 2, 22767, Hamburg, Germany
Thorsten Gehrke
Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
Department of Forensic Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany
Klaus Püschel
Tim Rolvien
Sebastian Butscheidt
T.R., C.F., T.G., M.H. and K.P. designed the study; T.R., S.B. and M.H. performed experiments and prepared the specimens; K.P. performed autopsies. T.R., M.H., S.B. and K.P. acquired and analyzed the data; T.R. performed the statistical analysis; T.R. and K.P. wrote the manuscript; all authors interpreted the data, revised the manuscript and approved its final version.
Correspondence to Tim Rolvien.
Supplementary Information.
Rolvien, T., Friesecke, C., Butscheidt, S. et al. A novel, multi-level approach to assess allograft incorporation in revision total hip arthroplasty. Sci Rep 10, 15226 (2020). https://doi.org/10.1038/s41598-020-72257-3
Received: 05 June 2020
Accepted: 20 August 2020


text:
Muñoyerro es una localidad perteneciente al municipio de Bularros, en la provincia de Ávila, comunidad autónoma de Castilla y León, España. En 2018 contaba con 30 habitantes.

Referencias

Localidades de la provincia de Ávila
Pedanías de la provincia de Ávila

redpajama_set_name: RedPajamaWikipedia


text:
Glades Road
Office and co-working space in Glades Road
Flexible offices in Glades Road
The Glades Road Center is in an attractive low-rise building in one of the city's prestigious business addresses. It offers a Class A environment with newly renovated reception, business lounge and three meeting rooms. The city provides business opportunities for all types of companies and already has a broad range of corporate and regional headquarters, small businesses and innovative start-ups. Florida Atlantic University is one of the city's top employers. It is one of the largest business concentrations in south Florida and its economic resources include a well-educated, talented workforce. The city enjoys a high quality of life with excellent facilities. And just up the road are the beautiful Boca Raton beaches.
FROM FORT LAUDERDALE INTERNATIONAL AIRPORT
Take I-95 north to Glades Rd. exit.
Go west to One Boca Place Building.
FROM WEST PALM BEACH AIRPORT
Take I-95 south to Glades Rd. exit.
Workspaces at Glades Road
Mizner Park
Mizner Park enjoys a reputation for its business to business facilities, workforce is well-educated and boasts one of the largest business concentrations in south Florida.
The Arbors
set in The Arbors Office Park conveniently located for Boca Raton Airport and has immediate access to the I-95 interstate highway.
On a landscaped corporate campus Close to all amenities,minutes from major highways, less than an hour from airport.
Cypress Park West
In a business district highly accessible from Interstate 95, in a hi-tech hub.
Broward County's premier shopping complex moments from U.S. Highway 1 and I-95 with first-rate amenities, retail and restaurants onsite.
Just five minutes from the Fort Lauderdale beaches in an international business hub, good transport links.
Las Olas Square
Inspiring workspace at the heart of Fort Lauderdale's designer business hub.
In the pristine Crossroads Business Park near Fort Lauderdale, hosts the world's 3rd largest boat show.
South Pine Island (Office Suites Plus)
In an elegant low-level building with views of manicured gardens with easy access to I-595, I-75, I-95 and the Florida Turnpike.
One of the most sought-after addresses in the Sawgrass Corporate Park with easy access to the thriving business centers of Fort Lauderdale and Miami.
Emerald View
A hurricane proof building off Florida's Turnpike and Okeechobee Boulevard - three miles from I-95 and Palm Beach Int'l Airport.
Philips Point
In the heart of downtown, stunning views of Palm Beach Island, easy commute to Fort Lauderdale, Miami, Boca Raton and Coral Gables.
Next steps for working at: Glades Road

