Your Private Sightseeing Excursion takes in the stunning Loch Lomond & The Trossachs National Park, using a luxury Mercedes Benz and local chauffeur with years of Scottish experience. Your day is planned to cover all the sights and attractions that Loch Lomond & The Trossachs have to offer, with no waiting for other passengers so if there is something you really want to see we will ensure it is added to your itinerary. Just remember this is Your Day, Your Way!With Door to Door service from Edinburgh complimentary Bottled Water and Wi-Fi Access you truly are getting that First Class experience.
As your tour leaves Edinburgh you head west along the south of the Firth of Forth towards Stirling and the gateway to the Highlands. Passing The Kelpies you then travel past Stirling with views of the famous Castle and The National Wallace Monument. • The First stop of the tour is the Loch Lomond Bird of Prey Centre in Balloch, with a range of Scottish Birds of prey to see including a Golden Eagle. Another experience available is the Loch Lomond Sea Life Aquarium, with the largest selection of Sharks in Scotland. • You leave Balloch and make your way up the east coast of Loch Lomond, travelling past the famous Loch Lomond Golf Club. As your continue north the mountain Ben Lomond starts to come into view, towering over the west coast of Loch Lomond and making for a stunning photo of the loch. • The next stop is the falls of Falloch, located just a few miles before Crianlarich. Set in a peaceful glen it makes for a great photo and break. Your journey continues through the village of Crianlarich located on the West Highland Way, with Ben More over looking it. • The next stop is at the Falls of Dochart at Killin, located at the western end of Loch Tay. The Falls cascade over the rocks around the island of Inchbuie, which is the ancient burial place of the MacNab clan and a great place for a photo. • Travelling south through the east of The Trossachs, you stop at Loch Lubnaig for a break and photos before setting off for Callander the eastern gateway to the highlands. Spend time walking around the town visiting the small shops and sampling local produce and pick up a souvenir for your trip. • On leaving Callander you could stop at Doune Castle, recently used in the Outlander TV Show or head towards Deanston Distillery for a dram or two of our famous Whisky. Now it is time to start your journey back, passing Stirling and the Kelpies on the home leg back into Edinburgh.


Some people are just naturally organised. From their savings to their shopping, everything is carefully considered, neatly arranged and perfectly scheduled. We look at their lives with envy, often mixed with a touch of concern that they might be taking life a bit too seriously. We quietly wonder whether they iron their underwear.
So when these people talk about having pre-purchased funeral plots, it might strike us as slightly grim and possibly a bit over the top. Most of us can see the sense in health insurance and life insurance – preparing for the unknown – but seeing as we are all aware that we are going to die one day, is there really any sense in getting ready for it so far ahead of time?
If we put the death conversation aside for a moment and just look at saving dollars, the first surprise many people get comes with the realisation of just how quickly cemetery sites appreciate in value. Let's start with a historically referenced example. If you thought about buying a lawn burial plot at Enfield Memorial Park in 2008 but then put it off until 2018, appreciation on that same plot would have cost you $3,765. Had your purchased back in 2008, that sort of appreciation would have been, quite literally, better than money in the bank.
What could you do with a saving of $3,765? Or what might your children do with that money? When we come to realise how significant the savings are that can be made, pre-purchasing starts to make a lot of sense. It means that when the inevitable finally happens, a key expense has already been met, rather than that cost, at present day prices, having to come out of your estate. After all, wouldn't your partner or your children be better off with that money?
If you're not normally a stringently organised type of person, pre-purchasing offers a very healthy financial reward for your efforts, and that's all the incentive many people need. It's really just a case of considering how you'd rather be using the money that you stand to save. And there's absolutely no need to start ironing your underwear.


text:
Our Bricks
NCM - Our Bricks
Our Club and some of our members have purchased commerorative bricks at the National Corvette Museum at Bowling Green, Kentucky. We encourage members to contribute to this worthwhile way of memorializing themselves and their Corvettes while supporting the Museum.
CJCC's brick at the National Corvette Museum, Located in Section 50 of the NCM Walk of Fame
CJCC Charter Members Rick and Rae Artz's brick at the National Corvette Museum
CJCC Master Ambassador Bruce C's brick located in Section 61.5 at the National Corvettte Museum
CJCC Member Russ Stroh's brick for his previous Corvettelocated in Section 79 at the National Corvette Museum
CJCC Members Russ Stroh's and son-in-law Umair Akhter's bricks at the National Corvette Museum celebrating their C4 and C7 Corvettes located at HEX4C in front of the Museum Store.
Memorial brick for deceased Club member, former Vice President and our "King of the Impromptu Cruises", Al Tone located indoors on Corvette Boulevard.
Johann (John) Franz Levinski, age 74, died April 18th, 2021 in Hillsborough, NJ. John was born July 3, 1946 in Munich, Germany. His father was an American Army soldier during World War II and met John's mother after the war. They moved to America when John was 3 years old and resided in New Brunswick, NJ.

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: blackbox exporter not coming up as service Blackbox exporter of prometheus is not coming up as service.
When I run command from ExecStart it just works fine.
Would like to know what's missing from below configuration.
pwd ; cat blackbox_exporter.service
/usr/lib/systemd/system
[Unit]
Description=Blackbox Exporter Service
Wants=network-online.target
After=network-online.target

[Service]
Type=simple
Restart=always
User=root
Group=root
ExecStart=/opt/blackbox_exporter/blackbox_exporter --config.file=/etc/prometheus/blackbox.yml --web.listen-address="<hostNameGoesHere>:9115"

[Install]
WantedBy=multi-user.target

And all files are with root privilege only.
ls -l blackbox_exporter.service /opt/blackbox_exporter/blackbox_exporter /etc/prometheus/blackbox.yml
-rw-r--r-- 1 root root      343 Oct  4 06:55 blackbox_exporter.service
-rw-r--r-- 1 root root      775 May  3 05:46 /etc/prometheus/blackbox.yml
-rwxr-xr-x 1 root root 16074005 Feb 27  2018 /opt/blackbox_exporter/blackbox_exporter

Error message is as per below.
systemctl status blackbox_exporter.service
● blackbox_exporter.service - Blackbox Exporter Service
   Loaded: loaded (/usr/lib/systemd/system/blackbox_exporter.service; enabled; vendor preset: disabled)
   Active: failed (Result: start-limit) since <TIMESTAMP>; 2s ago
  Process: 101522 ExecStart=/opt/blackbox_exporter/blackbox_exporter --config.file=/etc/prometheus/blackbox.yml --web.listen-address="<hostNameGoesHere>:9115" **(code=exited, status=1/FAILURE)
 Main PID: 101522 (code=exited, status=1/FAILURE)**

 systemd[1]: Unit blackbox_exporter.service entered failed state.
 systemd[1]: blackbox_exporter.service failed.
 systemd[1]: blackbox_exporter.service holdoff time over, scheduling restart.
 systemd[1]: Stopped Blackbox Exporter Service.
 systemd[1]: start request repeated too quickly for blackbox_exporter.service
 systemd[1]: Failed to start Blackbox Exporter Service.
 systemd[1]: Unit blackbox_exporter.service entered failed state.
 systemd[1]: blackbox_exporter.service failed.

A: Removed double quotes : "" from ExecStart line & it just worked like a charm!!
ExecStart=/opt/blackbox_exporter/blackbox_exporter --config.file=/etc/prometheus/blackbox.yml --web.listen-address=<hostNameGoesHere>:9115

redpajama_set_name: RedPajamaStackExchange


Yes, I stumble across random posts by believers that are trying to give advice to other believers and it hurts. Seriously it hurts. First when my jaw hits the desk and then again when trying to do a triple face palm.
This post is a comment on one from altruisco, you might know them. He feels privileged that he can pray to a god and he is concerned that some might be discouraged when their prayers do not seem to be answered right away.
Mark 11:24 – Therefore I tell you, whatever you ask in prayer, believe that you have received it, and it will be yours.
It's just a shame he doesn't answer the prayers of those parents with starving children.
God always seems silent to starving children. He sends them to the grave empty handed and with empty stomachs. Yes, trust that your god will answer your prayer. It worked out so very well for those now dead starving children and their families. Those starving children must not have believed in god with enough fervor. Maybe they forgot to pray without ceasing.


