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Volume : 9 Issue : 2
Imaging in ischemia of bone – A pictorial essay
Kakarla S
Pdf Page Numbers :- 108-118
Subbarao Kakarla1,2,*
1KIMS Foundation and Research Centre, Minister Road, Secunderabad - 500003, Telangana, India
2Kakarla Subba Rao Radiological and Imaging Educational Sciences Trust (KREST), ShaikpetNala, Hyderabad - 500008, Telangana, India
*Corresponding author: Prof. Kakarla Subbarao, MS, D.Sc. (HON), FRCR, FACR, FICP, FSASMA, FCCP, FICR, FCGP, Chairman - KREST, 8-1-300/2, Shaikpet Nala, Hyderabad, 500008, Telangana, India. Email: subbaraokakarla25@gmail.com
Received 9 December 2020; Revised 24 February 2021; Accepted 5 March 2021; Published 15 March 2021
Citation: Kakarla S. Imaging in ischemia of bone – A pictorial essay. J Med Sci Res. 2021; 9(2):108-118. DOI: http://dx.doi.org/10.17727/JMSR.2021/9-17
Copyright: © 2021 Kakarla S. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Ischemia of bone is not uncommon and is not recognized clinically unless it is acute. Ischemia of bone marrow in shafts of long bones goes by the name of infarction and is well recognized. Ischemia of epiphysis, small bones and subarticular ends of bones goes by the name of avascular necrosis and ischemia of cortical bone goes by the name of Osteosclerosis. The imaging features of these three entities are described with differential diagnosis wherever necessary.
Keywords: bone infarction; avascular necrosis; osteosclerosis; hemoglobinopathies; Gaucher's; radiation therapy; chronic osteomyelitis
Ischemia of bone includes medullary infarction, cortical ischemia and osteonecrosis of the articular margins. Bone infarction is a term used to refer to bone marrow necrosis within the metaphysis or diaphysis of a long bone. Necrosis is a type of cell death due to irreversible cell injury. Bone ischemia also includes cortical bone sclerosis and avascular necrosis by the way of collapse of articular ends of bones, small bones of hands and feet and ossification centres [1]. The causes of these are many and are listed in Table 1.
Table 1: Associated lesions and causes of Ischemia of bone:
• Idiopathic
• Trauma
• Hemoglobinopathies, e.g. sickle cell disease
• Gaucher disease
• Collagen vascular disorders including Lupus
• Behçet's disease
• Corticosteroid excess (both endogenous and exogenous)
• Alcohol
• Radiotherapy
• Chemotherapy for lymphoma
• Pancreatitis
• Gout
• Infection
• Renal transplant
• Caisson disease
• Fibrous dysplasia
Of these, the common entities include steroids and other non-steroidal pain killing drugs, alcoholism, trauma and systemic disorders including hemoglobinopathies, Gaucher disease, Gout, collagen vascular disorders, etc. [2].
Bone infarction involves the bone marrow of long bones.
Bone ischemia that occurs in systemic disorders such as hemoglobinopathies is shown as sclerosis of the cortical bone on conventional films with infarcts. Ischemia of the physeal region results in shortening of the bone such as seen in trauma, sickle cell anemia, radiation therapy, etc.
Osteonecrosis involves the epiphysis, small bones of the hands and feet, articular margins of long bones in adults and ossification centres in children. Radiographically there are several stages in bone marrow infarction and avascular necrosis. Plain films may be normal initially but MRI demonstrates classical findings in the bone marrow and in osteonecrosis.
Pathologically, the blood supply to a section of bone is interrupted and an infarct forms. The infarct includes a central necrotic core which is surrounded by a hyperemic ischemic zone. With time collagen granulation tissue becomes layered around the necrotic core. Demarcation between the normal surrounding marrow, the ischemic zone, and the necrotic core accounts for many of the radiographic appearances of bone infarcts. Calcification occurs eventually due to saponification of fat in necrotic areas. Investigations mainly include conventional radiology and MRI. An interesting observation is the presence of gas in post traumatic osteonecrosis of the vertebral body and it goes by the name of Kummell disease. Similarly gas emboli producing osteonecrosis in bones is noted in Caisson disease. Other methods of imaging are included in Table 2.
Table 2: Imaging methods.
• Conventional radiographs
• CT
• MRI
• Nuclear bone scanning
• PET CT
Imaging features and discussion
Conventional radiology is the initial investigation and the infarct can be missed in early stages, where CT and MRI will help. Radionuclide scanning is non-specific but identifies the location of the lesion. In acute ischemia, radionuclide scan is cold and as reparative changes take place, it becomes hot. PET scan shows the different changes better (Figure 1).
Figure 1a-c: Bone infarcts, (a) conventional, (b) MRI, (c) PET scan.
Imaging features of bone infarction
On conventional radiography, a significant delay occurs between the onset of infarct and development of radiographic signs. In acute infarct, the findings may simulate acute osteomyelitis such as seen in children with osteolysis and periosteal reaction. It is better noted in Sickle Cell Dactylitis (Figure 2a,b). In the spine, cup-like deformities are noted with a "step off" density in the middle-third of the depressed articular plate (Figure 2c). This is called Raynold's Phenomenon representing the site of infarction of bone. MRI at this time identifies the lesion. Early in the course of disease a bone infarct may develop as an area of rarefaction and, later, may have a mixed, osteolytic and sclerotic pattern. With healing, the lesion becomes well demarcated, with a serpiginous or linear zone of calcification and ossification. The calcified peripheral zone is called fibroosseous membrane and this is specific for bone infarct.
Figure 2: (a) Sickle cell dactylitis - with infarctions, (b) Sickle cell dactylitis -shortening of bones in sickle cell anemia, (c) Sickle cell disease, step-off defect.
The serpiginous calcifications when seen end-on simulate enchondroma. However, the calcifications in enchondroma are nodular, arc-like, and circular. Radiographic findings depend upon the stage of the disease. Periostitis is rare in chronic infarcts. The lesion may be limited to diaphysis, metaphysis or may extend from metaphysis to articular margin. They are often bilateral and multiple, and whatever the etiology, the imaging findings are similar. However, the morphological characteristics of infarcts are different in each case.
CT: CT would outline the mineralized portion of the infarct (Figure 3).
Figure 3: CT – Infarct of the humerus extending to the head.
MRI features are as follows
An important feature in differentiating bone infarct from other medullary lesions is that the central signal usually remains that of normal marrow. The marrow is not replaced.
T1 shows serpiginous peripheral low signal due to granulation tissue and to lesser extent sclerosis, peripheral rim may enhance post gadolinium and central signal usually that of marrow (Figure 4).
T2 shows double-line sign: hyperintense inner ring of granulation tissue and a hypointense outer ring of sclerosis, absence of double-line sign does not exclude bone infarct and central signal usually that of marrow.
Radionuclide bone scan shows no uptake (cold spot) in the early stage where blood supply is absent, and shows mildly increased uptake at periphery during acute phase.
Differential diagnosis: (1) Enchondroma: chondroid matrix, central marrow signal is absent, (2) Healing non-ossifying fibroma: usually cortically oriented and is not medullary, (3) Lipoma: well circumscribed fatty lesion with varying degrees of calcification, (4) Brodie's Abscess: Penumbra effect of the border.
Figure 4: (a, b) Infarct, well demarcated peripheral rim, (c) Enchondroma, note the arc-like and circular calcifications.
Idiopathic
Osteonecrosis of femoral head or otherwise called avascular necrosis (AVN) is defined as bone death of the adult femoral head owing to ischemia. Majority of the times, the etiology may not be established. The plain radiographic features follow a sequence with the Crescent sign (Figure 5a) to start with, followed by osteoporosis, osteosclerosis, cystic changes, collapse of femoral head and secondary osteoarthritic changes (Figure 5b-e). It may be bilateral (Figure 5f). Another sign which is characteristic of avascular necrosis of the head of the femur is Snowcap sign which is on the top of the necrotic area (Figure 5c) [3]. There is classification of the stages of osteonecrosis of the femoral head, the details of which are not included in this article.
Figure 5: (a) Avascular necrosis head of femur – Crescent sign. (b-d) Crescent sign in osteonecrosis with collapse of fragment, (c) Snowcap sign, (e) Specimen AVN femoral head, (f) Bilateral avascular necrosis both femoral heads, 24 F.
Osteonecrosis (ischemic necrosis) of the proximal epiphysis of the femur is called Perthe's disease and is common in boys aged between 4-8 years. Bilateral involvement is not uncommon (Figure 6). There is classification regarding the stages of Perthe's disease, the details of which are not included in this article.
Figure 6a-c: Legg calve Perthe's hips, (c) ivory type of epiphysis.
Osteonecrosis of the knee is necrosis of unknown origin affecting predominantly the medial condyle of the distal femur in adults. On occasion the lateral condyle is also involved. It may be associated with trauma or any other cause such as SLE (Figure 7) [4].
Figure 7a-d: Osteonecrosis of medial condyle, systemic lupus erythematosis, (d) advanced stage.
The exact mechanism of osteonecrosis depends primarily on the predisposing cause. In trauma, interruption of arterial supply to bone (e.g., scaphoid fracture, fracture neck of femur) is noted (Figure 8a-d).
Figure 8a-c: Post traumatic osteonecrosis of talus (T), (b, c) Osteonecrosis of the talus, Diaz's disease, (b) and (c) stages of necrosis.
Keinbock's disease is osteonecrosis of the lunate bone either due to trauma or some other reason. Very often the exact cause could not be established. There are five stages in the radiological spectrum, the details of which are not included here. The ultimate result is dense collapsed lunate bone (Figure 8e,f) [5].
Figure 8d-f: (d) Post-traumatic avascular necrosis of scaphoid (Preiser disease), (e, f) Keinbock's disease.
Kümmell disease or vertebral osteonecrosis is generally noted in cases of osteoporosis, whatever the cause maybe. Gas bubbles are demonstrated in plain films as well as in CT or MRI (Figure 8g,h) [6].
Figure 8g,h: Kummell disease, post traumatic osteonecrosis with gas production.
Spontaneous multifactorial adult onset osteonecrosis of the tarsal navicular occurs in adults between 40 and 60 years of age. Plain radiographic features can include comma-shaped deformity due to collapse of the lateral part of the bone and medial or dorsal protrusion of a portion of the bone or the entire navicular bone. The disease may be bilateral or asymmetric and associated with pathologic fractures (Figure 9) [7].
Figure 9a,b: Mueller-Weiss disease, avascular necrosis of navicular.
Hemoglobin SC (HbSC) disease, although a sickle cell disease subtype, with similarities to the classic condition, should ideally be considered as a distinct pathological entity (Figure 10) [8].
Figure 10: Bone infarcts in Sickle Cell Disease, (a) Fibroosseous membrane, (b) cortical thickening, (c) Osteosclerosis and osteonecrosis, (d) extensive bone infarct.
Gaucher's disease
Gaucher's disease is a rare familial disturbance of the cellular metabolism in the reticulo-endothelial cells and histiocytes, characterized by an accumulation and retention of the cerebroside kerasin. Marrow packing by Gaucher cells causing medullary hypertension and intraosseous venous occlusion is noted [9]. Proliferation of endosteal bone is another finding. Compromised blood supply will result in bone infarction at both subarticular and diaphyseal sites (Figure 11).
Figure 11: Infarcts in Gaucher's disease.
Collagen vascular diseases including lupus
The body's immune system attacks its own tissues such as seen in Lupus. In many of the collagen vascular disorders, vasculitis with arterial occlusion is noted (Figure 12) [10].
Figure 12a-d: (a-c) Osteonecrosis humeral head in lupus (HASS disease), (d) Lupus AVN both femoral heads.
Figure 12e-g: (e, f) Bone infarcts and osteonecrosis of lateral femoral condyle in lupus, (g) Osteonecrosis humeral head in lupus.
Behcet's disease
Behcet's disease is a multisystem disease characterized by recurrent oral and genital ulcers, relapsing uveitis, mucocutaneous, articular, gastrointestinal, neurologic, and vascular manifestations. Rheumatologic manifestations may also occur in Behcet's disease, and arthritis and arthralgia are the most common musculoskeletal findings followed by enthesopathy, avascular necrosis, myalgia, and myositis [11]. Although the main pathology of Behcet's disease has been known to be the underlying vasculitis, the etiology and exact pathogenesis of the disease are still unclear. Vasculitis causing arterial occlusion is noted.
Corticosteroid excess (both endogenous and exogenous)
Endogenous steroids are involved in a large number of physiologic processes, including modulating immune function, behavior, cardiovascular function, growth, metabolism, and inflammatory responses. In regional anesthesia and pain medicine, exogenous glucocorticosteroids (GCS) are some of the most common pharmacologic agents in clinical use. These potent intermediate to long-acting GCS are now used to promote predominantly anti-inflammatory effects on target tissues [12]. Fat cell enlargement causing medullary hypertension and intraosseous venous occlusion is noted (Figure 13).