redpajama_set_name: RedPajamaCommonCrawl


text:
Jon McCormack
Codeform
Jon McCormack, Codeform, Virtual Ecosystem of Artificial Life, 2012
Artificial Life created from museum visitor's tickets, 2012.
Commission for the Ars Electronica Museum, Linz, Austria.
Codefom is a real-time 3D stereoscopic work developed specifically for Deep Space in the Ars Electronica Centre. Visitors to Deep Space can use their museum entry tickets to generate the "DNA" of a virtual creature that grows and develops in an electronic ecosystem. The QR code on each ticket is used to generate an artificial life-form that is unique to each visitor. Each new life form develops from an egg that floats in a pool on the floor. After a short time the embryo develops and hatches, beginning to move around within Deep Space. Here the creature may join other creatures that have been created by previous visitors in a digital ecosystem. Creatures mate and create offspring. Some creatures may die and others survive, creating a dynamic environment unique to each group of visitors. The most adapted creatures live on until the next show, moving about the floor. A visitor who returns to a later show can track the progress of their creature over evolutionary time and see how it has fared in the ecosystem and what it has evolved to become. While visually strange and electronic, the ecosystem of Codeform suggests an affinity with nature from the processes and behaviours of the system rather than its form and appearance.
Codeform is a reflection of popular concepts of genetics, it questions the influence of an individual in a collective society and the codification of the individual by technology. Inspired by the diminishing and changing relationship between natural and human-made environments, Codeform provides a glimpse into a new form of electronic nature.
This project was developed in collaboration with the Ars Electronica Future Lab and with support from Monash University and the Australian Research Council (Discovery Project DP1094064) and is part of Studiolab funded by the EC Seventh Framework Programme. The Australian Artist-in-Residence program at the FutureLab was initiated and produced by Novamedia in partnership with the Australia Council for the Arts and Ars Electronica.
Original Concept, Programming, Direction: Jon McCormack
Programming and Deep Space support: Benjamin Mayr
Sound design: Peter McIlwain (Sonic Design)
Codeform was developed as part of the Australian Artist-in-Residence program at the Ars Electronica FutureLab.
Keywords: Ars Electronica, art, artificial life, Austria, Codeform, ecosystemics, virtual ecosystem, virtual reality
Last modified Tuesday, January 27, 2015
Interview in the journal Nature.
Technical information on creative ecosystems.
Codeform Exhibitions
Current and Forthcoming
No current exhibitions found.
Ars Electronica Museum
Ars Electronica museum features two works by Jon McCormack: Codeform and Fifty Sisters
EvoMUSART 2014
New paper on variation and utility in Evolutionary Art to be presented at EvoMUSART 2014
The Penguin Pool
Jon McCormack will be speaking at "The Penguin Pool" Arup's global creative event series designed to inform, inspire and entertain.
Ars Electronica Festival 2012 – the Big Picture
I'll be presenting two new works at the 2012 Ars Electronica Festival.
Copyright © 2019 · All Rights Reserved · Jon McCormack


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We use food-grade, naturally derived USP glycerin, and natural conditioning agents from honey and the Brassica plant instead of petrochemicals. We are also committed to cruelty-free development and vow to never test our personal care products on animals.
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We are committed to cruelty-free development and manufacturing. Our products and formulations are never tested on animals and are Leaping Bunny-certified.


NAUGATUCK — The Naugatuck boys tennis team is learning how to battle through some hotly-contested matches.
The Greyhounds opened the season with a pair of 5-0 wins over Crosby and Wilby, before falling to Pomperaug, 4-1, in an out-of-league match.
Naugatuck got back to Naugatuck Valley League play last week, picking up three wins to improve to 5-1 on the season.
The Greyhounds handed Watertown its first loss of the season, 4-1, on April 9. Naugatuck's Chris Cook went to three sets before getting past Casey Butwell, 6-4, 4-6, 10-6. Jared Montini won a tie breaker 7-6 (9-7) and a 6-0, and Jay Mezzo earned a 6-1, 6-3 sweep to assure the Greyhounds' win.
The doubles team of Brandon Sampaio and Andres Maldonado took a pair of 6-0 decisions, and the team of D.J. Fine and Ray Hess dropped a close 4-6, 5-7 decision.
Naugatuck faced another stiff test against Woodland April 10 and pulled out a 3-2 win. Montini got by Dante Polletta 6-1, 6-2, and Jay Mezzo battled past Austin Roberts, 6-3, 7-5, to give Naugy a 2-1 advantage heading into doubles. The Greyhounds pulled out a close with the team of Fine and Jonathan Vincent earning a 7-5, 6-4 victory in the No. 2 doubles match.
"We just faced two real tough teams and were fortunate to come out with the wins," said Hayward about the Watertown and Woodland matches.
Naugatuck earned its third win in three days by beating Torrington on April 11. Cook and Montini won singles matches, and the teams of Sampaio and Maldonado and Fine and Vincent won in doubles play.
Naugatuck is set to play Holy Cross on Wednesday.