I have 5 bank A/c. >2 lakhs was deposited during demonetisation in 1 bank a/c.Got notice reagrding this,was replied through online portal immediately.Further ITR was filed and has been proccessed for AY 2017-2018.
ON 20-11-2015,sold a property in 4 parts to 4 buyers for which I received 60L in cash in total from (4 buyers) which was deposited in CGAS account before due date of filing on ie,31-07-2016.
Since i dint utilise the money i have paid LTCG TAX (1st installment of advance tax paid) and will pay the entire advance tax before 15/03/2019.
Now today i have recived this notice.
How sholud I reply through e proceedings??
Should i attach bank statement of canara bank in which money was deposited?
Or bank statements of all other banks?
CASH TRANSCATION 2016(immediate online reply which was already done) , should this be attached?
Any additional documents to be attached??
I have heard from your videos,further notice U/s. 142(1) would be issued.
So this cash is from "income from capital gains" for AY 2016-2017 which was shown in ITR of that year,that it was deposited in CGAS a/c.Thus how should i reply with what documents attached ? Also last date for reply is 05/09/2018(as per notice),but i dont know the exact details of which transaction,of which they are seeking information? Should i wait for subsequent notice under sec 142(1)?(to enable me to attach exact statements they are seeking) OR if not,please advise on attachments?
What and how should i respond?This is my last query wont ask anything further on this.also there is no table as you said.please list all doc to be attached. Thank u.
I received a notice under142 (1) from ITO and asked to furnish few deatils or AY 16-17.
For AY 16-17 I have already filled the income tax return.
in that year I have taken some loan from bank and invested that amount in share market and lost all of my money.
My question is that is loan taken from bank is taxable ?
I have traded in Intraday and FO and making a loss of 16 lacs.
I have borrowed money from my friends 4 lacs ,my salary 5 lacs And taken a loan from bank of 7 lacs .
Information asked by A.O is already mentioned in trailing mail.
I want to know that whether I have to show him or inform him about my loans also as he requried details of money source z.
Please help and guide .
Screen shot from e-proceeding has been attached in previous Question.
Please reply as 24-05-2018 is last date to reply.
While filling return my CA has s...View MoreHi sir .
While filling return my CA has shown the occurred loss but source of money was not shown.
I will just paste the notice received in bottom.
per annexure and on the points or matters specified therein on or before 24/05/2018 at 02:45 PM.
through your account in 'e-filing' website of Income Tax Department.
account or manually (if e-mail is not available).
section 143(3), assessment proceedings would be conducted manually.


text:
Correlation between quadriceps endurance and adduction moment in medial knee osteoarthritis
Soon Hyuck Lee, Jin Hyuck Lee, Sung Eun Ahn, Min Ji Park, Dae Hee Lee
It is not clear whether the strength or endurance of thigh muscles (quadriceps and hamstring) is positively or negatively correlated with the adduction moment of osteoarthritic knees. This study therefore assessed the relationships between the strength and endurance of the quadriceps and hamstring muscles and adduction moment in osteoarthritic knees and evaluated predictors of the adduction moment. The study cohort comprised 35 patients with unilateral medial osteoarthritis and varus deformity who were candidates for open wedge osteotomy. The maximal torque (60°/sec) and total work (180°/sec) of the quadriceps and hamstring muscles and knee adduction moment were evaluated using an isokinetic testing device and gait analysis system. The total work of the quadriceps (r = 0.429, P = 0.037) and hamstring (r = 0.426, P = 0.045) muscles at 180°/sec each correlated with knee adduction moment. Preoperative varus deformity was positively correlated with adduction moment (r = 0.421, P = 0.041). Multiple linear regression analysis showed that quadriceps endurance at 180°/sec was the only factor independently associated with adduction moment (β = 0.790, P = 0.032). The adduction moment of osteoarthritic knees correlated with the endurance, but not the strength, of the quadriceps muscle. However, knee adduction moment did not correlate with the strength or endurance of the hamstring muscle.
Dive into the research topics of 'Correlation between quadriceps endurance and adduction moment in medial knee osteoarthritis'. Together they form a unique fingerprint.
osteoarthritis Agriculture & Biology 100%
knees Agriculture & Biology 86%
Knee Osteoarthritis Medicine & Life Sciences 78%
Hamstring Muscles Medicine & Life Sciences 59%
Knee Medicine & Life Sciences 58%
Quadriceps Muscle Medicine & Life Sciences 52%
Strength Chemical Compounds 45%
muscles Agriculture & Biology 39%
Lee, S. H., Lee, J. H., Ahn, S. E., Park, M. J., & Lee, D. H. (2015). Correlation between quadriceps endurance and adduction moment in medial knee osteoarthritis. PloS one, 10(11), [e0141972]. https://doi.org/10.1371/journal.pone.0141972
Correlation between quadriceps endurance and adduction moment in medial knee osteoarthritis. / Lee, Soon Hyuck; Lee, Jin Hyuck; Ahn, Sung Eun et al.
In: PloS one, Vol. 10, No. 11, e0141972, 05.11.2015.
Lee, SH, Lee, JH, Ahn, SE, Park, MJ & Lee, DH 2015, 'Correlation between quadriceps endurance and adduction moment in medial knee osteoarthritis', PloS one, vol. 10, no. 11, e0141972. https://doi.org/10.1371/journal.pone.0141972
Lee SH, Lee JH, Ahn SE, Park MJ, Lee DH. Correlation between quadriceps endurance and adduction moment in medial knee osteoarthritis. PloS one. 2015 Nov 5;10(11):e0141972. doi: 10.1371/journal.pone.0141972
Lee, Soon Hyuck ; Lee, Jin Hyuck ; Ahn, Sung Eun et al. / Correlation between quadriceps endurance and adduction moment in medial knee osteoarthritis. In: PloS one. 2015 ; Vol. 10, No. 11.
@article{2c209be95aab42fa8b99c338b17cdbfa,
title = "Correlation between quadriceps endurance and adduction moment in medial knee osteoarthritis",
abstract = "It is not clear whether the strength or endurance of thigh muscles (quadriceps and hamstring) is positively or negatively correlated with the adduction moment of osteoarthritic knees. This study therefore assessed the relationships between the strength and endurance of the quadriceps and hamstring muscles and adduction moment in osteoarthritic knees and evaluated predictors of the adduction moment. The study cohort comprised 35 patients with unilateral medial osteoarthritis and varus deformity who were candidates for open wedge osteotomy. The maximal torque (60°/sec) and total work (180°/sec) of the quadriceps and hamstring muscles and knee adduction moment were evaluated using an isokinetic testing device and gait analysis system. The total work of the quadriceps (r = 0.429, P = 0.037) and hamstring (r = 0.426, P = 0.045) muscles at 180°/sec each correlated with knee adduction moment. Preoperative varus deformity was positively correlated with adduction moment (r = 0.421, P = 0.041). Multiple linear regression analysis showed that quadriceps endurance at 180°/sec was the only factor independently associated with adduction moment (β = 0.790, P = 0.032). The adduction moment of osteoarthritic knees correlated with the endurance, but not the strength, of the quadriceps muscle. However, knee adduction moment did not correlate with the strength or endurance of the hamstring muscle.",
author = "Lee, {Soon Hyuck} and Lee, {Jin Hyuck} and Ahn, {Sung Eun} and Park, {Min Ji} and Lee, {Dae Hee}",
note = "Publisher Copyright: {\textcopyright} 2015 Lee et al. 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.",
T1 - Correlation between quadriceps endurance and adduction moment in medial knee osteoarthritis
AU - Lee, Soon Hyuck
AU - Lee, Jin Hyuck
AU - Ahn, Sung Eun
AU - Park, Min Ji
AU - Lee, Dae Hee
N1 - Publisher Copyright: © 2015 Lee et al. 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.
N2 - It is not clear whether the strength or endurance of thigh muscles (quadriceps and hamstring) is positively or negatively correlated with the adduction moment of osteoarthritic knees. This study therefore assessed the relationships between the strength and endurance of the quadriceps and hamstring muscles and adduction moment in osteoarthritic knees and evaluated predictors of the adduction moment. The study cohort comprised 35 patients with unilateral medial osteoarthritis and varus deformity who were candidates for open wedge osteotomy. The maximal torque (60°/sec) and total work (180°/sec) of the quadriceps and hamstring muscles and knee adduction moment were evaluated using an isokinetic testing device and gait analysis system. The total work of the quadriceps (r = 0.429, P = 0.037) and hamstring (r = 0.426, P = 0.045) muscles at 180°/sec each correlated with knee adduction moment. Preoperative varus deformity was positively correlated with adduction moment (r = 0.421, P = 0.041). Multiple linear regression analysis showed that quadriceps endurance at 180°/sec was the only factor independently associated with adduction moment (β = 0.790, P = 0.032). The adduction moment of osteoarthritic knees correlated with the endurance, but not the strength, of the quadriceps muscle. However, knee adduction moment did not correlate with the strength or endurance of the hamstring muscle.
AB - It is not clear whether the strength or endurance of thigh muscles (quadriceps and hamstring) is positively or negatively correlated with the adduction moment of osteoarthritic knees. This study therefore assessed the relationships between the strength and endurance of the quadriceps and hamstring muscles and adduction moment in osteoarthritic knees and evaluated predictors of the adduction moment. The study cohort comprised 35 patients with unilateral medial osteoarthritis and varus deformity who were candidates for open wedge osteotomy. The maximal torque (60°/sec) and total work (180°/sec) of the quadriceps and hamstring muscles and knee adduction moment were evaluated using an isokinetic testing device and gait analysis system. The total work of the quadriceps (r = 0.429, P = 0.037) and hamstring (r = 0.426, P = 0.045) muscles at 180°/sec each correlated with knee adduction moment. Preoperative varus deformity was positively correlated with adduction moment (r = 0.421, P = 0.041). Multiple linear regression analysis showed that quadriceps endurance at 180°/sec was the only factor independently associated with adduction moment (β = 0.790, P = 0.032). The adduction moment of osteoarthritic knees correlated with the endurance, but not the strength, of the quadriceps muscle. However, knee adduction moment did not correlate with the strength or endurance of the hamstring muscle.
M1 - e0141972