Figure 13a-d: (a) Steroid arthropathy, note the changes in the head of humerus and glenoid, (b-d) MRI - Bone infarct, steroid therapy. Plain films do no show infarcts. MRI reveals infarcts.
Figure 13e-g: (e) Bilateral bone infarcts, note the serpiginous outer margin, steroid,(f, g) 46 F, Steroid induced bone infarct extending to the articular margin.
Figure 13h-j: Corticosteroid therapy producing Infarcts extending to the subarticular area.
Alcohol induced osteonecrosis is part of the differential diagnosis in patients with history of alcohol abuse and diffuse bone pain. Usually patients have a longer than 10 year history of alcohol abuse prior to the development of osteonecrosis. The femoral head is the commonest site involved; however, involvement of the long bones is also seen [13]. Fat embolism secondary to coexisting hyperlipidemia has been postulated as a possible cause of osteonecrosis in alcoholics. Fatty emboli causing arterial occlusion is also noted (Figure 14).
Figure 14: (a, b) Multiple bone infarcts in a chronic alcoholic, (c) Osteonecrosis femoral condyles in alcoholic.
Osteoradionecrosis (ORN) refers to a severe delayed radiation-induced injury and is characterized by bone tissue necrosis and failure in healing [14]. There is some overlap with the term Radiation osteitis. Direct injury to vascular supply leading to occlusion is noted (Figure 15a,b).
Chemotherapy Single or multiple infarcts are not uncommon in therapy of lymphomas and other myeloproliferative disorders (Figure 15c,d) [15].
Figure 15: (a, b) Necrosis of femoral head after radiotherapy for carcinoma of the breast, (c) Multiple Infarcts iliac bone after chemotherapy for lymphoma. (d) Lymphoma chemotherapy, lower end of tibia in a child.
Sporadic cases of intramedullary fat necrosis associated with bone destruction have been reported in conjunction with acute and subacute pancreatitis, traumatic pancreatitis, and pancreatic carcinoma [16].
The radiographic manifestations of bone ischemia and the possible mechanism of infarction in gout are monosodium crystal deposits in small vessels [17].
In chronic osteomyelitis, sequestrum is a common observation which is a dead bone and an example of ischemic bone (Figure 16) [18]. The increased bone density in the sequestrum is partly due to ischemia and mostly due to collapsed trabeculae.
Figure 16: Chronic osteomyelitis with sequestrum.
Renal transplant
It is not uncommon to observe bone necrosis in patients who had organ transplant therapy particularly renal transplant. Besides the classical findings of osteonecrosis, infarcts also may be seen (Figure 17) [19]. Some of the necrotic cases are attributed to steroid and other immunotherapy.
Figure 17: Renal transplant, bilateral osteonecrosis femoral heads MRI.
In chronic diabetes, bone infarcts are noted either due to arteriosclerosis/ microvascular disease or sub-clinical trauma [20]. The imaging characteristics are the same as in other entities (Figure 18).
Figure 18a,b: Bone infarct, diabetic 79 Y/O, note the fibroosseous membrane with sclerotic peripheral rim.
Caisson disease
The etiopathology of Caisson disease: accumulation of nitrogen gas in blood vessels. These act as emboli and produce bone ischemia, infarction and osteonecrosis. This phenomenon is noted in deep sea drivers who are removed too rapidly from a high pressure environment, less frequently from low pressure environments such as in high altitude flying. The entire syndrome has been called Decompression sickness (Figure 19) [21].
Figure 19: Caisson disease, bone infarction and osteonecrosis.
Fibrous dysplasia associated with avascular head of the femur is extremely rare. But it has been reported in adults, but its association with Perthe's is being described for the first time (Figure 20).
Figure 20: Fibrous dysplasia associated with Perthe's disease of femoral head.
Bone ischemia and its imaging forms an interesting part of radiology where the ischemia manifests in increased density of bone in traumatic and infective diseases, collapse in different stages in osteonecrosis, and bone infarcts in long tubular bones. The identification by imaging methods is important. Each one of the above entities gives a different spectrum. There are numerous causes of ischemia but few imaging methods which include conventional, MRI and nuclide scan. The article is profusely illustrated with classical examples.
NIMS, KIMS and KREST, Hyderabad, India.
Author declares no conflicts of interest.
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10 Best Nigeria History Books
The 10 Best Nigeria History Books list have been recommended not only by normal readers but also by experts.
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ISLAM'S BLACK SLAVES P Check Price
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2. There Was a Country: A Memoir by Chinua Achebe Review Summary
There Was a Country: A Memoir
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3. A Fistful of Shells: West Africa from the Rise of the Slave Trade to the Age of Revolution by Toby Green Review Summary
A Fistful of Shells: West Africa from the Rise of the Slave Trade to the Age of Revolution
By the time the "Scramble for Africa" among European colonial powers began in the late nineteenth century, Africa had already been globally connected for centuries. Its gold had fueled the economies of Europe and the Islamic world for nearly a millennium, and the sophisticated kingdoms spanning its west coast had traded with Europeans since the fifteenth century. Until at least 1650, this was a trade of equals, using a variety of currencies–most importantly, cowrie shells imported from the Maldives and nzimbu shells imported from Brazil. But, as the slave trade grew, African kingdoms began to lose prominence in the growing global economy. We have been living with the effects of this shift ever since. With A Fistful of Shells, Toby Green transforms our view of West and West- Central Africa by reconstructing the world of these kingdoms, which revolved around trade, diplomacy, complex religious beliefs, and the production of art. Green shows how the slave trade led to economic disparities that caused African kingdoms to lose relative political and economic power. The concentration of money in the hands of Atlantic elites in and outside these kingdoms brought about a revolutionary nineteenth century in Africa, parallel to the upheavals then taking place in Europe and America. Yet political fragmentation following the fall of African aristocracies produced radically different results as European colonization took hold. Drawing not just on written histories, but on archival research in nine countries, art, oral history, archaeology, and letters, Green lays bare the transformations that have shaped world politics and the global economy since the fifteenth century and paints a new and masterful portrait of West Africa, past and present.
4. The Bright Continent: Breaking Rules and Making Change in Modern Africa by Dayo Olopade Review Summary
The Bright Continent: Breaking Rules and Making Change in Modern Africa
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" It is no accident that the places in the world where we see the most instability are those in which the rights of women and girls are denied. Isha Sesay's indispensable and gripping account of the brutal abduction of Nigerian schoolgirls by Boko Haram terrorists provides a stark reminder of the great unfinished business of the 21st century: equality for girls and women around the world."– Hillary Rodham Clinton The first definitive account of the lost girls of Boko Haram and why their story still matters –by celebrated international journalist Isha Sesay. In the early morning of April 14, 2014, the militant Islamic group Boko Haram violently burst into the small town of Chibok, Nigeria, and abducted 276 girls from their school dorm rooms. From poor families, these girls were determined to make better lives for themselves, but pursuing an education made them targets, resulting in one of the most high-profile abductions in modern history. While the Chibok kidnapping made international headlines, and prompted the #BringBackOurGirls movement, many unanswered questions surrounding that fateful night remain about the girls ' experiences in captivity, and where many of them are today. In Beneath the Tamarind Tree, Isha Sesay tells this story as no one else can. Originally from Sierra Leone, Sesay led CNN's Africa reporting for more than a decade, and she was on the front lines when this story broke. With unprecedented access to a group of girls who made it home, she follows the journeys of Priscilla, Saa, and Dorcas in an uplifting tale of sisterhood and survival. Sesay delves into the Nigerian government's inadequate response to the kidnapping, exposes the hierarchy of how the news gets covered, and synthesizes crucial lessons about global national security. She also reminds us of the personal sacrifice required of journalists to bring us the truth at a time of growing mistrust of the media. Beneath the Tamarind Tree is a gripping read and a story of resilience with a soaring message of hope at its core, reminding us of the ever-present truth that progress for all of us hinges on unleashing the potential of women.
6. Viceregalism: The Crown as Head of State in Political Crises in the Postwar Commonwealth (Cambridge Imperial and Post-Colonial Studies) by H. Kumarasingham Review Summary
Viceregalism: The Crown as Head of State in Political Crises in the Postwar Commonwealth (Cambridge Imperial and Post-Colonial Studies)
This book examines how the Crown has performed as Head of State across the UK and post war Commonwealth during times of political crisis. It explores the little-known relationships, powers and imperial legacies regarding modern heads of state in parliamentary regimes where so many decisions occur without parliamentary or public scrutiny. This original study highlights how the Queen's position has been replicated across continents with surprising results. It also shows the topicality and contemporary relevance of this historical research to interpret and understand crises of governance and the enduring legacy of monarchy and colonialism to modern politics. This collection uniquely brings together a diverse set of states including specific chapters on England, Scotland, Northern Ireland, Sri Lanka, Malaysia, Brunei, Ghana, Nigeria, Zimbabwe/Rhodesia, Australia, Tuvalu, and the Commonwealth Caribbean. Viceregalism is written and conceptualised to remind that the Crown is not just a ceremonial part of the constitution, but a crucial political and international actor of real importance.
7. A Black Byzantium: The Kingdom of Nupe in Nigeria (African Ethnographic Studies of the 20th Century Book 49) by S. F. Nadel Review Summary
A Black Byzantium: The Kingdom of Nupe in Nigeria (African Ethnographic Studies of the 20th Century Book 49)
Originally published in 1942 this now classic book is a study of the Nupe of Northern Nigeria. The economic and political complexity of their kingdom evoked comparisons with the civilization of Byzantium. The detailed description and analysis of their social life and political institutions was the first study of a Muslim Emirate in Nigeria and as such is still an indispensable work.
9. Re-Creating Ourselves: African Women & Critical Transformations by Molara Ogundipe-Leslie Review Summary
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A selection of writings in which the author has critically and creatively pondered issues of gender, politics, and social transformation for at least three decades
10. Nigeria: What Everyone Needs to Know® by John Campbell Review Summary
Nigeria: What Everyone Needs to Know®
As the "Giant of Africa" Nigeria is home to about twenty percent of the population of Sub-Saharan Africa, serves as Africa's largest producer of oil and natural gas, comprises Africa's largest economy, and represents the cultural center of African literature, film, and music. Yet the country is plagued by problems that keep it from realizing its potential as a world power. Boko Haram, a radical Islamist insurrection centered in the northeast of the country, is an ongoing security challenge, as is the continuous unrest in the Niger Delta, the heartland of Nigeria's petroleum wealth. There is also persistent violence associated with land and water use, ethnicity, and religion. In Nigeria: What Everyone Needs to Know �, John Campbell and Matthew Page provide a rich contemporary overview of this crucial African country. Delving into Nigeria's recent history, politics, and culture, this volume tackles essential questions related to widening inequality, the historic 2015 presidential election, the persistent security threat of Boko Haram, rampant government corruption, human rights concerns, and the continual conflicts that arise in a country that is roughly half Christian and half Muslim. With its continent-wide influence in a host of areas, Nigeria's success as a democracy is in the fundamental interest of its African neighbors, the United States, and the international community. This book will provide interested readers with an accessible, one-of-a-kind overview of the country.
10 Best Niger & Nigeria Travel Guides Books
10 Best Afghan War Military History Books

