Variable-speed technology provides quiet startups and shutdowns with greater humidity control and energy savings.
Unique cabinet design allows less moisture and fewer dust particles to be drawn in from garages, attics and crawl spaces. This design also helps prevent energy loss and virtually eliminates condensation.


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The Patriarchal Visit to China: An Interview with Fr. Dionisy Pozdnyaev
Maria Senchukova | 16 May 2013
Pilgrims from Russia visit Orthodox churches in China
His Holiness, Patriarch Kirill of Moscow and All Russia, conducted an official visit to China from May 10 to 15, 2013. On March 14, Pravmir spoke with Archpriest Dionisy Pozdnyaev, Rector of the Church of Sts. Peter and Paul in Hong Kong, about the preliminary results and expectations from this visit.
The first visit in history of a Primate of the Russian Church to China is in itself an extraordinary event. In connection with the fact that the position of the Chinese Autonomous Orthodox Church is now in need of normalization, one can address two aspects of the ongoing visit.
First, the visit is taking place by invitation not of the Chinese Orthodox Church, but of the country's secular leadership, for which reason a secular element is present. His Holiness himself spelled this out to journalists. Relations between China and Russia are improving, but without contacts on the spiritual plane no understanding between the two countries can ever be called complete.
A significant component of this visit is a demonstration that, in the question of religious contacts, China and Russia are open and ready for dialogue.
Second. It goes without saying that the spiritual side is very important: this means services in Beijing (on the territory of the embassy), in Harbin, and in Shanghai, as well as meeting with the Orthodox flock, both Russian and Chinese. Moreover, it is the latter that I see as the most important outcome of the visit so far.
The day before yesterday [May 12], after the service a very important meeting took place between the Patriarch and Chinese Christians – about which, unfortunately, not very much has been written in the mass media. The Chinese Church, owing to historical circumstances, has been deprived of its clergy: both bishops and simple priests. For Chinese believers, the Patriarchal visit offered a unique opportunity: during the meeting, the Orthodox Chinese clearly stated their life's dream for the full existence of a Chinese Orthodox Church with its own clergy and divine services.
This was a very touching, emotional, and humane encounter. His Holiness felt this request of the Chinese faithful very deeply.
In general, he is one of the few hierarchs in the Russian Church who, over the course of many years already, has been keenly responsive to this problem. The fact that, now that he has become Patriarch, he returns to it again and again is encouraging. I very much hope that this meeting will bring attention to this problem.
It is too early to speak of the results of the visit because it is ongoing, but it can already be noted that the visit has raised many issues. It is another thing that these issues still need to be worked on.
What, in your opinion, does the Chinese leadership expect from this visit?
It needs to be borne in mind that the Chinese government is secular. Its official ideology is communism, albeit of a specific form. The general attitude towards religious life in China now comes down to the fact that, from the point of view of the authorities, religion can play a positive role in the life of society.
I think the Chinese authorities view the Patriarch's visit largely as a political one. The very fact that it is taking place is an essential success for Chinese diplomacy.
It goes without saying that the Chinese authorities have political objectives: to show that the course of the country's new political leadership is one of openness and of greater flexibility than before.
What do the Chinese Orthodox expect as a result of this visit?
By and large, I do not see that the Chinese authorities have created any kind of problems for the Orthodox. The problems are in the inner life of the Church. Due to historical circumstances, the Church was institutionally destroyed, rendered lifeless, and deprived of clergy. Without help from the outside, the Chinese Church cannot recover.
It is important that the Chinese authorities understand that the Russian Orthodox Church can help in the restoral and revival of the Chinese Orthodox Church. But, by and large, this is its own task.
The legal relationship between the Chinese and Russian Orthodox Churches and the Chinese government is as follows: legislation in China prohibits missionary work by foreign citizens, but exchanges between Chinese and foreign religious organizations in the purely religious sphere are permitted.
What can be done to enlighten the Chinese with the light of the Orthodox faith?
I think the focus needs to be on the sphere of education. Orthodox Chinese do not have access to basic literature and there are no teachers.
There can be different forms of educational activities. One can organize more or less lengthy pilgrimages. It is essential to publish books. It might be worth translating certain films.
I think this should be a major undertaking of the Russian Orthodox Church, the planning of a multi-year mission, not reducible to any single activity. It is essential to create an environment in which people can become acquainted with the Orthodox Church, understand what Orthodox is, and make an independent and informed decision about whether or not they need it.
In the general Chinese public, a few people know a little bit about Orthodoxy: scholars, intellectuals, and specialists. But there is a great and constantly growing interest, one that should be answered in a prompt, accurate, and competent manner.
The growth of interest in Orthodoxy is connected with the fact that China, as a whole, is becoming more open. Moreover, China and Russia are neighboring, bordering countries with a fairly friendly relationship. It has so happened that, on the whole, the intensity of contacts in the humanitarian sphere between Russian and China is far behind the intensity of contacts in the sphere of economic or military cooperation. The politics of our countries are mostly of an economic and pragmatic character, and in this connection the complex of important spiritual questions has been neglected.
Moreover, the Chinese have a question regarding the order of civilization. Their classical, traditional worldview began to fall apart a long time ago, since the beginning of the twentieth century. Then it was replaced by Marxism and communism, which now, in principle, have already outlived their function, having been transformed into a fairly effective system of governance. But the country's spiritual questions have remained unsatisfied.
In China there is a strong movement of searching for the meaning of life: both among the common people and among intellectuals, in academic circles. In this sense, the country is absolutely open to all outside ideas. Orthodoxy and its view of the world – and not necessarily the Russian version, but one irrespective of ethnic basis – offers something fundamentally new to the Chinese. People are ready to listen, to hear, to study, and perhaps to accept the Christian faith.
Interview conducted by Maria Senchukova.
Translated from the Russian
Maria Senchukova
His Holiness, Patriarch Kirill of Moscow and All Russia, conducted an official visit to China from May 10 to 15, 2013. On March 14, Pravmir spoke with Archpriest Dionisy Pozdnyaev, Rector of the Church of Sts. Peter and Paul in Hong Kong, about the preliminary results and expectations from this ...
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redpajama_set_name: RedPajamaCommonCrawl


In May at the Conference Center at Kent State University at Stark, The Junior League of Stark County celebrated two outstanding women volunteers at its annual Women of the Year luncheon. Started on its 10th anniversary in 1947, for 71 years, The Junior League has solicited nominations from the community and honored two women; one with the President's Award, meant for a woman who has made a significant impact in one area, and the Community Award, for a woman whose volunteer work has touched many areas. This year's honorees were J. Lynne Biery for the President's Award for her work with the Louisville YMCA, and Jacqueline DeGarmo for the Community Award for her work intended to better the educational opportunities for all in Stark County.


The Charleston Tea Plantation is located on historic Wadmalaw Island in the heart of the Lowcountry of South Carolina. Home to The Charleston Tea Plantation, Wadmalaw provides the perfect environment for propagating tea. With its sandy soils, sub-tropical climate and average rainfall of 52 inches per year, Wadmalaw possesses idyllic conditions for the Camellia Sinensis tea plant. This plant is currently used to produce both black and green teas and exists in over 320 varieties on the 127 acre grounds of the Charleston Tea Plantation. They do NOT use any pesticides (herbicides, fungicides and insecticides)!
This is the home of Charleston Tea Plantation teas - nine very special flavors of tea, including our original American Classic Tea. This is the only brand of tea in the world that is made exclusively with 100% tea grown in America. The Charleston Tea Plantation, America's own tea garden, is pleased to offer our group an experience that is not only educational but more importantly one-of-a-kind. After the factory and garden trolley tour, you will receive a lunch to be enjoyed onsite.
Before returning back to the hotel, you will stop at the Angel Oak Tree on John's Island. The tree is estimated to be 400-500 years old. It stands 66.5 ft (20 m) tall, measures 28 ft (8.5 m) in circumference, and produces shade that covers 17,200 square feet. Its longest branch distance is 187 ft in length. Angel Oak was the 210th tree to be registered with the Live Oak Society.
Situated on the edge of Charleston Harbor and offering spectacular views of the city, Fort Sumter, and ships arriving from all over the world, Patriots Point has been for years a favorite place to play for local Charleston golfers and resort guests. It's located in Mount Pleasant at the foot of the Arthur Ravenel Jr. Bridge and just five minutes from downtown.
You can play with a group or be paired up with other Summit attendees to form a team. The tournament is friendly competition aimed at having fun and networking. Lunch is included. Reserve your spot on the Summit registration form.
The CPRC meeting will cover the latest topics of note in the plastics recycling industry such as how purchasing policies can innovate demand, the "Your Bottle Means Jobs" outreach campaign, and networking for the plastics recycling industry across the Southeast. Network with plastics industry leaders and decision makers, stay connected with the latest information in innovation and technology, and learn from experts in the field. Register here.
This half-day workshop empowers state and local governments, solid waste directors, recycling organization representatives and others to gain the knowledge to implement and train others to introduce concepts and tools in their local communities. Choose this workshop when you register for the Summit.
Join us Monday night for a true taste of the Low Country. Vegetarian options will also be available. Your reception ticket includes all you can eat as well as drink tickets for a fun evening. Weather agreeing, it will be held in the courtyard of the DoubleTree hotel.
Choose this option when you register for the Summit.