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Simply give us a call and we will answer any questions you may have about the 78419 dumpster rental procedure, allowed materials, size you may need, etc.
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text:
TribPapers
Meeting dominated by questions of accepting roads into town system
Abi Cole
Out of all the requests for private roads to be accepted into the town's road system, Creekside Village development was the only one allowed to go forward to testing stage to see if it met town standards.
Weaverville – Nearly 80 attendees joined the Town Council of Weaverville at a virtual meeting held on Wednesday, May 20. Many citizens that joined the call were predominantly invested in the discussion of public street commitment applications. Commissioners undertook the meeting that lasted nearly three hours.
A consent agenda was first approved, greenlighting the development of a subdivision plat, the monthly tax report and an audit contract for the town that included implementing programs to detect fraud.
Three public street commitment applications were submitted by residents and businesses for the Town of Weaverville to acquire private roads and make them public. If public, the Town of Weaverville bears the responsibility to maintain and fix the streets. While Weaver Village Way was petitioned to be public by Aldi, petitions for a collection of streets in Reems Creek Village, Reems Creek Villas, and the Creekside Village were spearheaded by fervent homeowners.
Weaverville Mayor Al Root noted that it was unlikely for the three roads petitioned in Reems Creek Village to be approved as public, saying that he is "Expecting significant skepticism that if they were to be examined would meet town standards." This is partly due to the private gate on Governor Thompson Terrace that prohibits public entry into the neighborhood by way of Hamburg Mountain Road. Commissioners affirmed that without the removal of this gate, the Reems Creek Village roads will likely never be acquired by the town and was voted down.
Contrarily, the private Garrison Branch Road of Creekside Village was allowed to begin the path to becoming public. Creekside Village Residents occupied the entire eighteen minutes of public comments with letters that they had mailed into the Town Council. "The Town of Weaverville would be placing the undue and onerous burden on the residents of Creekside, many of whom are retired if it does not incorporate the Creekside development into road maintenance… This is an equivalent of taxation without representation, and it is a taxation without receiving equitable services that other property owners are entitled to," said resident William Swartz in a submitted public comment, read to the commissioners.
Creekside Village is a finished development of approximately 155 homes pending approval to be included in the town's public roads. "For new development, developers must declare whether they want their streets to be private or public at the outset of the project," said the Town of Weaverville in a January press release. Creekside Village developer Serrus Capital Partners failed to alert Weaverville of a desire for the roads to be public at the dawn of the project, raising the possibility that the street was not constructed to Town standards. This jeopardizes its inclusion in Weaverville's 20 miles of public town streets.
Weaverville Councilmembers voted unanimously on Thursday, May 2, to proceed forward with an inspection of the Garrison Branch Road in the next three months at the cost of the homeowners. The homeowners will then have a six-month window to fix any problems found with the road before it is acquired by the city.
In another issue before the council, the board held a conditional zoning request hearing before the meeting on a development project on Garrison Branch Road. The final decision was held over to Wednesday night where it was approved after the developer accepted a limitation on only having two signs of 75 square feet instead of three.
Weaverville Town Manager's monthly report reminded attendees of upcoming events or notices involving the town and its residents. The public hearing on the proposed budget for the Fiscal Year 2020-2021 will take place on Tuesday, June 9, at 6 pm. Two events have been canceled in response to COVID-19, one being the popular June Summer Music Series that usually takes place on Main Street. Three sessions of the annual Citizen's Academy, providing the community with education on the workings of the town government, have already been canceled, but Town Manager Selena Coffey is considering conducting Academy sessions via Zoom if there is interest.
Weaverville officials have also begun working on bike/pedestrian grant applications to expand biking and pedestrian opportunities in the town. A resolution of support for the application passed Wednesday evening as the town recessed until then to allow any further comments on the two public hearings held before Monday's regular monthly meeting.
Council members also heard quarterly reports from the police, finance and fire departments to conclude the meeting on Monday.
Tags: Creekside Village, Reems Creek Village, Town Council of Weaverville, Zoning
Developers take notice
Clint Parker
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Communities in the process of developing the water supply chapter of their comprehensive plans will find guidance here. In addition, there is information to assist planning and zoning department staff who are reviewing a site plan that proposes water conservation measures. Select a topic below to see an expanded list of sub-topics that focus on your specific interest or question.
What conservation information should be contained in a Local Water Supply Plan?
MN Statute adopted in 2009 that establishes water conservation requirements for public water suppliers that construct new or increase existing appropriation of water.
Where is general guidance for comprehensive plans?
Is there guidance for developing Local Water Supply Plans?
Are there examples of building codes with water conservation requirements?
Are there templates for outdoor water restriction ordinances?
Where can I find a model water conservation ordinance (indoor)?
What tools are available to assist with reviewing development plans?
What are water conservation requirements in the MN Plumbing Code?