redpajama_set_name: RedPajamaCommonCrawl


CRUZ L. EXPRESS #2 CORP. is an entity registered at KINGS county with company number 2325418. CRUZ L. EXPRESS #2 CORP. located at the address 511 Brighton Beach Avenue Brooklyn, New York, 11235. Company is incorporated on December 10, 1998. Current status of the company is inactive - dissolution by proclamation / annulment of authority (jun 26, 2002).
December 15, 1998 Actual CRUZ L. EXPRESS #2 CORP.
IRIANAS & DELI GROCERY CORP.
WALL STREET RARITIES GROUP HOLDINGS, INC.
E. GEORGE KASSNER M.D., P.C.


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Home | Opinion | From Florence to flourishing
From Florence to flourishing
By: Tona Gillen in Opinion, Top Stories, Workforce January 18, 2019	0
Nursing shortages have been predicted worldwide, with headlines reporting that this is one of the dominant issues in healthcare today. Nursing attrition is on the cusp of becoming a crisis, with perilous implications for patients and healthcare providers alike. Can anything be done to mitigate this nursing crisis?
The Victorian era was known for its hierarchal social order, where upper-class males enjoyed a privileged lifestyle with great wealth and education. The expectation that women would marry and take care of the household and children meant access to higher education and the pursuit of careers were restricted.
The medical profession in the late 19th and early 20th century is often characterised by male physicians and surgeons giving unambiguous orders to female nurses. The nurses dressed in demure color-coded, floor-length uniforms identifying their level of rank. This depiction may reveal some insight into the sexual discrimination that was prevalent at this time.
In 1820, Florence Nightingale was born to an upper-class English family. In 1851, despite the intense objections of her family, she was keen to join the noble profession of nursing: so keen in fact that she enrolled as a nursing student in Germany (there was no training for nurses in the UK at that time). Her nursing career started during the Crimean War (1853–56) where she is recognised for nursing the injured and dying soldiers as well as raising hygiene standards.
In 1859 she wrote a book, Notes on Nursing, which is still considered a classic. Her achievements were truly remarkable given that, in 1860, she opened the Nightingale Nursing School, whose mission was to train nurses to care for the injured and sick. Her greatest work is said to be professionalising nursing roles for women,13,14 but arguably her lasting impact may be as a trailblazer and a feminist.
Nightingale is credited as the founder of nursing, which in Australia is currently the largest single health profession. Nursing in the 21st century requires the provision of high-quality care to discerning patients while dealing with increasingly complex caseloads. In 2012, there were 273,404 registered nurses (RNs) and almost 60,000 enrolled nurses (ENs) registered in Australia, many with postgraduate or doctoral degrees.15
Patient and family-centred care, empathy and compassion are core fundamentals for all healthcare professionals. Empathy is the capacity to understand what another is feeling. Whereas, paradoxically, compassion is the capacity to co-suffer with another; it is the desire to alleviate another's pain or suffering. Emotionally intelligent nurses have both interpersonal social competence as well as intrapersonal self-awareness, which allows them to engage well with each other and with their patients.7
Most nurses adapt positively to stressful working conditions, manage their emotional demands, foster effective coping strategies and improve wellbeing and enhance professional growth,4,5 which in turn promotes optimism, humour and hope.3 Personal resilience is required if one is to survive and thrive in the healthcare sector. Fortunately, resilience does not have to be innate, it can be taught and developed if one is willing to engage in self-development that promotes psychological flexibility and positivity.6
After hearing harrowing stories told by patients, with intensity, sincerity or frequency, a nurse may be affected in a vicarious way – experiencing the emotional journey through empathetic imagination. This can have a heavy impact on one's personal resources, including compassion, a well-recognised phenomenon known as 'compassion fatigue'.1,2 To counter this would be to flourish.
Flourishing is a central concept in positive psychology that includes positive perceptions, attitudes and expectations. It incorporates two dimensions: feeling good and functioning well. Nurses who feel appreciated and acknowledged, and where possible have a sense of autonomy in their workplace, are invariably energetic, dedicated, self-determined, focused and positive, and they will find meaning and purpose at work.
Developing a positive mindset and flourishing was popularised by Irish philosopher Gertrude Anscombe, and this concept has been extended by Corey Keyes and Barbara Fredrickson. They hypothesised that optimal wellbeing and flourishing increased with age, education and confidence,18 therefore accommodating this in workforce planning may promote nursing tenure and endurance.
It has never been more important with workforce planning to nurture new graduates as they gain experience, skills and proficiency in healthcare. Failure to do this may contribute to the worldwide shortage in registered nurses. Millennials tend to have more than one career over their lifetime given their heightened expectations of appropriate remuneration, conditions and career opportunities. Unfortunately, there are global estimates that by 2020 there will be a deficit in registered nurses by approximately 20 per cent.24 In addition to recruiting new staff, it is important to retain senior staff, creating a multigenerational skill mix that has benefits, such as a broad range of skills, mentoring for new staff, better reasoning ability with greater clinical oversight as well as a greater depth of work experience. Aging in this context is viewed as a positive attribute. Senior staff members tend to have higher levels of job satisfaction, are more committed to their organisations, are less likely to transfer to other healthcare facilities, and have fewer sick days and workplace accidents. Seasoned staff are also more likely to know how to wield the organisation's culture and deal effectively with administrators and others to ensure the safety and wellbeing of patients and families.11
Professional development progression can be enhanced by using an array of online personality tests that highlight a person's strengths. Flourishing nurses have a natural inclination towards positive energy, and these tests reveal emotional intelligence traits, and linguistic, logical, spatial and social skills.
Introspective evaluations may provide the impetus for developing a positive mindset, particularly when supported by the team leader. Two such evaluation tools are Diener's eight-item Flourishing Scale (FS), which measures self-perceived achievement, self-esteem and optimism;21 and the Losada Ratio which is used primarily to distinguish flourishing from floundering people. Harnessing employees' natural positive traits and nourishing their strengths will inspire both accomplishment and productivity. In addition, professional performance, staff retention and flourishing teams can be enhanced with peer empowerment, encouragement and engagement. When these three factors are embedded in nursing, there is an increase in quality patient care, satisfied patients, greater productivity, motivation and a positive healthy work environment.19
According to the 2017 survey Australia's Healthiest Workplace, 50 per cent of Australians have at least one aspect of work-related stress. In the same year, a UK survey on wellbeing in the workplace, published by Damian Stancombe, noted that 66 per cent of workers admitted to coasting, and 7 per cent of employees admitted to struggling or floundering. Being mindful of these ratios, organisations may need to change their culture, recognise and turn unfavourable situations into great opportunities, and be the vanguard of progressive healthcare.
An innovative Swedish study, known as the Svartedalens experiment, promotes flexibility and a better work-life balance. This two-year study looked at the effects on nurses working a 35-hour week (paid for a 40-hour week). Though an expensive experiment, there was no sick leave reported over the two-year period, 20 per cent of staff reported being happier, and there was a 64 per cent increase in efficiency and productivity.26