" As you enter into a time of joy, abundance and prosperity, you must be more careful than ever to build your hedge stronger and check its security more diligently than ever.
The anointing of My Holy Spirit will give you the ability to keep a strong hedge, but you must be sure to not let your defenses down for even a minute. Never forget that the enemy is like a fox , he just needs one opening and he will often kill all of the chickens just because he can. He does not even need to be hungry. Use the armor daily, just because a few days pass with no attacks , does not mean that the enemy has decided to leave you alone. Be sure of this fact, he will never leave you alone.
Sure he may focus attention elsewhere for a season, but often that is just to lull you into a sense of security in the hope that you will let your guard down. That you will stop doing the things that provide your protection. That you will return to the world, maybe temporarily. When you are in the worlds influence you are in his domain and your protection is vulnerable. If you lapse back to being of the world you are completely outside of My will and therefore your protection may be penetrated.
Stay close to Me for the fox is ineffective against the lion. Keep focused with singleness of purpose. Be sure that you are in harmony with your purpose, for the blessings fall more easily on you when there is clarity , cooperation and continuity .


The image was created by Nikon D7000 camera with shoot mode 24.0mm · ƒ/7.1 · 1/60s · ISO 100, gives a picture excellent quality. It was archived in the category "Nature/Landscapes", largest dimension is 4945×3265 pixels, you can download it to JPEG format. We were tagged: Landscape, Spring, Wood, Scenic, Green, Trees, Nature.


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Lifetime Income & Retirement Security
Retirement Plan Design
Personal Finance (P-Fin) Index
Higher Education Leadership
Higher Education Workforce Trends
Foundations & Nonprofits
TIAA Institute
© 2020 and prior years, Teachers Insurance and Annuity Association of America - College Retirement Equities Fund, New York, NY 10017.
African-Americans Experience Low Financial Literacy Levels
A new report from the TIAA Institute and GFLEC examines African-Americans' level of personal finance knowledge and the link to financial well-being.
NEW YORK (November 20, 2019) – The TIAA Institute and the Global Financial Literacy Excellence Center (GFLEC) at the George Washington University School of Business (GWSB) today released a new report documenting particularly low levels of financial literacy among African-American adults.
"Financial Literacy and Wellness among African-Americans: New Insights from the Personal Finance (P-Fin) Index" reports that African-Americans answered 38 percent of the Personal Finance (P-Fin) Index questions correctly compared with 55 percent among whites, indicating a significant financial literacy gap.
African-American financial literacy was highest in the functional area of borrowing, with 47 percent of these questions answered correctly, on average, and lowest in the area of insuring, with 32 percent of questions answered correctly. African-American financial literacy is lower than that of whites in all but one functional knowledge area. African-American and white respondents scored similarly in the area of comprehending risk.
There is a strong link between financial literacy and financial wellness among African-Americans. Those who are more financially literate are more likely to plan and save for retirement, to have non-retirement savings and to better manage their debt; they are also less likely to be financially fragile.
"African-Americans make up 13 percent of the U.S. population and constitute a critical segment of our economy. Yet financial literacy gaps exist across this demographic group regardless of gender, age, income level, or degree of education," said Stephanie Bell-Rose, Head of the TIAA Institute. "It is imperative that we continue to shed light on this challenge in order to better map a course for financial success."
"Our research finds that African-Americans tend to exhibit lower financial well-being than the U.S. white population. Given the strong link between financial literacy and financial well-being, increased financial knowledge can lead to improved financial capability and behaviors," said Annamaria Lusardi, Academic Director of GFLEC and Denit Trust Endowed Chair of Economics and Accountancy at GWSB. "Increasing efforts to promote research-based financial education in school and the workplace is one key solution for promoting financial well-being among African-Americans."
"This important research and data set underscore the centrality of financial decision making in modern America," said Cy Richardson, Senior Vice President for Programs, National Urban League. "The convergence of financial, credit and debt management provides headwinds for us all – yet structurally speaking the African American community has little margin for error compared to other groups and must continue to demonstrate progress on the critical measures and knowledge that is necessary to make financially responsible decisions – decisions, that are integral to our everyday lives and existence."
The TIAA Institute-GFLEC Personal Finance Index (P-Fin Index) provides a comprehensive barometer of U.S. adults' readiness to make sound financial decisions. It is unique in its capacity to examine financial literacy across eight common financial activities: earning, consuming, saving, investing, borrowing, insuring, understanding risk and gathering information.
The report with new insights on financial literacy levels of the African-American population was authored by Paul Yakoboski, Senior Economist at the TIAA Institute; Annamaria Lusardi, Academic Director at GFLEC, GWSB; and Andrea Hasler, Assistant Research Professor in Financial Literacy at GFLEC, GWSB.
The full report can be found HERE.
Press contact: Mike Tetuan, 888-200-4062, media@tiaa.org
About the TIAA Institute
The TIAA Institute helps advance the ways individuals and institutions plan for financial security and organizational effectiveness. The institute conducts in-depth research, provides access to a network of thought leaders, and enables those it serves to anticipate trends, plan future strategies and maximize opportunities for success. For more information about the TIAA Institute, visit www.tiaainstitute.org.
About TIAA
With an award-winning track record for consistent investment performance, TIAA (TIAA.org) is the leading provider of financial services in the academic, research, medical, cultural and government fields. TIAA has $1 trillion in assets under management (as of 9/30/2019 ) and offers a wide range of financial solutions, including investing, banking, advice and education, and retirement services.
About GFLEC
The Global Financial Literacy Excellence Center (GFLEC) is dedicated to advancing research and solutions that open the door to universal financial literacy. In working toward that mission, GFLEC has positioned itself as the world's leading incubator for financial literacy research, policy, and solutions. GFLEC launched in 2011 at the George Washington University School of Business in Washington, D.C. Since then, it has pioneered breakthrough tools to measure financial literacy, developed and advised on educational programs, and crafted policy guidelines aimed at advancing financial knowledge in the United States and around the world. For more information on GFLEC, visit www.gflec.org.
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If you have minor dental flaws or major dental problems, they can be fixed in a smile makeover. The smile makeover essentially combines various dental treatments and disciplines together in order to enhance overall dental health and aesthetics. The team here at our Knoxville cosmetic dentistry office would like to take a brief minute right now to cover the basic dental flaws that a smile makeover can handle.
There are plenty of options for dealing with cavities and tooth decay. For basic cavities, dental fillings are a great option. Tooth decay on the front of a tooth can be best dealt with using dentla bonding, and substantial tooth decay that's too large for fillings can be addressed through inlays and onlays.
Minor chips and cracks on a tooth can be best at addressed through the use of dental bonding. When that's not an option, porcelain veneers just might do the trick. For any major damage to a tooth (whether due to injury or decay), there's always dental crowns.
For general stains on the teeth, consider teeth whitening. Professional teeth whitening is able to brighten a smile by up to ten shades in just one visit. For really serious stains, consider Knoxville porcelain veneers to mask the discoloration from view.
If you are missing teeth, there are plenty of options to keep in mind. Removable dental bridges and dentures are certainly a serviceable answer, but you may want to consider getting dental implants. Dental implants serve as artificial tooth roots, which means a secure hold for dental restorations. They will also help prevent major dental health problems down the road.
If you have teeth that are slightly uneven or misaligned, porcelain veneers may be able to effectively address that matter. For more substantial tooth misalignment or crookedness, your best bet is to get orthodontic treatment of some kind, such as Invisalign® or traditional braces.
To find out how a smile makeover can be of great benefit to you, be sure to contact our Knoxville cosmetic dentistry office today to schedule a consultation.


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Met Office bank holiday forecast: Weather for Somerset looks 'distinctly promising'
The Met Office is optimistic about the three day break
Forecasts appear to show dry and mild weather across all three days
The Met Office is predicting that the weather for the May bank holiday is looking "distinctly promising" for the South West.
Forecasts appear to show dry and mild weather across all three days, although it is forecast to be cloudy.
Temperatures will likely peak at around sixteen to seventeen degrees on each of the three days.
Countryfile talks beavers in Cornwall and viewers couldn't help getting smutty
A Met Office spokesperson said: "Rain will clear on Wednesday morning leaving a dry and bright afternoon.
"Thursday and Friday will be largely cloudy and mainly dry. Feeling warmer in any bright spells.
"Friday will be dry, bright and warmer in the southern half of the UK.
"The bank holiday weekend looks distinctly promising in the south with plenty of dry weather and a good chance of warm sunshine.
"A dry and bright spell of weather with light winds may continue after the bank holiday, bringing above-average temperatures for many places."
Lamb stolen by drunken raver from a field near Bristol is rescued by police
Somerset Live has launched a WhatsApp group to help you keep up to date with the latest news from across the county. If you'd like to receive breaking news alerts, text NEWS to 07834 893492. Then add the number to your phone contacts book as 'Somerset Live'. We will send you a maximum of four messages a day. Your phone number won't be shared with other members of the group or be used for any other purpose.