stripping of the free fatty acids under deep vacuum.
Physical refining - also called steam refining - is the neutralisation of fats and oils by steam stripping under vacuum.
This process is well suited to most edible oils provided they are thoroughly degummed and purified.
the requirements for effluent water treatment are minimised.
To properly neutralise the oil in the stripper, it is essential that the oil entering the neutraliser/stripper is free of impurities.


of the controversy. Either way, youre going to need strong evidence. Our national Constitution and Bill of Rights have ensured that the people of America maintain their basic rights.
tags: gun control act, shooter, debate Term Papers 1906 words (5.4 pages) Preview - Mary Read was only 19 years old on the last day of her life. The possession of a gun is a sign of power. And the worst problem of gun control is not that not every state prohibits its use but that this topic daunts a large amount of students. The culprits were either detained or killed. tags: Gun Rights Better Essays 944 words (2.7 pages) Preview - Gun Control in the United States has gone out of control. Even if we have stricter laws for guns, it will not stop killers from shooting innocent people. Columbine High School massacre, Eric Harris and Dylan Klebold, Firearm 1641 Words 5 Pages Open Document strengthening gun control English Composition I November 30, 2013 Argumentative Essay To Strengthen Gun Control or Not Gun control is an issue that is much talked about in the. There should not be any gun control laws, because criminals can get a gun no matter the law money talks; many of the gun massacres happen in gun-free zones; and when was the last time you saw a story on the national evening news about. So keep reading and find out more about the gun control laws that the federal and some state governments want to enforce.S. While others will argue that the current laws and regulations violate every Americans right to the Second Amendment.