text:
Center on Teaching & Learning
Advancing Teaching and Learning through Research
Center on Teaching and Learning (CTL), one of the largest research centers at the University of Oregon (UO), was established in 2000 as part of the College of Education. Over the last decade, CTL has been awarded 50+ state and federal research grants.
CTL is committed to conducting rigorous research on the design, delivery and efficacy of curriculum, instruction, and assessment as individual elements used in schools, especially in the primary, elementary, and middle school grades. CTL's mission is to conduct, translate, and disseminate research that focuses on the solutions to serious but practical problems in school systems.
Presently, CTL research is focused on the rigorous evaluation of instructional strategies and materials in the teaching and assessment of reading and mathematic skills in K-8.
CTL is the official home to DIBELS and the UO DIBELS Data System (DDS). The DDS, through its support of DIBELS and other student performance measures (e.g., easyCBM in reading and math), serves approximately 20% of all U.S. public schools (K–3). CTL also actively develops and thoroughly tests instructional programs, learning games, and education technology to enhance student learning across a range of academic subjects. We bring that rigorous research to the CTL Marketplace where we offer education products directly to schools and classrooms.
Center on Teaching and Learning
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Email: ctl@uoregon.edu
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Brasserie is a type of French café where people come to eat, and where the interior and the menu might stay the same for decades. Iz Brasserie restaurant provides gastronomic pleasure above all; the interior and service are little more than the package for guests' gustatory experiences.
The basic menu is not very extensive. Chef Dmitry Lyubimov presents original interpretations of well-known, popular dishes that are tempting to eat every day like borsch, soups, pancakes, charbroiled chicken, and beef stroganoff. Each dish has its own twist, some distinctive feature; for example, beef stroganoff from marbled beef or bison, dumplings stuffed with wild game and mushrooms, fiddlehead ferns sautéed with venison – and the herring is not only pickled in a special in-house brine, but also made into a Korean appetizer that is very popular among Far East residents. Scallop fritters, sea cucumber stewed with vegetables, chopped venison steak, forest herb and sweetbrier teas, sea buckthorn and honey – obviously, local specialties play first violin on Iz Brasserie's menu.
Apart from the main menu, there are special seasonal offerings – lemonades, gazpacho, tandoori meat, fish and vegetables, as well as cozy hot beverages. A terrace with 100 seats is open throughout the summer until the end of October.
The wide selection on the wine list deserves special mention, and Iz Brasserie also offers guests an elite wine list, designed for true connoisseurs. Enthusiasts of home winemaking can happily resort to special liqueurs and cordials.
One last tip: during city festivals and holidays, you may often see an Iz Brasserie booth or counter where they sell soft drinks, salads, puffs, pies and cakes. Do not just walk on by!
They serve grouse here! «Lesnaya Zaimka» is a culinary and historical monument for the Soviet era.
One hundred and fifty wine products at affordable prices, raw oysters, and cozy hearth atmosphere.


text:
New "meditation room" is now open at Mitchell International Airport
By: Stephanie Staudinger
Posted: Nov 15, 2017 5:26 PM CST
NOW: New "meditation room" is now open at Mitchell International Airport
New "meditation room" is now open at Mitchell International Airport
MILWAUKEE (CBS 58) -- Milwaukee's airport already has a "recombobulation area." Now, they're adding something else to make flying a little less stressful.
Relaxing music was played at the dedication ceremony for a new "meditation room" just across from the international terminal.
Suzanne McKinney says it's a dream come true for her. She says she's been working to get this kind of space created since 2009.
"To get away from the busyness of travel. To come and sit and have a few moments of peace and relaxation. To pray or just be," said McKinney.
The room is not specifically a chapel but representatives from several faiths were on hand for the dedication.