Why personal essays matter more now than ever.
As a writer and editor of personal narratives, I've been having a bit of an existential crisis since the 2016 presidential election. I've been wondering if there's space for the personal and internal in a world so politically fraught; with people having their rights stripped away in new and horrifying ways every day, what place do I have reflecting on the past traumas, joys, and humiliations of my own life? As an editor, I've been more selective than ever when reading first-person submissions, as most of the conflicts feel petty, superficial, and meaningless in the face of ongoing national tragedy. When Jia Tolentino wrote for The New Yorker that the fluffy, self-as-spectacle style of personal essay died with the election, I nearly jumped out of my seat to shout my agreement.
But as the months have rolled on, I've realized that while the superficial and self-indulgent no longer deserve a seat at the table of public discussion, the vibrant, meaningful personal narrative is in fact more needed now than ever before.
If we're going to continue to fight, we need art to fuel the fire.
And we need this kind of personal narrative tied to the travesties that are happening in our own era as well. One of the greatest challenges of the Trump era so far has been the effort to fight off emotional fatigue; waking up and reading the news every day takes more fortitude and deep breathing techniques than it should. It would be so much easier to shut it out, to surrender to apathy and decide to accept that the world we live in is a terrible place. It's much harder to take that second step of not just reading the news, but also looking for ways to fight against each new horrifying announcement. To stand up for the refugees who, like Anne Frank, are being denied access to this country, and for immigrants who grew up here and are now being told to leave, for survivors of sexual assault who are being told to quit school if they don't want to share a campus with their attackers, and for scientists who are trying to convince an oblivious administration that we'll all be drowned and burned soon if we don't start fighting for the environment.
We need personal narratives so that we can carry with us every day the lived experiences of the marginalized people who need advocates more now than they ever have. To remind us why apathy isn't an option. If we're going to continue to fight, we need art to fuel the fire.
I wondered at first whether personal narratives would have this same impact in the Trump era. I wondered what the point was of sharing personal stories in a world where so many people see the basic human rights of marginalized people as extravagances they don't have time to concern themselves with; the rights of LGBTQ people who face discrimination as a superfluous distraction, the desire to shelter undocumented immigrants as un-American, where even condemnation of Nazis is a partisan issue. In a world where an attempt to express our personal experience to others, to share where it hurts, is met with taunts of "snowflake" and barely coherent tirades about participation trophies.
Storytelling can humanize, but what do we do when the opposition knows we're human and just doesn't care?
Maybe the answer is that this art is not for the enemy. Yes, sometimes art is about changing minds, about opening up your world to people who would not otherwise see you. Sometimes art is to provoke, to challenge, to force confrontation. But sometimes art is for ourselves, to feed and nurture and show others like us that we're here. We may not be able to reach into the dark hearts of those who gleefully watch Trump and his cronies strip us of our rights, who barely bat an eye when a Black man is shot in the street but get ruffled by a Nazi getting punched in the face. We may never convince the bigots to care about our humanity, but we can still share our stories with each other, and in doing so make our resistance more united through empathy for each other, even if we can't get it from the opposition. Only by sharing these experiences of our own can we let others who are struggling know that they're not the first.
And, just as stories that humanize the most pressing political issues can give us the will to keep fighting, personal narratives that are totally disconnected from the political can give us much-needed respite. It's not sustainable to spend every second of every day being angry and fighting. Once in a while, we need to stop and recharge, to reclaim our own humanity and our own lives. And what better way to hold onto humanity than by indulging in a beautiful, contemplative, human story? By having the audacity to find our own stories worth telling, we make ourselves real. We remind ourselves and each other that there's more to life than the constant doom streaming out of Washington. We remember the value of connecting with others and remember that we're not just fighting against, but for.
—Lilly Dancyger is the Deputy Editor of Narratively, where she oversees the memoir section. She's written personal essays for Psychology Today, the Washington Post, BUST, the Jewish Daily Forward, and more. Her debut memoir, Hunted: A Memoir of Art and Addiction, is forthcoming in 2018. Find her on Twitter at @lillydancyger.


Coffee production in Colombia has grown by 52% in June, when compared to the same month last year, the National Federation of Coffee Growers said Monday.
The increase in coffee production, which jumped from 471,000 sacks in June 2011 to 714,000 sacks this year, was attributed to less rainfall and new coffee plants being harvested, Reuters news reported.
Until March, Colombian coffee production was showing 12 consecutive months of shortfalls because of heavy rains and a renovation program, which put nearly 750,000 of Colombia's 2 million acres of coffee plants out of production. But this year the renovation program has begun to bear fruit. More than 289,000 acres of coffee were renovated by the end of 2011, and this year another 128,000 acres has been completed.
"The acceleration in the rates of renovated coffee plants reaffirm the commitment of producers to the future and sustainability of the sector," said Luis Genaro Muñoz, general manager of the National Federation of Coffee Growers.
Exports of Colombian coffee also increased 7 percent in June to 615,000 sacks, up from 576,000 sacks in the same month last year.
Heavy rains in prime growing areas caused the 2011 Colombian coffee crop to drop to its lowest point in more than 30 years, 7.8 million sacks. It was the third consecutive year that the growers association missed its goal of at least 9 million 130 pound sacks. President Juan Manuel Santos has made it a priority to support massive plantation renewal projects, which provide farmers with loans in order to renovate low-yielding coffee farms.


Though higher education marketers and admissions counselors work year-round to attract and retain students, one of the most impactful moments for an admissions campaign is the acceptance offer.
A well-crafted acceptance package is a door opener that sets your admissions team up for success throughout the campaign cycle. Students are becoming more discerning in their college search, and are applying to more schools than ever before. That means there's even more pressure to deliver on their expectations.
To that end, here are some recommended best practices for getting the most out of your acceptance package.
Prospective students have been looking forward to their acceptance notification for ages. They've poured countless hours into researching schools, completing applications and touring campuses in search of the right place for them. Many have dreamed of this moment for years, and now that their application is in, it's time to deliver a sense of accomplishment—and excitement—about being accepted.
The psychology of excitement in marketing makes it clear that behind these strong emotions is an innate impulse toward action. Students can be major influencers within their peer group, and building on that initial excitement by providing an experience that includes clear, actionable next steps is a great way to spread the message of your institution far and wide.
Inside the acceptance package for Florida Polytechnic University, students are treated to their own augmented reality fireworks show over the top of the Innovation, Science and Technology building with a celebratory "You're In!" message. The interactive experience not only makes for an exciting announcement, but does so in an innovative and unexpected way. In the same experience, Florida Polytechnic University also gives students the ability to instantly make their deposit from their mobile device which makes the next step easier to complete.
Acceptance packages come in all shapes and sizes—some schools send a simple letter, while others go all-out with a variety of materials designed to dazzle students into submitting a deposit.
Breaking through the clutter is important, especially when prospective students are more overloaded with college decisions than ever before. Three-dimensional "lumpy" mail is a great way to showcase your school's unique culture while showing prospective students that you're making a real effort to impress them.
University of the Ozarks uses a self-mailing box filled with great information and university swag to reinforce the excitement of the acceptance announcement. Although much smaller, Saint Leo University's acceptance package stands out by going digital with an enclosed USB loaded with all of the next-step information accepted students will need to make their final decision.
If you're looking for engagement, give your audience a #humblebrag moment. With the acceptance letter, it's pretty much baked in, but a prominent call to action and an ownable hashtag can help remind students to share their great news. Naturally, accepted students are going to post their acceptance, but you can make the moment more Instagrammable by cheering them on in your own unique way.
Students accepted into Middlebury College show their pride on Instagram.
Pamela Fogg, Creative Director at Middlebury College, updated their package to become a bright, colorful and buzzworthy touchpoint by incorporating a pennant wrap around the outside of the folder. She brought together her team including designers, social media managers, and others to weigh in together in a heavily iterative and collaborative process and created something unique that could garner attention and build excitement for accepted students. One of the most surprising facts about the campaign was that it received the strongest social media response from non-traditional and first-gen college students.
While the presentation of your acceptance package is important to the success of the campaign, your chief goal should always be to convey the culture of your institution in an authentic way. This is your opportunity to show students who you are and why you feel they'll find the best fit for them within your walls.
University of the Ozarks uses their admissions package to drive home a compelling story inspired by the outdoors. Rather than trying to hide the school's rural setting, the Ozarks acceptance package leans into it, with messaging that emphasizes the university's outdoor appeal.
This is the place where it's important to embrace your true brand and showcase its benefits to prospective students. Knowing and understanding who you are is the surest path to identifying right-fit students and increasing your institution's retention rate.
For Florida Polytechnic University, the acceptance experience looks completely different. While there was considerable effort to "wow" prospects, close attention was paid to demonstrate the innovative nature of this STEM-focused school. An augmented-reality-infused box and a welcome booklet were created to help highlight the university's campus, students and high-tech labs. So far, the campaign has garnered hours of engagement from admitted students, resulting in an impressive start to the early stages of their current admissions cycle.
The best-laid plans in today's marketing ecosystem always have a digital component, and acceptance is no different. After the confetti has fallen, there's still work to be done. Your acceptance package should drive the user to complete their deposit online, and should immediately allow them to see what remaining follow up needs to be completed.
One of the fundamental beliefs of our agency is that usability is an ideal opportunity for organizations to express empathy. The easier you make it for students to complete next steps, the quicker you'll see results. A sharp-looking microsite, like the one used for admitted students at Saint Leo University, can be a useful tool for keeping students on-task. Instead of letting the excitement wear off, Saint Leo's acceptance package drives students to a microsite that provides everything they need to commit, including step-by-step instructions on how to deposit and a centralized list of admissions FAQs.
While admit packages are a powerful tool at your disposal, they lose their punch when they're viewed as an isolated tactic. Ultimately, a splashy admit package is making a promise that your larger campaign and the institution as a whole needs to be ready to deliver on. So as you move forward planning your upcoming campaign, consider how this moment can be thoughtfully crafted from every angle to make your institution the unmistakable choice.
Martin is a self-taught Photoshop phenom and social media branding expert who knows that pushing the envelope starts with pushing yourself. He joined the Echo Delta creative team in 2014 after a five year stint as graphic designer and marketing manager for Bok Tower Gardens.