Countries such as Japan and South Korea focus on the importance of job security, with most employees either on permanent or 'lifetime' contracts. Long-term strategic planning is possible due to workforce predictability, in addition to enhanced productivity given the seamless, consistent workflow.
The OECD Better Life Index compares 35 similar countries in regard to work-life balance, social connections and work-life balance/health status. In the 2018 index, the Netherlands outperformed all other OECD countries, including Australia. Less than 0.5 per cent of Dutch people work more than 50 hours per week. This is similar to Denmark, where 75 per cent of Danes have a paid job, but only about 2 per cent of employees work very long hours. Denmark was ranked first in the 2013 World Happiness Report and first again in 2016.30
It is therefore vital to be innovative and flexible, provide job security and positive leadership, enhance education, and celebrate and validate members of the team who meet or exceed those expectations. We know from Viktor Frankl that meaningful purposeful engagement in the workplace has both immediate and long-term benefits, such as cognitive and physical longevity. Job satisfaction has a strong correlation with life satisfaction. It is known that dissatisfied employees are more prone to depression, including ill health and ischaemic heart disease.19 Depression has been linked with limited cognition and low engagement, burnout, resentment and apathy. Conversely, positive psychology and optimism aim to redress this imbalance with improved levels of happiness and wellbeing as well as greater job satisfaction. Psychological wellbeing is associated with a reduced risk of heart disease.20
Aristotle believed that happiness depends on ourselves, and should be the central purpose of our lives both personally and professionally.17 Spector suggests that flourishing teams are happier, more co-operative, more helpful with their co-workers and more loyal to their organisation, and they tend to use time more efficiently as they pursue intrinsically satisfying goals with vitality and passion.19
A unified, robust workforce plan for the acute hospital sector (both public and private) with flexible working hours will positively impact on attrition rates and health service delivery. According to Rodolphe Dutel (founder of remotive.io), employees need flexibility to do their best work and enjoy life. High-quality nursing requires good governance, robust quality management systems, including a recognition and reward system for top performers and team milestones. Enforced human resources policies will promote respect and safety in the workplace.
Regular professional development progress reports will provide an opportunity for maximising timelines and acknowledging accomplishments.9 If nurses are motivated by a belief, with evidence, that they are making a difference in the patient's journey, this will keep them invested and enriched in the whole experience of healthcare. Research tells us that grit, determination and perseverance are in direct proportion to workplace satisfaction and happiness.9
Organisations that invest time in their staff will reap the benefits of individuals and teams working at maximum performance, despite the tensions and challenges of staff-to-patient ratios and busy caseloads. Teaching nurses to flourish is a powerful and worthwhile investment and this in turn will have a tangible impact on the organisation.21
In fact, it could be said that the achievements of Florence Nightingale in pursuing her nursing career in the 19th century has inspired females in the digital age to aspire to greatness, whether choosing careers within or outside the healthcare profession.8,10
Tona Gillen is nurse manager, trauma, at Queensland Children's Hospital.
1. Figley CR. Brunner-Routledge; Compassion fatigue as secondary traumatic stress disorder: An overview. Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: 1995. pp. 1–20.
2. Françoise Mathieu. Compassion Running on Empty: Compassion Fatigue in Health Professionals Compassion Fatigue Specialist (Published in Rehab & Community Care Medicine, spring 2007).
3. Harvey Max Chochinov. Dignity and the essence of medicine: The A, B, C, and D of dignity conserving care. BMJ. 2007 Jul 28; 335 (7612): 184–187.
4. Morrison, T. (2007) Emotional intelligence, emotion and social work: context, characteristics complications and contribution. British Journal of Social Work. 37, 245–63.
5. McDonald, G., Jackson, D., Wilkes, J. and Vickers, M. (2012) A work-based educational intervention to support the development of personal resilience in nurses and midwives. Nurse Education Today. 32, 378–84.
6. Chen, J-Y. (2010) Problem-based learning: developing resilience in nursing students. Kaohsiung Journal of Medical Sciences. 27, 230–3.
7. Bonanno, G. A. (2004) Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist. 59 (1), 20–8.
8. Buerhaus, P. I., Staiger, D. O., & Auerbach, D. I. (2000). Implications of an aging registered
nurse workforce. The Journal of the American Medical Association, 283, 2948-2954.
9. Potratz, Elizabeth, "Transforming Care at the Bedside: A Model to Promote Staff Nurse Empowerment and Engagement" (2012).
Master of Arts in Nursing Theses. Paper 39.
10. Peter I. Buerhaus, PhD, RN et al. Implications of an Aging Registered Nurse Workforce 2948 JAMA, June 14, 2000—Vol 283, No. 22
11. Peter I. Buerhaus, PhD, RN, FAAN, FAANP(h); Lucy E. Skinner, BA; David I. Auerbach, PhD; and Douglas O. Staiger, Four Challenges Facing the Nursing Workforce in the United States PhD Journal of Nursing Regulation Volume 8/Issue 2 July 2017
12. The Social Cure. Identity, Health and well-being – Jolanda Jetten, Catherine Haslam and S Alexander Haslam. Psychology Press. 2012.
13. Florence Nightingale and Gerard Vallee (Editor) (2003). "passim, see esp Introduction". Florence Nightingale on Mysticism and Eastern Religions. Wilfrid Laurier University Press. ISBN 0-88920-413-6.
14. Bostridge, Mark. Florence Nightingale: The Making of an Icon. Farrar, Straus, and Giroux, 2008.
15. https://healthtimes.com.au/hub/nursing-careers/ Seabreeze Communications Pty Ltd, ABN: 29 071 328 053 in Australia
16. Health Workforce Australia 2014: Australia's Future Health Workforce – Nurses Detailed. Department of Education /uCube Higher Education Statistics.
17. Aristotle. (2000). The Nicomachean ethics (R. Crisp, Trans.). Cambridge: Cambridge University Press.
18. Optimizing well-being: The empirical encounter of two traditions. CLM Keyes, D Shmotkin, CD Ryff Journal of personality and social psychology 82 (6), 1007
19. Spector, P. (1997). Job Satisfaction: Application, Assessment, Causes and Consequences. Thousand Oaks, CA. Sage Publications.
20. Boehm, J. et al. (2011). A prospective study of positive psychological well-being and coronary heart disease. Health Psychology, 30, 259-267
21. Positive Affect and the Complex Dynamics of Human Flourishing. By Fredrickson, Barbara L.,Losada, Marcial F.
American Psychologist, Vol 60(7), Oct 2005, 678-686
22. Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D., Oishi, S., & Biswas-Diener, R. (2009). New measures of well-being: Flourishing and positive and negative feelings. Social Indicators Research, 39, 247-266.
23. https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/nursingprojections.pdf
24. http://www.who.int/mediacentre/news/releases/2013/health-workforce-shortage/en/
25. https://www.businesspsychology.com/
26. http://tony-silva.com/eslefl/miscstudent/downloadpagearticles/6hourdaysweden-nyt.pdf
27. White Paper: The talent shortage continues - How the ever-changing role of HR can bridge the gap http://bit.ly/1xVonjD
28. www.barnett-waddingham.co.uk
29. http://dx.doi.org/10.1787/eco_surveys-dnk-2016-en
30. http://www.oecdbetterlifeindex.org/countries/denmark/
31. Reivich, K & Shatté, A. (2003). The Resilience Factor: Seven keys to finding your inner strength and overcoming life's hurdles. NY: Broadway Books.
32. Styles, C (2011) Brilliant Positive Psychology: What Makes Us Happy, Optimistic And Motivated
33. Masten, A.S. (2001). Ordinary magic. Resilience processes in development. American Psychologist, 56, 227-238.
34. Masten, A.S, & Wright, M.O. (2010). Resilience over the lifespan: Developmental perspectives on resistance, recovery and transformation. Handbook of Adult Resilience, 213-237.
35. Tedeschi, R.G. & Calhoun, L.G.(2004). Posttraumatic Growth: Conceptual Foundations and Empirical Evidence, Psychological Inquiry,15,1-18.
ageing nursing population recruitment challenge resilience 2019-01-18
Tona Gillen
Tagged with: ageing nursing population recruitment challenge resilience