Trial record 1 of 12322 for: "National Cancer Institute (NCI)"
Assesses with dose limiting toxicities. Descriptive statistics, including means, standard deviations, and ranges for continuous parameters, as well as percentages and frequencies for categorical parameters, will be presented.
Graded per Common Terminology Criteria for Adverse Events version 5.0. National Cancer Institute toxicity grade 3 and grade 4 laboratory abnormalities will be listed.
The exact two-sided 95% confidence intervals (CIs) for the RR will be reported.
Will be estimated using the Kaplan-Meier method with the 95% CIs. The CI based on Greenwood's variance will be reported. In addition, the possible risk factors will be compared for survival with log-rank test.
The 95% CIs for the duration of response will be reported.
Measured by an apoptosis multiplex immunoassay. Statistical and bioinformatic data analysis for laboratory non-omics data and clinical data will utilize the following general strategies, as appropriate. For single time-point lab data, tests of hypotheses concerning within-group comparisons will be completed using the paired t-test or Wilcoxon signed-rank test for continuous parameters of interest, or McNemar's Chi-square test for categorical parameters of interest. Between-group comparisons will be assessed using either analysis of variance (ANOVA) with adjusted least squares means or Fisher's exact test, for continuous or categorical variables of interest, respectively. For count or binary multiple time-points or correlated data, tests of between-group comparisons will be completed using the generalized estimating equation (GEE) statistical procedure for longitudinal data analysis with multiple observable vectors for the same subject.
Measured by ribonucleic acid (RNA) and protein expression. Statistical and bioinformatic data analysis for laboratory non-omics data and clinical data will utilize the following general strategies, as appropriate. For single time-point lab data, tests of hypotheses concerning within-group comparisons will be completed using the paired t-test or Wilcoxon signed-rank test for continuous parameters of interest, or McNemar's Chi-square test for categorical parameters of interest. Between-group comparisons will be assessed using either ANOVA with adjusted least squares means or Fisher's exact test, for continuous or categorical variables of interest, respectively. For count or binary multiple time-points or correlated data, tests of between-group comparisons will be completed using the GEE statistical procedure for longitudinal data analysis with multiple observable vectors for the same subject.
Measured by RNA and protein expression. Statistical and bioinformatic data analysis for laboratory non-omics data and clinical data will utilize the following general strategies, as appropriate. For single time-point lab data, tests of hypotheses concerning within-group comparisons will be completed using the paired t-test or Wilcoxon signed-rank test for continuous parameters of interest, or McNemar's Chi-square test for categorical parameters of interest. Between-group comparisons will be assessed using either ANOVA with adjusted least squares means or Fisher's exact test, for continuous or categorical variables of interest, respectively. For count or binary multiple time-points or correlated data, tests of between-group comparisons will be completed using the GEE statistical procedure for longitudinal data analysis with multiple observable vectors for the same subject.
As measured by whole exome sequencing and RNA sequencing (RNASeq) on circulating tumor deoxyribonucleic acid (DNA) specimens.
As measured by whole exome sequencing and RNASeq on circulating tumor DNA specimens.
This phase I trial studies the side effects and best dose of molibresib and entinostat in treating patients with solid tumors or lymphomas that have spread to other parts of the body or are not responding to treatment. Molibresib and entinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. This study may help doctors find out if giving the combination of molibresib and entinostat is better or worse than the usual approach for treating solid tumors or lymphomas.
I. To determine the maximum tolerated dose (MTD) of molibresib (GSK525762C) and entinostat in combination in patients with advanced and refractory solid tumors and lymphomas based on dose limiting toxicities (DLTs) of the combination of GSK525762C and entinostat.
I. To describe the safety profile of GSK525762C and entinostat in advanced and refractory solid tumors and lymphomas.
II. To determine the overall response rate (ORR) of GSK525762C and entinostat in advanced and refractory solid tumors and lymphomas.
III. To determine the progression-free survival (PFS), duration of response (DOR), and overall survival (OS) of GSK525762C and entinostat in this patient population.
I. To assess the effect of GSK525762C and entinostat therapy on apoptosis, as measured by an apoptosis multiplex immunoassay.
II. To assess the effect of GSK525762C and entinostat therapy on c-MYC and YAP1 as measured by ribonucleic acid (RNA) and protein expression.
III. To assess the effect of GSK525762C and entinostat therapy on tumor burden and gene expression patterns as measured by whole exome sequencing (WES) and RNA sequencing (RNASeq) on circulating tumor deoxyribonucleic acid (DNA) (ctDNA) specimens.
Patients receive entinostat orally (PO) on days 1, 8, 15, and 22, and molibresib PO once daily (QD) on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Patients receive entinostat PO on days 1, 8, 15, and 22 and molibresib PO QD on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Patients must have advanced or refractory solid tumor or lymphoma (all B cell lymphomas and T cell lymphomas other than natural killer [NK]-cell lymphoma).
Cohort A: Patients must have locally advanced, unresectable OR metastatic pancreatic cancer refractory to standard therapy.
Patients must have measurable disease based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria.
Patients should have received previous therapy with at least one combination chemotherapy regimen for metastatic disease.
Patients with lymphoma must have exhausted or refused potential curative therapy prior to enrolling.
Weight of >= 35 kg.
Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 50%).
Hemoglobin >= 9.0 g/dL (within 14 days prior to administration of study treatment).
Absolute neutrophil count (ANC) >= 1,500/mcL (within 14 days prior to administration of study treatment).
Platelets >= 100,000/mcL (within 14 days prior to administration of study treatment).
Total bilirubin =< institutional upper limit of normal (ULN) (within 14 days prior to administration of study treatment).
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional ULN (within 14 days prior to administration of study treatment).
Serum creatinine clearance > 50 mL/min (within 14 days prior to administration of study treatment).
Serum bilirubin =< 1.5 x institutional ULN (within 14 days prior to administration of study treatment).
Glomerular filtration rate (GFR) >= 60 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal unless data exists supporting safe use at lower kidney function values, no lower than 30 mL/min/1.73m^2 as measured by the Cockcroft-Gault equation (within 14 days prior to administration of study treatment).
Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial.
For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated.
Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load.
Patients with treated brain metastases are eligible if follow-up brain imaging at least 4 weeks after central nervous system (CNS)-directed therapy shows no evidence of progression.
Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial.
Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association functional classification. To be eligible for this trial, patients should be class 2B or better.
Patients must be able to swallow and retain orally administered medication.
Women of childbearing potential must have a negative pregnancy test within 7 days of starting treatment.
The effects of entinostat and GSK525762C on the developing human fetus are unknown. For this reason and because HDAC inhibitor (HDACi) and BET inhibitor (BETi) agents are known to be teratogenic, women of child-bearing potential and their male partner must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation and for 7 months after completion of entinostat and GSK525762C administration. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 4 months after completion of entinostat and GSK525762C administration.
Patients must have tumors determined to be easily accessible for biopsy and must be willing to have serial biopsies. Tumor biopsies will be performed on the most accessible biopsiable site of disease. All possible precautions to avoid complications will be taken, including discussions in multidisciplinary meetings, if needed. If a biopsy cannot be performed safely (e.g. there is no safely accessible biopsiable tumor tissue) or biopsy does not yield sufficient tissue for analysis, participation is still allowed.
Patients on both therapeutic and prophylactic anticoagulation may participate as long as they have no history of clinically significant bleeding while on anticoagulation.
Patients who have had any anti-cancer therapy within 14 days (or 5 half-lives, whichever is longer) prior to the first dose of the investigational products.
Patients who have received radiation therapy within 21 days prior to the first dose of the investigational products.
Patients who have a diagnosis of NK cell lymphoma.
Patients who have not recovered from adverse events due to prior anti-cancer therapy. Toxicities should have recovered to =< grade 1, excluding alopecia, or should be stable chronic grade 2 toxicities that do not overlap with presumed toxicities of entinostat or GSK525762C.
Patients who are receiving any other investigational agents.
Patients with known untreated or symptomatic brain or leptomeningeal metastases are excluded. Patients with previously treated central nervous system (CNS) metastasis may be included provided that they have stable CNS disease for at least 4 weeks (confirmed by imaging) without symptoms and are off corticosteroids (above physiologic dose) for that indication.
Patients with significant malabsorption or nausea and vomiting that would interfere with oral therapies.
Patients with bleeding diathesis or clinically significant bleeding within the prior 6 months.
History of allergic reactions attributed to compounds of similar chemical or biologic composition to entinostat (e.g. medications that have a benzamide structure [tiapride, remoxipride, clebopride] or GSK525762C [e.g. benzodiazepines]).
Patients receiving any medications or substances that are strong inhibitors or strong inducers of CYP3A4 are ineligible. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product.
Patients with uncontrolled intercurrent illness.
Patients with a history of clinically significant bleeding.
Patients with psychiatric illness/social situations that would limit compliance with study requirements.
Pregnant women are excluded from this study because entinostat is an HDACi and GSK525762C is a BETi with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with entinostat or GSK525762C, breastfeeding should be discontinued throughout the treatment period and for at least 28 days following the last dose of study treatment if the mother is treated with entinostat or GSK525762C.
Plan Description: NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page.


Novotel Amsterdam City is set to complete a full refurbishment in February 2010.
The 610-room four-star hotel offers a gym, wellness centre and event space for 1,000 delegates.
Sofitel Amsterdam the Grand, also in Amsterdam, is set to complete its refurbishment in May 2010, and will offer a restaurant with a raw food bar, 177 rooms and 19 event spaces, the largest of which has capacity for 328 delegates.


Your van can be financed in two different ways through either hire purchase or lease purchase, subject to financial status. Written details on request. We deal with a wide group of funders throughout the UK and can offer Prime, Sub-Prime and Non-Prime finance to our customers at highly competitive rates.
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Incentivos para Terras Produtivas
Oceanos + Peixes
Energia Inteligente + Infraestrutura de Transportes
Pradaria
Recifes de Corais
Zonas Úmidas
Vídeos Educativos - Economia
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Comitê de Assessoramento
William Jaeger
Professor, Oregon State University, Oregon
William Jaeger is a professor in the Department of Agricultural and Resource Economics at Oregon State University. His research and interests include environmental and natural resource economics, public economics and development economics. He has worked on a range of policy-related issues including water allocation, land use, energy economics, economic growth and development, agriculture in Africa, environmental taxation, and sustainability. Professor Jaeger got his PhD at Stanford University and was a research economist and consultant for five years at the World Bank. He then taught for twelve years at Williams College, MA before coming to Oregon State University in 2001. He was a Fulbright Scholar at the University of Venice Ca' Foscari, Italy in 2007, has taught at the University of Washington, the University of Oregon, and published Environmental Economics for Tree Huggers and Other Skeptics, Island Press in 2005.
Tabalhe Conosco
Dados Financeiros


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Lucozade Says YES To Crystal Palace
Book Review: The Colour Of Magic By Terry Pratchett
Book Review: Back from the Dead by Nick Kyme
Film Review: Sherlock Gnomes
Hot Air Ballooning (71)
In the same way that there are many different types and sizes of car, there are as many diferent types and sizes of hot air balloons. For me, one of my absolutely favourites, are the small one man balloons known as cloudhoppers. Where the traditional wicker basket is replaced with a simple seat for the pilot.
Lucozade are currently using a cloudhopper to advertise their YES campaign as they feel the small, sleek image better fits their active brand, and I spent two days tethering the balloon at the National Sports Center, Crystal Palace for the Aviva London Athletics Grand Prix.
Operated by Airship & Balloon Company, the balloon was tethered next to the tube station between the entrances to both stands at the athletics stadium ensuring that as the public arrived they couldn't help but notice the balloon.
I tethered the balloon for most of the afternoon in near perfect conditions, ensuring maximum exposure for Lucozade, before unfortunately, being beaten by the weather, and around 6pm the wind picked up to a point where it wasn't safe to keep the balloon inflated.
However, the forecast was suggesting that while the wind would pick up in the early evening just as it had, once the sun had set, the wind would once again die down and allow us safe conditions to tether the balloon.
The forecast was bang on, and just after sunset, I was able to reinflate the balloon and steal the show as the light from the balloon illuminates the balloon like a giant lightbulb. A spectacle that virtually no other form of advertising can compete with for sheer impact.
Weather forecasters, especially UK based ones have a bad reputation for either getting the forecast totally wrong or simple hiding behind the old 'Sunshine and Showers' card. These days, however, when it comes to aviation forecasting they are usually accurate in their predictions.
Unfortunately, they'd predicted that day two of the athletics meet would bring some rain and much strong winds, and annoyingly, they were right. This meant, that we would have a lot of waiting around…
You get used to waiting around when the weather is bad for the one opportunity to inflate the balloon. After all, I'm a pilot who wants to tether and fly balloons, not sit around in a car bored. With the showers having cleared past London, we took the chance to inflate the balloon and while it was still rather windy, we managed to get it hot inflated to the delights of everyone around.
Lucozade's YES campaign is all about those moments in life where you just want to go YES, from an athlete crossing the finish line first, to the commuter running for the bus and making it, as a balloon pilot having sat around watching it rain a few hours earlier, finally doing some ballooning was my YES moment that day!
Posted on 8th August 2011 by 5WC	in Hot Air Ballooning First Edition
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Beautiful afternoons in Autumn in Austin, Texas, are the norm. This image was taken in November while on a kayak underneath the 360 Bridge. I used a 15mm fisheye lens to capture the width of the bridge. I also have a panorama of this same scene. Photo © copyright by Rob Greebon.