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Le parc national de Lossiny Ostrov (en , c'est-à-dire parc national de l'« île aux élans »)  est le premier parc national russe. Il est situé en partie sur le territoire de la ville de Moscou en partie sur celui de l'oblast de Moscou.

Sa surface totale est de . La forêt occupe plus de 90 % de la surface dont le tiers se situe dans les limites de la ville de Moscou. Le parc a été créé en 1983.

Histoire du parc

La forêt de Lossiny Ostrov est citée depuis 1406. Du  au  les terres avoisinantes faisaient partie du palais du volost de Taininski, et servaient depuis des temps anciens de terrains de chasse pour les princes et les tsars russes. En 1564 Ivan IV chassait l'ours sur ces terres. En 1799 les forêts sont transférées à l'administration des caisses de l'État. Une première expertise topographique y est réalisée ; la forêt est divisée en quartiers, la superficie de chaque quartier étant équivalente à une verste carrée. La première foresterie a été fondée pour la forêt en 1842. L'agent taxateur était alors Egor Grimme et il était secondé par Nikolaï Chelgounov. Les résultats de l'époque renseignaient que l'épinette recouvrait 67 % de l'ensemble forestier. Elle a été remplacée ensuite par le pin et le bouleau.

En 1844, le forestier Vassili Gerchner a commencé à planter de nouvelles forêts dans  Lossiny Ostrov. Pendant 115 ans, des activités forestières, principalement la plantation et la culture de pins y ont été menées. Ces plantations ont résisté aux effets de l'anthropisation intenses.

Au milieu du , est aménagée la datcha forestière de  Lossiny Ostrov et débute une période d'exploitation forestière systématique.

L'idée de créer un parc national est avancée par le chef des exploitations, le conseiller Vassilievitch Diakov . En 1934, Lossiny Ostrov est incluse dans la ceinture verte de 50 km autour de Moscou.

Une grande partie des arbres de la forêt a été coupée pendant la Seconde Guerre mondiale. En 1943, la décision est prise de restaurer la forêt de  Lossiny Ostrov. La réalisation du plan débute en 1944. En 1979, par une décision conjointe des conseils municipaux et régionaux des députés de Moscou, Lossiny Ostrov a été transformée en parc naturel, puis le  par décision des ministres de la RSFSR un parc national a été créé .

En septembre 2006, la maire de Moscou Iouri Loujkov a demandé au gouvernement russe une réduction de  de la superficie du parc national. Sur cette surface le maire prévoyait de construire le quatrième anneau routier autour de Moscou ainsi que des quartiers résidentiels appelés ville des ambassades. Une compensation de surface aurait été opérée par une partie d'un autre parc. En janvier 2007, le gouvernement russe a refusé au maire cette modification de surface.

En septembre 2016, la station de chemin de fer de l'anneau central de Moscou  s'est ouverte directement sur le territoire du parc national.

En mars 2019, le premier ministre Dmitri Medvedev a annoncé qu'il chargeait le ministère de l'environnement de modifier les limites du parc  Lossiny Ostrov afin de moderniser la section de l'autoroute A103 Chtchiolkovski . Il est prévu de reprendre  de territoire du parc naturel dont 54 sont plantes d'arbres. En échange  d'autres forêts de la région de Moscou sera apporté au parc national. Greenpeace Russie a demandé au bureau du procureur général d'empêcher cette opération d'échange avec des terres de  Lossiny Ostrov..Le présentateur écologiste Nikolaï Drozdov demande au gouverneur de la région de Moscou Andreï Vorobiev de sauver lîle aux élans.

Flore et faune

Le parc national est situé dans la sous-zone des forêts d'épicéas de la sous-région Valdaï-Onega de la taïga d'Eurasie. Dans le parc national de Lossiny Ostrov on trouve  de plantes vasculaires, dont  ligneuses, 37 arbustives. Parmi les essences forestières le bouleau couvre 46 % de la surface, le pin 22 %, l'épicéa 16 %, le tilleul 13 %, le chêne 3 %. La part des autres espèces est négligeable. Les plantes herbacées classées rares et à protéger, sur le territoire de la région de Moscou sont le bois-joli, le muguet de mai, le trolle d'Europe, la campanule à feuilles de pêcher, la campanule gantelée, la platanthera chlorantha, la platanthère à deux feuilles, la néottie nid d'oiseau etc…. C'est le seul endroit de la banlieue de Moscou où pousse l'anémone hépatique.

La faune compte plus de   de vertébrés dont plus de 160 espèces d'oiseaux, 38 espèces de mammifères ;  de poissons, 10 d'amphibiens (que les résultats des surveillances de 2020 limitent à  : le crapaud commun, le triton crêté, le triton commun, la grenouille rieuse, la grenouille rousse et la grenouille des champs, et à deux espèces de reptiles. Selon les informations provenant du personnel du service du maintien et de l'embellissement du parc national, au début de l'année 2013, sur le territoire de Losinny Ostrov vivaient 70 élans, 300 cerfs sika, 200 sangliers, 300 lièvres; on y rencontre aussi le renard roux, le vison d'Amérique, le chien viverrin, l'écureuil roux, le muscardin, le castor commun, le rat musqué, le campagnol roussâtre, le mulot, l'autour des palombes, le pygargue à queue blanche, le balbuzard pêcheur et beaucoup d'autres oiseaux.

Le Livre rouge
Les oiseaux repris dans les listes du Livre rouge de Russie que l'on retrouve dans Lossiny Ostrov sont : la pie-grièche grise, le pygargue à queue blanche, le balbuzard pêcheur, la mésange azurée.

Quant à la flore, ce sont: le sparassis crépu, le phallus de chien, l'herícium coralloídes

Extermination de la faune par des chiens errants
Au début du , la faune sauvage a été exterminée par des meutes de chiens sans abris vivant dans le parc. Selon le journal Izvestia, une quinzaine de chiens en meute chassaient de jeunes sangliers et des élans, en les éloignant de leurs parents, détruisaient les nids d'oiseaux, attrapaient des écureuils, des hermines des furets et d'autres animaux . Selon le rédacteur en chef du Livre rouge de Moscou Boris Samoïlov, les animaux sans abri de Moscou ont presque entièrement fait disparaître le cerf sika du parc.

Le directeur adjoint du parc, Vladimir Soboliev, a déclaré en 2009 que l'hiver cinq incidents s'étaient produits et avaient provoqué la mort de cerfs, d'élans et de sangliers par des meutes de chiens abandonnés .

Selon le journal Moskovski komsomolets qui se réfère aux employés du parc, 17 cerfs d'extrême-orient ont été introduits dans la partie protégée du parc national de Lossiny Ostrov dans les années 1960. Au début du  le troupeau comptait . Mais en 2005, le personnel du parc a commencé à trouver des squelettes de cerfs victimes d'attaques de chiens errants. En 2008-2009  ont été tués , ce qui représente dix pour cent de l'ensemble du troupeau .

Braconnage
En février 2021 sur le territoire du parc les corps de 16 cerfs tachetés tués par balle ont été découverts.

Références

Article connexe
 Liste des parcs nationaux de Russie

Liens externes

  Site officieux
   Documentaire sur la faune du parc

Losiny Ostrov
Parc ou jardin public à Moscou
Oblast de Moscou
Parc national créé en 1983

redpajama_set_name: RedPajamaWikipedia


text:
Sarah on life down South
Page last updated at 9:11PM UTC, Friday, 26 October 2012
New signing Sarah McCrea is enjoying her time with the Charlton women's team so far, with her rise to the first team coinciding with an upturn in form for the Addicks.
McCrea joined Charlton shortly into the season and made her first appearance as a sub in the 7-2 win against Portsmouth and her first start the following week in the 1-0 victory in Cardiff, where she set up the winning goal.
That first team chance came around after impressive performances for the reserve team where she scored a 25-yard effort against Bristol Academy and assisted four goals in their 6-0 win over Arsenal.
And the former England under 17 left-winger believes her good form is down to the fact she is enjoying her football.
Speaking after having made her full debut, she said: "The girls are really welcoming, the club's really friendly and the training sessions are nice and relaxed but in a positive way.
"I'm enjoying my football and I think that is showing because I play better when I'm enjoying myself. I'm enjoying it more than feeling the pressure and strain of trying to climb my way into the first team.
"It's always nice to have a start [against Cardiff] and it's nice to feel wanted in a team, which I have definitely felt. I just hope I can build on that week by week and have that little bit of input and show that I am capable."
The 23-year-old started her career at the age of 12 with Blackburn Rovers and was playing in the FA Women's Premier League National Division when she was 14.
McCrea lined up for Blackburn in the 2007 FA Cup semi-final clash against the Addicks, which Charlton won before losing 4-1 to Arsenal in the final.
Leaving Rovers for Preston North End four years later whilst at University, she is now getting back into playing football after a two-year sabbatical.
"Unfortunately I couldn't play for two years when I was living back at home in Carlisle because there aren't any teams around and I couldn't afford to travel anymore," she said.
"Now I'm relishing the opportunity to play football again at a good standard with a great bunch of girls.
"With my job I have different intentions of football, I want to enjoy it a little bit more now. It's more of a release from work as opposed to when I was a student."
On her reasons for joining the Addicks, Sarah added: "I have played against all the top clubs before with Blackburn and the game we played against Charlton was memorable.
"It was an FA Cup semi-final [in 2007] and they just seemed like a really good footballing side. The club seems friendly and it's in a nice location for me and it just seems that maybe I can help establish the club a bit more.
"They are in a good position, finishing in the top half of the league last season so we can build on that and hopefully I can bring something different to the club."