You've signed up to Twitter and seem to be gaining a following. The articles you link to seem to be of interest, and that nerdy joke you posted got retweeted 10 times. You feel like you're on a roll. But at this stage it's easy to make a couple mistakes and stunt your ability to grow your reach.
Here are 5 things you should avoid when using Twitter.
Hashtags and Twitter are synonymous. But whilst they come hand in hand, there are many faux pas that should be avoided.
Firstly, always check your spelling, and be consistent with the hashtags you use. If you're using #medicaljournal don't change it to #medjournals later on. Be consistent. And don't worry if your hashtag doesn't gain an instant following. Be persistent, keep using it, and give it time.
Don't #hashtag #every #word. It is suggested that 2-3 hashtags per post are more than sufficient.
While we're on the topic of hashtags, when do we use them, and when do we use @? Well, it's simple. Don't use @to connect your tweet to a trending topic – that's a job for the hashtag. Use it when you're talking directly to a specific Twitter account user, or if you want to share specific information with a person and their followers. Tweet us @GPViewUK to see how it works.
Don't forget that it is social media. Don't go silent and just tweet in one direction. Make it a conversation and engage with your followers. It might be a good idea to decide whether your profile will be used in a personal or professional capacity. Remember that unless your profile is private, your tweets will be available to the wider public. If you would rather not share your views with just anyone, simply change your privacy settings.
Use the @to speak directly to other Twitter uses, and don't forget to reply if they include you in a tweet first. Some things are best kept to Direct Messages (a private inbox), however, if it's a topic for the many, keep it out there, and don't forget to connect and hashtag relevantly to keep the conversation going.
We all follow a few people who have great rapport. Their tweets express exactly what we think, and they put it so eloquently. It's tempting to share their ideas, and there's no reason why you shouldn't. But don't do it too much. After all your followers want to hear from you. If you promote other accounts too much, you run the risk of your followers cutting you out of the picture.
That said, don't avoid retweeting completely. Just be picky about who you choose. One tweet may be great, but the original author may not share the same values you are trying to portray, so check out their page and see if their tweet, and ultimately their profile (which will be publicly approved by you, if you choose to retweet), matches the message you're trying to convey.
Nobody wants to be constantly advertised to, and you won't gain followers by promoting your self too much. This may seem contradictory, but the point is, don't use Twitter for one thing. Mix it up. Share the odd interesting read, engage with your followers, and don't forget to acknowledge them once in a while, especially if they retweet you. You need to use Twitter to add value. So, try to keep it at about 1/5thadvertising of your work, and 4/5thsharing knowledge, creating content, and connecting with your network.
So now you have it. 5 things to consider, and 5 things to avoid.
Give it a go, and contact us @GPViewUK, or leave a comment below.


I started playing RuneScape back in the 2005 and above all I praise quests and lore, trying to get every piece of the story I can. I've been editing different wikis almost a decade now and RuneScape one since 2008, although not much until recently. I'm also one of admins of the Ossus Library, independent Polish Star Wars wiki. After quite a break I started playing again in late 2012 with main focus on quests.
This page was last modified on 28 April 2016, at 22:10.


The following post is a guest post.
constitutes 'medical' reasons is unclear... Will children left facially disfigured after an accident, for example, be able to have surgery?
Germany's proposed ban has sparked a debate about the purpose of cosmetic surgery- if children need to be 'protected' from it, should we also be questioning the popularity of cosmetic procedures among adults?
People have cosmetic surgery for all different reasons- to improve a facial deformity for example or for medical reasons, or because they have already suffered a lifetime of bullying. Some people might see it as trivial and vain, but if someone is suffering from cripplingly low self-esteem, cosmetic surgery can change their life.
There is a stereotype that people undergo cosmetic surgery for purely shallow reasons, but most of the time patients choose to have a procedure to improve their confidence, more than their physical appearance. Nobody chooses to undergo cosmetic surgery on a silly whim, or for a quick fix. Surgeons in the UK follow strict guidelines which mean patients have to give their procedure a lot of serious thought. www.mya.co.uk focus on helping their patients making informed decisions, offering free consultations and making their clinical data completely transparent.
Cosmetic surgery is not a decision to be taken lightly, nor should it be made by children or forced upon them by their parents, even though they have the best intentions in the world. Germany might have the right idea!
I don't agree 100%. I can see something being out of control for a minor. Some things, the smallest of fixes like dental work can help a kid or teen with a future. Its not all about bullying. If my child had a scar on his/her body and kept them from wearing a dress to a dance or taking a shirt off at a pool. Darn right I would get it fixed. In my opinion, governments are taking away our free rights..
i have to agree with the previous commenter...i think there's ok reasons to do it and if it's affecting a childs well being then maybe it's whats needed..
I can't say plastic surgery is a bad idea. Everyone wants to look awesome and we can't blame if one decides to make his/her look better. Moreover there are many people out there who are satisfied with the aesthetic plastic surgery they have undergone. And yeah.. I have heard stories telling about surgeries that gone wrong. It might have because they consulted a wrong surgeon. A right surgeon will do it right for you. Dr. Sammy Sliwin is the one whom I know.
I think one should be able to choose for themselves whether they want to get plastic surgery or not. A country can't tell you what you can or can not do with your own body. Besides, people who really want to get plastic surgery will get it no matter what, and they wont mind travelling to another country to do it. When Germany bans plastic surgery they relinquish their right to regulate the industry and make sure that if people do decide to get plastic surgery Germany will have the proper regulations in place to protect their citizens.


In the previous post we discussed animal cell cultures and we now proceed to plant cell cultures which have some specific attributes to remember. Big thanks to http://web.mnstate.edu/provost/PlantandMamalianTissueCulture.htm.
Firstly, take a look at the video about aseptic technique while working with plant tissues.
Next, there are some theory notes.
To end with, one more video.


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Matygi – wieś w Polsce położona w województwie lubelskim, w powiecie puławskim, w gminie Puławy.

W latach 1975–1998 miejscowość należała administracyjnie do ówczesnego województwa lubelskiego.

Miejscowość ta leży po prawej stronie Wisły, między Puławami a Dęblinem, przy trasie nadwiślańskiej. Jest położona nad jeziorem Matyckim.

Przypisy

Linki zewnętrzne

Puławy (gmina wiejska)

redpajama_set_name: RedPajamaWikipedia


text:
| Action | Shortcut |
| ------ | -------- |
| Add | `Ctrl+D` |
| Organize | `Ctrl+Shift+O` |
| Sidebar | `Ctrl+B` |

# Run javascript on bookmark

Add a bookmark with the following content on the URL:

```javascript
javascript:var main = function(){ doSomething(); }()
```

## Example

Pretty-print a page with JSON content.

```javascript
javascript:var main = function(){ document.getElementsByTagName('pre')[0].textContent = JSON.stringify(JSON.parse(document.getElementsByTagName('pre')[0].textContent), null, 2); }()
```

# Show bookmarks bar only on new tab

- [Creating userChrome.css](https://www.userchrome.org/how-create-userchrome-css.html)
- [File contents](https://www.reddit.com/r/FirefoxCSS/comments/7evwow/show_bookmarks_toolbar_only_on_new_tab/)

1. Type `about:support` in the address bar
2. Find the Profile Folder row and click `Open Folder`
3. Create a new folder named `chrome`
4. Create `userChrome.css` inside the `chrome` folder

```css
#main-window #PersonalToolbar {
  visibility: collapse !important;
}
#main-window[title^="about:newtab"] #PersonalToolbar,
#main-window[title^="New Tab"] #PersonalToolbar,
#main-window[title^="Nightly"] #PersonalToolbar,
#main-window[title^="Mozilla Firefox"] #PersonalToolbar,
#main-window[title^="Firefox"] #PersonalToolbar {
  visibility: visible !important;
}
```

redpajama_set_name: RedPajamaGithub


text:
How Does Betterhelp.Com Bill 2022 – Sign up with BetterHelp
in the US, where huge online treatment platforms …How Does Betterhelp.Com Bill…have come under the spotlight.
Buckley said patients ought to examine services' personal privacy policies prior to signing up. "Not all online counselling sites utilize professionally trained therapists or adhere to an ethics policy, so ask your GP for a suggestion in the first instance. As with all sort of services and assistance, what works for someone may not work for somebody else," he said.
Marc Bush, primary policy advisor at Young Minds, stated that while online counselling services are valuable, "they should not change face-to-face therapy with a skilled expert. If a young person is having a hard time, we would motivate them to talk to their GP in the very first instance, or to get in touch with an established service like The Mix, Childline or the Samaritans.".
For Rackham, who has actually generalised anxiety condition, online counselling wasn't the ideal fit. "I felt it was near impossible for the therapist to really get a sense of the problems I was handling, as all they had to go from was my typed-out words. I believe I understood after that online session how essential interpersonal interaction was.
" I'm a huge fan of using innovation in all areas of my life as a service to daily issues. I have apps for whatever, but when it pertains to mental health, you need to select how technology plays a role in your recovery really carefully.". How Does Betterhelp.Com Bill
The company describes BetterHelp as the "largest online counseling platform worldwide," tailored toward assisting people handling concerns "such as stress, stress and anxiety, relationships, parenting, depression, addictions, eating, sleeping, injury, anger, household conflicts, LGBT matters, grief, faith [or] self esteem." The business's FAQ section on its site clearly mentions BetterHelp's app and therapists shouldn't be utilized for people dealing with a serious mental illness (schizophrenia, bipolar affective disorder) or for people thinking about self-harm. Instead, the app prides itself on having certified therapists and psychological health professionals offered to help individuals through text, call or video chat. That's what many YouTubers who have accepted sponsorships from the company frequently say in their own videos, where they speak on the tensions in their individual lives and sensations bordering on anxiety or anxiety. Bobby Burns, Elle Mills, Philip DeFranco, Heath Hussar, Boogie2988, Shane Dawson and ChandlerNWilson are all creators who have How Does Betterhelp.Com Bill sponsors now.
Much of these developers have actually spoken about mental health issues in the past, however as burnout becomes a larger subject within the neighborhood– and mainstream world– sponsorships involving BetterHelp have increased, despite the app not being precisely what the creators are touting.
Betterhelp Betterhelp Counselor Experience 2022 – Sign up with BetterHelp
Better Help Malaysia 2022 – Sign up with BetterHelp


fotofinish by Warehouse Stationery, it's the place to print your photos, photo books, Canvas prints, Calendars. Your local print shop, NZ wide! We can help with everything from print and copy, business cards and photo restoration and more. Shop online or in store. Warehouse Order highquality digital photo prints online. Same day pick up at your local Warehouse Stationery or home delivery. Get started by uploading some photos from your computer. Warehouse Stationery's online photo centre is treating you to by taking 35 off EVERYTHING!
Print your Spring photos, create holiday Photo Books, or Download the Printicular app, and select photos to print directly from social media or upload your files through the Printicular site for printing at Warehouse Stationery. Get Started Photo Restoration Photo Warehouse is New Zealand's leading photographic retailer, with stores in all the main centres as well as over 5, 000 products online.