The Fremantle Dockers have snatched a win from the Tigers thanks to a David Mundy goal in the final minute to give the visitors a four-point lead when it counted, finishing the game 10.18 (78) to 12.10 (82) at the MCG on Saturday.
In a scrappy, but tight contest, emotions boiled over on many occasions with the Tigers leading for most of the game.
In the third quarter nothing was going right for the Dockers as Clancee Pearce injured his shoulder only moments after Fremantle had subbed out Matt Taberner, but after a long coaches talk at three quarter time, the Dockers found their feet again.
Mundy kicked the winning goal and was the leading disposal winner for Fremantle with 28, while Richmond's Brandon Ellis topped the list with 31 disposals.


It was such a lovely lovely time. Thank you all for coming!
Who knew lemon curd was so popular! It was an after thought even.
Loved my decorations. And those are flowers from my yard!
Homemade hummus and delicious (albeit huge) crackers.
The real break out star of the party? Roasted veggies. Who knew? Drizzle veggies with olive oil then throw in the oven 400 F for 15 ish minutes.
If you serve them at your party they will be the first treat gone. Gauranteed. Or maybe only is you have veggie loving friends like I do.
In researching mojito recipes for a crowd I discovered one that said it made 8 drinks but used a whole bottle of rum. Good times indeed. Ours were not nearly that stiff.
Flavored water and sweet take home treats!
And in case you have had too many cupcakes and the roasted veggies were gone we had the obligatory plate of fresh fruit.
I sold enough raffle tickets to pay for my new camera lens. So very very blessed.


My answer is this: the famous permaculturalist Geoff Lawton said, "All the world's problems can be solved in a garden." I wish I'd said it first, because I agree wholeheartedly. Sure, we're not in a wartime situation, but people have their own personal reasons for growing food today.
While the landscape industry is taking a nosedive financially, as people have cut back their discretionary spending, the interest (and spending) related to food gardening has increased almost 70% over the last three years. A soon-to-be-released study from Rutgers University (and co-sponsored by the American Community Garden Association) on community gardens reveals that urban, suburban, and rural communities all over the country are starting community gardens in droves. People from all income levels and walks of life, in cities and in the country, want to grow their own food for a thousand good reasons at their homes or in community gardens.
I call these "Today's Victories." They're all valid and they're all important.
Here's a few of those victories that we're going to be highlighting at the Chicago Flower and Garden Show March 9-17 in our exhibit, The Peterson Garden Project: Victory Today!
The types of vegetables you find in the grocery store are grown to withstand shipping distances, not to taste great. When you grow your own food, it is more flavorful, and you have numerous tasty varieties to choose from.
Eating more fruits and vegetables reduces the risks of obesity, heart disease and other health problems caused by poor nutrition. By growing your own, you have more control over your health and wellness.
Growing a portion of your own food can save you money. A package of seeds costs less than two dollars and, if they are non-hybrid, you can save them to use next year, too.
The average commercial produce travels an estimated 1,500 miles to get to the store. By growing your own food at home or in a community garden, you help the environment by removing the carbon footprint of some of your food.
Children are natural gardeners! By spending time growing food with your children, you not only increase outdoor family time but your kids learn new skills and, more importantly, where their food comes from.
Founding Father Thomas Jefferson said, "Although I am an old man, I am but a young gardener." Skills like gardening, cooking, and canning all come into play when you want to grow your own food. These skills last a lifetime, can be shared with others, and can bring great joy.
Growing food with others in a community garden is a great way to get to know new people and do something good for your neighborhood. "Many hands make light work," and your group efforts can beautify your corner of the world and feed a lot of people, too.
In Chicago alone, 1 in 6 individuals are food insecure, which means they don't know when or where their next meal will come from. By sharing the excess produce you grow with local food pantries, you help neighbors in need.
The nut of the matter is this – during WW2 there was a problem and people banded together and grew food to solve that problem. 70 years later we have lots of problems with our food system and our own lives and communities. Growing food is one way we can solve our own problems. So get out there and DO IT. Who knows, 70 years from now maybe people will remember the time when American's took back their food supply, their health, their communities by growing their own food. Until then… what's your Victory?
It's not just "Americans" that are growing their own food…the rest of the world is doing it too!