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Summer's here for all intents and purposes and with that comes selfies, sunsets, cocktails and canoes. For Lisa LaVecchia, vice president and CMO of the Ontario Tourism Marketing Partnership Corporation (OTMPC), those photo opportunities represent a powerful marketing and branding tool via social media for Canada's fourth largest province.
LaVecchia's team has a specific process: when they create a page on a social channe l, they wholely commit and the results are staggering. On Facebook, Ontario Tourism has 252,000 Likes. On Twitter @OntarioTravel has 54,000 followers. But it is Instagram that the organization has seen the fastest growth. Since May 20, the brand has seen a 10 per cent increase in followers from 64,000 to more than 70,000 today.
LaVecchia attributes this success to a toolkit she created and shared with her team internally and tourism operators and representatives around the province.
"We have more than 100,000 consumers using #DiscoverON, that number grows every day so we know the message is getting out there," said LaVecchia.
It isn't enough to run an account by committee, someone has to own it. In LaVecchia's case, she brought on Jennifer Curtis as director of digital marketing to lead social for the brand.
So, find your own Jennifer, she's taken!
"We're a community not a campaign," said LaVecchia, which means staying on trend and finding new ways to engage.
This summer the brand will invite people to share photos for a series OTMPC is calling "From Where I Stand".
"It is already something that people love to do but we'll share your photo of where you are standing in Ontario," said LaVecchia.
The key here is to sometimes keep it simple—and it capture the zeitgeist when you can.
What works well one side of the province, might not, on another. To help mitigate this and maintain an honest brand voice throughout Ontario, LaVecchia has armed tourism information stations with their own branded social accounts to serve as ambassadors.
Traditional tourism information centres hand out pamphlets, as does OTMPC in between engaging with potential visitors to a region on social media.
By extending the team beyond a traditional base of marketers you can also increase the number of eyeballs scanning for unique content to crowd source.
Tag your photos #DiscoverON to give us permission to repost.
A brand cannot be in every corner of a region but tourists can be. Tap into your audience to create content.
Ontario Travel will also augment social reach by using sponsored posts on Twitter and Facebook. Don't be afraid to spend money to get results. It is a pay-to-play environment.
Every platform has its own character and content requirements. Just because a piece of content gets traction on Facebook doesn't mean it is suitable for Instagram. Facebook is where a community comes to talk and Instagram is where it comes to gawk.
Regardless of the platform, the tourism industry's social media goals should revolve around creating content that feels organic and represents the region appropriately.
Find new visitors and listen to what interests them using Cision's social intelligence solutions. Learn how to monitor everything in this whitepaper.


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text:
Jordan Somers | The Seattle Collegian
COVID reflections – Collective shifts & internal struggles
Jordan Somers
By Jordan Somers on 10/03/2020
On Tuesday, September 29th 2020, I willingly flung myself out to sea. With a soggy, faded map in hand, I hurried toward the deep foreboding depths of the all-too-familiar unknown. I had been anticipating the turbulent nature of this return voyage for the last three months. The place I sought, after all, was familiar to me. And although I anticipated what was at stake, I proceeded with the plan. This was the way to go because, well, it was the only way I knew.
School. It's back in session, and the stakes are higher; worldwide modalities of being have been shifted, transcended, obliterated, leaving everyone and everything to face both heartily undesired and subtly celebrated outcomes. To brave these waters successfully depends largely in part on what kind of vessel one has the privilege to captain. Yet, as we continue to brave these tumultuous tides of unprecedented proportions, it becomes amply clear that neither yacht nor rowboat will be left unscathed.
A perfect concoction of pandemic and reinvigorated revolution, along with horrific forest fires and a complete systematic crumbling of perceived democracy, has thrusted us in severe bouts of wavering, wandering, erratic and sedentary livelihoods. To speak for those who have been impacted in ways other than my own would be unfair, yet as I write from an ever-recovering state of bewilderment, lapping waves of anxiety, currents of sadness, grief and indecision – particularly in a season that is associated with sunshine, vibrancy, fun, togetherness –, I hope to convey some sort of collective sentiment through a reflection of my relative internal struggles of late.
Classes have begun; an encouraging, however muddled, welcome sight for those who have been grappling to maintain grasp of the helm of their ship. A shove back into a routine that serves as a reminder that we students are a resilient, if frightened, bunch. A great many of us received a taste of what was in store last spring when all COVID hell was breaking loose, as we hazily stumbled into an online class framework as the school institutions acted accordingly while attempting to assuage student concerns. We downloaded Zoom, we situated ourselves in our new spaces in front of the screen. We awaited further instructions from our country's leaders, from our loved ones, from our instructors. We feared for our lives, particularly for the lives of those more vulnerable. We waited, we showed up. We forged ahead, hopeful and determined, as we do.
I longed to be finished with spring quarter soon after it had commenced. I was drained, disenchanted, utterly distracted and consumed by the revolution that was violently unfolding on our very doorstep. COVID regulations were in full effect, but the protestors' intent to gather had transcended any novel, flimsy rules for social distancing. We were in it. I was in it, and there was no place I would have rather been. It was and is a seemingly rare cacophony of events that revealed so much about our existence, about our perceptions, how we treat each other. A signifier, both welcomed and unwelcomed, that things are always changing out of necessity.
After the formation of the CHOP, protests dramatically reduced in size, and have remained prominent ever since its shutdown (over 100 days of demonstrations and counting). Meanwhile, I retreated back into the depths of inner pursuits, seeking a welcoming attitude toward summertime and all I expected it to be. Camping trips, walkabouts, and time with friends outside, while being both mindful and paranoid amid the social distancing concerns. This was a harsh deviation from what I had chosen to experience just days and months prior: online schooling, strict quarantining and documenting the protests. And although I had convinced myself a break was needed, the sought-after summer activities somehow caused nothing but inner anguish and heightened anxiety.
My experiences and pursuit of knowledge over the last several years have solidified my appreciation for the collective consciousness; how our very presence in this world ripples energies through everyone and everything around us and beyond. Yet my actions still seem to reflect earned and inherited traits that had led me to the early summer mindset, "I need to take a break," and subsequently, "I feel miserable" while experiencing this so-called "break." Thinking I need to be anywhere else other than where I presently am. Why am I not out there in the streets protesting? Why am I not volunteering my time to an organization that needs all the support it can muster? Why am I not utilizing this quarantine to read more? Why am I not slowing down, even when things are slower?
Extreme situations tend to reveal what already exists, what's already at stake – perhaps a latent potential, a desperation, unresolved grief, an internal disequilibrium, implicit bias or racism. We have all been pushed to some brink in the wake of these circumstances. Children no longer receiving a certain early childhood peer-to-peer connection that healthy brain development requires. An extreme polarized spectrum constituting people who claim COVID is a hoax, while others attempt to exploit and succumb to the fear-inducing nature of the pandemic (cough, cough, toilet paper). The psychological implications of quarantining, and the skyrocketing rates of depression that have followed. Inadequate, privatized healthcare posing further obstacles to those with serious health risks, as well as to those trapped in prisons and detention centers. Exponentially rising numbers of people living on the streets, all while infection rates sore and wildfires blaze.
This shift, in revelatory fashion, has also allowed people to come face-to-face with what matters. Working from home has become a blessing for many – more time with their children, their loved ones, not spending hours commuting to a fluorescently lit office. COVID, it can be argued, was a key player that sparked the protests; we were quarantined, losing our jobs, subjected to the onslaught of media, now more concentrated on the always present abuse, corruption and hypocrisy of our so-called democracy, until a point of no return erupted. Innovation, creativity, entrepreneurial pursuits have elevated in importance and acknowledgement. The culture which we call our own, has unified us in struggle.
This is the collective. This is, in the most understated of ways, a coalescence of our very thoughts, ideas, emotions, action and inaction. And considering what's at stake for each of us, there is no wrong way to go about this because, in the end, it's our way. What exists is a testament to what is possible, to what must be confronted, to what must be forgiven. In pondering this, I confide in my future self who, at some particular instance, will have said, "I understand why you did what you did, why you felt what you felt, but in the end you proved there was another way to serve yourself and others better, however big, however small. High five!"
This is my hope to people I have wronged and to people who have wronged me, to the nastiest of politicians, to my dearest of friends, to my classmates and professors, to the billions with whom I share this planet – that the inevitable silver linings of growth shine brightly upon us. For these changes will forever be embedded in the collective march that I like to believe seeks a unifying flow of connection, humility and kindness.
School has begun. We have shown up to the occasion to earn our keep, to hopefully experience and receive a sort of psychological solace that propels comfort within our notions of success and personal enrichment. None of this is easy, particularly in this abrupt, virtually driven transitionary phase, but fortunately we have proven to ourselves that we are resilient as we've made it this far. Obstacles of relative scale have left us cold, numb, angry, distracted, encumbered. Yet these experiences, I hope, are the uniquely inherited keys that somehow enable each of us to show up another day, in whatever ways we can manage, with whatever strength we can marshal. We are the beautiful little droplets that form the vast collective ocean of possibility. We will continue to find ways to navigate these uncharted waters. We can't get this wrong.
jordan.somers@seattlecollegian.com
Jordan Somers is currently in his second year of Visual Media at Seattle Central College. He specializes in photojournalism and documentary work, with a particular emphasis on social movements happening throughout the city. His 2020 documentary, Hope is Not Cancelled, was an official selection at the Local Sightings Film Festival, and won an award for best editing at the Oregon Documentary Film Festival. Jordan is an avid traveler when granted the opportunity, and has a keen interest in psychology and existential philosophy.
https://seattlecollegian.com/author/jordan-somers/
A timeline in pictures: Inside the shutdown
Disappointment, longing and silver linings
Signs of the times-A photo set of a changing city
Boarded up against the storm-Seattle in pictures
Published in Opinion
COVID and college
COVID reflections
COVID silver linings