The Law Offices of John C. Manoog, III is dedicated to fighting for Massachusetts residents who have been injured by prescription drug errors and other incidents of medical malpractice. Our Cape Cod pharmacy negligence lawyers have over 146 years of combined legal experience, which helps us develop strategies that are tailored to each client's situation as we assert their right to compensation for their injuries. We work tirelessly to investigate cases, negotiate favorable settlement deals when appropriate, and are always ready to take a case through the litigation process all the way to trial if this is needed. Explore our track record of success in personal injury cases to see the basis for our strong reputation.
Prescription drugs are often a key part of the pain management and healing process for people who have been hurt in an accident or are dealing with an ongoing illness or condition. Sometimes, however, they do more harm than good. For example, medication unfortunately may come with faulty dosage instructions or other inaccurate information about how it should be used. In other instances, a pharmacist may provide the wrong medication altogether while labeling it as the appropriate medication for the patient. Providing incorrect instructions or labels often leads to complications that may cause serious injuries and even death.
A person injured because a pharmacy provided incorrect information regarding the use of a drug or the contents of a bottle has a right to seek compensation from the parties that were responsible. State and federal laws hold pharmacists and prescription drug professionals to a high standard of care, based on their specialized training and experience in the industry, as well as a patient's lack of knowledge in this area. When a pharmacy provides drugs with inadequate instructions, or if it provides the wrong medication while labeling it as the correct medication, it is likely to be held responsible for any injuries that result.
To prove negligence in these cases, the victim usually needs to show that the person or entity being sued (the defendant) breached the applicable duty of care by providing inadequate, incomplete, or inaccurate information. The victim also must try to prove that the faulty instructions or label directly caused them to be hurt or exacerbated their pre-existing illness or injury. This process often requires detailed medical evidence and expert testimony describing the faulty instructions and showing precisely how they contributed to the victim's harm.
The compensation available in these cases typically includes damages for related medical costs and missed wages due to time away from a job. It may also provide money for pain and suffering, emotional distress, and other forms of harm that may be more subjective.
We have been representing injured individuals in pharmacy negligence and other cases since 1994. Our Cape Cod pharmacy negligence attorneys understand the pain and stress that these situations may cause for both the injured person and their family. We are committed to guiding clients through the legal process and pursuing the full compensation that they deserve. Our attorneys provide free case evaluations at offices in Hyannis and Plymouth, or in your home or hospital room as needed. We do not charge a fee in most cases unless we obtain compensation for you. Call us at 888-262-6664 or contact us online if you need a pharmacy negligence or medical malpractice attorney. Nós Falamos Português.


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Serving Greeley and Weld County, CO
Go & Do
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Groups raise $10,000
Roxye Arellano
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GHENT MOTOR CO. of Greeley and local chapters of the Colorado Future Farmers of America announced that the two organizations raised more than $10,000 in scholarship funds through the FFA/Chevrolet Scholarship Program.
The program ran from Aug. 23 to Oct. 22 and was managed by many local FFA high school chapters at Pawnee (Grover), Roosevelt (Johnstown-Milliken), Platte Valley (Kersey), Briggsdale and Valley (La Salle-Gilcrest-Platteville) high schools. FFA members accepted $5 donations from residents in exchange for a Chevrolet T-shirt and a chance to win a new 2005 Chevrolet Silverado.
The donated funds are earmarked for FFA chapter scholarships, the chapter's treasury for operational needs and to support the states' FFA organizations, which helps fund all statewide FFA programs.
Ghent Motor Co. provided the opportunity but also supported, promoted and elevated the scholarship program beyond their expectations, according to Scott Stump, Colorado FFA director.
Funds raised through the program will send help send FFA member to colleges, increase FFA programs and help defray the costs of chapter fees and enhance the development of future agricultural leaders.
Bob Ghent, president of Ghent Chevrolet in Greeley, said in a written statement that the program gave Ghent Motor Co. an opportunity to directly impact and participate in the community. As a business member in Greeley, he thinks it's the responsibility of the community to assist area students as they strive for success and meet their goals.
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With great leaders in our community, who would want to live anywhere else?
A big high-five should be given to the folks at Ghent Chevrolet for being a great role model for the youth of Weld County.
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Northridge cheerleaders are on their way to success.
The coed team competed in an all-girls competition because other coed teams had more males, and the stunts performed in 4A coed competition with as many as six guys on the teams were more advanced.
But having one less member, didn't stop them.
The 19 girls competed at the Colorado State Spirit Competition on Dec. 11 in Denver against 32 other teams throughout the state.
By 7:45 a.m., Northridge cheer
team had been notified they were in the finals bracket and had to compete again for the second time that day.
The bracket went from 32 teams to the top six teams for the final competition.
Northridge cheer team placed sixth in the competition out of the 32 overall in the division. This is the second time the cheer team has ever competed at state. Last year, they placed ninth.
Brodie Subia, assistant coach, said all the coaches couldn't be any prouder of the 20 team members.
Their next goal is to create an ultimate coed routine, adding the guy back into the mix and preparing them for competitions at nationals at Disneyland in Anaheim, Calif., in April.
There's only one response for the upcoming event – Go. Fight. Win!
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Was Trump right to declare an emergency on the southern border to fund a wall?
Yes. It is an emergency.
If it's the only way to get it done, I'm OK with it.
No. It's just politics.
Let's build a wall around Trump.
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https://www.barrons.com/articles/the-food-stock-boom-isnt-over-yet-51592009001
The Food Stock Boom Isn't Over Yet
Teresa Rivas
Updated June 12, 2020 10:08 pm ET / Original June 12, 2020 8:43 pm ET
Campbell Brands, Conagra Brands, and General Mills remain some of the most appealing of the big packaged-food players.
For every amateur chef touting a perfect sourdough on social media, there are plenty of lumpy loaves and burned crusts that never make the cut but still taste delicious. And that's good news for packaged-food companies like Conagra Brands and General Mills, because it means eating at home may not end even when coronavirus-related lockdowns do.
We're clearly not at that point yet, even if for a moment, it felt like we had reached it. That helped push food stocks like Campbell Soup (ticker: CPB) and Conagra (CAG) well off their...
For every amateur chef touting a perfect sourdough on social media, there are plenty of lumpy loaves and burned crusts that never make the cut but still taste delicious.