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SYMPOSIUM - POLYTRAUMA MANAGEMENT
National statistics of road traffic accidents in India
Manisha Ruikar
January-April 2013, 6(1):1-6
National reports published annually by Transport Research Wing of the Ministry of Road Transport & Highways and National Crimes Records Bureau of Ministry of Home Affairs, Government of India describe national statistical trends and normalized indicators of road accidents, injuries & fatalities. This article highlights trends, indicators, interstate comparisons and the latest characteristics of road traffic accidents in India. While the official road traffic fatality data may be close to the actual number, the injury data are gross underestimates. As per bibliometric analysis, India contributed only 0.7 per cent papers on road traffic injuries and had less than one article on road traffic injuries per 1,000 road traffic related deaths. To be effective, policies on injury prevention and safety must be based on local evidence and research. Health professionals and their professional bodies across wide disciplines need to take an initiative for the same with active commitment.
[ABSTRACT] [FULL TEXT] [PDF] [Mobile Full text] [EPub] [CITATIONS]
30 113,888 14,011
SYMPOSIUM ON PELVIC TRAUMA
Classification of pelvic fractures and its clinical relevance
Rehan Ul Haq, Ish K Dhammi, Amit Srivastava
January-April 2014, 7(1):8-13
Pelvic fractures are one of the common cause of mortality in polytrauma patients, especially following high velocity trauma. The management in emergency requires good clinical judgment and access to radiological modalities. There are various classifications to define the pattern of injury in pelvic fractures. Previously, fracture patterns were described on the basis of anatomical fracture pattern on radiographs. With the introduction of concept of force vector and stability defined by Pennal and Tile, which was further modified by Young and Burgess, the corrective forces required to reduce such fractures were defined. With the introduction of these newer classification systems along with the introduction of external fixators, the mortality and morbidity has significantly reduced in pelvic fractures.
4 18,339 1,266
Antibiotic laden bone cement in chronic osteomyelitis
Nirmal Chandra Mohapatra, Suraj Jain
July-December 2017, 9(2):74-77
DOI:10.4103/jotr.jotr_18_17
Background: Chronic osteomyelitis is a dreaded sequel to acute haematogenous osteomyelitis. It is also more frequent following open fracture and orthopedic surgeries. Principle in treatment of chronic osteomyelitis based on removal of devitalized tissue and filling up of dead space. Systemic antibiotic therapy may not provide minimum inhibitory concentration for prolong period. Antibiotic laden bone cement can be used in adjunct to usual treatment of debridement and systemic antibiotic therapy for local antibiotic delivery and filling dead space temporarily. Material and Method: 32 cases of chronic osteomyelitis (7 haematogenous and 25 exogenous following trauma or surgery) were included in our study which included 21 male and 9 female, age ranging from 18 to 55 year. Pre-operative culture from sinus tract, ESR, and CRP were done. All patient were treated with debridement and removal of implant if present, followed by filling the dead space by antibiotic laden bone cement beads or antibiotic laden bone cement coated nail. Control of infection was assessed by laboratory parameter. Antibiotic cement was removed at an average of 10.62 weeks. All patients were followed up for at least 2 years. Result: Infection was controlled in 28 patients out of 32 patients at the time of cement removal, secondary procedure was done in all patients of infected non union in the form of bone grafting and definite fixation except 3 patients where antibiotic cement coated nails are retained till union as there was callus formation at the end of three month. Conclusion: Antibiotic laden cement is an effective method in local control of infection in chronic osteomyelitis without any systemic side effect.
3 2,948 372
Osteopoikilosis: A case report with review of literature
Daya Krishna, Subhash Chand
January-April 2013, 6(1):84-86
Osteopoikilosis is a rare hereditary condition present as an autosomal dominant trait in families, but can also present as sporadic cases. It is an asymptomatic condition; incidental radiological finding play an important role in its diagnosis. These are symmetrically distributed numerous small, well-defined, homogenous, circular or ovoid radio-densities clustered in epiphysis and metaphysis of long bones in periarticular regions. There is no age and sex affinity; age at the time of diagnosis range from 15 to 60 years. There are no specific clinical features; histological features are similar to the bone island and it may be associated with connective tissue disorders, synovial osteochondromatosis and a rare bone disease melorheostosis; genetically LEMD3 gene mutations are responsible for it. Osteopoikilosis must be differentiated from osteoblastic metastasis, synovial chondromatosis, tuberous sclerosis and mastocytosis. There are three rare complications, which have been reported like-spinal stenosis, dacrocrystitis and malignant transformation.
Use of dorsalis pedis artery flap in the coverage of distal lower leg defects
Sohaib Akhtar, Fahud Khurram, Rampukar Choudhary, A. H. Khan, Imran Ahmad, Ehsan Rashidi
Aim: To evaluate the role of dorsalis pedis artery flap in the coverage of distal lower leg defect. Materials and Methods: a retrospective review of patients who underwent soft tissue coverage over distal lower leg with dorsalis pedis artery flap was performed. A total of 16 patients were identified and included in this study. Soft tissue defects ranged in size from 3 × 7 cm to 6 × 10 cm were located over lower one-third of leg either, anteriorly (n = 8), posteriorly (n = 4), laterally (n = 2), or medially (n = 2). Associated injuries included open fractures of only tibia (n = 5), fibula (n = 2), both tibia and fibula (n = 3), or calcaneum (n = 2). Results: all flaps survived uneventfully except in three cases there was mild venous congestion in the distal part of the flap, two resolved within 4 days without further surgical intervention but one required skin grafting. Three patients developed donor site problems. Wound coverage was achieved in a mean duration of 14 days (range: 11 to 30 days). Conclusion: The dorsalis pedis artery flap is a reliable procedure to cover difficult wound such as distal lower leg.
Does pre-operative flexion factor influence the post operative range of motion in total knee arthroplasty
Ganesh Babu Natarajan, Veera Ram Narayan, Vijayaraghavan
Background: Range of motion and flexion are important outcome measures following total knee arthroplasty. Many of the activities of daily living require knee flexion in the range of 45 to 105°. Several factors affect postoperative range of motion (ROM), including pre-operative and post operative factors, among which pre-operative ROM is the most important factor. Aim: To analyze the patient's pre-operative flexion factor responsible for the outcome of range of motion in post operative Total Knee Replacement (TKR). Materials and Methods: We studied 80 patients having Total Knee Replacement (TKR) by a single surgeon in SRMC, Chennai, between 2005 and 2010 with a minimum follow up of upto 1 year. Results: The mean pre-operative flexion was 85° and post operative mean flexion was 115°. Obesity is associated with poor flexion after TKR. Knees with Rheumatoid arthritis started with a lesser flexion (80°) than those with Osteoarthritis (90°) and the change in flexion score has shown a significant difference of 40 and 20°, respectively. Average post operative range of motion for patient with pre-operative ROM <90° was 110° flexion, whereas in patients with pre-operative ROM >90° flexion, the average post operative ROM was 120° flexion. This shows, the gain in flexion is more in patients with <90° than those with >90° pre-operative flexion. Conclusion: Yes, the pre-operative flexion significantly influenced the post operative flexion and it is a good parameter for predicting the post operative outcome.
Management of idiopathic congenital talipes equinovarus by standard versus accelerated Ponseti plaster technique: A prospective study
Biswajit Sahu, Rajesh Rajavelu, Barsha Tudu
Introduction: Ponseti technique has been accepted as the standard method of treatment for clubfoot. Accelerated Ponseti method with casts being done twice weekly, is being utilized recently to reduce the duration of plaster treatment. Materials and Methods: A prospective study was done in 80 feet (53 patients), who were randomly allotted with 40 feet in standard group and 40 feet in accelerated group. In standard group, manipulation and casting were done at weekly intervals, whereas in accelerated group, the same was done at 3 days interval. The initial and final Pirani score, number of casts required, duration of casting and relapse after treatment were recorded for all cases in both the groups and the results were analyzed. Results: Average initial Pirani score was 5.03 and 5.3 in standard Ponseti group and accelerated Ponseti group, respectively. The average final Pirani score was 0.2 and 0.25 in standard Ponseti group and accelerated Ponseti group, respectively. The average number of casts required for correction was 6.2 and the average duration of casting was 8.2 weeks in standard Ponseti group. The average number of casts required for correction was 7.4, and the average duration of casting was 3.4 weeks in accelerated Ponseti group. Conclusion: The advantage of accelerated Ponseti is early correction of the deformity with better acceptability by the parents. Accelerated method can be considered as an effective alternative method for correction of clubfoot.
Epidemiology of traumatic fractures in a tertiary health center in Nigeria
OM Babalola, Oni Nasiru Salawu, BA Ahmed, GH Ibraheem, A Olawepo, SB Agaja
July-December 2018, 10(2):87-89
Background: The incidence of fractures from trauma is increasing due to increase in means of transportation, poor roads and disobedience of road safety laws. Adequate knowledge about the involvement of different parts of the body in trauma will aid planning towards management of these fractures. Aim: This is to show the etiology and frequency of the affected bone of the body by trauma, which can serve as a template for future health care planning and delivery. Patients and Methods: This was a prospective study in which data from all patients that presented at the accident and emergency unit of University of Ilorin Teaching Hospital with fractures, from January 2012 to December 2012 were analyzed. Results: During the study period, a total of 401 fractures in 334 patients were seen. Isolated fractures were seen in 227 patients, while 107 patients had multiple fractures. Male to female ratio was 2.8 : 1, the mean age was 34.2 ± 5.4 years. The commonest bone fractured was the Tibia which accounted for 25% (100 cases). The commonest form of trauma causing these fractures was motor vehicle crash which accounted for 75.6% (303 cases). Conclusion: Prevention of road traffic accident by provision of good roads and enforcement of road safety laws will reduce fractures significantly.