text:
Year : 2017 | Volume : 8 | Issue : 2 | Page : 117-124
Use of 0.5% bupivacaine with buprenorphine in minor oral surgical procedures
Varun Nagpal1, Tejinder Kaur2, Sarika Kapila2, Ramandeep Singh Bhullar2, Amit Dhawan2, Yashmeet Kaur2
1 Department of Oral Surgery, Maharaja Ganga Singh Dental College, Sri Ganganagar, Rajasthan, India
2 Department of Oral Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, Punjab, India
Dr. Tejinder Kaur
Department of Oral Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, Punjab
DOI: 10.4103/njms.NJMS_53_16
Background: Minor oral surgical procedures are the most commonly performed procedures by oral and maxillofacial surgeons. Performance of painless surgical procedure is highly appreciated by the patients and is possible through the use of local anesthesia, conscious sedation or general anesthesia. Postoperative pain can also be controlled by the use of opioids, as opioid receptors exist in the peripheral nervous system and offers the possibility of providing postoperative analgesia in the surgical patient. The present study compares the efficacy of 0.5% bupivacaine versus 0.5% bupivacaine with 0.3 mg buprenorphine in minor oral surgical procedures.
Patients and Methods: The present study was conducted in 50 patients who required minor oral surgical procedures under local anesthesia. Two types of local anesthetic solutions were used- 0.5% bupivacaine with 1:200000 epinephrine in group I and a mixture of 39 ml of 0.5% bupivacaine with epinephrine 1:200000 and 1 ml of 300 μg buprenorphine (3 μg/kg)in group II. Intraoperative and postoperative evaluation was carried out for both the anesthetic solutions.
Results: The mean duration of postoperative analgesia in bupivacaine group (508.92 ± 63.30 minutes) was quite less than the buprenorphine combination group (1840.84 ± 819.51 minutes). The mean dose of postoperative analgesic medication in bupivacaine group (1.64 ± 0.99 tablets) was higher than buprenorphine combination group (0.80 ± 1.08 tablets). There was no significant difference between the two groups regarding the onset of action of the anesthetic effect and duration of anesthesia.
Conclusion: Buprenorphine can be used in combination with bupivacaine for patients undergoing minor oral surgical procedures to provide postoperative analgesia for a longer duration.
Keywords: Bupivacaine, buprenorphine, minor oral surgical procedures
Nagpal V, Kaur T, Kapila S, Bhullar RS, Dhawan A, Kaur Y. Use of 0.5% bupivacaine with buprenorphine in minor oral surgical procedures. Natl J Maxillofac Surg 2017;8:117-24
Nagpal V, Kaur T, Kapila S, Bhullar RS, Dhawan A, Kaur Y. Use of 0.5% bupivacaine with buprenorphine in minor oral surgical procedures. Natl J Maxillofac Surg [serial online] 2017 [cited 2023 Jan 29];8:117-24. Available from: https://www.njms.in/text.asp?2017/8/2/117/221710
Local anesthetic agents are the mainstay of perioperative pain control for most office-based oral surgical procedures. Amide types of local anesthetics (bupivacaine, etidocaine, lidocaine, mepivacaine, prilocaine, and articaine) with a moderate-to-long duration of action are commonly used for these surgical procedures.[1]
Bupivacaine hydrochloride, introduced in 1963, is a long-acting amide type of local anesthetic. It is a powerful anesthetic with an intermediate onset of action (2–5 min), allowing a slow return to normal sensation (180–600 min).[2] It provides additional analgesia time, known as residual analgesia, and minimizes the duration of postoperative pain, facilitating postoperative care, and maintenance of proper oral hygiene.[3]
Infection if present alters the ability of local anesthetic to achieve adequate pain control during surgery as the low pH of the inflamed tissue leads to quick dissociation of local anesthetic to cation form, which is not able to penetrate the phospholipid membrane of the neuronal cells. Locally injected opioids may act synergistically with local anesthetics in inflamed tissues and increase the perioperative analgesic effect.[4]
Buprenorphine is a semi-synthetic, oripavine alkaloid derived from thebaine. It is a long-acting, lipid-soluble, mixed agonist-antagonist opioid analgesic which was first synthesized in 1966.[5] The low abuse liability of the drug in humans soon turned it into a widely used therapeutic agent in patients with opioid dependence. The principal clinical application of buprenorphine is as an analgesic for moderate-to-severe pain in perioperative setting.[6] The analgesic effect of buprenorphine appears to depend on the integrity of descending fibers from the rostral ventromedial medulla. Residual analgesic effects of opioids after inactivation of descending fibers may be caused by peripheral effects in the presence of inflammation.[7] Buprenorphine is shown to be fully efficacious with an antinociceptive potency 20-70 times higher than morphine. It binds to mu, kappa, and delta opioid receptors and dissociates slowly from these receptors. Buprenorphine acts as a partial mu opioid agonist and a kappa opioid antagonist.[8] The parenteral formulation of buprenorphine has an onset time of 5-15 min, and duration of action is about 8 h after administration. It is metabolized by the gut and liver.
The various advantages associated with the use of buprenorphine are that it has a longer duration of analgesic action, low addiction propensity, and a high therapeutic index. The adverse effects associated with it include sedation, nausea, itching, constipation, addiction in higher doses, confusion, hallucinations, dry mouth, blurred vision, and respiratory depression with the overdose of drug.[6],[7]
The purpose of the study was to compare the efficacy of 0.5% bupivacaine versus 0.5% bupivacaine with buprenorphine in providing prolonged postoperative analgesia during various minor oral surgical procedures.
Fifty healthy adult patients who reported to the department of oral and maxillofacial surgery requiring minor oral surgical procedures were included in this study. Various minor surgical procedures included incision and drainage of abscess, removal of impacted third molars, apicoectomy, neurectomy, surgical extraction of teeth, cyst enucleation, and fracture reduction and fixation under local anesthesia. Diagnosis was made on the basis of history, clinical examination, and radiological examination. Patients were informed about the surgical procedure, postsurgical recommendations, and possible complications. Informed consent was obtained from each patient. Exclusion criteria included patients with a history of uncontrolled medical illness, sensitivity to local anesthesia, tolerance or addiction to analgesic drugs, pregnancy, bleeding disorders, chronic obstructive pulmonary disease, neurologic, psychiatric illness, or positive drug abuse history. The study protocol and informed consent form was approved by the Institutional Ethical Committee.
Treatment groups
Patients were assigned to one of the two equal groups by randomization method using table of random numbers. Patients in Group I (25 patients) received various intraoral nerve blocks as indicated using 0.5% bupivacaine with 1:200,000 epinephrine, whereas patients in Group II (25 patients) received the same blocks using the mixture of 39 ml of 0.5% bupivacaine with 1:200,000 epinephrine and 1 ml of 300 microgram buprenorphine (3 μg/kg). In addition, local infiltration was given in both the groups wherever needed to achieve hemostasis of the site. Analgesics were prescribed postoperatively only when the patient began to complaint of pain. The prescribed analgesic was tablet ketorol 10 mg (ketorolac 10 mg - Dr. Reddy's Laboratories Limited). Patients were asked to note down the number of tablets required, if any, to relieve pain.
It included evaluation of following parameters in both the groups intraoperatively and postoperatively:
Total volume of anesthetic solution used during the surgery (in ml)
Onset of action of anesthetic agent: The onset of anesthesia was determined by evaluating the subjective and objective symptoms of anesthesia of the respective nerve block used
Duration of surgery after anesthetic administration (in minutes): The duration of surgery corresponded to the period between the first incision and the last suture
Duration of anesthesia (in minutes): The duration of anesthesia was determined as the time from onset of anesthesia to the time when symptoms of anesthesia began to wear off
Duration of postoperative analgesia (in minutes): The duration of postoperative analgesia was taken as the time from the end of surgery to the time for the need of first analgesic medication. The total amount of analgesic medication ingested during the postoperative period, and the percentage of patients who required medication in each group was also evaluated
Efficacy of postoperative analgesia: The efficacy of analgesia was recorded with the aid of a 100 mm-length visual analog scale (VAS) with the markings between:
1–25: Mild pain
26–50: Moderate pain
51–75: Intense pain
76–100: Unbearable pain
Each patient scored pain intensity every hourly for the first 10 h and then again at 24, 36, and 48 h.
Patients were observed for side effects such as sedation, pruritus, nausea, vomiting, and respiratory depression.
The data obtained were subjected to statistical analysis and expressed as mean ± standard deviation. Unpaired t-test was used to analyze the data for the mean volume of anesthetic solution, onset and duration of anesthesia, postoperative analgesia, and duration of surgery for both the groups. Data for the percentage of patients taking postoperative analgesics were analyzed using nonparametric Chi-square test. Mann–Whitney test was used for the evaluation of pain with VAS because the data were not normally distributed, P < 0.01 was considered statistically significant.
Out of total 50 patients selected for the study, there were 29 (58%) male and 21 (42%) female [Figure 1]. The mean age of patients was 27.60 years in bupivacaine group and 27.50 years in buprenorphine combination with bupivacaine group.
Figure 1: Demographic data