7Submit yourselves therefore to God. Resist the devil, and he will flee from you. 8Draw near to God, and he will draw near to you. Cleanse your hands, you sinners, and purify your hearts, you double-minded. 9Lament and mourn and weep. Let your laughter be turned into mourning and your joy into dejection. 10Humble yourselves before the Lord, and he will exalt you.
11Do not speak evil against one another, brothers and sisters.4.11 Gk brothers Whoever speaks evil against another or judges another, speaks evil against the law and judges the law; but if you judge the law, you are not a doer of the law but a judge. 12There is one lawgiver and judge who is able to save and to destroy. So who, then, are you to judge your neighbour?
13Come now, you who say, 'Today or tomorrow we will go to such and such a town and spend a year there, doing business and making money.' 14Yet you do not even know what tomorrow will bring. What is your life? For you are a mist that appears for a little while and then vanishes. 15Instead you ought to say, 'If the Lord wishes, we will live and do this or that.' 16As it is, you boast in your arrogance; all such boasting is evil. 17Anyone, then, who knows the right thing to do and fails to do it, commits sin.


Candidates should have at least graduated from high school. Two or four year turf degree would be preferred. Willing to train the right candidate.
Previous experience in the turfgrass industry is preferred, but willing to train qualified candidates.
Greenhaven Turf Care is a professional turf application business that specializes in the development and implementation of agronomic programs for sports turf, golf, and grounds. We currently provide our services in Massachusetts and Rhode Island.
Greenhaven Turf Care is currently seeking a motivated candidate with the appropriate background to assume the responsibility of Turf Management Fertilizer/Spray Tech. This position requires a candidate who posses a turf background with experience in fertilizer and pesticide applications. A formal education in Agronomy and Environmental Science/Turfgrass Management is preferred but not necessary if the candidate has significant experience in the field. A working knowledge of computer technology is preferred as the position entails proper record keeping methods. Good communication, teamwork, time management and self motivation are necessary qualities for this position.
This position generally involves working closely with our team to implement specialized turf management programs for school districts, towns, municipalities, universities, golf courses,estates and minor league organizations. The Fertilizer/Spray Tech works to ensure the highest quality turf applications for our clients. Site inspections for quality are performed and programs may be supplemented based on observations. Routine maintenance on equipment to ensure cleanliness and detail in presentation along with proper working order are performed and a working knowledge of equipment with minor mechanical skills is beneficial. Most turf applications are performed during normal weekday business hours; however, there are occasions where we schedule necessary weekend applications. Generally speaking, we start early in the morning so the ideal candidate would be an early riser and willing to be flexible in work schedule.
Interested candidates should email their resume to Brian at greenhaventurfcare@gmail.com.