text:
Aaron Sharif's Israeli Chatterbox
(click on "Archives" for previous Chattebox scribbles.)
Please Remember: We did not receive EARTH as an inheritance from our parents. We received EARTH in safekeeping, to be handed on to our children and grandchildren. MAKE IT SAFE.
אהרון שריף
Our Social Tent Protests and the Baby Turtles
Some connected LINKS
My Hebrew Blog
My Picasa Photos
Gesher Haziv
Its been a hot and busy Israeli summer, pockmarked by so many small protest tents around the country, all demonstrating the need for a radical "change". But wait……I'll get to that……. first something about the turtles.
The little turtles are about two inches long as they hatch on the Betzet beachfront near our home. Their elderly mothers swam perhaps thousands of miles to home-in on many centuries-old remembered spots of Israeli beaches to lay their eggs in the sand. These centuries-old spots are today filled with skyline buildings, factories and industrial garbage, hotels and people garbage. Eggs left in these municipal sands would crumble under the weight of our coastal development. Stubborn nature paramours gather the eggs and bring them to a protected area along our northern beachfront….Betzet beach, where the Betzet wadi\stream ends its journey from the eastern hills to the Mediterranean. Here the baby turtles hatch and clumsily scramble their way through the sand back into the open sea.
Standing on the beach, with my back to the sea, I see trees and local shrubbery….no hotels, no factories….just nature at its pastoral best. No longer does any other such beach exist along the northern Israeli landscape between our border with Lebanon and Haifa………..and perhaps this too will vanish. Our local oligarchs with the help of our government's Land Authority are planning to add many hotel buildings to this last vestige of open nature. Standing with my back to the sea I'll view the encroaching development of our Israeli capitulation to the wealth of our oligarchs. Those two-inch baby turtles won't hatch and grow to over two feet. But aside from turtles…..also people….I and my neighbors from far and wide won't enjoy the one natural sanctuary left along our northern coastline.
We've been fighting the change for over two years now….petitions, meetings, etc…..We thought we made headway, and found we've been outflanked. This summer we set up a large protest tent on the beach and have enlisted the signatures of the many Israelis who come here because it truly is the last real natural sanctuary along our northern beachfront. We have more than 30,000 signatures and a few thousand letters sent to government ministers, but in the context of a country whose economic and social policies are dominated by a right-wing oligarchy and "Tea-Party" ideologues, I fear our pastoral summer on Betzet Beach may be our last.
Meanwhile, a ten minute drive from our Betzet protest tent returns me to the bustling Nahariya intersection where a small tent town has sprung up and has become our local protest station and our identification anchor with the massive protest tent city which rose this summer along Rothschild Boulevard in Tel-Aviv. I've been a frequent visitor and supporter of this small tent town, so peripheral from the main action. Each evening, surrounded by a few tents and protest signs, gather a strange mixture of people representing the normal Israeli street. No, not a town-hall session of many……..just twenty or so people of various political and social backgrounds (different people from evening to evening)……from a homeless to a well-to-do contractor…….from a Bibi-lover to an old-time communist…….and everything in-between…………and they talk……together……wooowww!.....and not just about the destruction of nature….but about the destruction of humans and values…..The words "Social Justice" have come out of hiding and are hitting the streets in every town and city…….including our backyard in Nahariya.
Why?????
Evidently the evening gatherers really do agree on something…….they agree that something is seriously amiss with our economic and social policies; that our governments have created a society with a vast gulf between the very rich and everyone else; that allowing the richest percentile to be the guiding force of our economic policies, has turned our social democracy into an economic oligarchy; and it all shows up in our shopping cart….from the price of cottage cheese and milk to electricity and gas, from the cost of housing, rental or bought, to the structure of our taxation, from the cost of "free education" to the strangulation of social services; but mainly, perhaps, by placing a "Tea-Party" social ideology and what has been branded as "Piggish-Capitalism" in the forefront of our policies during the past 35 years, with Bibi Netanyahu being its main leader and proponent during the last 20 years. The people coming to these evening get-togethers at the Nahariya protest tents are evidently asking for a more "human" approach to social and economic planning. Do they have answers?? Not really, it seems. They want the people "up there" to change things. Are they representative of their neighbors?? Perhaps they really are…..maybe. Why do I say this?? Because it seems like the people "up there", including Bibi, are beginning to act and look slightly worried. They are even proposing some interesting changes to their long term economic and social doctrines. Will they actually change something?? Perhaps a little, no more, just enough to brag about at the next elections………. Will the next elections bring on the change??…..I've too often seen how the very people most hurt by our "Tea-Party" ideologues continue voting them into office. Does the mass show of disapproval in the tent towns and demonstrations around the country show a real change?........again, maybe….. so keep plugging away, keep supporting…..don't let go. Keep constantly in mind that the call for social justice reverberating around the country was so much the result of a variety of nameless individuals with tents as their weapons and who wouldn't let go.
There is a straight line from our two-inch baby turtles and our natural beach at Betzet to the motley bunch of protest tents in Nahariya with the cry for social justice. Its all about what kind of human beings, what kind of public, and what kind of nation we'd like to be. Perhaps it's the same line that will lead us to re-examine the kind of rapport we'd like to build with all of our neighbors in a country which once more (can this really happen?) places social justice in the forefront of public concern. Perhaps there is still a slight chance for "Ki me-Tziyon Teitzei Torah".
פורסם על ידי אהרון שריף ב- 6:21 PM