Patients were divided into two groups and the surgical procedures included surgical removal of impacted mandibular third molars, incision and drainage of space infections, enucleation of cysts, dentoalveolar fractures, isolated mandibular fractures, maxillary fractures, elective implant removal, and excision of tumors [Figure 2].
Figure 2: Various minor oral surgical procedures done
In both groups, the minimum volume of anesthetic solution used was 4 ml. However, the mean volume of bupivacaine solution including the amount needed for infiltration/reanesthesia was slightly higher (4.15 ± 0.52 ml) than the mean volume of buprenorphine combination with bupivacaine solution (4.12 ± 0.60 ml). The difference in the mean volume of both the solutions used was found to be statistically nonsignificant (P = 0.84).
The mean subjective onset of action in bupivacaine group (3.00 ± 1.08 min) was slightly longer than buprenorphine combination group (2.92 ± 1.03 min) whereas, on pinprick test, reverse was the case with the mean of 7.40 ± 1.93 min in buprenorphine combination group and 7.28 ± 1.59 min in bupivacaine group [Table 1]. Statistically, no significant difference was observed between both groups regarding subjective (P = 0.79) and objective onset of action (P = 0.81).
Table 1: Evaluation of onset of action
Similarly, there was no significant difference in the duration of surgical procedure (P = 0.76) and duration of anesthesia with respect to initial recovery from anesthesia and complete recovery of sensation in both groups (P = 0.32, P = 0.63, respectively). However, the mean duration of postoperative analgesia in bupivacaine group (508.92 ± 63.30 min) was observed to be quite less than buprenorphine combination group (1840.84 ± 819.51 min), and value was found to be highly significant statistically (P < 0.001) [Table 2].
Table 2: Evaluation of duration of anesthesia, postoperative analgesia, and duration of surgery
On comparing the total amount of analgesic medication ingested during the postoperative period, the mean dose of analgesic medication in bupivacaine group (1.64 ± 0.99 tablets) was observed to be higher than buprenorphine combination group (0.80 ± 1.08 tablets). The difference between both the anesthetic solutions regarding number of analgesic tablets was found to be statistically significant (P = 0.006) [Table 3].
Table 3: Evaluation of analgesic medication
The percentage of patients who had taken analgesic medication in the early postoperative period (1, 2, 3, 4, 5, 6, 7, 8, 9, and 10 h) and in the later postoperative period (12, 24, 36 and 48 h) was compared in both the groups, and it revealed that the patients in buprenorphine combination group had significantly less pain during both periods [Figure 3]. At the end of 10 h, all patients (100%) in buprenorphine combination group were pain free, as compared to only 4% of patients who were absolutely pain free in bupivacaine group. In this group, 12% of patients had mild pain but did not take analgesic medication. Only 84% of patients took analgesic medication till the 10th h evaluation. However, at 12, 24, and 36 h, 4%, 12%, and 16% of patients, respectively, in buprenorphine combination group had taken analgesic medication as compared to 100% of patients in bupivacaine group at all-time intervals. At the 48th h, 20% of patients were still pain free in buprenorphine combination group as compared to no pain-free patient in bupivacaine group.
Figure 3: Patients who had taken analgesic medication
The difference between number of analgesic tablets taken in both groups was statistically highly significant at the 10th, 12th, 24th, 36th, and 48th h (P< 0.001) [Table 4].
Table 4: Percentage of patients who had taken analgesic medication
The efficacy of postoperative analgesia was recorded with the help of 100 mm-length VAS in both the groups [Figure 4]. Till the 5th postoperative hour, the P value was found to be statistically insignificant as all the patients in buprenorphine combination group had no pain and only three patients in bupivacaine group had very mild pain. Difference in median postoperative pain score between both anesthetic solutions was found to be statistically significant at the 6th and 10th h (P = 0.001). However, it was observed to be statistically highly significant from 7th h to 9th h (P< 0.001). As all the patients in the bupivacaine group had taken analgesic medication by the 12th h, they were excluded from further statistical analysis [Table 5].
Figure 4: Evaluation of pain using visual analog scale
Table 5: Evaluation of pain using visual analog scale
None of the patients in either group reported opioid-related side effects such as nausea, vomiting, pruritus, or any evidence of respiratory depression during intraoperative and postoperative assessment.
Pain may be described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Buprenorphine has been used for the treatment of acute and chronic pain as a supplement to anesthesia for behavior and psychiatric disorders and as a maintenance medication for heroin dependence.[6],[7] The analgesic effect of buprenorphine appears to depend on the integrity of descending fibers from the rostral ventromedial medulla. Prolonged duration of analgesia is due to the fact that buprenorphine dissociates very slowly from opioid receptors. The postoperative analgesic effects of buprenorphine added to local anesthetic have been discussed by various authors.[7],[8],[9],[10]
Being a partial mu opioid agonist, buprenorphine has a wider safety profile as compared to full mu agonists. Further, the slow dissociation of buprenorphine from the receptor may result in fewer signs and symptoms of opioid withdrawal upon termination of buprenorphine therapy than those which occur with full mu opioid agonists such as morphine, heroin, and methadone. Antagonist effects at the kappa receptors are associated with limited spinal analgesia, dysphoria, and psychomimetic effects.[6] Buprenorphine can be used by various routes in human beings such as epidural, intravenous, intramuscular, sublingual, transdermal, delivery routes [6],[7],[8] and for intraoral nerve blocks.[8]
The pH of the tissue and pKa of drug are the most important factors which affect the time of onset of anesthesia. The pKa defines the pH at which the ionized and nonionized forms of a drug are in complete equilibrium, that is, half of the drug is ionized. Only the nonionized form of the local anesthetic can diffuse across lipid nerve sheath and cell membrane. pKa also reflects the proportion of local anesthetic that is in a diffusible nonionized state and therefore contributes greatly to the rate of onset of anesthesia. The pKa values of commonly used local anesthetics are greater than the normal tissue pH (approximately 7.4) which means the drugs exist predominantly in the ionized form after injection. At normal tissue pH, the proportion of nonionized form of bupivacaine is 20%; this contributes in part to slightly slower onset of anesthesia with bupivacaine, particularly for nerve block anesthesia.[2],[11],[12] In the present study, the mean value for time of onset as referred to lip and tongue numbness and also on pinprick test in bupivacaine group was 3.00 ± 1.08 and 7.28 ± 1.59 min, respectively, as compared to 2.92 ± 1.03 min and 7.40 ± 1.93 min, respectively, in buprenorphine combination group. Contrary to our results, Brkovic et al.[13] found the mean time of onset as referred to lower lip numbness as 8.7 ± 2.2 min and 7.4 ± 1.4 min on pinprick test while using 0.5% bupivacaine (2 ml) for the lower third molar surgery. Swarnkar et al.[14] reported the onset time of sensory block (with intravenous regional anesthesia) when 0.3 mg buprenorphine was added to the local anesthetic as 5.0 ± 1.0 min and the onset time of sensory block as 4.0 ± 0.4 min when 0.3 mg buprenorphine was given intramuscularly. Sarkar et al.[15] reported the onset time of sensory block as 3.28 min (supraclavicular block) when 1 ml (0.3 mg) buprenorphine was added to the mixture of local anesthetics. Our results are in agreement with those of Trullenque-Eriksson and Guisado-Moya [3] who found the mean onset of time for inferior alveolar nerve block as 3.68 ± 3.11 min and for buccal nerve as 1.95 ± 1.25 min while using 0.5% bupivacaine with 1:200,000 epinephrine for surgical extraction of mandibular third molars. Duration of the effect of an anesthetic is proportional to its degree of protein binding. Those agents who have a high affinity for the protein component of a nerve are less liable to diffuse from the injection site and be absorbed into the systemic circulation. Bupivacaine's long duration of action is largely due to this characteristic. Bupivacaine has one of the greatest protein binding values out of all the amide local anesthetics. The reported protein binding value for bupivacaine is 95%. However, the duration of the effect of the local anesthetic is also dependent on the injection site and the concentration of vasoconstrictor present in the anesthetic solution.[2],[11],[12] In the present study, there was no statistically significant difference in the mean duration of anesthetic effect of 0.5% bupivacaine with epinephrine 1:200,000 (526.84 ± 101.13 min) and buprenorphine combination group (540.80 ± 103.78 min). Our results are in agreement with Brkovic et al.[13] who reported that duration of anesthesia was slightly longer with 0.5% bupivacaine (688 ± 85 min and 550 ± 48 min) as compared to 0.75% ropivacaine group (582 ± 67 min and 450 ± 73 min) with reference to lower lip numbness and pinprick test, respectively.