Crabmeat every which way and loose can be yours at the Crab Bash this coming Tuesday, August 7th. As numerous regional chefs gather for the 3rd annual event competing for Best of Show and People's Choice Awards you get to taste all their dishes along with specially created sample cocktails for each dish prepared by the Baltimore Bartenders Guild.
B&O American Brasserie and Hotel Monaco Baltimore will host the annual Crab Bash chef cook-off, once again benefiting the National Aquarium this coming Tuesday, August 7th from 6 p.m. to 9 p.m.


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MoneyMagpie › Make Money › Make Quick Money › Make Money From Old Video Games
Make Money From Old Video Games
By Lydia Posted on September 1, 2022 One Comment
Clearing your clutter can be hard especially when you're looking at everything you've spent money on. But we are here to make it easier for you by showing you how to make money from your old belongings. Today we want to share with you how to make money from your old video games. We've told you how to make from old CDs, VHS tape and cassettes so it's only fair video games get mentioned. Keep reading to find out how to collect and sell video games as well as the big players when it comes to earning money.
Collecting Video Games
Selling Video Games
Big Players
Most people nowadays tend to have some form of games console – anything from a Nintendo switch to a vintage N64. There's a big range of consoles and games that appeal to most people across the globe. With the Video Gaming Industry estimated to be worth around $178.73 Billion in 2021, it is clear to see that people are putting their money into it. It grew by 14.4% from 2020 and it is predicted to be worth $268 Billion by 2025 so it seems to be the perfect time to get investing.
Like with most things, nostalgia plays a part in the popularity of gaming but there is always interest from younger audiences – so what should you be investing in? Well, that's up to you – you could go for vintage games or maybe just start collecting what you like to play. The market is unpredictable, something you deem to be a popular game might have fewer cartridges purchased so it may be worth more in the long run.
There are a lot of choices when it comes to selling video games so we're going to give you the run-down on your best options.
eBay is a good choice when it comes to selling anything on the internet – it's easy to join, easy to sell, easy to make money. You have the option to sell your games individually or as a collection, the choice Is up to you.
Music Magpie
Music Magpie allows you to type in the barcode of your game to find out how much they'll pay you for it. All you have to do then is post it off to them and wait for the money to appear in your bank account. This is easier than selling on eBay, but you might not make as much money.
Maybe your games aren't worth loads – but don't despair. You can still get some of that cash back by selling at car boot sales. You can sell job lots or individual games – either way, you'll recuperate some losses.
We've put together a list of the top 5 most expensive games sold at auction just in case you have any lurking in your attic.
Nintendo Campus Challenge
Made for Nintendo systems, this game was designed to be played on college campuses. With three games in one, it works as a triathlon. It was designed to be a marketing tool to sell more consoles and encourage competitive gaming. It sold in 2009, at an American auction for $20,100.
PowerFest '94
Again, this game was designed for a gaming competition. 4 teams competed to get the highest score possible on three Nintendo games. Originally 35 cartridges were produced but only 2 remain. Whilst they are yet to be sold, one seller is asking for $25,000.
Made for Atari 2600, this unique T-Shaped cartridge game was released on January 1st, 1982. Similar to space invaders, users fight in the skies to defend the earth from invaders. In 2012, a copy of the game sold for a whopping $33,433.30 – worth checking your attic for.
1990 Nintendo World Championships
Another competition game, this game was produced in 1990, with a limited run of 116 cartridges. 26 of the 116 were encased in gold with the remaining in the traditional grey. In 2014, a gold cased game sold for $100,088 on eBay.