Sheldon Adelson is the founder of the Las Vegas Sands casino. He actually owns many private jets, including two Boeing 747's. He also owns a large yacht named Queen Miri.
Richard Duchoissos is the owner of a 2011 Dassault Falcon 7X jet, with registration N-66DD. Duchoissos is the founder of the Duchoissos Group, a privately held investment company.
The company's investments include The Chamberlain Group, Inc. (access control products) and. Chamberlain Manufacturing Company (defense products). Duchossois is active in horse racing, he owns the Arlington Park Race Track and served as a director of the Thoroughbred Racing Association.
He owns a large $75 million yacht, named Blue Moon.
Crane Worldwide Logistics, and Crane Freight & Shipping. Jim Crane also owns the Houston Astros, the American professional baseball team based in Houston, Texas. Jim Crane's net worth is estimated at US$ 2 billion.
Some sources mention that Marc Cuban is the owner of the Boeing 767 with registration N767MW. We think that this is not true. The jet is owned by MWL Air, a luxury air charter services based in Dallas.
And we think that Mr. Cuban and his Dallas Mavericks basketball team are regular clients of MLW Air, and thus often spotted on board this jet. Do you know more about this jet or any jet owned by Marc Cuban? Please do send us a message.
Barry Diller is the Chairman of Expedia and IAC. And he is responsible for creating the Fox Broadcasting Network. He is married to fashion designer Diane von Fürstenberg.
Barry Diller owns a Bombardier BD 700 with registration N393BV and owns a large sailing yacht named EOS.
Patrick Dolan is the owner of a Bombardier private jet with registration N350DA. He is the son of Charles Dolan, founder of Cablevision.
Larry Ellison is the owner of a Gulfstream G650 private jet. Ellison is co-founder and chief executive of Oracle Corporation, one of the world's largest enterprise software companies.
Bill Gates owns one jet, with registration N887WM (WM for his parents William and Mart), he also frequently uses a Boeing Business Jet, chartering from Netjets.
David Geffen is the owner of a Gulfstream G650 with registration N221DG. Geffen is an American record executive, film producer, theatrical producer and philanthropist.
David Geffen is known for creating Asylum Records in 1970 and Geffen Records in 1980. Geffen Records launched the careers of the Eagles, Aerosmith and Guns N' Roses. His net worth is estimated at US$ 6.5 billion.
He owns one of the World's largest yachts, named Rising Sun.
Dennis Gillings is the owner of a Gulfstream G650 jet, with registration N912GG.
Dennis Gilling is the founder of Quintiles. Quintiles was incorporated as a privately held company in 1982, and over the past years, has grown from that small collection of statisticians and college students into the world's largest provider of biopharmaceutical services, a FORTUNE 500 company with nearly 35,000 employees conducting business in 100 countries.
Dennis Gillings took Quintiles public through its first Initial Public Offering (IPO) in 1994, and then led a leveraged buyout to take the company private again in 2003. Quintiles remained a private company for 10 years until its second IPO in 2013. The net worth of Dennis Gillings is estimated at US$ 1 billion.
John Henry is the owner of a Bombardier Global 5000 private jet. He is a billionaire with a US$ 2.6 billion net worth, and known for owning the Boston Red Sox. He also owns a large yacht named Elysian.
The Gulfstream G650 jet with registration N2N is owned by Steve Jobs' widow Laurene Powell Jobs. Steve Jobs is best known as the co-founder, chairman, and CEO of Apple Inc.teve Jobs died in 2011 of pancreatic cancer.
His widow Laurene Powell Jobs inherited 5.5 million shares in Apple, worth US$ 7 billion and a 7% stake in The Walt Disney company worth US$ 9 billion. Laurene Powell Jobs owns a large yacht named Venus.
Shahid Khan is a Pakistan born billionaire. He is the founder of Flex-N-Gate, producing car parts for Toyota and other car brands. His company actually owns several jets. Khan also owns one of the world's largest yachts: named Kismet.
Robert Kraft is the owner of a Gulfstream G650, with registration N616KG. Robert Kraft is Chairman of the Kraft Group, active in entertainment, manufacturing and real estate development.
His investments include the packaging company Rand Whitney Group and the Gilette Stadium in Foxborough, Massachusetts. His net worth is estimated at US$ 3.5 billion.
Ralph Lauren is the owner of a Gulfstream G650 with registration N711RL. Ralph Lauren is an American fashion designer,and owner of the Ralph Lauren Corporation clothing company.
The net worth of Ralph Lauren is estimated at more than US$ 8 billion.
Ronald Perelman is the owner of a Gulfstream G650, with registration number N838MF. The 'MF' relates to Perelman's holding company MacAndrews & Forbes Co.
The companies logo is visible on the jet's tail. Ronald Owen Perelman is US based billionaire, most known for owning the Revlon Group. Perelman is a successful investor, through his private holding MacAndrews and Forbes he invests a fortune of US$ 14 billion.
Investments include the Revlon Group, Harland Clarke, Mafco, Scantron and AM General. Perelman is the owner of a large yacht named C2.
Christopher Reyes owns two jets: a 2014 Gulfstream G550 with registration N550R and a 2015 G650 with registration N108R. Reyes is the owner of Reyes Holdings.
Reyes Holdings is a food service wholesaler and distributor, based in the USA. Its divisions include McDonald's distributor Martin-Brower, foodservice company Reinhart FoodService, and beer distributor Reyes Beverage Group.
Reyes is one of the largest private companies in the United States. The net worth of Christopher Reyes is estimated at US$ 2.6 billion.
Alex Rodriguez (born 1975), nicknamed "A-Rod", is an American former professional baseball shortstop and third baseman. He played 22 seasons in Major League Baseball (MLB) for the Seattle Mariners, Texas Rangers, and New York Yankees.
He is engaged to Jennifer Lopez. Alex Rodriquez net worth is US$ 300 million.
James Simons is the founder of Renaissance Technologies, a successful hedge fund management company. Renaissance has over 20 billion in assets and uses complex mathematical models to analyze and execute trades. Simons net worth is estimated at more than US$ 15 billion.
James Simon's business jet is a Gulfstream G650. He also owns a large yacht named Archimedes.
Charles Simonyi is known as the developer of Microsoft's Word an Excel programs. He was one of the first Microsoft employees, which made him a billionaire. His jet is colored gray, like his yacht Skat and his Medina, Washington house.
Steven Spielberg is the owner of a brand new Gulfstream G650, with registration # N900KS. The jet is formally registered to a company related to Amblin Entertainment, the film and television production company founded by Steven Spielberg.
Spielberg is one of the co-founders of DreamWorks Studios and he is known for films like Schindler's List (1993) and Saving Private Ryan (1998), Jaws (1975), E.T. the Extra-Terrestrial (1982), and Jurassic Park (1993).
Steven Spielberg owns a large yacht named Seven Seas, the name relating to his seven children. His net worth is estimated at US$ 3.7 billion.
Donald Trump is the owner of a Boeing 757 business jet. He purchased the jet from Microsoft co-founder Paul Allen. It was reported that he paid US$ 100 million for the jet.
Larry Van Tuyl is the owner of a Gulfstream G280, with registration N711VT. Van Tuyl sold his Van Tuyl Group for US$ 4.1 billion to Berkshire Hathaway.
The Van Tuyl Group was founded in 1948 by Cecil Van Tuyl (who passed away in 2012 at age 85). The Van Tuyl Group became the fifth-largest car dealership group in the U.S, with 78 dealerships selling 240,000 vehicles per year.
Van Tuyl also owns a Eurocopter with registration N735VT, which is based on his yacht Vanish.
Richard M. DeVos, Sr. Is the co-founder of Amway, which is now known as Alticor. He also owns the Orlando Magic NBA basketball team. Alticore is active in direct selling.
His net worth is estimated at US$ 6 billion. DeVos' Boeing 737 BBJ has the Orlando Magic logo on its tail.
Nancy Walton Laurie is heiress to a US$ 4 billion Walmart shares fortune. She and her husband Bill Laurie also own a large yacht named Secret.
Dennis Washington owns a large consortium of companies known as the Washington Companies. Washington started working at his uncle's construction company.
At the age of 30 he purchased a bulldozer and started his own construction company. In five years time his company was the largest contractor in Montana. Later he purchased a copper mine in Montana, which is now worth more than US$ 1 billion.
Oprah Winfrey is the owner of a 2015 Gulfstream G650.
Steve Wynn is the owner of two private jets: A G450 with registration N88WR (Wynn Resorts) and a G650 with registration N711SW (Steve Wynn).
He used to owns a BBJ 737 with registration N88WR, but she was sold in 2015. Steve Wynn also owns a large yacht named Aquarius.
We were told that Shawn Corey Carter also known as Jay-Z is the owner of a LearJet with registration N60GF. The Jet was said to be a gift from his wife Beyonce.
In 2014, Forbes estimated Jay Z's net worth at nearly $520 million. Jay-Z is one of the world's best-selling artists of all time, having sold more than 100 million records. UPDATE: we actually think this jet is not owned by Jay Z.
Jerry Seinfeld is part-owner of three private jets through a NetJets shared ownership program. He co-owns two brand new Bombardier Challenger jets (N743QS and N799QS) and an older (2006) Cessna 680. (N380QS).
The (shares of) the private jets are owned through his company FREE AS A BIRD LTD LLC. His net worth is more than US$ 800 million.
Jerry Seinfeld is the owner of a Gulfstream G-V. He bought the NFL team Dallas Cowboys in 1987. The team now has a value of US$ 4 billion.


Allu Arjun's Stock Pick- A Bumper Hit Awaiting?
We have not read too many stories about Indian film stars who heavily invest in stock market. Most of them take the normal route of mutual funds investment or PMS services. Amitab Bachan was an exception to this. In-fact his experiment with direct stock market investment has given a mixed response. He had few block-blusters hits like just dial, Neuland Labs, Stampede Capital etc, few of them turned to be disastrous. Examples are Birla Pacific Medspa and Fineotex Chemicals. You can go through his current portfolio here.
Now coming to the latest story, South Indian star Allu Arjun and his father Aravind Babu Allu bought a whooping 10 lakhs shares of Moschip Semiconductors @Rs. 49.05 through their Limited Liability Partnership firm Allure Infra Llp. Moschip Semiconductor is a stock which we detailed in the stock study session pointing out its huge potential for growth for the next 10 years. You can read the whole story here.
In March there were few more positive developments happened in the company. Damodar Rao Gummadapu took over the charge of CEO and Camillo Martino was appointed as an Independent director. Also company has got the approval from its board to raise a capital of Rs. 1000 crore which is much higher than its current market cap. This clearly shows that the company has huge expansion or acquisition plans in near future.
Mr. Damodar Rao Gummadapu has more than 25 years of global experience across various Fortune 500 companies including bi g 5 consulting companies including KPMG, Bearing Point, Deloitte, Johnson & Johnson and Pfizer. Mr. Damodar Rao Gummadapu is the co-founder of Techwave.
He is a proven leader, entrepreneur and instrumental for Techwave's rapid growth. He has tremendous experience and vision for role of technology solutions for business growth, optimization and expansion. In his leadership, Techwave has not only grew in size but also expanded globally in to Europe, Middle East and APAC regions. is the driving force behind Techwave's journey to Present position. His foresight has been instrumental in the company's exponential growth by venturing into global markets and diversifying into varied service domains.
Martino has over 30 years of experience in the high-tech industry, having served in various global executive management roles successfully turning around underperforming companies and also growing healthy technology companies in the consumer electronics, communications, automotive and computing markets.
Currently, Martino is currently active in the high-tech industry by advising companies and serving on company Boards. Most recently, Martino was the Chief Executive Officer (CEO) and Director of Silicon Image Inc. until it was acquired by Lattice Semiconductor Corporation in 2015. During his more than five year tenure, Silicon Image transformed from multi-year revenue declines to become a profitable and with high gross margin.
Prior to Silicon Image, Martino was a Board Member in SAI Technology, Inc., a privately held company. Prior to SAI, Martino was the CEO and Board Member of Cornice Inc., a privately held company. Martino also held the position of COO at Zoran Corporation. Martino also served at National Semiconductor in four different countries during a nearly 14 years. This included positions at its headquarters in Silicon Valley, Japan, China and Australia.
Since the company is from Hyderabad and its promoters are from Hyderabad, it seems Allu Arjun and his father have some sought of insight (insider news in raw term😀) about Moschip's growth prospectus. Lets see where it is heading but wishing Allu Arjun a block-bluster from Moschip!!