Functional outcome in tibial spine fracture treated with arthroscopic pull through suture technique
Vikram Sapre, Samir C Dwidmuthe, Vaibhav Bagaria, Sidharth Yadav
Introduction: Various fixations techniques are available for fixation of tibial spine avulsion fracture. Arthroscopic assisted fixation can be achieved by screw fixation, pull through sutures, and using suture anchors. We conducted a prospective study to analyze the results of arthroscopic assisted pull through suture technique for treatment of tibial spine avulsion. Materials and Methods: Ten patients with displaced tibial spine avulsion fractures without other associated ligament injuries were included in the study. Ten patients (2 female and 8 male) with a mean age of 29.2 years (19-42 years) underwent arthroscopic assisted fixation with pull through suture technique. The postoperative results were analyzed using clinical tests, radiological evaluation and International Knee Documentation Committee (IKDC), Lysholm score and Tegner activity level. Observations and Results: The mean follow-up period was 21.7 months. We evaluated all patients at 18 months after the surgery. Radiographs showed that all fracture healed anatomically at an average duration of 3 months after surgery. At the final follow-up, all patients reported no symptoms of instability, such as giving – way episodes, clinical signs of anterior cruciate ligament deficiency were negative. The mean Lysholm score was 96.9 (range 91-100), mean IKDC score was 87.9 (range 83-93), and all patients achieved their pre injury Tegner activity levels. One patient had postoperative arthrofibrosis with the loss of terminal extension of 5° which responded to arthroscopic adhesiolysis and physiotherapy. We had no case of infection. Conclusion: Arthroscopic suture pull through a technique for tibial spine fracture is a minimally invasive technique with good functional and radiological results with a lesser risk of arthrofibrosis, infection, and need for hardware removal.
2 6,024 1,517
Full resolution of subacute acetabular osteomyelitis in an 11-year-old patient following nonsurgical management
Barry D Kerr, Graham D Finlayson, Lara J Thompson, Jim H. F. McConway
January-June 2017, 9(1):62-64
Subacute acetabular osteomyelitis is uncommon and often misdiagnosed due to ill-defined symptomology and indolent disease course. An afebrile 11-year-old boy re-presented with 4 weeks atraumatic limp and increasingly severe right hip pain previously believed to be transient synovitis. Examination revealed hip tenderness and reduced mobility. X-rays showed loss of bone density in the proximal femur and a visible joint effusion. T2-weighted magnetic resonance imaging demonstrated the regions of high signal superior to the triradiate cartilage, widening of the cartilage space and a sympathetic effusion, consistent with acetabular osteomyelitis. Six weeks following antibiotic therapy, pain subsided and normal hip mobility was achieved. Review magnetic resonance scan confirmed clinical findings with reduced bone marrow edema, surrounding swelling, and hip effusion. Clinical resolution was confirmed 8 weeks postpresentation. Subacute acetabular osteomyelitis is rare and largely misdiagnosed at first presentation. It should be considered in all cases of atraumatic limp and low-grade hip pain.
A rarely seen shoulder dislocation: Luxatio erecta
Yunus Demirtas, Ahmet Ozgur Yildirim, Hakan Tirin, Özdamar Fuad Öken, Ahmet Uçaner
As shoulder joint stability is mainly provided by muscles and connective tissue, it has a wide range of movement and is the joint where dislocation is most often seen due to frequent exposure to trauma. Inferior shoulder dislocation is seen rarely and has been determined in literature as 0.5% of all shoulder dislocations. In this study, two cases of inferior shoulder dislocation are discussed in the light of the information in literature.
Long angular stable plates: A solution for complex fractures of humerus
Vipin Sharma, Seema Sharma, Bhanu Awasthi
Segmental fractures of humerus are difficult to treat. Various options exist for treating ipsilateral metadiaphyseal fractures of humerus but have their own set of complications. Management of these fractures with long angular stable plates gives us an advantage of treating these two level fractures simultaneously thereby reducing complications and postoperative morbidity. Applying minimally invasive plate osteosynthesis (MIPO) principles helps in the biological healing of fracture by being minimally invasive and preserving blood supply to the soft tissues. We are presenting a small series of ipsilateral metadiaphyseal fractures humerus using long angular stable plates in an MIPO fashion.
A neglected case of Klippel Trenaunay Weber syndrome
Vikram Khanna, Gaurav Singh, Sanjeev Kumar, Sudhir Singh
This congenital vascular disorder is described by a "triad" of symptoms affecting one or more limbs. The "triad" constitutes varicose veins, cutaneous hemangioma, with bone and soft tissue hypertrophy. The cutaneous hemangioma presents as a substantial port-wine stain or nevus. Varicose veins are often very numerous. Bone and soft tissue hypertrophy is variable in presentation and the affected limb may be either larger or smaller than the normal limb. This disorder is generally reported in childhood or adolescent age groups. We herein present a neglected case of Klippel Trenaunay Syndrome with all the classical clinical and radiological findings. A 30-year-old man reported with the classical triad. On clinical examination substantial port wine stain was seen and radiographs showed multiple bony outgrowths whereas MRI showed multiple varicosities displaying heterogeneous hyper intense signals on T2 Weighted Images and T1 hypo intensity with hypertrophy of soft tissue in left lower limb.
Clavicular fracture in a national wrestler: A case report of rapid return to play
Erdinc Acar, Serdar Toker
The objective of the present study was to present the case of surgical treatment and rehabilitation of a midshaft clavicular fracture in a national wrestler. This is a case report of a 20-year-old female national wrestler who met a motorcycle accident (July 9, 2014). Postinjury radiographs revealed a midshaft clavicular fracture. She came a month after the accident. She had got a pain. Differential diagnosis revealed spiral oblique midshaft clavicular fracture. The sports medicine staff discussed surgical and nonsurgical options. A surgical procedure of internal fixation with an 8-hole anatomic clavicula plate was performed. In August 2014, she had surgery at Emirdag/Afyon County Hospital. Surgical treatment for clavicular fractures is becoming increasingly common. We suggest that new rehabilitation protocols for clavicular repairs should be investigated now that surgical treatment is being pursued more frequently. More aggressive treatment procedures and rehabilitation protocols for clavicular fractures have evolved in recent years. With these medical advancements, athletes are able to return to play much more quickly without compromising their health and safety.
Osteochondral fracture of patella
Sanjay Keshkar, Nirmal Dey, Ratnesh Kumar
Osteochondral fractures of patella are commonly associated with acute patellar dislocations and are frequently missed or misinterpreted in initial radiograph. Usually such fractures need surgical treatment. This article presents a case of a 13-year-old girl who sustained a twisting knee injury while doing exercise (yoga) and sustained a small osteochondral fracture of the central part of the patella, displaced inferolaterally, lying close to lateral femoral condyle. The initial radiograph was misinterpreted as chip fracture of lateral femoral condyle. Diagnosis of osteochondral fracture of patella was confirmed only during the surgery. This case needs to be reported as the osteochondral fracture of patella was not only missed but also misinterpreted.
Isolated lesser tuberosity avulsion with rupture of long head of biceps
David Raju Seeli, Sasibhushan Rao Sasapu, Bala Aditya Somayaji Dhavala, Venkata Raja Sekhar Vaddiraju
May-August 2014, 7(2):172-175
Two part lesser tuberosity fracture of proximal humerus, a rare entity is usually associated with posterior dislocation of shoulder. Its rarity accounts for the misdiagnosis and consequent inappropriate management. Very few case reports are available in literature about this entity. Herein, we present a young male with isolated lesser tuberosity avulsion associated with long head of biceps tendon rupture with an emphasis on diagnostic tools and appropriate management.
To study the pattern of bacterial isolates in open fractures
Digvijay Agarwal, Rajesh Maheshwari, Atul Agrawal, Vijendra D Chauhan, Anil Juyal
Introduction: Open fractures are fairly common in developing countries. Causes of open fractures vary widely including road traffic accident, fall from height, gunshot, assault, machine injuries and others. Infection is a common complication of open fractures. Chronic osteomyelitis, nonunion, loss of function or even limb loss are some serious outcome of deep fracture site infections. Primary goal in management of open fractures is prevention of infection of bone and soft tissue by early debridement, irrigation of wound and administration of broad spectrum antibiotics with stabilization of fractures. Aim: The aim of the study is to elucidate pattern of microbial isolates in open fractures so as to form rationale antibiotic regimen for treating open fractures. Methods: 70 patients were taken into study of all ages, both the sexes with open fracture classified according to Gustilo Anderson classification. Primarily wound was examined and description of the wound was recorded with 1st culture swab taken at that time followed by 2nd culture swab on 1st dressing after debridement and 3rd culture swab if infection continues further. Culture and sensitivity reports were collected for studying pattern of bacterial isolate and their sensitivity. Results: Pre-debridement cultures are of no importance. Post-debridement cultures are important in formulating an antibiotic regime. Gram negative organisms are the most probable cause of infection. Aminoglycosides are the most sensitive group of drugs in both gram positive and gram negative bacteria. Cephalosporins or quinolones should be used in combination with aminoglycosides in all cases of open fracture in our vicinity. Conclusion: All institutions and hospitals should find out the most common infecting pathogen in their environment and formulate an antibiotic policy accordingly.
Evaluation of injury severity score of missed injuries in pediatric trauma patients at institutional adult level II trauma center: Do we need a revised National Trauma policy for pediatric trauma?
Ajai Singh, Sabir Ali, Rajeshwar Nath Srivastava