Sealed Super Mario Bros
Made for the original Nintendo, this sealed copy of Super Mario Bros, from 1985 is the most expensive video game ever sold. You can get your hands on it for an eyewatering $2,000,000! This copy has its extreme price tag due to it still being brand-new and a "limited print run".
Why not have a look through your loft now you know how to make money from old video games!
Alisan
Great content!
Buying and selling video games seems to be a lucrative business, but the important thing here is how we can get the keys cheaply.
Thank you. Your articles help improve my business
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Silk Road was an online black market and the first modern Dark-Net market, best known as a platform for selling Illegal Drugs.
Around 70 percent of the Earth's surface is covered by oceans.
The Amazon has an incredibly rich Ecosystem – around 40,000 plants, 1,300 birds, 3,000 types of fish, 430 mammals and 2.5 million insects species.
The tallest tree ever was an Australian Eucalyptus – In 1872 it was measured at 435 feet tall.
The name "Pacific Ocean" comes form the Latin name Tepre Pacificum, "peaceful sea".
Cockroach Milk more than four times as nutritious as cow's milk and the researchers think it could be the key to feeding our growing population in the future.
The caste system is a social hierarchy in India that divides Hindus based on their Karma and Dharma.
Kiwis are endangered, flightless birds that live in New Zealand. They lay the largest eggs relative to their body size of any bird in the world.
The AMAZON is the world's largest tropical Rainforest, Plays the vital role of a Carbon Sink and Slow downGlobal Warming.
There are two major sects in Islam The Sunnis and the Shiites. Sunnis make up nearly 90% of Muslims worldwide.
Dark Web sellers creating "Mystery Boxes" that contain Random and Terrifying objects. People purchase them and open n Videos that posted on YouTube.
The deepest known area of the Earth's oceans is known as the Mariana Trench. It's deepest point measures 11km. That's a long dive down!
73 % of marketers believe that social media marketing has been "somewhat effective" or "very effective" for their business
Hinduism is the World's Third Largest religion; its followers, known as Hindus, constitute about 1.15 billion, or 15–16% of the global population.
The deathstalker is one of the most dangerous scorpions on the planet, and its venom is also the most expensive liquid in the world at $39 million per gallon.
The Torah—the first five books of the Tanakh—outlines laws for Jews to follow. It's sometimes also referred to as the Pentateuch.
Around 50 percent of Orangutans have fractured bones, due to falling out of trees on a regular basis.
The largest island in the world that is not inhabited by humans is Devon Island, Nunavut, Canada.
The Dark Web and Bitcoin have a strong relationship, as Bitcoin is often used on the dark web. The dark web is suitable for anonymous payments.
Most Jews (with the exception of Messianic Jews and a few other groups) believe that their Messiah hasn't come—but will one day.
The King James Bible is possibly the most widely-known edition of the Bible, though in England it is known as the "Authorized Version".
An average size Tree can provide enough wood to make 170,100 pencils.
It is estimated that approximately 1/6th of the world's population lives on an island.
Almost 6 billion tonnes of Fish and other Seafood have been taken from the world's Oceans since 1950.
The Quran deals with all subjects which concern us as human beings: Wisdom, Doctrine, Worship, and Law
The YouTube.com domain was bought on Valentine's Day, 2005. The first video was posted by co-founder Jawed Karim.
Today, 90% of the world's Seabirds are estimated to have fragments of plastic in their stomach.
In 2007, British Prime Minister Tony Blair became the first world leader to launch his own YouTube channel.
Every minute 24 hours of video is uploaded to YouTube. More video content is uploaded to YouTube in a 60-day period than the U.S. television networks created in 60 years.
Christianity is the World's Largest religion with over 2.4 billion followers commonly known as Christans.
Among many species of Birds, Crow is the only bird which hold Funerals for their Dead as humans do.