For states experiencing the arctic freeze, music festival are the last thing most people's list of fun for February. But, when you live in South Florida, winter is the perfect time for music festivals. And, if you have not seen the line-up for the upcoming iiiPoints event in Wynwood, you may miss out pretty amazing festival.
But Island Water Sports has got you covered with our iii Point guide and our favorite festival must have.
We had over 1,000 entries, so BIG congrats to our two winners. Stop in Island Water Sports, with a valid photo id, this week to pick up your baskets of festival essentials and leave your full name for iiiPoint's guest list.
Because we LOVE our IWS family, we are hooking you up with a special discount on 3-day tickets and single day passes with code "IWS". Enter the code when you purchase your tickets online here.
iiiPoints is multi sensory experience encompassing 100+ performers, 6+ stages, immersive art installations, lectures, panels, masterclasses and more.
In 2013, iii Points launched as a way to showcase Miami's up and coming music acts by placing them alongside the greatest musical and artistic minds in the world. Six years later we are still being blessed with a diverse showcase of some of the best talent in the world.
Reflective of Miami's diversity, iii Points festival lineup showcases "versatility and genre-bending artists who open the door to creative discovery". Each day the festival gates open at 5pm ET, with music ALL NIGHT until 5am.
Headliners like Tyler, The Creator; Beach House, SZA, A$AP Rocky, James Blake and legends like Erykah Badu and Herbie Hancock will be gracing the stage during thre days, February 15th – 17th. They will be joined by with over 150 sound and visual artisst at Mana Wynwood Convention Center in Miami.
2019 art program featuring 21 multi-sensory installations from artists of all disciplines. Check out the lineup here.
Plus, collaboration look for the @boilerroomtv stage and the DOOR IV stage, a speakeasy stage featuring three intimate dance parties: EXTRA CREDIT, CASTAWAY, and 10 YEARS OF THE ELECTRIC PICKLE.
iiiPoints also organizes a ton of events for a variety of interests. Check out this year's events.
Combat the evening chills with an Island Water Sports hoodie. Just what you need for South Florida winter nights! Grab Yours Here.
Grab your skates and enjoy SKATE SPACE, the iiiPoints roller skating rink stage ⛸ created in cooperation with @faenaart Each day, SKATE SPACE will be curated musically by @spacetapesmia, @internetfriends.us and Bermuda Triangle 🔻.
For those sunny festival days, grab some Electric Shades. Shop Electric here.
Keep your necessities close and your hands free as you dance the night away. Buy Yours Online Now.
iii Points is open every night until 5am with everything from house to ambient.
Protect your skin with Beach Gypsy. SPF 30+ with biodegradable gold glitter. The perfect festival accessory. Buy it here.
Stay hydrated with Hyroflask – the perfect refillable bottle to quench your thirst. Shop here.
Make the perfect chill zone for you and your friends with Slowtide blankets. The perfect seat for iiipoints. Grab one here.


The presented dataset contains the 3D surface scan of the holotype of Birgeria americana, a partial skull described and depicted in: Romano, C., Jenks, J.F., Jattiot, R., Scheyer, T.M., Bylund, K.G. & Bucher, H. 2017. Marine Early Triassic Actinopterygii from Elko County (Nevada, USA): implications for the Smithian equatorial vertebrate eclipse. Journal of Paleontology. https://doi.org/10.1017/jpa.2017.36 .
NMMNH P-66225 is from upper lower Smithian to lower upper Smithian beds (Thaynes Group). The collecting site is located about 2.75 km south-southeast of the Winecup Ranch, east-central Elko County, Nevada, USA. P-66225 is a partial skull preserved within a large limestone nodule, with its right side exposed. It preserves the portion between the cleithrum posteriorly, and the level of the hind margin of the orbital opening anteriorly. The fossil has a length of 26 cm.


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Home microtransactions
Rock,Paper,Shotgun
Cyberpunk 2077 multiplayer will have microtransactions, but not singleplayer
September 8, 2020RockPaperShotgun
CD Projekt Red have been clear about their 'no microtransactions' policy for Cyberpunk 2077 the singleplayer RPG for ages, but their vagueness on Cyberpunk multiplayer has caused trouble and confusion. This week they clarified yes, the Cyberpunk online doodad due after launch will have microtransactions, but no, they're not liars because this is a separate project. I'm not surprised that some fans have been confused, because the exact nature of Cyberpunk's multiplayer side has often been hazy – whether it's a separate game or just a mode – and spoken of in business language on business calls. Time to be…
Australian government rules that games with microtransactions must address them in box art
August 17, 2020VG247
The Australian ratings board has ruled that all games featuring microtransactions must highlight them on the front cover of the game packaging from here on out. The news comes from Reddit, where a user has collected a wide range of rating listings for upcoming games from the official Australian classification board. You can check out the Reddit post below, which includes several relevant links if you're interested in viewing the new format for yourself. No news sites have reported this, so let's discuss: Australia now requires in-game purchases to be disclosed on the front covers of physical video games starting…


These stunning Jasmine Bloom Clusters are made of the finest Rose Pink felt fabric paired with our gorgeous Rose Gold chunky glitter.
Due to the handmade nature, no two will be exactly the same .The length of these clusters are approx. 10cm and can be attached to clips or headbands.


A reading taken on a level rod held in its unchanged position on a survey point of previously determined elevation when the leveling instrument has been moved to a new position. It is used to determine the height of the instrument prior to making a foresight. Abbrev: BS. Ant: foresight.


How telephone trunking works and what options are offered for your phone system.
Any business with more than a few outside phone lines knows that trunk lines are the way to go. The next question is what type of trunk service to get. You might think that with a VoIP telephone system, the obvious choice is SIP Trunking. But is it? Take a closer look at what's available and then decide.
The idea of telephone trunking originated with the phone companies back when Ma Bell ran the industry. When phones were new, a couple of wires were all you needed to connect from your location to the local phone company. Then everybody wanted a phone and businesses started installing switchboards to handle all the lines they needed. You know those old-timey photos of phone line congestion in the cities. That's what happens when you build out one line at a time.
The mass of subscriber lines was gotten under control using multi-pair cable, often buried. But long distance lines between switching offices were another matter. The more simultaneous calls you carried, the more wires were needed. That gets expensive fast when you're talking about dozens or hundreds of miles. Wouldn't it be nice if one pair of wires couldcarry multiple conversations? That's the niche that trunk lines fill.
The early systems were set up like radio stations on the dial, except over wires. Each call modulated its own carrier frequency that was spaced far enough in the spectrum from adjacent carriers so that they wouldn't interfere. This was analog carrier telephony. The switch from analog to digital technology came with the T1 line. It's been around for at least half a century and is still going strong.
T1 telephone trunks are divided into 24 separate channels, each transporting one two-way telephone call. All the dialing and switching is done on these channels, just as it would be on analog phone lines. You can get devices called channel banks to convert T1 to and from 24 analog phone lines at your office. The T1 line itself is two twisted pair running from your building to the nearest phone company central office.
The advantage of T1 lines as telephone trunks is that save a lot of wire and can save cost, too. There is no economy of scale when you buy your phone lines one at a time. Soon you have a dozen or two at the price of a dozen or two times the cost of one line. If you convert all those lines into a T1 telephone line (trunk), you'll generally save money even if you only use half the capacity of the T1. If you need dozens of lines for your call center, T1 can save you a bundle.
Chances are that you won't need a channel bank unless your phone system is completely analog. Most PBX systems have T1 ports already installed. Even the new IP PBX systems designed for VoIP telephones usually have T1 ports where you just plug in one or more T1 lines for your outside telephone service.
A closely related service that is even more popular than T1 telephone trunks is ISDN PRI. This service runs on a T1 line and is very similar to a T1 trunk. The difference is that only 23 channels are used for individual phone lines. The remaining channel is used for all the dialing, switching and data such as Caller ID. The switching is faster than with T1 telephony and most everyone wants Caller ID anyway. The port for this is called a PRI, ISDN PRI or T1 PRI an it is likely installed in your system now.
The other digital trunk option that is becoming popular thanks to VoIP is the SIP Trunk. SIP is the switching protocol used with IP telephones in a VoIP system. A SIP Trunk, which might also be carried on a T1 line, is not broken up into channels. Instead it is more like your local area network that transports Ethernet packets.
This is one of the big advantages of a SIP Trunk. It can connect directly to your network without having to convert from one protocol to another. In fact, just like your network carries both VoIP phone traffic and computer data traffic, a SIP Trunk can provide both telephone and broadband service from your service provider. This is the preferred arrangement, as it allows the provider to establish class of service controls to maintain voice quality regardless of other network traffic.
As you might suspect, an IP PBX system works well with a SIP Trunk. But SIP trunks can also be ordered with customer premises equipment that offers a T1 or ISDN PRI digital handoff or even analog phone lines.


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package org.apache.tapestry5.ioc;

import static java.lang.annotation.ElementType.FIELD;
import static java.lang.annotation.ElementType.METHOD;
import static java.lang.annotation.ElementType.PARAMETER;
import static java.lang.annotation.RetentionPolicy.RUNTIME;

import java.lang.annotation.Documented;
import java.lang.annotation.Retention;
import java.lang.annotation.Target;

@Target(
{ PARAMETER, FIELD, METHOD })
@Retention(RUNTIME)
@Documented
public @interface RedMarker
{

}


I have to say that on rare occasions I come across books that seem to entwine themselves into my life. Whereby events in my day to day existence synchronise with aspects of what I'm reading, some before I read them, some after. These books are doing just that, suggested to me in a dream that followed a question I asked. I'm on book 2 now and am still being surprised by this phenomena. Thank you.
Kelly these book are amazing, and this is a message that I hope does go around the world. It seems to me that the teachings here are coming at a time when we need them most. I am particularly looking forward to book 3 because of all the input from others, including yourself (along with the first two), so my gratitude goes to all involved. These things are never a solitary event.
I have a story still in the making and the first two books have helped me understand a lot.
Sincere gratitude for all involved.