Aims: The aim of the following study is to establish the incidence contributing factors and impact of the missed injuries in pediatric trauma patients at adult trauma center on the prognosis and overall outcome of these children. Settings and Design: Longitudinal prospective cohort study involving 603 patients in over 06 months. Materials and Methods: The relevant data (as defined) of all included patients were recorded. These patients were then followed to document the total length of hospital stay and the injury list defined at the discharge or on the 7 th day of admission; whichever came first. The injury severity score (ISS) at admission was compared with final ISS (multivariate regression analysis). Results: Total 115 (19.1%) missed injuries (adult + pediatric both) were discovered, out of which 71 (61.7%) were pediatric trauma missed injuries. The pediatric trauma missed injuries were 32.2% of all pediatric trauma patients and 11.8% of all trauma patients. Main contributing factors were incomplete assessment (52.5%) and patients' arrival time. None of the missed injuries led to any mortality, morbidity or increased length of hospitalization. Final ISS did not correlate with missed injury. Conclusions: Missed injuries are a significant problem in trauma patients especially the pediatric trauma patients. Though the majority of children with trauma were treated efficiently in the anaplastic thyroid carcinoma, but there is a need for improvement in patient assessment and monitoring, that is, extended tertiary survey; with special exposure to the attending residents at casualty about pediatric trauma and its pathophysiology.
Primary plating osteosynthesis in open fractures
Chandra Prakash Pal, Neeraj Mishra, Karuna Shankar Dinkar, Harish Kumar, Pulkesh Singh, RK Goyal
Introduction: The management of open fractures poses one of the greatest challenges to orthopaedic surgeons because it not only requires management of a contaminated soft tissue injury involving skin, muscles and neurovascular structures but also treatment of underlying fracture which is also contaminated. Primary internal fixation if done can solve many problems. With the use of internal fixation the fracture remain in good position so that soft tissue injuries can be handled easily and effectively. Materials and Methods: Present study was carried out in 12 skeletally mature patients. All open fractures of upper and lower extremities presenting within 12 hours of trauma were included in study. The wound was then cleaned and injured part was then splinted so that movement of fracture fragment causing further damage could be prevented. In operation theatre wound debridement was done before internal fixation under aseptic conditions. Results: Regarding soft tissue healing all the cases of grade I showed either good (66.67%) or fair (33.33%) results. Out of 4 cases of upper limb, 2 cases (50%) of grade I united within 4 months. One case of grade III of upper limb united in 6 months. Out of 8 cases of lower limb, 3 cases (37.5%) united within 5 months and 4 cases (50%) united within 6 months. One case of grade III fracture tibia showed delayed union, bone grafting was done in this case. Conclusion: We conclude from the study that the judicious selection of cases, skillful management of the injured limb and early rehabilitation is the key for compound fractures.
Treatment of idiopathic clubfoot by ponseti method
Harshal Suhas Sakale, Alok C Agrawal, Ajit Singh, Bikas Sahoo, Abhishekh Jain
DOI:10.4103/jotr.jotr_2_17
Background: Club foot is one of the most common congenital birth defects, with approximate incidence of 1 in 1000 live births. It is one of the unsolved clinical challenge for the orthopedic surgeons. The results of Ponseti treatment have been encouraging. There have been many reports of successful treatment of idiopathic clubfoot with Ponseti method in the western world, but there are only few studies done in the developing country like India. So the present study was undertaken with the following objective. Objective: To evaluate the efficacy of Ponseti method in the treatment of idiopathic clubfoot A prospective study was done among all the patients below 1 year of age with Idiopathic Clubfoot presenting to AIIMS Raipur from August 2015 to December 2016 who were treated by Ponseti method. Twenty feets [mean Pirani score (total) 5.6] in 13 children were treated by the Ponseti method. A prospective follow-up for a mean duration of 6 months (range 6–30 months) was undertaken. Evaluation of the deformity by Pirani score was performed, before and after the treatment and the results were assessed.
Spectrum of synovial lesions with a rare case report of lipoma arborescens
Kalaivani Selvi Subramanian, Sandhya Panjeta Gulia, M Lavanya, SP Arun Kumar
Context: Synovium is the site for a series of pathologic processes that are characteristic and in some cases specific, to a particular disease. Examination of the synovial biopsies plays a key role in the diagnosis of joint diseases as the disease affecting the joints can have varied clinical presentations. Materials and Methods: We present here the different spectrum of synovial lesions that was diagnosed on synovial biopsy. Results: There were ten cases of synovium and related diseases which includes two cases of Chronic nonspecific synovitis, one case of Septic arthritis, two cases of Tuberculous synovitis, one case of Rheumatoid arthritis, one case of Tenosynovial giant cell tumor of tendon sheath, one case of Synovial lipomatosis, and two cases of Secondary chondromatosis. Conclusion: This series highlights the various spectrums of joint diseases. Synovial biopsy is an important and final tool for definitive diagnosis of joint disorders. Correlation with clinical, radiological, and serological findings helps to arrive at an accurate diagnosis.
Platelet-rich plasma in osteoporotic fractures: A review of literature
Ajai Singh, Sabir Ali, Rajeshwar N Srivastava
At present, osteoporotic fractures are the functional as well as an economic challenge for the patient, and these are equally challenging for the surgeon to manage them. However, nowadays most of the clinical settings are biologically optimized to enhance the bone regenerations, but still many patients continue to experience impaired healing of various origins. Autologous bone grafting remains the standard biological procedure to treat these impaired healing against which all the novel technologies are compared. The osteoporotic fracture healing undergoes the same stages of healing except that, they are slow in progress and takes a longer period of healing than the normal bone healing. As the fracture healing initiates with the formation of fracture clot, several investigators have suggested that degranulation of platelets at fracture clot elaborates the bioactive component, especially the growth factors that are essential for the bone formation. Because autologous platelet-rich plasma (PRP) products are safe and easy to prepare and administer, in the present review, we highlight the role of bioactive component released by activated PRP in the fracture healing process complicated by osteoporosis.
SYMPOSIUM — FRAGILITY FRACTURES
Osteoporosis: Current review
Alok Chandra Agrawal, Roop Bhushan Kalia
Although hormone therapy using estrogens plus progestogens (EPT) is effective for the management of menopausal symptoms (e.g., vasomotor symptoms and vulvar/vaginal atrophy) and prevention/treatment of postmenopausal osteoporosis, EPT is associated with safety and tolerability concerns. A new alternative to EPT is the tissue selective estrogen complex (TSEC), which partners a selective estrogen receptor modulator (SERM) with one or more estrogens and is designed to treat menopausal symptoms and prevent postmenopausal osteoporosis without the tolerability concerns associated with EPT. The first TSEC to reach advanced clinical development is a combination of the SERM bazedoxifene (BZA) with conjugated estrogens (CE). BZA has been shown to inhibit the stimulatory activity of CE on uterine tissue and breast in vitro and in vivo. In clinical studies, BZA/CE treatment has been associated with significant improvements in menopausal symptoms including hot flushes and vulvar/vaginal atrophy and significant increases in bone mineral density, coupled with reductions in bone turnover marker levels and improvements in sleep and health-related quality of life. Additionally, BZA/CE has been shown to have a neutral effect on endometrial and breast tissue because BZA inhibits the stimulatory effects of estrogens in selective tissue fashion in these two organs. Taken together, results of these preclinical and clinical studies indicate that the benefits of estrogens for treating menopausal symptoms are maintained with BZA/CE without endometrial or breast stimulation, resulting in a safe and effective treatment for symptomatic postmenopausal women.
Pelvic trauma in women of reproductive age
Sarita Agrawal, Prasanta Kumar Nayak, Subarna Mitra, Alok Chandra Agrawal, Asha Jain, Vinita Singh
The pelvic trauma can be a simple isolated one or can involve multiple skeletal structures or viscera also. Women of childbearing age who suffer from pelvic trauma have always a question in their mind regarding the future fertility and type of delivery they are going to have. The final functional outcome of pelvic injury depends on the severity of trauma and the type of surgical management. The aim of this article is to review the female pelvic anatomy, pelvic injuries, management options and future reproductive potential and other impacts of pelvic trauma in women of childbearing age.The pelvic trauma can be a simple isolated one or can involve multiple skeletal structures or viscera also. Women of childbearing age who suffer from pelvic trauma have always a question in their mind regarding the future fertility and type of delivery they are going to have. The final functional outcome of pelvic injury depends on the severity of trauma and the type of surgical management. The aim of this article is to review the female pelvic anatomy, pelvic injuries, management options and future reproductive potential and other impacts of pelvic trauma in women of childbearing age.
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Neglected pelvic fractures: An overview of literature
Ramesh Kumar Sen, Tarun Goyal, Sujit Kumar Tripathy
Despite numerous advancement in surgical techniques and better understanding on pelvic injuries, it is not uncommon to see neglected pelvic fractures in India. The pelvic injuries are either neglected by the patients themselves by late presentation or poor compliance to treatment or sometimes even neglected by the surgeons by inadequate treatment. The usual manifestations of neglected pelvic fractures are either a nonunion or a malunion. Pelvic nonunion or malunion results in huge disability to the patients. These disabilities manifest in the form of pain, leg length discrepancy, sitting or standing imbalance and even sexual or excretory dysfunction. Treatment of such old injuries is extremely difficult. Correction of malunion may be performed in stage wise procedure with multiple osteotomy. The nonunion may be treated with bone grafting and plate stabilization. This literature review focused on the manifestations, treatment and residual problem of such pelvic malunions and nonunions
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