In contrast to the present study, Sarkar et al.[15] reported the total duration of sensory block and motor block when 1 ml (0.3 mg) buprenorphine was added to the mixture of local anesthetics for supraclavicular block as 261.84 ± 53.30 min and 328.32 ± 47.94 min, respectively, which was less than the present study. Trullenque-Eriksson and Guisado-Moya [3] reported the duration of soft-tissue anesthesia being 8.20 ± 4.54 h in case of 0.5% bupivacaine with 1:200000 epinephrine group. Our results are also supported by Sancho-Puchades et al.[16] who compared 4% articaine and 0.5% bupivacaine both with epinephrine 1:200000 and reported that mean duration of soft-tissue anesthesia with respect to the final lip recovery (621.2 ± 148.4 min) was longer than final tongue recovery (512.1 ± 127.3 min). Singam et al.[17] reported the total duration of sensory block and motor block when 2 ml (0.3 mg) buprenorphine was added to the local anesthetic and then used for supraclavicular block as 647.83 ± 55.70 min and 306.33 ± 20.12 min, respectively, which is quite close to the findings of the present study.
Postoperative pain control has been the subject of continuous research in the field of oral and maxillofacial surgery since pain can interfere with patient's quality of life. Surgical trauma elicits a variety of tissue responses producing and releasing biochemical mediators involved in the pain process.[18] Several authors have studied the various methods to control pain, such as the use of long-acting local anesthetics to decrease analgesic intake, the preoperative prescription of steroidal anti-inflammatory drugs for decreasing edema, pain and the postoperative use of soft-tissue lasers for better healing, and less postoperative pain and inflammation.[19] In the present study, duration of postoperative analgesia in bupivacaine group was 508.92 ± 63.30 min and in buprenorphine combination group being 1840.84 ± 819.51 min. Opioids exert their analgesic effect by acting exclusively in the central nervous system. Various mechanisms are proposed for activation of opioid receptors on peripheral neurons.
Opioids increase potassium current and decrease calcium current in the cell bodies of sensory neurons. This inhibits the neuronal firing and transmitter release as well as the calcium-dependent release of excitatory pro-inflammatory compounds (e.g., substance P) which contributes to their analgesic and anti-inflammatory actions
Opioid antinociceptive effect is particularly prominent in inflamed tissue
Inflammation disrupts the perineurium (normally an impermeable membrane) and facilitates the passage of corticotropin-releasing hormones, interleukin 1B, and other cytokines. These substances apparently stimulate the release of opioid peptides from immune cells which activate opioid receptors on the sensory nerve endings leading to antinociception
Inflammation also enhances the peripherally directed axonal transport of opioid receptors (dorsal root ganglia → peripheral) which leads to receptor upregulation (increase in their number in peripheral nerve terminals). Furthermore, the previously inactive opioid receptors become active in an inflamed tissue enhancing the analgesic potential of
Opioids.
Prolonged duration of analgesia is due to the fact that buprenorphine dissociates very slowly from opioid receptors.[8],[20],[21],[22] Our results are supported by Nespeca,[23] Bouloux and Punnia Moorthy,[24] and Modi et al.[8] who found duration of postoperative analgesia in 0.5% bupivacaine with 1:200000 epinephrine groups as 449 ± 19.25 min, 480 min, and 500.4 ± 6.6 min, respectively, in their studies. Viel et al.[9] reported duration of postoperative analgesia when 0.3 mg buprenorphine was added to 0.5% bupivacaine in brachial plexus block as 2103 ± 117 min. Our results are supported by Modi et al.[8] who found duration of postoperative analgesia in Group II patients (0.3 mg of buprenorphine combined with 0.5% bupivacaine with epinephrine 1:200,000) as 1690.8 ± 61.2 min. The authors stated that the addition of buprenorphine to the local anesthetic mixture prolonged the duration of postoperative analgesia up to three times provided by the local anesthetics alone.
Tissue injury associated with surgical trauma directly and indirectly leads to the activation of nociceptors with increased expression of pro-inflammatory cytokines and induction of cyclooxygenase-2 leading to peripheral and central sensitization with subsequent hyperalgesia. Prostaglandin E2 is an abundant eicosanoid released after surgical trauma and has been associated with inflammation and pain. The synthesis of prostaglandin is suppressed by a number of anti-inflammatory agents including the nonsteroidal anti-inflammatory drugs.[25],[26] In the present study, the mean dose of postoperative analgesic medication tablet ketorol DT 10 mg (ketorolac 10 mg Dr. Reddy's) in bupivacaine group ([1.64 ± 0.99 tablets] 16.4 ± 9.9 mg) was higher than buprenorphine combination group ([0.80 ± 1.08 tablets] 8 ± 10.8 mg). Trieger and Gillen [25] reported that patients receiving 0.5% bupivacaine with epinephrine 1:200000 required only 2.3 doses of codeine phosphate (30 mg) as postoperative analgesics. Our results are supported by Crout et al.[26] who found that only 1.4 ± 1.0 tablets of postoperative analgesic medication (325 mg acetaminophen with codeine 30 mg) were required in 0.5% bupivacaine with epinephrine 1:200000 group. Contrary to our results, Brkovic et al.[13] reported that there was no requirement of analgesic tablet in 0.5% bupivacaine group patients. Swarnkar et al.[14] found that 56 ± 9 mg of postoperative analgesic medication (diclofenac 1 mg/kg) was consumed when 0.3 mg of buprenorphine was added to local anesthetic for intravenous regional anesthesia. Analgesic dose consumption was higher (120 ± 24 mg) when 0.3 mg of buprenorphine was given intramuscularly as compared to intravenous route. Mehta et al.[21] reported that total dose of postoperative analgesic medication (tramadol 50 mg) consumed was 12.5 ± 5.38 mg when 2 μg/kg of buprenorphine was added to local anesthetic for wound infiltration.
In the present study, VAS was used for assessment of postoperative pain. At the end of 10th h, all patients (100%) in buprenorphine combination group were pain free, as compared to only 4% pain-free patients in bupivacaine group. At the 48th h, 20% of patients were still pain free in buprenorphine combination group as compared to none in the bupivacaine group. Viel et al.[9] compared the effectiveness of both buprenorphine and morphine when used in combination with local anesthetic (5% bupivacaine) in brachial plexus block for postoperative pain relief. The authors reported that 12 h postanesthesia, all patients (100%) had satisfactory or tolerable anesthesia in buprenorphine group as compared to 80% of patients in morphine group. At the 48th h, 5% of patients were still pain free in buprenorphine combination group as compared to no pain-free patient in morphine combination group. Candido et al.[10] also studied that the addition of buprenorphine to local anesthetic used for brachial plexus block provided long-lasting postoperative analgesia with complete analgesia persisting 30 h beyond the duration (6 h) provided by local anesthetic alone in 75% of patients. In their study, at the 48th h evaluation, 10% of patients were pain free in buprenorphine combination group as compared to no pain-free patient in local anesthetic group. Their findings are in agreement with the present study and with the findings of Modi et al.[8] in which also postoperatively at the 48th h evaluation, 20% of patients of buprenorphine combination group were pain free as compared to no pain-free patient in bupivacaine group.
Buprenorphine in combination with 0.5% bupivacaine group in comparison to 0.5% bupivacaine group alone provided a longer duration of postoperative analgesia and markedly decreased the need for analgesic medication in postoperative period. Overall, buprenorphine is a highly effective analgesic for the treatment of moderate-to-severe pain. It has a unique pharmacological and physiochemical profile allowing for relatively safe use and flexibility with regard to dosage and dosage forms. Thus, buprenorphine can be used in combination with bupivacaine for patients undergoing minor oral surgical procedures to provide postoperative analgesia for a longer duration, but it should be used cautiously in individuals with a past or current history of substance abuse or dependence, as it produces opioid-like subjective and physiologic effects dependent on the dose and the route of administration.
The authors wish to state that this paper does not have any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.
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Nagpal V
Kaur T
Kapila S
Bhullar RS
Dhawan A
Kaur Y
Bupivacaine
minor oral surgical procedures


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Of course, that won't matter if Northwestern State can't build on the improvements it made late last season to the Southland's worst defense. They could make more strides with the help of four junior college transfers in the starting lineup, including all three linebackers.
Chrishard Buhl moved back to his former position on the outside and believes the newcomers created more competition to bring the best out of returning Demons such as Peyton Guidry and Shawn Stephens. Both of them should still see plenty of playing time for a group Thomas said goes seven or eight players deep without much of a dropoff.
The newcomers will look for leadership from senior defensive end JeMarcus Marshall and defensive backs Darius Poullard and Adam Jones, especially as they break in several young cornerbacks. But the most important returnee might be Daryl Daye, the first defensive coordinator to return for a second year since 2011.
"To have Coach Daye back this year, that's a huge plus," Poullard said. "We are light years ahead of where we were last year coming into camp."
It won't take long after Friday's challenging opener at Baylor to find out if this year will be special, as Thomas tries to reach new milestones in each of the Demons' next three weeks. He could win his first conference opener at home against Incarnate Word, then two big road trips offer the chance for Thomas to finally beat Central Arkansas and Southeastern Louisiana.
"I feel really good about where we are," Thomas said. "We're finally getting there. It's a process when you go through and (start) building the team."
Demons look to transfers for key contributions